2. 75H70521R00004 RFP Package.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

CODE 16. ADMINISTERED BYCODE

X

561320

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR235

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

01/11/2021 1600 CS

12/23/2020

JENNIFER RICHARDSON

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70521R00004

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 55 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Bemidji MN 56601 2225 Cooperative Ct NW, Rm 200

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$30.00

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

WILLIAM F. FISHER

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

X 100

X

Provide Non personal Emergency Room Nursing Services for Cass Lake Hospital, Cass Lake, MN.

Provide (4) Registered Nurses IAW terms and conditions set forth

Period of Performance: Base plus (4) Option Years

Individual funded Task Orders shall be issued accordingly x x

1x

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

2 2 of

EST.

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs. .

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs.

BASE YEAR GRAND TOTAL:

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs. .

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs.

OPTION YEAR 1 GRAND TOTAL:

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs. .

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs.

OPTION YEAR 2 YEAR GRAND TOTAL :

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs. .

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs.

OPTION YEAR 3 YEAR GRAND TOTAL:

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs. .

Registered Nurse (RN) 2080 Hrs.

Registered Nurse (RN) 2080 Hrs.

OPTION YEAR 4 GRAND TOTAL:

75H70521R00004 Emergency Room Nursing Services - CLSU

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION BLOCK

B.1. CONTRACT ADMINISTRATION DATA 4

B.2 INVOICES 4

B.3 PAYMENT 5

B.4 PLACE OF PERFORMANCE 5

B.5 PERIOD OF PERFORMANCE 5

B.6 SCHEDULE OF PRICES/COSTS 6

B.7 PERFORMANCE WORK STATEMENT 8

B.8 PERSONNEL QUALIFICATION REQUIREMENT 21

B.9 COMPLIANCE 22

B.10 CONTRACTING OFFICER REPRESENTATIVE (COR) 22

SECTION C - CONTRACT CLAUSES

C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE 23

C.2 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR

EXECUTIVE ORDERS—COMMERCIAL ITEMS 23

C.3 52.216-24 LIMITATION OF GOVERNMENT LIABILITY 27

C.4 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT 27

C.5 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR 27

C.6 52.216-18 ORDERING 2

C.7 52.216-19 ORDER LIMITATIONS 28

C.8 52.216-21 REQUIREMENTS 28

C.9 52.222-41 -- SERVICE CONTRACT LABOR STANDARDS 29

C.10 DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION REGULATION

(HHSAR) (48 CFR CHAPTER 3) CLAUSES 29

C.11 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACCT 29

C.12 352.239-75 KEY PERSONNEL 29

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 APPLICABLE DOCUMENTS 30

D.2 DEFINITIONS 3

D.3 BACKGROUND INVESTIGATION 32

D.4 SECURITY NOTICE 3

D.5 WAGE DETERMINATION 54

D.6 BUSINESS ASSOCIATES AGREEMENT

D.7. IHS SECURITY AGREEMENT SUMMARY

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS 34

E.2 52.212-2 EVALUATION--COMMERCIAL ITEMS 37

E.3 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS -- COMMERCIAL ITEMS 38

E.4 52.216-1 TYPE OF CONTRACT 5

E.5 52.233-2 SERVICE OF PROTEST 53

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 CONTRACT ADMINISTRATION DATA

Contract Administration: All contract administration matters will be handled by the following individuals:

CONTRACTOR NAME AND ADDRESS:

TAX ID#_______________________

DUNS #________________________

GSA #_________________________

Phone_________________________

E-Mail ________________________

Person responsible for Contractor Performance Assessment Reporting System (CPARS), reporting if different from above:

Name: _________________________________

Title: _________________________________

Email: _________________________________

CONTRACTOR REGISTRATION: All required information must be in the System for Award Management (SAM) at www.sam.gov.

GOVERNMENT:

Jennifer Richardson Indian Health Service 2225 Boring Ct NW Bemidji, MN 56601

Jennifer.Richardson@IHS.gov

NAICS:

The associated North American Industrial Classification System (NAICS) code for this procurement is 561320 with a small business size standard of $30.0.

CONTRACT TYPE: Indefinite Delivery Contract, Indefinite Delivery-Indefinite Quantity

B.2 INVOICES: In accordance with the Prompt Payment Act, payment will be due 30 days after receipt of services or receipt of a proper invoice, whichever is later.

INVOICE INSTRUCTIONS:

Contractor shall provide all invoices to –

Cass Lake Indian Health Service Email: kami.wooldridge@ihs.gov ATTN: Kami Wooldridge 425 7th St NW Cass Lake, MN 56633

BEM_AOInvoices@ihs.gov

At a minimum, a properly prepared invoice shall include:

1) Name and address of the Contractor.

2) Invoice date and invoice number. (The Contractor should date invoices as close as possible to the date of the mailing or transmission.)

3) IHS Contract No: TBD

Task Order: TBD

4) Description, quantity, unit of measure, unit price, and extended price of supplies delivered or services performed.

5) Shipping and payment terms (e.g., shipment number and date of shipment, discount for prompt payment terms). Bill of lading number and weight of shipment will be shown for shipments on Government bills of lading.

6) Name and address of Contractor official to whom payment is to be sent (must be the same as that in the contract or in a proper notice of assignment).

7) Name (where practicable), title, phone number, and mailing address of person to notify in the event of a defective invoice.

8) Contractor Taxpayer Identification Number (TIN).

9) Contractor Dun & Bradstreet Number (DUNS).

Improperly prepared invoices or statements shall be returned to the contractor and may delay payment.

B.3 PAYMENT

a) The IHS Bemidji Division of Finance is designated for payment processing. Payment shall be made by electronic funds transfer (EFT). Payment shall be made in arrears.

b) The Contractor’s rate identified for services described herein is considered as an all-inclusive rate. All-inclusive is defined to include but is not limited to services, travel, lodging, liability insurance, fringe benefits, federal, state and local taxes, and all other costs pertinent to the performance of this contract.

B.4 PLACE OF PERFORMANCE: CASS LAKE HOSPITAL

Indian Health Service Cass Lake Hospital 425 7th St NW Cass Lake, MN 56633

B.5 PERIOD OF PERFORMANCE:

Government anticipates a Base plus 4 option years, funded individual task orders will be issued

FAR 52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE.

It is expressly agreed and understood that this is a non-personal 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 administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the Contractor’s professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: amount normally prevailing within the local community for the medical specialty concerned.

B.6 SCHEDULE OF PRICE /COSTS

The quantities in the Schedule are for pricing purposes and basis for evaluation for award and do not represent what the Government will order. The Government is using the Indefinite-Delivery, Indefinite Quantity type contract because exact quantities cannot be pre-determined. The Government will issue orders in accordance with the Ordering and Requirements Clauses as needs arise and the contractor will be reimbursed for exact quantities performed at the prices quoted. The Government will Order during the life of this contract a minimum of $10,000 and a maximum of $500,000.

a. BASE YEAR PRICING:

ITEM

NO.

TYPE OF SERVICE EST. UNIT OF

ISSUE

UNIT

PRICE

TOTAL

AMOUNT

1. Registered Nurse (RN) 2080 Hrs.

2. Registered Nurse (RN) 2080 Hrs.

3. Registered Nurse (RN) 2080 Hrs.

4. Registered Nurse (RN) 2080 Hrs.

BASE YEAR GRAND TOTAL

b. OPTION YEAR 1:

ITEM

NO.

TYPE OF SERVICE EST. UNIT OF

ISSUE

UNIT

PRICE

TOTAL

AMOUNT

1. Registered Nurse (RN) 2080 Hrs.

2. Registered Nurse (RN) 2080 Hrs.

3. Registered Nurse (RN) 2080 Hrs.

4. Registered Nurse (RN) 2080 Hrs.

OPTION YEAR 1 GRAND TOTAL

c. OPTION YEAR 2

ITEM

NO.

TYPE OF SERVICE EST. UNIT OF

ISSUE

UNIT

PRICE

TOTAL

AMOUNT

1. Registered Nurse (RN) 2080 Hrs.

2. Registered Nurse (RN) 2080 Hrs.

3. Registered Nurse (RN) 2080 Hrs.

4. Registered Nurse (RN) 2080 Hrs.

OPTION YEAR 2 YEAR GRAND TOTAL

d. OPTION YEAR 3

ITEM

NO.

TYPE OF SERVICE EST. UNIT OF

ISSUE

UNIT

PRICE

TOTAL

AMOUNT

1. Registered Nurse (RN) 2080 Hrs.

2. Registered Nurse (RN) 2080 Hrs.

3. Registered Nurse (RN) 2080 Hrs.

4. Registered Nurse (RN) 2080 Hrs.

OPTION YEAR 3 GRAND TOTAL

e. OPTION YEAR 4

ITEM

NO.

TYPE OF SERVICE EST. UNIT OF

ISSUE

UNIT

PRICE

TOTAL

AMOUNT

1. Registered Nurse (RN) 2080 Hrs.

2. Registered Nurse (RN) 2080 Hrs.

3. Registered Nurse (RN) 2080 Hrs.

4. Registered Nurse (RN) 2080 Hrs.

OPTION YEAR 4 GRAND TOTAL

Minimum Order: $50,000.00 Maximum Order: $2,500,000.00

a. BASE YEAR: $_____________________

b. OPTION YEAR 1: $_____________________

c. OPTION YEAR 2: $_____________________

d. OPTION YEAR 3: $_____________________

e. OPTION YEAR 4: $_____________________

GRAND TOTAL: $_____________________

PURPOSE OF CONTRACT:

The Bemidji Area Indian Health Service (BAIHS) depends on contracting outside resources with a wide range of expertise in order to provide services not readily available within IHS. This firm-fixed priced IDIQ unit priced contract will provide Emergency Room Nursing Services for the Bemidji Area Indian Health Services.

B.7 PERFORMANCE WORK STATEMENT:

PERFORMANCE WORK STATEMENT (PWS)

Emergency Room Registered Nurse Cass Lake Indian Health Service

1. GENERAL: This is a non-personnel services contract to provide Emergency Room (ER)/Inpatient Unit Registered Nurse. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform the duties of an Emergency Room (ER)/Inpatient Unit Registered Nurse as defined in this Performance Work Statement, except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: The Mission statement for Cass Lake Hospital is “Working together to promote health and well-being is the mission of the Cass Lake Indian Hospital and Clinic”. To meet this mission, the Cass Lake Indian Health Service Unit has identified a need for a Non-Personal Service Contract for providing nursing care services for Emergency Room (ER)/Inpatient Unit nursing service.

1.3 Objectives: The contract Emergency Room (ER)/Inpatient Unit RN for the Emergency Room agrees, to provide all necessary covered services within the Registered Nurses’ scope of practice, under the direction of the Emergency Room Nurse Supervisor or designee.

The Contracted Emergency Room (ER)/Inpatient Unit RN shall provide a full scope of ER services to include newborn, child, adolescent and adult patients at the Cass Lake Indian Health Service Unit

The Contracted Emergency Room (ER)/Inpatient Unit RN may also provide services to Inpatients and Outpatient patients, when Emergency Department census is low.

The Contracted Emergency Room (ER)/Inpatient Unit RN may accompany patients on transfers as needed.

1.4 Scope: Provide nursing care services for Emergency Room (ER)/Inpatient Unit Nursing. Services include provide direct care to patients of all ages with a variety of medical, surgical, pediatric, ambulatory and emergency conditions. The Indian Health Service requires Emergency Room (ER)/Inpatient Unit RN services as described above to continue without interruption when requested during the term of this contract. The contractor shall accomplish nursing care provided by the Contracted Emergency Room (ER)/Inpatient Unit RN and shall be as comprehensive as the Indian Health Service supplied facilities, equipment, and support services permit.

The contract resulting from this solicitation shall:

1. Be a non-personal services contract under which the contractor is an independent contractor;

2. Require the contractor promptly provide all requested information to allow for the proper credentialing and background check;

3. Allow the government to evaluate the quality of professional and quality of care services provided;

4. Require the contractor to cover the government for any liability producing act of omission by the contractor, its employees and agents occurring during contract performance;

5. Require the contractor to maintain nursing liability insurance, in the coverage amount acceptable to the contracting officer, which is not less than the amount normally prevailing with the local community for the nursing specialty concerned;

6. Candidates with pending Nursing Licensure actions are not eligible for employment with this agency.

1.5 Period of Performance: The Period of Performance shall be listed on the Task Order as scheduled with the Emergency Room Nurse Supervisor or designated representative. The Emergency Room/Inpatient RN shall provide health care services, for the entire Period of Performance at the Cass Lake Indian Hospital. The usual work day will be from 7:45 am to 7:45 pm or 7:45 pm to 7:45 am rotating shifts nights, days, weekends, and holidays, three shifts one week and four shifts the next week or vice versa.

1.6 General Information:

1.6.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program (QCP) is the means by which he assures himself that his work complies with the requirement of the contract. The QCP is to be delivered within 30 days after contract award or with the contractors proposal if it is an evaluation factor, three copies of a comprehensive written QCP shall be submitted to the Contract Officer (CO) and Contracting Officer Representative (COR) within five working days when changes are made thereafter. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: The provider will be required to work Federal Government holidays, weeknights and weekends as depicted on schedules provided upon issuance of Task Order.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Independence Day Christmas Day

1.6.4 Hours of Operation: The contract manager or alternate shall be available at all times for administrative concerns. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at Cass Lake Indian Hospital which is an Indian Health Service government facility.

1.6.6 Type of Contract: The government will award a firm-fixed price, non-personal service contract.

1.6.7 Security Requirements: The Contracted Nurse is subject to a background investigation and shall comply with Section 231 of the Crime Control Act of 1990, P.L. 101-647; and the Indian Child Protection and Family Violence Prevention Act, P.L. 101-630. In addition, the nurse shall also comply with the Privacy Act of 1974 and the HIPPA Act of 1996. Failure to comply with these statutes will result in immediate removal.

Contractor personnel performing work under this contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act” P.L. 101-630. The Indian Health Service Personnel Office will conduct these investigations following award of a contract unless in the judgment of the Contracting Officer, in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individual shall not have unsupervised contact with Indian children. Contract RN will need to be accompanied by a chaperone until investigation is complete.

The Contracting Officer has the authority to temporarily waive the character investigation of a contractor. The “Agreement to a Temporary Waiver of Character Investigation” (See Attachment B) authorizes an agency to hire a contractor prior to the completion of a background check provided that at all times the contractor is within the sight and under the supervision of a government employee who has successfully completed the National Agency Check with written Inquiries (NACI).

This level of security is required, and must be maintained for the life of the contract.

1.6.7.1 PHYSICAL Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured. The contract nurse shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with Indian Health Service regulations, facility policy and in accordance with HIPPA. The contract nurse shall prepare all medical records documentation to meet or exceed the established standards of the I.H.S. facility to include, but not be limited to: timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

1.6.7.2 Key Control: The Contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the Contractor by the Government shall be duplicated. The Contractor shall develop procedures covering key control that shall be included in the Quality Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Contracting Officer.

1.6.7.2.1. In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

1.6.7.2.2. The Contractor shall prohibit the use of Government issued keys/key cards by any persons other than the Contractor’s employees. The Contractor shall prohibit the opening of locked areas by Contractor employees to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.6.8 Special Qualifications: It is a condition of this contract that all required certifications remain current during the life of this contract.

The contractor is responsible for ensuring the contracted RN shall possess a current, unrestricted state nursing license from any of the 50 United States or the Commonwealth of Puerto Rico, be registered with a Nursing Board and possess a Registered Nursing Licensure.

Possess current (BLS) Basic Life Support certification. (ACLS) Advanced Cardiac Life Support and (PALS) Pediatric Advanced Life Support, and Trauma Nursing Core Couse (TNCC) is required.

The contractor is responsible for ensuring the contracted RN shall

a. Not have any work or health restrictions, which interfere with the performance within the Emergency Department

b. Have skill and knowledge in providing nursing care with full consideration of the mental, emotional, physical, and cultural factors involved, such that he/she can relate constructively to patients from the Native American community.

c. Ability to work with patients, the public, and hospital staff.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.6.10 Contracting Officer Representative (COR): The COR will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.11 Key Personnel: The follow personnel are considered key personnel by the government:

Barbara Nyberg, Acting Director of Nursing

Jennifer Richardson, Contracting Specialist

Kami Woodbridge, COR II

The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer.

The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available at all times for administrative reasons.

1.6.12 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed. The contractor personnel will be required to obtain and wear badges in the performance of this service.

1.6.13 Contractor Travel: The Contractor shall be responsible for arranging travel and all associated costs related to the performance of this contract.

1.6.14 Other Direct Costs: The Contractor shall be responsible for arranging travel, lodging, per diem, labor, fringe benefits, and any applicable Federal, State, and Local taxes, plus any other costs pertinent to the performance of this contract.

1.6.15 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.6.16 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart

9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

This section identifies those items such as property, information and/or services that will be provided for the contractor’s use (without cost to the contractor) to allow them to provide the required nursing services, such as materials, facilities, training, etc. Examples provided below.

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. Services: The Government will provide personnel to assist with orientation and guidance to the Indian Health Service and its requirements.

3.2 Facilities: The Government will provide the necessary workspace for the contractor staff to provide the support outlined in the PWS to include desk space, telephones, computers, and other items necessary to maintain an office environment for nursing services.

3.3 Utilities: The Government will provide all utilities in the facility will be available for the contractor’s use in performance of tasks outlined in this PWS. If utilities are furnished, the following is required: The Contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

3.4 Equipment: The Government will provide equipment and/or what the contractor will have access to, i.e., computer, phone, scanners, fax machines, printers, shipping crates, lighting and sound, etc.

3.5 Materials: The Government will provide materials, i.e., Standard Operating Procedures and Policies and medical supplies and equipment to perform nursing duties.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1 General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS.

4.2 Verification of Licensure

To ensure that nurses providing services under this contract are properly licensed and that the I.H.S. is made aware of all disciplinary actions taken against such nurses, the contractor will:

1. Verify through the National Nursing Boards database all active, inactive, and lapsed licenses that are held, or have been held, by nurses who would provide services in I.H.S. hospitals and clinics under this contract.

2. Inform I.H.S. of the status of all licenses for each nurse who would provide services under this contract in I.H.S.

hospitals and clinics, including all reasons for each inactive or lapsed license.

3. Obtain at least three letters of reference from health care providers whom have knowledge of the applicant’s clinical practice skills within the past six months. One letter must be from the previous supervisor, at the hospital where the nurse holds or last provided nursing care.

4. Provide all information regarding performance and disciplinary actions that is collected on nurses who would be placed under this contract to the receiving I.H.S. facility Emergency Room Nurse Supervisor. This includes all information that is collected and compiled on such nurses at the time of initial hire by the Contractor, and/or information that is reported during periods that the Contractor is an agent of such nurses for placement under this contract.

5. Certify that all information obtained on nurses whom they would assign to I.H.S. hospitals and clinics has been reviewed and verified by the Contractor. This certification must include a statement that the Contractor has found no reason to reject the nurse’s application. The names of the contacts, their titles, telephone numbers, and dates of representative collecting and reviewing such information must be recorded in writing and made available to the I.H.S.

by the Contractor.

The Contractor must provide all of the information required above to the Director of Nursing, Assistant Director of Nursing or designee of the receiving I.H.S. facility no less than ten to fourteen days before the nurses actual report date.

When the requirements or the I.H.S. do not allow for hard copies of information to be received at least ten days before a nurses placement, the Contractor may provide such assurances to the I.H.S. facility Emergency Room Nurse Supervisor within five days after nurse’s placement. Such instances shall be kept to a minimum and the reasons for each instance must be documented and well justified by the Emergency Room Nurse Supervisor at the receiving I.H.S. facility.

4.3 Nursing liability Insurance:

The Contractor will be solely liable for and expressly agrees to indemnify the Government with respect to any professional liability producing acts or omissions by it or its employees or agents. The Contractor will maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than One (1) Million Dollars per occurrence and $3,000,000.00 aggregate.

An apparently successful offers or upon request by the contracting officer, will furnish prior to contract award evidence of its insurability concerning the nursing liability insurance required by this contract.

Liability insurance may be on either an occurrence basis or on claims made basis. If the policy is on claims made basis, an extended reporting endorsement (tail) for a period of not less than three years after the end of the contract term must also be provided.

A CERTIFICATE OF INSURANCE EVIDENCING THE REQUIRED COVERAGE WILL BE PROVIDED TO THE CONTRACTING OFFICER PRIOR TO THE COMMENCEMENT OF SERVICES UNDER THIS CONTRACT. If the insurance is on a claims made basis and evidence of an extended reporting endorsement (tail) is not provided prior to the commencement of services, evidence of such endorsement will be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract will be withheld until evidence of the extended reporting endorsement (tail) is provided to the Contracting Officer.

The policies evidencing required insurance will also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest will not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If during the performance period of the contract the Contractor changes insurance providers, the Contractor will provide evidence that the Government will be indemnified to the limits specified in this Statement of Work. This will be for the entire period of the contract, either under the new policy, or a combination of old and new policies.

4.4 Employee Health Requirements:

Cass Lake Indian Hospital requires contract provider onboarding health information for all job applicants to whom conditional offers of employment have been made in order to evaluate the applicant’s health, to protect patients and staff from exposure to communicable diseases. If the job applicant refuses to provide health information, proof of immunizations as recommended by the Centers for Disease Control (CDC) concerning health-care workers in the United States, the refusal is deemed sufficient grounds for Cass Lake Indian Hospital Service Unit to deny employment.

Information obtained regarding the medical condition or history of the applicant will be collected and maintained on separate forms and in separate medical files in accordance with federal law and will be treated as a confidential medical record. Cass Lake Indian Health Service will not provide immunizations or testing for contract personnel.

GUIDELINES

Contract provider onboarding health information must include the following:

Previous immunization history is reviewed by the Employee Health Nurse. Cass Lake Indian Hospital requires all potential caregivers to provide proof of the following immunization records. If the caregiver cannot provide proof appropriate lab testing should be provided prior to onboarding. Lack of immunization history is deemed sufficient grounds for Cass Lake Indian Hospital Service Unit to deny employment.

Hepatitis B (Vaccination-declination required) All Cass Lake Indian Hospital contract providers who perform tasks that may involve exposure to blood or body fluids should receive a 3-dose series of hepatitis B vaccine according to manufacturer recommendations. Test for hepatitis B surface antibody (HBSAB) to document immunity 1-2 months after dose #3. If HBSAB is positive, the caregiver is immune. No further testing or vaccination is recommended.

For new hires providing proof of previous vaccination: HBSAB testing will be performed. If HBSAB results are >10mIU/mL the caregiver is immune and no additional vaccination is required. If the HBSAB is < 10mIU/mL the care giver should be revaccinated with 3-dose series on an appropriate schedule and serologic testing repeated in 1-2 months. If HBSAB is negative following 6 doses of vaccine, the caregiver is a non-responder.

For non-responder blood exposure: Consult the Cass Lake Indian Hospital Infection Control Plan.

Measles, Mumps, Rubella (MMR) All Cass Lake Indian Hospital contract providers must be immune to Measles (Rubeola), Mumps and Rubella. For HCP without serologic evidence of immunity to each component of the vaccine or proof of 2 vaccinations, recommend additional doses needed per CDC guidelines.

Varicella All Cass Lake Indian Hospital contract providers must be immune to varicella. Evidence of immunity for the Caregiver includes documentation of 2 doses of varicella vaccine give per manufacturer recommendation, history of varicella or herpes zoster, laboratory evidence of immunity or laboratory confirmation of disease. Proof of varicella history will be obtained through laboratory testing if no serologic testing is provided at the time of screening at contractor’s expense.

All Cass Lake Indian Hospital Caregivers between 19-64 years of age (or per manufacturer recommendation) must receive a 1-time dose of T-dap, with priority given to those having contact with infants younger than age 12 months.

Influenza (Required Vaccination unless approved declination for medical or religious reasons)

Tuberculosis All potential Cass Lake Indian Hospital contract providers must have a two-step (boosted) TBST or show proof of a tuberculin skin test in the last twelve months. If not completed within 12 months contractor will need to have two-step TBST completed at contractor’s expense.

If a potential Cass Lake Indian Hospital contract provider is a known TBST reactor, he/she will be required to complete a chest x-ray. The x-ray may be waived if the potential caregiver can provide documented proof of a chest x-ray, which was done in the last twelve months and the potential caregiver denies signs and symptoms of Tuberculosis.

PART 5

SPECIFIC TASKS

5. Specific Tasks:

5.1. Basic Services. The contractor shall provide services for the contracted RN shall provide highly competent direct patient care to all Emergency Room, Inpatient and Outpatient clients.

5.2. Tasks: Nursing services contract to provide Emergency Room/Inpatient Registered Nurse.

5.3.1 The Contract RN will perform the following assessment in these areas.

5.3.2 Assess patient care need on the unit and adjusts staff assignments appropriately, collaborates with the Nursing

Supervisor as necessary.

5.3.3 Assess the delivery of nursing care on assigned unit and identifies problems and opportunities for improvement.

5.3.4 Assess the biophysical, psychosocial, emotional, spiritual needs of the patient on the unit as outlined in the Unit

Nursing Standard.

5.4.1 The Contract RN will implement nursing interventions in accordance with patient care standards

5.4.2 Provides direct patient care, evaluated outcomes, consults with other specialists as required and adjust nursing care processes as indicated to ensure optimal patient care.

5.4.3 Participates in implementing planned changes and activities to improve nursing service in collaboration with nursing administration.

5.4.4 Consults with primary care providers and other health care professionals on patients coordinate diagnostic and therapeutic regimens for patients.

5.4.5 Promotes harmonious relationships and favorable attitudes among the health care team.

5.4.6 Supports and adheres to administrative and nursing service policies and procedures for employees.

5.4.7 Assist with orientation of new employees, instructs personnel on specific tasks and job techniques.

5.4.8 Participates and contributes to hospital performance improvement activities

5.4.9 Initiates treatments, medication, emergency and resuscitative measures based on appropriate utilization of standing orders and unit protocols. Manages self, patients, and other employees during any emergency situation.

5.4.10 Administers therapeutic measures as prescribed by the physician, such as medications, treatments, procedures, intravenous fluids and blood transfusion adhering to current scientific knowledge including principles of safety and infection control.

5.4.11 Provides patient and family education, which include counseling and assisting the patients’ family to understand and accept the implication of care, diagnosis, and treatment.

5.4.12 Operates specialized equipment such as resuscitative equipment, cardiac monitors, defibrillator, pulse oximeters, infusion pumps, hypothermic blanket, central venous lines, accucheck machine, etc.

5.4.13 Maintains equipment checklist per unit protocol.

5.4.14 Accurately assigns triage categories.

5.4.15 Assists with the maintenance of supplies and equipment in the emergency and inpatient departments.

5.4.16 Assist in cost containment through the appropriate ordering and conserving of supplies and equipment.

5.4.17 Ensures an adequate stock of supplied and the proper functioning of equipment.

5.4.18 Obtains knowledge in the operation of equipment on the assigned unit.

5.4.19 Maintains professional knowledge and proficiency through continuing education/training and staff meetings.

5.4.20 Responds promptly to changes in the workload, adjusting assignments as necessary to achieve optimal productivity and efficiency.

5.4.21 Demonstrates the ability to assist physicians with procedures in the ED/Inpatient/Outpatient.

5.4.22 Maintains professional license current.

5.4.23 Documents observations, nursing interventions, therapeutic measures administered and patient response to treatment or nursing care according to medical, surgical, pediatric, geriatric, obstetric, and neonatal care standards.

5.4.24 Adheres to established time, attendance, and transfer policy. Remains accessible and available at all times when on duty and when on call.

5.4.25 Assist the Director of Nursing in the development, implementation, and evaluation or performance improvement indicators to improve outcomes and the work environment.

5.4.26 Operates computer systems required in the emergency department such as admit and discharge patients from RPMS/ERS; enters data into the electronic health record.

5.4.27 Performs other related nursing duties as assigned.

5.4.28 The contract RN shall:

a. Participate in a continual process of quality of health care evaluation to assure the provision of quality service.

b. Strive for excellence in providing emergency medical services.

c. Comply with all I.H.S. facility infection control and safety procedures, practices, and standards.

d. Meet all applicable Centers for Medicare and Medicaid Services (CMS) standards during the performance of this contract.

e. Respect and maintain the basic right of patients, to include but not be limited to personal dignity.

f. The contract RN shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with Indian Health Service regulations. The contract nurse shall prepare all medical records documentation to meet or exceed the established standards of the I.H.S. facility to include, but not be limited to:

timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

PART 6

APPLICABLE PUBLICATIONS

6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS)

6.1. The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures of the Cass Lake Indian Health Service, CMS, HIPPA, OSHA and any other State, Federal regulatory requirements.

PART 7

ATTACHMENT/TECHNICAL EXHIBIT LISTING

7 Attachment/Technical Exhibit List:

7.1 Attachment 1/Technical Exhibit 1 – Performance Requirements Summary

7.2 Attachment 2/Technical Exhibit 2 – Deliverables Schedule

7.3 Attachment 3/Technical Exhibit 3 – Estimated Workload Data

PART 8

PRIVACY ACT NOTIFICATION

8 Privacy Act 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/task orders issued under this contract. IHS will use the information for financial, legal, research, and health care purposes.

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.

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.); and billing third parties 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 Ordering Official.

TECHNICAL EXHIBIT 1

Performance Requirements Summary The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Performance Objective (The Service required—usually a shall statement)

Standard Performance Threshold (This is the maximum error rate. It could possibly be “Zero deviation from standard”)

Method of Surveillance

PRS # 1

The contract provider shall provide all performance objects as outlined in PWS paragraph 5.1

Patient Care outcomes No deviations from Standard of Care per report.

Daily review, Periodic Surveillance/ Peer Review by Nursing Services

PRS # 2

The contract provider shall provide all performance objects as outlined in PWS paragraph 5.4(n), (f).

HIM documentation standards, Nursing Services QAPI requirements

No…