E.3 Responsibility_Questionnaire.doc

DOC document 28 KB Posted

Attached to
Recovery Audit Contractor Validation Contractor (RVC) Federal contract opportunity
Solicitation number
75FCMC20R0017-Solicitation
Issued by
Department of Health and Human Services Centers for Medicare and Medicaid Services

About this file

This document contains a responsibility questionnaire and details of a federal contract opportunity for recovery audit validation services. The responsibility questionnaire includes seven questions for offerors pertaining to their financial resources, performance schedules, past performance history, business ethics, organizational experience and controls, technical equipment and facilities, and general qualifications. The related federal contract opportunity is a solicitation from the Centers for Medicare and Medicaid Services to obtain a Recovery Audit Contractor Validation Contractor. The primary purpose of the RVC is to review claim determinations made by Recovery Auditor Contractors on Medicare claims paid under Parts A and B of title XVIII, to ensure the RACs are not improperly denying claims.

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Text version

75FCMC20R0017

E.3 Responsibility Questionnaire

Responsibility Questionnaire

Solicitation Number:

75FCMC20R0017

Offeror Name/Address:

In order to facilitate the Contracting Officer’s determination of responsibility as required in accordance with FAR 9.104-3(a), please provide responses to the questions below. Responses shall be supported by appropriate explanations and where substantiating information can be found, i.e. proposal, websites, etc.

1.

Does your firm have adequate financial resources to perform the contract, or the ability to obtain them (see 9.104-3(a)?

Offeror Response:

2.

Does your company have ability to comply with the required or proposed delivery or performance schedule, taking into consideration all existing commercial and governmental business commitments?

Offeror Response:

3.

Does your company have a satisfactory performance record (see 9.104-3(b) and Subpart 42.15) or any negative past performance ratings?

Offeror Response:

4.

Does your company have a satisfactory record of integrity and business ethics (for example, see Subpart 42.15); support your confirmation by indicating that your firm is not on a debarred list, OIG list, or the Federal Contractor Misconduct Database?

Offeror Response:

5.

Does your company have the necessary organization, experience, accounting and operational controls, and technical skills, or the ability to obtain them to provide the services to be performed (See 9.104-3 (a)?

Offeror Response:

6.

Does your company have the necessary technical equipment and facilities, or the ability to obtain them (see 9.104-3(a)); to provide the required services?

Offeror Response:

7.

Is your company otherwise qualified and eligible to receive an award under applicable laws and regulations?

Offeror Response:

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