Attachment B1_Financial Proposal Form.xlsx
XLSX spreadsheet 23 KB Posted
- Solicitation number
- BPM025056
- Issued by
- Maryland
About this file
This document is the Financial Proposal Form for a Request for Proposals (RFP) issued by the Maryland Department of Aging to provide Fiscal Intermediary Services for the Veterans Directed Care (VDC) Program. The RFP requires the Fiscal Intermediary to provide payroll processing, tax withholding services, fiscal accounting, and reporting for independent Attendant Services Providers, as well as submission of electronic claims, management of claim resubmissions or appeals, and payment processing for Vendor Goods or Services. The projected number of participants ranges from 15 to 70 over the 24-month contract period with a 1-year renewal option.
The Financial Proposal Form includes pricing for the Enrollment Fee per Participant, as well as the Contractor Price per Participant per Month for both Vendor Goods or Services and Attendant Services. The total proposal price is calculated based on the Enrollment Fee, the estimated number of enrollments, and the extended prices for both service categories over the 24-month contract period.
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Other files
| File | Type | Posted |
|---|---|---|
| PreproposalMtgSummary VDC FIS Procurement 10.15.2021.pdf | ||
| RFP_FIS for VDC.pdf | ||
| Q&A_V1.pdf |
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Text version
Part 1
ATTACHMENT B 1 - FINANCIAL PROPOSAL FORM
PART 1
(A) Enrollment Fee Per Participant [for base 2 years and 1, 1-year Renewal Option] Multiplied by (B) Estimated # of Enrollments Equals ( C ) = (A) * (B) Total Annual Participant Enrollment Fee 0 * 24 = $0.00
Total Annual Participant Enrollment Fee $0.00
Part 2
ATTACHMENT B1 - FINANCIAL PROPOSAL FORM
PART 2
# of Estimated Participants in the Month Contractor Price per Participant per Month using Vendor Goods or Services Contractor Price per Participant per Month using Attendant Services
| up to 30 | $0.00 | $0.00 |
| up to 50 | $0.00 | $0.00 |
| up to 70 | $0.00 | $0.00 |
| up to 100 | $0.00 | $0.00 |
Part 3
ATTACHMENT B1 - FINANCIAL PROPOSAL FORM
PART 3
| (A) | |
| Contract Month after Go Live date | (B) |
| # of Projected Participants:Using Vendor Goods or Services | ( C ) |
| Times Offeror’s Proposed Rate [Part 2_Price per Month: Participants using Vendor Goods or Services] | (D) |
| Offeror’s Extended Price for Vendor Goods or Services for the Month | ( E ) |
| # of Projected Participants Using Attendant Services | (F) |
| Times Offeror’s Proposed Rate [Part 2_Price per Month: Participants Using Attendant Services] | ( G ) |
| Offeror’s Extended Price for Attendant Services for the Month | ( H ) |
Total of Extended Prices for both service categories [D + G]
| 1 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 2 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 3 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 4 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 5 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 6 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 7 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 8 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 9 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 10 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 11 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 12 | 15 | $0.00 | $0.00 | 65 | $0.00 | $0.00 | $0.00 |
| 13 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 14 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 15 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 16 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 17 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 18 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 19 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 20 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 21 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 22 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 23 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| 24 | 20 | $0.00 | $0.00 | 70 | $0.00 | $0.00 | $0.00 |
| Extended Price Total | $0.00 |
Part 4 Summary Page
ATTACHMENT B1 - FINANCIAL PROPOSAL FORM
PART 4
SUMMARY PAGE
(A) Enrollment Fee Per Participant [Part 1, Line A3] Multiplied by (B) Estimated # of Enrollments [Part 1, Line C3] Plus ( C) Total of Extended Prices for both service categories [Part 3, Line H27] Equals (D) = (A) * (B) + ( C) Total Proposal Price
| $0.00 | * | 24 | + | $0.00 | = | $0.00 |
| Total Proposal Price | $0.00 |
| Submitted by: |
| Offeror |
| Offeror Name (please print or type) |
| Signature |
| Signature of Authorized Representative |
| Printed Name |
| Printed Name |
| Title |
| Title |
| Date |
| Date |
| Address |
| Company Address |
File details come from the government source that posted it. Updated .