CONTINUATION PAGE 4. CLIN #22 will be decreased by one (1) from one (1) to zero (0). 5. CLIN #23 will be decreased by one (1) from one (1) to zero (0). 6. This Amendment is hereby issued to include FAR Clause 52.217-5 "Evaluations of Options (July 1990) as follows: Except when it is determined in accordance with FAR 17.206(b) not to be in the Government's best interests, the Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. This includes options under FAR 52.217-8, Option to Extend Services, which applies to this solicitation. Evaluation of options under FAR 52.217-8 will be accomplished by using the prices offered for the last option period to determine the price for a 6-month option period, which will be added to the base and other option years to arrive at the total price. Evaluation of options will not obligate the Government to exercise the option(s)." 7. By reason of this amendment Solicitation Number VA248-15-Q-0378 due date has been extended until April 09, 2015 by or before 1500/0300PM without discussions. 8. For a complete Solicitation package need to contact the Contracting Officer by e-mail below. 9. GOVERNMENT POINT OF CONTACT: 1. Jose R. Sierra-Colon, Contracting Officer e-mail: [email protected] B.4 Cost/Price Schedule Item Information ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 BASE YEAR: FROM 04/20/2015 to 03/19/2016. PREVENTIVE MAINTENANCE AND SERVICES AS PER SCOPE OF WORK ON THIS RFQ FOR THE FOLLOWING AUDIOLOGY EQUIPMENT: AUDIOMETER GSI MODEL 61 - CALIBRATION 4.00 EA $___________ $___________ LOCATION: SAN JUAN 0002 AUDIOMETER GSI MODEL AUDIOSTAR PRO- CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 0003 MAICO AUDIOMETER MODEL MA42 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0004 BELTONE AUDIOMETER MODEL 119 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 0005 MAICO TYMPANOMETER MODEL MI-24 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0006 OTODYNAMICS ECHOPORTS MODEL ILO292 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 0007 ICS MEDICAL CHARTR MODEL MCU-90 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0008 GN OTOMETRICS CALORIC IRRIGATOR MODEL NCI 480 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0009 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR MODEL NCA 20 - VERIFICAITON 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0010 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0011 MICROMEDICAL MODEL FIREWIRE VNG -VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0012 GN OTOMETRICS MODEL ICS CHARTR 200 (INCL. VNG AND ABR "AUDIOTORY BRAIN STEM RESPONSE") - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0013 MICROMEDICAL ROTATIONAL CHAIR MODEL SYSTEM 2000 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0014 AUDIOSCAN MODEL RM 500 - CALIIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 0015 AUDIOSCAN MODEL RM 500SL - CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 0016 SOUNDROOMS CERTIFICATIONS 4.00 EA $___________ $___________ LOCATION: SAN JUAN 0017 TYMPANOMETERS MODEL TYMPSTAR V2 - CALIBRATION 5.00 EA $___________ $___________ LOCATION: SAN JUAN 0018 AUDIOSCAN MODEL RM 500SL - CALIBRATION 2.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 0019 GSI AUDIOMETERS MODEL 61 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 0020 TYMPANOMETERS MODEL TYMPSTAR V1 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 0021 SOUNDROOM - CERTIFICATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 0022 GN OTOMETRICS AUDIOMETER MODEL ASTERA - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 0023 GN OTOMETRICS TYMPANOMETER MODEL OTOFLEX - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 0022 GN OTOMETRICS REAL EAR MODEL FREE FITS - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC BASE YEAR GRAND TOTAL______________________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 1001 OPTION 1: FROM 04/20/2016 to 03/19/2017. PREVENTIVE MAINTENANCE AND SERVICES AS PER SCOPE OF WORK ON THIS RFQ FOR THE FOLLOWING AUDIOLOGY EQUIPMENT: AUDIOMETER GSI MODEL 61 - CALIBRATION 4.00 EA $___________ $___________ LOCATION: SAN JUAN 1002 AUDIOMETER GSI MODEL AUDIOSTAR PRO- CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 1003 MAICO AUDIOMETER MODEL MA42 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1004 BELTONE AUDIOMETER MODEL 119 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 1005 MAICO TYMPANOMETER MODEL MI-24 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1006 OTODYNAMICS ECHOPORTS MODEL ILO292 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 1007 ICS MEDICAL CHARTR MODEL MCU-90 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1008 GN OTOMETRICS CALORIC IRRIGATOR MODEL NCI 480 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1009 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR MODEL NCA 20 - VERIFICAITON 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1010 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1011 MICROMEDICAL MODEL FIREWIRE VNG -VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1012 GN OTOMETRICS MODEL ICS CHARTR 200 (INCL. VNG AND ABR "AUDIOTORY BRAIN STEM RESPONSE") - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1013 MICROMEDICAL ROTATIONAL CHAIR MODEL SYSTEM 2000 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1014 AUDIOSCAN MODEL RM 500 - CALIIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 1015 AUDIOSCAN MODEL RM 500SL - CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 1016 SOUNDROOMS CERTIFICATIONS 4.00 EA $___________ $___________ LOCATION: SAN JUAN 1017 TYMPANOMETERS MODEL TYMPSTAR V2 - CALIBRATION 5.00 EA $___________ $___________ LOCATION: SAN JUAN 1018 AUDIOSCAN MODEL RM 500SL - CALIBRATION 2.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 1019 GSI AUDIOMETERS MODEL 61 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 1020 TYMPANOMETERS MODEL TYMPSTAR V1 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 1021 SOUNDROOM - CERTIFICATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 1022 GN OTOMETRICS AUDIOMETER MODEL ASTERA - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 1023 GN OTOMETRICS TYMPANOMETER MODEL OTOFLEX - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 1024 GN OTOMETRICS REAL EAR MODEL FREE FITS - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC OPTION PERIOD 1 GRAND TOTAL______________________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 2001 OPTION 2: FROM 04/20/2017 to 03/19/2018. PREVENTIVE MAINTENANCE AND SERVICES AS PER SCOPE OF WORK ON THIS RFQ FOR THE FOLLOWING AUDIOLOGY EQUIPMENT: AUDIOMETER GSI MODEL 61 - CALIBRATION 4.00 EA $___________ $___________ LOCATION: SAN JUAN 2002 AUDIOMETER GSI MODEL AUDIOSTAR PRO- CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 2003 MAICO AUDIOMETER MODEL MA42 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2004 BELTONE AUDIOMETER MODEL 119 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 2005 MAICO TYMPANOMETER MODEL MI-24 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2006 OTODYNAMICS ECHOPORTS MODEL ILO292 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 2007 ICS MEDICAL CHARTR MODEL MCU-90 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2008 GN OTOMETRICS CALORIC IRRIGATOR MODEL NCI 480 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2009 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR MODEL NCA 20 - VERIFICAITON 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2010 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2011 MICROMEDICAL MODEL FIREWIRE VNG -VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2012 GN OTOMETRICS MODEL ICS CHARTR 200 (INCL. VNG AND ABR "AUDIOTORY BRAIN STEM RESPONSE") - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2013 MICROMEDICAL ROTATIONAL CHAIR MODEL SYSTEM 2000 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2014 AUDIOSCAN MODEL RM 500 - CALIIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 2015 AUDIOSCAN MODEL RM 500SL - CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 2016 SOUNDROOMS CERTIFICATIONS 4.00 EA $___________ $___________ LOCATION: SAN JUAN 2017 TYMPANOMETERS MODEL TYMPSTAR V2 - CALIBRATION 5.00 EA $___________ $___________ LOCATION: SAN JUAN 2018 AUDIOSCAN MODEL RM 500SL - CALIBRATION 2.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 2019 GSI AUDIOMETERS MODEL 61 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 2020 TYMPANOMETERS MODEL TYMPSTAR V1 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 2021 SOUNDROOM - CERTIFICATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 2022 GN OTOMETRICS AUDIOMETER MODEL ASTERA - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 2023 GN OTOMETRICS TYMPANOMETER MODEL OTOFLEX - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 2024 GN OTOMETRICS REAL EAR MODEL FREE FITS - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC OPTION 2 GRAND TOTAL______________________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 3001 OPTION YEAR 3: FROM 04/20/2018 to 03/19/2019. PREVENTIVE MAINTENANCE AND SERVICES AS PER SCOPE OF WORK ON THIS RFQ FOR THE FOLLOWING AUDIOLOGY EQUIPMENT: AUDIOMETER GSI MODEL 61 - CALIBRATION 4.00 EA $___________ $___________ LOCATION: SAN JUAN 3002 AUDIOMETER GSI MODEL AUDIOSTAR PRO- CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 3003 MAICO AUDIOMETER MODEL MA42 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3004 BELTONE AUDIOMETER MODEL 119 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 3005 MAICO TYMPANOMETER MODEL MI-24 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3006 OTODYNAMICS ECHOPORTS MODEL ILO292 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 3007 ICS MEDICAL CHARTR MODEL MCU-90 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3008 GN OTOMETRICS CALORIC IRRIGATOR MODEL NCI 480 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3009 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR MODEL NCA 20 - VERIFICAITON 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3010 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3011 MICROMEDICAL MODEL FIREWIRE VNG -VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3012 GN OTOMETRICS MODEL ICS CHARTR 200 (INCL. VNG AND ABR "AUDIOTORY BRAIN STEM RESPONSE") - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3013 MICROMEDICAL ROTATIONAL CHAIR MODEL SYSTEM 2000 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3014 AUDIOSCAN MODEL RM 500 - CALIIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 3015 AUDIOSCAN MODEL RM 500SL - CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 3016 SOUNDROOMS CERTIFICATIONS 4.00 EA $___________ $___________ LOCATION: SAN JUAN 3017 TYMPANOMETERS MODEL TYMPSTAR V2 - CALIBRATION 5.00 EA $___________ $___________ LOCATION: SAN JUAN 3018 AUDIOSCAN MODEL RM 500SL - CALIBRATION 2.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 3019 GSI AUDIOMETERS MODEL 61 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 3020 TYMPANOMETERS MODEL TYMPSTAR V1 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 3021 SOUNDROOM - CERTIFICATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 3022 GN OTOMETRICS AUDIOMETER MODEL ASTERA - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 3023 GN OTOMETRICS TYMPANOMETER MODEL OTOFLEX - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 3024 GN OTOMETRICS REAL EAR MODEL FREE FITS - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC OPTION 3 GRAND TOTAL______________________ ? ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 4001 OPTION YEAR 4: FROM 04/20/2019 to 03/19/2020. PREVENTIVE MAINTENANCE AND SERVICES AS PER SCOPE OF WORK ON THIS RFQ FOR THE FOLLOWING AUDIOLOGY EQUIPMENT: AUDIOMETER GSI MODEL 61 - CALIBRATION 4.00 EA $___________ $___________ LOCATION: SAN JUAN 4002 AUDIOMETER GSI MODEL AUDIOSTAR PRO- CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 4003 MAICO AUDIOMETER MODEL MA42 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4004 BELTONE AUDIOMETER MODEL 119 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 4005 MAICO TYMPANOMETER MODEL MI-24 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4006 OTODYNAMICS ECHOPORTS MODEL ILO292 - CALIBRATION 2.00 EA $___________ $___________ LOCATION: SAN JUAN 4007 ICS MEDICAL CHARTR MODEL MCU-90 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4008 GN OTOMETRICS CALORIC IRRIGATOR MODEL NCI 480 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4009 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR MODEL NCA 20 - VERIFICAITON 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4010 GN OTOMETRICS ICS AIR CALORIC IRRIGATOR - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4011 MICROMEDICAL MODEL FIREWIRE VNG -VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4012 GN OTOMETRICS MODEL ICS CHARTR 200 (INCL. VNG AND ABR "AUDIOTORY BRAIN STEM RESPONSE") - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4013 MICROMEDICAL ROTATIONAL CHAIR MODEL SYSTEM 2000 - VERIFICATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4014 AUDIOSCAN MODEL RM 500 - CALIIBRATION 1.00 EA $___________ $___________ LOCATION: SAN JUAN 4015 AUDIOSCAN MODEL RM 500SL - CALIBRATION 3.00 EA $___________ $___________ LOCATION: SAN JUAN 4016 SOUNDROOMS CERTIFICATIONS 4.00 EA $___________ $___________ LOCATION: SAN JUAN 4017 TYMPANOMETERS MODEL TYMPSTAR V2 - CALIBRATION 5.00 EA $___________ $___________ LOCATION: SAN JUAN 4018 AUDIOSCAN MODEL RM 500SL - CALIBRATION 2.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 4019 GSI AUDIOMETERS MODEL 61 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 4020 TYMPANOMETERS MODEL TYMPSTAR V1 - CALIBRATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 4021 SOUNDROOM - CERTIFICATION 1.00 EA $___________ $___________ LOCATION: MAYAGUEZ OUTPATIENT CLINIC 4022 GN OTOMETRICS AUDIOMETER MODEL ASTERA - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 4023 GN OTOMETRICS TYMPANOMETER MODEL OTOFLEX - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC 4024 GN OTOMETRICS REAL EAR MODEL FREE FITS - CALIBRATION 1.00 EA $___________ $___________ LOCATION:PONCE OUTPATIENT CLINIC OPTION 4 GRAND TOTAL______________________ BASE + OPTION YEARS GRAND TOTAL _____________ B.5 Delivery Schedule ITEM NUMBER QUANTITY DELIVERY DATE 0001 4.00 0002 3.00 0003 1.00 0004 2.00 0005 1.00 0006 2.00 0007 1.00 0008 1.00 0009 1.00 0010 1.00 0011 1.00 0012 1.00 0013 1.00 0014 1.00 0015 3.00 0016 4.00 0017 5.00 0018 2.00 0019 1.00 0020 1.00 0021 1.00 0022 1.00 0023 1.00 0024 1.00

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