Attachment M - Proposal Form.pdf
PDF 4 MB Posted
- Attached to
- MLRM External Clinical Review BPA
- Solicitation number
- 36C10X24R0038
About this file
This document is an Attachment M - Proposal Form for Solicitation 36C10X24R0038 issued by the Department of Veterans Affairs (VA) for the Office of Medical-Legal Risk Management (MLRM) External Clinical Review.
The solicitation seeks to establish multiple Blanket Purchase Agreements (BPAs) for peer review services of selected episodes of care. The contractor must provide a recruitment strategy, demonstrate depth in all required labor categories, offer providers in all identified specialties and subspecialties, provide onboarding support, and have sound contract management processes. Past performance will be evaluated for relevance, recency, and satisfactory or better performance. Offerors must submit the completed Proposal Form, signed SF 1449, representations and certifications, and proposed pricing by the July 2, 2024 deadline. The BPAs will have a 5-year period of performance. All responsible sources may submit proposals for this unrestricted, full and open competition solicitation.
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ATTACHMENT M - PROPOSAL FORM
Office of Medical-Legal Risk Management (MLRM) External Clinical Review
Proposal Files for Solicitation 36C10X24R0038
Instructions: Offeror must complete the following information as instructed.
Page Limitations for each section are provided within each section.
Basis for Award- Technical Approach, Past Performance, Socioeconomic Considerations, and Price: The Government requires contractors capable of simultaneously meeting unique and highly complex peer reviews across all provider disciplines with expertise in conducting reviews of selected episodes of care. The Government requires a provider panel of sufficient size in each discipline to meet the volume and demand of the VA. The Government will conduct a comparative evaluation of the Offeror’s written response.
Solicitation 36C10X24R0038 Offeror Name:
Technical Approach
Complete the Technical Approach and Past Performance questions below in full detail, as outline in section E.2 of the Solicitation.
Responses are limited to the space provided for each area.
Recruitment Strategy (2,000 Character limit on this page and 4,000 Characters limit on the next)
(continue on next page)
The Government will evaluate Technical Approach as follows:
The Government will therefore evaluate the Offeror to determine whether their Technical Approach is fully capable recruitment strategy, depth in all labor categories (LCATs), offers providers in all identified specialties and sub-specialties as described in Attachment A - Specialties, provides on-boarding support including IT troubleshooting for staff and reviewers, and has sound contract management processes with the ability to administer orders in an efficient manner.
Recruitment Strategy cont. (4,000 Character limit)
Depth in all Labor Categories (LCATs)(4,000 Character limit)
Offers providers in all identified specialties and subspecialties as described in Attachment A - Specialties(4,000 Character limit)
Provides onboarding support including IT troubleshooting for staff and reviewers (4,000 Character limit)
Contract Management processes with the ability to administer orders in an efficient manner (4,000 Character limit.)
Area for additional details, if needed(4,000 Character limit)
Past Performance #1
2. Past Performance Name of Contracting Organization:
Contract Number and Task Order Number:
WORK WAS PERFORMED AS THE: PRIME SUBCONTRACTOR
Total Awarded Price/Cost:
Final or Projected Final Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer’s Name, Email, and Telephone Number:
Program Manager’s Name, Email and Telephone Number
North American Industry Classification System (NAICS) Code:
Was there a CPARS? : YES NO UNKNOWN
Description of the Requirement (5,000 Characters)
Past performance will be evaluated to determine whether each reference is relevant (based on size, scope, and/or complexity to this requirement), recent (within the past three years), and reflects performance which is satisfactory or better.
Past Performance #1 cont.
< Narrative of timely completion and declined cases> (5,000 Characters)
The Government will also evaluate the rate of timely completion of deliverables on similar size contracts and if cases were ever declined. If cases were ever declined, offeror shall provide the percentage of declined cases.
Past Performance #2
2. Past Performance Name of Contracting Organization:
Contract Number and Task Order Number:
WORK WAS PERFORMED AS THE: PRIME SUBCONTRACTOR
Total Awarded Price/Cost:
Final or Projected Final Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer’s Name, Email, and Telephone Number:
Program Manager’s Name, Email and Telephone Number
North American Industry Classification System (NAICS) Code:
Was there a CPARS? : YES NO UNKNOWN
Description of the Requirement (5,000 Characters)
Past performance will be evaluated to determine whether each reference is relevant (based on size, scope, and/or complexity to this requirement), recent (within the past three years), and reflects performance which is satisfactory or better.
Past Performance #2 cont.
< Narrative of timely completion and declined cases> (5,000 Characters)
The Government will also evaluate the rate of timely completion of deliverables on similar size contracts and if cases were ever declined. If cases were ever declined, offeror shall provide the percentage of declined
Past Performance #3
2. Past Performance Name of Contracting Organization:
Contract Number and Task Order Number:
WORK WAS PERFORMED AS THE: PRIME SUBCONTRACTOR
Total Awarded Price/Cost:
Final or Projected Final Price/Cost:
Delivery date/Period of performance (including base and options if applicable):
Contracting Officer’s Name, Email, and Telephone Number:
Program Manager’s Name, Email and Telephone Number
North American Industry Classification System (NAICS) Code:
Was there a CPARS? : YES NO UNKNOWN
Description of the Requirement (5,000 Characters)
Past performance will be evaluated to determine whether each reference is relevant (based on size, scope, and/or complexity to this requirement), recent (within the past three years), and reflects performance which is satisfactory or better.
Past Performance #3 cont.
< Narrative of timely completion and declined cases> (5,000 Characters)
The Government will also evaluate the rate of timely completion of deliverables on similar size contracts and if cases were ever declined. If cases were ever declined, offeror shall provide the percentage of declined
Offeror Name:
SF 1449, AMENDMENTS, OTHER DOCUMENTS
Instructions: The following shall be submitted in addition to this proposal form:
1. Signed SF 1449 and amendment(s), if any. An authorized official of the VITAL submitting the response shall sign the SF 1449, amendment(s) and all certifications requiring signature.
2. Offeror’s statement(s) as required by paragraph b. of the VAAR Clause, E.2 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST and any applicable OCI Mitigation Plans.
3. Paragraph b of 52.212-3, Offeror Representations and Certifications.
4. Paragraph (a)(4) from 52.212-4 Contract Terms and Conditions – Commercial Items (May 2015)
Alternate 1 (May 2014) must be completed, if applicable.
5. Any proposed terms and conditions and/or assumptions upon which the proposal is predicated.
Offerors are hereby advised that any offeror-imposed terms and conditions and/or assumptions which deviate from the Government’s material terms and conditions established by the solicitation, may render the offeror’s proposal unacceptable, and thus ineligible for award.
6. Completed Price Schedule (Section B.4 of this solicitation)
| Attachment D- Proposal Forms |
| Attachment G- Proposal Booklet |
| ggg.pdf |
| Attachment D- Proposal Forms |
| Attachment G- Proposal Booklet |
| Blank Page |
| ggg.pdf |
| Attachment D- Proposal Forms |
| Attachment G- Proposal Booklet |
| Blank Page |
| Blank Page |
| Attachment L Phase 1 Proposal Form.pdf |
| Attachment D- Proposal Forms |
| Attachment G- Proposal Booklet |
| ggg.pdf |
| Attachment D- Proposal Forms |
| Attachment G- Proposal Booklet |
| Blank Page |
| ggg.pdf |
| Attachment D- Proposal Forms |
| Attachment G- Proposal Booklet |
| Blank Page |
Blank Page
| Prime Offeror Name: |
| SDVOSB or JV Name: |
| Name of VIT Member: |
| Group33: Off |
| Program and Project ManagementRow1: |
| Program and Project Management continued: |
| Busines Requirements: |
| Strategic Planning: |
| Program Evaluation: |
| Busines Process Reengineering: |
| Change Management: |
| PRIME SUBCONTRACTORTotal Awarded PriceCost: |
| PRIME SUBCONTRACTORFinal or Projected Final Total PriceCost: |
| PRIME SUBCONTRACTORDelivery datePeriod of performance including base and options if applicable: |
| PRIME SUBCONTRACTORContracting Officers Name Email and Telephone Number: |
| PRIME SUBCONTRACTORProgram Managers Name Email and Telephone Number: |
| PRIME SUBCONTRACTORNorth American Industry Classification System NAICS Code: |
| undefined_18: |
| Contract# or Task Oredr#: |
| Detail plan for contract management and administration here: |
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