9-DHHS25038 Attachment G Cost Proposal Sheet.xlsx

XLSX spreadsheet 11 KB Posted

Attached to
Audiology Services
Solicitation number
DHHS25038
Issued by
Utah

About this file

This is a Cost Proposal Sheet for Attachment G of DHHS25038, an audiology services contract issued by the Utah Department of Health and Human Services for provision of services at Utah State Correctional Facility (USCF) and Central Utah Correctional Facility (CUCF). The services encompass comprehensive audiology care for inmates, including hearing evaluations, hearing aid fitting, maintenance, and minor repairs. The cost proposal sheet requires offerors to submit unit pricing for multiple service categories and product lines organized into two sections, with line items covering basic hearing evaluations, comprehensive audiometric examinations, various types of hearing aid devices (behind-the-ear, in-the-ear, and in-the-canal), diagnostic tests (tympanometry, acoustic reflex, pure tone), batteries, warranties, and related accessories and services.

Offerors must complete the Cost Proposal Sheet by entering pricing only in designated shaded cells without altering the sheet's format, with any deviation potentially resulting in disqualification. The offeror's quoted rates must encompass all direct and indirect costs associated with service delivery, and no additional fees beyond those itemized on the cost proposal sheet are permitted. The specific pricing amounts, contract term, renewal options, and evaluation timeline are not detailed in this attachment but would be specified in other sections of the request for proposal documentation.

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Attachment G

Attachment G: Cost Proposal Sheet
DHHS25038
Audiology Service
The Offeror shall submit its bid for the services requested in this RFP using this Cost Proposal Sheet by entering values into the shaded cells. Offeror shall not change the format of this Cost Proposal Sheet and must submit pricing in the exact format requested. Any deviation from this Cost Proposal Sheet may result in disqualification of the Offeror.

The Offeror’s rate shall take into consideration all anticipated costs associated with performing the required service, including the Offeror’s direct and indirect costs. No other fees can be charged.

ItemUnit PriceUnit of Measure
Basic Hearing EvaluationPer evaluation
Hearing Aid Evaluation (to include air, bone, speech, and discrimination)Per evaluation
Comprehensive Audiometric ExamPer exam
Consultant-examPer exam
Behind-the-ear hearing aid (including a potentiometer)Per hearing aid
Standard ear moldPer mold
Testing and adjustment of hearing aid as needed to assure satisfactory operationPer test & adjustment
Total costs to be evaluated:$ - 0
ItemUnit PriceUnit of Measure
Batteries (4-pack)4 pack
Provision and adaptation of hearing aid and checks for proper operationPer Patient Treatment
Non-warranty service and internal repairs on hearing aids not coveredPer hearing aid
Cases for in the ear hearing aidsPer case
Face plates for in the ear hearing aidsPer face plate
TympanometryPer evaluation
Acoustic ReflexPer evaluation
Pure TonePer evaluation
In-the-ear hearing aidPer hearing aid
In-the-canal hearing aidPer hearing aid
Extended additional six-month warranty after the manufacturer’s warrantyPer warranty
Loss & Damage replacement cost (one-time replacement per purchase for life of hearing aid in the event of loss, theft, or damage beyond repair.)Per replacement

File details come from the government source that posted it. Updated .