75H70626Q00010-RFQ.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

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

OFFEROR

Belcourt ND 58316 PO Box 160 1300 Hospital Road Belcourt PHS Indian Hospital

IHSBELCOURT CODE 16. ADMINISTERED BYCODE

X

X

561320

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR163

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

12/08/2025 1200 CT

11/07/2025

701-477-8416JODY LONGIE

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70626Q00010

5. SOLICITATION NUMBER

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

1 82 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Belcourt ND 58316 PO Box 160 1300 Hospital Road Q.N.B.M.H.C.F

IHSBELCOURT

15. DELIVER TO

Belcourt ND 58316 P.O. Box 160 1300 Hospital Road

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$34

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

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Belcourt PHS Indian Hospital

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Firm Fixed Priced, Non-personal, Healthcare Service, Commerical Item, Purchase Order for Temporary Optometrists service for the Quentin N Burdick Memorial Healthcare Facility, 1300 Hospital Loop, Located in Belcourt North Dakota.

The Period of performance will be determined after the award.

Attachments:

Statement of Work (SOW)

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

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED

NICHOLE R. LEREW

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

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

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

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

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

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

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

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

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

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

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

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. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

SF-1449

Clauses Incorporated by Reference and Full Text

Contractors Performance Conditions &

Responsibilities

Indian Firm Representative Form

Business Associates Agreement

Wage Grade Determination

Delivery: 11/30/2026

Period of Performance: 01/01/2026 to 12/31/2026

1 Temporary Optometrists service for estimate of one (1) year

Period of Performance: 12/01/2025 to 11/30/2026

The "Unit Price" is an all-inclusive cost. All

"inclusive cost" is defined to include travel, lodging, per diem, fringe benefits, i.e., life insurance, social security, federal, state, and local taxes, plus all other costs pertinent to the performance of this purchase order/contract.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

82 2 of

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 Temporary Optometrist service, Purchase Order for one (1) year in response to Request for Quote (RFQ) 75H70626Q00010.

C. This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2025-06 October 1, 2025.

D. This RFQ is issued as 100% Indian Economic Enterprises (IEE) Set-Aside, and the associated NAICS Code is #561320, code for Temporary Help Services.

This means that for a business to be considered a small business under this NAICS code, size standards in millions of dollars $34.0. Quoter is required to fill out the attached INDIAN FIRM REPRESENTATION FORM.

E. The quoted unit pricing must be all inclusive (including, 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.

See the attached SF-1449: Complete, sign and return the SF-1449 along with the Business Associates Agreement for the Quote #75H70626Q00010 for Temporary Optometrist service.

Quotes will be valid until December 31, 2025.

F. Firm Fixed Price, Non-Personal Temporary Optometrist services to be provided for the Quentin N Burdick Memorial Healthcare Facility 1300 Hospital Loop Belcourt North Dakota 58316. See the Statement of Work (SOW) attached. The period of performance will be for one (1) year.

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: 75H70626Q00010

2. Closing Date: December 8, 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. FAR 52.212-2 Evaluation-Commercial Products and Commercial Services (Nov 2021);

attached in full text.

Basis of Award: Best Value with Lowest Price Technical Acceptable.

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 an 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 offerors 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. Technical Approach:

• Understanding of the Statement of Work (SOW) requirements

• Clarity, feasibility, and detail of the proposed approach

• Innovative methods and ability to address potential challenges

• Quality assurance and compliance with standards/regulations

2. Price:

• Fair and reasonable in comparison to the Independent Government Estimate (IGE), competition received, and historical pricing data.

• Complete, with all Contract Line Item Numbers (CLINs), option periods, and required elements properly priced in accordance with the solicitation.

• Balanced, ensuring that no line items are significantly overstated or understated in a manner that poses risk to the Government.

• Realistic (if applicable), assessing whether the price is sufficient to accomplish the technical requirements and reflects a clear understanding of the work.

3. Past Performance:

• Relevance of past performance contracts

• Quality of services delivered (timeliness, accuracy, customer satisfaction)

• Record of compliance with contract terms and conditions

• Responsiveness to performance issues and corrective actions

FAR 52.212-3 Offer Representations and Certifications-Commercial Products and Commercial Services (Oct 2025).

Offeror shall complete only paragraphs

See attachment for full text. The

(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.

II. FAR 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial

Services (Nov 2023). Applied to this acquisition and “incorporated by reference.”

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

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

Services Acquisition Regulation (HHSAR) clauses that are applicable, including below.

V. Submit proposal to:

Quentin N Burdick Memorial Healthcare Facility Attn: Jody Keplin, Purchasing Agent 1300 Hospital Loop Belcourt, ND 58316 Email: jody.keplin@ihs.gov

Questions regarding to this solicitation shall be submitted in writing by email to jody.keplin@ihs.gov.

The last day to submit questions is November 26, 2025, before 12:00 pm, CT.

http://www.acquisition.gov/ mailto:jody.keplin@ihs.gov mailto:jody.keplin@ihs.gov

SECURITY CLEARANCE

A security pre-clearance must be provided 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 a 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 business days for I.H.S. processing of fingerprints taken electronically at an I.H.S. site and thirty 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 pre-clearance 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.

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).

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.

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.

http://exclusions.oig.hhs.gov/ http://exclusions.oig.hhs.gov/ https://www.ihs.gov/sexualabuseprevention/training/ mailto:Kimmen.LeBeau@ihs.gov https://obamawhitehouse.archives.gov/sites/default/files/omb/memoranda/2015/m-15-19.pdf

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 to 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”.

ATTACHMENTS:

Combined Synopsis Notice SF-1449 Request for Quotes Performance Work Statement Provisions and Clauses Indian Firm Representative Form Business Associate Agreement

Wage Determination Number # _2015-5385 https://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov

PERFORMANCE WORK STATEMENT

Optometrist Quentin N. Burdick Memorial Health Care Facility.

Part 1

General Information

1. GENERAL: This is a non-personnel services contract to provide a Optometrist. The Government shall not exercise any supervision or control over the contract service providers performing the services herein.

Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

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

1.2 Background: The Mission of the Quentin Burdick Memorial Healthcare Facility Indian Health Service is to provide the best possible healthcare services to the patients of the Quentin Burdick Memorial Healthcare Facility Indian Health Hospital. To meet this mission, the Quentin Burdick Memorial Healthcare Facility Service Unit has identified a need for a Non-Personal Service Contract for providing Optometric services with an Optometrist.

1.3 Objectives: The contract Optometrist, to provide all necessary covered services within the Optometrist’s scope of practice, under the direction of the Clinical Director or designee.

• The Contracted Optometrist shall provide a full scope of services to all age range of patients at the Quentin Burdick Memorial Healthcare Facility Service Unit

1.4 Scope: Provide medical care services for Clinical services. Services include providing direct care to patients of all ages with a variety of Optometric maintenance needs. The Indian Health Service requires the Optometrist services as described above to continue without interruption during the term of this contract.

The contractor shall accomplish Optometric care provided by the contracted Optometrist and shall be as comprehensive as the Indian Health Service supplied facilities, equipment, and support services permit.

The contract resulting from this solicitation shall:

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

b. Require the contractor to promptly provide any and all requested information to allow for the proper credentialing and privileging of medical providers.

c. 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 judgments, diagnosis for specific medical treatment);

d. Require the contractor to indemnify the government for any liability producing act of omission by the contractor, its employees and agents occurring during contract performance;

e. 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 with the local community for the medical specialty concerned; and

f. Require the contractor to ensure its subcontracts for provisions of health care services, contain the requirements of the clause at FAR 52.237-7 (Indemnification and Medical Liability Insurance), including the maintenance of medical liability insurance and meet the Quentin Burdick Memorial Healthcare Facility Indian Health Hospital’s accreditation requirements with regard to professional credentials including any support staff.

g. Candidates with prior Medical Licensure actions are not eligible for temporary privileges. The process of granting of privileges by the facility Governing Body may take up to 3 months.

1.5 Period of Performance: The Period of Performance shall be listed on the Task Order as scheduled with the Clinical Director or designated representative. The contract Optometrist shall provide health care services, for the entire Period of Performance at the Quentin Burdick Memorial Healthcare Facility.

The usual work day will be from 8:00 am to 4:30 pm (8 hour shifts). The Optometrist shall schedule and perform procedures as appropriate.

1.6 General Information:

1.6.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. The QCP is to be delivered within 30 days after contract award or with the contractors proposal if it is an evaluation factor, three copies of a comprehensive written QCP shall be submitted to the CO and COR within 5 working days when changes are made thereafter. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

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

1.6.3 Recognized Holidays: The provider will not be on-call for Federal Government holidays, weeknights and weekends as depicted in schedules provided upon issuance of Task Order.

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

1.6.4 Hours of Operation: The contractor is responsible for conducting business, between the hours of 8:00 am-4:30 pm. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at Quentin N.

Burdick Health care facility, Belcourt, ND which is an Indian Health Service government facility.

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

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

a. Contractor personnel performing work under this contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act” P.L.

101-630. The Indian Health Service Personnel Office will conduct these investigations following award of a contract unless in the judgment of the Contracting Officer, in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individual shall not have unsupervised contact with Indian children.

b. The Contracting Officer has the authority to temporarily waive the character investigation of a contractor. The “Agreement to a Temporary Waiver of Character Investigation” (See Attachment B) 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).

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

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

1.6.7.2 Key Control: The Contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the Contractor by the Government shall be duplicated. The Contractor shall develop procedures covering key control that shall be included in the Quality Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Contracting Officer.

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

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

1.6.8 Special Qualifications: It is a condition of this contract that all required certifications remain current during the life of this contract.

The contractor is responsible for ensuring the contract Optometrist shall possess a current, unrestricted state Optometrist license from any of the 50 United States or the Commonwealth of Puerto Rico, be registered with an Optometry Board and registered with an Optometry Licensure.

Possess current (BLS) Basic Life Support certification.

The contractor is responsible for ensuring the contract Optometrist shall

a. Not have any work or health restrictions, which interfere with the performance of general medical services.

b. Have actively performed emergent or non-emergent Optometric procedures.

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

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

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues.

These meetings shall be at no additional cost to the government.

1.6.10 Contracting Officer Representative (COR): The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance:

maintain written and oral communications with the Contractor concerning technical aspects of the contract:

issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

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

Gilbert Falcon, MD or Shyleen Hall, MD/Acting Clinical Director

Jennilee Blue, Credentialing Coordinator

Yvette Wallette, COR II

The contractor shall provide a contract manager who shall be responsible for the performance of the work.

The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between 8:00 a.m. to 4:30p.m., Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons.

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

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

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

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

1.6.16 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

Authority

1.1. No person other than the Contracting Officer has authority to bind the Government with respect to this contract.

1.2. No action or omission of any government employee or representative other than the Contracting Officer shall increase or decrease the scope of this contract or shall otherwise modify the terms and conditions of this contract.

1.3. In no event shall any of the following be effective or binding on the Government or imputed to the Contracting Officer with respect to this contract:

1.3.1. An understanding or agreement between the Contractor and anyone other than the Contracting Officer;

1.3.2. A purported modification or change order issued by anyone other than the Contracting Officer;

1.3.3. A promise by anyone other than the Contracting Officer to provide additional funding or make payments; or

1.3.4. An order, direction, consent, or permission from anyone other than the Contracting Officer to:

1.3.4.1. Incur costs in excess of a specified estimated cost, allotment of funds, or other ceiling; or,

1.3.4.2. Expend hours in excess of a specified level of effort.

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS:

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

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

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

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

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

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

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

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

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

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

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

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

2.1.12. WORK WEEK. As specified otherwise.

2.2. ACRONYMS:

ACOR Alternate Contracting Officer's Representative AFARS Army Federal Acquisition Regulation Supplement OD Doctor of Optometry

CCE Contracting Center of Excellence CFR Code of Federal Regulations CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTR Contracting Officer's Technical Representative COTS Commercial-Off-the-Shelf IHS Indian Health Service DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense FAR Federal Acquisition Regulation HIPAA Health Insurance Portability and Accountability Act of 1996 KO Contracting Officer OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program TE Technical Exhibit

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

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

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

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

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

3.3 Utilities: The Government will provide all utilities in the facility will be available for the contractor’s use in performance of tasks outlined in this PWS. If utilities are furnished, the following is required: The Contractor shall instruct employees in utilities conservation practices. The contractor shall be responsible for operating under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

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

3.5 Materials: The Government will provide materials, i.e., Standard Operating Procedures and Policies.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

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

4.2 Verification of Licensure

To ensure that Optometrist providing services under this contract are properly licensed and that the I.H.S. is made aware of all disciplinary actions taken against such physicians, the contractor will:

a. Verify through the National Optometry Boards database all active, inactive, and lapsed licenses that are held, or have been held, by Optometrist who would provide services in I.H.S. hospitals and clinics under this contract.

b. Inform I.H.S. of the status of all licenses for each Optometrist who would provide services under this contract in I.H.S. hospitals and clinics, including all reasons for each inactive or lapsed license.

c. Obtain at least three letters of reference from health care providers whom have knowledge of the applicant’s clinical practice skills within the past six months. One letter must be from the previous supervisor, at the hospital where the Optometrist holds or last provided medical/surgical care.

d. Provide all information regarding performance and disciplinary actions that is collected on a provider who would be placed under this contract to the receiving I.H.S. facility Clinical Director.

This includes all information that is collected and compiled on such providers at the time of initial hire by the Contractor, and/or information that is reported during periods that the Contractor is an agent of such Optometrist for placement under this contract.

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

The Contractor must provide all of the information required above to the Clinical Director of the receiving I.H.S. facility no less than ten to fourteen days before the Optometrist actual report date. When the requirements or the I.H.S. do not allow for hard copies of information to be received at least ten days before an Optometrist placement, the Contractor may provide such assurances to the I.H.S. facility Clinical Director within five days after Optometrist placement. Such instances shall be kept to a minimum and the reasons for each instance must be documented and well justified by the Clinical Director at the receiving I.H.S. facility. (Per amend. #2-9/28/95)

4.3 Medical liability Insurance:

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

An apparently successful offers or upon request by the contracting officer, will furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by this contract.

Liability insurance may be on either an occurrence basis or on claims made basis. If the policy is on claims made basis, an extended reporting endorsement (tail) for a period of not less than three (3) years after the end of the contract term must also be provided.

A CERTIFICATE OF INSURANCE EVIDENCING THE REQUIRED COVERAGE WILL BE

PROVIDED TO THE CONTRACTING OFFICER PRIOR TO THE COMMENCEMENT OF SERVICES

UNDER THIS CONTRACT. If the insurance is on a claims made basis and evidence of an extended reporting endorsement (tail) is not provided prior to the commencement of services, evidence of such endorsement will be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract will be withheld until evidence of the extended reporting endorsement (tail) is provided to the Contracting Officer.

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

The contractor shall insert the substance of this clause, including this paragraph, in all subcontracts under this contract for health care services and will require such subcontractors to provide evidence of and maintain insurance in accordance with this clause.

At least 5 days before the commencement of work by any subcontractor, the contractor will furnish to the contracting officer evidence of such insurance.

4.3 Payment for services

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

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

4.3.1 Invoice information requirements:

1. Contractor/Vendor Name

2. Mailing Address

3. Telephone Number

4. TIN (Tax Identification Number)

5. Bank Routing Number (9 digits)

6. Checking or Savings Account Number

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

8. Invoice Date and Number

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

10. DUNS Number (Data Universal Number)

Please provide a copy of the invoice to:

Quentin N. Burdick Memorial Healthcare Email: Julie.Laducer@ihs.gov COR II Facility, Indian Health Service ATTN: Property & Supply P.O. 160 Belcourt, ND 58316

4.4 Employee Health Requirements:

Quentin N. Burdick Health Care Facility (QNBMHCF) requires contract provider onboarding health information for all job applicants to whom conditional offers of employment have been made in order to evaluate the applicant’s health, to protect patients and staff from exposure to communicable diseases. If the job applicant refuses to provide health information, proof of immunizations as recommended by the Centers for Disease Control (CDC) concerning health-care workers in the United States, the refusal is deemed sufficient grounds for Quentin N. Burdick Health Care Service Unit to deny employment.

Information obtained regarding the medical condition or history of the applicant will be collected and maintained on separate forms and in separate medical files in accordance with federal law and will be treated as a confidential medical record.

GUIDELINES

Contract provider onboarding health information must include the following:

Previous immunization history is reviewed by the Employee Health Nurse. QNBMHCF requires all potential caregivers to provide proof of the following immunization records. If the caregiver cannot provide proof appropriate laboratory testing will be ordered.

Hepatitis B (Vaccination-declination required) All QNBMHCF contract providers who perform tasks that may involve exposure to blood or body fluids should receive a 3-dose series of hepatitis B vaccine according to manufacturer recommendations. Test for hepatitis B surface antibody (HBSAB) to document immunity 1-2 months after dose #3. If HBSAB is positive, the caregiver is immune. No further testing or vaccination is recommended.

For new hires providing proof of previous vaccination: HBSAB testing will be performed. If HBSAB results are >10mIU/mL the caregiver is immune and no additional vaccination is required.