01. ATTCH 01-Contractor Information & Pricing Table.pdf
PDF 179 KB Posted
- Solicitation number
- W912LP-25-Q-5005
About this file
This is a contractor information and pricing template form for RFQ #W912LP-25-Q-5005 for Medical Surveillance Examination Services at AASF #3 in Davenport, Iowa. The form contains two main sections: a Contractor Information Table requiring company details including POC information, CAGE code, SAM Unique Entity ID, Tax ID, payment terms, and business size/socioeconomic status; and a Pricing Table with six line items for medical services.
The Pricing Table requires unit pricing for 17 each of: Physical/Dermatological Exams, Complete Lab Draws, Vision Screening, Chromium Blood Level tests, Lead Blood Level tests, and Cadmium Blood Level tests. The form must be completed and submitted as the official quote, even if additional quote documentation is provided. The template includes fields for both unit prices and extended prices, with automatic calculation of the total price.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment 01 – Contractor Information and Pricing Tables
RFQ # W912LP-25-Q-5005
Medical Surveillance Examination Services (AASF #3 Davenport, Iowa)
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.
PRICING TABLE
Item # Description Qty Unit Unit Price Extended Price
0001 Physical / Dermatological Exam EA
0002 Complete Lab Draw EA
0003 Vision Screening EA
0004 Chromium Blood Level EA
0005 Lead Blood Level EA
0006 Cadmium Blood Level EA
Total
CONTRACTOR INFORMATION TABLE
Company Name:
Point of Contact (POC) Name:
POC Phone:
POC Email:
CAGE Code:
SAM Unique 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)
| Company Name: |
| Point of Contact POC Name: |
| POC Phone: |
| POC Email: |
| CAGE Code: |
| SAM Unique 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: 0 |
| Unit PriceEA_2: |
| Extended PriceEA_2: 0 |
| Unit PriceEA_3: |
| Extended PriceEA_3: 0 |
| Unit PriceEA_4: |
| Extended PriceEA_4: 0 |
| Unit PriceEA_5: |
| Extended PriceEA_5: 0 |
| Unit PriceEA_6: |
| Extended PriceEA_6: 0 |
| Extended PriceTotal: 0 |
| Text1: 17 |
File details come from the government source that posted it. Updated .