Attachment I Cost Proposal Form_1.xlsx
XLSX spreadsheet 26 KB Posted
- Attached to
- DPH | 503A Sterile Compounding Pharmacy Services
- Solicitation number
- SFGOV-0000011956
- Issued by
- California
About this file
Summary of Attachment I Cost Proposal Form
This is a Cost Proposal Form for Request for Proposals SFGOV-0000011956 issued by the San Francisco Department of Public Health (DPH) for 503A Sterile Compounding Pharmacy Services at Zuckerberg San Francisco General Hospital. The RFP seeks qualified proposers to provide patient-specific Total Parenteral Nutrition (TPN) solutions for neonatal, pediatric, and adult patients on a 24/7, 365-days-per-year basis. The solicitation was published on September 8, 2026, with a pre-proposal conference scheduled for September 21, 2026, at 1:00 PM PST. The deadline for submitting written questions is September 28, 2026, at 5:00 PM PST, with a question and answer addendum to be posted by October 5, 2026. Proposals are due by October 12, 2026, at 2:00 PM PST. Short-listing notifications are estimated for November 9, 2026, with demonstrations scheduled between November 12 and November 20, 2026. The award announcement is estimated for December 2, 2026, with an estimated contract start date of March 1, 2027.
The cost proposal form requires proposers to provide unit-based pricing for TPN ingredients in various volumes, including Trophamine/Plenamine formulations, Nutrilipid, Intralipid, SMOF Lipid, and Clinimax solutions. Proposers must also specify costs for delivery fees, latex surcharges, containers, and other necessary services to execute the scope of work. Additionally, the form includes an unscored informational section requesting unit costs for electrolytes such as sodium chloride, potassium chloride, calcium gluconate, and magnesium sulphate, as well as additives including multivitamins, trace elements, insulin, heparin, and various micronutrients. The form explicitly states that pricing information serves comparative purposes only and does not determine the final contract value, with proposers required to complete both worksheets and provide pricing assumptions and notes as applicable.
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Text version
Cost Proposal
| ATTACHMENT I | |||||
| COST PROPOSAL FORM | |||||
| REQUEST FOR PROPOSALS SFGOV-0000011956 | |||||
| 503A STERILE COMPOUNDING PHARMACY SERVICES | |||||
| Note: The information provided by the Proposer on this form is for comparative purposes only. This form does not determine the contract value. Please be sure to complete both worksheets. | |||||
| Key: Orange-shaded cells require Proposer input. All other cells are pre-formatted labels or auto-calculated totals. | |||||
| Proposer's Name: | |||||
| SECTION 1: UNIT-BASED PRICING | |||||
| Enter your proposed unit costs for each ingredient for the initial year of the contract. Costs should include amino acids, dextrose, and water. | |||||
| Item | Ingredient | TPN Volume | Unit Cost ($) | Units per Year | Total Cost ($) |
| 1 | Trophamine® / Plenamine™ | 1-1000 mL | 300 | $ - 0 | |
| 2 | Trophamine® / Plenamine™ | 1001-1500 mL | 300 | $ - 0 | |
| 3 | Trophamine® / Plenamine™ | 1501-2000 mL | 100 | $ - 0 | |
| 4 | Trophamine® / Plenamine™ | 2501-2500 mL | 100 | $ - 0 | |
| 5 | Trophamine® / Plenamine™ | 2501-3000 mL | 100 | $ - 0 | |
| 6 | Trophamine® / Plenamine™ | 3000 mL or greater | 100 | $ - 0 | |
| 7 | Nutrilipid 20% | Per 100 mL | 500 | $ - 0 | |
| 8 | Nutrilipid 20% in Syringe (up to 50 mL) | Per Syringe | 200 | $ - 0 | |
| 9 | Nutrilipid 20% | 250 mL | 500 | $ - 0 | |
| 10 | Intralipid | 500 mL | 400 | $ - 0 | |
| 11 | SMOF Lipid in 3-in-1 TPN | Per 100 mL | 50 | $ - 0 | |
| 12 | SMOF Lipid in Syringe (up to 50 mL) | Per Syringe | 50 | $ - 0 | |
| 13 | SMOF 20% | 250 mL | 600 | $ - 0 | |
| 14 | Clinimax 5%-20% | 2000 mL | 300 | ||
| Subtotal | $ - 0 | ||||
| SECTION 2: OTHER COSTS | |||||
| List any delivery fees or other costs the Proposer believes are necessary to successfully carry out the scope of work in the initial year of the contract. | |||||
| Item | Description | Unit Type | Unit Cost ($) | Units per Year | Total Cost ($) |
| 1 | Delivery Fees | Per Delivery | 350 | $ - 0 | |
| 2 | Other fees (e.g. Latex surcharge) | Per Bag | 1,000 | $ - 0 | |
| 3 | Containers | Per Item | 1,000 | $ - 0 | |
| 4 | $ - 0 | ||||
| 5 | $ - 0 | ||||
| 6 | $ - 0 | ||||
| 7 | $ - 0 | ||||
| 8 | $ - 0 | ||||
| Subtotal | $ - 0 | ||||
| EVALUATION TOTAL (Section 1 + Section 2) | $ - 0 | ||||
| This is the amount used to compare Proposers' cost scores. |
| PROPOSER'S ASSUMPTIONS & NOTES |
| Please describe any pricing assumptions, exclusions, or optional services below. Note this section is not scored. |
UNSCORED Information
| ATTACHMENT I |
| COST PROPOSAL FORM |
| REQUEST FOR PROPOSALS SFGOV-0000011956 |
| 503A STERILE COMPOUNDING PHARMACY SERVICES |
| Note: The information provided on this form will not be scored or compared across Proposers. It is for informatlonal purposes only. |
Proposer's Name:
| INSTRUCTIONS |
| Provide your unit cost for each item in the list of electrolytes and additives. Modify the TPN volume to align with your pricing structure. Add additional lines if needed. |
Electrolytes
| Item | Ingredient | TPN Volume | Unit Cost ($) |
| 1 | Sodium Chloride | 0-140 mEq/L | |
| 2 | Potassium Chloride | 0-40 mEq/L | |
| 3 | Calcium Gluconate | 0-9 mEq/L | |
| 4 | Magnesium Sulphate | 0-12mEq/L | |
| 5 | Sodium Phosphate | 0-20 mEq/L | |
| 6 | Calcium Gluconate | 10 - 100 mEq/L | |
| 7 | Sodium Acetate | 0-10 mEq/L | |
| 8 | Potassium Phosphate | 3 mmol/mL | |
| 9 | Potassium Acetate | 0-4 mEq/L |
Additives
| Item | Ingredient | TPN Volume | Unit Cost ($) |
| 1 | Multivitamins | 10 mL | |
| 2 | Trace Elements | 2 mL | |
| 3 | Thiamine | 100 mg/mL | |
| 4 | Folic Acid | 1-5 mg/mL | |
| 5 | Zinc Sulfate | 2 mg | |
| 6 | Insulin Regular | 10-60 units | |
| 7 | Famotidine | 10-40 mg | |
| 8 | Copper | ||
| 9 | Cysteine | 50 mg/mL | |
| 10 | Selenium | 40 mcg/mL | |
| 11 | Carnitine | ||
| 12 | Heparin | 100 units/mL | |
| 13 | Ascorbic Acid | 500 mg/mL | |
| 14 | Chromium | ||
| 15 | Cyanocobalamin | 1000 mcg/mL | |
| 16 | Levocarnitine | 200 mg/mL | |
| 17 | Manganese | 0.1 mg/mL | |
| 18 | Pyridoxone | 100 mg/mL |
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