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The Department of Veterans Affairs

Federal Supply Service

Authorized Federal Supply Schedule Price List

VA FSS Contract V797D-40225

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Schedule: 65II A – Medical Equipment and Supplies

FSC Group 65

FSC Class: 6515

Contract Number: V797D-40225

For more information on ordering Federal Supply Schedules visit .

Contract Period August 15, 2014 – August 14, 2019

Contractor Belmont Instrument Corporation

780 Boston Road, Billerica MA 01821

Phone: 866.663.0212

Fax: 978.663.0214



Contract Administration Source Jola McCarthy

Phone:  978-663-0212 ext. 124

Fax:  978-663-0214

email:  jmccarthy@

Business Size Small

Tax Identification Number (TIN) 04-270-5177

780 Boston Road, Billerica, MA 01821 | T: 866.663.0212 | F: 978.663.0214 |

Customer Information

1. Table of awarded special item number(s) with appropriate cross reference to page number(s):

SIN Page

A-43 4

2. Maximum Order: $50,000

3. Minimum Order: None

4. Geographic Coverage: Domestic Delivery

5. Points of Production: Component material and equipment: Billerica, Middlesex County, Massachusetts, 01821, Sterilization: Northborough, Worcester County, Massachusetts

6. Discount: Prices shown herein are net, discount deducted

7. Quantity Discount: See attached pricing schedule

8. Prompt Payment Terms: Net 30 days, Credit Cards excluded

9a. Government purchase cards are accepted at the micro-purchase threshold

9b. Government purchase cards are accepted above the micro-purchase threshold

10. Foreign Items: None

11a. Time of Delivery: 45 days after receipt of order (ARO)

11b. Expedited Delivery: 1 day After Receipt of Order (ARO). Ordering facilities are required to pay the difference between normal and expedited delivery charges.

12. FOB Point(s): FOB Destination, all 50 states, including the District of Columbia, Alaska, Hawaii and Puerto Rico

13a. Ordering Address: Belmont Instrument Corporation, 780 Boston Road, Billerica, MA 01821 phone: 978-330-7624; email: jmccarthy@; fax: 978-663-0214

13b. Ordering Procedures: Ordering procedures, information on Blanket Purchase Agreements (BPA), and a sample BPA can be found at the GSA/FSS Schedule homepage at

14. Payment Address: P.O. Box 3219, Boston, MA 02241-3219

15a. Warranty Policy: see attached

15b. Return/Exchange Goods Policy: If a shipping error occurs due to Contractor’s error, the Contractor will pay freight both ways for return/exchange of goods. If an ordering facility error occurs, the ordering facility will pay return freight. Please note Disposables are not returnable. Please call Belmont’s customer service department for a return authorization (RA#) at 1-866-663-0212. Returns will be credited back by the same method of purchase- Government Credit card or Automated Clearing House (ACH) or Electric Funds Transfer (EFT) payment.

16. Export Packing Charges: N/A

17. Terms and Conditions of Government Purchase Card Acceptance: See #9a-b, no additional terms.

18. Terms and Conditions of Rental, Maintenance, and Repair: Not Offered

19. Terms and Conditions of Installation/Training: Quick reference guides and manuals are included with all products. Free training is available upon request in the Contiguous U.S.

20. Terms and Conditions of Repair Parts Indicated Date of Parts Price Lists and Any Discounts from List Prices: See attached price list

20a. Terms and Conditions for Any Other Services: N/A

21. List of Service and Distribution Points: N/A

22. List of Participating Dealers: None

23. Preventive Maintenance: See Operators/Service Manual for Instructions

24a. Special Attributes: N/A

24b. Section 508 Compliance Information: No

25. DUNS Number: 07-8330362

26. Notification Regarding Registration in the Central Contract Registration (CCR) Database: CCR registration number - yes

Belmont Instrument Corporation

V797D-40225

|SIN |Product Number |Description |Unit Of Measure |QTY |FSS Net Price |

|  |  |  |  | |  |

|A-43 |903-00001 |Fluid Management System |EA |1 |$18,115.58 |

| | | | |5 |$16,995.00 |

| | | | |10 |$16,377.00 |

| | | | |25 |$15,965.00 |

| | | | |50 |$15,639.52 |

|A-43 |903-00006 |Universal 3-Spike Disposable Set |CS |1 |$1,268.09 |

| | | | |10 |$12,17.46 |

| | | | |25 |$1,196.86 |

|A-43 |903-00004 |Dual Patient Line |CS |1 |$154.24 |

| | | | |5 |$150.38 |

|A-43 |101-00021A |FMS 2000 Repair Part-Battery Set (2) |EA | |$51.76 |

|A-43 |106-00008 |FMS 2000 Repair Part-Display |EA | |$615.93 |

|A-43 |202-00060 |FMS 2000 Repair Part- Membrane Panel |EA | |$258.79 |

|A-43 |403-00111 |FMS 2000 Repair Part – Valve Motor |EA | |$356.85 |

|A-43 |403-00110 |FMS 2000 Repair Part – Pump Motor |EA | |$595.10 |

|A-43 |402-00031A |FMS 2000 Repair Part – CPU PCB Assembly |EA | |$697.06 |

|A-43 |402-00032 |FMS 2000 Repair Part – AC/DC PCB Assembly |EA | |$753.24 |

|A-43 |403-00104 |FMS 2000 Repair Part – Pump Hub Assembly |EA | |$676.24 |

|A-43 |399-00033 |FMS 2000 Repair Part – Fan Guard |EA | |$7.29 |

|A-43 |401-00172 |FMS 2000 Repair Part – Power Cord |EA | |$57.22 |

|A-43 |403-00132 |FMS 2000 Repair Part – Power Driver Module |EA | |$2980.68 |

|A-43 |310-00017 |FMS 2000 Repair Part – Transducer |EA | |$117.56 |

|A-43 |203-00114 |FMS 2000 Repair Part – Heater Disk |EA | |$134.21 |

|A-43 |203-00276 |FMS 2000 Repair Part – Gasket for Ceramic Disk |EA | |$7.29 |

|A-43 |403-00116 |FMS 2000 Repair Part – Valve Pincher Assembly |EA | |$83.23 |

|A-43 |403-00158 |FMS 2000 Repair Part-Temperature Probe Assembly |EA | |$187.27 |

|A-43 |403-00159 |FMS 2000 Repair Part – Out put Temperature Probe Assembly |EA | |$197.67 |

|A-43 |402-00034A |FMS 2000 Repair Part – Daughter PCB Assembly |EA | |$1456.53 |

|A-43 |905-00001 |Buddy fluid warmer |EA |1 |$1455.49 |

| | | | |5 |$1,287.50 |

| | | | |10-25 |$1,184.50 |

|A-43 |905-00010 |Disposable set for fluid warmer |CS |1 |$343.83 |

| | | | |50 |$306.94 |

|A-43 |903-00018 |Cardiotomy Reservoir |CS |1 |$551.40 |

| | | | |5 |$527.36 |

STANDARD WARRANTY AGREEMENT

The device is warranted to the original purchaser to be free from defects in material and workmanship for a period of one year from date of shipment. If the device proves to be so defective, the purchaser may return same to Belmont Instrument, or its designated agent, for repair or replacement, or have a service representative repair the unit on site, as Belmont deems appropriate. The liability of Belmont Instrument under this limited warranty does not extend to any device, which has been abused, misused or serviced by anyone other than the authorized Belmont representative.

While the device is within the stated warranty period, no unauthorized service repairs or modifications on this equipment other than that described in the Operations Manual should be attempted. Any unauthorized repairs will immediately void the remainder of the warranty.

No agent, employee or representative of Belmont Instrument Corporation, has any authority to bind Belmont Instrument Corporation, to any affirmation, representation or warranty concerning its products, and any affirmation/representation, or warranty made by any agent, employee, or representative shall not be enforceable by buyer.

Belmont Instrument Corporation’s obligation under this Agreement is to provide maintenance service in a timely manner in accordance with the terms of this agreement. Belmont Instrument Corporation accepts Government clause 52.212-4(o) (p) (Tailored) as follow.

The Contractor warrants and implies that the items delivered hereunder are merchantable and fit for use for the particular purpose described in this contract. In the event that the terms of the contractor’s standard commercial warranty conflict with the warranty terms contained in this clause, the terms of this clause will govern this contract, unless some other resolution is specified in the award document.

Except as otherwise provided by an express warranty, the contractor will not be liable to the Government in a breach of warranty action for consequential damages resulting from any defect or deficiencies in accepted items. In the event that the terms of the contractor’s standard commercial warranty/limitation of liability clause(s) place greater limits on the contractor’s liability than do the terms contained in this clause, the terms of this clause will govern the contract.

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