6091 - EMS Billing & PCR Services, 1.Pricing Sheet **SEE ADDENDUM 1**Exhibit 1
RFP 6091 Pricing Sheet for EMS Billing & Patient Care Reporting Services
The respondent shall complete the following section, which directly corresponds to the specifications. The contractor shall not make changes to this format.
The items listed below including equipment, software, license, and services are representative of the City's of Denton requirements for the identified project. The requested pricing
shall be utilized to determine the "cost of service", of the various phases of the project, and any additional needs that may become known to the City during the contract period.
Required Services Pricing:
The following services are described in Exhibit 3, Scope of Work (SOW). Refer to the corresponding SOW item number in Exhibit 3 for details. Please note for evaluation purposes only,
assume the monthly revenue collected in the amount of $250,000 will be use to evaluate each proposed rate in dollars. The actual monthly revenue will vary.
Item
1
*Assumed amount for evaluation purposes only
Item
2
2a
2b
TOTAL
Alternate Services Pricing Proposal:
The City will consider the following performance-based pricing structure as an alternative to the above required pricing structure. The total amount collected during the prior 12 month
period will determine the rate to be charged during the current contract period. The revenue collection period will revert back to $0 on the contract's anniversary date.
Item
3
If the following services are not included in the pricing for the above Pricing Items 1 and 2, please indicate them below. Refer to the corresponding SOW item number in Exhibit 3 for
details.
Item
4
5
TOTAL
Required Equipment Pricing (F.O.B. Destination):
Item
6
7
TOTAL
Additional Equipment to be supplied as needed after initial contract year:
ITEM
8
9
Monthly Revenue Collected
250000
Quantity
1
1
DESCRIPTION
Percentage Rate for EMS Billing Services - Tiered Compensation (Exhibit 3 Item #62)
DESCRIPTION
Health Data Exchange (Exhibit 3 Item #35, if priced separately)
EMS Implementation (Exhibit 3 Items #58 & 63, if priced separately)
Req'd Quantity
8
8
QTY
1
1
*NOTE: PLEASE EMAIL THIS EXHIBIT 1 AS AN EXCEL FILE TO EBIDS@CITYOFDENTON.COM
UOM
MO
UOM
EA
YR
UOM
EA
EA
UOM
EA
EA
Type of Service Requested
EMS Billing Services (Section A: Items #1-23 and Transactional Assistance: Items #60-61)
Type of Service Requested
Patient Care Reporting (Section B: Items #30-52)
System Design and Configuration, Implementation, Testing, and Training (Exhibit 3 Item #58)
Annual Maintenance and Support Services, including 24/7/365 help desk support and software upgrades (Section B: Items #47-52)
Description
Patient Care Reporting Hardware Devices (Exhibit 3 Section B: Items #47-52)
Patient Care Reporting Annual Software Subscription Fee (Exhibit 3 Section B: Items #47-52)
Description
Patient Care Reporting Devices & Support (Exhibit 3 Section B: Items #47-49)
Patient Care Reporting Annual Software Subscription Fee (Exhibit 3 Section B: Items #47-52)
Cost of Service
Annual % Rate
City's Price
0
Annual % Rate Following the
Initial Contract Year
Total Annual Revenue
<$3M
%
City's Price
$
$
0
Unit Price
Unit Price
Respondent's Business Name
Principal Place of Business (City and State)
Monthly Amount*
0
Total Annual Revenue
$3M to $3.5M
%
Extended Price
0
0
0
Total Annual Revenue >$3.5M
%