E.5 Responsibility Questionnaire.doc

Exhibit E.5 75FCMC18R00046 National Correct Coding Initiative

Responsibility Questionnaire

Offeror Name/Address:

In order to facilitate the Contracting Officer’s determination of responsibility as required in accordance with FAR 9.104-3(a), please provide responses to the questions below. Responses shall be supported by appropriate explanations and where substantiating information can be found, i.e. proposal, websites, etc.

1.

Does your firm have adequate financial resources to perform the contract, or the ability to obtain them (see 9.104-3(a)?

Offeror Response:

2.

Does your company have ability to comply with the required or proposed delivery or performance schedule, taking into consideration all existing commercial and governmental business commitments?

Offeror Response:

3.

Does your company have a satisfactory performance record (see 9.104-3(b) and Subpart 42.15) and/or address any negative past performance ratings received?

Offeror Response:

4.

Does your company have a satisfactory record of integrity and business ethics (for example, see Subpart 42.15); support your confirmation by indicating that your firm is not on a debarred list, OIG list, or the Federal Contractor Misconduct Database?

Offeror Response:

5.

Does your company have the necessary organization, experience, accounting and operational controls, and technical skills, or the ability to obtain them to provide the services to be performed (See 9.104-3 (a)?

Offeror Response:

6.

Does your company have the necessary technical equipment and facilities, or the ability to obtain them (see 9.104-3(a)); to provide the required services?

Offeror Response:

7.

Is your company otherwise qualified and eligible to receive an award under applicable laws and regulations?

Offeror Response: