Section A - Solicitation/Contract Form CLAUSES INCORPORATED BY FULL TEXT Fill in Blanks: TIN: ________________ CAGE: ________________ DUNS: __________________ Vendor POC: ______________________Phone: ____________________ Vendor email: ______________________ Payment in Arrears Vendor to reference RFQ number N00183-07-T-0186 on all inquiries. PROMPT PAYMENT For Prompt Payment Act Purposes, this contract is: Subject to the 7-calender day constructive acceptance period. Vendor?s price should be inclusive of all costs including shipping. This solicitation will be awarded on an All Or Nothing basis. Section B - Supplies or Services and Prices ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 4 Each System Pump Continuum MR Compatible FFP Infusion System includes: 2 remote monitors; gray, medical grade cord set; non-magnetic IV stand; instructional DVD for continuum; FOB: Destination MILSTRIP: N0018307RQXR232 PURCHASE REQUEST NUMBER: N0018307RQXR232 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0002 3 Each Installation of Continuum pumps FFP FOB: Destination MILSTRIP: N0018307RQXR232 PURCHASE REQUEST NUMBER: N0018307RQXR232 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0003 1 Each Continuum installation FFP FOB: Destination MILSTRIP: N0018307RQXR232 PURCHASE REQUEST NUMBER: N0018307RQXR232 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0004 1 Each Wireless System, MR FFP FOB: Destination MILSTRIP: N0018307RQXR232 PURCHASE REQUEST NUMBER: N0018307RQXR232 NET AMT Section C - Descriptions and Specifications CLAUSES INCORPORATED BY FULL TEXT This solicitation is restricted (set-aside) to small businesses. Requirement to be awarded on a brand name or equal basis. Vendor to supply a current published price list or GSA/VA Federal supply schedule contract for supplies and/or services being procured.

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