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APPENDIX L-05

CFM Healthcare DBnC MATOC
Solicitation 36C10F27R0003
APPENDIX L-05
DOCUMENT VERIFICATION AND SELF SCORING WORKSHEET

OFFEROR NAME:

SectionElementEnter Yes or No for each question as applicableMaximum Self-Score PointsOfferor Proposed Self-Score PointsFile Name(s), e.g. ABC.VOL1.TOC.pdf
2.3VOLUME 1 - Contract Documentation
2.3.1Offeror Company Information
(Appendix L-01)Yes/NoN/AN/A
2.3.2Choice of Competition
(Appendix L-02)Yes/NoN/AN/A
2.3.3.2Proof of Bonding CapabilityYes/NoN/AN/A
2.3.4Organizational Conflict of Interest StatementYes/NoN/AN/A
2.3.5Signed Model Contract / Award DocumentYes/NoN/AN/A
2.3.6Representations and CertificationsYes/NoN/AN/A
VOLUME 2 - Factor 1 Relevant Experience
2.5.1Work Samples Submitted (Max 22)Yes/NoN/AN/A
2.5.1.1Work Sample Cover Sheets (Appendix L‑03)Yes/NoN/AN/A
2.5.1.2Work Sample QualificationsYes/NoN/AN/A
2.5.2.1Total Number of Primary Construction Program AreasYes/No14
2.5.2.2Total Number of States/Territories in Pool (fill in only for pool respective pool(s)
Eastern PoolYes/No22
Central PoolYes/No17
Western PoolYes/No13
2.5.2.3Total Number of Subcontractors Managed (Prime Only)Yes/No50
2.5.2.4Total Number of Prime Contracts Performed at a Single Point in TimeYes/No15
2.5.2.5(SDVOSB Only) Magnitude of Design‑Build ProjectsYes/No88
2.5.2.6(Full & Open Only) Magnitude of Design‑Build ProjectsYes/No88
2.5.4Cross Reference Matrix (Appendix L‑04)Yes/NoN/AN/A
2.5.5Team Structure (Appendix L‑06) & Teaming Agreements (Signed)Yes/NoN/AN/A
2.5.7Organizational Structure Change HistoryYes/NoN/AN/A
Factor 2: Past Performance
2.6Past Performance Submission IncludedYes/NoN/AN/A
2.6CPARS Provided for Each Work SampleYes/NoN/AN/A
2.6PPQs Provided Where CPARS Not AvailableYes/NoN/AN/A
2.6Past Performance Scoring (CPARS/PPQ)Yes/NoN/AN/A
Factor 3: Small Business Participation (Full & Open Only)
2.7Volume III SubmissionYes/NoN/AN/A
2.7.2Small Business Participation Commitment Document (SBPCD, Appendix L‑09)Yes/NoN/AN/A
2.7.3Small Business Subcontracting Plan (Appendix L‑10)Yes/NoN/AN/A
Factor 4: Price
2.8Price Volume SubmittedYes/NoN/AN/A
2.8.3NTE Fully Burdened Labor Rates (Appendix L‑08 Excel File)Yes/NoN/AN/A

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