6640--INTENT TO SOLE SOURCE TO OLYMPUS AMERICA, INC. Olympus Urology Equipment Lease (VA-20-00033211)

Statement of Work Oscar G Johnson VA Urology Equipment/Scope Lease Background The Oscar G Johnson VA has hired a Urologist and is requesting to obtain Olympus Urology Scopes to perform urology procedures within the OGJ VA facility. The current inventory of urology scopes is at or near the end of life usage. The lease includes all equipment listed below: Quantity Model Number Equipment One(1) 00102.1 00102.1 STOPCOCK LUER LOCK One (1) 00102.1 00102.1 STOPCOCK LUER LOCK Three (3) WA03300A Light-guide cable 2.8 mm 3 m CF type One (1) A5976 A5976 TRAY INSERT UROLOGY PRE- MOLDED One (1) MAJ-1921 MAJ-1921 VISERA ELITE KEYBOARD Two (2) MR-6LA MR-6LA URETEROSCOPE, 43cm Three (3) A20972A A20972A ALBARRAN DEF BR IDGE DOUBLE CH Six (6) CYF-VHR CYF-VHR HD FlexCystoNephroVideoscope Re Three (3) OTV-S7PROH-HD-10E OTV-S7PROH-HD-10E CAM HEAD 1.0X EYEPIECE Two (2) MRA-GT MRA-GT SLIMLINE GAS STER & STORAGE TRAY Two (2) WA05974A WA05974A LID FOR WA05971A AND EA05972A One (1) WA05974A WA05974A LID FOR WA05971A AND EA05972A Two (2) URF-V3R URF-V3R URETEROSCOPE, FLEX, VIDEO, REV One (1) WB91051W WB91051W ESG-400 ELECTROSURGICAL GEN One (1) WA20021A WA20021A TELESCOPE 4MM LONG 12DEG One (1) WA20023A WA20023A TELESCOPE 4MM 70DEG LONG One (1) WA22367A WA22367A PASSIVE WORKING ELEMENT TURIS One (1) WA22017T WA22017T Inner SHEATH LONG W DEF TIP One (1) A22051A A22051A IRRIGATION PORT 1 STOPCOCK ROT One (1) WA22016A WA22016A OBTURATOR OPTICAL 24Fr LONG One (1) WA22018A WA22018A SHEATH OUTER LONG 27FR One (1) WA22019A WA22019A SHEATH OUTER LONG ROT 27FR One (1) A22093A A22093A BRIDGE FOR 70DEG TELE AND RESECT One (1) WA05970A WA05970A HIQ+ STERILIZATION TRAY W/ LID One (1) A5976 A5976 TRAY INSERT UROLOGY PRE- MOLDED Two (2) WA2T470A Telescope "OES Elite", 4 mm, 70 deg, HD, One (1) 13839 13839 Aptimax Sterrad Sterilization Tray Eight (8) 99240 99240 APTIMAX STERRAD Ster. Tray Holder Three (3) 00102.1 00102.1 STOPCOCK LUER LOCK Two (2) 00102.1 00102.1 STOPCOCK LUER LOCK One (1) CLV-190 CLV-190 EVIS EXERA III LIGHT SOURCE One (1) LMD-X310S LMD-X310S 31 inch 4K Sony Monitor One (1) K10021612 K10021612 WM-NP2 WORKSTATION SI STD SET One (1) OEP-5 OEP-5 HD OLYMPUS PRINTER One (1) MAJ-1951 MAJ-1951 SDI CABLE 2.5M One (1) MAJ-1918 MAJ-1918 REMOTE CABLE PERIPH DEVICE 1.8M One (1) WA2T412A Telescope "OES Elite", 4 mm, 12 deg, HD, Three (3) WA2T430A Telescope "OES Elite", 4 mm, 30 deg,HD,g Three (3) WA2T470A Telescope "OES Elite", 4 mm, 70 deg, HD, Two (2) A20934A A20934A CYSTO SHEATH 22.5F STR TIP Two (2) A20924A A20924A VISUAL OBTURATOR 22.5 FR Two (2) A20915A A20915A CYSTO SHEA TH 25FR Two (2) A20925A A20925A VISUAL OBTURATOR 25 FR Three (3) A20931A A20931A CYSTO SHEATH 17FR STRT TIP Three (3) A20713A A20713A BIOPSY FRCPS SPOON TYPE OPTICAL Three (3) A20718A A20718A GRASPING FRCPS OPTICAL 12/30 DEG Three (3) WA05970A WA05970A HIQ+ STERILIZATION TRAY W/ LID Three (3) A5976 A5976 TRAY INSERT UROLOGY PRE- MOLDED Two (2) A22026A A22026A OUTER SHEATH 2 STPCCK ROT 26FR Two (2) WA22367A WA22367A PASSIVE WORKING ELEMENT TURIS Two (2) WA2T430A Telescope "OES Elite", 4 mm, 30 deg,HD,g Two (2) A5976 A5976 TRAY INSERT UROLOGY PRE- MOLDED The lease also includes the trade in assets of $13,020. Below is a list of equipment that will be turned in. Trade-In Olympus A22001A : A22001A TELESCOPE 12 DEGREES 4MM XL00159 1 $(480.00) Trade-In Olympus A22001A : A22001A TELESCOPE 12 DEGREES 4MM 503286 1 $(480.00) Trade-In Olympus A22002A : A22002A TELESCOPE 30 DEGREES 4 MM 543555 1 $(480.00) Trade-In Olympus CLV-S190 : CLV-S190 VISERA ELITE XENON LIGHT SRCE 7202322 1 $(2,420.00) Trade-In Olympus OTV-S190 : OTV-S190 VISERA ELITE VIDEO SYSTEM CNTR 7232150 1 $(2,420.00) Trade-In Olympus MR-6LA : MR-6LA URETEROSCOPE, 43cm 202591 1 $(480.00) Trade-In Olympus URF-V : URF-V Flex UreteroReno Videoscope 2800323 1 $(1,940.00) Trade In Olympus OTV-S7PROH-HD-12E : OTV-S7PROH-HD- 12E CAM Head Piece 1.2X EYEPIECE 7805478 1 $(720.00) Trade_In Olympus OTV-S7PROH-HD-12E : OTV-S7PROH-HD-12E CAM HEAD 1.2X EYEPIECE 7805551 1 $(720.00) Trade-In Olympus N3828430 : CYF-VH HD Flex CystoNephro Videoscope 2301109 1 $(480.00) Trade-In Olympus N3828430 : CYF-VH HD Flex CystoNephro Videoscope 2301112 1 $(480.00) Trade-In Olympus N3828430 : CYF-VH HD Flex CystoNephro Videoscope 2301113 1 $(480.00) Trade-In Olympus N3828430 : CYF-VH HD Flex CystoNephro Videoscope 2301114 1 $(480.00) Trade-In - Olympus N3828430 : CYF-VH HD Flex CystoNephro Videoscope 2301115 1 $(480.00) Trade-In - Olympus N3828430: CYF-VH HD Flex CystoNephro Vodeoscope 2301110 1 $(480.00) Scope: Contractor shall provide full lease of the above equipment to include preventative maintenance, repair service, training and support of above equipment for OGJ VA. The term of the lease period shall begin on or about May 25, 2020 for a period of a base year, plus two (2) pre-priced option year periods in strict accordance with all specifications, schedules, terms, conditions, clauses and provisions of the statement of work and the resulting contract document Olympus Quote number Q-00901246. All equipment and training needs to be completed by June 1st, 2020. Contractor shall provide a value added maintenance service for the full lease period for a period of a base year on or about May 25, 2020, plus two (2) pre-priced option periods in in strict accordance with all specifications, schedules, terms, conditions, clauses and provisions of this statement of work and Olympus Quote number Q-00901827. Specific tasks: 3.1 Training: The Contractor/Service Rep shall provide initial training to approximately 25 clinician and reprocessing personnel, including the Sterile Processing Service and Biomedical Engineering. Clinician and reprocessing personnel training shall include the use, handling, and reprocessing of the leased equipment. This training shall be onsite and provided by the Contractor/Service Rep a minimum of two different dates to accommodate the number of personnel and schedules as requested and agreed upon by both parties. Contractor will be responsible for providing all equipment and course materials to provide the training. Contractor shall provide full access to web-based Preventive Maintenance and Educational Courses for the duration of the contract. 3.2 Maintenance & Repair: Full repair coverage with no cap for all contracted equipment, including accidental damage coverage at no extra charge -Prioritized repairs, typically with 24 - 48 hour turnaround -Next day shipping in both directions included at no extra charge -24/7 technical support: Weekdays 7:00 a.m. - 8:00 p.m. ET at (800) 848-9024 or all other times at (877) 624-7267 -Online repair tracking and history at www.olympusamerica.com/serviceportal -Periodic and on-demand training and support provided by Olympus Endoscopy Support Specialists -Full access to preventative maintenance and educational courses offered through Olympus University - Prioritized access to loaner equipment (available upon request and subject to availability) at no extra charge -Service Contracts administrative support: Weekdays 8:30 a.m. - 5:30 p.m. ET by phone at (800) 401-1075, by fax at (484) 896-7135 or by email at [email protected]