D.1 36C25026Q7571 RFQ 7.7.2026.docx

36C25026Q5521

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

PHONE:

FAX:

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

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

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

ARE

ARE NOT ATTACHED.

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

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

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

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

757-26-3-826-0122

36C25026Q7571 07-07-2026 Robert J. Bolcavage III None 07-16-2026 13:00

EDT

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

X

621910 $22.5 Million

N/A

36C250

Chalmers P. Wylier VAACC

420 N James Rd Columbus OH 43219 36C250 Network Contracting Office (NCO) 10 Department of Veterans Affairs

3140 Governors Place Blvd. Suite 210 Kettering OH 45409-1337

Financial Services Center Invoices To Be Submitted Electronically https://www.ob10.com/us/en/veterans-affairs// Invoice Setup Info Phone 877 353 9791 512 460 5429

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 Veterans Affairs Ambulatory Care Center (VAACC) Columbus, Ohio in accordance with the terms and conditions established herein.

This Solicitation is a total Small Business set-aside.

FAR 52.232-18 Availability of Funds applies to this

Requirement.

Questions accepted by email robert.bolcavage@va.gov.

by July 3rd, 2026, 1:00 PM EST.

See CONTINUATION Page

Robert J. Bolcavage Contracting Officer

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C250

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:

3. INVOICES: Invoices shall be submitted in arrears:

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

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

B.2 PRICE/COST SCHEDULE

Item Information.

The maximum total amount, or ceiling amount, for all orders issued against this contract shall not exceed $8,999,999.00.

Minimum total amount for this contract shall be 1500Trips

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 guaranteed minimum only applies to the Federal Government Fiscal Year in which the contract is awarded. The guaranteed minimum is 200 trips.

Contract Period: Base POP Begin: 09-01-2026 POP End: 08-31-2027

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

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.

Contract Period: Base POP Begin: 09-01-2026 POP End: 08-31-2027

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2026 POP End: 08-31-2027

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

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 guaranteed minimum only applies to the Federal Government Fiscal Year in which the contract is awarded. The guaranteed minimum is 200 trips.

Contract Period: Base POP Begin: 09-01-2026 POP End: 08-31-2027

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

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.

POP Begin: 09-01-2026 POP End: 08-31-2027

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2026 POP End: 08-31-2027

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

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.

Contract Period: Ordering Period 1 POP Begin: 09-01-2027 POP End: 08-31-2028

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

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.

POP Begin: 09-01-2027 POP End: 08-31-2028

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2027 POP End: 08-31-2028

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

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.

POP Begin: 09-01-2027 POP End: 08-31-2028

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

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.

POP Begin: 09-01-2027 POP End: 08-31-2028

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2027 POP End: 08-31-2028

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

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.

Contract Period: Ordering Period 2 POP Begin: 09-01-2028 POP End: 08-31-2029

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

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.

POP Begin: 09-01-2028 POP End: 08-31-2029

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2028 POP End: 08-31-2029

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

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.

POP Begin: 09-01-2028 POP End: 08-31-2029

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

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.

POP Begin: 09-01-2028 POP End: 08-31-2029

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2028 POP End: 08-31-2029

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

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.

Contract Period: Ordering Period 3 POP Begin: 09-01-2029 POP End: 08-31-2030

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

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.

POP Begin: 09-01-2029 POP End: 08-31-2030

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS..

POP Begin: 09-01-2029 POP End: 08-31-2030

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

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.

POP Begin: 09-01-2029 POP End: 08-31-2030

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

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.

POP Begin: 09-01-2029 POP End: 08-31-2030

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2029 POP End: 08-31-2030

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

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.

Contract Period: Ordering Period 4 POP Begin: 09-01-2030 POP End: 08-31-2031

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

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.

POP Begin: 09-01-2030 POP End: 08-31-2031

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2030 POP End: 08-31-2031

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

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.

POP Begin: 09-01-2030 POP End: 08-31-2031

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

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.

POP Begin: 09-01-2030 POP End: 08-31-2031

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

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” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2030 POP End: 08-31-2031

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

GRAND TOTAL

Base Period: (CLINS 0001 through 0006) Total $_____________ Ordering Period 1: (CLINS 1001 through 1006) Total $_____________ Ordering Period 2: (CLINS 2001 through 2006) Total $_____________ Ordering Period 3: (CLINS 3001 through 3006) Total $_____________ Ordering Period 4: (CLINS 4001 through 4006) Total $_____________

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. Purpose: The Chalmers P. Wylie Veterans Administration Ambulatory Care Center (VAACC) (hereafter CPWVACC), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency and emergency ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Stretcher or Lay Flat Transports, Basic Life Support (BLS), or Advanced Life Support (ALS). The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

2. Background: The Chalmers P. Wylie Veterans Administration Ambulatory Care Center (CWVAACC) main campus is located at 420 North James Road, Columbus, Ohio 43219. CWVAACC serves over 42,000 veterans, primarily from the Central Ohio area and it’s four Community-Based Outpatient Clinics. The hospital has zero inpatient beds and over 504,000 outpatient visits a year. Veterans served within this facility live within the following counties and zip codes:

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

4. Scope/Requirements

4.1. Types of Ambulance Service

4.1.1. The contractor shall provide Emergent, non-emergent Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) Tier 1, 2, and 3 ambulance services on an as-needed basis in accordance with all federal, state, and local regulations. The contractor shall furnish vehicles sufficient to provide full and complete coverage for pick-up and delivery of all veteran patients requiring transport by ambulance to/from the Chalmers P. Wylie VA Ambulatory Care Center (VAACC) at 420 North James Road, Columbus, Ohio 43219 and to the locations specified herein. Business hours/days are defined as the time of 5:00am to 9:00pm, Monday through Friday, except Federal holidays, Weekends and Holidays 5:00am to 9:00pm.

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

4.2. Transport of Miscellaneous Items with the Patient

The Contractor may also be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government. Luggage to be transported will be restricted to suitcase and valise types. When patients are transported to the CPWVACC, destination is deemed to be the ER, Admissions, the clinic, or service within the hospital, or directly to the ward as instructed by VA Staff.

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

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

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

4.3.1.2. All non-medical personnel i.e. Ambulette Drivers, shall wear appropriate attire with a picture identification (ID) badge that clearly identifies the company they work for. Drivers shall secure all beneficiaries and passengers with approved security devices prior to transport. Driver shall meet all applicable requirements set by federal, state and local government laws while transporting patients.

4.3.1.3. If the contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing, and any other qualifications to the COR for review.

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

4.3.1.5. CCTPs shall have met all state requirements for the tier in which they are performing services in (I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request. EMTs, CCTPs, and other contractor personnel as applicable must pass the Contractor’s background check and must not have

4.3.1.6. been convicted of (or have any pending charges for) a felony for the past five years. Personnel (and Contractor) must report any new or additional charges or convictions if they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated.

4.3.2. Tuberculosis Exposure Control Policy

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

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

4.4. Contractor Equipment, Vehicles, and Inspection

4.4.1. Ambulances and/or ambulettes shall meet all applicable federal, state, and local regulations and specifications, including but not limited to licensing, registration, and safety standards.

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

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

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

4.4.5. The contractor shall furnish all linen required for patient transport at no additional cost. Linen shall not be exchanged with linen belonging to CPWVACC or its CBOCs/Community Facilities.

4.4.6. The contractor must be capable of transporting the drugs and/or equipment as required by the patient as listed in Attachment A Specialty Care Transport (SCT) or Critical Care Transport (CCT) Capabilities Confirmation. The contractor shall have the appropriate medications, including Specialty Care and Critical Care Transport, if necessary, based on the EMS region the ambulance provider is functioning in. Transports for stretcher where the patient is to Lay flat with no medical assistance, transporting of medications may not be required.

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

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

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

· Be at least 18 years of age and have not less than one year of experience as a licensed driver; and

· For the past three years:

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

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

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

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

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

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

4.4.7.5. Emergency Medical Technician (EMT) and Paramedic Qualifications: EMT’s and Paramedic’s providing services under this contract shall have the following qualifications, in additions to those required by Federal, State, and Local Government:

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

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

4.5. Transportation Request

4.5.1 VetRide or VA-approved Transportation Software Utilization:

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

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

a) Receive and respond to electronic trip requests

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

c) Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-Approved Transportation Software system.

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

i. The contractor’s invoice must be on the HCFA 1500 to include:

ii. Contract Number

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

iv. Authorization number(s)

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

vi. Base Rate

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

viii. Date of Birth and Sex

ix. Diagnosis Codes or Nature of Illness or Injury

x. Documentation of circumstances when billing for waiting time

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

xii. VA authorizing official’s name

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

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

4.5.1.1. A transportation request is defined as one incidence of a request for one-way service (Stretcher Transports, BLS, ALS). No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or VA-Approved Transportation Software Utilization. Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. CPWVACC Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff. In the event VetRide or other VA-Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests.

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

4.5.1.1.2. The Contractor must update VetRide or VA-Approved Transportation Software Utilization with any data and/or notes in real time that deviate from the original order such as invoicing for additional mileage due to a road closure, wait time, reason for no load, etc. CPWVACC Travel Program Staff/or authorized VA employees may place a “hold” on payment of this order until it has been reconciled.

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

Contracting Officer’s Representative (COR)

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

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

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

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

· Mode of transportation required,

· Required time of arrival

· Name of the beneficiary,

· Pick-up and delivery point,

· Type and number of additional medical care specialists required,

· Type of equipment required,

· Last four of the patient's Social Security Number, and

· Any other special instructions

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

4.5.1.4. The type of transportation service (Stretcher Transports, BLS, ALS, CCT) required will be discussed and determined by VA clinical personnel and the contractor. The contractor shall transport the patient per its policies and standard industry practice. If the type of transportation service differs from what was agreed upon by the VA and contractor, the contractor shall submit documentation to the VA explaining its rationale.

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

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

4.5.1.7. The number of transports under normal operating conditions will typically range from 10-30 transports each weekday and significantly less on weekends and holidays. The number of actual transports may vary throughout the life of the contract. Only Base period minimum quantities identified in the Price Schedule (B.2) are guaranteed. Government contract does not guarantee any trips beyond the minimum quantities.

4.5.1.8. The patient may bring with her or him up to three (3) liters of oxygen. The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

4.5.1.9. Response Times*

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

4.5.1.9.2. Urgent Transport (Originating from VA (Only): The contractor shall be required to provide Ground Ambulance transportation within thirty (30) minutes of order/patient pick up call.

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

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

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

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

b. Pick-up appointment times shall be agreed upon by the VA and contractor at time of order placement and be reasonable based upon travel distance, speed limits, and weather conditions.

c. The contractor’s patient pick-up time cannot be more than 15 minutes prior to the schedule pickup time nor 15 minutes later than the scheduled pickup time for transportation requests scheduled in advance.

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

4.5.2. Cancellations

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

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

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

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

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

4.6.2. When applicable, ambulance personnel shall report to the Veteran Transportation Service (VTS) Dispatcher or Administrative Officer of the Day (AOD) to (1) announce his/her arrival to pick-up and transfer the patient and (2) obtain report of pertinent information regarding the patient’s condition from the primary nurse/physician.

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

4.6.4. In cases where ambulance personnel must divert to a local emergency department while performing a VA authorized transport, the contractor’s dispatcher shall notify the VA Beneficiary Travel Department or Administrative Officer of the Day of the patient’s location and status as soon as this information becomes available.

4.7. Patient Welfare

4.7.1. The contractor shall be responsible for the patient’s welfare during transport. The contractor shall be held responsible for patient and/or VA property during transport. Any damaged or lost wheelchairs, walkers, crutches, or personal belongings shall be replaced at the contractor’s expense.

4.7.2. The VA requires the contractor to exercise extreme caution and care in the handling of patients.

4.7.3. If a VA beneficiary being transported declines to be properly secured or removed the securement devices himself/herself, the driver will notify the COR of this fact prior to departure. The contractor is not required to transport any VA beneficiary who refuses to be properly secured while being transported. In the event that the beneficiary refuses to be properly secured, they shall be returned back into the building which they came from.

4.8. Incident Reporting

4.8.1. The contractor shall notify the COR, Requestor, Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the COR, Program Manager, or Beneficiary Travel Department, by the close of business of the next working day.

4.8.2. The COR will monitor the service provided.