MEDICAL GAS DISTRO SYSTEM INSPECTION

Form / Attachment / Pricing Sheet

This document is IRS Form W-9, "Request for Taxpayer Identification Number and Certification." It is used by individuals and entities to provide their correct Taxpayer Identification Number (TIN) to a requester who is required to file an information return with the IRS.

• Part I: Taxpayer Identification Number (TIN): Requires the individual or entity's name and TIN (Social Security Number, Individual Taxpayer Identification Number, or Employer Identification Number).
• Part II: Certification: Requires the individual or entity to certify that the TIN provided is correct, that they are not subject to backup withholding, and that they are a U.S. person (or provide other required certifications).
• Lines 1-7: Collects identifying information such as name, business name, address, city, state, and ZIP code.
• Taxpayer Identification Number (TIN) Section: Where the SSN or EIN is entered.
• Certification Section: Where the individual or entity certifies their status and TIN.

If this form is attached to a SAM.gov opportunity, it indicates that the government (the requester) needs the vendor to provide their TIN and certify their status. Bidders will likely need to complete and submit this form as part of their proposal or contract onboarding process to receive payments and for the government to comply with IRS reporting requirements. Failure to provide a correct TIN can lead to backup withholding.

Form / Attachment / Pricing Sheet

This document, VA Form 10091, is the Vendor File Request Form used by the VA-Financial Services Center (VA-FSC) to gather essential payment data from vendors. It is used to establish or update vendor records for processing electronic payments in accordance with federal regulations.

• Request Type: Vendors must select either 'NEW VENDOR' or 'UPDATE EXISTING VENDOR'.
• VA Facility Information: For internal VA use, including station number, contact, and communication details.
• Payee/Vendor Information: Includes details such as SAM.gov registration status, Unique Entity Identifier (UEI), EFT Indicator, Taxpayer Identification Number (TIN) or Social Security Number (SSN), NPI (for medical providers), business name, DBA, contact information, and current/previous addresses.
• EFT/ACH Information: Requires current bank name, routing number, and account number for electronic payments.
• Authorized Representative: Section for the vendor's designated representative to provide their name, title, and signature, certifying the accuracy of the information.

Vendors seeking to do business with the VA must complete this form to ensure they can receive electronic payments. New vendors must register and provide all necessary information. Existing vendors may need to update their records, particularly if banking information or other details have changed. Failure to provide accurate and matching information (especially with SAM.gov) can delay or prevent payments.

Solicitation / RFP / RFQ

This solicitation, RFQ 36C26226Q0737, is for Medical Gas Testing and Inspection services at the VA San Diego Healthcare System (VASDHS). The primary goal is to ensure the medical gas system complies with NFPA 99 Healthcare Facilities Code.

• Conduct inspections of the VA San Diego Medical Gas System by certified medical gas inspectors.

• Verify all medical gas systems, including patient terminal outlets/inlets, alarm systems, shut-off valves, and source equipment.

• Test positive and negative pressure medical gases according to NFPA 99 and ASSE 6000 requirements, including specific tests such as Standing Pressure, Cross-connection, Valve, Alarms, Piping Purge, Piping Particulates, Piping Purity, and Medical Air Purity.

• Perform monthly preventative maintenance as per manufacturer's guidelines.

• Provide service calls for on-site repair labor and parts, not to exceed $2,000.00 per contract year. Any repairs exceeding this amount will require a contract modification.

• Deliverables include an electronic and paper copy of the Medical Gas System report, detailing certifications, test results, scope of work, actions taken, and any discrepancies found.

• Contract Type: Firm Fixed Price

• Period of Performance:

  • Base: 05/15/2026 – 05/14/2027
  • Option Year 1: 05/15/2027 – 05/14/2028
  • Option Year 2: 05/15/2028 – 05/14/2029
  • Option Year 3: 05/15/2029 – 05/14/2030
  • Option Year 4: 05/15/2030 – 05/14/2031

• Place of Performance: VASDHS, 3350 La Jolla Village Drive, San Diego CA 92161

• All questions must be submitted via email to jasmon.cornick@va.gov no later than 1:00 PM MST on May 4, 2026.

• All offers must be submitted via email to jasmon.cornick@va.gov no later than 3:00 PM MST on May 11, 2026.

• Offers must be in PDF format and compatible with Microsoft Office Software.

• Evaluation will be based on Technical Approach, Experience, and Price. Lowest Price Technical Acceptable (LPTA) methods will not be used.

• This acquisition is a total set-aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSBs).

• Offerors must be certified SDVOSBs listed in the SBA certification database.

• The contract includes numerous FAR and VAAR clauses related to terms and conditions, representations, certifications, and specific requirements for SDVOSB concerns.