Attachment B - Pricing Worksheet.docx
DOCX document 30 KB Posted
- Attached to
- 6830--AMENDMENT - Weekly/Reoccurring Carbon Dioxide (Dry Ice) Supply Federal contract opportunity
- Solicitation number
- 36C24E26Q0083
About this file
This is a Pricing Worksheet template attachment for a Request for Quotation (RFQ) issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 4 for weekly/recurring carbon dioxide (dry ice) supply under solicitation number 36C24E26Q0083. The RFQ is designated for commercial items under FAR Part 13 Simplified Acquisition Procedures and includes a 100% Service-Disabled Veteran-Owned Small Business (SDVOSB) set-aside. The procurement falls under NAICS code 325120 (Industrial Gas Manufacturing) with a 1,200-employee size standard and Product/Service Code 6830 (Gases: Compressed and Liquefied). All offers must be submitted electronically via email to Millicent Covert at millicent.covert@va.gov with the solicitation number referenced in the subject line by the deadline of Thursday, August 13, 2026, at 11:59 AM Eastern Time. Prospective offerors must be registered and active in the System for Awards Management (SAM.gov) to participate, and any questions must be submitted by Wednesday, August 5, 2026, at 11:59 AM Eastern Time.
This pricing worksheet serves as the template for vendors to submit their cost quotations for the dry ice supply contract. While the specific pricing structure and line items are not detailed in the available documentation, vendors using this worksheet would provide their pricing for the weekly/recurring delivery of carbon dioxide (dry ice) to meet the Veterans Health Administration's operational requirements. The worksheet format ensures standardized cost submission across all responding contractors to facilitate evaluation and comparison.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment D - Amendment of Solicitation - RFQ 36C24E26Q0083.docx | DOCX document | |
| Attachment C - RFQ 36C24E26Q0083_amended.docx | DOCX document | |
| 36C24E26Q0083_2.docx | DOCX document | |
| Attachment C - RFQ 36C24E26Q0083 Document .docx | DOCX document | |
| Attachment A - Offeror Information.docx | DOCX document | |
| 36C24E26Q0083_1.docx | DOCX document |
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Text version
Attachment B – PRICING/OFFER WORKSHEET
INSTRUCTIONS:
· Provide unit price and total amount per Item Number.
· Provide Grand Total of all Items Incomplete submissions will be considered non-responsive.
ITEM INFORMATION
PRINCIPAL NAICS CODE: 325120 - Industrial Gas Manufacturing PRODUCT/SERVICE CODE: 6830 - Gases: Compressed and Liquefied
| ITEM NUMBER |
| DESCRIPTION OF SUPPLIES/SERVICES |
| QUANTITY |
| UNIT |
| UNIT PRICE |
| AMOUNT |
| 0001 |
| Order Year 1 |
| 52,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC, LOCATION 1,000 LBS IN TWO BINS TO BUILDING 114
LOCAL STOCK NUMBER: 0001
| 0002 |
| Order Year 1 |
| 26,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC LOCATION 500LBS IN A 500LBS BIN TO BUILDING 500
LOCAL STOCK NUMBER: 0002
| 0003 |
| Order Year 1 |
| 13,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO SEPULVEDA OUTPATIENT CLINIC ONE LOCATION: 250LBS IN ONE 250LBS TO BUILDING 7, ROOM 140
LOCAL STOCK NUMBER: 0003
| 0004 |
| Order Year 1 |
| 24.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 2 BIN FOR 12 MONTHS= 24 RENTAL UNITS, EACH BUILDING 114 WEST LA
LOCAL STOCK NUMBER: 0004
| 0005 |
| Order Year 1 |
| 12.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 1 BIN FOR 12 MONTHS= 12 RENTAL UNITS, EACH BUILDING 500 WEST LA
LOCAL STOCK NUMBER: 0005
| 0006 |
| Order Year 1 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUILDING 500: 52 EACH
LOCAL STOCK NUMBER: 0006
| 0007 |
| Order Year 1 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUIDING 11: 52 EACH
LOCAL STOCK NUMBER: 007
| 0008 |
| Order Year 1 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK SEPULVEDA BUILDING 7, RM 1-100: 52 EACH
LOCAL STOCK NUMBER: 0008
| 1001 |
| Order Year 2 |
| 52,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC, LOCATION 1,000 LBS IN TWO BINS TO BUILDING 114
| 1002 |
| Order Year 2 |
| 26,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC LOCATION 500LBS IN A 500LBS BIN TO BUILDING 500
| 1003 |
| Order Year 2 |
| 13,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO SEPULVEDA OUTPATIENT CLINIC ONE LOCATION: 250LBS IN ONE 250LBS TO BUILDING 7, ROOM 140
| 1004 |
| Order Year 2 |
| 24.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 2 BIN FOR 12 MONTHS= 24 RENTAL UNITS, EACH BUILDING 114 WEST LA
| 1005 |
| Order Year 2 |
| 12.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 1 BIN FOR 12 MONTHS= 12 RENTAL UNITS, EACH BUILDING 500 WEST LA
| 1006 |
| Order Year 2 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUILDING 500: 52 EACH
| 1007 |
| Order Year 2 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUIDING 11: 52 EACH
LOCAL STOCK NUMBER: 0007
| 1008 |
| Order Year 2 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK SEPULVEDA BUILDING 7, RM 1-100: 52 EACH
| 2001 |
| Order Year 3 |
| 52,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC, LOCATION 1,000 LBS IN TWO BINS TO BUILDING 114
| 2002 |
| Order Year 3 |
| 26,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC LOCATION 500LBS IN A 500LBS BIN TO BUILDING 500
| 2003 |
| Order Year 3 |
| 13,000.00 |
| LB |
| __________________ |
| __________________ |
Order Year 3 - DRY ICE, SLAB DELIVERED TO SEPULVEDA OUTPATIENT CLINIC ONE LOCATION: 250LBS IN ONE 250LBS TO BUILDING 7, ROOM 140
| 2004 |
| Order Year 3 |
| 24.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 2 BIN FOR 12 MONTHS= 24 RENTAL UNITS, EACH BUILDING 114 WEST LA
| 2005 |
| Order Year 3 |
| 12.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 1 BIN FOR 12 MONTHS= 12 RENTAL UNITS, EACH BUILDING 500 WEST LA
| 2006 |
| Order Year 3 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUILDING 500: 52 EACH
| 2007 |
| Order Year 3 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUIDING 11: 52 EACH
| 2008 |
| Order Year 3 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK SEPULVEDA BUILDING 7, RM 1-100: 52 EACH
| 3001 |
| Order Year 4 |
| 52,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC, LOCATION 1,000 LBS IN TWO BINS TO BUILDING 114
| 3002 |
| Order Year 4 |
| 26,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC LOCATION 500LBS IN A 500LBS BIN TO BUILDING 500
| 3003 |
| Order Year 4 |
| 13,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO SEPULVEDA OUTPATIENT CLINIC ONE LOCATION: 250LBS IN ONE 250LBS TO BUILDING 7, ROOM 140
| 3004 |
| Order Year 4 |
| 24.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 2 BIN FOR 12 MONTHS= 24 RENTAL UNITS, EACH BUILDING 114 WEST LA
| 3005 |
| Order Year 4 |
| 12.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 1 BIN FOR 12 MONTHS= 12 RENTAL UNITS, EACH BUILDING 500 WEST LA
| 3006 |
| Order Year 4 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUILDING 500: 52 EACH
| 3007 |
| Order Year 4 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUIDING 11: 52 EACH
| 3008 |
| Order Year 4 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK SEPULVEDA BUILDING 7, RM 1-100: 52 EACH
| 4001 |
| Order Year 5 |
| 52,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC, LOCATION 1,000 LBS IN TWO BINS TO BUILDING 114
| 4002 |
| Order Year 5 |
| 26,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO WEST LOS ANGELES VAMC LOCATION 500LBS IN A 500LBS BIN TO BUILDING 500
| 4003 |
| Order Year 5 |
| 13,000.00 |
| LB |
| __________________ |
| __________________ |
DRY ICE, SLAB DELIVERED TO SEPULVEDA OUTPATIENT CLINIC ONE LOCATION: 250LBS IN ONE 250LBS TO BUILDING 7, ROOM 140
| 4004 |
| Order Year 5 |
| 24.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 2 BIN FOR 12 MONTHS= 24 RENTAL UNITS, EACH BUILDING 114 WEST LA
| 4005 |
| Order Year 5 |
| 12.00 |
| EA |
| __________________ |
| __________________ |
BIN RENTAL, 1 BIN FOR 12 MONTHS= 12 RENTAL UNITS, EACH BUILDING 500 WEST LA
| 4006 |
| Order Year 5 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUILDING 500: 52 EACH
| 4007 |
| Order Year 5 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK, WEST LA BUIDING 11: 52 EACH
| 4008 |
| Order Year 5 |
| 52.00 |
| EA |
| __________________ |
| __________________ |
DELIVERY, FUEL AND HAZMAT, 1 DELIVERY A WEEK SEPULVEDA BUILDING 7, RM 1-100: 52 EACH
| GRAND TOTAL |
| __________________ |
ATTACHMENT B - 36C24E26Q0083
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