ATTACHMENT H - CERTIFICATION OF RECALL OR SAFETY ISSUES - NX EQ Workstations_Medical_PACS.pdf
PDF 72 KB Posted
- Attached to
- NX EQ Workstations Medical PACS
- Solicitation number
- 36C10G25R0043
About this file
Attachment H is a certification form for a federal solicitation (36C10G25R0043) for NX EQ Workstations Medical PACS issued by the Veterans Health Administration. The form requires vendors to certify that their medical equipment: 1) has no outstanding recalls, 2) has no known safety issues, 3) complies with all relevant medical equipment regulations and standards, and 4) has been thoroughly checked for safety and performance standards. The form must be completed, signed by an authorized company representative, and submitted with the quote.
The form contains blank fields for the Company Unique Entity Identifier (UEI), the authorized representative's name, title, signature, and date. The document warns that providing false or misleading information may result in disqualification from the solicitation and potential legal penalties. This certification is part of a larger solicitation for medical workstations designed to process and store digital medical imaging data across VA medical centers, with a base 12-month contract period and four potential 12-month option periods.
View the file
Other files
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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: 36C10G25R0043 Requirement for: NX EQ Workstations Medical PACS
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 .