E.5 Prime Proposal Checklist.pdf
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- Solicitation number
- 75FCMC25RJ003
About this file
This is a proposal checklist (Attachment E.5) for prime contractors bidding on the Recovery Audit Contractor (RAC) Regions 3, 4, & 5 contract (75FCMC25RJ003) for the Centers for Medicare and Medicaid Services (CMS). The checklist requires bidders to provide basic company information including name, address, contact details, parent company information for newly formed entities, and proposed subcontractors.
The form requires contractors to indicate their business size according to NAICS code 561440, with options for large business or small business classifications including additional categories for disadvantaged, woman-owned, veteran-owned, HUBZone, and 8(a) status. Additional required information includes the company's TIN number, UEI number, CAGE code, and productive hours for exempt and non-exempt employees. The document is marked as "DRAFT" indicating it may not be the final version.
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Text version
Attachment E.5 75FCMC25RJ003
RAC REGION 3, 4, & 5
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 561440, 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) UEI# _______________
7) Cage Code _____________
8) Productive Hours for Exempt and Non-Exempt Employees ________
B9XI
Draft
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