Attachment K - Anatomic Pathology Staffing Worksheet.docx
DOCX document 14 KB Posted
- Attached to
- Q515--Pathology and Laboratory Staffing Services
- Solicitation number
- 36C26223R0009
About this file
This document contains an attachment worksheet for evaluating proposals to provide anatomic pathology staffing services. The worksheet requires offerors to provide details of their most recent reference contract for each of five subspecialty areas: cytotechnologist, diener, histology technician, histology technologist, and pathology assistant. For each subspecialty contract reference, offerors must provide the name of the healthcare facility that received the services, dates of service, name and contact information for a facility point of contact to verify the services, and the name of the staffing company that provided the services. The related federal contract opportunity is solicitation number 36C26223R0009 from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22 to provide pathology and laboratory staffing services.
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ATTACHMENT K - Anatomic Pathology Staffing Worksheet
The information collected by this Worksheet will be used to evaluate proposals for STEP 1 of proposal evaluations. Offerors submitting proposals to provide anatomic pathology staffing services must complete each Table shown below for the most recent reference contract only for each subspecialty and submit the completed Worksheet with their proposal. Each subspecialty Table may reference a different contract, but each Table must contain the information pertaining to only one contract, namely, the most recent reference contract the Offeror wishes to submit for evaluation for that subspecialty under STEP 1 of proposal evaluations. Offerors must complete each Table entry unless the Table entry is marked as “Optional.”
| Anatomic Pathology Staff Subspecialty: |
| Cytotechnologist |
Contract Number/ID (Optional):
Name of Healthcare Facility Receiving These Staffing Services:
Dates These Staffing Services Were Provided:
Name of Healthcare Facility Point of Contact Who Can Verify Services Provided:
Contact Information for Healthcare Facility Point of Contact (Email or Phone Number):
Name of Staffing Company Who Provided These Services:
| Anatomic Pathology Staff Subspecialty: |
| Diener |
Contract Number/ID (Optional):
Name of Healthcare Facility Receiving These Staffing Services:
Dates These Staffing Services Were Provided:
Name of Healthcare Facility Point of Contact Who Can Verify Services Provided:
Contact Information for Healthcare Facility Point of Contact (Email or Phone Number):
Name of Staffing Company Who Provided These Services:
| Anatomic Pathology Staff Subspecialty: |
| Histology Technician |
Contract Number/ID (Optional):
Name of Healthcare Facility Receiving These Staffing Services:
Dates These Staffing Services Were Provided:
Name of Healthcare Facility Point of Contact Who Can Verify Services Provided:
Contact Information for Healthcare Facility Point of Contact (Email or Phone Number):
Name of Staffing Company Who Provided These Services:
| Anatomic Pathology Staff Subspecialty: |
| Histology Technologist |
Contract Number/ID (Optional):
Name of Healthcare Facility Receiving These Staffing Services:
Dates These Staffing Services Were Provided:
Name of Healthcare Facility Point of Contact Who Can Verify Services Provided:
Contact Information for Healthcare Facility Point of Contact (Email or Phone Number):
Name of Staffing Company Who Provided These Services:
| Anatomic Pathology Staff Subspecialty: |
| Pathology Assistant |
Contract Number/ID (Optional):
Name of Healthcare Facility Receiving These Staffing Services:
Dates These Staffing Services Were Provided:
Name of Healthcare Facility Point of Contact Who Can Verify Services Provided:
Contact Information for Healthcare Facility Point of Contact (Email or Phone Number):
Name of Staffing Company Who Provided These Services:
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