Task Order PWS Template - Prismax - Thermax.pdf

MQS2-NG Task Order Template Type I Configuration as of 12 Feb 25 Page 1 of 15

Department of Defense

Defense Health Agency

Medical Q-Coded Support & Services – Next Generation (MQS2-NG)

Type I Configuration - Task Order (TO) Performance Work Statement (PWS) Template (as of: 15 Jan 2025)

Service:

Prismax & Thermax Warming/Cooling Equipment; Hypercare Full Service Maintenance Contract

Location:

Naval Medical Center San Diego / Intensive Care Unit

Date:

JUNE 29, 2026

PART 1 PERFORMANCE WORK STATEMENT

The contractor shall provide all services, materials and equipment necessary for the repair/maintenance of the (2) Baxter Prismax Hemodialysis units and their components, (2) Baxter Blood warming units located at Naval Medical Readiness and Training Center (NMRTC) San Diego Intensive Care Unit– BLDG 1, 4th floor or BIOMED Engineering located in

MQS2-NG Task Order Template Type I Configuration as of 12 Feb 25 Page 2 of 15 bldg. 1, ground floor, San Diego CA to ensure dependable and reliable equipment operation. The scope of work performed under these specifications includes the furnishing of all labor, and parts to perform all repairs on equipment listed, to assure continued operation at their designed efficiency and capacity.

NO. ECN SERIAL NUMBER MODEL MFR

1 174062 PX205218 955724 Baxter 2 174063 PX205215 955724 Baxter 3 174064 TX205357 955630 Baxter 4 174065 TX205356 955630 Baxter

PREVENTIVE MAINTENANCE:

• Perform service repair/maintenance to industry standards.

• Ensure that only FULLY QUALIFIED FIELD ENGINEERS and TECHNICIANS who have gone through original equipment manufacturer (OEM) or comparable third-party service schools for the above mentioned equipment, shall be employed in the performance of any and all work performed under this contract. Upon request, the contractor shall provide training certificates (or notarized copies) to the Biomed Repair Division for verification. The highest standard of professional capability and electrical/mechanical workmanship is to be maintained throughout the life of this contract.

• Make repairs to the extent necessary (as determined by inspection tests or disassembly) to ensure a functional system that will efficiently serve its intended purpose.

• All travel, on-site labor and repair parts needed to perform repairs.

• One scheduled preventive maintenance check according to Manufacturer.

• 24 x 7 Telephone Technical Support

• Extend to the Government all commercial warranties on replacement parts, consistent with standard industry practices.

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If vendor will exceed work outside of normal working hours; they must get prior approval from the Head, BioMedical Department, before proceeding with any repairs.

TITLE TO EQUIPMENT: The contractor shall not assume possession or control of any part of the equipment. The Government retains ownership to title thereof.

LIABILITY: The contractor shall not be liable for any loss, damage, or delay due to any cause beyond his reasonable control including but not limited to, acts of government, strikes, lockouts, fire, explosion, theft, floods, riot, civil commotion, war, malicious mischief or acts of God.

UTILITIES: The contractor may use Government utilities, (e.g., electrical power, compressed air, and water) that are available and required for any service performed under this contract. The building engineer, to ensure compatibility with the Naval Hospital Camp Pendleton electrical wiring and equipment, must approve contractor electrical equipment.

ACCESS TO EQUIPMENT: The contractor shall be provided reasonable access to all equipment that is to be serviced and utility outlets required to do the service. The contractor shall be free to start and stop all primary equipment incidentals to the operation of the maintained equipment after permission is received from on duty personnel responsible for such equipment.

CONTRACTOR CHECK-IN/CHECK-OUT: The Contractor, or his representative, is required to check-in and out at the Naval Medical Readiness and Training Center BIOMED division bldg. 1, ground floor during the hours of 0730 - 1600 hours, Monday through Friday, prior to and upon completion of any service/repair performed.

FIELD SERVICE REPORTS: The contractor, or his representative shall furnish to:

Biomedical Engineering Division Naval Medical Readiness and Training Center San Diego Building 1, Ground Floor Phone: (619) 532- 8010 E-mail: usn.san-diego.navmedcensanca.list.nmcsd-medrepairlist@health.mil.

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A legible copy of the Field Service Report upon completion of work performed. The contractor, or his representative, shall complete the Government copy of this Field Service Report to include the following:

• Date and Time Notified

• Date and Time Arrival

• ECN (Equipment Control Number), Type, serial # and model #

• Time expended repairing/servicing

• Description of malfunction

• General Description of replaced parts and service performed

• Comments as to cause of malfunction

FIELD SERVICE REPORTS ARE REQUIRED TO APPROVAL OF ALL INVOICES

GOVERNMENT PERSONNEL: NMRTC employees will not perform maintenance or attempt repairs to equipment while such equipment is under the purview of this contract unless agreed to in writing by the contractor.

PARTS AVAILABILITY: To ensure minimal equipment downtime, the contractor shall maintain replacement repair parts and materials necessary to perform each repair or supply said parts and materials within three (3) days.

Normal Work Hours – This Agreement specified equipment maintenance be performed during normal work hours – 7AM through 4PM, Monday through Friday. Work performed on equipment listed above outside the scope of the contract will be billed at the preferred labor rate.

After Hours – Work performed after 5PM through 8AM, Monday through Saturday, (excluding national holidays) will be billed at 1.5 times the preferred labor rate at a minimum of 4 hours, portal to portal.

Emergency After Hours – Emergency after hours work performed on a Sunday, or national holiday will be billed at 2 times the preferred labor rate at a minimum of 4 hours portal to portal.

Labor: All compensation for labor is included in the contract price.

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Parts and materials: Compensation for only the parts and materials listed is included in contract price.

Parts/Supplies Quality: Parts and Supplies provided under this contract shall be guaranteed to be equal in all respects, including performance, interchangeability, durability and quality to the OEM parts when new or as presently recommended by the manufacturer.

PREVENTIVE MAINTENANCE AND CORRECTIVE

MAINTENANCE SCHEDULES

IN ADDITION TO THE BASIC CONTRACT PWS, THE FOLLOWING TERMS

AND CONDITIONS ARE REQUIRED:

1.4. Description of Services:

Prismax & Thermax Warming/Cooling Equipment; Hypercare Full Service Maintenance Contract

The Contractor shall provide the following labor categories in accordance with the titles listed in Technical Exhibit (TE) 4:

JSC: J063

The services required on this TO are in the following labor segments: n/a

Physician Services under PSC:

Dental Services under PSC code:

Ancillary Services under PSC:

Nursing Services under PSC:

Med Support Services under PSC:

1.4.1. This TO is issued under the following arrangement: n/a Personal Services: The performance of health care services by contract workers under a personal services arrangement are subject to day-to-day supervision and control by health care facility personnel comparable to that exercised over military and civil service health care personnel engaged in comparable health care services. Contract workers under a

MQS2-NG Task Order Template Type I Configuration as of 12 Feb 25 Page 6 of 15 personal services arrangement requiring licensure may maintain a license in any U.S.

jurisdiction as outlined in DHAPM 6025-13, Volume 4.

Non-Personal Services: The performance of health care services by contract workers under a non-personal services arrangement are not subject to day-to-day supervision and control by health care facility personnel comparable to that exercised over military and civil service health care personnel engaged in comparable health care services. The Government shall neither supervise non-personal services employees nor control the method by which the Contractor performs these required tasks. Contract workers under a non-personal services arrangement requiring licensure must maintain an unrestricted license in the U.S. jurisdiction within which the contract worker is performing on the contract as outlined in DHAPM 6025.13, Volume 4 (no licensure portability, includes telehealth visits).

1.4.2. Performance Location: The work to be performed under this contract will be at:

Naval Medical Center San Diego

1.4.3. The Government is ordering services under a Type I configuration.

These labor categories will be contracted for a base period of (enter number of months and number of options. The positions for this requirement are or are not (n/a) currently fully staffed. Company may contact the Contracting Officer Representative (COR) to obtain information about the incumbents. n/a

1.5. General Information:

1.5.1. Key Government Personnel: The following personnel are considered key Government personnel at the TO level:

1.5.1.1. Task Order Contracting Officer (TOCO): The following individual is the TOCO for this TO and Vendor will be notified of any changes:

Name of TOCO: n/a TOCO Email Address: n/a.

TOCO Telephone Number: n/a.

1.5.1.2. Contracting Officer’s Representative (COR): The following individual is designated as the COR for this TO and Vendor will be notified of any changes:

Name of COR: Jesse Bell COR Email Address: jesse.a.bell2.civ@health.mil COR Telephone Number: 619-532-8010

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Contract workers under this TO will or will not [Select the appropriate requirement and identify which positions/labor cate will and which won’t (Verify with MTF Credentials Monitor)] require a DEA registration number.

1.5.3. Work Schedule: n/a

1.5.3.1. Overage Hours: (NOTE: Overage hours are variable hours that may, or may not, be used for services beyond the regularly scheduled duty hours. n/a

* Note, overage hours are often used by the Contractor to pay overtime pay to their employees.

1.5.3.3. Duty Hours: n/a

1.5.3.4. On-Call Hours: n/a

1. 5.4: Contract Worker Required Start Date:

• Initial Fills: The contract worker required start date for a position will be no less than (n/a) calendar days from the CLIN period of performance start date. n/a

• Replacement Fills: The contract worker required start date for a replacement will be no less than (n/a) calendar days from the unfilled date of the departing contract worker. n/a

1.5.5. Competency-Based Interviews: Prior to contract worker placement, the

Government will or will not (Select appropriate requirement) contact the contract worker to determine if the contract worker meets the requirements set in the contract and/or TO.

(See base contract PWS)

1.5.6. Recognized Holidays: Contract workers will or will not (Select appropriate requirement) be required to work on federally recognized holidays. If required to work, the federally recognized holidays are: n/a

1.5.7 Planned Closures: Other than the recognized holidays identified in paragraph 1.5.6 of this TO PWS, the following are known non-duty days (family or training days) where the contract workers will not be able to perform their duties, even in a telework environment, and the Contractor cannot bill for services: n/a

1.5.8. Unplanned Closures: During unplanned (unknown) closures due to no fault of the Contractor (e.g., natural disaster, military emergency, severe weather, pandemic, or Government decision to close the facility outside of a planned closure), the contract worker will: (Select appropriate statement(s) below as applicable)

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-be compensated only for the actual hours the contract worker provided services. -be compensated for the unplanned closure

1.5.9 Emergency Essential Services: Contract worker positions are or are not (Select appropriate requirement) considered emergency/mission essential in an emergency services status.

1.5.11. Telework Arrangements: Contract workers will or will not (Select appropriate requirement) be capable of providing services in a telework environment.

1.5.12. Relocation Costs: The Government will or will not (Select appropriate requirement) pay the Contractor to relocate contract workers.

1.5.18. Service Contract Labor Standards Wage Determination. The Services Contract Labor Standards Act applies or does not apply (Select appropriate requirement) to one or more labor categories on this TO. (Insert table with FTEs that must follow Labor Standards Wage Determination as a minimum). Fill in SAMPLE table below with accurate information for this TO.

CLIN Labor Category FTE Location 0001 Pharmacist 2 WRNMMC 0002 Registered Nurse - Dermatology 1 Fort Belvoir 0003 Dental Hygienist 4 Andrews AFB 0004 Medical Billing Clerk 2 Indian Head 0005 Physician – Flight Surgeon 1 Kenner

TOTAL 10

1.5.24.2.2 Task Order Quality Control Plan (QCP): The Contractor shall submit a complete QCP to the TO Contracting Officer (TOCO) (Enter when a QCP must be submitted. For example, ‘within 15 days of TO award.).

1.5.35. Malpractice Insurance for Non-Personal Services: The Contractor, and all subcontractors, shall meet the requirements of DHA PM 6025.13, vol. 4 and the FAR Clause 52.237‑7, Indemnification and Medical Liability Insurance, for its non-personal service contract workers, in the following amounts for the entire performance period of the TO: n/a

1.5.36. Recording Contract Worker Time: Follow procedures listed in base contract PWS 1.5.36 or follow these changes to the recording of contract worker time identified in the base contract PWS are as follows: n/a

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1.5.37. Contract Worker Planned Absences:

1.5. 37.1. Personal Services Arrangement: The notification policy for planned absences requires contract workers under a personal services arrangement to notify the Government Supervisor (n/a) prior to the absence in accordance with the place of performance policy.

1.5.37.1.2. Scheduling, Personal Services Arrangement: The work schedule for each contract worker under a personal services arrangement is as follows (Add table if multiple labor categories):

CLIN Labor Category Schedule 0001 Pharmacist M-F 0730-1630 0002 Registered Nurse - Dermatology Sun-Thurs 0700-1600 0003 Dental Hygienist Tue-Fri 0800-1800 0004 Medical Billing Clerk M-F 1500-2300 0005 Physician – Flight Surgeon Rotating 3 days-12hrs & 4 days off

TOTAL

Labor Category: n/a

1.5.37.2. Non-Personal Services Arrangement: The notification policy for planned absences requires contract workers under a non-personal services arrangement to notify the COR (n/a) prior to the absence in accordance with the place of performance policy.

1.5.37.2.1. Scheduling, Non-Personal Services Arrangements: Hours of service requirements for contract workers under a non-personal services arrangement are as follows: (Add table if multiple labor categories):

CLIN Labor Category Schedule 0001 Pharmacist M-F 0730-1630 0002 Registered Nurse - Dermatology Sun-Thurs 0700-1600 0003 Dental Hygienist Tue-Fri 0800-1800 0004 Medical Billing Clerk M-F 1500-2300 0005 Physician – Flight Surgeon Rotating 3 days-12hrs & 4 days off

TOTAL

Labor Category: n/a.

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1.5.37.3. Medical Supplemental (Type I) Substitute Contract Worker: The place of performance will or will not (Select appropriate requirement) require a substitute contract worker unless the permanent contract worker is absent for more than (n/a) calendar days.

1.5.40. Occupational Health: The contract worker shall or shall not (Select appropriate requirement) be required to obtain documentation of required physical testing or a report of a physical examination.

1.5.41. Tuberculosis Screening: The Contractor ensure contract workers shall or shall not (Select appropriate requirement) be screened for tuberculosis (TB). In addition, contract worker will be screened prior to reporting for services at the place of performance for the following: n/a

1.5.42. Health Requirements. The Contractor shall or shall not (Select appropriate requirement) provide documentation certifying health requirements such as immunizations, annual vaccinations, and physical examination when required at the time of initial placement.

1.5.45.8. Physical Qualifications: Beyond the general physical qualifications outlined in the base contract PWS, contract workers shall be capable of the following:

n/a

1.5.45.14. National Provider Identifier (NPI): The following labor categories on this TO shall or shall not (Select appropriate requirement) require a 10-digit NPI from the Centers for Medicare and Medicaid Services: n/a

1.5.45.16 Training: Contract workers shall complete all agency-specified training requirements and comply with all policies and procedures applicable to the place of performance. Refer to MTF and DHA policies for required training.

1.5.45.22 Dress and Appearance: Contract workers shall maintain good personal hygiene and present a well-groomed and professional appearance IAW the policy at the place of performance. If required, the following uniform (e.g., smocks, EMT/Paramedic uniform) is mandatory: n/a

1.5.45.23. Contractor Travel: Reimbursement will or will not (Select appropriate requirement) be provided for travel within a 40-mile radius of the place of performance.

Contract worker travel requirements are as follows: n/a

PART 2

DEFINITIONS AND ACRONYMNS NOT FOUND IN BASE CONTRACT PWS

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2.1. Definitions: The following additions are made to the Government Definitions and Acronyms for this TO: Enter additional items or type “NA” if no additional items are required from those listed in the base contract PWS (Reference base contract PWS Section 2 as necessary)

ART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3. Government Furnished Items and Services:

3.1. General: The following additions are made to the Government furnished items, equipment and services for this TO: Enter additional items or type “NA” if no additional items are required from those listed in the base contract PWS (Reference base contract PWS as necessary)

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PART 4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. Contractor Furnished Items and Responsibilities:

4.1. General: The following additions are made to the Contractor furnished items and services for this TO: Enter items or type “N/A” if no additional Contractor furnished items are required on this TO (Reference base contract PWS as necessary)

PART 5 SPECIFIC TASKS

(Identify the qualifications for each labor category required on the TO in the labor category (TE 4) below. The labor category qualifications in this section can be additional to, supplemental with, or in lieu of the standard qualifications at TE 5.

(Ensure the all the below information is provided for each labor category required for this TO.)

5.8. The Contractor shall conduct competency-based screening against preliminary Government minimum requirements, verify candidate qualifications against Government minimum requirements, and submit qualifying documentation for candidate approval as identified at the time of order placement.

5.8.1. Labor Category: List the labor category title from TE 4.

5.8.1.1. Legal Authorization to Work in the United States: The contract worker performing under this contract must be a U.S. Citizen (see base contract PWS 1.5.45.12.)

Enter other legal authorizations to work under this contract or type “nothing follows”.

5.8.1.2. Education:

• Degree/Education: Type, “See TE 5” or type in the degree and education when either none is listed at TE 5 for the labor category or a different degree and/or education level is required. Type “None” if a degree or education is not required.

• Equivalency Determination Request: The Contractor may or may not (Select appropriate requirement) request an equivalency determination as a substitute for education requirements on this labor category.

5.8.1.3 Certifications (in addition to Basic Life Support identified in paragraph 1.5.45.6.): Type “See TE 5” or type the required certification when either none exists at TE 5 for the labor category or additional certification is required. Type “None” if no certifications are required for this labor category.

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5.8.1.4. Board Certification: (see base contract PWS 1.5.45.3.: Type in the specific board certification or type “None” if no certifications are required for this labor category.

5.8.1.5. Licensure: (see base contract PWS 1.5.45.2). Type “See TE 5” or type in the license requirements when none are listed at TE 5 or type “None” if not required for the labor category.

5.8.1.6. Contract Worker Standard Qualifications: (see base contract PWS 1.5.45.1.).

The standard qualifications (duties) or the labor category are as follows: This is a free text area. Either type “See TE 5” or type in the duties for the labor category when either none exists at TE 5 or additional duties not listed at TE 5 are required for this labor category.

5.8.1.7. Submit Qualifying Documentation: Select the appropriate qualifying documentation, by labor category:

5.8.1.7.1. ☐Submit Qualifying Package for Non-Credentialed Contract Worker (see base contract PWS 5.9. and definition at 2.1.71. in base contract PWS): The Contractor shall provide a complete, current, and accurate qualifying package for Enter the non-credentialed labor categories requiring a qualifying package) within Enter the time frame for submission (i.e., 15 days before contract worker placement”).

5.8.1.7.2. ☐Submit Credentialing Package for Credentialed Contract Workers (see base contract PWS 5.10. and definition 2.1.18. in base contract PWS): The Contractor shall provide a complete, current, and accurate credentialing packages for Enter the credentialed labor categories requiring a credentials package) within Enter the time frame for submission (i.e., 30 days before contract worker placement”). Additional requirements from those listed in DHAPM 6025.13, Volume 4 for this TO are: Enter additional requirements not outlined in DHAPM 6025.13 Volume 4 or type “N/A

5.22. Invoice for Services: The Contractor shall invoice for services as follows: Outline the frequency (i.e., monthly) and method of invoice (i.e., hourly rate, flat rate, or performance-based using a designated ‘unit’ such as call transactions, number of encounters, or transcribed lines.

PART 6 OTHER TERMS, CONDITIONS, AND PROVISIONS

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In addition to the terms, conditions, and provisions listed in the MQS2-NG base contract, the Contractor shall abide by these additional provisions: Enter any agency specific provisions or type N/A if not applicable.

PART 7 APPLICABLE PUBLICATIONS

7.1. Publications: In addition to the publications listed in the MQS2-NG base contract, you are responsible to use the current version. The Contractor shall abide by these additional applicable service regulations, publications or manuals: Enter additional regulations, publications or manuals not already identified in the contract specific to this TO or type N/A if not applicable.

TECHNICAL EXHIBIT 1

PROGRAM PERFORMANCE SUMMARY (PPS)

Replace table information with any additional or different TO minimum acceptable quality levels (AQLs) of service required for each objective at the TO level that is not already required at the base contract level.

Performance Objective Reference Performance Objective Method of

Surveillance AQL

Overall Fill Percentage 5.2.3.3.2

Percentage of days FTEs are assigned to a position in a reporting period (Type I Configuration only)

Government management oversight;

discrepancy reports

>= 90%

Customer Satisfaction 5.2.3.3.2

The aggregate rating for compliance on a 5-point scale as reported by CORs in a reporting period

Government management oversight;

discrepancy reports

>= 3.0

LOIA Percentage 5.2.3.3.2

The percentage of FTEs submitted to the Government that were approved from an LOIA in a reporting period (Type I Configuration only)

Government management oversight;

discrepancy reports

>= 95%

Package Acceptance Percentage 5.2.3.3.2

The percentage of qualifying and credentials packages that were not returned because of errors or omissions in a reporting period

Government management oversight;

discrepancy reports

>= 92%

MPSR Submission Accuracy Count 5.2.3.2

The count of the number of MPSRs the Government returned to the submitter due to inaccurate reporting and the number of MPSRs that were not submitted on time each month

Monthly MPSR

No more than two error and untimely reports each month, which were caused by inaccurate or late reporting

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TECHNICAL EXHIBIT 2 TASK ORDER DELIVERABLE SCHEDULE

n/a

Deliverable Frequency # of Copies Medium/Format Submit To

Key Personnel List

NLT enter number of days business days of TO award

Enter number of copies

Electronic copy (MS Word) via email

Enter the person receiving the document i.e., COR

Quality Control Plan Within enter number of days days of TO award

Enter number of copies Enter format

Enter the person receiving the document

Security Investigative Package

NLT enter number of days days before the required start date of the contract worker

Enter number of copies Enter format

Enter the person receiving the document

Credentials Package

NLT enter number of days days before the required start date of the contract worker

Enter number of copies Enter format

Enter the person receiving the document