HomeMy WebLinkAboutD-04-592 DPH Misc. Docs.pdf CONTRACT STATUS FORM �ti co�,�
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DATE: July 01, 2024 RE S�
DIVISION(S): Epidemiology, Surveillance and Data Management JUL 1-8 2024
(Lead Division listed first)
CONTRACTOR: Inter-Dept: DPH & Child Support Services OEP�CONTRACTPUBLIC
SECTION HEALTH
SERVICES: Vital Statistics Paternity Services Acknowledgment
CONTRACT TERM: 1/21/04 to 1/20/25 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
Contract#: D-04-592 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by:October 1. 2024
Extend contract through: , 20
❑ With no changes in terms or conditions.
❑ With the following change(s):
Evergreen: Continue contract through: onw.Lx ZO , 20 Z K
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Supervisor/Staff Analyst: ` �— Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
CONTRACT STATUS FORM ti COUP
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DATE: July 06, 2023 RECEIVE
DIVISION(S): Epidemiology DEC 0 b 2023
(Lead Division listed first) DEPARTMENT OF PUBLIC H
CONTRACTOR: Inter-Dept: DPH & Child Support Services CONTRACTS SECTION
SERVICES: Vital Statistics Paternity Services Acknowledgment
CONTRACT TERM: 1/21/04 to 1/20/24 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
Contract#: D-04-592 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by:October 1, 2023
1 _
Extend contract through: (,2,n_ , 20
With no changes in terms or conditions.
❑ With the following change(s):
Evergreen: Continue contract through: , 20
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
r
Approved by:
Program Supervisor/Staff Analy - Date:
Division Manager: _ � - Date: 22
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
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CONTRACT STATUS FORM
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DATE: July 01, 2022 REC ESQ
DIVISION(S): Epidemiology OCT 2 4 20�2
(Lead Division listed first) OEPAC N TOF PUBLIC
H
CONTRACTOR: Inter-Dept: DPH & Child Support Services ONTR,gCTSSECTIb
SERVICES: Vital Statistics Paternity Services Acknowledgment
CONTRACT TERM: 1/21/04 to 1/20/23 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
Contract#: D-04-592 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by:October 1, 2022
Extend contract through: , 20
With no changes in terms or conditions.
With the following change(s):
0--E-vergreen: Continue contract through:'— 20
Cancel contract effective: -
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by: ZZ
Program Supervisor/Staff Ana e:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
COUP
C5NTRACT STATUS FO*d
1VED O 856 O
DATE: July 07, 2020 RE�EEs�
DEc 2 a 202�
DIVISION(S): Community Health H
(Lead Division listed first) pE.PP ZMEN1 OV Ppg�j10N
CpN(RA�ISSE.
CONTRACTOR: Inter-Dept: DPH & Child Support Services
SERVICES: Vital Statistics Paternity Services Acknowledgment
CURRENT PERIOD: 1/21/04 to 1/20/21 E Auto-renewal: ❑ through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO: Evergreen Agreement-Please Review
Contract#: D-04-592 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by:October 1, 2020
F
Renew contract through: , zu_
With no changes in terms or conditions.
❑ With the following change(s):
Evergreen: Continue contract through: ja,r)yovy 20 , 20 23
❑ Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor/Staff Analyst: Date: 12
Division Manager: Date: ?
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
co
CONTRACT STATUS FORM
RECEIVED o 856 O
DATE: July 01, 2021 JUL 16 202 Est'
DIVISION(S): Community Health
(Lead Division listed first) DEPARTMENT OF PUBLIC TH
CONTRACTS SECTIO
CONTRACTOR: Inter-Dept: DPH & Child Support Services
SERVICES: Vital Statistics Paternity Services Acknowledgment
CONTRACT TERM: 1/21/04 to 1/20/22 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
Contract#: D-04-592 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by:October 1, 2021
❑ Extend contract through: , 20
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: 20 ate.
Cancel contract effective: , 20 -
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by: d -
Program Supervisor/Staff Analyst: UW� Date: 13 2
Division Manager: Gam- Date: Z "
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone#: 600-7090
I CO L�
CONTRACT STATUS FOkvM
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DATE: July 07, 2020 FxErn
DIVISION(S): Community Health RE�E�VED
(Lead Division listed first)
CONTRACTOR: Inter-Dept: DPH & Child Support Services
SERVICES: Vital Statistics Paternity Services Acknowledgment DUNRIMENI��jSSB��`pNpL1
CON
CURRENT PERIOD: 1/21/04 to 1/20/21 E Auto-renewal: 0 through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO: Evergreen Agreement-Please Review
Contract#: D-04-592 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by:October 1, 2020
Renew contract through: , 20
11 With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: r Y. Z� , 20 122
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
I pproved by.
Program Supervisor/Staff Analyst: Date: \
Division Manager: Date: "
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone#: 600-7090
�
CONTRACT STATUS FOOM co
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DATE: July 02, 2019 FxEs�
DIVISION(S): Community Health
(Lead Division listed first)
CONTRACTOR: Inter-Dept: DPH & Child Support Services
SERVICES: Vital Statistics Paternity Services Acknowledgment
CURRENT PERIOD: 1/21/04 to 1/20/2020 E Auto-renewal: ❑ through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO: ���g�
Contract#: N/A State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by:October 1, 2019
Renew ontract through: 02� , 20 cd
With no changes in terms or conditions.
With the following change(s):
❑ Evergreen: Continue contract through: 20
Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Supervisor/Staff Analyst: Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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CATRACT STATUS FORM �
O 560
DATE: July 02, 2018tES�
DIVISION(S): Community Health
RECEIVED
(Lead Division listed first) JUL 0 6 2018
CONTRACTOR: Inter-Dept: DPH & Child Support S DEPART RT OF PUBLIC HEALTH
PURCHASING SERVICES
SERVICES: Vital Statistics Paternity Services Acknowledgment
CURRENT PERIOD: 1/21/04 to 1/20/2019 E Auto-renewal: through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO:
Contract#: N/A State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by:October 1, 2018
Renew contract through: , 20
❑ With no changes in terms or conditions.
❑ With the following change(s):
vergreen: Continue contract through: J T-\ -0 , 20 _1
Cancel contract effective: 120
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor/Staff Anal st: ��-� ate�� w
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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CU 'RACT STATUS FORD
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DATE: July 01, 2014 FRESH
DIVISION(S): Community Health
(Lead Division listed first) RECEIVED
CONTRACTOR: Inter-Dept: DPH & Child Support Services JUL 0 3 2014
SERVICES: Vital Statistics PaternityServices Acknowledgment DEPARTMENT Of PUBLIC HEALTH
g CONTRACTS SECTION
CURRENT PERIOD: 1/21/14 to 1/20/15 E Auto-renewal: ❑ through:
(if not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO:
Contract#: N/A State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by: October 1, 2014
Renew contract through: , 20
With no changes in terms or conditions.
With the following change(s):
❑ Evergreen: Continue contract through: 20
❑ Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
w',L '/"
Approved by:
Program Supervisor/Staff Analyst: Date:
Division Manager: Date:
1017
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
COUP
CONTRACT STATUS FORM
DATE: July 01, 2013 F1ZESt3'
DIVISION(S): Community Health
(Lead Division listed first)
CONTRACTOR: Inter-Dept: DPH & Child Support Services
SERVICES: Vital Statistics Paternity Services Acknowledgment
CURRENT PERIOD: 1/21/13 to 1/20/14 E Auto-renewal: ❑ through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO:
Contract#: N/A State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by: October 1, 2013
❑ Renew contract through: , LO_
❑ With no changes in terms or conditions.
❑ With the following change(s):
�vergreen: Continue contract through: �,, 2� , 20
❑ Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by: Z"
Program Supervis tall Analyses=t-- Date: /
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
Co U�
CUkTRACT STATUS FOMJ
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DATE: June 29, 2012 14'RES�
DIVISION(S): Community Health
(Lead Division listed first)
CONTRACTOR: Inter-Dept: DPH & Child Support Services
SERVICES: Vital Statistics Paternity Services Acknowledgment
CURRENT PERIOD: 1/21/12 to 1/20/13 E Auto-renewal: O through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO:
Contract#: N/A State/Vendor#: N/A
Lead Dept: DPH Other Dept(s)' Child Stjppnr+ SPrvires
Complete the information below and return to DPH Contracts by: October 1, 2012
Renew contract through: 920..
With no changes in terms or conditions.
❑ With the following change(s):
[i]//Evergreen: Continue contract through: c�a n. , 20 1 .
Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Superviso Staff Analys : Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
co
CMiTRACT STATUS FORM
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DATE: July 01, 2011 FRESH
DIVISION(S): Community Health
(Lead Division listed first)
CONTRACTOR: Inter-Dept: DPH & Child Support Services
SERVICES: Vital Statistics Paternity Services Acknowledgment
CURRENT PERIOD: 1/21/11 to 1/20/12 E Auto-renewal: El through:
(if not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO:
Contract#: N/A State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Support Services
Complete the information below and return to DPH Contracts by: October 1, 2011
Renew contract through: 20
With no changes in terms or conditions.
With the following change(s):
[D/'Evergreen: Continue contract through: �, , 20
❑ Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Superviso taff An— aln. � -- Date: i i
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090
COLS
CONTRACT STATUS FORM
O� s6 O
DATE: June 28, 2010
DIVISION(S): Community Health
(Lead Division listed first)
CONTRACTOR: Inter-Dept: DPH & Child Support Services
SERVICES: Vital Statistics Paternity Services Acknowledgment
CURRENT PERIOD: 1/21/10 to 1/20/11 E Auto-renewal: ❑ through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 1/21/2004 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201505
CONTRACT AMOUNT: $10.00
ADDITIONAL INFO:
Contract#: N/A State/Vendor#: N/A
Lead Dept: DPH Other Dept(s): Child Su -- -;rvice-
Complete the information Gplow and return to DPH Contracts by: October 1, 2010
Renew contract through:
`With no changes in terms or conditions.
With the following change(s): _
2"'Evergreen: Continue contract through: c o,.y,. �.�, , 20
❑ Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor tall Analyst Date: 721 io
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 445-7090