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Purchased Services > Contract 2009

Contract 2009 - Table of Contents

Business Associate Agreement

 Microsoft Word* Adobe PDF*  

Provider Summary Page

 Microsoft Word* Adobe PDF*  

Standard Agreement Cover Page

 Microsoft Word*    

Contract Billing Form

 Microsoft Word* Adobe PDF*  

Vendor Form

     Microsoft Excel*

Debarment Form

 Microsoft Word* Adobe PDF*  
 

Agreement Authorization
Agreement Authorization Form     Microsoft Excel*
 

Signature Page
BP 18 Agreement for Special Services ($5,000 level) Microsoft Word* Adobe PDF*  
BP 54 Agreement to Purchase Services Microsoft Word*    
Amendments Signature Microsoft Word*    
Amendment- Vendor Change Microsoft Word*    
Cooperative Agreement Microsoft Word* Adobe PDF*  
 

Rider "A"
Specifications Of Work To Be Performed - Generic Microsoft Word* Adobe PDF*  
OSA - Prevention Contract Template Microsoft Word*    
OSA - Treatment Contract Template Microsoft Word*    
OSA - Special Services Contract Template Microsoft Word*    
OSA - MECare Contract Template Microsoft Word*    
CDC -  Specification of Work to be Performed Microsoft Word* Adobe PDF*  
 

Rider "B"
Rider B – 12 Monthly Payments Microsoft word* Adobe PDF* HTML
Rider "B" Program Administrator/Agreement Administrator Microsoft Word* Adobe PDF*  
Rider "B" Purchases' Form Agreement Administrator Only Microsoft Word* Adobe PDF*  
 

Rider "C"
ARRA- Rider C Microsoft Word* Adobe PDF*  
Exceptions to Rider"B"      HTML
Office of Adult Mental Health Microsoft Word* Adobe PDF*  
 

Rider "D"

Addition Requirements – Client Services Microsoft Word* Adobe PDF*  
Addition Requirements – State Services Microsoft Word* Adobe PDF*  
 

Rider "E" Program Requirements
Adult Mental Health Microsoft Word* Adobe PDF* HTML
Children's Behavioral Health Microsoft Word* Adobe PDF* HTML
Adult with Physical and Cognitive Disabilities Microsoft Word* Adobe PDF* HTML
Maine Center for Disease Control Microsoft Word* Adobe PDF*  
 

Rider "G"
Identification of Country In Which Contracted Work Will Be Performed Microsoft Word* Adobe PDF*  
 

Rider "I"
Assurance of Compliance Microsoft Word* Adobe PDF* HTML
Resolution Agreement Cover Letter Microsoft Word* Adobe PDF*  
 

Service Definitions

     HTML
 

Performance Indicators
Adult Mental Health (updated September 08, 2006)     Microsoft Excel*
Children's Behavioral Health (updated September 08, 2006)     Microsoft Excel*
  • Instructions for Reporting Performance Indicators (updated September 08, 2006)
 Microsoft Word* Adobe PDF* HTML
 

Budget Forms
Budget Form - Generic     Microsoft Excel*
  • Instructions for Completing Budget Forms
 Microsoft Word* Adobe PDF*  
 
Budget Forms - Adult with Physical and Cognitive Disabilities
  •    Summary of Services Form 6
     Microsoft Excel*
 
Budget Forms - Children's     Microsoft Excel*
  •    Instructions for Completing Budget Forms
 Microsoft Word* Adobe PDF*  
 
Budget Forms - Mental Health     Microsoft Excel*
  •    Instructions for Completing Budget Forms
Microsoft Word* Adobe PDF*  
 
Budget Forms - OSA     Microsoft Excel*
 
FY 07 Rate Setting Report - PNMI and Room/Board     Microsoft Excel*
 

Quarterly Financial Report
Quarterly Financial Report Form     Microsoft Excel*
 

Pro Forma
Instructions Microsoft Word* Adobe PDF*  
 

Agreement Close-out Report
Agreement Close-out Report     Microsoft Excel*
Sub-recipient Agreement Close-out Report     Microsoft Excel*
Instructions Microsoft Word* Adobe PDF*  
 

 

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