11-242-SOL-00024 Nutritionist.pdf

11-242-SOL-00024

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

1 28

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ______________ calendar days (60 calendar days unless a different period is inserted

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

02/10/2011 X

Albuquerque Indian Health Service 5300 Homestead Road NE Albuquerque NM 87110

1630 MS 03/16/2011

BRADLEY ( PLATERO 505

bradley.platero@ihs.gov

248-4557

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X

X

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PAGE(S)

VERONICA ZUNI

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

2-5

5-8 8-10 10-12 12-14 14-18

18-28

29-38

38-44

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

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(A) (B) (C) (D) (E) (F)

PART I- THE SCHEDULE

SECTION B - Supplies or Services and Price/Costs

The Jicarilla Service Unit (JSU) has a requirement for Nutritionist Services at the

Jicarilla Service Unit, Dulce, New Mexico.

Prior to start of services the Contractor must contact the General Service Office at the designated IHS facility to schedule an appointment to complete the fingerprinting process required by the IHS regulations pertinent to security and character background investigations.

B.1 Services:

Services under this contract shall be provided under a Non-Personal Service Contract as defined by Federal Acquisition Regulation (FAR) Part

Subpart 37.401, (a) as defined in 37.101, the contractor is an independent contract, (b) the

Government may evaluate the quality of professional and administrative services provided, but no direct supervision over the medical, professional aspects of the services,

(c) requires that the contractor indemnify the

Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance, (d) require that the contractor maintain medical liability insurance, in a coverage amount

($1,000,000) acceptable to the Contracting

Officer, which is not less than the amount normally prevailing in the local community for the medical specialty concerned, and (e) require that the contractor to ensure that its subcontractors for provisions of health care services, contain the requirements of the clause at 52.237-7, including the maintenance of medical liability insurance.

The Indian Health Service has authority for non-personal healthcare service contracts to be awarded to medical locum tenen companies and medical professional groups.

Credentialing Requirements

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FAR (48 CFR) 53.110

NSN 7540-01-152-8067

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(A) (B) (C) (D) (E) (F)

Medical contractors (physicians, advance practice nurses, physical therapists dentists, optometrists, psychologists, psychiatrists, audiologists, etc.) must apply and be approved for clinical privileges prior to providing patient care.

Contractors shall submit the following to the service unit medical staff office: medical staff application with request for clinical privileges, copies of active unrestricted professional licensure, professional degree, residency and board certification in specialty, current curriculum vitae, proof of professional liability coverage, and DEA certificate.

PLEASE NOTE: The credentialing/privileging process takes a minimum of 4 to 6 weeks to complete.

During the contract period the contractor shall:

1.Maintain active professional licensure and board certifications;

2.Immediately disclose to service unit medical staff if any answer to the Professional Practice questions on the Medical Staff Application become a "Yes";

3.Abide by policies, rules and regulations and bylaws of the facility;

4.Document in a timely manner, complete and legible medical records of all care and services provided to patients;

5.Disclose any default or notice of default on student loans.

Background investigations must be initiated before the provider can start providing services.

Waivers may be requested by the service unit for a period not to exceed 30 days.

B.2 Price/Cost

The contractor's pricing/cost to include all mandatory Federal, State and Local taxes. It is the sole responsibility of the contractor to

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(A) (B) (C) (D) (E) (F) collect and pay for all New Mexico State Gross

Receipt Taxes for business/work if services are performed in the State of New Mexico, regardless of county the business/work was performed.

It is anticipated that a fixed-price requirements type contract will be awarded for a base year with four one-year options for renewal. Total contract award shall not exceed five years.

Individual task orders will be awarded against the base contract on an as-needed basis. The task order will obligate funds for services required.

52.232-19 Availability of Funds for the Next

Fiscal Year (Apr 1984)

Funds are not presently available for performance under this contract beyond March 4, 2011. The

Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond March 4, 2011, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer.

Estimated Requirements:

a.Base Year: Apr 01, 2011 through Mar 31, 2012

Est Quant Cost Per Unit Total Annual Cost

1161 hrs $________Per Hr $__________ b.First Year Option: Apr 01, 2012 through Mar 31, Est Quant Cost Per Unit Total Annual Cost

1161 hrs $________Per Hr $__________ c.Second Year Option: Apr 01, 2013 through Mar

31, 2014

Est Quant Cost Per Unit Total Annual Cost

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(A) (B) (C) (D) (E) (F)

1161 hrs $________Per Hr $__________ d.Third Year Option: Apr 01, 2014 through ApMar

31, 2015

Est Quant Cost Per Unit Total Annual Cost

1161 hrs $________Per Hr $__________ e.Forth Year Option: Apr 01, 2015 through Mar 31, Est Quant Cost Per Unit Total Annual Cost

1161 hrs $________Per Hr $__________

Note: Reimbursement will be based on a "per hour basis" not to exceed 1161 hours per year.

Overtime hours are not allowed under this contract.

B.3 Place of Performance

Service to be provided at the Jicarilla Service

Unit (JSU), Located in Dulce, New Mexico.

Section C - Description/Specs./Work Statements

C.1 Description

Contractor shall provide Nutrition Services at the Jicarilla Service Unit (JSU).

C.2 Scope of Work (SOW)

1.The Contactor shall provide leadership in weight reduction and exercise programs as needed to patients.

2.The Contractor shall conduct appropriate nutritional assessments and pertinent nutritional history of nutritional patients.

3.The Contractor shall develop a care plan for patients identified as nutritional risk.

4.The Contractor shall record clinical data in the electronic patients medical records system.

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(A) (B) (C) (D) (E) (F)

5.The Contractor shall provide nutritional consultation to patients by telephone call or a home visit as appropriate.

6.The Contractor shall provide therapeutic diet counseling to physician referred patients.

7.The Contractor shall provide nutrition consultation services to community related programs that are requesting nutritional consultation as clinic schedule allows.

8.The Contractor shall provide in-service training to IHS staff as needed.

9.The Contractor shall conduct cooking classes as appropriate for programs and individuals in communities.

10.The Contractor shall perform food demonstrations that include food preparations and meal planning. Instruction shall be used to illustrate appropriate nutritional management of diseases as well as individual diabetic nutrition counseling. Food items needed for demonstrations and preparations shall be provided by the Service

Unit.

11.The Contractor shall coordinate classes on

Childbirth, Breastfeeding, Diabetes and Tai Chi based on community needs.

12.The Contractor shall provide educational health nutrition services by working with various programs that include the Teen Clinic, Jicarilla

Dormitory, Culture Program, Women, Infants and

Children (WIC), Senior Citizens Center, etc.

13.The Contractor shall have oversight of the

Breastfeeding Peer-Counseling program and the

Healthy-Start program.

C.3 Contractor Business Responsibilities

The contractor is responsible to ensure that the following health requirements are met prior to performance of service if a medical provider under non-personal service contract.

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(A) (B) (C) (D) (E) (F)

Evidence of current immunization for tetanus, rubella, rubeola and hepatitis B (o positive titer).

Evidence of negative PPD or chest x-ray if history of positive PPD must be provided within one (1) month of assignment.

Complete and return the form "Addendum to

Declaration for Federal Employment". Completed document shall be returned to the Contracting

Officer. Failure to respond may be cause for termination.

Is subject to character investigation in the performance of the contract in accordance with

P.L. 101-630, "Indian Child Protection and Family

Violence Act of 1990".

Contractor is responsible for reporting all taxes from wages earned under the contract to the appropriate State, Federal and local agencies.

Contractor is responsible for his/her reliable transportation, travel and per-diem expenses in the performance of this contract.

The Contractor is responsible for all fringe benefits and other benefits such as health and retirement.

The Contractor shall be responsible for maintaining satisfactory standards of competence, conduct, appearance and integrity. The quality of work performance of the Contractor shall be subject to review.

The Contractor is responsible for notifying his/her designated project officer is he/she will be late, ill or unable to work for other reasons.

If the Contractor subcontracts the services to another provider, the prime Contractor with IHS if ultimately responsible for all correspondence, payments, etc., to his/her subcontractor.

However, the IHS Project Officer may audit and inspect the services provided by the subcontractor.

The Contractor earns no leave and is compensated

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(A) (B) (C) (D) (E) (F) only for hours actually worked at the agreed compensatory rate.

The Contractor shall provide services in such manner as to meet the highest standards of professional ethics and conduct particularly in regard to confidentiality and patient rights. If any time during the term of the contract, the

Government suspect's unprofessional behavior and practices, the Contractor will be contacted and requested to take appropriate action in accordance with applicable Federal Acquisition

Regulations (FAR).

C.4 Client Background

Some IHS patients receiving services under this contract may only speak their native language or may have limited comprehension of the English language, and/or may reside on or near a Native

American Indian Reservation. The Contractor is expected to demonstrate sensitivity to cross-cultural and language barriers and have the ability to work through interpreters as necessary. Consideration must be given to potentially limited transportation and/or home environment facilities.

Section D - Packaging and Marking

The Contractor shall mark all written correspondence related to this solicitation with the following:

Solicitation No.: 11-242-SOL-00024

Section E - Inspection and Acceptance

E.1 Inspection of Services - Fixed Price (Aug

1996) a.Definition "Services," as used in this clause, includes services performed, workmanship, and material furnished or utilized in the performance of services.

b.The Contractor shall provide and maintain an inspection system acceptable to the Government covering the services under this contract.

Complete records of all inspection work performed

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(A) (B) (C) (D) (E) (F) by the Contractor shall be maintained and made available to the Government during contract performance and for as long afterwards as the contract requires.

c.The Government has the right to inspect and test all services called for by the contract, to the extent practicable at all times and places during the term of the contract. The Government shall perform inspections and tests of the contract. The Government shall perform inspections and tests in a manner that will not unduly delay the work.

d.If the Government performs inspections or tests on the premises of the Contractor or a subcontractor, the Contractor shall furnish, and shall require subcontractor to finish, at no increase in contract price, all reasonable facilities and assistance for the safe and convenient performance of these duties.

e.If any of the services do not conform with contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements, at no increase in contract amount. When the defects in services cannot be corrected by re-performance, the Government may:

1.Require the Contactor to take necessary action to ensure that future performance conforms to contract requirements; and

2.Reduce the contract price to reflect the reduced value of the services performed f.If the Contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with contract requirements, the Government may-

1.By contract or otherwise, perform the services and charge to the Contractor any cost incurred by the Government that is directly related to the performance of such service; or

2.Terminate the contract for default.

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(A) (B) (C) (D) (E) (F)

E.2 Review and Approval and Evaluation

The Contracting Officer or his duly authorized representative shall review and approve services provided under the terms and conditions of the contract.

Evaluation of services performed under this contract will be made jointly by the Contractor and the Government Project Officer during the term of this contract and results of such evaluation made a part of the contract file. The evaluation report will be directed toward the progress made in meeting the contract objectives.

Evaluation will be conducted on a date mutually agreed to between the Contractor and the

Government Project Officer.

E.3 Quality Assurance Review

The work of the Contractor is subject to review as part of the JSU Quality Assurance Program.

Review will consist of assignment accomplished, the Project Officer review of work. The

Contractor is required to correct any deficiencies identified. Failure to take corrective action may result in termination of the contract. The contract may also be terminated for cause if facilities are endangered or harmed as a result of the Contractor's action.

Section F - Deliveries or Performance

F.1 Period of Performance:

Performance under this contract shall be for a period of 12 months commencing on April 01, 2011 and shall not extend beyond the completion date of March 31, 2012, unless changed by a written modification issued and signed by the Contracting

Officer.

F.2 Option Year Period of Performance:

If the Government requires services beyond the base year period of performance the option year renewal shall be as follows:

1st Yr Option: Apr 01, 2012 through Mar 31, 2013

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(A) (B) (C) (D) (E) (F)

2nd Yr Option: Apr 01, 2013 through Mar 31, 2014

3rd Yr Option: Apr 01, 2014 through Mar 31, 2015

4th Yr Option: Apr 01, 2015 through Mar 31, 2016

F.3 Place and Hours of Performance

Normal hours of performance will be Monday through Friday from 8:00 AM to 4:30 PM with a 30 minute lunch break.

IHS clinics are usually closed for lunch break from 12:00 Noon to 1:00 PM, the Contractor may take a lunch break during this time. If the

Contractor chooses not to take a lunch break, it can not be claimed/invoiced as time worked.

Travel to and from the facility/office site are not included in the tour of duty and cannot be invoiced as part of the tour of duty day.

Performance of services shall be within the confines of the Jicarilla Service Unit (JSU), Dulce, NM.

If this contract requires services to be provided at an IHS facility/Clinic located on an Indian

Reservation and the Contractor is unable to provide services due the closure of the community for religious observation, the services shall be rescheduled by mutual agreement between the

Project Office and the Contractor.

F.4 Reporting Requirements

1.Delivery and accountability of work shall be documented by the Project Officer.

2.Contractor shall submit monthly narrative reports to the Health Center Director.

3.Contractor shall complete patient notes in the

Electronic Health record in accordance with JSU policy and procedures.

4.Contractor shall provide Nutritionist Services to be scheduled based upon current projects, clinic needs, and may be up to 15 days a month.

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(A) (B) (C) (D) (E) (F) number of patients seen, type of services provided and amount due. Signature indicates services were provided and payment has not been received. Invoices will be forwarded to the

Project Officer who shall certify services were received in accordance with contract. Invoice will then be forwarded by the contractor to the

AAIHS to Division of Financial Management.

Section G - Contract Administration Data

G.1 Task Orders

(a)Individual task order under this contract will be issued against the base contract.

(b)Contractor must have a signed/approved task order.

G.2.Accounting and Appropriation Data

Each task order shall contain the appropriate fiscal/funding codes for proper accountability of reimbursement.

G.3 Contracting Officer Responsibility

The authority to negotiate changes in the terms and conditions or the amounts cited in the contract are reserved to the Contracting Officer.

G.4 Compensation

The contractor shall be compensated at the agreed contract amount based on invoices submitted and only for services in direct performance of this contract. Overtime compensation is not authorized unless specifically included in the scope of work and approved.

G.5 Invoice Submission

The Contractor shall submit monthly invoices and narrative reports with the following information on each invoice.

- Contract No. ______________________

- Contractor's Name and Address

- Date of Invoice period

- Invoice No.

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(A) (B) (C) (D) (E) (F)

- Appropriation Data cited by a task order

- Invoice signed and dated by the authorized representative of the Contractor, to include the individual's name, title, and telephone number

- The following certification shall be cited on each invoice submitted for payment.

"I hereby certify that all services provided and invoiced are for appropriate purposes and in accordance with the terms and conditions of the cited contract"

G.6 Payment Office

Per mandate by the U. S. Department of Treasury and effective July 1996, payments by Electronic

Funds Transfer System will be made to the

Contractors designated financial institute.

The payment office is: Albuquerque Indian Health

Service, Division of Accounting Services, 5300

Homestead Road, NE, Albuquerque, New Mexico 87110.

The contractor shall submit an invoice directly to the payment office at the above address on a bi-weekly basis.

EFT Disbursed by: U. S. Department of Treasury

Office of Disbursements, Austin, TX

G.7 918 DESIGNATION OF PROJECT OFFICER

The Project Officer to be designated to this award is Diane Holzem, Registered Nurse, JSU

Administration, 12000 Stone Lake Road, Dulce, NM

87528, Telephone No. (575)759-7233. The Project

Officer listed above is hereby designated to monitor the performance of this order on behalf of the Government. The Project Officer will provide no supervisory or instructional assistance to Contractor personnel. The Project

Officer's function is primarily to provide the

Contractor with working data. The Project Officer is not empowered to make any commitments, nor authorized to make any changes which affect prices, terms, or delivery as specified on this order. Any such proposed changes shall be brought to the immediate attention of the Ordering

Officer for action. The acceptance of any change by the Contractor without specific approval and

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(A) (B) (C) (D) (E) (F) written consent of the Ordering Officer will be at the Contractor's own risk.

Alternate Project Officer: Jim Sutton, JSU

Administration, 12000 Stone Lake Road, Dulce, NM

87528, Telephone No. (575) 759-7226.

For questions regarding the solicitation please contact the designated Project Officer. Pricing and negotiating is strictly prohibited during inquiries with the Project Officer.

G.8 900 PROJECT OFFICER AUTHORITY

The Project officer will provide no supervisory or instructional assistance to Contractor personnel. The Project Officer's function is primarily to provide the Contractor with working data. The Project Officer is not empowered to make any commitments, nor authorized to make any changes which affect prices, terms, or delivery as specified on this order. Any such proposed changes shall be brought to the immediate attention of the ordering officer for action. The acceptance of any change by the Contractor without specific approval and written consent of the ordering officer will be at the Contractor's own risk.

Section H - Special Contract Requirements

H.1 Legal Requirements

The Contract shall obtain and maintain, at his/her own expense, all state and/or medical licenses, registrations or certification required in the performance of the contract, and shall comply with all laws, regulations, (Federal, State, Tribal and respective hospital) ordinances in the performance of this contract.

H.2 Government Furnished

Facilities/Equipment/Supplies

The JSU may furnish all necessary supplies, equipment, exam rooms, forms, data entry equipment and all other incidental required in delivery of services in the ambulatory care facility in which the contractor will be working.

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(A) (B) (C) (D) (E) (F)

H.3 Privacy Act Notification

(a.) This contract requires the Contractor, on behalf of the IHS, to provide health care to

American Indians and Alaskan Natives and report selected medical records and financial information to IHS. The Synder Act (23 U.S.C 13) and Public Law 83-5658 (42 U.S. 2001) authorizes the collection of this information. To be reimbursed by IHS, you must provide the information requested by delivery orders issued under this contract and complete any separate billing forms required. Indian Health Service will use the information for financial, legal and health care purposes.

(b.) Disclosure of this information may be made by IHS to: other providers of health care for treatment or health maintenance of Indians or

Alaskan Natives, designated Fiscal

Intermediaries, the Office of Workers

Compensation Programs, Department of Labor, the

Department of Justice for their representation to the United States, and for Congressional inquiry, quality assessment, medical audit, or utilization review, billing third parties for the payment of care, analytical and evaluation studies, to

Federal or State agencies as required by law, research purposes supported by IHS, and identification of handicapped children under 10

U.S.C. 1401 et.seq.

(c.) Disclosure of the appropriate medical record information without prior consent of the subject patient may be made by you to: another provider of health care treating the same patient, a

Federal or State agency as required by law such as the reporting of communicable diseases, births, deaths, or the commission of crimes

(i.e., gunshot wounds, rape, child abuse or neglect, alcohol or drug abuse, etc.) designated fiscal intermediaries, and billing third parties for the payment of care not reimbursable by IHS.

You must forward all other requests for information to the applicable IHS ordering official.

H.4 Privacy Act Violation Notification

Pursuant to the section of the Privacy Act

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(A) (B) (C) (D) (E) (F) entitled, "Civil Remedies", a Federal Employee or

Contractor can be Required to pay up to $5000 if;

A Federal employee or Contractor, who knows that certain types of releases of information about a patient are prohibited, willfully discloses the information to a The Privacy Act of 1974 was designed to establish and protect certain rights of people served by the employees of the Federal

Government to their Contractors. The Contractor shall ensure that each Contractor employee.

Questions concerning the Privacy Act Procedures may be directed to:

Marla Jones, Area Privacy Act Coordinator

5300 Homestead Road NE

Albuquerque, New Mexico 87110

Telephone: (505) 248-4620

H.5 Disposition and Identification of Data a.The Contractor is not permitted to make use of any data derived from these services for any purpose not directly related to and/or authorized by the Albuquerque Area Indian Health Service.

All patient data/information are subject to the

Privacy Act and the Confidentiality of

Information Clause (HHSAR 352.224-70) b.Upon completion/termination of the contract, all information, statistical or analytical material or reports and other data generated by the Contractor shall become the property of the

Albuquerque Area Indian Health Service. The

Contractor is prohibited from gathering data, statistics, or use of material for publication and/or research for its own benefits.

Dissemination of information, prior approval shall be obtained from the Government Contracting

Officer for the release or dissemination of information related to this contract.

H.6 Confidentiality of Alcohol and Drug Abuse

Patient Records

If this contract involves alcohol or drug treatment or diagnosis, the provider agrees:

A.In receiving, restoring, processing, or otherwise dealing with any information from the

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(A) (B) (C) (D) (E) (F) program about patients in the program, it is fully bound by the provision of Title 42 Chapter

1, Part 2;

B.To institute appropriate procedures for safeguarding such information, with particular reference to patient identifying information;

and, c. to resist in judicial proceedings any efforts to obtain access to information pertaining to patients otherwise than as expressly provided for in Title 42, Part 2.

H.7 Contractor Qualifications/Certification

Professional service contractors shall be subject to the same quality assurance, credentials, licensure, and other qualification standards as those required by IHS Staff.

In addition, health care providers, other than paraprofessionals, must be licensed in a State, the District of Columbia, Puerto Rico, or a

Territory of the United States to perform the contract services within IHS facilities.

My license to practice ( ) has ( ) has not been terminated, suspended, or revoked, in any

State, the District of Columbia, Puerto Rico, or a Territory of the U.S.

I currently hold an active Nutritionist license in the following State(s):

STATE LICENSE NO. ISSUE DATE

I have an inactive Nutritionist license in the following State(s):

STATE LICENSE NO. ISSUE DATE

I hereby certify that for purposes of application of the false statements provisions of the Program

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Fraud Civil Remedies Act of 1986 (45 CFR 79), that to the best of my knowledge, each of the above statements is true, accurate, and does not omit any material fact that would render the statement false, fictitious, or fraudulent as a result of the omission.

Signature of Practitioner Date

H.8 Character Investigation (Public Law 101-630, Indian Child Protection and Family Violence

Prevention Act)

1.In order to be determined acceptable, your offer/quotes must include a completed "Addendum to Declaration for Federal Employment Form"

(Attachment j.1). Failure to complete and return the addendum will result in the automatic rejection of your offer/quote.

Period of Performance: 04/01/2011 to 03/31/2012

2.The successful offeror/quote shall be required to complete the following background investigation forms: Optional Form 306, Declaration for Federal Employment

I. Contract Clauses

I.2 52.252-2 Clauses Incorporated by Reference

(Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the

Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): http//www.arnet.gov/far/current/html

I-3 52.202-1 Definitions 7/2004

I-4 52.203-3 Gratuities 4/1984

I-5 52.203-5 Covenant Against Contingent Fees, 4/1984

I-6 52.203-6 Restrictions on Subcontractor Sales to the Government 9/2006

I-7 52.203-7 Anti-Kickback Procedures 10/2010

I-8 52.203-8 Cancellation, Rescission, and

Recovery of Funds for Illegal and Improper

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(A) (B) (C) (D) (E) (F)

Activity 1/1997

I-9 52.203-10 Price or Fee Adjustment for Illegal or Improper Activity 1/1997

I-10 52.203-12 Limitation on Payments to Influence

Certain Federal Transactions 10/2010

I-11 52.204-4 Printed or Copied Double-Sided on

Recycled Paper 8/2000

I-12 52.209-6 Protecting the Government's

Interest when Subcontracting with Contractors

Debarred, Suspended, or Proposed for Debarment

12/2010

I-13 52.215-2 Audit and Records Negotiation

10/2010

I-14 52.215-8 Order of Precedence-Uniform

Contract Format 10/1997

I-15 52.217-8 Option to Extend Services 11/1999

I-16 52.219-8 Utilization of Small Business

Concerns 01/2011

I-17 52.219-9 Small Business Subcontracting Plan

01/2011

I-18 52.222-3 Convict Labor 6/2003

I-19 52.222-26 Equal Opportunity 3/2007

I-20 52.222-35 Equal Opportunity for Veterans

9/2010

I-21 52.222-36 Affirmative Action for Workers with Disabilities 10/2010

I-22 52.222-37 Employment Reports on Veterans

9/2010

I-23 52.223-6 Drug-Free Workplace 5/2001

I-24 52.224-1 Privacy Act Notification 4/1984

I-25 52.224-2 Privacy Act 4/1984

I-26 52.225-13 Restrictions on Certain Foreign

Purchases 6/2008

I-27 52.227-2 Notice and Assistance Regarding

Patent and Copyright Infringement 12/2007

I-28 52.229-3 Federal, State and Local Taxes

4/2003

I-29 52.229-4 Federal, State, and Local Taxes

(State and Local Adjustments) 4/2003

I-30 52.232-1 Payments 4/1984

I-31 52.232-8 Discounts for Prompt Payment 2/2002

I-32 52.232-11 Extras 4/1984

I-33 52.232-17 Interest 10/2010

I-34 52.232-23 Assignment of Claims 1/1986

I-35 52.232-25 Prompt Payment 10/2008

I-36 52.232-33 Payment by Electronic Funds

Transfer Central Contractor Registration 10/2003

I-37 52.233-1 Disputes (Alternate I) 7/2002

I-38 52.233-3 Protest After Award 8/1996

I-39 52.233-4 Applicable Law for Breach of

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Contract Claim 10/2004

I-40 52.242-13 Bankruptcy 7/1995

I-41 52.243-1 Changes (Fixed-Price) 8/1987

I-42 52.244-2 Subcontracts 10/2010

I-43 52.244-5 Competition in Subcontracting

12/1996

I-44 52.246-25 Limitation of Liability Services

2/1997

I-45 52.249-2 Termination for Convenience of the

Government (Fixed-Price) 5/2004

Health & Human Services Acquisition Regulation

Clauses (48 CFR Chapter 3)

I-46 352.202-1 Definitions 1/2006

I-47 352.224-70 Confidentiality of Information

1/2006

I-48 352.232-9 Withholding of Contract Payments

4/1984

I-49 352.270-2 Indian Preference 4/1984

I-50 352.270-3 Indian Preference Program 4/1984

I-51 352.270-6 Publications and Publicity 7/1991

I-52 352.270-7 Paperwork Reduction Act 1/2001

I-53 352.270-12 Pro-Children Act 1/2006

I-54 352.270-13 Tobacco-free facilities 1/2006

I-55 352.270-17 Crime Control Act - reporting of child abuse 1/2006

I-56 352.270-18 Crime Control Act - requirement for background checks 1/2006

FAR Clauses written in full text:

I.57 52.204-1 Approval of Contract 12/1989

The contract is subject to the written approval of the Contracting Officer, and shall not be binding until so approved.

I.58 52.217-9 Option to Extend the Term of the

Contract 3/2000

(a)The Government may extend the term of this contract by written notice to the Contractor within 30 days [insert the period of time within which the Contracting Officer may exercise the option]; provided that the Government gives the

Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension.

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(b)If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c)The total duration of this contract, including the exercise of any options under this clause, shall not exceed 5 years.

I.59 52.216-18 Ordering 10/1995

(a)Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the

Schedule. Such orders maybe issued from April

01, 2011 through March 31, 2012.

(b)All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control.

(c)If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.

I.60 2.216-19 Order Limitations 10/1995

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than 1161 hrs, the Government is not obligated to purchase, nor is the

Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor:

(1) Any order for a single item in excess of 1161 hrs.;

(2) Any order for a combination of items in excess of 1161 hrs.; or

(3) A series of orders from the same ordering office within 5 days that together call for quantities exceeding the limitation in paragraph

(b)(1) or (2) of this section.

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(A) (B) (C) (D) (E) (F)

(c) If this is a requirements contract (i.e., includes the Requirements clause at subsection

52.216-21 of the Federal Acquisition Regulation

(FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section.

(d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within 5 days after issuance, with written notice stating the

Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.

I.61 52.216-21 Requirements. 10/1995

(a)This is a requirements contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies or services specified in the Schedule are estimates only and are not purchased by this contract. Except as this contract may otherwise provide, if the

Government's requirements do not result in orders in the quantities described as "estimated'' or

"maximum" in the Schedule, that fact shall not constitute the basis for an equitable price adjustment.

(b)Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause. Subject to any limitations in the Order Limitations clause or elsewhere in this contract, the Contractor shall furnish to the Government all supplies or services specified in the Schedule and called for by orders issued in accordance with the Ordering clause. The

Government may issue orders requiring delivery to multiple destinations or performance at multiple locations.

(c)Except as this contract otherwise provides, the Government shall order from the Contractor all the supplies or services specified in the

Schedule that are required to be purchased by the

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Government activity or activities specified in the Schedule.

(d)The Government is not required to purchase from the Contractor requirements in excess of any limit on total orders under this contract.

(e)If the Government urgently requires delivery of any quantity of an item before the earliest date that delivery may be specified under this contract, and if the Contractor will not accept an order providing for the accelerated delivery, the Government may acquire the urgently required goods or services from another source.

(f)Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and

Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after expiration of the contract March

31, 2012.

I-62 52.204-7 CENTRAL CONTRACTOR REGISTRATION

4/2008

(a) Definitions. As used in this clause:

"Central Contractor Registration (CCR) database" means the primary Government repository for

Contractor information required for the conduct of business with the Government.

"Data Universal Numbering System (DUNS) number" means the 9-digit number assigned by Dun and

Bradstreet, Inc. (D&B) to identify unique business entities.

"Data Universal Numbering System +4 (DUNS+4) number" means the DUNS number assigned by D&B plus a 4-character suffix that may be assigned by a business concern. (D&B has no affiliation with this 4-character suffix.) This 4-character suffix may be assigned at the discretion of the business concern to establish additional CCR records for

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(A) (B) (C) (D) (E) (F) identifying alternative Electronic Funds Transfer

(EFT) accounts (see the FAR at Subpart 32.11) for the same concern.

"Registered in the CCR database" means that:

(1) The Contractor has entered all mandatory information, including the DUNS number or the

DUNS+4 number, into the CCR database; and

(2) The Government has validated all mandatory data fields, to include validation of the

Taxpayer Identification Number (TIN) with the

Internal Revenue Service (IRS), and has marked the record "Active". The Contractor will be required to provide consent for TIN validation to the Government as a part of the CCR registration process.

(b)(1) By submission of an offer, the offeror acknowledges the requirement that a prospective awardee shall be registered in the CCR database prior to award, during performance, and through final payment of any contract, basic agreement, basic ordering agreement, or blanket purchasing agreement resulting from this solicitation.

(2) The offeror shall enter, in the block with its name and address on the cover page of its offer, the annotation "DUNS" or "DUNS +4" followed by the DUNS or DUNS +4 number that identifies the offeror's name and address exactly as stated in the offer. The DUNS number will be used by the Contracting Officer to verify that the offeror is registered in the CCR database.

(c) If the offeror does not have a DUNS number, it should contact Dun and Bradstreet directly to obtain one.

(1) An offeror may obtain a DUNS number:

(i) Via the Internet at http://fedgov.dnb.com/webform or if the offeror does not have internet access, it may call Dun and Bradstreet at 1-866-705-5711 if located within the United States; or

(ii) If located outside the United States, by contacting the local Dun and Bradstreet office.

The offeror should indicate that it is an offeror

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(A) (B) (C) (D) (E) (F) for a U.S. Government contract when contacting the local Dun and Bradstreet office.

(2) The offeror should be prepared to provide the following information:

(i) Company legal business.

(ii) Trade style, doing business, or other name by which your entity is commonly recognized.

(iii) Company Physical Street Address, City, State, and ZIP Code.

(iv) Company Mailing Address, City, State and ZIP

Code (if separate from physical).

(v) Company Telephone Number.

(vi) Date the company was started.

(vii) Number of employees at your location.

(viii) Chief executive officer/key manager.

(ix) Line of business (industry).

(x) Company Headquarters name and address

(reporting relationship within your entity).

(d) If the Offeror does not become registered in the CCR database in the time prescribed by the

Contracting Officer, the Contracting Officer will proceed to award to the next otherwise successful registered Offeror.

(e) Processing time, which normally takes 48 hours, should be taken into consideration when registering. Offerors who are not registered should consider applying for registration immediately upon receipt of this solicitation.

(f) The Contractor is responsible for the accuracy and completeness of the data within the

CCR database, and for any liability resulting from the Government's reliance on inaccurate or incomplete data. To remain registered in the CCR database after the initial registration, the

Contractor is required to review and update on an annual basis from the date of initial

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(A) (B) (C) (D) (E) (F) registration or subsequent updates its information in the CCR database to ensure it is current, accurate and complete. Updating information in the CCR does not alter the terms and conditions of this contract and is not a substitute for a properly executed contractual document.

(g)

(1) (i) If a Contractor has legally changed its business name, "doing business as" name, or division name (whichever is shown on the contract), or has transferred the assets used in performing the contract, but has not completed the necessary requirements regarding novation and change-of-name agreements in Subpart 42.12, the

Contractor shall provide the responsible

Contracting Officer a minimum of one business day's written notification of its intention to

(A) change the name in the CCR database; (B) comply with the requirements of Subpart 42.12 of the FAR; and (C) agree in writing to the timeline and procedures specified by the responsible

Contracting Officer. The Contractor must provide with the notification sufficient documentation to support the legally changed name.

(ii) If the Contractor fails to comply with the requirements of paragraph (g)(1)(i) of this clause, or fails to perform the agreement at paragraph (g)(1)(i)(C) of this clause, and, in the absence of a properly executed novation or change-of-name agreement, the CCR information that shows the Contractor to be other than the

Contractor indicated in the contract will be considered to be incorrect information within the meaning of the "Suspension of Payment" paragraph of the electronic funds transfer (EFT) clause of this contract.

(2) The Contractor shall not change the name or address for EFT payments or manual payments, as appropriate, in the CCR record to reflect an assignee for the purpose of assignment of claims

(see FAR Subpart 32.8, Assignment of Claims).

Assignees shall be separately registered in the

CCR database. Information provided to the

Contractor's CCR record that indicates payments, including those made by EFT, to an ultimate recipient other than that Contractor will be

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(A) (B) (C) (D) (E) (F) considered to be incorrect information within the meaning of the "Suspension of payment" paragraph of the EFT clause of this contract.

(h) Offerors and Contractors may obtain information on registration and annual confirmation requirements via the internet at http://www.ccr.gov or by calling 1-888-227-2423, or 269-961-5757.

I.63 52.237-7 Indemnification and Medical

Liability Insurance 01/1997

(a) It is expressly agreed and understood that this is a nonpersonal services contract, as defined in Federal Acquisition Regulation (FAR)

37.101, under which the professional services rendered by the Contractor are rendered in its capacity as an independent contractor. The

Government may evaluate the quality of professional and…