Attachment B - IHS1525675 SOW Ventilation Service Contract.pdf

STATEMENT OF WORK

ANNUAL CRITICAL CARE VENTILATION TAB & CERTIFICATION

WHITERIVER SERVICE UNIT

A. BACKGROUND

The Whiteriver Indian Health Service (WRSU) Hospital and Special Service Building (SSB) requires a contracting action for the procurement of annual ventilation assessment services to include Heating, Ventilation, Air Conditioning (HVAC) system Testing and Balancing (TAB). The scope of work detailed below outlines the required project outcomes. The Contractor shall be responsible for all necessary work to achieve required outcomes including labor, equipment, tools, personal protective equipment (PPE), policy adherence, infection control compliance, incidental design, travel, per diem, tribal fees, and other related expenses required to complete the project.

Locations:

Whiteriver Hospital and Special Service Building.

200 West Hospital Drive Whiteriver, Arizona 85941

B. SUMMARY

The contractor shall perform the critical care ventilation certification to include all associated HVAC TAB requirements. The critical care ventilation certification shall provide a report including pressure, airflow, and air changes per hour (ACH) for the isolation rooms, soiled utility rooms, decontamination rooms, operating rooms, and the Central Sterile Receiving (CSR) room to illustrated compliance with the critical care ventilation requirements of ANSI/ASHRAE Standard 170-2008 (Ventilation for Healthcare Facilities), Facility Guidelines Institute – Guidelines for Design & Construction of Hear Care Facilities (Table 7- 1 Design Parameters), and Joint Commission Environment of Care Physical Environment (PE) element of performance (PE) PE 04.01.03 Section 4. Whiteriver Hospital critical care areas requiring ventilation certifications are: 116, 151,152, 159, 185, 198, 199, 216, 218, 222, 231, 251, 317, 319, 319a, 529, and 546. SSB critical care areas requiring ventilation certifications are: 117, 175, and 176.

LOCATION ROOM

NUMBER

ROOM NAME

Hospital 116 Soil Room Hospital 151 Operating Room Hospital 152 Operating Room Hospital 159 Soil Room Hospital 185 Soil Room Hospital 198 Central Sterile Room Hospital 199 Central Sterile Room Hospital 216 Patient Isolation Room Hospital 218 Patient Isolation Room Hospital 222 Patient Isolation Room Hospital 231 Soil Room

Annual Ventilation Assessment with HVAC TAB Whiteriver Service Unit

Hospital 251 Central Sterile Room Hospital 319 Patient Isolation Room Hospital 319A Patient Decontamination Room Hospital 546 Soil Room Hospital 317 Soil Room Hospital 529 Soil Room

Special Service Building

117 Soil Room

Special Service Building

175 Dental Sterile Room

Special Service Building

176 Dental Clean Room

Service to be provided annually. Services and activities required in the operating rooms (151 and 152) shall occur on Fridays only.

C. DELIVERABLES

1. The contractor shall provide onsite:

a. Room pressurization TAB certification at Table 1 for the following rooms: 116, 151, 152, 159, 185, 198, 199, 216, 218, 222, 231, 317, 319, 319a, 251, 117, 175, 176, and 546. Actions shall include measuring and documenting each registers actual airflow in Cubic Feet per Minute (CFM), room pressure, and ventilation adjustments so that each room has the designed pressure relationship per Table 1 of the ANSI/ASHRAE Standard 170-2008.

Additionally, Contractors shall determine and document the supply-to-return airflow differential, room pressure relationship, and actual ACH.

b. Air distribution testing at Table 2 for the following rooms: 151, 152, 198, 199, and 251.

Actions shall include measuring each vents actual CFM airflow and adjusting the ventilation airflow to match as close as possible to the design airflow while maintaining the required room pressure requirements identified in Table 1.

c. Variable Air Volume (VAV) with air distribution testing at Table 3 for the following rooms:

198, 199, and 251. Actions shall include measuring each vents actual CFM airflow and adjusting the ventilation airflow to match as close as possible to the design airflow while maintaining the required room pressure requirements identified in Table 1.

2. The contractor shall balance and make adjustments for each room identified above so that the designed pressure relationship is achieved. Balancing shall be accomplished via manual controls or via the building automation system (Automated Logic).

3. The contractor shall coordinate with the Contracting Officer Representative (COR) prior to arriving onsite to ensure they obtain a functioning Automated Logic account and login.

4. A report with tables similar to that in APPENDIX B shall be submitted. A copy of the Certificate of Calibration for EACH piece of equipment shall be provided with the report.

Annual Ventilation Assessment with HVAC TAB Whiteriver Service Unit

D. PERIOD OF PERFORMANCE

1. The ventilation assessment to include the testing and balancing shall occur annually.

2. Activities required in the Operating Room shall occur on Fridays only.

3. Facility day time hours of operation are 7:00 AM – 4:00 PM, Monday through Friday (excluding

Federal holidays). Work outside of these hours must be requested in writing to the Contracting Officers Representative (COR).

4. Base Year plus Four Option Years. Dates will be determined upon the award of the contract by the Contracting Officer.

E. PLACE OF PERFORMANCE: All work shall be performed at the Whiteriver Service Unit (WRSU) located at 200 West Hospital Drive, Whiteriver, Arizona 85941.

F. CODES AND STANDARDS

1. The Contractor is responsible for securing all required permits and for ensuring compliance with all federal, state, tribal, and local codes and design standards, latest editions.

2. The Contractor shall adhere to the following code requirements for work performed, testing and inspections, including, but not limited to the Occupational Safety and Health Administration (OSHA) regulations, National Fire Protection Association (NFPA) standards NFPA 70, NFPA 99, NFPA 101, and NFPA 111.

3. The WRSU infection control policy shall be adhered to including the wearing of clean room scrub suits where required.

4. ANSI/ASHRAE Standard 170-2008, Ventilation for Healthcare Facilities

5. Facility Guidelines Institute – Guidelines for Design & Construction of Hear Care

Facilities, Table 7-1 Design Parameters.

6. The Joint Commission - Environment of Care (PE) element of performance (EP)

PE 04.01.03 Section 4.

WHITERIVER HOSPITAL POINTS OF CONTACT

Contracting Officer Representative (COR):

Shawn Gant Shawn.Gant@ihs.gov 928-221-6700

WRSU Point of Contact (POC):

Chris Tortice Chris.Torice@ihs.gov 928-338-4911

Shandon Altaha 928-338-4911 Shandon.Altaha@ihs.gov

GOVERNMENT SITE LOCATION MAP 1

Whiteriver Hospital, Garret Building, Administration, Garrett Building, Government Housing Site (Medicine City), and Facilities Site.

Latitude: 33.8765056 Longitude: -109.9597917

900 ft

N

N Image © 2025 Airbus

Image © 2025 Airbus

Image © 2025 Airbus

SUPPLY RETURN EXHAUST DESIGN ACTUAL

Room 116

Soiled Utility 630 6 Negative

Room 151 O.R. 1

4307 20 Positive

Room 152 O.R. 2

3185 20 Positive

Room 159 O.R. Soiled Utility

567 6 Negative

Room 185 O.B. Soiled Utility

532 6 Negative

Room 198 Central Sterile Receiving Dirty

1217 4 Negative

Room 199 Central Sterile Receiving Ante Room

1305 10 Positive

Room 216 FCU Isolation Room

1756 12 Negative

Room 216 FCU Isolation Room Restroom

486 6 Negative

Room 218 FCU Isolation Room

1756 12 Negative

Room 218 FCU Isolation Room Restroom

486 6 Negative

Room 222 FCU Isolation Room

1512 12 Negative

Room 222 FCU Isolation Ante Room

424 10 Positive

Room 222 FCU Isolation Room Restroom

337 6 Negative

Room 231 Soiled Utility

891 6 Negative

Room 251 Central Sterile Receiving

4291 4 Positive

Room 317 Soiled Utility

693 6 Negative

Room 319 Isolation Room

1260 12 Negative

Room 319 Isolation Room Restroom

319 6 Negative

Room 319a Decontamination Room

760 6 Negative

Room 546 Clinic B Soiled Utility

495 6 Negative

TABLE 1

ROOM

PRESSURE

ROOM PRESSURIZATION TEST & BALANCE

ROOM NUMBER

ROOM CU

FT

CFM DIFF.

Supply - Exhaust

DESIGN

ACH

ACTUAL

ACH

PRESSURE RELATIONSHIPACTUAL CFM

dmelton Text Box

APPENDIX A

DESIGN PRE-LIM FINAL

NO SIZE CFM TEST CFM

AH-9 Supply OR 1 151 1 2 X 4 1.0 177 1 AH-9 Supply OR 1 151 2 2 X 4 1.0 177 1 AH-9 Supply OR 1 151 3 2 X 4 1.0 177 1 AH-9 Supply OR 1 151 4 2 X 4 1.0 177 1 AH-9 Supply OR 1 151 5 2 X 4 1.0 177 1 AH-9 Supply OR 1 151 6 2 X 4 1.0 177 1 AH-9 Supply OR 1 151 7 2 X 4 1.0 178 1 AH-9 Supply OR 1 151 8 2 X 4 1.0 180 1 AH-9 Supply OR 1 151 9 2 X 4 1.0 180 1

Total: 1600 AH-9 Return OR 1 151 1 10 X 24 1.0 510 1 AH-9 Return OR 1 151 2 10 X 24 1.0 510 1

Total: 1020 AH-9 Supply OR 2 152 1 2 X 4 1.0 300 1 AH-9 Supply OR 2 152 2 2 X 4 1.0 300 1 AH-9 Supply OR 2 152 3 2 X 4 1.0 300 1 AH-9 Supply OR 2 152 4 2 X 4 1.0 300 1

Total: 1200 AH-9 Return OR 2 152 1 10 X 24 1.0 650 1 AH-9 Return OR 2 152 2 10 X 24 1.0 650 1

Total: 1300 RTU-Supply CSR Dirty 198 1 2 X 2 1.0 N/A RTU-Supply CSR Ante 199 2 2 X 2 1.0 N/A RTU-Supply CSR 251 3 2 X 2 1.0 N/A RTU-Supply CSR 251 4 2 X 2 1.0 N/A RTU-Supply CSR 251 5 2 X 2 1.0 N/A RTU-Supply CSR 251 6 2 X 2 1.0 N/A

Total: N/A Exhaust-CSR CSR Ante 199 7 2 X 2 1.0 N/A Exhaust-CSR CSR Ante 199 8 2 X 2 1.0 N/A Exhaust-CSR CSR Dirty 198 9 2 X 2 1.0 N/A Exhaust-CSR CSR Dirty 198 10 2 X 2 1.0 N/A Exhaust-CSR CSR Dirty 198 11 2 X 2 1.0 N/A Exhaust-CSR CSR 251 12 1 X 1 1.0 N/A Exhaust-CSR CSR 251 13 1 X 1 1.0 N/A Exhaust-CSR CSR 251 14 2 X 2 1.0 N/A Exhaust-CSR CSR 251 16 2 X 2 1.0 N/A

Total: N/A

1. No access to balancing damper.

TABLE 2

AIR DISTRIBUTION TEST

SYSTEM ROOM

TERMINAL SIZE

K NOTESLOCATION

VAV-EX18 AH-6

V-87

No. Size (Inch) 198 3 2 X 2 1.0 200 199 4 2 X 2 1.0 200 251 1 2 X 2 1.0 350 251 2 2 X 2 1.0 350

Total: 1100

TABLE 3

FINAL

CFM

TEST

CFM

VAV WITH AIR DISTRIBUTION TEST

ASSOCIATED SYSTEM:

ADDRESS:

TERMINAL UNIT #:

Terminal KRoom

DESIGN

CFM

STATEMENT OF WORK