PRICE_WORKSHEET_-_TEMPLATE.xlsx
XLSX spreadsheet 26 KB Posted
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- 36C24219Q0147
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36C24219Q0147 PRICE WORKSHEET - TEMPLATE.xlsx
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| File | Type | Posted |
|---|---|---|
| 36C24219D0056-000.docx | DOCX document | |
| QUALITY_ASSURANCE_SURVEILLANCE_PLAN_(QASP).docx | DOCX document | |
| BAA.docx | DOCX document | |
| Wage_Determination_No_2015-4161_Livingston,_Monroe,_Ontario,_Orleans,_Wayne.pdf | ||
| Wage_Determination_No_2015-4179_Allegany,_Cattaraugus,_Chautauqua,_Wyoming.pdf | ||
| Wage_Determination_No_2015-4147_Erie,_Niagara.pdf | ||
| Wage_Determination_No_2015-4181_Genesee,_Seneca,_Steuben.pdf | ||
| 36C24219Q0147_1.docx | DOCX document | |
| 36C24219Q0147.docx | DOCX document |
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BASE YEAR
| AMBULETTE PRICE EVALUATION SHEET | |||||
| CLIN | BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE |
| 0001 | BASE RATE (Erie County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 2000 | $0.00 | |
| 0002 | BASE RATE (Erie County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 0003 | BASE RATE (Erie County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| BATAVIA VAMC | |||||
| 0004 | BASE RATE (Genesee County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 0005 | BASE RATE (Genesee County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| 0006 | BASE RATE (Genesee County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| CBOCs | |||||
| 0007 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 100 | $0.00 | |
| 0008 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| 0009 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| MILEAGE RATE | |||||
| 0010 | RATE FOR EACH LOADED MILE BEYOND 10 MILE BASE FOR ALL TRIPS (OTHER THAN FLAT RATE) THE SERVICE AREA | MILE | 15000 | $0.00 | |
| FLAT RATE TRIPS | |||||
| 0011 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 0012 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 0013 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 0014 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 0015 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 0016 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 0017 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 0018 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 0019 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 0020 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 |
TOTAL $0.00
TOTAL BASE AND ALL OPTIONS (FOR EVALUATION) $0.00
OPTION YEAR 1
| AMBULETTE PRICE EVALUATION SHEET | |||||
| CLIN | BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE |
| 1001 | BASE RATE (Erie County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 2000 | $0.00 | |
| 1002 | BASE RATE (Erie County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 1003 | BASE RATE (Erie County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| BATAVIA VAMC | |||||
| 1004 | BASE RATE (Genesee County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 1005 | BASE RATE (Genesee County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| 1006 | BASE RATE (Genesee County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| CBOCs | |||||
| 1007 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 100 | $0.00 | |
| 1008 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| 1009 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| MILEAGE RATE | |||||
| 1010 | RATE FOR EACH LOADED MILE BEYOND 10 MILE BASE FOR ALL TRIPS (OTHER THAN FLAT RATE) THE SERVICE AREA | MILE | 15000 | $0.00 | |
| FLAT RATE TRIPS | |||||
| 1011 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 1012 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 1013 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 1014 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 1015 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 1016 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 1017 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 1018 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 1019 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 1020 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 |
TOTAL $0.00
OPTION YEAR 2
| AMBULETTE PRICE EVALUATION SHEET | |||||
| CLIN | BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE |
| 2001 | BASE RATE (Erie County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 2000 | $0.00 | |
| 2002 | BASE RATE (Erie County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 2003 | BASE RATE (Erie County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| BATAVIA VAMC | |||||
| 2004 | BASE RATE (Genesee County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 2005 | BASE RATE (Genesee County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| 2006 | BASE RATE (Genesee County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| CBOCs | |||||
| 2007 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 100 | $0.00 | |
| 2008 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| 2009 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| MILEAGE RATE | |||||
| 2010 | RATE FOR EACH LOADED MILE BEYOND 10 MILE BASE FOR ALL TRIPS (OTHER THAN FLAT RATE) THE SERVICE AREA | MILE | 15000 | $0.00 | |
| FLAT RATE TRIPS | |||||
| 2011 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 2012 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 2013 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 2014 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 2015 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 2016 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 2017 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 2018 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 2019 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 2020 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 |
TOTAL $0.00
OPTION YEAR 3
| AMBULETTE PRICE EVALUATION SHEET | |||||
| CLIN | BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE |
| 3001 | BASE RATE (Erie County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 2000 | $0.00 | |
| 3002 | BASE RATE (Erie County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 3003 | BASE RATE (Erie County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| BATAVIA VAMC | |||||
| 3004 | BASE RATE (Genesee County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 3005 | BASE RATE (Genesee County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| 3006 | BASE RATE (Genesee County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| CBOCs | |||||
| 3007 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 100 | $0.00 | |
| 3008 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| 3009 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| MILEAGE RATE | |||||
| 3010 | RATE FOR EACH LOADED MILE BEYOND 10 MILE BASE FOR ALL TRIPS (OTHER THAN FLAT RATE) THE SERVICE AREA | MILE | 15000 | $0.00 | |
| FLAT RATE TRIPS | |||||
| 3011 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 3012 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 3013 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 3014 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 3015 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 3016 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 3017 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 3018 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 3019 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 3020 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 |
TOTAL $0.00
OPTION YEAR 4
| AMBULETTE PRICE EVALUATION SHEET | |||||
| CLIN | BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE |
| 4001 | BASE RATE (Erie County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 2000 | $0.00 | |
| 4002 | BASE RATE (Erie County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 4003 | BASE RATE (Erie County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| BATAVIA VAMC | |||||
| 4004 | BASE RATE (Genesee County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 400 | $0.00 | |
| 4005 | BASE RATE (Genesee County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| 4006 | BASE RATE (Genesee County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 50 | $0.00 | |
| CBOCs | |||||
| 4007 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - WHEELCHAIR - INCLUDES FIRST 10 MILES | TRIP | 100 | $0.00 | |
| 4008 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - 2-MAN ASSIST - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| 4009 | BASE RATE (Alleghany, Cattaraugus, Chautauqua, Livingston, Monroe, Niagara, Ontario, Orleans, Steuben and Wyoming County) - STRETCHER SERVICE - INCLUDES FIRST 10 MILES | TRIP | 20 | $0.00 | |
| MILEAGE RATE | |||||
| 4010 | RATE FOR EACH LOADED MILE BEYOND 10 MILE BASE FOR ALL TRIPS (OTHER THAN FLAT RATE) THE SERVICE AREA | MILE | 15000 | $0.00 | |
| FLAT RATE TRIPS | |||||
| 4011 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 4012 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATAVIA VAMC | TRIP | 5 | $0.00 | |
| 4013 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 4014 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 4015 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 4016 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BUFFALO VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 4017 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 4018 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND SYRACUSE VAMC | TRIP | 5 | $0.00 | |
| 4019 | WHEELCHAIR - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 | |
| 4020 | STRETCHER - FLAT RATE FOR TRIPS BETWEEN BATAVIA VAMC AND BATH VAMC | TRIP | 5 | $0.00 |
TOTAL $0.00
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