Attachment M - Staffing Services Experience Worksheet.docx

ATTACHMENT M - Staffing Services Experience Worksheet The information collected by this Worksheet will be used to evaluate proposals for the Experience proposal evaluation factor in STEP 2 of proposal evaluations. Offerors must use this Worksheet to describe their specific experience providing contracted staffing services in a healthcare setting for the specialty areas of anatomic pathology or clinical pathology, or both, for each reference contract the Offeror submits as evidence of its experience providing these services. Offerors are encouraged to identify the reference contract(s) for consideration for STEP 2 of proposal evaluations that the Offeror believes best demonstrate the Offeror’s level of experience providing contracted anatomic pathology staffing services (cytotechnologist, diener, histology technician, histology technologist, and pathologist assistant) or contracted clinical pathology staffing services (medical laboratory technician, medical technologist, and phlebotomist), or both, in a healthcare setting. Offerors must complete a separate Worksheet for each reference contract the Offeror wishes to have considered for Step 2 of proposal evaluations. No other format may be used.

Reference Contract Worksheet # ______

Contract number (or other identifier):

Subspecialty staff provided under this reference contract:

[Do not include specialties outside of the anatomic and clinical pathology specialty areas] [List all of the anatomic and clinical pathology staff subspecialties provided under this reference contract]

Narrative providing details of the specific tasks the Offeror performed under this reference contract:

The dates during which the Offeror performed this reference contract:

The average monthly number of staff the Offeror provided for each staff subspecialty provided under this reference contract:

[Break out and specify numbers separately for each anatomic and clinical pathology staff subspecialty provided under the reference contract] [Example:

Average number of dieners provided each month: 2 Average number of pathologist assistants provided each month: 5 Average number of phlebotomists provided each month : 17

Legal name of the entity who provided the staffing services under this reference contract:

[If the reference contract is work for performed by a proposed subcontractor for this procurement, identify the proposed subcontractor] [Name either the Offeror or a proposed subcontractor of the Offeror]

Whether the Offeror or its proposed subcontractor was the prime contractor or a subcontractor for this reference contract:

The name, phone number, and email address of a person at the entity with whom the Offeror (or Offeror’s proposed subcontractor) held this reference contract who can verify the information provided in this Worksheet: