SOFTWARE_285-18-RFQ-0054.docx

285-18-RFQ-0054 SOFTWARE

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

1. Provide an electronic policy management solution which enables the creation, update and maintenance of official healthcare policies and procedures for all the healthcare facilities listed in SECTION C..

2. PRICE/COST SCHEDULE

SOFTWARE/250 users $________ $____________

INSTALLATION $________ $____________

TRAINING $________ $____________

MAINTANENCE/UPDATE $________ $____________

Grand Total: $__________ $_____________

SECTION C- DESCRIPTION/SPECS./SCOPE OF WORK STATMENT

1. The Nashville Area Indian Health Service (NAIHS) provides health care services to thi1ty-five Tribal nations in the States between Maine, Florida, and Texas with a volume of approximately 85,000 patient visits annually. The Nashville Area Indian Health Service operates eight (8) service units, inclusive of ambulatory health care centers, purchased and referred care only sites, and a Youth Residential Treatment facility (YRTC) on/or around reservations located primarily in remote geographic areas of Maine, Massachusetts, New York, Virginia, North Carolina, and South Carolina. The Nashville Area Office is located in Nashville, Tennessee.

Currently policy management processes within the Nashville Area Indian Health Service vary by facility, and includes a patchwork of paper documents and electronic management processes. Nashville Area Indian Health Service facilities are charged with assuring compliance with healthcare regulatory and accreditation requirements, as well as requirements unique to federal agencies and the Indian Health Service; however, sharing of policies and related documents amongst facilities is not easily supported by current systems and processes, often resulting in duplication of efforts in the respective facilities of the Nashville Area Indian Health Service.

The requirement is to implement an electronic healthcare Policy Management System for the various health facilities in the Nashville Area Indian Health Service to align policy management processes, to provide the capability to increase standardization of policies, where appropriate, across facilities within the Nashville Area, and to support facility compliance with regulatory and accreditation requirements . The services will be provided under the Statutory Authority as implemented by Public Law l 03-332; 10 USC.2304 and 41 USC .253, FAR 37 - Service Contracting and (for Medical Positions -FAR Part 37.4 -Non-persona l Health Care Services); HHSAR Part 337.

II. SCOPE

The overall scope of this requirement shall be performed according to the requirements and conditions contained in this Statement of Work. The primary purpose of this contract is to provide an electronic solution for the management of official policies and procedures for eight (8) healthcare facilities, inclusive of ambulatory health care centers, purchased and referred care only sites, and a Youth Residential Treatment facility (YRTC), and the Nashville Area Office facility within the Nashville Area Indian Health Service.

Approximately 250 users will be utilizing the policy management software.

III. OBJECTIVES AND GOALS.

The Contractor is to provide an electronic Policy Management solution, which enables the creation, update and maintenance of official healthcare policies and procedures throughout all of the included healthcare facilities. This service will provide organization and standardization of policies and documents for each facility as well as an automated approval and review process. The Contractor shall provide the Nashville Area health facilities with information to assist them in maintaining continuous compliance with their accreditation body and maintain compliance with Medicare requirements, including Conditions of Participation (CoP). The contract will assist each site in maintaining up-to-date Policy & Procedures and provide a mechanism to store, maintain and share the information with staff within their healthcare facility.

IV. TASKS

The Contractor shall provide an electronic Policy Management System which supports all aspects of the document life cycle and policy management in a healthcare setting. The electronic Policy Management Program shall enable the following:

· User-friendly interface to create, update, index, maintain, publish/distribute, and store policies in a standardized format, as established by each facility.

· Concurrent access by an unlimited number of users

· Capability for document search functions, such as keys word or phrase search

· Version preservation and archiving of policies

· Automated creation/revision, approval and review process which supports

· Creation of approval workflows by department or policy/document

· Collaborative authoring and editing functions

· Time-sensitive assignment of policies for task completion, such as review, revision, acknowledgement, approval, etc.

· Tracking and filtering of policies with regards to the following:

· Status of review/completion.

· Policies assigned to a specific supervisor, department, or program.

· Addition of new employees, editing employee accounts, enroll employees in courses.

· Oversight for managers through a dashboard that contains various reports (policies pending signature, number of days pending for signature, policies nearing expiration, staff assignment accountability, etc.).

· Access to reports for designated administrators and/or managers

· Access to a Policy & Procedure reference library which includes samples, templates and customizable forms from healthcare facilities of similar type and function

· The contractor must provide the Nashville Area health facilities with information , including notification of updates or changes, to assist them in maintaining continuous compliance with the requirements of their respective accreditation and regulatory bodies, including CMS Conditions of Participation (CoP), The Joint Commission (TJC), CMS, NIA HO, CDC, OSHA, HIPAA,

· NCQA, AAAHC, Det Norske Veritas and Germanischer Lloyd (DNV GL), DHHS, FDA and other applicable regulatory bodies.

· Initial uploading/importing and conversion of current policies and procedures in preferred format

· Unlimited training for staff, end users and administrators throughout the contract.

· The Contractor will assign the Nashville Area IHS an account representative who will serve as the primary point of contact for the contract

· The Contractor provide a consultant with extensive experience and a high degree of knowledge of the Joint Commission , DNV GL, and AAAHC accreditation standards and CMS Conditions of Participation (CoPs) applicable to hospitals and ambulatory care clinics

· OPTION: Pricing for onsite implementation and the availability of training module (or training provided) for employees to access to become familiar with website/software.

V. SECURITY

The Contractor will assure companion and system security in compliance with Indian Health Service security settings, requirements and parameters.

VI. PLACE OF PERFORMANCE

The contract will be performed in the following facilities of the Nashville Area Indian Health Service (see Appendix A for a list of further information on each main service unit):

· Catawba Service Unit (SC)

· Lockport Service Unit (NY)

· Mashpee Wampanoag Health Service Unit (MA)

· Micmac Service Unit (ME)

· Manlius Service Unit (NY)

· Richmond Service Unit (VA)

· Shinnecock Service Unit (NY)

· Unity Healing Center - Youth Regional Treatment Center (YRTC) (NC)

· Nashville Area Indian Health Service Area Office (TN)

VII. PERIOD OF PERFORMANCE

The period of performance will be for a Base Year (12 month period) and Four (4) Year 12-month option periods, which may be exercised at the IHS discretion and are subject to the Contractor's satisfactory performance of the Services under this contract.

Pre-Award Conference. The Contractor shall be afforded a reasonable preparation time in which the contractor will be allowed to set up, prepare, plan, organize and make ready any necessary training, groundwork and set up that may be needed in order to begin performing the required services. This time period does not extend the length of the contract by any means.

VIII. POINTS OF CONTACT

Government Point of Contact/COR: Donna S. Harjo / CAPT Max Boykin / CAPT Robin Bartlett

· Donna S. Harjo, Contracting Officer Nashville Area Indian Health Service 711 Stewarts Ferry Pike Nashville, TN 37214 Telephone: (615) 467-1522

· CAPT Max Boykin, RN, Area Nurse Consultant Nashville Area Indian Health Service 711 Stewarts Ferry Pike Nashville, TN 37214 Telephone: (615) 467-1628

· CAPT Robin Bartlett , PharmD, MSP, CPC, Area Clinical Applications Coordinator/Area Pharmacy Consultant Nashville Area Indian Health Service 711 Stewarts Ferry Pike Nashville, TN 37214 Telephone: (615) 467-1577

The Point of Contact/COR responsibilities will be to coordinate with the Contractor the technical aspects of this service, perform inspection and the review of performance hereunder. This individual does not have the authority to change or alter the order amount, terms, and conditions.

The Point of Contact/COR shall be responsible for the following:

1. Shall monitor the Contractor's technical progress, including the surveillance and assessment of performance and recommending to the Contracting Officer changes to the contract.

2. Shall perform technical evaluation as required

3. Shall perform technical (daily and final) inspection and acceptance as required by this contract

4. Shall assist the Contractor in the resolution of technical problems encountered during performance

5. Shall certify receipt and acceptance of service and submit a receiving report.

The Contracting Officer is the only person with authority to: (I) act as agent of the government under this Statement of Work; (2) modify or extend the period of performance; (3) change the delivery schedule; (4) authorize reimbursement to the contractor for any costs incurred during the performance of this contract; or (5) otherwise change any terms and conditions of this contract. The Government may unilaterally change this COR designation.

IX. Pricing Schedule The Government intends to award a Firm Fixed Price Contract.

SECTION D – PACKING AND MARKING

1. All information and deliverables shall be delivered to the Point of Contact (POC) and shall be marked as follows:

1. Name and business address of Contractor.

2. Order number

3. Description of item or service contained therein, and

4. Consignee’s name and address

SECTION E – INSPECTION AND ACCEPTANCE

The Point of Contact (POC) as duly authorized representative of the Contracting Officer shall assume the responsibilities for monitoring the Contractor’s performance and performing the final inspection and acceptance of all service/deliverables.

SECTION F – DELIVERIES OR PERFORMANCE

1. PERIOD OF SERVICE

The performance period shall be as follows:

October 1, 2018 (or date of award) – September 30, 2019 with 4 option years.

2. DELIVERY

Contractor shall deliver all items necessary to complete the installation of the software to the facilities list in Appendix A.

3. REPORTING REQUIREMENTS

Contractor shall provide a report of monthly progress.

SECTION G- CONTRACT ADMINISTRATION DATA

1. INDIAN HEALTH SERVICE INVOICE SUBMISSION INSTRUCTIONS

The Contractor shall submit invoice after services received. A complete invoice with all required back-up documentation shall be sent, electronically via e-mail or by regular postal mail to:

1. Contract Specialist* (CS): Donna S. Harjo, donna.harjo@ihs.gov Indian Health Service, Nashville Area, 711 Stewarts Ferry Pike, Nashville, TN 37214

2. Point of Contact (POC): Robin Bartlet, robin.bartlet@ihs.gov Indian Health Service, Nashville Area, 711 Stewarts Ferry Pike, Nashville, TN 37214

3. Accounting Tech., Hayley Fleek, Hayley.fleek@ihs.gov, Indian Health Service, Nashville Area, 711 Stewarts Ferry Pike, Nashville, TN 37214

* No other non-invoice related documents (i.e. deliverables, reports, balance statements) shall be sent to the CS or [enter billing office acronym]. Failure to submit directly to the offices listed above will delay prompt payment of your invoice.

For invoices submitted by email: the subject line of your email invoice submission shall contain the contractor name, contract/order number, and invoice number (e.g. Company Name, Contract HHSIXXXXX, Invoice #123). The Contractor shall send one email per contract/order after completion. The email may have multiple invoices for the contract. Invoices must be in one of the following formats: PDF, TIFF, or Word. No Excel formats will be accepted. The electronic file cannot contain multiple invoices; example, 10 invoices requires 10 separate files (PDF, TIFF, or Word).

Additionally, the Contractor is required to include its Data Universal Numbering System (DUNS) number on each invoice. For additional information about the Dun & Bradstreet (D&B) DUNS number, please visit http://fedgov.dnb.com/webform.

Invoices shall be submitted in accordance with the contract terms, i.e. payment schedule, progress payments, partial payments, deliverables, etc.

All information set forth in FAR Clause 52.212-4(g), Invoice, must be included in all invoices for it to constitute a proper invoice.

FAR 52.212-4(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, contract line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi)Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer—Central Contractor Registration, or 52.232-34, Payment by Electronic Funds Transfer—Other Than Central Contractor Registration), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR Part 1315.

In accordance with OMB Memorandum, M-11-32, Agencies shall make payments to small businesses as soon as practicable, with the goal of making payments within 15 days of receipt of a proper invoice. If a small business contractor is not paid within this (15 day) accelerated period, the contractor will not be given a late-payment interest penalty. Interest penalties, as prescribed by the Prompt Payment Act, remain unchanged by means of this memorandum. All small businesses shall label all invoices as “Small Business.”

Additionally, in accordance with OMB Memorandum, M-12-16, all prime contractors are encouraged to disburse funds received from the Federal Government to their small business subcontractors in a prompt manner. To assist prime contractors in expediting contractor payments to small business subcontractors, Agencies shall, to the full extent permitted by law, temporarily establish an earlier, accelerated date for making agency payments to all prime contractors. Consistent with OMB Memorandum M-11-32 above, Agencies shall have a goal of paying all prime contractors within 15 days of receiving proper documentation. In an effort to support small business growth, drive economic activity and job creation, the Contractor is encouraged to accelerate payments to their small business subcontractors.

In accordance with the requirements of the Debt Collection Improvement Act of 1996, all payments under this order will be made by electronic funds transfer (EFT). The Contractor shall provide financial institution information to the Finance Office designated above in accordance with FAR 52.232-33 Payment by Electronic Funds Transfer – Central Contractor Registration.

SECTION H – SPECIAL CONTRACT REQUIREMENTS

1. GOVERNMENT FURISHED PROPERTY

The Nashville Area Indian Health Service will provide adequate space for the contractor to perform any onsite training. The Nashville Area facilities will provide all policies in an electronic document format to the company prior to implementation.

SECTION I – CONTRACT CLAUSES

1. FEDERAL, STATE, AND LOCAL TAXES

Contractor understands that the government does not pay any IRS requirements (taxes), insurance or any other benefits for the contractor under this contract. This is in accordance with (FAR 52.229-3 FEDERAL, STATE, AND LOCAL TAXES (Feb 2013) and FAR 52.229-4 FEDERAL, STATE, AND LOCAL TAXES (NON-COMPETITIVE CONTRACT [Feb 2013]). Clauses may be assessed electronically at: www.acquisition.gov/far/

2. CLAUSES INCORPORATED BY FULL TEXT

Full text of the Federal Acquisition Regulation (FAR) and Health and Human Services Acquisition Regulations (HHSAR) can be accessed on the Internet at:

www.hhs.gov/policies/hhsar https://www.acquisition.gov/

ADDITIONAL CLAUSES INCORPORATED BY REFERENCE (FAR):

ADDITIONAL CLAUSES INCORPORATED BY REFERENCE:

Full text of the Federal Acquisition Regulation (FAR) and Health and Human Services Acquisition Regulations (HHSAR) can be accessed on the Internet at:

www.hhs.gov/policies/hhsar https://www.acquisition.gov/

SECTION J – LIST OF ATTACHMENTS AND EXHIBITD

1. Appendix A: Site Area Information

SECTION K – REPRESENTATION AND CERTIFICATIONS

1.52.212-3 Offeror Representations and Certifications—Commercial Items. (NOV 2017) The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) website located at https://www.sam.gov/portal. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (u) of this provision.

(a) Definitions. As used in this provision.

“Economically disadvantaged women-owned small business (EDWOSB) concern” means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

“Highest-level owner” means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

“Immediate owner” means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

“Inverted domestic corporation”, means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

“Manufactured end product” means any end product in product and service codes (PSCs) 1000-9999, except.

(1) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

“Place of manufacture” means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

“Predecessor” means an entity that is replaced by a successor and includes any predecessors of the predecessor.

“Restricted business operations” means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate.

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended.

“Sensitive technology”.

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically.

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

“Service-disabled veteran-owned small business concern”.

(1) Means a small business concern.

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).

“Small business concern” means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

“Small disadvantaged business concern”, consistent with 13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that.

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by.

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13.CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

“Subsidiary” means an entity in which more than 50 percent of the entity is owned.

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

“Veteran-owned small business concern” means a small business concern.

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more veterans.

“Successor” means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

“Women-owned business concern” means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

“Women-owned small business concern” means a small business concern.

(1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and

(2) Whose management and daily business operations are controlled by one or more women.

“Women-owned small business (WOSB) concern eligible under the WOSB Program” (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States.

(b)(1) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications posted on the SAM website.

(2) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through http://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications.Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ______________.

[Offeror to identify the applicable paragraphs at (c) through (t) of this provision that the offeror has completed for the purposes of this solicitation only, if any.

These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.

Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted electronically on SAM.]

(c) Offerors must complete the following representations when the resulting contract will be performed in the United States or its outlying areas. Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that it □ is, □ is not a small business concern.

(2) Veteran-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it □ is, □ is not a veteran-owned small business concern.

(3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it □ is, □ is not a service-disabled veteran-owned small business concern.

(4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, that it □ is, □ is not a small disadvantaged business concern as defined in 13 CFR 124.1002.

(5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it □ is, □ is not a women-owned small business concern.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that.

(i) It □ is,□ is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It □ is, □ is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: __________.] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

(7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that.

(i) It □ is, □ is not an EDWOSB concern, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It □ is, □ is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: __________.] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.

Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

(8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it □ is a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price:____________________________________

(10) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that.

(i) It □ is, □ is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR Part 126; and

(ii) It □ is, □ is not a HUBZone joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (c)(10)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture. [The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture: __________.] Each HUBZone small business concern participating in the HUBZone joint venture shall submit a separate signed copy of the HUBZone representation.

(d) Representations required to implement provisions of Executive Order 11246.

(1) Previous contracts and compliance. The offeror represents that.

(i) It □ has, □ has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; and

(ii) It □ has, □ has not filed all required compliance reports.

(2) Affirmative Action Compliance. The offeror represents that.

(i) It □ has developed and has on file, □ has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor (41 cfr parts 60-1 and 60-2), or

(ii) It □ has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

(e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 1352). (Applies only if the contract is expected to exceed $150,000.) By submission of its offer, the offeror certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress on his or her behalf in connection with the award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made.

(f) Buy American Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy American.Supplies, is included in this solicitation.)

(1) The offeror certifies that each end product, except those listed in paragraph (f)(2) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.” The terms “commercially available off-the-shelf (COTS) item” “component,” “domestic end product,” “end product,” “foreign end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American.Supplies.”

(2) Foreign End Products:

[List as necessary]

(3) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25.

(g)(1) Buy American.Free Trade Agreements.Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy American.Free Trade Agreements.Israeli Trade Act, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms “Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product,” “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” “Free Trade Agreement country,” “Free Trade Agreement country end product,” “Israeli end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American.Free Trade Agreements–Israeli Trade Act.”

(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American.Free Trade Agreements.Israeli Trade Act”:

Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

(iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(1)(ii) of this provision) as defined in the clause of this solicitation entitled “Buy American.Free Trade Agreements.Israeli Trade Act.” The offeror shall list as other foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.”

Other Foreign End Products:

(iv) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25.

(2) Buy American.Free Trade Agreements.Israeli Trade Act Certificate, Alternate I. If Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled “Buy American.Free Trade Agreements.Israeli Trade Act”:

Canadian End Products:

Line Item No.

(3) Buy American.Free Trade Agreements.Israeli Trade Act Certificate, Alternate II. If Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled “Buy American.Free Trade Agreements.Israeli Trade Act”:

Canadian or Israeli End Products:

(4) Buy American.Free Trade Agreements.Israeli Trade Act Certificate, Alternate III. If Alternate III to the clause at 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American-Free Trade Agreements-Israeli Trade Act”:

Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

(5) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) of this provision, is a U.S.-made or designated country end product, as defined in the clause of this solicitation entitled “Trade Agreements.”

(ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country end products.

Other End Products:

(iii) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American statute. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fulfill the requirements of the solicitation.

(h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals.

(1) □ Are, □ are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(2) □ Have, □ have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property;

(3) □ Are, □ are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and

(4) □ Have, □ have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

(i) Taxes are considered delinquent if both of the following criteria apply:

(A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

(ii) Examples.

(A) The taxpayer has received a statutory notice of deficiency, under I.R.C. §6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. §6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(C) The taxpayer has entered into an installment agreement pursuant to I.R.C. §6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment.

(D) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. §362 (the Bankruptcy Code).

(i) Certification Regarding Knowledge of Child Labor for Listed End Products (Executive Order 13126). [The Contracting Officer must list in paragraph (i)(1) any end products being acquired under this solicitation that are included in the List of Products Requiring Contractor Certification as to Forced or Indentured Child Labor, unless excluded at .]

(1) Listed end products.

(2) Certification. [If the Contracting Officer has identified end products and countries of origin in paragraph (i)(1) of this provision, then the offeror must certify to either (i)(2)(i) or (i)(2)(ii) by checking the appropriate block.]

□ (i) The offeror will not supply any end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product.

□ (ii) The offeror may supply an end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. The offeror certifies that it has made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or manufacture any such end product furnished under this contract. On the basis of those efforts, the offeror certifies that it is not aware of any such use of child labor.

(j) Place of manufacture. (Does not apply unless the solicitation is predominantly for the acquisition of manufactured end products.) For statistical purposes only, the offeror shall indicate whether the place of manufacture of the end products it expects to provide in response to this solicitation is predominantly.

(1) □ In the United States (Check this box if the total anticipated price of offered end products manufactured in the United States exceeds the total anticipated price of offered end products manufactured outside the United States); or

(2) □ Outside the United States.

(k) Certificates regarding exemptions from the application of the Service Contract Labor Standards (Certification by the offeror as to its compliance with respect to the contract also constitutes its certification as to compliance by its subcontractor if it subcontracts out the exempt services.) [The contracting officer is to check a box to indicate if paragraph (k)(1) or (k)(2) applies.]

□ (1) Maintenance, calibration, or repair of certain equipment as described in FAR 22.1003-4(c)(1). The offeror □ does □ does not certify that.

(i) The items of equipment to be serviced under this contract are used regularly for other than Governmental purposes and are sold or traded by the offeror (or subcontractor in the case of an exempt subcontract) in substantial quantities to the general public in the course…