Pediatric_Dentist_and_Endodontist_RFP_15-249-SOL-00039__090315.pdf

15-249-SOL-00039

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

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

Tucson Area Office 7900 S. J. Stock Road Tucson AZ 85746

1500 ET 10/02/2015

KATHERYN J CAMACHO 520

katheryn.camacho@ihs.gov

295-2472

PAGE(S)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c) kcamacho Typewritten Text kcamacho Typewritten Text

BLDG 650T

kcamacho Typewritten Text kcamacho Typewritten Text X kcamacho Typewritten Text X kcamacho Typewritten Text kcamacho Typewritten Text X kcamacho Typewritten Text kcamacho Typewritten Text X kcamacho Typewritten Text kcamacho Typewritten Text kcamacho Typewritten Text kcamacho Typewritten Text X kcamacho Typewritten Text X kcamacho Typewritten Text X kcamacho Typewritten Text X kcamacho Typewritten Text X kcamacho Typewritten Text X kcamacho Typewritten Text X kcamacho Typewritten Text X kcamacho Typewritten Text

SUSAN PROTHO

kcamacho Typewritten Text Tucson Area Indian Health Service Chief of Contracting Office 7900 South J Stock Road Tucson, AZ 85746 kcamacho Typewritten Text

RFP #15-249-SOL-00039 Dental Services P a g e | 2

PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE OF CONTRACT

B.2 SCOPE OF WORK

B.3 SCHEDULE OF PRICING

B.4 PRICING FOR BASE YEAR AND ALL OPTION YEARS…………….………………………………………….5

SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 SCOPE

C.2 DESCRIPTION OF SERVICES TO BE PERFORMED

C.3 PEDIATRIC DENTIST………………………………………………………………………………………...…………….12

C.4 ENDODONTIST SERVICES…………………………………………………………………………………………...……13

SECTION D - PACKAGING AND MARKING

SECTION E – INSPECTION AND ACCEPTANCE

E.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

E.2 METHODS OF ASSESSMENT OF PERFORMANCE

SECTION F – DELIVERIES OR PERFORMANCE

F.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

F.2 PERIOD OF PERFORMANCE

F.3 OPTION PERIOD OF PERFORMANCE

F.4 PLACE OF PERFORMANCE

F.5 HOURS OF OPERATION

F.6 DELIVERABLES

F.7 SCHEDULE OF DELIVERABLES/REPORTING REQUIREMENTS/INVOICING

SECTION G – CONTRACT ADMINISTRATION DATA

G.1 CONTRACTING OFFICER RESPONSIBILITY

G.2 ORDERING OFFICIAL

G.3 CONTRACTING OFFICER’S REPRESENTATIVE

G.4 ORDERING (FAR 52.216-18) (OCT 1995)

G.5 ORDER LIMITATIONS (FAR 52.216-19) (OCT 1995)

G.6 REQUIREMENTS (FAR 52.216-21) (OCT 1995)

G.7 PAYMENT

SECTION H – SPECIAL CONTRACT REQUIREMENTS

H.1 TAX INFORMATION

H.2 ARIZONA STATE TAXES

H.3 TOHONO O’ODHAM NATION SALES AND OTHER TAXES

H.4 TRIBAL EMPLOYMENT RIGHTS ORDINANCE (T.E.R.O.)

H.5 GOVERNMENT FURNISHED MATERIAL/FACILITIES

H.6 PRIVACY ACT NOTIFICATION

H.7 NON-DISCRIMINATION IN SERVICES, BENEFITS, AND FACILITIES

H.8 ECONOMIC PRICE ADJUSTMENT GUIDELINES

H.9 352.223-70 SAFETY AND HEALTH (JAN 2006)

H.10 INDIAN CHILD PROTECTION AND FAMILY VIOLENCE PREVENTION…………………………………………26

H.11 CRIME CONTROL ACT OF 1990…………………………………………………………………………………………..26

H.12 PRO-CHILDREN ACT OF 1984…………………………………………………...………………………………………..26

PART II – CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

I.1 52.252-2 Clauses Incorporated by Reference. (FEB 1998)

I.2 52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND REQUIREMENT TO INFORM

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EMPLOYEES OF WHISTLEBLOWER RIGHTS (APR 2014)…………………………………………………………...27

I.3 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011)

I.4 FAR 52.212-5 CONTRACT TERMS AND CONDITIONSREQUIRED TO IMPLEMENT STATURES OR

EXECUTIVE ORDERS- COMMERCIAL ITEMS (MAY2015)

I.5 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

I.6 52.232-18 AVAILABILITY OF FUNDS (APR 1984)

I.7 352.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)

I-8 352.270-17 CRIME CONTROL ACT—REPORTING OF CHILD ABUSE (JAN 2006)

I.9 352.270-18 CRIME CONTROL ACT-REQUIREMENT FOR BACKGROUND CHECKS (JAN 2006

I.10 52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 1997)

I.11 DEPARTMENT OF HEALTH & HUMAN SERVICES ACQUISITION REGULATION CLAUSES(48 CFR CH 3).34

I.12 352.203-70 ANTI-LOBBYING (JAN 2006)…………………………………………………………………………………34

I.13 352.222-70 CONTRACTOR COOPERATION IN EQUAL EMPLOYMENT OPPORTUNITY INVESTIGATION

(JAN 2006)……………………………………………………………………………………………………………….……34

I.14 352.224-70 PRIVACY ACT (JAN 2006)…………………………………………………………………………………….35

I.15 352.242-71 TOBACCO-FREE FACILITIES (JAN 2006)………………………………………………………………….35

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACHMENTS

SECTION J - List of Documents, Exhibits and Other Attachments

SECTION K - REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF OFFERORS

K.1 TO BE COMPLETED BY THE OFFEROR

K.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

K.3 52.204-6 DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER (JUL 2013)

K.4 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN

FEDERAL TRANSACTIONS (SEP 2007)....……………………………………………………………………………….37

K.5 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (APR 2010)…………….………………..37 K.6 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)………………….…………….39

K.7 52.219-1 SMALL BUSINESS PROGRAM REPRESENTATIONS (OCT2014)…………………………………………40

K.8 52.222-22 PREVIOUS CONTRACTS COMPLIANCE REPORTS (FEB 1999)…………………………………………42

K.9 52.233-13 CERTIFICATION OF TOXIC CHEMICAL RELEASE REPORTING (AUG 2003)……………………….42

SECTION L – INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS

L.1 NOTICE LISTING SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

L.2 52.215-12 RESTRICTIONS ON DISCLOSURE AND USE OF DATA (APR 1984)

L.3 52.216-1 TYPE OF CONTRACT (APR 1984)

L.4 52.233-2 SERVICE OF PROTEST (SEP 2006)

L.5 FAR 52.216-27 SINGLE OR MULTIPLE AWARDS (OCT 1995)

L.6 GENERAL INSTRUCTIONS

SECTION M – EVALUATION FACTORS FOR AWARD

M.1 52.212-2 EVALUATION – COMMERCIAL ITEMS (OCT 2014)

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PART I - THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 PURPOSE OF CONTRACT

This solicitation will result in multiple-award, indefinite-delivery, requirements (also known as Task Order) type contracts.

A number of contracts will be awarded as a result of this solicitation. The actual number of awards will be dependent on offers received and the best value analysis process, but the intent is to have a sufficient number of awardees to meet the dental service requirements of the TAIHS. The Government anticipates at least 1 award per specialty but reserves the right to award more or less.

Services will be acquired each performance year on an “as needed” basis through the issuance of Task Orders by the TAIHS.

Individual Task Orders shall not exceed $250,000.00 or the delegations of authority for each individual Contract Specialist placing Orders.

Pursuant to the Federal Acquisition Regulations (FAR), Part 37, the contracts will be awarded as non-personal services contract; to mean a contract under which the personnel rendering services are not subject to supervision and control of the Government. It is possible minimum administrative orientation may be provided by the Government for purposes of Task Order issuance. The Contractor is not a federal government employee or an employee of the Indian Health Service, and shall be responsible for collecting and paying the State taxes, federal, and other applicable taxes. The Indian Health Service will not withhold taxes under this contract nor issue a W-2 to the contractor. Refer to Contract Clause H.1 “TAX INFORMATION” for additional tax information.

B.2 SCOPE OF WORK

Contracts issued will provide for basic diagnostic, preventative and restorative dental services to Indian beneficiaries who seek dental care at the dental facilities within the Sells Service Unit, Tucson Area Indian Health Service (TAIHS), for the purpose of maintaining and improving their oral health. The Government may evaluate the quality of services provided, but retains no control over the professional aspects of services rendered (e.g., professional judgments and diagnosis for specific treatment).

B.3 SCHEDULE OF PRICING

The following schedule lists the dental specialties that TAIHS may order on as-needed basis. Indicate their specialty by completing the proposed daily rate (based on 8 hours) for the appropriate specialty. The daily rate will be inclusive of all associated costs, i.e. travel, per diem, airfare, transportation, lodging, and all applicable taxes, etc. Contractor staff may be required to work full days (8 hours) or half-days (4 hours or less). The Government will pay a pro-rate of the daily rate for any days worked 4 hours or less.

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B.4 PRICING FOR BASE YEAR AND ALL OPTION YEARS

Base Year: Period of Performance: October 1, 2015 through September 30, 2016

Sells Indian Hospital, Sells, AZ

Description of Services

Estimated Days per Year Daily Rate Estimated Annual Rate

Pediatric Dentist

80 $__________ $_______________

Endodontist

7 $__________ $_______________

San Xavier Clinic, Tucson, AZ

Services

3 $__________ $_______________

20 $__________ $_______________

Santa Rosa Health Center

Services

San Simon Clinic

Services

2 $__________ $_______________

1 $__________ $_______________

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Option Year One: Period of Performance: October 1, 2016 through September 30, 2017

Services

Services

Services

Services

Estimate Days per Year Daily Rate Estimated Annual Rate

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Option Year Two: Period of Performance: October 1, 2017 through September 30, 2018

Services

Services

Services

Services

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Option Year Three: Period of Performance: October 1, 2018 through September 30, 2019

Services

Services

Services

Services

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Option Year Four: Period of Performance: October 1, 2019 through September 30, 2020

Services

Services

Services

Services

TOTALS:

Base Year: $

Option Year I: $

Option Year II: $

Option Year III: $

Option Year IV: $

Estimated Grand Total: $

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B.4 PRICING FOR BASE YEAR AND ALL OPTION YEARS (continued)

Note: The estimated quantities are not a reflection of what will actually be ordered throughout the life of the contract. They are merely an estimate of what the Government anticipates materializing throughout the life of the contract.

Only Warranted Contracting Officers of the TAIHS are authorized to place Task Orders against the resultant contract. Task Orders may be issued orally, by facsimile, or by electronic commerce methods. Task Orders that are issued orally will be confirmed in writing.

NOTE: This solicitation requires all successful offerors to be registered in the System for Award Management, (SAM) database at www.sam.gov. Contract awards cannot be made to offerors not registered in the SAM database.

Reference FAR Clause 52.204-7 entitled “System for Award Management”, Paragraph (t) (4) of Clause 52.212-4 “Contract Terms and Conditions—Commercial Items”, and Paragraphs (j) and (k) of Clause 52.212-1 “Instructions to Offerors—Commercial Items”.

http://www.sam.gov/

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SECTION C - DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C.1 SCOPE-INTRODUCTION

Pediatric and Endodontic Dental Services are on an as-needed basis located at the following facilities of the Tucson Area Indian Health Service (TAIHS).

a) Sells Dental Clinic located 60 miles West of Tucson, AZ.

b) San Xavier Dental Clinic located in Tucson, AZ.

c) Santa Rosa Dental Clinic located 93 miles West of Tucson, AZ.

d) San Simon Dental Clinic located 100 miles West of Tucson, AZ

The Contractor may need to travel to any of the four dental clinic locations as assigned. The purpose of the work is to diagnose and treat the full range of very difficult dental problems in pediatric dentistry, manage patients with special behavior problems and deal with patient-management problems. Another purpose is to treat complex endodontic cases onsite instead of referring patients to private endodontic offices in Tucson. Services are needed to support the dental team by performing a range of pediatric and endodontic dental services allowing the dental team to smoothly function and better serve the intended population. See attached map for location of clinics.

C.2 DESCRIPTION OF SERVICES TO BE PERFORMED

A. The Contractor shall provide pediatric dental services or endodontic services as an adjunct to the general dentistry services that are currently provided on an ongoing basis. The Contractor shall aid the dental team in performance of their general dental duties which will benefit the population through the increased provision of pediatric dental care.

B. In the provision of these services the contract staff shall:

i. Be a graduate from an American Dental Association approved pediatric dentistry specialty program or endodontic specialty program

ii. Provide pediatric dental or endodontic consultative services as needed for the dental providers at the Sells Service Unit (Sells Hospital, San Xavier Clinic, Santa Rosa Clinic, and San Simon Health Center).

iii. Provide pediatric dental care or endodontic care to Native American patients. Provide examinations, diagnosis, prognosis, treatment planning, follow-up, and consultations as needed for all patients seen.

iv. Consult with other health care providers when a medical and/or developmental condition requires further investigation.

C. Statement of Qualifications Compliance: The Contractor’s certification of the “Statement of Qualifications Compliance” ensures that each contracted Pediatric Dentist or Endodontist meets the minimum requirements as shown below:

v. CPR/BCLS Certification: Current Certification of Cardio-Pulmonary Resuscitation (CPR) in Basic

Cardiac Life Support (BCLS) or equivalent.

vi. Employment History: Have practiced as a pediatric dental or endodontic.

vii. Certification of Immunization: Demonstrate Immunity to Rubella & Rubella, and current TB status in accordance with the IHS Immunization policy (policy available upon request).

viii. Criminal History Background Check: In compliance with Public Law 101-647, The Crime Control Act of 1990 and Public Law 101-630, The Indian Child Protection and Family Violence Act, each individual who will provide services is subject to a background check. Individuals must demonstrate in complying with these laws that they are not ineligible for an award.

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C.3 PEDIATRIC DENTIST

A. THE CONTRACTOR SHALL PROVIDE DENTAL SERVICES AS FOLLOWS:

1. Examination, diagnosis and treatment plan, and consultation of all patients treated.

2. Restoration of primary and permanent teeth with silver alloy and/or composite restorative materials, and stainless steel crowns.

3. Extraction of teeth diagnosed as non-restorative or associated with periodontal pathology including erupted teeth and impacted teeth, which may require sectioning and/or removal of bone.

4. Complete patient charting in accordance with the IHS Tucson Area Sells Service Unit Medical-Dental Staff Bylaws and Policies and Procedures (Shall be provided upon hire).

5. Prescribe preventative supplements to patients as required.

6. Impart information with clinical and administrative staff on a periodic basis. Communicate and interact with other clinical and administrative staff, especially when problems arise.

7. Prescribe appropriate medications and order lab work in the Electronic Health Record (EHR) when indicated

8. Document treatment needs and treatment provided in the Electronic Dental Record (EDR) of the patients in accordance with the Sells Service Unit Dental Program’s Policy and Procedures.

9. Arrive 15 minutes before first scheduled patient in order to prepare for the clinic day schedule.

10. Referrals to a dental specialist to any facility outside the IHS will require authorization from the Purchased/Referred Care (PRC) Department, only if those funds are utilized for payment. Contractors must obtain approval from the Chief or Deputy Chief Dental Officer and the PRC Department to check patient eligibility for contract care prior to making any arrangements for treatment with an outside provider. If the patient wishes to seek treatment at their own expense, the Dental contractors may refer patients to any specialist without obtaining prior authorization from anyone in the Sells Service Unit.

11. Follow the criterion stated in the IHS Technical Quality of Care and Indirect Review of Clinical Quality and Risk Management (available at http://www.ihs.gov/RiskManagement) contained in the Oral Health Program Guide for the IHS (fourth edition, 2014) available at http://www.doh.ihs.gov/clinicmanagement/ohpg/OHPG.pdf in the performance of this contract to maintain continuity of care with other IHS facilities and to insure proper health care for the patients.

12. The Contractor shall provide pediatric dental services that include but are not limited to the professional and scientific work in the prevention, diagnosis and treatment of diseases, injuries and deformities of the teeth, the jaws, organs of the mouth, and other structures in the oral cavity and mastication system of patients of any age.

13. The Contractor shall be able to diagnose and treat oral pathology within the limits of their usual professional qualifications and within the standards of quality generally provided by licensed and practicing dentists in the United States. In providing these services, the contractor assumes the same responsibilities and provides the same consideration, advise, instruction, personal home care guidance, and quality of treatment to IHS beneficiaries, under the terms of this contract, as is provided to the general public.

http://www.ihs.gov/RiskManagement

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C.4 ENDODONTIST SERVICES

A. The Contractor shall provide specialized dental services to be performed at government facilities, using government provided equipment, instruments, and supplies. In the provision of these services the contractor staff shall as a minimum, provide the following:

1. Shall obtain medical histories and perform the appropriate clinical examinations on patients receiving the specialty care.

2. Shall interpret radiographs and diagnostic tests to determine the type of endodontic problem, formulate a diagnosis and provide an appropriate treatment plan.

3. Professional treatment shall include restoring health and function as well as routine preventative health care of the teeth, therapy for supporting hard and soft tissues of the teeth.

4. Shall be required to provide endodontic services, root canal therapy for patients referred. These services shall be provided for a single or a multi-rooted tooth.

5. Shall be required to perform additional services related to this specialty such as apicoectomies and apexifications.

6. Shall ensure that endodontic services are offered to patients who meet the minimal requirements:

i. Complete exam

ii. All required services through Level III completed

iii. Must keep all specialty appointments

7. Shall provide eight hours per clinic day providing direct patient care to a variety of endodontic patients (refer to HOURS OF OPERATION).

8. Shall ensure that all chart entries and a final X-ray will be completed on patients treated before the end of the clinic day.

9. Shall be required to impart information with clinical and administrative staff on a periodic basis. The contractor will need to communicate and interact with other clinical and administrative staff, especially when problems arise

10. Shall provide dental services provided by hospital protocols and procedures, and shall be consistent with all rules and regulations of the hospital and its medical staff.

11. Complete patient charting in accordance with the IHS Tucson Area Sells Service Unit Medical-Dental Staff Bylaws and Policies and Procedures (Shall be provided upon hire).

12. Impart information with clinical and administrative staff on a periodic basis. Communicate and interact with other clinical and administrative staff, especially when problems arise.

13. Prescribe appropriate medications and order lab work in the Electronic Health Record (EHR) when indicated

14. Document treatment needs and treatment provided in the Electronic Dental Record (EDR) of the patients in accordance with the Sells Service Unit Dental Program’s Policy and Procedures.

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15. Arrive 15 minutes before first scheduled patient in order to prepare for the clinic day schedule.

16. Referrals to a dental specialist to any facility outside the IHS will require authorization from the Purchased/Referred Care (PRC) Department, only if those funds are utilized for payment. Contractors must obtain approval from the Chief or Deputy Chief Dental Officer and the PRC Department to check patient eligibility for contract care prior to making any arrangements for treatment with an outside provider. If the patient wishes to seek treatment at their own expense, the Dental contractors may refer patients to any specialist without obtaining prior authorization from anyone in the Sells Service Unit.

17. Follow the criterion stated in the IHS Technical Quality of Care and Indirect Review of Clinical Quality and Risk Management (available at http://www.ihs.gov/RiskManagement) contained in the Oral Health Program Guide for the IHS (fourth edition, 2014) available at http://www.doh.ihs.gov/clinicmanagement/ohpg/OHPG.pdf in the performance of this contract to maintain continuity of care with other IHS facilities and to insure proper health care for the patients.

18. The Contractor shall provide endodontic dental services that include but are not limited to the professional and scientific work in the prevention, diagnosis and treatment of diseases, injuries and deformities of the teeth, the jaws, organs of the mouth, and other structures in the oral cavity and mastication system of patients of any age.

19. The Contractor shall be able to diagnose and treat oral pathology within the limits of their usual professional qualifications and within the standards of quality generally provided by licensed and practicing dentists in the United States. In providing these services, the contractor assumes the same responsibilities and provides the same consideration, advise, instruction, personal home care guidance, and quality of treatment to IHS beneficiaries, under the terms of this contract, as is provided to the general public.

http://www.ihs.gov/RiskManagement

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SECTION D - PACKAGING AND MARKING

[FOR THIS SOLICITATION, THERE ARE NO CLAUSES IN THIS SECTION]

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SECTION E – INSPECTION AND ACCEPTANCE

E.1 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): https://www.acquisition.gov

52.246-4 Inspection of Services - Fixed-Price (AUG 1996)

E.2 METHODS OF ASSESSMENT OF PERFORMANCE

A. Consistency of attendance at scheduled clinics including day and hours of clinic service.

B. Participation and compliance with Sells Service Unit Quality Assurance requirements.

C. Patient complaints against the Contractor.

D. Compliance with all other contract terms and conditions.

https://www.acquisition.gov/

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SECTION F – DELIVERIES OR PERFORMANCE

F.1 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.acqnet.gov/far

52.242-15 Stop-Work Order. (AUG 1989)

F.2 PERIOD OF PERFORMANCE

Performance under this contract shall begin October 1, 2015 and shall not exceed September 30, 2016, unless the period is changed by written modification of the contract issued and signed by the Contracting Officer

F.3 OPTION PERIOD OF PERFORMANCE

If the Government exercises its option to renew pursuant to FAR Clause No. 52.217-9, Option to Extend the Term of the

Contract, the following schedule shall prevail:

Base Year: October 1, 2015 through September 30. 2016 1st Option Year: October 1, 2016 through September 30, 2017 2nd Option Year: October 1, 2017 through September 30, 2018 3rd Option Year: October 1, 2018 through September 30, 2019 4th Option Year: October 1, 2019 through September 30, 2020

F.4 PLACE OF PERFORMANCE

A. Sells Indian Hospital, Hwy 86 & Topawa Rd. Sells, AZ 85634 (60 Miles West of Tucson , AZ) B. San Xavier Indian Health Clinic, 7900 S. J. Stock Rd. Tucson, AZ 85746

C. Santa Rosa Health Center, HC 01 Box 8700, Sells, AZ 85634 (93 Miles West of Tucson, AZ) D. San Simon Health Center, HC 01 Box 8150, W Hwy 86 Mile Marker 74, Sells, AZ 85634(100 Miles West of Tucson, AZ)

F.5 HOURS OF OPERATION

The Contractor shall provide dental services at the facilities of the Tucson Area IHS on an as-needed basis. After credentialing process is completed, the contractor shall be expected to provide services within 24-hours of notification if available locally, up to 3 months if the contractor is located out of the State of Arizona. Travel to and from the facility/office site are not included in the hours of operation and cannot be invoiced as part of the hours of operation.

The Contractors staff shall call in to the immediate assigned department if unable to report to work due to illness or emergency, as soon as possible in order to make necessary changes in the provider schedule.

The hours of business and clinical operations for the facilities are as follows:

A. Sells Indian Hospital, Sells, AZ

Monday, Tuesday, Thursday and Friday from 8:00 am to 4:30 pm, with one-half hour for lunch.

Wednesday from 1:00pm to 4:30pm

B. San Xavier Indian Health Clinic, Tucson, AZ Monday, Tuesday, Thursday and Friday from 8:00 am to 4:30 pm, with one hour for lunch Wednesday from 1:00 pm to 4:30 pm

C. Santa Rosa Health Center, Santa Rosa, AZ Monday, Tuesday, Thursday and Friday from 9:00 am to 4:00 pm, with one-half hour for lunch.

Wednesday from 12:30 pm to 4:30 pm.

D. San Simon Health Center, San Simon, AZ Monday, Tuesday, Thursday and Friday from 8:00 am to 5:00 pm, with one-half hour for lunch Wednesday from 12:30 pm to 5:00 pm E. The Contractor SHALL NOT provide services on federally recognized holidays.

http://www.calendar-12.com/federal_holidays/2015 http://www.calendar-12.com/federal_holidays/2015

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F.6 DELIVERABLES

The Contractor is required to provide a copy of each Contract Pediatric Dentist and Endodontist profile to the COR prior to providing services and on an annual basis thereafter.

Services furnished under this contract shall not be subcontracted or transferred to another Contractor or organization without the specific written prior approval of the Contracting Officer.

Provide names and titles of the principal administrative professional persons who will be responsible for administering the services under the contract. Submit their academic credentials, certifications, and resume with particular emphasis on breadth and versatility of experience and any prior work experience with people in cross cultural settings, past history of dental services provided to the target population, past history of providing clinical dental services for the military and/or community health centers, Specify names of dental staff and submit documentation to substantiate the following:

Current license to practice from any U.S. state, territory or commonwealth Primary or specialty field of practice Board certified or eligibility Name of U.S. dental school of graduation/accreditation Short description of any malpractice actions.

Proof of U.S. citizenship Continuing Education

F.7 SCHEDULE OF DELIVERABLES/REPORTING REQUIREMENTS/INVOICING

Payment shall be made in ARREARS; Electronic Funds Transfer (EFT) shall be utilized as method for processing payment; contractors shall provide within five (5) calendar days after the end of each month, a type-written monthly invoice for all services provided during that month for every patient. Invoices should be faxed or mailed to the Point of Contact. Upon receipt of the Contractor’s properly prepared invoice, each Point of Contact (POC) is responsible for certifying the invoice for acceptance of services.

kcamacho Typewritten Text

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SECTION G – CONTRACT ADMINISTRATION DATA

G.1 CONTRACTING OFFICER RESPONSIBILITY

Authority to negotiate change in terms, conditions, or amounts cited in the contract is reserved to the Contracting Officer.

G.2 ORDERING OFFICIAL

The Contracting Officer may designate in writing one or more ordering officials to issue Task Orders under this contract. Designations will be made by separate correspondence and shall identify the maximum dollar limitations authorized for each ordering official. In addition, the Contracting Officer is authorized to issue orders under this contract.

G.3 CONTRACTING OFFICER’S REPRESENTATIVE

A. The Contracting Officer shall designate in writing the Contracting Officer’s Representative (COR) representing the Government for the purpose of this contract. A copy of the designation will be provided to the Contractor. The Contracting Officer’s Representative for this contract is Dr.

Hosek: 520-383-7341

B. The major responsibility of the COR is to ensure Contractor accountability, monitor contract performance, and assist the Contractor in the resolution of program problems encountered during the performance of this contract. Other duties specifically delegated are as follows:

(i) Monitoring the Contractor’s technical progress, including the surveillance and assessment of performance and recommending to the Contracting Officer changes in requirements;

(ii) Interpreting Scope of Work;

(iii) Performing technical evaluation as required;

(iv) Performing technical inspections and acceptances required by this contract;

(v) Assisting the Contractor in the resolution of technical problems encountered during performance, and;

(vi) Contractor’s files will be reviewed quarterly by all dental providers.

G.4 ORDERING (FAR 52.216-18) (OCT 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 may be issued from October 1, 2015 through September 30, 2016.

(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.

G.5 ORDER LIMITATIONS (FAR 52.216-19) (OCT 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $100.00 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 $250,000;

(2) Any order for a combination of items in excess of $250,000; or

(3) A series of orders from the same ordering office within 3 days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section.

(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 https://www.acquisition.gov/far/current/html/52_216.html#wp1115057

RFP #15-249-SOL-00039 Dental Services P a g e | 20 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 3 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.

G.6 REQUIREMENTS (FAR 52.216-21) (OCT 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 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 September 30, 2016.

G.7 PAYMENT

The Albuquerque Area Indian Health Service Financial Management Office shall make payment in accordance with Section B.3, Schedule of Pricing. Improperly prepared invoices will be returned to the Contractor resulting in delayed payment. Original invoice shall be submitted to the address cited on Page 1, Block 9 of the SF 1449, and a copy to the POC:

Invoice Submission to: Point(s) of Contact Tucson Area Finance Dept.

Attn: Claudia Oldman 7900 S J Stock Rd Tucson, AZ 85704

22 Indian Health Service, Sells Dental ATTN: Joseph Hosek P.O. Box 548 Hwy 86 & Topawa Rd Sells, AZ 85635 Phone: (520) 383-7334 Fax: (520) 383-7341

The following shall constitute a “proper” invoice.

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Name of Vendor Invoice Number and Date Government Contract No. (Purchase Order No.) and Task Order Number (if applicable) Description, price, and quantity of goods and services rendered Shipping and payment terms Taxpayer Identification Number (TIN), EIN or Social Security Number Data Universal Numbering System (DUNS) number (to ensure payment is made to the correct bank account) and vendor mailing address, as provided in the System for Award Management

(SAM).

Vendor contact name, address, title, telephone number and fax number and Signature Dates of Service, types of services provided, unit cost for services and subtotal for each Total cost for all patient services for the month Copies of Contractors staff records of signed time and attendance sheets supporting the services provided.

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SECTION H – SPECIAL CONTRACT REQUIREMENTS

H.1 TAX INFORMATION

Agencies may enter into non-personal health care services contracts with dentists and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. 253. Each contract shall—

(a) State that the contract is a non-personal health care services contract, as defined in 37.101, under which the contractor is an independent contractor; The Government and the Contractor understand and agree that the services to be delivered under this contract by the contractor to the Government are non-personal services and the parties recognize and agree that no employer-employee relationship exists or will exist under the contract between the Government and the Contractor's personnel. It is, therefore, in the best interest of the Government to afford both parties a full understanding of their respective obligations

Pursuant to FAR Part 4.900, (b) and 4.903(a), the Albuquerque Indian Health Service, Division of Accounting Services will issue Form 1099 Miscellaneous Income for reporting payments received under this contract to the Internal Revenue Service (IRS). It is the responsibility of the contractor to notify the IHS of any changes in the Tax ID No., address or company name at least 30 days prior to the effective date of change, otherwise; the IHS will mail the Form 1099 to the last address on file.

For more information regarding taxes under this contract Contractors can contact or visit the Internal Revenue Service (IRS) by going to the following IRS website at:

http://www.irs.gov/businesses

The entire consideration and benefits to the Contractor for performance of this contract is contained in the provisions for payment under this contract.

H.2 ARIZONA STATE TAXES:

The Department of Health and Human Services, Tucson Area Indian Health Service, is Tax Exempt under A.R.S.42-5063(C)(3)(a), A.R.S.42-5067(B)(1), A.R.S.42-5065(B)(2)(a), A.R.S.42-5066(B)(3) (a), A.R.S.42-5074(B)(8), A.R.S.42-5071(B)(2)(a), A.R.S.42-5061(A)(25)(a), and A.R.S.42- 5159(A)(13)(a),(b),(c), State of Arizona Department of Revenue. (Copy of Certificate available upon request). Contractor is responsible for determining and paying all required taxes. The final quotation amount shall include all applicable taxes. Award amount shall not be adjusted due to failure of the offeror to include taxes into the quotation.

H.3 TOHONO O’ODHAM NATION SALES AND OTHER TAXES

Contractor is responsible for determining and paying all required sales or other taxes. The proposal amount shall include all applicable taxes. For additional information, please contact the Tohono O’Odham Nation Treasurer Office at 520-383-1800

H.4. TRIBAL EMPLOYMENT RIGHTS ORDINANCE (T.E.R.O.):

All Contractors working within the Tohono O'Odham Reservation are subject to the Tribal Employment Rights Ordinance (TERO). It is the responsibly of the offeror to inquire into TERO 01-85 and to ensure their proposal includes any additional costs or taxes required by the Tohono O’Odham Nation.

Contractor is responsible for determining and paying all required taxes.

For additional information, please contact the Tribal Employment Rights Office at 520-383-3304 or 1- 888-882-5510.

Award amount shall not be adjusted due to failure of the offeror to include taxes into the proposal.

http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t09t12+37+408++%2810%29%20%252 http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t41t42+2+13++%2841%29%20%20AND%20%28%2841%29%20ADJ%20USC%29%3ACITE%20%20%20%20%20%20%20%20%20 https://www.acquisition.gov/far/html/Subpart%2037_1.html#wp1082881 http://www.irs.gov/businesses

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H.5 GOVERNMENT FURNISHED MATERIAL/FACILITIES

The Sells Service Unit and health care centers/clinics are fully equipped with all the necessary dental chairs, supplies and trained auxiliary dental staff available during the operation of the dental clinic. Contractors may bring their own auxiliary staff pending completion of background check and security clearance by the Tucson Area Human Resources Department.

TAIHS shall provide all tools and facilities necessary for the Contractor to accomplish all tasks associated with this order. The Contractor will have access to a personal computer, appropriate software, and other routine office equipment. The Contractor shall be provided with an orientation to the Sells Service Unit and the Indian community being served. TAIHS shall provide the orientation for two days: one at the Tucson Area Office and one full day at Sells Hospital.

Use of Government vehicles is not permitted under this contract.

H.6 PRIVACY ACT NOTIFICATION

A. This contract requires the Contractor, on behalf of the Indian Health Service (IHS), to provide health care to American Indians and Alaskan Natives and report selected medical record and financial information to IHS. The Snyder Act (25.U.S.C. 13) and Public Law 83-5658 (42 U.S.C.

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. IHS will use the information for financial, legal, research 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 American Indian or Alaskan Native people; the Office of Worker’s Compensation Programs; Department of Labor; the Department of Justice for their representation of 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 to you; 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.); and billing third party for the payment of care not reimbursed by IHS. You must forward all other requests for information contained on this form to the applicable IHS Contracting Officer’s Representative.

D. The contractor is required to comply with Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996.

H.7 NON-DISCRIMINATION IN SERVICES, BENEFITS, AND FACILITIES

A. The Contractor agrees to make no distinctions among patients under this contract on the basis or race, color, creed, or national origin. For the purpose of this contract, distinctions on the grounds of race, color, creed or national origin include, but are not limited to the following: Denying a patient any service or benefit or availability of a facility; providing any service or benefit to a patient which is different, or is provided in a different manner or at a different time from that provided to other patients under this contract; subjecting a patient to segregation of separate treatment in any manner related to this receipt of service, restricting a patient in any way in the enjoyment of any advantage of privilege enjoyed by others in determining whether he satisfies any admission, enrollment quota, eligibility, membership or other requirement or condition which an individual must meet in order to be provided any service or benefits; the assignment of times or places for the provision of services on the basis of race, color, creed, or national origin of the patient served.

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B. The Government reserves the right to terminate this contract in whole or in part whenever the Contractor fails to comply with the requirements of this clause.

H.8 ECONOMIC PRICE ADJUSTMENT GUIDELINES

Pursuant to the contract clause entitled “Economic Price Adjustment - Labor and Materials (JAN 1997) (FAR 52.216-4)”, the following specific guidelines shall be utilized in the application of Economic Price Adjustment - Labor and Materials clause.

(a) The Contractor shall notify the Contracting Officer if, at any time during contract performance, the rate of pay for labor (including fringe benefits) or the unit prices for material shown in the Schedule either increase or decrease. The Contractor shall furnish this notice within 60 days after the increase or decrease, or within any additional period that the Contracting Officer may approve in writing, but not later than the date of final payment under this contract. The notice shall include the Contractor’s proposal for an adjustment in the contract unit prices to be negotiated under paragraph (b) of this clause, and shall include, in the form required by the Contracting Officer, supporting data explaining the cause, effective date, and amount of the increase or decrease and the amount of the Contractor’s adjustment proposal.

(b) Promptly after the Contracting Officer receives the notice and data under paragraph (a) of this clause, the Contracting Officer and the Contractor shall negotiate a price adjustment in the contract unit prices and its effective date. However, the Contracting Officer may postpone the negotiations until an accumulation of increases and decreases in the labor rates (including fringe benefits) and unit prices of material shown in the Schedule results in an adjustment allowable under paragraph (c)(3) of this clause. The Contracting Officer shall modify this contract (1) to include the price adjustment and its effective date and (2) to revise the labor rates (including fringe benefits) or unit prices of material as shown in the Schedule to reflect the increases or decreases resulting from the adjustment. The Contractor shall continue performance pending agreement on, or determination of, any adjustment and its effective date.

(c) Any price adjustment under this clause is subject to the following limitations:

(1) Any adjustment shall be limited to the effect on unit prices of the increases or decreases in the rates of pay for labor (including fringe benefits) or unit prices for material shown in the Schedule.