Exhibit C - S02 RFQ SOW 36C248-20-Q-1341.pdf

1. Statement of work:

1.1. Provide all labor, equipment and repair parts for the preventive and corrective maintenance of the systems hardware and software included under schedule A (item 1.2) herein located in the Audiology Service of the VA Caribbean Healthcare System in accordance with the following conditions:

1.1.1. Perform all inspections and maintenance services in accordance to manufacturer’s service manual instructions and procedures.

1.1.2. Thorough inspection of equipment’s to detect defective components capable of adversely affecting system performance.

1.1.3. Replacement of parts found defective during inspections. Contractor will repair or replace the system component with equal or superior functioning equipment or software with respect to any part of the system that is not properly functioning

1.1.4. Cleaning, calibration and adjustment of components to maintain equipment within manufacturer’s specifications, level of performance and accuracy.

1.1.5. Operational tests after each corrective and preventive maintenance service to assure level of performance is within specifications.

1.1.6. Contractor shall perform at least two (2) preventive maintenance services per system per year in February and in August in accordance with manufacturer’s recommendations and procedures. If updates to manufacturer’s requirements and/or recommendations occur, contractor must assure compliance with these requirements.

1.1.7. Contractor will provide and install any software update, patches and enhancement intended to update system software version or correct software errors and deficiencies.

1.1.8. Contractor shall supply all labor, parts, test instruments, tools, hardware and software required to perform all maintenance and repair work.

1.1.9. Unlimited service and technical support calls can be performed during regular hours, 8:00AM to 5:00PM.

1.1.10. The response time to emergency calls for service will be no more than two (2) hour after notification.

1.1.11. Contractor will respond with onsite visits to service calls within 48 hours in the event that phone or technical support cannot resolve the problem.

1.1.12. On-site service will be offered between 8:00am and end by 5:00pm, except when a change in hours is requested by the VACHS. If service is to be continued after 3:30PM, prior notification needs to be done to COTR or his/her designee.

1.1.13. Unlimited Technical Support will be available from 8:00am to 5:00pm, Monday thru Friday except holidays.

1.1.14. Contractor’s service personnel shall report to the Biomedical Supervisor or his designee when called.

1.1.15. A copy of each service report with a checklist of all tasks performed will be provided to the Biomedical Supervisor or his designee at the conclusion of each service call.

1.1.16. Major repairs due to acts of God, renovation of equipment, negligence or misuse, power line fluctuations and computer virus unattributable to contractor, are not covered by this contract.

1.2. Schedule A:

Manufacturer Model VA property number Serial number Location

GSI 61 65186762 AA052328 Audiology, SJ

GSI 61 65186763 AA052326 Audiology, SJ

GSI 61 65188541 981865 Audiology, SJ

GSI 61 65170049 20010394 Audiology, SJ

GSI Audio Star Pro 65222685 GS0052364 Audiology, SJ

GSI Audio Star Pro 65222684 GS0052363 Audiology, SJ

GSI Audio Star Pro 65222683 GS0052368 Audiology, SJ

Maico MA42 65194402 23189 Audiology, SJ

Beltone 119 65169774 12B5307 Audiology, SJ

Beltone 119 65165590 12B2596 Audiology, SJ

GSI Tympstar Pro 65236783 GS0074732 Audiology, SJ

GSI Tympstar Pro 65236782 GS0075023 Audiology, SJ

GSI Tympstar V2 65222687 GS0052187 Audiology, SJ

GSI Tympstar V2 65222686 GS0052179 Audiology, SJ

Maico Mi-24 24526 32060 Audiology, SJ

Audioscan RM-500SL 65194164 A1501 Audiology, SJ

Audioscan RM-500SL 65194165 A1502 Audiology, SJ

Audioscan RM-500SL 65194167 A1504 Audiology, SJ

GN Otometrics AIR CALORIC

IRRIGATOR

65239634 1231257 Audiology, SJ

GN Otometrics AIR CALORIC

IRRIGATOR

65221098 957183 Audiology, SJ

N/V Sound room SPD-113-1 101947A, 101947B

Audiology, SJ

N/V Sound room 65226028 AC755703, AC755702

Audiology, SJ

N/V Sound room 65226027 AC755702, AC755701

Audiology, SJ

N/V Sound room 65226026 AC755701, AC755703

Audiology, SJ

Otodinamics Otoports Advance 65221231 OAC/13108154 Audiology, SJ

Otodinamics Echoports ILO 292 65194474 DP4/07/060356 Audiology, SJ

Otodinamics Echoports ILO 292 65194475 DP4/07/060358 Audiology, SJ

MICROMEDICAL ROTARY CHAIR

MODEL SYST. 2000

65221213 360 Audiology, SJ

GN Otometrics ICS CHARTR 200

EP

65221099 459117 Audiology, SJ

GN Otometrics ICS CHARTR 200 65221097 449373 Audiology, SJ

GSI 61 65199345 AA084047 MOPC

GSI Tympstar V1 65226023 GS0056563 MOPC

Audioscan RM-500SL 65194168 A1505 MOPC

N/V Sound room 65199344 108342 (Two) MOPC

GN Otometrics Air Caloric Irrigator 65227090 926262 MOPC

GN Otometrics ICS CHARTR 200 65227089 947422 MOPC

NATUS Navigator Pro 65227368 14K007365M MOPC

NATUS Scout Sport 65227369 14J021482B MOPC

GSI Audio Star Pro 65226024 GS0055532 MOPC

N/V Sound room 65228253 GAA-15265 POPC

GN Otometrics Astera (s/n.367074) 65212234 39D022265 POPC

GN Otometrics Otoplex (s/n.349797) 65212234 39D022265 POPC

GN Otometrics Real Ear Free Fits (443762)

65212234 39D022265 POPC

1.3. Safety Requirements

1.3.1. The contractor shall take all safety precautions and safety measurement necessary to protect the lives and health of occupants of the building.

2. Delivery/Performance Information

2.1. Preventive and corrective maintenance services will consist of a Base Period and four Option Period Years.

Preventive maintenance service will be given as specified in item 1.2.

2.2. Contractor’s service personnel shall report to the COR prior to starting any component of the system detailed in item 1.2.

3. Information and Information Technology Security Equipment is not connected to the network and it do not involve patient information.

4. Access to VA Information and VA Information Systems is not applicable.

5. Quality Assurance Service Plan

5.1. The contractor shall establish complete quality control programs to ensure the requirement of the contract are provided as specified.

5.2. Within five workdays prior to the starting date of the contract the contractor shall submit a copy of his Preventive and Corrective Maintenance program to the Contracting Officer and/or COR. The program shall include, but not be limited to the following:

5.2.1. The name(s) of the individual(s) who will perform the services described in contract.

5.2.2. A checklist used in the inspection and performance verification during preventive maintenance and corrective maintenance services. The checklist shall include every requirement included in the manufacturer’s manual(s), updates, notices and any other requirement from accrediting organizations or agencies, as well as every task required to be performed.

5.2.3. A schedule of the dates scheduled for the preventive maintenance service requested.

5.2.4. A system for identifying and correcting deficiencies in the quality of services before the level of performance becomes unacceptable and/or the COR identifies the deficiencies.

5.2.5. An audit system covering all the services required.

5.3. In addition to providing the documentation at the end of each service, the contractor is responsible for maintaining the required documents of all the services conducted by the Contractor and the corrective actions taken.

All documentation shall be made available to the Government during the term of the contract.

PERFORMANCE REQUIREMENT SUMMARY (PRS)

Performance Objective Surveillance

Methods Performance Threshold SOW

Emergency calls are answered within established requirement in

SOW

Random Sampling No deficiencies accepted. As per SOW

Regular service calls are answered within established requirement in

SOW

Random Sampling No more than 1 deficiency complaints per month

As per SOW

Service personnel are on site within established requirement in SOW

Random Sampling No more than 2 deficiencies per year.

As per SOW

Preventive maintenance service is performed within the due month.

Random Sampling No deficiencies accepted. As per SOW

Service personnel reports to COTR or his/her designee prior to performing service on equipment.

Random Sampling No more than 3 deficiencies per year

As per SOW

Service is accepted by COTR or his/her designee.

Random Sampling No deficiencies accepted. As per SOW

Service documentation is provided to COTR or his/her designee at the end of each service.

Random Sampling No deficiencies accepted. As per SOW

Service documentation includes a completed performance verification checklist.

Random Sampling No deficiencies accepted. As per SOW

6.4. Competency Requirements

6.4.1. The contractor shall comply with requirements of The Joint Commission Accreditation of Health Care Organizations (TJC). To comply with TJC requirements the contractor shall provide written confirmation that employees are competent to perform the task as described in the statement of work assigned on this contract. This written confirmation shall specify in which areas each contract employees are competent. Also, evidence of factory training of these employees shall be supplied.

6.4.2. The following is an example of a Certification of Competency.

This is to certify that __________________________ meets all qualification requirements for the services requested, is properly trained, has all applicable credentials and is competent to perform the tasks as described in the statement of work contract.

Signature: Date:

Name:

Position Title: Contractor:

7. COR Designation

7.1. COR: Felix M. Concepcion, Biomedical Equipment Support Specialist, VACHS 001FM.