Department of Veterans Affairs Page 1 of 3 MARKET RESEARCH QUESTIONNAIRE Onsite Neurology Services requirement- VA Fargo Health Care System The U.S. Department of Veterans Affairs is conducting market research pursuant to Federal Acquisition Regulation Part 10. It is anticipated a single solicitation will be issued for onsite Neurology Services requirement at the VA Central Health Care System located in Fargo, ND. The Government contemplates awarding a Firm Fixed Price contract resulting from the future solicitation. The service requirement will be performed at the Fargo VAHCS in accordance with the Performance Work Statement. Please answer the following questions: 1. Can your firm provide Neurology Services as either a prime contractor or as a subcontractor in Fargo, ND. Prime Subcontractor ___________No 2. Has your firm provided Neurology Services as a prime or subcontractor contractor in the last twelve months successfully? No________ Yes________ If yes please list the contract number(s):___________________________________________________________________________________________________________________________________________________________________________________________________________________ 3. Can your firm recruit Neurologists successfully with as little as 30 days notice. Please take a moment to explain your recruiting capabilities to find qualified providers that can make it through the VA credentialing process (you may use an attachment if necessary). Is your firm an established business with experience in providing Neurologists? Can you please identify an hourly rate that your firm charges for these services? Hourly Rate: ______ Daily Per Diem Rate: ______ Daily Travel Rate: ______ Daily Lodging Rate: _________________________________________________ .___________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ 3. The North American Industrial Classification System (NAICS) code 561320 Temporary Help Services, which sets the small business size standard at $27.5 million. (greater than $27.5 million is considered large business) Based on this standard, what is your business size, small or large? Small Large 4. If you are a small business, what level of subcontracting, if any, would be available for the service you are interested in providing? % 5. Is your firm eligible for participation in one of the following small business programs? If so, please indicate the program. 8(a) program Women-owned small business concern Economically Disadvantaged Women-owned small business concern Veteran-owned small business concern Service-disabled veteran-owned small business concern Use of a price evaluation adjustment for a small disadvantaged business concern 6. How many calendar days does your firm need to prepare a quotation resulting from this solicitation? ___ 15 days 30 days 45 days ____Less than 15 days 7. Is your company registered in the System for Award Management (www.sam.gov)? Yes No 8. Please furnish the following information in reference to your firm: Name: Point of Contact: Telephone Number: E-mail Address: ____________________________________________________________ Department of Veterans Affairs I am extremely appreciative of the time you have taken to complete this questionnaire. Please provide your responses to me by email NLT 5:00PM CST February 13, 2018. If you have any questions please don t hesitate to contract me at (651)-293-3037 or [email protected] Sincerely, Daniel Reinke Contracting Specialist Network 23 Contracting Office 316 Robert Street N. St. Paul, MN 55101 NOTE: The resulting solicitation will be distributed solely through FBO. Hard copies of the solicitation will not be available. The website provides downloading instructions to obtain all documents relating to the solicitation. Completing this market research questionnaire is completely voluntary and is not reimbursable.

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