Atch E - Timesheet for Contract Service HHCC.xlsx
XLSX spreadsheet 11 KB Posted
- Solicitation number
- RFP-22-PHX-07
About this file
This document contains a federal contract solicitation for emergency room physician services at the Hopi Health Care Center in Polacca, Arizona. The solicitation is identified as number RFP-22-PHX-07 and seeks proposals for a firm fixed price contract to provide non-personal professional emergency room physician services in accordance with the statement of work. The North American Industry Classification System code is 621111 for offices of physicians and the size standard is $12 million. The period of performance is estimated at a base period of August 1, 2022 through July 31, 2023 with four optional one-year extension periods. The place of performance is the Hopi Health Care Center located in Polacca, Arizona. The government will award to the responsive and responsible offeror providing the best value based on price and other factors. The solicitation also includes rate schedules, business associate agreements, tax exemption letters, statements of work, timesheets, and wage determinations as attachments.
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Text version
Sheet1
| Hopi Health Care Center (HHCC) |
| STANDARD TIMESHEET FOR CONTRACT SERVICES |
| Contract Number:_____________________________ |
| PRINTED CONTRACTOR'S NAME:____________________________________DEPT/SERVICE__________________________________________ |
"I hereby certify that the hours worked during the weeks noted below are correct and are in accordance to the terms of the contract"
SIGNATURE OF CONTRACTOR: _________________________________________________ DATE SIGNED: ____________________________
| WEEK OF _________________________________________ | ||||||
| Weekday | Date | Time In | Lunch | Time Out | Total Hours | Description of Hours |
| Week of _________________________________ | ||||||
| Weekday | Date | Time In | Lunch | Time Out | Total Hours | Description of Hours |
"I hereby certify that the contract services provided in this timesheet are correct and are in accordance to the terms of the contract"
VERIFIED BY Department Receiving Official (Printed Name/Signature):_______________________________________________________________________
Contracting Officer Representative (Printed Name/Signature):________________________________________________________________________________
Sheet2
Sheet3
File details come from the government source that posted it. Updated .