RFQ No. 70FB8026Q00000056 Attachment 3 Pricing Table.xlsx
XLSX spreadsheet 38 KB Posted
- Attached to
- Region IX Emergency Medical Membership Access
- Solicitation number
- 70FB8026Q00000056
About this file
This is a pricing table template for RFQ No. 70FB8026Q00000056 for Emergency Medical Evacuation Insurance and Services. The document is an Excel spreadsheet designed to capture pricing information from offerors bidding on providing emergency medical evacuation insurance and services to Federal Emergency Management Agency (FEMA) Region IX personnel and individuals performing work on behalf of FEMA in US Territories in the Pacific. The pricing table serves as the submission format for vendors to propose their costs for the required insurance coverage and evacuation services. As a template document, it does not contain pricing data itself but rather establishes the structure and categories that offerors must use when submitting their financial proposals in response to this solicitation.
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CAE Approval
| CAE Approval and Date: |
| For new development or production contracts (including services contracts) with a total IGCE value above $20 million that support a Level I or II acquisition program, the program office shall obtain IGCE review and signature by the CAE. A copy of the signed IGCE is required to be provided by the CAE to the Office of the USM when the procurement request package is submitted to the contracting activity. (Reference DHS Instruction 102-01-001- Rev 2) |
BOE
| Independent Government Cost Estimate |
| Basis of Estimate: For each major cost element (e.g., labor, material), explain how the estimate was developed. For example, if recent contracts for similar supplies or services were reviewed to develop the estimate, list the contract number(s), briefly describe the products or services under those contracts, the performance periods/delivery dates, and state what information from those contracts were used in developing this IGCE. Identify information obtained from market research and briefly explain how that information was used in developing the estimate. For example, if labor rates from a DHS strategic sourcing or GSA federal supply contracts were used to develop the estimate, identify the contracts used and provide a brief rational for using those labor categories. |
| Assumptions: List key assumptions associated with each major cost element of the IGCE. For example, identify assumptions regarding inflation, the location of performance (e.g., government site vs. contractor site), extent to which commercial items may require modification, technology refresh cycles, and availability of materials or special expertise. |
Sheet1
| Company Name: | ||||||
| UEI: | ||||||
| ATTACHMENT 3 PRICING TABLE | ||||||
| Description of Cost Elements | Year 1 | Year 2 | Year 3 | Year 4 | Year 5 | 5-Year Total |
| Yearly Membership Fee | $0 | |||||
| Medical Evacuation Services | $0 | |||||
| Annual Total | $0 | $0 | $0 | $0 | $0 | $0 |
IGCE_T&M
| Independent Government Cost Estimate for Time and Material Contracts | ||||||||||||||||||
| Component: | Prepared by: | Phone/Email: | ||||||||||||||||
| Program/Project Title: | Date Prepared: | |||||||||||||||||
| BASE YEAR | OPTION YEAR 1 | OPTION YEAR 2 | OPTION YEAR 3 | OPTION YEAR 4 | TOTAL | |||||||||||||
| PRIME CONTRACTOR - LABOR CATEGORY (Note 1) | WBS Reference (Note 6) | LCCE Reference (Note 6) | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Total Cost |
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Total Prime Contractor Labor | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | $0.00 | |||||||
| SUBCONTRACTOR A - LABOR CATEGORY (Note 2) | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Total Cost | ||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Total Subcontract A Labor | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | $0.00 | |||||||
| SUBCONTRACTOR B - (If applicable)(Note 2) | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Total Cost | ||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Total Subcontract B Labor | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | $0.00 | |||||||
| SUBCONTRACTOR C - (If applicable) (Note 2) | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Hours | Fixed Hourly Rate | Cost | Total Cost | ||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Labor category title | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||||
| Total Subcontract C Labor | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | 0 | $0.00 | $0.00 |
TOTAL PRIME AND SUBCONTRACTOR LABOR 0 $0.00 0 $0.00 0 $0.00 0 $0.00 0 $0.00 $0.00
| MATERIALS and OTHER DIRECT COSTS (ODC) (Notes 3 & 4) | Quantity | Unit Cost | Cost | Quantity | Unit Cost | Cost | Quantity | Unit Cost | Cost | Quantity | Unit Cost | Cost | Quantity | Unit Cost | Cost | Total Cost |
| Material or ODC Description | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| Material or ODC Description | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| Material or ODC Description | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| Material or ODC Description | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| Material or ODC Description | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| Material or ODC Description | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| Material or ODC Description | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| Material or ODC Description | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||||
| Total Materials and Other Direct Costs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| INDIRECT BURDEN APPLIED TO MATERIAL & ODC (Note 5) | Rate | Cost | Rate | Cost | Rate | Cost | Rate | Cost | Rate | Cost | Total Cost |
| Indirect Burden Applied To Material/ODC Cost Pool 1 | $0.00 | ||||||||||
| Indirect Burden Applied To Material/ODC Cost Pool 2 | $0.00 | ||||||||||
| TOTAL INDIRECT BURDEN APPLIED TO MATERIAL & ODC | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
TOTAL ESTIMATED CEILING PRICE $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Note 1: The rates should be fully burdened labor rates for effort performed by the Prime contractor (including indirect costs and profit).
Note 2: Rates should be fully burdened labor rates for effort performed by this particular Subcontractor including indirect cost & profit
Note 3: Materials include direct materials, subcontracts for supplies and incidental services, other direct costs (e.g., travel, computer usage)
Note 4: Profit is NOT allowable on Materials.
| Note 5: For all Indirect Material Cost pools, please provide the description of the allocation base for each pool (please add additional pools if aplicable): |
| Indirect Burden Applied to Material Cost Pool 1: |
| Indirect Burden Applied to Material Cost Pool 2: |
| Note 6: HSAM 3007.104(d)(1)(ii) The IGCE shall include line item mapping to corresponding sections of the programmatic Work Breakdown Structure (WBS) and Life Cycle Cost Estimate (LCCE), when a WBS and LCCE exist or explain why the mapping is not applicable. DHS Standard WBS Material and LCCE Templates can be located on the following OCFO Sharepoint Site: |
| Cost Tools and Templates |
&"Arial,Bold"&16PRICING TEMPLATE - TIME AND MATERIALS COMPETITIVE MODEL
Page &P of &N https://dhsconnect.dhs.gov/org/comp/mgmt/cfo/Pages/Tools-%26-Templates.aspx
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