Attachment_J.5.C__Eastern_Region_Site_Verification_Services_Business_Proposal_Template.xlsx
XLSX spreadsheet 78 KB Posted
- Attached to
- Provider Enrollment and Oversight Federal contract opportunity
- Solicitation number
- 75FCMC18R0014
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Attachment J.5.C
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SUMMARY
| PEO MA IDIQ 75FCMC18R0014 | |
| SITE VERIFICATION SERVICES EASTERN REGION TASK ORDER |
| Fixed-Price Per Site Visit Proposed | Fixed-Price Per IDTF Visit Proposed | ||||||||||
| CLIN 0001AA | CLIN 0002AA | CLIN 0003AA | CLIN 0004AA | CLIN 0005AA | CLIN 0001AB | CLIN 0002AB | CLIN 0003AB | CLIN 0004AB | CLIN 0005AB | ||
| 30-Day Site Visit | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | 30-Day Site Visit | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
15-Day Site Visit $0.00 $0.00 $0.00 $0.00 $0.00 15-Day Site Visit $0.00 $0.00 $0.00 $0.00 $0.00
7-Day Site Visit $0.00 $0.00 $0.00 $0.00 $0.00 7-Day Site Visit $0.00 $0.00 $0.00 $0.00 $0.00
48-Hour Site Visit $0.00 $0.00 $0.00 $0.00 $0.00 48-Hour Site Visit $0.00 $0.00 $0.00 $0.00 $0.00
| GRAND TOTAL - SUBCLIN AA | GRAND TOTAL IDTF - SUBCLIN AB | ||||||||||||
| CLIN 0001AA Total | CLIN 0002AA Total | CLIN 0003AA Total | CLIN 0004AA Total | CLIN 0005AA Total | Grand Total | CLIN 0001AB Total | CLIN 0002AB Total | CLIN 0003AB Total | CLIN 0004AB Total | CLIN 0005AB Total | Grand Total | ||
| 30-Day Site Visit | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | 30-Day Site Visit | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
15-Day Site Visit $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 15-Day Site Visit $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
7-Day Site Visit $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 7-Day Site Visit $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
| 48-Hour Site Visit | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | 48-Hour Site Visit | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| TOTAL | $0.00 | TOTAL | $0.00 | ||||||||||
| Estimated (Base + Options) Grand Total for All Visits | |||||||||||||
| Site Visits | Non-IDTF Site Visits | IDTF Visits | Grand Total | ||||||||||
| 30-Day Site Visit | $0.00 | 30-Day Site Visit | $0.00 |
15-Day Site Visit $0.00 15-Day Site Visit $0.00
7-Day Site Visit $0.00 7-Day Site Visit $0.00
| 48-Hour Site Visit | $0.00 | 48-Hour Site Visit | $0.00 | Five Year Period |
| TOTAL | $0.00 | TOTAL | $0.00 | $0.00 |
&"Adobe Devanagari,Regular"&12Attachment J.5.C Eastern Region Site Verification Services Business Proposal Template
Minimum Guarantee Summary
| CLIN 0001AA Total Per Site Visit Minimum Guarantee | CLIN 0001AB Total Per IDTF Visit Minimum Guarantee | ||||||
| Fixed Price Per Site Visit | Minimum Qty | Total | Fixed Price Per Site Visit | Minimum Qty | Total | ||
| 30-Day Site Visit | $0.00 | 22,500 | $0.00 | 30-Day Site Visit | $0.00 | 750 | $0.00 |
15-Day Site Visit $0.00 7,500 $0.00 15-Day Site Visit $0.00 750 $0.00
7-Day Site Visit $0.00 375 $0.00 7-Day Site Visit $0.00 45 $0.00
| 48-Hour Site Visit | $0.00 | 10 | $0.00 | 48-Hour Site Visit | $0.00 | 2 | $0.00 |
| TOTAL | 30,385 | $0.00 | TOTAL | 1,547 | $0.00 |
| CLIN 0002AA Total Per Site Visit Minimum Guarantee | CLIN 0002AB Total Per IDTF Visit Minimum Guarantee | ||||||
| Fixed Price Per Site Visit | Minimum Qty | Total | Fixed Price Per Site Visit | Minimum Qty | Total | ||
| 30-Day Site Visit | $0.00 | 22,500 | $0.00 | 30-Day Site Visit | $0.00 | 750 | $0.00 |
15-Day Site Visit $0.00 7,500 $0.00 15-Day Site Visit $0.00 750 $0.00
7-Day Site Visit $0.00 375 $0.00 7-Day Site Visit $0.00 45 $0.00
| 48-Hour Site Visit | $0.00 | 10 | $0.00 | 48-Hour Site Visit | $0.00 | 2 | $0.00 |
| TOTAL | $0.00 | TOTAL | $0.00 |
| CLIN 0003AA Total Per Site Visit Minimum Guarantee | CLIN 0003AB Total Per IDTF Visit Minimum Guarantee | ||||||
| Fixed Price Per Site Visit | Minimum Qty | Total | Fixed Price Per Site Visit | Minimum Qty | Total | ||
| 30-Day Site Visit | $0.00 | 22,500 | $0.00 | 30-Day Site Visit | $0.00 | 750 | $0.00 |
15-Day Site Visit $0.00 7,500 $0.00 15-Day Site Visit $0.00 750 $0.00
7-Day Site Visit $0.00 375 $0.00 7-Day Site Visit $0.00 45 $0.00
| 48-Hour Site Visit | $0.00 | 10 | $0.00 | 48-Hour Site Visit | $0.00 | 2 | $0.00 |
| TOTAL | $0.00 | TOTAL | $0.00 |
| CLIN 0004AA Total Per Site Visit Minimum Guarantee | CLIN 0004AB Total Per IDTF Visit Minimum Guarantee | ||||||
| Fixed Price Per Site Visit | Minimum Qty | Total | Fixed Price Per Site Visit | Minimum Qty | Total | ||
| 30-Day Site Visit | $0.00 | 22,500 | $0.00 | 30-Day Site Visit | $0.00 | 750 | $0.00 |
15-Day Site Visit $0.00 7,500 $0.00 15-Day Site Visit $0.00 750 $0.00
7-Day Site Visit $0.00 375 $0.00 7-Day Site Visit $0.00 45 $0.00
| 48-Hour Site Visit | $0.00 | 10 | $0.00 | 48-Hour Site Visit | $0.00 | 2 | $0.00 |
| TOTAL | $0.00 | TOTAL | $0.00 |
| CLIN 0005AA Total Per Site Visit Minimum Guarantee | CLIN 0005AB Total Per IDTF Visit Minimum Guarantee | ||||||
| Fixed Price Per Site Visit | Minimum Qty | Total | Fixed Price Per Site Visit | Minimum Qty | Total | ||
| 30-Day Site Visit | $0.00 | 22,500 | $0.00 | 30-Day Site Visit | $0.00 | 750 | $0.00 |
15-Day Site Visit $0.00 7,500 $0.00 15-Day Site Visit $0.00 750 $0.00
7-Day Site Visit $0.00 375 $0.00 7-Day Site Visit $0.00 45 $0.00
| 48-Hour Site Visit | $0.00 | 10 | $0.00 | 48-Hour Site Visit | $0.00 | 2 | $0.00 |
| TOTAL | $0.00 | TOTAL | $0.00 |
CLIN 0001
| CLIN 0001AA | CLIN 0001AA | CLIN 0001AA | CLIN 0001AA | CLIN 0001AA |
| 30-Day Site Visit - Price Per Visit | 15-Day Site Visit - Price Per Visit | 7-Day Site Visit - Price Per Visit | 48-Hour Site Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor(s) Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 60,000 | $0.00 | Total Estimated Visits | 15,000 | $0.00 | Total Estimated Visits | 1,000 | $0.00 | Total Estimated Visits | 50 | $0.00 | Total Estimated Visits | 76,050 | $0 |
| CLIN 0001AB | CLIN 0001AB | CLIN 0001AB | CLIN 0001AB | CLIN 0001AB |
| 30-Day IDTF Visit - Price Per Visit | 15-Day IDTF Visit - Price Per Visit | 7-Day IDTF Visit - Price Per Visit | 48-Hour IDTF Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 2,500 | $0.00 | Total Estimated Visits | 2,000 | $0.00 | Total Estimated Visits | 100 | $0.00 | Total Estimated Visits | 20 | $0.00 | Total Estimated Visits | 4,620 | $0 |
| . | ||||||||||||||
| Total Site Visit Contract Value Base Period | ||||||||||||||
| SLINs 0001AA & 0001AB | ||||||||||||||
| $0.00 |
CLIN 0002
| CLIN 0002AA | CLIN 0002AA | CLIN 0002AA | CLIN 0002AA | CLIN 0002AA |
| 30-Day Site Visit - Price Per Visit | 15-Day Site Visit - Price Per Visit | 7-Day Site Visit - Price Per Visit | 48-Hour Site Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 60,000 | $0.00 | Total Estimated Visits | 15,000 | $0.00 | Total Estimated Visits | 1,000 | $0.00 | Total Estimated Visits | 50 | $0.00 | Total Estimated Visits | 76,050 | $0 |
| CLIN 0002AB | CLIN 0002AB | CLIN 0002AB | CLIN 0002AB | CLIN 0002AB |
| 30-Day IDTF Visit - Price Per Visit | 15-Day IDTF Visit - Price Per Visit | 7-Day IDTF Visit - Price Per Visit | 48-Hour IDTF Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 2,500 | $0.00 | Total Estimated Visits | 2,000 | $0.00 | Total Estimated Visits | 100 | $0.00 | Total Estimated Visits | 20 | $0.00 | Total Estimated Visits | 4,620 | $0 |
| Total Site Visit Contract Value Base Period |
| SLINs 0002AA & 0002AB |
| $0.00 |
CLIN 0003
| CLIN 0003AA | CLIN 0003AA | CLIN 0003AA | CLIN 0003AA | CLIN 0003AA |
| 30-Day Site Visit - Price Per Visit | 15-Day Site Visit - Price Per Visit | 7-Day Site Visit - Price Per Visit | 48-Hour Site Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 60,000 | $0.00 | Total Estimated Visits | 15,000 | $0.00 | Total Estimated Visits | 1,000 | $0.00 | Total Estimated Visits | 50 | $0.00 | Total Estimated Visits | 76,050 | $0 |
| CLIN 0003AB | CLIN 0003AB | CLIN 0003AB | CLIN 0003AB | CLIN 0003AB |
| 30-Day IDTF Visit - Price Per Visit | 15-Day IDTF Visit - Price Per Visit | 7-Day IDTF Visit - Price Per Visit | 48-Hour IDTF Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 2,500 | $0.00 | Total Estimated Visits | 2,000 | $0.00 | Total Estimated Visits | 100 | $0.00 | Total Estimated Visits | 20 | $0.00 | Total Estimated Visits | 4,620 | $0 |
| Total Site Visit Contract Value Base Period |
| SLINs 0003AA & 0003AB |
| $0.00 |
CLIN 0004
| CLIN 0004AA | CLIN 0004AA | CLIN 0004AA | CLIN 0004AA | CLIN 0004AA |
| 30-Day Site Visit - Price Per Visit | 15-Day Site Visit - Price Per Visit | 7-Day Site Visit - Price Per Visit | 48-Hour Site Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 60,000 | $0.00 | Total Estimated Visits | 15,000 | $0.00 | Total Estimated Visits | 1,000 | $0.00 | Total Estimated Visits | 50 | $0.00 | Total Estimated Visits | 76,050 | $0 |
| CLIN 0004AB | CLIN 0004AB | CLIN 0004AB | CLIN 0004AB | CLIN 0004AB |
| 30-Day IDTF Visit - Price Per Visit | 15-Day IDTF Visit - Price Per Visit | 7-Day IDTF Visit - Price Per Visit | 48-Hour IDTF Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 2,500 | $0.00 | Total Estimated Visits | 2,000 | $0.00 | Total Estimated Visits | 100 | $0.00 | Total Estimated Visits | 20 | $0.00 | Total Estimated Visits | 4,620 | $0 |
| Total Site Visit Contract Value Base Period |
| SLINs 0004AA & 0004AB |
| $0.00 |
CLIN 0005
| CLIN 0005AA | CLIN 0005AA | CLIN 0005AA | CLIN 0005AA | CLIN 0005AA |
| 30-Day Site Visit - Price Per Visit | 15-Day Site Visit - Price Per Visit | 7-Day Site Visit - Price Per Visit | 48-Hour Site Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 60,000 | $0.00 | Total Estimated Visits | 15,000 | $0.00 | Total Estimated Visits | 1,000 | $0.00 | Total Estimated Visits | 50 | $0.00 | Total Estimated Visits | 76,050 | $0 |
| CLIN 0005AB | CLIN 0005AB | CLIN 0005AB | CLIN 0005AB | CLIN 0005AB |
| 30-Day IDTF Visit - Price Per Visit | 15-Day IDTF Visit - Price Per Visit | 7-Day IDTF Visit - Price Per Visit | 48-Hour IDTF Visit - Price Per Visit | TOTAL |
| Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total | Price Category | Hours | Total |
| Total Labor | Total Labor | Total Labor | Total Labor |
Travel Travel Travel Travel
ODCs ODCs ODCs ODCs
Subcontractor Subcontractor Subcontractor Subcontractor
Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00 Total FFP PER SITE VISIT $0.00
| Per Site Visit Cost x # of Visits | ||||||||||||||
| Total Estimated Visits | 2,500 | $0.00 | Total Estimated Visits | 2,000 | $0.00 | Total Estimated Visits | 100 | $0.00 | Total Estimated Visits | 20 | $0.00 | Total Estimated Visits | 4,620 | $0 |
| Total Site Visit Contract Value Base Period |
| SLINs 0005AA & 0005AB |
| $0.00 |
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