2C RLP 36C10F23R0074 Appendix A_2 Lease Design Narrative LDN Clarksville TN OPC - 8-10-2023.pdf

November 29, 2022

VA Leased CBOC Design Narrative

LEASED CBOC DESIGN NARRATIVE

TABLE OF CONTENTS

VA Leased CBOC Design Narrative November 29th, 2022

Table of Contents - Page 1

1. INTRODUCTION

2. GENERAL REQUIREMENTS

2.1 General

2.2 Codes

2.3 Standards

2.4 References

3. PLANNING AND DESIGN CRITERIA

3.1 Background

3.2 PACT Guiding Principles

3.3 Community Based Outpatient Clinics (CBOC) Planning Approach

3.4 Room Data Matrix

3.5 Surgical Design Criteria

4. TECHNICAL NARRATIVE

4.1 Site/Civil

4.1.1 Pedestrian and Vehicle Access & Circulation

4.1.2 Parking

4.1.3 Site Grading

4.2 Architecture

4.2.1 General Criteria

4.2.2 Accommodations for Care of Patients of Size

4.2.3 Acoustics

4.2.4 Equipment/Accessories/Furnishings

4.2.5 Signage and Wayfinding

4.2.6 Critical Dimensions

4.2.7 Entry Canopies

4.2.8 Elevators

4.2.9 Slab Depressions and Thickened Slabs

4.2.10 Millwork

4.2.11 Joint Sealant Systems

4.2.12 Doors and Frames

4.2.13 Hardware

4.2.14 Pharmacy Dispensing Windows

4.2.15 Radiation Shielding

4.2.16 Radio Frequency Shielding and Magnetic Shielding

4.3 Interior Design

4.3.1 General Criteria

4.3.2 Acoustic Ceiling Tile

4.3.3 Concrete Floor Treatment

4.3.4 Fiberglass-Reinforced Panels

4.3.5 Painting

4.3.6 Wall Protection

4.3.7 Window Shades

LEASED CBOC DESIGN NARRATIVE

TABLE OF CONTENTS

VA Leased CBOC Design Narrative November 29th, 2022

Table of Contents - Page 2

4.3.8 Privacy Curtains / Screens

4.3.9 Flooring, Carpet

4.4 Mechanical

4.4.1 References

4.4.2 HVAC Design Basis

4.4.3 Air Handling Units (AHUs)

4.4.4 Exhaust Systems

4.4.5 Cooling System

4.4.6 Hot Water Heating System

4.4.7 Humidification System

4.4.8 HVAC Piping Systems

4.4.9 Air Distribution and Duct Systems

4.4.10 HVAC Insulation Systems

4.4.11 Testing, Adjusting and Balancing

4.4.12 Automatic Temperature Control Systems

4.4.13 Special Conditions

4.5 Plumbing

4.5.1 References

4.5.2 Plumbing Design Basis

4.5.3 Materials

4.5.4 Medical Gases

4.5.5 Special Conditions

4.6 Electrical

4.6.1 Standby Generator

4.7 Lighting

4.7.1 General

4.7.2 Indoor Lighting Specifics

4.7.3 Lighting Controls

4.7.4 LED Drivers

4.7.5 Special Conditions

4.8 Telecommunications

4.8.1 Scope of Work

4.8.2 Pathways

4.8.3 Spaces

4.8.4 Telecommunications Bonding and Grounding

4.8.5 Equipment Racks and Equipment Cabinets

4.8.6 Power Distribution Units and Uninterruptable Power Supplies

4.8.7 Telecommunications Infrastructure Plant

4.8.8 Special Systems

5. Hardware Groups and Modifiers

SECTION 1

INTRODUCTION

Section 1 - Page 1

SECTION 1 - INTRODUCTION

1.1 The purpose of this Leased CBOC Design Narrative is to consolidate the governing codes, standards, references, and guidelines in a document that provides performance-based standards for a VA leased CBOC.

1.2 The governing codes, standards, and references are based on a VA affiliated outpatient clinic.

1.3 The design of the VA leased CBOC is based on the Prototype for Standardized Design and

Construction of Community Based Outpatient Clinics which is described in Part 3 Planning and Design Criteria.

1.4 Commonly Used Acronyms and Definitions:

PCMH Patient Centered Medical Home

A team based, comprehensive, coordinated patient care model (refer to PACT) PACT Patient Aligned Care Team

Provides service to veterans that is patient-centered with the right care at the right time by the right person. A typical “teamlet” serving a veteran consists of four caregivers: A Primary Care Provider – physician (MD), physician assistant (PA) or nurse practitioner (NP); a Registered Nurse (RN); a clinical staff assistant (LPN or Medical Assistant) and an administrative staff member (Clerk).

CBOC Community Based Outpatient Clinic Is VA-operated, VA-funded, or VA-reimbursed site of care which is located separate from a VA Medical Facility. A CBOC can provide primary, specialty, subspeciality, mental health, or any combination of healthcare delivery services that can be appropriately provided in an outpatient setting.

PFD Program for Design Net square feet (NSF) listing of all spaces and rooms that are to be included in a construction project.

VA Veterans Affairs VHA Veterans Health Administration VISN Veterans Integrated Services Network

SECTION 2

GENERAL REQUIREMENTS

VA Leased CBOC Design Narrative

Section 2 - Page 2

SECTION 2 – GENERAL REQUIREMENTS

2.1 General

2.1.1 The codes, standards, and references listed below indicate minimum performance requirements. Based on input from Owner representatives and recommendations from the architectural/engineering firm, minimum requirements or standards may be exceeded by site specific project design.

2.1.2 Compliance is required with applicable codes and standards throughout the process of design, construction, acceptance, and on-going maintenance of the facility.

2.1.3 Design and construction of the CBOC shall be in compliance with the requirements of the GSA Form L100 Global Lease and the codes, standards, and references listed below. This Leased CBOC Design Narrative covers construction materials and standards not fully addressed by the codes, standards, and references below.

2.1.4 Use the most current edition at the date and time of bid submission

Additional General Requirements:

• The lessor shall provide one (1) office space not less than 120 SF for the sole use of the VA and its delegate, when present. The office space shall be within three (3) miles of the jobsite and may be within the prime contractor’s trailer. Offsite locations must be approved by the Senior Resident Engineer (SRE) considering safety and security. The off ice space shall have condit ioned air and electricity for proper lighting and receptacles in accordance with typical off ice area standards. Access to high-speed wireless internet shall be provided. The space shall be near a restroom, break room, copy room, and conference room in which the RE is able to use as needed. The break room shall contain a shared microwave, refr igerator, and coffee pot. The conference room shall be able to seat a minimum of 10 people. The off ice space shall contain the following items:

• One (1) Office desk, double pedestal, executive size

• One (1) Swivel chair with arms

• Two (2) Armchairs

• One (1) 5-drawer f i le cabinet, letter size

• Two (2) Drawing rack, with 12-30 inch “Plan Hold” drawing holders, freestanding

• Two (2) Apple I PAD Pro 12” Tablets, Wi-Fi + 4G service, 510 GB and Word app, with Signed/Numbered awarded SFO loaded. Loading of all drawings and specif ications when “completed” after acceptance of final drawings should be up-loaded / accomplished at that time frame.

• Photographic Documentation

• During the construction period through completion, a 3rd party shall provide photographic documentation of construction progress and at selected milestones (such as blocking in walls, stub-up connection points for equipment, security mesh in wall (if required), walls going to deck (where required)) including electronic indexing, navigation, storage and remote access to the documentation, as per these specif ications. The commercial

VA Leased CBOC Design Narrative photographer or the subcontractor used for this work shall meet the following qualifications:

• Demonstrable minimum experience of f ive (5) years in operation with at least 500 projects documented to date providing documentation and advanced indexing/navigation systems including a representative portfolio of construction projects of similar type, size, duration and complexity as the Project.

• Demonstrable abil ity to service projects throughout North America with operational resources within 150 miles of project, which shall be demonstrated by a representative portfolio of active projects of similar type, size, duration and complexity as the Project.

• Photographic Specifications.

• Each digital image shall be taken with a professional grade camera with minimum size of 6 megapixels (MP) capable of producing 200x250mm (8 x 10 inch) prints with a minimum of 2272 x 1704 pixels and 400x500mm (16 x 20 inch) prints with a minimum 2592 x 1944 pixels.

• Indexing and navigation system shall util ize actual AUTOCAD construction drawings, making such drawings interactive on an on-line interface. For all documentation referenced herein, indexing and navigation must be organized by both time (date-stamped) and location throughout the project.

• Documentation shall combine indexing and navigation system with inspection-grade digital photography designed to capture actual condit ions throughout construction and at crit ical milestones. Documentation shall be accessible on-line through use of an internet connection. Documentation shall allow for secure multiple-user access, simultaneously, on-line.

• Construction progress for all trades shall be tracked at pre-determined intervals, but not less than once every thirty (30) calendar days throughout the project upon commencement of vertical construction (“Progressions”).

Progression documentation shall track both the exterior and interior construction of the building. Exterior Progressions shall track 360 degrees around the site and each building. Interior Progressions shall track interior improvements beginning when stud work commences and continuing until Project completion.

• Miscellaneous events that occur during any Contractor site visit, or events captured by the Department of Veterans Affairs independently, shall be dated, labeled and inserted into a Section in the navigation structure entit led “Slideshows,” allowing this information to be stored in the same “place” as the formal scope.

• Customizable project-specif ic digital photographic documentation of other details or milestones. Indexing and navigation accomplished through interactive architectural plans.

• Monthly exterior progressions (360 degrees around the project) and slideshows (all elevations and building envelope). The slideshows allow for the inclusion of Department of Veterans Affairs pictures, aerial photographs, and timely images which do not f it into any regular monthly photo-path.

• Regular (5 max) interior progressions of all walls of the entire project to

VA Leased CBOC Design Narrative begin at t ime of substantial framed or as directed by the Resident Engineer through to completion.

• Images shall be taken by a commercial photographer and must show distinctly, at as large a scale as possible, all parts of work embraced in the picture.

• Coordination of photo shoots is accomplished through Resident Engineer or other designated on-site point of contact. Contractor shall also attend construction team meetings as necessary. Contractor’s operations team shall provide regular updates regarding the status of the documentation, including photo shoots concluded, the availabil ity of new Progressions or Exact-Builts viewable on-line and anticipated future shoot date.

• Contractor shall provide all on-line domain/web hosting, security measures, and redundant server back-up of the documentation.

• Contractor shall provide technical support related to using the system or service.

• Upon completion of the project, final copies of the documentation (the “Permanent Record”) with the indexing and navigation system embedded (and active) shall be provided in an electronic media format, typically a DVD or external hard-drive. Permanent Record shall have Building Information Modeling (BIM) interface capabil it ies.

• VA requires one 30-yard dumpster in addition to the facil ity dumpsters for the use of all VA and VA contractors during the Activation Period. Activation period shall begin upon space acceptance for a duration of four (4) months.

Maximum of 10 Disposals expected.

2.2 Codes

2.2.1 All VA leased CBOC facilities are to conform to the most recent applicable codes, which include but is not limited to following:

2.2.1.1 National Fire Protection Association (NFPA) 70 National Electric Code, NFPA 75 Standard for the Fire Protection of Information Technology (applicable when CBOC contains a Data Center), NFPA 99 Health Care Facilities Code and all standards referenced therein, NFPA 101 Life Safety Code, NFPA 110 Standard for Emergency and Standby Power Systems, current editions.

2.2.1.2 Architectural Barriers Act Accessibility Standards (ABAAS), current edition.

2.2.1.3 International Building Codes (IBC): 2018 or latest edition (within 2 years of release). The latest edition shall be used for structural and seismic design.

2.2.1.3.1 International Building Code

2.2.1.3.2 International Energy Code

2.2.1.3.3 International Mechanical Code

2.2.1.3.4 International Plumbing Code

2.2.1.4 State and local codes as required by the local Authority Having Jurisdiction

(AHJ).

Additional Code information:

• For the Lessor to properly determine occupancy type, VA intends to simultaneously treat ZERO patients at any given time who are incapable of self-preservation.

• Lessor wil l maintain uti l it ies and equipment as prescribed by local codes

VA Leased CBOC Design Narrative and references listed in Appendix D. Lessor wil l provide records of the maintenance in the format and frequency required by the VAMC to ensure compliance with TJC.

2.3 Standards

2.3.1 All leased CBOC facilities are to conform to the following standards:

2.3.1.1 FGI Guidelines for the Design and Construction of Outpatient Facilities, current edition (referred to as FGI Guidelines herein).

2.3.1.2 The Joint Commission (TJC) accreditation standards apply to the facility under the affiliated VA medical center license. Building construction and on-going maintenance procedures shall meet TJC standards. Lessor shall provide and submit all documentation that is required for TJC requirements.

2.3.1.3 Facility Security Level (FSL) shall be as outlined in GSA Form L100 Global Lease.

2.3.1.4 Sustainability standards shall be as outlined in GSA Form L100 Global Lease.

2.3.1.5 American Society of Heating, Refrigerating and Air-Conditioning Engineers

(ASHRAE) Standard 170, Ventilation of Health Care Facilities, current edition (referred to as ASHRAE 170 herein)

2.3.1.6 ASHRAE Standard 12, Minimizing the Risk of Legionellosis Associated with Building Water Systems, current edition.

2.3.1.7 ASHRAE Standard 188, Legionellosis: Risk Management for Building Water Systems, current edition.

2.3.1.8 ASHRAE Standard 62.1, Ventilation for Acceptable Indoor Air Quality, current edition (referred to as ASHRAE 62.1 herein)

2.3.1.9 ANSI/ASHRAE/IES Standard 90.1-2019 -- Energy Standard for Buildings Except Low-Rise Residential Buildings

2.3.1.10 Sheet Metal and Air Conditioning Contractors National Association (SMACNA) Standard, HVAC Duct Construction Standards - Metal and Flexible.

2.3.1.11 USP General Chapter 795 Pharmaceutical Compounding – Nonsterile Preparations

2.3.1.12 USP General Chapter 797 Pharmaceutical Compounding – Sterile Preparations

2.3.1.13 USP General Chapter 800 Hazardous Drugs - Handling in Healthcare Settings

2.3.1.14 Association for the Advancement of Medical Instruments (AAMI) standards as applicable to SPS and RME storage

2.3.1.15 Illuminating Engineering Society North America (IESNA) Handbook - latest edition

2.3.1.16 VA Signage Design Manual PG 18-12

2.3.1.17 H 18-8 Seismic Design Handbook is required when the clinic includes

Ambulatory Surgery

2.4 References

2.4.1 The following guides, manuals, and other references developed by VA are for reference only, however, they are applicable to VA leased CBOCs:

2.4.1.1 VA Enterprise Facility IT Support Infrastructure Standard, most current.

2.4.1.2 Prototype for Standardized Design and Construction of Community Based

Outpatient Clinicshttps://www.cfm.va.gov/til/prototypes.asp#CBOC

2.4.1.3 PACT Space Module Design Guide

https://www.cfm.va.gov/til/prototypes.asp#CBOC

VA Leased CBOC Design Narrative https://www.cfm.va.gov/til/dGuide/dgPACT.pdf

2.4.1.4 Room Templates, Leased Community Based Outpatient Clinics https://www.cfm.va.gov/til/rTemplate/LeasingCBOCw.asp

2.4.1.5 VA Design Guides (PG18-12)

https://www.cfm.va.gov/til/dGuide/dgPACT.pdf https://www.cfm.va.gov/til/rTemplate/LeasingCBOCw.asp

SECTION 3

PLANNING AND DESIGN CRITERIA

SECTION 3 – PLANNING AND DESIGN CRITERIA

3.1. Background

3.1.1. VHA has committed to the development of a patient-centered medical home model for enhanced outpatient primary care services to veterans. The result was a patient care delivery model and a set of planning and design standards.

3.2. PACT Guiding Principles

3.2.1. An operational and planning design guide was developed which identified key principles and objectives. Refer to PACT Space Module Design Guide under References Section 2.4.

3.3. Community Based Outpatient Clinics (CBOC) Planning Approach

3.3.1. The development of the PACT Planning Module was complimented by the development of a Prototype for Standardized Design and Construction of Community Based Outpatient Clinics. Using the PACT Module as the building block, prototypes were developed for three types and sizes of outpatient facilities.

3.4. Room Data Matrix

3.4.1. A collection of typical rooms within leased CBOCs. It lists the required finishes, STC ratings, ceiling heights, door size and type, hardware sets, HVAC space ventilation, number of electrical receptacles, lighting controls and fixture types, and number of standard density work area outlets for each room type.

3.4.2. The Lessor shall associate rooms listed on the program for design with the room data matrix by room name. Use department level room names and types when available, otherwise use general room/space for like room function.

3.4.3. FGI Equivalent for ASHRAE 170 – Where HVAC space ventilation requirements are omitted, ASHRAE 170 Tables 8-1 and 8-2 shall be followed. Column “FGI Equivalent for ASHRAE 170” lists the equivalent room name for use in the tables.

3.4.4. FGI Equivalent for Table 1.2-5 “Minimum Sound Isolation” - Where Column “STC” in the Room Data Matrix states “See FGI”, Column “FGI Equivalent for Table 1.2-5 Minimum Sound Isolation” lists the equivalent room name for use in FGI Table 1.2-5.

3.4.5. Additional Requirements in this LDN take precedence over the standard in the RDM.

3.5. Surgical Design Criteria

3.5.1. Projects including operating rooms shall follow all requirements in the Surgical and

Endovascular Services Design Guide. Surgical and Endovascular Service Design Guide

Additional Planning Requirements:

Adjacencies shown on the block diagram shall be maintained. Interior storefront on conference rooms, staff lounges, and teamwork areas to maximize daylight to these areas is required. The following services shall be located on the first f loor:

• Welcome/Lobby – Welcome desk shall be prominent feature to main entry.

There shall be a feature staircase adjacent to welcome desk that connects to 2nd floor.

• Canteen – shall be located adjacent to main lobby

• Patient Advocate – shall be located adjacent to main lobby

• Police – shall be located with quick access to main lobby and staff area

• Logistics – shall be located to allow for deliveries

• BioMed – shall be near Logistics

• ITOPS – shall be near Logistics

• EMS – shall be adjacent to the loading dock

• SPS – shall be near to staff elevator

• Education – shall be located where after-hours visitors can be restr icted from accessing remainder of clinic

• Pathology – located adjacent to main entry with ample wait ing in close proximity

• Radiology

The following services may be located on an upper floor:

https://www.cfm.va.gov/til/dGuide/dgSurg.pdf

SECTION 4

• Primary Care

• Mental Health

• Dental – shall be located near SPS

• Urology – shall be located near SPS

• Whole Health (CIH)

• Mult i-specialty

• Audiology

• Eye

• Clinic Admin

• Occupational Health

• Volunteers

• PMRS – shall be located adjacent to Prosthetics

• Prosthetics – shall be located adjacent to PMRS

Section 3 - Page 1

TECHNICAL NARRATIVE

SECTION 4 – TECHNICAL NARRATIVE

4.1 Site/Civil

4.1.1 Pedestrian and Vehicle Access & Circulation

4.1.1.1 Minimum traffic lane width is 12 feet, and minimum sidewalk width is 4 feet. Curves for traffic lanes and radii at intersections must be adequately sized to prevent vehicles from encroaching on an opposing lane of traffic.

4.1.1.2 An accessible route must be provided from the public right-of-way abutting the site to the accessible building entrance.

4.1.1.3 Provide a service area with a loading dock designed to accommodate truck (WB-

62) maneuverability. Loading dock shall be 4 feet above the driveway. Platforms shall have a minimum depth of 8 feet front to back or between dock lift/leveler and back wall. Provide canopy over the platform with 14 feet of clearance from grade to the underside of the canopy. Canopy shall extend minimum of 4 feet beyond the edge of the dock for weather protection. Provide stair or ramp to the platform.

Provide hydraulic dock levelers with 25,000 pounds capacity for recessed installation at loading dock.

4.1.1.4 Service area shall accommodate vehicles that pick-up trash and recycled materials.

Locate service area away from public and patient areas.

4.1.1.5 Provide reflective traffic control signs as required for intersections, no parking lanes, and guidance of site traffic.

Additional Site/Civil Requirements:

The driveway shall be off a two directional entry (i.e. Do not locate on a one-way street or boulevard).

Provide a separate service/ambulance entrance.

Provide 6’ wide, ABAAS accessible walking path around perimeter of property.

Benches are required within the parking areas and around the building; should play an integral part of this design. Provide concrete pad for VA furnished benches in green spaces. Pads shall be equipped with means to anchor benches.

Provide direct access from Physical Medicine & Rehabil itation (PM&R) to an outside secure courtyard for gait training.

Provide exterior paved dining area large enough for thirty-two (32) people (seated at 4-top tables) to be used by staff.

Provide space for outdoor green plaza space (approximately 500 to 1,000 SF).

Provide buffers of either greenery and/or natural barriers along adjacent property l ines.

Provide a pet relief area.

Dumpsters are to be placed on a concrete pad and shall not be visible to patients.

Enclosure materials shall meet AHJ standards and complement the building architecture.

In addit ion to a flagpole and flag representing the United States of America, the Lessor shall furnish and install flagpoles and flags representing the Department of Veterans Affairs and the state of Tennessee either near the entry to the building or along the entry drive in a landscaped setting. Confirm with the VA in f inal site selection and landscape/parking layout.

The Lessor shall furnish and install a minimum of one rack each at patient and staff entrance for a minimum of 20 bicycles.

Provide a covered one-lane drive through area, separate from the main entry, complete with power and data.

Provide recessed scissor l ift at loading dock; 25,000 lbs capacity.

4.1.2 Parking

4.1.2.1 Parking lots with 90-degree stalls must have minimum parking stall dimensions of 9 feet by 18 feet, and a minimum drive aisle width of 24 feet. Angled parking must have one-way drive aisles with the same stall sizes as 90-degree parking. Angled parking drive aisle width must comply with a published design standard for a designated parking angle.

Additional Parking Requirements:

Provide a minimum of 1500 (55% patient, 45% staff) parking spaces. Provide six

(6) percent of patient and six (6) percent of staff parking as accessible parking, per ABAAS. Provide ten (10) percent of the accessible parking as van accessible parking, per ABAAS. Provide thirty (30) designated spaces, with signage, for senior staff parking.

Structured parking is acceptable but cannot be located under the clinic.

Offeror shall provide a minimum of six (6) Motorcycle parking spaces.

Provide covered area with power for charging and parking six (6) golf carts.

Provide four (4) minimum patient parking spaces for electric vehicles with a “plug and pay” system owned and operated by the Lessor.

Provide six (6) minimum covered designated waiting areas throughout vehicle circulation areas for patient drop-off/pickup.

4.1.3 Site Grading

4.1.3.1 Roads and walks should have a typical cross slope of 2% unless adequate surface drainage is provided by other slope conditions.

4.2 Architecture

4.2.1 General Criteria

4.2.1.1 Refer to Appendix: Room Data Matrix for Door, Hardware and Acoustic requirements listed by Room Type.

Additional Architecture Requirements:

There shall be no L-shaped or off-set doors in front vestibule entry.

Separate employee entrance shall be located convenient to staff parking.

VRC/Homeless shall have separate exterior entrance and vestibule. If not located on first f loor, provide dedicated elevator.

All interior partition walls shall be secured to the deck above.

Provide bulkheads above all wall mounted cabinets and lockers.

Each floor shall have at least one each lactation room for patients and for staff.

Each floor shall have one exam room that meets the requirements of an Airborne Infection Isolation room.

Specimen collection toilets shall have pass-thru cabinets.

Mental Health Acute Care rooms/Quiet rooms shall have anitl igature features.

4.2.2 Accommodations for Care of Patients of Size

4.2.2.1 Refer to FGI Guidelines for Outpatient Facilities for accommodations for care of patients of size. Minimum requirements are to provide access to a Procedure Room and Procedure Room Toilet in one PACT Module using a 650lb capacity design requirement. Additional capacity may be required and listed in the project specific requirements.

Additional Patients of Size Requirements:

For this project, the design requirement shall be 770 lbs. Where ceil ing l ifts are required, lessor shall provide all structural support necessary to support l if ts.

4.2.3 Acoustics

4.2.3.1 Refer to FGI Guidelines for Outpatient Facilities for acoustics requirements for enclosed rooms. Refer to the Room Data Matrix-Interior Construction for information on rooms not covered under FGI or rooms with special acoustics requirements.

Additional Acoustics Requirements:

Acoustical folding walls in group rooms and shared appointment rooms shall have a minimum STC of 55.

Lab and support spaces within Prosthetics shall have a minimum STC rating of 60.

4.2.4 Equipment/Accessories/Furnishings

4.2.4.1 Refer to CBOC Project Contents List and Room Template sheets provided with the

RLP for equipment, accessories, and furnishings descriptions and locations. Items to be provided and/or installed by Lessor are noted on the list. Provide partitions, partition backing, and above ceiling structural support as required for wall and/or ceiling mounted equipment, accessories, and furnishings. Provide required utility connections for scheduled equipment.

Additional Equipment Requirements:

Lessor is responsible for providing and connecting uti l ity connections for all VA equipment which requires mechanical, plumbing, electrical, gas, water, air, data, steam, or any other uti li ty.

4.2.5 Signage and Wayfinding

4.2.5.1 Refer to VA Signage Design Guide in Section 2.4 for signage standards and requirements.

Additional Signage Requirements:

Site Monument Sign shall be type El-01.01. Monument sign shall display

“Clarksvil le VA Clinic” with “Tennessee Valley Healthcare System” and the facil ity address. It shall have a backlight.

Building signage, in addit ion to VA logo, shall read EI-09.9 “Outpatient Center”.

4.2.6 Critical Dimensions

4.2.6.1 Patient-use corridors are to be 6 feet minimum. Staff corridors for transport of supplies from loading dock area to services shall be 8 feet minimum.

4.2.6.2 Refer to Room Data Matrix – Interior Construction for required ceiling heights by room type.

4.2.7 Entry Canopies

4.2.7.1 Provide non-combustible canopies over the following locations: patient entry to clinic, ambulance building access point and receiving area/loading dock.

4.2.7.2 At patient entry, provide a covered patient drop-off zone with space for at least one full size passenger vehicle (19 feet long) and an accessible access aisle.

4.2.7.3 At ambulance building access point, provide a covered patient drop-off zone with space for at least one ambulance (typical size used in area) and an accessible access aisle.

4.2.7.4 Provide clearance from grade to underside of canopy with for typical emergency and transport vehicles used in the area.

Additional Canopy Requirements:

Canopies complying with requirements of the Lease Design Narrative shall be provided at Staff and VRC/Homeless entrances.

At patient entry, canopy shall accommodate the passenger side for four (4) vehicles.

4.2.8 Elevators

4.2.8.1 Where elevators are provided in a leased facility, not less than one elevator car shall accommodate an ambulance stretcher of 24 inches by 84 inches in the horizontal open position and shall be identified by the international symbol for emergency medical services (star of life). The symbol shall be not less than 3 inches high placed inside on both sides of the hoist way door frame.

Additional Elevator Requirements:

A freight elevator shall be provided and sized per the requirements of this section.

4.2.9 Slab Depressions and Thickened Slabs

4.2.9.1 At new construction, provide slab depression and thickened slabs as required to provide flush threshold installation at audiology booths, MRIs, and other equipment requiring recessed installation or additional structure as recommended by equipment manufacturer. At these equipment locations, concrete slab levelness shall be level and true to meet vendor requirements and shall have a minimum flatness and levelness of FF=45 and FL=35. At existing construction, provide ramp to meet ABAAS.

4.2.10 Millwork

4.2.10.1 Quality compliance to conform to Architectural Woodwork Institute (AWI) and

Woodwork Institute (WI) quality standards.

4.2.10.2 Wood Veneer Casework Construction: Combination of custom wood casework and countertops to conform to program and functional requirements. (Location: Lobby, Reception)

4.2.10.2.1 Construction: Flush overlay construction with concealed hinges. AWI custom grade.

4.2.10.3 Plastic Laminate Casework Construction: Custom plastic laminate casework to conform to program and functional requirements. (Location: Typical).

4.2.10.3.1 Construction: Flush overlay construction with concealed hinges, AWI Custom Grade.

4.2.10.3.2 Cabinet Hardware:

4.2.10.3.2.1 Concealed hinges, all metal, 110 degree opening, self-closing.

4.2.10.3.2.2 Full extension drawer guides, 100 lbs. capacity.

4.2.10.3.2.3 Door and drawer pulls: 4” center to center wire pull, 5/16” diameter round, 1 ¼” projection, satin chrome.

4.2.10.4 Solid Surface Fabrications: Hard, solid, non-porous mineral-filled acrylic resin

(methyl methacrylate) material in color to be selected by designer. Thickness: 1/2” minimum.

4.2.10.4.1 Locations:

4.2.10.4.1.1 Transaction tops at nurse stations and reception desks.

4.2.10.4.1.2 All counters in patient treatment areas to have solid surface countertop with 4” high minimum integral coved side and backsplash.

4.2.10.4.1.3 Where scheduled as wall protection, provide ¼” thick material with welded seams.

4.2.10.5 Heavy gauge stainless steel (SS): fully welded with a work surface load capacity of at least 300 lbs. per linear foot and antimicrobial

4.2.10.5.1 Locations:

4.2.10.5.1.1 SPS Decontamination, Scope Processing, Preparations and Assembly, and Sterilization Areas.

4.2.11 Joint Sealant Systems

4.2.11.1 Joints at plumbing fixtures, ceramic tile to be mildew resistant silicone.

4.2.12 Doors and Frames

4.2.12.1 Refer to Room Data Matrix for door and hardware requirements by room type.

4.2.12.2 Finish: Prefinished in compliance with AWI Section 1500.

4.2.12.3 Automatic Sliding Doors: Single Slide Automatic Sliding Door, Class 1 Clean Room

Certified, narrow stile, 84” wide w/ 35.3” nominal clear door opening, trackless, clear anodized finish, and touchless actuators.

4.2.12.3.1 Comply with BHMA Standard ANSI A156.10 (BHMA 1601), Power Operated Pedestrian Door Standard and UL Standard UL 325, Electric Door, Drapery, Gate, Louver and Window Operators and Systems.

4.2.12.3.2 Service Life: Provide automatic sliding doors capable of operating without failure of any component, for not less than 300,000 open and close cycles, with normal maintenance as defined in manufacturer's standard operating manual.

4.2.12.4 Access Panels:

4.2.12.4.1 Flush stainless steel at toilet areas.

4.2.12.4.2 Flush gypsum board surface with concealed hinges at public and office areas.

4.2.12.4.3 Fire rated steel at rated construction.

Additional Door Requirements:

All rooms where a wall mounted folding chair is specified to be installed behind the door, the door frame must be a minimum 6” from the wall and include a door stop to keep door from hitt ing chair.

Loading dock shall have 10’x10’ roll-up door on clean dock and 6’x8’ double door on dirty dock.

Between Logistics receiving and bulk storage shall have 6’x8’ double door with air curtain.

All doors within Logistics shall be metal doors, metal frames.

Doors to clinic entrances shall be full glass. Doors from patient to staff areas shall be full wood.

In addit ion to doors specif ied in RDM, provide all doors as indicated on block diagram.

4.2.13 Hardware

4.2.13.1 General Note

4.2.13.1.1 Hardware sets shall be provided as per Section 5 Hardware Groups and Modifiers. Provide extra heavy duty, Grade 1 hardware for all components.

Additional Hardware Requirements:

All patient toilets, specimen toilets, dressing rooms, and lactation rooms shall have occupancy indicator on hardware.

All Primary Care exam rooms shall have two locking mechanisms on staff side door: one will be a one-sided deadbolt, lockable from patient side, with occupancy indicator and coin turn on opposite side, the other will be an off ice lock, lockable from staff side.

Soiled and biohazard/hazard rooms shall have door closers.

5-pin, tumbler cylinder cores shall be used. Lessor is responsible for keying and any necessary rekeying, as requested by VA. VA shall be responsible for the cost of requested rekeying.

Automatic Door Openers shall be required in the following locations:

• Vestibule entrances (main lobby, VRC/Homeless, ambulance/staff, etc.).

• All patient toilet areas and main lobby toilets.

• Doors leading from clinical areas to lobby.

4.2.13.2 Major components and finishes are as follows:

4.2.13.2.1 Cylinders and Keying: Key locks/cylinders in groups with new master key or grandmaster key system as directed by Owner. Provide three (3) keys per lock. Provide construction master keying. Cylinders shall meet the requirements of ANSI/BHMA A156.5-14.

4.2.13.2.2 Low Energy Automatic operators, ANSI A156.19-07. Heavy duty commercial grade. Provide complete with drop plates, bracket, or adapters for arms as required to suit details. Provide a terminal strip in an enclosed box near or above door that indicates connections for Security and Fire Alarm equipment and for electrified hardware items associated with proper door operation, as indicated by hardware group operational description. Refer to floor plans for type of actuation devices and bollards if required. Coordinate with Security Contractor for doors actuated by electronic access control system.

4.2.13.2.3 Electronic access control: Electronic access control system/device(s), power supplies (unless otherwise noted in hardware group) and monitoring/alarm(s) are provided with Security System. General Contractor to coordinate the provision and installation of the products. Refer to documents with Security Information for location(s) and type(s) of control(s). Connection by Electrical.

4.2.14 Pharmacy Dispensing Windows

4.2.14.1 Provide secure transaction drawer/pass through cabinet and window with amplified speak thru at Pharmacy Dispense/Consult windows for staff to patient transactions.

4.2.14.2 Provide stainless steel, type 304, #4 finish, pass-through cabinet with mechanical interlock doors with clear tempered safety glass windows to comply with USP 800 clean air requirements at Pharmacy pass-through windows. (location: Clean Room- Chemotherapy Compounding)

4.2.14.3 Provide protection for dispensing windows, and for walls around windows, window and the wall around a dispensing window shall meet U.L. Standard 752 for Class III Ballistic level via the use of concrete block walls with cores filled with sand, or appropriately rated metal panels, and extension of perimeter walls to structure above.

4.2.15 Radiation Shielding

4.2.15.1 For Radiology, Fluoroscopy, Mammography, CT Scan, and Dental X-Ray Rooms, obtain the services of a physicist to design, specify the level of radiation protection required, test and certifies the installations.

4.2.15.2 Comply with requirements of the National Council on Radiation Protection and Measurement (NCRP) Report #49.

4.2.15.3 Provide lead lining of gypsum wall board, wood doors and hardware, hollow metal frames, and lead glass view window.

4.2.15.4 Lead sheet to be FS QQ-L-201, Grade C, thickness as required by physicist report but not less than 1/16 inch.

4.2.16 Radio Frequency Shielding and Magnetic Shielding

4.2.16.1 Magnetic Resonance Imaging (MRI) Radio Frequency Interference Shielding: It is required that the RF shielded room and all penetrations through the RF Shielding, i.e., electrical plumbing, and venting be electrically isolated by 1000 ohms or greater and RFI filtered to meet the minimum attenuation level of 100dB (10 MHz- 100 MHz) for plane wave and 90 dB (10 MHz-30 MHz) for magnetic wave.

4.2.16.1.1 Material should be brass-copper or aluminum which has been treated to prevent oxidation and all joints should be either welded or lapped and bolted.

4.2.16.1.2 Shielding to include wall, floor, door, and windows.

4.2.16.2 Magnetic Shielding System: Annealed steel plate, accessories, and coordination of shielding work.

4.2.16.3 Applicable Standards: Comply with requirements of State and Local regulating agencies where standards and criteria apply. Comply with MIL-STDS-220A and 285.

4.2.16.4 Employ Independent Testing Laboratory (ITL), experienced in testing and design of

RF and magnetic shielded rooms, to review fabrication, design and installation, and perform tests of radio frequency shielding as required to ascertain correct functioning of shielding.

4.3.20.4.1 Correct part of work which is found to be deficient in electromagnetic shielding.

4.3.20.4.2 Provide second test of RF enclosure after construction is complete.

4.3.20.4.3 Submit certified test results.

4.3 Interior Design

4.3.1 General Criteria

4.3.1.1 Refer to Appendix: Room Data Matrix – Interior Construction for finish requirements listed by room type.

Additional Design Requirements:

See attached TVHS standard interior f inishes. Finishes shall comply with this document. For any finishes not covered in the TVHS standards, use Room Data Matrix.

4.3.2 Acoustic Ceiling Tile

4.3.2.1 AT: Acoustical ceiling tile, standard size to be 24”x24”x 1”.

4.3.2.2 AT-SP: Acoustical, scrubbable ceiling tile, standard size to be 24”x24”x 1”, with vinyl- laminated or sealed face and sealed edges.

Additional Ceiling Requirements:

Ceiling height in PMR exercise area shall be 12’-0” minimum.

4.3.3 Concrete Floor Treatment

4.3.3.1 Concrete Sealer (CS): 30 percent clear, non-yellowing, waterborne, membrane-forming curing and sealing compound: ASTM C1315, Type 1, Class A, minimum 30 percent total solids. Comply with ACI 301.

4.3.4 Fiberglass-Reinforced Panels

4.3.4.1 Fiberglass-reinforced panels (FRP): Gelcoat-finished, glass-fiber reinforced plastic panels complying with ASTM D 5319. Fire-Rating per ASTM E 84: Class A.

Nominal thickness: 0.09 inch.

4.3.5 Painting

4.3.5.1 Interior painting: Paint (P) and Epoxy Paint (EP): Paint surfaces with primer and two finish coats that are compatible with one another as demonstrated by manufacturer or field experience, unless otherwise indicated.

4.3.5.2 Materials: Use low VOC, low odor latex top coats where indicated. Paint the following items and surfaces:

4.3.5.2.1 Ceilings: Flat latex.

4.3.5.2.2 Walls - gypsum wallboard: Satin latex.

4.3.5.2.3 Walls - concrete block: Semi-gloss latex with block filler.

4.3.5.2.4 Hollow metal doors and frames: Semi-gloss latex over alkyd primer.

4.3.6 Wall Protection

4.3.6.1 Rigid Wall Covering (RWC): Nominal thickness .060 inch, high-impact, PVC-free, standard texture, chemical and stain resistant, with vertical, inside and outside trims. To comply with ASTM E84, ASTM F476 and ASTM D543.

4.3.6.2 Corner Guard (CG): Surface mounted assembly for angled corner consisting of a continuous aluminum retainer and vinyl/alloy extrusion in standard texture with ¼ inch corner radius. Size to be 2” width each way from corner. Height to be 7’ from top of base.

4.3.6.2.1 Location: Provide at all outside exposed corners in all clinic corridors outside of public areas as defined by FGI.

4.3.6.3 Corner Guard – Stainless Steel (CG-SS): Surface mounted stainless steel, 3-1/2” wing size, 7’ height, 16 gauge in Kitchen and/or Standard Grade, #4 satin finish.

4.3.6.3.1 Location: Provide at all outside exposed corners in food service areas, loading dock area and heavy use equipment storage areas.

Additional Wall Protection Requirements:

Handrails and bumper guards shall be provided in Lobby and patient corridors.

4.3.7 Window Shades

4.3.7.1 Manually operated window shade, chain driven, vertical roll-up, stainless steel bead chain with hold down clips, extruded aluminum rollers, and bottom slats.

Aluminum headbox with endcaps and fascia with powder coat finish. Light gap reduction channels available for black out shades. PVC-free shades, Flame- Resistance Ratings: NFPA 701. Comply with WCMA A100.1. Window treatments should not compromise patient safety.

4.3.7.1.1 Locations:

4.3.7.1.1.1 Semi-Transparent to be typical, unless otherwise noted.

4.3.7.1.1.2 Black-out at conference rooms, tele-medicine rooms, optometry exam rooms.

4.3.8 Privacy Curtains / Screens

4.3.8.1 Provide curtain tracks with carriers and hooks (curtains shall be provided by the

VA). Tracks shall be of extruded aluminum, ASTM B221, alloy 6063, temper T5 or T6, channel shaped, with smooth inside raceway for curtain carriers. End stop connectors, ceiling flanges and other accessories shall be fabricated from the same material with the same finish as the tracks or from nylon.

4.3.8.2 Provide privacy curtains/screens to encompass adequate space for the healthcare provider to perform examination unencumbered by the curtain and provide a visually private patient changing area that allows the provider to remain in the room.

4.3.8.2.1 Locations shall be per the room contents list.

4.3.9 Flooring, Carpet

4.3.9.1 Rooms specified to receive carpet and also contain a sink shall a minimum 4’ x 4’ area of LVT installed at the sink location.

Additional Flooring Requirements:

Flooring transit ions shall be no more than ¼” max. where dissimilar materials are used. A change in level greater than ¼” is prohibited.

4.4 Mechanical

4.4.1 References

4.4.1.1 The following publications shall be referenced for applicable systems calculations and design information.

4.4.1.1.1 ASHRAE Handbooks.

4.4.2 HVAC Design Basis

4.4.2.1 Indoor design conditions:

4.4.2.1.1 Health care function design conditions shall be in compliance with the requirements of the FGI Guidelines and ASHRAE Standard 170, with the Room Data Matrix taking precedence and/or indicating required space design conditions when the FGI Guidelines do not fully address a space or room type.

4.4.2.1.2 Imaging Equipment Space Design Conditions

4.4.2.1.2.1 Equipment manufacturer requirements shall be followed.

4.4.2.1.2.2 Provide a dedicated computer room type AC unit to cool and control humidity for separate equipment rooms for radiology equipment.

4.4.2.1.2.3 Provide a computer room type AC unit to cool UPS rooms when segregated from other spaces.

4.4.2.1.3 Basic MEP Equipment Room Design Conditions:

4.7.2.1.5.1 Design conditions shall be as required to ensure tenant space design conditions are maintained.

4.4.2.1.4 Loading Docks:

4.4.2.1.4.1 Space shall have provisions to limit the intrusion airborne particulate and insects through dock door openings.

4.4.2.2 Outdoor design conditions:

4.4.2.2.1 ASHRAE 99.6% (winter) and 0.4% (summer) conditions associated with the site-specific location.

4.4.3 Air Handling Units (AHUs)

4.4.3.1 Air handling units shall consist of, but not be limited to, the following:

4.7.3.1.1 The units shall be constructed of double wall, insulated metal panels with an overall U-value and necessary features to meet/exceed energy code (and prevent condensation based on the site-specific outdoor design conditions).

4.7.3.1.2 Incorporate supply, return and outdoor air flow measuring stations for proper control feedback and ensure minimum ventilation needs.

4.7.3.1.3 For AHU’s that are in excess of 15,000 cfm, SA/RA Array fans (minimum 2 fans per system) with backdraft isolation dampers shall be employed.

4.7.3.1.4 VSD controllers for fan array systems shall be provided in quantities that will provide no less than a 50% loss of nominal fan capacity if a single VSD were to fail.

4.4.3.2 For overall building capacity needs greater than 50,000 cfm, multiple AHUs shall be provided.

4.4.3.3 For building programs that have a Production Kitchen/Food Preparation, a dedicated air handling unit shall be provided capable of serving the conditioning and ventilation needs of the Kitchen space, including capability for a high percentage of outside air to accommodate the make-up air needs of the space.

4.4.3.4 The design criteria of the dedicated AHUs for Pharmacy Services, Pharmacy Compounding Suite, Sterile Processing Service (SPS), and the Surgical Suite shall be as required in the VA HVAC Design Manual. Where air handling units are combined the design shall be based on the aggregate of the most stringent requirements for the units being combined so that the selected unit meets all requirements of the combined units.

4.4.4 Exhaust Systems

4.4.4.1 Provide exhaust fans to provide general exhaust for toilet rooms, janitor’s closets, soiled utility rooms and similar spaces.

4.4.4.2 Dedicated exhaust fans shall be provided for Pharmacy, Sterile Processing Service

(SPS), Laboratory, Kitchen/Cafeteria areas, and similar specialized spaces.

Additional Exhaust Requirements:

Armory shall have dedicated exhaust system.

4.4.5 Cooling System

4.4.5.1 Chillers shall employ multiple, independent refrigerant circuits, and shall have capacity control provisions to achieve at least 4 to 1 turndown.

4.4.5.2 The pumping system for the chilled water supply shall consist of variable speed pumps providing variable primary flow, arranged in a headered approach. Variable speed pumps shall each have a variable speed drive controller.

4.4.5.3 DX systems:

4.4.5.3.1 AHUs packaged with DX cooling sections shall have compressors/condensing units with direct drive scroll or screw compressors, all-aluminum microchannel condenser coils, and direct drive TEFC condenser fans. Units shall employ multiple, independent refrigerant circuits, and shall have capacity control provisions to achieve at least 4 to 1 turndown.

4.4.5.3.2 Provide spring isolated mounting curbs for vibration attenuation, if applicable.

4.4.5.4 Provide unit supported screen wall panels, if roof supported structural screen wall elements are not incorporated.

4.4.5.5 Variable Refrigerant Flow (VRF) systems shall not be considered for VA CBOC projects due to various concerns such as inappropriate system type for healthcare facility applications due to higher amounts of fresh air requirement as well as safety risk to building occupants due to use of high refrigerant volumes and associated potential leaks.

4.4.6 Hot Water Heating System

4.4.6.1 Hot water heating shall be generated by direct vent, sealed combustion, condensing type boilers.

4.4.6.2 The heating water system distribution shall be a variable/primary pumping system.

The pumping system will consist of variable speed pumps providing variable primary flow. Variable speed pumps shall each have a variable speed drive controller.

4.4.7 Humidification System

4.4.7.1 Centralized humidification shall be provided when necessary to maintain 20%-60% relative humidity in all seasons. Each air handling unit shall have a dedicated humidifier.

4.4.7.2 Water treatment shall be provided for humidifier feedwater as required by the humidifier equipment manufacturer.

4.4.8 HVAC Piping Systems

4.4.8.1 Provide isolation valves on branch and lateral lines to reduce the amount of space that can be disrupted for maintenance and repair efforts. Provide isolation valves at each equipment connection.

4.4.8.2 For hydronic systems utilized in specific sites with freezing climate considerations, use of propylene glycol and/or proven freeze protection methodologies must be incorporated.

4.4.8.3 When propylene glycol is used, the freezing point of the glycol solution shall be at least 5°F lower than the minimum annual extreme daily temperature, to prevent the formation of crystals.

4.4.9 Air Distribution and Duct Systems

4.4.9.1 Duct construction shall be as follows:

4.4.9.1.1 All supply return and exhaust air ductwork shall be constructed of G90 galvanized steel. Non-ducted Return Air Plenum is not allowed. Flexible duct is prohibited except for the last three feet to connect diffusers.

4.4.9.1.2 Ductwork shall be rectangular, round or flat oval constructed to SMACNA standards.

4.4.9.1.3 Ductwork shall be constructed and tested with leakage classifications and pressure ratings and based on at least 125% of the actual operating pressure of the duct system.

4.4.9.2 Grilles, registers and diffusers shall be steel, aluminum or extruded aluminum with appropriate finish.

4.4.10 HVAC Insulation Systems

4.4.10.1 All exposed (visible in space) supply and return ductwork in the occupied conditioned spaces shall be provided with rigid insulation with proper seals.

Painting and finish requirements shall be coordinated with the finish schedule.

4.4.11 Testing, Adjusting and Balancing

4.4.11.1 An independent third-party NEBB, ABBC or TABB certified test and balance contractor shall be hired by the general contractor to balance and document all air and hydronic systems within project scope. All ductwork shall be constructed and properly sealed in accordance with applicable energy code requirements.