Attachment 1 - Program Cover Page.docx
DOCX document 18 KB Posted
- Attached to
- 24PMOPRTCLNCLSFTYRSKSTE - RFR for Clinical and Safety Risk Assessment Sites, Staffing, and Related
- Solicitation number
- BD-24-1039-EHS01-ASHWA-96819
- Issued by
- Norfolk County, Massachusetts
About this file
This document appears to be a Program Cover Page for a Purchase of Service contract with the Massachusetts government. The program is seeking to procure services related to operating and staffing one or more Clinical and Safety Risk Assessment sites. The contract duration is from [start date] to [end date] with [x] options to renew for [x] years each.
The pricing structure is either a Price Agreement, Summary Budget, or Complete Budget, with unit rates specified. The total anticipated contract value is $[x] over the initial contract term and any renewal periods. Funding will be provided by the state, with prior, current, and future year allocations detailed.
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Text version
FY: Amendment #, if Applicable: If Federal Funds, CFDA #:
PURCHASE OF SERVICE - ATTACHMENT 1: PROGRAM COVER PAGE
PROGRAM INFORMATION
Contractor Name:
Department Name:
Program Type:
Document ID #:
Program Name:
UFR Program #:
Program Address:
MMARS Activity Code:
City/State/Zip:
Other Reference Information (Information Purposes Only):
Contact Person:
Telephone:
Contact Person:
Telephone:
| RFR INFORMATION: | Attached | RFR Reference # __________ |
| legislative exemption | emergency collective purchase interim amendment |
SCOPE OF SERVICES: Bidder's Response Attached Description of Services Attached
TOTAL ANTICIPATED CONTRACT DURATION: __________________________ to ________________________
INITIAL DURATION: _________________________ to ______________________________
OPTIONS TO RENEW: ____________options to renew for ______ years each option
FISCAL TERMS
FUNDING SUMMARY
| Prior Years |
| Current Year |
| Future Years |
| FY |
| Amount |
| FY |
| Amount |
| FY |
| Amount |
PRICE IS ESTABLISHED THROUGH: (CHECK 1, 2, OR 3)
OPTION 1: PRICE AGREEMENT (list price)
| $____________________________________ |
| rate regulation (if any)___________________ |
OPTION 2: SUMMARY BUDGET ("T" lines only)
| unit rate |
| cost reimbursement |
| other _____________________________ |
OPTION 3: COMPLETE BUDGET
cost reimbursement
| unit rate | |
| Total: $ | |
| Total: $ | |
| Total: $ |
| other ______________________________ | |
| Multi-Year Total: | |
| $ |
CURRENT
MAX OBLIGATION: $________________ UNIT RATE: $__________per __________ # BILLABLE UNITS: ____________
ADDITIONAL PAYMENT OR PRICE SPECIFICATIONS:
Updated 11/1/05 Sensitivity level - low Sensitivity level - low
File details come from the government source that posted it. Updated .