36C24723R0084.docx

36C24723R0084

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE

DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a.

PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE

ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26.

TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

544-25-1-036-0001 36C24723R0084 09-06-2024 Marcus Watts 334-725-3166 09-17-2024 1:00

EDT

Department of Veterans Affairs Central Alabama Health Care System East Campus 2400 Hospital Road Tuskegee AL 36083-5001 X X 339116 500 Employees N/A X Department of Veteran Affairs WJB Dorn Va Medical Center 6439 Garners Ferry Rd.

Columbia SC 29209 Department of Veterans Affairs Central Alabama Health Care System East Campus 2400 Hospital Road Tuskegee AL 36083-5001

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971 See CONTINUATION Page Contractor shall provide Dental Prostheses IAW the Performance Work Statement and Price Schedule for WJB Dorn VA Medical Center.

This solicitation is set-aside for a Small Business See Performance Work Statement.

POP:

DATE OF AWARD THROUGH ONE CALENDAR YEAR WITH FOUR ONE-

YEAR OPTIONS FOR RENEWAL.

$0.00 See CONTINUATION Page x X x Benford Brundage Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

Left Blank Intentionally

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C247 Benford Brundage Department of Veterans Affairs Central Alabama Health Care System East Campus 2400 Hospital Road Tuskegee AL 36083-5001

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

36C24723R0084

Page 1 of Page 1 of

1.0 PERFORMANCE WORK STATEMENT GENERAL INFORMATION

Contractor shall furnish all necessary labor (including diagnostic wax up services), equipment, supplies, packaging, transportation, manifests, and reports necessary to fabricate, and deliver the materials listed below in accordance with the period of performance in section 1.2 of this document.

All work requested in this contract shall include all necessary “model work” including impression pouring, die trimming, and articulation.

The price of a fixed partial denture includes the price of the retainers and pontic(s). These bridge units will be priced at the rate of a single crown times the number of units in the fixed partial denture. The price of the prosthesis (dental porcelain fused to metal crowns and fixed partial dentures) shall not change if the prescription request metal occlusal or lingual surfaces; metal rest seats, guide planes and contour undercuts (survey crowns); porcelain butt margins, metal collars; or retro-fitting a crown to an existing removable partial denture. The price of the crown and bridge unit will include the price of the metal (dental casting high noble or noble alloy). There will not be an additional cost for metal.

The price of a removable partial denture cast framework shall not change if the prescription requests multiple clasps or wrought wire clasps, metal backings; or a lingual plate major connector. Complete dentures and partial dentures will include patient identifying information if requested at no additional charge.

1.1 SCOPE OF WORK

The Contractor shall provide all resources necessary to accomplish the requirements described in the Performance Work Statement (PWS). The Contractor shall provide dental laboratory services outlined in this PWS.

The dental laboratory services that may be authorized under this contract include:

· Fabrication of porcelain fused to metal crowns and fixed partial dentures

· Fabrication of Full gold crowns and fixed partial dentures

· Implant supported crowns and fixed partial dentures

· Abutments

· Resin-bonded bridges

· Removable partial denture frameworks

· Diagnostic wax-ups for crown and bridge (C&B) cases

· Custom provisional C&B prostheses

· All-ceramic C&B prostheses

· Implant connecting bars (precious metal/titanium)

· C&B metal/titanium/zirconium substructures

· Application of veneering porcelain to existing/CDL submitted metal or ceramic C&B copings and fixed partial denture (FPD) substructures.

· Acrylic services including complete dentures, removable partial dentures and flexible partial dentures

· Devices for the treatment of obstructive sleep apnea

· Occlusal guards The Contractor shall provide sufficient management to ensure that the work specified in this contract is performed efficiently, accurately, on time, and in compliance with the terms and conditions of the contract.

The Contractor shall provide services and support to VA customers as defined herein.

1.2 PERFORMANCE DETAILS

PERIOD OF PERFORMANCE

a. The period of performance of this contract award shall be from December 01, 2024 through November 30, 2025

b. If the Government exercises its option(s) pursuant to the OPTION PROVISION (52.217-9) of this contract, the period of performance will be increased as listed below:

c. Any work at the Government site shall not take place on Federal holidays or weekends, or OPM-directed closing unless directed by the Contracting Officer (CO). Work hours will be from 8:00 a.m. – 4:30 p.m. from Monday through Friday, Eastern Standard/Daylight Time (EST/EDT) no overtime is authorized.

PLACE OF PERFORMANCE

Tasks under this PWS shall be completed at the Contractor’s facilities.

1.3 TRAVEL

The Government does not anticipate travel for this requirement.

1.4 POST-AWARD KICKOFF MEETING

Within 10 business days of contract award, the Contractor shall coordinate with the VA Contracting Officer Representative (COR) and the Contracting Officer (CO) to conduct a Kickoff meeting with VA. The meeting shall initiate the communication process between VA and the Contractor and shall be held via TEAMS. The purpose of this meeting is to:

Introduce the key contractor personnel performing work related to this requirement; Provide an overview of requirement administration and reporting;

Review draft baseline management plan and significant dates; and, Complete standard administrative tasks.

2.0 SUMMARY OF REQUIREMENTS

GENERAL INFORMATION

Contracting Officer’s Representative (COR), in collaboration with the customer will regularly inspect returned work specimens in accordance with Quality Assurance Surveillance Plan (QASP).

2.1 PRODUCT REQUIREMENTS

2.1.1 AMERICAN NATIONAL STANDARDS INSTITUTE (ANSI) REQUIREMENTS

Standards by the ANSI in cooperation with the American Dental Association Department of Standards require that all materials used for fabrication of dental prostheses meet the Standard Practices for Biological Evaluation of Dental Materials.

2.1.2 FOOD AND DRUG ADMINISTRATION (FDA) REQUIREMENTS

Contractor must comply with the regulations governing FDA Quality System/Good Manufacturing Practices for products distributed in the United States dental laboratories. FDA regulations prohibit the use of lead in the surface material used to fabricate dental prostheses.

2.1.3 QUALITY MANUFACTURING

The Contractor must assure that all dental prostheses supplied to VA customers comply with all FDA and ANSI regulations and standards, using high quality materials. The Contractor must assure that dental prostheses or appliances assembled or created under the contract will not be manufactured outside of the United States.

2.1.4 CLEANLINESS

Contractor shall adhere to OSHA standards and disinfect all dental impressions and prostheses.

2.1.5 MATERIAL REQUIREMENTS

High Noble Alloys: Noble Metal Content must be >40% (Gold + Platinum Group) and shall be used in the fabrication of full gold crowns and fixed partial dentures (bridges); and in porcelain fused to metal crowns and fixed partial dentures if requested by the customer.

Noble Alloys: Noble Metal Content must be > 25% (Gold + Platinum Group) shall be used in the fabrication of full gold crowns and fixed partial dentures (bridges) and in porcelain fused to metal crowns and fixed partial dentures.

The contractor shall provide porcelain fused to metal crowns and fixed partial dentures with options of metal occlusal surfaces, crown (survey) under partial denture, porcelain labial butt margin and implant crown and abutments. The contract laboratory shall identify by affixing the most recent manufacturer label to provide a description of the metal alloy components and percentages used in the fabrication of each of the requested dental prostheses. The contract laboratory shall identify in writing (per case) the type of porcelain used in the fabrication of the porcelain fused to metal dental restorations and in instances where porcelain application only is requested. The alloy used for PFM restorations shall contain less than 30% silver. The total combined content of the base metals used for PFM restorations shall not exceed 25%.

Non-precious alloys (nickel and beryllium free) shall be used for resin-bonded (Maryland bridges) fixed partial dentures.

Cast metal partial denture frameworks shall be fabricated of a cobalt chromium metal alloy; free of nickel and beryllium.

2.2 TURN-AROUND TIMES

Turn-around times required for each type of fabrication or repair from Contractor receipt of an order from the government shall be within stated business times below: Services will be based on the chart below. Turn-around times are defined in business days and do not include weekends or federal holidays as defined by the Office of Personnel Management. In case of longer turn-around times, the Contractor must notify the COR of the delay, in writing, as soon as the delay becomes known and before the maximum number of days has expired. This notification must include the reason for delay and the requested amount of additional time. Contractor shall pick up and deliver once daily Monday through Friday between the hours of 3:00 p.m. and 4:00 p.m. at both locations defined in 2.4.3.

Clasp additions and repairs Complete Denture and Removable Partial Denture, Process and Finish

Cast Partial Framework

Occlusal guards

Processed Surgical Stents

Mandibular Repositioning Device for Treatment of Sleep Apnea

Implant Connecting Bars

2.3 ORDERING PROCEDURES

2.4.1 ORDERING OFFICIALS

The ordering customer VA Department Dental Program (Dentist) will issue a prescription by email to a contractor. An order is defined as a prescription.

PROCEDURES

IDIQ contracts to single awardees are established with a minimum and maximum order limits.

2.4.2 GOVERNMENT PACKAGING

Orders sent to contractors will include the following information:

(i) Date of order.

(ii) Case Number

(ii) Contract number and order number.

(iii) For supplies and services, description and quantity as per prescription.

(iv) Place of delivery or performance (including consignee).

(v) Accounting and Appropriation data

2.4.3 SHIPPING REQUIREMENTS

SHIPPING LOCATIONS

WJB Dorn VA Medical Center 6439 Garners Ferry Rd Columbia, SC 29209 Greenville Outpatient Clinic 41 Park Creek Drive Greenville, SC 29605

2.4.4 SHIPPING METHOD

Contractor shall use “Next Day” mail or equivalent overnight express delivery service for all products. Return shipping costs shall be the responsibility of the Contractor. Signature confirmation is required.

2.4.5 CONTRACTOR PACKAGING

Contractor shall adhere to the following guidelines when packaging products for return to VA:

· Remove dies from models, wrap in cotton and place in plastic containers.

· Wrap all components individually in bubble wrap and secure.

· Pack items securely in shipping box with sufficient bubble wrap to avoid movement during shipment.

· All completed cases shall be disinfected and returned to the authorizing station via shipping methods defined in 2.4.4.

· Contractor must identify the specific type of metal used in the prosthesis and include with the shipment.

2.4.6 CONTENTS

Contractor shall include the following items in each returned product to VA:

· All original materials supplied by VA

· Chain of custody from receipt of items to packaging for shipment

· Itemized non-payable invoice or packing list as detailed in paragraph 3.0

· A copy or original of the manufacturer label, to provide a description of the metal alloy components and percentages used in the fabrication of each of the requested dental products. Contractor shall identify in writing (per case), the type of porcelain used in the fabrication of the porcelain fused to metal dental restorations

· A copy of the original lab prescription from the authorizing CDL or Dental Service

2.5. GOVERNMENT

Government shall be responsible for the following during the term of the contract.

· (Pick-up) Ensure completion of a Prescription of service required for each Impression submitted.

· Place Prescription and Impression at Dental Laboratory Shipping Counter of the Dental Service for Contractor daily pick up.

· (Delivery) Verify returned Impressions are matched to Prescription requested with no issues.

· Maintain and log in all delivered items to be invoiced for each month.

CONTRACTOR

The contractor shall be responsible for the following during the term of the contract.

· (Pick-up) Daily pick up at the at Dental Laboratory Shipping Counter of the Dental Service (both locations are to be conducted for Dental Material/Impressions created by the facility to have fabricated with a Prescription for each one explaining what service is required.

· Packaging and Shipment to required Lab of all collected Impressions.

· Fabricate all request(s) per doctor’s prescriptions orders and specified instructions provided with each Impression.

· (Delivery) Return delivery of requested product(s), no later than the patient scheduled appointment date identified on Prescription(s) return date.

· Provide proper notification to the designated COR within 48 hours if unable to meet this time frame.

2.6 DELINQUENCY

Delinquent delivery shall not exceed 5% of the number of orders placed per batch, per quarter, and/or the total number of orders placed for this contract period (year).

2.7 QUALITY

2.7.1 GENERAL GUIDELINES

All dental prostheses returned from the contracted laboratory will be evaluated by the authorizing customer. Returned prostheses that fail to meet patient requirements will be returned to the contractor for correction, adjustment, or remake. All dental prostheses returned to the contractor for correction, adjustment, or remake shall be delivered to the authorizing customer within three (3) business days of date received.

2.7.2 REQUIREMENTS

Prostheses delivered to VA must adhere to the following standards:

· Marginal integrity – crown and bridge prosthetic margins are complete and closed to the marked die margins

· Occlusal relationship – the prosthesis contacts the opposing teeth positively and lightly when biting; for complete or partial dentures the occlusal scheme will be monoplane, anatomic (full balanced); or lingualized per prescription

· Esthetics/anatomic contours – the prosthesis matches the shape and contour of the surrounding teeth, as well as the prescribed shade/color

· Acrylic resin - Acrylic dentures will utilize Lucitone 199 acrylic resin or equivalent

· Denture Teeth - Dentures will utilize Trubyte IPN (Dentsply) teeth or equivalent

Products not conforming to these requirements will require rework. Financial responsibility for rework is defined in paragraph 2.8. Acceptable quantities of rework are defined in paragraph 2.8.

2.8 FINANCIAL RESPONSIBLIITY

Prostheses returned to Contractor for rework due to Contractor error shall have necessary corrections, adjustments, or remakes performed no cost to VA. Prostheses returned to Contractor for rework due to VA error will have necessary corrections, adjustments, or remakes performed at contract rates – payable by VA. The Contractor must provide proof that the error was due to VA error for consideration of payment under the contract.

2.8.1 FREQUENCY OF REWORK

Rework due to contractor error shall not exceed 5% of the number of orders placed per batch, per quarter, and/or the total number of orders placed for this contract period (year).

2.9 INVOICING

The Product Copy, as outlined in paragraph 3.0 is not considered a request for payment. Only invoices received via the Electronic Batch process in paragraph 3.1 will be processed for payment. The contractor must ensure that they invoice based on the customer that requested the work. Monthly Invoicing only. Track and Invoice at the beginning of each month all delivered items for the prior month and submit an Invoice for all Delivered Items only.

3.0 PRODUCT COPY

Contractor shall include a packing list of the contents of each returned product, included in return packaging as described in paragraph 2.4.5, which includes the following information:

· Itemized invoice

· Invoice number

· Name, address, & phone number of Contractor

· Current year’s purchase order number

· Authorizing Dental Service

· Case tracking number

· Lot number of materials used in each product

· Original VA cast number if designated

3.1.1 ELECTRONIC BATCH

Electronic invoices for received batches shall be submitted to the authorizing medical facility via the Financial Services Center (FSC) for payment.

http://www.tungsten-network.com/us/en/. A properly prepared invoice shall contain:

· Invoice Number and Date

· Contractor’s Name and Address

· Accurate Purchase Order Number

· Supply or Service provided

· Period Supply or Service Provided

· Total Amount Due

3.2 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

The Government will utilize a Quality Assurance Surveillance Plan (QASP) to monitor the quality of the Contractor’s performance. The oversight provided for in the QASP will help to ensure that the Contractor performs satisfactorily and will reach and maintain the required levels throughout the contract term. Further, the QASP provides the COR with a proactive way to monitor unacceptable or deficient performance, and provides verifiable input for the required Past Performance Information Assessments. The QASP is incorporated as in the document.

The Contractor shall establish and implement a Quality Assurance Plan (QAP) which corresponds to the VA Quality Assurance and Surveillance Plan, which monitors, evaluates, and appropriately addresses its quality assurance, performance measurement, and other quality and safety-related issues. The plan shall be in compliance with all relevant Federal or State laws and regulations. The Contractor shall submit a copy of their plan to the COR and the CO for approval before commencement of contract performance and every 12 months thereafter.

The Quality Assurance Surveillance Plan (QASP) does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s objective to be objective, fair and consistent in evaluation performance.

Task

ID

Indicator

Standard

Quality

Marginal Integrity

Direct Observation and evaluation

Occlusal Relationship

Direct Observation and evaluation

Indicator

Standard

Esthetics and anatomical contours

Direct observation and evaluation

Dental Materials

Dental materials (metal alloy) used in fabrication Dental alloy used in fabrication of porcelain fused to metal and all gold restorations will be classified as Noble metal or High Noble metal.

98% of the time; less than 5% errors in terms of accuracy Direct observation, random sampling (assay) of metal and review of manufacture’s alloy label.

Fabrication of dental crown and bridge

Shall not exceed 5% Direct observation and evaluation prostheses

Product is

Timeliness

Delivery of Casework (Dental Prostheses) received by VA by required turn-around

95%

Direct observation times

Indicator

Standard

Appropriate

98% of the time; less than 5% errors in terms of accuracy charges will be invoiced upon completion of dental

Billing and invoice

Accuracy in Billing crown and bridge prostheses.

There will

Direct observation and evaluation be no deviation from the

Performance

Work Statement and fees contracted.

3.3 RECORDS MANAGEMENT AND CONTRACT SECURITY

1. Contractor shall comply with VA Handbook 6300.1 Records Management Procedures and VA Handbook 6500.6 Contract Security.

1. Both can be found at: https://www.va.gov/vapubs/search_action.cfm?dType=2.

Note: This link is the complete list of VA Handbooks and are in sequential order.

Instructions for accessing VA Handbooks at link listed above:

Click on link above and once it is opened, please scroll down on the left side until you get to VA Handbook 6300.1. Once there, go to the PDF Format Column and click on PDF. VA Handbook 6300.1 will then ask you to open or save the document. Please follow the same instructions listed above for accessing VA Handbook 6500.6. All contractor employees working on this requirement are required to complete mandatory annual training entitled, “VA Privacy and Information Security Awareness” and “HIPPA Training” prior to providing service for each year of the contract with copies sent to the COR for each and available for audit as requested. The course numbers are VA10203 and VA 10176. You must select that you are a contractor. Contractor employees are to self-enroll into TMS via the link:

https://www.tms.va.gov/learning/user/SelfRegistrationUserSelection.do A VA employee will escort the contractor when contractor is required to enter/work in sensitive areas.

VAAR Clauses included:

852.204-70- Personal Identity Verifications of Contractor personnel 852.204-71- information and Information Systems Security "The A&A requirements do not apply, and that a Security Accreditation Package is not required.

B.2 PRICE/COST SCHEDULE

The guaranteed minimum for this contract is $5.00 for the fiscal year in which this contract was awarded. The contract’s stated maximum (or ceiling amount) is $8,600,000.

Estimated Quantities only.

ITEM INFORMATION

PFM Crowns + Survey Porcelain Crown (Noble Alloy) Contract Period: Base POP Begin: 12-01-2024 POP End: 11-30-2025

PFM Crowns + Survey Porcelain Crown (High Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (High Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (High Noble Alloy)

Full Gold Bridges (Bridge units) (Noble Alloy)

Full Gold Bridges (Bridge units) (High Noble Alloy)

Implant supported Full gold Restorations (Noble Alloy)

Implant supported Full Gold Restorations (High Noble Alloy)

Implant supported Restorations (PFM Noble Alloy)

Implant supported Restorations (PFM High Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM High Noble Alloy)

Implant supported restorations (All Ceramic/layered zirconia)

Implant supported Restorations (Full Contoured Zirconia)

Implant supported Restorations (Lithium di Silicate)

Implant connecting Bars (precious metal/Titanium)

Resin-bonded Bridges (Maryland Bridge) (Bridge units)

Screw-retained Restorations (not including final crown)

Porcelain Laminate Veneer

All-Ceramic C&B prostheses (units)

C&B metal/Titanium/Zirconium substructures

Post and Core

CAD/CAM Abutment (Titanium)

CAD/CAM Abutment (Zirconia)

Removable Partial Denture Frameworks

Flexible Partial Dentures – Fully fabricated

Flexible Partial Dentures – Setup for Try-in

Flexible Partial Dentures – Process and Finish

Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent)

Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent)

Complete Denture – Process and Finish

Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps

Partial Denture – Setup for Try-in

Partial Denture – Process and Finish

Custom tray, Record Base, and Occlusal Rims

Fabrication of Hard Acrylic Night Guards

Fabrication of dual Laminate Bite Guards

Fabricate Diagnostic Wax-ups

Fabricate Provisional Crowns and Fixed Partial Dentures

Denture Repair (Acrylic)

Record base and Occlusal Rim – full or partial (per arch)

Denture Repair (additional teeth)

Mandibular Repositioning Devices (Sleep Apnea)

Trim cast Immediate Dentures

Template, Vacuum-formed

Denture, Immediate

Denture Reline, partial or complete Dentures

Articulation, Upper and Lower Casts

Casts, Maxillary and Mandibular

POP Begin: 12-01-2024

BASE YEAR TOTAL:__________

PFM Crowns + Survey Porcelain Crown (Noble Alloy) Contract Period: Option 1 POP Begin: 12-01-2025 POP End: 11-30-2026

PFM Crowns + Survey Porcelain Crown (High Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (High Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (High Noble Alloy)

Full Gold Bridges (Bridge units) (Noble Alloy)

Full Gold Bridges (Bridge units) (High Noble Alloy)

Implant supported Full gold Restorations (Noble Alloy)

Implant supported Full Gold Restorations (High Noble Alloy)

Implant supported Restorations (PFM Noble Alloy)

Implant supported Restorations (PFM High Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM High Noble Alloy)

Implant supported restorations (All Ceramic/layered zirconia)

Implant supported Restorations (Full Contoured Zirconia)

Implant supported Restorations (Lithium di Silicate)

Implant connecting Bars (precious metal/Titanium)

Resin-bonded Bridges (Maryland Bridge) (Bridge units)

Screw-retained Restorations (not including final crown)

Porcelain Laminate Veneer

All-Ceramic C&B prostheses (units)

C&B metal/Titanium/Zirconium substructures

Post and Core

CAD/CAM Abutment (Titanium)

CAD/CAM Abutment (Zirconia)

Removable Partial Denture Frameworks

Flexible Partial Dentures – Fully fabricated

Flexible Partial Dentures – Setup for Try-in

Flexible Partial Dentures – Process and Finish

Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent)

Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent)

Complete Denture – Process and Finish

Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps

Partial Denture – Setup for Try-in

Partial Denture – Process and Finish

Custom tray, Record Base, and Occlusal Rims

Fabrication of Hard Acrylic Night Guards

Fabrication of dual Laminate Bite Guards

Fabricate Diagnostic Wax-ups

Fabricate Provisional Crowns and Fixed Partial Dentures

Denture Repair (Acrylic)

Record base and Occlusal Rim – full or partial (per arch)

Denture Repair (additional teeth)

Mandibular Repositioning Devices (Sleep Apnea)

Trim cast Immediate Dentures

Template, Vacuum-formed

Denture, Immediate

Denture Reline, partial or complete Dentures

Articulation, Upper and Lower Casts

Casts, Maxillary and Mandibular

POP Begin: 12-01-2025

Contract Period #1 TOTAL:____________

PFM Crowns + Survey Porcelain Crown (Noble Alloy) Contract Period: Option 2 POP Begin: 12-01-2026 POP End: 11-30-2027

PFM Crowns + Survey Porcelain Crown (High Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (High Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (High Noble Alloy)

Full Gold Bridges (Bridge units) (Noble Alloy)

Full Gold Bridges (Bridge units) (High Noble Alloy)

Implant supported Full gold Restorations (Noble Alloy)

Implant supported Full Gold Restorations (High Noble Alloy)

Implant supported Restorations (PFM Noble Alloy)

Implant supported Restorations (PFM High Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM High Noble Alloy)

Implant supported restorations (All Ceramic/layered zirconia)

Implant supported Restorations (Full Contoured Zirconia)

Implant supported Restorations (Lithium di Silicate)

Implant connecting Bars (precious metal/Titanium)

Resin-bonded Bridges (Maryland Bridge) (Bridge units)

Screw-retained Restorations (not including final crown)

Porcelain Laminate Veneer

All-Ceramic C&B prostheses (units)

C&B metal/Titanium/Zirconium substructures

Post and Core

CAD/CAM Abutment (Titanium)

CAD/CAM Abutment (Zirconia)

Removable Partial Denture Frameworks

Flexible Partial Dentures – Fully fabricated

Flexible Partial Dentures – Setup for Try-in

Flexible Partial Dentures – Process and Finish

Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent)

Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent)

Complete Denture – Process and Finish

Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps

Partial Denture – Setup for Try-in

Partial Denture – Process and Finish

Custom tray, Record Base, and Occlusal Rims

Fabrication of Hard Acrylic Night Guards

Fabrication of dual Laminate Bite Guards

Fabricate Diagnostic Wax-ups

Fabricate Provisional Crowns and Fixed Partial Dentures

Denture Repair (Acrylic)

Record base and Occlusal Rim – full or partial (per arch)

Denture Repair (additional teeth)

Mandibular Repositioning Devices (Sleep Apnea)

Trim cast Immediate Dentures

Template, Vacuum-formed

Denture, Immediate

Denture Reline, partial or complete Dentures

Articulation, Upper and Lower Casts

Casts, Maxillary and Mandibular

POP Begin: 12-01-2026

Contract Period #2 TOTAL: ____________

PFM Crowns + Survey Porcelain Crown (Noble Alloy) Contract Period: Option 3 POP Begin: 12-01-2027 POP End: 11-30-2028

PFM Crowns + Survey Porcelain Crown (High Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (High Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (High Noble Alloy)

Full Gold Bridges (Bridge units) (Noble Alloy)

Full Gold Bridges (Bridge units) (High Noble Alloy)

Implant supported Full gold Restorations (Noble Alloy)

Implant supported Full Gold Restorations (High Noble Alloy)

Implant supported Restorations (PFM Noble Alloy)

Implant supported Restorations (PFM High Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM High Noble Alloy)

Implant supported restorations (All Ceramic/layered zirconia)

Implant supported Restorations (Full Contoured Zirconia)

Implant supported Restorations (Lithium di Silicate)

Implant connecting Bars (precious metal/Titanium)

Resin-bonded Bridges (Maryland Bridge) (Bridge units)

Screw-retained Restorations (not including final crown)

Porcelain Laminate Veneer

All-Ceramic C&B prostheses (units)

C&B metal/Titanium/Zirconium substructures

Post and Core

CAD/CAM Abutment (Titanium)

CAD/CAM Abutment (Zirconia)

Removable Partial Denture Frameworks

Flexible Partial Dentures – Fully fabricated

Flexible Partial Dentures – Setup for Try-in

Flexible Partial Dentures – Process and Finish

Complete Denture – Fully fabricated (Premium Teeth, IPN or equivalent)

Complete Denture – Setup for Try-in (Premium Teeth, IPN or equivalent)

Complete Denture – Process and Finish

Transitional Removable Partial Denture (RPD) w/ Wrought Wire Clasps

Partial Denture – Setup for Try-in

Partial Denture – Process and Finish

Custom tray, Record Base, and Occlusal Rims

Fabrication of Hard Acrylic Night Guards

Fabrication of dual Laminate Bite Guards

Fabricate Diagnostic Wax-ups

Fabricate Provisional Crowns and Fixed Partial Dentures

Denture Repair (Acrylic)

Record base and Occlusal Rim – full or partial (per arch)

Denture Repair (additional teeth)

Mandibular Repositioning Devices (Sleep Apnea)

Trim cast Immediate Dentures

Template, Vacuum-formed

Denture, Immediate

Denture Reline, partial or complete Dentures

Articulation, Upper and Lower Casts

Casts, Maxillary and Mandibular

POP Begin: 12-01-2027

Contract Period #3 TOTAL: ________________

PFM Crowns + Survey Porcelain Crown (Noble Alloy) Contract Period: Option 4 POP Begin: 12-01-2028 POP End: 11-30-2029

PFM Crowns + Survey Porcelain Crown (High Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (Noble Alloy)

PFM Bridges (Bridge units - Retainer and Pontics) (High Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (Noble Alloy)

Full Gold Crowns + Survey Gold Crowns (High Noble Alloy)

Full Gold Bridges (Bridge units) (Noble Alloy)

Full Gold Bridges (Bridge units) (High Noble Alloy)

Implant supported Full gold Restorations (Noble Alloy)

Implant supported Full Gold Restorations (High Noble Alloy)

Implant supported Restorations (PFM Noble Alloy)

Implant supported Restorations (PFM High Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM Noble Alloy)

Implant supported Bridge units (Retainer and Pontics – PFM High Noble Alloy)

Implant supported restorations (All Ceramic/layered zirconia)

Implant supported Restorations (Full Contoured Zirconia)

Implant supported Restorations (Lithium di Silicate)

Implant connecting Bars (precious metal/Titanium)

Resin-bonded Bridges (Maryland Bridge) (Bridge units)

Screw-retained Restorations (not including final crown)

Porcelain Laminate Veneer

All-Ceramic C&B prostheses (units)

C&B metal/Titanium/Zirconium substructures

Post and Core

CAD/CAM Abutment…