E.1__ZPICProposalChecklist.doc

RFP-CMS-2007-0027

Exhibit E.1

Proposal Checklist ZPIC Cycle One You are requested to complete the following checklist for each IDIQ proposal and task order proposal for each zone. This submission will allow CMS to more readily identify various aspects of your proposal. Please check the appropriate items and provide an explanation, if necessary.

1) Company name, address, point of contact and telephone number

2) If a newly formed company, provide name and address of parent companies forming the new entity:

a. __________________ b.__________________

3) List of proposed subcontractors (if applicable):

a. _____________________________________

b. _____________________________________

c. _____________________________________

4) In accordance with the North American Industry Code 541990, indicate the business size of the prime entity/company.

□ Large Business

□ Small Business

5) This proposal is for the following zone:

Zone 4______ Zone 5______ Zone 7______

6) TIN # _______________

7) DUNS# _______________

8) Productive Hours for Exempt and Non-Exempt Employees ________