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Attachment 1, Pricing Schedule
FA561320Q0027
Base Period 01 Oct 2020 – 30 Sep 2021, CLINs 0001 through 0032
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examinations With diagnosis by physician (e.g. hearing and/or other screening test per DGUV Guidelines) in accordance with (IAW) the attached Performance Work Statement (PWS).
Period of Performance from 01 October 2020 through 30 September 2021
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 150 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician to include in the extended volumes: health history, physical, clinical examination, vision test, hearing test, pulmonary function test, EKG test, small laboratory, blood count, urinalysis, Gamma GT and GPT, documentation, diagnosis, and reporting (e.g. clinical procedures per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 180 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician with medical-technical and toxicological-analytical parameters not covered under CLIN 0002 (e.g. biomonitoring lead, benzene, toluene; as well as x-ray examination and/or exercise EKG (Ergometry) per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area (i.e. work site inspections, briefings, safety meetings) Quantity: 1 EA – 1 Hour IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Of reports on problematic cases by qualified doctor.
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations
To an Occupational Health Care as described under CLIN 0001 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described under CLIN 0002 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described und CLIN 0003 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Medical referral to specialist To complete more extensive testing and evaluation that may not be available from the contractor (i.e. audiologist, optometrist, etc.) IAW the attached PWS. The price shall be inclusive of the special test and/or needed examinations.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Analysis of biological material (Blood or urine) from employees for presence of hazardous substances. These tests will be ordered for employees referred under CLIN 0003 (e.g. Heavy
Metal or Benzene series), only if indicated IAW the attached PWS. The CLIN will be used per test indicating parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
X-ray
Only if clinically indicated IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Color Vision Examination IAW the attached PWS
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Tuberculin Test
This test is administered to rule out an exposure to tuberculosis IAW the attached PWS. The exam is included in the unit price.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 50 |
| Each |
| EUR____________ |
| EUR________________ |
Titer determination
Prior or following an immunization IAW the attached PWS, CLIN will be used per test indicating which parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 15 |
| Each |
| EUR____________ |
| EUR________________ |
Consultation, blood taking, and documentation IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis A Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 45 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis B Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 55 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis AB Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
FSME Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 25 |
| Each |
| EUR____________ |
| EUR________________ |
Meningococcal (ACWY) Immunization Initial/Booster (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Mumps/Measles/Rubella Immunization (Combination vaccine) (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Pertussis Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Polio Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Rabies Immunization Initial/Booster
(One single shot as initial, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria (Td) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria/Pertussis (Tdap) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Typhoid Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Varicella Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Yellow Fever Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
Total for Base Period, CLINs 0001 through 0032:
ESTIMATED EUR______________
1st Option Period 01 Oct 2021 – 30 Sep 2022, CLINs 1001 through 1032
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examinations With diagnosis by physician (e.g. hearing and/or other screening test per DGUV Guidelines) in accordance with (IAW) the attached Performance Work Statement (PWS).
Period of Performance from 01 October 2021 through 30 September 2022
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 150 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician to include in the extended volumes: health history, physical, clinical examination, vision test, hearing test, pulmonary function test, EKG test, small laboratory, blood count, urinalysis, Gamma GT and GPT, documentation, diagnosis, and reporting (e.g. clinical procedures per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 180 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician with medical-technical and toxicological-analytical parameters not covered under CLIN 1002 (e.g. biomonitoring lead, benzene, toluene; as well as x-ray examination and/or exercise EKG (Ergometry) per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations
To an Occupational Health Care as described under CLIN 1001 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described under CLIN 1002 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described und CLIN 1003 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Medical referral to specialist To complete more extensive testing and evaluation that may not be available from the contractor (i.e. audiologist, optometrist, etc.) IAW the attached PWS. The price shall be inclusive of the special test and/or needed examinations.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Analysis of biological material (Blood or urine) from employees for presence of hazardous substances. These tests will be ordered for employees referred under CLIN 1003 (e.g. Heavy
Metal or Benzene series), only if indicated IAW the attached PWS. The CLIN will be used per test indicating parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
X-ray
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Color Vision Examination
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Tuberculin Test
This test is administered to rule out an exposure to tuberculosis IAW the attached PWS. The exam is included in the unit price.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 50 |
| Each |
| EUR____________ |
| EUR________________ |
Titer determination
Prior or following an immunization IAW the attached PWS, CLIN will be used per test indicating which parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 15 |
| Each |
| EUR____________ |
| EUR________________ |
Consultation, blood taking, and documentation
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis A Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 45 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis B Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 55 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis AB Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
FSME Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 25 |
| Each |
| EUR____________ |
| EUR________________ |
Meningococcal (ACWY) Immunization Initial/Booster (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Mumps/Measles/Rubella Immunization (Combination vaccine) (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Pertussis Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Polio Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Rabies Immunization Initial/Booster
(One single shot as initial, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria (Td) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria/Pertussis (Tdap) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Typhoid Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Varicella Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Yellow Fever Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
Total for 1st Option Year, CLINs 1001 through 1032:
2nd Option Period 01 Oct 2022 – 30 Sep 2023, CLINs 2001 through 2032
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examinations With diagnosis by physician (e.g. hearing and/or other screening test per DGUV Guidelines) in accordance with (IAW) the attached Performance Work Statement (PWS).
Period of Performance from 01 October 2022 through 30 September 2023
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 150 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician to include in the extended volumes: health history, physical, clinical examination, vision test, hearing test, pulmonary function test, EKG test, small laboratory, blood count, urinalysis, Gamma GT and GPT, documentation, diagnosis, and reporting (e.g. clinical procedures per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 180 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician with medical-technical and toxicological-analytical parameters not covered under CLIN 2002 (e.g. biomonitoring lead, benzene, toluene; as well as x-ray examination and/or exercise EKG (Ergometry) per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations
To an Occupational Health Care as described under CLIN 2001 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described under CLIN 2002 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described und CLIN 2003 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Medical referral to specialist To complete more extensive testing and evaluation that may not be available from the contractor (i.e. audiologist, optometrist, etc.) IAW the attached PWS. The price shall be inclusive of the special test and/or needed examinations.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Analysis of biological material (Blood or urine) from employees for presence of hazardous substances. These tests will be ordered for employees referred under CLIN 2003 (e.g. Heavy
Metal or Benzene series), only if indicated IAW the attached PWS. The CLIN will be used per test indicating parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
X-ray
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Color Vision Examination
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Tuberculin Test
This test is administered to rule out an exposure to tuberculosis IAW the attached PWS. The exam is included in the unit price.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 50 |
| Each |
| EUR____________ |
| EUR________________ |
Titer determination
Prior or following an immunization IAW the attached PWS, CLIN will be used per test indicating which parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 15 |
| Each |
| EUR____________ |
| EUR________________ |
Consultation, blood taking, and documentation
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis A Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 45 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis B Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 55 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis AB Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
FSME Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 25 |
| Each |
| EUR____________ |
| EUR________________ |
Meningococcal (ACWY) Immunization Initial/Booster (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Mumps/Measles/Rubella Immunization (Combination vaccine) (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Pertussis Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Polio Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Rabies Immunization Initial/Booster
(One single shot as initial, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria (Td) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria/Pertussis (Tdap) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Typhoid Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Varicella Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Yellow Fever Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
Total for 2nd Option Year, CLINs 2001 through 2032:
3rd Option Period 01 Oct 2023 – 30 Sep 2024, CLINs 3001 through 3032
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examinations With diagnosis by physician (e.g. hearing and/or other screening test per DGUV Guidelines) in accordance with (IAW) the attached Performance Work Statement (PWS).
Period of Performance from 01 October 2023 through 30 September 2024
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 150 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician to include in the extended volumes: health history, physical, clinical examination, vision test, hearing test, pulmonary function test, EKG test, small laboratory, blood count, urinalysis, Gamma GT and GPT, documentation, diagnosis, and reporting (e.g. clinical procedures per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 180 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician with medical-technical and toxicological-analytical parameters not covered under CLIN 3002 (e.g. biomonitoring lead, benzene, toluene; as well as x-ray examination and/or exercise EKG (Ergometry) per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations
To an Occupational Health Care as described under CLIN 3001 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described under CLIN 3002 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described und CLIN 3003 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Medical referral to specialist To complete more extensive testing and evaluation that may not be available from the contractor (i.e. audiologist, optometrist, etc.) IAW the attached PWS. The price shall be inclusive of the special test and/or needed examinations.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Analysis of biological material (Blood or urine) from employees for presence of hazardous substances. These tests will be ordered for employees referred under CLIN 3003 (e.g. Heavy
Metal or Benzene series), only if indicated IAW the attached PWS. The CLIN will be used per test indicating parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
X-ray
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Color Vision Examination
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Tuberculin Test
This test is administered to rule out an exposure to tuberculosis IAW the attached PWS. The exam is included in the unit price.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 50 |
| Each |
| EUR____________ |
| EUR________________ |
Titer determination
Prior or following an immunization IAW the attached PWS, CLIN will be used per test indicating which parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 15 |
| Each |
| EUR____________ |
| EUR________________ |
Consultation, blood taking, and documentation
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis A Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 45 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis B Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 55 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis AB Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
FSME Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 25 |
| Each |
| EUR____________ |
| EUR________________ |
Meningococcal (ACWY) Immunization Initial/Booster (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Mumps/Measles/Rubella Immunization (Combination vaccine) (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Pertussis Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Polio Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Rabies Immunization Initial/Booster
(One single shot as initial, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria (Td) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria/Pertussis (Tdap) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Typhoid Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Varicella Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Yellow Fever Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
Total for 3rd Option Year, CLINs 3001 through 3032:
4th Option Period 01 Oct 2024 – 30 Sep 2025, CLINs 4001 through 4032
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examinations With diagnosis by physician (e.g. hearing and/or other screening test per DGUV Guidelines) in accordance with (IAW) the attached Performance Work Statement (PWS).
Period of Performance from 01 October 2024 through 30 September 2025
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 150 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician to include in the extended volumes: health history, physical, clinical examination, vision test, hearing test, pulmonary function test, EKG test, small laboratory, blood count, urinalysis, Gamma GT and GPT, documentation, diagnosis, and reporting (e.g. clinical procedures per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 180 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician with medical-technical and toxicological-analytical parameters not covered under CLIN 4002 (e.g. biomonitoring lead, benzene, toluene; as well as x-ray examination and/or exercise EKG (Ergometry) per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations
To an Occupational Health Care as described under CLIN 4001 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described under CLIN 4002 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described und CLIN 4003 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Medical referral to specialist To complete more extensive testing and evaluation that may not be available from the contractor (i.e. audiologist, optometrist, etc.) IAW the attached PWS. The price shall be inclusive of the special test and/or needed examinations.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Analysis of biological material (Blood or urine) from employees for presence of hazardous substances. These tests will be ordered for employees referred under CLIN 4003 (e.g. Heavy
Metal or Benzene series), only if indicated IAW the attached PWS. The CLIN will be used per test indicating parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
X-ray
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Color Vision Examination
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Tuberculin Test
This test is administered to rule out an exposure to tuberculosis IAW the attached PWS. The exam is included in the unit price.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 50 |
| Each |
| EUR____________ |
| EUR________________ |
Titer determination
Prior or following an immunization IAW the attached PWS, CLIN will be used per test indicating which parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 15 |
| Each |
| EUR____________ |
| EUR________________ |
Consultation, blood taking, and documentation
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis A Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 45 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis B Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 55 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis AB Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
FSME Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 25 |
| Each |
| EUR____________ |
| EUR________________ |
Meningococcal (ACWY) Immunization Initial/Booster (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Mumps/Measles/Rubella Immunization (Combination vaccine) (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Pertussis Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Polio Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Rabies Immunization Initial/Booster
(One single shot as initial, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria (Td) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Tetanus/Diphtheria/Pertussis (Tdap) Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Typhoid Immunization
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Varicella Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Yellow Fever Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
Total for 4th Option Year, CLINs 4001 through 4032:
5th Option Period 01 Oct 2025 – 30 Sep 2026, CLINs 5001 through 5032
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examinations With diagnosis by physician (e.g. hearing and/or other screening test per DGUV Guidelines) in accordance with (IAW) the attached Performance Work Statement (PWS).
Period of Performance from 01 October 2025 through 30 September 2026
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 150 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician to include in the extended volumes: health history, physical, clinical examination, vision test, hearing test, pulmonary function test, EKG test, small laboratory, blood count, urinalysis, Gamma GT and GPT, documentation, diagnosis, and reporting (e.g. clinical procedures per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 180 |
| Each |
| EUR____________ |
| EUR________________ |
Occupational Health Consultation and Medical Examination With diagnosis by physician with medical-technical and toxicological-analytical parameters not covered under CLIN 5002 (e.g. biomonitoring lead, benzene, toluene; as well as x-ray examination and/or exercise EKG (Ergometry) per DGUV Guidelines) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 200 |
| Each |
| EUR____________ |
| EUR________________ |
Activities related to work area
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 1 Hour
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Diagnosis/Examination
Quantity: 1 EA – 15 Minutes
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations
To an Occupational Health Care as described under CLIN 5001 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described under CLIN 5002 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Follow-up examinations To an Occupational Health Care as described und CLIN 5003 IAW the attached PWS, price to be all inclusive (labor, and all material necessary).
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Medical referral to specialist To complete more extensive testing and evaluation that may not be available from the contractor (i.e. audiologist, optometrist, etc.) IAW the attached PWS. The price shall be inclusive of the special test and/or needed examinations.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Analysis of biological material (Blood or urine) from employees for presence of hazardous substances. These tests will be ordered for employees referred under CLIN 5003 (e.g. Heavy
Metal or Benzene series), only if indicated IAW the attached PWS. The CLIN will be used per test indicating parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
X-ray
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Color Vision Examination
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 20 |
| Each |
| EUR____________ |
| EUR________________ |
Tuberculin Test
This test is administered to rule out an exposure to tuberculosis IAW the attached PWS. The exam is included in the unit price.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 50 |
| Each |
| EUR____________ |
| EUR________________ |
Titer determination
Prior or following an immunization IAW the attached PWS, CLIN will be used per test indicating which parameter tested.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 15 |
| Each |
| EUR____________ |
| EUR________________ |
Consultation, blood taking, and documentation
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis A Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 45 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis B Immunization Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 55 |
| Each |
| EUR____________ |
| EUR________________ |
Hepatitis AB Initial/Booster
(One single shot as initial or booster to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 30 |
| Each |
| EUR____________ |
| EUR________________ |
FSME Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 25 |
| Each |
| EUR____________ |
| EUR________________ |
Meningococcal (ACWY) Immunization Initial/Booster (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Mumps/Measles/Rubella Immunization (Combination vaccine) (One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 5 |
| Each |
| EUR____________ |
| EUR________________ |
Pertussis Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and documentation) IAW the attached PWS.
| ITEM NO |
| SUPPLIES/SERVICES |
| ESTIMATED QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED AMOUNT |
| 10 |
| Each |
| EUR____________ |
| EUR________________ |
Polio Immunization Initial/Booster
(One single shot as initial or booster, to include vaccine, consultation and…
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