E990A518-E8F3-4318-3125803AC770B0DD.pdf
PDF 12 KB Posted
- Attached to
- Cancer Concierge/Navigation Services
- Solicitation number
- RFP 2026-06-04
- Issued by
- Franklin County, Ohio
About this file
This is an invoice template for mediation services provided by a vendor to a government agency. The document establishes the billing structure and service documentation requirements for mediation sessions conducted during a specified month and year of service.
The invoice template includes fields for capturing essential service delivery information: vendor name, remittance address, date of service, case number, case type, and names of participants involved in mediation sessions. Services are billed at $150 per mediation session, with a $25 charge for no-show incidents. The template provides a straightforward mechanism for vendors to document services rendered and calculate the total amount due for monthly invoicing purposes.
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Text version
Vendor Name
Remittance Address
Month and Year of Service
Date of Service Case Number Case Type Name of Participants Mediation Session $150 No Show $25 Total
ATTACHMENT A
INVOICE
Total Due
File details come from the government source that posted it. Updated .