RFP_Submission_Checklist.pdf
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- Attached to
- Non-Personal Healthcare Services-Physicians & Other Professional Ambulatory Services for PRC Program
- Solicitation number
- 75H70726R00002
About this file
This is a Document Submission Checklist for Request for Proposal (RFP: 17-242-SOL-00018) for Professional Physician and Other Ambulatory Health Care Services. The checklist outlines the minimum acceptable documents that must be submitted with a proposal, each signed by an authorized organizational official.
Required submissions include: Standard Form 1449 (Solicitation/Contract/Order for Commercial Items) with original signature and DUNS number citation; the General/Purpose of Contract identifying the type of professional health care service; a Fee Schedule/Pricing with discount, offer, and no-show fee information; FAR 52.212-3 Offeror Representation and Certifications for Commercial Items (completing specified paragraphs on pages 17-18 and 22-23); a completed Business Associate Agreement; Attachment D-6 (Provider Contract Summary Sheet) with original signature; Attachment D-7 (Provider Certification) with original signature; and copies of certifications, licenses, medical malpractice insurance, and specialty training documentation for each provider, if applicable. The checklist specifies the number of copies required for each document, with several documents requiring original signatures. Offerors are advised to retain a copy of the RFP package for their reference.
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Document Submission Checklist
Request for Proposal (RFP: 17-242-SOL-00018)
Professional Physician and Other Ambulatory Health Care Services
The following checklist is to assist you in ensuring that the acceptable minimum documents are submitted with your proposal and signed by an official authorized to bind your organization.
Document Requirement Number of Copies
1. Standard Form 1449, Solicitation/Contract/ 1 Copy with Original Order for Commercial Items Signature (Page 1) (Complete blocks 17a and 30a-30c) *Cite DUNS# in block 17a of the Standard Form 1449*
2. Paragraph B-1.b. (General/Purpose of Contract) 1 Copy Enter in Type of Professional Health Care Service
(Page 5)
3. Paragraph B-5.b.1.-5. (Fee Schedule/Pricing) 1 Copy Enter Discount/Offer/No-Show Fee
(Page 5)
4. Paragraph C-3 (FAR 52.212-3 Offeror 1 Copy Representation and Certifications –
Commercial Items (JAN 2017) Complete Pages 17 and 18, paragraphs (c)1- (c)10 and (d)1- (d)2 (Page 16, only b(2) if Annual Reps & Certs are up to date in SAM.gov)
5. Paragraph C-3 (FAR 52.212-3 Offeror 1 Copy Representation and Certifications –
Commercial Items (JAN 2017) Complete Page 22 and 23, paragraphs (l)3- (l)5, (n)2, (q)2 (Page 16, only b(2) if Annual Reps & Certs are up to date in SAM.gov)
6. Appendix D-2: Business Associate Agreement 1 Copy Complete Fillable items in I and IIA.
7. Attachment D-6: Provider Contract Summary Sheet 1 Copy with Original Complete Fillable items and sign. Signature
8. Attachment D-7: Provider Certification 1 Copy with Original Complete Fillable items and sign. Signature
9. Copies of Certifications, Licenses, Medical Malpractice Insurance 1 Copy and Specialty Training for each provider (if applicable).
Note: Please retain a copy of the RFP package for your reference.
File details come from the government source that posted it. Updated .