7-Attachment E - Cost Proposal Form.xlsx
XLSX spreadsheet 80 KB Posted
- Attached to
- BB27-104, Oxygen Concentrators for Utah Medicaid
- Solicitation number
- BB27-104
- Issued by
- Utah
About this file
This is a Cost Proposal Form Attachment E for a state contract issued by the State of Utah Division of Purchasing through the Utah Department of Health and Human Services for oxygen concentrators and related services under Utah Medicaid. The RFP (BB27-104) seeks a single qualified vendor to provide oxygen concentrators, associated equipment, supplies, and maintenance for all eligible enrolled Medicaid members statewide. The contract term is five years, with vendors required to guarantee pricing for a minimum of one year. The cost proposal form requires vendors to submit fully loaded costs including all implementation, logistics, travel, maintenance, and ancillary services necessary to fulfill the contract requirements.
The cost evaluation methodology bases point assignments on the lowest proposed price, with all other offerors receiving proportional cost points using the formula: Cost Points × (Lowest Proposed Price / Proposed Price). The cost proposal form includes line items for unit costs of concentrators, annual reporting and communication costs, and telephone services. The sample cost proposal submitted reflects an estimated average monthly quantity of 956 units at $55.00 per unit, with a total annual proposed cost of $52,582.00. Any costs not captured on the Cost Schedule form will not be permitted into the resulting contract. Vendors must also provide complete product descriptions and cost drivers for any value-added services proposed as part of their overall offering. Deviation from the specified cost proposal format may result in disqualification of the vendor's proposal.
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Other files
| File | Type | Posted |
|---|---|---|
| 8-Attachment F - Oxygen Concentrator Reporting Measures Worksheet 1.docx | DOCX document | |
| 2-Vendor Prerequisites - RFP Agency.pdf | ||
| 4-Attachment B - Scope of Work - Medicaid Oxygen Concentrator.docx | DOCX document | |
| 5-Attachment C - Intro Background Mandatory Minimum Requirements.docx | DOCX document | |
| 1-Claim of Business Confidentiality Updated.pdf.pdf | ||
| 3-Attachment A - Terms and Conditions.docx | DOCX document | |
| 9-Score Sheet - FOR INFORMATION ONLY.xlsx | XLSX spreadsheet | |
| 6-Attachment D - Technical Criteria Questions.docx | DOCX document |
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Text version
Cost Proposal Form
| Attachment E: Cost Proposal Form |
| Oxygen Concentrators for Utah Medicaid |
Vendor Name:
| Costing Considerations & Instructions |
| 1. All cells in a yellow highlight require an input. All line items must be fully loaded and include all costs, including travel. |
| 2. Cost will be evaluated based on the Total Proposed Costs provided below. |
| 3. Technical Requirements and Cost Proposals must be reflective of one another. All costs necessary to implement and maintain the proposed solution over the contract's term must be included on this Cost Schedule form. |
| 4. If zero is entered for any cell or if any cell is left blank, the State will assume that the related services are either provided at no cost or built into another cost item. If a cost category is not applicable, enter N/A. |
| 6. Any cost not provided on this Cost Schedule, will not be allowed into the resulting contract. If you identify a cost that cannot be properly captured in this Cost Schedule, then provide suggestions for modifying this Cost Schedule to the Q&A board for this solicitation. |
| 8. Any deviation from this format may result in disqualification of Offeror's proposal. |
| Implementation and Annual Maintenance Costs | ||||
| Description | Rate | Average Monthly Quantity | Total Annual Cost | |
| Unit cost for Concentrators ^ (including all unit tied costs associated with logistics, implementation, etc. as outlined in the RFP or anticipated by the Offeror, not including items broken out below or items separately reportable based on the Medicaid Fee Schedule as mentioned in the Introduction/Purpose) | $ 55.00 | 956 | $ 52,580.00 | |
| Annual cost associated with the production and communication of reports | $ 1.00 | 1 | $ 1.00 | |
| Annual cost of running telephone services | $ 1.00 | 1 | $ 1.00 | |
| 1 | $ - 0 | |||
| $ - 0 | TOTAL PROPOSED ANNUAL COSTS** | |||
| ANNUAL TOTALS: | $ 57.00 | 959 | $ 52,582.00 | $ 52,582.00 |
| *Values provided for the Estimated Average Quantity per Month are for cost evaluation purposes. Such values do not constitute a guaranteed volume. Please refer to Introduction section 1.1 for estimates relating to location of services; these estimates also are for cost evalutaion purposes and do not constitute a guarantee in future service area dispersion. |
| **The State will use the following cost formula: The points assigned to each offerors cost proposal will be based on the lowest proposal price. The offeror with the lowest Proposed Price will receive 100% of the price points. All other offerors will receive a portion of the total cost points based on what percentage higher their Proposed Price is than the Lowest Proposed Price. The formula to compute the points is: Cost Points x (Lowest Proposed Price/ Proposed Price). |
| Value Added Services | ||
| Offeror is to provide the complete product description, product cost driver, and prodouct costs for all other offerings Offeror is proposing under its proposal. | ||
| Product Description | Product Cost Driver | Product Cost |
Sheet1
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