36C25220Q0313-001.docx

36C25220Q0313

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

36C25220Q0313 04-27-2020 Maureen Falaschi x44853 05-26-2020 2:00pm local 36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101 Milwaukee WI 53214-1476 X 621910 $16.5 Million N/A X 36C252 Clement J. Zablocki VAMC located in Milwaukee, WI and other VA and non-VA medical facilities.

See Section 5 Place of Performance in the 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 Non-emergency ambulance transportation services (Basic Life Support, Advanced Life Support, and Critical Care Transports).

See Performance Work Statement.

See CONTINUATION Page 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 (OCT 2018)

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.

See 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS (OCT 2018) in Section E.

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 WEDNESDAY, MAY 13, 2020 by 4:00pm local time. Contracting will issue a consolidated response via solicitation amendment to www.fbo.gov to all parties if questions are received.

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.

SITE VISIT:

Offerors may schedule a site visit at the Milwaukee VAMC under this solicitation to fully understand the nature of the work (pickup and drop-off areas, etc.). Failure to do so shall in no way relieve the successful offeror from performing the work in accordance with the PWS.

Prospective offerors are requested to contact Maureen Falaschi at maureen.falaschi@va.gov or 414-844-4853 to schedule a site visit NO LATER THAN MAY 12, 2020.

Price Schedule Contractor must provide firm-fixed unit pricing and total pricing for all line items listed in the following Price Schedule for all ordering periods and an estimated grand total.

The total maximum amount of services acquired under this contract shall not exceed $3,500,000.00 The guaranteed minimum is $100,000.00 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 and line items ending in 007 for a flat fee if unloaded mileage exceeds loaded mileage in accordance with PWS 4.9.4.

Transportation services listed shall include any bridge, tunnel or road toll charges. Contractor shall not bill the VA for any such separate charges.

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, 004 and 006 (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

QUANTITY

700.00

BLS Ambulance Services Base Rate (up to 25 miles) Includes 30 min. wait time Ordering Period 1 POP Begin: 10-01-2020 POP End: 09-30-2021

22,000.00

BLS Loaded Mileage Rate (per mile rate beyond the 25-mile radius) Ordering Period 1

200.00

ALS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 1

15,000.00

ALS Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

75.00

Critical Care Transport (up to 25 miles)

100.00

CCT Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

20.00

Flat fee: When unloaded mileage exceeds loaded mileage (See PWS 4.9.4)

120.00

Waiting time (15 min. intervals, beyond initial 30 min.)

700.00

BLS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 2 POP Begin: 10-01-2021 POP End: 09-30-2022

22,000.00

BLS Loaded Mileage Rate (per mile rate beyond the 25-mile radius) Ordering Period 2

200.00

ALS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 2

15,000.00

ALS Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

75.00

Critical Care Transport (up to 25 miles)

100.00

CCT Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

20.00

Flat fee: When unloaded mileage exceeds loaded mileage (See PWS 4.9.4)

120.00

Waiting time (15 min. intervals, beyond initial 30 min.)

700.00

BLS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 3 POP Begin: 10-01-2022 POP End: 09-30-2023

22,000.00

BLS Loaded Mileage Rate (per mile rate beyond the 25-mile radius) Ordering Period 3

200.00

ALS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 3

15,000.00

ALS Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

75.00

Critical Care Transport (up to 25 miles)

100.00

CCT Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

20.00

Flat fee: When unloaded mileage exceeds loaded mileage (See PWS 4.9.4)

120.00

Waiting time (15 min. intervals, beyond initial 30 min.)

700.00

BLS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 4 POP Begin: 10-01-2023 POP End: 09-30-2024

22,000.00

BLS Loaded Mileage Rate (per mile rate beyond the 25-mile radius) Ordering Period 4

200.00

ALS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 4

15,000.00

ALS Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

75.00

Critical Care Transport (up to 25 miles)

100.00

CCT Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

20.00

Flat fee: When unloaded mileage exceeds loaded mileage (See PWS 4.9.4)

120.00

Waiting time (15 min. intervals, beyond initial 30 min.)

700.00

BLS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 5 POP Begin: 10-01-2024 POP End: 09-30-2025

22,000.00

BLS Loaded Mileage Rate (per mile rate beyond the 25-mile radius) Ordering Period 5

200.00

ALS Ambulance Services Base Rate (up to 25 miles)

Ordering Period 5

15,000.00

ALS Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

75.00

Critical Care Transport (up to 25 miles)

100.00

CCT Loaded Mileage Rate (per mile rate beyond the 25-mile radius)

20.00

Flat fee: When unloaded mileage exceeds loaded mileage (See PWS 4.9.4)

120.00

Waiting time (15 min. intervals, beyond initial 30 min.)

PERFORMANCE WORK STATEMENT (PWS)

1. Purpose: The Department of Veterans Affairs (VA) Clement J. Zablocki VA Medical Center (hereafter VAMC), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transports (CCT) services. 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 VAMC located in Milwaukee, WI (245-acre campus), its three CBOCs and affiliated healthcare clinics, serves over 60,000 veterans across southeastern and central Wisconsin. The hospital has 503 inpatient beds (185 acute care beds, 113 nursing home beds, and 205 domiciliary beds) and sees approximately 15,000 inpatient admissions and 857,000 outpatient visits a year.

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

3. Acronyms ALS – Advanced Life Support AOD – Administrator on Duty BLS – Basic Life Support CCT – Critical Care Transport CO – Contracting Officer COR – Contracting Officer’s Representative CPR – Cardiopulmonary Resuscitation DOL – Department of Labor EMT – Emergency Medical Technical IAW – In Accordance With PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QC – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VAMC – Clement J. Zablocki VA Medical Center

4. Scope/Requirements

4.1 Types of Ambulance Service

The contractor shall provide the following 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:

Refer to Wisconsin State Legislature Department of Health Services Administrative Code Chapter DHS 110 Emergency Medical Services Licensing, Certification, and Training Requirements1 for specifics on the requirements for BLS, ALS, and CCT.

1 https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/110

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 VAMC, 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 conduct themselves in a businesslike manner at all times 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 and other medical personnel (as applicable) shall at all times meet the qualifications specified in this contract as well as all applicable federal, state (see Wisconsin Statute 256.15 Emergency medical services personnel; licensure; certification; training2 and Wisconsin Administrative Code Chapter DHS 110 Emergency Medical Services Licensing, Certification, and Training Requirements3) 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.

4.3.1.2 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 applicable qualifications to the Contracting Officer’s Representative (COR) for review.

4.3.1.3 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. 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.

4.3.1.4 CCTPs shall be capable of administering oxygen and have successfully completed the Standards and Advanced First Aid Courses of the American Red Cross or equivalent. Proof in the form of a current certificate for the successful completion of such training must be provided to the COR for any personnel added or replaced throughout the life of the contract.

4.3.1.5 Investigative Requirements for Contract Personnel: Contract personnel will be subject to the same investigative requirements as those for regular VA appointees and employees. The level of investigation commensurate with the level of access to perform the performance work statement is: Special Agreement Checks (SAC). Fingerprinting for contract personnel will be conducted at the VAMC. Thereafter the contracted employees will be subject annually to the same requirement, with a 90-day window to complete such requirement as provided by the VAMC. The VA Security and Investigation Center (SIC) is responsible for adjudicating all background investigations for contract employees.

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 annually 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 tests by October 1 each year.

2 https://docs.legis.wisconsin.gov/statutes/statutes/256/15 3 https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/110

4.4 Contractor Equipment, Vehicles, and Inspection

4.4.1 Ambulances shall meet all applicable federal, state and local regulations and specifications, including but not limited to licensing, registration, and safety standards. The contractor shall meet or exceed the ambulance inspection standards of the Wisconsin Department of Transportation under Wisconsin Statute 341.085 Registration of Ambulance4 and Wisconsin Administrative Code Chapter Trans 309 Ambulance Inspections5.

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). 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 must be capable of transporting the drugs and/or equipment as required by the patient as listed in Attachment A Critical Care Transport Capabilities Confirmation. The contractor shall have the appropriate medications, up to and including CCT Tier III if necessary, based on the EMS region the ambulance provider is functioning in.

4 http://docs.legis.wisconsin.gov/statutes/statutes/341/I/085 5 http://docs.legis.wisconsin.gov/code/admin_code/trans/309

4.5 Transportation Request

4.5.1 Scheduling

4.5.1.1 A transportation request is defined as one incidence of a request for one-way service (BLS, ALS, CCT). No more than one patient will be transported per order unless approved by an authorized VA ordering employee.

4.5.1.2 Transportation requests will be made by telephone. Only the following VA staff are authorized to place transportation requests or make changes to transportation requests:

Contracting Officer’s Representative (COR) PoC for Beneficiary Travel Office All Administrative Officers of the Day (AOD) Non-authorized VA employees and private agencies (e.g. nursing homes) are not considered authorized to place transportation requests. A list containing the names and phone numbers of VA staff who are authorized (Delegated Ordering Officers) to place transportation requests will be submitted to the contractor at time of award and updated as needed periodically throughout the life of the contract.

4.5.1.2.1 For each transportation request, the contractor will be given the patient’s name, pick-up appointment time, pickup address, caregiver/escort information (if applicable), drop-off address, and other applicable details. Orders may be confirmed in writing included in the daily manifest.

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 (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 two (2) simultaneous transportation requests, for any mix of BLS, ALS, or CCT. If VAMC requires ambulance services exceeding two (2) 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 Response Times*

4.5.1.7.1 Orders that are scheduled 4 hours prior to required services are defined as being scheduled in advance. With the exceptions found under 4.5.1.7.4 below, the contractor shall arrive on time for all orders scheduled in advance.

4.5.1.7.2 For all transportation requests with pick up at VAMC:

a. The contractor will be allotted up to a sixty (60) minute arrival response time from time of order placement for transportation requests that are not previously scheduled in advance.

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

4.5.1.7.3 For all transportation requests, which have a pick-up address within a 25-mile radius of the VAMC:

a. The contractor will be allotted up to a sixty (60) minute arrival response time from time of order placement for transportation requests that are not previously scheduled in advance.

4.5.1.7.4 For all transportation requests which have a pick-up address beyond a 25-mile radius of the VAMC:

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 fifteen (15) minutes of receiving the order;

b. Pick-up appointment arrival times shall be agreed upon by the VA and contractor at time of order placement. Pick-up arrival time shall be reasonable based upon travel distance, speed limits, and weather conditions. The contractor’s patient pick-up time shall not deviate by more than fifteen (15) minutes.

c. The contractor’s patient pick-up time shall not deviate by more than fifteen (15) minutes of the scheduled pick-up 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 (BLS, ALS, CCT) and the one-way mileage (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 VAMC ONLY – The contractor will 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 VAMC, 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 residence, Emergency Department, Ward, Clinic, etc.). 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 Nursing Station 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 Veterans Transportation Program Manager 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.

4.8 Incident Reporting

4.8.1 The contractor shall notify the COR, Requestor, and Veterans Transportation Program Manager, 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, or Veterans Transportation Program Manager, by the close of business of the next working day.

4.8.2 The COR will monitor the service provided. The contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The contractor shall promptly inform the COR 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.

4.9 Invoicing

4.9.1 Each transport shall include thirty (30) minutes of wait time; the contractor may invoice for wait times in excess of this initial thirty (30) minutes. Wait time shall begin only once the contractor has both reached the pick-up address location and the appointment time has elapsed. All wait times shall be itemized and invoiced in fifteen (15) minute intervals. For partial fifteen (15) minute intervals, zero (0) to seven (7) minutes shall be rounded down to zero (0) minutes and eight (8) to fifteen (15) minutes rounded up to fifteen (15) minutes.

4.9.2 When invoicing for mileage, the contractor shall round to the nearest mile. Mileage ending in .5 or higher shall be rounded up to the nearest mile. Mileage ending in .4 or lower shall be rounded down to the nearest mile. Payment for mileage to or from the point of care shall be limited to the VA’s calculation according to the VA’s Bing Maps API determination. Bing Maps API is optimized to determine mileage based on the shortest time of travel.

4.9.3 With the exception of “no shows” defined in 4.5.2.1.1 above, the contractor shall invoice for loaded (patient onboard) services and mileage only. The contractor shall submit an electronic invoice by the tenth (10th) day 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, but shall include the following:

· Contractor Name and Contract Number

· Current Purchase Order Number

· Dates of service

· Total amount invoiced, including a summary of the total number of charges that align with the line items of this contract (total number of BLS Transports, total BLS Mileage incurred, etc.)

· An itemized list of charges or services rendered that align with the line items of this contract (BLS Base Rate, BLS Mileage incurred, etc).

Additionally, a copy of the invoice along with secondary documentation shall be provided to the COR. This may be delivered via fax, email, or hand carried. The secondary documentation must include the following information:

· Contractor name and telephone number for billing questions

· Contract Number

· Current Purchase Order Number

· Dates of service

· Name of the patient

· Date and time of pick-up/drop-off

· Address for pick-up/drop-off

· Daily itemized listing of transports and charges that align with the line items of this contract (BLS Base Rate, BLS Mileage incurred, etc). List should include patient’s name, the last four digits of the SSN, date of transport, and pick‐up/drop‐off points.

· Total amount invoiced, including a summary of the total number of charges that align with the line items of this contract (total number of BLS Transports, total BLS Mileage incurred, etc.)

4.9.4 If unloaded mileage exceeds loaded mileage, the contractor may invoice for a flat fee only if the following also occur:

· Unloaded mileage exceeds 75 miles

· The contractor does not deviate from a route to intentionally make unloaded mileage exceed loaded mileage.

4.9.5 Invoices may be paid by the Government using Purchase Order Numbers.

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

5. Period & Place of Performance

5.1 This contract’s ordering period shall be effective from October 1, 2020 through September 30, 2025.

5.2 The Place of Performance is variable and may occur within the states of Wisconsin, Michigan, and Illinois; ambulance services may be required to or from locations including, but not limited to the following:

5.2.1 Clement J. Zablocki VAMC to include specific clinics, Emergency Department, wards, or out-buildings on the VAMC campus. The Clement J. Zablocki VA Medical Center address is: 5000 W National Avenue, Milwaukee, WI 53295-0001.

5.2.2 Clement J. Zablocki VAMC Hospital Community-Based Outpatient Clinics (CBOCs):

Appleton CBOC 10 Tri-Park Way Appleton, WI 54914 Cleveland CBOC 1205 North Ave.

Cleveland, WI 53015

Green Bay CBOC 2851 University Ave.

Green Bay, WI 54311 Union Grove CBOC 21425 Spring St.

Union Grove, WI 53182

5.2.3 Other VA Medical Centers, Hospitals, or CBOCs within Veterans Integrated Service Network (VISN) 12 including, but not limited to:

5.2.4 Other Non-VA Medical facilities and Community Care facilities as authorized by VA.

5.2.5 Veterans’ residences.

6. Quality Control Plan

6.1 Quality Control

6.1.1 The contractor shall provide a Quality Control Plan (QCP) that contains, at a minimum, the items listed below. The Contracting Officer will notify the contractor of acceptance or required modification 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.

6.1.1.1 A description of the company’s organizational structure including a description of the roles and responsibilities of management and supervisors.

6.1.1.2 A description of the methods to be used by the contractor for identifying and preventing deficiencies or problems in the quality of service performed and specific steps the contractor will take for corrective action if needed.

6.1.1.3 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.

6.1.1.4 A description of the method used to provide on-time ambulance services to meet the requirements of this contract (24/7 availability and up to 2 simultaneous transports for any mix of BLS, ALS, or CCT).

6.1.1.5 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.

6.1.1.6 A description of the method/system used to log all requests for service. The contractor shall confirm that the log indicates 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 confirm the log sheet will be sent to the COR monthly.

6.2 Quality Assurance

6.2.1 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).

6.2.2 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.

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

6.3 Minimum Performance Standards

6.3.1 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 result in termination of the contract.

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

36C25220Q0313

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, 2020 through September 30, 2025.

(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 ride in excess of 220 miles;

(2) Any order for a combination of items in excess of 2 rides simultaneously; or

(3) A series of orders from the same ordering office within 1 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 days 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, 2025.

(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. The specified rates under this clause will be those rates in effect under the last ordering period.

(End of Clause) C.6 52.219-4 NOTICE OF PRICE EVALUATION PREFERENCE FOR HUBZONE SMALL BUSINESS CONCERNS (DEVIATION 2019-01)

(a) Definitions. As used in this clause— “HUBZone small business concern” means a small business concern, certified by the Small Business Administration (SBA), that appears on the List of Qualified HUBZone Small Business Concerns maintained by the SBA (13 CFR 126.103).

“Similarly situated entity” means a first-tier subcontractor, including an independent contractor, that has the same small business program status as that which qualified the prime contractor for the award, and that is considered small for the NAICS code the prime contractor assigned to the subcontract the subcontractor will perform. An example of a similarly situated entity is a first-tier subcontractor that is a HUBZone small business concern for a HUBZone set-aside or sole source award under the HUBZone Program.

(b) Evaluation preference.

(1) Offers will be evaluated by adding a factor of 10 percent to the price of all offers, except—

(i) Offers from HUBZone small business concerns that have not waived the evaluation preference; and

(ii) Otherwise successful offers from small business concerns.

(2) The factor of 10 percent shall be applied on a line item basis or to any group of items on which award may be made. Other evaluation factors described in the solicitation shall be applied before application of the factor.

(3) When the two highest rated offerors are a HUBZone small business concern and a large business, and the evaluated offer of the HUBZone small business concern is equal to the evaluated offer of the large business after considering the price evaluation preference, award will be made to the HUBZone small business concern.

(c) Waiver of evaluation preference. A HUBZone small business concern may elect to waive the evaluation preference, in which case the factor will be added to its offer for evaluation purposes. The agreements in paragraphs (e) and (f) of this clause do not apply if the offeror has waived the evaluation preference.

[ ] Offeror elects to waive the evaluation preference.

(d) Independent contractors. An independent contractor shall be considered a subcontractor.

(e) Agreement. By submission of an offer and execution of a…