Attach 4_TM Pricing Template.xlsx

XLSX spreadsheet 19 KB Posted Jul 10, 2026

Attached to: CDC NIOSH on campus Medical Services 2026(3-Year T&M Revision 2) Total Small-Business Set-Aside
Solicitation number: 75D301-26-Q-78995
Issued by: Department of Health and Human Services Centers for Disease Control and Prevention Office of Acquisition Services

About this file

Written by GovTribe AI · Jul 10, 2026

This is a Time-and-Materials (T&M) Pricing Template for CDC NIOSH Medical Support Services covering a three-year period from July 2026 through July 2029. Respondents are required to submit fully burdened pricing (inclusive of overhead, G&A, and profit) for medical procedures performed at four continental U.S. locations: Cincinnati, Ohio; Morgantown, West Virginia; Pittsburgh, Pennsylvania; and Spokane, Washington. The template establishes separate Contract Line Item Numbers (CLINs) for the base year (0001-0002) and two option years (1001-1002 and 2001-2002), with estimated annual quantities provided for each service at each location.

Medical services priced in the template include responder readiness evaluations (medical clearance, interim medical evaluations, post-deployment health assessments), respiratory evaluations (questionnaires and fit testing), occupational health services (beryllium surveillance blood work, hearing tests, laser eye exams), influenza on-site clinics, and underground mining physicals. The template also accommodates travel costs broken down by location, including transportation per diem, food/lodging per diem, and estimated deployment costs, which must be justified and itemized in the technical proposal and limited to GSA per diem rates. Proposals are due Friday, July 17, 2026, at 3:00 PM ET via email to wlv7@cdc.gov. This solicitation is set aside for small businesses under NAICS code 621999 with an SBA size standard of $21 million in annual revenue.

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Other files

File	Type	Posted
Combined Synopsis Solicitation_75D301-26-Q-78995_NIOSH Medical Services_TM revision 2.pdf	PDF	Jul 10, 2026
RFQ 75D301-26-Q-78995_SOW_TM rv2.pdf	PDF	Jul 10, 2026
RFQ 75D301-26-Q-78995_provisions and clauses_TM rv2.pdf	PDF	Jul 10, 2026
Attach 1 CDC Responder Readiness Medical Clearance.pdf	PDF	Jun 1, 2026
RFQ 75D301-26-Q-78995_Q_A.pdf	PDF	Jun 1, 2026
Combined Synopsis Solicitation_75D301-26-Q-78995_NIOSH Medical Services_revision 1.pdf	PDF	Jun 1, 2026
Attach 2 CDC Responder Readiness Program Interim Med Eval.pdf	PDF	Jun 1, 2026
Attach 3 Confidential Post Deployment Health Assessment.pdf	PDF	Jun 1, 2026
RFQ 75D301-26-Q-78995_provisions and clauses.pdf	PDF	May 23, 2026
Combined Synopsis Solicitation_75D301-26-Q-78995_NIOSH Medical Services.pdf	PDF	May 23, 2026
RFQ 75D301-26-Q-78995_Statement of Work.pdf	PDF	May 23, 2026

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Sheet1

CDC NIOSH Medical Support Services		Price Per Procedure CLIN 0001, 1001, 2001*
T&M Pricing Template - Due Friday, July 17, 3:00 PM ET via email to wlv7@cdc.gov		July 2026 - July 2027		July 2027 - July 2028		July 2028 - July 2029
Services Cincinnati, OH	Estimated quantity (per year not a guaranteed minimum)	CLIN 0001 Price per	Base Est	CLIN 1001 Price	Option 1 Est	CLIN 2001 Price Per	Option 2 Est	Total Est
Responder Readiness Medical Clearance	20	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Responder Readiness Program Interim Medical Evaluation	20	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Post-Deployment Health Assessment	20	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Respiratory Medical Evaluation Questionnaire	71	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Respiratory Fit testing	71	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Titer/ Immunization	21	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Beryllium Surveillance BeLPT (blood work)	3	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Hearing Test for mandatory Hearing Conservation Program	58	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		total	$ - 0	total	$ - 0	total	$ - 0	$ - 0
Services Morgantown, WV	Estimated quantity (per year not a guaranteed minimum)	CLIN 0001 Price per	Base Est	CLIN 1002 Price	Option 1 Est	CLIN 2002 Price Per	Option 2 Est	Total Est
Responder Readiness Medical Clearance	10	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Responder Readiness Program Interim Medical Evaluation	10	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Post-Deployment Health Assessment	10	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Respiratory Medical Evaluation Questionnaire	80	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Respiratory Fit testing	80	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Beryllium Surveillance BeLPT (blood work)	5	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Hearing Test for mandatory Hearing Conservation Program	5	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Laser Eye Exam	2	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Influenza on site clinic	50	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		total	$ - 0	total	$ - 0	total	$ - 0	$ - 0
Services Pittsburgh, PA	Estimated quantity (per year not a guaranteed minimum)	CLIN 0001 Price per	Base Est	CLIN 1002 Price	Option 1 Est	CLIN 2002 Price Per	Option 2 Est	Total Est
Underground Mining Physical	8	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Respiratory Medical Evaluation Questionnaire	10	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Respiratory Fit testing	10	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Hearing Test for mandatory Hearing Conservation Program	6	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Laser Eye Exam	4	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Influenza on site clinic	50	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		total	$ - 0	total	$ - 0	total	$ - 0	$ - 0
Services Spokane, WA	Estimated quantity (per year not a guaranteed minimum)	CLIN 0001 Price per	Base Est	CLIN 1002 Price	Option 1 Est	CLIN 2002 Price Per	Option 2 Est	Total Est
Respiratory Medical Evaluation Questionnaire	30	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Respiratory Fit testing	30	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Beryllium Surveillance BeLPT (blood work)	2	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Hearing Test for mandatory Hearing Conservation Program	5	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Laser Eye Exam	2	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Influenza on site clinic	25	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		total	$ - 0	total	$ - 0	total	$ - 0	$ - 0

Service CLIN Totals	CLIN 0001	$ - 0	CLIN 1001	$ - 0	CLIN 2001	$ - 0	$ - 0
*Prices shall be fully burdened and inclusive of overhead, G&A, profit, etc. for the performance periods.

Travel (all estimated travel cost should be justified in technical proposal, itemized to the extent possible, e limited to GSA per diem)		Travel Estimated Price CLIN 0002, 1002, 2002**						Total Est
		July 2026 - July 2027		July 2027 - July 2028		July 2028 - July 2029
Travel Cincinnati, OH	Estimated Quantity (funded via mod)	CLIN 0002 Est #	Base Est	CLIN 1002 Est #	Option 1 Est	CLIN 2002 Est #	Option 2 Est	Total Est
Transportation Per Diem	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Food/Lodging Per Diem	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Estimated Deployment Cost (if needed and not part of loaded rates)	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		total	$ - 0	total	$ - 0	total	$ - 0	$ - 0
Travel Morgantown, WV	Estimated Quantity (funded via mod)	CLIN 0002 Est #	Base Est	CLIN 1002 Est #	Option 1 Est	CLIN 2002 Est #	Option 2 Est	Total Est
Transportation Per Diem	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Food/Lodging Per Diem	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Estimated Deployment Cost (if needed and not part of loaded rates)	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		total	$ - 0	total	$ - 0	total	$ - 0	$ - 0
Travel Pittsburgh, PA	Estimated Quantity (funded via mod)	CLIN 0002 Est #	Base Est	CLIN 1002 Est #	Option 1 Est	CLIN 2002 Est #	Option 2 Est	Total Est
Transportation Per Diem	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Food/Lodging Per Diem	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Estimated Deployment Cost (if needed and not part of loaded rates)	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		total	$ - 0	total	$ - 0	total	$ - 0	$ - 0
Travel Spokane, WA	Estimated Quantity (funded via mod)	CLIN 0002 Est #	Base Est	CLIN 1002 Est #	Option 1 Est	CLIN 2002 Est #	Option 2 Est	Total Est
Transportation Per Diem	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Food/Lodging Per Diem	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
Estimated Deployment Cost (if needed and not part of loaded rates)	0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0	$ - 0
		total	$ - 0	total	$ - 0	total	$ - 0	$ - 0

Travel CLIN Totals	CLIN 0002	$ - 0	CLIN 1002	$ - 0	CLIN 2002	$ - 0	$ - 0
**Travel Breakdown / Justification/ Description as needed:

File details come from the government source that posted it. Updated Jul 10, 2026.