BPM048195.Optometry_Services_at_CTPHC.R1.pdf

Maryland Department of Health

Clifton T Perkins Hospital Center

TITLE: Optometry Services at Clifton T. Perkins Hospital Center

PROCUREMENT ID NUMBER: BPM048195

EMARYLAND MARKETPLACE ADVANTAGE (EMMA) NUMBER:

ISSUE DATE: January 24, 2025

DUE DATE: February 18, 2025, by 1:00 p.m.

THIS SOLICITATION SHALL BE MADE IN ACCORDANCE WITH THE SMALL PROCUREMENT

REGULATIONS DESCRIBED IN COMAR 21.05.07

Brief Description of Services:

The State is issuing this solicitation for the purposes of procuring a vendor to provide optometry services for a period of one year at Clifton T. Perkins Hospital Center. Optometry services will include eye exams, eyeglass repairs, lenses, and standard frames beginning on/around March 1, 2025, through the term of the contract period.

I. PROCUREMENT OBJECTIVES

A. Issuing Office

Clifton T. Perkins Hospital Center

8450 Dorsey Run Rd.

Jessup, Maryland 20794

The Procurement Officer for this solicitation: The Contract Monitor is:

Victoria F. Bell Timsy Patel, RNC

Director of Procurement Acting Manager, Medical Clinic

410-724-3104 410-724-3150

Email: Victoria.bell1@maryland.gov Email: timsy.patel@maryland.gov

The sole point of contact in the State for purposes of this solicitation is the Procurement

Officer.

B. Submission Deadline mailto:Victoria.bell1@maryland.gov mailto:timsy.patel@maryland.gov

Bids MUST be submitted on eMaryland Marketplace Advantage (eMMA) by 1:00 PM Eastern

Time on February 18, 2025, in order to be considered.

II. GENERAL INFORMATION FOR VENDORS

A. Contract

1. A single contract will be awarded to the Bidder that best meets the needs of the evaluation criteria. The contract resulting from this solicitation shall be an indefinite quantity, fixed price contract, beginning March 1, 2025, for a period of approximately three (3) years..

2. The Department reserves the right to reduce or withhold contract payment in the event the Contractor does not provide the Department with all required deliverables within the time frame specified in the contract or in the event that the Contractor otherwise materially breaches the terms and conditions of the contract.

B. Submission of Bids

Bidders MUST submit on eMMA.

Mailed, emailed, or faxed bids will not be accepted for this solicitation.

The bid shall contain all price information in the format specified on the Bid Form (Exhibit A).

Complete the Bid Form only as provided in the Bid Pricing Instructions. Do not amend, alter, or leave blank any items on the Bid Form or include additional clarifying or contingent language on or attached to the Bid Form. Failure to adhere to any of these instructions may result in the Bid being determined to be non-responsive and rejected by the Department.

Questions related to this solicitation must be submitted to the Procurement Officer by email at vbell1@maryland.gov or through the Questions and Answers tab on eMMA by February 4, 2025, at 1:00PM in order to be answered prior to the submission deadline.

C. Vendor Experience and References

1. The vendor must have at least three years of successful experience in providing optometry services. With the transmittal letter, the vendor must show evidence of reliability, ability, and experience by including:

a. A list of personnel who will perform under the contract, showing the length and type of experience of such personnel and;

b. The names and addresses where prior comparable services have been or are being rendered by the bidder. The ability to meet the foregoing experience requirements and the adequacy of the information submitted will be considered in determining the responsibility of the bidder.

2. The vendor must provide a list of at least three references which each include contact name(s), phone number(s), and email address(es).

3. The vendor is to provide a list of all current contracts with any entity of the State of

Maryland, or which have been completed within the last 5 years. For each identified contract the vendor is to provide:

a. The State contracting entity

b. A brief description of the services/goods provided

c. The dollar value of the contract

d. The term of the contract

e. The State employee contact person (name, title, telephone number and e-mail address)

f. Whether the contract was terminated before the end of the term specified in the original contract, including whether any available renewal option was not exercised.

D. Transmittal Letter

A transmittal letter prepared on the Bidder’s business stationary MUST be uploaded on eMMA with the solicitation response submission. The transmittal letter should be brief but must include acknowledgement of meeting the requirements of the solicitation and required experience. The transmittal letter must include in body or accompanying uploaded documentation:

1. The required reference and information as described above in Section II.C;

2. “Attachment C. Bid/Proposal Affidavit”

3. “Attachment H. Conflict of Interest Affidavit and Disclosure”

4. “Attachment J. HIPPA Business Associate Agreement”

5. A copy of the vendor’s Continuous Quality Improvement Program’s Policy and

Procedures Manual. If a policy and procedure manual does not exist, the vendor must prepare a narrative fully explaining their CQI Program and submit it with their bid. As part of the CQI program, the vendor shall provide the Hospital with a plan to maintain the confidentiality, security and integrity of patient and Hospital related data and information. The letter shall be signed by an individual or corporate officer who is authorized to bind his firm to all statements, including services, material availability, timeliness and prices contained in the bid.

E. Selection Process

The contract resulting from this solicitation shall be awarded to the responsible and responsive bidder whose bid meets the requirements noted in this solicitation document and is the most favorable bid price (lowest cost).

F. Invoicing

The Contractor shall bill the Department on a monthly basis for the work performed the previous month. The total cost of work may not exceed $50,000 for the term of the contract.

To be considered for payment, submission of a proper invoice must include the following information, without error:

1. Contractor name and address;

2. Remittance address;

3. Federal taxpayer identification (FEIN) number, social security number, appropriate;

4. Invoice period (i.e. time period during which services covered by invoice were performed);

5. Invoice date;

6. Invoice number;

7. State assigned Contract number;

8. State assigned (Blanket) Purchase Order number(s);

9. Goods or services provided;

10. Amount due; and

11. Any additional documentation required by regulation or the Contract.

The State reserves the right to reduce or withhold Contract payment in the event the Contractor does not provide all required deliverables within the time frame specified in the Contract or otherwise breaches the terms and conditions of the Contract until such time as the Contractor brings itself into full compliance with the Contract.

The State is generally exempt from federal excise taxes, Maryland sales and use taxes, District of

Columbia sales taxes and transportation taxes. The Contractor, however, is not exempt from such sales and use taxes and may be liable for the same. Invoices for final payment shall be clearly marked as “Final” and submitted when all work requirements have been completed, and no further charges are to be incurred under the Contract. In no event shall any invoice be submitted later than sixty (60) calendar days from the Contract termination date. The Contractor shall submit invoices by the 15th of the month in which services were delivered and shall be submitted electronically to:

dlctphcfiscalservices_MDH@maryland.gov

III. TECHNICAL SPECIFICATIONS

A. SCOPE

Optometry services for a period of one year at Clifton T. Perkins Hospital Center which will include eye exams, eyeglass repairs, lenses, and standard frames beginning on or around March

1, 2025, through the term of the contract period.

mailto:dlctphcfiscalservices_MDH@maryland.gov

B. Description of Work

1. Clifton T. Perkins Hospital Center will provide a work area or exam room, refractor, ophthalmoscope, vision projector, examination chair with slit lamp and phoropter along with nursing staff for support services. The Contractor shall provide all other equipment and supplies necessary to provide the services.

2. The Contractor shall be responsible for providing optometry services in accordance with all applicable licensure, certification, and accreditation standards of State of Maryland, Department of Health, Office of Health Care Quality

3. Services to be performed under this contract include:

a. Eye clinics twice a month during normal State business hours for eye exams, necessary treatments and adjustments. The clinics through shall not exceed four hours each.

b. Comprehensive eye examinations from a Maryland State licensed optometrist, which includes possible Dilated Fundus Examination.

i. The Contractor shall provide a written treatment plan on the Clifton T. Perkins

Hospital Center consultation referral forms.

ii. Each exam shall consist of the visual acuity tests and inner ocular pressure. c.

Administrative and clerical services required for managing and coordinating services, rendering invoices, and performing other functions necessary for the management of the Contract.

4. Services to be performed under this contract include:

a. Eye clinics twice a month during normal State business hours for eye exams, necessary treatments and adjustments, and repairs and fittings of eyeglass frames. The clinics shall not exceed four hours each.

b. Comprehensive eye examinations from a Maryland State licensed optometrist, which includes measurements to ensure proper fitting of eyeglasses and possible

Dilated Fundus Examination.

i. The Contractor shall provide a written treatment plan on the Clifton T. Perkins

Hospital Center consultation referral form.

ii. Each exam shall consist of the visual acuity tests and inner ocular pressure.

c. Providing standard, not designer style, eyeglass frames

d. Providing fitting, repair, and routine adjustment of eyeglass frames on an as needed basis during scheduled monthly eye clinics.

i. Once an eye clinic has been scheduled, eyeglasses that can be repaired on site by the Contractor shall be repaired at the time of the clinic.

ii. If the eyeglasses cannot be repaired on site, the Contractor shall take the glasses back to their place of business to repair.

e. Providing single, lined bifocal, and lined trifocal lenses based on the prescriptions written from an eye examination.

f. Delivery: Once new eyeglasses or repair work are completed the Contractor shall notify the Clifton T. Perkins Hospital Center Contract Monitor or designee that they eyeglasses are ready. The Contractor is responsible for having new and repaired glasses delivered to Clifton T. Perkins Hospital Center within 5-10 business days after initial eye exam or repair request.

g. Administrative and clerical services required for managing and coordinating services, rendering invoices, and performing other function necessary for the management of the Contract.

5. The optometrist will respond to consults/referrals and provide services within 7 working days (except during the optometrist’s scheduled vacation time) of the clinic’s request for services.

6. Documentation shall include, but is not limited to, consultant reports and prescriptions written.

7. Optometrists assigned by the Contractor to perform services under this Contract are responsible for reporting to the Director of Medical Services or his/her designee as needed.

8. Clifton T. Perkins Hospital Center will not pay for the following services:

a. Services not medically necessary,

b. Investigational or experimental drugs or procedures,

c. Services prohibited by the State Board of Examiners in Optometry,

d. Repairs,

e. Cost of travel by the provider,

f. Delivery,

g. Routine adjustments to eyeglasses.

9. The Contractor shall not bill Clifton T. Perkins Hospital center nor the patient for:

a. Completion of forms and reports,

b. Cancelled or missed appointments,

c. Professional services rendered by mail or telephone,

d. Services which are provided at no charge to the general public, and

e. Providing a copy of a recipient’s patient record when requested by another licensed provider on behalf of the recipient.

10. The Contractor shall not make any referral to any health care entity in which the

Contractor or immediate family member has a beneficial interest, except for services to be provided directly by the Contractor as off-site services covered by the provisions of this Contract.

11. The Contractor shall provide monthly schedules in order to meet the requirements of the monthly clinic. Schedules shall be approved by the Clifton T. Perkins Hospital

Center Contract Monitor or designee prior to commencement of the Contract. At the end of each scheduled month, the Contractor must document that the scheduled services were provided and document any changes that were made in the schedule.

Failure to do so may result in withholding of payment until satisfactory documentation is provided.

a. Forty-eight (48) hours’ notice by either Clifton T. Perkins Hospital Center or the

Contractor shall be given for any cancellation or rescheduling of any clinic.

Rescheduling shall be to a time agreeable to both parties. Notice shall be given to either the Contract Monitor or designee and/or the Contractor’s representative as appropriate. Clifton T. Perkins Hospital Center will not provide any payment for a clinic in which the Contractor is provided a forty-eight (48) hours’ notice of cancellation.

12. Satisfaction with Services Rendered: To ensure ongoing satisfaction with the quality and quantity of the service provided, the Contract Monitor or designee will meet with the Contractor at least quarterly. During these meetings, the Contract Monitor or designee will assess the performance of the Contractor based upon the provisions of this contract, hospital, and medical staff policies and bylaws, and clinical competence or performance improvement activities Any problems identified concerning quality of performance shall be communicated in writing by the Contract Monitor or designee to the Contractor.

13. Performance Improvement: the contract specifications will form the basis of the performance review as a means of quality control and quality assurance to determine the degree of Contractor compliance and level of performance satisfaction. Incidents of unacceptable performance will be documented with a copy to Clifton T. Perkins

Hospital Center’s Director of Procurement, Clifton T. Perkins Hospital Center’s Contract

Monitor, and the Contractor’s Account Representative. The Contractor shall be required to submit a written plan of correction identifying the timeframe for completion to the Contract Monitor or designee within Three (3) business days of receiving written notification regarding unacceptable performance. The Clifton T.

Perkins Hospital Center Contract Monitor or designee will approve or reject the plan within two (2) business days of receipt. Continuing failure to satisfactorily respond in the timeframes required in accordance with this section, or more than a total of three

(3) situations involving unacceptable performance during a twelve (12) month period may be viewed as grounds for termination.

a. The Contractor’s plan must provide a mechanism for assuring that there is prompt written and verbal communication of performance improvement issues between

Clifton T. Perkins Hospital Center, the Contractor, and the Optometrists.

b. Provide a mechanism for collaborating with Clifton T. Perkins Hospital Center’s

Director of Medical Services or designee.

c. Provide a mechanism for implementing corrective actions, in collaboration with the

Clifton T. Perkins Hospital Center Director of Medical Services or designee. For this purpose, the Contractor shall meet with the Director of Medical Services or the Chief

Executive Officer on a regular basis, as deemed appropriate by the Director of

Medical Services or the Chief Executive Officer.

14. Record Documentation: records shall be maintained for all patients on a continuous basis. These records shall satisfy the regulatory requirements as set forth in Federal

HIPPA and State Confidentiality Law as established by Clifton T. Perkins Hospital Center, third party insurers, Medicare, Joint Commission, Medicaid and the MDH Office of

Health Care Quality. The records shall document all treatment provided. The

Contractor’s Optometrists shall be responsible for documenting medical records on an ongoing, timely, and orderly basis. All entries shall be legible, organized, and thorough.

15. Orientation and Annual Training: Clifton T. Perkins Hospital Center is required by the

Joint Commission to ensure that all staff, including Contractor staff, is provided an initial orientation and annual updates thereafter. Clifton T. Perkins Hospital Center shall provide the above referenced initial and annual training. The Contractor shall be responsible for scheduling contracted staff for the required training. Orientation (initial training) shall be completed prior to beginning work at the hospital. Annual training shall be completed each year anytime between a month prior to or the month of the entry on duty initial training date. The following criteria have been established for training of contracted optometrists:

a. The Contractor will complete a three-day initial orientation and annual training program. The initial orientation is held over a three-day period from 8:00 AM- 4:30

PM and the annual training will consist of CPR and PMAB training as well as any other required updates.

16. Credentialing and Clinical Privileging: Prior to commencement of the contract and assumption of clinical duties, all applicable optometrists under the contract shall have received initial credentialing by the Clifton T. Perkins Hospital Center Credentials

Committee. In the event that the Contractor Optometrist is denied clinical privileges on the Medical Staff, or in the event that such privileges are revoked, suspended, limited, or not renewed, the Contractor shall be responsible for arranging for the optometrist’s replacement within a reasonable period of time, such that there is no adverse impact on the delivery of services as required herein. Under no circumstances shall this period of time exceed sixty (60) calendar days. During any interim period, the Contractor shall remain responsible for the delivery of all required services.

17. Tuberculosis (PPD) Testing and Hepatitis B and Influenza Vaccination: In accordance with Clifton T. Perkins Hospital Center’s policy, all staff, including contracted staff, are required to either receive an initial PPD test or show proof of receipt of the annual test elsewhere. The Contractor is responsible for obtaining this test and submitting proof to the Contract Monitor or designee. Additionally, Clifton T. Perkins Hospital Center’s Joint

Commission accreditation requires that all health care providers and contracted staff be offered Hepatitis B and Influenza vaccination. Clifton T. Perkins Hospital Center must maintain a record of contracted staff either receiving the vaccination or declining it.

Clifton T. Perkins Hospital Center will provide the vaccination, if the medical consultant chooses, at no cost.

18. Criminal Background Check: Clifton T. Perkins Hospital Center will obtain a criminal background check for each individual. The Contractor shall obtain from each individual assigned to work on the contract a statement permitting a criminal background check.

The Contractor may not assign an employee with a criminal record unless prior written approval is obtained from the Contract Monitor or designee. Clifton T. Perkins Hospital

Center reserves the right to reject any individual based upon the results of the background check. All individuals assigned by the Contractor to provide services at

Clifton T. Perkins Hospital Center shall comply with access and related security and identification requirements of Clifton T. Perkins Hospital Center.

19. All of the services described above must be provided on the grounds of Clifton T.

Perkins Hospital Center. The optometrist will comply with all hospital policies and procedures in the delivering of services.

20. Adherence to Licensing and regulatory Requirements: the Contractor’s optometrists shall adhere to all licensure and certification requirements established by Maryland

Department of Health and all Clifton T. Perkins Hospital Center bylaws, rules, regulations and guidelines. Failure to submit required credentialing information, or to achieve or maintain Medical Staff membership or clinical privileges by the Contractor’s optometrists shall cause the Contractor to be in default.

21. Personnel/Staff Management Requirements: the Contractor may not substitute personnel, other than by reason of an individual’s death, sudden illness, or termination of employment, without the prior written approval of the Contract Monitor or designee. To replace any optometrist, the Contractor shall submit the resumes of the proposed substitute personnel to the Contract Monitor or designee for approval at least one month prior to the effective date of substitution. All proposed substitute personnel shall have qualifications at least equal to those of the replaced personnel.

Any replacement optometrist(s) must complete all required screening and initial/annual trainings prior to beginning work on campus. Clifton T. Perkins Hospital

Center will not reimburse for time related to initial training of replacement optometrist(s) and/or annual training for more than one optometrist each year.

a. The Contractor shall be responsible for maintaining sufficient optometrists for delivery of all services on an ongoing basis as described herein.

b. The Contractor shall be required to provide documentation to verify time and attendance of all of its optometrists as applicable.

c. The Contractor shall ensure and be responsible for timely and adequate communication, verbal and written, between its optometrists, itself, and Clifton T.

Perkins Hospital Center.

d. Documentation of the time and attendance of each of the Contractor’s optometrists shall be submitted by the Contractor to Clifton T. Perkins Hospital Center’s Contract

Monitor or designee monthly. Documentation of an optometrist’s time and attendance must correspond with invoices and billing cycles and must justify the

Contractor’s monthly invoice.

e. The Contractor shall ensure that Clifton T. Perkins Hospital Center’s Contract Monitor or designee has direct access to the Contractor, through a designated Director of

Operations/Contact Operon who will be available by telephone and electronically via email on a twenty-four (24) hour, seven (7) day/week, and emergency basis.

22. Documentation: all written correspondence to Clifton T. Perkins Hospital Center shall be on the Contractor’s company letterhead.

23. All consults and bills/invoices will specify the type of service provided, the patients name and hospital number, purchase order number, amount of payment due, optometrist address and phone number and will be signed and monitored by the clinic’s nurse manager and medical director.

24. This is a fee for service contract and the hospital is not responsible for any other fees beyond those submitted on the pricing grid of this solicitation.

25. Before starting any work on the campus, the Contractor will report to the Contract

Monitor or designee for screening and authorization to proceed with any service. Any

Contractor staff will sign in an out at the STPHC medical clinic. All consults and bill/invoices will be signed and monitored by the clinic’s Nurse Manager and the clinic’s Medical Director.

a. All billing shall be addressed to: Clifton T. Perkins Hospital Center 8450 Dorsey Run

Road Jessup, MD 20794/Attention Medical Clinic

b. Each bill/invoice must all specify the type of service(s) provided, the amount of payment due for each service and in total, the referred patient(s)’ name(s) and hospital number(s), the Purchase Order (PO) number assigned to the resulting contract, and the Contractor’s address and telephone number.

c. All questions related to billing/payments should be directed to the Financial Services

Office of Clifton T. Perkins Hospital Center.

C. Licensing, Regulation, and Certification Requirements

1. The contractor shall be responsible for providing services in accordance with all applicable licensure, certification and accreditation standards of:

a. Maryland Department of Health;

b. The Medical Staff of Clifton T. Perkins Hospital Center;

c. The Joint Commission (TJC); and

d. All applicable existing and pending Federal Licenses.

2. The contractor(s) must:

a. Have a current Doctor of Optometry License issued by the Maryland Department of

Health Division of Licensure/Certification/Training;

b. Meet with the approval of the Medical Executive Committee;

c. Have a minimum of two years prior experience providing services; and

d. Be credentialed and privileged to practice by the hospital as a consultant.

3. The Contractor’s Optometrist’s shall adhere to all licensure and requirements

Established by the Maryland Department of Health and all of Clifton T. Perkins Hospital

Center bylaws, rules, regulations and guidelines established by Clifton T. Perkins

Hospital Center. Failure to submit required credentialing information, or to achieve or maintain Medical Staff membership or clinical privileges by the Contractor’s optometrist shall cause the Contractor to be in default. If the contractor is deemed, by the Credentialing Committee of the medical staff or the Clinical Director, unable to provide service due to intoxication, the influence of a controlled substance, and/or exhibits inappropriate behavior with patients and/or is found to be in violation of

Hospital policy and procedures, the contract with that contractor will be terminated.

4. Contractor’s Responsibility: It is necessary for the contractor to have an acceptable

Continuous Quality Improvement Program (CQI). Therefore, with its bid, each vendor must submit a copy of its Continuous Quality Improvement Program’s Policy and

Procedures Manual. If a policy and procedure manual does not exist, the vendor must prepare a narrative fully explaining their CQI Program and submit it with their bid. As part of the CQI program, the vendor shall provide the Hospital with a plan to maintain the confidentiality, security and integrity of patient and Hospital related data and information.

5. Hospital Responsibility- Peer Review: Six months after the implementation of the contact, and once quarterly after that, peer review will be performed. It is expected that 100% of a random sample of optometric evaluations meet peer review standards.

If the benchmark of 100% is not met, the hospital will notify the contractor and expect a response and a plan of correction within five working days. Follow-up review will be performed in three months. If the peer review benchmark is not met again during the follow-up review, the contractor may be found in default of the contract.

D. Drawings and Attachments

1. “Attachment C. Bid/Proposal Affidavit” (to be submitted with bid submission) https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-A.-Bid-Proposal-Affidavit.pdf

2. “Attachment H. Conflict of Interest Affidavit and Disclosure” (to be submitted with bid submission) content/uploads/sites/12/2024/07/Attachment-I.-Conflict-of-Interest-Affidavit.pdf

3. “MDH HIPPA Business Associate Agreement” (to be submitted with bid submission) content/uploads/sites/12/2024/07/Attachment-T.-HIPAA-Business-Associate-

Agreement.pdf

4. Sample Small Procurement Contract (contract to be completed upon award)

5. “Attachment U. Contract Affidavit” (to be completed upon award) content/uploads/sites/12/2024/07/Attachment-U.-Contract-Affidavit.pdf

6. No Bid Notice/Vendor Feedback Form content/uploads/sites/12/2024/07/Attachment-1.-No-Bid_Proposal-Notice_Vendor-

Feedback-Form-1-1.docx http://go.microsoft.com/fwlink/p/?LinkId=255141 http://go.microsoft.com/fwlink/p/?LinkId=255141 https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-I.-Conflict-of-Interest-Affidavit.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-I.-Conflict-of-Interest-Affidavit.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-T.-HIPAA-Business-Associate-Agreement.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-T.-HIPAA-Business-Associate-Agreement.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-T.-HIPAA-Business-Associate-Agreement.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-U.-Contract-Affidavit.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-U.-Contract-Affidavit.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-1.-No-Bid_Proposal-Notice_Vendor-Feedback-Form-1-1.docx https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-1.-No-Bid_Proposal-Notice_Vendor-Feedback-Form-1-1.docx https://procurement.maryland.gov/wp-content/uploads/sites/12/2024/07/Attachment-1.-No-Bid_Proposal-Notice_Vendor-Feedback-Form-1-1.docx

BID PAGE EXHIBIT A

Price is based on Section III Technical Specifications

*The total amount of this contract will not exceed $50,000.00

Year One (1):

Description Hourly or Rate/Per

Item

X Quantity Total

Comprehensive Eye Exam $ X 48 Hours $

Standard Frames &

Polycarbonate Single Vision

$ X 45 $

Standard Frames &

Polycarbonate Lines Bifocal

$ X 15 $

Standard Frames &

Polycarbonate Lines Trifocal

$ X 1 $

Frames Replacement Only $ X 10 $

Orientation $ X 1 $

Total Year One (1) $

Year Two (2):

Item

X Quantity Total

Comprehensive Eye Exam $ X 48 Hours $

Standard Frames &

Polycarbonate Single Vision

$ X 45 $

Standard Frames &

Polycarbonate Lines Bifocal

$ X 15 $

Standard Frames &

Polycarbonate Lines Trifocal

$ X 1 $

Frames Replacement Only $ X 10 $

Total Year Two (2) $

Year Three (3):

Item

X Quantity Total

Comprehensive Eye Exam $ X 48 Hours $

Standard Frames &

Polycarbonate Single Vision

$ X 45 $

Standard Frames &

Polycarbonate Lines Bifocal

$ X 15 $

Standard Frames & $ X 1 $

Polycarbonate Lines Trifocal

Frames Replacement Only $ X 10 $

Total Year Three (3) $

Total Bid Price:

Total Year One (1) + Total Year Two (2) + Total Year Three (3) = Total Bid Price

Bid Price Authorized by:

Name/Title____________________________________________________

Signature________________________________Date_________________

Address______________________________________________________

City, State, Zip________________________________________________

Federal ID #:__________________________________________________

Phone Number/Fax Number______________________________________ eMM#_______________________________________________________

E-mail Address________________________________________________

THE STATE OF MARYLAND ENCOURAGES

MINORITY BUSINESS ENTERPRISES TO

PARTICIPATE IN THIS PROCUREMENT PROCESS.