BPM006728_Exhibit_E_-_Notice_of_Selection_DDD-1923A__9-24_.pdf

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Attached to
Master Agreement AZ|CTR077220
Contract number
CTR077220
Issued by
Arizona

About this file

This document is a Notice of Selection from the Arizona Department of Economic Security's Division of Developmental Disabilities (DDD), issued under Governor Katie Hobbs's administration. The notice is a formal communication related to Home Modification Services, involving a selected provider who will perform specific home modification work for a DDD member.

The document outlines key contractual requirements, including a mandated seven-day window for the provider to contact the family and schedule a start date, and an eight-day window to email the DDD Home Modifications Unit with project details. The contract specifies a fixed price for the home modification project that cannot be altered without written authorization, with invoices deviating from this price subject to rejection. The provider is responsible for completing the project by the specified completion date and adhering to all requirements outlined in the Scope of Work. Contact information for follow-up is provided, including the DDD Home Modifications Unit's email (DHomeModifications@azdes.gov) and phone number.

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Text version

DDD-1923A LTHFF (09/24)

Katie Hobbs Governor

Angie Rodgers Director

Division of Developmental Disabilities Home Modification Service

NOTICE OF SELECTION

DDD Project Number:

Completion Due Date:

Provider ID:

Dear , This is notification that your organization has been selected by the Arizona Department of Economic Security, Division of Developmental Disabilities (Division) to provide the Home Modification Services specified on the Project Specification and Price Sheet for the DDD Project Number identified above for the price of $ . Contact information for this home modification project is listed below:

DDD Member Name:

ASSISTS ID:

*Address (No.,Street) City, State, ZIP Code:

Family Contact: Tel:

*If a name or address is not identified above, contact the C.E.A.C. regarding ACP participants.

Per the requirements of our contract:

• You are required to call the Family Contact within seven (7) calendar days of receiving this notice, and schedule a start date.

• You are required to email the DDD Home Modifications Unit at DHomeModifications@azdes.gov¬ within eight (8) calendar days of receiving this notice, and provide the following:

◦ The DDD Project Number (as the subject line of your email);

◦ The scheduled start and estimated finished dates.

• This home modification project must be completed by the Completion Date identified above.

Additional information:

• The price listed above cannot be changed without written authorization from the Division. Invoices submitted for an amount different than the above price, will be rejected.

• Contractor is responsible for all other requirements listed in the Scope of Work.

Thank you, The Division of Developmental Disabilities

Equal Opportunity Employer / Program • Auxiliary aids and services are available upon request to individuals with disabilities • To request this document in alternative format or for further information about this policy, contact the Division of Developmental Disabilities Customer Service Center at 1-844-770-9500; TTY/TDD Services: 7-1-1

DDD Home Modifications Unit • 4000 N. Central Ave., Suite 300, Mail Drop 2H91, Phoenix, AZ 85012 Telephone (602) 771-8080 • eFax (602) 666-8807 • Email: DHomeModifications@azdes.gov • https://des.az.gov/

Date1:
Project_ID:
Date3:
Provider:
Info1:
Contact_Name:
Amount:
Contact_Name 2:
ASSISTS:
Address1:
Contact_Name3:
Phone:

File details come from the government source that posted it. Updated .