ESBD_481083_1767887460034_Exhibit C Pricing Sheet_HHS0016850.pdf
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- Attached to
- Dental Anesthesia Services at Austin SSLC
- Solicitation number
- HHS0016850
- Issued by
- Texas
About this file
This is an Exhibit C Pricing Sheet for a Request for Proposal issued by the Texas Health and Human Services (HHS) agency for dental anesthesia services at the Austin State Supported Living Center (SSLC). The solicitation seeks qualified dental anesthesia providers to deliver sedation services during both regular and outside business hours. Respondents must submit completed bid documentation by January 23, 2026, with the post date of January 8, 2026. The contract requires bidders to demonstrate minimum experience and qualifications as outlined in Section 7.1.5 of the scope of work.
Pricing responses must be submitted on a per 15-minute increment basis and must be all-inclusive with separate rates for regular hours and outside-of-hours services. Bidders are required to provide a fee schedule on company letterhead for any additional pricing related to dental anesthesia services and must include documentation of current Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) licensing, as well as a Texas State Board of Dental Examiners (TSBDE) anesthesia permit with endorsement to provide sedation. Additional submission requirements include completed Exhibit A HHS Solicitation Affirmations (v. 2.9, effective December 2025), Exhibit D Bidder Reference Form, proof of financial capability and solvency, Addendum Acknowledgement Forms if applicable, and documentation of minimum experience and qualifications. Failure to complete and submit the Exhibit C Pricing Sheet and Exhibit A forms will result in bid disqualification.
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Text version
Exhibit C Pricing Sheet
Event ID Format Type Round Version Respondent:
HHSTX-HHS0016850 Buy RFx 1 1
Event Name
Post Date
Event Currency: US Dollar
Bids Allowed in Other Currency: No Submit To: HHS Purchasing
See Solicitation for Submission Instructions
United States
Contact: Graham,Mary Ann
Event Description
General Questions
Attach completed Exhibit C Pricing Sheet. FAILURE TO
COMPLETE FORM AND SUBMIT WILL DISQUALIFY BID
RESPONSE.
Attach completed and signed Exhibit A HHS Solicitation Affirmations, v. 2.9, effective December 2025, Pages 1-14.
FAILURE TO COMPLETE FORM AND SUBMIT WILL
DISQUALIFY BID RESPONSE.
Bid Factor Response Required: Yes
Attach Fee Schedule, on company letterhead, for any additional pricing related to providing dental anesthesia services.
Bid Factor Response Required: Yes
Attach Texas State Board of Dental Examiners (TSBDE) anesthesia permit with endorsement to provide sedation as outlined in Section 7.1.5 Minimum Experience and Qualifications.
Bid Factor Response Required: Yes
Attach proof of Doctor of Dental Surgery (DDS) and/or Doctor of Dental Medicine (DMD) licensing as outlined in Section 7.1.5 Minimum Experience and Qualifications.
Bid Factor Response Required: Yes
What is your rate, per 15-minute increment, to provide dental anesthesia services OUTSIDE of regular hours as outlined in Section 7 Scope of Work? Pricing must be all inclusive.
Bid Factor Response Required: Yes
Dental Anesthesia Services at Austin SSLC
Question Response:
What is your rate, per 15-minute increment, to provide dental anesthesia services as outlined in Section 7 Scope of Work?
Pricing must be all inclusive.
Bid Factor Response Required: Yes
1/8/2026 1/23/2026
Dental Anesthesia Services at Austin SSLC
Due Date
Attach Public Information Act copy of bid response, if applicable. Reference Section 12.7 Public Information Act.
Bid Factor Response Required: Yes
Attach completed and signed Addendum Acknowledgement Form(s), if issued. Reference Section 6.8 Notification of Addenda or Cancellation.
Bid Factor Response Required: Yes
Attach other information pertinent to demonstrate financial capability, financial solvency and ability to perform and capacity to fulfill the solicitation requirements.
Bid Factor Response Required: Yes
Attach documentation of Minimum Experience and Qualifications, per Section 7.1.5.
Bid Factor Response Required: Yes
Attach completed Exhibit D Bidder Reference Form.
Bid Factor Response Required: Yes
Bid Factor Response Required: Yes
General Details
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