ATTACHMENT_B_-_Modification_Check_List_V2_per_Amendment_0004.docx
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- Attached to
- DINPACS IV Federal contract opportunity
- Solicitation number
- SPE2D1-15-R-0004
About this file
This is a modification checklist for the Digital Imaging Network - Picture Archiving and Communications System (DIN-PACS) IV contract. The DIN-PACS system provides for digital diagnostic x-ray images that can be transmitted and accessed anywhere, eliminating constraints within and between diagnostic centers. It includes DIN-PACS systems and components, options and accessories, upgrades, training, and maintenance services. The contract supports business process changes throughout the Military Health System and enables a virtual radiology department. Ordering offices include the Defense Supply Center Philadelphia and Veterans Administration National Acquisition Center, serving all federally funded Department of Defense and non-DOD facilities. The modification checklist allows contractors to request additions, deletions, price adjustments and other changes to products on contract, and requires supporting documentation including price lists, discount structures and certifications depending on the type of modification.
ATTACHMENT B - Modification Check List V2 per Amendment 0004
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ATTACHMENT B
Modification Checklist (DIN-PACS)
Company Name (include a Doing Business As (DBA) if applicable):
Contract Number(s):
Address (for contract administration):
Email:
FAX:
Company Contact:
Contracting Specialist/Contracting Officer
|_|Original submission |_|Clarification |_|Resubmitted - previously rejected
Type of Modification Action(s) requested:
1) |_| Add products from existing product line with established contract discounts (insert # of product/services) |_| All products being added are Commercially Available.
|_| All products being added are in compliance with Trade Agreements Act.
|_| All products being added that require 510K certification have it.
|_| All products contain no hazardous substances as defined by the Federal Hazardous Substances Act.
|_| All products being added are not substantially equal to deleted products that were price lower under this contract.
| |_| Spreadsheet attached detailing items added (DINPAC RFQ Attachment C). |
| |_| Commercial Price List with Effective Date is included |
|_| A sample of recent commercial invoices that will be used substantiate your commercial price list and disclosed commercial customer discounting policies.
If not included please explain why?
|_| A completed invoice analysis spreadsheet
2) |_| Add New Product Line |_| Commercial Sales Practice Information needs to be provided for each new product line added including a list of your commercial customers (also include FSS pricing if applicable), basic discount (or discount range) provided per customer off of the commercial list price, quantity discounts offered, other concessions, FOB point (destination or origin).
|_| All products being added are Commercially Available.
|_| All products being added are in compliance with Trade Agreements Act.
|_| All products being added that require 510K certification have it.
|_| All products contain no hazardous substances as defined by the Federal Hazardous Substances Act.
|_| Spreadsheet attached detailing products added (DINPAC RFQ Attachment C).
|_| Commercial Price List with Effective Date is included |_| A sample of recent commercial invoices that will be used to substantiate commercial price list and disclosed commercial customer discounting policies.
If not included please explain why?
|_| A completed invoice analysis spreadsheet
3) |_| Delete (insert # of products/services) |_| Spreadsheet attached detailing products deleted (DINPAC RFQ Attachment C).
*Please note if items are being deleted from your contract please ensure that maintenance for those items are still included on your contract until it reaches the end of service life.
4) |_| Price Decrease (insert # of product/services) |_| Commercial Price List with Effective Date is included |_| Spreadsheet attached detailing percentage of decrease (DINPAC RFQ Attachment C).
5) |_| Temporary Price Decrease (insert # of product/services)
| |_| Temporary Price Reduction will run from_____ to _____ |
| |_| Spreadsheet attached detailing percentage of decrease (DINPAC RFQ Attachment C). |
6) |_|Economic Price Adjustment (EPA) (include # of changes) |_| The products / services incurring a price increase have not been subject to a price increase in the past 12 months.
| |_| The reason for requesting the price increase is_______________________________. | |
| |_| Commercial Price List with Effective Date is included | |
| |_| A Separate Excel Spreadsheet attached detailing percentage of increase/decrease (DINPAC RFQ Attachment C). |
The spreadsheet must contain the following information for each item with a proposed increase:
| (a) The item number; e.g., 0003 |
| (b) The Supplier (Catalog) |
| (c) The product name/nomenclature |
| (d) The part number; e.g., HIH2000 |
(e) For the initial year, the list price that determined the Award Unit Price, the applicable Contract Discount, and the Award Unit Price. For all subsequent contract years, the list price that determined the highest Contract Unit Price that was in effect at any time during the preceding Contract Year, the applicable discount, and the highest Contract Unit Price that was in effect during the preceding Contract Year.
| (f) The increased List Price and its effective date, the applicable Contract Discount or | ||
| Larger Contract Discount now offered, and the proposed higher Contract Unit Price. | (g) For the initial year, the percentage change from the List Price that determined the | award unit price to the new higher List Price. For all subsequent contract years, the |
| percentage change from the List Price that determined the highest Contract Unit Price |
that was in effect at any time during the preceding Contract Year to the new higher List Price.
| (h) For the initial year, the percentage change from the award unit price to the new |
| higher proposed Contract Unit Price. For all subsequent contract years, the percentage |
| change from the highest Contract Unit Price that was in effect at any time during the |
| preceding contract year to the new higher proposed Contract Unit Price. |
| (i) For any items offered to the Department of Veterans Affairs (DVA) under the FSS, the |
| current FSS Unit Price(s) for the same item. |
| (j) Any other information required by the Contracting Officer. |
*Please note as detailed in your contracts EPA clause that your upward adjustments are subject to a ceiling rate.
7) |_| Novation – See FAR 42.12 for required documentation needed
8) |_| Name Change – See FAR 42.12 for required documentation needed
9) |_| Address Change (please update your CCR first):
| From: |
| To: |
10) |_| Administrative (Specify) _____________
11) |_| Other (Specify) ________________________
Signature____________________________________ Date ___________
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