Attachment-11-LTRC_CC_Cost_Proposal_Template_Amendment_001.xlsx
XLSX spreadsheet 99 KB Posted
- Attached to
- Title Lung Tissue Research Consortium - Clinical Center Federal contract opportunity
- Solicitation number
- NHLBI-HR-16-07
About this file
Attachment 11 - Cost Proposal Template
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| LTRC_CC_Amendment_002.pdf | ||
| LTRC_CC_Amendment_001.pdf | ||
| Attachment-1-LTRC-CC_Additional_Information.pdf | ||
| Attachment-2-Clinical_Centers_Past_Performance_Questionnaire.pdf | ||
| RFP_Cvr_Ltr.pdf | ||
| Attachment-3-NIH-Reps-and-Certs.pdf | ||
| NHLBI-_HR-16-07-_RFP.pdf |
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Text version
INSTRUCTIONS
OMB Control No. 9000-0013
How to use this Excel file:
(Updated 10/9/2008)
IMPORTANT NOTE: If you have opened this file before saving on your computer, you will be prompted for a user name and a password and you will lose all the data you may have inserted. Please close the file and click on the link again and save before opening.
This worksheet is intended to help you prepare your cost proposal. If you provide us with an electronic copy of the cost proposal, we can save time by not recreating it. This will help speed up the review/award process and perhaps reduce the number of questions we need to ask in order to understand your proposal. We understand that one spreadsheet format can not fit every situation; however, we have attempted to create a simple model that fits most circumstances that arise in Government contracting. Feel free to modify the spreadsheet to fit your circumstances, and to use the parts that work for you. There are more specific instructions on specific cost element pages where applicable.
Summary Page Please insert your organization's name in cell A2 and the RFP No. in cell A3.
The totals from each cost element page are automatically carried forward to the Summary worksheet. Enter the start date of the contract in cell C5.
This Excel file is set up for seven periods.
Direct Labor Use the Labor - Percent of Effort worksheet if you track labor on a percent of effort basis. Generally, Universities, Hospitals, and Non-Profit Organizations tract labor by percent of effort.
Use the Labor - Hourly worksheet if you track labor on an hourly basis. Commercial organizations track labor on an hourly basis.
Use both pages if you track some employees by each method. Please do not put any employee on both pages. Consultants should be proposed on the consultants worksheet, not the labor worksheets.
The proposed amounts must be based on current payroll information which shows hourly, monthly, or annual rate/salary for each proposed (named) individuals. Acceptable documentation includes any one of the following: 1) personnel action forms, or 2) most recent payroll register showing name, pay rate, and percent of effort if applicable, or 3) copy of pay stub. Supporting documentation may be requested at a later date.
If the proposed positions have not been filled or are to be named or hired, then acceptable documentation includes the following: 1) letter of intent to hire including salary rate and title, or 2) position descriptions and salary scales or organizational wage table showing salary range and a copy of hiring policy, or 3) a comparable employee's payroll document. Supporting documentation may be requested at a later date. Increases for the to be named or hired are not eligible for increases in the first period.
Indirect Rates Including Fringe Benefit Rate(s) for Commercial Organizations If your organization does not have negotiated rates, the following website contains information which will assist you in computing indirect rates: http://oamp.od.nih.gov/dfas/IdCSubmission.asp Please do not submit your indirect proposal to the Division of Financial Advisory Services at this time.
Points of Contact If you have any questions regarding this Excel file, please contact Cindi Brown (301-496-4494) email at CB25B@NIH.GOV.
If you have contracting questions, please call the NIH Contracting Official who is listed in the RFP.
CPI
LTRC CLINICAL CENTER
| Weighted Average Inflation Rate |
| For the Contract Period |
Performance Period: 12/16/15 thru 12/15/18
| (2) | (3) | ||
| (1) | Est. | # of Months | (2) x (3) |
| Period | CPI | Applicable |
| 12/16/15 | To | 12/31/15 | 1.60% | 0.5 | 0.80% | 2015 |
| 1/1/16 | To | 12/31/16 | 1.60% | 12.0 | 19.20% | 2016 |
| 1/1/17 | To | 12/31/17 | 1.90% | 12.0 | 22.80% | 2017 |
| 1/1/18 | To | 12/31/18 | 2.00% | 11.5 | 23.00% | 2018 |
| 1/1/19 | To | 12/15/19 | 1.90% | - 0 | 0.00% | 2019 |
| 36.0 | 65.80% |
36.0 into 65.80% = 1.80%
SUMMARY
| SUMMARY OF PROPOSED COSTS |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
| LTRC CLINICAL CENTER |
| Task Area A | YEAR 2 | YEAR 3 | |||||||
| CORE | PROTOCOL | CORE | PROTOCOL | CORE | PROTOCOL | TOTAL | TOTAL | TOTAL | |
| 12/16/2015 - 12/15/2016 | 12/16/2016 - 12/15/2017 | 12/16/2017 - 12/15/2018 | CORE | PROTOCOL | CORE & | ||||
| PROTOCL | |||||||||
| CORE | |||||||||
| DIRECT LABOR | $ - | $ - | $ - | $ - | $ - | ||||
| FRINGE BENEFITS | $ - | $ - | $ - | $ - | $ - | ||||
| TOTAL DIRECT LABOR | $ - | $ - | $ - | $ - | $ - |
| MATERIAL AND SUPPLIES | $ - | $ - | $ - | $ - | $ - |
| TRAVEL | $ - | $ - | $ - | $ - | $ - |
| OTHER DIRECT COSTS | $ - | $ - | $ - | $ - | $ - |
| SUBCONTRACTS | $ - | $ - | $ - | $ - | $ - |
| PROTOCOL | |||||
| Characterization Costs | $ - | $ - | $ - | $ - | $ - |
| Tissue Costs | $ - | $ - | $ - | $ - | $ - |
| CT Costs | $ - | $ - | $ - | $ - | $ - |
TOTAL DIRECT COSTS $ - $ - $ - $ - $ - $ - $ - $ - $ -
| IDC EXCLUSIONS | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | |||
| IDC BASE | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | |||
| INDIRECT COSTS | 0.0% | $ - | $ - | 0.0% | $ - | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - |
TOTAL COSTS $ - $ - $ - $ - $ - $ - $ - $ - $ -
TOTAL CORE & PROTOCOL $0 $0 $0 $0 $ -
| Note: |
| Indirect costs are included in the capitation rate and are therefore not reflected above under Protocol. |
Attachment 11
Not all organizations allocate indirect cost in the same way. It is important that you use the indirect rate structure applicable to your organization. For example, if you have a two tier indirect rate structure, then you will use a two tier structure when proposing indirect costs.
Generally, Universities and Non-Profits have fringe benefit and G&A (or sometimes called F&A) rates, while For-Profit Companies can have various indirect rates such as fringe benefits, overhead, G&A, etc.
The base for overhead costs includes direct labor and fringe benefits. Please modify if your base is different.
If applicable, insert exclusions to the G&A base in row 26.
If you have questions regarding indirect (F&A) rates see website: http://oamp.od.nih.gov/dfas/IdCSubmission.asp This website also contains definitions, examples, and training.
Please insert the Company's name and the RFP #.
Labor - Core
| SUMMARY OF DIRECT LABOR (CORE) |
| AND FRINGE BENEFITS |
| PERCENT OF EFFORT |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
| YEAR 1 | YEAR 2 | YEAR 3 | ||||||||||||||||||
| 12/16/15 | Through | 12/15/16 | 12/16/16 | Through | 12/16/17 | 12/17/17 | Through | 12/16/18 | TOTAL | TOTAL | ||||||||||
| CURRENT | ADJUSTED | PERCENT | NUMBER | SALARY | FRINGE | FRINGE | PERCENT | NUMBER | SALARY | FRINGE | FRINGE | PERCENT | NUMBER | SALARY | FRINGE | FRINGE | SALARY | FRINGE | ||
| EMPLOYEE | POSITION | BASE SAL | BASE SAL | EFFORT | MONTHS | COST | RATE | COST | EFFORT | MONTHS | COST | RATE | COST | EFFORT | MONTHS | COST | RATE | COST | COST | COST |
| 1 | Principal Investigator | $0 | 10% | 12.00 | $0 | 0.0% | $0 | 10% | 12.00 | $ - 0 | 0.0% | $0 | 10% | 12.00 | $ - 0 | 0.0% | $0 | $ - 0 | $ - 0 |
| 2 | Co-Investigator | $0 | 5% | 12.00 | $0 | 0.0% | 0 | 5% | 12.00 | $ - 0 | 0.0% | 0 | 5% | 12.00 | $ - 0 | 0.0% | 0 | $ - 0 | $ - 0 |
| 3 | Clinical Coordinator | $0 | 20% | 12.00 | $0 | 0.0% | 0 | 20% | 12.00 | $ - 0 | 0.0% | 0 | 20% | 12.00 | $ - 0 | 0.0% | 0 | $ - 0 | $ - 0 |
| 4 | Tissue Tech. | $0 | 20% | 12.00 | $0 | 0.0% | 0 | 20% | 12.00 | $ - 0 | 0.0% | 0 | 20% | 12.00 | $ - 0 | 0.0% | 0 | $ - 0 | $ - 0 |
SUBTOTALS = 55% $0 $0 55% $ - 0 $0 55% $ - 0 $0 $ - 0 $ - 0
ANNUAL INCREASE FACTOR: 0.00%
ANNUAL INCREASE DATE: 00/00/00
NUMBER OF MONTHS AT NEXT ANNUAL INCREASE 0
CORE LABOR
&D &F
Insert annual cost of living % and/or merit increases as applicable and explain the % in the budget justification.
Insert annual increase date.
Insert number of months at the the new hourly rate.
Materials
| SUMMARY OF MATERIALS AND SUPPLIES (CORE) |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
| Period I | Period II | Period III | Period IV | |||||||||||
| Unit | Unit | Unit | Unit | Unit | Unit | Unit | Unit | |||||||
| ITEM | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | TOTAL | |
| 1 | $0.00 | 0 | $0.00 | $0.00 | 0 | $0.00 | $0.00 | 0 | $0.00 | $0.00 | 0 | $0.00 | $0.00 | |
| 2 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 3 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 4 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 5 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 6 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 7 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 8 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 9 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 10 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 11 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 12 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 13 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 14 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 15 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 16 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 17 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 18 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 19 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 20 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 21 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 22 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 23 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 24 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 25 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 26 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 27 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 28 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 29 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 30 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| TOTAL = | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Please use current catalog prices, or vendor quotes. Supporting documentation may be requested at a later date.
Travel
| SUMMARY OF TRAVEL (CORE) |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
| TRAVEL | Year 1 | Year 2 | Year 3 | ||
| Rate | Totals | ||||
| A. STEERING COMMITTEE | 1.018 | 1.018 | 1.018 | ||
| Bethesda, MD | |||||
| Average RT airfare to Bethesda, MD | - 0 | - 0 | - 0 | ||
| Per Diem (1 days) | - 0 | - 0 | - 0 | ||
| Ground Transp./Miscellaneous | - 0 | - 0 | - 0 | ||
| Total Trip Cost | - 0 | - 0 | - 0 | ||
| No. of Trips Per Year | 3 | 1 | 1 | ||
| No. Persons Traveling | 3 | 3 | 3 | ||
| Yearly Travel Costs | - 0 | - 0 | - 0 | - 0 |
ODC
| SUMMARY OF OTHER DIRECT COSTS (CORE) |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
| Period I | Period II | Period III | |||||||||
| Unit | Unit | Unit | Unit | Unit | Unit | ||||||
| ITEM | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | TOTAL | |
| 1 | $0.00 | 0 | $0.00 | $0.00 | 0 | $0.00 | $0.00 | 0 | $0.00 | $0.00 | |
| 2 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 3 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 4 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 5 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 6 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 7 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 8 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 9 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 10 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 11 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 12 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 13 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 14 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 15 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 16 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 17 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 18 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 19 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 20 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 21 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 22 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 23 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 24 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 25 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 26 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 27 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 28 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 29 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| 30 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | 0.00 | 0 | 0.00 | $0.00 | |
| TOTAL = | $0.00 | $0.00 | $0.00 | $0.00 |
Please use current catalog prices, or vendor quotes. Supporting documentation may be requested at a later date.
Subcontract
| SUMMARY OF SUBCONTRACTOR COSTS (CORE) |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
| SUBCONTRACT # | Period I | Period II | Period III | TOTAL | |
| (1) | $0 | $0 | $0 | $0 | |
| (2) | 0 | 0 | 0 | 0 | |
| (3) | 0 | 0 | 0 | 0 | |
| (4) | 0 | 0 | 0 | 0 | |
| (5) | 0 | 0 | 0 | 0 | |
| (6) | 0 | 0 | 0 | 0 | |
| (7) | 0 | 0 | 0 | 0 | |
| (8) | 0 | 0 | 0 | 0 | |
| (9) | 0 | 0 | 0 | 0 | |
| (10) | 0 | 0 | 0 | 0 | |
| TOTAL = | $0 | $0 | $0 | $0 |
A complete breakdown and summary sheet for each proposed subcontract must be included with the prime proposal. The same format should be used for both the prime and subcontract proposals.
Characterization
| SUMMARY OF CAPITATION - ENROLLMENT AND CHARACTERIZATION |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
| LABOR | YEAR 1 | YEAR 2 | YEAR 3 | YEAR 4 | ||||||||
| ADJUSTED | PERCENT | SALARY | FRINGE | FRINGE | 12/16/15 | 12/16/16 | 12/16/17 | |||||
| EMPLOYEE | POSITION | BASE SAL | EFFORT | COST | RATE | COST | 12/15/16 | 12/15/17 | 12/15/18 | TOTAL | ||
| Enter Inflation Factor | 0 | 0 | 0 | |||||||||
| 1 | Principal Investigator | $ - | 3% | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - | $ - | |
| 2 | Co-Investigator | $ - | 0% | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - | $ - | |
| 3 | Clinical Coordinator | $ - | 15% | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - | $ - | |
| 4 | Radiology Tech | $ - | 15% | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - | $ - | |
| 5 | Data Entry/Admin. | $ - | 15% | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - | $ - | |
| $ - | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - | $ - |
SUBTOTALS 48% $ - $ - $ - $ - $ - $ - $ -
| OTHER DIRECT COSTS | 12/16/15 | 12/16/16 | 12/16/17 | |||||||||||
| Unit | Unit | 12/15/16 | Unit | Unit | 12/15/17 | Unit | Unit | 12/15/18 | Unit | Unit | ||||
| ITEM | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Total | |
| 1.018 | 1.018 | 1.018 | ||||||||||||
| Shipping: | ||||||||||||||
| 1 | FedEx 10 lbs. box | $ - 0 | 33 | $ - 0 | $ - 0 | 33 | $ - 0 | $ - 0 | 33 | $ - 0 | $ - 0 | 0.00 | $ - 0 | |
| 2 | Dry Ice 5 lbs. | $ - 0 | 33 | $ - 0 | $ - 0 | 33 | $ - 0 | $ - 0 | 33 | $ - 0 | $ - 0 | 0.00 | $ - 0 |
SUBTOTAL $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
| PATIENT CARE | 12/16/15 | 12/16/16 | 12/16/17 | |||||||||||
| Unit | Unit | 12/15/16 | Unit | Unit | 12/15/17 | Unit | Unit | 12/15/18 | Unit | Unit | ||||
| ITEM | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Total | |
| 1.018 | 1.018 | - 0 | ||||||||||||
| 1 | PFT with DLCO | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 0 | $ - | $ - |
| 2 | Blood Draw | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 0 | $ - | $ - |
| 3 | Six Minute Walk | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 0 | $ - | $ - |
| Blood Tests | 33 | 33 | 33 | 0 | ||||||||||
| 4 | CBC | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 0 | $ - | $ - |
| 5 | Rheumatoid Factor (RF) | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 0 | $ - | $ - |
| 6 | Creatine Kinase (CK) | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 0 | $ - | $ - |
| 7 | Erythrocyte Sedimentation Rate (ESR) | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 0 | $ - | $ - |
| 8 | Anti-Nuclear Antibody (ANA) | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 0 | $ - | $ - |
| 9 | Antibodies to double standard DNA (Anti-dsDNA) | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 0 | $ - | $ - |
| 10 | Jo-1 Antigen | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 0 | $ - | $ - |
| 11 | Antibodies to SCL-70 | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 0 | $ - | $ - |
| 12 | Antibodies to SS-A | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 0 | $ - | $ - |
| 13 | Antibodies to SS-B | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 0 | $ - | $ - |
| 14 | Anti-centromene Antibodies | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 0 | $ - | $ - |
| 15 | Extractable Nuclear Antigen (ENA) | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 3 | $ - | $ - 0 | 0 | $ - | $ - |
| 16 | Alpha-1 Antitrysin Level | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 17 | $ - | $ - 0 | 0 | $ - | $ - |
SUBTOTAL $ - $ - $ - $ - $ -
| YEAR 1 | YEAR 2 | YEAR 3 | Total | ||||||
| SUBTOTALS | $ - | $ - | $ - | $ - | $ - | ||||
| IDC EXCLUSIONS | $ - | $ - | $ - | $ - | $ - | ||||
| IDC BASE | $ - | $ - | $ - | $ - | $ - | ||||
| INDIRECT COSTS | 0.00% | $ - | 0.00% | $ - | 0.00% | $ - | 0.00% | $ - | $ - |
TOTALS $ - $ - $ - $ - $ -
| Capitation Rate Characterization | $ - | $ - | $ - | $ - |
| Note: Capitation rates based on 33 enrollments per year. |
Tissue
| SUMMARY OF CAPITATION - TISSUE PROCUREMENT AND PROCESSING |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
| LABOR | YEAR 1 | YEAR 2 | YEAR 3 | |||||||||
| ADJUSTED | PERCENT | SALARY | FRINGE | FRINGE | 12/16/15 | 12/16/16 | 12/16/17 | |||||
| EMPLOYEE | POSITION | BASE SAL | EFFORT | COST | RATE | COST | 12/15/16 | 12/15/17 | 12/15/18 | TOTAL | ||
| Enter Escalation Factor | 0 | 0 | 0 | |||||||||
| 1 | Lab Tech/Tissue | $ - | 15% | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - | $ - | |
| 2 | $ - | $ - | 0.0% | $ - | $ - | $ - | $ - | $ - | $ - |
SUBTOTALS 15% $ - $ - $ - $ - $ - $ - $ -
| MATERIALS & SUPPLIES | YEAR 1 | YEAR 2 | YEAR 3 | |||||||||||||
| 12/16/15 | 12/16/16 | 12/16/17 | ||||||||||||||
| Unit | Unit | 12/15/16 | Unit | Unit | 12/15/17 | Unit | Unit | 12/15/18 | Unit | Unit | Unit | |||||
| ITEM | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Total | Quantity | Subtotal | |
| 1.018 | 1.018 | 1.018 | ||||||||||||||
| 1 | Laboratory supplies | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $0.00 |
SUBTOTAL $ - 0 $ - 0 $ - 0 $ - 0 $ - 0
| YEAR 1 | YEAR 2 | YEAR 3 | ||||||||||||
| OTHER DIRECT COSTS | 12/16/15 | 12/16/16 | 12/16/17 | |||||||||||
| Unit | Unit | 12/15/16 | Unit | Unit | 12/15/17 | Unit | Unit | 12/15/18 | Unit | Unit | ||||
| ITEM | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Total | |
| Shipping | 1.018 | 1.018 | 1.018 | |||||||||||
| 1 | FedEx 10 lbs. box | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - | $ - 0 |
| 2 | Dry Ice 5 lbs. | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - 0 | $ - 0 | 0 | $ - | $ - 0 |
SUBTOTAL $ - 0 $ - 0 $ - 0 $ - $ - 0
| YEAR 1 | YEAR 2 | YEAR 3 | Total | ||||||
| 12/16/15 | 12/16/16 | 12/16/17 | |||||||
| 12/15/16 | 12/15/17 | 12/15/18 | |||||||
| SUBTOTALS | $ - | $ - | $ - | $ - | $ - | ||||
| IDC EXCLUSIONS | $ - | $ - | $ - | $ - | $ - | ||||
| IDC BASE | $ - | $ - | $ - | $ - | $ - | ||||
| INDIRECT COSTS | 0.00% | $ - | 0.00% | $ - | 0.00% | $ - | 0.00% | $ - | $ - |
TOTALS $ - $ - $ - $ - $ -
| Capitation Rate Tissue | $ - | $ - | $ - | $ - |
| Note: Capitation rates based on 33 tissues per year. |
CT
| SUMMARY OF CAPITATION - CT SCAN AND CARDIOPULMONARY EXERCISE TESTING |
| ** Enter Contractor's Name |
| RFP No. NHLBI-HR-16-07 |
CAPITATION -- CT SCAN
| PATIENT CARE | 12/16/15 | 12/16/16 | 12/16/17 | |||||||||||
| Unit | Unit | 12/15/16 | Unit | Unit | 12/15/17 | Unit | Unit | 12/15/18 | Unit | Unit | ||||
| ITEM | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | Price | Quantity | Subtotal | TOTAL | |
| 1.018 | 1.018 | 1.018 | ||||||||||||
| 1 | Chest CT scan | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - 0 | 33 | $ - | $ - |
TOTAL $ - $ - $ - $ - $ -
| Capitation Rate CT | $ - | $ - | $ - | $ - |
| Note: Capitation rates based on 33 per year. |
File details come from the government source that posted it. Updated .