E.6 Subcontractor Proposal Checklist.pdf
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- Solicitation number
- 75FCMC25RJ003
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This is a Subcontractor Proposal Checklist form (Attachment E.6) for the Recovery Audit Contractor (RAC) Regions 3, 4, & 5 solicitation (75FCMC25RJ003). The checklist is designed to help CMS identify and evaluate various aspects of subcontractor proposals.
The form requires basic information including the prime offeror's name, subcontractor details (name, address, point of contact, telephone number), parent company information for newly formed entities, and a list of proposed subcontractors. It also requests business size classification under NAICS code 561440, with options for large business or small business designations including additional categories for disadvantaged, woman-owned, veteran-owned, and HUBZone businesses. The form requires identification numbers (TIN, UEI, and Cage Code) and productive hours for exempt and non-exempt employees.
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Attachment E.6 75FCMC25RJ003
RAC REGION 3, 4, & 5
Proposal Checklist - Subcontractor
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) Prime Offeror’s Name: _________________________________
2) Subcontractor’s Name: _________________________________
3) Subcontractor address, point of contact and telephone number
4) If a newly formed company, provide name and address of parent companies forming the new entity and cage codes:
a. __________________ b.__________________
5) List of proposed subcontractors (if applicable):
a. _____________________________________
b. _____________________________________
c. _____________________________________
6) 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
6) TIN # _______________
7) UEI# _______________
8) Cage Code _____________
9) Productive Hours for Exempt and Non-Exempt Employees ________
B9XI
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