Section_L,_Attachment_4_Self-Scoring_Worksheet.xlsx
XLSX spreadsheet 26 KB Posted
- Attached to
- Western Medical Services, Multiple Award Task Order Contract Federal contract opportunity
- Solicitation number
- N62645-17-R-0014
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Section L, Attachment 4 Self-Scoring Worksheet
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Instructions
| Western Medical MATO N62645-17-R-0014 |
| Self-Scoring Worksheet Instruction Page |
| Offerors shall complete the "Self-Scoring Worksheet" tab using the following instructions: | Definitions: |
| FTE = full time equivalent | |
| 1. Do not alter rows or columns of the Self-Scoring Worksheet. Enter responses in blue highlighted cells only. | HCW = health care worker |
| 2. Address each Data Element by marking the individual Data Element Lines with an “X”. Only one score will be received per Data Element Line. Do not leave a Data Element Line blank. When completed, there should be 23 "X" responses. | RFP = request for proposal |
| 3. Unless otherwise noted, contracts cited shall be current or have ended not more than three years prior to the closing date of the solicitation. | IDIQ = indefinite-delivery indefinite-quantity |
| 4. Unless otherwise noted, performance can be for the prime contractor or a proposed teaming partner(s). See Section L.2.2.3. through L.2.2.6. for detailed information on applicable performance. | FFP = firm-fixed-price |
| 5. Enter a contract or task order number(s) for each Data Element Line corresponding to the given response. | Prime Contract = offeror or in the case of a joint venture, the joint venture itself or either member of the joint venture |
| 6. When calculating FTEs, if citing an indefinite-delivery contract or blanket purchase agreement, aggregate the total of all orders or calls taking into account #3 above. Do not count the same FTEs in multiple periods of performance toward the aggregate number on a given contracts or count the same FTEs across multiple orders or calls for the same requirement, i.e., do not count the FTEs on each logical follow-on order separately. | |
| 7. Coverage and part-time hours shall be converted to FTEs at a rate of 1 FTE per 2,088 hours per year. | |
| 8. Do not include per diem, locum tenens, or temporary positions as FTEs. | |
| 9. FTE numbers cited herein shall align with the clinical medical services identified in the chart in Section I on the Past Performance Information Sheet(s). | |
| 10. When calculating dollar value, if citing an indefinite-delivery contract or blanket purchase agreement, aggregate the total of all orders or calls awarded in the past three years. Do not use the maximum contract value. | |
| 11. The same contract reference can be used for multiple Data Element Lines. For example: If the offeror provided both physician and nursing services under the same contract, that contract may be cited in both the Physician Labor Band Data Element and Nursing Labor Band Data Element. |
Self-Scoring Worksheet
| Western Medical Services MATO |
| Solicitation: N62645-17-R-0014 |
| ATTACHMENT 4 - SELF-SCORING WORKSHEET |
| (See instructions in Section L.2.2.) |
OFFEROR NAME:
| Self-Scoring Section | |||||||||
| Data Element | Enter an X in the cell that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||||
| Number of FTEs: | None | > 1 to < 4 | > 4 to < 8 | > 8 | Point Value | ||||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||||
| Total Points: | FALSE | FALSE | FALSE | FALSE | |||||
| Physician Labor Band Services | Total HCWs placed in the Physician Labor Band, see Section C of the RFP for more information on this Labor Band | 0 | |||||||
| Data Element | Enter an X in the cell that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||||
| Number of FTEs: | None | > 1 to < 15 | > 15 to < 33 | > 33 | Point Value | ||||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||||
| Total Points: | FALSE | FALSE | FALSE | FALSE | |||||
| Allied Health Labor Band Services | Total HCWs placed in the Allied Health Labor Band, see Section C of the RFP for more information on this Labor Band | 0 | |||||||
| Data Element | Enter an X in the cell that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||||
| Number of FTEs: | None | > 1 to < 3 | > 3 to < 5 | > 5 | Point Value | ||||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||||
| Total Points: | FALSE | FALSE | FALSE | FALSE | |||||
| Advanced Practice Nurse Labor Band Services | Total HCWs placed in the Advanced Practice Nurse Labor Band, see Section C of the RFP for more information on this Labor Band | 0 | |||||||
| Data Element | Enter an X in the cell that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||||
| Number of FTEs: | None | > 1 to < 15 | > 15 to < 36 | > 36 | Point Value | ||||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||||
| Total Points: | FALSE | FALSE | FALSE | FALSE | |||||
| Nursing Labor Band Services | Total HCWs placed in the Nursing Labor Band, see Section C of the RFP for more information on this Labor Band | 0 | |||||||
| Data Element | Enter an X in the cell that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||||
| Number of FTEs: | None | > 1 to < 7 | > 7 to < 13 | > 13 | Point Value | ||||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||||
| Total Points: | FALSE | FALSE | FALSE | FALSE | |||||
| Technologist Labor Band Services | Total HCWs placed in the Technologist Labor Band, see Section C of the RFP for more information on this Labor Band | 0 | |||||||
| Data Element | Enter an X in the cell that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||||
| Number of FTEs: | None | > 1 to < 15 | > 15 to < 35 | > 35 | Point Value | ||||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||||
| Total Points: | FALSE | FALSE | FALSE | FALSE | |||||
| Technician Labor Band Services | Total HCWs placed in the Technician Labor Band, see Section C of the RFP for more information on this Labor Band | 0 | |||||||
| Data Element | Enter an X in the column that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||||
| Number of FTEs: | None | > 1 to < 25 | > 25 to < 50 | > 50 | Point Value | ||||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||||
| Total Points: | FALSE | FALSE | FALSE | FALSE | |||||
| Assistant Labor Band Services | Total HCWs placed in the Assistant Labor Band, see Section C of the RFP for more information on this Labor Band | 0 | |||||||
| Data Element | Enter an X in the cell that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||||
| Number of FTEs: | None | > 1 to < 10 | > 10 to < 25 | > 25 | Point Value | ||||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||||
| FALSE | FALSE | FALSE | FALSE | ||||||
| Most common and difficult to fill labor categories | Contract placing Pharmacy Technicians | 0 | |||||||
| FALSE | FALSE | FALSE | FALSE | ||||||
| Contract placing Certified Medical Assistants or Medical Assistants | 0 | ||||||||
| FALSE | FALSE | FALSE | FALSE | ||||||
| Contract placing Licensed Practical Nurses or Licensed Vocational Nurses | 0 | ||||||||
| FALSE | FALSE | FALSE | FALSE | ||||||
| Contract placing Psychiatrists | 0 | ||||||||
| FALSE | FALSE | FALSE | FALSE | ||||||
| Contract placing Licensed Clinical Social Workers | 0 | ||||||||
| FALSE | FALSE | FALSE | FALSE | ||||||
| Contract placing Registered Nurse, Outpatient | 0 | ||||||||
| Total Points: | 0 | ||||||||
| Data Element | Enter an X in the column that corresponds to the highest contract value | Contract or Task Order Number(s) | |||||||
| Dollar Value: | $0 to < $1M | > $1M to | |||||||
| < $5M | > $5M to | ||||||||
| < $10M | > $10M to | ||||||||
| < $20M | > $20M | Point Value | |||||||
| Point Value: | 0 | 500 | 1,000 | 1,500 | 2,000 | ||||
| Total Points: | FALSE | FALSE | FALSE | FALSE | FALSE | ||||
| Dollar value of clinical services provided | Highest contract value (including all options) for clinical medical services, as defined in Section M of the RFP, held by the prime contractor | 0 | |||||||
| Data Element | Enter an X in the cell that corresponds to the state FTEs were placed | Contract or Task Order Number(s) | |||||||
| Yes or No: | Yes | No | Point Value | ||||||
| Point Value: | 1,000 | 0 | |||||||
| FALSE | FALSE | ||||||||
| Geographic Location | Contract with clinical HCW performance in California | 0 |
Contract with clinical HCW performance in Hawaii 0
| Contract with clinical HCW performance in Washington | 0 | ||||||
| Total Points: | 0 | ||||||
| Data Element | Enter an X in the column that corresponds to the answer | Contract or Task Order Number(s) | |||||
| Yes or No: | Yes | No | Point Value | ||||
| Point Value: | 500 | 0 | |||||
| Total Points: | FALSE | FALSE | |||||
| IDIQ Experience | Performance on an IDIQ contract by the prime contractor | 0 | |||||
| Data Element | Enter an X in the column that corresponds to the answer | Contract or Task Order Number(s) | |||||
| Yes or No: | Yes | No | Point Value | ||||
| Point Value: | 1,000 | 0 | |||||
| Total Points: | FALSE | FALSE | |||||
| FFP Experience | Performance on a FFP contract by the prime contractor | 0 | |||||
| Data Element | Enter an X in the cell that corresponds to the total number of FTEs placed | Contract or Task Order Number(s) | |||||
| Number of FTEs: | None | > 1 to < 4 | > 4 to < 8 | > 8 | Point Value | ||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||
| FALSE | FALSE | FALSE | FALSE | ||||
| Prime Contractor Experience | Total HCWs placed in the Physician Labor Band by the prime contractor, see Section C of the RFP for more information on this Labor Band | 0 | |||||
| Number of FTEs: | None | > 1 to < 15 | > 15 to < 33 | > 33 | |||
| Point Value: | 500 | 1,000 | 2,000 | ||||
| FALSE | FALSE | FALSE | |||||
| Total HCWs placed in the Allied Health Labor Band by the prime contractor, see Section C of the RFP for more information on this Labor Band | 0 | ||||||
| Number of FTEs: | None | > 1 to < 3 | > 3 to < 5 | > 5 | |||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||
| FALSE | FALSE | FALSE | FALSE | ||||
| Total HCWs placed in the Advanced Practice Nurse Labor Band by the prime contractor, see Section C of the RFP for more information on this Labor Band | 0 | ||||||
| Number of FTEs: | None | > 1 to < 15 | > 15 to < 36 | > 36 | |||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||
| FALSE | FALSE | FALSE | FALSE | ||||
| Total HCWs placed in the Nursing Labor Band by the prime contractor, see Section C of the RFP for more information on this Labor Band | 0 | ||||||
| Number of FTEs: | None | > 1 to < 7 | > 7 to < 13 | > 13 | |||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||
| FALSE | FALSE | FALSE | FALSE | ||||
| Total HCWs placed in the Technologist Labor Band by the prime contractor, see Section C of the RFP for more information on this Labor Band | 0 | ||||||
| Number of FTEs: | None | > 1 to < 15 | > 15 to < 35 | > 35 | |||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||
| FALSE | FALSE | FALSE | FALSE | ||||
| Total HCWs placed in the Technician Labor Band by the prime contractor, see Section C of the RFP for more information on this Labor Band | 0 | ||||||
| Number of FTEs: | None | > 1 to < 25 | > 25 to < 50 | > 50 | |||
| Point Value: | 0 | 500 | 1,000 | 2,000 | |||
| FALSE | FALSE | FALSE | FALSE | ||||
| Total HCWs placed in the Assistant Labor Band by the prime contractor, see Section C of the RFP for more information on this Labor Band | 0 | ||||||
| Total Points: | 0 |
| Data Element | Points Scored |
| Physician Labor Band Services | 0 |
| Allied Health Labor Band Services | 0 |
| Advanced Practice Nurse Labor Band Services | 0 |
| Nursing Labor Band Services | 0 |
| Technologist Labor Band Services | 0 |
| Technician Labor Band Services | 0 |
| Assistant Labor Band Services | 0 |
| Most common and difficult to fill labor categories | 0 |
| Dollar value of clinical services provided | 0 |
| Geographic Location | 0 |
| IDIQ Experience | 0 |
| FFP Experience | 0 |
| Prime Contractor Experience | 0 |
| TOTAL SCORE | 0 |
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