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SOLICITATION FOR OFFERS OUTPATIENT CLINIC[INSERT LOCATION OF FACILITY]Department / Functional AreaRoomCodeQty ofRooms FunctionSCHEDULE B--SPECIAL REQUIREMENTS: Functional Room ListEquipmentSymbol orJSN Code Item Description Qty Unit Cost Extension Subtotal NotesP7650 Trap, Plaster, Small 1 $405.00 $405.00C0052 Pegboard, Heavy Duty, w/Hangers, 48x96 1 $275.00 $275.00M1620 Holder, Chart, Patient, Wall orDoor Mounted 1 $28.00 $28.00Orthopedics (Ortho) DR001 2 Dressing Room, Patient $672.00A1066 Mirror, SS Framed, 20x48 1 $95.00 $95.00A5021 Bench, Dressing, Wall Mounted 1 $211.00 $211.00A5145 Coat Hook, SS, Surface Mounted 2 $15.00 $30.00Orthopedics (Ortho) ORPC1 1 Storage, Plaster and Splints $825.00C0052Pegboard, Heavy Duty, w/Hangers, 48x96 3 $275.00 $825.00Clinic Based Home Care (CBHC) OFA02 5 Office $150.00A5145 Coat Hook, SS, Surface Mounted 2 $15.00 $30.00Clinic Based Home Care (CBHC) OFD03 3 Office $297.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00A3010 Bulletin Board, 48" x 48" 1 $84.00 $84.00Clinic Based Home Care (CBHC) OFA01 1 Office $30.00A5145 Coat Hook, SS, Surface Mounted 2 $15.00 $30.00Patient Education (Pat EDU) LIBV1 1 Information Resource Center $2,531.00F3055 Whiteboard, w/ Sliding Panels 1 $1,423.00 $1,423.00M0410Screen, Projection, RecessedCeiling Mounted, ManualOperation, 69x92 Viewing Area,120" Diagonal 1 $1,108.00 $1,108.00Patient Education (Pat EDU) CLR01 1 Classroom $2,531.00F3055 Whiteboard, w/ Sliding Panels 1 $1,423.00 $1,423.00M0410Screen, Projection, RecessedCeiling Mounted, ManualOperation, 69x92 Viewing Area,120" Diagonal 1 $1,108.00 $1,108.00Audiology and Speech PathologyAudiology (AUD) PEHS1 1 Booth, Audometric Exam $19,736.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00M0050M1620Booth, Audio, Double Wall,Definitive teat, 1 Person 1 $19,693.00 $19,693.00Holder, Chart, Patient, Wall orDoor Mounted 1 $28.00 $28.00Audiology (AUD) EXEN1 1 Electrophysiology Room $483.00A1066 Mirror, SS Framed, 24x36 1 $75.00 $75.00A5080 Dispenser, Paper Towel, SS,Surface Mounted 1 $67.00 $67.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00M1620 Holder, Chart, Patient, Wall orDoor Mounted 1 $28.00 $28.00P-418 Lavatory, Vitreous China, withSensor Faucet 1 $298.00 $298.00Audiology (AUD) OPMH1 1 Group Therapy Room $400.00A5120 Window, Observation, One-Way 1 $400.00 $400.00Audiology (AUD) HAFR1 1Hearing Aid Fabrication /Modification Room $440.00A1066 Mirror, SS Framed, 24x36 1 $75.00 $75.00______Lessor Gov't_______Part III: Special Requirements -- Schedule BMAY 2009SFO No. VA-101-XX-RP-XXXX___ of _____ Pages
SOLICITATION FOR OFFERS OUTPATIENT CLINIC[INSERT LOCATION OF FACILITY]MAY 2009SFO No. VA-101-XX-RP-XXXXDepartment / Functional AreaRoomCodeQty ofRooms FunctionSCHEDULE B--SPECIAL REQUIREMENTS: Functional Room ListEquipmentSymbol orJSN Code Item Description Qty Unit Cost Extension Subtotal NotesA5080P-418Dispenser, Paper Towel, SS,Surface Mounted 1 $67.00 $67.00Lavatory, Vitreous China, withSensor Faucet 1 $298.00 $298.00Audiology (AUD) TREN1 1 Immittance Room $55,890.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00M0041 Booth, Audio, Double Wall, Suite 1 $55,847.00 $55,847.00Audiology (AUD) SRCH1 NRM1620Holder, Chart, Patient, Wall orDoor Mounted 1 $28.00 $28.00Instrument Calibrationand StorageRoom 1No Additional Schedule B ItemsAudiology (AUD) EXOS1 1 Office, Therapy Room, Audiologist $15.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00Audiology (AUD) EXEN1 1 Posturography Room $483.00A1066 Mirror, SS Framed, 24x36 1 $75.00 $75.00A5080 Dispenser, Paper Towel, SS,Surface Mounted 1 $67.00 $67.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00M1620 Holder, Chart, Patient, Wall orDoor Mounted 1 $28.00 $28.00P-418 Lavatory, Vitreous China, withSensor Faucet 1 $298.00 $298.00Audiology (AUD) PESH4 1 Suite, Audiometric Exam $55,890.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00M0041 Booth, Audio, Double Wall, Suite 1 $55,847.00 $55,847.00M1620 Holder, Chart, Patient, Wall orDoor Mounted 1 $28.00 $28.00Audiology (AUD) EXVE1 1 Vestibulography Room $365.00A5080 Dispenser, Paper Towel, SS,Surface Mounted 1 $67.00 $67.00P-418 Lavatory, Vitreous China, withSensor Faucet 1 $298.00 $298.00Audiology (AUD) SRSE1 NR Equipment Area 1 No Additional Schedule B ItemsAudiology and Speech Pathology OFA03 1 Office, Administrative Assistant $99.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00F3010 Bulletin Board, 48" x 48" 1 $84.00 $84.00Audiology and Speech Pathology OFA02 1 Office, Chief of Service $15.00A5145 Coat Hook, SS, Surface Mounted 1 $15.00 $15.00Audiology and Speech Pathology RECP1 1 Office, Reception / Control Clerk $2,812.00C0038 Rail, Apron, 4x42x1 1 $116.00 $116.00C0039 Rail, Apron, 4x48x1 1 $84.00 $84.00C0045 Frame, Apron, 1 Drawer, 4x36x22 1 $420.00 $420.00C0046 Frame, Apron, 2 Drawer, 4x48x22 1 $629.00 $629.00C06M0CT030Cabinet, Under Counter, Pull-outBoard, 2 Drawer, 1 File Drawer,30x18x22 1 $863.00 $863.00Countertop, High PressureLaminate 10 $70.00 $700.00Audiology and Speech Pathology SEC01 1 Office, Secretary / Clerks $30.00A5145 Coat Hook, SS, Surface Mounted 2 $15.00 $30.00______Lessor Gov't_______Part III: Special Requirements -- Schedule B___ of _____ Pages
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Department ofVeterans AffairsOffice
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MAY 2009SOLICITATION FOR OFFERS OUT
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Refer to Part I Section 10 and the
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GSA FORM 1364A - PROPOSAL TO LEASE
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Block 8a(4)Annual Rate per Rentable
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For purposes of the price evaluatio
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IV. SECTION IV -OWNER IDENTIFICATIO
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