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Fillable Table (3 Tables Total) RFQ No. 75H70726Q00006
Table #1: Total Pricing (dates are tentative)
| Item # |
| Contract Period |
| Pricing |
| Total Amount |
CLIN 1
| Base Year: 11/15/2025 – 11/14/2026 |
| Equipment: $______________ |
$______________/year
Service: $______________
Test Per Cost or Test Per Reportable: $______________
| CLIN 2 |
| 1st Option Year: 11/15/2026 – 11/14/2027 |
| Equipment: $______________ |
Service: $______________
Test Per Cost or Test Per Reportable: $______________
| CLIN 3 |
| 2nd Option Year: 11/15/2027 – 11/14/2028 |
| Equipment: $______________ |
Service: $______________
Test Per Cost or Test Per Reportable: $______________
| CLIN 4 |
| 3rd Option Year: 11/15/2028 – 11/14/2029 |
| Equipment: $______________ |
Service: $______________
Test Per Cost or Test Per Reportable: $______________
| CLIN 5 |
| 4th Option Year: 11/15/2029 – 11/14/2030 |
| Equipment: $______________ |
Service: $______________
Test Per Cost or Test Per Reportable: $______________
| GRAND TOTAL (base year + option years): |
| $__________________ |
Table #2: Supplies
| Products: Supplies |
| Part # |
| Annual # of Kits |
| Cost |
| 1 |
| ANEMIA CAL - DIMENSION - CAL - 5x2x2mL |
| 10463372 |
| 6 |
| $_________ |
| 2 |
| Alkaline Phosphatase - DIMENSION - CAL - 3x2x1mL |
| 10714028 |
| 3 |
| $_________ |
| 3 |
| Check - DIMENSION - CONS - 8 Flexe |
| 10481507 |
| 23 |
| $_________ |
| 4 |
| Chem 1 Calibrator - DIMENSION - CAL - 2x3x2mL |
| 10716280 |
| 8 |
| $_________ |
| 5 |
| Chem 3 Calibrator - DIMENSION - CAL - 3x2x2.5mL |
| 10711580 |
| 4 |
| $_________ |
| 6 |
| Chem II - DIMENSION - CAL - 2x3x1,2mL |
| 10444997 |
| 2 |
| $_________ |
| 7 |
| Chemistry Wash - DIMENSION - CONS - 1x1,7 Liter |
| 10445052 |
| 12 |
| $_________ |
| 8 |
| Cholesterol II - DIMENSION - CAL - 2x3x1mL |
| 10444998 |
| 2 |
| $_________ |
| 9 |
| Cup Small - DIMENSION - CONS - 1000 Pieces |
| 10445040 |
| 4 |
| $_________ |
| 10 |
| Cup/Lid - DIMENSION - CONS - 1000 Pieces |
| 10445041 |
| 3 |
| $_________ |
| 11 |
| Cuvette Cartridge - DIMENSION - CONS - 1 Cartridge |
| 10445042 |
| 39 |
| $_________ |
| 12 |
| Enzyme 2 - DIMENSION - CAL - 2x3x1,5mL |
| 10476170 |
| 6 |
| $_________ |
| 13 |
| Enzyme Diluent 790035901 - DIMENSION - CAL - 10x10mL |
| 10444870 |
| 6 |
| $_________ |
| 14 |
| Enzyme Verifier - DIMENSION - CONS - 2x3x2mL |
| 10445016 |
| 2 |
| $_________ |
| 15 |
| Ferritin - DIMENSION - CAL - 2x5x1mL |
| 10445017 |
| 3 |
| $_________ |
| 16 |
| HDL Cholestrol - DIMENSION - CAL - 2x3x1mL |
| 10464328 |
| 2 |
| $_________ |
| 17 |
| HM Reaction Vessel - DIMENSION - CONS |
| 10445044 |
| 23 |
| $_________ |
| 18 |
| Iron Binding Capacity - DIMENSION - CAL - 2x3x1mL |
| 10445006 |
| 2 |
| $_________ |
| 19 |
| Iron revised - DIMENSION - CAL - 2x2x1,2mL |
| 10445010 |
| 3 |
| $_________ |
| 20 |
| LDL Cholestrol - DIMENSION - CAL - 2x3x2ml |
| 10444996 |
| 3 |
| $_________ |
| 21 |
| Microalbumin - DIMENSION - CAL - 2x5x1mL |
| 10445022 |
| 6 |
| $_________ |
| 22 |
| Multi 2 sample diluent - VISTA - CAL - 6x2,5mL |
| 10483586 |
| 3 |
| $_________ |
| 23 |
| Paper - DIMENSION - CONS - 4 Rolls |
| 10445050 |
| 5 |
| $_________ |
| 24 |
| Probe Cleaner - DIMENSION - CONS - 1x500mL |
| 10445036 |
| 73 |
| $_________ |
| 25 |
| Protein (CSF/Urine) - DIMENSION - CAL - 2x5x4mL |
| 10444989 |
| 3 |
| $_________ |
| 26 |
| Sample Probe Cleaner - DIMENSION - CONS - 1x1 Liter |
| 10445035 |
| 12 |
| $_________ |
| 27 |
| Thyroid - DIMENSION - CAL - 2x5x2mL |
| 10484354 |
| 3 |
| $_________ |
| 28 |
| Total Protein/Albumin - DIMENSION - CAL - 2x3x2mL |
| 10444993 |
| 2 |
| $_________ |
| 29 |
| Total/DirectBilirubin - DIMENSION - CAL - 2x2x1mL |
| 10445013 |
| 2 |
| $_________ |
| 30 |
| Vitamin D Cal - Dimension - CAL - 5x2x1.5mL |
| 10711395 |
| 6 |
| $_________ |
| 31 |
| Water ACAIV/V DIM710615901 - DIMENSION - CONS - 4x3,5 |
Liter
Table #3: Test Analytes
| Test Description |
| Annual Volume |
| Cost |
| High Density Lipoprotein (cholesterol) |
| 8400 |
| $____________ |
| Albumin |
| 9600 |
| $____________ |
| Low Density Lipoprotein (cholesterol) |
| 960 |
| $____________ |
| Alanine Aminotransferase |
| 9600 |
| $____________ |
| Amylase |
| 1440 |
| $____________ |
| Aspartate Aminotransferase |
| 9720 |
| $____________ |
| Calcium |
| 10,560 |
| $____________ |
| Cholesterol |
| 8640 |
| $____________ |
| Creatinine |
| 15,840 |
| $____________ |
| Enzymatic Carbonate |
| 9720 |
| $____________ |
| Ferritin |
| 1320 |
| $____________ |
| Free T3 |
| 1920 |
| $____________ |
| Free T4 |
| 1920 |
| $____________ |
| Glucose |
| 8640 |
| $____________ |
| Hemoglobin A1C |
| 9840 |
| $____________ |
| Iron Binding (IBCT) |
| 1440 |
| $____________ |
| Magnesium |
| 1920 |
| $____________ |
| Microalbumin |
| 6720 |
| $____________ |
| Phosphorus |
| 2880 |
| $____________ |
| Total bilirubin |
| 9600 |
| $____________ |
| Triglyceride |
| 8640 |
| $____________ |
| Total Protein |
| 9600 |
| $____________ |
| Urine Protein |
| 720 |
| $____________ |
| Vitamin B12 |
| 6960 |
| $____________ |
| Vitamin D 25-OH |
| 5200 |
| $____________ |
**Please include initial set-up fee, if necessary.
**If price is included in yearly total, you may list “included” for price.
***You may use a format of your own***
