BPM006728_Exhibit_D_-_RSA_HM_Request_for_Project_Pricing.pdf
PDF 125 KB Posted
- Attached to
- Master Agreement AZ|CTR077218
- Contract number
- CTR077218
- Issued by
- Arizona
About this file
This document is a Home Modification Request for Project Pricing issued by the Arizona Department of Economic Security (ADES), specifically through the Rehabilitation Services Administration (RSA). The form is designed for contractors to submit pricing proposals for home modification projects for clients with accessibility needs, with the primary point of contact being Paul Ferry, the RSA Home Modification Coordinator.
The document provides a structured template for contractors to detail project-specific modifications, including itemized service/task descriptions, material costs, labor costs, and total project pricing. Contractors are required to complete the proposal within the specifications attached to the document, with a standard completion timeframe of 30 calendar days from receiving the RSA Purchase Authorization. The form emphasizes the confidential nature of client data and requires submission of the pricing proposal via email to the RSA Home Modification Coordinator. The pricing proposal includes space for contractors to provide their company information, estimated project timeframe, and any additional notes relevant to the proposed home modification work.
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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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