36C26126Q0457.pdf

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. UEI: EFT:

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. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

36C26126Q0457 03-26-2026

Emily Trinh | Emily.Trinh@va.gov 702-791-9000 x13424 04-17-2026

12:00PM PDT

612MCP

Department of Veterans Affairs

Network Contracting Office (NCO) 21

X 100

X

485999

$19 Million

N/A

See Performance Work Statement

612MCP

Network Contracting Office (NCO) 21

FMS VA-9(101) Financial Services Center

PO Box 149971

Austin TX 78714-9971

See CONTINUATION Page

This is a Request for Quote for Special Mode Transportation services for eligible beneficiaries of VA Northern

California Health Care System.

Please carefully read the Addendum to RFO 52.212-1

Instructions to Offerors - Commercial Items and RFO 52.212-2

Evaluation to ensure quotes submitted are complete and conforming to the solicitation's requirements.

Period of Performance: 06/01/2026 - 03/31/2027

Important: It is the vendor's responsibility to check

SAM.gov for any amendments to the solicitation.

This RFQ is set-aside to SDVOSBs. The Government will check https://search.certifications.sba.gov/ to confirm the vendor's SDVOSB status for the specified NAICS.

Vendors shall complete, sign, and submit VAAR 852.219-75.

Failure to do so will result in non-consideration for award.

See CONTINUATION Page

X 1

Emily Trinh

Contracting Officer

36C26126Q0457

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

B.3 PERFORMANCE WORK STATEMENT

B.4 MANDATORY WRITTEN DISCLOSURES

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS

AND COMMERCIAL SERVICES (NOV 2023)(DEVIATION OCT 2025)

C.2 52.216-18 ORDERING (AUG 2020)

C.3 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.4 52.216-22 INDEFINITE QUANTITY (NOV 2025) (DEVIATION)

C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.6 52.219-14 LIMITATIONS ON SUBCONTRACTING (NOV 2025) (DEVIATION)

C.7 52.222-42 STATEMENT OF EQUIVALENT RATES FOR FEDERAL HIRES (MAY

2014)

C.8 52.240-91 SECURITY PROHIBITIONS AND EXCLUSIONS (NOV 2025)

(DEVIATION)

C.9 52.240-93 BASIC SAFEGAURDING OF COVERED CONTRACTOR

INFORMATION SYSTEMS (DEVIATION) (NOV 2025)

C.10 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.11 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.12 52.252-6 AUTHORIZED DEVIATIONS IN CLAUSES (NOV 2020)

C.13 852.204-72 PERSONNEL VETTING AND CREDENTIALLING (MARCH 2026) 66

C.14 VAAR 852.219-73 VA NOTICE OF TOTAL SET-ASIDE FOR CERTIFIED

SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESSES (JAN 2023)

(DEVIATION)

C.15 VAAR 852.219-75 VA NOTICE OF LIMITATIONS ON SUBCONTRACTING—

CERTIFICATE OF COMPLIANCE FOR SERVICES AND CONSTRUCTION (JAN 2023)

(DEVIATION)

C.16 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) . 73

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (SEP 2023) (DEVIATION OCT 2025)

SUBMISSION INSTRUCTIONS

E.2 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

(DEVIATION NOV 2025)

E.3 52.219-1 SMALL BUSINESS PROGRAM REPRESENTATIONS (NOV 2025)

(DEVIATION)

E.4 52.233-2 SERVICE OF PROTEST (SEP 2006) (DEVIATION NOV 2025)

E.5 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

E.6 52.216-1 TYPE OF CONTRACT (NOV 2025) (DEVIATION)

E.7 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB

1998)

E.8 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

E.9 52.252-5 AUTHORIZED DEVIATIONS IN PROVISIONS (NOV 2020)

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer

Network Contracting Office 21

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly in accordance with issued task orders

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment

Requests.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

B.2 PRICE/COST SCHEDULE

The guaranteed minimum award amount for this contract is $1,000.00 The maximum aggregate value of orders that can be placed under this contract is $9,000,000.00. The Government does not guarantee that it will place any orders under this contract in excess of the guaranteed minimum.

The quantities below are only estimated number of trips and the actual number of trips may vary.

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES

ESTIMATED

QUANTITY UNIT UNIT PRICE

ESTIMATED

AMOUNT

20,000.00 TRP __________________ __________________

Wheelchair Van Services (0-40 miles)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

- Transportation: Other MANUFACTURER PART NUMBER (MPN): None

15,000.00 TRP __________________ __________________

Wheelchair Van Services (41-80 miles)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

7,500.00 MI __________________ __________________

Wheelchair Van Services (over 80 miles)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

5,000.00 TRP __________________ __________________

Gurney Van Services (0-40 miles)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground

Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

3,500.00 TRP __________________ __________________

Gurney Van Services (41-80 miles)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

5,000.00 MI __________________ __________________

Gurney Van Services (over 80 miles)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

100.00 TRP __________________ __________________

Secure Car with Attendant Services (0-40 miles)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

100.00 TRP __________________ __________________

Secure Car with Attendant Services (41-80 miles)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

100.00 MI __________________ __________________

Secure Car with Attendant Services (over 80 miles)

Contract Period: Base POP Begin: 06-01-2026

POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

8,500.00 EA __________________ __________________

Oxygen Utilization (Per Patient)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

1,000.00 EA __________________ __________________

Waiting Time Beyond Grace Period (per 15 minutes)

Contract Period: Base POP Begin: 06-01-2026 POP End: 03-31-2027 PRINCIPAL NAICS CODE: 485999 - All Other Transit and Ground Passenger Transportation PRODUCT/SERVICE CODE: V119 - Transportation/Travel/Relocation

GRAND TOTAL __________________

B.3 PERFORMANCE WORK STATEMENT

Non-Emergency, Special Mode Transportation Services for VA Northern California Health Care System

1. DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

a. The contractor shall provide all Non-Emergency, Special Mode Transportation (SMT) services as identified within the performance work statement (PWS) for beneficiaries of VA Northern California Health Care System (NCHCS), and its associated healthcare facilities. The Contractor shall provide all transport vehicles, personnel, management, supplies, transportation, fuel, equipment, reports, and anything else necessary to successfully furnish Non-Emergency SMT service as identified in the Price and Cost Schedule and the PWS in accordance with all terms, conditions, and provisions stated herein. The contractor’s responsibility shall cover non-emergency transportation services with Northern California Health Care System. The successful vendor is required to continuously be compliant with the requirement contained herein, and meet or exceed the standards of, but not limited to the Joint Commission and California State Department of Health Regulations. The following facilities shall be covered under this PWS; however, their physical addresses may change during the life of the contract, and this list may expand in conjunction with the Mission Act:

VA Northern California Health Care System

10535 Hospital Way

Mather, CA 95655

VA Northern California Health Care System

150 Muir Road

Martinez, CA 94553

VA Fairfield Outpatient Clinic David Grant Medical Center

103 Bodin Circle Travis AFB

Fairfield, CA 94535

McClellan CBOC at McClellan

5342 Dudley Blvd, Bldg. 98

McClellan, CA 95652

Redding CBOC 3455 Knighton Road

Redding CA 96002

Redding CBOC 760 Cypress Ave, Suite 100

Redding CA 96001

Chico CBOC 1601 Concord Avenue

Chico CA 95928

Ukiah VA CBOC 238 B Hospital Drive

Ukiah, CA 95482

Mare Island CBOC Walnut Ave, Bldg. 201

Vallejo, CA 94592

Stockton CBOC 6505 South Manthey Road

French Camp CA 95231

Marysville/Yuba CBOC 1231 Plumas Street

Yuba City CA 95991

Sierra Foothills VA Outpatient Clinic

11985 Heritage Oak Pl Ste

Auburn, CA 95603

Modesto CBOC 1225 Oakdale Road

Modesto CA 95355

Sonora CBOC 13663 Mono Way

Sonora CA 95370

2. CONTRACT DEFINITIONS/ACRONYMS AND TERMS

a. Catchment Area – defined as all areas located within the list of the locations shown above.

b. Ambulatory Patient – A non-emergency VA beneficiary who does not require the use of a handicap ambulance, wheelchair, or Gurney van, who can utilize normal forms of transportation such as taxi or hired car but have been determined as needing transportation assistance for medical reasons. A VA clinician determines if the patient requires special mode transportation based on a medical impairment or special need (to include but not limited to: mental health deficiencies.

c. Gurney Patient – A non-emergency patient whose severe mobility impairment requires him or her to remain in a lying position, unable to sit in an upright position for prolonged periods of time. A VA clinician determines the patient’s need for Gurney transport.

d. Wheelchair Patient- A non-emergency VA beneficiary confined to a wheelchair, using a wheelchair for mobility or with mobility impairments, whose handicap prevents use of normal modes of transportation such as car, van or taxi. A VA clinician determines the patient needs wheelchair transport.

e. Attendant/Escort – A medical attendant may be required to assist with transportation, when deemed necessary by a VA physician. An escort is a non-medical attendant which can be a caregiver, family member, medical technician or VA employee that may accompany the patient in addition to the driver.

f. Beneficiary – Veterans and other members determined to be eligible for benefits by the VA.

g. Base Rate – Base Rate is defined as the rate paid for one-way transportation from a designated pick-up point to a designated delivery point. This rate shall be paid for all authorized one-way trips ordered under this contract action, with employees (included in Section Contract Documents, Exhibits, or Attachments) during all phases of the trip made on behalf of the Government. The attached Service Contract Act wage determination shall be updated for each option when/if new revisions are issued. The Base Rate shall constitute full compensation for one-way trips as shown in the Price and Cost Schedule for the medical facility

h. Cancellation - A cancellation is defined as a request for service by authorized Medical Center personnel whereby the Contractor arrives at the designated pick-up point and no patient is transported due to a change in the Medical Center’s needs. Attendant fees for cancellation/no shows will begin at the point of picking up the veteran. A flat rate will be assessed for the attendant for cancellation/no shows.

i. Mileage Rate – Mileage rate for special mode is the rate paid for each mile traveled.

This rate applies to one-way transportation only. Reimbursement for mileage shall be at the mileage rate stated in the price/cost schedule and shall be based upon the miles from the pick-up point and the specified destination. Distances areas of coverage shall be calculated using current www.bing.com/maps.

j. No Show - is defined when the beneficiary receiving services is not present at the time of transport or declines to go with the contracted service. Attendant fees for cancellation/no shows will begin at the point of picking up the veteran. No Shows will be treated as Cancellations and will be covered under the Cancelled Trips CLIN for invoicing purposes.

k. No-Patient Transport – The Contractor shall not assess charges on scheduled pick-ups that are cancelled in advance by the VA and/or the patient cancels due to being unable to arrive for scheduled appointment in time.

l. Routine Services – Trips scheduled in advance by the VA, typically one day prior to travel. Beneficiary, caregiver, or significant others cannot contact the Contractor directly to schedule routine trips.

m. Wait Time – Is the time a vehicle is waiting at a medical provider’s facility, to which the transportation provider transported the beneficiary to, transport the beneficiary to another destination, during the same trip.

n. Cognitive Impairment - cognitive impairment affects a person’s ability to reason, understand, and learn.

o. Disability – The term “disability means, with respect to an individual means:

2.o.1. A physical or a mental impairment that substantially limits one or more of the major life activities of such individual.

2.o.2. A record of such impairment

2.o.3. Being regarded as having such impairment (P.L. 101-336, Se)

p. Hearing Impairment - Hearing impairments range from a mild hearing loss to total deafness. Those who are hard of hearing often use their residual hearing and lip read when communicating face-to-face. People who are deaf may use American Sign Language or lip-read and may speak for themselves or use a sign-language interpreter.

q. Mobility Impairment - Mobility impairment refers to the inability of a person to use one or more of his/her extremities, or a lack of strength to walk, grasp, or lift objects. The use of a wheelchair, crutches, or a walker may be utilized to aid in mobility.

r. Speech Impairment - Speech impairments range from problems with articulation or voice strength to complete voiceless. People with speech impairments may have difficulty in projection, articulation and fluency. Some people with speech impairments may use assistive devices or an interpreter to communicate.

s. Visual Impairment - A visual impairment affects a person’s ability to see and includes:

(1) inability to see images clearly and distinctly; (2) loss of visual field; (3) inability to detect small changes in brightness; (4) color blindness; and (5) sensitivity to light. A cane or sight dog may be used to assist with mobility, and/or Braille may be used to read.

http://www.bing.com/maps

t. Durable Medical Equipment (DME) - Medical equipment that is ordered by a doctor for use in the home, such as walkers and wheelchairs.

u. Joint Commission (JC) (Formerly Joint Commission on Accreditation of Healthcare Organizations) – A national organization dedicated to improving the care, safety and treatment of patients in a health care facility and environment.

v. Quality Control and Quality Control Plan (QCP) – Those actions taken by the Contractor to control the production of goods or services, so they shall meet the requirements of the contract.

w. Contracting Officer (CO) – VA official with the authority to enter, administer, and/or terminate contracts and make related determinations and findings.

x. Contracting Officer's Representative (COR) – VA official responsible for providing contract oversight and technical guidance to the Contracting Officer. Responsibilities include certification of invoices, placing orders for service, providing technical guidance, overseeing technical aspects of the contract, and serves as a member of the vehicle inspection team. All administrative functions remain with the Contracting Officer.

y. Scheduled Trip(s) – The term "Scheduled Trip" refers to those trips in which the Contractor has been given notice by 4:30., the prior business day of required services and a specific pick-up time.

z. Contractor – The term "Contractor” as used herein refers to both the prime Contractor and his/her employees, and any sub-contractor and their employees. The Contractor shall be responsible for assuring that his/her subcontractors comply with the provisions of this contract.

aa. Administrative Officer of the Day (AOD) - VA official that works in the admission/ Emergency Department area during evenings and nights and monitors hospital activities during other than normal working hours. This person authorized transports.

bb. Beneficiary Travel Department – Department within the VA that oversees the Beneficiary Travel Program and its entitlements. This includes transportation such as the SMT services.

cc. Beneficiary Travel Department Supervisor - Individual who manages the employees working within the Beneficiary Travel Department.

dd. Beneficiary Travel (BT) Department Personnel – An individual designated by the Contracting Officer for the medical facility, who is authorized to commit and obligate the government through the life of the contract, with consent from the Contracting Officer.

ee. Federal holidays include New Year’s Day, Martin Luther King Day, Presidents Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, Christmas Day and other specifically designated days by the President of the United States to be a national holiday. When a holiday falls on a Sunday, the following Monday shall be observed as a legal holiday. When a holiday falls on a Saturday, the preceding Friday is observed by U. S. Government agencies.

3. JCAHO STANDARDS

a. The Contractor shall perform required services in accordance with the standards of the Joint Commission on the Accreditation of Healthcare Organization (JCAHO) and the established principles and ethics of the medical profession established by the American Medical Association (AMA) and American College of Emergency Physicians (ACEP).

The Contractor shall adhere to the Department of Veteran Affairs policies, procedures, and a regulation that governs the Beneficiary Travel Program is Title 38 Code of Federal Regulations (CFR) Section 70.

b. The Contractor shall comply with the provisions of the Privacy Act of 1974, Portability and Accountability Act (HIPAA) of 1996 and VA Directive and Handbook 0710. The Contractor shall not maintain and/or share sensitive or patient identifiable information in any form or for any purpose, other than what is needed to perform its obligation under the established business associate agreement (BAA). By entering this contract, the Contractor certifies they comply with HIPAA as it pertains to general patient information, HIV, drug and alcohol abuse, and sickle cell anemia.

c. The contractor shall, always during the contract period, have on his/her premises a functioning fax machine, email and telephone to communicate requirements with the VA (i.e., patient incidents, requests for service, special correspondence, etc.

4. PERFORMANCE AND QUALIFICATIONS

a. The Contractor shall provide non-emergency transportation services on an “as needed” basis. Services may be required 24-hours per day/7-day a week, 365 days a year, within the State of California. The contractor shall provide all manpower, equipment, vehicles, fuel, materials and supplies and supervision necessary to perform all tasks.

Vehicles shall have appropriate fuel capacity to complete the transport without stopping for refueling, unless making a transport beyond the capability of the fuel tank of the vehicle.

b. The Contractor, when requested and scheduled, shall allow treatment by VA providers to be performed on the Contractor’s gurney. The VA will be responsible for the patient during the treatment on the Contractors gurney. In such cases the Contractor will wait until the treatment is completed. The contracted wait time fee will be applied in such cases.

c. The Contractor shall provide oxygen tanks when transporting patients requiring. The VA will notify the Contactor when a patient requires oxygen. The standard oxygen tank volume will be approximately 24 CF. The size and dimensions of the oxygen tank shall fit the vehicle used in transporting the patient. The standard oxygen tank is approximately 26 inches by 4.5 inches in diameter. The contactor’s driver shall assist the patient with the connecting and disconnecting the tubes from the oxygen tank and as needed during transport. The contractor shall store and secure the oxygen tank safely in the vehicle at all times.

d. The Contractor shall adhere to the Department of Veteran Affairs regulations and the policies, procedures, and regulations of NCHCS.

e. The contractor, upon request, shall provide quality data and information related to services for participation in NCHCS Performance Improvement Programs when requested to do so. Upon request the contractor shall also provide documentation of the competency of staff that shall be providing the contracted services. The Contractor shall ensure employees providing work on this contract are fully trained and competent to perform the required work; they shall also maintain records that document competence/performance level of employees working on this contract. Upon request, the contractor shall provide a current copy of their competency assessment checklist and annual performance evaluation to the Contracting Officers’ Representative (COR) for each contractor employee working on this contract.

f. The Contractor shall provide a minimum of a toll-free telephone and/or a locally dialed telephone number for accepting VA calls. It is estimated that 95% of all requests for Beneficiary/Patient Transportation Services shall be placed initially by - followed by a written request via secure Facsimile or email. Requests for service may also be in writing or oral from an authorized representative of the VA, and may be completed by telephone, facsimile, e-mail, text message or in person.

g. The contractor shall install and provide a toll-free number, for accepting the NCHCS calls.

h. The contractor shall, always during the contract period, have on his/her premises a functioning telephone to communicate requirements with the VA (i.e., patient incidents, requests for service, special correspondence, etc.). Use of this communication system shall be mutually agreed upon after award but prior to contract performance.

i. Secure/Encrypted Email - The Contractor shall acquire compatible Public Key Infrastructure (PKI) to transmit encrypted email with personally identifiable information and receive similar encrypted email from the VA.

5. ORDERING SERVICE

a. VetRide or VA-approved Transportation Software Utilization:

The contractor agrees to utilize the VetRide Vendor Portal or VA-Approved Transportation Software with every patient transported under this contract.

Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal or VA-Approved Transportation Software for the vendor/contractor in this contract. The Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed:

b. Receive and respond to electronic trip requests

c. Receive, use, and ensure the use of the Vendor pass by the driver.

d. Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-

Approved Transportation Software system.

c. All invoices must be submitted within 30 calendar days of date of service in accordance with 38 CFR 70 to be considered timely submission.

i. The contractor’s invoice must be on HCFA 1500 to include:

ii. Contract Number

iii. Date of Service (to include Box 24 A-J)

iv. Authorization number(s)

v. Pick-up and drop-off location of the patient

vi. Base Rate

vii. Name (Last, First and Middle Initial (if any)) and Full Social Security number

(Box 1a) of patient transported

viii. Date of Birth and Sex

ix. Diagnosis Codes or Nature of Illness or Injury

x. Documentation of circumstances when billing for waiting time

xi. Any miscellaneous charges for which the contractor is expecting reimbursement i.e., Tool charges, waiting time, etc.

xii. VA authorizing official’s name

xiii. Healthcare Procedure Coding System/National Level II (HCPCS)

d. Unauthorized charges will be reviewed by the Contracting Officer Representative (COR) as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges which are being suspended.

e. Transportation Request:

i. Transportation requests will be made through VetRide or VA-Approved

Transportation Software Utilization. Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff. In the event VetRide or other VA- Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests.

ii. Travel Program Staff/or authorized VA employees will work with the Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA-Approved Transportation Software Utilization.

iii. The Contractor must update VetRide or VA-Approved Transportation Software

Utilization with any data and/or notes in real time that deviate from the original order such as invoicing for additional mileage due to a road closure, wait time, reason for no load, etc. Travel Program Staff/or authorized VA employees may place a “hold” on payment of this order until it has been reconciled.

f. Only the following VA staff are authorized to place, cancel, or make changes to transportation requests:

i. Contracting Officer (CO)

ii. Ordering Officers (OO)

iii. Administrative Officer of the Day (AOD)

iv. Beneficiary Travel Office Staff

v. Contracting Officer’s Representative (COR)

g. The Contracting Officer will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The Contracting Officer will update this list throughout the life of the contract as Ordering Officers change.

h. Ordering Officers are responsible for issuing and administering orders placed under this contract. Ordering Officers have no authority to modify any term of this basic contract.

Any deviation from the terms of the basic contract must be approved in writing by the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer may result in loss or delay in payment for supplies/services provided under such orders.

i. Non-authorized VA employees and private agencies (e.g., nursing homes) are not considered authorized to place transportation requests.

j. All patient pick-up(s) and drop-off(s) shall be authorized via “orders” which shall only be issued by the designated Ordering Officers. When placing orders for services, the Ordering Officer shall contact the designated contractor point of contact(s) to provide the following information:

i. Mode of transportation required,

ii. Required time of arrival

iii. Name of the beneficiary,

iv. Pick-up and delivery point,

v. Type and number of additional medical care specialists required,

vi. Type of equipment required,

vii. Last four of the patient's Social Security Number, and

viii. Any other special instructions

k. For ALL Transports – an Audit system will be put in place by the VA to include the COR or designee, Beneficiary Travel Department staff, and clinical staff to ensure appropriateness of the order and timeliness of the response.

l. The contractor shall transport the patient per its policies and standard industry practice.

If the type of transportation service differs from what was agreed upon by the VA and contractor, the contractor shall submit documentation to the VA explaining its rationale.

m. The VA may authorize an escort (e.g., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient’s, best interest. The contractor shall allow the escort to accompany the patient at no additional cost.

n. The contractor shall have sufficient vehicles and personnel to provide services for up to four (4) simultaneous transportation requests. If VANCHCS requires ambulance services exceeding four (4) simultaneous transportation requests, the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

o. The patient may bring with her or him up to three (3) liters of oxygen. The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

p. Pick-up appointment times shall be agreed upon by the VA and contractor at time of order placement and be reasonable based upon travel distance, speed limits, and weather conditions.

q. The contractor’s patient pick-up time cannot be more than 15 minutes prior to the schedule pickup time nor 15 minutes later than the scheduled pickup time for transportation requests scheduled in advance.

r. The contractor shall not be held liable for nonperformance 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 its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, and unusually severe weather. The contractor MUST notify the VA with as much advance notice as possible should any of these occur.

S. Cancellations

i. For trips in which the contractor is notified of cancellation before the vehicle is dispatched, there shall be no charge to the Government.

ii. A “no show” is defined as a transportation request which is cancelled after the contractor has dispatched a vehicle, the vehicle is enroute, or has arrived at the pick-up location, and there is no longer a requirement for patient transportation. The contractor may request one-way reimbursement for no-shows. No-show reimbursement shall be based upon the base rate for the type of service requested and the one-way mileage accrued enroute to the pick-up location at time of cancellation.

iii. Mileage for no- show cancellations shall be confirmed by the contractor and reported to the VA as soon as possible from time of cancellation.

5.1 Pick-Up/Drop-Off/Reporting Procedures

a. Drivers shall return patients in the order that they are requested. Drivers shall not skip departing patients to cover a longer distance versus a shorter distance. Only with the approval of the Travel Section Supervisor will this be authorized. Repeated instances of skipping may lead to termination of the contract or discontinuance of further order placement. Invoices for payment shall include a copy of the trip ticket and the name of the trip requester to ensure payments.

b. Request(s) for VA Beneficiary/Patient special mode transportation services shall be provided to the Contractor as soon as it is known by the Beneficiary Travel Department, and/or Administrator Officer on Duty (AOD). The authorized VA staff must obtain a written authorization in the form of a Beneficiary Travel consult.

c. When transporting patient(s) leaving the medical facility, the Contractor shall be required, if necessary, to transport a maximum of three items (boxes or luggage) of the patient’s personal effects at no additional cost to the VA. Weight and size of these items shall be limited to that which one person can reasonably pick up and load into the vehicle. All patients (including mental health) shall have belongings inventoried and maintained separately while being transported.

d. When transporting a patient leaving the hospital, the Contractor shall be required, if necessary, to transport a maximum of three (3) items (boxes or luggage) of the patient’s personal effects at no additional cost to the VA. Patients may bring a reasonable amount of equipment, such as folding wheelchair, consumable medical supplies and a personal suitcase. When transporting patients to or from Medical facilities, the driver, acting for the Contractor, shall ensure that the patient's luggage, medical records, medications and prosthetic devices are properly accounted for and delivered with the patient, as required

e. Patients may be transported to or from any designated location within the defined

Catchment Area, encompassing the state of California, to include county to county transports and within the county. All transports shall be between VA facilities or between the VA facility and a facility that provides care under VA auspices (i.e. Contract Nursing

Home, Care in the Community Outpatient Clinics,) and/or between the home of the beneficiary receiving travel services and the VA facility. The VA staff shall specify the points of origin and the destination of every trip.

f. When transporting patients to a VA or Community nursing home and/or Assisted Living

Facility, upon arrival at the nursing home the driver shall give the VA Nursing Home

Packet that accompanies the patient to the responsible nursing home staff member. If there are any discrepancies between the address listed on the Nursing Home Packet and the address listed in the trip request, the driver shall clarify the correct destination address with the Beneficiary Travel Department or the Administrator of the Day (AOD).

g. The contractor shall provide and respond to all special mode transportation calls in accordance with all Federal, State, and Local regulations governing dispatch of special mode/handicap transportation vehicles and medical care of on-board patients, to include measures to ensure timely arrival at the designated healthcare facility.

h. In cases where personnel must divert to a local emergency department while performing a VA authorized transport, the contractor’s dispatcher shall notify the VA Beneficiary

Travel Department or Administrative Officer of the Day of the patient’s location and status as soon as this information becomes available.

5.2 INCIDENT REPORTING

a. The contractor shall notify the COR, Requestor, Program Manager, Beneficiary Travel Department, of any accidents and/or safety problems that occur while the patient is being transported.

This notification shall occur within one (1) hour by telephone. A written report of the incident shall be delivered to the COR, Program Manager, or Beneficiary Travel Department, by the close of business of the next working day

b. The COR will monitor the service provided. The contractor shall cooperate with the COR in providing information and answering questions in a timely manner. The contractor shall promptly inform the COR of any complaints received directly from patients. If warranted, the VA may conduct incident investigations and require written response from the contractor within 48 hours of request

5.3 INVOICING

5.3.1 Each transport shall include thirty (30) minutes of wait time; the contractor may invoice for wait times in excess of this initial thirty (30) minutes. Wait time shall begin only once the contractor has both reached the pick-up address location and the appointment time has elapsed. All wait times shall be itemized and invoiced in fifteen (15) minute intervals. For partial fifteen (15) minute intervals, zero (0) to seven (7) minutes shall be rounded down to zero (0) minutes and eight (8) to fifteen (15) minutes rounded up to fifteen (15) minutes.

5.3.2 When invoicing for mileage, the contractor shall round to the nearest mile. Mileage ending in .5 or higher shall be rounded up to the nearest mile. Mileage ending in .4 or lower shall be rounded down to the nearest mile. Payment for mileage to or from the point of care shall be limited to the VA’s calculation according to the VA’s Bing Maps API determination. Bing Maps API is optimized to determine mileage based on the shortest time of travel.

5.3.3 Long Distance Mileage — Payment for mileage outside the contract miles covered in the base rate, shall be at the mileage rate stated in the price schedule, and shall be based upon the miles from the pick-up point and the specified destination. Any mileage from the place of business and/or location of vehicle and the pick-up point, or from the delivery destination back to the place of business and/or location of next trip are not considered as a separate item of this reimbursement but would be expected to be incorporated into the mileage rate as part of the administrative costs (or costs of doing business).

5.3.4 Upon notification of the contracting officer, the vendor must receive training and begin implementation of invoices via Vet Ride within 30 days versus VA Tungsten Network e- Invoicing network. Invoices must be submitted via the electronic HCFA 1500 in the VetRide Vendor Portal or other VA approved software. These invoices shall not include patient information, but shall include the following:

▪ Contractor Name

▪ Contract Number

▪ Current Purchase Order Number

▪ Date of service

▪ Total amount invoiced including a summary of the total number of charges that align with the line items of this contract (i.e., total number of BLS Base Rate, total BLS Mileage incurred, etc.)

▪ An itemized list of charges or services rendered that align with the line items of this contract (i.e., BLS Base Rate, BLS Mileage incurred, etc.)

Payment by VA under this contract to a provider of ground ambulance transportation services authorized under this contract extinguishes any and all liability on the part of the VA BENEFICIARY for that transportation service. UNDER NO CIRCUMSTANCES

ARE VA BENEFICIARIES, THIRD PARTY INSURANCES, MEDICARE, OR MEDICAID

TO BE BILLED FOR THE SERVICES PERFORMED UNDER THIS CONTRACT.

5.4 RESPONSE TIME

a. For all add-ons (not scheduled in advance), the Contractor’s vehicles must respond within the times listed below for scheduled transport.

VA Mather 2 hours

VA Martinez 2 hours

VA Redding 3 hours

VA Chico 3 hours

VA McClellan 2 hours

VA David Grant 2 hours

VA Mare Island 3 hours

VA Yuba City 2 hours

VA Ukiah 4 hours

VA Sierra Foothills 2 hours

VA Stockton 2 hours

VA Modesto 2 hours

VA Sonora 2hours

b. Response time will be calculated from the Contractor’s receipt in VetRide or telephonic/fax/email request for service. The Contractor is responsible for finding any replacement vehicles as necessary. Payment will be made in accordance with the applicable CLIN pricing.

c. For return trips from scheduled outpatient visits, the Contractor shall ensure Veterans and other beneficiaries do not wait more than one hour after notification for unscheduled return trips and 30 minutes for scheduled return trips, no matter where patient lives.

d. Patient pickups shall be completed within one hour after notification for unscheduled trips and 30 minutes for scheduled trips.

e. The contractor shall miss no more than three patient pickups per 50. The COR will review the circumstances of each incident to determine who is at fault. A Letter of

Concern shall be issued on the fourth missed ride out of 50 which they are at fault, and the contractor shall provide a plan to prevent further instances.

f. Repeated failure to meet required response timeframes may result in termination of the contract, or discontinuation of further orders.

g. Failure of the contractor to perform in accordance with this compliance rating may constitute sufficient cause for termination of the contract for cause [see FAR Clause 52.212-4(m), Termination for Cause].

6. PATIENTS RIGHTS

a. The Contractor shall be courteous to VA Beneficiaries/Patients and any Authorized

Escort, Family Member passenger or Significant Other passenger and “SMOKING IS NOT PERMITTED” in the Contractors’ Vehicles.

b. Drivers must be courteous and considerate of all patients they are transporting. Any substantiated mistreatment of patients in the performance of this contract may be cause for immediate termination of the contract, or discontinuance of further ordering of services from the Contractor. Substantiated reports of mistreatment may be referred to appropriate law enforcement authorities as applicable. The VA reserves the right to request driver removal from transporting VA patients if mistreatment is substantiated.

c. The contractor shall be responsible for the patient’s welfare during transport. The contractor shall be held responsible for patient and/or VA property during transport. Any damaged or lost wheelchairs, walkers, crutches, or personal belongings shall be replaced at the contractor’s expense.

d. The VA requires the contractor to exercise extreme caution and care in the handling of patients.

e. If a VA beneficiary being transported declines to be properly secured or removed the securement devices himself/herself, the driver will notify the Contracting Officer’s Representative (COR) of this fact prior to departure. The contractor is not required to transport any VA beneficiary who refuses to be properly secured while being transported. In the event that the beneficiary refuses to be properly secured, they shall be returned back into the building which they came from

f. The Contractor shall report any patient incident initially on a signed incident report within twenty-four hours of the incident to the Beneficiary Travel Department. An assessment of the incident and a signed contractor response to the incident to include training and process changes shall be submitted to the Supervisor within five days from the date of the incident. A signed final analysis to include education, training, and process changes to prevent future incidents shall be submitted within thirty days to the Travel Department Supervisor.

g. The Contractor shall not employ any persons for work on this contract if such employee is considered by the VA contracting officer to be a potential threat to the health, safety, security or operations of the VA. Contractor’s employees shall understand, speak, read, and write the English Language. No employee of the contractor can be a Federal employee, nor can they have any conflict of interest.

h. The Contractor shall display a visible means of a medium that allows the patient to provide feedback, positive and negative to the Contractor (comment cards). Contractor shall provide a quarterly report of patient feedback to the Contracting Officer Representative (COR).

7. PATIENT ESCORT/CAREGIVER

a. The VA reserves the right to have an escort, such as a relative, or care provider of beneficiary or VA staff accompany beneficiary when the VA determines that such an escort is in the best interest of the beneficiary. The VA will be the sole judge in determining when an escort is required. There shall be no additional charge to the VA when escorts are authorized to travel with beneficiary. Contractor shall only be required to transport escort with patient and will not be required to return the escort back to point of origin if patient is admitted to hospital (unless the escort is a VA attendant or authorized VA caregiver).

b. The NCHCS reserves the right to send an authorized official (Registered Nurse, Licensed Practical Nurse, Nursing Assistant, or Physician) to attend the patient in a transfer from our facility when deemed necessary to the patient’s welfare by medical staff.

c. Contractor is required to return VA attendant to the point of origin. Reimbursement shall be limited to mileage rates as stated in the Price Schedule. The furnishing of the VA attendant does not relieve the Contractor from furnishing a qualified attendant in accordance with this contract.

d. The Contractor shall provide an attendant upon request of the VA. An attendant is defined as a Contractor employee other than the driver on a given trip that meets the qualifications needed for medical transport. When completing a Gurney transport the vendor is responsible for ensuring that a Gurney is included with this run, with no extra charge to the VA. The VA shall provide pertinent medical information and inform Contractor of special needs required for patient to determine the specific training and qualifications of the attendant needed. The Contractor shall ensure that each person employed is trained, qualified and certified to perform the duties required, including CPR certification.

8. RATES

a. The web-based application at www.bing.com/maps, using the shortest time driving option, shall determine trip mileage. For all one-way trips ordered under this contract, the Contractor shall receive Special Mode Transportation base rate quoted. The Special Mode Transportation rate, as defined in section B.2 Price/Cost Schedule, shall constitute full compensation for one-way trips as defined herein.

b. The same rates shall apply 24 hours per day. Payment for mileage traveled shall be limited to “one way only”, the distance over which the patient is transported. Such mileage costs shall be paid in addition to the pick-up charge per trip for any trip.

Allowable charges for mileage outside the contract Catchment Area (California) shall not exceed +5% of the web-based application at www.bing.com.maps using the shortest time driving option shall determine trip mileage.

9. WAIT TIMES/TOLLS/NO SHOWS

a. “Waiting time” is billable for trips approved by the COR or authorized personnel. This will be approved prior to trip. If vendor invoiced wait time is not pre-approved, payment will be denied.

b. If the pickup is other than NCHCS locations, the contractor shall call the Beneficiary Travel Office, during normal working hours, or the AOD, after-hours, as soon as the contractor anticipates that a delay may develop for which he/she expects to claim reimbursement.