Att. C. Rev. 1_Quote Submission Form_RFQ S-44000-00016442.docx

RFQ S-44000-00016442 – Clinical Advisory Services Att. C, Rev. 1

ATTACHMENT C, REVISION 1

QUOTE SUBMISSION FORM

Company Name: ___________________________________________________________________________________ Contact Person: ___________________________________________Title: ____________________________________ Address: ____________________________________________________________________________________________ Telephone: ____________________________Email: ___________________________________________________ Federal ID #: _________________________ Oregon Secretary of State Registry #_____________________ COBID CERT# (if applicable) __________________________________________________________________

Each Offeror must submit this quote Form. The quote Form must be signed and submitted to the SPC prior to Closing. Quotes must be received no later than April 15, 2026, 2:00 PM (PT)

Award will be made to the lowest responsive and responsible Offeror. Agency intends to award one (1) Contract, but reserves the right to award more or less at Agency’s discretion.

Offerors must meet or exceed all the following minimum qualifications, as outlined in RFQ Section 6:

Yes / No

1. Does the Offeror meet the mandatory requirements as outlined in Section 6 of the RFQ?

Agency will be requiring the Contractor to create drug review reports similar to reports from 2025 published on the PDAB website, linked here. Please provide an estimated cost to complete a similar report, which, at a minimum, must include the following section:

· Clinical information based on manufacturer material The cost for the report should represent an average of all drugs that Agency may require reviewed. The drugs selected for review in 2026 are posted on the PDAB website, linked here. Agency is not requesting Offeror to submit an example report, just the estimated cost to create one. The report must also meet the requirements of Section 5 of the RFQ.

Offerors will be evaluated based on the cost submitted below. The Offeror with the lowest cost will be awarded the contract.

1. Total estimated cost to complete example report:

Offer must also submit the following cost information. This information will not be used to evaluate the offer. If cost information is not applicable, please leave it blank.

1. Hourly rate of Key Persons

2. Flat rate for each report deliverable $______________.

3. Costs of any additional components or services required to execute the services

SIGNATURE OF OFFEROR’S DULY AUTHORIZED REPRESENTATIVE

I, the undersigned, agree to be bound by the form of Agreement and all remaining contract documents, including instructions to Offeror’s; Standard Terms and Conditions; Special Conditions; Federal Provisions, if applicable; and Specifications.

I, the undersigned, certify compliance with State of Oregon statutory requirements governing registration of corporations and assumed business names.

I, the undersigned, certify that this Quote has been arrived at independently and has been submitted without any collusion designed to limit independent bidding or competition. I, the undersigned duly authorized representative of the Offeror, understand that the quote must be signed in ink by the Offeror and that any alterations or erasures must be initialed in ink by the person signing the quote. Further, I acknowledge that I have read and understand all quote instructions, specifications, terms and conditions, (including the attachments indicated above) and agree, on behalf of myself and the Offeror to be bound by them.

I the undersigned, duly authorized representative of the Offeror, certify that the information provided in this quote is true and accurate. Further, I understand and acknowledge that providing incorrect information may cause for quote rejections or contract termination.

Company Name: __________________________________________________________________________________

Name of Authorized Representative: ___________________________________________________________

Title: _______________________________________________________________________________________________

Signature: _____________________________________________ Date: ____________________________________