HealthBenefitsPlanCosts.doc
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- Solicitation number
- F41689-02-R-0048
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Certification of Health Benefits Plan Data This is to certify that, to the best of my knowledge and belief, the information submitted in writing to the Contracting Officer in support of __________________* is accurate, complete, and current as of ___________**.
Firm ____________________________________________________
Signature ________________________________________________
Name ___________________________________________________
Title ____________________________________________________
Date of execution** _______________________________________
* Identify the proposal (e.g., RFP No.).
** Insert the day, month, and year when data is submitted.
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