Section D Attachment -Limitations of Subcontracting Offer Worksheet.pdf
PDF 199 KB Posted
- Attached to
- R602--Amendment to the Primary Care Service Courier Services for SLC VA Medical Center & CBOCs
- Solicitation number
- 36C25925Q0754
About this file
This document is a Limitation on Subcontracting worksheet for a VA (Department of Veterans Affairs) courier service solicitation. The contract (Solicitation Number 36C25925Q0754) covers courier services for a five-year period from 10/01/2025 to 09/30/2030, specifically involving daily and as-needed courier runs for medical facilities. The Contract Line Item Numbers (CLINs) detail various service types including daily courier services for Community-Based Outpatient Clinics (CBOCs), hospitals, and laboratories, weekly performance runs to Utah Public Health, and multiple categories of routine, stat, and urgent runs within 50 miles of the Salt Lake City VA (SLCVA). The document is structured for a Service-Disabled Veteran-Owned Small Business (SDVOSB) or Veteran-Owned Small Business (VOSB) to complete, requiring detailed documentation of prime and subcontractor payment estimations across 20 distinct line items, with provisions for future compliance verification through employee and subcontract agreements.
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Other files
| File | Type | Posted |
|---|---|---|
| SOW QASP Courier Services - 9.8.25.docx | DOCX document | |
| 36C25925Q0754 0001.docx | DOCX document | |
| S02 36C25925Q0754 0001_1.docx | DOCX document | |
| 36C25925Q0754.docx | DOCX document | |
| 36C25925Q0754_1.docx | DOCX document |
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Text version
Contractor's Name and Address:
Solicitation Number:
Subcontractor Dollar Value:
Total Offer Dollar Value:
Contract Period of Performance:
Solicitation Line Item Number (CLIN)/Brief Description Estimated Amount to be
Paid to Prime
Estimated Amount to be
Paid to Subcontractor
CLIN 0001 - DAILY COURIER SERVICE FOR CBOC'S, HOSPITAL, LABORATORY $ - $ -
CLIN 0002 - 52 WEEKLY PERF. RUN TO UTAH PUBLIC HEALTH $ - $ -
CLIN 0003 - 160 AS NEEDED ROUTINE RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 0004 - 100 AS NEEDED STAT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 0005 - 100 AS NEEDED URGENT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 1001 - DAILY COURIER SERVICE FOR CBOC'S, HOSPITAL, LABORATORY $ - $ -
CLIN 1002 - 52 WEEKLY PERF. RUN TO UTAH PUBLIC HEALTH $ - $ -
CLIN 1003 - 160 AS NEEDED ROUTINE RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 1004 - 100 AS NEEDED STAT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 1005 - 100 AS NEEDED URGENT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 2001 - DAILY COURIER SERVICE FOR CBOC'S, HOSPITAL, LABORATORY $ - $ -
CLIN 2002 - 52 WEEKLY PERF. RUN TO UTAH PUBLIC HEALTH $ - $ -
CLIN 2003 - 160 AS NEEDED ROUTINE RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 2004 - 100 AS NEEDED STAT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 2005 - 100 AS NEEDED URGENT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 3001 - DAILY COURIER SERVICE FOR CBOC'S, HOSPITAL, LABORATORY $ - $ -
CLIN 3002 - 52 WEEKLY PERF. RUN TO UTAH PUBLIC HEALTH $ - $ -
CLIN 3003 - 160 AS NEEDED ROUTINE RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 3004 - 100 AS NEEDED STAT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 3005 - 100 AS NEEDED URGENT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 4001 - DAILY COURIER SERVICE FOR CBOC'S, HOSPITAL, LABORATORY $ - $ -
CLIN 4002 - 52 WEEKLY PERF. RUN TO UTAH PUBLIC HEALTH $ - $ -
CLIN 4003 - 160 AS NEEDED ROUTINE RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 4004 - 100 AS NEEDED STAT RUN WITHIN 50 MILES OF SLCVA $ - $ -
CLIN 4005 - 100 AS NEEDED URGENT RUN WITHIN 50 MILES OF SLCVA $ - $ -
Total $ - $ -
I hereby certify the above representations are true and correct to the best of my knowledge.
{Insert Signature Here} {Insert Date Here}
Typed Name and Title of Authorized Representative for SDVOSB or
VOSB (Prime Contractor):
Date:
{Insert Typed Name Here}
{Insert Title Here}
INSTRUCTIONS:
List the name(s) and addresss of the SDVOSB(s) or VOSB(s) proposed to subcontract with under solicitation 36C25925Q0754:
SDVOSB or VOSB (prime contractor) must complete the following chart below in accordance with VAAR 852.219-73 (if applicable) and VAAR 852.219-74 (if applicable).
1. Prime Contractor shall fill out rows 3 through 35.
2. SDVOSB or VOSB (prime contractor) shall fill in the cells in Table 2 in accordance with VAAR 852.219-73 (if applicable) and VAAR
852.219-74 (if applicable), then certify and sign.
3. SDVOSB or VOSB (prime contractor) shall provide relevant documents/information in the future that demonstrate or show evidence of contractors' compliance to the offer provided during this solicitation. This may include, but not limited to, employee and subcontract agreements, subcontractor invoices, and proof of payments.
LIMITATION ON SUBCONTRACTING - SDVOSBs & VOSBs
COMPLETE THE ENTIRE WORKSHEET
Description of Requirement:
36C25925Q0754
10/01/2025 -09/30/2030
File details come from the government source that posted it. Updated .