ATTACHMENT A SAMPLE CONTRACT RFQQ #1835-684Services Contract • June 28th, 2018 • Washington
Contract Type FiledJune 28th, 2018 JurisdictionSERVICES CONTRACT Inspection of Care (IOC) DSHS Contract Number:1835-60153Resulting 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 NAMEMary J. Smith CONTRACTOR doing business as (DBA) CONTRACTOR ADDRESS7233 Harbor Lane SWLa Conner, WA 98222-2222 WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI) DSHS INDEX NUMBER 146176 CONTRACTOR CONTACTMary Smith CONTRACTOR TELEPHONE(360) 555-1212 CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESSMaryJ@email DSHS ADMINISTRATIONAging & Long Term Support Admin DSHS DIVISIONDivision of Home And Community Services DSHS CONTRACT CODE1000PC-35 DSHS CONTACT NAME AND TITLEStudent One Contracts Manager DSHS CONTACT ADDRESS4500 10th Ave SE Lacey, WA 98504 DSHS CONTACT TELEPHONE(888) 888-8888 DSHS CONTACT FAX(888) 888-8888 DSHS CONTACT E-MAIL ADDRESSeacdhelp@dshs.wa.