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CONTRACT PRICING WORKSHEET <br />ContractDate <br />09/11/12 <br />AM04-10 <br />No.:Prepared: <br />For MOTOR VEHICLES Only <br />This Worksheet is prepared by Contractor and given to End User. <br />Worksheet MUST be faxed to H-GAC @ 713-993-4548. Therefore please type or pri <br />Buying <br />City of La Porte EMSDallas Dodge Quote #7600C-HGAC <br />Contractor: <br />Agency: <br />ContactPrepared <br />Jason PeugeotTim Middlebrooks <br />Person:By: <br />281-471-9244214-319-1336 <br />Phone:Phone: <br />281-471-0688214-319-1306 <br />Fax:Fax: <br />peugeotj@laportetx.govtmiddlebrooks@kag-1.net <br />Email:Email: <br />Product <br />LA10Type I 14' on Dodge Ram 4500 Diesel DRW Cab/Chassis, Gen Pwrd Mo <br />Description: <br />Code: <br />$124,500.00 <br />A. Product Item Base Unit Price Per Contractor's H-GAC Contract: <br />B. Published Options - Itemize below - Attach additional sheet(s <br />(Note: Published Options are options which were submitted and pr <br />DescriptionCostDescriptionCost <br />1-Heat shielding for diesel chassis$1,500.001199-(x6) Install miscellaneous equipment $3,000.00 <br />59-Granning air suspension system for Dodge Ram 4500$5,500.001140-Install a Voyager back up camera on the rear wall$400.00 <br />277-Air Liquide electric O2 panel with monitor at the action wal$1,275.001142-Install a Voyager camera in the patient compartment on the $400.00 <br />1305-All products listed in the current Stryker ÅList Price Book$16,161.001147-Install a Voyager quad view monitor in the truck cab near t$800.00 <br />89-Buell dual 10Æ & 12Æ air horns through front bumper$800.0016-Arm rests on the console$200.00 <br />99-Mount a fast recovery compressor for the air horn system belo$1,200.006-(2) large aluminum map holders on rear of console$350.00 <br />1209-(x14)Lighting modification from base (each)$7,000.0028-3 receptacle 12VDC outlet, no medical diode isolator on passe$100.00 <br />188-Squad bench cabinet w/ padding on end$600.0042-2 high glove box holder on back wall of truck cab$125.00 <br />368-Grey EVS captain's chair with built-in child safety seat$700.00380-Install a Sharps container and bracket on the rear wall abov$75.00 <br />185-Netting at the head of the squad bench$750.00415-Install a 2 high glove box holder on the rear wall above the$125.00 <br />1167-3M diamond grade conspicuity tape in Chevron pattern on rea$1,500.00$16,825.00 <br />Subtotal From Additional Sheet(s): <br />1171-Double 8Æ 3M reflective stripe with non-reflective pinstrip$2,700.00$62,086.00 <br /> Subtotal B: <br />C. Unpublished Options - Itemize below / attach additional sheet <br />(Note: Unpublished options are items which were not submitted an <br />DescriptionCostDescriptionCost <br />Rear Sway Bar$700.00 <br />Knox MedVault$2,189.00 <br />Subtotal From Additional Sheet(s): <br />Software package$250.003139 <br />Subtotal C: <br /> Total cost of Unpublished Options (C) cannot exceed 25% of the <br />Check: <br />2% <br />For this transaction the percentage is: <br />Price plus Published Options (A+B). <br />D. Total Cost Before Any Applicable Trade-In / Other Allowances <br />$189,725.00$189,725.00 <br />Quantity Ordered: 1X Subtotal of A + B + C: =Subtotal D: <br />$1,000.00 <br />E. H-GAC Order Processing Charge (Amount Per Current Policy)Subtotal E: <br />F. Trade-Ins / Special Discounts / Other Allowances / Freight / <br />DescriptionCostDescriptionCost <br />Trade-In-$10,000.00 <br />-10000 <br />Subtotal F: <br />Delivery Date: G. Total Purchase Price (D+E+F): <br />$180,725.00 <br /> <br />