RFP-797-FSS-99-0115-R3

Exhibit 6 – Sample FSS Pricelist

Department of Veterans Affairs

Federal Supply Service

Authorized Federal Supply Schedule Price List

Effective Date: March 15, 2009

On-line access to contract ordering information, terms and conditions, up-to-date

pricing, and the option to create an electronic delivery order are available through

GSA Advantage!, a menu-driven database system. The Internet address for

GSA Advantage! is: www.GSAAdvantage.gov

Federal Supply Schedule (FSS) 621 I

Professional Allied Healthcare Staffing

Services

Product Service Code Q

Contract #: V797P-7197a

For more information on ordering from Federal Supply Schedules click on

the FSS Schedules at http://www.fss.gsa.gov

Contract Period: 03/15/2009 through 03/14/2014

Locum Tenens USA

1030 Matheson Way

Alpharetta GA 30022

Company Website: www.locumtenensusa.com

Primary Contact: Robert Berton /

Alternative Contact: Beau Berton /

Phone# 770-663-9988 Fax# 770-377-7374

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RFP-797-FSS-99-0115-R3

Exhibit 6 – Sample FSS Pricelist

Business Size: Small Business (include Woman Owned; Veteran Owned;

HubZone)

Data Universal Number System (DUNS) Number: 137022468

Central Contractor Registration (CCR) Cage Code: 3VYY5

Customer Information:

1. Table of awarded special item number(s):

Special Item

Number Position Description

621-001 General & Family Practice

621-002 Emergency Medicine I

621-002 Emergency Medicine II & III

621-002 Emergency Medicine IV & V

621-003 Internal Medicine

621-006 Anesthesiologist

621-017 Psychiatrist

621-020 Radiologist

621-053 CRNA

621-054 Nurse Practitioner

2. Maximum order: $1,000,000 per order.

3. Minimum order: 13 weeks at 36-40 hours per week.

4. Geographic coverage (service area): NC, WY, TN, CA, GA, CO, MI, FL, OK, PA, AL, AK,

AZ, IL, IN, IA, TX, ME, MD, MN, MS, MO, MT, NM, NY, OH, OR, SC, VA, WV, WA.

5. Prompt Payment Terms: ½% if paid within 20 days, Net 30 days

6. Government Commercial Credit Card: Accepted up to the micro-purchase

threshold.

7. Ordering address: 1030 Matheson Way, Alpharetta GA 30022

8. Payment address: 1030 Matheson Way, Alpharetta GA 30022

9. Prices shown herein are “net” ceiling prices-not to exceed rates. The net

ceiling rates include malpractice insurance for non-personal services task-

orders and exclude travel and lodging. Personal Services task-orders will

also be accepted. See Page 3.

10. Minimum Qualifications of Professionals: See pages 4 – 5.

11. Medical Liability Insurance Limits: $1 Million per occurrence; $3 Million

aggregate.

12. For services, the ordering procedures, information on Blanket Purchase

Agreements (BPA’s), are found in the Federal Acquisition Regulation (FAR)

8.405-3.

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RFP-797-FSS-99-0115-R3

Exhibit 6 – Sample FSS Pricelist

If the contract has been modified to include Disaster Recovery Purchasing, add

the following statement at no. 12:

Effective at Modification xxxx, participating in Disaster Recovery Purchasing (Public Law

109-364, John Warner National Defense Authorization Act 2007).

Locum Tenens USA Not to Exceed Hourly Rates

Special FSS Net

Item Ceiling Price

Number Position Description (per hour)

621-001 General & Family Practice $109.50

621-002 Emergency Medicine I $175.00

621-002 Emergency Medicine II & III $165.00

621-002 Emergency Medicine IV & V $118.50

621-003 Internal Medicine $109.50

621-006 Anesthesiologist $201.00

621-017 Psychiatrist $198.00

621-020 Radiologist $242.00

621-053 CRNA $122.50

621-054 Nurse Practitioner $74.00

Note: Rates shown are ceiling rates, including malpractice insurance. The rates

shown exclude lodging and transportation charges.

Shift Differentials: (insert your actual awarded terms here– SEE

SUMMARY OF AWARD)

Work Week: Sunday – Saturday

Overtime Rate(s): No additional overtime charges

Holiday Rate(s): Normal hourly rate applies for all hours worked on holidays

recognized by the Federal Government

On-Call Rate(s): Not offered

Call Back Rate(s): Not offered

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RFP-797-FSS-99-0115-R3

Exhibit 6 – Sample FSS Pricelist

Minimum Qualifications of Professionals: (please list the page numbers in the

customer Information section, Para 10 above)

621-001 General and Family Practice with OB

Years of Experience in Specialty: Minimum twelve months experience in OB

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

residency program.

Licensure: A current valid drivers’ license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support.

621-002 Emergency Medicine I:

Years of Experience in Specialty: Minimum twelve months experience

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

Residency Program

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support

621-002 Emergency Medicine II III:

Years of Experience in Specialty: Minimum eight months experience

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

Residency Program

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support

621-002 Emergency Medicine IV V:

Years of Experience in Specialty: Minimum three months experience

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

Residency Program

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support

621-003 Internal Medicine

Years of Experience in Specialty: Minimum twelve months experience

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

Residency Program

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support

621-004 Pediatrician

Years of Experience in Specialty: Minimum twelve months experience

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

Residency Program

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support

621-006 Anesthesiologist

Years of Experience in Specialty: Minimum twelve months experience

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

Residency Program

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support

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RFP-797-FSS-99-0115-R3

Exhibit 6 – Sample FSS Pricelist

621-017 Psychiatrist

Years of Experience in Specialty: Minimum twelve months experience

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

Residency Program

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support

621-020 Radiologist

Years of Experience in Specialty: Minimum twelve months experience

Minimum Education: Possesses a Medical School (MD or DO); Internship; ACGME approved

Residency Program

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Board Certified or eligible. Basic Life Support or Advanced Cardiac Life Support

621-053 Registered Nurse (Anesthetist)

Years of Experience in Specialty: Minimum twelve months experience

Minimum Education: Bachelor of Science in Nursing degree and a Masters degree in their

specialty areas, such as Family Practitioner, Anesthetist or Midwifery

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Certification in their specialty by the appropriate certifying organization, i.e.

American Academy of Nurse Practitioners, American Association of Nurse Anesthetists or the

American College of Nurse Midwifes Certification Council. Subspecialty training is appropriate.

Basic Life Support of Advanced Cardiac Life Support.

621-054 Registered Nurse – Nurse Practitioner

Years of Experience in Specialty: Minimum twelve months experience

Minimum Education: Bachelor of Science in Nursing degree and a Masters degree in their

specialty areas, such as Family Practitioner, Anesthetist or Midwifery

State Licensure: A current, valid license in one of the US states, territories or commonwealths.

Certification: Certification in their specialty by the appropriate certifying organization, i.e.

American Academy of Nurse Practitioners, American Association of Nurse Anesthetists or the

American College of Nurse Midwifes Certification Council. Subspecialty training is appropriate.

Basic Life Support of Advanced Cardiac Life Support.

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