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Porterville Developmental Center
PR169001
STATE OF CALIFORNIA--HEALTH AND HUMAN SERVICES AGENCY
EDMUND G. BROWN, Governor
PORTERVILLE DEVELOPMENTAL CENTER
P.O. BOX 2000, PORTERVILLE, CA 93258-2000
(559) 782-2222
TDD 781-7822
INVITATION FOR BID
Notice to Prospective Bidders
Addemdum #1 March 16, 2016 You are invited to review and respond to this Invitation for Bid (IFB), entitled Clinical Laboratory Blood Analysis Services –PR169001. In submitting your bid, you must comply with these instructions.
Note that all agreements entered into with the State of California will include by reference General Terms and Conditions and Contractor Certification Clauses that may be viewed and downloaded at Internet site www.ols.dgs.ca.gov/Standard +Language. If you do not have Internet access, a hard copy can be provided by contacting the person listed below.
In the opinion of Porterville Developmental Center, this Invitation for Bid is complete and without need of explanation. However, if you have questions, or should you need any clarifying information, the contact person for this IFB is:
DeeAnn LeVasser – Contract Analyst Porterville Developmental Center
(559)782-2261
The State has waived the Disabled Veteran Business Enterprise (DVBE) Participation Program requirement for this contract.
Please note that no verbal information given will be binding upon the State unless such information is issued in writing as an official addendum.
DeeAnn LeVasser
Contract Analyst Table of Contents
Section
Page
A) Purpose and Description of Services
B) Bidder Minimum Qualifications
C) Bid Requirements and Information
1) Key Action Dates ………………………………………………………………..
2) Submission of Bid……………………………………………………………….
3) Evaluation and Selection……………………………………………………….
4) Award and Protest……………………………………………………………….
5) Disposition of Bid………………………………………………………………..
6) Agreement Execution and Performance ……………………………………..
D) Preference Programs
1) Small Business Preference…..………………………………………………..
E) Required Attachments
1) Disabled Veteran Business Enterprise (DVBE) Participation Program
2) Required Attachment Check List
3) Bid/Bidder Certification Sheet
4) Sample Cost Sheet
5) Bidder References
6) Darfur Contracting Act
7) Lab Test and Cost List Bid Sheets
F) Sample Standard Agreement (STD 213)
1) Exhibit A, Scope of Work
2) Exhibit B, Budget Detail and Payment Provisions
3) Exhibit C, General Terms and Conditions
4) Exhibit D, Special Terms and Conditions
5) Exhibit E, Statement of Assurances for Protection of Personal Information
A) Purpose and Description of Services
Contractor will provide clinical laboratory analysis services to test blood samples for clients and employees in accordance with the attached Sample Agreement. See Exhibit A of the IFB for the description of required services. The terms of this Agreement will be July 1, 2016, through June 30, 2018.
B) Bidder Minimum Qualifications
All bidders must meet the following requirements to be considered responsible and responsive to this IFB.
1. No bidder may bid on work of any kind that the bidder is not properly licensed to perform. Any such bid received will be disqualified. Copies of all licenses must be included with the BID documents.
2. Contractor must comply with all state licensing requirements and be an approved Medicare/Medi-Cal provider.
3. Bidder must be able to supply all specified items and services to Porterville Developmental Center (PDC) in accordance with the attached Sample Agreement.
C) Bid Requirements and Information
1) Key Action Dates
Event
Date
IFB available to prospective bidders
March 16, 2016
Final Date for Bid Submission
April 8, 2016 @ 1:00 p.m.
Bid Opening
April 8, 2016 @ 1:30 p.m.
Notice of Intent to Award
April 8, 2016 Proposed Award Date
April 13, 2016 2) Submission of Bid
a) All bids must be submitted under sealed cover and sent to Porterville Developmental Center Attention DeeAnn LeVasser by dates and times shown in Section C, Bid Requirements and Information, Item 1) Key Action Dates, (page 3). The sealed cover must be plainly marked with the IFB number and title, must show your firm name and address, and must be marked with "DO NOT OPEN", as shown in the following example:
PR169001
Laboratory Blood Analysis Services Porterville Developmental Center
26501 Avenue 140
Porterville, CA 93257
DO NOT OPEN
Bids not submitted under sealed cover may be rejected. A minimum of one copy of the bid must be submitted.
b) All bids shall include the documents identified in Section E, Required Attachment Checklist (see page 8). Bids not including the proper "required attachments" shall be deemed non-responsive. A non-responsive bid is one that does not meet the basic bid requirements.
c) All documents requiring a signature must bear an original signature of a person authorized to bind the bidding firm.
d) Mail or deliver bids to the following address:
U.S. Postal Service Deliveries & Hand Deliveries
(UPS, Express Mail, Federal Express)
Porterville Developmental Center
26501 Avenue 140
Porterville, CA 93257
e) Bids must be submitted for the performance of all the services described herein. Any deviation from the work specifications will not be considered and will cause a bid to be rejected.
f) A bid may be rejected if it is conditional or incomplete, or if it contains any alterations of form or other irregularities of any kind. The State may reject any or all bids and may waive an immaterial deviation in a bid. The State's waiver of an immaterial deviation shall in no way modify the IFB document or excuse the bidder from full compliance with all requirements if awarded the agreement.
g) Costs incurred for developing bids and in anticipation of award of the agreement are entirely the responsibility of the bidder and shall not be charged to the State of California.
h) An individual who is authorized to bind the bidder contractually shall sign the Bid/Bidder Certification Sheet, page 9. The signature should indicate the title or position that the individual holds in the firm. An unsigned bid may be rejected.
i) A bidder may modify a bid after its submission by withdrawing its original bid and resubmitting a new bid prior to the bid submission deadline. Bidder modifications offered in any other manner, oral or written, will not be considered.
j) A bidder may withdraw its bid by submitting a written withdrawal request to the State, signed by the bidder or an authorized agent. A bidder may thereafter submit a new bid prior to the bid submission deadline. Bids may not be withdrawn without cause subsequent to bid submission deadline.
k) The awarding agency may modify the IFB prior to the date fixed for submission of bids by the issuance of an addendum to all parties who received a bid package.
l) The awarding agency reserves the right to reject all bids. The agency is not required to award an agreement.
m) Before submitting a response to this solicitation, bidders should review, correct all errors and confirm compliance with the IFB requirements.
n) Where applicable, bidder should carefully examine work sites and specifications. Bidder shall investigate conditions, character, and quality of surface or subsurface materials or obstacles that might be encountered. No additions or increases to the agreement amount will be made due to a lack of careful examination of work sites and specifications.
o) The State does not accept alternate contract language from a prospective contractor. A bid with such language will be considered a counter proposal and will be rejected. The State’s General Terms and Conditions (GTC) are not negotiable.
p) No oral understanding or agreement shall be binding on either party.
3) Evaluation and Selection
a) At the time of bid opening, each bid will be checked for the presence or absence of required information in conformance with the submission requirements of this IFB.
b) The State will evaluate each bid to determine its responsiveness to the published requirements.
c) Bids that contain false or misleading statements, or which provide references, which do not support an attribute or condition claimed by the bidder, may be rejected.
d) Award if made, will be to the lowest responsive responsible bidder.
4) Award and Protest
a) Whenever an agreement is awarded under a procedure, which provides for competitive bidding, but the agreement is not to be awarded to the low bidder, the low bidder shall be notified by telegram, electronic facsimile transmission, overnight courier, or personal delivery five (5) working days prior to the award of the agreement.
b) Upon written request by any bidder, notice of the proposed award shall be posted in a public place in the office of the awarding agency at least five (5) working days prior to awarding the agreement.
c) If any bidder, prior to the award of agreement, files a written protest with the Department of General Services, Office of Legal Services, 707 Third Street, 7th Floor, Suite 7-330, West Sacramento, CA 95605 and the (insert name of awarding agency) on the grounds that the (protesting) bidder is the lowest responsive responsible bidder, the agreement shall not be awarded until either the protest has been withdrawn or the Department of General Services has decided the matter.
d) Within five (5) days after filing the initial protest, the protesting bidder shall file with the Department of General Services and the awarding agency a detailed written statement specifying the grounds for the protest. The written protest must be sent to the Department of General Services, Office of Legal Services, 707 Third Street, 7th Floor, Suite 7-330, West Sacramento, California 95605. A copy of the detailed written statement should be mailed to the awarding agency. It is suggested that you submit any protest by certified or registered mail.
e) Upon resolution of the protest and award of the agreement, Contractor must complete and submit to the awarding agency the Payee Data Record (STD 204), to determine if the Contractor is subject to state income tax withholding pursuant to California Revenue and Taxation Code Sections 18662 and 26131. This form can be found on the Internet at www.osp.dgs.ca.gov under the heading FORMS MANAGEMENT CENTER. No payment shall be made unless a completed STD 204 has been returned to the awarding agency.
f) Upon resolution of the protest and award of the agreement, Contractor must sign and submit to the awarding agency, page one (1) of the Contractor Certification Clauses (CCC), which can be found on the Internet at www.dgs.ca.gov/contracts. This document is only required if the bidder has not submitted this form to the awarding agency within the last three (3) years.
5) Disposition of Bids
a) Upon bid opening, all documents submitted in response to this IFB will become the property of the State of California, and will be regarded as public records under the California Public Records Act (Government Code Section 6250 et seq.) and subject to review by the public.
b) Bid packages may be returned only at the bidder's expense, unless such expense is waived by the awarding agency.
6) Agreement Execution and Performance
a) Performance shall start not later than the express date set by the awarding agency and the Contractor, after all approvals have been obtained and the agreement is fully executed. Should the Contractor fail to commence work at the agreed upon time, the awarding agency, upon five (5) days written notice to the Contractor, reserves the right to terminate the agreement. In addition, the Contractor shall be liable to the State for the difference between Contractor's bid price and the actual cost of performing work by the second lowest bidder or by another contractor.
b) All performance under the agreement shall be completed on or before the termination date of the agreement.
D) Preference Programs
1) Small Business Preference: www.pd.dgs.ca.gov E) Required Attachments
The State has waived the Disabled Veteran Business Enterprise (DVBE) Participation Program requirement for this contract.
Refer to the following pages for additional Required Attachments that are a part of this agreement.
ATTACHMENT 1
REQUIRED ATTACHMENT CHECK LIST
A complete bid or bid package will consist of the items identified below.
Complete this checklist to confirm the items in your bid. Place a check mark or “X” next to each item that you are submitting to the State. For your bid to be responsive, all required attachments must be returned. This checklist should be returned with your bid package also.
Attachment Attachment Name/Description Attachment 1 Required Attachment Check List
Attachment 2 Bid/Bidder Certification Sheet
Attachment 3 Cost Sheet + pages 14-25 Attachment 4 Bidder References Attachment 5 Required copies of License and Certification Attachment 6 Darfur Contracting Act (if applicable)
ATTACHMENT 2
BID/BIDDER CERTIFICATION SHEET
This Bid/Bidder Certification Sheet must be signed and returned along with all the "required attachments" as an entire package in duplicate with original signatures. The bid must be transmitted in a sealed envelope in accordance with IFB instructions.
Do not return Section C, Bid Requirements and Information (pages 3 through 6) nor the "Sample Agreement" at the end of this IFB.
A. Our all-inclusive bid is submitted as detailed in Attachment 3, Cost Sheet.
B. All required attachments are included with this certification sheet.
C. The signature affixed hereon and dated certifies compliance with all the requirements of this bid document. The signature below authorizes the verification of this certification.
An Unsigned Bid/Bidder Certification Sheet May Be Cause For Rejection.
| 1. Company Name |
| 2. Telephone Number |
| 2a. Fax Number |
3. Address
Indicate your organization type:
4. FORMCHECKBOX
Sole Proprietorship
5. FORMCHECKBOX
Partnership
6. FORMCHECKBOX
Corporation
Indicate the applicable employee and/or corporation number:
| 7. Federal Employee ID No. (FEIN) |
| 8. California Corporation No. |
9. Indicate applicable license and/or certification information:
| 10. Bidder’s Name (Print) |
| 11. Title |
14. Are you certified with the Department of General Services, Office of Small Business Certification and Resources (OSBCR) as:
a. California Small Business
Yes FORMCHECKBOX No FORMCHECKBOX
If yes, enter certification number:
b. Disabled Veteran Business Enterprise Yes FORMCHECKBOX No FORMCHECKBOX
If yes, enter your service code below:
NOTE: A copy of your Certification is required to be included if either of the above items is checked “Yes”.
| Date application was submitted to OSBCR, if an application is pending: |
Completion Instructions for Bid/Bidder Certification Sheet Complete the numbered items on the
Bid/Bidder Certification Sheet by following the instructions below.
| Item Numbers |
| Instructions |
| 1, 2, 2a, 3 |
| Must be completed. These items are self-explanatory. |
| 4 |
| Check if your firm is a sole proprietorship. A sole proprietorship is a form of business in which one person owns all the assets of the business in contrast to a partnership and corporation. The sole proprietor is solely liable for all the debts of the business. |
| 5 |
| Check if your firm is a partnership. A partnership is a voluntary agreement between two or more competent persons to place their money, effects, labor, and skill, or some or all of them in lawful commerce or business, with the understanding that there shall be a proportional sharing of the profits and losses between them. An association of two or more persons to carry on, as co-owners, a business for profit. |
| 6 |
| Check if your firm is a corporation. A corporation is an artificial person or legal entity created by or under the authority of the laws of a state or nation, composed, in some rare instances, of a single person and his successors, being the incumbents of a particular office, but ordinarily consisting of an association of numerous individuals. |
| 7 |
| Enter your federal employee tax identification number. |
| 8 |
| Enter your corporation number assigned by the California Secretary of State’s Office. This information is used for checking if a corporation is in good standing and qualified to conduct business in California. |
Complete, if applicable, by indicating the type of license and/or certification that your firm possesses and that is required for the type of services being procured.
10, 11, 12, 13 Must be completed. These items are self-explanatory.
If certified as a California Small Business, place a check in the "Yes" box, and enter your certification number on the line. If certified as a Disabled Veterans Business Enterprise, place a check in the "Yes" box and enter your service code on the line. If you are not certified to one or both, place a check in the "No" box. If your certification is pending, enter the date your application was submitted to OSBCR.
ATTACHMENT 3
SAMPLE COST SHEET
In compliance with your Invitation for Bid for Laboratory Blood Analysis Services. I hereby propose to perform the work, as specified and described during the term July 1, 2016, through June 30, 2018, for the total sum of $_______________________.
The above bid is the grand total from pages 14 through 25, which are attached and required to be submitted as a part of this bid.
Bidder understands that the number of tests listed on pages 14 through 25 is an estimate only of the tests to be performed during the Agreement term. The sample number of tests is provided to identify the lowest responsible bidder for the purpose of awarding this Agreement only.
Billing cycle:
FORMCHECKBOX
Monthly
FORMCHECKBOX
Quarterly
FORMCHECKBOX
Semi-Annually
FORMCHECKBOX
Annually
Note: All services performed are paid in arrears according to billing cycle indicated above.
Bidders Name (Print)
Bidders Title (Print)
Bidders Signature
Date
ATTACHMENT 4
BIDDER REFERENCES
Submission of this attachment is mandatory. Failure to complete and return this attachment with your bid will cause your bid to be rejected and deemed nonresponsive.
List below three references for services performed within the last five years, which are similar to the scope of work to be performed in this contract.
UNSATISFACTORY REFERENCES MAY RESULT IN YOUR BID BEING DISQUALIFIED.
REFERENCE 1
Name of Firm
| Street Address |
| City |
| State |
| Zip Code |
| Contact Person |
| Telephone Number |
| Dates of Service |
| Value or Cost of Service |
Brief Description of Service Provided
REFERENCE 2
Name of Firm
| Street Address |
| City |
| State |
| Zip Code |
| Contact Person |
| Telephone Number |
| Dates of Service |
| Value or Cost of Service |
Brief Description of Service Provided
REFERENCE 3
Name of Firm
| Street Address |
| City |
| State |
| Zip Code |
| Contact Person |
| Telephone Number |
| Dates of Service |
| Value or Cost of Service |
Brief Description of Service Provided
ATTACHMENT 7
DARFUR CONTRACTING ACT CERTIFICATION
Public Contract Code Sections 10475 -10481 applies to any company that currently or within the previous three years has had business activities or other operations outside of the United States. For such a company to bid on or submit a proposal for a State of California contract, the company must certify that it is either a) not a scrutinized company; or b) a scrutinized company that has been granted permission by the Department of General Services to submit a proposal.
If your company has not, within the previous three years, had any business activities or other operations outside of the United States, you do not need to complete this form.
OPTION #1 - CERTIFICATION
If your company, within the previous three years, has had business activities or other operations outside of the United States, in order to be eligible to submit a bid or proposal, please insert your company name and Federal ID Number and complete the certification below.
I, the official named below, CERTIFY UNDER PENALTY OF PERJURY that a) the prospective proposer/bidder named below is not a scrutinized company per Public Contract Code 10476; and b) I am duly authorized to legally bind the prospective proposer/bidder named below. This certification is made under the laws of the State of California.
| Company/Vendor Name (Printed) |
| Federal ID Number |
By (Authorized Signature)
Printed Name and Title of Person Signing
| Date Executed |
| Executed in the County and State of |
OPTION #2 – WRITTEN PERMISSION FROM DGS
Pursuant to Public Contract Code section 10477(b), the Director of the Department of General Services may permit a scrutinized company, on a case-by-case basis, to bid on or submit a proposal for a contract with a state agency for goods or services, if it is in the best interests of the state. If you are a scrutinized company that has obtained written permission from the DGS to submit a bid or proposal, complete the information below.
We are a scrutinized company as defined in Public Contract Code section 10476, but we have received written permission from the Department of General Services to submit a bid or proposal pursuant to Public Contract Code section 10477(b). A copy of the written permission from DGS is included with our bid or proposal.
| Company/Vendor Name (Printed) |
| Federal ID Number |
Initials of Submitter
Printed Name and Title of Person Initialing
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| ACID PHOSPHATASE |
| 20 |
| X |
| $ |
| = |
| $ |
| AEROBIC CULTURES |
| 148 |
| X |
| $ |
| = |
| $ |
| AFB, CULTURE AND SMEAR |
| 1 |
| X |
| $ |
| = |
| $ |
ALKALINE PHOSPHATASE
ISOENZYMES
| ALLERGY SCREENING PANEL |
| 10 |
| X |
| $ |
| = |
| $ |
| ALPHA 1 ANTITRYPSIN |
| 1 |
| X |
| $ |
| = |
| $ |
| ALPHA-FETO PROTEIN |
| 6 |
| X |
| $ |
| = |
| $ |
| ANAEROBIC CULTURES |
| 30 |
| x |
| $ |
| = |
| $ |
| ANTI MITOCHONDRIAL ANTIBODIES (AMA) |
| 2 |
| X |
| $ |
| = |
| $ |
| ANTI PLATELET ANTIBODY |
| 1 |
| X |
| $ |
| = |
| $ |
| ANTI MICROSOMAL ANTIBODIES |
| 1 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 14 OF 25 = $
| Company Name:: |
| Signature: |
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| ANTIBODY (ACNA) |
| 1 |
| X |
| $ |
| = |
| $ |
| ANTI SMOOTH MUSCLE AB |
| 5 |
| X |
| $ |
| = |
| $ |
| ANTI THYROGLOBULIN ANTIBODIES |
| 3 |
| X |
| $ |
| = |
| $ |
| BILIRUBIN, TOTAL AND DIRECT |
| 1 |
| X |
| $ |
| = |
| $ |
| CBC COMPLETE BLOOD COUNT |
| 1 |
| X |
| $ |
| = |
| $ |
| C-REACTIVE PROTEIN |
| 5 |
| X |
| $ |
| = |
| $ |
| CALCIUM, IONIZED |
| 1 |
| X |
| $ |
| = |
| $ |
| CALCIUM, SERUM OR URINE |
| 1 |
| X |
| $ |
| = |
| $ |
| CALCULI (STONE ANALYSIS) |
| 1 |
| X |
| $ |
| = |
| $ |
| CARBAMAZEPINE 10, 11 EPOXIDE |
| 20 |
| X |
| $ |
| = |
| $ |
| CARNITINE, TOTAL AND FREE |
| 15 |
| X |
| $ |
| = |
| $ |
| CHLAMYDIA NEISSERIA GONORRHEA RNA, TMA |
| 200 |
| X |
| $ |
| = |
| $ |
| CHROMOSOME, FRAGILE X |
| 1 |
| X |
| $ |
| = |
| $ |
| CHROMOSOME ANALYSIS |
| 1 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 15 OF 25 = $
| Company Name:: |
| Signature: |
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| CITRATE, URINE, ACID #21670 |
| 1 |
| X |
| $ |
| = |
| $ |
| CLORAZEPATE (AS) NORDIAZEPATE |
| 1 |
| x |
| $ |
| = |
| $ |
| CLOSTRIDIUM DIFFICILE CULTURE |
| 1 |
| X |
| $ |
| = |
| $ |
| CLOSTRIDIUM DIFFICILE, CYTOTOXINS |
| 4 |
| X |
| $ |
| = |
| $ |
COCCIDIODES, AB,
COMPLEMENT FIXATION (UCD)
| COCCIDIODES, AB, COCCI, ID |
| 12 |
| X |
| $ |
| = |
| $ |
| COLD HEMAGGLUTININS |
| 5 |
| X |
| $ |
| = |
| $ |
| COMBS, DIRECT AND INDIRECT |
| 1 |
| X |
| $ |
| = |
| $ |
COMPLEMENT TOTAL
(CH50, CH100)
| CREATININE CLEARANCE |
| 20 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 16 OF 25 = $
| Company Name:: |
| Signature: |
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| CREATININE, URINE, RANDOM |
| 15 |
| X |
| $ |
| = |
| $ |
| DOUBLE STRANDED DNA |
| 12 |
| X |
| $ |
| = |
| $ |
| EPSTEIN-BARR VIRUS #81734 |
| 4 |
| X |
| $ |
| = |
| $ |
| ERYTHROPOIETIN LEVEL |
| 20 |
| X |
| $ |
| = |
| $ |
| FIBRINOGEN LEVEL |
| 1 |
| X |
| $ |
| = |
| $ |
| FLUOXETINE, PROZAC |
| 1 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 17 OF 25 = $
| Company Name:: |
| Signature: |
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| FOLATE VIT B12 |
| 40 |
| X |
| $ |
| = |
| $ |
| FOOD ALLERGY SCREENING PANEL #63292 |
| 1 |
| X |
| $ |
| = |
| $ |
| FRAGILE X SYNDROME |
| 1 |
| X |
| $ |
| = |
| $ |
| FUNGUS CULTURE, BLOOD |
| 1 |
| X |
| $ |
| = |
| $ |
| FUNGUS CULTURE, OTHER SOURCE |
| 3 |
| X |
| $ |
| = |
| $ |
FUNGUS CULTURE,
SKIN, HAIR, NAILS
| GEN-PROBE FOR CHLAMYDIA AND NEISSERIA |
| 25 |
| X |
| $ |
| = |
| $ |
| GGT (GAMMA GLUTAMYL TRANSFERASE) |
| 4 |
| X |
| $ |
| = |
| $ |
| GLYCOHEMHEMOGLOBIN |
| 200 |
| X |
| $ |
| = |
| $ |
| HAV IGG REFLUX IGM, HEPA, AB |
| 1 |
| X |
| $ |
| = |
| $ |
| HAV IGG REFLUX, HEPA, IGM |
| 1 |
| X |
| $ |
| = |
| $ |
| HBV QUANT PCR (VIRAL LOAD) |
| 3 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 18 OF 25 = $
| Company Name:: |
| Signature: |
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| HCG BETA SUB-UNITS (QUANT) |
| 13 |
| X |
| $ |
| = |
| $ |
| HCV RNA BY PCR (VIRAL LOAD) |
| 10 |
| X |
| $ |
| = |
| $ |
| HELICOBACTER PYLORII AB & IGA |
| 6 |
| X |
| $ |
| = |
| $ |
| HELICOBACTER PYLOR II AB&IGG |
| 6 |
| X |
| $ |
| = |
| $ |
| HEMOCYSTINE, CYSTINE URINE |
| 1 |
| X |
| $ |
| = |
| $ |
| HEMOCYSTINE, METHYLMALONIC |
| 1 |
| X |
| $ |
| = |
| $ |
| HEMOGLOBIN ELECTROPHORESIS |
| 3 |
| X |
| $ |
| = |
| $ |
| HEPATITIS A ANTIBODY (IgM) |
| 2 |
| X |
| $ |
| = |
| $ |
| HEPATITIS A ANTIBODY TOTAL IGG |
| 35 |
| X |
| $ |
| = |
| $ |
| HEPATITIS B ANTIBODY |
| 616 |
| X |
| $ |
| = |
| $ |
| HEPATITIS B ANTIGEN |
| 32 |
| X |
| $ |
| = |
| $ |
| HEPATITIS B CORE ANTIBODY (IGM) |
| 1 |
| X |
| $ |
| = |
| $ |
HEPATITIS B CORE ANTIBODY
(IGG)
| HEPATITIS B DNA PCR |
| 20 |
| X |
| $ |
| = |
| $ |
| HEPATITIS B E ANTIGEN/ANTIBODY AG |
| 1 |
| X |
| $ |
| = |
| $ |
| HEPATITIS B E ANTIGEN/ANTIBODY AB |
| 1 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 19 OF 25 = $
| Company Name:: |
| Signature: |
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| HEPATITIS C ANTIBODY |
| 29 |
| X |
| $ |
| = |
| $ |
| HEPATITIS C PCR |
| 30 |
| X |
| $ |
| = |
| $ |
| HEPATITIS HCV (Riba) |
| 820 |
| X |
| $ |
| = |
| $ |
| HGB ELETROPHORESIS |
| 10 |
| X |
| $ |
| = |
| $ |
| HIV RNA/PCR (VIRAL LOAD) |
| 35 |
| X |
| $ |
| = |
| $ |
| HIV LYMPHOCYTE SUBSET PANEL (CD4) |
| 35 |
| X |
| $ |
| = |
| $ |
| HOMOCYSTEINE TOTAL |
| 1 |
| X |
| $ |
| = |
| $ |
HYDROXY CARBAMAZEPIRE
OXCARB METABOLITE
| IMMUNOELECTROPHORESIS |
| 6 |
| X |
| $ |
| = |
| $ |
| IMMUNOFIXATION SERUM |
| 2 |
| X |
| $ |
| = |
| $ |
| IMMUNOFIXATION URINE |
| 1 |
| X |
| $ |
| = |
| $ |
| IMMUNOGLOBULIN (IGA, IGM, IGG) |
| 4 |
| X |
| $ |
| = |
| $ |
| INFLUENZAE A AND B |
| 6 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 20 OF 25 = $
| Company Name:: |
| Signature: |
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| LEUKEMIA/LYMPHOMA EVALUATION |
| 2 |
| X |
| $ |
| = |
| $ |
| LIPOPROTEIN (A) |
| 2 |
| X |
| $ |
| = |
| $ |
| LIPOPROTEIN ELECTROPHORESIS |
| 1 |
| X |
| $ |
| = |
| $ |
| LUPUS ANTICOAGULANT EVALUATION |
| 1 |
| X |
| $ |
| = |
| $ |
| MAGNESIUM, SERUM |
| 1 |
| X |
| $ |
| = |
| $ |
| MAGNESIUM, URINE |
| 1 |
| X |
| $ |
| = |
| $ |
| MICRO ALBUMIN/CREATINE RATIO |
| 120 |
| X |
| $ |
| = |
| $ |
| MMR PANELA (MEASLES, MUMPS, RUBELLA IMMUNITY) |
| 2 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 21 OF 25 = $
| Company Name:: |
| Signature: |
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| MUMPS VIRUS AB, IGG |
| 1 |
| X |
| $ |
| = |
| $ |
| MUMPS VIRUS AB, IGM |
| 1 |
| X |
| $ |
| = |
| $ |
| MYCOPLASMA PHEUMONIAE (IGG, IGM) |
| 10 |
| X |
| $ |
| = |
| $ |
| OSMOLALITY, SERUM |
| 1 |
| X |
| $ |
| = |
| $ |
| OSMOLALITY, URINE |
| 1 |
| X |
| $ |
| = |
| $ |
| OVA AND PARASITES STOOL |
| 60 |
| X |
| $ |
| = |
| $ |
| OXCARBAMAZEPINE METABOLITE |
| 20 |
| X |
| $ |
| = |
| $ |
| PAROXETINE (PAXIL) |
| 1 |
| X |
| $ |
| = |
| $ |
| PHOSPHOLIPIDS, SERUM |
| 1 |
| X |
| $ |
| = |
| $ |
| PLATELET ANTIBODIES |
| 3 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 22 OF 25 = $
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| PROSTATIC SPECIFIC ANTIGEN |
| 257 |
| X |
| $ |
| = |
| $ |
| PROTEIN ELECTROPHORESIS |
| 6 |
| X |
| $ |
| = |
| $ |
| PROTEIN URINE, RANDOM |
| 30 |
| X |
| $ |
| = |
| $ |
| PSA, FREE & TOTAL |
| 2 |
| X |
| $ |
| = |
| $ |
| RA (RHEUMATOID ARTHRITIS) |
| 3 |
| X |
| $ |
| = |
| $ |
| RHEUMATOID FACTOR, QUAL AND QUANT |
| 27 |
| X |
| $ |
| = |
| $ |
| RISPERIDONE (OL) |
| 1 |
| X |
| $ |
| = |
| $ |
| RSV, CULTURE AND ANTIBODIES |
| 35 |
| X |
| $ |
| = |
| $ |
| RSV, RNA QUAL PCR |
| 1 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 23 OF 25 = $
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| SINEQUAN (OXAZEPAM) |
| 1 |
| X |
| $ |
| = |
| $ |
| SICKLE CELL SCREEN |
| 7 |
| X |
| $ |
| = |
| $ |
| TESTOSTERONE FREE AND TOTAL |
| 25 |
| X |
| $ |
| = |
| $ |
| THYROID PEROXIDASE ANTIBODY |
| 1 |
| X |
| $ |
| = |
| $ |
| TOXOPLASMA TITER |
| 1 |
| X |
| $ |
| = |
| $ |
| ULTRA CENTREFUGATION (LIPEMIC SPECIMEN) |
| 1 |
| X |
| $ |
| = |
| $ |
| URINE CULTURES |
| 120 |
| X |
| $ |
| = |
| $ |
| URINE DRUG SCREEN #69134 |
| 60 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 24 OF 25 = $
| TEST |
| APPROX # OF TEST PER TERM OF CONTRACT |
| X |
| COST PER TEST |
| = |
| TOTAL |
| VARICELLA CULTURE |
| 3 |
| X |
| $ |
| = |
| $ |
| VARICELLA ZOSTER AB, IGG |
| 1 |
| X |
| $ |
| = |
| $ |
| VARICELLA ZOSTER AB, IGM |
| 1 |
| X |
| $ |
| = |
| $ |
| VIRAL CULTURES |
| 20 |
| X |
| $ |
| = |
| $ |
| VISCOSITY, SERUM |
| 2 |
| X |
| $ |
| = |
| $ |
| VITAMIN D, 1 25 DIHYDROXY |
| 1 |
| X |
| $ |
| = |
| $ |
| VITAMIN D, 25 DIHYDROXY |
| 1 |
| X |
| $ |
| = |
| $ |
| VAN WILLEBRAND PROFILE |
| 5 |
| X |
| $ |
| = |
| $ |
| LDH ISOENZYMES |
| 40 |
| X |
| $ |
| = |
| $ |
| LOXAPINE + METABOLITES |
| 20 |
| X |
| $ |
| = |
| $ |
| METANEPHERINES, FRACTIONATED |
| 20 |
| X |
| $ |
| = |
| $ |
| METHYLMALONIC ACID |
| 20 |
| X |
| $ |
| = |
| $ |
SUB TOTAL PAGE 25 OF 25 = $
GRAND TOTAL BID OF PAGES 14 THROUGH 25 = $
NOTE: The GRAND TOTAL BID amount (above) should be the same on Page #11, entitled “Attachment 3, Cost Sheet” of your bid proposal.
PAGE