WCMBP_Section_J_Attachment_12_-_Past_Perf_Contact_Sheet_Template_AMD_5.doc
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United States Department of Labor
(DOL)
Workers’ Compensation Medical Bill Process (WCMBP)
Attachment 12 –
Past Performance Contact Sheet Template December 30, 2013 Office of Workers’ Compensation Programs (OWCP) Past Performance Contact Sheet Unique Project Identifier:
Project Name:
Customer Name:
Offeror:
Company Name:
Corporate Division:
Address:
City, State, Zip
Phone:
email:
FAX:
Contracting Officer’s Point of Contact:
Name
Address:
City, State, Zip
Phone:
email:
FAX:
Offeror’s Primary Point of Contact:
Name:
Title:
Address:
City, State, Zip:
Phone:
email:
FAX:
Customer’s Primary Project Point of Contact:
Name:
Title:
Address:
City, State, Zip
Phone:
email:
FAX:
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