36C25721R0028.docx

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

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

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

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

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

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

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

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

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

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

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

none 36C25721R0028 03-05-2021 Hassan Wilson, Contract Specialist 915-217-1241 04-05-2021

5:00 PM

EDT

36C257 Department of Veterans Affairs VHA Regional Procurement Office West Network Contracting Office 17 Health Care Resources Branch I El Paso

TX

79936-1372 X 621498 $22 Million Net 30 N/A X 36C671 Department of Veterans Affairs South Texas Veterans Health Care System

(STVHCS)

7400 Merton Minter San Antonio, Texas 78229

TX

79936-1372 36C257 Same as Block# 9 none Financial Services Center (FSC) Department of Veterans Affairs P.O. Box 149971 Austin

TX

78714-8971 See CONTINUATION Page Contractor shall provide Community Base Outpatient Clinic (CBOC) services supporting South West (SW) San Antonio, Texas eligible Veterans of the South Texas Veterans Health Care System (STVHCS).

This requirement is solicited under 38 U.S.C., Section 8153 - Enhanced Sharing Authority. Reference the Price Cost Schedule (Page# 6) and Performance Work Statement (PWS) (Page# 10).

Period of Performance is for one (1) base year with nine (9) option years.

See CONTINUATION Page X x Marisela Galarza Contracting Officer Due to system errors, see forthcoming RFP amendment for entire solicitation.

See attached document: D.1 Quality Assurance Surveillance Plan.

See attached document: D.2 Immigration Certification.R.

See attached document: D.3 Organizational Conflict of Interest.R.

See attached document: D.4 Document Scanning Policy.

See attached document: D.5 Rights and Resp. of VA Patients, Not Mine.

See attached document: D.6 Suicide Prev. Assessment and Mgt, Not M.

See attached document: D.7 Ancillary and Point of Care Testing.

See attached document: D.8 Past Performance References.

See attached document: D.9 Past Performance Questionnaire.

See attached document: D.10 Government Provided Equipment.

See attached document: D.11 VA Hanbook 6500.6 Contractor Rules of Behavior.

See attached document: D.12 Wage Determination.

See attached document: D.13 VHA T-21 Implementation Guide.

See attached document: D.14 VHA Handbook 1605.02 Minimum Necessary Standard for Protected Health Information.

See attached document: D.15 VHA Handbook 1101.11 Coordinated Care for Traveling Veterans.

See attached document: D.16 VHA Handbook 1101.10 Patient Aligned Care Tea PACT.

See attached document: D.17 VHA Handbook 1006.02 Site Classifications and Definitions.

See attached document: D.18 VHA Directive 2009-031 Improving Safety in the Use of Medical Equipment.

See attached document: D.19 VHA Handbook 1106.01 Path and Lab Medicine Services Procedures.

See attached document: D. 20 Proper Use of Email.

See attached document: D.21 Communicating Test Results to Providers and Patients.

See attached document: D. 22 Home Telehealth.

See attached document: D. 23 Patient Medical Records-VA.

See attached document: D.24 36C25721R0028 SUBCONTRACTING PLAN TEMPLATE_01.

See attached document: D.25 IT Security.

See attached document: D.26 Pre-treatment Transport of Soiled Critical Semi-Critical RME.

See attached document: D.27 Updated Pre-treatment and Trans. of Soiled Critical and Semi-Critical RME.