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Attachment 3 Contractor Submittal Form
Please complete the following:
| 3 |
| Unique Entity ID (UEI) Number |
| 5 |
| NAICS Code (Must match page 1 of the RFQ/solicitation and offeror must be registered in SAM under this NAICS in order to be considered responsive) |
| 6 |
| Point(s) of Contact (for decisions made in respect to the offer and who is authorized to negotiate on behalf of the company) (Name, phone number and email) |
| 7 |
| Payment Terms (Net 30 unless any discount terms are offered) |
| 8 |
| Reps & Certs Are /Are not current at SAM.gov If not current, please update and submit on this document. |
| 9 |
| Identify, if applicable, any amendments the proposal includes. |
Base Year Pricing
| CLIN |
| Service |
| Qty |
| Unit |
| $ per Unit |
| Total |
| 0001 |
| Annual Maintenance IAW PWS para 1.1.2 |
| 1 |
| Job |
| 0002 |
| Routine Call out IAW PWS para 1.2.1.1 |
| 5 |
| Job |
| 0003 |
| Emergency Call Out IAW PWS para 1.2.1.2. |
| 3 |
| Job |
| 0004 |
| Material NTE - IAW PWS para 1.2.1.3 |
| 1 |
| Job |
| $10,000.00 |
| $10,000.00 |
30 Sep 2024 – 29 Sept 2025
Total Base Year Cost
Option Year 1 Pricing
| CLIN |
| Service |
| Qty |
| Unit |
| $ per Unit |
| Total |
| 1001 |
| Annual Maintenance IAW PWS para 1.1.2 |
| 1 |
| Job |
| 1002 |
| Routine Call out IAW PWS para 1.2.1.1 |
| 5 |
| Job |
| 1003 |
| Emergency Call Out IAW PWS para 1.2.1.2. |
| 3 |
| Job |
| 1004 |
| Material NTE - IAW PWS para 1.2.1.3 |
| 1 |
| Job |
| $2,500.00 |
| $2,500.00 |
30 Sep 2025 – 29 Sept 2026
Total Option Year 1 Cost
Option Year 2 Pricing
| CLIN |
| Service |
| Qty |
| Unit |
| $ per Unit |
| Total |
| 2001 |
| Annual Maintenance IAW PWS para 1.1.2 |
| 1 |
| Job |
| 2002 |
| Routine Call out IAW PWS para 1.2.1.1 |
| 5 |
| Job |
| 2003 |
| Emergency Call Out IAW PWS para 1.2.1.2. |
| 3 |
| Job |
| 2004 |
| Material NTE - IAW PWS para 1.2.1.3 |
| 1 |
| Job |
| $2,500.00 |
| $2,500.00 |
30 Sep 2026 – 29 Sept 2027
Total Option Year 2 Cost
Option Year 3 Pricing
| CLIN |
| Service |
| Qty |
| Unit |
| $ per Unit |
| Total |
| 3001 |
| Annual Maintenance IAW PWS para 1.1.2 |
| 1 |
| Job |
| 3002 |
| Routine Call out IAW PWS para 1.2.1.1 |
| 5 |
| Job |
| 3003 |
| Emergency Call Out IAW PWS para 1.2.1.2. |
| 3 |
| Job |
| 3004 |
| Material NTE - IAW PWS para 1.2.1.3 |
| 1 |
| Job |
| $2,626.00 |
| $2,626.00 |
30 Sep 2027 – 29 Sept 2028
Total Option Year 3 Cost
Option Year 4 Pricing
| CLIN |
| Service |
| Qty |
| Unit |
| $ per Unit |
| Total |
| 4001 |
| Annual Maintenance IAW PWS para 1.1.2 |
| 1 |
| Job |
| 4002 |
| Routine Call out IAW PWS para 1.2.1.1 |
| 5 |
| Job |
| 4003 |
| Emergency Call Out IAW PWS para 1.2.1.2. |
| 3 |
| Job |
| 4004 |
| Material NTE - IAW PWS para 1.2.1.3 |
| 1 |
| Job |
| 2692.00 |
| $2,692.00 |
| 4005 |
| 5 Year Maintenance IAW PWS para 1.1.3 |
| 1 |
| Job |
30 Sep 2028 – 29 Sept 2029
Total Option Year 4 Cost
For the purpose of calulating the Total Evaluated Price, the prices below shall be the same as Option Year 4 prices.
Extension Pricing
| CLIN |
| Service |
| Qty |
| Unit |
| $ per Unit |
| Total |
| 5001 |
| Annual Maintenance IAW PWS para 1.1.2 |
| 1 |
| Job |
| 5002 |
| Routine Call out IAW PWS para 1.2.1.1 |
| 3 |
| Job |
| 5003 |
| Emergency Call Out IAW PWS para 1.2.1.2. |
| 2 |
| Job |
| 5004 |
| Material NTE - IAW PWS para 1.2.1.3 |
| 1 |
| Job |
| $2,757.00 |
| $2,757.00 |
| 30 Sep 2029 - 29 March 2030 |
| Total extension price |
Total Evaluatated price will be calculated by using the total of each period above. Please complete the following.
Total Base Year: ___________________ Total Option Year 1: ___________________ Total Option Year 2: ___________________ Total Option Year 3: ___________________ Total Option Year 4: ___________________ Total 6 month extension: ___________________ Total Evaluated Price: (Sum of the 6 items above)___________________________