Exhibit C - Cost Exhibit.xlsm

This is a Cost Exhibit for a Colorado Department of Personnel & Administration (DPA) procurement for Short-Term and Long-Term Disability Benefits. The solicitation seeks proposals for both STD and LTD insurance coverage with pricing structured across five contract years commencing July 1, 2027, and concluding June 30, 2032. Offerors must complete three exhibits: an Offeror Information Sheet documenting organizational details and authorized representatives; Exhibit 1 providing STD fee quotations based on an assumed annual covered payroll of $10,000,000 with pricing expressed as a monthly premium rate per $100 of covered payroll for each contract year; and Exhibit 2 outlining the Schedule of Benefits for STD coverage with a current maximum weekly benefit of $3,000, a 60% benefit percentage, a 22-week benefit period, and a 30-calendar-day waiting period. Offerors must also complete Exhibit 3 for LTD pricing with rates expressed per $1,000 of monthly payroll, segmented by age bracket across the five-year term.

All exhibits must be submitted in Excel format without alterations to pre-populated rows, columns, or labeled text, with offerors instructed to complete only yellow-shaded areas and provide detailed comments clarifying pricing proposals and any deviations from the current plan. Vendors must identify any services within the Scope of Work that their fee does not include and indicate additional fees accordingly, or mark services as N/A if unable to offer them. The current STD plan includes standard exclusions for occupational injuries, self-inflicted injuries, loss of professional license, criminal acts, incarceration, and war-related disabilities, with offsets for state compulsory benefits, workers' compensation, Social Security disability payments, and other group insurance plans.