75H70720R00009 - complete.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

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225 Albuquerque Indian Health Service

CODE 16. ADMINISTERED BYCODE

X

X

X

561320

SIZE STANDARD:

100.00 % FOR:SET ASIDE:UNRESTRICTED OR203

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

04/17/2020 1700 MS

03/23/2020

505-256-6751GENEVIEVE MONK

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70720R00009

5. SOLICITATION NUMBER

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

1 69 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Albuquerque New Mexico 87120-3101 9169 Coors Blvd., NW Albuquerque Indian Dental Clinic

15. DELIVER TO

Albuquerque NM 87110 4101 Indian School Rd NE, Suite 225

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$30.00

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

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

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)X

Albuquerque Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

This Acquisition is a 100% Small Business Set-Aside.

The DHHS/USPHS Albuquerque Area Indian Health Service - Albuquerque Indian Dental Clinic has a Requirement for Three(3) Dental Assistants to provide services at the Albuquerque Indian Dental Clinic.

SINGLE AWARDS WILL BE MADE AS A RESULT OF THIS

SOLICIATION

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

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

CLARISA N. GALLEGOS

. 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.

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

69 2 of

75H70720R00009 – THREE(3) DENTAL ASSISTANT TO PROVIDE SERVICES AT THE

ALBUQUERQUE INDIAN DENTAL CLINIC

This solicitation is set-aside for Small Business Indian Firms (SBIF) pursuant to the Buy Indian Act 25 U.S.C. 47. If IHS does not receive at least two offiers that are reasonable priced offers from SBIF's, IHS will then evaluate quotes and consider award to other small business concerns under the following 5-tier cascading set-aside (in order of first consideration to last consideration):

1st Tier: Small Business Indian Firms

2nd Tier: Service Disabled Veteran Owned Small Businesses

3rd Tier: Certified Hub-Zone Small Businesses

4th Tier: Small Disadvantage Businesses

5th Tier: All other Small Business Concerns

SECTION 1 - SUPPLIES OR SERVICES AND PRICES/COSTS

1.1 SERVICES

1.1.1 The Indian Health Service (IHS)/Albuquerque Area Office, Albuquerque Indian Dental Clinic has a requirement for three (3) dental assistants to provide services.

1.1.2 The Government contemplates to award single Contracts resulting from this solicitation.

1.2 PRICE OR COST

This solicitation will result in single Firm-Fixed-Price (FFP) Definite-Quantity Contract with being issued with the quantities shown in the Schedule of Charges. They are definite quantities, and representative of actual ordering quantities, and serve as a means of arriving at price reasonableness for award purposes. Utilization of the "Requirements" contract has been determined to be appropriate for three (3) Dental Assistant (DAs) Non-Personal Health Care Services as the government anticipates recurring requirements but cannot pre-determine the precise quantities that will be ordered during the contract period. Pricing proposals should be determined based on the – 8 -hour shifts.

1.3 GENERAL CONTRACT INFORMATION

1.3.1 This is a non-personal health care service contract, as defined in Federal Acquisition Regulation (FAR) 37.401, under which the contractor is an independent contractor.

1.3.2 As an independent Contractor; billing and collecting for the federal, state and other local city/county taxes is the burden of the Contractor, this includes the New Mexico Gross Receipt Taxes (NMGRT) for services provided in any county of the State of New Mexico.

1.3.3 The Contractor's price/cost for services under this contract should include all applicable taxes for Internal Revenue Service (IRS), State of New Mexico Taxation and Revenue agency and/or other revenue agencies. The Indian Health Service will not withhold taxes nor will it issue a W-2 to the contractor.

1.3.4 FINGERPRINTING REQUIREMENTS FOR SECURITY AND SUITABILITY:

"Prior to start of services specified by the contract scope of work, the Contractor must contact Warren Cheromiah, at Telephone No. (505) 256-6749, AAO, Division of Contracts and Grants, to schedule an appointment to complete the fingerprinting process required by the IHS regulations pertinent to security and character background investigations."

1.4 CONTRACT PRICE

1.4.1 This solicitation will result in a Firm-Fixed-Price (FFP) Definite-Quantity Contract.

1.4.2 Upon delivery and acceptance of the item(s) specified in the DELIVERY Article in of this contract, the Government shall pay to the Contractor resulting from the awarded contract price.

1.4.3 Upon delivery and acceptance the services described in the Performance Work Statement (PWS) and identified in the schedule of charges below, the Government shall pay to the Contractor the total prices set forth below and will be paid from the following Contract Line Item Numbers (CLINs) accordingly:

Contract Line Item Numbers (CLINs)

Description of Services Unit of Issue Unit Price

Base Year - 0001 Dental Assistant (2,000 per Dental Assistant) Per hourly rate $_____________ Per Hour

Base year total 6,000 hours

Option Year One - 0002 Dental Assistant (2,000 per Dental Assistant) Per hourly rate $_____________ Per Hour

Option Year One total 6,000 hours

Option Year Two - 0003 Dental Assistant (2,000 per Dental Assistant) Per hourly rate $_____________ Per Hour

Option Year Two total 6,000 hours

Option Year Three - 0004 Dental Assistant (2,000 per Dental Assistant) Per hourly rate $_____________ Per Hour

Option Year Three total 6,000 hours

Option Year Four - 0005 Dental Assistant (2,000 per Dental Assistant) Per hourly rate $_____________ Per Hour

Option Year Four total 6,000 hours

Grand Total $______________________________

SECTION 2 – DEFINITIONS:

2.1 Acceptance: As stated in FAR, subpart 46.5, Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

2.4 Blanket Purchase Agreement (BPA): is a simplified method of filling anticipated repetitive needs for supplies or services.

2.5 Business Associate (BA): Any company or person that shown to, handles, or works with the data or medical records of the medical entity.

2.6 Business Associate Agreement (BAA): A BAA is a contract between a HIPAA-covered entity and a HIPAA BA.

The contract protects personal health information (PHI) in accordance with HIPAA guidelines.

2.7 Contract: This is a legal binding document between the Government and the Contractor.

2.9 Contractor: The individual award a legal binding contract to provide supplies and or services.

2.10 Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.11 Contracting Officer's Representative (COR): A federal employee who assists the CO in the administration of this contract. The COR is primarily responsible for the technical assistance and day-to-day program management.

2.12 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.13 Customer Evaluation/Input: Written comments made to the COR regarding the Contractors performance. This is one of the criteria used to evaluate the Contractor's performance.

2.14 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

2.15 Health Clinics/Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray, which are available at least 40 hours a week for outpatient care.

2.16 Indefinite Delivery/Indefinite Quantity: No set delivery time and no set quantity amount (used for recurring purchases with no set delivery time or quantity).

2.17 Non-Personal Health Care Services: A contract under which the personnel rendering the health care services are not subject, either by the contract's terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees, as defined in FAR 37.401

2.18 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

2.19 Orientation: An activity designed to provide basic familiarization of the facility and transition into the IHS Service Unit and/or Health Center.

2.20 Past Performance Information: Relevant information regarding a contractor's actions under previously awarded contracts.

2.21 Patient Outcome: End result of dental assistant care.

2.22 Performance Based Matrix: Lists the services and the standards to determine quality of performance.

2.23 Personal Protective Equipment (PPE): The equipment used to protect medical personnel from exposure to biological, chemical, and radioactive hazards.

2.24 Point of Contact: Person other than the COR or the Alternate COR

2.25 Quality Assurance Surveillance Plan (QASP): A written document prepared and used by the government for Quality Assurance surveillance of the contractor's performance.

2.26 Service Unit: The local administrative unit of IHS.

2.27 Standards of Practice and Standards of Care: Authoritative statements by which it describes the responsibilities for which its practitioners are accountable.

2.28 Technical Direction: A directive to the Contractor that approves approaches, solutions, designs, or refinements;

fills in details or otherwise completes the general description of work or documentation items; shifts emphasis among work areas or tasks; or furnishes similar instruction to the Contractor.

2.29 Task Order: An order issued in accordance with the terms of a contract (GSA or VA, etc.) that details a specific requirement.

2.30 Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

2.31 Verifiable Emergency: An unexpected/unplanned absence by the contractor requiring valid documentation to confirm the occurrence.

SECTION 3 – GOVERNMENT-FURNISHED PROPERTY AND SERVICES:

3.1 The Government will provide the following item(s) of Government property to the Contractor for use in the performance of this contract. This property used and maintained by the Contractor in accordance with provisions of FAR Clause 52.245-1, Government Property (found in Section 3).

Item No

Property Description Property Value Qty. Location Date Available

1 Computer 1 Upon Arrival 2 Telephone 1 Upon Arrival 3 Desk/Chair 1 Upon Arrival 4 PIV Card 1 Upon Arrival 5 PPE Equipment Upon Arrival

3.2 Government Furnished Information / Property and Services

3.2.1 Information: Government unique information related to this requirement, which is necessary for Contractor performance, made available to the Contractor. The COR will be the point of contact for identification of any required information to be supplied by the Government.

3.2.2 Joint Use by the Government and the Contractor: Except for the property and service listed in 10.7.1, the Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.2.3 Contractor Exclusive Use:

3.2.3.1 Personal Protective Equipment (PPE): The Government will furnish the Contractor with appropriate PPE other than specified in the contract. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.2.3.2 The Government will provide facility specific contractor identification badges for each contractor. For lost or destroyed badges, there is a minimum charge of $20.00.

3.2.3.3 Training: Facility specific orientation/training necessary for the Contractor to perform the required duties, e.g., IHS information technology (IT) systems and operational procedures.

Training provided ONLY if the subject matter is necessary to improve or enhance the quality of services or includes mandates made by the IHS Service Units/Health Centers while the providers are working under this contract. Training not provided for the purpose of continuing education, career development or individual development.

3.3 Contractor Furnished Property

3.3.1 Except for the property specified in paragraph 10.9.3 as government furnished, the Contractor shall provide all uniforms and other personal medical instruments subject to the following:

3.3.2 Uniforms and Lab Coats: Uniforms and Lab Coats must conform to the requirements of the Indian Health Service Manual, Part 3, and Chapter 4 and meet the approval of the COR at the IHS facility.

3.3.3 Other personal medical instruments: "Other personal medical instruments" defined, as Contractor owned items include but not limited to stethoscope, scissors, as appropriate to the work unit. The

Contractor must not use unsafe equipment or supplies at any time during performance of this contract. All Contractor furnished equipment and supplies shall be subject to inspection by the Government and must be approved by the COR prior to use by the Contractor. The Government reserves the right to prohibit the use of any materials, supplies, or equipment.

SECTION 4 - CONTRACTOR FURNISHED ITEMS

4.1 Except for the property specified Contractor will provide all other items as required to carry out the services.

SECTION 5 - PERFORMANCE WORK STATEMENT

5.1 The Contractor shall provide dental assistant services, particularly focusing in the utilization of his/her professional training and experience in order to perform the following tasks in the Orthodontic or General Dental Clinics

5.1.1 Utilizes the dental assistant process in identifying individual patient problems and in developing, implementing and evaluating patient care plans.

5.1.2 Provides dental assistant care to meet the emotional, spiritual and socio-cultural needs of the patient, by means of direct care and teaching.

5.1.3 Maintains and updates the team's patient panel.

5.2 Work Schedule: Dental Assistant will work Monday through Friday with no Federal Holidays worked.

5.2.1 Work Shift: Dental Clinic hours are from 8:00 am to 5:00 pm

5.2.3 Scheduling of Shifts: The COR or Alternate COR at the IHS facility will determine specific tour of duty.

The scheduler will determine the schedule along with the COR or the Alternate. The Contractor's employee must commit to working a full 52 weeks for the term of the contract (task orders).

5.2.4 Work Flexibility: As directed by the COR, the Contractor's employee must rotate into other duty sections as needed to support dental patient’s care.

5.2.5 Work Absence: The Contractor will perform and obtain approval from their agency who will inform the COR and/or Alternate COR prior to any absence from work. If the length of the absence exceeds working hours the Contractor must request from agency approval at least fifteen (15) days, (the exception is verifiable emergencies) in advance of the desired absence.

5.2.6 The Contractor must perform and maintain documentation from a qualified health care provider for absences of three (3) or more consecutive days, due to illness, stating:

5.2.6.1 The cause of the current illness or incapacitation AND

5.2.6.2 Indicating the Contractor as contagious or non-contagious.

5.2.7 Training: Not provided to Contractor employees. The only training provided to the Contractor employees will be in house at Albuquerque Indian Dental Clinic.

5.3 Performance Evaluation: In accordance with the standards set forth in the contract and Performance Work Statement Matrix (Section 6).

5.3.1 The Contractor meets with the care team to discuss scheduled patients and communicates the patients’ needs and recommended treatment to care team. Provides assistance to the care team.

5.3.2 The Contractor contacts patients for follow up diagnostic tests, referrals, appointments, or medical follow-up as appropriate. The Contractor provides patient education and self-management support by making weekly/monthly calls to encourage patient to meet goals.

5.3.3 The Contractor maintains, identifies, and creates panel of high-risk patients for care management. The Contractor will track performance measures monthly and shares with the team. The Contractor will triage patients, on the teams’ panel, who walk-in or call for services and directs them appropriately.

5.3.4 The Contractor will in emergency situations, when a physician is not present or immediately available, initiates appropriate measures; for example, takes resuscitation measures in case of cardiac or respiratory arrest, calls for assistance, (begins CPR, call Code Blue).

5.3.5 The Contractor will document observations, nursing interventions, therapeutic measures administered and status of coordinated activities between nursing and other professional disciplines utilizing the problem oriented record system.

5.3.6 The Contractor is responsible for operating specialized equipment during patient visit.

5.4 The contractor will perform work with multicultural patients and interpreters as necessary for non-English speaking patients.

5.5 Conduct: The Contractor must perform standards as listed in the Federal Code of Conduct.

5.6 Conditions of Contract Services: All RNs’ providing service under this contract must attend mandatory orientations specified by the Service Unit.

5.6.1 The contractor must be subject to character investigation as required by Public Law 101-360, the Indian Health Child Protection and Family Violence Prevention Act prior to performance of a contract by utilizing the US Office of Personnel Management (OPM), Electronic Questionnaire for Investigation Processing (eQIP) system and this shall include all fingerprinting procedures and clearances. The contractor must provide all requested information necessary to perform Level I and Level II background checks. The contractor must comply with the requirement to obtain security investigations. The contractor must work with the IHS to ensure that the pre-employment screening process includes the appropriate investigation questionnaires and forms to be completed. The contractor will review all completed forms and forward onto the Government personnel. The contractor will be immediately removed from the position (at any time the investigation receives unfavorable adjudication, or, if other unfavorable information that would affect the investigation becomes known.

5.6.2 Identification of Contractor: The Contractor must wear a government issued contractor identification badge during performance of duty. After 120 day’s PIV, cards issued at the Service Unit.

5.6.3 Management of Medical Information: The Contractor must manage all patient information in accordance with HIPAA standards, Privacy Act, and IHS Service Unit and/or Health Center specific policies and protocols. The Contractor must immediately report to the Contracting Officer or COR any information or circumstances that may violate any statute, policy, or procedure.

5.6.4 IHS Information Technology Systems: In performance of this contract, the Contractor must adapt to and successfully utilize IHS information technology systems such as Electronic Health Records (EHR) or RPMS, which the IHS has deemed necessary for acceptable contractor performance. The IT policies and procedures are available to the Contractor at the Service Unit and the Contractor will adhere to the IHS Information Technology System Security Policies and procedures. The Contractor must follow all appropriate federal required information Technology security requirements and will be operating under Health Insurance Portability and Accountability (HIPAA) and Privacy Act regulations.

5.7. CONTRACTOR QUALIFICATION REQUIREMENTS:

5.7.1 Professional Development: The contractor must have a dental assistance license/certificate and be a graduate of an accredited dental assistance training school or proof of on the job training. From an accredited program approved by the legally designated State accrediting agency at the time the program was completed by the applicant.

5.7.2 Experience: The Contractor must have thirty-six (36) months of dental assistant experience, with a minimum of twelve months (12) in the specialty required by the contract, unless otherwise approved by the Contracting Officer. The Contractor must have a resume that provides experience that equips the applicant with the particular knowledge, skills and abilities to perform successfully the duties of the position, and that is typically in or related to the work of the position.

5.7.3 Motor Vehicle Operator's License: Contractors will not operate any Government-Owned vehicles. If required to provide health care services, they are allowed only as passengers in the Government-Owned Vehicle driven by a Federal employee.

5.7.4 Certifications: Current Basic Life Support (BLS), Pediatric Advanced Life Support (PALS) are mandatory. Advanced Cardiac Life Support (ACLS).

5.7.5 Health Requirements of Contracted Healthcare Providers: Furnish documentation that reflects immunity for the indicated vaccine preventable diseases through documented disease, vaccination history, serology results, and/or any documented episodes of adverse events after vaccination. Any contractor’s employee who is allergic to a component of a vaccine and/or have a history of a severe reaction to a vaccine is not required to receive that vaccine with documented proof of contraindication to the vaccination. The following are additional requirements for specific vaccine preventable diseases.

• Measles:

- Vaccinations with 2 doses of live measles or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or Birth before 1957.

• Mumps:

- Vaccinations with 2 doses of live mumps or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or

- Birth before 1957.

• Rubella:

- Vaccinations with 1 dose of live rubella or MMR vaccines administered at least 28 days apart,

- Laboratory evidence of immunity,

- Laboratory confirmation of disease, or - Birth before 1957 • Hepatitis B:

- Vaccinations with three doses of Hepatitis B vaccines, or

- signed declination of Hepatitis B vaccination series.

• Varicella:

- Vaccinations with two doses of varicella at least 4 weeks apart,

- Laboratory evidence of immunity or confirmation of disease,

- Diagnosis or verification of history of varicella disease by a health care provider, or - Diagnosis or verification of a history of herpes zoster by a health care provider.

• Influenza:

- Vaccination with one dose of current annual influenza season vaccine.

- Documented proof of the contraindication to the influenza vaccination as outlined by Advisory Committee on Immunization Practices recommendations, or

- Written statement justifying religious exemption from influenza vaccination.

Note: unvaccinated contract staff with an approved medical or religious exemption must wear an IHS-provided surgical or similar mask when working in patient care areas or other areas frequented by patients in an IHS facility during the influenza season.

• Pertussis

-Vaccination with one dose of Tdap vaccine.

• Any additional immunization in accordance with IHS Immunization Policy that is available upon request.

The contract staff must have written documentation of TB test (TST or IGRA) within the last 12 months. If documented Positive TB test:

- Provide chest x-ray report of “No active TB disease” following positive TB test.

- Annual sign and symptoms screen:

• If negative sign and symptom screen, follow up chest x-ray not indicated.

• If signs and symptoms screen positive, contract staff must have written documentation of chest x-ray and health care provider evaluation.

Credentialed provider contract staff must have documentation from the provider’s physician or chief of staff that confirms they do not have any health problems (including disability, emotional stability, drug, or alcohol dependency) that might impair his/her ability to care for patient at time of application.

5.7.6 Criminal History Background Check:

Contractor’s employees whose duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by Public Law 101-630, The Indian Child Protection and Family Violence Act. The minimum standards of character shall ensure that none of the individuals described in this order have been found guilty of, or entered a plea of nolo contendere or guilty to, any felonious offense, or any of two or more misdemeanor offenses, under federal, state, or tribal law involving crimes of violence; sexual assault, molestation, exploitation, contact or prostitution; crimes against persons; or offenses committed against children. These crimes do not hold a time statue and will be evaluated the same under any Child Care “CNACI” investigation with IHS. IHS will conduct these investigations following award of a contract. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor‘s employees must not have unsupervised contact with Indian children. Contractor’s employees are not able to work a scheduled shift until the security check is performed and clearance has been obtained by the appropriate agency. At a minimum, fingerprints are required, and upon clearance of this stage, a contractor’s employee may work a scheduled shift. However, Contractor’s employees are required to complete the detailed background application and the application is to be completed within 30 days once the contractor’s employee has been given physical and logical access. All Contractors’ employees are subject to criminal background check prior to performing services in accordance with Task Order terms and conditions. The contractor shall ensure that each of their employees complete the Certification of Criminal History and Background Check Packet. The completed forms are to be returned to the COR.

Additional Background Check packets can be obtained through the COR. See HHSAR Clauses 352.237-72 and 352.237- 73.

5.7.7 Required Training: Protecting Children from Sexual Abuse as stated in IHM Circular 19-05: Contractor Training

Plan for Implementation of Indian Health Manual Part 3, Chapter 20, Protecting Children from Sexual Abuse by

Health Care Providers. Each provider must take this training within

30 days from their start date at the service unit. Certificate should be provided to the COR.

5.7.8 Subpoenas/Testimonies: Contractors are mandated to cooperate with the appropriate IHS managers when the contractors' employees are subpoenaed or requested by Tribal, State or Federal Parties to provide testimony as stated in Section 5-27.3(B)(9) of the Indian Health Manual.

5.8 Challenges to Conflicts: For any inconsistency between COR and Contractor's employee, the employee should contact their agency. If this situation needs further remedies, then the Contractor will contact the COR

5.9 When the Contractor demonstrates impaired judgement, they cannot continue working on the task order. The Government reserves the right to remove from the facility any Contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

6. Quality Assurance Surveillance Matrix:

A. In accordance with FAR 37.401, the Government will evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g.

professional judgments, diagnosis for specific medical treatment, etc.)

The Contractor will receive performance evaluations in accordance with the Quality Assurance Surveillance Plan for this requirement, which shall be provided to the Contractor by the CO or the COR. Performance evaluation will include assessment of the following:

Performance-Based Task Standard Quality Assurance Incentives

Performs orthodontic assisting duties which encompasses all routine orthodontic adjustments in the specialty of orthodontics.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Acquiring and processing patient orthodontic records including but not limited to: intra and extra oral photographs, impression taking for study models, pouring up models, trimming orthodontic models, obtaining prelapical, occlusal, panoramic, hand-wrist and lateral cephalometric radiographs, and uploading pertinent data into a digital format.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Outstanding – 100% of Monitored on a periodic Outstanding. Means there are no issues so

Performs all banding procedures, including separation of teeth, selecting and fitting bands, taking impressions and seating bands in the impression, pouring up the impression, and cementing bands.

Individual bands may be cemented or appliances incorporating bands such as holding arches, expanders and habit controlling appliances.

patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit basis when services occur.

Final determination will happen when job is completed.

payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Provides patient education and instruction or case presentations where clinic policies, patients expectations, oral hygiene instruction, patient problems, patient objectives, treatment goals, possible appliances and risks and complications are given.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

During Endodontics procedures, assistant will isolate tooth remove temporary restoration with low speed handpiece, cleanse and dry field and after treatment by dentist, assistant will irrigate, dry and apply proper medicament as prescribed by dentist and temporarily close tooth.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Instructs patients in post-operative home care procedures.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Places and removes rubber dams, removes sutures, applies desensitizing agents, applies tissue-conditioning agents places surgical gauze following extractions and applies and removes periodontal dressings.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Takes primary impression or study models, pours and trims models, fabricates custom trays and bit rims.

Performs complex oral prophylaxis and applies topical fluoride treatments.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets

Operates ultrasonic scaler(cavitron) and uses hand instruments to remove visible calculus.

Places pit and fissure sealants.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Restores teeth after the dentist has accomplished preparation. This includes selection, contouring and placement of matrices, placement of bases and liners, packing, carving and polishing of routine and complex alloy restorations including those requiring cusp replacements and retentive pins.

Also places and finishes complex composite restorations and places and contours temporary restorations.

Selects, contours, and cements stainless steel crowns and fabricates, cements, and adjusts temporary acrylic crowns and bridges.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets either Satisfactory or Outstanding.

Demonstrates proficiency in sterilization and disinfection techniques. Adheres to the standards of infection control.

Provides routine and preventative maintenance on all dental equipment.

Is responsible for keeping clinic well supplied by requisitioning supplies and equipment and keeping supply inventory.

Maintains the Orthodontic Clinic workplace environment including all common areas in a clean and operative condition.

Outstanding – 100% of patient needs are being meet per visit.

Acceptable – 80 to 99% of patient needs are being meet per visit.

Satisfactory – 65 to 80% of patient needs are being meet per visit

Monitored on a periodic basis when services occur.

Final determination will happen when job is completed.

Outstanding. Means there are no issues so payments processed promptly.

Acceptable. Means there are some issues so payment is on hold until issues cleared.

Satisfactory – Means there are too many issues and payment not processed until this meets

SECTION 7 PACKAGING AND MARKING

7.1 PACKAGING

All deliverables shall be preserved, packaged, and packed in accordance with normal commercial practices to meet the packing requirements of the carrier including which is necessary to prevent deterioration and damages due to the hazards of shipping, handling, and storing.

7.2 MARKING

Each package/container shall be clearly marked as follows:

• Name of Contractor

• Contract Number

• Description of Items Contained Therein

• Consignee's Name and Address

7.3 DELIVERY

All deliverables delivered to the following addresses:

Albuquerque Indian Dental Clinic

Attention: Darlene Sorrell, Dental Administrator

9169 Coors Road, NW, Albuquerque, New Mexico 87193

Phone (505) 922-4239

SECTION 8 INSPECTION AND ACCEPTANCE

8.1 INSPECTION AND ACCEPTANCE: All work under this contract is subject to inspection and final acceptance by the Contracting Officer or the duly authorized representative of the government. The COR, as a duly authorized representative of the Contracting Officer, shall assume the responsibilities for monitoring the Contractor's performance, evaluating the quality of services provided by the Contractor and performing final inspection and acceptance of all deliverables and services called for by the contract.

8.2 FEDERAL ACQUISITION REGULATION {48 CFR CHAPTER 1) CLAUSES

FAR Clause No. Title Date

52.246-4 Inspection of Services – Fixed Priced (Aug 1996)

SECTION 9 DELIVERIES OR PERFORMANCE

9.1 PERIOD OF PERFORMANCE: The period of performance is a Base Period of 12 months with four -

12-month Option Periods, unless extended by modification to this contract. The Government may exercise options to extend the period of performance in accordance with FAR Clause 52.217-9 - Option to Extend the Term of the Contract (Oct 2014); upon written notification by the Contracting Officer within 30 days of contract expiration.

9.1.1 Services under this contract shall commence NLT 10 days after all clearances occur.

Base Year: TBD, 2020 to TBD, 2021

Option Year 1: TBD, 2021 to TBD, 2022

Option Year 2: TBD, 2022 to TBD, 2023

Option Year 3: TBD, 2023 to TBD, 2024

Option Year 4: TBD, 2024 to TBD, 2025

9.1.2 Performance must be for the period of TBD/2020 to TBD/2021 unless the period changed by written modification to the purchase order in accordance with FAR 52.217-9, Option to Extend the Term of the Contract.

9.1.3 Total contract award must not exceed five years. Based option year renewals on satisfactory services provided availability of funds for the appropriate fiscal year, and existing requirements.

9.2 PLACE OF PERFORMANCE: The contractor must provide three (3) Dental Assistant non-personal healthcare services to the following Albuquerque Area Indian Health Service Facility:

9.2.1 Albuquerque Indian Dental Clinic (AIDC) 9169 Coors Road, NW, Albuquerque, New Mexico 87193.

9.3 Travel to and from the facility/office site are not included in the tour of duty. See Section 5.2 for shift hours.

9.4 GOVERNMENT HOLIDAYS (https://www.federalpay.org/holidays)

New Year's Day Martin Luther King's Birthday

President's Day Memorial Day

Independence Day Labor Day

Columbus Day Veteran's Day

Thanksgiving Day Christmas Day

*Any other day specifically declared by the President of the United States to be a national holiday (see www.opm.gov/fedhol).

SECTION 10 - CONTRACT ADMINISTRATION

10.1 AUTHORITIES OF GOVERNMENT PERSONNEL: Notwithstanding the Contractor's responsibility for total management during the performance of this Contract, the administration of the Contract will require maximum coordination between the Government and the Contractor. The following individuals will be the Government's points of contact during the performance of this Contract.

10.2 CONTRACTING OFFICER

The IHS Contracting Officer (CO) is the only individual authorized to modify this Contract. The CO responsible for administrative and contractual issues concerning this Contract is:

Clarisa Gallegos (CO)

Indian Health Service/Division of Contracts & Grants Management (DCGM)

4101 Indian School Road NE, Suite 225

Albuquerque, NM 87110

Phone: 505-256-6748

Email: Clarisa.gallegos@ihs.gov

Send all communications pertaining to contractual and/or administrative matters to the address above and to the Contract Specialist administering this Contract.

10.3 CONTRACT ADMINISTRATOR

· All Contract administration performed by:

Genevieve Monk, Contract Specialist (CS)

Indian Health Service/Division of Contracts & Grants Management (DCGM)

4101 Indian School Road NE, Suite 225 Albuquerque, NM 87110

Phone: 505-256-6751

Email: Genevieve.monk@ihs.gov

10.4 CONTRACTING OFFICER'S REPRESENTATIVE (COR)

10.4.1 Darlene Sorrell, Dental Administrator, 505-922-4239, is hereby designated as COR for this service. The COR responsibilities will be to coordinate with the contractor the technical aspects of this service and the review of performance hereunder. The COR does not have the authority to change or alter the order amount, terms and conditions.

10.4.2 Alternate: Maureen Cordova, CEO, 505-922-4248, hereby designated as the Alternate COR for this service. The Alternate COR responsibilities will be to help coordinate with the contractor the technical aspects of this service and the review of performance hereunder. The Alternate COR does not have the authority to change or alter the order amount, terms and conditions.

10.4.3 The COR and Alternate’s responsibilities will include ensuring contractor accountability. Monitoring the Contractor’s technical progress including the surveillance and assessment of performance and recommending to the CO changes in requirements. Interpreting the PWS. Performing technical evaluations as required. Perform technical inspection and acceptance as required. Assisting the Contractor in the resolution of technical problems encountered during performance. Perform receiving and processing invoices for payment.

10.5 TECHNICAL MONITORING

(a) Performance of work under this contract must be subject to the technical direction of the COR identified above, or an Alternate COR designated in writing. The term "technical direction" includes, without limitation, direction to the Contractor that directs or redirects the labor effort. Shifts the work between work areas or locations, fills in details and otherwise serves to ensure that task areas outlined in the PWS accomplished satisfactorily.

(b) Technical direction must be within the scope of the specification(s)/work statement. The COR does not have authority to issue technical direction that

(1) Constitutes a change of assignment or additional work outside the specification(s)/ statement of work;

(2) Constitutes a change as defined in the clause entitled "Changes;"

(3) In any manner causes an increase or decrease in the contract price, or the time required for contract performance;

(4) Changes any of the terms, conditions, or specification(s)/work statement of the contract;

(5) Interferes with the Contractor's right to perform under the terms and conditions of the contract; or

(6) Directs, supervises or otherwise controls the actions of the Contractor's employees.

(c) Technical direction may be oral or in writing. The COR shall confirm oral direction in writing within five workdays, with a copy to the Contracting Officer.

(d) The Contractor shall proceed promptly with performance resulting from the technical direction issued by the

COR.

If, in the opinion of the Contractor, any direction of the COR, or his designee, falls within the limitations in (b), above, the Contractor shall immediately notify the CO no later than the beginning of the next Government work day.

(e) Failure of the Contractor and the CO to agree that technical direction is within the scope of the contract shall be subject to the terms of the clause entitled "Disputes" (FAR 52.233-1, Disputes).

10.6 INVOICE SUBMISSION

10.6.1 The Contractor shall submit invoices once per month. Electronically sent via e-mail complete invoice with all required documentation to:

10.6.1.1 Contracting Officer's Representative (COR): Darlene Sorrell, email: Darlene.sorrell@ihs.gov

10.6.1.2 Alternate Contracting Officer's Representative (ACOR): Maureen Cordova, Maureen.cordova@ihs.gov

10.6.1.3 Albuquerque IHS Finance Office, ALB_AOAPinvoices@ihs.gov

* Please do not sent to the CS or Finance Office any other invoice related documents such as deliverables, reports or balance statements). Failure to submit required documents directly to the offices listed above will delay prompt payment of your invoice.

10.6.2 For invoices submitted by email, the subject line of your email invoice submission shall contain the Contractor's name, DUNS and TIN numbers, contract number, and invoice. The Contractor shall send one email per contract monthly. The email may have multiple invoices for the contract. Invoices accepted in one of these formats: PDF, TIFF, or Word only (no Excel formats). The electronic file cannot contain multiple invoices; example, 10 invoices requires 10 separate files (PDF, TIFF, or Word).

10.6.3 Additionally, the Contractor is required to include its Data Universal Numbering System (DUNS) number on each invoice. For additional information about the Dun & Bradstreet (D&B) DUNS number, please visit http://fedgov.dnb.com/webform.

10.6.4 Submit invoices in accordance with the contract terms, i.e. payment schedule, progress payments, partial payments, deliverables, etc.

10.6.5 All information set forth in FAR Clause 52.212-4(g), Invoice, must be included in all invoices for it to constitute a proper invoice.

FAR 52.212-4(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and…