Att_D_MedUtilities.pdf
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- Attached to
- Regional Rental Surveys
- Solicitation number
- 140D0421R0017
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Other files
| File | Type | Posted |
|---|---|---|
| Att_C_OS2001.pdf | ||
| Attachment 2 - Vendor Question Template.docx | DOCX document | |
| Att_A_Communities.pdf | ||
| Attachment 1 - Rental Survey SOW.docx | DOCX document | |
| Att_B_OS2000.pdf | ||
| Source Sought Notice 140D0421R0017.pdf | ||
| Att_E_HousingData.pdf |
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ATTACHMENT D COMMUNITY MEDICAL/UTILITIES SURVEY
Community Medical and Utilities Survey
Survey Region________ Survey Year____________
Survey Community/State______________________________
Collected By_____________________________ Date Collected_______________________
Doctor Office/Clinic/Business Name___________________________________________________________
Not Available (Contact IBC immediately because community is not valid)
Accepting New Patients (If not, survey another doctor in the community)
Doctor Name(s)______________________________________________________________________
Address____________________________________________________________________________
Phone/Web__________________________________________________________________________
Comments/Hours_____________________________________________________________________
Dentist Office/Clinic/Business Name__________________________________________________________
Not Available (Contact IBC immediately because community is not valid)
Accepting New Patients (If not, survey another dentist in the community)
Dentist Name(s)______________________________________________________________________
Address____________________________________________________________________________
Phone/Web__________________________________________________________________________
Comments/Hours____________________________________________________________________
Electric Utility Company Name_______________________________________________________________
Copy of rate sheets required
Phone/Web__________________________________________________________________________
Comments/Contact Name_______________________________________________________________
Method 1: Cost to Residential Customers: (average summer/winter rates if applicable; include all taxes) 500 KwH____________ 1,000 KwH___________ 1,500 KwH___________ 2,000 KwH___________
Method 2: Contractor can enter into iQMIS the following cost components:
Summer/Year-Round (_____Months) Winter (______Months)
Tier 1 ______ KwH @ Tier 1 Rate ___________ Tier 1 ______ KwH @ Tier 1 Rate ___________
Tier 2 ______ KwH @ Tier 2 Rate ___________ Tier 2 ______ KwH @ Tier 2 Rate ___________
Tier 3 ______ KwH @ Tier 3 Rate ___________ Tier 3 ______ KwH @ Tier 3 Rate ___________
Tier 4 ______ KwH @ Tier 4 Rate ___________ Tier 4 ______ KwH @ Tier 4 Rate ___________
All Over Tier 4 @ Tier 5 Rate ___________ All Over Tier 4 @ Tier 5 Rate ___________
Other Charges (Year Round):
Base Rate/Service Fee/Minimum Fee/Flat Rate Per Month ________________
Additional/Surcharges Per KwH _______________________________ _________________
Additional/Surcharges Per KwH _______________________________ _________________
Additional/Surcharges Per KwH _______________________________ _________________
Taxes Per KwH_____________________ Taxes Percent ________________%
Natural Gas Utility Company Name ____________________________________ Not Available
Phone/Web______________________________________________
Comments/ Contact Name_______________________________________________________________
Method 1: Cost to Residential Customers: (average summer/winter rates if applicable; include all taxes) 50 Therms____________ 100 Therms___________ 150 Therms___________ 200 Therms___________ (1 Therm = 1 CCF = 100 CF. 10 Therms = 10 CCF = 1,000 CF = 1 MCF)
Method 2: Contractor can enter into iQMIS the following cost components:
Natural Gas Units and Rates are published by: Therm CCF MCF
Summer/Year-Round (_______Months) Winter (________Months)
Tier 1 ______ Units @ Tier 1 Rate ___________ Tier 1 ______ Units @ Tier 1 Rate ___________
Tier 2 ______ Units @ Tier 2 Rate ___________ Tier 2 ______ Units @ Tier 2 Rate ___________
Tier 3 ______ Units @ Tier 3 Rate ___________ Tier 3 ______ Units @ Tier 4 Rate ___________
Tier 4 ______ Units @ Tier 4 Rate ___________ Tier 4 ______ Units @ Tier 5 Rate ___________
All Over Tier 4 Units @ Tier 5 Rate __________ All Over Tier 4 Units @ Tier 5 Rate __________
Other Charges (Year-Round):
Base Rate/Service Fee/Minimum Fee Per Month $___________ (optional -- includes ____________Units)
Additional Flat Rate Service Fee Per Month $______________
Additional/Surcharges Per Unit________________________ __________
Additional/Surcharges Per Unit________________________ __________
Additional/Surcharges Per Unit________________________ __________
Taxes Per Unit_____________________
Taxes/Additional Percent ____________%
Water Utility Company Name _______________________________________ Not Available (Wells)
Copy of rate sheets required Phone, Web____________________________________________
Comments/ Contact Name_______________________________________________________________
Method 1: Cost to Residential Customers: (average summer/winter rates if applicable; include all taxes) 3,000 gals.____________ 5,000 gals.___________ 7,500 gals.___________ 10,000 gals.___________
(1 cu ft = 7.48 gals. 100 cu ft = 748 gals. 100 cu ft = 1 CCF)
Method 2: Contractor can enter into iQMIS the following cost components:
Water Units and Rates are published by: Gallon CF CCF Summer/Year-Round (_______Months) Winter (________Months)
Tier 1 ______ Units @ Tier 1 Rate ___________ Tier 1 ______ Units @ Tier 1 Rate ___________
Tier 2 ______ Units @ Tier 2 Rate ___________ Tier 2 ______ Units @ Tier 2 Rate ___________
Tier 3 ______ Units @ Tier 3 Rate ___________ Tier 3 ______ Units @ Tier 4 Rate ___________
Tier 4 ______ Units @ Tier 4 Rate ___________ Tier 4 ______ Units @ Tier 5 Rate ___________
All Over Tier 4 Units @ Tier 5 Rate __________ All Over Tier 4 Units @ Tier 5 Rate __________
Other Charges (Year-Round):
Base Rate/Service Fee/Minimum Fee Per Month $___________ (optional -- includes ____________Units)
Additional Flat Rate Service Fee Per Month $______________
Additional Surcharges Per Unit___________________ _________
Additional Surcharges Per Unit___________________ _________
Additional Surcharges Per Unit___________________ _________
Taxes Per Unit_____________________
Taxes/Additional Percent ____________%
Sewer Utility Company Name _______________________________________ Not Available (Septic)
Phone, Web____________________________________________
Comments/ Contact Name_______________________________________________________________
Method 1: Cost to Residential Customers: (average summer/winter rates if applicable; include all taxes) 3,000 gals.____________ 5,000 gals.___________ 7,500 gals.___________ 10,000 gals.___________
(1 cu ft = 7.48 gals. 100 cu ft = 748 gals. 100 cu ft = 1 CCF)
Method 2: Contractor can enter into iQMIS the following cost components:
Sewer Units and Rates are published by: Gallon CF CCF Summer/Year-Round (_______Months) Winter (________Months)
Tier 1 ______ Units @ Tier 1 Rate ___________ Tier 1 ______ Units @ Tier 1 Rate ___________
Tier 2 ______ Units @ Tier 2 Rate ___________ Tier 2 ______ Units @ Tier 2 Rate ___________
Tier 3 ______ Units @ Tier 3 Rate ___________ Tier 3 ______ Units @ Tier 4 Rate ___________
Tier 4 ______ Units @ Tier 4 Rate ___________ Tier 4 ______ Units @ Tier 5 Rate ___________
All Over Tier 4 Units @ Tier 5 Rate __________ All Over Tier 4 Units @ Tier 5 Rate __________
Other Charges (Year-Round):
Base Rate/Service Fee/Minimum Fee Per Month $___________ (optional -- includes ____________Units)
Additional Flat Rate Service Fee Per Month $______________
Additional Surcharges Per Unit___________________ _________
Additional Surcharges Per Unit___________________ _________
Additional Surcharges Per Unit___________________ _________
Taxes Per Unit_____________________ (taxes usually do not apply to sewer charges)
Taxes/Additional Percent ____________% (taxes usually do not apply to sewer charges)
Garbage Collection Company Name___________________________________ Not Available
Phone, Web______________________________ Incl. in Property Taxes
Contact Name/Comments_______________________________________________________________
Rate Per Month $____________________ include recycling, yard debris, mosquito control, and other charges that are typically included in the monthly garbage fee. Assume 2 cans per week or one 65 gal. can
Propane Company #1 Name ____________________________________ Not Available
Contact Name, Phone, Web________________________________________________
Rate Per Gal. $________________ (include taxes)
Propane Company #2 Name (if available) _____________________________________________
Rate Per Gal. $________________ (include taxes)
Fuel Oil Company #1 Name____________________________________ Not Available
Rate Per Gal. $________________ (include taxes)
Fuel Oil Company #2 Name (if available) ____________________________________
Contact Name, Phone, Web_______________________________________________
Rate Per Gal. $_______________ (include taxes)
File details come from the government source that posted it. Updated .