RFP_277-15-0424 _Attachment_9 _Proposal_Intent_Response.docx

RFP No. 277-15-0424 Health Communications and Marketing (HCM) for Public Engagement Attachment 9: Proposal Intent Response Sheet

PROPOSAL INTENT RESPONSE SHEET

RFP No. 277-15-0424

TITLE: “Health Communications and Marketing (HCM) for Public Engagement”

PLEASE REVIEW THE ATTACHED REQUEST FOR PROPOSAL. FURNISH THE INFORMATION REQUESTED BELOW AND RETURN THIS PAGE BY THE EARLIEST PRACTICABLE DATE, BUT NOT LATER THAN March 20, 2015. YOUR EXPRESSION OF INTENT IS NOT BINDING BUT WILL GREATLY ASSIST US IN PLANNING FOR PROPOSAL EVALUATION.

[ ] DO INTEND TO SUBMIT A PROPOSAL

[ ] DO NOT INTEND TO SUBMIT A PROPOSAL FOR THE FOLLOWING REASONS:

COMPANY/INSTITUTION NAME:

AUTHORIZED SIGNATURE:

TYPED NAME AND TITLE:

COMPANY PHONE NUMBER:

COMPANY FAX NUMBER:

DATE:

PLANNED COLLABORATORS/CONSULTANTS/SUBCONTRACTORS

(PROVIDE NAME(S) AND ORGANIZATION)

RETURN TO:

Substance Abuse and Mental Health Services Administration Division of Contracts Management Attention: Susan Dawson, Contract Specialist 1 Choke Cherry Road, Room 7-1059 Rockville, MD 20857

OR FAX TO: 240-276-1510

PLEASE RETURN THIS PAGE BY March 20, 2015