Government of the District of ColumbiaHuman Care Agreement • November 14th, 2012 • District of Columbia
Contract Type FiledNovember 14th, 2012 JurisdictionHUMAN 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