D.4 TECHNICAL PLAN QUESTIONNAIRE.docx

TECHNICAL PLAN QUESTIONNAIRE

TITLE: VISN 2 SOUTH MEDICAL GASES

SOLICITATION #: 36C24222R0100

SAM UEI #: ____________________

1. About the Company: Please introduce your company and describe your capabilities in providing, filling, transporting, handling, servicing, maintaining, delivering, picking up and storing medical gases and cylinders. Describe your facility and where it is located.

2. Identify Manufacturing Source: Is your firm the manufacturer of the gases required in this solicitation or is your firm authorized by the manufacturer to resell?

2a. If offeror is the manufacturer: provide verification that you hold current licensing, permits, certifications or registrations required by the FDA and the states in which this contract is performed. If offeror is not the manufacturer, skip this question, but be prepared to provide this documentation within 10 days of contract award and annually thereafter.

2b. If offeror is not the manufacturer: provide a copy of the resellers agreement with the manufacturer demonstrating that the offeror has authorization by the manufacturer to resell the medical gases and to rent the medical gas cylinders that the Contractor intends to provide under this contract. If offeror is the manufacturer, skip this question.

3. Identify any Subcontractors Proposed: If offeror proposes utilizing Subcontractors, please identify the firms, POCs and describe the Subcontractor’s functional role(s) in this proposed effort. Describe the Subcontractor’s facility and where it is located.

4. Identify Key Personnel: Identify Prime and Subcontractor personnel proposed for this contract effort (Name, Title, Role, Phone, Email).

5. Summary of Experience: Provide a summary or relevant experience and training certification for each key personnel identified in paragraph 4 above.

6. Other: Provide a copy of the most recent version of the Compressed Gas Association (CGA) publications identified in the Instructions to Offerors of this solicitation.