Attachment 3CLINS_PricingSheet.xlsx
XLSX spreadsheet 51 KB Posted
- Attached to
- 6835--Med Gas Supply and Cylinder Rental
- Solicitation number
- 36C24E26Q0044
About this file
This is a pricing sheet template for a Request for Quote (RFQ) solicitation for medical gas supply and cylinder rental services. The file, designated as Attachment 3, contains CLINs (Contract Line Item Numbers) and associated pricing structure that offerors must complete as part of their quote submission to the Department of Veterans Affairs Veterans Health Administration, Veterans Integrated Service Network 4 (VA VISN 4). The solicitation number is 36C24E26Q0044, and the contract involves the supply and delivery of medical gases under NAICS Code 325120 (Industrial Gas Manufacturing) with Product Service Code 6835.
The contract opportunity is a Total Service Disabled Veteran Owned Small Business Set-Aside with a performance period from September 1, 2026, through August 31, 2031. Offerors are required to register in the System for Award Management (SAM) database prior to award. The pricing sheet serves as a critical submission document where vendors must provide their proposed costs for the various line items associated with medical gas supply and cylinder rental services. This template is part of the formal solicitation package and must be completed in accordance with the specific submission instructions outlined in Attachment 2 of the RFQ.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C24E26Q0044 0001.docx | DOCX document | |
| Questions and answers6-30-2026.docx | DOCX document | |
| Attachment 1 STATEMENT OF WORK 6-30-2026.docx | DOCX document | |
| 36C24E26Q0044 0001_1.docx | DOCX document | |
| Attachment 3CLINS_PricingSheet6-30-2026.xlsx | XLSX spreadsheet | |
| Attachment 1 STATEMENT OF WORK 6-11-2026.docx | DOCX document | |
| Attachment 2_Terms_Conditions_Submit__Eval36C24E26Q0044.docx | DOCX document | |
| 36C24E26Q0044_1.docx | DOCX document |
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Text version
Items
| ITEM NUMBER | DESCRIPTION | CONTRACT PERIOD | POP BEGIN | POP END | QUANTITY | UNIT OF MEASURE | LINE ITEM IS | UNIT PRICE | Total |
| 0001 | LQ NI 250 Liquid nitrogen tank on wheels w digital gauge | Base | 9/1/26 | 8/31/27 | 96 | EA | Priced | $0.00 | $0.00 |
| 0002 | CSP CO2 ANA-50 CO2 Anerobic grade 50 lb tank | Base | 9/1/26 | 8/31/27 | 48 | EA | Priced | $0.00 | $0.00 |
| 0003 | OX RX-E Medical Oxygen E tank | Base | 9/1/26 | 8/31/27 | 48 | EA | Priced | $0.00 | $0.00 |
| 0004 | 12 Medical Gas Cylinders - Daily Rental (12 x 365 = 4380 days) | Base | 9/1/26 | 8/31/27 | 4380 | EA | Priced | $0.00 | $0.00 |
| 0005 | 12 Specialty Gas Cylinders- Daily Rental (12 x 365 = 4380 days) | Base | 9/1/26 | 8/31/27 | 4380 | EA | Priced | $0.00 | $0.00 |
| 0006 | 4 Liquid Cylinders - Daily Rental (4 x 365 = 1460 days) | Base | 9/1/26 | 8/31/27 | 1460 | EA | Priced | $0.00 | $0.00 |
| 0007 | Delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/26 | 8/31/27 | 48 | EA | Priced | $0.00 | $0.00 |
| 0008 | Fuel Surcharge per delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/26 | 8/31/27 | 48 | EA | Priced | $0.00 | $0.00 |
| 0009 | Annual Audit | Base | 9/1/26 | 8/31/27 | 1 | EA | $0.00 | $0.00 | |
| 1001 | LQ NI 250 Liquid nitrogen tank on wheels w digital gauge | Base | 9/1/27 | 8/31/28 | 96 | EA | Priced | $0.00 | $0.00 |
| 1002 | CSP CO2 ANA-50 CO2 Anerobic grade 50 lb tank | Base | 9/1/27 | 8/31/28 | 48 | EA | Priced | $0.00 | $0.00 |
| 1003 | OX RX-E Medical Oxygen E tank | Base | 9/1/27 | 8/31/28 | 48 | EA | Priced | $0.00 | $0.00 |
| 1004 | 12 Medical Gas Cylinders - Daily Rental (12 x 365 = 4380 days) | Base | 9/1/27 | 8/31/28 | 4380 | EA | Priced | $0.00 | $0.00 |
| 1005 | 12 Specialty Gas Cylinders- Daily Rental (12 x 365 = 4380 days) | Base | 9/1/27 | 8/31/28 | 4380 | EA | Priced | $0.00 | $0.00 |
| 1006 | 4 Liquid Cylinders - Daily Rental (4 x 365 = 1460 days) | Base | 9/1/27 | 8/31/28 | 1460 | EA | Priced | $0.00 | $0.00 |
| 1007 | Delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/27 | 8/31/28 | 48 | EA | Priced | $0.00 | $0.00 |
| 1008 | Fuel Surcharge per delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/27 | 8/31/28 | 48 | EA | Priced | $0.00 | $0.00 |
| 1009 | Annual Audit | Base | 9/1/27 | 8/31/28 | 1 | EA | $0.00 | $0.00 | |
| 2001 | LQ NI 250 Liquid nitrogen tank on wheels w digital gauge | Base | 9/1/28 | 8/31/29 | 96 | EA | Priced | $0.00 | $0.00 |
| 2002 | CSP CO2 ANA-50 CO2 Anerobic grade 50 lb tank | Base | 9/1/28 | 8/31/29 | 48 | EA | Priced | $0.00 | $0.00 |
| 2003 | OX RX-E Medical Oxygen E tank | Base | 9/1/28 | 8/31/29 | 48 | EA | Priced | $0.00 | $0.00 |
| 2004 | 12 Medical Gas Cylinders - Daily Rental (12 x 365 = 4380 days) | Base | 9/1/28 | 8/31/29 | 4380 | EA | Priced | $0.00 | $0.00 |
| 2005 | 12 Specialty Gas Cylinders- Daily Rental (12 x 365 = 4380 days) | Base | 9/1/28 | 8/31/29 | 4380 | EA | Priced | $0.00 | $0.00 |
| 2006 | 4 Liquid Cylinders - Daily Rental (4 x 365 = 1460 days) | Base | 9/1/28 | 8/31/29 | 1460 | EA | Priced | $0.00 | $0.00 |
| 2007 | Delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/28 | 8/31/29 | 48 | EA | Priced | $0.00 | $0.00 |
| 2008 | Fuel Surcharge per delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/28 | 8/31/29 | 48 | EA | Priced | $0.00 | $0.00 |
| 2009 | Annual Audit | Base | 9/1/28 | 8/31/29 | 1 | EA | $0.00 | $0.00 | |
| 3001 | LQ NI 250 Liquid nitrogen tank on wheels w digital gauge | Base | 9/1/29 | 8/31/30 | 96 | EA | Priced | $0.00 | $0.00 |
| 3002 | CSP CO2 ANA-50 CO2 Anerobic grade 50 lb tank | Base | 9/1/29 | 8/31/30 | 48 | EA | Priced | $0.00 | $0.00 |
| 3003 | OX RX-E Medical Oxygen E tank | Base | 9/1/29 | 8/31/30 | 48 | EA | Priced | $0.00 | $0.00 |
| 3004 | 12 Medical Gas Cylinders - Daily Rental (12 x 365 = 4380 days) | Base | 9/1/29 | 8/31/30 | 4380 | EA | Priced | $0.00 | $0.00 |
| 3005 | 12 Specialty Gas Cylinders- Daily Rental (12 x 365 = 4380 days) | Base | 9/1/29 | 8/31/30 | 4380 | EA | Priced | $0.00 | $0.00 |
| 3006 | 4 Liquid Cylinders - Daily Rental (4 x 365 = 1460 days) | Base | 9/1/29 | 8/31/30 | 1460 | EA | Priced | $0.00 | $0.00 |
| 3007 | Delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/29 | 8/31/30 | 48 | EA | Priced | $0.00 | $0.00 |
| 3008 | Fuel Surcharge per delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/29 | 8/31/30 | 48 | EA | Priced | $0.00 | $0.00 |
| 3009 | Annual Audit | Base | 9/1/29 | 8/31/30 | 1 | EA | $0.00 | $0.00 | |
| 4001 | LQ NI 250 Liquid nitrogen tank on wheels w digital gauge | Base | 9/1/30 | 8/31/31 | 96 | EA | Priced | $0.00 | $0.00 |
| 4002 | CSP CO2 ANA-50 CO2 Anerobic grade 50 lb tank | Base | 9/1/30 | 8/31/31 | 48 | EA | Priced | $0.00 | $0.00 |
| 4003 | OX RX-E Medical Oxygen E tank | Base | 9/1/30 | 8/31/31 | 48 | EA | Priced | $0.00 | $0.00 |
| 4004 | 12 Medical Gas Cylinders - Daily Rental (12 x 365 = 4380 days) | Base | 9/1/30 | 8/31/31 | 4380 | EA | Priced | $0.00 | $0.00 |
| 4005 | 12 Specialty Gas Cylinders- Daily Rental (12 x 365 = 4380 days) | Base | 9/1/30 | 8/31/31 | 4380 | EA | Priced | $0.00 | $0.00 |
| 4006 | 4 Liquid Cylinders - Daily Rental (4 x 365 = 1460 days) | Base | 9/1/30 | 8/31/31 | 1460 | EA | Priced | $0.00 | $0.00 |
| 4007 | Delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/30 | 8/31/31 | 48 | EA | Priced | $0.00 | $0.00 |
| 4008 | Fuel Surcharge per delivery (4 deliveries per month) (4 x 12 = 48) | Base | 9/1/30 | 8/31/31 | 48 | EA | Priced | $0.00 | $0.00 |
| 4009 | Annual Audit | Base | 9/1/30 | 8/31/31 | 1 | EA | $0.00 | $0.00 | |
| $0.00 |
Unit of Measure of Cylinder is not available in the system and therefore was not used.
FOB Destination for all
Alternative CLIN set-up will not be considered. This includes grouping and a daily versus a monthly rate.
RefData
| Discount Type | YN | Options | Receipt Type | Line Item is | FOB | State Code | State Description |
| Percent | Yes | Base | Quantity | Priced | (none) | AK | Alaska |
| Amount | No | Option 1 | Amount | NSP | Origin | AL | Alabama |
| Option 2 | N/C | Destination | AR | Arkansas | |||
| Option 3 | AS | American Samoa | |||||
| Option 4 | AZ | Arizona | |||||
| Option 5 | CA | California | |||||
| Option 6 | CO | Colorado | |||||
| Option 7 | CT | Connecticut | |||||
| Option 8 | DC | District of Columbia | |||||
| Option 9 | DE | Delaware | |||||
| Option 10 | FL | Florida | |||||
| FM | Federal States of Micronesia | ||||||
| GA | Georgia | ||||||
| GU | Guam | ||||||
| HI | Hawaii | ||||||
| IA | Iowa | ||||||
| ID | Idaho | ||||||
| IL | Illinois | ||||||
| IN | Indiana | ||||||
| KS | Kansas | ||||||
| KY | Kentucky | ||||||
| LA | Louisiana | ||||||
| MA | Massachusetts | ||||||
| MD | Maryland | ||||||
| ME | Maine | ||||||
| MH | Marshall Islands | ||||||
| MI | Michigan | ||||||
| MN | Minnesota | ||||||
| MO | Missouri | ||||||
| MP | Northern Mariana Islands | ||||||
| MS | Mississippi | ||||||
| MT | Montana | ||||||
| NC | North Carolina | ||||||
| ND | North Dakota | ||||||
| NE | Nebraska | ||||||
| NH | New Hampshire | ||||||
| NJ | New Jersy | ||||||
| NM | New Mexico | ||||||
| NV | Nevada | ||||||
| NY | New York | ||||||
| OH | Ohio | ||||||
| OK | Oklahoma | ||||||
| OR | Oregon | ||||||
| PA | Pennsylvania | ||||||
| PR | Puerto Rico | ||||||
| PW | Palau | ||||||
| RI | Rhode Island | ||||||
| SC | South Carolina | ||||||
| SD | South Dakota | ||||||
| TN | Tennessee | ||||||
| TX | Texas | ||||||
| UT | Utah | ||||||
| VA | Virginia | ||||||
| VI | Virgin Islands | ||||||
| VT | Vermont | ||||||
| WA | Washington | ||||||
| WI | Wisconsin | ||||||
| WV | West Virginia | ||||||
| WY | Wyoming |
File details come from the government source that posted it. Updated .