36C26319Q0017-003.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. DUNS: DUNS+4:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. 2/2012)

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

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 97

Included on task orders issued against IDIQ.

36C26319Q0017 11-15-2018

Doug Reed 605-336-3230 x 7844 12-06-2018

10:00am CST

Services Branch

Department of Veterans Affairs

Network Contract Office 23 (NCO 23)

2501 W. 22nd St.

Sioux Falls SD 57105

X 100

X

621910

$15 Million

N/A

VA Nebraska-Western Iowa Health Care

System

4101 Woolworth Avenue

Omaha NE 68105

Services Branch

Network Contract Office 23 (NCO 23)

2501 W. 22nd St.

Sioux Falls SD 57105

Financial Services Center

Via The Tungsten Network

Refer to VAAR Clause 852.232.72

See CONTINUATION Page

Description of Services:

Omaha VA Medical Center (VAMC)

Advanced Life Support (ALS)/Basic Life Support (BLS) Ground

Ambulance Transport for VA Nebraska Western Iowa Health Care

System.

Period of Performance: 02-01-2019 to 08-31-2023

This is a solicitation conducted using FAR Part 13

(Simplified Acquisition) procedures.

This solicitation is a Total Small Business Set-Aside.

Offeror shall have active registration in System for Award

Management at https://www.sam.gov at time of offer to the

Government.

Refer to B.2 (Price Schedule) for line items.

Refer to B.3 (Statement of Work) for scope of work.

Refer to FAR 52.212-1 for offer submittal instructions.

Refer to FAR 52.212-2 for evaluation factors.

See CONTINUATION Page

To be cited on all task orders issued against awarded

Indefinite Delivery, Indefinite Quantity (IDIQ) Contract.

X X

X 1

Doug Reed

VA-VHA-SAOC-2016-AC23EC83

36C26319Q0017

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE SCHEDULE

B.3 STATEMENT OF WORK (SOW)…………………………………………………………14

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN

2017)

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

C.3 52.216-18 ORDERING (OCT 1995)

C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)

C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995)

C.6 52.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 1997) 36

C.7 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008)

C.8 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)

C.9 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN

2011)

C.10 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2012)

C.11 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE

(JAN 2008)

C.12 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)

C.13 IT CONTRACT SECURITY

C14. National Archives and Records Administration (NARA) Records Management Language for Contracts

C.15 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (JAN 2018)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

SECTION E - SOLICITATION PROVISIONS

E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017)

1. Name/address of organization contract was with

2. Contract number/title

4. Brief description of contract scope and dollar value

5. Point of contact information (name/title/phone number/e-mail address)

References may be from Federal/State/Local Government organizations or from commercial organizations in which the contractor performed as a Prime Contractor. Government references are considered more relevant in priority order of Federal, State, and then Local. . 73

E.2 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013)

E.3 52.216-1 TYPE OF CONTRACT (APR 1984)

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

E.5 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-

OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION)

E.6 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION

(JAN 2008)

E.7 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) .. 78

E.8 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO

BENEFICIARIES (JAN 2008)

E.9 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014) [TAILORED]

E.10 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (NOV 2017)

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: TBD

b. GOVERNMENT: Contracting Officer 36C263 Doug Reed, douglas.reed3@va.gov

Services Branch

Department of Veterans Affairs

Network Contract Office 23 (NCO 23)

2501 W. 22nd St.

Sioux Falls SD 57105

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] Weekly through Tungsten Network

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.

Department of Veterans Affairs

Financial Services Center

Via The Tungsten Network

Refer to VAAR Clause 852.232.72

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

AMENDMENT NO DATE

B.2 PRICE SCHEDULE

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

0001 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

0003 16,000.00 MI __________________ __________________

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 __________________ __________________

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.

0005 10.00 TRP __________________ __________________

Ordering Period 1: 02-01-2019 to 01-31-2020

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

0006 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.

0007 10.00 TRP __________________ __________________

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.

0008 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

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

1001 300.00 TRP __________________ __________________

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

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

1002 500.00 TRP __________________ __________________

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

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

1003 16,000.00 MI __________________ __________________

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

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

1004 15.00 EA __________________ __________________

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

1005 10.00 TRP __________________ __________________

1006 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

1007 10.00 TRP __________________ __________________

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

1008 68.27 TRP __________________ __________________

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

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

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

2001 300.00 TRP __________________ __________________

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

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

2002 500.00 TRP __________________ __________________

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

2003 16,000.00 MI __________________ __________________

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

2004 15.00 EA __________________ __________________

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

2005 10.00 TRP __________________ __________________

2006 15.00 EA __________________ __________________

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

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

2007 10.00 TRP __________________ __________________

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

2008 55.00 TRP __________________ __________________

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

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

3001 300.00 TRP __________________ __________________

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

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

3002 500.00 TRP __________________ __________________

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

3003 16,000.00 MI __________________ __________________

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

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

3004 15.00 EA __________________ __________________

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

3005 10.00 TRP __________________ __________________

3006 15.00 EA __________________ __________________

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

3007 10.00 TRP __________________ __________________

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

3008 55.00 TRP __________________ __________________

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

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

4001 300.00 TRP __________________ __________________

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

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

4002 500.00 TRP __________________ __________________

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

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

4003 16,000.00 MI __________________ __________________

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

4004 15.00 EA __________________ __________________

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

4005 10.00 TRP __________________ __________________

4006 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

4007 10.00 TRP __________________ __________________

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

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

4008 55.00 TRP __________________ __________________

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

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

GRAND TOTAL __________________

B.3 STATEMENT OF WORK (SOW)

Description of Requirement

Omaha VA Medical Center (VAMC) Advanced Life Support (ALS)/ Basic Life Support (BLS) Ground

Ambulance Transport for VA Nebraska-Western Iowa (NWI) Health Care System.

Contractor shall provide ALS/BLS Ground Transport to and from NWI’s Omaha VAMC. This includes transport to and from 40-mile radius of Omaha VAMC, to include Interfacility transport to other medical facilities within Omaha-Council Bluffs metropolitan area at the basic rate / transport beyond the 40-mile radius at additional costs.

Place of Performance

Omaha VAMC

4101 Woolworth Avenue

Omaha, NE 68105

Service Contract Labor Standards Requirement

Contractor shall provide hourly wages in accordance with U.S. Department of Labor Wage Determinations and FAR Subpart 22.10 (Service Contract Labor Standards); see Solicitation Attachment 1 (USDOL Wage

Determinations).

The following position is applicable:

12010 – Ambulance Driver

Period of Performance

This will be a single award Indefinite Delivery Indefinite Quantity (IDIQ) contract with period of performance of 2-1-2019 to 8-31-2023.

Funds will be obligated via issuance of task orders against IDIQ contract for each ordering period:

Ordering Period Period Begins Period Ends

1 2-1-2019 1-31-2020

2 2-1-2020 1-31-2021

3 2-1-2021 1-31-2022

4 2-1-2022 1-31-2023

5 2-1-2023 8-31-2023

Hours of Service

Contractor shall provide service seven (7) days a week, 24 hours per day, including weekends and holidays, during the period of performance of this contract.

Vehicle Requirements

1. The ambulances under the terms of this contract shall be licensed and meet the minimum requirements as mandated by the rules and regulations governing Ambulance Licensure

Certification and Emergency Medical Services law, adopted by the Board of Ambulance

Advisors of the State of Nebraska and approved by the State Department of Health.

2. Each ambulance shall be of a model and make to ensure safe and comfortable transportation of patients and must have sufficient headroom to accommodate the patient in the Fowlers position.

3. Ambulances must be inspected and maintained daily to assure mechanical fitness for public safety.

4. Ambulances shall be equipped with such safety items as required by the rules and regulations governing Ambulance Licensure of the State of Nebraska.

5. Ambulances for the transport of patients must comply with state registration requirements for motor vehicle inspection and must have minimum insurance coverage. Compliance with the state inspection requirements and insurance must be verified annually or prior to exercise of any option year.

6. Each ambulance shall be equipped and stocked in strict accordance with the standards as prescribed by Nebraska state laws and Nebraska Department of Health.

7. Contractor shall have available at all times one (1) ALS and two (2) BLS ambulances to provide

Non-Emergent transportation services for the beneficiaries in the surrounding area of Omaha

VAMC. Must also have, available at all times, one (1) ambulance with ALS critical care capabilities for Urgent/Emergent transports from the Omaha VA Medical Center facility.

8. Contracted vehicle operators shall enforce the use of seat belts or safety restraint devices by all vehicle occupants.

9. Contracted vehicle operators must not leave a vehicle running and unattended.

10. Contracted vehicle operators are responsible for ensuring all equipment and cargo is secured prior to driving of vehicles. All patient support equipment and supplies shall be fully secured to the vehicle body during transport (lock to body or tie downs).

11. All contracted vehicles used for the transport of patients must contain emergency roadside and communication equipment.

12. Communication equipment must be isolated from the engine battery.

13. Cellular phones and two-way radios are acceptable communication equipment. NOTE: Contract vehicles must be furnished with communication equipment by the contractor.

14. Fire extinguishers must be inspected and maintained in accordance with National Fire Protection

Association (NFPA) Standard 10 and secured to the vehicle body.

15. Personal protective equipment (gloves) and spill kits must be provided to drivers to ensure they are adequately prepared to address biological fluids.

16. If the transfer of clinical specimens with patient passengers is required, it must comply with DOT and OSHA regulations.

17. Clinical staff giving specimens to contracted vehicle operators transporting patients must ensure compliance with the specimen identification, packing and labeling requirements of U.S.

Occupational Safety & Health Administration (OSHA) 29 Code of Federal Regulations (CFR)

1910.1030, Bloodborne Pathogens and the Material of Trade (MOT) exception for Class 6, Division 6.2 substances of U.S. Department of Transportation (DOT) 49 CFR 173.134.

18. All specimen packages shall be packed in a container secured to the vehicle body to prevent movement during driving.

19. Contractor shall provide list of vehicles, broken down by make, model, Vehicle Identification

Number (VIN), and License Plate Number/State within five (5) business days after post-award conference.

Insurance Requirements

In addition to insurance requirements cited in Section C of solicitation, the Contractor certificate of insurance contain an endorsement to the effect, that cancellation of or any material change in the policies, which adversely affect the interests of the Government, shall not be effective unless a 30-day written notice of cancellation or change is furnished to the Contracting Officer (CO). Certificate of Insurance shall be provided by Contractor within five (5) business days after post-award conference. Contractor shall provide copy of updated certificate of insurance based by beginning of each ordering period task order cited under “Period of Performance.”

Post-Award Conference

Upon award of contract, Contractor shall attend a post-award conference via conference call with the

Contracting Officer (CO), Contracting Officer Representative (COR), and COR designated representatives from NWI.

EMT, Advanced EMT, and Paramedic Qualifications

1. Ambulance “Attendant” is classified either as an Emergency Medical Technician (EMT) or

Paramedic and shall be certified through the State of Nebraska.

2. Emergency Medical Technician (EMT), EMT-A, EMT-I, and Paramedic – shall mean an out-of-hospital emergency care provider trained and certified to the level of basic and advanced life support as prescribed in Nebraska Revised Statute 38 – Health Occupations and Professions (Chapter 38) and for such other skills as determined by the Department of Health Regulations and Standards of the

State of Nebraska.

3. EMTs and Paramedics shall provide a copy of their Nebraska EMT or Paramedic license prior to performing any service under the contract and within five (5) business days after post-award conference. The EMT must be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity under which the ambulance service is operated or which governs it.

4. An additional Attendant may be required for high acuity patients; an EMT or Paramedic may fill that requirement.

Advanced Life Support (ALS) Ambulance

An ALS Ambulance is staffed with at least one EMT or Paramedic taking direct care of the patient and another EMT, Paramedic or qualified Ambulance driver providing the transportation. The vehicle is to be equipped with all the supplies needed to care for a severely injured or ill patient, such as IV supplies, cardiac monitor, intubation equipment and a ventilator.

Basic Life Support (BLS) Ambulance

A Basic Life Support (BLS) Ambulance is staffed with at least one EMT, EMT-A, EMT-I or Paramedic taking direct care of the patient and an EMT, Paramedic or qualified Ambulance driver providing the transportation. The vehicle is to be equipped with all the supplies needed to provide services including the administration of oxygen and other non-invasive procedures including splinting broken bones, administering glucose for mild hypoglycemia, and basic wound management.

Ambulance Driver

1. All ambulance drivers shall be verified for current and valid State Drivers’ License through the

Department of Transportation (DOT), National Highway Traffic Safety Administration (NHTSA), National Driver Register, or an equivalent State program.

2. The Contracting Officer Representative (COR) must conduct a review prior to the assignment of a new

Ambulance Driver, upon an accident event, and at any other time at the discretion of the COR.

Driving records exhibiting any at-fault accident or moving violation must prompt a review of driver suitability for the transport of patients. Ambulance Drivers may be limited or prohibited from transporting patients based on driving record or license status. Contractor shall provide copy of ambulance driver license and driving records to COR prior to assigning ambulance driver.

3. The COR maintains Ambulance Driver records, license verification, training, and insurance coverage and will conduct an annual review prior to assignment of a new Ambulance Driver.

4. All Ambulance Drivers transporting patients shall receive initial basic safe driver training and annual refresher from Contractor to include defensive driving techniques, use of safety belts, patient safety, and emergency response procedures.

5. A qualified Ambulance driver, other than the EMT or Paramedic, must receive training on basic First

Aid, Cardiopulmonary Resuscitation (CPR), Bloodborne Pathogens, and the use of Personal

Protective Equipment (PPE).

6. Ambulance Drivers shall be trained in methods for securing patients including use of restraint systems and other assistive devices during transportation as well as safe loading and unloading practices.

7. Contractors must provide an annual statement prior to beginning of each ordering period that

Vehicle Operators’ are screened, trained and competent to safely transport patients. This annual statement of driver competency must include any advanced certifications, such as EMT, Paramedic, Advanced Medical Life Support (AMLS), Advanced Cardiac Life Support (ACLS), BLS, CPR, Automated External Defibrillator (AED) First Aid and any other specialized training to assist and secure patients by stretcher.

Number of Patients

It is understood and agreed that only one (1) patient will be transported on a trip unless specifically authorized by COR or authorized VA official. An authorized official of VA may, in the best interest of the beneficiary, allow a relative to accompany him/her at no additional cost. When more than one (1) patient is transported on a trip, reimbursement will be made at the rate not exceeding the cost of transporting a single patient; however, when travel beyond the city limits (40- mile radius from the Grand

Island or Lincoln CBOC) is involved, the longest distance over which a patient is transported may be claimed when more than one (1) patient is transported in a single ambulance concurrently. The contractor must ensure that the pick-ups and drop-offs are scheduled so that the total distance traveled will result in a most economical charge to the Government. The COR will provide a list of authorized officials upon award to the Contractor.

Waiting Time

1. Thirty (30) minutes of wait time is included for all transports. Any wait time in excess of 30 minutes will be reimbursed at the rate prescribed in Section B.2 (Price Schedule).

2. The Contractor will call the Veterans Transportation Services at 402-995-4458 after waiting 15 minutes. This call will enable the Veterans Transportation Services to ensure patient transport has not been additionally delayed.

Requesting Transport

1. Requests for transport will be made by faxing a Trip Ticket from the Omaha Veterans Transportation

Services or the Administrative Officers of the Day (AODs) designated by the COR. Exception to this rule is for an Urgent/Emergent transport request which cannot be delayed by waiting for a trip ticket.

2. If the Contractor fails to furnish ambulance service within 45 minutes (15 minutes for

Urgent/Emergent) after receiving a request for any order, the VA reserves the right to obtain the service from another source. The COR or authorized officials if designated by COR will be the sole judge in determining when to order service from another source.

3. Designated NWI Veteran Transportation Service (VTS) staff and all of the Administrative Officers of the Day (AODs) will be designated to schedule patient pickups/drop offs. A letter designating such individuals will be forwarded to the successful Contractor upon award.

Pick-Up and Delivery

1. Pickup and delivery of patients at the Omaha VAMC shall be at the following locations:

Emergency Room entrance on West Side of Main Facility

Or, Entrance to Dialysis Center, Building 9 (For Non-Emergent transports only) Emergencies from

Dialysis are covered by calling 911.

2. Patients will be taken to or from a pre-arranged destination, for example Outpatient Clinic, Admissions

Office in the Emergency Department, or Inpatient Unit whenever possible.

3. In all other cases, the patient shall be brought into the Admissions Office and either placed on a hospital stretcher or immediately removed to an Inpatient Unit as directed by the Administrative

Officer of the Day (AOD), or an employee of NWI VTS.

Safety Requirements

In the performance of this contract, the Contractor shall take such safety precautions as the Contracting

Officer or COR or his/her designee may determine to be reasonably necessary to protect the lives and health of the occupants of the buildings and/or vehicles. The CO, COR, or his/her designee will notify the Contractor of any noncompliance with the forgoing provisions and the action to be taken. The

Contractor shall, after receipt of such notice, immediately correct the conditions to which attention has been directed. Such notice, when served on the Contractor or his/her designee at the site of the work, shall be deemed sufficient for the purposes aforesaid. If the Contractor fails or refuses to comply promptly, the CO may issue an order stopping all or any part of the work, including legal remedies as stated in Section C.

Incident Reporting

Contractor shall report vehicle accidents and incidents to the COR and COR designees verbally immediately with a formal accident report within three (3) business days. The COR will forward a copy to the Omaha VAMC Patient Safety Manager.

Every effort shall be made by the contractor to prevent errors, falls, and patient injury caused by acts of commission or omission in the delivery of care.

Any adverse event related to patient injury or other patient safety issues will be reported to the COR verbally immediately following the event and then followed with a written notification (incident report) to

COR within three (3) business days. A Root Cause Analysis will be conducted by VA to determine what happened, why it happened, and what will be done to prevent recurrence.

If the ambulance is involved in an automobile accident, a copy of the police report shall be provided to the COR as soon as it is available.

Preparation of Invoices

In addition to invoice instructions specified in VAAR Clause 852.232-72 of this contract, the Contractor shall include the following on invoices submitted:

1. All invoices for payment shall be submitted electronically through Tungsten on a weekly basis. These electronic invoices shall avoid placing patient personal information on them but will need to include the following for cross reference and verification the charges:

a. Trip Ticket Number for Non-Emergent transports

b. Run # or Patient’s Acct Number (Contractor’s patient identification number) that is also reflected on each individual claim form described below.

c. Applicable Contract Line Item (CLIN) w/ individual Line Item Charge

d. Pick-up point and time

e. Drop-off point and time

f. Date of Service (Trip Date)

g. Total Charges

2. Additionally, a Health Care Finance Administration (HCFA)/Center for Medicare and Medicaid

Services (CMS)-1500 (professional) or National Uniform Billing Committee (NUBC) UB-04

(institutional) claim form for each patient’s transport will be submitted separately and directly to the

VA to the claims payer in person or through the mail. HCFA/UB will include the trip ticket number.

These will be bundled along with a copy of their corresponding Tungsten invoice from Contractor and a spreadsheet with the following information:

a) Patient’s Name

b) Social Security Number

c) Trip Ticket Number

d) Date of Service (Trip Date)

e) Pick-up point and time

f) Drop-off point and time

g) Number of miles if greater than 40 miles (geographic area)

h) Contract number /PO number

i) Applicable HCPCS & ICD-10 Codes

3. A ‘trip’ is defined as a one-way transport and is limited to the 40-mile radius of the Omaha VAMC.

4. When round-trip service is provided for the same patient on the same day, both trips may be entered on the same invoice but as separate line items.

5. Mileage beyond the 40-mile radius will be reimbursed ONE WAY ONLY. Contractor will list these charges separately on their invoice.

6. Approved waiting time will be billed as a separate line item on the claim in 15- minute increments at one fourth the hourly rate quoted in his / her bid from the time the driver reports and gains approval for the wait.

7. Prices are to include additional attendant charges separately, when a second attendant is required for high acuity patients.

8. TOLL CHARGES. It is agreed and understood that the prices quoted in the price schedule include any bridge toll charges.

Deliverables Table

Item Section

Referenced

Due By Format Provided To

Copies of EMT and

Paramedic Licenses

B.3 (SOW), EMT,

Advanced EMT, and Paramedic

Qualifications

Five (5) business days after post-award conference

E-mail or alternate format if approved by COR

COR

Certificate of

Insurance

B.3 (SOW),

Insurance

Requirements

Five (5) business days after post-award conference;

updated certificate prior to beginning of each ordering period task order

E-mail CO with cc to

COR

Provide list of vehicles, broken down by make, model, Vehicle

Identification

Number (VIN), and

License Plate

Number/State

B.3 (SOW),

Vehicle

Requirements

Five (5) business days after post-award conference

E-mail or alternate format if approved by COR

Copy of

Ambulance Driver

License and

Driving Records

B.3 (SOW),

Ambulance Driver

Prior to assigning ambulance driver to contract

E-mail or alternate format if

Vehicle Accident

Report

B.3 (SOW),

Incident Reporting

Verbal notification immediately upon incident, with written report no later than three (3) business days of incident

E-mail or alternate format if approved by COR

COR

Incident Report B.3 (SOW), Incident Reporting

Verbal notification immediately upon incident, with written report no later than three (3) business days of incident

E-mail or alternate format if approved by COR

COR

Annual statement that vehicle operators are screened, trained and competent to safely transport patients

B.3 (SOW),

Ambulance Driver

Prior to beginning of each ordering period task order listed in B.3

(SOW), Period of

Performance

E-mail or alternate format if

Point of Contact Information

Veterans Transportation Service (VTS)

Omaha VAMC / 136A2

4101 Woolworth Avenue

Omaha, NE 68105

Phone: 402-995-4458

Required State Licensure

Contractor shall provide a copy of State of Nebraska Emergency Medical Services Advanced Life

Support (ALS) services license from Nebraska Department of Health and Human Services (DHHS).

Please refer to http://dhhs.ne.gov/publichealth/Licensure/Documents/EMSServiceRequirements.pdf)

Historical Data

The quantities listed below are estimates based on NWI historical data. Actual quantities on task orders issued against IDIQ contract could be equal to, greater than, or lesser than estimated quantities:

Contract

Line Item

Numbers

(CLIN)

Description

Estimated

Quantity

Over Five (5)

Years

0001, 1001, 2001, 3001, and 4001

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).

1500 trips

0002, 1002, 2002, 3002, and 4002

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).

2500 trips

0003, 1003, 2003, 3003, and 4003

Mileage: Transport beyond 40-mile radius; one way only (In addition to rate per trip in CLINs

0001 & 0002).

80,000 miles

0004, 1004, 2004, 3004, and 4004

Wait Time, billed on a ¼ the hourly rate quoted ** Note: Radiation Patients are automatically given 30 minutes.

60 quarter hours

0005, 1005, 2005, 3005, and 4005

Additional Attendant: When a second attendant is required for high acuity patients. 50 trips

0006, 1006, 2006, 3006, and 4006

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.

75 trips http://dhhs.ne.gov/publichealth/Licensure/Documents/EMSServiceRequirements.pdf

0007, 1007, 2007, 3007, and 4007

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.

50 trips

0008, 1008, 2008, 3008, and 4008

Urgent / Emergent Inter-Facility Ambulance Transport - Differences:

- Response within 15 minutes of request for transport

- No trip ticket required

- Between medical facilities within the Omaha

275 trips

Quality Assurance Surveillance Plan (QASP)

The contractor will be evaluated in accordance with the following:

PURPOSE:

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:

• What will be monitored?

• How monitoring will take place?

• Who will conduct the monitoring?

• How monitoring efforts and results will be documented?

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.

This QASP is a “living document” and the Government may review and revise it on a regular basis.

However, the Government shall coordinate changes with the contractor through contract modification.

Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

GOVERNMENT ROLES AND RESPONSIBILITIES:

The following personnel shall oversee and coordinate surveillance activities.

Contracting Officer (CO) – The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United

States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance

Contracting Officer’s Representative (COR) – The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.

PERFORMANCE STANDARDS:

The contractor is responsible for performance of ALL terms and conditions of the contract. CORs will provide contract progress reports quarterly to the CO reflecting performance on this plan and all other aspects of the resultant contract. The performance standards outlined in this QASP shall be used to determine the level of contractor performance in the elements defined.

Performance standards define desired services. The Government performs surveillance to determine the level of Contractor performance to these standards.

The Performance Requirements are listed below under “Performance Requirements”. The

Government shall use these standards to determine contractor performance and shall compare contractor performance to the standard and assign a rating. At the end of the performance period, these ratings will be used, in part, to establish the past performance of the contractor on the contract.

INCENTIVES/DEDUCTS:

The Government shall use past performance as incentives. Incentives shall be based on ratings received on the performance standards. This contract also includes monetary disincentives for non-compliance.

METHODS OF QA SURVEILLANCE:

Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP.

COR – RANDOM CHECKS: COR may, at any time, request copies of current licenses.

COR - RANDOM INSPECTION: Random inspection will be done throughout the month to ensure that ambulance is staffed with applicable personnel.

DIRECT OBSERVATION; COR REPORT: COR will review reports on a monthly basis.

INSPECTION – TIMELY INVOICES: The COR reviews the invoice through the VA Invoice Payment

Processing System (IPPS) to ensure that the invoice is timely and accurate.

PERFORMANCE REQUIREMENTS:

Measure

Performance

Requirement

Standard

Acceptable

Quality

Level

Surveillance

Method

Incentive Disincentive

Ambulances

Ambulances shall have current licenses and meet the requirements as outlined in the

Performance

Work

Statement.

Licensing and registration information kept current.

PASS /

FAIL

COR –

Random

Requests

Favorable contractor performance evaluation.

Unfavorable contractor performance evaluation.

If recurrent violations occur, this could result in contract termination.

Key

Personnel

Advanced Life

Support

Ambulance

(ALS)

Staffed with, a minimum, of one

Paramedic and an EMT.

PASS /

FAIL

COR -

Random

Inspection

Favorable contractor performance evaluation.

Unfavorable contractor evaluation occur, this could result in contract termination.

Measure

Performance

Requirement Standard

Acceptable

Quality

Level

Surveillance

Method Incentive Disincentive

Timeliness

Provide timely ambulance service

Provide timely ambulance service within 45 minutes after receiving a request for an order

PASS /

FAIL

Direct

Observation;

COR Report

Favorable contractor performance evaluation.

VA may contact another source to perform the service;

contractor will be charged with any excess cost which may result.

occur, this could result in contract termination.

Timely

Invoicing

Submitted within 30 days

Invoices to be submitted electronically within 30 days

PASS /

FAIL

VA Invoice

Payment

Processing

System

(IPPS)

Favorable contractor performance evaluation.

Unfavorable contractor evaluation

DOCUMENTING PERFORMANCE:

The Government shall document positive and/or negative performance. Any report may become a part of the supporting documentation for any contractual action and preparing annual past performance using

CONTRACTOR PERFORMANCE ASSESSMENT REPORT (CPAR).

If contractor performance does not meet the Acceptable Quality level, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and provide this to CO to place in the contract file.

When the COR and the CO determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to CO. The CO will in turn review and will present to the contractor's program manager for corrective action.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the CO. The Government shall review the contractor's corrective action plan to determine acceptability. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance and the acceptability of the Contractor’s corrective action plan.

Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

FREQUENCY OF MEASUREMENT:

Frequency of Measurement: The frequency of measurement is defined in the contract or otherwise in this document. The government (COR) will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

Frequency of Performance Reporting: The COR shall communicate with the contractor on a quarterly and semi-annual basis. Formal written reports, as outlined in the contract, will be submitted to the

Contracting Officer for review of contractor performance.

SECTION C - CONTRACT CLAUSES

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

ITEMS (JAN 2017)

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

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

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

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any

Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the

Contractor may not assign its rights to receive payment under this contract.

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

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR

52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

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

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

Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address…