AMENDMENT_0002_memo_to_all_quoters.pdf

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Indian Health Service Tucson Area Office

7900 South J. Stock Road Tucson, AZ 85746-7012

DATE: April 6, 2015

TO: All Quoters:

SUBJECT: AMENDMENT 0002, Request for Quotation (RFQ) 15-249-SOL-00003, Radiology Equipment for the Tucson Area Indian Health, Sells Indian Hospital and San Xavier Health Center.

A Document Submission Checklist and a Return Packet has been provided to assist you in returning the required documents for this AMENDMENT 0002. Your responses, enclosed forms and required documents must be returned no later than April 14, 2015, 5:00 P.M. Eastern to:

Tucson Area Indian Health Service Attn: Nadine Joe 7900 South J. Stock Road Tucson, AZ 85746-7012;

or by e-mail to nadine.joe@ihs.gov;

or by fax to 520/295-2626.

The original must be mailed as follow up to any email quotes or facsimiles.

Please be advised that you will now need to be active in the System for Award Management (SAM) website.

Please go to the website at www.sam.gov to check your status.

Should you have any questions regarding this package, please do not hesitate to contact me at 520/295-2464.

Respectfully, /s/ Nadine Joe Nadine Joe Contract Specialist

Enclosures cc: RFQ 15-249-SOL-00003 mailto:nadine.joe@ihs.gov

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Indian Health Service Tucson Area Office

7900 South J. Stock Road Tucson, AZ 85746-7012

Document Submission Checklist

Radiology Equipment for the Tucson Area Indian Health Service Sells Indian Hospital and San Xavier Health Center

AMENDMENT 0002 for Request for Quote (15-249-SOL-00003)

The following checklist is to assist you in ensuring that the acceptable minimum documents are submitted and signed by an official authorized to bind your organization.

STANDARD FORM 1449,

Solcitation/Contract/Order for Commercial Items-Page 1, Boxes 17a. and 30a.-30c.

2 Signed Originals

STANDARD FORM 30,

Page 1, Boxes 15A-15C.

2 Signed Originals

PRICING COMPLETED FOR SCHEDULE OF

ITEMS AND SERVICES, PAGES 4-12

1 Original

ATTACHMENT B, PAST PERFORMANCE

QUESTIONNAIRES-Please make sure that you follow-up with the companies you requested QUESTIONNAIRES from-PLEASE SEND OUT AT LEAST 3. Forms will need to be completed by 04/14/2015, 5pm ET.

1 copy

ATTACHMENT C, PAST EXPERIENCE

QUESTIONNAIRE-Please make sure that you submit this form by 04/14/2015, 5pm ET.

1 copy

Note: You may submit your response by email to nadine.joe@ihs.gov or fax to 520/295-2626 by APRIL 14, 2015, 5pm eastern, but the original documents must be mailed as follow up to any email quotes or facsimiles.

Please make sure to retain a copy for your files.

(x)

15-249-SOL-00003

x x

2 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT

THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

Tucson AZ 85746 7900 S. J. Stock Road Tucson Area Office

04/06/2015

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

7. ADMINISTERED BY (If other than Item 6)CODE 6. ISSUED BY

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

04/06/2015

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not, is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

AMENDMENT 0002

The following changes have been made to Solicitation number 15-249-SOL-00003 for the Tucson

Area Indian Health Service, Radiology Equipment Request for Quote:

1) Add to Page 3, first paragraph, "Streamlined Procedures for Evaluation and Solicitation for Commercial Items and Subpart 13.5 -Test Program for Certain Commercial Items."

FROM: "This is a combined synopsis/solicitation for commercial items prepared in accordance with the FAR Subpart 12.6 and supplemented in additional information and clauses included in this notice."

Continued ...

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

NSN 7540-01-152-8070

Previous edition unusable

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

nadine.joe Typewritten Text Amendment 0002 nadine.joe Typewritten Text

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 19

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

15-249-SOL-00003

TO: "This is a combined synopsis/solicitation for commercial items prepared in accordance with the

FAR Subpart 12.6 - Streamlined Procedures for

Evaluation and Solicitation for Commercial Items and Subpart 13.5 -Test Program for Certain

Commercial Items, supplemented in additional information and clauses included in this notice."

2) Change the following to Page 15-16, Paragraph number 20), EVALUATION - COMMERCIAL ITEMS (JAN

1999)

FROM: "The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the

Government, considering relevant past performance, IT compatibility, price and other factors considered. The following factors listed in order of importance shall be used to evaluate offers. When combined, price is equal to all non-price factors.

BASIC RESPONBILITY FACTORS The following will be go/no go factors: Offerors who fail to provide the following will not be considered further for evaluation for award:

-See Paragraph 4,Meet specifications noted in the

SCHEDULE OF ITEMS AND SERVICES.

-See Paragraph 5, include all requested items in the DELIVERABLES paragraph

-See Pargraph 9, Provide information in RFQ submission regarding the information noted in the

SAFETY paragraph

-Must be registered in the Systems for Awards

Management (SAM) (https//www.sam.gov)

EVALUATION FACTORS FOR AWARD

1.IT COMPATIBILITY: FDA APPROVED DEVICE, DICOM

COMPATIBILITY UNIT, AND THE EQUIPMENT HAS TO BE

ON THE VISTA IMAGING APPROVED DICOM MODALITY

INTERFACES (SEE ATTACHMENT A).

2.Weight Capacity of Equipment: The equipment must be fully functional at the maximum weight capacity of at least 600 pounds. The table must be able to handle a 600 pound patient and still be functional and electronically adjustable while the patient is on the table.

3.RELEVANT PAST PERFORMANCE: This factor provides an assessment of the Government's confidence in an offeror's ability to fulfill the

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

3 19

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

15-249-SOL-00003

solicitation based on the offeror's demonstrated record of past performance. The offeror will be evaluated on performance over the past ten years relative to experience on similar projects and types of work. Relevant Past performance is a measure of the degree to which an offeror, as an organization, has: (1) satisfied its customers, and (2) complied with federal, state, and local laws and regulations. The Government will inquire about the following elements, which are all of equal importance in relation to each other. 1) Quality of Services: Demonstrated ability to perform services specifically relevant to the subject Statement of Work related techniques and conformance to good standards of workmanship. (2) Customer Satisfaction:

Satisfaction of end users with the Contractor's completed products and services. (3) Timeliness of performance: Compliance with delivery schedules; reliability; responsiveness to technical direction, and no assessment of liquidated damages. (4) Cost Control: Ability to complete contracts within budget (at or below);

reasonableness of price change proposals submitted; providing current, accurate, and complete billings. (5) Business relations:

Effective management; ability to manage projects involving subcontracts; working relationship with the Contracting Officer and technical representatives; reasonable/cooperative behavior;

flexibility; effective contractor recommended solutions; businesslike concern for Government's interests.

Each offeror will be evaluated on their performance under existing and prior contracts of a similar nature. The Government will focus on information that demonstrates quality of performance relative to the size and complexity of the procurement under consideration. The

Government may contact references beyond those identified by the offeror to obtain additional information for use in both the responsibility determination and in further evaluation of the offerors's past performance.

The Government will consider the relevance of past performance information obtained in relation to the scope of this procurement with respect to similar efforts, and the length and scope, number, complexity, and diversity of contracts completed by the firm.

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

15-249-SOL-00003

The Government may research offeror performance on any federal, state, local, and commercial contract performance of the offeror that is known to the Government, but not included on the submitted performance information. Additionally, personal experience and evaluator knowledge of offeror performance may be utilized. The

Government may obtain information from existing contract files. The offeror may refute any past contractual problems, and should do so in their original offer because discussions might not be held.

Offerors with relevant past performance data will be evaluated in the same manner as all other evaluation factors; however, those offerors with no relevant past performance data will treated as an unknown performance risk and neither be evaluated favorably nor unfavorably (i.e. "not rated"). Therefore, offerors will receive credit for good relevant past performance, lose credit for poor relevant past performance, and neither receive nor lose credit for no relevant past performance. Offeror may provide information on any problems encountered on the contracts and subcontracts listed and the corrective action taken to resolve the problems.

4.TRAININGS AND TECHNICAL SUPPORT

PROVIDED/AVAILABLE: All training for use (DRT) and management (Biomedical) of radiographic equipment and portable components must be provided by the selected vendor. A minimum of twenty four (24) hours of on-site clinical education training, scheduled consecutively

(Monday - Friday) during standard business hours for Diagnostic Radiologic Technologist (DRT) imaging professionals. Availability and quality of clinical education phone support provided during the warranty period for specified posted hours. Biomedical Technical Training provided for one technician shall include factory-provided technical service training, typically located at the equipment manufacturer's facility and shall consist of equipment overview/ theory, troubleshooting, preventive maintenance and repair procedures, to a level that will allow the trained technician to fully support the equipment. Training provided shall include (if available) any basic x-ray service skills course(s) that may be considered prerequisite to other advanced course(s).

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

5 19

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

15-249-SOL-00003

5.PRICE: The degree of importance of price will increase with the degree of equality of the proposals in relation to the other factors on which selection is to be used or when the price is so significantly high as to diminish the value of the technical superiority to the Government.

Pricing will need to include all costs associated within the terms and conditions of this contract."

TO: "The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the

Government, considering relevant past performance, experience and price considered.

BASIC RESPONBILITY FACTORS The following will be go/no go factors. Offerors who fail to provide the following will not be considered further for evaluation for award:

-Must comply with Scope of Work

-See Paragraph 4, Meet specifications noted in the SCHEDULE OF ITEMS AND SERVICES.

-See Paragraph 5, include all requested items in the DELIVERABLES paragraph

-See Pargraph 9, Provide information in RFQ submission regarding the information noted in the

SAFETY paragraph

-Must be registered in the Systems for Awards

Management (SAM) (https//www.sam.gov)

-Vendor must provide full offer amount, which should include the TRADE-IN VALUE if applicable, in paragraph 4, page 12, TOTAL.

The following factors listed in order of importance shall be used to evaluate offers.

When combined, price is equal to all non-price factors.

EVALUATION FACTORS FOR AWARD

1.RELEVANT PAST PERFORMANCE: This factor provides an assessment of the Government's confidence in an offeror's ability to fulfill the solicitation based on the offeror's demonstrated record of past performance. The offeror will be evaluated on performance over the past five (5) years. Relevant Past performance is a measure of the degree to which an offeror, as an organization, has: (1) satisfied its customers, and (2) complied with federal, state, and local laws and regulations. The Government will inquire about the following elements, which are all of equal importance in relation to each

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

15-249-SOL-00003

other. A REFERENCE QUESTIONNAIRE PACKAGE will need to be submitted to at least three relevant projects completed in the past ten years. SEE

ATTACHMENT B. 1) Quality of Services:

Demonstrated ability to perform services specifically relevant to the subject Statement of

Work related techniques and conformance to good standards of workmanship and whether the effort design was built and set up (2) Customer

Satisfaction: Satisfaction of end users with the

Contractor's completed products and services.

(3) Timeliness of performance: Compliance with delivery schedules; reliability; responsiveness to technical direction, to warranty issues and assessment of liquidated damages. (4) Cost

Control: Ability to complete contracts within budget (at or below); reasonableness of price change proposals submitted; providing current, accurate, and complete billings. (5) Business relations: Effective management; ability to manage projects involving subcontracts; working relationship with the Contracting Officer and technical representatives; reasonable/cooperative behavior; flexibility; effective contractor recommended solutions; businesslike concern for

Government's interests. (6) Training: How many hours of training did the contractor provide for

Biomedical training and Onsite training for technologists and were the courses helpful to both the technologist and the biomedical staff.

Each offeror will be evaluated on their performance under existing and prior contracts of a similar nature. The Government will focus on information that demonstrates quality of performance relative to the size and complexity of the procurement under consideration. The

Government may contact references beyond those identified by the offeror to obtain additional information for use in both the responsibility determination and in further evaluation of the offerors's past performance.

The Government will consider the relevance of past performance information obtained in relation to the scope of this procurement with respect to similar efforts, and the length and scope, number, complexity, and diversity of contracts completed by the firm.

The Government may research offeror performance on any federal, state, local, and commercial contract performance of the offeror that is known

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

7 19

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

15-249-SOL-00003

to the Government, but not included on the submitted performance information. Additionally, personal experience and evaluator knowledge of offeror performance may be utilized. The

Government may obtain information from existing contract files. The offeror may refute any past contractual problems, and should do so in their original offer because discussions might not be held.

Offerors with relevant past performance data will be evaluated in the same manner as all other evaluation factors; however, those offerors with no relevant past performance data will treated as an unknown performance risk and neither be evaluated favorably nor unfavorably (i.e. "not rated"). Therefore, offerors will receive credit for good relevant past performance, lose credit for poor relevant past performance, and neither receive nor lose credit for no relevant past performance. Offeror may provide information on any problems encountered on the contracts and subcontracts listed and the corrective action taken to resolve the problems.

2.EXPERIENCE: The Offer shall provide the past 5 years of relevant experience. Experience from employees must be US Citizens or legal residents.

This factor provides an assessment of the

Government's confidence in the offeror's ability to fulfil the contract's scope of work.

ATTACHMENT C "Past Experience Questionnaire" must be completed and forwarded to Susan M. Protho, Contracting Officer by email susan.protho@ihs.gov or fax 520/295-2626 by the amended solicitation end date.

3.PRICE: The degree of importance of price will increase with the degree of equality of the proposals in relation to the other factors on which selection is to be used or when the price is so significantly high as to diminish the value of the technical superiority to the Government.

Pricing will need to include all costs associated within the scope of work and terms and conditions of this contract."

3) Add the following to Page 30, paragraph 23, LIST OF ATTACHMENTS:

FROM:

"1. ATTACHMENT A - VistA Imaging Approved DICOM

Modality Interfaces

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

15-249-SOL-00003

2.ATTACHMENT B - REFRENCE QUESTIONNAIRE PACKAGE

INFORMATION AND FORMS"

TO:

". ATTACHMENT A -VistA Imaging Approved DICOM

Modality Interfaces

2.ATTACHMENT B - REFRENCE QUESTIONNAIRE PACKAGE

INFORMATION AND FORMS

3.ATTACHMENT C - PAST EXPERIENCE QUESTIONNAIRE"

4) OFFER DUE DATE HAS BEEN CHANGED FROM

"12/17/2014, 1700 ET" TO "04/14/2015, 1700 ET."

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

ATTACHMENT B

PAST PERFORMANCE-REFERENCE QUESTIONNAIRE PACKAGE

INFORMATION AND FORMS

Instructions to Offeror for sending Reference Questionnaire Forms:

Offeror: Prepare and send a reference questionnaire package for at least three relevant projects completed in the past five (5) years. It is your responsibility to follow-up and to encourage your references to send in their questionnaire.

Your questionnaire package should contain the following.

Cover Letter (See attached SAMPLE) Past Performance Evaluation Questionnaire

Complete Part 1 (To Be Completed by Firm Requesting Reference) of each Questionnaire before sending it to the individual who will be providing the reference.

PLACE THE NAME OF THE ENTITY MAKING THE SUBMITTAL TO THE

IDIAN HEALTH SERVICE AND THE SOLICITATION NUMBER, 15-249-

SOL-00003 IN THE HEADER SO THEY APPEAR ON EACH QUESTIONNAIRE

PAGE

OFFEROR SHOULD DELETE THESE INSTRUCTIONS BEFORE SENDING OUT

QUESTIONNAIRES

SAMPLE TRANSMITTAL LETTER

Your Company Letterhead

Date: _________________ To: ______________________________________

We have listed you as a reference for work we have performed for your firm as noted on the attached questionnaire. Our firm intends to submit a proposal under a solicitation no. 15-249-SOL-00002 for the Tucson Area Indian Health Service (TAIHS). In accordance with the TAIHS’s Rules and Regulations, they will evaluate our firm's past performance. Your candid response to the attached questionnaire will assist the evaluation team in this process. We understand that you have a busy schedule and your participation in this evaluation is greatly appreciated. Please complete the enclosed questionnaire as thoroughly as possible.

Space is provided for comments.

Please send your completed questionnaire to the following address to arrive NOT LATER THAN Tuesday, April 14, 2015.

ADDRESS: Tucson Area Indian Health Service, 7900 South. J. Stock Road, Tucson AZ 85746 ATTENTION: Nadine Joe, Contract Specialist E-Mail: nadine.joe@ihs.gov FAX Number: 520/295-2626

Questionnaires may be mailed, faxed or e-mailed to the above address. E-Mail is preferred.

If you have questions regarding the attached questionnaire, or require assistance, please contact Nadine Joe, Contract Specialist for the Tucson Area Indian Health Service at 520/295-2464. Thank you for your assistance.

Signature and Title

CDB Project Number: _________________

OFFEROR NAME________________

PAST PERFORMANCE EVALUATION QUESTIONNAIRE

Part 1 (To Be Completed by Firm Requesting Reference)

1. Name/Title, Firm Name & Address (City and State):

2. Title of Project/Contract Number:

3. Description of Project for Which Reference is Requested (Include type of work/trades performed):

4. Complexity of Work: High ________ Mid _________ Routine __________

5. Location of Work:______________________________________________

6. Role on Project: Prime Subcontractor/Subconsultant

7. Contract Amount:_______________________________

8. Date of Award: ________________________

9. Status: Percent complete __________ Project Completion Date: Scheduled Actual

Part 2 (To Be Completed by Person Providing Reference)

Reference is provided by: ____________________________ Company/Agency:_________________________________________________________________ Business Address;________________________________________________________________ Telephone Number: _______________________________________________________________ E-Mail Address: __________________________________________________________________ Relationship to Contract: ___________________________________________________________

If the information provided in Part 1 is not accurate, please indicate and correct.

Return completed questionnaire (pages 1-4) via email to nadine.joe@ihs.gov, or FAX (520/295-2626) or mail to: Tucson Area Indian Health Service-Attn: Nadine Joe, 7900 South J. Stock Road, Tucson,, AZ 85746 . Mark cover sheet of fax or subject line of e-mail or outside of envelope: Attention: SOLICITATION NO.15-249-SOL-00003 “Reference Questionnaire.”

1. QUALITY OF WORK/SERVICES:

Evaluate performance in complying with contract requirements, quality achieved and overall technical expertise demonstrated.

Excellent Quality Above Average Quality Average Quality Below Average Quality Unsuccessful or Experienced Significant Quality Problems Remarks: _____________________________________________________________

2. CUSTOMER SATISFACTION:

To what extent were the end users satisfied with: Quality? Cost? Schedule?

Exceptionally Satisfied Q____ C_____S____ Highly Satisfied Q____ C_____S____ Satisfied Q____ C_____S____ Somewhat Dissatisfied (please explain) Q____ C_____S____ Remarks:

3. TIMELINESS OF PERFORMANCE:

To what extent were contract performance requirements met? Consider also such things as;

contract performance period requirements; provided submittals in a timely manner; timely completion of punch-list items; timely submission of close out documents. Was timely and satisfactory response to warranty issues after project completion provided? How well managed were the firm’s availability and quality of clinical education phone support provided during the warranty period for specified training hours.

Completed Substantially Ahead of Schedule Completed on Schedule with no Time Delays Completed on Schedule with Minor Delays Under Extenuating Circumstances OTHER (explain)______________________________________________________ Remarks: _____________________________________________________________

4. COST CONTROL: DOCUMENTATION

Ability to complete contracts within budget (at or below); reasonableness of price change proposals submitted; providing current, accurate, and complete billings. To what extent were change submittals and other required documentation/billing accurate, complete?

Excellent Quality Above Average Quality Average Quality Below Average Quality Unsuccessful or Experienced Significant Quality Problems Remarks: _____________________________________________________________

5. BUSINESS RELATIONS: COORDINATION

Evaluate if the contractor provided effective management; ability to manage projects involving subcontracts if applicable; working relationship with the Contracting Officer and technical representatives; reasonable/cooperative behavior; flexibility; effective contractor recommended solutions; businesslike concern for Government's interests.

Excellent Above Average Average Below Average Unsuccessful Remarks: _____________________________________________________________

6. Did the company provide or offer training for use and management of equipment?

How many hours of training were provided for each?

BIOMED training for management of equipment

On-Site Technologist training for use of equipment

Were the courses helpful to both the technologist and the biomedical staff?

Yes No

Remarks:

If given the opportunity, would you work with this firm again?

Yes ___________ No ____________ Not Sure ____________ Remarks:

OTHER REMARKS:

Use the space below to provide other information related to the contractor's performance. This may include selection of subcontractors/subconsultants, flexibility in dealing with contract challenges, payment issues, their overall concern for the client's interest (if applicable), project awards received, etc.

ATTACHMENT C

Past Experience Questionnaire

Use the following, or similar, form to submit your (Offeror’s) Qualifications Statement.

Tucson Area Office Indian Health Service

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 8, Remarks, if extra space is needed to answer any item below. Mark “X” in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

2. Submit to: Nadine Joe, Contract Specialist Email: nadine.joe@ihs.gov Fax: 520/295-2626

3. Business [ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual [ ] Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation?

5. How many years experience have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor

6. List below the projects your business has completed within the last FIVE (5) years:

Contract Amount

Type of Project Date Completed

Name, Address, and Telephone No. of Owner/Person to Contact for Project Information

7a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No 7b. Has work ever been completed by performance bond? [ ] Yes [ ] No 7c. If “Yes” to either item 7a. or 7b., specify location(s) and reason(s) why:

ATTACHMENT C

8. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question(s).):

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO

SUCCESSFULLY COMPLETE THIS PROJECT.

CERTIFICATION

I certify that all of the statements made by me are complete and correct to the best of my knowledge, and that any persons named as references are authorized to furnish the Indian Health Service with any information needed to verify my capability to perform this project.

9a. CERTIFYING OFFICIAL’S NAME AND TITLE

b. SIGNATURE (Sign in ink) 10. DATE