S06 - Amendment 36C24826R0015 0006.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

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

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

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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

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

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

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

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

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 97

05-19-2026

None

36C248

Department of Veterans Affairs Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy Ste 160A Tampa FL 33637

36C248

Department of Veterans Affairs Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy

To all Offerors/Bidders

36C24826R0015

01-30-2026

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to: 06-03-2026 4:00 pm EDT

See CONTINUATION Page

Amendment 0006 is hereby issued as a consolidated amendment to the solicitation. This amendment incorporates all prior solicitation amendments issued to date. Offerors need only acknowledge Amendment 0006, and such acknowledgment shall constitute acknowledgment of all prior amendments.

Offerors claiming status as a Service-Disabled Veteran-Owned Small Business (SDVOSB) or Veteran-Owned Small Business (VOSB) shall review VAAR 852.215-70 and VAAR 852.215-71 and submit the information and representations required by those provisions.

Solicitation extended to 06-03-2026 by 4:00pm EST.

LeTray Womble Contracting Officer

VA-VHA-RPOE-2025-0042

PAGE 2 OF 97 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 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. 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

36C24826R0015 01-30-2026

J'Vonne Wilson (813) 816-4620 06-03-2026

4:00PM EST

36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) J'Vonne Wilson, Contract Specialist 8875 Hidden River Pkwy Suite 160A

621910

$22.5 Million

Net 30

N/A

Department of Veterans Affairs James A. Haley Veterans Hospital (90C) 13000 Bruce B. Downs Blvd

Tampa FL 33612

36C248

Department of Veterans Affairs Network Contracting Office 8 (NCO 8)

8875 Hidden River Pkwy

Financial Services Center

P.O. Box 149971 Austin TX 78714-9971

a. This is a combined synopsis/solicitation for commercial services prepared in accordance with part 12. This announcement constitutes the only solicitation. Proposals are being requested and a separate written solicitation will not be issued.

b. Offerors shall provide services in accordance with the attached Performance Work Statement (PWS).

c. Offerors shall complete section B.2 Price/Cost Schedule.

d. Offerors are requested to complete Experience References (Atch D1) and provide completed Experience Questionnaire (Atch D2) to References identified in Sect. D.

e. All applicable documents are requested to be submitted to the Point of Contact individual listed on the form.

f. Experience Questionnaire will only be accepted by the identified References no later than 06/03/2026.

g. The contract will be for a period of five years, a base year and 4 option years.

h. Contract will be subject to WD15-4571, Revision 29, dated 04/29/26.

X 1

Letray Womble

VA-VHA-RPOE-2025-0042

Table of Contents

SECTION A

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

COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

B.3 STATEMENT OF NEED

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)

C.2 52.216-18 ORDERING (AUG 2020)

C.3 52.216-21 REQUIREMENTS (OCT 1995)

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

C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

C.7 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.8 52.240-91 SECURITY PROHIBITIONS AND EXCLUSIONS (NOV 2025)

(DEVIATION)

C.9 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.10 52.203-16 PREVENTING PERSONAL CONFLICTS OF INTEREST (JUN 2020)

C.11 VAAR 852.219-70 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM

REQUIREMENTS (JAN 2023) (DEVIATION)

C.12 52.204-13 SYSTEM FOR AWARD MANAGEMENT—MAINTENANCE

(DEVIATION) (NOV 2025)

C.13 52.228-5 INSURANCE—WORK ON A GOVERNMENT INSTALLATION (JAN 1997) 65

C.14 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JAN 2023) (DEVIATION)

C.15 MANDATORY WRITTEN DISCLOSURES

WAGE DETERMINATION

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023)

E.2 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.3 52.216-1 TYPE OF CONTRACT (NOV 2025) (DEVIATION)

E.4 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.5 52.240-90 SECURITY PROHIBITIONS AND EXCLUSIONS REPRESENTATIONS

AND CERTIFICATIONS (NOV 2025) (DEVIATION)

E.6 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(OCT 2018)

E.7 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.8 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES INCORPORATED BY

REFERENCE (JAN 2008)

E.9 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.10 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.11 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES (OCT 2025)

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) LeTray Womble

Network Contracting Office 8 (NCO 8) J'Vonne Wilson, Contract Specialist 8875 Hidden River Pkwy Suite 160A Tampa, FL 33637

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

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

[ ] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly [ ]

b. Semi-Annually [ ]

c. Other [X] Monthly

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

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

AMENDMENT NO DATE

B.2 PRICE/COST SCHEDULE

NOTE: Quantities listed in the Price Schedule are provided for evaluation purposes and planning only and are not-to-exceed (NTE) quantities. Actual quantities ordered may be less, and the Government will pay only for supplies/services actually ordered and accepted.

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

NOT-TO-

EXCEED

QUANTITY UNIT UNIT PRICE AMOUNT

300.00 EA __________________ __________________

(A0427) Advanced Life Support Emergent Transport, Level 1 (ALS 1) ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Base POP Begin: 08-01-2026 POP End: 07-31-2027

NAICS AND PSC APPLIES TO ALL CLINS

PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

0001AA

5.00 EA __________________ __________________

No Shows (ALS Only) Cancellation after the Contractor has dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Base POP Begin: 08-01-2026 POP End: 07-31-2027

4,000.00 EA __________________ __________________

(A0428) Basic Life Support, Non-Emergency Transport, Basic Life Support

(BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration. One-Way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Base

0002AA

20.00 EA __________________ __________________

No Shows (BLS Only) Cancellation after the Contractor has dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Base

(A0426) Non-Emergent Advance Life Support Transport, Level 1 (ALS 1)

One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Base

0003AA

No Shows (Non-Emergent ALS Only) Cancellation after the Contractor has dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Base

150.00 EA __________________ __________________

(A0434) Critical Care Transport (Upper-Level Care) Specialty Care

Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area. One-way trip is equivalent to one each for the unit of issue.

(*base rate to include first 25 miles).

Contract Period: Base

0004AA

3.00 EA __________________ __________________

No Shows (Critical Care Transport Only) Cancellation after the Contractor has dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Base

50,000.00 EA __________________ __________________

(A0425) Mileage Trip Outside the Base Rate

Contract Period: Base

100.00 EA __________________ __________________

(A0420) Waiting Time (more than 30 minutes shall be paid in 15-minute increments). 15-minute increment is equivalent to one each for the unit of issue.

Contract Period: Base ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Option 1 POP Begin: 08-01-2027 POP End: 07-31-2028

1001AA

vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 1

(BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration. One-Way trip is equivalent to one each for the unit of issue. (*base rate, to include first 25 miles).

Contract Period: Option 1

1002AA

vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 1

One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Option 1

1003AA

dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 1

Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area. One-way trip is equivalent to one each for the unit of issue.

(*base rate to include first 25 miles).

Contract Period: Option 1

1004AA

has dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 1

Contract Period: Option 1 increments). 15-minute increment is equivalent to one each for the unit of issue.

Contract Period: Option 1 ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Option 2 POP Begin: 08-01-2028 POP End: 07-31-2029

2001AA

vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 2

(BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration. One-Way trip is equivalent to one each for the unit of issue. (*base rate, to include first 25 miles).

Contract Period: Option 2

2002AA

vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 2

(A0426) Non-Emergent Advance Life Support Transport, Level 1 (ALS

1)(*base rate to include first 25 miles) One-way trip is equivalent to one each for the unit of issue)

Contract Period: Option 2

2003AA

dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 2

Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area. One-way trip is equivalent to one each for the unit of issue.

(*base rate to include first 25 miles).

Contract Period: Option 2

2004AA

has dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 2

Contract Period: Option 2 increments). 15-minute increment is equivalent to one each for the unit of issue.

Contract Period: Option 2 ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Option 3 POP Begin: 08-01-2029 POP End: 07-31-2030

3001AA

vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 3

(BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration. One-Way trip is equivalent to one each for the unit of issue. (*base rate, to include first 25 miles).

Contract Period: Option 3

3002AA

vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 3

One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Option 3

3003AA

dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 3

Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area. One-way trip is equivalent to one each for the unit of issue.

(*base rate to include first 25 miles).

Contract Period: Option 3

3004AA

has dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 3

Contract Period: Option 3 increments). 15-minute increment is equivalent to one each for the unit of issue.

Contract Period: Option 3 ambulances transport patients who need a higher level of care during transport above those services provided by a BLS ambulance. The unit is staffed by at least one paramedic who has more than 1,000 hours of education and training and are qualified to render advanced life support to patients such as advanced airway management, drug administration and cardiac monitoring under the direction of a hospital. One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Option 4 POP Begin: 08-01-2030 POP End: 07-31-2031

4001AA

vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 4

(BLS) ambulances provide transport to patients who do not require extra support or cardiac monitoring. A BLS ambulance is staffed by two emergency medical technicians (EMTs) who have training in basic emergency medical care such as basic airway management, use of an automated external defibrillator and basic drug administration. One-Way trip is equivalent to one each for the unit of issue. (*base rate, to include first 25 miles).

Contract Period: Option 4

4002AA

vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 4

One-way trip is equivalent to one each for the unit of issue. (*base rate to include first 25 miles).

Contract Period: Option 4

4003AA

dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 4

Transport (SCT) – As defined by the Centers for Medicare & Medicaid Services (CMS) — is IFT of a critically injured or ill beneficiary by a ground ambulance vehicle including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic SCT is necessary when a beneficiary’s condition requires ongoing care that must be furnished by one or more health professionals in an appropriate specialty area. One-way trip is equivalent to one each for the unit of issue.

(*base rate to include first 25 miles).

Contract Period: Option 4

4004AA

has dispatched a vehicle. (Reimbursement for One-Way Trip)

Contract Period: Option 4

Contract Period: Option 4 increments). 15-minute increment is equivalent to one each for the unit of issue.

Contract Period: Option 4

GRAND TOTAL __________________

*Base Rate - Base Rate is defined as the rate paid for one-way transportation and handling of a patient, from the designated pick-up point to a designated drop-off point. This rate will be paid for all VA- Initiated one-way trips ordered under this contract action up to 25 miles.

B.3 PERFORMANCE WORK STATEMENT

1. Purpose: The James A. Haley VA Medical Center (JAH VAMC), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency ambulance transportation services. The Contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), Specialty Care Transport (SCT) or Critical Care Transport (CCT) services. The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

2. Background: The JAH VAMC main campus is located 13000 Bruce B. Downs Blvd, Tampa FL

33612, serving over 129,000 veterans, primarily from the Hillsborough County area and it’s eight Community-Based Outpatient Clinics. The hospital has 517 inpatient beds and sees approximately 15,000 inpatient admissions and 1,779,000 outpatient visits a year. Veterans served within this facility lives within the following counties and zip codes. Contractor shall obtain an approved Certificate of Public Convenience and Necessity (COPCN) prior to award for each county listed below.

County/Zip Code County/Zip Code Citrus/34423, 34428, 34429, 34433, 34434, 34436, 34441, 34442, 34445, 34446, 34447, 34448, 34450, 34451, 34452, 34460, 34461, 34464, 34465, 34487

Pasco/33523, 33524, 33525, 33526, 33537, 33539, 33540, 33541, 33542, 33543, 33544, 33545, 33574, 33576, 33593, 34610, 34637, 34638, 34639, 34652, 34653, 34654, 34655, 34656, 34667, 34668, 34669, 34673, 34674, 34679, 34680, 34691, 34692

Hardee/33834 Pinellas/34688 Hernando/34601, 34602, 34603, 34604, 34605, 34606, 34607, 34608, 34609, 34611, 34613, 34614, 34636, 34661

Sumter/33513

Hillsborough/33503, 33508, 33509, 33510, 33511, 33527, 33530, 33534, 33547, 33548, 33549, 33550, 33556, 33558, 33559, 33563, 33564, 33565, 33566, 33567, 33568, 33569, 33570, 33571, 33572, 33573, 33575, 33578, 33579, 33583, 33584, 33586, 33587, 33592, 33594, 33595, 33596, 33598, 33601, 33602, 33603, 33604, 33605, 33606, 33607, 33608, 33609, 33610, 33611, 33612, 33613, 33614, 33617, 33618, 33619, 33620, 33621, 33622, 33623, 33624, 33625, 33629, 33634, 33637, 33646, 33647, 33655, 33672, 33673, 33674, 33675, 33677, 33679, 33680, 33682, 33684, 33685, 33687, 33688, 33689, 33690, 33694

Polk/33801, 33802, 33803, 33804, 33805, 33806, 33807, 33809, 33810, 33811, 33812, 33813, 33815, 33820, 33823, 33827, 33830, 33831, 33835, 33838, 33839, 33840, 33841, 33847, 33849, 33850, 33851, 33853, 33860, 33863, 33868, 33877, 33898

Levy/32625, 32639, 34449, 34498 Marion/34430, 34431

3. Acronyms ALS – Advanced Life Support AOD – Administrative Officers of the Day BLS – Basic Life Support CCT – Critical Care Transport CCTP – Critical Care Transport Paramedic CCEMTP – Critical Care Emergency Medical Transport CO – Contracting Officer COR – Contracting Officer’s Representative CPR – Cardiopulmonary Resuscitation DOL – Department of Labor EMT – Emergency Medical Technician IAW – In Accordance With OO – Ordering Officer PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QC – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VTS – Veteran Transportation Service

4. Scope/Requirements

4.1. Types of Ambulance Service

4.1.1. The Contractor shall provide Urgent, non-emergent Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) Tier 1, 2, and 3 ambulance services on an as-needed basis in accordance with all federal, state, and local regulations.

4.1.2. Occasionally a veteran will need to be transported with VA staff and equipment; the Contractor shall return VA Staff and equipment to the original place of pick-up.

4.2. Transport of Miscellaneous Items with the Patient

The Contractor may also be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government.

Luggage to be transported will be restricted to suitcase and valise types. When patients are transported to the JAH VAMC, destination is deemed to be the ER, Admissions, the clinic, or service within the hospital, or directly to the ward as instructed by VA Staff.

4.3. Contractor Personnel: Contractor personnel shall be courteous and always conduct themselves in a businesslike manner while providing services under this contract.

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

4.3.1.1. EMTs, CCTPs and other medical personnel (as applicable) shall at all times meet the qualifications specified in this contract as well as all applicable federal, state, and local government laws, regulations, and standards. EMTs, CCTPs and other medical personnel (as applicable) shall be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity where the emergency service is operated or by which it is governed.

4.3.1.2. If the Contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing (i.e., Driver & Transportation-for Hire) and any other qualifications to the Contracting Officer’s Representative (COR) for review.

4.3.1.3. All ambulance drivers shall have a valid driver’s license in accordance with state requirements for their place of operation and the services they perform. If the Contractor wishes to add or replace drivers throughout the life of the contract, it shall provide a valid driver’s license to the COR.

4.3.1.4. CCTPs shall have met all state requirements for the tier in which they are performing services in (I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request.

4.3.1.5. Investigative Requirements for Contract Personnel: Contract personnel will be subject to the same investigative requirements as those for regular VA appointees and employees. The level of investigation commensurate with the level of access to perform the performance work statement is: Special Agreement Checks (SAC).

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

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

Contractor’s background check and must not have been convicted of (or have any pending charges for) a felony for the past five years. Personnel (and Contractor) must report any new or additional charges or convictions if they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated. The Contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. Failure to comply with the Contractor personnel security requirements may result in termination of the contract or cause.

4.3.2. Tuberculosis Exposure Control Policy

4.3.2.1. The Contractor shall provide the VA with a policy on tuberculosis (TB) exposure and control, to include TB decontamination.

4.3.2.2. The Contractor shall have its personnel tested for TB in accordance with state guidelines and provide written confirmation to the COR that all personnel (current employees and any new hires) performing services under this contract are current in their TB test at the start of each Ordering Period.

4.4. Contractor Equipment, Vehicles, and Inspection

4.4.1. Ambulances shall meet all applicable federal, state, and local regulations and specifications, including but not limited to licensing (i.e., Driver & Transportation-for Hire), registration, and safety standards.

4.4.2. The VA reserves the right to inspect the Contractor’s equipment and vehicles or require documentation of compliance with state laws, rules, regulations, and guidelines governing emergency medical transport vehicles (ambulances). VA inspections of Contractor equipment do not constitute a warranty or guarantee that the Contractor’s vehicles and equipment are properly maintained. The VA reserves the right to restrict the Contractor’s use of equipment and vehicles in the performance of this contract which are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the Contractor from performance in accordance with the contract nor necessitate additional cost to the VA.

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

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

4.4.5. The Contractor shall furnish all linen required for patient transport at no additional cost.

Linen shall not be exchanged with linen belonging to JAH VAMC or its CBOCs.

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

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

4.4.7.1. The Contractor personnel performing services for the VA, shall, at all times, conduct themselves in a professional manner, and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications shall be worn in clear view above the waist. The Contractor personnel shall not smoke/play loud music originating from any device in vehicles while transporting VA patients.

4.4.7.2. Each driver shall possess a driver’s license that is valid for the class of vehicle driven. Evidence of a special transportation service vehicle permit, or endorsement issued by the commissioner of public safety.

Be at least 18 years of age and have not less than one year of experience as a licensed driver; and o For the past three years:

Have not had a driver’s license canceled or suspended.

Have a driving record clear of convictions for operating a motor vehicle or motorcycle without insurance.

Have a driving record clear of convictions for driving a motor vehicle without a valid current license for the class of vehicle driven.

Have a driving and criminal record clear of convictions for driving under the influence of alcohol or a controlled substance.

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

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

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

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

Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304. (1974).

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

4.5. Transportation Request

4.5.1 VetRide or VA-approved Transportation Software Utilization:

The Contractor agrees to utilize the VetRide Vendor Portal or VA-Approved Transportation Software with every patient transported under this contract.

Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal or VA-Approved Transportation Software for the vendor/Contractor in this contract. The Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed:

a) Receive and respond to electronic trip requests

b) Receive, use, and ensure the use of the Vendor pass by the driver.

c) Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-

Approved Transportation Software system.

d) All invoices must be submitted within 30 calendar days of date of service in accordance with 38 CFR 70 to be considered timely submission.

e) The Contractor’s invoice must be on the HCFA 1500 to include:

i. Contract Number

ii. Date of Service (to include Box 24 A-J)

iii. Authorization number(s)

iv. Pick-up and drop-off location of the patient

v. Base Rate

vi. Name (Last, First and Middle Initial (if any)) and Full Social Security number (Box 1a) of patient transported

vii. Date of Birth and Sex

viii. Diagnosis Codes or Nature of Illness or Injury

ix. Documentation of circumstances when billing for waiting time

x. Any miscellaneous charges for which the Contractor is expecting reimbursement i.e., Tool charges, waiting time, etc.

xi. VA authorizing official’s name

xii. Healthcare Procedure Coding System/National Level II (HCPCS)

f) Unauthorized charges will be reviewed by the Contracting Officer Representative (COR) as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges which are being suspended.

4.5.1.1. A transportation request is defined as one incidence of a request for one-way service

(Stretcher Transports, BLS, ALS, CCT). No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or VA-Approved Transportation Software Utilization.

Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. JAH VAMC Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff. In the event VetRide or other VA-Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests.

4.5.1.1.1. JAH VAMC Travel Program Staff/or authorized VA employees will work with the Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA- Approved Transportation Software Utilization.

4.5.1.1.2. “Reconcile" refers to the collaborative process undertaken by VA staff and the contracted vendor to ensure the consistency and completeness of transportation records. This process involves comparing and updating the records to account for any transportation requests that were not initially captured in VetRide or the VA-approved transportation software due to system unavailability. Reconciliation ensures that all transportation requests are accurately recorded and reflected in the system.

4.5.1.2. Only the following VA staff are authorized to place, cancel, or make changes to transportation requests:

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

The Contracting Officer will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The Contracting Officer will update this list throughout the life of the contract as Ordering Officers change.

Ordering Officers are responsible for issuing and administering orders placed under this contract. Ordering Officers have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer may result in loss or delay in payment for supplies/services provided under such orders.

Non-authorized VA employees and private agencies (e.g., nursing homes) are not considered authorized to place transportation requests.

4.5.1.2.1. All patient pick-up(s) and drop-off(s) shall be authorized via “orders” which shall only be issued by the designated Ordering Officers. When placing orders for services, the Ordering Officer shall contact the designated Contractor point of contact(s) to provide the following information:

Mode of transportation required, Required time of arrival Name of the beneficiary, Pick-up and delivery point, Type and number of additional medical care specialists required, Type of equipment required, Last four of the patient's Social Security Number, and Any other special instructions

4.5.1.3. For ALL Transports – an Audit system will be put in place by the VA to include the COR or designee, Beneficiary Travel Department staff, and clinical staff to ensure appropriateness of the order and timeliness of the response.

4.5.1.4. The type of transportation service (Stretcher Transports, BLS, ALS, CCT) required will be discussed and determined by VA clinical personnel and the Contractor. The Contractor shall transport the patient per its policies and standard industry practice.

If the type of transportation service differs from what was agreed upon by the VA and Contractor, the Contractor shall submit documentation to the VA explaining its rationale.

4.5.1.5. The VA may authorize an escort (e.g., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient’s, best interest. The Contractor shall allow the escort to accompany the patient at no additional cost.

4.5.1.6. The Contractor shall have sufficient vehicles and personnel to provide services for up to four (4) simultaneous transportation requests. Transports required may be for any mix of Stretcher Transports, BLS, ALS transports. One of these four simultaneous transports may require CCT capability up to Tier III. If JAH VAMC requires ambulance services exceeding four (4) simultaneous transportation requests, the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

4.5.1.7. The number of transports under normal operating conditions will typically range from 8 – 15 transports each weekday and significantly less on weekends and holidays.

The number of actual transports may vary throughout the life of the contract.

4.5.1.8. The patient may bring with her or him up to three (3) liters of oxygen. The

Contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

4.5.1.9. Response Times*

4.5.1.9.1. Orders that are scheduled by 7pm local time the day before the required services are defined as scheduled in advance. With the exceptions found below, the Contractor shall arrive on time for all orders scheduled in advance.

4.5.1.9.2. Urgent Transport (Originating from JAH VAMC Only): The Contractor shall be required to provide Ground Ambulance transportation (Stretcher Transport, BLS, ALS, CCT) within thirty (30) minutes of order/patient pick up call.

4.5.1.9.3. For all add-ons (not scheduled in advance) transportation requests, with pick up at JAH VAMC: The Contractor will be allotted up to a sixty (60) minute response time from time of order placement for transportation requests (Stretcher Transport, BLS, ALS, CCT) that are not previously scheduled in advance.

a. For an urgent transport request for a critical patient (as deemed by the physician) with pick up at JAH VAMC, the Contractor will be allotted up to a thirty (30) minute response time.

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

a. The Contractor may be required, if requested by the VA, to dispatch ambulances (Stretcher Transport, BLS, ALS, CCT) on short notice for transportation requests not scheduled in advance; for these transportation requests the Contractor shall dispatch ambulances within thirty (30) minutes of receiving the order.

b. Pick-up appointment times shall be agreed upon by the VA and

Contractor at time of order placement and be reasonable based upon travel distance, speed limits, and weather conditions.

c. Vendor Responsibility for Pick-Up and Drop-Off Times: The vendor is responsible for managing and recording pick-up and drop-off times to ensure timely transportation for Veterans.

1. Management and Entry of Pick-Up Times:

All pick-up times must be managed by the vendor and accurately recorded in the VetRide system.

2. Veteran’s Scheduled Appointment Time:

The Veteran's scheduled appointment time is annotated in the

VetRide system to ensure proper coordination.

3. Scheduled Pick-Up Time:

Pick-up times should be scheduled to ensure the Veteran arrives on time for their appointment.

4. Drop-Off Times:

Drop-off times must occur within a reasonable period after the Veteran's appointment. Veterans should not have to wait more than 1 hour after their appointment to be transported home.

* The Contractor shall not be held liable for nonperformance caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, and unusually severe weather. The Contractor MUST notify the VA with as much advance notice as possible should any of these occur.

4.5.2. Cancellations

4.5.2.1. For trips in which the Contractor is notified of cancellation before the vehicle is dispatched, there shall be no charge to the Government.

4.5.2.1.1. A “no show” is defined as a transportation request which is cancelled after the Contractor has dispatched a vehicle, the vehicle is enroute, or has arrived at the pick-up location, and there is no longer a requirement for patient transportation. The Contractor may request one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for the type of service requested (Stretcher Transports, BLS, ALS, CCT) and the one-way mileage (Stretcher Transports, BLS, ALS, CCT) accrued enroute to the pick-up location at time of cancellation. Mileage for no- show cancellations shall be confirmed by the Contractor and reported to the VA as soon as possible from time of cancellation.

4.5.2.2. For transportation requests OUT of JAH VAMC ONLY – The Contractor will immediately (no Immediate Dispatch required) dispatch a vehicle upon receipt of the order (including transportation requests in which the final destination may change prior to pick up due to the critical condition of the patient). When the Contractor is notified of a cancellation prior to arrival at the JAH VAMC campus, there shall be no charge to the Government.

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

4.6.1. Ambulance personnel shall pick up and deliver patients at specified locations (e.g., Unit 4 South Entrance). These locations will be specified by VA staff when an order is placed and communicated to the transporting personnel.

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

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

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

4.6.4. In cases where ambulance personnel must divert to a local emergency department while performing a VA authorized transport, the Contractor’s dispatcher shall notify the VA Beneficiary Travel Department or…