Pharmacy Shredding Services Combo w Attachments - Amendment 1.pdf

For the best experience, open this PDF portfolio in

Acrobat X or Adobe Reader X, or later.

Get Adobe Reader Now!

http://www.adobe.com/go/reader

Combined Synopsis/Solicitation

Page 1 of 5Page 1 of 5

Requirement Title:

Solicitation Number:

Solicitation Issue Date:

Response Deadline:

Shredding Services

FA3010-22-Q-C001

Monday, 18 October 2021

Thursday, 22 October 2021 no later than 11:00 AM CT Point(s) of Contact: SrA Daniela J. Garcia, Contract Specialist

Phone: 228-377-1825 | Email: daniela.garcia.1@us.af.mil

General Information

1. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

2. This solicitation is being issued as a(n) Request For Quotation (RFQ).

3. This solicitation document and incorporated provisions and clauses are those in effect through:

Federal Acquisition Circular 04/02/2020 Defense Federal Acquisition Regulation Public Notice 03/24/2020 Air Force Federal Acquisition Circular 10/03/2019

4. This requirement is being set-aside for:

The North American Industry Size Classification System (NAICS) code associated with this requirement is 561990.

Requirement Information

Description:

The 81st Medical Group requests the procurement of shredding services for three specified pharmacies and a total of twelve bins. IAW Attachment 1 - Performance Work Statement and Attachment 3 - WD # 2015-5147 Rev 14.

Place of Delivery/Performance/Acceptance/FOB Point:

Keesler Medical Center Period of Performance: 1 November 2021 - 31 October 2026

Line Item Description Quantity Unit Unit Price Extended Price CLIN 0001 Shredding Services For 3 Pharmacies IAW PWS 12 MO

CLIN 0001 POP: 1 November 2021 - 31 October 2022 CLIN 1001 Shredding Services For 3 Pharmacies IAW PWS 12 MO

CLIN 1001 POP: 1 November 2022 - 31 October 2023 CLIN 2001 Shredding Services For 3 Pharmacies IAW PWS 12 MO

CLIN 2001 POP: 1 November 2023 - 31 October 2024 CLIN 3001 Shredding Services For 3 Pharmacies IAW PWS 12 MO

CLIN 3001 POP: 1 November 2024 - 31 October 2025 CLIN 4001 Shredding Services For 3 Pharmacies IAW PWS 12 MO

CLIN 4001 POP: 1 November 2025 - 31 October 2026

DEPARTMENT OF THE AIR FORCE

81st CONTRACTING SQUADRON (AETC)

Page 2 of 5Page 2 of 5

Instructions to Offerors

FAR provision 52.212-1, Instructions to Offerors -- Commercial, applies to this acquisition. As prescribed in FAR 12.301(b)(1), the following addendum is provided for this solicitation and hereby amends any language therein:

- Quoted amounts need to be net prices without tax

- The Government reserves the right to award on an "All or None" basis

- Provide Quote Expiration Date, Best Delivery Date, and any Discount Terms

- Quotes, attachments, and all other correspondence as listed in this solicitation must be emailed to both points of contact (POCs)

- All questions are to be submitted in writing by Thursday, 21 October 2021 @ 0800 AM CT

- Quotes are required to be valid until 30 December 2021

Evaluation Criteria

FAR Provision 52.212-2, Evaluation -- Commercial Items, applies to this acquisition. As prescribed in FAR 12.301(c), the following addendum is provided for this solicitation and hereby amends any language therein:

Clauses and Provisions

FAR provision 52.212-3, Offeror Representations and Certifications -- Commercial Items with alternate I applies to this acquisition;

the offeror verifies by submission of their offer that the representation and certifications posted at FAR 52.212-3 have been entered or updated electronically via the System for Award Management (SAM) Web site located at http://www.sam.gov/portal in the last 12 months, and are current, accurate, complete, and applicable to this solicitation. Alternatively, if the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (u) of this provision and include a completed copy with its offer.

FAR clause 52.212-4, Contract Terms and Conditions -- Commercial Items applies to this acquisition.

FAR clause 52.212-5, Contract Terms and Conditions Required To Implement Statutes or Executive Orders -- Commercial Items applies to this acquisition; the following checked clauses are hereby included by reference:

52.204-10, Reporting Executive compensation and First-Tier Subcontract Awards ✖

52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment ✖

52.222-21, Prohibition of Segregated Facilities ✖

52.222-26, Equal Opportunity✖

52.222-36, Equal Opportunity for Workers with Disabilities✖ 52.222-50, Combating Trafficking Persons✖

52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving✖

52.225-13, Restrictions on Certain Foreign Purchases✖

52.232-33, Payment by Electronic Funds Transfer--System for Award Management✖

The provisions and clauses listed below have been determined by the contracting officer to be necessary for this acquisition and consistent with customary commercial practices. The following provisions and clauses are hereby included by reference:

Page 3 of 5Page 3 of 5

No additional clauses or provisions will be added to this requirement (by reference) for the purposes of this solicitation. However, additional applicable and/or required clauses may be added to the purchase order as required by the Federal Acquisition Regulation, Defense Federal Acquisition Regulation Supplement, and the Air Force Federal Acquisition Regulation Supplement.

The following provisions and clauses are hereby included by full text:

252.232-7006 Wife Area WorkFlow Instructions

As prescribed in 232.7004(b), use the following clause:

WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (DEC 2018)

(a) Definitions. As used in this clause-

Department of Defense Activity Address Code (DoDAAC) is a six position code that uniquely identifies a unit, activity, or organization.

Document type means the type of payment request or receiving report available for creation in Wide Area WorkFlow

(WAWF).

Local processing office (LPO) is the office responsible for payment certification when payment certification is done external to the entitlement system.

Payment request and receiving report are defined in the clause at 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(b) Electronic invoicing. The WAWF system provides the method to electronically process vendor payment requests and receiving reports, as authorized by Defense Federal Acquisition Regulation Supplement (DFARS) 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) WAWF access. To access WAWF, the Contractor shall-

(1) Have a designated electronic business point of contact in the System for Award Management at https:// www.sam.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site before submitting payment requests through WAWF. Both can be accessed by selecting the Web Based Training link on the WAWF home page at https://wawf.eb.mil/

(e) WAWF methods of document submission. Document submissions may be via web entry, Electronic Data Interchange, or File Transfer Protocol.

(f) WAWF payment instructions. The Contractor shall use the following information when submitting payment requests and receiving reports in WAWF for this contract or task or delivery order:

(1) Document type. The Contractor shall submit payment requests using the following document type(s):

(i) For cost-type line items, including labor-hour or time-and-materials, submit a cost voucher.

(ii) For fixed price line items-

(A) That require shipment of a deliverable, submit the invoice and receiving report specified by the Contracting Officer.

Not Applicable

(B) For services that do not require shipment of a deliverable, submit either the Invoice 2-in-1, which meets the requirements for the invoice and receiving report, or the applicable invoice and receiving report, as specified by the Contracting Officer.

Invoice (Stand-Alone)

(iii) For customary progress payments based on costs incurred, submit a progress payment request.

(iv) For performance based payments, submit a performance based payment request.

(v) For commercial item financing, submit a commercial item financing request.

(2) Fast Pay requests are only permitted when Federal Acquisition Regulation (FAR) 52.213-1 is included in the contract.

(f) [Note: The Contractor may use a WAWF combo document type to create some combinations of invoice and receiving report in one step.]

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table*

Field Name in WAWF || Data to be entered in WAWF

Pay Official DoDAAC || F87100

Issue By DoDAAC || FA3010

Admin DoDAAC || FA3010

Inspect By DoDAAC ||

Ship To Code ||

Ship From Code ||

Mark For Code ||

Service Approver (DoDAAC) || F2J4PC

Service Acceptor (DoDAAC) || F2J4PC

Accept at Other DoDAAC ||

LPO DoDAAC ||

DCAA Auditor DoDAAC ||

Other DoDAAC(s) ||

(4) Payment request. The Contractor shall ensure a payment request includes documentation appropriate to the type of payment request in accordance with the payment clause, contract financing clause, or Federal Acquisition Regulation

52.216-7, Allowable Cost and Payment, as applicable.

(5) Receiving report. The Contractor shall ensure a receiving report meets the requirements of DFARS Appendix F.

(g) WAWF point of contact.

(1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact.

r.l.vansittert.civ@mail.mil daniela.garcia.1@us.af.mil

(2) Contact the WAWF HelpDesk at 866-618-5988, if assistance is needed.

(End of clause)

Attachments

Attachment 1 - Performance Work Statement Attachment 2 - Photos Attachment 3 - WD #2015-5147 Rev 14

Funds Available

Funds Not Currently Available

Attachment 1

PERFORMANCE WORK STATEMENT

For

81 MDG SHREDDING

1. DESCRIPTION OF SERVICES AND GENERAL INFORMATION. The Contractor shall provide shredding services for all paper/plastics generated by the Keesler Pharmacy. All st shredding shall be performed on site at the 81 Medical Group (81 MDG), Keesler Air Force Base (KAFB), Mississippi, or extension thereof.

1.1. SPECIFIC PROCEDURES FOR WHICH THE CONTRACTOR SHALL BE

RESPONSIBLE.

1.1.1. Shredding shall be conducted in accordance with (IAW) the HIPAA Act of 1996.

1.1.2. The Contractor shall provide open bag/containers in the locations identified in Attachment

2. All of these containers will have wheels to be mobile, so they can be transported for on the spot needs. Maximum space allotted is 33"H X 22"W X 12"D.

1.1.3. The Contractor shall empty open bags/Bins into a secure locked plastic bin to be transported to the shredding vehicle and replace with empty containers a minimum of once per week depending on usage. The Contractor will be responsible for transporting the containers to and from each location listed in Attachment 1.

1.1.4. Depending on usage, the Contractor may need to place more than one lock box container of either smaller or larger size to accommodate space limitations in some locations.

1.1.5. The contractor shall provide Medical Logistics a report detailing the number of pounds picked up each service cycle. Provide a consolidated monthly and yearly report on the number of pounds that has been picked up and shredded.

1.1.6. The contractor shall provide a certificate of shredding and disposal for each visit.

1.2. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

OF 1996. HIPAA is comprised of several different sections, each to be implemented by the Dept.

of Health and Human Services. The medical facilities of the military services and the DOD health plans are specifically listed as covered by HIPAA. Currently, HIPAA Privacy and Security Rules, as set forth in the Code of Federal Regulations, are in effect for all MTFs. The specific implementation of HIPAA Privacy for DOD medical facilities is set forth in DOD 6025.18-R, and for HIPAA Security, the requirements for AF MTFs are contained in DOD 8580.02-R and AFI 41-217 , which also contains additional Information Assurance requirements for all AF MTFs.

DOD 6025.18-R, DOD 8580.02-R and AFI 41-217 are incorporated herein by reference. MTFs are responsible to insure overall compliance with HIPAA requirements, which includes incorporation of certain requirements in contracts entered or amended after the respective implementation dates.

In accordance with these regulations, the Contractor and its employees meet the definition of Business Associates. Therefore, a Business Associate Agreement is required by law to comply with both the HIPAA Privacy and Security regulations. This clause serves as that agreement for each MTF, whereby the Contractor and its employees agree to abide by all HIPAA Privacy and Security requirements regarding health information as defined in this clause, DoD 6025-18-R, DOD 8520.02-R and AFI 41-217. Additional HIPAA requirements will be addressed when implemented.

a. Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DOD 6025.18-R, DOD 8520.02-R, or

AFI 41-217.

(1) HITECH Act shall mean the Health Information Technology for Economic and Clinical Health Act included in the American Recovery and Reinvestment Act of 2009.

(2) Individual has the same meaning as the term “individual” in 45 CFR 164.50 1 and

164.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

(3) Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

(4) Protected Health Information has the same meaning as the term “protected health information” in 45 CFR 164.501, limited to the information created or received by The Contractor from or on behalf of the Government.

(5) Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

(6) Required by Law has the same meaning as the term “required by law” in 45 CFR

164.501 and 164.103.

(7) Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

(8) Security Incident shall have the same meaning as the term “security incident” in 45 CFR 164.304, limited to the information created or received by Contractor from or on behalf of the Covered Entity.

(9) Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160,162 and part 164, subpart C.

b. Terms used, but not otherwise defined, in this Agreement shall have the same meaning as those terms in 45 CFR 160.103, 160.502, 164.103, 164.304 and 164.501.

(1) The Contractor agrees to not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

(2) The Contractor agrees to use appropriate safeguards to maintain the privacy of the Protected Health Information and to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

(3) The HIPAA Security administrative, physical, and technical safeguards in 45 CFR 164.308, 164. 310, and 164.312, and the requirements for policies, procedures and documentation in 45 CFR 164.316 shall apply to the Contractor. The additional requirements of Title XIII of the HITECH Act that relate to security and that are made applicable with respect to covered entities shall also be applicable to the Contractor. The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

(4) The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Contract.

(5) The Contractor agrees to report to the Government any security incident involving protected health information of which it becomes aware.

(6) The Contractor agrees to report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Contractor becomes aware.

(7) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

(8) The Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

(9) The Contractor agrees to provide access, at the request of the Government, and in the time and manner designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(10) The Contractor agrees to make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government or an Individual, and in the time and manner designated by the Government.

(11) The Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor on behalf of, the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner designated by the Government or the Secretary, for purposes of the Secretary determining the Government's compliance with the Privacy Rule.

(12) The Contractor agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(13) The Contractor agrees to provide to the Government or an Individual, in time and manner designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

c. General Use and Disclosure Provisions.

(1) Except as otherwise limited in this Agreement, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, DOD 6025.18-R, the HIPAA Security Rule, or DOD 8580.02-R if done by the Government. The additional requirements of Title XIII of the HITECH Act that relate to privacy and that are made applicable with respect to covered entities shall also be applicable to the Contractor.

(2) Specific Use and Disclosure Provisions

(3) Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(4) Except as otherwise limited in this Agreement, the Contractor may disclose Protected Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(5) Except as otherwise limited in this Agreement, the Contractor may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

(6) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j) (1).

d. Obligations of the Government. Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions.

(1) Upon request the Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520, as well as any changes to such notice.

(2) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor's permitted or required uses and disclosures.

(3) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

e. Permissible Requests by the Government. The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, DOD 6025.18R, the HIPAA Security Rule, or DOD 8580.02-R, if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

f. Termination.

(1) Termination. A breach by the Contractor of this clause may subject the Contractor to termination under any applicable default or termination provision of this Contract.

(2) Effect of Termination.

(a) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (b) and (c) below.

(b) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

(c) If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information.

g. Miscellaneous

(1) Regulatory References. A reference in this Clause to a section in DOD 6025.18-R, HIPAA Privacy Regulation or DOD 8580.02-R, HIPAA Security Regulation, or any CFR or AFI provision means the section as currently in effect or as amended, and for which compliance is required.

(2) Survival. The respective rights and obligations of Business Associate agreements under the "Effect of Termination" provision of this Clause shall survive the termination of this Contract.

(3) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DOD 6025.18-R, the CFR HIPAA Privacy Rule, DOD 8520.02-R, the CFR HIPAA Security Rule and AFI 41-217.

1.3. Pass and Identification (ID) Requirements. Contractor personnel whose duties require access to the KAFB computer system are required to obtain a Common Access Card (CAC). To obtain a CAC, Contractor personnel must coordinate with their gaining unit’s security manager or the 81st Communications Squadron Consolidated Client Support Activity (CSA) at 228-376- 4335. Para 1.16. below, in its entirety, is not applicable to Contractor personnel who obtain a

CAC.

1.4. Entry/Access Requirements for Contractor Personnel Requiring Access to KAFB When CAC is Not Issued.

1.4.1. Applicability.

(a) These requirements apply to Contractor personnel requiring entry/access to KAFB for service contracts with periods of performance (POP) exceeding 60 days when a CAC is not issued.

(1) Contract POP begins at performance start date. The POP end date is based on the contract completion date.

(2) These requirements shall be included (flow-down) to subcontracts at every tier.

(b) These requirements do not apply to Contractor personnel requiring entry/access to KAFB with POP of 60 days or less when a CAC is not issued. Entry/access to KAFB for Contractor personnel with POP not exceeding 60 days will be coordinated between the gaining unit and the 81st Security Forces Squadron (81 SFS).

(c) When work under this contract requires unescorted entry to controlled or restricted areas, the Contractor shall comply with AFI 31-101, The Air Force Installation Security Program, and AFI 31-501, Personnel Security Program Management, as applicable.

(d) Contractor personnel are not covered by FAR 52.222-3, Convict Labor, for the purposes of entry/access to installations/locations.

1.4.2. Badging System Data Requirements.

(a) The Contractor shall provide the following to the CO and the 81 CONS Visitor Control Center (81 CONS/VCC):

(1) “Listing of personnel requiring access/entry.” The list shall contain the following:

(i) Contract number.

(ii) Contract award date.

(iii) POP dates.

(iv) Work site(s) or location(s).

(v) Each employee’s full name and Social Security number (SSN). For those without SSNs, a working visa or Resident Alien number must be provided, or base entry will be denied.

(vi) Identify up to two (2) employees for designation as “escort” authorities. Badge will identify employee(s) that have escort authority.

(vii) A statement that the SSNs of the listed employees have been verified with the Social Security Administration (Contractors should reference www.ssa.gov/employer/ssnv.htm).

(2) The list shall be submitted in electronic format. The Contractor shall provide written notification of any additions to the personnel listing and submit Contractor/Subcontractor http://www.ssa.gov/employer/ssnv.htm)

Access Affidavit(s) (see Contractor/Subcontractor Access Affidavit at APPENDIX B) for all new personnel.

(3) Completed Contractor/Subcontractor Access Affidavits shall authorize the AF to fingerprint Contractor personnel and conduct additional background checks. The consent form will outline the following:

(i) The Contractor has briefed the Contractor personnel for the purpose of the Contractor/Subcontractor Access Affidavit.

(ii) The information on the form is collected IAW 50 U.S.C. 797 and DoDD 5200.8 that permits installation commanders to limit access to installations for security reasons.

(iii) Completion of the form is voluntary.

(iv) Agreement to provide a specimen of fingerprints.

(v) Awareness of a list of “disqualifying factors” and/or access to the list.

(vi) Consent and authorization for the AF to conduct background screening and to compare fingerprints against state and Federal criminal databases.

(vii) Knowing and willful false statements on the form can be punished by a fine or imprisonment, or both (10 U.S.C. 1001).

(viii) The consent form shall remain valid for not longer than a 24-month period, or the end of the contract POP, (to include all options) whichever is lesser.

(b) The personnel list and consent form(s) shall be submitted as follows:

(1) 81 CONS/VCC e-mail account: 81cons.vcc@keesler.af.mil. Personnel list must be submitted IAW this PWS. The signed Contractor/ Subcontractor Access Affidavit(s) may be submitted in “pdf” format; or

(2) The electronic file (USB storage device or CD-ROM) and consent form(s) may be submitted in person or mailed to the 81 CONS/VCC at the following address:

81 CONS/VCC

310 M Street Bldg 4605 Keesler AFB MS 39534-2147

(3) Refer questions regarding the personnel list and Contractor/Subcontractor Access Affidavit(s) to the 81 CONS/VCC at 228-377-1845 or to 81cons/vcc@keesler.af.mil.

1.4.3. Background Checks.

1.4.3.1. Upon receipt of the Contractor/Subcontractor Access Affidavit(s), a background check will be accomplished. Background checks will be categorized as favorable or unfavorable.

“Favorable” background checks will not contain any of the following negative screening criteria (i.e., “disqualifying factors”):

mailto:81cons.vcc@keesler.af.mil mailto:81cons/vcc@keesler.af.mil

(a) U.S. citizenship, immigration status, or SSN cannot be verified.

(b) Barred from entry/access to any military installation or facility.

(c) Wanted by Federal or civil law enforcement authorities, regardless of offense/violation (i.e., an “order to arrest” has been issued by a judge).

(d) Conviction of a firearms or explosive violation within the past three years.

(e) Incarcerated for 12 months or longer within the past three years, regardless of offense/ violation.

(f) Any conviction for espionage, sabotage, treason, terrorism, or murder.

(g) A conviction of sexual assault, armed assault/robbery, rape, child molestation, drug possession with intent to sell, or drug distribution within the past ten years.

(h) Name appears on any Federal agency’s “watch list” or “hit list” for criminal behavior or terrorist activity.

1.4.3.2. An unfavorable background check may be appealed to the CO. The appeal shall include a signed letter of rebuttal and any associated supporting documentation to the CO. The CO will forward the appeal to the 81 CONS/VCC. 81 CONS/VCC will forward the appeal to the appeal authority, 81st Mission Support Group/Deputy Commander (81 MSG/CD). 81 CONS/VCC will provide the appeal results to the CO.

1.4.3.3. Given a reasonable cause, condition, or reason, these requirements do not circumvent the installation/location commander’s unilateral authority to deny or withdraw any individual’s entry/access to an installation/location.

1.4.4. Badge and Fingerprint Schedule. 81 CONS/VCC will notify the Contractor upon completion of background checks. Badging and fingerprinting shall be scheduled by contacting the 81 CONS/VCC at 228-377-1845 or by e-mail via 81cons.vcc@keesler.af.mil. Personnel shall report to the 81 CONS/VCC with a photo identification issued by a Federal/State activity. If no photo ID is shown, a badge will not be issued.

1.4.5. Change in Employee Entry/Access Status (Deletions).

(a) No later than five (5) working days after a change in status for Contractor personnel requiring entry/access, the Contractor shall e-mail personnel list deletions and return identified badges to the 81 CONS/VCC. Personnel list deletions shall be e-mailed to 81cons.vcc@keesler.af.mil as outlined in this PWS.

(b) The Contractor shall notify the employee of their change in status for entry/access to

KAFB.

(c) Unfavorable fingerprint results shall constitute immediate deactivation of the issued badge(s) to the disqualified employee(s).

(1) 81 SFS may confiscate badge(s) of the individual(s) present on base at the time of the unfavorable result notification. 81 SFS may escort the individual(s) from KAFB IAW Security Forces guidelines.

(2) 81 CONS/VCC shall notify the Contractor of an unfavorable fingerprint result and request the Contractor return the badge IAW this PWS (unless already confiscated).

1.4.6. Badge Loss/Replacement.

(a) Personnel requiring a replacement badge shall contact the 81 CONS/VCC at 228-377- 1845 or via e-mail to 81cons.vcc@keesler.af.mil to schedule a badge appointment.

(b) Lost badge(s) require a signed letter from the prime Contractor requesting replacement of badge(s) due to loss or damage.

(c) A $25 fee will be withheld for each unreturned badge from the final payment.

Returned (damaged) badges may be replaced at no charge.

(d) Personnel shall report to the 81 CONS/VCC with a photo identification issued by a Federal/state activity.

1.4.7. Badge Display (For Individuals). All identification badges shall be prominently worn/displayed in a visible manner. Safety related exceptions to this requirement shall be addressed to the CO. The CO will notify 81 CONS/VCC of exceptions granted.

1.4.8. Contract Completion, Return of Badges.

(a) No later than five (5) working days after contract completion, the Contractor shall return all badges to 81 CONS/VCC. All badges are returned collectively by the Contractor, not incrementally/ individually by the employee(s). The badge turn-in shall identify the contract number.

(b) Failure to return badges IAW this PWS shall result in withholding $25 for each unreturned badge from the final payment per this PWS.

1.5. NATIONAL AGENCY CHECK (NAC). As a minimum, Contractor personnel shall successfully complete a NAC before operating Government-furnished workstations that have access to Air Force automated information systems. Requests for Contractor personnel hired at the beginning of the contract shall be submitted to the Government not later than 45 working days from the contract start date. Requests for Contractor personnel hired subsequent to contract start date shall be submitted to the Government not later than five workdays from the Contractor personnel’s first duty day. Contractor personnel receiving unfavorable NACs shall not be employed. The Government will submit requests for investigations on AF Form 2583, “Request for Personnel Security Action,” at no additional cost to the Contractor. The Contractor shall comply with the requirements of DoD 5200.2-R, Personnel Security Program, and AFI 33-119, Electronic Mail (E-Mail) Management and Use.

1.17.1. The Contractor shall comply with the requirements of Volume 1, AFI 71-101, Criminal Investigations, and paragraph 1.1 of Volume 2, Protective Service Matters. Contractor providers shall report any information or circumstances of which they are aware that may pose a threat to the security of DoD personnel, Contractor providers, resources, and classified or unclassified defense information to the Flight Commander/Medical Director. The Contractor personnel’s immediate supervisor shall brief him/her upon initial on-base assignment and as required thereafter.

1.5.2. PHYSICAL SECURITY. The Contractor shall safeguard all Government property, including controlled forms provided for Contractor use. At the close of each work period, Government equipment, facilities, and other valuable materials shall be secured.

1.5.3. Entry Procedures to Controlled/Restricted Areas. The Contractor shall implement local base procedures for entry to Air Force controlled/restricted areas where Contractor personnel will work.

1.5.4. Key Control. The Contractor shall establish and implement key control procedures in the Quality Control Plan to ensure keys issued to Contractor personnel by the Government are properly safeguarded and not used by unauthorized personnel. The Contractor shall not duplicate keys issued by the Government.

1.5.5. Lost Keys. Lost keys shall be reported immediately to the CO. The Government replaces lost keys or performs re-keying. The total cost of lost keys, re-keying, or lock replacement shall be deducted from the monthly payment due the Contractor.

1.5.6. GOVERNMENT-ISSUED KEYS. The Contractor shall ensure its employees do not allow Government-issued keys to be used by personnel other than current authorized Contractor providers. Contractor providers shall not use keys to open work areas for personnel other than Contractor providers engaged in performance of their duties, unless authorized by the Government functional area chief.

1.6. TRAFFIC LAWS. The Contractor shall comply with the installation traffic code as specified in Mississippi State Law and KAFB Instruction 31-204, Rules of the Road.

1.7. SMOKING IN AIR EDUCATION & TRAINING (AETC) FACILITIES. Contractors are advised that the Commander has placed restrictions on the smoking of tobacco products in AETC facilities. AFI 40-102, Tobacco Use in the Air Force, and its AETC Supplement 1, outline the procedures used by the commander to control smoking in our facilities. Contractor personnel and visitors are subject to the same restrictions as Government personnel. Smoking is permitted only in designated smoking areas.

1.8. ENVIRONMENT MANAGEMENT. In order to comply with Federally mandated environmental preference programs and DoD Green Procurement Program (GPP) policy, KAFB requires the use of environmentally preferable products and services. These program elements include: recovered material products, energy and water efficient products, alternative fuels and fuel efficiency, bio-based products, non-ozone depleting substances, priority chemicals, and environmentally preferable products. These program elements are described on the Office of the Federal Environmental Executive (OFEE) website (http://www.ofee.gov).

1.8.1. PRODUCTS AND MATERIALS. Custodial cleaning products required in the performance of this PWS shall meet as a minimum, Green Seal Product Standards (http://www.greenseal.org/certproducts.htm). If it is determined that a product does not meet Government performance requirements, the Contractor shall submit a proposed alternative that would meet the performance requirements with the lowest environmental impact for evaluation and acceptance. Products that fall under the Environmental Protection Agency (EPA) http://www.greenseal.org/certproducts.htm)

Comprehensive Procurement Guidelines (CPG) (http://www.epa.gov/cpg) shall meet the minimum recovered (recycled) content. Bio-based products shall be used upon issuance of the bio-based product listing from the United States Department of Agriculture (USDA) (http://www.usda.gov). The Contractor shall purchase and use Energy Star or other energy-efficient items listed on the Department of Energy’s Federal Energy Management Program (FEMP) Product Energy Efficiency Recommendations product list. Supplements or amendments to listed publications from any organizational level may be issued during the life of the contract. Before implementing any change that will result in a change to the contract price, the Contractor shall submit to the CO a price proposal within 30 calendar days following receipt of the change. An equitable adjustment (increase or decrease) will be negotiated, if applicable, under the “Changes” clause of the contract.

2. SERVICES SUMMARY (SS).

Performance Objectives PWS Paragraph Performance Thresholds

1. Maintains patient privacy/confidentiality.

1.1.1 Standard is zero breaches of

privacy (May be exceed by actively protecting patient information)

2. Provides weekly service in a professional manner.

1.1.3 No more than 1 valid complaint

per quarter.

3. Provides service reports to Medical Logistics on pounds shredded.

1.1.5 Mandatory 100% compliance.

4. Adheres to all HIPAA requirements. 1.2 Standard is zero breaches of HIPAA requirements.

2.1. The Government will periodically evaluate the Contractor’s performance by appointing a representative(s) to monitor performance to ensure services are received.

The Government representative will evaluate the Contractor’s performance through inspections of call logs/reports and receive and investigate all complaints from base personnel. The Government may inspect each task as completed or increase the number of quality assurance inspections if deemed appropriate because of repeated failures or because of repeated customer complaints. Likewise, the Government may decrease the number of quality assurance inspections if performance dictates. The CO shall make final determination of the validity of customer complaint(s).

2.2. If any of the services do not conform with contract requirements, the Government may require the Contractor to perform the services again in conformity with contract requirements, at no increase in contract amount. When the defects in services cannot be corrected by re- performance, the Government may:

(a) Require the Contractor to take necessary action to ensure that future performance conforms to contract requirements; and

(b) Reduce the contract price to reflect the reduced value of the services performed.

3. GOVERNMENT-FURNISHED PROPERTY (GFP) AND SERVICES.

3.1. EQUIPMENT. NONE.

http://www.epa.gov/cpg)

3.2. PERSONAL PROTECTIVE EQUIPMENT (PPE). The Contractor will be responsible for all required PPE.

3.3. IDENTIFICATION CREDENTIALS. The MTF will sign out temporary Contractor visitor identification badges to Contractor personnel.

3.4. FORMS. N/A

3.5. SUPPLIES. The contractor will provide all required supplies.

3.6. UTILITIES. N/A

3.7. SERVICES. N/A

3.8. CONTRACTOR-FURNISHED ITEMS AND SERVICES. Except for those items or services specifically stated above to be Government-furnished, the Contractor shall furnish everything required to perform this contract IAW all of its terms.

APPENDIX A GENERAL DEFINITIONS

As used throughout this Performance Work Statement (PWS), the following terms shall have the meaning set forth below:

Composite Health Care System (CHCS) Computer system, which stores clinical and administrative data. This system provides on-line communication for users in any supported location.

Contracting Officer (CO). A duly appointed person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings on behalf of the Government.

Contractor provider. Any contract health care professional who, under regulations of a Military Department, is granted clinical practice privileges in a military MTF of Dental Treatment Facility, or who is licensed or certified to perform health care services by a Governmental board or Agency, or professional health care society or organization.

Credentials. Certified documents providing evidence of education, training, licensure, board certification, experience, and expertise of a health care provider.

Defective Service. A service output that does not meet the standard of performance specified in the contract for that service. The method of surveillance for each performance objective is listed in the Service Delivery Summary. Defective services will be determined by either customer complaint or periodic inspection. A defect may be either an unsatisfactory inspection report or a customer complaint, which addresses unacceptable turn-around times or errors in reports.

Exposure-prone procedure. A certain invasive surgical or dental procedure that has been implicated in the transmission of the hepatitis-B virus from an infected health care worker to a patient. Characteristics of exposure-prone procedures include digital palpation of a needle tip in a body cavity or the simultaneous presence of the health care worker’s fingers and a needle or other sharp instrument or object in a poorly visualized or highly confined anatomic site.

Freedom of Information Act (FOIA) Request. A written request for DoD records made by any person, including a member of the public, an organization, or a business that either explicitly or implicitly involves the FOIA, DoD Directive 5400.7.

Full reimbursement rate. A rate, which is set annually by Congress, for reimbursement by non-eligible personnel who receive medical services at the MTF. This is a flat rate set for outpatient and inpatient care.

Functional Commander/Functional Director (FC/FD). The Chief/Director of the MTF medical service for whom the contracted providers are acquired, or his designated representative. Also referred to as the FAC.

Functional Request. A written request for DoD records made by any person, including a member of the public, an organization, or a business that either does not cite the FOIA or Privacy Act.

This does not include requests from Government employees with a need to know to perform official Government business.

Invasive medical procedure. Any procedure that involves a puncture or incision of the skin, the insertion of an instrument or foreign material into the body, or breaking of the mucosal lining of the body.

Privacy Act Request. A written request from the subject of the records or a request with the subject’s written consent.

Quality Assurance. A planned and systematic pattern of all actions necessary to provide confidence that adequate technical requirements are established, products and services conform to established technical requirements, and satisfactory performance is achieved. For purposes of this contract, quality assurance refers to actions by the government.

Quality Improvement/Risk Management (QI/RM) Plan. An organized document that describes the methods of doing QI reviews within the MTF. The plan designates the areas of responsibility and accountability for the QI program and the mechanisms for monitoring and evaluating patient care. It is consistent with the JCAHO monitoring and evaluation (M&E) approach and the Air Force Risk Management (RM) efforts.

Valid license. A grant of permission by an official agency of the District of Columbia, a state, or territory of the United States, to provide care independently as a health care professional.

Licenses must be current to be valid. Some jurisdictions issue no-fee licenses to Federal employees or military personnel. These are acceptable if the issuing authority will exercise professional regulating control over individuals with these licenses.

APPENDIX B – CONTRACTOR/SUBCONTRACTOR ACCESS AFFIDAVIT

CONTRACTOR/SUBCONTRACTOR ACCESS AFFIDAVIT

(THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974)

CONTRACT NUMBER

Submit original to 81 SFS/S5B. This data will be used to screen individuals who have or are seeking access to Keesler AFB or facilities controlled by Keesler AFB. Please answer each question. Access will be denied if this questionnaire is incomplete or missing from the Contractor Access Package. This information will be used to generate state and federal criminal history records checks.

Section I. P E R S O N A L I N F O R M A T I O N

1. NAME (Last, First, Middle) 2. ALIASES (AKA) 3. SSN 4. DATE OF BIRTH (YYYYMMDD)

5. EMPLOYER AND ADDRESS (Include City/State/ZIP Code) 6. CURRENT RESIDENCE ADDRESS & LOCAL PHONE # (Include City/State/ZIP Code)

7. SEX 8. RACE 9. EYE COLOR 10. HAIR COLOR 11. HEIGHT 12. WEIGHT

Section II. P L A C E O F B I R T H

1. CITY 2. STATE (If applicable) 3. COUNTRY

4. CITIZENSHIP 5. RESIDENT ALIEN # OR IMMIGRATION DOCUMENT # AND DESCRIPTION

Section III. P L E A S E A N S W E R T H E F O L L O W I N G Q U E S T I O N S

YES NO

1.) Have you ever been barred from entry/access to any military installation or facility?

2.) Are you wanted by federal or civilian law enforcement authorities, regardless of offense or violation (i.e., has a judge issued an order for your arrest)?

3.) Have you ever been incarcerated for 12 months or longer within the past seven years, regardless of offense or violation?

4.) Have you ever been convicted of a firearms or explosive violation within the past seven years?

5.) Have you ever been convicted of espionage, sabotage, treason or terrorism, murder, sexual assault, armed assault or robbery, rape, child molestation, felony drug possession with intent to sell or drug distribution?

IF YOU ANSWERED YES TO ANY OF THE ABOVE, PLEASE PROVIDE A FULL EXPLANATION.

Section IV. NOTE TO APPLICANT: ATTESTATION

I attest to the fact that I have been briefed by my employer and understand the purpose for the contractor background check. I understand the information on this form is being collected in accordance with 50 U.S.C., Section 797, and DoDD 5200.8 federal laws permitting the installation commander to limit access to the installation for security reasons and that this data will be used to screen DoD contractor employees who have or are seeking access to US Air Force installations. I have voluntarily completed this “Form” and shall provide the Air Force a specimen of my fingerprints, if/when requested. I understand that by signing this application, I acknowledge that I have been made aware of and have reviewed the list of Keesler AFB “Disqualifying Factors” above. I hereby give my consent and authorization for the Air Force to conduct any additional background screenings deemed necessary over the next 24 months, unless otherwise directed by 81st Contracting Squadron, to include comparing/checking my fingerprints against local, state, and federal criminal databases. The information I have provided on this application is true, complete, and correct to the best of my knowledge and belief, and is provided in good faith. I understand that a knowing and willfully false statement on this application can be punished by fine or imprisonment or both (18 U.S.C section 1001).

Applicant Signature: Date:

81 SFS Contractor/Subcontractor Access Affidavit Form (14 JAN 08) Page 1 of 2

Section V. P R I V A C Y A C T S T A T E M E N T

Authority: 50USC Section 797; E.O.9397

PRINCIPAL PURPOSE(S): The purpose for requesting personal information is to assist Security Forces…