Attachment C Government Furnish Price Model (GFPM).xlsx

XLSX spreadsheet 46 KB Posted

Attached to
United States Army Reserve Command (USARC) Physical Exams
Solicitation number
W81K04-22-R-0018
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File Type Posted
Attachment C Government Furnish Price Model (GFPM)v7.xlsx XLSX spreadsheet
Attachment C Government Furnish Price Model (GFPM)v6.xlsx XLSX spreadsheet
W81K04-22-R-0018-0003 USARC MedExams Services.pdf PDF
Attachment C Government Furnish Price Model (GFPM)v5.xlsx XLSX spreadsheet
Attachment C Government Furnish Price Model (GFPM)v4.xlsx XLSX spreadsheet
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Attachment C Government Furnish Price Model (GFPM)v3.xlsx XLSX spreadsheet
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W81K04-22-R-0018-0002 USARC MedExams Services.pdf PDF
W81K04-22-R-0018-0001 USARC MedExams Services.pdf PDF
PWS Attachment 06 Respirator Medical Evaluation Questionnaire.pdf PDF
PWS Attachment 03 DD 254 Fillable 1.pdf PDF
PWS Attachment 15 Maintenance Personnel Pre-employment Physical Exam Form.pdf PDF
PWS Attachment 07 Respirator Medical Examination Questionnaire.pdf PDF
PWS Attachment 09 PFAS DOD Firefighter Fact Sheet.pdf PDF
Attachment B Performance Requirements Summary (PRS).docx DOCX document
PWS Attachment 12 Chronological Record of Medical Care Police Security Guard Termination Physical.pdf PDF
PWS Attachment 14 Maintenance Personnel Annual Physical Exam Form.pdf PDF
Attachment E Past Performance Questionnaire.docx DOCX document
PWS Attachment 17 WAMC Form 3021 Respirator Medical Evaluation Questionnaire.pdf PDF
PWS Attachment 16 Maintenance Personnel Termination Physical Exam Form.pdf PDF
PWS Attachment 13 Chronological Record Police Security Pre employment Physical.pdf PDF
PWS Attachment 19 PFAS Guide for Department of Defense Firefighters.pdf PDF
PWS Attachment 23 DD Form 2808 Report of Medical Examination.pdf PDF
PWS Attachment 21 Cardio Eval MEDCOM MEMO 5June07.pdf PDF
Attachment D Customer Reference Information Sheet.docx DOCX document
PWS Attachment 18 PFAS Occupational Medicine Providers Evaluating DoD Firefighters.pdf PDF
PWS Attachment 02 DD254 Handbook HQDA G-2.pdf PDF
Attachment A QASP.docx DOCX document
PWS Attachment 04 Firefighter Annual Exam Form.pdf PDF
PWS Attachment 05 Chronological Record Firefighter Pre employment.pdf PDF
PWS Attachment 25 MOD15 Tab-A Amplification of the Minimal Stds of Fitness for Deployment CENTCOM AOR.pdf PDF
PWS Attachment 11 Chronological Police Security Guard Annual Physical.pdf PDF
W81K04-22-R-0018 USARC MedExams Services.pdf PDF
PWS Attachment 08 Firefighter Termination Exam Form.pdf PDF
PWS Attachment 27 ACI 4200.09A Force Health Protect Req and Med Guidance for Entry into US Africa Comm Theater.pdf PDF
PWS Attachment 22 DA Form 7708 Personnel Reliability Screening and Evaluation.pdf PDF
PWS Attachment 01 Quality Assurance Surveillance Plan.pdf PDF
PWS Attachment 10 ASDR Memo Blood Testing.pdf PDF
PWS W81K04-22-R-0018 Final (17May22).docx DOCX document
PWS Attachment 26 ECI 4202.01 Health Service Support US European CC Theater Medical Entry Requirements.pdf PDF
PWS Attachment 24 DD Form 2807-1 Report of Medical History.pdf PDF
PWS Attachment 20 MEDCOM Form 829 Initial Entry Tuberculosis Risk Assessment Tool.pdf PDF
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Instructions to Offerors

INSTRUCTION TO OFFERORS
GENERAL INSTRUCTIONS
Offerors are to only complete cells highlight in yellow.
Tab "Summary"
1. Offerors are instructed not to complete this tab or make any changes to this tab.
Tab "CLIN x001 Deployment Physical
1. Offerors are to complete cells highlight in yellow.
Tab "CLIN x002 Fire Fighters
1. Offerors are to complete cells highlight in yellow.
Tab "CLIN x003 CDL Physical
1. Offerors are to complete cells highlight in yellow.
Tab "CLIN x004 Annual Physical
1. Offerors are to complete cells highlight in yellow.
Tab "CLIN x005 Police and Guards
1. Offerors are to complete cells highlight in yellow.
Tab "CLIN x006 Admin RN - Comp Plan
1. Offerors are to complete cells highlight in yellow.
Tab "CLIN x006 Admin RN Totals
1. Offerors are instructed not to complete this tab or make any changes to this tab.

Summary

CLINSOrdering Period FY229/22/22 - 9/21/23 (FY22)Ordering Period FY239/22/23 - 9/21/24 (FY23)Ordering Period FY249/22/24 - 9/21/25 (FY24)Ordering Period FY259/22/25- 9/21/26 (FY25)Ordering Period FY269/22/26- 9/21/27 (FY26)
CLIN X001 DEPLOYMENT PHYSICALTotal CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0
CLIN X002 FIRE FIGHTERSTotal CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0
CLIN X003 CDL PHYSICALTotal CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0
CLIN X004 ANNUAL PHYSICALTotal CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0
CLIN X005 POLICE AND GUARDSTotal CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0
CLIN X006 ADMIN RN TOTALSTotal CLIN Dollar Amount$ 152.96Total CLIN Dollar Amount$ 152.96Total CLIN Dollar Amount$ 152.96Total CLIN Dollar Amount$ 152.96Total CLIN Dollar Amount$ 152.96
SUBTOTALS BY ORDERING PERIOD$ 152.96$ 152.96$ 152.96$ 152.96$ 152.96
GRANDTOTAL$ 764.80
OFFERORS ARE NOT TO COMPLETE THIS TAB OR MAKE ANY CHANGES

CLIN x001 Deployment Physical

Ordering Period FY229/22/22 - 9/21/23 (FY22)Ordering Period FY239/22/23 - 9/21/24 (FY23)Ordering Period FY249/22/24 - 9/21/25 (FY24)Ordering Period FY259/22/25- 9/21/26 (FY25)Ordering Period FY269/22/26- 9/21/27 (FY26)
CLIN x001 Deployment Physical - Pre-Deployment, Post Deployment, and Retirement/TerminationFrequencyDollar AmountFrequencyDollar AmountFrequencyDollar AmountFrequencyDollar AmountFrequencyDollar Amount
COMPONENTS
Blood pressure, heart rate, height, weight, body mass indexOrdering Period FY22$ - 0Ordering Period FY23$ - 0Ordering Period FY24$ - 0Ordering Period FY25$ - 0Ordering Period FY26$ - 0
TB (tuberculosis) screeningOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
AudiogramOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
SpirometryOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Vision screeningOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
ECG (electrocardiogram)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Chest x-rayOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
LABORATORIES
CBC (Complete Blood Count) With Differential And Platelet CountsOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
CMP (Comprehensive Metabolic Panel)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Lipid Profile (Cholesterol And Triglycerides)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
UrinalysisOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Hemoglobin A1c (Diabetics Or Fasting Glucose Over 110)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Human Immunodeficiency Virus (HIV)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Glucose-6-Phosphate Dehydrogenase (G6pd)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Blood Type (ABO/Rh)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Deoxyribonucleic acid (DNA)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Quantitative Human Chorionic Gonadotropin (HCG)(If Female Within 30 Days Of Deploying)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Quantiferon GoldOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
IMMUNIZATIONS: ENSURE UP TO DATE WITH EACH VISIT FOLLOWING ACIP AND CDC RECOMMENDATIONS. (TO BE PROVIDED IF NOT UP TO DATE)
Td/Tdap (Tetanus, Diphtheria, And Pertussis) VaccinesOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
TB (Tuberculosis) ScreeningOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Hepatitis B Vaccine Series or Record of Positive TiterOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Hepatitis A Vaccine Series or Record of Positive TiterOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
MMR (Measles, Mumps And Rubella) Vaccine Series or Record of Positive TiterOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Varicella Series or Record of Positive TiterOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
InfluenzaOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0

CLIN x002 Fire Fighters

Ordering Period FY229/22/22 - 9/21/23 (FY22)Ordering Period FY239/22/23 - 9/21/24 (FY23)Ordering Period FY249/22/24 - 9/21/25 (FY24)Ordering Period FY259/22/25- 9/21/26 (FY25)Ordering Period FY269/22/26- 9/21/27 (FY26)
CLIN x002 Fire Fighters Physical - NFPA 1582 Standards on Comprehensive Physical Exams for FirefightersFrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amount
Components
Blood Pressure, Heart Rate, Height, Weight, Body Mass IndexOrdering Period FY22$ - 0Ordering Period FY23$ - 0Ordering Period FY24$ - 0Ordering Period FY25$ - 0Ordering Period FY26$ - 0
AudiogramOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Spirometry PFT (Pulmonary Function Test)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Visual Acuity and Confrontational FieldOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
ECG (Electrocardiogram)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Chest X-RayOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Lifting weight 45 lbs.Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
LABORATORIES
CBC (Complete Blood Count) with differential and platelet countsOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
CMP (comprehensive metabolic panel)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
LIPID Profile (Cholesterol and triglycerides)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
UrinalysisOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Hemoglobin A1C (Diabetics)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Perfluoroalkyl and Polyfluoroalkyl substances (PFAS)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Quantiferon GoldOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
IMMUNIZATION
Td/Tdap (tetanus, diphtheria, and pertussis) vaccines within last ten yearsOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
TB (Tuberculosis) Screening (Form)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Hepatitis B vaccine seriesOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Hepatitis A vaccine seriesOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
MMR (measles, mumps and rubella) vaccine seriesOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Varicella seriesOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
InfluenzaOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0

CLIN x003 CDL Physical

Ordering Period FY229/22/22 - 9/21/23 (FY22)Ordering Period FY239/22/23 - 9/21/24 (FY23)Ordering Period FY249/22/24 - 9/21/25 (FY24)Ordering Period FY259/22/25- 9/21/26 (FY25)Ordering Period FY269/22/26- 9/21/27 (FY26)
CLIN x003 CDL Physical 49 CRF §391.41 Standard - Commercial Motor Vehicle Operators Medical CertificationFrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amount
Components
Blood Pressure, Heart Rate, Height, Weight, Body Mass IndexOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Vision Screen per CDL formOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
AudiogramOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
LABORATORIES
UrinalysisOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
HX of Diabetes: CMP and HbA1cOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0

CLIN x004 Annual Physical

Ordering Period FY229/22/22 - 9/21/23 (FY22)Ordering Period FY239/22/23 - 9/21/24 (FY23)Ordering Period FY249/22/24 - 9/21/25 (FY24)Ordering Period FY259/22/25- 9/21/26 (FY25)Ordering Period FY269/22/26- 9/21/27 (FY26)
CLIN x004 Annual Physical Exams for Fire Fighter, Police/Security Guard, Maintenance Personnel and, Occupational Health & Safety Specialist.FrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amount
Components
Vision Screen including color visionOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
AudiogramOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
PFT - as clinically indicated by provider (Possible exposure respiratory problems)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Chest X-ray- as clinically indicated by provider (Possible exposure respiratory problems)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
IMMUNIZATION (to be provide if not up to date)
Td/Tdap (tetanus, diphtheria, and pertussis) vaccinesOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
LABORATORIES
CBC (Complete Blood Count) with differential and platelet countsOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
CMP (comprehensive metabolic panel)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Blood lead level (BLL)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Zinc protoporphyrin level (ZPP)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
UrinalysisOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Hemoglobin A1C (Diabetics)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0

CLIN x005 Police and Guards

Ordering Period FY229/22/22 - 9/21/23 (FY22)Ordering Period FY239/22/23 - 9/21/24 (FY23)Ordering Period FY249/22/24 - 9/21/25 (FY24)Ordering Period FY259/22/25- 9/21/26 (FY25)Ordering Period FY269/22/26- 9/21/27 (FY26)
CLIN x005 Police/Guards Physical Comprehensive Physical Examination to Police/Guards.FrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amount
Components
Blood Pressure (2 readings at least 15 minutes apart), Heart Rate, Height, Weight, Body Mass IndexOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
TB (Tuberculosis) ScreeningOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
AudiogramOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Spirometry (Pulmonary Function Test)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Visual Acuity and Confrontational FieldOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
ECG (Electrocardiogram)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Vision screening with confrontation fieldsOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
LABORATORIES (Baseline and age related 30,35,40, then annually)
Lipid panelOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
CMP (comprehensive metabolic panel)Ordering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Hemoglobin A1C (Diabetics)
Titers for adult immunizations if neededOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
UrinalysisOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
IMMUNIZATIONS (to be provided if not up to date)
Hepatitis B vaccine completed series OR record of positive titerOrdering Period FY22$ - 0Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
InfluenzaOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Tdap once, and then subsequent Td every 10 yearsOrdering Period FY22Ordering Period FY23Ordering Period FY24Ordering Period FY25Ordering Period FY26
Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0Total CLIN Dollar Amount$ - 0

CLIN x006 Admin RN - Comp Plan

Solicitation # W81K04-22-R-0018
Set by LawSet by LawSet by LawNorth Carolina SUTA0.00%0.00%0.00%0.00%0.00%0.00%
Ordering PeriodCLINPOSITIONDirect Labor Rate-AnnualDirect Labor Rate-HourlyFICA 6.2%Medicare 1.45%FUTA 0.60% base 7000SUTA North CarolinaWorker's Comp RateSub-Total w/BurdenFringeSub-Total w/FringeG&A RateOver-head RateSub-TotalProfit RateSub Total w/ProfitBurdened Rate (hrly)# FTEsContract HrsCONTRACTOR PROPOSAL
9/22/22 - 9/21/23 (FY22)0006Administrative Registered Nurse$0.00$0.00$0.00$0.0042.000.00$42.00$0.00$42.00$ - 0$ - 0$42.00$0.00$42.00$0.0247648$152.96

9/22/23 - 9/21/24 (FY23) 1006 Administrative Registered Nurse $0.00 $0.00 $0.00 $0.00 42.00 0.00 $42.00 $0.00 $42.00 $ - 0 $ - 0 $42.00 $0.00 $42.00 $0.02 4 7648 $152.96

9/22/24 - 9/21/25 (FY24) 2006 Administrative Registered Nurse $0.00 $0.00 $0.00 $0.00 42.00 0.00 $42.00 $0.00 $42.00 $ - 0 $ - 0 $42.00 $0.00 $42.00 $0.02 4 7648 $152.96

9/22/25- 9/21/26 (FY25) 3006 Administrative Registered Nurse $0.00 $0.00 $0.00 $0.00 42.00 0.00 $42.00 $0.00 $42.00 $ - 0 $ - 0 $42.00 $0.00 $42.00 $0.02 4 7648 $152.96

9/22/26- 9/21/27 (FY26) 4006 Administrative Registered Nurse $0.00 $0.00 $0.00 $0.00 42.00 0.00 $42.00 $0.00 $42.00 $ - 0 $ - 0 $42.00 $0.00 $42.00 $0.02 4 7648 $152.96

Vendor/Contractor Notes:
Annual Escalation in Base Labor Rate and Benefits0.00%
Tax rate entered by offeror based on North Carolina SUTA
ONLY COMPLETE CELLS HIGHLIGHTED IN YELLOW

mailto:Medicare@1.45%25 CLIN x006 Admin RN Totals

Ordering Period FY229/22/22 - 9/21/23 (FY22)Ordering Period FY239/22/23 - 9/21/24 (FY23)Ordering Period FY249/22/24 - 9/21/25 (FY24)Ordering Period FY259/22/25- 9/21/26 (FY25)Ordering Period FY269/22/26- 9/21/27 (FY26)
CLIN x006 Administrative Registered Nurse ServicesFrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amountFrequencyDollar amount
1FTE (1912 Hours)Ordering Period FY22$38.24Ordering Period FY23$ 38.24Ordering Period FY24$38.24Ordering Period FY25$38.24Ordering Period FY26$ 38.24
1FTE (1912 Hours)Ordering Period FY22$38.24Ordering Period FY23$ 38.24Ordering Period FY24$38.24Ordering Period FY25$38.24Ordering Period FY26$ 38.24
1FTE (1912 Hours)Ordering Period FY22$38.24Ordering Period FY23$ 38.24Ordering Period FY24$38.24Ordering Period FY25$38.24Ordering Period FY26$ 38.24
1FTE (1912 Hours)Ordering Period FY22$38.24Ordering Period FY23$ 38.24Ordering Period FY24$38.24Ordering Period FY25$38.24Ordering Period FY26$ 38.24
Total CLIN Dollar Amount$ 152.96Total CLIN Dollar Amount$ 152.96Total CLIN Dollar Amount$ 152.96Total CLIN Dollar Amount$ 152.96Total CLIN Dollar Amount$ 152.96
OFFERORS DO NOT COMPLETE THIS TAB

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