ATTACHMENT A - PRICE COST SCHEDULE - NX EQ PHYSIOLOGIC MONITOR MODULES PULSE OXIMETRY.xlsx

XLSX spreadsheet 24 KB Posted

Attached to
6515--Physiologic Monitor Modules: Pulse Oximetry
Solicitation number
36C10X26Q0167
Issued by

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This is a Price Cost Schedule template for a Request for Quote (RFQ) issued by the Department of Veterans Affairs Strategic Acquisition Center Frederick for Physiologic Monitor Modules: Pulse Oximetry equipment and related services. The solicitation number is 36C10X26Q0167, and the requirement is for noninvasive patient monitoring systems utilizing near-infrared spectroscopy (NIRS) technology to measure regional hemoglobin oxygen saturation during patient care at VA Medical Centers nationwide.

The pricing schedule specifies 18 line items (CLINs) for Masimo O3 brand name equipment or equivalent products, with estimated quantities across a base year plus four option years. Line items include the O3 Root Monitor, O3 Regional Oximeter Module, sensors, module clamps, cable tethers, roll stands, DLMS Virtual Server, gateway applications, barcode readers, HL7 interface modules, installation services, IRIS DCX licenses, three-year IRIS service, wireless site surveys, and three-year Concierge+ service plans. Vendors must complete all yellow-highlighted pricing fields, including proposed unit prices, 3% Service Level Agreement (SLA) fees, total prices per item, and delivery timelines (ARO—After Receipt of Order in days). Offerors proposing equivalent products must identify the manufacturer name and part numbers for their proposed solutions in the designated columns. All pricing entries must correspond with items proposed in the technical volume. This is a brand name or equal commercial items procurement structured as a single award Requirements contract.

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36C10X26Q0167 0001.docx DOCX document
ATTACHMENT E - REPORTING TOOL - NX EQ PHYSIOLOGIC MONITOR MODULES PULSE OXIMETRY.xlsx XLSX spreadsheet
ATTACHMENT F - PAST PERFORMANCE REFERENCE - NX EQ PHYSIOLOGIC MONITOR MODULES PULSE OXIMETRY.docx DOCX document
ATTACHMENT B - CONTRACT ADMINISTRATION - NX EQ PHYSIOLOGIC MONITOR MODULES PULSE OXIMETRY.docx DOCX document
36C10X26Q0167.docx DOCX document
ATTACHMENT C - CONTRACT CLAUSES - NX EQ PHYSIOLOGIC MONITOR MODULES PULSE OXIMETRY.docx DOCX document
ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ PHYSIOLOGIC MONITOR MODULES PULSE OXIMETRY.docx DOCX document
ATTACHMENT G - PAST PERFORMANCE QUESTIONNAIRE - NX EQ PHYSIOLOGY MONITOR MODULES PULSE OXIMETRY.docx DOCX document

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Sheet1

CLINPart NumberBrand NameItem DescriptionUnit of Measure (UOM)Quantity Per UOMEstimated Quantity (Base Year)Estimated Quantity (Year 1)Estimated Quantity (Year 2)Estimated Quantity (Year 3)Estimated Quantity (Year 4)Manufacturer NameManufacturer Part NumberItem DescriptionContractor Part Number (if different from OEM)Unit of MeasureQuantity per UOMDelivery Days AROCommercial PriceProposed Unit
Price (Base Year)SLA (3%)Total Price (Unit Price plus SLA)
Base YearProposed Unit
Price (Option Year 1)SLA (3%)Total Price (Unit Price plus SLA)
Option Year 1Proposed Unit
Price (Option Year 2)SLA (3%)Total Price (Unit Price plus SLA)
Option Year 2Proposed Unit
Price (Option Year 3)SLA (3%)Total Price (Unit Price plus SLA)
Option Year 3Proposed Unit
Price (Option Year 4)SLA (3%)Total Price (Unit Price plus SLA)
Option Year 4Total Evaluated Price (with 3% SLA and estimated quantities) - Base YearTotal Evaluated Price (with 3% SLA and estimated quantities) - Opt Year 1Total Evaluated Price (with 3% SLA and estimated quantities) - Opt Year 2Total Evaluated Price (with 3% SLA and estimated quantities) - Opt Year 3Total Evaluated Price (with 3% SLA and estimated quantities) - Opt Year 4Total Evaluated Price
00019515Masimo O3®Root MonitorEA12020202020$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00029637Masimo O3®O3 Regional Oximeter ModuleEA12020202020$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00033756Masimo O3®O3 Sensor, Adult (20/box)BX14040404040$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00044575Masimo O3®O3 Module ClampEA12020202020$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
000515785Curbell MedicalCurbell Cable Tethers, 6" (12/box)BX11010101010$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
0006300238Masimo O3®Root Roll StandEA155555$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
000728814Masimo O3®DLMS Virtual ServerEA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
000827161Masimo O3®BAG ASSY, IRIS GTWY VIRTL APPL, V2.0.0.1EA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
000927274Masimo O3®BAG ASY, IRIS GTWY VRT APPL, TST SVR, V2001EA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
0010101138Masimo O3®USB 1D/2D BARCODE READEREA11010101010$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00113963Masimo O3®HL7, ADT, INTERFACEEA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00124526Masimo O3®HL7, NOTIFCATIONSEA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00133964Masimo O3®HL7, RESULTS OUT, INTERFACEEA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00142456Masimo O3®INSTALLATION SERVICES, SAFETY NETEA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00159712-LICMasimo O3®IRIS DCX PER BED LICENSEEA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
0016102-3YMasimo O3®IRIS SERVICE, 3 YrEA11010101010$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
00172457Masimo O3®WIRELESS SITE SURVEYEA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
0018114-3YMasimo O3®CONCIERGE+ SERVICE PLAN FOR DEVICES, 3YREA144444$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0$ - 0
$ - 0Total Price
*VENDOR IS TO COMPLETE ALL "YELLOW" HIGHLIGHTED SPACES*VENDOR IS TO COMPLETE ALL "YELLOW" HIGHLIGHTED SPACES
**ARO = Delivery Days After Receipt of Order**ARO = Delivery Days After Receipt of Order
Offerors proposing equivalent product must enter Name of Manufacturer for its proposed solution, Description of Part Number(s), etc. starting at Column L. If offeror’s proposed solution does not require a particular CLIN, vendor shall indicate such by writing N/A, None, or Zero (0). Also, the items priced in Pricing volume must correspond with the items proposed in offeror’s Technical volume as the brand name or equivalent solution.

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