CMS-07-021/023 - Los Angeles County Department of Children and ...

PROSPECTIVE CONTRACTOR LIST OF TERMINATED CONTRACTS
Contractor’s Name: _____________________________
List all contracts that have been terminated with the past three (3) years.
1. Name of Firm Address of Firm Contact Person Telephone # Fax #
( ) ( )
Name or Contract No. Reason for Termination:
2. Name of Firm Address of Firm Contact Person Telephone # Fax #
( ) ( )
Name or Contract No. Reason for Termination:
3. Name of Firm Address of Firm Contact Person Telephone # Fax #
( ) ( )
Name or Contract No. Reason for Termination:
4. Name of Firm Address of Firm Contact Person Telephone # Fax #
( ) ( )
Name or Contract No. Reason for Termination:
5. Name of Firm Address of Firm Contact Person Telephone # Fax #
( ) ( )
Name or Contract No. Reason for Termination:
REQUIRED FORMS - FORM 7