36C26322Q0658.docx

36C26322Q0658

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

36C26322Q0658 06-14-2022 Don Gilbert 605-347-7030 06-22-2022 4pm

MDT

Department of Veterans Affairs Network 23 Contracting Office (NCO 23) 113 Comanche Rd.

Fort Meade

SD

57741 X 621910 $16.5 Million N/A X Department of Veterans Affairs St. Cloud VAMC 4801 Veterans Dr St Cloud

MN

56303 Department of Veterans Affairs Network 23 Contracting Office (NCO 23) 113 Comanche Rd.

Fort Meade

SD

57741

Department of Veterans Affairs

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin

TX

78714-9971 See CONTINUATION Page Provide Ambulance services per the Performance Work Statement (below) See Clause 52.212-1 (Addendum), Instructions to Offerors for directions to complete offer.

See CONTINUATION Page X X X Donald R. Gilbert

NCO231SL3-4302

Table of Contents

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 36C263 Department of Veterans Affairs Network 23 Contracting Office (NCO 23)

113 Comanche Rd.

Fort Meade SD 57741

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

3. INVOICES: Invoices shall be submitted in arrears:

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:

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

Provide Ambulance service for St. Cloud VAMC per the Performance Work Statement (PWS).

See Rate Table attached.

Contract Period: Base POP Begin: 07-01-2022 POP End: 06-30-2023 PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Provide Ambulance service for St. Cloud VAMC per the Performance Work Statement (PWS).

Contract Period: Option 1 POP Begin: 07-01-2023 POP End: 06-30-2024

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Provide Ambulance service for St. Cloud VAMC per the Performance Work Statement (PWS).

Contract Period: Option 2 POP Begin: 07-01-2024 POP End: 06-30-2025

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Provide Ambulance service for St. Cloud VAMC per the Performance Work Statement (PWS).

Contract Period: Option 3 POP Begin: 07-01-2025 POP End: 06-30-2026

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Provide Ambulance service for St. Cloud VAMC per the Performance Work Statement (PWS).

Contract Period: Option 4 POP Begin: 07-01-2026 POP End: 06-30-2027

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

B.3 RATE TABLE

BASE YEAR CLIN 0001

AMBULANCE SERVICES

Estimated Total Ambulance Services

OPTION YEAR ONE CLIN 1001

AMBULANCE SERVICES

Estimated

Ambulance Services

OPTION YEAR TWO CLIN 2001

AMBULANCE SERVICES

Estimated

Ambulance Services

OPTION YEAR THREE CLIN 3001

AMBULANCE SERVICES

Estimated

Ambulance Services

OPTION YEAR FOUR CLIN 4001

AMBULANCE SERVICES

Estimated

Ambulance Services

Page 1 of Page 1 of B.4 Performance Work Statement

ALS/BLS/CC-ALS Ground Ambulance

1. REQUIREMENTS

In accordance with standard industry practice furnish Basic Life Support (BLS) and Advanced Life Support (ALS) and/or Critical Care Advanced Life Support (CC-ALS) Ground Ambulance Services to authorized Department of Veterans Affairs beneficiaries in accordance with the specifications, terms and conditions of this Performance Work Statement (PWS).

The quantity of trips and mileages indicated in the Schedule of Items are estimated only and were based upon historical data for the twelve (12) month period of October through September 2016. The Government makes no guarantee that these estimates will become actual quantities of trips or mileages.

When scheduling, the mode of transportation, i.e., BLS, ALS, or CC-ALS, will be discussed and determined by the St. Cloud Veteran Affairs Medical Center (STCVAMC) clinical personnel. The Contractor will transport per its policies and standard industry practices. If mode of transport differs from what was agreed upon, vendor must submit documentation to STCVAMC explaining reasons for change.

b. The Contractor will have a medical director qualified for ambulance services, be Minnesota Emergency Medical Services Regulatory Board (EMSRB) certified, and multi-state certified; will be a physician who accepts responsibility for the quality of care provided during transport by drivers and attendants; provides standards for training and orientation of personnel; provides standards on upgrading and purchasing equipment; prescribes any standing orders for the provision of life support care; provides triage, treatment, and transporting protocols to ensure that patients requiring care are transported appropriately; assists with the development and operation of an internal quality assurance mechanism that includes a review of services provided; provides written procedures for the storage and administration of drugs; and provides written standards for medical equipment and supplies used to provide ambulance services.

VA reminds contractors of the Department of Labor Regulations which implement the SCLS and which read at 29 CFR § 4.155:

Employee coverage does not depend on form of employment contract. The Act, in section 8(b), makes it plain that the coverage of service employees depends on whether their work for the contractor or subcontractor on a covered contract is that of a service employee as defined in section 8(b) and not on any contractual relationship that may be alleged to exist between the contractor or subcontractor and such persons. In other words, any person, except those discussed in §4.156 below, who performs work called for by a contract or that portion of a contract subject to the Act is, per se, a service employee. Thus, for example, a person's status as an “owner-operator” or an “independent contractor” is immaterial in determining coverage under the Act and all such persons performing the work of service employees must be compensated in accordance with the Act's requirements.

References: 29 CFR § 4.155

5. ORDERS:

a. Requests for alteration of services will be made in writing or by telephone by the Contracting Officer or his/her designee at the VA Medical Center. VA must authorize any requested change of specialized transportation that differs from the original destination.

b. A copy of the Contracting Officer Representative (COR) designation will be furnished to the Contractor.

6. DRIVERS AND ATTENDANTS:

Contractor must provide service 7 days a week, 24 hours per day, including weekends and holidays, for the term of this contract.

10. REQUEST FOR SERVICES:

a. Request for services will be made in writing (facsmile, e-mail, mail) or by telephone by an authorized representative of the VA. When ordering services the VA shall provide the Contractor with the following type of information:

1. Mode of transportation required;

1. Required date and time of arrival;

1. Name of Beneficiary and last 4 digits of Social Security;

1. Pick-up and delivery point;

1. Type and number of additional medical care specialists required;

1. Any other special instructions;

d. The contractor shall, at all times during the contract period, have on his/her premises a functioning fax machine to communicate requirements with the VA (i.e., requests for service, patient incidents, special correspondence, etc.). Each contractor shall indicate if there is e-mail availability for their company to complete communications with the VA (use of this communication system will be mutually agreed upon after award of contract before any communications are completed in this manner). If the contractor’s place of business is located beyond the local telephone call zone of the VA (area code 320), the contractor shall install and provide to the VA, a toll free number for accepting the VA calls.

The Contractor shall establish and maintain a complete QCP to ensure the requirements of this contract are provided as specified. An original and one (1) copy of this QCP are due with the initial proposal. The Contractor’s QCP shall include the following at a minimum:

a. An inspection plan covering all services required by this contract. The inspection plan must specify the areas to be inspected on either a scheduled or unscheduled basis, how often inspections will be accomplished and documented, or the title of the individual(s) who will perform the inspections.

b. On-site records of all inspections conducted by the Contractor noting necessary corrective action taken. The Government reserves the right to request copies of any and/or each inspection.

c. Incorporation of either active or established internal policy and procedures for updating service protocols that may affect performance of contract.

d. The methods for identifying and preventing deficiencies in the quality of service performed, before the level of performance becomes unacceptable, and organizational functions noting intermediate supervisory responsibilities and overall management responsibilities for ensuring total acceptable performance.

e. On-site records of all vehicle maintenance and repairs performed on vehicles used in the performance of this contract. The methods of identifying and preventing vehicle breakdowns, and detailed procedure for alternative transportation of patients in the event of mechanical breakdown of vehicle.

f. On-site records identifying the character (background checks) and certifications of ongoing training of each employee performing services under this contract.

g. The methods of identifying and preventing radio communication breakdowns. A detailed procedure for alternative communications in the event of electronic and mechanical breakdown of vehicle two-way radios.

h. A log to account for all requests for service. The log shall indicate the date and time of service call, name of patient requiring services, designated pick-up and delivery points, actual time of arrival at pick-up and delivery points and actual waiting time at pick-up and delivery points, if waiting charges are claimed.

i. On-site records of any complaints or problems, with procedures taken to allow for corrections and/or elimination before effects caused interruption of performance of contract.

a. Contractor employees are expected to demonstrate the highest levels of professionalism and technical expertise at all times. Appearance, mannerisms and conduct of official duties will meet or exceed the expectations of professional paramedics / ambulance crews.

b. When transporting patients to or from medical facilities, the driver, acting for the Contractor, will ensure that patient’s luggage, medical records, medications, and prosthetic devices are properly accounted for and delivered with the patient as required.

END PERFORMANCE WORK STATEMENT

Page 1 of Page 1 of

B.5 Quality Assurance Surveillance Plan Ground Ambulance Services

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) is a Government developed and applied document used to make sure that systematic quality assurance methods are used in the administration of the Performance Based Service Contract (PBSC) standards included in this contract. The intent is to ensure that the Contractor performs in accordance with performance metrics set forth in the contract documents, that the Government receives the quality of services called for in the contract and that the Government only pays for the acceptable level of services received.

2. SCOPE

To fully understand the roles and the responsibilities of the parties, it is important to first define the distinction in terminology between the Quality Control Plan and the Quality Assurance Surveillance Plan. The Contractor, and not the Government, is responsible for management and quality control actions necessary to meet the quality standards set forth in the contract. The Contractor develops and submits his/her Quality Control Plan (QCP) for Government approval in compliance with his contract deliverables. Once accepted, the Contractor then uses the QCP to guide and to rigorously document the implementation of the required management and quality control actions to achieve the specified results. The QASP on the other hand, is put in place to provide Government surveillance oversight of the Contractor’s quality control efforts to assure that they are timely, effective and are delivering the results specified in the contract. The QASP is not a part of the contract nor is it intended to duplicate the Contractor’s QCP. The Government may provide the Contractor an information copy of the QASP as an Attachment to the solicitation to support the Contractor’s efforts in developing a QCP that will interrelate with the Government’s QASP.

3. GOVERNMENT RESOURCES/RESPONSIBILITIES

a. CONTRACTING OFFICER: The Contracting Officer (C.O.) ensures performance of all necessary actions for effective contracting, ensures compliance with the terms of the contract and safeguards the interests of the United States in the contractual relationship. It is the Contracting Officer that assures the Contractor receives impartial, fair, and equitable treatment under the contract. The Contracting Officer is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.

b. Contracting Officer’s Representative (COR) - The COR provides detailed technical oversight of the Contractor’s performance and reports his or her findings to the C.O. in a timely, complete and impartial fashion. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. Any changes that the Contractor deems may affect contract, price, terms, or conditions shall be referred to the Contracting Officer for action.

4. METHODS OF QA SURVEILLANCE

Various methods exist to monitor performance. The COR shall use the surveillance methods listed in the above matrix chart for the administration of this QASP.

a. PERIODIC INSPECTION (AUDITING). Evaluates outcomes on a periodic basis. Inspections may be scheduled [Daily, Weekly, Monthly, Quarterly, or annually] or unscheduled, as required.

b. VALIDATED USER/CUSTOMER COMPLAINTS. Relies on the patient to identify deficiencies. Complaints are then investigated and validated.

c. OBSERVATION and 100% INSPECTION. Evaluates all outcomes.

5. Performance Standards The Performance Requirements Summary in the Performance Work Statement (PWS), includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL), and determine incentives.

6. Incentives The Government shall use CPARs Evaluation Ratings (Excellent +) as incentives. Incentives shall be based on exceeding the satisfactory performance standards.

7. RATINGS

Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome.

Required Services (Tasks)

EXAMPLES:

Ground Ambulance Service

Certifications and Training

Submit Monthly Reports

Ambulance Maintenance/Safety

The vendor may write their own CPARs, subject to review and approval of the Contracting Officer for excellent service.

8. DOCUMENTING PERFORMANCE

a. ACCEPTABLE PERFORMANCE The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

b. UNACCEPTABLE PERFORMANCE When unacceptable performance occurs, 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 place it in the COR file. When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the Contractor's Program Manager. 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 COR. The Government shall review the Contractor's corrective action plan to determine acceptability. Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO.

c. EXCEPTIONAL PERFORMANCE The Government shall document exceptional performance. Any report may become a part of the supporting documentation for any contractual action. Incentives are then applicable.

FREQUENCY OF MEASUREMENT

a. Frequency of Measurement.

During contract performance, the COR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed.

b. Frequency of Performance Assessment Meetings.

The COR shall meet with the contractor semi-annually to assess performance and shall provide a written assessment.

**ALL PARTIES SHALL SIGN THIS DOCUMENT AFTER AWARD AND PRIOR TO PERFORMANCE**

Signature – Contractor Date:

Signature – Contracting Officer’s Representative Date:

Signature – Contracting Officer Date:

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2021)

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

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

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

(g) Invoice.

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

(i) Name and address of the Contractor;

(ii) Invoice date and number;

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

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

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

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

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

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

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

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

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

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

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

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

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

(i) Payment.—

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

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

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

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

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