ATCH_3_Contractor Information and Pricing Schedule_Amendment 0001.pdf
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- W912LP-20-Q-4528
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ATTACHMENT #3
Iowa Army National Guard Request for Quotation (RFQ) # W912LP-20-Q-4528
Medical Surveillance Exams – Camp Dodge and Boone, Iowa
Vendor shall complete the contractor information table and the pricing table and attach this attachment to their quotation.
CONTACT INFORMATION TABLE
Company Name
Point of Contact (POC) Name
POC Phone
POC Email
CAGE Code
DUNS Number
Tax ID Number
Prompt Payment Discount Terms (Net 30 unless otherwise noted)
Business Size/Socio-economic Group(s) (Must correspond with FAR 52.212-3 representations and certifications completed within SAM)
Period of Performance
PRICING TABLE
ITEM # DESCRIPTION QUANTITY UNIT UNIT PRICE AMOUNT
0001 Medical Exam 143 Each $ $ 0002 Vision Exam 142 Each $ $ 0003 Cadmium Exam 12 Each $ $ 0004 ZPP Lab 36 Each $ $ 0005 Lead Lab 27 Each $ $ 0006 HDI, MDI, and TDI Labs 5 Each $ $ 0007 Manganese Lab 14 Each $ $ 0008 Chromium Lab 17 Each $ $ 0009 Heavy Metal Panel 15 Each $ $
Contractor Manpower Reporting (CMR) 1 Each $ $
TOTAL $
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