IRE_PRICING_FORM2.pdf

Attachment B — Pricing Form Hattiesburg Clinic RFP No. [HC-RTG-2026-IRE] | EHR Isolated Recovery Environment (IRE) Service

Bidder Information

Company (legal name): UEI (SAM.gov):

Contact name / title: Email:

Phone:

Enter amounts in U.S. dollars, excluding sales tax. Subtotals and totals calculate automatically. Do not leave required lines blank; enter 0 if not applicable.

A. One-Time Implementation Costs Amount (USD)

A1 Project management, design, installation and configuration

A2 Initial data seeding and initial full recovery test

A3 Runbooks, documentation, training / knowledge transfer

A4 Other one-time costs (describe in Pricing Notes)

Subtotal A — One-Time Costs

B. Year 1 Recurring Costs (12 months from service acceptance) Amount (USD)

B1 IRE subscription — hosting, isolated environment, immutable storage Sized for protected capacity stated in SOW Section 3

B2 Clean-room recovery / malware scanning capability If not included in B1, enter 0

B3 24x7 monitoring, support and managed services

B4 Scheduled recovery testing (minimum per SOW Section 4.6) If not included in B1/B3, enter 0

B5 Other recurring costs (describe in Pricing Notes)

Subtotal B — Year 1 Recurring Costs

C. Year 1 Total Amount (USD)

C1 Year 1 Total, pre-tax (Subtotal A + Subtotal B)

C2 Applicable sales tax (if any) Identify basis / rate in Pricing Notes

C3 YEAR 1 GRAND TOTAL (C1 + C2)

Attachment B — Pricing Form Hattiesburg Clinic RFP No. [HC-RTG-2026-IRE] | EHR Isolated Recovery Environment (IRE) Service

D. Optional Renewal Years (pre-tax; Clinic not obligated to renew) Amount (USD)

D1 Year 2 — annual recurring cost (all services in Section B)

D2 Year 3 — annual recurring cost (all services in Section B)

Three-Year Total, pre-tax (C1 + D1 + D2)

E. Unit Rates (for growth or additional work) Amount (USD)

E1 Additional protected capacity — price per TB per month

E2 Professional services — hourly rate

E3 Additional recovery test (beyond contracted frequency) — per test

F. Proposed Service Commitments

Committed RPO (EHR environment):

Committed RTO (EHR environment):

Annual price escalation cap for renewal years (%):

Proposal valid through (date):

G. Pricing Notes, Assumptions and Exclusions

H. Certification The undersigned certifies that the prices above are complete for all requirements of the Scope of Work, were arrived at independently, and will remain firm for the validity period stated. Any cost not listed will not be paid by the Clinic.

Authorized signature:

Printed name / title:

Date:

Signature may be applied digitally, or the completed form may be printed, signed and scanned.

Supplemental vendor quotes may be attached but do not replace this form.