Required Contract Documents

Contract Documentation Table

Please use the table below to identify the documents required to process your contract. Complete and return the documents and certifications to your Program Manager and Contract Liaison.

Documents may be scanned and emailed*. Documents sent through the mail should be directed to the attention of:

Your Program Manager
Chicago Department of Public Health
111 W. Washington Street, 4th floor
Chicago, IL 60601

*Budgets must be submitted in Excel.

Document Name Document Description Form/Certification Link Requirements for Original Award Requirements for Release of Funds Under an Existing Award Budget Revisions Requirements for Amendments to Existing Contracts (as applicable)
Insurance Certification Insurance requirements: Please print form, complete, sign, and return. A new form is needed when insurance expires. The city will not pay vouchers if insurance on file has expired. Insurance Certificate of coverage ✶ ✶   ✶
Budget Form Budget Instructions 2024 Budget Form ✶ ✶ ✶ ✶
Scope of Services or Work Plan Please contact your CDPH program manager for Scope and/or Work Plan requirements. Scopes must be signed by both parties   ✶ ✶   ✶
Certificate of Good Standing with the IRS If your organization is not found on this website, contact local IRS office to check your IRS status and ensure your organization is included. Please print and submit certificate. Tax Exempt Organization Search ✶ ✶   ✶
CCR or Sam Certificate Please access the link. If necessary, please contact and coordinate with website administrator/Service Desk URL directly (http://www.FSD.gov) to check your SAM entity registration status and ensure your organization is included in this website. Please print and submit certification. SAM.gov Link ✶ ✶   ✶
Certificate of Good Standing with the State of Illinois Please provide a copy of State Good Standing report. The state link and a sample of the certification required are attached. Please print and submit certification IL Secretary of State Business Entity Search ✶ ✶   ✶
Economic Disclosure Statement with City (EDS) Please provide a copy of the EDS statement. The link to request a copy and a sample of the certification required are attached. Please print and submit certification. Online Economic Disclosure Statement ✶ ✶   ✶
Contract Service Site Form Please complete this form as it relates to your grant. The form is pdf fillable and can be emailed to your CDPH contact. Delegate Agency Resource Fillable Form ✶ ✶   ✶

Delegate Agency Voucher Documents

Delegate Agency Budget Relinquishments