EXHIBIT 2A - SCHEDULE OF QUANTITIES AND PRICES.xlsx

XLSX spreadsheet 12 KB Posted

Attached to
Third Party Administrator (TPA) Conflict Claims. Amendment 1 added. update 8/27
Solicitation number
PS143950
Issued by
California

About this file

This is a price proposal exhibit for a Third Party Administrator (TPA) Conflict Claims contract opportunity with the State of California, specifically for Metro. The TPA will deliver administrative, operational, and compliance-related services for conflict claims in accordance with applicable laws, regulatory requirements, industry standards, and agreed upon performance metrics. The contract term is three years (Years 1 through 3), with the pricing proposal structured to evaluate two claim types: Indemnity claims (estimated at 12 per year) and Medical Only claims (estimated at 2 per year).

Proposers must submit fully burdened annual claim administration fees for each year of the contract period in the designated yellow cells. The pricing structure requires proposers to provide rates for each claim type for Years 1, 2, and 3, with estimated costs calculated by multiplying the proposed fee by the estimated claims per year for evaluation purposes only. The document emphasizes that the estimated claims per year figures are hypothetical scenarios used solely for proposal evaluation and do not represent actual claims for contract performance. Proposers must complete the form with authorized signatory information including name, signature, title, and date.

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Other files

File Type Posted
EXHIBIT 7 - LIST OF COMPLETED CONTRACTS - LAST FIVE (5) YEARS.pdf PDF
EXHIBIT 5 - PROPOSAL LETTER.pdf PDF
FORM 4 - SBE AFFIRMATION.pdf PDF
FORM 1 - SBE PROPOSED SUBCONTRACTORS & SUPPLIERS.pdf PDF
RFP No. PS143950 - Third Party Administrator (TPA) Conflict Claims.pdf PDF
EXHIBIT E-1 - PAYMENT CERTIFICATION (CONTINUOUS).pdf PDF
EXHIBIT 6 - LIST OF CURRENT CONTRACTS - BACKLOG.pdf PDF
EXHIBIT B - PRICING AGREEMENT.pdf PDF
EXHIBIT 9 - GENERAL CERTIFICATIONS.pdf PDF
EXHIBIT G - APPROVED SUBCONTRACTORS AND SUPPLIERS.pdf PDF
FORM 3 - SBE BUSINESS DATA SHEET.pdf PDF
EXHIBIT E-2 - PAYMENT CERTIFICATION (FINAL).pdf PDF
EXHIBIT 8 - ETHICS DECLARATION.pdf PDF
EXHIBIT A - SCOPE OF SERVICES.pdf PDF
EXHIBIT D - DEOD CONTRACT COMPLIANCE MANUAL (SET-ASIDE).pdf PDF
FORM 5 - SBE BIDDERS LIST.pdf PDF
EXHIBIT 4 - LIST OF CERTIFIED FIRMS (RESERVED).pdf PDF
EXHIBIT 2B - FORM 60 INSTRUCTIONS - PROFESSIONAL SERVICES COST_PRICE SUMMARY.pdf PDF
RFP No. PS143950 - Amendment No. 1.pdf PDF
EXHIBIT C - WORK-COMPLETION_DELIVERABLE SCHEDULE (RESERVED).pdf PDF
EXHIBIT 10 - CERTIFICATE OF COMPLIANCE WITH 49 CFR PART 655.pdf PDF
EXHIBIT 11 - NONCOLLUSION AFFIDAVIT TO BE EXECUTED BY PROPOSER.pdf PDF
EXHIBIT G - APPROVED SUBCONTRACTORS AND SUPPLIERS (RESERVED).pdf PDF
EXHIBIT F - RELEASE OF CLAIMS.pdf PDF
EXHIBIT 3 - EVALUATION CRITERIA.pdf PDF
EXHIBIT 2B - FORM 60.xlsx XLSX spreadsheet
FORM 2 - SBE AFFIDAVIT.pdf PDF
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Price Proposal

EXHIBIT 2A - SCHEDULE OF QUANTITIES AND PRICES
THIRD PARTY ADMINISTRATOR (TPA) CONFLICT CLAIMS
Proposers must only completed cells highlighted in Yellow.

Using the Estimated Claims Per Year (G), Proposers are required to provide their fully burdened annual rates under Claim Administration Fee for each year (A through C) for claims listed in the Description of Claim Types (Column 1) and calculate the Estimated Cost Per Year and Extended Cost Estimate, which will be used solely for of the evaluation of proposals.

Note: The Estimated Claims Per Year (G) listed in the scenario is not representative of the actual claims for contract performance. They are for proposal evaluation purposes only. The Estimated Cost Per Year will auto-calculate, please do not make changes to those fields.

Proposer: _______________________

PERIOD OF PERFORMANCE (YEARS 1 THROUGH 3)
1. Description of Claim Types2. Claim Administration Fee3. Estimated Claims Per Year *4. Estimated Cost Per Year5. Extended Cost Estimate
(A)(B)(C)(G)(A x G)(B x G)(C x G)
Year 1Year 2Year 3Year 1Year 2Year 3
Indemnity12$0.00$0.00$0.00$0.00
Medical Only2$0.00$0.00$0.00$0.00
Total (3-Year Base Term)$0.00$0.00$0.00$0.00

*TOTALS FOR EVALUATION PURPOSES ONLY

Name of Authorized Signatory: __________________________________Signature: ___________________________________
Title of Authorized Signatory: ____________________________________Date: _______________________________________

File details come from the government source that posted it. Updated .