Section A - Solicitation/Contract Form CLAUSES INCORPORATED BY FULL TEXT Fill in Blanks: TIN: ________________ CAGE: ________________ DUNS: __________________ Vendor Point of Contact: ______________________Phone: ____________________ Vendor email: ______________________ NAPS 5232.903 PROMPT PAYMENT For Prompt Payment Act Purposes, this contract is: Subject to the 7-calendar day constructive acceptance period. Section B - Supplies or Services and Prices ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 2 Each KV10434 Glide Blade HandleFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0002 2 Each KV10445 INTACS FORCEPSFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0003 2 Each KV10606 POCKETING HOOKSFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0004 2 Each KV10730-1 CORNEAL SEPARATOR, CW, 0.9mmFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0005 2 Each KV10730-2 CORNEAL SEPARATOR, CCW, 0.9mmFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0006 2 Each KV10732 INSPECTION GUAGE, 0.9mmFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0007 2 Each KV10733 PROCEDURE MARKER, 0.9mmFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0008 2 Each KV1162 SYMETRIC GLIDE SETFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0009 2 Each 2-110 BONN FORCEPFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0010 2 Each 5-362 15 DEGREE ARC DIAMOND KNIFEFFP(GUARDED)MILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0011 4 Each 6-251 SINSKEY HOOKFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0012 2 Each 9-556F SPECULUMFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0013 2 Each 9-789W-1 11mm ZONE MARKER (D & K)FFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0014 2 Each 1-7110 STERILIZATION TRAY, SMALLFFP(10.5"X6.25"X1.36")MILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0015 1 SHIPPING 3rd DAYFFPMILSTRIP: N0018304RQ68011PURCHASE REQUEST NUMBER: N0018304RQ68011 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0016 4 Each 10700-250 INTACS F/P, U.S. 0.250mmFFPTHICKNESS, 150 ARC LENGTHMILSTRIP: N0018304RQ68012PURCHASE REQUEST NUMBER: N0018304RQ68012 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0017 8 Each 10700-300 INTACS F/P, U.S. 0.300mmFFPTHICKNESS, 150 ARC LENGTHMILSTRIP: N0018304RQ68012PURCHASE REQUEST NUMBER: N0018304RQ68012 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0018 8 Each 10700-350 INTACS F/P, U.S. 0.350mmFFPTHICKNESS, 150 ARC LENGTHMILSTRIP: N0018304RQ68012PURCHASE REQUEST NUMBER: N0018304RQ68012 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0019 1 Each KV2000 VACUUM SYSTEMFFPMILSTRIP: N0018304RQ68013PURCHASE REQUEST NUMBER: N0018304RQ68013 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0020 2 Each KV10478-2 VACUUM CENTERING GUIDE, SLOPEDFFPSHELFMILSTRIP: N0018304RQ68013PURCHASE REQUEST NUMBER: N0018304RQ68013 NET AMT FOB: Destination ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0021 1 Case 7K5000 VACUUM TUBING, 10/CS STERILEFFPMILSTRIP: N0018304RQ68013PURCHASE REQUEST NUMBER: N0018304RQ68013 NET AMT FOB: Destination Section C - Descriptions and Specifications CLAUSES INCORPORATED BY FULL TEXT THE MINIMUM REQUIREMENTS OF THIS ORDER ARE AS FOLLOWS: „h Vendor to provide all items as specified in section B for the Addition technology, Inc. Standard Prolate System. These part numbers are from Addition Technology Inc. o Minimum of 2 Service / Operators Manuals to be included for each system. o Vendors price to include all parts, labor and transportation including Shipping. „h Vendor to provide minimum 1 year warranty o Warranty shall be all inclusive against manufactures defects o Vendor to provide no cost telephone support during warranty period. Telephone support shall include services for both general system operation questions and questions concerning system faults / failures. „h Equipment supplied must be certified for use in US adhering to UL requirements as required. Section E - Inspection and Acceptance INSPECTION AND ACCEPTANCE TERMS Supplies/services will be inspected/accepted at: CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY 0001 Destination Government Destination Government 0002 Destination Government Destination Government 0003 Destination Government Destination Government 0004 Destination Government Destination Government 0005 Destination Government Destination Government 0006 Destination Government Destination Government 0007 Destination Government Destination Government 0008 Destination Government Destination Government 0009 Destination Government Destination Government 0010 Destination Government Destination Government 0011 Destination Government Destination Government 0012 Destination Government Destination Government 0013 Destination Government Destination Government 0014 Destination Government Destination Government 0015 Destination Government Destination Government 0016 Destination Government Destination Government 0017 Destination Government Destination Government 0018 Destination Government Destination Government 0019 Destination Government Destination Government 0020 Destination Government Destination Government 0021 Destination Government Destination Government Section F - Deliveries or Performance DELIVERY INFORMATION CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS UIC 0001 15-JUL-2004 2 NAVAL MEDICAL CENTERRECEIVING DEPARTMENTMMD54 LEWIS MINORS STREETPORTSMOUTH VA 23708-2297757-953-5770FOB: Destination N00183 0002 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0003 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0004 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0005 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0006 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0007 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0008 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0009 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0010 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0011 15-JUL-2004 4 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0012 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0013 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0014 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0015 15-JUL-2004 1 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0016 15-JUL-2004 4 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0017 15-JUL-2004 8 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0018 15-JUL-2004 8 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0019 15-JUL-2004 1 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0020 15-JUL-2004 2 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 0021 15-JUL-2004 1 (SAME AS PREVIOUS LOCATION)FOB: Destination N00183 CLAUSES INCORPORATED BY REFERENCE 52.211-17 Delivery of Excess Quantities SEP 1989 52.247-34 F.O.B. Destination NOV 1991 Section G - Contract Administration Data CLAUSES INCORPORATED BY FULL TEXT Invoices for supplies rendered under this Task Order shall be submitted electronically through Wide Area Work Flow ¡V Receipt and Acceptance (WAWF): The vendor shall self-register at the web site https://wawf.eb.mil. Vendor training is available on the internet at http://wawftraining.com. One or more separate invoices will be prepared per order. Do not combine the payment claims for supplies provided under this contract ordered through multiple orders within one invoice. Select the Create Invoice And Receiving Report combo within WAWF as the invoice type (destination/destination). The Invoice and Receiving Report combo prepares the Material Inspection and Receiving Report, DD Form 250, and the Invoice at the same time. Back up documentation (such as delivery receipts, etc.) can be included and attached to the invoice in WAWF. Attachments created in any Microsoft Office product are attachable to the invoice in WAWF. The following information regarding Naval Medical Center Portsmouth is provided for completion of the invoice in WAWF: Issuing Office DODAAC: N00183 Admin DODAAC: N00183 Ship To DODAAC: N00183 LPO DODAAC: N00183 Pay DODAAC: N68688 The contractor shall submit invoices for payment per contract terms. The Government shall process invoices for payment per contract terms. For more information on Wide Area Workflow, please contact the Wide Area Workflow Implementation Team at [email protected] Section I - Contract Clauses CLAUSES INCORPORATED BY REFERENCE 52.203-3 Gratuities APR 1984 52.213-2 Invoices APR 1984 52.219-3 Notice of Total HUBZone Set-Aide JAN 1999 52.219-6 Notice Of Total Small Business Set-Aside JUN 2003 52.219-6 Alt I Notice of Total Small Business Set-Aside (Jun 2003) - Alternate I OCT 1995 52.222-20 Walsh-Healey Public Contracts Act DEC 1996 52.222-35 Equal Opportunity For Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans DEC 2001 52.222-36 Affirmative Action For Workers With Disabilities JUN 1998 52.223-3 Hazardous Material Identification And Material Safety Data JAN 1997 52.226-1 Utilization Of Indian Organizations And Indian-Owned Economic Enterprises JUN 2000 52.232-1 Payments APR 1984 52.232-8 Discounts For Prompt Payment FEB 2002 52.233-3 Protest After Award AUG 1996 52.246-1 Contractor Inspection Requirements APR 1984 252.204-7004 Alt A Required Central Contractor Registration Alternate A NOV 2003 252.232-7003 Electronic Submission of Payment Requests JAN 2004 CLAUSES INCORPORATED BY FULL TEXT 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): www.arnet.gov/far (End of clause)

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