Comptroller General

United States Government Accountability Office

Washington, DC 20548 

of the United States

DOCUMENT FOR PUBLIC RELEASE

The decision issued on the date below was subject to a 

GAO Protective Order. This redacted version has been 

approved for public release. 

Decision 

Matter of: International Medical Corps 

File: B-403688 

Date: December 6, 2010 

William M. Weisberg, Esq., Bryan Cave LLP, for the protester. 

R. Rene Dupuy, Esq., Agency for International Development, for the agency. 

Pedro E. Briones, Esq., and Guy R. Pietrovito, Esq., Office of the General Counsel, 

GAO, participated in the preparation of the decision. 

DIGEST 

Protest that an agency unreasonably evaluated protester’s technical proposal and 

excluded it from the competitive range is denied where the agency reasonably 

determined that the protester’s proposal contained numerous weaknesses and 

deficiencies and was not among the most highly rated offers. 

DECISION 

International Medical Corps (IMC) of Washington, D.C., protests the exclusion of its 

proposal from the competitive range under request for proposals (RFP) No. 267-10-

009, issued by the Agency for International Development (AID) for healthcare 

support services for the Iraqi Ministry of Health (MOH). The protester challenges 

the agency’s evaluation of its proposal and complains that the agency did not clarify 

its proposal before excluding it from the competitive range. 

We deny the protest. 

BACKGROUND 

The RFP, issued under Federal Acquisition Regulation (FAR) part 15, provided for 

the award of a 4-year, cost-plus-fixed-fee contract for services supporting AID’s 

primary healthcare project in Iraq. This project is intended to assist the Iraqi MOH in 

achieving better quality primary healthcare services. See RFP at 1. 

The RFP included a detailed statement of work (SOW). The SOW provided an 

overview of the current Iraqi healthcare system and identified a number of 

deliverables corresponding to project components and key principles. These 

principles included rapid, measurable improvements in the quality of healthcare 
services delivered to the Iraqi people; improving professional training and expanding 

job duties for healthcare providers, especially nurses; and realistic, practical 

technical assistance procedures which can be effectively applied in all primary 

healthcare clinics, not only in “model” sites. See SOW at 12-16. In this regard, the 

deliverables include, among other things, developing standards, materials, and 

training programs for clinical operations, patient records and rights, and quality 

improvement. See id. at 16-29. The SOW also identified three required key 

personnel (a chief of party, a director of health systems, and a director of quality 

clinical care) and their qualifications.1

 The contractor was also required to 

incorporate gender issues, geographic coverage, clinic selection, and other 

considerations. For example, all guidelines with regard to medical waste 

management and/or clinical sanitary practices must meet certain specified 

environmental conditions. See id. at 30. 

Offerors were informed that award would be made on a best value basis, considering 

cost and the following four technical evaluation factors (in descending order of 

importance): technical approach; key personnel and staffing plan; management plan; 

and organizational capacity and past performance. RFP at 108. The technical 

evaluation factors were significantly more important than cost. Id. at 107. The RFP 

stated that the agency intended to make award without conducting discussions and, 

in this respect, advised offerors that they should propose their best cost and 

technical terms. Id. at 90. 

With regard to the technical approach factor, offerors were informed that proposals 

would be evaluated on the extent to which the offeror provides a clear, proven, and 

feasible approach to improving healthcare in Iraq. See id. at 108. With regard to the 

key personnel/staffing plan factor, proposals would be evaluated on the extent to 

which key personnel satisfied the SOW criteria, and the staffing plan demonstrated 

the offeror’s ability to effectively implement their proposed technical approach.2 

With regard to the management plan factor, proposals would be evaluated on the 

extent to which the offeror’s institutional experience and management capability 

demonstrated the ability to successfully implement the program and achieve rapid, 

realistic “quick wins” within the first year. Id. at 109. 

 

1

 For example, the project’s chief of party was required to have, among other things, 

at least 7 years of relevant healthcare experience and a masters degree in a relevant 

field. SOW at 31-32. The SOW stated for each of the three identified key personnel 

knowledge of Arabic and experience in the Arab world was desirable, but not 

required.

2

 The key personnel factor includes 2 subfactors: (1) key personnel (chief of party, 

director of health systems, and director of quality clinical care) and (2) other 

additional key personnel and overall staffing plan. RFP at 108-09. 

Page 2 B-403688 
Detailed instructions were provided for the preparation of proposals under each 

evaluation factor. Offerors were also advised to be sensitive to the situation in Iraq 

and balance international best practices with a unique, country-specific approach. 

RFP at 94. 

Under the technical approach factor, proposals were required to succinctly describe 

the offeror’s proposed approach for carrying out the SOW requirements, and explain 

how the approach will be adapted to the Iraqi context. See id. at 92-95. That is, 

offerors were required to provide a rationale for how their proposed approach would 

contribute to the goals of strengthening the primary healthcare system and 

improving healthcare delivery.3

 In this respect, offerors were required to provide an 

illustrative performance monitoring plan with basic and higher-level indicators to 

measure results, such as the number of people trained and standards developed. 

Under the key personnel/staffing plan factor, offerors were instructed to submit 

staffing and organization plans. Offerors were also required to provide resumes that 

highlighted key personnel’s education, work experience, and professional 

accomplishments that were directly relevant to the project. Id. at 96. Under the 

management plan factor, offerors were required to include operations plans and 1-

year illustrative work plans. Offerors were also required to demonstrate experience 

in managing similarly complex quality improvement/primary healthcare programs in 

challenging development contexts like Iraq. Id. at 97. 

The agency received eight proposals, including IMC’s. Contracting Officer’s (CO) 

Statement at 1. Four proposals were rejected as being noncompliant to the RFP 

requirements, and the remaining proposals, including IMC’s, were evaluated by the 

agency’s technical evaluation committee (TEC). CO’s Statement at 2; Agency Report 

(AR), Tab 10, Technical Evaluation Memorandum, at 1. 

 

IMC proposed a [DELETED] model. IMC’s Technical Proposal at 1. IMC’s model 

would [DELETED]. The proposal describes this model as a [DELETED]. See id.

at 6-7. The proposal also states that the [DELETED]. According to IMC, the strategy 

 

3

 Offerors were also required to describe their experience in successfully 

implementing their proposed approach and achieving quantified, documented 

improvement in healthcare. 

Page 3 B-403688 
is based on a business process model and was developed after analyzing many 

alternative approaches.4

 Id. at 2. 

The TEC assigned the following adjectival ratings:5

Offeror A Offeror B Offeror C IMC 

Technical approach Acceptable Marginal Better Marginal 

Key personnel/ 

staffing plan Better Acceptable Acceptable Marginal 

Management Plan Acceptable Acceptable Acceptable Marginal 

Past performance Acceptable Acceptable Better Acceptable

OVERALL Acceptable Acceptable Better Marginal 

AR, Tab 10, Technical Evaluation Memorandum, Table 1, Consensus Score Sheet. 

IMC’s overall marginal rating reflected the evaluators’ judgment that, although IMC’s 

proposal presented some strengths, it contained a number of weaknesses, significant 

weaknesses, and deficiencies. 

With respect to IMC’s marginal rating under the technical approach factor, the TEC 

found that IMC’s approach “relied heavily” on [DELETED] within a very short time 

period and that the amount of resources and efforts required [DELETED] was not 

consonant with the project’s intent to support “realistic, practical systems, 

procedures, and tools which can be effectively applied in all primary healthcare 

 

4

 IMC’s technical proposal included approximately four dozen diagrams, figures, 

tables, charts, and graphs, a number of which are illegible and repeated throughout 

the proposal. The diagrams, figures, tables, charts, and graphs include IMC’s 

proposed network model; system approach; implementation framework; operational 

model; cascade development plan; product development model; training, mentoring, 

and capabilities development and continuous improvement model; illustrative 

strengthening methodologies; fully functional service delivery point; pathways 

conceptual framework; illustrative activities, methodologies, and deliverables; 

healthcare intervention planning and tracking tool; performance monitoring 

framework; overall plan for performance management; design for establishing and 

incorporating baseline and target measures into IMC’s overall performance 

monitoring plan; staffing considerations; process-based project planning; process for 

project reporting; lines of authority; and illustrative first year work plan. 

5

 Proposals were rated as either outstanding, better, acceptable, marginal, or 

unacceptable. A marginal rating reflected a proposal that was less than acceptable, 

having some deficiencies, but that had a reasonable chance of becoming acceptable 

if discussions were conducted. See AR, Tab 10, Technical Evaluation Memorandum, 

attach., Evaluation Method: Adjectival Scale, at 1. 

Page 4 B-403688 
clinics, not only in higher functional ‘model’ sites.” Id. at 2. The TEC doubted that 

IMC’s proposed model could be successfully implemented in Iraq given IMC’s 

proposed timeframe, the relatively poor quality of clinical care, shortage of qualified 

health professionals, frequent turnover of clinical staff, and heavy patient workload 

at many primary care centers. In this regard, the TEC noted that IMC provided no 

evidence to demonstrate that its approach has been successfully pilot tested or 

implemented in Iraq or elsewhere.6

 The TEC also found IMC’s illustrative 

performance monitoring plan to be unacceptable, stating that the plan was poorly 

organized, provided no explanation of what indicators will be measured to assess 

compliance with the quality standards, and did not reflect higher level impact or 

outcome indicators for the project. See id. at 31-32. In addition, the TEC found that 

IMC’s proposal did not address environmental compliance, as required by the RFP. 

Under the key personnel/staffing plan factor, the TEC noted as a deficiency in IMC’s 

proposal that no overall rationale or narrative was provided to explain IMC’s 

“complicated” staffing plan and that the proposal’s organizational chart did not 

include all the positions shown in its staffing plan. Id. at 34. The TEC also noted a 

number of weaknesses with respect to IMC’s proposed key personnel (chief of party, 

director of health systems, and director of quality clinical care), although the TEC 

found these personnel to be acceptable. For example, with respect to its proposed 

chief of party, the TEC noted that this individual had advanced degrees but not in 

areas directly relevant to the scope of the project and his specific area of expertise 

was unclear. In this regard, the TEC noted that it found it difficult to assess IMC’s 

proposed key personnel because resumes for these individuals were formatted in 

such a way that the TEC could not ascertain which work experience/job duties went 

with which position (and timeframe).7

 See id. at 33. In addition, although the TEC 

found proposed key personnel to be acceptable, it noted that IMC had not indicated 

any Arabic language skills for these individuals. Id. at 33-34. 

With respect to IMC’s marginal rating under the management plan factor, the TEC 

noted a number of significant weaknesses and deficiencies in the protester’s 

proposal, including that the firm’s proposed [DELETED] timeline [DELETED] was 

 

6

 The TEC also noted that the proposal failed to clearly present IMC’s proposed 

approach and that, in this regard, the proposal’s numerous diagrams, figures, charts, 

and tables were repetitive, unhelpful, and created “a sense of complexity rather than 

clarity.” See AR, Tab 10, Technical Evaluation Memorandum, at 30, 32. 

7

 The TEC had similar concerns for IMC’s other two proposed key personnel, for 

which the evaluators stated that they could not determine how much of their prior 

experience was relevant to primary healthcare. AR, Tab 10, Technical Evaluation 

Memorandum, at 33-34. 

Page 5 B-403688 
unrealistic.8

 The TEC also noted as a deficiency that IMC’s proposed illustrative 

work plan did not clearly address two required SOW deliverables (primary 

healthcare improvement program and research agenda and studies for strengthening 

primary healthcare in Iraq). Id. at 35-36. 

Considering the four offerors’ probable costs and technical ratings, the CO 

determined that only the proposals of Offerors A, B, and C should be included in the 

competitive range as the mostly highly rated offerors.9 CO’s Statement at 2; AR, 

Tab 11, Competitive Range Determination, at 43-44. In this regard, the CO 

determined that IMC’s proposal was technically inferior and would require major 

revisions to become competitive. Id. at 44. 

DISCUSSION 

The protester complains that the agency improperly evaluated its technical proposal. 

The protester contends that its [DELETED] approach adequately responds to the 

RFP’s various training requirements. See Protest at 4. In this regard, the protester 

objects to the agency’s assertion that IMC had not demonstrated the success of its 

approach, pointing out that its proposed model is widely accepted and used 

worldwide, including by AID in the Ukraine, Tajikistan, Palestine, and the Dominican 

Republic. The protester also disputes the TEC’s finding that its illustrative 

performance monitoring plan did not reflect higher level impact or outcome 

indicators. The protester also complains that the agency applied an undisclosed 

evaluation factor where the agency assessed a weakness for IMC’s key personnel 

lack of Arabic, because knowledge of Arabic was not required by the RFP. 

Comments at 5-6. Finally, IMC complains that its proposal should have been 

included in the competitive range, because IMC proposed the lowest overall cost and 

its proposal had a reasonable chance of being made acceptable through discussions. 

The agency responds that it did not fault or question the relative merits of the 

protester’s proposed [DELETED] model, but questioned the feasibility of IMC’s 

approach within the Iraqi public healthcare system. See AR at 13. According to the 

agency, IMC did not provide sufficient information for the agency to conclude that 

 

8

 The TEC also noted a number of strengths, including that IMC has worked in Iraq 

for 8 years, has experience implementing health-related projects in Iraq, proposed 

staff and consultants with significant international health expertise and relevant 

experience, and its approach includes positive aspects and a good integration of 

gender issues. 

9

 Although IMC proposed the lowest overall cost, it had the highest overall probable 

costs of the four offerors. IMC’s proposed costs were found to be unrealistic, 

unbalanced and inconsistent with the firm’s technical approach and/or the program 

requirements. AR, Tab 11, Competitive Range Determination, at 44. 

Page 6 B-403688 
its proposed methodology was a feasible approach here. See CO’s Statement at 3. In 

this regard, the agency states that the proposal’s basic structure was not realistic 

given the current state of the Iraqi healthcare system and the time frames proposed 

by IMC, and was therefore incompatible with providing technical assistance which 

can be effectively applied in all primary healthcare clinics. See AR at 14, 16. 

Our Office will review an agency’s evaluation and exclusion of a proposal from the 

competitive range for reasonableness and consistency with the solicitation criteria 

and applicable statutes and regulations. Cylab Inc., B-402716, July 13, 2010, 2010 

CPD ¶ 163 at 4. Contracting agencies are not required to retain in the competitive 

range proposals that are not among the most highly rated or that the agency 

otherwise reasonably concludes have no realistic prospect of being selected for 

award. FAR § 15.306(c)(1); General Atomics Aeronautical Sys., Inc., B-311004, 

B-311004.2, Mar. 28, 2008, 2008 CPD ¶ 105 at 5. In this regard, a protester’s mere 

disagreement with an agency’s evaluation and competitive range judgment does not 

establish that the agency acted unreasonably. CMC & Maint., Inc., B-290152, June 24, 

2002, 2002 CPD ¶ 107 at 2. 

Here, the RFP informed offerors that proposals would be evaluated on the extent to 

which offerors provided a feasible approach to improving the quality of primary 

healthcare delivery in Iraq and demonstrated the ability to implement the project 

rapidly and realistically and achieve “quick wins” within the first year. RFP at 16, 

108. In this regard, the SOW provided an overview of the current Iraqi healthcare 

system and advised offerors to be sensitive to the country’s situation and balance 

international best practices with a unique, country-specific approach. Offerors were 

also required to demonstrate institutional experience in successfully implementing 

their proposed approach. The SOW also states that the project requires practical 

technical assistance that could be effectively applied in all primary healthcare 

clinics, not simply model sites like the centers proposed by the protester. 

Although the protester generally challenges the agency’s evaluation of its proposed 

approach as marginal (and disputes the agency’s evaluation of its proposed 

illustrative performance monitoring plan and key personnel), it does not dispute or 

address the agency’s finding that IMC’s proposed timeline and “quick wins” were 

unrealistic in the Iraqi context and that its proposal could not be rapidly applied in 

all primary healthcare clinics in Iraq. See Protest at 4; Comments at 6. To the extent 

that the protester contends that its proposed model is used worldwide, including by 

AID, that rationale is not discussed in the protester’s proposal; moreover, this does 

not address the agency’s concerns with the use of this model in Iraq. The protester’s 

proposal merely states that it analyzed alternative models, but only provides 

generalized statements regarding best practices in Iraq “and similar environments,” 

“tools proven in challenging field environments like Iraq,” and frameworks employed 

in Iraq and Afghanistan. See, e.g., IMC’s Technical Proposal at 2, 8-10. In fact, there 

are a number of significant weaknesses and deficiencies assessed in its proposal that 

the protester does not contest, including for example, the agency’s finding that its 

Page 7 B-403688 
proposal did not address environmental considerations and that its staffing plan 

provides no overall rationale or narrative. 

Moreover, we agree with the agency that the protester’s proposal did not clearly 

explain IMC’s proposed technical approach and that the protester’s staffing and 

illustrative performance monitoring plans are not clearly presented. It is an offeror’s 

responsibility to submit a well-written proposal, with adequately detailed 

information which clearly demonstrates compliance with the solicitation 

requirements and allows a meaningful review by the procuring agency. CACI Techs., 

Inc., B-296946, Oct. 27, 2005, 2005 CPD ¶ 198 at 5. Here, we find from our review of 

IMC’s proposal that IMC appeared to rely more upon a dizzying array of complex 

diagrams, figures, tables, charts, and graphs, than a well-written explanation of its 

proposed technical approach. Indeed, several diagrams and figures are completely 

illegible. The resumes submitted for IMC’s key personnel are also disorganized and 

difficult to follow. See, e.g., Mike Kesler Enter., B-401633, Oct. 23, 2009, 2009 CPD 

¶ 205 at 3-4 (agency reasonably determined that protester’s proposal did not provide 

sufficient detail and was technically unacceptable where proposal lacked clear and 

consistent language and information necessary to determine if the proposal would 

function as proposed). 

The protester also challenges the agency’s assessment that IMC’s proposed 

illustrative performance monitoring plan failed to provide higher level impact or 

outcome indicators. We find no reason to disagree with the agency’s finding in this 

regard. IMC’s plan listed 39 so-called “indicators” and “measurements,” which 

simply parrot the list of deliverables in the RFP. See IMC’s Technical Proposal 

at 25-28, annex A, at 1-7. For example, the plan restates the deliverables for the 

establishment of a national technical advisory group and the development of a 

handbook of quality standards for clinic management, describes these deliverables 

as “indicators,” and states that the targets for those so-called indicators are 

“designated rating,” but does not define or explain the term “designated rating.” See

id., annex A, at 1. Also, the plan purports to identify “intermediate” indicators and 

outcomes, but does not in fact identify any “higher-level” indicators as required by 

the SOW. See, e.g., id.

With respect to the protester’s complaint that the agency assessed a weakness in its 

proposal for its key personnel’s lack of Arabic language skills, we find no reasonable 

possibility that the protester was competitively prejudiced in this regard. As noted 

above, the TEC found that IMC’s proposed key personnel were acceptable, despite 

the evaluators’ concern that these individuals lacked Arabic language skills.10 The 

record shows that the marginal rating that IMC received under the key 

 

10 In its comments, the protester states that its key personnel are indeed fluent or 

have a working knowledge of Arabic. This was not provided in IMC’s personnel 

resumes or proposal. See Comments at 6. 

Page 8 B-403688 
personnel/staffing plan factor and overall was not due to the assessment of this one 

weakness. 

Finally, we find no merit to IMC’s argument that its proposal should have been 

included in the competitive range, because IMC proposed the lowest overall cost and 

its proposal was susceptible of being made acceptable through discussions. 

Although it is true that IMC proposed the lowest overall costs, where, as here, an 

agency evaluates proposals for the award of a cost-reimbursement contract, an 

offeror’s proposed estimated costs are not controlling because, regardless of the 

costs proposed by an offeror, the government is bound to pay the contractor its 

actual and allowable costs. The Boeing Co., B-311344 et al., June 18, 2008, 2008 CPD 

¶ 114 at 63. Here, the agency found IMC’s proposed costs to be unrealistic, 

unbalanced and inconsistent with the firm’s technical approach and/or the program 

requirements.11 AR, Tab 11, Competitive Range Determination, at 44. IMC’s 

evaluated probable costs of performance were significantly higher than the three 

offerors’ whose proposals were included in the competitive range. Given IMC’s 

much higher probable costs and the evaluated weaknesses and deficiencies in its 

proposal, we find that the agency reasonably concluded that IMC’s proposal was not 

among the most highly rated offers for inclusion in the competitive range. 

The protester also contends that, prior to excluding its proposal from the 

competitive range, the agency should have sought clarifications from IMC. The 

agency responds that the significant weaknesses and deficiencies in IMC’s proposal 

could not be resolved by clarifications. See AR at 16-20. Moreover, the agency 

contends that it was under no obligation to seek clarifications, in any event. 

FAR § 15.306 describes a spectrum of exchanges that may take place between a 

contracting agency and an offeror during negotiated procurements. Clarifications 

are limited exchanges between the agency and offerors that may occur when 

contract award without discussions is contemplated; an agency may, but is not 

required to, engage in clarifications that give offerors an opportunity to clarify 

certain aspects of proposals or to resolve minor or clerical errors. FAR § 15.306(a); 

Satellite Servs., Inc., B-295866; B-295866.2, Apr. 20, 2005, 2005 CPD ¶ 84 at 2 n. 2. By 

contrast, discussions--which are to occur after establishment of the competitive 

range--involve the agency indicating to each offeror the significant weaknesses, 

deficiencies, and other aspects of its proposal that could be altered or explained to 

materially enhance the proposal’s potential for award. FAR § 15.306(d)(3). 

Where, as here, the agency establishes a competitive range to conduct discussions, 

the agency may conduct communications with an offeror to facilitate the agency’s 

understanding and evaluation of the offeror’s proposal or for the purpose of 

exploring whether a proposal should be included in the competitive range. See FAR 

 

11 IMC does not protest the agency’s cost realism evaluation of its proposal. 

Page 9 B-403688 
Page 10 B-403688 

§ 15.306(b)(2). Such communications, however, cannot “be used to cure proposal 

deficiencies or material omissions, materially alter the technical or cost elements of 

the proposal, and/or otherwise revise the proposal.” Id.; Battelle Mem’l Inst., 

B-299533, May 14, 2007, 2007 CPD ¶ 94 at 4. 

We agree with AID that the agency was not required to seek clarifications from, or 

otherwise have communications with IMC, prior to the establishment of the 

competitive range. See JBlanco Enter., Inc., B-402905, Aug. 05, 2010, 2010 CPD ¶ 186 

at 4, n.4. Moreover, the significant weaknesses and deficiencies in IMC’s proposal 

could not properly be the subject of either clarifications or communications before 

the establishment of the competitive range, as this would require material revisions 

to IMC’s proposal. 

The protest is denied. 

Lynn H. Gibson 

Acting General Counsel