Sources_Sought_Checklist.docx

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Attached to
Health Care Advisory Board Memebership Subscription
Solicitation number
W9124J-16-R-0099
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Name of Company

Physical Address

Mailing Address

Point of Contact (Name and Title)

Phone Number

Fax Number

Email Address

Company Website

DUNS Number

CAGE Code

NAICS Code(s)

Socio-Economic Size Status |_| Large Business |_| Small Business (also check all the following that apply as well) |_| Small Disadvantage Business |_| Woman-Owned Small Business

|_| HBCU/MI

|_| Veteran-Owned Small Business |_| Service-Disabled Veteran-Owned Small Business |_| HUBzone |_| 8(a) |_| Other ___________________________________

1. Briefly describe your company’s primary business line(s):

1. Briefly describe the services that your company provides to include providing resources to plan, organize, manage personnel, operate and perform the Exercise Media Portal Services?

1. If you are interested in competing for this requirement, what, if any subcontracting, joint ventures or teaming arrangement will be pursued. Please provide detail, specifically on the type of business that will be utilized.

1. Please demonstrate your capability by providing recent (i.e., within the last 5 years) and relevant (i.e. size, scope, complexity) past performance history for federal, state, and local governments or commercial contracts. You shall include the contract type, total dollar value and name/phone of a customer point of contact and contracting officer’s name and telephone number for each contract.

1. On the average, what percentage of total effort does your company normally subcontract for this type and magnitude of work; describe how your company maintains effective control (management and quality) over subcontracted portions of these contracts and list major subcontractors including name, address and telephone of primary point of contact.

1. Please provide any company literature (free to the public) on the services provided for this service.

1. In terms of resources, will you require Contract Financing (e.g. Assignment of claims)?

Yes: __________ No: ___________

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