Attachment F - Applicant Reference Form.docx
DOCX document 19 KB Posted
- Solicitation number
- 49115
- Issued by
- Washington
About this file
The document is an Applicant Reference Form related to Solicitation #1745-662 issued by the Washington State Department of Social and Health Services, Division of Child Support (DCS). The form is used to collect information about an applicant's prior services provided, including the category of services, time frame, and description of services performed. The related state and local contract opportunity is for Vendors to provide alternate payment options for Non-Custodial Parents paying child support, where Vendors will collect funds, identify payer account information, and electronically transfer funds with payment remittance details to DCS.
The form requires the reference to provide contact information, the applicant's name, a description of the services provided, and the reference's signature and date. The agency will use the information collected on this form during the evaluation process for the Alternate Payment Options contract opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment E - Contractor Intake Form.doc | DOC document | |
| Attachment G - Solicitation Schedule.pdf | ||
| 1745-662 Amendment 3.pdf | ||
| 1745-662 Amendment 2 Question and Answer.pdf | ||
| Attachment C - Certifications and Assurances.docx | DOCX document | |
| Attachment H-Payee Registration and W-9.pdf | ||
| 1745-662 -Request for Applications.pdf | ||
| Attachment D - RFA Bidder Response.doc | DOC document | |
| Attachment B - Submission Letter .docx | DOCX document | |
| 1745-662 Amendment 1 Questions and Answers .pdf | ||
| Attachment A - Sample Contract.pdf |
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Text version
Solicitation #1745-662 Attachment F Applicant Reference Form
1. Name of Applicant for whom this reference applies
Applicant submission of this form constitutes permission for the AGENCY to contact the reference indicated herein. .
| 2. Contact Name & Mailing Address of Reference |
| 3. Contact's Phone Number |
4. Contact’s E-mail
5. Category of Services Provided
6. Time Frame of Services Provided
7. Description of Services Performed
8. Signature: Date:
9. (This space reserved for AGENCY use)
DSHS Purchased Services Application – DCS Alternate Payment Options
DSHS/DCS RFA #1745-662
[9/25/17]
File details come from the government source that posted it. Updated .