ATTJ104 _ Business Proposal Format 04212025.xlsx
XLSX spreadsheet 199 KB Posted
- Attached to
- Solicitation - World Trade Center Health Program - Survivor Clinical Center of Excellence
- Solicitation number
- CDC-75D301-01-Solicitation-WTCHP
About this file
This Excel file is a comprehensive Business Proposal Format template for a World Trade Center Health Program (WTCHP) Survivor Clinical Center of Excellence (CCE) contract, designed to capture detailed cost proposals across multiple contract periods. The template provides extensive worksheets for documenting direct and subcontract labor, other direct costs (ODCs), materials and equipment, travel expenses, and indirect rates, with specific instructions for offerors to differentiate costs between transition-in, start of healthcare delivery, sustainment, and transition-out periods.
The template includes granular sections for tracking labor categories, wage determinations, service contract act compliance, and cost allocations across a base period and four option years. It requires offerors to specify exempt/non-exempt labor status, applicable wage determination numbers, productive hours, indirect rates, and labor adders. Notable features include detailed activity code mapping, instructions for documenting rent/lease calculations, and specific guidance on differentiating costs across various contract performance stages, demonstrating a structured approach to capturing comprehensive cost proposals for healthcare services for 9/11 Survivors in the New York Metropolitan Area.
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Budget Snapshot Date: Summary of Proposed Costs Survivor CCE, Solicitation 75D301-25-R-00088
| Budget Category | Base Period | Option Yr 1 | Option Yr 2 | Option Yr 3 | Option Yr 4 | Total | |||
| Transition-In Period | Implementation of Start of Healthcare Delivery & Sustainment | Implementation of Start of Healthcare Delivery & Sustainment | Transition-Out Period | ||||||
| Total Direct Labor | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Total Subcontract Labor | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Materials | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Equipment | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Other Direct Costs | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Total Direct Costs | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Sub-total | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Indirect Costs (See Note 1) | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Sub-total | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Facilities Capital Cost of Money (FCCOM) | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Sub-total | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Fixed Fee, if proposed | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Total Price/Cost for CLIN X001, CCE Operations | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Travel Costs | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Indirect Cost applies to Travel, if applicable | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Total Cost for CLIN X002, Travel | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Total for CLINs X001 and X002 - | |||||||||
| Total Cost/Grand Price) | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 |
Note 1: Offerors may add rows to identify each separate proposed indirect costs.
Note 2: Offerors may edit the order of the budget category rows to accurately capture the Offeror's indirect cost applications
Direct Labor Proposed Costs for Base Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1) Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2) PWS Paragraph No. Transition-In -OR- Start of Healthcare Delivery/Sustainment Labor (See Note 3) Direct Labor Rate Direct Labor Annual Salary Percentage of Effort / Full-Time Equivalent Productive Hours Direct Charged Non-Productive Hours, if applicable Total Direct Salary for Period (Direct Labor Cost) Subtotal Indirect Rate Identifier/Percentage, e.g Fringe, Overhead, etc. (See Note 4) Labor Adders (See Notes 5) Fixed Fee Total Cost / Grand Total Price Comments
TOTAL (as applicable)
NOTES:
Note 1: Exempt / Non-Exempt Labor – The Offeror shall identify whether a proposed labor category is exempt or non-exempt to the Service Contract Act. The Offeror shall either input “Exempt” or “Non-Exempt,” as applicable.
Note 2: Applicable Service Contract Act (SCA) Wage Determination (WD) Number – The Offeror shall identify the applicable SCA WD number, e.g. WD # 2017-0087, as applicable. Offerors are responsible for determining which SCA WD is applicable to its proposed labor.
Note 3: Transition-In -OR- Start of Healthcare Delivery/Sustainment Labor – The Offeror shall differentiate labor proposed to meet its proposed technical approach for the transition-in requirements of the Performance Work Statement (PWS) and labor proposed to meet its proposed technical approach for the Start of HealthCare Delivery (SHCD)/Sustainment requirements of the PWS. The Offeror shall identify this differentiation by inputting “Transition-In” or “SHCD/Sustainment,” as applicable.
Note 4: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Note 5: Labor Adders - If proposed compensation includes more than just basic labor pay (i.e., proposed compensation includes additional items such as bonuses, Service Contract Act requirements, etc.). Depending on the offeror's circumstances and proposal preparation methodology, more than one Labor Adder column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
"Labor Data for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number) "
Subcontract Labor Proposed Subcontract Labor Costs for Base Period: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1 from "Direct Labor Tab") Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2 from "Direct Labor Tab") PWS Paragraph No. Transition-In -OR- Start of Healthcare Delivery/Sustainment Labor (See Note 3 from "Direct Labor Tab") Full Burdened Labor Rate Fully Burdened Annual Salary Percentage of Effort / Full-Time Equivalents Productive Hours Total for Period Rate Identifiers / Labor Adders, if applicable (See Note 4 from "Direct Labor" tab) Fixed Fee, if applicable Total cost / Total Price Comments
TOTAL (as applicable)
Totals 0
Activity Report
| Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Base Period: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category. | ||||
| Activity Codes | WTC Billing Labor Category | FTE | Transition-In -OR- Start of Healthcare Delivery/Sustainment Labor (See Note 3 from "Direct Labor Tab") | Comments |
| Total FTE reported | 0 |
Rent - Lease Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: (enter contract number) Provide how Rent/Lease is calculated by completing Attachment 23 (include supporting documentation on original invoice and if a change in rate occurs.
ODC
Proposed Other Direct Costs (ODC) for Base Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | |||||||||
| Invoice/Receipt #, as applicable | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Transition-In -OR- Start of Healthcare Delivery/Sustainment ODC (See Note 1) | Indirect Rate Identifiers, if applicable (See Note 2) | Fixed Fee, if applicable | Total Cost / Total Price |
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment ODCs – The Offeror shall differentiate ODCs proposed to meet its proposed technical approach for the transition-in requirements of the Performance Work Statement (PWS) and ODCs proposed to meet its proposed technical approach for the Start of HealthCare Delivery (SHCD)/Sustainment requirements of the PWS. The Offeror shall identify this differentiation by inputting “Transition-In” or “SHCD/Sustainment,” as applicable.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Materials_Equipment Proposed Materials & Equipment for Base Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | ||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Transition-In -OR- Start of Healthcare Delivery/Sustainment ODC (See Note 1) | Indirect Rate Identifiers, if applicable (See Note 2) | Total Cost / Total Price |
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment Materials/Equipment – The Offeror shall differentiate materials/equipment proposed to meet its proposed technical approach for the transition-in requirements of the Performance Work Statement (PWS) and materials/equipment proposed to meet its proposed technical approach for the Start of HealthCare Delivery (SHCD)/Sustainment requirements of the PWS. The Offeror shall identify this differentiation by inputting “Transition-In” or “SHCD/Sustainment,” as applicable.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Travel Travel Expenditures Contract #: TBD Base Period:
All items must have been on proposal or approved in a change request.
Travel requires pre approval documentation.
All items over $5,000 require a receipt.
All travel requires invoices/receipt.
PWS Paragraph No. CLIN Transition-In -OR- Start of Healthcare Delivery/Sustainment Travel (See Note 1) Destination Duration Purpose Number of Travelers Proposed Airfare Transportation Cost, if applicable Proposed Rental Car Transportation Cost, if applicable Per Diem Subtotal Indirect Rate Identifier (See Note 2) Total Cost
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment Travel – The Offeror shall differentiate travel proposed to meet its proposed technical approach for the transition-in requirements of the Performance Work Statement (PWS) and travel proposed to meet its proposed technical approach for the Start of HealthCare Delivery (SHCD)/Sustainment requirements of the PWS, if applicable. The Offeror shall identify this differentiation by inputting “Transition-In” or “SHCD/Sustainment,” as applicable.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Indirect Rates Overhead for Base Period: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| Note: G&A, F&A, Fees, and Indirect Rates are to be defined and calculated here. | |
| Allowable Expense Categories: | |
| Facilities Costs (Attachment 23) | |
| Total Expenses | 0 |
| Overhead Rate | |
| Total Overhead | 0 |
Direct Labor (1) Labor Data for Option Period 1: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1) Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2) PWS Paragraph No. Start of Healthcare Delivery/Sustainment Labor Direct Labor Rate Direct Labor Annual Salary Percentage of Effort / Full-Time Equivalent Productive Hours Direct Charged Non-Productive Hours, if applicable Total Direct Salary for Period (Direct Labor Cost) Subtotal Indirect Rate Identifier/Percentage, e.g Fringe, Overhead, etc. (See Note 4) Labor Adders (See Notes 5) Fixed Fee Total Cost / Grand Total Price Comments
TOTAL (as applicable)
NOTES:
Note 1: Exempt / Non-Exempt Labor – The Offeror shall identify whether a proposed labor category is exempt or non-exempt to the Service Contract Act. The Offeror shall either input “Exempt” or “Non-Exempt,” as applicable.
Note 2: Applicable Service Contract Act (SCA) Wage Determination (WD) Number – The Offeror shall identify the applicable SCA WD number, e.g. WD # 2017-0087, as applicable. Offerors are responsible for determining which SCA WD is applicable to its proposed labor.
Note 3: Transition-In -OR- Start of Healthcare Delivery/Sustainment Labor – Not applicable to the Option Period 1 tab.
Note 4: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Note 5: Labor Adders - If proposed compensation includes more than just basic labor pay (i.e., proposed compensation includes additional items such as bonuses, Service Contract Act requirements, etc.). Depending on the offeror's circumstances and proposal preparation methodology, more than one Labor Adder column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Subcontract Labor (1) Subcontract Labor Data for Option Period 1: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1 from "Direct Labor Tab") Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2 from "Direct Labor Tab") PWS Paragraph No. Start of Healthcare Delivery/Sustainment Labor Full Burdened Labor Rate Fully Burdened Annual Salary Percentage of Effort / Full-Time Equivalents Productive Hours Total for Period Rate Identifiers / Labor Adders, if applicable (See Note 4 from "Direct Labor" tab) Fixed Fee, if applicable Total cost / Total Price Comments
TOTAL (as applicable)
Activity Report (1)
| Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Option Period 1: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category. | ||||
| Activity Codes | WTC Billing Labor Category | FTE | Start of Healthcare Delivery/Sustainment Labor | Comments |
| Total FTE reported | 0 |
ODC (1)
Other Direct Costs (ODC) for Option Period 1: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | |||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Start of Healthcare Delivery/Sustainment ODC | Indirect Rate Identifiers, if applicable (See Note 2) | Fixed Fee, if applicable | Total Cost / Total Price |
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment ODCs – Not applicable to the Option Period 1 tabs
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Rent - Lease (1) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)
Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change
Materials_Equipment (1) Materials & Equipment for Option Period 1: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | ||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Start of Healthcare Delivery/Sustainment ODC | Indirect Rate Identifiers, if applicable (See Note 2) | Total Cost / Total Price |
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment Materials/Equipment – Not applicable to the Option Period 1 tabs.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Travel (1) Travel Expenditures Option Period 1 Contract #: TBD All items must have been on proposal or approved in a change request.
Travel requires pre approval documentation.
All items over $5,000 require a receipt.
PWS Paragraph CLIN Start of Healthcare Delivery/Sustainment Travel Destination Duration Purpose Number of Travelers Proposed Airfare Transportation Cost, if applicable Proposed Rental Car Transportation Cost, if applicable Per Diem Subtotal Indirect Rate Identifier (See Note 2) Total Cost
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment Travel – Not applicable to the Option Period 1 tabs.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Direct Labor (2) Labor Data for Option Period 2: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1) Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2) PWS Paragraph No. Start of Healthcare Delivery/Sustainment Labor Direct Labor Rate Direct Labor Annual Salary Percentage of Effort / Full-Time Equivalent Productive Hours Direct Charged Non-Productive Hours, if applicable Total Direct Salary for Period (Direct Labor Cost) Subtotal Indirect Rate Identifier/Percentage, e.g Fringe, Overhead, etc. (See Note 4) Labor Adders (See Notes 5) Fixed Fee Total Cost / Grand Total Price Comments
TOTAL (as applicable)
NOTES:
Note 1: Exempt / Non-Exempt Labor – The Offeror shall identify whether a proposed labor category is exempt or non-exempt to the Service Contract Act. The Offeror shall either input “Exempt” or “Non-Exempt,” as applicable.
Note 2: Applicable Service Contract Act (SCA) Wage Determination (WD) Number – The Offeror shall identify the applicable SCA WD number, e.g. WD # 2017-0087, as applicable. Offerors are responsible for determining which SCA WD is applicable to its proposed labor.
Note 3: Transition-In -OR- Start of Healthcare Delivery/Sustainment Labor – Not applicable to the Option Period 2 tabs.
Note 4: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Note 5: Labor Adders - If proposed compensation includes more than just basic labor pay (i.e., proposed compensation includes additional items such as bonuses, Service Contract Act requirements, etc.). Depending on the offeror's circumstances and proposal preparation methodology, more than one Labor Adder column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Subcontract Labor (2) Subcontract Labor Data for Option Period 2: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1 from "Direct Labor Tab") Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2 from "Direct Labor Tab") PWS Paragraph No. Start of Healthcare Delivery/Sustainment Labor Full Burdened Labor Rate Fully Burdened Annual Salary Percentage of Effort / Full-Time Equivalents Productive Hours Total for Period Rate Identifiers / Labor Adders, if applicable (See Note 4 from "Direct Labor" tab) Fixed Fee, if applicable Total cost / Total Price Comments
TOTAL (as applicable)
Activity Report (2)
| Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Option Period 2: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and Direct Labor for each category. | ||||
| Activity Codes | WTC Billing Labor Category | FTE | Start of Healthcare Delivery/Sustainment Labor | Comments |
| Total FTE reported | 0 |
ODC (2)
Other Direct Costs (ODC) for Option Period 2: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | |||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Start of Healthcare Delivery/Sustainment ODC | Indirect Rate Identifiers, if applicable (See Note 2) | Fixed Fee, if applicable | Total Cost / Total Price |
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment ODCs – Not applicable to the Option Period 2 tabs.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Rent - Lease (2) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)
Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change
Materials_Equipment (2) Materials & Equipment for Option Period 2: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | ||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Start of Healthcare Delivery/Sustainment ODC | Indirect Rate Identifiers, if applicable (See Note 2) | Total Cost / Total Price |
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment Materials/Equipment – Not applicable to the Option Period 2 tabs.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Travel (2) Travel Expenditures Option Period 2 Contract #: TBD All items must have been on proposal or approved in a change request.
Travel requires pre approval documentation.
All items over $5,000 require a receipt.
PWS Paragraph No. CLIN Start of Healthcare Delivery/Sustainment Travel Destination Duration Purpose Number of Travelers Proposed Airfare Transportation Cost, if applicable Proposed Rental Car Transportation Cost, if applicable Per Diem Subtotal Indirect Rate Identifier (See Note 2) Total Cost
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment Travel – Not applicable to the Option Period 2 tabs.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Direct Labor (3) Labor Data for Option Period 3: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1) Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2) PWS Paragraph No. Start of Healthcare Delivery/Sustainment Labor Direct Labor Rate Direct Labor Annual Salary Percentage of Effort / Full-Time Equivalent Productive Hours Direct Charged Non-Productive Hours, if applicable Total Direct Salary for Period (Direct Labor Cost) Subtotal Indirect Rate Identifier/Percentage, e.g Fringe, Overhead, etc. (See Note 4) Labor Adders (See Notes 5) Fixed Fee Total Cost / Grand Total Price Comments
TOTAL (as applicable)
NOTES:
Note 1: Exempt / Non-Exempt Labor – The Offeror shall identify whether a proposed labor category is exempt or non-exempt to the Service Contract Act. The Offeror shall either input “Exempt” or “Non-Exempt,” as applicable.
Note 2: Applicable Service Contract Act (SCA) Wage Determination (WD) Number – The Offeror shall identify the applicable SCA WD number, e.g. WD # 2017-0087, as applicable. Offerors are responsible for determining which SCA WD is applicable to its proposed labor.
Note 3: Transition-In -OR- Start of Healthcare Delivery/Sustainment Labor – Not applicable to the Option Period 3 tabs.
Note 4: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Note 5: Labor Adders - If proposed compensation includes more than just basic labor pay (i.e., proposed compensation includes additional items such as bonuses, Service Contract Act requirements, etc.). Depending on the offeror's circumstances and proposal preparation methodology, more than one Labor Adder column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Subcontract Labor (3) Subcontract Labor Data for Option Period 3: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1 from "Direct Labor Tab") Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2 from "Direct Labor Tab") PWS Paragraph No. Start of Healthcare Delivery/Sustainment Labor Full Burdened Labor Rate Fully Burdened Annual Salary Percentage of Effort / Full-Time Equivalents Productive Hours Total for Period Rate Identifiers / Labor Adders, if applicable (See Note 4 from "Direct Labor" tab) Fixed Fee, if applicable Total cost / Total Price Comments
TOTAL (as applicable)
Activity Report (3)
| Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Option Period 3: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category. | ||||
| Activity Codes | WTC Billing Labor Category | FTE | Start of Healthcare Delivery/Sustainment Labor | Comments |
| Total FTE reported | 0 |
ODC (3)
Other Direct Costs (ODC) for Option Period 3: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | |||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Start of Healthcare Delivery/Sustainment ODC | Indirect Rate Identifiers, if applicable (See Note 2) | Fixed Fee, if applicable | Total Cost / Total Price |
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment ODCs – Not applicable to the Option Period 3 tabs.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Rent - Lease (3) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)
Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change
Materials_Equipment (3) Materials & Equipment for Option Period 3: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | ||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Start of Healthcare Delivery/Sustainment ODC | Indirect Rate Identifiers, if applicable (See Note 2) | Total Cost / Total Price |
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment Materials/Equipment – Not applicable to the Option Period 3 tabs.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Travel (3) Travel Expenditures Option Period 3 Contract #: TBD All items must have been on proposal or approved in a change request.
Travel requires pre approval documentation.
All items over $5,000 require a receipt.
PWS Paragraph No. CLIN Start of Healthcare Delivery/Sustainment Travel Destination Duration Purpose Number of Travelers Proposed Airfare Transportation Cost, if applicable Proposed Rental Car Transportation Cost, if applicable Per Diem Subtotal Indirect Rate Identifier (See Note 2) Total Cost
Note 1: Transition-In -OR- Start of Healthcare Delivery/Sustainment Travel – Not applicable to the Option Period 3 tabs.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Direct Labor (4) Labor Data for Option Period 4: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1) Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2) PWS Paragraph No. Start of Healthcare Delivery/Sustainment Labor -OR- Transition-Out Labor (See Note 3) Direct Labor Rate Direct Labor Annual Salary Percentage of Effort / Full-Time Equivalent Productive Hours Direct Charged Non-Productive Hours, if applicable Total Direct Salary for Period (Direct Labor Cost) Subtotal Indirect Rate Identifier/Percentage, e.g Fringe, Overhead, etc. (See Note 4) Labor Adders (See Notes 5) Fixed Fee Total Cost / Grand Total Price Comments
TOTAL (as applicable)
NOTES:
Note 1: Exempt / Non-Exempt Labor – The Offeror shall identify whether a proposed labor category is exempt or non-exempt to the Service Contract Act. The Offeror shall either input “Exempt” or “Non-Exempt,” as applicable.
Note 2: Applicable Service Contract Act (SCA) Wage Determination (WD) Number – The Offeror shall identify the applicable SCA WD number, e.g. WD # 2017-0087, as applicable. Offerors are responsible for determining which SCA WD is applicable to its proposed labor.
Note 3: Start of Healthcare Delivery/Sustainment Labor -OR- Transition-Out Labor – The Offeror shall differentiate labor proposed to meet its proposed technical approach for the transition-out requirements of the Performance Work Statement (PWS) and labor proposed to meet its proposed technical approach for the Start of HealthCare Delivery (SHCD)/Sustainment requirements of the PWS. The Offeror shall identify this differentiation by inputting “Transition-Out” or “SHCD/Sustainment,” as applicable.
Note 4: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Note 5: Labor Adders - If proposed compensation includes more than just basic labor pay (i.e., proposed compensation includes additional items such as bonuses, Service Contract Act requirements, etc.). Depending on the offeror's circumstances and proposal preparation methodology, more than one Labor Adder column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Subcontract Labor (4) Subcontract Labor Data for Option Period 4: XXXX (xx/xx/xx - xx/xx/xx)
Facility Employee Name WTC Billing Labor Category Exempt / Non-Exempt Labor (See Note 1 from "Direct Labor Tab") Applicable Service Contract Act Wage Determination Number, if applicable (See Note 2 from "Direct Labor Tab") PWS Paragraph No. Start of Healthcare Delivery/Sustainment Labor -OR- Transition-Out Labor (See Note 3 from "Direct Labor Tab" for Option Period 4) Full Burdened Labor Rate Fully Burdened Annual Salary Percentage of Effort / Full-Time Equivalents Productive Hours Total for Period Rate Identifiers / Labor Adders, if applicable (See Note 4 from "Direct Labor" tab) Fixed Fee, if applicable Total cost / Total Price Comments
TOTAL (as applicable)
Activity Report (4)
| Activity Codes Aligning to Labor Category for Direct and SubContract Labor CCE: Date for Option Period 4: XXXX (xx/xx/xx - xx/xx/xx) Note: Labor Category shall match the total reported for Subcontractor and DIrect Labor for each category. | ||||
| Activity Codes | WTC Billing Labor Category | FTE | Start of Healthcare Delivery/Sustainment Labor -OR- Transition-Out Labor (See Note 3 from "Direct Labor Tab" for Option Period 4) | Comments |
| Total FTE reported | 0 |
ODC (4)
Other Direct Costs (ODC) for Option Period 4: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | |||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Start of Healthcare Delivery/Sustainment ODCs -OR- Transition-Out ODCs (See Note 1) | Indirect Rate Identifiers, if applicable (See Note 2) | Fixed Fee, if applicable | Total Cost / Total Price |
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| $ - 0 | |||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Start of Healthcare Delivery/Sustainment ODCs -OR- Transition-Out ODCs – The Offeror shall differentiate ODCs proposed to meet its proposed technical approach for the transition-out requirements of the Performance Work Statement (PWS) and ODCs proposed to meet its proposed technical approach for the Start of HealthCare Delivery (SHCD)/Sustainment requirements of the PWS. The Offeror shall identify this differentiation by inputting “Transition-Out” or “SHCD/Sustainment,” as applicable.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Materials_Equipment (4) Materials & Equipment for Option Period 4: XXXX (xx/xx/xx - xx/xx/xx) Contract #: TBD
| All items must have been on proposal or approved in a change request. All receipts to be attached | ||||||||
| Invoice/Receipt # | Category of expenses | Quantity | PWS Paragraph No. | Amount | Description | Start of Healthcare Delivery/Sustainment ODCs -OR- Transition-Out ODCs (See Note 1) | Indirect Rate Identifiers, if applicable (See Note 2) | Total Cost / Total Price |
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| $ - 0 | ||||||||
| Total Other Direct Costs | $ - 0 |
Note 1: Start of Healthcare Delivery/Sustainment Materials/Equipment -OR- Transition-Out ODCs – The Offeror shall differentiate materials/equipment proposed to meet its proposed technical approach for the transition-out requirements of the Performance Work Statement (PWS) and materials/equipment proposed to meet its proposed technical approach for the Start of HealthCare Delivery (SHCD)/Sustainment requirements of the PWS. The Offeror shall identify this differentiation by inputting “Transition-Out” or “SHCD/Sustainment,” as applicable.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Rent - Lease (4) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)
Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change
Travel (4) Travel Expenditures Option Period 4 Contract #: TBD All items must have been on proposal or approved in a change request.
Travel requires pre approval documentation.
All items over $5,000 require a receipt.
PWS Paragraph No. CLIN Start of Healthcare Delivery/Sustainment Travel -OR- Transition-Out Travel (See Note 1) Destination Duration Purpose Number of Travelers Proposed Airfare Transportation Cost, if applicable Proposed Rental Car Transportation Cost, if applicable Per Diem Subtotal Indirect Rate Identifier (See Note 2) Total Cost
Note 1: Start of Healthcare Delivery/Sustainment Travel -OR- Transition-Out Travel – The Offeror shall differentiate travel proposed to meet its proposed technical approach for the transition-out requirements of the Performance Work Statement (PWS) and travel proposed to meet its proposed technical approach for the Start of HealthCare Delivery (SHCD)/Sustainment requirements of the PWS, if applicable. The Offeror shall identify this differentiation by inputting “Transition-Out” or “SHCD/Sustainment,” as applicable.
Note 2: Indirect Rate Identifier/Percentage, e.g. Fringe, Overhead, etc. - If the costs for a given column in any one period of performance are based on two or more rates, the offeror should provide an appropriately titled column that identifies the rate being used in the calculations for each row. Depending on the offeror's circumstances and proposal preparation methodology, more than one rate identifier column may be needed. The Offeror may add columns as necessary and change the title of the columns as necessary. The Offeror may re-order the columns for the “Rate Identifier/Percentage, e.g. Fringe, Overhead, etc.” and “Labor Adders” requests, as appropriate, to align with the offeror’s circumstances and proposal preparation methodology.
Rent - Lease (5) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)
Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change
Rent - Lease (6) Rent/Lease for Option Period: XXXX (xx/xx/xx - xx/xx/xx)
Provide how Rent/Lease is calculated - Include supporting documentation on original invoice and with each change
Activity & WTC Billing Title
| Activity Code | WTC Billing Labor Category | yes | Categories of expenses |
| 4.1 Contract Management (Directors only for this activity) | Administrative Assistant | no | Cleaning Supplies |
| 4.1.1 Training | Administrative Coordinator | Equipment | |
| 4.1.1.1 Training Reporting | Benefits Coordinator | Information Tech software | |
| 4.1.2 Staffing Requirements | Case Management | Information Tech Supplies | |
| 4.1.2.1 Staffing Report and Wages Report | Claims/Billing Manager | Medical Records | |
| 4.1.3 Coordination and Participation | Claims/Billing Specialist | Medical Supplies | |
| 4.1.4 Change Request (CR), Documentation, and Control Log | Clinic Manager | Office Supplies | |
| 4.1.5 Technical Guidance Document Compliance | Data Analyst | Other | |
| 4.1.6 Records Management | Deputy Director | Postage/Mailings | |
| 4.1.7 Risk and Issue Management | Director | ||
| 4.1.8 Fraud Waste and Abuse Compliance | Finance Specialist | ||
| 4.1.9 Quality Assurance Plan | Information Technology | ||
| 4.1.9.1 Quality Assurance Internal Audit Report | Medical Assistant | ||
| 4.2 Systems | Medical Records Coordinator | ||
| 4.2.1.2 Member Records | Member Services Coordinator | ||
| 4.2.2 Cost Tracking and Invoicing | Member Services Manager | ||
| 4.2.3 Operations Manual | Nurse | ||
| 4.3.1 Member Services | Nurse Manager | ||
| 4.3.2 Member Enrollment and Initial Contact | Pharmacist | ||
| 4.3.3 Member Retention | Physician | ||
| 4.3.4 Transfers | Physician Assistant | ||
| 4.3.5 Disruptive member and Member in Crisis Protocol | Project Coordinator | ||
| 4.3.6 Benefits Counseling | Psychiatrist | ||
| 4.3.6.1 Social Benefits Functions | Psychologist | ||
| 4.3.6.2 Assistance with Workers Compensation and other Healthcare Benefits | Pulmonologist | ||
| 4.3.7 Communication | Quality Assurance | ||
| 4.3.7.1 Translation and Interpretive Services | Revised Title | ||
| 4.3.7.2 Retention Activities for Current Members | Social Worker | ||
| 4.3.7.3 Outreach and Education for Prospective Members | |||
| 4.3.7.4 Establish Formal Mechanism for Consulting with Representative of Eligible Populations | |||
| 4.3.8 Administering Health Benefits | |||
| 4.3.8.1 Responsibilities of the Medical Director | |||
| 4.3.8.1.1 External Providers | |||
| 4.3.8.2 Responsibilities of the Mental Health Director | |||
| 4.3.8.3 Monitoring and Initial Health Evaluations | |||
| 4.3.8.3.1 Initial Health Evaluations | |||
| 4.3.8.3.2 Annual Monitoring Exam | |||
| 4.3.8.3.3 General Administration for AME/IHE | |||
| 4.3.8.4 Diagnostic Services | |||
| 4.3.8.6 Cancer Screening | |||
| 4.3.8.7 Certifications | |||
| 4.3.9 Medical Treatment for Certified Conditions | |||
| 4.3.9.1 Authorization of Services | |||
| 4.3.9.3 Prior Authorization] |
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