RFB 24 - 003 ATTACHMENT A – COST FORM

Vendor Name: ___

Instructions:

  • Vendors shall enter pricing on this cost sheet.
  • Vendors shall not alter the language or format of the price sheet or they shall be deemed non-responsive.
  • Vendors shall not add additional information to the cost sheet(s) or they shall be deemed non-responsive.
  • Vendors shall enter cost as final (not estimated or average) amounts or they shall be deemed non-responsive.
Cost
DescriptionQtyCost
One (1) 2023 One Exam Room Mobile Clinic ADA units with a 2023 Van E350 DRW 1 passenger & driver capability (or similar vehicle) with the following accessories: • Blood Draw Chair/ Phlebotomy Chair • ADA Compliant Lift • Overall Length 22' 11.5" • 110V Outlet • Double W/C Lift Door - Deluxe • Braun Century Lift NCL919, 34" Wide • Pull 110V 12 Gauge Cable for Rooftop A/C • Wheel Liners Stainless Steel E350/450 w/Valve Ext. • Exam Bench • Check In Desk with Desk Chair • Accucold Medical Grade Refrigerator 5.5 cu ft • Sharps Disposable System • Waiting Area Bench • Eye Wash Station • Vent Fan Header Compartment w/ Cover • Smoke/Carbon Detector1