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Instructions
| S000000219 PPE |
| Official Solicitation Price Sheet |
| Prospective Contractor Name |
| Instructions: |
| 1. Insert your company's name on this tab in the yellow highlighted cell. |
| Table 1: Evaluated Items |
| 1. Enter pricing and other required information for ALL items and shaded areas on Table 1. Failure to enter all required fields may cause Prospective Contractor's proposal to be rejected. |
| 2. Awards will be made on an All or None basis. Prospective Contractor shall bid all items on Table 1 in order to be considered for award. Contractor shall not be considered for award if any items have not been bid on the spreadsheet. |
| 3. Enter the Brand & Model # for each proposed item in Column D. |
| 4. Enter the "Per Each List Price" for all items in Column F. |
| 5. Enter the "Minimum Percentage Discount Off List" in Column G. |
| 6. The "Per Each Contract Price" will automatically calculate in Column H. |
| 7. Enter the "Bulk Unit of Measure" in Column I, i.e., how many of each items are included in a box and/or case. |
| 8. The "Contract Price per Box/Case". Box/Case Contract Price will automatically calculate in Column K. |
| 9. Award determination will be made based on the per each price of the specified items based on quantity of 1,000. For example, if the Prospective Contractor sells masks in a box with a quantity of 500 for $20 List, then the List Price Per Each would be $0.04. If the contractor proposed a 25% Discount Off List on this item, the Per Each Contract Price would be $.03. The cost for a box of 500 would be $15. The cost for a case of 1,000 would be $30. The evaluated each price multiplied by 1,000 would be $30.00. Please see Example on Table 1. |
| 10. Pricing must be based on a minimum discount off list price. Contractor may offer additional discounts to purchasing entities at time of order based on order quantites, etc. Contractor shall not be considered for award if "Minimum Percentage Discount Off" does not exceed 0%. |
| 11. Prospective Contractor shall not add or modify fields on the Price Sheet unless specifically instructed to do so. |
| Table 2: Optional Non-Evaluated Items |
| 1. Prospective Contractors may provide pricing for additional optional PPE products not specified by the State in Table 1. |
| 2. Table 2 will NOT be used in low cost determination. |
| 3. The State may at it's discretion choose to include any or all of the proposed optional items in any contract(s) resulting from this soliciation. |
| 4. Prospective Contractor may add addional rows as necessary. |
Pricing
S000000219/OFFICIAL BID PRICE SHEET
| Table 1 - Evaluated Items | | | | | | | | | | | |
| ITEM | LOT | DESCRIPTION | | ESTIMATED QUANTITY/UM | LIST PRICE PER EACH | Minimum Percentage Discount off LIST PRICE | PER EA PRICE | Bulk UOM | | Cost Per Box/Case | |
| EXAMPLE | EXAMPLE | Face Mask | | 1,000 | $0.04 | 25.00% | $0.03 | 500 | /Box | $15.00 | /Box |
| | Brand/Mfr.: | ACME Face Mask | | | | | 1000 | /Case | $30.00 | /Case |
| | Model/Item No.: | 8675309 | | | | | | | | |
| 1 | 1 | N95 Mask: Surgical Respirator | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 2 | 1 | N95 Mask: Industrial Respirator | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 3 | 1 | Qualitative Fit Test Kits | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 4 | 1 | Fit Test Solution- Bitter | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 5 | 1 | Fit Test Solution- Sweet | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 6 | 2 | Surgical Mask | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 7 | 2 | Non-Surgical/Non Medical ADULT (Indvidually Wrapped) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 8 | 2 | Non-Surgical/Non Medical ADULT (Non-Indvidually Wrapped) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 9 | 2 | Non-Surgical/Non Medical CHILD | | | | | | | |
| (Indvidually Wrapped) | | 1,000 | | $0.00 | /Box | $0.00 | /Box | | | |
| | | Brand/Mfr.: | | | | | /Case | $0.00 | /Case |
| | | Model/Item No.: | | | | | | | |
| 10 | 2 | Non-Surgical/Non Medical CHILD | | | | | | | |
| (Non-Indvidually Wrapped) | | 1,000 | | $0.00 | /Box | $0.00 | /Box | | | |
| | | Brand/Mfr.: | | | | | /Case | $0.00 | /Case |
| | | Model/Item No.: | | | | | | | |
| 11 | 3 | Face Shield without Glasses | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 12 | 3 | Face Shield with Glasses | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 13 | 3 | Medical Goggles | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 14 | 4 | Nitrile Gloves- 4 mil (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 15 | 4 | Nitrile Gloves- 4 mil (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 16 | 4 | Nitrile Gloves- 4 mil (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 17 | 4 | Nitrile Gloves- 4 mil (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 18 | 4 | Purple Nitrile Exam Gloves- 4 mil (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 19 | 4 | Purple Nitrile Exam Gloves- 4 mil (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 20 | 4 | Purple Nitrile Exam Gloves- 4 mil (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 21 | 4 | Purple Nitrile Exam Gloves- 4 mil (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 22 | 4 | Extended Cuff Nitrile Gloves- 4 mil (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 23 | 4 | Extended Cuff Nitrile Gloves- 4 mil (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 24 | 4 | Extended Cuff Nitrile Gloves- 4 mil (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 25 | 4 | Extended Cuff Nitrile Gloves- 4 mil (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 26 | 5 | Disposable Isolation Gowns Level 1 (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 27 | 5 | Disposable Isolation Gowns Level 1 (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 28 | 5 | Disposable Isolation Gowns Level 1 (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 29 | 5 | Disposable Isolation Gowns Level 1 (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 30 | 5 | Disposable Isolation Gowns Level 2 (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 31 | 5 | Disposable Isolation Gowns Level 2 (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 32 | 5 | Disposable Isolation Gowns Level 2 (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 33 | 5 | Disposable Isolation Gowns Level 2 (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 34 | 5 | Disposable Isolation Gowns Level 3 (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 35 | 5 | Disposable Isolation Gowns Level 3 (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 36 | 5 | Disposable Isolation Gowns Level 3 (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 37 | 5 | Disposable Isolation Gowns Level 3 (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 38 | 5 | Disposable Isolation Gowns Level 4 (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 39 | 5 | Disposable Isolation Gowns Level 4 (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 40 | 5 | Disposable Isolation Gowns Level 4 (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 41 | 5 | Disposable Isolation Gowns Level 4 (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 42 | 5 | Disposable Surgical Gowns Level 1 (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 43 | 5 | Disposable Surgical Gowns Level 1 (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 44 | 5 | Disposable Surgical Gowns Level 1 (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 45 | 5 | Disposable Surgical Gowns Level 1 (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 46 | 5 | Disposable Surgical Gowns Level 2 (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 47 | 5 | Disposable Surgical Gowns Level 2 (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 48 | 5 | Disposable Surgical Gowns Level 2 (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 49 | 5 | Disposable Surgical Gowns Level 2 (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 50 | 5 | Disposable Surgical Gowns Level 3 (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 51 | 5 | Disposable Surgical Gowns Level 3 (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 52 | 5 | Disposable Surgical Gowns Level 3 (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 53 | 5 | Disposable Surgical Gowns Level 3 (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 54 | 5 | Disposable Surgical Gowns Level 4 (S) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 55 | 5 | Disposable Surgical Gowns Level 4 (M) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 56 | 5 | Disposable Surgical Gowns Level 4 (L) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 57 | 5 | Disposable Surgical Gowns Level 4 (XL) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 58 | 6 | Shoe/Boot Covers (ankle) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 59 | 6 | Shoe/Boot Covers (calf) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 60 | 6 | Shoe/Boot Covers (knee) | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 61 | 6 | Hair Covers/Bouffant | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 62 | 6 | Disposable Blood Preasure Cuff Covers | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 63 | 7 | Hand Sanitizer - Isopropyl 2 oz. | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 64 | 7 | Hand Sanitizer - Isopropyl 4 oz. | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 65 | 7 | Hand Sanitizer - Isopropyl 8 oz. | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 66 | 7 | Hand Sanitizer - Isopropyl 12 oz. | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 67 | 7 | Hand Sanitizer - Isopropyl 32 oz. | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 68 | 7 | Hand Sanitizer - Isopropyl Gallon | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 69 | 8 | Dimethyl Benzyl Ammonium Chloride Flat Pack | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 70 | 8 | Disinfecting wipes - Dimethyl Benzyl Ammonium Chloride Canister | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 71 | 8 | Disinfecting wipes - Isopropyl Alcohol Flat Pack | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
| 72 | 8 | Disinfecting wipes - Isopropyl Alcohol Canister | 1,000 | $0.00 | /Box | $0.00 | /Box |
| | Brand/Mfr.: | | | /Case | $0.00 | /Case |
| | Model/Item No.: | | | | | |
% $0.00
Optional Items
S000000219/OFFICIAL BID PRICE SHEET
| Table 2 - Optional Non-Evaluated Items | | | | | | | |
| ITEM | DESCRIPTION | LIST PRICE PER EACH | Minimum Percentage Discount off LIST PRICE | Bulk UOM | | Cost Per Box/Case | |
| 1 | Item Description: | | | | /Box | | /Box |
| Brand/Mfr.: | | | | /Case | | /Case |
| Model/Item No.: | | | | | | |
| 2 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 3 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 4 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 5 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 6 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 7 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 8 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 9 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 10 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 11 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 12 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 13 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 14 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 15 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 16 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 17 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |
| 18 | Item Description: | /Box | /Box |
| Brand/Mfr.: | /Case | /Case |
| Model/Item No.: | | |