Exhibit A ASR Requirements.pdf

JOHN J. PERSHING VA MEDICAL CENTER

WEST PLAINS, MO COMMUNITY BASED OUTPATIENT CENTER

AGENCY SPECIFIC REQUIREMENTS (ASR)

GENERAL OVERVIEW:

The Department of Veterans Affairs is interested in leasing a minimum of 18,500 (contiguous) net usable square feet of clinical space for a Community Based Outpatient Center (CBOC) in the city of West Plains, Missouri.

Space shall be available for use by Tenant (VA) for personnel, furnishings, and equipment to meet the needs and requirements for an Outpatient VA Clinic in the West Plains, MO area as referenced at www.cfm.va.gov/TIL

The leased property shall be within the boundaries specified below:

North Boundary: County Road 1180 South Boundary: County Road 8620 East Boundary: County Road 2730 West Boundary: County Road 6460

LEASED PROPERTY MINIMUM CRITERIA:

The space shall be of contiguous office space in a professional and aesthetically pleasing Building. Space offered must be in a quality seismically compliant building of sound and substantial construction, either a new, modernized building, or one that has undergone restoration or rehabilitation for the intended use. Space shall be located in a prime commercial office space with attractive, professional surroundings. Streets and public walkways shall be well maintained. Space shall be located on the ground floor.

Submitted designs must meet Patient Aligned Care Team (PACT) design guide philosophy. Patient Centered Care (PCC) and the PACT model has transformed the way the Department of Veterans Affairs, Veterans Health Administration provides care to our nation’s Veterans. PCC and PACT require focus on the Veteran. Lean operations thinking and lean design combine to support a proactive Veteran‐focused approach to aligning operations and space. Lean management ideas must be used to center on the Veteran’s needs, increase quality, and decrease waste.

Space design will provide maximum co‐location of the staff providing services to our patients. It will bring the service to the veterans, reduce the number of steps required to deliver services, and simplify the Veteran’s experience.

Design must maximize co‐location of the care teams. The team requires a space where they can function as teams. Staff needs to be able to see each other, to frequently interact, share information, coordinate care, plan work, and hand‐off patients and tasks. They need to be able to see each other in an acoustically conducive space that supports concentration and conversation.

JJP VAMC West Plains, MO CBOC Agency Specific Requirements

(Rev: 07/30/2021)

The lease shall be full serviced and follow the standard specifications and requirements for a New/Replacing Lease as per the GSA Global Lease or Simplified Lease.

PROVISIONS:

GOVERNMENT PROVIDED

1) Courier Service

2) Hazardous Material Removal

3) Tenant Improvements to Buildings

LESSOR PROVIDED (as part of the fully serviced lease)

Recurring Utility Bills

1) Electrical Utility Service

2) Water Service

3) Heating Fuel / Natural Gas Utility Service

4) Trash Removal

5) Cable Television Service

6) Guest WiFi High Speed Internet

Life Safety and Security

1) A Fire Alarm and Intrusion System. Include a Dispatch Service and all Maintenance and Testing in accordance with NFPA

2) Security Service that transmits to a 24/7 security service

3) Security Alarm System and Monitoring

4) Duress alarms

Janitorial Services (reference the attached janitorial requirements)

1) Supplies (soaps, tissues, towels, toilet paper, etc.)

2) Wall‐mounted hand sanitizer units at a ratio of one (1) for every three (3) doors; to be maintained at all times in good working order and stocked with date‐compliant hand sanitizer

3) Special Disinfecting requirements – The Lessor shall routinely (not less than once daily) wipe down all solid, high contact surfaces in common and high traffic

4) Window washing and window washing supplies

Building & Grounds Maintenance and Repairs

1) Snow / Ice Pretreatment and Removal

2) Lawn and landscaping maintenance (including exterior trash pickup outside 5‐foot radius of exterior doors) performed weekly.

3) Heating system, and heating system maintenance and repair

4) Air conditioning, and air conditioning system maintenance and repair

5) Plumbing maintenance and repair

6) Electrical maintenance and repair

7) Replacement of exterior/interior light bulbs/lamps that are hardwired to the building power

8) Painting: scheduled paintings every 3 years with wall patching and touchups quarterly at no additional cost

9) Pest Control – sprayed at least quarterly

10) Lessor is responsible for moving and returning furniture for services as needed and must coordinate such with the Contracting Officer’s Representative (COR) or designee.

SPACE CRITERIA:

The Veteran’s Health Administration has determined that the Patient Align Care Team (PACT) concept will be implemented in the all future Outpatient VA Clinic leases. Essentially the process is for the patient to arrive and be seen by care givers in a manner where the care givers come to the patient.

Functions such as blood draw, nutrition/dietary advice, and pharmaceuticals will now come to the patient rather than the patient going to separate offices. Additionally, care givers will no longer have private areas, but sit in communal areas with system furniture.

The guidance for how facilities are to be created and how they will function can be found at the below internet location. It should be noted that not all of the functions identified in the PACT Guidance will be used for this specific lease.

Unless Annotated below, room finishes, equipment, furniture, door hardware and wall mounted items for each Room Code can be found at the following internet location:

http://www.cfm.va.gov/til/room/RoomFinishes.pdf

Room / area specification requirements can be found in the Room Specification Requirements Document.

ROOM REQUIREMENTS:

VESTIBULE

1) Vestibules with an air curtain shall be provided at public entrances and exits. In the event of negative air pressure conditions, provisions shall be made for equalizing air pressure.

2) Vestibule shall be ADA compliant. Vestibule (air lock) must have 2 sets of doors separated by at least

8 feet. One door in each set must have an automatic door opener.

3) The Lessor shall provide permanent entryway systems (such as grilles or grates) to control dirt and particulates from entering the Building at all primary exterior entryways.

RECEPTION / WAITING AREA

1) Four (4) quad electrical outlets, location as determined by VA.

2) Two (2) sets OIT ports minimum, Cat 6, location as determined by the VA.

3) Additional OIT ports as required to support ancillary equipment; location as determined by VA

4) Minimum 5 (five) foot width x 24 (twenty‐four) inch depth worksurface/counter per Reception employee additional 11 (eleven) inch depth to provide surface for client/patient

5) Each desk space shall be divided by acoustical partitions

6) Reception space design must consider and allow for “sit to stand” desk accommodations

7) Consider frosted glass as needed in designs to protect patient health information from public view

8) 6 workstations for patient check‐in & out – workstations must have space for under desk file cabinets

9) Direct view of waiting area and entrance

10) Duress alarm

11) Restricted access or lockable door from the receptionist work area into the clinic area – may require double sided lock

12) Restricted access from the waiting area into the clinic area

13) Support for wall mounted TV Brackets, locations will be determined by VA

14) Upper data port and separate electric outlet for wall mounted TV, locations will be determined by

VA

15) One (1) dimmer light switch

16) Double coat hooks on walls behind doors

17) Drinking fountain with bottle filling station

18) Flooring shall be per VA’s selection.

PHOTOCOPY / FAX, MAIL & STORAGE AREA

1) Accommodates 1 workstation

2) Built in upper cabinetry for supply storage

3) Space for Fax/Printer Multi‐Functional Device

CORRIDOR

1) Alcove built off front (toward waiting room) patient corridor to accommodate standing/wheelchair patient scale

2) Additional square footage nook built off the back corridor to host a clinic wide shared printer

3) Non‐ligature flat PVC patient handrails ADA compliant 34‐38” above floor surface with return to the wall at the end of the handrails

4) Patient corridors must be 6 feet in clear width

LABORATORY

1) To be off the reception area for a shared waiting room space

2) Restroom within laboratory

3) Requires pass through to 2 restrooms one within lab and one restroom adjacent to the lab for specimens

4) Counter mounted swing away eyewash station

5) Shelf for specimen cup beside toilet in restroom adjacent to lab

6) Upper and lower built in cabinetry

7) Cabinetry built in design for undercounter refrigerator and freezer

8) Space for growth to eventually accommodate 2 lab draw chairs and 2 technician workstations

9) Duress alarm

RESTROOMS (UNISEX)

1) Door, hardware, lavatory, mirror, and other accessories shall be accessible and designed for wheelchair access as per the ADAAG

2) Restroom doors should open in but should be equipped with doors and hardware that will permit emergency access (without use of a key, Allen key, or special device) from the outside in a manner that will negate the need to push against a patient who may have collapsed in the restroom

3) Minimum one (1) accessible wall hung water closet and wall hung lavatory or as required by the International Plumbing & Building Codes

4) Grab bars: For water closet

5) Toilet paper dispenser

6) Lavatory: Wall Hung with automatic sensors, gooseneck spout with plain outlet. At VA's option power operated automatic sensors may be required.

7) Mirror: Minimum over lavatory, 24"x 36"

8) Built‐in waste receptacle and paper towel dispenser

9) Wall mounted soap dispenser

10) Double coat hooks on walls behind doors

11) Wall‐mounted baby changing station

12) One (1) GFCI electrical outlet

13) Pull cord alarm with a location alert to MSA staff at reception area

14) Flooring shall be per VA’s selection.

WEIGHING STATION ALCOVES

1) (1) Weighing station alcove 5’ foot deep to accommodate a wheelchair scale up to 45” by 45” with clearance for rolling on and off the ramp

2) (1) Weighing station alcove to accommodate a standing patient scale with rails 22” by 60”

GROUP / CONFERENCE ROOMS

1) STC 50 requirements for partitions and sound gasketing and sweeps for the doors

2) Eight (8) duplex Electrical outlets

3) Three (3) sets OIT ports, Cat 6

4) One (1) additional OIT port located by COR for conference call system (Possible location: Floor center of room)

5) Support for wall mounted TV Bracket, locations will be determined by VA

6) Upper data port and separate electric outlet for wall mounted TV, locations will be determined by

VA

7) Duress Alarm

8) One (1) Dimmer light switch

9) Flooring shall be per VA’s selection

10) Closet storage

PHYSICAL THERAPY / WHOLE HEALTH ROOM

1) STC 50 requirements for partitions. Door cores must have a minimum STC of 35 with sound gasketing and acoustic door bottom seals to achieve a NIC of 39 at 3’

2) Eight (8) duplex electrical outlets – two (2) per wall

3) Three (3) sets OIT ports, Cat 6, location as determined by VA

4) Outlets and ports at heights determined by VA to accommodate wall mounted otoscope, vital machine, wall mounted computer station, wall mounted phone

5) Ceiling must be 10’ height

6) PT workroom adjacent to the PT room with views and sound access

RADIOLOGY ROOMS

1) STC 50 requirements for partitions. Door cores must have a minimum STC of 35 with sound gasketing and acoustic door bottom seals to achieve a NIC of 39 at 3’

2) Two (2) sets OIT ports, Cat 6, location as determined by VA

3) Outlets and ports at heights determined by VA to accommodate wall mounted otoscope, vital machine, wall mounted computer station, wall mounted phone

4) Double coat hooks on walls behind doors

5) Door window glass panels shall be frosted for privacy (or other method of privacy as accepted by

CO)

6) Duress Alarm

7) Wall‐mounted sink needs to have a cabinet on wall above it. The sink casework must not have storage below it or designed in a way where items could be stored and become damaged by a plumbing leak or moist environment. Sink casework requires drawers. Location of sink as determined by VA.

8) Wall mounted soap and paper towel dispenser need to be at sink

9) One (1) Dimmer light switch

10) Two (2) 20‐amp electrical outlet. One near provider area.

11) Ceiling mounted healthcare standard cubicle curtain track around perimeter of door swing from wall to adjacent wall, inclusive of hooks to support quantity of cubicle curtains required for patient privacy. Cubicle curtains to be provided and maintained by VA.

12) Walls shall have internal structural bracing to support modular wall‐mounted exam room casework and armature that supports PC, location to be determined by VA

13) Each room shall have a sliding door

14) Design of the space application must follow the VA Design Guides found in the VA Technical

Information Library, www.cfm.va.gov/TIL

15) Flooring shall be per VA’s selection

EXAMINIATION / PROCEDURE / CONSULTATION ROOM

16) STC 50 requirements for partitions. Door cores must have a minimum STC of 35 with sound gasketing and acoustic door bottom seals to achieve a NIC of 39 at 3’

17) Eight (8) duplex electrical outlets – two (2) per wall

18) Two (2) sets OIT ports, Cat 6, location as determined by VA

19) Outlets and ports at heights determined by VA to accommodate wall mounted otoscope, vital machine, wall mounted computer station, wall mounted phone

20) Double coat hooks on walls behind doors

21) Door window glass panels shall be frosted for privacy (or other method of privacy as accepted by

CO)

22) Duress Alarm

23) Wall‐mounted sink needs to have a cabinet on wall above it. The sink casework must not have storage below it or designed in a way where items could be stored and become damaged by a plumbing leak or moist environment. Sink casework requires drawers. Location of sink as determined by VA.

24) Wall mounted soap and paper towel dispenser need to be at sink

25) One (1) Dimmer light switch

26) Two (2) 20‐amp electrical outlet. One near exam table for BP, table, etc., the other near provider area.

27) Ceiling mounted healthcare standard cubicle curtain track around perimeter of door swing from wall to adjacent wall, inclusive of hooks to support quantity of cubicle curtains required for patient privacy. Cubicle curtains to be provided and maintained by VA.

28) Walls shall have internal structural bracing to support modular wall‐mounted exam room casework and armature that supports PC, location to be determined by VA

29) Each room shall have 2 entrance/exit, each with a sliding door

30) Exam tables shall not face the door

31) Flooring shall be per VA’s selection

PACT TEAM ROOMS

1) Must have solid plan to minimize acoustics – very important

2) Sound absorbing wood grain acoustic panels with aesthetic design may be wall or ceiling mounted

3) STC 50 requirements for partitions and sound gasketing and sweeps for the doors

4) Eight (8) duplex electrical outlets – two (2) per employee, location as determined by VA

5) Two (2) sets OIT ports per employee, Cat 6, location as determined by VA

6) No less than two (2) sets of double coat hooks on walls behind doors

7) Door window glass panels shall be frosted for privacy (or other method of privacy as accepted by

COR)

8) Duress Alarm

9) One (1) Dimmer light switch

10) One (1) 20‐amp electrical outlet

11) Flooring shall be per VA’s selection

EMPLOYEE BREAK ROOM

1) All perimeter walls shall extend from floor slab to six inches above the ceiling grid and filled with acoustic panels to ensure acoustical privacy

2) Four (4) GFCI Electrical outlets and one 20‐amp refrigerator outlet (not GFCI)

3) Two (2) sets OIT ports, Cat 6, location as determined by VA

4) Minimum of six (6) feet of counter with base and overhead cabinets; single compartment sink

5) Cabinetry built in to accommodate full size refrigerator which is lessor provided

6) Lockers to be provided by lessor

7) Flooring per VA’s selection

HOUSEKEEPING / JANATORIAL CLOSET

1) Required if lessor does not have housekeeping closet on site with onsite management

2) Mop Sink

3) Four (4) GFCI Electrical outlets

4) Adjustable shelving on two walls

5) Flooring per VA’s selection

6) Must be accessible by VA staff

SUPPLY / STORAGE ROOMS

1) Four (4) Electrical outlets

2) One (1) set OIT ports, Cat 6

3) Adjustable shelving on two walls of each storage room ‐ 3 shelves per wall with a depth of 15” and space for a roll‐in prosthetics supply cabinet

4) Requires both a keypad and keyed lock

5) Flooring per VA’s selection

6) Separate temperature and humidity control with relative humidity <70% and temperature control of

64‐76 degrees Fahrenheit

7) No windows permitted

MEDICATION STORAGE ROOM

1) Four (4) Electrical outlets

2) Two (2) set OIT ports, Cat 6

3) Flooring per VA’s selection

4) One wall to have cabinets, the other wall with side by side Pyxis, Pyxis Tower/Cabinet

(31Wx28Dx79.5H), and Medication Refrigerator

5) Equipment alcove with electrical outlet

6) Temperature and humidity control with additional capacity for AC (cooling) – see HVAC requirements ‐ relative humidity <60% and temperature control of 68‐76 degrees Fahrenheit

7) Facility requires backup generator or power specifically to support and maintain medication room temperature parameters and medication room vaccine refrigerator during a power outage

8) No windows permitted

OTHER CONSIDERATIONS

1) Centralized check‐in/check‐out

2) The reception area is to be strategically located to give the office manager and/or team leader clear observation of waiting areas

3) Each workspace without an exterior window, shall have glass pane adjacent to door frame, in the door, or in the office with shades for secure view of visitors (or other privacy mechanism as approved by COR)

4) Signage outside building provided by the Lessor, according to VA specifications and meets City Ordinances

5) All rooms (except Data Closet) should be master keyed, locking mechanism should be on the inside of the frame, and locking mechanism must be approved by the VA.

6) Facilities shall be non‐smoking

7) The VA requires two walls with a series of exterior windows, maximizing the amount of natural light, unless waived by the Leasing Contracting Officer (LCO)

8) Outdoor bench for Veteran seating to be provided by lessor

9) Facility requires backup generator or power to support the following during a power outage:

a) Medication room temperature and humidity control

b) Medication room vaccine refrigerator

c) Supply room temperature and humidity control

d) Laboratory room refrigerators and freezers

e) Data closet HVAC system, switches, and servers

GENERAL TECHNICAL REQUIREMENTS:

ACCESSIBILITY

Facility must be in full compliance with Americans with Disabilities Act (ADA) Guidelines, including building, building access, and parking. Accessibility for new construction: to be considered for award, building to be constructed must fully meet the new construction requirements of the Americans with Disabilities Act Accessibility Guide (ADAAG) (36 CFR Par 36, App. A), the Uniform Federal Accessibility Standards (UFAS) and Department of Veterans Affairs Barrier Free Design Guide (PG‐18‐13, 11/1/18).

The VA Barrier Free Design Guide can be found at the following link:

https://www.cfm.va.gov/til/etc/dsBarrFree.pdf

All doors to patient accessible areas shall be 48” minimum width. Where standards conflict, the more stringent shall apply.

CODES

Structure shall be in compliance with local, national, and the International Building Code, and all applicable current NFPA Fire and Life Safety codes. Where codes conflict, the more stringent shall apply.

1) The Lessor shall develop and submit a design that is clearly defined, meets the overall solution for the primary VA Clinic construction project. The design shall be in accordance with the Criteria For Design And Project Development, General Requirements and address the technical requirements, and new construction.

2) The Lessor shall meet with the Contracting Officer’s Representative (COR) prior to start of design to determine detailed requirements of work involved GOVERNMENT‐FURNISHED DESIGN CRITERIA.

3) The Lessor shall design the space to conform to the requirements of the following VA documents, in preparing the design specified in this work order amendment. These documents can be found at the following website: http://www.cfm.va.gov/til/spec.asp CRITERIA FOR DESIGN AND PROJECT DEVELOPMENT (as applicable to project). Other design criteria may be required to meet specific requirements of the design work scope that are not listed above, or are not available on the VA Office of Facilities web site. Design shall be in accordance with applicable federal, state, and local codes. The Lessor is responsible for obtaining and complying with all such criteria.

CONSTRUCTION STANDARDS AND SHELL COMPONENTS:

Design must also support creation of flexible use space and standardization that will permit ease of alteration as the mission and operational requirements of the facility changes.

Design of the space must follow VA Design Guides found in the VA Technical Information Library, www.cfm.va.gov/TIL. This includes, but is not limited to, all Design Criteria, Leasing Criteria, BIM/CAD standards, and other information for use and inclusion in the design and construction of this leased space.

BUILDING COMMISSIONING

Lessor will contract with an independent 3rd party commissioning agent (“Commissioning Agent”) to perform Acceptance and Testing Phase Commissioning in accordance with Chapter 8 of the VA’s Whole

Building Commissioning Process Manual dated May 1, 2013 (https://www.cfm.va.gov/til/Cx‐

RCx/CxManual.PDF). Systems requiring commissioning include Fire Suppression, Plumbing, HVAC, Electrical, Communications, Electronic Safety and Security, and Integrated Systems Tests as further described in Chapter 3. The cost of the Commissioning shall be paid by the lessor and included in the build out cost.

BUILDING DIMENSIONS

Area of building must be roughly rectangular in shape and must not be more than 3 times longer than its width.

FLOORS

All areas, waiting area, reception area, vestibule, exam rooms and other rooms with sinks shall be vinyl tile or equivalent. VA is to select color. Please refer to VA Design Guides found in the VA Technical Information Library, www.cfm.va.gov/TIL

SIZES

All room square feet listed are minimums. The facility may have up to 30% larger rooms or 15% additional rooms. Rooms other than storage rooms and corridors may not be over 3 times longer than they are wide.

WALLS

The Lessor shall provide sound dampening insulation inside all interior walls. Walls shall extend from floor slab to six inches above the ceiling grid and filled with acoustic panels to ensure acoustical privacy

See Privacy & Acoustical Requirements.

WALL FINISHES

Wall coverings shall be washable paint. VA to select colors. Scheduled paintings every 3 years with wall patching and touchups quarterly at no additional cost. Lessor shall be responsible for moving and returning of furniture to allow wall repair and painting and will be responsible for wall repair/repainting as needed during the lifetime of the rental agreement. Painting/repair work shall be done after hours and must be odor free when open for business. Perimeters of rooms must have rubber or vinyl cove base. All walls shall be finished, no exposed ductwork, conduit or piping. Corners shall also be protected with appropriate wall‐guard materials.

PAINTING

Prior to acceptance, all surfaces within the Space which are designated by VA for painting shall be newly finished in colors acceptable to the Government. Painted walls shall be washable semi‐gloss; ceilings shall be flat paint finish. All other painted surfaces shall be washable semi‐gloss.

The Lessor shall provide interior paints, primers, coatings, stains, and sealers that meet or are equivalent to the Green Seal GS‐11 standard that incorporates environmental, health, and performance criteria.

The Lessor shall use reprocessed latex paint in accordance with EPA’s CPG (Comprehensive Procurement Guidelines) on all painted surfaces where feasible. The type of paint shall be acceptable to the Government.

FLOORING

Waiting area, Conference Room, Team offices, and Reception area flooring shall be per VA selection and may be LVT/LVP, or linoleum plank tile. Breakroom, restroom flooring and wainscoting shall be ceramic/porcelain tile, large format is preferable on the floor, surface must meet or exceed 0.42 DCOF wet. Corridors, Group rooms, Multipurpose room, Exam/Procedure/Consultation rooms shall be per VA selection and may be LVT/LVP or linoleum plank tile. Vestibule flooring needs to be a modular walk‐off tile product. MDF room shall have static dissipative tile. VA to select color. All flooring must meet Class 1 fire/smoke resistance requirements as per code. All flooring shall be occupancy‐ready from the factory. Flooring materials shall be free of asbestos containing materials.

COVE BASE

Cove base may be either vinyl or rubber. It needs to be standard toe. Cove base height in Exam/Procedure/Consultation rooms should be 6”, all other rooms and corridors should be 4” height.

Continuous roll is preferable. Color to be determined by VA.

CEILING FINISH

Ceilings may be sheetrock or non‐textured washable lay in tile with a Class A fire performance rating and an NRC of between 0.70 and 0.80. Lessor to replace any wet, cut, or damaged ceiling tiles or sheetrock as damage occurs. Complete ceiling tiles to be replaced and metal grid replaced or repainted every 10 years.

LIGHTING

Fixture location shall be coordinated with the furniture and cubicle curtain track layout so they do not interfere with the lighting.

ASBESTOS / ENVIRONMENTAL HAZARDS

Existing buildings must be asbestos, mold and lead free.

ENERGY CONSERVATION

The windows must be double glazed, and the walls and roofs must be insulated. Entire facility, including doors and windows must be weather tight. Building insulation and HVAC system must meet DOE recommendations for this region.

SECURITY

The leased property shall conform to VA’s Physical Security and Resiliency Requirements Design Manual for //Life Safety Protected Facilities//Mission Critical Facilities// VA Technical Information Library, www.cfm.va.gov/TIL. The required Intrusion Detection System (IDS), and Video Assessment and Surveillance System (VASS) shall be compliant for use on VA’s OI&T secure network and compatible with the VASTLHCS’s current security infrastructure provider. The Lessor shall consult with VASTLHCS’s security infrastructure provider (PASS Security) for compatibility of any IDS or VASS components. The costs associated with connecting the IDS and VASS to the VA’s secure network shall be borne by the Lessor.

DOORS

Minimum door width is 36 inches. Half of the exam room doors must have a minimum of 42 inches.

Doors shall be 1‐3/4” solid core wood. Exterior entrance door shall be a minimum of 48 inches.

Automatic door openers are required at the main entrance of the clinic and waiting room bathrooms for handicap accessibility. Doors to the clinic area shall be push pad operated on the clinic side and numerical combination operated on the waiting room side. Exterior doors with removable hinge pins will be retained with set pins or spot welded. A locked door will be required from the main waiting room to access the clinic areas. VA will assign locations of doors after award of contract. Patient access doors on the exam rooms may be sliding but must be sealable and must have a soft close dampening system for noise and slam reduction. All airspaces around the doors shall be sealed for soundproofing and privacy. STC 50 requirements for partitions. Door cores must have a minimum STC of 35 with sound gasketing and acoustic door bottom seals to achieve a NIC of 39 at 3’. See Acoustical Requirements

DOOR HARDWARE

Doors shall have door handles or door pulls with heavyweight hinges. All doors shall have corresponding doorstops (wall or floor mounted) and silencers. All public use doors and toilet room doors shall be equipped with 34 inch height door protection plates. Exterior doors and all common area doors shall have automatic door closers. All building exterior doors shall have locking devices shall be panic type devices. All hardware shall provide unrestricted egress and be capable of restricting access from the exterior. Properly rated and labeled fire door assemblies shall be installed on all fire egress doors.

Doors shall have door handles or door pulls with heavyweight hinges. The Lessor is encouraged to avoid the use of chrome‐plated hardware. All doors shall have corresponding doorstops (wall‐ or floor‐ mounted) and silencers. Doors designated by the Government shall be equipped with 7‐pin, tumbler cylinder locks and strike plates. All door entrances leading into the government‐demised area from public corridors and exterior doors shall have automatic door closers. All locks shall be master keyed.

Furnish at least two master keys for each lock to the government. Any exterior entrance shall have a high security lock, with appropriate key control procedures, as determined by government specifications. Hinge pins and hasps shall be secured against unauthorized removal by using spot welds or peened mounting bolts. The exterior side of the door shall have a lock guard or astragal to prevent jimmying of the latch hardware. Doors used for egress only shall not have any operable exterior hardware. All security‐locking arrangements on doors used for egress shall comply with requirements of

NFPA 101.

Patient restroom doors: Should open in but should be equipped with doors and hardware that will permit emergency access (without use of a key, Allen key, or special device) from the outside in a manner that will negate the need to push against a patient who may have collapsed in the restroom

Telecommunication closet(s) doors: Suite entry door and all other doors connecting the government space with the rest of the building, shall be equipped with 7‐pin Interchangeable Cores and strike plates to be operated by card readers.

LOCKS

All doors must be equipped with cylinder lock locking hardware and master keyed to match existing VA “Best” brand, 7 pin locking system. Single motion egress mortise style locks are required on the Data Closet and Medication Room doors. Egress doors must be equipped with panic hardware and meet NFPA requirements for exit. Toilets are to be equipped with privacy locks that can be unlocked in emergency with a coin from outside. The Lessor will be responsible for providing and installing an automatic locking system with a keypad entry to be used on the door from the waiting room to access the clinic area. The Lessor/Owner shall provide all hardware to include the interchangeable cores. The Lessor shall be responsible for the cost of the cores. The Lessor/Owner shall provide a door schedule submittal for VA approval. The key numbering convention will be agreed upon during the design phase.

VA uses “Best” locks SFIC 7 pin cores with a “K keyway”

Three master keys will be provided to the government. An exception to the building entrance will be made when the VA is not sole building tenant. The entire space will be keyed the same with the exception of the following spaces: Electrical Closet, OI&T Closet, Janitorial Closet, Storage/Supply Closets, Medication Storage Room, Mechanical Space

INTERIOR SIGNAGE

All rooms must be equipped with solid plastic identification signs with room function and room number.

Toilet rooms/Restrooms that include Baby Changing Stations must include the appropriate identification on the signage. Restrooms not designated as containing Diaper Changing Tables, signage shall be placed to indicate to users where the nearest available diaper changing table can be accessed. Signage shall be posted outside the restroom, near the restroom entrance and conspicuously within the restroom. Lessor to provide overhead directional signage to Lab, restrooms, clinics, and Behavioral Medicine. Emergency egress signage meeting Life Safety code and The Joint Commission (TJC) is required. All signage must be ADA compliant and comply with VA standards. Please refer to VA Design Guides found in the VA Technical Information Library, www.cfm.va.gov/TIL

PRIVACY

Aural privacy is required between rooms and between rooms and corridor so that private patient information may be discussed without being overheard. For sound privacy, walls of exam/procedure rooms, Team Offices, Mental Health, telemedicine, group and Multipurpose/conference rooms must go from deck to deck and be sound insulated with an approved acoustical insulation. All doors must be solid core and include mechanical door bottom seals where necessary. There is to be a privacy door(s) between the clinical area and the waiting/reception area. Privacy curtain tracks at doors required in all exam rooms. Track to be provided by lessor and curtain by VA. See VHA Program Guide PG‐18‐3, Topic 11, Noise Transmission Control for further guidance.

ACOUSTICAL REQUIREMENTS

1) Reverberation Control. Ceilings in offices, conference rooms, and corridors having resilient flooring shall have an NRC of not less than 0.65.

2) Ambient Noise Control. Ambient noise from mechanical equipment shall not exceed noise criteria curve (NC) 35 in accordance with the ASHRAE Handbook of Fundamentals in offices and conference rooms; STC 50 in corridors, cafeterias, lobbies, and toilets; STC 50 in other spaces.

3) Noise Isolation. Rooms separated from adjacent spaces by ceiling high partitions (not including doors) shall not be less than the following noise isolation class (NIC) standards when tested in accordance with ASTM E 336:

a) Group Rooms STC 47‐50

b) Counseling Offices/Exam Rooms STC 50

4) The sound resistant enclosures (partitions, doors, duct system) of the spaces listed below shall be designed to suppress generated noise and provide a satisfactory degree of acoustical isolation for adjacent occupied spaces. A minimum Sound Transmission Class (STC) rating of 50 shall be achieved.

The required rating may be achieved through the use of construction such as a double layer of GWB on both sides or Quiet Rock product on both sides, slab/slab and/or ROXUL insulation for above ceiling.

5) Alternatively, a gypsum board ceiling or gypsum board lay‐in ceiling panels, both with sound attenuation blanket above the ceiling, shall be provided where ducts, pipes, etc., make it impractical to extend sound partitions to slabs or deck above. Where gypsum board ceilings with attenuation blankets are used, the double GWB partitions and sound attenuation blanket shall extend 6" above the ceiling. Studs shall continue to the floor above. Special attention shall be given to prevent possible flanking paths for noise transmission.

a) The sound resistant enclosures of the following spaces shall be designed to assure speech privacy and achieve an STC rating of 50.

b) Use sound gasketing around doors and door sweeps.

c) In the design of exterior building walls at sites near airports, freeways, or heavy city traffic, consideration shall be given for the control of noise transmission from external sources.

WINDOW TREATMENT

Windows need to be covered with solar window shades of no greater than 1% openness provided by the Lessor. Shades that utilize loop pull cords are not acceptable. Horizontal blinds are acceptable only as enclosed blinds integrated inside windows sealed between the glass. Draperies are not acceptable.

RESTROOMS

Please refer to VA Design Guides found in the VA Technical Information Library, www.cfm.va.gov/TIL Sinks shall be equipped with electronic liquid antimicrobial soap dispenser provided by the lessor.

A shelf and mirror provided by the lessor shall be installed above each sink. Each restroom shall have a toilet paper dispenser provided by the lessor installed within easy reach. Lessor shall provide all soap and paper products. A paper towel dispenser provided by the lessor shall be installed near the sink.

Each stall in the Women’s, Unisex and Family restrooms shall have a tampon/sanitary napkin disposal bin. Each women’s, unisex and family restroom shall have a non‐coin operated tampon/sanitary napkin dispenser. Lessor shall provide all feminine hygiene products. All bathrooms shall meet handicap accessibility codes and will include grab bars at commode. Metal partitions required at urinals and metal partitions with doors at commodes unless otherwise noted. All stalls shall be mounted from the ceiling/wall and not floor for infection prevention/cleaning purposes. Lessor to install baby changing station in public female, male and unisex patient/visitor restrooms.

CORRIDORS

Patient corridors must be 6 feet in clear width. Install healthcare grade non‐ligature handrail at ADAAG‐ specified height of 34‐38” above floor surface on both sides of all corridors to protect wall surfaces.

Must have return to the wall at the end of the handrails. Provide continuous reinforcing in the wall for attachment of chair/handrails and wall guards.

FIRE EXTINGUISHERS

Portable 10 lb. fire extinguishers will be provided, hung and maintained in accordance with the most recent addition of NFPA by the Lessor. Lessor is to install recessed fire extinguisher cabinets at appropriate locations to meet NFPA Lessor to provide and hang signage highlighting fire extinguisher location.

SPECIAL FIRE CODE

The storage rooms, laboratory room, mechanical rooms and housekeeping closets will be protected by one‐hour fire walls and doors.

WET AUTOMATIC FIRE SPRINKLERS

Building will have an NFPA compliant wet automatic sprinkler system. Building shall be fully sprinklered and contain all necessary fire alarm features.

COUNTERS

All counter tops shall be solid surface material (ex. Corian type) or quartz composite material, all exposed edges shall have a minimum 1/2” radius (top, bottom, and corners). No aprons are approved.

CASEWORK

Casework needs to be in Breakroom, Lab and Reception only and modular casework to go in the exam rooms. All casework vertical surfaces must be finished with high‐pressure laminate. No exposed substrate is acceptable. All exposed toe‐kicks to be the same vinyl or rubber cove base as the balance of the clinic. Casework in Reception shouldn’t include any storage but should be worksurface/countertop only, with the top surface at a height of no less than 29” above the finished floor. The reception casework should not have an apron. All countertop/worksurface should be either quartz composite or solid surface. All hardware must be ADA compliant.

CANOPIES

Entrance doors will be recessed 3 feet or a minimum of 6 ft by 6 ft rain canopies will be over each entrance door. Vestibule (air lock) must have 2 sets of doors separated by at least 8 feet. One door in each set must have an automatic door opener.

MAILBOX

Lessor to install a mailbox at the main entrance of the clinic. VA will assist in defining the location during design. Mailbox must lock.

SITE CONSIDERATIONS:

LOCATION

Facility must be highly visible and located in an area accessible to and from main thoroughfares.

PARKING

Adequate, safe lighted parking on site for regular vehicles and handicap vehicle parking spaces shall be provided, with one designated van drop off/loading area.

ACCESSIBLE PARKING

The accessible parking spaces must be immediately adjacent to the building, meeting local code but not exceeding a distance of 60 feet of entrance. Accessible spaces will be marked with signage by lessor.

Entrance to the clinic must be handicap accessible in accordance with ADA.

SITE TOPOGRAPHY

Site topography must not have pedestrian traffic grades exceeding 3% slope, 1 ft elevation change in 33 feet.

SITE / EXTERIOR SIGNAGE

Lessor must provide internally lighted sign with VA logo and words "Department of Veterans Affairs Clinic" on sign a minimum of 4 ft by 6 ft legible from main serving road. Sign shall be a minimum of 24 inches above finished grade. Please refer to VA Design Guides found in the VA Technical Information Library, www.cfm.va.gov/TIL

SIGNAGE AND WAYFINDING

A "wayfinding" process needs to be designed into every project. Veteran clients, visitors, and staff need to know where they are, what their destination is, how to get there, and how to return to their origination point. Identification, personalization of occupied spaces, and orientation are all to be addressed in the design. Wayfinding is to be thought of broadly as building elements, color, texture, and pattern cues, as well as a coordinated set‐up for separate contacted signage and artwork. Lessor shall provide interior signage for and 10 x 2 inch standard aluminum wall sign (holder) for slide in name plates. (VA will purchase name plates). Signage must state room number only. Room name or purpose must not be stated on sign.

SITE FLAGPOLE

A flagpole will be provided and installed by the Lessor at a location to be approved by the COR. The flagpole will be 25 foot (minimum height). Flagpole shall include adequate lighting to illuminate flag between dusk and dawn. Flagpole shall be protected from vehicular traffic. Lighting shall be controlled by a photocell device. The flag will be provided by the government.

SIDEWALKS

Accessible minimum 5‐foot‐wide sidewalks must be available from parking to entrance.

HEATED “NO‐FREEZE” SIDEWALKS

If new construction, Lessor/Owner will imbed heated snow melt wiring on sidewalk 20 feet out in all directions from main entrance and one designated main employee entrance.

RAMPS

Ramps with over 5% rise, 1:20 slope, must have metal handicap style handrails on both sides.

LANDSCAPING

If site topography permits, site will be equipped with bushes and trees. Outdoor bench for Veteran seating to be provided by lessor.

MARQUEE

Marquee will be required if the property is located within a mall‐type area. The Lessor will provide a lighted marquee. VA will provide design.

MAINTENANCE:

JANITORIAL SERVICES AND SUPPLIES

The Lessor is responsible for interior cleaning according to the attached schedule (See Janitorial Requirements Attachment). The Lessor is responsible for exterior cleaning and maintenance.

PEST CONTROL

The Lessor is responsible to exterminate insects, rodents, and other pests quarterly and when pests are detected in the leased property. Pest spraying must be done so as not to interfere with VA work. Due to sensitive nature of patients, spraying must be odorless and non‐irritating.

MAINTENANCE

Building equipment and maintenance requirements, interior and exterior, shall be met by the Lessor.

The Lessor must have a building superintendent or local designated representative to promptly correct deficiencies or attempt to correct safety deficiencies within 4 hours. Lessor’s representative shall be available via pager or cell phone for emergencies. Cosmetic and non‐emergent deficiencies must be corrected within two weeks. If no attempt is made to correct the deficiency within the required time frame, the cost of the repairs will be deducted from the next month's lease payment. The Lessor is responsible for the total maintenance of the leased property with the exceptions listed specifically in this document. Such maintenance includes but is not limited to electrical systems, light fixtures, mechanical systems, fire alarm, intercom/emergency call systems, exterior care for the building and the site, all sidewalks, parking areas, driveways, private access roads, lawns, shrubbery including all repairs and replacements. All equipment shall be maintained to provide reliable service without unusual interruption, disturbing noises, exposure to fire or safety hazards, unusual emissions of dirt. All maintenance will be done with applicable codes and manufacturer recommendations.

The Lessor will provide all labor and materials and supervision to adequately maintain the structure, roof, necessary building appurtenances to provide watertight integrity, structural soundness and acceptable appearance. All work done by the Lessor will be coordinated with the VA Contracting

Officers Representative (COR).

SNOW AND ICE REMOVAL

Lessor shall provide snow/ice removal services for the government on all days for which this leased property is in operation. Lessor shall clear parking lots if the accumulation of snow exceeds two inches.

Lessor shall clear sidewalks, walkways and other entrances before accumulation exceeds 1.5 inches. The snow removal shall occur no later than 6:30 AM, without exception. Should snow accumulation continue throughout the day, the Lessor shall provide such additional removal services to prevent accumulation greater than the maximums specified in this paragraph. In addition to snow removal, the Lessor shall keep walkways, sidewalks and parking lots free of ice during the normal hours. Preventative salting shall occur as to stop any ice from surface accumulation. The Lessor shall remove excess buildup of sand and/or ice melt to minimize slipping hazards. Building waiting rooms must be mopped If the building entrance(s) has a northern exposure, then Lessor shall take additional measures to protect the safety of pedestrians.

EXTERIOR MAINTENANCE

Lessor is responsible for removing weeds from around building, parking areas and sidewalks. The Lessor is responsible for mowing, edging, trimming landscaping and watering lawns as well as leaf raking and removal.

PARKING LOT

Lessor shall re‐seal parking lot and re‐paint parking space lines as damaged. Entire lot to be resealed and painted every three years.

PLUMBING PROBLEMS

Drain problems that can be solved by simple application of a plunger will be handled by VA Staff. Drain problems that cannot be solved by simple application of a plunger or require repeated applications will be solved by the Lessor. All other plumbing problems are the responsibility of the Lessor and will be addressed within 24 hours of notification to Lessor’s representative.

UTILITIES:

EMERGENCY POWER:

Facility requires backup generator or power to support the following during a power outage:

Medication room temperature and humidity control

Medication room vaccine refrigerator

Supply room temperature and humidity control

Laboratory room refrigerators and freezers

Data closet HVAC system, switches, and servers

CABLE TELEVISION

Lessor shall provide empty 2x4 boxes for cable TV audio/video wall jack for connection to a VA furnished television in the reception area (2 locations) and staff break room, locations to be determined by VA. A 120‐volt duplex electrical outlet will be located adjacent to the cable box outlet. The Lessor shall provide duplex outlet, empty cable box and cable route access. Lessor will provide and pay for basic cable.

MESSAGE BOARD

Lessor shall provide a 120V power and a data outlet for the message board. Outlet shall be located 6” below the finished ceiling at a location identified during the design phase.

EMERGENCY CALL SYSTEM

An emergency call system from each toilet to the reception area will be provided. A call light will be installed above the door to each of these rooms. The call system in the toilet will include a vinyl pull cord extending from 30 inches above floor to within 6 inches of the floor at the water closet.

SINKS

The lessor shall provide and install wall‐mounted soap dispenser and paper towel dispenser for each sink.

PLUMBING

In addition to the rooms with sinks noted in page one (1) of this SOW, all other rooms will be plumbed for future expansion or alteration.

STAFF CONFERENCE / BREAK / MEETING / STAFF EDUCATION ROOM UTILITIES

This room will be equipped with a small kitchen‐type sink, counter with over and under storage cabinets along with counter space for a microwave (microwave can be within the cabinet space design) and floor space for a freestanding refrigerator. The microwave and refrigerator will be provided by the VA. All casework below sinks must be closed off per design manual. Lessor to provide Power/data above ceiling for projector.

EMERGENCY LIGHTING

Must have adequate power failure lighting in corridors and waiting room. Lessor responsible to maintain function of emergency lighting including bulbs, batteries, and all other parts. Lights will be periodically tested by VA. Lights will have dual power source (normal power and battery back‐up) and automatic activation to illuminate egress route. Employ and maintain an automatic emergency lighting that activates in the event of power outage or disruption, and that covers emergency exits and evacuation routes within the vicinity of the telecommunications wiring closet.

LIGHTING

All interior and exterior lighting shall be LED lighting. Lessor shall be responsible for replacing failed fixtures, drivers, or other parts on interior and exterior LED fixtures. Lighting requirements such as room foot candles and color rendering index shall follow the VA lighting design guide except for the lighting temperature. All LED lighting temperatures will be 4000 K unless VA agrees to change the temperature in a specific area. Lighting shall be controlled with occupancy/vacancy sensor(s) with a manual switch override. Lighting in all areas shall be dimmable. Building entrances and parking lot to be lighted with high efficiency exterior LED lighting. Lighting design guide website https://www.cfm.va.gov/til/dManual.asp.

Lessor responsible for replacing failed fixtures, ballasts, or other parts. Lessor to replace lamps on interior lights. Lessor to provide and replace lamps on exterior lights.

DRINKING FOUNTAINS

An accessible public refrigerated, wall hung drinking fountain with bottle filling station will be provided in the waiting room or adjacent to the waiting room but not in the corridor.

HEATING, VENTILATION AND AIR CONDITIONING

The heating, air conditioning and ventilating systems shall meet city, state and national codes and be designed to ASHRAE minimum recommendations. The repair and maintenance of the HVAC system including replacement/cleaning of filters according to manufacturer recommendations shall be maintained by the lessor.