Attachment 3 - Pricing Chart.xlsx

XLSX spreadsheet 128 KB Posted

Attached to
DOS- INL Haiti SMEs Federal contract opportunity
Solicitation number
19AQMM25R0201
Issued by
Department of State Office of Acquisition Management

About this file

This file is a detailed pricing chart (Attachment 3) for Request for Proposal (RFP) No. 19AQMM25R0201 for the Department of State's INL Haiti SMEs contract. The solicitation involves providing subject matter expert (SME) advisors, logistics support for Haiti National Police (HNP) School and Academy Facilities, and special projects. The pricing structure includes six Contract Line Item Numbers (CLINs) covering fully burdened labor, inventory management, program management, other direct costs, DBA insurance, and a surge labor/urgent requirements CLIN with a $500,000 not-to-exceed cap.

The pricing template is designed for a hybrid contract type (Firm Fixed Price and Cost Reimbursement) with a base period and four option periods. It requires offerors to detail labor costs by personnel category (key and non-key personnel), indirect rates, and various other direct costs including housing, vehicles, travel, medical tests, and phase-in/phase-out expenses. The solicitation allows for comprehensive cost breakdowns across multiple performance periods, with specific instructions for offerors to complete detailed pricing tables for each CLIN and performance period. The contract will support the HNP's goals through comprehensive logistical and advisory services.

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Summary

Request for Proposal (RFP) No. 19AQMM25R0201 - INL Haiti SMEs and Logistical

DescriptionTotal Price BaseTotal Price Option 1Total Price Option 2Total Price Option 3Total Price Option 4Total PriceDetailsIndirect Rates
FULLY BURDEN LABOR (FFP)
CLIN 0001ERROR:#REF!Solicitation Number:19AQMM25R0201Fringe0.00%Enter your % rates here, it will carry over into associated tabs
CLIN 1001ERROR:#REF!Project Title:INL HaitiOverhead0.00%
CLIN 2001ERROR:#REF!Contract Type:HYBRID -FFP AND CRG&A0.00%
CLIN 3001ERROR:#REF!Period:BASE+ 4 OPTION PeriodFee0.00%
CLIN 4001ERROR:#REF!ERROR:#REF!Period of Performance:TBDEscalation0.00%
DBA - US0.00%
INVENTORY MANAGEMENT & OPERATIONS - GOVERNMENT PROPERTY (FFP)DBA - OCN0.00%
CLIN 0002ERROR:#REF!DBA - Sub0.00%
CLIN 1002ERROR:#REF!
CLIN 2002ERROR:#REF!
CLIN 3002ERROR:#REF!
CLIN 4002ERROR:#REF!ERROR:#REF!
PROGRAM MANAGEMENT & COORDINATION OF OPERATIONS (FFP)
CLIN 0003ERROR:#REF!
CLIN 1003ERROR:#REF!
CLIN 2003ERROR:#REF!
CLIN 3003ERROR:#REF!
CLIN 4003ERROR:#REF!ERROR:#REF!
OTHER DIRECT COSTS - ODCs (CR)
CLIN 0004ERROR:#REF!
CLIN 1004ERROR:#REF!
CLIN 2004ERROR:#REF!
CLIN 3004ERROR:#REF!
CLIN 4004ERROR:#REF!ERROR:#REF!
DBA INSURANCE, POST HARSHIP, DIFFERENTIAL PAY AND DANGER PAY (CR)
CLIN 0005ERROR:#REF!
CLIN 1005ERROR:#REF!
CLIN 2005ERROR:#REF!
CLIN 3005ERROR:#REF!
CLIN 4005ERROR:#REF!ERROR:#REF!
SURGE IN LABOR AND/OTHER ADDITIONAL (URGENT) REQUIREMENTS (HYBRID CLIN - FFP AND/OR CR)
The USG will cap this CLIN with a not-to-exceed amoung of $500,000.00. Services need to be pre-approved by the COR or CO.
CLIN 0006$ 500,000.00
CLIN 1006$ 500,000.00
CLIN 2006$ 500,000.00
CLIN 3006$ 500,000.00
CLIN 4006$ 500,000.00$ 2,500,000.00
Grand Total$ - 0
NOTE: OFFERORS MUST UPDATE FORMULAS AND CALCULATIONS. THE CELL MUST BE UNLOCKED FOR USG COST REVIEWS

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CLIN 001

Labor Details (Base Period, OY1, OY2, OY3, OY4). Each period of performance to be priced separately.

CLIN Series 001 - Base PeriodTotal Labor Base Period$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLIN# of Staff RequiredFTEsStandard Hours (Per year)Direct Unit Labor Rate, $Fringe
Rate, $OH
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

CATEGORY I - BASE YEARKEY PERSONNEL LIST
Program Manager (Example) , Offeror will complete as required in the SOW)Key PersonnelSOW X.XUS (example)SECRET (example)0001XX0.00%0.00%0.00%0.00%
SME-HNP Training and Professional Development CoordinatorKey Personnel0001XX0.00%0.00%0.00%0.00%
SME-HNP Public Information/Communications AdvisorKey Personnel0001XX0.00%0.00%0.00%0.00%
Position TitleKey Personnel0001XX0.00%0.00%0.00%0.00%
Note: Offeror will add all positions as required in the SOW)Key Personnel0001XX0.00%0.00%0.00%0.00%
0001XX0.00%0.00%0.00%0.00%
CATEGOTY II -BASE YEARNON-KEY PERSONNEL0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
Position Title0001XX0.00%0.00%0.00%0.00%
0001XX0.00%0.00%0.00%0.00%
0001XX0.00%0.00%0.00%0.00%
0001XX0.00%0.00%0.00%0.00%
TOTAL00013,1200.00%0.00%0.00%0.00%
Option Period One (1)Total Labor Option Period One (1)$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLIN# of Staff RequiredFTEsStandard HoursDirect Unit Labor Rate, $Fringe
Rate, $OVHD
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

CATEGORY I - OPTION YEAR 1KEY PERSONNEL LIST
Program Manager (example)Key PersonnelSOW Section X1001xxx
1001xxx
1001xxx
1001xxx
CATEGOTY II -OPTION YEAR 1NON-KEY PERSONNEL1001xxx0.00%0.00%0.00%0.00%
Positin title1001xxx
1001xxx
Option Period Two (2)Total Labor Option Period Two (2)$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLIN# of Staff RequiredFTEsStandard HoursDirect Unit Labor Rate, $Fringe
Rate, $OVHD
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

CATEGORY I - OPTION YEAR 2KEY PERSONNEL LIST2001
Program Manager (example)Key PersonnelSOW Section X2001xxx
2001XX
2001XX
2001XX
CATEGOTY II -OPTION YEAR 2NON-KEY PERSONNEL2001xxx0.00%0.00%0.00%0.00%
Position title2001XX
2001XX
2001XX
Option Period Three (3)Total Labor Option Period Three (3)$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLIN# of Staff RequiredFTEsStandard HoursDirect Unit Labor Rate, $Fringe
Rate, $OVHD
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

CATEGORY I - OPTION YEAR 3KEY PERSONNEL LIST3001
Program Manager (example)Key PersonnelSOW Section X2001xxx
3001xx
3001xx
3001xx
CATEGOTY II -OPTION YEAR 3NON-KEY PERSONNEL3001xxx0.00%0.00%0.00%0.00%
Position title3001xx
3001xx
3001xx
Option Period Four (4)Total Labor Option Period Four (4)$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLIN# of Staff RequiredFTEsStandard HoursDirect Unit Labor Rate, $Fringe
Rate, $OVHD
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

CATEGORY I - OPTION YEAR 4KEY PERSONNEL LIST4001
Program Manager (example)Key PersonnelSOW Section X4001xxx
4001xxx
4001xxx
4001xxx
CATEGOTY II -OPTION YEAR 4NON-KEY PERSONNEL4001xxx0.00%0.00%0.00%0.00%
Position title4001xxx
4001xxx
4001xxx
TOTAL OPTION YEAR 4

GRAND TOTAL BASE PLUS OPTION YEARS

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CLIN 002

Inventory management & operations of Government Own Property (GOP)
CLIN series 002 - Base Period$0.00
CLIN seriesPWS Para/Sub-Para DescriptionSOW Para #Description of MaterialPrime/
Sub*Unit CostQuantitySubtotalG&A, $Total Cost
(Rounded - 2 Decimal Places)Vendor/Source (if known)Supporting documentation has been provided (Y/N)Reference Document Number
0002Example: Inventory software procurment, installation and maintenace to include bar coding and serialization trackingSOW Section xxxSoftware$0.00$0.00
0002Offeror list here all the equipment for this task to include computers, printers, etc. Add new lines as neededSOW Section xxxOffice Equipment
0002Offeror propose materials/supplies packs or lots but need to list (description of lots or packages of supplies needs to be provided in a new tab)SOW Section xxxOffice Supplies
0002Armored vehicle Disposal and handover - cost per unit for both, armored vs non-armoredSOW Section xxxxx
0002Offeror include new vehicles to be procured for award (provide details of the vehicles)SOW Section xxxxx
0002Offeror includes leases or rental of vehicles for award as it may applySOW Section xxxxx
0002NOTE: Offeror will include any additional costs as it may apply to this CLIN per attached SOW
TOTAL ESTIMATED COSTS
NOTE:Offeror must include similar tables for all option years (option 1 - option 4)

CLIN 003

Program Management and coordination of operations
CLIN series 003 - Base Period$0.00
CLIN series 003 - Base PeriodSOW Para/Sub-Para DescriptionSOW Para #Description of MaterialPrime/
Sub*Unit CostQuantitySubtotalG&A, $Total Cost
(Rounded - 2 Decimal Places)Vendor/Source (if known)Supporting documentation has been provided (Y/N)Reference Document Number
0003Physical office set-up to include utilities, fees, lease, etc. Offoror will list in the TAB materials (items by item needed)SOW Section xxxoffice space$0.00$0.00
0003PMO office equiment to include cell phones, computers, printers, and others as needed. Offeror includes details in the Material Tab.SOW Section xxxOffice equipment
0003Medical package per recruiter. Offeror includes details in the Medical Test TabSOW Section xxx
0003Offeror add other costs as needed for this CLINSOW Section xxx
0003SOW Section xxxxx
0003SOW Section xxxxx
0003SOW Section xxxxx
TOTAL FOR BASE YEAR
NOTE:Offeror must include similar tables for all option years (option 1 - option 4)

CLIN 004

Other Direct Costs (ODCs) Each period of performance to be priced separately.

* include breakout of pricing for subcontractors
Base PeriodTotal ODCs Base Period$0.00
CLINPWS ReferenceSOW Sub Category ReferenceSub Category ReferencePrime/
Sub*Resource DescriptionUnit CostUnit of Measurement (UOM)QuantityExtended CostG&A, $SubtotalsFee, $Total Cost

(Rounded - 2 Decimal Places)

004Housing, Offeror must provide costs details under the Housing Tab.SOW Section XxxxxxxMo12$0.00$0.00$0.00
004Cadets uniforms/supplies/equipment. Offeror must provide details of this under the Material Tab.SOW Section Xxx
004Armored vehicle (per unit costs) routine maintenance. Offeror provides details of costs under the Vehicles TabSOW Section Xxx
004Phase-in cost. Offeror must provide details under the Tab IN-OUTSOW Section Xxx
004Phase-out costs. Offeror must provide details under the Tab IN-OUTSOW Section Xxx
004Travel. Offeror must provide details under the Tab Travelxx
005Visa fees, and other fees. Offeror must provide details under the Tab Travel
004Offeror adds costs as needed for this CLINxx
004xx
004xx
004xx

NOTE: Offeror must include similar tables for all option years (option 1 - option 4)

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CLIN 005

DBA Insurance, post hardship, differential/danger pays
* include breakout of pricing for subcontractors
Base Period$0.00
CLINPWS ReferenceSOW Sub Category ReferenceSub Category ReferencePrime/
Sub*Resource DescriptionUnit CostUnit of Measurement (UOM)QuantityExtended CostG&A, $SubtotalsFee, $Total Cost

(Rounded - 2 Decimal Places)

005Defense Base Act (DBA) InsuranceSOW Section XxxxxxxMo12$0.00$0.00$0.00
005post hardshipSOW Section Xxxxxxx
005xx
005Offeror adds costs as neededxx
005Note: Offeror must provide cost details for all lines under the Others ODCs Tab.xx
005xx
005xx
005xx
005xx
Total Base Yearxx
NOTE:Offeror must include similar tables for all option years (option 1 - option 4)

CLIN 006

Surge Labor and Urgent (undefined) Service Requirements
Surge Labor shall be priced per hour. Offeror should estimate a surge hours that may be required over the standard work week (48 hrs).
For Urgent additional services, the USG will negotiate and approved through a modification.
The offeror must estimate surge labor hrs in the next tableTotal Labor Transition$ - 0
Position TitlePWS DescriptionSOW Ref.NationalityClearanceCLINEstimated Surge HoursDirect Unit Labor Rate, $Fringe
Rate, $OH
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

Program Manager (example)Key PersonnelXXX0006
Deputy Program Manager (Example)Non key personnelXXX0006
Position Titlexxx0006
0006
Offeror will add positions as needed0006
0006
0006
Option Period One (1)Total Labor Base Period$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLINEstimated Surge HoursDirect Unit Labor Rate, $Fringe
Rate, $OVHD
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

Program Manager (example)Key PersonnelXXX0006
Deputy Program Manager (Example)Non key personnelXXX0006
Position Titlexxx0006
0006
Offeror will add positions as needed0006
0006
0006
Option Period Two (2)Total Labor Option Period One (1)$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLINEstimated Surge HoursDirect Unit Labor Rate, $Fringe
Rate, $OVHD
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

Program Manager (example)Key PersonnelXXX0006
Deputy Program Manager (Example)Non key personnelXXX0006
Position Titlexxx0006
0006
Offeror will add positions as needed0006
0006
0006
Option Period Three (3)Total Labor Option Period Two (2)$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLINEstimated Surge HoursDirect Unit Labor Rate, $Fringe
Rate, $OVHD
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

Program Manager (example)Key PersonnelXXX0006
Deputy Program Manager (Example)Non key personnelXXX0006
Position Titlexxx0006
0006
Offeror will add positions as needed0006
0006
Option Period Four (4)Total Labor Option Period Three (3)$ - 0
Position TitlePWS DescriptionPWS Ref.NationalityClearanceCLINEstimated Surge HoursDirect Unit Labor Rate, $Fringe
Rate, $OVHD
Rate, $G&A
Rate, $Fee, $Fully Burden Standard Labor, $

(Rounded - 2 Decimal Places)

Program Manager (example)Key PersonnelXXX0006
Deputy Program Manager (Example)Non key personnelXXX0006
Position Titlexxx0006
0006
Offeror will add positions as needed0006
0006

&A

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Material Materials Each period of performance to be priced separately.

* include breakout of pricing for subcontractors

Base Period$0.00
CLINPWS Para/Sub-Para DescriptionSOW Para #Description of MaterialPrime/
Sub*Unit CostQuantitySubtotalG&A, $Total Cost
(Rounded - 2 Decimal Places)Vendor/Source (if known)Supporting documentation has been provided (Y/N)Reference Document Number
00xMaterialsXXXX$0.00$0.00
00xXXXX
00xOfferor will list as neededxxXX
00xxxxx
00xxx
00xxx
00xxx
00x
00x

NOTE: Offeror must include similar tables for all option years (option 1 - option 4)

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Vehicles Vehicles

Base Period$0.00
CLINDesctription of Food ProcurementPrime/
Sub*Unit CostTotal UnitsSubtotalG&A, $Total Cost

(Rounded - 2 Decimal Places)

xExample: Rental of vehicle$ - 0$ - 0$ - 0$ - 0
xExample: Procurement of vehicle$ - 0$ - 0$ - 0$ - 0
x$ - 0$ - 0$ - 0$ - 0
x$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
$ - 0$ - 0$ - 0$ - 0
NOTE:Offeror must include similar tables for all option years (option 1 - option 4)

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Sheet8

Housing Housing - Cost Reimbursement x = add cost description Each period of performance to be priced separately.

Base Period$0.00
CLINDesctription of Food ProcurementPrime/
Sub*Unit CostTotal UnitsSubtotalG&A, $Total Cost

(Rounded - 2 Decimal Places)

0004Housing for Position Title$ - 0$ - 0$ - 0$ - 0
0004Housing for Position Title$ - 0$ - 0$ - 0$ - 0
0004Housing for Position Title$ - 0$ - 0$ - 0$ - 0
0004Housing for Position Title$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
0004x$ - 0$ - 0$ - 0$ - 0
NOTE:Offeror must include similar tables for all option years (option 1 - option 4)

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Travel Travel x = add cost description Each period of performance to be priced separately.

* include breakout of pricing for subcontractors

Base PeriodTotal Travel Base Period$0.00
CLINDescription Of TravelPrime/
Sub*Unit CostUnits
# of Trips# of PersonnelTotal UnitsSubtotalG&A, $Total Cost

(Rounded - 2 Decimal Places)

U.S Personnel
Airfare$ - 0$ - 0$ - 0$ - 0
Visa$ - 0$ - 0
Ground Transportation$ - 0$ - 0
Work Permits$ - 0$ - 0
Per Diem$ - 0$ - 0
Lodging$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
OCN/TCN Personnel
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
Option Period One (1)Total Travel Option Period One (1)$0.00
CLINDescription Of TravelPrime/
Sub*Unit CostUnits
# of Trips# of PersonnelTotal UnitsSubtotalG&A, $Total Cost

(Rounded - 2 Decimal Places)

U.S Personnel
Airfare$ - 0$ - 0$ - 0$ - 0
Visa$ - 0$ - 0
Ground Transportation$ - 0$ - 0
Work Permits$ - 0$ - 0
Per Diem$ - 0$ - 0
Lodging$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
OCN/TCN Personnel
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
Option Period Two (2)Total Travel Option Period Two (2)$0.00
CLINDescription Of TravelPrime/
Sub*Unit CostUnits
# of Trips# of PersonnelTotal UnitsSubtotalG&A, $Total Cost

(Rounded - 2 Decimal Places)

U.S Personnel
Airfare$ - 0$ - 0$ - 0$ - 0
Visa$ - 0$ - 0
Ground Transportation$ - 0$ - 0
Work Permits$ - 0$ - 0
Per Diem$ - 0$ - 0
Lodging$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
OCN/TCN Personnel
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
Option Period Three (3)Total Travel Option Period Three (3)$0.00
CLINDescription Of TravelPrime/
Sub*Unit CostUnits
# of Trips# of PersonnelTotal UnitsSubtotalG&A, $Total Cost

(Rounded - 2 Decimal Places)

U.S Personnel
Airfare$ - 0$ - 0$ - 0$ - 0
Visa$ - 0$ - 0
Ground Transportation$ - 0$ - 0
Work Permits$ - 0$ - 0
Per Diem$ - 0$ - 0
Lodging$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
OCN/TCN Personnel
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
Option Period four (4)Total Travel Option Period Four (4)$0.00
CLINDescription Of TravelPrime/
Sub*Unit CostUnits
# of Trips# of PersonnelTotal UnitsSubtotalG&A, $Total Cost

(Rounded - 2 Decimal Places)

U.S Personnel
Airfare$ - 0$ - 0$ - 0$ - 0
Visa$ - 0$ - 0
Ground Transportation$ - 0$ - 0
Work Permits$ - 0$ - 0
Per Diem$ - 0$ - 0
Lodging$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
OCN/TCN Personnel
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0
x$ - 0$ - 0

&A

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Medical tests

Medical Screening of Recruits
Base Period (Package details for all medical examination) per recruiter/px$0.00
CLINDesctription of servicesPrime/
Sub*Unit CostTotal UnitsSubtotalG&A, $Total Cost

(Rounded - 2 Decimal Places)

xxDental$ - 0$ - 0$ - 0$ - 0
xxX-rays$ - 0$ - 0$ - 0$ - 0
Psychology$ - 0$ - 0$ - 0$ - 0
blood$ - 0$ - 0$ - 0$ - 0
Syphilis$ - 0$ - 0$ - 0$ - 0
urinalysis$ - 0$ - 0$ - 0$ - 0
x$ - 0$ - 0$ - 0$ - 0
x$ - 0$ - 0$ - 0$ - 0
x$ - 0$ - 0$ - 0$ - 0
x$ - 0$ - 0$ - 0$ - 0
Total Medical Screening per px
NOTE:Offeror must include similar tables for all option years (option 1 - option 4)

IN-OUT

OFFEROR MUST PROVIDE COST DETAILS, ITEM BY ITEM FOR :

A) Phase -in: Transition in
B) Phase - out: Demobilization

Other costs

OFFEROR MUST COMPLET THIS SECTION AS INSTRUCTED AT THE CLIN LEVEL

Sheet1

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