36C25721Q0685 0001.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODE CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

1 5

0001 549-21-2-5088-0514

Department of Veterans Affairs VISN17 Network Contracting Activity 5441 Babcock Road Ste. 302 San Antonio TX 78240

Department of Veterans Affairs VISN17 Network Contracting Activity 5441 Babcock Road Ste. 302 San Antonio TX 78240

To all Offerors/Bidders 36C25721Q0685

08-27-2021 X x x one

The purpose of this Amendment is to include the correct Statement of Work (SOW). Please use this SOW as reference when submitting proposals associated with this modification.

Point of contact for this Amendment is Ognian Ivanov and can be reached via email: ognian.ivanov@va.gov

Robyn Nussbaum

CONTRACTING OFFICER

CONTINUATION PAGE

1. Title of Project: Medical Gas Systems Inspection and Certification

2. Scope of Work: The contractor shall perform the Med Gas Safe TM annual inspection of the medical gas system at the Dallas Veterans Affairs Medical Center, 4500 S. Lancaster Rd., Dallas, TX 75216-7167 in accordance with current NFPA. ANSI, CGA, USP and Joint Commission specifications. Systems include Oxygen, Medical Air, Medical Vacuum, Nitrogen, Carbon Dioxide, Nitrous Oxide and Waste Anesthetic Gas (WAGD). The following inspections shall be performed.

a. Testing of master alarm panels. NFPA 99 – 5.1.14.4.8. Function test of all signals from source and bulk systems to master alarm panels, simulate failures at all source field switches. Includes determination of trip setting accuracy and correct bulk/source system labeling. (There are 117 master alarms)

b. Testing of area alarm panels. NFPA 99 – 5.1.14.4.8. Test all audible and visual alarm signals for continuity, determine accuracy of trip settings and readouts.

Includes determination of proper area served signage. Pressure transducers/pressure switches shall be function tested to determine proper operation of hi/lo pressure signals, proper communication with area panel, and determination of hi/lo trip setting on alarm display. (There are 157 area alarm)

c. Zone valves. ASSE – 3.5 & 3.6, NFPA 99 – 5.1.14.2.3.1 (8). Verify proper area served labeling, test for external leakage and validate accuracy of pressure gauge.

A l s o , p articulate samples in each zone to test for contamination. (There are 514 zone valves)

d. Liquid bulk systems. NFPA 99 – 5.1.14.2.3.1 (6), ASSE 3.5. Test operation of the reserve and reserve in use signaling devices, check proper function of level activating switch. Inspect all cryogenic tanks for security, leaks, control configuration and labeling. (There is 1 liquid bulk storage tank)

e. Gas source systems. NFPA 99 – 5.1.14.2.3.1 (5), ASSE 3.5. Leak test all manifold components including valves, pigtails and regulators. Test for proper reserve in use pressure switch activation. Test for proper operation of the changeover for secondary supply. (There are 6 manifold and switches that need to be tested)

f. Medical air system. NFPA 99 – 5.1.14.2.3.1 (1), ASSE 3.3, 3.3 and 3.5. Verify compressor operating within manufacturer specifications. Check for documented maintenance plan in place. Function test of automatic alternating controls. Test audible and visual alarms. Test pressure across filters. Calibrate dew point monitor and verify proper operation. (There are 11 medical air compressors)

g. Vacuum system. NFPA 99 – 5.1.14.2.2.4. Verify maintenance conducted according to manufacturer specifications. Function test automatic alternating controls. Test pressure/vacuum switch for proper operation. Validate frequency of pump starts and duration of runs. Measure cut-in and cut-out pressure/vacuum.

h. Manufactured assemblies. NFPA 99 – 5.1.14.2.3.2 (A). Exam and Verify that each joint and DISS fitting is examined for leakage and that the flexible assemblies are in a safe working condition. (there are 4279 D.I.S.S disconnects in the system)

i. Vacuum inlets and pressure gas outlets. NFPA 99 – 5.1.14.2.3.1 (11). Test flow of all vacuum inlets. Check pressure and flow of all outlets in critical care areas:

emergency room, intensive care, special care units, procedure labs, delivery rooms, operating rooms and recovery rooms. (there are 4279 patient terminals)

3. All inspections shall be performed during normal working hours, 7:00 AM to 4:30 PM, on normal government workdays. All surgical suite testing shall be performed after normal hours. Critical care unit testing shall be coordinated with respiratory services.

4. The contractor shall submit a written report to the COR in a commercially acceptable format by the required delivery date in the contract delivery schedule.

5. Performance Period: September 30, 2021 to 29 September 2022 plus four option years.

6. Type of Contract: Firm-fixed-price contract.

Information Systems Officer, Information Protection: The contractor will not have access to VA Desktop computers nor will they have access to online resources belonging to the government while conducting services.

The COTR and the Contractor will assure that-

A. No other information except what is in this contract will be shared with the contractor in any follow up communication.

B. None of the information in this contract includes Protected Health Information (PHI) or Individually Identifiable Information (III).

Privacy Officer: The contractor will not have access to Patient Health Information (PHI) nor will they have the capability of accessing patient information during the services provided to the VA.

Records Management:

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. VANTHCS 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 VANTHCS 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 VANTHCS. 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 VANTHCS 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 VANTHCS 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 VANTHCS policy.

8. The Contractor shall not create or maintain any records containing any non-public VANTHCS 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 VANTHCS 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 VANTHCS 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, Talent Management System (TMS) Item #3873736, Records Management for Records Officers and Liaisons. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training.