Attachment_3_Contractor Information and Pricing Table.pdf
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- Solicitation number
- W912LP-22-Q-4512
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Attachment 3
Iowa Army National Guard Request for Quotation (RFQ) # W912LP-22-Q-4512
Medical Surveillance Exams – Camp Dodge and Boone, Iowa
Vendor shall complete the contractor information table and the pricing table and attach this attachment to their quotation.
CONTRACTOR INFORMATION TABLE
Company Name
Point of Contact (POC) Name
POC Phone
POC Email
CAGE Code
UEI Number
Tax ID Number
Prompt Payment Discount Terms (Net 30 unless otherwise noted)
Business Size/Socio-economic Group(s) (Must correspond with FAR 52.212-3 representations and certifications completed within SAM)
Period of Performance
PRICING TABLE
ITEM # DESCRIPTION QUANTITY UNIT UNIT PRICE AMOUNT
0001 Medical Exam 116 Each $ $ 0002 Vision Screening 116 Each $ $ 0003 Complete Lab Draw 75 Each $ $ 0004 Lead Lab 45 Each $ $ 0005 Chromium Lab 10 Each $ $ 0006 Manganese Lab 8 Each $ $ 0007 Cadmium Lab 75 Each $ $
TOTAL $
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