36C25018Q9301-001.docx

36C25018Q9301

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

552-19-1-151-0003 36C25018Q9301 -2018 Jennifer Bowden jennifer.bowden@va.gov 937-268-6511 x3041 -2018

14:00 EST

36C250 Department of Veterans Affairs

NCO 10

3140 Governor’s Place Blvd., Suite 210 Kettering OH 45409-1337 X 621910 $15 Million X N/A X 36C552 Department of Veterans Affairs Dayton VA Medical Center 4100 West Third Street Dayton OH 45428-9000 36C250 Department of Veterans Affairs

NCO 10

3140 Governor’s Place Blvd., Suite 210 Kettering OH 45409-1337

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971 See CONTINUATION Page RFQ for Ambulance Transportation - Dayton VA Medical Center Evaluation is on Non-price and Price related factors to determine Best Value

– PAGE 26-33

See CONTINUATION Page X X 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: TBD

b. GOVERNMENT: Adam Weber, Contracting Officer and Jennifer Bowden, Contract Specialist Department of Veterans Affairs – NCO 10 3140 Governor’s Place Blvd., Suite 210 Kettering, OH 45409-1337

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: 52.232-33, Payment by Electronic Funds Transfer—System For Award Management

3. INVOICES: Invoices shall be submitted in arrears 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.

Tungsten Network Client Services 877-489-6135 http://www.tungsten-network.com/customer-campaigns/veterans-affairs/ va.registration@tungsten-network.com

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

This solicitation includes FAR 52.219-4 Notice of Price Evaluation Preference for HubZone Small Business Concerns. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.

B.3 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011)

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

B.4 SUBCONTRACTING PLAN--MONITORING AND COMPLIANCE (JUN 2011)

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

36C25018Q9301

PERFORMANCE WORK STATEMENT (PWS)

1) Contract Title: Ambulance Transportation

2) Background VA requires Transportation Service to transport eligible beneficiaries, by stretcher, including physical or mentally disabled beneficiaries, their aides, attendants, and personal belongings, between designated points. Contractor shall provide all labor, materials and equipment necessary to transport designated beneficiaries, their aides, attendants and personal belongings. Contractor shall also provide morbid transportation from on- campus VA nursing homes. Offerors should thoroughly review the specifications and be familiar with the area of coverage prior to submitting their proposal to have a complete understanding of the services being requested. Failure to do so shall not relieve the contractor from performing in accordance with the strict intent and meaning of the specifications without additional cost to the Government.

3) Scope Contractor shall provide Ambulance Transportation for the Dayton Veterans Affairs Medical Center, DVAMC beneficiaries. Trips generally involve transportation to and or from the Veterans residences, VA facilities or other medical facilities in the community. Contractor shall also provide morbid transportation from on- campus VA nursing homes. The area of responsibility and jurisdiction of the DVAMC includes the following Ohio counties – Allen, Auglaize, Champaign, Clark, Clinton, Darke, Greene, Mercer, Miami, Montgomery, Paulding, Preble, Putnam, Shelby, Van Wert, and Warren, as well as Wayne County in Indiana. Trips are not restricted to these counties and may include transportation to the Northern Indiana Healthcare System, Indianapolis, Saginaw MI, Ann Arbor, Detroit, Battle Creek, Cleveland, Chillicothe, Cincinnati and Columbus VA Hospitals, all within VISN, in addition to non-VA healthcare facilities to which Veterans are referred for care. This includes Wright-Patterson Air Force Base, a Department of Defense installation.

4) Specific Tasks

a. Hours of Performance

i. This is a full-service contract, 24 hours per day, 365 days per year. Contractor shall provide all BLS and ALS services as stated in the scope of work for Veteran beneficiaries, when requested by the VA.

ii. Contractor will furnish and maintain vehicles to ensure timely pick-up and delivery service to all Veterans serviced by the VA.

b. Response Time

i. The Contractor shall respond to all BLS and ACLS calls for ambulance transport service by being on-site at the designated VA facility within 30 minutes of notification, EXCEPT where the VA staff requesting the service specifically states otherwise. Should the time for pick-up, stated herein, be physically impossible due to location of Veteran beneficiary, the Contractor will contact the appropriate individuals at the VA including the CBOC locations from a list of extensions which will be provided to the Contractor from the PBS Beneficiary Travel Section and notify then of the anticipated time for pick-up and delivery of said patient.

ii. The Contractor shall provide and respond to all emergency calls in accordance with all Federal, State, and Local regulations governing dispatch of emergency medical i.e. ambulance vehicles, and medical care of on-board patients, to include the use of sirens and other measures to ensure timely arrival at the designated location.

c. Response Time Compliance Rate

i. The Contractor shall maintain at a minimum, a 90% monthly compliance rate on response time to pick-up during the contract year. Failure of the Contractor to perform in accordance with this compliance rating may constitute sufficient cause for termination of the contract for CAUSE as per FAR clause 52.212-4m.

d. Method of Contact

i. The Contractor shall install and provide to the VA, a toll free number for accepting the VA calls. It is estimated that 90% of all requests for service may be placed by telephone. Requests for service may be made in writing or orally from an authorized representative of the VA.

e. Electronic Transmissions

i. The contractor shall, during the contract period, have on his or her premises a functioning fax machine to communicate with the VA, i.e., patient incidents, etc.

f. Request for Services

i. When ordering services, the VA will contact the Contractor and provide the following information

1. Mode of transportation required

2. Required time of arrival which is within a 30-minute time frame

3. Name of beneficiary

4. Pick-up and delivery point

5. Type and number of additional medical care specialists required

6. Type of equipment required

7. Last four of the patient Social Security Number

8. Any other special instructions

ii. The Contractor shall be required to transport non-ambulatory Veterans on the appropriate gurney, litter or Geri chairs who are not in need of emergency transportation or medical attention.

g. Pickup and delivery of patients to appropriate destination, contractor will ensure the patient is taken directly to his or her appointment location. Contractors will pick-up the patient from the patient appointment location or as agreed upon with VA travel representatives. For in-patient transports, the contractor will pick up and drop off the patient at the place of in-patient admission, i.e. the ward where the patient has a bed assigned. For inpatient to inpatient transports, the contractor will bring the patient to the placed designated during the scheduling of the trip.

5) Performance Monitoring – Performance Requirement Summary Matrix

6) Security Requirements:

a. The VA reserves the right to inspect Contractor equipment and vehicles and or require documentation of compliance with contract specifications, and State laws, rules, regulations and guidelines governing emergency medical transport vehicles, i. e., ambulance. Written emergency procedures must be available in each vehicle. VA inspections of Contractor facilities shall in no way constitute a warranty by the VA that the Contractors vehicles and equipment are properly maintained. The VA reserves the right to restrict the Contractors use of equipment and vehicles which need repair, unclean, unsafe, damaged on the interior or exterior body, and are not in compliance with contract specifications. The restriction of such equipment and vehicles shall not relieve the Contractor from performing in accordance with the strict intent and meaning of the contract without additional cost to the VA.

b. The VA reserves the right to have VA personnel, such as Contracting Officer and Contracting Officer Representative, or their designee, observe and inspect Contractor operations at any time during the term of this contract. The VA shall conduct scheduled or unscheduled site visits to observe and inspect Contractor operations.

7) Government-Furnished Equipment (GFE)/Government-Furnished Information (GFI): n/a

8) Other Pertinent Information or Special Considerations:

a. Contractor Notification

i. The contractor shall be responsible for providing all vehicles and manpower, necessary to meet all BLS and ACLS transport requirements of this contract. In the event the Contractor is unable to perform services as required, the Contractor shall immediately notify the VA COR in addition to providing a written justification for non-performance. The VA reserves the right to re-procure services which cannot be performed by the Contractor in accordance with the terms, conditions, and schedule of this contract. The Contractor shall indemnify the VA for excess re-procurement cost, which may result from the Contractors inability to perform the required service. Payment of re-procurement costs shall not relieve the Contractor from any other provision in this contract covering inspection, acceptance and deductions from payment. The VA will be the sole judge in determining when services will be re-procured. The failure of the contractor to perform services within the required time frames and in accordance with terms and conditions may also provide cause for termination of the contract for CAUSE, as per FAR clause 52.212-4 m.

ii. Should the VA determine that immediate transportation is essential to prevent loss of life or serious bodily harm, transportation, services may be procured without referral to the ambulance Contractor. However, in these extremely rare cases, no charge shall be levied against the Contractor.

b. Escort

i. The VA reserves the right to have an escort, such as a relative, or care provider of beneficiary or VA staff accompany beneficiary when the VA determines that such an escort is in the best interest of the beneficiary. The VA will also be the sole judge in determining when an escort is required. There shall be no additional charge to the VA when escorts are authorized to travel with beneficiary. Contractor shall only be required to transport escort with patient and shall not be required to return the escort back to point of origin except for a patient admission.

c. Substitution of Beneficiary

i. The VA reserves the right to substitute the beneficiary requiring services at any time during the performance of this contract, to prevent delays, cancellations, or dry runs. There shall be no additional charge to the VA when such changes occur.

d. Types of Ambulance Services

i. The Contractor shall transport VA beneficiaries in ambulances that meet the specifications identified herein.

ii. Ambulances shall meet all current applicable Federal, State and local specifications and regulations including, but not limited to, licensing, registration, and safety standards. Licensing by the State of Ohio is required.

iii. Vehicles shall be clean and maintained in good repair in accordance with manufacturer instructions and specifications, during the performance of this contract, and shall contain:

1. An emergency safety kit

2. Portable oxygen

3. Fire suppression equipment

4. Appropriate road emergency warning equipment

5. Written emergency procedures,

6. Protective clothing required for the protection of contractor employees, such as gowns, gloves, masks, etc.

iv. BLS vehicle shall, in conjunction with the above, also provide on-board EMT to perform basic airway management, and provide IV KVO without additives. Contractor shall provide restraint and seclusion management when needed.

v. ALS vehicle shall, in conjunction with the above, also provide an on-board Paramedic to perform Cardiac Monitoring, provide ALS drugs and procedures, perform advanced airway management and medication monitoring and administration, and provide restraint and seclusion management when needed. Advanced airway management means the ability to intubate a patient and provide appropriate respiratory care, which does not include tracheotomies, cricoidectomies or cricotracheotomies.

e. Reimbursement for Mileage outside Contract Geographic Zone of Coverage

i. Mileage Reimbursement

1. Reimbursement for trips that extend beyond the geographic zone of coverage, defined as the rate paid to a contracted ambulance company for mileage traveled when the point of drop off is outside the contracted geographic zone. The mileage from the point of pick up to the point of drop off which is inside the geographic zone is included in the base rate. When the point of drop-off is outside the contracted geographic zone, the mileage rate is paid in addition to the base rate which is charged within the zone.

2. Distances beyond the geographic zone of coverage shall be calculated using current Google Maps Guide. Allowable charges for mileage outside of the geographic zone of coverage shall not exceed plus or minus 5% of the current Google Maps Mileage Guide.

3. Should the VA decide that a previously scheduled trip may be or was cancelled, and a vehicle has already been dispatched to the designated pick-up point, VA may notify the Contractor to cancel the order. For orders that are cancelled while the contractor is already on route to the designated pick-up, the Contractor shall be entitled to receive 50% of the base rate for the trip. This charge shall not include any mileage charge.

4. Should the Contractor arrive at the destination before VA cancels the order, or if the Contractor is unable to perform a scheduled pick-up for reasons beyond the Contractor control, e.g., incorrect address, or patient absence, or patient refusal, then the Contractor shall receive 100% of base rate for a one-way trip and applicable mileage if outside geographic zone of coverage.

ii. Other Charges

1. It is understood that the prices shall be inclusive of all ferry, bridge, tunnel or road toll charges. Contractor shall not bill the VA separately for any such charges.

f. Patient Rights

i. The Contractor shall be courteous to VA beneficiaries and shall not smoke and or play loud music while transporting patients. Patients may bring a reasonable amount of equipment, such as folding wheelchair, consumable medical supplies and personal suitcase.

ii. The Contractor shall immediately notify the VA of any incidents involving injury to a VA patient during pick-up, transport or drop-off. The Contractor shall complete and submit to the COR, the form entitled, Incident Report – Contract Ambulance Contractor within 24 hours.

iii. The Contractor will notify the COR, in writing, within 24 hours of any complaints made by the patients with regards to the ambulance service. The Contractor may provide recommendations for improved services along with the patient complaints for the VA review. No recommendation shall be construed as being effective until a written modification to the contract is executed by the Contracting Officer.

iv. Upon delivery or pick-up of a patient, the Contractor shall log in the patient on a log sheet at the location designated at the facility. Contractor shall provide the following information on the log sheet.

1. Patient name

2. Last four of the patient Social Security Number

3. Time of delivery or pick-up

4. Point of origin or destination, and

5. Name of Contractor personnel picking or delivering patient

g. Waiting Time

i. For unscheduled trips, waiting charges shall commence 15 minutes after the Time the Contractor arrives at the designated pick-up and or delivery points. For scheduled trips, waiting charges shall commence 15 minutes after the scheduled pick-up time or from the time the Contractor checks in as having arrived at the designated pick-up point, whichever is later.

ii. If the designated pick-up and or delivery points are at other than the Medical Centers and waiting beyond the required 15-minute grace period is anticipated, the Contractor shall notify the individual requesting the travel as defined by the points of contact stated in Paragraph 2.8 (b), and iii (d). A specific list of authorized contacts will be provided to the Contractor. This call is only for the purpose of verifying the Contractors time of arrival at pick-up and or delivery points and is not necessary if the Contractor does not anticipate a delay for which waiting charges will be claimed. The Contractor failure to notify the travel section when waiting beyond the grace period shall result in non-payment for waiting time.

iii. Infection Control Procedures

1. When ambulance services are required, the Contractor shall use universal precautionary measures for the prevention and control of the spread of infectious agents to all persons.

iv. Required Reports and Documents

1. Within fifteen (15) days after contract award, the Contractor shall provide the following.

2. Contractor Personnel Roster - In this document, contractor shall identify the employee

a. Name

b. Position

c. Title, and

d. Work assignment area

3. Thereafter, all changes shall be submitted to the COR within two (2) business days after the changes occur.

4. At the discretion of the VA, the Contractor may be required to provide a Run Sheet as part of patients’ permanent record. This Run Sheet shall include a record of the patient vital signs, medications used, oxygen use, and any changes in the patient condition. The list stated here shall not be construed as all inclusive, and the contractor shall provide all pertinent information.

5. Contractor Quality Control Program, QCP

a. The Contractor shall establish and maintain a complete QCP to ensure the requirements of this contract are provided as specified. An original and one copy of this QCP will be forwarded to the CO along with the requested initial proposal. The Contractor QCP shall include, at a minimum, the following

b. An inspection plan covering all services required by this contract. The inspection plan must specify the areas to be inspected on either a scheduled or unscheduled basis, how often inspections will be accomplished and documented, and the title of the individuals who will perform the inspections.

c. On-site records of all inspections conducted by the Contractor noting necessary corrective action taken. The Government reserves the right to request copies of any or all inspections which occur.

d. Incorporation of either active or established internal policy and procedures for updating medical service protocols, that may affect performance of the contract.

e. The methods for identifying and preventing deficiencies in the quality of service performed, before the level of performance becomes unacceptable and organizational functions noting intermediate supervisory responsibilities and overall management responsibilities for ensuring total acceptable performance.

f. On-site records of all vehicle maintenance and repairs performed, on vehicles used in the performance of this contract including the methods of identifying and preventing vehicle breakdowns, and detailed procedure for alternative transportation of patients in the event of mechanical breakdown of ambulance.

g. On-site records identifying the background check, character, physical capabilities, certifications and ongoing training of each employee performing services under this contract.

h. The methods of identifying and preventing radio communication breakdowns. A detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios.

i. A log to account for all requests for service. The log shall indicate the date and time of service call, name of authorizing VA employee, name of beneficiary requiring services, type of transportation requested, designated pick-up and delivery points, actual time of arrival at pick-up and delivery points and actual waiting time at pick-up and delivery points, if waiting charges are claimed.

j. On-site records of any complaints or problems, with procedures taken to allow for corrections and or elimination before effects caused interruption of performance of contract.

k. The Contractor shall establish and maintain quality control to ensure all contract requirements and applicable Joint Commission requirements are met. The Contractor shall identify how he or she shall measure and provide customer satisfaction, the method of identifying deficiencies, the quality of service to be performed and methods for identifying and implementing necessary corrective actions.

l. The Contractor shall participate in quarterly scheduled and or non-scheduled conference calls with the VA representatives to provide a report of on-going operational issues.

6. Invoices

a. Ambulance invoices shall be submitted every month and within 30 days of service. Invoices should be sent to the Dayton, VA Medical Center, Attn - Mobility Manager, 136A, 4100 W. Third Street, Dayton, OH 45428. Invoices may be submitted electronically, if authorized. Note - Invoices shall not be sent to the Austin Financial Services Center until reviewed by the COR or designee. All billing shall include items as listed below in an excel spreadsheet and must be sent password protected in compliance with HIIPA.

i. Patient name

ii. Last four of Social Security number

iii. Trip date

iv. Pick-up point

v. Drop-off point

vi. Identify as round trip or one way

vii. Mode of transportation, for example, ALS or BLS

viii. Number of miles traveled

ix. Identify if trip extended outside of geographic zone of coverage

x. Base charge plus an itemization of additional charges if applicable, and

xi. Name of VA Official who authorized trip

b. Documentation of services performed shall be reviewed prior to certifying payment. The COR and, or Alternate COR shall perform periodic spot checks and document services with the using service to ensure records monitoring. VA shall pay only for services performed and in strict accordance with the schedule of prices and or costs shown in the Schedule of Items. Contract monitoring and recordkeeping procedures shall be sufficient to ensure proper payment and to allow audit verification that services were provided.

c. Ambulance invoices shall be submitted every month and within 30 days of service. Invoices should be sent to the Dayton, VA Medical Center, Attn- Mobility Manager, 36A, 4100 W. Third Street, Dayton, OH 45428. Invoices may be submitted electronically, if authorized. Services are to be verified for actual performance against the schedule and logs. Only after verification are the invoices processed and certified for payment.

d. The using service, through the COR, shall provide a written statement annually to the Contracting Officer to include a summary of Contractor actions and a statement that the Contractor has been compliant with all requirements of the contract and they have been fulfilled as agreed. This summary evaluation will be submitted 60 days prior to expiration of contract, and or prior to election of option year renewals, if applicable.

e. A Contractor employee may not certify bills for payment.

v. Contractor Personnel Qualifications

1. All Contractor personnel performing contract services shall meet the qualifications as specified in this contract, as well as any qualifications required by Federal, State, County and local government entities from the place in which they operate. Contractor personnel shall meet these qualifications at all times while performing contract services. The failure of the contractor to provide qualified personnel, as specified in the contract, could result in termination of the contract for CAUSE. See FAR clause 52.212-4m.

2. During the contract period of performance, if the Contractor proposes to add-on personnel to perform contract services, the Contractor shall submit the required background check, evidence of training, certifications, licensing and any other qualifications to the designated COR. At no time shall the Contractor utilize personnel to perform contract services who do not meet the qualifications under the terms and conditions of this contract.

3. It will be the responsibility of the Contractor to complete background and criminal checks on all employees at the Contractor expense and be available for inspection by the CO and or designated COR.

4. Within seven days after receipt of award notification, the Contractor shall provide evidence of required background check, training, certifications, licensing, military base pass privileges and any other qualifications of any personnel performing services under this contract. The initial documentation shall be provided to the Contracting Officer. At a minimum, an annual review of verification of licensing and driving records for all drivers is required.

vi. Emergency Medical Technician, EMT and Paramedic Qualifications

1. EMTs and Paramedics providing services under this contract shall have the following qualifications, in addition to those required by Federal, State, and Local Government.

2. 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.

3. Shall submit evidence of equivalent training program, which has been successfully completed, to the Contracting Officer.

4. 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.

5. Shall attend all refresher continuing education, or advanced training programs as required by the local or state government entity in which service is rendered. In no instance, will this be less frequent than every two years. Such refresher training shall be equivalent to that developed by the Department of Transportation, National Highway Safety Administration.

6. Registered Nurse, RN

a. Personnel assigned by the Contractor to perform the services covered by this contract shall be a Licensed Registered Nurses in a State, Territory, or Commonwealth of the United States or the District of Columbia. The Qualifications of such personnel shall also be subject to review by the VA Chief of Staff and approval by the VA Facility Director or his or her designee.

7. Ambulance Driver

a. Drivers shall have a valid operator or chauffeur 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 or U.S. Bureaus of Mines or equivalent and can provide necessary medical assistance to the attending medical care specialist.

9) Special Contract Requirements

a. Healthcare Resources Services

i. The Contractor agrees, in accordance with the terms and conditions stated herein, to furnish for the Department of Veterans Affairs, hereinafter called the VA, the services specified. The initial listing of services to be furnished and the prices for same are identified in Schedule of Items and Description, Specifications, Work Statement.

b. Resources

i. The services specified in Schedule of Items, Description, Specifications, Work Statement and Special Contract Requirements may be changed by written modification to this contract. The modification shall be prepared by the VA Contracting Officer.

c. Qualifications

i. Personnel assigned by the Contractor to perform the services covered by this contract shall be licensed in a State, Territory or Commonwealth of the United States or the District of Columbia and meet the professional qualification criteria of the VA. The qualifications of such personnel shall also be subject to review by VA Chief of Staff and approval by VA Facility Director. The Contracting Officer will be notified prior to any changes in personnel.

d. Operating Hours

i. The services covered by this contract shall be furnished by the Contractor as defined herein. The Contractor shall be required to furnish such services 24 hours a day, 365 days a year.

e. Personnel Policy

i. The Contractor shall assume full responsibility for the protection of its personnel furnishing services under this contract, in accordance with the personnel policy of the Contractor. To carry out this responsibility, the Contractor shall provide workers compensation, professional liability insurance, health examinations, income tax withholding, and social security payments. The parties agree that the Contractor, its employees, agents and subcontractors shall not be considered VA employees for any purpose.

f. Recordkeeping System – Contractor

i. Contractor must establish a recordkeeping system of itemized services provided under the contract.

10) Risk Control

a. The VA does not guarantee any specific number of ambulance runs, and, the numbers provided for the purposes of bidding are based upon historical figures.

b. The Government reserves the right to terminate this contract, or any part hereof for its Convenience.

11) Place of Performance

a. The services of this contract will be utilized for trips starting and or ending at addresses provided by the Dayton VAMC such as Veterans location including residences, nursing homes, and other medical facilities with the trip terminating at the Dayton VAMC, assigned CBOCs, or vice versa.

b. Some trips will start at the Dayton VAMC and end at other medical facilities or Veterans residence.

12) Period of Performance Base period: October 1, 2018 thru September 30, 2019 Option 1: October 1, 2019 thru September 30, 2020 Option 2: October 1, 2020 thru September 30, 2021 Option 3: October 1, 2021 thru September 30, 2022 Option 4: October 1, 2022 thru September 30, 2023

B.5 PRICE/COST SCHEDULE

ITEM INFORMATION

15 min increments

15 min increments

15 min increments

15 min increments

15 min increments

15 min increments

15 min increments

15 min increments

OPTION 4 TOTAL

GRAND TOTAL

SECTION C - CONTRACT CLAUSES

C.1 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2018)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)).

(2) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (NOV 2015).

(3) 52.233-3, Protest After Award (Aug 1996) (31 U.S.C. 3553).

(4) 52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Public Laws 108-77 and 108-78 (19 U.S.C. 3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

[X] (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402).

[] (2) 52.203-13, Contractor Code of Business Ethics and Conduct (OCT 2015) (41 U.S.C. 3509).

[] (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (JUN 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.)

[] (4) 52.204–10, Reporting Executive Compensation and First-Tier Subcontract Awards (OCT 2016) (Pub. L. 109–282) (31 U.S.C. 6101 note).

[] (5) [Reserved] [] (6) 52.204–14, Service Contract Reporting Requirements (OCT 2016) (Pub. L. 111–117, section 743 of Div. C).

[] (7) 52.204–15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts (OCT 2016) (Pub. L. 111–117, section 743 of Div. C).

[X] (8) 52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (OCT 2015) (31 U.S.C. 6101 note).

[X] (9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Jul 2013) (41 U.S.C. 2313).

[] (10) [Reserved] [] (11)(i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (NOV 2011) (15 U.S.C. 657a).

[] (ii) Alternate I (NOV 2011) of 52.219-3.

[X] (12)(i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (OCT 2014) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a).

[] (ii) Alternate I (JAN 2011) of 52.219-4.

[] (13) [Reserved] [] (14)(i) 52.219-6, Notice of Total Small Business Set-Aside (NOV 2011) (15 U.S.C. 644).

[] (ii) Alternate I (NOV 2011).

[] (iii) Alternate II (NOV 2011).

[] (15)(i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644).

[] (ii) Alternate I (Oct 1995) of 52.219-7.

[] (iii) Alternate II (Mar 2004) of 52.219-7.

[X] (16) 52.219-8, Utilization of Small Business Concerns (NOV 2016) (15 U.S.C. 637(d)(2) and (3)).

[] (17)(i) 52.219-9, Small Business Subcontracting Plan (JAN 2017) (15 U.S.C. 637(d)(4)).

[] (ii) Alternate I (NOV 2016) of 52.219-9.

[] (iii) Alternate II (NOV 2016) of 52.219-9.

[X] (iv) Alternate III (NOV 2016) of 52.219-9.

[] (v) Alternate IV (NOV 2016) of 52.219-9.

[] (18) 52.219-13, Notice of Set-Aside of Orders (NOV 2011) (15 U.S.C. 644(r)).

[] (19) 52.219-14, Limitations on Subcontracting (JAN 2017) (15 U.S.C. 637(a)(14)).

[X] (20) 52.219-16, Liquidated Damages—Subcontracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)).

[] (21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (NOV 2011) (15 U.S.C. 657f).

[X] (22) 52.219-28, Post Award Small Business Program Rerepresentation (Jul 2013) (15 U.S.C 632(a)(2)).

[] (23) 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically Disadvantaged Women-Owned Small Business Concerns (DEC 2015) (15 U.S.C. 637(m)).

[] (24) 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small Business Concerns Eligible Under the Women-Owned Small Business Program (DEC 2015) (15 U.S.C. 637(m)).

[X] (25) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

[] (26) 52.222–19, Child Labor—Cooperation with Authorities and Remedies (JAN 2018) (E.O. 13126).

[X] (27) 52.222-21, Prohibition of Segregated Facilities (APR 2015).

[X] (28) 52.222–26, Equal Opportunity (SEP 2016) (E.O. 11246).

[X] (29) 52.222-35, Equal Opportunity for Veterans (OCT 2015) (38 U.S.C. 4212).

[X] (30) 52.222-36, Equal Opportunity for Workers with Disabilities (JUL 2014) (29 U.S.C. 793).

[X] (31) 52.222-37, Employment Reports on Veterans (FEB 2016) (38 U.S.C. 4212).

[X] (32) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O. 13496).

[X] (33)(i) 52.222-50, Combating Trafficking in Persons (MAR 2015) (22 U.S.C. chapter 78 and E.O. 13627).

[] (ii) Alternate I (MAR 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627).

[X] (34) 52.222-54, Employment Eligibility Verification (OCT 2015). (E. O. 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.)

[] (35)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA-Designated Items (May 2008) (42 U.S.C.6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

[] (ii) Alternate I (MAY 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

[] (36) 52.223-11, Ozone-Depleting Substances and High Global Warming Potential Hydrofluorocarbons (JUN 2016) (E.O. 13693).

[] (37) 52.223-12, Maintenance, Service, Repair, or Disposal of Refrigeration Equipment and Air Conditioners (JUN 2016) (E.O. 13693).

[] (38)(i) 52.223-13, Acquisition of EPEAT®-Registered Imaging Equipment (JUN 2014) (E.O.s 13423 and 13514).

[] (ii) Alternate I (OCT 2015) of 52.223-13.

[] (39)(i) 52.223-14, Acquisition of EPEAT®-Registered Televisions (JUN 2014) (E.O.s 13423 and 13514).

[] (ii) Alternate I (JUN 2014) of 52.223-14.

[] (40) 52.223-15, Energy Efficiency in Energy-Consuming Products (DEC 2007)(42 U.S.C. 8259b).

[] (41)(i) 52.223-16, Acquisition of EPEAT®-Registered Personal Computer Products (OCT 2015) (E.O.s 13423 and 13514).

[] (ii) Alternate I (JUN 2014) of 52.223-16.

[X] (42) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (AUG 2011) [] (43) 52.223-20, Aerosols (JUN 2016) (E.O. 13693).

[] (44) 52.223-21, Foams (JUN 2016) (E.O. 13693).

[] (45) (i) 52.224-3, Privacy Training (JAN 2017) (5 U.S.C. 552a).

[] (ii) Alternate I (JAN 2017) of 52.224-3.

[] (46) 52.225-1, Buy American—Supplies (MAY 2014) (41 U.S.C. chapter 83).

[] (47)(i) 52.225-3, Buy American—Free Trade Agreements—Israeli Trade Act (MAY 2014) (41 U.S.C. chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001 note, Pub. L. 103-182, 108-77, 108-78, 108-286, 108-302, 109-53, 109-169, 109-283, 110-138, 112-41, 112-42, and 112-43.

[] (ii) Alternate I (MAY 2014) of 52.225-3.

[] (iii) Alternate II (MAY 2014) of 52.225-3.

[] (iv) Alternate III (MAY 2014) of 52.225-3.

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