Department of Veterans Affairs

Federal Supply Service

####### Authorized Federal Supply Schedule Price List

**Effective Date:      **

####### 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](http://www.GSAAdvantage.gov/)

#### Federal Supply Schedule (FSS) 621 I

**Professional & Allied Healthcare Staffing Services**

##### Product Service Code Q

######## Contract #: V797P-          

*For more information on ordering from Federal Supply Schedules click on
the FSS Schedules at [http://www.fss.gsa.gov](http://www.fss.gsa.gov/)*

Contract Period: *MM/DD/YYYY* through *MM/DD/YYYY*

*Contractor Name*

*Company Address:*

######### *Company Website:*

**Primary Contact:** *Name / E-Mail Address*

**Alternative Contact:** *Name / E-Mail Address*

Phone# (**     **)**     **-**     ** Fax#
(**     **)**     **-**     **

##### Business Size:       (include Woman Owned; Veteran Owned; HubZone)

> Data Universal Number System (DUNS) Number**:** **     **

Central Contractor Registration (CCR) Cage Code**:**      

Customer Information:

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

+-------------+--------------------------------------------------------+
| ###         | **Description**                                        |
| ## SIN 621- |                                                        |
+-------------+--------------------------------------------------------+
| *025*       | *i.e. Registered Nurse -- General*                     |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
|             |                                                        |
+-------------+--------------------------------------------------------+
| []{.mark}   |                                                        |
+-------------+--------------------------------------------------------+
| []{.mark}   |                                                        |
+-------------+--------------------------------------------------------+
| []{.mark}   |                                                        |
+-------------+--------------------------------------------------------+

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

> 3\. **Minimum order:      **

4.  **Geographic coverage (service area):      **

5.  Prompt Payment Terms:      

6.  **Government Commercial Credit Card:      **

7.  **Ordering address:      **

8.  Payment address:      

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]{.underline}**. Personal Services task-orders will also be
    accepted. See pages **      through       of this price list.**

###### **Minimum Qualifications of Professionals:** See pages **     **

11. **Medical Liability Insurance Limits:** \$**     ** per occurrence;
    \$**     **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.

> *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).*

**(Insert company name) Not to Exceed Hourly Rates**

+----------+---------------------------------------------+-------------+
| #####    | **Position Description**                    | **FSS Net   |
| SIN 621- |                                             | Ceiling     |
|          |                                             | Hourly      |
|          |                                             | Price**     |
+----------+---------------------------------------------+-------------+
| *025*    | *i.e. Registered Nurse -- General*          | *\$XX.XX*   |
+----------+---------------------------------------------+-------------+
|          |                                             |             |
+----------+---------------------------------------------+-------------+
|          |                                             |             |
+----------+---------------------------------------------+-------------+
|          |                                             |             |
+----------+---------------------------------------------+-------------+
|          |                                             |             |
+----------+---------------------------------------------+-------------+
|          |                                             |             |
+----------+---------------------------------------------+-------------+
|          |                                             |             |
+----------+---------------------------------------------+-------------+
|          |                                             |             |
+----------+---------------------------------------------+-------------+
|          |                                             |             |
+----------+---------------------------------------------+-------------+

***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) ]{.underline}***

#### Work Week: Sunday -- Saturday 

**Overtime Rate(s):** **     ** *(insert your actual awarded terms
here)*

**Holiday Rate(s):** **     ** *(insert your actual awarded terms here)*

**On-Call Rate(s):** **     ** *(insert your actual awarded terms here)*

**Call Back Rate(s):** **     ** *(insert your actual awarded terms
here)*

**Minimum Qualifications of Professionals: (please list the page numbers
in the customer Information section, Para 10 above)**

###### *(This is a Sample Only)*

**[621-025 Registered Nurse -- General]{.underline}**

Education/License: e.g. RN AD or Diploma

Experience: e.g. 1-year full-time experience

Certification: as applicable

References: e.g. three professional references

\*Include any other additional minimum qualifications that may apply.