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Statement of Objectives Keesler Medical Center Replacement LED Sign

15 November 2021

1. Overall Objective. The Keesler Medical Center requires the procurement of an LED Display to inform the local population of MDG announcements including hours of operation and the MDG vision statement.

2. Contract Objectives. The objective of this requirement is to identify an experienced signage company who can provide a replacement LED sign as described below.

2.1. LED sign must be at least 4ft. x 7ft. (L x W) but no bigger than 5ft. x 8ft. LED sign must have a minimum of p5 pixel pitch with at least a 30 ft. viewing distance. LED sign must meet electrical standard specifications (208v single phase with a 30 amp breaker). LED sign must support Ethernet cable(s) (Cat 5e or Cat 6) connectivity to a computer that can manage signage content over hospital standalone network. LED sign must contain software application to manage software content that supports Windows based operating systems. LED sign must have 5 year warranty on parts, on site services, and any defects.

2.2. Contractor must remove old sign and properly dispose of it. Contractor must install new sign in designated location. Contractor must ensure LED sign is fully functionally prior to leaving site Contractor must ensure they have the appropriate lift equipment, tools and personnel to mount sign. Contractor must be able to obtain a military base pass to access DOD installation.

3. Contract Requirements. The contractor shall provide a proposal that states the resources and capabilities for the requirement as stated above. The contractor shall remove the current sign and install a new one on the existing structure.

LED Sign 1

LED Sign 2

LED Sign 3

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 81ST TRAINING WING (AETC)

MEMORANDUM FOR KEESLER AFB CONTRACTOR EMPLOYEES

FROM: 81st Contracting Squadron

310 M Street, Bldg. 4605 Rm 102 Keesler AFB MS 39534

SUBJECT: Implementation of Executive Order 14042, Compliance with Safer Federal Workforce Taskforce Guidance, DD Form 3150

1. In Accordance With Executive Order 14042, starting 10 Dec 21, all contract employees that work within a facility on Keesler AFB shall be required to present a DD Form 3150, Contractor Personnel and Visitor Certification of Vaccination. Contractors that are not fully vaccinated or fail to produce a DD Form 3150, are required to show proof of a negative COVID-19 test result to enter a DoD facility. The COVID-19 test results must be from a test dating no later than 72 hours prior to seeking entrance to the DoD Facility. Contractors can utilize the 81 TRW screening process as available.

2. Contractor employers shall ensure compliance with the Safer Federal Workforce Taskforce. Guidance can be found at: https://www.saferfederalworkforce.gov/contractors/. In accordance with this guidance, the Contract employer or supervisor shall validate the employee vaccination status as recorded on their DD Form 3150. Acceptable forms of validation are as follows: a copy of the record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), a copy of medical records documenting the vaccination, a copy of immunization records from a public health or State immunization information system, or a copy of any other official documentation verifying vaccination with information on the vaccine name, date(s) of administration, and the name of health care professional or clinic site administering vaccine.

DEITRE L. BROWNE

Contracting Officer

Attachment:

1. DD Form 3150 https://www.saferfederalworkforce.gov/contractors/

2021-11-29T08:49:24-0600

BROWNE.DEITRE.LYNN.1174194110

CUI (when filled in)

CUI (when filled in) Controlled by: OUSD(P&R) Controlled by: ASD(HA) CUI Category: HLTH: PRVCY; OPSEC LDC: DL(DoD Only) POC: osd.pentagon.ousd-p-r.mbx.forms@mail.mil

DD FORM 3150, OCT 2021

CONTRACTOR PERSONNEL AND VISITOR CERTIFICATION OF VACCINATION OMB No. 0704-0613 Expiration: 20220228

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PRIVACY ACT STATEMENT

Authority: DoD is authorized to collect the information on this form pursuant to Executive Order (E.O.) 14042, Ensuring Adequate COVID Safety Protocols for Federal Contractors; E.O. 13991, Protecting the Federal Workforce and Requiring Mask-Wearing; and E.O. 12196, Occupational Safety and Health Program for Federal Employees; as well as 10 U.S.C. 113, 10 U.S.C. 136, 10 U.S.C. 7013, 10 U.S.C. 8013, 10 U.S.C. 9013, 10 U.S.C. 2672, 5 U.S.C. chapter 79, and DoD Instruction 6200.03.

Principal Purpose: This information is being collected to implement Coronavirus Disease 2019 (COVID-19) workplace safety plans, including DoD's COVID-19 testing programs, and to ensure the safety and protection of the DoD workforce, workplace, and other DoD facilities and environments, consistent with the above-referenced authorities, the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force, and guidance from the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration.

Routine Use(s): While the information requested on this form is intended to be used primarily for internal purposes, in certain circumstances it may be necessary to disclose this information externally, for example to disclose information to: a person, organization, or governmental entity as necessary and relevant to notify them of, respond to, or guard against a public health emergency or other similar crisis, including to comply with laws governing the reporting of communicable disease or other laws concerning health and safety in the work environment; adjudicative or administrative bodies or officials when the records are relevant and necessary to an adjudicative or administrative proceeding; contractors, grantees, experts, consultants, students, and others as necessary to perform their duties for the Federal government; agencies, courts, and persons as necessary and relevant in the course of litigation, and as necessary and in accordance with requirements for law enforcement; or to a person authorized to act on your behalf. A complete list of routine uses may be found in the applicable System of Records Notice (SORN) associated with the collection of this information from contractor personnel and DoD visitors: DPR 39 DoD, DoD Personnel Accountability and Assessment System of Records, 85 Fed. Reg. 17047 (Mar. 26, 2020) (also available at https://dpcld.defense.gov/Portals/49/ Documents/Privacy/SORNs/OSDJS/DPR-39-DoD.pdf).

Consequences of Failure to Provide Information: Providing this information is voluntary. However, if you fail to provide this information, you will be treated as not fully vaccinated for purposes of implementing safety measures, including subject to COVID-19 screening testing and/or denied access to DoD facilities.

Failure to provide such information may also hinder DoD's ability to implement COVID-19 workplace safety plans, thereby increasing the health or safety risk to DoD-affiliated personnel and DoD facilities.

INSTRUCTIONS: This form should be completed by DoD contractor personnel and official visitors in accordance with current DoD Force Health Protection Guidance. DoD civilian employees should not complete this form.

1. NAME (Last, First, MI): 2. DoD ID NUMBER:

3. PLEASE CHECK THE BOX BELOW THAT COINCIDES WITH YOUR COVID-19 VACCINATION STATUS :

I am fully vaccinated.

Individuals are considered “fully vaccinated” two weeks after completing the second dose of a two-dose COVID-19 vaccine or two weeks after receiving a single dose of a one-dose vaccine. Accepted COVID-19 vaccines are those which have received a license or emergency use authorization from the U.S. Food and Drug Administration and those COVID-19 vaccines on the World Health Organization Emergency Use Listing.

“Fully vaccinated” also includes circumstances in which the individual was a participant in a U.S. site clinical trial and has received all recommended doses.

I am not yet fully vaccinated. I received only one dose of an accepted two-dose COVID-19 vaccine, or I received my final dose of an accepted COVID-19 vaccine less than two weeks ago.

I have not been vaccinated.

I decline to respond.

Individuals who choose not to complete the form will be assumed to be not fully vaccinated for purposes of application of the safety protocols. If you are not vaccinated due to medical or religious reasons, please check either “I have not been vaccinated” or “I decline to respond.” Note that if you have already received one dose of a vaccine, but are not yet fully vaccinated, or if you received your final dose less than two weeks ago, then you will be treated as not fully vaccinated until you are at least two weeks past your final dose and resubmit your vaccination information.

I certify that the information provided in this form is accurate and true to the best of my knowledge.

I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (18 U.S.C. 1001). Checking “I decline to respond” does not constitute a false statement.

4. DATE (YYYYMMDD) 5. SIGNATURE (Full Name) mailto:osd.pentagon.ousd-p-r.mbx.forms@mail.mil?subject=CUI%20Question%20regarding%20DD%20Form%203150

DRAFT

SAMPLE

DD FORM 3150, OCT 2021

Page of

CUI (when filled in)

Document Controlled Unclassified Information when filled in

CUI (when filled in)

Document Controlled Unclassified Information when filled in

Controlled by: OUSD(P&R)

Controlled by: ASD(HA)

CUI Category: HLTH: PRVCY; OPSEC

LDC: DL(DoD Only)

POC: osd.pentagon.ousd-p-r.mbx.forms@mail.mil

CUI designation indicator

DD FORM ####, YYYYMMDD DRAFT

NEEDS DD67

PREVIOUS EDITION IS OBSOLETE.

Page of

CUI (when filled in)

Document Controlled Unclassified Information when filled in

CUI (when filled in)

Document Controlled Unclassified Information when filled in

CONTRACTOR PERSONNEL AND VISITOR CERTIFICATION OF VACCINATION

OMB No. 0704-0613 Expiration: 20220228

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PRIVACY ACT STATEMENT

Authority: DoD is authorized to collect the information on this form pursuant to Executive Order (E.O.) 14042, Ensuring Adequate COVID Safety Protocols for Federal Contractors; E.O. 13991, Protecting the Federal Workforce and Requiring Mask-Wearing; and E.O. 12196, Occupational Safety and Health Program for Federal Employees; as well as 10 U.S.C. 113, 10 U.S.C. 136, 10 U.S.C. 7013, 10 U.S.C. 8013, 10 U.S.C. 9013, 10 U.S.C. 2672, 5 U.S.C. chapter 79, and DoD Instruction 6200.03.

Principal Purpose: This information is being collected to implement Coronavirus Disease 2019 (COVID-19) workplace safety plans, including DoD's COVID-19 testing programs, and to ensure the safety and protection of the DoD workforce, workplace, and other DoD facilities and environments, consistent with the above-referenced authorities, the COVID-19 Workplace Safety: Agency Model Safety Principles established by the Safer Federal Workforce Task Force, and guidance from the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration.

Routine Use(s): While the information requested on this form is intended to be used primarily for internal purposes, in certain circumstances it may be necessary to disclose this information externally, for example to disclose information to: a person, organization, or governmental entity as necessary and relevant to notify them of, respond to, or guard against a public health emergency or other similar crisis, including to comply with laws governing the reporting of communicable disease or other laws concerning health and safety in the work environment; adjudicative or administrative bodies or officials when the records are relevant and necessary to an adjudicative or administrative proceeding; contractors, grantees, experts, consultants, students, and others as necessary to perform their duties for the Federal government; agencies, courts, and persons as necessary and relevant in the course of litigation, and as necessary and in accordance with requirements for law enforcement; or to a person authorized to act on your behalf. A complete list of routine uses may be found in the applicable System of Records Notice (SORN) associated with the collection of this information from contractor personnel and DoD visitors: DPR 39 DoD, DoD Personnel Accountability and Assessment System of Records, 85 Fed. Reg. 17047 (Mar. 26, 2020) (also available at https://dpcld.defense.gov/Portals/49/Documents/Privacy/SORNs/OSDJS/DPR-39-DoD.pdf).

Consequences of Failure to Provide Information: Providing this information is voluntary. However, if you fail to provide this information, you will be treated as not fully vaccinated for purposes of implementing safety measures, including subject to COVID-19 screening testing and/or denied access to DoD facilities. Failure to provide such information may also hinder DoD's ability to implement COVID-19 workplace safety plans, thereby increasing the health or safety risk to DoD-affiliated personnel and DoD facilities.

INSTRUCTIONS: This form should be completed by DoD contractor personnel and official visitors in accordance with current DoD Force Health Protection Guidance. DoD civilian employees should not complete this form.

3. PLEASE CHECK THE BOX BELOW THAT COINCIDES WITH YOUR COVID-19 VACCINATION STATUS :

I am fully vaccinated.

Individuals are considered “fully vaccinated” two weeks after completing the second dose of a two-dose COVID-19 vaccine or two weeks after receiving a single dose of a one-dose vaccine. Accepted COVID-19 vaccines are those which have received a license or emergency use authorization from the U.S. Food and Drug Administration and those COVID-19 vaccines on the World Health Organization Emergency Use Listing. “Fully vaccinated” also includes circumstances in which the individual was a participant in a U.S. site clinical trial and has received all recommended doses.

I am not yet fully vaccinated. I received only one dose of an accepted two-dose COVID-19 vaccine, or I received my final dose of an accepted COVID-19 vaccine less than two weeks ago.

I have not been vaccinated.

I decline to respond.

Individuals who choose not to complete the form will be assumed to be not fully vaccinated for purposes of application of the safety protocols. If you are not vaccinated due to medical or religious reasons, please check either “I have not been vaccinated” or “I decline to respond.” Note that if you have already received one dose of a vaccine, but are not yet fully vaccinated, or if you received your final dose less than two weeks ago, then you will be treated as not fully vaccinated until you are at least two weeks past your final dose and resubmit your vaccination information.

I certify that the information provided in this form is accurate and true to the best of my knowledge.

I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both (18 U.S.C. 1001). Checking “I decline to respond” does not constitute a false statement.

9.0.0.2.20120627.2.874785

DD Form 3150, "Certification of Vaccination"

Forms Management Office

OUSD(P&R)

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Combined Synopsis/Solicitation

81st CONTRACTING SQUADRON (AETC)

Page 1 of 5Page 1 of 5

Requirement Title: LED Sign

Solicitation Number: FA3010-22-Q-C003

Solicitation Issue Date: December 1, 2021

Response Deadline: Friday, 10 December 2021 no later than 11:00 AM CST

Point(s) of Contact: Rachel Davis, Contracting Specialist

Phone: 228-377-1804 | Email: rachel.davis.15@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 06/10/2021 Defense Federal Acquisition Regulation Public Notice 07/09/2021 Air Force Federal Acquisition Circular 05/21/2021

4. This requirement is being set-aside for: 100% Small Business Set-Aside

The North American Industry Size Classification System (NAICS) code associated with this requirement is 339950

Requirement Information

Description:

The 81 MDG is requesting procurement of an LED Display to inform the local population of MDG announcements, which includes hours of operation and the MDG vision statement.

Place of Delivery/Performance/Acceptance/FOB Point:

Keesler Medical Center FOB Destination

Line Item Description Quantity Unit Unit Price Extended Price 0001 LED Sign with installation/removal IAW attach 1/SOO 1 each

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 2 December 2021 @ 4:00 pm CST

Amendment 1

Page 2 of 5Page 2 of 5

- Quotes are required to be valid until 31 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:

Price and Technical Acceptability

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✖

52.222-19, Child Labor--Cooperation with Authorities and Remedies✖

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:

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.

Page 3 of 5Page 3 of 5

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.

Invoice (Stand-Alone) or Combo

(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.

N/A

(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 || F67100

Issue By DoDAAC || FA3010

Admin DoDAAC || FA3010

Inspect By DoDAAC ||FM3010

Ship To Code ||FM3010

Ship From Code ||

Mark For Code ||

Service Approver (DoDAAC) ||

Service Acceptor (DoDAAC) ||

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.

rachel.davis.15@us.af.mil kimberley.alvarez.1@us.af.mil

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

(End of clause)

Attachments

Attachment 1- Statement of Objectives Attachment 2 - Photos of LED Sign to be Replaced Attachment 3 - Implementation of Executive Order 14042, Compliance with Safer Federal Workforce Taskforce Guidance, DD

Form 3150 Attachment 4 - DD Form 3150_Certification of Vaccination

Funds Available

Funds Not Currently Available

Attachment 5 - V1 Questions and Answers

Question # Date Received Question Response

1 12/02/21

"In lieu of Cat5 or Cat6 Data cable, can we use Broadband wireless? Broadband Wireless does not run on the Hospital network and is secure. If not, we can run fiber optic cable. With broad ban wireless, we can load the soft ware on any machine that is sending messages, or we can use a cloud based software. Most Casinos use the cloud based software. It is very secure. "

We must use Cat 5e / 6 for the new sign device and it will be patched into our standalone network. There is already a cat 5e / cat 6 cable coming from the existing sign. We cannot use cloud based at this time due to Govt STIGs etc.

2 12/02/21 "The electrical specs call for 208 voltage, however, most signs run on 120v single Phase. The 30 amps circuit breaker is fine. "

120v single phase unit will work

3 12/02/21

"Sign displays come in 6mm, 8mm, 10mm and 16mm. For this location, 8mm is more than what is needed. I am not sure what P5 pixel pitch means.

Can you explain."

p5 correlates with 5mm which is an estimated viewing distance. 6mm would be acceptable.

LED Sign Q&A Version 1

Date

LED Sign Portfolio - Copy 2

V1 Question and Answer - LED Sign answers

Q&A