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Instructions
| Instructions |
| English |
| You may use this file to enter and submit responses to the line item(s) on the Pricing grid(s). |
| Use the empty fields to enter your response. Do not change any parts of the file or structure of the answer grids. |
| Once all responses have been entered, save the file on your computer. |
| Once the file is saved, re-attach by using the "Click or Drag to add file" box. |
| Review file once loaded to ensure accuracy. |
| Once completed, the Excel Price Form must be uploaded and submitted in eMMA. In addition, bidders must also enter the Total Evaluated Bid Price directly in eMMA as lump sum pricing by jurisdiction. Failure to both upload the completed Excel Price Form and enter the lump sum amount in eMMA shall result in the bid being deemed non-responsive by the DPSCS Procurement Officer. |
Price Form
| Attachment B - Price Form |
| DPDS - Substance Use Disorder Treatment Services (Pre-Trial) |
| Solicitation #: BPM055260 |
| The Bid shall contain all price information in the format specified in these pages. Complete the BID form only as provided in the Bid Pricing Instructions. Do not amend, alter, or leave blank any items on the Bid Form. If option years are included, Bidders must submit Bids for each option year. Failure to adhere to any of these instructions shall result in the bid being determined non-responsive and rejected by the Department. |
| Administrative Fee | 3 Months | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | Year 6 | Year 7 | |
| Term: | Initial Term | Initial Term | Initial Term | Initial Term | Option 1 / Year 1 | Option 1/Year 2 | Option 2 /Year 1 | Option 2 /Year 2 | Total: |
| Administrative Fee: | | | | | | | | | $0.00 |
| The Contractor shall provide the total administratrive fee for each term provided. This administrative fee shall include all expenses to provide the services requested. The Administrative Fee for each term will be divided evenly by the number of months in the term and billed on a monhtly basis. | | | | | | | | | |
| Acupuncture Services | 3 Months | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | Year 6 | Year 7 | |
| Term: | Initial Term | Initial Term | Initial Term | Initial Term | Option 1 / Year 1 | Option 1/Year 2 | Option 2 /Year 1 | Option 2 /Year 2 | |
| Acupuncture Services Hourly Rate: | | | | | | | | | |
| Estimated Hours: | 180 | 780 | 780 | 780 | 780 | 780 | 780 | 780 | Total: |
| Total: | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| SUDTS Staffing Services | 3 Months | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | Year 6 | Year 7 | |
| Term | Initial Term | Initial Term | Initial Term | Initial Term | Option 1 / Year 1 | Option 1/Year 2 | Option 2 /Year 1 | Option 2 /Year 2 | |
| Hourly Rate (Program Clinical Director): | | | | | | | | | |
| Estimated Number of Employees: | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
| Estimated Number of Hours: | 520 | 2080 | 2080 | 2080 | 2080 | 2080 | 2080 | 2080 | Total: |
| Total: | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Hourly Rate (Program Clinical Supervisor): | | | | | | | | | |
| Estimated Number of Employees: | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 2 | |
| Full Time Hours: | 520 | 2080 | 2080 | 2080 | 2080 | 2080 | 2080 | 2080 | Total: |
| Total: | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Hourly Rate (Social Worker): | | | | | | | | | |
| Estimated Number of Employees: | 3 | 3 | 3 | 4 | 5 | 5 | 6 | 6 | |
| Full Time Hours: | 520 | 2080 | 2080 | 2080 | 2080 | 2080 | 2080 | 2080 | Total: |
| Total: | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Hourly Rate (MOUD Counselors): | | | | | | | | | |
| Estimated Number of Employees: | 13 | 13 | 15 | 17 | 19 | 19 | 21 | 21 | |
| Full Time Hours: | 520 | 2080 | 2080 | 2080 | 2080 | 2080 | 2080 | 2080 | Total: |
| Total: | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Total Evaluated Proposal Price (Column K): $0.00 Once completed, the Excel Price Form must be uploaded and submitted in eMMA. In addition, bidders must also enter the Total Evaluated Bid Price (Cell K41) directly in eMMA as lump sum pricing. Failure to both upload the completed Excel Price Form and enter the lump sum amount in eMMA may result in the bid being deemed non-responsive by the DPSCS Procurement Officer.
| Submitted By: | ____________________________________________________________________________________________________________ | | |
| Signature of Authorized Representative: ____________________________________ | | | Date: |
| Printed Name and Title: | | | |
| Bidder Company Name: | | | |
| Bidder Company Address: | | | |
| Location(s) from which services will be performed (City/State): | | | |
| FEIN: | | eMM #: | |
| Bidder Contact Information: | Name: ____________________________________________________________________________________________________________ | | |
| Telephone: | | |
| Email: | | |