CHILD CARE - RFP CNSHQ-10-T-0009 COVER PAGE.doc

ADMINISTRATION OF CHILD CARE BENEFITS

Request for Proposal~ Number CNSHQ-10-T-0009 Company Name:____________________________________________

Name, Title, E-Mail address, and Phone Number of Company Representative: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Payment Terms:_________________________________

Please Check Business size: (All that apply):

□ Large

□ Small

□ Minority-owned

□ Women-owned

□ Veteran-owned

□ Service Disabled Veteran-Owned

□ Small Disadvantage Business

□ 8(a)

Tax Identification Number: ________________________

DUNS:

Cage Code: ________________________

NAICS:

Complete Mailing Address: ________________________________________________________________________________________________________________________________________________________________

Other Pertinent Information: ________________________________________________________________________________________________________________________________________________________________ Quote Validity Period (quote valid for 30 days, etc….):______________________________

Name, Title, E-mail Address, and Phone Number of Person Authorize to Sign Offer: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Signature:______________________________________

Date:___________________

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