ATTACHMENT A SAMPLE CONTRACT RFQ 1813-695Client Service Contract • May 5th, 2020 • Washington
Contract Type FiledMay 5th, 2020 JurisdictionCLIENT SERVICE CONTRACT Regional Client Advocacy Services DSHS Contract Number:1813-60196Resulting From Solicitation Number: 1813-695 This Contract is between the State of Washington Department of Social and Health Services (DSHS) and the Contractor identified below. Program Contract Number: Contractor Contract Number: CONTRACTOR NAME John J. Smith CONTRACTOR doing business as (DBA) Johns Place AFH CONTRACTOR ADDRESS 1234 12th Ave NEJunction City, WA 98333-3333 WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI) 600-123-123 DSHS INDEX NUMBER 146175 CONTRACTOR CONTACT Fred Jones CONTRACTOR TELEPHONE (360) 555-1212 CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS fred@someemail.com DSHS ADMINISTRATION Services and Enterprise Support Administration DSHS DIVISION Central Contracts & Legal Services DSHS CONTRACT CODE 8404XS-12 DSHS CONTACT NAME AND TITLE Maria Rogers Contracts Consultant DSHS CONTACT ADDRESS1115 Washington St SE Olympia, WA 98504-5811 DSHS CONTACT TELEPHONE (360)664-6034 DSHS CONTACT FAX