EXHIBIT 2A - SCHEDULE OF QUANTITIES AND PRICES.xlsx
XLSX spreadsheet 12 KB Posted
- 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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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 Types | 2. Claim Administration Fee | 3. Estimated Claims Per Year * | 4. Estimated Cost Per Year | 5. Extended Cost Estimate | ||||
| (A) | (B) | (C) | (G) | (A x G) | (B x G) | (C x G) | ||
| Year 1 | Year 2 | Year 3 | Year 1 | Year 2 | Year 3 | |||
| Indemnity | 12 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| Medical Only | 2 | $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 .