APPLICATION SUBMISSION INSTRUCTIONS
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 84015
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.