36C26120Q0136-008.docx

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Attached to
V225--Ground Ambulance Service Federal contract opportunity
Solicitation number
36C26120Q0136
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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36C26120Q0136 Attach 5 Price Schedule.docx

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It is understood that the prices listed in the accepted Schedule shall be inclusive of any and all ferry, bridge, tunnel or road toll charges. Contractor shall not bill the VA for any such separate charges.

All quantities are estimated yearly quantities and may change based on the VA Fresno’s need.

Base Period: April 1, 2019 – March 31, 2020

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
0001
Basic Life Support (BLS) or Advanced Life Support (ALS), base rate, to include first 20 miles
190
TRIP
$
$
0002
Critical Care Transport (CCT), base rate, to include first 20 miles
8
TRIP
$
$
0003
Rate, per mile, one way, first passenger only, loaded miles only beyond first 20 miles
400
MILES
$
$
0004
Wait Time – for roundtrip only
20
HOUR
$
$

The Fresno VA has certain destinations that passengers are repeatedly transported to and from. The price for the destinations below shall constitute the final one-way transport price. Trips, other than these listed below, will be billed in accordance with Items 0001 through 0004 above. The destinations below are interchangeable (for example, X to Y may also be Y to X).

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
0005
VA Fresno to VA San Francisco – ALS or BLS
96
TRIP
$
$
0006
VA Fresno to VA San Francisco – CCT
5
TRIP
$
$
0007
VA Fresno to VA Palo Alto, CA – ALS or BLS
60
TRIP
$
$
0008
VA Fresno to VA Mather – ALS or BLS
5
TRIP
$
$
0009
VA Fresno to VA Mather – CCT
3
TRIP
$
$
0010
VA Fresno to Community Regional Medical Center (CRMC) – ALS or BLS
480
TRIP
$
$
0011
VA Fresno to David Grant U.S. Air Force Medical Center (David Grant) – ALS or BLS
52
TRIP
$
$
0012
VA Fresno to David Grant – CCT
5
TRIP
$
$
TOTAL CLINS 0001-0012:
$

Option Period One: April 1, 2020 – March 31, 2021

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
1001
Basic Life Support (BLS) or Advanced Life Support (ALS), base rate, to include first 20 miles
190
TRIP
$
$
1002
Critical Care Transport (CCT), base rate, to include first 20 miles
8
TRIP
$
$
1003
Rate, per mile, one way, first passenger only, loaded miles only beyond first 20 miles
400
MILES
$
$
1004
Wait Time – for roundtrip only
20
HOUR
$
$

The Fresno VA has certain destinations that passengers are repeatedly transported to and from. The price for the destinations below shall constitute the final one-way transport price. Trips, other than these listed below, will be billed in accordance with Items 1001 through 1004 above. The destinations below are interchangeable (for example, X to Y may also be Y to X).

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
1005
VA Fresno to VA San Francisco – ALS or BLS
96
TRIP
$
$
1006
VA Fresno to VA San Francisco – CCT
5
TRIP
$
$
1007
VA Fresno to VA Palo Alto, CA - ALS
60
TRIP
$
$
1008
VA Fresno to VA Mather – ALS or BLS
5
TRIP
$
$
1009
VA Fresno to VA Mather – CCT
3
TRIP
$
$
1010
VA Fresno to Community Regional Medical Center (CRMC) – ALS or BLS
480
TRIP
$
$
1011
VA Fresno to David Grant U.S. Air Force Medical Center (David Grant) – ALS or BLS
52
TRIP
$
$
1012
VA Fresno to David Grant – CCT
5
TRIP
$
$
TOTAL CLINS 1001-1012:
$

Option Period Two: April 1, 2021 – March 31, 2022

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
2001
Basic Life Support (BLS) or Advanced Life Support (ALS), base rate, to include first 20 miles
190
TRIP
$
$
2002
Critical Care Transport (CCT), base rate, to include first 20 miles
8
TRIP
$
$
2003
Rate, per mile, one way, first passenger only, loaded miles only beyond first 20 miles
400
MILES
$
$
2004
Wait Time – for roundtrip only
20
HOUR
$
$

The Fresno VA has certain destinations that passengers are repeatedly transported to and from. The price for the destinations below shall constitute the final one-way transport price. Trips, other than these listed below, will be billed in accordance with Items 2001 through 2004 above. The destinations below are interchangeable (for example, X to Y may also be Y to X).

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
2005
VA Fresno to VA San Francisco – ALS or BLS
96
TRIP
$
$
2006
VA Fresno to VA San Francisco – CCT
5
TRIP
$
$
2007
VA Fresno to VA Palo Alto, CA – ALS or BLS
60
TRIP
$
$
2008
VA Fresno to VA Mather – ALS or BLS
5
TRIP
$
$
2009
VA Fresno to VA Mather – CCT
3
TRIP
$
$
2010
VA Fresno to Community Regional Medical Center (CRMC) – ALS or BLS
480
TRIP
$
$
2011
VA Fresno to David Grant U.S. Air Force Medical Center (David Grant) – ALS or BLS
52
TRIP
$
$
2012
VA Fresno to David Grant – CCT
5
TRIP
$
$
TOTAL CLINS 2001-2012:
$

Option Period Three: April 1, 2022 – March 31, 2023

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
3001
Basic Life Support (BLS) or Advanced Life Support (ALS), base rate, to include first 20 miles
190
TRIP
$
$
3002
Critical Care Transport (CCT), base rate, to include first 20 miles
8
TRIP
$
$
3003
Rate, per mile, one way, first passenger only, loaded miles only beyond first 20 miles
400
MILES
$
$
3004
Wait Time – for roundtrip only
20
HOUR
$
$

The Fresno VA has certain destinations that passengers are repeatedly transported to and from. Please provide a price for each of the destinations below. Trips, other than these listed below, will be billed in accordance with Items 3001 through 3004 above. The destinations below are interchangeable (for example, X to Y may also be Y to X).

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
3005
VA Fresno to VA San Francisco – ALS or BLS
96
TRIP
$
$
3006
VA Fresno to VA San Francisco – CCT
5
TRIP
$
$
3007
VA Fresno to VA Palo Alto, CA – ALS or BLS
60
TRIP
$
$
3008
VA Fresno to VA Mather – ALS or BLS
5
TRIP
$
$
3009
VA Fresno to VA Mather – CCT
3
TRIP
$
$
3010
VA Fresno to Community Regional Medical Center (CRMC) – ALS or BLS
480
TRIP
$
$
3011
VA Fresno to David Grant U.S. Air Force Medical Center (David Grant) – ALS or BLS
52
TRIP
$
$
3012
VA Fresno to David Grant – CCT
5
TRIP
$
$
TOTAL CLINS 3001-3012:
$

Option Period Four: April 1, 2023 – March 31, 2024

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
4001
Basic Life Support (BLS) or Advanced Life Support (ALS), base rate, to include first 20 miles
190
TRIP
$
$
4002
Critical Care Transport (CCT), base rate, to include first 20 miles
8
TRIP
$
$
4003
Rate, per mile, one way, first passenger only, loaded miles only beyond first 20 miles
400
MILES
$
$
4004
Wait Time – for roundtrip only
20
HOUR
$
$

The Fresno VA has certain destinations that passengers are repeatedly transported to and from. Please provide a price for each of the destinations below. Trips, other than these listed below, will be billed in accordance with Items 4001 through 4004 above. The destinations below are interchangeable (for example, X to Y may also be Y to X).

CLIN
Description
Estimated Quantity
Unit
Unit Cost
Estimated Total Cost
4005
VA Fresno to VA San Francisco – ALS or BLS
96
TRIP
$
$
4006
VA Fresno to VA San Francisco – CCT
5
TRIP
$
$
4007
VA Fresno to VA Palo Alto, CA – ALS or BLS
60
TRIP
$
$
4008
VA Fresno to VA Mather – ALS or BLS
5
TRIP
$
$
4009
VA Fresno to VA Mather – CCT
3
TRIP
$
$
4010
VA Fresno to Community Regional Medical Center (CRMC) – ALS or BLS
480
TRIP
$
$
4011
VA Fresno to David Grant U.S. Air Force Medical Center (David Grant) – ALS or BLS
52
TRIP
$
$
4012
VA Fresno to David Grant – CCT
5
TRIP
$
$
TOTAL CLINS 4001-4012:
$
Period of Performance
Price
Base Yr: April 2020 to 31 March 2021
$
OY#1: 1 April 2021 to 31 March 2022
$
OY#2: 1 April 2022 to 31 March 2023
$
OY#3: 1 April 2023 to 31 March 2024
$
OY#4: 1 April 2024 to 31 March 2025
$
Grand Total
$
SERVICE FOR:VA CENTRAL CALIFORNIA HEALTH CARE SYSTEM
Fresno VA
2615 E Clinton Ave

Fresno, CA 93703

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