Response Cover Sheet.doc

DOC document 23 KB Posted

Attached to
Religious Services Master Agreement (MA) RFR
Solicitation number
BD-15-1022-DMH07-7110A-00000003893
Issued by
Worcester County, Massachusetts

About this file

This document is a Response Cover Sheet for the Department of Mental Health (DMH) Request for Response (RFR) for a Religious Services Master Agreement (MA). The RFR is seeking providers to offer religious services across various DMH regions in Massachusetts, including Western Massachusetts, Southeast, Central Massachusetts, Metro Boston, Northeast, Central Office, and Metro Suburban, with the option to provide services statewide. The RFR number is 2016-3140-RELIGIOUS SERVICES-01, and the contact person is MICH RYGIEL.

The cover sheet requires respondents to provide their company information, including name, address, contact name, telephone number, email address, and fax number. Respondents must also indicate the DMH areas they are willing to provide services to. The response must be submitted to DMH, and the date and time of receipt will be documented for internal use.

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Text version

DEPARTMENT OF MENTAL HEALTH

RFR RESPONSE COVER SHEET

Please use this as the first page of your response materials and the label on your submission package.

DMH RFR NUMBER: 2016-3140-RELIGIOUS SERVICES-01

DMH RFR TITLE: RELIGIOUS SERVICES MASTER AGREEMENT RFR

DMH CONTACT: MICH RYGIEL

RESPONDENT INFORMATION

NAME:

ADDRESS:

CONTACT NAME IF DIFFERENT FROM ABOVE:

TELEPHONE NUMBER:

EMAIL ADDRESS:

FAX NUMBER:

INDICATE DMH AREAS TO WHICH YOU ARE WILLING TO PROVIDE SERVICES (If requested in RFR document). CHECK ALL THAT APPLY.

_____ Western Massachusetts

_____ Southeast

_____ Central Massachusetts

_____ Metro Boston

_____ Northeast

_____ Central Office

_____ Metro Suburban

_____ Statewide

FOR DMH USE ONLY

Date Response Received:

Time:

Received by:

Name:

Title/Department:

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