When contracting with the Stafford County Human Services Office the following process must be followed to ensure timely execution of the Contract.
- Complete all fillable blanks within the Contract document. Print and sign the Contract and all applicable addenda
- The following documents are required to be submitted with the signed Contract and Addenda. Missing documentation will result in non-execution of the Contract:
- The authorized Contract with signatures by authorized representatives of the Provider and the Buyer;
- The Provider’s required license(s) received from the appropriate licensing agent;
- The Provider’s current rates and descriptions of services offered;
- Certificate of Liability Insurance meeting the requirements of Section 19 of this Contract;
- Background check certification letter;
- Provider’s W-9 for tax identification;
- School Calendar (if applicable): calendars must provide the exact number of school days for each month; and
- CSA Service Name vs. Provider Service Name sheet: Providers will fill in their service name next to the CSA service name it falls under.
- The signed Contract and Addendum/a and required documentation should be sent via mail to:
Stafford County Human Services Office
PO Box 339
Stafford VA 22555
Attn: Stephanie Beamer
Or via email with the subject line “Stafford County Purchase of Services Contract” to firstname.lastname@example.org
- Human Services Office staff will review all submitted Contracts, Addenda, and required documentation. All Contracts deemed appropriate for the Child Services Act Program will be executed by the Human Services Director. Signatures pages will be mailed to the Provider for their records.
- It is the responsibility of the Provider to ensure all staff required to carry out the responsibilities of the Contract are familiar with the requirements.
- If your Agency is unable to comply with any of the requirements of the Contract and would like to request a variance please submit a written request to email@example.com and staff will review to determine if the variance can be approved.
**Submission of the Contract to the Stafford County Human Services Office does not guarantee Provider will be accepted as a Stafford County Contracted Provider.