Common Contracts

Attachment A – Sample Contract RFQQ #1734-656

Personal Service Contract • September 7th, 2017 • Washington

• Contract Type
  Personal Service Contract
• Filed
  September 7th, 2017
• Jurisdiction
  Washington

PERSONAL SERVICE CONTRACT DSHS Contract Number:1734-60145Resulting From Procurement Number:1734-656 This Contract is between the state of Washington Department of Socialand Health Services (DSHS) and the Contractor identified below, and is governed by chapter 39.26 RCW. Program Contract Number: Contractor Contract Number: CONTRACTOR NAMEJohn J. Smith CONTRACTOR doing business as (DBA)Johns Place AFH CONTRACTOR ADDRESS1234 12th Ave NEJunction City, WA 98333-3333 WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI) 600-123-123 DSHS INDEX NUMBER 146175 CONTRACTOR CONTACTJohn Smith CONTRACTOR TELEPHONE(360) 555-1212 CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESSjohn@someemail.com DSHS ADMINISTRATIONExecutive Administration DSHS DIVISIONOperation Support and Services Division DSHS CONTRACT CODE1000PC-34 DSHS CONTACT NAME AND TITLEMaria Rogers Contracts Consultant DSHS CONTACT ADDRESS1115 Washington St SE Olympia, WA 98504-5811 DSHS CONTACT TELEPHONE(360)664-6034 DSHS CONTACT FAX(360)664-6184 DSHS CONTACT