J.5_Prime_Proposal_Checklist.docx

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Attached to
Plan Program Integrity Medicare Drug Integrity Contract (PPI MEDIC)
Solicitation number
75FCMC19R0042
Issued by

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This document provides a checklist for prime contractor proposals in response to the Centers for Medicare and Medicaid Services' Request for Proposal number 75FCMC19R0042 for Plan Program Integrity Medicare Drug Integrity Contract services. The checklist requests information on the prime contractor name, address, point of contact, parent companies if newly formed, proposed subcontractors, business size classification as large or small and associated socioeconomic categories, taxpayer identification number, DUNS number, and CAGE code. Productive hours for exempt and non-exempt employees are also requested. The related federal contract opportunity describes the services required as proactive and reactive data analysis within Medicare Parts C and D to identify program vulnerabilities and provide findings to Medicare Advantage and Prescription Drug Plans. The cost-plus-fixed-fee contract will have a base period of one year and four one-year option periods, is under NAICS code 541990 with a size standard of $15 million, and will be available on the Federal Business Opportunities website as of September 3, 2019 with proposals due 30 days after RFP issuance.

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Attachment J.5 RFP-75FCMC19R0042 PPI MEDIC

Proposal Checklist (Prime)

You are requested to complete the following checklist to allow CMS to more readily identify various aspects of your proposal. Please check the appropriate items and provide an explanation, if necessary.

1) Company name, address, point of contact and telephone number

2) If a newly formed company, provide name and address of parent companies forming the new entity:

a. __________________b.__________________
____________________________________
______________________
____________________________________

3) List of proposed subcontractors (if applicable):

a. _____________________________________

b. _____________________________________

c. _____________________________________

4) In accordance with the North American Industry Code 541611, indicate the business size of the prime entity/company.

□ Large Business

□ Small Business – check additional categories as applicable:

____ Disadvantaged
____ Woman-owned
____ Veteran-owned
____ HUBZone
____ (8)a

5) TIN # _______________

6) DUNS# _______________

7) Cage Code _____________

8) Productive Hours for Exempt and Non-Exempt Employees ________

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