36C26319Q0017-0001001.pdf

36C26319Q0017

B.2 PRICE SCHEDULE

OFFEROR:

Contract guaranteed minimum is $25,000 for the base period of performance and will be awarded at time of contract award via the initial task order.

Contract maximum is $2,500,000 for lifetime of the contract.

Quantities listed are estimates only based on historical data. Actual quantities on task orders can be less than or greater than estimated quantities listed based on VA Nebraska Western Iowa Health Care System needs.

Only warranted Contracting Officers from Network Contracting Office (NCO) 23, Department of Veterans Affairs, can issue task orders against this single award Indefinite Delivery, Indefinite Quantity (IDIQ) contract:

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SERVICES

ESTIMATED

QUANTITY UNIT UNIT PRICE

ESTIMATED

AMOUNT

300.00 TRP __________________ __________________

Ordering Period 1: 02-01-2019 to 01-31-2020 ALS-capable Non-Emergent ambulance trips for patients requiring transport between a medical facility and another location within the Omaha Metropolitan Area (within 40 miles of Omaha VAMC).

0002 500.00 TRP __________________ __________________

Ordering Period 1: 02-01-2019 to 01-31-2020 BLS-capable Non-Emergent ambulance trips for patients requiring transport between a medical facility and another location within the Omaha Metropolitan Area (within 40 miles of Omaha VAMC).

0003 16,000.00 MI __________________ __________________

Ordering Period 1: 02-01-2019 to 01-31-2020 Mileage: Transport beyond 40-mile radius; one way only (In addition to rate per trip in CLINs 0001 & 0002). Loaded miles only when a VA beneficiary is being transported. The unloaded mileage for the return shall not be included.

0004 15.00 EA __________________ __________________

Ordering Period 1: 02-01-2019 to 01-31-2020 Waiting Time, when required and verified (more than 30 minutes) at 15-minute intervals (quarter hour) as verified by VA. The quantity of "Each" means one 15-minute interval of time.

10.00 TRP __________________ __________________

Additional Attendant: When a second attendant is required for high acuity patients.

15.00 EA __________________ __________________

Lift Assist – Second Unit: When VA beneficiary lives in a building that has stairs with no alternative to accommodate stretcher movement such as a ramp or elevator. A BLS Ambulance is also dispatched to the same location as the second unit which includes at least two more people who literally pick up the patient on the stretcher and moves them in tandem either up or down the stairs – inside and/or outside. For trips beyond the 40-mile radius, additional charges will apply per CLIN 0003.

Trip Cancellation: Occurs when the VA beneficiary is not present at the destination and the contractor has waited the minimum 30-minute waiting time, the beneficiary refuses transportation (through no fault of the contractor), or the VA cancels the pickup after the contractor has departed from the contractor’s place of business enroute to the destination.

55.00 TRP __________________ __________________

Urgent / Emergent Inter-Facility Ambulance Transport; Response within 15 minutes of request for transport; No trip ticket required ; Between medical facilities within the Omaha Metropolitan Area (within 40 miles of Omaha VAMC).

ORDERING PERIOD 1 ESTIMATED TOTAL (CLINS 0001 to 0008):

Ordering Period 2: 02-01-2020 to 01-31-2019

ALS-capable Non-Emergent ambulance trips for patients requiring transport between a medical facility and another location within the Omaha Metropolitan Area (within 40 miles of Omaha VAMC).

500.00 TRP __________________ __________________

Ordering Period 2: 02-01-2020 to 01-31-2021

BLS-capable Non-Emergent ambulance trips for patients requiring transport

16,000.00 MI __________________ __________________

Mileage: Transport beyond 40-mile radius; one way only (In addition to rate per trip in CLINs 1001 & 1002). Loaded miles only when a VA beneficiary is being transported. The unloaded mileage for the return shall not be included.

Waiting Time, when required and verified (more than 30 minutes) at 15-

Lift Assist – Second Unit: When VA beneficiary lives in a building that has stairs with no alternative to accommodate stretcher movement such as a ramp or elevator. A BLS Ambulance is also dispatched to the same location as the second unit which includes at least two more people who literally pick up the patient on the stretcher and moves them in tandem either up or down

Trip Cancellation: Occurs when the VA beneficiary is not present at the destination and the contractor has waited the minimum 30-minute waiting time, the beneficiary refuses transportation (through no fault of the

68.27 TRP __________________ __________________

Urgent / Emergent Inter-Facility Ambulance Transport; Response within 15 minutes of request for transport; No trip ticket required ; Between medical facilities within the Omaha Metropolitan Area (within 40 miles of Omaha VAMC).

ORDERING PERIOD 2 ESTIMATED TOTAL (CLINS 1001 to 1008):

Ordering Period 3: 02-01-2021 to 01-31-2022

ALS-capable Non-Emergent ambulance trips for patients requiring transport

BLS-capable Non-Emergent ambulance trips for patients requiring transport

Mileage: Transport beyond 40-mile radius; one way only (In addition to rate per trip in CLINs 2001 & 2002). Loaded miles only when a VA beneficiary

Waiting Time, when required and verified (more than 30 minutes) at 15-

Lift Assist – Second Unit: When VA beneficiary lives in a building that has stairs with no alternative to accommodate stretcher movement such as a ramp or elevator. A BLS Ambulance is also dispatched to the same location as the second unit which includes at least two more people who literally pick up the patient on the stretcher and moves them in tandem either up or down

Trip Cancellation: Occurs when the VA beneficiary is not present at the destination and the contractor has waited the minimum 30-minute waiting time, the beneficiary refuses transportation (through no fault of the

Urgent / Emergent Inter-Facility Ambulance Transport; Response within 15 minutes of request for transport; No trip ticket required ; Between medical facilities within the Omaha Metropolitan Area (within 40 miles of Omaha VAMC).

ORDERING PERIOD 3 ESTIMATED TOTAL (CLINS 2001 to 2008):

Ordering Period 4: 02-01-2022 to 01-31-2023

ALS-capable Non-Emergent ambulance trips for patients requiring transport

BLS-capable Non-Emergent ambulance trips for patients requiring transport

Mileage: Transport beyond 40-mile radius; one way only (In addition to rate per trip in CLINs 3001 & 3002). Loaded miles only when a VA beneficiary

Waiting Time, when required and verified (more than 30 minutes) at 15-

Ordering Period 4: 02-01-2021 to 01-31-2023

Lift Assist – Second Unit: When VA beneficiary lives in a building that has stairs with no alternative to accommodate stretcher movement such as a ramp or elevator. A BLS Ambulance is also dispatched to the same location as the second unit which includes at least two more people who literally pick up the patient on the stretcher and moves them in tandem either up or down

Trip Cancellation: Occurs when the VA beneficiary is not present at the destination and the contractor has waited the minimum 30-minute waiting time, the beneficiary refuses transportation (through no fault of the

Urgent / Emergent Inter-Facility Ambulance Transport; Response within 15 minutes of request for transport; No trip ticket required ; Between medical facilities within the Omaha

ORDERING PERIOD 4 ESTIMATED TOTAL (CLINS 3001 to 3008):

Ordering Period 5: 02-01-2023 to 08-31-2023

ALS-capable Non-Emergent ambulance trips for patients requiring transport

BLS-capable Non-Emergent ambulance trips for patients requiring transport

Mileage: Transport beyond 40-mile radius; one way only (In addition to rate per trip in CLINs 4001 & 4002). Loaded miles only when a VA beneficiary

Waiting Time, when required and verified (more than 30 minutes) at 15-

Lift Assist – Second Unit: When VA beneficiary lives in a building that has stairs with no alternative to accommodate stretcher movement such as a ramp or elevator. A BLS Ambulance is also dispatched to the same location as the second unit which includes at least two more people who literally pick up the patient on the stretcher and moves them in tandem either up or down

Trip Cancellation: Occurs when the VA beneficiary is not present at the destination and the contractor has waited the minimum 30-minute waiting time, the beneficiary refuses transportation (through no fault of the

Urgent / Emergent Inter-Facility Ambulance Transport; Response within 15 minutes of request for transport; No trip ticket required ; Between medical facilities within the Omaha

ORDERING PERIOD 5 ESTIMATED TOTAL (CLINS 4001 to 4008):

ESTIMATED

GRAND TOTAL

(CLINS 0001 TO

4008)