HRS11532 RFP Attachments AHEC ATACC.doc

Request for Proposal Number HRS11532, Attachments

ATTACHMENTS

BILLING INSTRUCTIONS

ATTACHMENT A

Applicable to all cost-reimbursement contracts.

I. INTRODUCTION

These instructions reflect the standards of the Health Resource and Services Administration (HRSA) for adequately prepared vouchers or invoices. Prompt payment of your claims will be promoted by your compliance. All vouchers submitted under this contract are subject to audit, therefore all costs claimed must be adequately supported by accounting records and other data that can be audited.

II. VOUCHER SUBMISSION

A. FORMS - In claiming reimbursement use: The Standard Form (SF) 1034, PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL (with continuation sheet SF 1035) PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL, which can be found at http://www.onr.navy.mil/02/024/forms. The billing content should include all applicable information contained below:

(k) Amount Funded

(l Variance

(m)

Current

(i) Cumulative

(j)

Direct Costs:

(1) Direct Labor/Hourly Rate

(2) Fringe Benefits

(3) Accountable Property

(4) Materials & Supplies

(5) Premium pay -if applicable

(6) Consultant Hourly Rate

(7) Travel

(8) Subcontracts

(9) Other

Total Direct Costs

Overhead

G&A

Fixed Fee

Total Amount Claimed

Adjustments

Grand Totals

B. NUMBER OF COPIES - For submission purposes each voucher will be prepared in an original and two (2) copies. See Section G.43 for Submission of Invoices/Vouchers information.

C. TIME FOR SUBMISSION - Vouchers may be submitted at the beginning of each calendar month for costs incurred during the preceding month. Costs incurred earlier than the preceding month, but not previously billed for, may be included, but the amount and month(s) in which such costs were incurred must be stated in the voucher.

D. RESUBMISSION OF COSTS - Costs resubmitted after suspension should be claimed in a separate public voucher and marked "Resubmission of Costs.”

E. COST INCURRENCE PERIOD - Costs must be incurred and the dates of the related "billed for" period must fall within the contract performance period as set forth in the original contract and any amendments thereof.

F. CONTRACTOR'S FISCAL YEAR - Vouchers should be prepared in such a manner that costs claimed can be associated or identified with the contractor's fiscal year. This will ensure proper application of an indirect cost rate(s) to the direct costs of a particular fiscal year.

III. PREPARATION GUIDE

A. COMPLETION OF FORM 1034 OR CONTRACTOR EQUIVALENT - On the Form 1034 or equivalent, the following information is required. Complete the blocks entitled:

Voucher No., U.S. Department, Bureau, or Establishment and Location, Date Voucher Prepared, Contract Number and Date, Payee’s Name and Address, Number and Date of Order, Date of Delivery of Service Articles or Services, Amount, and Total. Leave all other blocks blank.

Instructions:

In block entitled, U.S. Department, Bureau or Establishment and Location enter:

DHHS/Health Resources and Services Administration

Acquisitions Branch

5600 Fishers Lane, Room 13A-19

Rockville, MD 20857

In block entitled, Payee’s Name and Address, enter the name and address to which payment should be made, except in case of assignment of claims, and the address of the organization to which payments have been assigned.

• In block entitled, Number and Date of Order, enter the number and date of the applicable order only if the billings are consequent to work assignments or task orders.

• In block entitled, Date of Delivery or Service, enter the specific month/year, or months/year if quarterly.

• In block entitled, Articles or Services, enter the following statement: “For reimbursement of costs incurred under Contract No ____________, as detailed in attachments.”

• In blocks entitled, Amount and Total, enter the total dollar amount of this billing.

B. COMPLETION OF SUMMARY OF EXPENDITURES -This page follows directly behind the Form SF 1034 and contains two main categories of information: 1) gross summary of costs by category showing amount previously claimed, amount claimed under this voucher, and cumulative through this voucher and 2) necessary certifications and signature.

1. Gross Summary - Include only major categories of costs in the order illustrated.

2. Certifications and Signature are illustrated in Exhibit B. The Certification of Costs/Fee is mandatory; the Price Stabilization Certification is required only when called for in the SUBMISSION OF INVOICES AND PLACE OF PAYMENT article of the contract.

The next page in order should be the SF 1035.

C. COMPLETION OF FORM 1034 - - On the "Detail" Form 1035, provide a breakdown to support the total amount cited in both Form 1034 AND SUMMARY OF EXPENDITURES. The purpose of the detailed information is to assist the HRSA Contracting officer and program personnel in relating costs incurred to work performed. The several categories of cost will be itemized and described as follows:

1. Direct Labor costs consist of salaries and wages paid for work performed directly for the contract and pursuant to its terms. Such labor costs (excluding fringe benefits and overtime premium pay) will be billed as follows:

a. Provide the job title or classification of the worker and provide for each classification: the number of hours worked, the hourly rate, and the total wage or salary. The name of the worker should be provided, but when a great number of routine workers are involved, the position classifications only will suffice.

The cost of direct labor charged to the contract must be supported by time records maintained in the contractor’s office; if salaries are involved, reasonable estimates on a post basis may be used in lieu of time records.

2. Fringe Benefits are to be treated according to the contractor's established practice:

a. If fringe benefits, bonuses, etc. are included in the overhead pool, no specific entry is required.

b. Fringe benefits can be treated as direct costs, in which case enter the Fringe Benefits expressed as a percentage factor of the direct labor base or show the Actual Fringe Benefits cost.

3. Materials and Supplies should include only those items that the contractor normally treats as

"direct costs.” Bill these costs under major classifications or categories such as office supplies, chemicals, electronics parts, etc., unless any one particular item within a class exceeds $300.00, in which case all such item(s) exceeding $300.00 must be specifically identified. NOTE: UNDER NO CIRCUMSTANCE SHALL ANY ITEM OF NON-EXPENDABLE

EQUIPMENT BE INCLUDED WITHIN THESE CLASSIFICATIONS. (See 8 below)

4. Premium pay of any kind (including overtime) must be authorized by the Contracting Officer in advance. Billings for unauthorized premium pay cause frequent delays in payment due to suspensions and exchange of correspondence. Generally such pay is not included in the direct labor base and should not be included in the billing for "direct labor" unless the contractor has consistently followed this practice in the past as a matter of policy. Make entries as follows:

a. In SUMMARY OF EXPENDITURES - List as a single item.

b. In SF 1035 - itemize for each position or job category referencing the Contracting Officer's c.

letter of authorization. NOTE ON SPECIAL AUTHORIZATIONS: According to the contract, certain costs require specific authorization in writing by the Contracting Officer. Whenever, the voucher includes costs pursuant to C.O. authorization, include for example, the reference:

"C.O. letter (date)" or "approval number 57/74/115" if the C.O. cites said number in his letter.

5. Travel, as authorized by the contract, shall include the following in the SF 1035.

a. Travel by contractor shall provide:

- Name of traveler or title

- Dates of departure and return to departure point

- Transportation costs

- If claim for subsistence is on per diem basis, show number of days, rate, and amount, as authorized in contract. If claim is based on actual cost of subsistence, show on a daily basis the amounts claimed for lodging and meals separately.

- References to Contracting Officer's letter of authorization if approval is necessary

b. Travel by consultants shall provide detail similar to contractor travel above.

6. Consultant Fees must reflect each consultant's name, daily honorarium, and number of days claimed. Travel for consultants (if applicable) must be itemized separately.

7. Subcontract requires the name of each subcontractor involved and the dollar amount claimed.

Costs claimed by cost reimbursement subcontractors must be on an "as incurred" basis and subcontractor back-up information similar to the SF 1035 must be obtained and attached for each subcontractor.

8. Equipment is an article of personal property, complete in itself, that is of a durable nature with an expected service life of one year or more. Equipment does not ordinarily lose its identity or become a component part of another article when put to use. For the purposes of invoicing and reporting under HRSA contracts, the definition of non-expendable property and equipment are equivalent because the HRSA definition of non-expendable property does not include a dollar limitation. (The standard definition of "non-expendable property" considers items costing $200.00 or more - excluding transportation, installation, taxes - with a useful life of a year or more and property sensitive to conversation to private use (no cost limit).

Therefore, when billing for non-expendable property (equipment) costs, the Contractor must attach live (5) copies of a completed form, HRSA 565 Report of Non-expendable Government Property in Possession of Contractor, to the original invoice copy. The contractor will retain the sixth copy. Only that property being billed for during the applicable billing period shall be included in the HEW 565. In addition, one (1) copy of each vendor invoice covering purchased property shall be attached to the original invoice.

9. Overhead will be charged at provisional rates resulting from audit determination and\or negotiation. Provisional rates will apply pending the establishment of final negotiated overhead rates for the contractor's fiscal year.

10. Other Direct costs are minor costs that cannot be placed within any of the categories listed above. Identify by categories to the extent both possible and reasonable.

11. Fixed Fee when applicable, should be billed by prorating the negotiated total fixed fee to costs incurred. Applying a fee percentage to the fee percentage to the fee base will achieve this effect.

Refer to the contract provisions for guidance.

VOUCHER SUBMISSION ADDRESS:

Submit one copy to:

HRSA Project Officer

Submit one original and one copy to: HRSA Contracting Officer

ATTACHMENT B

Health Resources and Services Administration

Contractor Performance Evaluation

1. FINAL REPORT _____ INTERIM REPORT _____

(Check one)

2. REPORTING PERIOD:

(From)

(To)

3. CONTRACTING OFFICER:

4. CONTRACT NUMBER:

5. CONTRACTOR NAME:

DEPARTMENT/ COMPONENT:

ADDRESS:

CITY:

STATE:

ZIP CODE:

6. CONTRACT AWARD DATE:

CONTRACT EXPIRATION DATE:

7. CONTRACT VALUE :

8. DESCRIPTION OF REQUIREMENT (Title):

9.

RATINGS

Circle the number that corresponds to the rating for each category (see attached Rating Guidelines), and provide comments to support the rating.

QUALITY OF PRODUCT OR SERVICE

Rating 0 1 2 3 4 5

Comments:

COST CONTROL

Rating

0 1 2 3 4 5

Health Resources and Services Administration

Contractor Performance Evaluation

TIMELINESS OF PERFORMANCE

Rating

0 1 2 3 4 5

BUSINESS RELATIONS

Rating

0 1 2 3 4 5

10.

SUBCONTRACTS

Are subcontracts involved?

Yes No (Circle one) Comments: [Briefly summarize the quality of performance of major subcontractors. This information serves two purposes: (1) it provides some insight into the contractor’s effectiveness in managing its subcontractors; and (2) it provides information that may be useful for future procurements when evaluating the past performance of offerors that have only performed as subcontractors. ]

11.

KEY PERSONNEL

PROJECT MANAGER/PRINCIPAL INVESTIGATOR (name):

Source Selection Information

KEY PERSON (name) :

Comments:

KEY PERSON (name) :

12.

CUSTOMER SATISFACTION

Is/was the contractor committed to customer satisfaction?

Yes No (Circle one)

Would you recommend selection of this firm again?

Yes No (Circle one)

13. PROJECT OFFICER (name):

SIGNATURE: ____________________________________Date_________

Phone:

FAX:

Internet Address:

14. CONTRACTING OFFICER CONCURRENCE: (Initial) __________

Date:

Source Selection Information

15. CONTRACTOR’S REVIEW:

Were comments or additional information provided?

Yes No (Circle one)

If yes, they are:

On file in:

(Location)

(Phone)

Attached: _____ (Check if attached)

CONTRACTOR’S REPRESENTATIVE:

(name)

SIGNATURE: ____________________________________Date__________

16. AGENCY REVIEW:

Were contractor comments reviewed at a level above the contracting officer?

Yes

(Circle one)

If yes, Agency Decision is:

On file in:

(Location)

(Phone)

Attached: _____ (Check if attached)

17. SUMMARY RATINGS:

QUALITY: _______

COST CONTROL: _______

TIMELINESS OF

PERFORMANCE: _______

BUSINESS RELATIONS: _______

18. CONTRACTING OFFICER

(name):

SIGNATURE: ____________________________________Date__________

Rating Guidelines Quality of Product or Service 0 = Unsatisfactory 1 = Poor 2 = Fair 3 = Good 4 = Excellent

5 = Outstanding

Cost Control 0 = Unsatisfactory 1 = Poor 2 = Fair 3 = Good 4 = Excellent

5 = Outstanding

Timeliness of Performance

5 = Outstanding

Business Relations

5 = Outstanding

OMB CLEARANCE NO. 9000-0142 SOURCE SELECTION INFORMATION CONFIDENTIAL

DEPARTMENT OF HEALTH AND HUMAN SERVICES ATTACHMENT C

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden disclosure.)

1.

Type of Federal Action:

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance 2.

Status of Federal Action:

a. bid/offer/application

b. initial award

c. post-award 3.

Report Type:

a. initial filing

b. material change

For Material Change Only:

year quarter date of last report

4.

Name and Address of Reporting Entity:

Prime

Subawardee

Tier , if known:

Congressional District, if known:

5.

If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Congressional District, if known:

6.

Federal Department/Agency:

7.

Federal Program Name/Description:

CFDA Number, if applicable:

8.

Federal Action Number, if known:

9.

Award Amount, if known:

10.

a.

Name and Address of Lobbying Entity (if individual, last name, first name, MI):

b.

Individuals Performing Services (including address if different from No. 10a)

(last name, first name, MI):

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

11.

Amount of Payment (check all that apply):

actual planned 13.

Type of Payment (check all that apply)

a. retainer

b. one-time fee

c. commission

d. contingent fee

e. deferred

f. other; specify

12.

Form of Payment (check all that apply):

a. cash

b. in-kind: specify:

nature value

14.

Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment indicated in Item 11:

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

15.

Continuation Sheet(s) SF-LLL-A attached:

Yes

16.

Signature:

Print Name:

Title:

Telephone No.:

Standard Form – LLL

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, as the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1.

Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2.

Identify the status of the covered Federal action.

3.

Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entry for this covered Federal action.

4.

Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the first tier. Subawards include but are not limited to subcontracts, subgrants, and contract awards under grants.

5.

If the organization filing the report in item 4 checks "Subawardee", then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known.

6.

Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7.

Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8.

Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001".

9.

For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10.

(a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address, if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).

11.

Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.

12.

Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

13.

Check the appropriate box(es). Check all boxes that apply. If other, specify nature.

14.

Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. identify the Federal official(s) or employee(s) contracted or the officer(s), employee(s), or Member(s) of Congress that were contacted.

15.

Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.

16.

The certifying official shall sign and date the form, print his/her name, title, and telephone number.

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction project (0348-0046), Washington, DC 20503.

ATTACHMENT D

Table 15-2- Instructions for Submitting Cost/Price Proposals When Cost or Pricing Data Are Required

This document provides instructions for preparing a contract pricing proposal when cost or pricing data are required.

Note 1. There is a clear distinction between submitting cost or pricing data and merely making available books, records, and other documents without identification. The requirement for submission of cost or pricing data is met when all accurate cost or pricing data reasonably available to the offeror have been submitted, either actually or by specific identification, to the Contracting Officer or an authorized representative. As later information comes into your possession, it should be submitted promptly to the Contracting Officer in a manner that clearly shows how the information relates to the offeror's price proposal. The requirement for submission of cost or pricing data continues up to the time of agreement on price, or an earlier date agreed upon between the parties if applicable.

Note 2. By submitting your proposal, you grant the Contracting Officer or an authorized representative the right to examine records that formed the basis for the pricing proposal. That examination can take place at any time before award. It may include those books, records, documents, and other types of factual information (regardless of form or whether the information is specifically referenced or included in the proposal as the basis for pricing) that will permit an adequate evaluation of the proposed price.

I. General Instructions

A. You must provide the following information on the first page of your pricing proposal:

(1) Solicitation, contract, and/or modification number;

(2) Name and address of offeror;

(3) Name and telephone number of point of contact;

(4) Name of contract administration office (if available);

(5) Type of contract action (that is, new contract, change order, price revision/redetermination, letter contract, unpressed order, or other);

(6) Proposed cost; profit or fee; and total;

(7) Whether you will require the use of Government property in the performance of the contract, and, if so, what property;

(8) Whether your organization is subject to cost accounting standards; whether your organization haS submitted a CASB Disclosure Statement, and if it has been determined adequate; whether you have been notified that you are or may be in noncompliance with your Disclosure Statement or CAS (other than a noncompliance that the cognizant Federal agency official has determined to have an immaterial cost impact), and, if yes, an explanation; whether any aspect of this proposal is inconsistent with your disclosed practices or applicable CAS, and, if so, an explanation; and whether the proposal is consistent with your established estimating and accounting principles and procedures and FAR Part 31, Cost Principles, and, if not, an explanation;

(9) The following statement: This proposal reflects our estimates and/or actual costs as of this date and conforms with the instructions in FAR 15.403-5(b)(1) and Table 15-2. By submitting this proposal, we grant the Contracting Officer and authorized representative(s) the right to examine, at any time before award, those records, which include books, documents, accounting procedures and practices, and other data, regardless of type and form or whether such supporting information is specifically referenced or included in the proposal as the basis for pricing, that will permit an adequate evaluation of the proposed price.

(10) Date of submission; and

(11) Name, title, and signature of authorized representative.

B. In submitting your proposal, you must include an index, appropriately referenced, of all the cost or pricing data and information accompanying or identified in the proposal. In addition, you must annotate any future additions and/or revisions, up to the date of agreement on price, or an earlier date agreed upon by the parties, on a supplemental index.

C. As part of the specific information required, you must submit, with your proposal, cost or pricing data (that is, data that are verifiable and factual and otherwise as defined at FAR 2.101). You must clearly identify on your cover sheet that cost or pricing data are included as part of the proposal. In addition, you must submit with your proposal any information reasonably required to explain your estimating process, including-

(1) The judgmental factors applied and the mathematical or other methods used in the estimate, including those used in projecting from known data; and

(2) The nature and amount of any contingencies included in the proposed price.

D. You must show the relationship between contract line item prices and the total contract price. You must attach cost-element breakdowns for each proposed line item, using the appropriate format prescribed in the "Formats for Submission of Line Item Summaries" section of this table. You must furnish supporting breakdowns for each cost element, consistent with your cost accounting system.

E. When more than one contract line item is proposed, you must also provide summary total amounts covering all line items for each element of cost.

F. Whenever you have incurred costs for work performed before submission of a proposal, you must identify those costs in your cost/price proposal.

G. If you have reached an agreement with Government representatives on use of forward pricing rates/factors, identify the agreement, include a copy, and describe its nature.

H. As soon as practicable after final agreement on price or an earlier date agreed to by the parties, but before the award resulting from the proposal, you must, under the conditions stated in FAR 15.406-2, submit a Certificate of Current Cost or Pricing Data.

II. Cost Elements

Depending on your system, you must provide breakdowns for the following basic cost elements, as applicable:

A. Materials and services. Provide a consolidated priced summary of individual material quantities included in the various tasks, orders, or contract line items being proposed and the basis for pricing (vendor quotes, invoice prices, etc.). Include raw materials, parts, components, assemblies, and services to be produced or performed by others. For all items proposed, identify the item and show the source, quantity, and price. Conduct price analyses of all subcontractor proposals. Conduct cost analyses for all subcontracts when cost or pricing data are submitted by the subcontractor. Include these analyses as part of your own cost or pricing data submissions for subcontracts expected to exceed the appropriate threshold in FAR 15.403-4. Submit the subcontractor cost or pricing data as part of your own cost or pricing data as required in paragraph IIA(2) of this table. These requirements also apply to all subcontractors if required to submit cost or pricing data.

(1) Adequate Price Competition. Provide data showing the degree of competition and the basis for establishing the source and reasonableness of price for those acquisitions (such as subcontracts, purchase orders, material order, etc.) exceeding, or expected to exceed, the appropriate threshold set forth at FAR 15.403-4 priced on the basis of adequate price competition. For interorganizational transfers priced at other than the cost of comparable competitive commercial work of the division, subsidiary, or affiliate of the contractor, explain the pricing method (see FAR 31.205-26(e)).

(2) All Other. Obtain cost or pricing data from prospective sources for those acquisitions (such as subcontracts, purchase orders, material order, etc.) exceeding the threshold set forth in FAR 15.403-4 and not otherwise exempt, in accordance with FAR 15.403-1(b) (i.e., adequate price competition, commercial items, prices set by law or regulation or waiver). Also provide data showing the basis for establishing source and reasonableness of price. In addition, provide a summary of your cost analysis and a copy of cost or pricing data submitted by the prospective source in support of each subcontract, or purchase order that is the lower of either $10,000,000 or more, or both more than the pertinent cost or pricing data threshold and more than 10 percent of the prime contractor's proposed price. The Contracting Officer may require you to submit cost or pricing data in support of proposals in lower amounts. Subcontractor cost or pricing data must be accurate, complete and current as of the date of final price agreement, or an earlier date agreed upon by the parties, given on the prime contractor's Certificate of Current Cost or Pricing Data. The prime contractor is responsible for updating a prospective subcontractor's data. For standard commercial items fabricated by the offeror that are generally stocked in inventory, provide a separate cost breakdown, if priced based on cost. For interorganizational transfers priced at cost, provide a separate breakdown of cost elements. Analyze the cost or pricing data and submit the results of your analysis of the prospective source's proposal. When submission of a prospective source's cost or pricing data is required as described in this paragraph, it must be included along with your own cost or pricing data submission, as part of your own cost or pricing data. You must also submit any other cost or pricing data obtained from a subcontractor, either actually or by specific identification, along with the results of any analysis performed on that data.

B. Direct Labor. Provide a time-phased (e.g., monthly, quarterly, etc.) breakdown of labor hours, rates, and cost by appropriate category, and furnish bases for estimates.

C. Indirect Costs. Indicate how you have computed and applied your indirect costs, including cost breakdowns. Show trends and budgetary data to provide a basis for evaluating the reasonableness of proposed rates. Indicate the rates used and provide an appropriate explanation.

D. Other Costs. List all other costs not otherwise included in the categories described above (e.g., special tooling, travel, computer and consultant services, preservation, packaging and packing, spoilage and rework, and Federal excise tax on finished articles) and provide bases for pricing.

E. Royalties. If royalties exceed $1,500, you must provide the following information on a separate page for each separate royalty or license fee:

(1) Name and address of licensor.

(2) Date of license agreement.

(3) Patent numbers.

(4) Patent application serial numbers, or other basis on which the royalty is payable.

(5) Brief description (including any part or model numbers of each contract item or component on which the royalty is payable)

(6) Percentage or dollar rate of royalty per unit.

(7) Unit price of contract item.

(8) Number of units.

(9) Total dollar amount of royalties.

(10) If specifically requested by the Contracting Officer, a copy of the current license agreement and identification of applicable claims of specific patents (see FAR 27.204 and 31.205-37).

F. Facilities Capital Cost of Money. When you elect to claim facilities capital cost of money as an allowable cost, you must submit Form CASB-CMF and show the calculation of the proposed amount (see FAR 31.205-10).

III. Formats for Submission of Line Item Summaries

A. New Contracts (including letter contracts).

Cost Elements Proposed Contract Proposed Contract Reference

Estimate-Total Cost Estimate-Unit Cost

(1) (2)

(3) (4)

Column Instruction

(1) Enter appropriate cost elements.

(2) Enter those necessary and reasonable costs that, in your judgment, will properly be incurred in efficient contract performance. When any of the costs in this column have already been incurred (e.g., under a letter contract), describe them on an attached supporting page. When preproduction or startup costs are significant, or when specifically requested to do so by the Contracting Officer, provide a full identification and explanation of them.

(3) Optional, unless required by the Contracting Officer.

(4) Identify the attachment in which the information supporting the specific cost element may be found. (Attach separate pages as necessary.)

B. Change Orders, Modifications, and Claims.

TABLE OMITTED

Column and Instruction

(1) Enter appropriate cost elements.

(2) Include the current estimates of what the cost would have been to complete the deleted work not yet performed (not the original proposal estimates), and the cost of deleted work already performed.

(3) Include the incurred cost of deleted work already performed, using actuals incurred if possible, or, if actuals are not available, estimates from your accounting records. Attach a detailed inventory of work, materials, parts, components, and hardware already purchased, manufactured, or performed and deleted by the change, indicating the cost and proposed disposition of each line item. Also, if you desire to retain these items or any portion of them, indicate the amount offered for them.

(4) Enter the net cost to be deleted, which is the estimated cost of all deleted work less the cost of deleted work already performed. Column (2) minus Column (3) equals Column (4).

(5) Enter your estimate for cost of work added by the change. When nonrecurring costs are significant, or when specifically requested to do so by the Contracting Officer, provide a full identification and explanation of them. When any of the costs in this column have already been incurred, describe them on an attached supporting schedule.

(6) Enter the net cost of change, which is the cost of work added, less the net cost to be deleted. Column (5) minus Column (4) equals Column (6). When this result is negative, place the amount in parentheses.

(7) Identify the attachment in which the information supporting the specific cost element may be found.

(Attach separate pages as necessary.)

C. Price Revision/Redetermination.

TABLE OMITTED

(Use as applicable)

Column and Instruction

(1) Enter the cutoff date required by the contract, if applicable.

(2) Enter the number of units completed during the period for which experienced costs of production are being submitted.

(3) Enter the number of units remaining to be completed under the contract.

(4) Enter the cumulative contract amount.

(5) Enter your redetermination proposal amount.

(6) Enter the difference between the contract amount and the redetermination proposal amount. When this result is negative, place the amount in parentheses. Column (4) minus Column (5) equals Column (6).

(7) Enter appropriate cost elements. When residual inventory exists, the final costs established under fixed-price-incentive and fixed-price-redeterminable arrangements should be net of the fair market value of such inventory. In support of subcontract costs, submit a listing of all subcontracts subject to repricing action, annotated as to their status.

(8) Enter all costs incurred under the contract before starting production and other nonrecurring costs (usually referred to as startup costs) from your books and records as of the cutoff date. These include such costs as preproduction engineering, special plant rearrangement, training program, and any identifiable nonrecurring costs such as initial rework, spoilage, pilot runs, etc. In the event the amounts are not segregated in or otherwise available from your records, enter in this column your best estimates. Explain the basis for each estimate and how the costs are charged on your accounting records (e.g., included in production costs as direct engineering labor, charged to manufacturing overhead). Also show how the costs would be allocated to the units at their various stages of contract completion.

(9) Enter in Column (9) the production costs from your books and records (exclusive of preproduction costs reported in Column (8)) of the units completed as of the cutoff date.

(10) Enter in Column (10) the costs of work in process as determined from your records or inventories at the cutoff date. When the amounts for work in process are not available in your records but reliable estimates for them can be made, enter the estimated amounts in Column (10) and enter in column (9) the differences between the total incurred costs (exclusive of preproduction costs) as of the cutoff date and these estimates. Explain the basis for the estimates, including identification of any provision for experienced or anticipated allowances, such as shrinkage, rework, design changes, etc. Furnish experienced unit or lot costs (or labor hours) from inception of contract to the cutoff date, improvement curves, and any other available production cost history pertaining to the item(s) to which your proposal relates.

(11) Enter total incurred costs (Total of Columns (8), (9), and (10)).

(12) Enter those necessary and reasonable costs that in your judgment will properly be incurred in completing the remaining work to be performed under the contract with respect to the item(s) to which your proposal relates.

(13) Enter total estimated cost (Total of Columns (11) and (12)).

(14) Identify the attachment in which the information supporting the specific cost element may be found.

(Attach separate pages as necessary.)

ATTACHMENT E

CERTIFICATE OF CURRENT COST OR PRICING DATA

FAR 15.406-2

This is to certify that, to the best of my knowledge and belief, the cost or pricing data (as defined in section 2.101 of the Federal Acquisition Regulation (FAR) and required under FAR subsection 15.403-4) submitted, either actually or by specific identification in writing, to the Contracting Officer or to the Contracting Officer's representative in support of _______________* are accurate, complete, and current as of ____________________**. This certification includes the cost or pricing data supporting any advance agreements and forward pricing rate agreements between the offeror and the Government that are part of the proposal.

Firm _____________________________________

Signature ________________________________

Name _____________________________________

Title ____________________________________

Date of execution*** _____________________

*Identify the proposal, request for price adjustment, or other submission involved, giving the appropriate identifying number (e.g., RFP No.).

**Insert the day, month, and year when price negotiations were concluded and price agreement was reached or if applicable, an earlier date agreed upon between the parties that is as close as practicable to the date of agreement on price.

***Insert the day, month, and year of signing, which should be as close as practicable to the date when the price negotiations were concluded and the contract price was agreed to.

(End of certificate)

ATTACHMENT F

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Rockville, MD 20857 ___________________________

Date Dear Client:

We are currently responding to the Health Resources and Services Administration Solicitation No.

HRS6898 entitled “Accreditation Initiative”. The Government is placing increased emphasis in its acquisition on past performance as a source selection factor and is requiring that clients of firms responding to HRSA solicitations be identified and their participation in the evaluation process be requested.

Therefore, enclosed is a past performance questionnaire for your completion. We are requesting that you complete the questionnaire and send it directly to HRSA at the following address:

Dottie Watson

Health Resources and Services Administration

Contracts Operations Branch, DPM 5600 Fishers Lane, Room 13A19

Rockville, MD 20857

Phone: 301‑443-2752

Fax: 301‑443‑5462 dwatson@hrsa.gov

Since this information will be used as one of the evaluation factors for contract award, we are requesting that you complete this questionnaire and return it to the HRSA at the above address no later than _________.

We thank you for your prompt response in this matter.

Sincerely, (To be signed by offeror)

PAST PERFORMANCE INFORMATION SURVEY QUESTIONNAIRE

HRSA//DPM/COB

FOR: [ INSERT OFFEROR’S NAME OF COMPANY ]

PLEASE RETURN COMPLETED SURVEY ASAP but no later than _____________ TO:

HRSA, Division of Procurement Management

5600 Fishers Lane, Room 13A19, Rockville, MD 20857

Attn: Dottie Watson Phone: 301‑443‑2752, Fax: 301‑443‑5462 dwatson@hrsa.gov

PLEASE FILL IN THE FOLLOWING:

YOUR NAME:____________________________

YOUR AGENCY:______________________

ADDRESS:____________________________________________________________________

PHONE NUMBER:____________________

FAX :________________________________

SIGNATURE OF PERSON COMPLETING SURVEY:________________________________

CONTRACT NUMBER/SOLICITATION NUMBER: _________________________________

YOUR ROLE IN THIS CONTRACT ‑CIRCLE ONE

PROJECT OFFICER

CONTRACTING OFFICER

CONTRACT SPECIALIST

CONTRACT VALUE (INCLUDING OPTIONS): $___________________________________

PERIOD OF PERFORMANCE (INCLUDING OPTIONS):_____________________________

TYPE CONTRACT (I.E. COST REIMBURSEMENT, FIXED PRICE, ETC.):______________

APPROXIMATE PERCENTAGE OF WORK COMPETED BY SUBCONTRACTORS: ___ %

GENERAL DESCRIPTION OR TITLE OF CONTRACT: _____________________________

RATINGS: Please answer each of the following questions with a rating that is based on objective measurable performance indicators to the maximum extent possible. Comments to support rating may be noted on last page.

NUMERICAL RATINGS ARE DEFINED AS FOLLOWS:

+2 EXCELLENT ‑Based on the Offeror=s performance record, no doubt exists that the Offeror will successfully perform the required effort. A significant majority of sources of information are consistently firm instating that the Offeror=s performance was superior and that they would unhesitatingly do business with the Offeror again.

+1 GOOD ‑Based on the Offeror=s performance record, little doubt exists that the Offeror will successfully perform the required effort. Most sources of information state that the Offeror=s performance was good, better that average, etc., that they would do business with the Offeror again.

0 None ‑No past performance history identifiable.

‑1 MARGINAL ‑Based on the Offeror=s performance record, some doubt exists that the Offeror will successfully perform the required effort. Many sources of information make unfavorable reports about the Offeror=s performance and express concern about doing business with the Offeror again.

‑2 POOR ‑Based on the offeror=s performance record, serious doubt exists that the Offeror will successfully perform the required effort. A significant majority of sources of information consistently stated that the Offeror=s performance was entirely unsatisfactory and that they would not do business with the Offeror again.

PAGE 2 - PAST PERFORMANCE INFORMATION SURVEY QUESTIONNAIRE

PLEASE CIRCLE THE NUMERICAL SCORE INDICATING YOU’RE RATING

QUALITY OF SERVICE

1. Compliance with contract requirements

+2 +1 ‑1 ‑2

2. Accuracy of reports

+2 +1 ‑1

3. Effectiveness of personnel

‑1

4. Technical excellence

‑1 ‑2

COST CONTROL

1. Record of forecasting and controlling target

+2 +1 ‑1 costs

2. Current. Accurate and complete billings

+2 +1 ‑1 ‑2

3. Relationship of negotiated costs to actuals

+2 +1 ‑1

4. Cost efficiencies

‑1 ‑2

TIMELINESS OF PERFORMANCE

1. Met interim milestones

‑1

2. Reliability

‑1

3. Responsive to technical direction

‑1 ‑2

4. Completed on time including wrap up and contract administration

‑1

5. Met delivery schedules

‑1

6. Liquidated damage assessed: yes/no

‑1 ‑2

BUSINESS RELATIONS

1. Effective management, including subcontracts

+2 +1 ‑1

2. Reasonable/cooperative behavior

‑1

3. Responsive to contract requirements

‑1

4. Notification of problems

‑1

5. Flexibility

‑1

6. Pro‑active vs. Reactive

‑1 ‑2

7. Effective small/small disadvantaged business subcontracting program

‑1 ‑2

CUSTOMER SATISFACTION

1. The contractor is committed to customer satisfaction +2 +1 ‑1 ‑2

2. Would you recommend selection of this firm again?

+2 +1 ‑1 ‑2

GENERAL OVERALL RATING OF CONTRACTOR

+2 +1 0 ‑1 ‑2

ADDITIONAL COMMENTS:

OFFICE OF SMALL AND DISADVANTAGED BUSINESS UTILIZATION

SMALL BUSINESS SUBCONTRACTING PLAN

The following outline meets the minimum requirements of section 8(d) of the Small Business Act, as amended, and implemented by the Federal Acquisition Regulations (FAR) Subpart 19.7. The U.S. Department of Health and Human Services (HHS), Office of Small and Disadvantaged Business Utilization (OSDBU) recommend offerors use the following format to submit proposed Individual Subcontracting Plans, including modifications. It is not intended to replace any existing Corporate/Commercial Plan that is more extensive. A subcontracting Plan is required if the estimated cost of the contract may exceed $550,000 (small businesses are excluded). Questions should be forwarded to the Contracting Officer or Teneshia Alston, Senior Small Business Analyst (Teneshia.Alston@HHS.GOV).

HHS Operating Division (OPDIV): _______________________________

SOLICITATION OR CONTRACT NUMBER: ______________________________

DATE OF PLAN: ___________________________________________________

CONTRACTOR: ____________________________________________________

ADDRESS: ________________________________________________________

STATE/ZIP CODE___________________________________________________

DUNN & BRADSTREET NUMBER: _____________________________________

ITEM/SERVICE (Description): _______________________________________

NEW/INITIAL CONTRACT

PERIOD OF CONTRACT PERFORMANCE (Month, Day & Year):__________________

Base Performance Period/Quantity ____________

Option 1:

Performance Period/Quantity ____________

Option 2:

Performance Period/Quantity ____________

Option 3:

Performance Period/Quantity…