D.1 ATTACHMENT A - VA CONTRACTOR BACKGROUND INVESTIGATION REQUEST WORKSHEET.pdf

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Veterans Health Administration (VHA) Caregiver Support Program Financial and Legal Services
Solicitation number
36C10X22R0017
Issued by

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This solicitation is for financial and legal services to support the Veterans Health Administration Caregiver Support Program. The solicitation was issued as a request for proposal with number 36C10X22R0017 under the North American Industry Classification System code 541110 for offices of lawyers and product service code R418 for legal services. The small business size standard is $12 million in average annual revenue. The Department of Veterans Affairs Strategic Acquisition Center Frederick will award a single contract for the required services. Interested parties should review the solicitation documentation for details on submission requirements and evaluation criteria.

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Other files

File Type Posted
36C10X22R0017 0005.pdf PDF
36C10X22R0017 0004.pdf PDF
36C10X22R0017 0003.pdf PDF
D.5 ATTACHMENT E_PRICE SCHEDULE.xlsx XLSX spreadsheet
36C10X22R0017_0002.pdf PDF
36C10X22R0017 0001.pdf PDF
D.4 ATTACHMENT D_APPENDIX D_CONTRACTOR RULES OF BEHAVIOR.pdf PDF
D.2 ATTACHMENT B - PAST PERFORMANCE REFERENCES.pdf PDF
36C10X22R0017.pdf PDF
D.3 ATTACHMENT C- PAST PERFORMANCE QUESTIONAIRRE (PPQ).docx DOCX document

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Contractor Background Investigation Request

VA Organization Billing Information

Organization: [ ]
Station:
Station Label: Station #
Date Label: Current Date:
Date:
Organization Label: VA Organization
City Of Birth Label: City of Birth
Date of Birth Label: Date of Birth
Company POC Label: Company POC
Company POC Email Label: POC Email Address
Company City Label: City
Company Zip Label: Zip
Last Name:
Middle Name:
Country of Birth: [ ]
City of Birth:
Date of Birth:
Company State: [ ]
First Name:
Company State Label: State
Last Name Label: Last Name
Middle Name Label: Middle Name
First Name Label: First Name
SSN Label: SSN
SSN:
Gender:
Gender Label: Gender
Email Address:
Country of Citizenship: [ ]
Country Of Birth Label: Country of Birth
State of Birth Label: State of Birth
Email Address Label: Email Address
Country of Citizenship Label: Country of Citizenship
Position Title Label: Position Title
Company POC:
Position Title:
Priority Label: Priority
Child Care Label: Child Care
Priority: Off
Child Care: Off
Individual Information Label: Individual Information
Company Information Label: Company Information
COR Information: CO / COR
COR Email Label: CO / COR Email
COR Address 1 Label: CO / COR Address 1
COR Address 2 Label: CO / COR Address 2
COR Name Label: Name of CO / COR
COR Phone Label: CO / COR Phone Number
COR Station Label: CO / COR Station #
COR State: [ ]
State of Birth: [ ]
COR State Label: State
COR City Label: City
COR Zip Label: Zip
Company Zip:
Company City:
COR City:
COR Address 1:
COR Zip:
COR Address 2:
Company POC Email: Use semicolons for multiple addresses.
COR Email: Use semicolons for multiple addresses.
COR Name:
COR Station:
State Instructions: Leave blank if foreign born.
Options Label: Additional options may be presented after an investigation is selected.
Investigation Label: Investigation
Investigation: [Select One...]
COR Phone:
Contractor Company Label: Contractor Company
Contractor Company:
Task Order Number Label: Task Order Number
Task Order Number:
POC Address Label: POC Address
POC Address:
Phone Number Label: Phone Number
Phone Number:
Reinvestigation Label: Reinvestigation
Reinvestigation: Off
Include SAC Label: Include SAC
Include SAC: Off

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