ATTACHMENT H - CERTIFICATION OF RECALL OR SAFETY ISSUES.pdf
PDF 72 KB Posted
- Attached to
- NX EQ Microwave Therapy Systems Tissue Ablation
- Solicitation number
- 36C10G25R0040
About this file
Attachment H is a certification form for a federal solicitation (36C10G25R0040) for Microwave Therapy Systems Tissue Ablation by the Veterans Health Administration. The form requires companies to certify that their medical equipment: 1) has no outstanding recalls, 2) has no known safety issues, 3) complies with relevant medical equipment regulations and standards, and 4) has been thoroughly checked for safety and performance compliance.
The certification must be completed by an authorized company representative, who signs and dates the document, acknowledging potential disqualification or legal penalties for providing false information. This form is to be submitted alongside a quote for the NX EQ Microwave Therapy Systems Tissue Ablation, which are medical devices designed for thermal ablation of soft tissue and solid organ regions, using microwave frequencies for tissue heating and percutaneous tumor treatment.
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Attachment H Certification of Recall or Safety Issues
Instructions to Quoters:
1. Complete all fields in the certification form.
2. Ensure that the form is signed by an authorized representative of the company.
3. Submit the completed form along with your quote.
Certification of No Outstanding Recalls or Safety Issues Solicitation Number: 36C10G25R0040 Requirement for: NX EQ Microwave Therapy Systems Tissue Ablation
Company Unique Entity Identifier (UEI): __________________________________________
Certification:
By signing below, I, the undersigned, certify on behalf of the company identified by the UEI above, the medical equipment quoted in response to the above-referenced solicitation:
1. Does not have any outstanding recalls.
2. Does not have any known safety issues.
3. Complies with all relevant regulations and standards for medical equipment.
4. Has been thoroughly checked for compliance with safety and performance standards.
I understand that any false or misleading information provided in this certification may result in disqualification from the solicitation process and other penalties as permitted by law.
Authorized Representative:
Name: __________________________________________
Title: __________________________________________
Signature: __________________________________________
Date: __________________________________________
File details come from the government source that posted it. Updated .