Attachment_1.docx

Combined Synopsis/Solicitation No. AG-82A7-S-15-0049 Attachment 1 Page 7 of 7

QUOTER QUESTIONAIRE

☐ Completed Schedule of Services (page 2) with proposed pricing for the base year and 4 Option Years. – (1 page allowed)

☐ Quoter confirms the attached Scope of work has been thoroughly reviewed before submitting a quotation.

☐ The registration process at www.SAM.gov has been successfully completed.

☐ Quoter confirms the provision FAR 52.212-3, the annual representations and certifications, has been electronically completed at www.SAM.gov. The complete provision can be found at https://www.acquisition.gov/far/loadmainre.html.

☐ Contract Federal Tax ID Number is provided:__________________________

☐ Contractor DUNS number is provided:_________________________

☐ A copy of the State of Nebraska license for each proposed Key Personnel is provided (1 page allowed).

☐ A copy of the State of Nebraska license for the proposed substitute(s) is provided (1 page allowed).

☐ Proof of General Insurance, in accordance with FAR 52.228-5 and AGAR 452.228-71; AND Medical Insurance, in accordance with FAR 52.237-7, ☐ IS provided (1 page allowed each) OR ☐ CAN be provided before contract award.

☐ A resume for each proposed Key Personnel is provided (1 page allowed).

☐ A resume for the proposed substitute(s) is provided (1 page allowed).

Contractor’s Point of Contact (POC) Information is provided:

Name: Organization:

Position: Email:

Phone: Fax:

☐ The following questions have been answered as provided below (1 additional page allowed, if necessary):

1. How will your company provide a qualified substitute, when necessary?

2. Do you have any other Job Corp experience or experience working with disadvantage young adults? If so, where?

3. Within the past 5 years have you failed to complete any work awarded to you or been terminated for default or breach of contract? If yes, explain.

4. How many years of experience do your company and any key personnel have in regards to the requirements stated in this solicitation? Provide a summary of your experience.

☐ The following three (3) professional references of similar past work performance is provided:

1. Name: Organization:

Phone: Email:______________________________________

2. Name: Organization:

Phone: Email:______________________________________

3. Name: Organization:

Phone: Email:

☐ I certify that all of the information provided above is complete, true, and correct to the best of my knowledge.

Sign:______________________________________ Date:_______________________________________

SCHEDULE OF SERVICES

The quantities listed below are the Government’s best estimates. The Contractor will be paid based upon the actual work performed pursuant to the PWS. Services/supplies should not exceed the estimated quantities below.

19.

ITEM NO.

20.

SCHEDULE OF SERVICES

21.

QTY

22.

UNIT

23.

UNIT PRICE

24.

TOTAL AMT

BASE YEAR SERVICES – July 01, 2015 through June 30, 2016

(As prescribed by the Optometrist) *Note

19.

ITEM NO.

20.

SCHEDULE OF SERVICES

21.

QTY

22.

UNIT

23.

UNIT PRICE

24.

OPTION YEAR ONE SERVICES – July 01, 2016 through June 30, 2017

(As prescribed by the Optometrist) *Note

19.

20.

SCHEDULE OF SERVICES

21.

QTY

22.

UNIT

23.

UNIT PRICE

24.

OPTION YEAR TWO SERVICES – July 01, 2017 through June 30, 2018

(As prescribed by the Optometrist) *Note

19.

20.

SCHEDULE OF SERVICES

21.

QTY

22.

UNIT

23.

UNIT PRICE

24.

OPTION YEAR THREE SERVICES – July 01, 2018 through June 30, 2019

(As prescribed by the Optometrist) *Note

19.

20.

SCHEDULE OF SERVICES

21.

QTY

22.

UNIT

23.

UNIT PRICE

24.

OPTION YEAR FOUR SERVICES – July 01, 2019 through June 30, 2020

(As prescribed by the Optometrist) *Note

*Note: Lenses with no optional upgrades; Frames to be the least expensive options available

GRAND TOTAL WITH ALL OPTIONS: $_________________

A detailed breakdown of the Quote may be requested.

PERFORMANCE WORK STATEMENT

1. INTRODUCTION:

The USDA Forest Service Job Corps Civilian Conservation Centers (JCCCC) provide academic, vocational, and life-learning skills to at risk youth and young adults at 28 Job Corps Centers across the United States (U.S.). As part of this program, youth and young adults at the Centers are provided healthcare services as follows: medical, dental, mental health, and drug & alcohol intervention. Each Forest Service JCCCC has a need for basic health services provided by licensed medical professionals that includes examinations and assessments, treatment, issuance of prescriptions and immunizations, monitoring health conditions, recommending hospitalization, follow-up care, and prevention planning and intervention.

2. BACKGROUND:

Job Corps is a U.S. Department of Labor (DOL), Employment and Training Administration (ETA) program. Job Corps is designed to assist young people who need and can benefit from the wide-range of services provided at a Job Corps center. Services include the following: basic education, High School Diploma (HSD) program; General Educational Development (GED); vocational skills training; residential living program; healthcare; and related support services. The comprehensive combination of training and support services is designed to help each student become a responsible and productive citizen. Student populations range from 100 to over 300 enrollments depending on the Center’s On Board Strength (OBS). Job Corps is a self-paced program: therefore, a student’s length of enrollment varies. Students may remain in the program for up to two years, but the average length of enrollment is approximately eight months.

3. CONTRACT EFFORT REQUIRED:

A. Performance Required

· Pine Ridge Job corps requires vision services for students enrolled in the Job Corps program. Vision Services will need to consist of the following:

· Basic eye exam is to include same services provided to the public to include; near and far vision testing along with glaucoma testing.

· Glasses to be provided are as follows:

· Frames: students may choose from the lowest cost frame available at the office

· Lens: are to be poly carbonate (safety lens), single vision (bifocal, trifocal on a very rare occasion), non-progressive, and clear (no transitions).

· Side shields are to be provided with glasses.

· Appointments shall be scheduled at a time that is beneficial to both the vendor and Pine Ridge Job Corps.

B. Program Direction

· The Optician shall provide optical program direction within the Policy and Requirements Handbook (PRH) Chapter 6. This shall include review, approval, and issue of necessary standing orders regarding eye care if necessary.

· Providing advice and assistance to health education instructors in the development and implementation of the optical education components of the health education program.

· Assist in the development and compliance of the Job Corps infection control policies and procedures. The Contractor and assistant(s) shall wear personal protective equipment during time of treatment.

4. SERVICE SCHEDULE:

The Contractor shall provide optical services at their office, with established days of the week and working hours to be agreed upon by the Contractor and the Contracting Officers Representative. Work will be performed between the hours of 8:00 am and 4:00 p.m. Additional days or a change in work schedule must be agreed upon by the Contractor and the Contracting Officer’s Representative (COR), with the Contractor requesting such approval 24 hours in advance for cancellation of services or changes thereof.

The estimated number of appointments varies depending on student population and the needs of individual students enrolled in the program. The Center is closed for approximately 6 weeks throughout the year, for summer and winter break. The Contracting Officer’s Representative will provide the Contractor with the Center calendar for planning purposes.

All Center optical services shall be provided at the Contractor’s optical facility.

5. QUALIFICATIONS:

A. The duties may include, but are not limited to the following:

· Awareness of and responsiveness to the problems in addressing the optical care needs of an individual.

· Managing and organizing an effective optical care program including budgeting and establishing optical care priorities.

· Ability to work effectively with both health and non-health care personnel in delivery of an effective optical program.

B. Certifications/Education Requirements:

Contractor personnel:

· shall be licensed to provide optical services in the State of Kentucky; all licensing requirements/certification/accreditation of the contractor’s staff must be maintained during the entire performance period with proof being submitted at the request of the Government;

· are responsible for maintaining their own malpractice/professional liability insurance and general liability insurance;

· may be subject to a criminal background check and drug testing as prerequisites for contract performance.

6. ATTENDANCE/LEAVE/AND SUBSTITUTION:

Substitution: The Contractor shall furnish a substitute licensed optometrist during any scheduled or unscheduled absences. The Contractor shall furnish a substitute at no additional cost to the Government. The Contractor shall notify the Health and Wellness Manager of any absences at least 24 hours in advance and shall identify and provide background information and qualifications of substitute personnel who will be providing services during the absence.

7. MATERIALS, EQUIPMENT, TRAINING, AND UTILITIES:

A. The Government Shall Furnish (at the discretion of the CO or COR) transportation of Job Corps students to and from the Contractor’s facility.

B. The Contractor shall furnish all labor, supervision, facilities, equipment, and all other requirements to provide Optical Services.

8. THE ROLE OF GOVERNMENT PERSONNEL AND RESPONSIBILITY FOR CONTRACT ADMINISTRATION:

A. Contracting Officer (CO): The CO has the overall responsibility for the administration of this contract. The CO alone, without delegation, is authorized to amend, modify, or deviate from the contract. Other responsibilities may be delegated to authorized representatives.

B. Contracting Officer's Representative (COR): The COR will be designated in writing at the time of award to assist the CO in the day-to-day on-site administration of the contract requirements. The responsibilities of the COR include, but are not limited to;

· Determining the compliance and adequacy of performance by the Contractor in accordance with the terms and conditions of this contract;

· Requesting removal of unsuitable contractor employees;

· Ensuring adequacy of schedule and Quality Control Plan, including changes;

· Ordering re-performance of unacceptable work or performance by other mean, etc.

9. RECORDS, REPORTS, AND REQUIRED SUBMITTALS:

The Contractor shall maintain accurate, legible records of patient eye conditions and all services performed. These forms and other summaries of care are confidential records to be disclosed only to authorized personnel. All existing student health records will be available to the Contractor. Written prescriptions for drugs dispensed by the Center Nurse shall be included in patient records. The Government will perform periodic inspections of the total contract work, including records maintenance. Job Corps Health Consultants and other authorized personnel may be involved in inspections.

All records and reports are subject to the HIPPA.

Upon request, authorized Job Corps staff shall have access to and obtain copies of all student medical records, evaluation and treatment reports prepared by the Contractor. Student medical records will be subject to review by the Contracting Officer and/or COR for validation of payment and services rendered.

10. GOVERNING REGULATIONS, HANDBOOKS, AND REFERENCES:

Contractor personnel shall be familiar with and all work shall be performed in accordance with the following applicable documents:

· 20 CFR Section 638 and 20 CFR Section 670: The CFR (available at http://www.gpo.gov/fdsys/browse/collectionCfr.action?collectionCode=CFR) states the operating regulations for Job Corps.

· Policy and Requirements Handbook (PRH): the Department of Labor PRH which defines the operating policy and procedures of the Job Corps program. There are 6 PRH Chapters, Chapter 6, defines the required parameters and services of the Health Programs although Chapter 6 is critical to understanding the health requirements, Contractor staff should be familiar with the entire PRH. The PRH is available at the following website http://www.jobcorps.gov/Libraries/pdf/prh.sflb.

· PAG: The PAG provides guidance on how Center programs are assessed and can be accessed at the Center.

· Center Operating Procedures: Available from Center personnel.

Any documents referred to in any contractual documents that are not available online at a public website may be requested in writing from the Contracting Officer.

11. QUALITY ASSURANCE SURVEILLANCE MATRIX:

In accordance with FAR 37.401, the Government will evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g. professional judgments, diagnosis for specific medical treatment, etc.)

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

Appointments are limited to between the hours of 8:00 AM-3:00 PM.