Technical_Personnel_List.pdf

PDF 143 KB Posted

Attached to
Community Treatment Services in Washington, D. C.
Solicitation number
RFQ-CTS-009-18
Issued by

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Technical Personnel List

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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

Signature of Authorized Negotiator:

Date:

Page: of

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