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INSTRUCTIONS

OMB Control No. 9000-0013


How to use this Excel file:
(Updated 10/9/2008)

IMPORTANT NOTE: If you have opened this file before saving on your computer, you will be prompted for a user name and a password
and you will lose all the data you may have inserted. Please close the file and click on the link again and save before opening.
This worksheet is intended to help you prepare your cost proposal. If you provide us with an electronic copy of the cost proposal, we can save time by not recreating it. This
will help speed up the review/award process and perhaps reduce the number of questions we need to ask in order to understand your proposal. We understand that one
spreadsheet format can not fit every situation; however, we have attempted to create a simple model that fits most circumstances that arise in Government contracting. Feel
free to modify the spreadsheet to fit your circumstances, and to use the parts that work for you. There are more specific instructions on specific cost element pages where
applicable.
Summary Page
Please insert your organization's name in cell A2 and the RFP No. in cell A3.
The totals from each cost element page are automatically carried forward to the Summary worksheet. Enter the start date of the contract in cell C5.
This Excel file is set up for seven periods.
Direct Labor
Use the Labor - Percent of Effort worksheet if you track labor on a percent of effort basis. Generally, Universities, Hospitals, and Non-Profit Organizations tract labor by
percent of effort.
Use the Labor - Hourly worksheet if you track labor on an hourly basis. Commercial organizations track labor on an hourly basis.
Use both pages if you track some employees by each method. Please do not put any employee on both pages. Consultants should be proposed on the consultants
worksheet, not the labor worksheets.
The proposed amounts must be based on current payroll information which shows hourly, monthly, or annual rate/salary for each proposed (named) individuals. Acceptable
documentation includes any one of the following: 1) personnel action forms, or 2) most recent payroll register showing name, pay rate, and percent of effort if applicable, or 3)
copy of pay stub. Supporting documentation may be requested at a later date.
If the proposed positions have not been filled or are to be named or hired, then acceptable documentation includes the following: 1) letter of intent to hire including salary rate
and title, or 2) position descriptions and salary scales or organizational wage table showing salary range and a copy of hiring policy, or 3) a comparable employee's payroll
document. Supporting documentation may be requested at a later date. Increases for the to be named or hired are not eligible for increases in the first period.
Indirect Rates Including Fringe Benefit Rate(s) for Commercial Organizations
If your organization does not have negotiated rates, the following website contains information which will assist you in computing indirect rates:
http://oamp.od.nih.gov/dfas/IdCSubmission.asp
Please do not submit your indirect proposal to the Division of Financial Advisory Services at this time.
Points of Contact
If you have any questions regarding this Excel file, please contact Cindi Brown (301-496-4494) email at CB25B@NIH.GOV.
If you have contracting questions, please call the NIH Contracting Official who is listed in the RFP.

Page 1

SUMMARY OF PROPOSED COSTS


** Contractor's Name
** RFP No.
PERIOD I
1/1/2007
Through
12/31/2007
$0
0
0
0
$0

*** Period ( dates)

Direct Labor - Percent of Effort


Fringe Benefits - Percent of Effort
Direct Labor - Hourly
Fringe Benefits - Hourly
Total Direct Labor & Fringe Benefits
Overhead

0%

$0

Materials and Supplies


Professional Travel
Equipment
Consultants
Other Direct Costs
Patient Care Costs
Subcontracts
Total Other Direct Costs

$2
0
223,936
0
0
0
0
$223,938

Subtotal: Direct Labor, Fringe Benefits, Overhead , & Other Directs

$223,938
0
$223,938
0
223,938
0
$223,938

Exclusion(s) From Base For G&A


Adjusted Base for G&A
G&A
Total Proposed Cost Excluding Fee
Proposed Fee/Profit
Total Proposed Cost Plus Fee/Profit

0%
0%

PERIOD II
1/1/2008
Through
12/31/2008
$0
0
0
0
$0
0%

$0

PERIOD III
1/1/2009
Through
12/31/2009
$0
0
0
0
$0
0%

MCA2220F

0%
0%

$0

PERIOD IV
1/1/2010
Through
12/31/2010
$0
0
0
0
$0
0%

$0

PERIOD V
1/1/2011
Through
12/31/2011
$0
0
0
0
$0
0%

$0

$0

$0
0
0
0
11,994
0
0
$11,994

$0
0
0
0
0
0
0
$0

$0
0
0
0
0
0
0
$0

$11,994
0
$11,994
0
11,994
0
$11,994

$12,787
0
$12,787
0
12,787
0
$12,787

$11,994
0
$11,994
0
11,994
0
$11,994

$11,994
0
$11,994
0
11,994
0
$11,994

$0
0
$0
0
0
0
$0

$0
0
$0
0
0
0
$0

0%
0%

If applicable, insert exclusions to the G&A base in row 26.

If you have questions regarding indirect (F&A) rates see website: http://oamp.od.nih.gov/dfas/IdCSubmission.asp

Enter the contract start date in cell C5 and make adjustments for leap year.

0%

$0
0
0
0
11,994
0
0
$11,994

The base for overhead costs includes direct labor and fringe benefits. Please modify if your base is different.

***

$0

$794
0
0
0
11,994
0
0
$12,787

0%
0%

0%
0%

Generally, Universities and Non-Profits have fringe benefit and G&A (or sometimes called F&A) rates, while For-Profit Companies can have various indirect rates
such as fringe benefits, overhead, G&A, etc.

Please insert the Company's name and the RFP #.

0%

PERIOD VII
1/1/2013
Through
12/31/2013
$0
0
0
0
$0

0
0
0
11,994
0
0
$11,994

Not all organizations allocate indirect cost in the same way. It is important that you use the indirect rate structure applicable to your organization. For example,
if you have a two tier indirect rate structure, then you will use a two tier structure when proposing indirect costs.

**

PERIOD VI
1/1/2012
Through
12/31/2012
$0
0
0
0
$0

0%
0%

0%
0%

TOTAL

$0
0
0
0
$0
$0
#VALUE!
0
223,936
0
47,975
0
0
#VALUE!
$272,706
0
$272,706
0
272,706
0
$272,706

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


PERCENT OF EFFORT

** Contractor's Name

PERIOD I*

** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT
ADJUSTED
PERCENT OF
BASE SALARY BASE SALARY
EFFORT
$0
$0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
0
0
0%
SUBTOTALS =
0%

1/1/2007
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

PERIOD II*
12/31/2007
FRINGE
RATE
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually
in Column "D" of the spreadsheet and explained in the budget justification)

ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

Insert annual cost of living % and/or merit increases as


applicable and explain the % in the budget justification.
Insert annual increase date.
Insert number of months at the new salary.

*Adjust the number of months per period as recommended in the RFP.

Page 4

1/1/2008
PERCENT OF NUMBER
EFFORT
MONTHS
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%

Through
12/31/2008
SALARY
FRINGE
COST
RATE
$0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
$0

SUMMARY OF DIRECT LABOR

Page 5

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


PERCENT OF EFFORT

** Contractor's Name
** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT
ADJUSTED
BASE SALARY BASE SALARY
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SUBTOTALS =

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually
in Column "D" of the spreadsheet and explained in the budget justification)

ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 6

SUMMARY OF DIRECT LABOR

Page 7

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


PERCENT OF EFFORT

** Contractor's Name

PERIOD III*

** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT
ADJUSTED
BASE SALARY BASE SALARY
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SUBTOTALS =

PERCENT OF
EFFORT
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

1/1/2009
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually
in Column "D" of the spreadsheet and explained in the budget justification)

ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 8

PERIOD IV*
12/31/2009
FRINGE
RATE
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

PERCENT OF
EFFORT
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

1/1/2010
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
12/31/2010
SALARY
FRINGE
COST
RATE
$0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
$0

SUMMARY OF DIRECT LABOR

Page 9

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


PERCENT OF EFFORT

** Contractor's Name
** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT
ADJUSTED
BASE SALARY BASE SALARY
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SUBTOTALS =

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually
in Column "D" of the spreadsheet and explained in the budget justification)

ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 10

SUMMARY OF DIRECT LABOR

Page 11

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


PERCENT OF EFFORT

** Contractor's Name

PERIOD V*

** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT
ADJUSTED
BASE SALARY BASE SALARY
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SUBTOTALS =

PERCENT OF
EFFORT
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

1/1/2011
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually
in Column "D" of the spreadsheet and explained in the budget justification)

ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 12

PERIOD VI*
12/31/2011
FRINGE
RATE
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

1/1/2012
PERCENT OF NUMBER
EFFORT
MONTHS
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%

Through
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

12/31/2012
FRINGE
RATE
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

SUMMARY OF DIRECT LABOR

Page 13

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


PERCENT OF EFFORT

** Contractor's Name
** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT
ADJUSTED
BASE SALARY BASE SALARY
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SUBTOTALS =

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually
in Column "D" of the spreadsheet and explained in the budget justification)

ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 14

SUMMARY OF DIRECT LABOR

Page 15

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


PERCENT OF EFFORT

** Contractor's Name

PERIOD VII*

** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT
ADJUSTED
BASE SALARY BASE SALARY
$0
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
SUBTOTALS =

1/1/2013
PERCENT OF NUMBER
EFFORT
MONTHS
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%
12.00
0%

Through
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually
in Column "D" of the spreadsheet and explained in the budget justification)

ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 16

12/31/2013
FRINGE
RATE
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

TOTAL
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

TOTAL
FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

SUMMARY OF DIRECT LABOR

Page 17

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


Hourly Rates

** Contractor's Name

PERIOD I*

** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT BASE ADJUSTED


HOURLY RATE HOURLY RATE
$0.00
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
SUBTOTALS =

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually in
Column "D" of the spreadsheet and explained in the budget justification)

NUMBER OF HOURS FOR FULL TIME EQUIVALENT:


ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0
0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

NUMBER
HOURS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

1/1/2007
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

PERIOD II*
12/31/2007
FRINGE
RATE
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

Insert your direct work year.

Insert annual cost of living % and/or merit increases as


applicable and explain the % in the budget justification.
Insert annual increase date.
Insert number of months at the the new hourly rate.

*Adjust the number of months per period as recommended in the RFP.

Page 18

NUMBER
HOURS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

1/1/2008
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
12/31/2008
SALARY
FRINGE
COST
RATE
$0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
$0

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


Hourly Rates

** Contractor's Name

PERIOD III*

** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT BASE ADJUSTED


HOURLY RATE HOURLY RATE
$0.00
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
SUBTOTALS =

1/1/2009
NUMBER NUMBER
HOURS MONTHS
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00

Through
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually in
Column "D" of the spreadsheet and explained in the budget justification)

NUMBER OF HOURS FOR FULL TIME EQUIVALENT:


ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0
0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 19

PERIOD IV*
12/31/2009
FRINGE
RATE
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

1/1/2010
NUMBER NUMBER
HOURS MONTHS
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00
12.00
0.00

Through
12/31/2010
SALARY
FRINGE
COST
RATE
$0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
$0

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


Hourly Rates

** Contractor's Name

PERIOD V*

** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT BASE ADJUSTED


HOURLY RATE HOURLY RATE
$0.00
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
SUBTOTALS =

NUMBER
HOURS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

1/1/2011
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
12/31/2011
SALARY
FRINGE
COST
RATE
$0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually in
Column "D" of the spreadsheet and explained in the budget justification)

NUMBER OF HOURS FOR FULL TIME EQUIVALENT:


ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0
0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 20

PERIOD VI*
FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

NUMBER
HOURS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

1/1/2012
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

12/31/2012
FRINGE
RATE
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITS


Hourly Rates

** Contractor's Name

PERIOD VII*

** RFP No.
EMPLOYEE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

POSITION

CURRENT BASE ADJUSTED


HOURLY RATE HOURLY RATE
$0.00
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
SUBTOTALS =

NUMBER
HOURS
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

1/1/2013
NUMBER
MONTHS
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00
12.00

Through
12/31/2013
SALARY
FRINGE
COST
RATE
$0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
0
0%
$0

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TO


CALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:
(Use of these cells will affect all of the adjusted base salary column; if individual
anniversary dates differ, the adjusted base salaries must be entered individually in
Column "D" of the spreadsheet and explained in the budget justification)

NUMBER OF HOURS FOR FULL TIME EQUIVALENT:


ANNUAL INCREASE FACTOR:

ANNUAL INCREASE DATE:

0
0.00%

00/00/00

NUMBER OF MONTHS AT NEXT ANNUAL INCREASE

*Adjust the number of months per period as recommended in the RFP.

Page 21

FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

TOTAL
SALARY
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

TOTAL
FRINGE
COST
$0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
$0

SUMMARY
OFby MATERIALS
AND SUPPLIES
Identify sole source suppliers
highlighting them:
Sole Source
Period I
ITEM
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36

factor Xa ELISA
Fibrinolysis Inhibiting Factor
Annexin V FITC
Calibrite Bead
FACSFlow Sheath Fluid
Sample Processing Fees
Adenosine 5-Diphosphate, Monosodium Salt (1
g)
Platelet Activating Factor-16
Protein S-100B ELISA
Prothrombin F1.2 (f1.2) ELISA
Platelet Factor 4 ELISA
- Thromboglobulin ELISA
TEG Level 1 control
TEG Level 2 control
Thromboelastograph Calcium
Thromboelastograph Disposable Cups
Thromboelastograph Heparinase Cups
Thromboelastograph Kaolin
D-dimer ELISA
R-phycoerythrin goat anti-mouse IgG (H+L) *1
mg/mL*, 1 mL
Extra long working distance objective lens (Not
a supply)
Kubjan 32 software (Not a Supply)
C3a ELISA
C5a ELISA
Specimen Stabilizing Solution for C3a ELISA
Hemoximeter Calibration solution
Hemoximeter Rinse solution with Enzyme
Additive
CD25
CD4
CD45 FITC
CD45 PE
CD62 P (MCA2418)
CD62
(MCA2419)
PleaseP use
current catalog, historical
IgG1
FITC
documentation,
or vendor quotes. Supporting
documentation
may be requested at a later date.
IgG1a
Control (MCA928)
IgG2a-FITC

PI

Subtotal
$ 1,875
$
480
$ 1,675
$
370
$
435
$ 4,191

Period II
Catalog
Unit
Vendor
Number
Price
American Diagnostica 832
$ 382.50
AnaSpec
24262
$ 81.60
Becton Dickinson
556419 $ 341.70
Becton Dickinson
349502 $ 188.70
Becton Dickinson
342003 $ 29.58
sample
$ 854.98

Unit
Quantity
5
6
4
2
15
6

4
4
3
2
3
3
5
5
2
4
14
18
3

$
$
$
$
$
$
$
$
$
$
$
$
$

Calbiochem
1171
$ 51.00
Calbiochem
511075 $ 32.64
International Point ofEL19801
Care
$ 897.60
Dade Behring
OPBD03 #######
Diagnostica Stago
Serochrome PF4
$ 710.94
Diagnostica Stago
Serochrome Btg
$ 717.06
Haemonetics
8001
$ 91.80
Haemonetics
8002
$ 91.80
Haemonetics
7003
$ 5.61
Haemonetics
6211
$ 108.12
Haemonetics
6212
$ 244.80
Haemonetics
6300
$ 107.10
ImmuClone
602
$ 525.30

4
4
2
2
3
3
5
5
2
4
14
18
2

$
$
$
$
$
$
$
$
$
$
$
$
$

253.00

$ 1,012 Invitrogen

$ 258.06

$ 1,032

$
$
$
$
$
$

540.00
540.00
150.00
106.50

0
0
3
3
1
5

$
$
$ 1,620 Quidell
A015
$ 1,620 Quidell
A020
$
150 Quidell
A9576
$
533 Radiometer America 943-770
Inc.

$
$
$ 550.80
$ 550.80
$ 153.00
$ 108.63

0
0
2
2
1
6

$
$
$ 1,102
$ 1,102
$
153
$
652

43.45

10

389.00
419.00
389.00
419.00
249.00
249.00
119.00
249.00
119.00

2
3
2
2
5
5
2
5
2

$ 44.32
MCA2218F $ 396.78
MCA2213PE $ 427.38
MCA2220F $ 396.78
MCA2220PE $ 427.38
MCA2418A488$ 253.98
MCA2419A488$ 253.98
MCA928F $ 121.38
MCA928A488$ 253.98
MCA928F $ 121.38

12
2
3
2
2
4
4
2
4
2

$
$
$
$
$
$
$
$
$
$

Catalog
Vendor
Number
American Diagnostica 832
AnaSpec
24262
Becton Dickinson
556419
Becton Dickinson
349502
Becton Dickinson
342003
sample
sample

$
$
$
$
$
$

Unit
Price
375.00
80.00
335.00
185.00
29.00
838.22

Calbiochem
1171
Calbiochem
511075
International Point of Care
EL19801
Dade Behring
OPBD03
Diagnostica StagoSerochrome PF4
Diagnostica StagoSerochrome Btg
Haemonetics
8001
Haemonetics
8002
Haemonetics
7003
Haemonetics
6211
Haemonetics
6212
Haemonetics
6300
ImmuClone
602

$
$
$
$
$
$
$
$
$
$
$
$
$

50.00
32.00
880.00
1,630.79
697.00
703.00
90.00
90.00
5.50
106.00
240.00
105.00
515.00

Linkam Scientific
Linkam Scientific
Quidell
A015
Quidell
A020
Quidell
A9576
Radiometer America Inc.
943-770
Radiometer America Inc.
943-730

Invitrogen

Serotec
Serotec
Serotec
Serotec
Serotec
Serotec
Serotec
Serotec
Serotec

P-852

MCA2218F
MCA2213PE
MCA2220F
MCA2220PE
MCA2418A488
MCA2419A488
MCA928F
MCA928A488
MCA928F

$
$
$
$
$
$
$
$
$
Page 22

Unit
Quantity
5
6
5
2
15
5

$
$
$
$
$
$
$
$
$
$

200
128
2,640
3,262
2,091
1,758
450
450
11
424
3,360
1,890
1,545

435
778
1,257
778
838
1,245
1,245
238
1,245
238

P-852

Radiometer America 943-730


Inc.
Serotec
Serotec
Serotec
Serotec
Serotec
Serotec
Serotec
Serotec
Serotec

Subtotal
$ 1,913
$
490
$ 1,367
$
377
$
444
$ 5,130
204
131
1,795
3,327
2,133
1,793
459
459
11
432
3,427
1,928
1,051

532
794
1,282
794
855
1,016
1,016
243
1,016
243

MHCDQ
37
Serotec
MCA2227F
$
SUMMARY
OF MATERIALS AND
MHCDR
38
Serotec SUPPLIES
MCA2226F
$
39

CD41/61

VMRD

CAPP2A

Page 23

389.00
389.00
425.00

2
2
1

$
$
$

778 Serotec
778 Serotec
425 VMRD

MCA2227F $ 396.78
MCA2226F $ 396.78
CAPP2A $ 433.50

2
2
1

$
$
$

794
794
434

SUMMARY
OFby MATERIALS
AND SUPPLIES
Identify sole source suppliers
highlighting them:
Sole Source

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36

ITEM
factor Xa ELISA
Fibrinolysis Inhibiting Factor
Annexin V FITC
Calibrite Bead
FACSFlow Sheath Fluid
Sample Processing Fees
Adenosine 5-Diphosphate, Monosodium Salt (1
g)
Platelet Activating Factor-16
Protein S-100B ELISA
Prothrombin F1.2 (f1.2) ELISA
Platelet Factor 4 ELISA
- Thromboglobulin ELISA
TEG Level 1 control
TEG Level 2 control
Thromboelastograph Calcium
Thromboelastograph Disposable Cups
Thromboelastograph Heparinase Cups
Thromboelastograph Kaolin
D-dimer ELISA
R-phycoerythrin goat anti-mouse IgG (H+L) *1
mg/mL*, 1 mL
Extra long working distance objective lens (Not
a supply)
Kubjan 32 software (Not a Supply)
C3a ELISA
C5a ELISA
Specimen Stabilizing Solution for C3a ELISA
Hemoximeter Calibration solution
Hemoximeter Rinse solution with Enzyme
Additive
CD25
CD4
CD45 FITC
CD45 PE
CD62 P (MCA2418)
CD62
(MCA2419)
PleaseP use
current catalog, historical
IgG1
FITC
documentation,
or vendor quotes. Supporting
documentation
may be requested at a later date.
IgG1a
Control (MCA928)
IgG2a-FITC

Catalog
Number

Unit
Price

Period III
Unit
Price
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

$
$
$
$
$
$

$
$
$
$
$
$
$
$
$
$

Page 24

MHCDQ
37
$
SUMMARY
OF MATERIALS AND SUPPLIES
MHCDR
38
$
39

CD41/61

Page 25

SUMMARY
OFby MATERIALS
AND SUPPLIES
Identify sole source suppliers
highlighting them:
Sole Source
Period III
ITEM
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36

factor Xa ELISA
Fibrinolysis Inhibiting Factor
Annexin V FITC
Calibrite Bead
FACSFlow Sheath Fluid
Sample Processing Fees
Adenosine 5-Diphosphate, Monosodium Salt (1
g)
Platelet Activating Factor-16
Protein S-100B ELISA
Prothrombin F1.2 (f1.2) ELISA
Platelet Factor 4 ELISA
- Thromboglobulin ELISA
TEG Level 1 control
TEG Level 2 control
Thromboelastograph Calcium
Thromboelastograph Disposable Cups
Thromboelastograph Heparinase Cups
Thromboelastograph Kaolin
D-dimer ELISA
R-phycoerythrin goat anti-mouse IgG (H+L) *1
mg/mL*, 1 mL
Extra long working distance objective lens (Not
a supply)
Kubjan 32 software (Not a Supply)
C3a ELISA
C5a ELISA
Specimen Stabilizing Solution for C3a ELISA
Hemoximeter Calibration solution
Hemoximeter Rinse solution with Enzyme
Additive
CD25
CD4
CD45 FITC
CD45 PE
CD62 P (MCA2418)
CD62
(MCA2419)
PleaseP use
current catalog, historical
IgG1
FITC
documentation,
or vendor quotes. Supporting
documentation
may be requested at a later date.
IgG1a
Control (MCA928)
IgG2a-FITC

Unit
Quantity
0
0
0
0
0
0

Catalog
Subtotal Number
$
$
$
$
$
$
-

Unit
Price

Period IV
Unit
Unit
Price
Quantity
$
0
$
0
$
0
$
0
$
0
$
0

Subtotal
$
$
$
$
$
$
-

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00

Period V
Unit
Quantity
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00

0
0
0
0
0
0
0
0
0
0
0
0
0

$
$
$
$
$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$
$
$
$
$

0
0
0
0
0
0
0
0
0
0
0
0
0

$
$
$
$
$
$
$
$
$
$
$
$
$

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0
0
0
0
0
0
0
0
0
0
0
0
0

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00

0.00

0.00

0
0
0
0
0
0

$
$
$
$
$
$

$
$
$
$
$
$

0
0
0
0
0
0

$
$
$
$
$
$

0.00
0.00
0.00
0.00
0.00
0.00

0
0
0
0
0
0

0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00

0
0
0
0
0
0
0
0
0
0

$
$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$
$
Page 26

0
0
0
0
0
0
0
0
0
0

$
$
$
$
$
$
$
$
$
$

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0
0
0
0
0
0
0
0
0
0

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

MHCDQ
37
$
$
SUMMARY
OF MATERIALS00 AND
MHCDR
38
$
- SUPPLIES
$
39

CD41/61

Page 27

0
0
0

$
$
$

0.00
0.00
0.00

0
0
0

0.00
0.00
0.00

0.00
0.00
0.00

SUMMARY OF TRAVEL COSTS


** Contractor's Name
** RFP No.

Cost Element
Trip #
Site
Reason
Airfare
Lodging
Meals
Incidentals
Ground Transport
Total Per Trip
No. of persons
SUBTOTAL =

Period I
1

Trip #
Site
Reason
Airfare
Lodging
Meals
Incidentals
Ground Transport
Total Per Trip
No. of persons
SUBTOTAL =

Trip #
Site
Reason
Airfare
Lodging
Meals
Incidentals
Ground Transport
Total Per Trip
No. of persons
SUBTOTAL =
TOTAL COST BY PERIOD =

Period II
1

$0
0
0
0
0
$0
0
$0

Period IV
1

Period V
1

Period VI
1

Period VII
1

$0
0
0
0
0
$0
0
$0

$0
0
0
0
0
$0
0
$0

$0
0
0
0
0
$0
0
$0

$0
0
0
0
0
$0
0
$0

$0
0
0
0
0
$0
0
$0

$0

$0
0
0
0
0
$0
0
$0

$0

$0
0
0
0
0
$0
0
$0
$0

$0
$0

$0
0
0
0
0
$0
0
$0
2

$0
0
0
0
0
$0
0
$0

$0
0
0
0
0
$0
0
$0
3

$0
0
0
0
0
$0
0
$0
$0

Period III
1

$0
0
0
0
0
$0
0
$0
3

$0
0
0
0
0
$0
0
$0
$0

$0
0
0
0
0
$0
0
$0
3

$0
0
0
0
0
$0
0
$0
$0

$0
0
0
0
0
$0
0
$0
3

$0
0
0
0
0
$0
0
$0
$0

$0
0
0
0
0
$0
0
$0
3

$0
0
0
0
0
$0
0
$0
$0

TOTAL

$0
0
0
0
0
$0
0
$0
$0

Please review the RFP for the recommended number of trips and destinations if applicable. Please use the company or
Page use
28 current vendor quotes for
institutional travel policy unless current Government Per Diem rates are utilized. Please

SUMMARY OF EQUIPMENT COSTS


** Contractor's Name
** RFP No.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Period I
Unit
Unit
ITEM
Price
Quantity
Microm HM550 OP-D Cryostat
$29,500.00
5
ULT Forma Freezer 23 UR 12,300.30
DBLDR Mondel#995
5
Model 995 Sliding rack and box
158.47
system 50
Model 995 sliding rack #820101
140.21
50
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
TOTAL =

Serial
cs/pk
Number
description Subtotal
956454DA
##########
15-474-341
61,501.50
13-994-100
7,923.50
13-994-105
7,010.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
##########

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

All proposed equipment costs should include a justification and be based on current

Page 29

Period II
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period III
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period IV
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

SUMMARY OF EQUIPMENT COSTS


** Contractor's Name
** RFP No.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Period V
Unit
Unit
ITEM
Subtotal
Price
Quantity
Microm HM550 OP-D Cryostat
$0.00
$0.00
0
ULT Forma Freezer 23 UR DBLDR
0.00 Mondel#995
0.00
0
Model 995 Sliding rack and box
0.00
system 0.00
0
Model 995 sliding rack #820101
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
TOTAL =
$0.00

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period VI
Unit
Quantity Subtotal
0
$0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
$0.00

All proposed equipment costs should include a justification and be based on current

Page 30

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period VII
Unit
Quantity Subtotal
TOTAL
0
$0.00 ########
0
0.00 ########
0
0.00 7,923.50
0
0.00 7,010.50
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
$0.00 ########

SUMMARY OF CONSULTANT COSTS


** Contractor's Name
** RFP No.

CONSULTANT
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)

Rate
# Hours # Days
$0
0
0
0
0
0
0
0
0
0

Period I
Travel
$0
0
0
0
0
0
0
0
0
0

Rate
# Hours # Days
$0
0
0
0
0
0
0
0
0
0

Period IV
Travel
$0
0
0
0
0
0
0
0
0
0

Rate
# Hours # Days
$0
0
0
0
0
0
0
0
0
0

Period VI
Travel
$0
0
0
0
0
0
0
0
0
0

TOTAL =

CONSULTANT
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
TOTAL =

CONSULTANT
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
TOTAL =

Subtotal
$0
0
0
0
0
0
0
0
0
0
$0

Rate
# Hours # Days
$0
0
0
0
0
0
0
0
0
0

Period II
Travel
$0
0
0
0
0
0
0
0
0
0

Subtotal
$0
0
0
0
0
0
0
0
0
0
$0

Rate
# Hours # Days
$0
0
0
0
0
0
0
0
0
0

Period V
Travel
$0
0
0
0
0
0
0
0
0
0

Subtotal
$0
0
0
0
0
0
0
0
0
0
$0

Rate
# Hours # Days
$0
0
0
0
0
0
0
0
0
0

Period VII
Travel
$0
0
0
0
0
0
0
0
0
0

Please provide a complete breakdown for each consultant with rates for the number hours or days plus any proposed travel
costs (including travel rates). Please obtain a signed letter of commitment which shows the base rate for each consultant.
Supporting doucmentation may be requested at a later date.

Page 31

Subtotal
$0
0
0
0
0
0
0
0
0
0
$0

Rate

# Hours # Days
$0
0
0
0
0
0
0
0
0
0

Subtotal
$0
0
0
0
0
0
0
0
0
0
$0

Subtotal
$0
0
0
0
0
0
0
0
0
0
$0

TOTAL
$0
0
0
0
0
0
0
0
0
0
$0

Period III
Travel
$0
0
0
0
0
0
0
0
0
0

Subtotal
$0
0
0
0
0
0
0
0
0
0
$0

SUMMARY OF OTHER DIRECT COSTS


** Contractor's Name
** RFP No.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

ITEM
ThermoFisher croystat model HM550 Service Maint

TOTAL =

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period I
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$2,398.75
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Please use current catalog prices, or vendor quotes.


Supporting documentation may be requested at a later
date.

Page 32

Period II
Unit
Quantity
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$11,993.75
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$11,993.75

Unit
Price
$2,398.75
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period III
Unit
Unit
Quantity
Subtotal
Price
5
$11,993.75 $2,398.75
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
$11,993.75

SUMMARY OF OTHER DIRECT COSTS


** Contractor's Name
** RFP No.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

ITEM
ThermoFisher croystat model HM550 Service Maint

TOTAL =

Period IV
Unit
Quantity
Subtotal
5
$11,993.75
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
$11,993.75

Please use current catalog prices, or vendor quotes.


Supporting documentation may be requested at a later
date.

Page 33

SUMMARY OF OTHER DIRECT COSTS


** Contractor's Name
** RFP No.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

ITEM
ThermoFisher croystat model HM550 Service Maint

TOTAL =

Unit
Price
$2,398.75
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period V
Unit
Quantity
Subtotal
5
$11,993.75
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
$11,993.75

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Please use current catalog prices, or vendor quotes.


Supporting documentation may be requested at a later
date.

Page 34

Period VI
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period VII
Unit
Quantity Subtotal
TOTAL
0
$0.00 $47,975.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
0
0.00
0.00
$0.00 $47,975.00

SUMMARY OF PATIENT CARE COSTS


** RFP No.

ITEM
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
TOTAL =

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period I
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period II
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Please use current institutional costs


or vendor quotes. Supporting

Page 35

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period III
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period IV
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

SUMMARY OF PATIENT CARE COSTS


** RFP No.

ITEM
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
TOTAL =

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Please use current institutional costs


or vendor quotes. Supporting

Page 36

SUMMARY OF PATIENT CARE COSTS


** RFP No.

ITEM
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
TOTAL =

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period V
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period VI
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Please use current institutional costs


or vendor quotes. Supporting

Page 37

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

Unit
Price
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Period VII
Unit
Quantity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Subtotal
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

TOTAL
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$0.00

SUMMARY OF SUBCONTRACTOR COSTS


** Contractor's Name
** RFP No.

SUBCONTRACT #
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
TOTAL =

Period I
$0
0
0
0
0
0
0
0
0
0
$0

Period II
$0
0
0
0
0
0
0
0
0
0
$0

Period III
$0
0
0
0
0
0
0
0
0
0
$0

Period IV
$0
0
0
0
0
0
0
0
0
0
$0

A complete breakdown and summary sheet for each proposed subcontract must be
included with the prime proposal. The same format should be used for both the prime and
subcontract proposals.

Page 38

Period V
$0
0
0
0
0
0
0
0
0
0
$0

Period VI
$0
0
0
0
0
0
0
0
0
0
$0

Period VII
$0
0
0
0
0
0
0
0
0
0
$0

TOTAL
$0
0
0
0
0
0
0
0
0
0
$0