DJD-17-Q-0147_NARCAN_(Naloxone_Hcl)(correction)v2.pdf
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- Attached to
- NARCAN (Naloxone Hcl)
- Solicitation number
- DJD-17-Q-0147
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RFQ Corrected Version 2
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REQUEST FOR QUOTATION
(THIS IS NOT AN ORDER) THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDEX
1. REQUEST NO.
DJD-17-Q-0147
2. DATE ISSUED
08/16/2017
3. REQUISITION/PURCHASE REQUEST NO.
D-17-HO-0328
4. CERT. FOR NAT. DEF.
UNDER BDSA REG. 2
AND/OR DMS REG. 1
RATING
DEA
Attn: Office of Acq & Relo Mgmt (FA) 8701 Morrissette Drive Springfield, VA 22152
5a. ISSUED BY 6. DELIVER BY (Date) See Lines
7. DELIVERY
OTHER
(See Schedule)X FOB DESTINATION
9. DESTINATION
5b. FOR INFORMATION CALL (NO COLLECT CALLS) a. NAME OF CONSIGNEE
DEA
NAME
Teresa Delgado
TELEPHONE NUMBER
AREA CODE NUMBER
Ext.:
8. TO:
Attn: Office of Forensic Sciences (SS) 8701 Morrissette Drive
b. STREET ADDRESS
c. CITY
Springfield
a. NAME b. COMPANY
c. STREET ADDRESS
d. CITY e. STATE f. ZIP CODE d. STATE
VA
e. ZIP CODE
22152
10. PLEASE FURNISH QUOTATIONS TO THE
ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS (Date)
08/25/2017 17:00:00
IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or service. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotation must be completed by the quoter.
11. SCHEDULE (Include applicable Federal, State and local taxes)
ITEM NO.
(a)
SUPPLIES/SERVICES
(b)
QUANTITY
(c)
UNIT
(d)
UNIT PRICE
(e)
AMOUNT
(f)
Attached please find the RFQ Guidelines;
Clauses; and Blanket Purchase Agreement
Note: Per RFQ, Questions should be sent via email to: teresa.a.roshau-delgado@usdoj.gov
See Continuation Sheet(s)
12. DISCOUNT FOR PROMPT PAYMENT
a. 10 CALENDAR DAYS (%)
0.00 %
b. 20 CALENDAR DAYS (%)
0.00 %
c. 30 CALENDAR DAYS (%)
0.00 %
d. CALENDAR DAYS
NUMBER
PERCENTAGE
0.00 NOTE: Additional provisions and representations [ ] are [ X ] are not attached.
13. NAME AND ADDRESS OF QUOTER 14. SIGNATURE OF PERSON AUTHORIZED TO SIGN
QUOTATION
15. DATE OF
QUOTATION
a. NAME OF QUOTER
b. STREET ADDRESS 16. SIGNER
a. NAME (Type or print) b. TELEPHONE
c. COUNTY AREA CODE
d. CITY e. STATE f. ZIP CODE c. TITLE (Type or print) NUMBER
AUTHORIZED FOR LOCAL REPRODUCTION
Previous edition not usable
STANDARD FORM 18 (REV. 6-95)
Prescribed by GSA-FAR (48 CFR) 53.215-1(a)
DJD-17-Q-0147 Page 1 of 6
Section 2 - Commodity or Services Schedule
SCHEDULE OF SUPPLIES/SERVICES
CONTINUATION SHEET
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
0001 NARCAN (Naloxone Hcl) 4mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2017 - 09/29/2018
0.000000 EA $____________ $___________________
0002 NARCAN (Naloxone Hcl) 2mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2017 - 09/29/2018
0.000000 EA $____________ $___________________
0003 NARCAN (Naloxone Hcl) 2mg Pre-Filled Syringe- 1ea
Line Period of Performance: 09/30/2017 - 09/29/2018
0.000000 EA $____________ $___________________
0004 NARCAN (Naloxone Hcl) KIT Kit Contains:
*(QTY: 1)Neoprene Accessory Pouch, black, zipper closure and carabineer clip. 5"W x 3"H *(QTY: 2) IMS3369/ Naloxone l mg/ mL 2mL Needleless PFS (Narcan) *(QTY: 2) WTMAD300/ Nasal Atomization Device w/o 3cc Syringe *(QTY: 1)MDI70-150/ Shield CPR Microshield *(QTY: 1)RU123128/ Nasal Airway 28FR *(QTY: 1)837168/ Surgical Lubricant Packet *(QTY: 1)KC55083/ Purple Nitrile Gloves, Large, pair
Line Period of Performance: 09/30/2017 - 09/29/2018
0.000000 EA $____________ $___________________
0005 NARCAN (Naloxone Hcl) 4mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2018 - 09/29/2019
0.000000 EA $____________ $___________________
0006 NARCAN (Naloxone Hcl) 2mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2018 - 09/29/2019
0.000000 EA $____________ $___________________
0007 NARCAN (Naloxone Hcl) 2mg Pre-Filled Syringe- 1ea
Line Period of Performance: 09/30/2018 - 09/29/2019
0.000000 EA $____________ $___________________
0008 NARCAN (Naloxone Hcl) KIT Kit Contains:
*(QTY: 1)Neoprene Accessory Pouch, black, zipper closure and carabineer clip. 5"W x 3"H *(QTY: 2) IMS3369/ Naloxone l mg/ mL 2mL Needleless PFS (Narcan) *(QTY: 2) WTMAD300/ Nasal Atomization Device w/o 3cc Syringe *(QTY: 1)MDI70-150/ Shield CPR Microshield *(QTY: 1)RU123128/ Nasal Airway 28FR *(QTY: 1)837168/ Surgical Lubricant Packet *(QTY: 1)KC55083/ Purple Nitrile Gloves, Large, pair
Line Period of Performance: 09/30/2018 - 09/29/2019
0.000000 EA $____________ $___________________
0009 NARCAN (Naloxone Hcl) 4mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2019 - 09/29/2020
0.000000 EA $____________ $___________________
0010 NARCAN (Naloxone Hcl) 2mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2019 - 09/29/2020
0.000000 EA $____________ $___________________
0011 NARCAN (Naloxone Hcl) 2mg Pre-Filled Syringe- 1ea
Line Period of Performance: 09/30/2019 - 09/29/2020
0.000000 EA $____________ $___________________
0012 NARCAN (Naloxone Hcl) KIT Kit Contains:
Syringe
*(QTY: 1)Neoprene Accessory Pouch, black, zipper closure and carabineer clip. 5"W x 3"H *(QTY: 2) IMS3369/ Naloxone l mg/ mL 2mL Needleless PFS (Narcan) *(QTY: 2) WTMAD300/ Nasal Atomization Device w/o 3cc Syringe
0.000000 EA $____________ $___________________
DJD-17-Q-0147 Page 2 of 6
*(QTY: 1)MDI70-150/ Shield CPR Microshield *(QTY: 1)RU123128/ Nasal Airway 28FR *(QTY: 1)837168/ Surgical Lubricant Packet *(QTY: 1)KC55083/ Purple Nitrile Gloves, Large, pair
Line Period of Performance: 09/30/2019 - 09/29/2020
0013 NARCAN (Naloxone Hcl) 4mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2020 - 09/29/2021
0.000000 EA $____________ $___________________
0014 NARCAN (Naloxone Hcl) 2mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2020 - 09/29/2021
0.000000 EA $____________ $___________________
0015 NARCAN (Naloxone Hcl) 2mg Pre-Filled Syringe- 1ea
Line Period of Performance: 09/30/2020 - 09/29/2021
0.000000 EA $____________ $___________________
0016 NARCAN (Naloxone Hcl) KIT Kit Contains:
*(QTY: 1)Neoprene Accessory Pouch, black, zipper closure and carabineer clip. 5"W x 3"H *(QTY: 2) IMS3369/ Naloxone l mg/ mL 2mL Needleless PFS (Narcan) *(QTY: 2) WTMAD300/ Nasal Atomization Device w/o 3cc Syringe *(QTY: 1)MDI70-150/ Shield CPR Microshield *(QTY: 1)RU123128/ Nasal Airway 28FR *(QTY: 1)837168/ Surgical Lubricant Packet *(QTY: 1)KC55083/ Purple Nitrile Gloves, Large, pair
Line Period of Performance: 09/30/2020 - 09/29/2021
0.000000 EA $____________ $___________________
0017 NARCAN (Naloxone Hcl) 4mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2021 - 09/29/2022
0.000000 EA $____________ $___________________
0018 NARCAN (Naloxone Hcl) 2mg Nasal Spray - 2pk
Line Period of Performance: 09/30/2021 - 09/29/2022
0.000000 EA $____________ $___________________
0019 NARCAN (Naloxone Hcl) 2mg Pre-Filled Syringe- 1ea
Line Period of Performance: 09/30/2021 - 09/29/2022
0.000000 EA $____________ $___________________
0020 NARCAN (Naloxone Hcl) KIT Kit Contains:
*(QTY: 1)Neoprene Accessory Pouch, black, zipper closure and carabineer clip. 5"W x 3"H *(QTY: 2) IMS3369/ Naloxone l mg/ mL 2mL Needleless PFS (Narcan) *(QTY: 2) WTMAD300/ Nasal Atomization Device w/o 3cc Syringe *(QTY: 1)MDI70-150/ Shield CPR Microshield *(QTY: 1)RU123128/ Nasal Airway 28FR *(QTY: 1)837168/ Surgical Lubricant Packet *(QTY: 1)KC55083/ Purple Nitrile Gloves, Large, pair
Line Period of Performance: 09/30/2021 - 09/29/2022
0.000000 EA $____________ $___________________
DJD-17-Q-0147 Page 3 of 6
Section 3 - Contract Clauses
This Section Is Intentionally Left Blank
DJD-17-Q-0147 Page 4 of 6
Section 4 - List of Attachments
Identifier Title Number of Pages
1 DEA-19, split info, quote 2 TRU Patient Svcs Quote 3 NARCAN Mountainside Medical quote 4 NARCAN - Adapt quote
DJD-17-Q-0147 Page 5 of 6
Section 5 - Solicitation Provisions
This Section Is Intentionally Left Blank
DJD-17-Q-0147 Page 6 of 6
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