Attachment 1 - Cost Submittal (6100065570).xlsx
XLSX spreadsheet 85 KB Posted
- Attached to
- OCYF/BJJS Facility Endodontic Services
- Solicitation number
- 6100065570
About this file
Summary of Cost Submittal for OCYF/BJJS Facility Endodontic Services
This is a cost submittal spreadsheet for Pennsylvania's Department of Human Services, Office of Children, Youth and Families (OCYF) and Bureau of Juvenile Justice Services (BJJS), issued under IFB No. 6100065570. The solicitation seeks endodontic services for six facilities across Pennsylvania: Loysville Complex, Northeast Secure Treatment Unit, South Mountain Secure Treatment Unit, Youth Forestry Camp #3, North Central Secure Treatment Unit, and Southeast Youth Development Center. Contractors may submit bids for one or multiple lots but must be located within 80 miles of the relevant facility. The cost submittal form requires vendors to provide pricing for specific dental services including incisor root canals, molar root canals, composite fillings, crowns, periapical and panorex X-rays, pulp tests, exams, and miscellaneous services.
Each lot has identical estimated service quantities across all six facilities, with line items including 15 incisor root canals, 12 molar root canals, 8 one-surface composite fillings, 8 two-surface composite fillings, 10 crowns, 75 periapical X-rays, 25 panorex X-rays, 15 pulp tests, 25 exams, and 5,600 miscellaneous service units. All pricing must be all-inclusive of travel and administrative expenses. Vendors must complete and sign the cost submittal spreadsheet and submit it electronically; failure to do so will result in bid rejection. The template shows placeholder pricing of $1.00 per miscellaneous service unit resulting in a $5,600.00 subtotal per facility, but vendors are required to input actual costs in the yellow-highlighted fields.
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Instructions OCYF/BJJS Facility Endodontic Services
| The selected Contractor shall complete and sign the Cost Submittal Spreadsheet. |
| Instructions: |
| This solicitation is divided into six (6) lots for each DHS Bureau of Juvenile Justice Services facilities. Contractors may choose to submit a signed bid for all items on one Lot, or multiple Lots. Be sure to submit a signed bid for each Lot. |
Failure to complete and submit this Cost Submittal Spreadsheet with your bid submission will result in the rejection of the contractor’s bid. Please indicate the locations (Lots) that you are submitting a bid for by marking an X to the left of your Lot selection.
(For Example: _X_Lot 1 LYDC)
____Lot 1 Loysville Complex ("LYDC") 8 Opportunity Drive Loysville, PA 17047
____Lot 2 Northeast Secure Treatment Unit (“NESTU”) 701 Sathers Drive Pittston, PA 18640
____Lot 3 South Mountain Secure Treatment Unit ("SMSTU") 10056 South Mountain Road South Mountain, PA. 17261
____Lot 4 Youth Forestry Camp #3 (“YDC#3”) 4534 Tar Kiln Road James Creek, PA 16657
____Lot 5 North Central Secure Treatment Unit (NCSTU) ` 36 Kirkbride Drive Danville, PA 17821
____Lot 6 Southeast Youth Development Center (SYDC) 1212 Mokychic Drive Schwenksville, PA 19473
| *Supplier will only need to input responses in the yellow highlighted areas. Other fields will populate. |
| **All rates must be inclusive of all travel and administrative expenses. |
| *** The completed Cost Submittal Sheet attached to the vendor's submission is considered final. |
| ****All submissions must be submitted electronically. |
Facility cost submittal
| Bureau of Procurement and Contract Management |
| Date: |
IFB No. 6100065570
| Project Title: | OCYF/BJJS Facility Endodontic Services | |
| VENDOR CONTACT INFORMATION | ||
| First Name: | Last Name: |
Street Address:
City:
State: Zip Code:
Phone Number: E-mail Address:
Vendor Name
Vendor Number Contract Number
| Lot No. | Description | Estimated Quantity | Unit of Measure | Cost | Total |
| 1 | Loysville Complex (LYDC) | 1 | EA | $0.00 | |
| 2 | Northeast Secure Treatment Unit (NESTU) | 1 | EA | $0.00 | |
| 3 | South Mountain Secure Treatment Unit (SMSTU) | 1 | EA | $0.00 | |
| 4 | Youth Forestry Camp #3 (YDC #3) | 1 | EA | $0.00 | |
| 5 | North Central Secure Treatment Unit (NCSTU) | 1 | EA | $0.00 | |
| 6 | Southeast Youth Development Center (SYDC) | 1 | EA | $0.00 | |
| Total Cost | $0.00 | ||||
| *Vendor should fill in the yellow highlighted areas above. | |||||
| **All costs should be all inclusive. All inclusive means all costs associated with providing the service or material, as defined in the Statement of Work. | |||||
| ***All submissions must be submitted electronically via email. |
Signature of Vendor:
Lot 1 Lot: 1
Facility: Loysville Complex (LYDC)
Facility Address: 8 Opportunity Drive, Loysville, PA 17047
| Description | Estimated Quantity | Unit of Measure | Cost | Total |
| Incisor Root Canal | 15 | EA | $0.00 | |
| Molar Root Canal | 12 | EA | $0.00 | |
| Permanent Composite Filling 1 Surf. | 8 | EA | $0.00 | |
| Permanent Composite Filling 2 Surf. | 8 | EA | $0.00 | |
| Crowns | 10 | EA | $0.00 | |
| Periapical X-Ray | 75 | EA | $0.00 | |
| Panorex X-Ray | 25 | EA | $0.00 | |
| Pulp Test | 15 | EA | $0.00 | |
| Exam | 25 | EA | $0.00 | |
| Miscellaneous Services | 5,600 | EA | $1.00 | $5,600.00 |
| Total Cost | $5,600.00 |
| *Vendor should fill in the yellow highlighted areas above. |
| **All costs should be all inclusive. All inclusive means all costs associated with providing the service or material, as defined in the Statement of Work. |
| ***All submissions must be submitted electronically via email. |
Signature of Vendor:
Lot 2 Lot: 2
Facility: Northeast Secure Treatment Unit (NESTU)
Facility Address: 701 Sathers Drive, Pittston, PA 18640
| Description | Estimated Quantity | Unit of Measure | Cost | Total |
| Incisor Root Canal | 15 | EA | $0.00 | |
| Molar Root Canal | 12 | EA | $0.00 | |
| Permanent Composite Filling 1 Surf. | 8 | EA | $0.00 | |
| Permanent Composite Filling 2 Surf. | 8 | EA | $0.00 | |
| Crowns | 10 | EA | $0.00 | |
| Periapical X-Ray | 75 | EA | $0.00 | |
| Panorex X-Ray | 25 | EA | $0.00 | |
| Pulp Test | 15 | EA | $0.00 | |
| Exam | 25 | EA | $0.00 | |
| Miscellaneous Services | 5,600 | EA | $1.00 | $5,600.00 |
| Total Cost | $5,600.00 |
| *Vendor should fill in the yellow highlighted areas above. |
| **All costs should be all inclusive. All inclusive means all costs associated with providing the service or material, as defined in the Statement of Work. |
| ***All submissions must be submitted electronically via email. |
Signature of Vendor:
Lot 3 Lot: 3
Facility: South Mountain Secure Treatment Unit (SMSTU)
Facility Address: 10056 South Mountain Road, South Mountain, PA 17621
| Description | Estimated Quantity | Unit of Measure | Cost | Total |
| Incisor Root Canal | 15 | EA | $0.00 | |
| Molar Root Canal | 12 | EA | $0.00 | |
| Permanent Composite Filling 1 Surf. | 8 | EA | $0.00 | |
| Permanent Composite Filling 2 Surf. | 8 | EA | $0.00 | |
| Crowns | 10 | EA | $0.00 | |
| Periapical X-Ray | 75 | EA | $0.00 | |
| Panorex X-Ray | 25 | EA | $0.00 | |
| Pulp Test | 15 | EA | $0.00 | |
| Exam | 25 | EA | $0.00 | |
| Miscellaneous Services | 5,600 | EA | $1.00 | $5,600.00 |
| Total Cost | $5,600.00 |
| *Vendor should fill in the yellow highlighted areas above. |
| **All costs should be all inclusive. All inclusive means all costs associated with providing the service or material, as defined in the Statement of Work. |
| ***All submissions must be submitted electronically via email. |
Signature of Vendor:
Lot 4 Lot: 4
Facility: Youth Forestry Camp #3 (YDC#3)
Facility Address: 4534 Tar Kiln Road, James Creek, PA 16657
| Description | Estimated Quantity | Unit of Measure | Cost | Total |
| Incisor Root Canal | 15 | EA | $0.00 | |
| Molar Root Canal | 12 | EA | $0.00 | |
| Permanent Composite Filling 1 Surf. | 8 | EA | $0.00 | |
| Permanent Composite Filling 2 Surf. | 8 | EA | $0.00 | |
| Crowns | 10 | EA | $0.00 | |
| Periapical X-Ray | 75 | EA | $0.00 | |
| Panorex X-Ray | 25 | EA | $0.00 | |
| Pulp Test | 15 | EA | $0.00 | |
| Exam | 25 | EA | $0.00 | |
| Miscellaneous Services | 5,600 | EA | $1.00 | $5,600.00 |
| Total Cost | $5,600.00 |
| *Vendor should fill in the yellow highlighted areas above. |
| **All costs should be all inclusive. All inclusive means all costs associated with providing the service or material, as defined in the Statement of Work. |
| ***All submissions must be submitted electronically via email. |
Signature of Vendor:
Lot 5 Lot: 5
Facility: North Central Secure Treatment Unit (NCSTU)
Facility Address: 36 Kirkbride Drive, Danville, PA 17821
| Description | Estimated Quantity | Unit of Measure | Cost | Total |
| Incisor Root Canal | 15 | EA | $0.00 | |
| Molar Root Canal | 12 | EA | $0.00 | |
| Permanent Composite Filling 1 Surf. | 8 | EA | $0.00 | |
| Permanent Composite Filling 2 Surf. | 8 | EA | $0.00 | |
| Crowns | 10 | EA | $0.00 | |
| Periapical X-Ray | 75 | EA | $0.00 | |
| Panorex X-Ray | 25 | EA | $0.00 | |
| Pulp Test | 15 | EA | $0.00 | |
| Exam | 25 | EA | $0.00 | |
| Miscellaneous Services | 5,600 | EA | $1.00 | $5,600.00 |
| Total Cost | $5,600.00 |
| *Vendor should fill in the yellow highlighted areas above. |
| **All costs should be all inclusive. All inclusive means all costs associated with providing the service or material, as defined in the Statement of Work. |
| ***All submissions must be submitted electronically via email. |
Signature of Vendor:
Lot 6 Lot: 6
Facility: Southeast Youth Development Center (SYDC)
Facility Address: 1212 Mokychic Drive, Schwenksville, PA 19473
| Description | Estimated Quantity | Unit of Measure | Cost | Total |
| Incisor Root Canal | 15 | EA | $0.00 | |
| Molar Root Canal | 12 | EA | $0.00 | |
| Permanent Composite Filling 1 Surf. | 8 | EA | $0.00 | |
| Permanent Composite Filling 2 Surf. | 8 | EA | $0.00 | |
| Crowns | 10 | EA | $0.00 | |
| Periapical X-Ray | 75 | EA | $0.00 | |
| Panorex X-Ray | 25 | EA | $0.00 | |
| Pulp Test | 15 | EA | $0.00 | |
| Exam | 25 | EA | $0.00 | |
| Miscellaneous Services | 5,600 | EA | $1.00 | $5,600.00 |
| Total Cost | $5,600.00 |
| *Vendor should fill in the yellow highlighted areas above. |
| **All costs should be all inclusive. All inclusive means all costs associated with providing the service or material, as defined in the Statement of Work. |
| ***All submissions must be submitted electronically via email. |
Signature of Vendor:
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