BIDDER Cover Sheet RESTATED 1-1-19~1.docx
DOCX document 23 KB Posted
- Solicitation number
- BD-19-1022-DMH08-8220A-33600
- Issued by
- Massachusetts
About this file
This document is a cover sheet for a Request for Response (RFR) issued by the Massachusetts Department of Mental Health (DMH), Child, Youth, and Family Services Division, for Flexible Support Services. The RFR is seeking to establish a pool of qualified Provider organizations to deliver home and community-based Clinical Services, Parent/Caregiver Peer Support, Young Adult Peer Mentoring, and Therapeutic Support services, to be provided within the context of a Flexible Support Team, Flexible Support Group, or through Individual Practitioners. Responders must indicate the DMH areas and specific sites/geographic locations they are seeking to serve, as well as the specific Flexible Support Services and modalities they intend to provide.
The cover sheet requires the Responder's organization information, signatory authority details, and confirmation of having read and agreeing to follow the Flexible Fund Procedures outlined in Attachment C. Responders must complete and sign this cover sheet to qualify for providing any Flexible Support Service under this RFR.
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Text version
Department of Mental Health - Child, Youth, and Family Services Division Flexible Support Services Request For Response File Number:
RE-RESTATED COVER SHEET
BID RESPONDER ORGANIZATION:
Principle Address:
Name and Title of Signatory Authority:
Signatory email and phone number:
I attest to having read Attachment C, “Procedures for the Use of DMH Flexible Support Services Flexible Funds” and this Responder Organization agrees to follow the Flexible Fund Procedures and act as a Flexible Fund Administrator:
yes no.
Signature:
This section must be completed and signed by all Responders in order to qualify to provide any Flexible Support Service. Additionally, Responders must also indicate intent to qualify for at least one Flexible Support Service Modality (Team, Group, Individual Practitioner) below.
1. Check off all DMH Areas where you are seeking to provide Flexible Support Services:
Metro-Boston Southeast Northeast Central Western
2. List any specific DMH Sites/geographic locations you are seeking to serve:
3. Check off all Flexible Support Services you are seeking to provide:
Clinical Parent/Caregiver Peer Support Young Adult Peer Mentoring Therapeutic Support Specialist
4. Check off all modalities you are seeking to provide:
Team Specialty Team Group Individual Practitioner
File details come from the government source that posted it. Updated .