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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