Exhibit C - Cost Exhibit.xlsm

This is a Cost Exhibit form for a Colorado Department of Personnel and Administration (DPA) request for proposal regarding Short-Term and Long-Term Disability Benefits. The solicitation seeks pricing and benefit proposals for disability insurance coverage with an assumed annual covered payroll of $10,000,000. The contract term spans five years from July 1, 2027, through June 30, 2032, with annual pricing required for each contract year (7/1/27-6/30/28, 7/1/28-6/30/29, 7/1/29-6/30/30, 7/1/30-6/30/31, and 7/1/31-6/30/32).

The exhibit requires vendors to submit detailed pricing for Short-Term Disability (STD) benefits and Long-Term Disability (LTD) benefits in Excel format only. For STD, offerors must provide monthly premium rates per $100 of covered payroll based on a current plan maximum weekly benefit of $3,000, with a benefit commencement period of 30 calendar days and a 22-week benefit period at 60% wage replacement. For LTD, vendors must submit volume rates per $1,000 of monthly payroll across multiple age brackets for each contract year. Offerors must clearly identify any services from the Scope of Work not included in their fees, provide additional fees where applicable, or indicate "N/A" if unable to offer specific services. All responses must include vendor name, authorized signature, contact information, and detailed comments clarifying proposal pricing. Offerors are prohibited from adding or deleting rows, altering pre-labeled text, or extracting individual worksheets as separate files.