COBID Quote Form.docx

COBID Notice S-44000-00012871

HEALTHCARE FINANCE AND REVENUE CONSULTING SERVICES

QUOTE FORM

COBID ONLY VENDORS

Offeror Information

Company Name:

Contact Person:

Title:

Address:

Telephone:

Email:

Cert #:

Each Offeror must submit this Quote Form. The Quote Form must be signed and submitted via email to:

Frances.j.wilkins@dcbs.oregon.gov by February 26, 2025 at 2:00 PM PT.

By answering the following questions, Offeror denotes whether they meet or exceed all the following minimum qualifications. Agency reserves the right to determine if Offeror meets the minimum qualifications as part of the evaluation process.

Yes / No

1. Does Offeror have five years’ experience performing state policy, revenue, and taxation forecasting modeling?

2. Does Offeror’s employ or subcontract staff with 10 years’ experience in healthcare financing, state taxation, and revenue forecasting?

3. Does Offeror employ or subcontract staff that have an advanced degree such as a Masters or PhD in economics or other relevant field?

4. Can Offeror meet the various timelines included in the workstream deliverables of Exhibit A, Sample contract?

5. Does Offeror have experience working with committees that include members of the public, and bringing these committees to a consensus on technical finance issues?

Quote Form should be inclusive of all positions and related costs necessary to perform the requested Services, excluding any travel related expenses. Agency does not anticipate any travel expenses associated with these Services. Agency shall not reimburse any expenses, unless included in the Sample Contract, Statement of Work.

Add additional lines if needed for positions.

Rate Estimated Hours for Services

Position 1:

Position 2:

Position 3:

Position 4:

Position 5:

Position 6:

Position 7:

Position 8:

Position 9:

Position 10:

Contract will be awarded to the lowest cost quote meeting all the minimum requirements.

Note: Only positions and hourly rates included on this Quote Form will be included on the awarded Contract. The estimated hours is for Agency to determine the total contract compensation.

If requested by Agency, any travel costs will be negotiated separately.

SIGNATURE OF OFFEROR’S DULY AUTHORIZED REPRESENTATIVE

I, the undersigned, agree to be bound by the form of Agreement and all remaining contract documents, including instructions to Offeror’s; Standard Terms and Conditions; Special Conditions; Federal Provisions, if applicable; and Specifications.

I, the undersigned, certify compliance with State of Oregon statutory requirements governing registration of corporations and assumed business names.

I, the undersigned, certify that this Cost Proposal has been arrived at independently and has been submitted without any collusion designed to limit independent bidding or competition. I, the undersigned duly authorized representative of the Offeror, understand that the Cost Proposal Submission Form must be signed by the Offeror and that any alterations or erasures must be initialed by the person signing the Cost Proposal Submission Form. Further, I acknowledge that I have read and understand all cost instructions, specifications, terms and conditions, (including the attachments indicated above) and agree on behalf of myself and the Offeror to be bound by them.

I, the undersigned, duly authorized representative of the Offeror, certify that the information provided in this Cost Proposal is true and accurate. Further, I understand and acknowledge that providing incorrect information may cause Cost Proposal rejections or contract termination.

Company Name: __________________________________________________________________________________

Name of Authorized Representative: ___________________________________________________________

Title: _______________________________________________________________________________________________

Signature: _____________________________________________ Date: ____________________________________