75H70522R00008.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

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

OFFEROR

IHSCASSLAKE CODE 16. ADMINISTERED BYCODE

X

X

621210

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR235

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

05/31/2022 1300 CT

05/04/2022

218-444-0482TAMMY SHUMATE

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70522R00008

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 45IHS1446737OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

CASS LAKE MN 56633

425 7TH STREET NW

IHSCASSLAKE

15. DELIVER TO

Bemidji MN 56601 2225 Cooperative Ct NW, Rm 200

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$8.00

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

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

COMPLETE PROPOSAL IN ACCORDANCE WITH SOLICITATION

INSTRUCTIONS HEREIN

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

WILLIAM F. FISHER

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

100% IEE SET ASIDE

SECTION A

A.1 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SECTION B - CONTINUATION BLOCK

B.1 CONTRACT ADMINISTRATION DATA

B.2 INVOICES

B.3 PAYMENT

B.4 CONTRACTING OFFICER REPRESENTATIVE (COR)

B.5 PLACE OF PERFORMANCE

B.6 PERIOD OF PERFORMANCE

B.7 SCHEDULE OF PRICE/COST (ATTACHMENT 4 BID SCHEDULE 43-44)

B.8 PERFORMANCE WORK STATEMENT 6-23

B.9 COMPLIANCE

SECTION C - CONTRACT CLAUSES

C.1 FEDERAL ACQUISITION REGULATIONS

C.2 DEPARTMENT OF HEALTH AND HUMAN SERVICES ACQUISITION REGULATION

(HHSAR) (48 CFR CHAPTER 3) CLAUSES

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 APPLICABLE DOCUMENTS

D.2 DEFINITIONS

D.3 BACKGROUND INVESTIGATION

D.4 SECURITY NOTICE

D.5 WAGE DETERMINATION

D.6. ATTACHMENT 1 - IHS IEE REPRESENTATION FORM 35

D.7 ATTACHMENT 2 - BUSINESS ASSOCIATES AGREEMENT 36-42

D.8 ATTACHMENT 3 - BID SCHEDULE 43-44

D.9 ATTACHMENT 4 - INSTRUCTION TO OFFERORS 45

SECTION E – SOLICITATION PROVISIONS

52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS (IBR)

52.212-2 EVALUATION – COMMERCIAL ITEMS

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS – COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES

75H70522R00008

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 CONTRACT ADMINISTRATION DATA

Contract Administration: All contract administration matters will be handled by the following individuals:

CONTRACTOR NAME AND ADDRESS:

TAX ID#_______________________

SAM UEI #________________________

GSA #(if applicable) _________________________

Phone_________________________

E-Mail ________________________

Person responsible for Contractor Performance Assessment Reporting System (CPARS), reporting if different from above:

Name:

Title:

Email:

CONTRACTOR REGISTRATION: All required information must be in the System for Award Management (SAM) at www.sam.gov.

GOVERNMENT:

Tammy Shumate Indian Health Service 2225 Cooperative Ct NW, Rm 200 Bemidji, MN 56601 Tammy.Shumate@IHS.gov

NAICS:

The associated North American Industrial Classification System (NAICS) code for this procurement is 621210 Office of Dentist with a small business size standard of $8.0M.

PSC: Q503 Medical - Dentistry

CONTRACT TYPE: FIRM FIXED PRICE

Period of Performance: Base year plus four (4) one-year options

75H70522R00008 http://www.sam.gov/

B.2 INVOICES: In accordance with the Prompt Payment Act, payment will be due 15 days after receipt of services or receipt of a proper invoice, whichever is later.

INVOICE INSTRUCTIONS:

Invoices shall be VOID of protected information such as PII / PHI and vendor banking data. Invoice which contain protected information must be submitted to the Government through a secure data exchange network or physically mailed.

Contractor shall provide all invoices to – BEM_AOInvoices@ihs.gov and Kami.wooldridge@ihs.gov

Cass Lake Indian Health Service ATTN: Kami Wooldridge Cass Lake Indian Health Service 425 7th St NW Cass Lake, MN 56633 Email: kami.wooldridge@ihs.gov

At a minimum, a properly prepared invoice shall include:

1) Name and address of the Contractor: Company Name:

Address:

POC Name:

Phone:

E-mail:

CAGE:

FSS Contract # (If applicable):

2) Invoice date and invoice number. (The Contractor should date invoices as close as possible to the date of the mailing or transmission.)

3) IHS Contract No: TBD

4) Description, quantity, unit of measure, unit price, and extended price of supplies delivered or services performed.

5) Shipping and payment terms (e.g., shipment number and date of shipment, discount for prompt payment terms). Bill of lading number and weight of shipment will be shown for shipments on Government bills of lading.

6) Name and address of Contractor official to whom payment is to be sent (must be the same as that in the contract or in a proper notice of assignment).

7) Name (where practicable), title, phone number, and mailing address of person to notify in the event of a defective invoice.

8) Contractor Taxpayer Identification Number (TIN).

9) Contractor SAM Unique Entity ID (UEI) formerly (DUNS).

** TIN & UEI shall be the same numbers used to create the company www.sam.gov registration**

Improperly prepared invoices or statements shall be returned to the contractor and may delay payment.

B.3 PAYMENT

a) The IHS Bemidji Division of Finance is designated for payment processing. Payment shall be made by electronic funds transfer (EFT). Payment shall be made in arrears.

b) The Contractor’s rate identified for services described herein is considered as an all-inclusive rate. All-inclusive is defined to include but is not limited to services, travel, lodging, liability insurance, fringe benefits, federal, state and local taxes, and all other costs pertinent to the performance of this contract.

B.4 CONTRACTING OFFICER REPRESENTATIVE (COR)

75H70522R00008 mailto:BEM_AOInvoices@ihs.gov

The role of program and technical personnel in monitoring the contract is to assist and advise the Contracting Officer, and act as the COR when so designated by the Contracting Officer. The COR does not have the authority to change or alter the order amount, terms and conditions.

COR activities include—

1. Providing technical monitoring during contract performance and advising the Contracting Officer relating to delivery, acceptance, or rejection of deliverables in accordance with the terms of the contract;

2. Assessing contractor performance

3. Recommending necessary changes to the schedule of work and period of performance to accomplish the objectives of the contract (The COR shall provide the Contracting Officer a written request along with an appropriate justification and a funding document, if additional funds are needed.);

4. Reviewing invoices/vouchers and recommending approval/disapproval by the Contracting Officer, including providing comments regarding anything unusual discovered in the review;

5. Reviewing and recommending approval or disapproval of technical submissions, subcontractors, overtime, travel, and key personnel changes;

6. Assisting the Contractor in the resolution of technical problems encountered during performance; and

7. Participating, as necessary, in various phases of the contract closeout process;

8. Provide receiving authorization within two days of services/items received or invoiced

CONTRACTING OFFICER REPRESENTATIVE (COR):

Kami Wooldridge Kami.wooldridge@ihs.gov

B.5 PLACE OF PERFORMANCE: CASS LAKE INDIAN HOSPITAL

Cass Lake Indian Hospital 425 7th St NW Cass Lake, MN 56633-3360

B.6 PERIOD OF PERFORMANCE: Base plus Four (4) One-Year Options

B.7 SCHEDULE OF PRICE /COSTS

The quantities in the Schedule are for pricing purposes and basis for evaluation for award. The Government will be issuing a base plus 4 one-year option contract for up to 4 full time and 2 part time (1/2 time and 1/4 time) Dental Assistants.

a. PRICING: Utilize Attachment 3 Bid Schedule or Contractor provided quotation

b. PURPOSE OF CONTRACT:

The Bemidji Area Indian Health Service (BAIHS) depends on contracting outside resources with a wide range of expertise in order to provide services not readily available within IHS. This firm-fixed priced Base plus four (4) one-year option contract shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform the duties of Dental Assistants as defined in this Performance Work Statement (PWS), except for those items specified as government furnished property and services

75H70522R00008 mailto:Kami.wooldridge@ihs.gov

B.8 PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT (PWS)

Dental Assistants Cass Lake Indian Health Service

PART 1

GENERAL INFORMATION

1. GENERAL

This is a non-personnel services contract to provide Dental Assistants. The Government shall not exercise any supervision or control over the Contracted Dental Assistants performing the services herein. Such Contracted Dental Assistants shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform the duties of Dental Assistants as defined in this Performance Work Statement (PWS), except for those items specified as government furnished property and services. The Contractor shall perform to the standards in this contract.

1.2 Background: The Mission statement for Cass Lake Hospital is “Working together to promote health and well-being is the mission of the Cass Lake Indian Hospital and Clinic”. To meet this mission, the Cass Lake Indian Health Service Unit has identified a need for a non-personal service contract for providing dental services.

1.3 Objectives: The Contracted Dental Assistants agree to provide all necessary covered services within the Dental Assistants’ scope of practice, under the direction of the Dental Assistant Supervisor or designee.

• The Contracted Dental Assistants shall provide a full scope of dental assisting services including: chairside dental assisting, operatory set-up and break down, instrument pre-cleaning, and operatory/equipment/supply disinfection at the Cass Lake Indian Health Service Unit.

• The Contracted Dental Assistants shall provide a full scope of direct patient care services including: sealants, temporary fillings, prophies, fluoride treatments, silver ion antimicrobial treatments, x-rays, patient triaging, and patient education at Cass Lake Indian Health Service Unit.

• The Contracted Dental Assistants shall provide a full scope of clinical documentation services including charting, documentation in the electronic dental record at Cass Lake Indian Health Service Unit.

1.4 Scope: Assist with provision of dental services. Services include providing direct care to patients of all ages with a variety of medical conditions. The Contractor shall accomplish dental services provided by the Contracted Dental Assistants and shall be as comprehensive as the Indian Health Service supplied facilities, equipment, and support services permit.

The contract resulting from this solicitation shall:

1. Be a non-personal services contract under which the Contractor is an independent contractor;

2. Require the Contractor to promptly provide all requested information to allow for proper background checks;

3. Allow the Government to evaluate the quality of professionalism and the quality of care services provided;

4. Require the Contractor to cover the Government for any liability producing act of omission by the Contractor, its employees and agents occurring during contract performance;

5. Require the Contractor to maintain liability insurance, in the coverage amount acceptable to the Contracting

Officer, which is not less than the amount normally prevailing with the local community;

6. Candidates with pending dental assistant licensure, certification, or registration actions are not eligible for employment with this agency.

1.5 Period of Performance: The Period of Performance shall be listed on the Task Order as scheduled with the Dental Assistant Supervisor or designated representative. The Contracted Dental Assistant shall provide dental services for the entire Period of Performance at the Cass Lake Indian Hospital and Cass Lake Indian Hospital outreach sites.

Outreach sites include local Head Start Programs and local schools. The usual work day will be from 7:00 AM to 3:30 PM Monday - Friday.

1.6 General Information:

1.6.1 Quality Control: The Contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The Contractor’s quality control program (QCP) is the means by which he assures himself that his work complies with the requirement of the contract. The QCP is to be delivered within 30 days after contract award or with the Contractor’s proposal if it is an evaluation factor. Three copies of a comprehensive written QCP shall be submitted to the Contract Officer (CO) and Contracting Officer Representative (COR) within five working days when changes are made thereafter. After acceptance of the quality control plan, the Contractor shall receive the Contracting Officer’s acceptance in writing of any proposed change to his quality control (QC) system.

1.6.2 Quality Assurance: The Government shall evaluate the Contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the Contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: The Contracted Dental Assistant will not work on federal government holidays, as depicted on schedules provided upon issuance of Task Order.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Juneteenth Christmas Day Independence Day

1.6.4 Hours of Operation: The contract manager, or alternate, shall be available Monday – Friday 8 AM – 4 PM for administrative concerns. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at Cass Lake Indian Hospital, which is an Indian Health Service government facility.

1.6.6 Type of Contract: The Government will award a firm-fixed price, non-personal service contract.

1.6.7 Security Requirements: The Contracted Dental Assistants is subject to a background investigation and shall comply with Section 231 of the Crime Control Act of 1990, P.L. 101-647; and the Indian Child Protection and Family Violence Prevention Act, P.L. 101-630. In addition, the Dental Assistants shall also comply with the Privacy Act of 1974 and the HIPPA Act of 1996. Failure to comply with these statutes will result in immediate removal.

Contracted personnel performing work under this contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act” P.L. 101-630. The Indian Health Service Personnel Office will conduct these investigations following award of a contract unless in the judgment of the Contracting Officer, in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individual shall not have unsupervised contact with Indian children. Contracted Dental Assistants will need to be accompanied by a chaperone until investigation is complete.

The Contracting Officer has the authority to temporarily waive the character investigation of a contracted personnel. The “Agreement to a Temporary Waiver of Character Investigation” (See Attachment B) authorizes an agency to hire contracted personnel prior to the completion of a background check provided that, at all times, the contracted personnel is within the sight and under the supervision of a government employee who has successfully completed the National Agency Check with written Inquiries (NACI).

This level of security is required, and must be maintained for the life of the contract.

1.6.7.1 Physical Security: The Contracted Dental Assistants shall be responsible for safeguarding all government equipment, information and property provided for Contracted Dental Assistant use. At the close of each work period, government facilities, equipment, and materials shall be secured. The Contracted Dental Assistants shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with Indian Health Service regulations, facility policy and in accordance with HIPPA. The Contracted Dental Assistants shall prepare all medical records documentation to meet or exceed the established standards of the IHS facility to include, but not be limited to: timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

1.6.7.2 Key Control: The Contractor shall establish and implement methods of making sure all keys/key cards issued to the contracted personnel by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the contracted personnel by the Government shall be duplicated.

The Contractor shall develop procedures covering key control that shall be included in the Quality Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Contracting Officer.

1.6.7.2.1. In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

1.6.7.2.2. The Contractor shall prohibit the use of government issued keys/key cards by any persons other than the Contractor’s employees. The Contractor shall prohibit the opening of locked areas by contracted personnel to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.6.8 Special Qualifications: Contracted Dental Assistants must meet at least one of the following qualifications:

a) Experience + Dental Radiology = 6 months experience as a dental assistant and has a dental radiology certificate or certification

b) Military Training Program + Dental Radiology = Completed a military dental assisting training program and has a dental radiology certificate or certification

c) Graduate of Dental Assisting Program = Graduated from a CODA accredited, one year dental assisting degree program that issues a dental assisting degree or certificate

d) National Registration (RDA) = Achieved and maintains registered dental assistant certification through AMT

e) State Registration (RDA) = Achieved and maintains dental assisting registration from any of the 50 United States or the Commonwealth of Puerto Rico

f) Certification (CDA) = Achieved and maintains DANB certification

g) State Licensure (LDA) = Maintains a current, unrestricted state dental assisting license from any of the 50 United States or the Commonwealth of Puerto Rico

Licensure, certification, or registration are preferred. It is a condition of this contract that all qualifying registrations, certifications, and/or licensures remain current during the life of this contract.

Must also possess current (BLS) Basic Life Support certification or certificate.

The Contractor is responsible for ensuring the Contracted Dental Assistant shall:

a) Not have any work or health restrictions which interfere with the performance within the dental department

b) Have skill and knowledge in providing dental assistant services with full consideration of the mental, emotional, physical, and cultural factors involved, such that he/she can relate constructively to patients from the Native American community.

c) Ability to work with patients, the public, and hospital staff.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other government personnel, as appropriate, may meet periodically with the Contractor to review the Contractor's performance. At these meetings the Contracting Officer will apprise the Contractor of how the Government views the Contractor's performance and the Contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the Government.

1.6.10 Contracting Officer Representative (COR): The COR will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of contracted personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.11 Key Personnel: The follow personnel are considered key personnel by the Government:

Anna Woods, Deputy Dental Director and Dental Assistant Supervisor

Brandy Larson, Dental Director

Jennifer Richardson, Contracting Specialist

Kami Woodbridge, COR II

The Contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the Contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the Contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available at all times for administrative reasons.

1.6.12 Identification of Contractor Employees: All contracted personnel attending meetings, answering government telephones, and working in other situations where their contracted personnel status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contracted personnel products or that contracted personnel participation is appropriately disclosed. The contracted personnel will be required to obtain and wear badges in the performance of this service.

1.6.13 Contractor Travel: The Contractor shall be responsible for arranging travel and all associated costs related to the performance of this contract.

1.6.14 Other Direct Costs: The Contractor shall be responsible for arranging travel, lodging, per diem, labor, fringe benefits, and any applicable Federal, State, and Local taxes, plus any other costs pertinent to the performance of this contract.

1.6.15 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the Contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other government rights.

1.6.16 Organizational Conflict of Interest: Contracted and subcontracted personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart

9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS

2.1. DEFINITIONS:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER (CO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of government property.

2.1.8. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.12. WORK WEEK. As specified otherwise.

2.2. ACRONYMS:

ACOR Alternate Contracting Officer's Representative AFARS Army Federal Acquisition Regulation Supplement AMT American Medical Technologists Association BLS Basic Life Support CCE Contracting Center of Excellence CDA Certified Dental Assistant (from DANB) CDC Center for Disease Control & Prevention (Dept. of Health & Human Services) CFR Code of Federal Regulations CMS Centers for Medicare and Medicaid Services CODA Commission on Dental Accreditation CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTR Contracting Officer's Technical Representative COTS Commercial-Off-the-Shelf IHS Indian Health Service DANB Dental Assistant National Board DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense FAR Federal Acquisition Regulation HBSAB Hepatitis B Surface Antibody HCW Healthcare Worker HHS US Department of Health and Human Services

HIPAA Health Insurance Portability and Accountability Act of 1996 IHS Indian Health Service KO Contracting Officer LDA Licensed Dental Assistant (issued by a state or Puerto Rico) MMR Measles, Mumps, Rubella vaccine NEDLA National Entry Level Dental Assistant Certification (from DANB) OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs OSAP Organization for Safety, Asepsis and Prevention OSHA Occupational Safety and Health Administration (US Dept. of Labor) PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program RDA Registered Dental Assistant (nationally from AMT or by state dental board) TBST Tuberculosis Skin Test TE Technical Exhibit Tdap Tetanus Toxoid, Reduced Diphtheria Toxid, Acellular Pertussis vaccine

PWS PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

This section identifies those items such as property, information and/or services that will be provided for the Contractor’s use (without cost to the Contractor) to allow them to provide the required dental services, such as materials, facilities, training, etc. Examples provided below.

3. GOVERNMENT FURNISHED ITEMS AND SERVICES

3.1. Services: The Government will provide personnel to assist with orientation and guidance to the Indian Health Service and its requirements.

3.2 Facilities: The Government will provide the necessary workspace for the contractor staff to provide the support outlined in the PWS to include desk space, telephones, computers, and other items necessary to maintain an office environment for dental services.

3.3 Utilities: The Government will provide all utilities in the facility will be available for the contractor’s use in performance of tasks outlined in this PWS. If utilities are furnished, the following is required: The Contractor shall instruct employees in utilities conservation practices. The Contractor shall be responsible for operating under conditions that preclude the waste of utilities.

3.4 Equipment: The Government will provide equipment and/or what the Contractor will have access to, i.e., computer, phone, scanners, fax machines, printers, shipping crates, lighting and sound, etc.

3.5 Materials: The Government will provide materials, i.e., Standard Operating Procedures (SOPs), policies, and medical supplies and equipment to perform duties.

PWS PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES

4.1 General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS.

4.2 Verification of Licensure, Certification, Certificates, Degrees, or Registration

To ensure that Dental Assistants providing services under this contract are properly qualified and that the IHS is made aware of all disciplinary actions taken against such Dental Assistants, the contractor will:

1. Verify through a State Board of Dentistry database all active, inactive, and lapsed licenses or registrations that are held, or have been held, by Dental Assistants who would provide services in IHS hospitals and clinics under this contract.

2. Verify through DANB all active, inactive, and lapsed certifications that are held, or have been held, by Dental Assistants who would provide services in IHS hospitals and clinics under this contract.

3. Verify through AMT all active, inactive, and lapsed registrations that are held, or have been held, by Dental Assistants who would provide services in IHS hospitals and clinics under this contract.

2. Inform IHS of the status of all dental assisting licenses, registrations, and/or certifications for each Dental Assistant who would provide services under this contract in IHS hospitals and clinics, including all reasons for each inactive or lapsed license.

3. Obtain at least three letters of reference from dental staff members whom have knowledge of the applicant’s clinical practice skills within the past six months. One letter must be from the previous supervisor at the hospital or clinic where the Dental Assistant last provided dental assistant services. One letter must be from a dentist at the hospital or clinic where the Dental Assistant last provided dental assistant services.

4. Provide all information regarding performance and disciplinary actions that is collected on Dental Assistants who would be placed under this contract to the receiving IHS facility Dental Assistant Supervisor or Lead Dental Assistant. This includes all information that is collected and compiled on such Dental Assistants at the time of initial hire by the Contractor, and/or information that is reported during periods that the Contractor is an agent of such Dental Assistants for placement under this contract.

5. Certify that all information obtained on Dental Assistants whom they would assign to IHS hospitals and clinics has been reviewed and verified by the Contractor. This certification must include a statement that the Contractor has found no reason to reject the Dental Assistant’s application. The names of the contacts, their titles, telephone numbers, and dates of representative collecting and reviewing such information must be recorded in writing and made available to the IHS by the Contractor.

The Contractor must provide all of the information required above to the Deputy Dental Director, Dental Director, or designee of the receiving IHS facility no less than ten to fourteen days before the Dental Assistants’ actual report date.

When the requirements or the IHS do not allow for hard copies of information to be received at least ten days before a Dental Assistants placement, the Contractor may provide such assurances to the IHS facility within five days after Dental Assistant placement. Such instances shall be kept to a minimum and the reasons for each instance must be documented and well justified by the Dental Assistant Supervisor at the receiving IHS facility.

4.3 Liability Insurance:

The Contractor will be solely liable for, and expressly agrees to, indemnify the Government with respect to any professional liability producing acts or omissions by it or its employees or agents. The Contractor will maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than One (1) Million Dollars per occurrence and $3,000,000.00 aggregate.

Upon apparent successful offers, or upon request by the contracting officer, the potential Contractor will furnish, prior to contract award, evidence of its insurability concerning the liability insurance required by this contract.

Liability insurance may be on either an occurrence basis or on claims made basis. If the policy is on claims made basis, an extended reporting endorsement (tail) for a period of not less than three years after the end of the contract term must also be provided.

A CERTIFICATE OF INSURANCE EVIDENCING THE REQUIRED COVERAGE WILL BE PROVIDED TO THE CONTRACTING OFFICER PRIOR TO THE COMMENCEMENT OF SERVICES UNDER THIS CONTRACT. If the insurance is on a claims made basis and evidence of an extended reporting endorsement (tail) is not provided prior to the commencement of services, evidence of such endorsement will be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract will be withheld until evidence of the extended reporting endorsement (tail) is provided to the Contracting Officer.

The policies evidencing required insurance will also contain an endorsement to the effect that any cancellation or material change adversely affecting the Government's interest will not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. If during the performance period of the contract the Contractor changes insurance providers, the Contractor will provide evidence that the Government will be indemnified to the limits specified in this Statement of Work. This will be for the entire period of the contract, either under the new policy, or a combination of old and new policies.

THE CONTRACTOR SHALL INSERT THE SUBSTANCE OF THIS CLAUSE, INCLUDING THIS PARAGRAPH, IN ALL SUBCONTRACTS UNDER THIS CONTRACT FOR HEALTH CARE SERVICES AND WILL REQUIRE SUCH

SUBCONTRACTORS TO PROVIDE EVIDENCE OF AND MAINTAIN INSURANCE IN ACCORDANCE WITH

THIS CLAUSE.

AT LEAST FIVE DAYS BEFORE THE COMMENCEMENT OF WORK BY ANY SUBCONTRACTOR, THE

CONTRACTOR WILL FURNISH TO THE CONTRACTING OFFICER EVIDENCE OF SUCH INSURANCE.

4.3 Payment for services

The Government reserves the right to accept or reject services if the level of work is unsatisfactory.

A task order will be used to pay for the services rendered. The payment shall be mutually agreed between the Contractor and the Contracting Officer or designated representative. The Contractor shall submit an original timesheet for review and verification to the Deputy Dental Director, Dental Director, or designee. The Contractor shall submit an original invoice to purchase order instructions.

4.3.1 Invoice information requirements:

1. Contractor/Vendor Name

2. Mailing Address

3. Telephone Number

4. TIN (Tax Identification Number)

5. Bank Routing Number (9 digits)

6. Checking or Savings Account Number

7. Purchase Order Number (in Block #3 of the OF-347 form)

8. Invoice Date and Number

9. Description of Services Provided, Quantity, Unit Issue, Unit Price, and Total Amount Due

10. DUNS Number (Data Universal Number)

Please provide a copy of the invoice to:

Bemidji Area Office Email: BEM_AOInvoices@ihs.gov ATTN: Division of Finance 2225 Cooperative Ct NW Bemidji, MN 56601

4.4 Employee Health Requirements:

Cass Lake Indian Hospital requires Contracted Dental Assistant onboarding health information for all applicants to whom conditional offers of employment have been made in order to evaluate the applicant’s health and to protect patients and staff from exposure to communicable diseases. If the applicant refuses to provide health information or proof of immunizations, as recommended by the Centers for Disease Control (CDC) and Occupational Safety and Health Administration (OSHA) concerning health-care workers in the United States, the refusal is deemed sufficient grounds for Cass Lake Indian Hospital Service Unit to deny employment. Information obtained regarding the medical condition or history of the applicant will be collected and maintained on separate forms and in separate medical files, in accordance with federal law, and will be treated as a confidential medical record. Cass Lake Indian Health Service will not provide immunizations or testing for contract personnel.

GUIDELINES

Contracted Dental Assistant onboarding health information must include the following:

Previous immunization history is reviewed by the Employee Health. Cass Lake Indian Hospital requires all potential healthcare workers to provide proof of the following immunization records. If the healthcare worker cannot provide proof of immunizations, appropriate lab testing should be provided prior to onboarding. Lack of immunization history is deemed sufficient grounds for Cass Lake Indian Hospital Service Unit to deny employment.

If the potential healthcare worker wishes to request a medical or religious vaccine exemption, a vaccination declination form must be submitted to Employee Health. The declination form must be reviewed and approved by Cass Lake Indian Hospital prior to acceptance of the contracted employee. Disapproval of a vaccination exemption request is deemed sufficient grounds for Cass Lake Indian Hospital Service Unit to deny employment.

Required vaccinations, titers, boosters, skin testing, and proof of immunity is accomplished at the expense of the potential contracted healthcare worker. The only vaccines that may be provided to potential contracted healthcare workers at Cass Lake Indian Hospital at no cost to the potential contracted healthcare worker are COVID-19 and Influenza vaccines.

Hepatitis B All Cass Lake Indian Hospital contracted healthcare workers who perform tasks that may involve exposure to blood or body fluids should receive a 3-dose series of hepatitis B vaccine, following the manufacturer recommendations. Test for hepatitis B surface antibody (HBSAB) to document immunity 1-2 months after dose #3. If HBSAB is positive, the healthcare worker is immune and no further testing or vaccination is recommended. For new hires providing proof of previous vaccination, HBSAB testing will be performed. If HBSAB results are >10mIU/mL, the healthcare worker is immune and no additional vaccination is required. If the HBSAB is < 10mIU/mL the healthcare worker should be revaccinated with 3-dose series on an appropriate schedule, with serologic testing repeated in 1-2 months. If HBSAB is negative following 6 doses of vaccine, the healthcare worker is a non-responder. For non-responder blood exposures, consult the Cass Lake Indian Hospital Infection Control Plan.

Measles, Mumps, Rubella (MMR) All Cass Lake Indian Hospital contracted healthcare workers must be immune to Measles (Rubeola), Mumps and Rubella.

For healthcare workers without serologic evidence of immunity to each component of the vaccine or without proof of 2 vaccinations, recommend additional doses needed per CDC & OSHA guidelines.

Tetanus, Diphtheria, Acellular Pertussis (Tdap) All Cass Lake Indian Hospital contracted healthcare workers between 19-64 years of age (or per manufacturer recommendation) must receive a 1-time dose of T-dap, with priority given to those having contact with infants younger than age 12 months.

Tuberculosis All Cass Lake Indian Hospital contracted healthcare workers must have a two-step Tuberculosis skin test (TBST) or show proof of a TBST in the last twelve months. If not completed within 12 months, contracted healthcare worker will need to have the two-step TBST skin test completed at their expense. If a potential contracted healthcare worker is a known TBST reactor, he/she will be required to complete a chest x-ray. The x-ray may be waived if the potential healthcare worker can provide documented proof of a chest x-ray, which was done in the last twelve months and the potential healthcare worker denies signs and symptoms of Tuberculosis. The chest x-ray will be done at the expense of the potential contracted healthcare worker.

Varicella All Cass Lake Indian Hospital contracted healthcare workers must be immune to varicella. Evidence of immunity for the healthcare worker includes documentation of 2 doses of varicella vaccine give per manufacturer recommendation, history of varicella or herpes zoster, laboratory evidence of immunity, or laboratory confirmation of disease.

Influenza (annual) All Cass Lake Indian Hospital contracted healthcare workers are required to have annual influenza vaccinations.

Influenza vaccines are available to contracted healthcare workers at no cost during annual employee vaccination clinics.

If contracted healthcare worker does not participate in the vaccination clinics, they may be required to get the Influenza vaccine elsewhere at their own expense.

COVID – 19

All Cass Lake Indian Hospital contracted healthcare workers are required to have two doses of COVID-19 vaccine in a two-dose series vaccine, or one dose of COVID-19 vaccine in a single-dose vaccine. They are also required to have boosters if recommended or required by CDC, OSHA, HHS, or IHS. COVID-19 vaccines are available to contracted healthcare workers at no cost during annual employee vaccination clinics. If contracted healthcare worker does not participate in the vaccination clinics, they may be required to get the COVID-19 vaccine elsewhere at their own expense.

PART 5

SPECIFIC TASKS

5. SPECIFIC TASKS

5.1. Basic Services. The contracted Dental Assistant shall provide highly competent direct patient care, patient education, infection control, equipment and supply maintenance, and chairside dental assisting services.

5.2. Tasks. Dental Assistant Services Contract to provide Dental Assistants.

5.3.1 The contracted Dental Assistant will perform infection control, equipment maintenance, and inventory management services per hospital policy, protocols, or standing operating procedures:

5.3.2 Comply with all IHS facility infection control and safety procedures, practices, and standards.

5.3.3 Disinfect equipment, supplies, operatories, and other patient care areas, following manufacturers’ instructions for use.

5.3.4 Pre-clean reusable instruments and supplies prior to sterilization, following manufacturer’s instructions for use.

5.3.5 Follow all dental waterline protocols to keep dental waterlines clean.

5.3.6 Transport instruments to and from sterilization area.

5.3.7 Follow infection control protocols for inventory management and storage.

5.3.8 Dispose of medical waste following standing operating procedures, protocols, and policies.

5.3.9 Follow handwashing and personal protective equipment protocols.

5.3.10 Follow universal masking and distancing protocols, if required by hospital policy.

5.3.11 Perform and document equipment maintenance per daily, weekly, monthly, quarterly, and annual schedules.

5.3.12 Maintain equipment checklists and log books, per departmental protocol.

5.3.13 Work with Lead Dental Assistant to request supplies and maintain adequate stocks.

5.4.1 The contracted Dental Assistant will perform routine chairside dental assisting services:

5.4.2 Assist with dental procedures by suctioning, retracting, irrigating, nitrous oxide administration, and passing instruments / supplies.

5.4.3 Set up and breakdown operatories and panoramic x-ray room. Set up will vary based on anticipated procedure.

5.4.4 Pour up dental models and…