Acist MRI Injector SOW-signed.pdf

Department of Health and Human Services Indian Health Service

Claremore Indian Hospital

Statement of Work (SOW) ACIST Empower MRI Injector

1. PURPOSE OF THE PROJECT

The Claremore Indian Hospital, Indian Health Services has a requirement for preventative maintenance inspection in accordance with manufacturer requirements, specifications, guidelines, checklists, revisions and addendum modifications that includes labor on the ACIST Empower MRI Injector- Serial Number M80350.

2. DETAILED DESCRIPTION OF THE TECHNICAL REQUIREMENTS

The contractor shall provide the following:

Annual preventative maintenance and full service contract on the power injector which will include a tech to provide onsite service for this preventative maintenance.

Full coverage on all labor, parts, travel, loaner systems and freight on the MRI Injection System.

All work shall be scheduled with Radiology to ensure arrangements can be made to work in the area. Notify Stephanie McAlvain, contact person in Radiology at 918-342-6207.

PM work to be performed Monday through Friday, 8:00 am to 5:00 PM.

Replacement parts shall be original equipment manufacturer (OEM) parts.

3. PERIOD OF PERFORMANCE

9/15/2024 – 9/14/2025 9/15/2025 – 9/14/2026 9/15/2026 – 9/14/2027

4. LEVEL OF EFFORT

4.1. The contractor shall provide preventative maintenance and services compatible with the Claremore Indian Hospital Radiology department schedule and availability.

5. SPECIAL REQUIREMENTS

5.1. In accordance with HHSAR 304.1300(b) non-routine contractor employees shall comply with OPDIV DHHS/SE Region – Human Resources, Security Clearance Guidance – Visitors (3/29/12) policy for contract performance period. Contractor employees will be required to obtain a visitor’s pass upon arrival for services from Facilities Management.-

Claremore Indian Hospital

5.2. The US PHS Claremore Indian Hospital is a tobacco/smoke free environment (buildings and grounds). No tobacco/smoking use will be tolerated during service.

5.3. Security Requirements: Contractor personnel will be required to contact the government designated point of contact upon arrival when reporting for service calls or delivery supplies. The contractor shall be responsible for the security of all organizational information. Current rules and regulations applicable to the premises, where the work shall be performed shall apply to the contractor and its employees while working on the premises.

These regulations include but are not limited to, escort by Claremore Indian Hospital official, presenting valid identification, smoking restriction and any safety procedures.

5.4. The contractor shall not disclose or cause to disseminate any information concerning operations of Claremore Indian Hospital. Such action(s) could result in violation of the contract and possible legal actions.

5.4.1. All inquiries, comments, or complaints arising from any matter observed, experienced or learned of as a result of or in connection with the performance of the contract, the resolution of which may require the dissemination of official information, shall be directed to the government’s designated representative.

5.4.2.

5.5. Termination Amortization Schedule: A termination amortization schedule shall be included as an attachment of the awarded contract. If the Government does not exercise any of the options listed in the price / cost schedule, the Government’s not exercising the options will have the same effect as if the Government terminated for convenience. All remedies afforded to contractor in regards to a termination for convenience shall be available to the contractor.

6. DELIVERABLES AND REPORTING REQUIREMENTS

6.1. Delivery: The contractor will coordinate the delivery, installation and training date with the designated government employee. The government will provide the contractor with dock access and building access for this sole purpose. The government requires a minimum of 24-hour notice of the contractor’s need to deliver parts and/or remove parts or deliver replacement parts. The designated government employee will work with the pertinent government agency(ies) to secure the needed dock access. No deliveries can be made after 4:15pm. Driver needs a valid ID.

Claremore Indian Hospital

6.2. Contractor Point of Contact: The contractor shall furnish one designated point of contact (POC) to the government’s designated representative for coordination of supplies, delivery, and/or maintenance. The POC will be empowered to make daily decisions to ensure that the contract implementation and day-to-day maintenance meets the terms and conditions of this contract.

6.3. Contractor’s Phone Numbers: The contractor shall provide a toll-free telephone number for service calls, which must be answered during at least eight working hours, between 8:00 am and 4:30 pm, Monday through Friday.

6.4. Personnel Qualifications: Only Authorized Service Providers should service or repair ACIST Empower MRI Injector.

6.5. Reporting: The contractor shall provide the Radiology Supervisor and biomedical technicians, with electronic PM service reports on the system covered by this contract.

7. GOVERNMENT FURNISHED PROPERTY, FACILITIES AND SERVICES

7.1. The Government shall not supply any equipment.

8. CONTRACTOR FURNISHED PROPERTY, FACILITIES AND SERVICES

8.1. Required personnel, materials, supplies and equipment: The contractor shall furnish all personnel, materials, supplies and equipment required to perform work under the contract.

9. CHANGES TO THE STATEMENT OF WORK (SOW)

Any changes to this SOW shall be authorized and approved only through written correspondence from the Contracting Officer. Costs incurred by the contractor through the actions of parties other than the Contracting Officer shall be borne by the contractor.

10. DELIVERABLES/PERFORMANCE METRIX

Service/Support- Contractor provided services and PM in accordance with Statement of Work.

Delivery- Contractor provided services in timely manner and provided a a 98% or greater percentile of guaranteed equipment up-time status operating according to manufacturer design specifications, based upon an average 6 month period.

Claremore Indian Hospital

Department Supervisor Signature:_________________________

Administrative Officer Signature:_________________________

Stephanie R.

Mcalvain -S

Digitally signed by Stephanie R. Mcalvain -S Date: 2024.04.30 14:06:27 -05'00'

Carl A. Murray - S

Digitally signed by Carl A.

Murray -S Date: 2024.05.01 08:08:55 -05'00'

CONTRACT QUALITY ASSURANCE INSPECTION FORM

Contractor Name: ________ for annual service and PM on the Acist Empower MRI Injector.

Project Officer and or Designee who performed inspection:

Date Quality Assurance Report submitted to Contracting Officer:

Quality Assurance Rating:

Superior: a level of performance which exceeds the minimum standards of performance;

Acceptable: an acceptable level of performance which meets the minimum standards of performance; or

Unacceptable: a level of performance that is fails to meet the minimum standards of performance.

Task Indicator Standard QA Rating

QA comments

1 Service/Support Contractor provided services and PM in accordance with

SOW.

2 Delivery Services were delivered in a timely manner.

Project Office or Contracting Officer’s Corrective Action Plan discussed with Contractor of substandard performance Date/Comment Project Officer inspected/accepted Contractor’s correction of substandard performance issue: