Sc Samplebudget

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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 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 recreatiwill 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 thspreadsheet format can not fit every situation; however, we have attempted to create a simple model that fits most circumstances that arise in Government contracfree 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 pageapplicable.

Summary PagePlease 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 LaborUse the Labor - Percent of Effort worksheet if you track labor on a percent of effort basis. Generally, Universities, Hospitals, and Non-Profit Organizations tract labpercent 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 consultanworksheet, 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. Adocumentation 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 applcopy 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 includingand 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'sdocument. 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 OrganizationsIf 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.aspPlease do not submit your indirect proposal to the Division of Financial Advisory Services at this time.

Points of ContactIf you have any questions regarding this Excel file, please contact Cindi Brown (301-496-4494) email at [email protected].

If you have contracting questions, please call the NIH Contracting Official who is listed in the RFP.


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SUMMARY OF PROPOSED COSTS** Contractor's Name** RFP No.

PERIOD I PERIOD II PERIOD III PERIOD IV PERIO*** Period ( dates) 1/1/2007 1/1/2008 1/1/2009 1/1/2010 1/1

Through Through Through Through Thr12/31/2007 12/31/2008 12/31/2009 12/31/2010 12/3

Direct Labor - Percent of Effort $0 $0 $0 $0Fringe Benefits - Percent of Effort 0 0 0 0Direct Labor - Hourly 0 0 0 0Fringe Benefits - Hourly 0 0 0 0Total Direct Labor & Fringe Benefits $0 $0 $0 $0

Overhead 0% $0 0% $0 0% $0 0% $0 0%

Materials and Supplies $2 MCA2220F $794 $0Professional Travel 0 0 0 0Equipment 223,936 0 0 0Consultants 0 0 0 0Other Direct Costs 0 11,994 11,994 11,994

Patient Care Costs 0 0 0 0Subcontracts 0 0 0 0Total Other Direct Costs $223,938 $11,994 $12,787 $11,994 $

Subtotal: Direct Labor, Fringe Benefits, Overhead , & Other Directs $223,938 $11,994 $12,787 $11,994 $Exclusion(s) From Base For G&A 0 0 0 0Adjusted Base for G&A $223,938 $11,994 $12,787 $11,994 $

G&A 0% 0 0% 0 0% 0 0% 0 0%Total Proposed Cost Excluding Fee 223,938 11,994 12,787 11,994Proposed Fee/Profit 0% 0 0% 0 0% 0 0% 0 0%Total Proposed Cost Plus Fee/Profit $223,938 $11,994 $12,787 $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. Foif you have a two tier indirect rate structure, then you will use a two tier structure when proposing indirect costs.

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


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SUMMARY OF DIRECT LABOR

AND FRINGE BENEFITSPERCENT OF EFFORT

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

CURRENT ADJUSTED PERCENT OF NUMBER SALARY FRINGE FRINGE PERCENT OF NU

EMPLOYEE POSITION BASE SALARY BASE SALARY EFFORT MONTHS COST RATE COST EFFORT MO1 $0 $0 0% 12.00 $0 0% $0 0%2 0 0 0% 12.00 0 0% 0 0%3 0 0 0% 12.00 0 0% 0 0%4 0 0 0% 12.00 0 0% 0 0%5 0 0 0% 12.00 0 0% 0 0%6 0 0 0% 12.00 0 0% 0 0%7 0 0 0% 12.00 0 0% 0 0%8 0 0 0% 12.00 0 0% 0 0%9 0 0 0% 12.00 0 0% 0 0%

10 0 0 0% 12.00 0 0% 0 0%

11 0 0 0% 12.00 0 0% 0 0%12 0 0 0% 12.00 0 0% 0 0%13 0 0 0% 12.00 0 0% 0 0%14 0 0 0% 12.00 0 0% 0 0%15 0 0 0% 12.00 0 0% 0 0%16 0 0 0% 12.00 0 0% 0 0%17 0 0 0% 12.00 0 0% 0 0%18 0 0 0% 12.00 0 0% 0 0%19 0 0 0% 12.00 0 0% 0 0%20 0 0 0% 12.00 0 0% 0 0%21 0 0 0% 12.00 0 0% 0 0%

22 0 0 0% 12.00 0 0% 0 0%23 0 0 0% 12.00 0 0% 0 0%24 0 0 0% 12.00 0 0% 0 0%25 0 0 0% 12.00 0 0% 0 0%26 0 0 0% 12.00 0 0% 0 0%27 0 0 0% 12.00 0 0% 0 0%28 0 0 0% 12.00 0 0% 0 0%29 0 0 0% 12.00 0 0% 0 0%30 0 0 0% 12.00 0 0% 0 0%31 0 0 0% 12.00 0 0% 0 0%

SUBTOTALS = 0% $0 $0 0%

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TOCALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:(Use of these cells will affect all of the adjusted base salary column; if individualanniversary dates differ, the adjusted base salaries must be entered individuallyin Column "D" of the spreadsheet and explained in the budget justification)


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** Contractor's Name** RFP No.

CURRENT ADJUSTED

EMPLOYEE POSITION BASE SALARY BASE SALARY1 $0 $02 0 03 0 04 0 05 0 06 0 07 0 08 0 09 0 0

10 0 0

11 0 012 0 013 0 014 0 015 0 016 0 017 0 018 0 019 0 020 0 021 0 022 0 023 0 024 0 025 0 026 0 027 0 028 0 029 0 030 0 031 0 0

SUBTOTALS =

ANNUAL INCREASE FACTOR: 0 00%


FRINGE

COST$0000000000

000000000000000000000

$0


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CURRENT ADJUSTED


10 0 0

11 0 012 0 013 0 014 0 015 0 016 0 017 0 018 0 019 0 020 0 021 0 0

22 0 023 0 024 0 025 0 026 0 027 0 028 0 029 0 030 0 031 0 0

SUBTOTALS =


PERIOD III*

1/1/2009 Through 12/31/2009

PERCENT OF NUMBER SALARY FRINGE FRINGE PERCENT OF N

EFFORT MONTHS COST RATE COST EFFORT M0% 12.00 $0 0% $0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%

0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%

0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% 12.00 0 0% 0 0%0% $0 $0 0%


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CURRENT ADJUSTED


10 0 011 0 012 0 013 0 014 0 015 0 016 0 017 0 018 0 019 0 020 0 021 0 022 0 023 0 024 0 025 0 026 0 027 0 028 0 029 0 030 0 031 0 0

SUBTOTALS =



FRINGE

COST$0000000000000000000000000000000

$0


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CURRENT ADJUSTED


10 0 0

11 0 012 0 013 0 014 0 015 0 016 0 017 0 018 0 019 0 020 0 021 0 0

22 0 023 0 024 0 025 0 026 0 027 0 028 0 029 0 030 0 031 0 0

SUBTOTALS =


PERIOD V*

1/1/2011 Through 12/31/2011 1

PERCENT OF NUMBER SALARY FRINGE FRINGE PERCENT OF NU

EFFORT MONTHS COST RATE COST EFFORT MO0% 12.00 $0 0% $0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 1

0% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 1

0% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% 12.00 0 0% 0 0% 10% $0 $0 0%


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CURRENT ADJUSTEDEMPLOYEE POSITION BASE SALARY BASE SALARY

1 $0 $02 0 03 0 04 0 05 0 06 0 07 0 08 0 09 0 0

10 0 011 0 012 0 013 0 014 0 015 0 016 0 017 0 018 0 019 0 020 0 021 0 022 0 0

23 0 024 0 025 0 026 0 027 0 028 0 029 0 030 0 031 0 0

SUBTOTALS =



FRINGECOST

$0000000000000000000000

000000000

$0


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CURRENT ADJUSTED


10 0 0

11 0 012 0 013 0 014 0 015 0 016 0 017 0 018 0 019 0 020 0 021 0 0

22 0 023 0 024 0 025 0 026 0 027 0 028 0 029 0 030 0 031 0 0

SUBTOTALS =


PERIOD VII*

1/1/2013 Through 12/31/2013 TOTAL TOTA

PERCENT OF NUMBER SALARY FRINGE FRINGE SALARY FRING

EFFORT MONTHS COST RATE COST COST COST0% 12.00 $0 0% $0 $00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 0

0% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 0

0% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% 12.00 0 0% 0 00% $0 $0 $0


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AND FRINGE BENEFITSHourly Rates

** Contractor's Name PERIOD I*** RFP No. 1/1/2007 Through 12/31/2007 1/1/200

CURRENT BASE ADJUSTED NUMBER NUMBER SALARY FRINGE FRINGE NUMBER NUMBEEMPLOYEE POSITION HOURLY RATE HOURLY RATE HOURS MONTHS COST RATE COST HOURS MONTH

1 $0.00 $0.00 0.00 12.00 $0 0% $0 0.00 12.002 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.003 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.004 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.005 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.006 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.007 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.008 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.009 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.00

10 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0011 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.00

12 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0013 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0014 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0015 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0016 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0017 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0018 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0019 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0020 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0021 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0022 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.00

23 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0024 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0025 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0026 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0027 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0028 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0029 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0030 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.0031 0.00 0.00 0.00 12.00 0 0% 0 0.00 12.00

SUBTOTALS = 0.00 $0 $0 0.00

NUMBER OF HOURS FOR FULL TIME EQUIVALENT: 0ANNUAL INCREASE FACTOR 0 00%

THE FOLLOWING BOXES IN COLUMN "D" BELOW MAY BE USED TOCALCULATE THE ADJUSTED BASE SALARY, AS INDICATED:(Use of these cells will affect all of the adjusted base salary column; if individualanniversary dates differ, the adjusted base salaries must be entered individually inColumn "D" of the spreadsheet and explained in the budget justification)

Insert our direct work ear.



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CURRENT BASE ADJUSTEDEMPLOYEE POSITION HOURLY RATE HOURLY RATE

1 $0.00 $0.002 0.00 0.003 0.00 0.004 0.00 0.005 0.00 0.006 0.00 0.007 0.00 0.008 0.00 0.009 0.00 0.00

10 0.00 0.0011 0.00 0.00

12 0.00 0.0013 0.00 0.0014 0.00 0.0015 0.00 0.0016 0.00 0.0017 0.00 0.0018 0.00 0.0019 0.00 0.0020 0.00 0.0021 0.00 0.0022 0.00 0.00

23 0.00 0.0024 0.00 0.0025 0.00 0.0026 0.00 0.0027 0.00 0.0028 0.00 0.0029 0.00 0.0030 0.00 0.0031 0.00 0.00

SUBTOTALS =

NUMBER OF HOURS FOR FULL TIME EQUIVALENT: 0ANNUAL INCREASE FACTOR: 0 00%


PERIOD III*

1/1/2009 Through 12/31/2009 1/1/2010

NUMBER NUMBER SALARY FRINGE FRINGE NUMBER NUMBERHOURS MONTHS COST RATE COST HOURS MONTHS

0.00 12.00 $0 0% $0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.00

0.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.00

0.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 $0 $0 0.00



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1 $0.00 $0.002 0.00 0.003 0.00 0.004 0.00 0.005 0.00 0.006 0.00 0.007 0.00 0.008 0.00 0.009 0.00 0.00

10 0.00 0.0011 0.00 0.00

12 0.00 0.0013 0.00 0.0014 0.00 0.0015 0.00 0.0016 0.00 0.0017 0.00 0.0018 0.00 0.0019 0.00 0.0020 0.00 0.0021 0.00 0.0022 0.00 0.00

23 0.00 0.0024 0.00 0.0025 0.00 0.0026 0.00 0.0027 0.00 0.0028 0.00 0.0029 0.00 0.0030 0.00 0.0031 0.00 0.00

SUBTOTALS =



PERIOD V*

1/1/2011 Through 12/31/2011 1/1/2012

NUMBER NUMBER SALARY FRINGE FRINGE NUMBER NUMBERHOURS MONTHS COST RATE COST HOURS MONTHS

0.00 12.00 $0 0% $0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.00

0.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.00

0.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 12.00 0 0% 0 0.00 12.000.00 $0 $0 0.00



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1 $0.00 $0.002 0.00 0.003 0.00 0.004 0.00 0.005 0.00 0.006 0.00 0.007 0.00 0.008 0.00 0.009 0.00 0.00

10 0.00 0.0011 0.00 0.00

12 0.00 0.0013 0.00 0.0014 0.00 0.0015 0.00 0.0016 0.00 0.0017 0.00 0.0018 0.00 0.0019 0.00 0.0020 0.00 0.0021 0.00 0.0022 0.00 0.00

23 0.00 0.0024 0.00 0.0025 0.00 0.0026 0.00 0.0027 0.00 0.0028 0.00 0.0029 0.00 0.0030 0.00 0.0031 0.00 0.00

SUBTOTALS =



PERIOD VII*

1/1/2013 Through 12/31/2013 TOTAL TOTAL

NUMBER NUMBER SALARY FRINGE FRINGE SALARY FRINGEHOURS MONTHS COST RATE COST COST COST

0.00 12.00 $0 0% $0 $0 $00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 0

0.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 0

0.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 12.00 0 0% 0 0 00.00 $0 $0 $0 $0


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SUMMARY OF MATERIALS AND SUPPLIESSole Source

Catalog Unit Unit

ITEM PI Vendor Number Price Quantity Subtotal Ve1 factor Xa ELISA American Diag 832 375.00$ 5 1,875$ America

2 Fibrinolysis Inhibiting Factor AnaSpec 24262 80.00$ 6 480$ AnaSpe3 Annexin V FITC Becton Dickins 556419 335.00$ 5 1,675$ Becton

4 Calibrite Bead Becton Dickins 349502 185.00$ 2 370$ Becton

5 FACSFlow Sheath Fluid Becton Dickins 342003 29.00$ 15 435$ Becton 6 Sample Processing Fees sample sample 838.22$ 5 4,191$ sample

7

Adenosine 5-Diphosphate, Monosodium Salt (1

g) Calbiochem 1171 50.00$ 4 200$ Calbioch8 Platelet Activating Factor-16 Calbiochem 511075 32.00$ 4 128$ Calbioch

9 Protein S-100B ELISA International Po EL19801 880.00$ 3 2,640$ Internati

10 Prothrombin F1.2 (f1.2) ELISA Dade Behring OPBD03 1,630.79$ 2 3,262$ Dade Be11 Platelet Factor 4 ELISA Diagnostica Sta Serochrome PF4 697.00$ 3 2,091$ Diagnos

12 - Thromboglobulin ELISA Diagnostica Sta Serochrome Btg 703.00$ 3 1,758$ Diagnos

13 TEG Level 1 control Haemonetics 8001 90.00$ 5 450$ Haemon14 TEG Level 2 control Haemonetics 8002 90.00$ 5 450$ Haemon

15 Thromboelastograph Calcium Haemonetics 7003 5.50$ 2 11$ Haemon

16 Thromboelastograph Disposable Cups Haemonetics 6211 106.00$ 4 424$ Haemon17 Thromboelastograph Heparinase Cups Haemonetics 6212 240.00$ 14 3,360$ Haemon

18 Thromboelastograph Kaolin Haemonetics 6300 105.00$ 18 1,890$ Haemon19 D-dimer ELISA ImmuClone 602 515.00$ 3 1,545$ ImmuCl

20

R-phycoerythrin goat anti-mouse IgG (H+L) *1mg/mL*, 1 mL Invitrogen P-852 253.00$ 4 1,012$ Invitroge

21Extra long working distance objective lens (Not

a supply) Linkam Scientific -$ 0 -$

22 Kubjan 32 software (Not a Supply) Linkam Scientific -$ 0 -$

23 C3a ELISA Quidell A015 540.00$ 3 1,620$ Quidell24 C5a ELISA Quidell A020 540.00$ 3 1,620$ Quidell

25 Specimen Stabilizing Solution for C3a ELISA Quidell A9576 150.00$ 1 150$ Quidell

26 Hemoximeter Calibration solution Radiometer Am 943-770 106.50$ 5 533$ Radiom

27Hemoximeter Rinse solution with Enzyme

AdditiveRadiometer Am 943-730 43.45$ 10

435$Radiom

28 CD25 Serotec MCA2218F 389.00$ 2 778$ Serotec29 CD4 Serotec MCA2213PE 419.00$ 3 1,257$ Serotec

30 CD45 FITC Serotec MCA2220F 389.00$ 2 778$ Serotec

31 CD45 PE Serotec MCA2220PE 419.00$ 2 838$ Serotec32 CD62 P (MCA2418) Serotec MCA2418A488 249.00$ 5 1,245$ Serotec

33 CD62 P (MCA2419) Serotec MCA2419A488 249.00$ 5 1,245$ Serotec

34 IgG1 FITC Serotec MCA928F 119.00$ 2 238$ Serotec35 IgG1a Control (MCA928) Serotec MCA928A488 249 00$ 5 1 245$ Serotec

Identify sole source suppliers by highlighting them:

Period I

Please use current catalog, historicaldocumentation, or vendor quotes. Supportingdocumentation may be requested at a later date


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SUMMARY OF MATERIALS AND SUPPLIES37 MHCDQ Serotec MCA2227F 389.00$ 2 778$ Serotec MCA2227F $38 MHCDR Serotec MCA2226F 389.00$ 2 778$ Serotec MCA2226F $39 CD41/61 VMRD CAPP2A 425.00$ 1 425$ VMRD CAPP2A $

Page 23


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SUMMARY OF MATERIALS AND SUPPLIES

Sole Source

ITEM1 factor Xa ELISA

2 Fibrinolysis Inhibiting Factor

3 Annexin V FITC

4 Calibrite Bead

5 FACSFlow Sheath Fluid

6 Sample Processing Fees

7


g)

8 Platelet Activating Factor-16

9 Protein S-100B ELISA

10 Prothrombin F1.2 (f1.2) ELISA11 Platelet Factor 4 ELISA

12 - Thromboglobulin ELISA

13 TEG Level 1 control


15 Thromboelastograph Calcium

16 Thromboelastograph Disposable Cups

17 Thromboelastograph Heparinase Cups

18 Thromboelastograph Kaolin

19 D-dimer ELISA

20

R-phycoerythrin goat anti-mouse IgG (H+L) *1

mg/mL*, 1 mL


a supply)22 Kubjan 32 software (Not a Supply)23 C3a ELISA

24 C5a ELISA

25 Specimen Stabilizing Solution for C3a ELISA

26 Hemoximeter Calibration solution

27Hemoximeter Rinse solution with EnzymeAdditive

28 CD25

29 CD430 CD45 FITC

31 CD45 PE

32 CD62 P (MCA2418)

33 CD62 P (MCA2419)

34 IgG1 FITC

35 IgG1a Control (MCA928)

36 IgG2a-FITC


Please use current catalog, historicaldocumentation, or vendor quotes. Supportingdocumentation may be requested at a later date.

Catalog Unit Unit

Number Price Price-$-$

-$-$-$-$

-$-$

-$

-$-$-$-$

-$-$-$-$

-$-$

-$

-$-$

-$-$-$-$

-$-$

-$-$-$-$-$

-$-$-$

Period III


25/38

SUMMARY OF MATERIALS AND SUPPLIES37MHCDQ

38 MHCDR

39 CD41/61

-$

-$

-$

Page 25


26/38

SUMMARY OF MATERIALS AND SUPPLIES

Sole Source

ITEM1 factor Xa ELISA

2 Fibrinolysis Inhibiting Factor

3 Annexin V FITC

4 Calibrite Bead

5 FACSFlow Sheath Fluid

6 Sample Processing Fees

7


g)

8 Platelet Activating Factor-16

9 Protein S-100B ELISA

10 Prothrombin F1.2 (f1.2) ELISA11 Platelet Factor 4 ELISA

12 - Thromboglobulin ELISA



15 Thromboelastograph Calcium

16 Thromboelastograph Disposable Cups

17 Thromboelastograph Heparinase Cups

18 Thromboelastograph Kaolin

19 D-dimer ELISA

20

R-phycoerythrin goat anti-mouse IgG (H+L) *1

mg/mL*, 1 mL


a supply)22 Kubjan 32 software (Not a Supply)23 C3a ELISA

24 C5a ELISA

25 Specimen Stabilizing Solution for C3a ELISA

26 Hemoximeter Calibration solution

27Hemoximeter Rinse solution with Enzyme

Additive28 CD25

29 CD4

30 CD45 FITC

31 CD45 PE

32 CD62 P (MCA2418)

33 CD62 P (MCA2419)

34 IgG1 FITC

35 IgG1a Control (MCA928)


Please use current catalog, historicaldocumentation, or vendor quotes. Supportingdocumentation may be requested at a later date.

Period VUnit Catalog Unit Unit Unit Unit Unit

Quantity Subtotal Number Price Price Quantity Subtotal Price Quantity Subt0 -$ -$ 0 -$ $0.00 0 $00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

0 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 00 -$ -$ 0 -$ 0.00 0 0

Period IV


27/38

SUMMARY OF MATERIALS AND SUPPLIES37 MHCDQ38 MHCDR39 CD41/61

0 -$ -$ 0 -$ 0.00 0 0.00 0.000 -$ -$ 0 -$ 0.00 0 0.00 0.000 -$ -$ 0 -$ 0.00 0 0.00 0.00

Page 27

SUMMARY OF TRAVEL COSTS** Contractor's Name


28/38

** Contractor s Name** RFP No.

Cost Element Period I Period II Period III Period IV Period V Period VI Period VII TOTALTrip # 1 1 1 1 1 1 1

Site

ReasonAirfare $0 $0 $0 $0 $0 $0 $0

Lodging 0 0 0 0 0 0 0Meals 0 0 0 0 0 0 0

Incidentals 0 0 0 0 0 0 0Ground Transport 0 0 0 0 0 0 0

Total Per Trip $0 $0 $0 $0 $0 $0 $0No. of persons 0 0 0 0 0 0 0SUBTOTAL = $0 $0 $0 $0 $0 $0 $0 $0

Trip # 2 2 2 2 2 2 2Site

ReasonAirfare $0 $0 $0 $0 $0 $0 $0

Lodging 0 0 0 0 0 0 0Meals 0 0 0 0 0 0 0

Incidentals 0 0 0 0 0 0 0Ground Transport 0 0 0 0 0 0 0

Total Per Trip $0 $0 $0 $0 $0 $0 $0No. of persons 0 0 0 0 0 0 0SUBTOTAL = $0 $0 $0 $0 $0 $0 $0 $0

Trip # 3 3 3 3 3 3 3Site

Reason

Airfare $0 $0 $0 $0 $0 $0 $0Lodging 0 0 0 0 0 0 0

Meals 0 0 0 0 0 0 0Incidentals 0 0 0 0 0 0 0

Ground Transport 0 0 0 0 0 0 0Total Per Trip $0 $0 $0 $0 $0 $0 $0

No. of persons 0 0 0 0 0 0 0

SUBTOTAL = $0 $0 $0 $0 $0 $0 $0 $0TOTAL COST BY PERIOD = $0 $0 $0 $0 $0 $0 $0 $0

Please review the RFP for the recommended number of tri s and destinations if a licable. Please use the com an orPage 28

SUMMARY OF EQUIPMENT COSTS


29/38


Period I Period II Period IIIUnit Unit Serial cs/pk Unit Unit Unit Unit Unit

ITEM Price Quantity Number description Subtotal Price Quantity Subtotal Price Quantity Subtotal Price1 Microm HM550 OP-D Cr $29,500.00 5 956454DA ########## $0.00 0 $0.00 $0.00 0 $0.00 $0.002 ULT Forma Freezer 23 12,300.30 5 15-474-341 61,501.50 0.00 0 0.00 0.00 0 0.00 0.003 Model 995 Sliding rack 158.47 50 13-994-100 7,923.50 0.00 0 0.00 0.00 0 0.00 0.004 Model 995 sliding rack # 140.21 50 13-994-105 7,010.50 0.00 0 0.00 0.00 0 0.00 0.005 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.006 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.007 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.008 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.009 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

10 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0011 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0012 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0013 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0014 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0015 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0016 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0017 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0018 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0019 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

20 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0021 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0022 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0023 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0024 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0025 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0026 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0027 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0028 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0029 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.0030 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

TOTAL = ########## $0.00 $0.00

SUMMARY OF EQUIPMENT COSTS


30/38

** Contractor's Nam** RFP No.

ITEM1 Microm HM550 OP-D Cr2 ULT Forma Freezer 233 Model 995 Sliding rack4 Model 995 sliding rack #56789

10111213141516171819

2021222324252627282930

TOTAL =

Period V Period VI Period VIIUnit Unit Unit Unit Unit Unit

Subtotal Price Quantity Subtotal Price Quantity Subtotal Price Quantity Subtotal TOTAL$0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 ########

0.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 ########0.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 7,923.500.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 7,010.500.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

$0.00 $0.00 $0.00 $0.00 ########

SUMMARY OF CONSULTANT COSTS** C t t ' N


31/38


Period I Period IICONSULTANT Rate # Hours # Days Travel Subtotal Rate # Hours # Days Travel Subtotal Rate # Hours #

(1) $0 $0 $0 $0 $0 $0 $0(2) 0 0 0 0 0 0 0(3) 0 0 0 0 0 0 0(4) 0 0 0 0 0 0 0(5) 0 0 0 0 0 0 0(6) 0 0 0 0 0 0 0(7) 0 0 0 0 0 0 0(8) 0 0 0 0 0 0 0(9) 0 0 0 0 0 0 0

(10) 0 0 0 0 0 0 0

TOTAL = $0 $0

Period IV Period VCONSULTANT Rate # Hours # Days Travel Subtotal Rate # Hours # Days Travel Subtotal

(1) $0 $0 $0 $0 $0 $0(2) 0 0 0 0 0 0(3) 0 0 0 0 0 0(4) 0 0 0 0 0 0(5) 0 0 0 0 0 0(6) 0 0 0 0 0 0

(7) 0 0 0 0 0 0(8) 0 0 0 0 0 0(9) 0 0 0 0 0 0

(10) 0 0 0 0 0 0

TOTAL = $0 $0

Period VI Period VIICONSULTANT Rate # Hours # Days Travel Subtotal Rate # Hours # Days Travel Subtotal TOTAL

(1) $0 $0 $0 $0 $0 $0 $0

(2) 0 0 0 0 0 0 0

(3) 0 0 0 0 0 0 0

(4) 0 0 0 0 0 0 0

(5) 0 0 0 0 0 0 0

(6) 0 0 0 0 0 0 0

(7) 0 0 0 0 0 0 0

(8) 0 0 0 0 0 0 0

(9) 0 0 0 0 0 0 0

SUMMARY OF OTHER DIRECT COSTS


32/38


Period I Period II Period IIIUnit Unit Unit Unit Unit Unit

ITEM Price Quantity Subtotal Price Quantity Subtotal Price Quantity Subtotal1 ThermoFisher croystat model HM550 Service Maint $0.00 0 $0.00 $2,398.75 5 $11,993.75 $2,398.75 5 $11,993.75 $22 0.00 0 0.00 0.00 0 0.00 0.00 0 0.003 0.00 0 0.00 0.00 0 0.00 0.00 0 0.004 0.00 0 0.00 0.00 0 0.00 0.00 0 0.005 0.00 0 0.00 0.00 0 0.00 0.00 0 0.006 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00

7 0.00 0 0.00 0.00 0 0.00 0.00 0 0.008 0.00 0 0.00 0.00 0 0.00 0.00 0 0.009 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0010 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00

11 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0012 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0013 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0014 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0015 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0016 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0017 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00

18 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0019 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0020 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0021 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00

22 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0023 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0024 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0025 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0026 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00

27 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0028 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0029 0.00 0 0.00 0.00 0 0.00 0.00 0 0.0030 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00

TOTAL = $0.00 $11,993.75 $11,993.75

Please use current catalog prices, or vendor quotes.Supporting documentation may be requested at a later



33/38


ITEM

1 ThermoFisher croystat model HM550 Service Maint234567891011121314151617181920212223

24252627282930

TOTAL =


Period IVUnit

Quanti ty Subtotal

5 $11,993.750 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.00

0 0.000 0.000 0.000 0.000 0.000 0.000 0.00

$11,993.75



34/38


ITEM1 ThermoFisher croystat model HM550 Service Maint23456789

10

111213141516171819

2021

2223242526272829

30TOTAL =


Period V Period VI Period VIIUnit Unit Unit Unit Unit Unit

Price Quantity Subtotal Price Quantity Subtotal Price Quantity Subtotal TOTAL$2,398.75 5 $11,993.75 $0.00 0 $0.00 $0.00 0 $0.00 $47,975.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00$11,993.75 $0.00 $0.00 $47,975.00

SUMMARY OF PATIENT CARE COSTS


35/38

** RFP No.

Period I Period II Period III Period IVUnit Unit Unit Unit Unit Unit Unit Unit

ITEM Price Quantity Subtotal Price Quantity Subtotal Price Quantity Subtotal Price Quantity

1 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.00 02 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0

3 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 04 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 05 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 06 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 07 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 08 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 09 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0

10 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 011 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0

12 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 013 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 014 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 015 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 016 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 017 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0

18 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 019 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 020 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 021 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 022 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0

23 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 024 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 025 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 026 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 027 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0

28 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 029 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 030 0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00 0

TOTAL = $0.00 $0.00 $0.00

Please use current institutional costs



36/38

** RFP No.

ITEM1

23456789

101112131415161718192021222324252627282930

TOTAL =

Please use current institutional cost

Subtotal$0.00

0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00

$0.00

Page 36



37/38

** RFP No.

ITEM

12345

67891011

1213141516171819202122

2324252627282930

TOTAL =

Please use current institutional cost

Period V Period VI Period VIIUnit Unit Unit Unit Unit UnitPrice Quantity Subtotal Price Quantity Subtotal Price Quantity Subtotal TOTAL

$0.00 0 $0.00 $0.00 0 $0.00 $0.00 0 $0.00 $0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

0.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.000.00 0 0.00 0.00 0 0.00 0.00 0 0.00 0.00

$0.00 $0.00 $0.00 $0.00

P 37

SUMMARY OF SUBCONTRACTOR COSTS** Contractor's Name** RFP No


38/38

RFP No.

SUBCONTRACT # Period I Period II Period III Period IV Period V Period VI Period VII TOTAL

(1) $0 $0 $0 $0 $0 $0 $0 $0(2) 0 0 0 0 0 0 0 0(3) 0 0 0 0 0 0 0 0(4) 0 0 0 0 0 0 0 0(5) 0 0 0 0 0 0 0 0(6) 0 0 0 0 0 0 0 0(7) 0 0 0 0 0 0 0 0(8) 0 0 0 0 0 0 0 0(9) 0 0 0 0 0 0 0 0(10) 0 0 0 0 0 0 0 0

TOTAL = $0 $0 $0 $0 $0 $0 $0 $0

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

Page 38

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