36C25222Q0701.docx

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE

DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a.

PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

PHONE:

FAX:

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

SEE

ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

26.

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

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212

-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNAT

URE OF OFFEROR/CONTRACTOR

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

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

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

607-22-4-6022-0145 36C25222Q0701 07-26-2022 Pasholk,Susan 414-844-4846 08-15-2022 10:00

CDT

36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101 Milwaukee WI 53214-1476 X X 811219 $22 Million N/A X 36C252

WILLIAM S. MIDDLETON VA HOSPITAL

Department of Veterans Affairs

2500 OVERLOOK TERRACE

MADISON WI 53705-2286

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

MEDICAL GAS TESTING AND INSPECTION AT MADISON VA HOSPITAL

PER STATEMENT OF WORK

BASE PERIOD 9/1/2022 - 8/31/2023

OPTION 1 PERIOD 9/1/2023 - 8/31/2024

OPTION 2 PERIOD 9/1/2024 -

8/31/2025

OPTION 3 PERIOD 9/1/2025 - 8/31/2026

OPTINO 4 PERIOD 9/1/2026 - 8/31/2027

VA POC: JAMES CULP 608-256-1901 X13197

CO: SUSAN PASHOLK 414-844-4846

100% SMALL BUSINESS SET-ASIDE

See CONTINUATION Page 607-3620162-6022-855100-2580 010050100 X X X

SUSAN PASHOLK

CONTRACTING OFFICER

SECTION B - CONTINUATION OF SF 1449 BLOCKS

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

a. CONTRACTOR:

CONTRACTOR NAME _____________________________________

ADDRESS _____________________________________

CITY-STATE-ZIP _____________________________________

POINT OF CONTACT/TITLE _____________________________________

UNIQUE ENTITY INDENTIFIER _____________________________________

DUNS NUMBER NO. _____________________________________

b. GOVERNMENT: SUSAN PASHOLK, CONTRACTING OFFIER

CONTRACTING OFFICE CODE: 36C252

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 FOR AWARD MANAGEMENT (OCT 2018)

3. INVOICES:

a. Invoices shall be submitted 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 Veterans Affairs (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/veteransaffairs/ 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 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. From this RFQ, the Government intends to award a firm fixed price contract 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 contract.

6. SITE VISIT:

It is strongly suggested and expected that the offeror inspect the campus to be serviced to fully understand the nature of the work and the conditions under which the work is to be performed. In no case shall failure to inspect the campus constitute grounds for a claim after contract award.

SITE VISIT IS SCHEDULED FOR THURSDAY AUGUST 4, 2022 AT 11:00 AM LOCAL TIME. ALL INTERESTED PARTIES TO MEET COR JAMES CULP (608-256-1901 X13197) AT ENGINEERING SHOP ROOM GB1-07.

PLEASE NOTE: WHILE ON CAMPUS, ALL PERSONS WILL BE REQUIRED TO WEAR MASKS INSIDE ANY VAMC BUILDING AND WHILE TRAVELING IN VEHICLES FOR PURPOSES OF THE SITE VISIT.

7. 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 Officer (CO) susan.pasholk@va.gov no later than FRIDAY AUGUST 5, 2022 AT NOON LOCAL TIME. Contracting will issue a consolidated response via solicitation amendment to https://sam.gov Contract Opportunities within 2 business days to all parties

8. CONTRACTING OFFICER AUTHORITY:

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.

9. IDENTIFICATION, PARKING, SMOKING AND VA REGULATIONS:

a. All VA property is considered Federal property and all Federal laws are applicable.

b. 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.

c. All VA facilities are drug free. Possession of drugs, to include Marijuana and all Marijuana bi-products are 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.

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

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

f. 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.

g. 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.

10. VHA SUPPLEMENTAL CONTRACT REQUIREMENTS FOR COMBATTING COVID-19

1. Contractor employees who work in or travel to VHA locations must comply with the following:

a. Documentation requirements:

1) If fully vaccinated, contractors shall show proof of vaccination.

i. NOTE: Acceptable proof of vaccination includes a signed record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), or a copy of medical records documenting the vaccination.

2) If unvaccinated, contractors shall show negative COVID-19 test results dated within three calendar days prior to desired entry date. Test must be approved by the Food and Drug Administration (FDA) for emergency use or full approval. This includes tests available by a doctor’s order or an FDA approved over-the-counter test that includes an affiliated telehealth service.

3) Documentation cited in this section shall be digitally or physically maintained on each contractor employee while in a VA facility and is subject to inspection prior to entry to VA facilities and after entry for spot inspections by Contracting Officer Representatives (COR) or other hospital personnel.

4) Documentation will not be collected by the VA; contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

2. Contractor employees are subject to daily screening for COVID-19 and may be denied entry to VA facilities if they fail to pass screening protocols. As part of the screening process contractors may be asked screening questions found on the COVID-19 Screening Tool. Check regularly for updates.

a. Contractor employees who work away from VA locations, but who will have direct contact with VA patients shall self-screen utilizing the COVID-19 Screening Tool, in advance, each day that they will have direct patient contact and in accordance with their person or persons who coordinate COVID-19 workplace safety efforts at covered contractor workplaces. Contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information.

3. Contractor must immediately notify their COR or Contracting Officer if contract performance is jeopardized due to contractor employees being denied entry into VA Facilities.

1. For indefinite delivery contracts: Contractor agrees to comply with VHA Supplemental Contract Requirements for any task or delivery orders issued prior to this modification when performance has already commenced.

11. SECURITY & PRIVACY CONTROL:

The Authorization & Accreditation (A&A) requirements of VHA Handbook 6500.6 do not apply to this requirement. 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.

12. FACILITY CHECK-IN/OUT REQUIREMENT:

The Contractor shall be required to report to Engineering Shop GB1-07 to sign-in. This check-in is mandatory. The Contractor technicians shall also be required to log-out.

Upon completion of each service visit, the Contractor shall complete a written report as noted in the Statement of Work.

VA Contact Person(s): James Culp Telephone Number & Extension(s): 608-256-1901 x13197

Contractor- Provide telephone number(s) to call for your service: _____________________ Provide name(s) of authorized contact person(s): ___________________________________

SUPPLIES OR SERVICES AND PRICES/COSTS

MEDICAL GAS TESTING AND INSPECTION

ITEM INFORMATION

AMOUNT

Medical Gas and Vacuum System Inspection and Testing per Statement of Work Contract Period: Base POP Begin: 09-01-2022 POP End: 08-31-2023 PRINCIPAL NAICS CODE: 811219 - Other Electronic and Precision Equipment Repair and Maintenance PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

OPTIONAL LINE ITEM Hourly Rate that will be charged for repair work paid separately from this contract.

Contract Period: Base POP Begin: 09-01-2022 POP End: 08-31-2023

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

Medical Gas and Vacuum System Inspection and Testing per Statement of Work Contract Period: Option 1 POP Begin: 09-01-2023 POP End: 08-31-2024

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

OPTIONAL LINE ITEM Hourly Rate that will be charged for repair work paid separately from this contract.

Contract Period: Option 1 POP Begin: 09-01-2023 POP End: 08-31-2024

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

Medical Gas and Vacuum System Inspection and Testing per Statement of Work Contract Period: Option 2 POP Begin: 09-01-2024 POP End: 08-31-2025

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

OPTIONAL LINE ITEM Hourly Rate that will be charged for repair work paid separately from this contract.

Contract Period: Option 2 POP Begin: 09-01-2024 POP End: 08-31-2025

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

Medical Gas and Vacuum System Inspection and Testing per Statement of Work Contract Period: Option 3 POP Begin: 09-01-2025 POP End: 08-31-2026

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

OPTIONAL LINE ITEM Hourly Rate that will be charged for repair work paid separately from this contract.

Contract Period: Option 3 POP Begin: 09-01-2025 POP End: 08-31-2026

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

Medical Gas and Vacuum System Inspection and Testing per Statement of Work Contract Period: Option 4 POP Begin: 09-01-2026 POP End: 08-31-2027

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

OPTIONAL LINE ITEM Hourly Rate that will be charged for repair work paid separately from this contract.

Contract Period: Option 4 POP Begin: 09-01-2026 POP End: 08-31-2027

PRODUCT/SERVICE CODE: H265 - Equipment and Materials Testing - Medical, Dental, and Veterinary Equipment and Supplies

STATEMENT OF WORK

MEDICAL GAS TESTING AND INSPECTION

The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items necessary to perform Medical Gas Preventative Maintenance, Inspection and Certification as outlined in the Statement of Work (SOW) at the William S. Middleton VA Hospital, 2500 Overlook Terrace, Madison, WI. The contractor shall perform to the standards stated in this contract.

1.0 GENERAL OVERVIEW

1.1 The contractor shall provide Annual Medical Gas Preventative Maintenance, Inspection and Certification located at the William S. Middleton VA Hospital in Madison, WI. on the following equipment:

A. Medical Air Compressor B. Nitrous Oxide Manifold C. Nitrogen Manifold D. Carbon Dioxide Manifold E. Medical Vacuum Unit F. Master Alarms G. Area Alarms H. Zone Valve Boxes I. Gas Purity

1.2 Contractor shall notify COR of any emergent deficiencies immediately upon discovery during inspection. At the end of each inspection, the technician shall review deficiencies with the COR prior to leaving the facility.

1.3 Within 20 business days of inspection completion, contractor shall provide a report detailing/confirming the maintenance items that were completed along with an evaluation report of all items listed in the scope of work.

1.4 Contractor shall provide certification of all the medical gas systems listed in the scope of work. The report shall also include any recommendations noted during inspection.

1.5 If any deficiencies are noted, contractor shall provide a quote (labor/parts) for repair of the deficiencies broken down with each deficiency as a separate line item. Repairs will be paid separate from this contract, on a separate purchase order at the rates specified on Optional Line Items 0002, 1002, 2002, 3002 and 4002. Repair work shall not commence without separate Purchase Order being issued.

1.6 Contractor shall provide trouble-shooting emergency telephone response 24/7/365 within 30 minutes of call being placed.

2.0 SCOPE/SPECIFIC TASKS

Contractor shall perform the following tasks:

A. Medical Air Compressor

a. Details

· Location: B8049

· Manufacturer: Beacon

· Model: LPS-10D-SD120-DAY

b. Provide, semi-annually, the below preventative maintenance items:

1. Drain receiver tank and check traps for proper operation

2. Check operation of the cut-in and cut-out pressure controls

3. Clean and degrease the compressor coiling fins

4. Check and adjust belt tension

5. Check belt condition.

6. Check sheave alignment and level of shafts

7. Check operation of unloader and check valves

8. Check high pressure safety relief valves

9. Record compressor run times

10. Check operation of all safety relief valves

11. Inspect coalescent filters and change

12. Record pressure reducing valve settings and adjust as required

13. Check operation of all valve assemblies as required

14. Ensure that lead/lag sequencing controls are operating compressors efficiently

c. Provide, annually, the below preventative maintenance items:

1. Replace belts

2. Replace dew point sensor and CO sensor with new

3. Replace the air intake filters

4. Replace the desiccant beads in the Base Year and Option Year 4.

d. Perform an annual inspection for the Medical Air Compressor. Confirm the following in the report and note any deficiencies:

1. Report Line Pressure:

· Medical Air

· Lab Air

2. Medical Air System is dedicated to the Medical Air System only

3. Medical Air System is used for the laboratory

4. Flexible connectors are located on the inlet / outlet side of the compressor

5. Are mechanical sources operational

6. Manufacturer components are UL listed

7. Isolation valves present at each compressor and the receiver

8. Lead / Lag cut in and out set at the proper settings

9. The Lag Alarm is installed on the Master Alarm panel

10. The Lag Alarm functions properly

11. The High Temp shutdown is installed on the control panel/ local alarm

12. The High Temp Alarm activates the Master Alarm panel

13. Automatic alteration of the compressors

14. System controlled by means of the Emergency Electrical System

15. Manual system disconnection installed on the control panel

16. There is a manual receiver drain installed

17. There is an automatic receiver drain installed on the receiver

18. The receiver can be isolated from the medical air system piping

19. The receiver has a three valve or single valve bypass

20. The receiver has an ASME Boiler and Pressure Code Stamp installed

21. The Medical Air System have Anti- Vibration pads installed under the unit, pump to frame

22. All isolation valves labeled properly

23. The Source Valve is located in a dedicated space

24. The mechanical space is adequately ventilated, constructed

25. The area is ventilated to prevent accumulation of heat beyond manufacturers temp range

26. All components of the system are OEM recommended materials

27. Duplexed final line regulators are present that can be isolated

28. The regulator can be fully isolated from the complete system

29. Intermediate and final line relief valve present

30. No leaks are discovered in the compressor system

31. Main line valve present where source is remote to the building

32. The main valve is located just inside the building area downstream of the Source Valve

33. The main valve is labeled with the correct gas, area controlled, and emergency instructions

34. Source valve present adjacent to the source equipment

35. The source valve is labeled with the correct gas, area controlled, and emergency instructions

36. The source valve is located in a restricted area of the building

37. The main line has a pressure switch located adjacent to the main/ source valve

38. Is there a DISS Check valve on the pressure switch

39. The main line has a pressure gauge located adjacent to the main / source valve

40. There is a DISS Check valve on the pressure gauge

41. The gauge is visible from a standing position

42. The materials used in the manifold assembly are cleaned for oxygen use

43. Hard tempered tubing in use only

44. All turns and changes in direction made with fittings and are brazed together

45. All exposed piping is protected from physical damage

46. The Medical Air System has a 1/4" sampling port located at the compressor unit

47. Receiver drain piped to the floor drain

48. Intake located outdoors where it will not be affected by vehicles, public areas

49. The intake is at a different level than the exhaust and is at least 10' from any door or window

50. The intake is screened to keep debris, etc. out

51. Intake system is made up of hard drawn copper, stainless steel

52. Drip legs are installed in the medical air intake to eliminate liquid backup

53. The intake has proper labeling

54. There is a Dew Point monitor installed downstream of the regulator station

55. The Dew Point is wired to the Master Alarm panel

56. There is a CO Monitor installed downstream of the regulator station

57. The CO Monitor is wired to the Master Alarm panel

58. The High-Pressure Switch activates the Master Alarm locations

59. The Low-Pressure Switch activates the Master Alarm locations

60. There are two dryers installed in the Medical Air System either Refrigerated or Desiccant Type

61. There is a Pressure Relief Vent located on the downstream side of each compressor

62. Check valves are located / installed after each compressor unit

63. There is an aftercooler installed after each compressor unit to reduce heat from the compressor

64. There is a Pressure Relief Valve located on the downstream side of the regulator station?

65. Each dryer can be isolated from the system

66. There are final line filters installed at the dryer station

67. The filter assembly and regulator station can be isolated from service by way of a valved bypass

68. There are a dual set of regulators / filters that can be removed from service

69. There is a pressure gauge located on each regulator station with a pressure relief valve

e. Provide recommendations for any deficiencies and a quote to repair (labor/parts)

B. Nitrous Oxide Manifold C. Nitrogen Manifold D. Carbon Dioxide Manifold

a. Details:

· Nitrous Oxide Manifold

· Location: B8057A

· Manufacturer: Allied

· Nitrogen Manifold

· Location: B8057A

· Manufacturer: Allied

· Carbon Dioxide Manifold

· Location: D8207

· Manufacturer: Beacon Lifeline

b. Perform an annual inspection of the Nitrous Oxide Manifold, the Nitrogen Manifold and the Carbon Dioxide Manifold. Confirm the following in the report and note any deficiencies:

1. Manufacturer components UL Listed

2. The area contains only manifolds and/or cryogenic cylinders

3. The area is free of flammable materials, open flames, engines, open electrical contacts

4. Cylinders are protected from reaching temp below 20oF or above 130o F

5. Area doors lockable with a 1-HR rating

6. The manifold enclosure contains signage- High Pressure Cylinders, No Smoking

7. Accessible for delivery of cylinders, means to secure them to a solid structure

8. The manifold room is heated indirectly

9. The manifold room has a mechanical exhaust or an atmospheric with 144 Sq In each side?

10. All electrical components located and protected from cylinders, container

11. Manifold located outside designed for such use with a NEMA 4 enclosure

12. The manifold has an equal number of cylinders on each side of header bar

13. The reserve header bar has a minimum of 3 cylinders

14. The header bar has an isolation valve installed on each side

15. Check valves are present in the header bar to prevent backflow

16. The manifold alternates from one side to the other automatically

17. The secondary header bar automatically begins supply when the primary is depleted

18. One-way check valve present in the header bar to prevent backflow

19. The reserve automatically activates when the primary and secondary are depleted

20. The manifold is controlled by an emergency circuit

21. The manifold is equipped with warning lights, and status / warning systems

22. Pigtails on the header bar constructed of copper, all others stainless steel

23. Report Pigtail date of installation

24. All isolation valves labeled properly

25. Duplexed final line regulators are present that can be isolated

26. The regulator can be fully isolated from the complete system

27. Intermediate and final line relief valve present

28. The relief valve has piping to an outside location

29. The relief valve piping is turned down and screened and constructed on similar materials

30. The relief valve piping is turned down and screened as well as labeled

31. Vent lines are made to be individual to each manifold system.

32. No leaks are discovered in the manifold system

33. Main line valve present where source is remote to the building

34. The main valve is located just inside the building area downstream of the manifold system

35. Source valve present adjacent to the source equipment

36. The source valve is labeled with the correct gas, area controlled, and emergency instructions

37. The source valve is located in a restricted area of the building

38. The main line has a pressure switch located adjacent to the main/ source valve?

39. There is a DISS Check valve on the pressure switch

40. The main line has a pressure gauge located adjacent to the main / source valve

41. There is a DISS Check valve on the pressure gauge

42. The gauge is visible from a standing position

43. The materials used in the manifold assembly are cleaned for oxygen use

44. Hard tempered tubing in use only

45. All turns and changes in direction made with fittings and are brazed together

46. All exposed piping is protected from physical damage

47. The High-Pressure Switch activates the Master Alarm locations

48. The Low-Pressure Switch activates the Master Alarm locations

49. The Reserve in Use alarm goes to the Master Alarm locations

50. The Reserve Header Bar in Use alarm goes to the Master Alarm locations

51. The Reserve Header Pressure Low Switch activates the Master Alarm

c. Provide recommendations for any failed ratings and a quote to repair (labor/parts)

E. Medical Vacuum Unit

a. Details:

· Location: BB1-07

· Manufacturer: Beacon

· Model: Busch Rotary Vane

· Configuration: Quadruple

· Vacuum Type: Rotary Vane

· Vacuum Mount: Base

b. Provide, annually, the below preventative maintenance items:

· Change oil and filters

· Inspect drive couplings and replace as needed

· Provide one (1) drive coupling per year to have on hand to COR

c. Perform an annual inspection of the Medical Vacuum Unit. Confirm the following in the report and note any deficiencies:

1. Line Pressure:

· Medical Vacuum

· Evacuation

2. The Medical Vac System is dedicated to the Medical Vacuum System only

3. The Medical Vac System is used for the laboratory

4. Flexible connectors are located on the inlet / outlet side of the compressor

5. Mechanical sources are operational

6. Manufacturer components are UL listed

7. Isolation valves present at each compressor and the receiver

8. Valves or means to cap exhaust on the discharge side of the pump

9. Isolation valves properly labeled

10. Check valves are located between pump and receiver for each pump

11. Lead / Lag cut in and out set at the proper settings

12. The Lag Alarm is installed on the Master Alarm panel

13. The Lag Alarm functions properly

14. The High Temp Alarm activates the Master Alarm panel?

15. Automatic alteration of the compressors

16. System controlled by means of the Emergency Electrical System

17. Manual system disconnection installed on the control panel

18. There is a manual receiver drain installed

19. There is a Vacuum Gauge located on the receiver tank

20. The receiver can be isolated from the medical vac system piping

21. The receiver has a three valve or single valve bypass

22. The receiver has an ASME Boiler and Pressure Code Stamp installed

23. The Medical Vac System has Anti- Vibration pads installed under the unit, pump to frame

24. The Source Valve is located in a dedicated space

25. The mechanical space is adequately ventilated, constructed

26. The area is ventilated to prevent accumulation of heat beyond manufacturers temp range

27. All components of the system are OEM recommended materials

28. No leaks are discovered in the pump system

29. Main line valve present where source is remote to the building

30. The main valve is located just inside the building area downstream of the Source Valve

31. The main valve is labeled with the correct gas, area controlled, and emergency instructions

32. Source valve present adjacent to the source equipment

33. The source valve is labeled with the correct gas, area controlled, and emergency instructions

34. The source valve is located in a restricted area of the building

35. The main line has a pressure switch located adjacent to the main/ source valve

36. There is a DISS Check valve on the pressure switch

37. The main line has a pressure gauge located adjacent to the main / source valve

38. There is a DISS Check valve on the pressure gauge

39. The gauge is visible from a standing position

40. Hard tempered tubing in use only

41. All turns and changes in direction made with fittings and are brazed together

42. All exposed piping is protected from physical damage

43. Receiver drain piped to the floor drain

44. Exhaust located outdoors where it will not blow into public areas

45. The exhaust is at a different level than the air intake and is at least 10' from any door or window

46. The exhaust is screened to keep debris, etc. out

47. Exhaust system is made up of hard drawn copper, stainless steel

48. Drip legs are installed in the medical vac exhaust to eliminate liquid backup

49. The exhaust has proper labeling

50. There are mufflers installed in the exhaust pipeline to eliminate sound and oil mist

51. A common is exhaust sized properly to prevent back pressure

d. Provide recommendations for any deficiencies and a quote to repair (labor/parts)

F. Master Alarms

a. Details:

· Location 1: GB1-07

· Location 2: Building 2 Room 232 (Call Center)

b. Perform an annual inspection for each (2) Master Alarm panel to include the following:

1. Inspect for proper labeling and function.

2. Test and recalibrate all alarm setpoints.

3. Test and activate each source equipment signal to ensure proper operation and low voltage wiring function

c. Provide recommendations for any failed ratings and a quote to repair (labor/parts) G. Area Alarms

a. Details

· Location 1: B8069

· Manufacturer: Beacon

· Model: Mega

· Location 2: B7066

· Manufacturer: Allied

· Model: DIG 2

· Location 3: A7011

· Manufacturer: Beacon

· Model: Mega

· Location 4: A7035

· Manufacturer: Beacon

· Model: Mega

· Location 5: D7200 (OR Nurse Station)

· Manufacturer: Beacon

· Model: Mega

· Location 6: B6090

· Manufacturer: Allied

· Model: DIG 2

· Location 7: A6014

· Manufacturer: Amico

· Model: Alert

· Location 8: A6016

· Manufacturer: Amico

· Model: Alert

· Location 9: A6030

· Manufacturer: Amico

· Model: Alert

· Location 10: A6040

· Manufacturer: Amico

· Model: Alert

· Location 11: A6041

· Manufacturer: Amico

· Model: Alert

· Location 12: A6045

· Manufacturer: Amico

· Model: Alert

· Location 13: A6016

· Manufacturer: Amico

· Model: Digital

· Location 14: A4020

· Manufacturer: Hillrom

· Model: Plus

· Location 15: B4127

· Manufacturer: TBD

· Model: TBD

· Location 16: B4157

· Manufacturer: TBD

· Model: TBD

· Location 17: A1576

· Manufacturer: Amico

· Model: Alert

· Location 18: B1608

· Manufacturer: Amico

· Model: Alert

· Location 19: B1557

· Manufacturer: Amico

· Model: Alert

· Location 20: D1285 (Infusion Clinic)

· Manufacturer: Beacon

· Model: Mega

· Location 21: D1352

· Manufacturer: Beacon

· Model: Mega

· Location 22: 2B Sally Port

· Manufacturer: Allied

· Model: DIG 2

· Location 23: B1511

· Manufacturer: Amico

· Model: Alert

· Location 24: DG245 (Aspen MRI Control)

· Manufacturer: Amico

· Model: Alert

· Location 25: DG504 (Beach MRI Control)

· Manufacturer: Amico

· Model:

· Location 26: FG633 Cancer Treatment Center

· Manufacturer: Amico

· Model:

· Location 27: B3060

· Manufacturer: Amico

· Model:

b. Perform an annual inspection for each (27) Area Alarm panels to include the following:

1. Inspect for proper labeling and function.

2. Test and Recalibrate all alarm setpoints.

3. Replace missing/inaccurate labels with new labels.

c. Provide recommendations for any deficiencies and a quote to repair (labor/parts)

H. Zone Valve Boxes

a. Details:

· Location 1: B8060

· Manufacturer: Beacon

· Location 2: B8060

· Manufacturer: Beacon

· Location 3: B7085

· Manufacturer: Allied

· Location 4: A7002

· Manufacturer: Beacon

· Location 5: A7045

· Manufacturer: Beacon

· Location 6: D7221

· Manufacturer: Beacon

· Location 7: D7221

· Manufacturer: Beacon

· Location 8: D7221

· Manufacturer: Beacon

· Location 9: D7220

· Manufacturer: Beacon

· Location 10: D7211

· Manufacturer: Beacon

· Location 11: D7209

· Manufacturer: Beacon

· Location 12: D7205

· Manufacturer: Beacon

· Location 13: B6057

· Manufacturer: Ohio

· Location 14: A6045

· Manufacturer: Amico

· Location 15: A6042

· Manufacturer: Amico

· Location 16: A6041

· Manufacturer: Amico

· Location 17: A6002

· Manufacturer: Amico

· Location 18: A6003

· Manufacturer: Amico

· Location 19: A6037

· Manufacturer: Amico

· Location 20: A6024

· Manufacturer: Amico

· Location 21: A6030

· Manufacturer: Amico

· Location 22: A6048

· Manufacturer: Amico

· Location 23: A5001

· Manufacturer: Ohio

· Location 24: A5030

· Manufacturer: Ohio

· Location 25: B4050

· Manufacturer: Ohio

· Location 26: B4050

· Manufacturer: Ohio

· Location 27: C4159

· Manufacturer: Beacon

· Location 28: C4159

· Manufacturer: Beacon

· Location 29: C4150

· Manufacturer: Beacon

· Location 30: C4150

· Manufacturer: Beacon

· Location 31: B3049

· Manufacturer: Ohio

· Location 32: B2142

· Manufacturer: Ohio

· Location 33: B2150

· Manufacturer: Ohio

· Location 34: B1511

· Manufacturer: Amico

· Location 35: B1511

· Manufacturer: Amico

· Location 36: D1348 (ED Nurse Station)

· Manufacturer: Amico

· Location 37: D1305

· Manufacturer: Amico

· Location 38: D1285 (Infusion Clinic)

· Manufacturer: Beacon

· Location 39: B1521

· Manufacturer: Amico

· Location 40: DG265

· Manufacturer: Allied

· Location 41: DG241

· Manufacturer: Allied

· Location 42: DG241

· Manufacturer: Allied

· Location 43: DG245

· Manufacturer: Allied

· Location 44: DG506

· Manufacturer: Beacon

· Location 45: DG506

· Manufacturer: Beacon

· Location 46: B8057A – Source Valve

· Manufacturer: NCG

· Location 47: B8057A– Source Valve

· Manufacturer: NCG

· Location 48: B8057A – Isolation Valve

· Manufacturer: NCG

· Location 49: B8049 – Source Valve

· Manufacturer: NCG

· Location 50: B8049 – Source Valve

· Manufacturer: NCG

· Location 51: BB1-07 – Isolation Valve

· Manufacturer: NCG

· Location 52: BB1-07 – Source Valve

· Manufacturer: NCG

· Location 53: CB1-26A (Loading Dock) – Main Valve

· Manufacturer: NCG

· Location 54: CB1-26A (Loading Dock) – Emergency Source Valve

· Manufacturer: NCG

b. Perform an annual inspection for each Zone Valve Box to include the following:

· Inspect for proper labeling, function and leakage of valves and gauges

· Replace missing/inaccurate labels with new labels as required

c. Provide recommendations for any deficiencies and a quote to repair (labor/parts)

I. Outlets/Inlets

a. Details:

· Approximately 1300 outlets/inlets

b. Perform an annual inspection, function, pressure, and flow tests on each outlet/inlet

c. Provide recommendations for any deficiencies and a quote to repair (labor/parts)

J. Gas Purity

a. Perform an annual laboratory gas purity test on each of the patient respiratory systems:

· Oxygen

· Medical Air

· Nitrous Oxide

b. Provide recommendations for any deficiencies and a quote to repair (labor/parts)

3.0 CONTRACT DELIVERABLES/DOCUMENTATION

Upon inspection, repair and/or certification completion, contractor shall provide electronic copies of the report and certification to the VA staff emails below.

a. Jonathan.Bucy@va.gov (Jonathan Bucy, Chief Engineer)

b. Matthew.McKinley@va.gov (Matthew McKinley, Facilities Engineer)

c. Olaf.Vanderslice@va.gov (Olaf Vanderslice, Mechanical Systems Engineer)

d. James.Culp@va.gov (James Culp, Engineering Technician)

e. Colin.Janisch@va.gov (Colin Janisch, Maintenance and Operations Supervisor)

4.0 HOURS OF OPERATION

A. Normal hours of operation are Monday through Friday from 7:00 am to 4:30 pm Local Time, excluding national holidays. Services shall be performed during normal hours of operation, unless otherwise requested or approved by the COR or his/her authorized designee. Work shall be scheduled to have minimal impact on patient care services.

B. National Holidays observed by the VAMC are:

National Holidays

New Year's Day Labor Day Independence Day Memorial Day Thanksgiving Day Christmas Day

1. Also included would be any other day specifically declared by the President of the United States to be a National Holiday.

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

5.0 CONTRACTOR QUALIFICATIONS

All services shall meet and/or exceed current State of Wisconsin, the Joint Commission, CMS, NFPA 99, ASSE and Department of Veterans Affairs requirements. All work shall be performed by credentialed ASSE 6040 Medical Gas Service Technicians.

6.0 PROTECTION OF GOVERNMENT PROPERTY

During work execution, the Contractor shall take special care to protect Government property including furniture, walls, baseboards, and other surfaces. Accidental splashes shall be removed immediately. Damage resulting from the Contractor operations shall be repaired by the Contractor, including painting, refinishing, or replacement, if necessary, at no additional cost to the Government. The Contractor shall be responsible to meet OSHA/Safety requirements in the performance of the work. This shall include, but not limited to, taking all the necessary precautions to protect the patients, visitors, and/or staff at each location. The Contractor shall be held responsible for any injuries and /or damage, which may be caused as a result of the Contractors failure to adhere to these requirements.

7.0 CONTRACTING OFFICER REPRESENTATIVE (COR)

Contracting Officer Representative (COR): The (COR) will be identified by a COR Delegation Memorandum. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

SECTION C - CONTRACT CLAUSES

C.1 FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (NOV 2021) is incorporated by reference.

ADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS:

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

This contract order 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/oamm/oa/ars/policyreg/vaar/index.cfm The following clauses are incorporated by reference:

SMALL BUSINESS SUBCONTRACTORS

C.3 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 30 calendar days prior to the contract’s performance period end. The “specified” rates under this clause will be those rates in effect under the contract each time an option is exercised under this clause.

(End of Clause)

C.4 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor 15 calendar days prior to the contract’s performance period end; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 30 calendar days prior to contract’s performance period end. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed FIVE (5) years. (End of Clause) C.5 VAAR 852.212-70 PROVISIONS AND CLAUSES APPLICABLE TO VA ACQUISITIONS 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.

_X_ 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors.

_X_ 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.

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

_X_ 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.6 VAAR 852.219-74 LIMITATIONS ON SUBCONTRACTING – MONITORING AND COMPLIANCE (JUL 2018) (DEVIATION)

(a) This solicitation includes 52.219-6 Notice of Total Small Business Set-Aside and 52.219-14 Limitations on Subcontracting

(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…