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This is a Performance Work Statement (PWS) Attachment A containing a comprehensive equipment list for a Karl Storz Endoscopy Systems lease for VA Maine Healthcare System (Togus).

The equipment list is divided into two categories: New Equipment and Rollover Equipment. New Equipment consists of four items totaling minimal quantities: four UI600 Insufflator Endoflator units with power supplies, three TZ110-KT transmitter/receiver kits, three dual power brick holders, and three bifurcated 15-foot power cords. The Rollover Equipment section represents the substantial portion of the procurement, encompassing over 140 line items with multiple quantities ranging from one to 13 units per item. This includes imaging and camera systems (IMAGE1 S Connect II Module Kits, CCU modular units, camera heads), visualization equipment (32" 4K UHD LED monitors, 27" 4K 12G LED monitors, medical-grade printers), light sources and cables, endoscopic instruments (rigid scopes, flexible video cysto scopes, telescopes in various angles and sizes), arthroscopy and urology equipment (arthroscope sheaths, cystoscope sheaths, resectoscope sheaths, ureteroscopes), surgical instruments (biopsy forceps, scissors, grasping instruments, optical equipment), electrosurgical equipment (AUTOCON III ESU units with footswitches, high-frequency cords), sterilization trays, and support equipment (video carts, endoscopy stands). The equipment collectively supports multiple surgical specialties including general endoscopy, urology, gynecology, otolaryngology, and arthroscopy procedures.

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Performance Work Statement (PWS) Attachment A: Equipment List

Karl Storz Endoscopy Systems Lease - VA Maine Healthcare System (Togus)

New Equipment ITEM NUMBER DESCRIPTION Qty

UI600

INSUFFLATOR ENDOFLATOR® +,POWER SUPPLY 100-240 VAC, 50/60

HZ 4

TZ110-KT TRANSMITTER TZ112US + RECEIVER TZ111 TZ112US + TZ111 3

9402-9 DUAL POWER BRICK HOLDER FOR 9402 STAND 3

XUSM0019 BIFURCATED POWER CORD, 15FT FOR ZEROWIRES/TM343 3

Rollover Equipment ITEM NUMBER DESCRIPTION Qty

TC201US-KT IMAGE1 S CONNECT II MODULE KIT 3

TC304US CCU,MODULAR,4U-LINK,US 3

TC301US CCU,MODULAR,IMAGE1 S X-LINK,US 3

TH121 IMAGE1S 4U RUBINA, OPAL1 NIR/ICG 12

495ND LIGHT CABLE, 3.5MM X 300CM. LGTH 9.8 FT 13

KSZ-39301HCTS CONTAINER SYSTEM, CAMERA HEADS 12

TL400 Power LED RUBINA, OPAL1 NIR/ICG 3 TL005 Triple Adapter f. Light Source 3

UI500-KT1 ENDOFLATOR 50L KIT 3

WD350-KT AIDA BELLA W/SMARTSCREEN AND SWL 3

WU1333 SONY UP-DR80MD MEDICAL GRADE PRINTER 3

TM343 32" 4K UHD LED Monitor 6

XUSM0015 VIDEO CART VT, 40U 3

XUSM0007 DUAL YOKE CO2 HOSE ASSEMBLY 3

9402 UNIVERSAL VARIABLE HEIGHT MONITOR STAND 3

TC008 12G-SDI CABLE,33 FT,10M 4

INITIATE-CONFIG-0 VIDEO CONFIGURATION SERVICES FEE TIER 0 4

TC201US-KT IMAGE1 S CONNECT II MODULE KIT 1

TC304US CCU,MODULAR,4U-LINK,US 1

TC301US CCU,MODULAR,IMAGE1 S X-LINK,US 1

TL400 Power LED RUBINA, OPAL1 NIR/ICG 1 TL005 Triple Adapter f. Light Source 1

UI500-KT1 ENDOFLATOR 50L KIT 1

WU1333 SONY UP-DR80MD MEDICAL GRADE PRINTER 1

26046ARA HOPKINS RUBINA 0°, NIR/ICG, Ø 5 mm 8 26046BRA HOPKINS RUBINA 30°, NIR/ICG, Ø 5 mm 8 26003ARA HOPKINS RUBINA 0°, NIR/ICG, Ø 10 mm 8

26003BRA HOPKINS RUBINA 30°, NIR/ICG, Ø 10 mm 8

KSZ-39301BS CONTAINER SYSTEM, 2 SCOPES TO 5.5MMX35CM 6

KSZ-39301CS CONTAINER, 2 RIGID SCOPES, 10MM X 31CM 6

28731BWA HOPKINS Telescope 30°, 4 mm, 18 cm 8 28731CWA HOPKINS Telescope 70°, 4 mm, 18 cm 4 28136DS High-Flow Arthroscope Sheath 8 28136BT Obturator, semisharp 8

KSZ-39301AS CONTAINER, 2 RIGID SCOPES, 4MM X 18CM 2

28208BA HOPKINS Telescope 30°, 2.7 mm, 11 cm 2 28133DS Arthroscope Sheath 2 28133BC Obturator, blunt 2 27005AA HOPKINS Telescope 0°, 4 mm, 30 cm 2 27068DK SACHSE Urethrotome Sheath, Set 2 27068DO Obturator, for 27068D 2 27050E Working Element 2 27068CD Telescope Bridge 2

39312D TRAY, RESECTION INSTRUMENT SET 2

27005BA HOPKINS Telescope 30°, 4 mm, 30 cm 8 27005CA HOPKINS Telescope 70°, 4 mm 4 27005EA HOPKINS Telescope 120°, 4mm 4

11278VSUEK VIDEO-URETERO-RENOSCOPE FLEX XC 8

KSZ-39406AS-ZBZ CONTAINER SYSTEM, FLEX CMOS SCOPE SET 4

27010LA Uretero-Renoscope, 7 Fr., 43cm 2

39301LC TRAY, STRAIGHT EYEPIECE URETEROSCOPE 2

27026DAK Cystoscope Sheath, 19 Fr., Set 6 27026BAK Cystoscope Sheath, 22 Fr., Set 6 27026EF Catheter Deflecting Mechanism 6 27025GA Telescope Bridge 6 27072BSA Optical Biopsy Forceps 6 27502 LUER-Lock Tube Connector 12 27550A-10 Sealing Cap 2 27050SCK Resectoscope Sheath, 26 Fr., Set 6 27040SLK Resectoscope Sheath, 26 Fr., Set 6 27048CK Deflecting Obturator, 24/26 Fr. 6 27050BK Visual Obturator, for sheaths 24/26 Fr 6 UH801 Bipolar High Frequency Cord, 400 cm 8 27040EB Working Element, bipolar 6 27224 ELLIK Evacuator 6 27224A Connector with Tube, for 27224 3

UH400U-KT AUTOCON® III 400 W/ TWO-PEDAL FOOTSWITCH 2

9700AC CART FOR AUTOCON III 400 ESU 2

27770E Coagulating Electrode, 8 Fr. 6 26006M Unipolar High Frequency Cord, 300 cm 6 27092AMA HOPKINS Telescope 6° 1 27292AMA HOPKINS Telescope 6° 1

27325BA HOPKINS Telescope 30°, 3.5 mm 2 27027KLK Cystoscope Sheath, 22 Fr., Set 2 27027NL Telescope Bridge 2 27027E Catheter Deflecting Mechanism 2 27040EO Working Element, bipolar 2 27051PLK Resectoscope Sheath, 26 Fr., Set 2 27040BB Standard-Obturator 2 PV27051B SCHMIEDT Visual Obturator, 24/26 Fr. 2 26120BA HOPKINS Telescope 30°, 2.9 mm, 30 cm 4 26153EA Hysteroscope Sheath, 5 mm 3 26161VB Inner Sheath, Ø 3.8 mm 3 26159UHW Biopsy and Grasping Forceps, 5 Fr. 3 26159EHW Scissors, blunt, 5 Fr., 34 cm 3 26159BHW Biopsy Spoon Forceps, 5 Fr. 3 26159H Tenaculum Grasping Forceps, 34 cm 3 27502 LUER-Lock Tube Connector 3

39314A TRAY, BETTOCCHI HYSTEROSCOPY INSTRUMENTS 3

7230AA HOPKINS Telescope 0°, 4 mm, 18 cm 6 7230BA HOPKINS Telescope 30°, 4 mm, 18 cm 6

KSZ-39301AS-ZBZ CONTAINER SYSTEM, 2 SCOPES TO 4MMX18CM 4

12015AA HOPKINS Telescope 0°, 5.5 mm, 53 cm 2

39316A-ZBD ESOPHAGOSCOPE STERILIZATION TRAY 2

20040241US-UG USB SILICONE KEYBOARD, W/US EN CHAR SET 2

XUSM0001-UG Compact Endoscopy Cart W/ drawer, UG 2

WU1333-UG SONY UP-DR80MD MEDICAL GRADE PRINTER 2

11272VHUK-TL FLEXIBLE VIDEO CYSTO HD-VIEW, SCOPE 16

27425FG Forceps, 5 Fr., flexible, 60 cm 6

KSZ-39406AS-ZBZ CONTAINER SYSTEM, FLEX CMOS SCOPE SET 3

TH110-HN IMAGE1 S HX, CAMERA HEAD, 1080P HD, HN 4

KSZ-39301HCTS-

ZBD HIGH DEF CAMERA HEAD CONTAINER 4

40160040 Stroboscopy Kit for TP101 and TP100 3

495NA-ENT LIGHT CABLE, 3.5MM X 230CM 3

XUSM0013-HN Compact Endoscopy Stand , HN 3

XUSM0012-HN PLATINUM CART FOR VIDEO INTUBATION 2

495NA-ENT LIGHT CABLE, 3.5MM X 230CM 1

KSZ-39301HCTS-

ZBD HIGH DEF CAMERA HEAD CONTAINER 1

WU1333 SONY UP-DR80MD MEDICAL GRADE PRINTER 4

XUSM0003 27" 4K 12G LED MONITOR 3

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