Amendment HT940625QE0080002_PWS_Delivery Schedule_QA.pdf

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11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended. is not extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

(a) By completing items 8 and 15, and returning copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER

NUMBER IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

16C. DATE SIGNED

Previous edition unusable STANDARD FORM 30 (REV. 11/2016) Prescribed by GSA FAR (48 CFR) 53.243

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE PAGE OF PAGES

2. AMENDMENT/MODIFICATION NUMBER 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)

6. ISSUED BY CODE 7. ADMINISTERED BY (If other than Item 6) CODE

8. NAME AND ADDRESS OF CONTRACTOR (Number, street, county, State and ZIP Code) (X) 9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NUMBE

10B. DATED (SEE ITEM 13)

CODE FACILITY CODE

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

The purpose of Amendment 0002 is to: (1) modify the Performance Work Statement (PWS), Block 14 (Description of Amendment/Modification):

Section 2.3.3.3; (2) change the Delivery Schedule for Line Items 0001 through 0004; (3) address the question received in response to Request for Quotation (RFQ) HT940625QE008:

(1) PWS, Section 2.3.3.3 is modified, as follows:

FROM:

2.3.3.3 The audiometric test booth must have hospital-grade recessed electrical device with pre-wired jack panel with cable pass-thru. (NOTE:

NBHC Key West currently has hearing test instrumentation which shall be re-connected and reconfigured to the new audiometric test booth by the contractor.)

TO:

2.3.3.3 The audiometric test booth must have hospital-grade recessed electrical device with pre-wired jack panel with cable pass-thru. (NOTE:

NBHC Key West currently has hearing test instrumentation manufactured by Grason Stadler Inc., Model: Auto Tymp, and Model: GSI 61 CLIN AUDI, which shall be re-connected and tested to ensure that devices are fully functional as per OEM specifications to the new audiometric test booth by the contractor.)

(2) The Delivery Schedule for Line Items 0001 through 0004 is changed, as follows:

FROM:

Delivery Required On Delivery Date 01 September 2025

TO:

Delivery Estimated By Delivery Date 09/22/2025

(3) Question:

The equipment currently connect to the booth being removed is what? The statement of work describes GSI equipment and Benson instruments. If GSI equipment is used in the new booth there has to be a special connection jack pane to allow this, please confirm.

Answer:

Reference the revised PWS, Section 2.3.3.3, and Section 2.3.3.11.

Description/Specifications/Statement of Work

Miscellaneous text in this section has been modified to:

1.0 GENERAL INFORMATION

1.1 This is a non-personal services contract to provide Procurement, deinstallation, and installation of the purchased Audiometric Double Walled Booth.

1.1.1 : The contractor shall provide all personnel, equipment, supplies, transportation, tools, materials, Description of services/introduction supervision, and other items and non-personal services necessary to disassemble and remove the existing audiometric test booth. The audio booth shall be able to be occupied by a minimum of two(2) persons) during hearing screenings. Current facility hearing test instrumentation shall be re-connected and calibrated to the new audiometric booth by contractor.

1.1.2 Background: The facility currently has an outdated booth with only one-person capacity and limits the patients that are screened in accordance with Navy deployable status along with a slow down in patientcare. Naval Hospital Jacksonville, Branch Health Clinic Key West has grown in size, now requiring a larger capacity audiometric booth that can meet the clinic patient demand. The facility supports active duty to meet medical readiness, used to perform hearing examinations and help DOD civilians and Pre-Hire Civilians get certified to work on base.

1.1.3 The scope of this project is to, deinstall and remove the existing audiometric booth, and procure and install a new audiometric double Scope:

walled test booth. The booth shall be able to be occupied by a minimum of two (2) persons with the capability to test two (2) people concurrently during hearing screenings. The contractor shall remove the existing current test instrumentation contained in the existing booth, de-install the current booth from the facility and dispose of the booth. Contractor shall maintain a clean work space and be responsible for any damage occurring during de-installation, to include floors, paint, walls and ceiling. Inspect and prepare the existing room for installation of purchased double walled audio booth.

The room shall meet current equipment manufacturer's (OEM) specifications, in accordance with the newest United States, State, and Local law and regulations, DHA regulations, and The Joint Commission (TJC) requirements. The Joint Commission's requirements are specified in its Comprehensive Accreditation Manual for Hospitals (CAMH), and fire codes. Final testing and calibration certification upon completion of the installation and re-connection of current instrumentation.

HT940625QE0080002

1.1.4 Period of Performance (PoP): The period of performance is for a two (2)month period beginning at contract award.

1.1.5 Delivery: The equipment shall be delivered Branch Health Clinic Key West, 1300 Douglas Circle, Key West, Florida. Building #L-48. Room # 1072.

1.1.6 Installation: The contractor shall provide qualified labor, tools, and necessary equipment to complete the installation as per manufacturer specifications. Room #1072 where the booth is be installed must be ready to receive the new booth along with any needed repairs from deinstallation completed before installation of the new booth. Base access instruction will be provided once contract is awarded.

1.2 Administrative specifications

1.2.1 Place of performance: The work shall be performed at Naval Hospital Jacksonville, Branch Health Clinic Key West, 1300 Douglas Circle, Key West, Florida, Building # L-48. Room # 1072.

Recognized Federal holidays1.2.2 : Contractor must not perform project scope during federal 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

Juneteenth Day Christmas Day

Independence Day

1.2.3 Hours of operation: The contractor is responsible for conducting business Monday through Friday, 0730-1600, except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings. 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. No overtime will be authorized.

1.3 Contractor Identification

1.3.1 Contractor personnel performing services in a contractor capacity in a Government facility are required to possess and wear an identification badge that displays his or her name and the name of their company.

1.4 Warranty

1.4.1 The contractor shall warranty for audiometric test booth for a period not less than five (5) years.

2.0 SPECIFIC TASKS

2.1 Service Event Documentation

2.1.1 Upon completion of the removal of existing audio booth and installation of new audio booth, the Field Service Engineers submit a signed Field Service Report (FSR)to BIOMED. The service report indicates all problems addressed, devices checked, parts replaced/repaired, parts ordered, and problem resolution or pending action. Each service report must at a minimum document the following data legibly, in English, and in complete detail:

1. Name of Contractor

2. Name of Contractor personnel performing service

3. Contractor personnel log/control number

4. Equipment identification factors: Manufacturer, make, model, serial number

5. Date & time, beginning and ending, of hours on-site for service call

6. Itemized description of service performed to include, but not be limited to: parts used, problem(s)found, corrective action(s) taken or recommended, communications had with Medical Treatment Facility (MTF) personnel

7. Resolution and/or pending action(s)

8. Signatures:

a. Contractor employee performing service

b. BMET verifying service rendered

2.1.2 Test equipment: Ensure that all certified test equipment calibration standards are traceable and are certified in accordance with National Institute of Standards and Technology (NIST).

2.1.3 Point of Contact: Report to Biomedical Equipment Technician, HM1 Madru, Kevin at kevin.j.madru.mil@health.mil or 305- 293-4871 upon arrival.

2.2.4 Removal and disposal of existing Audio booth: Remove existing test instrumentation contained in the existing booth, de-install the current booth. The contractor shall coordinate with the BMET POC for proper disposal instructions.

2.2.5 Maintain a clean workspace. Responsible for repairs for any damage that occurs during the de-installation to include floors, paint, walls and ceiling.

2.3 Audio booth Installation

2.3.1 Room Preparation: Prior to installation, the contractor shall inspect the existing room and ensure it meets all fire codes, that proper egress (exit access) is maintained, and that electrical compliance is verified by both the clinic facility manager and the clinic safety manager. The room shall meet current equipment manufacturer's (OEM) specifications, in accordance with the newest United States, Florida, DHA regulations, and The Joint Commission (TJC) regulations. Any damages made by contractor to walls, ceilings, and floor shall be repaired at contractor expense. The Joint Commission's requirements are specified in its Comprehensive Accreditation Manual for Hospitals (CAMH), and fire codes. Contractor shall final testing and calibration certification upon completion of the installation and re-connection of current successfully complete instrumentation.

Maintain a clean work space. The Contractor shall be responsible for repairs for any damage that occurs during the installation to include floors, paint, walls and ceiling.

2.3.2 : Contractor shall conduct one (1) on-site room inspection 30 days prior to installation. On-Site Inspection During the on-site visit the contractor, BMET, and Facility manager will inspect and discuss any preparation needed in the existing room for installation of the new double walled audio booth. The room must meet current equipment manufacturer's(OEM) specifications, in accordance with the newest United States, State, and Local law and regulations, DHA regulations, and The Joint Commission (TJC)requirements. The Joint Commission's requirements are specified in its Comprehensive Accreditation Manual for Hospitals (CAMH), and fire codes.

Final testing and calibration certification upon completion of the installation and re-connection of current instrumentation.

2.3.3 Essential Characteristics

2.3.3.1 The audiometric test booth must not exceed the room dimensions of length (209.5 inches), height (1193/4 inches), and width (139 inches) to fit in the allocated space area.

2.3.3.2 The audiometric test booth must be doubled walled with interior wall and roof manufactured with perforated steel and exterior wall manufactured with solid steel.

2.3.3.3 The audiometric test booth must have hospital-grade recessed electrical device with pre-wired jack panel with cable pass-thru. (NOTE: NBHC Key West currently has hearing test instrumentation manufactured by Grason Stadler, Inc., Model: Auto Tymp, and Model: GSI 61 CLIN AUDI, which shall be re-connected and tested to ensure that devices are fully functional as per OEM specifications to the new audiometric test booth by the contractor.)

2.3.3.4 The audiometric test booth must have a double-glazed acoustic patient viewing window on the front right side of the room.

2.3.3.5 The audiometric Booth entrance must be on the left front side of room.

2.3.3.6 The audiometric test booth must be acoustically engineered with roof-mounted ventilation.

2.3.3.7 The audiometric test booth lighting system must be switch-activated with an LED illuminations system. LED illumination system must be energy efficient with recessed bulbs and soft white lighting.

HT940625QE0080002

mailto:kevin.j.madru.mil@health.mil

2.3.3.8 The audiometric test booth must be compatible with Grason-Stadler, Inc., (GSI), GSI 61Audiometer, GSI Tymp GSI 39 Middle Ear Analyzer, and GSI Tympstar Tympanometer. The contractor must possess the capability to disconnect the GSI 61 Audiometer, GSI Tymp GSI 39 Middle Ear Analyzer, and GSI Tympstar Tympanometer from existing audiometric booth and reconnect the GSI 61 Audiometer, GSI Tymp GSI 39Middle Ear Analyzer, and GSI Tympstar Tympanometer to its original configuration in the new audiometric booth.

2.3.3.9 The audiometric test booth must be compatible with the Navy and Marine Corps Force Health Protection Command (NMCPHC) Hearing CCA-200 mini Benson Medical Instruments audiometer. The contractor must be able to disconnect and reconnect CCA-200 mini Benson to its original configuration and to the new audiometric test booth. The contractor must possess the capability to disconnect the CCA-200Mini Benson Medical Instruments audiometer from existing audio booth and reconnect the CCA-200 to its original configuration in the new audiometric test booth.

2.3.3.10 The audiometric test booth must have an available space for operators to sit at desk within the test room. The audiometer equipment must be set-up closest to the acoustic patient viewing window.

2.3.3.11 The audiometric test booth must connect to120V, 60HZ power. The electrical wiring must be in accordance with (IAW) the 2011 National Electric Code.

2.3.3.12 The audiometric test booth must have an18-inch minimum clearance and must not impede the overhead fire sprinklers.

2.3.3.13 The audiometric test booth must pass annual certification in accordance with (IAW) ANSI certifications.

2.3.3.14 The audiometric test booth must meet the maximum permissible ambient noise level (MPANLs) allowed in an audiometric test room that produce negligible masking (p2 dB) of test signals presented at reference equivalent threshold levels specified in the American National Standards Institute (ANSI) S3.6-1996, American National Standard Specifications for Audiometers. The MPANLs are specified from 125 to 8000 Hz in octave and one-third octave band intervals fortwo audiometric testing conditions (ears covered and ears not covered) and for three test frequency ranges (125 to 8000 Hz, 250 to 8000 Hz, and 500 to8000Hz). The standard is intended for use by all persons testing hearing and for distributors, installers, designers, and manufacturers of audiometric test rooms. This standard is a revision of ANSI S3.1-1991, American National Standard Maximum Permissible Ambient Noise Levels for Audiometric Test Rooms.

2.3.4 Training: Upon audiometric booth installation, the contractor shall conduct initial in-person general operator training for all designated BMET personnel at NBHC Key West, FL. This training will provide the BMET with insight into the OEM specified procedures for preventive maintenance and frequently observed issues with properly maintaining the new audiometric test booth.

2.3.5 User Manuals: P rovide two (2) operator manuals (1 manual in digital format and 1 manual in hardcopy format).

3.0 Qualifications/Considerations

3.1 Special Qualifications/Considerations: The contractor must be an OEM-certified service provider. Contractor shall verify that an individual whom they plan to employ or continue to employ in the United States is authorized to accept employment in the United States. Individuals such as those who have been admitted as permanent residents, granted asylum or refugee status, or admitted in work-related nonimmigrant classifications may have employment authorization, as direct result of their immigration status. Contractor Service personnel shall have sufficient experience to demonstrate proficiency in maintenance of the product.

3.1.1 Branch Health Clinic Key West, reserves the right to refuse any of the contractor's permission to enter the premises or work on Branch Health equipment. This right may be exercised at any time. The reasons for rejections may include: lack of training and experience, but Clinic Key West, may also include, but not be limited to: behavior, attire, security concerns, and immigration status.

4.0 Government Task

4.1 The NBHC Key West will assign a Government point of contact (POC) to monitor the dismantling, removal, and disposal of the existing audiometric test booth. The Government POC will provide proper disposal instructions for the dismantled audiometric test booth at contract award.

4.2 The assigned POC for NBHC Key West will be responsible for monitoring the installation of the new audiometric test booth to ensure proper installation and functionality.

5.0 Points of Contact

5.1 Points of Contact:

Officer In Charge: CDR Clapper, Stephanie. Email: stephanie.c.clapper.mil@health.mil.

Department Head Medical Readiness Clinic: LCDR Hare, Ryan. Email: ryan.w.hare.mil@health.mil. Phone: 305-293-3953

Biomedical Equipment Technician: HM1 Madru, Kevin. Email: kevin.j.madru.mil@health.mil. Phone: 305-293-4871

Contracting Officer: Andrea Giuliano - andrea.l.giuliano.civ@health.mil

Deliveries or Performance

The delivery information for the following CLIN(s) / SLIN(s) / ELIN(s) were modified:

Ship To - DoDAAC: HT0320

INFORMATION FROM TO

Delivery Delivery Required On 01 Sep 2025. Delivery Estimated By 22 Sep 2025.

Ship To - DoDAAC: HT0320

INFORMATION FROM TO

Delivery Delivery Required On 01 Sep 2025. Delivery Estimated By 22 Sep 2025.

Ship To - DoDAAC: HT0320

INFORMATION FROM TO

Delivery Delivery Required On 01 Sep 2025. Delivery Required On 22 Sep 2025.

Ship To - DoDAAC: HT0320

INFORMATION FROM TO

Delivery Delivery Required On 01 Sep 2025. Delivery Estimated By 22 Sep 2025.

HCD SOUTHEAST, 7700 ARLINGTON BLVD, ATTN SE DIV

FALLS CHURCH, VA 22042

UNITED STATES

Derrick Walker, Email: derrick.w.walker.civ@health.mil Telephone: 7262030012 AdminBy:

SCD: PAS: