Common Contracts

Exhibit D – Sample Contract RFQ 1436-522

Service Contract • July 17th, 2018 • Washington

• Contract Type
  Service Contract
• Filed
  July 17th, 2018
• Jurisdiction
  Washington

PERSONAL SERVICE CONTRACT CSD Mental Incapacity Evaluations DSHS Contract Number: Resulting From Procurement Number: This Contract is between the state of Washington Department of Social and Health Services (DSHS) and the Contractor identified below, and isgoverned by chapter 39.29 RCW. Program Contract Number: Contractor Contract Number: CONTRACTOR NAME CONTRACTOR doing business as (DBA) CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI) DSHS INDEX NUMBER CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?Click here to enter text. CFDA NUMBER(S) CONTRACT START DATE CONTRACT END DATE CONTRACT MAXIMUM AMOUNT EXHIBITS. The following Exhibits are attached and are incorporated into this Contract by reference: Exhibit