Dads form 3254-2025

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3.9 out of 5

31 votes

The document is a certification form from the Texas Department of Aging and Disability Services, outlining the necessary certifications required from contractors before entering into a service provider agreement. It includes various legal and compliance assurances regarding the contractor's eligibility, including their organization status, debarment status, criminal convictions, lobbying restrictions, child support obligations, and tax payments. The contractor must certify accuracy in these statements to avoid contract termination or payment withholding.

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Click ‘Get Form’ to open dads form 3254 in the editor.
Begin by entering the 'Name of Legal Entity (Contractor)' and 'Taxpayer ID No. (EIN or SSN)' in the designated fields.
If applicable, provide the 'Doing Business As (d/b/a) Name' and 'National Provider Identifier (NPI) or Atypical Provider Identifier (API)' in their respective sections.
Carefully review each certification section, ensuring that all statements are accurate. This includes confirming your organization’s authority to contract and checking for any exclusions or debarments.
Complete the signature section at the bottom of the form, including the name and title of the authorized representative, and ensure it is notarized as required.

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Versions	Form popularity	Fillable & printable
2014	3.9 Satisfied (31 Votes)

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