36C25221Q0639_1.docx

36C25221Q0639

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

550-21-3-1464-0209 07/01/2021 36C25221Q0639 06-02-2021 Jerri Schuster 414-844-4800 ext 43244 06-14-2021 10:00 am

CDT

36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101 Milwaukee WI 53214-1476 X X 541620 $16.5 Million N/A X 36C252 VA Illiana Health Care System 1900 E Main Street Danville, IL 61832-5198

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 Certified Industrial Hygienist for VA Illiana Health Care System located in Danville, IL.

The purchase order will be for one (1) year Pricing will be inclusive, including travel. Please see Performance Work Statement (PWS) for details.

See CONTINUATION Page

550-3610162-1464-854200-2580- ND02D2001

x X x

ONE

Joni Dorr Contracting Officer

SECTION B - CONTINUATION OF SF 1449 BLOCKS

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

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:

1. PURCHASE ORDER ADMINISTRATION: All purchase order administration matters will be handled by the following individuals:

a. CONTRACTOR:

CONTRACTOR NAME _____________________________________

ADDRESS ________________________________________________

CITY-STATE-ZIP __________________________________________

POINT OF CONTACT/TITLE ________________________________

DUNS NUMBER NO. ______________________________________

CONTRACTOR’S PAST PERFORMANCE POINT OF CONTACT

(IF DIFFERENT THAN ABOVE):

NAME: __________________________________________

EMAIL ADDRESS:_________________________________

MILWAUKEE WI 53214

JERRI.SCHUSTER@VA.GOV

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 FOR AWARD MANAGEMENT (OCT 2018)

3. INVOICES:

a. Invoices shall be submitted monthly in arrears in accordance with: 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

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

c. 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.

d. 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.

e. 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.

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 Veterans Affairs Financial Services Center (VAFSC) 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. As of July 1, 2020, the VA10091 form has been eliminated and the VAFSC is requiring our vendors to update and add their information in the Customer Engagement Portal (CEP) at https://www.cep.fsc.va.gov/. This is for new vendors being added to FMS only.

e. 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. ACQUISITION OF COMMERCIAL ITEMS:

This Request for Quote (RFQ) solicitation is issued under the authority of FAR Part 12 Acquisition of Commercial Items and FAR Part 13 Simplified Acquisition Procedures. FAR Part 15 will not be used. The procedures in Part 12 used in conjunction with Part 13 allow the Government to procure services resembling those in the commercial marketplace and streamline the procurement process. From this RFQ, the Government intends to award a firm fixed price purchase order where the contractor provides a price that is not subject to any adjustment on the basis of the contractor’s cost experience in performing the purchase order.

6. RFQ QUESTIONS:

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 Specialist jerri.schuster@va.gov no later than TUESDAY JUNE 8, 2021 AT NOON LOCAL TIME. Contracting will issue a consolidated response via solicitation amendment to https://beta.sam.gov Contract Opportunities within 2 business days to all parties

7. CONTRACTING OFFICER AUTHORITY:

The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this purchase order. The Contractor shall communicate with the Contracting Officer on all matters pertaining to purchase order administration. Only the Contracting Officer is authorized to make commitment or issue changes that will affect price, quantity or quality of performance of this purchase order. 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 purchase order price to cover any increase in cost incurred thereof.

8. IDENTIFICATION, PARKING, SMOKING AND VA REGULATIONS:

a. It is the responsibility of the Contractor to park in the appropriate designated parking areas. Information on parking is available from the VA Police Section. The VA will not invalidate or make reimbursement for parking violations of the Contractor under any conditions.

b. All VA facilities are drug free.

c. All contractor personnel are required to adhere to all VA rules and regulations.

d. Smoking is prohibited on the entire campus, both inside and outside the VA Facility

e. Possession of weapons is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court.

f. VHA DIRECTIVE 1192: This Veterans Health Administration (VHA) directive establishes policy and provides guidance for the prevention of seasonal influenza in VHA facilities through the vaccination or masking of health care personnel (HCP). AUTHORITY: Title 38 United States Code (U.S.C.) 7301(b), 7318(b). Contractor is responsible in ensuring that all aspects of this directive are implemented, including providing face masks and influenza vaccines for all employees working at a VA facility.

g. While on campus, all persons shall be required to wear masks inside any VA Medical Center building, walking on the grounds, and while traveling in vehicles. Contractor shall confirm with COR before arrival of current mask mandate.

9. SECURITY & PRIVACY CONTROL:

The Authorization & Accreditation (A&A) requirements of VHA Handbook 6500.6 do not apply to this requirement, therefore, a Security Accreditation Package is not required. No A&A or MOU/ISA is required. Sensitive information exposure as part of this purchase order 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.

Visitor Passes:

Issuance of visitor passes is the responsibility and at the discretion of each Facility Director. Visitor passes may be issued to individuals requiring short-term access to a VA facility for a period not to exceed 15 days in a 365-day period. Visitor passes are issued on a daily basis and expire at the end of the day of issuance. Visitor passes are issued following, at a minimum, review of one valid and current State or Federal government issued photo ID. Visitors must be escorted in areas restricted to the general public.

B.2 PERFORMANCE WORK STATEMENT (PWS)

1. Background. This shall be a new services purchase order to support the Environmental and Safety Section (ESS) at VA Illiana Health Care System (VAIHCS). Per the Occupational Safety and Health Administration (OSHA) Respiratory Protection Standard (29 CFR 1920.134), employers shall establish worksite-specific procedures and elements for required respirator use to ensure compliance with the OSHA, including respirator fit test and training for the protection of employees. Training and testing shall be provided to VAIHCS and Community-Based Outpatient Clinics (CBOCs) employees who shall be required to wear the 3M 1860 Health Care Particulate Respirator (N95), MaxAir Systems, such as Powered Air Purifying Respirators (PAPR) and Controlled Air Purifying Respirators (CAPR), or other types of respirators for protection against certain airborne biological particles.

Initial and annual respiratory training shall be required by OSHA 1910.134 (k). Contractor shall provide competent staff who shall be trained and have experience to perform the following: formal training on the use, proper fit, care, inspection, cleaning, maintenance and storage of the respirator, limitations and capabilities of the respirator recognizing medical signs and symptoms that shall limit or prevent the effective use of respirators. Qualitative fit-testing using safe and OSHA approved test agents shall be Saccharin or Bitrex Fit Testing, and training shall be provided in a flexible schedule to meet the needs of VAIHCS. A comprehensive report documenting the results of each employee fit-tested and trained shall be developed and provided. VA, or similar forms, shall be used for employees to sign in. All work shall be coordinated with VAIHCS and CBOCs Industrial Hygienists.

2. Scope. The Contractor shall provide Respirator Fit Test and Training services at the VAIHCS Danville location as well as the following CBOCs: Bloomington, Decatur, Mattoon, Peoria, and Springfield.

3. Quality Control. The Contractor shall develop and maintain an effective Quality Control Plan (QCP) to ensure services are performed in accordance with this PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s QCP should demonstrate how the work complies with the requirement of the purchase order. The QCP is to be provided with the Contractor’s proposal and included as an evaluation factor. After acceptance of the QCP the Contractor shall obtain the Contracting Officer’s (CO’s) acceptance in writing of any proposed change to the QCP.

4. Contractor Responsibilities. In accomplishing any work under this purchase order, the contractor shall be responsible for compliance with any, and all applicable, federal, state, and local government policies, regulations, procedures, specifications, etc., that apply to the work of this nature. In addition, the contractor shall obtain and keep current all licenses, OSHA training, permits, etc., that shall be required by the above-mentioned agencies to accomplish the work. Contractor shall provide proof of competence training, education, and/or certification as a certified Industrial Hygienist by submitting copies of their degree and/or certificate. Fit test administrators shall be competent and trained to know how to conduct a test, recognize invalid results, and properly clean and maintain equipment. Contractor shall include proof of having reasonable experience in Respirator Fit Test and Training by providing documentation of a minimum of 2 companies/organizations and the corresponding number of people that have been fit tested and trained.

The contractor shall send a Respiratory Fit Test and Training Report to the VAIHCS and CBOCs ESS Office by the end of the business day, which shall be an electronic documentation in Microsoft Excel that shall categorize and track fit test and training of healthcare personnel using the information employee provides on the VAIHCS and CBOCs Qualitative Respirator Fit Test Form. Completed VAIHCS and CBOCs Qualitative Respirator Fit Test Forms shall be delivered and filed at the ESS Office by the end of the week. The contractor shall also provide each wearer of a fitted respiratory device a plastic covered credit-card size or similar facsimile record that contains a minimum:

a) Date Tested,

b) Assigned Care Line/Service,

c) Name of employee tested, Occupation

d) Fitted respirator make, model, style, size, and filter type/number, if applicable,

e) Type of fit test performed, and

f) Pass/Fail test results.

5. Contractor Work Hours. The Contractor is required to schedule and complete work any day of the week, for a total of 8 hours to include all sites, either completed in one day or spread over multiple days, except Holidays, as needed. Federal Holidays include:

· New Year’s Day

· Labor Day

· Martin Luther King Jr.’s Birthday

· Columbus Day

· President’s Day

· Veteran’s Day

· Memorial Day

· Thanksgiving Day

· Independence Day

· Christmas Day

Any other day specifically declared by the President of the United States to be a Federal Holiday

When a holiday falls on a Sunday, the following Monday shall be observed as a Federal Holiday by U.S. Government agencies. When a holiday falls on a Saturday, the preceding Friday shall be observed as a Federal Holiday.

6. Facility Check-in Requirements. On each visit, the contractor(s) shall report to the COR or their designee, prior to performing any work. Details shall be discussed with contractor after award of purchase order by the COR.

1. Check-in. The Contractor's representative shall report to the Environmental and Safety Section, Building 102, Room 135-J prior to performance of service at the Danville location. When necessary, Contractor shall report to Police Dispatch. Vendors shall check in with the Office Managers at the CBOCs.

· Identification. The Contractor shall always wear visible identification while on VAIHCS and CBOCs premises.

7. Respirator Fit Test Training. Contractor shall schedule for Respiratory Fit Test and Training with VAIHCS and CBOCs employees through direct communication (phone). The training and testing shall both be done simultaneously in one appointment. If necessary, Contractor shall coordinate with VAIHCS Occupational Safety and Health (OSH) and CBOCs to ensure VAIHCS and CBOCs employees have completed medical evaluations through VAIHCS OSH and CBOCs prior to Respiratory Fit Test and Training. Contractor shall be able to provide training to VAIHCS and CBOCs employees under two categories of respirator users (involuntary/Mandatory and Voluntary/Not Required), which as a minimum must include:

a) why the respirator shall be necessary and how to improper fit, use, or maintenance can compromise the protective effect of the respirator,

b) limitations and capabilities of the respirator,

c) how to inspect, put on and remove, use and check the seals of the respirator,

d) procedures for maintenance and storage,

e) recognition of medical signs and symptoms that shall limit or prevent effective use, and

f) general requirements of the respirator standard.

8. Contractor Assessment of Test Subject. Purchase order shall ensure an assessment of comfort and fit of the respirator shall be performed on each test subject and that the test subject shall be allowed adequate time to determine the comfort of the respirator using the following points of view:

a) position of respirator on the nose,

b) room for eye protection,

c) room to talk,

d) position of the respirator on the face and cheeks,

e) chin properly placed,

f) adequate strap tension not overly tightened,

g) fit across the bridge of the nose,

h) respirator of proper size to span distance from nose to chin, and

i) tendency of respirator to slip.

9. Purchase Order Fit Test Assessment For Test Subject. Contractor shall use an OSHA accepted Fit Test Protocol (i.e. Qualitative/Quantitative Fit Test), per OSHA 1910.134 for each test subject fitted, tested and issued a National Institute for Occupational Safety and Health (NIOSH) Approved respiratory device. Contractor shall ensure the test subject conducts a user seal check, either the negative and positive pressure seal check as described in OSHA Standard Appendix B-1 or those recommended by the respirator manufacturer which provides equivalent protection to the procedures in Appendix B-1. The Contractor shall discontinue or not fit test a test subject, if any of the following shall be detected:

a) Hair growth, such as stubble beard growth, beard, mustache or sideburns between the skin and respirator face-piece that prevents or interferes with respirator face seal,

b) any apparel which interferes which a satisfactory fit,

c) Test subject exhibits difficulty in breathing during the tests, the contractor shall refer the employee back to VAIHCS OSH and shall coordinate with VAIHCS OSH, CBOCs and the employee to determine whether the test subject can wear a respirator while performing her or his duties.

The Contractor shall provide a Respiratory Fit Test and Training Report by close of business each day fit test and training is conducted.

10. Performance Monitoring. The Contracting Officer’s Representative (COR) shall coordinate with the Contractor to ensure that the Contractor has appropriate employee contact information to coordinate scheduling for Respiratory Fit Test and Training. The COR shall routinely review the Respiratory Fit Test and Training Report to ensure that the Contractor completes record keeping requirements in accordance with this purchase order. The Contractor shall submit monthly invoices that includes a spreadsheet of services provided.

11. Government-Furnished Equipment (GFE)/Government-Furnished Information (GFI). There shall not be any government-furnished equipment or information required for this purchase order. Contractor shall furnish all labor, materials, equipment, Personal Protective Equipment (PPE), insurance and supervision to complete work in a professional manner, comply with the VAIHCS’s and CBOC’s criteria, and meet all Federal, state, and local regulations. VAIHCS and CBOCs shall supply the respirators (3M 1860 Health Care Particulate Respirator (N95), MaxAir Systems of Powered Air Purifying Respirators (PAPRs) and Controlled Air Purifying Respirators (CAPRs), or other types of respirators for fitting and distribution to employees who successfully pass the fit test. Contractor shall support the VAIHCS and CBOCs ESS in preparation and assembly of PAPRs and CAPRs as necessary. Distribution of PAPRs and CAPRs must be coordinated with the VAIHCS and CBOCs Industrial Hygienist under ESS.

12. Other Pertinent Information or Special Considerations.

1.

2.

3.

4.

5.

6.

As a non-personal services purchase order, any staff shall not be considered VA employees for any purpose. Contractor retains all control over monitoring staff and responsibility for direct supervision. Purchase order staff shall not supervise VA staff, but shall provide direction and instruction as required by duties. Daily activity shall be monitored and managed by the primary or alternate CORs.

13. Risk Control. Not Applicable.

14. Place of Performance. The primary location for services shall be at the VAIHCS Danville location, 1900 East Main Street, as well as the following CBOCs:

Bloomington 207 Hamilton Road Bloomington, IL 61704-7527

Decatur 792 N. Sunnyside Road Decatur, IL 62522

Mattoon 501 Lakeland Blvd.

Mattoon, IL 61938

Peoria 7717 N. Orange Prairie Road Peoria, IL 61615

Springfield 5850 South 6th Street, Suite A Springfield, IL 62703

QUALITY ASSURANCE SURVEILLANCE PLAN

Version – June 2010

Respiratory Services Contract Number: < upon award, enter contract number> Contract Description: VAIHCS and CBOCs Respirator Fit Test and Training Services Contractor’s name: < upon award, enter contractor name > (hereafter referred to as the contractor)

1. PURPOSE.

This Quality Assurance Surveillance Plan (QASP), derived from the Performance Work Statement (PWS), provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

· What will be monitored,

· How monitoring will take place,

· Who will conduct the monitoring,

· How monitoring efforts and results will be documented.

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance. In addition, the QASP should recognize that unforeseen and uncontrollable situations may occur.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Updates shall ensure that the QASP remains a valid, useful, and enforceable document. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

The following FAR clauses may apply depending on contract type:

52.246-6 Inspection of Services – Time-and-Material and Labor-Hour

2. CONTRACTOR RESPONSIBILITIES

a. Quality Control. The contractor shall comply with the PWS and maintain/furnish the following if requested by the Contracting Officer or COR.

· Records of all Respiratory Fit Test and Training, which shall be an electronic documentation in Microsoft Excel that shall categorize and track fit test and training of healthcare personnel using the information employee provides on the VAIHCS and CBOCs Qualitative Respirator Fit Test Forms.

· Up-to-date certifications, tests, and training records of contractor performing services under this contract.

· A record of log of all requests for service including date and time of service call, actual time of pick-up versus the scheduled time, name of the 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.

b. Administration & Management. The contractor shall:

· Inform the VA when the Contractor’s organizational or management structure has changed and provide the VA with an updated employee roster and contact information.

· Inform the COR when respirator supplies are low.

c. Equipment, Vehicles, and Inspection. The Contractor shall comply with the requirements of the PWS and all applicable Federal, State, and local laws and regulations.

3. GOVERNMENT ROLES AND RESPONSIBILITIES

The following personnel shall oversee and coordinate surveillance activities.

a. The Contracting Officer shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The Contracting Officer shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract and is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

Assigned CO: Joni Dorr

b. Contracting Officer’s Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. At the conclusion of the contract or when requested by the Contracting Officer, the COR shall provide documentation to the Contracting Officer. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. The contractor shall refer any changes they deem may affect contract price, terms, or conditions to the Contracting Officer for action.

Assigned COR: Margaret McDonald

4. CONTRACTOR REPRESENTATIVES

The following employee(s) of the contractor serves as the contractor’s program manager for this contract.

Name:

5. DELIVERABLES/WORK REQUIREMENTS

List below the deliverables/tasks specified in the Performance Work Statement (PWS).

· Deliverable 1 – Quality Control Plan

· Deliverable 2 – Competence Education, Training, and/or Certification Records

· Deliverable 3 – Respiratory Fit Test and Training Report

· Deliverable 4 – Invoice Reports

6. PERFORMANCE STANDARD

· Deliverable 1 – Quality Control Plan

· The Contractor shall provide Quality Control Plan (QCP) to identify, prevent, and ensure non-recurrence of defective services.

· Deliverable 2 – Competence Education, Training, and/or Certification Records

· Contractor shall provide proof of competence training, education, and/or certification as a certified Industrial Hygienist by submitting copies of their degree and/or certificate. Fit test administrators shall be competent and trained to know how to conduct a test, recognize invalid results, and properly clean and maintain equipment. Contractor shall include proof of having reasonable experience in Respirator Fit Test and Training by providing documentation of a minimum of 2 companies/organizations and the corresponding number of people that have been fit tested and trained.

· Deliverable 3 – Respiratory Fit Test and Training Report

· The Contractor shall provide a Respiratory Fit Test and Training Report by close of business each day fit test and training is conducted.

· Deliverable 4 – Invoice Report

· Provide a monthly invoice in accordance with Section 4.9 of the PWS.

7. ACCEPTABLE QUALITY LEVEL

· Deliverable 1 – Quality Control Plan - 95% at review of proposal.

· Deliverable 2 – Competence Education, Training, and/or Certification Records - 95%

· Deliverable 3 – Respiratory Fit Test and Training Report - 95%

· Deliverable 4 – Invoice Reports - 95% per monthly billing period.

8. METHOD OF SURVEILLANCE

· Deliverable 1 – Quality Control Plan – review at proposal and continual as necessary.

· Deliverable 2 – Competence Education, Training, and/or Certification Records – review at proposal and continual as necessary.

· Deliverable 3 – Respiratory Fit Test and Training Report – review upon submission and customer feedback.

· Deliverable 4 – Invoice Reports – 100% inspection of monthly invoice/reports.

9. RATINGS

To be completed by the Government after Contractor performance. Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level.

A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:

Excellent = Exceeds Standards Satisfactory = Meets Standards Unsatisfactory = Fails to Meet Standards

10. QASP SUMMARY TABLE

11. INCENTIVES

The Government shall use past performance as incentives. Incentives shall be based on exceeding, meeting, or not meeting performance standards.

12. DOCUMENTING PERFORMANCE

The CO shall document the Contractor’s performance for the record for its completeness and accuracy.

a. ACCEPTABLE PERFORMANCE: The Government shall document positive performance. The report will include the Date, Time, and Observation.

b. UNACCEPTABLE PERFORMANCE: When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR) and present it to the contractor's task manager or on-site representative.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor must present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

Any CDRs may become a part of the supporting documentation for contract payment deductions, fixed fee deductions, award fee nonpayment, or other actions deemed necessary by the Contracting Officer.

B.3 PRICE/COST SCHEDULE

Pricing will be all inclusive, including travel.

ITEM INFORMATION

Certified Industrial Hygienist (See PWS)

Contract Period: Base POP Begin: 06-15-2021 POP End: 06-15-2022

SECTION C – CONTRACT (PURCHASE ORDER) 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 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS SUBCONTRACTORS (DEC 2013) (DEVIATION AUG 2020)

(a) (1) In accordance with 31 U.S.C. 3903 and 10 U.S.C. 2307, upon receipt of accelerated payments from the Government, the Contractor shall make accelerated payments to its small business subcontractors under this contract in accordance with the accelerated payment date established, to the maximum extent practicable and prior to when such payment is otherwise required under the applicable contract or subcontract, with a goal of 15 days after receipt of a proper invoice and all other required documentation from the small business subcontractor if a specific payment date is not established by contract.

(2) The Contractor agrees to make such payments to its small business subcontractors without any further consideration from or fees charged to the subcontractor.

(b) The acceleration of payments under this clause does not provide any new rights under the Prompt Payment Act.

(c) Include the substance of this clause, including this paragraph (c), in all subcontracts with small business concerns, including subcontracts with small business concerns for the acquisition of commercial items.

(End of Clause) C.3 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA ACQUISITION OF COMMERCIAL ITEMS (APR 2020)

(a) The Contractor agrees to comply with any provision or clause that is incorporated herein by reference to implement agency policy applicable to acquisition of commercial items or components. The following provisions and clauses that have been checked by the Contracting Officer are incorporated by reference.

[X] 852.203–70, Commercial Advertising.

[] 852.209–70, Organizational Conflicts of Interest.

[] 852.211–70, Equipment Operation and Maintenance Manuals.

[] 852.214–71, Restrictions on Alternate Item(s).

[] 852.214–72, Alternate Item(s). [Note: this is a fillable clause.] [] 852.214–73, Alternate Packaging and Packing.

[] 852.214–74, Marking of Bid Samples.

[] 852.215–70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors.

[] 852.215–71, Evaluation Factor Commitments.

[] 852.216–71, Economic Price Adjustment of Contract Price(s) Based on a Price Index.

[] 852.216–72, Proportional Economic Price Adjustment of Contract Price(s) Based on a Price Index.

[] 852.216–73, Economic Price Adjustment—State Nursing Home Care for Veterans.

[] 852.216–74, Economic Price Adjustment—Medicaid Labor Rates.

[] 852.216–75, Economic Price Adjustment—Fuel Surcharge.

[] 852.219–9, VA Small Business Subcontracting Plan Minimum Requirements.

[X] 852.219–10, VA Notice of Total Service-Disabled Veteran-Owned Small Business Set-Aside.

[] 852.219–11, VA Notice of Total Veteran-Owned Small Business Set-Aside.

[] 852.222–70, Contract Work Hours and Safety Standards—Nursing Home Care for Veterans.

[] 852.228–70, Bond Premium Adjustment.

[] 852.228–71, Indemnification and Insurance.

[] 852.228–72, Assisting Service-Disabled Veteran-Owned and Veteran-Owned Small Businesses in Obtaining Bonds.

[X] 852.232–72, Electronic Submission of Payment Requests.

[] 852.233–70, Protest Content/Alternative Dispute Resolution.

[] 852.233–71, Alternate Protest Procedure.

[] 852.237–70, Indemnification and Medical Liability Insurance.

[] 852.246–71, Rejected Goods.

[] 852.246–72, Frozen Processed Foods.

[] 852.246–73, Noncompliance with Packaging, Packing, and/or Marking Requirements.

[X] 852.270–1, Representatives of Contracting Officers.

[] 852.271–72, Time Spent by Counselee in Counseling Process.

[] 852.271–73, Use and Publication of Counseling Results.

[] 852.271–74, Inspection.

[] 852.271–75, Extension of Contract Period.

[X] 852.273–70, Late Offers.

[] 852.273–71, Alternative Negotiation Techniques.

[] 852.273–72, Alternative Evaluation.

[] 852.273–73, Evaluation—Health-Care Resources.

[] 852.273–74, Award without Exchanges.

(b) All requests for quotations, solicitations, and contracts for commercial item services to be provided to beneficiaries must include the following clause:

[] 852.237–74, Nondiscrimination in Service Delivery.

(End of Clause) C.4 VAAR 852.219-74 Limitations on Subcontracting—Monitoring and Compliance. (JUL 2018)

(a) This solicitation includes the following set-aside clause:

(i) 852.219-10 VA Notice of Total Service-Disabled Veteran-Owned Small Business Set-Aside (JUL 2019) (DEVIATION)

(b) Accordingly, any contract resulting from this solicitation is subject to the limitation on subcontracting requirements in 13 CFR 125.6. The Contractor is advised that in performing contract administration functions, the Contracting Officer may use the services of a support contractor(s) retained by VA to assist in assessing the Contractor’s compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to Contractor’s offices where the Contractor’s business records or other proprietary data are retained and to review such business records regarding the Contractor’s compliance with this requirement.

(c) All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the Contractor’s business records or other proprietary data reviewed or obtained in the course of assisting the Contracting Officer in assessing the Contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs.

(d) Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the Contractor to protect proprietary information as required by FAR 9.505-4, Obtaining access to proprietary information, paragraph (b). The Contractor is required to cooperate fully and make available any records as may be required to enable the Contracting Officer to assess the Contractor’s compliance with the limitations on subcontracting or percentage of work performance requirement.

(End of clause)

C.5 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

The key personnel specified in this contract are considered to be essential to work performance. At least 30 days prior to the Contractor voluntarily diverting any of the specified individuals to other programs or contracts the Contractor shall notify the Contracting Officer and shall submit a justification for the diversion or replacement and a request to replace the individual. The request must identify the proposed replacement and provide an explanation of how the replacement’s skills, experience, and credentials meet or exceed the requirements of the contract. If the employee of the Contractor is terminated for cause or separates from the contractor voluntarily with less than thirty days notice, the Contractor shall provide the maximum notice practicable under the circumstances. The Contractor shall not divert, replace, or announce any such change to key personnel without the written consent of the Contracting Officer. The contract will be modified to add or delete key personnel as necessary to reflect the agreement of the parties.

(End of Clause)

C.6 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

The Contracting Officer reserves the right to designate an Administrative Contracting Officer (ACO) for the purpose of performing certain tasks/duties in the administration of the contract. Such designation will be in writing through an ACO Letter of Delegation and will identify the responsibilities and limitations of the ACO. A copy of the ACO Letter of Delegation will be furnished to the Contractor.

(End of Clause) (End of Addendum to 52.212-4)

C.7 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2021) (JUL 2020) (DEVIATION)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)).

(2) 52.204–23, Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities (Jul 2018) (Section 1634 of Pub. L. 115–91).

(3) 52.204–25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment. (AUG 2020) (Section 889(a)(1)(A) of Pub. L. 115–232).

(4) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (NOV 2015).

(5) 52.233-3, Protest After Award (Aug 1996) (31 U.S.C. 3553).

(6) 52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Public Laws 108-77 and 108-78 (19 U.S.C. 3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

[] (1) 52.203–6, Restrictions on Subcontractor Sales to the Government (JUN 2020), with Alternate I (OCT 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402).

[] (2) 52.203–13, Contractor Code of Business Ethics and Conduct (JUN 2020) (41 U.S.C. 3509).

[] (3) 52.203–15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (JUN 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.)

[X] (4) 52.204–10, Reporting Executive Compensation and First-Tier Subcontract Awards (JUN 2020) (Pub. L. 109–282) (31 U.S.C. 6101 note).

[] (5) [Reserved] [] (6) 52.204–14, Service Contract Reporting Requirements (OCT 2016) (Pub. L. 111–117, section 743 of Div. C).

[] (7) 52.204–15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts (OCT 2016) (Pub. L. 111–117, section 743 of Div. C).

[X] (8) 52.209–6, Protecting the Government’s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (JUN 2020) (31 U.S.C. 6101 note).

[] (9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Oct 2018) (41 U.S.C. 2313).

[] (10) [Reserved] [] (11)(i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (MAR 2020) (15 U.S.C. 657a).

[] (ii) Alternate I (MAR 2020) of 52.219-3.

[] (12)(i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (MAR 2020) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a).

[] (ii) Alternate I (MAR 2020) of 52.219-4.

[] (13) [Reserved] [X] (14)(i) 52.219-6, Notice of Total Small Business Set-Aside (NOV 2020) (15 U.S.C. 644).

[] (ii) Alternate I (MAR 2020) of 52.219-6.

[] (15)(i) 52.219-7, Notice of Partial Small Business Set-Aside (NOV 2020) (15 U.S.C. 644).

[] (ii) Alternate I (MAR 2020) of 52.219-7.

[] (16) 52.219-8, Utilization of Small Business Concerns (Oct 2018) (15 U.S.C. 637(d)(2) and (3)).

[] (17)(i) 52.219–9, Small Business Subcontracting Plan (JUN 2020) (15 U.S.C. 637(d)(4)).

[] (ii) Alternate I (NOV 2016) of 52.219-9.

[] (iii) Alternate II (NOV 2016) of 52.219-9.

[] (iv) Alternate III (JUN 2020) of 52.219–9.

[] (v) Alternate IV (JUN 2020) of 52.219–9.

[] (18)(i) 52.219-13, Notice of Set-Aside of Orders (MAR 2020) (15 U.S.C. 644(r)).

[] (ii) Alternate I (MAR 2020) of 52.219-13.

[] (19) 52.219-14, Limitations on Subcontracting (MAR 2020) (15 U.S.C. 637(a)(14)).

[] (20) 52.219-16, Liquidated Damages—Subcontracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)).

[] (21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (MAR 2020) (15 U.S.C. 657f).

[X] (22)(i) 52.219-28, Post Award Small Business Program Rerepresentation (NOV 2020) (15 U.S.C 632(a)(2)).

[] (ii) Alternate I (MAR 2020) of 52.219-28.

[] (23) 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically Disadvantaged Women-Owned Small Business (EDWOSB) Concerns (MAR 2020) (15 U.S.C. 637(m)).

[] (24) 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small Business Concerns Eligible Under the Women-Owned Small Business Program (MAR 2020) (15 U.S.C. 637(m)).

[X] (25) 52.219-32, Orders Issued Directly Under Small Business Reserves (MAR 2020) (15 U.S.C. 644(r)).

[] (26) 52.219-33, Nonmanufacturer Rule (MAR 2020) (15 U.S.C. 637(a)(17)) [X] (27) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

[] (28) 52.222–19, Child Labor—Cooperation with Authorities and Remedies (JUL 2020) (DEVIATION) (E.O. 13126).

[X] (29) 52.222-21, Prohibition of Segregated Facilities (APR 2015).

[X] (30)(i) 52.222–26, Equal Opportunity (SEP 2016) (E.O. 11246).

[] (ii) Alternate I (FEB 1999) of 52.222-26.

[] (31)(i) 52.222–35, Equal Opportunity for Veterans (JUN 2020) (38 U.S.C. 4212).

[] (ii) Alternate I (JULY 2014) of 52.222-35.

[X] (32)(i) 52.222–36, Equal Opportunity for Workers with Disabilities (JUN 2020) (29 U.S.C. 793).

[] (ii) Alternate I (JULY 2014) of 52.222-36.

[] (33) 52.222–37, Employment Reports on Veterans (JUN 2020) (38 U.S.C. 4212).

[] (34) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O. 13496).

[X] (35)(i) 52.222-50, Combating Trafficking in Persons (OCT 2020) (22 U.S.C. chapter 78 and E.O. 13627).

[] (ii) Alternate I (MAR 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627).

[] (36) 52.222-54, Employment Eligibility Verification (OCT 2015). (E. O. 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.)

[] (37)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA-Designated Items (May 2008) (42 U.S.C.6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

[] (ii) Alternate I (MAY 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

[] (38) 52.223-11, Ozone-Depleting Substances and High Global Warming Potential Hydrofluorocarbons (JUN 2016) (E.O. 13693).

[] (39) 52.223-12, Maintenance, Service, Repair, or Disposal of Refrigeration Equipment and Air Conditioners (JUN 2016) (E.O. 13693).

[] (40)(i) 52.223-13, Acquisition of…