36C25619Q1183-001.pdf

36C25619Q1183

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

B.3 STATEMENT OF WORK (SOW)

SECTION C - CONTRACT CLAUSES

C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.2 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

C.3 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND COMPLIANCE (JUL 2018)

C.4 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

C.5 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 PAST PERFORMANCE QUESTIONNAIRE

D.2 RELEVANT EXPERIENCE FORM

D.3 WAGE DETERMINATIONS

SECTION E - SOLICITATION PROVISIONS

E.1 CONTRACTOR TEAM ARRANGEMENTS (CTAS)

E.2 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES INCORPORATED BY REFERENCE (JAN 2008)

E.3 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS

EVALUATION FACTORS (JUL 2016)(DEVIATION)

E.4 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014)

E.5 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (OCT 2018)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

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

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

a. CONTRACTOR: Company Name:_________________________________________________

ATTN/POC Name:________________________________________________

Address:________________________________________________________

Phone: _________________________________________________________

Email:__________________________________________________________

DUNS: _________________________________________________________

Tax ID: _________________________________________________________

GSA/FSS, NAC, SEWP Contract# (if applicable): _________________________

b. GOVERNMENT: Shasta Britt

Contract Specialist

Department of Veterans Affairs

Network Contracting Office (NCO) 16

2002 Holcombe Blvd., Bldg. 100 Houston, TX 77030 Phone: 713-791-1414 x21883 Email: shasta.britt@va.gov

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

a. 52.232-33 Payment by Electronic Funds Transfer - System for Award Management through TUNGSTEN

3. INVOICES: Invoices shall be submitted in arrears:

a. Shall submit monthly within 30 days in conclusion of services.

b. The timing of payments to the affiliate for this agreement is payments in arrears.

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

a. Include purchase order number (PO#) on all invoices, located Standard Form 1449 block 4.

b. Facsimile, e-mail, and scanned documents are not acceptable.

c. VA’s Electronic Invoice Presentment and Payment System – The FSC uses a third-party contractor, Tungsten, to transition vendors from paper to electronic invoice submission. Please go to this website:

http://www.tungsten-network.com/US/en/veterans-affairs/ to begin submitting electronic invoices, free of charge.

5. Offeror shall complete the following located in Sections B thru E of this solicitation:

a. Section B- CONTRACT ADMINISTRATION DATA, CONTRACTOR name, address, phone, and email.

b. Section B- PRICE/COST SCHEDULE, unit price, amount and grand total.

c. Section D- Past Performance Questionnaire

d. Section D- Relevant Experience Form

e. Section E- 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS:

mailto:shasta.britt@va.gov http://www.tungsten-network.com/US/en/veterans-affairs/

• Paragraph (c) Offerors shall complete, if not already completed through SAM.

• Paragraph (q) Representation by Corporations Regarding Delinquent Tax Liability or a Felony

Conviction under any Federal Law, if not already completed through SAM.

f. Section E- Instruction to Contractor

a. Submission of proof of capability to meet SOW requirements

b. Submission of proof of accredited by nationally recognized organizations governing nursing

c. Submission of proof of capability to provide certification and maintenance of certification in

Case Management for RNs

d. Submission of proof of capability for online training to supplement and prepare for on-site two day Face-to-Face instructional lead training per the statement of work (SOW)

e. Contractor Team Arrangements (CTAs) (if applicable)

6. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

(End of Contract Administration Data)

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

120.00 EA __________________ __________________

CONTRACTOR SHALL PROVIDE CMSA's INTEGRATED CASE MANAGEMENT: A

MANUAL FOR CASE MANAGERS BY CASE MANAGERS

Contract Period: Base POP Begin: 09-30-2019 POP End: 09-29-2020

LOCAL STOCK NUMBER: N/A

120.00 EA __________________ __________________

CONTRACTOR SHALL PROVIDE ONLINE LEARNING AND INSTRUCTOR-LED

TRAINING CMSA (Per-Person)

Contract Period: Base POP Begin: 09-30-2019 POP End: 09-29-2020

LOCAL STOCK NUMBER: 1020

GRAND TOTAL

B.3 STATEMENT OF WORK (SOW)

A. BACKGROUND

a) Central Arkansas Veterans Healthcare System (CAVHS), Little Rock, Arkansas, has identified a need for Integrated Case Management (ICM) case manager training for Registered Nurses to take place at CAVHS and the Gulf Coast Veterans Health Care System (GCVHS), Biloxi, and Mississippi facilities.

b) Training shall effectively and efficiently prepare Registered Nurses for RN Case Manager Roles. Case management is intended to maximize resource utilization and promote quality Veteran-centric care while producing cost effective outcomes. Case management requires well-coordinated and collaborative interdisciplinary efforts, which are dependent upon effective communication and cooperation across internal and external VA care.

B. SCOPE

a) Contractor shall be accredited to provide continuing education credits and a didactic curriculum that supports and prepares an individual to take the national certification examination, with a focus on role development of the Registered Nurse Case Manager across all healthcare settings.

b) Contractor shall provide an accredited trained representative for on-site delivery of training covering RN Case Manager Roles and Responsibilities in conjunction with online resources and continual technical and guidance support available after completion of the on-site training.

C. SERVICES REQUIRED

a) Online training to supplement and prepare for on-site Face to Face training

a. Contractor shall include an electronic/online Integrated Case Management Assessment tool

b) Two days Face-to-Face training delivered at a VA Facility

c) Successful completion of the online and on-site Face to Face training shall provide RN attendees with documentation showing no less than 30 Continuing Education Units (CEU) earned (Contractor shall be accredited by nationally recognized organizations governing nursing and shall be eligible for certification or maintenance of certification in Case Management

a. organizations currently conduct specialized accreditation of nursing education, include the National League for Nursing (for all levels of nursing education, including practical, hospital diploma, as well as associate-, baccalaureate-, and master's-degree programs), the American Association of Nurse Anesthetists (for nurse anesthesia education), the American College of Nurse-Midwives (for pre-accreditation and accreditation of nurse-midwifery programs), and the American Nurses Association (for continuing education). In addition, programs in institutions of higher education are reviewed by regional accrediting agencies, as well as by state agencies such as boards of education or state boards of nursing charged with approval of nursing education programs.

d) Contractor shall provide all course materials to include but not limited to workbooks, supplemental textbooks and reference materials, access to online coursework and videos for classroom sessions

e) Technical Support. Offer a help desk, available by telephone from 8:30 a.m. to 5:30 p.m. Eastern time, for trouble-shooting and technical support services for videos and the on-line learning components of program

f) Coach Support for assistance in any program-related items (including and beyond technical issues). Vendor shall contact coaches periodically regarding program performance and outcomes.

D. TRAINING TOPICS

a) Screening tools: General training relating to the use of screening tools

b) Assessment tools: Complete health, functional, and psychosocial assessment, considers cultural and language needs, and reading ability. Interview family, medical providers, and review records of past utilization of health care systems. Identify problems and develop a plan/education to discuss with the patient regarding any risky behaviors—discuss negative consequences of patient actions if needed

c) Care planning tools: Identify short-term, long-term and ongoing needs of the patient and family and develop strategies to meet these needs. (Use of Specific, Measurable, Achievable, Realistic, and Timely (SMART) goals

d) Implementing (care coordination): Customize plan of care to meet the needs of the Veteran and caregivers

e) Follow-up (Ongoing): Monitoring ongoing assessment and document Veterans’ response to care provided, monitor patient progress toward his or her goals. Educate and support Veteran as needed. Revise Veteran plan of care if needed to assist him or her to better achieve desired outcomes

f) Transitioning (transitional care) Case manager facilitates coordination, communication, and collaboration with Veteran’s and caregivers/stakeholders to achieve goals and maximize positive outcomes

g) Evaluating-Case Manager works to maximize Veteran’s health, wellness, safety, and promotes self-care whenever able

h) Risk Stratification—Low, moderate or high risk and determine appropriate levels of intervention. High risk diseases include but are not limited to CHF, Diabetes, COPD, Anticoagulation, Hypertension for example.

Complicating risk factors may include alcohol abuse, smoking history, MST, drug abuse, psychiatric history, access to care and services, PTSD, Suicide Risk

i) Intervention: Interventions may include monitoring defined parameters & facilitating provider orders based on those parameters, education, facilitation

j) Communication Post Transition: Moving Veteran across the health and human services continuum or levels of care depending on his or her health condition and needed services/resources. Case Manager prepares support system, during this phase; the case manager prepares the Veteran and his/her support system either for discharge from the current care setting/facility to home or for transfer to another healthcare facility or a community-based clinician for further care. Promote transitions of care through PACT, the transitioning veteran program, the traveling veteran program, HBPC, OB-GYN referrals and referrals too Community Care. To maintain continuity of care, the complete execution of the Veteran’s transition through communication with key individuals (including sharing of necessary information) at the next level of care or setting, the client and client's support system, and members of the healthcare team. The case manager shall have ongoing collaboration with the responsible PACT MD or provider and shall collaborate and execute within the Office of Community Care (OCCN) at the facility. (Commission for Case Manager Certification (CCMC), 2012-2017)

E. TRAINING OBJECTIVES

a) Execute strategies to ensure safe transitions and timely communication among multiple providers within and outside of the VA health care system

b) Establish trusting relationships with Veterans and Caregivers; Provide Veterans with optimal communication, collaboration and coordination of care

c) Standardized identification and management of chronic diseases (ACSC)

d) Enhanced Veteran satisfaction and compliance with health goals (SHEP)

e) Enhanced use of Virtual Care Modalities

f) Optimize use of VISN 16 Regionalized Health care

g) Identify and optimize screening tool

h) Complete health, functional, and psychosocial assessment

i) Care planning tools

j) Identify strategies and methods to maximize positive outcomes

k) Address assessment, planning, advocacy, support, coordination of multiple services, and evaluation to meet the

Veteran’s complex health care need

l) Address intensive-acute case management which includes extensive contact with the Veteran, the Veteran’s family/caregiver, and the Veteran’s health care providers

m) Risk Stratification – looking at risk factors such as alcohol abuse, smoking history, MST, drug abuse, psychiatric history, access to care and services, PTSD, Suicide Risk

n) Coordinating transition of care

F. Specific recommendations for primary care clinics and health systems from the Macy Foundation include:

a) Primary care practices should redesign their care models to utilize the skills and expertise of RNs in meeting the healthcare needs of patient – and payers and regulators should facilitate this design.

b) Leaders of primary care practices and health systems should facilitate lifelong education and professional development opportunities in primary care and support practicing RNs in pursuing careers in primary care.

c) The purpose of this demonstration project is to measure the effectiveness of enhanced care/case management education and professional training for registered nurses on system and patient outcomes in a complex VA health system.

G. Training should include the following:

a) Coordinating care and managing patients’ transitions across settings.

b) Engage the patient in self-care management.

c) Determine what is important to the patient.

d) Set mutual goals with patients, families, and caregivers.

e) Provide effective health coaching.

f) Develop a patient-centered care plan.

g) Manage populations of patients within the context of where they live, work, play, and pray.

h) Caring for patients with chronic conditions and complex needs.

i) Learn to care for high-utilization patients with multiple chronic and/or complex conditions.

j) Understanding the social determinants of health, including the roles of poverty and culture and fundamentals of population health and empanelment.

k) Talking to patients about setting and achieving personal health goals.

l) Heal patient to envision personal health goals and determine capacity to meet goals.

m) Address health-related needs independently or with assistance.

n) Evidence-based practice and working with data and quality measures.

o) Gather, analyze, and apply data to decisions.

p) Identify trends and use data to encourage positive outcomes among patients and populations.

q) Managing multiple patients across settings and over time.

r) Teamwork and collaboration.

s) Coaching, mentoring, and empowering others.

t) Leadership of interprofessional healthcare teams and leadership within healthcare systems.

u) Creative problem-solving, critical thinking, teamwork and team building.

v) Knowledge of healthcare financing and policy, quality improvement, patient safety and satisfaction.

H. INSTRUCTOR TRAVEL EXPENSES

Travel expenses shall not be reimbursed under this agreement or any orders resulting from this agreement.

I. PERIOD AND PLACE OF PERFORMANCE

a) Exact training dates shall be determined after award. CAVHS anticipates up to three on-site training sessions per year.

b) Exact training dates and locations to be mutually agreed upon with 6 weeks advanced notice. The place of performance shall be at the CAVHS and/or GCVHS facility or facilities within the boundaries of VA VISN 16 to be determined after award by agreement.

J. GOVERNMENT PERSONNEL OBSERVED HOLIDAYS

a) The Government hereby provides notice and Contractor hereby acknowledges receipt that Government personnel observe the listed days as holidays:

a. New Year's Day January 1

b. Martin Luther King's Birthday Third Monday in January

c. President's Birthday Third Monday in February

d. Memorial Day Last Monday in May

e. Independence Day July 4

f. Labor Day First Monday in September

g. Columbus Day Second Monday in October

h. Veterans Day November 11

i. Thanksgiving Day Fourth Thursday in November

j. Christmas December 2

b) In addition to the days designated as holidays, the Government observes the following days:

a. Any other day designated by Federal Statute

b. Any other day designated by Executive Order

c. Any other day designated by the President’s Proclamation

c) It is understood and agreed between the Government and the Contractor that observance of such days by Government personnel shall not otherwise be a reason for an additional period of performance, or entitlement of compensation. In the event the Contractor's personnel work during the holiday, they may be reimbursed by the Contractor, however, no form of holiday or other premium compensation shall be reimbursed either as a direct or indirect cost, other than their normal compensation for the time worked.

(End of Statement of Work)

SECTION C - CONTRACT CLAUSES

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

Clauses that are incorporated by reference (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.

The following clauses are incorporated into 52.212-4 as an addendum to this contract:

C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

http://www.acquisition.gov/far/index.html http://www.va.gov/oal/library/vaar/

FAR Number Title Date

52.204-13 SYSTEM FOR AWARD MANAGEMENT MAINTENANCE OCT 2018

52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE JUL 2016

52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS OCT 2018

52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS

MAY 2019

52.217-8 OPTION TO EXTEND SERVICES NOV 1999

52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS

DEC 2013

852.203-70 COMMERCIAL ADVERTISING MAY 2018

(End of Clause)

C.2 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

The offeror agrees, if awarded a contract, to use the service-disabled veteran-owned small businesses or veteran-owned small businesses proposed as subcontractors in accordance with 852.215-70, Service-Disabled Veteran-Owned and

Veteran-Owned Small Business Evaluation Factors, or to substitute one or more service-disabled veteran-owned small businesses or veteran-owned small businesses for subcontract work of the same or similar value.

C.3 VAAR 852.219-75 SUBCONTRACTING COMMITMENTS MONITORING AND COMPLIANCE

(JUL 2018)

(a) This solicitation includes the clause: 852.215-70 Service-disabled veteran-owned and veteran-owned small business evaluation factors. Accordingly, any contract resulting from this solicitation will include the clause 852.215-71 Evaluation factor commitments.

(b) The Contractor is advised that in performing contract administration functions, the Contracting Officer may use the services of a support contractor(s) to assist in assessing Contractor compliance with the subcontracting commitments http://www.acquisition.gov/far/index.html http://www.va.gov/oal/library/vaar/ incorporated into the contract. To that end, the support contractor(s) may require access to the Contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement.

(c) All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and

Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the Contractor's business records or other proprietary data reviewed or obtained in the course of assisting the Contracting Officer in assessing the Contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs.

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

C.4 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)

(a) Definitions. As used in this clause—

(1) Contract financing payment has the meaning given in FAR 32.001;

(2) Designated agency office means the office designated by the purchase order, agreement, or contract to first receive and review invoices. This office can be contractually designated as the receiving entity. This office may be different from the office issuing the payment;

(3) Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods and formats identified in paragraph (c) of this clause. Facsimile, email, and scanned documents are not acceptable electronic forms for submission of payment requests;

(4) Invoice payment has the meaning given in FAR 32.001; and

(5) Payment request means any request for contract financing payment or invoice payment submitted by the contractor under this contract.

(b) Electronic payment requests. Except as provided in paragraph (e) of this clause, the contractor shall submit payment requests in electronic form. Purchases paid with a Government-wide commercial purchase card are considered to be an electronic transaction for purposes of this rule, and therefore no additional electronic invoice submission is required.

(c) Data transmission. A contractor must ensure that the data transmission method and format are through one of the following:

(1) VA’s Electronic Invoice Presentment and Payment System at the current website address provided in the contract.

(2) Any system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited

Standards Center (ASC) and chartered by the American National Standards Institute (ANSI).

(d) Invoice requirements. Invoices shall comply with FAR 32.905.

(e) Exceptions. If, based on one of the circumstances in this paragraph (e), the Contracting Officer directs that payment requests be made by mail, the Contractor shall submit payment requests by mail through the United States Postal

Service to the designated agency office. Submission of payment requests by mail may be required for—

(1) Awards made to foreign vendors for work performed outside the United States;

(2) Classified contracts or purchases when electronic submission and processing of payment requests could compromise the safeguarding of classified or privacy information;

(3) Contracts awarded by contracting officers in the conduct of emergency operations, such as responses to national emergencies;

(4) Solicitations or contracts in which the designated agency office is a VA entity other than the VA Financial Services

Center in Austin, Texas; or

(5) Solicitations or contracts in which the VA designated agency office does not have electronic invoicing capability as described above.

C.5 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

The contractor shall obtain all necessary licenses and/or permits required to perform this work. He/she shall take all reasonable precautions necessary to protect persons and property from injury or damage during the performance of this contract. He/she shall be responsible for any injury to himself/herself, his/her employees, as well as for any damage to personal or public property that occurs during the performance of this contract that is caused by his/her employees’ fault or negligence and shall maintain personal liability and property damage insurance having coverage for a limit as required by the laws of the State of Arkansas and Mississippi. Further, it is agreed that any negligence of the

Government, its officers, agents, servants and employees, shall not be the responsibility of the contractor hereunder with the regard to any claims, loss, damage, injury, and liability resulting there from.

(End of Addendum to 52.212-4)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 PAST PERFORMANCE QUESTIONNAIRE

REFERENCE INSTRUCTIONS: The Michael E. Debakey VA Medical Center is considering the Offeror listed below for award of a VA contract. Your comments would be appreciated regarding this firm’s past performance. The intent of this form is to evaluate the offeror’s services. Your comments are considered Source Selection Sensitive; therefore, you are advised that the Federal Acquisition Regulation prohibits the release of the names of individuals providing reference information about Offeror’s past performance. This survey should be completed by an evaluator with sufficient familiarity of the offeror’s performance and returned to the contracting office by the closing date of the solicitation by e-mail to shasta.britt@va.gov.

Include the solicitation number on the subject line of all e-mails.

Offeror’s Name: _____________________________ Offeror’s e-mail: __________________________________

Request for Quote: ______________________________________________________________________________

Name of Person Completing the Evaluation: ______________________

Telephone: _______ E-mail: _______________ mailto:shasta.britt@va.gov.

Title: _______________________________________________________

Company/Organization: ________________

Please rate the offeror in each of the following areas. Note: there is room for comments where you deem remarks would be helpful to our evaluation.

• Not Applicable: N/A

• 1: Performance clearly below the contract performance standard or requirement

• 2: Performance occasionally does not meet minimum contract performance standard or requirement

• 3: Performance that meets the minimum contract performance standard or requirement

• 4: Performance that meets and occasionally exceeds the contract performance standard or requirement

• 5: Performance that almost always exceeds the contract performance standard or requirement

1. Overall quality/satisfaction N/A 1 2 3 4 5

Overall satisfaction with the Offeror’s performance. Would you (the reference) choose to work with this offeror again?

2. Delivery performance N/A 1 2 3 4 5

Delivery performance includes delivery consistency, on time performance, and flexibility in responding to emerging issues and implementing required solutions.

3. Satisfaction with the quality of service delivered N/A 1 2 3 4 5

Rate the effectiveness and applicability of the plans and strategies delivered and the actual implementation of those.

4. Satisfaction with problem resolution N/A 1 2 3 4 5

This includes the offeror’s ability to solve problems, the speed in which they handle problems, and their effective delivery of resolutions.

5. Satisfaction with the quality of contractor personnel N/A 1 2 3 4 5

Rate the quality of the contractor’s staff in executing the project work scope.

6. Have you issued a cure notice, show cause notice, suspension of progress payments or other letters directing the correction of a performance problem in the past 3 years?

Yes No If Yes, please explain.

7. Have you terminated this contractor for default within the past 3 years, or are there any pending termination actions?

Yes No If Yes, please explain.

8. Based on the offeror’s overall performance, would you award them another contract?

Yes No If No, please explain.

9. Have you discussed any adverse past performance problems with the Offeror and given them an opportunity to comment?

Yes No Please explain.

10. Do you file past performance information in a database that the Contracting Officer may search?

11. If the contract had options, were those options exercised?

12. List the dates of the contract period of performance (when were services provided)?

Dates: _______________________________________________________

13. What was the dollar value of the contract performed by the offeror?

Dollar Value: __________________________________________________

14. Provide a brief description of the services provided by the offeror for this contract.

Please attach any past performance database reports or other material you deem appropriate to a full understanding of the Offeror’s past performance by the evaluator.

*for template see attachment with FBO solicitation

(End of Past Performance)

D.2 RELEVANT EXPERIENCE FORM

Please list your contracts as the prime in the chronological order beginning with the most recent one. Contracts listed shall provide timeline for relevant experience within the last five (5) years. You can list ongoing contracts first, then move on to past relevant experience. As the prime contractor.

Contract

1. Customer Name 2. Customer’s Address

3. Name and Title of Contact Point 4. Contact Point’s Email Address

5. Contact Point’s Phone Number 6. Estimated Contract Value

7. Contract Term (Month and Years)

From /_______ through ______/_________

8. Contract Effective Date

9. Contract Status

___Ongoing ___Completed

*for template see attachment with FBO solicitation

(End of Relevant Experience)

D.3 WAGE DETERMINATIONS

WD 15-5118 (Rev.10) was first posted on www.wdol.gov on 05/09/2019

"REGISTER OF WAGE DETERMINATIONS UNDER | U.S. DEPARTMENT OF LABOR

THE SERVICE CONTRACT ACT | EMPLOYMENT STANDARDS ADMINISTRATION

By direction of the Secretary of Labor | WAGE AND HOUR DIVISION

| WASHINGTON D.C. 20210

| Wage Determination No.: 2015-5118 Daniel W. Simms Division of | Revision No.: 10

Director Wage Determinations | Date Of Last Revision: 05/09/2019 Note: Under Executive Order (EO) 13658 an hourly minimum wage of $10.60 for calendar year 2019 applies to all contracts subject to the Service Contract Act for which the contract is awarded (and any solicitation was issued) on or after January 1, 2015. If this contract is covered by the EO the contractor must pay all workers in any classification listed on this wage determination at least $10.60 per hour (or the applicable wage rate listed on this wage determination if it is higher) for all hours spent performing on the contract in calendar year 2019. The EO minimum wage rate will be adjusted annually. Additional information on contractor requirements and worker protections under the EO is available at www.dol.gov/whd/govcontracts.

State: Arkansas Area: Arkansas Counties of Faulkner Lonoke Perry Pulaski Saline **Fringe Benefits Required Follow the Occupational Listing**

OCCUPATION CODE - TITLE FOOTNOTE

RATE

01000 - Administrative Support And Clerical Occupations 01011 - Accounting Clerk I 13.99 01012 - Accounting Clerk II 15.71 01013 - Accounting Clerk III 19.95 01020 - Administrative Assistant 23.69 01035 - Court Reporter 18.99 01041 - Customer Service Representative I 12.20 01042 - Customer Service Representative II 13.72 01043 - Customer Service Representative III 14.97 01051 - Data Entry Operator I 13.02 01052 - Data Entry Operator II 14.38 01060 - Dispatcher Motor Vehicle 16.42 01070 - Document Preparation Clerk 11.47 01090 - Duplicating Machine Operator 11.47 01111 - General Clerk I 13.10 01112 - General Clerk II 14.29 01113 - General Clerk III 16.04 01120 - Housing Referral Assistant 19.36 01141 - Messenger Courier 12.44 01191 - Order Clerk I 12.38 01192 - Order Clerk II 13.51 01261 - Personnel Assistant (Employment) I 15.19 01262 - Personnel Assistant (Employment) II 17.00 01263 - Personnel Assistant (Employment) III 18.94 01270 - Production Control Clerk 22.69 01290 - Rental Clerk 11.27 01300 - Scheduler Maintenance 15.53 01311 - Secretary I 15.53 01312 - Secretary II 17.38 01313 - Secretary III 19.36 01320 - Service Order Dispatcher 16.25 01410 - Supply Technician 23.69 01420 - Survey Worker 15.65 01460 - Switchboard Operator/Receptionist 13.31 01531 - Travel Clerk I 14.30

01532 - Travel Clerk II 15.57 01533 - Travel Clerk III 16.46 01611 - Word Processor I 14.17 01612 - Word Processor II 15.90 01613 - Word Processor III 17.79 05000 - Automotive Service Occupations 05005 - Automobile Body Repairer Fiberglass 20.99 05010 - Automotive Electrician 17.59 05040 - Automotive Glass Installer 15.77 05070 - Automotive Worker 15.77 05110 - Mobile Equipment Servicer 13.87 05130 - Motor Equipment Metal Mechanic 17.87 05160 - Motor Equipment Metal Worker 15.77 05190 - Motor Vehicle Mechanic 17.87 05220 - Motor Vehicle Mechanic Helper 12.91 05250 - Motor Vehicle Upholstery Worker 14.86 05280 - Motor Vehicle Wrecker 15.77 05310 - Painter Automotive 16.82 05340 - Radiator Repair Specialist 15.77 05370 - Tire Repairer 12.63 05400 - Transmission Repair Specialist 17.87 07000 - Food Preparation And Service Occupations 07010 - Baker 12.28 07041 - Cook I 10.87 07042 - Cook II 12.37 07070 - Dishwasher 9.31 07130 - Food Service Worker 10.47 07210 - Meat Cutter 15.29 07260 - Waiter/Waitress 9.26 09000 - Furniture Maintenance And Repair Occupations 09010 - Electrostatic Spray Painter 17.32 09040 - Furniture Handler 10.37 09080 - Furniture Refinisher 14.76 09090 - Furniture Refinisher Helper 11.53 09110 - Furniture Repairer Minor 13.15 09130 - Upholsterer 14.76 11000 - General Services And Support Occupations 11030 - Cleaner Vehicles 10.74 11060 - Elevator Operator 10.74 11090 - Gardener 16.05 11122 - Housekeeping Aide 10.44 11150 - Janitor 10.44 11210 - Laborer Grounds Maintenance 12.46 11240 - Maid or Houseman 9.48 11260 - Pruner 11.36 11270 - Tractor Operator 14.95 11330 - Trail Maintenance Worker 12.46 11360 - Window Cleaner 11.46 12000 - Health Occupations

- Ambulance Driver 14.60

- Breath Alcohol Technician 18.41

- Certified Occupational Therapist Assistant 27.74

12015 - Certified Physical Therapist Assistant 28.56 12020 - Dental Assistant 15.98 12025 - Dental Hygienist 36.26 12030 - EKG Technician 26.27 12035 – Electro neuro diagnostic Technologist 26.27 12040 - Emergency Medical Technician 14.60

- Licensed Practical Nurse I 16.45

- Licensed Practical Nurse II 18.41

- Licensed Practical Nurse III 20.51 12100 - Medical Assistant 14.78 12130 - Medical Laboratory Technician 19.74 12160 - Medical Record Clerk 16.09 12190 - Medical Record Technician 18.00 12195 - Medical Transcriptionist 14.98 12210 - Nuclear Medicine Technologist 35.38

- Nursing Assistant I 11.43

- Nursing Assistant II 12.85

- Nursing Assistant III 14.03

- Nursing Assistant IV 15.75

- Optical Dispenser 18.95

- Optical Technician 16.49 12250 - Pharmacy Technician 14.10 12280 - Phlebotomist 14.17 12305 - Radiologic Technologist 23.84

- Registered Nurse I 24.41

- Registered Nurse II 29.86

- Registered Nurse II Specialist 29.86

- Registered Nurse III 36.12

- Registered Nurse III Anesthetist 36.12

- Registered Nurse IV 43.29

- Scheduler (Drug and Alcohol Testing) 22.80 12320 - Substance Abuse Treatment Counselor 18.26 13000 - Information And Arts Occupations

- Exhibits Specialist I 20.21

- Exhibits Specialist II 25.03

- Exhibits Specialist III 30.61

- Illustrator I 20.21

- Illustrator II 25.03

- Illustrator III 30.61 13047 - Librarian 27.72 13050 - Library Aide/Clerk 11.39 13054 - Library Information Technology Systems Administrator 25.03 13058 - Library Technician 13.35

- Media Specialist I 18.06

- Media Specialist II 20.21

- Media Specialist III 22.52

- Photographer I 15.21

- Photographer II 17.02

- Photographer III 21.08

- Photographer IV 25.79

- Photographer V 31.19 13090 - Technical Order Library Clerk 14.31

13110 - Video Teleconference Technician 18.38 14000 - Information Technology Occupations

- Computer Operator I 15.69

- Computer Operator II 17.55

- Computer Operator III 19.57

- Computer Operator IV 21.84 14045 - Computer Operator V 24.08

- Computer Programmer I (see 1) 21.44

- Computer Programmer II (see 1) 25.80

- Computer Programmer III (see 1)

- Computer Programmer IV (see 1)

- Computer Systems Analyst I (see 1)

- Computer Systems Analyst II (see 1)

- Computer Systems Analyst III (see 1) 14150 - Peripheral Equipment Operator 15.69 14160 - Personal Computer Support Technician 24.02 14170 - System Support Specialist 24.24 15000 - Instructional Occupations 15010 - Aircrew Training Devices Instructor (Non-Rated) 29.78 15020 - Aircrew Training Devices Instructor (Rated) 35.88 15030 - Air Crew Training Devices Instructor (Pilot) 40.56 15050 - Computer Based Training Specialist / Instructor 29.78 15060 - Educational Technologist 29.22 15070 - Flight Instructor (Pilot) 40.56 15080 - Graphic Artist 20.59

- Maintenance Test Pilot Fixed Jet/Prop 40.56

- Maintenance Test Pilot Rotary Wing 40.56 15088 - Non-Maintenance Test/Co-Pilot 40.56 15090 - Technical Instructor 20.60 15095 - Technical Instructor/Course Developer 25.20 15110 - Test Proctor 16.63 15120 - Tutor 16.63 16000 - Laundry Dry-Cleaning Pressing And Related Occupations 16010 - Assembler 10.12 16030 - Counter Attendant 10.12 16040 - Dry Cleaner 11.84 16070 - Finisher Flatwork Machine 10.12 16090 - Presser Hand 10.12 16110 - Presser Machine Dry-cleaning 10.12 16130 - Presser Machine Shirts 10.12 16160 - Presser Machine Wearing Apparel Laundry 10.12 16190 - Sewing Machine Operator 12.71 16220 - Tailor 13.59 16250 - Washer Machine 10.60 19000 - Machine Tool Operation And Repair Occupations 19010 - Machine-Tool Operator (Tool Room) 17.67 19040 - Tool And Die Maker 22.01 21000 - Materials Handling And Packing Occupations 21020 - Forklift Operator 15.52 21030 - Material Coordinator 22.69 21040 - Material Expediter 22.69 21050 - Material Handling Laborer 11.87

21071 - Order Filler 11.83 21080 - Production Line Worker (Food Processing) 15.52 21110 - Shipping Packer 15.71 21130 - Shipping/Receiving Clerk 15.71 21140 - Store Worker I 11.41 21150 - Stock Clerk 15.35 21210 - Tools And Parts Attendant 15.52 21410 - Warehouse Specialist 15.52 23000 - Mechanics And Maintenance And Repair Occupations 23010 - Aerospace Structural Welder 28.16 23019 - Aircraft Logs and Records Technician 22.13

- Aircraft Mechanic I 26.66

- Aircraft Mechanic II 28.16

- Aircraft Mechanic III 29.70 23040 - Aircraft Mechanic Helper 19.26 23050 - Aircraft Painter 25.10 23060 - Aircraft Servicer 22.13 23070 - Aircraft Survival Flight Equipment Technician 25.10 23080 - Aircraft Worker 23.53

- Aircrew Life Support Equipment (ALSE) Mechanic I 23.53

- Aircrew Life Support Equipment (ALSE) Mechanic II 26.66 23110 - Appliance Mechanic 17.11 23120 - Bicycle Repairer 15.85 23125 - Cable Splicer 29.18 23130 - Carpenter Maintenance 17.85 23140 - Carpet Layer 19.18 23160 - Electrician Maintenance 20.98

- Electronics Technician Maintenance I 22.46

- Electronics Technician Maintenance II 23.95

- Electronics Technician Maintenance III 25.44 23260 - Fabric Worker 18.04 23290 - Fire Alarm System Mechanic 17.37

- Fire Extinguisher Repairer 16.86

- Fuel Distribution System Mechanic 26.53

- Fuel Distribution System Operator 20.83 23370 - General Maintenance Worker 14.98

- Ground Support Equipment Mechanic 26.66

- Ground Support Equipment Servicer 22.13

- Ground Support Equipment Worker 23.53

- Gunsmith I 16.86

- Gunsmith II 19.18

- Gunsmith III 21.73

- Heating Ventilation And Air-Conditioning Mechanic 19.47

- Heating Ventilation And Air Conditioning Mechanic (Research Facility) 20.58 23430 - Heavy Equipment Mechanic 22.43 23440 - Heavy Equipment Operator 17.38 23460 - Instrument Mechanic 22.55 23465 - Laboratory/Shelter Mechanic 20.46 23470 - Laborer 11.87 23510 - Locksmith 18.36 23530 - Machinery Maintenance Mechanic 22.03 23550 - Machinist Maintenance 19.05

23580 - Maintenance Trades Helper 12.02

- Metrology Technician I 22.55

- Metrology Technician II 23.82

- Metrology Technician III 25.13 23640 - Millwright 21.73 23710 - Office Appliance Repairer 18.65 23760 - Painter Maintenance 17.77 23790 - Pipefitter Maintenance 22.61 23810 - Plumber Maintenance 21.28 23820 - Pneudraulic Systems Mechanic 21.73 23850 - Rigger 21.59 23870 - Scale Mechanic 19.18 23890 - Sheet-Metal Worker Maintenance 18.06 23910 - Small Engine Mechanic 16.74

- Telecommunications Mechanic I 23.33

- Telecommunications Mechanic II 24.64 23950 - Telephone Lineman 24.02 23960 - Welder Combination Maintenance 17.75 23965 - Well Driller 21.73 23970 - Woodcraft Worker 21.73 23980 - Woodworker 16.86 24000 - Personal Needs Occupations 24550 - Case Manager 15.81 24570 - Child Care Attendant 9.71 24580 - Child Care Center Clerk 12.11 24610 - Chore Aide 10.01 24620 - Family Readiness And Support Services Coordinator 15.81 24630 - Homemaker 15.81 25000 - Plant And System Operations Occupations 25010 - Boiler Tender 20.21 25040 - Sewage Plant Operator 18.59 25070 - Stationary Engineer 20.21 25190 - Ventilation Equipment Tender 14.61 25210 - Water Treatment Plant Operator 18.59 27000 - Protective Service Occupations 27004 - Alarm Monitor 15.50

- Baggage Inspector 13.55

- Corrections Officer 16.56 27010 - Court Security Officer 19.31 27030 - Detection Dog Handler 15.18 27040 - Detention Officer 16.56 27070 - Firefighter 22.25

- Guard I 13.55

- Guard II 15.18 27131 - Police Officer I 19.78 27132 - Police Officer II 21.98 28000 - Recreation Occupations

- Carnival Equipment Operator 12.11

- Carnival Equipment Repairer 13.01

- Carnival Worker 9.20 28210 - Gate Attendant/Gate Tender 13.18 28310 - Lifeguard 11.34

28350 - Park Attendant (Aide) 14.74 28510 - Recreation Aide/Health Facility Attendant 10.52 28515 - Recreation Specialist 17.85 28630 - Sports Official 11.47 28690 - Swimming Pool Operator 16.09 29000 - Stevedoring/Longshoremen Occupational Services 29010 - Blocker And Bracer 20.54 29020 - Hatch Tender 20.54 29030 - Line Handler 20.54

- Stevedore I 19.32

- Stevedore II 21.91 30000 - Technical Occupations

- Air Traffic Control Specialist Center (HFO) (see 2) 38.78

- Air Traffic Control Specialist Station (HFO) (see 2) 26.74

- Air Traffic Control Specialist Terminal (HFO) (see 2) 29.45

- Archeological Technician I 17.38

- Archeological Technician II 19.44

- Archeological Technician III 22.65 30030 - Cartographic Technician 24.09 30040 - Civil Engineering Technician 22.95

- Cryogenic Technician I 26.67

- Cryogenic Technician II 29.46

- Drafter/CAD Operator I 17.38

- Drafter/CAD Operator II 19.44

- Drafter/CAD Operator III 21.68

- Drafter/CAD Operator IV 26.67

- Engineering Technician I 15.66

- Engineering Technician II 17.58

- Engineering Technician III 19.68

- Engineering Technician IV 24.37 30085 - Engineering Technician V 29.81 30086 - Engineering Technician VI 36.06 30090 - Environmental Technician 21.41 30095 - Evidence Control Specialist 21.70 30210 - Laboratory Technician 19.37

- Latent Fingerprint Technician I 20.57

- Latent Fingerprint Technician II 22.72 30240 - Mathematical Technician 24.09

- Paralegal/Legal Assistant I 19.36

- Paralegal/Legal Assistant II 22.04

- Paralegal/Legal Assistant III 25.64

- Paralegal/Legal Assistant IV 29.76 30375 - Petroleum Supply Specialist 26.57 30390 - Photo-Optics Technician 24.09 30395 - Radiation Control Technician 26.57

- Technical Writer I 23.82

- Technical Writer II 29.14

- Technical Writer III 35.25

- Unexploded Ordnance (UXO) Technician I 24.65

- Unexploded Ordnance (UXO) Technician II 29.82

- Unexploded Ordnance (UXO) Technician III 35.74

- Unexploded (UXO) Safety Escort 24.65

- Unexploded (UXO) Sweep Personnel 24.65

- Weather Forecaster I 26.67

- Weather Forecaster II 32.45

- Weather Observer Combined Upper Air Or Surface Programs (see 2) 21.68

- Weather Observer Senior (see 2) 24.09 31000 - Transportation/Mobile Equipment Operation Occupations 31010 - Airplane Pilot 29.82 31020 - Bus Aide 13.13 31030 - Bus Driver 18.10 31043 - Driver Courier 13.14 31260 - Parking and Lot Attendant 11.65 31290 - Shuttle Bus Driver 13.98 31310 - Taxi Driver 11.79

- Truckdriver Light 13.98

- Truckdriver Medium 14.96

- Truckdriver Heavy 20.87

- Truckdriver Tractor-Trailer 20.87 99000 - Miscellaneous Occupations 99020 - Cabin Safety Specialist 14.54 99030 - Cashier 9.71 99050 - Desk Clerk 9.81 99095 - Embalmer 23.46 99130 - Flight Follower 24.65

- Laboratory Animal Caretaker I 10.44

- Laboratory Animal Caretaker II 11.21 99260 - Marketing Analyst 29.32 99310 - Mortician 23.46 99410 - Pest Controller 14.08 99510 - Photofinishing Worker 12.95

- Recycling Laborer 15.11

- Recycling Specialist 18.13 99730 - Refuse Collector 13.77 99810 - Sales Clerk 11.20 99820 - School Crossing Guard 9.45

- Survey Party Chief 22.11

- Surveying Aide 14.63

- Surveying Technician 20.10

- Vending Machine Attendant 13.41

- Vending Machine Repairer 16.38

- Vending Machine Repairer Helper 13.41 Note: Executive Order (EO) 13706 Establishing Paid Sick Leave for Federal Contractors applies to all contracts subject to the Service Contract Act for which the contract is awarded (and any solicitation was issued) on or after January 1, 2017.

If this contract is covered by the EO the contractor must provide employees with 1 hour of paid sick leave for every 30 hours they work up to 56 hours of paid sick leave each year. Employees must be permitted to use paid sick leave for their own illness injury or other health-related needs including preventive care; to assist a family member (or person who is like family to the employee) who is ill injured or has other health-related needs including preventive care; or for reasons resulting from or to assist a family member (or person who is like family to the employee) who is the victim of domestic violence sexual assault or stalking. Additional information on contractor requirements and worker protections under the EO is available at www.dol.gov/whd/govcontracts.

ALL OCCUPATIONS LISTED ABOVE RECEIVE THE FOLLOWING BENEFITS:

HEALTH & WELFARE: Life accident and health insurance plans sick leave pension plans civic and personal leave severance pay and savings and thrift plans. Minimum employer contributions costing an average of $4.48 per hour computed on the basis of all hours worked by service employees employed on the contract.

HEALTH & WELFARE EO 13706: Minimum employer contributions costing an average of $4. 18 per hour computed on the basis of all hours worked by service employees employed on the covered contracts.

*This rate is to be used only when compensating employees for performance on an SCA- covered contract also covered by EO 13706 Establishing Paid Sick Leave for Federal Contractors. A contractor may not receive credit toward its SCA obligations for any paid sick leave provided pursuant to EO 13706.

VACATION: 2 weeks paid vacation after 1 year of service with a contractor or successor 3 weeks after 5 years and 4 weeks after 15 years. Length of service includes the whole span of continuous service with the present contractor or successor wherever employed and with the predecessor contractors in the performance of similar work at the same Federal facility. (Reg. 29 CFR 4.173)

HOLIDAYS: A minimum of ten paid holidays per year: New Year's Day Martin Luther King Jr.'s Birthday, Washington's Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veterans' Day, Thanksgiving Day, and Christmas Day. (A contractor may substitute for any of the named holidays another day off with pay in accordance with a plan communicated to the employees involved.) (See 29 CFR 4.174)

THE OCCUPATIONS WHICH HAVE NUMBERED FOOTNOTES IN PARENTHESES RECEIVE THE FOLLOWING:

COMPUTER EMPLOYEES: Under the SCA at section 8(b) this wage determination does not apply to any employee who individually qualifies as a bona fide executive administrative or professional employee as defined in 29 C.F.R. Part 541.

Because most Computer System Analysts and Computer Programmers who are compensated at a rate not less than $27.63 (or on a salary or fee basis at a rate not less than $455 per week) an hour would likely qualify as exempt computer professionals (29 C.F.R. 541. 400) wage rates may not be listed on this wage determination for all occupations within those job families. In addition, because this wage determination may not list a wage rate for some or all occupations within those job families if the survey data indicates that the prevailing wage rate for the occupation equals or exceeds $27.63 per hour conformances may be necessary for certain nonexempt employees. For example, if an individual employee is nonexempt but nevertheless performs duties within the scope of one of the Computer Systems Analyst or Computer Programmer occupations for which this wage determination does not specify an SCA wage rate then the wage rate for that employee must be conformed in accordance with the conformance procedures described in the conformance note included on this wage determination.

Additionally, because job titles vary widely and change quickly in the computer industry job titles are not determinative of the application of the computer professional exemption. Therefore, the exemption applies only to computer employees who satisfy the compensation requirements and whose primary duty consists of:

The application of systems analysis techniques and procedures including consulting with users to determine hardware software or system functional specifications;

The design development documentation analysis creation testing or modification of computer systems or programs including prototypes based on and related to user or system design specifications;

The design documentation testing creation or modification of computer programs related to machine operating systems; or A combination of the aforementioned duties the performance of which requires the same level of skills. (29 C.F.R.

541.400).

AIR TRAFFIC CONTROLLERS AND WEATHER OBSERVERS - NIGHT PAY & SUNDAY PAY: If you work at night as part of a regular tour of duty you will earn a night differential and receive an additional 10% of basic pay for any hours worked between 6pm and 6am.