Get Attachment D - Att-b Contract Information And Verification Form 2011 - Baltimorehealth

Filling out the Attachment D - ATT-B Contract Information And Verification Form is a crucial step in ensuring that contract-related communications reach the appropriate personnel at your organization. This guide provides clear instructions to help you complete the form accurately and effectively online.

Follow the steps to complete the form seamlessly.

1. Click the ‘Get Form’ button to obtain the form and open it for editing. This will allow you to fill out the necessary fields with your information.
2. In Section I, provide the 'Legal Agency Name.' This name should match all contracts and related correspondence. Repeat this information on the top of pages 2 and 3. If your agency is not currently funded, leave the 'Provider Number' section blank.
3. Proceed to Sections II-VII. Review the role definitions for each contact to determine the correct individuals at your organization who should be listed. Ensure to enter all relevant information accurately.
4. In Sections II-VI, fill in the required contact details for the first five contract contacts, including names, titles, addresses, and professional credentials. Make sure to type or print clearly.
5. Each designated contract contact must sign and date their section in blue ink only. This is crucial for validating the information provided.
6. Complete Section VII if you wish to designate an alternate contract signatory who can sign the Agreement and/or amendments if the primary signatory is unavailable.
7. Once the form is filled out, ensure that all information is correct. You can then save your changes, download, print, or share the completed form as needed.
8. Finally, return the completed original form to Associated Black Charities at the specified address. Remember that faxed or photocopied versions will not be accepted.

Complete your documents online to ensure smooth processing.