2016 Version COA_form~1.docx
DOCX document 98 KB Posted
- Solicitation number
- BD-15-1067-MCD01-MCD01-00000003934
- Issued by
- Suffolk County, Massachusetts
About this file
This document appears to be a Change of Address form from the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH) Department of Interpreter and CART Services. It allows vendors providing interpreter and transliterator services to the MCDHH under the MCD01 Contract to update their contact information, including mailing address, legal address, phone, and fax numbers. Vendors can also select the regions they will be able to cover from their new address, including both general referral regions and after-hours emergency regions. This form is likely used to notify MCDHH of any address changes during the FY'16 to FY'18 contract term.
The pricing terms, set asides, and funding sources are not explicitly stated in this document. However, it is likely that the MCD01 Contract for Interpreter and Transliterator services has already been awarded, and this form is used to manage vendor contact information changes during the multi-year contract period.
View the file
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| 2016 Version contractor auth signatory list form.rtf | RTF text file | |
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| 2016 Version MCD01 Affirmations and Approvals.docx | DOCX document | |
| MCD01 Renewal RFR Contract FY16 to FY18 FINAL~1.docx | DOCX document | |
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| 2016 Version RID_Membership_Affirmation.docx | DOCX document | |
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Text version
The Commonwealth of Massachusetts Executive Office of Health and Human Services Massachusetts Commission for the Deaf and Hard of Hearing 600 Washington Street Boston, Massachusetts 02111 Tel. (617) 740-1600
TTY (617) 740-1700
VP (617) 326-7546
Fax (617) 740-1880 www.mass.gov/mcdhh
Department of Interpreter and CART Services / A & F Change of Address
To: MCDHH Business Department;
From: __________________________________________ Effective date of address change: ____________________
Please change my address from:
CURRENT ADDRESS
Mailing Address:
Legal Address:
| City: |
| State: |
| Zip + 4: |
| Home Phone: |
| Home Fax: |
To:
NEW ADDRESS
Mailing Address:
Legal Address:
| City: |
| State: |
| Zip + 4: |
| Home Phone: |
| Home Fax: |
Please select regions you will cover from your new address
General Referral Regions:
| Boston Region |
| Metro Region |
| Northeast Region |
| Southeast Region |
| Central Region |
| Western Region |
After-Hours Emergency Regions:
| Berkshire County Region |
| Western Region |
| Central Region |
| Metro/Central Region |
| Northeast Region |
| Greater Boston Region |
| Southeast Region |
| Cape Cod & Islands Region |
Signature of Vendor Date
INTERNAL USE ONLY
MMARS updated – By: _____________________
Date sent to OSC: ____________________________
Approved by OSC – date: ____________________
Avianco updated – By: _________________________
DATE RECEIVED
Effective 4/6/12 image1.wmf oleObject1.bin
File details come from the government source that posted it. Updated .