D.1 36C25026Q7571 RFQ.docx

DOCX document 222 KB Posted Jun 24, 2026

Attached to: V225--Ambulance Service (Columbus)
Solicitation number: 36C25026Q7571
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10

About this file

Written by GovTribe AI · Jun 24, 2026

This is a Request for Quotation (RFQ) for ambulance transportation services to support the Chalmers P. Wylie Veterans Administration Ambulatory Care Center (VAACC) in Columbus, Ohio. The solicitation number is 36C25026Q7571, with an offer due date of July 16, 2026 at 1:00 PM EDT and an award/effective date of June 28, 2026. This is a 100% small business set-aside restricted to Service-Disabled Veteran-Owned Small Businesses (SDVOSBs), with NAICS code 621910 (Ambulance Services) and a small business size standard of $22.5 million. The contract is an indefinite-delivery/indefinite-quantity (IDIQ) vehicle with a maximum total ceiling amount of $8,999,999.00 covering a base period from September 1, 2026 through August 31, 2027, plus four one-year ordering periods extending through August 31, 2031. The Department of Veterans Affairs' Network Contracting Office (NCO-10) is the issuing agency, with the Dayton VA Medical Center as the contracting activity.

The contractor must provide 24/7 non-emergency and emergency ambulance transportation services including Basic Life Support (BLS), Advanced Life Support (ALS), Critical Care Transport (CCT), and stretcher/lay-flat transports throughout Ohio to the VAACC main campus at 420 North James Road, Columbus, Ohio 43219, four community-based outpatient clinics (CBOCs), and other VA facilities within VISN 10. Pricing is structured on a per-trip basis with three rate categories for each service type: base rate (one-way trips up to 20 miles), mileage rate (per mile for trips exceeding 20 miles), and wait time rate (15-minute increments beyond the initial 30-minute grace period). The guaranteed minimum is 200 trips per service type annually in the base period. The contractor must maintain all vehicles, employ qualified EMTs/paramedics with current certifications, respond to scheduled orders within established timeframes (30-60 minutes for urgent requests), maintain 24/7 availability with capacity for up to four simultaneous transports, utilize the VetRide vendor portal or VA-approved transportation software for all orders and invoicing via HCFA 1500 forms, and comply with comprehensive requirements including TB exposure control policies, vehicle maintenance and inspection standards, background checks, HIPAA privacy requirements, and COVID-19 prevention protocols. Service Contract Act wage rates apply, workers' compensation and medical liability insurance are required, and annual compliance training must be completed by contractor personnel.

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Other files

File	Type	Posted
36C25026Q7571 0003.docx	DOCX document	Jul 13, 2026
36C25026Q7571 0004.docx	DOCX document	Jul 7, 2026
D.1 36C25026Q7571 RFQ 7.7.2026.docx	DOCX document	Jul 7, 2026
36C25026Q7571_4.docx	DOCX document	Jul 7, 2026
D.5 Past Performance Questionnaire updated 7.6.2026.docx	DOCX document	Jul 6, 2026
36C25026Q7571_3.docx	DOCX document	Jul 6, 2026
36C25026Q7571_2.docx	DOCX document	Jul 6, 2026
D.7 Compliance Checklist updated 7.6.2026.docx	DOCX document	Jul 6, 2026
36C25026Q7571 0002.docx	DOCX document	Jul 6, 2026
D.1 36C25026Q7571 RFQ 7.6.2026.docx	DOCX document	Jul 6, 2026
D.6 Statement of Start Date Confirmation updated.docx	DOCX document	Jun 25, 2026
36C25026Q7571_1.docx	DOCX document	Jun 25, 2026
D.4 Statement of FAR 52.219-14 Limitations on Subcontracting Compliance.docx	DOCX document	Jun 24, 2026
D.5 Past Performance Questionnaire.docx	DOCX document	Jun 24, 2026
D.6 Statement of Start Date Confirmation.docx	DOCX document	Jun 24, 2026
D.2 WD 2015-4729 Rev 33 Columubs 13 May 2026.docx	DOCX document	Jun 24, 2026
D.7 Required Compliance Checklist.docx	DOCX document	Jun 24, 2026
36C25026Q7571.docx	DOCX document	Jun 24, 2026
D.3 Statement of FAR 52.222-41 - Statement of DoL WD Compliance.docx	DOCX document	Jun 24, 2026

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36C25026Q5521

PAGE 1 OF

1. 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.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

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

757-26-3-826-0122 36C25026Q7571 -2026 Robert J. Bolcavage III None -2026 13:00

EDT

Department of Veterans Affairs Dayton VA Medical Center 3140 Governor’s Place Blvd. Suite 210 Kettering OH 45409-1337 X X 621910 $22.5 Million N/A X 36C250 Department of Veterans Affairs Chalmers P.

Wylier

VAACC

420 N James Rd Columbus OH 43219 36C250 Network Contracting Office (NCO) 10 Department of Veterans Affairs 3140 Governors Place Blvd. Suite 210 Kettering OH 45409-1337

Department of Veterans Affairs Financial Services Center Invoices To Be Submitted Electronically https://www.ob10.com/us/en/veterans-affairs// Invoice Setup Info Phone 877 353 9791 512 460 5429 See CONTINUATION Page The contractor shall provide all required labor, material, supplies, equipment and supervision of contractor personnel necessary to perform Advanced Life Support (ALS) and Basic Life Support (BLS) ambulance service for the Veterans Affairs Ambulatory Care Center (VAACC) Columbus, Ohio in accordance with the terms and conditions established herein.

This Solicitation is a total Small Business set-aside.

FAR 52.232-18 Availability of Funds applies to this Requirement.

Questions accepted by email robert.bolcavage@va.gov.

by July 3rd , 2026

, 1:00 PM EST.

See CONTINUATION Page X Robert J. Bolcavage Contracting Officer Table of Contents

SECTION A	1
A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES	1
SECTION B - CONTINUATION OF SF 1449 BLOCKS	5
B.1 CONTRACT ADMINISTRATION DATA	5
B.2 PRICE/COST SCHEDULE	6
B.3 PERFORMANCE WORK STATEMENT (PWS)	19
SECTION C - CONTRACT CLAUSES	47
C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2025)	47
C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)	52
C.3 52.204-15 SERVICE CONTRACT PREPORTING REQUIREMENTS FOR INDEFINITE-DELIVERY CONTRACTS (DEVIATION NOV 2025)	54
C.4 52.209-14 DISPLAY OF HOTLINE POSTER(S) (NOV 2021)	54
C.5 52.216-18 ORDERING (AUG 2020)	55
C.6 52.216-19 ORDER LIMITATIONS (OCT 1995)	56
C.7 52.216-22 INDEFINITE QUANTITY (NOV 2025) (DEVIATION)	56
C.8 SUPPLEMENTAL INSURANCE REQUIREMENTS	57
C.9 52.222-90 ADDRESSING DEI DISCRIMINATION BY GENERAL CONTRACTORS (APR 2026)	57
C.10 52.232-19 AVILABILITY OF FUNDS (APR 1984)	58
C.11 52.240-91 SECURITY PROHIBITIONS AND EXCLUSIONS (NOV 2025) (DEVIATION)	58
C.12 VAAR 852.204-72 PERSONNEL VETTING AND CREDENTIALING (DEVIATION) (MAR 2026)	68
C.13 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)	71
C.14 VAAR 852.211-76 LIQUIDATED DAMAGES – REIMBURSEMENT FOR DATA BREACH COSTS (FEB 2023) ALTERNATE I (FEB 2023)	72
C.15 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS. (OCT 2019)	73
C.16 VAAR 852.215-71 EVALUATION FACTOR COMMENTS (OCT 2019)	74
C.17 VAAR 852.242-71 ADMINISTRATIVE CONTRACTING OFFICER (OCT 2020)	74
C.18 MANDATORY WRITTEN DISCLOSURES	74
SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS	76
BUSINESS ASSOCIATE AGREEMENT BETWEEN THE DEPARTMENT OF VETERANS AFFAIRS VETERANS HEALTH ADMINISTRATION, , AND	77
SECTION E - SOLICITATION PROVISIONS	82
E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2025)	82
E.2 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2021) (DEVIATION)	84
E.3 EVALUATION OF QUOTES	85
E.4 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)	87
E.5 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (NOV 2025) (DEVIATION)	88
E.6 52.216-1 TYPE OF CONTRACT (NOV 2025) (DEVIATION)	89
E.7 52.233-2 SERVICE OF PROTEST (SEP 2006) (DEVIATION)	89
E.8 52.240-90 SECURITY PROHIBITIONS AND EXCLUSIONS REPRESENTATIONS AND CERTIFICATIONS (NOV 2025) (DEVIATION)	90
E.9 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2021) (DEVIATION)	94

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:

b. GOVERNMENT: Contracting Officer 36C250 Department of Veterans Affairs Dayton VA Medical Center 3140 Governor’s Place Blvd. Suite 210 Kettering OH 45409-1337

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] Bi-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.

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO

DATE

B.2 PRICE/COST SCHEDULE

Item Information.

The maximum total amount, or ceiling amount, for all orders issued against this contract shall not exceed $8,999,999.00.

ITEM NUMBER

DESCRIPTION OF SUPPLIES/SERVICES

ESTIMATED QUANTITY

UNIT

UNIT PRICE

AMOUNT

1,050.00

TRP

__________________

BLS Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS.

The guaranteed minimum only applies to the Federal Government Fiscal Year in which the contract is awarded. The guaranteed minimum is 200 trips.

Contract Period: Base POP Begin: 09-01-2026 POP End: 08-31-2027

PRINCIPAL NAICS CODE: 621910 - Ambulance Services PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

800.00

__________________

BLS Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE-WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS.

Contract Period: Base POP Begin: 09-01-2026 POP End: 08-31-2027

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

215.00

__________________

BLS Ambulance | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

POP Begin: 09-01-2026 POP End: 08-31-2027

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

950.00

TRP

__________________

ALS Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS

The guaranteed minimum only applies to the Federal Government Fiscal Year in which the contract is awarded. The guaranteed minimum is 200 trips.

Contract Period: Base POP Begin: 09-01-2026 POP End: 08-31-2027

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

ALS Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE-WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS.

POP Begin: 09-01-2026 POP End: 08-31-2027

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

ALS Ambulance | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

2,190.00

TRP

__________________

Stretcher BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS.

The guaranteed minimum only applies to the Federal Government Fiscal Year in which the contract is awarded. The guaranteed minimum is 200 trips.

Contract Period: Base

1,600.00

__________________

Stretcher MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE-WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS.

435.00

__________________

Stretcher | WAIT TIME RATE (15-Minute Increments): The wait time rate of 15-minute increments shall only be authorized for patient transports which exceed the “wait time grace period” of thirty minutes upon approval by the COR or authorized government representative designated in writing by the CO as specified in this PWS.

1,050.00

TRP

__________________

Contract Period: Ordering Period 1 POP Begin: 09-01-2027 POP End: 08-31-2028

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

800.00

__________________

POP Begin: 09-01-2027 POP End: 08-31-2028

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

215.00

__________________

POP Begin: 09-01-2027 POP End: 08-31-2028

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

950.00

TRP

__________________

POP Begin: 09-01-2027 POP End: 08-31-2028

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

POP Begin: 09-01-2027 POP End: 08-31-2028

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

POP Begin: 09-01-2027 POP End: 08-31-2028

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

2,190.00

TRP

__________________

POP End: 08-31-2028

1,600.00

__________________

435.00

__________________

1,050.00

TRP

__________________

Contract Period: Ordering Period 2 POP Begin: 09-01-2028 POP End: 08-31-2029

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

800.00

__________________

POP Begin: 09-01-2028 POP End: 08-31-2029

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

215.00

__________________

POP Begin: 09-01-2028 POP End: 08-31-2029

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

950.00

TRP

__________________

POP Begin: 09-01-2028 POP End: 08-31-2029

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

POP Begin: 09-01-2028 POP End: 08-31-2029

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

POP Begin: 09-01-2028 POP End: 08-31-2029

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

2,190.00

TRP

__________________

Stretcher Ambulance BASE RATE (ONE-WAY): The BASE RATE (ONE-WAY) is for authorized one-way patient transports with a point-to-point (one-way) travel distance of 20 miles or less from the designated VA Medical Center as specified in the PWS.

POP Begin: 09-01-2028 POP End: 08-31-2029

1,600.00

__________________

Stretcher Ambulance MILEAGE RATE (ONE-WAY): The MILEAGE RATE (ONE-WAY) shall only be authorized for patient transports which exceed the BASE RATE (ONE-WAY) travel distance radius of 20 miles from the designated VA Medical Center as specified in the PWS.

435.00

__________________

1,050.00

TRP

__________________

Contract Period: Ordering Period 3 POP Begin: 09-01-2029 POP End: 08-31-2030

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

800.00

__________________

POP Begin: 09-01-2029 POP End: 08-31-2030

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

215.00

__________________

POP Begin: 09-01-2029 POP End: 08-31-2030

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

950.00

TRP

__________________

POP Begin: 09-01-2029 POP End: 08-31-2030

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

POP Begin: 09-01-2029 POP End: 08-31-2030

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

POP Begin: 09-01-2029 POP End: 08-31-2030

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

2,190.00

TRP

__________________

POP Begin: 09-01-2029 POP End: 08-31-2030

1,600.00

__________________

435.00

__________________

1,050.00

TRP

__________________

Contract Period: Ordering Period 4 POP Begin: 09-01-2030 POP End: 08-31-2031

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

800.00

__________________

POP Begin: 09-01-2030 POP End: 08-31-2031

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

215.00

__________________

POP Begin: 09-01-2030 POP End: 08-31-2031

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

950.00

TRP

__________________

POP Begin: 09-01-2030 POP End: 08-31-2031

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

POP Begin: 09-01-2030 POP End: 08-31-2031

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

20.00

__________________

POP Begin: 09-01-2030 POP End: 08-31-2031

PRODUCT/SERVICE CODE: V225 - Transportation/Travel/Relocation - Travel/Lodging/Recruitment: Ambulance

2,190.00

TRP

__________________

POP Begin: 09-01-2030 POP End: 08-31-2031

1,600.00

__________________

435.00

__________________

GRAND TOTAL

Base Period: (CLINS 0001 through 0009) Total $_____________ Ordering Period 1: (CLINS 1001 through 1009) Total $_____________ Ordering Period 2: (CLINS 2001 through 2009) Total $_____________ Ordering Period 3: (CLINS 3001 through 3009) Total $_____________ Ordering Period 4: (CLINS 4001 through 4009) Total $_____________

B.3 PERFORMANCE WORK STATEMENT (PWS)

1. Purpose: The Chalmers P. Wylie Veterans Administration Ambulatory Care Center (VAACC) (hereafter CPWVACC), its associated Community-Based Outpatient Clinics (CBOCs), and affiliated healthcare clinics require contracted non-emergency and emergency ambulance transportation services. The contractor shall provide all vehicles, personnel, management, supplies, equipment, and necessary reporting for the provision of Stretcher or Lay Flat Transports, Basic Life Support (BLS), or Advanced Life Support (ALS). The contactor shall make these ambulance services available to the VA as needed, 24 hours a day, seven days a week (24/7), including weekends and holidays.

2. Background: The Chalmers P. Wylie Veterans Administration Ambulatory Care Center (CWVAACC) main campus is located at 420 North James Road, Columbus, Ohio 43219. CWVAACC serves over 42,000 veterans, primarily from the Central Ohio area and it’s four Community-Based Outpatient Clinics. The hospital has zero inpatient beds and over 504,000 outpatient visits a year. Veterans served within this facility live within the following counties and zip codes:

County/Zip Code

Wyandot/43351

Marion/43833

Perry/43150

Franklin/43291

Franklin/43002

Wyandot /43323

Marion/43356

Perry/43730

Franklin/43217

Franklin/43004

Wyandot /43330

Marion/43301

Perry/43731

Franklin/43218

Franklin/43016

Wyandot /43337

Marion/43302

Perry/43739

Franklin/43219

Franklin/43017

Wyandot /43351

Marion/43306

Perry/43748

Franklin/43220

Franklin/43026

Wyandot /43359

Marion/43315

Perry/43760

Franklin/43287

Franklin/43054

Wyandot /44849

Marion/43322

Perry/43761

Franklin/43279

Franklin/43064

Wyandot /44882

Marion/43326

Perry/43764

Franklin/43272

Franklin/43068

Wyandot /45843

Marion/43335

Perry/43766

Franklin/43271

Franklin/43069

Wyandot /43316

Marion/43337

Perry/45732

Franklin/43236

Franklin/43081

Wyandot /44844

Marion/43342

Perry/43138

Franklin/43137

Franklin/43085

Delaware/43334

Marion/43344

Perry/43148

Franklin/43140

Franklin/43109

Delaware/43003

Morrow/44903

Perry/43076

Franklin/43146

Franklin/43110

Delaware/43011

Morrow/44833

Perry/43107

Franklin/43147

Franklin/43119

Delaware/43015

Morrow/43011

Perry/43783

Franklin/43165

Franklin/43123

Delaware/43017

Morrow/43003

Perry/43782

Franklin/43194

Franklin/43125

Delaware/43021

Morrow/44904

Perry/43777

Franklin/43195

Franklin/43126

Delaware/43031

Morrow/43019

Perry/43107

Franklin/43199

Franklin/43221

Delaware/43032

Morrow/43314

Licking/43058

Franklin/43201

Union/ 43016

Delaware/43035

Morrow/43315

Licking/43018

Franklin/43202

Union/ 43029

Delaware/43040

Morrow/43317

Licking/43023

Franklin/43203

Union/ 43036

Delaware/43061

Morrow/43320

Licking/43025

Franklin/43204

Union/ 43040

Delaware/43065

Morrow/43321

Licking/43027

Franklin/43205

Union/ 43041

Delaware/43066

Morrow/43325

Licking/43031

Franklin/43206

Union/ 43045

Delaware/43074

Morrow/43334

Licking/43011

Franklin/43207

Union/ 43060

Delaware/43082

Morrow/43338

Licking/43013

Franklin/43209

Union/ 43061

Delaware/43086

Morrow/43349

Licking/43030

Franklin/43210

Union/ 43064

Delaware/43074

Morrow/43350

Licking/43056

Franklin/43211

Union/ 43067

Delaware/43082

Morrow/44813

Licking/43055

Franklin/43212

Union/ 43077

Delaware/43086

Madison/43029

Licking/43054

Franklin/43213

Union/ 43084

Delaware/43240

Madison/43044

Licking/43033

Franklin/43214

Union/ 43302

Knox/44628

Madison/43064

Licking/43760

Franklin/43215

Union/ 43340

Knox/44813

Madison/43119

Licking/43746

Franklin/43216

Union/ 43344

Knox/43005

Madison/43140

Licking/43062

Franklin/43268

Union/ 43358

Knox/43006

Madison/43143

Licking/43068

Franklin/43266

Union/ 43007

Knox/43011

Madison/43151

Licking/43071

Franklin/43260

Knox/43014

Madison/43153

Licking/43073

Franklin/43251

Knox/43019

Madison/43156

Licking/43076

Franklin/43235

Knox/43022

Morgan/45732

Licking/43080

Franklin/43232

Knox/43028

Morgan/45786

Licking/43093

Franklin/43231

Knox/43037

Morgan/43731

Licking/43721

Franklin/43230

Knox/43048

Morgan/43728

Licking/43739

Franklin/43228

Knox/43050

Morgan/43724

Licking/43740

Franklin/43227

Knox/43080

Morgan/45715

Licking/43822

Franklin/43226

Knox/43822

Morgan/43758

Licking/43830

Franklin/43224

Knox/44822

Morgan/45711

Licking/43001

Franklin/43225

Marion/43341

Morgan/43787

Licking/43008

Franklin/43222

Marion/43322

Morgan/43756

Franklin/43229

Franklin/43223

3. Acronyms ALS – Advanced Life Support AOD – Administrative Officers of the Day BLS – Basic Life Support CCT – Critical Care Transport CCTP – Critical Care Transport Paramedic CCEMTP – Critical Care Emergency Medical Transport CO – Contracting Officer COR – Contracting Officer’s Representative CPR – Cardiopulmonary Resuscitation DOL – Department of Labor EMT – Emergency Medical Technician IAW – In Accordance With OO – Ordering Officer PWS – Performance Work Statement QASP – Quality Assurance Surveillance Plan QC – Quality Control Plan TB – Tuberculosis TJC – The Joint Commission VTS – Veteran Transportation Service

4. Scope/Requirements

4.1. Types of Ambulance Service

4.1.1. The contractor shall provide Emergent, non-emergent Stretcher Transports, Basic Life Support (BLS), Advanced Life Support (ALS), and Critical Care Transport (CCT) Tier 1, 2, and 3 ambulance services on an as-needed basis in accordance with all federal, state, and local regulations. The contractor shall furnish vehicles sufficient to provide full and complete coverage for pick-up and delivery of all veteran patients requiring transport by ambulance to/from the Chalmers P. Wylie VA Ambulatory Care Center (VAACC) at 420 North James Road, Columbus, Ohio 43219 and to the locations specified herein. Business hours/days are defined as the time of 5:00am to 9:00pm, Monday through Friday, except Federal holidays, Weekends and Holidays 5:00am to 9:00pm.

4.1.2. Occasionally a veteran will need to be transported with VA staff and equipment; the contractor shall return VA Staff and equipment to the original place of pick-up.

4.2. Transport of Miscellaneous Items with the Patient

The Contractor may also be required to transport patient luggage, medical records, medication, and comfort items from pickup points to destination at no additional cost to the Government. Luggage to be transported will be restricted to suitcase and valise types. When patients are transported to the CPWVACC, destination is deemed to be the ER, Admissions, the clinic, or service within the hospital, or directly to the ward as instructed by VA Staff.

4.3. Contractor Personnel: Contractor personnel shall be courteous and always conduct themselves in a businesslike manner while providing services under this contract.

4.3.1. Emergency Medical Technicians (EMTs), Critical Care Transport Paramedics (CCTPs) & Other Personnel

4.3.1.1. EMTs, CCTPs and other medical personnel (as applicable) shall at all times meet the qualifications specified in this contract as well as all applicable federal, state, and local government laws, regulations, and standards. EMTs, CCTPs and other medical personnel (as applicable) shall be certified, licensed, or otherwise officially recognized by the local, state, or regional government or public entity where the emergency service is operated or by which it is governed.

4.3.1.2. All non-medical personnel i.e. Ambulette Drivers, shall wear appropriate attire with a picture identification (ID) badge that clearly identifies the company they work for. Drivers shall secure all beneficiaries and passengers with approved security devices prior to transport. Driver shall meet all applicable requirements set by federal, state and local government laws while transporting patients.

4.3.1.3. If the contractor wishes to add or replace personnel throughout the life of the contract, it shall provide evidence of required training, certifications, licensing, and any other qualifications to the COR for review.

4.3.1.4. All drivers shall have a valid driver’s license in accordance with state requirements for their place of operation and the services they perform. If the contractor wishes to add or replace drivers throughout the life of the contract, it shall provide a valid driver’s license to the COR.

4.3.1.5. CCTPs shall have met all state requirements for the tier in which they are performing services in (I, II, III). Proof in the form of a current certificate for the successful completion of such must be provided to the COR upon request. EMTs, CCTPs, and other contractor personnel as applicable must pass the Contractor’s background check and must not have

4.3.1.6. been convicted of (or have any pending charges for) a felony for the past five years. Personnel (and Contractor) must report any new or additional charges or convictions if they arise during the course of performance under this contract so VA can review them and determine whether the employee in question needs to be discharged of his or her duties until the matter is adjudicated.

4.3.2. Tuberculosis Exposure Control Policy

4.3.2.1. The contractor shall provide the VA with a policy on tuberculosis (TB) exposure and control, to include TB decontamination.

4.3.2.2. The contractor shall have its personnel tested for TB in accordance with state guidelines and provide written confirmation to the COR that all personnel (current employees and any new hires) performing services under this contract are current in their TB test by at the start of each Ordering Period.

4.4. Contractor Equipment, Vehicles, and Inspection

4.4.1. Ambulances and/or ambulettes shall meet all applicable federal, state, and local regulations and specifications, including but not limited to licensing, registration, and safety standards.

4.4.2. The VA reserves the right to inspect the contractor’s equipment and vehicles or require documentation of compliance with state laws, rules, regulations, and guidelines governing emergency medical transport vehicles (ambulances and/or ambulette). VA inspections of contractor equipment do not constitute a warranty or guarantee that the contractor’s vehicles and equipment are properly maintained. The VA reserves the right to restrict the contractor’s use of equipment and vehicles in the performance of this contract which are not in compliance with contract requirements. The restriction of such equipment and vehicles shall not relieve the contractor from performance in accordance with the contract nor necessitate additional cost to the VA.

4.4.3. Vehicles shall be clean and maintained in good repair in accordance with manufacturer’s instructions.

4.4.4. The contractor shall not borrow or exchange supplies, equipment, and/or medications with the VA. Equipment attached to or in use by the patient at time of pick-up may remain with the patient during transport to ensure continuity of care. Medical Control Authorities are responsible for maintaining and supplying medication during patient transport. All VA equipment and unused medications must be returned to VA during patient drop-off or as promptly as feasible within 24 hours.

4.4.5. The contractor shall furnish all linen required for patient transport at no additional cost. Linen shall not be exchanged with linen belonging to CPWVACC or its CBOCs/Community Facilities.

4.4.6. The contractor must be capable of transporting the drugs and/or equipment as required by the patient as listed in Attachment A Specialty Care Transport (SCT) or Critical Care Transport (CCT) Capabilities Confirmation. The contractor shall have the appropriate medications, including Specialty Care and Critical Care Transport, if necessary, based on the EMS region the ambulance provider is functioning in. Transports for stretcher where the patient is to Lay flat with no medical assistance, transporting of medications may not be required.

4.4.7. The contractor shall furnish qualified personnel as required by contract specifications to accomplish all services under this contract.

4.4.7.1. The contractor personnel performing services for the VA, shall, at all times, conduct themselves in a professional manner, and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, uniforms, nametags and/or badges for performance of services under this contract. Employee identifications shall be worn in clear view above the waist. The contractor personnel shall not smoke/play loud music originating from any device in vehicles while transporting VA patients.

4.4.7.2. Each driver shall possess a driver’s license that is valid for the class of vehicle driven. Evidence of a special transportation service vehicle permit, or endorsement issued by the commissioner of public safety.

· Be at least 18 years of age and have not less than one year of experience as a licensed driver; and

· For the past three years:

· Have not had a driver’s license canceled or suspended.

· Have a driving record clear of convictions for operating a motor vehicle or motorcycle without insurance.

· Have a driving record clear of convictions for driving a motor vehicle without a valid current license for the class of vehicle driven.

· Have a driving and criminal record clear of convictions for driving under the influence of alcohol or a controlled substance.

4.4.7.3. The contractor personnel will ensure that the patient is secured to the stretcher/cot/chair and that the stretcher /cot /chair is secure in the back of the ambulance or ambulette before the vehicle moves.

4.4.7.4. Ambulance drivers shall have a valid driver’s license, in accordance with Federal, State, and local government requirements for their place of operation for the services they perform, be capable of administering oxygen and shall have successfully completed the standard and advanced first aid course of the American Red Cross of U.S. Bureaus of Mines or equivalent and be capable of providing necessary medical assistance to the attending emergency medical technician or paramedic.

4.4.7.5. Emergency Medical Technician (EMT) and Paramedic Qualifications: EMT’s and Paramedic’s providing services under this contract shall have the following qualifications, in additions to those required by Federal, State, and Local Government:

· Have completed training in accordance with the standards published by the Department of Health and Human Services with a minimum curriculum of 150 hours or equivalent including an in-hospital training period. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by DHHS under PL 93-154, Federal Register 39:24304. (1974).

· Shall be certified, licensed, or otherwise officially recognized by the local, state or regional government or public entity where the emergency ambulance service is operated or by which it is governed.

4.5. Transportation Request

4.5.1 VetRide or VA-approved Transportation Software Utilization:

The contractor agrees to utilize the VetRide Vendor Portal or VA-Approved Transportation Software with every patient transported under this contract.

Department of Veteran Affairs will provide the software and access to the VetRide Vendor Portal or VA-Approved Transportation Software for the vendor/contractor in this contract. The Contractor will utilize the VetRide Vendor Portal or VA-Approved Transportation Software fully as instructed:

a) Receive and respond to electronic trip requests

b) Receive, use, and ensure the use of the Vendor pass by the driver.

c) Submit claims via the electronic HCFA 1500 in the VetRide Vendor Portal or VA-Approved Transportation Software system.

d) All invoices must be submitted within 30 calendar days of date of service in accordance with 38 CFR 70 to be considered timely submission.

i. The contractor’s invoice must be on the HCFA 1500 to include:

ii. Contract Number

iii. Date of Service (to include Box 24 A-J)

iv. Authorization number(s)

v. Pick-up and drop-off location of the patient

vi. Base Rate

vii. Name (Last, First and Middle Initial (if any)) and Full Social Security number (Box 1a) of patient transported

viii. Date of Birth and Sex

ix. Diagnosis Codes or Nature of Illness or Injury

x. Documentation of circumstances when billing for waiting time

xi. Any miscellaneous charges for which the contractor is expecting reimbursement i.e., Tool charges, waiting time, etc.

xii. VA authorizing official’s name

xiii. Healthcare Procedure Coding System/National Level II (HCPCS)

e) Unauthorized charges will be reviewed by the COR as to the validity of the charges and as to whether the payment will be made. A final determination will be made within 30 days after notifying the Contractor of the charges, which are being suspended.

4.5.1.1. A transportation request is defined as one incidence of a request for one-way service (Stretcher Transports, BLS, ALS). No more than one patient will be transported per order unless approved by an authorized VA staff. Transportation requests will be made through VetRide or VA-Approved Transportation Software Utilization. Contractors must have the capability to receive orders, update ride status, and input trip costs and other required data through this portal. Contractors must have dedicated staff available to monitor this portal 24/7. CPWVACC Travel Program Staff will be available to assist with account setup and training for the Contractor’s Staff. In the event VetRide or other VA-Approved Transportation Software Utilization is down, other methods of communication (i.e., telephone, facsimile) will be used to place Transportation requests.

4.5.1.1.1. CPWVACC Travel Program Staff/or authorized VA employees will work with the Contractor the following business day to reconcile any transportation requests that were placed outside of VetRide or VA-Approved Transportation Software Utilization.

4.5.1.1.2. The Contractor must update VetRide or VA-Approved Transportation Software Utilization with any data and/or notes in real time that deviate from the original order such as invoicing for additional mileage due to a road closure, wait time, reason for no load, etc. CPWVACC Travel Program Staff/or authorized VA employees may place a “hold” on payment of this order until it has been reconciled.

4.5.1.2. Only the following VA staff are authorized to place, cancel, or make changes to transportation requests:

Contracting Officer (CO)		Ordering Officers (OO)
Administrative Officer of the Day (AOD)	Beneficiary Travel Office Staff

Contracting Officer’s Representative (COR)

The Contracting Officer will furnish the Contractor with the names of individuals above, who are authorized as Ordering Officers, by separate memorandum upon issuance of the contract. The Contracting Officer will update this list throughout the life of the contract as Ordering Officers change.

Ordering Officers are responsible for issuing and administering orders placed under this contract. Ordering Officers have no authority to modify any term of this basic contract. Any deviation from the terms of the basic contract must be approved in writing by the Contracting Officer responsible for this contract. The Contractor shall accept orders against this contract only from the Contracting Officer and/or authorized ordering officers. Fulfilling orders from persons other than the Contracting Officer or ordering officer may result in loss or delay in payment for supplies/services provided under such orders.

Non-authorized VA employees and private agencies (e.g., nursing homes) are not considered authorized to place transportation requests.

4.5.1.2.1. All patient pick-up(s) and drop-off(s) shall be authorized via “orders” which shall only be issued by the designated Ordering Officers. When placing orders for services, the Ordering Officer shall contact the designated contractor point of contact(s) to provide the following information:

· Mode of transportation required,

· Required time of arrival

· Name of the beneficiary,

· Pick-up and delivery point,

· Type and number of additional medical care specialists required,

· Type of equipment required,

· Last four of the patient's Social Security Number, and

· Any other special instructions

4.5.1.3. For ALL Transports – an Audit system will be put in place by the VA to include the COR or designee, Beneficiary Travel Department staff, and clinical staff to ensure appropriateness of the order and timeliness of the response.

4.5.1.4. The type of transportation service (Stretcher Transports, BLS, ALS, CCT) required will be discussed and determined by VA clinical personnel and the contractor. The contractor shall transport the patient per its policies and standard industry practice. If the type of transportation service differs from what was agreed upon by the VA and contractor, the contractor shall submit documentation to the VA explaining its rationale.

4.5.1.5. The VA may authorize an escort (e.g., spouse, relative, guardian, etc.) to accompany the patient during medical transport if it is practicable and, in the patient’s, best interest. The contractor shall allow the escort to accompany the patient at no additional cost.

4.5.1.6. The contractor shall have sufficient vehicles and personnel to provide services for up to four (4) simultaneous transportation requests. Transports required may be for any mix of Stretcher Transports, BLS, ALS transports. One of these four simultaneous transports may require CCT capability up to Tier III. If CPWVACC requires ambulance services exceeding four (4) simultaneous transportation requests, the vendor will be offered to provide the services if they have sufficient vehicles/personnel available; but may decline these additional orders if sufficient vehicles/personnel are unavailable.

4.5.1.7. The number of transports under normal operating conditions will typically range from 10-30 transports each weekday and significantly less on weekends and holidays. The number of actual transports may vary throughout the life of the contract. Only Base period minimum quantities identified in the Price Schedule (B.2) are guaranteed. Government contract does not guarantee any trips beyond the minimum quantities.

4.5.1.8. The patient may bring with her or him up to three (3) liters of oxygen. The contractor shall be responsible for providing adequate and safe storage of the oxygen tanks during transport.

4.5.1.9. Response Times*

4.5.1.9.1. Orders that are scheduled by 7pm local time the day before the required services are defined as scheduled in advance. With the exceptions found below, the contractor shall arrive on time for all orders scheduled in advance.

4.5.1.9.2. Urgent Transport (Originating from VA (Only): The contractor shall be required to provide Ground Ambulance transportation within thirty (30) minutes of order/patient pick up call.

4.5.1.9.3. For all add-ons (not scheduled in advance) transportation requests, with pick up at CPWVACC: The contractor will be allotted up to a sixty (60) minute response time from time of order placement for transportation requests that are not previously scheduled in advance.

a. For an urgent transport request for a critical patient (as deemed by the physician) with pick up at CPWVACC, the contractor will be allotted up to a thirty (30) minute response time.

4.5.1.9.4. For transportation requests which do not have a pick-up at CPWVACC:

a. The contractor may be required, if…

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