P09 SOW 25AP4792.docx

STATEMENT OF WORK (SOW)

as of 30/APR/2025

The SOW must have an “as of” date. When SOWs are revised for modifications (after award) each revised SOW will have a new “as of” date.

REMEMBER to delete all italicized text, contained within parentheses herein when completing your SOW.

It is shown here for instructional purposes only and must not remain part of the final document. Requestor fills out red text and Contracting Officer fills out blue text.

Contract Number:

Task Order Number:

Follow-on to Contract and Task Order Number:

1. Contracting Officer’s Representative (COR). Identify the individuals who will act as the COR. COR responsibilities are explained in VA IL xxx dated xxx.

Name:

Section:

Environment of patient

Phone Number:

Fax Number:

E-Mail Address:

2. Contract Title.

Imagine Milling Technologies, LLC (Digital Dentistry)

3. Background.

The VA Northeast Ohio Healthcare System is requesting Digital Dentistry equipment from Imagine Milling Technologies, LLC. for the continued expansion of 3D printing in the healthcare space. These machines, along with the dental specific post processing equipment will be the foundation of establishing and sustaining a Digital Dentistry program for VA Northeast Ohio Healthcare System. This 3D Digital Dentistry program will provide patients with patient matched Digital Dentistry products to include 3D printed monolithic Dentures, Dental Implant Surgical Guides and Occlusal Guards.

The VA Northeast Ohio Healthcare System is expanding its additive manufacturing capabilities to include patient specific Digital Dentistry products to include:

Dentures Dental Implant Surgical Guides Occlusal Guards The requested 3D Printers, dental equipment and post processing machines are essential to implementing and sustaining a Digital Dentistry 3D Printing program for the VA Northeast Ohio Healthcare System which will provide design & manufacturing services o f patient specific 3D printed dental products.

4. Scope.

The VA Northeast Ohio Healthcare System is requesting that the contractor shall provide all resources necessary to accomplish the deliverables described in the statement of work. Technical and operational support should be provided via telephone or video communication. On site installation and training of equipment will not be required.

5. Specific Tasks.

5.1 Task 1:

Deliverables:

6. Performance Monitoring

Performance monitoring will be completed by the COR. COR will be responsible to ensure all work is done in accordance with the award.

7. Security Requirements The contract will not involve sensitive information or contractor/vendor access to VA OIT/computer systems. This equipment will not have access to PHI or PII.

8. Government-Furnished Equipment (GFE)/Government-Furnished Information (GFI).

Not applicable to this request.

9. Other Pertinent Information or Special Considerations.

Not applicable to this request.

a. Identification of Possible Follow-on Work.

Follow-on work is not anticipated.

b. Identification of Potential Conflicts of Interest (COI).

There are no known conflicts of interest related to this request.

c. Identification of Non-Disclosure Requirements.

Not applicable to this request

d. Packaging, Packing and Shipping Instructions.

Louis Stokes Cleveland VA Medical Center ATTN: 3D Print Lab 10701 East Blvd Cleveland, OH 44106

e. Inspection and Acceptance Criteria.

COR, Requestor and warehouse staff will be responsible for all inspection and acceptance criteria related to this request.

10. Risk Control No risk control assessment is required.

11. Place of Performance.

Louis Stokes Cleveland VA Medical Center 3D Print Lab 10701 East Blvd Cleveland, OH 44106

12. Period of Performance.

Delivery schedule/installation will be determined and agreed upon with vendor at the time of award.

13. Delivery Schedule.

Delivery schedule/installation will be determined and agreed upon with vendor at the time of award.