REQUEST FOR INFORMATION This is only a request for potential suppliers of the items identified in the schedule below. The Charlie Norwood Veterans Affairs Medical Center is not seeking quotes at this time. If suitable potential vendors are found as a result of this RFI, a formal solicitation will be issued at a later date through the Government Point of Entry (GPE). Please fill out this sheet and return via email to [email protected]. Please be sure and to indicated the identification number VA247-13-I-0884 in the subject line of the email. INFORMATION REQUESTED 1) Can you provide ALL items listed in this RFI? Yes ___________ No ___________ 2) If NO is the response, what prohibit you from being able to fulfill this requirement? 3) If YES is the response, please provided ARO date from order placement? Is the item brand name or equal? Delivery Time ARO Brand Name: Y / N FSS # & Expiration date 4) If YES, what is your socio-economic status (SB, SDVOSB, VOSB, Woman Owned, Other, etc.)? 5) Please provide the following: Company Name: DUNS: TAX ID: POC (Name, Contact No. e-mail): 6) Are you: Authorized distributor for the ____Manufacturer ____ or Other: ______________________ 7) Is your company registered with System for Award Management (SAM)? Yes No DISCLAIMER This RFI is issued solely for information and planning purposes only and does not constitute a solicitation. All information received in response to this RFI that is marked as proprietary will be handled accordingly. In accordance with FAR 15.201(e), responses to this notice are not offers and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses associated with responding to this RFI. Request for Information (This is not a solicitation for quote) Note: Use the "remarks" column to indicate if your item is on FSS or open market. If the item your company offers is not the brand name (ALCON Constellation Vitrectomy) listed herein, please indicate "equal" and provide supporting documentation (brochure, articles, etc.). ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 1 CONSTELLATION VITRECTOMY PLUS PAK ASSY PREM 23G VALVED RFID MANUFACTURER PART NUMBER (MPN): 8065751900 - LOCAL STOCK NUMBER: 8065751900 - 1.00 BX ________ ______________ 2 CONSTELLATION VITRECTOMY TOTAL PLUS PAK 25G 5.0CPM RFID MANUFACTURER PART NUMBER (MPN): 8065751462 - LOCAL STOCK NUMBER: 8065751462 - 1.00 BX _______ _____________ 3 KIT,VIRECTOMY, TOTAL PLUS 23GA, CONSTELLATION ,5.0 STDRFID MANUFACTURER PART NUMBER (MPN): 8065751058 - LOCAL STOCK NUMBER: 8065751058 - 1.00 BX _______ _____________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 4 CONSTELLATION VITRECTOMY TOTAL PLUS PAK VALVED CANNULAS 25G MANUFACTURER PART NUMBER (MPN): 8065751902 - LOCAL STOCK NUMBER: 8065751902 - 1.00 BX ______ ______________ 5 CONSTELLATION COMBINED 20G 5000 CPM 0.9MM PROCEDURE PAKS MANUFACTURER PART NUMBER (MPN): 8065751079 - LOCAL STOCK NUMBER: 8065751079 - 1.00 BX ______ ______________ 6 CONSTELLATION COMBINED 23G 5000 CPM 0.9MM PROCEDURE PAKS MANUFACTURER PART NUMBER (MPN): 8065751077 - LOCAL STOCK NUMBER: 8065751077 - 1.00 BX ______ ______________ 7 CONSTELLATION COMBINED 23G 5000 CPM 0.9MM VALVED MANUFACTURER PART NUMBER (MPN): 8065751908 - LOCAL STOCK NUMBER: 8065751908 - 1.00 BX ______ ______________ 8 CONSTELLATION COMBINED 25G+ 5000 CPM 0.9MM PROCEDURE PAKS MANUFACTURER PART NUMBER (MPN): 8065751468 - LOCAL STOCK NUMBER: 8065751468 - 1.00 BX ______ ______________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 9 CONSTELLATION COMBINED 25G+ 5000 CPM 1.1MM PROCEDURE PAKS MANUFACTURER PART NUMBER (MPN): 8065751466 LOCAL STOCK NUMBER: 8065751466 - 1.00 BX ______ ______________ 10 CONSTELLATION COMBINED 25G+ 5000 CPM 0.9MM VALVED MANUFACTURER PART NUMBER (MPN): 8065751910 LOCAL STOCK NUMBER: 8065751910 - 1.00 BX ______ ______________ 11 PROBES,ULTRAVIT,CONSTELLATION,23GA,5000 MANUFACTURER PART NUMBER (MPN): 806750949 LOCAL STOCK NUMBER: 8065750949 - 1.00 BX ______ ______________ 12 PROBES,ULTRAVIT,CONSTELLATION,25GA,5000 MANUFACTURER PART NUMBER (MPN): 806750950 LOCAL STOCK NUMBER: 8065750950 - 1.00 BX ______ ______________ 13 PROBES,ULTRAVIT,CONSTELLATION,25GA+5000 MANUFACTURER PART NUMBER (MPN): 806751438 LOCAL STOCK NUMBER: 8065751438 - 1.00 BX ______ ______________ 14 PAK,VFC CONSELLATION LO MANUFACTURER PART NUMBER (MPN): 806750957 CAL STOCK NUMBER: 8065750957 - 1.00 BX ______ ______________ 15 PAK,FRAG CONSTELLATION MANUFACTURER PART NUMBER (MPN): 806750958 LOCAL STOCK NUMBER: 8065750958 - 1.00 BX ______ ______________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 16 TUBING INFUSION SET,W/AUTO INFUSION VALVE CONSTELLATION MANUFACTURER PART NUMBER (MPN): 806750914 LOCAL STOCK NUMBER: 8065750914 - 1.00 BX ______ ______________ 17 TUBING,AUXILIARY ASPIRATION CONSTELLATION MANUFACTURER PART NUMBER: 8065750917 LOCAL STOCK NUMBER: 8065750917 - 1.00 BX ______ ______________ 18 TUBING SET,IRRIGATION/ASPIRATION CONSTELLATION LOCAL STOCK NUMBER: 8065750918 - 1.00 BX ______ _ _____________ 19 TUBING SET,GFI ADMIN CONSTELLATION MANUFACTURER PART NUMBER: 8065750920 LOCAL STOCK NUMBER: 8065750920 - 1.00 BX ______ ______________ 20 TRAY,ARM COVER CONSTELLATION MANUFACTURER PART NUMBER: 8065751163 LOCAL STOCK NUMBER: 8065751163 - 1.00 BX ______ ______________ 21 GAS,AUTO FILL,CONSTELLATION MANUFACTURER PART NUMBER: 80657501014 LOCAL STOCK NUMBER: 8065751014 - 1.00 BX ______ ______________ 22 HANDPIECE,FRAG,CONSTELLATION MANUFACTURER PART NUMBER: 8065750088 LOCAL STOCK NUMBER: 8065750888 - 1.00 EA ______ ______________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 23 GAS,C3F8 125GM TANK FOR CONSTELLATION MANUFACTURER PART NUMBER: 8065797102 LOCAL STOCK NUMBER: 8065797105 - 2.00 EA ______ ______________ 24 GAS,SF6,125GM TANK FOR CONSTELLATION MANUFACTURER PART NUMBER: 8065797005 LOCAL STOCK NUMBER: 8065797005 - 2.00 EA ______ ______________ 25 BAGS,DRAIN CONSTELLATION MANUFACTURER PART NUMBER: 8065751162 LOCAL STOCK NUMBER: 8065751162 - 1.00 BX ______ ______________ 26 CANNULA/TROCAR,25G+(SINGLE) MANUFACTURER PART NUMBER (MPN): 8065751448 LOCAL STOCK NUMBER: 8065751448 - 1.00 BX ______ ______________ 27 CANNULA,INFUSION,25G+ MANUFACTURER PART NUMBER (MPN): 8065751459 LOCAL STOCK NUMBER: 8065751459 - 1.00 BX ______ ______________ 28 PLUGS,TROCAR 25G+ MANUFACTURER PART NUMBER (MPN): 8065751443 LOCAL STOCK NUMBER: 8065751443 - 1.00 BX ______ ______________ 29 KIT,SMALL PARTS 25G+(INFUSION CANNULA&PLUGS) MANUFACTURER PART NUMBER (MPN): 8065751442 LOCAL STOCK NUMBER: 8065751442 - 1.00 BX ______ ______________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 30 KIT,SMALL PARTS 23G(INFUSION CANULA&PLUGS) MANUFACTURER PART NUMBER (MPN): 8065750842 LOCAL STOCK NUMBER: 8065750842 - 1.00 BX ______ ______________ 31 CANNULA,INFUSION 25G 6MM (1 COUNT) MANUFACTURER PART NUMBER (MPN): 8065751780 LOCAL STOCK NUMBER: 8065751780 - 1.00 BX ______ ______________ 32 CANNULA,INFUSION 23G 6MM(1 COUNT) MANUFACTURER PART NUMBER (MPN): 8065751444 LOCAL STOCK NUMBER: 8065751444 - 1.00 BX ______ ______________ 33 CANNULA,TROCAR VALVED 25G(3 COUNT) MANUFACTURER PART NUMBER (MPN): 8065751658 LOCAL STOCK NUMBER: 8065751658 - 1.00 ______ ______________ 34 CANNULA,VALVED TROCAR 23G(3 COUNT) MANUFACTURER PART NUMBER (MPN): 8065751657 LOCAL STOCK NUMBER: 8065751657 - 1.00 BX ______ ______________ 35 CANNULA,VALVED TROCAR 25G 6MM(3 COUNT) MANUFACTURER PART NUMBER (MPN): 8065751778 LOCAL STOCK NUMBER: 8065751778 - 1.00 BX ______ ______________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 36 CANNULA,VALVED TROCAR 23G 6MM(3 COUNT) MANUFACTURER PART NUMBER (MPN): 8065751801 LOCAL STOCK NUMBER: 8065751801 - 1.00 BX _______ ______________ 37 CANNULA,INFUSION 23G MANUFACTURER PART NUMBER (MPN): 8065750841 LOCAL STOCK NUMBER: 8065750841 - 1.00 BX _______ ______________ 38 PLUGS,23G MANUFACTURER PART NUMBER (MPN): 8065750837 LOCAL STOCK NUMBER: 8065750837 - 1.00 BX _______ ______________ 39 PROBE LASER STRAIGHT RFID 23G MANUFACTURER PART NUMBER (MPN): 8065750991 LOCAL STOCK NUMBER: 8065750991 - 1.00 BX ______ ______________ 40 PROBE LASER STRAIGHT RFID 25G MANUFACTURER PART NUMBER (MPN): 8065750978 LOCAL STOCK NUMBER: 8065750978 - 1.00 BX _______ ______________ 41 PROBE LASER RFID, FLEX TIP 23G MANUFACTURER PART NUMBER (MPN): 8065751113 LOCAL STOCK NUMBER: 8065751113 - 1.00 BX _______ ______________ 42 PROBE LASER RFID FLEX TIP 25G MANUFACTURER PART NUMBER (MPN): 8065751114 LOCAL STOCK NUMBER: 8065751114 - 1.00 BX _______ ______________ ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 43 PROBE LASER FLEX TIP 23G ILLUMINATED RFID MANUFACTURER PART NUMBER (MPN): 8065751592 LOCAL STOCK NUMBER: 8065751592 - 1.00 BX _______ ______________ 44 PROBE LASER FLEXTIP 25G ILLUMINATED RFID MANUFACTURER PART NUMBER (MPN): 8065751593 LOCAL STOCK NUMBER: 8065751593 - 1.00 BX _______ ______________ 45 CHANDELLER 25G RFID MANUFACTURER PART NUMBER (MPN): 8065751577 LOCAL STOCK NUMBER: 8065751577 - 1.00 BX _______ ______________ 46 ILLUMINATOR WIDE ANGLE 23G SAPPHIRE RFID MANUFACTURER PART NUMBER (MPN): 8065751184 LOCAL STOCK NUMBER: 8065751184 - 1.00 BX _______ ______________ 47 ILLUMINATOR WIDE ANGLE SAPPHIRE 25G RFID MANUFACTURER PART NUMBER (MPN): 8065751185 LOCAL STOCK NUMBER: 8065751185 - 1.00 BX _______ ______________ 48 LENS MACULAR DSP-59-30DEG FOV GRIESHABER MANUFACTURER PART NUMBER (MPN): 618.60 - LOCAL STOCK NUMBER: 618.60 - 1.00 BX _______ ______________ 49 GRIP MAX DSP, FCP 25G MANUFACTURER PART NUMBER (MPN): 705.13 - LOCAL STOCK NUMBER: 705.13 - 1.00 BX _______ ______________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 50 GRASP END DSP FCP 25G MANUFACTURER PART NUMBER (MPN): 705.43 - LOCAL STOCK NUMBER: 705.43 - 1.00 BX _______ ______________ 51 FORCEPS ILM DSP 25G FCP MANUFACTURER PART NUMBER (MPN): 705.44 - LOCAL STOCK NUMBER: 705.44 - 1.00 BX _______ ______________ 52 FORCEP, 25G ASYMMETRICAL DISPOSABLE MANUFACTURER PART NUMBER (MPN): 705.45 - LOCAL STOCK NUMBER: 705.45 - 1.00 BX _______ ______________ 53 FORCEP, 25G SERRATED DISPOSABLE MANUFACTURER PART NUMBER (MPN): 705.47 - LOCAL STOCK NUMBER: 705.47 - 1.00 BX _______ ______________ 54 SCISSOR, 25G CURVED DISPOSABLE MANUFACTURER PART NUMBER (MPN): 705.52 - LOCAL STOCK NUMBER: 705.52 - 1.00 BX _______ ______________ 55 FORCEP, 23G MAXGRIP DISPOSABLE MANUFACTURER PART NUMBER (MPN): 706.13 - LOCAL STOCK NUMBER: 706.13 - 1.00 BX _______ ______________ 56 FORCEP, 23G END GRASP DISPOSABLE MANUFACTURER PART NUMBER (MPN): 706.43 - LOCAL STOCK NUMBER: 706.43 - 1.00 BX _______ ______________ 57 FORCEPS, 23G ILM DISPOSABLE MANUFACTURER PART NUMBER (MPN): 706.44 - LOCAL STOCK NUMBER: 706.44 - 1.00 BX _______ ______________ ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 58 FORCEP, 23G ASYMMETRICAL DISPOSABLE MANUFACTURER PART NUMBER (MPN): 706.45 - LOCAL STOCK NUMBER: 706.45 - 1.00 BX _______ ______________ 59 FORCEP, 23G SERRATED DISPOSABLE MANUFACTURER PART NUMBER (MPN): 706.47 - LOCAL STOCK NUMBER: 706.47 - 1.00 BX _______ ______________ 60 SCISSOR, 23G CURVED DISPOSABLE MANUFACTURER PART NUMBER (MPN): 706.52 - LOCAL STOCK NUMBER: 706.52 - 1.00 BX _______ ______________ 61 SCISSOR, 23G VERTICAL DISPOSABLE MANUFACTURER PART NUMBER (MPN): 706.26 - LOCAL STOCK NUMBER: 706.26 - 1.00 BX _______ ______________ 62 BACKFLUSH, 23G SOFT TIP DISPOSABLE MANUFACTURER PART NUMBER (MPN): 8065149523 LOCAL STOCK NUMBER: 8065149523 - 1.00 BX _______ ______________ 63 BACKFLUSH, 25G SOFT TIP DISPOSABLE MANUFACTURER PART NUMBER (MPN): 8065149525 LOCAL STOCK NUMBER: 8065149525 - 1.00 BX _______ ______________ 64 SPATULA, 25G 45 DEGREE MANUFACTURER PART NUMBER (MPN): 337.91 - LOCAL STOCK NUMBER: 337.91 - 1.00 BX _______ ______________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 65 PICK, 25G 45 DEGREE MANUFACTURER PART NUMBER (MPN): 337.92 - LOCAL STOCK NUMBER: 337.92 - 1.00 BX _______ ______________ 66 SPATULA, 23G 45 DEGREE MANUFACTURER PART NUMBER (MPN): 337.94 - LOCAL STOCK NUMBER: 337.94 - 1.00 BX _______ ______________ 67 LANCE, V 23G MVR MANUFACTURER PART NUMBER (MPN): 8065912301 - LOCAL STOCK NUMBER: 8065912301 - 1.00 BX _______ ______________ 68 LANCE, V 25G MVR MANUFACTURER PART NUMBER (MPN): 8065912501 LOCAL STOCK NUMBER: 8065912501 - 1.00 BX _______ ______________ 69 PIC, 25G ILLUMINATED MANUFACTURER PART NUMBER (MPN): 8065751572 LOCAL STOCK NUMBER: 8065751572 - 1.00 BX _______ ______________ 70 PICK, 23G 45 DEGREE MANUFACTURER PART NUMBER (MPN): 337.95 - LOCAL STOCK NUMBER: 337.95 - 1.00 BX _______ ______________ 71 PIC, 23G ILLUMINATED MANUFACTURER PART NUMBER (MPN): 8065751576 LOCAL STOCK NUMBER: 8065751576 - 1.00 BX _______ ______________ 72 RETRACTORS, FLEXIBLE IRIS MANUFACTURER PART NUMBER (MPN): 611.74 - LOCAL STOCK NUMBER: 611.74 - 1.00 BX _______ ________________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 73 RETRACTORS, FLEXIBLE IRIS MANUFACTURER PART NUMBER (MPN): 611.75 - LOCAL STOCK NUMBER: 611.75 - 1.00 BX _______ ______________ 74 KNIFE, IRIS RETRACTOR 5MM MANUFACTURER PART NUMER (MPN) 681.05 LOCAL STOCK NUMBER: 681.05 - 1.00 BX _______ ______________ 75 SILIKON, 1000 (100CS SILICON OIL,8.5ML) MANUFACTURER PART NUMBER (MPN): 8065601185 LOCAL STOCK NUMBER: 8065601185 - 1.00 EA _______ ______________ 76 BOX, SF6 RETURN BOX MANUFACTURER PART NUMBER (MPN): 8065797701 LOCAL STOCK NUMBER: 8065797701 - 1.00 EA _______ _____________ 77 BOX, RETURN C3F8 MANUFACTURER PART NUMBER (MPN): 8065797601 LOCAL STOCK NUMBER: 8065797601 - 1.00 EA _______ _____________ 78 TANK, REGULATOR ISPAN (STAND ALONE TANKS) MANUFACTURER PART NUMBER (MPN): 8065797303 LOCAL STOCK NUMBER: 8065797303 - 1.00 EA _______ _____________ 79 PERFLUORON(PERFLUORACARBON LIQUID PROCEDURAL KIT, 7ML :MANUFACTURER PART NUMBER (MPN): 8065900164 - LOCAL STOCK NUMBER: 8065900164 - 1.00 BX _______ _____________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QTY UNIT UNIT PRICE AMOUNT FSS # W/EXP DATE 80 TIP DSP MPC 23G MANUFACTURER PART NUMBER (MPN): 723.26 - LOCAL STOCK NUMBER: 723.26 - 1.00 BX ______ _____________ GRAND TOTAL

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