Contract Agency. An entity that has been sponsored by an existing Member Agency, approved by the Board of Directors according to terms acceptable to CONFIRE.
Contract Agency. City of Tumwater, Washington Lewis County Washington By: Xxxxxx X. Xxxxx, Sheriff (Authorized Representative) Xxxxxx Xxxxxxxx, Mayor Attest: Melody Valiant, City Clerk Approved as to form:
Contract Agency. The Contract Agency agrees to retain documentation to support all charges and expenditures and to immediately report changes to the Department which may affect the payment status of the child. Documentation of Agency prior approval for any nonscheduled payment is to be maintained by the Contract Agency. Local Department Office - The Department agrees to submit the following documentation: Referral Material as required in the Master Agreement. Payment Authorization/Billing Document, Acknowledgment of Receipt and approval of Initial Service Plan and Updated Service Plan, a Quarterly Report if providing primary family services APPROVALS DHS Local Office Director or Designee Signature (If two offices involved, both signatures required) Signature Date Contract Agency Director or Designee Signature Signature Date AUTHORITY: Public Act 280, 1939 COMPLETION: Required. PENALTY: No payment for services Department of Human Services (DHS) will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.
