36C24823Q0624.docx

36C24823Q0624

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

672-23-1-820-0001 36C24823Q0624 04-04-2023 Elder Vazquez 939-321-7682 04-19-2023 10:00am

EDT

36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) VA Caribbean HCS (Admin Bldg) #10 Calle Casia Suite #4M440 San Juan

PR

00921-3201 X X 621910 $20 Million N/A X See Delivery Schedule

36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) VA Caribbean HCS (Admin Bldg) #10 Calle Casia Suite #4M440 San Juan

PR

00921-3201

Financial Services Center P.O. Box 149971 Austin

TX

78714-9971 See CONTINUATION Page FY23 Cardiovascular Ambulance Service Provide one (1) Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, a nd reports necessary to furnish 7 hours per day See CONTINUATION Page X Wilfredo Perez

VA-VHA-RPOE-2023-0020

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C248

Network Contracting Office 8 (NCO 8) VA Caribbean HCS (Admin Bldg) #10 Calle Casia Suite #4M440 San Juan PR 00921-3201

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

3. INVOICES: Invoices shall be submitted in arrears:

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

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

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

Provide one (1) Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, and reports necessary to furnish services 7 hours per day, Contract Period: Base POP Begin: 05-15-2023 POP End: 05-14-2024 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Provide one (1) Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, and reports necessary to furnish 7 services hours per day, Contract Period: Option 1 POP Begin: 05-15-2024 POP End: 05-14-2025

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

Provide one (1) Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, and reports necessary to furnish 7 services hours per day, Contract Period: Option 2 POP Begin: 05-15-2025 POP End: 05-14-2026

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

Provide one (1) Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, and reports necessary to furnish 7 services hours per day, Contract Period: Option 3 POP Begin: 05-15-2026 POP End: 05-14-2027

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

Provide one (1) Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, and reports necessary to furnish services 7 hours per day, Contract Period: Option 4 POP Begin: 05-15-2027 POP End: 05-14-2028

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

Provide one (1) Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, and reports necessary to furnish services 7 hours per day.

Government option to extend service after Based period or any Option Period in accordance with FAR 52.217-8 Option to Extend Services (NOV 1999), Non-Separately Priced (NSP).

Contract Period: Option 5 POP Begin: 05-15-2028 POP End: 11-14-2028

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

B.3 PERFORMANCE WORK STATEMENT

I: General Information

Introduction: The VA Caribbean Healthcare System (VACHS) has a requirement for Advanced Cardiovascular Life Support (ALS) Ambulance Services. The VACHS Cardiac Surgery program was brought to a halt due to staffing and equipment issues since June, 2020. Consequently, cardiac surgery along with high-risk cardiac catheterizations and all non-emergent coronary angioplasties have request referral to community care. This requires accepting hospital to perform procedure the same day patient is accepted. The VACHS experience has shown that the availability of ambulances for inter-hospital transfers in Puerto Rico is notoriously unreliable. The timeliness of ambulance transfer coordination is crucial to adequately provide the patients with needed care.

As a result, we must provide one (1) ambulance, ready and immediately available on-site to transport patients requiring medical treatment.

Description: The Contractor shall provide one (1) Advance Life Support (ALS) Ambulance, personnel, management, supplies, transportation, equipment, materials, and reports necessary to furnish seven (7) hours per day, Ground Transportation Services from/ to the VA Caribbean Healthcare System (VACHS) and the approved non-VA facility accepting the patient. VACHS may require that ambulance service perform some transportations in the metropolitan area for discharged patients when cardiovascular transfers are not scheduled. The VACHS main facility is located at 10 Casia Street, Bo. Monacillos, San Juan, Puerto Rico.

Period of Performance:

One Year Base Period: (Monday thru Friday Staring 6am to 1:00pm – Excluding Holidays)

One Year Option Period 1: (Monday thru Friday Staring 6am to 1:00pm – Workdays/Holidays excluded)

One Year Option Period 2: (Monday thru Friday Staring 6am to 1:00pm – Workdays/Holidays excluded)

One Year Option Period 3: (Monday thru Friday Staring 6am to 1:00pm – Workdays/Holidays excluded)

One Year Option Period 4: (Monday thru Friday Staring 6am to 1:00pm – Workdays/Holidays excluded)

Changes to the contract shall only be made by written modification formally executed by the Contracting Officer and Contractor; duly signed by both parties.

II: Work Requirements

1. Contractor shall provide all vehicles, personnel, management, supplies, transportation, equipment, materials, and necessary reports as previously mentioned, in providing ambulance services.

2. Transportation required, but different to that on the Schedule of Services, shall be previously notified to the COR, and approved by the CO, or the COR; if the CO is not available.

3. Contractor shall make available a bariatric stretcher when requested to accommodate patients weighting more than 300 pounds.

4. Only one (1) patient shall be transported on a trip unless specifically authorized by the CO or COR. When more than one patient is transported on a trip, reimbursement shall not exceed the cost of transporting a single patient. However, if transportation is out of the covered area by the contract, the longest distance over which the patient is transported may be claimed when more than one (1) patient is transported in a single ambulance at the same time. The COR/ CO/Medical Administrative Assistant or an appointed Government representative for this contract, may, if in the best interest of the patient, allow a relative to accompany him/her. Contractor shall ensure that pick-ups and drop-offs are scheduled so that the total distance traveled will result in the most economical charge to the Government.

5. Request for services will be made by telephone, written and/or in person by the designated representative during regular working hours, nights and/or weekends. The COR, Health Administration Service Representative, Medical Administrative Assistant (AOD), CO, and/or Beneficiary Travel, or any other Government designee shall be considered the point of contact.

6. Acceptance of the trip shall obligate the Contractor’s ambulance crew to arrive within the required period and/or to assume payment of the difference in billing rate if they fail to meet this deadline.

7. The Contractor shall notify the COR as soon as possible of those instances in which the Contractor knows that he will be unable to provide the additional ambulance(s) within one (1) hour of the request, and if the Contractor fails to notify the VA ordering officer of this inability to so provide, the Contractor shall be required to pay any difference in price. Failure to notify the VA of any instance of inability to provide an ambulance may reflect upon the Contractor’s ability to perform under this contract and will be documented in the evaluation of Contractor’s performance (CPARS) and/or may constitute sufficient cause for termination of the existing contract.

8. The Contractor shall provide monthly reports of patients transported which with the following basic information: patient name, identifier number, date transported, where it was transported.

III: Personnel Requirements

A. Minimum of two (2) years of experience

B. Minimum Qualifications Standards

i. Contractor Education/Experience: Possess a high school education or equivalency and have two (2) years of experience demonstrating the ability to meet and deal with the general public, to read, understand and apply printed rules, detailed orders, instructions, and training materials; to maintain pose and self- control under stress; and to construct and write clear, concise, accurate and detailed reports as determined by successful, high level of performance with other customers. Any type of military service may be credited toward meeting the requirements. In lieu of the above, each employee shall have two years of relevant education at a residency school above the high school level, or any combination of relevant education above the high school level and relevant experience totaling two (2) years.

ii. Age: Contractor and employees performing work under this contract shall be a minimum of eighteen (18) years of age or as required by local laws.

iii. Health and Physical Fitness Requirements:

1. All employees assigned by the Contractor to work under this contract shall be physically able to perform all general duties, functions and activities. Contractor shall certify that personnel performing under this contract do not have current medical condition(s) which interfere with the ability to drive safely or perform their assigned duties. This includes vision, hearing, mental capacity, and any other condition that may restrict the ability to operate transport service vehicle or/and provide the required assistance and services to the transported patient. Physical examination report to describe above requirements for each driver shall be provided upon request.

2. All employees shall be literate and able to communicate (speak) with clients in English and Spanish to the extent of reading and understanding printed regulations, detailed written orders, training instructions and material, and shall be able to compose reports which convey complete information. The Contractor is to certify the ability of all employees designated to provide service for this contract. When a patient is transported with any VA owned equipment the equipment shall be returned to the respective VA Medical Center within 24 hours in the same condition as it was released at no addition cost to the Government.

iv. Drivers:

1. Education/Experience: Possess a high school education or equivalency and have two (2) years of experience demonstrating the ability: to meet and deal with the general public; to read, understand and apply printed rules, detailed orders, instructions, and training materials: to maintain pose and self-control under stress; and to construct and write clear, concise, accurate and detailed reports as determined by successful, high level of performance with another clientele.

2. Possesses a valid operator's license issued by the Commonwealth of Puerto Rico that has not, within the last three years, been convicted of reckless driving or driving under the influence of alcohol or controlled substances and has not had a driver’s license suspended under the point system issued by the state. Possess a valid American Red Cross standard first aid and personal safety course card or its equivalent. Drivers must provide full name, date of birth, and social security number to VA prior to operating vehicles with VA beneficiaries. Proof in the form of a current certificate that such first aid training has been successfully completed must be available upon request.

3. Possess a working knowledge of route specific to the area, and knowledge of the geographical areas covered by this contract, and knowledge of the nearest hospital available.

4. Contractor must provide an annual statement that drivers are screened, trained and competent to safely transport patients. This annual statement of driver competency must include any advanced certifications, such as Advanced Cardiac Life Support or specialized training to assist and secure patients by stretcher or wheelchair. used during the provision of these services

v. Attendants - Emergency Medical Technician (EMT) and Paramedics used during the provision of these services of a minimum of two (2) Emergency- Medical Technicians (EMTs) for BCLS and a minimum of one EMT and one Paramedic for every ACLS Service. In the event the VA Medical Center determines it necessary for the patient to have more than one ACLS attendant at bed side during transport, the Contractor must provide the additional attendant. Contractor shall provide the additional attendant when mechanical ventilator is required during the transportation. If the patient being transported requires accompaniment by a Registered Nurse (RN), the government will supply the RN to accompany the patient during transport. The RN's responsibilities during transport will be clearly outlined in written physician orders. In the event of emergency, the care of the patient in transport will be the responsibility of the EMT/Paramedic.

Paramedics, in addition to the above, will be licensed in advanced and basic life support and having completed an appropriate training courses as required by the Public Service Commission of Puerto Rico. Attendant should have a minimum of four (4) hours of training in crisis intervention (documented), since some of the patients requiring an attendant will be psychiatric patients. EMT's, in addition to above requirements, must be licensed in basic life support and having completed an appropriate training course as required by the Public Service Commission of Puerto Rico. An Attendant will always be required for stretcher patients strictly for their safety during the trip and help during transfer to and from an ambulance. Contractor shall assure that EMT/Paramedics comply with their continuing education, or advanced training programs as required by the Puerto Rico Department of Health, the Puerto Rico Public Service Commission (Comisión de Servicio Público), and the Commonwealth of Puerto Rico. Such continuing education must be equivalent to that developed by the Commonwealth of Puerto Rico agencies. Evidence of successful completion for continuing education must be provided to the Contracting Officer for inspection.

EMT’s shall have satisfactorily completed a course as Medical Emergency Technician in accordance with the Commonwealth of Puerto Rico Health Secretary, as established by the Federal Transportation Department (DOT) and duly approved the Health Department of Puerto Rico, which is taught by an institution credited by the General Education or Superior Education Counsel in Puerto Rico.

IV. Personnel Duties

Paramedics and EMTs, among their duties, may transport any of the following under the medical control of the VACHS medical director or designee.

· Patient Controlled Analgesia (PCA) pump with any medication or fluid infusing through a peripheral IV

· Medication infusing through a peripheral IV or continuous subcutaneous catheter via a closed, locked system

· A central catheter that is clamped off (subclavian, Hickman, Peripherally Inserted Central Catheter, and Passport)

· A patient with a feeding tube that is clamped off

· A patient with a Holter monitor

· A patient with a peripheral IV infusing vitamins

· IV fluids infusing through a peripheral IV via gravity or an infusing system that allows the technician to change the rate of infusion are limited to D5W, Lactated Ringers, Sodium Chloride (0.9% or less), Potassium chloride (20mEq or less for EMTs, 40mEq or less for Advanced EMTs)

· Medication infusing through a peripheral or central IV or fluid infusing through a central IV via gravity or an infusing system that allows the operator or assistant to change the rate of infusion

· A patient with a chest tube

· A patient with a continuous feeding tube

· A vent dependent patient

Most of their routine duties include:

· Determine blood glucose levels

· Oxygen & pulse oximetry

· Cardiac Monitoring

· Administer standard intravenous (IV) solutions of Normal Saline & Lactated Ringer’s

· Insert nasogastric tubes for administration of Activated Charcoal

· Insert Esophageal Tracheal Combi Tube

· Perform Needle Cricothyrotomy

· Oral Endotracheal intubation

· Nasal Endotracheal intubation

· Endotracheal suction

· Administer drugs through the following routes:

· Sublingual

· Subcutaneous

· Intramuscular

· Intravenous

· Endotracheal

· Perform needle thoracotomy to relieve tension pneumothorax

· Application of splints

· Order trauma alert (and request aero medical helicopters for serious trauma patient with significant mechanisms of injury or a grade or less than 12 on the Glasco Coma scale

· BLS in accordance with current Cardio-Pulmonary Resuscitation standards

· ALS in accordance with ACLS protocols, to include defibrillation, cardioversion, and external pacing if the RPM has current documentation of successful ALS course completion

· Treatment of acute respiratory failure

· PCA pump with any medication or fluid infusing through a peripheral IV

V. Safety Requirements Contractor shall take such safety precautions as the CO and/or the COR may determine to be reasonably necessary to protect the lives and health of patients, and occupancy of the buildings and/or facilities. The CO/COR shall notify the Contractor of any noncompliance with the foregoing provision and the action to be taken. The Contractor shall correct the situation within one (1) hour to which attention has been directed. If the Contractor fails to promptly comply, the CO may issue an order stopping all or any part of the work and hold the Contractor by default.

VI. Insurance Certification Contractor shall have Certificate of Insurance which shall contain an endorsement to the effect that cancellation of, or any material change in the policies which adversely affect the interest of the Government in such insurance shall not be effective unless thirty (30) days written notice of cancellation or change is furnished to the CO.

VII. Training in Psychiatric Behavior All Contractor personnel shall be trained in the prevention and management of disturbed behavior as well as suicide prevention techniques. Documentation/certification must be submitted to the CO within thirty (30) days of contract award. If no prior training has been received on this subject, Contractor personnel shall be required to complete VA provided training.

VIII. Minimum Quality Considerations A. The contractor shall continuously meet or exceed all The Joint Commission (TJC) standards. All applicable VACHS policies and procedures shall be followed by the contractor. Contract personnel shall provide compassionate care with respect for the special needs of the veteran population served. Care delivered shall reflect the VACHS Medical Center’s mission, vision, and values.

a. (http://www.jointcommission.org/standards_information/standards.aspx) B. The Contractor shall maintain records that document competence/performance level of contractor employees working on this contract in accordance with TJC and other regulatory body requirements.

C. Contractor shall provide and document a general orientation for all Contractor employees who are providing work on this contract prior to performance. Documentation of the orientation shall be maintained by the contractor and made available to the Government upon request. This orientation, at minimum, shall include the following topics:

i. Fire and safety policy and procedure

ii. Infection control policy and procedure

iii. Emergency Preparedness /Disaster policy and procedure

iv. Performance requirements according to the contract PWS D. The Government will monitor contractor(s) performance using the Quality Assurance Surveillance Plan (QASP) and reserves the right to conduct unannounced visits for the purpose of inspecting and/or verifying contract compliance.

E. The Contractor shall have a written Quality Control Plan (QCP). It shall specify the areas to be inspected either on a scheduled or an unscheduled basis, how often inspections shall occur, and the title of the individual(s) who shall perform the inspection. At a minimum, the QCP shall include the following:

i. An inspection system covering work performance of the contract. This system shall specify items to be inspected on both: scheduled and unscheduled basis.

ii. Method of identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable.

iii. A file of all inspections conducted by the contractor and corrective action taken.

IX. Patient Rights

The contractor(s) shall respect the patients’ beliefs, values, and cultural diversity. Protection of all patient rights is of highest priority. Patient privacy and confidentiality shall be maintained at all times.

The Contractor shall be courteous to VA beneficiaries, and shall not smoke or text while transporting patients. Patients may bring a reasonable amount of belongings such as a personal suitcase. Texting while driving is a federal violation, and it is also prohibited by Commonwealth of Puerto Rico.

X. Patient Safety and Welfare

Patient safety shall be a primary focus of the contractor. Every effort shall be made by the Contractor to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breaches of patient safety shall be reported to the COR utilizing Report of Accident VA Form 2162 and/or in the case of motor vehicle accident the Standard Form 91 and shall be notified in no more than twenty-four (24) hours from the event.

The Contractor shall be held responsible for patient and/or Government property during transport. Any damaged or lost wheelchairs, walkers, crutches or personal belongings will be replaced by the Contractor at no additional cost to the Government or the transported beneficiary.

The Government requires the contractor to exercise extreme caution and care in the handling of patients. Any abuse of patients will be grounds for default action or Termination of the contract.

In the event a patient's condition worsens during transport, the Contractor shall transport the patient to the closest emergency room facility that can provide the required care and inform the COR about the situation. In the event a patient should expire during transport the Contractor shall return to the VA Medical Center.

XI. Deliverables

a. The original copy of the trip ticket shall be turned into the transportation office at the time services are rendered. For runs that terminate at the VACHS, San Juan, Puerto Rico, the driver shall sign the trip ticket, certifying the information thereon, and shall leave a copy with the Travel Clerk after completion of the transport.

b. For those transports that do not terminate at the VACHS, San Juan, PR, or that ends after 4:30 pm, trip tickets shall be given to the Travel Clerk no more than a week later of rendered services.

c. Contractor shall submit weekly invoices in arrears for all services performed during the week. These invoices shall be submitted no later than noon on the Monday following the previous week. A bulk invoice shall be submitted which includes data on each transport. All invoices shall be attached to VA Form 10-2511. The Contractor shall complete VA Form 10-2511 (Authorization for Travel by Ambulance), which shall be furnished by the COR as confirmation of all verbal orders. The COR shall review invoices and will notify the contractor of invoice discrepancies. The following information shall be provided by the Contractor:

· Name, address, POC and phone number of the contractor

· Invoice date and number

· Contract number and order number

· Time call received

· Time ambulance dispatched

· Name of beneficiary

· Address or location(s) where beneficiary was given service

· Address or location where beneficiary was taken

· In case of service to a point outside city limits, show one way mileage

· Mileage from starting point to ending point

Invoices shall also be sent to The Department of Veterans Affairs FMS, VIA Tungsten Network. Information regarding invoice requirements can be found at http://www.tungsten-network.com/customer-campaigns/veterans-affairs/.

XI. Sensitive Information

a. Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

b. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

c. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

d. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.

XII. Contractor Personnel Security Requirements: Comment by Perez, Wilfredo: This section and its subsections must be in the same format as the rest of the PWS.

A. All contractor employees who require access to the Department of Veterans Affairs’ computer systems shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement prior to contract performance. This requirement is applicable to all subcontractor personnel requiring the same access. If the investigation is not completed prior to the start date of the contract the contractor will be responsible for the actions of those individuals that provide or perform work for the VA.

1. Position Sensitivity – The position sensitivity has been designated as __ low __ risk.

2. Background Investigation – The level of background investigation commensurate with the required level of access is National Agency Check (NACI) with written inquiries.

3. Contractor Responsibilities

a. The contractor shall bear the expense of obtaining background investigations. If the investigation is conducted by the Office of Personnel Management (OPM), the contractor shall reimburse the VA within 30 days.

The web site which provides information on the cost of the security investigation is:

www.opm.gov\extra\investigate – Select Federal Investigations Notices (FIN 01-01)

b. The contractor shall prescreen all personnel requiring access to the computer systems to ensure they maintain a U.S. citizenship and are able to read, write, speak, and understand the English language.

c. The contractor will provide to the Contracting Officer prior to award the following: (1) List of names of contract personnel. (2) Social security numbers of contractor personnel. (3) Home address of contractor personnel or the contractor address.

The Contracting Officer will submit the above information to the Office of Security and Law Enforcement, Washington, D.C. The Office of Security and Law Enforcement will provide the necessary investigative forms (these forms are indicated in paragraph 3.d. below) to the contractor’s personnel, coordinate the background investigations with OPM and notify the Contracting Officer and contractor of the results of the investigation.

d. The contractor shall submit or have their employees submit the following required forms to the VA Office of Security and Law Enforcement within 30 days of receipt:

(i) Standard From 85P, Questionnaire for Public Trust Positions

(ii) Standard Form 85P-S, Supplemental Questionnaire for Selected Positions

(iii) FD 258, U.S. Department of Justice Fingerprint Applicant Chart

(iv) VA Form 0710, Authority for Release of Information Form

(v) Optional Form 306, Declaration for Federal Employment

(vi) Optional Form 612, Optional Application for Federal Employment

d. The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract.

e. Failure to comply with the contractor personnel security requirements may result in termination of the contract for default.

XIII. HIPAA Compliance, Privacy and Confidentiality

Contractor shall comply with the provision of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). Contractor shall comply with applicable confidentiality statutes, including 38 U.S.C. 5701, 38 U.S.C. 7332, and 5 U.S.C. 552a (Privacy Act), as well as 45 C.F.R. Parts 160, 162, and 164 (Health Insurance Portability and Accountability Act).

XIV. Contractor Rules Of Behavior This User Agreement contains rights and authorizations regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the Department of Veterans Affairs (VA). This User Agreement covers my access to all VA data whether electronic or hard copy ("Data"), VA information systems and resources ("Systems"), and VA sites ("Sites"). This User Agreement incorporates Rules of Behavior for using VA, and other information systems and resources under the contract.

1. General Terms And Conditions For All Actions And Activities Under The Contract:

a. I understand and agree that I have no reasonable expectation of privacy in accessing or using any VA, or other Federal Government information systems.

b. I consent to reviews and actions by the Office of Information & Technology (OI&T) staff designated and authorized by the VA Chief Information Officer (CIO) and to the VA OIG regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the VA. These actions may include monitoring, recording, copying, inspecting, restricting access, blocking, tracking, and disclosing to all authorized OI&T, VA, and law enforcement personnel as directed by the VA CIO without my prior consent or notification.

c. I consent to reviews and actions by authorized VA systems administrators and Information Security Officers solely for protection of the VA infrastructure, including, but not limited to monitoring, recording, auditing, inspecting, investigating, restricting access, blocking, tracking, disclosing to authorized personnel, or any other authorized actions by all authorized OI&T, VA, and law enforcement personnel.

d. I understand and accept that unauthorized attempts or acts to access, upload, change, or delete information on Federal Government systems; modify Federal government systems; deny access to Federal government systems; accrue resources for unauthorized use on Federal government systems; or otherwise misuse Federal government systems or resources are prohibited.

e. I understand that such unauthorized attempts or acts are subject to action that may result in criminal, civil, or administrative penalties. This includes penalties for violations of Federal laws including, but not limited to, 18 U.S.C. §1030 (fraud and related activity in connection with computers) and 18 U.S.C. §2701 (unlawful access to stored communications).

f. I agree that OI&T staff, in the course of obtaining access to information or systems on my behalf for performance under the contract, may provide information about me including, but not limited to, appropriate unique personal identifiers such as date of birth and social security number to other system administrators, Information Security Officers (ISOs), or other authorized staff without further notifying me or obtaining additional written or verbal permission from me.

g. I understand I must comply with VA’s security and data privacy directives and handbooks. I understand that copies of those directives and handbooks can be obtained from the Contracting Officer's Technical Representative (COTR). If the contractor believes the policies and guidance provided by the COTR is a material unilateral change to the contract, the contractor must elevate such concerns to the Contracting Officer for resolution.

h. I will report suspected or identified information security/privacy incidents to the COTR and to the local ISO or Privacy Officer as appropriate.

2. GENERAL RULES OF BEHAVIOR

a. Rules of Behavior are part of a comprehensive program to provide complete information security. These rules establish standards of behavior in recognition of the fact that knowledgeable users are the foundation of a successful security program. Users must understand that taking personal responsibility for the security of their computer and the information it contains is an essential part of their job.

b. The following rules apply to all VA contractors. I agree to:

(1) Follow established procedures for requesting, accessing, and closing user accounts and access. I will not request or obtain access beyond what is normally granted to users or by what is outlined in the contract.

(2) Use only systems, software, databases, and data which I am authorized to use, including any copyright restrictions.

(3) I will not use other equipment (OE) (non-contractor owned) for the storage, transfer, or processing of VA sensitive information without a VA CIO approved waiver, unless it has been reviewed and approved by local management and is included in the language of the contract. If authorized to use OE IT equipment, I must ensure that the system meets all applicable 6500 Handbook requirements for OE.

(4) Not use my position of trust and access rights to exploit system controls or access information for any reason other than in the performance of the contract.

(5) Not attempt to override or disable security, technical, or management controls unless expressly permitted to do so as an explicit requirement under the contract or at the direction of the COTR or ISO. If I am allowed or required to have a local administrator account on a government-owned computer, that local administrative account does not confer me unrestricted access or use, nor the authority to bypass security or other controls except as expressly permitted by the VA CIO or CIO's designee.

(6) Contractors’ use of systems, information, or sites is strictly limited to fulfill the terms of the contract. I understand no personal use is authorized. I will only use other Federal government information systems as expressly authorized by the terms of those systems. I accept that the restrictions under ethics regulations and criminal law still apply.

(7) Grant access to systems and information only to those who have an official need to know.

(8) Protect passwords from access by other individuals.

(9) Create and change passwords in accordance with VA Handbook 6500 on systems and any devices protecting VA information as well as the rules of behavior and security settings for the particular system in question.

(10) Protect information and systems from unauthorized disclosure, use, modification, or destruction. I will only use encryption that is FIPS 140-2 validated to safeguard VA sensitive information, both safeguarding VA sensitive information in storage and in transit regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with the VA.

(11) Follow VA Handbook 6500.1, Electronic Media Sanitization to protect VA information. I will contact the COTR for policies and guidance on complying with this requirement and will follow the COTR's orders.

(12) Ensure that the COTR has previously approved VA information for public dissemination, including e-mail communications outside of the VA as appropriate. I will not make any unauthorized disclosure of any VA sensitive information through the use of any means of communication including but not limited to e-mail, instant messaging, online chat, and web bulletin boards or logs.

(13) Not host, set up, administer, or run an Internet server related to my access to and use of any information assets or resources associated with my performance of services under the contract terms with the VA unless explicitly authorized under the contract or in writing by the COTR.

(14) Protect government property from theft, destruction, or misuse. I will follow VA directives and handbooks on handling Federal government IT equipment, information, and systems. I will not take VA sensitive information from the workplace without authorization from the COTR.

(15) Only use anti-virus software, antispyware, and firewall/intrusion detection software authorized by VA. I will contact the COTR for policies and guidance on complying with this requirement and will follow the COTR's orders regarding my access to and use of any information assets or resources associated with my performance of services under the contract terms with VA.

(16) Not disable or degrade the standard anti-virus software, antispyware, and/or firewall/intrusion detection software on the computer I use to access and use information assets or resources associated with my performance of services under the contract terms with VA. I will report anti-virus, antispyware, firewall or intrusion detection software errors, or significant alert messages to the COTR.

(17) Understand that restoration of service of any VA system is a concern of all users of the system.

(18) Complete required information security and privacy training, and complete required training for the particular systems to which I require access.

3. ADDITIONAL CONDITIONS FOR USE OF NON- VA INFORMATION TECHNOLOGY RESOURCES

a. When required to complete work under the contract, I will directly connect to the VA network whenever possible. If a direct connection to the VA network is not possible, then I will use VA approved remote access software and services.

b. Remote access to non-public VA information technology resources is prohibited from publicly-available IT computers, such as remotely connecting to the internal VA network from computers in a public library.

c. I will not have both a VA network line and any kind of non-VA network line including a wireless network card, modem with phone line, or other network device physically connected to my computer at the same time, unless the dual connection is explicitly authorized by the COTR.

d. I understand that I may not obviate or evade my responsibility to adhere to VA security requirements by subcontracting any work under any given contract or agreement with VA, and that any subcontractor(s) I engage shall likewise be bound by the same security requirements and penalties for violating the same.

4. STATEMENT ON LITIGATION

This User Agreement does not and should not be relied upon to create any other right or benefit, substantive or procedural, enforceable by law, by a party to litigation with the United States Government.

5. ACKNOWLEDGEMENT AND ACCEPTANCE

I acknowledge receipt of this User Agreement. I understand and accept all terms and conditions of this User Agreement, and I will comply with the terms and conditions of this agreement and any additional VA warning banners, directives, handbooks, notices, or directions regarding access to or use of information systems or information. The terms and conditions of this document do not supersede the terms and conditions of the signatory’s employer and VA.

Print or type your full name Signature

Last 4 digits of SSN Date

Office Phone Position Title Contractor’s Company Name Please complete and return the original signed document to the COTR within the timeframe stated in the terms of the contract.

XIX. Recognized Holidays

In accordance with 5 U.S.C. 6103, Executive Order 11582 and Public Law 94-97 the following national holidays are observed and for the purpose of this contract is defined as “Legal Federal official holidays” as follows:

The Wage Determination shall be enforced by each contract under the Services Contract Act. The latest and applicable Wage Determination shall be found in website http://www.dol.gov/

Eleven (11) holidays are observed as prescribed in the Wage Determinations revision applicable to the Commonwealth of Puerto Rico statewide areas as follows:

XX. Ordering Service

Personnel authorized by the Contracting Officer shall make requests for service by telephone. Request for services will be made to the telephone number specified by the Contractor or to one back-up number in the event of no answer at the primary number specified. All contacts from the Contractor will be with the Travel Coordinator at (787)641-7582 ext. 131234/131235/131233, Mobility Manager (COR) at (787)641-7582 ext. 131517 or the Administrative Officer of the Day (AOD) at (787)641-7582 ext. 131119, 131105 or 131117 during non-administrative hours.

A list of authorized ordering personnel shall be made available upon award of the contract. Employees may be added or deleted from the list during the term of the contract at the discretion of the Contracting Officer and the COR. The Contractor shall be notified of such changes as they occur.

If the VA is unable to establish telephone contact with the Contractor for ALS ambulance service within five (5) minutes or if the Contractor fails to furnish within 45 minutes after receiving a request or within 45 minutes of the scheduled pick-up time, the VA reserves the right to obtain the service from another source and to charge the Contractor with any excess costs which may result there from. The VA will be the sole judge in determining when to order service from another source.

Advanced Life Support (ALS) will be furnished for only life-threatening transport. If the VA is unable to establish telephone contact with the Contractor for life threatening Advanced Life Support (ALS) service within one (1) minute at the numbers specified, or Contractor fails to furnish an ALS ambulance within fifteen (15) minutes after receiving a request, the VA reserves the right to obtain service from another source and to charge the Contractor with any excess costs which may result. If, within five (5) minutes after receiving a request for ALS service, the Contractor determines they are unable to provide this service within fifteen (15) minutes, the Contractor shall contact the Emergency Management Department at 911 to respond to the call, providing them with the location and the need for an ALS unit. The Contractor will inform VA of their inability to meet the contractual needs and confirm they have contacted the Emergency Management Service Department to provide this service.

Confirmation that vendor can meet our request will be confirmed within 30 minutes of receiving the order (if it is not confirmed at the time the request is placed). If the contractor is unable to provide the service at the time required and wishes to subcontract with another company, the VA will be notified within thirty (30) minutes of the request of the company responsible for transporting the patient on their behalf. The contractor will be charged the difference between the contract price and the sub-contractor amount charged. If Contractor has not arrived or called within one (1) hour of the time requested, and has not provided this service through another company, the VA reserves the right to request service from another source and the contractor will be charged the difference between the contact price and the amount charged. The VA will be the sole judge in determining when to order service from another source. This requirement will be strictly enforced.