36C26126Q0041 0001.docx

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) 11-24-2025 None

612MCP

Department of Veterans Affairs Network Contracting Office (NCO) 21

612MCP

Department of Veterans Affairs Network Contracting Office (NCO) 21

To all Offerors/Bidders

36C26126Q0041 11-13-2025

X X X X The purpose of this amendment is to include the Question and Answer response and revises the Performance Work Statement.

Revisions to the Performance Work Statement are highlighted below.

All other terms and conditions remain unchanged.

Tim Smith Contracting Officer Question and Answer

1) How was it determined that the NAICS Code of 621910 – Ambulance Services would be used for this requirement.

VA Response – In accordance with FAR 19.102(b), the Contracting Officer determined the appropriate NAICS code by classifying the service being acquired in the one industry that best describes the principal purpose of the supply or service being acquired. NAICS 621910 is the most appropriate because the requirement is for ambulance services.

2) How was the set-aside strategy for this requirement determined?

VA Response – This strategy was formulated from market research which included responses received from a sources sought notice posted to SAM.gov.

3) Billing when using VA-contacted ground ambulance providers. Reference: PWS, Section 6 “Specific Tasks,” paragraph titled “Ground Ambulance” (requirement to use VA-contracted ambulance services when available). The PWS states that, when available, the contractor shall utilize VA-contracted ambulance services for ground transport. When the air ambulance contractor uses a destination ground ambulance provider that already has a VA contract, how does billing work? Specifically, does the VA intend for those ground ambulance providers to bill VA directly under their existing VA contract, or will the selected air ambulance contractor be responsible for paying the ground ambulance provider and then invoicing VA for those costs under this Firm-Fixed-Price (FFP) IDIQ, so that we can structure billing and coordination in accordance with VA’s preferred process?

VA Response – Ground transportation to/from airport is the responsibility of the contractor and cost should be included in the quote provided. PWS was revised to remove language related to VA ground ambulance contract.

4) Destination facilities list to support ground pricing. Reference: PWS, Section 6 “Specific Tasks,” “Ground Ambulance” paragraph. If the Government intends for the prime contractor to pay the ground ambulance provider and then invoice VA, does the Government have a list of facilities to which patients are expected to be flown (destination hospitals/clinics), so that the contractor can ensure consistent availability of ground ambulance providers serving those areas and determine appropriate pricing for ground ambulance providers serving those areas?

VA Response – Destination facilities typically include: Palo Alto VA Medical Center (VAMC), Sacramento VAMC, San Francisco VAMC, University California Davis Medical Center (Davis, CA), and Stanford Medical Center (Palo Alto, CA).

5) Historical destination facilities list (last 12 months). Reference: PWS Section 4 – Scope (sample RENO-to-VA routes and mileages) and PWS Section 6 – Specific Tasks, Ground Ambulance (VASNHCS catchment area language). The PWS provides example flight plans and mileages (e.g., Reno to San Francisco VA, Palo Alto VA, Mather, Los Angeles VA, and Salt Lake City VA) and notes that patients may be transported from various locations within the VASNHCS catchment area. To properly plan operations, staffing, and price this requirement, would the Government be able to provide a list of destination facilities used for VASNHCS air ambulance transports over the previous 12 months, along with the best available historical utilization data (e.g., approximate number of trips per destination during that period)?

VA Response – All services requested will originate from the VA Sierra Nevada Health Care System, 975 Kirman Ave. Reno, NV 89502. The PWS was revised to remove mention of VASNHCS catchment area under section 6.

Destination Facilities within last 12 months:

1. Palo Alto VAMC x 6 trips

2. Sacramento VAMC x 5 trips

3. San Francisco VAMC x 1 trips

4. U.C. Davis (Davis, CA) x 1 trips

5. Stanford Medical Center (Palo Alto, CA) x1 trips

6) HCFA 1500 (OMB-form-1500) requirement vs. Tungsten. Reference: PWS “Payments” paragraph (HCFA 1500 requirement) and clauses referencing VAAR 852.232-72 Electronic Submission of Payment Requests and use of Tungsten Network. Can the Government please confirm whether submission of a separate OMB-form-1500 (HCFA) is still required under this contract, or whether it is sufficient for the contractor to enter the equivalent claim information directly into Tungsten Network without attaching the HCFA 1500 form?

VA Response – HCFA 1500 must be attached when submitting invoice in TUNGSTEN

7) Maximum aggregate value of orders. Reference: Section B.2 – Price/Cost Schedule, first paragraph (guaranteed minimum and “maximum aggregate value of orders…$3,200,000.00”). The Price/Cost Schedule states that “the maximum aggregate value of orders that can be placed under this contract is $3,200,000.00.” Please clarify whether the $3,200,000 ceiling applies to: (a) the entire contract term (all ordering periods combined), or (b) each individual ordering period (e.g., per year/ordering period) so that we can accurately plan ordering, performance capacity, and subcontracting compliance.

VA Response – the $3,200,000 ceiling applies to the entire contract (all ordering periods combined).

8) “Minutes Late” metric and delays caused by VA/patient. Reference: Quality Assurance Surveillance Plan (QASP) / Performance Requirements Summary table, where “Minutes Late” or on-time performance is defined and tied to performance expectations. Will the Government confirm that “Minutes Late” (or any similar timeliness metric) will not be assessed against the contractor when the aircraft and crew are on site and ready at the scheduled pickup time, but any delay in departure or transport is due to patient readiness, VA clinical decisions, or Government/facility processes outside the contractor’s control?

VA Response – If delay is the result of government/facility the “Minutes Late” performance expectation will not be used to seek compensation as long as the ground transport was at the facility at the requested time.

9) Standby charges and crew duty-time limits for VA/patient-caused delays. Reference: Same as Q6 – QASP Performance Requirements / “Minutes Late” metric and any PWS language regarding being ready to transport and waiting times. Would the Government consider adding reciprocal language allowing the contractor to invoice a mutually agreed-upon standby charge when the aircraft and medical team are required to wait beyond a reasonable grace period due to Government- or patient-caused delays, while the contractor is otherwise on time and ready to perform and continues to fully support clinical decision-making and patient readiness requirements? Additionally, if extended VA- or patient-caused delays result in the flight crew reaching applicable duty-time limits before initiating or completing the transport, how does the Government expect such missions to be handled (e.g., relief crew, mission cancellation, rescheduling), and how will any associated costs (such as crew changes, aircraft repositioning, or rescheduled departures) be treated for payment and performance-evaluation purposes?

VA Response – PWS states “If the delivery order is cancelled by the Requesting Physician, the Contractor will be paid for actual statute miles traveled at the time of the cancellation, plus the necessary statute miles the Contractor's aircraft must travel to return to its starting location. The return mileage is only reimbursable if the contractor does not have another destination on its flight plan.”

“The contractor shall be reimbursed at the full contract amount for “dry runs” (trips made by the contractor when the VA patient is not available at the scheduled pick-up time). This charge shall not be allowed if the trip is cancelled by the COR (authorized VA personnel) within one (1) hour before the scheduled pick-up time.”

10) Fuel price volatility / economic price adjustment. Reference: Section B – Price/Cost Schedule (unit price per trip and mileage), contract type stated as FFP IDIQ, and clauses incorporating FAR 52.212-4 Contract Terms and Conditions – Commercial Items. This requirement covers air ambulance services over a multi-year period of performance during a time of significant volatility in aviation fuel prices, and we want to ensure stable, predictable service for VA throughout the contract. A) Does the Government intend for the base rate and per-mile pricing to remain firm and not subject to adjustment for fuel cost changes over the full period of performance (base and option periods)? B) If so, would the Government consider adding an economic price adjustment / equitable adjustment mechanism tied to an objective fuel price index (e.g., an aviation fuel/Jet-A index) to address substantial increases or decreases in fuel prices during contract performance? C) If the Government is open to such a mechanism, would it consider a fuel-related adjustment (upward or downward) to the base and/or mileage rates when documented fuel costs vary by more than an agreed-upon threshold from the baseline at time of award?

VA Response – EPA clause will not be added to the solicitation/contract.

11) VA doctor/nurse accompanying patient and return leg. Reference: PWS, “Flight Crew” paragraph (under Contractor Aircraft / Medical Equipment and Supplies / Flight Crew). The PWS states that, if VA deems necessary, a VA doctor or VA nurse may accompany the VA patient at no additional cost to the VA, in addition to the required minimum flight crew. Please clarify whether the contractor is also responsible for transporting that VA clinician on the return leg at no additional cost, including situations where the clinician: (a) returns without the patient, or (b) must return on a separate flight at a different time.

VA Response – Contractor would only be responsible if VA clinician is travelling with a patient. If no patient is present, contractor is under no obligation to transport VA clinician.

12) List of VA-contracted ground ambulance providers. Reference: PWS Section 6 “Specific Tasks,” “Ground Ambulance” paragraph. To support pricing, route planning, and coordination, can the Government provide a current list of VA-contracted ground ambulance providers (including contract numbers and primary service areas) that are expected to be used in connection with this requirement?

VA Response – Ground transportation to/from airport is the responsibility of the contractor and cost should be included in the quote provided. PWS was revised to remove language related to VA ground ambulance contract.

13) VAAR 852.219-75 in an “Unrestricted” procurement. The solicitation is labeled “Set-Aside: None / Unrestricted.” However, in Section C, VAAR 852.219-75, Limitations on Subcontracting, is included and the “Services” provision is checked. There is no reference to VAAR 819.7011(b) or to VAAR 852.219-73 / 852.219-74, and there is no explicit Section L/M language discussing SDVOSB/VOSB set-aside requirements. Can the Government please confirm: A) Whether the inclusion of VAAR 852.219-75 (Services) was intentional for this unrestricted procurement; and B) If so, how the Government intends to measure compliance with the 50% limitation on subcontracting for services under the Firm-Fixed-Price IDIQ “per trip” pricing structure (e.g., by total dollars paid over the base and option periods, by personnel costs, or another metric)?

VA Response – Although this is being solicited as unrestricted, the inclusion of 852.219-75 was intentional to determine if offerors can receive credit for SDVOSB/VOSB status. As stated in in the clause, will not pay more than 50% of the amount paid by the government to it to firms that are not certified SDVOSBs listed in the SBA certification database as set forth in 852.219–73 or certified VOSBs listed in the SBA certification database as set forth in 852.219–74.

14) Tungsten vs. VetRide for invoicing. Reference: Invoice and payment instructions referencing VAAR 852.232-72 Electronic Submission of Payment Requests and Presentment and Payment System / Tungsten Network, and PWS language referencing VetRide for scheduling and trip management. The solicitation references VAAR 852.232-72 and requires electronic submission of payment requests through Tungsten Network. If the selected contractor is already using VetRide for scheduling and trip management, can invoicing and payment requests be submitted through VetRide in lieu of Tungsten, or is Tungsten Network still the mandatory system of record for all invoices under this contract? If VetRide can be used, please clarify the process and any integration expectations. If not, we will plan to use VetRide solely for internal scheduling and Tungsten as the system of record for all invoices.

VA Response – All invoices will be submitted through TUNGSTEN.

15) Definition of VASNHCS catchment area. Reference: PWS Section 6 “Specific Tasks,” “Ground Ambulance” paragraph. The PWS states that “there is a possibility patients may need transported from various locations within the VASNHCS catchment area.” We are unsure what is encompassed in the “VASNHCS catchment area.” Could the Government please define the VASNHCS catchment area for this requirement (e.g., list of counties, facilities, and/or typical originating locations), so that we can accurately plan routing, staffing, and pricing?

VA Response – All services requested will originate from the VA Sierra Nevada Health Care System, 975 Kirman Ave. Reno, NV 89502. The PWS was revised to remove mention of VASNHCS catchment area under section 6.

16) Backup air provider vs. VA making alternate arrangements. Reference: PWS Section 6 “Specific Tasks,” “Response Time” paragraph. The PWS states that if the contractor cannot begin the flight within four (4) hours of notification, VASNHCS may contact another air ambulance company to provide the services. Would the Government prefer that the prime contractor identify and maintain a pre-arranged backup/subcontractor to cover missions when the prime cannot meet the required response timeframe, or does VASNHCS intend to make those alternate air ambulance arrangements independently on a case-by-case basis?

VA Response – Contractor is expected to meet the required response time. VASNHCS does not intend to make alternate arrangements. Contractor is required to notify timely if unable to meet the requirement.

Performance Work Statement (PWS)

1. CONTRACT TITLE: Air Ambulance Services to include Ground Transportation to and from Airport

2. GENERAL INFORMATION:

This Performance Work Statement (PWS) defines services to provide Air Ambulance (emergent/non-emergent fixed wing or rotary wing) transportation services under a fixed price Indefinite Delivery Indefinite Quantity (IDIQ) contract for the VA Sierra Nevada Health Care System (VASNHCS). Transportation originates at a medical facility in the local area and ends at a medical facility outside the local area. The price should include all legs of transportation including ground ambulance to and from respective airports.

3. DEFINITIONS:

AIR AMBULANCE: Fixed wing aircraft with a compartment that is designed and constructed to afford relative safety and comfort and to avoid aggravation of the patient's condition. The aircraft, compartment, and personnel must meet all applicable federal and state standards for medical air transport.

ALS: Advanced Life Support.

GROUND AMBULANCE: Vehicles for emergency medical care which provide a driver compartment and a patient compartment that will accommodate emergency personnel and patient, equipment and supplies for emergency care at the scene as well as during transport, and two-way radio communication and equipment for light rescue procedures. The ambulance must be designed and constructed to afford relative safety and comfort and to avoid aggravation of the patient's condition.

AOD: Administrative Officer of the Day. This government employee is the administrative officer in charge during other than normal business hours.

BLS: Basic Life Support.

CCT: Critical Care Transport.

CO/Contracting Officer: The person executing this contract on behalf of the Government and the only person authorized to make changes to the contract.

COR/Contracting Officer Representative: Person or persons authorized to act for the Contracting Officer within the limits of his / her authority.

Chief, Health Administration Service: Person or persons authorized to act for the Contracting Officer within the limits of his / her authority in the absence of a COR.

Federal Holidays: New Year's Day, Martin Luther King Jr. Birthday, Presidents Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Columbus Day, Veteran's Day, Thanksgiving Day, Christmas Day, and any day determined by the President of the United States to be a Federal Holiday.

Normal Business Hours: Normal business hours are defined as Monday thru Friday, 8:00 a.m. to 4:30 p.m. local time excluding Federal Holidays.

TRIP: A trip is defined as the distance, "ONE WAY ONLY," over which a beneficiary will be transported. For all one-way trips ordered under this contract, the Contractor shall receive the base rate.

POC: Point of contact.

4. SCOPE:

The purpose of this contract is to provide air and ground transportation as deemed medically necessary for VA Sierra Nevada Healthcare System (VASNHS) enrolled and eligible Veterans to outpatient medical appointments or for inpatient admissions. These appointments and/or admissions are within a mileage range up to 300 miles per one-way trip.

*Base Rate: Base rate for Air Ambulance service includes: Ground transportation, which shall include BLS, ALS, CC-ALS to and from the airport. Appropriate basic medical equipment listed under Basic Medical Equipment that meets or exceeds standards CAMTS. Base rate will include air transportation for up to 300 nautical miles.

The following is a list of most flight plans along with estimated miles but are not limited to just these:

RENO TO SAN FRANCISCO VA (SFO) – 190 miles RENO TO PALO ALTO VA (SJC) – 189 miles RENO TO MATHER (SAC) – 113 miles RENO TO LOS ANGELES VA (LAX) – 392 miles RENO TO SALT LAKE CITY VA (SLC) – 421 miles

5. COMPLIANCE:

All work related to this contract must be performed by the Contractor in accordance with all applicable Federal Aviation Administration (FAA), U.S. Department of Transportation, or Occupational Safety and Health Administration (OSHA) regulations, as well as applicable State health and safety regulations, health care accreditation standards (Joint Commission or equivalent accreditation organization) and standard industry practices as defined by the Association of Air Medical Services for air ambulance transportation. Contractor shall be accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS) or National Accreditation Alliance/Medical Transport Applications (NAAMTA) and provide documentation showing current accreditation.

6. SPECIFIC TASKS:

· Response Time:

Contractor shall respond within thirty (30) minutes of notification twenty-four (24) hours a day, three hundred sixty-five (365) days per year, including all Federal Holidays.

For prescheduled pickups, the Contractor shall be required to furnish the ground ambulance within twenty (20) minutes of the prearranged time.

For unscheduled pickups, the Contractor agrees to have patient(s) transported to the departing airport, prepared, and airborne within 4 hours after the receipt of order or as agreed between the contractor and the authorized VASNHCS requestor. If the Contractor identifies they cannot furnish the services within the time required, they shall notify the government at the time of scheduling, or as soon as possible.

Contractor shall commence the flight within four (4) hours of notification of patient pick-up from the Contracting Officer’s Representative (COR). In the event the contractor cannot begin the flight within this time frame, the VA Sierra Nevada Healthcare System (VASNHS) may contact another Air Ambulance Company to provide the services.

· Ground Ambulance:

The contractor shall coordinate all (origin and destination) ground transportation for VASNHS patients. These services shall be a Department of Transportation (DOT) approved ambulance staffed with appropriately trained medical personnel.

Patients will be transported from VASNHCS located at 975 Kirman Ave. Reno, NV 89502.

· Authorization:

Personnel authorized to order service shall make requests for service via telephone. Contractor will be provided with patient’s pick-up and delivery points and vehicle requirements. Only such travel is authorized, and any costs incurred for unauthorized travel, stops, waiting time, etc. shall be the responsibility of the Contractor. Under no circumstances shall orders or changes be accepted by any other party.

VA Ordering Officials by position:

Travel Clerk Transfer Coordinator Nurse/Case Manager Administrative Officer of the Day (AOD) Mobility Manager Chief, Patient Benefits Chief, Health Administration Service

A list of authorized ordering personnel shall be made available upon award of the contract. Employees may be added or deleted from the list during the term of the contract at the discretion of the VASNHS. The contractor shall be notified to such changes as they occur.

· Payments:

Payments shall be based upon one-way direct air mileage (Nautical Mile) (one-way trip is defined as one-way pick-up from the VA hospital) and is computed on the appropriate Sectional Aeronautical Chart prepared by the Coast and Geodetic Survey In case a circuitous route shall be employed by reasons of safety (such as unfavorable terrain or weather), a copy of the flight log showing the reason which necessitated the detour from a directed route, shall be provided to the COR.

Invoices shall be submitted (monthly in arrears) no later than fifteen (15) calendar days following the end of the month in which services are rendered. The invoice must contain the following information:

(1) Contract Number

(2) Purchase Order Number

(3) Date of Service

(4) Time of pick-up

(5) Patient’s Full Name

(6) Last Four Digits of Patient’s Social Security Number

(7) Origination and Destination points

(8) Ground Ambulance Costs (if applicable)

(9) Detailed Documentation of all items used and circumstances

(10) Total Dollar Amounts

All invoices must include a Health Insurance Claim Form OMB-form-1500 (HCFA).

All invoices shall include a fixed base-rate line item & a mileage rate line item. Each line item shall include rate, quantity, description, and line total.

Invoices will be reviewed and reconciled with trip tickets and travel logs. Unauthorized charges will be suspended pending investigation. Unauthorized charges are those that are being disputed or have not been pre-approved by authorized VA personnel. A final determination will be made within 30 days after notifying the Contractor of charges being suspended.

All invoices rendered by the Contractor to VASNHCS for contract services furnished in accordance with this contract shall be in full. Neither the beneficiary nor any other party shall be required to bear the burden of additional payments, surcharges, tip or other gratuity.

Authorized invoices shall be submitted through Tungsten Network (formally OB10) for payments. Invoicing information can be found at http://www.tungsten-network.comius/enheterans-affairs-us/.

· Rates:

For all one-way trips ordered under this contract, the Contractor shall receive the base rate as stated in the price/cost schedule. The "BASE RATE" shall constitute full compensation for ONE-WAY trips up to 300 miles. For all one-way trips exceeding 300 miles the contractor shall receive the base rate as stated in the price/cost schedule plus a per mile fee for every mile over 300 miles.

The government will obtain compensation for late pickups according to the following chart:

*Minutes Late refer to when a team is available or estimated time provided when a team is unavailable.

**Trip value is the total of the basic trip for the scheduled trip.

The Government reserves the right to cancel any patient pick-up due to late response time at any time after the specified or latest pick-up time ordered. Government may employ the services of another source, contracted or non-contracted, for same day service. Contractor will be responsible for all additional costs incurred by the Government if another source is utilized.

The Government will not pay for services under this contract for late response time when such delays are not determined to be excusable by VA.

The Government reserves the right to cancel any patient pick-up.

If the delivery order is cancelled by the Requesting Physician, the Contractor will be paid for actual statute miles traveled at the time of the cancellation, plus the necessary statute miles the Contractor's aircraft must travel to return to its starting location. The return mileage is only reimbursable if the contractor does not have another destination on its flight plan.

DRY RUNS: The contractor shall be reimbursed at the full contract amount for “dry runs” (trips made by the contractor when the VA patient is not available at the scheduled pick-up time). This charge shall not be allowed if the trip is cancelled by the COR (authorized VA personnel) within one (1) hour before the scheduled pick-up time.

· Government’s Minimum Quantity:

The VA attempts to be as accurate as possible when providing estimated quantities; however, actual dollar value quantities may vary from the dollar value quantities as listed in the price schedule. The Government's guaranteed minimum amount to be ordered from this contract is $2,500.00 for the base year and during each ordering period, if exercised.

· Number and Types of Patients The contractor will transport only one (1) VA patient per trip, unless specifically authorized by the COR and in agreement of the contractor. When more than one VA patient is transported on a trip, reimbursement shall be made at the rate not to exceed the cost of transporting a single VA patient; however, the longest over which a VA patient is transported may be claimed. Under no circumstances shall the VA order the contractor to transport more than two (2) VA patients for any one (1) flight.

The contractor shall not refuse to transport VA patients deemed transportable by VA medical staff.

Contractors shall not be expected to accept any VA patient unless the COR authorizes the flight and informs the contractor regarding any special treatment or care required on route (such as administration of oxygen or medications).

Passengers, such as family members may be carried at the discretion of the pilot in command, providing all applicable FAA regulations are met. There shall be no extra cost to the VA.

The contractor shall transport patient belongings and specialized equipment at no additional charge.

The contractor shall provide at the destination any VA patient mobility devices deemed by the contractor to be to large or heavy for air transport, at no additional charge to the VA.

7. QUALIFICATIONS/DUTIES:

· Contractor Qualification:

The contractor must obtain a State of Nevada Emergency Medical System’s Air Ambulance Transportation Permit per required for Air Ambulance performing emergency response services.

· Driver/Pilot List:

Note: The term “driver” will be interpreted also as “pilot” and applicable and comparable vehicle control license requirements, character, qualifications, training, physical abilities, and behavior, shall be equally applied to aircraft transportation.

Contractor shall provide the COR a complete list of all drivers, utilized for this contract by the fifth day of each month. Updates must be submitted prior to drivers beginning to transport patients.

· Driver/Pilot Qualification:

A record of each employee as to character, qualifications and physical capabilities of performing the duties of ambulance care driver or attendant must be maintained and made available for inspection upon request. Air Ambulance Pilot shall have a valid operator's license in accordance with Federal, State and local government requirements for their place of operation and for the services they perform.

All drivers of said contractor MUST possess a valid state driver’s license. The contractor shall ensure all drivers providing services under this contract will have less than five (5) current points on their driver’s license, none of which were assessed for “Reckless Driving.” VASNHS will be provided copies of driver licenses and may independently verify the driving record of drivers at any time. VASNHS reserves the right to order the removal from service under this contract, any driver who violates the provisions of this section.

· Driver Duties:

Contractor shall ensure its drivers will:

(1) Perform their duties with due regard for the safety, comfort and convenience of customers and their property.

(2) Comply with all applicable Federal and State laws, regulations and licensing requirements, including drug testing.

(3) Have and maintain a current driver’s license, valid in the state in which contractor’s facility is located, with less than five current points, none of which were assessed for “Reckless Driving.”

(4) Contact the Contractor’s dispatcher before leaving the designated location without picking up the customer(s) and when encountering problems such as patient(s) not ready, incorrect addresses or addresses which are inaccessible to wheelchairs.

(5) Drivers will also be required to dress in a professional manner at all times when transporting VA patients. Dress will contain and emblem of the transport company.

(6) No passengers other than the patient and/or their attendant will be allowed in the vehicle during transport

(7) Ensure smoking, eating and/or drinking in vehicles are not permitted by the drivers.

(8) Ensure no playing of audio/visual equipment in vehicles will be allowed without the approval of the patient aboard.

(9) Ensure its personnel comply with 49 Code of Federal Regulations (CFR) Parts 40, 653 and 654 on Substance Abuse Prevention, which are respectively incorporated herein by reference and made part of this contract.

· Driver Conduct:

The following acts are not permissible by drivers, which provide services under this contract or while on VA premises. Violations will be reported to the appropriate law enforcement agency:

(1) Use of intoxicating liquor, narcotics or controlled substances of any kind (excluding doctor prescribed medications which do not impair driver’s driving ability) while on duty or reporting for duty while under the influence.

(2) Smoking and other uses of tobacco while on duty

(3) Carrying of pistols, firearms or concealed weapons

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

(5) Spitting in prohibited places or other unsanitary, offensive or insensitive practices or behavior

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

(7) Stopping for personal business, including use of the restroom facilities, while vehicle is occupied by a passenger. The driver shall not leave the vehicle with the key in the ignition at any time. Patient must be attended at all times by at least one contract staff member

(8) Engaging patient or family member in a verbal confrontation in any attempt to settle a disagreement. Should a disagreement arise, the driver is to contact his dispatcher/supervisor via the radio system

(9) Soliciting or accepting tips from customers, companions or others at any time.

(10) Use of loud music

(11) Lack of security/confidentiality of patient health information (HIPAA violations)

8. CERTIFICATIONS AND INSURANCE:

· Aircraft Certification:

All aircraft shall hold a valid Air Carrier Operating Certificate issued by the Federal Aviation Administration (FAA) for an air operator and provide a copy to the COR. The operations authorized under this certificate shall be such that he/she can perform the services required by this contract. The contractor shall abide by all applicable FAA regulations. Each pilot who performs under this contract shall hold a valid commercial airman’s certificate with the appropriate ratings for the conditions of the flight being undertaken and operate under the air taxi rules for that certificate. The contractor shall comply with all applicable Federal, State and Local Regulation governing the operation of an air ambulance service.

(1) A FAA flight plan shall be filed and used for any aircraft used for air ambulance flight under this contract. Whenever practicable and possible, the pilot shall take advantage of all existing ground and air communication facilities. Before each flight, the pilot shall obtain the latest information relative to weather, airport conditions and navigational facilities and, further, shall be satisfied that all conditions are such that they shall not constitute a hazard. In the event a flight is interrupted short of destination, the contractor shall immediately notify the COR by telephone. When appropriated medical personnel accompanying the flight determine that the patient requires medical attention, the contractor shall obtain authorization from the COR and make the necessary arrangements.

(2) Pilots shall use the “LIFEGUARD” call sign only when time critical medical and emergency operations warrant such service.

· Evidence of Insurance Coverage:

After award of a contract, the contractor shall furnish to the COR a certificate of insurance which shall contain an endorsement to the effect that cancellation of, or any material change in the policies which adversely affect the interest of the Government in such insurance cancellation, shall not be effective unless a thirty (30) day written notice of cancellation or change is furnished to the COR.

Certification of insurance per contract clause VAAR 852.237-7, and VAAR 852.237-70, must be provided to the Contracting Officer no later than 10 days after notification of award, but SHALL BE SUBMITTED PRIOR TO THE START OF WORK.

It shall be the responsibility of the Contractor to provide insurance in the amounts required by law.

Contractor shall resolve patient complaints of damage to personal material. Contractor will be responsible for repair replacement of patient personal property damaged while in the custody of the contractor until delivery and turnover of patient.

9. TRAINING:

The contractor will provide documentation of training on transporting/assisting disabled passengers for all personnel who will be assigned to work performing any transportation for VA patients under this contract. Training shall be in place covering Blood borne Pathogens, Age Related Personal interactions and communication, Body Mechanics, and HIPAA (as stated in Clause 852.273-75 Security Requirements for Unclassified Information Technology Resources). Copies of this documentation of training will be submitted to and held by the COR.

10. OPERATING PRACTICES:

All operations under the contract shall be supervised by competent, trained personnel who adhere to safe practices.

VA patients and accompanying guest shall only board and depart the aircraft when engines are not running. Definite precautions shall be taken to keep passengers and spectators away from aircraft when the power is on.

All contractor facilities, including ramps, ramp areas, buildings, passenger areas, etc., shall be maintained in a clean and orderly condition, free from debris and any accumulation which may constitute an accident or fire hazard. Fences and warning signs shall be provided for public protection against hazards.

No aircraft shall be refueled with the VA patient and accompanying guest on board. If completely unavoidable, all precautions shall include but are not limited to an attendant on watch near the cabin door, a dependable fire extinguisher, and adequate grounding of aircraft, fueling nozzle and fuel truck.

· Reporting Responsibilities:

The Contractor shall furnish an in-flight medical attendant report of the patient's status to the receiving facility. The report should include:

(1) Patient's full name and social security number (whenever possible) — if not possible, explain the reasons.

(2) Time picked up.

(3) Originating and terminating points.

(4) Who called (initiator).

(5) Presenting problem.

(6) Immediate First Aid Measures (bandages, oxygen, restraints, etc.)

(7) State of consciousness.

(8) Blood pressure.

(9) Pulse.

(10) Respiration.

(11) Any other noted symptoms or pertinent information, including vital signs not already described, level of consciousness, drugs administered, and details of therapeutic intervention.

(12) Any unusual circumstances encountered during the flight, including but not limited to inordinate altitudes flown, turbulence, and times associated with these conditions.

All personnel transporting veteran patients should be immunized against influenza, or wear face masks during the influenza season.

· Contractor Aircraft:

(1) Shall comply with all FAA criteria.

(2) Shall provide a climate-controlled environment to prevent temperature extremes that would adversely affect patient care.

(3) Shall have an entry that allows loading and unloading without excessive maneuvering of the VA patient and does not compromise functioning of monitoring systems, IV lines, manual or mechanical ventilation.

(4) Shall be configured in such a way that the medical transport personnel have access to the patient to begin and maintain both basic and advanced life support.

(5) Shall have interior lighting to ensure adequate observation of the patient. Aircraft cockpit should be capable of being shielded from the light in the patient care area.

(6) Shall provide sufficient isolation from the patient care area to minimize in-flight distractions and interference.

(7) Shall provide an inverter or appropriate power source with sufficient output and outlets to meet the requirement of the complete specialized equipment without compromising the operation of any electrical aircraft equipment.

(8) Shall be configured so all equipment, stretchers and seating allow for rapid and safe transport of the veteran.

(9) Shall be configured so that all equipment and supplies are secured in racks, compartments or straps to meet or exceed all FAA Regulations.

(10) Shall be equipped with sufficient quantities of medical supplies and equipment specific to the type of mission being assigned and adhere to all local and state requirements. VA Medical Centers shall not provide supplies replenishment. These supplies shall include, but are not limited to:

(a) Industry standard medications and disposable medical bandages and supplies.

(b) Airway management equipment including oxygen, mechanical suction, intubation equipment and ventilator support equipment.

(c) Cardiac monitor/defibrillator.

(d) ACLS drugs and therapeutic modalities; or equivalent specific to type of mission assigned.

(e) Other electronic devices deemed necessary to deliver specific patient care for the mission assigned.

Medications/intravenous solutions, dressing, catheterizations kits for specific patients’ needs shall be provided by the VA.

(11) Shall be equipped with sharps disposal container for contaminated needles. Disposal of all contaminated materials from aircraft and/or ambulance shall meet Federal OSHA Guidelines.

(12) Shall be equipped with collection container for soiled and disposable items.

· Medical Equipment and Supplies:

Each piece of linen (including blankets, pillows, sheets) that has come into contact with the patient shall be thoroughly cleaned and if necessary disinfected after each flight. Disposable or single use items may be used but shall be disposed after usage.

(1) Each piece of equipment that has come into contact with the patient shall be properly washed and disinfected after each flight.

(2) Each stretcher pad, mattress, and pillow shall be impervious to moisture.

All hazardous material shall be contained and disposed of in accordance with Federal, State, Local laws, regulations and procedures.

Contractor shall maintain all medical equipment in accordance with manufacturer’s recommendations, be functional at all altitudes and shall not interfere with aircraft avionics. Likewise, aircraft avionics shall not interfere with medical equipment. Adequate records showing maintenance and calibrations shall be kept and presented to the Contracting Officer or COR upon written request.

All communication equipment shall be capable of transmitting and receiving clear and understandable voice communications to and from the base station at a reasonable distance.

All communication equipment shall be maintained in full operating condition and in good repair. Radios on aircraft (as range permits) shall be capable of communicating with the following:

(1) Medical advice and direction

(2) Communication center

(3) Air traffic control

(4) EMS and law enforcement agencies

The aircraft shall be equipped with appropriate survival equipment.

Contractor shall use FAA approved air medical stretchers.

· Flight Crew:

The Contractor shall provide the necessary licenses/certificates, competencies, privilege and credentialing in accordance with applicable State(s) and Federal regulation for each employee that will perform services under this contract.

At a minimum, Flight crew shall consist of three (3) personnel:

(1) One (1) Pilot in command

(a) Pilot(s) shall not be considered as part of the medical crew.

(b) Shall meet or exceed the minimum requirements of the FAA for type of aircraft being used in fulfillment of this contract

(c) Shall follow all FAA flight regulations

(d) Shall be responsible for all in-flight security for the patient and crew.

(2) Designated Flight Nurse (a Flight Physician may be substituted for a Critical Care Nurse) with the following minimum qualifications as required for the mission assigned:

(a) Certified in BLS and ACLS. (Certification by Board of Emergency Nursing (CFRN) is desired.)

(b) Be ventilator certified from an accredited program.

(c) Shall be current on certifications and continuing education.

(3) Medical Flight Attendant with minimum qualifications, education, and certifications of an EMT. An additional Flight Nurse meeting the qualifications as Number 2 above shall meet the requirement.

(4) If VA deems necessary, a VA Doctor or VA Nurse may accompany the VA patient at no additional cost to the VA. This person would be in addition to the required minimal three (3) person flight crew.

(5) Flight Crew shall have access to a program Medical Director to act as a technical advisor to assist the Flight Crew and attending physician in identifying precautions and care while inflight.

· Aircraft Maintenance:

All aircrafts used in the performance of this contract shall be maintained in an air worthy condition in accordance with all applicable FAA regulations by means of an established inspection and maintenance plan. Line inspections shall be performed at least once in twenty-four (24) hours preceding a flight. Aircraft shall be handled exclusively by trained personnel.

Contactor shall own and operate adequate maintenance facilities or shall have a contract with an acceptable shop to perform aircraft maintenance; said contract to provide that maintenance shall be performed as and when required by air taxi operator per FAA regulations.

All ambulance aircraft shall be maintained in clean condition, including cabin interior, windows and aircraft exteriors.

· Smoking:

There shall be no smoking:

(1) Within 10 feet where oxygen is stored, dispensed or is in use.

(2) Aboard aircraft in which VA patients shall be transported

(3) In ground ambulances where VA patients shall be transported

(4) Within 50 feet of any Government building.

(5) In an area where prohibited by Federal, State, Local ordinances.

· ID Badges All Contractor personnel required to wear identification (ID) badges during the entire time they are on the VA grounds. ID badges shall have an identification picture, name of the individual and the represented company depicted on it.

· Parking It is the responsibility of Contractor personnel to park only in designated parking areas. Parking information is available from the VA Police Service. The VA shall not validate or make reimbursement for parking violations of the Contractor’s personnel under any circumstances.

11. CONTRACT CHANGES:

Changes determined by the assigned Contracting Officer to be within the general scope and intent of this contract shall be made in accordance with FAR 52.212-4, Contract Terms and Conditions – (c) Changes, and shall not necessitate a new procurement action.

Changes can only be made by the Contracting Office. Any deviation/changes from this contract by the Contractor shall not be paid nor authorized by the VA.

12. INSPECTION, QUALITY AND PERFORMANCE STANDARDS:

The Contractor will provide a list of all drivers, copies of certifications of operations, a certificate of insurance, and if requested by the COR any copies of maintenance schedules. The COR will review each request for transport and once approved, receive a copy of the rate quote. The COR will maintain each rate quote on a spreadsheet to compare and verify when the invoice is received that the charges are accurate before paying the invoice. The COR will track any patient related issues or complaints, meet with the Contractor to coordinate any respond and answer the issue or complaint timely to ensure quality; if the issue is medical in nature, the COR will seek guidance/review with the Chief of Staff’s office.

The Government has the right to inspect the contractor premises, maintenance records of medical equipment and aircraft(s), flight logs, and dispatch records being used for the contracted services. Furthermore, annually the contractor must provide proof of insurance (see paragraph J.4 and Clauses 852.228-71, 852.237-7, and 852.237-70 for further details on insurance requirements) and copies of any licenses for all staff providing services under this contract upon request of the POC (see also paragraph D).

The last month of each contract year the Contracting Officer will review contract compliance reports submitted by the POC. The review will employ various monitoring methods but will specifically include complaints and timeliness.

Maintain full compliance with Quality Assurance Surveillance Plan (QASP)

13. DELIVERY SCHEDULE:

Within three (3) calendar days of contract award, Contractor shall provide copies of certifications, and qualifications of all the personnel and aircraft involved in…