Camden County

SENIOR CITIZENS' SERVICES FUND BOARD

SENIOR SERVICES PROPOSAL

FOR SENIOR CENTERS

This document constitutes a proposal by the Provider, indicated below, to furnish services to persons, sixty years of age or older, who reside in Camden County, Missouri.

IMPORTANT

This proposal must be received NO LATER THAN:

TIME: 4:00 p.m.

DATE: Second Friday in November

Late proposals are subject to rejection or penalty.

Original Proposal and seven (7) copies must be securely sealed, clearly marked SENIOR SERVICES PROPOSAL, and mailed or hand-carried to:

Senior Services Fund Board
PO BOX 44
Sunrise Beach, MO 65079

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TO BE COMPLETED BY PROVIDER

Date of Proposal:

Corporate Office Location:

Organization Name:

Telephone:

Mailing Address:

Email Address:

Organizational Status:

Check whether your organization is for profit or is non-profit:

Profit

Non-Profit

The Provider hereby agrees to provide the following services for those persons, sixty years of age or older, who reside in Camden County, Missouri:

Specify the dollar amount requested:

Indicate the Contract period (not to exceed the projected fiscal year), for the dollar amount requested:

Person to contact:

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