65--TOPCON AUDIOLOGY EQUIPMENT for Telehealth Brand Name Only

STATEMENT OF WORK BACKGROUND The attached line items are needed for the Phoenix, VAMC for the opening of two new Community Based Outpatient Clinics (CBOC)s. This is an RFI to determine if verified SDVOSB or VOSB sources are available to provide this requirement. Please respond if you intent to quote. Please do not submit a full quote at this time, just submit a $0. Quote with statement of intent to quote. SCOPE OF WORK: The contractor shall provide all line items to Phoenix VAMC as stated in the following pages. The Manufacturer must be Topcon. This is a BRAND NAME ONLY Request. Contractor will supply all items and quantities listed in B.4 Price/Cost Schedule and Item Information. All items are Brand name Topcon products or services. DELIVERY: The contractor will deliver all items and quantities per Delivery Schedule. Planed Delivery October 2017. All items will ship to Phoenix VAMC address/s listed under delivery schedule for the corresponding line item/s. VA shall not pay for freight charges exceeding $250.00, Per VAAR 847.303-1 F.O.B. origin. A copy of a packing slip will be furnished at the time the order is delivered. B.2 PRICE/COST SCHEDULE ITEM INFORMATION ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 TRC-NW400 Imaging System w/ImageNet Software MANUFACTURER PART NUMBER (MPN): TRC-NW400 2.00 EA _____________ ______________ 0002 Upgrade to AIT-250W Wheelchair Accessible Table (MPN): 25042-11-001 2.00 EA _____________ ______________ 0003 OS-200 Operator Stool of Operator/Patient Stool Set (MPN): 26006-BL-000 2.00 EA _____________ ______________ 0004 OS-400 Patient Stool of Operator/Patient Stool Set (MPN): 2614-BL-000 2.00 EA _____________ ______________ 0005 Installation and Training - on site VA Midtown CBOC at Camelback Medical Plaza 5040 N 15TH AVE, PHOENIX, AZ 85015 1.00 EA _____________ ______________ 0006 Installation and Training - on site VA SW CBOC at Algodon Medical Office Park 9250 W. Thomas Rd., Phoenix, AZ 85037 1.00 EA _____________ ______________ 0007 Three year warranty with certified internet access 1.00 ea _____________ ______________ 0008 USER MANUALS 2.00 EA _____________ ________________ 0009 OPERATOR'S, SERVICE AND REPAIR PARTS MANUALS, ONE HARD COPY ONE ELECTRONIC (IF AVAILABLE) SENT VIA E-MAIL 2.00 ea _____________ ______________ GRAND TOTAL ______________