BPM006728_Exhibit_D_-_RSA_HM_Request_for_Project_Pricing.pdf
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- Attached to
- Master Agreement AZ|CTR077219
- Contract number
- CTR077219
- Issued by
- Arizona
About this file
This document is a Home Modification Request for Project Pricing form issued by the Arizona Department of Economic Security (ADES), specifically through the Rehabilitation Services Administration (RSA). The form is designed to solicit pricing proposals from contractors for home modification projects for clients with disabilities, with the goal of facilitating necessary home adaptations to improve accessibility and quality of life.
The document provides a structured template for contractors to detail their proposed services, including itemized material and labor costs for specific home modification tasks. Contractors are required to complete Section II of the form, breaking down each service/task with descriptions, material costs, labor costs, and total project pricing. The project must be completed within 30 calendar days of receiving RSA Purchase Authorization, and the pricing proposal should be emailed to the RSA Home Modification Coordinator. The form emphasizes the confidential nature of client information and requires contractors to provide detailed project estimates, estimated timeframes, and additional notes about the proposed modifications.
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Text version
Exhibit D
V1_RSA Request for Project Pricing
Arizona Department of Economic Security (ADES) Rehabilitation Services Administration (RSA)
HOME MODIFICATION
REQUEST FOR PROJECT PRICING
SECTION I: PROJECT INFORMATION
ADES/RSA is issuing this request for pricing for a client’s home modification. Information included in this document contains CONFIDENTIAL client data which must be always protected.
Complete and submit Section II: Project Pricing Proposal in accordance with the service specification recommendations attached to this document.
If approved, the project must be completed in 30 calendar days from the receipt of RSA Purchase Authorization unless otherwise specified.
Email your Project Pricing Proposal to: pferry@azdes.gov
Paul Ferry, RSA Home Modification Coordinator Phone: (602) 309-7682
Project Number:
CLIENT INFORMATION:
Client Name: ________________ Phone Number: ______________ Email: ____________________
Family Contact: ______________ Phone Number: ______________ Email: ____________________
Adress: __________________________________________________________________________
Major Cross Streets: ________________________________________________________________
RSA INFORMATION:
VR Counselor: ______________ Phone Number: _______________ Email: ____________________
Evaluator: _________________ Phone Number: ________________ Email: ___________________ mailto:pferry@azdes.gov
Exhibit D
V1_RSA Request for Project Pricing
Arizona Department of Economic Security (ADES) Rehabilitation Services Administration (RSA)
HOME MODIFICATION
REQUEST FOR PROJECT PRICING
SECTION II: PROJECT PRICING PROPOSAL
Service/Task Description of service/task including make/model/materials to be used.
See before photos below.
Material Cost
Labor Cost
Total ($)
1.
2.
3.
4.
5.
6.
7. Administrative
Total(s) Total Project Pricing:
Contractor Signature: _________________________________ Date: _______________________
Printed Name: ______________________________
CONTRACTOR INFORMATION:
Name: _________________________________________________
Address: _______________________________________________
Phone Number: ____________________________ Email: ________________________________
Project Number: ____________________________
Contractor Estimated Timeframe: ____________________________________________________
Additional Contractor Notes:
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