Request for Quotations (RFQ)

October 29, 2026
Application ends: November 11, 2026

Apply for this job

Job Description

Request for Quotations (RFQ) 

RFQ Number: RFQ-PSM-SL-OPS-2026-10 

Issuance Date: October 28, 2026 

Deadline for Offers: November 11, 2026; 17:00 (5:00 PM) local Freetown time (GMT) Description: Provision of warehouse storage services for project files for six (6) years 

For: Global Health Supply Chain Program – Procurement and Supply  Management (GHSC-PSM) in Sierra Leone 

Funded By: U.S. Government Contract No. AID-OAA-I-15-00004; AID-OAA-TO-15-00009 Implemented By: Chemonics International Inc. 

Point of Contact: Aya Kaissi  

PSMSierraLeone-Procurement@ghsc-psm.org 

***** ETHICAL AND BUSINESS CONDUCT REQUIREMENTS ***** 

Chemonics is committed to integrity in procurement, and only selects vendors based on objective business criteria such as  price and technical merit. Chemonics expects vendors to comply with our Standards of Business Conduct, available at  https://www.chemonics.com/our-approach/standards-business-conduct/.  

Chemonics does not tolerate fraud, collusion among offerors, falsified proposals/bids, bribery, or kickbacks. Any firm or  individual violating these standards will be disqualified from this procurement, barred from future procurement  opportunities, and may be reported to both USAID and the Office of the Inspector General. 

Employees and agents of Chemonics are strictly prohibited from asking for or accepting any money, fee, commission,  credit, gift, gratuity, object of value or compensation from current or potential vendors in exchange for or as a reward for  business. Employees and agents engaging in this conduct are subject to termination and will be reported to USAID and the  Office of the Inspector General. In addition, Chemonics will inform USAID and the Office of the Inspector General of any  vendor offers of money, fee, commission, credit, gift, gratuity, object of value, or compensation to obtain business. 

Offerors responding to this RFQ must include the following as part of the proposal submission: • Disclose any close, familial, or financial relationships with Chemonics or project staff. For example, if an offeror’s  cousin is employed by the project, the offeror must state this. 

  • Disclose any family or financial relationship with other offerors submitting offers. For example, if the offeror’s father  owns a company that is submitting another offer, the offeror must state this.  
  • Certify that the prices in the offer have been arrived at independently, without any consultation, communication, or  agreement with any other offeror or competitor for the purpose of restricting competition. 
  • Certify that all information in the offer and all supporting documentation are authentic and accurate. • Certify understanding and agreement to Chemonics’ prohibitions against fraud, bribery and kickbacks.

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 1 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Please contact Aya Kaissi, Senior Manager (akaissi@chemonics.com) with any questions or concerns regarding the above  information or to report any potential violations. Potential violations may also be reported directly to Chemonics’  Washington office through the contact information listed on the website found at the hyperlink above. Section 1: Instructions to Offerors 

  1. Introduction: The Global Health Supply Chain – Procurement and Supply Management (GHSC PSM) Project is a U.S. Government-funded program implemented by Chemonics International in  Sierra Leone. The goal of the GHSC-PSM project is to 1) procure and provide health  commodities, 2) provide technical assistance to improve partner country management of the  health supply chain, and 3) collaborate with key international stakeholders to support global  health initiatives. As part of project activities, the GHSC-PSM project requires secure storage,  management, and retrieval services for hard copy project records to meet the requirement that  GHSC-PSM retain hard copy project documents in Sierra Leone for six (6) years in case of future  local audits. The purpose of this RFQ is to solicit quotations for these services. 

Offerors are responsible for ensuring that their offers are received by Chemonics in accordance  with the instructions, terms, and conditions described in this RFQ. Failure to adhere with  instructions described in this RFQ may lead to disqualification of an offer from consideration. 

  1. Offer Deadline and Protocol: Offers must be received no later than 17:00 (5:00 PM) local  Freetown time on November 11, 2026 by email to PSMSierraLeone-Procurement@ghsc-psm.org.  

Please reference the RFQ number in any response to this RFQ. Offers received after the specified  time and date will be considered late and will be considered only at the discretion of Chemonics. 

  1. Questions: Questions regarding the technical or administrative requirements of this RFQ may be  submitted no later than 17:00 (5:00 PM) local Freetown time on November 4, 2026 by email to PSMSierraLeone-Procurement@ghsc-psm.org. Questions must be submitted in writing; phone  calls will not be accepted. Questions and requests for clarification—and the responses thereto— that Chemonics believes may be of interest to other offerors will be circulated to all RFQ  recipients who have indicated an interest in bidding.  

Only the written answers issued by Chemonics will be considered official and carry weight in the  RFQ process and subsequent evaluation. Any verbal information received from employees of  Chemonics or any other entity should not be considered as an official response to any questions  regarding this RFQ. 

  1. Scope of Work: Section 3 contains the Scope of Work, the Capabilities Statement (Table 1), and  the Pricing Schedule (Table 2) for the required records storage and management services. 
  2. Quotations: Quotations in response to this RFQ must be priced on a fixed-price, all-inclusive  basis, including all other costs. Pricing must be presented in Sierra Leonean Leones (SLE). Offers  must remain valid for not less than thirty (30) calendar days after the offer deadline. Offerors are  requested to provide quotations on their official quotation format or letterhead; in the event  this is not possible, offerors may complete the table in Section 3. Offerors should clearly indicate  any proposed price escalation terms over the period of performance, including the basis,  frequency, and applicable percentage or index for such adjustments, if applicable. 

In addition, offerors responding to this RFQ are requested to submit the following: • Organizations responding to this RFQ are requested to submit a copy of their official  registration or business license.

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 2 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

  • Individuals responding to this RFQ are requested to submit a copy of their identification  card. 
  • A completed Table 1. Capabilities Statement (Section 3), including photographs of the  proposed facility and storage area. 
  • A brief implementation plan describing how the offeror will receive, inventory, and store  the initial transfer of records. 
  • The name and contact information of a minimum of three (3) references for similar  records storage services. 
  1. Availability of Storage Space: As part of its response to this RFQ, each offeror is expected to  state the date from which the storage space will be available. The storage space must be  available no later than December 10, 2026. The availability presented in an offer in response to  this RFQ must be upheld in the performance of any resulting contract. 
  2. Source/Nationality/Manufacture: All goods and services offered in response to this RFQ or  supplied under any resulting award must meet USAID Geographic Code 935 in accordance with  the United States Code of Federal Regulations (CFR), 22 CFR §228. The cooperating country for  this RFQ is Sierra Leone.  

Offerors may not offer or supply any commodities or services that are manufactured or  assembled in, shipped from, transported through, or otherwise involving any of the following  countries: Cuba, Iran, North Korea, Syria. 

  1. Taxes and VAT:  

In accordance with the agreement under which this procurement is financed, Chemonics will be  reimbursed by the Cooperating Country government for taxes imposed on vendors and  subcontractors. Therefore, offerors must include taxes, VAT, charges, tariffs, duties, and levies  in accordance with the laws of the Cooperating Country. If selected for award, the selected  vendor will cooperate in providing Chemonics with the documentation necessary to obtain tax  reimbursement. 

  1. UEI Number: Companies or organizations, whether for-profit or non-profit, shall be requested to  provide a Unique Entity Identifier (UEI) number if selected to receive an award in response to  this RFQ valued greater than or equal to $30,000 (or equivalent in other currency). If the Offeror  does not have a UEI number and is unable to obtain one before the offer submission deadline,  the Offeror shall include a statement noting their intention to register for a UEI number should it  be selected as the successful offeror or explaining why registration for a UEI number is not  possible. UEI numbers can be obtained online at SAM.gov. Further guidance on obtaining a UEI  number is available from Chemonics upon request.  
  2. Eligibility: By submitting an offer in response to this RFQ, the offeror certifies that it and its  principal officers are not debarred, suspended, or otherwise considered ineligible for an award  by the U.S. Government. Chemonics will not award a contract to any firm that is debarred,  suspended, or considered to be ineligible by the U.S. Government. 
  3. Evaluation and Award: The award will be made to a responsible offeror whose offer follows the  RFQ instructions, meets the eligibility requirements, and is determined via a trade-off analysis to  be the best value based on application of the following evaluation criteria. The relative  importance of each individual criterion is indicated by the number of points below:

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 3 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

 

Criteria Maximum Point Value
Capabilities & Available Services (per Table 1 in Section 3) 45 Points
Pricing (per Table 2 in Section 3) 40 Points
Initial and Ongoing Account Support (Client Management) 15 Points
TOTAL 100 Points

 

Please note that if there are significant deficiencies regarding responsiveness to the  requirements of this RFQ, an offer may be deemed “non-responsive” and thereby disqualified  from consideration. Chemonics reserves the right to waive immaterial deficiencies at its  discretion. 

Best-offer quotations are requested. It is anticipated that award will be made solely on the basis  of these original quotations. However, Chemonics reserves the right to conduct any of the  following: 

  • Chemonics may conduct negotiations with and/or request clarifications from any offeror  prior to award. 
  • While preference will be given to offerors who can address the full technical  requirements of this RFQ, Chemonics may issue a partial award or split the award among  various vendors, if in the best interest of the GHSC-PSM Project.  
  • Chemonics may cancel this RFQ at any time. 

Please note that in submitting a response to this RFQ, the offeror understands that USAID is not  a party to this solicitation and the offeror agrees that any protest hereunder must be  presented—in writing with full explanations—to the GHSC-PSM Project for consideration, as  USAID will not consider protests regarding procurements carried out by implementing partners.  Chemonics, at its sole discretion, will make a final decision on the protest for this procurement. 

  1. Terms and Conditions: This is a Request for Quotations only. Issuance of this RFQ does not in  any way obligate Chemonics, the GHSC-PSM Project, or USAID to make an award or pay for costs  incurred by potential offerors in the preparation and submission of an offer.  

This solicitation is subject to Chemonics’ standard terms and conditions. Any resultant award will  be governed by these terms and conditions; a copy of the full terms and conditions is available  upon request. Please note the following terms and conditions will apply: 

(a) Chemonics’ standard payment terms are net 30 days after receipt and acceptance of any  commodities or deliverables. Payment will only be issued to the entity submitting the offer  in response to this RFQ and identified in the resulting award; payment will not be issued to a  third party. 

(b) Any award resulting from this RFQ will be firm fixed price, in the form of a subcontract. (c) No commodities or services may be supplied that are manufactured or assembled in,  shipped from, transported through, or otherwise involving any of the following countries:  Cuba, Iran, North Korea, Syria. 

(d) Any international air or ocean transportation or shipping carried out under any award  resulting from this RFQ must take place on U.S.-flag carriers/vessels. 

(e) United States law prohibits transactions with, and the provision of resources and support to,  individuals and organizations associated with terrorism. The vendor under any award  resulting from this RFQ must ensure compliance with these laws.

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 4 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Section 2: Offer Checklist 

To assist offerors in preparation of proposals, the following checklist summarizes the documentation  to include an offer in response to this RFQ: 

□Cover letter, signed by an authorized representative of the offeror (see Section 4 for template) □ Official quotation (completed Table 2. Pricing Schedule; see Section 3) 

□Federal Funding Accountability and Transparency Act (FFATA) Subaward Reporting  Questionnaire, signed by an authorized representative of the offeror (see Section 5 for  questionnaire) 

□Copy of offeror’s registration or business license (see Section 1.5 for more details) 

□Completed Table 1. Capabilities Statement, including photographs of the proposed facility (see  Section 3) 

□Implementation plan for the initial transfer of records (see Section 1.5)

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 5 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Section 3: Scope of Work, Capabilities Statement, and Pricing Schedule 

Background 

The GHSC-PSM Project in Sierra Leone maintains hard copy project records that must be retained in  country for six (6) years. GHSC-PSM seeks a qualified vendor to provide secure storage, management,  and retrieval of these records for the full retention period, in line with GHSC-PSM’s records retention  requirements. 

The records consist of archival paper documents packed in standard archive boxes. The records are  non-hazardous and non-perishable. No commodities, equipment, or electronic media will be stored  under this scope of work. 

Estimated Volume and Period of Performance 

  1. a) Estimated number of boxes: 70 
  2. b) Average box size (estimate): 46 cm x 33 cm x 26 cm 
  3. e) Period of performance: December 10, 2026 – December 31, 2032 

Scope of Services 

The scope of services GHSC-PSM seeks through this RFQ includes, but is not limited to, the following: 

  1. a) Provide secure physical storage with access controls, climate control, and environmental and  security safeguards. 
  2. b) Organize and manage records to ensure efficient retrieval, tracking, and lifecycle management,  using a reliable records management system. 
  3. c) Provide retrieval, and refiling of records, and access to records for GHSC-PSM staff and auditors. 
  4. d) Manage records in accordance with GHSC-PSM’s retention requirements, including authorized  destruction and the ability to immediately suspend destruction upon notice of a legal hold or  audit. 
  5. e) Maintain the confidentiality of all records. 
  6. f) Provide timely and reliable reporting and documentation, and initial and ongoing account support. 

The vendor shall meet the following requirements: 

  1. Facility Requirements 

1.1 The facility must be secure. A secure facility is defined as one that has: a) Access control (guards (preferred), locks, and gates); 

  1. b) Regular monitoring by facility management and positive control of the premises; and 
  2. c) Climate control both inside the facility and externally, to minimize the risk of damage from  moisture, extreme heat or cold, rain, or flooding. 

1.2 The facility shall be located in Freetown, Sierra Leone. 

1.3 The facility shall be a fully enclosed, permanent structure, with roof and walls free of leaks. 

1.4 Climate control shall operate continuously, 24 hours a day, throughout the period of  performance. The facility shall have backup power (e.g., generator or inverter) sufficient to  maintain climate control during grid power outages.

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 6 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

1.5 The facility shall be protected against water damage, including through location outside of  known flood-prone areas, adequate drainage, and storage of all boxes on shelving or racking  off the floor. Where possible, no water pipes shall run directly above the storage area. 

1.6 The facility shall have fire detection equipment and fire extinguishers suitable for paper  records, maintained in working order. 

1.7 Boxes shall be stored on sturdy shelving or racking, organized to allow quick location and  retrieval of any box, and shall not be stacked in a manner that risks crushing or damage. 

1.8 GHSC-PSM records shall be stored in a lockable room with a segregated area and shall not be  mixed with the materials of other clients. 

  1. Security and Access Control 

2.1 The vendor shall ensure the safety and security of the facility and records through security  services on premise/location, 24 hours a day, 7 days a week; a secure perimeter, storage areas  locked when not in use and secured at all times, and CCTV coverage of facility entrances and  storage areas (preferred). 

2.2 Access to GHSC-PSM records shall be restricted to authorized vendor staff and to GHSC-PSM  personnel named on a written authorization list provided by GHSC-PSM. Visitors must show  identification and be recorded in a visitor log. 

2.3 The vendor shall notify GHSC-PSM in writing of any security incident, loss, damage, or  suspected unauthorized access within 24 hours of discovery. 

  1. Receiving and Records Management System 

3.1 Receiving and entering: For each transfer of records, the vendor shall verify the boxes  received against a GHSC-PSM transfer list, sign the list to acknowledge custody, and enter  each box into its records management system/tracker noting the location. 

3.2 Records management system: The vendor shall maintain a records management system that  tracks each box through its lifecycle, including location, status (in storage, retrieved,  permanently withdrawn, or destroyed), and movement history.  

  1. Retrieval, Refiling, and Access 

4.1 Retrieval: Upon written request from an authorized GHSC-PSM staff member, the vendor shall  retrieve records at the carton (box) level within two (2) working days for regular requests and 24 hours for rush requests. GHSC-PSM or Chemonics personnel will then pick up the carton.  

4.2 Refiling and interfiling: The vendor shall return retrieved cartons to storage, and add new  cartons when requested. 

4.3 Client access: The vendor shall allow GHSC-PSM staff and auditors to review records at the  facility, in a private viewing area. 

4.4 Permanent withdrawal: Upon written request from GHSC-PSM, the vendor shall permanently  withdraw cartons from storage, return them to GHSC-PSM, and update the records  management system. 

4.5 Chain of custody: The vendor shall maintain a chain-of-custody record for every carton that  leaves and returns to the facility.

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 7 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

  1. Retention, Legal Hold, and Destruction 

5.1 The vendor shall manage records in accordance with GHSC-PSM’s retention requirements,  including retention in country for a minimum of six (6) years. 

5.2 The vendor shall not destroy any records without explicit prior written authorization from  GHSC-PSM. 

5.3 The vendor shall immediately suspend any destruction activity upon notice of a legal hold or  audit, and comply with GHSC-PSM’s legal and audit requirements. 

5.4 When authorized in writing, the vendor shall perform secure destruction (shredding), on-site  or off-site, and provide GHSC-PSM a formal certificate of destruction listing all destroyed  items. 

5.5 At the end of the period of performance, the vendor shall return all records to GHSC-PSM or  transfer them to another records management provider designated by GHSC-PSM, and shall  cooperate fully in that transfer. 

  1. Confidentiality and Data Protection 

6.1 All stored records are confidential. The vendor shall not open, read, copy, photograph, or  disclose any records or their contents, except as required to fulfill a written request from  GHSC-PSM. 

  1. Insurance and Liability 

7.1 The vendor selected for award will be required to maintain insurance coverage appropriate  to the nature and risks of the services to be performed. At a minimum, such insurance is  expected to include commercially reasonable levels of: 

  1. a) Commercial general liability insurance; 
  2. b) Workers’ compensation insurance; and 

7.2 Coverage amounts, policy terms, and additional requirements, if any, will be specified in the  resulting contract. 

7.3 The vendor shall be liable for any loss of or damage to the records attributable to the fault of  the vendor, its employees, or its contracted third parties. 

  1. Business Continuity 

8.1 The vendor shall maintain a plan to protect the records and continue services in the event of  fire, flood, extended power outage, or other events beyond its control. Records shall not be  relocated to another facility without prior written approval from GHSC-PSM. 

  1. Account Support 

9.1 The vendor shall designate an account manager as the single point of contact for GHSC-PSM,  and shall provide initial support for the transfer of records into storage and ongoing support  for records management throughout the period of performance.

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 8 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Table 1. Capabilities Statement 

The offeror shall describe its approach to providing GHSC-PSM with secure, efficient, and compliant  records storage and management services. The table below outlines the information GHSC-PSM  requires regarding offerors’ capabilities. Offerors should also attach photographs of the proposed  facility and storage area.

Capabilities Offeror’s Comments
Please provide a company overview. For example, how big is the  storage facility? How long have you been in operation?
What services do you provide?
What does your current client footprint look like? Do you have  experience serving international organizations, donor-funded  projects, or other clients with similar records storage needs?
Where is the proposed facility located? Please provide its full  address.
What records management system do you use to track records? Is  barcoding or another unique identifier used? Can clients view their  inventory?
Are clients able to access records within your facility? If yes, please  describe client access (e.g., viewing room for staff and auditors).
What are the retrieval, delivery, and pickup options for records?  Please share an overview of these processes and the standard and  rush turnaround times.
Do you provide secure destruction services? How do you confirm  destruction, and how do you suspend destruction when a legal hold  or audit notice is received?
Do you have minimum or maximum storage or destruction levels?
Is pricing for services dependent on volume?
Do your prices change over time? If so, how and when?
Please describe the process and timing for transferring records  to/from another records management provider.
Please describe your initial and ongoing account support structure.  What type of support do your clients receive? Are there costs  associated with this support?
What insurance coverage do you currently maintain for your facility  and for clients’ stored records?

 

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 9 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Table 2. Pricing Schedule 

Offerors are requested to submit quotations for the services below for the six (6) year period of  performance. For any services not provided, offerors should enter “N/A” in the corresponding cells.  Offerors may add other relevant services, with descriptions and pricing, as needed. 

Offerors are requested to provide quotations containing the information below on official letterhead  or official quotation format. In the event this is not possible, offerors may complete this Section 3 and  submit a signed/stamped version to Chemonics. 

Line Item Description and SpecificationsUnit (e.g.  

carton, cubic  

meter, month)

Items and  

Specifications  

Offered

Unit Price 

SLE

Total Price 

SLE

Storage
1 Carton storage: monthly storage of one  standard box
Receiving, Retrieving, and Refiling
2Carton receiving and entering: receive,  label, and enter each new box into the  records management system
4 Carton retrieval – regular
5 Carton retrieval – rush
8 Carton refile
Permanent Withdrawal
10 Carton
Archival Destruction
12 Carton: secure shredding, with certificate of  destruction
Other
19On-site records review: use of a private  viewing area by GHSC-PSM staff or auditors,  if any charge applies
20 Transfer of records to/from another  records management provider
21 Administrative or account fee, if applicable
22 Miscellaneous services – labor
Offerors may add line items for other  services as needed.
Subtotal:
Other Costs (Describe: ______________________):
GRAND TOTAL (SLE):

 

Date from which storage space will be available:  

Full address of the proposed storage facility:  

Proposed price escalation terms, if any (basis, frequency, percentage or index): 

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 10 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Section 4: Offer Cover Letter 

The following cover letter must be placed on letterhead and completed/signed/stamped by a  representative authorized to sign on behalf of the offeror: 

To: Global Health Supply Chain Program – Procurement and Supply Management  (GHSC-PSM) Project 

24 Cantonment Road, Brookfields, Freetown, Sierra Leone 

Reference: RFQ No. RFQ-PSM-SL-OPS-2026-10 

To Whom It May Concern: 

We, the undersigned, hereby provide the attached offer to perform all work required to complete the  activities and requirements as described in the above-referenced RFQ. Please find our offer attached. 

We hereby acknowledge and agree to all terms, conditions, special provisions, and instructions  included in the above-referenced RFQ. We further certify that the below-named firm—as well as the  firm’s principal officers and all commodities and services offered in response to this RFQ—are  eligible to participate in this procurement under the terms of this solicitation and under USAID  regulations. 

Furthermore, we hereby certify that, to the best of our knowledge and belief: 

  • We have no close, familial, or financial relationships with any Chemonics or GHSC-PSM project staff members; 
  • We have no close, familial, or financial relationships with any other offerors submitting offers  in response to the above-referenced RFQ; and 
  • The prices in our offer have been arrived at independently, without any consultation,  communication, or agreement with any other offeror or competitor for the purpose of restricting  competition. 
  • All information in our offer and all supporting documentation is authentic and accurate. • We understand and agree to Chemonics’ prohibitions against fraud, bribery, and kickbacks. 

We hereby certify that the enclosed representations, certifications, and other statements are accurate,  current, and complete. 

Authorized Signature:  

Name and Title of Signatory:  

Date:  

Company Name:  

Company Address:  

Company Telephone and Website:  

Company Registration or Taxpayer ID Number:  

Company UEI Number:  

Does the company have an active bank account (Yes/No)?  

Official name associated with bank account (for payment): 

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 11 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Section 5: Federal Funding Accountability and Transparency Act (FFATA) Subaward Reporting  Questionnaire 

If the offeror is selected for an award valued at $30,000 or above and is not exempted based on a  positive response to paragraph (a) below, any first-tier subaward to the organization may be reported  and made public through FSRS.gov in accordance with The Transparency Acts of 2006 and 2008.  Further, in accordance with FAR 52.204-10 and 2 CFR Part 170, if the offeror positively certifies  below in paragraph (b) and negatively certifies in paragraphs (c) and (d), the offeror will be required  to disclose to Chemonics for reporting in accordance with the regulations, the names and total  compensation of the organization’s five most highly compensated executives. By submitting this  offer, the offeror agrees to comply with this requirement as applicable if selected for a subaward. 

Prime Contract Global Health Supply Chain – Procurement and Supply Management (GHSC PSM) Project in Sierra Leone 

Insert Prime Contract Number/Task Order Number 

Subcontractor Data 

Insert Subcontractor Name 

Insert Subcontractor Address 

Insert Subcontractor City 

Insert Subcontractor State in USA, or Province/Other 

Insert Subcontractor Zip code or Postal Code 

Insert Subcontractor Country 

Subcontract/Grant Number: Insert Subcontract Number 

Start Date: Insert Subcontract Start Date 

Subcontract/Grant Value: Insert Subcontract Value 

  1. a) In the previous tax year, was your company’s gross income from all sources under $300,000? Yes No 

If “No” is the response to the preceding question, please provide the below information and answer  the remaining questions.  

  1. b) In your business or organization’s preceding completed fiscal year, did your business or  organization (the legal entity to which the UEI number belongs) receive (1) 80 percent or  more of its annual gross revenues in U.S. federal contracts, subcontracts, loans, grants,  subgrants, and/or cooperative agreements; and (2) $25,000,000 or more in annual gross  revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or  cooperative agreements?:  

Yes No 

  

  1. c) Does the public have access to information about the compensation of the executives in your  business or organization (the legal entity to which the UEI number it provided belongs)  through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of  1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986)?: 

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 12 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Yes No  

  

  1. d) Does your business or organization maintain an active registration in the System for Award  Management (SAM.gov)? 

Yes No  

  1. e) If you have indicated “Yes” for paragraph (b) and “No” for paragraphs (c) and (d) above,  provide the names and total compensation* of your five most highly compensated executives** for the preceding completed fiscal year. 
  2. Name: ______________________________________________________________ Amount: _____________________________________________________________ 
  3. Name: ______________________________________________________________ Amount: _____________________________________________________________ 
  4. Name: ______________________________________________________________ Amount: _____________________________________________________________ 
  5. Name: ______________________________________________________________ Amount: _____________________________________________________________ 
  6. Name: ______________________________________________________________ Amount: _____________________________________________________________ 

By signature below, I hereby certify that the information provided above is true and accurate as of the  date of execution of this document, and I further understand that annual certification is required for  information provided in paragraph (e) above. 

Signature and Title (required) Date  

*“Total compensation” means the cash and noncash dollar value earned by the executive during the Subcontractor’s  preceding fiscal year and includes the following (for more information see 17 CFR 229.402(c)(2)):  (1) Salary and bonus.  

(2) Awards of stock, stock options, and stock appreciation rights. Use the dollar amount recognized for financial statement  reporting purposes with respect to the fiscal year in accordance with the Financial Accounting Standards Board’s  Accounting Standards Codification (FASB ASC) 718, Compensation-Stock Compensation.  

(3) Earnings for services under non-equity incentive plans. This does not include group life, health, hospitalization or  medical reimbursement plans that do not discriminate in favor of executives and are available generally to all salaried  employees.  

(4) Change in pension value. This is the change in present value of defined benefit and actuarial pension plans.  (5) Above-market earnings on deferred compensation which is not tax-qualified.  

(6) Other compensation, if the aggregate value of all such other compensation (e.g., severance, termination payments,  value of life insurance paid on behalf of the employee, perquisites or property) for the executive exceeds $10,000. 

**”Executive” means officers, managing partners, or any other employees in management positions. I hereby certify that the above statements are true and accurate, to the best of my knowledge. Authorized Signature:  

Name and Title of Signatory: 

RFQ No. RFQ-PSM-SL-OPS-2026-10 

Page 13 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025 

Date: 

RFQ No. RFQ-PSM-SL-OPS-2026-10 Page 14 of 14 

GlobalQMS ID: (Old ID: 879) 201.9, 24 September 2025