Attachment A - Sample ContractPersonal Service Contract • March 25th, 2019 • Washington
Contract Type FiledMarch 25th, 2019 JurisdictionPERSONAL SERVICE CONTRACT Functional Family Therapy (FFT) Workgroup Supervision Services 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 39.26 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 ADMINISTRATIONRehabilitation 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?No CFDA NUMBER(S) CONTRACT START DATE CONTRACT END DATE CONTRACT MAXIMUM AMOUNT EXHIBITS. The following Exhibits are attached and are incorporated into t