36C26121Q0751.docx

36C26121Q0751

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

459-22-1-829-0002 36C26121Q0751 07-24-2021 Maria Teodoro-Tanksley 916-923-4511 08-16-2021

10AM

PDT

612MCP

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO) 21 5342 Dudley Blvd Bldg 209 McClellan

CA

95652 X X 485991 $16.5 Million N/A X See Price Schedule

612MCP

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO) 21 5342 Dudley Blvd Bldg 209 McClellan

CA

95952

Department of Veterans Affairs FMS VA-9(101) Financial Services Center PO Box 149971 Austin TX 78714-9971

See CONTINUATION Page

SPECIAL NEEDS GROUND TRANSPORTATION SERVICE FOR

VA Pacific Islands Health Care System (VAPIHCS), HI POP- 01 Oct 2021- 30 Sep 2022 plus 2 option years.

This is a 100% Service Disabled Veteran Owned Small Business (SDVOSB). Offerors must be registered in VIP upon quote submittal or quote will be rejected.

Offerors to submit quote(s) per instruction provided in 52.212-1 and 52.212-2.

See CONTINUATION Page X X Jason Hill

CONTRACTING OFFICER

SECTION B - CONTINUATION OF SF 1449 BLOCKS

Note to Offeror. Submit an electronic copy of your offer to Maria.Teodoro-Tanksley@va.gov by the date and time specified in Block 8 of Standard Form 1449. See FAR 52.212-1 for additional Instructions, Conditions, and Notices to Offerors or Respondents.

It is imperative that the Solicitation Number be included in the “Subject” line of the email.

1. Contract Administration: Indicate below the names, phone numbers and email addresses of individuals who will handle all contract administration matters:

a. CONTRACTOR: Company Name: ____________________________________ Address: __________________________________________ City & State & Zip: __________________________________ POC & Number: ____________________________________

b. GOVERNMENT: Network Contracting Office (NCO 21) 5342 Dudley Blvd, Bldg 209 McClellan Park, CA 95652

2. Invoice: Contractor shall submit Invoices monthly in arrears electronically through the Tungsten network. No advanced payments are authorized.

3. Payments: The Government will make all payments to the Contractor in accordance with FAR Clause 52.232-33, Payment by Electronic Funds Transfer - Other Systems for Award Management (SAM) Registration and FAR 52.212-4(i).

4. Acknowledgement of Amendments: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO ____________________ DATE _____________________

AMENDMENT NO ____________________ DATE _____________________

5. DUNS Number: Provide the Duns and Bradstreet Number assigned to your firm in the space provided below:

DUNS#________________________________

6. TAX Identification Number: Provide Company’s Tax ID number: _____________________ Registrations. All offerors must be registered at the System for Award Management (SAM) website at www.sam.gov, the On-Line Representations and Certifications (ORCA) website at www.bpn.gov, and have a tax identification number (TIN) and a Data Universal Numbering System (DUNS) number. DUNS information and/or application can be accessed at http://smallbusiness.dnb.com or by calling 1-800-234-3867.

B.1 PRICE/COST SCHEDULE

ITEM INFORMATION

Contractor shall provide all personnel, management, transportation, equipment, supplies, tools, and other items and non-personal services necessary to perform the special needs ground transportation to all eligible beneficiaries of the Department of Veterans Affairs (VA) facilities within the VA Pacific Islands Health Care System (VAPIHCS).

PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

Note: Flat rate per trip for all Items 0001 to 4004

Contract Period: Base POP Begin: 10-01-2021 POP End: 09-30-2022 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

200 trips per month

Contract Period: Base POP Begin: 10-01-2021 POP End: 09-30-2022 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

1,100 trips per month

Contract Period: Base POP Begin: 10-01-2021 POP End: 09-30-2022 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

12 trips per month

Contract Period: Option 1 POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

200 trips per month

Contract Period: Option 1 POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

1,100 trips per month

Contract Period: Option 1 POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

12 trips per month

Contract Period: Option 2 POP Begin: 10-01-2023 POP End: 09-30-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

200 trips per month

Contract Period: Option 2 POP Begin: 10-01-2023 POP End: 09-30-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

1,100 trips per month

Contract Period: Option 2 POP Begin: 10-01-2023 POP End: 09-30-2024 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

12 trips per month

Contract Period: Option 3 POP Begin: 10-01-2024 POP End: 09-30-2025 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

200 trips per month

Contract Period: Option 3 POP Begin: 10-01-2024 POP End: 09-30-2025 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

1,100 trips per month

Contract Period: Option 3 POP Begin: 10-01-2024 POP End: 09-30-2025 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

12 trips per month

Contract Period: Option 4 POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

200 trips per month

Contract Period: Option 4 POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

1,100 trips per month

Contract Period: Option 4 POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 485991 - Special Needs Transportation PRODUCT/SERVICE CODE: V122 - Transportation/Travel/Relocation - Transportation: Motor Charter

MANUFACTURER PART NUMBER (MPN): NA

12 trips per month

36C26121Q0751

PERFROMANCE OF WORK STATEMENT (PWS)

1. General: This is a non-personnel services contract to provide Special Needs Ground Transportation. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform patient transportation as defined in this Performance Work Statement except for those items specified as government furnished property and services.

1.1.1 The Contractor shall pick-up at the patient address and deliver to destination; and return to patient address upon completion of medical appointment. Payment from patient address to destination; and return to patient address.

1.1.1.1 Definitions:

a. Trip: A one-way ride from one pick-up point to one drop-off point. Contractor will charge per trip.

b. Long or Short Trip: No price difference for a long or short trip. Price Schedule will not define a long or short trip.

c. Mileage: No charge for mileage. Contractor will charge per trip.

d. Waiting: Driver is not required to wait for the patient’s appointment to conclude. Driver may give patient their contact information and pick-up when ready. There will be no charges for waiting.

e. Obstacles: There will be no extra charge for obstacles such as, stairs, dirt roads, undriveable driveways, paid parking, etc. The Contractor will communicate with the patient and come to an agreement on where the pick-up point will be.

1.1.2 Services are to be provided 5 days per week, Monday through Friday, between 7:30 a.m. to 5:00 p.m. on the Island of Oahu, Hawaii, except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings.

1.1.3 The contractor shall perform to the standards in this contract.

1.2 Scope:

1.2.1 The Contractor shall provide all vehicles, personnel, management, supplies, transportation, equipment, and reports necessary to provide ground transportation services for eligible beneficiaries, as determined and authorized in advance by VA Pacific Islands Health Care System (VA PIHCS) Beneficiary Travel Supervisors, Beneficiary Physician Utilization Management Advisor (PUMA), Transportation Coordinators, and the Administrative Officer of the Day (AOD). The Contractor shall accomplish specific ground transportation services, approved in advance by the VA Pacific, as identified within this performance work statement.

1.2.2 The Contractor shall provide a toll-free number for accepting telephone calls. Request for services will be requested by authorized personnel as identified in the PWS, by telephone and followed/confirmed in writing.

1.2.2 The Contractor shall ensure the request is from an authorized VA PIHCS official and their name and title shall be added to the contractor’s records documenting such request.

1.2.2 A list of personnel authorized to place requests for service will be provided at contract award and updated regularly as needed by VA PIHCS.

1.2.3 Contractor shall provide VA PIHCS a daily list of scheduled patients.

1.2.4 VA PIHCS will provide a daily Trip Manifest via Vet Ride. Trip Manifest will include passenger name, phone number, mobility needs, if an attendant will be joining them, departure time, appointment time, pick-up address, drop-off address, estimated distance, and contact information (address and phone number) for the appointment clinic. Access to Vet Ride will be provided to Contractor identified employees buy the Veterans Transportation Service (VTS) Supervisor or the VTS Coordinators.

1.3 General Information

1.3.1 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.3.3 Recognized Federal Holidays:

Independence Day

1.3 DEFINITIONS/ACRONYMS

1.3.1 DEFINITIONS:

1.3.2 CONTRACTOR. A supplier or Contractor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

1.3.3 CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

1.3.4 CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

1.3.5 DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

1.3.6 DELIVERABLE. Anything that can be physically delivered but may include non- manufactured things such as meeting minutes or reports.

1.3.7 PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

1.3.8 QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

1.3.9 QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

1.3.10 QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

1.3.11 SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

1.3.12 WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

1.3.13 WORK WEEK. Monday through Friday, unless specified otherwise.

1.4 ACRONYMS

Record System

2. QUALIFICATIONS

2.1 STAFF/FACILITY:

2.1.1 Contractor personnel shall perform services in accordance with ethical, professional, and technical standards of the healthcare industry consistent with VA policy, regulations, procedures, and protocol.

2.1.2 Contractor personnel shall be technically proficient in the skills necessary to fulfill the requirements stated herein including the ability to understand, speak, read, and write the English language.

2.2. TECHNICAL DIRECTION:

2.2.1 Maintain transport vehicles in a safe and orderly manner and perform other related activities.

2.2.2 Contractor will assure that Contractor personnel have worker's compensation, professional liability insurance if applicable, health insurance, and Federal and State income tax withholding and any other employee requirements mandated by local, state, and federal law or agencies.

2.2.3 Conflict of Interest: The Contractor and all contract personnel are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest. These statements shall be in response to the VAAR provision 852.209-70 Organizational Conflicts of Interest (Jan 2008) and fully outlined in response to the subject attachment in Section D of the solicitation document.

2.2.4 Citizenship related Requirements: The Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals.

2.2.5 While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract, or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.

2.2.6 If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.

2.2.7 This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.

2.2.8 The Contractor agrees to obtain a similar certification from its subcontractors. The certification shall be made as part of the offerors response to the RFP using the subject attachment in Section D of the solicitation document.

2.2.9 Annual Office of Inspector General (OIG) Statement: In accordance with HIPAA and the Balanced Budget Act (BBA) of 1977, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs.

2.2.9.1 Contractor shall review the HHS OIG List of Excluded Individuals/Entities on the HHS OIG web site at http://oig.hhs.gov/exclusions/index.asp to ensure that the proposed contract physicians (s) are not listed. Contractor should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against the Contractor that employ or enter into contracts with excluded individuals to provide items or services to Federal program beneficiaries.

2.2.9.2 By submitting their proposal, the Contractor certifies that the HHS OIG List of Excluded Individuals/Entities has been reviewed and that the Contractors are and/or firm is not listed as of the date the offer/bid was signed.

2.3 NON-PERSONAL SERVICES

2.3.1 No Employee status: The Contractor shall be responsible for protecting Contract personnel furnishing services. To carry out this responsibility, the Contractor shall provide or certify that the following is provided for all their staff providing services under the resultant contract:

2.3.1.1 Workers’ compensation

2.3.1.2 Professional liability insurance

2.3.1.3 Health examinations

2.3.1.4 Income tax withholding, and

2.3.1.5 Social security payments

2.4 Tort Liability: The Federal Tort Claims Act does not cover Contractor. When a Contractor has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s action or non-action shall be the responsibility of the Contractor and/or insurance carrier.

2.5 Non-Personal Healthcare Services: The parties agree that the Contractor shall not be considered VA employees for any purpose.

2.6 Inherent Government Functions: Contractor shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy.

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. The Government will not furnish services, facilities, utilities, equipment, or materials.

4. PERFORMANCE STANDARDS, QUALITY ASSURANCE (QA) AND QUALITY IMPROVEMENT (QI)

4.1 Quality Management/Quality Assurance Surveillance: Contractor shall be subject to Quality Management measures, such as patient satisfaction surveys. Contractor performance will be monitored by the government using the standards as outlined in this Performance Work Statement (PWS) and methods of surveillance detailed in the Quality Assurance Surveillance Plan (QASP). The QASP shall be attached to the resultant contract and shall define the methods and frequency of surveillance conducted.

4.2 Patient Complaints: The CO will resolve complaints concerning Contractor relations with the Government employees or patients. The CO is final authority on validating complaints. In the event that the Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.

4.3 The Government reserves the right to refuse acceptance of any Contractor personnel at any time after performance begins, if personal or professional conduct jeopardizes patient care or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction, or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient or other staff members to designated Government representatives. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The CO and COR shall deal with issues raised concerning Contractor’s conduct. The final arbiter on questions of acceptability is the CO.

5. GOVERNMENT RESPONSIBLILITES

5.1 CO Responsibilities: Contracting Officer (CO).

5.1.1 The CO is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the CO on all matters pertaining to contract administration. Only the CO is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity, or quality of performance of this contract.

5.1.2 The CO shall resolve complaints concerning Contractor performance. The CO is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the CO without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof.

5.1.3 In the event that contracted services do not meet quality and/or safety expectations, the best remedy will be implemented, to include but not limited to a targeted and time limited performance improvement plan; increased monitoring of the contracted services; consultation or training for the contract staff to be provided by the VA; replacement of the contract staff and/or renegotiation of the contract terms or termination of the contract.

5.2 COR Responsibilities:

5.2.1 The COR shall be the VA official responsible for verifying contract compliance. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

5.2.2 The COR will be responsible for monitoring the Contractor’s performance to ensure all specifications and requirements are fulfilled. Quality Improvement data that will be collected for ongoing monitoring includes but is not limited to enter data that may be collected.

5.2.3 The COR will maintain a record-keeping system of services by invoicing. The COR will review this data monthly when invoices are received and certify all invoices for payment by comparing the hours documented on the VA record-keeping system and those on the invoices. Any evidence of the Contractor's non-compliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer.

5.2.4 The COR will review and certify monthly invoices for payment. If in the event the Contractor fails to provide the services in this contract, payments will be adjusted to compensate the Government for the difference.

5.2.5 All contract administration functions will be retained by the VA.

6. SPECIAL CONTRACT REQUIREMENTS

6.1 REPORTS/DELIVERABLES: The Contractor shall be responsible for complying with all reporting requirements established by the Contract. Contractor shall be responsible for assuring the accuracy and completeness of all reports and other documents as well as the timely submission of each. Contractor shall comply with contract requirements regarding the appropriate reporting formats, instructions, submission timetables, and technical assistance as required.

6.2 BILLING/INVOICING

6.2.1 Payment: Contractor shall be paid procedure performed at the Medicare’s Jurisdiction 1 Part B, current year Ambulatory Surgical Center (ASC) Fee Schedule for Hawaii. https://www.cms.gov/

6.2.2. Invoicing: Contractor shall provide monthly invoicing to the government within 10 days of the end of each month for when services were provided. Subsequent changes or corrections shall be submitted by separate invoice. In addition to information required for submission of a “proper” invoice in accordance with VAAR 852.232-72 Electronic submission of payment requests, and shall include the following at a minimum:

6.2.2.1 Name and Address of Contractor

6.2.2.2 Invoice Date and Invoice Number

6.2.2.3 Contract Number and Purchase/Task Order Number

6.2.2.4 Date of Service

6.2.2.5 Name of Patient

6.2.2.6 Pick-up Address

6.2.2.7 Destination Address

6.2.2.8 Name of Facility

6.2.2.9 Total price

6.3. Contractor Electronic Invoice Submission Methods. Facsimile, e-mail, and scanned documents are not acceptable forms of submission for payment requests. Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods.

6.4. Contractor e-Invoice Set-Up Information. Submit your electronic invoices to the VA Financial Services Center for payment processing via the OB-10 system http://ob10.com/us/en/veterans-affairs-us/, free of charge. If you have question about the e- invoicing program or OB10, please contact the FSC at the phone number or email address listed below:

OB10 e-Invoice Setup Information: 1-877-489-6135 OB10 e-Invoice email: VA.Registration@ob10.com FSC e-Invoice Contact Information: 1-877-353-9791 FSC e-invoice email: vafsccshd@va.gov

6.5. No Direct Billing of VA beneficiaries.

6.5.1. Contractor shall accept payment for services rendered under this contract as payment in full. VA beneficiaries shall not under any circumstances be charged nor their insurance companies charged for services rendered by the Contractor, even if VA does not pay for those services. This provision shall survive the termination or ending of the contract.

6.5.2. To the extent that the Veteran desires services which are not a VA benefit or covered under the terms of this contract, the Contractor shall be required to notify the Veteran that there will be a charge for such service and that the VA will not be responsible for payment.

6.5.3. The Contractor shall not bill, charge, collect a deposit from, seek compensation, remuneration, or reimbursement from, or have any recourse against, any person or entity other than VA for services provided pursuant to this contract. It shall be considered fraudulent for the Contractor to bill other third party insurance sources (including Medicare) for services rendered to VA beneficiaries under this contract.

6.5.4. Contractor shall provide monthly invoicing to the government within 10 days of the end of each month for when services were provided.

6.5.5. Payment is due within 30 business days upon receipt of a valid Clean Claim. A Clean Claim means a claim in which the information in the possession of VA PIHCS reasonably indicated that (i) the claim is for authorized and Covered Services provided; (ii) the claim has no material defect or impropriety; (iii) there is no dispute regarding the amount claimed; and (iv) VA PIHCS has no reasonable reason to believe that the claim was submitted fraudulently.

7. CONTRACTOR SECURITY REQUIREMENTS

7.1. Contractor and any subcontractors must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996. This includes both Privacy and Security Rules published by the Department of Health and Human Services (DHHS). As required by HIPAA, HHS has promulgated rules governing the use and disclosure of protected health information by covered entities. The covered entity component of VA is the Veterans Health Administration (VHA).

7.2. Employees involved in patient care shall complete the VA Privacy and Security Training in TMS at https://www.tms.va.gov/learning/user/SelfRegistrationUserSelection.do annually.

7.3. To ensure that the individuals providing services under the contract have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the Contractor is required to check the Health and Human Services – Office of Inspector General, List of excluded individuals/entities on the OIG website (www.hhs.gov/oig) for each person providing services under the contract. Further the Contractor is required to certify in its proposal that all persons listed in the Contractor’s proposal have been compared against the OIG list and are not listed. During the performance of this contract the Contractor is prohibited from using any individual or business listed on the List of Excluded Individual/Entities.

7.4. The following acts are not permissible by staff personnel who provide services under this contract while on facility premises:

7.4.1. Use of intoxicating liquors, narcotics, or controlled substances of any kind (excluding doctors’ prescriptions which do not impair driver’s driving ability) while on duty, or reporting for duty while under the influence of liquors, narcotics, or controlled substance of any kind (excluding doctors’ prescriptions which do not impair driver’s driving ability).

7.4.2. Gambling in any form.

7.4.3. Carrying of pistols, firearms, or concealed weapons.

7.4.4. Resorting to physical violence to settle a dispute with a fellow employee, customer(s), or the general public while on duty.

7.4.5. Spitting in prohibited places or any other unsanitary, offensive, or insensitive practices or behavior.

7.4.6. Use of loud, indecent, or profane language and/or making threatening or obscene gestures toward customers or other employees.

7.4.7. Engaging customer in a verbal confrontation in an attempt to settle a disagreement.

7.4.8. Soliciting or accepting tips from customer, companions, or others at any time.

7.4.9. Utilizing resident Veterans for labor on or around the property/facility.

7.4.10. Borrowing or lending money or items to the residents.

7.4.11. Engaging in any illegal behavior or acting in a manner that takes advantage of the residents.

8 REQUIRED REGISTRATION WITH CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM (CPARS)

8.1. As prescribed in Federal Acquisition Regulation (FAR) Part 42.15, the Department of Veterans Affairs (VA) evaluates Contractor past performance on all contracts that exceed $150,000, and shares those evaluations with other Federal Government contract specialists and procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations prior to each report closing. To fulfill this requirement VA uses an online database, CPARS, which is maintained by the Naval Seal Logistics Center in Portsmouth, New Hampshire. CPARS has connectivity with the Past Performance Information Retrieval System (PPIRS) database, which is available to all Federal agencies. PPIRS is the system used to collect and retrieve performance assessment reports used in source selection determinations and completed CPARS report cards transferred to PPIRS. CPARS also includes access to the federal awardee performance and integrity information system (FAPIIS). FAPIIS is a web-enabled application accessed via CPARS for Contractor responsibility determination information.

8.2. Each Contractor whose contract award is estimated to exceed $150,000 is required to register with CPARS database at the following web address: www.cpars.csd.disa.mil. Help in registering can be obtained by contacting Customer Support Desk @ DSN: 684-1690 or COMM: 207-438-1690. Registration should occur no later than thirty days after contract award, and must be kept current should there be any change to the Contractor’s registered representative.

8.3. For contracts with a period of one year or less, the contracting officer will perform a single evaluation when the contract is complete. For contracts exceeding one year, the contracting officer will evaluate the Contractor’s performance annually. Interim reports will be filed each year until the last year of the contract, when the final report will be completed. The report shall be assigned in CPARS to the Contractor’s designated representative for comment. The

Contractor representative will have thirty days to submit any comments and re-assign the report to the CO.

8.4. Failure to have a current registration with the CPARS database, or to re-assign the report to the CO within those thirty days, will result in the Government’s evaluation being placed on file in the database with a statement that the Contractor failed to respond.

Special Note:

Under subject Solicitation, for any resultant Award executed, Task Orders issued, or Options Exercised, it should be noted that any in-house personnel, subcontractors, outside associates, or consultants shall be limited to individuals or firms that were specifically identified in the Contractor's accepted offer / proposal. The Contractor shall obtain the Contracting Officer's written approval before making any substitution for these designated in-house personnel, subcontractors, outside associates, or consultants. If the Contractor proposes a substitution, it shall submit the same type of information that was submitted in the accepted offer / proposal to the Contracting Officer for evaluation and approval. The level of qualifications and experience submitted in the accepted offer / proposal, or the level required by and mandated in the Solicitation, whichever is greater, is the minimum standard for any substitution.

- End of PWS -

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT 2018)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer—System for Award Management, or 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award Management), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315.

(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

(i) Payment.—

(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.

(2) Prompt payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR part 1315.

(3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause.

(4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made.

(5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall—

(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the—

(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment);

(B) Affected contract number and delivery order number, if applicable;

(C) Affected line item or subline item, if applicable; and

(D) Contractor point of contact.

(ii) Provide a copy of the remittance and supporting documentation to the Contracting Officer.

(6) Interest.

(i) All amounts that become payable by the Contractor to the Government under this contract shall bear simple interest from the date due until paid unless paid within 30 days of becoming due. The interest rate shall be the interest rate established by the Secretary of the Treasury as provided in 41 U.S.C. 7109, which is applicable to the period in which the amount becomes due, as provided in (i)(6)(v) of this clause, and then at the rate applicable for each six-month period as fixed by the Secretary until the amount is paid.

(ii) The Government may issue a demand for payment to the Contractor upon finding a debt is due under the contract.

(iii) Final decisions. The Contracting Officer will issue a final decision as required by 33.211 if—

(A) The Contracting Officer and the Contractor are unable to reach agreement on the existence or amount of a debt within 30 days;

(B) The Contractor fails to liquidate a debt previously demanded by the Contracting Officer within the timeline specified in the demand for payment unless the amounts were not repaid because the Contractor has requested an installment payment agreement; or

(C) The Contractor requests a deferment of collection on a debt previously demanded by the Contracting Officer (see 32.607-2).

(iv) If a demand for payment was previously issued for the debt, the demand for payment included in the final decision shall identify the same due date as the original demand for payment.

(v) Amounts shall be due at the earliest of the following dates:

(A) The date fixed under this contract.

(B) The date of the first written demand for payment, including any demand for payment resulting from a default termination.

(vi) The interest charge shall be computed for the actual number of calendar days involved beginning on the due date and ending on—

(A) The date on which the designated office receives payment from the Contractor;

(B) The date of issuance of a Government check to the Contractor from which an amount otherwise payable has been withheld as a credit…