CSA Vendors

An approved annual Contract for Services must be on file with the CSA Coordinator’s office for all providers of CSA funded services in King George County.

Contract Process

The following must be provided when submitting a contract request to King George County CSA:

1. A signed Contract for Services
   Note: if you wish to request a variance to the contract terms prior to signing, please submit your written request to the CSA Coordinator. The CPMT will review to determine if the variance can be approved.
2. Proof of Licensure from the appropriate licensing agency
3. Current rate sheet and description of services offered
4. Certificate of Liability meeting the requirements of section 16 of the Contract for Services
5. CSA Service Name vs Provider Service Name worksheet
6. School Calendar (if applicable)
7. Admission/Intake and Billing Representative contact information
8. Program/Target population descriptions for Home-Based and Mentoring programs
9. Provider’s current W-9
10. All other specific requirements contained in Addendums A, B, C, and D

Return all required documents to:

•  robin.thompson1@dss.virginia.gov
  
  OR
  
  
• King George County DSS
  Attn: CSA Coordinator 
  P.O. Box 130
  King George, VA 22485

The King George County Fiscal Agent will sign approval for all contracts meeting the specified requirements and a copy will be provided to the approved vendor.

***Submission of a contract does not guarantee that a Provider will be approved as a King George County CSA Contracted Provider***