36C26326Q0269 0001 wp.pdf

5. PROJECT NUMBER (if applicable)

CODE7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODECODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

0001 01-15-2026 36C263-26-AP-1119

36C26326Q0269

36C263

DEPARTMENT OF VETERANS AFFAIRS

NETWORK CONTRACTING OFFICE 23

1303 5TH STREET, SUITE 300

CORALVILLE IA 52241

DEPARTMENT OF VETERANS AFFAIRS

NETWORK CONTRACTING OFFICE 23

1303 5TH STREET, SUITE 300

CORALVILLE IA 52241

36C26326Q0269

X

X X

See CONTINUATION Page 636-3660162-5058-854200-3220-636-010055592 x 1

8th Floor Cook Exhaust Vent Replacement - NWI

To add pictures and specification of installation to solicitation 36C26326Q0269

The lift will need to be a 180’ capacity lift.

The staging area for the lift will be the parking lot near the warehouse.

The fan can only be replaced from the outside.

The fan is a 900 CFM fan.

Steve Hernandez Contracting Officer

CONTINUATION PAGE

Project Name: OMVA 8th Floor Cook Exhaust Vent Replacement Location of Services

VA Nebraska-Western Iowa Health Care System Omaha Division, 4101 Woolworth Avenue Omaha, Nebraska 68105

Contract Vehicle This statement of work for a firm fixed contract. As stated, this is a firm-fixed-price contract that provides for a price that is not subject to any adjustment based on the contractor’s cost experience in fulfilling the contract. This contract type places upon the contractor maximum risk and full responsibility for all costs and resulting profit or loss. It provides maximum incentive for the contractor to control costs and perform effectively and imposes a minimum administrative burden upon the contracting parties. Any questions regarding the SOW shall be provided to the contracting officer (CO) during the solicitation phase prior to award to prevent ambiguity and potential contractor loss due to misinterpretation of the SOW requirements.

Performance Work Statement Scope

Remove and properly dispose of the existing 900 cfm cook exhaust ventilator.

Supply and install newly provided 900 cfm Cook Exhaust Fan.

Provide and install all necessary piping, fittings, and components to reconnect the existing:

Equipment will need to be boom lifted in place.

Work to be performed on a scheduled weekend.

Performance Work Period of Performance 01/26/26 – 02/26/25

Work Hours Expected The contractor shall limit all patient, or staff impacts by phasing work during or after hours. Normal business hours are 0730-1600. If services provided do not impact on patients or staff services, work can be performed during normal business hours.

Questions on local facility impacts and work proposed by the contractor shall be directed to the contracting officer representative for approval of work to be performed during or after hours.

Kickoff Meeting The general contractor shall schedule a kickoff meeting no later than 5 business days following notice to proceed. At a minimum the local site COR and the contracting officer shall attend. The contractor shall provide an agenda in preparation of the meeting. The contractor shall take meeting minutes and shall email these notes to all parties included in the meeting invite. At a minimum the contractor shall provide the general contractor contact information that can be reached 24/7 as well as subcontractors, and any required onsite coordination for inspection, testing or deliveries during the duration of the period of performance, any hazards expected, preconstruction risk assessments where applicable and infection control risk assessments where applicable are applicable. At the discretion of the contracting officer (CO) in accordance with FAR 42.503-1 the action of establishing a time and place of the conference, agenda and summary may be delegated or taken on by the contracting officer who awarded the contract.

Certifications It is the expectation that all contractors meet the below qualifications. If contracted employees change from the proposal provided in the solicitation the general contractor shall provide credentials for VA review and approval prior to work.

General contractor shall provide one OSHA “Competent Person” (CP) to be physically present at all job sites. This individual shall be directly employed by the general contractor with authority to speak on behalf of the general contractor. This individual shall be capable of identifying existing and predictable hazards in the surroundings and working conditions which are unsanitary, hazardous or dangerous to employees, and who has the authorization to take prompt corrective measures to eliminate them (see 29 CFR 1926.32(f)). The prime contractor(s) are responsible for informing their subcontractors of the safety provisions under the terms of the contract and the penalties for noncompliance, coordinating the work to prevent one craft from interfering with or creating hazardous working conditions for other crafts, and inspecting subcontractor operations to ensure that Mishap prevention responsibilities are being carried out. This individual shall have a current OSHA 30 certification and provide no less than 3 years’ worth of job-related experience similar to that being asked in this contract.

Where work Qualified Persons shall as defined in NFPA 70, Article 100 have demonstrated skills and knowledge related to the construction and operation of electrical equipment and installations and received safety training to identify the hazards and reduce the associated risk. Training must be classroom, on-the-job or a combination of the two. The type and extent of training must be proportionate to the risk to the employee. The general contractor shall provide qualified persons that are licensed journeyman or master electricians for Nebraska. Licensure of each qualified person shall be provided as well as training certifications

HVAC technicians shall provide evidence of having met the qualifications of a qualified person above. Technicians shall provide EPA 608 technician certification. Technicians shall provide training certifications for the equipment involving servicing or shall provide NATE certification in its place.

General Requirements Should contractors work involve any of the below, the stated requirement shall be met.

All work shall comply with the most recent edition of USACE EM 385-1-1, comply with 29 CFR 1926, comply with 29 CFR 1910 as incorporated by reference within 29 CFR 1926, comply with ASSP A10.34, and all applicable federal, state, and local laws, ordinances, criteria, rules and regulations. Submit matters of interpretation of standards for resolution before starting work. Where the requirements of this specification, applicable laws, criteria, ordinances, regulations, and referenced documents vary, the most stringent requirements govern except with specific approval and acceptance.

All electrical work shall comply with VHA Directive 1028, NFPA 70 (NEC), NFPA 70B, NFPA 70E, 29 CFR Part 1910 Subpart J – General Environmental Controls, 29 CFR Part 1910 Subpart S – Electrical, and 29 CFR 1926 Subpart K.

All installation, maintenance, and servicing of equipment or machinery shall comply with 29 CFR 1910.147 except for specifically referenced operations in 29 CFR 1926

All hot work shall be safeguarded in accordance with NFPA 241 and NFPA 51B. Hot work permits shall be issued daily for work in accordance with local policy.

All confined space entry shall comply with 29 CFR 1926, Subpart AA except for specifically referenced operations in 29 CFR 1926.

All floor and wall openings shall comply with 29 CFR 1926 Subpart M and EM 385-1-1.

All crane work shall comply with 29 CFR 1926 Subpart CC and EM 385-1-1. Crane lift plans shall be reviewed and approved by the contracting officer representative prior to work

The fall protection (FP) threshold height requirement is 4ft for ALL WORK in government occupied sites, unless the OSHA 29 CFR 1926 or EM 385-1-1 requirements are more stringent. All work at or above this threshold shall meet OSHA or EM 385-1-1 whichever is more stringent.

The Contractor shall maintain free and unobstructed access to facility emergency services and for fire, police and other emergency response forces in accordance with

NFPA 241

Contractor shall follow OSHA standard 1926.405(a)(2)(i) when applicable which states temporary wiring shall be removed immediately upon completion of construction or the purpose for which the wiring was installed.

Government Furnished Property or Space The contractor will not be providing government furnished property. Contractor equipment shall be removed or approved on a case-by-case basis by the contracting officer representative. The government is not liable for theft or security of such equipment if approved.

The contractor will be responsible for keeping a reasonably clean (free of miscellaneous debris) working environment. Failure to do so on a continuous basis shall result in the contractor being back charged for cleaning services.

Job Hazard Analysis Shall any of the below hazards be expected or present themselves during the work, an activity hazard analysis also known as a job hazard analysis, job safety analyses and activity safety analyses shall be performed meeting all of the requirements from the below. Deviations will only be approved by the contracting officer.

Job Site Risks associated with the below

1) Emergency response;

2) Contingency for severe weather;

3) Fire Prevention;

4) Medical Support;

5) Posting of emergency telephone numbers;

6) Prevention of alcohol and drug abuse;

7) Site sanitation (housekeeping, drinking water, toilets);

8) Night operations and lighting;

9) Hazard communication program;

10) Welding/Cutting “Hot” work;

11) Electrical Safe Work Practices (Electrical LOTO/NFPA 70E);

12) General Electrical Safety;

13) Hazardous energy control (LOTO);

14) Site-Specific Fall Protection & Prevention;

15) Excavation/trenching;

16) Asbestos abatement;

17) Lead abatement;

18) Crane Critical lift;

19) Respiratory protection;

20) Health hazard control program;

21) Radiation Safety Program;

22) Abrasive blasting;

23) Heat/Cold Stress Monitoring;

24) Crystalline Silica Monitoring (Assessment);

25) Demolition plan (to include engineering survey);

26) Formwork and shoring erection and removal;

27) Pre-Cast Concrete;

28) Public (Mandatory compliance with ANSI/ASSP A10.34-2012);

29) Sub-contractor or cross-trade coordination;

Before beginning each work activity involving a type of work presenting hazards not experienced in previous project operations or where a new work crew or sub-contractor is to perform the work, the Contractor(s) performing that work activity shall prepare an AHA (Example electronic AHA forms can be found on the US Army Corps of Engineers web site)

AHAs shall define the activities being performed and identify the work sequences, the specific anticipated hazards, site conditions, equipment, materials, and the control measures to be implemented to eliminate or reduce each hazard to an acceptable level of risk.

Work shall not begin until the AHA for the work activity has been accepted by the Contracting Officer Representatives and discussed with all engaged in the activity, including the Contractor, subcontractor(s), and Government on-site representatives at preparatory and initial control phase meetings.

The names of the Competent/Qualified Person(s) required for a particular activity (for example, excavations, scaffolding, fall protection, other activities as specified by OSHA, EM 385-1-1, or other State and Local agencies) shall be identified and included in the AHA. Certification of their competency/qualification shall be submitted to the contracting officer representative for acceptance prior to the start of that work activity.

The AHA shall be reviewed and modified as necessary to address changing site conditions, operations, or change of competent/qualified person(s).

If more than one Competent/Qualified Person is used on the AHA activity, a list of names shall be submitted as an attachment to the AHA. Those listed must be Competent/Qualified for the type of work involved in the AHA and familiar with current site safety issues.

If a new Competent/Qualified Person (not on the original list) is added, the list shall be updated (an administrative action not requiring an updated AHA). The new person shall acknowledge in writing that he or she has reviewed the AHA and is familiar with current site safety issues.

Submit AHAs to the contracting officer, primary contracting officer representative and alternate contracting officer representative. Included with AHA’s for any electrical work shall include a contractor provided simplified one line diagram indicating all potential power sources and after work ensuring corrections to such diagram occur.

Preconstruction Risk Assessment / Infection Control Risk Assessment Contractors shall control all construction-associated hazards that affect VA medical facilities, their occupants, services and mission-essential functions and capabilities are critical in all medical center facilities.

Contractors shall ensure interior construction activities causing disturbance of existing dust, or creating new dust, must be conducted within ventilation-controlled areas that minimize the flow of airborne particles into patient areas.

Contractor shall ensure compliance VHA 7715 and post a copy of the latest PCRA and ICRA forms at all jobs sites found at

VHA PCRA: http://vaww.hefp.va.gov/resources/vha-pre-construction-risk-assessment-pcra

VHA ICRA: http://vaww.hefp.va.gov/resources/vha-infection-control-risk-assessment-icra

VHA-PCRAs and ICRAs will be re-validated and updated as needed based on but not limited to changes from affected individuals, areas/locations, scope, contractor means and methods, safety requirements, phasing, contractor competencies and capabilities.

The COR with concurrence from a VHA infection control specialist, VHA patient safety and VHA occupational health and safety officer will have ultimate decision on activity type and the level of precautions the contract needs to take.

Deliverables The contractor shall provide inspection and testing documentation no later than 7 business days following the onsite services. At a minimum they shall provide the manufacturer’s recommendations, the service performed, the results of such service and the technician who performed the work. This is to include the contractor’s failure to report clearly and precisely the above requirements. Documents shall be provided in a pdf form with standardized labeling to include the equipment with unique model numbers, location, frequency period, general description of inspection or maintenance performed.

Schedule The contractor shall provide a schedule to meet each aspect covered in the performance work statement NLT 10 calendar days from notice to proceed. Changes to this schedule shall be communicated to the Contracting Officer, primary and alternate contracting officer representatives immediately.

Due to the continuous operations of the hospital and sensitive populations served, all equipment or utility outages shall be communicated to the contracting officer, primary and alternate COR for VA approval. The contractor shall build time for the VA to receive adequate approvals for such outages into their schedule and be prepared to work outside of normal business hours to accomplish any outages to limit impact to the patients, staff and visitors of the NWIHCS.

Contracting Officer Authority Only contracting officers, acting within the scope of their authority, are able to bind the government by entering, administering, or terminating contracts, as well as making related determinations and findings. The contracting officer is also responsible for ensuring that all laws, executive orders, regulations, and other applicable procedures have been followed in addition, contracting officers are expected to take the lead in encouraging business process innovations and ensuring that business decisions are sound.

Site Security In accordance with FAR 52.204-9 and VA Directive 0735 – Personal Identity Verification of Federal Employees and Contractors, any contract person who requires routine physical access to a Federally-controlled facility and/or routine access to a Federally-controlled information system will be required to verify their identity prior to providing services under the contract. Prior to providing services under the contract, each contract person will be asked to provide two (2) forms of identification from the Accepted Identification Documentation List to the appropriate VA representative to obtain a proper VA-issued identification card (PIV badge). No work onsite shall ensue without the issuance of a VA PIV badge or internal escorting. Contractor is expected to build lead times for PIV issuance into schedules. The general contractor shall be onsite for any subcontractors who do not have a PIV card issued to them for the duration of the subcontractor’s work including escorting subcontractors. The prime contractor shall check in all subcontractors prior to performing work each day in the engineering office space.

Failure to Perform The contractor may receive termination based on failure to perform The following criteria apply for determining appropriate action:

Notifications. Consistent with FAR Part 49, the contracting officer shall notify the service provider of failure to meet standards through QA monitoring forms, cure notices, or show cause notices and shall inform the service provider manager or designated alternate of such notices.

Termination. If the contracting officer determines that the contractor has failed to perform to the extent that a termination for default is justified, the contracting officer shall issue a notice of termination, consistent with FAR Part 49.

Attachment 1: Performance Requirements Summary (PRS)

Required Services Performance Standards AQL Method of Surveillance Disincentive

Work Management submit reports within time window specified in deliverables section of PWS in a format that meets the minimum requirements

Files review, periodic and random observations, complaints

$1000 for each documented instance, $500 for each week uncorrected

Administrative Services Ensure visitor log entries are complete, and 100 Files review, periodic and $1000 for each documented instance

Facilities Services

Test, certify, inspect and/or service equipment listed in PWS as required per manufacturer's recommendations or regulations stated in the

PWS

Files review, periodic and random observations, complaints

$1000 for each documented instance, $500 for each week uncorrected

National Archives and Records Administration (NARA) Records Management Language for Contracts RECORDS MANAGEMENT

OBLIGATIONS

Applicability This clause applies to all Contractors whose employees create, work with, or otherwise handle Federal records, as defined in Section B, regardless of the medium in which the record exists.

Definitions “Federal record” as defined in 44 U.S.C. § 3301, includes all recorded information, regardless of form or characteristics, made or received by a Federal agency under Federal law or in connection with the transaction of public business and preserved or appropriate for preservation by that agency or its legitimate successor as evidence of the organization, functions, policies, decisions, procedures, operations, or other activities of the United States Government or because of the informational value of data in them.

The term Federal record:

includes Department of Veteran Affairs records.

does not include personal materials.

applies to records created, received, or maintained by Contractors pursuant to their Department of Veteran Affairs contract.

may include deliverables and documentation associated with deliverables.

Requirements Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a).

These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created while performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

Department of Veteran Affairs and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation.

Records may not be removed from the legal custody of Department of Veteran Affairs or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to Department of Veteran Affairs. The agency must report promptly to NARA in accordance with 36 CFR 1230.

The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the contract action.

The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to Department of Veteran Affairs control, or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the contract action. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

The 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, contracts. The Contractor (and any sub-contractor) is required to abide by Government and Department of Veteran Affairs guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with Department of Veteran Affairs policy.

The Contractor shall not create or maintain any records containing any non-public Department of Veteran Affairs information that are not specifically tied to or authorized by the contract.

The 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 from public disclosure by an exemption to the Freedom of Information Act.

The Department of Veteran Affairs owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S.

Government for which Department of Veteran Affairs shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

8303 Exhaust Fan Window Pic