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Quotation Estimate Nurse in United States Los Angeles –Free Word Template Download with AI

4520 Wilshire Boulevard, Suite 800, Los Angeles, California 90016, United States

Phone: (213) 555-0142 | Email: [email protected] | CA License #NPL-2024-0887

Quotation Estimate

Quotation Details

Quotation No.: QTE-2025-0731-LA

Date Issued: June 15, 2025

Valid Until: July 15, 2025

Service Location: United States Los Angeles, CA

Nurse Services – In-Home & Facility

Prepared For

Client Name: Margaret A. Thompson

Address: 2847 Sunset Blvd, Unit 12B, Los Angeles, CA 90026

Contact: (310) 555-7789

Email: [email protected]

Scope of Services – Nurse Care in United States Los Angeles

This Quotation Estimate is issued by Westside Care Partners, LLC to provide a comprehensive and transparent cost breakdown for professional Nurse services to be delivered within the United States Los Angeles metropolitan area. The Nurse services outlined below are designed to meet the specific healthcare needs of the client as discussed during our initial consultation on June 10, 2025. All Nurse personnel assigned to this engagement hold active California Registered Nurse (RN) or Licensed Practical Nurse (LPN) credentials and are fully insured under our professional liability coverage.

Itemized Quotation Estimate Breakdown
Item # Description of Nurse Service Frequency Duration Unit Rate Monthly Total
01 Registered Nurse (RN) – Daily vital signs monitoring, medication administration, and wound care assessment 5 days/week 4 hours/day $68.00/hr $5,440.00
02 Licensed Practical Nurse (LPN) – Assistance with personal hygiene, mobility support, and daily living activities 7 days/week 6 hours/day $42.00/hr $8,736.00
03 Nurse Case Management – Weekly care plan review, physician coordination, and progress documentation 1 day/week 2 hours/session $95.00/hr $760.00
04 Emergency Nurse Response – On-call Nurse availability for urgent medical situations within the United States Los Angeles service zone 24/7 standby As needed $150.00/visit $600.00 (est.)
05 Medical Supply & Equipment Coordination – Nurse-supervised procurement of prescribed medical supplies Monthly 1 hour $55.00/hr $55.00
06 Administrative & Compliance Fee – California healthcare regulatory compliance, insurance verification, and record-keeping Monthly — Flat fee $350.00
Estimated Monthly Total (Before Tax): $16,041.00
Estimated Quarterly Total (3 Months): $48,123.00
Terms and Conditions of This Quotation Estimate
  • Validity: This Quotation Estimate for Nurse services in United States Los Angeles is valid for thirty (30) calendar days from the date of issue. After the expiration date, rates may be subject to revision based on market conditions and California healthcare cost adjustments.
  • Payment Terms: Payment is due on the 1st of each month via ACH transfer, check, or approved credit card. A late payment fee of 1.5% per month will apply to outstanding balances exceeding fifteen (15) days.
  • Service Area: All Nurse services will be performed within the United States Los Angeles city limits and its immediate surrounding communities, including Beverly Hills, West Hollywood, Santa Monica, and Culver City. Travel beyond a 15-mile radius from the client's residence will incur an additional mileage charge of $0.85 per mile.
  • Nurse Qualifications: All Nurse staff assigned to this engagement will maintain current California Board of Registered Nursing (BRN) licenses, valid BLS/ACLS certifications, and a clean background check as required by California Health and Safety Code Section 1276.10.
  • Cancellation Policy: The client may cancel this Nurse service agreement with a minimum of fourteen (14) days written notice. Cancellation within the first thirty days of service will incur a 20% early termination fee on the remaining contracted period.
  • Insurance: Westside Care Partners, LLC maintains general liability insurance of $2,000,000 and professional Nurse malpractice coverage of $5,000,000 per occurrence. Certificates of insurance are available upon request.
  • Scope Changes: Any modification to the Nurse service plan, including changes in frequency, duration, or level of care, will require a written amendment to this Quotation Estimate and mutual agreement from both parties.
  • Governing Law: This Quotation Estimate and the resulting service agreement shall be governed by the laws of the State of California, with jurisdiction in the Superior Court of Los Angeles County, United States.
Acceptance and Authorization

By signing below, the client acknowledges receipt of this Quotation Estimate for Nurse services in United States Los Angeles and agrees to the terms, conditions, and pricing outlined herein. Upon acceptance, a formal Nurse Service Agreement will be executed within five (5) business days.

Client Signature:

_______________________________

Name: Margaret A. Thompson

Date: _______________

Authorized Representative – Westside Care Partners, LLC

_______________________________

Name: David R. Chen, RN, BSN – Director of Nurse Services

Date: _______________

Westside Care Partners, LLC | Quotation Estimate QTE-2025-0731-LA | Nurse Services – United States Los Angeles

This document is a Quotation Estimate only and does not constitute a binding contract until both parties have executed the formal Nurse Service Agreement.

© 2025 Westside Care Partners, LLC. All rights reserved. CA Healthcare Facility License #HCF-2024-1156.

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