01. ATTCH 01-Contractor Information & Pricing Table.pdf
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- Solicitation number
- W912LP-25-Q-5005
About this file
This is a pricing and contractor information template (Attachment 01) for RFQ #W912LP-25-Q-5005 for Medical Surveillance Examination Services at AASF #3 in Davenport, Iowa. The template requires contractors to provide company details including POC information, CAGE code, SAM Unique Entity ID, Tax ID number, payment terms, and business size/socioeconomic status.
The pricing table lists six required medical services, each with a quantity of 17 units: Physical/Dermatological Exam, Complete Lab Draw, Vision Screening, Chromium Blood Level, Lead Blood Level, and Cadmium Blood Level. Contractors must provide unit prices and extended prices for each service, with the template calculating a total price. This form must be completed and submitted as the official quote, even if additional quote documentation is provided.
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Attachment 01 – Contractor Information and Pricing Tables
RFQ # W912LP-25-Q-5005
Medical Surveillance Examination Services (AASF #3 Davenport, Iowa)
Contractor shall complete the Contractor Information Table and the Pricing Table and include this page as their official quote. If the contractor submits an additional quote document, this attachment shall still be completed and submitted with their other documents.
PRICING TABLE
Item # Description Qty Unit Unit Price Extended Price
0001 Physical / Dermatological Exam EA
0002 Complete Lab Draw EA
0003 Vision Screening EA
0004 Chromium Blood Level EA
0005 Lead Blood Level EA
0006 Cadmium Blood Level EA
Total
CONTRACTOR INFORMATION TABLE
Company Name:
Point of Contact (POC) Name:
POC Phone:
POC Email:
CAGE Code:
SAM Unique Entity ID:
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)
| Company Name: |
| Point of Contact POC Name: |
| POC Phone: |
| POC Email: |
| CAGE Code: |
| SAM Unique Entity ID: |
| Tax ID Number: |
| Prompt Payment Discount Terms Net 30 unless otherwise noted: |
| Business SizeSocioeconomic Groups Must correspond with FAR 522123 Representations and Certifications completed within SAM: |
| Unit PriceEA: |
| Extended PriceEA: 0 |
| Unit PriceEA_2: |
| Extended PriceEA_2: 0 |
| Unit PriceEA_3: |
| Extended PriceEA_3: 0 |
| Unit PriceEA_4: |
| Extended PriceEA_4: 0 |
| Unit PriceEA_5: |
| Extended PriceEA_5: 0 |
| Unit PriceEA_6: |
| Extended PriceEA_6: 0 |
| Extended PriceTotal: 0 |
| Text1: 17 |
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