• 22 S. State St. Clearfield, UT 84015
  • Main : (801) 525-5000
  • M-F 8am to 5pm

Senior Services Provider Contract Information

Below you will find an application with instructions to participate in a contract with Davis County Senior Services.

APPLICATION COMPLETION INSTRUCTIONS

Organizations proposing to participate in a contract with Davis County Senior Services are invited to attend a Contract Meeting scheduled for Thursday, May 16, 2019 at 9:00am, at 22 South State Street, 2nd Floor, Clearfield, Utah. All questions and concerns can be answered at that time.

Submission Instructions

The original application and required documents must be submitted to and received no later than June 3, 2019: Faxed or scanned copies will be accepted.

Mail:             

Davis County Health Department
Attention:  Shawna Mahan
PO Box 618
Farmington, UT  84025

Email: ShawnaN@co.davis.ut.us

Fax: 801-525-5071

Hand Delivery: (not a mailing address)
Davis County Health Department
Attention: Shawna Mahan
22 South State Street - 3rd Floor
Clearfield, UT
801-525-5050

To be considered complete, the packet must include:

  • Contract form with required signatures
  • Current W-9
  • Certificate of Insurance indicating required coverage amount
  • Current business license
    and/or
  • Current DOPL Home Health/Personal Care License
  • Completed cover sheet

Contracts missing any of the above items will be returned to sender as unprocessed.

Copyright © Davis County Government. All Rights Reserved

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