D.7 Required Compliance Checklist updated 7.30.2026.docx
DOCX document 20 KB Posted
- Attached to
- V226--Non Emergent Patient Transportation
- Solicitation number
- 36C25026Q2655
About this file
This file is a Required Compliance Checklist document, serving as a template or reference guide for vendors responding to the solicitation for Non-Emergency Patient Transportation services. While the specific contents of the checklist are not detailed in the provided information, this type of document typically outlines mandatory compliance requirements, certifications, and documentation that prospective contractors must complete and submit as part of their proposal response. The checklist was last updated on July 30, 2026, indicating it reflects the most current requirements for this procurement.
The checklist applies to RFQ 36C25026Q2655, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10 (NCO 10) on behalf of Aleda E. Lutz VA Medical Center. This is a Veteran Owned Small Business (VOSB) set-aside solicitation under FAR 12 Simplified Acquisition Procedures for special needs transportation services (NAICS 485991) with a small business size standard of $19.0 million. Vendors must use this compliance checklist to ensure all required submissions, qualifications, insurance documentation, and other contractual prerequisites are addressed in their proposal to avoid disqualification or delays in the evaluation process.
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| File | Type | Posted |
|---|---|---|
| D.2 Wage Determinations for Saginaw VAMC updated 7.30.2026.docx | DOCX document | |
| D.5 Past Performance Questionnaire updated 7.30.2026.docx | DOCX document | |
| D.1 36C25026Q2655 RFQ 7.30.2026 Re-issue.docx | DOCX document | |
| 36C25026Q2655_2.docx | DOCX document | |
| 36C25026Q2655 0002.docx | DOCX document | |
| D.1 36C25026Q2655 RFQ 7.23.2026 Re-issue.docx | DOCX document | |
| 36C25026Q2655 0001.docx | DOCX document | |
| 36C25026Q2655_1.docx | DOCX document | |
| D.4 Statement of VAAR 852.219-75 - Statement of Limitation of Subcontracting.docx | DOCX document | |
| D.3 Statement of FAR 52.222-41 - Statement of DoL WD Compliance.docx | DOCX document | |
| D.6 Statement of Start Date Confirmation.docx | DOCX document | |
| D.7 Required Compliance Checklist.docx | DOCX document | |
| D.2 Wage Determinations for Saginaw VAMC.docx | DOCX document | |
| D.5 Past Performance Questionnaire.docx | DOCX document | |
| D.1 36C25026Q2655 RFQ.docx | DOCX document | |
| 36C25026Q2655.docx | DOCX document |
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D.7 COMPLIANCE CHECKLIST – REQUIRED FOR CONTRACTORS TO COMPLETE
Interested parties please complete all sections of the following document. This checklist is provided to assist interested parties in submitting a compliant quote All sections below must be completed with accurate information. If an item is not applicable, indicate “None” or “N/A.” Do not leave any fields blank.
1. Contractor Information Name of Prime Contractor
DBA - Doing Business As (If applicable)
SAM UEI
Cage Code
Street Address of Prime Contractor
City, State & Zip
Primary POC – Prime Contractor
Phone Number
Email Address
2. SBA Certifications (Social-Economic Statuses) and active expiration date(s) of the PRIME ONLY.
Certification Mark (x) if held
| SBA Certification |
| Active Expiration Date |
Service Disabled Veteran Owned SB (SDVOSB)
Veteran Owned SB (VOSB)
Economically Disadvantaged Woman Owned SB (EDWOSB)
Woman Owned SB (WOSB)
8(a) Small Business (8(a))
HUBZone (HUB)
Small Disadvantaged Business (SDB)
3. The following are required based on the requirement document or submittals found on section E.1 FAR 52.212-1 ADDENDUM located on page ___ of the RFQ. Each item is required to be submitted ☐ SF 1449, Most updated. Must filled out and be signed ☐ SF 30, Amendment(s) must be signed. Each must be acknowledged on Table B.1 of RFQ.
| ☐ | D.3 Statement of FAR 52.222-41 Statement of DoL WD Compliance. Completed in its entirety to include occupational code(s) and occupational title. It must be signed. | |
| ☐ | D.4 Statement of VAAR 852.219-75 Statement of Limitation of Subcontracting Compliance. Completed in its entirety. It must be signed. | |
| ☐ | D.6 Start Date Confirmation. Completed and signed. | |
| ☐ | Proof of insurance. Meets limitations set in section C.7 of RFQ. | |
| ☐ | Past performance (References, Questionnaires, or CPARS) | |
| ☐ | Section E.4 - FAR 52.209-7 Information Regarding Responsibility Matters. Completed at the time of submitting quote. | |
| ☐ | Section E.6 - FAR 52.229-11 Tax on certain Foreign Procurements. Completed at the time of submitting quote. | |
| ☐ | Technical Approach | |
| ☐ Staffing Plan | ||
| ☐ Vehicle Fleet listing | ||
| ☐ Contingency Plan |
4. I understand that the above lists are items that must be included within the quote. Any items not included in the quote will render the package non-compliant and exclude it from consideration in the competition for award of the contract for Non-Emergency Medical Transportation service at Saginaw VAMC.
Signature: _____________________________________________________________________
Name: _________________________________________________________________________ Dated: _________________________________________________________________________ Title: ___________________________________________________________________________ Company: ______________________________________________________________________
File details come from the government source that posted it. Updated .