Attachment_J.5.B__Eastern_Region_Site_Verification_Services_TO_Subcontract_Reporting.xlsx

XLSX spreadsheet 14 KB Posted

Attached to
Provider Enrollment and Oversight Federal contract opportunity
Solicitation number
75FCMC18R0014
Issued by
Department of Health and Human Services Centers for Medicare and Medicaid Services

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Attachment J.5.B

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75FCMC18R0014_-_Amendment_0008_.pdf PDF
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Amendment_6_-_Exhibit_E.1.B_SVS_Task_Order_Questions_and_Responses_3rd_Rd.pdf PDF
75FCMC18R0014_Amendment_0006.pdf PDF
75FCMC18R0014_Amendment_0005.pdf PDF
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Amendment_5_-_Attachment_J.5__Eastern_Region_Site_Verification_Services_TO_RFP.doc DOC document
Amendment_5_-_Attachment_J.6.A.1_Western_Region_Site_Verification_Services_TO_SOW_Attachment_1_QASP.docx DOCX document
Amendment_5_-_Attachment_J.6__Western_Region_Site_Verification_Services_TO_RFP.doc DOC document
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Amendment_4_-_Attachment_J.6__Western_Region_Site_Verification_Services_TO_RFP.doc DOC document
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Amendment_2_-_Attachment_J.1_PEO_IDIQ_SOW.pdf PDF
Amendment_2_-_Exhibit_E.3__Subcontractor_Proposal_Information_Checklist.doc DOC document
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Amendment_2_-_75FCMC18R0014_PEO_Solicitation.pdf PDF
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Attachment_J.2.B__Contractor_Personal_Conflict_of_Interest_Financial_Disclosure_Template.docx DOCX document
Attachment_J.3__HHS_Subcontract_Plan_Template.docx DOCX document
Exhibit_E.10__Consent_to_Subcontract.doc DOC document
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Exhibit_E.9__Responsibility_Questionnaire.docx DOCX document
Exhibit_E.1.B__PEO_SVS_Task_Order_Questions_Submission.docx DOCX document
Attachment_J.1__PEO_IDIQ_SOW.pdf PDF
Exhibit_E.3__Subcontractor_Proposal_Information_Checklist.doc DOC document
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Text version

TO Information

Attachment J.5.B
Eastern Region Site Verification Services Task Order Subcontract Reporting
Contractor NameSubmission Date
Contract Number
Task Order Number

Provide a description of ALL the products and/or services subcontracted under this task order, and indicate the size and type of business supplying them as well as the name and DUNS (include all that apply):

Products and/or ServicesSubcontractor NameDUNSOtherSmall BusinessSDBWOSBHUBZoneVOSBSDVOSB
1
2
3
4
5
6

Dollars-%

Reporting PeriodTask Order Funded AmountTotal dollars subcontracted to small business concerns (including ANC and Indian tribes)Total dollars subcontracted to veteran-owned small business concernsTotal dollars subcontracted to service-disabled veteran-owned small businessTotal dollars subcontracted to HUBZone small business concernsTotal dollars subcontracted to small disadvantaged business concernsTotal dollars subcontracted to women-owned small business concernsTotal Subcontracting Dollars & Percentage with “Other” than Small Businesses (i.e., large companies, non profits, etc.)
Base Period Reporting
PoP: ________________Percentage of Total Funded%%%%%%%
Option Period 1 Reporting
PoP: ________________Percentage of Total Funded%%%%%%%
Option Period 2 Reporting
PoP: ________________Percentage of Total Funded%%%%%%%
Option Period 3 Reporting
PoP: ________________Percentage of Total Funded%%%%%%%
Option Period 4 Reporting
PoP: ________________Percentage of Total Funded%%%%%%%
Cumulative to Date
Percentage of Total Funded%%%%%%%

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