Attachment H - Contractor Contact Information.pdf

This is a Contractor Contact Information form issued by the Pennsylvania Department of Human Services, Bureau of Procurement and Contract Management, for the North East Secure Treatment Unit (NESTU) Outpatient and Emergency Care Services contract. The form is designed to collect essential supplier contact information for the contractor selected to provide outpatient and emergency care services at NESTU, a Bureau of Juvenile Justice Services facility located in Pittston, Pennsylvania. The solicitation encompasses Dauphin County, Luzerne County, Harveys Lake Borough, and Phoenixville Borough, with proposals due September 24, 2026.

The attachment requires vendors to designate a primary contact person who will be familiar with contract requirements, available during regular business hours, and authorized to act on the contractor's behalf in resolving contract-related issues. The form requires completion of the vendor's name, contact person's title, phone number, email address, and physical address, along with the contact person's signature and date. This contact information will serve as the official point of communication between the Department and the contractor throughout the contract period.