WPC (WQ wԏ]o@WKX"KN)[^KtTdW x ҎmzEUS{{_pm[ܮA ݉{CYqHkFP_,zn8^4MIW'Yǻ G@nu=r"ر;·$ xvq~Swj }8$u' {-Wo3a~!$HS99: CgBR%Q=y1x޴!ZE /vkw1>N!%ǰ*?Sݬ}H`Lno|Q%:م-IO:|S%D0oiM[1x9s`9;Ke'2jNX1өhH0"K2$;y0e*';w +)T Z  >d.Emailaddress: z   @ 1#  l   @ 0    0e.PhoneNumber: > D  ; ,    ; 0 z   0f.FaxNumber:    @ 1    @2.Thenominationisfor:  ̀򀀀ContractlevelCOR  Ѐ򀀀DeliveryOrderCOR  Ѐ򀀀TaskOrderCOR >D Ѐ򀀀WorkAssignmentCOR  ЀXOtherorAlternate(specify):AllwarrantedOSCandCORDuties z  inEmergencyResponseProgram󀀀 ! UnderContractNumber:AllEmergencyResponseContracts $  - %  -3.Trainingcompleted:DateCompleted: & a.CORMentorCourse򀀀 ( 33b.CORTrainingCourse򀀀󀀀 >D* Ѐ^\EitheraorbisrequiredforallCORs#\^K #Ԁ + 33 33c.RecertificationCourse򀀀 V\- Ѐ^\Requiredevery3yearsaftercompletingeitheraorb#\^x # . 33 Ӏ M :/   lM4.Brieflydescribethenominee'sexperienceinperformingCORdutiesandtechnicalexpertiseinthesubjectmatterofacquisition. 0 DescriptionofOSCsexperience. TZ1 ̀ 3  U B&.4 4 l   U5.IunderstandthatmyeligibilitytobeaCORisdependentonadequatelyperformingmyCORduties,followingethicalstandardsof TZ!5 conductforemployeesoftheExecutiveBranch,andmaintainingmytraining.Ifanyoftheseconditionsarenotmet,Imayberemoved !6 fromthiscontract. "7 IcannotredelegatemyCORduties.IntheeventthatIamunabletocontinueperformingmyCORduties,Iwillcontactthecontracting #9 officerimmediately. jp$: IhavefiledOfficeofGovernmentEthicsForm450,ConfidentialFinancialDisclosureReport,withthecognizantDeputyEthicsOfficial. L 9&%<    L򀀀󀀀򀀀󀀀 !(? SignatureofNomineeDate !(@ Ѐ U B&D"J)A    lU6.IfthereisaneedtoremovetheCOR,foranyreason,Iwillnotifythecontractingofficerimmediately. j#p*B  L 9&$+C l   L̀󀀀򀀀󀀀 %,E SignatureofNomineesImmediateSupervisorDate j&p-F ЀPhoneNumber: '.G ̀PrintedNameandTitle:Emailaddress: D(J/I 6,*(/J    6Ѐ )0J ЀEPAForm190065A(Rev.10/02).ElectronicandPaperversionsacceptable. *$1K ЀPreviouseditionsobsolete.