Name Email Address Applicable Designation. Enter Name of Each Individual Who Will Be Providing Service Under the Contract – If individuals have different disclosure requirements, duplicate this row and complete separately for each individual Enter email address(es) ☐ A. Full Disclosure ☐ B. Limited Disclosure (select one or more of the categories under which the consultant shall file): ☐ 1. ☐ 2. ☐ 3. ☐ 4. ☐ 5. ☐ 6. ☐ 7. Justification: ☐ C. Excluded from Disclosure
Name Email Address Applicable Designation. ☐ A. Full Disclosure ☐ B. Limited Disclosure (select one or more of the categories under which the Contractor shall file): ☐ 1. ☐ 2. ☐ 3. ☐ 4. ☐ 5. ☐ 6. ☐ 7. Justification: ☒ C. Excluded from Disclosure
Name Email Address Applicable Designation. ☐ A. Full Disclosure ☐ B. Limited Disclosure (select one or more of the categories under which the consultant shall file): ☐ 1. ☐ 2. ☐ 3. ☐ 4. ☐ 5. ☐ 6. ☐ 7. Justification: ☐ C. Excluded from Disclosure
Name Email Address Applicable Designation. Xxxx Xxxx Xxx Xxxx Xxxxxx Xxxxxx Xxxxx Xxxxxxxxx Xxxx.xxxx@xxxxxxxxxxxx.xxx Xxx.xxxx@xxxxxxxxxxxx.xxx Xxxxxx.xxxxxx@xxxxxxxxxxxx.xxx Xxxxx.xxxxxxxxx@xxxxxxxxxxxx.xxx ☐ A. Full Disclosure ☐ B. Limited Disclosure (select one or more of the categories under which the consultant shall file): ☐ 1. ☐ 2. ☐ 3. ☐ 4. ☐ 5. ☐6. ☐ 7. Justification: ☒ C. Excluded from Disclosure
Name Email Address Applicable Designation. Xxxxxxxx Xxxxxxx Xxxxxx Xxxxxx Xxxx Xxxxxxxx Xxxxxx Xxxxxx xxxxxxxxxxxxxxxx@xxxxx.xxx xxxxxxx@xxxxx.xxx xxxx@xxxxxxxxxx.xxx xxxxxxx@xxxxx.xxx ☐ A. Full Disclosure ☒ B. Limited Disclosure (select one or more of the categories under which the Contractor shall file): ☐ 1. ☐ 2. ☐ 3. ☐ 4. ☒ 5. ☐ 6. ☒ 7. Justification: ☐ C. Excluded from Disclosure
Name Email Address Applicable Designation. Enter Nam Who Will Under the individual disclosure duplicate complete individual e of Each Individual Be Providing Service Contract – If s have different requirements, this row and separately for each Enter email address(es) ☐ A. Full Disclosure ☐ B. Limited Disclosure (select one or more of the categories under which the consultant shall file): ☐ 1. ☐ 2. ☐ 3. ☐ 4. ☐ 5. ☐ 6. ☐ 7. Justification: ☐ C. Excluded from Disclosure
Name Email Address Applicable Designation. Xxxxx Xxxxxx Xxxxx Xxxxxx Xxxx Xxxxx Xxxxxx Xxxxx Xxxxxx Xxxxxxxxxx Xxxxx Xxxxx Xxxxx Xxxxx Xxxxx Xxxxx XXxxxxx@Xxxxxxx.xxx XXxxxxx@Xxxxxxx.xxx XXxxxx@Xxxxxxx.xxx XXxxxx@Xxxxxxx.xxx XXxxxxxxxxx@Xxxxxxx.xxx XXxxxx@Xxxxxxx.xxx XXxxxx@Xxxxxxx.xxx XXxxxx@Xxxxxxx.xxx ☐ A. Full Disclosure ☐ B. Limited Disclosure (select one or more of the categories under which the consultant shall file): ☐ 1. ☐ 2. ☐ 3. ☐ 4. ☐ 5. ☐ 6. ☐ 7. Justification: ☒ C. Excluded from Disclosure