E.4_Prime_Proposal_Checklist_revised.docx

RFP-75FCMC23R0015 E.4 Prime Proposal Checklist_Revised

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:

3) This proposal is valid for a period of no less than ______________ days

4) List of proposed subcontractors (if applicable):

a. _____________________________________

b. _____________________________________

c. _____________________________________

5) 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:

5) TIN # _______________

6) UEI # _______________

7) Cage Code _____________

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

9) Self-Verification: Limitations on Subcontracting and Small Business Designation

Offerors are required to comply with 13 C.F.R. 125.6. Offerors are to check which block applies:

[ ] I certify that no subcontractors are anticipated in performing services under this contract. My Company receives 100% of the cost of this contract.

[ ] I certify that, although utilizing subcontractors, as the prime, our company is estimated to receive at least 50% of the cost of contract performance incurred for personnel with my companies’ own employees.

[ ] I certify that my company and those subcontractors that are similarly situated are estimated to receive at least 50% of the cost of contract performance incurred for personnel with my companies’ own employees and employees of the similarly situated concern. I understand that the Government will not pay more than 50% of the amount paid by the government to it to firms that are not similarly situated and any work that a similarly situated subcontractor further subcontracts will count towards the 50% subcontract amount that cannot be exceeded. I understand that a similarly situated subcontractor must meet the size standard for the NAICS assigned by the prime (541611).

Please provide the following information to identify and calculate the cost of the work self-performed and what is subcontracted. For each subcontractor provide the following:

Size (i.e. Large, Small, 8(a))

(Y or N) Subcontractor Subcontracting any work?

(Y or N) If Yes, please provide % of work performed by the subcontractor’s subcontractor

Total % of cost of contract performance incurred for personnel with the Prime’s own employees _________________

Total % of cost of contract performance incurred for personnel for the similarly situated concern_________________

Total % of cost of contract performance incurred for personnel for other subcontractors __________

WARNING: Severe Penalties for Contractors that violate the Limitations on Subcontracting Rule: If caught during the performance violating the FAR government subcontracting rules or limitations on subcontracting clause under the Code of Federal Regulations 13 C.F.R. 125.6(g), there can be stiff penalties: “Whoever violates the requirements set forth in paragraph (a) of this section shall be subject to the penalties prescribed in 15 U.S.C. 645(d), except that the fine shall be treated as the greater of $500,000 or the dollar amount spent, in excess of permitted levels, by the entity on subcontractors. A party's failure to comply with the spirit and intent of a subcontract with a similarly situated entity may be considered a basis for debarment on the grounds, including but not limited to, that the parties have violated the terms of a Government contract or subcontract pursuant to FAR9.406-2(b)(1)(i) (48 CFR 9.406-2(b)(1)(i)).” Contracting Officers may require the contractor to demonstrate its compliance with the limitations on subcontracting at any time during the performance of the contract by having the Contractor provide invoices, copies of subcontracts, or a list of the value of tasks performed. IAW 1001 of Title 18, I certify the above representations are true and correct to the best of my knowledge.

(Contractor Signature) Title Date