B-FSS-96 Estimated Sales (Nov 1997) - Veterans Affairs



04 - VENDOR RESPONSE DOCUMENTALL OFFERORS MUST COMPLETE THIS DOCUMENT.PLEASE UTILIZE THE CHECKLIST ON PAGE 10 OF THE READ ME FIRST DOCUMENT.TABLE OF CONTENTSFormsSignatory Authority Form 2Agent Authorization 4SF-1449 5Continuation of SF-1449 Blocks 19-21, Schedule of Items 7B-FSS-96 Estimated Sales (Nov 1997) 8L-FSS-400 Introduction of New Services/Products (INSP) (Nov 2000) 8NAICS Code Designation 9ACH Vendor/Miscellaneous Payment Enrollment Form & Instructions 10Information / Clauses Applicable Only To Offers For SIN 42-2aManufacturer’s FSS Price List Election Form under Public Law 102-585 12Master Agreements and Pharmaceutical Pricing Agreements (Sep 2010) 14Public Law 102-585, Section 603, First Year Designation for Multi-Year Covered Drug Contracts 14552.238-78 Scope of Contract (Eligible Ordering Activities) (Sep 2008, Alt, I – Feb 2007) 15AS8005 Manufacturing Facilities / Place of Performance (Sep 2010) 17I-FSS-644 Dealers and Suppliers (Oct 1988) 23552.211-78 Commercial Delivery Schedule (Multiple Award Schedule) (Feb 1996, Tailored) 24F-FSS-202-G Delivery Prices (Jan 1994) 2552.216-19 Order Limitations (Oct 1995, Dev. II – Feb 2007) (Tailored) 26Minimum Acceptable Order Proposal 26Utilization of Dealers/Distributors/Specialty Distributors 27552.232-82 Contractor’s Remittance (Payment) Address (May 2003) 27K-FSS-9 Section 8(a) Representation for the MAS Program (Sep 2000) 27HYPERLINK \l "HazMatlIdent"52.223-3 Hazardous Material Identification and Material Safety Data (Jan 1997, Alt. I – July 1995) 2852.215-6 Place of Performance (Oct 1997) 30K-FSS-1 Authorized Negotiators (Mar 1998) 30G-FSS-900-C Contact for Contract Administration (Jul 2003) 31Contact for Sales Administration (Mar 2011) 32Supplemental Commercial Practices Information 32Compliance Confirmation 3452.209-7 Information Regarding Responsibility Matters (Jul 2013) 34Program ParticipationAmerican Recovery and Reinvestment Act Program Participation 36Recovery Purchasing Election 36Direct-To-Patient Distribution Program Participation (Jun 2012) 37AS5000 Pharmaceutical Prime Vendor Participation (Sep 2011) 38Public Health Emergencies Participation Election 38SIGNATORY AUTHORITY FOR OFFERS AND CONTRACTS / COMPANY INFORMATIONThe purpose of this document is to clearly identify who has been delegated the authority to sign your Federal Supply Schedule (FSS) offer or contract on behalf of the named firm as well as identify pertinent company information. Pursuant to our policy, the only person(s) with the ability to delegate authority is an officer of the company. Therefore, please list the officers of the company in block 6 of the form. In block 7, please list those persons to whom authority has been delegated to sign, negotiate and/or administer your Federal Supply Schedule (FSS) offer or contract. Finally, blocks 15, 16, 17 must be signed by an officer of the company (individual listed in block 6) in order for our office to accept the authority. If you require additional space, you may use a properly titled attachment.NOTE: All items must be completed; insert N/A if information is not applicable. Definitions are provided on page 2.1. TYPE2. DATE3. SOLICITATION4. CONTRACT # FORMCHECKBOX INITIAL FORMCHECKBOX REVISION FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????5. COMPANY INFORMATIONA. NAME FORMTEXT ?????B. STREET ADDRESS FORMTEXT ?????C. CITY FORMTEXT ?????D. STATE FORMTEXT ?????E. ZIP CODE FORMTEXT ?????F. TYPE OF ORGANIZATION (Check one) FORMCHECKBOX SOLE PROPRIETORSHIP FORMCHECKBOX NON-PROFIT ORGANIZATION FORMCHECKBOX PARTNERSHIP FORMCHECKBOX CORPORATION STATE OF INCORPORATION: FORMTEXT ????? FORMCHECKBOX LLC (LIMITED LIABILITY COMPANY) STATE OF FORMATION: FORMTEXT ?????6. NAMES OF OFFICERS, OWNERS, OR PARTNERSA. PRESIDENT FORMTEXT ?????B. VICE PRESIDENT FORMTEXT ?????C. SECRETARY FORMTEXT ?????D. TREASURER FORMTEXT ?????E. OWNERS OR PARTNERS FORMTEXT ?????7. PERSONS AUTHORIZED TO SIGN OFFERS AND CONTRACTS ON BEHALF OF THE COMPANY (Indicate if Agent)NAMEOFFICIAL CAPACITYTELEPHONE NUMBER FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????8. BUSINESS INFORMATION (See definitions on reverse)A. SIZE OF BUSINESS FORMCHECKBOX SMALL BUSINESS (Complete block 9) FORMCHECKBOX OTHER THAN SMALL BUSINESS B. AVERAGE NUMBER OF EMPLOYEES (Including affiliates) FOR FOUR (4) PRECEDING CALENDAR QUARTERS FORMTEXT ?????C. AVERAGE ANNUAL COMPANY SALES OR RECEIPTS FOR PRECEDING THREE (3) FISCAL YRS $ FORMTEXT ?????9. TYPE OF OWNERSHIP (See definitions on reverse)10. TYPE OF BUSINESS (See definitions on reverse) FORMCHECKBOX DISADVANTAGED BUSINESS FORMCHECKBOX WOMEN-OWNED BUSINESS FORMCHECKBOX HUBZONE SMALL BUSINESS FORMCHECKBOX VETERAN-OWNED BUSINESS FORMCHECKBOX VERY SMALL BUSINESS FORMCHECKBOX SERVICE DISABLED VETERAN FORMCHECKBOX 8(A) FORMCHECKBOX NONE OF THE ABOVE FORMCHECKBOX MANUFACTURER / PRODUCER FORMCHECKBOX SERVICE ESTABLISHMENT FORMCHECKBOX DEALER FORMCHECKBOX DISTRIBUTOR11. IDENTIFICATION NUMBERS (if applicable):12. HOW MANY YEARS IN PRESENT BUSINESSDUN & BRADSTREET: FORMTEXT ?????TAX IDENTIFICATION NUMBER: FORMTEXT ????? FORMTEXT ?????13. FLOOR SPACE (In square feet)14. NET WORTHA. MANUFACTURING FORMTEXT ?????B. WAREHOUSE FORMTEXT ?????A. DATE FORMTEXT ?????B. AMOUNT FORMTEXT ?????CERTIFICATION -- I certify that information supplied herein (including all pages attached) is correct and that neither the company nor any person (for concern) in any connection with the company as a principal or officer, so far as it known, is now debarred or otherwise declared ineligible by any agency of the Federal Government from making offers for furnishing materials, supplies, or services to the Government or any agency thereof.15. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN (TYPE/PRINT)16. SIGNATURE17. DATE SIGNED FORMTEXT ????? FORMTEXT ?????DEFINITIONSSIZE OF BUSINESS (See Item 8A.)Small business concern – A small business concern for the purpose of Government procurement is a concern, including its affiliates, which is independently owned and operated, is not dominant in the field of operation in which it is competing for government contracts and can further qualify under the criteria concerning number of employees, annual average gross revenue, or other criteria, as prescribed by the Small Business Administration. (See Code of Federal Regulations, Title 13, Part 121, as amended, which contains detailed industry definitions and related procedures.)Affiliates – means associated business concerns or individuals, if directly or indirectly, either one controls or has the power to control the other, or another concern controls or has the power to control both. In determining whether affiliation exists, consideration is given to all appropriate factors including common ownership, common management, and contractual relationships; provided, that restraints imposed by a franchise agreement are not considered in determining whether the franchisor controls or has power to control the franchisee, if the franchisee has the right to profit from its effort, commensurate with ownership, and bears the risk or loss or failure. Any business entity may be found to be an affiliate, whether or not it is organized for profit or located inside the United States. (See item 8B.)Number of employees – (Item 8B) In connection with the determination of small business status, number of employees means the average employment of any concern, including the employees of its domestic and foreign affiliates, based on the number of persons employed on a full-time, part-time, temporary, or other basis during each of the pay periods of the preceding 12 months. If a concern has not been in existence for 12 months, number of employees means the average employment of such concerns and its affiliates during the period that such concern has been in existence based on the number of persons employed during each of the pay periods of the period that such concern has been in business.TYPE OF BUSINESS (See Item 10.)Manufacturer or producer – means a person (or concern) owning, operating, or maintaining a store, warehouse, or other establishment that produces, on the premises, the materials, supplies, articles, or equipment of the general character of those listed in Item 10, or in the Federal Agency’s Supplemental Commodity List, if attached.Service Establishment – means a concern (or person) which owns, operates, or maintains any type of business which is principally engaged in the furnishing of nonpersonal services, such as (but not limited to) repairing, cleaning, redecorating, or rental of personal property, including the furnishing of necessary repair parts or other supplies as part of the services performed.TYPE OF OWNERSHIP (See Item 9.)Disadvantaged Small Business – means an offeror that represents as part of its offer, that it is a small business under the size standard applicable to the acquisition and either it has received certification as small disadvantaged business concern consistent with 13 CFR part 124 subpart b; and no materiel change in disadvantaged ownership and control has occurred since its certification; where the concern is owned by one or more disadvantaged individuals the net worth of each individual upon whom the certification is based does not exceed $750,000 after taking into account their applicable exclusion set forth at 13 CFR 124.104(c)(2) and it is identified on the date of its representation as a certified small disadvantage business concern in the database maintained by the Small Business Administration (Pro-Net).HUBZone Small Business – means a historically underutilized business zone which is an area located within one or more qualified census tracts, qualified nonmetropolitan counties or lands within the external boundaries of an Indian reservation. A small business concern that appears on the List of Qualified HUB Zone Small Business Concerns maintained by the SBA.Veteran-Owned Small Business – means not less than 51 percent of which is owned by one or more veteran or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and the management and daily business operations of which are controlled by one or more veterans. Women-Owned Small Business – means a small business concern which is at least 51 percent owned by one or more women or in the case of any publicly owned business at least 51 percent of the stock of which is owned by one or more women; and whose management and daily business operations are controlled by one or more women.Service Connected Disabled Veteran-Owned Small Business – A business that is at least 51 percent owned by a person(s) and managed by a service-connected disabled veteran(s) or any publicly owned small business, not less than 51 percent of the stock of which is owned by one or more service-connected disabled veteran. The term “service-connected” means, with respect to disability that such disability was incurred or aggravated in the line of duty in the active military, naval, or air service.Very Small Business – means a small business concern whose headquarters is located within the geographic area served by a designated SBA district and which together with its affiliates has no more than 15 employees and has average annual receipts that do not exceed $1 million.8(A) – Section 8(a) of the Small Business Act established a program that authorizes the Small Business Administration to enter into all types of contracts with other agencies and let subcontract for performing those contracts to firms eligible for program participation. The Small Business Administration for this program must certify you.AGENT AUTHORIZATIONThis form is to be used in conjunction with solicitation clause K-FSS-1, Authorized Negotiators, to authorize a third party agent to act on your company’s behalf in matters relating to your VA FSS proposal/contract. This form permits you to delineate agent roles and to limit those roles as needed. This form shall only be signed by an officer, owner, or partner of the offeror/contractor who is listed on the offeror/contractor’s Signatory Authority Form.For solicitation/contract number FORMTEXT , the undersigned offeror/contractor FORMTEXT hereby authorizes the below agent(s) to act as agent(s) for said offeror/contactor with said specific authority delegated from the contractor to the agent(s). The authority of the agent(s) is limited to exact and specific delegations. AGENT INFORMATION Pre- Post- AGENT AUTHORITY Award Award Agent: FORMTEXT _________________________ FORMCHECKBOX FORMCHECKBOX Signatory FORMCHECKBOX FORMCHECKBOX Negotiate ChangesPhone Number: FORMTEXT _________________________ FORMCHECKBOX FORMCHECKBOX Contract Administration FORMCHECKBOX FORMCHECKBOX Other: E-mail: FORMTEXT _________________________ FORMTEXT _________________________ AGENT INFORMATION Pre- Post- AGENT AUTHORITY Award Award Agent: FORMTEXT _________________________ FORMCHECKBOX FORMCHECKBOX Signatory FORMCHECKBOX FORMCHECKBOX Negotiate ChangesPhone Number: FORMTEXT _________________________ FORMCHECKBOX FORMCHECKBOX Contract Administration FORMCHECKBOX FORMCHECKBOX Other: E-mail: FORMTEXT _________________________ FORMTEXT _________________________DURATION OF AUTHORITY FORMCHECKBOX Agent authority valid until revoked. FORMCHECKBOX Agent authority valid for the following period: FORMTEXT _________________________Signature of Offeror/Contractor: FORMTEXT ___________________________________ Printed Name & Title: FORMTEXT ___________________________________Date: FORMTEXT _________________________SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMSOFFEROR TO COMPLETE BLOCKS 17 & 301. REQUISITION NUMBER N/APAGE 1 of 2. CONTRACT NO.3. AWARD/EFFECTIVE DATE4. ORDER NO./MODIFICATION NO. N/A5. SOLICITATION NO.M5-Q50A-03-R7 6. SOLICITATION ISSUE DATE: 2/19/20147. FOR SOLICITATION NFORMATION CALL:a. NAME:FEDERAL SUPPLY SCHEDULE HELPDESKb. TELEPHONE NO. (No Collect Calls) (708) 786-7737 8. OFFER DUE DATE /LOCAL TIME: N/A9. ISSUED BY CODE10. THIS ACQUISTION IS VA NATIONAL ACQUISITION CENTERFEDERAL SUPPLY SCHEDULE SERVICE 003A4BPO BOX 76, BLDG 37HINES, IL 60141OVERNIGHT DELIVERY SHOULD BE MAILED OR HAND DELIVERED TO THE ADDRESS LOCATED IN BLOCK 16 FORMCHECKBOX UNRESTRICTED OR FORMCHECKBOX SET ASIDE __% FOR: FORMCHECKBOX SMALL BUSINES FORMCHECKBOX WOMEN-OWNED SMALL BUSINESS (WOSB) FORMCHECKBOX HUBZONE SMALL ELIGIBLE UNDER THE WOMEN-OWNED BUSINESS SMALL BUSINESS PROGRAM FORMCHECKBOX SERVICE DISABLED FORMCHECKBOX EDWOSB FORMCHECKBOX 8(A) VETERAN OWNED Size Standards: See page 4 of the Read Me First Document SMALL BUSINESS for NAICS codes and size standards under this solicitation.11. DELIVERY FOR FOB DESTINATION UNLESS BLOCK IS MARKED FORMCHECKBOX SEE SCHEDULE12. DISCOUNT TERMS See Summary of Award FORMCHECKBOX 13a.THIS CONTRACT IS ARATED ORDER UNDERDPAS (15 CFR 700)13b. RATING14. METHOD OF SOLICITATION FORMCHECKBOX RFQ FORMCHECKBOX IFB FORMCHECKBOX RFP15. DELIVER TO CODE CODE16. ADMINISTERED BY CODE CODETO BE SHOWN ON EACH ORDER ISSUED UNDER ANY CONTRACT RESULTING FROM THIS SOLICIATIONVA NATIONAL ACQUISITION CENTER, FEDERAL SUPPLY SCHEDULE SERVICE 003A4B1ST AVENUE, 1 BLOCK NORTH OF 22ND STREET, BLDG 37 HINES, IL 6014117a. CONTRACTOR/OFFEROR CODE FACILITY CODE18a. PAYMENT WILL BE MADE BY CODE FORMTEXT ????? SEE BLOCK 15DUNS FORMTEXT ?????TELEPHONE NO. FORMTEXT ????? FORMCHECKBOX 17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED FORMCHECKBOX SEE ADDENDUM19. ITEM NO.20. SCHEDULE OF SUPPLIES/SERVICES21. QUANTITY22. UNIT23. UNIT PRICE24. AMOUNTFSC CLASSES:6505&6508 FSC Group 65, Part I, Section BDrugs, Pharmaceuticals & Hematology Related ProductsSEE CONTINUATION OF SF-1449 FOR SCHEDULE OF ITEMS(ATTACH REVERSE AND/OR ATTACH ADDITIONAL SHEETS AS NECESSARY)25. ACCOUNTING AND APPROPRIATION DATA SEE BLOCK 1526. TOTAL AWARD AMOUNT (For Govt. Use Only) ESTIMATED VALUE $ FORMCHECKBOX 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA FORMCHECKBOX ARE FORMCHECKBOX ARE NOT ATTACHED. FORMCHECKBOX 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA FORMCHECKBOX ARE FORMCHECKBOX ARE NOT ATTACHED. FORMCHECKBOX 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPY TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED. FORMCHECKBOX 29. AWARD OF CONTRACT: REFERENCE FPR OFFER DATED _________.YOUR OFFER ON SOLICITATION (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS: See Summary of Award.30a. SIGNATURE OF OFFEROR/CONTRACTOR31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) FORMTEXT ?????30c. DATE SIGNED FORMTEXT ?????31b. NAME OF CONTRACTING OFFICER (Type or print)31c. DATE SIGNEDAUTHORIZED FOR LOCAL REPRODUCTIONPREVIOUS EDITION IS NOT USABLESTANDARD FORM 1449 (REV. 2/2012)Prescribed by GSA - FAR (48 CFR) 53.21219.ITEM NO.20.SCHEDULE OF SUPPLIES/SERVICES21.QUANTITY22.UNIT23.UNIT PRICE24.AMOUNT32a. QUANTITY IN COLUMN 21 HAS BEEN FORMCHECKBOX RECEIVED FORMCHECKBOX INSPECTED FORMCHECKBOX ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE32c. DATE32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE33. SHIP NUMBER34. VOUVHER NUMBER35. AMOUNT VERIFIED CORRECT FOR36. PAYMENT FORMCHECKBOX COMPLETE FORMCHECKBOX PARTIAL FORMCHECKBOX FINAL37. NUMBERPARTIALFINAL38. S/R ACCOUNT NO.39. S/R VOUCHER NUMBER40. PAID BY41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT42a. RECEIVED BY (Print)41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER41c. DATE42b. RECEIVED AT (Location)42c. DATE REC’D (YY/MM/DD)42d. TOTAL CONTAINERSSTANDARD FORM 1449 (REV. 2/2012) BACKCONTINUATION OF SF 1449 – BLOCKS 19-21, SCHEDULE OF ITEMSSPECIAL ITEM NUMBER (SIN)DESCRIPTIONESTIMATED ANNUAL SALESCHECK ITEM OFFERED42-1Non-prescription medicated cosmetics & surgical soaps $2,130,831 FORMCHECKBOX 42-2A*Single source drug, innovator multiple source drug, and any biological product identified under Section 600.3 of Title 21, CFR*$5,781,313,023 FORMCHECKBOX 42-2BGeneric & multiple source pharmaceuticals & drugs, human blood products, & over-the-counter drugs$1,063,609,960 FORMCHECKBOX 42-3Complete IV delivery systems $1,336,304 FORMCHECKBOX 42-5Nutritional/Dietary Supplements $10,280,098 FORMCHECKBOX 622Antiseptic Liquid Skin Cleansing Detergents and Soaps; Dispensers and Accessories$4,289,505 FORMCHECKBOX INPIntroduction of New Products FORMCHECKBOX Note: When a National Contract is awarded, items that are the same or similar and appear on the FSS may be unavailable from the FSS for those authorized users that are mandatory users of the awarded National Contract. Government agencies that participate in a national committed use contract are required to purchase the products awarded on the national contract from the national contractor. Although Government agencies participating in the national contract would not be permitted to purchase the same or similar items from FSS contracts without a waiver issued by the ordering activity, any FSS contractor may maintain these items on its FSS contract for sale to all other authorized users of the schedule.* SIN 42-2A – COVERED DRUGS: A covered drug is a “branded” drug dispensed only by prescription. This includes: 1) Single-source drugs – drugs generally marketed under an original New Drug Application approved by the Food and Drug Administration (FDA); 2) Innovator multiple-source drugs – drugs that were originally marketed under an original NDA approved by the FDA; and 3) Specified biological products approved by the FDA through a biological license application (See 21 CFR 600.3 for a list). Products marketed under an abbreviated NDA (ANDA) and over-the-counter (OTC) products, including OTC products approved by the FDA as innovators under NDAs, are not classified as covered drugs. An authorized generic, however, is classified as a covered drug. An authorized generic is a “generic” version of a brand product that is marketed under the same NDA as the brand, as opposed to an ANDA.B-FSS-96 ESTIMATED SALES (NOV?1997) Note: Estimated sales figures for each SIN are based on annual total sales for domestic and overseas under the FSS program and thus reflect sales to multiple vendors under each SIN.The "Estimated Sales" column of the Schedule of Items shows (1)?a twelve-month reading of purchases in dollars or purchases in units as reported by the previous Contractor(s), or (2)?estimates of the anticipated dollar volume where the item is new. The absence of a figure indicates that neither reports of previous purchases nor estimates of sales are available.L-FSS-400 INTRODUCTION OF NEW SERVICES/PRODUCTS (INSP) (NOV?2000) Note: This clause is not applicable to new items under SIN 42-2a. "Manual\\FSS\\AL\\AL_98-4.DOC"FSS A/L FC-98-4 (a)Definition.Introduction of New Services/Products Special Item Number (INSP/SIN) means a new or improved service or product— within the scope of the Federal Supply Schedule, but not currently available under any Federal Supply Service contract— that provides a new service, function, task, or attribute that may provide a more economical or efficient means for Federal agencies to accomplish their mission. It may significantly improve an existing service or product. It may be a service or product existing in the commercial market, but not yet introduced to the Federal Government.(b)Offerors are encouraged to introduce new services or products via the Introduction of New Services/Products Special Item Number (INSP/SIN). A new or improved service or product can be offered at anytime. Offerors are requested to clearly identify the INSP/SIN item in the offer.(c)The Contracting Officer will evaluate and process the INSP/SIN offer. A technical review may be performed. Offerors may be required to demonstrate that the service or product can provide a more economical or efficient means for Federal agencies to accomplish their mission. The Contracting Officer has the sole discretion to determine whether a product or service will be accepted as an INSP/SIN item. The INSP/SIN provides temporary placement until the new service or product can be formally categorized.(d) If the Contractor has an existing Multiple Award Schedule contract, the Government may, at the sole discretion of the Contracting Officer, modify the existing contract to include the INSP/SIN item in accordance with 552.243-72, Modifications (Multiple Award Schedule).NAICS CODE DESIGNATION VA recognizes that offerors may certify their business size under more than one NAICS code at the SAM website (). A business may qualify as a small business under some NAICS codes and as an “other than small” business under other NAICS codes. Due to regulatory restrictions, wholesaler NAICS codes are not used for Government procurement purposes. For the procurement of supplies, only manufacturer NAICS codes are used. This does not preclude a dealer or distributor from submitting a proposal under the solicitation. The NAICS codes that have been identified as being applicable to this solicitation are listed below. For the purposes of this solicitation proposal, please indicate below the NAICS code which you are using to represent your business size. If you are a nonmanufacturer (e.g. wholesalers, dealers, and distributors), then the applicable size standard is 500 employees, per FAR 19.201(f). Please see Document 01 – Read Me First for more information about the SBA’s policy on determining business size. If your company is offering products under more than one of the listed NAICS codes, then please select the primary NAICS code for your offered products. FORMCHECKBOX 325412 Pharmaceutical Preparation Manufacturing / 750 employees FORMCHECKBOX 325611 Soap and Other Detergent Manufacturing / 750 employeesPlease also select the primary Federal Supply Code (FSC) for your offered products: FORMCHECKBOX 6505 Drugs and Biologicals FORMCHECKBOX 6508 Medicated Cosmetics and Toiletries ACH VENDOR/MISCELLANEOUS PAYMENT ENROLLMENT FORM OMB No. 5100056 This form is used for Automated Clearing House (ACH) payments with an addendum record that contains payment-related information processed through the Vendor Express Program. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion. See reverse for additional instructions. Note: Completed forms not currently on file must be faxed to the VA Finance Center at (512) 460-5221.PRIVACY ACT STATEMENT: The following information is provided to comply with the Privacy Act of 1974 (P.L. 93579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor’s financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System. AGENCY INFORMATIONFEDERAL PROGRAM AGENCY VA FINANCIAL SERVICES CENTERAGENCY IDENTIFIER:ADVANCE \d2AGENCY LOCATION CODE (ALC):ADVANCE \d2ACH FORMAT FORMCHECKBOX CCD + ADVANCE \d2 FORMCHECKBOX ADVANCE \u2 CTX ADVANCE \d2 FORMCHECKBOX ADVANCE \u2 CTPADDRESS: P.O. BOX 149971 AUSTIN, TX 78714CONTACT PERSON NAME: ATTN: VENDORIZING UNITTELEPHONE NUMBER: (512) 460-5049ADDITIONAL INFORMATION: FAX # (512) 460-5221PAYEE/COMPANY INFORMATIONNAME: FORMTEXT ?????SSN NO. OR TAXPAYER ID NO. FORMTEXT ?????ADDRESS FORMTEXT ????? FORMTEXT ?????CONTACT PERSON NAME: FORMTEXT ?????TELEPHONE NUMBER: ( FORMTEXT ?????) FORMTEXT ?????FINANCIAL INSTITUTION INFORMATIONNAME: FORMTEXT ?????ADDRESS: FORMTEXT ????? FORMTEXT ?????ACH COORDINATOR NAME: FORMTEXT ?????TELEPHONE NUMBER: ( FORMTEXT ?????) FORMTEXT ?????NINE-DIGIT ROUTING TRANSIT NUMBER: FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????DEPOSITOR ACCOUNT TITLE: FORMTEXT ?????DEPOSITOR ACCOUNT NUMBER: FORMTEXT ?????LOCKBOX NUMBER: FORMTEXT ?????TYPE OF ACCOUNT: FORMCHECKBOX CHECKING FORMCHECKBOX SAVINGS FORMCHECKBOX LOCKBOXSIGNATURE AND TITLE OF AUTHORIZED OFFICIAL (Could be the same as ACH Coordinator): FORMTEXT ?????TELEPHONE NUMBER: ( FORMTEXT ?????) FORMTEXT ?????AUTHORIZED FOR LOCAL REPRODUCTIONSF 3881# (Rev 2/2003) Prescribed by Department of Treasury 31 U S C 3322; 31 CFR 210 Instructions for Completing SF 3881 Form1.Agency Information Section? Federal agency prints or types the name and address of the Federal program agency originating the vendor/miscellaneous payment, agency identifier, agency location code, contact person name and telephone number of the agency. Also, the appropriate box for ACH format is checked.2.Payee/Company Information Section? Payee prints or types the name of the payee/company and address that will receive ACH vendor/miscellaneous payments, social security or taxpayer ID number, and contact person name and telephone number of the payee/company. Payee also verifies depositor account number, account title, and type of account entered by your financial institution in the Financial Institution Information Section.3.Financial Institution Information Section? Financial institution prints or types the name and address of the payee/company’s financial institution who will receive the ACH payment, ACH coordinator name and telephone number, nine-digit routing transit number, depositor (payee/company) account title and account number. Also, the box for type of account is checked, and the signature, title, and telephone number of the appropriate financial institution official are included.Burden Estimate Statement SEQ CHAPTER \h \r 1The estimated average burden associated with this collection of information is 15?minutes per respondent or record keeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Facilities Management Division, Property and Supply Branch, Room?B-101, 3700?East West Highway, Hyattsville,?MD 20782 and the Office of Management and Budget, Paperwork Reduction Project (1510-0056), Washington, DC RMATION / CLAUSES APPLICABLE ONLY TO OFFERS FOR SIN 42-2ACovered Drug Manufacturers:? The following clauses and provisions apply only to drugs covered under the Veterans Health Care Act of 1992, Public Law 102-585, Sect. 603 (38 U.S.C. 8126) (PL), and?listed on FSS contracts?under SIN 42-2A.? Please note, additional information regarding PL obligations and responsibilities is, from time to time, communicated to manufacturers?through “Dear Manufacturer Letters.”? These communications,? as well as other important PL updates and information,? may be found at or by contacting the FSS helpdesk at helpdesk.ammhinfss@. Manufacturers of influenza vaccines,?please note that information specific to these?covered?products is contained in the Dear Manufacturer Letter dated March 31, 2004.? MANUFACTURER'S FSS PRICE LIST ELECTION FORM UNDER PUBLIC LAW 102-58538 U.S.C. 8126(a) requires at least a 24% discount be given to "a Federal agency" that procures a covered drug under a depot contracting system or through the Federal Supply Schedule (FSS). Section 8126(b) describes the relevant "Federal agencies" as VA, DoD, PHS (including Indian Health Service), and Coast Guard. As you probably know, although these four Federal agencies place the overwhelming majority of all pharmaceutical orders made on the FSS, there are many other governmental or not-for-profit organizations which are authorized by Congress or the General Services Administration to use the FSS. Non-Federal-agency users of the FSS are not entitled to Federal Ceiling Prices (FCPs) established under the Law, unless manufacturers elect to give them the benefit of the FCPs. By publishing a single FSS price list after the award of a contract, manufacturers will be offering to sell their products to all FSS users at the same price, regardless of whether that price reflects the FCP.At this time, we would like to point out some of the ramifications of such a decision and ask each covered-drug manufacturer to formally elect to offer a single price to all FSS users or to adopt a dual price list (one for "the Federal agencies" and one for other FSS users and State Veteran Homes) whenever the FCPs of products are below what the FSS contract's most favored customer (MFC) price would be.In deciding whether to elect a single or dual price list approach, each manufacturer should consider, in addition to the sections of the Law mentioned above, the requirements of Section 8126(d). That provision deals with establishing FCPs in the second and subsequent years of a multi-year contract and requires two computations; the lower of the two computed prices becomes the second or subsequent year's multi-year contract ceiling price.Where the FCP and FSS-MFC price are approximately the same or where the FSS negotiated price is lower than the FCP, it may not seem necessary to make an election because there would be no current economic impact from the choice of a single or dual price list policy. (There would already be a single FSS price with no alternative to choose from.) However, even in these situations, VA has decided that each manufacturer must elect to establish a single FSS contract price for all users or dual price lists (where applicable) for the remainder of the contract period.At this time, the beginning of the solicitation for the new contract period of the schedule, your company must elect either a single or dual price list granting the benefits of FCPs to all FSS users where appropriate or a dual FSS price list, one version being applicable only to “the Federal agencies”. The latter election may be implemented on an item-by-item basis so that, where the FCP is lower than an MFC price, a manufacturer may elect to allow the ceiling price figure to stand as the all-FSS selling price for some items but not for others.Also, it should be remembered that the FSS contract price (and not the FCP, unless the Manufacturer specifies otherwise) will be subject to the FSS Price Reduction Clause with its comparable customer discount tracking mechanism.We ask that an authorized representative of your company make the required election using the below form. If your company elects separate FSS price lists, it will have the responsibility of providing the correct price list to the “Federal Agencies” and all other FSS users.Please fill in and execute the single paragraph below that reflects the Manufacturer's choice. Note: This section only applies to companies offering products under SIN 42-2a. 1. [Manufacturer Name] FORMTEXT ?????_____________________________________ through the undersigned, its officer or agent authorized to make this election, has read and understood VA's "Dear Manufacturer" letter concerning election of an FSS price list policy. Said manufacturer hereby elects to publish a single annual FSS price list that adopts for all FSS users the current Federal ceiling price (FCP) figure(s) for any covered drug whose FCP is below the most favored customer (MFC) price. This election will be effective immediately upon award of a contract and will remain in effect through the termination of the FSS Contract._________________________________________________ FORMTEXT ?????____________SIGNATURE DATE FORMTEXT ?????___________________________TITLE**************************************** (OR) **************************************2. [Manufacturer Name] FORMTEXT ?????____________________________________ through theundersigned, its officer or agent authorized to make this election, has read and understood VA's "Dear Manufacturer" letter concerning election of an FSS price list policy. Said manufacturer hereby elects NOT to publish a single FSS price list extending Federal ceiling price benefits to all FSS users, but rather, where a covered drug's FCP is lower that the company's MFC price, to publish separate price lists, one containing FSS contract prices to non-covered Federal-agency users and one containing those FCP capped prices which the Manufacturer wishes to extend only to the covered Big 4 (VA, DoD, PHS/IHS, and Coast Guard) Federal agencies. This election will be effective immediately upon award of a contract and will remain in effective through the termination of the FSS contract._________________________________________________ FORMTEXT ?????____________SIGNATURE DATE FORMTEXT ?????___________________________TITLEMASTER AGREEMENTS AND PHARMACEUTICAL PRICING AGREEMENTS (SEP 2010) Note: This section only applies to companies offering products under SIN 42-2a. In compliance with Public Law 102-585, Section 603 – The Veterans Healthcare Act of 1992, offerors of covered drug products (including biologics) must state below whether they currently have a Master Agreement (MA) and a Pharmaceutical Pricing Agreement (PPA) in place with the Department of Veterans Affairs (VA). FORMCHECKBOX YES, Offeror has an MA and a PPA in place with the VA FORMCHECKBOX NO, Offeror does not have an MA and a PPA in place with the VA.If the answer to the above is “NO” and if the prospective contractor is offering covered drug products (including biologics that fall within 21 CFR 600.3), contractor must submit and execute a MA and PPA with its offer. No offer of covered drugs submitted by a manufacturer will be considered for award unless and until the manufacturer has on file with VA’s National Acquisition Center an executed MA and PPA.PUBLIC LAW 102-585, SECTION 603, FIRST YEAR DESIGNATION FOR MULTI-YEAR COVERED DRUG CONTRACTSNote: This section only applies to companies offering products under SIN 42-2a. Pursuant to Public Law 102-585, Section 603, Veterans Health Care Act of 1992 (the Public Law), this notice is intended to explain the continuity of Public Law administration for Federal Supply Schedule (FSS) contracts with covered drugs awarded under an open and continuous solicitation. The first year of a multi-year contract period is an opportunity for contractors to calculate their Federal Ceiling Prices (FCP) without being subject to the limitation of a dual calculation. To meet the requirements of the Public Law, VA has determined that the first year of the new Pharmaceutical FSS multi-year contracts for purposes of the FCP calculation was 2009 and that 2014 will be the next “first year,” if VA does not exercise its rights under the Option To Extend Term of the contract clause. For subsequent years of the contract, excluding the designated first year, the dual calculation will apply when performing the contractor’s follow-on years’ FCP calculations. New covered drugs added to an existing FSS contract vehicle or to a recently awarded contract vehicle shall be subject to the Department’s policy on implementing provisional, temporary, and permanent FCPs. VA has determined that continuous contract coverage (i.e., provision of the covered drug under the FSS), as required by the Public Law, can be achieved through a combination of an Interim FSS Agreement, a previous FSS contract, and current FSS contract. Pursuant to the Master Agreement, the contractor is still required to submit Non-FAMP (Non-Federal Average Manufacturer’s Price) calculations to VA by November 15th of each year. FCP calculations will still be determined by using Calendar Year data and pertinent contract information. Contractor requests for modifications to incorporate the updated pricing calculations under the current and follow-on contract vehicles still must be submitted to VA by the published deadlines to ensure a January 1st effective date. Contractors who do not meet the deadlines may be subject to penalties as prescribed by the Public RMATION / CLAUSES APPLICABLE TO ALL SIN CATEGORIES552.238-78SCOPE OF CONTRACT (ELIGIBLE ORDERING ACTIVITIES) (SEP 2008) (ALTERNATE I - FEB 2007) Note: State Vet Homes with sharing agreements are also included as eligible ordering activities.(a)This solicitation is issued to establish contracts which may be used on a nonmandatory basis by the agencies and activities named below, as a source of supply for the supplies or services described herein, for domestic delivery.(1)Executive agencies (as defined in Federal Acquisition Regulation Subpart 2.1) including nonappropriated fund activities as prescribed in 41 CFR 101-26.000;(2)Government contractors authorized in writing by a Federal agency pursuant to Federal Acquisition Regulation Subpart 51.1;(3)Mixed ownership Government corporations (as defined in the Government Corporation Control Act);(4)Federal Agencies, including establishments in the legislative or judicial branch of government (except the Senate, the House of Representatives and the Architect of the Capitol and any activities under the direction of the Architect of the Capitol);(5)The District of Columbia;(6)Tribal governments when authorized under 25 U.S.C. 450j(k);(7)Qualified Nonprofit Agencies as authorized under 40 U.S.C. 502(b); and(8)Organizations, other than those identified in paragraph (d) of this clause, authorized by GSA pursuant to statute or regulation to use GSA as a source of supply.(b)Definitions—Domestic delivery is delivery within the 48 contiguous states, Alaska, Hawaii, Puerto Rico, Washington, DC, and U.S. territories. Domestic delivery also includes a port or consolidation point, within the aforementioned areas, for orders received from overseas activities.Overseas delivery is delivery to points outside of the 48 contiguous states, Washington, DC, Alaska, Hawaii, Puerto Rico, and U.S. territories.(c)Offerors are requested to check one of the following boxes: FORMCHECKBOX Contractor will provide domestic and overseas delivery. FORMCHECKBOX Contractor will provide overseas delivery only. FORMCHECKBOX Contractor will provide domestic delivery only.(d)The following activities may place orders against Federal Supply Schedules for products and services determined by the Secretary of Homeland Security to facilitate recovery from major disasters, terrorism, or nuclear, biological, chemical, or radiological attack, on an optional basis; PROVIDED, the Contractor accepts order(s) from such activities: State and local government entities, includes any state, local, regional or tribal government or any instrumentality thereof (including any local educational agency or institution of higher learning).State and local government entities, means the states of the United States, counties, municipalities, cities, towns, townships, tribal governments, public authorities (including public or Indian housing agencies under the United States Housing Act of 1937), school districts, colleges and other institutions of higher education, council of governments (incorporated or not), regional or interstate government entities, or any agency or instrumentality of the preceding entities (including any local educational agency or institution of higher education), and including legislative and judicial departments. The term does not include contractors of, or grantees of, State or local governments.(1)Local educational agency has the meaning given that term in section 8013 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7713).(2)Institution of higher education has the meaning given that term in section 101(a) of the Higher Education Act of 1965 (20 U.S.C. 1001(a)).(3)Tribal government means--(i)The governing body of any Indian tribe, band, nation, or other organized group or community located in the continental United States (excluding the State of Alaska) that is recognized as eligible for the special programs and services provided by the United States to Indians because of their status as Indians; and(ii)Any Alaska Native regional or village corporation established pursuant to the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.).(e)Articles or services may be ordered from time to time in such quantities as may be needed to fill any requirement, subject to the Order Limitations thresholds which will be specified in resultant contracts. Overseas activities may place orders directly with schedule contractors for delivery to CONUS port or consolidation point.(f)(1) The Contractor is obligated to accept orders received from activities within the Executive Branch of the Federal Government. (2)The Contractor is not obligated to accept orders received from activities outside the Executive Branch; however, the Contractor is encouraged to accept such orders. If the Contractor elects to accept such orders, all provisions of the contract shall apply, including clause 552.232-79, Payments by Credit Card. If the Contractor is unwilling to accept such orders, and the proposed method of payment is not through the Credit Card, the Contractor shall return the order by mail or other means of delivery within 5 workdays from receipt. If the Contractor is unwilling to accept such orders, and the proposed method of payment is through the Credit Card, the Contractor must so advise the ordering activity within 24 hours of receipt of order. (Reference clause 552.232-79, Payment by Credit Card.) Failure to return an order or advise the ordering activity within the time frames of this paragraph shall constitute acceptance whereupon all provisions of the contract shall apply.(g)The Government is obligated to purchase under each resultant contract a guaranteed minimum of $2,500 (two thousand, five hundred dollars) during the contract term.AS8005 MANUFACTURING FACILITIES/PLACE OF PERFORMANCE (SEP 2010)1. The U.S. Food and Drug Administration (FDA) is the Government agency responsible for providing and enforcing pharmaceutical current Good Manufacturing Practices (GMP) standards for human drugs, pharmaceutical products, biologicals, medical devices, chemical products, medical cylinder oxygen, reagents, diagnostics, test kits and sets included in this solicitation. Only offers from companies that have an acceptable GMP status on record with the FDA for the facilities identified by the offeror in Paragraph 8 below will be considered for award. The FDA will evaluate a prospective offeror for VA procurements only if the offeror has had a qualifying GMP inspection within the previous two years. Before a contract can be awarded, any successful offeror’s manufacturing facilities shall have a current acceptable GMP status with FDA, or shall have had an acceptable report from the last FDA facility inspection on record. In the absence of a current GMP evaluation, an offeror is required to include with its proposal documentation on the acceptable outcome of a FDA facility inspection that occurred more than two years prior to submission of the offer. 2. For any Nutritional/Dietary Supplements offered, documentation of clinical studies that were performed on the offered products pertaining to the therapeutic treatment of patients may be required by the Department of Veterans Affairs National Acquisition Center (VANAC) as a quality assurance measurement. Offerors of Nutritional/Dietary Supplements will be required to adhere to published FDA GMP standards after January 1, 2008. 3. If at any time during the life of the contract, the contractor’s facility or the source from which the contractor obtains any of the products offered on this contract is informed in a FDA “warning letter” that it fails to meet FDA current Good Manufacturing Practices (GMPs) (21 CFR Part 210 and 211), and/or a facility’s unacceptable FDA GMP status is communicated to the VANAC, the Contracting Officer will apply the procedures outlined in Paragraph 4 of this clause.4. The VANAC Contracting officer will review the contractor’s (or its source’s) unacceptable GMP status with appropriate VHA clinical staff and will either: 1) instruct the contractor to stop the shipment of products listed on this contract that were manufactured and/or packaged in a facility with unacceptable GMP status, or 2) authorize the contractor to continue to supply such contract products for 90 days from the date when unacceptable GMP status was communicated to VANAC, provided that the products have not been subjected to a consumer-level recall. An additional 90 days may be authorized at the discretion of the VANAC Contracting Officer.Contractors are cautioned that products that were manufactured and /or packaged in a facility with unacceptable GMP status and then shipped without written authorization from the VANAC Contracting Officer shall be returned to the contractor at the contractor’s risk and expense. The contractor shall have corrected all significant GMP deficiencies or have an acceptable plan with the FDA for the correction of such deficiencies which led to unacceptable status by the end of the 90-day authorization period and any extensions of such period granted by the VANAC Contracting Officer. Additionally, the contractor is responsible for keeping the VANAC Contracting Officer informed of all corrections made and shall provide the VANAC Contracting Officer with: 1) written documentation of the correction plan, 2) Notification from FDA of acceptance of plan, and 3) a copy of any reinspection requests and subsequent reinspection reports, when they are available. If FDA’s evaluation of contractor’s (or its source’s) compliance efforts and/or re-inspection of the non-compliant facility does not result in an acceptable rating by FDA within 90 days from the date when unacceptable GMP status was communicated to VANAC, or by the end of a VANAC Contracting Officer’s authorization period (whichever is the greater period of time), the contract may be terminated for cause in accordance with FAR Clause 52.212-4(m). The contractor’s (or its source’s) failure to correct the GMP deficiencies in a timely manner shall not constitute or give rise to any “excusable delays” pursuant to FAR Clause 52.212-4(f). (Nothing in this clause shall be read as limiting the recognized grounds upon which a Contracting Officer may terminate this contract or delete products pursuant to the applicable clause contained in the contract.) 5. The contractor shall use only the FDA-inspected manufacturing facilities provided in Paragraph 8, below, for the duration of the contract, unless substitution of manufacturing facilities is approved by the VANAC Contracting Officer. In case of any manufacturing facility relocation or substitution of manufacturing facilities, the contractor shall notify the VANACContracting Officer of the change, and the contractor shall request approval from the VANAC Contracting Officer to supply the contracted products from the new location. If the change is approved by the VANAC Contracting Officer after an inquiry to FDA for GMP status of the new location, approval will be provided by means of a formal contract modification. 6. If the products are to be manufactured at more than one location, each manufacturing facility and each facility address shall be listed along with the products manufactured at the facility. Subcontractors (i.e., packagers, labelers, etc.) that participate in the production of the products offered on this solicitation shall also be listed along with their addresses. All facilities described in this paragraph and listed below shall be substantially in compliance with applicable FDA GMP standards prior to contract award. 7. Offeror shall identify below or by attachment (if additional space is needed), the products offered on this solicitation (products shall be identified by product name and by solicitation item number); whether the offeror manufactures the products; and/or whether the offeror is a distributor of the products offered.8. If the finished products to be offered are of foreign manufacture, the complete name and address of the manufacturer shall be provided below. The offeror is also required to check the box below that is applicable to its offer. Please note that the information required below must be the name and address of the manufacturing facility, rather than the address of the foreign headquarters, distributor or agent. FORMCHECKBOX OFFEROR IS THE MANUFACTURER (AT THE FOLLOWING LOCATIONS) OF THE PRODUCTS OFFERED ON THIS SOLICITATION. FORMCHECKBOX OFFEROR IS A DISTRIBUTOR OF THE PRODUCTS OFFERED ON THIS SOLICITATION. THE PRODUCTS WILL BE MANUFACTURED BY THE FOLLOWING COMPANY(S) AT THE FOLLOWING LOCATIONS: FORMTEXT ?????(Name of Manufacturing Company) FORMTEXT ?????(Street Address) (Post Office Address Not Acceptable) FORMTEXT ?????(U.S.A. Point of Contact, e-Mail Address and U.S.A Telephone Number)PHARMACEUTICALS – PARENTERALSSOLICITATION IITEM NUMBER AND PRODUCT NAMELOCATION AND OWNER OF FACILITY WHERE INGREDIENTS ARE MEASURED, WEIGHED, MIXED AND COMPOUNDED (Facility Owner Name, Address, City, County, State and ZIP Code)POINT OF CONTACT (Including Phone Number) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PHARMACEUTICALS – PARENTERALS, STERILIZATION SOLICITATION ITEM NUMBER AND PRODUCT NAME:STERILIZATION AND OWNER LOCATION (Facility Owner Name, Address, City, County, State and ZIP Code):POINT OF CONTACT (Including Phone Number): FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????TABLETS, CAPSULES AND PILLS SOLICITATION ITEM NUMBER AND PRODUCT NAME:LOCATION AND OWNER OF FACILITY WHERE INGREDIENTS ARE MEASURED, WEIGHED, MIXED AND COMPOUNDED (Facility Owner Name, Address, City, County, State and ZIP Code):POINT OF CONTACT (Including Phone Number): FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????VACCINESSOLICITATION ITEM NUMBER AND PRODUCT NAME:LOCATION AND OWNER OF FACILITY WHERE VACCINE IS PRODUCED (Facility Owner Name, Address, City, County, State and ZIP Code):POINT OF CONTACT (Including Phone Number): FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????OTHER PHARMACEUTICAL PRODUCTS (Solutions, syrups, mixtures, powders, ointments, pastes, creams, etc.): SOLICITATION ITEM NUMBER AND PRODUCT NAME:LOCATION AND OWNER OF FACILITY WHERE INGREDIENTS ARE MEASURED, WEIGHED, MIXED AND COMPOUNDED (Facility Owner Name, Address, City, County, State and ZIP Code):POINT OF CONTACT (Including Phone Number): FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PACKAGING SOLICITATION ITEM NUMBER AND PRODUCT NAME:LOCATION OF FACILITIES WHERE INTERMEDIATE CONTAINERS WILL BE FIXED AND LABELED (Facility Owner Name, Address, City, County, State and ZIP Code):POINT OF CONTACT (Including Phone Number): FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PACKINGSOLICITATION ITEM NUMBER AND PRODUCT NAME:LOCATION OF FACILITIES WHERE PRODUCTS WILL BE PACKED AND PREPARED FOR SHIPMENT (Facility Owner Name, Address, City, County, State and ZIP Code):POINT OF CONTACT (Including Phone Number): FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????I-FSS-644DEALERS AND SUPPLIERS (OCT?1988)When requested by the Contracting Officer, if other than the manufacturer, the offeror must submit prior to award of a contract, either (1) a letter of commitment from the manufacturer which will assure the offeror of a source of supply sufficient to satisfy the Government's requirements for the contract period, OR (2) evidence that the offeror will have an uninterrupted source of supply from which to satisfy the Government's requirements for the contract period.NOTE: The following are the required components of an acceptable letter of supply/commitment: Must be on manufacturer’s letterhead and addressed to the offeror.Must be dated within 90 days of the date the SF1449 was signed by the company (for offers) or the date of the modification request (for product additions under existing FSS contracts).Must not have an expiration date.Must be signed by an officer of the company.Must reference the solicitation number (new offers) or contract number (for existing contracts).Must contain the phrase that the manufacturer is willing to provide “a source of supply sufficient to satisfy the Government’s requirements for the contract period”.Must contain the statement that end products are Trade Agreements Act (TAA) compliant.Must address any product or product category restrictions or state that none exist.NOTE: The following is a sample letter of supply/commitment:[Date}[Offeror Name][Offeror Point of Contact (POC)][Address][City, State, Zip code]Re: Letter of SupplyDear [Offeror POC]: This Letter of Supply is in reference to the offer that [Offeror Name] submitted in response to Federal Supply Schedule [enter Solicitation Number if a new offer or contract number of an existing contractIn the event that [Offeror Name] is awarded a Multiple Award Schedule (MAS) contract under the aforementioned solicitation number, [Manufacturer Name] can assure an uninterrupted source of supply, with sufficient quantities of product, for the duration of the base contract period (or option period). There is no product or product category restrictions regarding this letter of commitment.[Manufacturer Name] understands that all products and services that are offered on MAS contracts must be compliant with the Trade Agreements Act (TAA) (19?U.S.C.?2501, et?seq.) As such, all products supplied by [[Manufacturer Name] to [Offeror Name] will be TAA compliant. You will be notified immediately upon discovery of any changes in the Country of Origin of supplied products. The person whose signature appears below is authorized to make the commitments noted above.Sincerely, FORMTEXT [Name and title of Authorized Signatory] Must be an Officer of the companyTelephone Number of Authorized Signatory 552.211-78COMMERCIAL DELIVERY SCHEDULE (MULTIPLE AWARD SCHEDULE) (FEB?1996, Tailored) NOTE: This clause does not apply to orders placed through a Government Prime Vendor Program or Direct-to-Patient Distribution Program. (a)Time of Delivery. The Contractor shall deliver to destination within the number of calendar days after receipt of order (ARO) in the case of F.O.B. Destination prices, as set forth below. Offerors shall insert in the “Time of Delivery (days ARO)” column in the schedule of Items a definite number of calendar days within which delivery will be made. In no case shall the offered delivery time exceed the Contractor's normal commercial practice. The Government requires the Contractor's normal commercial delivery time, as long as it is less than the “stated” delivery time(s) shown below. If the Offeror does not insert a delivery time in the schedule of items, the Offeror will be deemed to offer delivery in accordance with the Government's stated delivery time, as stated below:ITEM OR GROUP OF ITEMS(SPECIAL Item Numbers or Nomenclature)Government’s Stated DeliveryTime(Days ARO)Offeror’s Normal Commercial Delivery TimeProposed Delivery Time to the GovernmentALL SINs10 FORMTEXT ????? FORMTEXT ?????(b)Expedited Delivery Times. For those items that can be delivered quicker than the delivery times in paragraph (a), above, the Offeror is requested to insert below, a time (hours/days ARO) that delivery can be made when expedited delivery is requested. Note: Indicate “None Offered” in the section below if expedited delivery is not being offered.ITEM OR GROUP OF ITEMS(SPECIAL Item No. of nomenclature)Expedited delivery time(Hours/Days ARO) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Note: If offering expedited delivery to the Government, indicate the terms (e.g. “no charge”, “Government is responsible for difference between normal and expedited delivery”, etc.). FORMTEXT ????? (c)Overnight and 2-Day Delivery Times. Ordering activities may require overnight or 2—day delivery. The Offeror is requested to annotate its price list or by separate attachment identify the items that can be delivered overnight or within 2?days. Contractors offering such delivery services will be required to state in the cover sheet to its FSS price list details concerning this service.F-FSS-202-G DELIVERY PRICES (JAN?1994) NOTE: This clause does not apply to orders placed through a Government Prime Vendor Program or Direct-to-Patient Distribution Program.NOTE: This clause is applicable to direct orders only"" \l "#16.506" \n16.506(b) (a) Prices offered must cover delivery as provided below to destinations located within the 48 contiguous States and the District of Columbia. (1) Delivery to the door of the specified Government activity by freight or express common carriers on articles for which store-door delivery is provided, free or subject to a charge, pursuant to regularly published tariffs duly filed with the Federal and/or State regulatory bodies governing such carrier; or, at the option of the Contractor, by parcel post on mailable articles, or by the Contractor's vehicle. Where store-door delivery is subject to a charge, the Contractor shall (a) place the notation "Delivery Service Requested" on bills of lading covering such shipments, and (b) pay such charge and add the actual cost thereof as a separate item to his invoice. (2)Delivery to siding at destinations when specified by the ordering office, if delivery is not covered under paragraph (a)(1), above. (3)Delivery to the freight station nearest destination when delivery is not covered under paragraph (a)(1) or (a)(2), above. (b) The offeror is requested to indicate below whether or not prices submitted cover delivery f.o.b. destination in Alaska, Hawaii, and the Commonwealth of Puerto Rico. (Yes)(No) Alaska FORMCHECKBOX FORMCHECKBOX Hawaii FORMCHECKBOX FORMCHECKBOX Puerto Rico FORMCHECKBOX FORMCHECKBOX (c)When deliveries are made to destinations outside the contiguous 48 States; i.e., Alaska, Hawaii, and the Commonwealth of Puerto Rico, and are not covered by paragraph (b), above, the following conditions will apply: (1) Delivery will be f.o.b. inland carrier, point of exportation (FAR 52.247-38), with the transportation charges to be paid by the Government from point of exportation to destination in Alaska, Hawaii, or the Commonwealth of Puerto Rico, as designated by the ordering office. The Contractor shall add the actual cost of transportation to destination from the point of exportation in the 48 contiguous States nearest to the designated destination. Such costs will, in all cases, be based upon the lowest regularly established rates on file with the Interstate Commerce Commission, the U.S. Maritime Commission (if shipped by water), or any State regulatory body, or those published by the U.S. Postal Service; and must be supported by paid freight or express receipt or by a statement of parcel post charges including weight of shipment. (2)The right is reserved to ordering agencies to furnish Government bills of lading.(d)Ordering offices will be required to pay differential between freight charges and express charges where express deliveries are desired by the Government. 52.216-19ORDER LIMITATIONS (OCT?1995) (DEVIATION II — FEB 2007) (TAILORED) NOTE: This clause does not apply to orders placed through a Government Prime Vendor Program or Direct-to-Patient Distribution Program.NOTE: This clause is applicable to direct orders only"" \l "#16.506" \n16.506(b)Minimum order. When the ordering activity requires supplies or services covered by this contract in an amount of less than $100, the ordering activity is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract. (b)Maximum order. The Contractor is not obligated to honor any single order or series of orders from the same ordering office within 5 days that exceeds the maximum order amount shown below.Special Item Number (SIN)Maximum Order42-1 thru 42-5 & INP$250,000 per item / $1,000,000 per order622$25,000 per item/per order (c)If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the ordering activity is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section.(d)Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within 72 hours after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the ordering activity may acquire the supplies or services from another source.MINIMUM ACCEPTABLE ORDER PROPOSALIn accordance with 52.216-19 Order Limitations (Oct 1995) (Deviation II-Feb 2007), the ordering activity is not obligated to purchase, nor is the Contractor obligated to furnish supplies or services covered by this contract in an amount of less than $100. However, offerors may, if willing to accept smaller orders, specify a smaller amount in their offers. If a smaller amount is offered, it is mutually agreed that the Contractor will accept such orders and specify the smaller minimum order limitation in the applicable catalog/pricelist.Proposed Minimum Acceptable Order (Select One): FORMCHECKBOX No minimum FORMCHECKBOX $ FORMTEXT ????? FORMCHECKBOX FORMTEXT ????? Units UTILIZATION OF DEALERS/DISTRIBUTORS/SPECIALTY DISTRIBUTORSOfferors marketing through dealers/distributors, including specialty distributors, shall indicate whether those dealers/distributors will be participating in the proposed contract. YES FORMCHECKBOX NO FORMCHECKBOX If "yes" is checked, then a list of participating dealers/distributors, including addresses and points of contact, shall accompany this offer and shall also be included in the contractor's Federal Supply Schedule pricelist. If a form is required for ordering activities to place orders with the authorized dealers/distributors/specialty distributors, then the application must be submitted with this offer for approval.Please note that the contractor is ultimately responsible for ensuring that all terms and conditions of the awarded contract are followed by the authorized dealers/distributors/specialty distributors. 552.232-82CONTRACTOR'S REMITTANCE (PAYMENT) ADDRESS (MAY 2003) (a)Payment by electronic funds transfer (EFT) is the preferred method of payment. However, under certain conditions, the ordering activity may elect to make payment by check. The offeror shall indicate below the payment address to which checks should be mailed for payment of proper invoices submitted under a resultant contract.PAYMENT ADDRESS: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????(b)Offeror shall furnish by attachment to this solicitation, the remittance (payment) addresses of all authorized participating dealers receiving orders and accepting payment by check in the name of the Contractor in care of the dealer, if different from their ordering address(es) specified elsewhere in this solicitation. If a dealer’s ordering and remittance address differ, both must be furnished and identified as such.(c)All offerors are cautioned that if the remittance (payment) address shown on an actual invoice differs from that shown in paragraph (b) of this provision or on the attachment, the remittance address(es) in paragraph (b) of this provision or attached will govern. Payment to any other address, except as provided for through EFT payment methods, will require an administrative change to the contract.Note: All orders placed against a Federal Supply Schedule contract are to be paid by the individual ordering activity placing the order. Each order will cite the appropriate ordering activity payment address, and proper invoices should be sent to that address. Proper invoices should be sent to GSA only for orders placed by GSA. Any other ordering activity’s invoices sent to GSA will only delay your payment.K-FSS-9 SECTION 8(a) REPRESENTATION FOR THE MULTIPLE AWARD SCHEDULE PROGRAM (SEP?2000) Note: Only provide the company name and date below if you check that your firm “is” a current 8(a) Business Development Program participant. "Manual\\FSS\\AL\\AL_00-6.DOC"FSS?A/L?FC-00-6The Offeror represents that it is FORMCHECKBOX is not FORMCHECKBOX a current 8(a) Business Development Program participant, and that it wishes to be designated as such on the FSS Schedules E-Library and GSA Advantage!? as well as the Federal Procurement Data System (FPDS).CONTRACTOR NAME & SIGNATURE: FORMTEXT ?????DATE: FORMTEXT ?????52.223-3HAZARDOUS MATERIAL IDENTIFICATION AND MATERIAL SAFETY DATA (JAN?1997) (ALTERNATE?I—JUL?1995) (a)Hazardous material, as used in this clause, includes any material defined as hazardous under the latest version of Federal Standard No. 313 (including revisions adopted during the term of the contract).(b)The offeror must list any hazardous material, as defined in paragraph (a) of this clause, to be delivered under this contract. The hazardous material shall be properly identified and include any applicable identification number, such as National Stock Number or Special Item Number. This information shall also be included on the Material Safety Data Sheet submitted under this contract.Material(If none, insert None)Identification No. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????(c)This list must be updated during performance of the contract whenever the Contractor determines that any other material to be delivered under this contract is hazardous.(d)The apparently successful offeror agrees to submit, for each item as required prior to award, a Material Safety Data Sheet, meeting the requirements of 29 CFR 1910.1200(g) and the latest version of Federal Standard No. 313, for all hazardous material identified in paragraph (b) of this clause. Data shall be submitted in accordance with Federal Standard No. 313, whether or not the apparently successful offeror is the actual manufacturer of these items. Failure to submit the Material Safety Data Sheet prior to award may result in the apparently successful offeror being considered nonresponsible and ineligible for award.(e)If, after award, there is a change in the composition of the item(s) or a revision to Federal Standard No. 313, which renders incomplete or inaccurate the data submitted under paragraph (d) of this clause, the Contractor shall promptly notify the Contracting Officer and resubmit the data.(f)Neither the requirements of this clause nor any act or failure to act by the Government shall relieve the Contractor of any responsibility or liability for the safety of Government, Contractor, or subcontractor personnel or property.(g)Nothing contained in this clause shall relieve the Contractor from complying with applicable Federal, State, and local laws, codes, ordinances, and regulations (including the obtaining of licenses and permits) in connection with hazardous material.(h)The Government's rights in data furnished under this contract with respect to hazardous material are as follows:(1)To use, duplicate and disclose any data to which this clause is applicable. The purposes of this right are to—(i)Apprise personnel of the hazards to which they may be exposed in using, handling, packaging, transporting, or disposing of hazardous materials;(ii)Obtain medical treatment for those affected by the material; and(iii)Have others use, duplicate, and disclose the data for the Government for these purposes.(2)To use, duplicate, and disclose data furnished under this clause, in accordance with subparagraph (h)(1) of this clause, in precedence over any other clause of this contract providing for rights in data.(3)The Government is not precluded from using similar or identical data acquired from other sources.(i)Except as provided in paragraph (i)(2) the Contractor shall prepare and submit a sufficient number of Material Safety Data Sheets (MSDS's), meeting the requirements of 29 CFR 1910.1200(g) and the latest version of Federal Standard No. 313, for all hazardous materials identified in paragraph (b) of this clause.(1)For items shipped to consignees, the Contractor shall include a copy of the MSDS with the packing list or other suitable shipping document which accompanies each shipment. Alternatively, the Contractor is permitted to transmit MSDS's to consignees in advance of receipt of shipments by consignees, if authorized in writing by the Contracting Officer.(2)For items shipped to consignees identified by mailing address as agency depots, distribution centers or customer supply centers, the Contractor shall provide one copy of the MSDS's in or on each shipping container. If affixed to the outside of each container, the MSDS must be placed in a weather resistant envelope.52.215-6 PLACE OF PERFORMANCE (OCT?1997)NOTE: This clause is to indicate where the offeror intends to conduct contract administrative functions. (a)The offeror or respondent, in the performance of any contract resulting from this solicitation, FORMCHECKBOX intends, FORMCHECKBOX does not intend [check applicable box] to use one or more plants or facilities located at a different address from the address of the offeror or respondent as indicated in this proposal or response to request for information.(b)If the offeror or respondent checks “intends” in paragraph (a) of this provision, it shall insert in the following spaces the required information:NAME AND ADDRESS OF PLACE OF PERFORMANCE (Street Address, City, State, County, Zip Code)NAME AND ADDRESS OF OWNER AND OPERATOR OF THE PLANT OR FACILITY IF OTHER THAN OFFEROR OR RESPONDENT FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????K-FSS-1AUTHORIZED NEGOTIATORS (MAR?1998) The offeror shall, in the spaces provided below, fill in the names of all persons authorized to negotiate with the Government in connection with this request for proposals or quotations. (List the names, titles, telephone numbers and electronic mail address of the authorized negotiators.) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????G-FSS-900-CCONTACT FOR CONTRACT ADMINISTRATION (JUL?2003) Offerors should complete paragraphs (a) and (b) if providing both domestic and overseas delivery. Complete paragraph (a) if providing domestic delivery only. Complete paragraph (b) if providing overseas delivery only.The Contractor shall designate a person to serve as the contract administrator for the contract both domestically and overseas. The contract administrator is responsible for overall compliance with contract terms and conditions. The contract administrator is also the responsible official for issues concerning 552.238-74, Industrial Funding Fee and Sales Reporting (JUL?2003), including reviews of contractor records. The Contractor’s designation of representatives to handle certain functions under this contract does not relieve the contract administrator of responsibility for contract compliance. Any changes to the designated individual must be provided to the Contracting Officer in writing, with the proposed effective date of the change (a) Domestic:NAME: FORMTEXT ????? TITLE: FORMTEXT ?????ADDRESS: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PHONE: FORMTEXT ????? FAX: FORMTEXT ????? E-MAIL: FORMTEXT ????? (b) Overseas: Overseas contact points are mandatory for local assistance with the resolution of any delivery, performance, or quality complaint from customer agencies. (Also, see the requirement in IFSS594, Parts and Service.) At a minimum, a contact point must be furnished for each area in which deliveries are contemplated, e.g., Europe, South America, Far East, etc.NAME: FORMTEXT ????? TITLE: FORMTEXT ?????ADDRESS: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PHONE: FORMTEXT ????? FAX: FORMTEXT ????? E-MAIL: FORMTEXT ????? CONTACT FOR SALES ADMINISTRATION (MAR 2011)The offeror shall, in the space provided below, fill in the name of the individual designated as the central contact for all Report of Sales and Industrial Funding Fee (IFF) issues associated with a contract awarded under this solicitation. This individual will be authorized to discuss with the Government all issues related to the submission of sales reports and the remission of IFF payments. (List the name, title, telephone number and electronic mail address of the authorized sales contact.)NAME: FORMTEXT ????? TITLE: FORMTEXT ?????ADDRESS: FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????PHONE: FORMTEXT ????? FAX: FORMTEXT ????? E-MAIL: FORMTEXT ????? SUPPLEMENTAL COMMERCIAL PRACTICES INFORMATIONPlease indicate below whether or not your firm’s commercial prices cover delivery f.o.b. destination to Alaska, Hawaii, and the Commonwealth of Puerto Rico. YESNOAlaska FORMCHECKBOX FORMCHECKBOX Hawaii FORMCHECKBOX FORMCHECKBOX Puerto Rico FORMCHECKBOX FORMCHECKBOX Please indicate if your firm accepts credit cards commercially: Yes FORMCHECKBOX No FORMCHECKBOX If yes, please indicate if your firm has a maximum allowable credit card charge limit commercially:Yes FORMCHECKBOX $ FORMTEXT ????? No FORMCHECKBOX Will your firm accept the Government-wide credit card for purchases over the micro-purchase threshold: (Acceptance of the Government credit card for purchases at or under the micro-purchase threshold is required. As of the issuance date of this solicitation, the micro-purchase threshold is $3,000 for equipment and supplies and is subject to change. Please refer to clause 552.232-79 as shown in 02 - Solicitation Document.): Yes FORMCHECKBOX No FORMCHECKBOX If yes, are you proposing a maximum allowable credit card charge for the Government?Yes FORMCHECKBOX $ FORMTEXT ????? No FORMCHECKBOX What is your firm’s minimum acceptable order limitation commercially (select one): FORMCHECKBOX No minimum or $ FORMTEXT ????? or FORMTEXT ????? Units Please provide your commercial payment terms (for direct orders): FORMTEXT ?????Does your firm offer a commercial Return Goods Policy: Yes FORMCHECKBOX No FORMCHECKBOX If your firm has a commercial return goods policy, will you be offering the same terms to the Government: Yes FORMCHECKBOX No FORMCHECKBOX If yes, please provide a full copy of the Return Goods Policy.Does your firm offer a commercial Warranty: Yes FORMCHECKBOX No FORMCHECKBOX If your firm has a commercial warranty, will you be offering the same terms to the Government:Yes FORMCHECKBOX No FORMCHECKBOX If yes, please provide a full copy of the Warranty policy.Do you offer rebates commercially (e.g. annual rebates, etc.)? Yes FORMCHECKBOX No FORMCHECKBOX If yes, please provide details on your commercial rebates. FORMTEXT ?????9. Do you offer quantity discounts commercially? Yes FORMCHECKBOX No FORMCHECKBOX If yes, please provide details on your commercially offered quantity discounts. FORMTEXT ?????10. Is expedited delivery offered to commercial customers? FORMCHECKBOX Yes FORMCHECKBOX No If yes, indicate whether offeror’s commercial customers are responsible for paying any additional shipping charges for expedited delivery: FORMCHECKBOX Yes FORMCHECKBOX No11. Are the items being submitted in this proposal over the counter drugs? Yes FORMCHECKBOX No FORMCHECKBOX If you responded “Yes” are they compliant with the U.S. Food and Drug Administration Monograph requirements? Yes FORMCHECKBOX No FORMCHECKBOX COMPLIANCE CONFIRMATIONThis section is mandatory for all offerors. Please confirm that your firm is in compliance with the following requirements of the solicitation as requested below. FORMCHECKBOX System for Acquisition Management (SAM) record is complete and active until (enter expiration date): FORMTEXT ????? Per 52.212-4 Contract Terms and Conditions – Commercial Items, paragraph (t), all offerors must be registered in the SAM database (now replacing both the CCR and ORCA databases) at . prior to receiving a contract award with FSS. Submissions must be updated on an annual basis to ensure that all information is current, accurate, and complete. This system includes the Online Representations and Certifications Application (see clause 52.212-3 Offeror Representations and Certifications – Commercial Items in 02 – Solicitation Document). The offeror verifies by submission of this offer that the representations and certifications have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs FORMTEXT ?????. FORMCHECKBOX VETS-100 compliance report is included with offer (required of those with existing FSS contracts) FORMCHECKBOX VETS-100 compliance report is not included with offer (not required of new offerors until first reporting period after contract award) In accordance with 52.222-37 Employment Reports on Veterans (incorporated by reference in 52.212-5), all FSS contract holders must comply with the annual reporting of VETS-100 at . For questions and information on filing VETS-100 reports or registering with VETS-100, please contact the VETS-100 Processing Center at (301) 306-6752 or helpdesk@.52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013) (a) Definitions. As used in this provision—“Administrative proceeding” means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.“Federal contracts and grants with total value greater than $10,000,000” means—(1) The total value of all current, active contracts and grants, including all priced options; and(2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules).“Principal” means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).(b) The offeror FORMCHECKBOX has FORMCHECKBOX does not have current active Federal contracts and grants with total value greater than $10,000,000.(c) If the offeror checked “has” in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information:(1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions:(i) In a criminal proceeding, a conviction.(ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more.(iii) In an administrative proceeding, a finding of fault and liability that results in—(A) The payment of a monetary fine or penalty of $5,000 or more; or(B) The payment of a reimbursement, restitution, or damages in excess of $100,000.(iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision.(2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence.(d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award Management database via (see 52.204-7). PROGRAM PARTICIPATIONTHE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 (RECOVERY ACT)REFERENCE CLAUSES52.203-15Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 52.204-11American Recovery and Reinvestment Act – Reporting Requirements 52.212-4Contract Terms and Conditions – Commercial Items 52.212-5Contract Terms and Conditions Required to Implement Statutes or Executive Orders – Commercial Items (Alternate II)On February 17, 2009, the President signed Public Law 111-5, the Recovery Act. The Recovery Act imposes a number of requirements on Executive Branch departments and agencies receiving Recovery Act funds, in order to meet the broader goals and objectives of the Act; i.e., job creation, economic benefit, and unprecedented levels of transparency and accountability.Federal Supply Schedule contractors have the option to voluntarily participate in the American Recovery and Reinvestment Act of 2009. If your company does not elect to participate, you will not be allowed to accept purchases made with monies allocated under the terms of the Act. Additional Recovery Act information may be found on the General Services Administration (GSA) Schedules website at . ? Please check one of the following: FORMCHECKBOX Offeror will participate in the American Recovery and Reinvestment Act of 2009 FORMCHECKBOX Offeror will not participate in the American Recovery and Reinvestment Act of 2009 RECOVERY PURCHASING PARTICIPATION ELECTIONAuthority: Public Law 109-364, John Warner National Defense Authorization Act for Fiscal Year 2007State and local governments have the authority to purchase products and services under FSS contracts to facilitate recovery from a major disaster, terrorism or nuclear, biological, chemical, or radiological attack. Federal Supply Schedule contractors have the option to voluntarily participate in the recovery purchasing. Even after contractors have volunteered to participate in recovery purchasing, they retain the right to decline orders from State and local governments on a case-by-case basis. For more information visit indicate your decision regarding voluntary participation in recovery purchasing: FORMCHECKBOX YES FORMCHECKBOX NODIRECT-TO-PATIENT DISTRIBUTION PROGRAM PARTICIPATION (JUN 2012)VA’s Direct-to-Patient Distribution Program is a concept of support whereby a commercial vendor serves as a contractor of VA’s Consolidated Mail Outpatient Pharmacies (CMOP) to deliver products to VA patients. Under this program, the Direct-to Patient Distribution contractor places orders with FSS contractors, maintains an inventory of products, and ships product received from the FSS contractors to VA patients at the direction of VA’s CMOP facilities. The Direct-to-Patient contractor directly pays FSS contractors for product ordered and delivered. Prices for the items distributed through this program are established for the most part by VA contracts and agreements, including the Federal Supply Schedule Program and Blanket Purchase Agreements against FSS. Products eligible for distribution through the Direct-to-Patient Distribution Program are medical and surgical items. Medical equipment is not eligible for distribution through the Direct-to-Patient Distribution Program. It should be noted that the Department of Veterans Affairs, National Acquisition Center’s Direct-to-Patient Distribution Program is utilized by all VA Consolidated Mail Outpatient Pharmacy (CMOP) facilities. For this reason, FSS contractors are strongly encouraged to participate in the Direct-to-Patient Distribution Program as product providers to the contractor. All prices and discount terms (except prompt payment discounts) agreed to and contained in any FSS award document resulting from this offer (including all future modifications) are applicable to all eligible awarded products sold to the Government under this contract through the authorized Direct-to-Patient Distribution Program contractors.For those contractors that elect to participate in the authorized Government Direct-to-Patient Distribution Program, all terms and conditions regarding time, quantity, place, method of delivery, payment terms, and chargeback agreements shall be determined between the FSS contractor and the authorized Government Direct-to-Patient Distribution contractor.Sales of FSS contract items through the Direct-to-Patient Program must be reported as FSS sales during the course of the FSS contract and included in the quarterly FSS Sales Reports. The applicable Industrial Funding Fee (IFF) must be remitted to VA for all FSS sales reported. (See 552.238-74 Industrial Funding Fee And Sales Reporting.) The following clauses do not apply to orders place through the Direct-to-Patient Distribution Program:52.216-18 Ordering (Deviation II)52.216-19 Ordering Limitations (Deviation II) (Tailored)52.232-37 Multiple Payment Arrangements552.211-78 Commercial Delivery Schedule (Multiple Award Schedule)552.216-73 Ordering Information (Alternate II) (Tailored)I-FSS-140-B Urgent RequirementsPlease check one of the following: FORMCHECKBOX Offeror is willing to participate in the VA Direct-to-Patient Distribution Vendor program. FORMCHECKBOX Offeror is not willing to participate in the VA Direct-to-Patient Distribution Vendor Program.AS5000 PHARMACEUTICAL PRIME VENDOR PARTICIPATION (SEP 2011)The Department of Veterans Affairs (VA) and Department of Defense (DOD) have established contracts with Pharmaceutical Prime Vendors (PPV) to distribute products and supplies under Government contracts, including FSS contracts. Other Government agencies such as Indian Health Services and Federal Bureau of Prisons may also participate under VA’s Prime Vendor contracts. Under these programs, the Prime Vendor (PV) contractors place orders with FSS contractors, maintain inventories of products, and deliver orders directly to Government ordering facilities. All prices and discount terms (except prompt payment discounts) agreed to and contained in any award document from this offer (including all future modifications) are applicable to all FSS contract products sold to the Government through the Government Prime Vendors. The Prime Vendor contractors directly pay FSS contractors for product ordered and delivered. All terms and conditions regarding ordering, time, quantity, place, method of delivery, payment terms, and chargeback agreements shall be determined between the FSS contractor and the Prime Vendor contractors. Sales of FSS contract items through the Prime Vendors to eligible Government agencies must be reported as FSS sales during the course of the FSS contract and included in the quarterly FSS Sales Reports. The applicable Industrial Funding Fee (IFF) must be remitted to VA for all FSS sales reported. (See 552.238-74 INDUSTRIAL FUNDING FEE AND SALES REPORTING.) Please check one of the following: Offeror will participate in the Federal Government Prime Vendor program.Offeror will not participate in the Federal Government Prime Vendor program at this time. Offeror does not have chargeback agreements in place with commercial wholesalers and/or has special delivery/handling requirements for all of their products. Offeror will have partial participation in the Prime Vendor program. The offeror does have chargeback agreements in place with commercial wholesalers, however one or several of the products on their FSS contract has special delivery/handling requirements that prevent participation in the Federal Government Prime Vendor program for that particular product at this time. (Please attach a listing of those items that will be participating in the PV program)The Big Four Agencies (VA, DOD, PHS, including IHS, and the Coast Guard) have Prime Vendor contracts through which they distribute their products. Covered drug manufacturers who normally distribute their drugs commercially through these Prime Vendors must check the first or third box. NOTE: Product rationing at quarter-end is unacceptable. Contractors are to ensure availability of product year-round, when participating in the PPV Program.PUBLIC HEALTH EMERGENCIES PARTICIPATION ELECTIONEffective August 17, 2009, state, local, territorial, and tribal governments may access all Federal Supply Schedules as authorized users for goods and services when expending Federal grant funds in response to Public Health Emergencies (PHE) declared by the Secretary of Health and Human Services under section 319 of the Public Health Services Act, codified at 42 U.S. C. 247d.Participation in this program is voluntary for state, local, tribal and territorial governments, as well as Schedule contractors. Please indicate your decision regarding voluntary participation in this program. FORMCHECKBOX YES FORMCHECKBOX NO ................
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