21._CCHCS-MC-332-_Contractor_Contact_Info.pdf
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- Attached to
- Electrocardiograph (ECG) Equipment and Cardiologist Over-Read and Interpretation Services SD23-00094
- Solicitation number
- 0000033006
- Issued by
- California
About this file
This document is the Contractor Contact Information form for the California Correctional Health Care Services (CCHCS) Request for Proposal (RFP) SD23-00094 for Electrocardiograph Equipment and Cardiologist Over-Read Services. The form requires the contractor to provide their company name, telephone number, fax number, authorized representative name and title, and signature. This information will be used by CCHCS institutions and facilities to contact the awarded contractor to request services. The contractor is responsible for submitting an updated form to CCHCS if there are any changes to the contact information provided.
The RFP is seeking contractors to provide electrocardiograph equipment and cardiologist over-read services. The contract term and any renewal options are not specified in this document. Pricing terms, set-asides, incumbent information, funding requirements, and other salient details are also not included in this particular attachment.
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Text version
Proposal Number: SD23-00094
Attachment 21
CCHCS-MC-332 – Contractor Contact Information Rev. 11/01/2017
CONTRACTOR CONTACT INFORMATION
The information provided below is included on the award matrix posted on the California Department of Corrections and Rehabilitation Internet website. This information is used by institutions/facilities to contact your company to request services. It is the contractor’s responsibility to submit a new form to California Correctional Health Care Services (CCHCS) if there are any changes to the telephone number and/or fax number provided below. If your company was awarded a contract for more than one service, then a separate form for each service type is required. Submit the completed form(s) to the CCHCS Direct Care Contracts Section Help Desk at: cchcshealthcarecontractshelpdesk@cdcr.ca.gov.
Type of Service: Electrocardiograph Equipment and Cardiologist Over-Read Services
Company Name: (Must be identical to the payee’s legal business name listed on the STD 204)
Telephone Number: Fax Number:
Name of Authorized Representative: Title:
Signature of Authorized Representative: Date:
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