75H70625R00004 SOL PKG 07.29.25.pdf

A. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 12.6, as supplemented with additional information included in this notice, FAR Part 12, Acquisition of Commercial Items (Title VIII of the Federal Acquisition Streamlining Act of 1994) (Public Law 103-355). This announcement constitutes the only solicitation; quotes are being requested and a written solicitation will not be issued.

B. The Great Plains Area Indian Health Service (IHS) intends to award a Firm-Fixed Price, Non-

Personal Medical Service, Purchase Order with a Base Period and Nine (9) Option Periods in response to Request for Proposal (RFP) 75H70625R00004.

C. This solicitation document and incorporated provisions and clauses are those in effect through

Federal Acquisition Circular 2025-04 on June 11, 2025.

D. This RFQ is issued as 100% Indian Small Business Economic Enterprises (ISBEE) Set-Aside, and the associated NAICS Code is #621999, which has a small business standard size $20.5. Quoter is required to fill out the attached INDIAN FIRM REPRESENTATION FORM.

E. The quoted unit pricing must be all inclusive (to include, but not be limited to, travel, lodging, per diem, fringe benefits, federal, state and local taxes) plus all other costs pertinent to the performance of this contract. Utilize your most competitive and reasonable rates.

Complete the attached Request for Proposal #75H70625P0004 SF1449 for Outpatient Family

Medicine Physicians and Outpatient Pediatricians along with the Business Associates

Agreement. The Business Associates Agreement must be acknowledged by the quoter.

F. Firm Fixed Price, Non-Personal, Medical Services to be provided for the Woodrow Wilson Keeble

Memorial Health Care Center-Sisseton Indian Health Service, 100 Lake Traverse Drive, Sisseton, South Dakota 57262. See Statement of Work (SOW) attached. The period of performance will be a Base Period with Nine (9) Option Periods. Base period will be Six (6) Months, and each option period will be six (6) months.

G. FAR 52.212-1 Instructions to Offerors-Commercial Products and Commercial Services (SEP

2023).

Quotes shall be submitted on company letterhead stationery, signed, dated and it shall include:

1. Solicitation number: 75H70625R00004

2. Closing Date: August 14, 2025 at 12:00 pm CST.

3. Name, address and telephone number of company and email address of contact person.

4. Technical description of the item/service being offered in sufficient detail to evaluate compliance with the requirements of the solicitation. This may include product literature, or other documents, if necessary.

5. Terms of any express warranty.

6. Price and any discount terms.

7. “Remit to” address, if different than mailing address.

8. A completed copy of the representations and certifications at FAR 52.212-3 (see

FAR 52.212-3(b) for those representations and certifications that the offeror shall complete electronically).

9. Acknowledgment of Solicitation Amendments (if any issued)

10. Past performance information, when included as an evaluation factor, to include recent and relevant contracts for the same or similar items and other references

(including contract numbers, points of contact with telephone numbers and other relevant information).

11. A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offerors that fail to furnish required representations or information, or reject the terms and conditions of the solicitation may be excluded from consideration.

H. The Government will evaluate quotations utilizing the procedures of FAR 13.106-2 Evaluation of quotations or offers. Offers will be evaluated for acceptability, but not ranked using the non-price factors/sub-factors. All non-price factors and sub-factors will be rated as either

“acceptable” or “unacceptable”. The Government intends to evaluate and make award without discussion with the offerors other than minor clarifications, unless discussions are determined to be necessary. A decision on the technical acceptability of each offeror’s quotations will be made. For those offeror’s which are determined to be technically acceptable, award will be made to that vendor with the lowest overall prices.

The LPTA evaluation process will be accomplished as follows - Technical Acceptability will be comprised of three subfactors:

1. Meeting all areas under the Statement of Work (SOW) which are consistent in the scope and complexity with Outpatient Registered Nurse Services.

2. Price: The Pricing Schedule must be completed for all the line items and will be evaluated as to completeness and reasonableness. The offeror with the lowest technically acceptable prices represents the best value to the Government.

3. Past Performance: The offeror’s performance on contracts completed during the past three (3) years and all contacts currently in progress for Outpatient Registered Nurse

Services. The offeror’s technical proposal shall include a listing of previous Outpatient

Registered Nurse Services awarded to the offeror for services provided to rural locations.

I. FAR 52.212-3 Offer Representations and Certifications-Commercial Products and Commercial

Services (MAY 2024). See attachment for full text. The Offeror shall complete only paragraphs

(b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) website accessed through http://www.acquisition.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (p) of this provision.

J. FAR 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial Services

(NOV 2023). Applied to this acquisition and it’s by reference.

K. FAR 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive

Orders Commercial Products and Commercial Services (JAN 2025). See attachment for full text.

L. FAR 52.214-16 Minimum Bid Acceptance Period (April 1984). See attachment for full text.

M. Attached are the Federal Acquisition Regulations (FAR) & Health & Human Services Acquisition

Regulation (HHSAR) clauses that are applicable including below.

N. SECURITY CLEARANCE

http://www.acquisition.gov/

A security pre-clearance must be performed for any employees referred to IHS through this contract.

Fingerprints must be completed and adjudicated prior to services being performed under this contract.

No contract award shall be made to any vendor or provider listed on the OIG Exclusion List http://exclusions.oig.hhs.gov throughout the duration of the contract. It shall be the responsibility of the contractor to notify the acquisition official if there is a change in provider.

Performance of this contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (I.H.S.). Before starting work requiring routine access to I.H.S. facilities or systems each person must complete an FBI National Criminal History Check (Fingerprint Check) adjudicated by an I.H.S. employee using the Office of Personnel Management Personnel Investigations Processing System.

Contractors shall allow five (5) business days for I.H.S. processing of fingerprints taken electronically at an I.H.S. site and thirty (30) business days for non-electronic processing of fingerprints using FBI Form FD-258. A list of I.H.S. sites with electronic fingerprint capability is available from the Contracting Officer.

In addition, no Contractor or subcontractor employee shall be permitted to perform work under this contract if listed on the HHS Office of Inspector General List of Excluded Individuals/Entities

(LEIE), http://exclusions.oig.hhs.gov. As soon as practicable prior to the start of work, the performance of the work the Contractor shall provide to the Contracting Officer the names of all individuals to be used in performance of work for screening against the LEIE. During the performance, the Contractor shall provide the Contracting Officer the names of any additional or substitute employees for screening before they begin work.

The Contractor is responsible for conducting security preclearance investigations in sufficient depth to ensure that each Contractor or subcontractor employee referred to I.H.S. is not on the

LEIE and can obtain a favorable fingerprint clearance. Each security preclearance shall be conducted sufficiently in advance of the start of performance to avoid delays caused by denial of access. If this is a Time and Materials, Labor-Hour or Cost Reimbursement contract, the contractor shall not charge for or be reimbursed for labor hours or other costs incurred for employees who are unable to perform due to denial or access or the excess time required to resolve and clear unfavorable security clearance findings. If this is a Fixed Price contract, denial of access due to security clearance findings shall not be a basis for excusable delay or an increase to the contract amount.

The Government will pay for the cost to process the contractor's suitability clearances.

However, multiple investigations for the same position may, at the Contracting Officers discretion, lead to reduction(s) in the contract price of no more than the cost of the extra investigation(s).

http://exclusions.oig.hhs.gov/ http://exclusions.oig.hhs.gov/

Employees that DO NOT have access to LMS, contractors, volunteers, or IHS employees with

IPA's or MOA's to tribal organizations please, click here IHS Sexual Abuse Prevention website.

When the contractors have completed and passed the training, please have them send a copy of the last page of the training with Name, Date, and Time to their Supervisor, COR, and Kimmen

LeBeau, e-mail: Kimmen.LeBeau@ihs.gov.

"Contract Personnel will arrive on a Business Day ONLY to complete all Orientation and

Background procedures. The Clinical Director or Designee will ensure all Orientation and

Background procedures have been completed and an email will be sent to the Contracting department to state as such. The Contract Personnel will NOT see patients until

Background/Fingerprints have been cleared."

"The standards of medical practice and duties of the Contractor through its Contract Personnel shall be determined pursuant to the bylaws of the Service Unit. The regulations of the hospital, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of Contract Personnel and hospitals must be followed. Also, the standards and recommendations of Centers for Medicare and Medicaid Services (CMS) or the Accreditation organization must be adhered to. The Contract Personnel shall be required to participate in a quality improvement program, which is consistent with current requirements for ongoing monitoring and evaluation of the quality and appropriateness of care."

O. Offers will be accepted electronically, Submit via e-mail to the following:

Great Plains Area Indian Health Service Division of Acquisition Management

Attn: William Kohl, Contract Specialist

Email: William.Kohl@ihs.gov

Any questions, please submit by email to: William.Kohl@ihs.gov; before August 11, 2025 by

12:00 pm CST. Contractors will need a Unique Entity ID (UEI) number, TIN number, and be registered with www.sam.gov.

Invoice Processing Platform (IPP)

The Indian Health Service (IHS) is in the process of implementing an electronic invoicing system. In compliance with the Office of Management and Budget (OMB) M-15-19 memorandum “Improving

Government Efficiency and Saving Taxpayer Dollars Through Electronic Invoicing” directing Federal agencies to adopt electronic invoicing as the primary means to disburse payment to vendors. Invoices submitted under any award will be required to utilize the Invoice Processing Platform (IPP) in accordance with HHSAR 352.232-71, Electronic Submission and Processing of Payment Requests”.

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the

Treasury’s Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis (FRSTL).

Respondents to this solicitation are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register-however, we encourage you make sure your organization and designated IPP user accounts are valid and up to date.

The IPP website address is: https://www.ipp.gov.

mailto:Kimmen.LeBeau@ihs.gov mailto:William.Kohl@ihs.gov mailto:William.Kohl@ihs.gov https://www.ipp.gov/

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at (866) 973-

3131 (M-F 8AM to 6PM ET), or IPPCustomerSupport@fiscal.treasury.gov Should the contractor feel that use of the IPP would be unduly burdensome, their response to this solicitation should include an explanation of this position for a determination by the contracting officer.

ATTACHMENTS:

1. Notice to Quoters

2. SF1449 Solicitation

3. Statement of Work

4. Provisions and Clauses

5. Indian Firm Representative Form

6. Business Associate Agreement

7. Wage Determination Number 2015-5377 mailto:IPPCustomerSupport@fiscal.treasury.gov

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

See Schedule

CODE 16. ADMINISTERED BYCODE

X

X

X

621999

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR159

REQUEST FOR

PROPOSAL

(RFP)

INVITATION

FOR BID (IFB)

10. THIS ACQUISITION ISCODE

REQUEST FOR

QUOTE (RFQ)

14. METHOD OF SOLICITATION

13b. RATING

NORTH AMERICAN INDUSTRY

CLASSIFICATION STANDARD

(NAICS):

SMALL BUSINESS

08/14/2025 1200 CT

07/29/2025

WILLIAM KOHL

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70625R00004

5. SOLICITATION NUMBER

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

1 94 IHS1505961OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Multiple Destinations

15. DELIVER TO

Aberdeen SD 57401 115 4th Ave SE-Federal Building Division of Acquisition Management

INDIAN HEALTH SERVICE

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$20.5

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

ISSUE DATE

DELIVERY FOR FREE ON BOARD

(FOB) DESTINATION UNLESS

BLOCK IS MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS THIS CONTRACT IS A RATED

ORDER UNDER THE DEFENSE

PRIORITIES AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

HUBZONE SMALL

BUSINESS

8(A)

Great Plains Area

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

ADMINISTERED BY:

Great Plains Area

INDIAN HEALTH SERVICE

Division of Acquisition Management 115 4th Ave SE-Federal Building Aberdeen SD 57401

***THIS IS AN INDIAN SMALL BUSINESS ECONOMIC

ENTERPRISE (ISBEE) SET-ASIDE***

Firm Fixed Price, Non-Personal Medical Service Purchase Order for OUTPATIENT FAMILY MEDICINE

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

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

VALERIE K. HEART BROKER

. 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 (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Government Use Only)

OFFER

STANDARD FORM 1449 (REV. 11/2021)

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: REFERENCE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

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

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

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

STANDARD FORM 1449 (REV. 11/2021) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

PHYSICIANS AND OUTPATIENT PEDIATRCIANS at the

Woodrow Wilson Keeble Memorial Health Care

Center-Sisseton Indian Health Service, 100 Lake

Traverse Drive, Sisseton, South Dakota 57262.

Base Period with Nine (9) Option Periods. Base period will be Six (6) Months, and each option period will be six (6) months as well.

WORK SCHEDULE: Work shifts will typically be eight (8) hours and will be worked between the hours of 8:00am and 8:00pm Monday through Friday, including holidays; occasionally additional hours may be required, the typical work week will be

40-50 hours per week and the Contract Provider will typically be scheduled to cover the closing work shift of 11:00am to 8:00pm, depending on staffing. Work shifts on the weekends will be four (4) hours each day 1:00pm to 5:00pm. When the Contract Provider is scheduled to work on a holiday or weekend, additional time may be scheduled off during the work week, depending on staffing. Work hours will be scheduled by the

Clinical Director or designee to correspond to the needs of the facility and are subject to change.

The quoted unit price is an all-inclusive cost.

All-inclusive is defined to include travel, Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

94 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004 lodging, per diem, fringe benefits, Federal/State/Local taxes, plus any other costs pertinent to the performance of this contract.

Period of Performance: 09/01/2025 to 08/31/2030

1 BASE PERIOD: 09/01/2025-02/28/2026

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

Delivery: 02/28/2026

Delivery Location Code: IHSSISSETON

SISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2025 to 02/28/2026

2 BASE PERIOD: 09/01/2025-02/28/2026

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

Delivery: 02/28/2026

Delivery Location Code: IHSSISSETON

SISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2025 to 02/28/2026

3 OPTION PERIOD ONE (1): 03/01/2026-08/31/2026

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

4 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004

02/27/2026

Delivery: 08/31/2026

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2026 to 08/31/2026

4 OPTION PERIOD ONE (1): 03/01/2026-08/31/2026

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/27/2026

Delivery: 08/31/2026

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2026 to 08/31/2026

5 OPTION PERIOD TWO (2): 09/01/2026-02/28/2027

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

08/31/2026

Delivery: 02/28/2027

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2026 to 02/28/2027

6 OPTION PERIOD TWO (2): 09/01/2026-02/28/2027

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

5 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

08/31/2026

Delivery: 02/28/2027

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2026 to 02/28/2027

7 OPTION PERIOD THREE (3): 03/01/2027-08/31/2027

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/26/2027

Delivery: 08/31/2027

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2027 to 08/31/2027

8 OPTION PERIOD THREE (3): 03/01/2027-08/31/2027

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/26/2027

Delivery: 08/31/2027

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2027 to 08/31/2027

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

6 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004

9 OPTION PERIOD FOUR (4): 09/01/2027-02/29/2028

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

08/31/2027

Delivery: 02/29/2028

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2027 to 02/29/2028

10 OPTION PERIOD FOUR (4): 09/01/2027-02/29/2028

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

08/31/2027

Delivery: 02/29/2028

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2027 to 02/29/2028

11 OPTION PERIOD FIVE (5): 03/01/2028-08/31/2028

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/29/2028

Delivery: 08/31/2028

Delivery Location Code: IHSSISSETON

IHSSISSETON

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

7 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2028 to 08/31/2028

12 OPTION PERIOD FIVE (5): 03/01/2028-08/31/2028

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/29/2028

Delivery: 08/31/2028

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2028 to 08/31/2028

13 OPTION PERIOD SIX (6): 09/01/2028-02/28/2029

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

08/31/2028

Delivery: 02/28/2029

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2028 to 02/28/2029

14 OPTION PERIOD SIX (6): 09/01/2028-02/28/2029

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

08/31/2028

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

8 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004

Delivery: 02/28/2029

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2028 to 02/28/2029

15 OPTION PERIOD SEVEN (7): 03/01/2029-08/31/2029

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/28/2029

Delivery: 08/31/2029

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2029 to 08/31/2029

16 OPTION PERIOD SEVEN (7): 03/01/2029-08/31/2029

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/28/2029

Delivery: 08/31/2029

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2029 to 08/31/2029

17 OPTION PERIOD EIGHT (8): 09/01/2029-02/28/2030

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

9 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004

$___________________ TOTAL

(Option Line Item)

08/31/2029

Delivery: 02/28/2030

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2029 to 02/28/2030

18 OPTION PERIOD EIGHT (8): 09/01/2029-02/28/2030

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

08/31/2029

Delivery: 02/28/2030

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 09/01/2029 to 02/28/2030

19 OPTION PERIOD NINE (9): 03/01/2030-08/31/2030

THREE (3) OUTPATIENT FAMILIY MEDICINE PHYSICIANS

ESTIMATED 3,900 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/28/2030

Delivery: 08/31/2030

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2030 to 08/31/2030

20 OPTION PERIOD NINE (9): 03/01/2030-08/31/2030

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

10 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004

ONE (1) PEDIATRICIAN

ESTIMATED 1,300 HOURS

$___________________ PER HOUR

$___________________ TOTAL

(Option Line Item)

02/28/2030

Delivery: 08/31/2030

Delivery Location Code: IHSSISSETON

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262 US

Period of Performance: 03/01/2030 to 08/31/2030

RFP TOTAL $____________________

ATTACHMENTS:

1. Notice to Quoters

2. SF18 Request for Quotes

3. Statement of Work

4. Business Associate Agreement

5. Provisions and Clauses

Invoice Processing Platform (IPP)

The Indian Health Service (IHS) is in the process of implementing an electronic invoicing system in compliance with the Office of Management and

Budget (OMB) M-15-19 memorandum Improving

Government Efficiency and Saving Taxpayer Dollars

Through Electronic Invoicing directing Federal agencies to adopt electronic invoicing as the primary means to disburse payment to vendors.

Invoices submitted under any award resulting from this solicitation will be required to utilize the

Invoice Processing Platform (IPP) in accordance with HHSAR 352.232-71, Electronic Submission and

Processing of Payment Requests.

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the

Treasurys Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St.

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

11 94

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70625R00004

Louis (FRSTL). Respondents to this solicitation are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register, however, we encourage you make sure your organization, and designated IPP user accounts are valid and up to date.

The IPP website address is: https://www.ipp.gov.

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at (866) 973-3131 (M-F 8AM to 6PM ET), or

IPPCustomerSupport@fiscal.treasury.gov. Should the contractor feel that use of the IPP would be unduly burdensome, their response to this solicitation should include an explanation of this position for a determination by the contracting officer.

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Statement of Work

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER

INDIAN HEALTH SERVICE

PERFORMANCE STATEMENT OF WORK

FAMILY PRACTICE PHYSICIAN AND PEDIATRICIAN SERVICES

GENERAL

The mission of the Sisseton Indian Health Service – Woodrow Wilson Keeble Memorial Health Care Center, also known as WWKMHCC, is to provide the best possible healthcare services to the patients on the Lake Traverse Reservation in South Dakota. To meet this mission, the WWKMHCC is requesting an all-inclusive, non-personal service contract for up to three (3) Family Medicine Outpatient Physician Providers and one (1) Pediatrician to assist with an ongoing primary care provider shortage.

PURPOSE

To provide uninterrupted outpatient Family Medicine and Pediatrician services, for the Outpatient Department (OPD) WWKMHCC with up to four (4) Contract Providers. The Contract Providers shall perform primary care services compatible with the IHS medical facility’s operating capacity and equipment, on the Lake Traverse Reservation. The Care shall cover the range of primary care typically provided in a rural civilian practice of similar size.

BACKGROUND

The IHS is an agency within the Department of Health & Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The Indian Health Service provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 567 federally recognized tribes, in 35 states. The Indian Health Service Headquarters is located in Rockville, MD and then divided into twelve (12) physical areas: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland, and Tucson.

The Great Plains Area Office (GPAO) works in conjunction with 19 Indian Health Service Units and Tribal Managed Service Units to provide health care to approximately 130,000 Native American located in North Dakota, South Dakota, Nebraska, and Iowa. The Area Office’s service units include seven hospitals, eight health centers, and several smaller health stations and satellite clinics.

Our facility, the WWKMHCC, falls under the GPAO. WWKMHCC provides medical care for approximately 7,000 tribal members living on the Lake Traverse Reservation. Serving a rural area, many of our patients travel 100 miles round trips to receive care. The WWKMHCC was built in 2007 to provide an expanded level of outpatient health care services specifically designed to meet the needs of the WWKMHCC population. Services include: Pharmacy, Physical Therapy, Public Health Nursing, Radiology Services, Laboratory, Dental, Community Health, Purchase & Referred Care Services, Nutrition Services, and Optometry.

PERIOD OF PERFORMANCE

Date of Award, Base Year plus four (4) Option Years.

PLACE OF PERFORMANCE

Woodrow Wilson Keeble Memorial Health Care Center Indian Health Service 100 Lake Traverse Drive Sisseton, SD, 57262

Treatment of IHS patients shall be performed at the IHS facility except in certain instances when patients are referred to private facility for performance of special diagnostic procedures or definitive care not offered in the IHS facility. All referrals to outside facilities shall follow Indian Health Service regulations and policies on patient referrals.

DESCRIPTION OF SERVICES

Upon the receipt of an IHS purchase order, the contractor shall locate, credential, and have available sufficient staffing to provide seamless coverage of Family Medicine Physician and Pediatrician Providers for the Outpatient Department in the WWKMHCC IHS in Sisseton, SD. The contractor shall provide a full orientation of this scope of work to the Contract Providers prior to submitting the confirmation service agreement.

The contract resulting from this solicitation shall:

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

2. Allow the government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of the services rendered, (e.g., professional judgements, diagnostics for specific medical treatment).

3. Require the Contractor to indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance.

4. Require the Contractor to maintain medical liability insurance, in the coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty concerned.

5. Require the Contractor to assume sole and exclusive responsibility for employee federal taxes, social security), unemployment insurance, and workman's compensation.

6. Require the Contractor to provide daily compensation and travel reimbursements to each Contract Provider as appropriate.

7. Provider's full name

8. Provider's date of birth

9. Provider's social security number

10. Provider's contact phone number

11. Provider's e-mail address

12. Provider's current curriculum vitae with listing of all work experience, and explanations for any employment gaps

13. Release of information signed by the Contract Provider

14. Minimum of three (3) letters of reference (preferably within the past 6 months); must have (1) medical supervisor and (2) peers from the same discipline or physicians providing oversight

In the event that the provider is not accepted, the documentation will be sent to the COR for review/comments and the Contractor will have three (3) business days to present a new provider(s).

Upon acceptance of a provider by the CD, a full background investigation and credentialing packet shall be sent to the contractor. The Contractor is responsible for ensuring that proposed providers possess the requisite credentials to enable granting of privileges by the Sisseton Medical Staff sufficient to allow for performance of all objectives identified. The contractor shall send a fully completed background investigation and credentialing packet back within seven (7) days. The entire candidate presentation and paperwork completion shall be accomplished within thirty (30) days.

Once a Contract Provider has been cleared for suitability with a completed eQIP and has been granted privileges, the Contractor shall submit a confirmation service agreement and include the following information:

1. Provider name and area of practice

2. Contract Provider phone number

3. Dates of service

4. Confirmation of completion of Contract Provider's orientation to this scope of work

5. Point of contact and phone number

CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of Health and Human Services (HHS) unless such a person seeks and receives approval in accordance with the Department of HHS.

CONTINUITY OF SERVICES. The Contract Providers' services are considered vital to the Government and must be continued with minimal interruption. In order to minimize interrupted services, the Contractor shall exercise best efforts and cooperation to provide seamless coverage with a 90-day advance schedule. In the event the contractor is unable to fulfill the purchase order requirements for whatever reason; the government reserves the right to fulfill its need outside of this contract. A written confirmation from the contractor indicating the inability to fulfill the purchase order is immediately required. The government’s right to fulfill its need outside this contract(s) does not waive its right to the issuance of a cure notice nor does it waive its right to terminate.

In the event the Contractor is unable to fulfill the purchase order requirements for whatever reason; the government reserves the right to fulfill its need outside of this contract. A written confirmation from the contractor indicating the inability to fulfill the purchase order is immediately required. The government's right to fulfill its need outside this contract(s) does not waive its right to the issuance of a cure notice nor does it waive its right to terminate.

TECHNICAL REQUIREMENTS

1. Ability to provide Physicians in a timely manner who diagnose and treat medical and minor surgical illnesses, perform follow-up, and obtain consultation for medically complex patients of all ages who present for care in an urgent care setting.

2. Ability to assist with completion of background investigation paperwork, including electronic, Questionnaires for Investigations Processing (eQIP), and credentialing Contract Providers by the established deadlines.

3. Ability to provide Contract Providers who can interact with patients and clinical staff in a customer friendly and culturally sensitive manner.

4. Ability to provide Contract Providers who possess Electronic Health Record experience.

CONTRACT PROVIDER REQUIREMENTS

COMPUTER SKILLS. Computer efficiency and Electronic Health Record experience is required.

ENGLISH LANGUAGE REQUIREMENT. The Contract Provider(s) shall read, understand, speak and write English fluently, and communicate with sufficient clarity to be understood by WWKMHCC personnel and patients.

HEALTH REQUIREMENTS. The Contract Provider shall not have any work or health restrictions which interfere with the performance of primary care provider services. The Contract Provider shall provide proof of current immunizations (Hep 8, MMR, Varicella, Tdap, Flu} status and a current PPD within the past year.

QUALIFICATIONS. Contract physicians shall be board certified, eligible, or have partial completion of an accredited residency program. Current Basic Life Support (BLS) certification is required of physicians placed by the Contractor. The Contract Provider must have a minimum of 2 years of experience within Family Medicine/General Medicine within the past 36 months, and must meet all credentialing and background investigation requirements.

CONTRACT PROVIDER RESPONSIBILITIES

APPEARANCE. Contract Providers are expected to comply with reasonable dress, grooming and hygiene standards based on comfort, productivity, health and type of position occupied as compatible with the expectations of the WWKMHCC IHS and the Native American community. Contract Providers' attire will be professional and in compliance with the expectations of the WWKMHCC Policy and Procedures, including display their identification badge on their outer clothing at all times.

CLINICAL DUTIES

The Contract Provider's actual clinical duties will be in accordance with his/her credentialed privileges within the Medical Staff Bylaws of the WWKMHCC, and will include the following:

1. Provide high quality and efficient care to patients; examine and diagnose the health-related conditions of patients of all ages who present for care, seeing an average of 16 patients per day.

2. Refer individuals for consultation when appropriate, and prescribe and carry out appropriate therapy as recommended by the specialist.

3. Participate in Patient Centered Medical Home (PCMH) model and encourage patient engagement.

4. Educate individuals in the nature of health-related conditions, recommended therapy, and general promotion of health and prevention of disease.

5. Obtain necessary information on patients seen in the OPD, such as medical records, x-ray images and reports, normal and abnormal test results, and documents pertinent to the patient's medical record.

6. Establish interpersonal, intra-departmental relationships, and social sensitivity such that he/she can relate constructively to patients from Native American communities to enhance optimal patient care.

7. Maintain familiarity and comply with Federal, State, Indian Health Service, accreditation standards, CMS regulations, and departmental regulation and requirements.

8. Participate in committees as assigned (Medical Staff, Purchase & Referred Care, Quality Assurance, Pain Management, Pharmacy & Therapeutics, Outpatient Department, etc.).

9. Staff development/education as assigned by the Clinical Director.

10. Peer reviews as assigned according to facility by-laws.

PATIENT SCHEDULING

Facility personnel will assist with patient scheduling. Patient appointments will be scheduled initially for sixty (60) minutes in length for the first three (3) weeks of orientation. Appointments will then be scheduled for thirty (30) minutes in length except for those appointments requiring additional time as determined by the facility, including but not limited to, physicals, initial pain agreements, newly established patients, etc.

TIMESHEETS

The Contract Provider will be responsible to report to work at the scheduled time. All Contract Providers will utilize the time clock to ensure accurate documentation of hours worked, which will be verified with submitted timesheets and invoices before payment is processed. Only hours authorized by the Clinical Director or designee will be authorized for payment.

ORIENTATION

All new contract providers will participate in the WWKMHCC facility orientation. The orientation must be completed prior to providing services at the facility, and will be scheduled for the first one (1) to three (3) days of arriving at the facility.

Alternate resource enrollment applications with the Business Office must be completed within two (2) days of onboarding.

PRESCRIPTIONS

The contractor shall receive pharmacy specific orientation and follow Indian Health Service procedures when prescribing medications. Contract Providers authorized to prescribe pharmaceuticals shall do so according to-the availability of drugs listed in the IHS formulary. The formulary list is approved and maintained by the WWKMHCC Pharmacy and Therapeutics Committee. A completed provider note is required before pharmacy can process medication orders in EHR as an IHS Standard of Care.

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATION

The Contract Providers shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contract Provider shall ensure strict compliance to the release of Protected Health Information in accordance with the Code of Federal Regulation, Title 45, Public Welfare, Subtitle A, Department of Health and Human Services, Part 164, Security and Privacy (45 CFR 164) and AFI 41-210, Patient Administration Functions, Health Insurance Portability and Accountability Act (HIPAA), and General Guidelines on Releasing Medical Information.

PROCEDURE GUIDANCE

Contract Providers shall perform procedures compatible with the medical facility's operating capacity and equipment. New medical procedures/services shall not be introduced without prior recommendation to, and approval of the Clinical Director or authorized representative.

RECORDS

The Contractor Provider shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided in accordance with Indian Health Service regulations and policies set forth by the Health Information Management (HIM) Department. Verbal orders are to be used for emergencies only. In the event of a major disaster or code all verbal orders are to be signed off immediately following the code or disaster. The Contract Provider shall prepare all medical record documentation to meet or exceed the established standards of the IHS facility including, but not be limited to, timeliness, accuracy, content, and signature.

All medical record information generated in the performance of this contract will remain the property of and subject to the exclusive control of the Indian Health Service.

REFERRALS AND CONSULTS

The provider shall follow IHS Purchased & Referred Care regulations and policies when arranging for a referral or consult.

The Contract Provider shall be required to consult with other specialty practitioners for consultative opinions and continuation of care. The Contract Provider is responsible for continuing any services/treatment as recommended by the consultant and shall communicate any patient care issues with the specialist as needed.

QUALITY IMPROVEMENT

The standards of medical practice and duties of the Contractor through its physician's shall be determined pursuant to the bylaws of the WWKMHCC, the regulations of the facility, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of physicians and outpatient facilities, and accrediting standards. All Contract Provider's shall be required to participate in a quality improvement program, which is consistent with current accreditation standards and Medicaid Services (CMS) Conditions of Participation (CoP) requirements for ongoing monitoring and evaluation of the quality and appropriateness of care.

WORK SCHEDULE

Work shifts will typically be eight (8) hours and will be worked between the hours of 8:00am and 8:00pm Monday through Friday, including holidays; occasionally additional hours may be required, the typical work week will be 40-50 hours per week and the Contract Provider will typically be scheduled to cover the closing work shift of 11 :00am to 8:00pm, depending on staffing. Work shifts on the weekends will be four (4) hours each day 1 :00pm to 5:00pm. When the Contract Provider is scheduled to work on a holiday or weekend, additional time may be scheduled off during the work week, depending on staffing. Work hours will be scheduled by the Clinical Director or designee to correspond to the needs of the facility and are subject to change.

PRIVILEGING REQUIREMENTS

In accordance with the Indian Health Service credentialing policy, a primary source verification shall be completed for all Contract Providers performing services under this contract. The WWKMHCC will provide the credentialing packet and all associated documents to the Contractor and the Contract Provider shall complete and return all documents.

Reappointment shall occur no less than every two years, in accordance with WWKMHCC Medical Bylaws.

When submitting a potential candidate, the following documents are required for credentialing:

1. Medical Staff Application (provide explanations to any "yes" questions on liability, final judgments, settlements, or claims from the application): Must have evidence of good standing at all facilities where the Contract Provider practices: Must not have been subject to involuntary limitation, reduction, denial or loss of clinical privileges, and have no current federal sanctions and provide a history of previous or pending malpractice lawsuits

2. Copies of pre-professional and professional school diplomas showing proof of graduation from an accredited school of their profession; must be in good standing with National Practitioner's Data Bank and the Health Integrity Protection Data Bank

3. Copies of certificates of completion of post-graduate training (residency)

4. Copy of Board Certification certificate or letter

5. Copies of all current licenses {active and inactive): Must maintain a current active and unrestricted license in at least one of the 50 United States or US territories

6. Copy of current DEA certificate

7. Copy of current liability insurance

8. Completed and signed clinical privileges request form (must be specific to the facility assigned and specific to the applicant's abilities/competencies)

9. Signed Medicare Agreement form

10. Signed Health Status Statement, including provider signature

11. Copy of immunization record (PPD within past year with x-ray if positive)

12. Signed Medical Staff Bylaws Attestation Statement

13. Three (3) letters of reference within the past year (one reference must be from the same discipline peer and one reference must be from the current or most recent medical supervisor)

14. Copy of a government issued photo identification card (Driver's license or passport)

15. Copy of Social Security card

16. Signed Confidentiality Statement

17. Signed Child Care and Indian Child Care Worker Positions Agreement

18. Current Continuing Medical Education (CME) for the past two (2) years

19. Copies of Basic Life Support (BLS) and if applicable, Acute Cardiac Life Support (ACLS) and Pediatric Acute Life Support (PALS) Certifications.

20. Copy of National Provider Identification (NPI) notification letter

21. Signed Provider Signature Card

22. A current copy of the proposed contract provider's professional curriculum vitae (submitted with initial candidate presentation)

Exceptions to the Indian Health Service credentialing review and clinical privileges process will not be considered. The Contractor's failure to submit successful applicants shall not excuse nonperformance of contract requirements. Any Contract Provider who falls to maintain medical staff appointment and clinical privileges will not be permitted to perform services under the contract and shall be promptly replaced by the Contractor.

CHARACTER INVESTIGATION

CRIMINAL BACKGROUND CHECK REQUIREMENT. The Government will conduct, at the government expense, a Tier 2 with Subject Interview (T2S) and state criminal history checks on individuals providing direct, unsupervised child care services under this contract.