Attachment_4_-_Proposal_Cover_Sheet_2016_-_ACIOP.docx

ATTACHMENT No. 4 RFQ No. NIHLM2016769-GB

HIV/AIDS Community Information Outreach Project 2016

RFQ No. NIHLM2016769-GB

AWARD COVER SHEET

Submitting Organization:

Name:

Address:

Telephone Number:

Web Address:

Email:

DUNS Number:

Administrative Contact Person:

Technical Contact Person:

Partnering Organization:

Name:

Address:

Telephone Number:

Web Address:

Email:

DUNS Number:

Administrative Contact Person:

Technical Contact Person:

Brief Summary of Project (250-400 Words):

Primary Place of Performance:

Name and Title of Person Authorized to Sign Quotation:

Signature of Person Authorized to Sign Quotation: