Attachment C - Contractor Information.pdf
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- Attached to
- Fee-for-Service Representative Payee Services for ODHS' Office of Developmental Disabilities Service
- Solicitation number
- S-10000-00001153
- Issued by
- Lane County, Eugene City, Oregon
About this file
This document is Attachment C - Contractor Information for RFP S-10000-00001153, issued by the Oregon Department of Human Services (ODHS) Office of Developmental Disabilities Services (ODDS) and its Stabilization and Crisis Unit (SACU) for Fee-for-Service Representative Payee Services. The RFP is seeking one or more contractors to provide representative payee services for beneficiaries of Social Security and/or Supplemental Security Income benefits for individuals with intellectual and/or developmental disabilities living in homes operated by ODDS SACU. The attachment requests proposers to provide their legal business name, address, contact information, and indicate the counties in Oregon (Clackamas, Lane, Linn, Marion, Multnomah, Washington, Yamhill) for which they are proposing to provide the representative payee services.
The business information section of the attachment requires proposers to specify their business designation (e.g. corporation, partnership, sole proprietorship) and to confirm their current registration with the Oregon Secretary of State. The contract opportunity is specific to the state of Oregon and the local jurisdictions of Lane County and the city of Eugene.
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Text version
RFP S-10000-00001153 – Fee-for-Service Representative Payee Services Attachment C
OregonBuys RFP S-10000-00001153 / l.thomas Page 1 of 1
ATTACHMENT C – CONTRACTOR INFORMATION
If Proposer is awarded a Contract, ODHS will use the following information for the Proposer’s
Contract to provide the Representative Payee Services.
CONTRACTOR INFORMATION
C1
Legal name of
Contractor
Doing business as (if applicable)
Address
City, State, Zip
CONTRACTOR CONTACT
This is the person ODHS will contact for Contract negotiations with a successful Proposer.
C2
Name
Title
Address
Phone
Email address
SERVICE LOCATION DESIGNATION
Check the boxes to indicate the county or counties for which the Proposer is proposing to provide
Representative Payee Services.
C3
Clackamas Lane Linn
Marion Multnomah Washington
Yamhill
BUSINESS INFORMATION
C4
Business
Designation
(Check one)
Professional Corporation Nonprofit Corporation Limited Partnership
Limited Liability Company Limited Liability Partnership
Sole Proprietorship Corporation Partnership NA_________________
Secretary of State
Business
Registration
State of Registration ___________________ Registry ID#_____________________
Oregon Secretary of State registration must be current at the time of Contract execution.
File details come from the government source that posted it. Updated .