36C24621Q0590 0005.docx

B.2 PRICE SCHEDULE

5. PROJECT NUMBER (if applicable)

CODE

7.

ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF

PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE

OF YOUR

ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERE

D CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES

SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR

OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendmen t, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED

STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF

CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF

SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 05-26-2021 658-21-3-085-0271 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 To all Offerors/Bidders

36C24621Q0590 05-26-2021

X X X

X The purpose of this amendment is to publish a revised performance work statement due to a change in the Government's requirement

a. See the revised performance work statement starting from page 2 to page 14 of this amendment document

b. See the revised B.2 Price Schedule starting from page 14 to page 18 of this amendment document

c. TECHINCAL QUESTIONS: Offerors should submit all technical questions related to this amendment to the Contract Specialist in writing via email, to Rod ney Wilson @ rodney.wilson2@va.gov. on or before 12 PM EST, June 2, 2021.

Address Subject Line: Beneficiary Travel Ambulance Services, 36C24621Q0590- 0005

All other terms and conditions remain the same.

Chinedu Nwauwa Contracting Officer Performance Work Statement ALS/BLS Ambulance Service Salem Veteran Affairs Medical Center 1970 Roanoke Boulevard Salem, VA 24153

I. INTRODUCTION

A. The Salem Veterans Affairs Medical Center (VAMC) provides diagnostic and therapeutic services in medicine, surgery, rehabilitation medicine, psychiatry, and skilled nursing home care. This facility also provides services to those Veterans not requiring hospitalization.

B. The contract requires provision of Basic Life Support (BLS) and/or Advanced Life Support (ALS) Ambulance Services, for emergent and/or scheduled transport, as well as ALS ambulance services on stand-by on the VAMC campus during cardiac catheterization procedures. The contractor shall furnish twenty-four (24) hour ambulance service for the beneficiaries of the Salem VAMC at the following location: 1970 Roanoke Boulevard, Salem, VA 24153.

C. All services conducted in Virginia must comply with the Virginia Department of Human Resources, Virginia Office of Emergency Medical Services standards. All Salem VAMC required services conducted in Virginia, must comply with the rules and regulations required of firms, corporations, agencies, organizations, or associations providing emergency medical services within the Commonwealth of Virginia.

II. DEFINITIONS

A. Basic Life Support (BLS) - the type of care that first-responders, healthcare providers and public safety professionals provide to anyone who is experiencing cardiac arrest, respiratory distress or an obstructed airway

B. Advanced Life Support (ALS) – a set of life-saving protocols and skills that extend beyond Basic Life Support (BLS). It is used to provide urgent treatment to cardiac emergencies such as cardiac arrest, stroke, myocardial infarction, and other conditions.

C. Advanced Life Support Transport - the provision of care by EMS personnel who are certified as an Emergency Medical Technician (EMT) - Enhanced, Advanced EMT, Intermediate, or Paramedic or equivalent as approved by the Board of Health.

D. Ambulance – (as defined by § 32.1-111.1 of the Code of Virginia) any vehicle, vessel or craft that holds a valid permit issued by the Office of EMS and that is specially constructed, equipped, maintained and operated, and intended to be used for emergency medical care and the transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless. The word "ambulance" may not appear on any vehicle, vessel, or aircraft that does not hold a valid EMS vehicle permit.

E. Board or State Board – The State Board of Health

F. Base Rates: The base rate shall constitute full compensation for one-way trips which do not exceed the mileage threshold as defined in this performance work statement. The Contractor shall receive the base rate quoted in the schedule for all one-way trips ordered.

G. CO – Contracting Officer

H. COR – Contracting Officer’s Representative

I. Certification – a credential issued by the Office of EMS for a specified period to a person who has successfully completed an approved training program.

J. EMS – Emergency Medical Services

K. Emergency Medical Services Vehicle or EMS Vehicle - Any vehicle, vessel, aircraft, or ambulance that holds a valid emergency medical services vehicle permit issued by the Office of EMS that is equipped, maintained or operated to provide emergency medical care or transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless.

L. License - An authorization issued by the Office of EMS to provide emergency medical services in the state as an EMS agency.

M. Mileage Rate – Mileage rate for ambulance transportation services is the rate paid for each mile traveled beyond the specified Mileage Threshold. This rate applies to loaded, one-way transportation outside of the 25-mile radius of Veterans Affairs Medical Center Salem, Danville CBOC, Stanton CBOC Wytheville CBOC and Tazewell CBOC, Virginia. In no event shall the Contractor receive this rate for miles traveled within the specified mileage threshold.

N. Mileage Threshold – The mileage threshold is defined as a 25-mile radius of each of the following facilities: Veterans Affairs Medical Center Salem, Danville CBOC, Stanton CBOC, Wytheville CBOC and Tazewell CBOC, Virginia using the MapQuest internet version (internet address: http://www.mapquest.com). For all one-way trips outside the mileage threshold and except trips to other VA Medical Centers under VISN 6, the Contractor will receive the flat rate awarded for that trip and if applicable the awarded mileage rate for one-way distance beyond the mileage threshold. In no event shall the Contractor receive reimbursement for mileage rate for trips inside of the 25-mile radius of Veterans Affairs Medical Center Salem, Danville CBOC, Stanton CBOC, Wytheville CBOC and Tazewell CBOC, Virginia. Mileage rate are only applicable outside the 25-mile radius of the Veterans Affairs Medical Center Salem, Danville CBOC, Stanton CBOC, Wytheville CBOC and Tazewell CBOC, Virginia.

O. No Load/Cancellation: Occurs when service is requested, and the contractor responds and arrives at the pick-up point, but a patient is not transported.

P. Outside PSA: Trips that are not described in the PSA. Trips may be taken to other VA Medical Centers within VISN 6. The VA Medical Centers in VISN 6 are as follows: Hampton VA Medical Center, Hampton Virginia; Hunter Holmes McGuire VA Medical Center, Richmond, VA; Durham VA Medical Center, Durham, North Carolina; Charles George VA Medical Center, Asheville, North Carolina; W.G. Hefner VA Medical Center, Salisbury, North Carolina; Fayetteville VA Medical Center, Fayetteville, North Carolina.

Q. Patient - A person who needs immediate medical attention or transport, or both, whose physical or mental condition is such that he is in danger of loss of life or health impairment, or who may be incapacitated or helpless as a result of physical or mental condition or a person who requires medical attention during transport from one medical care facility to another

R. PWS – Performance Work Statement

S. Primary Service Area (PSA): Salem VA Health Care System Primary Service Area: Areas in the Commonwealth of Virginia consisting of the following counties: Alleghany, Amherst, Appomattox, Augusta, Bath, Bedford, Botetourt, Campbell, Carroll, Craig, Floyd, Franklin, Giles, Grayson, Henry, Highland, Montgomery, Patrick, Pittsylvania, Pulaski, Roanoke, Rockbridge, Smyth, Tazewell, and Wythe. For the purpose of this contract, the mileage threshold is defined as within 25-mile radius of the Veterans Affairs Medical Center Salem, Danville CBOC, Stanton CBOC, Wytheville CBOC and Tazewell CBOC, Virginia

T. Standard of Care - The established approach to the provision of basic and advanced medical care that is considered appropriate, prudent and in the best interests of patients within a geographic area as derived by consensus among the physicians responsible for the delivery and oversight of that care. The standard of care is dynamic with changes reflective of knowledge gained by research and practice.

U. QASP – Quality Assurance Surveillance Plan

V. Stand-by - The emergency vehicle and crew do not leave the scene for the duration of the event due to the potential hazards or high risk of injury during the patient procedures.

W. TJC – The Joint Commission

X. Travel Clerk – VAMC agent responsible for setting up scheduled transport during normal business hours.

Y. Administrative Officer of the Day (AOD) – VAMC agent responsible for setting up scheduled or emergency transports during Weekends, Holidays, Evenings and Nights.

III. GENERAL REQUIREMENTS

A. All equipment, machinery, linens, etc. taken with patients from the Salem VAMC must be returned to the VAMC. The Contractor is responsible for furnishing linen and blankets for use in the ambulance. Clean and fresh linen and blankets must be used for each patient. The VAMC will not furnish linen or participate in a linen exchange program. The following items must be provided on each ambulance:

· 2 sheets, disposable or cloth

· 2 pillowcases, disposable or cloth for each pillow

· 2 cloth towels

B. Universal Precautions will be used on all VAMC\ patients.

C. If the contractor fails to furnish ambulance service within one hour after receiving a VAMC request for service, the VAMC reserves the right to obtain the services from another source and to charge the contractor any excess cost which may result. The VAMC will be the sole judge in determining when to order service from another source.

D. When conditions, neither foreseeable and/or controllable by the Contractor occur, such as but not limited to severe storms, flooding, hazardous road and travel conditions, time and distance requirements shall be considered secondary to safety precautions. Delays or exceptions to the required quality of services shall be reported to the Travel Clerk or AOD. The COR will determine as to whether such delays in service will be excused.

E. For excusable time lost in waiting at either or both ends of a trip, the contractor will be reimbursed at the rate of one-fourth the hourly rate for each quarter hour (fifteen minutes). As soon as a delay is anticipated, the contractor will contact the Travel Clerk at (540) 982-2463 x2809 Monday thru Friday 8:00 a.m. to 4:30 p.m. During other than normal duty hours, the contractor shall contact the AOD at (540) 982-2463 x2173.

F. Unless specifically authorized by the Chief, Health Administration Service or his/her designee, the driver is to take the shortest distance available. The contractor will be reimbursed accordingly if advised to take the most expeditious route regardless of mileage.

G. Requests for services will be made in writing or by telephone under the authority of the Chief, Health Administration Service, typically by the Travel Clerk, AOD, or COR. The contractor will be informed of the time and location for pick-up and drop-off of the patient. The contractor shall notify the VAMC of any delays in the transporting of patients.

H. On evenings and weekends the contractor shall have the right staff units in accordance with the typical demand requirements of the VAMC. Reduction in available units during the evening and weekend does not relieve the contractor of the responsibility to provide ambulance services when requested.

I. The contractor must provide the inspection reports on all vehicles that will be used in the performance of this contract. New vehicles must be reported before being used for this contract.

J. Adherence to schedules is of the utmost importance. Contractor shall pick up the customer as near to the scheduled pick-up time as possible. If Contractor arrives earlier than the scheduled pick-up, the driver shall wait at the pick-up location until fifteen (15) minutes past the scheduled pick-up time before calling the dispatcher for instructions.

K. Contractor shall immediately report to the COR all vehicle breakdowns or other problems which may cause service disruptions. When a breakdown occurs, it is the responsibility of the Contractor to provide a back-up vehicle to minimize any delay or inconvenience to the VAMC.

L. The Contractor shall be required to maintain 95% on time performance daily. Trips shall be considered “on-time” as long as they arrive at the destination on or before the scheduled arrival time.

M. STAND-BY ALS Services:

1. The Contractor shall provide ALS Ambulance and crew on stand-by on the VAMC Campus while cardiac catheterization procedures are being performed on patients in the hospital. ALS requirements are:

i. A ground ambulance equipped with an ALS equipment package. An ALS equipment package may be transferred to a ground ambulance not otherwise equipped to provide the needed level of ALS patient care from another appropriately equipped EMS vehicle. This transfer must include all items required for the type of ALS equipment package that the attendant-in-charge is authorized to use.

ii. The attendant-in-charge must be certified as an advanced life support level provider or an equivalent approved by the Office of EMS.

iii. An attendant must be certified as an emergency medical technician or an equivalent approved by the Office of EMS in addition to the attendant-in-charge. The attendant must not serve as the attendant-in-charge. An operator may serve as the attendant if certified as an emergency medical technician or an equivalent approved by the Office of EMS.

iv. An ALS provider may provide care if the required EMS personnel do not respond to a call to fully staff the ambulance that has responded to the scene. The extenuating circumstances of the call must be documented in writing. Based on extenuating circumstances and documentation, the EMS agency or the EMS provider may be subject to enforcement action.

2. The contractor will be contacted by telephone each day services are required; a minimum of one (1) hour notice prior to the requested time of arrival will be provided.

3. It is estimated that services may be required daily, Monday – Friday.

4. The contractor shall dispatch ALS ambulance in such a fashion as to ensure timely arrival (i.e. within ten (10) minutes of requested time due.)

5. Upon arrival the contractor will check in with the COR located in the Catheterization Lab, Building 143, Room IEF 169.

6. When transport becomes necessary, the contractor shall transport the patient to Lewis Gale Medical Center, 1900 Electric Road, Salem, Virginia or to another facility approved by the VAMC Chief of Medicine or Chief of Cardiology.

7. Contractor cannot refer patients to any other facility other than those approved by VAMC Chief of Medicine or Chief of Cardiology.

8. The contractor will remain until they are released by the COR or designated personnel.

IV. TERM OF CONTRACT.

A. The contract is effective for one year from date of award plus one renewal period each year until the Contracting Officer authorizes such services in writing. The term of contract is estimated to be:

V. PATIENT TRANSPORT FROM VAMC

A. Ambulance drivers will report to the AOD, located in the Emergency Department. The AOD is staffed 24 hours a day, seven days a week. The contractor will follow the following protocol.

1. Report to the AOD

2. Announce their arrival to pick-up and transfer patient

3. Obtain report of pertinent information regarding patient’s condition from the primary physician.

VI. NUMBER OF PATIENTS

A. Only one patient shall be transported on a trip unless specifically authorized by the VAMC.

VII. PATIENT WELFARE

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

B. The contractor shall exercise extreme caution and care in the handling of patients. Any abuse of patients shall be grounds for default action or termination of the contract.

C. The contractor is required to observe speed limits; vehicles should be swept clean and the exteriors washed periodically. Drivers are to escort patients in need of assistance to and from point of pick-up and destination.

VIII. INCIDENT REPORT

A. Contractor shall immediately report all medical incidents or accidents, including those where there is no apparent injury to the patient, which occurs while transporting VA beneficiaries. A written report from the driver documenting the facts of the incident/accident shall be provided to the COR within 24-hours of the occurrence. The written report shall include the names, addresses, and telephone numbers of any witnesses as well as any applicable Police Reports.

B. Any accident involving major damage, serious personal injury or loss of life shall be reported to the COR immediately. Records shall be kept for three (3) years for each accident a vehicle is involved in, including the repair work required to return the vehicle to service.

IX. EQUIPMENT SPECIFICATIONS – VEHICLES

A. The ambulance under the terms of this contract will be licensed and meet the minimum vehicle requirements as established by the Virginia office of Emergency Medical services.

B. The VA reserves the right to inspect the contractor’s equipment and vehicles or require documentation of compliance with contract specifications, and State Laws, rules, regulations, and guidelines governing Emergency Medical Services Vehicles (ambulances). VA inspections of contractor facilities shall in no way constitute a warranty by the VA 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 which are in need of repair, unclean, unsafe, contain damages to the interior or exterior body, and are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performing in accordance with the strict intent and meaning of the contract without additional cost to the VA.

X. EMERGENCY VEHICLES REQUIRED FOR THIS CONTRACT

A. BASIC LIFE SUPPORT AMBULANCE (BLS) shall be defined as a Class B Emergency Medical Services (EMS) vehicle. The Class B EMS vehicle is primarily intended for the response to the location of a call for the delivery of basic life support, and for the transportation of patients who require such care.

B. ADVANCED LIFE SUPPORT AMBULANCE (ALS) shall be defined as a Class C Emergency Medical Services (EMS) vehicle. The Class C EMS vehicle is primarily intended for the response of the call, delivery of basic and advanced life support, and for the transportation of patients who require such care.

C. EMERGENCY MEDICAL CARE VEHICLE shall have patient compartment facilities, oxygen, suction systems and equipment, and additional systems equipment, accessories, and supplies as well as environmental climatic equipment, and communications.

D. On evenings and weekends the contractor shall have the right staff units in accordance with the typical demand requirements of the Medical Center. Reduction in available units during the evening and weekend does not relieve the contractor of the responsibility to provide ambulance services when requested.

XI. TOLL CHARGES

A. Prices quoted in the schedules do not include any ferry, bridge, tunnel, or road charge. Any such legitimate toll charges incurred shall be limited to ONE WAY ONLY and shall be listed separately on Contractor’s invoices.

B. Service Provider shall be responsible for all county, cities, local or state fees imposed on the Service Provider during performance of this contract.

XII. PATIENT CUSTODY

A. Contractor shall not release the patient from his/her custody, unless custody is released to charge nurse on duty at the facility patient is being transported, or to a designated point of contact at the patient’s residence. Contractor shall take every reasonable measure to assure the well-being of the patient at their destination. Patients brought in by ambulance for a scheduled clinic appointment shall be delivered directly to that specific clinic, released to the custody of clinic personnel, and picked up, as ordered, in the clinic after the appointment by the ambulance crew.

XIII. CONDUCT

A. The following acts are not permissible while providing services under this contract or while on VAMC premises:

1. Use of intoxicating liquors, narcotics or controlled substances of any kind (excluding doctors’ prescriptions which do not impair drive’s driving ability) while on duty or reporting for duty while under the influence of liquors, narcotics or controlled substance of any kind (excluding doctors’ prescriptions which do not impair driver’s driving ability).

2. Gambling in any form.

3. Carrying of pistols, firearms or concealed weapons.

4. Smoking and other uses of tobacco while on duty.

5. Physical violence to settle a dispute with a fellow employee, customer(s) or the general public while on duty.

6. Spitting in prohibited places or any other unsanitary, offensive, or insensitive practices or behavior.

7. Use of loud, indecent, or profane language and/or making threatening or obscene gestures toward customers or other employees.

8. Stopping for personal business, including use or restroom facilities, while vehicle is occupied by a passenger. The driver shall not leave the vehicle with the key in the ignition at any time.

9. Engaging customer in a verbal confrontation to settle a disagreement. Should a disagreement arise, the driver is to contact his dispatcher/supervisor via the radio system.

10. Soliciting or accepting tips from customer, companions, or others at any time.

XIV. COMMUNICATION SYSTEM

A. Contractor’s Communication System shall consist of:

1. Telephone System

2. Contractor shall have sufficient telephone capacity to ensure immediate communication access between the Salem VAMC and the Contractor’s facility for the purposes of canceling trip requests as well as handling other emergencies. If the Contractor’s place of business is located beyond the local telephone call zone, the Contractor shall accept telephone orders for service on a collect basis or provide a toll free.

3. The Contractor shall have telephone coverage to accept calls from Salem VAMC seven (7) days a week/24 hours a day Sunday through Saturday.

4. Vehicle Communication

5. Contractor shall ensure the availability of mobile radio and /or cellular telephone communication with all vehicles providing transportation service at all time.

XV. COMPLAINTS

A. Complaints against behavior or courtesy received by the COR may result in requiring Contractor to remove offender from the provisions of contracted services. Offenders who accumulate five (5) unrelated, substantiated complaints in a 12-month period shall be prohibited from providing any further services under this contract. The COR shall monitor the service provided. Contractor shall cooperate with the COR in providing information and answering questions in a timely manner when requested. Contractor shall refer complaints received directly from the customer(s) to the COR. All complaints received by the COR and forwarded to the Contractor shall be investigated promptly. After investigation and disposition, Contractor shall respond to the COR within five (5) working days after receipt by the Contractor.

XVI. PERFORMANCE STANDARDS SUMMARY

Contractor shall provide Ambulance Transportation Services for beneficiaries for whom such service is specifically authorized by the VA Medical Center (VAMC), Salem, Virginia. Contractor shall furnish all personnel and equipment to provide services for Ambulance Transportation Services, in accordance with all of the terms, conditions, provisions, and referenced materials of this solicitation.

This is a Firm Fixed-Price Requirements contract.

Base Year Period of Performance: Date of Award – 12 months from date of award

Total Estimated Base Year Cost

Option Year 1 Period of Performance: 12 months from the end of the base year

hr.

Total Estimated Cost for Option Year 1

TOTAL ESTIMATED COST FOR BASE AND OPTION YEAR 1: $_________________