Attachment J.pdf
PDF 271 KB Posted
- Attached to
- Forensic Toxicology Drug Testing Laboratory Federal contract opportunity
- Solicitation number
- 693JK422R800003
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Q and As Primary Lab_ Final 2022.pdf | ||
| Amendment 3_693JK422R800003.pdf | ||
| Solicitation- Primary Lab w Att. J 693JK422R800003- Forensic Toxicology Drug Testing Laboratory.pdf | ||
| Amendment 2_693JK422R800003.pdf | ||
| Amendment 1_693JK422R800003.pdf | ||
| 693JK422R800003- Forensic Toxicology Drug Testing Laboratory.pdf | ||
| 693JK422R800003_SF-33.pdf |
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Attachment J-4A
MONTHLY INVOICE REPORT
The report shall include:
(a) billing period
(b) account number (See Section J, Attachment J-5)
(c) invoice number (i.e., summary and detail information by account number provided as separate documents)
(d) total specimens
(e) total screen cost
(f) total specimens confirmed
(g) total specimen confirmed cost
(h) total canceled specimens
(i) total canceled specimen costs
(j) total specimen validity test
(k) total specimen validity test cost
(l) total litigation packages
(m) total litigation package cost
(n) total kits and forms
(o) total kits and forms cost by account code
(p) cost of shipping kits and forms out with supporting documentation by account codes
(q) total cost of shipping specimens from the collection site to the laboratory and supporting documentation by account codes
(r) total costs
Attachment J-4B
MONTHLY REPORT BY ACCOUNTING CODES
(a) account code
(b) date period (should be based on the specimen collected date)
(c) total specimens tested by test type (should be based on the specimen collected date)
(d) total positives specimens with the type of drug
(e) total rejected specimens
(f) total adulterated specimens
(g) total substituted specimens
(h) total negative/positive diluted specimens
(i) Comments
Attachment J-4C
MONTHLY TRAVEL REPORT
(a) travel dates
(b) city of origin and city destination
(c) purpose of travel
(d) number of persons
(e) number of days
(f) laboratory accession ID number (if applicable)
(g) hotel costs
(h) cost of meals
(i) cost of airfare
(j) cost of car rental
(k) local mileage
(l) total travel costs
Attachment J-4D
DAILY LABORATORY TEST RESULTS REPORT (ELECTRONICALLY)
The data transmitted includes, and is not limited to:
(a) Donor’s Social Security Number/employee ID number
(b) Custody & Control Form Number
(c) Laboratory Accession Number
(d) Account Code
(e) Test Reason (i.e., Random (RD), Follow-up (FU), Post Accident (PA), Reasonable Suspicion (RS), Voluntary (VO), Pre-Employment (PE), and Return to Duty (RD))
(f) Drug Type Test Result
(g) Cancelled
(h) Date Specimen was received at the Laboratory
(i) Specimen Collection Date
(j) Result Report Date (i.e., date the lab reported the specimen out)
(k) Specimen Validity Results
Attachment J-5
Government Account Codes
I. FAA Pre-employment/Pre-appointment Codes
The following account codes are used on FAA specimens where the reason for testing is only pre- employment/pre-appointment.
203801-FAA Headquarters 203802-FAA/Western Pacific 203803-FAA/Southwest 203804-FAA/Central 203805-FAA/Alaska 203806-FAA Mike Monroney Aeronautical Center (ACM) 203807-FAA/New England 203808-FAA/Great Lakes 203809-FAA/Eastern 203811-FAA/Southern 203812-FAA/Northwest Mountain
II. DOT Account Numbers
The following account codes are used on all specimens except for CDL and FAA pre-employment/pre- appointment.
203814-Office of the Secretary 203815-United States Coast Guard 203816-Federal Highway Administration 203817-Federal Railroad Administration 203818-Saint Lawrence Seaway Development Corporation 203819-Federal Transit Administration 203820-National Highway Traffic Safety Administration 203821- [Reserved] 203822-Office of the Inspector General 203823-Maritime Administration 203824-FAA Headquarters 203825-FAA/Western Pacific 203826-FAA/Southwest 203827-FAA/Central 203828-FAA/Alaska 203829-FAA Mike Monroney Aeronautical Center (AMC) 203830-FAA/New England 203931-FAA/Great Lakes 203832-FAA/Eastern 203833-FAA/Southern 203834-FAA/Northwest Mountain 203836-DOT Missing Account Numbers 203838-Federal Motor Carrier Safety Administration 203839-Resaerch and Innovative Technology Administration 203840-DOT Special Account 203841-U.S. Merchant Marine Academy 203890-Transportation Security Administration 203891-Federal Air Marshals 401716-Merit System Protection Board
III. CDL Account Numbers
The following account codes are used on all CDL specimens.
14- Office of the Secretary 15- United States Coast Guard 16- Federal Highway Administration 17-Federal Railroad Administration 17-Federal Railroad Administration 18-Saint Lawrence Seaway Development Corporation
19- Federal Transit Administration 20- National Highway Traffic Safety Administration 21- Pipeline and Hazardous Materials Safety Administration 22- Office of the Inspector General 23- Maritime Administration 24- FAA Headquarters 25- FAA/Western Pacific 26- FAA/Southwest 27- FAA/Central 28- FAA/Alaska 29- FAA Mike Monroney Aeronautical Center (AMC) 30- FAA/New England 31- FAA/Great Lakes 32- FAA/Eastern
33- FAA/Southern 34- FAA/Northwest Mountain 38- Federal Motor Carrier Safety Administration
Attachment J-6
ACH VENDOR PAYMENT SYSTEM
This form is used for Automated Clearing House (ACH) payments with an addendum record that carries payment-related information. Recipients of these payments should bring this information to the attention of their financial institution when presenting this form for completion.
COMPANY INFORMATION
Name
Address
Contact Person Name Telephone Number
AGENCY INFORMATION
Contact Person Name Telephone Number
FINANCIAL INSTITUTION INFORMATION
Name
Address
ACH Coordinator Name Telephone Number
Nine Digit Routing Transit Number
Depositor Account Title
Depositor Account Number
Type of Account � Checking � Savings � Other
PAPERWORK REDUCTION ACT STATEMENT
The information being collected on this form is required under the provision of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means, to the vendors’ financial institution. Failure to provide the requested information may delay or prevent the receipt of payments through the ACH Payment System.
NSN 7540-01-274-9925 3881-101 SF
3881 (February 1988) Prescribed by Department of Treasury
31 U.S.C 3322: 31 CFR 210
(specify) Signature and Title of Representative Telephone Number
Attachment J-7 Data Transmission Format
01 File begin marker "BEGIN FILE"
Description
** Account Level Record 01 Record Type "A" 02 Lab Accession ID 03 Account Number 04 Account Name 05 Account Address 1 06 Account Address 2 07 Account City 08 Account State 09 Account ZIP Code 10 Account Phone Number 11 Account Contact
** Collection Site Record 01 Record Type = C "C" 02 Lab Accession ID 03 Collection Site ID 04 Collection Site Name 05 Collection Site Address 1 06 Collection Site Address 2 07 Collection Site City 08 Collection Site State 09 Collection Site ZIP Code 10 Collection Site Phone Number 11 Collection Site Contact 12 Collector Name 13 Collector Phone Number
** Sample Demographic Record 01 Record Type = S "S" 02 Lab Accession ID 03 Specimen ID (Custody Form ID) 04 Donor ID 05 Donor Name 06 Panel
07 Reason For Test (See list of values) 08 Regulated Sample (Y/N) 09 Collection Date 10 Collection Time 11 Lab Receipt Date 12 Lab Received Time 13 Lab Report Date 14 Lab Report Time 15 Result Send Date 16 Result Send Time 17 Location Code 18 Airbill Number 19 Sample Result (See list of values) 20 Lab Recv/Cancel Code 1 (See list of values) 21 Lab Recv/Cancel Code 2 22 Lab Recv/Cancel Code 3 23 Lab Recv/Cancel Code 4 24 Lab Recv/Cancel Code 5 25 Lab Comments 26 Medical Review Officer
** Detail Record For Sample Testing 01 Record Type = D "D" 02 Lab Accession ID 03 Panel 04 Test Code Type (Drug Class (C) or specific compound/analyte (D)) 05 Test Code (See list of values) 06 Test Result 07 Test Quantitation (If available) 08 Test Cutoff Level 09 Test Cutoff Units (See list of values)
01 File Ending "END FILE"
** EXAMPLE (No collection info was entered on this sample)
BEGIN FILE
A|100200|ABC0100|COMPANY B/WASHINGTON|4455 45TH AVE
SOUTH||SEATTLE|WA|98108|2066216255|MEDICAL SERVICES SUPERVISOR
C|100200||||||||||John Doe|8005551212
S|100200|5133330|542707646||5p50|PE|Y|05/08/00|00:00:00|05/10/00|15:04:33|05/10/00|16:00:00|05/10/00|16:
01:44|1Z84W2772750071527|P|||||||John Doe
D|100200|5p50|C|THC|N|0|50|NG/ML D|100200|5p50|C|AMP|P|0|1000|NG/ML D|100200|5p50|D|AMP1|P|0|500|NG/ML D|100200|5p50|D|AMP2|N|0|500|NG/ML D|100200|5p50|C|COC|N|0|300|NG/ML D|100200|5p50|C|OPI|N|0|2000|NG/ML D||100200C|5p50|PCP|N|0|25|NG/ML
END FILE
Lab List of Values
Reason for Test - Field S-07
PE Pre-Employment RA Random PA Post-Accident RC Reasonable Suspicion RH Rehab FU Follow-up RD Return to Duty
DR DRM
OT Other EX Expatriot NG Not given PM Periodic Medical
Sample Result - Field S-19
N Negative 1 Negative Dilute P Positive 2 Positive Dilute A Adulterated I Invalid/Unsuitable S Substituted F Rejected - Fatal Flaw U Rejected - Uncorrected Flaw
C Rejected - Lab Accident
Receiving and Cancel Codes Field(s) S-20 through S-24
A1 Federal collection on non-Federal form A2 No donor ID or SSN refusal not noted A3 Donor ID or SSN smudged or not legible A4 Collect didn't sign cert statement A5 Collect didn't date cert statement A6 Date missing on CCF A7 Inconsistent dates on CCF A8 Signature missing on CCF A9 Method of Shipment missing on CCF Aa Collect didn't sign cert statement Ab Collector didn't date cert statement Ac CCF did not accompany bottle Ad Signature missing on CCF; name present Ae Date missing on CCF and bottle label Af Specimen Temperature box not marked Ag Signature missing on CCF; name present Ah Date missing on CCF and bottle label Ai Specimen Temperature box not marked Aj CCF did not accompany bottle Ak No donor ID or SSN refusal not noted Al Date missing on CCF Am Inconsistent dates on CCF An Signature missing on CCF Ao Method of Shipment missing on CCF Ap Donor ID smudged/not legible C1 CCF did not accompany bottle C2 Bottle did not accompany CCF C3 Sample # on bottle and form don't match C4 No Specimen ID on bottle C5 No seal on bottle or seal not over top C6 Seal broken or shows signs of tampering C7 Quantity not sufficient <30 mls C8 Collector did not print/sign name on CCF CR Sample canceled at client request Ca Bottle did not accompany CCF Cb Sample # on bottle and form don't match Cc No Specimen ID on bottle
Cd No seal on bottle or seal not over top Ce Seal broken or shows signs of tampering Cf Quantity not sufficient 5 ml or less Cg Collector name and signature missing N1 Date on label doesn't match date on form N3 Donor initials missing on bottle seal N4 Temperature out of range, noted on CCF N5 Second collection noted in Remarks N6 Suspected tampering/Adulteration noted N7 Report/Original copy of CCF not rec'd N8 Extraneous paperwork received at Lab N9 Specimen older than 10 days FF Affidavit not returned, cancel sample Na No donor ID or SSN, refusal not noted Nb Temperature out of range - noted on CCF Nc Second collection noted in Remarks Nd Suspected tampering/adulteration noted Ne Donor ID or SSN smudged or illegible Nf Report/Original copy of CCF not rec'd Ng Extraneous paperwork received at lab Nh Specimen older than 10 days Ni Date on label doesn't match date on form Nj Split bottle rec'd, CCF listed as "NO" Nk Reason for test missing Nl Reason for test missing Ns Specimen is colorless Nt Specimen is blue Nu Specimen is green Nv Specimen is red Nw Specimen is black SS Split specimen received US Unsuitable Specimen Aq Federal Collection on an Expired Form
Test Code - Field D-04
6-MAM 6-Acetylmorphine
6AM 6-ACETYLMORPHINE
6AM1 6-Acetylmorphine 7AM 7-AminoFlunitrazepam 7AM1 7-AminoFlunitrazepam 7AM2 7-AminoClonazepam 7CL1 7-AminoFlunitrazepam 7CL2 7-AminoClonazepam
7CLN 7-AMINOCLONAZEPAM
AMB1 Ambien
AMBN AMBIEN
AMI1 Amitryptyline
AMIT AMITRIPTYLINE
AMP AMPHETAMINES
AMP1 Amphetamine
AMP2 Methamphetamine AMP5 Amphetamine AMP6 Methamphetamine
AMPI METHAMPHETAMINE ISOMERS
BA BLOOD ETHANOL
BA1 Blood Ethanol BAM1 Blood Amphetamine
BAMP BLOOD AMPHETAMINES
BAR BARBITURATES
BAR1 Amobarbital BAR3 Butalbital BAR4 Pentobarbital BAR5 Phenobarbital BAR6 Secobarbital BAR7 Butabarbital BBA1 Blood Amobarbital BBA3 Blood Butalbital BBA4 Blood Pentobarbital BBA5 Blood Phenobarbital BBA6 Blood Secobarbital
BBAR BLOOD BARBITURATES
BBEN BLOOD BENZODIAZEPINES
BBN1 Blood Flurazepam BBN2 Blood Nordiazepam BBN3 Blood Oxazepam BBN4 Blood Temazepam BBN5 Blood Desalkylflurazepam BBN6 Blood Diazepam BBN7 Blood Chlordiazepoxide BBN8 Blood Alprazolam BBN9 Blood Triazolam BCO1 Blood BZE (Cocaine metabolite) BCO2 Blood Cocaethylene BCO3 Blood Cocaine
BCOC BLOOD COCAINE
BE1 Benzoylecgonine
BEN BENZODIAZEPINES
BEN1 Alprazolam BEN2 Chlordiazepoxide BEN3 Clorazepate BEN4 Diazepam BEN5 Nordiazepam BEN6 Flurazepam BEN7 Lorazepam BEN8 Oxazepam BEN9 Temazepam BFN1 Blood Fentanyl
BFNT BLOOD FENTANYL
BLC1 Bleach
BLCH BLEACH
BLS1 Blood LSD
BLSD BLOOD LSD
BMEP BLOOD MEPERIDINE
BMP1 Blood Meperidine BMT1 Blood Methamphetamine
BMTHBLOOD METHAMPHETAMINES
BN10 Triazolam BN11 OH-Alprazolam BN12 OH-Triazolam BN13 Desalkylflurazepam BN14 7-AminoNitrazepam BN15 Midazolam metabolite BN16 Alprazolam metabolite BN17 Triazolam metabolite BN18 Flurazepam metabolite BN19 Clonazepam metabolite BN20 Flunitrazepam metabolite BN21 Nitrazepam metabolite BN22 Estazolam BOP1 Blood Codeine BOP4 Blood Morphine
BOPI BLOOD OPIATES
BPC1 Blood Phencyclidine
BPCP BLOOD PHENCYCLIDINE
BRO1 Brompheniramine
BROMBROMPHENIRAMINE
BSO1 Blood Codeine BSO2 Blood Hydrocodone BSO3 Blood Hydromorphone BSO4 Blood Morphine BSO5 Blood Oxycodone
BSOP BLOOD SPECIAL OPIATES
BTH1 THCA
BTH2 THC
BTH3 11-Hydroxy-THC
BTHC BLOOD THC
BUP BUPRENORPHINE
BUP1 Buprenorphine CAR1 carisoprodol
CARI CARISOPRODOL
CHL1 Chlorpheniramine
CHLR CHLORPHENIRAMINE
COC COCAINE
COC1 Cocaine metabolite COC2 Cocaine COCC Cocaine Confirmation
COD CODEINE
COT Cotinine COT1 Cotinine CRE1 Creatinine CRE2 Creatinine CRER Creatinine
CRET Creatinine
CRM CHROMIUM
CRM1 Chromium
DES1 MDA
DES2 MDEA
DES3 MDMA
DESN DESIGNER DRUGS
DEX DEXTROMETHORPHAN
DEX1 Dextromethorphan DIE1 Diethylpropion
DIET DIETHYLPROPION
DIP1 Diphenhydramine
DIPH DIPHENHYDRAMINE
DL METHAMPHETAMINE ISOMERS
DL1 D-Methamphetamine DL2 L-Methamphetamine DOX1 Doxylamine
DOXY DOXYLAMINE
EME EME
EME1 Ecgonine Methyl Ester
EPH EPHEDRINE
EPH1 Ephedrine EPH2 Pseudoephedrine EPH3 Phenylpropanolamine
ETG ETHYLGLUCURONIDE
ETG1 Ethylglucuronide ETO1 Ethanol
ETOH ETHANOL
FCHL Free Chlorine FEN Phen/Fen FEN1 Phen/Fen
FENT FENTANYL
FLR1 Fluoride
FLRD FLUORIDE
FLX1 Fluoxetine FLX2 Norfluoxetine
FLXT FLUOXETINE
FNF1 Fenfluramine
FNFL FENFLURAMINE
FNT1 Fentanyl
FUL FULL SCAN
FUL1 Full Scan
GHB GHB
GHB1 GHB
GLUT GLUTARALDEHYDE
HAM1 Amphetamine HAM2 Methamphetamine
HAM3 MDMA
HAM4 MDA
HAM5 MDEA
HAMPAMPHETAMINES in Hair
HCO1 Benzoylecgonine HCO2 Cocaethylene HCO3 Cocaine Parent HCO4 Norcocaine HCO5 Coc Ratio HCOC COCAINE in Hair
HCOP HEALTHCARE OPIATES
HDL METHAMP ISOMERS in Hair HDL1 D-Methamphetamine HOP1 6-Acetylmorphine HOP2 Codeine HOP3 Heroin HOP4 Morphine HOP5 Hydrocodone HOP6 Hydromorphone HOP7 Oxycodone HOP8 Oxymorphone HOPI OPIATES in Hair HPC1 Phencyclidine HPCP PHENCYCLIDINE in Hair
HTH1 THC-COOH
HTHC CANNABINOIDS in Hair
IBU IBUPROFEN
IBU1 Ibuprofen IDA1 Iodate IOD1 Iodine
IODA IODATE
IODI IODINE
KET KETAMINE
KET1 Ketamine (Qualitative Only)
LSD LSD
LSD1 LSD
MDA MDA/MDEA/MDMA
MDA1 MDA
MDZ1 Midazolam
MEP MEPERIDINE
MEP1 Meperidine MEP2 Normeperidine
MES MESCALINE
MES1 Mescaline
METD METHADONE
METH METHAMPHETAMINE
METQ METHAQUALONE
MIDZ MIDAZOLAM
MOPI MEDICAL OPIATES
MORP MORPHINE
MPB1 Meprobamate MPH1 Ritalinic Acid
MPHNMETHYLPHENIDATE
MPR1 Meprobamate
MPRB MEPROBAMATE
MTD1 Methadone
MTD2 EDDP
MTH1 Methamphetamine MTQ1 Methaqualone NAL1 Nalbuphine NAL2 Naltrexone NAL3 Butorphanol
NALB NALBUPH/NALTREX/BUTORPH
NIT1 Nitrite NIT2 Nitrite NITD Nitrite Dipstick
NITR NITRITE
NMEP NORMEPERIDINE
NORT NORTRIPTYLINE
NRT1 Nortriptyline
O300 OPIATES (300)
OAM1 Amphetamine OAM2 Methamphetamine
OAM3 MDMA
OAM4 MDA
OAM5 MDEA
OAMPAMPHETAMINES in Oral Fluid OCO1 Benzoylecgonine OCO2 Cocaethylene OCO3 Cocaine Parent OCO4 Norcocaine OCO5 Coc Ratio OCOC COCAINE in Oral Fluid OOP1 6-Acetylmorphine OOP2 Codeine OOP3 Heroin OOP4 Morphine OOP5 Oxymorphone OOP6 Hydromorphone OOP7 Oxycodone OOP8 Hydrocodone OOPI OPIATES in Oral Fluid OPC1 Phencyclidine OPCP PHENCYCLIDINE in Oral Fluid
OPI OPIATES
OPI1 Codeine OPI2 Hydrocodone OPI3 Hydromorphone OPI4 Morphine OPI5 Oxycodone OPI6 Oxymorphone OPI7 Dihydrocodeine
OTH1 THC
OTHC CANNABINOIDS in Oral Fluid
OXID OXIDANTS
OXY OXYCODONE
OXY1 Oxycodone
PCP PHENCYCLIDINE
PCP1 Phencyclidine PEN1 Pentazocine
PENT PENTAZOCINE
PEPH PSEUDOEPHEDRINE
PH pH PH1 pH PHA1 Pheniramine
PHAMPHENIRAMINE
PHN1 Phenylpropanolamine
PHNL PHENYLPROPANOLAMINE
PHNT PHENTERMINE
PHT1 Phentermine PMT1 Phenmetrazine
PMTZ PHENMETRAZINE
PND1 Phendimetrazine
PNDZ PHENDIMETRAZINE
PPX PROPOXYPHENE
PPX1 Propoxyphene PPX2 Norpropoxyphene PYR Pyridine
SERT SERTRALINE
SG Specific Gravity SG1 Specific Gravity SG2 Specific Gravity
SMA SYMPATHOMIMETIC AMINES
SMA1 Ephedrine SMA2 Pseudoephedrine SMA3 Phenylpropanolamine SMA4 Phentermine SMA5 Fenfluramine
SOAP
SOM1 Soma (Qualitative Only)
SOMASOMA
SOP1 Codeine SOP2 Hydrocodone SOP3 Hydromorphone SOP4 Morphine SOP5 Oxycodone SOP6 Oxymorphone
SOPI SPECIAL OPIATES
SRT1 Sertraline
THC CANNABINOIDS
THC1 CANNABINOIDS (THC metabolite)
THC2 CANNABINOIDS 100
TRA1 Tramadol (Qualitative Only) TRA2 Tramadol TRA3 Tramadol metabolite
TRAMTRAMADOL
TRAZ TRAZODONE
TRZ1 Trazodone
Units of Measure - Field D-09
% Percent dL deciliters gm % grams percent mL milliliters mg/L milligrams per liter mg/dL milligrams per deciliter mg/milligrams per milliliter ng/mL nanograms per milliliter pg picograms pg/mL picograms per milliliter ug/L micrograms per liter ug/mL micrograms per milliliter
Attachment J-8
Example of Past Performance Questionnaire Scoring
If this vendor provided or is providing services for your organization, please rate your level of satisfaction for each of the areas and also answer the following questions. Please rate your level of satisfaction using the following rating scale:
5 = Outstanding: Offeror's performance was technically acceptable and, in many respects, exceeded customer expectations and contract requirements, and provided significant, unusual, unique, worthwhile features or benefits.
4 = Good: Offeror’s performance was technically acceptable, and, in some but not all respects, exceeded customer expectations and contract requirements.
3 = Satisfactory: Offeror's performance met customer expectations or contract requirements (i.e., demonstrated an acceptable understanding of the requirements, provided an acceptable management approach to tasks; and provided complete response to customer needs).
2 = Marginal: Offeror's performance could have stood improvement (i.e., demonstrated a less than comprehensive understanding of requirements/tasks).
1 = Unsatisfactory: Offeror performance DID NOT meet customer expectations or contract requirements.
How would you rate the overall quality of the services provided?
How would you rate their ability to manage their staff and subcontractors?
How would you rate the attitude of their personnel, including the management, towards you and your customers?
Given the opportunity, would you use this Contractor again?
Attachment J-9
Past Performance Questionnaire
Reference Information: Provide the following information for the Organization that performed the referenced work:
Offeror’s (Prime)
Name:
Reference Informatio n n
Referencee’s Name:
Solicitation Number & Title:
693JK422R800003 “Forensic Toxicology Drug Testing Laboratory”
Organization/Person Providing the Reference Information: Provide the following information for the Organization and Person/Point of Contact (POC) providing the reference (to assist us in tracking responses received and resolving any conflicts in the evaluation process if necessary):
Organization Name:
Questionnaire Completion Date:
Name of Contact:
Contact Numbers:
Telephone e:
Facsimile le:
Reference Information
Organization/Office:
Position Title:
Reference Project Information: Provide the following information about the referenced project.
Customer Organization/Office:
Project Title:
POC Period of Involvement:
Type of Contract:
Reference Project
Information
Period of Project Performance:
Start Date: Length:
Current : Contract Value: Initial:
NOTE: THIS INFORMATION WILL BE KEPT CONFIDENTIAL
For the following questions, please circle/check the appropriate rating. Comment lines are provided for additional information if the #2 or #1 rating is given (however the comment lines may be used to provide any additional information deemed noteworthy).
High Low
1. TECHNICAL QUALITY OF SERVICE: 5 4 3 2 1
This area deals with compliance of contract requirements, to include appropriateness of personnel and technical excellence.
2. TIMELINESS OF PERFORMANCE: 5 4 3 2 1
This area deals with the contractor’s ability to meet milestones and delivery schedules, to include responsiveness to technical direction, completion of efforts on time including wrap-up and contract administration.
3. PRICE/COST CONTROL: 5 4 3 2 1
This area deals with the contractor’s ability to control price/cost escalation during performance to include appropriate budgetary estimates, current/accurate/complete billings/invoices, relationship of negotiated costs to actual, claim submissions, cost efficiencies, and change order issues.
4 BUSINESS RELATIONS: 5 4 3 2 1
This area deals with the contractor’s commitment to satisfaction and cooperative/reasonable businesslike behavior with own staff and customers to include: effective management, responsiveness to contract requirements, operates with honesty and integrity, prompt notification of problems, flexible and proactive qualities, effective contractor-recommended solutions, and effective subcontracting and teaming arrangements.
Comments (attach additional page(s) as necessary):
GENERAL INFORMATION: Please provide answers to the following questions.
5. Has the contractor ever been given a cure notice, show cause notice, suspension of progress payments, or other letters directing the correction of a performance problem; or has this contract been partially or completely terminated, or is there any pending termination actions? ( ) No ( ) Yes If yes: ( ) Default ( ) Convenience; and please explain:
6. Changes in contract dollar value throughout the life of the contract are/were attributable, for the most part, to:
( ) Government-issued change orders ( ) claims submitted by the contractor ( ) other Government actions ( ) other contractor actions (please explain below)
7. Based on this contractor’s overall performance, would you award this contractor another Government contract?
( ) Yes ( ) No If no, please explain:
8. If any of the above responses are based on adverse past performance, have you discussed it with the contractor and has the contractor had an opportunity to comment?
( ) Not Applicable ( ) Yes ( ) No If yes or no, please explain:
Attachment J-10 Previous Contracts List
PREVIOUS CONTRACTS LIST
The Previous Contracts List for (insert name of offeror or teaming partner), represent the offeror’s (or teaming partner’s) three largest-dollar-value contracts, and four most recent contracts, task orders or projects, which include work primarily the same or similar to that described in 693JK422R800003, and that have been performed during the last five years:
Contract Number
Gov’t or Comm
Custome r r Name
Customer Address Contact Name/Title /Phone
Size of Effort
Perfor m mance Period
Contrac t t Type2
Prime or Subcontract or
Example 1 Gov’t Federal Office of Info. Tech. Mike Jones M 11/1/0 CPFF AAZ Corp, Aviation 800 Independence / 2 to Wash., DC Admin. Ave. SW Manager 9/30/0 Washington, DC /202-000- 4 20591 0000
Enter below the three largest dollar value contracts, task orders or projects which include work primarily the same/very similar to that in the IT Services 2006-2011 SOW, and that have been performed over the last five years.
Enter below the four most recent contracts, task orders or projects, which include work primarily the same or similar to that described in DTOS59-07-R-00014, and that have been performed over the last five years.
Note: This table may be provided in landscape format to allow for additional space.
1 Large (.>$10M); Medium ($1M-10M); Small (<$1M) 2 Firm Fixed Price (FFP); Cost Price Firm Fixed (CPFF); Cost Plus Award Fee (CPAF); or Other
Attachment J-11 - Non-Disclosure Form
CONTRACTOR EMPLOYEE NON-DISCLOSURE AGREEMENT
It is understood that as part of my official duties under the “Forensic Toxicology Drug Testing Laboratory” Contract or any of its task orders, I may come in contact with Government procurement sensitive information or proprietary business information from other contractors (e.g., cost data). I, as an official Government contractor employee, certify that I will not disclose, publish, divulge, release, or make known, in any manner or to any extent, to any individual other than an appropriate or authorized Government employee, the content of any sensitive information provided during the course of my employment. I understand that for the purpose of this agreement, sensitive information is to include procurement data, contract information, plans, strategies or other information not of a publicly released and available nature through appropriate sources.
I further certify that I will use proprietary business information only for official purposes in the performance of the “Forensic Toxicology Drug Testing Laboratory”, and will disclose such information only to those individuals who have a specific need to know in performance of official Government duties. I specifically will not disclose any such information to employees of my company or any other contractor employees who have not signed an applicable non-disclosure agreement. I will take all reasonable precautions to protect and to prevent the unauthorized disclosure and use of such information.
I hereby certify that I have read the non-disclosure agreement described above and I am familiar with the directives and policies governing the disclosure of sensitive information. I will fully and completely observe these directives and will not disclose such information to any unauthorized person, or use any information obtained for private use or gain at any time.
NAME (Please Print) SIGNATURE DATE
ORGANIZATION/AFFILIATION
| Attachment J-4A |
| Attachment J-4B |
| Attachment J-4C |
| Attachment J-4D |
| ACH VENDOR PAYMENT SYSTEM |
| Attachment J-7 Data Transmission Format |
| Attachment J-8 |
| NOTE: THIS INFORMATION WILL BE KEPT CONFIDENTIAL |
| For the following questions, please circle/check the appropriate rating. Comment lines are provided for additional information if the #2 or #1 rating is given (however the comment |
| Attachment J-10 Previous Contracts List |
File details come from the government source that posted it. Updated .