36C25226Q0304_1.docx

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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. 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. 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

None 36C25226Q0304 03-24-2026 Cannaday, Erika erika.cannaday@va.gov 03-30-2026 8:00

CDT

Department of Veterans Affairs 36C252 115 South 84th Street, Suite 101 Milwaukee

WI

53214-1476 X 621910 $22.5 Million N/A X Oscar G Johnson VA Medical Center located in Iron Mountain, MI and other VA and non-VA locations

Department of Veterans Affairs 36C252 Great Lakes Acquisition Center - HC 115 South 84th Street, Suite 101 Milwaukee

WI

53214-1476

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin

TX

78714-9971 See CONTINUATION Page Non-emergency ambulance services (Basic and Advance Life Support for Oscar G Johnson VA Medical Center in Iron Mountain, MI, and area VA and non-VA locations in accordance with the Performance Work Statement Service Contract Labor Standards shall apply to any award resulting from this Solicitation.

See CONTINUATION Page X Ashley Johnson

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 ________________________________

SAM UEI NO. ____________________________________________

b. GOVERNMENT:

CONTRACTING OFFICE CODE: 36C252

MILWAUKEE WI 53214

2. ACQUISITION OF COMMERCIAL ITEMS:

This Request for Quote (RFQ) solicitation is issued under the authority of FAR Part 13.5 (RFO Part 12) 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. (Note: The terms “offeror” and “quoter” are both used in this Solicitation. For the purposes of this Solicitation, these terms are interchangeable; there is no

3. SET-ASIDE (If any): See box 10 of STANDARD FORM 1449

4. SOLICITATION TIMELINE SUMMARY

A. 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 erika.cannaday@va.gov no later than THURSDAY MARCH 26, AT 2:00 PM LOCAL TIME. Contracting will issue a consolidated response via solicitation amendment to https://sam.gov Contract Opportunities within 2 business days to all parties

B. SOLICITATION CLOSES/QUOTES DUE:

See box 8 of STANDARD FORM 1449 or most recent Amendment.

C. SUBMISSION OF QUOTE:

See 52.212-1 Instructions to Offerors—Commercial Products and Commercial Services and addendum for specific instructions to offerors.

5. 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.

6. INVOICES:

a. All payments by the Government to the contractor will be made in accordance with: FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER – SYSTEM FOR AWARD MANAGEMENT (OCT 2018)

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

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

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

e. The VA has mandated electronic invoice submission for Veterans Transportation contracts and has partnered with VetRide, for submissions of all electronic invoices to VA. VetRide electronic invoicing is free to all VA vendors.

f. Contractor shall submit an electronic invoice by the tenth (10th) of the following month services were preformed to the VetRide portal.

g. 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.

h. Training and support for the VetRide system shall be provided by facility or VetRide at no cost to the Vendor.

7. FACILITY REQUIREMENTS: In addition to any other requirements set forth in this Contract, the Contractor, including its employees, agents, and subcontractors (collectively “the Contractor”), shall comply with the following facility requirements. Failure to comply with these requirements shall be considered a material breach of this Contract and may be a violation of Federal law resulting in charges answerable in the United States District Court.

a. Contractor is responsible to follow all on site facility policies

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

c. 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.

d. 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.

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

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

g. 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.

h. 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.

8. 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 contract involves applicable security controls within the facility as part of the VA Information Security If there are any questions related to privacy, please have a member of your staff contact the VA Privacy Service at (202) 461-6309. If there are any questions related to the information security, please have a member of your staff contact the Office of Cyber Security at (304) 262-7733.

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

Specifically, contractor, contractor employees, and subcontractors shall be subject to security requirements in accordance with VA Handbook 0735 and VHA Directive 0735 and in coordination with the facility point of contact. Contractor shall bear any costs for these requirements.

9. SECURITY & PRIVACY CONTROL:

NARA Records Management Language for Contracts (May 2017):

https://www.archives.gov/records-mgmt/handbook/records-mgmt-language.html

RECORDS MANAGEMENT OBLIGATIONS

A. Applicability

This clause applies to all Contractors whose employees create, work with, or otherwise handle Federal records, as defined in Section B, regardless of the medium in which the record exists.

B. Definitions “Federal Record” as defined in 44 U.S.C. § 3301, includes all recorded information, regardless of form or characteristics, made or received by a Federal agency under Federal law or in connection with the transaction of public business and preserved or appropriate for preservation by that agency or its legitimate successor as evidence of the organization, functions, policies, decisions, procedures, operations, or other activities of the United States Government or because of the informational value of data in them.

The term Federal record:

1. includes [Agency] records.

2. does not include personal materials.

3. applies to records created, received, or maintained by Contractors pursuant to their [Agency] contract.

4. may include deliverables and documentation associated with deliverables.

C. Requirements

The following standard Items relate to records generated in executing this contract and should be included in a typical contract where records could possibly be created, maintained or dispositioned:

1. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

2. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

3. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

4. [FACILITY] and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of [FACILITY] or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701.

In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to [FACILITY]. The agency must report promptly to NARA in accordance with 36 CFR 1230.

5. The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to [FACILITY] control or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the [contract vehicle]. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

6. The Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, contracts. The Contractor (and any sub-contractor) is required to abide by Government and [FACILITY] guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

7. The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with [FACILITY] policy.

8. The Contractor shall not create or maintain any records containing any non-public [FACILITY] information that are not specifically tied to or authorized by the contract.

9. The Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected from public disclosure by an exemption to the Freedom of Information Act.

10. The [FACILITY] owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S. Government for which [FACILITY] shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

11. Training. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take VHA-provided records management training. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training.

[Note: To the extent an agency requires contractors to complete records management training, the agency must provide the training to the contractor.]

D. Flowdown of requirements to Subcontractors

1. The Contractor shall incorporate the substance of this clause, its terms and requirements including this paragraph, in all subcontracts under this [contract vehicle], and require written subcontractor acknowledgment of same.

2. Violation by a subcontractor of any provision set forth in this clause will be attributed to the Contractor.

B.2 PERFORMANCE WORK STATEMENT

1. Purpose: The Oscar G. Johnson VA Medical Center (hereafter OGJ 585), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), Specialty Care Transport (SCT) or Critical Care Transport (CCT) services. The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

2. Background: The OGJ 585 main campus is located at 325 East H Street Iron Mountain, MI 49802 serving over 22,000 veterans, primarily from the Upper Peninsula and Northern Wisconsin area and it’s 8 Community-Based Outpatient Clinics. The hospital has 5 inpatient beds and sees approximately 127 inpatient admissions and 234,089 outpatient visits a year. Veterans served within this facility live within the following counties and zip codes:

See Attachment C – Counties Covered

3. Acronyms ALS – Advanced Life Support AOD – Administrative Officers of the Day BLS – Basic Life Support CCT – Critical Care Transport CCTP – Critical Care Transport Paramedic CCEMTP – Critical Care Emergency Medical Transport CO – Contracting Officer COR – Contracting Officer’s Representative CPR – Cardiopulmonary Resuscitation DOL – Department of Labor EMT – Emergency Medical Technician IAW – In Accordance With OO – Ordering Officer PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QC – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VTS – Veteran Transportation Service

4. Scope/Requirements

4.1. Types of Ambulance Service

4.1.1. The contractor shall provide Urgent, non-emergent Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) Tier 1, 2, and 3 ambulance services on an as-needed basis in accordance with all federal, state, and local regulations.

4.1.2. Occasionally a veteran will need to be transported with VA staff and equipment; the contractor shall return VA Staff and equipment to the original place of pick-up.

4.2. Transport of Miscellaneous Items with the Patient

The Contractor may also be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government. Luggage to be transported will be restricted to suitcase and valise types. When patients are transported to the OGJ 585, destination is deemed to be the ER, Admissions, the clinic, or service within the hospital, or directly to the ward as instructed by VA Staff.

4.3. Contractor Personnel: Contractor personnel shall be courteous and always conduct themselves in a businesslike manner while providing services under this contract.

4.3.1. Emergency Medical Technicians (EMTs), Critical Care Transport Paramedics (CCTPs) & Other Personnel

4.3.1.1. EMTs, CCTPs and other medical personnel (as applicable) shall at all times meet the qualifications specified in this contract as well as all applicable federal, state, and local government laws, regulations, and standards. EMTs, CCTPs and other medical personnel (as applicable) shall be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity where the emergency service is operated or by which it is governed.

4.3.1.2. If the contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing, and any other qualifications to the Contracting Officer’s Representative (COR) for review.

4.3.1.3. All ambulance drivers shall have a valid driver’s license in accordance with state requirements for their place of operation and the services they perform. If the contractor wishes to add or replace drivers throughout the life of the contract, it shall provide a valid driver’s license to the COR.

4.3.1.4. CCTPs shall have met all state requirements for the tier in which they are performing services in (I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request.

4.3.1.5. EMTs, CCTPs, and other contractor personnel as applicable must pass the Contractor’s background check and must not have been convicted of (or have any pending charges for) a felony for the past five years. Personnel (and Contractor) must report any new or additional charges or convictions if they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated.

4.3.2. Tuberculosis Exposure Control Policy

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

4.3.2.2. The contractor shall have its personnel tested for TB in accordance with state guidelines and provide written confirmation to the COR that all personnel (current employees and any new hires) performing services under this contract are current in their TB test by at the start of each Ordering Period.

4.4. Contractor Equipment, Vehicles, and Inspection

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

4.4.2. The VA reserves the right to inspect the contractor’s equipment and vehicles or require documentation of compliance with state laws, rules, regulations, and guidelines governing emergency medical transport vehicles (ambulances). VA inspections of contractor equipment do not constitute a warranty or guarantee that the contractor’s vehicles and equipment are properly maintained. The VA reserves the right to restrict the contractor’s use of equipment and vehicles in the performance of this contract which are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performance in accordance with the contract nor necessitate additional cost to the VA.

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

4.4.4. The contractor shall not borrow or exchange supplies, equipment, and/or medications with the VA. Equipment attached to or in use by the patient at time of pick-up may remain with the patient during transport to ensure continuity of care. Medical Control Authorities are responsible for maintaining and supplying medication during patient transport. All VA equipment and unused medications must be returned to VA during patient drop-off or as promptly as feasible within 24 hours.

4.4.5. The contractor shall furnish all linen required for patient transport at no additional cost. Linen shall not be exchanged with linen belonging to OGJ 585 or its CBOCs.

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

4.4.7. The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

4.4.7.1. The contractor personnel performing services for the VA, shall, at all times, conduct themselves in a professional manner, and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications shall be worn in clear view above the waist. The contractor personnel shall not smoke/play loud music originating from any device in vehicles while transporting VA patients.

4.4.7.2. Each driver shall possess a driver’s license that is valid for the class of vehicle driven. Evidence of a special transportation service vehicle permit, or endorsement issued by the commissioner of public safety.

· Be at least 18 years of age and have not less than one year of experience as a licensed driver; and

· For the past three years:

· Have not had a driver’s license canceled or suspended.

· Have a driving record clear of convictions for operating a motor vehicle or motorcycle without insurance.

· Have a driving record clear of convictions for driving a motor vehicle without a valid current license for the class of vehicle driven

· Have a driving and criminal record clear of convictions for driving under the influence of alcohol or a controlled substance.

4.4.7.3. The contractor personnel will ensure that the patient is secured to the stretcher/cot and that the stretcher /cot is secure in the back of the ambulance before the vehicle moves.

4.4.7.4. Ambulance drivers shall have a valid driver’s license, in accordance with Federal, State, and local government requirements for their place of operation for the services they perform, be capable of administering oxygen and shall have successfully completed the standard and advanced first aid course of the American Red Cross of U.S. Bureaus of Mines of equivalent and be capable of providing necessary medical assistance to the attending emergency medical technician or paramedic.

4.4.7.5. Emergency Medical Technician (EMT) and Paramedic Qualifications: EMT’s and Paramedic’s providing services under this contract shall have the following qualifications, in additions to those required by Federal, State, and Local Government:

· Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304. (1974).

· Shall be certified, licensed, or otherwise officially recognized by the local, state of regional government or public entity where the emergency ambulance service is operated or by which it is governed.

4.5. Transportation Request

4.5.1 VetRide or VA-approved Transportation Software Utilization:

The contractor agrees to utilize the VetRide Vendor Portal or VA-Approved Transportation Software with every patient transported under this contract.

Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal or VA-Approved Transportation Software for the vendor/contractor in this contract. The Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed:

a) Receive and respond to electronic trip requests

b) Receive, use, and ensure the use of the Vendor pass by the driver.

c) Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-Approved Transportation Software system.

d) All invoices must be submitted within 30 calendar days of date of service in accordance with 38 CFR 70 to be considered timely submission.

i. The contractor’s invoice must be on the HCFA 1500 to include:

ii. Contract Number

iii. Date of Service (to include Box 24 A-J)

iv. Authorization number(s)

v. Pick-up and drop-off location of the patient

vi. Base Rate

vii. Name (Last, First and Middle Initial (if any)) and Full Social Security number (Box 1a) of patient transported

viii. Date of Birth and Sex

ix. Diagnosis Codes or Nature of Illness or Injury

x. Documentation of circumstances when billing for waiting time

xi. Any miscellaneous charges for which the contractor is expecting reimbursement i.e., Tool charges, waiting time, etc.

xii. VA authorizing official’s name

xiii. Healthcare Procedure Coding System/National Level II (HCPCS)

e) Unauthorized charges will be reviewed by the Contracting Officer Representative (COR) as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges, which are being suspended.

4.5.1.1. A transportation request is defined as one incidence of a request for one-way service (Stretcher Transports, BLS, ALS, CCT). No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or VA-Approved Transportation Software Utilization. Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. OGJ 585 Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff. In the event VetRide or other VA-Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests.

4.5.1.1.1. OGJ 585 Travel Program Staff/or authorized VA employees will work with the Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA-Approved Transportation Software Utilization.

4.5.1.1.2. The Contractor must update VetRide or VA-Approved Transportation Software Utilization with any data and/or notes in real time that deviate from the original order such as invoicing for additional mileage due to a road closure, wait time, reason for no load, etc. OGJ 585 Travel Program Staff/or authorized VA employees may place a “hold” on payment of this order until it has been reconciled.

4.5.1.2. Only the following VA staff are authorized to place, cancel, or make changes to transportation requests:

Contracting Officer’s Representative (COR)

The Contracting Officer will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The Contracting Officer will update this list throughout the life of the contract as Ordering Officers change.

Ordering Officers are responsible for issuing and administering orders placed under this contract. Ordering Officers have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer may result in loss or delay in payment for supplies/services provided under such orders.

Non-authorized VA employees and private agencies (e.g., nursing homes) are not considered authorized to place transportation requests.

4.5.1.2.1. All patient pick-up(s) and drop-off(s) shall be authorized via “orders” which shall only be issued by the designated Ordering Officers. When placing orders for services, the Ordering Officer shall contact the designated contractor point of contact(s) to provide the following information:

· Mode of transportation required,

· Required time of arrival

· Name of the beneficiary,

· Pick-up and delivery point,

· Type and number of additional medical care specialists required,

· Type of equipment required,

· Last four of the patient's Social Security Number, and

· Any other special instructions

4.5.1.3. For ALL Transports – an Audit system will be put in place by the VA to include the COR or designee, Beneficiary Travel Department staff, and clinical staff to ensure appropriateness of the order and timeliness of the response.

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

4.5.1.5. The VA may authorize an escort (e.g., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient’s, best interest. The contractor shall allow the escort to accompany the patient at no additional cost.

4.5.1.6. The contractor shall have sufficient vehicles and personnel to provide services for up to four (4) simultaneous transportation requests. Transports required may be for any mix of Stretcher Transports, BLS, ALS transports. One of these four simultaneous transports may require CCT capability up to Tier III. If OGJ 585 requires ambulance services exceeding four (4) simultaneous transportation requests, the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

4.5.1.7. The number of transports under normal operating conditions will typically range from 2 - 4 transports each weekday and significantly less on weekends and holidays. The number of actual transports may vary throughout the life of the contract.

4.5.1.8. The patient may bring with her or him up to three (3) liters of oxygen. The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

4.5.1.9. Response Times*

4.5.1.9.1. Orders that are scheduled by 7pm local time the day before the required services are defined as scheduled in advance. With the exceptions found below, the contractor shall arrive on time for all orders scheduled in advance.

4.5.1.9.2. Urgent Transport (Originating from VA (Only): The contractor shall be required to provide Ground Ambulance transportation within thirty (30) minutes of order/patient pick up call.

4.5.1.9.3. For all add-ons (not scheduled in advance) transportation requests, with pick up at OGJ 585: The contractor will be allotted up to a sixty (60) minute response time from time of order placement for transportation requests that are not previously scheduled in advance.

a. For an urgent transport request for a critical patient (as deemed by the physician) with pick up at OGJ 585, the contractor will be allotted up to a thirty (30) minute response time.

4.5.1.9.4. For transportation requests which do not have a pick-up at OGJ 585:

a. The contractor may be required, if requested by the VA, to dispatch ambulances on short notice for transportation request not scheduled in advance; for these transportation requests the contractor shall dispatch ambulances within thirty (30) minutes of receiving the order.

b. Pick-up appointment times shall be agreed upon by the VA and contractor at time of order placement and be reasonable based upon travel distance, speed limits, and weather conditions.

c. The contractor’s patient pick-up time cannot be more than 15 minutes prior to the schedule pickup time nor 15 minutes later than the scheduled pickup time for transportation requests scheduled in advance.

* The contractor shall not be held liable for nonperformance caused by an occurrence beyond the reasonable control of the contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, and unusually severe weather. The contractor MUST notify the VA with as much advance notice as possible should any of these occur.

4.5.2. Cancellations

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

4.5.2.1.1. A “no show” is defined as a transportation request which is cancelled after the contractor has dispatched a vehicle, the vehicle is enroute, or has arrived at the pick-up location, and there is no longer a requirement for patient transportation. The contractor may request one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for the type of service requested (Stretcher Transports, BLS, ALS, CCT) and the one-way mileage (Stretcher Transports, BLS, ALS, CCT) accrued enroute to the pick-up location at time of cancellation. Mileage for no- show cancellations shall be confirmed by the contractor and reported to the VA as soon as possible from time of cancellation.

4.5.2.2. For transportation requests OUT of OGJ 585 ONLY – The contractor will immediately dispatch a vehicle upon receipt of the order (including transportation requests in which the final destination may change prior to pick up due to the critical condition of the patient). When the contractor is notified of a cancellation prior to arrival at the OGJ 585 campus, there shall be no charge to the Government.

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

4.6.1. Ambulance personnel shall pick-up and deliver patients at specified locations (e.g., front door of OGJ 585 Entrance). These locations will be specified by VA staff when an order is placed and communicated to the transporting personnel.

4.6.2. When applicable, ambulance personnel shall report to the Veteran Transportation Service (VTS) Dispatcher or Administrative Officer of the Day (AOD) to (1) announce his/her arrival to pick-up and transfer the patient and (2) obtain report of pertinent information regarding the patient’s condition from the primary nurse/physician.

4.6.3. When delivering a patient, ambulance personnel shall give report to the appropriate VA healthcare staff and provide a copy of the run sheet which will be retained by the facility for inclusion to the patient’s medical record.

4.6.4. In cases where ambulance personnel must divert to a local emergency department while performing a VA authorized transport, the contractor’s dispatcher shall notify the VA Beneficiary Travel Department or Administrative Officer of the Day of the patient’s location and status as soon as this information becomes available.

4.7. Patient Welfare

4.7.1. The contractor shall be responsible for the patient’s welfare during transport. The contractor shall be held responsible for patient and/or VA property during transport. Any damaged or lost wheelchairs, walkers, crutches, or personal belongings shall be replaced at the contractor’s expense.

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

4.7.3. If a VA beneficiary being transported declines to be properly secured or removed the securement devices himself/herself, the driver will notify the Contracting Officer’s Representative (COR) of this fact prior to departure. The contractor is not required to transport any VA beneficiary who refuses to be properly secured while being transported. In the event that the beneficiary refuses to be properly secured, they shall be returned back into the building which they came from.

4.8. Incident Reporting

4.8.1. The contractor shall notify the COR, Requestor, Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported. This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the COR, Program Manager, or Beneficiary Travel Department, by the close of business of the next working day.

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

4.9. Invoicing

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

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

4.9.3. Long Distance Mileage — Payment for mileage outside the contract miles covered in the base rate, shall be at the mileage rate stated in the price schedule, and shall be based upon the miles from the pick-up point and the specified destination. Any mileage from the place of business and/or location of vehicle and the pick-up point, or from the delivery destination back to the place of business and/or location of next trip are not considered as a separate item of this reimbursement but would be expected to be incorporated into the mileage rate as part of the administrative costs (or costs of doing business).

4.9.4. Upon notification of the contracting officer, the vendor must receive training and begin implementation of invoices via Vet Ride within 30 days versus VA Tungsten Network e-Invoicing network. Invoices must be submitted via the electronic HCFA 1500 in the VetRide Vendor Portal or other VA approved software. These invoices shall not include patient information, but shall include the following:

· Contractor Name

· Contract Number

· Current Purchase Order Number

· Date of service

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

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

Payment by VA under this contract to a provider of ground ambulance transportation services authorized under this contract extinguishes any and all liability on the part of the VA BENEFICIARY for that transportation service. UNDER NO CIRCUMSTANCES ARE VA BENEFICIARIES, THIRD PARTY INSURANCES, MEDICARE, OR MEDICAID TO BE BILLED FOR THE SERVICES PERFORMED UNDER THIS CONTRACT.

5. Period & Place of Performance

5.1. This contract’s ordering period shall be effective for approximately five years, from the Date of Award through 3/31/2031.

5.2. The Place of Performance is variable and may occur within the states of Michigan, Wisconsin; ambulance services may be required to or from locations including, but not limited to the following: 325 East H St. Iron Mountain Michigan 49801

5.2.1 OGJ 585 VA Medical Center to include specific Atrium Clinics, Emergency Department, pavilions, or out-buildings on the OGJ 585 campus. The OGJ 585 address is: 325 East H St. Iron Mountain Michigan 49801

5.1.1 OGJ 585 Community-Based Outpatient Clinics (CBOCs):

Gladstone, MI 49837-2060

Hancock, MI 49930-1163

Ironwood, MI 49938-1070

Manistique, MI 49854-1683

Marquette, MI 49855-5406

Menominee, MI 49858-3058

Rhinelander, WI 54501-3879

Sault Saint Marie, MI 49783-3607

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

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

5.1.4 Veteran’s residence.

5.1.5 Local airports including: Ford Airport 250 Riverhills Rd. Kingsford, MI 49802.

6 Quality Control Plan

6.1 Quality Control

6.1.1 The contractor shall maintain a Quality Control Plan (QCP) that contains, at a minimum, the following:

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

6.1.1.2 A description of the methods to be used by the contractor for identifying and preventing deficiencies or problems in the quality of service.

6.1.1.3 A description of the specific steps the contractor will take for corrective action if needed if a deficiency or problem in the quality of service occurs.

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

6.1.1.5 A description of the method used to provide on-time ambulance services to meet the requirements of this contract (24/7 availability and up to 4 simultaneous transports in accordance with PWS 4.5.1.7).

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

6.1.1.7 CONTENGENCY PLAN: (In case VetRide Vendor Portal is down) A description of the method/system used to log all requests for service. The contractor shall confirm that the log indicates the date and time of service call, actual time of pick-up versus the scheduled time, name of patient requiring services, designated pick-up and delivery points, mileage, and actual waiting time at pick-up and delivery points if waiting charges are claimed. The contractor shall confirm the log will be sent to the COR monthly.

6.1.2 The Government will evaluate the contractor’s performance under this contract to ensure that the contractor’s QCP is adequate, and…