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Price Evaluation Template
| Base Period: April 05, 2024- April 04, 2025 | | QUANTITY | MATERIAL | | | | | | | | | | | | | LABOR | | | Pricing Assumptions |
| DESCRIPTION OF WORK | CPT CODES | NO. | UNIT | Region 1 | Region 2 | Region 3 | Region 4 | Region 5 | Region 6 | Region 7 | Region 8 | Region 9 | Region 10 | | | PER | | | |
| CLIN | | | UNITS | MEASURE | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | Escalation | SUBTOTALS (MAX for all units) | UNIT | Escalation | SUBTOTALS | The established quantity/ number of units represent the estimated annual number of units per line item. Hence, the quantity does not change by region. The Offeror should calculate the subtotal per line item by multiplying the number of units with the highest Region- per unit rate to reflect the maximum subtotal per line item. |
| 0001 | Triage Nurse Closure | COPTN | 18,359 | Case | $0.00 | The established "number of units" for the Triage Nurse (TN) Closure Cases is based on historical data of the average number of Triage Nurse Cases and respective invoices in a 12 month period. This is a flat rate per case based on an average of 1.5 hours per case. |
| 0001 | Nurse Report Regular | NIP001 | 28,487 | Each | $0.00 | The established "number of units" for the Nurse Report Regular* is 65% (approximately 28,487) of the annual average of Nurse reports (43,826). There is an average of four (4) Nurse Regular Reports/invoices per every assigned Nurse management case. The average number of labor hours per each Nurse Regular Report/invoice is six (6) hours. |
*As aforementioned, the Registered Field Nurses (FN) complete either Regular Reports or Site visit Reports for each assigned case on a monthly basis. The FNs may also complete SECOP Prep Packets in addition to the Regular/Site Visit Reports, if applicable. The overall bi-annual average of Nurse reports is based on historical data.
| 0001 | Nurse Report Site Visit | NIP002 | 15,339 | Each | $0.00 | The established "number of units" for the Nurse Report Site Visit is 35% (approximately 15,339) of the annual average of Nurse reports (43,826). The average number of labor hours per each Nurse Site Visit Report is 6.25 hours. |
| 0001 | Nurse Travel GSA Milage Charge | NITRA | 1,783,509 | Miles | $0.00 | The established "number of units" for the Nurse Travel GSA Milage Charge is based on the average number of miles billed in a 12 month period per historical data. The "per unit rate "is based on the GSA Mileage rates: https://www.gsa.gov/travel/plan-book/transportation-airfare-pov-etc/privately-owned-vehicle-mileage-rates/pov-mileage-rates-archived. |
| 0001 | Nurse Other Direct Expenses | NPART | - 0 | Actual | | Total cost is based on average ODC cost for FY 22 plus a 3% increase. |
| 0001 | SECOP Prep Packet | SOPRP | 6,574 | Each | $0.00 | The established "number of units" for the SECOP Prep Packet is 15% (approximately 6,574 reports) of the annual average of Nurse reports (43,826) that will need a SECOP Prep Packet and respective invoice in addition to the Nurse Regular/Site visit report. The average number of labor hours needed to complete this work product in addition to the regular report is 7.5 hours total per SECOP packet (6 hours for the regular monthly report and 1.5 for the additional monthly SECOP prep packet). |
| 0001 | RC Report Regular | VR001 | 8,430 | Each | $0.00 | The established "number of units" for the Rehabilitation Counselor (RC) Report Regular* in 65% (approximately 8,430) of the annual average of RC reports (12,970). There is an average of five (5) RC Regular Reports/invoices per every assigned RC management case. The average number of labor hours per each RC Regular Report/invoice is nine (9) hours. |
*As aforementioned, the Rehabilitation Counselors (RC) complete either Regular Reports or Site Visit Reports for each assigned case on a monthly basis. The RCs may also complete Specialized Reports in addition to the Regular/Site Visit Reports, if applicable. The overall bi-annual average of RC reports is based on historical data.
| 0001 | RC Report Site Visit | VR002 | 4,539 | Each | $0.00 | The established "number of units" for the RC Site Visit Report is 35% (approximately 4,539) of the annual average of RC reports (12,970). The average number of labor hours per each RC Site Visit Report is 9.25 hours. |
| 0001 | RC Specialized Report | SVRPT | 3,989 | Each | $0.00 | The established "number of units" for the RC Specialized Report is 3,989 based on historical data/annual average. The average number of labor hours needed to complete this work product in addition to the RC regular report is 12 hours per report (9 hours for the regular monthly report and 3 for the additional monthly Specialized report). |
| 0001 | RC Travel GSA Milage Charge | VRTRA | 343,292 | Miles | $0.00 | The established "number of units" for the RC Travel GSA Milage Charge is based on the average number of miles billed in a 12 month period per historical data. The "per unit rate "is based on the GSA Mileage rates: https://www.gsa.gov/travel/plan-book/transportation-airfare-pov-etc/privately-owned-vehicle-mileage-rates/pov-mileage-rates-archived |
| 0001 | RC Other Direct Expenses | VR018 | - 0 | Actual | | Total cost is based on average ODC cost for FY 22 plus a 3% increase. |
| 0001 | Longshore VR cases | | 20 | Case | $0 | The established "number of units" for Longshore VR cases is based on historical data/annual average. |
| 0002 | Travel | | | Each | | |
| | Base Period | | $0.00 | | For the required services under this contract are based on the specified work products and monthly reporting as detailed under Section 5- Task Area 3-5 for TN, FN, RC services. The cost for the contract management services, contractor personnel trainings, monthly critical reports, and additional support services described under Task 1- 2 and 6-9 shall be incorporated into the pricing of the expense billing codes (CPT codes) listed in the attached Evaluation Pricing Template. Once the contract is awarded, all terms and conditions of the initial contract shall remain unchanged, except whereas expressly and formally modified by both parties, when applicable. The price proposal shall be inclusive of any/all labor, indirect costs, materials, pick-up and delivery, ancillary costs and applicable fees. |
| Option Period 1: April 05, 2025- April 04, 2026 | | QUANTITY | MATERIAL | | | | | | | | | | | | | LABOR | | |
| DESCRIPTION OF WORK | CPT CODES | NO. | UNIT | Region 1 | Region 2 | Region 3 | Region 4 | Region 5 | Region 6 | Region 7 | Region 8 | Region 9 | Region 10 | | | PER | | |
| CLIN | | | UNITS | MEASURE | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | Escalation | SUBTOTALS (MAX for all units) | UNIT | Escalation | SUBTOTALS |
| 1001 | Triage Nurse Closure | COPTN | 18,359 | Case | $0.00 |
| 1001 | Nurse Report Regular | NIP001 | 28,487 | Each | $0.00 |
| 1001 | Nurse Report Site Visit | NIP002 | 15,339 | Each | $0.00 |
| 1001 | Nurse Travel GSA Milage Charge | NITRA | 1,783,509 | Miles | $0.00 |
| 1001 | Nurse Other Direct Expenses | NPART | - 0 | Actual | |
| 1001 | SECOP Prep Packet | SOPRP | 6,574 | Each | $0.00 |
| 1001 | RC Report Regular | VR001 | 8,430 | Each | $0.00 |
| 1001 | RC Report Site Visit | VR002 | 4,539 | Each | $0.00 |
| 1001 | RC Specialized Report | SVRPT | 3,989 | Each | $0.00 |
| 1001 | RC Travel GSA Milage Charge | VRTRA | 343,292 | Miles | $0.00 |
| 1001 | RC Other Direct Expenses | VR018 | - 0 | Actual | |
| 1001 | Longshore VR cases | | 20 | Case | $0 |
| 1002 | Travel | | | Each | |
| | Option Period 1 | | $0.00 | |
| Option Period 2: April 05, 2026- April 04, 2027 | | QUANTITY | MATERIAL | | | | | | | | | | | | | LABOR | | |
| DESCRIPTION OF WORK | CPT CODES | NO. | UNIT | Region 1 | Region 2 | Region 3 | Region 4 | Region 5 | Region 6 | Region 7 | Region 8 | Region 9 | Region 10 | | | PER | | |
| CLIN | | | UNITS | MEASURE | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | Escalation | SUBTOTALS (MAX for all units) | UNIT | Escalation | SUBTOTALS |
| 2001 | Triage Nurse Closure | COPTN | 18,359 | Case | | | | | | | | | | | | $0.00 | | | |
| 2001 | Nurse Report Regular | NIP001 | 28,487 | Each | | | | | | | | | | | | $0.00 | | | |
| 2001 | Nurse Report Site Visit | NIP002 | 15,339 | Each | | | | | | | | | | | | $0.00 | | | |
| 2001 | Nurse Travel GSA Milage Charge | NITRA | 1,783,509 | Miles | | | | | | | | | | | | $0.00 | | | |
| 2001 | Nurse Other Direct Expenses | NPART | - 0 | Actual | | | | | | | | | | | | | | | |
| 2001 | SECOP Prep Packet | SOPRP | 6,574 | Each | | | | | | | | | | | | $0.00 | | | |
| 2001 | RC Report Regular | VR001 | 8,430 | Each | | | | | | | | | | | | $0.00 | | | |
| 2001 | RC Report Site Visit | VR002 | 4,539 | Each | | | | | | | | | | | | $0.00 | | | |
| 2001 | RC Specialized Report | SVRPT | 3,989 | Each | | | | | | | | | | | | $0.00 | | | |
| 2001 | RC Travel GSA Milage Charge | VRTRA | 343,292 | Miles | | | | | | | | | | | | $0.00 | | | |
| 2001 | RC Other Direct Expenses | VR018 | - 0 | Actual | | | | | | | | | | | | | | | |
| 2001 | Longshore VR cases | | 20 | Case | | | | | | | | | | | | $0 | | | |
| 2002 | Travel | | | Each | | | | | | | | | | | | | | | |
| | Option Period 2 | | $0.00 | | | | | | | | | | | | | | | |
| Option Period 3: April 05, 2027- April 04, 2028 | | QUANTITY | MATERIAL | | | | | | | | | | | | | LABOR | | |
| DESCRIPTION OF WORK | CPT CODES | NO. | UNIT | Region 1 | Region 2 | Region 3 | Region 4 | Region 5 | Region 6 | Region 7 | Region 8 | Region 9 | Region 10 | | | PER | | |
| CLIN | | | UNITS | MEASURE | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | Escalation | SUBTOTALS (MAX for all units) | UNIT | Escalation | SUBTOTALS |
| 3001 | Triage Nurse Closure | COPTN | 18,359 | Case | | | | | | | | | | | | $0.00 | | | |
| 3001 | Nurse Report Regular | NIP001 | 28,487 | Each | | | | | | | | | | | | $0.00 | | | |
| 3001 | Nurse Report Site Visit | NIP002 | 15,339 | Each | | | | | | | | | | | | $0.00 | | | |
| 3001 | Nurse Travel GSA Milage Charge | NITRA | 1,783,509 | Miles | | | | | | | | | | | | $0.00 | | | |
| 3001 | Nurse Other Direct Expenses | NPART | - 0 | Actual | | | | | | | | | | | | | | | |
| 3001 | SECOP Prep Packet | SOPRP | 6,574 | Each | | | | | | | | | | | | $0.00 | | | |
| 3001 | RC Report Regular | VR001 | 8,430 | Each | | | | | | | | | | | | $0.00 | | | |
| 3001 | RC Report Site Visit | VR002 | 4,539 | Each | | | | | | | | | | | | $0.00 | | | |
| 3001 | RC Specialized Report | SVRPT | 3,989 | Each | | | | | | | | | | | | $0.00 | | | |
| 3001 | RC Travel GSA Milage Charge | VRTRA | 343,292 | Miles | | | | | | | | | | | | $0.00 | | | |
| 3001 | RC Other Direct Expenses | VR018 | - 0 | Actual | | | | | | | | | | | | | | | |
| 3001 | Longshore VR cases | | 20 | Case | | | | | | | | | | | | $0 | | | |
| 3002 | Travel | | | Each | | | | | | | | | | | | | | | |
| | Option Period 3 | | $0.00 | | | | | | | | | | | | | | | |
| Option Period 4: April 05, 2028- April 04, 2029 | | QUANTITY | MATERIAL | | | | | | | | | | | | | LABOR | | |
| DESCRIPTION OF WORK | CPT CODES | NO. | UNIT | Region 1 | Region 2 | Region 3 | Region 4 | Region 5 | Region 6 | Region 7 | Region 8 | Region 9 | Region 10 | | | PER | | |
| CLIN | | | UNITS | MEASURE | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | PER UNIT | Escalation | SUBTOTALS (MAX for all units) | UNIT | Escalation | SUBTOTALS |
| 4001 | Triage Nurse Closure | COPTN | 18,359 | Case | $0.00 |
| 4001 | Nurse Report Regular | NIP001 | 28,487 | Each | $0.00 |
| 4001 | Nurse Report Site Visit | NIP002 | 15,339 | Each | $0.00 |
| 4001 | Nurse Travel GSA Milage Charge | NITRA | 1,783,509 | Miles | $0.00 |
| 4001 | Nurse Other Direct Expenses | NPART | - 0 | Actual | |
| 4001 | SECOP Prep Packet | SOPRP | 6,574 | Each | $0.00 |
| 4001 | RC Report Regular | VR001 | 8,430 | Each | $0.00 |
| 4001 | RC Report Site Visit | VR002 | 4,539 | Each | $0.00 |
| 4001 | RC Specialized Report | SVRPT | 3,989 | Each | $0.00 |
| 4001 | RC Travel GSA Milage Charge | VRTRA | 343,292 | Miles | $0.00 |
| 4001 | RC Other Direct Expenses | VR018 | - 0 | Actual | |
| 4001 | Longshore VR cases | | 20 | Case | $0 |
| 4002 | Travel | | | Each | |
| | Option Period 4 | | $0.00 | |
| | | Contract Value with Options | $0.00 | |
