36C26324Q0180.pdf

PAGE 1 OF 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER

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

636-24-2-2096-0002

36C26324Q0180

6. SOLICITATION ISSUE DATE

12-20-2023

Jesse Sweesy 605-347-2511 x16724 01-09-2024

10:00 CST

36C263

DEPARTMENT OF VETERANS AFFAIRS

NETWORK 23 CONTRACTING OFFICE

2101 North Elm Street Building 30 (04-S)

FARGO ND 58102

X

621910

$22.5 Million

N/A

X

36C636

DEPARTMENT OF VETERAN AFFAIRS

NWI VA HEALTHCARE SYSTEM

Omaha VAMC 4101 Woolworth Ave Omaha NE 68105

36C263

DEPARTMENT OF VETERANS AFFAIRS

NETWORK 23 CONTRACTING OFFICE

2101 North Elm Street Building 30 (04-S)

FARGO ND 58102

Y

DEPARTMENT OF VETERANS AFFAIRS

FINANCIAL SERVICES CENTER

FMS-VA-2 (101)

P.O. BOX 149971

AUSTIN TX 78714-9971

877-353-9791 512-460-5540

See CONTINUATION Page

NWI CBOC Non-Emergent Ambulance Services Base 4 Options Contractor to provide all Materials, Labor and Ambulance Transportation Services in accordance with the attached Statement of Work.

Wage Determinations apply to this procurement and are attached.

See CONTINUATION Page 636-3640160-2096-829800-2119-020041086 636-24-2-2096-0002

PO# TBD

X X

X 1

Jesse Sweesy

36C26324Q0180

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 STATEMENT OF WORK (SOW)

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

B.4 IT CONTRACT SECURITY

SECTION C - CONTRACT CLAUSES

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

AND COMMERCIAL SERVICES (NOV 2023)

C.2 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

C.3 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) ...40

C.4 SUPPLEMENTAL INSURANCE REQUIREMENTS

C.5 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV

2018)

C.6 VAAR 852.237-75 KEY PERSONNEL (OCT 2019)

C.7 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)

C.8 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.9 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT

STATUTES OR EXECUTIVE ORDERS—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2023)

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)

E.2 52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS

AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

E.4 52.216-1 TYPE OF CONTRACT (APR 1984)

E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)

E.6 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)

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

1998)

E.8 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL

SERVICES (NOV 2021)

ADDENDUM to 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

E.9 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—

COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2023)

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

2101 North Elm Street

Building 30 (04-S)

FARGO ND 58102

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

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 STATEMENT OF WORK (SOW)

Description of Requirement The intent is to establish an all-inclusive process to the greatest extent possible a fixed price per trip for routine ambulance transports. Specialty Care Transport (SCT) / Advanced Life Support (ALS) / Basic Life Support (BLS) Ground Ambulance Transport for VA Nebraska-Western Iowa (NWI) Health Care System based outside the area immediately surrounding the Omaha VA Medical Center (VAMC) which includes services to and from the Lincoln, Grand Island and other smaller NWI CBOCs.

Contractor shall provide SCT/ALS/BLS Ground Ambulance Transport outside the surrounding area of NWI’s Omaha VAMC which includes services to and from the Lincoln, Grand Island and other smaller NWI CBOCs. This includes transport to and from other medical facilities which at times may be long distance transports throughout Nebraska and surrounding states.

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 contract with 4 Options, Expected period of performance of 3-1-2024 to 2-28- 2029. Exercising an Option will be determined by the Government and is not guaranteed.

Option Period Period Begins Period Ends 1 3-1-2024 2-28-2025 2 3-1-2025 2-28-2026 3 3-1-2026 2-28-2027 4 3-1-2027 2-29-2028 5 3-1-2028 2-28-2029

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.

Emergency Medical Service (EMS) Requirements

1. The contractor shall provide all transport vehicles, personnel, management, supplies, transportation, fuel, equipment, reports, and anything else necessary to successfully furnish services.

2. Required State Licensure: Contractor shall maintain a State of Nebraska Emergency Medical Services Advanced Life Support (ALS) services license from Nebraska Department of Health and Human Services (DHHS), at: https://www.nebraska.gov/LISSearch/search.cgi https://www.nebraska.gov/LISSearch/search.cgi

3. Required Insurance: In addition to insurance requirement, the contractor’s Certificate of Insurance must 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.”

Onboarding of Contractor Staff

The onboarding process shall begin within five (5) business days from date of award when all required documents are electronically submitted (encrypted email) to the COR and/or designee. Documents shall be provided upon award to Contractor by CO and COR. Background checks of Contractor personnel are required under this contract.

1. Required Training Courses

Required training through the VA Talent Management System (TMS) at https://www.tms.va.gov/SecureAuth35/ is required; Contractor staff can create an account by going to this site and select ‘Create New Non-Employee User’. List the COR as their supervisor with the site of: Nebraska-Western Iowa.

The following courses, within five (5) business days of award, shall be completed by Contractor personnel and training certificates shall be e-mailed by Contractor to COR:

• VA 10203 - Privacy and Health Insurance Portability and Accountability Act (HIPAA)

Focused Training

• VA 10176 - VA Privacy and Information Security Awareness & Rules of Behavior

Training shall be done annually and kept current to maintain ability to continue providing services under this contract; contractor shall track and submit to COR.

2. In addition to TMS training certificates, the following filled-out documents will be emailed by

Contractor to COR:

• Contractor Rules of Behavior Form (VA Handbook 6500.6, Appendix D)

• OF 306, Declaration for Federal Employment

• Self Certification of Continuous Service

• Information Sheet with Sensitive Information like SSN, DOB, Place of Birth, Home Address, Phone & Personal Email, Citizenship, etc.

Requirements may change including the documents to meet these requirements. Contractor shall comply with the request for any additional documents should such a request be made. If copies of blank documents are needed, they may be provided to the Contractor by the COR.

https://www.tms.va.gov/SecureAuth35/

3. SAC – Fingerprints

Each contractor employee will need to be ‘sponsored’ by the COR to have their fingerprints taken. They will be provided with a piece of paper that they will need to bring with them and present to the PIV office staff at their appointment along with two forms of ID (list of acceptable forms of ID will be provided). Contract employee may be able to schedule themselves for an appointment or get assistance from the COR @ https://portal.usaccess.gsa.gov/scheduler/select-agency?v=20803 .

• Select ‘Department of Veterans Affairs’ in Agency/Organization dropdown.

• Select ‘Enrollment – Take photo and fingerprints, present ID documents’ Activity.

• Enter City: Omaha, State: Nebraska or Zip: 68105

• Select: ‘Omaha VA Medical Center’

• Then a calendar will appear – select any day that there is a green circle with a number in it.

• Select one of the ‘Available Times’

4. Background Investigations and Special Agreement Checks

Once the results of the fingerprints come back, a background investigation will be requested by the COR. All contractor employees are subject to the same level of investigation as VA employees who have access to VA Sensitive Information. The level of background investigation commensurate with the level of access needed to perform the statement of work is Tier 1 / NACI (National Agency Check with Inquiries). This requirement is applicable to all subcontractor personnel requiring the same access. Investigation will include a background questionnaire emailed directly to each contractor employee who will have to complete and respond as quickly as possible.

Upon award of the contract and completion of post-award conference, the CO will send Contractor background check guidance. Constant communication with the COR on each milestone met will help expedite this process.

EMT-Basic (EMT), EMT- Advanced (EMT-A), EMT-Intermediate (EMT-I) and Paramedic (EMT-P) Qualifications

1. 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.

2. EMTs and Paramedics shall provide a copy of their Nebraska EMT or Paramedic license prior to performing any service under the contract, within five (5) business days after post-award conference, upon re-certification and on an annual basis when the contract is renewed.

3. Contractor’s staff shall acquire training to maintain current certification. Continuing education will be at the expense of the individual or the contractor who hires them. Proof of re-certification shall be provided to the COR when attained and on an annual basis when the contract is renewed.

https://portal.usaccess.gsa.gov/scheduler/select-agency?v=20803 https://portal.usaccess.gsa.gov/scheduler/select-agency?v=20803

4. The contractor shall provide its employees with certified training for ventilator operations as there may be a need to transport a patient who is on a ventilation system.

5. All ambulance staff will always act and look professional. They should also behave and appear to be healthy – staff will not be allowed to transport Omaha VAMC beneficiaries if they appear to be ill or under the influence of drugs or alcohol. They will have a standard uniform with the company logo and a picture ID badge that clearly identifies the company they work for.

Ambulance Driver Qualifications

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. Contractor shall provide copy of ambulance driver license, driving records & training records to COR prior to assigning ambulance driver. The Contracting Officer Representative (COR) must conduct a review prior to the assignment of a new ambulance driver, when an accident has occurred, on an annual basis when the contract is renewed, 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.

3. The COR maintains ambulance driver license, driving record, training / continuing education, and insurance coverage for verification. Review of these documents is required for all newly assigned drivers and on an annual basis when the contract is renewed.

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. 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.

6. A qualified ambulance driver, other than the EMT or Paramedic, must also receive training on basic

First Aid, Cardiopulmonary Resuscitation (CPR), Bloodborne Pathogens, and the use of Personal Protective Equipment (PPE).

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.

Vehicle Requirements

1. Contractor shall always have available one (1) ALS and two (2) BLS ambulances to provide non-emergent transportation services for VA beneficiaries.

2. 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.

3. All ambulances must meet the minimum requirements:

a. The ambulances under the terms of this contract shall be registered and meet the minimum requirements as mandated by the rules and regulations governing ambulance registration 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.

b. Each ambulance and gurney shall be of a model and make to ensure safe and comfortable transport of patients and must have sufficient headroom to accommodate the patient in the Fowler’s position.

c. Ambulances and gurneys shall be equipped with such safety items as required by the rules and regulations governing ambulance licensure of the State of Nebraska. This includes mechanisms to secure the gurney to the ambulance structure as well as restraints on the gurney to safely secure the patient for transport.

d. Ambulances for the transport of patients must comply with state registration requirements for motor vehicle and must maintain at least the minimum insurance coverage. Compliance with the state requirements and insurance must be verified annually when the contract is renewed.

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

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

4. Maintenance by contractor:

a. Ambulances and gurneys must be inspected & maintained daily to assure mechanical fitness for public safety.

b. The contractor must maintain preventative maintenance records for all vehicles being used to provide services under the terms of this contract.

c. The contractor will not use vehicles that do not meet industry and regulatory standards, have safety or operational deficiencies to provide services under this contract.

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

Safety Requirements

1. 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.

2. Ambulance Drivers shall enforce the use of seat belts or safety restraint devices by all vehicle occupants.

3. Ambulance Drivers must not leave a vehicle running and unattended.

4. Ambulance Drivers are responsible for ensuring all equipment and cargo are 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).

5. All vehicles used for the transport of patients must contain emergency roadside and communication equipment – furnished by the contractor:

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

b. Cellular phones and two-way radios are acceptable communication equipment.

6. In the performance of this contract, it is expected that contract staff operate in a safe manner, taking reasonable safety precautions wherever possible to protect the lives and health of the occupants of the buildings and vehicles they operate around. If at any time, a safety concern is brought to the attention of the contractor by the CO and/or COR, it is expected to be corrected immediately. When corrected, it is no longer an issue but if the contractor fails or refuses to comply, the CO may issue an order stopping all and any part of the work, including legal remedies as stated in Section C.

7. The contractor shall immediately report all vehicle breakdowns or other problems, which may cause service disruptions to VA staff.

8. When a breakdown occurs, the contractor shall provide a back-up vehicle to minimize any delays or inconvenience to the customer(s).

9. When conditions, neither foreseeable and/or controllable by the contractor occur, such as severe storms, flooding, hazardous road and travel conditions, time and distance requirements shall be considered secondary to safety precautions.

10. Delays or exceptions to services shall be reported to VA staff as soon as possible.

Incident Reporting

1. Patient Incident / Accident

a. Any medical adverse event or change to the patient status will be reported to the COR or if after hours, the AODs verbally immediately following the event and then followed with a written notification (incident report) to the COR by the end of the next business day.

b. Any adverse event related to patient injury or other patient safety issues will be reported to the

COR or if after hours, the AODs verbally immediately following the event and then followed with a written notification (incident report) to the COR by the end of the next business day.

2. Vehicular Incident / Accident

a. Contractor shall report any vehicle accidents / incidents, regardless of severity, to the COR or if after hours, AODs verbally immediately with a formal accident report to the COR by the close of the next business day.

b. Contractor shall also provide a copy of the police report associated with the vehicle accident / incident during transport of a VA beneficiary to the COR as soon as it becomes available.

c. Written report shall describe all the facts surrounding the accident /incident and shall include the names, addresses, and telephone numbers of any witnesses.

d. Reporting is to be done regardless of the extent of damage to the vehicle or injury to the patient.

All accidents / incidents are to be reported.

Types of Required Transports

1. A0434 – Specialty Care Transport (SCT)

The ambulance will be staffed with at least one Paramedic (EMT-P) taking direct care of the patient and another EMT, Paramedic or qualified Ambulance Driver providing the transportation. A Specialty Care Transport (SCT) Ambulance is the interfacility transportation of a critically injured or ill beneficiary by a ground ambulance vehicle, including the provision of medically necessary supplies and services, at a level of service beyond the scope of the EMT-Paramedic. SCT is necessary when a beneficiary's condition requires ongoing care (such as being on ECMO), that must be furnished by one or more health professionals in an appropriate specialty area, for example, emergency or critical care nursing, emergency medicine, respiratory care, cardiovascular care, or an EMT-Paramedic with additional training. For this reason, the EMT-P will be accompanied by another medical professional from our facility to provide the necessary care needed during transport. The healthcare professional that rode along will be returned to our facility right after the transport is completed at no additional cost.

2. A0433 – Advanced Life Support, Level 2 (ALS 2) An Advanced Life Support (ALS) Ambulance will be staffed with at least one Emergency Medical Technician – Intermediate (EMT-I) or Paramedic (EMT-P) taking direct care of the patient and another EMT, Paramedic or qualified Ambulance Driver providing the transportation. Advanced Life Support, level 2 (ALS2) is the transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including (1) at least three separate administrations of one of more medications by intravenous (IV) push/bolus or by continuous infusion (excluding crystalloid fluids) or (2) ground ambulance transport, medically necessary supplies and services, and the provision of at least one of the ALS2 procedures listed below:

a. Manual defibrillation/cardioversion

b. Endotracheal intubation

c. Central venous line

d. Cardiac pacing

e. Chest decompression

f. Surgical airway

g. Intraosseous line

3. A0426 – Ambulance Service, Advanced Life Support, Non-Emergency Transport, Level 1 (ALS 1)

An Advanced Life Support (ALS) Ambulance will be staffed with at least one Emergency Medical Technician – Intermediate (EMT-I) or Paramedic (EMT-P) taking direct care of the patient and another EMT, Paramedic or qualified Ambulance Driver providing the transportation. Advanced Life Support, Level 1 (ALS1) is the transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including the provision of an ALS assessment by ALS personnel or at least one ALS intervention. An advanced life support (ALS) assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service. In the case of an appropriately dispatched ALS service, if the ALS crew completes an ALS Assessment, the services provided by the ambulance transportation service provider or supplier shall be covered at the ALS level, regardless of whether the patient required ALS intervention services during the transport.

4. A0428 – Ambulance Service, Basic Life Support, Non-Emergency Transport, (BLS)

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. Basic life support (BLS) is transportation by ground ambulance vehicle and the provision of medically necessary supplies and services, including BLS ambulance services.

Additional Required Services

1. A0420 – Ambulance Waiting Time (ALS or BLS), one half (1/2) hour increments

a. Fifteen (15) minutes of wait time is included for all transports. Any wait time more than 15 minutes will be reimbursed at the rate prescribed in the attached price/cost schedule.

b. The Contractor will contact VA staff as soon as they anticipate that a delay may develop for which they expect to claim reimbursement. This call will enable VA staff to assist locating, contacting or otherwise arranging patient transport is not further delayed.

2. A0422 – Ambulance (ALS or BLS) Oxygen & Oxygen supplies, life sustaining situation

3. A0424 – Extra Ambulance Attendant (ALS or BLS)

Ride Along - An additional “Attendant’ may be required to accompany ambulance crew during the transport of high acuity patients; either an EMT or a Paramedic may fill that requirement.

4. A0424 – Extra Ambulance Attendant (ALS or BLS) Lift Assist - Transport of a bariatric patient or moving a patient up and down stairs on a gurney, through yards, etc. requires more manpower for safe maneuvering of the gurney and thus the safety of the patient as well as the ambulance crew. This may require the need for Lift Assist which includes additional personnel to help move the patient. For this purpose, a second ambulance crew is dispatched to assist at the price quoted on the price/cost schedule attached and invoiced as a separate line item.

5. A0425 – Ground Mileage, Per Statute Mile

All loaded miles between the pickup and drop off locations. It is also permissible to pay unloaded miles to the pickup location if the pickup and drop off are other than the originating location.

(Example: Ambulance from Omaha goes to Kearney to bring patient to Grand Island VA and then back home again in Kearney – in this case, we would pay for the ‘unloaded’ trip from Omaha to Kearney as well).

6. A0999 – Unlisted Ambulance Service Trip Cancellation (Dry Run) - When ambulance service deploys for a trip and the patient refuses transport or due to unforeseen circumstances the patient is not able to travel, the contractor will be reimbursed for the trip at the rates applicable under the schedule portion of the contract.

Requesting Transport

1. NWI Veteran Transportation Service (VTS) staff and Administrative Officers of the Day (AODs) are designated to schedule patient pick-ups / drop offs.

2. Requests for transport will be made through a new program called VetRide. This is a VA sponsored program specifically designed for the scheduling, transportation, and invoicing of patient transport services. Our contractor will have to be given access to this nationally mandated program. The transport information will be loaded into the program and then staff will await an ‘accept’ or ‘reject’ status update. It is expected that the Contractor regularly monitor the VetRide website for updates, cancellations, or same day request submittals. It is expected that VA staff will provide a courtesy call for last minute requests and/or cancellations. During the transport, the trip status will require updates through the completion of the transport. At which point, the invoice can be created and submitted.

This program is very new and still in the developmental stages when this package was submitted for solicitation. This is how we anticipate and are being told it will work but understandably, there may be some variance in the process. The contractor who is awarded this contract may be required to accept changes to this process. If in the future, the use of VetRide changes, the contractor will have to be flexible and accept the replacement process as well.

3. There are 2 types of scheduling:

a. Scheduled in advance with an established / scheduled time of pick-up with an expected arrival for pick-up within 15 minutes of the established / scheduled time

b. Same Day requests with an expected response time of 45 minutes or an agreed upon time

4. If the contractor cannot meet the response time requirements set forth by this contract, they must notify VA staff as soon as possible, if not immediately, so that other arrangements may be made for the best care of our patients. If VA staff feel, for any reason, that services must be made elsewhere, they have the right to do so and will, in turn, notify the contractor. VA Staff (VTS or AODs) will be the sole judge in determining when to order services from another source.

5. Under no circumstances shall the contractor transport patients who call for their own transport.

Pick-Up and Delivery

1. Pick-up and delivery of patients at the Omaha VAMC shall be at the following locations:

Emergency Room entrance on west side of main facility, main facility front entrance (flag circle), ACC front entrance or entrance to Dialysis Center, building 9.

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 moved to an inpatient unit as directed by the AODs.

4. Patients will be safely secured to the gurney prior to movement. Patients must also be covered up for modesty and dignity purposes as well as appropriate covers for warmth during colder weather.

5. Transport of patient belongings will occasionally be required.

6. The contractor shall be held responsible for patient welfare as well as all patient and/or government property during transport. Any damaged or lost canes, walkers, crutches, prosthetic devices, or personal belongings will be replaced by the contractor at no additional cost to the government or patient. Although, contractors are not expected to transport wheelchairs or scooters.

7. Copies of patient’s medical records may need to be transported with the patient from facility to facility. Those records will be guarded according to HIPAA regulations.

8. Transport of Specimens

a. If the transfer of clinical specimens along with the patient is required, it must comply with HIPAA, DOT & OSHA regulations.

b. Clinical staff giving specimens to ambulance crew members 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.

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

9. Response time for unscheduled trips shall be agreed upon at the time transport is requested based on patient location and availability. Contractor shall pick up patient no later than 15 minutes after that agreed upon time. If the contractor cannot provide the services for any reason, they will immediately notify VA staff so other arrangements can be made.

10. In the event a patient’s condition worsens during transport the contractor shall transport the patient to the closest facility appropriate for the required care. Notification to VA staff should be made as soon as possible and the contractor may be requested to wait for update / outcome reporting as well as possible continuation of transportation.

11. In the event a patient should expire during transport the contractor shall return the patient to the

Omaha VAMC. That notification should also be made to VA staff as soon as possible.

12. No Idle Policy: At no time will the contractor leave vehicles on VA premises unless a pick-up or delivery is in process. Once the patient is secured either by Emergency Room personnel or secured in the transport vehicle, the vehicle will be removed from the Emergency Room exit door to prevent environmental hazards due to exhaust fumes.

13. Transport of a bariatric patient or moving a patient up and down stairs on a gurney, through yards, etc. requires more manpower for safe maneuvering of the gurney and thus the safety of the patient as well as the ambulance crew. This may require the need for Lift Assist which includes additional personnel to help move the patient. For this purpose, a second ambulance crew is dispatched to assist at the price quoted on the price/cost schedule attached and invoiced as a separate line item.

14. Number of Patients: It is understood and agreed that only one (1) patient will be transported on a trip unless specifically approved by authorized VA staff. VA staff 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.

15. Government Owned Equipment or Supplies: Except for intravenous administration pumps, the contractor shall not be permitted to borrow medical equipment from the VAMC facilities. The contractor shall provide all medications required while in transport as well as gurneys, sheets, blankets, and other equipment and supplies required for use while in transit for direct patient care. An exception will be made for medications which are outside the realm of what is carried in the vehicle and are case-specific to the patient’s needs. Contractor shall not, under any circumstances exchange supplies, equipment and or medications with the VAMC (except for intravenous administration pumps, as determined by the transporting facility). The prices quoted in the Price/Cost Schedule of this contract shall be inclusive of consumables used in transport. Upon approval by the facility where the patient is located and being transported from, the contractor will be allowed to transport the intravenous administration pumps that are delivering a fluid or medication to a patient during transfer.

The contractor shall return the pumps to the lending facility immediately after the completion of the transport.

Preparation of Invoices

1. All invoices for payment shall be submitted electronically through VetRide routinely and in a timely manner. A Health Care Finance Administration (HCFA) / Center for Medicare and Medicaid Services (CMS) -1500 for each patient’s transport will be submitted through VetRide. All the same areas on the HCFA required for submittal to an insurance company must also be filled out for submittal to the VA. Most of the information will come directly from the entered request for transport. In addition to the routine requirements, HCFA must include PO #, Run #, Pick-up and Drop-off locations. This program is very new and still in the developmental stages when this package was submitted for solicitation. This is how we anticipate and are being told it will work but understandably, there may be some variance in the process. The contractor who is awarded this contract may be required to accept changes to this process. If in the future, the use of VetRide changes, the contractor will have to be flexible and accept the replacement process as well.

2. A ‘trip’ is defined as a one-way transport. Pricing is established on a one way / per trip basis with additional line items to cover mileage.

3. 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.

4. Mileage will be reimbursed one way only and will be verified using Bing Maps. Contractor will list these charges separately on their invoice. All loaded miles between the pickup and drop off locations.

It is also permissible to pay unloaded miles to the pickup location if the pickup and drop off are other than the originating location. (Example: Ambulance from Grand Island goes to O’Neill to bring patient to Norfolk and then back home again in O’Neill – in this case, we would pay for the ‘unloaded’ trip from Grand Island to O’Neill as well).

5. Approved waiting time will be invoiced as a separate line item on the claim in ½ hour (30- minute) increments at the rate in his / her bid from the time the driver reports and gains approval for the wait.

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

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

Future Modification Nebraska-Western Iowa Healthcare System (NWIHCS) reserves the right to negotiate with the winning contractor to expand services and served locations or regions without further solicitation for the duration of the contract. The expansion of services or service locations and the associated costs must be clearly defined with a new quote from the vendor, pre-approval from facility leadership and fiscal, and with guidance and final written approval/modification from the assigned contracting officer.

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 other key personnel from NWI.

Subcontracting Plan IAW FAR 19.702 (a)(1), the awarded contractor shall provide, if large business, a subcontracting plan for Contracting Officer review no later than five (5) business days after post-award conference.

Deliverables Table

Item Section

Referenced Due By Format Provided To

Copies of EMT and Paramedic Licenses

B.3 (SOW), EMT,

EMT-A, EMT-I,

and Paramedic Qualifications

Five (5) business days after post-award conference & annually at the time of contract renewal.

E-mail or alternate format if approved by COR

COR

Subcontracting Plan

B.3 (SOW),

Subcontracting Plan

Five (5) business days after post-award conference

E-mail CO

Certificate of Insurance

B.3 (SOW),

Insurance Requirements

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

updated certificates 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

COR

Copy of Ambulance Driver License and Driving Records

B.3 (SOW),

Ambulance Driver

Prior to assigning ambulance driver to contract & annually at the time of contract renewal

E-mail or alternate format if approved by COR

Vehicle Accident Report

B.3 (SOW),

Incident Reporting

Verbal notification immediately upon incident, with written report no later than close of the next business day

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 close of the next business day

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 approved by COR

B.3 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

1.00 YR __________________ __________________

CBOC Non-Emergent Ground Ambulance Transport Services (02-29-24 to 02-28-25) Contract Period: Base POP Begin: 02-29-2024 POP End: 02-28-2025 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

Option Year 1 CBOC Non-Emergent Ground Ambulance Transport Services (03-01-25 to 02-28-26) Contract Period: Option 1 POP Begin: 03-01-2025 POP End: 02-28-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

Option Year 2 CBOC Non-Emergent Ground Ambulance Transport Services (03-01-26 to 02-28-27) Contract Period: Option 2 POP Begin: 03-01-2026 POP End: 02-28-2027 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

Option Year 3 CBOC Non-Emergent Ground Ambulance Transport Services (03-01-27 to 02-29-28) Contract Period: Option 3 POP Begin: 03-01-2027 POP End: 02-29-2028 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

Option Year 4 CBOC Non-Emergent Ground Ambulance Transport Services (03-01028 to 02-28-29) Contract Period: Option 4 POP Begin: 03-01-2028 POP End: 02-28-2029 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

GRAND TOTAL __________________

REQUIRED RECORDS MANAGEMENT LANGUAGE

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION (NARA) RECORDS MANAGEMENT

LANGUAGE FOR CONTRACTS

a. Citations to pertinent laws, codes, and regulations such as 44 U.S.C. Chapter 21, 29, 31 and 33; Freedom of Information Act (5 U.S.C. 552); Privacy Act (5 U.S.C. 552a); 36 CFR Part 1222 and Part 1228.

b. Contractor shall treat all deliverables under the contract as the property of the U.S. Government for which the Government Agency shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest.

c. Contractor shall not create or maintain any records that are not specifically tied to or authorized by the contract using Government ‘IT’ equipment and/or Government records.

d. Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected by the Freedom of Information Act.

e. Contractor shall not create or maintain any records containing any Government Agency records that are not specifically tied to or authorized by the contract.

f. The Government Agency owns the rights to all data/records produced as part of this contract.

g. The Government Agency owns the rights to all electronic information (electronic data, electronic information systems, electronic databases, etc.) and all supporting documentation created as part of this contract. Contractor must deliver sufficient technical documentation with all data deliverables to permit the agency to use the data.

h. Contractor agrees to comply with Federal and Agency records management policies, including those policies associated with the safeguarding of records covered by the Privacy Act of 1974. These policies include the preservation of all records created or received regardless of format [paper, electronic, etc.] or mode of transmission [e-mail, fax, etc.] or state of completion [draft, final, etc.].

i. No disposition of documents will be allowed without the prior written consent of the Contracting Officer.

The Agency and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. Records may not be removed from the legal custody of the Agency or destroyed without regard to the provisions of the agency records schedules.

j. Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under or relating to this contract. The Contractor (and any sub-contractor) is required to abide by Government and Agency guidance for protecting sensitive and proprietary information.

B.4 IT CONTRACT SECURITY

VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY

1. GENERAL

Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.

2. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS

a. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.

b. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.

c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.

d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.

e. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor's employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.

3. VA INFORMATION CUSTODIAL LANGUAGE

a. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1).

b. VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor's information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met.