75H70526R00004 DENTIST SERVICES.pdf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

9. ISSUED BY

13b. RATING

14. METHOD OF SOLICITATION

CODE

16. ADMINISTERED BY CODE

18a. PAYMENT WILL BE MADE BY CODE17a. CONTRACTOR/

OFFEROR

CODE

FACILITY

CODE

CODE

TELEPHONE NUMBER

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

REQUEST

FOR QUOTE

(RFQ)

INVITATION

FOR BID

(IFB)

REQUEST

FOR

PROPOSAL

(RFP)

SEE ADDENDUM

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

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

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

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH

AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND

ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS

SPECIFIED

29. AWARD OF CONTRACT: REFERENCE OFFER

DATED . . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR

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

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

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

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

10. THIS ACQUISITION IS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

THE DEFENSE PRIORITIES

AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

XSET ASIDE: % :

11. DELIVERY FOR FREE ON

BOARD (FOB) DESTINATION

UNLESS BLOCK IS MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

ARE ARE NOT ATTACHED

ARE ARE NOT ATTACHED

27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

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

UNRESTRICTED OR

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY

DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

8(A)

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

HUBZONE SMALL

BUSINESS

SMALL BUSINESS

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30.

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED

1. REQUISITION NUMBER

IHS1523150 48

5. SOLICITATION NUMBER

75H70526R00004

Mary Simon mary.simon2@ihs.gov

15. DELIVER TO

White Earth Service Unit

40520 County Highway 34

Ogema, MN 56569

DENTIST SERVICES FOR WESU IAW ATTACHED PWS

NORTH AMERICAN

INDUSTRY CLASSIFICATION

STANDARD (NAICS):

561320

SIZE STANDARD:

34M

02/20/2026

LOCAL TIME

IEE

03/21/2026

STOCK RECORD (S/R)

STANDARD FORM 1449 (REV. 11/2021) BACK

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE RECEIVED (MM/DD/YYYY) 42d. TOTAL CONTAINERS

40. PAID BY

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELPHONE NUMBER OF AUTHORZED GOVERNMENT REPRESENTATIVE

32g. EMAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL FINAL

37. CHECK NUMBER

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER

36. PAYMENT

COMPLETE PARTIAL FINAL

75H70526R00004

DENTIST SERVICES

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:

EIN/TIN____________

UIE SAMS__________

CAGE______________

NAME: ______________

TELEPHONE: ________

EMAIL: _____________

LOCATION OF SERVICE:

White Earth Health Clinic Pine Point Satellite Clinic Naytahwaush Satellite Clinic 40520 CO HWY 34 47520 282nd Street 2471 310th Ave OGEMA MN 56569 Ponsford, MN 56575 Mahnomen, MN 56557

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

GOVERNMENT:

Mary Simon Indian Health Service 2225 Cooperative Ct NW, Rm 202 Bemidji, MN 56601 mary.simon2@IHS.Gov

The associated North American Industrial Classification System (NAICS) code: 561320 Temporary Help Services/Contract Staffing Services PSC: Q503 Medical Services-Dentistry

CONTRACT TYPE: Firm-Fixed Price

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:

Electronic Invoicing and Payment Requirements - Invoice Processing Platform (IPP) Payment requests must be submitted electronically through the U. S. Department of the Treasury's Invoice Processing Platform System (IPP).

mailto:mary.simon2@IHS.Gov

"Payment request" means any request for contract financing payment or invoice payment by the Contractor. To constitute a proper invoice, the payment request must comply with the requirements identified in the applicable Prompt Payment clause included in the contract, or the clause 52.212-4 Contract Terms and Conditions - Commercial Items included in commercial item contracts. The IPP website address is: https://www.ipp.gov.

Under this contract, the following documents are required to be submitted as an attachment to the IPP invoice:

- A copy of the Contractor's invoice shall be included with the IPP invoice. If no invoice is attached, the Invoice will be rejected;

- Contractor’s Invoice shall contain:

* Contract number

* SAM's Registration - Unique Identity Number (UEI Number)

* EIN or Tax ID Number

* List of deliverables;

- Timesheets if applicable - Number of hours worked with corresponding labor category and rate

HHSAR 352.232-71 Electronic Submission of Invoice Payment Requests (Feb 2022)

(a) Definitions.

Payment request means a bill, voucher, invoice, or request for contract financing payment with associated supporting documentation. The payment request must comply with the requirements identified in FAR 32.905(b), "Content of Invoices" and the applicable Payment clause included in this contract.

(b) Except as provided in paragraph (c) of this clause, the Contractor shall submit payment requests electronically using the Department of Treasury Invoice Processing Platform (IPP) or successor system.

Information regarding IPP, including IPP Customer Support contact information, is available at www.ipp.gov or any successor site.

(c) The Contractor may submit payment requests using other than IPP only when the Contracting Officer authorizes alternate procedures in writing in accordance with HHS procedures.

(d) If alternate payment procedures are authorized, the Contractor shall include a copy of the Contracting Officer's written authorization with each payment request.

Unless otherwise agreed to by the contracting officer per HHSAR 352.232-71(c), the use of IPP shall take precedence over previously established invoicing procedures.

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

BID SCHEDULE: BASE PLUS 4 OPTION YEARS

Request for up to (3) contract staff Dentists to fulfill staffing shortages in the Dental Department to ensure direct patient care will not be interrupted.

** OVER TIME IS NOT AUTHORIZED**

LINE ITEMS HOURS HOURLY RATE TOTAL

BASE YEAR:

0001) DENTIST 2,080 $ $

OPTION YEAR 1:

0002) DENTIST 2,080 $ $

OPTION YEAR 2:

003) DENTIST 2,080 $ $

OPTION YEAR 3:

0004) DENTIST 2,080 $ $

OPTION YEAR 4:

0005) DENTIST 2,080 $ $

CUMMULATIVE

BASE: $

Option Year 1: $ Option Year 2: $ Option Year 3: $ Option Year 4: $

TOTAL: $

Performance Work Statement

PERFORMANCE WORK STATEMENT

Dentist

WHITE EARTH HEALTH CENTER

OGEMA, MN 56509

GENERAL.

PURPOSE OF CONTRACT:

The mission of the White Earth Service Unit in Ogema, MN is to deliver quality care in order to attain positive health outcomes for all our valued patients with emphasis on cultural sensitivity and human dignity.

To meet the mission, the White Earth Service Unit requires a trained contract Dentist and assist in temporary duties assigned at the Dental Clinic.

Individuals providing services under contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with “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 will be waived based on prior investigations on file.

Until the Character Investigation has been completed and the contracting officer notified, such individual will not have unsupervised contact with Indian children.

The contracting officer has the authority to temporarily waive the character investigation of a contractor.

The “Agreement to a Temporary Waiver of Character Investigation” authorizes an agency to hire a contractor prior to the completion of a background check provided that at all times the contractor is within the sight and under the supervision of a government employee who has successfully completed the national agency check with written inquiries (NACI).

CONTRACTOR FURNISHED PROPERTY

The Indian Health Service does not anticipate a need for contractor furnished equipment.

GOVERNMENT FURNISHED PROPERTY, FACILITIES, AND SERVICES

The Contract Dentist will be authorized to use all areas of the treatment facility available to civil health providers and commissioned personnel in similar positions. The same restrictions apply to the contract health provider and any other Indian Health Service personnel to use areas for official business activities only.

The Chief of Dental shall provide Medical Staff Bylaws and Code of Ethics to Contract Dentist.

The Chief of Dental shall provide all equipment and medical supplies deemed necessary to provide dental care.

The clinic shall provide an ongoing method of monitoring and evaluation of the quality of services performed before the level of performance becomes unacceptable.

The contractor shall perform services compatible with the dental clinic operating capacity and equipment. The contract shall provide services for the Indian Health Service beneficiaries served by the clinic. Contract performance shall be according to the requirements contained in this statement of work.

Preference: Preference will be given to applicants who have experience working with Native American patients. Preference is also given to applicants with experience serving adults, children and youth of all ages. Preference will be given to applicants who have been credentialed at the White Earth Service Unit in the past.

What is expected: This position is expected to treat 10 patients per eight-hour work day. Patient ages range from infant to elderly, treatment of this age variance is mandatory. The Dental Department will provide supports services for scheduling, mailing appointments, and Dentist Assistant. Medication will be dispensed at the White Earth Health Center and/or Waabinokwe Health Center by pharmacy staff.

The Chief of Dental will conduct the evaluations on the contractor’s performance. The contractor shall advise the Chief of Dental and COR of any problem(s) encountered, or which be encountered, in connection with meeting the needs of patients served by the Dental Department. The contractor shall report continuing problems of any nature to the COR.

This position is expected to complete and submit all billing packets within 7 business days of employment such as but not limited to (MN Uniform Health Care Application, MN DHS Provider Enrollment Form and Provider Agreement, Medicare/CMS, 8551, 855R, and all private insurance forms as requested).

RESPONSIBILITIES:

The Contract Dentist shall provide emergency and routine Dental services for eligible patients (children, adults and elderly) at the White Earth Health Center, Naytahwaush Health Center and Pine Point Dental Clinics. The Chief of Dental will monitor activities.

Specific Contract Dentist Services shall include, are limited to the following:

The Contract Dentist actual duties will be in accordance with his/her credentialed privileges within the Medical Staff Bylaws of the White Earth Service Unit, and will include the following:

1. Performs a full range of professional dental duties in connection with the prevention and treatment of common and/or complex dental diseases or dental health problems.

2. Provides restorative, pediatric, periodontics, endodontic, prosthodontic, diagnostic, surgical, and preventive dental services of a scope, quality, and quantity consistent with IHS, Bemidji Area, and the Service Unit policies, standards of care, and best practices.

3. Performs oral and radiographic examinations of the oral cavity and diagnoses pathological or irregular conditions. Requests any required dental radiographs and performs radiographic interpretations. Examinations include inspection of hard and soft tissues of the oral cavity and surrounding structures. Insures that the results of examinations are properly recorded in patient charts.

4. Develops patient treatment plans and insures proper referral of patients for necessary medical evaluation if beyond the scope of general dental practice, i.e. recognizes symptoms of an assortment of systemic diseases and refers cases.

5. Performs restoration of simple and complex cavities with prescribed material that widely accepted as meeting standards of care.

6. Administers local anesthesia as required for treatment and diagnoses of dental diseases.

7. Performs single and relatively uncomplicated multiple extractions of teeth. May also perform challenging oral surgery procedures including full mouth extractions, select alveoloplasty procedures, removal of lesions for biopsies, and incision and drainage of abscesses.

8. Practices prosthetic dentistry by studying patient's mouth to determine type of restoration required, taking impressions and bite registrations for crowns, dentures and bridges, trying temporary setups in patient's mouth, and fitting and inserting the finished appliances.

9. Performs select challenging prosthodontic cases, to include crowns/bridges with acceptable yet non-ideal angulation or occlusal scheme, complete dentures for patients with Class II or Class Ill skeletal relationships or little residual ridge, immediate complete dentures, same day acrylic repairs and chairside relines.

10. Diagnose and perform root canal therapy on anterior and posterior teeth for children and adults

Dentist Services

11. Performs uncomplicated periodontal procedures such as scaling, root planning, and subgingival curettage.

12. Treats mouth and gum infections.

13. Provides all appropriate dental disease prevention measures for each patient being treated.

14. Performs uncomplicated endodontic therapy as well as select complicated endodontic therapy involving molars, partial calcifications or curved roots. Performs intra-canal post placement procedures.

15. Performs routine pedodontic procedures, as well as treating cases of rampant caries in children. Is able to perform case management/treatment in select challenging pediatric cases in the absence of a pediatric dentist.

16. Training and experience in Level 1 Sedation.

17. Experience in treating traumatic dental emergencies, to include avulsed teeth with corrective splinting. Experience in co-managing jaw fracture cases with an oral surgeon.

18. The dentist may occasionally perform difficult oral surgeries such as extraction of an impacted tooth where there is a complicating aspect, a difficult alveolectomy in connection with fitting of denture or other appliance, or other difficult dental procedures.

19. Educates patients in oral hygiene, brushing and flossing techniques, and post-operative care.

Plans and adapts instructions, tailoring them to the oral hygiene needs and oral problems of individual patients. Explains to patients the causes of periodontal disease and tooth decay, and the importance of diet as it relates to oral and systemic health. Explains to the patients the dental effects of substances such as tobacco, alcohol, and recreational drugs on oral health.

Tobacco counseling provided and appropriate referrals for tobacco cessation and substance abuse counseling are made.

20. Performs monitoring and screening of hypertension and diabetes and refers patients to appropriate medical program/clinic as outlined in Service Unit policy.

21. Refers patients to appropriate contracted and non-contracted dental sources for care and diagnostic procedures that cannot be provided in-house. Coordinates and integrates information obtained into the health care regimen and assures the provision of timely follow-up care as required.

22. Experience in managing medically complex patient cases. Obtains medical record information and physician/specialist phone consultations (when applicable) for all patients seen to ensure the accumulation and documentation of all pertinent medical data, which is required to provide comprehensive dental care.

23. Recognizes symptoms of an assortment of systemic diseases and refers cases for medical diagnosis.

24. The incumbent may be required, on a rotational basis, to provide the full range of professional dental services at the various field health clinics.

QUALIFICATIONS:

CONTRACTOR REQUIREMENTS.

The Contractor shall not employ any individual to provide direct health care services who is listed on the Health and Human Services (HHS) list of providers excluded from federally funded health care programs.

1. The Contract Dentist shall be a U.S. citizen or otherwise meet other applicable requirements.

2. Successful completion of a nationally recognized Doctor of Dental Surgery (DDS) or Doctor of

Dental Medicine (DMD) program.

3. Successful completion of an accredited post-doctoral residency in Pediatric Dentistry for all

Pediatric Dentist Candidates.

4. Must have 3 years of experience and have actively been practicing dentistry within the last 6 months.

5. Must provide 2 peer references that have observed them in the last 2 years.

6. Must be board certified or active participation in the examination process with achievement of certified in Pediatric Dentistry with in 5 years for all Pediatric Dentist Candidates.

7. Must have a current license to practice dentistry in one of the United States with no restrictions.

8. Must possess and provide documentation of continuing education

9. Must apply for and have approved appropriate medical privileges by medical staff.

10. Must have a current BLS certification that meets AHA-guidelines.

11. The Contract Dentist shall successfully complete a criminal history background check and submit all required documents within 7 days of request.

12. The Contract Dentist shall be able to read, write, and speak English well enough and enunciate with sufficient clarity to effectively communicate with patients and other health care providers.

13. The Contract Dentist shall possess sufficient initiative, interpersonal relationship skills and social sensitivity such that the Dentist can relate to a variety of patients from diverse backgrounds.

14. The Contract Dentist shall be able to operate a computer utilizing Microsoft applications, such as Word, Excel, and efficiently utilize an Electronic Medical Record.

15. The Contract Dentist shall be able to type and have had experience using computers.

16. White Earth Service Unit will provide computer training on their electronic medical records system including Dentrix. Failure to learn the computer system at the White Earth Service Unit and perform actions independently within 2 weeks of beginning service be grounds for immediate removal of the Contract Dentist.

SUPERVISORY CONTROLS

Work is reviewed to insure conformance with current policy and procedures of the Indian Health Service.

PERSONAL CONTACTS

Contactors are with service unit professional and Para professional employees, outside contractors and vendors, third party alternate resource organizations regulatory agencies patients and their families.

PHYSICAL DEMANDS

Work does demand frequent standing, walking, sitting, bending, carrying of items such as records, supplies, and working with equipment.

ORIENTATION AND TRAINING.

Prior to working, the contractor will provide a certificate of completion for mandatory ISSA training.

The Contract Dentist will be provided a Government paid orientation to familiarize the Contract Dentist with the policies and procedures. Orientation attendance will be required of all Contract Dentist and will be scheduled by the COR during the first normal duty day.

The clinic shall provide all required blank government forms applicable to the Indian Health Service.

Clinical personnel will also provide appropriate orientation to the necessity of such forms.

The Contractor shall ensure that each Contract Dentist is knowledgeable of the policies and procedures of his/her specific place of duty and of the dental activity. The Contractor shall ensure Contract Dentist receive any staff training required by the White Earth Service Unit, as a precondition/condition to performance. Such training will include instruction on automation processing, quality assurance policies and local in-service and safety briefings. This training shall be conducted during the scheduled shift of the Contract Dentist.

The Contract Dentist shall attend all and take all training prescribed for personnel as required by White Earth Health Center. Training shall be part of the workday.

ELECTRONIC MEDICAL RECORD KEEPING SYSTEMS.

The Government will provide training to Contract Dentist in the Electronic Medical Record Keeping Systems and Dentrix and other procedures that the dental staff is required to use. Access to such patient data systems is an "Automated Data Processing Sensitive" position requiring compliance with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. Refer to the Additional Information section “ADP Security Requirements” in this contract for further guidance.

Electronic Health Record (EHR) and Dentrix contains the facilities’ appointment scheduling program, Dental, pharmacy, lab, and radiology ordering system and is interlinked with other departments in the White Earth Service Unit. The Government will provide training to Contract Dentist in the Dentrix and EHR and/or other procedures that staff are required to use. Access to such patient data systems is an “Automated Data Processing Sensitive” position requiring compliance with the Health Insurance Portability and Accountability Act (HIPAA) Security Rule.

Training for EHR, Dentrix and other computer training will be scheduled through the Chief of Dentistry prior to the Contract Dentist providing direct support. The training will be on-site and during normal duty hours.

This training will be at no cost to the Contractor.

If additional training is needed due to mission changes, the White Earth Service Unit Information Management Office will conduct required computer training. This training will be at no cost to the Contractor. The COR will schedule this training.

REPORTING REQUIREMENTS.

The Contractor shall submit reports to the COR as requested for use in monitoring Contractor performance. Such reports will include, but are not limited to: time sheets, etc.

Safety. The Contractor shall ensure that its Contract Dentist comply with all installation safety regulations. Such regulations include, but are not limited to, general safety, fire prevention, waste disposal and infection control. Copies of these regulations are on file in the dental activity safety office or will be obtained through the COR.

Hours of Performance.

Contract Dentist shall provide Dentistry services to the patients of the White Earth Service Unit 5 – 8-hour days ranging between 8:00 am-4:30 pm each week to be performed for the White Earth Service Unit at the White Earth Health Center, Naytahwaush Health Center and Pine Point Dental Clinics.

The provider shall be required to perform Emergent, Urgent, acute, and primary Dental care as required in an outpatient setting, and as permitted by licensure and scope of practice.

Billing

The Government will only pay for hours, days or units actually worked/provided. The Contractor shall only submit payment requests for hours, days or units actually worked/provided. Submitting a payment request for more than the amount due based on the number hours, days or units actually worked/provided will constitute fraud or a false claim and will result in administrative or criminal action or both.

The Contract Dentist shall be able to provide services 8 hours a day, 5 days a week excluding federal holidays. A minimum break of 30 minutes will be given during the shift.

Work hours and days will be determined by White Earth Service Unit, and confirmed by the contractor. A schedule discussed between a Contract Dentist and staff is not considered valid.

Schedules are subject to change due to cancellations, clinic staff changes, organization day, emergencies, exodus, training holidays and unexpected events.

Signing in prior to scheduled time will not be considered as hours worked. The above timeframes are subject to change.

The hours do not include any break periods to eat. Break times are not billable. The government reserves the right to verify the hours worked by the Contract Dentist by sign-in/sign-out sheet, checking computer logs, use of a time clock, etc.

Overtime/Extended Shift: Overtime is not authorized under this contract.

Unscheduled Absences. Unscheduled absences shall be called into the assigned COR by the contractor at least 24 hours before the start of the shift. The contractor shall only be paid for actual hours worked.

Hours worked do not include travel time to reach the facility or other place of performance.

The Contract Dentist shall be rested and fully physically and mentally capable of performing the duties required under this contract.

The Contract Dentist shall not have worked the 8 hours before beginning services at a White Earth Service Unit.

Closures. During anticipated closure of the facility due to a White Earth Service Unit’s, declared training, holiday or during unplanned closure of the facility due to natural disasters, emergencies, severe weather, or otherwise, the Contractor shall not invoice the Government for services not performed and the Government will not be liable to the Contractors for any such closures.

Holidays.

There are eleven federal holidays observed by the facility; the Contract Dentist will not be scheduled during these days.

The following is a list of legal federal holidays as referred to elsewhere in the contract.

New Year's Day Birthday of Martin Luther King, Jr.

President's Day Memorial Day Juneteenth Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day

CONDUCT.

The Contractor shall ensure that each Contract Dentist records the time worked according to procedures determined by the White Earth Service Unit to include documenting hours on the time sheet.

The Contractor shall ensure that its Contract Dentist do not introduce new procedures or services without prior approval of the Credentialing Specialist and Chief of Dental, or representative. In disagreements or deviations from established or new protocols, the department Director, or COR, will be the deciding authority.

The Contractor shall ensure that its Contract Dentist comply with White Earth Service Unit’s policies regarding personal appearance and conduct.

The Contractor shall ensure that its Contract Dentist abide by federal and local White Earth Service Unit’s regulations and requirements concerning the nature of limited privileged communication between patients and the Contract Dentist as will be necessary for security and personnel reliability programs.

The Contractor shall also ensure that its Contract Dentist abide by federal and local White Earth Service Unit’s regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability & Accountability Act of 1996. All regulations referenced are available for review from the COR.

All medical records and reports are and will remain the property of the Government.

Contractor shall abide by all local White Earth Service Unit’s policies/rules. All personnel shall maintain and support the standards necessary to meet AAAHC and CMS (Centers for Medicare and Medicaid Services) certification. When commencing work under this contract, Contractor shall obtain an in-processing checklist from the COR and provide the COR a copy when completed. The Contractor shall wear a White Earth Service Unit’s identification badge. The COR will assist the Contractor in obtaining the identification badge through the White Earth Service Unit’s, Division- Security Officer. Upon termination of work at White Earth Service Unit, the contractor will be required to return identification badge, keys and out process through the activities identified on the out-processing checklist obtained from the COR.

The Contractor shall ensure that its Contract Dentist make use of all appropriate equipment; supplies and services made available by the Government for the direct patient care.

EMPLOYEE HEALTH REQUIREMENTS:

The White Earth Service Unit requires contract provider onboarding to provider immunization records or must show immunity prior to applying for an exemption. Contractor must have proof of a negative TB screening/test within the last 365 days.

REMOVAL OF DENTIST

At any time during the performance of this contract, the CO or COR will direct the Contractor to immediately remove any Contract Dentist whose actions or impaired/insubordinate state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other Contract Dentist, Government personnel or to the impaired individual.

This provision will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the Contractor. If the need for a removal occurs, the COR will contact the Contractor's point of contact and direct the Contractor to remove that individual from the facility and to not use that individual to perform any healthcare services required under this contract until the issue has been resolved by the CO. The Contractor shall formally meet with the COR to discuss further action in accordance with the scope of the contract. A review of the basis for removal will be made by the CO within three working days after the COR directed the removal. If, after any investigation deemed necessary by the CO and discussions with the Contractor's representative, the CO concludes that the Contract Dentist impairment requires permanent removal from performance under the contract, the CO will notify the Contractor that permanent removal is required. In the event of disagreements between the Government and the Contractor's representative concerning matters of impaired/insubordinate Contract Dentist, the decision of the CO will be final.

During the period of time between the removal and the final decision of the CO, the Contractor shall provide a backup/replacement Contract Dentist in accordance with the terms and conditions of this contract.

Inquiries.

Contractor shall ensure that its personnel do not respond to any media inquiries. Any inquiries from the media shall be immediately relayed to the COR, who will relay them to the White Earth Health Center Chief Executive Officer (CEO). There shall be no interviews, comments, or any other response without the knowledge and approval of the CEO.

Other than routine inquiries from external agencies, all other inquiries and complaints shall be brought to the attention of the Contract Dentist Government supervisor.

Smoking.

The Contractor shall ensure that its Contract Dentist comply with the White Earth Service Unit’s smoking policy.

Complaints. Complaints will be validated by the COR and be reported in writing to the CO and to the Contractor for action, if it constitutes a failure to perform, as determined by the Government. Patients will also be a source of legitimate complaints that constitute a failure to perform.

The Contractor shall have no more than two substantiated complaints per 12-month period per Contract Dentist. Any patient complaints received on services provided by the Contract Dentist will be taken very seriously at the White Earth Health Center and as such will be considered a part of the inspection process. The department Director will submit documentation to the COR regarding all patient and/or clinical complaints. Receipt of two valid complaints on the Contract Dentist within any twelve-month period will be considered grounds for immediate removal.

Conflict of Interest.

The Contract Dentist shall not bill any patient for services rendered under this contract. The Contract Dentist shall be prohibited from receiving compensation of any actions performed, except under the terms and conditions of this contract, at the rate specified.

The Contractor shall not use Government facilities or other Government property in connection with conducting a private practice and shall ensure that its employees do not do so.

Confidentiality of Information.

Unless otherwise specified, all financial, statistical, personnel, and/or technical data which are furnished, produced or otherwise available to the Contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of work under this contract. The Contractor shall not release any of the above information without prior written consent of the CO and shall ensure that its employees do not do so. The Contractor shall not use patient care rendered pursuant to this contract as part of a study, research project, or publication and shall ensure that its employees do not do so.

Professional Liability.

Contractor is responsible for providing an active Certificate of Liability Insurance and is not covered by Federal Tort for any personal injury claim alleging negligence by the Contract Dentist within the scope of the Contract Dentist performance under this contract as claims alleging negligence by the

White Earth Service Unit. The Government will not reimburse or otherwise pay for such insurance purchased.

RESPONSIBILITY AND PROCEDURES.

If any suit or action is filed or any claim is made against the Contract Dentist, which occurred as a result of work performed by the Contract Dentist under this contract, the Contract Dentist shall immediately notify the Contractor, the CO and the department Director of the appropriate services and promptly furnish them copies of all pertinent documents received.

The Contractor and Contract Dentist shall cooperate with the Government, without further compensation, in the processing, review, settlement, or defense of the suit, action, or claim. The Contract Dentist will, at the Contract Dentist own expense, participate in defense of such claim or litigation.

QUALITY MANAGEMENT.

Quality Control Plan (QC). The Contractor is required to follow the current QC program in place at the White Earth Service Unit to ensure that the services are provided at a level of quality that meets Bemidji Area Service Units standards.

Quality Assessment and Improvement (QA&I). The Government will monitor the Contractor's performance under this contract using the QA&I procedures established by the medical activity and pursuant to the Contract Terms and Work is performed in the different departments within the White Earth Health Center, Conditions-Commercial Items clause, paragraph entitled Inspection/Acceptance. Additionally, the Contractor's performance is subject to scheduled and unscheduled review by the QA&I Committee as defined by the medical activity Quality Assurance (QA) Plan.

CONTRACTOR REPRESENTATION.

The Contractor shall designate a representative for this contract. This representative will be employed under another contract/task order with the Contractor at the same Bemidji Area Service Unit. At least ten working days prior to performance start date, the Contractor shall provide in writing to the COR, Contractor representative contact information.

Changes in the contract representative, at any time after contract commencement, shall be in writing to the COR at least five working days prior to the change.

The Contractor's representative shall, at no additional cost, meet with the COR when requested by the COR to discuss any problems that the Contractor's personnel will be experiencing during the performance of this contract. Problems experienced by the Government with the Contractor's performance will be discussed and resolved. Unresolved problems will be referred to the CO for resolution.

The Contractor shall provide points of contact (POC) information for administration of the contract during normal business hours. Accordingly, the named individual(s) shall possess sufficient corporate authority to effectively deal with emergency situations and the telephone number provided shall be functioning at all times other than normal business hours. If there are different POCs for different conditions, such as weekdays, weekends, holidays, clearly provide such information.

GOVERNMENT PROPERTY

The Government will provide use of all available White Earth Service Unit’s facilities and support services, materials, publications and forms, equipment, and specialty clothing required for contract performance (except as designated in the contract). The Contractor shall ensure that its Contract Dentist keep Government-furnished supplies, equipment, and work areas in a safe, orderly and clean condition. The Contractor shall notify the Government whenever maintenance of equipment is required.

Personal long-distance calls are not authorized and the cost of all personal long-distance calls made will be deducted from the Contractor’s invoice.

Any space or equipment used by the Contract Dentist in performance of this contract will be used by the Government for other purposes during his/her absence. Items of clothing, personal effects, or equipment will not be able to be secured at all locations. The Government will not incur any liability for theft, damage to, or loss of such personal items.

Emergency Health Care for Contract Dentist. The White Earth Health Center will provide emergency health care for injuries or life-threatening medical emergencies occurring while on duty. The Contractor shall reimburse the Government for such services as billed by the White Earth Health Center, unless the Contract Dentist is otherwise authorized to receive such services at no cost (e.g., is retired military or other).

CONTRACTOR FURNISHED SUPPLIES/SERVICES.

Uniforms. The Contractor shall provide or ensure Contract Dentist have their own uniform.

CONTRACTING OFFICER’S REPRESENTATIVE (COR). The COR will be appointed in writing by the CO after the contract is awarded. The CO will provide a copy of this designation and COR contact information to the Contractor.

Security Requirements:

Background check and fingerprints are required prior to start date.

Individuals providing services under contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with “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 should not have unsupervised contact with Indian children. The contracting officer has the authority to temporarily waive the character investigation of a contractor. The “Agreement to a Temporary Waiver of Character Investigation” authorizes an agency to hire a contractor prior to the completion of a background check provided that at all times the contractor is within the sight and under the supervision of a government employee who has successfully completed the national agency check with written inquiries (NACI).

FEDERAL ACQUISITION REGULATIONS

52.252-2 Clauses Incorporated by Reference. This contract incorporates one or more clauses by reference, with same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address: www.acquisition.gov

52.202-1 Definitions.

52.204-19 Incorporation by Reference of Representations and Certifications.

52.204-23 Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities.

52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services 52.217-8 Option to Extend Services 52.223-18 Encouraging Contractor Policies to Ban Text Messaging While Driving.

52.225-13 Restrictions on Certain Foreign Purchases.

52.232-39 Unenforceability of Unauthorized Obligations.

52.232-40 Providing Accelerated Payments to Small Business Subcontractors.

52.233-3 Protest after Award.

52.233-4 Applicable Law for Breach of Contract Claim.

52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders—Commercial Items.

CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE

ORDERS—COMMERCIAL ITEMS. (JUL 2021)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)).

(2) 52.204-23, Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities (JUL 2018) (Section 1634 of Pub. L. 115-91).

(3) 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment. (AUG 2020) (Section 889(a)(1)(A) of Pub. L. 115-232).

(4) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (NOV 2015).

(5) 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

http://www.acquisition.gov/ https://www.acquisition.gov/far/part-52#FAR_52_203_19 https://www.acquisition.gov/far/part-52#FAR_52_204_23 https://www.acquisition.gov/far/part-52#FAR_52_204_25 https://www.acquisition.gov/far/part-52#FAR_52_209_10 https://www.acquisition.gov/far/part-52#FAR_52_233_3 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3

(6) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Public Laws 108-77 and 108-78 ( 19 U.S.C. 3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

__ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (JUNE 2020), with Alternate I (OCT 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402).

__ (2) 52.203-13, Contractor Code of Business Ethics and Conduct (JUN 2020) (41 U.S.C. 3509)).

__ (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (JUN 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.)

__ (4) 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (JUN 2020) (Pub. L. 109-282) ( 31 U.S.C. 6101 note).

__ (5) [Reserved].

__ (6) 52.204-14, Service Contract Reporting Requirements (OCT 2016) (Pub. L. 111-117, section 743 of Div. C).

__ (7) 52.204-15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts (OCT 2016) (Pub. L. 111-117, section 743 of Div. C).

X (8) 52.209-6, Protecting the Government’s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (JUN 2020) (31 U.S.C. 6101 note).

__ (9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (OCT 2018) __ (10) [Reserved].

__ (11) (i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (MAR 2020) (15 U.S.C. 657a).

__ (ii) Alternate I (MAR 2020) of 52.219-3.

__ (12) (i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (MAR 2020) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a).

__ (ii) Alternate I (MAR 2020) of 52.219-4.

__ (13) [Reserved] __ (14) (i) 52.219-6, Notice of Total Small Business Set-Aside (NOV 2020) (15 U.S.C. 644).

__ (ii) Alternate I (MAR 2020) of 52.219-6.

__ (15) (i) 52.219-7, Notice of Partial Small Business Set-Aside (NOV 2020) (15 U.S.C. 644).

__ (ii) Alternate I (MAR 2020) of 52.219-7.

__ (16) 52.219-8, Utilization of Small Business Concerns (OCT

2018) (15 U.S.C. 637(d)(2) and (3)).

__ (17) (i) 52.219-9, Small Business Subcontracting Plan (JUN 2020) (15 U.S.C. 637(d)(4)).

__ (ii) Alternate I (NOV 2016) of 52.219-9.

__ (iii) Alternate II (NOV 2016) of 52.219-9.

__ (iv) Alternate III (JUN 2020) of 52.219-9.

__ (v) Alternate IV (JUN 2020) of 52.219-9

__ (18) (i) 52.219-13, Notice of Set-Aside of Orders (MAR 2020) (15 U.S.C. 644(r)).

__ (ii) Alternate I (MAR 2020) of 52.219-13.

__ (19) 52.219-14, Limitations on Subcontracting (MAR 2020) (15 U.S.C. 637(a)(14)).

https://www.acquisition.gov/far/part-52#FAR_52_233_4 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_203_6 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_203_13 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_203_15 https://www.acquisition.gov/far/part-52#FAR_52_204_10 http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section6101&num=0&edition=prelim https://www.acquisition.gov/far/part-52#FAR_52_204_14 https://www.acquisition.gov/far/part-52#FAR_52_204_15 https://www.acquisition.gov/far/part-52#FAR_52_209_6 http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title31-section6101&num=0&edition=prelim https://www.acquisition.gov/far/part-52#FAR_52_209_9 https://www.acquisition.gov/far/part-52#FAR_52_219_3 http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title15-section637a&num=0&edition=prelim https://www.acquisition.gov/far/part-52#FAR_52_219_3 https://www.acquisition.gov/far/part-52#FAR_52_219_4 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_219_4 https://www.acquisition.gov/far/part-52#FAR_52_219_6 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_219_6 https://www.acquisition.gov/far/part-52#FAR_52_219_7 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_219_7 https://www.acquisition.gov/far/part-52#FAR_52_219_8 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_219_9 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_219_9 https://www.acquisition.gov/far/part-52#FAR_52_219_9 https://www.acquisition.gov/far/part-52#FAR_52_219_9 https://www.acquisition.gov/far/part-52#FAR_52_219_9 https://www.acquisition.gov/far/part-52#FAR_52_219_13 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-52#FAR_52_219_13 https://www.acquisition.gov/far/part-52#FAR_52_219_14

__ (20) 52.219-16, Liquidated Damages-Subcontracting Plan (JAN 1999) (15 U.S.C. 637(d)(4)(F)(i)).

__ (21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set- Aside (MAR 2020) (15 U.S.C. 657f).

__ (22) (i) 52.219-28, Post Award Small Business Program Rerepresentation (NOV 2020) (15 U.S.C. 632(a)(2)).

__ (ii) Alternate I (MAR 2020) of 52.219-28.

__ (23) 52.219-29, Notice of Set-Aside for, or Sole Source Award to, Economically Disadvantaged Women-Owned Small Business Concerns (MAR 2020) (15 U.S.C. 637(m)).

__ (24) 52.219-30, Notice of Set-Aside for, or Sole Source Award to, Women-Owned Small Business Concerns Eligible Under the Women-Owned Small Business Program (Mar2020) (15 U.S.C. 637(m)).

__ (25) 52.219-32, Orders Issued Directly Under Small Business Reserves (MAR 2020) (15 U.S.C. 644(r)).

__ (26) 52.219-33, Nonmanufacturer Rule (MAR 2020) (15U.S.C. 637(a)(17)).

X (27) 52.222-3, Convict Labor (JUN 2003) (E.O.11755).

__ (28) 52.222-19, Child Labor-Cooperation with Authorities and Remedies (JAN2020) (E.O.13126).

Subpart 22.16 -…