Exhibit B Agency Specific Requirements 1-29-25.pdf

NORTH SAN ANTONIO VA CLINIC INITIAL LEASE

1. SPACE CRITERIA/ QUALITY OF SPACE

a. See “Program for Design” for Space Lease attached to requirements.

b. Also refer to VA Leased CBOC Design Narrative (latest edition) – Small Lease – 02C – Appendix A.2 (see attached) – may be found using link: Community Based Outpatient Clinic Lease Templates | Healthcare Environment and Facilities Programs (va.gov)

c. The tenant improvement design and construction shall be executed in strict accordance with the latest editions of Veterans Health Administration (VHA) A/E Minimum Submission Requirements, Design Guides/Manuals, VHA Master Construction Specifications, International Building Code (IBC), International Mechanical and Plumbing Codes, and all applicable National Fire Protection Agency (NFPA) regulations, including NFPA 101 Life Safety Code.

d. The Program for Design dated December 09, 2023 estimates the need for a max ABOA of 16,044 SF and a Not to Exceed rentable SF of 14,586 for North San Antonio Primary/Specialty Care/Ancillary/Mental Health. The leased facility will be broadly based on but not limited to the following space utilization requirements: (Please see Program for Design dated December 09, 2023 for detailed information. The design program shall supersede the following broad descriptions.) Preliminary parking calculations indicate a need for 73 parking spaces and 5 dedicated handicap spaces..

e. Plan to minimize walking distances for patients from building main entrance to clinical destination and from clinical waiting area to clinical exam or treatment space.

f. To create flexibility, provide patient care space to handle the widest range of patient visits, reduce, to the extent possible, the amount of space customized for a single patient visit type.

g. Co-locate groups of exam and office / workspaces so other service teams can use rooms, as the demand fluctuates.

h. Create clinic modules with connecting corridors to allow internal circulation of patients and staff;

avoid crossing public circulation patterns to the greatest extent possible.

i. Design corridors a minimum of six (6) feet in width, to accommodate passage of two (2) wheelchairs.

2. REFERENCES

a. All room requirements are excerpts from the graphical design guides on the VA Office of

Construction and Facilities Management Technical Information Library (TIL) located at:

i. http://www.cfm.va.gov/til

b. NOTE: Applicable TIL standards will be upheld unless noted otherwise in this document. Shall follow using the latest editions.

i. Additional references available on the TIL that should be considered/consulted for requirements include, but are not limited to, the following:

ii. Design Criteria

1. Patient Aligned Care Team (PACT)

2. Office of Information and Technology

3. Architectural Accessibility, Barrier Free Design

4. Design Guides (PG-18-12)

5. Design Manuals (PG-18-10)

6. Physical Security Design Manual

a. *Applicable sections only, VA Leased Facilities shall comply with the Interagency Security Committee (ISC) Risk Management Process.

7. ISC Standards

EXHIBIT B - AGENCY SPECIFIC REQUIREMENTS

http://vaww.hefp.va.gov/sites/default/files/files/2023-10/Small%20Lease%20-%2002C%20-%20Appendix%20A.2%20-%20Lease%20Design%20Narrative%20%28LDN%29_0.docx http://vaww.hefp.va.gov/sites/default/files/files/2023-10/Small%20Lease%20-%2002C%20-%20Appendix%20A.2%20-%20Lease%20Design%20Narrative%20%28LDN%29_0.docx http://vaww.hefp.va.gov/sites/default/files/files/2023-10/Small%20Lease%20-%2002C%20-%20Appendix%20A.2%20-%20Lease%20Design%20Narrative%20%28LDN%29_0.docx http://www.cfm.va.gov/til

EXHIBIT A AGENCY SPECIFIC REQUIREMENTS

8. Commissioning Process

9. Signage and Wayfinding

10. Standard Details

11. PG18-1 Master Construction Specifications

12. PG18-3 Design and Construction Procedures

13. PG18-4 Standard Details and CAD Standards

14. PG18-10 Architectural Design Manual

15. PG18-13 Barrier Free Design Standard

16. PG18-14 Room Finishes, Door, and Hardware Schedule

17. International Building Codes: latest edition

a. International Building Code latest edition

b. International Energy Code latest edition

c. International Mechanical Code latest edition

d. International Plumbing Code latest edition

18. State and Local codes as required by the local Authority Having Jurisdiction (AHJ)

19. FGI Guidelines

20. Badging – HSPD-12

21. The Joint Commission – TJC (also see attached TJC file)

a. The Joint Commission | Healthcare Environment and Facilities Programs (va.gov)

b. Most recent TJC Checklist:

i. 2019 All Accreditation Programs Organization

SAG (va.gov)

3. OTHER REQUIREMENTS:

a. THE LESSOR WILL PROVIDE AT THE LESSOR’s SOLE COST AND EXPENSE:

i. Snow/ice removal between 5 am and 6 pm M-F and occasional weekends as designated by the lessee

ii. Heating system, and heating system maintenance and repair.

iii. Window washing and window washing supplies (windows to be washed inside and out by lessor every 6 months)

iv. Lawn and landscaping maintenance

v. Replacement of exterior/interior light bulbs/lamps that are hardwired to the building power

vi. Plumbing maintenance and repair

vii. Air conditioning, and air conditioning system maintenance and repair

viii. Electrical maintenance

ix. Carpet cleaning once every 6 months.

x. Painting

xi. Electrical Utility Service

xii. Water Service

xiii. Heating Fuel / Natural Gas Service

xiv. Trash removal (including exterior trash pickup)

xv. Cable Television

xvi. Janitorial service and janitorial supplies (including exterior trash pickup)

xvii. Supplies (soaps, hand lotions, cleaning chemicals, germicidal disinfectants, tissues, and towels)-must meet specified criteria outlined by the VA

xviii. Pest Control

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

xx. Two Communication Phone Lines for IT

xxi. Interior and External Signage

4. ARCHITECTURAL: Primary Care facility based on Program for Design.

a. FLOORS: Space shall be all on one level with direct parking lot access. Entrance shall be handicap accessible.

http://vaww.hefp.va.gov/topics/joint-commission http://vaww.hefp.va.gov/topics/joint-commission http://vaww.hefp.va.gov/sites/default/files/files/2021-08/Life%20Safety%20and%20Environment%20of%20Care%20-%20Document%20List%20and%20Review%20Tool%206-21%20%28R1%29.pdf http://vaww.hefp.va.gov/sites/default/files/files/2021-08/Life%20Safety%20and%20Environment%20of%20Care%20-%20Document%20List%20and%20Review%20Tool%206-21%20%28R1%29.pdf

b. 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.

c. The Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities, latest edition, shall be used as the primary standard for design and construction of VA leased facilities.

d. VA leased facilties are required to incorporate all applicable Joint Commission requirements.

e. The design and construction shall follow all State and local building codes and regulations.

f. WALL FINISHES: Wall coverings shall be washable PVC free vinyl wainscoting in corridors and washable paint elsewhere. Lessor shall repaint entire clinic on a 5-year cycle at no extra cost. Any vinyl covered walls to be refinished at a minimum of every 6 years at owner’s expense. VA to select colors. Vendor shall be responsible for moving and returning of furniture to allow painting and vinyl replacement. Painting/vinyl work shall be done after hours and must be odor free when clinic opens for business. Perimeters of rooms must have rubber or vinyl base cove. All walls shall be finished, no exposed ductwork, conduit or piping. Install wood or plastic chair rail to protect wall services. All finishes to meet national VA finish standards. See attached finish schedule for more detail.

g. PAINTING: Painted walls shall be washable eggshell; ceilings shall be flat paint finish. All other painted surfaces shall be washable semi-gloss. See attached finish schedule for more detail.

h. FLOOR FINISH: VA to select color and pattern of all floor surfaces, as applicable. Flooring shall be Vinyl composition floor tile (VCT) ASTM F1066 Composition 1, Class 2 (through pattern), 1/8in thickness, 12 inches square.

i. CEILING FINISH: Ceiling suspension system shall be heavy-duty system. Ceiling shall be lay in tile (mineral fiber units) with a minimum NRC (Noise Reduction Coefficient) of .55, and a ceiling attenuation class (CAC) rating of at least 33. Ceiling units shall have a flame-spread of 25 or less and a smoke development rating of 50 or less (ASTM E-84). Owner to replace any wet, cut or damaged ceiling tiles as damage occurs. Complete ceiling tiles to be replaced and metal grid replaced or repainted every 10 years.

j. INTERIOR DESIGN: For brand recognition and facility furniture inventory finishes must comply/blend with color palette in the attached finish schedule. Color/Finish proposals to be done by a professional interior design service. A minimum of 3 proposals will be provided to the VA each time new finishes are to be reviewed.

k. BUILDING DIMENSIONS: Area of building leased to VA must be roughly rectangular in shape and must not be more than 3 times longer than its width.

l. ASBESTOS: Existing building must be asbestos free.

m. 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 minimal DOE recommendations for this region. Building must have evening and weekend set back thermostats. Design to meet Energy Star rating of 75 or greater.

n. DOORS: Exterior doors and utility rooms to be equipped with automatic door closers. Automatic door openers are required at the main entrance of the clinic for handicap accessibility. Automatic doors are also required on doors leading from the waiting room to the clinic areas. Doors to the clinic area shall be push pad operated on the clinic side and numerical combination operated on the waiting room side. VA will have the option of selecting sliding doors or hinged doors for all exam, consult, procedure, or treatment rooms. All doors shall be 42 inches or greater throughout the clinic.

o. LOCKS: All doors must be equipped with cylinder lock locking hardware and master keyed to match existing VA “Best” brand, 7 pin locking system. 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 coin from outside.

p. SIGNAGE: All rooms must be equipped with solid plastic identification signs with room function and room number. Emergency egress signage meeting Life safety code and JCAHO is required.

No Smoking signage shall be located at the entrance(s) of the building by lessor. All signage must be ADA compliant For additional information regarding signage see http://www.cfm.va.gov/til/spec.asp. See attached finish schedule for more detail.

q. 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 rooms, Mental Health rooms and Multipurpose/conference room must go from deck to deck and be sound insulated with an approved acoustical insulation with a minimum STC of 40. Sound transmission shall be tested prior to acceptance and results provided to the VA. Shared Documentation space or Collaborative work areas are required to include multifaceted http://www.cfm.va.gov/til/spec.asp approaches for reductions in sound transmission to include lessor provided sound baffling/clouds, wall treatments, and white noise systems. 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 reception/waiting area. Privacy curtain tracks at doors required in all exam rooms. Track and curtain to be provided by owner. Track shall be “On the Right Track” white tracks/grommets with Maharam Peer Bundle fabric. See attachment #3, VHA Program Guide PG-18-3, Topic 11, Noise Transmission Control for further guidance. Aural privacy specifications

HTTP://WWW.CFM.VA.GOV/TIL/CRITERIA.ASP

r. TOILETS: Lavatories shall be equipped with supply dispensers for the building including toilet paper, paper towel, soap, shelf and mirror, tampons (ladies’ room) provided and installed by the lessor. Lessor shall provide recessed or semi-recessed trash receptacle. A coat hook shall be installed on inside face of door. The men's toilet shall have a urinal in addition to a commode. All toilets 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.

Commodes and urinals shall be auto sensor flush. Provide baby changing table in family-lavatory or plan for one in both male and female lavatory.

s. CORRIDORS: All corridors shall be a minimum of 6 feet wide and require a handrail.

t. FIRE EXTINGUISHERS: Portable fire extinguishers will be provided, hung and maintained by the Lessor in accordance with National Fire Protection Association (NFPA) 10, Standard for Portable Fire Extinguishers. If award is for a new building, fire extinguishers will be in recessed fire extinguisher cabinets to be approved by the VA and meet NFPA standards. Lessor is responsible for the required monthly and annual maintenance for fire extinguishers and emergency lights. All reports should be forwarded to the lessee safety office.

u. COUNTERS: All counter tops shall be solid surface material approved by VA. See attached finish schedule for more detail.

v. SPECIAL FIRE CODE: The storage rooms, laboratory room, mechanical rooms and housekeeping closets will be protected by one- hour fire walls and doors

w. PATIENT TRAFFIC FLOW IN BUILDING: Building to be arranged such that patients enter immediately into vestibule, then enter waiting room then go by reception counter and finally enter clinical areas. See attached prototype clinic layouts.

x. CANOPIES: Entrance doors will be recessed 3 feet or a minimum of 6ft. by 6ft. and rain canopies will be over all entrance doors. Vestibule (air lock) must have (2) two sets of doors separated by at least (8) eight feet and configured to avoid any wind-tunnel effects. One door in each set must have an automatic door opener.

5. SITE CONSIDERATIONS:

a. ENVIRONMENTAL COMPLIANCE: The following references shall be consulted to ensure environmental compliance of the lease site.

i. VA’s NEPA Implementing Regulations – 38 CFR Part 26 NEPA law and implementing regulations, including but not limited to:

i. NEPA of 1969, as amended

ii. Public Law [Pub.L.] 91-190

iii. 42 United States Code [U.S.C.] 4321-4370F

iv. Council on Environmental Quality (CEQ) regulations implementing NEPA

v. 40 Code of Federal Regulations [C.F.R.] Parts 1500-1508

b. LOCATION: Facility must be highly visible and located in a high traffic area accessible to and from main thoroughfares.

c. PARKING: Adequate, safe lighted parking on site for a minimum of 120 vehicles, with ten

(10%) of the total provided spaces for handicap parking stalls with aisles on both sides complying with Architectural Barriers Act Accessibility Standard (ABAAS). See attached “Parking Stall Layout”. This will allow sufficient parking for all VA staff at the site, 8-10 GOV vehicles for staff use, and parking for visitors/patients. For the GOV spaces, provide a “Reserved for GOV” sign.

d. ACCESSIBLE PARKING: The handicap 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/ABAAS and the VA Barrier Free Design Guide.

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

f. SITE SIGN: Lessor must provide internally lighted sign with VA logo and words as depicted on the attached sample. Sign shall be a minimum of 24 inches above finished grade.

http://www.cfm.va.gov/til/criteria.asp

g. SITE FLAGPOLE: Lessor is to provide a 25-foot (minimum height) flagpole on site/property in accordance with the VA criteria. Contractor shall provide all labor, materials and equipment necessary to accomplish the installation of an exterior light to illuminate light to illuminate the American Flag located outside the clinic site. The light shall properly illuminate the flag and be controlled by a power circuit located within the clinic. The feed from the clinic shall be buried below ground and the conductors shall be enclosed in exterior rated conduit. Flagpole shall be protected from vehicular traffic. Lighting shall be controlled by a photocell device and maintained by lessor.

1. Specifications:

a. Overall length: 25 ft minimum

b. Exposed height: 20 ft minimum

c. Top diameter: 3”

d. Butt diameter: 5”

e. Wall thickness: .125”

f. Flagpole weight: 92 lbs

g. Max unflagged wind speed: 250mph

h. Max flagged wind speed: 120+mph

i. Cast aluminum revolving truck assembly stainless steel bearing concealed inside a cylindrical hood

j. Stainless steel aircraft cable halyard

k. Two chrome plated swivel bronze snap hooks

l. Plastic covered counterweight with beaded sling

m. Internal winch with removable hand crank

n. Machine spun aluminum flash collar

o. 16 gauge galvanized corrugated ground sleeve

h. SIDEWALKS: Accessible minimal 5-foot wide sidewalks must be available from parking to 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

i. MARQUEE: The Lessor will provide a lighted Marquee at the entrance to the property. VA will provide design.

j. CLEANING: The Lessor is responsible for interior cleaning and litter pickup. The Lessor is responsible for exterior cleaning and trash pickup from grounds.

k. PEST CONTROL: The Lessor is responsible to exterminate insects, rodents and other pests as required. 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.

l. 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 rental 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, light fixture lamps/tubes/bulbs, 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.

m. 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).

n. EXTERIOR MAINTENANCE: The Lessor is responsible for snow and ice removal from parking areas and sidewalks. Snow and ice removal from overnight precipitation should be completed prior to opening of clinic if at all possible. 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.

o. PARKING LOT: Lessor shall re-seal parking lot and re-paint parking space lines as damaged.

Entire lot to be resealed and painted every five years.

p. PLUMBING PROBLEMS: All plumbing problems are the responsibility of the Lessor and will be addressed within 24 hours of notification of Lessor’s representative.

6. UTILITIES:

a. CABLE TV: Lessor will provide and pay for cable television service for up to two locations within the clinic. Wall jack shall be located within, or adjacent to all TV locations. A 120-volt duplex electrical outlet will be located adjacent to the cable box outlet.

b. 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.

c. SINKS: The lessor will provide and install wall- mounted soap dispenser and paper towel dispenser for each sink. The lessor shall install the VA-approved dispensers at each sink; sink fixtures shall be provided with ADA compliant paddle handles.

d. EMERGENCY EYEWASH/SHOWER (AS REQUIRED): The lab shall be equipped with emergency eyewash. The eyewash shall be readily accessible without blocking equipment access. The eyewash shall be installed in accordance with ANSI standards.

e. STAFF CONFERENCE/BREAK/MEETING/STAFF EDUCATION ROOM UTILITIES: This room will be equipped with a small kitchen-type sink, free-standing ice and water dispenser, counter with over and under sink storage cabinets along with counter space for a microwave and floor space for a freestanding refrigerator. The microwave and refrigerator will be provided by the VA.

f. EMERGENCY LIGHTING: Must have adequate power failure lighting in corridors and waiting room. Lessor is responsible to maintain function of emergency lighting including bulbs, batteries and all other parts. Lights will be periodically tested by the lessor as per NFPA 101 requirements.

Lights will have dual power source and automatic activation to illuminate egress route. The emergency lighting will be completely tested at least once per month by the owner with a copy of the testing report sent to the VA.

g. SECURITY ALARM: Automatic security alarm system with autodial to commercial security company or local police department must be provided by and maintained by the Lessor. Alarm sensors are required in the Medicine Storage Room and the IT / Data closet. A local minimum 80db alarm will be installed by the Lessor. The remote monitoring company shall be in the business full- time, shall be approved by the LCO, with all monitoring costs borne by the lessor for the term of the lease. The security alarm will be completely tested by the Lessor as required by the manufacturer. The security system will be completely tested at least once per month by the owner with a copy of the testing report sent to the VA. Updates to keypad entry, and code changes will be included in the lease. See VA HB Directive 0730/2 appendix B under 209 Security.HTTP://WWW.VA.GOV/VAPUBS/SEARCH_ACTION.CFM?DTYPE=2

h. LIGHTING: All interior lighting except for closets to be fluorescent lighting. Initially, the Lessor shall provide T8 ECOLOGIC ™ fluorescent lamps or better, designed to pass the Federal Toxic Characteristic Leaching Procedure (TCLP) criteria for classification as non-hazardous waste.

Lessor responsible for replacing failed fixtures, ballasts or other parts. Lessor shall replace lamps on interior lights. Lessor is to provide and replace lamps on exterior lights. Lessor is to provide and replace lamps on exterior lights. Lighting is to provide a minimum of 70-foot candles in work areas and 30-foot candles in non-work areas. Building entrances and parking lot to be lighted with high efficiency exterior lighting.

i. DRINKING FOUNTAINS: Two Dual high/low drinking fountains are required; one of them public accessible, may be placed in the waiting room.

j. HVAC: The heating, air conditioning and ventilating systems shall meet city, state and national codes and be designed to meet ASHRAE minimum recommendations. Return air shall be ducted.

The repair and maintenance of the HVAC system including replacement/cleaning of filters according to manufacturer recommendations shall be maintained by the lessor. At a minimum, equipment shall be serviced two times per year, once in the Fall prior to the heating season and once in the Spring prior to the cooling season. Failure of the HVAC system shall be treated as an emergency with response within 3 hours. Equipment must maintain temperature ranges between 70-76 degrees regardless of weather conditions. Toilets, Housekeeping closet and multipurpose exam room will all include exhaust venting to the outside to create a negative pressure in these http://www.va.gov/VAPUBS/SEARCH_ACTION.CFM?DTYPE=2 rooms. Rooms shall have a minimum of 6 air changes per hour.

k. The building will be provided with enough thermostats and controls to adequately control the space with a minimum of 15 zones. HVAC shall be a certified system and Lessor shall provide a Test and Balance report to the VA.

l. **The data closet will be provided a separate, thermostatically controlled cooling unit capable of maintaining 70 degrees F with computer equipment producing a 12,000 BTU heat load.

m. ELECTRIC: Electric panels must be circuit breaker type with 25% excess capacity. Circuit breakers must be identified as to area served. Toilets and other wet locations must be equipped with GFCI outlets. All items must be U.L. approved. Rooms over 90 square feet must be equipped with at least one duplex outlet on each of four walls of rooms and an additional outlet for walls longer than 12 feet. Smaller rooms must have at least two outlets. No more than 8 outlets per circuit. Data closet to have at least 5 120Vduplex outlets on 2 circuits and 1 dedicated 30 AMP, 208V, 2 pole, 3 wire circuit with a L6-30R outlet. Lessor is to provide one 120 V duplex in the center of the multipurpose/conference room, above the ceiling for future projector mounting provided and installed by the VA. Corridors will have outlets at least every 25 feet. All outlets in all rooms to be set ground plug up. All electrical systems shall meet and be in compliance with the National Electric Code (NFPA 70). Provide a standby generator adequately sized to provide power to essential loads in case of primary source failure. Lessor shall conduct tests as required by NFPA and JCO and provide records to the VA upon request.

n. SPECIAL ELECTRICAL OUTLETS: The Lessor will provide two (2) 240-volt electrical outlets on separate circuit breakers at a location in the clinic to be determined by the VA at the time of award. Owner to provide 5 additional 120 V duplex outlets in locations to be designated by the VA during drawing reviews. All receptacles will be hospital grade “green dot” outlets.

o. CHANGES: As part of the lease the Lessor will provide the VA with a cost per electrical outlet for the Lessor to install electrical outlet additions to the facility beyond the previously listed requirements.

p. FIRE ALARM: Building to be equipped with fire alarm system that meets city, state and NFPA code requirements and remote annunciation to local fire department or monitoring service. Fire alarm testing required by NFPA is the responsibility of the Lessor. Complete testing will be done at least once per year. Copies of all test reports will be sent to the VA. At a minimum there will be pull stations at each exit and smoke detectors in waiting areas, corridors, furnace/HVAC rooms and storage rooms. Strobes/audible devices will be installed as to be visible in all directions and in conference/multipurpose rooms. Any fire sprinklers will must have tamper and flow alarms and be tested in accordance with NFPA standards.

q. WET AUTOMATIC FIRE SPRINKLER: Building will have an NFPA compliant wet automatic sprinkler system. Building shall be fully sprinklered and contain all necessary fire alarm features.

Lessor will be responsible for performing all NFPA required testing and maintenance on the system and a copy of the test report provided to the VA.

r. UTILITIES: Availability of utilities is the responsibility of the Lessor. The lessor is responsible for the cost of utility usage (electricity, gas, water, sewage, and telecommunications) based on consumption. If the VA area is co-joined to space leased to others then the Lessor will provide separate metering to measure government usage. The Lessor is required to pay any deposits and hook-up fees relative to utilities.

s. DATA CLOSET REQUIREMENTS: See “Telecommunication Requirements” attached at the end of this document for all requirements. *** DATA CLOSET/IT ROOM MUST HAVE HARD CEILING

AND NO OTHER SERVICE CAN BE INSIDE, I.E SECURITY, FIRE***

7. OTHER:

a. CONDITION: Facility must be in a like new condition prior to VA occupancy. If the space is to undergo any construction, refinishing or remodeling prior to VA occupancy, Lessor to provide VA with color boards for selection of finishes and colors.

b. DRAWINGS: Lessor to provide drawings of facility building, site and location plan as part of bid and will provide “as-builts” as well as CAD drawings to the VA no later than 30 days from when the facility is turned over to the VA for occupancy.

c. DOCUMENTS: In addition to regular contract documents, test results described above and proof that the construction meets contract requirements, the contractor must provide MSDS sheets on chemicals used in maintenance such as pest control products, etc.

d. PHYSICAL SECURITY: Setback distance should be a minimum of 25ft. from the face of the Building's exterior to the protected/defended perimeter (i.e., any potential point of explosion). This means the distance from the Building to the curb or other boundary protected by bollards, planters, or other street furniture. Such potential points of explosion may be, but are not limited to, such areas that could be accessible by any motorized vehicle (i.e., street, alley, sidewalk, driveway, parking lot).

APPENDICES:

See attached for Appendix A.2 See attached for Appendix A.3 See attached for Appendix A.4 See attached for Appendix A.5 See attached for Appendix A.6 See attached for TJC Links

November 29, 2022

VA Leased CBOC Design Narrative

LEASED CBOC DESIGN NARRATIVE

TABLE OF CONTENTS

VA Leased CBOC Design Narrative November 29th, 2022

Table of Contents - Page 1

1. INTRODUCTION

2. GENERAL REQUIREMENTS

2.1 General

2.2 Codes

2.3 Standards

2.4 References

3. PLANNING AND DESIGN CRITERIA

3.1 Background

3.2 PACT Guiding Principles

3.3 Community Based Outpatient Clinics (CBOC) Planning Approach

3.4 Room Data Matrix

3.5 Surgical Design Criteria

4. TECHNICAL NARRATIVE

4.1 Site/Civil

4.1.1 Pedestrian and Vehicle Access & Circulation

4.1.2 Parking

4.1.3 Site Grading

4.2 Architecture

4.2.1 General Criteria

4.2.2 Accommodations for Care of Patients of Size

4.2.3 Acoustics

4.2.4 Equipment/Accessories/Furnishings

4.2.5 Signage and Wayfinding

4.2.6 Critical Dimensions

4.2.7 Entry Canopies

4.2.8 Elevators

4.2.9 Slab Depressions and Thickened Slabs

4.2.10 Millwork

4.2.11 Joint Sealant Systems

4.2.12 Doors and Frames

4.2.13 Hardware

4.2.14 Pharmacy Dispensing Windows

4.2.15 Radiation Shielding

4.2.16 Radio Frequency Shielding and Magnetic Shielding

4.3 Interior Design

4.3.1 General Criteria

4.3.2 Acoustic Ceiling Tile

4.3.3 Concrete Floor Treatment

4.3.4 Fiberglass-Reinforced Panels

4.3.5 Painting

4.3.6 Wall Protection

4.3.7 Window Shades

LEASED CBOC DESIGN NARRATIVE

TABLE OF CONTENTS

VA Leased CBOC Design Narrative November 29th, 2022

Table of Contents - Page 2

4.3.8 Privacy Curtains / Screens

4.3.9 Flooring, Carpet

4.4 Mechanical

4.4.1 References

4.4.2 HVAC Design Basis

4.4.3 Air Handling Units (AHUs)

4.4.4 Exhaust Systems

4.4.5 Cooling System

4.4.6 Hot Water Heating System

4.4.7 Humidification System

4.4.8 HVAC Piping Systems

4.4.9 Air Distribution and Duct Systems

4.4.10 HVAC Insulation Systems

4.4.11 Testing, Adjusting and Balancing

4.4.12 Automatic Temperature Control Systems

4.4.13 Special Conditions

4.5 Plumbing

4.5.1 References

4.5.2 Plumbing Design Basis

4.5.3 Materials

4.5.4 Medical Gases

4.5.5 Special Conditions

4.6 Electrical

4.6.1 Standby Generator

4.7 Lighting

4.7.1 General

4.7.2 Indoor Lighting Specifics

4.7.3 Lighting Controls

4.7.4 LED Drivers

4.7.5 Special Conditions

4.8 Telecommunications

4.8.1 Scope of Work

4.8.2 Pathways

4.8.3 Spaces

4.8.4 Telecommunications Bonding and Grounding

4.8.5 Equipment Racks and Equipment Cabinets

4.8.6 Power Distribution Units and Uninterruptable Power Supplies

4.8.7 Telecommunications Infrastructure Plant

4.8.8 Special Systems

5. Hardware Groups and Modifiers

SECTION 1

INTRODUCTION

Section 1 - Page 1

SECTION 1 - INTRODUCTION

1.1 The purpose of this Leased CBOC Design Narrative is to consolidate the governing codes, standards, references, and guidelines in a document that provides performance-based standards for a VA leased CBOC.

1.2 The governing codes, standards, and references are based on a VA affiliated outpatient clinic.

1.3 The design of the VA leased CBOC is based on the Prototype for Standardized Design and

Construction of Community Based Outpatient Clinics which is described in Part 3 Planning and Design Criteria.

1.4 Commonly Used Acronyms and Definitions:

PCMH Patient Centered Medical Home

A team based, comprehensive, coordinated patient care model (refer to PACT) PACT Patient Aligned Care Team

Provides service to veterans that is patient-centered with the right care at the right time by the right person. A typical “teamlet” serving a veteran consists of four caregivers: A Primary Care Provider – physician (MD), physician assistant (PA) or nurse practitioner (NP); a Registered Nurse (RN); a clinical staff assistant (LPN or Medical Assistant) and an administrative staff member (Clerk).

CBOC Community Based Outpatient Clinic Is VA-operated, VA-funded, or VA-reimbursed site of care which is located separate from a VA Medical Facility. A CBOC can provide primary, specialty, subspeciality, mental health, or any combination of healthcare delivery services that can be appropriately provided in an outpatient setting.

PFD Program for Design Net square feet (NSF) listing of all spaces and rooms that are to be included in a construction project.

VA Veterans Affairs VHA Veterans Health Administration VISN Veterans Integrated Services Network

SECTION 2

GENERAL REQUIREMENTS

VA Leased CBOC Design Narrative

Section 2 - Page 2

SECTION 2 – GENERAL REQUIREMENTS

2.1 General

2.1.1 The codes, standards, and references listed below indicate minimum performance requirements. Based on input from Owner representatives and recommendations from the architectural/engineering firm, minimum requirements or standards may be exceeded by site specific project design.

2.1.2 Compliance is required with applicable codes and standards throughout the process of design, construction, acceptance, and on-going maintenance of the facility.

2.1.3 Design and construction of the CBOC shall be in compliance with the requirements of the GSA Form L100 Global Lease and the codes, standards, and references listed below. This Leased CBOC Design Narrative covers construction materials and standards not fully addressed by the codes, standards, and references below.

2.1.4 Use the most current edition at the date and time of bid submission

2.2 Codes

2.2.1 All VA leased CBOC facilities are to conform to the most recent applicable codes, which include but is not limited to following:

2.2.1.1 National Fire Protection Association (NFPA) 70 National Electric Code, NFPA

75 Standard for the Fire Protection of Information Technology (applicable when CBOC contains a Data Center), NFPA 99 Health Care Facilities Code and all standards referenced therein, NFPA 101 Life Safety Code, NFPA 110 Standard for Emergency and Standby Power Systems, current editions.

2.2.1.2 Architectural Barriers Act Accessibility Standards (ABAAS), current edition.

2.2.1.3 International Building Codes (IBC): 2018 or latest edition (within 2 years of release). The latest edition shall be used for structural and seismic design.

2.2.1.3.1 International Building Code

2.2.1.3.2 International Energy Code

2.2.1.3.3 International Mechanical Code

2.2.1.3.4 International Plumbing Code

2.2.1.4 State and local codes as required by the local Authority Having Jurisdiction

(AHJ).

Additional Code information:

2.2.1.5 For the Lessor to properly determine occupancy type, VA intends to simultaneously treat 0 patients at any given time who are incapable of self-preservation.

2.2.1.6 Lessor shall maintain utilities and equipment as prescribed by local codes, as outlined within this document and all referenced and provided Appendices. Lessor will provide records of the maintenance in the format and frequency required by the VAMC and Life Safety Code to ensure compliance with TJC.

2.3 Standards

2.3.1 All leased CBOC facilities are to conform to the following standards:

2.3.1.1 FGI Guidelines for the Design and Construction of Outpatient Facilities, current edition (referred to as FGI Guidelines herein).

VA Leased CBOC Design Narrative

2.3.1.2 The Joint Commission (TJC) accreditation standards apply to the facility under the affiliated VA medical center license. Building construction and on-going maintenance procedures shall meet TJC standards. Lessor shall provide and submit all documentation that is required for TJC requirements.

See attached TJC checklist.

2.3.1.3 Facility Security Level (FSL) shall be as outlined in GSA Form L100 Global Lease.

2.3.1.4 Sustainability standards shall be as outlined in GSA Form L100 Global Lease.

2.3.1.5 American Society of Heating, Refrigerating and Air-Conditioning Engineers

(ASHRAE) Standard 170, Ventilation of Health Care Facilities, current edition (referred to as ASHRAE 170 herein)

2.3.1.6 ASHRAE Standard 12, Minimizing the Risk of Legionellosis Associated with Building Water Systems, current edition.

2.3.1.7 ASHRAE Standard 188, Legionellosis: Risk Management for Building Water Systems, current edition.

2.3.1.8 ASHRAE Standard 62.1, Ventilation for Acceptable Indoor Air Quality, current edition (referred to as ASHRAE 62.1 herein)

2.3.1.9 ANSI/ASHRAE/IES Standard 90.1-2019 -- Energy Standard for Buildings Except Low-Rise Residential Buildings

2.3.1.10 Sheet Metal and Air Conditioning Contractors National Association (SMACNA) Standard, HVAC Duct Construction Standards - Metal and Flexible.

2.3.1.11 USP General Chapter 795 Pharmaceutical Compounding – Nonsterile Preparations

2.3.1.12 USP General Chapter 797 Pharmaceutical Compounding – Sterile Preparations

2.3.1.13 USP General Chapter 800 Hazardous Drugs - Handling in Healthcare Settings

2.3.1.14 Association for the Advancement of Medical Instruments (AAMI) standards as applicable to SPS and RME storage

2.3.1.15 Illuminating Engineering Society North America (IESNA) Handbook - latest edition

2.3.1.16 VA Signage Design Manual PG 18-12

2.3.1.17 H 18-8 Seismic Design Handbook

2.3.1.17.1 Seismic Facility Criticality Designation (FCD), based on the Program for Design, is defined as: Ancillary, Essential, or Critical (select one) (Medical Center shall determine FCD based on the Program for Design, consult H-18-8 and the Seismic Program Manager if necessary)

2.4 References

2.4.1 The following guides, manuals, and other references developed by VA are for reference only, however, they are applicable to VA leased CBOCs:

2.4.1.1 VA Enterprise Facility IT Support Infrastructure Standard, most current.

2.4.1.2 Prototype for Standardized Design and Construction of Community Based

Outpatient Clinicshttps://www.cfm.va.gov/til/prototypes.asp#CBOC

2.4.1.3 PACT Space Module Design Guide

https://www.cfm.va.gov/til/dGuide/dgPACT.pdf

2.4.1.4 Room Templates, Leased Community Based Outpatient Clinics https://www.cfm.va.gov/til/rTemplate/LeasingCBOCw.asp

2.4.1.5 VA Design Guides (PG18-12)

2.4.1.6 http://www.cfm.va.gov/til/dManual/dmHVAC.pdf

2.4.1.7 http://www.cfm.va.gov/til/dManual/dmElec.pdf https://www.cfm.va.gov/til/prototypes.asp#CBOC https://www.cfm.va.gov/til/dGuide/dgPACT.pdf https://www.cfm.va.gov/til/rTemplate/LeasingCBOCw.asp http://www.cfm.va.gov/til/dManual/dmHVAC.pdf http://www.cfm.va.gov/til/dManual/dmElec.pdf

VA Leased CBOC Design Narrative

2.4.1.8 http://www.cfm.va.gov/til/dManual/dmLighting.pdf

2.4.1.9 http://www.cfm.va.gov/til/dManual/dmPlbg.pdf

2.4.1.10 http://www.cfm.va.gov/til/dManual/dmTelecomm.pdf

2.4.1.11 https://www.cfm.va.gov/til/telecom/OIT-ISTS.pdf

2.4.1.12 http://www.cfm.va.gov/til

2.4.1.13 The Joint Commission | Healthcare Environment and Facilities

Programs (va.gov)

2.4.1.14 2019 All Accreditation Programs Organization SAG (va.gov) http://www.cfm.va.gov/til/dManual/dmLighting.pdf http://www.cfm.va.gov/til/dManual/dmPlbg.pdf http://www.cfm.va.gov/til/dManual/dmTelecomm.pdf https://www.cfm.va.gov/til/telecom/OIT-ISTS.pdf http://www.cfm.va.gov/til http://vaww.hefp.va.gov/topics/joint-commission http://vaww.hefp.va.gov/topics/joint-commission http://vaww.hefp.va.gov/sites/default/files/files/2021-08/Life%20Safety%20and%20Environment%20of%20Care%20-%20Document%20List%20and%20Review%20Tool%206-21%20%28R1%29.pdf

SECTION 3

PLANNING AND DESIGN CRITERIA

SECTION 3 – PLANNING AND DESIGN CRITERIA

3.1. Background

3.1.1. VHA has committed to the development of a patient-centered medical home model for enhanced outpatient primary care services to veterans. The result was a patient care delivery model and a set of planning and design standards.

3.2. PACT Guiding Principles

3.2.1. An operational and planning design guide was developed which identified key principles and objectives. Refer to PACT Space Module Design Guide under References Section 2.4.

3.3. Community Based Outpatient Clinics (CBOC) Planning Approach

3.3.1. The development of the PACT Planning Module was complimented by the development of a Prototype for Standardized Design and Construction of Community Based Outpatient Clinics. Using the PACT Module as the building block, prototypes were developed for three types and sizes of outpatient facilities.

3.4. Room Data Matrix

3.4.1. A collection of typical rooms within leased CBOCs. It lists the required finishes, STC ratings, ceiling heights, door size and type, hardware sets, HVAC space ventilation, number of electrical receptacles, lighting controls and fixture types, and number of standard density work area outlets for each room type.

3.4.2. The Lessor shall associate rooms listed on the program for design with the room data matrix by room name. Use department level room names and types when available, otherwise use general room/space for like room function.

3.4.3. FGI Equivalent for ASHRAE 170 – Where HVAC space ventilation requirements are omitted, ASHRAE 170 Tables 8-1 and 8-2 shall be followed. Column “FGI Equivalent for ASHRAE 170” lists the equivalent room name for use in the tables.

3.4.4. FGI Equivalent for Table 1.2-5 “Minimum Sound Isolation” - Where Column “STC” in the Room Data Matrix states “See FGI”, Column “FGI Equivalent for Table 1.2-5 Minimum Sound Isolation” lists the equivalent room name for use in FGI Table 1.2-5.

3.4.5. Additional Requirements in this LDN take precedence over the standard in the RDM.

3.5. Surgical Design Criteria

3.5.1. Projects including operating rooms shall follow all requirements in the Surgical and

Endovascular Services Design Guide. Surgical and Endovascular Service Design Guide

Section 3 - Page 1 https://www.cfm.va.gov/til/dGuide/dgSurg.pdf

SECTION 4

TECHNICAL NARRATIVE

SECTION 4 – TECHNICAL NARRATIVE

4.1 Site/Civil

4.1.1 Pedestrian and Vehicle Access & Circulation

4.1.1.1 Minimum traffic lane width is 12 feet, and minimum sidewalk width is 4 feet. Curves for traffic lanes and radii at intersections must be adequately sized to prevent vehicles from encroaching on an opposing lane of traffic.

4.1.1.2 An accessible route must be provided from the public right-of-way abutting the site to the accessible building entrance.

4.1.1.3 Provide a service area with a loading dock designed to accommodate truck (WB-

62) maneuverability. Loading dock shall be 4 feet above the driveway. Platforms shall have a minimum depth of 8 feet front to back or between dock lift/leveler and back wall. Provide canopy over the platform with 14 feet of clearance from grade to the underside of the canopy. Canopy shall extend minimum of 4 feet beyond the edge of the dock for weather protection. Provide stair or ramp to the platform.

Provide hydraulic dock levelers with 25,000 pounds capacity for recessed installation at loading dock.

4.1.1.4 Service area shall accommodate vehicles that pick-up trash and recycled materials.

Locate service area away from public and patient areas.

4.1.1.5 Provide reflective traffic control signs as required for intersections, no parking lanes, and guidance of site traffic.

Additional Site/Civil Requirements:

4.1.1.6 Public transportation must be available to the facil ity with the pickup/drop off located at the main building public entry point.

4.1.1.7 All concrete curbs must be painted high visible yellow and maintained as such. At minimum, all curbs shall be repainted every three years, or as needed.

4.1.1.8 Provide necessary curb cuts with truncated domes at

all major pedestr ian intersections with vehicle pathways.

4.1.1 Parking

4.1.1.1 Parking lots with 90-degree stalls must have minimum parking stall dimensions of 9 feet by 18 feet, and a minimum drive aisle width of 24 feet. Angled parking must have one-way drive aisles with the same stall sizes as 90-degree parking. Angled parking drive aisle width must comply with a published design standard for a designated parking angle.

Additional Parking Requirements:

4.1.1.2 Parking spaces should accommodated #### cars.

This includes ### handicap spaces and ### staff parking spaces.

4.1.1.3 Provide dedicated parking spots with indicating signage for women patients (##), union partners (##), VA Police (##), and Spinal Cord Injury (##).

4.1.2 Site Grading

4.1.2.1 Roads and walks should have a typical cross slope of 2% unless adequate surface drainage is provided by other slope conditions.

4.2 Architecture

4.2.1 General Criteria

4.2.1.1 Refer to Appendix: Room Data Matrix for Door, Hardware and Acoustic requirements listed by Room Type.

4.2.2 Accommodations for Care of Patients of Size

4.2.2.1 Refer to FGI Guidelines for Outpatient Facilities for accommodations for care of patients of size. Minimum requirements are to provide access to a Procedure Room and Procedure Room Toilet in one PACT Module using a 650lb capacity design requirement. Additional capacity may be required and listed in the project specific requirements.

4.2.3 Acoustics

4.2.3.1 Refer to FGI Guidelines for Outpatient Facilities for acoustics requirements for enclosed rooms. Refer to the Room Data Matrix-Interior Construction for information on rooms not covered under FGI or rooms with special acoustics requirements.

4.2.4 Equipment/Accessories/Furnishings

4.2.4.1 Refer to CBOC Project Contents List and Room Template sheets provided with the

RLP for equipment, accessories, and furnishings descriptions and locations. Items to be provided and/or installed by Lessor are noted on the list. Provide partitions, partition backing, and above ceiling structural support as required for wall and/or ceiling mounted equipment, accessories, and furnishings. Provide required utility connections for scheduled equipment.

Additional Equipment Requirements:

4.2.4.2: Lessor is responsible for providing all uti l it ies to government furnished equipment.

4.2.5 Signage and Wayfinding

4.2.5.1 Refer to VA Signage Design Guide in Section 2.4 for signage standards and requirements.

Additional Signage Requirements:

Are there station specif ic signage requirements beyond the VA Signage Design Guide required?

4.2.6 Critical Dimensions

4.2.6.1 Patient-use corridors are to be 6 feet minimum. Staff corridors for transport of supplies from loading dock area to services shall be 8 feet minimum.

4.2.6.2 Refer to Room Data Matrix – Interior Construction for required ceiling heights by room type.

4.2.7 Entry Canopies

4.2.7.1 Provide non-combustible canopies over the following locations: patient entry to clinic, ambulance building access point and receiving area/loading dock.

4.2.7.2 At patient entry, provide a covered patient drop-off zone with space for at least one full size passenger vehicle (19 feet long) and an accessible access aisle.

4.2.7.3 At ambulance building access point, provide a covered patient drop-off zone with space for at least one ambulance (typical size used in area) and an accessible access aisle.

4.2.7.4 Provide clearance from grade to underside of canopy with for typical emergency and transport vehicles used in the area.

4.2.8 Elevators

4.2.8.1 Where elevators are provided in a leased facility, not less than one elevator car shall accommodate an ambulance stretcher of 24 inches by 84 inches in the horizontal open position and shall be identified by the international symbol for emergency medical services (star of life). The symbol shall be not less than 3 inches high placed inside on both sides of the hoist way door frame.

4.2.9 Slab Depressions and Thickened Slabs

4.2.9.1 At new construction, provide slab depression and thickened slabs as required to provide flush threshold installation at audiology booths, MRIs, and other equipment requiring recessed installation or additional structure as recommended by equipment manufacturer.