36C25019Q5000-001.pdf

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

17 June 2019

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 137

See Task Order(s)

36C25019Q5000

06-17-2019

Brad Burhite (513) 559-3704 06-19-2019 at 1400-EST

Department of Veterans Affairs Network Contracting Office (NCO) 10 260 E. University Avenue Cincinnati OH 45219

541519

$27.5 Million

X

N/A

X

See SCHEDULE OF SERVICES – PRICE SCHEDULE and PWS

Network Contracting Office (NCO) 10 260 E. University Avenue Cincinnati OH 45219

This solicitation is being issued in accordance with the authority to sole source as specified in FAR 6.302-1 under which all responsible sources may submit a capability statement, proposal or quotation which shall be considered By the agency.

153882816

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

See CONTINUATION Page

The contractor shall provide all required labor, material, supplies, equipment and supervision of contractor personnel necessary to provide integrated Tele-ICU/eICU® sustainment support for the VISN-10 command center and 317 pre-existing eICU® beds located in VISNs 1,4,5,6,7,9,10, and 19 as specified in the PWS in accordance with the terms and conditions established herein.

This is an Indefinite-Delivery type contract as defined in FAR Subpart 16.5. Performance under this contract shall only be authorized through the award of funded task order(s) by the cognizant government contracting office which will specify the period of performance for each task order issued.

The overall performance period for this IDIQ is 1-July-2019 to 29-February-2020 with base and options for this solicitation summarized as follows:

Base Period: 1-July-2019 to 29-February-2020 Option Period 1: 1-August-2019 to 29-February-2020 Option Period 2: 1-November-2019 to 29-February-2020

$0.00 See CONTINUATION Page

For accounting and appropriation data see each individually awarded task order. FAR 52.232-18 (Availability of Funds) applies to this contract.

X X

X 1

Bradley K. Burhite

VA-VHA-SAOC-2019-CD0069AC

Bradley K. Burhite 1461180 Digitally signed by Bradley K. Burhite 1461180 Date: 2019.06.17 11:45:27 -04'00'

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 SCHEDULE OF SERVICES – PRICE SCHEDULE (10 June 2019) B.3 PERFORMANCE WORK STATEMENT (PWS) dated 10 June 2019

B.4 IT CONTRACT SECURITY

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN

2017)

C.2 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2018)

C.3 52.215-22 LIMITATIONS ON PASS-THROUGH CHARGES—IDENTIFICATION OF

SUBCONTRACT EFFORTS (OCT 2009)

C.4 52.215-23 LIMITATIONS ON PASS-THROUGH CHARGES (OCT 2009)

C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.7 52.217-5 EVALUATION OF OPTIONS (JUL 1990)

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

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

C.10 52.216-18 ORDERING (OCT 1995)

C.11 52.224-1 PRIVACY ACT NOTIFICATION (APR 1984)

C.12 52.224-3 PRIVACY TRAINING (JAN 2017)

C.13 52.224-2 PRIVACY ACT (APR 1984)

C.14 52.227-14 RIGHTS IN DATA—GENERAL (MAY 2014)

C.15 52.227-19 COMMERCIAL COMPUTER SOFTWARE LICENSE (DEC 2007)

C.16 52.227-22 MAJOR SYSTEM—MINIMUM RIGHTS (JUN 1987)

C.17 VAAR 852.271-74 INSPECTION (JAN 2008)

C.18 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.19 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

C.20 VAAR 852.228-71 INDEMNIFICATION AND INSURANCE (MAR 2018)

C.21 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2012)

C.22 VAAR 852.236-76 CORRESPONDENCE (APR 1984)

C.23 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.24 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008)

C.25 52.232-18 AVAILABILITY OF FUNDS (APR 1984)

C.26 52.239-1 PRIVACY OR SECURITY SAFEGUARDS (AUG 1996)

C.27 OPERATING SOFTWARE

C.28 SOFTWARE PERFORMANCE

C.29 CONFIGURATION CONTROL

C.30 USE OF HARDWARE AND/OR SOFTWARE MONITORS

C.31 DOCUMENTATION

C.32 SOFTWARE FURNISHED

C.33 INTERRUPTION OF SERVICE

C.34 52.242-15 STOP-WORK ORDER (AUG 1989)

C.35 52.244-5 COMPETITION IN SUBCONTRACTING (DEC 1996)

C.36 52.244-6 SUBCONTRACTS FOR COMMERCIAL ITEMS (NOV 2017)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

B.1 BUSINESS ASSOCIATE AGREEMENT

BUSINESS ASSOCIATE AGREEMENT BETWEEN THE DEPARTMENT OF VETERANS

AFFAIRS VETERANS HEALTH ADMINISTRATION, CINCINNATI VAMC, AND

B.2 WD 15-4720 for Hamilton County, Ohio (see attached)

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017)

E.2 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

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

ITEMS (NOV 2017)

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: Philips Electronics North America Corporation Patricia Mckay

(425) 908-2172 pat.mckay@philips.com

b. GOVERNMENT: Contracting Officer 36C250

Bradley Burhite Department of Veterans Affairs Network Contracting Office (NCO) 10 260 E. University Avenue Cincinnati OH 45219

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

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

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly

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

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

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

AMENDMENT NO DATE

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.2 SCHEDULE OF SERVICES – PRICE SCHEDULE (10 June 2019)

SCHEDULE OF SERVICES – PRICE SCHEDULE

BASE PERIOD | 1 July 2019 to 29 February 2020 | CLINs-0001 (A-U)

Integrated Tele-ICU/eICU® Sustainment Support for VISN-10 Command Center and Participating Beds in VISNs 7 and 10

NOTE 1: The contractor shall reference the contract number, PO number and Contract Line Item Number (CLIN) for all invoices submitted under this contract to be considered acceptable for payment by the government.

NOTE 2: This contractor not-to-exceed (NTE) maximum quantity and total price established here in accordance with the terms and conditions of this contract.

Tele-ICU Command Center for VISN-10 | Located at Cincinnati VAMC Command Center *See Performance Work Statement

CLIN Tele-ICU Command Center and Beds by VISN and Location

Description of Services QTY

(NTE)

Unit of

Issue

Unit Price Total Price (Max NTE)

0001-A1 Command Center (eICU Center) VAMC Cincinnati Cincinnati, Ohio eICU® software sustainment support for command center *Price is 20% of original $500K perpetual license purchase amount.

MO

0001-A2 Command Center (eICU Center) VAMC Cincinnati eSearch® software sustainment support for command center *Price is 20% of original $100K perpetual license purchase amount.

0001-A3 Command Center

VAMC Cincinnati

Orion interface (80 ports) bundles for Tele-ICU command center *First set of Orion interface (80 ports) bundles for Tele-ICU command center *Price is 20% of original $30K perpetual license purchase amount.

0001-A4 Command Center

VAMC Cincinnati

Orion interface (80 ports) bundles for Tele-ICU command center *2nd set of Orion interface (80 ports) Add-on bundle for Tele-ICU command center added effective 1 May 18 (CLIN 0004-A4).

*Price is 20% of original $30K perpetual

Sub-Total | CLIN-0001 (A1-4)

VISN-7 | Atlanta VAMC | Atlanta, Georgia Medical Intensive Care Unit (MICU) *See Performance Work Statement 0001-B1 12 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260 perpetual license purchase amount for price tier range of 181 to 249 beds.

Each Bed

8-MO

0001-B2 Sub-license fee for APACHE mortality assessment software *Commercial price is $600 per year *Unit of issue is one (1) software sub-license for each participating bed.

0001-B3 Sub-license fee for FIRST DATA BANK (FDB) software formerly known as NDDF *Commercial price is $2,500 per year license for each medical unit.

0001-B4 Sustainment support for ADT IN- BOUND flowsheet software *Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-B5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-B6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-B7 Sustainment support for FLOWSHEET INTERFACE software *Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (B1-7)

VISN-7 | Atlanta VAMC | Atlanta, Georgia Surgical Intensive Care Unit (SICU) *See Performance Work Statement 0001-C1 12 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260 perpetual license purchase amount for price tier range of 181 to 249 beds.

0001-C2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit of issue is one (1) software sub-license for each participating bed.

0001-C3 Sub-license fee for FIRST DATA BANK (FDB) software formerly known as

NDDF

*Commercial price is $2,500 per year

0001-C4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-C5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-C6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-C7 Sustainment support for FLOWSHEET INTERFACE software *Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (C1-7)

VISN-7 | Charles Norwood VAMC | Augusta, Georgia Intensive Care Unit (ICU) *See Performance Work Statement 0001-D1 20 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260

0001-D2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

0001-D3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

0001-D4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-D5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-D6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-D7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (D1-7)

VISN-7 | Birmingham VAMC | Birmingham, Alabama Cardiovascular Intensive Care Unit/Coronary Care Unit (CVICU/CCU) *See Performance Work Statement 0001-E1 12 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260

0001-E2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

0001-E3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

0001-E4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-E5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-E6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-E7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (E1-7)

VISN-7 | Birmingham VAMC | Birmingham, Alabama Medical Intensive Care Unit (MICU) *See Performance Work Statement 0001-F1 10 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260 perpetual

0001-F2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

0001-F3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

0001-F4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-F5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-F6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-F7 Sustainment support for FLOWSHEET

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (F1-7)

VISN-7 | Birmingham VAMC | Birmingham, Alabama Surgical Intensive Care Unit (SICU) *See Performance Work Statement 0001-G1 7 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260 perpetual

0001-G2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

0001-G3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

0001-G4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-G5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-G6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-G7 Sustainment support for FLOWSHEET

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (G1-7)

VISN-7 | Montgomery VAMC | Montgomery, Alabama Intensive Care Unit (ICU) *See Performance Work Statement 0001-H1 8 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260

0001-H2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

0001-H3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

0001-H4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-H5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-H6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-H7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (H1-7)

VISN-7 | Ralph H. Johnson VAMC | Charleston, South Carolina Medical Intensive Care Unit (MICU) *See Performance Work Statement 0001-I1 8 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260

0001-I2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

0001-I3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

0001-I4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-I5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-I6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-I7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (I1-7)

VISN-7 | Ralph H. Johnson VAMC | Charleston, South Carolina Surgical Intensive Care Unit (SICU) *See Performance Work Statement 0001-J1 8 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260 perpetual

0001-J2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

0001-J3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

0001-J4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-J5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-J6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-J7 Sustainment support for FLOWSHEET

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (J1-7)

VISN-7 | Columbia VAMC | Columbia, South Carolina Intensive Care Unit (ICU) *See Performance Work Statement 0001-K1 21 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452.00 which is 20% of original $7,260

0001-K2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

0001-K3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

0001-K4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-K5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-K6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-K7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (K1-7)

VISN-10 | Cincinnati VAMC | Cincinnati, Ohio Medical Intensive Care Unit (MICU) *See Performance Work Statement 0001-L1 13 BEDS eICU® software sustainment support

*Annual unit price per year is $1,916.00 which is 20% of original $9,580 price tier range of 41 to 60 beds.

0001-L2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

0001-L3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

0001-L4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-L5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-L6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-L7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-0001 (L1-7)

VISN-10 | Cincinnati VAMC | Cincinnati, Ohio Surgical Intensive Care Unit (ICU) *See Performance Work Statement 0001-M1 10 BEDS eICU® software sustainment support

*Annual unit price per year is $1,916.00 which is 20% of original $9,580 perpetual range of 41 to 60 beds.

0001-M2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

0001-M3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

0001-M4 Annual sustainment support for ADT IN-BOUND flowsheet software.

*Unit price is 20% of original $5,000 perpetual license purchase amount.

*Unit of issue is one software sub-license for each medical unit (see above CLIN).

0001-M5 Annual sustainment support for LAB IN-BOUND flowsheet software.

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-M6 Sustainment support for MEDS IN-

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M6 which is no longer utilized effective 30 April 2018 due to CPRS interface issues.

0001-M7 Sustainment support for FLOWSHEET

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M7 for the Clinical Information System (CIS) for one (1) feed that covers all locations in VISN-10-wide to PICIS for VAMC Cincinnati, VAMC Cleveland, VAMC Chillicothe, and VAMC Dayton.

Sub-Total | CLIN-0001 (M1-7)

VISN-10 | Cincinnati VAMC | Cincinnati, Ohio Emergency Department (ED) *AV only configuration (See Performance Work Statement) 0001-N1 1 BED eICU® audio visual only software sustainment support *Annual unit price per year is $250 which is 20% of original $1,250 perpetual

0001-N2 Sub-license fee for APACHE mortality

*Unit price is standard commercial.

*Unit of issue is one software sub-license for each participating bed which ended effective 1 May 2018 for VAMC Cincinnati Emergency Department.

NOTE: This sub-license converted to AV ONLY effective 1 May 2018 on contract

VA250-17-C-0029.

0001-N3 Sub-license fee for FIRST DATA BANK

NDDF

*Unit price is standard commercial.

*FDB not required for Emergency Departments (ED).

0001-N4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-N5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-N6 Sustainment support for MEDS IN-

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M6 which

0001-N7 Sustainment support for FLOWSHEET

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M7 for the Clinical Information System (CIS) for one (1) feed that covers all locations in VISN-10-wide to PICIS for VAMC

Sub-Total | CLIN-0001 (N1-7)

VISN-10 | Louis Stokes VAMC | Cleveland, Ohio Medical Intensive Care Unit (MICU) *See Performance Work Statement 0001-O1 16 BEDS eICU® software sustainment support

*Annual unit price per year is $1,916.00 which is 20% of original $9,580

0001-O2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

0001-O3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

0001-O4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-O5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-O6 Sustainment support for MEDS IN- BOUND flowsheet software.

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M6 which

0001-O7 Sustainment support for

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M7 for the Clinical Information System (CIS) for one (1) feed that covers all locations in VISN-10-wide to PICIS for VAMC

Sub-Total | CLIN-0001 (O1-7)

VISN-10 | Louis Stokes VAMC | Cleveland, Ohio Surgical Intensive Care Unit (ICU) *See Performance Work Statement 0001-P1 12 BEDS eICU® software sustainment support

*Annual unit price per year is $1,750.00 which is 20% of original $8,750 perpetual range of 81 to 100 beds.

0001-P2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

0001-P3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

0001-P4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-P5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-P6 Sustainment support for MEDS IN-

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M6 which

0001-P7 Sustainment support for FLOWSHEET

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M7 for the Clinical Information System (CIS) for one (1) feed that covers all locations in VISN-10-wide to PICIS for VAMC

Sub-Total | CLIN-0001 (P1-7)

VISN-10 | Chillicothe VAMC | Chillicothe, Ohio Acute Care Unit (ACU) *See Performance Work Statement 0001-Q1 10 BEDS eAcute® software sustainment support

*Annual unit price per year is $1,000.00 which is 20% of original $5,000 perpetual

0001-Q2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit of issue is one (1) software sub-license for each participating bed.

**This sub-license is not required for Acute Care Units (ACUs).

0001-Q3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

0001-Q4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

for each medical unit.

0001-Q5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

for each medical unit.

0001-Q6 Sustainment support for MEDS IN-

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M6 which

0001-Q7 Sustainment support for FLOWSHEET

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M7 for the Clinical Information System (CIS) for one (1) feed that covers all locations in VISN-10-wide to PICIS for VAMC

Sub-Total | CLIN-0001 (Q1-7)

VISN-10 | Chillicothe VAMC | Chillicothe, Ohio Emergency Department (ED) *AV only configuration (See Performance Work Statement) 0001-R1 1 BED eICU® audio visual only software sustainment support *Annual unit price per year is $250 which

*NOTE: The software license for this location was contractually incorporated as Audio Visual ONLY effective 1 May 2018 on contract VA250-17-C-0029.

0001-R2 Sub-license fee for APACHE mortality assessment software *Unit price is standard commercial.

*Unit of issue is one software sub-license for each participating bed which ended effective 1 May 2018 for VAMC Chillicothe Emergency Department.

NOTE: This sub-license converted to AV ONLY effective 1 May 2018.

0001-R3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

0001-R4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-R5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-R6 Sustainment support for MEDS IN-

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M6 which

0001-R7 Sustainment support for FLOWSHEET

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M7 for the Clinical Information System (CIS) for one (1) feed that covers all locations in VISN-10-wide to PICIS for VAMC

Sub-Total | CLIN-0001 (R1-7)

VISN-10 | Dayton VAMC | Dayton, Ohio Intensive Care Unit (ICU) *See Performance Work Statement 0001-S1 10 BEDS eICU® software sustainment support

*Annual unit price per year is $1,916.00 which is 20% of original $9,580

0001-S2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

0001-S3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

0001-S4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-S5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-S6 Sustainment support for MEDS IN-

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M6 which

0001-S7 Sustainment support for

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M7 for the Clinical Information System (CIS) for one (1) feed that covers all locations in VISN-10-wide to PICIS for VAMC

Sub-Total | CLIN-0001 (S1-7)

VISN-10 | Dayton VAMC | Dayton, Ohio Intensive Care Unit (ICU) *See Performance Work Statement **Reference Note Below 0001-T1 3 BEDS eICU® software sustainment support

*Annual unit price per year is $1,812.00 which is 20% of original $9,060 perpetual range of 41 to 60 beds.

**NOTE: The sustainment support for this location was increased by three (3) beds from ten (10) beds to thirteen (13) beds at a different perpetual license purchase amount.

0001-T2 Sub-license fee for APACHE mortality assessment software *Unit price is standard commercial.

0001-T3 Sub-license fee for FIRST DATA BANK

NDDF

*This sub-license is paid for under the above CLIN for VAMC Dayton.

0001-T4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-T5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

0001-T6 Sustainment support for MEDS IN-

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M6 which

0001-T7 Sustainment support for FLOWSHEET

*Shared sub-license for all locations in VISN-10 paid for under VAMC Cincinnati MICU CLIN 0001-M7 for the Clinical Information System (CIS) for one (1) feed that covers all locations in VISN-10-wide to PICIS for VAMC

Sub-Total | CLIN-0001 (T1-7)

Total Base Period | CLINs-0001 (A-T) Beds

OPTION ONE (1) | 1 Aug 2019 to 28 Feb 2020 | CLINs-1001 (A-B)

Integrated Tele-ICU/eICU® Sustainment Support for Wilkes-Barre VAMC in PA (VISN-4)

NOTE 1: The contractor shall reference the contract number, PO number and Contract Line Item Number (CLIN) for all invoices

NOTE 2: This contractor not-to-exceed (NTE) maximum quantity and total price established here in accordance with the terms and

VISN-4 | Wilkes-Barre VAMC | Wilkes-Barre, Pennsylvania Intensive Care Unit (ICU) *See Performance Work Statement 1001-A1 14 BEDS eICU® software sustainment support

*Annual unit price per year is $1,452 which is 20% of original $7,260

7-MO

1001-A2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

1001-A3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

1001-A4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

1001-A5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

1001-A6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

1001-A7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-1001 (A1-7)

VISN-4 | Wilkes-Barre VAMC | Wilkes-Barre, Pennsylvania Emergency Department (ED) *AV only configuration (See Performance Work Statement) 1001-B1 2 BEDS eICU® audio visual only software sustainment support *Annual unit price per year is $250 which

1001-B2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

1001-B3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

1001-B4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

1001-B5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

1001-B6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

1001-B7 Sustainment support for FLOWSHEET

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-1001 (B1-7)

Total Option Period One | CLINs-1001 (A-B)

OPTION TWO (2) | 1 Nov 2019 to 29 Feb 2020 | CLINs-2001 (A-P)

Integrated Tele-ICU/eICU® Sustainment Support

NOTE 1: The contractor shall reference the contract number, PO number and Contract Line Item Number (CLIN) for all invoices

NOTE 2: This contractor not-to-exceed (NTE) maximum quantity and total price established here in accordance with the terms and

VISN-1 | Maine (Togus) VAMC | Augusta, Maine Special Care Unit (SCU) *See Performance Work Statement 2001-A1 11 BEDS eICU® software sustainment support

*Annual unit price per year is $1,400 which is 20% of original $7,000 price tier range of 250 to 499 beds.

4-MO

2001-A2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-A3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-A4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-A5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-A6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-A7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (A1-7)

VISN-1 | Maine (Togus) VAMC | Augusta, Maine Emergency Department (ED) *AV only configuration (See Performance Work Statement) 2001-B1 6 BEDS eICU® audio visual only software sustainment support *Annual unit price per year is $250 which is 20% of original $1,250

2001-B2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-B3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-B4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-B5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-B6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-B7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (B1-7)

VISN-4 | White River Junction VAMC | White River Junction, Vermont Intensive Care Unit (ICU) *See Performance Work Statement 2001-C1 8 BEDS eICU® software sustainment support

*Annual unit price per year is $1,400 which is 20% of original $7,000 perpetual range of 250 to 499 beds.

2001-C2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

2001-C3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

2001-C4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-C5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-C6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-C7 Sustainment support for FLOWSHEET

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (C1-7)

VISN-4 | White River Junction VAMC | White River Junction, Vermont Emergency Department (ED) *AV only configuration (See Performance Work Statement) 2001-D1 1 BEDS eICU® software sustainment support

*Annual unit price per year is $250

2001-D2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-D3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-D4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-D5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-D6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-D7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (D1-7)

VISN-4 | Wilmington VAMC | Wilmington, Delaware Intensive Care Unit (ICU) *See Performance Work Statement 2001-E1 6 BEDS eICU® software sustainment support

*Annual unit price per year is $1,400 which is 20% of original $7,000

2001-E2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-E3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-E4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-E5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-E6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-E7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (E1-7)

VISN-4 | Wilmington VAMC | Wilmington, Delaware Emergency Department (ED) *AV only configuration (See Performance Work Statement) 2001-F1 2 BEDS eICU® software sustainment support

*Annual unit price per year is $250 which

2001-F2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

2001-F3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

2001-F4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-F5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-F6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-F7 Sustainment support for FLOWSHEET

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (F1-7)

VISN-5 | Beckley VAMC | Beckley, West Virginia Intensive Care Unit (ICU) *See Performance Work Statement 2001-G1 5 BEDS eICU® software sustainment support

*Annual unit price per year is $1,400 which is 20% of original $7,000 perpetual range of 250 to 499 beds.

2001-G2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year *Unit

2001-G3 Sub-license fee for FIRST DATA BANK

NDDF

*Commercial price is $2,500 per year

2001-G4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-G5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-G6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-G7 Sustainment support for FLOWSHEET

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (G1-7)

VISN-5 | Beckley VAMC | Beckley, West Virginia Emergency Department (ED) *AV only configuration (See Performance Work Statement) 2001-H1 3 BEDS eICU® software sustainment support

*Annual unit price per year is $250

2001-H2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-H3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-H4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-H5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-H6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-H7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (H1-7)

VISN-5 | Clarksburg VAMC | Clarksburg, West Virginia Intensive Care Unit (ICU) *See Performance Work Statement 2001-I1 15 BEDS eICU® software sustainment support

*Annual unit price per year is $1,400 which is 20% of original $7,000

2001-I2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-I3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-I4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-I5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-I6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-I7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (I1-7)

VISN-5 | Clarksburg VAMC | Clarksburg, West Virginia Emergency Department (ED) *AV only configuration (See Performance Work Statement) 2001-J1 7 BEDS eICU® software sustainment support

*Annual unit price per year is $250

2001-J2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-J3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-J4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-J5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-J6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-J7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (J1-7)

VISN 9 | James H. Quillen VAMC | Mountain Home, Tennessee Intensive Care Unit (ICU) *See Performance Work Statement 2001-K1 17 BEDS eICU® software sustainment support

*Annual unit price per year is $1,400 which is 20% of original $7,000

2001-K2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-K3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-K4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-K5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-K6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-K7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (K1-7)

VISN 9 | James H. Quillen VAMC | Mountain Home, Tennessee Emergency Department (ED) *AV only configuration (See Performance Work Statement) 2001-L1 4 BEDS eICU® software sustainment support

*Annual unit price per year is $250

2001-L2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-L3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-L4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-L5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-L6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-L7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (L1-7)

VISN 10 | Fort Wayne VAMC | Fort Wayne, Indiana Intensive Care Unit (ICU) *See Performance Work Statement 2001-M1 4 BEDS eICU® software sustainment support

*Annual unit price per year is $1,400 which is 20% of original $7,000

2001-M2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-M3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-M4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-M5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-M6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-M7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (M1-7)

VISN 10 | Fort Wayne VAMC | Fort Wayne, Indiana Emergency Department (ED) *AV only configuration (See Performance Work Statement) 2001-N1 4 BEDS eICU® software sustainment support

*Annual unit price per year is $250

2001-N2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-N3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-N4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-N5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-N6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-N7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (N1-7)

VISN 19 | Jack C. Montgomery VAMC | Muskogee, Oklahoma Intensive Care Unit (ICU) *See Performance Work Statement 2001-O1 11 BEDS eICU® software sustainment support

*Annual unit price per year is $1,400 which is 20% of original $7,000

2001-O2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-O3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-O4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-O5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-O6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-O7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (O1-7)

VISN 19 | Jack C. Montgomery VAMC | Muskogee, Oklahoma Emergency Department (ED) *AV only configuration (See Performance Work Statement) 2001-P1 3 BEDS eICU® software sustainment support

*Annual unit price per year is $250

2001-P2 Sub-license fee for APACHE mortality

*Commercial price is $600 per year

2001-P3 Sub-license fee for FIRST DATA known as NDDF *Commercial price is $2,500 per year

2001-P4 Sustainment support for ADT IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-P5 Sustainment support for LAB IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-P6 Sustainment support for MEDS IN-

*Unit price is 20% of original $5,000 perpetual license purchase amount.

2001-P7 Sustainment support for

*Unit price is 20% of original $5,000 perpetual license purchase amount.

Sub-Total | CLIN-2001 (P1-7)

TOTAL Option Two | CLINs-2001 (A-P)

PRICE SUMMARY ROLL-UP (Base and Option Periods)

Integrated Tele-ICU/eICU® Sustainment Support for VISN-10 Command Center and Participating Beds in VISNs 1, 4, 5, 7, 9, 10 and 19

NOTE: The IDIQ minimum shall be applied to the BASE PERIOD only which shall not exceed 15% of the total value established herein.

CLIN

Period/Option

Period of Performance

Total Price (Minimum)

IDIQ Minimum is 15% for Base Period Only

Total Price (Max NTE)

CLINs-0001 (A-T) Base Period

Tele-ICU/eICU® sustainment for VISN-10 command center and 194 beds located in VISNs 7 and 10 (see PWS) 1 July 2019 to 29 February 2020

CLINs-1001 (A-B) Option 1

Tele-ICU/eICU® sustainment for 16 beds located at Wilkes-Barre VAMC in VISN-4 (see PWS) 1 August 2019 to 29 February 2020

CLINs-2001 (A-P) Option 2

Tele-ICU/eICU® sustainment for 107 beds located in VISNs 1, 4 ,5, 7, 9, 10 and 19 (see PWS) 1 November 2019 to 29 February 2020

TOTAL PRICE

B.3 PERFORMANCE WORK STATEMENT (PWS) dated 10 June 2019

PERFORMANCE WORK STATEMENT (PWS)

Integrated Tele-ICU/eICU® Sustainment Support for VISN-10 Command Center and Participating Beds in VISNs 1, 4, 5, 7, 9, 10 and 19

10 June 2019

1. GENERAL. This is a non-personal services contract to provide Tele-Intensive Care Unit (Tele-ICU)/eICU® integrated software sustainment support for the VISN-10 command center and participating beds in VISNs 1, 4, 5, 7, 9, 10 and 19 as specified below. The scope of this contract shall include eICU® proprietary software, associated software sub-licenses (i.e. APACHE, First Data Bank, etc.). The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the contractor who, in turn is responsible to the Government. The contractor shall provide eICU® as established in this performance work statement (PWS) and in accordance with the terms and conditions established in this contract.

The contractor shall be the primary contact for the customer associated with this contract for all maintenance and support concerns or reported issues that interface with the prime contractor’s intellectual property and/or sub-licenses the prime contractor has obtained which are associated with the prime contractor’s intellectual property, if required for intellectual property to perform. The contractor shall perform to the standards in this contract. The eICU® proprietary software and associated sub-licenses involves four (4) major acquisition life-cycle phases:

Phase A | eICU® New Site Assessments: The purpose of eICU® Phase A (new site assessments) is for the contractor to provide the government a list of all prerequisite items that the government must complete at the participating site to be prepared for implementation to go-live with operational usage as eICU® implementation ready. During this phase, the contractor shall conduct an onsite assessment of the units that will be monitored by Tele-ICU. In addition, the contractor shall document the cabling and power locations and equipment installation locations in each room to be monitored by Tele-ICU. Network closets and switch capacity on the current network are reviewed for the needs of the Tele-ICU program.