36C25219Q0419-002.docx

36C25219Q0419

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

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

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

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

ARE

ARE NOT ATTACHED.

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

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

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

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

585-20-1-071-0001 36C25219Q0419 08-12-2019 Maureen Falaschi 414-844-4853 08-26-2019 12:00pm CST 36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101 Milwaukee WI 53214-1476 X X 621910 $15 Million N/A X 36C252 Oscar G. Johnson VA Medical Center located in Iron Mountain, Michigan and other VA and non-VA Medical Centers.

See Performance Work Statement 36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101 Milwaukee WI 53214-1476

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 877-353-9791 512-460-5540 See CONTINUATION Page Ambulance transportation services (Basic Life Support and Advanced Life Support).

See Performance Work Statement.

See CONTINUATION Page X X X Maureen Falaschi

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA (continuation from Standard Form 1449)

1. CONTRACT ADMINISTRATION: All contract administration matters will be handled by the following individuals:

DUNS NUMBER NO. ______________________________________

CONTRACTOR’S PAST PERFORMANCE POINT OF CONTACT

(IF DIFFERENT THAN ABOVE):

NAME: __________________________________________

EMAIL ADDRESS:_________________________________

b. GOVERNMENT: MAUREEN FALASCHI

DEPARTMENT OF VETERANS AFFAIRS

GREAT LAKES ACQUISITION CENTER

115 S. 84TH ST., STE 100

MILWAUKEE WI 53214

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

a. FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER SYSTEM – SYSTEM FOR AWARD

3. INVOICES: Invoices shall be submitted in arrears in accordance with:

a. 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

4. GOVERNMENT INVOICE ADDRESS (See SF1449 Block 18):

a. All invoices from the contractor shall be submitted electronically in accordance with 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

b. Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests.

c. VA’s Electronic Invoice Presentment and Payment System – The FSC uses a third-party contractor, Tungsten Network e-Invoice, to transition vendors from paper to electronic invoice submission. Please go to this website: http://www.tungsten-network.com/customer-campaigns/veterans-affairs-us/ to begin submitting electronic invoices, free of charge.

d. For assistance setting up e-Invoice, the below information is provided:

i. * Tungsten Network e-Invoice Setup Information: 1-877-489-6135

* Tungsten Network e-Invoice email: VA.Registration@Tungsten-Network.com

* FSC e-Invoice Contact Information: 1-877-353-9791

* FSC e-invoice email: vafsccshd@va.gov

5. INVOICES cont:

a. Payments shall be made in arrears upon receipt of a properly prepared invoice

b. In order to comply with the Improper Payment Elimination and Recovery Act of 2010 (IPERA), the VA has mandated electronic invoice submission to the Veterans Affairs Financial Services Center (VAFSC). VAFSC has partnered with Tungsten Network e-Invoicing network, for submissions of all electronic invoices to VA. Tungsten Network electronic invoicing is free to all VA vendors. In order to submit electronic invoices, all VA vendors must register with Tungsten Network by submitting an email to VA.Registration@Tungsten-Network.com or calling 1-877-752-0900 option 2 for Enrollment.

c. Contractor shall submit an electronic invoice by the tenth (10th) of the following month services were performed to the Veterans Affairs Financial Services Center (VAFSC) e-Invoice through the website at https://portal.Tungsten-Network.com/Login.aspx. For questions regarding the submission of VA electronic invoices, Tungsten Network customer service may be contacted at 1-877-489-6135.

d. All invoices shall reference the vendor name and address, customer name, contract number, appropriate obligation/funding order number, description of services provided, quantity, unit price, and total invoice amount (any additional info). Invoices shall also include any payment discount terms.

e. For questions regarding invoice receipt or payment, please call VAFSC directly at 1-877-353-9791 or email vafsccshd@va.gov

OFFERORS MUST COMPLETE AND RETURN ALL INFORMATION DESIGNATED HEREIN PRIOR TO THE TIME SPECIFIED IN BLOCK 8 OF SF 1449 IN ORDER TO BE CONSIDERED FOR AWARD.

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

ACQUISITION OF COMMERCIAL ITEMS:

This Request for Quote (RFQ) solicitation is issued under the authority of FAR Part 13.5 Simplified Procedures for Certain Commercial Items in which simplified acquisition procedures in FAR Part 13 will be used. FAR Part 14 and 15 will not be used.

SPECIAL NOTES:

In order to maintain integrity of this solicitation and subsequent award date, all offerors are advised that any question and answer requests must be submitted in a written form via e-mail to the Contracting Officer Maureen.Falaschi@va.gov no later than close of business on August 19, 2019. Contracting will issue a consolidated response via solicitation amendment to www.fbo.gov to all parties.

The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitment or issue changes that will affect price, quantity or quality of performance of this contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered to have been made without authority and no adjustment will be made in the contract price to cover any increase in cost incurred thereof.

Price Schedule Contractor must provide firm-fixed unit pricing and total pricing for all of the line items listed in the following Price Schedule and must complete all years (Years 1-5) in the 5-year ordering period.

The total maximum amount of services acquired under this contract shall not exceed $6,000,000.00 The guaranteed minimum is $50,000.00 and will be met in the initial fiscal year of the contract award.

All prices and rates shall be for loaded (patient onboard) services and mileage only. The Government shall not pay for unloaded (no patient) services or mileage with the exception of “no shows” as indicated in PWS Paragraph 3.4.2 Cancellations.

The quantities listed in the schedule are estimated quantities only and shall be considered nonbinding.

The VA will conduct an annual economic price adjustment to CLINs ending in 002 and 007 (mileage rates). See VAAR Clause 852.216-72 PROPORTIONAL ECONOMIC PRICE ADJUSTMENT OF CONTRACT PRICE(S) BASED ON A PRICE INDEX (MAR 2018) for more information.

Ordering officers will be authorized to place orders against this contract. The Contracting Officer will furnish the Contractor with the names of individuals authorized as ordering officers, by separate memorandum upon issuance of the contract. When ordering officers are added after award, the Contracting Officer will furnish the Contractor with the names of individuals authorized as ordering officers, by memorandum upon ordering officer appointment. 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.

B.1 PRICE/COST SCHEDULE

ITEM INFORMATION

BLS Ambulance Services BLS Base Rate: Includes 30 min. wait time.

Ordering Period 1 POP Begin: 10-01-2019 POP End: 09-30-2020

BLS Ambulance Services:

Mileage Rate Ordering Period 1

BLS Ambulance Services:

Oxygen Ordering Period 1

BLS Ambulance Services:

Waiting Time per 30 min (beyond initial 30 min) Ordering Period 1

BLS Ambulance Services:

Orders requiring attendant Ordering Period 1

ALS Ambulance Services:

ALS Base Rate: Includes 30 min. wait time Ordering Period 1

ALS Ambulance Services:

Ordering Period 1

ALS Ambulance Services:

Ordering Period 1

ALS Ambulance Services:

Continuous Infusion Pump (including supplies) Ordering Period 1

ALS Ambulance Services:

Double Sealed Chest Drainage Unit Ordering Period 1

ALS Ambulance Services:

Ventilator Ordering Period 1

ALS Ambulance Services:

Suction Ordering Period 1

ALS Ambulance Services:

Ordering Period 1

ALS Ambulance Services:

Orders requiring attendant.

Ordering Period 1

BLS Ambulance Services

Ordering Period 2 POP Begin: 10-01-2020 POP End: 09-30-2021

BLS Ambulance Services:

Ordering Period 2

BLS Ambulance Services:

Ordering Period 2

BLS Ambulance Services:

Ordering Period 2

BLS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

ALS Ambulance Services:

Ordering Period 2

BLS Ambulance Services

Ordering Period 3 POP Begin: 10-01-2021 POP End: 09-30-2022

BLS Ambulance Services:

Ordering Period 3

BLS Ambulance Services:

Ordering Period 3

BLS Ambulance Services:

Ordering Period 3

BLS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

ALS Ambulance Services:

Ordering Period 3

BLS Ambulance Services

Ordering Period 4 POP Begin: 10-01-2022 POP End: 09-30-2023

BLS Ambulance Services:

Ordering Period 4

BLS Ambulance Services:

Ordering Period 4

BLS Ambulance Services:

Ordering Period 4

BLS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

ALS Ambulance Services:

Ordering Period 4

BLS Ambulance Services

Ordering Period 5 POP Begin: 10-01-2023 POP End: 09-30-2024

BLS Ambulance Services:

Ordering Period 5

BLS Ambulance Services:

Ordering Period 5

BLS Ambulance Services:

Ordering Period 5

BLS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

ALS Ambulance Services:

Ordering Period 5

GRAND TOTAL

Performance Work Statement

1. Purpose: The Department of Veterans Affairs’ (VA) Oscar G. Johnson VA Medical Center (VAMC) and its associated Community-Based Outpatient Clinics (CBOCs) require contracted ambulance transportation services. The contractor shall provide all personnel and equipment required for the provision of Basic Life Support and Advanced Life Support services. The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven (7) days a week.

1. Background: The Oscar G. Johnson VAMC located in Iron Mountain, MI and its seven (7) CBOCs serve over 25,000 veterans across the 15 counties which comprise the Upper Peninsula of Michigan and ten counties in northeastern Wisconsin. The Oscar G. Johnson VAMC has the largest patient service area of any VA Medical Center east of the Mississippi River.

Historically, the Oscar G. Johnson VAMC has relied upon contracted ambulance services to transport patients to and from its facility, CBOCs, and other locations. This procurement will establish a new indefinite-quantity contract for these services with a five-year ordering period.

1. Scope/Requirements:

2. The contractor shall provide the following non-emergent and emergent ambulance services on an as-needed basis:

0. Basic Life Support (BLS) is defined as a basic level of pre-hospital and inter-hospital emergency care and non-emergency medical services that includes but is not limited to airway management, cardiopulmonary resuscitation (CPR), control of shock and bleeding, and splinting of fractures, as outlined in the Basic Life Support national curriculum of the United States Department of Transportation, National Highway Traffic Safety Administration (NHTSA)[footnoteRef:1], and any modifications or replacements to that curriculum specified in rules adopted by the Department. [1: NHTSA standards and curricula can be found at: http://www.ems.gov/]

0. Staffing for BLS services: each ambulance shall be staffed by Emergency Medical Technicians (EMTs) as required by the local, state, or regional government or public entity where the ambulance services is operated or by which it is governed currently.

0. Advanced Life Support (ALS) is defined as an advanced level of pre-hospital and inter-hospital emergency care and non-emergency medical services that includes but is not limited to basic life support care, cardiac monitoring, cardiac defibrillation, electrocardiography, intravenous therapy, administration of medications, drugs and solutions, use of adjunctive medical devices, trauma care, and other authorized techniques and procedures.

Examples of situations where the VA may request ALS services include, but are not limited to patients with: chest pain, respiratory problems, diabetic emergencies, and patients requiring cardiac monitoring.

1. Critical Care services involving the following equipment or intravenous (IV) infusions may also be required:

0. Equipment: balloon pump (with RN only), chest tubes, IV pumps, portable mechanical vents for CPAP, 12 lead EKG monitoring, and left ventricular assist device (LVAD).

0. Intravenous (IV) infusions: Amiodarone, Dobutamine, Dopamine, Heparin, Insulin, Levophed, Lidocaine, Nitroglycerine, Potassium, Chloride, and total parenteral nutrition (TPN) and Lipids.

1. Staffing for ALS services: each ambulance shall be staffed by Advanced EMTs or Paramedics or as required by the local, state, or regional government or public entity where the ambulance service is operated or by which it is governed currently. See 4.2 for Place of Performance.

2. Contractor Personnel Contractor personnel shall be courteous and conduct themselves in a businesslike manner at all times while providing services under this contract.

1. Emergency Medical Technicians (EMTs) & Other Medical Personnel

0. EMTs 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 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.

0. The contractor shall provide evidence of required training, certifications, licensing, and any other qualifications of any personnel performing services under this contract. If the contractor wishes to add or replace personnel, it shall provide the above requirements to the Contracting Officer’s Representative (COR) for review.

1. Non-Emergency Attendants/Drivers

1. Attendants/drivers shall be capable of administering oxygen and have successfully completed the Standards and Advanced First Aid Courses of the American Red Cross or US Bureau of Mines or equivalent. Proof in the form of a current certificate for the successful completion of such training must be provided upon request.

1. All ambulance drivers shall have a valid driver’s license in accordance with state requirements for their place of operation and the services they perform.

1. Tuberculosis Exposure Control Policy

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

2. The contractor shall have its personnel tested for TB annually and provide each of these test results to the VA.

2. Contractor Equipment, Vehicles, and Inspection

2. Ambulances shall meet all applicable federal, state and local regulations and specifications, including but not limited to: licensing, registration, and safety standards.

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). 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.

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

2. 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 the VA during patient drop-off or as promptly as feasible.

2. At no time shall the contractor leave vehicles on VA premises unless a pick-up or a delivery is in process.

2. Orders

3. Scheduling

0. An order is defined as one incidence of a request for service (BLS or ALS service). No more than one patient will be transported per order unless approved by an authorized VA ordering employee.

0. Orders will be made by telephone. Only the following VA staff are authorized to place orders: the COR, Beneficiary Travel Department staff, and the Administrative Officer of the Day (AOD). Private agencies (e.g. nursing homes) are not considered authorized to place orders. A list containing the names and phone numbers of VA staff who are authorized to place orders will be submitted to the contractor at time of award and updated as necessary.

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

0. 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 to the VA.

0. The contractor shall have sufficient vehicles and personnel to provide services for up to four (4) orders within a calendar day for any mix of BLS and ALS services. Orders may be simultaneous. If the VA requires ambulance services which exceed four (4) orders per calendar day, the contractor may decline these additional order requests if sufficient vehicles and personnel are unavailable.

0. The VA reserves the right to obtain services from another source and charge the contractor with any cost in excess to that which would have been accrued through use of this contract if the contractor is unable to meet the requirements of this Performance Work Statement.

0. Response Times*

6. For all orders within a 20 mile radius of the Oscar G. Johnson VAMC, the contractor shall be on time for patient pick-up. The vendor will be allotted up to one hour from time of order placement for patient pick-up for orders not scheduled in advance.

6. For orders beyond a 20 mile radius of the Oscar G. Johnson VAMC, the contractor’s patient pick-up time shall not deviate by more than 20 minutes of the scheduled pick-up time.

6. The contractor may be required to dispatch ambulances on short notice for orders not scheduled in advance. For these orders the contractor shall dispatch ambulances within one hour of receiving the order. Pick-up times for orders beyond a 20 mile radius of the Oscar G. Johnson VAMC shall be agreed upon by the VA and contractor at time of order placement and be reasonable based upon factors such as dispatch lead time (up to one hour for short notice orders), travel distance, speed limits, construction, and weather conditions.

0. In the event the VA determines that emergent transportation is essential to prevent the loss of life or serious bodily harm, and the contractor cannot perform these services, the VA shall procure transportation services from another source. For these emergent events, no charge shall be levied against the contractor.

*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, unusually severe weather, and delays of common carriers. The contractor MUST notify the VA with as much advance notice as possible should any of these occur.

3. Cancellations

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

1. A “no show” is defined as an order 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 invoice for one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for the type of service requested (BLS or ALS) and the one-way mileage (BLS or ALS) accrued in 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 the time of cancellation.

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

4. Ambulance personnel shall deliver and pick-up patients at specified locations (e.g. Emergency Room, Ward, Clinic, etc.). These locations will be specified by VA staff when an order is placed. Contractor service shall be prompt; scheduled patient pick-ups shall not deviate more than 20 minutes past scheduled pick-up time for scheduled orders.

4. Ambulance personnel shall report to the Nursing Station to (1) announce their 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. When delivering a patient, the 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. In cases where the ambulance personnel must divert to a local emergency room 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.

2. Patient Welfare

5. The contractor shall be responsible for the patient 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.

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

2. Incident Reporting

6. The contractor shall notify the 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 Program Manager, Benefits Management, by the close of business of the next working day.

6. The Program Manager, Beneficiary Travel Department, will monitor the service provided. The contractor shall cooperate with the Program Manager in providing information and answering questions in a timely manner. The contractor shall promptly inform the Program Manager of any complaints received directly from patients. If warranted, the VA may conduct incident investigations and require written response from the contractor within 48 hours of request.

2. Invoicing

7. With the exception of “no shows” defined in 3.4.2.2, the contractor shall invoice for loaded (patient onboard) services and mileage only. The contractor shall submit an electronic invoice by the tenth day (10th) of each month for services which occurred during the preceding month. Electronic invoices shall be submitted to the Department of Veterans Affairs Financial Service Center; these invoices shall not include patient information. Additionally, a copy of the invoice along with secondary documentation shall be sent to the Beneficiary Travel Department. The secondary documentation must include the following information:

· Contract Number

· Purchase Order Number

· Dates of Service

· Name of the Patient

· Pick-up/drop-off points

· Total amount invoiced

· An itemized list of charges or services rendered

UNDER NO CIRCUMSTANCES ARE VA BENEFICIARIES, THIRD PARTY INSURANCES, MEDICARE OR MEDICAID TO BE BILLED FOR THE SERVICES PERFORMED UNDER THIS CONTRACT.

7. Invoices may be paid by the Government using Purchase Order Numbers of Delivery Order Numbers.

1. Period & Place of Performance:

3. This contract shall have a five-year ordering period, effective October 1, 2019 through September 30, 2024.

3. The Place of Performance is variable occurring within the states of Michigan and Wisconsin; ambulance services may be required to or from any of the following locations outlined below.

1. Oscar G. Johnson VAMC to include specific clinics, Urgent Care, wards, or out-buildings on the VAMC’s campus. The Oscar G. Johnson VAMC’s address is: 325 East H Street, Iron Mountain, MI 49801.

1. The majority of services under this contract will be between the Oscar G. Johnson VAMC and the following VA Medical Centers within Veterans Integrated Service Network (VISN) 122 and Non-VA Medical Facilities:

VA Medical Centers

Clement J. Zablocki VA Medical Center 5000 W. National Ave.

Milwaukee, WI 53295

William S. Middleton Memorial Veterans Hospital 2500 Overlook Terrace Madison, WI 53705

Tomah VA Medical Center 500 E. Veterans Street Tomah, WI 54660

Non-VA Medical Facilities

Bellin Green Bay 744 S. Webster Ave.

Green Bay, WI 54301 St. Vincent Hospital 835 S. Van Buren St.

Green Bay, WI 54301

UPHS Marquette 580 W. College Ave Marquette, MI 49855

Dickinson County Healthcare System 1721 S. Stephenson Ave.

Iron Mountain, MI 49801

1. Occasional services include, but are not limited to, the following VA facilities, Non-VA facilities, and the local airport:

VA Medical Facilities

Rhinelander CBOC 639 West Kemp St.

Rhinelander, WI 54501 Hancock CBOC 787 Market St.

Hancock, MI 49930

Ironwood CBOC 629 West Cloverland Dr. Suite 1 Ironwood, MI 49938 Menominee CBOC 1110 10th Ave. Suite 101 Menominee, MI 49858

Marquette CBOC 1414 W. Fair Ave. Suite 285 Marquette, MI 49855 Sault Ste. Marie CBOC 509 Osborn Blvd. Suite 306 Sault Ste. Marie, MI 49783

Manistique CBOC 813 East Lakeshore Drive Manistique, MI 49854 Ford Airport 500 Riverhills Road Kingsford, MI 49802

Non-VA Facilities

Aspirus Keweenaw Hospital 205 Osceola St.

Laurium, MI 49913 OSF St. Francis 3401 Ludington St.

Escanaba, MI 49829

Schoolcraft Memorial Hospital

7870W US-2

Manistique, MI 49854 UPHS Portage 500 Campus Dr.

Hancock, MI 49930

Aspirus Iron River Hospital 1500 Ice Lake Rd.

Iron River, MI 49935 Bay Area Medical Center 3003 University Dr.

Marinette, WI 54143

Ford Airport 500 Riverhills Road Kingsford, MI 49802

1. Confidentiality of Patient Information The contractor shall ensure the confidentiality and security of all patient information and shall be held liable in the event of breach of confidentiality. The contractor shall comply with the provisions of the Privacy Act of 1974 (5 U.S.C. 552a), Confidentiality of Certain Medical Records (38 U.S.C. 7332), Confidentiality of Medical Quality-Assurance Records (38 U.S.C. 5705), and Confidential Nature of Claims (38 U.S.C. 5701). The contractor shall comply with all laws and regulations pertaining to confidentiality and security statutes. The contractor shall comply with: Public Law 104-191, C.F.R. Parts 45, 160, 162 and 164 (Health Insurance Portability and Accountability Act). Failure to comply with statutes regarding confidentiality and security of patient health information/Individually identifiable information may result in financial sanctions.

VA protected health information (PHI) will be disclosed and used for treatment of patients. A Business Associate Agreement is not required for this contract. Except for medical emergencies (C.F.R. 42), the contractor is authorized to release patient medical record information to only the VA.

1. Quality

5. Quality Control

0. The contractor shall provide a quality control plan that contains, at a minimum, the items listed below. The Contracting Officer will notify the contractor of acceptance or required modifications to the plan before the contract start date. The contractor must make appropriate modifications and obtain acceptance of the plan by the Contracting Officer before the contract start date.

0. A description of the methods to be used by the contractor for identifying and preventing defects in the quality of service performed.

0. A description of the method used to provide on-time ambulance services.

0. A description of the company’s organizational structure denoting management and supervisory responsibilities.

0. A description of the company’s records and tracking system used to identify up-to-date background checks, applicable certifications, tests (e.g. TB tests), and training of each employee performing services under this contract.

0. A description of the methods used to identify and prevent radio communication breakdowns and a detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios.

0. A description of the method used to log all requests for service. The log shall indicate the date and time of service call, actual time of pick-up versus the scheduled time, name of patient requiring services, designated pick-up and delivery points, mileage, and actual waiting time at pick-up and delivery points if waiting charges are claimed. The contractor shall send log sheet to COR monthly.

5. Quality Assurance

1. The Government will evaluate the contractor’s performance under this contract to ensure that the contractor’s quality control plan is adequate and that quality is achieved through a Quality Assurance Surveillance Plan (QASP).

1. The Government shall prepare a QASP after contract award derived from the PWS and contractor’s submitted quality control plan. The QASP is a “living document” and the Government may review and revise it at any time. However, the Government shall coordinate changes to the QASP with the contractor.

1. The QASP will specify the work requiring surveillance and the Government’s method of surveillance.

5. Minimum Performance Standards

2. The contractor shall maintain performance standards in accordance with the standards outlined in the table below. Failure to meet the Acceptable Quality Levels (AQL) may results in termination of the contract.

2. The QASP will include the standards below as well as others derived from the successful offeror’s quality control plan.

SECTION C - CONTRACT CLAUSES

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

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

C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

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

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

(End of Clause)

C.2 52.216-18 ORDERING (OCT 1995)

(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from October 1, 2019 through September 30, 2024.

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

(c) If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.

(End of Clause)

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

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

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

(1) Any order for a single item in excess of $5,000;

(2) Any order for a combination of items in excess of 4 orders per calendar day; or

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

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

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

(End of Clause)

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

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

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

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

(d) Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after September 30, 2024.

(End of Clause)

C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30 days.

(End of Clause)

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

Funds are not presently available for performance under this contract beyond September 30, 2020. The Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond September 30, 2020, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer.

(End of Clause)

C.7 SUPPLEMENTAL INSURANCE REQUIREMENTS

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

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

(b) General Liability: $500,000.00 per occurrences.

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

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

(End of Clause)

C.8 VAAR 852.203-70 COMMERCIAL ADVERTISING (MAY 2018)

The Contractor shall not make reference in its commercial advertising to Department of Veterans Affairs contracts in a manner that states or implies the Department of Veterans Affairs approves or endorses the Contractor’s products or services or considers the Contractor’s products or services superior to other products or services.

(End of Clause)

C.9 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

The offeror agrees, if awarded a contract, to use the service-disabled veteran-owned small businesses or veteran-owned small businesses proposed as subcontractors in accordance with 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, or to substitute one or more service-disabled veteran-owned small businesses or veteran-owned small businesses for subcontract work of the same or similar value.

(End of Clause) VAAR 852.216-71 ECONOMIC PRICE ADJUSTMENT OF CONTRACT PRICE(S) BASED ON A PRICE INDEX (MAR 2018)

**PLEASE NOTE: This VAAR clause references a contract with a base period/year and option periods/years. This contract will be an IDIQ contract with a 5 year ordering period. Therefore the dates of contract adjustment under this contract shall be annually prior to the beginning of each ordering period rather than annually prior to an option period/year.**

(a) To the extent that contract cost increases are provided for by this economic price adjustment clause, the offeror warrants that the prices in this proposal for the period of performance do not include any amount to protect against such contingent cost increases.

(b) The cost index, for the purpose of price adjustment under this clause, shall be the Energy Information Administration’s Retail Gasoline Prices, Regular Grade Reformulated Areas, for the Midwest (PADD 2), as contained in http://www.eia.gov/petroleum/gasdiesel/, as published by the U.S. Department of Energy. All adjustments authorized under this clause shall be made by using the Base Index and Adjusting Indexes, which are published weekly each Monday at 5:00 PM (Eastern Time), or Tuesday if Monday is a holiday.

0. The Base Index, for the purposes of price adjustment under this clause, shall be the most recent Index published prior to the closing date for receipt of offers, or the due date for receipt of best and final offers if discussions are held. This Base Index shall remain constant throughout the life of the contract, including all options.

0. The Adjusting Index shall be the most recent Index published prior to the date of contract adjustment, as specified in paragraph (f).

(c) For the purposes of this clause, it will be conclusively presumed that 2.46% percent (%) of…