Provider Eligibility. The Provider agrees to the provisions of 7 AAC 81, Grant Services for Individuals (Appendix A), as well as all other applicable state and federal law; and declares and represents that it meets the eligibility requirements for a Service Provider for this Agreement. With the signed Agreement, the Provider must submit the following documentation: A. Proof of a Federal Tax ID Number; B. A current State of Alaska Business License; C. Alaska Native entities1 entering into a Provider Agreement with DFCS must provide a waiver of immunity from suit for claims arising out of activities of the Provider related to this Agreement using Appendix D; D. Necessary credentials for service personnel, such as copies of valid and current certifications or licenses; E. Necessary licensing/certifications for the service facility; F. Upon request: proof of any other mandatory education/training/relationship/location/agency P&P, etc. that is necessary for eligibility as a provider. G. Provider Background Check Policy and Procedures per Section IX(A)(1)(ii) of this Provider Agreement; H. Certificates of Insurance per Section IX (B) of this Provider Agreement I. Completed Appendix E – SOA DFCS HIPAA Business Associates Agreement By submission for the signed Agreement, the Provider further agrees that they will comply with the following: A. The provisions of Appendix C, Privacy & Security Procedures.
Appears in 2 contracts
Sources: Complex Placement Provider Agreement, Provider Agreement
Provider Eligibility. The Provider agrees to the provisions of 7 AAC 81, Grant Services for Individuals (Appendix A), as well as all other applicable state and federal law; and declares and represents that it meets the eligibility requirements for a Service Provider for this Agreement. With the signed Agreement, the Provider must submit the following documentation:
A. Proof of a Federal Tax ID Number;
B. A current State of Alaska Business License;
C. Alaska Native entities1 entering into a Provider Agreement with DFCS DHSS must provide a waiver of immunity from suit for claims arising out of activities of the Provider related to this Agreement using Appendix D;
D. Necessary ▇. ▇▇▇▇▇▇▇▇▇ credentials for service personnel, such as copies of valid and current certifications or licenses;
E. Necessary licensing/certifications for the service facility;
F. Upon request: proof of any other mandatory education/training/relationship/location/agency P&P, etc. that is necessary for eligibility as a provider.
G. Provider Background Check Policy and Procedures per Section IX(A)(1)(ii) of this Provider Agreement;
H. Certificates of Insurance per Section IX (B) of this Provider Agreement
Agreement I. Completed Appendix E – SOA DFCS DHSS HIPAA Business Associates Agreement By submission for the signed Agreement, the Provider further agrees that they will comply with the following:
A. The provisions of Appendix C, Privacy & Security Procedures.
Appears in 1 contract
Sources: Provider Agreement