36C24526Q0301.docx

Performance Work Statement (PWS)

NON-EMERGENT WHEELCHAIR TRANSPORTATION

VISN 05/Station 688 NAICS 485991

GENERAL INFORMATION

SET-ASIDE

VISN 5 Contracting 849 International Drive Linthicum MD 21090

POINT OF CONTACT*

Contract Specialist Dan Feng Lu danfeng.lu@va.gov

PLACE OF PERFORMANCE

50 Irving St NW

Washington DC

Wheelchair Van Transportation Services DC VA Medical Center The Government intends to establish a 5-year Commercial Firm Fixed Price, Multiple Award Indefinite Delivery/Indefinite Quantity (IDIQ), wheelchair van transportation services contract for the DC VA Medical Center.

The purpose of this Sources Sought is to identify contractors who possess the capabilities to provide the wheelchair van transportation services described in the draft Performance Work Statement below.

As permitted by the FAR Part 10, this is a market research tool being utilized for the informational and planning purposes. Your responses will assist the Government in the development of its acquisition strategy.

Response is strictly voluntary – it is not mandatory to submit a response to this notice to participate in formal RFQ process that may take place in the future. However, it should be noted that information gathered through this notice may significantly influence our acquisition strategy. All interested parties will be required to respond separately to any solicitation posted as a result of this sources sought notice.

Respondents will not be notified of the results of the evaluation. We appreciate your interest and thank you in advance for responding to the sources sought.

This service will be implemented using the North American Industry Classification System (NAICS) Code 485991.

If a small business is interested in this procurement, they must provide at least 51 percent of the services rendered.

Please respond to this RFI/Sources Sought 36C24526Q0301 with your:

1. Business name (including Unique Entity ID (SAM.gov))

2. Business type, socio-economic status (e.g., Veteran-Owned, Woman-Owned, Disadvantaged Small Business, 8(a), etc.), and

3. Person of contact (including telephone number & email address).

4. Capability statement and summary of previous experience providing these types of services for the Veterans Health Administration or other similar facilities.

5. Available contract vehicles (GSA FSS, etc.) for use by Department of VA (include applicable NAICS)

6. Brief Summary of categories of services that your company can/cannot provide.

7. Active Washington Metropolitan Area Transit Commission (WMATC) license. Any other Certification(s) / Licenses for meeting the local requirements to provide these services at the Washington, DC VAMC (if applicable)

8. Estimated monthly cost range to provide these services. (Not requesting official pricing. This will be used for initial market research and informational purposes only.)

9. Confirmation that your organization has the capability & expertise to meet the performance requirements while complying with applicable limitations in subcontracting by responding to the questions below with your response:

a. Do you intend to self-perform this effort?

b. If you are located outside the immediate area, how will you self-perform?

c. Or, do you intend to subcontract work under this contract?

d. If you intend to subcontract work under this contract, how will you ensure compliance with the limitations on subcontracting?

RESPONSE INSTRUCTION

All Capability Statements/Responses to this Sources Sought Notice shall be submitted via email only to Danfeng.lu@va.gov. Telephone, Fax, or any other form of communication inquiries will not be reviewed or accepted. Responses to this Sources Sought Notice must be received no later than March 06, 2026 at 3:00PM ET. This Sources Sought Notice may or may not assist the VA in determining sources only. A solicitation is not currently available. If a solicitation is issued, it may or may not be announced at a later date, and all interested parties shall respond to that solicitation announcement separately from the responses to this Sources Sought Notice.

DISCLAIMER

This RFI is issued for information and planning purposes only and does not constitute a solicitation. All information received in response to this RFI that is marked a proprietary will be handled accordingly in accordance with (IAW) Federal Acquisition Regulation (FAR) 15.201(e), RFIs may be used when the Government does not presently intend to award a contract, but wants to obtain price, delivery, other market information, or capabilities for planning purposes. Responses to these notices are not offers and cannot be accepted by the Government to form a binding contract. Responders are solely responsible for all expenses incurred associated with responding to this RFI.

Sources Sought Notice Sources Sought Notice

Sources Sought Notice

NON-EMERGENT WHEELCHAIR TRANSPORTATION

SCHEDULE OF SERVICES – PRICE SCHEDULE

NOTE: A price quote must be provided for all data elements shaded in YELLOW within this SCHEDULE OF SERVICES – PRICE SCHEDULE for any offeror to be determined technically acceptable for consideration for an award.

Line Item

Description of Services 12-Month Quantity (Estimated Maximum) Unit of Issue

(Maximum NTE)

Base Rate Transport (Using Bing Maps)

One-Way Trip

(One-Way Trips)

Per Trip (One-Way)

(One-Way Trips)

Per Trip (One-Way)

362,000 Maximum (Miles)

Price Per Mile

(Wait Time) (15-minute Increment)

Base Period (Total Price)

1. Purpose: The Washington DC VA Medical Center (hereafter DC VAMC), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergent wheelchair transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of non-emergent wheelchair transportation services. The contactor shall make these non-emergent wheelchair transportation services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

2. Background: The DC VAMC main campus is located at 50 Irving Street NW Washington, DC 20422, serving over 104,027 veterans, primarily from the DC, MD, & Northern VA areas and it’s six (6) Community-Based Outpatient Clinics. The hospital has 165 inpatient beds and sees approximately 6,100 inpatient admissions and 886,022 outpatient visits a year. Veterans served within this facility live within the following counties.

3. Acronyms:

AOD – Administrative Officers of the Day CO – Contracting Officer COR – Contracting Officer’s Representative DOL – Department of Labor IAW – In Accordance With OO – Ordering Officer PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QCP – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VTS – Veteran Transportation Service

4. Scope/Requirements:

4.1. Types of Non-Emergent Wheelchair Transportation Service:

4.1.1. The contractor shall provide Non-Emergent Wheelchair Transportation Service as-needed basis IAW all federal, state, and local regulations.

4.1.2. Occasionally a veteran will need to be transported with VA staff and equipment; the contractor shall return VA Staff and equipment to the original place of pick-up.

4.2. Transport of Miscellaneous Items with the Patient:

The Contractor may also be required to transport patient luggage (one – no more than 20 pounds), medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government. Luggage to be transported will be restricted to suitcase and valise types. When patients are transported to the Washington DC VA Medical Center, destination is deemed to be the ER, Admissions, the clinic, or service within the hospital, or directly to the ward as instructed by VA Staff. All patient records transported with the patient are confidential in accordance with HIPPA.

4.3. Contractor Personnel: Contractor personnel shall be courteous and always conduct themselves in a businesslike manner while providing services under this contract.

4.3.1. Non-Emergent Wheelchair Transport Drivers & Other Personnel

4.3.1.1. Non-emergent wheelchair van transport drivers shall at all times meet the qualifications specified in this contract as well as all applicable federal, state, and local government laws, regulations, and standards.

4.3.1.2. If the contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing, and any oPther qualifications to the Contracting Officer’s Representative (COR) for review.

4.3.1.3. All wheelchair transport drivers shall have a valid driver’s license IAW state requirements for their place of operation and the services they perform. If the contractor wishes to add or replace drivers throughout the life of the contract, it shall provide a valid driver’s license to the COR.

4.3.1.4. Investigative Requirements for Contract Personnel: Contract personnel will be subject to the same investigative requirements as those for regular VA appointees and employees. The level of investigation commensurate with the level of access to perform the performance work statement is: Special Agreement Checks (SAC). Fingerprinting for contract personnel will be conducted at Washington DC VA Medical Center. Thereafter, the contracted employees will be subject annually to the same investigative requirements as those for regular VA appointees and employees, with a 90-day window to complete such requirements as provided by Washington DC VA Medical Center. The VA Security and Investigation Center (SIC) is responsible for adjudicating all background investigations for contract employees.

4.3.2. Tuberculosis Exposure Control Policy

4.3.2.1. The contractor shall provide the VA with a policy on tuberculosis (TB) exposure and control, to include TB decontamination, within 5 business days upon award of contract by the Government.

4.3.2.2. The contractor shall have its personnel tested for TB IAW state guidelines and provide written confirmation to the COR that all personnel (current employees and any new hires) performing services under this contract are current in their TB test at the start of each Ordering Period.

4.4. Contractor Equipment, Vehicles, and Inspection:

4.4.1. Wheelchair vans shall meet all applicable federal, state, and local regulations and specifications, including but not limited to licensing, registration, and safety standards.

4.4.2. Wheelchair vans shall be safe and comfortable transportation of Veterans. It's essential that ample headroom must be available for Veterans transported in standard wheelchairs. Any type or style offering complete Veteran safety within the vehicle will be acceptable. Those considered lacking in this essential requirement will not be used for Veteran transport under this contract. Any replacement will be at the Contractor's expense.

4.4.3. The VA reserves the right to inspect the contractor’s equipment and vehicles or require documentation of compliance with state laws, rules, regulations, and guidelines governing non-emergent medical transport vehicles. VA inspections of contractor equipment do not constitute a warranty or guarantee that the contractor’s vehicles and equipment are properly maintained. The VA reserves the right to restrict the contractor’s use of equipment and vehicles in the performance of this contract that are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performance IAW the contract nor necessitate additional cost to the VA.

4.4.4. Each vehicle must be equipped with a general-use first aid kit.

4.4.5. Vehicles shall be clean and maintained in good repair IAW the manufacturer’s instructions.

4.4.6. The contractor shall not be permitted to borrow medical equipment from the Washington DC VA Medical Center facilities. Contractor shall at no time and under any circumstances exchange supplies, equipment, and/or medications with VA. The prices quoted in the Schedule shall be inclusive of consumables used in transport.

4.4.7. Contractor shall always have a wheelchair available for the transport of Veterans from the pickup point to the delivery point. When the Veteran is delivered to a destination other than the Department of Veterans Affairs and the return trip is ordered for the same day, the Veteran will transfer from the contractor's wheelchair to a facility-owned wheelchair. Veterans with scooters must only be transported in a regular passenger seat or in a wheelchair that can be safely strapped and locked down, and which provides for a seat belt for the passenger. Veterans requiring transport in a motorized scooter will transfer to a seat in the vehicle, with the scooter being transported with the Veteran as personal belongings at no additional cost to the VA.

4.4.8. The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

4.4.8.1. The contractor personnel performing services for the VA, shall, at all times, conduct themselves in a professional manner, and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications shall be worn in clear view above the waist. The contractor personnel shall not smoke/play loud music originating from any device in vehicles while transporting VA patients.

4.4.8.2. Each driver shall possess a driver’s license that is valid for the class of vehicle driven. Evidence of a special transportation service vehicle permit, or endorsement issued by the commissioner of public safety.

· Be at least 18 years of age and have not less than one year of experience as a licensed driver; and

· For the past three years:

· Have not had a driver’s license canceled or suspended.

· Have a driving record clear of convictions for operating a motor vehicle or motorcycle without insurance.

· Have a driving record clear of convictions for driving a motor vehicle without a valid current license for the class of vehicle driven

· Have a driving and criminal record clear of convictions for driving under the influence of alcohol or a controlled substance.

4.4.8.3. Responsibilities for Veteran safety will include the availability and appropriate use of Veteran restraining devices in each transport vehicle. The Contractor staff will adequately restrain the Veteran through every phase and during each movement to prevent injury to the Veteran. The need for additional staff to manage the Veteran in transport will be established before initiating the transport.

4.4.8.4. The driver will (within safety and reason) observe the Veteran during transport. Any indication of significant change in condition (i.e. sudden onset of rapid or labored respirations, complaints of chest pains) will be immediately communicated to the Medical Center Admitting office. Depending on the condition of the Veteran, the Veteran will be returned to the Admitting Office, transported to the nearest emergency room or advanced life support called.

4.4.8.5. Wheelchair van drivers shall be capable of administering oxygen and shall have completed the standard and advanced first aid course of the American Red Cross or equivalent. They must be capable of providing necessary medical assistance to the attending emergency medical technician or paramedic. It is the vendor's responsibility to provide a copy of the first aid certificates for all employees to the Contracting Officer Representative (COR) upon request.

4.5. Transportation Request:

4.5.1 VetRide or VA-approved Transportation Software Utilization:

The contractor agrees to utilize the VetRide Vendor Portal or VA-Approved Transportation Software with every patient transported under this contract.

Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal or VA-Approved Transportation Software for the vendor/contractor in this contract. The Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed:

a) Receive and respond to electronic trip requests.

b) Receive, use, and ensure the use of the Vendor pass by the driver.

c) Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-Approved Transportation Software system.

d) All invoices must be submitted within 30 calendar days of date of service IAW 38 CFR 70 to be considered timely submission.

i. The contractor’s invoice must be on the HCFA 1500 to include:

ii. Contract Number

iii. Date of Service (to include Box 24 A-J)

iv. Authorization number(s)

v. Pick-up and drop-off location of the patient

vi. Base Rate

vii. Name (Last, First and Middle Initial (if any)) and Full Social Security number (Box 1a) of patient transported

viii. Date of Birth and Sex

ix. Diagnosis Codes or Nature of Illness or Injury

x. Documentation of circumstances when billing for waiting time

xi. Any miscellaneous charges for which the contractor is expecting reimbursement i.e., Tool charges, waiting time, etc.

xii. VA authorizing official’s name

xiii. Healthcare Procedure Coding System/National Level II (HCPCS)

e) Unauthorized charges will be reviewed by the Contracting Officer Representative (COR) as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges that are being suspended.

4.5.1.1. A transportation request is defined as one incidence of a request for one-way service non-emergent wheelchair van transport. No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or VA-Approved Transportation Software Utilization. Contractors must have dedicated staff available to monitor this portal 24/7. Washington DC VA Medical Center Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff.

4.5.1.1.1. In the event VetRide or other VA-Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests. Washington DC VA Medical Center Travel Program Staff/or authorized VA employees will work with the Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA-Approved Transportation Software Utilization.

4.5.1.1.2. The Contractor must update VetRide or VA-Approved Transportation Software Utilization with any data and/or notes in real time that deviate from the original order such as invoicing for additional mileage due to a road closure, wait time, reason for no load, etc. Washington DC VA Medical Center Travel Program Staff/or authorized VA employees may place a “hold” on payment of this order until it has been reconciled.

4.5.1.2. Only the following VA staff are authorized to place, cancel, or make changes to transportation requests:

Contracting Officer’s Representative (COR) The Contracting Officer will furnish the Contractor with the names of individuals who are authorized, according to the list above, by a separate memorandum upon issuance of the contract. The Contracting Officer will update this memorandum throughout the life of the contract as personnel change.

Ordering Officers are responsible for issuing and administering orders placed under this contract. Ordering Officers have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from individuals listed on the memorandum issued by the Contracting Officer. Fulfilling orders from persons other than the individuals listed may result in loss or delay in payment for supplies/services provided under such orders.

Non-authorized VA employees and private agencies (e.g., nursing homes) are not considered authorized to place transportation requests.

4.5.1.2.1. All patient pick-up(s) and drop-off(s) shall be authorized via “orders” which shall only be issued by the Contracting Officer or designated Ordering Officers. When placing orders for services, the Ordering Officer shall contact the designated contractor point of contact(s) to provide the following information:

· Mode of transportation required,

· Required time of arrival

· Name of the beneficiary,

· Pick-up and delivery point,

· Type and number of additional medical care specialists required,

· Type of equipment required,

· Last four of the patient's Social Security Number, and

· Any other special instructions.

4.5.1.3. For ALL Transports – an Audit system will be put in place by the VA to include the COR or designee, Beneficiary Travel Department staff, and clinical staff to ensure appropriateness of the order and timeliness of the response.

4.5.1.4. The VA may authorize an escort (e.g., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient’s best interest. The contractor shall allow the escort to accompany the patient at no additional cost.

4.5.1.5. The Contractor shall be responsible for providing all vehicles and manpower necessary to meet all wheelchair van transport requirements of this contract. The Contractor will be authorized to utilize another company, as a subcontractor (certified to be within all requirements of this contract), to complete these transportation requests. All bills for this subcontractor service will be paid directly to the Contractor at the contract rate, and the Contractor shall reimburse the subcontractor at their agreed to rate. In the event the Contractor is unable to perform services or have services performed as required, the Contractor shall immediately notify the VA Travel Section and provide a justification for non-performance. The VA reserves the right to re-procure services, which cannot be performed by the Contractor, IAW the terms, conditions, and schedule of this contract. The Contractor shall indemnify the VA for excess re-procurement costs, which may result from the Contractor's inability to perform the required service. Payment of re-procurement costs shall not relieve the Contractor from any other provision in this contract covering inspection, acceptance, and deductions from payment. The VA will be the sole judge in determining when services will be re-procured. The failure of the Contractor to perform services within the required time frames and IAW terms and conditions may also provide cause for termination of the contract for "cause" (see FAR clause 52.212-4(m)).

4.5.1.6. The patient may bring up to three (3) liters of oxygen. The Contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

4.5.1.7. Response Times*

4.5.1.7.1. Orders that are scheduled by 7pm local time the day before the required services are defined as scheduled in advance. With the exceptions found below, the contractor shall arrive on time for all orders scheduled in advance.

4.5.1.7.2. For all add-ons (not scheduled in advance) transportation requests, with pick-up at Washington DC VA Medical Center: The contractor will be allotted up to a thirty (30) minute response time from time of order placement of the transportation requests.

4.5.1.7.3. For transportation requests which do not have a pick-up at Washington DC VA Medical Center:

a. The contractor may be required, if requested by the VA, to dispatch wheelchair van(s) on short notice for transportation requests not scheduled in advance; for these transportation requests, the contractor shall dispatch wheelchair van(s) within thirty (30) minutes of receiving the order.

b. Pick-up appointment times shall be agreed upon by the VA and contractor at time of order placement and be reasonable based upon travel distance, speed limits, and weather conditions.

c. The contractor’s patient pick-up time cannot be more than 15 minutes before the scheduled pickup time, nor 15 minutes later than the scheduled pickup time for transportation requests scheduled in advance.

* The contractor shall not be held liable for nonperformance caused by an occurrence beyond the reasonable control of the contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, and unusually severe weather. The contractor MUST notify the VA with as much advance notice as possible should any of these occur.

4.5.2. Cancellations

4.5.2.1. For trips in which the contractor is notified of cancellation before the vehicle is dispatched, there shall be no charge to the Government.

4.5.2.1.1 . A “no show” is defined as a transportation request which is cancelled after the contractor has dispatched a vehicle, the vehicle is enroute, or has arrived at the pick-up location, and there is no longer a requirement for patient transportation. The contractor may request one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for non-emergent wheelchair transport, and the one-way mileage accrued enroute to the pick-up location at time of cancellation. Mileage for no- show cancellations shall be confirmed by the contractor and reported to the VA as soon as possible from time of cancellation.

4.5.2.2. For transportation requests OUT of Washington DC VA Medical Center ONLY – The contractor will immediately dispatch a vehicle upon receipt of the order. When the contractor is notified of a cancellation before arrival at the Washington DC VA Medical Center campus, there shall be no charge to the Government.

4.6. Pick-Up/Drop-Off/Reporting Procedures:

4.6.1. The Veteran will be delivered to and picked up from the assigned appointment location. (For example, the (facility name) Medical Center nursing stations, wards or units, clinics, private home, or community nursing home.) All patients shall be attended by an authorized responsible party at all times. Assistance in maneuvering stairs and other barriers shall be provided by the driver and/or authorized attendant when necessary. These services may need to be provided within or outside the home (i.e., from the door to the vehicle. When the patient is delivered to a destination (i.e., a clinic or other appointment), an authorized care giver or medical staff at the destination must be informed of the patient’s arrival by the Contractor’s driver or authorized attendant.

4.6.2. All Veterans will be checked in and out with the appropriate administrative staff. Veterans must be checked in by their appointment time and picked up in a timely fashion after their schedule appointment.

4.7. Patient Welfare:

4.7.1. The contractor shall be responsible for the patient’s welfare during transport. The contractor shall be held responsible for patient and/or VA property during transport. Any damaged or lost wheelchairs, walkers, crutches, or personal belongings shall be replaced at the contractor’s expense.

4.7.2. The VA requires the contractor to exercise extreme caution and care in the handling of patients.

4.7.3. If a VA beneficiary being transported declines to be properly secured or removed the securement devices himself/herself, the driver will notify the Contracting Officer’s Representative (COR) of this fact prior to departure. The contractor is not required to transport any VA beneficiary who refuses to be properly secured while being transported. In the event that the beneficiary refuses to be properly secured, they shall be returned back into the building which they came from.

4.8. Incident Reporting:

4.8.1. The contractor shall notify the COR, Requestor, Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the COR, Program Manager, or Beneficiary Travel Department, by the close of business of the next working day.

4.8.2. The COR will monitor the service provided. The contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The contractor shall promptly inform the COR of any complaints received directly from patients. If warranted, the VA may conduct incident investigations and require written response from the contractor within 48 hours of request.

4.9. Invoicing:

4.9.1. Each transport shall include thirty (30) minutes of wait time; the contractor may invoice for wait times in excess of this initial thirty (30) minutes. Wait time shall begin only once the contractor has both reached the pick-up address location and the appointment time has elapsed. All wait times shall be itemized and invoiced in fifteen (15) minute intervals. For partial fifteen (15) minute intervals, zero (0) to seven (7) minutes shall be rounded down to zero (0) minutes and eight (8) to fifteen (15) minutes rounded up to fifteen (15) minutes.

4.9.2. When invoicing for mileage, the contractor shall round to the nearest mile. Mileage ending in .5 or higher shall be rounded up to the nearest mile. Mileage ending in .4 or lower shall be rounded down to the nearest mile. Payment for mileage to or from the point of care shall be limited to the VA’s calculation according to the VA’s Bing Maps API determination. Bing Maps API is optimized to determine mileage based on the shortest time of travel.

4.9.3. Long Distance Mileage — Payment for mileage outside the contract miles covered in the base rate, shall be

4.9.4. at the mileage rate stated in the price schedule and shall be based upon the miles from the pick-up point and the specified destination. Any mileage from the place of business and/or location of vehicle and the pick-up point, or from the delivery destination back to the place of business and/or location of next trip are not considered as a separate item of this reimbursement but would be expected to be incorporated into the mileage rate as part of the administrative costs (or costs of doing business).

4.9.5. Upon notification of the contracting officer, the vendor must receive training and begin implementation of invoices via VetRide within 30 days versus VA Tungsten Network e-Invoicing network. Invoices must be submitted via the electronic HCFA 1500 in the VetRide Vendor Portal or other VA approved software. These invoices shall not include patient information, but shall include the following:

· Contractor Name

· Contract Number

· Current Purchase Order Number

· Date of service

· Total amount invoiced including a summary of the total number of charges that align with the line items of this contract (i.e., total number of Non-Emergent Wheelchair Base Rate, total mileage incurred in excess of the base rate, etc.)

· An itemized list of charges or services rendered that align with the line items of this contract (i.e., Non-Emergent Wheelchair Base Rate, Mileage incurred outside the base rate, etc.)

Payment by VA under this contract to a provider of non-emergent wheelchair transportation services authorized under this contract extinguishes any and all liability on the part of the VA BENEFICIARY for that transportation service. UNDER NO CIRCUMSTANCES ARE VA BENEFICIARIES, THIRD PARTY INSURANCES, MEDICARE, OR MEDICAID TO BE BILLED FOR THE SERVICES PERFORMED UNDER THIS CONTRACT.

5. Period & Place of Performance:

5.1. This contract’s ordering period shall be five years effective from Date of Award.

5.2. The Place of Performance is variable and may occur within the states of DC, MD, VA; non-emergent wheelchair transportation services may be required to or from locations including, but not limited to the following:

5.2.1. Washington DC VA Medical Center to include specific Atrium Clinics, Emergency Department, pavilions, or out-buildings on the DC VAMC campus. The Washington DC VA Medical Center address is: 50 Irving Street NW Washington, DC 20422.

5.2.2. DC VAMC Community-Based Outpatient Clinics (CBOCs):

5.2.3. Other VA Locations within Veterans Integrated Service Network (VISN) 05 including, but not limited to:

5.2.4. Other Non-VA Medical facilities and Community Care facilities as authorized by the VA.

5.2.5. Veteran’s residence.

5.2.6. Local airports including: DCA, BWI, & IAD.

6. Quality Control Plan:

6.1. Quality Control:

6.1.1. The contractor shall maintain a Quality Control Plan (QCP) that contains, at a minimum, the following:

6.1.1.1. A description of the company’s organizational structure including a description of the roles and responsibilities of management and supervisors.

6.1.1.2. A description of the methods to be used by the contractor for identifying and preventing deficiencies or problems in the quality of service.

6.1.1.3. A description of the specific steps the contractor will take for corrective action if needed if a deficiency or problem in the quality of service occurs.

6.1.1.4. A description of the company’s records and tracking system used to identify up-to-date background checks, applicable certifications and tests, and training of each employee performing services under this contract.

6.1.1.5. A description of the method (s) used to provide on-time non-emergent wheelchair transportation services to meet the requirements of this contract (24/7 availability).

6.1.1.6. A description of the methods used to identify and prevent radio communication breakdowns and a detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios.

6.1.1.7. CONTINGENCY PLAN: (In case VetRide Vendor Portal is down) A description of the method/system used to log all service requests. The contractor shall confirm that the log indicates the date and time of service call, actual time of pick-up versus the scheduled time, name of patient requiring services, designated pick-up and delivery points, mileage, and actual waiting time at pick-up and delivery points if waiting charges are claimed. The contractor shall confirm that the log will be sent to the COR monthly.

6.1.2. The Government will evaluate the contractor’s performance under this contract to ensure that the contractor’s QCP is adequate, and that quality is achieved through a Quality Assurance Surveillance Plan (QASP).

6.1.3. The Government shall prepare a QASP after contract award derived from the PWS and contractor’s submitted QCP. The QASP is a “living document” and the Government may review and revise it at any time. However, the Government shall coordinate changes to the QASP with the contractor.

6.1.4. The QASP will specify the work requiring surveillance and the Government’s method of surveillance.

6.2. Minimum Performance Standards:

6.2.1. The contractor shall maintain performance standards IAW the standards outlined in the table below. Failure to meet the Acceptable Quality Levels (AQL) may result in termination of the contract.

6.2.2. The QASP will include the standards below as well as others derived from the successful offeror’s QCP.

Reference

Provide on- time non-emergent wheelchair van services

orders

of monthly invoices/reports

7. COVID-19 Or Other Similar Infectious Diseases:

7.1. Contractor shall not refuse transports of COVID-19 positive or other similarly infected patients.

7.2. Contractor shall abide by all additional procedures and precautions that may be implemented by the VA based on VA-issued guidance and/or CDC recommendations. These procedures are subject to change throughout the life of the contract and will be incorporated via attachment (See APPENDIX B VTS Patient Transport PPE and Vehicle Cleaning/Disinfection SOP).

7.3. Contractor shall have written policy of steps they will take to prevent the spread of COVID-19 or other similarly infectious diseases by their employees and/or vehicles. This policy shall, at a minimum, include procedures of screening drivers before each shift, deliberate decontamination of their vehicles and all other preventative precautions taken by Contractor employees.

7.4. Contractor shall furnish all required PPE throughout the life of the contract.

8. Conformity To Regulations:

8.1 The contractor and his/her operators shall conform to all Federal, State, and local regulations governing the performance of contracted services.

8.2 VAMC facilities have been designated NO SMOKING areas in their entirety. Individuals found in violation of this no smoking policy may be subject to a $50.00 federal citation for disregarding posted safety rules and regulations. Furthermore, the contractor may be directed to stop work. The contractor is to notify all of his/her employees and/or sub-contractors of this strict enforcement policy.

9. Wage Rates:

9.1. Wage Determination(s) as listed in Section D in this solicitation are applicable to any resulting contract.

9.2. The contractor certifies by signature on this offer that the salaries to be paid workers involved in the performance of the contract are equal to or greater than those specified in the attached Wage Determination(s).

9.3 The Department of Labor has held that contractors must pay their employees the Service Contract Labor Standards wage while they are driving both to and from destinations for the VA. The Wage Determination is attached in Section D.

10. Evidence of Coverage:

10.1 Before commencing work under the contract, the contractor shall furnish the Contracting Officer with a certification from his/her insurance company indicating that the coverage outlined in this contract has been obtained and that it may not be changed or canceled during the term of the contract.

11. Workers’ Compensation:

11.1 The Act of June 25, 1936, 42 Stat. 1938 (40 USC 290) authorized the constituted authority of the several states to apply their workmen’s compensation laws to all lands and premises owned or held by the United States. The contractor agrees to procure and maintain, while the contract is in effect, Workers’ Compensation and Employer's Public Liability insurance. The policy shall provide coverage for Public Liability Limits of not less than the statutory limitations for any one accident and at least meet the statutory limitations if more than one person is involved. Upon award of the contract, the contractor shall furnish to the Contracting Officer a certificate from its insurance company indicating that this coverage has been obtained and that such coverage may not be changed or canceled unless 30 days' advance written notice is provided to the Contracting Officer.

12. Contractor Personnel Security Requirements:

12.1 All contractor employees who require access to the Department of Veterans Affair's computer systems or who come into contact with veteran/beneficiaries shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement before contract performance. This requirement is applicable to all subcontractor personnel requiring the same access. If the investigation is not completed before the start date of the contract, the contractor will be responsible for the actions of those individuals they provide to perform work for the VA.

Position Sensitivity - The position sensitivity for this contract has been designated as LOW RISK.

Background Investigation - The level of background investigation commensurate with the required level of access for this contract is National Agency Check with Written Inquiries.

Contractor Responsibilities:

• The contractor shall pre-screen all personnel requiring VA access to ensure they maintain a U.S. citizenship and are able to read, write, speak, and understand the English language.

• The contractor shall submit or have their employees submit the following required forms requested by Department of Veterans Affairs, Office of Security and Law Enforcement, Security and Investigations Center, 2200 Fort Roots Drive Bldg. 104, North Little Rock, AR 72114 within 30 days of receipt:

• All documents completed and submitted at the following website: http://www.va.gov/SECURITYINVESTIGATIONSCENTER/

• The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. Failure to comply with the contractor personnel security requirements may result in termination of the contract or cause.

The contractor shall agree that all deliverables, associated working papers, and other material deemed relevant by the contractor in the performance of this task order are the property of the United States Government. The contractor shall agree that all individually identifiable health information shall be treated with the strictest confidentiality. Access to records shall be limited to essential personnel only. Records shall be secured when not in use. At the conclusion of the contract, all copies of individually identifiable health records shall be destroyed or returned to the VA. Any individually identifiable health records shall be deleted from computers not belonging to the VA. The contractor shall comply with the Privacy Act, 38 U.S.C. 5701, 38 U.S.C. 7332, and 5 U.S.C. 552(a) et. Seq. Contractor staff shall sign confidentiality statements before the start date of the contract. The contractor shall comply with all provisions of the Health Information Portability and Accountability Act (HIPAA), including but not limited to privacy, security of electronic health data, and adherence to standards and code sets as required by HIPAA. The contractor shall ensure the confidentiality of all patient and employee information and shall be held liable in the event of breach of confidentiality. Any person, who knowingly or willingly discloses confidential information obtained from the VA with non-essential persons, may be subject to fines.

12.1.1 HIPAA COMPLIANCE. HIPAA compliance is required. The contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health, and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans

Affairs (VA). IAW HIPAA, the contractor may be required to enter into a Business Associate Agreement (BAA) with VA.

12.1.2 BLOOD BORNE PATHOGENS: The contractor and the employees provided, pursuant to this contract, shall comply with the effective VAMC Policy (and Occupational Health requirements IAW OSHA Blood Borne Pathogens (BBP) Law and the OSHA Tuberculosis Compliance Directive, enforceable under OSHA’s General Duty Clause) governing health care workers infected with a blood borne pathogen. If the contractor obtains information that a health care worker providing care pursuant to this agreement may be infected with a blood borne pathogen, the contractor will advise the Contracting Officer immediately.

13. Medical Liabilities Insurance:

13.1 The contractor shall carry required insurance (See VAAR Clause 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE) and vehicle insurance IAW the Washington, DC; Maryland, and Virginia Department of State Health Services.

14. Annual VHA Training:

14.1 IAW VHA Directive 2003-028 "Compliance and Business Integrity Program", its updates or replacement directives, IG Guidance at 8994, Section II(C); Guidance at 4875, Section III (B)(4) Sentencing Guidelines, Section 8B2.1 (b) (4) (B) annual compliance training is to be provided to all contractors within the scope of their work. The medical center CORs are to coordinate the annual training with their respective Contracting Officer and Compliance and Business Integrity Officers. A copy of the documentation of the completed annual training is to be provided to the Compliance and Business Integrity Officers for their files.

14.2 IAW VHA Directive 1605.01 “Privacy and Release of Information”, updates or replacement directives, annual VHA Privacy Policy Training is to be provided to all contractors within the scope of their work. A copy of the documentation of the completed annual training is to be provided to the Contracting Officer and the facility's Privacy Officer for their files.

14.3 IAW VA Directive 6500, “Information Security Program”, updates or replacement directives, annual VHA Cyber and Security Information Training is to be provided to all contractors within the scope of their work. A copy of the documentation of the completed annual training is to be provided to the Contracting Officer and the facility's Information Security Officer for their files.

15. Conformance with Environmental Management Systems:

15.1 The contractor shall perform work under this contract consistent with the relevant policy and objectives identified in the agency, organizational, or facility environmental management system (EMS) applicable for your contract. The contractor shall perform work in a manner that conforms to all appropriate Environmental Management Programs and Operational Controls identified by the agency, organizational, or facility EMS, and provide monitoring and measurement information as necessary for the organization to address environmental performance relative to the environmental, energy, and transportation management goals. In the event an environmental nonconformance or noncompliance associated with the contracted services is identified, the contractor shall take corrective and/or preventative actions. In the case of a noncompliance, the contractor shall respond and take corrective action immediately. In the case of a nonconformance, the contractor shall respond and take corrective action based on the time schedule established by the EMS Site Coordinator. In addition, the Contractor shall ensure that their employees are aware of the roles and responsibilities identified by the environmental management system and how these requirements affect their work performed under this contract.

All on-site contractor personnel shall complete yearly EPA sponsored environmental training specified for the type of work conducted on-site. Upon contract award, the Contracting Officer's Representative will notify the facility-level Environmental Management Systems Coordinator to arrange EMS training for appropriate staff.

16. Contractor Performance Assessment Rating System (CPARS):

Required Registration with Contractor Performance Assessment Rating System (CPARS)

16.1 As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates contractor past performance on all contracts that exceed $250,000 and shares those evaluations with other Federal Government contract specialists and…