BPM006728_Exhibit_E_-_Notice_of_Selection_DDD-1923A__9-24_.pdf
PDF 240 KB Posted
- Attached to
- Master Agreement AZ|CTR077218
- Contract number
- CTR077218
- Issued by
- Arizona
About this file
This document is a Notice of Selection form from the Arizona Department of Economic Security's Division of Developmental Disabilities (DDD), issued under Governor Katie Hobbs' administration and Director Angie Rodgers' leadership. The form is specifically for Home Modification Services and appears to be a standardized template for selecting a service provider for a specific home modification project.
The document outlines contractual requirements for a home modification service provider, including specific timelines for communication and project completion. The provider must contact the family within seven calendar days of receiving the notice, email project details to DDD within eight calendar days, and complete the project by a predetermined completion date. The price for the modification is predetermined and cannot be altered without written authorization, and the contractor is responsible for meeting all requirements specified in the project's Scope of Work. The form includes placeholders for project-specific details such as DDD Project Number, Completion Date, Provider ID, DDD Member Name, and contact information.
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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/
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| Provider: |
| Info1: |
| Contact_Name: |
| Amount: |
| Contact_Name 2: |
| ASSISTS: |
| Address1: |
| Contact_Name3: |
| Phone: |
File details come from the government source that posted it. Updated .