36C25219Q0529-001.docx

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 SI

GN 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. SIGN

ATURE 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

695-19-3-6093-0030 36C25219Q0529 04-25-2019

PASHOLK,SUSAN

414-844-4846 05-09-2019

NOON CENTRAL

36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) Southern Tier 3001 Green Bay Rd., Bldg. 1, Rm. 326 North Chicago IL 60064-3048 X X 811219 $20.5 Million X N/A X

CLEMENT J.

ZABLOCKI VA MEDICAL CENTER

5000 W. NATIONAL AVENUE

MILWAUKEE WI 53295-1000

36C252 Department of Veterans Affairs

GLAC

815 S 84TH STREET

MILWAUKEE WI 53214

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 877-353-9791 512-460-5540 See CONTINUATION Page

MEDICAL GAS TESTING SERVICES PER STATEMENT OF WORK

AT THE MILWAUKEE VAMC

100% SB SET ASIDE

SERVICE CONTRACT LABOR STANDARDS APPLY

DOL WD 15-4899 REV-7 1.1.2019 APPLIES AND IS ATTACHED

VA POC: PERRY SCOTT 414-384-2000 X43931

CO: SUSAN PASHOLK 414-844-4846

695-3690162-6093-854100-2543 010050190 X X X

SUSAN PASHOLK

CONTRACTING OFFICER

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

(Continuation from Standard Form 1449, block 18A.)

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

a. CONTRACTOR: ______________________________________ (Contractor’s Name) ______________________________________ (Address) ______________________________________ (City-State-Zip) ______________________________________ (Point of Contact/Title)

PHONE NUMBER ______________________________________

FAX NUMBER ______________________________________

E-MAIL ADDRESS ______________________________________

DUNS NUMBER NO. ______________________________________

b. GOVERNMENT: SUSAN PASHOLK, CONTRACTING OFFICER

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:

52.232-34 -- Payment by Electronic Funds Transfer--Other Than System for Award Management.

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

a. 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012)

b. Monthly in arrears.

4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be submitted electronically in accordance with 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012)

FACSIMILE, E-MAIL, AND SCANNED DOCUMENTS ARE NOT ACCEPTABLE FORMS OF SUBMISSION FOR PAYMENT REQUESTS.

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://ob10.com/us/en/veterans-affairs-us/ to begin submitting electronic invoices, free of charge.

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

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

* Tungsten Network e-Invoice email: VA.Registration@ob10.com <http://VA.Registration@ob10.com/>

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

* FSC e-invoice email: vafsccshd@va.gov <http://va.gov/>

INVOICES:

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

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@ob10.com or calling 1-877-752-0900 option 2 for Enrollment.

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.ob10.com/Login.aspx. For questions regarding the submission of VA electronic invoices, Tungsten Network customer service may be contacted at 1-877-489-6135.

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.

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:

AMENDMENT NO DATE

Offers may be submitted electronically to the following email address: susan.pasholk@va.gov. However, a signed, dated and scanned 1449 must be included along with all other information requested herein by the due date and time. Offers may also be submitted through the regular mail and must be received by the date and time specified in Block 8. CAUTION - LATE Submissions, Modifications, and Withdrawals: See provision 52.212-1. All offers are subject to all terms and conditions of this solicitation.

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 susan.pasholk@va.gov no later than FRIDAY MAY 3, 2019 AT 9:00 AM CENTRAL. Contracting will issue a consolidated response via solicitation amendment to www.fbo.gov within 2 business days 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.

REQUIRED DOCUMENTATION: Contractor shall e-mail complete quote package with pricing information completed to susan.pasholk@va.gov:

1. Solicitation document with:

a. Contractor shall fill in the SF 1449 blocks 17a, 30a, 30b, and 30c.

b. Contractor shall fill in Pg. 2, 1(a).

c. Contractor shall fill in all unit and total costs under the PRICE/COST SCHEDULE or submit separately the spreadsheet with line items costs filled in.

2. Insurance, certifications, and documentation in accordance with the requirements within the performance work statement.

3. Quote documentation in accordance with 52.212-1; Instruction to Offerors

A signed, dated and scanned 1449 must be included along with all other information requested herein by the due date and time. Offers may also be submitted through the regular mail and must be received by the date and time specified in Block 8. CAUTION - LATE Submissions, Modifications, and Withdrawals: See provision 52.212-1. All offers are subject to all terms and conditions of this solicitation.

*VA has a maximum allowable incoming email size limitation including attachments of seven megabytes. Offerors submitting responses via email which exceed seven megabytes shall split their response into multiple email messages so as to not exceed the maximum allowable email size limitation. The VA is not responsible for late responses due to undelivered e-mails that exceed seven megabytes.

SECURITY & PRIVACY CONTROL:

The Certification & Accreditation (C&A) requirements of VHA Handbook 6500.6 do not apply to this requirement, therefore, a Security Accreditation Package is not required. No C&A or MOU/ISA is required. Sensitive information exposure as part of this contract involves applicable security controls within the facility as part of the VA Information Security If there are any questions related to privacy, please have a member of your staff contact the VA Privacy Service at (202) 461-6309. If there are any questions related to the information security, please have a member of your staff contact the Office of Cyber Security at (304) 262-7733.

AUTHORITY

This Request for Quote (RFQ) solicitation is issued under the authority of FAR Part 13.5 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.

The Lowest Price Technically Acceptable source selection process will be used for this FAR 13.5 procurement. This means award will be made on the basis of the lowest evaluated price of quotes meeting or exceeding the acceptability standards for non-cost factors. See 52.212-2 Evaluation – Commercial Items (Section E) for a description of the factors in addition to price that the Government will use to evaluate offers. Prospective contractors must furnish the information listed herein with their quotations to ensure they receive full consideration.

SITE VISIT

It is strongly suggested and expected that the offeror inspect the campus to be serviced to fully understand the nature of the work and the conditions under which the work is to be performed. In no case shall failure to inspect the campus constitute grounds for a claim after contract award. SITE VISIT IS SCHEDULED FOR WEDNESDAY MAY 1, 2019 AT 9:00 AM CENTRAL. INTERESTED PARTIES ARE TO MEET COR PERRY SCOTT (414-384-2000 X43931) AT BULDING 111 BASEMENT; ROOM BO225.

MEDICAL GAS TESTING

SERVICES PRICES/COSTS

Provide full service maintenance on the Government-owned equipment listed below to include all Labor, Time, Management and Equipment (L,T,M,E) in accordance with the terms and conditions of this Request for Quotation for The Clement J Zablocki VA Hospital Milwaukee, WI.

BASE YEAR JUNE 1, 2019 through MAY 31, 2020

CLIN DESCRIPTION QTY UNIT PRICE TOTAL

0002 Test and evaluate medical gas system Master Alarm

manufacturer’s specifications. Place each master in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Master Alarm Panels.

Annually in May 1 JOB $_______

0003 Test and evaluate medical gas system Area

0004 All L,T,M,E necessary for vendor to inspect,

standards. Vendor to provide complete documentation for facility records after each PM visit.

0005 All L,T,M,E necessary for vendor to perform testing on all medical gas pressure outlets:

0006 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in May 1 JOB $_________

0007 All L,T,M,E necessary for vendor to annually provide purity and

documentation of testing and results for facility records Due in May 1 JOB $_________

0008 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in Feb 1 JOB $_________

0009 All L,T,M,E necessary for vendor to annually

0010 All L,T,M,E necessary to inspect, functionally test, and

0010a. Replace all compressor filter elements and belts.

Properly lubricate as required. Replace all dryer elements, purge mufflers and dew point sensor

– Due in August 1 JOB $__________

0011 All L,T,M,E necessary for vendor to provide initial

0012 Provide a medical gas awareness training program for

0013 All L,T,M,E necessary to perform Flexible Outlet/Inlet Hose assembly testing – Due in August 1 JOB $___________

0014 Emergency Service/Maintenance performed outside normal hours of coverage 12 MO $________ $___________

TOTAL BASE YEAR: $________________

OPTION YEAR 1 JUNE 1, 2020 through MAY 31, 2021

CLIN DESCRIPTION QTY UNIT PRICE TOTAL

1001. All L,T,M,E necessary for vendor to inspect,

1002 Test and evaluate medical gas system Master Alarm Panels;

Vendor to provide complete documentation for facility records after each PM visit.

1002a. Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer’s specifications. Place each master in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Master Alarm Panels.

Annually in May 1 JOB $_______

1003 Test and evaluate medical gas system Area Alarm Panels;

(Facility Wide). Vendor to provide complete documentation for facility records after each PM visit.

1003a. Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer’s specifications. Place each panel in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Area Alarm Panels.

Annually in May 1 JOB $_______

1004 All L,T,M,E necessary for vendor to inspect, functionally test and perform preventive maintenance on the dental air compressor system per manufacturer’s and NFPA 99 standards. Vendor to provide complete documentation for facility records after each PM visit.

1005 All L,T,M,E necessary for vendor to perform testing On all medical gas pressure outlets:

work hours – Annually in Feb 1 JOB $_______

work hours – Annually in Feb 1 JOB $_______

1006 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in May 1 JOB $_______

1007 All L,T,M,E necessary for vendor to annually provide purity and

documentation of testing and results for facility records Due in May 1 JOB $_______

1008 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in Feb 1 JOB $_______

1009 All L,T,M,E necessary for vendor to annually

1010 All L,T,M,E necessary to inspect, functionally test, and

1010a. Replace all compressor filter elements and belts.

Properly lubricate as required. Replace all dryer elements, purge mufflers and dew point sensor

– Due in August 1 JOB $________

1010b. Perform semi-annually, thorough inspection, testing and recalibration of the instrument Air Compressor

1011 All L,T,M,E necessary for vendor to provide initial inventory

1012 All L,T,M,E necessary to perform Flexible Outlet/Inlet

1013 Emergency Service/Maintenance performed outside normal hours of coverage 12 MO $________ $__________

TOTAL OPTION YEAR 1: $_________________

OPTION YEAR 2 JUNE 1, 2021 through MAY 31, 2022

CLIN DESCRIPTION QTY UNIT PRICE TOTAL

2001. All L,T,M,E necessary for vendor to inspect,

2002 Test and evaluate medical gas system Master Alarm Panels;

Vendor to provide complete documentation for facility records after each PM visit.

2002a. Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer’s specifications. Place each master in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Master Alarm Panels.

Annually in May 1 JOB $________

2003 Test and evaluate medical gas system Area Alarm Panels;

(Facility Wide). Vendor to provide complete documentation for facility records after each PM visit.

2003a. Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer’s specifications. Place each panel in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Area Alarm Panels.

Annually in May 1 JOB $________

2004 All L,T,M,E necessary for vendor to inspect, functionally test and perform preventive maintenance on the dental air compressor system per manufacturer’s and NFPA 99 standards. Vendor to provide complete documentation for facility records after each PM visit.

2005 All L,T,M,E necessary for vendor to perform testing On all medical gas pressure outlets:

work hours – Annually in Feb 1 JOB $________

work hours – Annually in Feb 1 JOB $________

2006 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in May 1 JOB $________

2007 All L,T,M,E necessary for vendor to annually provide purity and

documentation of testing and results for facility records Due in May 1 JOB $________

2008 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in Feb 1 JOB $________

2009 All L,T,M,E necessary for vendor to annually

2010 All L,T,M,E necessary to inspect, functionally test, and

2010a. Replace all compressor filter elements and belts.

Properly lubricate as required. Replace all dryer elements, purge mufflers and dew point sensor

– Due in August 1 JOB $_________

2010b. Perform semi-annually, thorough inspection, testing and recalibration of the instrument Air Compressor

2011 All L,T,M,E necessary for vendor to provide initial inventory

2012 All L,T,M,E necessary to perform Flexible Outlet/Inlet

2013 Emergency Service/Maintenance performed outside normal hours of coverage 12 MO $_______ $__________

TOTAL OPTION YEAR 2: $________________

OPTION YEAR 3 JUNE 1, 2022 through MAY 31, 2023

CLIN DESCRIPTION QTY UNIT PRICE TOTAL

3001. All L,T,M,E necessary for vendor to inspect,

3002 Test and evaluate medical gas system Master Alarm Panels;

Vendor to provide complete documentation for facility records after each PM visit.

3002a. Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer’s specifications. Place each master in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Master Alarm Panels.

Annually in May 1 JOB $_______

3003 Test and evaluate medical gas system Area Alarm Panels;

(Facility Wide). Vendor to provide complete documentation for facility records after each PM visit.

3003a. Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer’s specifications. Place each panel in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Area Alarm Panels.

Annually in May 1 JOB $________

3004 All L,T,M,E necessary for vendor to inspect, functionally test and perform preventive maintenance on the dental air compressor system per manufacturer’s and NFPA 99 standards. Vendor to provide complete documentation for facility records after each PM visit.

3005 All L,T,M,E necessary for vendor to perform testing On all medical gas pressure outlets:

3006 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in May 1 JOB $________

3007 All L,T,M,E necessary for vendor to annually provide purity and

documentation of testing and results for facility records Due in May 1 JOB $________

3008 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in Feb 1 JOB $________

3009 All L,T,M,E necessary for vendor to annually

3010 All L,T,M,E necessary to inspect, functionally test, and

3010a. Replace all compressor filter elements and belts.

Properly lubricate as required. Replace all dryer elements, purge mufflers and dew point sensor

– Due in August 1 JOB $________

3010b. Perform semi-annually, thorough inspection, testing and recalibration of the instrument Air Compressor and dryer – Due in August and February 2 JOBS $_______ $_________

3011 All L,T,M,E necessary for vendor to provide initial inventory

3012 All L,T,M,E necessary to perform Flexible Outlet/Inlet Hose assembly testing – Due in August 1 JOB $_________

3013 Emergency Service/Maintenance performed outside normal hours of coverage 12 MO $_______ $_________

TOTAL OPTION YEAR 3: $_______________

OPTION YEAR 4 JUNE 1, 2023 through MAY 31, 2024

CLIN DESCRIPTION QTY UNIT PRICE TOTAL

4001 All L,T,M,E necessary for vendor to inspect,

4002 Test and evaluate medical gas system Master Alarm Panels;

Vendor to provide complete documentation for facility records after each PM visit.

4002a. Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer’s specifications. Place each master in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Master Alarm Panels. Annually in May 1 JOB $________

4003 Test and evaluate medical gas system Area Alarm Panels;

(Facility Wide). Vendor to provide complete documentation for facility records after each PM visit.

4003a. Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer’s specifications. Place each panel in actual alarm conditions and recalibrate. Include check of all lamps and audible alarms for sound at Area Alarm Panels.

Annually in May 1 JOB $________

4004 All L,T,M,E necessary for vendor to inspect, functionally test and perform preventive maintenance on the dental air compressor system per manufacturer’s and NFPA 99 standards. Vendor to provide complete documentation for facility records after each PM visit.

4005 All L,T,M,E necessary for vendor to perform testing on all medical gas pressure outlets:

4006 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in May 1 JOB $________

4007 All L,T,M,E necessary for vendor to annually provide purity and

documentation of testing and results for facility records Due in May 1 JOB $_________

4008 All L,T,M,E necessary for vendor to perform annual

documentation of testing and results for facility records Due in Feb 1 JOB $_________

4009 All L,T,M,E necessary for vendor to annually

4010 All L,T,M,E necessary to inspect, functionally test, and

4010a. Replace all compressor filter elements and belts.

Properly lubricate as required. Replace all dryer elements, purge mufflers and dew point sensor

– Due in August 1 JOB $__________

4010b. Perform semi-annually, thorough inspection, testing and recalibration of the instrument Air Compressor

4011 All L,T,M,E necessary for vendor to provide initial inventory

4012 All L,T,M,E necessary to perform Flexible Outlet/Inlet Hose assembly testing – Due in August 1 JOB $__________

4013 Emergency Service/Maintenance performed outside normal hours of coverage 12 MO $________ $__________

TOTAL OPTION YEAR 4: $________________

TOTAL BASE & 4 OPTION YEARS $_____________________

STATEMENT OF WORK/ TECHNICAL WORK REQUIREMENTS

The contractor shall provide all labor, materials, supervision, tools and equipment necessary to perform Preventive Maintenance/Inspections/Emergency Service for MEDICAL GAS SYSTEMS as described in this Statement of Work for campus buildings 111 and 144. Contractor shall perform scheduled PREVENTIVE MAINTENANCE (PM) INSPECTIONS in accordance with manufacturer's specifications and NFPA 2018 specifications. Services are for Clement J. Zablocki VA Medical Center, 5000 W. National Ave, Milwaukee, WI.

1. CRITICAL ELEMENTS:

A. Contractor will provide complete inventory and initial inspection of each piece of equipment listed herein. Inventory must be submitted to COR electronically using MS Excel (or other mutually agreed upon format). (Para 2) B. Based on initial inventory/inspection; Contractor will establish and provide to the COR a complete Preventive Maintenance Plan to ensure those requirements of the contract are provided within 10 days of completion of initial inventory/inspection. (Para 2) . Inventory will determine actual outlet and inlet count.

C. In addition to a Preventive Maintenance Plan, Contractor will establish a Quality Control Program, provided to COR within 10 days of completion of initial inventory/inspection (Para 12)

D. Contractor will provide in writing to the COR a schedule of all work and provide written work reports. (Para 3, 11) E. Contractor Response time is 8 hours after call is received for emergency services associated with the medical gas systems. (Para 5) F. Preventive maintenance shall be scheduled accordingly as defined per system, (Para 3) G. Frequency of scheduled preventive maintenance shall be either annual or semi-annual. (Para 3) H. Requests for extensive repairs shall be submitted in writing to the COR.

I. Provide documentation for repairs and preventive maintenance. Initial Inventory as well as monthly service reports must be submitted electronically using MS Excel (or other mutually agreed upon format). (Para 2, 11)

J. Contractor's personnel are required to sign-in immediately upon arrival on-site and sign-out at time of departure. (Para 14).

K. Medical gas transducers are located inside alarm panels.

2. TECHNICAL WORK REQUIREMENTS:

Upon award of the contract the Contractor shall coordinate with the COR a non-labor-intensive plan to inventory and inspect the Medical Gas Systems and provide the COR a written and electronic report of condition to include drawings. The report of condition must be provided to the COR before Work in the specified area starts. Within 10 days of completion of initial inventory/inspection, Contractor is required to submit a Preventive Maintenance Plan for all equipment listed herein.

3. PREVENTIVE MAINTENANCE AND INSPECTIONS SHALL INCLUDE:

A. All L,T,M,E necessary for Contractor to inspect, functionally test and perform preventive maintenance on the Medical Air Dryer and the Associated Alarm Panels. Vendor to provide complete documentation for facility records after each PM visit.

· Medical Air Dryer function testing per manufacturer's recommendation — semi-annually in November and May (0001a)

· Calibrate carbon monoxide monitor — annually in May (0001b)

· Test/Check dew point monitor with portable instrumentation — semi-annually in November and May(0001c)

· Replace all filter elements, purge mufflers and dew point monitor sensor — annually in May(0001d)

· Test Dew Point and carbon monoxide master panel signals — annually in May(0001e) B. Test and evaluate medical gas system Master Alarm Panels. Vendor to provide complete documentation for facility records after each PM visit.

· Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer's specifications. Place each master in actual alarm conditions and recalibrate, Include check of all lamps and audible alarms for sound at Master Alarm Panels. Annually in May. (0002a)

· Test each Master Alarm Panel for proper audible and visual function, and inspect for Proper labeling — quarterly in November, February, May and August. (0002b) C. Test and evaluate medical gas system Area Alarm Panels (Facility Wide). Vendor to provide complete documentation for facility records after each PM visit.

· Inspect for proper pressure switch locations, test alarm functions and settings in accordance with manufacturer's specifications. Place each panel in actual alarm conditions and recalibrate, Include check of all lamps and audible alarms for sound at Area Alarm Panels. Annually in May. (0003a)

· Test each Area Alarm Panel for proper audible and visual function, and inspect for Proper labeling — Quarterly in November, February, May and August.