Government of the District of ColumbiaHuman Care Agreement • November 14th, 2012 • District of Columbia
HUMAN CARE AGREEMENT PAGE OF PAGES 1 115 1. HUMAN CARE AGREEMENT NUMBER:DCRL-2013-H-0039 2. REQUISITION/PURCHASE REQUEST NO. 3. PURCHASE ORDER/TASK ORDER NUMBER 4. DATE OF AWARD 5. ISSUED BYChild and Family Services Agency 200 I Street, S.E., Suite 2030Washington, D.C. 20003 6. ADMINISTERED BY (If other than Item 5) See Section G 7. NAME AND ADDRESS OF PROVIDER/CONTRACTOR (No. street, county, state and ZIP Code) 8. PROVIDER/CONTRACTOR SHALL SUBMIT ALL INVOICES TO:Child and Family Services Agency Fiscal Operations200 I Street, S.E., Suite 2030Washington, DC 20003 9. DISTRICT SHALL SEND ALL PAYMENTS TO: 10. DESCRIPTION OF HUMAN CARE SERVICE AND COST (TO BE COMPLETED BY CFSA) ITEM/LINE NO. NIGP CODE BRIEF DESCRIPTION OF HUMAN CARE SERVICE QUANITY OF SERVICE REQUIRED TOTAL SERVICE UNITS SERVICE RATE TOTAL AMOUNT SEE ATTACHED SCHEDULE B Total $ Total From Any Continuation Pages $ GRAND TOTAL $ 11. APPROPRIATION DATA AND FINANCIAL CERTIFICATION LINW AGY YEAR INDEX PCA OBJ AOB
HUMAN CARE AGREEMENT CONTRACTOR QUALIFICATIONS RECORDHuman Care Agreement • February 10th, 2016
STATUTORY AND REGULATORY AUTHORITY D.C. Code section 2-354.06, authorizes the District of Columbia Chief Procurement Officer, or his or her designee, to award Human Care Agreements for the procurement of social, health, human, and education services directly to individuals in the District. The Human Care Agreement Contractor Qualifications Record (CQR) is an application package that will facilitate the process of pre-qualifying contractors for a Human Care Agreement with the District of Columbia in accordance with 27 DMCR Chapter 19. GENERAL INSTRUCTIONS 1. Please read and complete each section of the Human Care Agreement (HCA), Contractor Qualifications Record (CQR) form. All information must be completed in the spaces provided, or marked “N/A.” 2. Original signatures must be included. Copies or a stamped signature is not acceptable. 3. The Standard Contract Provisions (SCP) for use with District of Columbia Government Supplies and Services Contracts dated March 2007 (“SCP”) are
ContractHuman Care Agreement • December 28th, 2021 • District of Columbia
HUMAN CARE AGREEMENTDoc592402 PAGE OF PAGES 1 37 1. HUMAN CARE AGREEMENT NUMBER 2. REQUISITION/PURCHASE REQUEST NO. 3. DATE OF AWARD 4. ISSUED BY 5. ADMINISTERED BY (If other than Item No. 4): Office of Contracting and ProcurementField Office: Department of Behavioral Health (DBH) 64 New York Avenue, NE, 2nd FloorWashington, D.C.20002 Department of Behavioral Health Saint Elizabeths Hospital1100 Alabama Avenue, SE Washington, DC 20032 6. NAME AND ADDRESS OF CONTRACTOR/CONTRACTOR (No. street, county, state and ZIP Code) 7. CONTRACTOR/CONTRACTOR SHALL SUBMIT ALL CLAIMS/ INVOICES TO: 8. DISTRICT SHALL SEND ALL PAYMENTS TO: (Reference Section G) 9. DESCRIPTION OF HUMAN CARE SERVICE AND RATE COST ITEM/LINE NO. NIGP CODE BRIEF DESCRIPTION OF HUMAN CARE SERVICE QUANTITY OF SERVICEREQUIRED TOTAL SERVICEUNITS SERVICE RATE TOTAL AMOUNT See section B Total $ Total From Any Continuation Pages $ GRAND TOTAL NOT TO EXCEED $ 10. APPROPRIATION DATA AND F
