Atch E - Time Sheet.xlsx

XLSX spreadsheet 13 KB Posted

Attached to
BIA Set-Aside: Pathology Physicians at PIMC
Solicitation number
75H71225C00001
Issued by

About this file

The provided document is a timesheet template for contract services under Contract Number 75H71225C00001 for Pathology Physician Services at the Phoenix Indian Medical Center. The timesheet includes fields for the contractor company name, provider's name, service provided, and a detailed breakdown of hours worked by day, including descriptions of the hours (e.g., call-back, on-call, overtime, regular time). The timesheet requires verification by a department manager and approval by a certified Contracting Officer's Representative (COR).

The related federal contract opportunity is a notice of award for RFQ-25-PHX-002, Pathology Physician Services at the Phoenix Indian Medical Center. The contract, 75H71225C00001, was awarded to Prairie Band Health Services Inc. for $6,748,560 on November 21, 2024. The contract was set aside for the Bureau of Indian Affairs (BIA), and the awarding agency was the Department of Health and Human Services Indian Health Service (IHS).

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Text version

Sheet1

PHOENIX INDIAN MEDICAL CENTER
STANDARD TIMESHEET FOR CONTRACT SERVICES

CONTRACT NUMBER: 75H712 CONTRACTOR (Company Name)

PRINTED PROVIDER'S NAME:____________________________________ SERVICE PROVIDED: PATHOLOGY PHYSICIAN SERVICES

SIGNATURE OF PROVIDER: ___________________________________________________ DATE SIGNED: _____________________________

(Description of Hours: Call-Back, On-Call, Overtime, Regular Time, etc. - # Hours, Description of Hours, Hours Need to Match Invoice/Contract)

WEEK OF _________________________________________
WeekdayDateTime INLunch OutLunch InTime OUTTotal HoursDescription of Hours
WEEK OF ________________________________________
WeekdayDateTime INLunch OutLunch InTime OutTotal HoursDescription of Hours

VERIFIED BY Dept. Manager (Printed Name):_____________________________________ Signature: ___________________________________________________

APPROVED BY Certified COR (Printed Name):_____________________________________ Signature: __________________________________________________

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