Fill in Blanks: TIN (tax ID): ________________ CAGE: ________________ DUNS: __________________ Vendor Point of Contact: ______________________Phone: ____________________ Vendor email: ______________________ Naval Medical Center POC: BioMedical Engineering Payment Monthly, Quarterly, Annually (circle one) in Arrears Note: vendor will be required to provide billing electronically via the WAWF Electronic Invoicing method. For additional information, a review of the following web sites may be required: https://wawf.eb.mil http://wawftraining (email) [email protected] Vendor to reference N00183-06-T-0104 on all Inquires. Government reserves the right to: (1) award based on an "All or Nothing Evaluation". (2) award a “Best Value” requirement. Vendors with superior past performance histories may be given 1st consideration. 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 Base Year Maintenance FFP Period of performance: 1 Jun 06 - 30 Sep 06 FOB: Destination MILSTRIP: N3251006RQEY006 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AA 4 Months Maintenance in Accourance with Section C FFP on 1ea: Tonometer, Ophthalmic Model: 11625 Serial: BG654847 Manufacturer: Reichart PA# 0018310816 Location: Sewells Point Opthomology Clinic FOB: Destination MILSTRIP: N3251006RQEY006 PURCHASE REQUEST NUMBER: N3251006RQEY006 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AB 4 Months Maintenance in Accourance with Section C FFP on 1ea: Tonometer, Ophthalmic Model: 11625 Serial: BD45411 Manufacturer: Reichart PA# 0018310758 Location: Sewells Point Opthomology Clinic FOB: Destination MILSTRIP: N3251006RQEY006 PURCHASE REQUEST NUMBER: N3251006RQEY006 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AC 4 Months Maintenance in Accourance with Section C FFP on 1ea: Tonometer, Ophthalmic Model: CT80 Serial: 150393 Manufacturer: Topcon PA# 0018302375 Location: Sewells Point Opthomology Clinic FOB: Destination MILSTRIP: N3251006RQEY006 PURCHASE REQUEST NUMBER: N3251006RQEY006 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AD 4 Months Maintenance in Accourance with Section C FFP on 1ea: Tonometer, Ophthalmic Model: 11625 Serial: 138559 Manufacturer: Reichart PA# 00183003361 Location: Sewells Point Opthomology Clinic FOB: Destination MILSTRIP: N3251006RQEY006 PURCHASE REQUEST NUMBER: N3251006RQEY006 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AE 4 Months Maintenance in Accourance with Section C FFP on 1ea: Tonometer, Ophthalmic Model: 11625 Serial: 60142 Manufacturer: Reichart PA# 00183003366 Location: Sewells Point Opthomology Clinic FOB: Destination MILSTRIP: N3251006RQEY006 PURCHASE REQUEST NUMBER: N3251006RQEY006 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AF 4 Months Maintenance in Accourance with Section C FFP on 1ea: Tonometer, Ophthalmic Model: 11625 Serial: 0169111 Manufacturer: Reichart PA# 00183016911 Location: Sewells Point Opthomology Clinic FOB: Destination MILSTRIP: N3251006RQEY006 PURCHASE REQUEST NUMBER: N3251006RQEY006 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AG 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Opthalmic Model: 12450 Serial: 2629009 Manufacturer: Leica PA# 0018310128 Location: Tricare Chesapeake Opthomology Clinic FOB: Destination MILSTRIP: N3213A06RQPC003 PURCHASE REQUEST NUMBER: N3213A06RQPC003 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AH 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Opthalmic Model: 12430 Serial: 115911 Manufacturer: Reichart PA# 0018308100 Location: NNSY Opthomology Clinic FOB: Destination MILSTRIP: N3253206RQEY007 PURCHASE REQUEST NUMBER: N3253206RQEY007 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AJ 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Opthalmic Model: 12415 Serial: BN270121 Manufacturer: American Medical PA# 00183002367 Location: NNSY Opthomology Clinic FOB: Destination MILSTRIP: N3253206RQEY007 PURCHASE REQUEST NUMBER: N3253206RQEY007 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AK 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Opthalmic Model: 1165 Serial: BN37060 Manufacturer: American Optical PA# 00183005813 Location: Boone Opthomology Clinic FOB: Destination MILSTRIP: N3252906RQEY005 PURCHASE REQUEST NUMBER: N3252906RQEY005 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AL 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Opthalmic Model: CT80 Serial: 151101 Manufacturer: Topcon PA# 00183086232 Location: Boone Opthomology Clinic FOB: Destination MILSTRIP: N3252906RQEY005 PURCHASE REQUEST NUMBER: N3252906RQEY005 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AM 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Computerized Model: CT60 Serial: 112508 Manufacturer: Topcon PA# 0018391330 Location: Yorktown Opthomology Clinic FOB: Destination MILSTRIP: N3253306RQPC004 PURCHASE REQUEST NUMBER: N3253306RQPC004 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AN 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Opthalmic Model: 11625 Serial: AS10591 Manufacturer: American Optical PA# 0018302368 Location: Yorktown Opthomology Clinic FOB: Destination MILSTRIP: N3253306RQPC004 PURCHASE REQUEST NUMBER: N3253306RQPC004 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AP 4 Months Maintenance in Accordance with SectionC FFP on 1ea: Keratomer Model: 1 Serial: 24693 Manufacturer: Marco PA# 0018306786 Location: Tricare VA Beach Opthomology Clinic FOB: Destination MILSTRIP: N3212A06RQEY003 PURCHASE REQUEST NUMBER: N3212A06RQEY003 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AQ 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Ophthalmic Model: 11625 Serial: 11165-8 Manufacturer: Reichart PA# 0018304052 Location: Oceana Opthomology Clinic FOB: Destination MILSTRIP: N3252806RQEY005 PURCHASE REQUEST NUMBER: N3252806RQEY005 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001AR 4 Months Maintenance in Accordance with Section C FFP on 1ea: Tonometer, Ophthalmic Model: 11625 Serial: AL2804 Manufacturer: Reichart PA# 00183005131 Location: Oceana Opthomology Clinic FOB: Destination MILSTRIP: N3252806RQEY005 PURCHASE REQUEST NUMBER: N3252806RQEY005 with 1 option year. please request full package for reqruirment details

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