D.4 36C25023Q1850 Reissue 9.14.2023.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

See Task Order (s)

36C25023Q1850

6. SOLICITATION ISSUE DATE

Initial issue 8-18-2023 Reissue 9-14-2023

Robert J. Bolcavage III None 09-20-2023

13:00 EDT

Department of Veterans Affairs Dayton VA Medical Center 3140 Governor’s Place Blvd. Suite 210 Kettering OH 45409-1337

X 100

X

621910

$22.5 Million

N/A

X

36C250

Department of Veterans Affairs Chalmers P. Wylie VAACC

420 North James Road Columbus OH 43219

36C250

Network Contracting Office (NCO) 10 Department of Veterans Affairs 3140 Governors 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

The contractor shall provide all required labor, material, supplies, equipment and supervision of contractor personnel necessary to perform Advanced Life Support (ALS) and Basic Life Support (BLS) ambulance service for the Columbus Veterans Administration Ambulatory Care Clinic (VAACC) in accordance with the terms and conditions established herein.

This solicitation shall be conducted in accordance with FAR Subpart 13.5 and is anticipated to result in the award of an Indefinite-Delivery type contract as defined in FAR Subpart 16.5. The performance of services under this contract shall only be authorized though the award of funded task order(s) by the cognizant government contracting.

The anticipated performance periods are as follows:

- Base Year: 1 November 2023 to 31 October 2024

- Option Year On: 1 November 2024 to 31 October 2025

- Option Year Two: 1 November 2025 to 31 October 2026

No Questions accepted after 1:00PM, 13 September 2023.

See CONTINUATION Page

X X

X 1

John M. Ryan

VA-VHA-SAOC-2018-12C2305A

36C25023Q1850

Table of Contents

SECTION A

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

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

B.3 DELIVERY SCHEDULE

SECTION C - CONTRACT CLAUSES

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

AND COMMERCIAL SERVICES (DEC 2022)

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

C.3 52.216-18 ORDERING (AUG 2020)

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

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ... 48

C.7 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.8 VAAR 852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 2022)

C.9 VAAR 852.208-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS – ORDERS or BPAs (JAN

2023) (DEVIATION)

C.10 VAAR 852.208-71 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTOR COMMITMENTS-ORDERS AND

BPAS (JAN 2023) (DEVIATION)

C.11 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA

BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)

C.12 852.216-75 ECONOMIC PRICE ADJUSTMENT—FUEL SURCHARGE (NOV

2021)

C.13 VAAR 852.219-76 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SUPPLIES AND PRODUCTS (JAN 2023)

(DEVIATION)

C.14 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

C.15 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) . 56

C.16 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (JUN 2023)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

BUSINESS ASSOCIATE AGREEMENT BETWEEN THE DEPARTMENT OF

VETERANS AFFAIRS VETERANS HEALTH ADMINISTRATION, , AND

SECTION E - SOLICITATION PROVISIONS

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

COMMERCIAL SERVICES (MAR 2023)

E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.3 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.5 52.216-1 TYPE OF CONTRACT (APR 1984)

E.6 52.233-2 SERVICE OF PROTEST (SEP 2006)

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

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

BY REFERENCE (JAN 2008)

E.9 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.10 INSTRUCTIONS TO OFFEROR’S – EVALUATION OF QUOTES

E.11 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (DEC 2022)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C250

Department of Veterans Affairs

Dayton VA Medical Center

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:

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

Management, or [X] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Bi-Monthly

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

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

AMENDMENT NO DATE

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

3240.00 Trp _________________ _________________

BLS Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS. The contractor is NOT authorized to invoice for MILEAGE RATE (ONE-WAY) in addition to the BASE RATE (ONE-WAY) for patient transports with a point-to-point (one-way) travel distance radius of 20 miles or less from the designated VA Medical Center. For patient transports with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center, the BASE RATE (ONE-WAY) plus MILEAGE RATE (ONE-WAY) may be authorized. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Base POP Begin: 11-01-2023 POP End: 10-31-2024

0002 2,400.00 MI ________________ _________________

BLS Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE- WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS. The contractor shall ensure that all invoices submitted with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center include the MILEAGE RATE (ONE-WAY) plus BASE RATE (ONE-WAY) which shall be calculated based on the total travel distance

ESTIMATED

(one-way) minus 20 miles. The MILEAGE RATE (ONE- WAY) is not authorized for any patient transport that does not have a VA approved passenger onboard. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Base POP Begin: 11-01-2023 POP End: 10-31-2024

0003 650.00 EA ________________ _________________

BLS Ambulance | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” upon approval by the COR or authorized government representative designed in writing by the COR and/or CO as specified in this PWS.

Contract Period: Base POP Begin: 11-01-2023 POP End: 10-31-2024

0004 554.00 Trp _________________ _________________ ALS Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS. The contractor is NOT authorized to invoice for MILEAGE RATE (ONE-WAY) in addition to the BASE RATE (ONE-WAY) for patient transports with a point-to-point (one-way) travel distance radius of 20 miles or less from the designated VA Medical Center. For patient transports with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center, the BASE RATE (ONE-WAY) plus MILEAGE RATE (ONE-WAY) may be authorized. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Base POP Begin: 09-08-2023 POP End: 04-30-2024

0005 20.00 MI ________________ _________________

ALS Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE- WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS. The contractor shall ensure that all invoices submitted with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center include the MILEAGE RATE (ONE-WAY) plus BASE RATE (ONE-WAY) which shall be calculated based on the total travel distance (one-way) minus 20 miles. The MILEAGE RATE (ONE- WAY) is not authorized for any patient transport that does not have a VA approved passenger onboard. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Base POP Begin: 11-01-2023 POP End: 10-31-2024

0006 20.00 EA ________________ _________________

ALS Ambulance | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” upon approval by the COR or authorized government representative designed in writing by the COR and/or CO as specified in this PWS.

Contract Period: Base POP Begin: 11-01-2023 POP End: 10-31-2024

1001 3,240.00 Trp _________________ _________________ BLS Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS. The contractor is NOT authorized to invoice for MILEAGE RATE (ONE-WAY) in addition to the BASE RATE (ONE-WAY) for patient transports with a point-to-point (one-way) travel distance radius of 20 miles or less from the designated VA Medical Center. For patient transports with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center, the BASE RATE (ONE-WAY) plus MILEAGE RATE (ONE-WAY) may be authorized. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Option 1 POP Begin: 11-01-2024 POP End: 10-31-2025

1002 2,400.00 MI _________________ _________________

BLS Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE- WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS. The contractor shall ensure that all invoices submitted with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center include the MILEAGE RATE (ONE-WAY) plus BASE RATE (ONE-WAY) which shall be calculated based on the total travel distance (one-way) minus 20 miles. The MILEAGE RATE (ONE- WAY) is not authorized for any patient transport that does not have a VA approved passenger onboard. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Option 1 POP Begin: 11-01-2024 POP End: 10-31-2025

1003 650.00 EA _________________ _________________

BLS Ambulance | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” upon approval by the COR or authorized government representative designed in writing by the COR and/or CO as specified in this PWS.

Contract Period: Option 1 POP Begin: 11-01-2024 POP End: 10-31-2025

1004 950.00 Trp _________________ _________________ ALS Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS. The contractor is NOT authorized to invoice for MILEAGE RATE (ONE-WAY) in addition to the BASE RATE (ONE-WAY) for patient transports with a point-to-point (one-way) travel distance radius of 20 miles or less from the designated VA Medical Center. For patient transports with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center, the BASE RATE (ONE-WAY) plus MILEAGE RATE (ONE-WAY) may be authorized. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Option 1 POP Begin: 11-01-2024 POP End: 10-31-2025

1005 20.00 MI _________________ _________________

ALS Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE- WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS. The contractor shall ensure that all invoices submitted with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center include the MILEAGE RATE (ONE-WAY) plus BASE RATE (ONE-WAY) which shall be calculated based on the total travel distance (one-way) minus 20 miles. The MILEAGE RATE (ONE- WAY) is not authorized for any patient transport that does not have a VA approved passenger onboard. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Option 1 POP Begin: 11-01-2024 POP End: 10-31-2025

1006 20.00 EA _________________ _________________

ALS Ambulance | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” upon approval by the COR or authorized government representative designed in writing by the COR and/or CO as specified in this PWS.

Contract Period: Option 1 POP Begin: 11-01-2024 POP End: 10-31-2025

2001 3,240.00 Trp _________________ _________________ BLS Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS. The contractor is NOT authorized to invoice for MILEAGE RATE (ONE-WAY) in addition to the

BASE RATE (ONE-WAY) for patient transports with a point-to-point (one-way) travel distance radius of 20 miles or less from the designated VA Medical Center. For patient transports with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center, the BASE RATE (ONE-WAY) plus MILEAGE RATE (ONE-WAY) may be authorized. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Option 2 POP Begin: 11-01-2025 POP End: 10-31-2026

2002 2,400.00 MI _________________ _________________

BLS Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE- WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS. The contractor shall ensure that all invoices submitted with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center include the MILEAGE RATE (ONE-WAY) plus BASE RATE (ONE-WAY) which shall be calculated based on the total travel distance (one-way) minus 20 miles. The MILEAGE RATE (ONE- WAY) is not authorized for any patient transport that does not have a VA approved passenger onboard. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Option 2

POP Begin: 11-01-2025 POP End: 10-31-2026

2003 650.00 EA _________________ _________________

BLS Ambulance | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” upon approval by the COR or authorized government representative designed in writing by the COR and/or CO as specified in this PWS.

Contract Period: Option 2 POP Begin: 11-01-2025 POP End: 10-31-2026

2004 950.00 Trp _________________ _________________ ALS Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS. The contractor is NOT authorized to invoice for MILEAGE RATE (ONE-WAY) in addition to the BASE RATE (ONE-WAY) for patient transports with a point-to-point (one-way) travel distance radius of 20 miles or less from the designated VA Medical Center. For patient transports with a point-to-point (one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center, the BASE RATE (ONE-WAY) plus MILEAGE RATE (ONE-WAY) may be authorized. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Option 2 POP Begin: 11-01-2025 POP End: 10-31-2026

2005 20.00 MI _________________ _________________

ALS Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE- WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS. The contractor shall ensure that all invoices submitted with a point-to-point

(one-way) travel distance radius which exceeds 20 miles from the designated VA Medical Center include the MILEAGE RATE (ONE-WAY) plus BASE RATE (ONE-WAY) which shall be calculated based on the total travel distance (one-way) minus 20 miles. The MILEAGE RATE (ONE- WAY) is not authorized for any patient transport that does not have a VA approved passenger onboard. The contractor shall utilize the latest edition of BING maps to calculate the travel distance for all point-to-point trips.

The total quantity established for this contract line item (CLIN) is maximum not-to-exceed (NTE). This maximum NTE quantity shall not be exceeded by the contractor unless authorized via bilateral contract modification executed by the contracting officer. The minimum quantity authorized for this contract is applicable to the base period only which is 15% of the maximum NTE quantity established for each CLIN. The contractor shall only be authorized to invoice for the minimum quantity if the base period is physically complete and the minimum amount has not been exceeded.

Contract Period: Option 2 POP Begin: 05-01-2025 POP End: 04-30-2026

2006 20.00 EA _________________ __________________

ALS Ambulance | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” upon approval by the COR or authorized government representative designed in writing by the COR and/or CO as specified in this PWS.

Contract Period: Option 2 POP Begin: 11-01-2025 POP End: 10-31-2026

GRAND TOTAL _________________

B.3 DELIVERY SCHEDULE

ITEM NUMBER QUANTITY

DELIVERY

DATE

0001 1,890.00

0002 1,400.00

0003 379.00

0004 554.00

0005 12.00

0006 12.00

1001 3,240.00

1002 2,400.00

1003 650.00

1004 950.00

1005 20.00

1006 20.00

2001 3,240.00

2002 2,400.00

2003 650.00

2004 950.00

2005 20.00

2006 20.00

B.3 PERFORMANCE WORK STATEMENT (PWS) dated 10 August 2021

PERFORMANCE WORK STATEMENT (PWS)

Ambulance Service for Columbus VAACC (Non-Personal Services)

14 September 2023

1. GENERAL. This is a non-personnel services contract in which the contractor shall provide Advanced Life Support (ALS) and Basic Life Support (BLS) ambulance service for Chalmers P. Wylie Veterans Administration Ambulatory Care Center (VAACC) in Columbus, Ohio. The government shall not exercise any supervision or control over the contract service providers performing the services herein.

1.1 SCOPE SUMMARY. The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items necessary to provide ambulance service for Columbus (VAACC) as established in this Performance Work Statement (PWS). The contractor shall adhere to Ohio Administrative Code (OAC), State Board of Emergency Medical, Fire, and Transportation Services (EMFTS) and all applicable Federal, State and Local laws, rules, regulations and procedures as required to perform services under this contract. The contractor shall furnish the vehicles necessary to provide full and complete coverage for pick-up and delivery of all Veteran patients requiring transport in accordance with the terms and conditions of this contract for the locations specified herein. The contractor shall be responsible for providing patient pick-up and delivery as necessary from community hospitals and VA facilities within and outside the service area which may include personal residence of the patient and other locations as requested by the authorized government representative(s) designated in writing by the COR and/or CO in accordance with the procedures specified within this PWS in support of the following primary operating location:

Department of Veterans Affairs Chalmers P. Wylie Veterans Administration Ambulatory Care Center 420 North James Road Columbus, Ohio 43219

1.1.1 CLINICS. Also requiring service to/from locations are the following clinics as well as patient(s) residence.

CBOC Grove City 1955 Ohio Drive, Grove City, Ohio 43123

CBOC Newark 1855 West Main Street, Newark, Ohio 43055

CBOC Zanesville 2800 Maple Ave, Zanesville, Ohio 43701

CBOC Marion 1203 Delaware Ave, Marion, Ohio 43302

1.2 PERIOD OF PEFORMANCE. The periods of performance for base period and all option periods for this contract are summarized as follows:

See contract and/or task order of contract for Period of Performance.

1.3 GENERAL REQUIREMENTS

1.3.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall identify and define the management concept for ensuring compliance with all contract requirements. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor will have an on-going quality assurance and /or quality improvement program designed to objectively and systematically measure, assess, and improve performance to enhance patient care and all patient care services. The contractor’s quality control program is the means by which the contractor assures that all work complies with the requirement of the contract. The contractor shall provide a copy of the QCP with their offeror as specified by the Contracting Officer and upon request thereafter. After acceptance of the quality control plan, the contractor shall immediately notify the contracting officer of any proposed changes to their quality control program and submit a change request in writing to the contracting officer. The contractor shall furnish copies of these records if requested by the Contracting Officer, COR or individual(s) designated by the COR and/or CO in writing. The contractor’s quality control program shall include the following:

1.3.1.1 An inspection plan outlining all services defined in this contract. The inspection plan shall specify the areas to be inspected on both a scheduled and unscheduled basis, how often inspections shall be accomplished, and the title of the individual(s) who shall perform inspections.

1.3.1.2 The methods for identifying and preventing deficiencies in the quality of services being performed before the level of performance becomes unacceptable.

1.3.1.3 The on-site records of all inspections conducted by the contractor and corrective action taken.

1.3.1.4 The on-site records of all vehicle maintenance and repairs performed on vehicles used in the performance of this contract.

1.3.1.5 The on-site records of all vehicle maintenance and repairs performed on vehicles used in the performance of this contract. The methods of identifying and preventing vehicle breakdowns to include a detailed procedure for alternative transportation of patients in the event of mechanical breakdown of any vehicle.

1.3.1.6 The on-site records identifying the character, security and background checks, current driving records, physical capabilities, certifications and ongoing training of each employee performing services under this contract. This will include training in the safe and proper transport of beneficiaries and the necessary healthcare training, i.e., Health Insurance Portability and Accountability Act (HIPPA), Privacy Training for each employee performing services under this contract.

1.3.1.7 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.

1.3.1.8 A log to account for all requests for service. The log shall indicate the date and time of service call, name of beneficiary requiring services, any required Medicare/Medicaid forms with Doctor’s signatures, 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.

1.3.1.9 The 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.

1.3.2 Quality Assurance. The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s):

1.3.3 Federally Recognized Holidays. The contractor is not anticipated but may be required to provide service on Federally recognized holidays in accordance with the terms and conditions established in this PWS to include but not limited to the following:

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Christmas Day Independence Day

1.3.4 Hours of Operation. The contractor shall provide all ALS and BLS ambulance service on a 24-hours per day and 365 days per year basis as required in accordance with the terms and conditions of this PWS and the contract.

The contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.3.5 Place of Performance. The contractor shall furnish the vehicles necessary to provide full and complete coverage for pick-up and delivery of all Veteran patients requiring transport in accordance with the terms and conditions of this contract for the locations specified by the government. The contractor shall be responsible for providing patient pick-up and delivery as necessary from community hospitals and VA facilities within and outside the service area which may include personal residence of the patient and other locations and transportation across state lines as requested by the authorized government representative(s) designated in writing by the COR and/or CO in accordance with the procedures specified within this PWS. The general area of responsibility for patient transports shall include (but is not limited to) various locations within the states Ohio (such as Allen, Auglaize, Champaign, Clark, Clinton, Darke, Greene, Mercer, Miami, Montgomery, Paulding, Preble, Putnam, Shelby, Van Wert, and Warren Counties and Wright Patterson Air Force Base, Cincinnati VAMC, Columbus VAACC, Chillicothe VAMC, Cleveland VAMC) and other locations as required by Columbus VAACC.

1.3.6 Type of Contract and Task Orders. The government intends to award a single-award indefinite-delivery indefinite quantity (IDIQ) type contract for the effort specified herein. The base and option periods (if any) specified in the SCHEDULE OF SERVICES - PRICE SCHEDULE shall be exercised at the discretion of the government through the issuance of a task order for the entire period of performance. The authority that will be utilized to award this effort is FAR Part 13.5 (Simplified Procedures for Certain Commercial Items).

1.3.7 Security Requirements and Background Checks. All contractor employees shall comply with the security and background check requirements required by Federal, State, Local and the Department of Veterans Affairs to provide this service described in this PWS in support of this VA medical facility in the state of Ohio.

1.3.7.1 PHYSICAL Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured.

1.3.7.2 Key Control: Not Applicable.

1.3.7.3 Lock Combinations: Not Applicable.

1.3.7.4 Contractor Personnel Security Requirements | Background Investigations: The position sensitivity for this service has been designated as LOW RISK. The level of background investigation commensurate with the required level of access for this contract is National Agency Check with Written Inquiries. All contractor employees who require access to the Department of Veterans Affair's computer systems or who come into contact with veteran/beneficiaries shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement prior to contract performance.

This requirement is applicable to all subcontractor personnel requiring the same access. If the investigation is not completed prior to the start date of the contract, the contractor will be responsible for the actions of those individuals they provide to perform work for the VA with contractor responsibilities summarized as follows:

The contractor shall pre-screen all personnel requiring VA access to ensure they maintain a U.S.

citizenship and are able to read, write, speak and understand the English language.

The contractor shall submit or have their employees submit the following required forms requested by Department of Veterans Affairs, Office of Security and Law Enforcement, Security and Investigations Center, 2200 Fort Roots Drive Bldg. 104, North Little Rock, AR 72114 within 30 days of receipt.

The contractor shall submit all fingerprints as required at the primary medical facility supported under this contract.

All documents completed and submitted at the following website:

http://www.va.gov/SECURITYINVESTIGATIONSCENTER/

The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. Failure to comply with the contractor personnel security requirements may result in termination of the contract for cause.

1.3.8 Special Qualifications. The contractor shall provide qualified personnel as required by contract specifications to accomplish all services under this contract. The cognizant VA medical facility reserves the right to restrict any contractor employee from performing services under this contract who does not meet the required qualifications for the services they are required to perform, and who violates Federal, State or local regulations, or are identified as a potential threat to the security, safety, health and/or operational mission of the VA and its veteran population. The restriction of such contractor personnel shall not relieve the contractor from performing all the required services, in accordance with all terms, conditions, and schedule contained herein. The contractor shall ensure that all Emergency Medical Technician (EMT) and Paramedic personnel providing services under this contract have the following qualifications, in additions to those required by Federal, State, and Local Government to include the following:

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

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

• Shall hold and maintain all required certifications and licensures required to legally provide ambulance services by the local, state and regional government or public entity where the emergency ambulance service is performed (or governed by) the states of Ohio required by law:

o http://www.ems.ohio.gov/

• For the solicitation all offeror(s) shall submit a signed copy of their Emergency, Medical, Fire and

Transportation (EMFTS) certification to perform ambulance service in the state of Ohio with their offer to be considered for award.

• 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 shall this be less frequent than every two (2) years. Such refresher training shall be equivalent to that developed by the Department of Transportation, National Highway Safety Administration.

• Shall hold, maintain and enforce an approved protocol in accordance with the requirements of the state of Ohio that meet the needs of the requiring VA medical center with reference information which is subject to revision, change and/or recension by the proper authorities to include but not limited to the following:

o http://www.publicsafety.ohio.gov/links/ems_Guidelines-Emergency-Medical-Responders.pdf o http://www.publicsafety.ohio.gov/links/ems_Guidelines-Procedures-Manual.pdf o http://www.ems.ohio.gov/ o http://codes.ohio.gov/oac/4766-2 o https://www.in.gov/dhs/4142.htm

1.3.9 Post Award Conference/Periodic Progress Meetings. The contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced.

Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.3.10 Contracting Officer’s Representative (COR). The (COR) if designated will be identified by separate letter issued by the cognizant government Contracting Officer. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.3.11 Key Personnel. The following personnel are considered key personnel by the government: Project Manager/Alternate Project Manager and Officer in Charge. The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available 7 days a week, 24 hours per day, 365 days per year.

1.3.11.1 Personnel Roster. Within one (1) day of contract award, the contractor shall provide a list of all personnel that will perform services under this contract to the Contracting Officer (CO) that the CO shall forwarded to the requiring activity for review/action as appropriate. Thereafter, any changes to the personnel roster of the contractor shall be submitted to the CO within 24 hours of any change in staff. All personnel roster submissions shall include the following information:

Full Name Position and Title Assigned Responsibilities Qualifications and Professional Certifications Other information as requested by the COR and/or Contracting Officer

1.3.12 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed.

1.3.13 Contractor Travel: Not Applicable

1.3.14 Other Direct Costs: Not Applicable

1.3.15 Data Rights: Not Applicable

1.3.16 Organizational Conflict of Interest: Not Applicable

1.3.17 Phase-In /Phase-Out Period: Not Applicable

2. DEFINITIONS AND ACRONYMS

2.1. DEFINITIONS

BASE RATE. The base rate is defined as the rate paid for one-way transportation from a designated pick up point to a designated delivery point. This rate will be paid for all authorized one-way trips requested under this contract with employees receiving at a minimum the Department of Labor Service Contract Act (SCA) wage rates for the county in which the primary VA medical facility supported under this contract resides, as specified by the contracting officer for this requirement, during all phases of the trip made on behalf of the Government.

Service Contract Act (SCA) wage rate determinations will be updated each option year, when/if new revisions are issued. The base rate shall constitute full compensation for one-way trips which do not exceed the “Mileage Threshold” as shown below.

BENEFICIARY. Veterans and other members determined to be eligible for benefits by the VA.

COMMUNITY LIVING CENTER (CLC). The Community Living Centers (CLCs) are inpatient units for

VAMC nursing homes.

CONTRACT TASK ORDERS. Award of a funded contract task order for the appropriate period of performance is required prior to the commencement of any/all work in accordance with FAR part 16.506 as specified herein.

CONTRACTOR. A vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime contractor and its employees. The contractor is fully responsible for performance of their sub-contractor(s) and shall ensure that their subcontractor(s) are fully compliant with the terms and conditions of this contract at all-times.

CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the Contracting Officer to administer the contract.