D.7 Required Compliance Checklist.docx
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- Solicitation number
- 36C25027Q5393
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This is a Required Compliance Checklist that contractors must complete to submit a compliant quote for courier services at Cincinnati VA Medical Center under RFQ 36C25027Q5393. The checklist is mandatory for all interested parties and serves as a guide to ensure all required documentation and information are included in the submission package.
The checklist requires contractors to provide: prime contractor information (name, DBA, SAM UEI, CAGE code, address, and primary point of contact); active SBA certifications and expiration dates for socioeconomic statuses including SDVOSB, VOSB, EDWOSB, WOSB, 8(a), HUBZone, and SDB. Contractors must submit completed and signed forms including SF 1449 (current version), SF 30 amendments with acknowledgment in Table B.1, FAR 52.222-41 Statement of DoL WD Compliance with occupational codes and titles, VAAR 852.219-75 Statement of Limitation of Subcontracting Compliance, D.6 Start Date Confirmation, proof of insurance meeting section C.9 requirements, and past performance documentation. Additionally, quotes must include FAR 52.209-7 Information Regarding Responsibility Matters and FAR 52.229-11 Tax on Certain Foreign Procurements, completed at submission. Technical submissions must contain a technical approach, staffing plan, vehicle fleet listing, courier route details (pickup/drop locations and times), and contingency plan. Any missing items will render the quote non-compliant and exclude it from award consideration. The checklist requires contractor signature, name, date, title, and company name.
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Other files
| File | Type | Posted |
|---|---|---|
| D.10 36C25027Q5393 Amendment 0003.docx | DOCX document | |
| 36C25027Q5393_3.docx | DOCX document | |
| 36C25027Q5393_2.docx | DOCX document | |
| D.9 36C25027Q5393 Amendment 0002.docx | DOCX document | |
| D.1 36C25027Q5393 Re-Issue 10.9.2026.docx | DOCX document | |
| D.8 36C25027Q5393 Amendment 0001.docx | DOCX document | |
| 36C25027Q5393_1.docx | DOCX document | |
| D.1 36C25027Q5393 10.9.2026.docx | DOCX document | |
| D.5 Past Performance Questionnaire.docx | DOCX document | |
| 36C25027Q5393 Combined Synopsis.docx | DOCX document | |
| D.4 Statement of VAAR 852.219-75 - Statement of Limitation of Subcontracting.docx | DOCX document | |
| D.2 WD 2015-4719 Rev 34 Cincinnati VAMC.docx | DOCX document | |
| 36C25027Q5393.docx | DOCX document | |
| D.5 Past Performance Questionnaire.docx | DOCX document | |
| D.3 Statement of FAR 52.222-41 - Statement of DoL WD Compliance.docx | DOCX document | |
| D.1 36C25027Q5393.docx | DOCX document | |
| D.6 Statement of Start Date Confirmation.docx | DOCX document |
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D.7 COMPLIANCE CHECKLIST – REQUIRED FOR CONTRACTORS TO COMPLETE
Interested parties please complete all sections of the following document. This checklist is provided to assist interested parties in submitting a compliant quote All sections below must be completed with accurate information. If an item is not applicable, indicate “None” or “N/A.” Do not leave any fields blank.
1. Contractor Information Name of Prime Contractor
DBA - Doing Business As (If applicable)
SAM UEI
Cage Code
Street Address of Prime Contractor
City, State & Zip
Primary POC – Prime Contractor
Phone Number
Email Address
2. SBA Certifications (Social-Economic Statuses) and active expiration date(s) of the PRIME ONLY.
Certification Mark (x) if held
| SBA Certification |
| Active Expiration Date |
Service Disabled Veteran Owned SB (SDVOSB)
Veteran Owned SB (VOSB)
Economically Disadvantaged Woman Owned SB (EDWOSB)
Woman Owned SB (WOSB)
8(a) Small Business (8(a))
HUBZone (HUB)
Small Disadvantaged Business (SDB)
3. The following are required based on the requirement document or submittals found on section E.1 FAR 52.212-1 ADDENDUM located on page ___ of the RFQ. Each item is required to be submitted ☐ SF 1449, Most updated. Must filled out and be signed ☐ SF 30, Amendment(s) must be signed. Each must be acknowledged on Table B.1 of RFQ.
| ☐ | D.3 Statement of FAR 52.222-41 Statement of DoL WD Compliance. Completed in its entirety to include occupational code(s) and occupational title. It must be signed. | |
| ☐ | D.4 Statement of VAAR 852.219-75 Statement of Limitation of Subcontracting Compliance. Completed in its entirety. It must be signed. | |
| ☐ | D.6 Start Date Confirmation. Completed and signed. | |
| ☐ | Proof of insurance. Meets limitations set in section C.9 of RFQ. | |
| ☐ | Past performance (References, Questionnaires, or CPARS) | |
| ☐ | Section E.8 - FAR 52.209-7 Information Regarding Responsibility Matters. Completed at the time of submitting quote. | |
| ☐ | Section E.9 - FAR 52.229-11 Tax on certain Foreign Procurements. Completed at the time of submitting quote. | |
| ☐ | Technical Approach | |
| ☐ Staffing Plan | ||
| ☐ Vehicle Fleet listing |
☐ Courier Route Details (pickup/drop locations and times) ☐ Contingency Plan
4. I understand that the above lists are items that must be included within the quote. Any items not included in the quote will render the package non-compliant and exclude it from consideration in the competition for award of the contract for Courier service at Cincinnati VAMC.
Signature: _____________________________________________________________________
Name: _________________________________________________________________________ Dated: _________________________________________________________________________ Title: ___________________________________________________________________________ Company: ______________________________________________________________________
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