RFQ-19-Q-0044.pdf

Statement of Work Diabetes Program Shoes, Inserts and Compression Stockings

May9,2019

I. Statement of Work

2.

The statement of work describes the requirement for the provision of diabetic foot evaluations for diabetic shoes OTC or custom and inserts, custom or heat molded and compression stockings for the Wewoka Indian Health Center. Services shall include:

A Diabetic shoes, inserts, and compression stockings

i. Provide diabetic foot evaluations and diabetic shoes and/or inserts for patients referred for these services.

ii. Provide an onsite evaluation and fitting for diabetes program participants to insure proper fit and function.

iii. Deliver the shoes to check with each participant for proper fit and function.

iv. Services shall be fully coordinated and integrated with the direct patient care program with respect to services provided and professional relationships.

v. Accountability requires that all services be under professional direction, therefore, the Contractor shall be fully responsible for any subcontracts (if applicable), professionally, administratively, and financially.

B. Requirements for Diabetic Shoes, inserts and compression stockinis

• Diabetic Foot evaluations (measuring of feet, testing for protective sensation, palpating and checking for range of motion, foot deformities and gait evaluation)

• Extra Depth Diabetic Approved footwear ASS00 or equal

• Custom Molded Footwear ASSO I or equal

• Heat Molded Diabetic Inserts ASS 12 or equal

• Custom Fabricated Diabetic Inserts ASS 13 or equal

• Custom Fabricated Toe Fillers LS000 or equal

• Onsite (in-person) fitting and dispensing of footwear and inserts, checking for proper fit and function

• Adjustments and modifications of shoes and/or inserts if necessary

• Compression stockings 15-20mmHg Knee high and Thigh high may be dispensed for those patients with edema, vascular history or other medical need after Pedorthic assessment.

• 20-30mmHg Knee high and Thigh high if ordered by provider.

• After wearing the shoes at home or at the gym (without wearing outside), the contactor shall replace if the shoe does not fit well or is causing pain within 15 days. The contactor shall replace with a more appropriate fitting shoe.

Professional Qualifications Contractor shall be a Certified Pedorthist and have experience working with patients with complicated disease processes and complications of diabetes.

3. Government Furnished Information, Property and Services Written referrals for services shall be provided to the contractor by fax. Clinic space shall be provided twice per month for fitting and delivery of shoes, inserts and compression stockings. The Government shall contact all patients regarding the appointment times.

4. Contractor Furnished Information, Property and Service The Contractor shall provide patient evaluations, measurings, fittings, shoes and/or inserts, and adjustments or modifications as needed. Compression stockings shall be measured for each individual patient and fitted according to prescription strength compression. The patient shall be able to wear the shoes indoors and if they do not fit, return them for a different size, width, or style.

5. Work Schedule The contactor shall provide two monthly onsite visits to evaluate the patient's feet, to check for fitting and shoe delivery. This shall be during regular clinic hours.

6. Rates of Payment Payments on Diabetic shoes and inserts shall not exceed Medicare Rates for the services provided. Payments on the compression stocking shall not exceed reasonable retail cost for knee high and thigh high stockings.

If the contractor's price changes as a result of notification from CMS or cost to charge ratio, they must provide a letter from CMS to Wewoka Indian Health Center within 30 days of receipt along with a corrected price list in order to be paid at the new rate.

7. Reporting Requirements

a. The contractor shall provide services for patients referred within 30 days of receipt of the written referral.

b. The contractor shall provide special reports requested by the Contracting

Officer during the contract on technical or administrative aspects of the contract performance. Request for such reports shall be provided in writing to the Contractor stipulating information required, time frames for responses and instructions on submission.

c. The contractor shall provide a Monthly Report of Services, a narrative report with comparison of actual services provided according to requirements established and the quantity of shoes, inserts, and compression stockings provided as well as the number of problems encountered and circumstances, if any, adversely affecting the delivery of services and recommendations.

8. Performance Period June 16, 2019 - June 15, 2020

9. Indemnity and Insurance:

The Government assumes no responsibility for negligent acts of the Contractor;

therefore, the Contractor is responsible for obtaining that amount of professional liability insurance coverage of at least $1,000,000 per occurrence/$3,000,000 aggregate. The Contractor shall keep harmless and indemnify the Government against any or all loss, cost, damage, expense or liability whatsoever as a result from the performance of the Contractor.

Contractor shall hold the Federal Government and its agents including Clinical Director and the governing body immune from civil or professional liability for all acts related to quality care management and enforcement of this contract.

I 0. Reference Materials/Other Factors:

Contractor shall be required to possess familiarity and abide by the current policies, by�laws and regulations of clinical and medical staff of the Wewoka Indian Health Center.

Statement of Work• Diabetes Program Shoes, Inserts, and Compression Stockings

Supervisor/Project Officer Date

CEO Date

52.213-4 Terms and Conditions—Simplified Acquisitions (Other Than Commercial Items). (JAN 2019)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses that are incorporated by reference:

(1) The clauses listed below implement provisions of law or Executive order:

(i) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements

(Jan 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations

Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)).

(ii) 52.204-23, Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by

Kaspersky Lab and Other Covered Entities (Jul 2018) (Section 1634 of Pub. L. 115-91).

(iii) 52.222-3, Convict Labor (Jun 2003) (E.O.11755).

(iv) 52.222-21, Prohibition of Segregated Facilities (Apr 2015).

(v) 52.222-26, Equal Opportunity (Sept 2016) (E.O.11246).

(vi) 52.225-13, Restrictions on Certain Foreign Purchases (Jun 2008) (E.O.s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury).

(vii) 52.233-3, Protest After Award (Aug 1996) (31 U.S.C.3553).

(viii) 52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Pub.L.108-77, 108-78 (19 U.S.C.

3805 note)).

(2) Listed below are additional clauses that apply:

(i) 52.232-1, Payments (Apr 1984).

(ii) 52.232-8, Discounts for Prompt Payment (Feb 2002).

(iii) 52.232-11, Extras (Apr 1984).

(iv) 52.232-25, Prompt Payment (Jan 2017).

(v) 52.232-39, Unenforceability of Unauthorized Obligations (Jun 2013).

(vi) 52.232-40, Providing Accelerated Payments to Small Business Subcontractors (Dec2013)

(vii) 52.233-1, Disputes (May2014).

(viii) 52.244-6, Subcontracts for Commercial Items (Jan 2019).

(ix) 52.253-1, Computer Generated Forms (Jan 1991).

(b) The Contractor shall comply with the following FAR clauses, incorporated by reference, unless the circumstances do not apply:

(1) The clauses listed below implement provisions of law or Executive order:

(i) 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (Oct 2018)(Pub. L.

109-282) (31 U.S.C. 6101 note) (Applies to contracts valued at $30,000 or more).

(ii) 52.222-19, Child Labor-Cooperation with Authorities and Remedies (Jan2018) (E.O.13126) (Applies to contracts for supplies exceeding the micro-purchase threshold.)

(iii) 52.222-20, Contracts for Materials, Supplies, Articles, and Equipment Exceeding $15,000 (May 2014) (41

U.S.C.chapter 65) (Applies to supply contracts over $15,000 in the United States, Puerto Rico, or the U.S.

Virgin Islands).

(iv) 52.222-35, Equal Opportunity for Veterans (Oct2015) (38 U.S.C.4212) (applies to contracts of $150,000 or more).

https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_203-19 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#id189A70O0P1N https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1055332 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1055713 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1055793 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1054249 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1048661 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1048698 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1049385 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1049559 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1049598 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1050125 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1050840 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1050853 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1048610 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1048410 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1045361 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1064087 http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section6101&num=0&edition=prelim https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1055664 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1055699 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1056230 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3

(v) 52.222-36, Equal Employment for Workers with Disabilities (Jul 2014) (29 U.S.C.793) (Applies to contracts over $15,000, unless the work is to be performed outside the United States by employees recruited outside the United States.) (For purposes of this clause, “United States” includes the 50 States, the

District of Columbia, Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin

Islands, and Wake Island.)

(vi) 52.222-37, Employment Reports on Veterans (Feb 2016) (38 U.S.C.4212) (Applies to contracts of

$150,000 or more).

(vii) 52.222-41, Service Contract Labor Standards (Aug 2018) (41 U.S.C.chapter 67) (Applies to service contracts over $2,500 that are subject to the Service Contract Labor Standards statute and will be performed in the United States, District of Columbia, Puerto Rico, the Northern Mariana Islands, American

Samoa, Guam, the U.S. Virgin Islands, Johnston Island, Wake Island, or the outer Continental Shelf).

(viii) (A) 52.222-50, Combating Trafficking in Persons (Jan 2019) (22 U.S.C. chapter 78 and E.O 13627)

(Applies to all solicitations and contracts).

(B) Alternate I (Mar 2015) (Applies if the Contracting Officer has filled in the following information with regard to applicable directives or notices: Document title(s), source for obtaining document(s), and contract performance location outside the United States to which the document applies).

(ix) 52.222-55, Minimum Wages Under Executive Order 13658 (Dec 2015) (Applies when 52.222-

6 or 52.222-41 are in the contract and performance in whole or in part is in the United States (the 50 States and the District of Columbia)).

(x) 52.222-62, Paid Sick Leave Under Executive Order 13706 (Jan 2017) (E.O. 13706) (Applies when 52.222-

6 or 52.222-41 are in the contract and performance in whole or in part is in the United States (the 50 States and the District of Columbia.))

(xi) 52.223-5, Pollution Prevention and Right-to-Know Information (May2011) (E.O. 13423) (Applies to services performed on Federal facilities).

(xii) 52.223-11, Ozone-Depleting Substances and High Global Warming Potential Hydrofluorocarbons (Jun

2016) (E.O. 13693)(applies to contracts for products as prescribed at FAR 23.804(a)(1)).

(xiii) 52.223-12, Maintenance, Service, Repair, or Disposal of Refrigeration Equipment and Air Conditioners

(Jun2016) (E.O. 13693) (Applies to maintenance, service, repair, or disposal of refrigeration equipment and air conditioners).

(xiv) 52.223-15, Energy Efficiency in Energy-Consuming Products (Dec 2007) (42 U.S.C. 8259b) (Unless exempt pursuant to 23.204, applies to contracts when energy-consuming products listed in the ENERGY

STAR® Program or Federal Energy Management Program (FEMP)) will be-

(A) Delivered;

(B) Acquired by the Contractor for use in performing services at a Federally-controlled facility;

(C) Furnished by the Contractor for use by the Government; or

(D) Specified in the design of a building or work, or incorporated during its construction, renovation, or maintenance).

(xv) 52.223-20, Aerosols (Jun 2016) (E.O. 13693) (Applies to contracts for products that may contain high global warming potential hydrofluorocarbons as a propellant or as a solvent; or contracts for maintenance or repair of electronic or mechanical devices).

https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1056250 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1056265 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_222_41 http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title41-chapter67-front&num=0&edition=prelim https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1056535 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1056818 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_222_6 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_222_6 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_222_41 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_222_62 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_222_6 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_222_6 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i52_222_41 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053050 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053180 https://www.acquisition.gov/content/part-23-environment-energy-and-water-efficiency-renewable-energy-technologies-occupational#i1094309 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053196 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053246 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-23-environment-energy-and-water-efficiency-renewable-energy-technologies-occupational#i1094902

(xvi) 52.223-21, Foams (Jun 2016) (E.O. 13693) (Applies to contracts for products that may contain high global warming potential hydrofluorocarbons or refrigerant blends containing hydrofluorocarbons as a foam blowing agent; or contracts for construction of buildings or facilities.

(xvii) 52.225-1, Buy American-Supplies (May2014) (41 U.S.C.chapter 67) (Applies to contracts for supplies, and to contracts for services involving the furnishing of supplies, for use in the United States or its outlying areas, if the value of the supply contract or supply portion of a service contract exceeds the micro-purchase threshold and the acquisition-

(A) Is set aside for small business concerns; or

(B) Cannot be set aside for small business concerns (see 19.502-2), and does not exceed $25,000).

(xviii) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations (May 2014) (42 U.S.C. 1792)

(Applies to contracts greater than $25,000 that provide for the provision, the service, or the sale of food in the United States).

(xix) 52.232-33, Payment by Electronic Funds Transfer-System for Award Management (Oct 2013)(Applies when the payment will be made by electronic funds transfer (EFT) and the payment office uses the System for

Award Management (SAM) as its source of EFT information).

(xx) 52.232-34, Payment by Electronic Funds Transfer-Other than System for Award Management (Jul 2013)

(Applies when the payment will be made by EFT and the payment office does not use the SAM database as its source of EFT information).

(xxi) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46

U.S.C.App.1241) (Applies to supplies transported by ocean vessels (except for the types of subcontracts listed at 47.504(d)).

(2) Listed below are additional clauses that may apply:

(i) 52.204-21, Basic Safeguarding of Covered Contractor Information Systems (Jun 2016) (Applies to contracts when the contractor or a subcontractor at any tier may have Federal contract information residing in or transiting through its information system.

(ii) 52.209-6, Protecting the Government’s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment (Oct 2015) (Applies to contracts over $35,000).

(iii) 52.211-17, Delivery of Excess Quantities (Sept 1989) (Applies to fixed-price supplies).

(iv) 52.247-29, F.o.b. Origin (Feb 2006) (Applies to supplies if delivery is f.o.b. origin).

(v) 52.247-34, F.o.b. Destination (Nov 1991) (Applies to supplies if delivery is f.o.b. destination).

(c) FAR 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__

(d) Inspection/Acceptance. The Contractor shall tender for acceptance only those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. The Government must exercise its postacceptance rights-https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053372 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-19-small-business-programs#i1100762 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1055065 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1050674 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1050705 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1046560 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-47-transportation#i1069858 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#id1669B0A0E67 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1062590 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1063119 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1045849 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1046022 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1045305 https://www.acquisition.gov__/

(1) Within a reasonable period of time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(e) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence, such as acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(f) Termination for the Government's convenience. The Government reserves the right to terminate this contract, or any part hereof, for its sole convenience. In the event of such termination, the Contractor shall immediately stop all work hereunder and shall immediately cause any and all of its suppliers and subcontractors to cease work.

Subject to the terms of this contract, the Contractor shall be paid a percentage of the contract price reflecting the percentage of the work performed prior to the notice of termination, plus reasonable charges that the Contractor can demonstrate to the satisfaction of the Government, using its standard record keeping system, have resulted from the termination. The Contractor shall not be required to comply with the cost accounting standards or contract cost principles for this purpose. This paragraph does not give the Government any right to audit the

Contractor’s records. The Contractor shall not be paid for any work performed or costs incurred that reasonably could have been avoided.

(g) Termination for cause. The Government may terminate this contract, or any part hereof, for cause in the event of any default by the Contractor, or if the Contractor fails to comply with any contract terms and conditions, or fails to provide the Government, upon request, with adequate assurances of future performance. In the event of termination for cause, the Government shall not be liable to the Contractor for any amount for supplies or services not accepted, and the Contractor shall be liable to the Government for any and all rights and remedies provided by law. If it is determined that the Government improperly terminated this contract for default, such termination shall be deemed a termination for convenience.

(h) Warranty. The Contractor warrants and implies that the items delivered hereunder are merchantable and fit for use for the particular purpose described in this contract.

(End of clause)