Attachment J.10 Clinical East Monthly Invoice Submission Template.xlsx

XLSX spreadsheet 40 KB Posted

Attached to
Federal Occupational Health (FOH) Clinical East Staffing Solicitation
Solicitation number
PSCFOH-ClinicalEastStaffing-Solicitation75P00125R00012
Issued by

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Attachment J.10 is a monthly invoice submission template for the Federal Occupational Health (FOH) Clinical East Staffing contract. The template is designed for contractors to submit detailed invoices for labor and travel costs, with specific columns for site codes, job titles, employee names, hours worked, rates, and total amounts due. The template includes sections for clinical staff (such as Nurse Coordinators, Staff Nurses/RNs, and Medical Admin Support Staff) and travel-related expenses.

The associated federal contract opportunity (Solicitation Number PSCFOH-ClinicalEastStaffing-Solicitation75P00125R00012) is a total set-aside for 8(a) small business concerns, seeking professional medical staffing and occupational health professionals for the Clinical Eastern Region. The solicitation is issued by the Department of Health and Human Services (HHS) Program Support Center (PSC) Federal Occupational Health (FOH), with all inquiries to be submitted via email to the Contract Specialist Angelina Mulenga. The contract aims to provide clinical occupational health support services with staffing across various nursing and administrative roles.

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Other files

File Type Posted
75P00125R00012_ClinicalEast_Amendment_0001_7_7_25.pdf PDF
Attachment J.6_Clinical EastWage DeterminationList_Amendment_0001.xlsx XLSX spreadsheet
Attachment_J.1_Clinical East PricingWorksheet_Amendment_0001.xlsx XLSX spreadsheet
Attachment J.5 Clinical East Credential File Format.pdf PDF
Attachment J.11 Subcontractor Teaming Partner Consent Form.pdf PDF
Attachment J.13 Past Performance Questionaire.docx DOCX document
Attachment J.6-Clinical East Wage Determination List_Final.xlsx XLSX spreadsheet
Attachment J.3 Clinical East Labor Category Details.pdf PDF
Attachment J.9 Clinical East Contract Transition Incumbent Report.xlsx XLSX spreadsheet
Attachment J.1-Clinical East Pricing Worksheet_Final.xlsx XLSX spreadsheet
Attachment J.14 Disclosure of Lobbying Activities.pdf PDF
Attachment J.12 Client Authorization Letter.pdf PDF
Attachment J.8 Clinical East Monthly Labor Hour Tracker.xlsx XLSX spreadsheet
RFP 75P00125R00012 Clinical East Staffing_7.2.25.pdf PDF
Attachment J.7 Clinical East Contractor Performance Self-Assessment Template.docx DOCX document
Attachment J.4 Clinical East Security Clearance and Badging Info.docx DOCX document
Attachment J.2 Clinical East Site Staffing Plan.xlsx XLSX spreadsheet
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INVOICE

Clinical East Monthly Invoice Submission Template

ATTACHMENT J.10

INVOICE
PLEASE MAIL YOUR REMITTANCE TO:
Contractor's Name, TAX ID Number, Duns Number
Contractor's Address
Contractor's Phone Number
Invoice Date
Invoice #
CONTRACT #
FOR THE PERIOD OF :

LABOR

CAN Site Code State Job Title Cost Center Employee Name ConCat Monthly Hrs Worked Rate Total Due Vendor Comments FOH Comments

CLINICAL TOTAL:

TRAVEL

CAN Site Code Description CC Employee Name Date(s) of Travel Total Due Vendor Comments FOH Comments

TRAVEL TOTAL:

TOTAL AMOUNT DUE:

Grand Total

MD
Z0YNurse Coordinator ICody, Sharon
A7FNurse Coordinator IGaines, Carol
A7FStaff Nurse/RNWuerstlin, Rebecca
VA
Z3UNurse Coordinator IBurns, Andrea
Occ Health Orientation Hours
DC
A54Staff Nurse/RNHarry, Beverly
A7ENurse Coordinator IRostami, Christine
Z0AMed Admin Support StaffLaw, Schae
Z0GArea Nurse ManagerSharon, Cynthia
MD
A7FStaff Nurse/RNJohnson, Nicole
Z8AStaff Nurse/RNJohnson, Nicole

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