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:"; <br /> SUMMARY FoRM <br /> 2oo ao0 <br /> <br />To~ ~ cost for i~ate me,cd ~ices, - <br />~ncludmg S~g CO~ Option A ) · - <br /> <br /> Br~do~ ~6~at~on:' ' ": ' · <br /> :~ ; ~... · . : <br /> S-~.: O '~ "'" <br /> <br /> · ~; ': · Ph~uflc~ cost .:. <br /> <br /> : . j : ,?: ;::.' Supply~ost <br /> .~ .... .: 0~. " : <br /> <br />Addi~0n~ Se~S (51~fl~n 13 0) '" <br /> <br /> , Pe~ ~it ~ep~r ~st for Den~,.PII~i & p~s' <br /> <br /> · ~clud~ ~di~lo~st inm~m~fion~ ~?fip~on <br /> <br /> CO~ ~ ViSit fo} ~rgency Ps~cMa~c ·Crisis <br /> lnt~fion & Ewlmion ' .'~ :. <br /> <br />$656,400.00 <br /> <br /> $522,475. <br /> $576,9~.6.. <br /> $.40,600. <br /> <br />" $14,657. <br /> $78,668. <br /> <br />$200.00 <br /> <br />$48./$58.' <br /> <br />.~150.00 <br />$50.00 <br /> <br /> Monthly'administrative fee for billing servlees $400.00 <br /> <br />BIDDERS STATEMENT: I have read;understood and a~'ee to the terms ired conditions <br />on ail pages Of the t~quest for Proposal. Upon request, I will transfer and deliver goods <br />or services tO the City iii ~ccordance V~{th Said ~rms 'anti, conditions. <br /> <br />CorreCtional Man'gM Car~ M~dical CorPorat[on .. (7 4) 254~010 · . <br />Complcfg LegSl N~ic of Company Ph"ne Number <br />1000 S. Anaheim Boulevard, Suite :203 Aaaheim, C~!if0mia ' 92805 <br />' ' '" ............... i' Clty/~tat~ · Zip Code <br /> <br />$1i.~'e ofAu~orii~:l~IF:Tltl¢ ,. Prlnmd Narpe <br /> <br /> <br />