36C24818R0023-001.docx

36C24818R0023

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 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. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C24818R0023 03-15-2018 Kurt Kramer 407-646-4230 04-13-2018 11:00 AM e.s.t.

36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) 13800 Veterans Way Lakemont Bldg., Room 210 Orlando FL 32827-7401 X 621910 $15 Million X N/A X 00675 Department of Veterans Affairs Orlando VA Medical Center 13800 Veterans Way Orlando FL 32827-7401 36C248

NCO 8

Orlando Services Team 13800 Veterans Way Lakemont Bldg., Room 210 Orlando FL 32827-7401

Department of Veterans Affairs Financial Services Center P.O. Box 149971 Austin TX 78714-9971 877-353-9791 512-460-5540 Ambulance Services for Orlando Veterans Affairs facilities in accordance with the enclosed Performance Work Statement.

See Section B.4 for the SCHEDULE OF SERVICES AND PRICING Video or audio recording of transportation services provided under this contract is strictly prohibited unless independently authorized by the Contracting Officer.

X Ferdinand Rodriguez Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA (continuation from Standard Form 1449, block 18A.)

Ferdinand Rodriguez, Contracting Officer (E): Ferdinand.Rodriguez@va.gov

Network Contracting Office 8 (NCO 8) Orlando – Services Team 13800 Veterans Way Lakemont Bldg., Room 210 Orlando, FL 32827-7403

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

3. INVOICES/PAYMENT: Invoices shall be submitted in arrears in accordance with:

a. 852.232-72 Electronic Submission of Payment Requests (NOV 2012)

b. SUMITTED MONTHLY

c. See paragraph 5 of PWS

d. In order to comply with the Improper Payment Elimination and Recovery Act of 2010 (IPERA), the VA has mandated electronic invoice submission to the Veterans Affairs Financial Services Center (VAFSC). VAFSC has partnered with Tungsten Corporation e-Invoicing network, for submissions of all electronic invoices to VA. Tungsten Network electronic invoicing is free to all VA vendors. In order to submit electronic invoices, all VA vendors must register with Tungsten Network by submitting an email to Tungsten Network VA.Registration@tungsten-network.com or calling 1-877-752-0900 option 2 for Enrollment.

e. Contractor shall submit an electronic invoice to the Veterans Affairs Financial Services Center (VAFSC) e-Invoice through the website at https://portal.Tungsten-Network.com/Login.aspx after their itemized report has been reviewed and approved by the Contracting Officer’s Representative (COR). For questions regarding the submission of VA electronic invoices, Tungsten Network customer service may be contacted at 1-877-489-6135.

f. All invoices shall reference the vendor name and address, customer name, contract number, appropriate obligation/funding order number, description of services provided, quantity, unit price, and total invoice amount (any additional info listed in paragraph 5 of the PWS). Invoices shall also include any payment discount terms.

g. For questions regarding invoice receipt or payment, please call VAFSC directly at 1-877-353-9791 or email vafsccshd@va.gov

h. VA’s Electronic Invoice (e-Invoice) system uses a third-party contractor (Tungsten Network) for submission of electronic invoices. Go to this website to begin submitting electronic invoices, free of charge: http://www.tungsten-network.com/customer-campaigns/veteransaffairs-us/

4. GOVERNMENT INVOICE ADDRESS: (See SF1449 Block 18):

a. All invoices from the contractor shall be submitted electronically in accordance with 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012)

b. Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests.

c. VA’s Electronic Invoice Presentment and Payment System – The FSC uses a third-party contractor, Tungsten Network e-Invoice, to transition vendors from paper to electronic invoice submission. Please go to this website: http://www.tungsten-network.com/customer-campaigns/veterans-affairs-us/ to begin submitting electronic invoices, free of charge.

d. For assistance setting up e-Invoice, the below information is provided:

i. * Tungsten Network e-Invoice Setup Information: 1-877-489-6135

* Tungsten Network e-Invoice email: VA.Registration@ob10.com <http://VA.Registration@ob10.com/>

* FSC e-Invoice Contact Information: 1-877-353-9791

* FSC e-invoice email: vafsccshd@va.gov <http://va.gov/>

OFFERORS MUST COMPLETE AND RETURN ALL INFORMATION DESIGNATED HEREIN PRIOR TO THE TIME SPECIFIED IN BLOCK 8 OF SF 1449 IN ORDER TO BE CONSIDERED FOR AWARD.

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

AMENDMENT NO DATE

OFFER REQUIREMENTS & INSTRUCTIONS:

See Section E.1. 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS (JAN 2017) and Section E.2 GENERAL INSTRUCTIONS TO OFFERORS.

EVALUATION/BASIS OF AWARD:

This is a commercial item acquisition that will be conducted under the authority of FAR 15.101-2 – Lowest Price Technically Acceptable (LPTA) Source Selection Process. See 52.212-2 Evaluation – Commercial Items (Section E.13) for a description of the factors in addition to price that the Government will use to evaluate offers. Prospective contractors must furnish the information listed herein with their proposals to ensure they receive full consideration.

SPECIAL NOTE

In order to maintain integrity of this solicitation and subsequent award date, all offerors are advised that any questions must be submitted in written form via e-mail to Kurt.Kramer@va.gov and shall be received no later than WEDNESDAY, MARCH 28, 2018 AT 2:00 PM EASTERN STANDARD TIME (EST).

Proposals will be considered only from offerors who are regularly established in the business called for, who are financially responsible, and able to show evidence of their reliability, ability, experience, facilities and personnel, directly employed by them to render prompt and satisfactory service.

CONTRACT ADMINISTRATION

The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitment or issue changes that will affect price, quantity or quality of performance of this contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered to have been made without authority and no adjustment will be made in the contract price to cover any increase in cost incurred thereof.

B.2 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.

B.3 SUBCONTRACTING PLAN – MONITORING AND COMPLIANCE

This solicitation includes FAR 52.219-9, Small Business Subcontracting Plan, and VAAR 852.219-9, VA Small Business Subcontracting Plan Minimum Requirement. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing the contractor’s compliance with the plan, including reviewing the contractor’s accomplishments in achieving the subcontracting goals in the plan. To that end, the support contractor(s) may require access to the contractor’s business records or other proprietary data to review such business records regarding the contractor’s compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor’s business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting plan.

B.4 SCHEDULE OF SERVICES AND PRICING

All prices and rates shall be for loaded (patient onboard) services and mileage only. But for exceptions (dry-runs or cancellations) indicated in Section B.5, PWS Paragraph 9.F., the Government shall not pay for unloaded (no patient) services or mileage.

Orders shall be placed in accordance with Section B.5, PWS Paragraph 4. The default method of payment shall be electronic funds transfer submitted into Tungsten, unless the Contracting Officer specifies otherwise. The Contractor is required to maintain an awareness of available order quantities as they are depleted during performance. Services rendered which exceed order quantities issued by the Contracting Officer shall be the risk of the Contractor and any cost thereof may be borne by the Contractor.

The quantities are estimated quantities only and shall be considered nonbinding.

The guaranteed minimum for the fiscal year in which the contract was awarded shall be $2,000.00.

The total maximum amount of services acquired under this contract shall not exceed $15,000,000.00.

Base Period: Date of Award through September 30, 2018

QUANTITIES

UNIT PRICE

Basic Life Support (BLS) Ambulance Transportation (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation (A0433) orders $__________ per order

Basic Life Support (BLS) Ambulance Transportation (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation (A0433) orders

$__________ per order

(for services in CLINs 0001 through 0018) (A0425) 41,289 miles $__________ per mile

(in excess of initial 15 minutes) orders

$__________ per 15 minutes

Option Year 1: October 1, 2018 through September 30, 2019

ITEM NUMBER

QUANTITIES

UNIT PRICE

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders $__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

(for services in CLINs 0001 through 0018) (A0425) 55,052 miles $__________ per mile

(in excess of initial 15 minutes) orders

Option Year 2: October 1, 2019 through September 30, 2020

ITEM NUMBER

QUANTITIES

UNIT PRICE

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders $__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

(for services in CLINs 0001 through 0018) (A0425) 55,052 miles $__________ per mile

(in excess of initial 15 minutes) orders

Option Year 3: October 1, 2020 through September 30, 2021

ITEM NUMBER

QUANTITIES

UNIT PRICE

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders $__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

(for services in CLINs 0001 through 0018) (A0425) 55,052 miles $__________ per mile

(in excess of initial 15 minutes) orders

Option Year 4: October 1, 2021 through September 30, 2022

ITEM NUMBER

QUANTITIES

UNIT PRICE

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders $__________ per order

Basic Life Support (BLS) Ambulance Transportation Rate (A0428) orders

$__________ per order

Advanced Life Support 1 (ALS1) Ambulance Transportation Rate (A0426) orders

$__________ per order

Advanced Life Support 2 (ALS2) Ambulance Transportation Rate (A0433) orders

$__________ per order

(for services in CLINs 0001 through 0018) (A0425) 55,052 miles $__________ per mile

(in excess of initial 15 minutes) orders

36C24818R0023

B.5 PERFORMANCE WORK STATEMENT (PWS)

1. DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

The contractor shall provide all requested Non-Emergency, Advance Life Support (ALS) and Basic Life Support (BLS) ambulance services as identified within this performance work statement (PWS) for beneficiaries of the Orlando VA Medical Center (OVAMC), and, its associated healthcare facilities. The Contractor shall provide all transport vehicles, personnel, management, supplies, transportation, fuel, equipment, reports, and anything else necessary to successfully furnish Non-Emergency Ground Ambulance Medical Transportation Service as identified in the Schedule of Services and Pricing and the PWS in accordance with all terms, conditions, and provisions stated herein.

The contract term shall cover from the date of award through September 30, 2018, plus four 12-month option periods to extend services to be exercised at the Government’s discretion. The contractor’s responsibility shall cover non-emergency transportation services by ambulance within the OVAMC catchment area, which consists of the following six counties: Orange, Seminole, Osceola, Brevard, Volusia, and Lake County. ALS/BLS transportation may be required to be provided to Veterans that live in the adjacent counties that border the six identified counties identified under the OVAMC catchment area.

The Contractor is required to continuously be compliant with the requirements contained herein, and meet or exceed the standards of, but not limited to, the Joint Commission and Florida State Department of Health Regulations. The following facilities shall be covered; however, their physical addresses may change during the life of the contract:

· Orlando VA Medical Center, (Lake Nona campus) 13800 Veterans Way, Orlando, FL 32827

· Orlando VA Medical Center, (Lake Baldwin campus) 5201 Raymond St., Orlando, FL., 32803

· William V. Chappell Jr. Outpatient Clinic (OPC) 551 National Health Care Dr., Daytona Beach, FL., 32114-1495

· Viera Outpatient Clinic (OPC) 2900 Veterans Way, Viera, FL., 32940

· Kissimmee Community Based Outpatient Clinic (CBOC) 2285 N. Central Ave., Kissimmee, FL., 34741

· Tavares CBOC, 1390 E. Burleigh Blvd., Tavares, FL 32778

· Orange City CBOC, 2583 S. Volusia Ave., Suite 300, Orange City, FL., 32763

· Clermont CBOC, 805 Oakley Seaver Dr., Clermont, FL., 34711

· Crossroads CBOC, 925 S. Semoran Blvd., Winter Park, FL., 32792

2. CONTRACT DEFINITIONS/ACRONYMS & TERMS

A. Administrative Officer of the Day (AOD) - VA official that works in the admissions area during evenings and nights and monitors hospital activities during other than normal working hours. This person acts as the hospital administrator during off-hours.

B. Ambulatory Patient – A non-emergency VA beneficiary who does not require the use of a handicap ambulance, wheelchair, or stretcher van, who can utilize normal forms of transportation such as taxi or hired car but have been determined as needing transportation assistance for medical reasons. A VA clinician determines if the patient requires based on a medical impairment or special need (to include but not limited to: blindness, mental health deficiency, amputees, etc.)

C. Attendant/Escort – A medical attendant may be required to assist with transportation, when deemed necessary by a VA physician. An escort is a non-medical attendant which can be a caregiver, family member, or VA employee to accompany the patient.

D. Base Rate – Base Rate is defined as the rate paid for one-way transportation from a designated pick-up point to a designated delivery point. This rate will be paid for all authorized one-way trips ordered under this contract action, with employees during all phases of the trip made on behalf of the Government. The attached Service Contract Act wage determination will be updated for each option when/if new revisions are issued. The Base Rate will constitute full compensation for one-way trips as shown in the Schedule of Services and Pricing for the medical facility.

E. Beneficiary – Veterans and other members determined to be eligible for benefits by the VA.

F. Beneficiary Travel Department Personnel – An individual designated by the Contracting Officer for the medical facility, who is authorized to schedule transportation services for orders issued by the Contracting Officer.

G. Beneficiary Travel Department – Department within the VA that oversees the Beneficiary Travel Program and its entitlements. This includes transportation such as the ALS/BLS services.

H. Beneficiary Travel Department Supervisor - Individual who manages the employees working within the Beneficiary Travel Department.

I. Business Hours/Days - Business hours/days are defined as the time of 8:00AM to 4:30PM, Monday through Friday, except Federal holidays. Federal holidays include New Year’s Day, Martin Luther King Day, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, Christmas Day and other specifically designated days by the President of the United States to be a national holiday. Off Business hours/days are defined as the time of 4:31PM to 7:59AM, Monday through Friday, all day Saturday and Sunday and Federal holidays. When a holiday falls on a Sunday, the following Monday shall be observed as a legal holiday. When a holiday falls on a Saturday, the preceding Friday is observed by U. S. Government agencies.

J. Cognitive Impairment - A cognitive impairment affects a person’s ability to reason, understand, and learn.

K. Contracting Officer (CO) – VA official with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

L. Contracting Officer's Representative (COR) – VA official responsible for providing contract oversight and technical guidance to the Contracting Officer. Responsibilities include certification of invoices, placing orders for service, providing technical guidance, overseeing technical aspects of the contract, and serves as a member of the vehicle inspection team. All administrative functions remain with the Contracting Officer.

M. Contractor – The term "Contractor” as used herein refers to both the prime Contractor and his/her employees, and any sub-contractor and their employees. The Contractor shall be responsible for assuring that his/her subcontractors comply with the provisions of this contract.

N. Disability – The term “disability” means, with respect to an individual means:

1. A physical or a mental impairment that substantially limits one or more of the major life activities of such individual;

2. A record of such impairment

3. Being regarded as having such impairment. (P.L. 101-336, July 1990)

O. Dry Run - A dry run is defined as a request for service by authorized Medical Center personnel whereby the Contractor arrives at the designated pick-up point and no patient is transported due to a change in the Medical Center’s needs.

P. Durable Medical Equipment (DME) - Medical equipment that is ordered by a doctor for use in the home, such as walkers and wheelchairs.

Q. Escort/Caregiver - An escort/caregiver is defined as an individual, not employed by the Contractor, who provides direct care to the patient being transported via Special Mode.

R. The Joint Commission (TJC) (Formerly Joint Commission on Accreditation of Healthcare Organizations) – A national organization dedicated to improving the care, safety and treatment of patients in a health care facility and environment.

S. Hearing Impairment - Hearing impairments range from a mild hearing loss to total deafness. Those who are hard of hearing often use their residual hearing and lip read when communicating face-to-face. People who are deaf may use American Sign Language or lip-read, and may speak for themselves or use a sign-language interpreter.

T. Mileage Rate – Mileage rate for ambulance is the rate paid for each mile traveled for medical facility. This rate applies to one-way transportation only. Reimbursement for mileage shall be at the mileage rate stated in the schedule, and shall be based upon the miles from the pick-up point and the specified destination. Distances areas of coverage shall be calculated using current www.bing.com/maps.

U. Mobility Impairment - Mobility impairment refers to the inability of a person to use one or more of his/her extremities, or a lack of strength to walk, grasp, or lift objects. The use of a wheelchair, crutches, or a walker may be utilized to aid in mobility.

V. Multiple Riders - Multiple riders is defined as, more than one patient transported simultaneously in one vehicle at any given point during a trip.

W. No Show - is defined when the beneficiary receiving services is not present at the time of transport or declines to go with the contracted service.

X. No-Patient Transport – The Contractor shall not assess charges on scheduled pick-ups that are cancelled in advance by the VA and/or the patient cancels due to being unable to arrive for scheduled appointment in time.

Y. Non-Ambulatory Patient – A VA beneficiary who cannot utilize normal forms of transportation such as taxi, hired car, or wheelchair/stretcher van and has been determined as needing non-emergency transportation assistance for medical reasons. A VA clinician determines the level of care (ALS or BLS) based on a medical impairment or special need.

Z. Quality Assurance Surveillance Plan (QASP) – an organized written document used for quality assurance surveillance. The document contains specific methods for performing surveillance of the Contractors continuous performance.

AA. Quality Control and Quality Control Plan (QCP) – Those actions taken by the Contractor to control the production of goods or services so they shall meet the requirements of the contract.

AB. Routine Services – Trips scheduled in advance by the VA, typically one day prior to travel. Beneficiary, caregiver, or significant others cannot contact the Contractor directly to schedule routine trips.

AC. Scheduled Trip(s) – The term "Scheduled Trip" refers to those trips in which the Contractor has been given advanced notice of required services and a specific pick-up time.

AD. Speech Impairment - Speech impairments range from problems with articulation or voice strength to complete voiceless. People with speech impairments may have difficulty in projection, articulation and fluency. Some people with speech impairments may use assistive devices or an interpreter to communicate.

AE. Healthcare Common Procedure Coding System (HCPCS) - A collection of codes that represent medical procedures, products, and services. HCPCS codes primarily correspond to services not covered by Current Procedural Terminology (CPT) codes.

AF. Unauthorized Commitment (UAC) - An assurance that results in a contract action, either an original contract or a modification, that is not binding because the government representative who made it lacked the authority to undertake the action on behalf of the government. This usually occurs when a contractor relies upon the apparent authority of a Government official who does not, in fact, have authority to obligate the Government contractually. Such actions must be ratified at very high levels. If the approval authority, in his discretion, does not ratify the unauthorized commitment, the person who caused it may be held personally and financially liable. Even if the action is ratified, the person who caused it may be subjected to administrative or other penalties. (See Ratification)

AG. Ratification - The act of approving an unauthorized commitment made by a representative of the government who lacked the authority to contractually commit the VHA.

AH. Visual Impairment - A visual impairment affects a person’s ability to see, and includes: (1) inability to see images clearly and distinctly; (2) loss of visual field; (3) inability to detect small changes in brightness; (4) color blindness; and (5) sensitivity to light. A cane or sight dog may be used to assist with mobility, and/or Braille may be used to read.

AI. Ambulance Service - Basic Life Support, non-emergency transport (BLS) means transportation by ground ambulance vehicle and medically necessary supplies and services, plus the provision of BLS ambulance services. The ambulance must be staffed by an individual who is qualified in accordance with State of Florida and local laws as an emergency medical technician-basic (EMT-Basic).

Advanced Life Support, Level 1, non-emergency transport (ALS1) means transportation by ground ambulance, medically necessary supplies and services and an ALS assessment by ALS personnel or the provision of at least one ALS intervention. Advanced life support assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service. Advanced life support intervention means a procedure that is, in accordance with the State of Florida and local laws, beyond the scope of authority of an emergency medical technician-basic (EMT-Basic). Advanced life support personnel means an individual trained to the level of paramedic. The EMT-Paramedic is defined as possessing the qualifications of the EMT Basic and, in accordance with State of Florida and local laws, as having enhanced skills that includes being able to administer additional interventions and medications.

Advanced Life Support, Level 2 (ALS2) - The Advanced Life Support, Level 2 category is: Whereby the patient, during transport, is given three or more different administrations of medications by intravenous push/bolus or by continuous infusion excluding crystalloid, hypotonic, isotonic, and hypertonic solutions (Dextrose, Normal Saline, Ringer's Lactate), or Ground transportation, medically necessary supplies and services, and the provision of at least one of the following ALS procedures: Manual defibrillation/cardioversion Endotracheal intubation (The monitoring and maintenance of an endotracheal tube that was previously inserted prior to the transport also qualifies as an ALS2 procedure.);

· Central venous line

· Cardiac pacing

· Chest decompression

· Surgical airway or Intraosseous line

AJ. Commercial Subcontracting Plan – A subcontracting plan (including goals) that covers the offeror’s fiscal year and that applies to the entire production of commercial items sold by either the entire company or a portion thereof (e.g. division, plant, or production line). A commercial plan is the preferred type of subcontracting plan for contractors furnishing commercial items.

AK. Individual Subcontracting Plan - A subcontracting plan that covers the entire contract period (including option periods), applies to a specific contract, and has goals that are based on the offeror’s planned subcontracting in support of the specific contract, except that indirect costs incurred for common or joint purposes may be allocated on a prorated basis to the contract.

AL. Subcontract – Means any agreement (other than one involving an employer-employee relationship) entered into by a Government prime contractor or subcontractor calling for supplies and/or services required for performance of the contract, contract modifications, or subcontract.

AM. Electronic Subcontracting Reporting System (eSRS) - The Government-wide, electronic, web-based system for small business subcontracting program reporting.

3. PERFORMANCE & QUALIFICATIONS

A. The Contractor shall provide ambulance transportation services, 24 hour a day/7 days a week, 365 days a year, within the state of Florida, subject to the response time lines and other requirements as further detailed below and contained on the Florida State Department of Health website www.health.gov. The contractor shall provide all manpower, equipment, vehicles, fuel, materials and supplies, and supervision necessary to perform all tasks. Vehicles shall have appropriate fuel capacity to complete the transport without stopping for refueling, unless making a transport beyond the capability of the fuel tank of the vehicle.

B. The Contractor shall comply with all applicable Federal, State and local laws, executive orders, rules and regulations applicable to its performance under this contract. In addition, services shall be performed in accordance with the established principles and ethics of the medical profession established by the American Medical Association (AMA) and American College of Emergency Physicians (ACEP). The Contractor shall adhere to the Department of Veteran Affairs regulations and the policies of the Orlando VAMC. The regulation that governs the Beneficiary Travel Program is Title 38 Code of Federal Regulations (CFR) Section 70 and VHA Handbook 1601B.05, Beneficiary Travel.

C. The contractor, upon request, shall provide quality data and information related to services for verification purposes or participation in OVAMC Performance Improvement Programs. The contractor shall also provide documentation of the competency of staff that shall be providing the contracted services. The Contractor shall ensure Contractor employees providing work on this contract are fully qualified and licensed with the State of Florida to perform the required work; they shall also maintain records that document the employee’s certifications and competency assessment checklist. Upon request, the contractor shall make available for inspection at contractor’s headquarters a current copy of their competency assessment checklist and annual performance evaluation for each contractor employee working on this contract.

D. The Contractor shall comply with the provisions of the Privacy Act of 1974, the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and VA Handbook 0710 Personnel Security and Suitability Program. The Contractor shall not maintain and/or share sensitive or patient identifiable information in any form or for any purpose, other than what is needed to perform its obligation under the established Business Associate Agreement (BAA). By entering into this contract, the Contractor certifies they comply with HIPAA as it pertains to general patient information, HIV, drug and alcohol abuse, and sickle cell anemia.

E. The Contractor shall provide a minimum of a toll-free telephone and/or a locally dialed telephone number for accepting VA calls. It is estimated that 90% of all transportation services will be scheduled initially by telephone. Requests for service may also be submitted via email from an authorized representative of the VA.

The contractor shall, at all times during the contract period, have on his/her premises a functioning telephone and designated email address to communicate requirements with the VA (i.e., requests for service, patient incidents, special correspondence, etc.).

Secure/Encrypted Email - The Contractor shall have the ability to transmit encrypted email with personally identifiable information and receive similar encrypted email from the VA.

4. TRANSPORTATION SERVICES

A. A transportation request is defined as a one incidence for ambulance transportation services by the VA to the Contractor and shall be one-way only.

1. Ordering. Transportation requests will be made via Task Order (TO) or other arrangements deemed tenable by both the VA and Contractor.

a. Only the Contracting Officer is authorized to place orders or make changes to orders for transportation requests. Non-authorized VA employees and private agencies (e.g. nursing homes) are not authorized to place orders.

2. Scheduling. Scheduling is defined as providing the Contractor the following information for a transportation request:

a. - VA authorization number

- Mode of transportation required;

- Required date and time of arrival;

- Name of beneficiary;

- Pick-up and delivery point;

- Type of equipment required;

- Last four of the patient's Social Security Number

- Any special instructions

b. Only designated personnel are authorized to schedule transportation requests. Non-authorized VA employees and private agencies (e.g. nursing homes) are not authorized to schedule orders. Services rendered in response to a request from other than authorized personnel shall be the risk of the Contractor and any cost thereof may be borne by the Contractor.

c. Scheduling may be performed via telephone, email, in person, or other arrangements deemed tenable by both the VA and Contractor.

d. The Contracting Officer will provide the Contractor a written list of personnel authorized to schedule transportation services prior to the commencement of services. The list of authorized personnel shall be updated and provided to the Contractor, as needed. The list shall be reviewed by the COR for accuracy no less than annually.

3. Response time will be calculated from the Contractor’s receipt of the notification to schedule transportation service.

a. Contractors shall deliver services within the established response timeframes:

i. ALS: Thirty (30) minutes or sooner.

ii. BLS: Forty-five (45) minutes or sooner.

b. The Contractor shall acknowledge and confirm, to the OVAMC, Contractor’s ability to provide services within the…