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Carrier-contracting-officials - contracting_officials

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Carrier Contracting Officials
The Office of Personnel Management (OPM) will not accept any contractual action from
______________________________________________________________(Carrier),
including those involving rates and benefits, unless it is signed by one of the persons
named below (including the executor of this form), or on an amended form accepted by
OPM. This list of contracting officials will remain in effect until the carrier amends or
revises it.
The people named below have the authority to sign a contract or otherwise to bind the
Carrier for ______________________________________________(Plan)
Enrollment code(s):____________________________________________________
Typed name Title Signature Date
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
By: ___________________________________________
(Signature of contracting official) (Date)
___________________________________________
(Typed name and title)
___________________ ____________________
(Phone number) (FAX Number)
_________________
(E-mail address)
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Completed 31 December 2020

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