MEARNG Dental Chair Arms and Dental Equipment - PWS.docx
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- MEARNG Dental Chair Arms and Dental Equipment
- Solicitation number
- W912JD26QA020
About this file
This is a Performance Work Statement (PWS) for the Maine Army National Guard (MEARNG) Dental Chair Arms and Dental Equipment installation project. The contractor must procure, deliver, and perform on-site physical installation and integration of specialized dental equipment at the MEARNG Dental Clinic located at 194 Winthrop Street, Camp Keyes, Building 7, Augusta, Maine 04330 during the performance window of September 8-11, 2026. The acquisition comprises twelve line items: CLINs 0001-0004 are designated as Brand Name Only (Midmark) products including ASepsis 21 Continental Radius delivery systems, assistant's delivery systems, HP illumination systems, and fiber optic handpiece tubing that must seamlessly integrate with the Government's existing Midmark Ultratrim dental chairs. CLINs 0005-0012 are Brand Name or Equal items including sterilizers (SciCan Statim G4 5000 or equal), automatic handpiece lubrication systems, apex locators (J. Morita or equal), endodontic motors (J. Morita Tri-Auto ZX2T or equal), and high/low-speed fiber optic handpieces and motors (KaVo or equal).
The contractor's primary responsibilities include performing all necessary installation and integration work to result in two fully assembled, safe, and fully functioning dental workstations ready for immediate clinical patient care; executing comprehensive operational function checks verifying seamless integration, power delivery, and fluid/air routing in accordance with Original Equipment Manufacturer specifications and current dental industry standards; and removing all packaging, shipping materials, and installation debris from the facility for off-site disposal. All work must be performed between 7:30 AM and 4:30 PM, Monday through Friday, excluding recognized U.S. federal holidays. The contractor must furnish all personnel, equipment, tools, materials, supervision, and quality control, maintain a clean work environment, and complete a signed Installation and Function Check Report (Technical Exhibit 3) for submission to the Contracting Officer and Contracting Officer's Representative within two business days of completion. Additional requirements include providing Awareness Training Level 1 and iWATCH training certificates at least 15 calendar days prior to on-site performance, designating a Contract Manager with full authority to act on contract matters, ensuring all employees wear identification badges displaying company name and contractor status, and complying with all installation access, security policies, physical security, and personnel identification verification procedures established by the Department of Defense and local Army policies.
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Other files
| File | Type | Posted |
|---|---|---|
| Room 2 - Chair 2 - Side.jpeg | JPEG file | |
| Solicitation Amendment W912JD26QA0200002 SF 30.pdf | ||
| Room 2 - Chair 2.jpeg | JPEG file | |
| Room 1 - Chair 1.jpeg | JPEG file | |
| Image of SER and MODEL number - Chair 2.jpg | JPG image | |
| Room 2 - Chair 2 - back.jpeg | JPEG file | |
| 1000002034.jpg | JPG image | |
| Image of SER and MODEL number - Chair 1.jpg | JPG image | |
| 1000002032.jpg | JPG image | |
| Chair 2.jpg | JPG image | |
| Room 1 - Chair 1 - front.jpeg | JPEG file | |
| Chair 1.jpg | JPG image | |
| IMG_0765.jpeg | JPEG file | |
| IMG_0758.jpeg | JPEG file | |
| Chair 1 - side .jpg | JPG image | |
| 1000002031.jpg | JPG image | |
| Solicitation Amendment W912JD26QA0200001 SF 30.pdf | ||
| MEANRG Dental Chair Arms and Dental Equipment - Salient Characteristics.docx | DOCX document | |
| MEARNG Dental Chair Arms and Dental Equipment - Brand Name Justification Redacted - 5-18-2026.pdf | ||
| Solicitation - W912JD26QA020.pdf |
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PERFORMANCE WORK STATEMENT (PWS)
FOR
Maine Army National Guard (MEARNG) Dental Chair Arm Installation Services
1.0 General:
1.1 Scope: The contractor must provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform Dental Chair Arm Installation Services, as defined in this PWS.
1.1.1 Objectives. Reserved
1.2 Background: The MEARNG requires specialized dental equipment to support clinic operations. CLINs 0001-0004 are designated as Brand Name Only (Midmark) to ensure seamless physical, mechanical, and electrical integration with the Government’s existing Midmark dental chairs. The remaining items (Items 5-12) are Brand Name or Equal.
1.3 Period of Performance (PoP): The Period of Performance is templated for: 08SEP2026-11SEP2026.
1.4 General Information:
1.4.1 Place and Performance of Services: The contractor must provide services between the hours of 7:30 AM through 4:30 PM on Monday through Friday, except on recognized US holidays or when the Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government-directed facility/installation closings. Performance must be at 194 Winthrop St. Camp Keyes, BLDG 7, Augusta ME 04330. The contractor must at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS when the Government facility/installation is not closed for the above reasons. When hiring personnel, the contractor must keep in mind that the stability and continuity of the work force are essential. Teleworking is not authorized.
1.4.1.1 Telework: Government does not permit the contractor to telework in support of this requirement. In furtherance of Continuity of Operations Planning (COOP), a telework program may be enacted to ensure that the Government's mission-critical operations stay operational during times of national emergency or incidents of national significance.
1.4.1.2 Unscheduled gate closures by the Security Police may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays. Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.
1.4.1.3 The contractor’s employees must become familiar with and obey the regulations of the installation; including fire, traffic, safety and security regulations while on the installation. Contractor employees should only enter restricted areas when required to do so and only upon prior approval. All contractor employees must carry proper identification with them at all times, and shall be subject to such checks as may be deemed necessary. The contractor must ensure compliance with all regulations and orders of the installation, which may affect performance. The Government reserves the right to direct the removal of an employee from Government property or revoke access to Government systems for misconduct, security reasons, or any overt evidence of communicable disease. Removal of contractor employees for reasons stated above does not relieve the Contractor from responsibility for total performance of this contract.
1.4.2 Recognized Holidays: The following are recognized United States (US) holidays. The contractor must not perform services on these days:
1.4.2.1 New Year’s Day: January 1st
1.4.2.2 Martin Luther King, Jr.’s Birthday
1.4.2.3 President’s Day
1.4.2.4 Memorial Day
1.4.2.5 Juneteenth National Independence Day: June 19th
1.4.2.6 Independence Day: July 4th
1.4.2.7 Labor Day
1.4.2.8 Columbus Day
1.4.2.9 Veteran’s Day: November 11th
1.4.2.10 Thanksgiving Day
1.4.2.11 Christmas Day: December 25th
1.4.3 Quality Control (QC): Reserved
1.4.4 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) or defect rate(s).
1.4.5 Installation Access and Security Requirements. The contractor must comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the COR. The contractor and all associated subcontractor employees must provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services, or Security Office. The contractor must ensure compliance with all personal identity verification requirements as directed by Department of Defense (DoD), Headquarters Department of Army (HQDA) and/or local policy (see PWS 6.0). Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.
1.4.5.1 Reserved
1.4.5.2 For contractors that do not require a CAC, but require access to a DoD facility or installation: Contractor and all associated sub-contractors employees must comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification (NCIC-III) and Terrorist Screening Database (TSDB) (Army Directive 2014-05), and applicable installation, facility and area commander installation/facility access, and local security policies and procedures (provided by a Government representative).
1.4.5.3 Awareness Training (AT) Level 1: All contractor employees, including subcontractor employees, requiring access to Army installations, facilities, and controlled access areas must complete AT Level 1 training within 30 calendar days after contract start date and within 30 calendar days of new employees commencing performance. The contractor must submit certificates of completion for each affected contractor and subcontractor employee to the COR prior 15 calendar days before on-site performance begins. AT Level 1 awareness training is available at the following website: https://jko.jten.mil/courses/atl1/launch.html.
1.4.5.4 iWATCH Training: The contractor and all associated subcontractors with an area of performance within an Army-controlled installation, facilities or area must brief all employees on the local iWATCH program (training standards provided by the requiring activity Antiterrorism Officer (ATO)). This local developed training must be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR or the KO. This training must be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance. The contractor must report completion for each contractor employee and subcontractor employee to the COR, 15 calendar days before on-site performance begins.
1.4.5.5 Communications Security/Information Technology (COMSEC/IT) Security. All communications with DoD organizations are subject to COMSEC review. All telephone communications networks are continually subject to intercept by unfriendly intelligence organizations. DoD has authorized the military departments to conduct COMSEC monitoring and recording of telephone calls originating from, or terminating at, DoD organizations. Therefore, the contractor is advised that any time contractor personnel place or receive a call they are subject to COMSEC procedures. The contractor must ensure wide and frequent dissemination of the above information to all employees dealing with DoD information. The contractor must abide by all Government regulations concerning the authorized use of the Government's computer network, including the restriction against using the network to recruit Government personnel or advertise job openings.
1.4.5.6 Reserved
1.4.5.7 Reserved
1.4.5.8 Reserved
1.4.5.9 Reserved
1.4.5.10 Reserved
1.4.5.11 Reserved
1.4.5.12 OPSEC SOP/Plan. Reserved
1.4.5.13 Reserved
1.4.5.14 Reserved
1.4.6 Physical Security. The contractor must safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials must be secured.
1.4.6.1 Key Control. Reserved
1.4.6.2 Lock Combinations: Reserved
1.4.7 Special Qualifications. Reserved
1.4.8 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with FAR 42.5. The KO, COR and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the KO will apprise the contractor of how the Government views the contractor’s performance and the contractor must apprise the Government of problems, if any, being experienced. The contractor must resolve outstanding issues raised by the Government. Contractor attendance at these meetings must be at no additional cost to the Government.
1.4.9 Contract Manager (CM): The contactor must designate a CM who will ensure performance under this contract. The name of this person, and an alternate who will act for the contractor when the CM is absent, must be designated in writing to the KO. The CM or alternate must have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM must work through the COR, to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM must ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM must ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.
1.4.10 Identification of Contractor Employees: All contractor personnel attending meetings, answering Government telephones and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression that they are Government employees. The contractor must ensure that all documents or reports produced by contractor personnel are suitably marked as contractor products or that contractor participation is appropriately disclosed. The contractor’s status as a “contractor” must be predominantly displayed in all correspondence types (to include signature blocks on e-mail) and dealings with Government or non-Government entities. Contractor personnel must wear identification badges distinguishing themselves as such. The badges must have the company name, employee name and the word “contractor” displayed.
1.4.10.1 Reserved
1.4.11. Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees must not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor must notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. The contractor must take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at FAR 22.17.
1.4.12 Contractor Travel. Reserved
1.4.13 Data Rights. Reserved
1.4.14 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor must notify the KO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and must promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO. In the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may impose other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.
1.4.15 Phase In / Phase Out Periods. Reserved
2.0 Definitions and Acronyms:
2.1 Definitions:
2.1.1 Contractor: A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.
2.1.2 Defective Service: A service output that does not meet the standard of performance associated with the PWS.
2.1.3 Deliverable: Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.
2.1.4 Key Personnel: Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.
2.1.5 Physical Security: Actions that prevent the loss or damage of Government property.
2.1.6 Quality Assurance: The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.
2.1.7 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.
2.1.8 Quality Control: All necessary measures taken by the Contractor to ensure that the quality of an end product or service must meet contract requirements.
2.1.9 Subcontractor: One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.
2.2 Acronyms:
| AEI | Army Enterprise Infostructure | |
| AR | Army Regulation | |
| AT/OPSEC | Antiterrorism/Operational Security | |
| BI | Background Investigation | |
| CM | Contract Manager | |
| COR | Contracting Officer Representative | |
| DA | Department of the Army | |
| DD254 | Department of Defense Contract Security Classification Specification | |
| DFARS | Defense Federal Acquisition Regulation Supplement | |
| DoD | Department of Defense | |
| DSCA | Defense Counterintelligence and Security Agency | |
| FAR | Federal Acquisition Regulation | |
| GFP/M/E/S | Government Furnished Property/Material/Equipment/Services | |
| HQDA | Headquarters, Department of the Army | |
| HSPD | Homeland Security Presidential Directive | |
| IA | Information Assurance | |
| IS | Information System(s) | |
| KO | Contracting Officer | |
| NGB | National Guard Bureau | |
| OCI | Organizational Conflict of Interest | |
| PII | Personally Identifiable Information | |
| PIPO | Phase In/Phase Out | |
| POC | Point of Contact | |
| PRS | Performance Requirements Summary | |
| PWS | Performance Work Statement | |
| QA | Quality Assurance | |
| QASP | Quality Assurance Surveillance Plan | |
| QC | Quality Control | |
| QCP | Quality Control Program | |
| SCR | Service Contract Reporting | |
| SSN | Social Security Number | |
| TE | Technical Exhibit | |
| USD(I) | Under Secretary of Defense for Intelligence |
3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S): The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:
3.1 Property: Reserved
3.2 Materials: Reserved
3.3 Equipment: Reserved
3.4 Services: Reserved
3.5 Utilities: All utilities in the facility will be available for the contactor’s use in the performance of this contract. The contractor must instruct employees in utilities conservation practices. The contractor must operate under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount.
4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):
4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor must furnish everything required to perform these services as indicated in Paragraph 1.1.
4.2 Secret Facility Clearance: Reserved
4.3 Contractor Security Clearance: Reserved
5.0 Requirements: The contractor must:
5.1 Task 1: Equipment Installation and Integration
Perform all necessary installation and integration of the provided Midmark Dental Chair Arms and equipment (CLIN 0001-0004) onto the Government’s pre-existing Midmark dental chairs. The contractor must provide all necessary tools, mounting hardware, and labor required for installation. The final end-state of this task must result in two fully assembled, safe, and fully functioning dental workstations/chairs that are immediately ready for clinical patient care.
5.2 Task 2: System Function Check and Quality Assurance
Upon completion of the physical installation, the contractor must execute a comprehensive operational function check of both workstations. Contractor complete Technical Exhibit 3 and submit to KO&COR. This function check must:
· Verify the seamless integration, power delivery, and fluid/air routing between the newly installed delivery systems and the pre-existing chair infrastructure.
· Confirm that all pre-existing chair functions (e.g., articulation, lift mechanisms) remain fully operational and were not degraded during the installation process.
· Ensure the complete, integrated system operates strictly in accordance with Original Equipment Manufacturer (OEM) specifications and current dental industry standards.
5.3 Task 3: Clean-up and Debris Removal
The contractor must maintain a clean and safe work environment during installation. Upon completion of the installation and function checks, the contractor must remove all packaging, shipping materials, and installation debris from the Government facility and dispose of them in accordance with local regulations. On-site military installation dumpsters are not permitted for use in the waste disposal of this contract.
6.0 Applicable Publications: Publications applicable to this PWS are listed below:
Publication (Chapter/Page)
| Date of Publication |
| Mandatory or Advisory |
| Website |
Federal Acquisition Regulation
| Mandatory |
| https://www.acquisition.gov/?q=browsefar |
Defense Federal Acquisition Regulation Supplement
| Mandatory |
| http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html or https://www.acquisition.gov/dfars |
Joint Travel Regulation (JTR)
| Advisory |
| https://www.defensetravel.dod.mil/site/travelreg.cfm |
DoDM 1000.13-M-V1 DoD Identification (ID) Cards (Enclosure 2, paragraph 3.b) 01/23/2014 (Change 1: 07/28/2020)
| Advisory |
| http://www.esd.whs.mil/Directives/issuances/dodm |
Federal Information Processing Standards (FIPS) Publication 201-2 Personal Identity Verification (PIV) of Federal Employees and Contractors (paragraph 9)
| August 2013 |
| Advisory |
| http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201-2.pdf |
| DoDM 5200.2 Procedures for the DoD Personnel Security Program (PSP) |
| 04/03/2017 |
| Advisory |
| https://www.esd.whs.mil/Directives/issuances/dodm/ |
DoDI 5200.46 DoD Investigative and Adjudicative Guidance for Issuing the Common Access Card (CAC) 09/09/14 (Change 1: 05/04/2018)
| Advisory |
| https://www.esd.whs.mil/Directives/issuances/dodi/ |
Homeland Security Presidential Directive (HSPD)-12 Policy for a Common Identification Standard for Federal Employees and Contractors
| 08/27/2004 |
| Advisory |
| https://www.dhs.gov/homeland-security-presidential-directive-12 |
DoDI 5400.11 Department of Defense Privacy and Civil Liberties Programs 01/29/2019
| Advisory |
| https://www.esd.whs.mil/Directives/issuances/dodi/ |
DoD 5400.11-R Department of Defense Privacy Program
| 05/14/2007 |
| Advisory |
| https://www.esd.whs.mil/Directives/issuances/dodm/ |
DoDD 8140.01 Cyberspace Workforce Management
10/05/2020
| Advisory |
| https://www.esd.whs.mil/Directives/issuances/dodd/ |
DoD 8570.01-M Information Assurance Workforce Improvement Program
| 12/19/2005 (Change 4: 11/10/2015) |
| Advisory |
| https://www.esd.whs.mil/Directives/issuances/dodm/ |
DoD 5220.22-M National Industrial Security Program Operating Manual (NISPOM) 02/28/2006 (Change 2: 05/18/2016)
| Advisory |
| https://www.esd.whs.mil/Directives/issuances/dodm/ |
Army Directive 2014-05 Policy and Implementation Procedures for Common Access Card Credentialing and Installation Access for Uncleared Contractors
| 03/07/2014 |
| Advisory |
| https://armypubs.army.mil/ProductMaps/PubForm/ArmyDir.aspx |
AR 25-2
Information Assurance 04/04/2019
| Advisory |
| http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx |
AR 530-1
Operations Security
| 09/26/2014 |
| Advisory |
| http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx |
AR 525-13
Antiterrorism
| 12/09/2019 |
| Mandatory |
| http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx |
6.1 Applicable Forms: Forms applicable to the PWS are listed below:
| Form |
| Date |
| Website |
DD 1172-2
Application for Identification Card/DEERS Enrollment
| Mar 2017 |
| http://www.dtic.mil/whs/directives/forms/index.htm |
I-9 Employment Eligibility Verification 10/21/2019 https://www.uscis.gov/sites/default/files/files/form/i-9.pdf
DD 441
Department of Defense Security Agreement Feb 2020 http://www.dtic.mil/whs/directives/forms/dd/ddforms0001-0499.htm
DD 250
Material Inspection and Receiving Report
| Aug 2000 |
| https://www.esd.whs.mil/Directives/forms/dd0001_0499/ |
TECHNICAL EXHIBIT 1
Performance Requirements Summary (PRS)
This PRS includes performance objectives the Government will use to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).
| Performance Objective |
| Performance Standard |
| Acceptable Quality Levels (AQL) |
| Surveillance Method / By Whom |
| 5.1 Task 1: Equipment Installation and Integration |
| Equipment is physically mounted and integrated without damaging existing Government property. Workstations are fully assembled. |
| Zero incidents of damage to existing equipment. 100% complete assembly. |
| 100% Visual Inspection by the Government Point of Contact (COR/End User). |
| 5.2 Task 2: System Function Check and Quality Assurance |
| Newly installed and pre-existing equipment operate together flawlessly, meeting OEM and industry standards. |
| 100% pass rate on operational checks (water, air, power, and chair movement) prior to contractor departure. |
| Demonstration / Function Check observed by the Government Point of Contact / COR |
| 5.3 Task 3: Clean-up and Debris Removal |
| Clinic footprint is returned to a clean, usable state with all refuse removed. |
| Zero packaging materials or debris left behind. |
| 100% Visual Inspection. |
TECHNICAL EXHIBIT 2
Deliverables Schedule
| PWS Reference / Deliverable Title |
| Frequency |
| Number of Copies |
| Medium/Format |
| Submit To |
| 1.4.5.3 AT Level 1 Awareness Training Certificates |
| Provide within 15 calendar days prior to on-site performance. |
| 1 |
| Electronic Submission |
| COR |
1.4.5.4 iWATCH Training Certificates
| Provide within 15 calendar days prior to on-site performance. |
| 1 |
| Electronic Submission |
| COR |
| 1.4.10 Identification Media |
| Return within 14 days of employee’s departure from contract performance. |
| Original(s) |
| Hard Copy |
| KO |
| 1.4.9 Contract Manager |
| Within 7 Calander days of award. |
| 1 |
| Electronic Submission |
| COR&KO |
| 5.2 Installation and Function Check Sign off report (T.E. 3) |
| Upon completion of task 2, prior to departure. |
| 1 |
| Electronic/Hard Copy |
| COR&KO |
TECHNICAL EXHIBIT 3
MEARNG Dental Clinic Equipment Installation & Function Check Report Instructions: This form must be completed, signed, and dated by the Contractor’s Lead Installer upon the completion of all tasks under the contract. A copy of the signed form must be submitted to the Contracting Officer (KO) and COR within 2 business days of completion and attached to the Wide Area Workflow (WAWF) receiving report for invoicing.
Part I: Contract & Facility Administration
| Administrative Field |
| Contract / Facility Details |
| Contract Number |
| W912JD-26-P-XXXX (To be populated at award) |
Contractor Name
Lead Installer Name & Title
| Performance Location |
| 194 Winthrop St., Camp Keyes BLDG 7, Augusta, Maine 04333 (Dental Clinic) |
Date of Installation
Part II: Delivered & Installed Equipment Verification The contractor has delivered and integrated/installed the following items in accordance with PWS Section 5.1 (Task 1):
| CLIN |
| Description of Equipment (populated at award) |
| QTY (EA) |
| Installed (Y/N) |
| Serial Number(s) |
| Initials |
Part III: Functional Check & Quality Assurance (PWS Section 5.2 / Task 2) The contractor has successfully performed operational function checks and verified integration with the pre-existing Midmark Ultratrim Dental Chairs as follows:
| System/Operational Check |
| Verification Standard |
| Pass (Y/N) |
| Remarks/Measurements |
| Water Line & Pressure Routing |
| Syringe and handpiece water spray lines are verified leak-free; fluid pressure is adjusted to OEM specified PSI. |
| Air Line & Pressure Routing |
| Drive air and chip air line routing is leak-free and adjusted to OEM specified operating PSI. |
| Electrical & Illumination Integration |
| Handpiece fiber optic illumination systems (Items 3, 4, 9, 10, 11) power on, dim, and operate correctly upon foot control depression. |
| Delivery Arm Articulation & Articulation Clearance |
| Continental Radius arm and assistant's arm articulate smoothly through their entire range of motion without binding, drifting, or catching. |
| Existing Chair Function Verification |
| Pre-existing Midmark Ultratrim chairs maintain full range of motion, articulation, and height adjustment without umbilical line interference. |
| Autoclave Setup & Test Run |
| Scican Statim G4 5000 is powered on, water reservoir filled with distilled water, and a standard test cycle completed with "Cycle Passed" output. |
| Lubrication System Compatibility Check |
| Automatic lubrication system is verified compatible with JMorita and Kavo handpieces and operates standard purging cycle correctly. |
| Clean-up & Refuse Removal (PWS 5.3) |
| Footprint is returned to a clean state. All wood crates, cardboard boxes, and packing materials are removed from the facility by the contractor. |
Part IV: Contractor Certification I certify that the equipment listed in Part II has been physically installed, integrated, and functionally tested to the Original Equipment Manufacturer (OEM) specifications. All work has been completed in accordance with the contract terms, and the facility has been left in a clean and safe operating condition.
· Contract Lead Installer Signature:____________________
· Printed Name & Title: ____________________
· Date: ________________
Ver. October 2022
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