ATTACHMENT D_PRICE COST SCHEDULE_NX EQ Recorders.xlsx

XLSX spreadsheet 31 KB Posted May 13, 2026

Attached to: 6515--NX EQ Recorders, Physiologic, pH, Upper Gastrointestinal Tract (VA-26-00040316)
Solicitation number: 36C10X26Q0087
Issued by: Department of Veterans Affairs Strategic Acquisition Center Frederick

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Written by GovTribe AI · May 13, 2026

This is a price cost schedule template for a Firm Fixed Price (FFP) sole source procurement of Medtronic Bravo Reflux Testing System equipment and associated service plans for the Department of Veterans Affairs. The spreadsheet itemizes 18 contract line items (CLINs) across a base year and four option years, with estimated quantities of 20 units per line item annually. The required products include the Bravo CF Reflux Recorder (CLIN 1), Bravo Vacuum Pump and accessories (CLINs 2-5), calibration equipment (CLIN 6), virus filters (CLIN 7), pH recorder straps (CLIN 8), Reflux Software v6.1 with 10 licenses (CLIN 9), power adapters and cables (CLINs 10-12), and service plans for both initial and additional recorders with 1-, 2-, and 3-year coverage options (CLINs 13-18). All unit prices and SLA costs (3% markup) are currently blank and must be completed by the vendor in the yellow-highlighted columns. Vendors are required to populate proposed unit prices for the base year and all four option years, calculate the 3% Service Level Agreement pricing, and compute total evaluated prices for each year, with the pricing structure accommodating equivalent product proposals if offerors propose alternatives to the Medtronic equipment specified.

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Other files

File	Type	Posted
ATTACHMENT C_REPORTING TOOL_NX EQ Recorders.xlsx	XLSX spreadsheet	May 13, 2026
Attachment A_RFQ 36C10X26Q0087_V2.docx	DOCX document	May 13, 2026
36C10X26Q0087_1.docx	DOCX document	May 13, 2026
Attachment B_Product Description_NX EQ Recorders.docx	DOCX document	May 13, 2026

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Sheet1

	CLIN	Part Number	Brand Name	Item Description	Unit of Measure (UOM)	Quantity Per UOM	Estimated Quantity (Base Year)	Estimated Quantity (Opt Year 1)	Estimated Quantity (Opt Year 2)	Estimated Quantity (Opt Year 3)	Estimated Quantity (Opt Year 4)	Manufacturer Name	Manufacturer Part Number	Item Description	Contractor Part Number (if different from OEM)	Unit of Measure	Quantity per UOM	Delivery Days ARO	Commercial Price	Proposed Unit
Price (Base Year)	SLA (3%)	Total Price (Unit Price plus SLA)
Base Year	Proposed Unit
Price (Option Year 1)	SLA (3%)	Total Price (Unit Price plus SLA)
Option Year 1	Proposed Unit
Price (Option Year 2)	SLA (3%)	Total Price (Unit Price plus SLA)
Option Year 2	Proposed Unit
Price (Option Year 3)	SLA (3%)	Total Price (Unit Price plus SLA)
Option Year 3	Proposed Unit
Price (Option Year 4)	SLA (3%)	Total Price (Unit Price plus SLA)
Option Year 4	Total Evaluated Price (with 3% SLA and estimated quantities) - Base Year	Total Evaluated Price (with 3% SLA and estimated quantities) - Opt Year 1	Total Evaluated Price (with 3% SLA and estimated quantities) - Opt Year 2	Total Evaluated Price (with 3% SLA and estimated quantities) - Opt Year 3	Total Evaluated Price (with 3% SLA and estimated quantities) - Opt Year 4	Total Evaluated Price
	1	FGS-0634	Medtronic	Bravo CF Reflux Recorder	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	2	FGS-0306	Medtronic	Bravo Vacuum Pump (110V) Medela brand pump	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	3	FGS-0309	Medtronic	Bravo Vacuum Pump Kit Includes silicone tubing with coupling, 180 cm tubing (no fingertip control), 0.25 L canister, and lid with overflow protection	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	4	ASM-0550-01	Medtronic	Carry Case for BR2 Receiver Case only; straps sold separately USD 31.00	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	5	FGS-0340	Medtronic	Bravo Vacuum Pump Tubes (10-pack)For Medela brand pump	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	6	FGS-0493	Medtronic	Calibration Stand – Bravo/Digitrapper Includes four 2793 tubes (250 mm x 18 mm)	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	7	FGS-0687	Medtronic	Bravo Pump Virus Filters (10-pack)	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	8	FGS-0516	Medtronic	Bravo pH Recorder Straps (5-pack)	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	9	FGS-0656	Medtronic	Reflux Software v6.1 Includes 10 licenses: for use with Bravo Calibration-Free (CF)	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	10	PSP-0023-LF	Medtronic	15W AC-DC Adaptor with Mini USB Plug
Wall charger: plug adapter sold separately	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	11	PSP-0024-LF	Medtronic	Interchangeable AC Plug Kit
Includes EU, UK, Australia, and US adapters	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	12	WIR-0075-LF	Medtronic	USB 1.1 Cable (A Male to B Mini, 1 m) USB cable only	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
				Service/ Labor Only
	13	80263	Medtronic	Reflux Recorder – 1 Year Service Plan
Service Plan Reflux Recorder 1 Year, First Recorder	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	14	80264	Medtronic	Reflux Recorder – 2 Year Service Plan Service Plan Reflux Recorder 2 Year, First Recorder (Bravo or Digitrapper)	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	15	80265	Medtronic	Reflux Recorder – 3 Year Service Plan Service Plan Reflux Recorder 3 Year, First Recorder	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	16	80268	Medtronic	Reflux Recorder – 1 Year Service Plan (Additional Recorder)	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	17	80269	Medtronic	Reflux Recorder – 2 Year Service Plan (Additional Recorder) Service Plan Reflux Recorder 2 Year, Additional Recorder (Bravo or Digitrapper)	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
	18	80270	Medtronic	Reflux Recorder – 3 Year Service Plan (Additional Recorder)	Each	1	20	20	20	20	20										$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0		$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
																																								$ - 0	Total 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.

File details come from the government source that posted it. Updated May 13, 2026.