AG-04H1-S-17-0006_Medical_Director.pdf

REGION 6 – FIRE AND AVIATION CONTRACTING INSTRUCTIONAL COVER SHEET

ISSUING OFFICE:

U.S. DEPARTMENT OF AGRICULTURE

FOREST SERVICE

REGION 6 FIRE & AVIATION CONTRACTING

1740 SE OCHOCO WAY

REDMOND, OR 97756

SOLICITATION NO.: AG-04H1-S-17-0006

QUOTES ARE SOLICITED FOR: MEDICAL DIRECTOR

IMPORTANT – NOTICE TO QUOTER:

AT A MINIMUM, QUOTER SHALL SUBMIT THE FOLLOWING DOCUMENTS BACK AS THEIR RESPONSE

TO THIS SOLICITATION:

1.SF-18 Request For Quotation (Complete, date, and sign)

2.Section B – Schedule of Items (Page 2). (Complete Unit Price and Amount)

3.Section K – Representations and Certifications (Pages 13-15). (System for awards management SAM.gov)

4.Section L – Capability Statement

IT IS REQUIRED THAT YOU SUBMIT YOUR QUOTE ELECTRONICALLY TO THE EMAIL ADDRESS

BELOW NO FACSIMILE (FAX) QUOTES WILL BE ACCEPTED.

Return to: Nathan Sabo, Contracting Officer nsabo@fs.fed.us 541-408-8754

**Please keep a copy of your quote for your records.

IT IS REQUIRED THAT ALL CONTRACTOR’S BE REGISTERED IN THE SYSTEM FOR AWARD MANAGEMENT (SAM) REGISTRATION DATABASE PRIOR TO AWARD UNDER THIS SOLICITATION. SEE WWW. SAM.GOV FOR

DETAILS ON HOW TO APPLY.

mailto:nsabo@fs.fed.us

REQUEST FOR QUOTATION PAGE OF PAGES

(THIS IS NOT AN ORDER) THIS RFQ X IS IS NOT A SMALL BUSINESS SET- ASIDE 1 18

1. REQUEST NO. 2. DATE ISSUED 3. REQUISITION/PURCHASE REQUEST NO. 4. CERT. FOR NAT.DEF. RATING

AG-04H1-S-17-0006 08/28/2017

UNDER BDSA REG. 2

AND/OR DMS REG. 1

5a. ISSUED BY 6. DELIVER BY (Date) R6 FIRE & AVIATION; 1740 SE OCHOCO WAY; REDMOND, OR 97756 See Contract Time

5b. FOR INFORMATION CALL (NO COLLECT CALLS) 7. DELIVERY FOB DESTINATION NAME TELEPHONE NUMBER X OTHER (See Schedule)

AREA CODE NUMBER 9. DESTINATION

NATHAN SABO 541 408-8754 a. NAME OF CONSIGNEE

8. TO: Section C - Location & Description

a. NAME b. COMPANY b. STREET ADDRESS

c. STREET ADDRESS c. CITY

d. CITY e. STATE f. ZIP CODE d. STATE e. ZIP CODE

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5A ON OR

BEFORE CLOSE OF BUSINESS

IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in BLOCK 5A.

This request does not commit the Government to pay any costs incurred in the preparation of the

SEPTEMBER 13, 2017 no later than 3:00 p.m. PST submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(a) (b) (c) (d) (e) (f)

EMT MEDICAL DIRECTOR,

REGION 6 – FIRE & AVIATION,

PACIFIC NOTHWEST REGION

OREGION AND WASHINGTON

FACSIMILE(FAX) WILL NOT BE ACCEPTED. PLEASE PLACE YOUR QUOTE IN SECTION B- SCHEDULE OF ITEMS

This requirement is being procured as a fixed-price Simplified Acquisition.

a. 10 CALENDAR DAYS (%) b. 20 CALENDAR

DAYS

c. 30 CALENDAR DAYS d. CALENDAR DAYS

12. DISCOUNT FOR PROMPT PAYMENT NUMBER PERCENTAGE

NOTE: Additional provisions and representations X are are not attached.

13. NAME AND ADDRESS OF QUOTER 14. SIGNATURE OF PERSON AUTHORIZED TO 15. DATE OF

a. NAME OF QUOTER SIGN QUOTATION QUOTATION

DUNS # ___________ TIN # _______________________

b. STREET ADDRESS 16. SIGNER

a. NAME (Type or print) b. TELEPHONE

c. COUNTY AREA CODE

d. CITY e.

STATE

f. ZIP CODE c. TITLE (Type or Print) NUMBER

NSN 7540-01-152-8084

Previous edition not usable

18-121 STANDARD FORM 18 (Rev. 6-95) Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

SECTION B--SUPPLIES OR SERVICES AND PRICES

EMT MEDICAL DIRECTOR

Pacific Northwest Region

Oregon & Washington

B- 1 - Schedule of Items

Base – Emergency Medical Services from October 1, 2017 – September 30, 2018

Line Item

Description

Quantity

Unit of Issue

Unit Price

Amount

0001 Providing Services listed in the Statement of Work (SOW).

5-50 EMR to EMTA LS $ $

0002 Providing Services listed in the Statement of Work (SOW).

51-75 EMR to EMTA LS

0003 Providing Services listed in the Statement of Work (SOW).

76-100 EMR to EMTA LS $ $

0004 Providing Services listed in the Statement of Work (SOW).

101-125 EMR to EMTA LS $ $

0005 Providing Services listed in the Statement of Work (SOW).

126-175 EMR to EMTA LS $ $

Option 1 (Year 2) – Emergency Medical Services October 1, 2018 – September 30, 2019

Issue

1001 Providing Services listed in the Statement of Work (SOW).

5-50 EMR to EMTA LS $ $

1002 Providing Services listed in the Statement of Work (SOW).

51-75 EMR to EMTA

LS

1003 Providing Services listed in the Statement of Work (SOW).

76-100 EMR to EMTA LS $ $

1004 Providing Services listed in the Statement of Work (SOW).

101-125 EMR to EMTA LS $ $

1005 Providing Services listed in the Statement of Work (SOW).

Option 2 (Year 3) – Emergency Medical Services from October 1, 2019 – September 30, 2020

Issue

2001 Providing Services listed in the Statement of Work (SOW).

5-50 EMR to EMTA LS $ $

2002 Providing Services listed in the Statement of Work (SOW).

2003 Providing Services listed in the Statement of Work (SOW).

76-100 EMR to EMTA LS $ $

2004 Providing Services listed in the Statement of Work (SOW).

101-125

2005 Providing Services listed in the Statement of Work (SOW).

Option 3 (Year 4) – Emergency Medical Services from October 1, 2020 – September 30, 2021

Issue

3001 Providing Services listed in the Statement of Work (SOW).

5-50 EMR to EMTA LS $ $

3002 Providing Services listed in the Statement of Work (SOW).

3003 Providing Services listed in the Statement of Work (SOW).

76-100 EMR to EMTA LS $ $

3004 Providing Services listed in the Statement of Work (SOW).

101-125 EMR to EMTA LS $ $

3005 Providing Services listed in the Statement of Work (SOW).

Option 4 (Year 5) – Emergency Medical Services from October 1, 2021 – September 30, 2022

Issue

4001 Providing Services listed in the Statement of Work (SOW).

5-50 EMR to EMTA LS $ $

4002 Providing Services listed in the Statement of Work (SOW).

4003 Providing Services listed in the Statement of Work (SOW).

76-100 EMR to EMTA LS $ $

4004 Providing Services listed in the Statement of Work (SOW).

101-125 EMR to EMTA LS $ $

4005 Providing Services listed in the Statement of Work (SOW).

* The period of performance is a base-year with four 1 – year options. Total period of performance shall note exceed 5 years.

* Quote on all items. Only quotes to the nearest cent will be accepted.

SECTION C--DESCRIPTION/SPECIFICATIONS/STATEMENT OF WORK

C- 1 - Scope of Contract

The USDA – Forest Service Region 6 Fire and Aviation Contracting Team is currently in the process of solicitation to obtain the professional services to provide Emergency Medical Services (EMS) medical direction for Bureau of Land Management (BLM) and Forest Service (FS) employees stationed in Oregon and Washington. These employees are collateral duty Emergency Care Providers and as such are normally employed as wildland firefighters, law enforcement officers, wilderness rangers, recreation technicians etc. These employees need both direct and indirect medical oversight both in home response areas and for employees on off-unit assignments within Oregon and Washington. These employees are currently credentialed in Oregon or Washington, or other states, as Emergency Medical Responders (EMR), Basic Emergency Medical Technicians, Intermediate Emergency Medical Technicians, Advanced Emergency Medical Technicians (EMTA), or Paramedics.

The Bureau of Land Management and Forest Service employees occasionally provide emergency medical care for employees and cooperative incident responders associated with high risk work activities such as wildland fire operations and law enforcement. Some of these medical responses may be for patients who are several hours or potentially a day away from definitive care. It is preferably that the federal emergency providers covered under this medical direction will have protocols that are appropriate for a remote, wilderness environment. Federal wildland firefighters in Oregon and Washington have an anticipated response to Medical Emergencies of about +/- 10 calls per year per EMT.

The following number of Bureau of Land Management and Forest Service Emergency Medical Care Providers that will be covered under this medical direction may vary from year to year:

• 5 – 50 EMR up to EMTA

• 51 – 75 EMR up to EMTA

• 76 – 100 EMR up to EMTA

• 101 – 125 EMR up to EMTA

• 126 – 175 EMR up to EMTA

Desired initiation into the medical director’s coverage would be those selected by the agency representative who possess a National Registry of Emergency Medical Technician certification AND state certification in Oregon or Washington. This would allow for immediate medical direction on basic protocols, while any necessary training and face-to-face interactions would occur at a later date. The purpose of this is to cover federal emergency medicine providers immediately upon contract award.

Medical personnel could be located in any Regional Bureau of Land Management District Office or National Forest Service Office within the states of Oregon or Washington.

These employees are distributed across various locations and are applying to the State EMS board to become licensed providers (non-transport). The Bureau of Land Management and Forest Service anticipates a range of employees on a yearly basis identified in the scale above.

The contractor must be a licensed physician in Oregon AND Washington and will have overall responsibility for the medical aspects of care provided by these federal emergency medical personnel within Oregon and Washington.

The contractor should have the following qualifications and background:

1. Experience in providing or identifying available EMS courses or emergency medical presentations.

2. Focused expertise in Wildland Fire, Wilderness and Remote Medicine, and Prolonged Patient Care.

3. Poses the following current licenses and certifications:

a. American Board of Emergency Medicine board certification

b. American Board of Emergency Medicine – EMS subspecialty board certified or board eligible

(preferred) Oregon and Washington State Boards of Medicine license

c. Unrestricted DEA license

Medical Director Services shall include:

1. Training: The contractor or his/her designee will provide once annual face to face training in no more than four separate locations annually. The contractor will provide input for training which will cover the dynamics of emergency medical care for wildland fire operations, law enforcement activities and employees involved in remote work projects.

a. These annual trainings will be approved continuing education units for EMRs, EMTs, I-EMTs, and A- EMTs to maintain both National Registry of Emergency Medical Technicians and state certifications.

2. Credentialing: The contractor will support and advise Bureau of Land Management and Forest Service Outdoor

Emergency Care Providers, (Emergency Medical Responders, Basic Emergency Medical Technicians, Intermediate Emergency Medical Technicians, and Advanced Emergency Medical Technicians) to ensure continuing education is completed.

a. Support for federal emergency medical providers to attend semi-annual refresher courses to maintain their national and state certifications are desired, though not required.

3. Protocol Development, Review and Approval: The contractor will assist in developing treatment protocols and will function as the medical director who will review and approve the protocols annually or as necessary. Some protocols may be more advanced than standard protocol levels.

a. This includes, but not limited to, Basic Emergency Medical Technicians administering intramuscular injections of epinephrine; oral administration of acetaminophen, ibuprofen, diphenhydramine; administering albuterol via a non-rebreather mask; applying tourniquets; and clearing a spinal injuring for non-back boarding transports.

4. Subject Matter Expert (SME): As requested by the employees under medical direction, the contractor will provide advice and guidance on emergency medical service issues affecting the Bureau of Land Management and the Forest Service.

5. Documentation: The contractor will provide a patient care report form for the emergency medical providers to document patient treatment, which all providers will be expected to use.

a. The contractor will also provide a care refusal form so emergency medical providers can document the patient’s condition and the provider’s recommendations should the patient refuse care.

6. Patient Care Report (PCR) review: The contractor will review an adequate sample (approximately 15%) of PCR’s annually to determine quality of documentation for problem assessment/reassessment, treatment, and disposition.

Based on this review, he/she will provide a written response with recommendations such as a change in documentation or treatment protocol and topics for continuing education. Patient Care Reports shall be submitted to Contracting Officer (CO) and Contracting Officer’s Representative (COR).annually.

7. Emergency Medical Direction: A designee or representative from the contractor will be available via telephone to answer questions and provide direction to the EMS providers in the field. The contractor or his/her approved designee will provide a response within 15 minutes from initial contact from Bureau of Land Management or Forest Service EMS personnel engaged in an emergency medical response. The contractor will also have a designated email address capable of viewing electronically sent photos for non-urgent question from the field. The contractor or his/her designee will respond to email questions from the field within 24 hours.

8. Liability Insurance: The medical director will maintain and provide proof of liability insurance on an annual basis to the Contracting Officer (CO) and Contracting Officer’s Representative (COR).

9. Quality Assurances Performance Plan (QAPP): As the medical director, the contractor will submit twice a year written reports to the Contracting Officer (CO) and Contracting Officer’s Representative (COR) the following reporting:

a. Summary of all submitted patient care reports (PCR).

b. Summary of issues and concerns with Bureau of Land Management and Forest Service emergency care providers covered under this medical direction.

SECTION E--INSPECTION AND ACCEPTANCE

E- 1 - FAR 52.252-2 Clauses Incorporated by Reference (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text.

Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): www.arnet.gov/far/

FEDERAL ACQUISITION REGULATION (48 CFR CHAPTER 1) CLAUSES

52.246-1 Contractor Inspection Requirements (APR 1984)

E- 2 - FAR 52.246-4 Inspection of Services--Fixed-Price (AUG 1996)

(a) Definitions. "Services," as used in this clause, includes services performed, workmanship, and material furnished or utilized in the performance of services.

(b) The Contractor shall provide and maintain an inspection system acceptable to the Government covering the services under this contract. Complete records of all inspection work performed by the Contractor shall be maintained and made available to the Government during contract performance and for as long afterwards as the contract requires.

(c) The Government has the right to inspect and test all services called for by the contract, to the extent practicable at all times and places during the term of the contract. The Government shall perform inspections and tests in a manner that will not unduly delay the work.

(d) If the Government performs inspections or tests on the premises of the Contractor or a subcontractor, the Contractor shall furnish, and shall require subcontractors to furnish, at no increase in contract price, all reasonable facilities and assistance for the safe and convenient performance of these duties.

(e) If any of the services do not conform with contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements, at no increase in contract amount. When the defects in services cannot be corrected by reperformance, the Government may (1) require the Contractor to take necessary action to ensure that future performance conforms to contract requirements and (2) reduce the contract price to reflect the reduced value of the services performed.

(f) If the Contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with contract requirements, the Government may (1) by contract or otherwise, perform the services and charge to the Contractor any cost incurred by the Government that is directly related to the performance of such service or (2) terminate the contract for default.

http://www.arnet.gov/far/

SECTION H--SPECIAL CONTRACT REQUIREMENTS

H- 1 - Designation of Contracting Officer Representative

Prior to the commencement of work, the COR will be designated. The COR is responsible for administering the performance of the work under this contract. In no event, however, will any understanding, agreement, modification, change order, or other matter deviating from the terms of this contract be effective or binding upon the Government unless formalized by the Contracting Officer prior to the completion of this contract.

SECTION I--CONTRACT CLAUSES

I- 1 - FAR 52.252-2 Clauses Incorporated by Reference (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text.

Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

www.arnet.gov/far/ www.usda.gov/procurement/policy/agar.html

FEDERAL ACQUISITION REGULATION (48 CFR CHAPTER 1) CLAUSES

52.211-18 Variation in Estimated Quantity (APR 1984) 52.217-8 Option to Extend Services (NOV 1999) 52.217-9 Option to Extend the Term of the Contract (NOV 1999) 52.219-6 Notice of Total Small Business Set-Aside (NOV 2011) 52.219-28 Post-Award Small Business Program Re-representation (JUL 2013) 52.222-3 Convict Labor (JUN 2003) 52.222-21 Prohibition of Segregated Facilities (APR 2015) 52.222-26 Equal Opportunity (SEP 2016) 52.222-36 Affirmative Action for Workers with Disabilities (JUL 2014) 52.222-44 Fair Labor Standards Act and Service Contract Act - Price Adjustment (SEP 2009) 52.222-50 Combating Trafficking in Persons (MAR 2015) 52.223-6 Drug-Free Workplace (MAY 2014) 52.224-1 Privacy Act Notification (APR 1984) 52.225-13 Restrictions on Certain Foreign Purchases (JUN 2008) 52.232-3 Payments under Personal Services Contracts (JAN 2017) 52.232-8 Discounts for Prompt Payment (FEB 2002) 52.232-11 Extras (APR 1984) 52.232-23 Assignment of Claims (MAY 2014) 52.232-25 Prompt Payment (JAN 2017) 52.232-33 Payment by Electronic Funds Transfer – Central Contractor Registration (JUL 2013) 52.233-1 Disputes (MAY 2014) Alternate I (DEC 1991) 52.233-3 Protest after Award (AUG 1996) 52.233-4 Applicable Law for Breach of Contract Claim (OCT 2004) 52.237-7 Indemnification and Medical Liability Insurance (JAN 1999) 52.243-1 Changes--Fixed-Price (AUG 1987) Alternate III (APR 1984) 52.244-6 Subcontracts for Commercial Items (DEC 2009) 52.245-1 Government Property (JUN 2017) 52.246-1 Contractor Inspection Requirements (APR 1984) 52.249-1 Termination for Convenience of the Government (Fixed-Price) (Short Form) (APR 1984) 52.249-8 Default (Fixed-Price Supply and Service) (APR 1984) 52.249-12 Terminations (Personal Services) (APR 1984) 52.252-6 Authorized Deviation in Clauses (APR 1984) 52.253-1 Computer Generated Forms (JAN 1991)

AGRICULTURE ACQUISITION REGULATION (48 CFR CHAPTER 4) CLAUSES

452.224-70 Confidentiality of Information (FEB 1988) 452.237-75 Restrictions Against Disclosure (FEB 1988) 452.246-70 Inspection and Acceptance http://www.arnet.gov/far/ http://www.usda.gov/procurement/policy/agar.html

I- 2- FAR 52.204-7 System for Award Management (OCT 2016)

(a) Definitions. As used in this provision—

“Electronic Funds Transfer (EFT) indicator” means a four-character suffix to the unique entity identifier. The suffix is assigned at the discretion of the commercial, nonprofit, or Government entity to establish additional System for Award Management records for identifying alternative EFT accounts (see subpart 32.11) for the same entity.

“Registered in the System for Award Management (SAM) database” means that—

(1) The Offeror has entered all mandatory information, including the unique entity identifier and the EFT indicator, if applicable, the Commercial and Government Entity (CAGE) code, as well as data required by the Federal Funding Accountability and Transparency Act of 2006 (see subpart 4.14), into the SAM database;

(2) The offeror has completed the Core, Assertions, and Representations and Certification, and Points of contact sections of the registration in the SAM database;

(3) The Government has validated all mandatory data fields, to include validation of the Taxpayer Identification Number (TIN) with the Internal Revenue Service (IRS). The Offeror will be required to provide consent for TIN validation to the Government as a part of the SAM registration process.

(4) The Government has marked the record “Active”.

“Unique entity identifier” means a number or other identifier used to identify a specific commercial, nonprofit, or Government entity. See www.sam.gov for the designated entity for establishing unique entity identifiers.

(b)

(1) By submission of an Offer, the offeror acknowledges the requirement that a prospective awardee shall be registered in the SAM database prior to award, during performance, and through final payment of any contract, basic agreement, basic ordering agreement, or blanket purchasing agreement resulting from this solicitation.

(2) The Offeror shall enter, in the block with its name and address on the cover page of its offer, the annotation “Unique Entity Identifier” followed by the unique entity identifier that identifies the Offeror’s name and address exactly as stated in the offer. The Offeror also shall enter its EFT indicator, if applicable. The unique entity identifier will be used by the Contracting Officer to verify that the Offeror is registered in the SAM database.

(c) If the Offeror does not have a unique entity identifier, it should contact the entity designated at www.sam.gov for establishment of the unique entity identifier directly to obtain one. The Offeror should be prepared to provide the following information:

(1) Company legal business name.

(2) Tradestyle, doing business, or other name by which your entity is commonly recognized.

(3) Company physical street address, city, state and Zip Code.

(4) Company mailing address, city, state and Zip Code (if separate from physical).

(5) Company telephone number.

(6) Date the company was started.

(7) Number of employees at your location.

(8) Chief executive officer/key manager.

(9) Line of business (industry).

(10) Company Headquarters name and address (reporting relationship within your entity).

(d) If the Offeror does not become registered in the SAM database in the time prescribed by the Contracting Officer, the Contracting Officer will proceed to award to the next otherwise successful registered Offeror.

http://www.sam.gov/ http://www.sam.gov/

(e) Processing time, which normally takes 48 hours, should be taken into consideration when registering. Offerors who are not registered should consider applying for registration immediately upon receipt of this solicitation.

(f) Offerors may obtain information on registration at https://www.acquisition.gov.

(End of Provision)

I- 3 - FAR 52.236-7 Permits and Responsibilities (NOV 1991)

The Contractor shall, without additional expense to the Government, be responsible for obtaining any necessary licenses and permits, and for complying with any Federal, State, and municipal laws, codes, and regulations applicable to the performance of the work. The Contractor shall also be responsible for all damages to persons or property that occur as a result of the Contractor's fault or negligence. The Contractor shall also be responsible for all materials delivered and work performed until completion and acceptance of the entire work, except for any completed unit of work which may have been accepted under the contract.

I- 4 - AGAR 452.209-70 Representation by Corporations Regarding an Unpaid Delinquent Tax

(a.) Awards made under this solicitation are subject to the provisions contained sections 433 and 434 in the Consolidated Appropriations Act, 2012 (P.L. No. 112-74), Division E, as amended and/or subsequently enacted, regarding corporate felony convictions and corporate federal tax delinquencies. To comply with these provisions, all offerors must complete paragraph

(1) of this representation, and all corporate offerors also must complete paragraphs (2) and (3) of this representation.

(b) The Offeror represents that –

(1) The Offeror is [ ], is not [ ] (check one) an entity that has filed articles of incorporation in one of the fifty states, the District of Columbia, or the various territories of the United States including American Samoa, Federated States of Micronesia, Guam, Midway Islands, Northern Mariana Islands, Puerto Rico, Republic of Palau, Republic of the Marshall Islands, U.S. Virgin Islands.

(Note that this includes both for-profit and non-profit organizations.)

If the Offeror checked "is" above, the Offeror must complete paragraphs (2) and (3) of the representation.

If Offeror checked "is not" above, Offeror may leave the remainder of the representation blank.

(2) (i) The Offeror has [ ], has not [ ] (check one) been convicted of a felony criminal violation under Federal or State law in the 24 months preceding the date of offer.

(ii) Offeror has [ ], has not [ ] (check one) had any officer or agent of Offeror convicted of a felony criminal violation for actions taken on behalf of Offeror under Federal law in the 24 months preceding the date of offer.

(3) The Offeror does [ ], does not [ ] (check one) have any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.

https://www.acquisition.gov/

PART IV--REPRESENTATIONS AND INSTRUCTIONS

SECTION K--REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF

OFFERORS OR RESPONDENTS

K- 1 - FAR 52.204-8 Annual Representations and Certifications (JAN 2017)

(1) The North American Industry classification System (NAICS) code for this acquisition is 621111 [insert NAICS code].

(2) The small business size standard is 11 MILLION [insert size standard].

(3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees.

(1) If the provision at 52.204-7, System for Award Management, is included in this solicitation, paragraph (d) of this provision applies.

(2) If the provision at 52.204-7 is not included in this solicitation, and the offeror is currently registered in the System for Award Management (SAM), and has completed the Representations and Certifications section of SAM electronically, the offeror may choose to use paragraph (d) of this provision instead of completing the corresponding individual representations and certification in the solicitation. The offeror shall indicate which option applies by checking one of the following boxes:

[_] (i) Paragraph (d) applies.

[_] (ii) Paragraph (d) does not apply and the offeror has completed the individual representations and certifications in the solicitation.

(c)

(1) The following representations or certifications in SAM are applicable to this solicitation as indicated:

(i) 52.203-2, Certificate of Independent Price Determination. This provision applies to solicitations when a firm-fixed-price contract or fixed-price contract with economic price adjustment is contemplated, unless—

(A) The acquisition is to be made under the simplified acquisition procedures in Part 13;

(B) The solicitation is a request for technical proposals under two-step sealed bidding procedures; or

(C) The solicitation is for utility services for which rates are set by law or regulation.

(ii) 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. This provision applies to solicitations expected to exceed $150,000.

(iii) 52.203-18, Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements— Representation. This provision applies to all solicitations.

(iv) 52.204-3, Taxpayer Identification. This provision applies to solicitations that do not include the provision at 52.204-7, System for Award Management.

(v) 52.204-5, Women-Owned Business (Other Than Small Business). This provision applies to solicitations that—

(A) Are not set aside for small business concerns;

(B) Exceed the simplified acquisition threshold; and

(C) Are for contracts that will be performed in the United States or its outlying areas.

(vi) 52.209-2, Prohibition on Contracting with Inverted Domestic Corporations—Representation.

(vii) 52.209-5; Certification Regarding Responsibility Matters. This provision applies to solicitations where the contract value is expected to exceed the simplified acquisition threshold.

(viii) 52.209-11, Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law. This provision applies to all solicitations.

(ix) 52.214-14, Place of Performance--Sealed Bidding. This provision applies to invitations for bids except those in which the place of performance is specified by the Government.

(x) 52.215-6, Place of Performance. This provision applies to solicitations unless the place of performance is specified by the

Government.

(xi) 52.219-1, Small Business Program Representations (Basic & Alternate I). This provision applies to solicitations when the contract will be performed in the United States or its outlying areas.

(A) The basic provision applies when the solicitations are issued by other than DoD, NASA, and the Coast Guard.

(B) The provision with its Alternate I applies to solicitations issued by DoD, NASA, or the Coast Guard.

(xii) 52.219-2, Equal Low Bids. This provision applies to solicitations when contracting by sealed bidding and the contract will be performed in the United States or its outlying areas.

(xiii) 52.222-22, Previous Contracts and Compliance Reports. This provision applies to solicitations that include the clause at 52.222-26, Equal Opportunity.

(xiv) 52.222-25, Affirmative Action Compliance. This provision applies to solicitations, other than those for construction, when the solicitation includes the clause at 52.222-26, Equal Opportunity.

(xv) 52.222-38, Compliance with Veterans' Employment Reporting Requirements. This provision applies to solicitations when it is anticipated the contract award will exceed the simplified acquisition threshold and the contract is not for acquisition of commercial items.

(xvi) 52.222-57, Representation Regarding Compliance with Labor Laws (Executive Order 13673). This provision applies to solicitations expected to exceed $50 million which are issued from October 25, 2016 through April 24, 2017, and solicitations expected to exceed $500,000, which are issued after April 24, 2017.

Note to paragraph (c)(1)(xvi): By a court order issued on October 24, 2016, 52.222-57 is enjoined indefinitely as of the date of the order. The enjoined paragraph will become effective immediately if the court terminates the injunction. At that time, DoD, GSA, and NASA will publish a document in the Federal Register advising the public of the termination of the injunction.

(xvii) 52.223-1, Biobased Product Certification. This provision applies to solicitations that require the delivery or specify the use of USDA-designated items; or include the clause at 52.223-2, Affirmative Procurement of Biobased Products Under Service and Construction Contracts.

(xviii) 52.223-4, Recovered Material Certification. This provision applies to solicitations that are for, or specify the use of, EPA-designated items

(xix) 52.223-22, Public Disclosure of Greenhouse Gas Emissions and Reduction Goals—Representation. This provision applies to solicitations that include the clause at 52.204-7.

(xx) 52.225-2, Buy American Certificate. This provision applies to solicitations containing the clause at 52.225-1.

(xxi) 52.225-4, Buy American--Free Trade Agreements--Israeli Trade Act Certificate. (Basic, Alternates I, II, and III.) This provision applies to solicitations containing the clause at 52.225- 3.

(A) If the acquisition value is less than $25,000, the basic provision applies.

(B) If the acquisition value is $25,000 or more but is less than $50,000, the provision with its Alternate I applies.

(C) If the acquisition value is $50,000 or more but is less than $77,533, the provision with its Alternate II applies.

(D) If the acquisition value is $79,507 or more but is less than $100,000, the provision with its Alternate III applies.

(xxii) 52.225-6, Trade Agreements Certificate. This provision applies to solicitations containing the clause at 52.225-5.

(xxiii) 52.225-20, Prohibition on Conducting Restricted Business Operations in Sudan--Certification. This provision applies to all solicitations.

(xxiv) 52.225-25, Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran— Representation and Certification. This provision applies to all solicitations.

(xxv) 52.226-2, Historically Black College or University and Minority Institution Representation. This provision applies to solicitations for research, studies, supplies, or services of the type normally acquired from higher educational institutions.

(2) The following representations or certifications are applicable as indicated by the Contracting Officer:

[Contracting Officer check as appropriate.]

___ (i) 52.204-17, Ownership or Control of Offeror.

___ (ii) 52.204-20, Predecessor of Offeror.

___ (iii) 52.222-18, Certification Regarding Knowledge of Child Labor for Listed End Products.

___ (iv) 52.222-48, Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Certification.

___ (v) 52.222-52 Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services-- Certification.

___ (vi) 52.223-9, with its Alternate I, Estimate of Percentage of Recovered Material Content for EPA-Designated Products (Alternate I only).

___ (vii) 52.227-6, Royalty Information.

___ (A) Basic.

___ (B) Alternate I.

___ (viii) 52.227-15, Representation of Limited Rights Data and Restricted Computer Software.

(d) The offeror has completed the annual representations and certifications electronically via the SAM Web site accessed through https://www.acquisition.gov . After reviewing the SAM database information, the offeror verifies by submission of the offer that the representations and certifications currently posted electronically that apply to this solicitation as indicated in paragraph (c) of this provision have been entered or updated within the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201); except for the changes identified below [offeror to insert changes, identifying change by clause number, title, date]. These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.

FAR Clause Title Date Change

Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted on SAM.

SECTION L--INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS OR

RESPONDENTS

L- 1 - Inquiries

Inquiries and all correspondence concerning this solicitation should be submitted in writing to the Contracting Officer. Quoters should contact only the Contracting Officer issuing the solicitation about any aspect of this requirement prior to contract award.

All questions shall be submitted in writing to the Contracting Officer no later than September 6, 2017.

L- 2 - Basis of Award

One award will be made, offer of award will be made to the Quoter whose quote, as determined by the Contracting Officer, provides the best value to the Government, considering the following factors:

1. Past Performance (FAR 15.304)

2. Key Personnel & Submittal

3. Price

1. Past Performance

Experience questionnaire (attachment) shall be completed describing quality and timeliness of performance, business relations and customer satisfaction, and company experience for similar work. Questionnaire must be contracts your firm has completed within the past 3 years and are in similar size, scope and complexity to that required by this solicitation and especially any contracts entered into with Federal, State and local Government.

The Government may contact a sample of your past customers concerning the quality of services provided by your firm and your subcontractors; timeliness of performance; business relations during project management such as flexibility, problem solving, and cooperation; and customer satisfaction.

2. Key personnel & Submittal

Provide the names of key personnel who will be project managers, and any approved designees; the role each will server on the project, and their qualifications and experience. Description of protocol development and company capacity to respond to calls described in the scope of work. Narrative shall not exceed 5 pages.

At a minimum plan should include:

1. Key personnel

2. Resumes / wildland fire experience

3. Residence license

4. Medical liability insurance

3. Price Proposal

This criterion will include consideration of cost information provided in Section B, Schedule of Items. It is the Government's intent to assess the price/cost breakdown to determine:

a. Reasonableness (Unit prices will be evaluated to determine, based on current/prior market conditions, reasonableness of proposed unit prices to effectively perform the requirements), and

b. Price Consistency (Unit prices will be evaluated to determine if costs/prices are balanced and consistent with Government cost estimates and those of other quotes).

c. Options the Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

Key Personnel and Past Performance, when combined, are significantly more important than Price.

L- 3 - Written Acceptance

Any Purchase Order resulting from this solicitation will require written acceptance within 10 days of receipt by the Contractor as required by Simplified Acquisition Procedures.

USDA Forest Service

EXPERIENCE QUESTIONNAIRE

Instructions: See Box 11, Remarks, if extra space is needed to answer any item below, Mark “X: in appropriate boxes.

1. Contractor Name, Address, and Telephone Number

2. Submitted to (Office Name and Address)

3. Business [ ] Company [ ] Co-partnership [ ] Corporation [ ] Individual [ ] Non-profit Organization

4. How many years do you or your firm have in the line of work contemplated by this solicitation?

5. How many years experience have you or your business had as a (a) prime contractor ____ and/or (b) sub-contractor ____?

6. List below the projects your business has completed within the last three years:

Contract Amount

Type of Project Date Completed

Name, Address, and Telephone No. of Owner/Person to Contact for Project Information

7. List below all of your firm’s contractual commitments running concurrently with the work contemplated by this solicitation:

Number

Dollar Amt.

of Award

Name, Address, and Telephone No. of Business/Government Agency Involved

Awarded (Units)

Percent Completed

Date

Complete

8a. Have you ever failed to complete any work awarded to you? [ ] Yes [ ] No 8b. Has work ever been completed by performance bond? [ ] Yes [ ] No 8c. Did you look at the project site(s) on-the-ground? [ ] Yes [ ] No 8d. If “Yes” to either item 8a. or 8b., specify location(s) and reason(s) why:

EXPERIENCE QUESTIONNAIRE CONTINUED

9. Employees and equipment that will be available for this project:

a. (1) Minimum number of employees: _____ and (2) Maximum number of employees: _____

b. Are employees regularly on your payroll: [ ] Yes [ ] No

c. Specify equipment available for this contract:______________________________________________________

d. Estimate rate of progress below (such as 2.0 acres/man/day):

(1) Minimum progress rate:________________ and (2) Maximum progress rate: _________________________

10. List below the experience of the principal individuals of your business. (Who will directly be involved in this contract?)

Individual’s Name Present Position Years of Experience

Magnitude and Type of Work

11. Remarks -- Specify Box Numbers (Attach sheets if extra space is needed to fully answer any above question.):

NOTE: PLEASE PROVIDE ANY ADDITIONAL INFORMATION THAT WILL HELP EVALUATE YOUR ABILITY TO

SUCCESSFULLY COMPLETE THIS PROJECT.

CERTIFICATION

I certify that all of the statements made by me are complete and correct to the best of my knowledge, and that any persons named as references are authorized to furnish the Forest Service with any information needed to verify my capability to perform this project.

12a. CERTIFYING OFFICIAL’S NAME AND TITLE

b. SIGNATURE (Sign in ink) 13.

DATE