P09_Statement of Need_SON_Exam Tables ACT Space Center.docx

High-Low Exam Table Statement of Need:

1.0 Purpose: – The Rocky Mountain Regional VA Medical Center has a requirement to purchase (16) Powered High-Low Exam Tables with an authorized vendor to supply, deliver, and install the items identified in Table 1 below. This is a Brand Name or Equal requirement; refer to the salient characteristics below. This requirement is in support of the activation of the Space Center Community Based Outpatient Clinic (CBOC). Brewer is the basis of design Table 1 – Package Item(s) Summary

Color: Blue Fog (32) – PR 46

2.0 Scope of Work: – All items will be shipped directly to the listed in Section 2, Paragraph 2.4.1. The equipment will be shipped in original OEM packaging and will be inspected upon receipt to ensure equipment is free of defect and/or damage. The equipment will ship complete, no partial shipments will be accepted.

2.1 Date of manufacture must not be greater than 2 years before the purchase order date. The equipment must not be used or refurbished and must have the latest manufacturer’s software/hardware updates installed. Any batteries provided with the unit will not be manufactured more than 12 months before the purchase order issue date.

2.2 The vendor will provide all applicable service manuals that includes theory of operation, maintenance requirements, repair information, schematics, part lists and troubleshooting information in electronic format for use by the VA Biomedical Engineering Department.

2.3 The tracking information will be emailed to the following Point of Contact (POC): Miranda Sims, Acquisition Utilization Specialist, Email: Miranda.sims@va.gov

2.4 The shipping label and packing slip will contain the following information for ease of receipt:

2.4.1 Ship To:

a. Activation Space Center

· VA Community-Based Outpatient Clinic (CBOC), 565 Space Center Drive, Suite 130, Colorado Springs, CO 80915

2.4.2 Mark For:

b. Miranda Sims, Voice 720.723.7435, or Govt. Cell 303.476.1463

2.4.3 Contract Number:

2.4.4 Purchase Order:

3.0 Delivery Schedule:

Table 2 – Anticipated Building Outfitting Schedule

3.1 The above delivery schedule listed in Table 2 is based upon the current construction schedule. Due to the nature of activation efforts and construction timelines and dates may vary and shift. Delivery dates need to be flexible. If there is a delay, the Contractor may be required to adjust the delivery date at no cost to the government. The Contractor will coordinate with the on-site POC(s) in Section 3, Paragraph 3.1.1 before delivery and installation.

3.2 The delivery of items identified in this document shall take place during normal business hours which are defined as: 8:00 AM to 4:00 PM MST, Monday through Friday; excluding Federal Holidays.

3.3 Due to the COVID19 situation, the vendor must follow CDC guidelines when on VA property. Any individuals who need to enter the building for installation &/or training may be required to be screened by the site staff prior to entry. Please allow time for this in your schedule.

3.4 Clean Up and Disposal

3.5 Truck with Lift Gate (Yes ☒ No ☐)

3.5 Assembly and Installation Required (Yes ☒ No ☐)

3.6 Training Required (Yes ☐ No ☒)

4.0 Billing & Payment

4.1 The supporting documentation and invoice(s) will be submitted monthly though OB10 (Tungsten) electronic invoice. Subsequent changes or corrections shall be submitted by a separate invoice. In addition to information required for submission of a ‘proper’ invoice in accordance with FAR 52.212-4 (g), all invoices must include the following information:

a. Name and Address of Contractor

b. Contractor’s Tax Identification Number

c. Date of Invoice

d. Invoice Number

e. Contract Number

f. Purchase Order Number

g. Date of Service

h. Contract Line Item Number (CLIN)

i. Description, Quantity, Unit of Measure, Unit Price and Extended Price of the items delivered

j. Total Price

5.0 Confidentiality and Non-Disclosure:

5.1 This equipment does not connect to a VA network. Therefore, in accordance with Appendix A, Handbook 6500.6 Checklist, Block 6, the C&A requirements do not apply to this requirement, and a Security and Accreditation Package in not required.

5.2 This equipment does not hold or store patient information. Therefore, in accordance with Appendix A, Handbook 6500.6 Checklist, Block 7, Appendix B and C provisions do not apply.

6.0 Salient Characteristics

Total Quantity: 16 ☐ Network Required if Checked ☒ Manufacturer Certified Installation Required if Checked ☐ BMET Training Required if Checked ☐ End User Training Required if Checked

Basis of Design is Brewer, MFG P/N: 6801-21

· Power High-Low Exam Table

· Weight Capacity: = or > 700lbs.

· Height Range: = or > 18-37 inches

· Length Range: = or > 57-78 inches

· Leg Extension: = or > 21 inches

· Back Range: = or > 0 (Horizontal) to 85 Degrees

· Includes Front Storage Drawer

· Heated

· Optional Side Drawers That Can Be Open From the Right or Left Side

· Optional Treatment Pan

· Pelvic Tilt: = or > 5 Degrees

· Paper Roll Storage

· Standard Adjustable Ergonomic Stirrups

· Standard Foot Control

· Safety Grab Bar Rotation: = or > 180 Degrees

· Ability to Lay Flat to at least 28 inches

· Ability to Provide 3 Points of Contact During Wheelchair Transfers

· On/Off Switch to Prevent Accidental Movement

· Easy to Clean, Durable Upholstery in a Selection of Colors

· Operating Conditions Temperature Range......................................65° to 85°F Humidity Range............................................10% to 90%

· Transportation and Storage Temperature Range.................................-20°F to 150°F Humidity Range............................................10% to 90%

· Hospital Grade Outlet

· Power Source: 115 VAC, 60 Hz, 9.3 amps max

· Power supplies and motors meet UL60601-1; CAN-CSA C22.2 No. 601.1

· Warranty: = or > 3 Years image1.emf