PPE Source Questionnaire Nitrile Gloves.docx

PPE Source Questionnaire

The purpose of this document is to ascertain information necessary to execute an award with your company, if you are not able to adequately respond to each item herein, the process will stop and no further consideration will be given to your company regarding a potential contract. Please complete all fields below and provide attachments with the response to support your responses below.

1. Company legal name, address, point of contact information

2. Has your company done business with the Federal government previously? If yes, please provide contract number for reference

3. Company DUNS

4. Cage Code

5. Are you registered in System for Award Management (SAM)? If so, are there any exclusions? Link below:

https://www.sam.gov/SAM/pages/public/samStatusTracker.jsf

6. Any proposed payment terms (Is any money needed up front? Standard Federal payment terms are NET30)

7. Any unique terms and conditions being proposed

8. Product being proposed, with product literature attached to response

9. Confirmation the product being proposed is not gray market or counterfeit in accordance with Veterans Affairs Acquisition Regulation Clause 852.212-72 below.

852.212-72 Gray Market and Counterfeit Items (MAR 2020) (DEVIATION)

GRAY MARKET AND COUNTERFEIT ITEMS (MAR 2020)

(a) No used, refurbished, or remanufactured supplies or equipment/parts shall be provided. This procurement is for new Original Equipment Manufacturer (OEM) items only. No gray market items shall be provided. Gray market items are OEM goods intentionally or unintentionally sold outside an authorized sales territory or sold by non-authorized dealers in an authorized sales territory.

(b) No counterfeit supplies or equipment/parts shall be provided. Counterfeit items include unlawful or unauthorized reproductions, substitutions, or alterations that have been mismarked, misidentified, or otherwise misrepresented to be an authentic, unmodified item from the original manufacturer, or a source with the express written authority of the original manufacturer or current design activity, including an authorized aftermarket manufacturer. Unlawful or unauthorized substitutions include used items represented as new, or the false identification of grade, serial number, lot number, date code, or performance characteristics.

(c) Vendor shall be an OEM, authorized dealer, authorized distributor or authorized reseller for the proposed equipment/system, verified by an authorization letter or other documents from the OEM. All software licensing, warranty and service associated with the equipment/system shall be in accordance with the OEM terms and conditions.

10. FDA, ASTIM, AMMI NIOSH Certifications, if applicable

11. Where are products being manufactured?

12. If already produced, where is product located now?

13. Quantity on hand

14. Estimated shipping and delivery information.

· Shipping terms (FOB Origin or Destination)

15. Price per unit

16. Any discounts for bulk purchase?

17. Provide summary of logistics chain (i.e. they are buying from the manufacture or are they buying from another wholesaler/importer and reselling again (how many hand exchanges before delivery)

18. Recent (during COVID19) experience providing this specific product to the Federal government and/or US hospital. If so, provide contract number and Government POC name and contact information.