Section A - Solicitation/Contract Form CLAUSES INCORPORATED BY FULL TEXT Fill in Blanks: TIN: ________________ CAGE: ________________ DUNS: __________________ Vendor POC: ______________________Phone: ____________________ Vendor email: ______________________ User POC: Payment in Arrears Vendor to reference RFQ number N00183-07-T-0130 on all inquires including PROMPT PAYMENT For Prompt Payment Act Purposes, this contract is: Subject to the 7-calender day constructive acceptance period. Section B - Supplies or Services and Prices ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 1 Each Upgrade EquiTest system FFP includes Pentium computer, HP Deskjet printer, 17" LCD color monitor, mobile cart with LCD swing arm assembly. Includes SEnsory Organization Test, Motor Control Test, Adaptation Test, Weight Bearing Squat Limits of Stability, Rhythmic Weight Shift, Unilateral Stance assessments. Includes training for one person FOB: Destination MILSTRIP: N0018307RQXC010 PURCHASE REQUEST NUMBER: N0018307RQXC010 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0002 1 Each Pressure test FFP Pressure test to document inner-ear pressure changes FOB: Destination MILSTRIP: N0018307RQXC010 PURCHASE REQUEST NUMBER: N0018307RQXC010 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0003 1 Each Dynamic Visual Acuity Test FFP Gaze Stabilization test, Head Shake protocols FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0004 1 Each Static 18"X60" Long Forceplate FFP includes Walk Across, Tandem walk, Step up/Over, Step/Quick Turn, Forward Lunge, Sit to Stand assessment protocols FOB: Destination MILSTRIP: N0018307RQXC010 PURCHASE REQUEST NUMBER: N0018307RQXC010 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0005 1 Each Annual Product Support Agreement FFP Warranty extended for one year FOB: Destination MILSTRIP: N0018307RQXC010 PURCHASE REQUEST NUMBER: N0018307RQXC010

Bid Protests Not Available