Attachment C - Cost Proposal Form - WSH Dental Services RFP.xlsx

This is a Cost Proposal Form for dental services at Western State Hospital (WSH) and Western State Nursing Facility (WSNF). The RFP closing date is June 7, 2018, with Locum Tenens RFP identification number 729 1800000171. The contract covers dental services and dental hygienist services, including standard weekday hours, weekday on-call coverage, weekend and holiday on-call coverage, and overtime services. The proposal form also includes estimated annual costs for Central State Hospital dental services. Contract Specialist Nina Anglin is overseeing this procurement.

The Cost Proposal Form requests vendors to provide hourly rates for eight service categories: WSH/WSNF Dental Services (16,640 estimated hours per year), Weekday On-Call (200 hours), Weekend/Holiday On-Call (400 hours), and Overtime (400 hours), with corresponding categories for Dental Hygienist Services with identical hour estimates. Vendors must complete the form by entering proposed hourly rates for each category, which will be multiplied by the estimated annual hours to calculate the estimated annual cost for each line item and determine the total estimated annual cost of award. The form does not specify pricing constraints, set-asides, contract term length, or renewal options.