Attachment Y8 - SF 1449 Amendment and Other_4-18.pdf

PDF 2 MB Posted

Attached to
R499--Amendment 0008- VHA Integrated Healthcare Transformation (IHT) 2. 0 IDIQ
Solicitation number
36C10X24R0026
Issued by

About this file

This document is Attachment Y8 - SF 1449 Amendment and Other in support of a federal contract opportunity. It contains instructions for submitting the SF-1449, amendments, organizational conflict of interest statements, VAAR 852.219-75 certification, and other representations required as part of a Phase II proposal for the Integrated Healthcare Transformation (IHT) 2.0 IDIQ contract. The opportunity is being solicited by the Department of Veterans Affairs Strategic Acquisition Center Frederick under Solicitation Number 36C10X24R0026. The SF-1449 and any amendments must be signed by an authorized official of the offeror. The offeror must also provide statements and certifications related to organizational conflicts of interest, limitations on subcontracting, annual representations and certifications, and information regarding responsibility matters. Joint venture offerors have additional certification requirements related to compliance with 13 CFR 125.6.

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2H. VIT PROPOSAL – SF 1449, AMENDMENTS, OTHER DOCUMENTS

Instructions: The following shall be submitted as the Phase II Volume “ph2_Other_<company name>.doc/docx/pdf”

1. Signed SF 1449 and Amendment(s), if any.

An authorized official of the VITAL submitting the response shall sign the SF 1449, and any amendment(s) and all certifications requiring signature and include within the proposal file directly following this checklist.

Checklist

Document Purpose Check

SF-1449

Request for Proposal for IHT 2.0 Signed by authorize agent

Attached within file

Amendment 1 Signed by authorize agent Attached within file

Amendment 2 Signed by authorize agent Attached within file

Amendment 3 Signed by authorize agent Attached within file

Amendment 4 (If applicable) Signed by authorize agent Attached within file

Amendment 5 (If applicable) Signed by authorize agent Attached within file

Amendment 6 (If applicable) Signed by authorize agent Attached within file

Amendment 7 (If applicable) Signed by authorize agent Attached within file

Amendment 8 (If applicable) Signed by authorize agent Attached within file

Amendment 9 (If applicable) Signed by authorize agent Attached within file

Amendment 10 (If applicable) Signed by authorize agent Attached within file

Amendment 11 (If applicable) Signed by authorize agent Attached within file

Amendment 12 (If applicable) Signed by authorize agent Attached within file

Insert signed SF-1449 and all Amendments Here (one page per signed/acknowledged document.)

2. Offeror’s statement(s) as required by paragraph b. of the VAAR Clause 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST and any applicable OCI Mitigation Plans;

Offeror shall provide information as required by checking the applicable statement, providing narrative, and providing any supplemental documentation.

In accordance with paragraph b. of Organizational Conflicts of Interest (OCT 2020)

“The Offeror shall provide a statement with its offer which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided under this solicitation. The Offeror shall also provide statements with its offer containing the same information for any consultants and subcontractors identified in its proposal and which will provide services under the solicitation. The Offeror may also provide relevant facts that show how its organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest.”

Check all below statements that apply:

My firm (the offeror) has NO past, present, currently planned interests (financial, contractual, organizational, or otherwise), or actual or potential organizational conflicts of interest related to the services to be provided under the solicitation.

Any consultants and subcontractors identified in my proposal, and which will provide services under the solicitation have NO past, present, currently planned interests (financial, contractual, organizational, or otherwise), or actual or potential organizational conflicts of interest related to the services to be provided under the solicitation.

My firm and/or consultants and subcontractors identified in my proposal have interests or actual or potential conflicts of interest referred to in the VAAR Clause. (if checked, provide statement below describing, in a concise manner, all relevant facts AND insert OCI mitigation plan if applicable).

OCI Statement

Insert OCI avoidance or mitigation plan here (if applicable).

3. Certification required under VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023) (DEVIATION)

Offeror shall complete the required Certification below.

VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—CERTIFICATE OF COMPLIANCE FOR SERVICES AND

CONSTRUCTION (JAN 2023) (DEVIATION)

(a) Pursuant to 38 U.S.C. 8127(l)(2), the offeror certifies that—

(1) If awarded a contract (see FAR 2.101 definition), it will comply with the limitations on subcontracting requirement as provided in the solicitation and the resultant contract, as follows:

(i) X Services. In the case of a contract for services (except construction), the contractor will not pay more than 50% of the amount paid by the government to it to firms that are not certified SDVOSBs listed in the SBA certification database as set forth in 852.219-73 or certified VOSBs [listed in the SBA certification database] as set forth in 852.219-74. Any work that a similarly situated VIP-listed [certified SDVOSB/VOSB] subcontractor further subcontracts will count towards the 50% subcontract amount that cannot be exceeded. Other direct costs may be excluded to the extent they are not the principal purpose of the acquisition and small business concerns do not provide the service as set forth in 13 CFR 125.6.

(ii) □ General construction. (Not applicable)

(iii) □ Special trade construction contractors. (Not applicable)

(2) The offeror acknowledges that this certification concerns a matter within the jurisdiction of an Agency of the United States. The offeror further acknowledges that this certification is subject to Title 18, United States Code, Section 1001, and, as such, a false, fictitious, or fraudulent certification may render the offeror subject to criminal, civil, or administrative penalties, including prosecution.

(3) If VA determines that an SDVOSB/VOSB awarded a contract pursuant to 38 U.S.C. 8127 did not act in good faith, such SDVOSB/VOSB shall be subject to any or all of the following:

(i) Referral to the VA Suspension and Debarment Committee;

(ii) A fine under section 16(g)(1) of the Small Business Act (15 U.S.C. 645(g)(1)); and

(iii) Prosecution for violating section 1001 of title 18 [U.S.C. 1001].

(b) The offeror represents and understands that by submission of its offer and award of a contract it may be required to provide copies of documents or records to VA that VA may review to determine whether the offeror complied with the limitations on subcontracting requirement specified in the contract. Contracting officers may, at their discretion, require the contractor to demonstrate its compliance with the limitations on subcontracting at any time during performance and upon completion of a contract if the information regarding such compliance is not already available to the contracting officer. Evidence of compliance includes, but is not limited to, invoices, copies of subcontracts, or a list of the value of tasks performed.

(c) The offeror further agrees to cooperate fully and make available any documents or records as may be required to enable VA to determine compliance with the limitations on subcontracting requirement. The offeror understands that failure to provide documents as requested by VA may result in remedial action as the Government deems appropriate.

(d) Offeror completed certification/fill-in required. The formal certification must be completed, signed and returned with the offeror’s bid, quotation, or proposal. The Government will not consider offers for award from offerors that do not provide the certification, and all such responses will be deemed ineligible for evaluation and award.

Certification:

I hereby certify that if awarded the contract, [insert name of offeror] will comply with the limitations on subcontracting specified in this clause and in the resultant contract. I further certify that I am authorized to execute this certification on behalf of [insert name of offeror].

Printed Name of Signee: Printed Title of Signee:

Signature: ________________________________ Date:

Company Name and Address:

4. Paragraph b of 52.212-3, Offeror Representations and Certifications

Please check (to confirm) and identify any exceptions to paragraph b below.

Excerpt from FAR 52.212-3 Offeror Representations and Certifications – Commercial Items (DEC 2014) (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 access 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

5. Paragraph (a)(4) from 52.212-4 Contract Terms and Conditions – Commercial Items (May 2015) Alternate 1 (May 2014)

The following paragraph fill-in (Portion of labor rate attributable to profit) must be completed below, if applicable.

Excerpt from FAR 52.212-4 Contract Terms and Conditions – Commercial Items (May 2015) Alternate 1 (May 2014)

(a)(4) At any time during contract performance, but not later than 6 months (or such other time as may be specified in the contract) after acceptance of the services or materials last delivered under this contract, the Government may require the Contractor to replace or correct services or materials that at time of delivery failed to meet contract requirements. Except as otherwise specified in paragraph (a)(6) of this clause, the cost of replacement or correction shall be determined under paragraph (i) of this clause, but the "hourly rate" for labor hours incurred in the replacement or correction shall be reduced to exclude that portion of the rate attributable to profit. Unless otherwise specified below, the portion of the "hourly rate" attributable to profit shall be 10 percent.

The Contractor shall not tender for acceptance materials and services required to be replaced or corrected without disclosing the former requirement for replacement or correction, and, when required, shall disclose the corrective action taken. [Portion of labor rate attributable to profit if other than 10% = ]

6. Offeror shall complete the representation from FAR 52.209-7 Information Regarding Responsibility

Matters.

INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

(a) Definitions. As used in this provision— Administrative proceeding means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.

Federal contracts and grants with total value greater than $10,000,000 means—

(1) The total value of all current, active contracts and grants, including all priced options; and

(2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules).

Principal means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

(b) The offeror _____has ______ does not have current active Federal contracts and grants with total value greater than $10,000,000.

(c) If the offeror checked "has" in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information:

(1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions:

(i) In a criminal proceeding, a conviction.

(ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more.

(iii) In an administrative proceeding, a finding of fault and liability that results in–

(A) The payment of a monetary fine or penalty of $5,000 or more; or

(B) The payment of a reimbursement, restitution, or damages in excess of $100,000.

(iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision.

(2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence.

(d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award Management, which can be accessed via https://www.sam.gov (see 52.204-7).

(End of provision)

*************End of representation from FAR 52.209-7************* https://www.sam.gov/ https://www.acquisition.gov/far/part-52#FAR_52_204_7

7. Offeror shall complete the representation from FAR 52.204-24 Representation Regarding Certain

Telecommunications and Video Surveillance Services or Equipment.

REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Products or Commercial Services. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision— Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition.

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) ( https://www.sam.gov) for entities excluded from receiving federal awards for "covered telecommunications equipment or services".

(d) Representation. The Offeror represents that—

(1) It _____will, _____ will not provide covered telecommunications equipment or services to the

Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds "will" in paragraph (d)(1) of this section; and

(2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that—

It _______ does, _______ does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services.

The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds "does" in paragraph (d)(2) of this section.

https://www.acquisition.gov/far/part-52#FAR_52_204_26 https://www.acquisition.gov/far/part-52#FAR_52_212_3 https://www.acquisition.gov/far/part-52#FAR_52_204_26 https://www.acquisition.gov/far/part-52#FAR_52_212_3 https://www.acquisition.gov/far/part-52#FAR_52_204_25 https://www.sam.gov/

(e) Disclosures.

(1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded "will" in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered

(include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

Additional Disclosure Information:

(2) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded "does" in the representation in paragraph (d)(2) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered

(include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the PSC of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

Additional Disclosure Information:

(End of provision)

*************End of representation from FAR 52.204-24 *************

8. Contractor proposed terms and conditions. Any proposed terms and conditions and/or assumptions upon which the proposal is predicated. Offerors are hereby advised that any offeror-imposed terms and conditions and/or assumptions which deviate from the Government’s material terms and conditions established by the solicitation, may render the offeror’s proposal unacceptable, and thus ineligible for award.

Contractor shall provide any proposed terms and conditions and/or assumptions upon which the proposal is predicated.

9. Compliance Certifications required by 13 CFR § 128.402 (FOR JOINT VENTURE OFFERORS ONLY)

In accordance with 13 CFR § 128.402 (e), JV Offerors must complete the following:

Certification of compliance —

(1) At time of offer. If submitting an offer as a joint venture for a(n)… SDVOSB contract, at the time of initial offer (and if applicable, final offer), each certified… SDVOSB joint venture partner must make the following certifications to the contracting officer separately under its own name:

(i) It is a certified VOSB or SDVOSB;

(ii) It, together with its affiliates, is small under the size standard corresponding to the NAICS code assigned to the procurement;

(iii) It will comply with the applicable limitations on subcontracting during performance of the contract, as set forth in § 125.6 of this chapter.

Joint Venture SDVOSB Partner 1 Company Name: ________________________________

I certify at time of this offer that (1.) I am an SBA certified SDVOSB, (2), together with my affiliates, I am small under the NAICS size standard for 541611 ($24.5M as of March 17, 2023), and I will comply with the limitations on subcontracting during performance of the IHT 2.0 contract, as set forth in 13 CFR § 125.6.

(Authorized Agent for SDVOSB JV Partner 1)

Printed Name: ___________________________ Signature: ___________________________

Joint Venture SDVOSB Partner 2 Company Name: ________________________________ (if applicable)

I certify at time of this offer that (1.) I am an SBA certified SDVOSB, (2), together with my affiliates, I am small under the NAICS size standard for 541611 ($24.5M as of March 17, 2023), and I will comply with the limitations on subcontracting during performance of the IHT 2.0 contract, as set forth in 13 CFR § 125.6.

(Authorized Agent for SDVOSB JV Partner 2)

Printed Name: ___________________________ Signature: ___________________________

Joint Venture SDVOSB Partner 3 Company Name: ________________________________ (if applicable)

I certify at time of this offer that (1.) I am an SBA certified SDVOSB, (2), together with my affiliates, I am small under the NAICS size standard for 541611 ($24.5M as of March 17, 2023), and I will comply with the limitations on subcontracting during performance of the IHT 2.0 contract, as set forth in 13 CFR § 125.6.

(Authorized Agent for SDVOSB JV Partner 3)

Printed Name: ___________________________ Signature: ___________________________

*************End of representation from FAR 52.204-24 ************* https://www.ecfr.gov/current/title-13/section-125.6 https://www.ecfr.gov/current/title-13/section-125.6 https://www.ecfr.gov/current/title-13/section-125.6 https://www.ecfr.gov/current/title-13/section-125.6

Attachment Y8 - Phase II Proposal Forms_3-25
Attachment L- Phase II Proposal Forms
Form 2H- SF1449_Amendments_Other

Form 2H- SF1449_Amendments_Other1

Y8 Additional Representations

undefined: Off
undefined_2: Off
Request for Proposal for Integrated Critical Staffing ProgramAmendment 1: Phase I Questions and Answers Amendment
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Request for Proposal for Integrated Critical Staffing ProgramAmendment 2: RFP updates and submission table
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Request for Proposal for Integrated Critical Staffing ProgramAmendment 3: QA Clarification and Updated RFP
undefined_7: Off
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Request for Proposal for Integrated Critical Staffing ProgramAmendment 4 If applicable: Additional Clarifications by Government
undefined_9: Off
undefined_10: Off
Request for Proposal for Integrated Critical Staffing ProgramAmendment 5 If applicable: Phase II Initiation with RFP and Attachment Updates
undefined_11: Off
undefined_12: Off
Request for Proposal for Integrated Critical Staffing ProgramAmendment 6 If applicable:
undefined_13: Off
undefined_14: Off
Request for Proposal for Integrated Critical Staffing ProgramAmendment 7 If applicable:
undefined_15: Off
undefined_16: Off
Request for Proposal for Integrated Critical Staffing ProgramAmendment 8 If applicable:
undefined_17: Off
undefined_18: Off
Request for Proposal for Integrated Critical Staffing ProgramAmendment 9 If applicable:
undefined_19: Off
undefined_20: Off
Request for Proposal for Integrated Critical Staffing ProgramAmendment 10 If applicable:
undefined_21: Off
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Request for Proposal for Integrated Critical Staffing ProgramAmendment 11 If applicable:
undefined_23: Off
undefined_24: Off
Request for Proposal for Integrated Critical Staffing ProgramAmendment 12 If applicable:
undefined_25: Off
undefined_26: Off
My firm the offeror has NO past present currently planned interests financial contractual: Off
Any consultants and subcontractors identified in my proposal and which will provide services under the: Off
My firm andor consultants and subcontractors identified in my proposal have interests or actual or: Off
OCI StatementRow1:
Company Name:
Printed Signer Name:
Printed Title of Signee:
Date5_af_date:
Comany Name and addres:
2 The offeror has completed the annual representations and certifications electronically via the SAM website: Off
Exceptions:
Other Percentage:
Propose T&Cs:
Group1: Choice2
Group2: Choice2
Group3: Choice2
Text2: <enter disclosure info here>
Text3: <enter disclosure info here>
Text4: <enter company name>
Text5: <enter printed name>
Text7: <enter company name>
Text8: <enter printed name>
Text10: <enter company name>
Text12: <enter printed name>

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