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It Services Contract Attachment • November 14th, 2018 • Washington

IT SERVICES CONTRACTAttachment A Sample Contract to RFQQ 1823-705 DSHS Contract Number: Resulting From Competition Number: Sole Source This Contract is between the State of Washington Department of Social and Health Services (DSHS) and the Contractor identified below, and is governed by chapter 43.19 and 43.105 RCW. 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? CFDA NUMBERS CONTRACT START DATE CONTRACT END DATE CONTRACT MAXIMUM AMOUNT EXHIBITS. The following Exhibits are attached and are incorporated into this Contract by reference: Exhibits (specify): Exhibit A

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