D.45 Documentation Checklist.pdf

D.45. DOCUMENTATION CHECKLIST

36C25923R0008

OFFEROR INSTRUCTIONS CHECKLIST- This checklist serves as an aid to offerors. The Government is not responsible for any missed documents as a result of this aid. The Offeror is responsible for submitting a complete proposal in accordance with the RFP. Offerors should thoroughly review and be familiar with the requirements of the solicitation, clauses, provision and attachments prior to submitting proposals.

Offerors is registered in the System For Award management (SAM) under the applicable North American Industry Classification System (NAICS) and completed annual representation and certification, Solicitation Clause 52.212-3 Offeror Representations and Certifications—Commercial Items, electronically at https://sam.gov/.

Yes No

Offeror must submit complete proposal consisting of: Technical Proposal, Past Performance and Price Proposal.

Yes No

The offeror shall submit two (2) electronic copies of the complete proposal, one proposal will be a redacted proposal; The technical and facility proposal must not contain any reference to cost/price. Offerors shall ensure their proposal clearly identifies the appliable sections relating each factor

Yes No

The proposals shall be 8 ½” x 11” paper except for foldouts used for charts, tables, or diagrams, which may not exceed 11”x 17”.

Yes No

A page is defined as one fact of a sheet of paper containing information. Yes No FONT/Typing shall not be less than 10 Pitch. Yes No The Cover sheet, Table of Content, Floor Plans and Drawings, Certification(s), Transcript(s), Certificate(s), License(s), and Curriculum Vitae (s) will not be counted towards the Technical Capability page limit. Any information that exceeds this page limit will not be reviewed.

Yes No

Past Performance page limit shall not exceed 7 pages. The letters, metrics, customer surveys will not be counted towards the 7 page limit. Any information that exceeds this page limit will not be reviewed.

Yes No

Indicate the name of the business on the first page only in the redacted proposal. Did not place business name on every page of the proposal.

Yes No

Each Evaluation Factor shall be labeled:

Factor A –Technical Capability

Sub-factor (1) – Offeror’s Capabilities/Experience

Sub-factor (2) – Quality Staffing

Sub-factor (3) – Implementation Plan

Sub-factor (4) – Quality Management/Performance Improvement

Factor B – Facility

Sub-factor (1) – Geographic Location

Sub-factor (2) – Clinical Design/Accessibility

Factor C – Past Performance

Factor D– Price

Yes No

Provide Davis Bacon Rates for proposed PACT Design Buildouts IAW DBA rates. Yes No Complete blocks 12, 17a, 17b, 30a ,30b and 30c of Standard Form (SF) 1449 Solicitation/Contract/Order for Commercial Items.

Yes No

D.47. DOCUMENTATION CHECKLIST

B.1 Continuation of Contract Administration Data: Complete block 1 with contractor information, block 5 Amendment Acknowledgement (if applicable) and return actual

Amendments (SF30) if applicable (blocks 15A, B, and C completed). Original signature of an authorized representative of the offeror is required for Block 15A. Complete block 6 with

Unique Entity ID, and block 7 Federal Tax ID Number.

Yes No

Schedule of Services: Insert proposed unit price, total cost per month and total cost per year prices for each Line-Item Number (LIN) for each period of performance (POP). The Total Estimated Cost Per Month amount must equal the whole dollar per unit price multiplied by the number of units. The Total Estimated Cost Per Year must equal The Total Estimated Cost Per Month multiplied by 12.

Yes No

Registered and verified in the Small Business Administration Veteran Small Business Certification (VetCert) database as a SDVOSB, https://veterans.certify.sba.gov/effective before the closing date of this solicitation.

Yes No

Offerors shall provide current organizational chart and description of organization’s history.

This chart shall clearly show organizational relationships, lines of authority and responsibility, as well as span of control.

Yes No

Provide a list of names of the qualified physicians, nurse practitioners, physician assistants, and other primary care provider staff intended to be utilized in the performance of the contract.

Yes No

Offerors shall provide copies of the following for any physician(s) to be assigned to perform services under the contract, including any physicians to provide coverage relief:

• Board Certification or Board Eligibility in Internal Medicine and/or Family Practice

• Active, current, unrestricted license in the state where the outpatient site of care (CBOC) is located

• Curriculum Vitae

Yes No

Offerors shall provide copies of the following on any nurse practitioner(s) to be assigned to perform services under the contract, including any nurse practitioner(s) to provide coverage relief:

• Transcript(s) from an Accredited Nurse Practitioner Program

• Graduation Certificate from an Accredited Nurse Practitioner Program

• Active, current, unrestricted license in the state where the outpatient site of care (CBOC) is located

• Curriculum Vitae

Yes No

Offerors shall provide copies of the following on any Physician Assistant to be assigned to perform services under the contract, including any Physician Assistant (s) to provide coverage relief:

• Transcript(s) from an Accredited Physician Assistant Program

• Graduation Certificate from an Accredited Physician Assistant Program

• Active, current, unrestricted license in the state where the outpatient site of care (CBOC) is located

• Curriculum Vitae

Yes No

Offerors shall provide a list of administrative support staff and describe the level of training and experience of each personnel that will be utilized to meet the administrative support functions in the performance of the contract requirements, including descriptions of the grievance system and quality assurance/performance improvement mechanisms.

Yes No

Offeror shall provide a detailed operational plan, to include staffing for the first 90 days of the clinic operation.

Yes No

Offeror shall provide a synopsis of their overall approach to quality control and improvement.

Yes No

D.47. DOCUMENTATION CHECKLIST

Offeror shall provide a detailed floorplan to meet the minimum patient care requirements

(In accordance with Section 4.4 Space Requirements of the Performance of Work Statement) Yes No

Offeror shall provide a detailed floorplan to meet the minimum OSHA, NFPA, ADA, and Joint Commission requirements. (In accordance with Section 4.4 Space Requirements of the Performance of Work Statement.

Yes No

Offerors shall identify three (3) active or recently completed contracts (within the past three years).

Yes No

Include a narrative, limited to no more than 2 pages per contract identified, in the Past

Performance References attachment that demonstrates satisfactory performance under the referenced contract.

Yes No

Provide any information currently available (letters, metrics, customer surveys, independent surveys, etc.) which demonstrates customer satisfaction with overall job performance and quality for same or similar type contracts. s, etc.) which demonstrates customer satisfaction with overall job performance and quality for same or similar type contracts.

Yes No

Provide a letter from all subcontractors that will perform major or critical aspects of the requirement, consenting to the release of their past performance information to the prime contractor.

Yes No

Followed Instructions - 852.219-75 – VA Notice of Limitations on Subcontracting Certificate of Compliance.

Yes No

Followed Instructions 52.212-3 – Offeror Representations and Certifications. Yes No Followed Instructions 52.203-13 – Contractor Code of Business Ethics and Conduct. Yes No

Followed Instructions 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services.

Yes No

Followed Instructions 52-209-7 – Information Regarding Responsibility Matters. Yes No

Followed Instructions 52.229-11- Tax on certain Foreign Procurements Notice and Representation.

Yes No

Followed Instructions Organizational Conflict of Interest. Yes No

Followed Instructions Immigration Certification. Yes No

Followed Instructions Contractor Rules of Behavior. Yes No