The file's text, extracted by GovTribe without its formatting.
Sheet1
| ***This is a small business set-aside in accordance with FAR 19.502-2(b) |
| CONTRACTOR NAME: |
| E-MAIL & PHONE NUMBER: |
| Registered on SAM.gov?: |
| DUNS Number: |
| CAGE Code: |
*** CONTRACTOR TO FILL IN CELLS BELOW
| | Service | Base | | | | | | Service | Option Period 3 | | | |
| | | Rate | Quantity | UOI | Extended Price | | | | Rate | Quantity | UOI | Extended Price |
| CLIN | 0001 | 8 Appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 3001 | 8 Appointments per day | $ - 0 | 2000 | Appointments | $ - 0 |
| CLIN | 0002 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 3002 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 |
| CLIN | 0003 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 3003 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 |
| CLIN | 0004 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 3004 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 |
| CLIN | 0005 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 3005 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 |
| CLIN | 0006 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 3006 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 |
| CLIN | 0007 | Contractor Manpower Reporting | $ - 0 | 1 | Each | $ - 0 | CLIN | 3007 | Contractor Manpower Reporting | $ - 0 | 1 | Each | $ - 0 |
| | | Base Year Total: | | | $ - 0 | | | | Option Year 3 Total: | | | $ - 0 |
| | | Option Period 1 | | | | | | | Option Period 4 | | | |
| | | Rate | Quantity | UOI | Extended Price | | | | Rate | Quantity | UOI | Extended Price |
| CLIN | 1001 | 8 Appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 4001 | 8 Appointments per day | $ - 0 | 2000 | Appointments | $ - 0 |
| CLIN | 1002 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 4002 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 |
| CLIN | 1003 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 4003 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 |
| CLIN | 1004 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 4004 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 |
| CLIN | 1005 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 4005 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 |
| CLIN | 1006 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 4006 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 |
| CLIN | 1007 | Contractor Manpower Reporting | $ - 0 | 1 | Each | $ - 0 | CLIN | 4007 | Contractor Manpower Reporting | $ - 0 | 1 | Each | $ - 0 |
| | | Option Year 1 Total: | | | $ - 0 | | | | Option Year 4 Total: | | | $ - 0 |
| | | Option Period 2 | | | | | | | 52.217-8 Extension Period | | | |
| | | Rate | Quantity | UOI | Extended Price | | | | Rate | Quantity | UOI | Extended Price |
| CLIN | 2001 | 8 Appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 5001 | 8 Appointments per day | $ - 0 | 1000 | Appointments | $ - 0 |
| CLIN | 2002 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 5002 | Late Cancellations* | $ - 0 | 100 | Appointments | $ - 0 |
| CLIN | 2003 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 5003 | 8 Additional appointments per day | $ - 0 | 1000 | Appointments | $ - 0 |
| CLIN | 2004 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 5004 | Late Cancellations* | $ - 0 | 100 | Appointments | $ - 0 |
| CLIN | 2005 | 8 Additional appointments per day | $ - 0 | 2000 | Appointments | $ - 0 | CLIN | 5005 | 8 Additional appointments per day | $ - 0 | 1000 | Appointments | $ - 0 |
| CLIN | 2006 | Late Cancellations* | $ - 0 | 200 | Appointments | $ - 0 | CLIN | 5006 | Late Cancellations* | $ - 0 | 100 | Appointments | $ - 0 |
| CLIN | 2007 | Contractor Manpower Reporting | $ - 0 | 1 | Each | $ - 0 | CLIN | 5007 | Contractor Manpower Reporting | $ - 0 | 1 | Each | $ - 0 |
| | | Option Year 2 Total: | | | $ - 0 | | | | Option Period 5 Total: | | | $ - 0 |
| Grand total | $ - 0 |
| *Charge per scheduled appointment not attended or canceled ____________________________________ (enter required cancellation period) before scheduled appointment time. | | |
| (The time established will apply to the full Period of Performance). | | |