Statement of Objectives (SOO) PMRSADAPT SCOPE OF REQUIREMENT ADAPTIVE VEHICLE EQUIPMENT The Department of Veteran Affairs, VISN 01, VA Boston Healthcare System due to numerous factors has a requirement for: KIT-HVL-A211 HVL:A211 TARSUS INSTRUCTOR PEDALS, ELECTRONIC GAS & MECHANICAL CABLE BRAKE FOR USE WITH AN EXISTING FEATHERLITE HAND CONTROL 1 KIT-HVL-A701 Howell Ventures HVL-A701 Tri-Pin 1 KIT-HVL-A703 Howell Ventures HVL-A703 Amputee Ring Only 1 KIT-HVL-A700 Howell Ventures HVL-A700 Palm Grip Only 1 KIT-HVL-A600B Howell Ventures HVL-A600B Spinner Knob - BASE ONLY 1 HVL:FLQDLS-C Featherlite Automotive Hand Controls, FL QD Custom Eval Hand Control Package Left Side 1 HVL:FLQDRS-C Featherlite Automotive Hand Controls, FL QD Custom Eval Hand Control Package Right Side 1 HVL:30A203 Brake Extension Assembly 1 KIT-HVL-SH103 HVL:SH103 Air Bag Disconnect - UNIVERSAL SHUNT, 2 OHM 1 KIT-HVL-RF360 Howell Ventures HVL-RF360 Easyspin 6 Function Spinner Knob 1 KIT-HVL-A604 HVL:A604 Spinner Knob with Base - BLACK 1 KIT-HVL-FLPED-QD HVL:FLPED-QD Left Foot Accelerator QD Pedal Pack, Featherlite Left Foot Accelerator Quick Disconnect Pedal Pack 1 Service 330830 Labor to install hand controls, spinner knob with funtions 1 Misc Change interior from cloth to leather and modify foam in seat. 1 Misc Rearview Mirror for passenger side The objective of this task order is to provide: PLACE OF PERFORMANCE VA Boston Healthcare System 940 Belmont Street Brockton, MA 02301 1.2 HOURS OF OPERATIONS Delivery schedule shall occur from 7:00 a.m. to 3:30 p.m., Monday through Friday, excluding Federal Holidays. 1.3 POINTS OF CONTACT Requestor: NIVALDA BARROS Email: NIVALDA.BARROS@VA.GOV Phone: 774-826-2899 Requestors Service: PHYSICAL MEDICINE & REHAB SERVICES Delivery and Warehouse Information: West Roxbury 857-203-5832 Jamaica Plain 857-364-6054 Brockton 774-826-1937 DESCRIPTION OF REQUIREMENT Description Manufacturer Model Number Quantity Unit of Purchase HVL:A211 TARSUS INSTRUCTOR PEDALS, ELECTRONIC GAS & MECHANICAL CABLE BRAKE FOR USE WITH AN EXISTING FEATHERLITE HAND CONTROL MOBILITY WORKS KIT-HVL-A211 1 EA Howell Ventures HVL-A701 Tri-Pin MOBILITY WORKS KIT-HVL-A701 1 EA Howell Ventures HVL-A703 Amputee Ring Only MOBILITY WORKS KIT-HVL-A703 1 EA Howell Ventures HVL-A700 Palm Grip Only MOBILITY WORKS KIT-HVL-A700 1 EA Howell Ventures HVL-A600B Spinner Knob - BASE ONLY MOBILITY WORKS KIT-HVL-A600B 1 EA Featherlite Automotive Hand Controls, FL QD Custom Eval Hand Control Package Left Side MOBILITY WORKS HVL:FLQDLS-C 1 EA Featherlite Automotive Hand Controls, FL QD Custom Eval Hand Control Package Right Side MOBILITY WORKS HVL:FLQDRS-C 1 EA Brake Extension Assembly MOBILITY WORKS HVL:30A203 1 EA HVL:SH103 Air Bag Disconnect - UNIVERSAL SHUNT, 2 OHM MOBILITY WORKS KIT-HVL-SH103 1 EA Howell Ventures HVL-RF360 Easyspin 6 Function Spinner Knob MOBILITY WORKS KIT-HVL-RF360 1 EA HVL:A604 Spinner Knob with Base - BLACK MOBILITY WORKS KIT-HVL-A604 1 EA HVL:FLPED-QD Left Foot Accelerator QD Pedal Pack, Featherlite Left Foot Accelerator Quick Disconnect Pedal Pack MOBILITY WORKS KIT-HVL-FLPED-QD 1 EA Labor to install hand controls, spinner knob with funtions MOBILITY WORKS Service 330830 1 EA Change interior from cloth to leather and modify foam in seat. MOBILITY WORKS Misc 1 EA Rearview Mirror for passenger side MOBILITY WORKS Misc 1 EA

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