ESBD_541915_1784820245967_EXhibit_C_Pricing Sheet.xlsm

This is a pricing sheet and submission requirements document for a Request for Proposal issued by the Texas Health and Human Services Commission (HHS) Purchasing on behalf of the Lubbock State Supported Living Center (SSLC). The solicitation seeks dental services for residents at the facility, with the event posted on July 23, 2026, and bids due by August 6, 2026, at 10:30 AM CST. The pricing sheet establishes a bid range with a best price of $0.00 and worst price of $200,000.00 per individual appointment during regular hours, as specified in PCS 137 solicitation document section 7.

Respondents must submit multiple required documents including valid State of Texas Medical Board of Dental Medical Examiners certification, anesthesia certification, current CPR certification, completed Exhibit A HHS Solicitation Affirmations (pages 1-13), completed Exhibit C Pricing Sheet, completed Exhibit D Bidder Reference Form, and documentation demonstrating financial capability and capacity to perform. Optional submissions include completed Exhibit F form 4109 application for TIN if applicable, Addendum Acknowledgement Form(s) if issued, and Public Information Act copies of the bid response if applicable. Failure to submit the affirmations, pricing sheet, and reference form will result in bid disqualification. All bids must be submitted in US Dollars, with no alternative currency accepted.