Range for Subcontracted Services definition

Range for Subcontracted Services. Start: End: DVHA Program Manager: Signature: Phone Number: Business Office Review Comments:

Range for Subcontracted Services. Start: End: DVHA Program Manager: Signature:______________________________ Phone Number: Business Office Review Comments: _____ _ Approval: _____ _ Title: _ Date: __ Required: Contractor cannotsubcontractuntilthey receivethis signed approvalfrom the State of Vermont. On the next page, there is language that must be included by thecontractor in all subcontractingagreements. Language to be included from State of Vermont Bulletin 3.5 in all subcontracting agreements: Set Off: The State may set off any sums which the Party owes the State against any sums due the Party under this Agreement; provided, however, that any set off of amounts due the State of Vermont as taxes shall be in accordance with the procedures more specifically provided hereinafter.

Range for Subcontracted Services. Start: End: DVHA Program Manager: Signature:______________________________ Phone Number: Business Office Review Comments: Approval: Title: Date: Required: Contractor cannot subcontract until they receive this signed approval from the State of Vermont.

Examples of Range for Subcontracted Services in a sentence

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Contact Person: Signature: Phone Number: Business Office Review Comments: Approval: Title: Date: Required: Contractor cannot subcontract until they receive this signed approval from the State of Vermont.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Contact Person: Signature:______________________________ Phone Number: Business Office Review Comments: Approval: Title: Date: Required: Contractor cannot subcontract until they receive this signed approval from the State of Vermont.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Program Manager: Signature:______________________________ Phone Number: Business Office Review Comments: Approval: Title: Date: Contractor cannot subcontract until they receive this signed approval from the State of Vermont.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Program Manager: Signature: Phone Number: Business Office Review Comments: _ Approval: Title: Date: Required: Contractor cannot subcontract until they receive this signed approval from the State of Vermont.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Program Manager: Signature: Phone Number: Business Office Review Comments: _ _ Approval: Title: Date: _ Required: Grantee cannot subcontract until they receive this signed approval from the State of Vermont.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt.) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Program Manager: Signature: Phone Number: Business Office Review Comments: _ _ Approval: Title: Date: _ Required: Grantee cannot subcontract until they receive this signed approval from the State of Vermont.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Program Manager: Signature: Phone Number: Business Office Review Comments: Approval: Title: Date: Contract #27818 Task Order 001 [numbered consecutively] Task Title: Contractor: Contract #: Effective Dates: Cost: Funding Source: [CFDA # if different than original] Budget Approval (Initials) 1.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Program Manager: Phone Number: Signature: Business Office Review Comments: Approval: Title: Date: Required: Contractor cannot subcontract until they receive this signed approval from the State of Vermont.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Contact Person: Signature:___ _ Phone Number: Business Office Review Comments Approval: Title: _ Date: _ Required: Contractor cannotsubcontractuntilthey receivethis signed approvalfrom the State of Vermont.

• YES NO (Note to Business Office: If Yes, do not proceed further with approval until reviewed with Finance & Mgmt) Dollar Amount of Subcontracted Services: $ Date Range for Subcontracted Services: Start: End: DVHA Program Manager: Signature: Phone Number: Business Office Review Comments: _ _ Approval: Title: Date: _ Required: Contractor cannot subcontract until they receive this signed approval from the State of Vermont.

More Definitions of Range for Subcontracted Services

Range for Subcontracted Services. Start: End: DVHA Program Manager: Signature: Phone Number: Business Office Review Comments: Approval: Title: Date: VHCIP Task Order Form HIS Professionals, #27511 Task Order # Start Date: MM/DD/YY End Date: MM/DD/YY Total Cost: Scope of Work Deliverable Description and Due Dates Contract Provision Reference Cost Comments: Contractor Representative (Name and Title) Xxxxx Xxxx, Principal Approval Signature Date State Authorized Rep: Xxxxxxx Xxxxxxx Approval Signature Date DVHA Contract Administrator Xxxxxxx Xxxxxxxxxx

Range for Subcontracted Services. Start: End: DVHA Program Manager: Signature: Phone Number: Business Office Review Comments: Approval: Title: Date: STATE OF VERMONT, CONTRACT FOR PERSONAL SERVICES PAGE 26 OF 26 DEPARTMENT OF VERMONT HEALTH ACCESS XXXXX & ASSOCIATES, INC. CONTRACT #28734 Travel and Expense Form Grantee/ Contractor Name: Invoice #: Starting Location Address: Invoice Date: Grant/Contract Number: Travel Meal Expenses Other Expenses (Receipts Required) State rate effective: 1/1/14- 12/31/14: .565/mile State rate effective beginning 1/1/15: .575/mile Per Diem In-State Rates (Vermont) B: $5.00 Per Diem Out-of- State B: $6.25 Receipts Required for Expenses in Categories Listed Below L: $6.00 L: $7.25 D: $12.85 D: $18.50 Description Training/ Travel Start Date Travel End Date (name of meeting, reason for travel, etc.) Starting Location Destination End Location Miles Amount Breakfast Lunch Dinner Lodging Airfare Registration Other Total $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - TOTALS 0 $ - $ - $ - $ - $ - $ - $ - $ - We the undersigned do hereby certify under that the reported information is accurate to the best of our knowledge and that all requests for services and expenses were incurred while performing work for the State of Vermont. The expenses I am requesting reimbursement for are in compliance with the State of Vermont Allowable Rates and Per Diems.The State reserves the right to withhold payment if the State does not receive required documentation and receipts. Claimant's Signature Date

Range for Subcontracted Services. Start: End: DVHA Program Manager: Signature:______________________________ Phone Number: Business Office Review Comments: Approval: Title: Date: Required: Contractor cannot subcontract until they receive this signed approval from the State of Vermont. On the reverse side of this form there is language that must be included by the contractor in all subcontracting agreements. Language to be included from State of Vermont Bulletin 3.5 in all subcontracting agreements: Set Off: The State may set off any sums which the Party owes the State against any sums due the Party under this Agreement; provided, however, that any set off of amounts due the State of Vermont as taxes shall be in accordance with the procedures more specifically provided hereinafter.