S02 - Fayetteville Ambulance 36C24625R0044 Final.pdf

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. UEI: EFT:

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 ATTACHED

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. SIGNATURE 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

36C24625R0044 07-09-2025

DAVID E. SMITH, CONTRACTING OFFICER 757-728-7156 07-31-2025

9:00AM EDT

DEPARTMENT OF VETERANS AFFAIRS

NETWORK CONTRACTING OFFICE 6

100 EMANCIPATION DRIVE

HAMPTON VA 23667

X

621910

$22.5 Million

N/A

X

FAYETTEVILLE VA MEDICAL CENTER

2300 RAMSEY STREET

FAYETTEVILLE NC 28301

NETWORK CONTRACTING OFFICE 6

100 EMANCIPATION DRIVE

HAMPTON VA 23667

FINANCIAL SERVICES S=CENTER

PO BOX 149971

AUSTIN TX 78714-9971

512-460-+5049 512-460-5221

X

See CONTINUATION Page

THE CONTRACTOR SHALL PROVIDE ALL VEHICLES, PERSONNEL,

MANAGEMENT, SUPPLIES, EQUIPMENT, AND NECESSARY REPORTING FOR

THE PROVISION OF STRETCHER TRANSPORTS, BASIC LIFESUPPORT(BLS),

ADVANCED LIFE SUPPORT (ALS), SPECIALTY CARE TRANSPORT (SCT),

OR CRITICIAL CARE TRANSPORT(CCT)SERVICES FOR THE EMERGENCY

DEPARTMENT AT FAYETTEVILLE NC VA COASTAL HEALTHCARE SYSTEM

VA MEDICAL CENTER.

See CONTINUATION Page

X X

DAVID E. SMITH

CONTRACTING OFFICER

36C24625R0044

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

B.3 PERFORMANCE WORK STATEMENT (PWS)

B.4 SPECIAL CONTRACT REQUIREMENTS

B.5 VA INFORMATION AND INFORMATION SYSTEM SECURITY AND PRIVACY

LANGUAGE FOR INCLUSION IN CONTRACTS, AS APPROPRIATE

SECTION C - CONTRACT CLAUSES

C.1 ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.3 52.216-18 ORDERING (AUG 2020)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-8 OPTION TO EXTEND SERVICES (Nov 1999)

C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.8 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.9 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) ... 57

C.10 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2024)

C.11 MANDATORY WRITTEN DISCLOSURES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 WAGE DETERMINATION

D.2 ATTACHMENT A – QUALITY ASSURRANCE SURVEILLANCE PLAN (QASP)

D.3 ATTACHMENT A – Critical Care Transport Capabilities Confirmation D.4 ATTACHMENT B – Veterans Transportation Service (VTS) Patient Transport PPE and Vehicle Cleaning/Disinfection Standard Operating Procedure

SECTION E - SOLICITATION PROVISIONS

E.1 INSTRUCTIONS FOR PROPOSAL SUBMISSION:

E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.4 52.204-29 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT ORDERS—

REPRESENTATION AND DISCLOSURES (DEC 2023)

E.5 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.6 52.216-1 TYPE OF CONTRACT (APR 1984)

E.7 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.8 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.9 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.10 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (MAY 2024)

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, David E. Smith David.smith78@va.gov Phone: 757-728-7156

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:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award

Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly in arrears after the receipt of proper invoicing

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.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

mailto:David.smith78@va.gov

B.2 PRICE/COST SCHEDULE

AMBULANCE (Ground)

SCHEDULE OF SERVICES – PRICE SCHEDULE

Fayetteville NC VA Coastal Healthcare System EMERGENCY DEPARTMENT

NOTE: A price proposal 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.

BASE YEAR: 10-01-2025 to 9-30-2026

Line Item

Description of Services

12-Month Quantity

(Estimated Maximum)

Unit of Issue

Unit Price Total Price

(Maximum

NTE)

Base Rate Transport

(Using Bing Maps) One-Way

Trip

0001 (A0427) Advanced Life Support) Emergent Transport, Level 1 (ALS

1) Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 40 miles) One-way trip is equivalent to one each for the unit of issue 30 minutes

50 Maximum

(One-way Trips)

Per Trip

(One-Way)

EA

0002 (A0428) Basic Life Support, Non- Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration. (base rate, to include first 40 miles) One-Way trip is equivalent to one each for the unit of issue 30 minutes

500 Maximum

0003 (A0426) Non-Emergent Advance Life Support Transport, Level 1 (ALS 1) ((base rate to include first 40 miles) One-way trip is equivalent to one each for the unit of issue 30 minutes

550 Maximum

0004 (A0434) Critical Care Transport (Upper-Level Care) Specialty Care Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT- Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area, for care. 30 minutes

25 Maximum

0005 STAT Trips (STEMI, stroke, dissection, Trauma-RED & other patients deemed emergent by the staff) requiring a response time of 15 minutes

0006 (A0425) Mileage Trip Outside the Base Rate

Price Per Mile

0007 (A0420) Waiting Time (more than 30 minutes shall be paid in 30-minute increments).

(30-minute Increment)

0008 Bariatric Transport Fee (a single patient with body weight equal to or more than 350 lbs.)

Each

0009 Oxygen 450 Maximum

Per patient, per trip

Total Estimated Cost of Base Year: $____________________

AMBULANCE (Ground)

SCHEDULE OF SERVICES – PRICE SCHEDULE

Fayetteville NC VA Coastal Healthcare System EMERGENCY DEPARTMENT

NOTE: A price proposal 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

OPTION YEAR 1: 10-01-2026 to 9-30-2027

(Estimated

1001 (A0427) Advanced Life Support) Emergent Transport, Level 1 (ALS 1) Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance.

The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 40 miles) One-way trip is equivalent to one each for the unit of issue 30 minutes

1002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration.

(base rate, to include first 40 miles) One-Way trip is equivalent to one each for the unit of issue 30 minutes

1003 (A0426) Non-Emergent Advance Life Support Transport, Level 1 (ALS 1) ((base rate to include first 40 miles) One-way trip is equivalent

1004 (A0434) Critical Care Transport (Upper-Level Care) Specialty Care Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT- Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area, for care. 30 minutes

1005 STAT Trips (STEMI, stroke, dissection, Trauma-RED & other patients deemed emergent by the staff) requiring a response time of 15 minutes

1006 (A0425) Mileage Trip Outside the Base Rate

1007 (A0420) Waiting Time (more than 30 minutes shall be paid in 30-minute

1008 Bariatric Transport Fee (a single patient with body weight equal to or more than 350 lbs.)

1009 Oxygen

Total Estimated Cost of Option Year 1: $____________________

SCHEDULE OF SERVICES – PRICE SCHEDULE

Fayetteville NC VA Coastal Healthcare System EMERGENCY DEPARTMENT

NOTE: A price proposal 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

OPTION YEAR 2: 10-01-2027 to 9-30-2028

(Estimated

2001 (A0427) Advanced Life

Level 1 (ALS 1) Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance.

The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 40 miles) One-

2002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration.

(base rate, to include first 40 miles) One-Way trip is equivalent

2003 (A0426) Non-Emergent Advance Life Support Transport, Level 1 (ALS 1) ((base rate to include first 40 miles) One-way trip is equivalent

2004 (A0434) Critical Care Transport (Upper-Level Care) Specialty Care Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT- Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an

2005 STAT Trips (STEMI, stroke, dissection, Trauma-RED & other patients deemed emergent by the staff)

2006 (A0425) Mileage Trip Outside the

2007 (A0420) Waiting Time (more than

2008 Bariatric Transport Fee (a single patient with body

2009 Oxygen

Total Estimated Cost of Option Year 2: $____________________

SCHEDULE OF SERVICES – PRICE SCHEDULE

Fayetteville NC VA Coastal Healthcare System EMERGENCY DEPARTMENT

NOTE: A price proposal 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

OPTION YEAR 3: 10-01-2028 to 9-30-2029

(Estimated

3001 (A0427) Advanced Life

Level 1 (ALS 1) Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance.

The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 40 miles) One-

3002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration.

(base rate, to include first 40 miles) One-Way trip is equivalent

3003 (A0426) Non-Emergent Advance Life Support Transport, Level 1 (ALS 1) ((base rate to include first 40 miles) One-way trip is equivalent

3004 (A0434) Critical Care Transport (Upper-Level Care) Specialty Care Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT- Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an

3005 STAT Trips (STEMI, stroke, dissection, Trauma-RED & other patients deemed emergent by the staff)

3006 (A0425) Mileage Trip Outside the

3007 (A0420) Waiting Time (more than

3008 Bariatric Transport Fee (a single patient with body

3009 Oxygen

Total Estimated Cost of Option Year 3: $____________________

SCHEDULE OF SERVICES – PRICE SCHEDULE

Fayetteville NC VA Coastal Healthcare System EMERGENCY DEPARTMENT

NOTE: A price proposal 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

BASE YEAR: 10-01-2029 to 9-30-2030

(Estimated

4001 (A0427) Advanced Life

Level 1 (ALS 1) Advanced Life Support (ALS) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance.

The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. (base rate to include first 40 miles) One-

4002 (A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support (BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration.

(base rate, to include first 40 miles) One-Way trip is equivalent

4003 (A0426) Non-Emergent Advance Life Support Transport, Level 1 (ALS 1) ((base rate to include first 40 miles) One-way trip is equivalent

4004 (A0434) Critical Care Transport (Upper-Level Care) Specialty Care Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT- Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an

4005 STAT Trips (STEMI, stroke, dissection, Trauma-RED & other patients deemed emergent by the staff)

4006 (A0425) Mileage Trip Outside the

4007 (A0420) Waiting Time (more than

4008 Bariatric Transport Fee (a single patient with body

4009 Oxygen 450 Maximum Per patient, per

Total Estimated Cost of Option Year 4: $____________________

Total Estimated Cost of Base and All Option Years: $____________________

B.3 PERFORMANCE WORK STATEMENT (PWS)

Advanced Life Support (ALS) / Basic Life Support (BLS) Ambulance Service for the Fayetteville NC VA Coastal Healthcare System (FNCVACHCS) Emergency Department

Address: 2300 Ramsey Street Fayetteville, NC 28301

1. Purpose: The Fayetteville NC VA Coastal Healthcare System (hereafter FNCVACHCS, and its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), Critical Care Transport (CCT) services. The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

2. Background: The FNCVACHCS main campus is located at 2300 Ramsey Street

Fayetteville, NC 28301, serving over 90,000 veterans, primarily from the Fayetteville, NC area and it’s 15 Community-Based Outpatient Clinics. The hospital has 77 inpatient beds and sees approximately 2,466 inpatient admissions and 861,325 outpatient visits a year. Veterans served within this facility lives within the following counties and zip codes.

County/Zip Code

County/Zip Code

County/Zip Code

County/Zip Code

County/Zip Code

Cumberland

NC / 28331

Brunswick

NC / 28424

Bladen NC / 28337

Columbus NC / 28472

Duplin NC / 28466

Harnett NC / 27546

Hoke NC / 28376

Johnston NC / 27520

Lee NC / 27330

Moore NC / 28374

Montgomery

NC / 27209

New Hanover NC / 28412

Onslow NC / 28540

Pender NC / 28443

Richmond NC / 28379

Robeson NC / 28358

Sampson

NC / 28328

Scotland NC / 28352

Wayne NC / 27530

3. Acronyms

ALS – Advanced Life Support AOD – Administrative Officers of the Day BLS – Basic Life Support CCT – Critical Care Transport CCTP – Critical Care Transport Paramedic CCEMTP – Critical Care Emergency Medical Transport CO – Contracting Officer COR – Contracting Officer’s Representative CPR – Cardiopulmonary Resuscitation DOL – Department of Labor EMT – Emergency Medical Technician IAW – In Accordance With OO – Ordering Officer

PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QC – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VTS – Veteran Transportation Service

4. Scope/Requirements

4.1. Types of Ambulance Service

4.1.1. The contractor shall provide Urgent, non-emergent Stretcher Transports, Basic

Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) Tier 1, 2, and 3 ambulance services on an as-needed basis in accordance with 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.

4.1.3. Cover 1-4 quarterly transports for stretcher-bound patients discharged from the Emergency Department. Vendor will transport to patients’ residences, Community Living Centers (CLC), or nursing facilities.

4.2. Transport of Miscellaneous Items with the Patient

The Contractor may also be required to transport patient luggage, 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 (FNCVACHCS), 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.

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. Emergency Medical Technicians (EMTs), Critical Care Transport Paramedics (CCTPs) & Other Personnel

4.3.1.1. EMTs, CCTPs and other medical personnel (as applicable) 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. EMTs, CCTPs and other medical personnel (as applicable) shall be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity where the emergency service is operated or by which it is governed.

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 other qualifications to the Contracting Officer’s Representative (COR) for review.

4.3.1.3. All ambulance drivers shall have a valid driver’s license in accordance with 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. CCTPs shall have met all state requirements for the tier in which they are performing services in (I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request.

4.3.1.5. 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 (Facility name). Thereafter the contracted employees will be subject annually to the same requirement, with a 90-day window to complete such requirement as provided by (Facility name). The Workforce Management and Consulting, Human Resource Operation Office, Personnel Security Contracting Team (WMC HROO PerSec Contracting Team) is responsible for adjudicating all background investigations for contract employees.

4.3.1.6. EMTs, CCTPs, and other contractor personnel as applicable must pass the

Contractor’s background check and must not have been convicted of (or have any pending charges for) a felony for the past five years. Personnel (and Contractor) must report any new or additional charges or convictions if they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated. 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.

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.

4.3.2.2.The contractor shall have its personnel tested for TB in accordance with 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 by at the start of each Ordering Period.

4.4. Contractor Equipment, Vehicles, and Inspection

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

4.4.2. 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 emergency medical transport vehicles (ambulances). 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 which are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performance in accordance with the contract nor necessitate additional cost to the VA.

4.4.3. Vehicles shall be clean and maintained in good repair in accordance with manufacturer’s instructions.

4.4.4. The contractor shall not borrow or exchange supplies, equipment, and/or medications with the VA. Equipment attached to or in use by the patient at time of pick-up may remain with the patient during transport to ensure continuity of care. Medical Control Authorities are responsible for maintaining and supplying medication during patient transport. All VA equipment and unused medications must be returned to VA during patient drop-off or as promptly as feasible within 24 hours.

4.4.5. The contractor shall furnish all linen required for patient transport at no additional cost. Linen shall not be exchanged with linen belonging to (FNCVACHCS) or its CBOCs / 15.

4.4.6. The contractor must be capable of transporting the drugs and/or equipment as required by the patient as listed in Attachment A Specialty Care Transport (SCT) or Critical Care Transport (CCT) Capabilities Confirmation. The contractor shall have the appropriate medications, including Specialty Care and Critical Care Transport, if necessary, based on the EMS region the ambulance provider is functioning in.

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

4.4.7.1. 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.

4.4.7.2. 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 o 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.

4.4.7.3. The contractor personnel will ensure that the patient is secured to the stretcher/cot, and that the stretcher /cot is secure in the back of the ambulance before the vehicle moves.

4.4.7.4. Ambulance drivers shall have a valid driver’s license, in accordance with

Federal, State, and local government requirements for their place of operation for the services they perform, be capable of administering oxygen and shall have successfully completed the standard and advanced first aid course of the American Red Cross of U.S. Bureaus of Mines of equivalent and be capable of providing necessary medical assistance to the attending emergency medical technician or paramedic.

4.4.7.5. Emergency Medical Technician (EMT) and Paramedic Qualifications:

EMT’s and Paramedic’s providing services under this contract shall have the following qualifications, in additions to those required by Federal, State, and Local Government:

• Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304.

(1974).

• Shall be certified, licensed, or otherwise officially recognized by the local, state of regional government or public entity where the emergency ambulance service is operated or by which it is governed.

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 in accordance with 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, which are being suspended.

4.5.1.1. A transportation request is defined as one incidence of a request for one-way service (Stretcher Transports, BLS, ALS, CCT). 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 the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. (FNCVACHCS) Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff. 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.

4.5.1.1.1. (FNCVACHCS) 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. (FNCVACHCS) 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 (CO) Ordering Officers (OO) Administrative Officer of the Day (AOD) Beneficiary Travel Office Staff Contracting Officer’s Representative (COR)

The Contracting Officer will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The Contracting Officer will update this list throughout the life of the contract as Ordering Officers 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 the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer 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 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 type of transportation service (Stretcher Transports, BLS, ALS, CCT) required will be discussed and determined by VA clinical personnel and the contractor. The contractor shall transport the patient per its policies and standard industry practice. If the type of transportation service differs from what was agreed upon by the VA and contractor, the contractor shall submit documentation to the VA explaining its rationale.

4.5.1.5.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.

4.5.1.6. The contractor shall have sufficient vehicles and personnel to provide services for up to two (2) simultaneous transportation requests. Transports required may be for any mix of Stretcher Transports, BLS, ALS transports. One of these two simultaneous transports may require CCT capability up to Tier III.

If (FNCVACHCS) requires ambulance services exceeding two (2) simultaneous transportation requests, the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

4.5.1.7.The number of transports under normal operating conditions will typically range from 1-5 transports each weekday and significantly less on weekends and holidays. The number of actual transports may vary throughout the life of the contract.

4.5.1.8. The patient may bring with her or him up to three (3) liters of oxygen. The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

4.5.1.9.Response Times*

4.5.1.9.1. 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.

4.5.1.9.2. Urgent Transport (Originating from VA (Only): The contractor shall be required to provide Ground Ambulance transportation within thirty (30) minutes of order/patient pick up call.

4.5.1.9.3. For all add-ons (not scheduled in advance) transportation requests, with pick up at (FNCVACHCS): The contractor will be allotted up to a thirty (30) minute response time from time of order placement for transportation requests that are not previously scheduled in advance.

a. For an emergent transport request for a critical patient (as deemed by the physician) with pick up at (FNCVACHCS), the contractor will be allotted up to a fifteen (15) minute response time.

4.5.1.9.4. For transportation requests which do not have a pick-up at

(FNCVACHCS):

a. The contractor may be required, if requested by the VA, to dispatch ambulances on short notice for transportation request not scheduled in advance; for these transportation requests the contractor shall dispatch ambulances 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 prior to the schedule 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 the type of service requested (Stretcher Transports, BLS, ALS, CCT) and the one-way mileage (Stretcher Transports, BLS, ALS, CCT) 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 (FNCVACHCS) ONLY – The contractor will immediately dispatch a vehicle upon receipt of the order (including transportation requests in which the final destination may change prior to pick up due to the critical condition of the patient). When the contractor is notified of a cancellation prior to arrival at the (FNCVACHCS) campus, there shall be no charge to the Government.

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

4.6.1. Ambulance personnel shall pick-up and deliver patients at specified locations

(e.g., front door of Emergency Department Entrance). These locations will be specified by VA staff when an order is placed and communicated to the transporting personnel.

4.6.2. When applicable, ambulance personnel shall report to the Veteran Transportation

Service (VTS) Dispatcher or Administrative Officer of the Day (AOD) to (1) announce his/her arrival to pick-up and transfer the patient and (2) obtain report of pertinent information regarding the patient’s condition from the primary nurse/physician.

4.6.3. When delivering a patient, ambulance personnel shall give report to the appropriate VA healthcare staff and provide a copy of the run sheet which will be retained by the facility for inclusion to the patient’s medical record.

4.6.4. In cases where ambulance personnel must divert to a local emergency department while performing a VA authorized transport, the contractor’s dispatcher shall notify the VA Beneficiary Travel Department or Administrative Officer of the Day of the patient’s location and status as soon as this information becomes available.

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 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).

4.9.4. Upon notification of the contracting officer, the vendor must receive training and begin implementation of invoices via Vet Ride 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 BLS Base Rate, total BLS Mileage incurred, etc.)

An itemized list of charges or services rendered that align with the line items of this contract (i.e., BLS Base Rate, BLS Mileage incurred, etc.)

Payment by VA under this contract to a provider of ground ambulance 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 effective from Date of Award through 09/30/2030.

5.2. The Place of Performance is variable and may occur within the states of North Carolina, South Carolina and Virginia; ambulance services may be required to or from locations including, but not limited to the following:

5.2.1. (FNCVACHCS) VA Medical Center to include specific Atrium Clinics, Emergency Department, pavilions, or out-buildings on the (FNCVACHCS) campus. The (FNCVACHCS) address is: 2 3 0 0 R a m s e y S t r e e t , F a y e t t e v i l l e , N C 2 8 3 0 1 .

5.2.2. (FNCVACHCS) Community-Based Outpatient Clinics (CBOCs):

CBOC Name Address Brunswick County VA Clinic 18 Doctors Circle, Suite 2

Supply, NC 28462-4089 Cumberland County VA Clinic 7300 South Raeford Road

Fayetteville, NC 28304-6162 Goldsboro VA Clinic 2610 Hospital Road

Goldsboro, NC 27534-9423 Hamlet VA Clinic 100 Jefferson Street

Hamlet, NC 28345-3100 Jacksonville VA Clinic 4006 Henderson Drive

Jacksonville, NC 28546-0055 Jacksonville 2 VA Clinic 306 Brynn Marr Road

Jacksonville, NC 28546-7023 Jacksonville 3 VA Clinic 4 Josh Court

Jacksonville, NC 28546-5253 Jacksonville 4 VA Clinic 2580 Henderson Drive

Jacksonville, NC 28546-5252 Johnson Air Force Base VA Clinic

1055 Jabara Avenue, Building 2803 Goldsboro, NC 27531-2311

Lee County VA Clinic 3112 Tramway Road Sanford, NC 27330-7142

Raeford Road VA Clinic 4101 Raeford Road, Suite 100-B Fayetteville, NC 28304-3359

Robeson County VA Clinic 139 Three Hunts Drive Pembroke, NC 28372-6800

Robeson Street VA Clinic 2301 Robeson Street Fayetteville, NC 28305-5640

Wilmington VA Clinic 1705 Gardner Road Wilmington, NC 28405-8873

Womack Army Medical Center 2817 Reilly Street, Fort Bragg, NC 28310

5.2.3. Other VA…