Request For Proposal Page 4

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RFP #540 COUNSELING SERVICES
EXHIBIT “A” COST/RATE FORM
This form is required to be submitted with response package. Failure to submit this form may result in rejection of proposal.
DATE:
COMPANY/INDIVIDUAL NAME: ____________________________________
The undersigned, having carefully examined the Request for Proposal for Counseling Services for Oxnard
Union High School District, California, hereby submits the following rates for said services. *This page MUST be
signed by authorized agent of the firm.
PROFESSIONAL FEES – (Proposed Team assigned to each category)
HOURLY RATES
1.
$_________
Per hour rate for counseling individuals
2.
$_________
Per hour rate for conducting group sessions
3.
$_________
Per hour rate for preparing materials
4..
$_________
Per hour rate for Other (specify)
5..
$_________
Per hour rate for Other (specify)
OTHER EXPENSES
7.
$_________
Materials such as paper, pencils, supplies
8.
$_________
Mileage rate (Other than travel to District)
9.
$_________
Additional Other Services (specify)
Company/Agency/Individual
Name:
Address:
Email:
Telephone Number:
Fax Number:
*Authorized Agent:
Signature
Printed Name:
Title:
OUHSD RFP #540 Counseling Services
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