HT001524R0030 ACC RFP.pdf

SEE ADDENDUM

(No Collect Calls)

HT001523R0030 29-Nov-2023

b. TELEPHONE NUMBER

210-295-2787

8. OFFER DUE DATE/LOCAL TIME

12:00 PM 05 Jan 2024

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA X ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

HT00159. ISSUED BY

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

RAUL GARCIA

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

1 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.X

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED ORX

SMALL BUSINESS

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

DHA CONTRACTING OFFICE-(EMS-CD) HT0015

DHA EMS-CD HT0015

4130 STANLEY ROAD SUITE 208

FORT SAM HOUSTON TX 78234

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE 16. ADMINISTERED BY

SEE SCHEDULE

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

FAX:

TEL: 210-295-2787 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$25,500,000

NAICS:

621498

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF161

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

HT001523R0030

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 540,000 Each

Per Member Per Month (PMPM)

FFP

The Contractor shall provide performance of all facility-related (except MRI equipment) requirements (PWS 5.16) (including any amortized facilities costs incurred during the phase-in transition period (PWS 1.7.1)), administrative requirements (PWS 5.13.2.1) and the Performance Work Statement (PWS) requirements associated with the following services:

1. Primary Care (PWS 5.13.2.2) (for ACC enrolled/assigned beneficiaries only)

2. Urgent Care (PWS 5.13.2.3) (for ACC enrolled/assigned beneficiaries only)

3. Radiology and Laboratory (PWS 5.13.2.5 and 5.13.2.4) (all for ACC enrolled/assigned beneficiaries only) The quantity for this CLIN represents Enrolled Beneficiaries represented by the unit of issue "Each". The Contractor may invoice each month for up to 45,000 Enrolled Beneficiaries IAW the PMPM clause and the PWS.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0002 10,524 Each

Urgent Care/Primary Care (non-enrollee)

FFP

The Contractor shall perform Urgent Care/Primary Care services for non-enrollee visits IAW attached PWS (para. 5.13.2.2, 5.13.2.3). The quantity for this CLIN is 10,524 -Non-Enrolled Beneficiary Urgent Care/Primary Care visits represented by the unit of issue "Each". The Contractor may invoice each month for services rendered IAW the PWS.

FOB: Destination

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0003 8,657 Each Laboratory (non-enrollee)

FFP

The Contractor shall perform Laboratory services for non-enrollee visits IAW attached PWS (para. 5.13.2.4). The quantity for this CLIN is 8657 Non-Enrolled Beneficiary Laboratory visits represented by the unit of issue "Each". The Contractor may invoice each month for services rendered IAW the PWS.

0004 2,876 Each Radiology (non-enrollee)

FFP

The Contractor shall perform Radiology services for non-enrollee visits IAW attached PWS (para. 5.13.2.5). The quantity for this CLIN is 2876 Non-Enrolled Beneficiary Radiiology visits represented by the unit of issue "Each". The

0005 576,409 Each Pharmacy Prescriptions

FFP

The Contractor shall provide Pharmacy Prescriptions IAW attached PWS (para.

5.13.2.18). The quantity for this CLIN is 576409 Pharmacy Prescriptions represented by the unit of issue "Each". The Contractor may invoice each month for services rendered IAW the PWS.

0006 3,374 Hours Dermatology - Provider

FFP

The Contractor shall provide Dermatology Provider services IAW the attached PWS (para. 5.13.2.16).

0007 6,849 Hours Dermatology - Support Staff

FFP

The Contractor shall provide Dermatology support services IAW the attached PWS (para. 5.13.2.16).

0008 3,374 Hours Optometry - Optometrist

FFP

The Contractor shall provide Optometrist services IAW the attached PWS (para.

5.13.2.10).

0009 8,503 Hours Optometry - Support Staff

FFP

The Contractor shall provide Optometry support services IAW the attached PWS (para. 5.13.2.10).

0010 3,374 Hours Orthopedic- Physician Assistants

FFP

The Contractor shall provide Orthopedic PA services IAW the attached PWS (para 5.13.2.14).

0011 8,941 Hours Orthopedic - Support Staff

FFP

The Contractor shall provide Orthopedic Support services IAW the attached PWS (para 5.13.2.14).

0012 3,374 Hours Sports Medicine - Provider

FFP

The Contractor shall provide Sports Medicine Provider services IAW the attached PWS (para. 5.13.2.9).

0013 8,941 Hours Sports Medicine - Support Staff

FFP

The Contractor shall provide Sports Medicine Support services IAW the attached

0014 3,374 Hours Dietitian

FFP

The Contractor shall provide Dietitian services IAW the attached PWS (para.

5.13.2.20.3).

0015 3,374 Hours Podiatry - Provider

FFP

The Contractor shall provide Podiatry Provider services IAW the attached PWS (para. 5.13.2.17).

0016 6,512 Hours Podiatry - Support Staff

FFP

The Contractor shall provide Podiatry Support services IAW the attached PWS (para.5.13.2.17) .

0017 6,748 Hours Obstetrics- Provider

FFP

Mission Essential position: The Contractor shall provide Obstetrics Provider services IAW the attached PWS (para. 5.13.2.15, 1.9.1).

0018 10,054 Hours Obstetrics- Support Staff

FFP

The Contractor shall provide Obstetrics Support services IAW the attached PWS (para. 5.13.2.15).

0019 1,248 Hours Obstetrics ON-CALL

FFP

The Contractor shall provide Obstetrics ON-CALL services IAW the attached PWS (para. 1.9.1, 1.15.2, 5.13.2.15).

0020 1,248 Hours Obstetrics ON-CALL IN-HOUSE

FFP

The Contractor shall provide Obstetrics ON-CALL IN-HOUSE services IAW the attached PWS (1.9.1, 1.15.2, 5.13.2.15).

0021 10,122 Hours Physical Therapy - Provider

FFP

The Contractor shall provide Physical Therapy Provider services IAW the attached PWS (para. 5.13.2.11, 5.13.2.13).

0022 17,917 Hours Physical Therapy - Support Staff

FFP

The Contractor shall provide Physical Therapy Support services IAW the attached

0023 3,374 Hours Occupational Therapy - Provider

FFP

The Contractor shall provide Occupational Therapy Provider services IAW the attached PWS (5.13.2.12, 5.13.2.13).

0024 6,478 Hours Occupational Therapy - Support Staff

FFP

The Contractor shall provide Occupational Therapy Support services IAW the attached PWS (para. 5.13.2.12, 5.13.2.13).

0025 39,680 Hours Behavioral Health - Support Staff

FFP

The Contractor shall provide Behavioral Health Support services IAW the attached PWS (para. 5.13.2.19).

0026 10,122 Hours Immunization Clinic - Staff

FFP

The Contractor shall provide Immunization Clinic services IAW the attached PWS (para.5.13.2.8) .

MRI Equipment

COST

The Contractor shall provide MRI Equipment IAW the terms of the PWS (para.

4.1.2)

ESTIMATED COST

Utilities

COST

The Contractor shall provide Utilities IAW with the terms of the PWS (para. 4.6)

Medical Supplies

COST

The Contractor shall provide Medical Supplies IAW with the terms of the PWS (para. 4.8)

Medical Equipment Maintenance

COST

The Contractor shall provide Equipment Mix IAW with the terms of the PWS (para. 3.6.3)

0031 1 Job Admin Transition

FFP

The Contractor shall provide admin transition services IAW the attached PWS (para. 1.7.1.2).Multiple invoices may be paid against this CLIN.

1001 612,000 Each OPTION Per Member Per Month (PMPM)

FFP

The Contractor shall provide performance of all facility-related (except MRI equipment) requirements (PWS 5.16) (including any amortized facilities costs incurred during the phase-in transition period (PWS 1.7.1)), administrative requirements (PWS 5.13.2.1) and the Performance Work Statement (PWS) requirements associated with the following services:

1. Primary Care (PWS 5.13.2.2) (for ACC enrolled/assigned beneficiaries only)

2. Urgent Care (PWS 5.13.2.3) (for ACC enrolled/assigned beneficiaries only)

3. Radiology and Laboratory (PWS 5.13.2.5 and 5.13.2.4) (all for ACC enrolled/assigned beneficiaries only) The quantity for this CLIN represents Enrolled Beneficiaries represented by the unit of issue "Each". The Contractor may invoice each month for up to 45,000 Enrolled Beneficiaries IAW the PMPM clause and the PWS.

1002 10,524 Each OPTION Urgent Care/Primary Care (non-enrollee)

FFP

The Contractor shall perform Urgent Care/Primary Care services for non-enrollee visits IAW attached PWS (para. 5.13.2.2, 5.13.2.3). The quantity for this CLIN is 10,524 -Non-Enrolled Beneficiary Urgent Care/Primary Care visits represented by the unit of issue "Each". The Contractor may invoice each month for services rendered IAW the PWS.

1003 8,657 Each OPTION Laboratory (non-enrollee)

FFP

The Contractor shall perform Laboratory services for non-enrollee visits IAW attached PWS (para. 5.13.2.4). The quantity for this CLIN is 8657 Non-Enrolled Beneficiary Laboratory visits represented by the unit of issue "Each". The

1004 2,876 Each OPTION Radiology (non-enrollee)

FFP

The Contractor shall perform Radiology services for non-enrollee visits IAW attached PWS (para. 5.13.2.5). The quantity for this CLIN is 2876 Non-Enrolled Beneficiary Radiiology visits represented by the unit of issue "Each". The

1005 576,409 Each OPTION Pharmacy Prescriptions

FFP

The Contractor shall provide Pharmacy Prescriptions IAW attached PWS (para.

5.13.2.18). The quantity for this CLIN is 576409 Pharmacy Prescriptions represented by the unit of issue "Each". The Contractor may invoice each month

1006 3,824 Hours OPTION Dermatology - Provider

FFP

The Contractor shall provide Dermatology Provider services IAW the attached

1007 7,763 Hours OPTION Dermatology - Support Staff

FFP

The Contractor shall provide Dermatology support services IAW the attached PWS

1008 3,824 Hours OPTION Optometry - Optometrist

FFP

The Contractor shall provide Optometrist services IAW the attached PWS (para.

1009 9,636 Hours OPTION Optometry - Support Staff

FFP

The Contractor shall provide Optometry support services IAW the attached PWS

1010 3,824 Hours OPTION Orthopedic- Physician Assistants

FFP

The Contractor shall provide Orthopedic PA services IAW the attached PWS (para

1011 10,134 Hours OPTION Orthopedic - Support Staff

FFP

The Contractor shall provide Orthopedic Support services IAW the attached PWS

1012 3,824 Hours OPTION Sports Medicine - Provider

FFP

The Contractor shall provide Sports Medicine Provider services IAW the attached

1013 10,134 Hours OPTION Sports Medicine - Support Staff

FFP

The Contractor shall provide Sports Medicine Support services IAW the attached

1014 3,824 Hours OPTION Dietitian

FFP

The Contractor shall provide Dietitian services IAW the attached PWS (para.

1015 3,824 Hours OPTION Podiatry - Provider

FFP

The Contractor shall provide Podiatry Provider services IAW the attached PWS

1016 7,380 Hours OPTION Podiatry - Support Staff

FFP

The Contractor shall provide Podiatry Support services IAW the attached PWS

1017 7,648 Hours OPTION Obstetrics- Provider

FFP

Mission Essential position: The Contractor shall provide Obstetrics Provider

1018 11,396 Hours OPTION Obstetrics- Support Staff

FFP

The Contractor shall provide Obstetrics Support services IAW the attached PWS

1019 1,248 Hours OPTION Obstetrics ON-CALL

FFP

The Contractor shall provide Obstetrics ON-CALL services IAW the attached

1020 1,248 Hours OPTION Obstetrics ON-CALL IN-HOUSE

FFP

The Contractor shall provide Obstetrics ON-CALL IN-HOUSE services IAW the

1021 11,472 Hours OPTION Physical Therapy - Provider

FFP

The Contractor shall provide Physical Therapy Provider services IAW the attached

1022 20,305 Hours OPTION Physical Therapy - Support Staff

FFP

The Contractor shall provide Physical Therapy Support services IAW the attached

1023 3,824 Hours OPTION Occupational Therapy - Provider

FFP

The Contractor shall provide Occupational Therapy Provider services IAW the

1024 7,342 Hours OPTION Occupational Therapy - Support Staff

FFP

The Contractor shall provide Occupational Therapy Support services IAW the

1025 44,970 Hours OPTION Behavioral Health - Support Staff

FFP

The Contractor shall provide Behavioral Health Support services IAW the attached

1026 11,472 Hours OPTION Immunization Clinic - Staff

FFP

The Contractor shall provide Immunization Clinic services IAW the attached PWS

OPTION MRI Equipment

COST

The Contractor shall provide MRI Equipment IAW the terms of the PWS (para.

OPTION Utilities

COST

OPTION Medical Supplies

COST

The Contractor shall provide Medical Supplies IAW with the terms of the PWS

OPTION Medical Equipment Maintenance

COST

The Contractor shall provide Equipment Mix IAW with the terms of the PWS

2001 612,000 Each OPTION Per Member Per Month (PMPM)

FFP

The Contractor shall provide performance of all facility-related (except MRI equipment) requirements (PWS 5.16) (including any amortized facilities costs incurred during the phase-in transition period (PWS 1.7.1)), administrative requirements (PWS 5.13.2.1) and the Performance Work Statement (PWS) requirements associated with the following services:

1. Primary Care (PWS 5.13.2.2) (for ACC enrolled/assigned beneficiaries only)

2. Urgent Care (PWS 5.13.2.3) (for ACC enrolled/assigned beneficiaries only)

3. Radiology and Laboratory (PWS 5.13.2.5 and 5.13.2.4) (all for ACC enrolled/assigned beneficiaries only) The quantity for this CLIN represents Enrolled Beneficiaries represented by the unit of issue "Each". The Contractor may invoice each month for up to 45,000

2002 10,524 Each OPTION Urgent Care/Primary Care (non-enrollee)

FFP

The Contractor shall perform Urgent Care/Primary Care services for non-enrollee visits IAW attached PWS (para. 5.13.2.2, 5.13.2.3). The quantity for this CLIN is 10,524 -Non-Enrolled Beneficiary Urgent Care/Primary Care visits represented by the unit of issue "Each". The Contractor may invoice each month for services

2003 8,657 Each OPTION Laboratory (non-enrollee)

FFP

The Contractor shall perform Laboratory services for non-enrollee visits IAW attached PWS (para. 5.13.2.4). The quantity for this CLIN is 8657 Non-Enrolled Beneficiary Laboratory visits represented by the unit of issue "Each". The

2004 2,876 Each OPTION Radiology (non-enrollee)

FFP

The Contractor shall perform Radiology services for non-enrollee visits IAW attached PWS (para. 5.13.2.5). The quantity for this CLIN is 2876 Non-Enrolled Beneficiary Radiiology visits represented by the unit of issue "Each". The

2005 576,409 Each OPTION Pharmacy Prescriptions

FFP

The Contractor shall provide Pharmacy Prescriptions IAW attached PWS (para.

5.13.2.18). The quantity for this CLIN is 576409 Pharmacy Prescriptions represented by the unit of issue "Each". The Contractor may invoice each month

2006 3,824 Hours OPTION Dermatology - Provider

FFP

The Contractor shall provide Dermatology Provider services IAW the attached

2007 7,763 Hours OPTION Dermatology - Support Staff

FFP

The Contractor shall provide Dermatology support services IAW the attached PWS

2008 3,824 Hours OPTION Optometry - Optometrist

FFP

The Contractor shall provide Optometrist services IAW the attached PWS (para.

2009 9,636 Hours OPTION Optometry - Support Staff

FFP

The Contractor shall provide Optometry support services IAW the attached PWS

2010 3,824 Hours OPTION Orthopedic- Physician Assistants

FFP

The Contractor shall provide Orthopedic PA services IAW the attached PWS (para

2011 10,134 Hours OPTION Orthopedic - Support Staff

FFP

The Contractor shall provide Orthopedic Support services IAW the attached PWS

2012 3,824 Hours OPTION Sports Medicine - Provider

FFP

The Contractor shall provide Sports Medicine Provider services IAW the attached

2013 10,134 Hours OPTION Sports Medicine - Support Staff

FFP

The Contractor shall provide Sports Medicine Support services IAW the attached

2014 3,824 Hours OPTION Dietitian

FFP

The Contractor shall provide Dietitian services IAW the attached PWS (para.

2015 3,824 Hours OPTION Podiatry - Provider

FFP

The Contractor shall provide Podiatry Provider services IAW the attached PWS

2016 7,380 Hours OPTION Podiatry - Support Staff

FFP

The Contractor shall provide Podiatry Support services IAW the attached PWS

2017 7,648 Hours OPTION Obstetrics- Provider

FFP

Mission Essential position: The Contractor shall provide Obstetrics Provider

2018 11,396 Hours OPTION Obstetrics- Support Staff

FFP

The Contractor shall provide Obstetrics Support services IAW the attached PWS

2019 1,248 Hours OPTION Obstetrics ON-CALL

FFP

The Contractor shall provide Obstetrics ON-CALL services IAW the attached

2020 1,248 Hours OPTION Obstetrics ON-CALL IN-HOUSE

FFP

The Contractor shall provide Obstetrics ON-CALL IN-HOUSE services IAW the

2021 11,472 Hours OPTION Physical Therapy - Provider

FFP

The Contractor shall provide Physical Therapy Provider services IAW the attached

2022 20,305 Hours OPTION Physical Therapy - Support Staff

FFP

The Contractor shall provide Physical Therapy Support services IAW the attached

2023 3,824 Hours OPTION Occupational Therapy - Provider

FFP

The Contractor shall provide Occupational Therapy Provider services IAW the

2024 7,342 Hours OPTION Occupational Therapy - Support Staff

FFP

The Contractor shall provide Occupational Therapy Support services IAW the

2025 44,970 Hours OPTION Behavioral Health - Support Staff

FFP

The Contractor shall provide Behavioral Health Support services IAW the attached

2026 11,472 Hours OPTION Immunization Clinic - Staff

FFP

The Contractor shall provide Immunization Clinic services IAW the attached PWS

OPTION MRI Equipment

COST

The Contractor shall provide MRI Equipment IAW the terms of the PWS (para.

OPTION Utilities

COST

OPTION Medical Supplies

COST

The Contractor shall provide Medical Supplies IAW with the terms of the PWS

OPTION Medical Equipment Maintenance

COST

The Contractor shall provide Equipment Mix IAW with the terms of the PWS

3001 612,000 Each OPTION Per Member Per Month (PMPM)

FFP

The Contractor shall provide performance of all facility-related (except MRI equipment) requirements (PWS 5.16) (including any amortized facilities costs incurred during the phase-in transition period (PWS 1.7.1)), administrative requirements (PWS 5.13.2.1) and the Performance Work Statement (PWS) requirements associated with the following services:

1. Primary Care (PWS 5.13.2.2) (for ACC enrolled/assigned beneficiaries only)

2. Urgent Care (PWS 5.13.2.3) (for ACC enrolled/assigned beneficiaries only)

3. Radiology and Laboratory (PWS 5.13.2.5 and 5.13.2.4) (all for ACC enrolled/assigned beneficiaries only) The quantity for this CLIN represents Enrolled Beneficiaries represented by the unit of issue "Each". The Contractor may invoice each month for up to 45,000

3002 10,524 Each OPTION Urgent Care/Primary Care (non-enrollee)

FFP

The Contractor shall perform Urgent Care/Primary Care services for non-enrollee visits IAW attached PWS (para. 5.13.2.2, 5.13.2.3). The quantity for this CLIN is 10,524 -Non-Enrolled Beneficiary Urgent Care/Primary Care visits represented by the unit of issue "Each". The Contractor may invoice each month for services

3003 8,657 Each OPTION Laboratory (non-enrollee)

FFP

The Contractor shall perform Laboratory services for non-enrollee visits IAW attached PWS (para. 5.13.2.4). The quantity for this CLIN is 8657 Non-Enrolled Beneficiary Laboratory visits represented by the unit of issue "Each". The

3004 2,876 Each OPTION Radiology (non-enrollee)

FFP

The Contractor shall perform Radiology services for non-enrollee visits IAW attached PWS (para. 5.13.2.5). The quantity for this CLIN is 2876 Non-Enrolled Beneficiary Radiiology visits represented by the unit of issue "Each". The

3005 576,409 Each OPTION Pharmacy Prescriptions

FFP

The Contractor shall provide Pharmacy Prescriptions IAW attached PWS (para.

5.13.2.18). The quantity for this CLIN is 576409 Pharmacy Prescriptions represented by the unit of issue "Each". The Contractor may invoice each month

3006 3,824 Hours OPTION Dermatology - Provider

FFP

The Contractor shall provide Dermatology Provider services IAW the attached

3007 7,763 Hours OPTION Dermatology - Support Staff

FFP

The Contractor shall provide Dermatology support services IAW the attached PWS

3008 3,824 Hours OPTION Optometry - Optometrist

FFP

The Contractor shall provide Optometrist services IAW the attached PWS (para.

3009 9,636 Hours OPTION Optometry - Support Staff

FFP

The Contractor shall provide Optometry support services IAW the attached PWS

3010 3,824 Hours OPTION Orthopedic- Physician Assistants

FFP

The Contractor shall provide Orthopedic PA services IAW the attached PWS (para

3011 10,134 Hours OPTION Orthopedic - Support Staff

FFP

The Contractor shall provide Orthopedic Support services IAW the attached PWS

3012 3,824 Hours OPTION Sports Medicine - Provider

FFP

The Contractor shall provide Sports Medicine Provider services IAW the attached

3013 10,134 Hours OPTION Sports Medicine - Support Staff

FFP

The Contractor shall provide Sports Medicine Support services IAW the attached

3014 3,824 Hours OPTION Dietitian

FFP

The Contractor shall provide Dietitian services IAW the attached PWS (para.

3015 3,824 Hours OPTION Podiatry - Provider

FFP

The Contractor shall provide Podiatry Provider services IAW the attached PWS

3016 7,380 Hours OPTION Podiatry - Support Staff

FFP

The Contractor shall provide Podiatry Support services IAW the attached PWS

3017 7,648 Hours OPTION Obstetrics- Provider

FFP

Mission Essential position: The Contractor shall provide Obstetrics Provider

3018 11,396 Hours OPTION Obstetrics- Support Staff

FFP

The Contractor shall provide Obstetrics Support services IAW the attached PWS

3019 1,248 Hours OPTION Obstetrics ON-CALL

FFP

The Contractor shall provide Obstetrics ON-CALL services IAW the attached

3020 1,248 Hours OPTION Obstetrics ON-CALL IN-HOUSE

FFP

The Contractor shall provide Obstetrics ON-CALL IN-HOUSE services IAW the

3021 11,472 Hours OPTION Physical Therapy - Provider

FFP

The Contractor shall provide Physical Therapy Provider services IAW the attached

3022 20,305 Hours OPTION Physical Therapy - Support Staff

FFP

The Contractor shall provide Physical Therapy Support services IAW the attached

3023 3,824 Hours OPTION Occupational Therapy - Provider

FFP

The Contractor shall provide Occupational Therapy Provider services IAW the

3024 7,342 Hours OPTION Occupational Therapy - Support Staff

FFP

The Contractor shall provide Occupational Therapy Support services IAW the

3025 44,970 Hours OPTION Behavioral Health - Support Staff

FFP

The Contractor shall provide Behavioral Health Support services IAW the attached

3026 11,472 Hours OPTION Immunization Clinic - Staff

FFP

The Contractor shall provide Immunization Clinic services IAW the attached PWS

OPTION MRI Equipment

COST

The Contractor shall provide MRI Equipment IAW the terms of the PWS (para.

OPTION Utilities

COST

OPTION Medical Supplies

COST

The Contractor shall provide Medical Supplies IAW with the terms of the PWS

OPTION Medical Equipment Maintenance

COST

The Contractor shall provide Equipment Mix IAW with the terms of the PWS

4001 612,000 Each OPTION Per Member Per Month (PMPM)

FFP

The Contractor shall provide performance of all facility-related (except MRI equipment) requirements (PWS 5.16) (including any amortized facilities costs incurred during the phase-in transition period (PWS 1.7.1)), administrative requirements (PWS 5.13.2.1) and the Performance Work Statement (PWS) requirements associated with the following services:

1. Primary Care (PWS 5.13.2.2) (for ACC enrolled/assigned beneficiaries only)

2. Urgent Care (PWS 5.13.2.3) (for ACC enrolled/assigned beneficiaries only)

3. Radiology and Laboratory (PWS 5.13.2.5 and 5.13.2.4) (all for ACC enrolled/assigned beneficiaries only) The quantity for this CLIN represents Enrolled Beneficiaries represented by the unit of issue "Each". The Contractor may invoice each month for up to 45,000

4002 10,524 Each OPTION Urgent Care/Primary Care (non-enrollee)

FFP

The Contractor shall perform Urgent Care/Primary Care services for non-enrollee visits IAW attached PWS (para. 5.13.2.2, 5.13.2.3). The quantity for this CLIN is 10,524 -Non-Enrolled Beneficiary Urgent Care/Primary Care visits represented by the unit of issue "Each". The Contractor may invoice each month for services

4003 8,657 Each OPTION Laboratory (non-enrollee)

FFP

The Contractor shall perform Laboratory services for non-enrollee visits IAW attached PWS (para. 5.13.2.4). The quantity for this CLIN is 8657 Non-Enrolled Beneficiary Laboratory visits represented by the unit of issue "Each". The

4004 2,876 Each OPTION Radiology (non-enrollee)

FFP

The Contractor shall perform Radiology services for non-enrollee visits IAW attached PWS (para. 5.13.2.5). The quantity for this CLIN is 2876 Non-Enrolled Beneficiary Radiiology visits represented by the unit of issue "Each". The

4005 576,409 Each OPTION Pharmacy Prescriptions

FFP

The Contractor shall provide Pharmacy Prescriptions IAW attached PWS (para.

5.13.2.18). The quantity for this CLIN is 576409 Pharmacy Prescriptions represented by the unit of issue "Each". The Contractor may invoice each month

4006 3,824 Hours OPTION Dermatology - Provider

FFP

The Contractor shall provide Dermatology Provider services IAW the attached

4007 7,763 Hours OPTION Dermatology - Support Staff

FFP

The Contractor shall provide Dermatology support services IAW the attached PWS

4008 3,824 Hours OPTION Optometry - Optometrist

FFP

The Contractor shall provide Optometrist services IAW the attached PWS (para.

4009 9,636 Hours OPTION Optometry - Support Staff

FFP

The Contractor shall provide Optometry support services IAW the attached PWS

4010 3,824 Hours OPTION Orthopedic- Physician Assistants

FFP

The Contractor shall provide Orthopedic PA services IAW the attached PWS (para

4011 10,134 Hours OPTION Orthopedic - Support Staff

FFP

The Contractor shall provide Orthopedic Support services IAW the attached PWS

4012 3,824 Hours OPTION Sports Medicine - Provider

FFP

The Contractor shall provide Sports Medicine Provider services IAW the attached

4013 10,134 Hours OPTION Sports Medicine - Support Staff

FFP

The Contractor shall provide Sports Medicine Support services IAW the attached

4014 3,824 Hours OPTION Dietitian

FFP

The Contractor shall provide Dietitian services IAW the attached PWS (para.

4015 3,824 Hours OPTION Podiatry - Provider

FFP

The Contractor shall provide Podiatry Provider services IAW the attached PWS

4016 7,380 Hours OPTION Podiatry - Support Staff

FFP

The Contractor shall provide Podiatry Support services IAW the attached PWS

4017 7,648 Hours OPTION Obstetrics- Provider

FFP

Mission Essential position: The Contractor shall provide Obstetrics Provider

4018 11,396 Hours OPTION Obstetrics- Support Staff

FFP

The Contractor shall provide Obstetrics Support services IAW the attached PWS

4019 1,248 Hours OPTION Obstetrics ON-CALL

FFP

The Contractor shall provide Obstetrics ON-CALL services IAW the attached

4020 1,248 Hours OPTION Obstetrics ON-CALL IN-HOUSE

FFP

The Contractor shall provide Obstetrics ON-CALL IN-HOUSE services IAW the

4021 11,472 Hours OPTION Physical Therapy - Provider

FFP

The Contractor shall provide Physical Therapy Provider services IAW the attached

4022 20,305 Hours OPTION Physical Therapy - Support Staff

FFP

The Contractor shall provide Physical Therapy Support services IAW the attached

4023 3,824 Hours OPTION Occupational Therapy - Provider

FFP

The Contractor shall provide Occupational Therapy Provider services IAW the

4024 7,342 Hours OPTION Occupational Therapy - Support Staff

FFP

The Contractor shall provide Occupational Therapy Support services IAW the

4025 44,970 Hours OPTION Behavioral Health - Support Staff

FFP

The Contractor shall provide Behavioral Health Support services IAW the attached

4026 11,472 Hours OPTION Immunization Clinic - Staff

FFP

The Contractor shall provide Immunization Clinic services IAW the attached PWS

OPTION MRI Equipment

COST

The Contractor shall provide MRI Equipment IAW the terms of the PWS (para.

OPTION Utilities

COST

OPTION Medical Supplies

COST

The Contractor shall provide Medical Supplies IAW with the terms of the PWS

OPTION Medical Equipment Maintenance

COST

The Contractor shall provide Equipment Mix IAW with the terms of the PWS

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 N/A N/A N/A Government 0002 N/A N/A N/A Government 0003 N/A N/A N/A Government 0004 N/A N/A N/A Government 0005 N/A N/A N/A Government 0006 N/A N/A N/A Government 0007 N/A N/A N/A Government 0008 N/A N/A N/A Government 0009 N/A N/A N/A Government 0010 N/A N/A N/A Government 0011 N/A N/A N/A Government 0012 N/A N/A N/A Government 0013 N/A N/A N/A Government 0014 N/A N/A N/A Government 0015 N/A N/A N/A Government 0016 N/A N/A N/A Government 0017 N/A N/A N/A Government 0018 N/A N/A N/A Government

0019 N/A N/A N/A Government 0020 N/A N/A N/A Government 0021 N/A N/A N/A Government 0022 N/A N/A N/A Government 0023 N/A N/A N/A Government 0024 N/A N/A N/A Government 0025 N/A N/A N/A Government 0026 N/A N/A N/A Government 0027 N/A N/A N/A Government 0028 N/A N/A N/A Government 0029 N/A N/A N/A Government 0030 N/A N/A N/A Government 0031 N/A N/A N/A Government 1001 N/A N/A N/A Government 1002 N/A N/A N/A Government 1003 N/A N/A N/A Government 1004 N/A N/A N/A Government 1005 N/A N/A N/A Government 1006 N/A N/A N/A Government 1007 N/A N/A N/A Government 1008 N/A N/A N/A Government 1009 N/A N/A N/A Government 1010 N/A N/A N/A Government 1011 N/A N/A N/A Government 1012 N/A N/A N/A Government 1013 N/A N/A N/A Government 1014 N/A N/A N/A Government 1015 N/A N/A N/A Government 1016 N/A N/A N/A Government 1017 N/A N/A N/A Government 1018 N/A N/A N/A Government 1019 N/A N/A N/A Government 1020 N/A N/A N/A Government 1021 N/A N/A N/A Government 1022 N/A N/A N/A Government 1023 N/A N/A N/A Government 1024 N/A N/A N/A Government 1025 N/A N/A N/A Government 1026 N/A N/A N/A Government 1027 N/A N/A N/A Government 1028 N/A N/A N/A Government 1029 N/A N/A N/A Government 1030 N/A N/A N/A Government 2001 N/A N/A N/A Government 2002 N/A N/A N/A Government 2003 N/A N/A N/A Government 2004 N/A N/A N/A Government 2005 N/A N/A N/A Government 2006 N/A N/A N/A Government 2007 N/A N/A N/A Government 2008 N/A N/A N/A Government 2009 N/A N/A N/A Government 2010 N/A N/A N/A Government 2011 N/A N/A N/A Government 2012 N/A N/A N/A Government

2013 N/A N/A N/A Government 2014 N/A N/A N/A Government 2015 N/A N/A N/A Government 2016 N/A N/A N/A Government 2017 N/A N/A N/A Government 2018 N/A N/A N/A Government 2019 N/A N/A N/A Government 2020 N/A N/A N/A Government 2021 N/A N/A N/A Government 2022 N/A N/A N/A Government 2023 N/A N/A N/A Government 2024 N/A N/A N/A Government 2025 N/A N/A N/A Government 2026 N/A N/A N/A Government 2027 N/A N/A N/A Government 2028 N/A N/A N/A Government 2029 N/A N/A N/A Government 2030 N/A N/A N/A Government 3001 N/A N/A N/A Government 3002 N/A N/A N/A Government 3003 N/A N/A N/A Government 3004 N/A N/A N/A Government 3005 N/A N/A N/A Government 3006 N/A N/A N/A Government 3007 N/A N/A N/A Government 3008 N/A N/A N/A Government 3009 N/A N/A N/A Government 3010 N/A N/A N/A Government 3011 N/A N/A N/A Government 3012 N/A N/A N/A Government 3013 N/A N/A N/A Government 3014 N/A N/A N/A Government 3015 N/A N/A N/A Government 3016 N/A N/A N/A Government 3017 N/A N/A N/A Government 3018 N/A N/A N/A Government 3019 N/A N/A N/A Government 3020 N/A N/A N/A Government 3021 N/A N/A N/A Government 3022 N/A N/A N/A Government 3023 N/A N/A N/A Government 3024 N/A N/A N/A Government 3025 N/A N/A N/A Government 3026 N/A N/A N/A Government 3027 N/A N/A N/A Government 3028 N/A N/A N/A Government 3029 N/A N/A N/A Government 3030 N/A N/A N/A Government 4001 N/A N/A N/A Government 4002 N/A N/A N/A Government 4003 N/A N/A N/A Government 4004 N/A N/A N/A Government 4005 N/A N/A N/A Government 4006 N/A N/A N/A Government 4007 N/A N/A N/A Government

4008 N/A N/A N/A Government 4009 N/A N/A N/A Government 4010 N/A N/A N/A Government 4011 N/A N/A N/A Government 4012 N/A N/A N/A Government 4013 N/A N/A N/A Government 4014 N/A N/A N/A Government 4015 N/A N/A N/A Government 4016 N/A N/A N/A Government 4017 N/A N/A N/A Government 4018 N/A N/A N/A Government 4019 N/A N/A N/A Government 4020 N/A N/A N/A Government 4021 N/A N/A N/A Government 4022 N/A N/A N/A Government 4023 N/A N/A N/A Government 4024 N/A N/A N/A Government 4025 N/A N/A N/A Government 4026 N/A N/A N/A Government 4027 N/A N/A N/A Government 4028 N/A N/A N/A Government 4029 N/A N/A N/A Government 4030 N/A N/A N/A Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

0001 POP 01-JUL-2024 TO

30-JUN-2025

N/A N/A

0002 POP 01-JUL-2024 TO

30-JUN-2025

0003 POP 01-JUL-2024 TO

0004 POP 01-JUL-2024 TO

0005 POP 01-JUL-2024 TO

0006 POP 01-JUL-2024 TO

0007 POP 01-JUL-2024 TO

0008 POP 01-JUL-2024 TO

0009 POP 01-JUL-2024 TO

0010 POP 01-JUL-2024 TO

0011 POP 01-JUL-2024 TO

0012 POP 01-JUL-2024 TO

0013 POP 01-JUL-2024 TO

0014 POP 01-JUL-2024 TO

0015 POP 01-JUL-2024 TO

0016 POP 01-JUL-2024 TO

0017 POP 01-JUL-2024 TO

0018 POP 01-JUL-2024 TO

0019 POP 01-JUL-2024 TO

0020 POP 01-JUL-2024 TO

0021 POP 01-JUL-2024 TO

0022 POP 01-JUL-2024 TO

0023 POP 01-JUL-2024 TO

0024 POP 01-JUL-2024 TO

0025 POP 01-JUL-2024 TO

0026 POP 01-JUL-2024 TO

0027 POP 01-JUL-2024 TO

0028 POP 01-JUL-2024 TO

0029 POP 01-JUL-2024 TO

0030 POP 01-JUL-2024 TO

0031 POP 01-JUL-2024 TO

1001 POP 01-JUL-2025 TO

30-JUN-2026

1002 POP 01-JUL-2025 TO

1003 POP 01-JUL-2025 TO

1004 POP 01-JUL-2025 TO

1005 POP 01-JUL-2025 TO

1006 POP 01-JUL-2025 TO

1007 POP 01-JUL-2025 TO

1008 POP 01-JUL-2025 TO

1009 POP 01-JUL-2025 TO

1010 POP 01-JUL-2025 TO

1011 POP 01-JUL-2025 TO

1012 POP 01-JUL-2025 TO

1013 POP 01-JUL-2025 TO

1014 POP 01-JUL-2025 TO

1015 POP 01-JUL-2025 TO

1016 POP 01-JUL-2025 TO

1017 POP 01-JUL-2025 TO

1018 POP 01-JUL-2025 TO

1019 POP 01-JUL-2025 TO

1020 POP 01-JUL-2025 TO

1021 POP 01-JUL-2025 TO

1022 POP 01-JUL-2025 TO

1023 POP 01-JUL-2025 TO

1024 POP 01-JUL-2025 TO

1025 POP 01-JUL-2025 TO

1026 POP 01-JUL-2025 TO

1027 POP 01-JUL-2025 TO

1028 POP 01-JUL-2025 TO

1029 POP 01-JUL-2025 TO

1030 POP 01-JUL-2025 TO

2001 POP 01-JUL-2026 TO

30-JUN-2027

2002 POP 01-JUL-2026 TO

2003 POP 01-JUL-2026 TO

2004 POP 01-JUL-2026 TO

2005 POP 01-JUL-2026 TO

2006 POP 01-JUL-2026 TO

2007 POP 01-JUL-2026 TO

2008 POP 01-JUL-2026 TO

2009 POP 01-JUL-2026 TO

2010 POP 01-JUL-2026 TO

2011 POP 01-JUL-2026 TO

2012 POP 01-JUL-2026 TO

2013 POP 01-JUL-2026 TO

2014 POP 01-JUL-2026 TO

2015 POP 01-JUL-2026 TO

2016 POP 01-JUL-2026 TO

2017 POP 01-JUL-2026 TO

2018 POP 01-JUL-2026 TO

2019 POP 01-JUL-2026 TO

2020 POP 01-JUL-2026 TO

2021 POP 01-JUL-2026 TO

2022 POP 01-JUL-2026 TO

2023 POP 01-JUL-2026 TO

2024 POP 01-JUL-2026 TO

2025 POP 01-JUL-2026 TO

2026 POP 01-JUL-2026 TO

2027 POP 01-JUL-2026 TO

2028 POP 01-JUL-2026 TO

2029 POP 01-JUL-2026 TO

2030 POP 01-JUL-2026 TO

3001 POP 01-JUL-2027 TO

30-JUN-2028

3002 POP 01-JUL-2027 TO

3003 POP 01-JUL-2027 TO

3004 POP 01-JUL-2027 TO

3005 POP 01-JUL-2027 TO

3006 POP 01-JUL-2027 TO

3007 POP 01-JUL-2027 TO

3008 POP 01-JUL-2027 TO

3009 POP 01-JUL-2027 TO

3010 POP 01-JUL-2027 TO

3011 POP 01-JUL-2027 TO

3012 POP 01-JUL-2027 TO

3013 POP 01-JUL-2027 TO

3014 POP 01-JUL-2027 TO

3015 POP 01-JUL-2027 TO

3016 POP 01-JUL-2027 TO

3017 POP 01-JUL-2027 TO

3018 POP 01-JUL-2027 TO

3019 POP 01-JUL-2027 TO

3020 POP 01-JUL-2027 TO

3021 POP 01-JUL-2027 TO

3022 POP 01-JUL-2027 TO

3023 POP 01-JUL-2027 TO

3024 POP 01-JUL-2027 TO

3025 POP 01-JUL-2027 TO

3026 POP 01-JUL-2027 TO

3027 POP 01-JUL-2027 TO

3028 POP 01-JUL-2027 TO

3029 POP 01-JUL-2027 TO

3030 POP 01-JUL-2027 TO

4001 POP 01-JUL-2028 TO

30-JUN-2029

4002 POP 01-JUL-2028 TO

4003 POP 01-JUL-2028 TO

4004 POP 01-JUL-2028 TO

4005 POP 01-JUL-2028 TO

4006 POP 01-JUL-2028 TO

4007 POP 01-JUL-2028 TO

4008 POP 01-JUL-2028 TO

4009 POP 01-JUL-2028 TO

4010 POP 01-JUL-2028 TO

4011 POP 01-JUL-2028 TO

4012 POP 01-JUL-2028 TO

4013 POP 01-JUL-2028 TO

4014 POP 01-JUL-2028 TO

4015 POP 01-JUL-2028 TO

4016 POP 01-JUL-2028 TO

4017 POP 01-JUL-2028 TO

4018 POP 01-JUL-2028 TO

4019 POP 01-JUL-2028 TO

4020 POP 01-JUL-2028 TO

4021 POP 01-JUL-2028 TO

4022 POP 01-JUL-2028 TO

4023 POP 01-JUL-2028 TO

4024 POP 01-JUL-2028 TO

4025 POP 01-JUL-2028 TO

4026 POP 01-JUL-2028 TO

4027 POP 01-JUL-2028 TO

4028 POP 01-JUL-2028 TO

4029 POP 01-JUL-2028 TO

4030 POP 01-JUL-2028 TO

CLAUSES INCORPORATED BY REFERENCE

52.202-1 Definitions JUN 2020 52.203-3 Gratuities APR 1984 52.203-6 Restrictions On Subcontractor Sales To The Government JUN 2020 52.203-6 Alt I Restrictions On Subcontractor Sales To The Government

(JUN 2020) -- Alternate I

NOV 2021

52.203-12 Limitation On Payments To Influence Certain Federal Transactions

JUN 2020

52.203-13 Contractor Code of Business Ethics and Conduct NOV 2021 52.203-14 Display of Hotline Poster(s) NOV 2021 52.203-16 Preventing Personal Conflicts of Interest JUN 2020 52.203-17 Contractor Employee Whistleblower Rights and Requirement

To Inform Employees of Whistleblower Rights

JUN 2020

52.204-2 Security Requirements MAR 2021 52.204-4 Printed or Copied Double-Sided on Postconsumer Fiber

Content Paper

MAY 2011

52.204-9 Personal Identity Verification of Contractor Personnel JAN 2011 52.204-10 Reporting Executive Compensation and First-Tier

Subcontract Awards

JUN 2020

52.204-13 System for Award Management Maintenance OCT 2018 52.204-18 Commercial and Government Entity Code Maintenance AUG 2020 52.204-19 Incorporation by Reference of Representations and

Certifications.

DEC 2014

52.204-21 Basic Safeguarding of Covered Contractor Information Systems

NOV 2021

52.204-23 Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities

NOV 2021

52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment

NOV 2021

52.204-27 Prohibition on a ByteDance Covered Application JUN 2023 52.209-6 Protecting the Government's Interest When Subcontracting

With Contractors Debarred, Suspended, or Proposed for Debarment

NOV 2021

52.209-9 Updates of Publicly Available Information Regarding Responsibility Matters

OCT 2018

52.212-1 Instructions to Offerors--Commercial Products and Commercial Services

MAR 2023

FAR ADDENDUM 52.212-1

Instruction to Offerors:

Pursuant to FAR 12.302(a), FAR Provision 52.212-1, Instructions to Offerors (ITO) – Commercial Items, is tailored. The basic provision paragraphs (a), (d), and (f) through (k) of the Addendum to FAR 52.212-1 are not replaced. The following paragraphs of specific instructions to offerors for this solicitation replace the basic provision paragraphs (b), (c), and (l). The basic provision paragraph (e) is deleted for this solicitation:

FAR Provision 52.212-1, Instructions to Offerors - Commercial Items is tailored by addendum as follows:

(b) Submission of Offers

1. General Instructions and Information This section provides general guidance for preparing proposals, as well as specific instructions on format and content of proposals.

Offerors are cautioned to follow the instructions provided in this section carefully to ensure the Government receives consistent information in a form that will facilitate proposal evaluation.

Proposals that take exception to inclusion of specific requirements in the resultant contract shall not be considered. Proposal must include all data and information requested herein and must be submitted in accordance with these instructions. The offeror is solely responsible for reading the solicitation and submitting a proposal in compliance with all instructions, requirements, terms, and conditions. The Government will review proposals for completeness and compliance with the solicitation and preparation instructions. Non-conformance with the instructions provided herein may result in an unfavorable proposal evaluation or rejection of the proposal. If an Offeror

(1) fails or refuses to assent to any of the terms and conditions of the solicitation, (2) proposes additional terms and conditions of this solicitation, or (3) fails to submit any of the information required by this solicitation, then the Government may consider the offer to be materially non-compliant, which could make the offer ineligible for contract award.

The Government is providing PWS references for the Offeror's convenience only. The Offeror is responsible for reading and complying with the solicitation requirements.

2. Proposal Organization Offerors shall submit proposals as stated in Addendum to FAR 52.212-1.

Organize your proposal as set forth in Table 1, Proposal Organization, into five (5) separate volumes. Failure to provide all information requested and in the appropriate format may cause the offer to be rejected and no longer considered for award.

Volume I – Cover Letter, Table of Contents, Business Information, Filled and Signed SF1449 as Amended, Contractor Team Organization Team Document and Representations & Certifications.

Volume II – Compensation Plan, Small Business Participation Commitment Document (SBPCD), Key Personnel List Volume III – Facility Approach, Administrative Approach and Clinical Operations Approach Volume IV – Past Performance Volume V – Price Title the volumes of your proposal with your company name, volume number, and tab number as shown in the filename example of Table 1. For example, ABC Incorporated filename for Volume I, Administration is ABC_VolumeI_Tab1.pdf.

Table 1 – Proposal Organization

Volume Required Volume File Name Required

Document Title Page Limit1 Format

I - Administrative ABC_VolumeI_Tab1thruTab5 Cover Letter

Tab 1 – Table of Contents

Tab 2 – Business Information

Tab 3 – Signed SF 1449 with all Amendments

(SF 30)

Tab 4 – Representations and Certifications

5 pages and will not be evaluated

Tab 1: 5 pages and will not be evaluated.

Tab 2: 10 Pages

Tab 3: No page limit unless identified in another section of Addendum to 52.212-1

Tab 4: No page limit unless identified in another section of Addendum to 52.212-1

PDF for all in Volume 1

II - Compensation Plan/SBPCD/Key Personnel: Factor 1, 2 & 32

ABC_VolumeII_Tab1thruTab3 Tab 1 – Compensation Plan

Tab 2 – SBPCD

Tab 3 – Key Personnel Information

Tab 1: Fill out compensation plan for each position listed

(ATTACHMENT

B)

Tab 2: Fill out Small Business Participation Commitment Document

(SBPCD) –

ATTACHMENT

C

Tab 3: Key Personnel Qualifications with supporting documentation List

- 20 pages

Microsoft Excel

PDF

PDF

III –

Technical/Risk:

Factor 42

ABC_VolumeIII_Tab1thruTab3 Tab 1 – Facilities Approach

Tab 2 – Administrative Operations Approach (Access to Care Plan)

Tab 3 – Clinical Operations Approach

Tab 1: 10 pages

Tab 2: 25 pages

Tab 3: 25 pages

PDF for all in Volume III

IV – Past Performance: Factor

ABC_VolumeIV_Tab1thruTab2 Tab 1A thru 1E References

Tab 2 – Organizational Change History

Tab 1A thru 1E:

5 pages per Tab

Tab 2:

Organizational Change History: 5 pages.

PDF for all in Volume in

V – Price: Factor 6 ABC_VolumeV_Tab1 Tab 1 – Price matrix

Limited to Government-provided spreadsheet

Microsoft Excel. Use Price matrix (Attachment

A)

1. Page limitations will be counted as maximums. If exceeded, the excess pages may not be read or considered in the evaluation of the proposal. Each side of a page will be counted as 1 page except for the following: Volume Cover Pages, Summary of Section, Glossaries, and Blank Pages.

2. The offeror is required to provide 2 copies of its proposal; (1) sanitized copy and (2) un-sanitized copy.

FORMAT AND CONTENT

Submit a second sanitized/redacted version of your technical proposal having all company names, addresses, logos, references, and other identifiable information removed.

Separate paragraphs by at least one blank line. Clearly identify the sanitized and un-sanitized copy of your proposal.

Font must be Arial or New Times Roman and no less than a 12-point size. Tables and illustrations may use a font size no less than 8-point.

Cross-referencing: Each volume shall be written on a standalone basis so that its contents may be evaluated with no requirement to cross-reference to other volumes of the proposal. Information required for proposal evaluation which is not found in its designated volume will be assumed to have been omitted from the proposal. Offerors are responsible for the accuracy of their proposals and the Government need not search for information that is not provided in the required volume.

Proprietary information shall be clearly marked. Proprietary information submitted in response to this solicitation will be protected from unauthorized disclosure as required by Subsection 27 of the Office of Procurement Policy Act as amended (41 U.S.C. 423), herein after referred to as “the Act,” as implemented in the FAR.

Digital and/or picture image signatures are acceptable.

3. Submission of Questions and Proposals

QUESTIONS

Comments, and questions shall be provided on attached feedback form (Attachment E) titled RFP_Att_E_ATAMMC_ACC_Q&A form. Participants are required to follow the instructions provided in Tab1 of the ATAMMC ACC Feedback form.

PROPOSAL

Submit proposals, a completed and signed solicitation as instructed in Addendum to FAR 52.212-1, and signed amendments, no later than the date/time specified in Block 8 of the solicitation (Standard Form [SF] 1449).

Email all questions, correspondence, and proposals to dha.ncr.acq‐sustainment.mbx.atammc‐ acc@health.mil

The offeror is responsible for verifying that the government has received its questions and proposals. Offerors may request verification by email to dha.ncr.acq‐sustainment.mbx.atammc‐ acc@health.mil to confirm that the government is in receipt of questions and proposals by the time specified in the solicitation.

4. Volume I – Administrative

Offerors shall submit Volume I with the following documents and information:

Tab 1: Table of Contents The Table of Contents serves as an overall guide to the files that are included, the volume and tabs they are located in, and a brief description of the documents. This document must be in Microsoft Word or Adobe PDF compatible format.

Tab 2: Business Information At a minimum, this document must include contact information such as e-mail addresses and telephone numbers for the principal point of contacts, company cage code, DUNS number, Tax ID number, and legal business name and other information about the business and major subcontractors as applicable. Offerors shall submit an organizational structure for all teaming partners and subcontractors used to demonstrate technical capability and past performance. If there are major subcontractors (performing 25% or more of the work), the offeror must state what percentage of the effort the subcontractor(s) will be performing. This document Adobe PDF compatible format.

Tab 3: SF1449 with Amendments Acknowledged Fully completed and signed SF 1449, page 1, Blocks 17a & b, 30a, b & c. Page 1 of the SF 1449 must be submitted in PDF compatible format. The offeror is not required to submit the entire SF 1449. The offeror MUST submit the SF 1449 pages that have been filled out by the offeror. Signed amendments (if any). Only Page 1 of the amendment shall be submitted and must be done so in PDF compatible format. The offeror should combine the SF 1449 and Amendments into a single file.

Tab 4: Representations and Certifications If the Offeror has not completed the annual representations and certifications electronically at the System for Award Management (SAM) website (https://www.sam.gov) or if the Offeror’s SAM registration does not include the following representations, the Offeror shall submit one (1) completed copy of each of the following:

FAR Provision 52.203-2, Certificate of Independent Price Determination FAR Provision 52.204-17, Ownership or Control of Offeror FAR Provision 52.204-24, Representation Regarding Certain Telecommunications and Video Surveillance or Equipment FAR Provision 52.204-26, Covered Telecommunications Equipment or Services- Representation FAR Provision 52.209-2, Prohibition on Contracting with Inverted Domestic Corporations— Representation FAR Provision 52.209-5, Certification Regarding Responsibility Matters FAR Provision 52.209-7, Information Regarding Responsibility Matters FAR…