BPM006728_Exhibit_D_-_RSA_HM_Request_for_Project_Pricing.pdf
PDF 125 KB Posted
- Attached to
- Master Agreement AZ|CTR077216
- Contract number
- CTR077216
- Issued by
- Arizona
About this file
This document is a Request for Project Pricing form from the Arizona Department of Economic Security (ADES), specifically from the Rehabilitation Services Administration (RSA), for a Home Modification project. The form is designed to capture project details and solicit pricing proposals from contractors for home accessibility modifications for a specific client served by the RSA.
The document provides a two-section template for contractors to submit project pricing, with spaces to detail individual services/tasks, including material and labor costs for up to seven specific modifications. The form requires contractors to break down costs, provide a total project price, and include their company information. 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. While specific financial details are not filled in, the form is structured to capture comprehensive project pricing information, including administrative costs, and allows for additional contractor notes and estimated timeframes.
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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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