ATTACHMENT 7 - FY2023-2028 - WALKERS SLA Contract Reporting.xlsx

XLSX spreadsheet 442 KB Posted

Attached to
6515--FY23 Requirement | PSAS Program Office | Pick-Up Walkers & Rollators | Posting of Amendment 0006
Solicitation number
36C10G22R0025
Issued by

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Written by GovTribe AI ·

This document contains a quarterly contract reporting template and related federal solicitation. The template is for reporting task order details to the Department of Veterans Affairs on a quarterly and annual basis. It requires information on VA medical centers, task order numbers, dates, pricing, and purchased items. The solicitation is for pick-up walkers and rollators for the VA's PSAS Program Office through September 2028. Responses are due by September 22, 2022, and the solicitation seeks pricing details in an attached Excel file. It involves the VA Headquarters and aims to procure mobility devices for veterans over multiple fiscal years.

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Other files

File Type Posted
36C10G22R0025 Solicitation - FY22 Walkers v5.pdf PDF
36C10G22R0025 0006_1.docx DOCX document
36C10G22R0025 0006 - Signed.pdf PDF
36C10G22R0025 0005_2.docx DOCX document
36C10G22R0025 Solicitation - FY22 Walkers v4.pdf PDF
36C10G22R0025 0005 - Signed.pdf PDF
36C10G22R0025 0004_1.docx DOCX document
ATTACHMENT 4 - Questions and GOV Responses - Round 2 - 10-13-2022.xlsx XLSX spreadsheet
36C10G22R0025 0004 - Signed.pdf PDF
36C10G22R0025 0003_1.docx DOCX document
36C10G22R0025 Solicitation - FY22 Walkers v3.pdf PDF
ATTACHMENT 4 - Questions Submission Format - Round 2.xlsx XLSX spreadsheet
36C10G22R0025 0003 - Signed.pdf PDF
36C10G22R0025 0002_1.docx DOCX document
36C10G22R0025 0002 - Signed.pdf PDF
ATTACHMENT 1 - Excel Product Price Schedule v2.xlsx XLSX spreadsheet
36C10G22R0025 0001 - Signed.pdf PDF
36C10G22R0025 0001_1.docx DOCX document
36C10G22R0025 Solicitation - FY22 Walkers v2.pdf PDF
ATTACHMENT 4 - Questions and GOV Responses - 09-22-2022.xlsx XLSX spreadsheet
ATTACHMENT 6 - Pay.gov Vendor Submittal Instructions.pdf PDF
ATTACHMENT 1 - Excel Product Price Schedule.xlsx XLSX spreadsheet
ATTACHMENT 3 - Invoice Inquiry Format.xlsx XLSX spreadsheet
36C10G22R0025_1.docx DOCX document
36C10G22R0025 Solicitation - FY22 Walkers.pdf PDF
ATTACHMENT 2 - Contractor Discrepancy Report (CDR).pdf PDF
ATTACHMENT 5 - Past Performance Questionnaire.docx DOCX document
ATTACHMENT 4 - Questions Submission Format.xlsx XLSX spreadsheet
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Quarter 1

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VA MEDICAL CENTER (Station Code)Program Office CodeTASK ORDER/DELIVERY ORDER NUMBERTASK ORDER DATEPO NumberCLINITEMIZED LIST OF ALL PURCHASED ITEMS UNDER CLINQUANTITYUNIT PRICETOTAL CLIN PRICETASK ORDER TOTAL PRICETotal Qtr Price
Salem VA Hospital Virginia

1970 Roanoke Boulevard, Salem, VA, 24153

USAUnited States1.00$6,500.00$6,500.00$6,500.00$6,500.00
Gainesville VA Hospital Florida Malcom Randall Mem

Malcom Randall VA Medical Center Nursing Services 1601 SW Archer Rd, Gainesville, FL, 32608-1197 USA & North Florida/South Georgia Veterans Health System 1601 S W Archer Road, Gainesville, FL, 32608

USA1.00$27,950.00$27,950.00$27,950.00$27,950.00
Milwaukee VA Hospital Wisconsin Clement J. Zablocki

5000 W. National Ave, Milwaukee, WI, 53295

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Miami VA Healthcare System

Miami VA Medical Center

WAREHOUSE (90D)

1201 N W 16th St, Miami, FL, 33125

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Sacramento VAMC Northern CA Health Care System

VAMC Sacramento ATTN: Biomedical Engineering 10535 Hospital Way , Mather, CA, 95655

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Boise VA Medical Center

500 West Fort Street, Boise, ID, 83702

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Muskogee VA Hospital Oklahoma Jack Montgomery Mem.

MARK FOR: Eric Tuck 1011 Honor Heights Drive, Muskogee, OK, 74401-1318

USA1.00$132,355.00$132,355.00$320,610.00$320,610.00
Muskogee VA Hospital Oklahoma Jack Montgomery Mem.

MARK FOR: Eric Tuck 1011 Honor Heights Drive, Muskogee, OK, 74401-1318

USA1.00$132,355.00$132,355.00
Muskogee VA Hospital Oklahoma Jack Montgomery Mem.

MARK FOR: Eric Tuck 1011 Honor Heights Drive, Muskogee, OK, 74401-1318

USA2.00$27,950.00$55,900.00
Atlanta VA Hospital Georgia

Atlanta VAMC Mr. Charles Miller 1670 Clairmont Road, Decatur, GA, 30033

USA1.00$27,950.00$27,950.00$27,950.00$27,950.00
Jesse Brown VA Medical Center

MARK FOR: Dr. Lyn Sue Kahng, MD 820 South Damen Avenue , IL , Chicago, IL, 60612-3728

USA1.00$27,950.00$27,950.00$27,950.00$27,950.00
Madison VA Hospital Wisconsin Willian S. Middleton Mem.

William S. Middleton VA Medical Center Warehouse 2500 Overlook Terrace, Madison, WI, 53705-2286

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
VA Black Hills Health Care System - Fort Meade Campus

113 Comanche Road, Fort Meade, SD, 57741

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Bronx VA Hospital New York James J. Peters

130 West Kingsbridge Road, Bronx, NY, 10468

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Dallas VA Medical Center

4500 S Lancaster Rd, Dallas, TX, 75216

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Salem VA Hospital Virginia

1970 Roanoke Boulevard, Salem, VA, 24153

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Long Beach VA (Tibor Rubin VAMC)

5901 E 7th Street, Long Beach, CA, 90815

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Bronx VA Hospital New York James J. Peters

130 West Kingsbridge Road, Bronx, NY, 10468

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
Indianapolis VA Hospital Indiana Richard L. Roudebush Mem.

1481 W 10th Street, ATTN: WAREHOUSE/TERRENCE (TED) KORUPP, TERRENCE.KORUPP@VA.GOV

Indianapolis, IN, 46202

USA1.00$6,500.00$6,500.00$6,500.00$6,500.00
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$488,960.00$488,960.00$488,960.00

Quarter 2

Summary Reporting for __________________________ Contract Number: ___________________________ PoP: _________________________
VA MEDICAL CENTER (Station Code)Program Office CodeTASK ORDER/DELIVERY ORDER NUMBERTASK ORDER DATEPO NumberCLINITEMIZED LIST OF ALL PURCHASED ITEMS UNDER CLINQUANTITYUNIT PRICETOTAL CLIN PRICETASK ORDER TOTAL PRICETotal Qtr Price
North Chicago VA Hospital Illinois Capt. James A. Lovell Mem.

3001 Green Bay Road

North Chicago, IL 60064N/A5/3/20556-R05436
Mountain Home VAMC/Johnson City

204 West Spear Street, Suite 3319

Carson City, NV 89703N/A02-27-2020621-P0A334
Cleveland VA Hospital Ohio Wade Park Campus

10701 East Boulevard

Cleveland, OH 44106N/A02-20-2020541C00260
VA North Texas Health Care System

4500 South Lancaster Road

Dallas, TX 75216-7167N/A02-13-2020549-P09411
VA Temple Olin E. Teague Veterans Medical Center

1901 Veterans Memorial Drive

Temple, TX 76504N/A11/2/20674-P03991
VISN 19: Rocky Mountain Network

4100 E Mississippi Ave

Glendale, CO 80246N/A01-27-2020554-C00158
Madison VA Hospital Wisconsin Willian S. Middleton Mem.

2500 Overlook Terrace

Madison, WI 53705-2286N/A9/1/20607C80189
Wm. Jennings Bryan Dorn VA Medical Center

6439 Garners Ferry Road

Columbia, SC 29209-1639N/A8/1/20534-P01260
Greenville Healthcare Center

401 Moye Blvd

Greenville, NC 27834N/A12-29-2019558-0P2495
Columbus VA Hospital Ohio Chalmers P. Wylie Mem.

420 N James Road

Columbus, OH 43219N/A1/12/19757C00051
Cleveland VA Hospital Ohio Wade Park Campus

10701 East Boulevard

Cleveland, OH 44106N/A10-28-2020541A05003
Miami VA Healthcare System

WAREHOUSE (90D)

1201 N W 16th St

Miami, FL 3312536C24820N0016-11/10/19546-C00002
VA Pacific Islands Health Care System

459 Patterson Road

Honolulu, HI 96819-152236C26119N01311/10/19612C04000
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Quarter 3

Summary Reporting for __________________________ Contract Number: ___________________________ PoP: _________________________
VA MEDICAL CENTER (Station Code)Program Office CodeTASK ORDER/DELIVERY ORDER NUMBERTASK ORDER DATEPO NumberCLINITEMIZED LIST OF ALL PURCHASED ITEMS UNDER CLINQUANTITYUNIT PRICETOTAL CLIN PRICETASK ORDER TOTAL PRICETotal Qtr Price
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Quarter 4

Summary Reporting for __________________________ Contract Number: ____________VA119-17-D-0033_______________ PoP: _________________________
VA MEDICAL CENTER (Station Code)Program Office CodeTASK ORDER/DELIVERY ORDER NUMBERTASK ORDER DATEPO NumberCLINITEMIZED LIST OF ALL PURCHASED ITEMS UNDER CLINQUANTITYUNIT PRICETOTAL CLIN PRICETASK ORDER TOTAL PRICETotal Qtr Price
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FY Summary

Summary Reporting for __________________________ Contract Number: ___________VA119-17-D-0033________________ PoP: _________________________
VA MEDICAL CENTER (Station Code)QTR (1-4)TASK ORDER/DELIVERY ORDER NUMBERTASK ORDER DATETASK ORDER TOTAL PRICETOTAL FY TASK ORDER PRICESLA Fee @3%
1 OCT-DEC
2 JAN-MAR
3 APR-JUN
4 JUL-SEP

Total $0.00

CONTRACT SUMMARY

Summary Reporting for Walkers - Contract Number:36C10G23D00XX PoP: _________________________
FISCAL YEAR (FY)QUARTERQUARTERLY TOTAL TASK ORDER PRICEFY TOTAL TASK ORDER PRICETOTAL CUMULATIVE CONTRACT PRICETOTAL SLA FEE @3%
FY 231 (1 OCT 22 - 31 DEC 22)$0.001 OCT-DEC
FY 232 (1 JAN 23 - 31 MAR 23)$0.001 OCT-DEC
FY 233 (1 APR 23 - 30 JUN 23)$0.002 JAN-MAR
FY 234( 1 JUL 23 - 30 SEP 23)$0.00$0.00$ - 03 APR-JUN
FY 23TOTAL$0.00$0.00$ - 0Paid on xxx - Pay.gov Tracking ID: xxx4 JUL-SEP
FY 241 (1 OCT 23 - 31 DEC 23)$0.00$ - 0
FY 242 (1 JAN 24 - 31 MAR 24)$0.00$ - 0
FY 243 (1 APR 24 - 30 JUN 24)$0.00$ - 0
FY 244 (1 JUL 24 - 30 SEP 24)$0.00$ - 0
FY 24TOTAL$0.00$0.00$ - 0
FY 251 (1 OCT 24 - 31 DEC 24)$0.00$ - 0
FY 252 (1 JAN 25 - 31 MAR 25)$0.00$ - 0
FY 253 (1 APR 25 - 30 JUN 25)$0.00$ - 0
FY 254 (1 JUL 25 - 30 SEP 25)$0.00$ - 0
FY 25TOTAL$0.00$0.00$ - 0
FY 261 (1 OCT 25 - 31 DEC 25)$0.00$ - 0
FY 262 (1 JAN 26 - 31 MAR 26)$0.00$ - 0
FY 263 (1 APR 26 - 30 JUN 26)$0.00$ - 0
FY 264 (1 JUL 26 - 30 SEP 26)$0.00$ - 0
FY 26TOTAL$0.00$0.00$ - 0
FY 271 (1 OCT 26 - 31 DEC 26)$0.00$ - 0
FY 272 (1 JAN 27 - 31 MAR 27)$0.00
FY 273 (1 APR 27 - 30 JUN 27)$0.00
FY 274 (1 JUL 27 - 30 SEP 27)$0.00
FY 27TOTAL$0.00$0.00$ - 0
FY 281 (1 OCT 27 - 31 DEC 27)$0.00
FY 282 (1 JAN 28 - 31 MAR 28)$0.00
FY 283 (1 APR 28 - 30 JUN 28)$0.00
FY 284 (1 JUL 28 - 30 SEP 28)$0.00
FY 28TOTAL$0.00$0.00

File details come from the government source that posted it. Updated .