36C24922R0088_1.docx

36C24922R0088

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

621-23-1-825-0001

09-13-2022 Nina Jones 615-225-5447 10-12-2022 09:00am

CST

Department of Veterans Affairs Network Contracting Office 9 (90C)

NCO 9

1639 Medical Center Parkway, Suite 400 Murfreesboro TN 37129

X

621910 $16.5 Million

NET 30

N/A

Department of Veterans Affairs James H. Quillen VA Medical Center Corner of Lamont and Veterans Way Dogwood Avenue, Building 205 Mountain Home TN 37684 90C Network Contracting Office 9 Department of Veterans Affairs Network Contracting Office (90C) 1639 Medical Center Parkway Suite 400 Murfreesboro TN 37129

90C FSC e-Invoicing Payment http://www.fsc.va.gov/fsc/einvoice.asp Invoice Setup Information 1-877-489-6135 Invoice must be submitted electronically

Setup 1-877-489-6135

See CONTINUATION Page

Non-emergent ambulance transportation services on an as-needed basis to beneficiaries of the James H. Quillen VA Medical Center located in Mountain Home, TN and the Community-Based Outpatient Clinics (CBOCs) referenced.

Period of Performance will be a base year with four Option Year renewals.

See CONTINUATION Page 621-3630160-825-829800-2119 010041085

See attached Wage Determination (WD) for various locations

QUESTIONS:

All questions shall be emailed to nina.jones2@va.gov NLT September 26,2022, 9:00am CST. The subject line must specify 36C24922Q0283 QUESTIONS/your company name.

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 36C249 Department of Veterans Affairs Network Contracting Office 9 (90C)

NCO 9

1639 Medical Center Parkway, Suite 400 Murfreesboro TN 37129

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

The contract’s maximum amount over the life of the contract is $14,000,000.00.

The contract’s minimum guaranteed amount over the life of the contract is $2,500.00.

Ordering Period: The contract will have five ordering periods as listed in the price schedule below. Task orders may only be placed by NCO 9 contracting officers."

ITEM INFORMATION

Basic Life Support Ambulance Transportation Services, Base Rate per trip includes the arrival and acceptance of patient at point of departure and delivery of patient within 30-mile radius of the James H. Quillen VA or Clinic.

Contract Period: Ordering Period One POP Begin: 12-01-2022 POP End: 11-30-2023 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Advance Life Support Ambulance Transportation Services, Base Rate per trip includes the arrival and acceptance of patient at point of departure and delivery of patient within 30-mile radius of the James H. Quillen VA Medical Center.

Contract Period: Ordering Period One POP Begin: 12-01-2022 POP End: 11-30-2023

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

Mileage Rate One Way Rate per mile ONE WAY ONLY. Additional Mileage:

this rate will only be paid for mileage over and above the 30 miles threshold included in the applicable cost per trip.

Contract Period: Ordering Period One POP Begin: 12-01-2022 POP End: 11-30-2023

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

On-Site Ambulance Transportation Services Provide Basic Life Support in accordance with Item 9 of the Performance Work Statement.

Contract Period: Ordering Period One POP Begin: 12-01-2022 POP End: 11-30-2023

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

Cancellation / No Show Contract Period: Ordering Period One POP Begin: 12-01-2022 POP End: 11-30-2023

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

Waiting Time (Per 5 Minutes) POP Begin: 12-01-2022 POP End: 11-30-2023 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Basic Life Support Ambulance Transportation Services, Base Rate of departure and delivery of patient within 30-mile radius of the James H. Quillen VA or Clinic.

Contract Period: Ordering Period Two POP Begin: 12-01-2023 POP End:11-30-2024

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

Advance Life Support Ambulance Transportation Services, Base Rate per trip includes the arrival and acceptance of patient at point of departure and delivery of patient within 30-mile radius of the James H. Quillen VA Medical Center.

Contract Period: Ordering Period Two POP Begin: 12-01-2023 POP End: 11-30-2024

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

Mileage Rate One Way this rate will only be paid for mileage over and above the 30 miles threshold included in the applicable cost per trip.

Contract Period: Ordering Period Two POP Begin: 12-01-2023 POP End: 11-30-2024

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

On-Site Ambulance Transportation Services

Contract Period: Ordering Period Two POP Begin: 12-01-2023 POP End: 11-30-2024

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

Cancellation / No Show Contract Period: Ordering Period Two POP Begin: 12-01-2023 POP End: 11-30-2024

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

Waiting Time (Per 5 Minutes) POP Begin: 12-01-2023 POP End: 11-30-2024 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Basic Life Support Ambulance Transportation Services, Base Rate of departure and delivery of patient within 30-mile radius of the James H. Quillen VA or Clinic.

Contract Period: Ordering Period Three POP Begin: 12-01-2024 POP End: 11-30-2025

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

Advance Life Support Ambulance Transportation Services, Base Rate per trip includes the arrival and acceptance of patient at point of departure and delivery of patient within 30-mile radius of the James H. Quillen VA Medical Center.

Contract Period: Ordering Period Three POP Begin: 12-01-2024 POP End: 11-30-2025

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

Mileage Rate One Way Rate per mile ONE WAY ONLY. Additional Rate:

this rate will only be paid for mileage over and above the 30 miles threshold included in the applicable cost per trip.

Contract Period: Ordering Period Three POP Begin: 12-01-2024 POP End: 11-30-2025

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

On-Site Ambulance Transportation Services

Contract Period: Ordering Period Three POP Begin: 12-01-2024 POP End: 11-30-2025

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

Cancellation / No Show Contract Period: Ordering Period Three POP Begin: 12-01-2024 POP End: 11-30-2025

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

Waiting Time (Per 5 Minutes) POP Begin: 12-01-2024 POP End: 11-30-2025 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Basic Life Support Ambulance Transportation Services, Base Rate of departure and delivery of patient within 30-mile radius of the James H. Quillen VA or Clinic.

Contract Period: Ordering Period Four POP Begin: 12-01-2025 POP End: 11-30-2026

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

Advance Life Support Ambulance Transportation Services, Base Rate per trip includes the arrival and acceptance of patient at point of departure and delivery of patient within 30-mile radius of the James H. Quillen VA Medical Center.

Contract Period: Ordering Period Four POP Begin: 12-01-2025 POP End: 11-30-2026

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

Mileage Rate One Way Rate per mile ONE WAY ONLY. Additional Rate:

this rate will only be paid for mileage over and above the 30 miles threshold included in the applicable cost per trip.

Contract Period: Ordering Period Four POP Begin: 12-01-2025 POP End: 11-30-2026

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

On-Site Ambulance Transportation Services

Contract Period: Ordering Period Four POP Begin: 12-01-2025 POP End: 11-30-2026

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

Cancellation / No Show Contract Period: Ordering Period Four POP Begin: 12-01-2025 POP End: 11-30-2026

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

Waiting Time (Per 5 Minutes) POP Begin: 12-01-2025 POP End: 11-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

3,583.00

TRP

Basic Life Support Ambulance Transportation Services, Base Rate of departure and delivery of patient within 30-mile radius of the James H. Quillen VA or Clinic.

Contract Period: Ordering Period Five POP Begin: 12-01-2026 POP End: 11-30-2027

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

Advance Life Support Ambulance Transportation Services, Base Rate per trip includes the arrival and acceptance of patient at point of departure and delivery of patient within 30-mile radius of the James H. Quillen VA Medical Center.

Contract Period: Ordering Period Five POP Begin: 12-01-2026 POP End: 11-30-2027

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

Mileage Rate One Way this rate will only be paid for mileage over and above the 30 miles threshold included in the applicable cost per trip.

Contract Period: Ordering Period Five POP Begin: 12-01-2026 POP End: 11-30-2027

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

On-Site Ambulance Transportation Services

Contract Period: Ordering Period Five POP Begin: 12-01-2026 POP End: 11-30-2027

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

Cancellation / No Show Contract Period: Ordering Period Five POP Begin: 12-01-2026 POP End: 11-30-2027

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

Waiting Time (Per 5 Minutes) POP Begin: 12-01-2026 POP End: 11-30-2027 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

B.3 PERFORMANCE WORK STATEMENT

NON-EMERGENCY AMBULANCE TRANSPORTATION

1. Contract Title: Non-emergency ambulance transportation to & from the James H.

Quillen VA Medical Center (JHQVAMC), Mountain Home, TN.

2. Background: An ambulance service is required to transport patients whose medical condition warrants them to be seen at JHQVAMC or local hospital setting and warrants them to travel by ambulance not private vehicle or other means. This contract provides non-emergent ambulance service for the JHQVAMC.

3. Scope: To transport Veteran patients who are medically stable for transport to & from the JHQVAMC or nearest applicable non-VA medical center. Further, JHQVAMC requires basic life support (BLS) for Veteran patient transport, and in some instances will also require advanced life support (ALS) for Veteran transportation to & from JHQVAMC to nearest appropriate non-VA medical center and from non - VA medical center to JHQVAMC.

4. Period of Performance: One base ordering period with four optional one-year ordering periods beginning December 1, 2022.

5. Community-Based Outpatient Clinics (CBOCs):

Ambulance services shall be provided to all healthcare facilities under the jurisdiction of Mountain Home John H. Quillen, VA Medical Center (809 Lamont St Johnson City, TN 37604) and the following CBOCs:

1. JHQVAMC, Mountain Home (Johnson City), TN 37684

2. Morristown VA Outpatient Clinic, 925 East Morris Blvd, Morristown, TN 37813

3. Rogersville VA Outpatient Clinic, 401 Scenic Drive, Rogersville, TN 37857

4. William C. Talent VA Outpatient Clinic (WCTOPC), 8033 Ray Mears Blvd, Knoxville, TN 37888

5. WCTOPC Annex I – 1557 Downtown West Blvd, Suite 20-21, Knoxville, TN 37919

6. WCTOPC Annex II – 1521 Downtown West Blvd, Knoxville, TN 37919

7. WCTOPC Annex III, 1612 Downtown West Blvd, Knoxville, TN 37919

8. Dannie A. Carr VA Outpatient Clinic, 1124 Blanton Dr, Sevierville, TN 37862

9. Campbell County VA Outpatient Clinic, 130 Independence Lane, LaFollette, TN 37757

10. Mountain City VA Outpatient Clinic, 1141 Cold Springs Road, Mountain City, TN 37683

11. Bristol VA Outpatient Clinic, 2525 Lee Highway, Bristol, VA 24202

12. Norton VA Outpatient Clinic, 654 Highway 58 East, Norton, VA 24273

13. Marion VA Outpatient Clinic, 1583 North Main Street, Marion, VA 24354

14. Vansant, 1941 Lover's Gap Lane, Suite A, Vansant, VA 24656

15. Jonesville, 32613 Wilderness Road, Suite 101, Jonesville, VA 24263

16. Veterans Recovery Learning Center, 500 Washington Ave, Johnson City, TN 37604

17. Johnson City Vet Center, 154 W Springbrook Dr, Johnson City, TN 37604

18. Knox County Vet Center, 1645 Downtown West Blvd, #28, Knoxville, TN 37919

6. Specific Tasks - Overview:

a. Mountain Home VA Medical Center (VAMC) has 529 beds in general medicine and surgery, alcohol treatment, psychiatry, nursing home care and domiciliary all under one management.

The medical center is primarily affiliated with East Tennessee State University James H. Quillen College of Medicine, developed with the assistance of a VA grant and principally located on VA grounds. Active and growing residency programs of various medical surgical specialties are offered. In addition, there are affiliations with other universities and colleges in medical, nursing, allied health, and administrative professions at the undergraduate, graduate, and postgraduate levels.

b. This contract includes requirements for a basic life support (BLS) vehicle staffed by an Emergency Medical Technician (EMT) and an advanced life support (ALS) vehicle staffed by Emergency Medical Technician Paramedic (EMTP). The contractor shall furnish 24 hours ambulance service for the beneficiaries of the VAMC when authorized in advance by the Travel Unit staff.

7. Mileage Threshold/Chargeable Mileage:

a. The mileage threshold is thirty (30) miles from the VAMC where no additional "mileage charge" shall be added to the base rate. For all one-way trips, the additional "mileage charge" shall apply only to those miles traveled beyond the 30-mile threshold. In the event fraction miles result, JHQVAMC shall pay the rounded off amount to the next higher even mile. The Bing, Dashboard Beneficiary Travel Mileage Calculator (BDBTMC) shall determine chargeable trip mileage from JHQVAMC to Veteran's home address. The BDBTMC shall be used to calculate all chargeable mileage. If the BDBTMC does not calculate the entire distance to the Veteran's address, JHQVAMC shall consider the actual mileage within a five-to-ten-mile variance.

Bing Maps - Directions, trip planning, traffic cameras & more

b. All one-way trips ordered under the contract shall receive the base rate quoted ("Base Rate"). The Base Rate shall constitute full compensation for one-way trips, which do not exceed the mileage threshold as defined above. The contractor shall also receive the mileage rate quoted ("Mileage Rate") for any one-way trips more than the mileage threshold. The mileage rate is applicable only for mileage more than the mileage threshold and at no time shall the contractor receives reimbursement for mileage less than the mileage threshold.

8. Number of Patients: It is understood and agreed upon that only one patient shall be transported on a trip unless specifically requested by the contractor. Pursuant to the JHQVAMC authorization, when more than one patient is transported concurrently on a trip, reimbursement shall be made at the rates contained under the pricing schedule for transporting a single patient.

Regardless of the number of patients transported concurrently on a single trip beyond the mileage threshold, the contractor shall be reimbursed at the mileage rate for one trip to the longest distance traveled with any one patient on that trip. The contractor must ensure that pick-ups and drop-offs are scheduled so that the distance traveled shall result in the most economical charge to the Government.

9. On-Site Transportation Services:

a. The contractor shall provide a BLS unit for transportation of patients within the James H.

Quillen VA Medical Center property on an as-needed basis. The services shall be required when the VA Medical Center's vehicle is unavailable due to scheduled maintenance, mechanical malfunctions, etc.

b. In non-emergency situations, the James H. Quillen VA Medical Center shall notify the contractor at least 48 hours in advance of need. In situations where the facility's vehicle is unavailable due to unexpected mechanical reasons, the contractor shall provide service within thirty (30) minutes of notification by the VAMC.

10. Waiting Time: Time lost in waiting at either or both ends of a trip due to causes beyond the contractor's control, the contractor shall be reimbursed at the rate of one fourth the hourly rate quoted in the contractor's proposal for each quarter hour or fraction thereof more than one-half hour from the time he/she reports to the designated person at JHQVAMC. If the pickup is other than at JHQVAMC, the contractor shall call the JHQVAMC Travel Dispatcher first, (423) 926-1171 extension 5659/2616 or COR (423) 926-1171 extension 4438 during administrative hours (7:45a.m. through 4:30p.m. eastern time, Monday through Friday) or the Medical Administrative Assistant (MAA) at (423) 926-1171 extension 7508 and ask for the Administrative Officer of the Day (AOD) on duty during non-administrative hours (during evenings, nights, weekends, and holidays) as soon as it is anticipated that a delay may develop for which the contractor expects to claim reimbursement. This call is only for the purpose of verifying the arrival time at the pick-up point and is not necessary if the contractor anticipates no delay for which reimbursement will be claimed. The contractor's failure to follow the above stated protocol when waiting beyond the grace period shall result in non-payment for waiting time.

11. Service Orders:

a. Request for services will be made in writing or by telephone, and subsequently confirmed in writing by individual(s) designated by the COR (423) 926-1171 extension 4438 or 5659/2616 7:45a.m. to 4:30 p.m. eastern time, Monday through Friday. After normal duty hours follow the protocol outlined in paragraph above (10. Waiting Time).

b. If the contractor fails to furnish ambulance service within 30 minutes after receiving a request for service, JHQVAMC reserves the right to obtain the service from another source and to charge the contractor excess cost/fees. The JHQVAMC shall be the sole judge in determining when to order service from another source. However, in no instance shall the contractor be required to furnish more than six ambulances for BLS service and two ambulances for ALS service at any one six-hour period. When the total number of contracted vehicles are in use with JHQVAMC patients, and the JHQVAMC requires additional vehicles, the JHQVAMC shall first contact the contractor to provide additional vehicles at the contracted rate. If additional vehicles are not available from the contractor, the JHQVAMC shall contact another ambulance provider for transport at no cost to the contractor.

c. The contractor shall immediately notify the COR as outlined in paragraph nine above of delays in transporting patients.

12. Vehicles:

a. The ambulance (emergency medical care vehicle) under the term of this contract shall be licensed and meet the minimum vehicle requirements as established by the Board of Health, State of Tennessee, Emergency Medical Services Division. The specifications are mandatory, as minimal requirements for such vehicles, but chassis or compartment modifications are permissible when they clearly exceed the minimal qualifications.

b. Each ambulance shall have all required ambulance medical equipment items including but not limited to patient facilities, oxygen, suction, and environmental climatic supplies as required by Federal Specification KKK-A-1822 Revision E for Ambulances.

13. Staff Qualifications: EMTs providing emergency services on ambulances serving JHQVAMC must have the following qualifications:

a. Completed training in accordance with the standards published by the Department of Health and Human Services (DHHS) with a minimum curriculum of eighty-one (81) hours or "equivalent" including an in-hospital training period. Such training programs must also be accepted under the regulating requirements for local emergency medical systems (EMS) supported by DHHS under PL 93-154.39 Federal Regulation 24304 (1974).

b. Evidence of the "equivalent" training program successfully completed by the EMT shall be submitted with the offer to the Contracting Officer for inspection. c. The EMT shall be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity where the emergency ambulance service is operated or by which it is governed. d. The EMT must be enrolled periodically in "refresher" continuing education or advanced training programs as required by local or state entity in which the service is rendered to Veterans, but in no instance shall this be more frequent than every two (2) years. Such refresher" training shall be equivalent to that developed by the Department of Transportation, National Highway Safety Administration. Evidence of successful completion of refresher training must be submitted to the Contacting Officer for inspection.

14. Non-Emergency Attendant/Driver: Prices include non-emergency attendants and drivers as appropriate. Attendants and drivers must be capable to administer oxygen and have successfully completed the Standards and Advanced First Aid Courses of the American Red Cross or U.S. Bureau of Mines or equivalent. Proof in the form of a current certification that such first aid training has been successfully completed must be submitted with offer and available upon request for option years.

15. Escort: An authorized official of the contractor may in the interest of the patient, allow a relative to accompany him/her at no extra charge to the Government.

16. Cancellations: On trips within the mileage threshold, there shall be no charge to the Government for cancelled trips if the contractor is notified before the vehicle is dispatched.

Outside the mileage threshold, there shall be no charge to the Government prior to the vehicle being dispatched. A "no show" is defined as a trip, which is cancelled upon the contractor's arrival at the pick-up point, and the contractor may request reimbursement for a one-way trip.

17. Patient Welfare and Abuse:

a. The contractor shall be held responsible for patient welfare during transport. The contractor shall be held responsible for patient and/or Government property during transport.

Any damage or lost wheelchairs, walkers, crutches, or personal belongings shall be replaced at the contractor's expense.

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

c. The contractor will consider that he/she is transporting ill patients. Drivers of vehicles are required to observe speed limits, vehicles should be swept clean, exteriors washed periodically, and drivers will refrain from smoking.

d. All employees shall be required to sign a JHQVAMC confidentiality statement and it is the responsibility of the contractor to assure these statements are kept current. This is inspectable by the COR upon request.

18. Incident Report: When an incident/accident occurs, involving the welfare of a Veteran the contractor must submit, in writing, an incident/accident report within twelve (12) hours of the occurrence to the COR.

19. Reporting Procedures:

a. During off duty tours, weekends and holidays, the crews shall report to the MAA at the JHQVAMC, who are located at the check-in desk of the JHQVAMC Emergency Room.

b. Transport of baggage, medical records, and other personal effects with Veterans, shall occasionally be required.

c. Ambulance drivers shall deliver and pick-up patients at designated locations with-in the clinic or within JHQVAMC. The location will be designated when contact is made by authorized JHQVAMC Staff as outlined in paragraph nine above.

d. Ambulance personnel shall report to the clinic check-in, to announce his/her arrival to pick-up and transfer the patient and obtain report of pertinent information regarding the patient's condition from the primary care team nurse/physician.

e. When delivering a patient, the ambulance personnel shall give report to appropriate nursing personnel and provide a copy of the run sheet, which shall be retained by the facility for the patient's medical record.

f. In cases where the ambulance crew must divert to a local emergency room while performing authorized transport, the contractor is obligated to notify the JHQVAMC Travel Department or MAA of the patient's location and status as soon as this information becomes available but not later than 20 minutes after diverting to the closest emergency room.

21. Equipment Specifications:

a. Vehicles: Ambulance fleet, minimum of six (6), and its equipment and supplies must be of the quality, model, and condition to assure the patient's complete safety, high quality medical transportation and emergency first aid, if needed; shall meet the minimum standards for maintenance, equipment and staffing for all ambulance vehicles operated.

b. Each ambulance shall be of a model and make to insure safe and comfortable transportation of the patient. Vehicles must have sufficient headroom to accommodate the patient in Fowler's position and must be effectively heated and air-conditioned. Vehicles will be inspected and maintained daily to assure mechanical fitness and cleanliness.

c. Ambulance Medical Equipment: Each ambulance shall be always equipped when transporting a patient in the performance of this contract with not less than required by Federal law, State law, County and City laws in which the ambulance is operated as well as the operational medical equipment described in Federal Specification KKK-A-1822 Revision E for Ambulances as:

"(i) Shall have one ambulance cot and collapsible stretcher or two stretchers, one of which is collapsible.

(ii) Shall have adequate straps to secure the patients safely to stretcher or ambulance cot, and adequate means of securing the stretcher or ambulance cot within the vehicle.

(iii) Shall have adequate supply of sanitary sheets, pillowcases, and blankets.

(iv) Shall have portable oxygen unit in good operating condition and with spare tank and with adequate supply of nasal cannulas or oxygen masks; oxygen masks must be of the disposable type or be thoroughly sterilized after each use and kept sterile.

(v) Shall have a standard first aid kit.

(vi) Shall have portable 02 suction units available for emergency use in transfer of severely ill patients, to be operated by professional staff only.

(vii) Shall have l. V. poles and stair chair.

(viii) The contractor must have or have access to IV pumps and cardiac monitors, which are compatible to those used by the JHQVAMC. The contractor must also have access to a portable ventilator to be used when transporting JHQVAMC patients."

22. Enterprise Management Controls: Contract Management: Prepare a contract management plan describing the technical approach, organizational resources, and management controls to be employed to meet the cost, performance, and schedule requirements throughout contract execution.

23. Performance Monitoring: The COR will monitor contractor performance and certify the work was done in accordance with the contract. Routine inspections and product sampling by the COR as recorded in the Quality Assurance Surveillance Plan is the method the COR will utilize to measure contractor performance.

24. Security Requirements: Contractor staff will have access to printed and verbal patient information and data but will not have access to JHQVAMC computer systems.

25. Government-Furnished Equipment (GFE)/Government-Furnished Information (GFI): The Government including JHQVAMC will not furnish any equipment under this contract. All government equipment, linens, etc., taken with patients must be returned. The contractor shall furnish all linens, blankets, and supplies. JHQVAMC will not participate in a linen exchange program or any supply exchange program. The contractor shall not be permitted to borrow medical equipment from the JHQVAMC. The contractor shall provide all medications required while in transport, sheets, blankets, and other equipment and supplies required for use while in transport, for direct patient care. The contractor shall at no time and under any circumstances exchange supplies, equipment, and/or medications with the JHQV AMC.

26. Holidays:

a. New Year’s Day

b. Birthday of Martin Luther King, Jr.

c. Washington’s Birthday

d. Memorial Day

e. Juneteenth National Independence Day

f. Independence Day

g. Labor Day

h. Columbus Day

i. Veterans Day

j. Thanksgiving Day

k. Christmas Day

27. Security Requirements for Unclassified Information Technology Resources: The contractor, their staff personnel, and their subcontractors shall be subject to federal laws, regulations, standards, and Department of Veterans Affairs (VA) and the Veterans Health Administration (VHA) directives and handbooks regarding personal identifiable information and health information security as delineated in this contract an as outlined in the Health Insurance Portability and Accountability Act (HIPAA).

28. Other Pertinent Information or Special Considerations:

a. RECORDS: At the option of the Government, the contractor may be required to transport records with patients from station to station.

b. Packaging, Packing and Shipping Instructions: The contractor shall provide secure storage of any Veteran's belongings left on an ambulance and can be asked to ship personal belonging to the Veterans home address or transport it to the JHQVAMC on the next trip. The contractor assumes complete responsibility for these belongings until turned over to the COR or the COR's designated point of contact.

c. Inspection and Acceptance Criteria: The COR is responsible for certifying that the work done under the contract is performed to time, standard and quality established. The COR is responsible to assure the inspection and acceptance of products provided incidental to services are acceptable.

29. Risk Control: The contractor is responsible for patient issues, infection control and risk management at the time of pick up until the time of drop off.

30. VHA Supplemental Contract Requirements for Combatting COVID-19:

1.Contractor employees who work in or travel to VHA locations must comply with the following:

Documentation requirements:

a) If fully vaccinated, contractors shall show proof of vaccination.

NOTE: Acceptable proof of vaccination includes a signed record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), or a copy of medical records documenting the vaccination.

b) If unvaccinated, contractors shall show negative COVID-19 test results dated within three calendar days prior to desired entry date. Test must be approved by the Food and Drug Administration (FDA) for emergency use or full approval. This includes tests available by a doctor’s order or an FDA approved over-the-counter test that includes an affiliated telehealth service.

c) Documentation cited in this section shall be digitally or physically maintained on each contractor employee while in a VA facility and is subject to inspection prior to entry to VA facilities and after entry for spot inspections by Contracting Officer Representatives (CORs) or other hospital personnel.

d) Documentation will not be collected by the VA; contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

2.Contractor employees are subject to daily screening for COVID-19 and may be denied entry to VA facilities if they fail to pass screening protocols. As part of the screening process contractors may be asked screening questions found on the COVID-19 Screening Tool. Check regularly for updates.

3. Contractor employees who work away from VA locations, but who will have direct contact with VA patients shall self-screen utilizing the COVID-19 Screening Tool, in advance, each day that they will have direct patient contact and in accordance with their person or persons who coordinate COVID-19 workplace safety efforts at covered contractor workplaces. Contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

4. Contractor must immediately notify their COR or Contracting Officer if contract performance is jeopardized due to contractor employees being denied entry into VA Facilities.

5. For indefinite delivery contracts: Contractor agrees to comply with VHA Supplemental Contract Requirements for any task or delivery orders issued prior to this modification when performance has already commenced.

36C24922R0088

SECTION C - CONTRACT CLAUSES

ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES Clauses that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

The following clauses are incorporated into 52.212-4 as an addendum to this contract:

C.1 52.252-2 INCORPORATE BY REFERENCE

(End of Clause)

C.11 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

http://www.acquisition.gov/far/index.html http://www.va.gov/oal/library/vaar/

C.2 52.216-18 ORDERING (AUG 2020)

(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from October 1, 2022, through September 30, 2027.

(b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control.

(c) A delivery order or task order is considered "issued" when—

(1) If sent by mail (includes transmittal by U.S. mail or private delivery service), the Government deposits the order in the mail;

(2) If sent by fax, the Government transmits the order to the Contractor’s fax number; or

(3) If sent electronically, the Government either—

(i) Posts a copy of the delivery order or task order to a Government document access system, and notice is sent to the Contractor; or

(ii) Distributes the delivery order or task order via email to the Contractor’s email address.

(d) Orders may be issued by methods other than those enumerated in this clause only if authorized in the contract.

(End of Clause)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $300.00 the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor—

(1) Any order for a single item in excess of $1,000.00.

(2) Any order for a combination of items in excess of $2,500,000.00; or

(3) A series of orders from the same ordering office within one calendar days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section.

(c) If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section.

(d) Not withstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within one calendar days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.

C.4 52.216-22 INDEFINITE QUANTITY (OCT 1995)

(a) This is an indefinite-quantity contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies and services specified in the Schedule are estimates only and are not purchased by this contract.

(b) Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause. The Contractor shall furnish to the Government, when and if ordered, the supplies or services specified in the Schedule up to and including the quantity designated in the Schedule as the "maximum." The Government shall order at least the quantity of supplies or services designated in the Schedule as the "minimum."

(c) Except for any limitations on quantities in the Order Limitations clause or in the Schedule, there is no limit on the number of orders that may be issued. The Government may issue orders requiring delivery to multiple destinations or performance at multiple locations.

(d) Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after one year from effective date of the last task order.

(End of Clause) C.5 52.223-99 ENSURING ADEQUATE COVID-19 SAFETY PROTOCOLS FOR FEDERAL CONTRACTORS (OCT 2021) (DEVIATION)

(a) Definition. As used in this clause-United States or its outlying areas means-

(1) The fifty States;

(2) The District of Columbia;

(3) The commonwealths of Puerto Rico and the Northern Mariana Islands;

(4) The territories of American Samoa, Guam, and the United States Virgin Islands; and

(5) The minor outlying islands of Baker Island, Howland Island, Jarvis Island, Johnston Atoll, Kingman Reef, Midway Islands, Navassa Island, Palmyra Atoll, and Wake Atoll.

(b) Authority. This clause implements Executive Order 14042, Ensuring Adequate COVID Safety Protocols for Federal Contractors, dated September 9, 2021 (published in the Federal Register on September 14, 2021, 86 FR 50985).

(c) Compliance. The Contractor shall comply with all guidance, including guidance conveyed through Frequently Asked Questions, as amended during the performance of this contract, for contractor or subcontractor workplace locations published by the Safer Federal Workforce Task Force (Task Force Guidance) at https:/www.saferfederalworkforce.gov/contractors/.

(d) Subcontracts. The Contractor shall include the substance of this clause, including this paragraph (d), in subcontracts at any tier that exceed the simplified acquisition threshold, as defined in Federal Acquisition Regulation 2.101 on the date of subcontract award, and are for services, including construction, performed in whole or in part within the United States or its outlying areas.

(End of clause)

C.5 SUPPLEMENTAL INSURANCE REQUIREMENTS

In accordance with FAR 28.307-2 and FAR 52.228-5, the following minimum coverage shall apply to this contract:

(a) Workers' compensation and employers’ liability: Contractors are required to comply with applicable Federal and State workers' compensation and occupational disease statutes. If occupational diseases are not compensable under those statutes, they shall be covered under the employer's liability section of the insurance policy, except when contract operations are so commingled with a Contractor's commercial operations that it would not be practical to require this coverage. Employer's liability coverage of at least $100,000 is required, except in States with exclusive or monopolistic funds that do not permit workers' compensation to be written by private carriers.

(b) General Liability: $500,00.00 per occurrences.

(c) Automobile liability: $200,000.00 per person; $500,000.00 per occurrence and $20,000.00 property damage.

(d) The successful bidder must present to the Contracting Officer, prior to award, evidence of general liability insurance without any exclusionary clauses for asbestos that would void the general liability coverage.

(End of Clause)

C.6 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCALYEAR (APR 1984)

Funds are not presently available for performance under this contract beyond September 30, 2022. The Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made.