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Page 16 of 25 <br />FORM 4.02 PRICE SHEET <br />REQUEST FOR PROPOSAL #2024- 156 COMMUNITY SUPPORT TRANSPORTATION <br />ASSISTANCE <br />Supplier Name: <br />Proposed compensation includes providing competency diversion services as detailed in the Scope of Work and <br />should include direct overhead, administrative expenses, labor, benefits, potential contingencies, as well as <br />unforeseen costs and incidentals, etc. Total compensation will be based on the following: <br /> <br />Proposed compensation includes providing all direct Transportation services as detailed in the Scope of Work and <br />should include direct overhead, administrative expenses, labor, benefits, gas, vehicle expenses, insurance, potential <br />contingencies, such as unforeseen costs and incidentals, etc. <br /> <br />Description Monthly Fee Months <br />February to <br />September <br />Contract Term Total Cost <br />Monthly compensation <br />amount. $ x 8 $ <br />*Direct Client Expenses – are not eligible under SAMHSA <br /> <br />EXHIBIT D