SAMPLE BID FORM for Reference Only.pdf
PDF 65 KB Posted
- Attached to
- Mobile X-Ray On-Site Services
- Solicitation number
- BPM031645
- Issued by
- Maryland
About this file
This document is a Sample Bid Form related to a state and local contract opportunity for providing on-site mobile x-ray services and diagnostic reading and interpretations for the Maryland Department of Health, Deer's Head Hospital Center. The contract is for a two-year term, with the contractor to be paid a fixed rate of $25.00 per x-ray per call for service. The most requested types of x-rays include chest, abdomen, hips, knee, femur, tibia/fibula, and ankle. No overtime, shift differential, or additional fees over the stated rate will be paid. Bidders must provide all pricing information as specified on the Bid Form and failure to adhere to the instructions may result in the bid being deemed non-responsive.
The contract does not mention any set-asides, incumbents, funding requirements, or other salient information. The key details focus on the scope of services, contract term, and pricing structure.
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Text version
Attachment A- Bid Form
On-site Mobile X-Ray Services
The Bid shall contain all price information in the format specified on these pages. Complete the Bid Form only as provided in the Bid Pricing Instructions. Do not amend, alter or leave blank any items on the Bid Form. Failure to adhere to any of these instructions may result in the bid being determined non-responsive and rejected by the
Department.
YEAR 1 **
$_25.00_________per X-Ray per Call for Service
YEAR 2 **
$_25.00_________per X-Ray per Call for Service
NOTE: The following types of x-rays that are most requested by a Physician’s order: Chest, Abdomen, Hips, Knee, Femur, Tibia/Fibula and Ankle
**NOTE: The contractor shall be paid for the actual number of X-Rays times the unit price (Cost per X-Ray) stated on the bid page.
***No overtime, shift differential or any fee over and above the rate bid shall be paid.
Submitted By:
Authorized Signature: _______________________________________________ Date: ________________________
Printed Name and Title: ___________________________________________________________________________
Bidder Name : ________________________________________________________________________________
Bidder Address: ________________________________________________________________________________
Location(s) from which services will be performed (City/State): ___________________________________________
FEIN: _________________________________________ eMMA #
Bidder Contact Information: Telephone: (____) ____-- ______________ Fax: (____) ____--_________________
E-mail: ______________________________________________________________
File details come from the government source that posted it. Updated .