38-25 Attachment E - Contractor Voucher Coversheet and Contractor Voucher.pdf
PDF 126 KB Posted
- Attached to
- OVERNIGHT RESPITE SERVICES State and local contract opportunity
- Solicitation number
- RFP-DCP-38-25
- Issued by
- Dutchess County, New York
About this file
These documents are voucher forms from the Dutchess County Office for the Aging located in Poughkeepsie, NY, specifically Attachment E forms for Overnight Respite services. The forms are designed for subcontractors to document and request reimbursement for overnight respite care services provided. Subcontractors are required to complete and submit these vouchers by the 10th of the month following the month in which services were rendered, including copies of signed verification sheets and applicable receipts.
The voucher forms include fields for capturing critical billing information such as subcontractor name, address, contract number, service month, invoice date, total days of service, daily rate, and total reimbursement amount. There is a payee certification section where an authorized subcontractor officer must certify that the expenditures are legitimate, the claim is correct, and that no unauthorized charges have been included. The forms provide a structured method for the Office for the Aging to track and reimburse overnight respite care services, ensuring proper documentation and financial accountability for services provided to aging community members.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 38-25 Specs - FINAL.pdf | ||
| BidNet Electronic Bid Submission Guide.pdf | ||
| 38-25 Electronic Proposal Submittal Procedures - FINAL.pdf | ||
| 38-25 Attachment D - Program Standards.pdf |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT E
Overnight Respite Voucher Coversheet
Dutchess County Office for the Aging 114 Delafield Street Poughkeepsie NY 12601 (845) 486-2555
Instructions: This voucher must be completed and submitted to the Office for the Aginf with copies of the signed verification sheet by the 10th of the month following the month during which service was provided
Subcontractor Name:
Address:
Contract #
Service Month:
Invoice Date:
Overnight Respite
Total Amount of Days Rate
Total Amount
Payee certification: I certify that the above expenditures have been incurred; that the claim is just and correct; that taxes from which the State is exempt are excluded.
Authorized Signature
Title
ATTACHMENT E
Contractor Voucher Dutchess County Office for the Aging
114 Delafield St. Poughkeepsie NY 12601
Instructions: Complete and submit this voucher to the Office for the Aging with copies of applicable receipts (if necessary) by the 10th of the month following the month service was provided.
Subcontractor Name:
Address
Contract # __________________ Expenditure Period ________ _________ Current Year Number from to
Contact Person:
Phone Number:
Signature of Client or Authorized Rep Dates of Service
Day of WK Date of Mo
Rate Per day
Amount
Total Days________________ Times daily rate: __________ Reimbursement Claimed: ________________
Payee Certification: I certify that the above expenditures have been incurred: that the claim is just and correct: that no part thereof has been charged except as stated: and that taxes from the state is exempt as excluded
Signature of subcontractor officer Title of Subcontractor Officer
Date: _________________________________
File details come from the government source that posted it. Updated .