MCD06 Affirmations and Approvals.docx

DOCX document 106 KB Posted

Attached to
MCD06 ASL Interpreters and Transliterators for the Deaf and Hard of Hearing
Solicitation number
BD-18-1067-MCD01-MCD01-26742
Issued by
Massachusetts

About this file

This document is the "MCD06 Affirmations and Approvals" form for the Commonwealth of Massachusetts Executive Office of Health and Human Services Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH) contract opportunity for American Sign Language Interpreters and Transliterators. The contract opportunity, identified as MCD06 with a MBPO of PO-18-1067-MCD01-MCD01-13286, requires vendors to complete this affirmation form agreeing to the policies, procedures, and guidelines contained within the "MCD06 Contract for American Sign Language Interpreters and Transliterators for the Deaf and Hard of Hearing: RFR/Contract and Procedures" document. The contract opportunity covers the jurisdictions of Suffolk County and the City of Boston. Vendors must also complete a separate approval form authorizing MCDHH to use the vendor's photograph on their website and internal referral software programs.

The contract documents are available for download as a single ZIP file or 22 individual files. Completed contract packages must be submitted by U.S. Mail to MCDHH two weeks after download. This contract opportunity does not provide any additional details on pricing terms, set asides, incumbents, funding requirements, or other salient information.

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Text version

The Commonwealth of Massachusetts Executive Office of Health and Human Services Massachusetts Commission for the Deaf and Hard of Hearing

600 Washington Street Boston, Massachusetts 02111 Tel. (617) 740-1600

TTY (617) 740-1700

Fax (617) 740-1880

VP (617) 326-7546

www.mass.gov/mcdhh

MCD06 Affirmations and Approvals

Complete this form and submit with your contract documents.

Affirmation: I have read the document “MCD06 Contract for American Sign Language Interpreters and Transliterators for the Deaf and Hard of Hearing: RFR/Contract and Procedures” and agree to abide by all policies, procedures, and guidelines contained within.

Authorized Signature Name Date

Approval: I authorize MCDHH to use my photograph on the MCDHH website and on internal referral software programs. I understand that the photograph will be used for the sole purpose of assisting consumers, requesters, and other user of interpreter services in identifying interpreters and transliterators.

(Please check appropriate box): Yes (Please sign below) No (Do not sign below)

Authorized Signature Name Date

Effective 4/2015 oleObject1.bin image1.wmf

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