36C24622Q0373_1.docx

36C24622Q0373

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9.

ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE

WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15

CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTA

CHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNAT

URE OF OFFEROR/CONTRACTOR

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C24622Q0373 02-28-2022 Amber Hess 7577229961 03-09-2022

2:00 PM

EST

36C246 Amber Hess Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 X X Y 485991 $16.5 Million N/A X 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

Department of Veterans Affairs Financial Services Center

PO BOX 149971

Austin TX 78714-9971 512-460-5049 512-460-5221 See CONTINUATION Page 24-hour Wheelchair Vans Services for the Beneficiary Travel Eligible Veterans of the Fayetteville, NC Healthcare System Places of Performance: See Performance Work Statement Period of Performance:

Base Year: April 1, 2022- September 30, 2022 Option YR 1:

October 1, 2022- September 30, 2023 Option YR 2: October 1, 2023- September 30, 2024 Option YR 3: October 1, 2024- September 30, 2025 See CONTINUATION Page X Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C246 Amber Hess Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Department of Veterans Affairs Financial Services Center

PO BOX 149971

Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

Performance Work Statement

1.0 PURPOSE:

The Veteran Affairs Medical Center in Fayetteville requires contracted Wheelchair Van Services. This includes both the Coastal and Sandhills regions listed out in section A. Contractor shall provide all vehicles and transportation, to beneficiaries of Fayetteville VAMC in accordance with the terms, schedule and referenced materials of this agreement. The contractor shall furnish 24-hour Wheelchair Vans Services for the Beneficiary Travel eligible Veterans of the Fayetteville NC VA Coastal Healthcare System on an as needed basis, and for patients with regular standing appointments at either the VAMC or private facilities in the community.

2.0 BACKGROUND

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

3.0 REQUIREMENTS:

Patient Pick-Up and Delivery From/To VAMC facilities: Services for Wheelchair Vans drivers shall report to the Fayetteville VAMC Urgent Care Center (UCC) to check in for each transport.

The Health Administration Service (HAS) has administrative staff in the UCC 24/7, during the hours of 8:00 a.m. to 4:30 p.m. Monday thru Friday and with the Administrative Officer of the Day (AOD), all other times to sign the driver’s log. The contractor shall follow the following protocol:

3.1. The VA Medical Center Contracting Officer’s Representative (COR), or his designee, will make requests for services in writing or by telephone, for Beneficiary Travel eligible Veterans. All trips for which the VA is the payer will be furnished at contract prices regardless of who initiates the call.

3.2. NOTE: The contractor shall notify the VAMC of any delays in the transporting of patients.

3.3. Universal Precautions shall be used on all VA patients.

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10

3.4. For excusable time lost in waiting at either end of a trip the contractor will be reimbursed at the rate of one-fourth the hourly rate for each quarter hour. As soon as the delay is anticipated, the contractor will contact the transportation office at (910) 475-6554/1485 or the Contracting Officer Representative (COR) at (910) 475-6040. The decision for excusable delay will be determined on a case-by-case basis. Final determination must be documented by the COR for invoicing purposes.

3.5. Rates will apply to any trip. Payment for mileage traveled beyond the 20-mile radius will be paid at the one way only rate. These mileage costs will be paid in addition to the applicable rate per trip for any trip within the 20-mile radius. Unless specifically authorized by Fiscal 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.

3.6. Requests for service will be made in writing via fax or by telephone from the Contracting Officer’s Representative (COR). The contractor will be informed at that time of the location for pick-up and drop-off of the patient.

3.7. The contractor shall provide telephone numbers and fax numbers for receiving requests for services. If the contractor fails to furnish the service within 45 minutes after receiving a request, including messages left on answering machine or with answering services, the Medical Center reserves the right to obtain the service from another source and charge the contractor for the additional expenses.

3.8. Transport of baggage with veterans shall occasionally be required.

4.0 DESTINATIONS FOR VETERANS TRANSPORTED TO INCLUDE:

Mileage threshold for wheelchair van services: The mileage threshold for the contract is twenty (20) miles radius for the VA Medical Center (VAMC), Health Care Centers (HCC), and Community Based Outpatient Clinics (CBOCS within the Fayetteville Medical Center enterprise. Fayetteville VAMC, HCC, and/or CBOC will be the point of origin for all mileage calculations. Charges for travel within this mileage threshold shall be billed at the base rate.

Fayetteville VA Medical Center 2300 Ramsey Street Fayetteville NC 28301

Fayetteville VA Health Care Center 7300 S. Raeford Road Fayetteville NC 28304

Wilmington VA Health Care Center 1705 Gardner Road Wilmington NC 28405

Jacksonville Community Based Outpatient Clinic 4006 Henderson Drive Jacksonville, NC 28546

Hamlet Community Based Outpatient Clinic 100 Jefferson St Hamlet NC 28345

Sanford Community Based Outpatient Clinic 3112 Tramway Road Sanford NC 27332

Robeson Community Based Outpatient Clinic 139 Tree Hunts Dr Pembroke NC 28372

Goldsboro Community Based Outpatient Clinic 2610 N. Hospital Road Goldsboro NC 27534

Brunswick County Community Based Outpatient Clinic 18 Doctors Circle, Units 2&3 Supply NC 28462

5.0 CONTRACTOR VEHICLES, EQUIPMENT, AND INSPECTION:

5.1 Wheelchair Van Vehicle Requirements: All vehicles used to provide services on this contract shall meet the following requirements.

1. All vehicles must be registered in the State of North Carolina at the time of award.

2. Shall have functioning mechanisms which ensure that all access doors are capable of being opened from the inside and remain closed and secure during travel.

3. Shall have a functioning speedometer indicating speed in miles per hour and a functioning odometer correctly indicating distance in tenths of a mile.

4. Shall be equipped with operational air conditioning heating systems. If the air conditioning system becomes inoperable during a day when the high temperature is forecast to reach 79 degrees or more, the vehicle shall be immediately pulled from service at the termination of the current trip and shall not be used again for service under this contract until the air conditioning system has been repaired.

5. Shall have exterior free of grime, oil or other substances and free from cracks, breaks, dents and damaged paint that noticeably detract from the overall appearance of the vehicle.

6. Shall be equipped with hubcaps or wheel covers.

7. Shall have all body molding in place, or if removed, holes shall be filled and painted.

8. Shall have passenger compartment that shall be clean of dirt and free from torn upholstery or floor coverings, damaged or broken seats, protruding sharp edges and vermin or insects.

9. Shall have unobstructed vision on all sides.

10. Shall be equipped with an operable two-way radio and/or cellular telephone communication system that provides for contact with the vehicle during all hours of operation. Beepers are not an acceptable substitute.

11. Shall meet all safety and mechanical standards established by Local, State and Federal statutes and regulations.

12. Shall have windows and doors that can be opened and closed in accordance with manufacturer standards.

13. Shall not have leaks of any kind.

14. Shall be equipped with a functioning horn.

15. Shall have operable seat belts on all seats.

16. Shall have fully charged, certified and non-expired fire extinguisher.

17. Shall have wheelchair tie-down straps and effective securement devices to secure both wheelchair and wheelchair beneficiaries.

18. Shall have a backup for all lift capacity. The lift shall incorporate an emergency method of deploying, lowering to ground level with a lift occupant, and raising and stowing the empty lift if the power to the lift fails.

19. Shall have a fixed seat position or a fixed secured floor or sidewall wheelchair lock and should be approved for each ambulatory or wheelchair restricted passenger being transported, according to the passenger’s needs. Driver shall ensure wheelchair locks are secured and seat belts and shoulder harnesses are in place before the vehicle is driven. Fayetteville VAMC will not incur any cost associated with the contractor providing inadequate or faulty equipment.

5.2 WHEELCHAIR SECUREMENT REQUIREMENTS FOR VEHICLES:

1. All wheelchair securement systems (for occupied or unoccupied wheelchairs) shall be designated to be stable in all manners of normal driving, and to secure the wheelchair during an accident.

2. All wheelchair tie-downs shall be installed in accordance with manufacturer instructions. Backing plates, as supplied by the tie-down manufacturer, are acceptable.

3. Wheelchair securement devices shall not be attached to van doors.

4. All wheelchair restraints (for occupied or unoccupied wheelchairs) shall hold the wheelchair stable in all manners of driving. Installation of wheelchair restraints should be installed according to the restraint manufacturer’s installation instructions. After installing the restraint system, the wheelchair should be properly positioned and restrained in the vehicle and tested for motion. The wheelchair should not be able to move more than ½ inch in any direction while driving under normal conditions.

5. Wheelchair securement systems intended for use while the wheelchair is occupied shall not be attached to any part of the wheelchair designed for easy removal (e.g.

footrest or armrest), or to the cross-member of the wheelchair. Patient must be always secured in the wheelchair when he is being transported to and from the vehicle, as well as being driven in a wheelchair van.

6. Wheelchair restraints for use by driver of a motor vehicle must be operable (into and out of) the restraint solely by the driver, without the need of assistance. When the wheelchair is restrained in the driver’s position, there must be audible or visual signal to the driver that assured the driver that the wheelchair is fully restrained by the restraint system.

7. Vehicles equipped with a transfer seat should have a tie-down system to secure the unoccupied wheelchair and be placed in such a position as to allow adequate client transfer. The tie-down must be operable by the client and shall be clearly labeled, “for unoccupied wheelchair only”, unless unit has been safety tested and approved for occupant use.

8. The only positions acceptable for a wheelchair occupant shall be forward facing or side facing. Securement systems for passengers must conform to all other wheelchair tie-down requirements.

9. A seat belt restraint system shall be provided at each driver and passenger position.

Anchorage for Occupied restraints shall either be directly to the vehicle or be mounted to suitable points on the wheelchair or wheelchair restraints, provided that such belts comply with the 30 MPH/20G force testing. Do not anchor to any movable or removable parts of the motor vehicle.

10. Additional chest straps, body positioners or other equipment shall be added when necessary to assist in a patient’s balance and stabilization.

11. All wheelchair securement systems, in conjunction with a safety belt system, must keep the wheelchair and occupant securely restrained in the event of a 30 MPH/20G frontal collision.

12. No one shall be allowed to be transported from a three-wheeled scooter type wheelchair.

13. On some vehicles, occupant restraint attachment points should be in the roof area.

This type of attachment may require reinforcement to facilitate proper mounting support.

5.3. VEHICLE INSPECTIONS:

1. The Fayetteville VA Medical Center will inspect all vehicles that are to be utilized in the performance of this contract. These inspections shall be conducted at the beginning of the contract and before each initial use of an added vehicle. All vehicles shall have State of North Carolina Inspections at the time of award.

2. Contractor shall not use any vehicles for this contract that has not passed inspection.

3. Contractor shall contact the COR to coordinate the date, time, and location for inspections.

4. The Contractor shall provide the COR with a list of all vehicles used to provide services under this contract, including vehicle license numbers, and insurance certificates prior to initiating service. An updated list shall be provided to the COR quarterly.

5. All vehicles shall be made available for inspection at any reasonable time during the performance of this contract when requested by the Contracting Officer or COR. Any vehicle found not in conformity with the above standards or any vehicle receiving two (2) or more unsatisfactory findings within a five (5) day period shall be removed from service immediately. That vehicle shall not be put back in service until subsequent inspections verify correction of the deficiencies.

6. The Government reserves the right to order the immediate removal from service any vehicle not in compliance with any vehicle standards referenced herein. Failure to comply with this requirement shall be cause for disallowance of compensation for services rendered in the violating vehicle.

5.4. EQUIPMENT TO BE FURNISHED BY THE CONTRACTOR

5.4.1 Contractor shall furnish and install communication or radio equipment in their wheelchair vans which allows them to be always in communication with their dispatcher.

5.4.2 The Contractor shall maintain sufficient telephone capacity to ensure immediate communication access between Fayetteville VA Medical Center and the Contractor’s facility for the purposes conducting business in the performance of the contract

6.0. PERSONNEL QUALIFICATIONS-Licensing of employees

1. All contractor personnel performing contract services shall meet the qualifications and be licensed as specified in the contract, as well as any qualifications required by Federal, State, County and local government entities from the place in which they operate. The qualifications of such personnel shall also be subject to review by the VA Chief of Staff and approval by the VA Facility Director. The Contractor shall provide the COR an updated list of drivers by the fourth day of each month when additions or deletions have been made during the previous month. The contractor shall ensure that all drivers providing service under this contract shall have less than five (5) current points on their driver’s license, none of which were assessed for “Reckless Driving”. Fayetteville VA Medical Center reserves the right to order the removal from service under this contract, any driver who violates the provisions of this section, Contractor shall provide a copy of the state driver’s license and background checks, for drivers under this contact as supporting documentation.

2. The Contractor shall maintain a record of each employee to include, current driving records and physical capabilities of performing the duties of a wheelchair vehicle driver.

The Contractor shall make these records available for inspection upon request by the Contracting Officer or the Contracting Officer’s Representative (COR).

3. Drivers shall not transport the Fayetteville VAMC beneficiaries if they appear to be ill or under the influence of drugs or alcohol. Drivers shall not transport anyone who insists on smoking during the transport; this includes drivers and attendants as well. Drivers shall always display professional manners. Rude or obscene behavior or language shall not be accepted.

4. Drivers shall wear appropriate attire with a picture identification (ID) badge that clearly identifies the company they work for. Drivers shall secure all beneficiaries and passengers with approved security devices prior to transport.

5. Contractor shall demonstrate to the Fayetteville VAMC that their attendants are adequately trained in the safe and proper transport of beneficiaries i.e. (current CPR, First Aid training, and have a Defensive Driving Course).

6. Contractor shall immediately notify the COR of any vehicle breakdowns or other problems that can result in service disruption.

7. Non-Emergency Attendant/Drivers shall be capable to administer oxygen and have successfully completed the Standards and Advanced First Aid Courses of the American Red Cross or U.S. Bureau of Mines or equivalent. Proof in the form of a current certificate that such first aid training has been successfully completed shall be submitted with offeror’s proposal and available upon request.

8. The contractor shall be responsible for protecting the personnel furnishing services under this contract. To carry out this responsibility, the contractor shall provide the following for these personnel:

- Workers’ compensation

- Professional liability insurance

- Health examinations

- Income tax withholding

- Social security payments -Personnel shall be considered employees of the contractor

7.0. CONDUCT:

The following acts are not permissible by drivers that provide services under this contract or while on VA premises.

1. Use of intoxicating liquors, narcotics or controlled substances of any kind (excluding doctor’s prescriptions which do not impair driver’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. Smoking and other uses of tobacco while on duty. Both Beneficiaries and Contractor are prohibited from smoking in vehicles.

4. Carrying of pistols, firearms, or concealed weapons.

5. Resorting to physical violence to settle a dispute with a fellow employee, beneficiaries 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 beneficiaries or other employees.

8. Stopping for personal business, including excessive use of 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 beneficiaries in a verbal confrontation, even if in an attempt to settle a disagreement. Should a disagreement arise, the driver shall contact his dispatcher/supervisor via the radio system.

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

11. Drivers who accumulate five (5) unrelated, substantiated complaints in a 12-month period shall be prohibited from providing any further services under this contract. The VA reserves the right to bar any driver from transporting VA beneficiaries should he/she violate any terms of this contract.

8.0. GENDER

In support of equal rights, wherever the masculine gender is used in this solicitation, and the resulting contract, it shall be considered to include both masculine and feminine gender.

9.0. QUALITY CONTROL PROGRAM

1. Contractor shall establish and maintain a complete Quality Control Program (QCP) to assure that the requirements of this contract are provided as specified. Contractor shall identify his management concept for ensuring compliance with all contract requirements.

Contractor shall furnish copies of these records if requested by the Contracting Officer or

COR.

The Contractor’s QCP shall include at a minimum the following:

(a) An inspection plan outlining all services defined in this contract. The inspection plan shall specify the areas to be inspected on both a scheduled and unscheduled basis, how often inspections shall be accomplished, and the title of the individual(s) who shall perform inspections.

(b) The QCP shall include the methods for identifying and preventing deficiencies in the quality of services being performed before the level of performance becomes unacceptable.

(c) The QCP shall have on-site records of all inspections conducted by the Contractor and corrective action taken.

(d) The QCP shall have on-site records of all vehicle maintenance and repairs performed on vehicles used in the performance of this contract.

10.0. TRANSPORTATION REQUEST

10.1. TRANSPORTATION REQUEST:

VA will FAX a transportation request to the Contractor for next day transportation requirements by 4:00 pm daily. The VA transportation office will maintain a log for all trips on the request (including weekend and holidays). Confirmation of receipt of the transportation request will be made by 4:15 each day. Orders, requests, or changes will only be made by the travel Clerk, AOD, or authorized party specified by the Chief, Health Administration Service. Changes will be made by telephone, fax or email and will be confirmed immediately upon receipt.

A list of authorized ordering personnel will be made available upon award of the contract. Employees may be added or deleted from the list during the term of the contract at the discretion of VA Medical Center Fayetteville. The Contractor will be notified of such changes as they occur.

10.2. SAME DAY TRANSPORTATION REQUEST:

During the course of the day, it may become necessary to add beneficiaries to the Contractor’s list. When this occurs, the VA will fax, telephone or email the request to the contractor. The transportation office will maintain a log for all same day trips (including weekend and holidays).

10.3. TRANSPORT AND DELIVERY:

1. Contractor shall be on time for its scheduled transports.

2. Beneficiaries will be transported, within 15 minutes of the scheduled transport time.

3. The Contractor shall transport and deliver beneficiary to the specific clinic where the beneficiary’s treatment is being provided. This includes transports at any location (i.e.

clinic or ward area at the N.C. State Nursing Homes and private residences). In no instance will the Contractor drop beneficiaries off in the hall or entrance of the VA.

Adherence to schedules is of utmost importance. If the veteran is not at the location, unable or refuses to be transported the contractor shall be reimbursed for a one-way trip after VA has authorized Contractor to leave without the beneficiary.

(a) All drivers shall report to the Travel Clerk or AOD on duty at the time a beneficiary is delivered to the Fayetteville VA Medical Center and record the trip on the drivers’ log located in the ED/UCC. The drivers log shall be delivered to the travel office no later than COB the following business day. Trips completed on weekends and holidays shall be recorded on the drivers log and delivered to the travel office no later than the next COB of the next business day. The drivers log should indicate date of trip, transport, and delivery points, veteran’s name, charges, driver’s name or number, and if same day service, the person’s name that ordered the service.

(b) Courtesy call shall be made to patients 45 minutes before scheduled pick-ups,

11.0 CANCELLATIONS:

11.1. The contractor shall not charge for scheduled trips cancelled sixty (60) minutes prior to transport time.

11.2. For trips scheduled for the same day, there shall be no charge to the Government for cancellations made prior to the vehicle being dispatched.

11.3 In the situation where the vehicle has already dispatched the customer can charge a cancellation fee of a flat rate of no more than $50.00. In the circumstance in which this occurs a call must immediately be made to the transportation office at (910) 475-6554/1485 or the Contracting Officer Representative (COR) at (910) 475-6040. Final determination must be documented by the COR for invoicing purposes.

12.0. WAITING TIME:

Wait time is defined as the amount of time spent waiting after a scheduled transport time.

12.1. In no instance is a beneficiary to wait longer than thirty (30) minutes after scheduled transport time or receipt of a transport order for an unscheduled transport.

12.2 When a beneficiary shall wait longer than 30 minutes, Contractor shall be charged for each quarter hour or fraction thereof more than 30 minutes at the rate quoted in the proposal for wait time.

12.3 If rescheduling of an appointment is necessary due to failure by the Contractor to transport within the 30 minutes, the Fayetteville VAMC will not pay for the round trip transport.

12.4 For time lost in waiting after the first 30 minutes at either end or both ends of the trip due to causes beyond control, the contractor shall be reimbursed at the rate specified in the schedule of supplies and services.

12.5 If the transport is other than at the designated area, the Contractor shall call the Transportation Assistant or Administrative Officer of the Day (AOD) on duty as soon as the Contractor anticipates that a delay may develop for which he/she expects to claim reimbursement. This call is only for the purpose of verifying his arrival time at the transport point and is not necessary if the Contractor anticipates no delay for which he shall claim reimbursement.

12.6 In order to keep waiting time at an absolute minimum, the Contractor shall immediately notify the Travel Clerk or AOD on duty when all vehicles are in service. All wait time charges shall be supported by Notification to the Travel Clerk or AOD that the driver (vehicle) is in a waiting status. At this point, information concerning reason for wait shall be provided.

13.0. SERVICE DISRUPTION:

13.1. The Contractor shall immediately report any and all vehicle breakdowns or other problems that may cause service disruptions to the COR. When breakdowns occur, the contractor shall provide a backup vehicle to minimize any delay or inconvenience to the beneficiaries. When conditions, neither foreseeable and/or controllable by the Contractor occur, such as 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.

13.2. Contractor shall immediately report all medical incidents and accidents, including those where there is no apparent injury to the beneficiary, which occurs while transporting VA beneficiaries. The driver shall provide a written report documenting the facts of the incident/accident 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. 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.

14.0. NUMBER OF BENEFICIARIES:

14.1. Generally, only two (2) beneficiaries will be transported on a trip. However, when more than two beneficiaries are transported on a trip, the VA will be notified for approval.

14.2 If Contractor transports more than two beneficiaries without approval, payment for extra beneficiary will not be made.

14.3 The Contractor should ensure that transports and deliveries are scheduled so that the total distance traveled shall result in the most economical charge to the Government.

14.4 For transportation of Fayetteville VAMC beneficiaries to the airports, the Attendants shall remain until the Fayetteville VAMC beneficiary safely boards the aircraft (or checks in). If a Fayetteville VAMC attendant accompanies a beneficiary, Contractor attendant may leave after the beneficiary and the Fayetteville VAMC attendant are transported to the airport. Contractor personnel shall assist veteran and attendant in anyway after arriving at the airport if requested to do so. If the Contractor is required to park at the airport and free parking arrangements cannot be made with airport security, Contractor shall submit receipt to the Fayetteville VAMC with daily trip tickets.

15.0. RATES:

15.1. For all one-way trips within a 20-mile radius of the VA Medical Center (VAMC) Fayetteville, North Carolina, the Contractor will receive the flat rate awarded for that trip.

15.2 The Contractor will also receive the mileage charge awarded for any one-way trips more than the flat rate outside the 20-mile radius of VAMC Fayetteville. In no event shall the Contractor receive reimbursement for the mileage charge for any mileage inside the 20-mile radius of VAMC Fayetteville. Mileage charges are only applicable outside the 20-mile radius of VAMC Fayetteville.

15.3 Payment for mileage travel beyond the 20-mile radius of Fayetteville VAMC shall be limited to the distance.

15.4 One-Way mileage for travel beyond the twenty (20) mile threshold shall be at the base rate plus the mileage for each mile beyond twenty (20) miles. Mileage shall be calculated using the current www.bingmaps.com guide.

(a) Toll Charges:

(1) It is agreed and understood that the prices quoted in the schedule do not include any ferry, bridge, tunnel or road toll charges. Any such legitimate toll charges incurred shall be limited to two ways only and shall be listed separately on Contractor’s trip tickets.

(b) Disaster Plan:

(1) In case of a disaster, natural or man-made, Contractor shall utilize maximum available resources to assist in the emergency transport of beneficiaries either to or from the Fayetteville VAMC.

(2) Contractor’s performance shall be in conformance with all Federal, state, and local laws.

16.0. REGULATIONS

16.1 Department of Transportation, 49 CFR, and Parts 27, 37, 38, 571 and VA Standards.

All regulations of the State Public Service Commission (PSC) (of where the Contractor’s facility is located) governing the control, operation of and licensing of the transportation contractor are incorporated herein by reference.

16.2 All records submitted to and/or compiled by the PSC regarding inspections, safety, records, and manifests, etc. may be reviewed prior to awarding a contract and periodically throughout the term of contract.

17.0. COMPLAINTS HANDLING:

17.1 The COR will monitor the service provided. The Contractor shall cooperate with the COR in providing information and answering questions related to any and all incidents.

17.2 All complaints received by the COR and forwarded to the Contractor shall be investigated promptly. All complaints received shall be forwarded to the Contracting Officer.

(a) After investigation and disposition, the Contractor shall respond to the COR in writing within five (5) working days after receipt by the Contractor.

18.0. BENEFICIARY WELFARE AND ABUSE:

18.1 The Contractor shall be responsible for beneficiary welfare during the transport of beneficiaries to or from Fayetteville VA Medical Center. Contractor shall ensure that the beneficiary's belongings are properly accounted for and delivered with the beneficiary.

18.2 The Government expects the successful offer to exercise extreme caution and care in handling of beneficiaries. Any abuse of beneficiaries shall be grounds for default action or termination of contract.

19.0. INFECTION CONTROL REQUIREMENTS:

19.1 Tuberculosis Testing - All contractor personnel shall provide documentation of a Purified Protein Derivative (PPD) test performed within the past year. In case of a past positive PPD test, a negative chest radiographic report to rule out active tuberculosis shall be provided. The PPD test shall be repeated annually.

19.2 In accordance with OSHA Regulation Concerning Occupational Exposure to Blood borne Pathogens

(a) The contractor shall provide training or a self-study training module to its personnel; provide Hepatitis B vaccination series at no cost to its personnel who elect to receive it; maintain and distribute an exposure determination and control plan to its personnel; maintain required records; and ensure that proper follow-up evaluation is provided following an exposure incident. Contractor shall provide documentation that the employee(s) have received the Hepatitis B vaccination series or that the employee(s) declined to receive the series.

19.3 VA shall notify the Contractor of any significant communicable disease exposures to its employees as appropriate. The Contractor’s occupational health provider shall adhere to current CDC/HICPAC Guideline for Infection Control in health care personnel (AJIC 1998; 26:289- 354) for disease control. If the employees of the contracting agency suffer a communicable disease, the Contractor shall provide follow up documentation of employee’s clearance to return to the workplace prior to their return.

20.0 SECURITY INCIDENT INVESTIGATION

21.1 The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.

21.2 To the extent known by the contractor/subcontractor, the contractor/subcontractor’s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant.

21.3 With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement.

21.4 In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.

22.0 SERVICE DELIVERY SUMMARY: Contractor service requirements are summarized into performance standards that relate directly to mission essential items. The maximum deviations briefly describe the acceptable levels of service needed for each requirement; which are critical to mission success. Refer to the Performance Matrix in 23.3d.

23.0 QUALITY ASSURANCE: Contractor shall ensure services are performed in accordance with accepted commercial practices. XXX VAMC will evaluate the Contractor’s performance and approve all services per the COR/designee in accordance with the QASP.

24.0 CONTRACTING OFFICER REPRESENTATIVE (COR):

NAME

PHONE

EMAIL

25.0 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP):

25.1 This QASP was developed to evaluate Contractor actions while implementing this PWS. It is designed to provide an effective method of monitoring Contractor performance for each listed objective in the PWS. The QASP provides a systematic method to evaluate the services the Contractor is required to furnish.

25.2 This QASP is based on the premise that the Government desires to maintain a quality standard in the operation of the systems to be serviced under this agreement and to provide the service is the best means of achieving that objective. The Contractor, not the Government, is responsible for management and quality control actions to meet the terms of the agreement. The Government’s role is quality assurance to ensure agreement standards are achieved.

Contractor shall have a plan in place for handling patient complaints, including methods for monitoring, correcting, and reporting. Contractor shall report any corrective action taken to the COR within 48 hours of incident. COR will track internal complaints as well as from the Contractor. Contractor shall maintain less than five (5) complaints per quarter.

i. Minor complaints – (i.e., complaints about timeliness, customer service, or vehicle cleanliness. Isolated incidents of minor complaints will be addressed by the COR at the task order level. The COR will be notified of the complaint and the Contractor will work with the COR to ensure the complaint is addressed or resolved.

ii. Minor complaints will be documented if the COR determines there is a pattern of minor complaints or if there is an alarming increase in frequency of minor complaints. If so, the severity level of the complaints would be designated as a major complaint.

iii. Major complaints – (i.e., concerns regarding Contractor’s driving abilities (e.g., driving recklessly or while under the influence), lack of safe vehicle conditions, or emotional or physical abuse by driver/passenger. All of these complaints shall be documented. COR will determine the validity of the complaint, then notify the Contractor. Major complaints left unresolved will be deemed subpar performance and will be sent to the CO.

When performance is deemed unacceptable, the COR will inform the Contractor’s on-site representative, or one of the Contractor’s managers. Disputes should be referred to the COR. The COR will notify the Contracting Officer of subpar performance. If any services do not conform to agreement requirements, the Government may:

i. Require the Contractor to take action necessary to ensure future performance conforms with agreement requirements.

ii. By separate agreement or otherwise, perform the services and charge to the Contractor any cost incurred by the Government that is directly related to the performance of such service 25.3d Performance Matrix - Wheelchair Service

END OF PERFORMANCE WORK STATEMENT

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

Base Rate: Fayetteville VA Medical Center 2300 Ramsey Street Fayetteville, NC 28301 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Base Rate- within a 20-mile radius Fayetteville VA Health Care Center 7300 S. Raeford Road Fayetteville, NC 28304 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Base Rate- within a 20-mile radius Wilmington VA Health Care Center 1705 Gardner Road Wilmington NC 28405 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Base Rate: within a 20-mile radius Jacksonville Community Based Outpatient Clinic 4006 Henderson Drive Jacksonville, NC 28546 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Base Rate: within a 20-mile radius Hamlet Community Based Outpatient Clinic 100 Jefferson St Hamlet NC 28345 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Base Rate- within a 20-mile radius

3112 Tramway Road Sanford NC 27332 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Base Rate: within a 20-mile radius Robeson Community Based Outpatient Clinic 139 Tree Hunts Dr Pembroke NC 28372 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Base Rate: within a 20-mile radius Goldsboro Community Based Outpatient Clinic 2610 N. Hospital Road Goldsboro NC 27534 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Base Rate: within a 20-mile radius Brunswick County Community Based Outpatient Clinic 18 Doctors Circle, Units 2&3 Supply NC 28462 Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Rater Per Mile Beyond Twenty (20) miles radius- one way only Contract Period: Base POP Begin: 04-01-2022 POP End: 09-30-2022