ESBD_423000_1748371670436_HHS0016228_Exhibit_F_ Pricing_Sheet.pdf

Formal IFB - Solicitation No:HHS0016228

Line No.

Class-Item Description Qty UOM Unit Price Extension

1 520/70 Orthosis insoles and shoes 1 EA $ - $ -

2 L3010 Foot, insert, removable, molded to patient model, longitudinal arch support

1 EA $ - $ -

3 L3020 Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support

1 EA $ - $ -

4 L3030 Foot, insert, removable 1 EA $ - $ - 5 L3310 Lift, elevation, heel and sole, neoprene 1 EA $ - $ -

6 L3332 Lift, elevation, inside shoe, tapered, up to one-half inch

1 EA $ - $ -

7 L3216 Orthopedic footwear, ladies shoe, depth inlay 1 EA $ - $ - 8 L3221 Orthopedic footwear, men’s shoe, depth inlay 1 EA $ - $ - 9 L3300 Lift, elevation, heel, tapered to metatarsals 1 EA $ - $ -

10 L3230 Custom shoe, orthopedic footwear, depth inlay 1 EA $ - $ -

11 L2360 Addition to lower extremity, extended steel shank 1 EA $ - $ -

12 L5000 Partial foot, shoe insert with longitudinal arch, toe filler

1 EA $ - $ -

13 L3580 Orthopedic shoe addition, convert instep to velcro closure

1 EA $ - $ -

14 L1930 Ankle foot orthosis, plastic or other material 1 EA $ - $ - 15 L1940 Ankle foot orthosis, plastic or other material 1 EA $ - $ - 16 L1960 Ankle foot orthosis, posterior solid ankle, plastic 1 EA $ - $ - 17 L1970 Foot orthosis, plastic with ankle joint 1 EA $ - $ -

18 L1820 Knee orthosis, elastic with condylar pads and joints, with or without patellar control

1 EA $ - $ -

19 Anke Socks 1 EA $ - $ - 20 creq Socks 1 EA $ - $ - 21 Over the calf Socks 1 EA $ - $ -

Fitting and Follow up fitting must be included $ -

A5500 Custom preparation and supply of off-the-shelf depth- inlay shoe manufactured to accommodate multi- density insert(s), EA $ -

A5501 Custom preparation and supply of shoe molded from cast(s) of patients foot (custom molded shoe), EA $ -

EXHIBIT F

PRICING SHEET

Response Due Date: 06-10-2025 @ 10:30AM

424 Mesquite Dr.

Mexia, TX 76667

Ship To:

Mexia State Supported Living Center

A5512

Multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, EA $ -

A5513

Multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher, includes arch filler and other shaping material, custom fabricated

EA $ -

A5503 Modification of off-the-shelf depth-inlay shoe or custom- molded shoe with roller or rigid rocker bottom

EA $ -

Beige w/ closed toe (sizes available) $ -

Price Per Pair 15-20 mmHg 20-30 mmHg

30-40 mmHg

Knee High (S, M, L, XL)

Knee High w/ silicone band

(M, L, XL)

Thigh High (S, M, L, XL)

Thigh high w/ silicone band

(S, M, L, XL)

Beige w/ Open toe (sizes available) $ -

Price Per Pair 15-20 mmHg 20-30 mmHg

30-40 mmHg

Knee High (S, M, L, XL)

Knee High w/ silicone band

(M, L, XL)

Thigh High (S, M, L, XL)

Thigh high w/ silicone band

(S, M, L, XL)

Black w/ closed toe (sizes available) $ -

Price Per Pair 15-20 mmHg 20-30 mmHg

30-40 mmHg

Knee High (S, M, L, XL)

Knee High w/ silicone band

(M, L, XL)

Thigh High (S, M, L, XL)

Thigh high w/ silicone band

(S, M, L, XL)

22 1 EA $ - $ -

23 1 EA $ -

24 2 EA $ - $ -

25 3 EA $ - $ -

Freight 1 EA $ - $ -

Total $ -

NOTE: Quote F.O.B. Destination Freight Prepaid & Included, otherwise show exact delivery cost and terms. Unless stated otherwise, delivery is considered to be 14 days after receipt of order

Estimated Delivery Time:

Exhibit