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Purchased Services > Contract 2010

Contract 2010 - Table of Contents

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Business Associate Agreement

 Microsoft Word* Adobe PDF*  

Provider Summary Page

 Microsoft Word* Adobe PDF*  

Standard Agreement Cover Page

 Microsoft Word*   Microsoft Excel*

Standard Agreement Cover Page – ARRA

Microsoft Word*    

Supplemental Sheet for Contracted Employees

     Microsoft Excel*

Contract Billing Form

 Microsoft Word* Adobe PDF*  

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*    
BP54 ARRA Microsoft Word*    
BP54 EO-IT Microosft Word*    
Instructions for Rider B BP54 EO-IT Microsoft Word* Adobe PDF*  
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*    
 

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

Rider "C"
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*  
Children's Behavioral Health Microsoft Word* Adobe PDF* HTML
Adult with Physical and Cognitive Disabilities Microsoft Word* Adobe PDF*  
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 - OSA     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*