SOL 75H70626Q00042 - Full.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

172IHSSISSETON CODE 16. ADMINISTERED BYCODE

X

X

X

621210

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR172

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

08/07/2026 1300 CT

07/08/2026

605-268-2022ANDREA WHIPPLE

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70626Q00042

5. SOLICITATION NUMBER

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

1 61 IHS1520548OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

15. DELIVER TO

Sisseton SD 57262

100 Lake Traverse Drive

Indian Health Service

Health Care Center

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$9

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)

Woodrow Wilson Keeble Memorial WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

SISSETON SD 57262

100 LAKE TRAVERSE DRIVE

SISSETON

Sisseton SD 57262

100 Lake Traverse Drive

Indian Health Service

Health Care Center

Woodrow Wilson Keeble Memorial

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

100% Indian Small Business Economic Enterprise (ISBEE) Set-Aside.

Firm Fixed-Price, Non-Personal Healthcare Service, Commercial Item, Single Award, Purchase Order, to provide General Dentists, Dental Hygienist, and Dental Assistant Services, per the Performance Work Statement, for the Woodrow Wilson Keeble Memorial Healthcare Center, Sisseton, South Dakota. The Period of Performance will be for one (1) year with four (4) one

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

HEREIN, IS ACCEPTED AS TO ITEMS:

X

DATED . 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.

(1)-year options to extend.

The quoted "unit price" is an all-inclusive cost.

All "inclusive cost" is defined to include regular hours, holidays, overtime, weeknight, weekends, call back, travel, lodging, per diem, fringe benefits, federal, state and local taxes plus all other costs pertinent to the performance of this purchase order.

1 Base Year - Two (2) General Dentists Services

See Performance Work Statement

Delivery: 08/31/2027

Period of Performance: 09/01/2026 to 08/31/2027

2 Base Year - Two (2) Dental Assistant Services

See Performance Work Statement

Delivery: 08/31/2027

Period of Performance: 09/01/2026 to 08/31/2027

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

61 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 61

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00042

3 Base Year - One (1) Dental Hygienist Services

See Performance Work Statement

Delivery: 08/31/2027

Period of Performance: 09/01/2026 to 08/31/2027

4 Option Year One (1) - Two (2) General Dentists

Services

See Performance Work Statement

(Option Line Item)

08/31/2027

Delivery: 08/31/2028

Period of Performance: 09/01/2027 to 08/31/2028

5 Option Year One (1) - Two (2) Dental Assistant

Services

See Performance Work Statement

(Option Line Item)

08/31/2027

Delivery: 08/31/2028

Period of Performance: 09/01/2027 to 08/31/2028

6 Option Year One (1) - One (1) Dental Hygienist

Services

See Performance Work Statement

(Option Line Item)

08/31/2027

Delivery: 08/31/2028

Period of Performance: 09/01/2027 to 08/31/2028

7 Option Year Two (2) - Two (2) General Dentists

Services

See Performance Work Statement

(Option Line Item)

08/31/2028

Delivery: 08/31/2029

Period of Performance: 09/01/2028 to 08/31/2029

8 Option Year Two (2) - Two (2) Dental Assistant

Services

See Performance Work Statement

(Option Line Item)

Continued ...

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

Sponsored by GSA

FAR (48 CFR) 53.110

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00042

08/31/2028

Delivery: 08/31/2029

Period of Performance: 09/01/2028 to 08/31/2029

9 Option Year Two (2) - One (1) Dental Hygienist

Services

See Performance Work Statement

(Option Line Item)

08/31/2028

Delivery: 08/31/2029

Period of Performance: 09/01/2028 to 08/31/2029

10 Option Year Three (3) - Two (2) General Dentists

Services

See Performance Work Statement

(Option Line Item)

08/31/2029

Delivery: 08/31/2030

Period of Performance: 09/01/2029 to 08/31/2030

11 Option Year Three (3) - Two (2) Dental Assistant

Services

See Performance Work Statement

(Option Line Item)

08/31/2029

Delivery: 08/31/2030

Period of Performance: 09/01/2029 to 08/31/2030

12 Option Year Three (3) - One (1) Dental Hygienist

Services

See Performance Work Statement

(Option Line Item)

08/31/2029

Delivery: 08/31/2030

Period of Performance: 09/01/2029 to 08/31/2030

13 Option Year Four (4) - Two (2) General Dentists

Services

See Performance Work Statement

(Option Line Item)

08/31/2030

Continued ...

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

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00042

Delivery: 08/31/2031

Period of Performance: 09/01/2030 to 08/31/2031

14 Option Year Four (4) - Two (2) Dental Assistant

Services

See Performance Work Statement

(Option Line Item)

08/31/2030

Delivery: 08/31/2031

Period of Performance: 09/01/2030 to 08/31/2031

15 Option Year Four (4) - One (1) Dental Hygienist

Services

See Performance Work Statement

(Option Line Item)

08/31/2030

Delivery: 08/31/2031

Period of Performance: 09/01/2030 to 08/31/2031

SECURITY CLEARANCE

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 a FBI National Criminal History Check

(Fingerprint Check) adjudicated by an I.H.S.

Continued ...

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

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CONTINUATION SHEET

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

75H70626Q00042 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 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.

Continued ...

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

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00042

Government will pay for the cost to process the contractors 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).

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

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

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

Continued ...

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

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70626Q00042 contracting officer".

The Government reserves the right to accept or reject services, if the level of performance is unacceptable.

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

WOODROW W. KEEBLE MEMORIAL HEALTHCARE CENTER

PERFORMANCE WORK STATEMENT

FIRM FIXED PRICE, PERFORMANCE BASED SERVICE CONTRACT

DENTAL SERVICES

1. GENERAL: This is a non-personnel, Firm-Fixed-Price (FFP) services contract at the Woodrow W. Keeble

Memorial Healthcare Center (WWKMHCC), Sisseton, South Dakota. The purpose of this requirement is to provide supplemental professional dental coverage to ensure continuity of oral health services and patients access to dental care. The contracted staff will augment federal staff and assist maintain safe, accurate, and effective dental services. 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: Upon award of the Contract, the Contractor shall ensure provide the requested staffing to provide coverage for Dentists, Dental Hygienist, and Dental Assistants at the Dental

Clinic in Sisseton, SD, during staffing shortages.

1.2 Be a non-personal health care service contract under which the Contractor is an independent contractor.

1.3 Allow the Government to evaluate the quality of professional and administrative services provided, but retain no control over the medical, professional aspects of the services rendered.

1.4 Require the Contractor to indemnify the Government for any liability-causing act or omission by the

Contractor, its employees, and agents occurring during contract performance.

1.5 Require the Contractor to maintain medical liability insurance int the coverage amount acceptable to the

Contracting Officer, $1,000,000-$3,000,000 or not less than the amount usually prevailing within the local community for the medical specialty concerned.

1.6 The Contractor shall be solely responsible for compensation, benefits, travel, lodging, recruiting, credentialing, supervision, taxes, insurance, and all other employee-related expenses associated with contractor personnel.

1.7 Background: Woodrow Wilson Keeble Memorial Healthcare Center operates under the auspices of the GPAO.

WWKMHCC offers medical care to approximately 7,000 tribal members living on the Lake Travers

Reservation. Serving a Rural community, many patients travel 100 miles round trip to receive care. The

WWKMHCC was established in 2007 to Expand outpatient healthcare services tailored to meet the needs of its population. WWKMHCC provides outpatient dental services to eligible beneficiaries utilizing a mixed federal and contractor personnel workforce. Contractor support is required to address and augment federal staffing patterns due to staffing shortages, vacancies, leave, workload fluctuations, and recruitment delays.

2. Objectives: Provide qualified, competent Dentists, Dental Hygienists, and Dental assistants to maintain continuity of operations and patients access to care.

2.1 Credentialing and Background- Contractor must be familiar with federal background and credentialing and submit candidates who are eligible to pass federal employee standards.

2.2 General Dentists Primary Duties: Diagnosing, treating, and preventing oral and systemic health issues such as caries and periodontal disease. Obtain accurate medical histories, obtain appropriate diagnostic information including laboratory testing and radiographic information. Administer local anesthetics and prescribe appropriate medications that are within scope and inclusive of service unit policies including antibiotic stewardship. Provide a full range of dental care within the service unit scope of service which includes but not limited to direct restorative, periodontal procedures, pedodontics, fixed and removable prosthodontics, endodontics, exodontia that fall within the service units scope of services. Providers must be proficient with managing medically compromised patients including care, consults, and referral management to the appropriate specialists/medical providers. Dentist must ensure accurate documentation and coding in a following service unit policies and accrediting body standards. Dental personnel must demonstrate professionalism and conduct that align with agency standards while respecting patients’ rights. Follow all appropriate policies and procedures including HIPPA, hospital-wide and dental specific. Participation in committees as needed is also required. All dental personnel undergo both focused and ongoing peer reviews and performance evaluations concerning their clinical skills consistent with service unit bylaws.

2.3 Dental Assistant Primary Duties. Dental assistants perform full-scope clinical duties following appropriate state licensing and clinical policies. This includes but not limited to checking in patients, rooming patients, taking vital signs, taking radiographs, providing appropriate stress-reduction techniques to anxious patients.

Provide high-quality, attentive chairside treatment such as suction, instrument passing, and procedure setup and take-down. Infection control duties include instrument reprocessing following applicable guidelines and service unit policies. Clerical duties of maintaining patient records, and scheduling appointments. Furthermore, they educate patients on oral hygiene and pre- and post-operative procedures. Dental assistants must ensure accurate documentation and coding, demonstrate proficiency in infection control, and follow clinical instructions and medical directions from appropriate staff including other assistants, hygienists, staff dentists, and the Chief Dental Officer. Additionally, dental assistants must ensure accurate documentation and coding in a timely manner. Dentist must ensure accurate documentation and coding in a following service unit policies and accrediting body standards. Dental personnel must demonstrate professionalism and conduct that align with agency standards while respecting patients’ rights. Follow all appropriate policies and procedures including HIPPA, hospital-wide and dental specific. Participation in committees as needed is also required. All dental personnel undergo both focused and ongoing peer reviews and performance evaluations concerning their clinical skills.

2.4 Dental Hygienists Primary Duties. Performing full range periodontal therapy including supra and sub-gingival prophylaxis, periodontal maintenance and scaling/root planning. Hygienists provide patient education on oral hygiene, nutrition, and oral cancer prevention, while advocation for patient comfort and effective treatment strategies. Hygienists are required to take appropriate radiographs, perform periodontal charting and provide chairside exam assistance with dentists. Clerical duties of maintaining patient records, and scheduling appointments Infection control duties include instrument reprocessing following applicable guidelines and service unit policies. Hygienists must ensure accurate documentation and coding in a following service unit policies and accrediting body standards. Dental personnel must demonstrate professionalism and conduct that align with agency standards while respecting patients’ rights. Follow all appropriate policies and procedures including HIPPA, hospital-wide and dental specific. Participation in committees as needed is also required. All dental personnel undergo both focused and ongoing peer reviews and performance evaluations concerning their clinical skills.

3. Scope: Provide requested labor category, quantity, schedule, duration, and place of performance meeting all requirements of this PWS. Contract must adequate staffing and recruiting to have contractor personnel on-site within one (1) month of personnel request and that recruiting of personnel is on-going. It is expected that contractor have personnel that have had internal vetting of background and credentialled to meet one (1) month advance requests.

3.1 Period of Performance: The Period of Performance shall be from time of award, Base Plus Four (4) Option

Years

3.2 Transition Period: The government reserves the right to not exercise any or all option periods including due to providing services with a new vendor. It is anticipated that any contracting change with require a transitional period and multiple vendors may be onsite training new contract staff. Contractor must still provide services until the end of the contract period during this transitional period.

3.3 PHASE IN /PHASE OUT PERIOD To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the Contractor shall have personnel on board, during the thirty (30) days phase in/ phase out periods. During the phase in period, the Contractor shall become familiar with performance requirements in order to commence full performance of services on the contract start date.

3.4 Place of Performance: The work to be performed under this contract will be performed at Woodrow Wilson

Keeble Memorial Healthcare Center 100 Lake Traverse Drive Sisseton SD 57262

3.5 Hours of Operation: The contractor is responsible for providing personnel for normal clinic hours and shifts, between the hours of 8:00 a.m. – 4:30 p.m. Monday thru Friday except Federal holidays or when the

Government facility is closed due to local or national emergencies, administrative closings, or similar

Government directed facility closings. The Contractor must maintain an adequate workforce for the uninterrupted performance of all tasks as requested 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.

3.6 Recognized Holidays: The Contract Staff will not work these Federal Holidays.

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

June 19th

4. Type of Contract: Firm Fixed-Price Non-Personal Service for Dentists, Dental Hygienists, and Dental

Assistants.

5. Quality Improvement: The standards of medical practice and duties of the Contract Dentists shall be determined pursuant to the bylaws of the WWKMHC, 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 dentists and outpatient facilities, and accrediting standards, all Contract Dentists 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

5.1 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). The Dental Chief or Delegate in conjunction with the Contracting Officer

Represenstitave (COR) may also monitor performance through performance through chart reviews, clinical observation, documentation compliance, scheduling attendance and adherence, patient satisfaction and complaints, and credentialing and licensure verification.

6. Security and Privacy: The vendor with maintain compliance with HIPPA, Indian Child Protection requirements, PIV requirements, key control, IT security, and background investigations.

6.1.1 Security Requirements: 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 childcare under this contract. This investigation will be conducted and will be based upon the Federal Bureau of

Investigation (FBI), State and Local criminal history repositories.

6.1.2 The dental personnel are subject to Public Law 101-630, The Indian Child Protection and Family Violence

Prevention act. The Indian Health Service Personnel Office will conduct the criminal background investigations and obtain fingerprints on each Contract dental personnel provided by the contractor. Until the Character investigating has been completed and the Contracting Officer notified of the results, the contract dental personnel must not have unsupervised contact with Indian children or access to Federal information Systems that contain Personally Identifiable Information (PII) or Protected Health Information

(PHI). The investigation may take several weeks to several months to complete. Contract dental personnel receiving unfavorable background investigations shall not be employed. If at any time the contractor fails to meet or maintain suitability or eligibility for Federal employment, the individual contact dental personnel will be removed from providing serves at the W.W.K.M.H.C.C.

6.1.2.1 PHYSICAL Security: Each 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. All PHI (Protected Health Information) shall be secured at all times and not left unattended in insecure areas. At the close of each work period, government equipment, facilities, and other valuable materials shall be secured, and all PHI shall be returned to the Health Information Management (H.I.M) department.

6.1.2.2 Weapons, Firearms, and Ammunitions: Contractors are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their contractor-owned vehicle or privately-owned vehicle while on the WWKMHCC grounds

6.1.2.3 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 for 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.

6.1.2.3.1. 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.

7. Credentialing, Background, and Licensure: The contractor shall maintain a sufficient pool of qualified candidates to support timely onboard and staffing requirements to fill requested shifts. All personnel shall maintain unrestricted licenses, certifications, registrations, and privileges required to perform assigned duties and meet WWKMHCC requirements for credentialing and privileging

7.1 The contractor shall submit suitable candidates for review within five (5) days of requesting candidates for desired labor category. Continuous recruiting of high quality candidates should be on-going. The government will make every attempt to give contractor anticipated service unit needs

7.2 The contractor shall submit all credentialing, privileging, licensure, certification, education, training, immunization, and background investigation documentation required by WWKMHCC within (10) business days of Government request. Furthermore, the contractor shall ensure that all submitted documentation is complete accurate, and current.

7.3 Delays resulting from incomplete or inaccurate credentialing packets may be considered contractor performance deficiencies.

7.4 Dentists:

7.4.1 Have a Doctor of Dental Medicine (DMD) or Doctor of Dental Surgery (DDS) degree from a school of approved by the American Dental Association (ADA) or the Commission on Dental Accreditation (CODA) or an accrediting body recognized by the U.S Department of Education at the time the degree was obtained.

7.4.2 Have passed the National Board Dental Examinations (NDBE) which are developed and administered by the

Joint Commission of National Dental Examinations (JCNDE)

7.4.3 Possess a current, full, and unrestricted license to practice dentistry in a State, the District of Columbia, the

Commonwealth of Puerto Rico, or a territory of the United States.

7.4.4 Hold a current, unrestricted DEA license to prescribe medications

7.4.5 Maintain continuing education/certification and have a current Basic Life Support (BLS) certification.

7.4.6 Have at least one year completion of a residency program in an institution accredited for such training and/or one year of professional experience as a dentist in the last 24 months

7.4.7 Must meet all credentialing and background investigation requirements.

7.4.8 Dental Assistants are required to have a high school diploma and at least two years of experience.

7.4.9 They must possess good customer service skills and hold certification from an accredited dental assistant program.

7.5 Dental Assistants:

7.5.1 Have minimum of high school diploma

7.5.2 Preference is for licensed/registered dental assistant with certification from an accredited program.

7.5.3 If assistant is unlicensed, they must have five (5) years experience and maintain dental radiographer training and license. Assistants without radiographer license will not be an acceptable candidate.

7.5.4 Maintain current Basic Life Support (BLS) Certification

7.6 Dental Hygienists:

7.6.1 Must have successfully completed an accredited dental hygiene program recognized by the Commission on

Dental Accreditation (CODA)

7.6.2 Possess and maintain a current, active, full , and unrestricted licenses to practice dental hygiene in a State, the District of Columbia, the Commonwealth of Puerto Rico, or a territory of the United States.

7.6.3 Have three (3) years experience

7.6.4 Maintain current Basic Life Support (BLS) Certification

8. Performance Requirements

8.1 The government will evaluate contractor performance using the following indicators:

PRS Standard AQL Surveillance Method

Staffing Response Candidate submission within 5 days 95% COR review

Replacement

Coverage Notification to COR within one business day of any anticipated vacancy, resignation, or inability of assigned personnel to report for duty and have replacement staff available within 3 days

95% COR review

Clinical Quality Meets standards of care 90% Peer review

Documentation Timely chart completion 95% Record review

Training Compliance Required trainings completed on time 100% Training records

Professional Conduct No more than one substantiated complaint in a 6-month period 95% Complaints log, Attendance Personnel report as scheduled 98% Attendance logs

Credentialing

Compliance The Contractor shall submit complete credentialing, privileging, licensure, certification, education, training, immunization, and background investigation documentation within ten (10) business days of Government request

100% COR review

9. Deliverables

9.1 Monthly staffing reports, credentialing status reports, training compliance reports, coverage reports, and corrective action plans when requested.

9.1.1 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 appraise 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.

10. Contracting Officer and Contracting Officer Representative (COR) Authority

10.1 The Contracting Officer Representative (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.

10.1.1 Contracting Officer Authority: No person other than the Contracting Officer has the authority to bind the

Government with the respect of this contract

10.1.2 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.

10.1.3 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:

10.1.4 An understanding or agreement between the Contractor and anyone other than the Contacting Officer.

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

10.1.6 A promise by anyone other that the Contracting officer to provide additional funding or make payments; or

10.1.7 An order, direction, consent, or permission from anyone other than the Contracting Officer to: incur costs in excess of a specified estimated cost, allotment of funds, or other ceiling; or Expend hours in excess of a specified level of effort

11. 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. P.I.V card will be issued after completion of a favorable adjudication process.

11.1 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.

12. Staffing Patterns: The contractor will provide staff to augment existing federal clinical staff and clinical operations. This entails complying with existing shift design, staffing workflow, and hours. The government will identify staffing needs and inform the contractor in writing (email) of the labor category desired with a minimum one (1) month lead time for candidate approval and arrival onsite. It is anticipated that the government will request contract staff to do a minimum one (1) month blocks, but requests may be variable including but not limited to 2 week on, 2 week off, or shorter re-occurring blocks to complement the existing staff. The # of staff requested is not limited by FTE, but it is anticipated that the government may request two (2) dental assistants, one (1) dental hygienist, and two (2) dentists

13. Attachments:

13.1 QASP

13.2 Schedule of Items

ATTACHMENT 1: QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

Dental Staffing Support Services

Woodrow Wilson Keeble Memorial Healthcare Center (WWKMHCC)

1. PURPOSE

This Quality Assurance Surveillance Plan (QASP) establishes the methods the Government will use to evaluate Contractor performance under the Dental Staffing Support Services contract.

The QASP is based on the Performance Requirements Summary (PRS) contained in Section

8.0 of the Performance Work Statement (PWS).

The Government will use surveillance methods including document review, record review, customer feedback, peer review, observation, and contractor reporting.

2. ROLES AND RESPONSIBILITIES

Contracting Officer (CO)

The Contracting Officer is responsible for overall contract administration and has sole authority to modify contract terms and conditions.

Contracting Officer's Representative (COR)

The COR is responsible for monitoring Contractor performance, documenting performance results, validating invoices, and reporting deficiencies to the Contracting Officer.

Dental Supervisor / Chief Dental Officer

The Dental Supervisor may assist the COR in evaluating clinical performance, attendance, documentation compliance, peer review findings, and other quality indicators.

3. SURVEILLANCE MATRIX

PRS

Performance

Objective

Performance

Standard

AQL

Surveillance

Method Frequency Documentation

PRS

Staffing

Response

Qualified candidates submitted within five (5) business days of

95%

Review staffing requests and candidate submission dates

Monthly COR Staffing Log

Government request

PRS

Replacement

Coverage

Contractor notifies COR within one (1) business day of anticipated vacancy and provides replacement personnel within three (3) business days

95%

Review vacancy notifications and replacement records

Monthly COR Staffing Log

PRS

Clinical Quality

Services meet accepted standards of dental care and facility clinical requirements

90%

Peer review, chart review, FPPE/OPPE review

Quarterly Peer Review

Reports

PRS

Documentation

Compliance

Clinical documentation completed accurately and within required timeframes

95% Medical record review Monthly

Chart Audit

Results

PRS

Training

Compliance

Required training completed within established deadlines

100%

Review training records and certificates

Quarterly Training

Records

PRS

Professional

Conduct

No more than two (2) substantiated complaints annually per provider

95%

Complaint review, patient feedback, supervisor observations

Quarterly Complaint Log

PRS

Attendance

Personnel report as scheduled and complete assigned coverage

98%

Review schedules, attendance records, and contractor reports

Monthly Attendance

Records

PRS

Credentialing

Documentation

Compliance

Complete credentialing, privileging, licensure, certification, education, training, immunization, and background investigation documentation submitted within ten (10) business days of

Government request

100%

Review credentialing packages and onboarding documentation

Monthly Credentialing

Files

4. PERFORMANCE DEFICIENCIES

When performance deficiencies are identified, the COR shall document the deficiency and notify the Contractor.

The Contractor may be required to submit a written Corrective Action Plan (CAP) within five (5) business days.

The CAP shall identify:

• Root cause of the deficiency

• Corrective actions to be implemented

• Responsible individual

• Completion date

• Preventive measures to avoid recurrence

5. CONTRACTOR REPORTING REQUIREMENTS

The Contractor shall submit:

• Monthly Staffing Report

• Credentialing Status Report

• Training Compliance Report

• Coverage Report

• Corrective Action Reports (when requested)

Reports shall be submitted electronically to the COR no later than the fifth (5th) business day of each month.

6. SURVEILLANCE METHODS

The Government may use one or more of the following surveillance methods:

6.1 Periodic Inspection

Review of contractor performance at scheduled intervals.

6.2 Random Sampling

Review of selected records, files, schedules, or reports.

6.3 Customer Feedback

Review of patient complaints, compliments, and stakeholder feedback.

6.4 Contractor Self-Reporting

Review of reports submitted by the Contractor.

6.5 Peer Review

Clinical quality reviews performed in accordance with WWKMHCC policies and procedures.

7. PERFORMANCE EVALUATIONS

Contractor performance information may be used in preparation of Contractor Performance

Assessment Reporting System (CPARS) evaluations.

Repeated failure to meet performance standards may result in corrective action requests, negative past performance evaluations, or other contractual remedies available to the

Government.

8. GOVERNMENT RIGHTS

The Government reserves the right to increase surveillance when performance concerns arise and may perform inspections, audits, and reviews at any time during contract performance.

SOLICITATION NO.75H70626Q00042

ATTACHMENT NO. 2

SUPPLIES OR SERVICES AND PRICES/COSTS

This requirement is for a Firm-Fixed-Price (FFP) purchase order with four option years for contracted dental hygienist, assistants, and dentist services to support the Dental Program at the

Woodrow W. Keeble Memorial Healthcare Center, Sisseton, SD. The purpose of this requirement is to provide supplemental professional dental coverage to ensure continuity of oral health services and patient access to dental care. The contracted dental hygienist, assistants, and dentists shall assist in maintaining safe, accurate, and effective dental services while supporting ongoing clinical operations and compliance with applicable standards of care. Services will be ordered and performed in accordance with the requirements of the Service Unit. The estimated number of hours may fluctuate at time of award depending on the accepted quoted price.

ITEM NO. ITEM DESCRIPTION

ESTIMATED

QUANTITY

UNIT OF

MEASURE

UNIT PRICE TOTAL

Dental Hygienist

Support Services

(Base)

2080 HOURS $ $

Dentist Support

Services

4160 HOURS $ $

Dental Assistant

Support Services 4160 Hours $ $

Base Year GRAND TOTAL $

ITEM NO. ITEM DESCRIPTION

ESTIMATED

QUANTITY

UNIT OF

MEASURE

UNIT PRICE TOTAL

Dental Hygienist

Support Services

(Base)

2080 HOURS $ $

Dentist Support

Services

4160 HOURS $ $

Dental Assistant

Support Services

Option Year 1 GRAND TOTAL $

SOLICITATION NO.75H70626Q00042

ATTACHMENT NO. 2

ITEM NO. ITEM DESCRIPTION

ESTIMATED

QUANTITY

UNIT OF

MEASURE

UNIT PRICE TOTAL

Dental Hygienist

Support Services

(Base)

2080 HOURS $ $

Dentist Support

Services

4160 HOURS $ $

Dental Assistant

Support Services

Option Year 2 GRAND TOTAL $

QUANTITY

UNIT OF

MEASURE

UNIT PRICE TOTAL

Dental Hygienist

Support Services

(Base)

2080 HOURS $ $

Dentist Support

Services

4160 HOURS $ $

Dental Assistant

Support Services

Option Year 3 GRAND TOTAL $

QUANTITY

UNIT OF

MEASURE

UNIT PRICE TOTAL

Dental Hygienist

Support Services

(Base)

2080 HOURS $ $

Dentist Support

Services

4160 HOURS $ $

Dental Assistant

Support Services

Option Year 4 GRAND TOTAL $

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price, Non-Personal Service – Commercial Items)

“System updates may lag policy updates. The System for Award Management (SAM) may continue to require entities to complete representations based on provisions that are not included in agency solicitations. Examples include 52.222-25, Affirmative Action Compliance, and paragraph (d) of 52.212-3, Offeror Representations and

Certifications—Commercial Products and Commercial Services. Contracting officers will not consider these representations when making award decisions or enforce requirements. Entities are not required to, nor are they able to, update their entity registration to remove these representations in SAM.”

I. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses

No. FAR Citation Clause Title Clause Date

1. 52.203-3 Gratuities April 1984

2. 52.203-6 Restriction on Subcontractor Sales to the Government June 2020

3. 52.203-11 Certification and Disclosure Regarding Payments to Influence Certain

Federal Transactions September 2024

4. 52.203-12 Limitation on Payments to Influence Certain Federal Transactions June 2020

5. 52.203-17 Contractor Employee Whistleblower Rights November 2023

6. 52.203-19 Prohibition on Requiring Certain Internal Confidentiality Agreements of

Statements January 2017

7. 52.204-7 System for Award Management November 2025

8. 52.204-9 Personal Identity Verification of Contractor Personnel January 2011

9. 52.204-10 Reporting Executive Compensation and First-Tier Subcontract Awards November 2025

10. 52.204-13 System for Award Management Maintenance. November 2025

11. 52.204-19 Incorporation by Reference of Representations and Certifications December 2014

12. 52.209-6 Protecting the Government’s Interest When Subcontracting with

Contractors Debarred, Suspended, Proposed for Debarment, or

Voluntarily Excluded November 2025

13. 52.209-9 Updates of Publicly Available Information Regarding Responsibility

Matters November 2025

14. 52.209-10 Prohibition on Contracting with Inverted Domestic Corporations November 2025

15. 52.212-1 Instructions to Offerors – Commercial Items November 2025

16. 52.212-4 Contract Terms and Conditions—Commercial Products and Commercial

Services November 2025

17. 52.215-1 Instructions to Offerors – Competitive Acquisition November 2025

18. 52.217-5 Evaluation of Options November 2025

19. 52.217-8 Option to Extend Services November 1999

20. 52.219-4 Notice of Price Evaluation Preference for HUBZone Small Business

Concerns November 2025

21. 52.219-6 Notice of Total Small Business Set-Aside November 2025

22. 52.219-8 Utilization of Small Business Concerns November 2025

23. 52.219-9 Small Business Subcontracting Plan November 2025

24. 52.219-14 Limitations on Subcontracting November 2025

25. 52.219-16 Liquidated Damages – Subcontracting Plan November 2025

26. 52.219-28 Post Award Small Business Program Re-representation November 2025

27. 52.222-3 Convict Labor June 2003

28. 52.222-35 Equal Opportunity for Veterans November 2025

29. 52.222-36 Equal Opportunity for Workers with Disabilities November 2025

30. 52.222-37 Employment Reports on Veterans November 2025

31. 52.222-40 Notification of Employee Rights Under the National Labor Relations Act December 2010

32. 52.222-41 Service Contract Labor Standards August 2018

33. 52.222-43 Fair Labor Standards Act and Service Contract Labor Standards-Price

Adjustment (Multiple Year and Option Contracts) August 2018

34. 52.222-50 Combating Trafficking in Persons November 2025

35. 52.222-54 Employment Eligibility Verification November 2025

36. 52.222-62 Paid Sick Leave Under Executive Order 13706 January 2022

37. 52.224-3 Privacy Training January 2017

38. 52.226-8 Encouraging Contractor Policies to Ban Text Messaging While Driving May 2024

39. 52.229-11 Tax on Certain Foreign Procurements – Notice and Representation June 2020

40. 52.229-12 Tax on Certain Foreign Procurements February 2021

41. 52.233-3 Protest After Award November 2025

42. 52.233-4 Applicable Law for Breach of Contract Claim November 2025

43. 52.237-7 Indemnification and Medical Liability Insurance November 2025

44. 52.242-5 Payments to Small Business Subcontractors January 2017

45. 52.242-13 Bankruptcy July 1995

46. 52.242-15 Stop-Work Order August 1989

47. 52.244-2 Subcontracts June 2020

48. 52.244-6 Subcontracts for Commercial Products and Commercial Services November 2025

II. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses in Full Text

No. FAR Citation Clause Title Clause…