CRHC22-06.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ IS A SMALL BUSINESS SET-ASIDE

PAGE OF PAGES

1. REQUEST NO.

CRHC-22-06

2. DATE ISSUED

11/8/2021

3. REQUISITION/PURCHASE REQUEST NO. 4. CERT.FOR NAT. DEF.

UNDER BDSA REG.2

AND/OR DMS REG. 1

RATING

5A. ISSUED BY

Eagle Butte Indian Health Service, Cheyenne River Service Unit 24276 166th St, PO Box 1012, Eagle Butte, SD 57625

6. DELIVER BY (Date)

See Schedule

5b. FOR INFORMATION CALL (NO COLLECT CALLS) 7. DELIVERY OTHER

FOB DESTINATION (See Schedule)

NAME

Paige Kerstiens paige.kerstiens@ihs.gov

TELEPHONE NUMBER 9. DESTINATION

AREA CODE

NUMBER

964-1565

a. NAME OF CONSIGNEE

Cheyenne River Service Unit

8. TO: b. STREET ADDRESS

24276 166th St, PO Box 1012

a. NAME b. COMPANY c. CITY

Eagle Butte

c. STREET ADDRESS

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

SD

e. ZIP CODE

57625

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BY 1:00 PM MST ON (Date)

November 22, 2021

IMPORTANT: This is a request for information, and quotations furnished are not offiers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

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

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

Firm-Fixed Price Non-Personal Service Health Care Purchase Order for Up to Two(2) CT Technologists for the Cheyenne River Health Center, Eagle Butte, SD.

Period of Performance is 6 months upon receipt of order.

CT Technologist Regular Hours

CT Technologist Overtime Hours

CT Technologist On-Call Hours

See Attached Performance Work Statement.

1,040 hrs hrs hrs

12. DISCOUNT FOR PROMPT

PAYMENT

a. 10 CALENDAR DAYS

b. 20

CALENDAR

DAYS%

c. 30 CALENDAR DAYS

d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

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

SIGN QUOTATION

15. DATE OF

QUOTATIONa. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY 16. SIGNER

a. NAME (Type of print) b. TELEPHONE

AREA CODE

d. CITY e. STATE f. ZIP CODE c. TITLE (type or print) NUMBER

AUTHORIZED FOR LOCAL REPRODUCTION FormFlow/Delrina Inc. STANDARD FORM 18 (REV 6-95) Previous edition not usable Prescribed by GSA-FAR (48 CFR) 53-215-1(a)

ITEM

NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

DUNS & Bradstreet Number:

(The Duns & Bradstreet number is required.

Provided you do not have it, you may call 866-705- 5711 and obtain one.) You will need a DUNS & Bradstreet NUMBER to be awarded the purchase order and registered with the System for Award Management; you can register at www.sam.gov

The quoter is hereby notified that they must be registered in the System for Award Management (SAM) before the Government will issue an award. You may do this by going to www.sam.gov to register and you are required to update this registration every year prior to the expiration date.

No contract award shall be made to a vendor listed on the OIG Exclusion List (http://exlusions.oig.hhs.gov) throughout the duration of the contract.

Federal Tax ID Number:

Email Address:

Net Terms:

NOTICE TO QUOTERS

REQUEST FOR QUOTES (RFQ):

QUOTE DUE DATE:

RETURN RFQ TO:

CRHC22-06

Quotes are due November 22, 2021 @ 1:00 PM MST

Cheyenne River Service Unit Attn: Paige Kerstiens PO Box 1012 Eagle Butte, SD 57625 Telephone: 605-964-7724 Ext. 1565 Fax: 605-964-1140

GENERAL DESCRIPTION:

Firm Fixed Price, Non-Personal Service Healthcare Purchase Order for Diagnostic/CT Technologist Services, at the Cheyenne River Health Center, Eagle Butte, SD. For up to Two (2) Diagnostic/CT Technologists/Technician(s) working in the Lab Department. Period of Performance: 6 Months upon receipt of order. Contractor shall perform in accordance with the PWS. The quoted “unit price” shall be an all-inclusive price. Multiple awards may be made against this RFQ, if advantageous for the government.

This RFQ is issued as an Indian Economic Enterprise Small Businesses Set-Aside and the associated NAICS code is 561320 with a small business size standard of $30 million.

BASIS FOR AWARD:

LPTA: (a) The Government will award one or more contracts resulting from this solicitation to the responsible offeror(s) whose offer, conforming to the solicitation, is the Lowest Price Technically Acceptable (LPTA). To be considered technically acceptable, offerer must submit proof of minimum qualification outlined in the Performance Work Statement. Specifically these elements must be included:

1) Proof of active, current, and unrestricted license (ARRT RT (R) and CT) corresponding to the individual’s level of training, meeting the requirements of the Performance Work Statement.

2) Candidate cannot have exclusions or sanctions from Medicare/Medicaid Programs. Attach OIG Exclusion for each candidate (https://exclusions.oig.hhs.gov/).

3) Resumes stating minimum qualifications as provided in Performance Work Statement.

4) Two (2) candidate references of similar work in the last three years.

RESPONSIBILITY: To be eligible for an award, an Offeror must be determined responsible in accordance with the standards in FAR Part 9.104.

PRICE EVALUATION: The price proposal shall be evaluated to determine the Offeror's ability to carry out its proposed technical approach and indicate that the Offeror understands the nature and extent of the work to be performed. The total price of each contract line item shall be added together to arrive at an overall total. The total of all options years shall be added together to arrive at an overall evaluated total, which will be evaluated for overall reasonableness of price. Offerors must include the formulas and factors used in calculation of the data.

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

AWARD WITHOUT DISCUSSIONS & COMPETITIVE RANGE DETERMINATIONS

The Government intends to evaluate proposals and award a contract without discussions with Offerors (except for clarifications as described in FAR 15.306(a)). Therefore, the Offeror's initial proposal should contain the Offeror's best terms from a price and technical standpoint. The Government reserves the right to conduct discussions if the Contracting Officer later determines them to be necessary. In the event discussions are held, a competitive range determination will be made. If the Contracting Officer determines that the number of proposals that would otherwise be in the competitive range exceeds the number at which an efficient competition can be conducted, the Contracting Officer may limit the number of proposals in the competitive range to the greatest number that will permit an efficient competition among the most highly rated proposals.

Contractor must be registered with the System for Award Management. The website to register is at:

www.sam.gov

INSTRUCTION TO QUOTERS:

To be considered an acceptable quote, the following items must be completed and returned by the due date stated above.

1. Complete and sign SF-18 – Request for Quotation (Signature required)

2. Complete Taxpayer Identification Form (FAR Part 52.204-3 – Taxpayer Identification)

3. Complete Annual Representations & Certifications form (FAR 52.212-5)

4. Candidate Resume (to include last employer), must include DOB on Resume.

5. Candidate License (active and inactive)

ATTACHMENTS:

1. SF-18 Request for Quotations

2. Notice to Quoters

3. Performance Work Statement

4. Clauses incorporated by reference

5. Clauses incorporated in full text

6. Business Associate Agreement

7. Ethics

8. Service Labor Standards

9. Face Mask Policy

Questions in regards to this solicitation shall be submitted in writing by email to (Paige.Kerstiens@ihs.gov). The last day to submit questions is November 18, 2021, 1:00pm, MST.

ACCEPTANCE PERIOD: Your quote must stipulate that it is predicated upon all the terms and conditions of this Solicitation. In addition, it must contain a statement to the effect that it is firm for a period of at least 60 days from the date of receipt by the Government.

NO CONTRACT AWARD SHALL BE MADE TO ANY VENDOR OR PROVIDER LISTED ON THE OIG

EXLUSION LIST http://exlusions.oig.hhs.gov THROUGHOUT THE DURATION OF THE CONTRACT. IT

SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO NOTIFY THE ACQUISITION

OFFICIAL IF THERE IS A CHANGE IN PROVIDER.

SECURITY CLEARANCE

Performance of this contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (I.H.S.). Before starting work requiring routine access to I.H.S. facilities or systems each person must complete a FBI National Criminal History Check (Fingerprint Check) adjudicated by an I.H.S. employee using the Office of Personnel Management Personnel Investigations Processing System. Contractors shall allow five business days for I.H.S. processing of fingerprints taken electronically at an I.H.S. site and thirty business days for non-electronic processing of fingerprints using FBI Form FD-258. A list of I.H.S. sites with electronic fingerprint capability is available from the Contracting Officer.

Quotation must set forth full, accurate, and complete information as required by this Request for Quotation (RFQ), and be returned no later than the date referenced in Block #10 of the Request for Quotation form SF-18.

All required information must be submitted in order to be considered responsive and eligible for award.

Performance Work Statement

To Provide Diagnostic/CT Technologist services for the Cheyenne River Health Center (CRHC) in

Eagle Butte, South Dakota. The mission of the CRHC is to provide the best possible Health Care services to the Native American population of the Cheyenne River Indian Reservation. To meet the mission of the

CRHC, contractor support will be required to assist the Indian Health Service Hospital with Diagnostic/CT

Technologist services in the Great Plains Area.

Each Contract resulting from this solicitation shall:

Be a fixed-price non-personal health care service contract, under which the Contractor is an independent contractor.

Allow the Government to evaluate the quality of professional and administrative services provided.

Scope of Work

The contractor will be required to provide a variety of computerized tomography (CT) and diagnostic radiographic (X-Ray) examinations. The government reserves the right to accept or reject services if the level of performance is unsatisfactory to Indian Health Service.

The Joint Commission on Accreditation of Health Care Organizations (JACHO) standards must be considered and adhered to at all time in order to be compliant. All Medical Record Information generated in the performance of this contract shall remain the property of and subject to the exclusive control of the Indian Health Service. The contractor is responsible for maintaining Patient Confidentiality and adhering to the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act

(HIPAA) of 1996.

Personnel

CT Technologist must have highly proficient experience with Toshiba (Canon) CT equipment. CT

Technologist may assist in the training of departmental staff. Diagnostic/CT Technologist must have verified documentation that technologists who perform diagnostic/CT examinations participate in ongoing education that includes annual training on safe radiation protection practices in the Radiology environment. Technologist must have taken the Image Gently, and Image Wisely pledge with documentation upon arrival. The contracting company will be solely responsible for Radiation monitoring of contract staff. A copy of the radiation monitoring will need to be sent to the Radiology supervisor quarterly.

Contractor Representative

The contractor shall designate a representative in accordance with FAR 52.236-6 included in section 1 of this contract. The name of this person shall be designated in writing and provided to the CO. The contractor representative shall have authority to act for the contractor on all contract matters relating to the daily operation of this contract.

Tour of Duty

Contract CT Tech will work into current departmental schedule. Assignments will require shifts of no less than 8 hours and no more than12 hours. These shifts may rotate any time during the 24 hour period for a total of 80 hours in a two-week pay period. Holidays and weekends will be included as part of the 80 hour work period. All scheduled hours will be determined by the Radiology Supervisor. Occasional On-

Call status and Holidays may be required.

Response Time

Contract CT Technologist will work into current department schedule assignments. This will require shifts where on-call status may be initiated. Response time for a stat exam is 15 minutes a routine exam will be 45 minutes. Holidays and will be included as part of the 80 hour work period. All scheduled hours will be determined by the Radiology Supervisor.

Emergency Services

On occasion, services may be required to support or exercise of contingency plans outside the normal duty hours described above.

Language

The contractor must be able to read, write, and understand English.

Employees Appearance

Contractor personnel shall present a neat appearance and be easily recognized. This may be accomplished by wearing distinctive clothing bearing the name of the company or by wearing appropriate badges that contain the company name and employee name.

Certifications

The contractor shall ensure employees have the following current and valid professional certifications before start date. ARRT certification for both General Radiography (XR) and Computed Tomography

(CT).

Government Review

The government may review the Contractor’s QC plan to determine if it is adequate. If the plan is found to be adequate, a government will authorize the plan. If the plan is not adequate as submitted, the deficiencies will be identified to the contractor in writing. The contractor shall correct all identified deficiencies and submit a corrected QC plan in writing within 10 working days or by contract start date whichever is sooner. Contractor-performed work that fails to conform to standards when the CO performs quality assurance (QA) work will serve as an indicator and the contractors QC system is not adequate.

Contracting Officer Representative Responsible for:

Monitoring the contractor’s technical process.

Interpreting the Performance work Statement.

Technical evaluation as required.

Technical inspections and acceptance required by this contract.

Assisting in the resolution of technical problems encountered during performance of this contract.

Government Monitoring

Government will monitor the contractor’s performance under this contract using the method(s) of surveillance specified in the PRS. All monitoring observation will be recorded by the government. When an observation indicates defective performance, the COR will request the contractor’s representative to confirm defective work and perform a corrective action.

Performance Evaluation Meetings

The contract manager may be required to meet weekly with that COR or others during the first month of the contract, meeting shall be as often as necessary thereafter as determined by the CO. However, if the contractor requests, a meeting will be held whenever a contract discrepancy report is issued. The meetings shall focus on contractor performance and actual potential problems.

All documentation, records, and schedules as described in the PWS that are the responsibility of the contractor are the property of the government and shall be turned over to the government upon completion or termination of the contract. All records are subject to the Freedom of Information and/or

Privacy Acts, and any request for release of any records shall be handled accordingly.

Acceptable Quality Level (AQL)

The maximum percent defective (or the maximum number of defects per 100 units) that, for the purposes of random sampling, may occur before the government will affect the price computation system in accordance with that PRS and the Inspection of Services clause. When the method of surveillance is other than random sampling, the AQL is defined as the number of defects or maximum percentage of defects and a lot that may occur before the government will affect the price computation system in accordance with the PRS and Inspection of Services clause. An AQL does not allow a contractor to knowingly offer defective service but limits reduced payment circumstances in which defective performance results in a measurable reduction in the value of services rendered.

Performance Requirements Summary (PRS)

Identifies the key service outputs of the contract that will be evaluated by the Government to ensure contract performance standards are met by the contractor.

Quality Assurance (QA)

The actions taken by the Government to ensure that services meet the requirements of the PWS.

Contracting Officer’s Representative

A government person designated by the CO with authority to act within the scope of the delegated authority.

Quality Assurance Surveillance Plan (QASP)

The purpose of the QASP is to describe the systematic methods used to monitor performance and to identify the required documentation and the resources to be employed. The QASP provides a means for evaluating whether the contractor is meeting the performance standards/quality levels identified in the

PWS and the contractor’s quality control plan (QCP), and to ensure that the government pays only for the level of services received.

Quality Control (QC)

Those actions taken by contractor to control the performance of services so that services meet the requirements of the PWS.

Random Sampling

A sampling method in which each service output in a lot has an equal chance of being selected. A sample consists of one or more service outputs drawn from a lot. The number of outputs in the sample is the sample size.

Government-Furnished Property

The government will provide any property, power, facilities, forms, supplies, and phone lines or physicians services if needed during the term of this contract.

Contractor-Furnished Property/Supplies/Material/Equipment/ETC.

The contractor will provide the necessary equipment to have the capabilities to do Diagnostic/CT

Technologist services.

Publications and Cited Standards

Task Description Performance Standard

Method of Monitoring

+ or – Incentives

Provide Diagnostic/CT Technologist services 40 hours/week.

Agency must provide competent Diagnostic/CT Technologist to ensure no gaps in department coverage.

Diagnostic/CT Technologist will be scheduled by the Radiology Department Supervisor Diagnostic/CT Technologist service 40 hours/week.

For every shift not covered by agency, the shift rate will be deducted from the next submitted invoice.

QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

TEMPLATE

CT Technologists

TABLE OF CONTENTS

1 INTRODUCTION

1.1 Purpose

1.2 Performance Management Approach

1.3 Performance Management Strategy

2 ROLES AND RESPONSIBILITIES

2.1 The Contracting Officer

2.2 The Contracting Officer’s Technical Representative

3 IDENTIFICATION OF REQUIRED PERFORMANCE STANDARDS/QUALITY LEVELS

4 METHODOLOGIES TO MONITOR PERFORMANCE

4.1 Surveillance Techniques

4.2 Customer Feedback

4.3 Acceptable Quality Levels

5 QUALITY ASSURANCE DOCUMENTATION

5.1 The Performance Management Feedback Loop

5.2 Monitoring Forms

6 ANALYSIS OF QUALITY ASSURANCE ASSESSMENT

6.1 Determining Performance

6.2 Reporting

6.3 Reviews and Resolution

ATTACHMENT 1: PERFORMANCE REQUIREMENTS SUMMARY

ATTACHMENT 2: SAMPLE QUALITY ASSURANCE MONITORING FORM

QUALITY ASSURANCE SURVEILLANCE PLAN

(QASP)

1 INTRODUCTION

This quality assurance surveillance plan (QASP) is pursuant to the requirements listed in the performance work statement (PWS) entitled CT Technologists. This plan sets forth the procedures and guidelines Cheyenne River Health Center will use in ensuring the required performance standards or services levels are achieved by the contractor.

1.1 Purpose

1.1.1 The purpose of the QASP is to describe the systematic methods used to monitor performance and to identify the required documentation and the resources to be employed. The QASP provides a means for evaluating whether the contractor is meeting the performance standards/quality levels identified in the PWS and the contractor’s quality control plan (QCP), and to ensure that the government pays only for the level of services received.

1.1.2 This QASP defines the roles and responsibilities of all members of the integrated project team (IPT), identifies the performance objectives, defines the methodologies used to monitor and evaluate the contractor’s performance, describes quality assurance documentation requirements, and describes the analysis of quality assurance monitoring results.

1.2 Performance Management Approach

1.2.1 The PWS structures the acquisition around “what” service or quality level is required, as opposed to “how” the contractor should perform the work (i.e., results, not compliance). This QASP will define the performance management approach taken by the Cheyenne River Health Center, Radiology Department to monitor and manage the contractor’s performance to ensure the expected outcomes or performance objectives communicated in the PWS are achieved. Performance management rests on developing a capability to review and analyze information generated through performance assessment.

The ability to make decisions based on the analysis of performance data is the cornerstone of performance management; this analysis yields information that indicates whether expected outcomes for the project are being achieved by the contractor.

1.2.2 Performance management represents a significant shift from the more traditional quality assurance (QA) concepts in several ways. Performance management focuses on assessing whether outcomes are being achieved and to what extent. This approach migrates away from scrutiny of compliance with the processes and practices used to achieve the outcome. A performance-based approach enables the contractor to play a large role in how the work is performed, as long as the proposed processes are within the stated constraints. The only exceptions to process reviews are those required by law (federal, state, and local) and compelling business situations, such as safety and health. A “results” focus provides the contractor flexibility to continuously improve and innovate over the course of the contract as long as the critical outcomes expected are being achieved and/or the desired performance levels are being met.

1.3 Performance Management Strategy

1.3.1 The contractor is responsible for the quality of all work performed. The contractor measures that quality through the contractor’s own quality control (QC) program. QC is work output, not workers, and therefore includes all work performed under this contract regardless of whether the work is performed by contractor employees or by subcontractors. The contractor’s QCP will set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the PWS. The contractor will develop and implement a performance management system with processes to assess and report its performance to the designated government representative. The contractor’s QCP will set forth the staffing and procedures for self-inspecting the quality, timeliness, responsiveness, customer satisfaction, and other performance requirements in the PWS. This QASP enables the government to take advantage of the contractor’s QC program.

1.3.2 The government representative(s) will monitor performance and review performance reports furnished by the contractor to determine how the contractor is performing against communicated performance objectives. The government will make determination regarding incentives based on performance measurement metric data and notify the contractor of those decisions. The contractor will be responsible for making required changes in processes and practices to ensure performance is managed effectively.

2 ROLES AND RESPONSIBILITIES

2.1 The Contracting Officer

The contracting officer (CO) is responsible for monitoring contract compliance, contract administration, and cost control and for resolving any differences between the observations documented by the contracting officer's representative (COR) and the contractor. The CO will designate one full-time COR as the government authority for performance management. The number of additional representatives serving as technical inspectors depends on the complexity of the services measured, as well as the contractor’s performance, and must be identified and designated by the CO.

2.2 The Contracting Officer’s Technical Representative

The contracting officer’s technical representative (COTR) is designated in writing by the CO to act as his or her authorized representative to assist in administering a contract. COTR limitations are contained in the written appointment letter. The COTR is responsible for technical administration of the project and ensures proper government surveillance of the contractor’s performance. The COTR is not empowered to make any contractual commitments or to authorize any contractual changes on the government’s behalf.

Any changes that the contractor deems may affect contract price, terms, or conditions shall be referred to the CO for action. The COTR will have the responsibility for completing QA monitoring forms used to document the inspection and evaluation of the contractor’s work performance. Government surveillance may occur under the inspection of services clause for any service relating to the contract.

3 IDENTIFICATION OF REQUIRED PERFORMANCE STANDARDS/QUALITY

LEVELS

The required performance standards and/or quality levels are included in the PWS and in Attachment 1, “Performance Requirements Summary.” [Adjust the following sentences to reflect the instant acquisition.] If the contractor meets the required service or performance level, it will be paid the monthly amount agreed on in the contract. If the contractor exceeds the service or performance level, it is eligible to receive an incentive or award fee as stated in the contract. Failure to meet the required service or performance level will result in a deduction from the monthly amount.

4 METHODOLOGIES TO MONITOR PERFORMANCE

4.1 Surveillance Techniques

In an effort to minimize the performance management burden, simplified surveillance methods shall be used by the government to evaluate contractor performance when appropriate. The primary methods of surveillance are (include those that apply)

Random monitoring, which shall be performed by the COTR/COR designated inspector.

100% Inspection – Each month, the COTR/COR, shall review the generated documentation and enter summary results into the Surveillance Activity Checklist.

Periodic Inspection – COTR/COR typically performs the periodic inspection on a monthly basis.

4.2 Customer Feedback

The contractor is expected to establish and maintain professional communication between its employees and customers. The primary objective of this communication is customer satisfaction. Customer satisfaction is the most significant external indicator of the success and effectiveness of all services provided and can be measured through customer complaints.

Performance management drives the contractor to be customer focused through initially and internally addressing customer complaints and investigating the issues and/or problems but the customer always has the option to communicate complaints to the COR as opposed to the contractor.

Customer complaints, to be considered valid, must set forth clearly and in writing the detailed nature of the complaint, must be signed, and must be forwarded to the COTR/COR. The COTR/COR will accept those customer complaints and investigate using the Quality Assurance Monitoring Form – Customer Complaint Investigation, identified in Attachment 3.

Customer feedback may also be obtained either from the results of formal customer satisfaction surveys or from random customer complaints.

4.3 Acceptable Quality Levels

The acceptable quality levels (AQLs) included in Attachment 1, Performance Requirements Summary Table, for contractor performance are structured to allow the contractor to manage how the work is performed while providing negative incentives for performance shortfalls. For certain critical activities such as those involving Provision of CT Tech Services, the desired performance level is established at 100 percent. Other levels of performance are keyed to the relative importance of the task to the overall mission performance at the Cheyenne River Health Center, Radiology Dept.

5 QUALITY ASSURANCE DOCUMENTATION

5.1 The Performance Management Feedback Loop

The performance management feedback loop begins with the communication of expected outcomes.

Performance standards are expressed in the PWS and are assessed using the performance monitoring techniques shown in Attachment 1.

5.2 Monitoring Forms

The government’s QA surveillance, accomplished by the COR, will be reported using the monitoring forms in Attachments 2 and 3. The forms, when completed, will document the government’s assessment of the contractor’s performance under the contract to ensure that the required results are being achieved.

5.2.1 The COR will retain a copy of all completed QA surveillance forms.

6 ANALYSIS OF QUALITY ASSURANCE ASSESSMENT

6.1 Determining Performance

6.1.1 Government shall use the monitoring methods cited to determine whether the performance standards/service levels/AQLs have been met. If the contractor has not met the minimum requirements, it may be asked to develop a corrective action plan to show how and by what date it intends to bring performance up to the required levels.

6.2 Reporting

6.2.1 At the end of each quarter, the Program Manager will prepare a written report for the COR summarizing the overall results of the quality assurance surveillance of the contractor’s performance.

This written report, which includes the contractor’s submitted monthly report and the completed quality assurance monitoring forms (Attachment 2), will become part of the QA documentation. It will enable the government to demonstrate whether the contractor is meeting the stated objectives and/or performance standards, including cost/technical/scheduling objectives.

6.3 Reviews and Resolution

6.3.1 The Program Manager may require the contractor’s project manager, or a designated alternate, to meet with the COR and other government IPT personnel as deemed necessary to discuss performance evaluation. The COR will define a frequency of in-depth reviews with the contractor, including appropriate self-assessments by the contractor; however, if the need arises, the contractor will meet with the COR as often as required or per the contractor’s request. The agenda of the reviews may include:

Monthly performance assessment data and trend analysis

Issues and concerns of both parties

Projected outlook for upcoming months and progress against expected trends, including a corrective action plan analysis

Recommendations for improved efficiency and/or effectiveness

6.3.2 The QAR must coordinate and communicate with the contractor to resolve issues and concerns regarding marginal or unacceptable performance.

6.3.3 The COR and contractor should jointly formulate tactical and long-term courses of action.

Decisions regarding changes to metrics, thresholds, or service levels should be clearly documented.

Changes to service levels, procedures, and metrics will be incorporated as a contract modification at the convenience of the PCO/ACO.

ATTACHMENT 1: PERFORMANCE REQUIREMENTS SUMMARY

Task Description Performance Standard

Method of Monitoring

+ or – Incentives

Provide Diagnostic/CT Technologist services 40 hours/week.

Agency must provide competent Diagnostic/CT Technologist to ensure no gaps in department coverage.

Diagnostic/CT Technologist will be scheduled by the Radiology Department Supervisor Diagnostic/CT Technologist service 40 hours/week.

For every shift not covered by agency, the shift rate will be deducted from the next submitted invoice.

ATTACHMENT 2: SAMPLE QUALITY ASSURANCE

MONITORING FORM

SERVICE or STANDARD:

SURVEY PERIOD:

SURVEILLANCE METHOD (Check):

Random Sampling 100% Inspection Periodic Inspection Customer Complaint

LEVEL OF SURVEILLANCE (Check):

Monthly Quarterly As needed

PERCENTAGE OF ITEMS SAMPLED DURING SURVEY PERIOD: ______ %

ANALYSIS OF RESULTS:

Observed Service Provider Performance Measurement Rate: ______%

Service Provider’s Performance (Check): Meets Standards

Does Not Meet Standards

Narrative of Performance During Survey Period:

PREPARED BY: ___________________________________ DATE: _________________

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price Service-Commercial Items)

FAR CITATION: 52.252-1: Solicitation Provision Incorporated by Reference. (FEB 1998) This solicitation incorporates one or more solicitation provisions by reference, with the same force and defect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es): https://www.acquisition.gov/?q=browsefar

I. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses

No. FAR Citation Clause Title Clause Date_______

1. 52.204-7 System for Award Management (P) Oct 2018

2. 52.204-9 Personal Identity Verification of Contractor Personnel Jan 2011

3. 52.204-13 System for Award Management Maintenance Oct 2018

4. 52.204-16 Commercial and Government Entity Code Reporting Aug 2020

5. 52.204-18 Commercial and Government Entity Code Maintenance Aug 2020

6. 52.204-21 Basic Safeguarding of Covered Contractor Information Systems Jun 2016

7. 52.212-1 Instructions to Offerors – Commercial Items Sept 2021

8. 52.212-4 Contract Terms and Conditions - Commercial Items Oct 2018

9. 52.215-5 Facsimile Proposals Oct 1997

10. 52.217-5 Evaluation of Options Jul 1990

11. 52.222-3 Convict Labor Jun 2003

12. 52.222-26 Equal Opportunity Sep 2016

13. 52.222-41 Service Contract Labor Standards Aug 2018

14. 52.222-43 Fair Labor Standards Act and Service Contract Labor Standards Aug 2018

15. 52.222-44 Fair Labor Standards Act and Service Contract Act-Price Adjustments May 2014

16. 52.222-55 Minimum Wage Under Executive Order 13658 Nov 2020

17. 52.223-5 Pollution Prevention and Right-To-Know Information May 2011

18. 52.223-6 Drug-Free Workplace May 2001

19. 52.224-1 Privacy Act Notification Apr 1984

20. 52.224-2 Privacy Act Apr 1984

21. 52.225-13 Restrictions on Certain Foreign Purchases Feb 2021

22. 52.232-1 Payments Apr 1984

23. 52.232-8 Discounts for Prompt Payment Feb 2002

24. 52.232-18 Availability of Funds Apr 1984

25. 52.232-25 Prompt Payment Jan 2017

26. 52.232-33 Payment by Electronic Funds Transfer – System for Award Mgtm Oct 2018

27. 52.232-39 Unenforceability of Unauthorized Obligations Jun 2013

28. 52.232-40 Providing Accelerated Payments to Small Business Subcontractors Dec 2013

29. 52.233-1 Disputes May 2014

30. 52.233-3 Protest After Award Aug 1996

31. 52.233-4 Applicable Law for Breach of Contract Claim Oct 2004

32. 52.237-1 Site Visit (P) Apr 1984

33. 52.237-2 Protection of Government Buildings, Equipment and Vegetation Apr 1984

34. 52.237-3 Continuity of Services Jan 1991

35. 52.237-7 Indemnification and Medical Liability Insurance Jan 1997

36. 52.242-15 Stop-Work Order Aug 1989

37. 52.243-1 Changes-Fixed-Price Aug 1987

38. 52.244-6 Subcontracts for Commercial Items Jul 2021

39. 52.246-4 Inspection of Services – Fixed-Price Aug 1996

40. 52.249-1 Termination for Convenience of the Government Apr 1984

41. 52.249-8 Default (Fixed-Price Supply and Service) Apr 1984

42. 52.253-1 Computer Generated Forms Jan 1991

II. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses in Full Text

No. FAR Citation Clause Title Clause Date_______

1. 52.204-3 Taxpayer Identification (P) Oct 1998

2. 52.212-2 Evaluation-Commercial Items Oct 2014

Feb 2021

Sept 2021

Nov 1999

3. 52.212-3

4. 52.212-5

5. 52.217-8

6. 52.223-99 Oct 2021

Offeror Representation and Certifications

- Commercial Items

Contract Terms and Condition Required to Implement Statutes or Executive Orders - Commercial Items

Option to Extend Services

Ensuring Adequate COVID-19 Safety Protocols for Federal Contractors

52.204-3 Taxpayer Identification

As prescribed in 4.905, insert the following provision:

TAXPAYER IDENTIFICATION (OCT 1998)

(a) Definitions.

“Common parent,” as used in this position, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member.

“Taxpayer Identification Number (TIN),” as used in this provision, means the number required by the Internal Revenue Service (IRS) to be used by the offeror in reporting income tax and other returns. The TIN may be either a Social Security Number or an Employer Identification Number.

(b) All offerors must submit the information required in paragraphs (d) through (f) of this provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26 U.S.C.

6041, 4051A, and 6050M, and implementing regulations issued by the IRS. If the resulting contract is subject to the payment reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the contract.

(c) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror’s relationship with the Government (31 U.S.C. 7701©(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror’s TIN.

(d) Taxpayer Identification Number (TIN)

TIN:

TIN has been applied for.

TIN is not required because:

Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States;

Offeror is an agency or instrumentality of a foreign Government;

Offeror is an agency or instrumentality of the Federal Government.

(e) Type of organization.

Sole proprietorship;

Partnership;

Corporate entity (not tax-exempt);

Corporate entity (tax-exempt);

Government entity (Federal, State, or local);

Foreign government;

International organization per 26 CFR 1.6049-4;

Other ;

(f) Common parent.

Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this provision.

Name and TIN of common parent:

Name

TIN

(End of provision) 52.212-2 -- Evaluation -- Commercial Items.

As prescribed in 12.301(c), the Contracting Officer may insert a provision substantially as follows:

Evaluation -- Commercial Items (Oct 2014)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror who is Lowest Price Technically Acceptable

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

(c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of Provision)

52.212-3 Offeror Representations and Certifications-Commercial Items.

As prescribed in 12.301(b)(2), insert the following provision:

OFFEROR REPRESENTATIONS AND CERTIFICATIONS-COMMERCIAL ITEMS (FEB 2021)

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v)) of this provision.

(a) Definitions. As used in this provision— "Covered telecommunications equipment or services" has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

Economically disadvantaged women-owned small business (EDWOSB) concern means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

Forced or indentured child labor means all work or service—

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

Highest-level owner means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

Inverted domestic corporation, means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

Manufactured end product means any end product in product and service codes (PSCs) 1000-9999, except—

(1) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

Place of manufacture means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

Predecessor means an entity that is replaced by a successor and includes any predecessors of the predecessor.

Reasonable inquiry has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

Restricted business operations means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate—

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended."Sensitive technology"— Sensitive technology—

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically—

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3)of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

Service-disabled veteran-owned small business concern—

(1) Means a small business concern—

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veteransor, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service connected, as defined in 38 U.S.C. 101(16).

Small business concern—

(1) Means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR part 121 and size standards in this solicitation.

(2) Affiliates, as used in this definition, means business concerns, one of whom directly or indirectly controls or has the power to control the others, or a third party or parties control or have the power to control the others. In determining whether affiliation exists, consideration is given to all appropriate factors including common ownership, common management, and contractual relationships. SBA determines affiliation based on the factors set forth at 13 CFR 121.103.

Small disadvantaged business concern, consistent with13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that—

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by—

(i) One or more socially disadvantaged (as defined at13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13.CFR

124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

Subsidiary means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation Successor means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term "successor" does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

Veteran-owned small business concern means a small business concern—

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C.

101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more veterans.

Women-owned small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States.

Women-owned small business concern means a small business concern—

(1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least51…