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Instructions
| A. The Financial Proposal Form shall contain all price information in the format specified on these pages. Complete the Finanical Proposal Form only as provided in the Financial Proposal Instructions. Do Not amend, alter or leave blank any items on the Financial Proposal Form. Failure to adhere to any of these instructions may result in the proposal being determined not reasonably susceptible of being selected for award. |
| B. The Offeror is to fill out the tab for the years of service. |
| C. Estimated units and totals prices are automatically filled in and tabulated. The Offeror is only to fill in their proposed price in the Unit Price Columns. The financial proposal forms will automatically calculate totals on each tab. Totals from each year will then be transferred to this page and totalled for the Offeror's Total Proposal Price. |
| D. An individual who is authorized to bind the Offeror to price entered is to sign and date bottom of this financial form and for each year. |
| E. *Note: All hours and estimated evaluations provided are based on current and /or historical figures. The estimates are for providing a baseline of fee for services. MDH makes no guarantee of any minimum or maximum numbers of hours or evaluations expressed in this RFP. Traveling to and from detention centers, FRCs, State residential centers and psychiatric hospitals, DDA regional offices and licensed community providers as required within the regions or the State is expected for all services provided and is not reimbursable. (see Attachment B Financial Proposal Instructrions & Form, B-1 Financial Proposal Form ) |
FORENSIC SERVICES
Summary
| Forensic Services Overall Total for Five (5) Base Years | | |
| Totals | |
| 1st Base Year | $0.00 | |
| 2nd Base Year | $0.00 | |
| 3rd Base Year | $0.00 | |
| 4th Base Year | $0.00 | |
| 5th Base Year | $0.00 | |
| ESTIMATED TOTAL PRICE (sum of all years) | $0.00 | *Offeror's Total Proposal Price |
FORENSIC SERVICES OVERALL TOTAL FOR 5 YEARS BASE
Base Year One
| Year One | | | |
| Service Description | Estimated Units (Evaluation and /or Hours) | Unit Price | Estimated Price |
| I. Competency to Stand Trial per RFP | | | |
Initial Evaluation Lead
| 68 | $0.00 | $0.00 |
| II. Competency to Stand Trial per RFP | | |
Initial Evaluation Non-Lead
| 27 | $0.00 | $0.00 | |
| III. Competency to Stand Trial per RFP Re-Evaluation | 142 | $0.00 | $0.00 |
| IV. Competency to Stand Trial and Criminal Responsibility per RFP | | | |
Initial Evaluation Lead
| 5 | $0.00 | $0.00 |
| V. Competency to Stand Trial and Criminal Responsibility per RFP | | |
Initial Evaluation Non-Lead
| 5 | $0.00 | $0.00 | |
| VI. Dangerousness Evaluation per RFP | 9 | $0.00 | $0.00 |
| VII. Competency to Proceed Evaluation per RFP | 23 | $0.00 | $0.00 |
| VIII. Competency to Proceed Follow-Up Evaluation per RFP | 12 | $0.00 | $0.00 |
| IX. Court Testimony Per RFP (per hours) | 30 | $0.00 | $0.00 |
| X. Participation in Peer Review per RFP (per hours) | 32 | $0.00 | $0.00 |
| XI. Training per RFP (per hours) | 32 | $0.00 | $0.00 |
| XII. Consultation per RFP (per hours) | 40 | $0.00 | $0.00 |
| YEAR ONE ESTIMANTED PRICE | | | $0.00 |
| Base Year One - Overall Totals | |
| ESTIMATED PROPOSAL PRICE | $0.00 |
| Authorized Signature:____________________________________________________________ |
| Date: ______________________________________ |
| Printed Name and Title: __________________________________________________________ |
| Company Name: _______________________________________________________________ |
| Company Address: ______________________________________________________________ |
| FEIN: ___________________________________________ |
| eMM #: ___________________________________________ |
| Telephone #: ___________________________________________ |
| Fax #: ___________________________________________ |
| *Note: The proposed number of each services listed are a projection based on historical data. The actual numbers may be higher or lower. |
| The State does not guarantee the number of services for each year. |
FORENSIC SERVICES - YEAR ONE FINANCIAL PROPOSAL FORM
Base Year Two
| BASE YEAR TWO | | | |
| Service Description | Estimated Units (Evaluation and /or Hours) | Unit Price | Estimated Price |
| I. Competency to Stand Trial per RFP | | | |
Initial Evaluation Lead
| 69 | $0.00 | $0.00 |
| II. Competency to Stand Trial per RFP | | |
Initial Evaluation Non-Lead
| 28 | $0.00 | $0.00 | |
| III. Competency to Stand Trial per RFP Re-Evaluation | 149 | $0.00 | $0.00 |
| IV. Competency to Stand Trial and Criminal Responsibility per RFP | | | |
| 5 | $0.00 | $0.00 | |
| V. Competency to Stand Trial and Criminal Responsibility per RFP | | | |
Initial Evaluation Non-Lead
| 5 | $0.00 | $0.00 | |
| VI. Dangerousness Evaluation per RFP | 9 | $0.00 | $0.00 |
| VII. Competency to Proceed Evaluation per RFP | 24 | $0.00 | $0.00 |
| VIII. Competency to Proceed Follow-Up Evaluation per RFP | 13 | $0.00 | $0.00 |
| IX. Court Testimony Per RFP (per hours) | 31 | $0.00 | $0.00 |
| X. Participation in Peer Review per RFP (per hours) | 34 | $0.00 | $0.00 |
| XI. Training per RFP (per hours) | 34 | $0.00 | $0.00 |
| XII. Consultation per RFP (per hours) | 43 | $0.00 | $0.00 |
| YEAR TWO ESTIMANTED PRICE | | | $0.00 |
| Base Year Two - OVERALL TOTALS | |
| ESTIMATED PROPOSAL PRICE | $0.00 |
| Authorized Signature:____________________________________________________________ |
| Date: ______________________________________ |
| Printed Name and Title: __________________________________________________________ |
| Company Name: _______________________________________________________________ |
| Company Address: ______________________________________________________________ |
| FEIN: ___________________________________________ |
| eMM #: ___________________________________________ |
| Telephone #: ___________________________________________ |
| Fax #: ___________________________________________ |
| *Note: The proposed number of each services listed are a projection based on historical data. The actual numbers may be higher or lower. |
| The State does not guarantee the number of services for each year. |
FORENCIS SERVICES - YEAR TWO FINANCIAL PROPOSAL FORM
Base Year Three
| BASE YEAR THREE | | | |
| Service Description | Estimated Units (Evaluation and /or Hours) | Unit Price | Estimated Price |
| I. Competency to Stand Trial per RFP | | | |
Initial Evaluation Lead
| 72 | $0.00 | $0.00 |
| II. Competency to Stand Trial per RFP | | |
Initial Evaluation Non-Lead
| 29 | $0.00 | $0.00 | |
| III. Competency to Stand Trial per RFP Re-Evaluation | 156 | $0.00 | $0.00 |
| IV. Competency to Stand Trial and Criminal Responsibility per RFP | | | |
Initial Evaluation Lead
| 5 | $0.00 | $0.00 |
| V. Competency to Stand Trial and Criminal Responsibility per RFP | | |
Initial Evaluation Non-Lead
| 5 | $0.00 | $0.00 | |
| VI. Dangerousness Evaluation per RFP | 9 | $0.00 | $0.00 |
| VII. Competency to Proceed Evaluation per RFP | 25 | $0.00 | $0.00 |
| VIII. Competency to Proceed Follow-Up Evaluation per RFP | 14 | $0.00 | $0.00 |
| IX. Court Testimony Per RFP (per hours) | 33 | $0.00 | $0.00 |
| X. Participation in Peer Review per RFP (per hours) | 36 | $0.00 | $0.00 |
| XI. Training per RFP (per hours) | 36 | $0.00 | $0.00 |
| XII. Consultation per RFP (per hours) | 44 | $0.00 | $0.00 |
| YEAR THREE ESTIMANTED PRICE | | | $0.00 |
| Base Year Three - OVERALL TOTALS | |
| ESTIMATED PROPOSAL PRICE | $0.00 |
| Authorized Signature:____________________________________________________________ |
| Date: ______________________________________ |
| Printed Name and Title: __________________________________________________________ |
| Company Name: _______________________________________________________________ |
| Company Address: ______________________________________________________________ |
| FEIN: ___________________________________________ |
| eMM #: ___________________________________________ |
| Telephone #: ___________________________________________ |
| Fax #: ___________________________________________ |
| *Note: The proposed number of each services listed are a projection based on historical data. The actual numbers may be higher or lower. |
| The State does not guarantee the number of services for each year. |
FORENSIC SERVICES - YEAR THREE FINANCIAL PROPOSAL FORM
Base Year Four
| BASE YEAR FOUR | | | |
| Service Description | Estimated Units (Evaluation and /or Hours) | Unit Price | Estimated Price |
| I. Competency to Stand Trial per RFP | | | |
Initial Evaluation Lead
| 76 | $0.00 | $0.00 |
| II. Competency to Stand Trial per RFP | | |
Initial Evaluation Non-Lead
| 30 | $0.00 | $0.00 | |
| III. Competency to Stand Trial per RFP Re-Evaluation | 164 | $0.00 | $0.00 |
| IV. Competency to Stand Trial and Criminal Responsibility per RFP | | | |
Initial Evaluation Lead
| 5 | $0.00 | $0.00 |
| V. Competency to Stand Trial and Criminal Responsibility per RFP | | |
Initial Evaluation Non-Lead
| 5 | $0.00 | $0.00 | |
| VI. Dangerousness Evaluation per RFP | 9 | $0.00 | $0.00 |
| VII. Competency to Proceed Evaluation per RFP | 26 | $0.00 | $0.00 |
| VIII. Competency to Proceed Follow-Up Evaluation per RFP | 15 | $0.00 | $0.00 |
| IX. Court Testimony Per RFP (per hours) | 35 | $0.00 | $0.00 |
| X. Participation in Peer Review per RFP (per hours) | 38 | $0.00 | $0.00 |
| XI. Training per RFP (per hours) | 38 | $0.00 | $0.00 |
| XII. Consultation per RFP (per hours) | 46 | $0.00 | $0.00 |
| YEAR FOUR ESTIMANTED PRICE | | | $0.00 |
| Base Year four - OVERALL TOTALS | |
| ESTIMATED PROPOSAL PRICE | $0.00 |
| Authorized Signature:____________________________________________________________ |
| Date: ______________________________________ |
| Printed Name and Title: __________________________________________________________ |
| Company Name: _______________________________________________________________ |
| Company Address: ______________________________________________________________ |
| FEIN: ___________________________________________ |
| eMM #: ___________________________________________ |
| Telephone #: ___________________________________________ |
| Fax #: ___________________________________________ |
| *Note: The proposed number of each services listed are a projection based on historical data. The actual numbers may be higher or lower. |
| The State does not guarantee the number of services for each year. |
FORENSIC SERVICES - YEAR FOUR FINANCIAL PROPOSAL FORM
Base Year Five
| BASE YEAR FIVE | | | |
| Service Description | Estimated Units (Evaluation and /or Hours) | Unit Price | Estimated Price |
| I. Competency to Stand Trial per RFP | | | |
Initial Evaluation Lead
| 80 | $0.00 | $0.00 |
| II. Competency to Stand Trial per RFP | | |
Initial Evaluation Non-Lead
| 32 | $0.00 | $0.00 | |
| III. Competency to Stand Trial per RFP Re-Evaluation | 172 | $0.00 | $0.00 |
| IV. Competency to Stand Trial and Criminal Responsibility per RFP | | | |
Initial Evaluation Lead
| 5 | $0.00 | $0.00 |
| V. Competency to Stand Trial and Criminal Responsibility per RFP | | |
Initial Evaluation Non-Lead
| 5 | $0.00 | $0.00 | |
| VI. Dangerousness Evaluation per RFP | 9 | $0.00 | $0.00 |
| VII. Competency to Proceed Evaluation per RFP | 27 | $0.00 | $0.00 |
| VIII. Competency to Proceed Follow-Up Evaluation per RFP | 16 | $0.00 | $0.00 |
| IX. Court Testimony Per RFP (per hours) | 37 | $0.00 | $0.00 |
| X. Participation in Peer Review per RFP (per hours) | 40 | $0.00 | $0.00 |
| XI. Training per RFP (per hours) | 40 | $0.00 | $0.00 |
| XII. Consultation per RFP (per hours) | 48 | $0.00 | $0.00 |
| YEAR FIVE ESTIMANTED PRICE | | | $0.00 |
| Base Year Five - OVERALL TOTALS | |
| ESTIMATED PROPOSAL PRICE | $0.00 |
| Authorized Signature:____________________________________________________________ |
| Date: ______________________________________ |
| Printed Name and Title: __________________________________________________________ |
| Company Name: _______________________________________________________________ |
| Company Address: ______________________________________________________________ |
| FEIN: ___________________________________________ |
| eMM #: ___________________________________________ |
| Telephone #: ___________________________________________ |
| Fax #: ___________________________________________ |
| *Note: The proposed number of each services listed are a projection based on historical data. The actual numbers may be higher or lower. |
| The State does not guarantee the number of services for each year. |
FORENSIC SERVICES - YEAR FIVE FINANCIAL PROPOSAL FORM