3 PERFORMANCE WORK STATEMENT.pdf

“PERFORMANCE WORK STATEMENT”

PINON HEALTH CENTER

“” PEST CONTROL SERVICES”

GLOSSARY:

COR – Contracting Officers Representative

SPOC – Supervisory Point of Contact

HSA – Health System Administrator

CO – Contracting Officers

PHC – Pinon Health Center

1. DESCRIPTION:

This summary describes the existing condition, Contractor shall provide 2 Monthly visits from January 2025 to December 2025 providing Pest Control Services for Pinon Health

Center. Facility management is required to maintain physical environmental safety of property, patients and staff. Contractor will provide deliveries and services to keep infection control, pests and rodents to a minimum, ensuring a safe physical environment.

Contractor will schedule services and deliveries with SPOC. Contractor shall work with

CO, COR for assuring compliance with the terms and conditions of the contract.

BLDG. # BUILDING NAME BUILDING USE AREA AREA SQ/FT

302090 Pinon Health

Center

Main level

Ambulatory services/business

34,773 SQ/FT

302090 Pinon Health

Center

Lower level

Facility

Management/General

Services/Housekeeping

16,979 SQ/FT

TOTAL: 51,752 SQ/FT

1. LIST OF SERVICES TO BE PROVIDED:

1.1 Contractor shall furnish all necessary labor, tools, supplies/materials, equipment, and transportation.

2.1 Contractor will Provide Pest Control Services for Pinon Health Center. Total Square

Footage, 51,751 SQ/FT.

3.1 Contractor will deliver and perform services during regular business hours, Monday

– Friday, 8:00am to 5:00pm. (Thursday morning from 8:00am to 12:00pm, there is no patient care services. This open time frame would be ideal for Pest Control

Services to minimize disrupting patient care services.)

4.1 Contractor will maintain timely deliveries/services and uphold delivery schedule dates.

5.1 Contractor shall inform SPOC of any changes in schedule with two days prior of scheduled delivery.

6.1 Contractor shall implement and ensure proper safety procedures pertaining to

Environment of Care.

7.1 Contractor shall supply and deliver Pest Control services in best interest of public safety, to minimize any infection control issues and implement EPA regulations.

8.1 Contractor shall Use only EPA approved pesticides and “reduced Risk” applications for environmentally friendly requirements.

9.1 The contractor will notify SPOC, time of deliveries and services, schedule change at least 2 days prior to services that’s scheduled.

10.1 Contractor personnel will have their company ID badge for identification purposes.

11.1 To minimize identified environment risk and maintain a safe physical environment pertaining to Environment of Care.

12.1 Contractor shall provide friendly customer care, reliability, implement best possible service, and practice good customer care. The Pinon Health Center maintains the Environment of Care by providing customer and patients with safe physical environment for patient care services.

13.1 Contractor will document and report all findings, surveillance, infestations and infection control issues.

14.1 Provide Pest Control Services and Surveillance on scheduled basis. (2x per Month)

15.1 Contractor shall provide required invoices and certification.

16.1 Contractor shall provide Safety Data Sheets (SDS) on Pesticides being used.

17.1 Contractor shall provide service ticket and reports when deliverables and services are complete.

2. QUALITY ASSURANCE:

The government shall evaluate the contractor’s performance under this contract in accordance with the quality assurance surveillance plan. This plan is primarily focused on what the government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum requirements.

Performance – Based Matrix

Performance-based task

Indicator Standard Quality Assurance Incentives

State the end results or outputs that you, the customer will formally accept or reject.

For the requirement, state the feature(s) of end result that will be surveilled.

For each

“indicator,” state a performance level that, when met, means the task has been performed satisfactorily.

This Standard describes “What

Success Looks

Like.”

For each

“Standard”, state the method use to check performance (i.e.

random sampling, 100% inspection, periodic inspection, customer complaints).

List Positive and

Negative incentives. Address method of linking payment to quality of service.

Contractor shall

Produces work that is accurate, Quality workmanship and

Professionalism.

Maintains a safe workplace and environment for self and others. Adheres and complies with

Pinon Health Center policies and procedures, all applicable federal, state and local regulations and requirements.

Competency

Compliance

Empowerment

Professionalism

Community

Awareness

Service Quality

Perform 100% required tasks at

100% of the required competencies.

100% compliance with Pinon Health

Center-- Facility

Management protocols.

Conduct in a professional manner at all time, 100% adherence to the

Behavioral Health

Code of Ethics and

Federal Code of

Conduct.

100% On Time

Delivery of Supplies and Services

100% Satisfaction with quality of supplies and services is evidenced by valid input from the

Community

COR: Surveillance systems will include periodic inspections and customer complaints.

Payment of contract price for satisfactory service.

Contractor performance will be evaluated using the

National Institutes of Health (NIH)

Contractor

Performance Report.

The evaluation will be considered when future IHS contract selections are made.

No payment for incomplete work.

2. SCHEDULED STATUE PLAN:

• REPORT: Service Ticket and Invoice

• PURPOSE: Use for Payment

• FREQUENCY: After each on-site visit

3. PERIOD OF PERFORMANCE:

• January 1, 2025 to December 31, 2025

4. CONTACT INFORMATION:

• Whitney Shorty – Contracting officer - /whitney.shorty@ihs.gov PH: 928-725-

• Phillip Antonio, Maintenance Mechanic Supervisor – COR representative / phillip.antonio@ihs.gov PH: 928-725-9810

5. LOCATION:

Pinon Health Center

2175 State Road 4

Pinon, AZ 86510

6. PROJECT DELIVERABLES WILL BE APPROVED/ACCEPTED BY:

• Contracting officer: /whitney.shorty@ihs.gov PH: 928-725-9801

• Receiving Agent: Rena Tsosie, General Service Supervisor

• Accounts Payable: Lavennia Deswood, Accounts