Appendix 5-3 GFE 15 Nov 11.xls
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- FA4801-11-R-0002
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PWS Appendix 5-3 GFE 15 Nov 11
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| # | DESCRIPTION OF ITEM | Serial Number | QUANTITY | ACQUISITION COST | TOTAL ACQUISITION COST | CONDITION | COMMENTS DURING INVENTORY |
| Building 15 (49th Medical Group) | |||||||
| 1 | Pulse Oximeter, DynaMed Equipment Control Number (ECN): 5775 | 280368951 | 1 | $ 697.50 | $ 697.50 | Good | |
| 2 | Ambulance Stretcher, Rugged MXPro 500lb Max Load ECN:5869 | 981239128 | 1 | $ 2,261.30 | $ 2,261.30 | Good | |
| 3 | Ambulance Stretcher, Rugged MXPro 500lb Max Load ECN:5868 | 981239126 | 1 | $ 2,261.30 | $ 2,261.30 | Good | |
| 4 | Aspirator, Emergency ECN: 7121 | 78300444708 | 1 | $ 801.67 | $ 801.67 | Great | |
| 5 | Aspirator, Emergency ECN: 6430 | 7860113258 | 1 | $ 801.67 | $ 801.67 | Great | |
| 6 | Propaq Monitoring System ECN: 5437 | DC00443 | 1 | $ 6,862.80 | $ 6,862.80 | Good | |
| 7 | Lifepak 500 BiPhasic Automatic External Defibrillator ECN: 7394 | 30366726 | 1 | $ 2,639.80 | $ 2,639.80 | Great | |
| 8 | Lifepak 500 BiPhasic Automatic External Defibrillator ECN: 7395 | 30366725 | 1 | $ 2,639.80 | $ 2,639.80 | Great | |
| 9 | Xergen Temporal Scanner ECN:7673 | A60809 | 1 | $ 377.39 | $ 377.39 | Good | |
| 10 | Dell Optiplex 755 PC Computer | HYZ2XG1 | 1 | $ 530.00 | $ 530.00 | Great | |
| 11 | Lifepak 15 defibrillator/cardiac monitor | 2 | $ 35,000.00 | $ 70,000.00 | New | ||
| 12 | Fiber Optic Intubation kit | 2 | $ 630.00 | $ 1,260.00 | New | ||
| 13 | HP Compaq dc5750 Microtower PC Computer | MXL7321897 | 1 | $ 530.00 | $ 530.00 | Great | |
| 14 | HP Laser Printer | CNGKK45035 | 1 | $ 250.00 | $ 250.00 | Good | |
| Subtotal for Building 15 | $ 91,913.23 | ||||||
| Fire Station #1 (After hours and Weekends) | |||||||
| 1 | Dell Computer HOLWS49MDGARE2 | 00144-047-958-056 | 1 | $ 530.00 | $ 530.00 | Great | |
| 2 | HP Compaq Computer HOLWS49MDGARE1 | MXL8010B82 | 1 | $ 530.00 | $ 530.00 | Great | |
| Subtotal for Fire Station #1 | $ 1,060.00 | ||||||
| Ambulances (Primary and Alternate) | |||||||
| 1 | Ambulance, Ford 350 XLT Super Duty, VIN 91FDWF37R29EB09280 | License Plate: 09B02456 | 1 | $131,201 | $ 131,201.00 | 2009 Model in Great Shape Mileage on 15 Nov 15118.5 | |
| 2 | Ambulance, Ford 350 XLT Super Duty, VIN 91FDWF36P36FB005404 | License Plate: 06B00238 | 1 | $135,461 | $ 135,461.00 | 2006 Model in Good Shape Mileage on 15 Nov 7975.1 | |
| Subtotal for Ambulances | $ 266,662.00 | ||||||
| TOTAL OF ALL SUBTOTALS ABOVE: | $ 359,635.23 | ||||||
| The following certify the above inventory was taken on the date signed below: | |||||||
| _____________________________ | ______________ | ||||||
| Contractor Representative Signature | Date | ||||||
| Print Name: __________________________________________ | |||||||
| Print Title: ____________________________________________ | |||||||
| ______________________________ | ______________ | ||||||
| Government Representative Signature | Date | ||||||
| Print Name: __________________________________________ | |||||||
| Print Title: ____________________________________________ |
&CAppendix 5-3, GFE 15 Nov 11
As of Date:________________ &"Arial,Italic"&8(should be same as signature dates)&RSolicitation FA4801-11-R-0002&K000000 Ambulance Service &L15 Nov 11&CAppendix 5-3, GFE&RPage &P of &N
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