01. ATTCH 01-Contractor Information & Pricing Table_5009.pdf
PDF 865 KB Posted
- Solicitation number
- W912LP-25-Q-5009
About this file
This document is a Request for Quote (RFQ) for Medical Surveillance Examination Services for the Iowa Army National Guard, solicitation number W912LP-25-Q-5009. The requirement covers medical examinations for 91 federal technicians employed in Field Maintenance and Aviation facilities, potentially exposed to workplace health hazards. The RFQ includes a detailed Contractor Information Table and Pricing Table with six specific medical examination and testing line items: Physical/Dermatological Exam, Complete Lab Draw, Vision Screening, and blood level tests for Chromium, Lead, and Cadmium.
The solicitation is for medical examinations to be conducted in Boone and Des Moines, Iowa, with services to be provided from the date of award through 29 May 2025 (18 medical examinations) and 27 June 2025 (73 medical examinations). Potential contractors are required to complete the attached Contractor Information & Pricing Table, providing company details, point of contact information, and unit pricing for each specified medical service. The document requires vendors to align their business size and socio-economic group representations with FAR 52.212-3 certifications in the System for Award Management (SAM).
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Text version
RFQ # W912LP-25-Q-5009
Medical Surveillance Examination Services
Boone & Des Moines, 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 91 EA
0002 Complete Lab Draw 91 EA
0003 Vision Screening 91 EA
0004 Chromium Blood Level 91 EA
0005 Lead Blood Level 91 EA
0006 Cadmium Blood Level 91 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 .