C03 - Signed 36C24626D0004 36C24626N0095 Funded Task Order.pdf

PAGE 1 OF1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

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

SEE ADDENDUM

19. 20. 21. 22. 23. 24.19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

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

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

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

565-26-1-025-0004

36C24625D0012 36C24625N0282

3. AWARD/EFFE

AWARDED:

TIVE DATE

EFFECTIVE: 10-01-2025

David E. Smith, Contracting Officer 757-728-7156

R DUE DATE/LOCAL

David.Smith78@va.gov Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

X

621910

Net 30 N/A

X

Department of Veterans Affairs Fayetteville VAMC

2300 Ramsey St.

Fayetteville NC 28301

Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

7CEA6 1

RELIANCE MEDICAL TRANSPORT, LLC

5261 CHALLEDON DR

PHONE: FAX:VIRGINIA BEACH VA 23462

EPHONE NO UEIUEI Y29LV4MTUNK7

Department of Veterans Affairs Financial Services Center

PO BOX 149971

Austin TX 78714-9971

512-460-5049 512-460-5221

X

ES/SERVICES QU

See CONTINUATION Page

Task Order 1: Ambulance Services for Fayetteville NC Veterans Administration Coastal HealthCare System (FNCVACHCS)

Reference PO number 565C60055 when invoicing for work completed during the period of performance from October 1, 2025 through September 30, 2026, under this task order.

( y) $1,592,612.68

See CONTINUATION Page 565-3660160-025-820100-3110 C60055 010020400

X X

X ___________1 ________________________________ARD OF CONTRACT

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

David E. Smith Contracting Officer

O THE TERMS AND CONDITIONS SPECIFIED

ACTOR

E OR PRINT) 30c. DATE

Jason Grimes, Government Contracting Manager 10/1/2025 10-01-2025

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36C24626D0004 36C24626N0095

Table of Contents

SECTION A

A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL

PRODUCTS AND COMMERCIAL SERVICES

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ACCOUNTING AND APPROPRIATION DATA

SECTION C - CONTRACT CLAUSES

C.1 TASK/DELIVERY ORDER INTRODUCTORY LANGUAGE

C.2 VAAR 852.239-76 INFORMATION AND COMMUNICATION TECHNOLOGY

ACCESSIBILITY (FEB 2023)

C.3 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020) 8

C.4 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

C.5 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS

D.1 WAGE DETERMINATION

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR: Reliance Medical Transport LLC POC: Jason Grimes 757-260-9990 jgrimes@reliancemt365.com

b. GOVERNMENT: Contracting Officer 36C246 David E. Smith David.Smith78@va.gov Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X] 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly []

b. Semi-Annually []

c. Other [X] Monthly.

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

B.2 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

25.00 EA $2,000.000000 $50,000.00

(A0427) Advanced Life Support, Emergency Transport, Level 1

(ALS 1) (base rate to include first 40 miles) One-way trip is equivalent to one each for the unit of issue 30 minutes Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

Transportation/Travel/Relocation - Travel/Lodging/Recruitment:

Ambulance

275.00 EA $1,700.000000 $467,500.00

(A0428) Basic Life Support, Non-Emergency Transport, (base rate, to include first 40 miles) One-Way trip is equivalent to one each for the unit of issue 30 minutes Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

400.00 EA $2,000.000000 $800,000.00

(A0426) Non-Emergent Advance Life Support Transport, Level 1

(ALS 1) ((base rate to include first 40 miles) One-way trip is equivalent to one each for the unit of issue 30 minutes Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

12.00 EA $3,299.140000 $39,589.68

(A0434) Critical Care Transport (Upper-Level Care) specialized care of patients with life-threatening conditions, requiring comprehensive care and constant monitoring by appropriately trained individuals 30 minutes Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026

PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

Transportation/Travel/Relocation - Travel/Lodging/Recruitment:

25.00 EA $3,440.860000 $86,021.50

STAT Trips (STEMI, stroke, dissection, Trauma-RED & other patients deemed emergent by the staff) requiring a response time of 15 minutes Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

0.00 EA $9.010000 $0.00

(A0425) Mileage Trip Outside the Base Rate

Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

0.00 EA $50.000000 $0.00

(A0420) Waiting Time (more than 30 minutes shall be paid in 30-minute increments). INCREASED QTY TO REFLECT 30MIN

INCREMENT.

Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

25.00 EA $50.000000 $1,250.00

Bariatric Transport Fee (a single patient with body weight equal to or more than 350 lbs.)

Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

150.00 EA $25.010000 $3,751.50

OXYGEN

Contract Period: Base POP Begin: 10-01-2025

POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

Transportation/Travel/Relocation - Travel/Lodging/Recruitment:

85.00 EA $1,700.000000 $144,500.00

Stretcher Transports, Stretcher- Bound Patients discharged from the

Emergency Department. Vendor will transport to patients’ residences, Community Living Centers (CLC), or nursing facilities.

(base rate, to include first 40 miles) One-Way trip is equivalent to one each for the unit of issue 30 minutes Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621910 - Ambulance Services

PRODUCT/SERVICE CODE: V225 -

GRAND

TOTAL

$1,592,612.68

ACCOUNTING AND APPROPRIATION DATA

ACRN APPROPRIATION

REQUISITION

NUMBER AMOUNT

1 565-3660160-025-820100 Medical-3110 Transportation Equipment-010020400

565-26-1-025-0004 (P)

$1,592,612.68

SECTION C - CONTRACT CLAUSES

C.1 TASK/DELIVERY ORDER INTRODUCTORY LANGUAGE

The terms and conditions of the Contractor's indefinite delivery contract (IDC) (including any contract modifications) apply to all task or delivery orders issued under the contract. When a lower price has been established, or when the delivery terms, FOB terms, or ordering requirements have been modified by the task/delivery order, those modified terms will apply to all purchases made pursuant to it and take precedence over the IDC. Any unique terms and conditions of an order issued under the contract that are not a part of the applicable IDC will govern. In the event of an inconsistency between the terms and conditions of a task/delivery order and the Contractor's IDC, other than those identified above, the terms of the IDC will take precedence.

C.2 VAAR 852.239-76 INFORMATION AND COMMUNICATION

TECHNOLOGY ACCESSIBILITY (FEB 2023)

(a) All information and communication technology (ICT) (formerly referred to as electronic and information technology (EIT)) supplies, information, documentation and services support developed, acquired, maintained or delivered under this contract or order must comply with the ‘‘Architectural and Transportation Barriers Compliance Board Electronic and Information Technology (EIT) Accessibility Standards’’ (see 36 CFR part 1194). Information about Section 508 is available at http://www.section508.va.gov/.

(b) The Section 508 accessibility standards applicable to this contract or order are identified in the specification, statement of work, or performance work statement. If it is determined by the Government that ICT supplies and services provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(c) The Section 508 accessibility standards applicable to this contract are:

(d) In the event of a modification(s) to this contract or order, which adds new EIT supplies or services or revises the type of, or specifications for, supplies or services, the Contracting Officer may require that the Contractor submit a completed VA Section 508 Checklist and any other additional information necessary to assist the Government in determining that the ICT supplies or services conform to Section 508 accessibility standards. If it is determined by the Government that ICT supplies and services provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(e) If this is an Indefinite-Delivery type contract, a Blanket Purchase Agreement or a Basic Ordering Agreement, the task/delivery order requests that include ICT supplies or services will define the specifications and accessibility standards for the order. In those cases, the Contractor may be required to provide a completed VA Section 508 Checklist and any other additional information necessary to assist the Government in determining that the ICT supplies or services conform to Section 508 accessibility standards. If it is determined by the Government that ICT supplies and services provided by the Contractor do not conform to the described accessibility standards in the provided documentation, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(End of Clause)

C.3 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT

2020)

The Contracting Officer reserves the right to designate an Administrative Contracting Officer (ACO) for the purpose of performing certain tasks/duties in the administration of the contract.

Such designation will be in writing through an ACO Letter of Delegation and will identify the responsibilities and limitations of the ACO. A copy of the ACO Letter of Delegation will be furnished to the Contractor.

(End of Clause)

C.4 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):

(End of Clause)

FAR

Number

Title Date

52.204-13 SYSTEM FOR AWARD MANAGEMENT

MAINTENANCE

OCT 2018

852.201-70 CONTRACTING OFFICER'S REPRESENTATIVE DEC 2022

852.203-70 COMMERCIAL ADVERTISING MAY 2018

C.5 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS

(NOV 2018)

(a) Definitions. As used in this clause—

(1) Contract financing payment has the meaning given in FAR 32.001;

(2) Designated agency office means the office designated by the purchase order, agreement, or contract to first receive and review invoices. This office can be contractually designated as the receiving entity. This office may be different from the office issuing the payment;

(3) Electronic form means an automated system transmitting information electronically according to the accepted electronic data transmission methods and formats identified in paragraph (c) of this clause. Facsimile, email, and scanned documents are not acceptable electronic forms for submission of payment requests;

(4) Invoice payment has the meaning given in FAR 32.001; and

(5) Payment request means any request for contract financing payment or invoice payment submitted by the contractor under this contract.

(b) Electronic payment requests. Except as provided in paragraph (e) of this clause, the contractor shall submit payment requests in electronic form. Purchases paid with a Government-wide commercial purchase card are considered to be an electronic transaction for purposes of this rule, and therefore no additional electronic invoice submission is required.

(c) Data transmission. A contractor must ensure that the data transmission method and format are through one of the following:

(1) VA’s Electronic Invoice Presentment and Payment System at the current website address provided in the contract.

(2) Any system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) and chartered by the American National Standards Institute (ANSI).

(d) Invoice requirements. Invoices shall comply with FAR 32.905.

(e) Exceptions. If, based on one of the circumstances in this paragraph (e), the Contracting Officer directs that payment requests be made by mail, the Contractor shall submit payment requests by mail through the United States Postal Service to the designated agency office.

Submission of payment requests by mail may be required for—

(1) Awards made to foreign vendors for work performed outside the United States;

(2) Classified contracts or purchases when electronic submission and processing of payment requests could compromise the safeguarding of classified or privacy information;

(3) Contracts awarded by contracting officers in the conduct of emergency operations, such as responses to national emergencies;

(4) Solicitations or contracts in which the designated agency office is a VA entity other than the VA Financial Services Center in Austin, Texas; or

(5) Solicitations or contracts in which the VA designated agency office does not have electronic invoicing capability as described above.

(End of Clause)

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR

ATTACHMENTS

D.1 WAGE DETERMINATION

The following Service Contract Act Wage Determinations are hereby incorporated in their entirety and are attached under Section D. The SCA wage determination is also retrievable from the SAM.gov website.

1. SCA WD 2015-4377 Revision 28, published May 21, 2025 Fayetteville VAMC: North Carolina Counties of Cumberland, Hoke

See attached document: ATTACHMENT Wage Determination 2015-4377 Revision 28, published May 21, 2025.