Attachment L - Phase II Proposal Forms_12 (Updated for Amendment 0003).pdf

ATTACHMENT L – PHASE II PROPOSAL FORMS

Proposal Files for Solicitation #36C10X23R0058 Instructions: Offeror must complete the following forms as instructed, for Phase II. Page or Character Limitations for each section are provided within each form.

The Phase II- VIT Proposal is the viable VITAL’s opportunity to assemble and present details on its proposed Veteran

Integrated Team’s collective capability to deliver the desired staffing under Occupational Categories I, II, and III.

Phase II Instructions- In addition to the specific instructions within each form, the following file naming and submission instructions apply. Phase II: The complete Phase 2 Proposal shall contain the following completed forms:

2A. VIT PROPOSAL – FULL MISSION CAPABILITY

Save all forms 2A into a single file titled: “ph2_VIT-FMC_<company name>. pdf”

2B. VIT PROPOSAL – TEAM ROBUSTNESS

Save completed spreadsheet as: “ph2_VIT-Robustness_<company name>.xls/xlsx”

Save all letters of commitment into a single file titled: “ph2_VIT-LOC_<company name>.pdf”

2C. VIT PROPOSAL – CONTRACT MANAGEMENT & ADMINISTRATION

Save completed form 2C into a single file titled: “ph2_VIT-CM_<company name>.pdf”

2D. VIT PROPOSAL – KEY PERSONNEL

Save form 2D into a single file titled: “ph2_VIT-KP_<company name>.pdf”

2E. VIT PROPOSAL – REPRESENTATIVE TO RESPONSE- STAFFING

Save form 2E into a file titled: “ph2_RTO-Staff_<company name>.pdf”

Save all candidate resumes into a file titled: “ph2_RTO-Resumes_<company name>.pdf”

Save credentialling package into a file titled: “ph2_RTO-CP_<company name>.pdf”

2F. VIT PROPOSAL – REPRESENTATIVE TO RESPONSE- PROGRAM SUPPORT

Save form 2F into a single file titled: “ph2_RTO-PM_<company name>.pdf”

2G. VIT PROPOSAL – PRICING

Save completed IDIQ pricing spreadsheet as: “ph2_IDIQ_Pricing_<company name>.xls/xlsx”

Save completed RTO pricing spreadsheet as: “ph2_RTO_Pricing_<company name>.xls/xlsx”

2H. VIT PROPOSAL – SF 1449, AMENDMENTS, OTHER DOCUMENTS

Save forms 2H into a single file titled: “ph2_Other_<company name>.pdf”

Submit the twelve (12) files as email attachments IAW Section E, PROPOSAL SUBMISSION INSTRUCTIONS of the RFP.

2A. PHASE II: VIT PROPOSAL – FULL MISSION CAPABILITY

The Government will evaluate the proposed VIT to determine whether it is fully mission capable. For the purposes of this evaluation, fully mission capable means that the VIT, inclusive of its collective team members, has confirmed capability across the three Occupational Categories in all labor categories, across the geographic scope of ICSP and has Program Support Capabilities for providing workforce planning and analytical services, strategic and operational support, implementation support, and monitoring and evaluation support.

The Government will determine capability of VIT members based upon the degree of capability and relevance of the experience information provided. The Government will evaluate the Program Support Capabilities based on capability and experience providing workforce planning and analytical services, strategic and operational support, implementation support, and monitoring and evaluation support.

If a VIT is found to be not fully mission capable, it will result in less than acceptable confidence on the part of the Government. A VIT found to not be fully mission capable will not be eligible for award (unless corrected during discussions conducted at the discretion of the Government).

Forms begin on next page.

Full Mission Capability (One form per company) Offerors shall complete the below to demonstrate capability for VITAL or named partner (one form per partner per OC)

OFFEROR (VITAL) NAME:

PROPOSED PARTNER:

(ENTER “N/A” if VITAL)

SBA Certified SDVOSB? YES NO NAICS Applied to Subcontract: NAICS: Partner small under NAICS? YES NO

OCCUPATIONAL CATEGORY

(check one addressed on this form)

OC1 (Clinical Occupational Series) OC2 (Non-Clinical Occupational Series) OC3 (Program Support Service Categories)

VITAL/ PARTNER CAPABILITY DESCRIPTION- TECHNICAL (3,000 Characters) Describe the capability of the firm to support staffing needs from within the OC selected above. If multiple OCs apply to a particular partner, form should be replicated and completed to address each OC with separate description.

vacosmithall Highlight

OFFEROR (VITAL) NAME:

PROPOSED PARTNER:

(ENTER “N/A” if VITAL)

OCCUPATIONAL

CATEGORY

OC1 (Clinical Occupational Series) OC2 (Non-Clinical Occupational Series) OC3 (Program Support Service Categories)

Most Relevant Past Performance Example (Associated with the OC selected above)

COMPANY that performed the work:

Work Performed as the: PRIME SUBCONTRACTOR

Total Awarded Price/Cost and Contract No.: PRICE CONTRACT NUMBER:

Final or Projected Final Total Price/Cost:

Delivery date/Period of performance (including base and options if applicable):

Contracting Officer’s Name, Email, and Telephone Number:

Program Manager’s Name, Email & Phone #:

NAICS of contract/subcontract agreement:

Was a CPARS/PPIRS Completed? : YES NO VITAL/ PARTNER CAPABILITY DESCRIPTION- PAST PERFORMANCE (3,000 Characters) Describe the performance supporting staffing needs from within the OC selected above. If multiple OCs apply to a particular partner, form should be replicated to address each OC with separate description. Narrative should include details of performance, breadth of experience, or other information to permit clear alignment of experience to staffing needs and understanding of relevance to future staffing needs.

Full Mission Capability (Program Support Capabilities) Offerors shall complete the below to demonstrate Program Support Capabilities (separate from staffing under OC3)

OFFEROR (VITAL) NAME:

VITAL/ PARTNER CAPABILITY DESCRIPTION- PROGRAM SUPPORT (3,000 Characters) Describe the capability and experience of the VIT (lead and partners) to provide workforce planning and analytical services, strategic and operational support, implementation support, and monitoring and evaluation support.

2B. PHASE II: VIT PROPOSAL – TEAM ROBUSTNESS

The Government requires a VIT capable of simultaneously meeting unique and highly complex requirements on multiple concurrent task orders covering a broad spectrum of clinical and non-clinical staffing needs across a national geographical coverage area. Further, the Government requires the flexibility to deploy contract teams to multiple supported locations nationwide, at times with little to no notice, with committed partners that are well-integrated with the VITALs. The Government anticipates that the VIT team robustness may improve after Phase 1 evaluations and encourages expansions of the VIT team with additional partners. To help evaluate the robustness of the VIT being proposed, the Government will evaluate the totality of exclusive partners with signed, exclusive teaming agreements or commitment letters. For the purposes of this evaluation, robustness refers to the quality and number of VIT members vetted against the ability to staff clinical and non-clinical occupational series and the national geographical coverage provided by the integrated team.

Offeror shall complete Attachment M- VIT Coverage (Robustness) and submit as “ph2_Robustness_<company name>.xls/xlsx”

Specific instructions for completing the Robustness Attachment (spreadsheet) are:

1. On “VIT Geographic Coverage” worksheet, in first four columns of the table:

a. Enter Offeror and Partner Names, SAM UEIs, and select the Socio-Economic status for each

(using dropdown), and “yes” or “no” based on whether prime offeror has a letter of commitment from proposed partner (Letters of commitment are required and shall be completed, signed, and submitted as prescribed below).

b. For the Offeror and each Partner, place an “x” below the states where staffing support is provided.

All offeror information will automatically be copied over to “VIT LCAT Coverage” worksheet.

2. On “VIT LCAT Coverage” worksheet:

a. For the Offeror and each Partner, place an “x” below all LCATs (Staffing) provided by Offeror and included Partners.

3. Using the Letter of Commitment form below, Offeror shall collect and submit signed Letters of Commitment from all partners confirming their role and commitment to the VIT.

See next page for Letter of Commitment Template.

LETTER OF COMMITMENT

Date:

___________________________<company name> (UEI: ________________) with an office at

________________________________________________<company address> commits by this letter to

___________________________<prospective VITAL> to serve as an exclusive team member on the proposed Veteran Integrated Team in support of VHA Integrated Critical Staffing Program Contract requirements.

___________________________ will serve as a key partner (VITEP or VITSO) to

______________________ only. If VITAL receives an award, _________________________ commits to providing support for task orders requiring staffing from:

(check all that apply)

Occupational Category 1 Occupational Category 2 Occupational Category 3 Program Support (workforce planning and analytical services, strategic and operational support, implementation support, and/or monitoring and evaluation support)

Sincerely, Name Title (Partner) Company Phone Number

2C. PHASE II: VIT PROPOSAL – CONTRACT MANAGEMENT & ADMINISTRATION

The proposal will be evaluated to ascertain the degree of risk and likelihood of success associated with the Offeror's proposed structure to manage contractor onboarding and training, travel administration, budgeting and invoicing, and general contract executions and administration. The Offeror shall describe its proposed structure and plan to manage contractor onboarding and training, travel administration, budgeting and invoicing, and general contract executions and administration. If the VITAL is relying on partner support to assist in any areas of managing contractor onboarding and training, travel administration, budgeting and invoicing, or general contract execution and administration, offeror must providea robust and detailed description of how the team member expertise and experience will be integrated and managed by the VITAL to enhance its ability to successfully manage contract activities.

Contract Management and Administration Offeror shall describe below its proposed structure to manage contractor onboarding and training, travel administration, budgeting and invoicing, and general contract executions and administration as detailed above.

OFFEROR (VITAL) NAME:

Contract Management & Administration (5,000 Characters) vacosmithall Highlight vacosmithall Highlight vacosmithall Highlight vacosmithall Highlight vacosmithall Highlight vacosmithall Highlight vacosmithall Highlight

2D. PHASE II: VIT PROPOSAL – KEY PERSONNEL

Key Personnel Biography- IDIQ Contract Manager Offeror shall complete and submit the form below for the proposed key person

OFFEROR (VITAL) NAME:

PROPOSED KEY PERSON’S NAME:

KEY PERSON LETTER OF COMMITMENT? ☐ YES ☐ NO

Education (List up to two relevant degrees and the area of focus) Note: The IDIQ Contract Manager Lead must have minimum education of a bachelor’s degree in a business or program related field.

First Education Example Second Education Example (if more than one)

University:

Level/Type of Degree:

Major/Field:

Experience (List relevant experience to the role of the key person being proposed) The IDIQ Contract Manager must have a minimum of 10 years of experience managing programs, projects, or contracts of comparable size, scope, and complexity to this procurement. The IDIQ Contract Manager shall have experience with government contract oversight.

Key Personnel Biography- Project Coordination and Oversight Lead Offeror shall complete and submit the form below for the proposed key person

OFFEROR (VITAL) NAME:

PROPOSED KEY PERSON’S NAME:

LETTER OF COMMITMENT? ☐ YES ☐ NO

Education (List up to two relevant degrees and the area of focus) Note: The Project Coordination and Oversight Lead must have minimum education of a bachelor’s degree in a business or program related field.

First Education Example Second Education Example (if more than one)

University:

Level/Type of Degree:

Major/Field:

Experience (List relevant experience to the role of the key person being proposed) The Project Coordination and Oversight Lead shall be an individual who is knowledgeable with the processes of managing their staff onboards, company’s invoices as well as managing their subcontractors and their processes.

• Familiarity with the standard operations of VHA

• Familiarity with onboarding new contract staff, required documents, and ICAMs.

• Familiarity with Invoicing and how to submit the invoices

• Understand their process of managing subcontractors

2E. PHASE II: VIT PROPOSAL – REPRESENTATIVE TO RESPONSE- STAFFING

NOTE: Task Order (TO) is an extreme representation of future potential orders and will not be awarded. Most future TOs will likely be much less complex.

1. Offerors shall identify up to three candidates in the form below for each site LCAT. Additionally, offeror shall identify one primary care physician for the Credentialling Package. Save form 2E into a file titled: “ph2_RTO- Staff_<company name>.pdf”.

2. For each candidate identified across all the 21 sites, offeror shall submit associated candidate resumes– 2 Pages max each. (21 sites x 6 LCATs x 3 resumes = 378 potential resumes). Save all candidate resumes into a file titled: “ph2_RTO-Resumes_<company name>.pdf”.

3. For the identified primary care physician, offeror shall submit one associated complete Credentialing Package (Personally identifiable Information (PII) Redacted). Save credentialing package into a file titled: “ph2_RTO- CP_<company name>.pdf”

Form begins on next page.

Representative Task Order Response- Facility Staffing Ability Centralized Critical Staffing Support of all VISNs- Offeror shall provide candidate names of all resumes submitted.

OFFEROR (VITAL) NAME:

VISN 1: Manchester VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 2: Syracuse VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 4: Belmont County Outpatient Clinic

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 5: Baltimore VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 6: Fayetteville VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 7: Tuscaloosa VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 8: Orlando VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 8: VA Caribbean Healthcare System

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 9: Bowling Green VA Clinic

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 10: Marion VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 12: VA Iliana Health Care System

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 15: Dodge City Kansas CBOC

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 16: G.V. (Sonny) Montgomery VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

VISN 17: Eastside EL Paso CBOC

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 19: Fort Harrison VA Medical Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 19: VA Eastern Colorado Health Care System (ECHCS)

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 20: White City or VA Southern Oregon Rehabilitation Center

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 20: Alaska VA Healthcare System

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 21: Pacific Islands Healthcare System

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

VISN 22: VA Greater Los Angeles Healthcare System

Candidate 1 Candidate 2 Candidate 3

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

VISN 23: Rapid City VA Clinic

1. Human Resource Specialist Sr:

2. Medical Support Assistant:

3. Primary Care Physician:

4. Social Worker (Mental Health Counselor):

5. Practical Nurse:

6. Diagnostic Radiologic Technician:

Primary Care Physician (name)

One (1) credentialing package of one of the identified Primary Care Physicians

2F. VIT PROPOSAL – REPRESENTATIVE TO RESPONSE- PROGRAM SUPPORT

This massive temporary staffing initiative scenario will require significant contractor program support. Expert levels of management and coordination of multiple concurrent critical staffing LCATs at the 21 facilities throughout the 18 VISNs will be required.

To ensure the success of the national initiative, the Offeror shall provide an associated Program Management Plan (PMP) in both a narrative and graphic format that details each of the sections identified in the table below.

PMP Section (in this order) Page limit:

(12pt. font, single spaced)

Cover page 1 page

1. The contractor’s approach/ task management (to include Work Breakdown Structure), 4 pages

2. Timeline (relative), 1 page

3. Staffing/onboarding plan, 3 pages

4. Requirements engagement (i.e., schedule, milestones, risks and resource support) 4 pages

5. Risk management plan, 2 pages

6. Change management plan, 3 pages

7. Communications plan, 3 pages

8. Quality assurance plan, 3 pages

9. Tools to be used in execution of the initiative. 1 page

Save PMP into a single file titled: “ph2_RTO-PM_<company name>.pdf”

2G. VIT PROPOSAL – PRICING

Instructions: Offeror shall complete Attachment N- IDIQ Pricing Spreadsheet and submit as its Phase II IDIQ Price Volume. Offeror shall additionally complete Attachment O- RTO Pricing Spreadsheet and submit as its Phase II Representative Task Order and Onboarding Task Order pricing.

1. Attachment N- IDIQ Pricing Spreadsheet: Provide fully burdened labor rates for all applicable Occupational Categories for Base and Option Period (all 10 years). Do not alter the spreadsheet in any way other than to add labor rates for each category, where indicated. If the templates are altered in any other way, they may not be accepted. Hourly rates must be rounded to two decimal places.

Save completed pricing spreadsheet as: “ph2_IDIQ_Pricing_<company name>.xls/xlsx”.

2. Attachment O- RTO Pricing Spreadsheet:

a. On the "Representative TO Price Sheet" worksheet, provide fully burdened hourly rates based on labor categories and location for the Representative Task Order. Rates are limited to IDIQ maximum rates proposed for the respective labor categories (from Attachment N).

The "Rep TO Price Schedule" will reflect the total RTO price based on the common basis (hours) established by the Government.

b. On the "Onboarding TO Price Schedule" worksheet, provide the proposed LCAT for the IDIQ Onboarding Liaison and enter the full burdened hourly labor rate. Rate is limited to IDIQ maximum rate proposed for the respective labor category (from Attachment N). See Attachment H- Onboarding Task Order ICSP for details of the Onboarding Task Order.

Save entire completed pricing spreadsheet as: “ph2_RTO_Pricing_<company name>.xls/xlsx”.

2H. VIT PROPOSAL – SF 1449, AMENDMENTS, OTHER DOCUMENTS

Instructions: The following shall be submitted as the Phase II Volume “ph2_Other_<company name>.doc/docx/pdf”

1. Signed SF 1449 and Amendment(s), if any.

An authorized official of the VITAL submitting the response shall sign the SF 1449, and any amendment(s) and all certifications requiring signature and include within the proposal file directly following this checklist.

Checklist

Document Purpose Check

SF-1449

Request for Proposal for Integrated Critical Staffing Program

Signed by authorize agent Attached within file

Amendment 1 Signed by authorize agent Attached within file

Amendment 2 Signed by authorize agent Attached within file

Amendment 3 Signed by authorize agent Attached within file

Amendment 4 (If applicable) Signed by authorize agent Attached within file

Amendment 5 (If applicable) Signed by authorize agent Attached within file

Amendment 6 (If applicable) Signed by authorize agent Attached within file

Amendment 7 (If applicable) Signed by authorize agent Attached within file

Amendment 8 (If applicable) Signed by authorize agent Attached within file

Amendment 9 (If applicable) Signed by authorize agent Attached within file

Amendment 10 (If applicable) Signed by authorize agent Attached within file

Amendment 11 (If applicable) Signed by authorize agent Attached within file

Amendment 12 (If applicable) Signed by authorize agent Attached within file

Insert signed SF-1449 and all Amendments Here (one page per signed/acknowledged document.)

2. Offeror’s statement(s) as required by paragraph b. of the VAAR Clause 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST and any applicable OCI Mitigation Plans;

Offeror shall provide information as required by checking the applicable statement, providing narrative, and providing any supplemental documentation.

In accordance with paragraph b. of Organizational Conflicts of Interest (OCT 2020)

“The Offeror shall provide a statement with its offer which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided under this solicitation. The Offeror shall also provide statements with its offer containing the same information for any consultants and subcontractors identified in its proposal and which will provide services under the solicitation. The Offeror may also provide relevant facts that show how its organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest.”

Check all below statements that apply:

My firm (the offeror) has NO past, present, currently planned interests (financial, contractual, organizational, or otherwise), or actual or potential organizational conflicts of interest related to the services to be provided under the solicitation.

Any consultants and subcontractors identified in my proposal, and which will provide services under the solicitation have NO past, present, currently planned interests (financial, contractual, organizational, or otherwise), or actual or potential organizational conflicts of interest related to the services to be provided under the solicitation.

My firm and/or consultants and subcontractors identified in my proposal have interests or actual or potential conflicts of interest referred to in the VAAR Clause. (if checked, provide statement below describing, in a concise manner, all relevant facts AND insert OCI mitigation plan if applicable).

OCI Statement

Insert OCI avoidance or mitigation plan here (if applicable).

3. Certification required under VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023) (DEVIATION)

Offeror shall complete the required Certification below.

VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—CERTIFICATE OF COMPLIANCE FOR SERVICES AND

CONSTRUCTION (JAN 2023) (DEVIATION)

(a) Pursuant to 38 U.S.C. 8127(l)(2), the offeror certifies that—

(1) If awarded a contract (see FAR 2.101 definition), it will comply with the limitations on subcontracting requirement as provided in the solicitation and the resultant contract, as follows:

(i) X Services. In the case of a contract for services (except construction), the contractor will not pay more than 50% of the amount paid by the government to it to firms that are not certified SDVOSBs listed in the SBA certification database as set forth in 852.219-73 or certified VOSBs [listed in the SBA certification database] as set forth in 852.219-74. Any work that a similarly situated VIP-listed [certified SDVOSB/VOSB] subcontractor further subcontracts will count towards the 50% subcontract amount that cannot be exceeded. Other direct costs may be excluded to the extent they are not the principal purpose of the acquisition and small business concerns do not provide the service as set forth in 13 CFR 125.6.

(ii) □ General construction. (Not applicable)

(iii) □ Special trade construction contractors. (Not applicable)

(2) The offeror acknowledges that this certification concerns a matter within the jurisdiction of an Agency of the United States. The offeror further acknowledges that this certification is subject to Title 18, United States Code, Section 1001, and, as such, a false, fictitious, or fraudulent certification may render the offeror subject to criminal, civil, or administrative penalties, including prosecution.

(3) If VA determines that an SDVOSB/VOSB awarded a contract pursuant to 38 U.S.C. 8127 did not act in good faith, such SDVOSB/VOSB shall be subject to any or all of the following:

(i) Referral to the VA Suspension and Debarment Committee;

(ii) A fine under section 16(g)(1) of the Small Business Act (15 U.S.C. 645(g)(1)); and

(iii) Prosecution for violating section 1001 of title 18 [U.S.C. 1001].

(b) The offeror represents and understands that by submission of its offer and award of a contract it may be required to provide copies of documents or records to VA that VA may review to determine whether the offeror complied with the limitations on subcontracting requirement specified in the contract. Contracting officers may, at their discretion, require the contractor to demonstrate its compliance with the limitations on subcontracting at any time during performance and upon completion of a contract if the information regarding such compliance is not already available to the contracting officer. Evidence of compliance includes, but is not limited to, invoices, copies of subcontracts, or a list of the value of tasks performed.

(c) The offeror further agrees to cooperate fully and make available any documents or records as may be required to enable VA to determine compliance with the limitations on subcontracting requirement. The offeror understands that failure to provide documents as requested by VA may result in remedial action as the Government deems appropriate.

(d) Offeror completed certification/fill-in required. The formal certification must be completed, signed and returned with the offeror’s bid, quotation, or proposal. The Government will not consider offers for award from offerors that do not provide the certification, and all such responses will be deemed ineligible for evaluation and award.

Certification:

I hereby certify that if awarded the contract, [insert name of offeror] will comply with the limitations on subcontracting specified in this clause and in the resultant contract. I further certify that I am authorized to execute this certification on behalf of [insert name of offeror].

Printed Name of Signee: Printed Title of Signee:

Signature: ________________________________ Date:

Company Name and Address:

4. Paragraph b of 52.212-3, Offeror Representations and Certifications

Please check (to confirm) and identify any exceptions to paragraph b below.

Excerpt from FAR 52.212-3 Offeror Representations and Certifications – Commercial Items (DEC 2014) (b)(1) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications posted on the SAM website.

(2) The offeror has completed the annual representations and certifications electronically via the SAM website access through http://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications—Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs

5. Paragraph (a)(4) from 52.212-4 Contract Terms and Conditions – Commercial Items (May 2015) Alternate 1 (May 2014)

The following paragraph fill-in (Portion of labor rate attributable to profit) must be completed below, if applicable.

Excerpt from FAR 52.212-4 Contract Terms and Conditions – Commercial Items (May 2015) Alternate 1 (May 2014)

(a)(4) At any time during contract performance, but not later than 6 months (or such other time as may be specified in the contract) after acceptance of the services or materials last delivered under this contract, the Government may require the Contractor to replace or correct services or materials that at time of delivery failed to meet contract requirements. Except as otherwise specified in paragraph (a)(6) of this clause, the cost of replacement or correction shall be determined under paragraph (i) of this clause, but the "hourly rate" for labor hours incurred in the replacement or correction shall be reduced to exclude that portion of the rate attributable to profit. Unless otherwise specified below, the portion of the "hourly rate" attributable to profit shall be 10 percent.

The Contractor shall not tender for acceptance materials and services required to be replaced or corrected without disclosing the former requirement for replacement or correction, and, when required, shall disclose the corrective action taken. [Portion of labor rate attributable to profit if other than 10% = ]

6. Contractor proposed terms and conditions. Any proposed terms and conditions and/or assumptions upon which the proposal is predicated. Offerors are hereby advised that any offeror-imposed terms and conditions and/or assumptions which deviate from the Government’s material terms and conditions established by the solicitation, may render the offeror’s proposal unacceptable, and thus ineligible for award.

Contractor shall provide any proposed terms and conditions and/or assumptions upon which the proposal is predicated.

Form 2A PSC

Form 2H- SF1449_Amendments_Other1