S02 - Attachment D.2 - Facility Locations.xlsx

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Attached to
6835--VISN 16 - Medical Gases
Solicitation number
36C77626Q0016
Issued by

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Written by GovTribe AI ·

This is a facility locations attachment for a Request for Quotation (RFQ) for medical gases supply to Department of Veterans Affairs facilities within the VISN 16 catchment area (Solicitation Number 36C77626Q0016).

The document is a template spreadsheet designed to collect detailed information about multiple VA medical facility locations that will receive medical gas deliveries. For each facility, the template requires vendors to provide or confirm: facility name and type (Main hospital, CBOC, Vet Center, or Research Facility); complete address including city, state, and zip code; whether cylinders are VA-owned or contractor-owned with current vendor identification; current bulk oxygen tank ownership, size of main and reserve tanks, and tank age; delivery schedule with specific days and times for each location; facility access requirements and point of contact information; main hospital square footage; and sales tax exemption documentation. The spreadsheet also requests identification of any VA-owned medical gases (carbon, oxygen, etc.) at each site. Contact information is directed to Tanya.Kuza@va.gov for VA-owned cylinder information. This attachment serves as the foundational data collection tool to establish baseline conditions and operational parameters across all VISN 16 facilities before vendors submit quotations for the medical gas supply contract due April 21, 2026, at 1:00 PM Central Time.

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File Type Posted
S06 - 36C77626Q0016 0003.pdf PDF
36C77626Q0016 0003_1.docx DOCX document
S06 - 36C77626Q0016 0002.pdf PDF
36C77626Q0016 0002_1.docx DOCX document
S06 - 36C77626Q0016 0001.pdf PDF
36C77626Q0016 0001_1.docx DOCX document
S02 - Attachment D.1 - Schedule of Items.xlsx XLSX spreadsheet
36C77626Q0016_1.docx DOCX document
S02 - 36C77626Q0016.pdf PDF

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VISN16 - P00002

Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code VA owned /Contractor owned cylinders (Identify the current Contractor by name) Delivery Days/Times Facility Access Point of Contact Annual Cylinder Audit Required Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and CBOC (example Tuesdays at 11am) amount of MAIN HOSPTIAL footprint by square feet Age of Bulk 02 tank (if known) Bulk 02 current owner of tanks (Identify the vendor by name or VA owned) Bulk 02 current size of main Bulk 02 current size of reserve Identify onsite facility access requirements for Vendors Facility Name Identify Main/CBOC/Vet Center/Research Facility Address City State Zip Code site double check on location names and address VA owned or Vendor owned cylinders (Identify the current vendor by name) IF VA owned cylinders (identify which med gases..carbon, oxygen,etc) email to: Tanya.Kuza@va.gov Sales Tax Exemption form per main station define delivery dates/times for each station and…

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