14. Exhibit M - Prototype for Standardized Design and Construction of Community Based Outpatient Clinics.pdf

PDF 11 MB Posted Mar 1, 2024

Attached to: X1DB--FY24 New Lease: Multispecialty Out Patient Clinic Ft Pierce
Solicitation number: 36C24824R0040
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8

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Written by GovTribe AI · Mar 1, 2024

This solicitation notice seeks offers for a lease of medical office and related space in the Vero Beach/Fort Pierce area of Florida. The Department of Veterans Affairs intends to award a lease for a minimum of 25,650 rentable square feet and up to 26,130 rentable square feet, yielding between 22,800 and 23,227 occupiable square feet, with a minimum of 100 parking spaces. The lease term may be up to 10 years for an existing building ready for occupancy by December 1, 2024.

The space must be located within boundaries of 41st Street to the north, Edwards Road to the south, US 1 to the east, and I-95 to the west. Offers are due by 3:00 PM ET on March 25, 2024 and must include documentation of ownership, the entity's status as a Service-Disabled Veteran Owned Small Business or Veteran Owned Small Business if claiming such status, authorization if responding on behalf of a property owner, and agreement to demonstrate fee simple ownership within 30 days of lease execution. The government will conduct a market survey and is limited by law to pay no more than fair market rent.

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15. Exhibit N - Room Templates PACT CBOC.pdf	PDF	Mar 1, 2024
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RLP # 36C248-24-R-0040 - LEASE # 36C248-24-L-0003

Exhibit M

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

Section 5 - CBOC Prototype Proposed Layouts

1. Section 5 below is an extract from the Prototype for Standardized Design and Construction of Community Based Outpatient Clinics found on the Technical Information Library (TIL) which provides guidance on VA space needs and standards.

2. Offerors shall adjust and/or scale the space according to their space availability as needed to propose a PACT Compliant VA CBOC measuring a minimum of 19,356 to a maximum of 26,130 Rentable Square Feet (RSF), yielding 19,356 Net Usable Square Feet of contiguous space.

3. The Offeror’s A/E firm is to review the TIL, RLP and all Exhibits and make adjustments accordingly to fit the design guide and the RLP and not exceed the space limitations. It is vital that the A/E review the entire design guide as it is the Offeror’s responsibility to provide designs and pricing including everything required on a PACT compliant VA CBOC or contained on the RLP or any of the Exhibits.

The TIL is available to the public following this link:

https://www.cfm.va.gov/til/catalog.asp

4. Although it is up to the Offeror’s to provide a design in accordance with their capabilities, available space and their proposed solution to comply with the TIL and RLP; the preferred layout would be based on section 5.2 Two-PACT CBOC Prototype, L-Shaped Layout (pages 5-14 to 5-35).

5. The West Palm Beach VA Healthcare System Engineering Service in conjunction with the Integrated Project Team (IPT) as Technical Advisors of the Source Selection Evaluation Board (SEEB) will review the Design Intended Drawings to determine full compliance with the requirements of the TIL and any other standards contained on this RLP.

https://www.cfm.va.gov/til/catalog.asp

Final Submittal May 16, 2014 CBOC Prototype Proposed LayoutsOffi ce of Construction & Facilities Management Department of Veterans Aff airs

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

5.1

5.0 Community Based Outpatient Clinic (CBOC)

Prototype Proposed Layouts

5.2

This page has been left blank intentionally.

Final Submittal May 16, 2014 CBOC Prototype Proposed LayoutsOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

5.3

5.1 One-PACT CBOC Prototype

Proposed Layout As discussed in Section 2, the One-PACT CBOC Prototype is based on One-PACT module. Th e module is complemented by other common components, such as Group Rooms and Pathology and Laboratory Medicine, to create a comprehensive care environment. Refer to Section 2 for an explanation of the services included in the prototype and Section 3 for a Prototype Program for Design.

Th e Entry component design allows for a police presence at the front door of the clinic, coupled with the vestibule and wheel chair storage. Th e lobby area, known as the Commons, holds combined waiting for the entire clinic. A variety of seating options allows patients choice and fl exibility. Th e Commons is energized by the inclusion of vending and Patient Education space, encouraging movement and interaction, off ering more than a typical passive waiting experience.

Th e Reception component is centrally located, providing two distinct entrances into the PACT area. Its location provides a clear check-in point for patients while aff ording staff visibility over the activity in the Commons. Kiosks are located near the patients’ path from the Entry component to the Reception component, encouraging patient use within reach of both the Reception desk and Volunteer area, should a patient require assistance. Th is centralized node of the Reception component is immediately adjacent to the clinic waiting areas. Th is distance provides patients visual and auditory privacy while talking to staff at the desk.

Th e Group Room component, consisting of a Group Room and Shared Medical Appointment Room, has access directly from the Commons. Th is allows patients to attend appointments and group sessions without entering the clinic space. Its location lends itself to hosting evening and weekend appointments since it can be accessed from outside of the clinic. Th e Lab component is also directly accessed via the Commons. Often, patients need access to the Lab without entering the clinic area. Th ese two components benefi t from the shared access from the public side and clinic side. Patients can enter the spaces from the Commons and providers can enter from the clinic.

A corridor separates the front bar of components from the PACT components. Upon entering the controlled access points to the PACT area, there is a Heights and Weights alcove that serves all exam rooms in the PACT. Exam, Consult and Procedure components are located in two patient circulation corridors on either side of a centralized PACT + Extended Team Work Area component. Exam and procedure rooms have entrances on two sides, allowing direct access from both the patient corridors and team work area. Refer to Section 4 for more information on the Exam and Consult, Procedure and PACT + Extended Team Work Area components.

Th e rear corridor of the One-PACT CBOC Prototype is the primary staff and service access. Th is allows for possible secondary staff entrance points, as well as exterior access to building support spaces.

Th e One-PACT CBOC Prototype lends itself to expansion.

Th e patient corridor at the front and the staff / support corridor at the rear of the PACT can easily connect to additional components. For an example, refer to Section 7 for a test fi t of an actual program, where a General Mental Health component is added, as dictated by local need.

Engineering Assumptions Electrical / Main Power:

(1) Th e incoming main power for the building will be from an outdoor, pad mounted transformer. Th is transformer will be located such that it adheres to AT/FP criteria and guidelines outlined in the Physical Security Design Manual for VA Facilities. (2) Back-up emergency power will be provided for the building via an outdoor, pad mounted generator installed in a weatherproof and soundproof enclosure. Th is generator will provide back-up power for life safety, critical, and essential electrical loads as required by the VA Electrical Design Manual.

Telecommunications / Security:

(1) Security systems hardware will not be housed inside the telecommunications rooms.

HVAC / Fire Protection / Plumbing:

(1) Th e mechanical and plumbing systems will follow the Sustainable Design Principles outlined in the VA Sustainable Design and Energy Reduction Manual (April 2010). (2) Th e mechanical systems will be based on the VA HVAC Design Manual for New, Replacement, Addition, and Renovation of Existing VA Facilities for Hospitals, Clinics (Outpatient and Inpatient), Emergency Care, Ambulatory Care, Animal Research and Holding, Laboratories, Energy Centers, and Warehouses (March 2011). (3) Th e plumbing systems will be based on the VA Plumbing Design Manual for New Hospitals, Replacement Hospitals, Ambulatory Care, Clinical Additions, Energy Centers, Outpatient Clinics, Animal Research Facilities, and Laboratory Buildings (April

5.4

2010). (4) Th e fi re protection systems will be based on the VA Fire Protection Design Manual (Sept 2011).

Electrical Th e main electrical room located at the perimeter of the building along the staff / support corridor will house the main switchgear fed from the outdoor pad mounted transformer. Th e facility is small enough that it will not require any additional electrical rooms, with a maximum branch circuit run is no more than 200 feet. Branch circuit panelboards, both 480Y/277V and 208Y/120V, and step down transformers (480V-208Y/120V) will be installed within the main electrical room.

Telecommunications and Security Th e main telecommunications room and Entrance Facility (EF) is located along the perimeter of the building, adjacent to the main electrical room with access from the staff / support corridor. Th e size of the facility eliminates the need to have multiple telecommunication rooms throughout the building, as cable runs will not exceed 200 feet. Communication racks will be used within this room to serve the entire building along with other equipment as required by the VA Electrical Design Manual, December 2010, Chapter 7: Telecommunication System. Th e racks needed to accommodate CCTV and security systems hardware will be located in police areas due to security accessibility concerns.

HVAC

Th e clinic building will be provided with a mechanical space sized to accommodate the Heating, Ventilating, and Air Conditioning (HVAC) systems equipment. Th e major components of the HVAC systems are assumed to include rooftop air handling units, heating hot water boilers, air-cooled chillers, expansion tanks, air separators, water treatment system, and associated pumps and controls. A mechanical penthouse located at the roof of the clinic building will be utilized to accommodate the hot water boiler equipment.

Ductwork from air handling units located on the roof will run through the ceiling spaces for distribution of supply and return air. Exhaust air from clinic spaces will be ducted to exhaust fans located at the roof level. Location of outside air intakes relative to building exhausts, and plumbing vents will require coordination review to adequate separation. In lieu of a roof hatch and ladder system, it is recommended that a stairwell be utilized to allow for easier maintenance accessibility. Th e penthouse space required to house two boilers sized at 100% of the building heating load, associated pumps, expansion tank, water treatment, domestic water heater, chilled water pumps and all controls for the air cooled chillers is approximately 800 SF.

Plumbing Space will be provided in the new clinic building for installation of plumbing systems equipment. It is recommended that the building’s domestic water backfl ow preventer assembly be located in a room on the ground fl oor level where the building water main enters the building.

Typically local authorities want the backfl ow preventer at the building entrance to reduce the possibility of obtaining unmetered water or contamination from an unauthorized connection into the water main upstream of the backfl ow preventer. In addition, the backfl ow preventer assemblies have a large pressure drop and it is best to locate them at the entrance where the incoming water pressure is the highest.

Ideally, the backfl ow preventer would be located in a separate room but may also be located in the fi re valve room. In addition to the domestic backfl ow preventer, the plumbing systems will include sanitary drainage piping, rain water drainage piping, domestic cold water piping, water booster pump (where required) water softening/fi lter equipment (where required), domestic hot water systems including water heaters, expansion tanks, and pumps. It is assumed any medical/dental air and vacuum systems required will be point of use located within the clinic area. Space required for this equipment is estimated at approximately 200 SF. Aside from the backfl ow preventer, the equipment may be located at the penthouse level.

Fire Protection Th e fi re protection equipment required to serve the clinic building shall be installed in a separate room located at the perimeter of the ground fl oor level where the main water supply enters the building. Th e location of this room may also be subject to the requirements of the local jurisdiction authorities. Th e room shall contain the main fi re protection valves and fi re pumps if required. Usually, the use of fi re pumps for a single story building is not necessary. However, the need for fi re pumps is dependent on the available water pressure at the point of main water entry. Should fi re pumps be necessary, the fi re protection equipment room must also be accessible directly from the building exterior. If the required building supply water pressure is adequate for the fi re suppression system, then fi re pumps are not necessary and direct access to the building exterior is not required. Th e recommended size of this room, regardless of whether a fi re pump is required, is approximately 120 SF.

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Final Submittal May 16, 2014 CBOC Prototype Proposed LayoutsOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

5.11

5.1.1 One-PACT CBOC Prototype

Area Calculation Plan

VA CBOC Program for Design Actual per prototype layouts Delta

Net SF Department Net SF Department DGSF

NSF DGSF NSF DGSF Delta

One-PACT Prototype 8,915 13,551 9,257 14,302 6%

Maui Test Fit 11,387 17,308 11,937 18,370 6%

Two-PACT L-SHAPED 29,550 44,916 31,189 49,302 10%

Brooksville Test Fit** N/A N/A 31,933 48,204 N/A

Three-PACT L-Shaped 48,544 73,787 51,158 79,416 8%

Rapid City Test Fit 35,350 53,732 33,811 58,028 8%

** Updated Program for Design has not been received at time of this report.

One-PACT Prototype 8,915 13,551 9,257 14,302 6%

In each of the prototype designs the net square feet (NSF) exceed the programs for design. Th is is due primarily to the inclusion of “fl ex” spaces. Inclusion of these spaces in the prototypes provides the fl exibility to accommodate VBA, Veteran Service Organizations, and other functions that do not require full-time equivalent (FTE) personnel and may not be identifi ed at the time a program for design is developed.

Refer to Section 3 - Program Space Comparison for additional information.

VA CBOC PFD Delta

Building Building BGSF

BGSF * BGSF Delta

One-PACT Prototype 16,939 16,172 -5%

Maui Test Fit 21,635 21,102 -2%

Two-PACT L-SHAPED 56,145 56,063 0%

Brooksville Test Fit** N/A 55,996 N/A

Three-PACT L-Shaped 92,234 88,874 -4%

Rapid City Test Fit 72,538 68,243 -6%

* The mechanical component for of the SEPS BGSF factor is 6.00.

** Updated Program for Design has not been received at time of this report.

Actual per prototype layouts

One-PACT Prototype 16,939 16,172 -5%O

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Final Submittal May 16, 2014 CBOC Prototype Proposed LayoutsOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

5.15

5.2 Two-PACT CBOC Prototype

L-Shaped Layout Th e Two-PACT CBOC Prototype follows the same criteria as the One-PACT Prototype, and expands to fulfi ll the larger space requirement. Th is clinic contains Two-PACT modules, a General Mental Health component and an Ancillary Services Diagnostic Module (ASDM). Refer to Section 2 for an explanation of the services included in the prototype and Section 3 for a Prototype Program for Design.

Th ere are three proposed layouts for the Two-PACT CBOC Prototype: the L-Shaped Layout, the Linear Layout and the Flare Layout. Refer to Sections 5.3 and 5.4 for descriptions of the other Two-PACT CBOC Prototypes. A two story scheme was also developed through the course of this study.

In discussions with key stakeholders, it was determined to be a non-optimal solution at the Two-PACT scale. Th e services prioritized for location on the fi rst level amounted to far more square footage than the services that could be co-located on the second level. Th is made an ineffi cient multi-story building with uneven fl oorplates.

Th e Entry component is similar to the One-PACT CBOC Prototype, with a Police presence at the front door. Like the One-PACT CBOC Prototype, the Commons is a shared waiting area with a mix of seating areas, Patient Education, and Canteen services. Th e Canteen grows to accommodate the larger population served at the clinic. As discussed in Section 4, the Canteen is sized per business case model supported by the population at the CBOC. Also like the One-PACT CBOC Prototype, the Group Room components have access directly from the Commons.

Other components requiring adjacency to the Commons are the Lab and Pharmacy components. Pharmacy is located in close proximity to the Entry component and in the corner of the ASDM, creating a separation of the waiting function for this high volume service. Th ere is also the possibility of adding another entrance / exit, allowing Veterans and family members to leave the CBOC directly after picking up their prescription(s).

Multiple fl ex offi ces located in the front bar between the public and clinical areas allow space for various functions utilized by Veterans and family members (Volunteers, Service Organizations, etc).

In the L-Shaped Two-PACT CBOC Prototype, two Reception components serve the clinic. One component is centrally located to serve the Two-PACT modules and a General Mental Health component. Th e three services have been co-located for patient convenience, to support the integration of care, and ease of sharing space, like the Group Room component nearby. Th ere is also Mental Health embedded within the PACT modules.

Th e other Reception component serves the Ancillary Services Diagnostic Module. Combining Reception facilitates staff sharing and a single common front door serving all of the ASDM components. Within the Ancillary Services Diagnostic Module, the diff erent services share multiple spaces: staff support areas, toilets, equipment storage, and team work areas designed in the PACT model. Th e services within this module will change based on local programmatic need, as evidenced in the test fi t. Th e ASDM has been rotated to create an “L” shape. Th is scheme supports optimum patient fl ow while creating distinct check-in spots along the “L” to help prevent overcrowded waiting areas and bottleneck circulation patterns.

At the corner of the L-Shaped CBOC Prototype is the Lab component. Th is service is highly utilized by patients coming to the CBOC for PACT and Ancillary Service Diagnostic appointments. Locating this service adjacent to both legs of the “L” facilitates convenient access from the Commons and clinical areas.

Th e Radiology component in the L-Shaped Two-PACT CBOC Prototype is located along an exterior wall. Th is allows for direct access to a Mobile Technology Pad component, as required by local need. Th e Home Based Primary Care component is behind the Radiology component, providing direct exterior access for staff needing to come and go to provide care. Th is “soft” space also permits Radiology to expand in the future, if necessary.

Th e end bay in the L-Shaped Two-PACT CBOC Prototype holds the PMR + Prosthetics component. Th e gym within the PMR component benefi ts from the natural light aff orded by an exterior wall. Prosthetics maintains presence along the Commons, for ease of dispensing to Veterans; while also sharing a storage area with PMR. Behind the PMR + Prosthetics component are staff support spaces. A shared lounge, locker and wellness area support the ASDM staff .

Th ere is also an additional Group Room, to be used by ASDM patients, visitors and staff .

5.16

Building support and mechanical spaces in the L-Shaped Two-PACT CBOC Prototype are located in the rear corner, at the end of the longer “L.” Th is zone does not have hard boundaries, which allows the area to grow and shrink pending the mechanical and material storage needs of the specifi c location.

Th e L-Shaped Two-PACT CBOC Prototype is the scheme preferred by the study’s stakeholders. Th e shape is expandable in several directions and off ers fl exibility while maintaining optimal adjacencies. Th ere is more front bar space available for shared services. Wayfi nding is simple and travel distances are reduced for patients. Th e building traffi c is easily segregated between public, patient, staff , and materials. A fl exible approach to mechanical and Logistics space allows locations to adapt the plan to their specifi c needs.

Engineering Assumptions Electrical / Main Power:

Telecommunication / Security:

(1) Security systems hardware will not be housed inside the telecommunications rooms.

HVAC / Plumbing / Fire Protection design: (1) Th e mechanical and plumbing systems will follow the Sustainable Design Principles outlined in the VA Sustainable Design and Energy Reduction Manual (April 2010). (2) Th e mechanical systems will be based on the VA HVAC Design Manual For New, Replacement, Addition, and Renovation of Existing VA Facilities for Hospitals, Clinics (Outpatient and Inpatient), Emergency Care, Ambulatory Care, Animal Research and Holding, Laboratories, Energy Centers, and Warehouses (March 2011). (3) Th e plumbing systems will be based on the VA Plumbing Design Manual For New Hospitals, Replacement Hospitals, Ambulatory Care, Clinical Additions, Energy Centers, Outpatient Clinics, Animal Research Facilities, and Laboratory Buildings (April 2013).

(4) Th e fi re protection systems will be based on the VA Fire Protection Design Manual (Sept 2011).

Electrical Th e main electrical room (approximately 200 SF) will be located at the perimeter of the building to house the main switchgear fed from the outdoor pad mounted transformer.

A facility of this size will require two additional electrical rooms (approximately 125 SF each), strategically located to minimize the lengths of the longest branch circuit runs (200’ or less). Th e two electrical rooms will contain branch circuit panelboards, both 480Y/277V and 208Y/120V, and step down transformers (480V-208Y/120V) to serve lighting, power and other electrical loads.

Telecommunications and Security Th e main telecommunications room and Entrance Facility (EF) will be approximately 130 SF and is located along the perimeter of the building, in close proximity to the main electrical room. Th e facility will require two additional telecommunications rooms (approximately 125 SF each) to adequately support all of the data, voice, and video signal distributions required throughout the building. Racks will be installed within the each telecommunications room to serve the building along with other equipment as required by the VA Electrical Design Manual, December 2010, Chapter 7: Telecommunication System. Th e racks needed to accommodate CCTV and security systems hardware will be located in police areas due to security accessibility concerns.

Mechanical Th e clinic building will be provided with mechanical space sized to accommodate the Heating, Ventilating, and Air Conditioning (HVAC) systems equipment. Th e major components of the HVAC systems are assumed to include rooftop air handling units, heating hot water boilers, water cooled chillers, cooling towers, expansion tanks, air separators, water treatment system, supporting pumps and controls. A mechanical room will be located at the perimeter of the ground fl oor level and a mechanical penthouse will be provided at the building roof level. Th e ground fl oor mechanical room will be utilized for hydronic equipment which includes two hot water heating boilers each sized at 100% of the building heating load, and associated pumping support equipment, controls, and water treatment. Th e mechanical penthouse located at the roof of the clinic building will be utilized to accommodate the chiller equipment and domestic water heaters. Ductwork from air handling units located on the

Final Submittal May 16, 2014 CBOC Prototype Proposed LayoutsOffi ce of Construction & Facilities Management

Prototype for Standardized Design and Construction of Community Based Outpatient Clinics

5.17 roof will run through the ceiling spaces for distribution of supply and return air. Exhaust air from clinic spaces will be ducted to exhaust fans located at the roof level. Location of outside air intakes relative to building exhausts, plumbing vents, and cooling tower plumes will require coordination to ensure adequate separation. In lieu of a roof hatch and ladder system, it is recommended that a stairwell be utilized to allow for easier maintenance accessibility. Th e estimated space required for the ground fl oor mechanical room serving the boilers is approximately 660 SF. Th e penthouse space required to house two chillers each sized for 100% of the building cooling capacity, associated chiller and cooling tower pumps, domestic water heater, expansion tanks, water treatment, and all controls is approximately 1000 SF.

Ideally, the backfl ow preventer would be located in a separate room but may also be located in the fi re valve room. In addition to the domestic backfl ow preventer, the plumbing systems will include sanitary drainage piping, rain water drainage piping, domestic cold water piping, water booster pump (where required) water softening/fi lter equipment (where required), domestic hot water systems including water heaters, expansion tanks, and pumps . It is assumed any medical/dental air and vacuum systems required will be point of use located within the clinic area. Space required for this equipment is estimated at approximately 200 SF. Aside from the backfl ow preventer, the equipment may be located at the penthouse level.

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