Exhibit F – Sample Contract RFQ 1436-522Personal Service Contract • May 16th, 2019 • Washington
Contract Type FiledMay 16th, 2019 JurisdictionSAMPLE PERSONAL SERVICE CONTRACTDDDS Consultative Psychiatric Examinations DSHS Contract Number: Resulting From Procurement Number: This Contract is between the state of Washington Department of Social and Health Services (DSHS) and the Contractor identified below, and is governed by chapter 39.29 RCW. Program Contract Number: Contractor Contract Number: CONTRACTOR NAME CONTRACTOR doing business as (DBA) CONTRACTOR ADDRESS , WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI) DSHS INDEX NUMBER CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS , DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBER(S) CONTRACT START DATE CONTRACT END DATE CONTRACT MAXIMUM AMOUNT EXHIBITS. The following Exhibits are attached and are incorporated into this Contract by reference: Data Security