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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Other files
| File | Type | Posted |
|---|---|---|
| 1-DHHS25038 Attachment A DHHS Client Service Terms.docx | DOCX document | |
| 10-DHHS25038 Attachment E Technical Response.docx | DOCX document | |
| 4-DHHS25038 Attachment C (b) Conflict of Interest Certification UGE.pdf | ||
| 3-DHHS25038 Attachment D W9.pdf | ||
| 7-DHHS25038 Request for Proposal.docx | DOCX document | |
| 6-DHHS25038 Attachment B Scope of Work.docx | DOCX document | |
| 2-DHHS25038 Attachment H Submission Checklist.docx | DOCX document | |
| 11-DHHS25038 Attachment I CHS Addendum.docx | DOCX document | |
| 8-DHHS25038 Attachment F Score Sheet.xlsx | XLSX spreadsheet | |
| 5-DHHS25038 Attachment C (a) Conflict of Interest Form.pdf |
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Text version
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.
| Item | Unit Price | Unit of Measure |
| Basic Hearing Evaluation | Per evaluation | |
| Hearing Aid Evaluation (to include air, bone, speech, and discrimination) | Per evaluation | |
| Comprehensive Audiometric Exam | Per exam | |
| Consultant-exam | Per exam | |
| Behind-the-ear hearing aid (including a potentiometer) | Per hearing aid | |
| Standard ear mold | Per mold | |
| Testing and adjustment of hearing aid as needed to assure satisfactory operation | Per test & adjustment | |
| Total costs to be evaluated: | $ - 0 |
| Item | Unit Price | Unit of Measure |
| Batteries (4-pack) | 4 pack | |
| Provision and adaptation of hearing aid and checks for proper operation | Per Patient Treatment | |
| Non-warranty service and internal repairs on hearing aids not covered | Per hearing aid | |
| Cases for in the ear hearing aids | Per case | |
| Face plates for in the ear hearing aids | Per face plate | |
| Tympanometry | Per evaluation | |
| Acoustic Reflex | Per evaluation | |
| Pure Tone | Per evaluation | |
| In-the-ear hearing aid | Per hearing aid | |
| In-the-canal hearing aid | Per hearing aid | |
| Extended additional six-month warranty after the manufacturer’s warranty | Per 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 .