• 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


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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