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ATTACHMENT #1: OFFEROR CERTIFICATION WORKSHEET
Please complete this worksheet in its entirety and submit it via email to peter.sorrentino@fema.gov and carolyn.abney@fema.dhs.gov by 2 p.m. local time, Tuesday, August 9, 2011. Submissions received by FEMA after this date will be considered non-responsive and the associated proposal will not be considered for award. Answers without explanation (where prompted) will be considered non-responsive.
Offeror: ______________________________________
| Ref: # |
| Factor |
| Yes |
| No |
| Location in Proposal |
| Explanation (provide in separate document associated using reference #) |
| 1 |
| Cot height is at least 16” without mattress and no more than a height of 19” with mattress. |
| 2 |
| Cot width is at least 30” and no more than 36”. |
| 3 |
| Cot is at least 80” in length. |
| 4 |
| Cot is able to support a minimum of 350 lbs. If yes, provide explanation. |
| 5 |
| Cot has safety rails that provide ease of use for raising, leaning back, lowering onto and lifting off of the cot. If yes, describe the tests conducted that prove the cot meets the SOW standards. |
| 6 |
| Cot head can be elevated to multiple positions, including, but not exceeding, a forty-five degree angle. If yes, provide explanation. |
| 7 |
| Cot has durable locking systems (e.g. latches, brackets) that do not have any sharp edges. If yes, provide explanation. |
| 8 |
| All fitted connections on the cot (slots, edges and tubing ends, etc.) must be capped. If yes, provide explanation |
| 9 |
| Cot has no sharp edges or components in which fingers, toes and other body parts could be caught, torn or otherwise injured. If yes, provide explanation |
| 10 |
| Cot corners and edges are rounded. If yes, provide explanation |
| 11 |
| If coils and/or fabric are used in the construction of the cot, the fabric is durable and the coils and coil ends do not pose a cutting, tearing or pinching hazard. If yes, provide explanation. |
| 12 |
| Cot must allow safe and easy transfer for all users onto and off of the sleeping surface and stable enough to avoid tipping over under normal use. This includes the point of entry (such as the edge of the cot). If yes, describe the tests conducted that prove the cot meets the SOW standards. |
| 13 |
| Cot possesses stable, “anti-tipping” legs that will withstand transfer to and from the cots by all users with mobility disabilities transferring from mobility devices. This includes the point of entry (such as the edge of the cot). If yes, describe the tests conducted that prove the cot meets the SOW standards. |
| 14 |
| Cot frame is fire retardant. If yes, provide explanation. |
| 15 |
| Cot frame and mattress can be sanitized after use. If yes, provide explanation. |
| 16 |
| Cot includes a mattress which fits the cot. |
| 17 |
| Cot mattress is at least two inches thick. |
| 18 |
| Cot mattress is of medium firmness. |
| 19 |
| The mattress can be secured to the cot to prevent falling or slippage. If yes, provide explanation. |
| 20 |
| Mattress (excluding outer shell) is made of foam. |
| 21 |
| Mattress outer shell does not contain latex based products. |
| 22 |
| Mattress (entire) is fire retardant. |
| 23 |
| Mattress (entire) is fully assembled. |
| 24 |
| Mattress outer shell is waterproof. |
| 25 |
| Mattress outer shell is durable. |
| 26 |
| Cot and mattress are resistant to mildew and rust. If yes, provide explanation. |
| 27 |
| Cot and mattress (entire) can withstand use in a temperature range of -20 to 120 degrees Fahrenheit. If yes, describe the tests conducted that prove the cot meets the SOW standards. |
| 28 |
| Offeror provides a commercial warranty for full replacement if product tears, breaks or otherwise fails during normal use within 1 (one) year of purchase. |
| 29 |
| Cot arrives fully assembled with the exception of the safety rails. |
| 30 |
| Complete cot unit can be assembled in ten minutes or less. If yes, describe the tests conducted that prove the cot meets the SOW standards. |
| 31 |
| Complete cot unit weighs no more than 40lbs. |
| 32 |
| Cost must be foldable within the storage dimensions of 40”X 48” X 55” with no overhang. If yes, provide explanation. |
| 33 |
| Offeror can deliver the initial order within thirty days of award. |
| 34 |
| Offeror has a one-time surge capacity to deliver 1,500 cots within 72 hours of delivery order receipt. If yes, provide explanation. |
| 35 |
| Offeror has a prolonged surge capacity to deliver at least 10,000 cots within 30 days. If yes, provide explanation. |
| 36 |
| Offeror can deliver to all of the stated locations. If yes, provide explanation. |
| 37 |
| Product offered complies with the requirements of the Buy American Act (See FAR Part 25). |
| 38 |
| Packaging and marking meets the criteria established in Section D of the RFP. |
| 39 |
| Offeror certifies that the product meets all of the above specifications. |
· Per unit, what percentage of the cot(s) proposed is produced/manufactured in the United States? _________%
