25_019 EMS Cost worksheet.pdf

PDF 145 KB Posted

Attached to
Emergency Medical Services Billing
Solicitation number
PE-64800-NONST-2026-000000054
Issued by
Douglas County, Georgia

About this file

This document is a Cost Proposal form issued by the Douglas County Board of Commissioners located in Douglasville, Georgia, specifically designated as document 25-019. The form is designed for potential vendors to submit a pricing proposal for collection services, with the county estimating an annual net cash collection of $5,000,000.00. The proposal requires vendors to specify their percentage of net collections to be paid by the county, along with any additional fees for technical support and licensing.

The cost proposal template allows vendors to detail their fee structure by providing spaces to indicate the percentage of net collections, the estimated annual collection fee based on the $5,000,000.00 projected net cash collection, and any supplemental fees for technical support and licensing. Vendors must complete the form, sign it, and submit it in a separate sealed envelope marked "Cost Proposal" as part of the bidding process. The form includes lines for the company name, date, authorized representative's name, and signature, indicating a formal competitive bidding process for collection services.

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Text version

25-019

COST PROPOSAL

(Note: Proposer must sign and submit their cost proposal in a separate sealed enveloped marked as “Cost Proposal.”)

Percentage of Net Collections to be paid to Firm from Douglas County

Estimated Annual Collection Fee Based on an Estimated Annual Net Cash

Collection of $5,000,000.00

All other Fees Including Technical Support and Licensing Fees

Total Annual Cost

Company’s Name Date

Authorized Representative’s Name Authorized Representative’s Signature (Print or Type)

Douglas County Board of Commissioners 8700 Hospital Drive, Purchasing Department, Douglasville, GA 30134

File details come from the government source that posted it. Updated .