Harford County Department of Social Services

OBF/CARM/14-001-S ATTACHMENT A DEPARTMENT OF HUMAN RESOURCES COST ALLOCATION AND REVENUE MANAGEMENT DIVISION ANNUAL OPERATING & HOSTING OF RANDOM MOMENT SAMPLING SOFTWARE PRICING PROPOSAL FORM 1 2 3 4 Fully Loaded Fixed Fully Loaded Fixed Fully Loaded Fixed Unit Price for First Unit Price for Base Unit Price for Base Item Description Option Period TOTALS Period Period (if exercised) Year One Year Two Year Three Transition-In Plan and Activities Hosting Maintenance Technical Support Training TOTAL EVALUATED PRICE *** Used as Basis for Financial Evaluation The Fully-Loaded Fixed Unit Prices for all services shall include all costs necessary to provide all services as described in the RFP. No additional monies shall be paid to the Contractor for costs associated with this Contract.

______Name of Firm (full legal name) Address (Include City, State, and Zip)

______eMM Registration Number FEIN/ SSN Telephone Number (Direct Line)

______Signature of Person Authorized to Printed Name & Title of Person Date Bind Prices and Services Authorized to Bind Prices and Services