36C26118Q0510-001.doc

Statement of Work

Ventilation System Verification Testing and Balancing Service

1. Basic Scope

1.1 Contractor shall furnish all equipment, labor, materials, apparatus, tools, parts, transportation, supervision, permits, disposal, reporting and expertise necessary to provide:

A. Testing/inspection report of the Supply Fans and Exhaust Fans listed in table 3.5.1

B. Preventive Maintenance report of belts for belt-driven exhaust fans listed in table 4.5.1 C. Quarterly Ventilation Testing and Balancing to the rooms listed below in table 5.4.1 up to 210 Rooms. The current list shows 185 rooms. Rooms located in Building 41 may be considered for this requirement; and all fans in this building are inspected or tested in sections A and B.

1.2 All services will be provided at San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121 and 1700 Owens Street, San Francisco, CA.

1.3 All reports, workbooks, spreadsheets, no matter what format used, are the property of the VA and must be sent unlocked and editable. Any formulas, data, functions and calculation that are part of the reports, workbooks, spread sheets must be included and are the property of the VA. All final quarterly reports are provided in both electronic (Microsoft Excel and Adobe Acrobat pdf) and hard copy format.

2. Definitions/Acronyms A.

Operations Facilities Manager – Engineering Supervisor or designee B.

CO - Contracting Officer

C.

COR - Contracting Officer Representative

D.

PM - Preventive Maintenance Inspection. Services which are periodic in nature and are required to maintain the equipment in such condition that it may be operated in accordance with its intended design and functional capacity with minimal incidence of malfunction or inoperative conditions.

E. Balancing – Adjustments to supply or exhaust dampers, either electronically or manually, to bring a specific room into “balance”, to provide the required supply, exhaust, air changes necessary for each room and function F.

Acceptance Signature - VA employee who is authorized to sign-off on the quarterly final reports which indicate that the maintenance or report has been concluded or is still pending completion G.

Authorization Signature - COR signature; indicates COR accepts work status as stated

H.

HVAC – Heating Ventilation and Air Conditioning I.

TIL – Technical Information Library: https://www.cfm.va.gov/TIL/ J.

VAMC - Department of Veterans Affairs Medical Center, 4150 Clement St. San Francisco, CA 94121 K.

MB – Mission Bay, 1700 Owens St. San Francisco, CA 94158

3. Fan Inspection Report

3.1 The Testing/Inspection Report for all Supply and Exhaust Fans shall include an inspection of all the fans listed in Table 1(3.5.1) serving the rooms listed in Table 3 (5.4.1). These inspections are made to confirm normal operation and safe conditions.

3.1.1 The COR or designee shall notify the Contracting Officer prior to adding or deleting any supply/exhaust fans from the contract. Equipment may be added or deleted from the service contract as needed upon notification by the Contracting Officer. Additions or deletions must be documented in writing via contract modification.

3.2 A quarterly report must be provided and accepted by the COR or designee at least one week prior to the start of Testing and Balancing, Section 5.

3.3 The Contractor shall perform necessary inspections according to manufacturer's specifications. The Contractor shall have written procedures to be followed and documented evidence demonstrating that each fan has been inspected according to those procedures.

3.4 The Contractor shall provide a printed and electronic check-off sheet noting the equipment being inspected and the specifications being met. Fan Inspection List Report must indicate date of service, the model, serial number and location of equipment serviced, and the services performed, and confirmation of test completion. Any fan that fails inspection, COR or designee shall be immediately notified of this failure in writing within 24 hours and provided recommended corrective action required.

3.5 The fans to be inspected and included in the Fan Inspection Report are listed in the table below.

Table 1: Fan Inspection List, 3.5.1

Supply Fans

Table 2: Fan Inspection List, 3.5.1 (Cont.)

Exhaust Fans

Rooftop Bldg 12 (old)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Top roof, above penthouse, Bldg 200

Top roof, above penthouse, Bldg 200

Rooftop Bldg 203-C

Rooftop Bldg 203-C

Rooftop, above Penthouse, Bldg 203

Rooftop, above ICU, Bldg 203

Rooftop, above ICU, Bldg 203

Rooftop Bldg 203-B SOUTH

Rooftop Bldg 203-B SOUTH

Rooftop Bldg 203-B SOUTH

Rooftop Bldg 203-B SOUTH

Rooftop Bldg 203-B NORTH

Rooftop Bldg 203-B NORTH

Rooftop Bldg 203-B NORTH

Rooftop Bldg 203-B NORTH

4. Replacement Belts.

4.1 The Testing/Inspection Report for all Belt-Driven Exhaust Fans shall include PMs of all belts on belt-driven exhaust fans serving the rooms listed in Table 3 (5.4.1). These inspections are made to confirm normal operation and safe conditions.

4.2 A quarterly report must be provided and accepted by the COR or designee at least one week prior to the start of Testing and Balancing, Section 5.

4.3 The Contractor shall evaluate all belts and replace according to manufacturer's specifications. The Contractor shall have written procedures to be followed and documented evidence demonstrating that each fan belt has been inspected according to those procedures. At a minimum, each belt must be replaced annually.

4.4 The contractor shall provide a printed and electronic check-off sheet noting the equipment being inspected and the specifications being met. The Belt Replacement Report must indicate date of service, the model, serial number and location of equipment serviced, and the services performed, parts replaced, and confirmation of test completion.

4.5 The fan belts to be inspected and included in the Belt Replacement Report are listed in the table below.

Table 2: Belt Replacement List, 4.5.1

Rooftop Bldg 12 (old)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop Bldg 12 (new)

Rooftop

Rooftop

Rooftop

Rooftop

Rooftop

Penthouse

Penthouse

Top roof, above penthouse, Bldg 200

Rooftop Bldg 203-C

Rooftop Bldg 203-C

Rooftop, above Penthouse, Bldg 203

Rooftop, above ICU, Bldg 203

Rooftop, above ICU, Bldg 203

Rooftop South

Rooftop South

Rooftop South

Rooftop South

Rooftop North

Rooftop North

Rooftop North

Rooftop North

5. Quarterly Testing and Balancing.

5.1 Testing and balancing will be scheduled and performed on a Quarterly basis.

a. Each report will indicate if room was balanced at the time of testing.

b. If corrections or errors identified by COR or designee are made after the testing report was submitted, a second report will be provided no later than 10 days after the adjustments or corrections were made.

c. It is the responsibility of the Contractor to Test and Balance each room listed in 5.4.1 each quarter. There are also an additional 25 rooms that may be required as well.

d. Any room that cannot meet the required air exchange rate or balanced by damper adjustments, COR or designee shall be immediately notified of this failure in writing within 24 hours and provided recommended corrective action required. These deficiencies and recommendations will also be documented as well in the comments of the quarterly report.

5.2 Testing and balancing will be performed when the work will minimize disruptions to patients, patient services or research professionals. Where possible, testing and balancing should be done on weekends or after normal business hours.

5.2.1 Rooms with In-patients must be tested and balanced after breakfast and before evening meals are served, after 10:00 AM but before 4:00 PM every day. Testing and balancing should be scheduled in advance each quarter, and agreement made in writing, between the COR or designee and Contractor.

5.2.2 All Operating Suite rooms, Cardiac Catheterizations Lab/Interventional Radiology rooms, Minor Procedures/Urology rooms inspections must be done after hours or on weekends when the Procedure Rooms are not occupied.

5.2.2.1 For Operating Room, Operating Suite and SPS (Sterile Processing Service) inspections, the Contractor must be suited in appropriate, approved, protective, sterile clothing and shall ensure no debris, dust, or fallout from ducts remain behind.

5.2.3 Readings of registers are made with a certified Alnor Balometer. For rooms with a fume hood, a certified Shortridge Instruments Verigrid is used. Proof of equipment certification shall be provided with report submission.

5.2.4 When Balancing is required in any room, an approved self-containment unit must be used and contractor must follow VA infection control procedures when working above ceiling and or in a restricted area. It is the responsibility of the contractor to clean up after they perform work that may have disrupted debris during the process.

5.2.5 Mission Bay is a leased facility and all balancing must be performed with Lessor assistance. Balancing will be performed with Lessor’s Building Management System and pre-approved by COR or designee.

5.3 Contractor shall provide necessary manpower and supervision to properly prepare reports of the Testing and Balancing each quarter. All reports for the quarter must be submitted at least 14 days prior to the end of the quarter.

5.3.1 The Testing and Balancing reports are compiled in two Quarterly reports:

a. The Patient Care Report, which includes all rooms and facilities listed in 5.4.1 for Buildings 200, 203, 208; and,

b. The Research Facilities Report, which includes all rooms and facilities listed in 5.4.1 for Buildings 12, MB, and possibly 41.

5.3.2 The Contractor must distribute the full reports to the COR or designee within 10 days after the completion of all quarterly testing and balancing of the rooms.

5.3.3 The Quarterly Testing and Air Balancing Report must provide the following for each room listed in 5.4.1:

a) Room Number

b) Building

c) Cubic Feet

d) Required Balance

e) Required Supply (CFM)

f) Required Exhaust (CFM)

g) Minimum Required Air Changes

h) Actual Supply (CFM) per register and total

i) Actual Exhaust/Return (CFM) per register and total

j) Actual Air Changes per Hour

k) Actual Percent POS/NEG

l) Comments from Readings and Observations (including if balancing performed)

m) Isolation Room Alarm Test Results

n) Latest VA HVAC Design Manual Reference page

5.3.4 Test and Balance Reports Requirements listed in 5.3.3, in regard to sections d) Required Balance, e) Required Supply (CFM), f) Required Exhaust (CFM), g) Minimum Required Air Changes, are provided and pre-approved by the COR or designee. Any changes must also be approved by the COR or designee. COR or designee will validate or relay any changes at the start of each quarter or prior to. These items must be included for each room on the Test and Balance Reports. Any changes to these requirements does not constitute a change to this contract.

5.4 The COR or designee can add up to 25 rooms at no additional charge at any time during the quarterly cycle. COR or designee will relay any additions and which report type, either patient care or research facilities, no later than the end of the second month of the quarter. The minimum number of rooms required are listed in the table below.

Table 3: Rooms requiring Testing and Balancing, 5.4.1

Building 200 Patient Non-Isolation Rooms

Building 203 Patient Non-Isolation Rooms

Building 200 Radiology Suite

Building 200 Sterile Processing and Distribution

Building 200 Patient Isolation Room

Building 200 Operating Rooms

Building 200/203 Operating Suite

Building 203 Nuclear Medicine Suite Non-Isolation Rooms

Mission Bay 1700 Owens.

5.4.1 Required Balance Designations:

NEG - Negative Air Balance

D-NEG - Double Negative Air Balance

POS - Positive Air Balance

D-POS - Double Positive Air Balance

Neutral - Neutral Air Balance

6. Qualification

3.1 Contractor shall have been engaged in maintaining/servicing/testing the equipment listed in table 3.5.1 for a minimum of three (3) years. Contractor shall have a field service representative who has received maintenance training specific to the models listed.

3.2 Contractor shall provide, upon request, evidence of appropriate training of any field service representative.

7. Quality Assurance

7.1 For the tasks listed in the Performance Requirement Table (PRT) below, the COR or designee will follow the methods of surveillance specified in this contract.

7.2 When a required service in the PRT indicates defective performance, the COR or designee will require the contract manager or representative at the site to document the observation and forward to the Contracting Officer to maintain in the file. The documentation of the observation does not necessarily constitute concurrence with the observation, only acknowledgment that he or she has been made aware of the defective performance. Government surveillance of tasks not listed in the PRT or by methods other than those listed in the PRT (such as provided for by the Inspection of Services clause) may occur during the performance period of this contract. Such surveillance will be done according to standard inspection procedures or other contract provisions. Any action taken by the contracting officer as a result of surveillance will be in accordance with the terms of this contract.

7.3 The Contractor and COR or designee will meet prior to end of each quarter to review reports and discuss any issues. These will be scheduled in person.

7.3.1 Performance Requirements

Table 4: Performance Requirements, 7.3.1

Surveillance Factors to consider for Option Year Renewal

Latest VA HVAC Design guide. Provide reports

VISN 21 90 CCA

Contractor Personnel Security Requirements

Reference:

VHA Directive 0710, Personnel Security and Suitability Program/ May 18, 2007 VA Handbook 0710, Personnel Suitability and Security Program/ September 10, 2004 Upon contract award, all key personnel shall be subject to the appropriate type of background investigation or screening per VA/VHA directive 0710 and must receive a favorable adjudication from CCA Personnel Security Specialist or VA Security and Investigations Center (SIC) depending on investigation or screening required. This requirement is applicable to all subcontract personnel. If the investigation or screening is not completed prior to the start date of the contract, the Contractor will be responsible for the actions of those individuals they provide to perform work for VA.

Contract personnel who previously received a favorable adjudication as a result of a Government background investigation or screening may be exempt from this contract requirement. They must provide documentation to support the previous adjudication. Proof of previous adjudication must be submitted by the Contractor to the VA Contracting Officer. Proof of previous adjudication is subject to verification. Some positions maybe subject to periodic re-investigation/screening.

1. Position Risk/Sensitivity – For all positions required under this contract, the position risk/sensitivity has been designated as: Low Risk

2. Background Investigation/Screening – It is anticipated that the Contractor or contract personnel will be providing services at a VA facility(s) for MORE than 180 days under a single contract or series of contracts, or have access to VA computer data systems. The background investigation/screening commensurate with the requirements of this contract is: N/A

3. Contractor Responsibilities

a) The Contractor shall prescreen all personnel to ensure they are able to read, write, speak, and understand the English language.

b) The Contractor shall submit or have their contract personnel submit the following required forms to the Personnel Security Specialist or VA Contracting Officer, through the COTR or Personnel Security Specialist, within five (5) business days of contract award.

4. Low Risk Investigative Requirements

a) All investigations must be completed through the Electronic Questionnaires for Investigations Process (e-QIP). All contractors must complete the Authorization for Investigation Worksheet before they can complete the online e-Qip.

b) Optional Form 306, Declaration for Federal Employment provide by VA point of contact.

c) Electronic Fingerprint Verification or FD 258, U.S. Department of Justice Fingerprint Applicant Chart.

d) Once the items requested are completed, the Contractor is authorized to provide services under the contract. As previously stated, if the investigation or screening is not completed prior to the start date of the contract, the Contractor will be responsible for the actions of those individuals they provide to perform work for VA.

e) The Contractor, when notified of an unfavorable determination by the Government, shall withdraw the contract person from consideration of working under the contract.

f) Failure to comply with these Contractor personnel security requirements may result in termination of the contract for default.

5. Government Responsibilities

a) The VA Contracting Officer will ensure a time for contract personnel to complete the fingerprint portion of this requirement, if any, and the COTR will responsible for performing any duties assigned by the VA Contracting Officer with regard to fulfilling the Contractor personnel security requirements described herein.

b) Upon receipt, the local VA facility or VA SIC, depending on the type of investigation/screening required, will review the accuracy of the items requested in paragraph above, and forward these items to OPM to conduct their portion of the background investigation or screening, as applicable.

c) The requesting VA facility will pay for any portion of the investigation or screening conducted by OPM, if any.

d) Depending on the type of investigation/screening required, the Personnel Security Specialist, or VA SIC will notify the VA Contracting Officer of the adjudicating results of the background investigation or screening.

e) The VA Contracting Officer and Personnel Security Specialist will ensure that the required investigations or screening have been completed or are in the process of being requested.

Personnel Identity Verification (PIV) of Contractor Personnel In accordance with FAR 52.204-9 and VA Directive 0735 – Personal Identity Verification of Federal Employees and Contractors, any contract person who requires routine physical access to a Federally-controlled facility and/or routine access to a Federally-controlled information system will be required to verify their identity prior to providing services under the contract. Prior to providing services under the contract, each contract person will be asked to provide two (2) forms of identification from the Accepted Identification Documentation List to the appropriate VA representative in order to obtain a proper VA-issued identification card. See the Accepted Identification Documentation List provided below. The COTR, or designee, will be responsible for sponsoring each contract person that requires a VA-issued identification card.

PIV ID Proofing Criteria

The following criteria must be met by all VA employees, contractors, and affiliates prior to being issued a PIV card or Temporary Identity Badge.

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Table of Accepted Identification (From Form I-9)

Last Update: January 7, 2008

1. Two forms of identification are required from the above list of acceptable documents. Either of the following is accepted:

a) Two forms of identification from the left column (Federal or State Government issued picture ID)

b) One form of identification from the left column (Federal or State Government issued picture ID) and one form from the right column (Non-Picture ID or Acceptable Picture ID not issued by Federal or State Government).

2. The following rules apply for form identification:

a) Any form of identification used for ID proofing may not be expired (except U.S. Passport)

b) Department of Veterans Affairs site/facility badges are not accepted as a valid form of identification.

c) VA PIV Cards are federally issued ID cards and can be used as a valid form of identification.

d) Handwritten or photocopied documents are not accepted.

e) An ID issued before a legal name change (e.g. birth certificate or driver's license) can be presented as one form of ID if a legal document (e.g. marriage certificate/license or a court order) is also presented linking the previous name to the current legal name. The linking document has to display both the former and current legal names. Both documents must be valid and not expired (except U.S Passport). For example, a married woman may use both a certified copy of her birth certificate displaying her maiden name and a driver’s license displaying her married name as the 2 forms of ID compliant with PIV Guidelines, as long as she provides a marriage license displaying both her maiden name and married name.

f) The Applicant’s name listed on the VA PIV Registration Portal, Request for One-VA Identification Card, must match the name on one of the IDs presented by the Applicant.

g) The names on both forms of ID presented for ID proofing must match exactly. If one form of ID has a middle name or initial, the other form of ID must have a matching middle name or initial. One form can contain a middle name and the other can have a middle initial as long as the they match. ALL names must be accounted for on both forms of ID. Please see the acceptable and unacceptable ID proofing examples provided below.

ACCEPTABLE NAME VARIATIONS

ID # 1 – John Henry Smith; ID # 2 – John Henry Smith

ID # 1 – John H. Smith; ID # 2 – John H. Smith

ID # 1 – John Henry Smith; ID # 2 – John H. Smith

UNACCEPTABLE NAME VARIATIONS

ID # 1 – John Henry Smith; ID # 2 – John Smith ID # 1 – John H. Smith; ID # 2 – John Smith

3. Access to and Safeguard of VA Information/Computer Systems

a) VA may provide contract personnel with access to VISTA and general files maintained on VA computer systems. Sharing of these access codes or misuse of VA information/computer systems is a Federal crime. When contract personnel no longer provides services to VA, the Contractor shall immediately inform the COTR to deactivated their access. The COTR is responsible for deactivation.

b) Computer access will require VA Cyber Security Awareness Training annually and acknowledge all agreements prior to access. (See attachment for security requirements). The COTR is responsible for ensuring and documenting this requirement.

c) Contract personnel with Computer access will take necessary precautions to safeguard information and prevent disclosures. If contract personnel suspect a compromised they will report such knowledge to the COTR that same day.

d) Remote access will require prior approval from Information Security Officer (ISO).

e) The Contractor shall make its internal policies and practices regarding the safeguarding medical electronic information available to VA. Contractors are not authorized to employ a lesser requirement then what is established by this document.

f) Any changes in the VA directives during the term of this contract, shall be deemed to be incorporated into this contract.

Dated 10-01-2013