01. ATTCH 01-Contractor Information & Pricing Table_5008.pdf
PDF 780 KB Posted
- Solicitation number
- W912LP-25-Q-5008
About this file
This document is a Request for Quote (RFQ) for Medical Surveillance Examination Services for the Iowa Army National Guard in Waterloo, IA, solicitation number W912LP-25-Q-5008. The RFQ includes a Contractor Information Table and Pricing Table for potential vendors to complete, with six specific line items for medical services: Physical/Dermatological Exam, Complete Lab Draw, Vision Screening, and blood level tests for Chromium, Lead, and Cadmium. The quantity for each service is 30 units, and vendors are required to provide unit pricing, with the expectation that they will complete the form as their official quote and submit it along with any additional documentation.
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Text version
RFQ # W912LP-25-Q-5008
Medical Surveillance Examination Services
Waterloo, IA
Contractor shall complete the Contractor Information Table and the Pricing Table and include this page as their official quote. If the contractor submits an additional quote document, this attachment shall still be completed and submitted with their other documents.
CONTRACTOR INFORMATION TABLE
Company Name:
Point of Contact (POC) Name:
POC Phone:
POC Email:
CAGE Code / Entity ID:
Tax ID Number:
Prompt Payment Discount Terms (Net 30 unless otherwise noted) Business Size/Socio-economic Group(s) (Must correspond with FAR 52.212-3 Representations and Certifications completed within SAM)
Proposed Service Location Address(es):
PRICING TABLE
Item # Description Qty Unit Unit Price Extended Price
0001 Physical / Dermatological Exam 30 EA
0002 Complete Lab Draw 30 EA
0003 Vision Screening 30 EA
0004 Chromium Blood Level 30 EA
0005 Lead Blood Level 30 EA
0006 Cadmium Blood Level 30 EA
Total
Attachment 01 - Contractor Information & Pricing Table
| Company Name: |
| Point of Contact POC Name: |
| POC Phone: |
| POC Email: |
| CAGE Code Entity ID: |
| Tax ID Number: |
| Prompt Payment Discount Terms Net 30 unless otherwise noted: |
| Business SizeSocioeconomic Groups Must correspond with FAR 522123 Representations and Certifications completed within SAM: |
| Unit PriceEA: |
| Extended PriceEA: |
| Unit PriceEA_2: |
| Extended PriceEA_2: |
| Unit PriceEA_3: |
| Extended PriceEA_3: |
| Unit PriceEA_4: |
| Extended PriceEA_4: |
| Unit PriceEA_5: |
| Extended PriceEA_5: |
| Unit PriceEA_6: |
| Extended PriceEA_6: |
| Extended PriceTotal: |
| Proposed Service Location Address(es): |
File details come from the government source that posted it. Updated .