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Purchase of Service Application

Part 1: Application Cover Letter

Address
Office Location set up

Please provide answers to the following questions:

1. Is your agency Medicare certified?
2. Has your agency previously been a contracted provider for TSA?
3. Is your agency able to provide services to all of TSA’s service area (34 communities of southern/western Wayne County)?
6. Does your agency have a bid agreement with another Area Agency on Aging or Waiver Agency?
10. Do you have a Registered Nurse (RN) licensed by the State of Michigan on staff?
11. Do you currently have Certified Nursing Assistants (CNA) employed at your agency?
12. Is your agency a staffing company that contracts direct care workers out?
13. Does your agency W2 all of the direct care workers that are employed at your agency?
15. Does your agency keep I9 information on file for all employees?
16. Does your agency have current insurance (i.e. general liability, worker’s comp, etc)?
17. Would your agency be willing to purchase additional insurance in order to become a vendor with The Senior Alliance (i.e. cyber liability, third party crime bond, etc) if applicable?
18. What services can your agency provide? Check all applicable
If you are interested in providing home modification services, does your agency have a current Builders License?
If you are interested in providing non-emergency transportation services, does your agency have a current Limousine License?
If you are interested in providing non-emergency transportation services, are all agency vehicles properly insured, inspected, and registered with the Michigan Secretary of State?

General Selection and Approval Process for All Applicants

A. Only complete applications submitted within the established timeframes will be considered for enrollment into the Purchase of Service (POS) vendor pool. The Contracts Manager and/or other Compliance department staff will determine if an application is complete. Requested application documents must be emailed to ewright@thesenioralliance.org.

B. Before the application is approved, an introductory meeting may be scheduled with applicable TSA staff.

C. Submission of this initial application does not guarantee admission into the vendor pool. Additional documentation may be requested as part of the application process.

D. Agreements for new vendors are effective on the date of the Chief Executive Officer’s signature and remain in effect per the terms of the Agreement.

E. If an application is approved, the vendor agency will be provided with a POS Agreement to complete and submit for processing.

F. Once the applicant agency becomes a POS vendor, TSA staff is provided with relevant bid information. TSA staff will purchase service from vendors on a case-by-case basis, taking into consideration participant preference, staff availability, location, and other relevant factors.

G. Applications will be processed and applicants notified of the outcome within 60 days of TSA’s decision and/or receiving a complete application with all supporting documentation.

H. Applicants may email contracts@thesenioralliance.org no more than once every 30 days to request an update on the application status.

I. Entry into the POS vendor pool does not guarantee that services will be purchased.

Consent(Required)
(Required)
By checking this box and signing below, the applying vendor is confirming that they have read the above application instructions and understand that additional documentation will need to be submitted by the applicant in order for the application to be considered for approval. They are also confirming that all information submitted in this application is accurate and complete.

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Contact Us

5454 Venoy Rd. Wayne, MI 48184

General Phone:

734-722-2830

800-815-1112

MI Health Link Phone:

734-736-6051

info@thesenioralliance.org

Click Here To Send The Senior Alliance A Secure Email

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