Home > Laws & Policies > Policy/Program Issuances > Information Memoranda > IM-05-02 > Attachment

blank cell

IM 05-02 Attachment

Acquisition Checklist

The Department of Agriculture, Food and Nutrition Service (FNS) and the Department of Health and Human Services (HHS) have developed the following optional checklist for states and territories to use to provide assurances that an acquisition of automated data processing equipment and/or services complies with all federal regulations and policies. The federal Department(s), in accordance with the regulations at 45 CFR 95.611, may grant an exemption from prior approval for an acquisition document based on a state’s favorable responses to items on the checklist.

This checklist may be used for Requests for Proposal, Requests for Quote, Invitations to Bid, or similar state and territory acquisition documents; however it may not be submitted for contracts or Advance Planning Documents that require federal prior approval. Please include the following information:

Project name:

Acquisition name:

Acquisition and/or reference number:

Date the acquisition document will be released to vendors:

Number of Days vendors will have to respond to the proposal or invitation to bid:

Estimated Cost of acquisition (including all option years):

A brief paragraph describing the acquisition activity should be included in the cover letter submitted with this request. The submission should identify (1) the state or territorial agency(s) and stakeholders involved, (2) basic system characteristics, project scope, life span, benefits and all pertinent details, and (3) the type of contract or agreement that is expected to result from the acquisition. For each “No” response to the checklist, a full narrative explanation must be provided either directly following the checklist or on a separate sheet of paper.

The checklist should be submitted to the applicable federal program office(s).

	Description	Checkbox
1.	Will the acquisition be conducted in a manner that provides, to the maximum extent practicable, open and free competition’(Note 1)	__Yes     __No
2.	Does the acquisition, if funded in whole or part by FNS and/or HHS, meet the standards and functional requirements set forth in the federal program regulations’	__Yes     __No
3.	Does the acquisition comply with all applicable federal, state and territorial acquisition standards, laws, policies and procedures’	__Yes     __No
4.	Does the acquisition document contain a clause that provides the United States Departments of Agriculture and Health and Human Services and/or their representatives access to state or territorial agency documents, papers, or other records pertinent to the procurement in order to make audits, examinations, excerpts and transcripts’	__Yes     __No
5.	Does the acquisition comply with federal rules relative to state or territorial ownership rights to all software products, documentation and intellectual property created under this acquisition’	__Yes     __No
6.	Does the acquisition document contain a clause that grants the Federal Government a royalty-free, nonexclusive, and irrevocable license to reproduce, publish, or otherwise use and to authorize others to use for Federal Government purposes, software, modifications, and documentation developed and/or obtained through this acquisition’	__Yes     __No
7.	Does the Statement of Work in the acquisition document convey expectations to be met by the successful contractor including items such as required tasks, deliverables and their schedule of delivery, technical requirements, security, privacy and confidentiality requirements, roles and responsibilities, and project reporting requirements’	__Yes     __No
8.	Does the acquisition document include clauses covering mandatory contract terms and conditions, order of precedence, compliance with laws, liability, period of performance, force majeure, availability of funds, notices, disputes, failure of performance, damages and termination’	__Yes     __No
9.	Does the acquisition document include information about the evaluation and selection process such as technical and cost scoring and weighting, and proposal ranking and selection’	__Yes     __No
10.	Has the evaluation and selection process been finalized relative to technical and cost scoring prior to the release of the acquisition document’	__Yes     __No
11.	Does the acquisition document delineate responsibilities relative to key staff, the change order process, and documentation requirements’	__Yes     __No

 

Note 1: The acquisition document must be submitted to the appropriate federal Agency or Agencies if the acquisition is a sole source solicitation and the cost exceeds the thresholds established in the federal regulations.

This form must be signed by either the appropriate state or territorial official authorized to submit acquisition documentation to the federal Department(s) or the state or territorial director of purchasing.

Signature: ______________________ Printed Name: __________________________

Title: ___________________________ Date: _______________________