2016 Version MCD01 Affirmations and Approvals.docx
DOCX document 102 KB Posted
- Solicitation number
- BD-15-1067-MCD01-MCD01-00000003934
- Issued by
- Suffolk County, Massachusetts
About this file
The document is an affirmations and approvals form for the MCD01 Interpreter Contract Renewal for FY'16 to FY'18 with the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH). The form requires interpreters and transliterators to affirm that they have read and will abide by the policies, procedures, and guidelines in the MCDHH's Interpreter Contract. The form also allows interpreters to authorize MCDHH to use their photographs on the MCDHH website and internal referral software programs to assist consumers, requesters, and other users in identifying them.
The contract opportunity relates to the renewal of MCDHH's MCD01 Contract for Interpreters and Transliterators for the Deaf and Hard of Hearing for the FY'16 to FY'18 term. Participants must complete the affirmations and approvals form and submit it with their contract documents as part of the renewal process. The contract term is for a three-year period from July 1, 2015 to June 30, 2018.
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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
Fax (617) 740-1880
VP (617) 326-7546
www.mass.gov/mcdhh
MCD01 Affirmations and Approvals
Complete this form and submit with your contract documents.
Affirmation: I have read the document “MCDHH’s Interpreter Contract: RFR/Contract and Procedures, Updated for the July 1, 2015 to June 30, 2018 Contract Renewal Period” and agree to abide by all policies, procedures, and guidelines contained within.
Authorized Signature Name Date
Approval: I authorize MCDHH to use my photograph on the MCDHH website and on internal referral software programs. I understand that the photograph will be used for the sole purpose of assisting consumers, requesters, and other user of interpreter services in identifying interpreters and transliterators.
(Please check appropriate box): Yes (Please sign below) No (Do not sign below)
Authorized Signature Name Date
Effective 4/2015 image1.wmf oleObject1.bin
File details come from the government source that posted it. Updated .