CITY: __________________________ STATE: ________ ZIP CODE: _____________ SIGNATURE: ___________________________________ DATE: _________________ This name and address will be used for all correspondence related to the Request for Proposals. Organization does/does not (circle one) intend to respond to this Request for Proposals. Marlene Acosta, Procurement Manager Assistance & Representation for Kinship Caregivers RFP # 18-624-01314 Aging and Long-Term Services Department 2550 Cerrillos Road (for physical delivery of proposal) PO Box 27118 Santa Fe, NM 87502-7118 Fax: (505) 476-4836 E-mail: APPENDIX B Campaign Contribution Disclosure Form
CITY: __________________________ STATE: ________ ZIP CODE: _____________ SIGNATURE: ___________________________________ DATE: _________________ This name and address will be used for all correspondence related to the Request for Proposals. Organization does/does not (circle one) intend to respond to this Request for Proposals. Marlene Acosta, Procurement Manager Assistance & Representation for Kinship Caregivers RFP # 18-624-01314 Aging and Long-Term Services Department 2550 Cerrillos Road (for physical delivery of proposal) PO Box 27118 Santa Fe, NM 87502-7118 Fax: (505) 476-4836 E-mail: APPENDIX B Campaign Contribution Disclosure Form
RFP%20FINAL%202_21_18.docx