DHHR43 Psychology.pdf
PDF 100 KB Posted
- Attached to
- ARFQ Psychology services to JWH residents
- Solicitation number
- ARFQ 0506 JWH2200000002 1
- Issued by
- Raleigh County, West Virginia
About this file
This is a Request for Quotations form issued by the West Virginia Department of Health and Human Resources, Office of Health Facilities, on behalf of Jackie Withrow Hospital in Beckley, West Virginia. The solicitation seeks bids to provide psychology services for hospital residents, with service delivery to commence on October 1, 2021. The bid submission deadline is September 9, 2021, at 1:00 p.m., with written questions regarding the solicitation due by August 27, 2021 at 1:00 p.m. All questions will be answered through addenda published in WVOASIS. Bids may be submitted through WVOASIS, USPS, fax, or hand delivery to Theresa Dorsey at One Davis Square, Room 111, Charleston, West Virginia 25301, or via fax to (304) 558-2892. Email submissions will not be accepted.
The pricing structure, specific service quantities, unit pricing, and contract term are not specified in this quotation form template. Bidders must certify that they have reviewed and understand the DHHR Master Terms and Conditions, which are incorporated by reference into the agreement. Vendors are required to provide their Federal Employer Identification Number (FEIN) and must verify registration with any applicable state agencies. The form indicates delivery requirements and FOB terms are to be determined, with services to be provided directly to Jackie Withrow Hospital at 105 South Eisenhower Drive, Beckley, West Virginia 25801.
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Other files
| File | Type | Posted |
|---|---|---|
| DHHR TCA Psychology.pdf | ||
| Hippa Agreement.docx | DOCX document | |
| Final_ARFQ_0506_JWH2200000002_1_WV_ARFQ_FORM.PDF | ||
| DHHR pAffidavit.pdf | ||
| Exhibit A Psychology Pricing.docx | DOCX document | |
| ServicesRFQ Psychology 2021.docx | DOCX document |
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Text version
DHHR-43 (REV. 11/1 /17)
Vendor w
Address w
Telephone Number w ( )
Date Acct. No.
Return by ______________ on ______________
Item Number Quantity Unit Price AmountDescription
Delivery Requirements F.O.B.
REQUEST FOR QUOTATIONS
THIS IS NOT AN ORDER
Req. No.
Delivery DateTermsFEIN
TOTAL $
Vendor - Authorized Representative Signature of Authorized Representative
Bid To Be Delivered To:
Goods/Services To Be Shipped To:
GENERAL TERMS AND CONDITIONS: The DHHR Master Terms and Conditions are hereby made a part of this agreement and are specifically incorporated herein by reference. By signing this document, Vendor certifies it has reviewed the Terms and Conditions, fully understands them, and agrees to be bound by their provisions.
By signing below, I certify that I have reviewed this Requisition for Quotations in its entirety; understand the requirements, terms and conditions, and other information contained herein; that I am submitting this quotation for review and consideration; that I am authorized by the bidder to execute this bid or any documents related thereto on bidder's behalf; that I am authorized to bind the bidder in a contractual relationship; and that to the best of my knowledge, the bidder has properly registered with any State agency that may require registration.
| on: 13:00 |
| undefined: 9/9/2021 |
| Req No: ARFQ JWH220000002 |
| Date: 8/17/2021 |
| Acct No: |
| Bid To Be Delivered To: Theresa Dorsey |
One Davis Square Room 111 Charleston, WV 25301 Fax (304) 558-2892
GoodsServices To Be Shipped To: Director of Nursing / Residents Jackie Withrow Hospital 105 S Eisenhower Dr.
Beckley, WV 25801
| Delivery Requirements: Beginning 10/1/2021 |
| FEIN: |
| Terms: |
| Delivery Date: |
| FOB: |
| Item Number: |
| Quantity: |
| Description: The West Virginia Department of Health and Human Resources, (WVDHHR), Office of Health Facilities, (OHF), Jackie Withrow Hospital is currently soliciting bids to provide Psychology Services for the residents of Jackie Withrow Hospital |
Any questions to this solicitation must be submitted in writing to Theresa Dorsey to the information above no later than 1:00pm on 8/27/2021. Questions may be sent to the information above or emailed to Theresa.J.Dorsey@wv.gov. All questions will be answered in the form of an addendum and published in WVOASIS.
We encourage you to place your bids through WVOASIS, if you need assistance with this you can contact the help desk toll free at (855) 666-8823, bids may also be sent usps, fax, or hand delivered. Email bids will not be considered.
| Unit Price: |
| Amount: |
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File details come from the government source that posted it. Updated .