B.08.02 Solicitaton (W912EF21Q0014).pdf

SEE ADDENDUM

(No Collect Calls)

W912EF21Q0014 17-Feb-2021

b. TELEPHONE NUMBER

509-527-7223

8. OFFER DUE DATE/LOCAL TIME

10:00 AM 19 Mar 2021

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA X ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W912EF9. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

ZACKERY A. HOFFER

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

1 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.X

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED ORX

SMALL BUSINESS

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

USAED, WALLA WALLA - CONTRACTING DIV.

ZACKERY A. HOFFER

201 N. THIRD AVENUE

WALLA WALLA WA 99362-1876

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE 16. ADMINISTERED BY

SEE SCHEDULE

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

X SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

509-527-7802FAX:

TEL: 509-527-7223 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$12,000,000

NAICS:

621112

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

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ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

W912EF21Q0014

Section SF 1449 - CONTINUATION SHEET

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT (PWS)

MEDICAL SURVEILLANCE SERVICES

FOR U.S. ARMY CORPS OF ENGINEERS, WALLA WALLA DISTRICT

01 FEBRUARY 2021

Part 1 – General Information

1.1 General: This is a non-personal, professional services requirements contract to provide medical surveillance services for the Walla Walla District (NWW). The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract services providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

Equal Opportunities for Veterans. In addition to complying with the requirements outlined in FAR Part 22.13, FAR Provision 52.222-38, FAR Clause 52.222-37, DFARS 222.13 and Department of Labor regulations, U.S. Army Corps of Engineers (COE) Contractors and subcontractors at all tiers are encouraged to promote the training and employment of U.S. veterans while performing under a COE contract. While no set-aside, evaluation preference, or incentive applies to the solicitation or performance under the resultant contract, COE Contractors are encouraged to seek out highly qualified veterans to perform services under this contract. The following resources are available to assist COE Contractors in their outreach efforts:

Federal Veteran employment information at http://www.fedshirevets.gov/index.aspx Department of Labor Veterans Employment Assistance http://dol.gov/vets/ Department of Veterans Affairs-VOW to Hire Heroes Act http://benefits.va.gov/vow/ Army Wounded Warrior Program - http://wtc.army.mil/modules/employers/index.html U.S. Chamber of Commerce Foundation-Hiring Our Heroes http://www.uschamberfoundation.org/hiring-our-heroes Guide to Hiring Veterans – Reference Material https://obamawhitehouse.archives.gov/sites/default/files/docs/white_house_business_council_- _guide_to_hiring_veterans_0.pdf

1.2 Background: Executive Order 12196, implementing Section 19, Public Law 91-596, the Occupational Safety and Health Act of 1970, requires that all Federal agencies adopt safety and health standards consistent with Occupational Safety and Health Administration (OSHA) standards. The overall intent of this Performance Work Statement (PWS) is to ensure COE NWW can meet mission goals and objectives by ensuring the safety and welfare of its employees.

1.3 Objectives: The objective of this service contract is to perform medical surveillance services in accordance with Federal, U.S. Army, and COE regulations. These regulations are 29 CFR 1910, DODI 6055.05-M, ER-385-1- 40, ER 385-1-89, EM 385-1-1, 49 CFR 391.41, and 46 CFR Part 10. The references for these regulations can be found in Part 6 of this PWS.

1.4 Scope:

1.4.1 The NWW District Area of Operations (AOR) for this medical surveillance services contact includes eight Operating Projects and their respective ancillary offices, and two Natural Resource Management Offices, across three states, Washington, Oregon and Idaho. These service locations are identified in Part 1.6 of this PWS, Place of Performance.

1.4.2 The Contractor will provide medical surveillance services in the form of occupational health examinations based on the physical requirements of the job, position hazards, and occupational and medical history, required medical clearances, medical tests for workplace hazards and exposures, laboratory services, and immunizations or prophylactic medicine for job-related biological exposures at each of the identified Places of Performance.

The Contractor will also provide offsite medical surveillance services through local service providers within 100 miles of the Place of Performance for current NWW employees for instances where the employee cannot be onsite during the agreed upon date(s) of service.

1.4.3 The Contractor shall provide all management, personnel, equipment, supplies, facilities, transportation, materials, supervision, and non-personal services necessary to perform the requested medical surveillance services for the NWW AOR as defined in this Performance Work Statement (PWS). The specific tasks are detailed in Part 5 of this PWS.

1.5 Period of Performance: The period of performance shall be for one Base Period of up to 12 months and four 12-month Option Periods. The performance periods are as follows:

Base Period April 16, 2021 thru April 15, 2022 Option Period 1 April 16, 2022 thru April 15, 2023 Option Period 2 April 16, 2023 thru April 15, 2024 Option Period 3 April 16, 2024 thru April 15, 2025 Option Period 4 April 16, 2025 thru April 15, 2026

1.6 Place of Performance: Medical surveillance services shall be performed at the following locations:

McNary Lock and Dam, 82790 Devore Road, Umatilla, OR 97882.

Ice Harbor Lock and Dam*, 2763 Monument Drive, Burbank, WA 99323.

Lower Monumental Lock and Dam, 5520 Devils Canyon Road, Kahlotus, WA 99335.

Little Goose, Lock and Dam, 1001 Little Goose Dam Road, Dayton WA 99328.

Lower Granite, Lock and Dam, 885 Almota Ferry Road, Pomeroy, WA 99347.

Lower Granite Natural Resources Management (NRM) Office, 100 Fair Street, Clarkston, WA 99403.

Dworshak Project, 1428 Northfork Drive, Ahsahka, ID 83520.

Lucky Peak Dam, 9723 East Highway 21, Boise, ID 83706.

Mill Creek Dam, 3211 Reservoir Road, Walla Walla, WA 99362.

*Ice Harbor Lock and Dam includes employees who work at the Tri-Rivers NRM Office and Pasco Shop.

1.7 Estimated Days of Performance: This is only an estimate and actual days onsite for one period of performance (one year) and the number of days may vary. This estimate includes the number of day(s) onsite for blood draws and urine collection as defined in Part 5.2 of this PWS, and medical surveillance examinations. The service window for each period of performance shall be as early as April 1st and no later than August 31st.

Place of Performance Blood Draw and Urine Collection Medical Surveillance Examinations McNary Lock and Dam 1 day 7 days* Ice Harbor Lock and Dam 1 day 2 days* Lower Monumental Lock and Dam 1 day 2 days* Little Goose Lock and Dam 1 day 2 days* Lower Granite Lock and Dam 1 day 3 days* Lower Granite NRM 1 day 1 day Dworshak Dam 1 day 1 day Lucky Peak Dam 1 day 1 day Mill Creek Dam 1 day 1 day

*Days onsite will be consecutive. In the case of McNary Lock and Dam there will be four consecutive days followed by the remaining three consecutive days. Again, this is only an estimate. The number of days are subject to change.

1.8 Days/Hours of Operation:

1.8.1 Hours of Operation. The Contractor is responsible for conducting medical surveillance services between the hours of 6:30AM and 5:00PM, Monday thru Thursday, excluding federal holidays or when the Government facility is closed due to Government-directed facility closings.

1.8 2 Federal Holidays. The Contractor is not requested or expected to perform medical surveillance services on any of the following federal holidays:

New Year’s Day Martin Luther King Jr.’s Birthday President’s Day Memorial Day Independence Day Labor Day Columbus Day Veterans’ Day Thanksgiving Day Christmas Day

1.9 Contractor Personnel: The Contractor will maintain a qualified and adequate workforce for the uninterrupted services defined in this PWS.

1.9.1 Special Qualifications. The Contractor shall obtain and maintain all licenses and permits with the federal, state, and local laws, codes, and regulations, as they apply to the services under this contract.

1.9.2 Physician. The Contractor shall obtain and maintain, on staff, Board Eligible (BE) / Board Certified (BC) Occupational Health Physician OHP(s) that is/are licensed and bonded. A BE/BC OHP shall be identified by virtue of education, specialized training, and experience acquired over a period of no less than five (5) years in occupational medicine. BE/BC OHP(s) shall be knowledgeable of the regulations relating to occupational medicine and any other applicable peer-reviewed supplemental resources known and recognized in the occupational medicine community. Contractor shall provide a list of BE/BC OHP(s) with license number(s) of who will be performing medical services to the Contracting Officer Representative (COR) prior to services being provided.

1.9.3 Physician Assistant (PA) and/or Nurse Practitioner (NP). The Contractor shall obtain and maintain, on staff, licensed and bonded PA(s) and/or NP(s); however, the BE/BC OHP shall have overall signatory authority and responsibility for all medical examinations and medical opinions. The Contractor shall provide a list of all PA’s and NP’s with their license numbers who will be performing medical services to the COR prior to services being provided.

1.9.4 Ancillary Medical Personnel. The Contractor shall ensure that all ancillary medical personnel such as nurses and technicians performing services are credentialed as required by applicable federal, state, and local laws. The Contractor shall provide a list of all ancillary medical personnel performing medical services to the COR prior to services being provided.

1.9.5 Laboratory. The Contractor shall ensure all clinical laboratory services are performed by a laboratory(ies) licensed through the Department of Health and Human Services (DHHS) and the College of American Pathologies (CAP). The Contractor shall provide a list of DHHS and CAP approved laboratory(ies) who will be performing medical services for the Customer to the COR prior to services being provided.

1.9.6 Addition of Physician, Physician Assistant and/or Nurse Practitioner, Ancillary Medical Personnel or Laboratory. If any of the approved BE/BC OHP(s), PA(s) and/or NP(s) or Laboratory(ies) change during the duration of this contract a new submission shall be provided to the COR to show this requirement has still been met prior to the continuation of services as outlined in this document.

1.9.7 Subcontracting. Compliance with the provisions of this contract by subcontractors shall be the responsibility of the Contractor.

1.9.8 Confidentiality. The Contractor shall adhere to professional and legal standards of confidentiality of records consistent with the needs and requirements related to specific services and in accordance with enforceable Health Insurance Portability and Accountability Act (HIPPA) requirements related to each service transfer of information shall conform to the items in this PWS.

1.10 Coordination:

1.10.1 Points of Contact. The POCs shall be finalized by both parties during the Post-award Conference outlined in Part 1.10.2 in this PWS.

1.10.1.1 Contractor Point of Contact. The Contractor shall provide a Contractor Representative and an alternate who shall be responsible for assisting in the scheduling of exams and replying to all inquiries that may arise as result of the work performed by this contract. The name of this person and an alternate who shall act for the Contractor when the point of contact is absent shall be designated in writing to the COR.

The Contractor shall immediately notify the COR if the Contractor’s representative or alternate change.

1.10.1.2 Contracting Officer (KO). Individual employed by COE responsible for the oversight and execution of this contract. IAW UAI 5115.504 “Only a warranted Contracting Officer (either a Contracting Officer or an Administrative Contracting Officer (ACO)), acting within their appointed limits, has the authority to issue modifications or otherwise change the terms and conditions of this contract. If an individual other than the Contracting Officer attempts to make changes to the terms and conditions of this contract, you shall not proceed with the change and shall immediately notify the Contracting Officer.

Proceeding with any work not authorized by the Contracting Officer will be at the Contractor’s own risk.”

1.10.1.3 Contracting Officer’s Representative (COR). Individual employed by COE who serves as the Contractor’s main point of contact for the execution of this contract. Duties include scheduling examinations, maintaining written and oral communication with the Contractor concerning technical aspects of the contract, monitoring Contractor’s performance, and receives invoices and administers payment per the terms of this contract.

1.10.1.4 Medical Surveillance Officer (MSO). Individual employed by COE who serves as the main point of contact for all medical information to include medical examination results, laboratory analyses, medical records, letters of opinion, clearances, and medical reports.

1.10.2 Post-award Conference. Within 15 calendar days of award, the Contractor shall participate in a Post-award Conference scheduled by the COR. This conference may be held in person at Walla Walla District Office in Walla Walla, WA, or telephonically, and will be scheduled at a time and date mutually agreed to by the Contractor and the Government.

1.10.3 Pre-work Submittals. The Contractor shall submit the following documents for review and acceptance by the Government prior to the Post-award Conference:

Name and contact information of the Contractor Representative and at least one alternate Contractor’s draft Abbreviated Accident Prevention Plan (paragraph 1.12.2)

1.10.4 Questionnaires and Forms. The COR and Contractor POC shall review all NWW questionnaires and forms (Attachment’s 1 through 11) and compare them to the equivalent Contractor questionnaires and forms and decide which ones will be used for this contract.

1.10.5 Medical Records. The COR will provide the Contractor with all required medical documentation by the mutually agreed upon date. The Contractor will provide all medical examination results, records, certifications, and laboratory analyses to the COR within timeframes outline in Part 5.3 and 5.4 of this PWS.

1.10.6 Service Requests. The COR is responsible for providing a request for medical services to Contractor utilizing the Medical Surveillance Service Request Form (Attachment 1). A request for medical surveillance services will be based on the employee’s Position Description (PD), Position Hazard Analysis (PHA) and position, tasks, and exposures outlined in Part 5 of this PWS. With the approval from the COR the Contractor may utilize the Bid Schedule (Attachment 12) to conduct services in addition to the initial service request when required by the examining BE/BC OHP to provide a final disposition. In the event that the additional medical services are needed and not listed on the bid schedule the Contractor shall not perform the service(s) and contact the COR and KO.

1.10.7 Scheduling. The COR and Contractor POCs shall coordinate and schedule medical surveillance examination service dates at each of the identified Places of Performance and for the Estimated Days of Performance during the Post-award Conference outlined in Parts 1.7, 1.8 and 1.10.2 of this PWS. The Contractor shall confirm in writing the agreed upon dates within 7 days after the Post-award Conference.

1.10.8 Periodic Progress Meetings. The KO, COR, and other Government personnel, as appropriate, may meet periodically. This conference may be held in person at Walla Walla District Office in Walla Walla, WA, or telephonically, and will be scheduled at a time and date mutually agreed to by the Contractor and the Government. At these meetings the KO 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.

1.11 Quality Control / Quality Assurance:

1.11.1 Quality Control. The Contractor shall develop and maintain an effective Quality Control Program (QCP) to ensure services are performed according to the standards in this PWS. The Contractor shall provide a copy of its QCP upon request by the COR.

1.11.2 Quality Assurance. The Government will evaluate the Contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government must do to ensure the Contractor’s QCP is effective in ensuring its performance is in accordance with this PWS.

1.12 Safety:

1.12.1 Safety Standards. The Contractor shall comply with all applicable Occupational Safety and Health Act (OSHA) Standards, as well as the Corps of Engineers’ Safety and Health Requirements Manual EM 385-1-1 in effect at time of contract award. This section calls out only a few specific requirements. Contractor personnel and equipment shall be subject to safety inspections by Government personnel while on federal property.

1.12.2 Abbreviated Accident Prevention Plan (APP). In accordance with EM 385-1-1 paragraph 01.A.12, the Contractor shall prepare and provide a copy of its Accident Prevention Plan / Safety Plan for review and acceptance by the Government.

1.12.3 COVID 19. The Contractor shall follow federal CDC, State and Local guidelines.

1.12.4 Training & PPE. The Contractor shall ensure that all personnel are trained to the level of expertise required for proper performance of this contract. Personal protective equipment (PPE) shall be provided by the Contractor and must be appropriate to the task.

1.12.5 Safe Clearance / Hazardous Energy Control / Lockout/Tagout. All Contractors who are required to be onsite shall meet the requirements of Walla Walla District "Safety and Occupational Health Office; Safe Clearance Program for the Control of Hazardous Energy,” NWWP 385-1-20 (see Part 6 for reference). A digital copy may be obtained online at: http://www.nww.usace.army.mil/Portals/28/docs/contracting/OP385120.pdf.

1.12.6 Required Annual HECP Training. Contractor and subcontractor employees operating under the Contractor shall take the HECP procedure training described below. Training and written tests for the modules below shall be completed online prior to commencing onsite work. Time estimates for training follow:

Awareness Level Training: Approximately 1 hour

All costs for this training shall be considered incidental to the work, and therefore, no additional payment will be made. Training is an annual requirement and will expire one year from completion date. Training is provided by Vivid Learning Systems and is available online at http://Hecp.vividlms.com. Cost for the training is displayed on the home page. Submit the training completion certification(s) to the COR a minimum of seven days prior to the individual's arrival at site.

1.12.8 Incident/Accident Reporting. An accident constitutes an incident or act involving the Contractor, which may or may not have caused obvious damage to persons or property. This includes injuries to Contractor employees, members of the public, or damage to Government or personal property. The Contractor shall notify the COR by telephone within 30 minutes of any incident or accident, followed by a written report. The report shall include, but not be limited to, location, nature of the injury or accident, name(s) of injured party(ies), conditions/circumstances surrounding the occurrence, cause of the occurrence, parties notified, and actions taken. The report shall be accompanied by sketches, graphs, drawings, and photographs, as needed, and forwarded to the COR within one working day following the occurrence of accident or injury.

1.13 Anti-terrorism / Operational Security / Project Security:

1.13.1 Access and General Protection. All Contractor and associated sub-Contractor employees shall comply with applicable facility access and local security policies and procedures (provided by Government representative). The Contractor shall also provide all information required for background checks to meet facility access requirements to be accomplished by installation Director of Emergency Services or Security Office. Contractor workforce must comply with all personal identity verification requirements (FAR clause 52.204-9, Personal Identity Verification of Contractor Personnel) as directed by DOD, HQDA, and/or local policy. In addition to the changes otherwise authorized by the changes clause of this contract, should the Force Protection Condition (FPCON) at any installation or facility change, the Government may require changes in Contractor security matters or processes.

1.13.2 Contractors Requiring Access to a DoD Facility. Contractor and associated sub-Contractor employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification Index (NCIC-III) and Terrorist Screening Database (TSDB) (Army Directive 2014-05 / AR 190- 13), applicable facility and area commander facility access, and local security policies and procedures (provided by Government representative, as NCIC and TSDB are available).

1.13.3 Pre-screen Candidates Using E-Verify Program. The Contractor must pre-screen candidates using the E-verify Program (http://www.uscis.gov/e-verify) website to meet the established employment eligibility requirements. The Vendor must ensure that the candidate has two valid forms of Government-issued identification prior to enrollment to ensure the correct information is entered into the E-verify system. An initial list of verified/eligible candidates must be provided to the COR no later than 30 business days after the initial contract award.

1.13.4 Authorized Personnel. Only persons directly involved with accomplishment of the Contractor’s operations on this contract shall be allowed on the Project. In accordance with the requirements above and each service locations access requirements, a complete submittal package for a Contractor employee includes:

Copy of employee’s driver’s license (paragraph 1.13.1) Copy of E-Verify certification (paragraph 1.13.3) Copies of current HECP certificates (paragraph 1.12.5) A completed (but not signed) Project Access Request Form (paragraph 1.13.2)

List of BE/BC OHP’s, PA’s and/or NPs and Ancillary Medical Personnel (paragraph 1.9) Copy of BE/BC OHP’s, PA’s and/or NPs license (paragraph 1.9)

1.13.5 Contractor Employee Identification. Contractor and subcontractor employees must wear official clothing that identifies them as employee of the Contractor, OR each must wear, visibly on their person at all times, a Contractor-provided laminate badge with employee name, photo, and Contractor’s company identification. In any case, all employees must have valid photo identification on their person at all times while on the Project.

Note: The Government reserves the right to obtain digital photographs of all Contractor personnel performing work onsite as part of the Project access control program.

1.13.6 Contractor Vehicles. All usual Contractor vehicles shall have permanent or temporary identification on both sides, of a size sufficient to provide visual identification from at least 20 feet from the vehicle. If a temporary unmarked vehicle must be used, the Contractor shall provide year, make, model, color, and license plate for the vehicle to the COR prior to arrival of the vehicle to the Project. All vehicles are subject to search.

1.14 Medical Waste. The Contractor is responsible for managing their activities to eliminate or minimize hazards and to provide a safe working environment. The collection, packaging, labeling, storage and disposal of all medical waste is the responsibility of the Contractor. All costs shall be considered incidental to the work, and therefore, no additional payment will be made. Medical wastes shall be managed in accordance will federal and state regulations.

Part 2 – Definitions & Acronyms

2.1 Definitions:

Acceptable Quality Level (AQL). A predetermined value selected and used by the Government Quality Assurance inspector to distinguish between satisfactory and unsatisfactory performance.

Contracting Officer (KO). A person with authority to enter into, administer, and or terminate Government contracts and make related determinations and findings on behalf of the Government. Only a Contracting Officer is authorized to legally obligate the Government and to make any changes to this contract in terms of scope, time, or cost.

Contracting Officer’s Representative (COR). An employee of the Government who is appointed by the Contracting Officer to administer a contract after award. The COR monitors all technical aspects of the contract and assists in contract administration. 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 or to waive any term of the contract, particularly with respect to scope, time, or cost.

Contractor. A supplier or service provider awarded a contract to provide specific supplies or service to the Government. The Government works directly with the prime Contractor; however, all references to and requirements of the Contractor in this document apply equally to any subcontractor.

Contractor Representative. The Contractor employee authorized by the Contractor to manage operations under this contract.

Quality Assurance. The Government’s procedures to verify that the Contractor’s Quality Control Plan is effective in ensuring the services being performed by the Contractor meet the contract requirements.

Quality Assurance Surveillance Plan (QASP). A written document specifying the surveillance methodology to be used by the Government for surveillance of Contractor performance. The QASP is a “living” document and may be changed through the life of the contract, as needed.

Quality Control. All necessary measures taken by the Contractor to assure that the quality of an end product or service conforms to contract requirements.

Subcontractor. A service provider that enters into a contract with a prime Contractor to provide service under a Government contract. The Government does not have privity of contract with the subcontractor. All requirements of the contract are binding on the subcontractor. The prime Contractor must ensure its subcontractor(s) understand all contract requirements.

2.2 Acronyms:

AOR Area of Responsibility APP Accident Prevention Plan AQL Acceptable Quality Level BC Board Certified BE Board Eligible CFR Code of Federal Regulations COE U.S. Army Corps of Engineers COR Contracting Officer Representative CR Contractor Representative DHHS Department of Health and Human Services DODM Department of Defense Manual DODI Department of Defense Issuances DFARS Defense Federal Acquisition Regulation Supplement DOT Department of Transportation EM Engineering Manual ER Engineering Regulation FAR Federal Acquisition Regulation HECP Hazardous Energy Control Program IDIQ Indefinite delivery indefinite quantity KO Contracting Officer NWW Walla Walla District NWWP Walla Walla District Pamphlet NP Nurse Practitioner OCP Occupational Health Physician OSHA Occupational Safety and Health Administration PA Physician Assistant POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QASP Quality Assurance Surveillance Plan QCP Quality Control Program/Plan

Part 3 – Government Furnished Property, Equipment, and Services

3.1 Utilities: The Government will provide utility services electrical outlets, water, and restroom facilities where available, that may be required in the performance of the contract. Utilities will be provided “as is,” and all extensions, adapters, and other necessary items shall be Contractors responsibility.

Part 4 – Contractor Furnished Items and Services

4.1 General: Contractor shall provide all management, personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and non-personal services necessary to perform work under this contract that are not listed under Part 3 of this PWS.

Part 5 – Specific Services

5.1 Comprehensive Examination. The Contractor shall perform a Comprehensive Examination based on the employees Position Description (PD), Position Hazard Analysis (PHA), Health History and Physical Examination Form (Attachment 2), Occupational and Exposure History Form (Attachment 3) and the applicable position(s), task(s) or exposure(s) listed below, 5.1.1 through 5.1.15. The position(s), task(s) or exposure(s) are specific to each employee and will be identified in the Medical Surveillance Service Request (Attachment 1) provided to the Contractor by the COR prior to the employee’s scheduled examination.

Comprehensive Examination I. A Comprehensive Examination and one (1) to two (2) of the position(s), task(s) or exposure(s) listed below in 5.1.1 to 5.1.15.

Comprehensive Examination II. A Comprehensive Examination and three (3) to five (5) of the position(s), task(s) or exposure(s) listed below in 5.1.1 to 5.1.15.

Comprehensive Examination III. A Comprehensive Examination and six (6) or more of the position(s), task(s) or exposure(s) listed below in 5.1.1 to 5.1.15.

The Contractor may utilize the Bid Schedule (Attachment 12) to conduct services in addition to the initial service request when required by the examining BE/BC OHP to provide a final disposition. The BE/BC OHP, or designated representative shall contact the COR by phone to get authorization after approval from Contractign Officer before performing such medical services. Expenses incurred due to additional services being performed without the COR’s authorization after approval from a Contracting Officer will be the Contractor’s responsibility.

When multiple position(s), task(s) or exposure(s) require the same medical services, duplicate services should only be performed once, unless required by examining BE/BC OHP to provide a final disposition.

5.1.1 Asbestos Worker. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 29 CFR 1910.1001 and Appendices (Attachments 4 & 5) and ER 385-1-40, B-2.c.

5.1.2 Bloodborne Pathogens, Potential for Exposure. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and administer applicable hepatitis vaccinations as required by 29 CFR 1910.1030 and ER 385-1-40, B-2.j. Vaccination periodicity is dependent on medical and occupational history.

5.1.3 Chromium (VI), Potential for Exposure. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 29 CFR 1910.1026 and ER 385-1-40, B-2.l.

5.1.4 Commercial Driver’s License (CDL). The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 49 CFR 391.41 – 391.49. The Contractor shall use the most recent versions of the Federal Motor Carrier Safety Administration (MCSA) form MSCA 5875, Medical Examination Report Form (for Commercial Driver Medical Certification) (Attachment 6) and MCSA 5876, Medical Examiner’s Certificate (for Commercial Driver Medical Certification) (Attachment 7).

5.1.5 Crane Operator and Load Handling Equipment (LHE). The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by EM 385-1-1, Section 16. The Contractor shall use the most recent version of the Crane Operator and LHE Examination Form (Attachment 8).

Exception. In the event the Crane Operator and LHE Examination Form, and CDL Examination per

5.1.4 above, are requested the examining BE/BC OHP shall use the CDL examination to provide final disposition for the Crane Operator and LHE.

5.1.6 Hazardous Waste Worker & Emergency Response. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 29 CFR 1910.120, 29 CFR 1910.134, 29 CFR 1910 Subpart Z, and ER 385-1-40, B-2.a.

5.1.7 Lead (Pb), Potential for Exposure. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 29 CFR 1910.1025, DoDI 6055.05-M, and ER 385-1-40, B-2.i.

5.1.8 Lock Operator. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by ER 385-1-40, B-3.d.

5.1.9 Non-Ionizing Radiation. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by ER 385-1-40, B-3.c.

5.1.10 Painter. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 29 CFR 1910 and ER 385-1-40, B-3.g.

5.1.11 Pesticide Applicator. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by DoDI 6055.05-M, C4.6 and ER 385-1-40, B-2.b.

5.1.12 Powerhouse Worker. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by ER 385-1-40, B-3.e.

5.1.13 Respirator User. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 29 CFR 1910.134 and Appendices (Attachment 9), DoDI 6055.05-M, and ER 385-1-40, B-2.k. Exception, Fit Tests / Fit Testing, to include qualitative and quantitative, will be solely performed by NWW personnel. The Contractor is not authorized to provide, nor perform, this service.

5.1.14 U.S. Coast Guard License Holder. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 46 CFR Part 10. The Contractor shall use the most recent version of the U.S. Coast Guard Application for Medical Certificate, Form CG-719K (Attachment 10).

5.1.15 Welder. The Contractor shall use the information from the employee’s Comprehensive Exam and perform a physical examination and all applicable medical tests as required by 29 CFR 1910 and ER 385-1-40, B-3.f.

5.2 Onsite Blood Draw and Urine Collection. The Contractor shall be responsible for providing onsite blood draws and urine collection and analysis for the requested services at each of the identified Places of Performance prior to the scheduled Comprehensive Exams. The Contractor shall ensure that the laboratory results (blood and urine analysis) are available to the BE/BC OHP at the time of the employees Comprehensive Exam. All costs shall be included in the service cost. Per Diem and Mileage excluded.

5.3 Records Review.

5.3.1 Comprehensive Examination Records Review. A BE/BC OHP shall perform a thorough review of the employee’s Comprehensive Examination and applicable position(s), task(s) or exposure(s) documentation, and provide a written medical opinion addressing the results of the examination, and a completed Report to Employer (Attachment 11) within 14 calendars day from the date of the examination.

5.3.2 Pre-Placement Comprehensive Examination Records Review. A BE/BC OHP shall perform a thorough review of the potential employee’s, or transfer employee’s Pre-Placement Comprehensive Examination and applicable position(s), task(s) or exposure(s) documentation, and provide a written medical opinion addressing the results of the examination, and a completed Report to Employer Attachment 11) within 14 calendars day from the date of the examination.

5.4 Transmitting Examination Results (Records Processing). The Contractor shall complete and return the Report to Employer (Attachment 11), and include all medical information to include medical examination results, laboratory analyses, medical records, letters of opinion, clearances, and medical reports to the MSO within 14 calendar days upon the final review and signature by a BE/BC OHP. All reports and/or results transmitted to the COR shall clearly identify the BE/BC OHP printed name, location of service, and a dated hard-copy or digital signature. Transfer of records shall be in accordance with 1.9.3. Electronic and hard copy records shall be sent to the following locations.

5.4.1 Examination Results.

Mailing Address: U.S. Army Corps of Engineers, Walla Walla District Safety and Occupational Health Office

Medical Surveillance Officer 201 North Third Avenue Walla Walla, WA 99362

5.5 Billing. The Contractor agrees to charge U.S. Army Corps of Engineers, Walla Walla District the service line item prices reflected on the signed Solicitation/Contract with the attached Bid Schedule (Attachment 12). The Contractor’s prices shall be fixed for the applicable period listed in this PWS. The Contractor shall provide the COR with an invoice for all services provided the month earlier, by the 5th of each month. The invoice shall identify the date of service, place of performance, employee’s full name, and services listed by ID # and description per the Bid Schedule (Attachment 12), for each employee.

Part 6 – Applicable Publications

6.1 29 CFR 1910: Labor, Department of Labor, Occupational Safety and Health Administration (OSHA).

https://www.osha.gov/pls/oshaweb/owastand.display_standard_group?p_toc_level=1&p_part_number=191

6.2 46 CFR PART 10: Shipping, Department of Homeland Security, U.S. Coast Guard, Merchant Mariner

Credential.

https://www.ecfr.gov/cgi-bin/text-idx?SID=a2761e8e699e43ebb0e2600bb200dd65&mc=true&node= pt46.1.10&rgn=div5

6.3 49 CFR 391.41 – 391.49: Transportation, Department of Transportation, Federal Motor Carrier Safety

Administration (MSCA), Qualifications of Drivers and Longer Combination Vehicle (LCV) Driver Instructors, Subpart E – Physical Qualification and Examinations.

https://www.ecfr.gov/cgi-bin/text-idx?SID=a2761e8e699e43ebb0e2600bb200dd65&mc=true&node= pt46.1.10&rgn=div5

6.4 DoD 6055.05-M: Department of Defense (DoD) Occupational Medical Examinations and Surveillance Manual.

https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/605505mp.pdf?ver=2018-11-19-150151-

6.5 HIPPA: The Health Insurance Portability and Accountability Act of 1996.

https://aspe.hhs.gov/report/health-insurance-portability-and-accountability-act-1996

6.7 EM385-1-1: U.S. Army Corps of Engineers Safety and Health Requirements Manual.

https://www.publications.usace.army.mil/Portals/76/Publications/EngineerManuals/EM_385-1- 1.pdf?ver=7Cpck_22Ct_-w6QSGyOKVQ%3d%3d

6.7 ER385-1-40: U.S. Army Corps of Engineers Occupational Health Program Regulation.

https://www.publications.usace.army.mil/Portals/76/Publications/EngineerRegulations/ER_385-1- 40.pdf?ver=VyXKHltPQ-1xwH-AV9TsnQ%3d%3d

6.8 NWWP 385-1-20: Walla Walla District Safety and Occupational Health Office; Safe Clearance Program for the

Control of Hazardous Energy.

http://www.nww.usace.army.mil/Portals/28/docs/contracting/OP385120.pdf

Part 7 – Attachments

7.1 Attachment 1: Medical Surveillance Service Request Form.

7.2 Attachment 2: Health History & Physical Examination Form, Part I. Personal Information & Medical History, Part II. Physical Examination, and Part III. Examiner’s Summary.

7.3 Attachment 3: Health History & Physical Examination Form, Part II, Occupational & Exposure History, Section 2, Exposure History.

7.4 Attachment 4: Asbestos Exposure, Part I – Initial Medical Questionnaire.

7.5 Attachment 5: Asbestos Exposure, Part II – Periodic Medical Questionnaire.

7.6 Attachment 6: Federal Motor Carrier Safety Administration (MCSA), Medical Examination Report Form

MCSA-5875.

7.7 Attachment 7: Federal Motor Carrier Safety Administration (MCSA), Medical Examiner’s Certificate Form

MCSA-5876.

7.8 Attachment 8: Crane Operator and Load Handling Equipment (LHE) Examination Form.

7.9 Attachment 9: Respirator Medical Evaluation Questionnaire.

7.10 Attachment 10: Department of Homeland Security, U.S. Coast Guard Application for Medical Certificate

Form CG-719K.

7.11 Attachment 11: Medical History and Physical Examination Form, Report to Employer.

7.12 Attachment 12: Medical Surveillance Service, Bid Schedule.

OPTION PRICING INSTRUCTIONS

PRICING FOR OPTION (applicable if price schedule contains option periods)

(a) If the option to extend the term of the contract, Clause No., 52.217-9 is exercised, prices shall be set forth in the schedule for the option year period being exercised.

(b) If the option to extend service, Clause No., 52.217-8, Option to Extend Services is exercised, the prices to be paid for such extension shall be the same as those in effect for the contract period being extended.

ATTENTION TO OFFERORS

Offerors are required to quote on ALL line items of the Bid Schedule.

AWARD will be made on the basis of lowest evaluated price for all line items of the bid schedule.

Requirements Contract: The resulting contract will be an indefinite Requirements contract, awarded to one contractor, for district wide medical surveillance services throughout the Walla Walla District. The contract performance period is one base year, which begins on the date of contract award. The Government may exercise options to extend the contract period for up to four additional years of contract performance (dates outlined in the Performance Work Statement). A requirements contract provides for filling all actual purchase requirements of a designated Government activity for services during a specified contract period (from one contractor) with deliveries or performance to be scheduled by placing task orders with the contractor. The quantities of services specified in the Bid Schedule are estimates only and are not purchased by this contract; purchases are only made when the Government places task orders for specific services. See Federal Acquisition Regulation Clause 52.216-21, Requirements

(OCT 1995)

INSTRUCTIONS TO OFFERORS

This is a request for quote for Medical Surveillance Services in accordance with the Performance Work Statement for the U.S. Army Corps of Engineers, Walla Walla District, Walla Walla, Washington.

Registration at www.sam.gov is required. Failure to register in the SAM database will make an offeror ineligible for award. Effective 29 April 2018, the notarized letter process is now mandatory on all CURRENT registrants at SAM who have a requirement to update data on their SAM record. The notarized letter is mandatory and is required in order for the GSA Federal Service Desk (FSD) to activate the entity's registration. Both Federal Assistance entities and all non-Federal entities must mail the original, signed copy of the notarized letter to the Federal Service Desk.

Failure to do so within 30 days of activation may result in the registration no longer being active. Mail the completed, signed, notarized letter to:

FEDERAL SERVICE DESK

ATTN: SAM.GOV REGISTRATION PROCESSING

460 INDUSTRIAL BLVD

LONDON, KY 40741-7285

UNITED STATES OF AMERICA

Completion of the required FAR 52.212-3, Offeror Representations and Certifications – Commercial Items is required. When you complete your SAM registration, the link to complete your Representations and Certifications is also available. Please do not hesitate to contact Zackery Hoffer, or the SAM web site for assistance or have questions.

TO ENSURE RECEIPT OF YOUR QUOTE, PLEASE SEND TO THE ATTENTION OF ZACKERY

HOFFER AT Zackery.A.Hoffer@usace.army.mil

If you have any questions or concerns regarding the Request for Quote, please contact Zackery Hoffer by Telephone 509-527-7223; or send an email to Zackery.A.Hoffer@usace.army.mil

Please return all pages of this request for quote. Be sure to also complete Blocks 17a, 30a, 30b, and 30c on page 1.

Name: _____________________________________________________________

Contact Telephone Number: ____________________________________________

Email Address: __________________________________________________________________

Company’s Federal Tax Identification Number: ____________________________________________

CAGE CODE: _________________________ DUNS Number ________________________________

The System for Award Management (SAM) is online. SAM replaces CCR/FedReg, ORCA, and EPLS.

If you have been using those systems, you should now go to www.sam.gov to find your information.

Completion of FAR 52.212-3 Offeror Representations and Certifications–Commercial Items – Alternate 1 (May 2014). Electronic completion is encouraged (see https://www.acquisition.gov to download Representations and Certifications).

An offeror shall complete only paragraph (b) of this provision if the offeror has completed the annual representations and certifications electronically via https://www.acquisition.gov. If an offeror has not completed the annual representations and certifications electronically at the ORCA website, the offeror shall complete only paragraphs (b) through (i) of this provision.

In accordance with FAR Part 29.3 – State and Local Taxes, and per Title 4 of US Code 104-107, the Government is exempt from paying state and local taxes. Exempt tax identification number 91-8028090.

ADDENDUM TO FAR 52.212-1 INSTRUCTIONS TO OFFERORS – COMMERCIAL ITEMS

Submission of Price Quote – Offeror shall submit 1 copy of the following:

1. Signed and dated Standard Form 1449 (Solicitation/Contract/Order for Commercial Items)

2. Signed and dated Standard Form 30, if applicable, for any Amendments to the Solicitation

3. Completed schedule (pricing information) for all contract line item numbers

4. Completed Clause 52.212-3 and Alt I, “Offeror Representations and Certifications—Commercial Items” as noted above.

PRICES QUOTED MUST BE VALID FOR 60 DAYS. Solicitation shall result in a firm-fixed-price contract.

All pricing shall include shipping FOB destination (include shipping cost in price).

BUSINESS HOURS: The standard business hours for the Walla Walla District, Corps of Engineers are Monday through Friday from 8:00 a.m. to 4:00 p.m., excluding federal holidays.

BASIS FOR AWARD

The Government will award one contract resulting from this solicitation in accordance with FAR 13.106 to the responsible offeror meeting or exceeding all solicitation requirements based on price. The government does not intend to have discussions with offerors so please ensure that all information required in this solicitation is provided with your quote.

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