Agency Contact: name/phone number e-mail address Carla Thompson (410) 260-6155 __-IT-MOD. MARYLAND DEPARTMENT OF HEALTH Program Name Contract Title Contract ID: MDH-OPASS Contract #; M00B______, COF______ DoIT Item # and BPW date Contract Approved: Vendor Name and State Contractor: Provide contract description. Contract Description: Provide mod description. Modification Description: start and end dates Original Term: mod start and end dates Modification Term: enter approved amount Original Amount: enter mod amount Modification Amount: Revised Total Contract Amount: enter amount enter percent Percent +/- (This Modification): enter procurement method Original Procurement Method: enter Goal MBE Participation: enter remarks Remarks: enter fund source Fund Source: enter Approp. Code: enter Resident Business: enter MD Tax Clearance:
Agency Contact: name/phone number e-mail address Carla Thompson (410) 260-6155 __-IT-MOD. MARYLAND DEPARTMENT OF HEALTH Program Name Contract ID: Contract Title MDH-OPASS Contract #; M00B______, COF______ Contract Approved: DoIT Item # and BPW date Contractor: Vendor Name and State Contract Description: Provide contract description. Modification Description: Provide mod description. Original Term: start and end dates Modification Term: mod start and end dates Original Amount: enter approved amount Modification Amount: enter mod amount Revised Total Contract Amount: enter amount Percent +/- (This Modification): enter percent Original Procurement Method: enter procurement method MBE Participation: enter Goal Remarks: enter remarks Fund Source: enter fund source Approp. Code: enter Resident Business: enter MD Tax Clearance: enter
DOIT%20Mod-Option%20Agenda%20for%20BPW%20Mtg.docx