7897 APPENDIX 4 ContrctrComplincAgrmnt (DOC-2818).docx
DOCX document 26 KB Posted
- Attached to
- Substance Use Disorder (SUD) Counselor Services
- Contract number
- 410014-M21-CJO7897-RFB-00
- Issued by
- Wisconsin
About this file
This is a Contractor Compliance Agreement form (DOC-2818) issued by the Wisconsin Department of Corrections, Division of Management Services. The document serves as a standardized compliance certification form that contractors must complete and submit to ensure adherence to all contract terms and conditions when providing services to the Wisconsin Department of Corrections.
The agreement requires contractors to certify compliance with all DOC contract provisions, particularly regarding background check requirements for contractor staff and applicants. The form establishes a twelve-month compliance period from the date of signature, during which contractors must verify continued compliance annually by filing new completed forms with DOC Purchasing Services. Contractors are required to list all current DOC contract identification numbers, and the completed form covers all contracts the contractor holds with the DOC during the specified period. The document does not specify particular goods or services but applies broadly to all contractor relationships with the Wisconsin Department of Corrections.
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Text version
DEPARTMENT OF CORRECTIONS WISCONSIN
Division of Management Services DOC-2818 (Rev. 8/2018)
CONTRACTOR COMPLIANCE AGREEMENT
INSTRUCTIONS: Complete entire form and return to the Department of Corrections Purchasing Services, Contract Manager or the Purchasing Helpdesk, email address listed below.
| CONTRACTOR NAME: |
|_| CONTRACT COMPLIANCE
The contractor hereby agrees that as a contractor who provides services to the State of Wisconsin Department of Corrections (DOC), they will ensure that the contractor and all contractor staff shall provide any and all contracted services in a manner consistent with each DOC contract.
|_| CONTRACTOR STAFF & APPLICANT BACKGROUND CHECKS
Furthermore, the contractor affirms compliance with all Contract Terms and Conditions concerning all provisions relating to background checks of all contractor staff and applicants.
Authorized Contractor Representative Information:
| NAME |
| POSITION TITLE |
| CONTRACTOR ADDRESS |
| CONTRACTOR PHONE |
| CONTRACTOR EMAIL |
List all contract(s) currently held with DOC (include contract identification numbers for proper routing):
If contractor enters into any other contract(s) with the DOC prior to the expiration of this statement of compliance, the contractor need not submit an additional compliance form. This completed form shall cover all contract(s) the contractor has with the DOC for a twelve (12) month period, following the date signed by the authorized contractor representative identified above.
During the life of the contract(s), the contractor shall continue to verify compliance on an annual basis, by filing a new completed, signed form with DOC Purchasing Services every twelve (12) months, or within 30 days of each contact year end date or date listed below, whichever is earlier.
| SIGNATURE |
| DATE SIGNED |
Return completed and signed form to:
Or to the DOC Purchasing Helpdesk DOCPurchasingHelpdesk@wisconsin.gov
DISTRIBUTION: Original – Designated Contractor File
File details come from the government source that posted it. Updated .