A19-J.1 - Pricing Schedule.xlsx

XLSX spreadsheet 46 KB Posted Sep 15, 2025

Attached to: Directed Medical Services for the Department of Labor, Office of Workers' Compensation Programs (OWCP), Division of Federal Employees Compensation (DFEC) program
Solicitation number: 1605C3-25-R-00007
Issued by: Department of Labor Office of the Assistant Secretary for Administration and Management

About this file

Written by GovTribe AI · Sep 15, 2025

This document is an Independent Government Cost Estimate (IGCE) template for a Department of Labor solicitation for Directed Medical Services for the Division of Federal Employees Compensation (DFEC). The IGCE provides a detailed pricing framework for a five-year contract with a base period and four option periods, covering medical services such as medical second opinions, examinations, impairment ratings, file reviews, and supplemental reports. The estimated contract value across all periods is $0.00 in the template, with anticipated volumes including 19,000 medical second opinion and examination services, 600 Independent Medical Examinations (IME), 3,665 schedule award/impairment ratings, and various file review categories.

The solicitation (RFP 1605C3-25-R-00007) is a combined synopsis/solicitation for commercial services under FAR Parts 12 and 15, seeking a contractor to provide medical services for federal employee compensation program claimants across the United States and its territories. Services are intended to establish work-related medical diagnoses, assess disability, and determine permanent impairment degrees. The IGCE instructions indicate the cost estimate was prepared by reviewing GSA IT Schedule 70 vendor pricing, with a 3% annual escalation applied based on the Bureau of Labor Statistics Consumer Price Index, and prepared by John Doe, Contracting Officer's Representative from the Bureau of Labor Statistics.

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Other files

File	Type	Posted
A19-J.2 – SMALL BUSINESS SUBCONTRACTING PLAN TEMPLATE.xlsx	XLSX spreadsheet	Sep 15, 2025
1605C3-25-R-00007.pdf	PDF	Sep 15, 2025
A19-J.3 - QUESTION AND ANSWER SPREADSHEET.xlsx	XLSX spreadsheet	Sep 15, 2025
A19-J.1.a - Supplemental Pricing Schedule.xlsx	XLSX spreadsheet	Sep 15, 2025
A19-J.2 – SMALL BUSINESS SUBCONTRACTING PLAN TEMPLATE.docx	DOCX document	Sep 15, 2025
A19-J.4 – PAST PERFORMANCE QUESTIONNAIRE.docx	DOCX document	Sep 15, 2025

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Instructions

	INSTRUCTIONS FOR INDEPENDENT GOVERNMENT COST ESTIMATE (IGCE) TEMPLATE
This IGCE is an Excel document composed of 3 individual sheets:

	--Instructions (the current one)
	--IGCE Sample
	--IGCE Template
	See the tabs at the bottom of the screen. When you click on a tab, the worksheet is displayed, and the tab is highlighted.
	What Data to Enter
	--Originating Office: This is the name and address of the DOL agency/business unit preparing the IGCE.
	--Date Submitted: This is the date that the IGCE is prepared/submitted to OSPE.
	--Project No.: This is the requisition number, if known.
	--Contract No.: This is the current contract or order number, if this IGCE action is for a modification to an existing contract or order.
	--Purpose (project name): This is a brief description of the requirement.
	--Estimated by (print name): This is generally the name of the Contracting Officer's Represenative (COR), or the name of the individual who prepared the estimate.
	--Base and Option Periods: This is the base period of performance, and optional periods of performance, if any.
	--Description of Work: This is the product/good/equipment to be provided by the contractor, which forms the basis of the estimate.
	--Quantity - This is the number of units to be provided by the contractor.
	--Unit of Measure - This is the description of how the items are measured.
	--Unit Price - This is the estimated unit price.
	--Subtotals - This is the quantity multiplied by the unit price. This field calculates automatically.
	--Labor Categories - This is the name of any labor categories expected under the contract.
	--Per Hour - This is the estimated hourly rate for each labor category.
	--Sub-Total (Base Period, option periods, etc) - This is the total amount of all materials and labor. These amounts calculate automatically.
	--Base Period (option periods, etc.) - This is the total amount of all materials and labor combined. These amounts calculate automatically.
	--Escalation - This is the annual price escalation. Enter the percentage for each option period. The spreadsheet will automatically apply the escalation to the option period pricing.
	--Sources for Independent Government Cost Estimate - These are the sources used to develop the IGCE. Place a box in the choice that reflects the source of information used to prepare the estimate.
	--Discuss The Rationale For The Independent Government Cost Estimate (IGCE) - This is a narrative explanation of how the IGCE was derived.
	--Signature of Preparer - This is the name and title of the individual who prepared the IGCE.
	--Phone - This is the phone number of the preparer.
	--Email - This is the email address of the preparer.
Tips for using the IGCE Template
	-- When you exit the spreadsheet, you will be prompted to save it. Remember that,
	when you use it the next time, it will open onto the worksheet and cell you were on
	when you last saved it.
	-- You may print each spreadsheet.
	-- You may separate the IGCE Template and create a new file for your IGCE by doing the following:
		-- Right click on the IGCE Template tab
		-- Select "Move or Copy"
		-- In the drop-down select "(new book)"
		-- Check the box for "create a copy"
		-- Select "OK"
		-- A new file will be created. Be sure to save the new file containing the IGCE.
		THIS IS THE END OF THE INSTRUCTIONS.

IGCE SAMPLE

OSPE Independent Government Cost Estimate

Note: The columns highlighted in gray will automatically calculate. You do not need to fill in anything in those columns.

	ORIGINATING OFFICE	DATE SUBMITTED	PROJECT NO.	CONTRACT NO. (For Mods)
	Bureau of Labor Statistics	2/1/22
ESTIMATE			PURPOSE (Project Name)
WORKSHEET	200 Constitution Ave NW		Office of Compensation and Working Conditions Tableau Software Analysis and Support
	Washington DC 20201

		ESTIMATED BY (Print Name)
		John Doe, COR
	Base Period: June 1, 2022-May 31, 2023	QUANTITY		MATERIAL/SUPPLIES				LABOR
Period	DESCRIPTION OF WORK	NO.	UNIT	PER		LABOR		UNIT	PER
		UNITS	MEASURE	UNIT	SUBTOTALS	CATEGORY	QUANTITY	MEASURE	HOUR	SUBTOTALS
Base
	Statistical Publication A	1	EACH	$1,000.00	$1,000.00	Economist	1,000	hours	$75.00	$75,000.00
	Statistical Publication B	1	EACH	$2,000.00	$2,000.00	Statistician	501	hours	$75.00	$37,575.00
					$0.00	Program Manager	40	hours	$75.00	$3,000.00
					$0.00					$0.00
					$0.00					$0.00
					$0.00					$0.00

Sub-Total Base Period $3,000.00 $115,575.00

Base Period $118,575.00

	Option Period One: June 1, 2023-May 31, 2024	QUANTITY		MATERIAL/SUPPLIES					LABOR
1st	DESCRIPTION OF WORK	NO.	UNIT	PER			LABOR		UNIT	PER
		UNITS	MEASURE	UNIT	Escalation	SUBTOTALS	CATEGORY	QUANTITY	MEASURE	HOUR	Escalation	SUBTOTALS
	Statistical Publication A	1	EACH	$1,030.00	3.00%	$1,030.00	Economist	1,000	hours	$77.25	3.00%	$77,250.00
	Statistical Publication B	1	EACH	$2,060.00	3.00%	$2,060.00	Statistician	501	hours	$77.25	3.00%	$38,702.25
				$0.00		$0.00	Program Manager	40	hours	$77.25	3.00%	$3,090.00
				$0.00		$0.00				$0.00		$0.00
				$0.00		$0.00				$0.00		$0.00
				$0.00		$0.00				$0.00		$0.00

Sub-Total Option Period One $3,090.00 $119,042.25

Option Period One $122,132.25

	Option Period Two: June 1, 2024-May 31, 2025	QUANTITY		MATERIAL/SUPPLIES					LABOR
2nd	DESCRIPTION OF WORK	NO.	UNIT	PER			LABOR		UNIT	PER
		UNITS	MEASURE	UNIT	Escalation	SUBTOTALS	CATEGORY	QUANTITY	MEASURE	UNIT	Escalation	SUBTOTALS
	Statistical Publication A	1	EACH	$1,060.90	3.00%	$1,060.93	Economist	1,000	hours	$79.57	3.00%	$79,567.50
	Statistical Publication B	1	EACH	$2,121.80	3.00%	$2,121.80	Statistician	501	hours	$79.57	3.00%	$39,863.32
				$0.00		$0.00	Program Manager	40	hours	$79.57	3.00%	$3,182.70
				$0.00		$0.00				$0.00		$0.00
				$0.00		$0.00				$0.00		$0.00
				$0.00		$0.00				$0.00		$0.00

Sub-Total Option Period Two $3,182.73 $122,613.52

		Option Period Two	$125,796.25
3rd	Option Period Three: June 1, 2025-May 31, 2026	QUANTITY		MATERIAL/SUPPLIES					LABOR
	DESCRIPTION OF WORK	NO.	UNIT	PER			LABOR		UNIT	PER
		UNITS	MEASURE	UNIT	Escalation	SUBTOTALS	CATEGORY	QUANTITY	MEASURE	UNIT	Escalation	SUBTOTALS
	Statistical Publication A	1	EACH	$1,092.73	3.00%	$1,092.76	Economist	1,000	hours	$81.95	3.00%	$81,954.53
	Statistical Publication B	1	EACH	$2,185.45	3.00%	$2,185.45	Statistician	501	hours	$81.95	3.00%	$41,059.22
				$0.00		$0.00	Program Manager	40	hours	$81.95	3.00%	$3,278.18
				$0.00		$0.00				$0.00		$0.00
				$0.00		$0.00				$0.00		$0.00
				$0.00		$0.00				$0.00		$0.00

Sub-Total Option Period Three $3,278.21 $126,291.92

		Option Period Three	$129,570.13
4th	Option Period Four: June 1, 2026-May 31, 2027	QUANTITY		MATERIAL/SUPPLIES					LABOR
	DESCRIPTION OF WORK	NO.	UNIT	PER			LABOR		UNIT	PER
		UNITS	MEASURE	UNIT	Escalation	SUBTOTALS	CATEGORY	QUANTITY	MEASURE	UNIT	Escalation	SUBTOTALS
	Statistical Publication A	1	EACH	$1,125.51	3.00%	$1,125.54	Economist	1,000	hours	$84.41	3.00%	$84,413.16
	Statistical Publication B	1	EACH	$2,251.02	3.00%	$2,251.02	Statistician	501	hours	$84.41	3.00%	$42,290.99
				$0.00		$0.00	Program Manager	40	hours	$84.41	3.00%	$3,376.53
				$0.00		$0.00				$0.00		$0.00
				$0.00		$0.00				$0.00		$0.00
				$0.00		$0.00				$0.00		$0.00

Sub-Total Option Period Four $3,376.56 $130,080.68

	Option Period Four	$133,457.24
	Contract Value with Options	$629,530.87
SOURCE(S) FOR INDEPENDENT GOVERNMENT COST ESTIMATE (IGCE):
GSA Schedule: X	Catalogs:		Previous Buys:
Published Price List:	Market Surveys:		Other:

DISCUSS THE RATIONALE FOR THE INDEPENDENT GOVERNMENT COST ESTIMATE (IGCE)

Narrative:

I prepared this IGCE by reviewing the pricing of three vendors on GSA IT Schedule 70.

I completed my review on January 4, 2022.

I calculated the average of the vendors' hourly rates and unit prices to develop the base year pricing.

A 3% escalation was applied to each of the option periods, based on the BLS Consumer Price Index released on January 10, 2022.

Signature of Preparer:________________________John Doe, COR______________________________________

Phone: 202-693-1234

Email: Doe.John@dol.gov

RFP 1605C3-25-R-00007

RFP 1605C3-25-R-00007 - Directed Medical Services for the Division of Federal Employees Compensation

Note: The columns highlighted in gray will automatically calculate. You do not need to fill in anything in those columns.

Base Period:
DESCRIPTION OF WORK	Quantity	UOM	Price per Unit	Escalation	SUBTOTALS

Medical Second Opinion and Examination Services	19,000	Case	0.00%	$0.00
IME	600	Case	0.00%	$0.00
Schedule Award/Impairment Ratings	3665	Case	0.00%	$0.00
Supplemental Reports	1700	Each	0.00%	$0.00
File Review Surgical	1015	Each	0.00%	$0.00
File Review Impairment Rating, IME File Review	910	Case	0.00%	$0.00
File Review Other	910	Case	0.00%	$0.00
Travel/Transportation*	1	Fee	0.00%	$0.00
Other Direct Cost - Canceled Appointments*, Interpretive Services, Diagnostic Tests*	1	Fee	0.00%	$0.00

Sub-Total Base Period $0.00

Option Period One:
DESCRIPTION OF WORK	Quantity	UOM	Price per Unit	Escalation	SUBTOTALS

Medical Second Opinion and Examination Services	19,000	Case	$0.00	$0.00
IME	600	Case	$0.00	$0.00
Schedule Award/Impairment Ratings	3665	Case	$0.00	$0.00
Supplemental Reports	1700	Each	$0.00	$0.00
File Review Surgical	1015	Each	$0.00	$0.00
File Review Impairment Rating, IME File Review	910	Case	$0.00	$0.00
File Review Other	910	Case	$0.00	$0.00
Travel/Transportation*	1	Fee	$0.00	$0.00
Other Direct Cost - Canceled Appointments*, Interpretive Services, Diagnostic Tests*	1	Fee	$0.00	$0.00

Sub-Total Option Period One $0.00

Option Period Two:
DESCRIPTION OF WORK	Quantity	UOM	Price per Unit	Escalation	SUBTOTALS

Medical Second Opinion and Examination Services	19,000	Case	$0.00	$0.00
IME	600	Case	$0.00	$0.00
Schedule Award/Impairment Ratings	3665	Case	$0.00	$0.00
Supplemental Reports	1700	Each	$0.00	$0.00
File Review Surgical	1015	Each	$0.00	$0.00
File Review Impairment Rating, IME File Review	910	Case	$0.00	$0.00
File Review Other	910	Case	$0.00	$0.00
Travel/Transportation*	1	Fee	$0.00	$0.00
Other Direct Cost - Canceled Appointments*, Interpretive Services, Diagnostic Tests*	1	Fee	$0.00	$0.00

	Sub-Total Option Period Two				$0.00
Option Period Three:
DESCRIPTION OF WORK	Quantity	UOM	Price per Unit	Escalation	SUBTOTALS

Medical Second Opinion and Examination Services	19,000	Case	$0.00	$0.00
IME	600	Case	$0.00	$0.00
Schedule Award/Impairment Ratings	3665	Case	$0.00	$0.00
Supplemental Reports	1800	Each	$0.00	$0.00
File Review Surgical	1015	Each	$0.00	$0.00
File Review Impairment Rating, IME File Review	910	Case	$0.00	$0.00
File Review Other	910	Case	$0.00	$0.00
Travel/Transportation*	1	Fee	$0.00	$0.00
Other Direct Cost - Canceled Appointments*, Interpretive Services, Diagnostic Tests*	1	Fee	$0.00	$0.00

	Sub-Total Option Period Three				$0.00
Option Period Four:
DESCRIPTION OF WORK	Quantity	UOM	Price per Unit	Escalation	SUBTOTALS

Medical Second Opinion and Examination Services	19,000	Case	$0.00	$0.00
IME	600	Case	$0.00	$0.00
Schedule Award/Impairment Ratings	3665	Case	$0.00	$0.00
Supplemental Reports	1700	Each	$0.00	$0.00
File Review Surgical	1015	Each	$0.00	$0.00
File Review Impairment Rating, IME File Review	910	Case	$0.00	$0.00
File Review Other	910	Case	$0.00	$0.00
Travel/Transportation*	1	Fee	$0.00	$0.00
Other Direct Cost - Canceled Appointments*, Interpretive Services, Diagnostic Tests*	1	Fee	$0.00	$0.00

	Sub-Total Option Period Four		$0.00
Contract Value with Options		$0.00

* Pay-As-Billed Per OWCP CPT Code

** Billed/Paid at the fixed rate of $200 Per OWCP CPT Code

File details come from the government source that posted it. Updated Sep 18, 2025.