ContractMulti-Year Agreement • June 10th, 2013
Contract Type FiledJune 10th, 2013STATE AGENCY (Name & Address): NYS Office of Mental Health 44 Holland AvenueAlbany, NY 12229 BUSINESS UNIT/DEPT.ID: OMH01/3650000 CONTRACT NUMBER: C012345/0CONTRACT TYPE:✔ Multi-Year Agreement Simplified Renewal Agreement Fixed-Term Agreement CONTRACTOR SFS PAYEE NAME:Faith Based Community, Inc. TRANSACTION TYPE:✔ NewRenewal Amendment CONTRACTOR DOS INCORPORATED NAME:Faith-Based Community, Inc., The PROJECT NAME:Community Residence Program Supported Housing Program CONTRACTOR IDENTIFICATION NUMBERS: NYS Vendor ID Number: 1000009999 Federal Tax ID Number: 123456789 DUNS Number (if applicable): 987654321 AGENCY IDENTIFIER: CFDA NUMBER (Federally Funded Grants Only): CONTRACTOR PRIMARY MAILING ADDRESS:1 Main StreetAnytown, NY 12000 CONTRACTOR PAYMENT ADDRESS:✔ Check if same as primary mailing address CONTRACT MAILING ADDRESS:✔ Check if same as primary mailing address CONTRACTOR STATUS: For ProfitMunicipality, Code: Tribal Nation IndividualNot-for-Profit ✔ Charities Registratio