Center for Care Innovations – Contract Request

To request a contract from the Center for Care Innovations (CCI), please complete the following contract request.


For any questions regarding the contract, email a[email protected]. You will be contacted if there are any questions or missing components for this request.

Contractor Information

May be contracting organization or individual name









You may upload here or submit W-9 through Tides' secure portal.
CCI / Tides Information


CCI lead for this contract

If multiple PIDs apply, separate with a semi colon

If multiple RIDs apply, separate with a semi colon

Scope of Work

Date that the SOW was finalized between CCI & Contractor.

Date that work payable under this contract will begin

Date that work payable under this contract will end
Provide a Scope of Work document with containing as much detail as possible.

Scopes of Work allow us to manage budgets, project needs, and pay based on mutually agreed-upon deliverables. Details also provide a set of obligations so that all parties are aligned on expectations. Be sure to include concrete deadlines.

Compensation



$

$
Maximum amount budgeted for hourly contract. Should equal Hourly Rate * Total # Hours Budgeted

$
Maximum amount budgeted for contract.


$
Maximum budget for professional fees.



$
Maximum budget for additional expenses


If you are uncertain what your funder requires, require expense receipts.



Before submitting, please verify the details below:


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Contact Information