4_-_Technical_Personnel_List.docx
DOCX document 23 KB Posted
- Solicitation number
- RFQ-CTS-002-18
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Technical Personnel List
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Text version
Attachment IV
NOTE: Only personnel listed on this form will be considered for the solicitation or contract.
TECHNICAL PERSONNEL LIST
| Solicitation or Contract Number: |
| Agency/Company Name: |
| Address of Performance Site: |
Last Name, First Name (as it appears on license) Title / Position / Authorized Negotiator (point of contact for billing, clinical, etc.)
| Professional License Type, DEA License, and Number |
| License Expiration Date |
| Employee or Subcontractor |
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| 7 |
| 8 |
| 9 |
Signature of Authorized Negotiator:
| Date: |
Page: of
File details come from the government source that posted it. Updated .