N68908-16-T-0033.pdf

NAVAL HOSPITAL CAMP LEJEUNE

RECEIVING OFFICER

100 BREWSTER BLVD.

CAMP LEJEUNE NC 28547

TEL: 910-450-4836 FAX: 910-450-4922

N6809316RC04558

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER) 1

PAGE OF PAGES

1. REQUEST NO. 2. DATE ISSUED RATING

N68908-16-T-0033 24-Feb-2016 5a. ISSUED BY

8. TO: NAME AND ADDRESS, INCLUDING ZIP CODE

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 services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this

Request for Quotations 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) (f)

SEE SCHEDULE

AMOUNT

% No. %

NOTE: Additional provisions and representations [ ] are [ ] are not attached.

13. NAME AND ADDRESS OF QUOTER (Street, City, County, State, and ZIP Code)

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

15. DATE OF

QUOTATION

16. NAME AND TITLE OF SIGNER (Type or print) (Include area code)

TELEPHONE NO.

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 18 (REV. 6-95)

PREVIOUS EDITION NOT USABLE Prescribed by GSA FAR (48 CFR) 53.215-1(a)

THIS RFQ X[ ] IS [ ] IS NOT A SMALL BUSINESS SET-ASIDE

6. DELIVER BY (Date)

SEE SCHEDULE

AND/OR DMS REG. 1

UNDER BDSA REG. 2

4. CERT. FOR NAT. DEF.3. REQUISITION/PURCHASE

REQUEST NO.

NAVY MEDICINE EAST

ATTN: LYNN LOVEJOY

SUITE 1400

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708-2106

9. DESTINATION (Consignee and address, including ZIP Code)

7. DELIVERY

[ ]X FOB

DESTINATION

[ ] OTHER

(See Schedule)

05-Mar-2016(Date)

PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5a ON OR BEFORE CLOSE OF BUSINESS:10.

757-953-7920LYNN V. LOVEJOY

(Name and Telephone no.) (No collect calls)5b. FOR INFORMATION CALL:

d. CALENDAR DAYSc. 30 CALENDAR DAYSb. 20 CALENDAR DAYS12. DISCOUNT FOR PROMPT PAYMENT a. 10 CALENDAR DAYS

N68908-16-T-0033

Section A - Solicitation/Contract Form

CLAUSES INCORPORATED BY FULL TEXT

TIN:

CAGE:

DUNS:

Vendor Point of Contact:

Phone:

Vendor email:

Billing/Payment in Arrears.

Navy Medicine East Regional Acquisition POC: Lynn Lovejoy Phone: 757-953-7324 Fax: 757-953-0361 Email: lynn.v.lovejoy.civ@mail.mil

Product/Services for:

Naval Hospital Camp Lejeune POC: Melissa Carpenter Phone: 910-450-4497 Email: melissa.g.carpenter.civ@mail.mil

Vendor to reference RFQ number N68908-16-T-0033 on all inquiries.

Reference:

PROMPT PAYMENT

For Prompt Payment Act Purposes, this contract is:

Subject to the 7-calender day constructive acceptance period.

Section B - Supplies or Services and Prices

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 15 Each

10 25-872-09-91 MAXDRIVE MINI SCREW,

FFP

10 25-872-09-91 MAXDRIVE MINI SCREW, 2 . OMM: X

9MM, TI-6AL-4V TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment , and Supplies

FOB: Destination

MILSTRIP: N6809316RC04558

PURCHASE REQUEST NUMBER: N6809316RC04558

NET AMT

0002 20 Each

25-872-17-91 MAXDRIVE MINI SCREW

FFP

25-872-17-91 MAXDRIVE MINI SCREW, 2.0MMx

17MM:, TI- 6AL-4V TITANIUM

ALLOY

Psc, 6515 - Medical and Surgical Instruments, Equipment , and Supplies

FOB: Destination

0003 10 Each

25-872-19-91 MAXDRIVE MINI SCREW

FFP

25-872-19-91 MAXDRIVE MINI SCREW, 2.0MM X

19MM, TI-6AL-4V

TITANIUM ALLOY

PSC• 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0004 25 Each

25-879-07-91 DRILL-FREE MAXDRIVE MINI

FFP

25-879-07-91 DRILL-FREE MAXDRIVE MINI SCRRW I 2 .OMM x 7MM, TI-6AL-4V

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0005 25 Each

25-879-05-91 DRILL-FREE MAXDRIVE MINI

FFP

25-879-05-91 DRILL-FREE MAXDRIVE MINI SCREW, 2.0MM X 5MM,

TI-6AL-4V

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0006 25 Each

25-878-07-91 DRILL-FREE MAXDRIVE MICRO

FFP

25-878-07-91 DRILL-FREE MAXDRIVE MICRO SCREW, 1.5MM X 7MM,

TI-6AL-4V

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0007 25 Each

25-878-05-91 DRILL-FREE MAXDRIVE MICRO

FFP

25-878-05-91 DRILL-FREE MAXDRIVE MICRO SCREW, 1.5MM X 5MM,

TI-6AL-4V

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0008 10 Each 25-875-11-91 MAXDRIVE MICRO SCRE·w, FFP

25-875-11-91 MAXDRIVE MICRO SCRE·w, 1.5MM x 11MM, TI-6AL-4V TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0009 25 Each

25-878-04-91 DRILL-FREE MAXDRIVE MICRO

FFP

25-878-04-91 DRILL-FREE MAXDRIVE MICRO SCREW, 1.5MM X 4MM,

TI-6AL-4V

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0010 10 Each

25-875-13-91 MAXDRIVE MICRO SCREW,

FFP

25-875-13-91 MAXDRIVE MICRO SCREW, 1.5M.M: x 13MM:, TI-6AL-4V TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0011 10 Each 25-875-15-91 MAXDRIVE MICRO SCRE·w, FFP

25-875-15-91 MAXDRIVE MICRO SCRE·w, 1. 5MM x 15MM, TI-6AL-4V TITANIIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0012 10 Each

25-875-17-91 MAXDRIVE MICRO SCREW,

FFP

25-875-17-91 MAXDRIVE MICRO SCREW, 1.5MM x 17MM,TI-6AL-4V

TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0013 5 Each

25-875-19-91 MAXDRIVE MICRO SCREW,

FFP

25-875-19-91 MAXDRIVE MICRO SCREW, 1.5MM x 19MM, TI-6AL-4V TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0014 10 Each

25-876-04-91 DRILL-FREE MAXDRIVE MICRO

FFP

25-876-04-91 DRILL-FREE MAXDRIVE MICRO EMERGENCY SCREW,

l.8MM x 4MM, TI-6AL-4V TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0015 10 Each

25-876-05-91 DRILL-FREE MAXDRIVE MICRO

FFP

25-876-05-91 DRILL-FREE MAXDRIVE MICRO EMERGENCY SCREW,

l.8MM x 5MM, TI-6AL-4V TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0016 10 Each

25-876-07-91 DRILL-FREE MAXDRIVE MICRO

FFP

25-876-07-91 DRILL-FREE MAXDRIVE MICROEMERGENCY SCREW,

l.8MM x 7MM, TI-6AL-4V TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0017 2 Each

50-301-03-09 SMITH GENIOPLASTY PLATE, 3M

FFP

50-301-03-09 SMITH GENIOPLASTY PLATE, 3MM, 2.0MM SYSTEM, CP

TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0018 2 Each

50-301-05-09 SMITH GENIOPLASTY PLATE, 5M

FFP

50-301-05-09 SMITH GENIOPLASTY PLATE, 5MM,

2.0MM SYSTEM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0019 2 Each

50-301-07-09 SMITH GENIOPLASTY PLATE, 7M

FFP

50-301-07-09 SMITH GENIOPLASTY PLATE, 7MM,

2.0MM SYSTEM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0020 2 Each

50-301-09-09 SMITH GENIOPLASTY PLATE, 9M

FFP

50-301-09-09 SMITH GENIOPLASTY PLATE, 9MM,

2.0MM SYSTEM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0021 2 Each

50-301-11-09 SMITH GENIOPLASTY PLATE,

FFP

50-301-11-09 SMITH GENIOPLASTY PLATE, 11MM,

2.0MM SYSTEM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0022 2 Each

00-104-19-09 GRIFFIN MODIFIED LINDORF

FFP

00-104-19-09 GRIFFIN MODIFIED LINDORF

CHIN PLATE, 3MM, 2.OMM: SYSTEM,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments,Equipment, and Supplies

FOB: Destination

0023 2 Each

00-104-20-09 GRIFFIN MODIFIED LINDORF

FFP

00-104-20-09 GRIFFIN MODIFIED LINDORF

CHIN PLATE, 5MM, 2.0MM SYSTEM,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0024 2 Each

00-104-21-09 GRIFFIN MODIFIED LINDORF

FFP

00-104-21-09 GRIFFIN MODIFIED LINDORF

CHIN PLATE, 7M.M, 2.OMM SYSTEM,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0025 2 Each

00-104-22-09 GRIFFIN MODIFIED LINDORF

FFP

00-104-22-09 GRIFFIN MODIFIED LINDORF

CHIN PLATE, 9MM, 2.0MM SYSTEM,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0026 2 Each

50-304-02-09 CHIN PLATE, DOUBLE Y,

FFP

50-304-02-09 CHIN PLATE, DOUBLE Y, 2MM,

ARNETT STY, O.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0027 2 Each

50-304-03-09 CHIN PLATE, DOUBLE Y,

FFP

50-304-03-09 CHIN PLATE, DOUBLE Y, 3MM,

ARNETT STY, 0.8MM, CP TITANIUM:

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0028 2 Each

50-304-04-09 CHIN PLATE, DOUBLE Y,

FFP

50-304-04-09 CHIN PLATE, DOUBLE Y, 4MM,

ARNETT STY, O.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0029 2 Each

50-304-06-09 CHIN PLATE, DOUBLE Y,

FFP

50-304-06-09 CHIN PLATE, DOUBLE Y, 6MM,

ARNETT STY, 0.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0030 2 Each

50-304-08-09 CHIN PLATE, DOUBLE Y,

FFP

50-304-08-09 CHIN PLATE, DOUBLE Y, 8MM:,

ARNETT STY, 0 .BMM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0031 2 Each

50-304-10-09 CHIN PLATE, DOUBLE Y,

FFP

50-304-10-09 CHIN PLATE, DOUBLE Y, lOMM:, ARNETT STY, 0.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0032 2 Each

25-399-26-09 PLATE, 2.0MM SYS,

FFP

25-399-26-09 PLATE, 2.0MM SYS, MINI,ARNETT,

T-SHAPE, 4 HOLE, SMALL,

T=O .8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0033 2 Each

25-399-32-09 PLATE, 2.0MM SYS,

FFP

25-399-32-09 PLATE, 2.0MM SYS, MINI,ARNETT,

T-SHAPE, 4 HOLE, MEDIUM, T=O.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0034 2 Each

25-399-37-09 PLATE, 2.0NM SYS,

FFP

25-399-37-09 PLATE, 2.0NM SYS, MINI,ARNETT,

T-SHAPE, 4 HOLE, LARGE,

T=l.OMM, CP TITANIUM Psc, 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0035 2 Each

25-396-29-09 PLATE, 2.0MM SYS,

FFP

25-396-29-09 PLATE, 2.0MM SYS, MINI,ARNETT,

STRAIGHT, lMM MARKS, 4 HOLE, SMALL, T=l.OMM, CP TITANIUM Psc, 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0036 2 Each

25-396-34-09 PLATE, 2.0MM SYS,

FFP

25-396-34-09 PLATE, 2.0MM SYS, MINI,ARNETT,

STRAIGHT, lMM MARKS, 4 HOLE, MEDIUM, T=l.OMM, CP TITANIUM Psc, 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0037 2 Each

25-396-39-09 PLATE, 2 .OM1•!SYS,

FFP

25-396-39-09 PLATE, 2 .OM1•!SYS, MINI,ARNETT,

STRAIGHT, lMM MARKS, 4 HOLE, ARGE, T=l.OMM, CP TITANIUM PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0038 2 Each

25-396-44-09 PLATE, 2.0MM SYS,

FFP

25-396-44-09 PLATE, 2.0MM SYS, MINI I ARNETT I

STRAIGHT, lMM MARKS, 4 HOLE, EXTRA LARGE, T=l.OMM CP TITANIUM PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0039 2 Each

25-396-56-09 PLATE, 2.0MM SYS,

FFP

25-396-56-09 PLATE, 2.0MM SYS, MINI,ARNETT,

STRAIGHT, lMM, MARKS, 6 HOLE, EXTRA LARGE, T=l.OMM, CP TITAN PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0040 10 Each

01-473-70-07 TWIST DRILL,

FFP

01-473-70-07 TWIST DRILL, MORRISON/ KLSMARTIN,

l.5MMX105MM, W/NOTCH SAGITTAL SPLIT,FOR LEVl TROCAR PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0041 5 Each

25-449-16-91 TWIST DRILL,

FFP

25-449-16-91 TWIST DRILL, 1.5MM DIA X 50MM,

20MM STOP

·w/NOTCH, SINGLE USE ONLY PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0042 5 Each 25-449-05-91 Tl'WIST DRILL, FFP

25-449-05-91 TlWIST DRILL, l.5MM DIA X 50MM, 5MM STOP, W/NOTCH, SINGLE USE ONLY

PSC: 6515 - Medical and Surgical Instruments,Equipment, and Supplies

FOB: Destination

0043 5 Each

25-469-11-07 TWIST DRILL,

FFP

25-469-11-07 TWIST DRILL, l.5MM DIA X 115MM

W/NOTCH,

SINGLE USE ONLY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0044 5 Each

25-452-00-91 T'WIST DRILL,

FFP

25-452-00-91 TWIST DRILL, 1.lMM DIA X 50MM, W/NOTCH, SINGLE USE ONLY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0045 5 Each 25-452-05-91 TlWIST DRILL, FFP

25-452-05-91 TlWIST DRILL, l.lMM DIA X 50MM, 5MM STOP, W/NOTCH, SINGLE USE ONLY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0046 4 Each

25-397-27-09 PLATE,

FFP

25-397-27-09 PLATE, 2.0MM SYS, MINI,ARNETT,

L-SHAPE, 4 HOLE, SMALL,

T=O.BMM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0047 4 Each

25-397-31-09 PLATE,

FFP

25-397-31-09 PLATE, 2.0MM SYS, MINI,ARNETT,

L-SHAPE, 4 HOLE, MEDIUM,

TO.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0048 4 Each

25-397-35-09 PLATE,

FFP

25-397-35-09 PLATE, 2.0MM SYS, MINI,ARNETT,

L-SHAPE, 4 HOLE, LARGE,

T=0.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0049 4 Each

25-397-39-09 PLATE,

FFP

25-397-39-09 PLATE, 2.0MM SYS, MINI,ARNETT,

L-SHAPE, 4 HOLE, EXTRA LARGE,

T=l.OMM, CP TITANIUM PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0050 4 Each

25-398-27-09 PLATE,

FFP

25-398-27-09 PLATE, 2.0MM SYS, MINI,ARNETT,

C-SHAPE, 4 HOLE, SMALL,

T=O.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0051 4 Each

25-398-31-09 PLATE,

FFP

25-398-31-09 PLATE, 2.0MM SYS, MINI,ARNETT,

C-SHAPE, 4 HOLE, MEDIUM,

T=0.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0052 4 Each

25-398-35-09 PLATE,

FFP

25-398-35-09 PLATE, 2.0MM SYS, MINI,ARNETT,C-SHAPE, 4 HOLE,

LARGE,

T=0.8MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0053 4 Each

25-398-39-09 PLATE,

FFP

25-398-39-09 PLATE, 2.0MM SYS, MINI,ARNETT,

C-SHAPE, 4 HOLE, EXTRA LARGE,

T=l.OMM, CP TITANIUM PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0054 5 Each

50-379-04-91 LP PLATE,

FFP

50-379-04-91 LP PLATE, L-SHAPE, RIGHT,

LONG, 0.6MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0055 5 Each

50-386-06-91 LP PLATE,

FFP

50-386-06-91 LP PLATE, T-SHAPE,

90* REGULAR, 0.6MM

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0056 5 Each

50-381-04-91 LP PLATE,

FFP

50-381-04-91 LP PLATE, L-SHAPE, LEFT, LONG,

0.6MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0057 5 Each

50-375-04-91 LP PLATE,

FFP

50-375-04-91 LP PLATE, L-SHAPE, RIGHT,

MEDIUM, 0.6MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0058 4 Each

50-390-05-91 LP PLATE,

FFP

50-390-05-91 LP PLATE, Y-SHAPE,

REGULAR, 0.6MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0059 5 Each

50-377-04-91 LP PLATE,

FFP

50-377-04-91 LP PLATE, L-SHAPE, LEFT,

MEDiill•1, 0.6MM, CP TITANIUM PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0060 4 Each

50-368-16-91 LP PLATE,

FFP

50-368-16-91 LP PLATE, STRAIGHT, 16 HOLE,

REGULAR, 0.6MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0061 4 Each

50-409-04-91 LP PLATE,

FFP

50-409-04-91 LP PLATE, Z-SHAPE, RIGHT,

LONG, 0.6MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0062 4 Each

50-408-04-91 LP PLATE,

FFP

50-408-04-91 LP PLATE, Z-SHAPE, LEFT, LONG,

0 .6MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0063 5 Each

50-396-06-91 LP PLATE,

FFP

50-396-06-91 LP PLATE, DOUBLE Y-SHAPE,REGULAR, 0.6MM, CP

TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0064 4 Each

25-550-08-91 MINI PLATE,

FFP

25-550-08-91 MINI PLATE, 8 HOLE REGULAR, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0065 5 Each

25-552-04-91 MINI PLATE,

FFP

25-552-04-91 MINI PLATE, 4 HOLE LONG,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0066 4 Each

25-550-04-91 MINI PLATE,

FFP

25-550-04-91 MINI PLATE, 4 HOLE REGULAR, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0067 4 Each

50-405-17-09 LO PLATE,

FFP

50-405-17-09 LO PLATE, STRAIGHT, 20 HOLE,

1.OMM, 2.0 TRAlUMA SYSTEM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0068 4 Each

50-407-09-09 LO PLATE,

FFP

50-407-09-09 LO PLATE, L-SHAPE, LEFT,

9 HOLES, .70MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0069 4 Each

50-407-07-09 LO PLATE,

FFP

50-407-07-09 LO PLATE, L-SHAPE, LEFT,

7 HOLES, .70MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0070 4 Each

50-383-05-09 LO PLATE,

FFP

50-383-05-09 LO PLATE, L-SHAPE, LEFT,

5 HOLES, .7OMM, CP TITANIUM

PSC: 6515 - M.edical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0071 4 Each

50-381-05-09 LO PLATE,

FFP

50-381-05-09 LO PLATE, L-SHAPE, RIGHT,

5 HOLES, .70MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0072 4 Each

50-405-07-09 LO PLATE,

FFP

50-405-07-09 LO PLATE, L-SHAPE, RIGHT,

7 HOLES, ,70MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0073 4 Each

50-405-09-09 LO PLATE,

FFP

50-405-09-09 LO PLATE, L-SHAPE, RIGHT,

9 HOLES, .70MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0074 4 Each

25-315-85-91 MICRO PLATE,

FFP

25-315-85-91 MICRO PLATE, L-SHAPE, 100*, RIGHT, LONG, 3X2, CP

TITANIUM

PSC: 6515 - M:edical and Surgical Instruments,Equipment, and Supplies

FOB: Destination

0075 4 Each

25-311-70-91 MICRO PLATE,

FFP

25-311-70-91 MICRO PLATE, L-SHAPE, RIGHT,

MEDIIUM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0076 4 Each

25-326-55-91 MICRO PLATE,

FFP

25-326-55-91 MICRO PLATE, X-SHAPE, REGULAR,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0077 4 Each

25-310-70-91 MICRO PLATE,

FFP

25-310-70-91 MICRO PLATE, L-SHAPE, LEFT,

MEDIIUM, CP TITANIIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0078 4 Each

25-314-85-91 MICRO PLATE,

FFP

25-314-85-91 MICRO PLATE, L-SHAPE, 100*,

LEFT, LONG, 3X2, CP TITANIIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0079 4 Each

25-311-85-91 MICRO PLATE,

FFP

25-311-85-91 MICRO PLATE, L-SHAPE, RIGHT,

LONG, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0080 4 Each

25-315-06-91 MICRO PLATE,

FFP

25-315-06-91 MICRO PLATE, T-SHAPE, REGULAR,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0081 4 Each

25-310-85-91 MICRO PLATE,

FFP

25-310-85-91 MICRO PLATE, L-SHAPE, LEFT,

LONG, CP TITANIIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0082 4 Each

25-320-70-91 MICRO PLATE,

FFP

25-320-70-91 MICRO PLATE, Y-SHAPE, LONG,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0083 4 Each

25-322-55-91 MICRO PLATE,

FFP

25-322-55-91 MICRO PLATE, DOUBLE Y-SHAPE,

SHORT, CP TITANIIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0084 5 Each

25-304-00-91 MICRO PLATE,

FFP

25-304-00-91 MICRO PLATE, STRAIGHT, 4 HOLE,

CP TITANiIUM PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0085 5 Each

25-304-55-91 MICRO PLATE,

FFP

25-304-55-91 MICRO PLATE, STRAIGHT, 4 HOLE,

SHORT, CP TITANIUM

PSC: 6515 - Medic'al and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0086 4 Each

25-306-00-91 MICRO PLATE,

FFP

25-306-00-91 MICRO PLATE, STRAIGHT, 6 HOLE,CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0087 4 Each

25-306-55-91 MICRO PLATE,

FFP

25-306-55-91 MICRO PLATE, STRAIGHT, 6 HOLE,

SHORT, CP TITANlUM PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0088 4 Each

25-308-00-91 MICRO PLATE,

FFP

25-308-00-91 MICRO PLATE, STRAIGHT, 8 HOLE,

REGULAR, CP TITANIIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0089 4 Each

25-316-00-91 MICRO PLATE,

FFP

25-316-00-91 MICRO PLATE, STRAIGHT,16 HOLE,

CP TITANIIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0090 6 Each

25-330-85-91 MICRO PLATE,

FFP

25-330-85-91 MICRO PLATE, L-SHAPE, 100*,

LEFT, LONG, 3 X 3, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0091 6 Each

25-331-85-91 MICRO PLATE,

FFP

25-331-85-91 MICRO PLATE, L-SHAPE, 100*,

RIGHT, LONG, 3 X 3,

CP TITANIIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0092 4 Each

25-330-24-09 MICRO PLATE,

FFP

25-330-24-09 MICRO PLATE, STRAIGHT,

24 HOLE, 1.5 TRAUMA SYSTEM,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0093 4 Each

50-322-04-09 MINI PLATE,

FFP

50-322-04-09 MINI PLATE, RIGID BLUE,

4 HOLE, LONG, TI-6AL-4V

TITANIUM. ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0094 4 Each

50-330-06-09 MINI PLATE,

FFP

50-330-06-09 MINI PLATE, SAGITTAL, RIGID

BLUE, 6 HOLE, CURVED, MEDIUM,

TI-6AL-4V TITANIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0095 4 Each

50-331-06-09 MINI PLATE,

FFP

50-331-06-09 MINI PLATE, SAGITTAL, RIGID

BLUE, 6 HOLE, CURVED, LONG,

TI-6AL-4V TITANIIUM ALLOY

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0096 4 Each

50-332-06-09 MINI PLATE,

FFP

50-332-06-09 MINI PLATE, SAGITTAL, RIGID

BLUE, 6 HOLE, CURVED, EX-LONG,

TI-6AL-4V TITANIUM ALLOY PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

0097 4 Each

01-100-36-09 MODIFIED,

FFP

01-100-36-09 MODIFIED, RIGID BLUE, SAGITTAL

PLATE, CURVED, 6 TRI SHAPED

HOLES, 25MM LONG, TI-6AL-4V

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0098 4 Each

01-200-36-09 MINI PLATE,

FFP

01-200-36-09 MINI PLATE,SAGITTAL,RI GID BLUE

CURVED,6 TRI SHAPED HOLES,24MM

LONG, lOMM BTW HOLES TI-6AL-4V PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0099 4 Each

01-200-37-09 MINI PLATE,

FFP

01-200-37-09 MINI PLATE,SAGITTAL,RIGI D BLUE

CURVED,6 TRI SHAPED HOLES,28MM

LONG, 14MM BTW HOLES TI-6AL-4V

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0100 4 Each

50-282-00-09 LINDORF LEFORT ONE MICRO

FFP

50-282-00-09 LINDORF LEFORT ONE MICRO

PLATE, RIGHT, FLAT,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0101 4 Each

50-282-03-09 LINDORF LEFORT ONE MICRO

FFP

50-282-03-09 LINDORF LEFORT ONE MICRO

PLATE, RIGHT, 3MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0102 4 Each

50-282-05-09 LINDORF LEFORT ONE MICRO

FFP

50-282-05-09 LINDORF LEFORT ONE MICRO

PLATE, RIGHT, 5MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0103 4 Each

50-282-07-09 LINDORF LEFORT ONE MICRO

FFP

50-282-07-09 LINDORF LEFORT ONE MICRO

PLATE RIGHT, 7MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0104 4 Each

50-282-09-09 LINDORF LEFORT ONE MICRO

FFP

50-282-09-09 LINDORF LEFORT ONE MICRO

PLATE, RIGHT, 9MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0105 4 Each

50-282-11-09 LINDORF LEFORT ONE MICRO

FFP

50-282-11-09 LINDORF LEFORT ONE MICRO

PLATE, RIGHT, 11MM,

CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0106 4 Each

50-280-00-09 LINDORF LEFORT ONE MICRO

FFP

50-280-00-09 LINDORF LEFORT ONE MICRO

PLATE, LEFT, FLAT, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0107 4 Each

50 -280-03-0 9 LINDORF LEFORT ONE MICR

FFP

50 -280-03-0 9 LINDORF LEFORT ONE MICRO

PLATE, LEFT, 3MM, CP TITANIUM

PSC: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

FOB: Destination

0108 4 Each

50-280-05-0 9 LINDORF LEFORT ONE MICRO

FFP

50-280-05-0 9 LINDORF LEFORT ONE MICRO

PLATE, LEFT, 5MM, CP TITANIUM

PSC: 6515 - Medical and surgical Instruments, Equipment, and Supplies

FOB: Destination

0109 4 Each

50 -280 -07-09 LINDORF LEFORT ONE MICRO

FFP

50 -280 -07-09 LINDORF LEFORT ONE MICRO

PLATE, LEFT, 7MM, CP TITANIUM

PSC: 6515 - Medical and surgical Instruments, Equipment, and Supplies

FOB: Destination

0110 4 Each

50-280-09-09 LINDORF LEFORT ONE MICRO

FFP

50-280-09-09 LINDORF LEFORT ONE MICRO

PLATE, LEFT, 9MM, CP TITANIUM

PSC: 6515 - Medical and surgical Instruments, Equipment, and Supplies

FOB: Destination

0111 4 Each

50-280-11-09 LINDORF LEFORT ONE MICRO

FFP

50-280-11-09 LINDORF LEFORT ONE MICRO PLATE, LEFT, llMM, CP

TITANIUM

PSC: 6515 - Medical and surgical Instruments, Equipment, and Supplies

FOB: Destination

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government 0002 Destination Government Destination Government 0003 Destination Government Destination Government 0004 Destination Government Destination Government 0005 Destination Government Destination Government 0006 Destination Government Destination Government 0007 Destination Government Destination Government 0008 Destination Government Destination Government 0009 Destination Government Destination Government 0010 Destination Government Destination Government 0011 Destination Government Destination Government 0012 Destination Government Destination Government 0013 Destination Government Destination Government 0014 Destination Government Destination Government 0015 Destination Government Destination Government 0016 Destination Government Destination Government 0017 Destination Government Destination Government 0018 Destination Government Destination Government 0019 Destination Government Destination Government 0020 Destination Government Destination Government 0021 Destination Government Destination Government 0022 Destination Government Destination Government 0023 Destination Government Destination Government 0024 Destination Government Destination Government 0025 Destination Government Destination Government 0026 Destination Government Destination Government 0027 Destination Government Destination Government 0028 Destination Government Destination Government 0029 Destination Government Destination Government 0030 Destination Government Destination Government 0031 Destination Government Destination Government 0032 Destination Government Destination Government 0033 Destination Government Destination Government 0034 Destination Government Destination Government 0035 Destination Government Destination Government 0036 Destination Government Destination Government 0037 Destination Government Destination Government 0038 Destination Government Destination Government 0039 Destination Government Destination Government 0040 Destination Government Destination Government 0041 Destination Government Destination Government 0042 Destination Government Destination Government 0043 Destination Government Destination Government 0044 Destination Government Destination Government

0045 Destination Government Destination Government 0046 Destination Government Destination Government 0047 Destination Government Destination Government 0048 Destination Government Destination Government 0049 Destination Government Destination Government 0050 Destination Government Destination Government 0051 Destination Government Destination Government 0052 Destination Government Destination Government 0053 Destination Government Destination Government 0054 Destination Government Destination Government 0055 Destination Government Destination Government 0056 Destination Government Destination Government 0057 Destination Government Destination Government 0058 Destination Government Destination Government 0059 Destination Government Destination Government 0060 Destination Government Destination Government 0061 Destination Government Destination Government 0062 Destination Government Destination Government 0063 Destination Government Destination Government 0064 Destination Government Destination Government 0065 Destination Government Destination Government 0066 Destination Government Destination Government 0067 Destination Government Destination Government 0068 Destination Government Destination Government 0069 Destination Government Destination Government 0070 Destination Government Destination Government 0071 Destination Government Destination Government 0072 Destination Government Destination Government 0073 Destination Government Destination Government 0074 Destination Government Destination Government 0075 Destination Government Destination Government 0076 Destination Government Destination Government 0077 Destination Government Destination Government 0078 Destination Government Destination Government 0079 Destination Government Destination Government 0080 Destination Government Destination Government 0081 Destination Government Destination Government 0082 Destination Government Destination Government 0083 Destination Government Destination Government 0084 Destination Government Destination Government 0085 Destination Government Destination Government 0086 Destination Government Destination Government 0087 Destination Government Destination Government 0088 Destination Government Destination Government 0089 Destination Government Destination Government 0090 Destination Government Destination Government 0091 Destination Government Destination Government 0092 Destination Government Destination Government 0093 Destination Government Destination Government 0094 Destination Government Destination Government 0095 Destination Government Destination Government 0096 Destination Government Destination Government 0097 Destination Government Destination Government 0098 Destination Government Destination Government 0099 Destination Government Destination Government

0100 Destination Government Destination Government 0101 Destination Government Destination Government 0102 Destination Government Destination Government 0103 Destination Government Destination Government 0104 Destination Government Destination Government 0105 Destination Government Destination Government 0106 Destination Government Destination Government 0107 Destination Government Destination Government 0108 Destination Government Destination Government 0109 Destination Government Destination Government 0110 Destination Government Destination Government 0111 Destination Government Destination Government

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0001 31-MAR-2016 15 NAVAL HOSPITAL CAMP LEJEUNE

RECEIVING OFFICER

100 BREWSTER BLVD.

CAMP LEJEUNE NC 28547

910-450-4836

N68093

0002 N/A N/A N/A N/A

0003 N/A N/A N/A N/A

0004 N/A N/A N/A N/A

0005 N/A N/A N/A N/A

0006 N/A N/A N/A N/A

0007 N/A N/A N/A N/A

0008 N/A N/A N/A N/A

0009 N/A N/A N/A N/A

0010 N/A N/A N/A N/A

0011 N/A N/A N/A N/A

0012 N/A N/A N/A N/A

0013 N/A N/A N/A N/A

0014 N/A N/A N/A N/A

0015 N/A N/A N/A N/A

0016 N/A N/A N/A N/A

0017 N/A N/A N/A N/A

0018 N/A N/A N/A N/A

0019 N/A N/A N/A N/A

0020 N/A N/A N/A N/A

0021 N/A N/A N/A N/A

0022 N/A N/A N/A N/A

0023 N/A N/A N/A N/A

0024 N/A N/A N/A N/A

0025 N/A N/A N/A N/A

0026 N/A N/A N/A N/A

0027 N/A N/A N/A N/A

0028 N/A N/A N/A N/A

0029 N/A N/A N/A N/A

0030 N/A N/A N/A N/A

0031 N/A N/A N/A N/A

0032 N/A N/A N/A N/A

0033 N/A N/A N/A N/A

0034 N/A N/A N/A N/A

0035 N/A N/A N/A N/A

0036 N/A N/A N/A N/A

0037 N/A N/A N/A N/A

0038 N/A N/A N/A N/A

0039 N/A N/A N/A N/A

0040 N/A N/A N/A N/A

0041 N/A N/A N/A N/A

0042 N/A N/A N/A N/A

0043 N/A N/A N/A N/A

0044 N/A N/A N/A N/A

0045 N/A N/A N/A N/A

0046 N/A N/A N/A N/A

0047 N/A N/A N/A N/A

0048 N/A N/A N/A N/A

0049 N/A N/A N/A N/A

0050 N/A N/A N/A N/A

0051 N/A N/A N/A N/A

0052 N/A N/A N/A N/A

0053 N/A N/A N/A N/A

0054 N/A N/A N/A N/A

0055 N/A N/A N/A N/A

0056 N/A N/A N/A N/A

0057 N/A N/A N/A N/A

0058 N/A N/A N/A N/A

0059 N/A N/A N/A N/A

0060 N/A N/A N/A N/A

0061 N/A N/A N/A N/A

0062 N/A N/A N/A N/A

0063 N/A N/A N/A N/A

0064 N/A N/A N/A N/A

0065 N/A N/A N/A N/A

0066 N/A N/A N/A N/A

0067 N/A N/A N/A N/A

0068 N/A N/A N/A N/A

0069 N/A N/A N/A N/A

0070 N/A N/A N/A N/A

0071 N/A N/A N/A N/A

0072 N/A N/A N/A N/A

0073 N/A N/A N/A N/A

0074 N/A N/A N/A N/A

0075 N/A N/A N/A N/A

0076 N/A N/A N/A N/A

0077 N/A N/A N/A N/A

0078 N/A N/A N/A N/A

0079 N/A N/A N/A N/A

0080 N/A N/A N/A N/A

0081 N/A N/A N/A N/A

0082 N/A N/A N/A N/A

0083 N/A N/A N/A N/A

0084 N/A N/A N/A N/A

0085 N/A N/A N/A N/A

0086 N/A N/A N/A N/A

0087 N/A N/A N/A N/A

0088 N/A N/A N/A N/A

0089 N/A N/A N/A N/A

0090 N/A N/A N/A N/A

0091 N/A N/A N/A N/A

0092 N/A N/A N/A N/A

0093 N/A N/A N/A N/A

0094 N/A N/A N/A N/A

0095 N/A N/A N/A N/A

0096 N/A N/A N/A N/A

0097 N/A N/A N/A N/A

0098 N/A N/A N/A N/A

0099 N/A N/A N/A N/A

0100 N/A N/A N/A N/A

0101 N/A N/A N/A N/A

0102 N/A N/A N/A N/A

0103 N/A N/A N/A N/A

0104 N/A N/A N/A N/A

0105 N/A N/A N/A N/A

0106 N/A N/A N/A N/A

0107 N/A N/A N/A N/A

0108 N/A N/A N/A N/A

0109 N/A N/A N/A N/A

0110 N/A N/A N/A N/A

0111 N/A N/A N/A N/A

CLAUSES INCORPORATED BY REFERENCE

52.242-15 Stop-Work Order AUG 1989 52.242-17 Government Delay Of Work APR 1984 52.247-34 F.O.B. Destination NOV 1991

52.211-17 DELIVERY OF EXCESS QUANTITIES (SEP 1989)

The Contractor is responsible for the delivery of each item quantity within allowable variations, if any. If the Contractor delivers and the Government receives quantities of any item in excess of the quantity called for (after considering any allowable variation in quantity), such excess quantities will be treated as being delivered for the convenience of the Contractor. The Government may retain such excess quantities up to $250 in value without compensating the Contractor therefor, and the Contractor waives all right, title, or interests therein. Quantities in excess of $250 will, at the option of the Government, either be returned at the Contractor's expense or retained and paid for by the Government at the contract unit price.

Section G - Contract Administration Data

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (MAY 2013)

(a) Definitions. As used in this clause--

Department of Defense Activity Address Code (DoDAAC) is a six position code that uniquely identifies a unit, activity, or organization.

Document type means the type of payment request or receiving report available for creation in Wide Area WorkFlow (WAWF).

Local processing office (LPO) is the office responsible for payment certification when payment certification is done external to the entitlement system.

(b) Electronic invoicing. The WAWF system is the method to electronically process vendor payment requests and receiving reports, as authorized by DFARS 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) WAWF access. To access WAWF, the Contractor shall--

(1) Have a designated electronic business point of contact in the System for Award Management at https://www.acquisition.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this Web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site before submitting payment requests through WAWF. Both can be accessed by selecting the “Web Based Training” link on the WAWF home page at https://wawf.eb.mil/.

(e) WAWF methods of document submission. Document submissions may be via Web entry, Electronic Data Interchange, or File Transfer Protocol.

(f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order:

(1) Document type. The Contractor shall use the following document type(s).

(Contracting Officer: Insert applicable document type(s). Note: If a “Combo” document type is identified but not supportable by the Contractor's business systems, an “Invoice” (stand-alone) and “Receiving Report” (stand-alone) document type may be used instead.)

(2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in WAWF, as specified by the contracting officer.

(Contracting Officer: Insert inspection and acceptance locations or “Not applicable”.)

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table* Field Name in WAWF Data to be entered in WAWF Pay Official DoDAAC ____ Issue By DoDAAC ____ Admin DoDAAC ____ Inspect By DoDAAC ____ Ship To Code ____ Ship From Code ____ Mark For Code ____ Service Approver (DoDAAC) ____ Service Acceptor (DoDAAC) ____ Accept at Other DoDAAC ____ LPO DoDAAC ____ DCAA Auditor DoDAAC ____ Other DoDAAC(s) ____

(*Contracting Officer: Insert applicable DoDAAC information or “See schedule” if multiple ship to/acceptance locations apply, or “Not applicable.”)

(4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back-up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request.

(5) WAWF email notifications. The Contractor shall enter the email address identified below in the “Send Additional Email Notifications” field of WAWF once a document is submitted in the system.

(Contracting Officer: Insert applicable email addresses or “Not applicable.”)

(g) WAWF point of contact. (1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact.

(Contracting Officer: Insert applicable information or “Not applicable.”)

(2) For technical WAWF help, contact the WAWF helpdesk at 866-618-5988.

(End of clause)

Section H - Special Contract Requirements

PRIVACY AND SECURITY OF PROTECTED HEALTH INFORMATION

1. Introduction

In accordance with DoD 6025.18-R “Department of Defense Health Information Privacy Regulation,” January 24, 2003, the Business Associate meets the definition of Business Associate. Therefore, a Business Associate Agreement is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security regulations. This clause serves as that agreement whereby the Business Associate agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in this clause, and in DoD 6025.18-R and DoD 8580.02-R, as amended. Additional requirements will be addressed when implemented.

a. Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DoD 6025.18-R or DoD 8580.02-R.

(1) HITECH Act shall mean the Health Information Technology for Economic and Clinical Health Act included in the American Recovery and Reinvestment Act of 2009.

(2) Individual has the same meaning as the term “individual” in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

(3) Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

(4) Protected Health Information has the same meaning as the term “protected health information” in 45 CFR 160.103, limited to the information created or received by the Business Associate from or on behalf of the Government pursuant to the Contract.

(5) Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

(6) Required by Law has the same meaning as the term “required by law” in 45 CFR 164.103.

(7) Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

(8) Security Incident will have the same meaning as the term “security incident” in 45 CFR 164.304, limited to the information created or received by Business Associate from or on behalf of Covered Entity.

(9) Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160, 162 and part 164, subpart C.

(10) Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45 CFR 160.103, 160.502, 164.103, 164.304, and 164.501.

b. The Business Associate shall not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

c. The Business Associate shall use appropriate safeguards to maintain the privacy of the Protected Health Information and to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

d. The HIPAA Security administrative, physical, and technical safeguards in 45 CFR 164.308, 164.310, and 164.312, and the requirements for policies and procedures and documentation in 45 CFR 164.316 shall apply to Business Associate. The additional requirements of Title XIII of the HITECH Act that relate to the security and that are made applicable with respect to covered entities shall also be applicable to Business Associate. The Business Associate agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

e. The Business Associate shall, at their own expense, take action to mitigate, to the extent practicable, any harmful effect that is known to the Business Associate of a use or disclosure of Protected Health Information by the Business Associate in violation of the requirements of this Clause. These mitigation actions will include as a minimum those listed in the TMA Breach Notification Standard Operating Procedure (SOP), which is available at:

http://www.tricare.mil/tmaprivacy/breach.cfm

f. The Business Associate shall report to the Government any security incident involving protected health information of which it becomes aware.

g. The Business Associate shall report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Business Associate becomes aware.

h. The Business Associate shall ensure that any agent, including a sub Business Associate, to whom it provides Protected Health Information received from, or created or received by the Business Associate, on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Business Associate with respect to such information.

i. The Business Associate shall ensure that any agent, including a subBusiness Associate, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

j. The Business Associate shall provide access, at the request of the Government, and in the time and manner reasonably designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

k. The Business Associate shall make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government, and in the time and manner reasonably designated by the Government.

l. The Business Associate shall make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Business Associate, on behalf of the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner reasonably designated by the Government or the Secretary, for purposes of the Secretary determining the Government’s compliance with the Privacy Rule.

m. The Business Associate shall document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

n. The Business Associate shall provide to the Government or an Individual, in time and manner reasonably designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

2. General Use and Disclosure Provisions

Except as otherwise limited in this Clause, the Business Associate may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, the HIPAA Security Rule, DoD 6025.18-R or DoD 8580.02-R if done by the Government. The additional requirements of Title XIII of the HITECH Act that relate to privacy and that are made applicable with respect to covered entities shall also be applicable to Business Associate.

3. Specific Use and Disclosure Provisions

a. Except as otherwise limited in this Clause, the Business Associate may use Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate.

b. Except as otherwise limited in this Clause, the Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate, provided that disclosures are required by law, or the Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

c. Except as otherwise limited in this Clause, the Business Associate may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

d. Business Associate may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

4. Obligations of the Government

Provisions for the Government to Inform the Business Associate of Privacy Practices and Restrictions

a. The Government shall provide the Business Associate with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520.

b. The Government shall provide the Business Associate with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Business Associate’s permitted or required uses and disclosures.

c. The Government shall notify the Business Associate of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

5. Permissible Requests by the Government

The Government shall not request the Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, the HIPAA Security Rule, or any applicable Government regulations (including without limitation, DoD 6025.18-R and DoD 8580.02-R) if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Business Associate as otherwise permitted by this clause.

6. Termination

a. Termination. A breach by the Business Associate of this clause, may subject the Business Associate to termination under any applicable default or termination provision of this Contract.

b. Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Business Associate shall return or destroy all Protected Health Information received from the Government, or created or received by the Business Associate on behalf of the Government. This provision shall apply to Protected Health Information that agents of the Business Associate may come in contact. The Business Associate shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the Business Associate determines that returning or destroying the Protected Health Information is infeasible, the Business Associate shall provide to the Government notification of the conditions that make return or destruction infeasible.