Performance_Work_Statement.pdf

PERFORMANCE WORK STATEMENT

HYPERBARIC MEDICINE EVAPCO AIR COMPRESSOR

COOLING TOWERS REPAIR

DAVID GRANT MEDICAL CENTER, TRAVIS AFB, CA

26 Feb 2018

Table of Contents

Section Title Page

1 Description of Services 3

2 Government Furnished Property and Services 4

3 General Information 4

4 Contractor Identification 4

Appendix A Applicable Publications 5

Appendix B Standard Abbreviations and Terms 8

1. DESCRIPTION OF SERVICES

1.1 The contractor shall provide non-personal services consisting of service, repair, parts, calibration, upgrading and performing preventive maintenance as defined in this Performance

Work Statement (PWS) to upgrade the cooling towers in the hyhperbarics department, located at the 60th Medical Group, David Grant Medical Center, Travis Air Force Base, California. The contractor shall perform these services in accordance with the standards specified in this contract and in accordance with the Original Equipment Manufacturer (OEM) Specifications, the National

Fire Protection Association Standard NFPA 99 (Electrical Equipment in Healthcare Facilities), the

Bureau of Radiological Health (BRH), Health Insurance Portability and Accountability Act

(HIPAA) IAW 45CFR 160 and 164, and the Joint Commission for Accreditation of Health Care

Organizations (JCAHO). The contractor shall submit reports and documentation as identified throughout this PWS. The contractor shall make available a standard commercial quality control plan upon request by a government representative. Contractor tasks include:

OEM Replacement Parts

Furnish and insall 2 new spray pumps

Modifty piping for pums

Install new mounting brakets if necessary

Furnish and install 2 new 3 probe float assemblies

Wire in controls and test

Replace 2 water fill solenoids

Review of system operation

Remove all debris created by contractor

Certified Training

All Parts Included/No Exclusions

Any other remedial maintenance of non-emergency nature including but not limited to adjustments, calibrations, lubrications, cleaning, testing, replacement of work or defective non-consumable parts, etc. required to keep the equipment in good operating condition.

due to an emergency malfunction includes the cost of replacement parts as required on an exchange or new part basis. Service outside of the normal hours covered by the contract shall require prior authorization from the Contracting Officer’s Representative and upon approval coordination with the Radiation Oncology Department and Medical Equipment Repair Center prior to the start of any work by the contractor.

1.4. Operator Training. Contractor shall provide instructions, training, and minor troubleshooting support to DGMC equipment operators through telephone technical or on-site during maintenance.

1.5. Service Reports. A service report is required for any maintenance service performed at any time. Contractor shall check in at the Medical Equipment Repair Center both upon arrival on-site and upon completion of the work. The original service report, signed off by the department using the equipment, must be presented to the Medical Equipment Repair Center upon completion of the work prior to departure and a copy provided to the Medicare Equipment Repair Center. The service report must include the following as a minimum:

Date and time of service.

Company and service representative names.

Contract number.

A detailed description of any services or repairs performed, documenting labor and any parts used.

Any contractor recommendations necessary to maintain the equipment in the best operating condition.

For PM/Calibration service calls, the PM/Calibration checklist with results will serve as the service report.

Contractor shall ensure compliance with the National Fire Protection Association Standard

NFPA 99 (Electrical Equipment in Healthcare Facilities), and shall list electrical leakage current and ground resistance readings for equipment and provide this information as part of the service report if applicable.

2. GOVERNMENT FURNISHED PROPERTY AND SERVICES.

3.1. Emergency Medical Treatment. In the event contractor personnel are injured while performing contract duties on the base and emergency treatment is required, the MTF services may be used. If used, the contractor will be billed for the service at the standard rate for civilian emergencies.

3. GENERAL INFORMATION

3.1. Contractor Personnel:

3.1.1. Management. The contractor shall provide a company representative who shall be responsible for ensuring that the contract services are provided satisfactorily. The name of this company representative, and an alternate or alternates, who shall act for the company representative when he/she is absent, shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The company representative or alternate shall be available during normal duty hours (7:30 AM – 4:30 PM) to discuss problem areas.

3.2. Removal of Equipment. Should the equipment or any component listed herein require repair at the contractor’s plant, contractor shall obtain a signed authorization from the FRED authorizing removal of government equipment. Contractor shall be responsible for damage or loss of equipment while in contractor’s possession.

4. CONTRACTOR IDENTIFICATION

All contractor management staff or contracted employee shall clearly be identified as such at all times, including conversations, mail, email, faxes, and/or other electronic communication whether with government personnel, other contractor personnel, or with public when supporting this contract. Likewise, the contractor shall abide by all applicable laws and regulations when using government equipment and services in performance of this contract. As a minimum, contractor management staff or contracted personnel shall clearly identify themselves as contractors by: wearing badges which clearly and legibly identify the employee as a contractor; using the label “contractor” in email addresses in accordance with

Federal Acquisition Regulation (FAR) 37.114. MTF issued identification badge shall be worn above the waistline during the individual’s duty hours.

5. ENVIRONMENTAL CONTROLS

5.1. Compliance with Laws and Regulations. The contractor shall be knowledgeable of and comply with all applicable Local, State, and Federal requirements regarding environmental protection. In the event environmental laws/regulations change during the term of this contract, the contractor is required to comply as such laws come into effect. If there is an increase or decrease in cost as a result of the change, the contractor shall inform the Contracting Officer pursuant to notice requirements and negotiate a modification to the contract.

5.2. Environmental Management System (EMS). Contractors shall perform work under this contract in a manner that is consistent with Travis AFB EMS and conforms to all applicable environmental laws, regulations and policies. Upon awarding of the contract, the Contracting Officer's Representative will direct the Contractor to review and post the Travis EMS Environmental Policy Letter in the workplace and review the EMS Awareness Training slide presentation; both items are located at the Travis AFB

Environmental website at http://www.travis.af.mil/Portals/30/AFD-120628-061.pdf?ver=2016-05-10-

163604-510. Within seven business days of the start date, the Contractor shall provide the Contracting

Officer with a list of names of all employees who viewed the applicable training as well as the date training was completed. The Contractor shall provide information when necessary to demonstrate written conformance with these requirements upon request.

APPENDIX A

APPLICABLE PUBLICATIONS

Publications and forms are available electronically through the internet. For example: http://www.e-publishing.af.mil/ is the Air Force’s e-publishing site and one way to obtain Air Force Instructions. DoD

Directives can be found at http://www.esd.whs.mil/DD/. Regulations are followed by a “-R” (e.g., DoD

5200.-R) and be located on a website by clicking on “publications” instead of “directives”. 60th Medical

Group Instructions (60 MDGIs) can be located on the MTF website and can be provided to the contractor upon request.

DEPARTMENT OF DEFENSE (DoD) REGULATIONS/MANUALS INSTRUCTIONS/DIRECTIVES

PUB NO. TITLE

http://www.e-publishing.af.mil/ http://www.e-publishing.af.mil/ http://www.esd.whs.mil/DD/

DoD 5200.01 Information Security Program and Protection of Sensitive

Compartmented Information

DoD 5200.2-R Personnel Security Program

DoDD 5400.11 Privacy Program

DoDD 5500.7 Standards of Conduct

DoD 6025.18-R Health Information Privacy Regulation Jan 03

DoD 6025.40 Military Health System Data Quality Management Controls

Procedures

DoD 6040.41 Medical Records Retention and Coding at Military treatment

Facilities

DoDD 8500.1 Information Assurance

DoD 8580.02-R HIPAA Security Rule

AIR FORCE INSTRUCTIONS/MANUALS

PUB NO. TITLE

AFI 16-1404 Air Force Information Security Program

AFI 16-1406 Air force Industrial Security Program

AFI 31-501 Personal Security Program Management

AFI 33-322 Records Management Program

AFI 33-332 The Air Force Privacy and Civil Liberties Program

AFI 33-364 Records Disposition – Procedures and Responsibilities

AFI 35-107 Public Web and Social Communications

AFI 36-2201 Air Force Training Program

AFI 36-3002 Casualty Services

AFI 40-102 Tobacco Free Living

AFI 44-102 Medical Care Management

AFI 41-117 Medical Service Officers Education

AFI 44-119 Medical Quality Operations

AFI 48-105 Surveillance, Prevention, and Control of Diseases and

Conditions of Public Health or Military Significance

AFI 33-360 Publications and Forms Management

AFMAN 33-152 User Responsibilities and Guidance for Information Systems

AFMAN 33-363 Management of Records

Publications Code:

AFI--Air Force Instruction

AFMAN--Air Force Manual

AFP--Air Force Pamphlet

AF Form--Air Force Form

DD Form--Department of Defense Form

APPENDIX B

STANDARD ABBREVIATIONS AND TERMS

Abbreviation and acronyms

CO: Contracting Officer

COR: Contracting Officer Representative

FRED: Functional Requirements Evaluator Designee

MTF: Medical Treatment Facility

PWS: Performance Work Statement

QC: Quality Control

Terms

Contracting Officer (CO) – The CO has the overall responsibility for contract administration and is the primary focal point for formal government-contractor interface. The CO is responsible for monitoring contract compliance and resolving disagreements regarding interpretation of contract terms and conditions. The two primary functions of the CO with regard to surveillance are to authorize changes to the contract and to approve payment. Payment is authorized based on documented objective evidence provided by the COR that contractor performance meets the performance standards specified. The CO is also responsible for approving the QASP.

Contractor - The company identified in block 15A of Standard Form 33. The Contractor is an independent contractor and is responsible for its own liability. Contractor refers to the prime Contractor.

The prime Contractor retains responsibility for any teaming partner or subcontractor and shall be accountable for their performance.

Functional Requirements Evaluator Designee (FRED) - Individual/s who are appointed to provide technical surveillance over contracted healthcare workers and who will provide feedback on a regular basis to the COR.

Medical Treatment Facility (MTF) - Air Force hospitals or clinics, including all activities providing outpatient and/or in-patient healthcare services for authorized personnel.

Performance Work Statement (PWS) - The standard of work that describes the core requirements in clear, specific, and objective terms with measureable outcomes.