• 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 SUBMISSION INSTRUCTIONS

The original application and required documents must be received no later than May 25, 2021. 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 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.

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