AFRL PWS Vers 1.1.pdf

PERFORMANCE WORK STATEMENT (PWS) [TEMPLATE]

[Insert Title and Activity] Edwards Air Force Base (EAFB) Ambulance Services

Part 1

General Information

(General information will include background information, a brief description of the scope of work, personnel related matters such as safety requirements, security requirements, security clearances, quality control requirements, …etc.)

1. GENERAL: This is a non-personnel services contract to provide [Insert title of service to be provided.

Ambulance 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: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform [Insert title of service to be provided. Ambulance services] as defined in this Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: [Insert history and/or background information on the services that are to be provided. This requirement has been historically satisfied through contracted positions that were dedicated to cover division 4. These positions will now be integrated into the PAS flight and will be a part of the total force available to cover all EAFB ambulance response requirements

1.3 Objectives: [Insert a few bullets stating what the basic service objective is. To procure paramedic services to provide treatment in emergency ambulance response; in-flight emergency response; non-in-flight emergency response; transfer and transport services for the population on EAFB, in accordance with the terms and conditions of this contract. The Paramedics shall be required to assist with patient care within the military treatment facility (MTF) when not performing emergency response or transport services. Paramedics shall cover the range of services provided in a civilian medical treatment facility, such as emergency patient care. The Paramedics shall operate under the medical direction of the awarded Contractor’s Medical Director and protocols provided by the government. The protocols will be provided/approved by the Contractor’s Medical Director. The Paramedic will be assisted by an emergency medical technician (EMT) from the MTF.]

1.4 Scope: [Insert the type of services that are to be performed. The Contractor shall supply all necessary labor required to perform services for the MTF and the government will provide all equipment required with the exception of personal items.]. Services include [Insert what is included in the services to be provided.

The Contractor monitors, manages and reports on services for higher management and develops plan to improve timeliness and accuracy rates, service availability, and overall MTF performance and compliance].

The contractor shall accomplish [Insert what should be accomplished, if applicable.

1.4.1 The Personnel shall be responsible for creating, maintaining, and disposing of medical documentation as required.

NOTE TO OUR CUSTOMERS: THIS TEMPLATE MUST BE TAILORED FOR YOUR AGENCY

BY INCLUDING YOUR UNIQUE REQUIREMENTS, QUANTITIES FOR WORKLOAD,

SPECIFIC SURVEILLANCE TECHNIQUES, ETC. ANY QUESTIONS REGARDING THIS

TEMPLATE SHOULD BE ADDRESSED WITH YOUR ASSIGNED ACQUISITION TEAM.

GENERAL INFORMATION IS PRESENTED IN BLUE ITALICS WITH PARENTHESIS

BORDERS, WHILE FILL-IN GUIDANCE IS PRESENTED IN BLUE ITALICS WITH BRACKET

BORDERS. PLEASE DELETE ALL BLUE ITALICS WHEN FINALIZING THE PWS.

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Bituin, Karl F Lt Col USAF 412 MDG (USA) Confirm with Contracting personal vs. non-personal.

Bituin, Karl F Lt Col USAF 412 MDG (USA) Verify with contracting if some of this stuff in Scope should go under Part 5.

Bituin, Karl F Lt Col USAF 412 MDG (USA) Change to personnel

1.4.2 Performs a full range of ambulance services on site at the MTF and in the field when performing ambulance emergency or in-flight response, transfer, or transport services. The personnel will respond to calls within EAFB jurisdiction. The personnel shall practice within the guidelines set by the NCOIC, Flight Commander and the Contractor’s Medical Director. Provides emergency hospital and pre-hospital care for all types of patients.

1.4.3 Maintains the Government provided (GOV) ambulance according to local policy ensuring preparedness and availability for immediate response in accordance with local policy, AFI 24-302, QTP24-3-B162, and Technical Order 36-1-191. A local checklist will be provided for daily/monthly checks. Shall obtain a valid Government driver’s license for on-base response. A flight line driver’s license is also required.

1.5 Period of Performance: [State period of performance and option years, if applicable.] For example:

The period of performance shall be for one (1) Base Year of 12 months and two (4) 12-month option years. The Period of Performance reads as follows:

Base Year Option Year I Option Year II Option Year III Option Year IV

1.6 General Information

1.6.1 Quality Control (If applicable): The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services.

The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. [Insert when and how the QCP is to be delivered, i.e., within 30 days after contract award or with the contractors proposal if it is an evaluation factor, three copies of a

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Bituin, Karl F Lt Col USAF 412 MDG (USA) PAS to review verbiage

Include 4 option years comprehensive written QCP shall be submitted to the KO and COR within 5 working days when changes are made thereafter.] After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the

Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: [State if the contractor is or is not required to perform services on holidays.

The contractor is required to provide coverage on 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

1.6.4 Hours of Operation: The contractor is responsible for conducting business, between the hours of [Insert the appropriate hours for your organization. 0630-1830] Monday thru Saturday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.4.1 Occasional Sunday and night coverage may be required with previous notification to the contractor based on mission requirements with 72 hour prior notification

1.6.4.2 The government may upon notification to the contractor require a change in the hours of operation from those listed in section 1.6.4 to 24/7 coverage. This would be required to occur within 2 weeks of notification of the change in requirement.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at [Insert the place of performance, i.e., contractor facility or government facilities]. The contractor’s personnel will report for coverage assignments at the start of shift. The particular area to be covered will be determined based on requirements on the given day. The shift will be completed upon return to the 412 MDG.

1.6.6 Type of Contract: The government will award a (Type of contract to be determined by CCE and the customer). Firm-Fixed Price contract.

1.6.7 Security Requirements: Contractor personnel performing work under this contract must have a [Insert the level of security required, if applicable] at time of the proposal submission, and must maintain the level of security required for the life of the contract. The security requirements are in accordance with the attached DD254 (The unit security monitor is responsible for initiating this form). Contract employees shall be subject to the following security investigative processes to include appointments with the Security Managers. The security appointment will be scheduled on the first day of work. The COR will be the point of contact for security. Employees shall be required to have fingerprints taken.

Fingerprint appointments may be scheduled prior to the start of work. HCWs will be required to have social security account card and 1 Federal/State picture Identification with them during the scheduled fingerprint appointment. The Government may request a replacement candidate if fingerprint results indicate a record. Employees shall complete an OF306 and e-Qip Shell Form and the completed forms

DRAFT

Bituin, Karl F Lt Col USAF 412 MDG (USA) Edit to include working on holidays.

Edit to include 0630 to 1830. Edit to Monday thru Saturday. Include option to work on Sunday or provide night time coverage with 72 hour notice.

will be sent to the Contracting Officer Representative NLT 15 days prior to start of work. OF306 shall be typed and HCW shall sign the form. The HCW will not begin performance until required security forms and electronic e-Qip questionnaire are completed. Hard copy SF85/86 forms will only be required when the e-Qip system is down. Copies of blank form shall be provided via email to the contract company when candidate has been accepted by the 412th Medical Group.

1.6.7.1 Pass and Identification. Pass and identification items, required for contract performance, shall be obtained for Contractor personnel.

1.6.7.2 The Contractor shall obtain personnel pass application forms from the Contract COR. The Contractor employee shall complete and carry the forms to the Security Forces, Pass and Registration Office. The PAS flight will provide a base pass for new employees working at the 412th Medical Group.

1.6.7.3 Retrieving pass and identification items shall be accomplished by the contract manager and given to the COR upon the departure from employment, prior to contract expiration, of any Contractor employee and turned in to the Visitors’ Center, Pass and Identification Office. Common Access Card’s and Medical Group badges will be turned in to the COR prior to the employee leaving. In addition, employee will out process. If employee is unable to turn in items, the company will send items to the COR.

1.6.7.4

1.6.7.5 PHYSICAL Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. (Insert the following sentence, if performing in a government facility.) At the close of each work period, government facilities, equipment, and materials shall be secured.

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

1.6.7.6.1. 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, DRAFT at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

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

1.6.7.7 Lock Combinations (If applicable). The Contractor shall establish and implement methods of ensuring that all lock combinations are not revealed to unauthorized persons. The Contractor shall ensure that lock combinations are changed when personnel having access to the combinations no longer have a need to know such combinations. These procedures shall be included in the Contractor’s Quality Control Plan.

1.6.8 Special Qualifications: [Insert any special certification requirements for employees if deemed appropriate i.e.," The contractor is responsible for ensuring all employees possess and maintain current Information Assurance Technician (IAT) Level I professional certification during the execution of this contract."]

1.6.8.1 Knowledge. The following USAF specific knowledge must be completed within 30 days of the Contractor start date.

1.6.8.1.1. Emergency Medical Treatment; Job and Office Safety Standards; Aseptic and Surgical Technique;

Infection Control, Communicable Diseases; Medical Ethics and Legal Aspects; Operation and Maintenance of Therapeutic Equipment; Medical Terminology; Transportation of the Sick and Injured;

Disaster Preparedness Procedures, National Incident Management System (NIMS).

1.6.8.1.2. Knowledge of current hospital and pre-hospital protocols within 45 days of the Contractor employee start date, in order to assess, plan, implement, and evaluate care of patients in hospital and pre- hospital settings. The Paramedic shall be required to assist with patient care within the MTF when not performing emergency response or transport services.

1.6.8.1.3. Knowledge and skill in CPR and advanced life saving measures used to initiate resuscitation measures when necessary and assist unit in providing support measures.

1.6.8.1.4. Education. Graduation from an accredited EMT-Paramedic certification program; a current, valid paramedic license and certification from the National Registry of Emergency Medical Technicians (NREMT); or State of Georgia Office of Emergency Medical Services (OEMS); Current certification in Basic Life Support (BLS); Advanced Cardiac Life Support (ACLS); Pediatric Advanced Life Support (PALS); Tactical Emergency Casualty Care (TECC); and Hazard Materials Awareness.

Certificate/license provided at time of Contractor award or prior to start date for a replacement employee. An updated copy will be kept in their Competency Assessment Folder. Certifications shall be through an American Heart Association and/or Red Cross approved training program and shall be renewed every two years.

1.6.8.1.5. Experience. One (1) year of full-time experience having performed as a paramedic within the last three

(3) years. Experience in personnel management is highly desirable.

1.6.8.1.6. Language Skills. The Paramedic must be able to read, write, and speak fluent English. All documentation shall be completed in English.

1.6.8.1.7. Driving Skills. Drivers must not have any reckless or dangerous driving citations within the previous twenty-four-(24)-month period and have no Driving While Intoxicated (DWI) or Driving Under the Influence (DUI) convictions in the previous five (5) years. Drivers can have a maximum of six (6)

DRAFT

PAS to verify qualifications meet requirements.

points per year assessed under the state of California driving infraction system. Certificate/license provided at time of award or prior to replacement employee start date. An updated copy kept in their Competency Assessment Folder. Flight Line Driver’s license is required. Training will be provided by and scheduled by the Government.

1.6.8.1.8. Physical Abilities. The Paramedic must be able to run 100 yards and lift 175 lbs with assistance.

Verification provided at time of award or prior to replacement employee start date. An updated copy will be kept in their Competency Assessment Folder.

1.6.8.1.9. Non-Personal Service Healthcare Worker (HCW) Licensure. Non-personal service HCWs requiring licensure shall have and maintain a current, valid, unrestricted license specific to the position (with no limitations, stipulations or pending adverse actions) in the U.S. jurisdiction within which the HCW is performing as outlined in the applicable regulation or instruction at the place of performance. All licenses must be unencumbered and remain in effect during the duration of the HCW performance on the contract.

1.6.8.1.10. Health Requirements. Contractor personnel shall have records showing proof of immunization against Hepatitis A and B, Measles, Mumps, Rubella, Varicella, Influenza and any other vaccines recommended by the Center for Disease Control (CDC) or health organizations. The offeror shall also provide proof of negative tuberculosis (TB) skin test taken within the past 12 months. A 2 step tuberculin skin test (TST) is required. If the TB test was positive, submit proof of negative chest x-ray within the past 12 months. Contractor shall comply with CDC Health and Prevention record requirements and any other applicable guidance. The Contractor shall comply with all health requirements in the contract. No later than 10 days prior to physical performance of services by the HCW, the Contractor shall provide documentation certifying health requirements such as immunizations, annual vaccinations, medical testing, (i.e., tuberculosis/N95 particulate respirator duckbill mask fitting) at the time of initial placement and annually thereafter, as required. The expense for all health requirements, to include monitoring and tracking annual requirements, shall be borne by the Contractor at no additional cost to the Government. Documentation shall be provided to the COR.

1.6.8.1.11. Annual Immunizations. The Contractor shall ensure HCWs are immunized annually with the seasonal influenza vaccine and any other vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) of the CDC for HCWs or service/MTF specific guidance as outlined in DoDD 6205.02E, Policy and Program for Immunizations to Protect the Health of Service Members and Military Beneficiaries. The annual influenza vaccine may be provided by the Government, if available, as determined by the MTF. Alternately, the HCW may obtain the vaccine at another facility, at no cost to the Government, and provide proof of vaccination to the Government.

1.6.8.1.12. Immunization Tracking. The Contractor shall maintain their own process and system of tracking the currency of health immunizations and shall not rely on the Government for ensuring the HCWs are in compliance.

1.6.8.1.13. Blood Borne Pathogen Exposure. HCWs shall participate in the MTF’s Blood Borne Pathogen Program, which outlines the post blood borne exposure protocols for testing, treatment, and monitoring.

1.6.8.1.14. Tuberculosis Screening. Prior to reporting for service at an MTF, each contract HCW shall be screened at Contractor expense for risk of exposure to tuberculosis (TB). A 2 step TST is required. If the initial screening results in a determination that the HCW has an increased risk of exposure to TB, the Contractor is responsible for ensuring that the HCW receives targeted screening and testing IAW CDC Guidelines for Healthcare Settings at Contractor expense and submitting timely records of subsequent screening or testing to the COR.

1.6.8.1.15. Health Notifications. The Government will notify the Contractor of any work hazards. If work hazards exist, it will be the Government’s decision whether the HCW continues work in the environment.

1.6.8.1.16. Medical Tests. No medical tests or procedures required by the contract will be performed by the Government with the exception post blood borne exposure protocols after exposure.

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1.6.8.1.17. Personnel will maintain good personal hygiene and a well-groomed, professional appearance. Personnel shall wear identifying badges (e.g., MTF-issued identification badge and/or Contractor badge) above the waistline during duty hours.

1.6.8.1.18. Qualifying document packages must include certifications, licensure, resume and experience. The Government will review the credentialing package to include Health Requirements, BLS/ACLS/PALS/TECC and any other documents listed under Qualifications.

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

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

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

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

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

1.6.11 Key Personnel: The follow personnel are considered key personnel by the government: [Insert the titles of the key personnel i.e., contract manager/Alternate contract manager, Systems Engineer, etc.] The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between [Insert the hours, i.e., 8:00 a.m. to 4:30p.m. 0730-1630.], Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons. Qualifications for all key personnel are listed below: [Insert the qualifications for all key personnel, i.e.,

1.6.12.1 Contract Manager and Alternate, 1.6.12.1.1 The Contract Manager and Alternate must have 24 semester hours in mathematical, engineering, and/or quantitative analysis courses; 15 or more years cost analysis experience; and familiarity with Defense Department Data Sources (e.g. cost and software data reporting, EVM), 1.6.12.2 Systems Administrator, 1.6.12.2.1 The Systems Administrator must have a high degree of expertise with the following systems/protocols: Microsoft Server 2000 and XP operation and administration, and Network Administration.]

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

1.6.13 Contractor Travel (If applicable): [Insert any travel requirements.Not Applicable]. For example:

Contractor will be required to travel CONUS and within the NCR during the performance of this contract to attend meetings, conferences, and training. The contractor may be required to travel to off-site training locations and to ship training aids to these locations in support of this PWS. Required language should travel be needed: Contractor will be authorized travel expenses consistent with the substantive provisions of the Joint Travel Regulation (JTR) and the limitation of funds specified in this contract. All travel requires Government approval/authorization and notification to the COR. For proposal purposes, a Not to exceed amount for travel can be established or you can include in your IGCE and the workload summary , a projected listing of travel locations to include frequency and number of persons required to travel so the offerors can provide pricing.

1.6.14 Other Direct Costs (If applicable): [Insert what the other direct costs requirements will be. These costs must be preapproved by the contracting officer] For example: This category includes travel (outlined in 1.6.13), reproduction, and shipping expenses associated with training activities and visits to contractor facilities. It could also entail the renting of suitable training venues. Additional costs will include the initial purchase of the following uniform items: 4 short-sleeve shirts, 3 long-sleeve shirts, 1 quarter-zip with design, 1 Carhartt jacket with design, 1 pair of EMS boots, 3 pairs of EMS pants, and associated print/embroidery fees.

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

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

1.6.17 PHASE IN /PHASE OUT PERIOD (If applicable): To minimize any decreases in productivity and to prevent possible negative impacts on additional services, the Contractor shall have personnel on board, DRAFT

Include what uniforms will be included. Include hours to overtime. Ask contracting how they recommend overtime is included in the contract.

during the [Insert the time period, i.e., sixty (60) day, thirty (30) day, etc. 30 Day] 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.

PART 2

DEFINITIONS & ACRONYMS

(This section includes all appropriate terms and phrases for this PWS. The definition must be clear and concise, not ambiguous. Carefully consider each definition because they will be binding for the duration of this contract, unless modified. In addition, include a complete listing of all acronyms and words or phrases they represent.)

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS: [List any terms used within the PWS that require further definition. At a minimum, insert the definitions provided below].

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

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

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

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

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

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

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

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

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

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

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

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

2.1.12. WORK WEEK. Monday through Saturday, unless specified otherwise.

2.2. ACRONYMS: [List all acronyms used in the PWS and what they represent. At a minimum, insert the acronyms provided below].

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

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

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

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. Services (If applicable): The Government will provide [Insert the services that will be provided, i.e., may include personnel to assist with production set-up].

3.2 Facilities (If applicable): The Government will provide [Insert what facilities will be provided, i.e., the necessary workspace for the contractor staff to provide the support outlined in the PWS to include desk space, telephones, computers, and other items necessary to maintain an office environment]. The Government will furnish the following: Office and rest room at, 30 Nightingale lane, Edwards AFB, CA.

Dormitory capabilities to include sleeping quarters, showers, and restrooms. The Government will provide the necessary workspace in the MTF for the Contractor staff to provide the support outlined in the PWS to include desk space, telephones, computers, and other items necessary to maintain an office environment.

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

3.4 Equipment (If applicable): The Government will provide [computer equipment required to schedule, check in, document, order ancillary services, and maintain appropriate electronic medical information that support the hard copy medical record. The MTF will provide required training for these systems. The Contractor is required to use the computer systems that are standard for the support of health care delivery at the MTF. All software and hardware, passwords/access to military internet/e-mail and applicable databases will be available within the scope of this contract. The Contractor shall comply with local, Air Force and DoD policies concerning Information Management and Information Technology applications and connectivity to military systems. The MTF will provide medical and non-medical supplies commonly used in the facility for the care and management of patients. Commonly used supplies are those routinely stocked by the MTF. The Government will furnish the Contractor with appropriate Personal Protective Equipment (PPE), e.g.: gloves, masks, gowns, equipment, etc. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform, laboratory coat, or respirator devices.

Insert what equipment will be provided and/or what the contractor will have access to, i.e., scanners fax machines, printers, shipping crates, lighting and sound, etc.]

3.5 Vehicles: The Contractor shall have use of a Government-supplied modular ambulance for emergency response according to the terms of this contract. The vehicle is a Standard Modular Type One Ambulance meeting Department of Transportation specifications. Must comply with licensing requirements of the State and local motor vehicle laws and shall be certified, by the Contractor and at the Contractor’s expense, as being fully qualified to operate the vehicles/equipment to which they are assigned in accordance with AFI 24-301, VEHICLE OPERATIONS, Section 8E, Licensing for Federal Civilian Employees, Contractor Personnel, and Federal Prison Camp Inmates, and paragraph 8.10, Licensing Contractor Personnel.

3.6 Materials (If applicable): The Government will provide [Insert what materials will be provided, i.e., Standard Operating Procedures and Policies. The Government will provide Standard Operating Procedures and Policies.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

(This section is used to identify the materials and equipment that the contractor must provide. Examples provided below.)

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

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

4.2 Contract employee training: The Contractor shall maintain at no cost to the Government, current certification in either the American Heart Association BLS Course C or the American Red Cross CPR/BLS Course. The Contractor shall continue to meet minimum Continuing Medical Education requirements as prescribed by AFI 44-117, Medical Service Officer Education and shall be obtained at no additional cost to the Government and shall be reported to the COR. The Contractor shall train, qualify and certify personnel for specific job tasks to be performed in Medical Services. Records of training, qualifications and certifications shall be maintained by the Contractor on file and provided to the Government upon request. The Contractor shall fund any additional training required to meet the scope of this contract and maintain the proficiency of contract personnel during the performance period. If trained personnel resign prior to the end of this contract, the Contractor, not the Government shall be responsible for all training costs for replacement personnel.

4.3 Contractor Health Requirements: The Contractor shall be responsible for annual immunizations, health requirements and medical tests with the exception of post blood borne exposure protocols after exposure.

4.4 Secret Facility Clearance (If applicable): The contractor shall possess and maintain a SECRET facility clearance from the Defense Security Service. The Contractor’s employees, performing work in support of this contract shall have been granted a SECRET security clearance from the Defense Industrial Security Clearance Office. The DD 254 is provided as Attachment [Insert the attachment number]. N/A

4.3. Materials (If applicable). The Contractor shall [Insert what materials will be provided, i.e., furnish materials, supplies, and equipment necessary to meet the requirements under this PWS]. N/A

4.4. Equipment (If applicable). The Contractor shall [Insert what equipment will be provided, i.e., furnish tractors, lighting and sound, containers, etc. to meet the requirements under this PWS]. N/A

PART 5

SPECIFIC TASKS

(This section is the heart of the PWS. All of the services to be performed under the contract should be described in sufficient detail here. This includes all general tasks required by the Government.)

5. Specific Tasks:

5.1. Basic Services. The contractor shall provide services for [Insert the services and/or tasks to be provided by the contractor].

5.2. The Personnel shall be responsible for creating, maintaining, and disposing of medical documentation as required.

5.3. Performs a full range of ambulance services on site at the MTF and in the field when performing ambulance emergency or in-flight response, transfer, or transport services. The personnel will respond to calls within EAFB jurisdiction. The personnel shall practice within the guidelines set by the NCOIC, Flight Commander and the Contractor’s Medical Director. Provides emergency hospital and pre-hospital care for all types of patients.

5.4. Maintains the Government provided (GOV) ambulance according to local policy ensuring preparedness and availability for immediate response in accordance with local policy, AFI 24-302, QTP24-3-B162, and Technical Order 36-1-191. A local checklist will be provided for daily/monthly checks. Shall obtain a valid Government driver’s license for on-base response. A flight line driver’s license is also required.

5.5. Responds to advance life support (ALS) emergency calls within established time frames according to DoDI 6055.06, Table E3.T1: Aggregate Response Times (ART) for ALS calls will be within twelve (12) minutes for 90% of the calls. 412 CES/CEF Fire Control will be the official time keeper who screens all emergency calls and dispatches them via Government issued hand-held radios or radios hard mounted in the ambulances.

5.6. Recognizes medical emergencies and responds appropriately. Initiates Cardiopulmonary resuscitation (CPR) as required, and administers advanced cardiac life support measures when necessary.

5.7. Provides, documents and completes patient exam on approved forms; provides verbal/written reports to receiving physician and medical facility. Performs documentation audit after each response is complete, to ensure documentation compliance with peer review standards. Peer reviews are conducted after each ambulance run. The results which are reviewed for trends and appropriate feedback will be sent to the Contractor via the Contracting Officer Representative (COR). Enter patient information into the computer database.

5.8. Immediately cleans, sanitizes, and restocks GOV ambulance with MTF supplies according to established policy.

5.9. Assisted by EMTs the Paramedic shall be fully integrated into the nursing team, responsible for direct patient care.

5.10. Responsible for and assists with orientation and training of newly assigned and inexperienced personnel

5.11. Participates in base exercises, in-service training, and continuing education programs.

Maintains MTF training record.

5.12. Establishes and maintains good interpersonal relationships with co-workers, families, peers, and other health team members.

DRAFT

Bituin, Karl F Lt Col USAF 412 MDG (USA) Change to personnel�

PAS to review verbiage�

5.13. MTF Requirements. The Contractor shall complete all MTF-specified orientation program(s), initial and all required annual training, and comply with all MTF policies, procedures, productivity standards and instructions as provided by the MTF.

5.14. Health Insurance Portability and Accountability Act (HIPAA) OF 1996: All individuals performing services at an Air Force MTF are required to complete an initial and annual refresher HIPAA Privacy and Security Rule training as provided by the MTF for its personnel and will be held accountable for complying with health information privacy and security policies and procedures. Reference Section 8.3 Appendix C, Section H, Special Contract Clauses, for detailed HIPAA language.

5.15. Periodic Continuing Medical Education (CME) may be conducted at the MTF and will be available, at no cost, to any healthcare provider desiring to attend.

5.16. During contingencies, the Government may require an additional Contractor to respond to emergencies if there is no military personnel available to accompany the paramedic on duty. If needed, the contracting officer will notify the company of the requirement.

5.17. Task Heading. (If applicable) [Insert the specific task to be provided in sequential order, i.e.,5.2, 5.3, etc. by the contractor]

5.18. CONTRACTOR MANAGEMENT REPORTING (CMR) (Only applies to Army Customers): The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the Contractor shall report ALL Contractor manpower (including subcontractor manpower) required for performance of this contract. The Contractor shall completely fill in all the information in the format using the following web address https://Contractormanpower.army.pentagon.mil. The required information includes: (1) Contracting Office, Contracting Officer, Contracting Officer’s Technical Representative (COTR) or also know as the Contracting Officer’s Representative (COR); (2) Contract number, including task and delivery order number; (3) Beginning and ending dates covered by reporting period; (4) Contractor's name, address, phone number, e-mail address, identity of Contractor employee entering data; (5) Estimated direct labor hours (including sub-Contractors); (6) Estimated direct labor dollars paid this reporting period (including sub-Contractors); (7) Total payments (including sub-Contractors); (8) Predominant Federal Service Code (FSC) reflecting services provided by Contractor (and separate predominant FSC for each sub-Contractor if different); (9) Estimated data collection cost; (10) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the Contractor with its UIC for the purposes of reporting this information); (11) Locations where Contractor and sub-Contractors perform the work (specified by zip code in the United States and nearest city, country, when in an overseas location, using standardized nomenclature provided on website); (12) Presence of deployment or contingency contract language; and (13) Number of Contractor and sub- Contractor employees deployed in theater this reporting period (by country). As part of its submission, the Contractor shall provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period shall be the period of performance not to exceed 12 months ending September 30 of each government fiscal year and must be reported by 31 October of each calendar year.

Contractors may use a direct XML data transfer to the database server or fill in the fields on the website.

The XML direct transfer is a format for transferring files from a Contractor’s system to the secure website without the need for separate data entries for each required data element at the website. The specific formats for the XML direct transfer may be downloaded from the website.

PART 6

APPLICABLE PUBLICATIONS

(In this section list any publications, manuals, and/or regulations that the contractor must abide by. See example provided below.)

6. APPLICABLE PUBLICATIONS (CURRENT EDITIONS) (If applicable): (In this section list any publications, manuals, and/or regulations that the contractor must abide by. See example provided below.)

6.1. The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures. (For example, insert AR 25-2, AR 530-1.)

Section complete:

Publication number Title Date AFI24-302 Vehicle Management 20 February 2020 QTP24-3-B162 Ambulance Vehicle

Training Package 13 January 2019

DODI 6055.06 DOD FIRE AND

EMERGENCY

SERVICES (F&ES)

PROGRAM

3 October 2019

Joint Prehospital Emergency Care Protocols

FY2025 Version 4, or latest version

Joint EMS Minimum Credentialing Standards

2025 or latest version.

MDGI 24-01 Ambulance Operations MDGI 41-2 Shift Responsibilities

PART 7

ATTACHMENT/TECHNICAL EXHIBIT LISTING

(Under this section list all attachments and technical exhibits that will be useful for the contractor to submit an appropriate proposal. )

7. Attachment/Technical Exhibit List:

7.1. Attachment 1/Technical Exhibit 1 – Performance Requirements Summary (This document is required for every PWS. See attached example for format.)

7.2. Attachment 2/Technical Exhibit 2 – Deliverables Schedule (This document is required for every PWS.

See attached example for format.)

7…