Att_12_MIOSS_Sample_DOL_Wage_Determination_Price_Adjustment_Workbook.xlsx
XLSX spreadsheet 27 KB Posted
- Attached to
- The Medical Simulation Training Center (MSTC), Instructor, Operator Support Services (MIOSS) acquisition
- Solicitation number
- W900KK-23-R-0016
About this file
This document contains a sample price adjustment request form and related federal contract opportunity solicitation. The price adjustment request form is a sample template for a contract to provide Medical Instructor and Operator Support Services at various military medical simulation training centers. It includes wage determination and collective bargaining agreement information as well as calculations for adjusting labor rates and fringe benefits.
The related federal contract opportunity is solicitation number W900KK-23-R-0016 to provide Medical Instructor and Operator Support Services at medical simulation training centers. The requirements include instructor and operator services to support immersive medical training using computerized mannequins, task trainers, and associated audiovisual equipment. The firm-fixed-price contract will have a two-month phase-in period, six-month base period, and four one-year options. This is a small business set-aside awarded under NAICS code 541990 by the Department of the Army Materiel Command Contracting Command Orlando Contracting Center.
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Text version
SAMPLE
SAMPLE Price Adjustment Request Form
| Section A | ||
| Contract Number: | TBD | |
| CLIN Number: | ||
| CLIN Description: | MIOSS | |
| Location: | Various | |
| Applicable Wage Determination Number/ | ||
| Collective Bargaining Agreement: | Various | |
| Price Adjustment for Option/FY |
| Column (a) | Column (b) | Column (c) | Column (d) | Column (e) | Column (f) | |
| CBA/WD Classification | Employee Number | Employee | ||||
| Base Rate | WD/CBA | |||||
| Rate | Hourly Salary | |||||
| Increase | Labor Category Description | CLIN | Applicable Wage |
Determination Number/
| Collective Bargaining Agreement: | Location | ||||||||
| 1 | $ 14.31 | $ 14.31 | $ - 0 | Computer Operator I | TBD | 2005-2312 Rev 19 | Fort Leonard Wood | ||
| 2 | $ 14.31 | $ 14.31 | $ - 0 | Computer Operator I | TBD | 2005-2312 Rev 19 | Fort Leonard Wood | ||
| 3 | $ 14.31 | $ 14.31 | $ - 0 | Computer Operator I | TBD | 2005-2312 Rev 19 | Fort Leonard Wood | ||
| 4 | $ - 0 | 0 | |||||||
| 5 | $ - 0 | 0 | |||||||
| Health & Welfare | Health & Welfare | $ 4.02 | $ 4.27 | $ 0.25 | All | All - Health & Welfare |
| Section B | |||
| Contract Number: | TBD | ||
| CLIN Number: | 0 | ||
| CLIN Description: | MIOSS | ||
| Location: | Various | ||
| Applicable Wage Determination Number/ | |||
| Collective Bargaining Agreement: | Various | . | |
| Price Adjustment for Option/FY | 0 |
| Column (a) | Column (b) | Column (c) | Column (d) | Column (e) | Column (f) | Column (g) | Column (h) | Column (i) | Column (j) | ||||||||
| Employee Number | Hourly Salary | ||||||||||||||||
| Increase | Total Projected Hours | Total Salary Increase | 7.65% | ||||||||||||||
| Hollenbaugh, Devin: Obtained from the Dept. of Labor website. | 0.00% | 0.00% | 0.00% | 0.00% | 0.00% | ||||||||||||
| Hollenbaugh, Devin: FUI, SDI, SUI, WCI Vary by Company | Option 1 | Option 2 | Option 3 | Option 4 | TOTAL | ||||||||||||
| FICA (Current Rate: 7.65%) | Federal Unemployment Insurance (FUI) | State Disability Insurance (SDI) | State Unemployment Insurance (SUI) | Workmen's Compensation Insurance (WCI) | Other | Total Adjustment | Total Adjustment | Total Adjustment | Total Adjustment | TOTAL | CLIN | Applicable Wage |
Determination Number/
| Collective Bargaining Agreement: | Location | |||||||||||||||||
| 1 | $ - 0 | 2,080.0 | $ - 0 | $ - 0 | $ - 0 | - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | TBD | 2005-2312 Rev 19 | Fort Leonard Wood | |
| 2 | $ - 0 | 2,080.0 | $ - 0 | $ - 0 | $ - 0 | - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | TBD | 2005-2312 Rev 19 | Fort Leonard Wood | |
| 3 | $ - 0 | 2,080.0 | $ - 0 | $ - 0 | $ - 0 | - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | TBD | 2005-2312 Rev 19 | Fort Leonard Wood | |
| 4 | ||||||||||||||||||
| 5 | ||||||||||||||||||
| Health & Welfare | $ 0.25 | $ 6,240.00 | $ 1,560.00 | $ 119.34 | 0 | 0 | $ 1,679.34 | $ 1,679.34 | $ 1,679.34 | $ 1,679.34 | $ 6,717.36 | 0 | All | All - Health & Welfare |
$ 1,679.34 $ 1,679.34 $ 1,679.34 $ 1,679.34 $ 6,717.36
File details come from the government source that posted it. Updated .