Award_HT0011-13-P-0024_TapRoot.pdf

6 . ISSUE D BY CODE

HT0011-13-P-0024

1 . CO N TRA CT/P U RCH . O RD E R/

A G RE E M E N T N O .

H T0011

2 . D E L IVE RY O RD E R/ CA L L N O .

44P AGE 1 OF

5 . P RIO RITY

CODE

8 . DEL IVERY FOB

DEST INAT IONX

OT HE R

(See Sch edule if o t h er)

OR D ER FOR SUPPLIES OR SER VICES

3 . D A TE O F O RD E R/CA L L

2013 Sep 27

4 . RE Q ./ P U RCH . RE Q U E ST N O .

H T000331985867

SEE IT EM 6

TR IC AR E MAN AGEMEN T AC TIVITY

7700 AR LIN GTON BLVD

F ALLS C H U R C H VA 22042

7 . ADM INIST E RE D BY (if o th er th a n 6 )

( YYYYM M M D D )

1 0 . D E L IVE R TO FO B P O IN T BY (D ate)

( YYYYM M M D D )

SY STEM IMPR OVEMEN TS, IN C .

ED W AR D SKOMPSKI

238 S PETER S R D STE 301

KN OXVILLE TN 37923-5224

CODE 0PWJ49 . CONT RACT OR FACIL IT Y

SEE SCHEDULE

1 2 . D ISCO U N T TE RM S

N et 30 D ays

M A RK IF BU SIN E SS IS1 1 .

SM A L L

SM A L L

D ISA D VA N TA G E D

W O M E N -O W N E D

1 3 . M AIL INVOICE S T O T HE ADDRESS IN BLOCK

See Item 15

2 5 . T OT AL $154,822.00

TR IC AR E MAN AGEMEN T AC TIVITY

OF F IC E OF C H IEF MED IC AL OF F IC ER - OC MO

D H H Q BU ILD IN G

7700 AR LIN GTON BLVD , SU ITE 5101

F ALLS C H U R C H VA 22042-5101

1 7 . ACCOUNT ING AND AP P ROP RIAT ION DAT A/ L OCAL USE

CODE

1 8 . IT E M NO. 1 9 . SCHEDUL E OF SUP P LIE S/ SERVICE S

* If q u a n t i ty a ccep ted b y th e G o ver n m en t is s a m e a s q u a n t i ty a ccep ted b elo w q u a n t i ty o r d er ed a n d en cir cle.

DE L IVE RY/1 6 .

1 4 . SHIP T O

Se e Sche dule

H T0003 H Q0649

MARK ALL

P AC KAG ES AND

P AP ERS W ITH

IDENTIFIC ATIO N

NUMB ERS IN

B LO C KS 1 AND 2 .

2 3 . AM OUNT

1 5 . P AYM ENT W IL L BE M ADE BY CODE

D F AS IN VP D AI TMA

8899 EAST 56TH STR EET

IN D IAN APOLIS IN 46249-1505

Th is d el iv ery o rd er/cal l i s i s s u ed o n an o th er G o v ern men t ag en cy o r in acco rd an ce w i th an d s u b ject to terms an d co n d i t io n s o f ab o v e n u mb ered co n tract .

T YP E CAL L

OF P URCHASE X

ORDE R

SEE SCHEDULE

24. UNITED STATES OF AMERICA

TEL:

EMAIL: Robert.LeBlanc@tma.osd.mil

CONTRACTING / ORDERING OFFICER

q u a n t i ty o r d er ed , in d ica te b y X . If d i f f er en t , en ter a ctu a l

BY: Robert LeBlanc

If t h is bo x is m ark ed, sup p lier m ust sign Accep t an ce an d ret urn t h e fo llo win g n um ber o f co p ies:

NAM E OF CONT RACT OR SIGNAT URE T YP E D NAM E AND T IT L E

( YYYYM M M D D )

DAT E SIGNE D

ACCE P T ANCE. T HE CONT RACT OR HE REBY ACCE P T S T HE OFFE R REP RESE NT ED BY T HE NUM BE RED P URCHASE ORDE R AS IT M AY P REVIOUSL Y HAVE BEE N OR IS NOW M ODIFIE D, SUBJE CT T O AL L OF T HE T E RM S

AND CONDIT IONS SE T FORT H, AND AGRE ES T O P ERFORM T HE SAM E.

2013 Sep 23Referen ce y o u r q u o te d ated

Fu rn is h th e fo l lo w in g o n terms s p eci fied h erein . REF :

2 0 . QUANT IT Y

ORDERE D/

ACCE P T ED*

2 1 . UNIT 2 2 . UNIT P RICE

D IFFE RE N CE S

2 6 .

INSP E CT E D RE CE IVED ACCEP T E D, AND CONFORM S T O T HE

CONT RACT EXCEP T AS NOT E D

2 7 a. QUANT IT Y IN COL UM N 2 0 HAS BE E N

( YYYYM M M D D )

c. DAT E d. P RINT E D NAM E AND T IT L E OF AUT HORIZ ED

GOVERNM E NT RE P RE SENT AT IVE

b. SIGNAT URE OF AUT HORIZ E D GOVE RNM E NT RE P RE SENT AT IVE

e. M AIL ING ADDRE SS OF AUT HORIZ ED GOVE RNM ENT REP RESE NT AT IVE

36. I ce r tify th is account is cor re ct and prope r for paym e nt.

g. E -M AIL ADDRESSf. T EL EP HONE NUM BE R

a. DAT E

( YYYYM M M D D )

b. SIGNAT URE AND T IT LE OF CE RT IFYING OFFICE R

2 8 . SHIP NO. 2 9 . DO VOUCHER NO. 3 0 .

INIT IAL S

3 2 . P AID BY 3 3 . AM OUNT VE RIFIED

CORRE CT FOR

3 5 . BIL L OF LADING NO.

3 4 . CHE CK NUM BE R

3 7 . RE CEIVED AT 3 8 . RECE IVE D BY

( YYYYM M M D D )

3 1 . P AYM E NT

COM P L ET E

P ART IAL

FINAL

P ART IAL

FINAL

DD For m 1155, DEC 2001 P RE VIOUS EDIT ION IS OBSOL ET E .

3 9 . DAT E RE CE IVED 4 0 . T OT AL

CONT AINERS

4 1 . S/R ACCOUNT NO. 4 2 . S/R VOUCHE R NO.

AD D R ESS

AN D

N AME

Section B - Supplies or Services and Prices

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Each $14,520.00 $14,520.00 Labor-TapRoot-

FFP

Program Manager I( 24 hours) and Subject Matter Expert III( 72 hours). See performance work statement and pricing sheet for more information.

FOB: Destination

BRAND NAME/SOLE SOURCE: SS

PURCHASE REQUEST NUMBER: HT000331985867

NET AMT $14,520.00

000101 $0.00 Funding for CLIN 0001

FFP

FOB: Destination

NET AMT $0.00

ACRN AA

CIN: HT000331985867000101

$14,520.00

0002 Lot $134,902.00 Direct Cost- Non Labor

COST

Software license and maintenance (1 qty), 2 day TapRoot Training Session( 2 qty), TapRoot training materials ( 10 sets), instructor Recertification, Travel (1 qty), and tapRoot training Material Sets (353 qty). see schedule for information.

FOB: Destination

ESTIMATED COST $134,902.00

000201 $0.00 Funding for CLIN 0002

CIN: HT000331985867000201

$134,902.00

0003 Lot $18,250.00 OPTION Optional Task 1-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 36-45. See section C for more information.

FOB: Destination

ESTIMATED COST $18,250.00

0004 Lot $20,550.00 OPTION Optional Task 2-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 46-55. See section C for more information.

FOB: Destination

ESTIMATED COST $20,550.00

0005 Lot $5,400.00 Other Direct Cost

COST

Shipping Cost. Shipping cost for training materials 100 students and for 358 sets of training materials.

FOB: Destination

ESTIMATED COST $5,400.00

000501 $0.00 Funding for CLIN 0005

CIN: HT000331985867000501

$5,400.00

1001 1 Months $14,520.00 $14,520.00 OPTION Labor-TapRoot-

FFP

Program Manager I( 24 hours) and Subject Matter Expert III( 72 hours). See performance work statement and pricing sheet for more information.

FOB: Destination

1002 Lot $141,539.00 OPTION Direct Cost- Non Labor

COST

Software license and maintenance (1 qty), 2 day TapRoot Training Session( 2 qty), TapRoot training materials ( 10 sets), instructor Recertification, Travel (1 qty), and tapRoot training Material Sets (353 qty). see schedule for information.

FOB: Destination

ESTIMATED COST $141,539.00

1003 Lot $19,163.00 OPTION Optional Task 1-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 36-45. See section C for more information.

FOB: Destination

ESTIMATED COST $19,163.00

1004 Lot $21,578.00 OPTION Optional Task 2-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 46-55. See section C for more information.

FOB: Destination

ESTIMATED COST $21,578.00

1005 Lot $5,675.00 OPTION Other Direct Cost

COST

Shipping Cost. Shipping cost for training materials 100 students and for 358 sets of training materials.

FOB: Destination

ESTIMATED COST $5,675.00

2001 1 Each $14,520.00 $14,520.00 OPTION Labor-TapRoot-

FFP

Program Manager I( 24 hours) and Subject Matter Expert III( 72 hours). See performance work statement and pricing sheet for more information.

FOB: Destination

2002 Lot $144,454.00 OPTION Direct Cost- Non Labor

COST

Software license and maintenance (1 qty), 2 day TapRoot Training Session( 2 qty), TapRoot training materials ( 10 sets), instructor Recertification, Travel (1 qty), and tapRoot training Material Sets (353 qty). see schedule for information.

FOB: Destination

ESTIMATED COST $144,454.00

2003 Lot $20,121.00 OPTION Optional Task 1-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 36-45. See section C for more information.

FOB: Destination

ESTIMATED COST $20,121.00

2004 1 Lot $22,656.00 $22,656.00 OPTION Optional Task 2-2 day TapRoot Training

FFP

2 day TapRoot training, classroom size 46-55. See section C for more information.

FOB: Destination

NET AMT $22,656.00

2005 Lot $5,951.00 OPTION Other Direct Cost

COST

Shipping Cost. Shipping cost for training materials 100 students and for 358 sets of training materials.

FOB: Destination

ESTIMATED COST $5,951.00

3001 1 Each $14,520.00 $14,520.00 OPTION Labor-TapRoot-

FFP

Program Manager I( 24 hours) and Subject Matter Expert III( 72 hours). See performance work statement and pricing sheet for more information.

FOB: Destination

3002 Lot $155,606.00 OPTION Direct Cost- Non Labor

COST

Software license and maintenance (1 qty), 2 day TapRoot Training Session( 2 qty), TapRoot training materials ( 10 sets), instructor Recertification, Travel (1 qty), and tapRoot training Material Sets (353 qty). see schedule for information.

FOB: Destination

ESTIMATED COST $155,606.00

3003 Lot $21,127.00 OPTION Optional Task 1-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 36-45. See section C for more information.

FOB: Destination

ESTIMATED COST $21,127.00

3004 Lot $23,789.00 OPTION Optional Task 2-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 46-55. See section C for more information.

FOB: Destination

ESTIMATED COST $23,789.00

3005 Lot $6,248.00 OPTION Other Direct Cost

COST

Shipping Cost. Shipping cost for training materials 100 students and for 358 sets of training materials.

FOB: Destination

ESTIMATED COST $6,248.00

4001 1 Each $14,520.00 $14,520.00 OPTION Labor-TapRoot-

FFP

Program Manager I( 24 hours) and Subject Matter Expert III( 72 hours). See performance work statement and pricing sheet for more information.

FOB: Destination

4002 Lot $163,098.00 OPTION Direct Cost- Non Labor

COST

Software license and maintenance (1 qty), 2 day TapRoot Training Session( 2 qty), TapRoot training materials ( 10 sets), instructor Recertification, Travel (1 qty), and tapRoot training Material Sets (353 qty). see schedule for information.

FOB: Destination

ESTIMATED COST $163,098.00

4003 Lot $22,183.00 OPTION Optional Task 1-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 36-45. See section C for more information.

FOB: Destination

ESTIMATED COST $22,183.00

4004 Lot $24,979.00 OPTION Optional Task 2-2 day TapRoot Training

COST

2 day TapRoot training, classroom size 46-55. See section C for more information.

FOB: Destination

ESTIMATED COST $24,979.00

4005 Lot $6,567.00 OPTION Other Direct Cost

COST

Shipping Cost. Shipping cost for training materials 100 students and for 358 sets of training materials.

FOB: Destination

ESTIMATED COST $6,567.00

Section C - Descriptions and Specifications

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT (PWS)

TAPROOT® LICENSE, METHODOLOGY, TRAINING MATERIALS AND SUPPORT

Part 1

General Information

1. GENERAL: This is a non-personnel services requirement to provide TapRooT software license, methodology, training, recertification of instructors, and technical support maintenance for those products and services. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform and deliver TapRooT software license, methodology, training, recertification of instructors, and technical support maintenance as defined in this Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: TapRooT® was selected by the government as the Root Cause Analysis (RCA) methodology and software tool for use in military treatment facilities (MTFs) in the conduct of RCAs for patient safety events and other risk evaluations. The TapRooT® product has been distributed to all fixed facilities in the Military Healthcare System (MHS) for use by appropriately trained personnel. Currently, that distribution is inclusive of over 450 facilities, exclusive of the operational theater environment of the MHS.

1.3 Objectives: The objectives of this Statement of Work are:

To provide for the training of additional DoD personnel to become certified in conducting

TapRooT® investigations.

To provide TapRooT® training materials to support the Basic TapRooT® Course (2-day classroom based for methodology and four-hour virtual for software).

To provide for technical consulting services for each of the Services in order to enhance their understanding of the TapRooT® products and to provide consultation services regarding the Basic TapRooT courses held for MHS staff.

To provide for the annual re-certification of the MHS TapRooT® instructors.

To provide TapRoot® Software License and Maintenance

1.4 Scope: This PWS provides for technical support for DoD Patient Safety Training activities to support the implementation of DODI 6025.13, Medical Quality Assurance (MQA) in the Military Health System (MHS).

Contractor shall provide the necessary personnel and materials to support the development of a cadre of instructors capable of training MHS personnel in the TapRooT® Incident Investigation and Root Cause Analysis 2-day course, to teach classes as provided for in this Statement of Work, provide appropriate materials for training programs offered by the Office of the Chief Medical Officer (OCMO), and support technical needs associated with use of TapRooT software.

1.5 Period of Performance: The period of performance shall be for one (1) Base Year of 12 months and four (4) 12-month option years. The Period of Performance reads as follows:

Base Year: 30-SEP-2013 TO 29-SEP-2014 Option Year I: 30-SEP-2014 TO 29-SEP-2015 Option Year II: 30-SEP-2015 TO 29-SEP-2016 Option Year III: 30-SEP-2016 TO 29-SEP-2017 Option Year IV: 30-SEP-2017 TO 29-SEP-2018

1.6 General Information

1.6.1 Quality Control The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. The Contractor shall prepare and adhere to a Quality Control Plan (QCP). The QCP shall be updated following award (Deliverable 8). The QCP shall document how the Contractor shall meet and comply with the quality standards established in this statement of work. At a minimum, the QCP must include a self-inspection plan, an internal staffing plan, and an outline of the procedures that the Contractor shall use to maintain quality, timeliness, responsiveness, customer satisfaction, and any other requirements set forth in this solicitation. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: The contractor is not required to perform services on holidays.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Independence Day Christmas Day

1.6.4 Hours of Operation: The contractor is responsible for conducting business, between the hours of 0900 and 1700 ET Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at the contractor selected facility or location for all tasks except the TapRooT investigation. The TapRooT investigation training will be delivered at a location identified by the government.

1.6.6 Type of Contract: The government will award a firm fixed contract.

1.6.7 Security Requirements: Contractor personnel performing work under this contract must have a security plan at time of the proposal submission, and must maintain the level of security according to that plan for the life of the contract. The security requirements are in accordance with the attached DD254.

1.6.7.1 Physical Security: Not Applicable as the government shall not provide the contractor government equipment, information and property.

1.6.7.2 Key Control: Not applicable.

1.6.7.3 Lock Combinations: Not applicable.

1.6.8 Special Qualifications: Not applicable.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced.

Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.6.10 Contracting Officer Representative (COR): The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract:

perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.11 Key Personnel:

The key personnel for this requirement is as follows.

Subject Matter Expert Level III:

1.6.12 Identification of Contractor Employees: Not Applicable

1.6.13 Contractor Travel Contractor authorized personnel will be required to travel CONUS and within the NCR during the performance of this contract to deliver TapRooT® incident investigation and root cause analysis training.

Contractor will be authorized travel expenses consistent with the substantive provisions of the Joint Travel Regulation (JTR) and the limitation of funds specified in this contract. All travel requires Government approval/authorization and notification to the COR.

From To Round Trip (Y/N)

# of Trips

# of People

# of Days

CONTRACTO

R

Knoxville, TN Washington, DC

Y 2 1 4

1.6.14 Other Direct Costs This category includes reproduction, shipping and any other direct expenses associated with PWS tasks activities.

1.6.15 Data Rights Not Applicable

1.6.16 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.6.17 PHASE IN /PHASE OUT PERIOD Not Applicable

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.12. WORK WEEK. Monday through Friday, unless specified otherwise.

2.2. ACRONYMS:

ACOR Alternate Contracting Officer's Representative

CFR Code of Federal Regulations CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTR Contracting Officer's Technical Representative COTS Commercial-Off-the-Shelf DD254 Department of Defense Contract Security Requirement List DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense FAR Federal Acquisition Regulation HIPAA Health Insurance Portability and Accountability Act of 1996 CO Contracting Officer OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program TE Technical Exhibit

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. Services: The Government will provide schedule and location for TapRooT investigation training and logistical support for training room set up and virtual training hosting.

3.2 Facilities: The Government will provide the facility to host the TapRooT investigation training.

3.3 Utilities Not applicable.

3.4 Equipment Not applicable.

3.5 Materials Not applicable.

PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1 General: Not applicable.

4.2 Secret Facility Clearance: Not applicable.

4.3. Materials: The Contractor shall provide training materials associated with the TapRooT investigation training materials ( to include the TapRooT textbook, dictionary, tree, and corrective action helper) software technical and function use guides.

4.4. Equipment: Not applicable.

PART 5

SPECIFIC TASKS

5. Specific Tasks:

5.1. Basic Services. The contractor shall provide services for Contractor shall provide the necessary personnel and materials to support a cadre of instructors capable of training MHS personnel in the TapRooT® Incident Investigation and Root Cause Analysis course, provide appropriate materials for training programs offered by the Office of the Chief Medical Officer (OCMO), and support technical needs associated with use of TapRooT software.

5.1.2. TapRooT incident investigation and root cause analysis training courses

The Contractor shall co-teach TapRooT® Training course, consisting of a classroom based portion focused on TapRooT methodology and a virtual portion for training.

5.1.2.1 TapRooT classroom based training (Deliverable 10). The classroom courses shall be held at a CONUS location, as determined by the Task Manager at a frequency of no more than twice (2) during a twelve month period. The classroom based courses shall be no more than 2-days in length for training up to thirty-five (35) students. Each classroom based course shall be taught by a combination of one (1) Contractor supplied instructor and one (1) MHS instructor. That Contractor supplied TapRooT instructor shall possess no less than 10 years of experience conducting root cause analyses investigations in related industries to improve safety and quality as well as no less than 5 years of experience with instructing the TapRooT 2-day course. To prepare for the classroom training courses, the Contractor shall facilitate planning needs across the Contractor supplied instructors, MHS instructors, and the Task Manager. The contractor shall supply instructor training materials for each classroom based course no less than four weeks prior to the scheduled course delivery date (Deliverable 11 ). The Contractor shall supply instructors for the classroom room based training as long as the Task Manager identifies the need no less than eight weeks prior to the scheduled course date. The Contractor shall supply a template for students to evaluate the classroom training; the Contractor shall discuss results from evaluations with the Task Manager and suggest corrections to assure course objectives are met (Deliverable 12).

5.1.2.1.1 OPTIONAL TASK 1: The same services as described in 5.1.2.1 where the course attendance exceeds 35 students up to 45 students within one class.

5.1.2.1.2 OPTIONAL TASK 2: The same services as described in 5.1.2.1 where the course attendance exceeds 45 students up to 55 students within one class.

The Government reserves the right to cancel the classroom course should government fiscal policies or cancellations restrict the course attendance, delivery methods, or related aspects impacting the ability to meet the course objectives. The Government will notify the vender no less than ten days prior to the scheduled course; no cancellation fees shall be charged to the Government.

5.1.2.2 TapRooT virtual training. The Contractor will host two types of virtual training; software training and TapRooT methodology refresher training. The virtual training shall be hosted by the government.

5.1.2.2.1 TapRooT software virtual training (Deliverable 13).. The virtual course shall be no more than four hours in length, and may be delivered across several days/times as approved by the Task Manager; the software virtual training shall be offered no more than twice (2) during a twelve month period. The Contractor shall supply a certified TapRooT instructor deliver the virtual course on software training.

5.1.2.2.2 TapRooT methodology refresher virtual training (Deliverable 14). The methodology refresher virtual training shall be no more than 2 hours total in length, and may be delivered across several days/times as approved by the Task Manager; the methodology refresher virtual training shall be offered no more than twice (2) during a twelve month period. The Contractor will supply a certified TapRooT instructor deliver the TapRooT methodology refresher virtual course on topics approved by the Task Manager.

5.1.3 Training Materials

5.1.3.1 The contractor shall provide training materials (10 sets), to support TapRooT® Training courses taught by MHS staff who are certified TapRooT® instructors. The training materials shall be defined as the TapRooT textbook, tree, dictionary, and corrective action helper.

a. Training materials shall be furnished for each course as directed and approved by the Task Manager.

b. Training materials shall be furnished by the Contractors when directed by the Task Manager with a fourteen (14) business day notice prior to the scheduled course date.

c. Training materials shall be shipped to the training site location and shall arrive not later than four (4) business days before the schedule training session. (Deliverable 15)

5.1.3.2 The contractor shall provide 358 sets of the following training materials to be distributed by the PSP, where each set consist of: (Deliverable 19)

a. TapRooT® Root Cause Tree Dictionary (Quantity: 1)

b. TapRooT® Root Cause Tree® Pad of 50 (Quantity: 1 pad)

c. TapRooT® Root Cause Tree® Laminated Version (Quantity: 1)

d. TapRooT® Corrective Action Helper® Guide (Quantity: 1)

The sets shall be delivered to: Intelligencer Mailing & Fulfillment Services, 1842 Colonial Village Lane, Lancaster

PA 17601 ATTN: Matt Baker for DoD Patient Safety Program. The shipment will be made as one bulk shipment at the beginning of the contract.

5.1.4 TapRooT Methodology and Software Technical support. The contractor shall provide up to 60 hours (included in the 72 SME hours) of consulting and/or teaching services as requested by the Government Program Office to support the update of TapRooT® software. The contractor shall respond to consulting/technical support requests within two (2) business days. The Contractor shall supply the Task Manager a quarterly listing of the support requests received and addressed to include associated Military Service affiliation and the resolution.

(Deliverable 16)

5.1.4.1 TapRooT software Technical Support. The Contractor shall obtain the DOD TapRooT Military Service point of contact list from the Task Manager which will include up to five (5) individuals; the Contractor shall notify the designated individuals of software related updates, to include unresolved TapRooT technical issues experienced by users, new software versions/hotfixes/patches, availability of software user guides/tools, and similar software related information within 5 business days of the Contractor’s awareness of the issue/update. The TapRooT software technical support team shall communicate directly with the identified individuals to resolve TapRooT software related technical issues experienced by MHS users.

5.1.5 TapRooT instructor re-certification for MHS staff. The contractor shall provide re-certification training for up to four (4) DoD TapRooT® instructors. After successful completion of the training the contractor shall provide the students with documentation indicating their renewed TapRooT® certification. (Deliverable 17)

5.1.6 TapRooT software license and maintenance. The contractor shall provide the software license and maintenance for TapRooT® software. This requirement is for a stand-alone system that will not require any interface with DoD network systems. The software required is specifically the TapRooT® root cause analysis software. This requirement shall be considered a renewal of the DoD Patient Safety Software License (contract W81XWH-08-P-0200 and contract W81XWH-09-P-0977). The Contractor shall supply a memorandum communicating the parameters of the software license and maintenance. (Deliverable 18).

5.3 Enterprise-wide Contractor Manpower Reporting Application, dated November 28, 2013

CONTRACTOR MANPOWER REPORTING FOR CONTRACT PERFORMANCE WORK STATEMENTS and Related Background Information

"The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the TRICARE Management Activity Office of the Chief Medical Officer via a secure data collection site. The contractor is required to completely fill in all required data fields using the following web address: http://www.ecmra.mil/

Reporting inputs will be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2013. Contractors may direct questions to the help desk at help desk at: http://www.ecmra.mil

PART 6

OTHER TERMS, CONDITIONS, AND PROVISIONS

6.0 Other Terms, Conditions, and Provisions

6.1 Non-Disclosure /Non-Use Agreement – Deliverable #

The Contractor shall ensure that the Non-Disclosure/Non-Use Agreement (Attachment to PWS) (Deliverable #) is signed by all staff assigned to or performing on this Task order before performing any work, including all subcontractors and consultants. The Non-Disclosure/Non-Use Agreement shall be cosigned by a corporate official (Contractor Task Manager or higher). The Contractor shall also ensure that all staff understand and adhere to the terms of the non-disclosure statement, protecting the procurement sensitive information of the Government and the proprietary information of other Contractors. Assignment of staff who have not executed this statement or failure to adhere to this statement shall constitute default on the part of the Contractor.

6.2 Information Assurance

6.3 Enterprise Architecture (EA)

Not applicable for this task

6.4 Protection of Information

6.4.1 Dissemination of Information/Publishing

There shall be no dissemination or publication, except within and between the Contractor and any subcontractors or specified Integrated Product/Process Team (IPT) members who have a need to know, of information developed under this order or contained in the reports to be furnished pursuant to this order without prior written approval of the TMA TM or the Contracting Officer. TMA approval for publication will require provisions which protect the intellectual property and patent rights of both TMA and the Contractor.

6.4.2 Contractor Employees

6.4.2.1 Contractor Identification

The Contractor shall ensure that Contractor personnel identify themselves as Contractors when attending meetings, answering Government telephones, providing any type of written correspondence, or working in situations where their actions could be construed as official Government acts.

6.4.2.2 Attendance at Meetings

Contractor personnel may be required to attend meetings or otherwise communicate with Government and/or other contract representatives to meet the requirements of this order. Contractor personnel make their Contractor status known during introductions.

6.4.2.3 Use of Military Rank by Contractor Personnel

Contractor personnel, while performing in a Contractor capacity, are prohibited from using their retired or reserve component military rank or title in all written or verbal communications associated with the contract under which they provide services.

6.4.3 Personally Identifiable Information (PII) and Protected Health Information (PHI) The TMA Privacy Office website at http://www.tricare.mil/tmaprivacy/contract.cfm contains guidance regarding Protected Health Information (PHI) and Personally Identifiable Information PII). The Contractor will not have access to any PHI and should the Contractor be exposed to PHI, the incident shall be handled as a breach and reported according to guidance supplied by the TMA Privacy Office. The Contractor will come into contact with limited PII, restricted to student and instructor names, email addresses, phone numbers and mailing addresses. All PII associated with work under this contract shall be managed according to TMA Privacy Office standards and any breaches of the Privacy Act shall be reported accordingly.

PART 7

APPLICABLE PUBLICATIONS

7. APPLICABLE PUBLICATIONS (CURRENT EDITIONS)

7.1. The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures. Not applicable.

PART 8

ATTACHMENT/TECHNICAL EXHIBIT LISTING

8. Attachment/Technical Exhibit List:

7.1. Attachment 1/Technical Exhibit 1 – Performance Requirements Summary

7.2. Attachment 2/Technical Exhibit 2 – Deliverables Schedule

7.3 Attachment 3/Technical Exhibit 3 – Estimated Workload Data

TECHNICAL EXHIBIT 1

Performance Requirements Summary

The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Performance Objective (The Service required—usually a shall statement)

Standard Performance Threshold (This is the maximum error rate. It could possibly be “Zero deviation from standard”)

Method of Surveillance

PRS # 1.

The contractor shall supply instructor training materials for each classroom based course no less than four weeks prior to the scheduled course delivery date.

The number of times the Contractor provides training materials in less than fourteen business days prior to scheduled course.

Zero deviation from standard.

Electronic receipt of instructor training materials by

TM. 100%

inspection.

PRS # 2

The contractor shall supply a TapRooT certified instructor for classroom training provided the government notifies contractor eight weeks prior to scheduled course date.

The number of times the Contractor is unable to supply a TapRooT certified instructor for the classroom course within six weeks of the scheduled course date.

Zero deviation from standard.

Electronic notification of instructor confirmation to

TM. 100%

inspection.

PRS # 3

Contractor shall notify the TM designated individuals of software related updates, technical issues, or availability of software enhancements within 5 business days of awareness.

The contractor does not notify the TM designated individuals of TapRooT software related updates, technical issues, or availability of software enhancements within 5 business days.

No more than twice in a twelve month period.

Military Service Branch

POC

notification to TM or COR of a delay.

Random sampling.

PRS # 4

Contractor shall respond to technical support requests within 2 business days.

The number of times the contractor does not respond to technical support requests within 2 business days.

No more than twice in a quarter.

Military Service Branch

POC

notification to TM or COR of a delay.

Random sampling.

TECHNICAL EXHIBIT 2

DELIVERABLES SCHEDULE

DELIVERABLE TITLE SUBMIT

TO

QTY INITIAL

DELIVERY

SUBSEQUENT

DELIVERY

Deliverable 1 Non-Disclosure Agreement

AM

COR

Signed statements are due, from each employee assigned, prior to performing ANY work on this task.

Deliverable 2 Monthly Progress Report

AM

COR

NLT 45 DACA NLT 15th of each month

Deliverable 3 Subcontract Expenditures Report

CO

AM

COR

NLT 90 DACA Quarterly thereafter.

A final submission reflecting all expenditures on this order is due within 5 days of completion of the order.

Deliverable 4 Work Breakdown Structure

COR

AM

NA

Deliverable 5 Transition Plan – Incoming Transition

COR

NA

Deliverable 6 Transition Plan – Outgoing Transition

Deliverable 7 Program Management Plan

COR

AM

Deliverable 8 Quality Control Plan COR

NLT 30 DACA Updated as required

Deliverable 9 Contingency Operations Plan

NLT 10 DACA Updated as required

Deliverable 10 TapRooT classroom course training

COR,

TM

2 NLT 180 DACA

Deliverable 11 Instructor Facilitation Materials for TapRooT classroom course

COR,

TM

1 NLT 4 weeks prior to scheduled course date

Updated for each classroom course.

Deliverable 12 Classroom course student evaluation template

COR,

TM

1 NLT 30 DACA Updated every twelve months.

Deliverable 13 TapRooT software virtual training

COR,

TM

2 NLT 270 DACA NLT 300 DACA; 2

per every twelve months

Deliverable 14 TapRooT methodology refresher virtual training

COR,

TM

2 NLT 90 DACA NLT 180 DACA; 2

per every twelve months

DELIVERABLE TITLE SUBMIT

TO

QTY INITIAL

DELIVERY

SUBSEQUENT

DELIVERY

Deliverable 15 Training materials for MHS TapRooT instruction

COR 1 NLT 270 DACA As directed by COR

Deliverable 16 TapRooT Technical Support request and resolution list

COR 1 NLT 90 DACA Quarterly

Deliverable 17 MHS TapRooT Instructor recertification

COR 4 NLT 30 days after re-certification achieved

As directed by COR

Deliverable 18 TapRooT software license and maintenance memorandum

COR 1 NLT 60 DACA Every twelve months

Deliverable 19 TapRoot Training Material Sets

COR 358 NLT 30 DACA Base Year Only

TM=Task Manager

Attachment 3/Technical Exhibit 3 – Estimated Workload Data

Program Manager I:

Education: B.A. or B.S. degree in business, finance, accounting or related field.

Basic Experience: Ten years of accounting or financial experience, including at least 3 years of experience with financial management related to federal contracts.

Specialized Experience: Specialized experience includes oversight of federal contract tasks, submission of invoices, and expense tracking according to federal regulations and policies.

Duties: Performs task management of overall contract support operations to include documentation of progress reports, timely review and submission of invoices, coordination to deliver materials necessary for trainings.

Subject Matter Expert III: Key Personnel Education: B.A. or B.S. degree. Masters Degree or specialized field certification, and TapRooT certified instructor.

Basic Experience: Fifteen years of experience in the field of error and event investigation, root cause analyses, safety and quality process controls, adult learning principles, education and training methods.

Specialized Experience: TapRooT methodology, TapRooT instructor competencies, TapRooT course delivery facilitation, TapRooT software development along with TapRooT software functional and technical specification management. A minimum of 10 years of experience improving safety or quality through the use of TapRooT methodology in conducting root cause analyses across multiple industries. A minimum of 10 years of experience instructing TapRooT methodology for root cause analyses and training TapRooT instructors.

Duties: Provides TapRooT technical, managerial and functional direction for meeting tasks and deliverables according to the scope of work. Makes recommendations and advises on improvements with use of TapRooT training, software, and methodology based on emerging evidence on error reduction and accident prevention models. Facilitates technical and functional resolution of TapRooT software.

CONTRACTOR LABOR BASE OY1 OY2 OY3 OY4 TOTAL

Program Manager I 24 24 24 24 24 120

Subject Matter Expert III 72 72 72 72 72 360

TOTAL LABOR HOURS

96 96 96 96 96 480

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government 000101 N/A N/A N/A Government 0002 Destination Government Destination Government 000201 N/A N/A N/A Government 0003 Destination Government Destination Government 0004 Destination Government Destination Government 0005 Destination Government Destination Government 000501 N/A N/A N/A Government 1001 Destination Government Destination Government 1002 Destination Government Destination Government 1003 Destination Government Destination Government 1004 Destination Government Destination Government 1005 Destination Government Destination Government 2001 Destination Government Destination Government 2002 Destination Government Destination Government 2003 Destination Government Destination Government 2004 Destination Government Destination Government 2005 Destination Government Destination Government 3001 Destination Government Destination Government 3002 Destination Government Destination Government 3003 Destination Government Destination Government 3004 Destination Government Destination Government 3005 Destination Government Destination Government 4001 Destination Government Destination Government 4002 Destination Government Destination Government 4003 Destination Government Destination Government 4004 Destination Government Destination Government 4005 Destination Government Destination Government

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS UIC

0001 POP 30-SEP-2013 TO

29-SEP-2014

N/A TRICARE MANAGEMENT ACTIVITY

OFFICE OF CHIEF MEDICAL OFFICER -

OCMO

DHHQ BUILDING

7700 ARLINGTON BLVD, SUITE 5101

FALLS CHURCH VA 22042-5101

HT0003

000101 N/A N/A N/A N/A

0002 POP 30-SEP-2013 TO

29-SEP-2014

N/A TRICARE MANAGEMENT ACTIVITY

OFFICE OF CHIEF MEDICAL OFFICER -

OCMO

DHHQ BUILDING

7700 ARLINGTON BLVD, SUITE 5101

FALLS CHURCH VA 22042-5101

000201 N/A N/A N/A N/A

0003 POP 30-SEP-2013 TO

29-SEP-2014

N/A TRICARE MANAGEMENT ACTIVITY

OFFICE OF CHIEF MEDICAL OFFICER -

OCMO

DHHQ BUILDING

7700 ARLINGTON BLVD, SUITE 5101

FALLS CHURCH VA 22042-5101

0004 POP 30-SEP-2013 TO

29-SEP-2014

N/A (SAME AS PREVIOUS LOCATION)

0005 POP 30-SEP-2013 TO

29-SEP-2014

N/A (SAME AS PREVIOUS LOCATION)

000501 N/A N/A N/A N/A

1001 POP 30-SEP-2014 TO

29-SEP-2015

N/A TRICARE MANAGEMENT ACTIVITY

OFFICE OF CHIEF MEDICAL OFFICER -

OCMO

DHHQ BUILDING

7700 ARLINGTON BLVD, SUITE 5101

FALLS CHURCH VA 22042-5101

1002 POP 30-SEP-2014 TO

29-SEP-2015

N/A (SAME AS PREVIOUS LOCATION)

1003 POP 30-SEP-2014 TO

N/A (SAME AS PREVIOUS LOCATION)

1004 POP 30-SEP-2014 TO

N/A (SAME AS PREVIOUS LOCATION)

1005 POP 30-SEP-2014 TO

N/A (SAME AS PREVIOUS LOCATION)

2001 POP 30-SEP-2015 TO

29-SEP-2016

N/A (SAME AS PREVIOUS LOCATION)

2002 POP 30-SEP-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

2003 POP 30-SEP-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

2004 POP 30-SEP-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

2005 POP 30-SEP-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

3001 POP 30-SEP-2016 TO

29-SEP-2017

N/A (SAME AS PREVIOUS LOCATION)

3002 POP 30-SEP-2016 TO

N/A (SAME AS PREVIOUS LOCATION)

3003 POP 30-SEP-2016 TO

N/A (SAME AS PREVIOUS LOCATION)

3004 POP 30-SEP-2016 TO

N/A (SAME AS PREVIOUS LOCATION)

3005 POP 30-SEP-2016 TO

N/A (SAME AS PREVIOUS LOCATION)

4001 POP 30-SEP-2017 TO

29-SEP-2018

N/A (SAME AS PREVIOUS LOCATION)

4002 POP 30-SEP-2017 TO

N/A (SAME AS PREVIOUS LOCATION)

4003 POP 30-SEP-2017 TO

N/A (SAME AS PREVIOUS LOCATION)

4004 POP 30-SEP-2017 TO

N/A (SAME AS PREVIOUS LOCATION)

4005 POP 30-SEP-2017 TO

N/A (SAME AS PREVIOUS LOCATION)

Section G - Contract Administration Data

ACCOUNTING AND APPROPRIATION DATA

AA: 970130.1313D-2013 0101010300807714-1884 257.22 044226 PRC35867

AMOUNT: $154,822.00

CIN HT000331985867000101: $14,520.00

CIN HT000331985867000201: $134,902.00

CIN HT000331985867000501: $5,400.00

WAWF INSTRUCTIONS

Invoicing and Receiving Report Instructions

The Contractor is responsible for submitting invoices and initiating receiving reports electronically through Wide Area Work Flow – Receipt and Acceptance (WAWF) for goods and services rendered under this Contract. For fixed price contracts, the WAWF 2 IN 1 format (for services), and the COMBO format (only for supplies or equipment), are the preferred methods of processing electronic invoices and receiving reports within TMA. Back up documentation (such as timesheets, etc.) can be included and attached to WAWF documents as requested by the responsible COR. Attachments created in any Microsoft Office product are attachable to the invoice in WAWF.

Contractor personnel (WAWF Vendor role) shall self-register at the web site: https://wawf.eb.mil/, and be activated by the Contractor’s designated Electronic Business Point of Contact. WAWF training is available on the internet at http://wawftraining.com.

The Contractor shall submit invoices for payment and initiate receiving reports every month.

The Government shall process invoices for payment and associated receiving reports every month.

Prior to submitting the first WAWF-RA electronic form for a given task order, Contractors should first coordinate with the assigned TMA COR.

252.232-7003 Electronic Submission of Payment Requests and Receiving Reports.

As prescribed in 232.7004, use the following clause:

ELECTRONIC SUBMISSION OF PAYMENT REQUESTS AND RECEIVING REPORTS (MAR 2008)

(a) Definitions. As used in this clause—

(1) “Contract financing payment” and “invoice payment” have the meanings given in section 32.001 of the Federal Acquisition Regulation.

(2) “Electronic form” means any automated system that transmits information electronically from the initiating system to all affected systems. Facsimile, e-mail, and scanned documents are not acceptable electronic forms for submission of payment requests.