N00183-13-T-0040.doc

Section A - Solicitation/Contract Form

NOTICE:

Submit all quotes/offers via email to Yvette.Williams@med.navy.mil . Do not submit via NECO or U.S. postal service.

CONTRACTOR SHALL PROVIDE THE FOLLOWING INFORMATION:

1. Contractor Information:

CAGE CODE:

DUNS:

TIN:

Contractor Point of Contact:

Phone:

Contractor Point of Contact:

Phone:

Contractor E-Mail:

Fax:

2. A copy of your published/commercial price sheet containing the items and/or services requested in Section B of this RFQ.

PAYMENT INFORMATION:

Note that payment shall be in arrears. Example: If you select “Annually” you will not receive payment until the end of the period of performance date.

(Please “x” one) Payment in Arrears: __Monthly __Quarterly __Semi-Annually __Annually

Contractor shall be required to provide billing electronically via the WAWF Electronic Invoicing Method per Section G of this RFQ. For additional information, visit the following web sites: https://wawf.eb.mil http://wawftraining and/or Email: wawf@nmlc.med.navy.mil Prompt Payment: For Prompt Payment Act purposes, this contract is subject to the 7 calendar-day constructive acceptance period.

Invoice/Payment in Arrears, Net 30 Days

SOLICITATION EVALUATION AND AWARD INFORMATION:

The Government reserves the right to make an award based on an “all or none” evaluation; to the Contractor’s offer that represents the best value for the government in terms of past performance and price. Contractor’s quote shall include three references of companies that you have previously provided the same or similar services as requested in this RFQ. These references shall be recent, within the last two years. Contractors with superior past performance history may be given first consideration. The Government reserves the right to disqualify all offers/quotes that do not provide requested references.

Section B - Supplies or Services and Prices

Water Treatment Services - FY13

FFP

Contractor shall provide maintenance of all water treatment equipment, Quad-50 Filter/Softener and UV Light systems, to include the UV bulb replacements, RO filter replacements, salt addition and general maintenance of the systems for (11) Dental Clinics located at the 2d Dental Battalion, Naval Dental Center, Naval Hospital, Camp Lejeune, NC. Services shall be provided in accordance with Section C, Statement of Work. Quoted price shall be inclusive of all cost including travel, replacement parts, labor, quarterly filtration monitoring, water testing, and maintenance.

POP: 01 Dec 2012 - 30 Nov 2013

FOB: Destination

MILSTRIP: N6841013RC5A205

PURCHASE REQUEST NUMBER: N6841013RC5A205

NET AMT

FFP

Contractor shall provide maintenance of all water treatment equipment, Quad-50 Filter/Softener and UV Light systems, to include the UV bulb replacements, RO filter replacements, salt addition and general maintenance of the systems for (11) Dental Clinics located at the 2d Dental Battalion, Naval Dental Center, Naval Hospital, Camp Lejeune, NC. Services shall be provided in accordance with Section C, Statement of Work. Quoted price shall be inclusive of all cost including travel, replacement parts, labor, quarterly filtration monitoring, water testing, and maintenance.

POP: 01 Dec 2013 - 30 Nov 2014

FOB: Destination

NET AMT

FFP

Contractor shall provide maintenance of all water treatment equipment, Quad-50 Filter/Softener and UV Light systems, to include the UV bulb replacements, RO filter replacements, salt addition and general maintenance of the systems for (11) Dental Clinics located at the 2d Dental Battalion, Naval Dental Center, Naval Hospital, Camp Lejeune, NC. Services shall be provided in accordance with Section C, Statement of Work. Quoted price shall be inclusive of all cost including travel, replacement parts, labor, quarterly filtration monitoring, water testing, and maintenance.

POP: 01 Dec 2014 - 30 Nov 2015

NET AMT

FFP

Contractor shall provide maintenance of all water treatment equipment, Quad-50 Filter/Softener and UV Light systems, to include the UV bulb replacements, RO filter replacements, salt addition and general maintenance of the systems for (11) Dental Clinics located at the 2d Dental Battalion, Naval Dental Center, Naval Hospital, Camp Lejeune, NC. Services shall be provided in accordance with Section C, Statement of Work. Quoted price shall be inclusive of all cost including travel, replacement parts, labor, quarterly filtration monitoring, water testing, and maintenance.

POP: 01 Dec 2015 - 30 Nov 2016

NET AMT

FFP

Contractor shall provide maintenance of all water treatment equipment, Quad-50 Filter/Softener and UV Light systems, to include the UV bulb replacements, RO filter replacements, salt addition and general maintenance of the systems for (11) Dental Clinics located at the 2d Dental Battalion, Naval Dental Center, Naval Hospital, Camp Lejeune, NC. Services shall be provided in accordance with Section C, Statement of Work. Quoted price shall be inclusive of all cost including travel, replacement parts, labor, quarterly filtration monitoring, water testing, and maintenance.

POP: 01 Dec 2016 - 30 Nov 2017

NET AMT

Section C - Descriptions and Specifications

STATEMENT OF WORK

CONTRACTOR SHALL PROVIDE WATER TREATMENT SERVICES FOR KINETICO QUAD –50 FILTER / SOFTENERS SYSTEMS AND UV LIGHT FOR THE 2D BATTALION, NAVAL DENTAL CLINICS. SERVICES SHALL INCLUDE: (4) QUARTERLY VISITS TO ALL SITES WITH A COMPLETE CHECK OF EQUIPMENT, WATER TEST OF EQUIPMENT PERFORMANCE FOR EFFLUENT WATER, ALL LABOR COST INVOLVED IN REPAIR OF EQUIPMENT AS LONG AS FAILURE WAS RELATED TO THE ACTUAL EQUIPMENT MALFUNCITION, DELIVERY OF SALT TO ALL LOCATIONS, AND MONITORING OF ALL FILTER SYSTEMS FOR FILTER REPLACEMENT AND UV BULB CHANGES FOR ELEVEN LOCATIONS.

LOCATIONS: MAINSIDE, COURTHOUSE BAY, FRENCH CREEK, BLDG 65, HADNOT POINT, BLDG H-1, OSBOURNE, CAMP JOHNSON, CAMP GEIGER, NEW RIVER AIR STATION AND CHERRY POINT NAVAL STATION.

SERVICE MONTHS: DEC, MAR, JUN, SEP AT AN AGREED UPON TIME AND DATE WITH THE DENTAL REPAIR DIVISION PERSONNEL AND THE CONTRACTOR REPRESENTATIVE.

RESPONSE TIME: THE CONTRACTOR SHALL PROVIDE ON SITE RESPONSE WITHIN EIGHT HOURS OF RECEIPT OF SERVICE CALL.

PERFORMANCE TIME: ALL SERVICE WILL BE PROVIDED ON GOVERNMENT PREMISES DURING NORMAL WORKING HOURS.7:00AM THROUGH 4:00PM, MONDAY THROUGH FRIDAY EXCLUDING WEEKENDS AND FEDERAL HOLIDAYS OBSERVED BY THIS INSTALLATION.

CONTRACTOR REPRESENTATIVE:

CONTRACTOR REPRESENTATIVE/REPAIR PERSONNEL SHALL REPORT TO THE DENTAL REPAIR DIVISION UPON ARRIVAL TO THE 2ND DENTAL BN CAMP LEJEUNE.

1. General

a. The Contractor shall comply with Federal, State, and Local Laws, plus any Federal Regulations as applicable to the performance of this contract. Naval Regulations (NAVFAC) prohibits the use of Amines in chemical treatment systems in the hospital.

b. The Contractor shall not accept any instructions issued by any person employed by the U. S. Government, other than: the Contracting Officer (KO) or point of contact designated by the KO, acting within the limits of their authority.

c. The Contractor shall be qualified / authorized to chemically treat all equipment listed within this contract. Contractor shall maintain qualifications throughout entire contract period. Qualification includes, but not limited to, the certification of all persons to perform required services. Qualifications must be current (within 2 years). The Government shall maintain the right to seek proof of qualification prior to award and anytime during contract period of performance.

2. Scope of Work

a. The Contractor shall provide trained, experienced, English speaking personnel, bulk tanks, pumps, piping, connections, labor, tools, diagnostic equipment, software, test phantoms, material, supplies, transportation, parts and equipment necessary to perform Water Treatment Services and Testing. The Contractor shall inventory, deliver, and transfer chemicals to bulk tanks, maintain pumps, piping and connections to all systems.

b. The Contractor shall provide telephonic communications with the Government to discuss technical matters relating to the performance of this contract. A systems operator will be made available to answer technical questions regarding water treatment services.

c. The Contractor Point of Contact (POC). The Contractor shall provide in writing the name and telephone number of a primary and alternate English-speaking individual to act as their representative for the scheduling and coordination of service calls, and to be responsible for the coordination of the contract with the Government.

3. Contractor Report Requirements.

a. The Contractor shall provide full service report within two (2) days after completion of all service performed. The service report shall include, but not be limited to: contract number, equipment description (model, serial number, equipment control number) contractor’s log number, detailed description of the service(s) performed, the completion date and time. In the event that agents / sub-contractor’s are used in the performance of the water treatment services, said agent shall be identified on the service report by company name and contact information (i.e., telephone number).

4. Corrective Maintenance

a. Normal Working Hour Water Treatment Coverage will be Monday through Friday, between 7:00 A.M. to 4:00 P.M.

b. In the event that emergency service outside the normal working hours are required by the Government, additional work shall be billable to the Government at published commercial rates, and negotiated and approved by a Contracting Officer prior to services rendered.

c. The Contractor shall assign a unique Log/Reference Number to each Government request for Water Treatment Services.

d. Contractor’s pricing shall be inclusive of all cost including bulk tanks, piping, parts, labor, travel and shipping, unless otherwise indicated.

f. The Contractor shall have his/her own service manuals, specifications, schematic diagrams, and parts lists to assist in the treatment of all Systems included in this contract.

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

Section F - Deliveries or Performance

DELIVERY INFORMATION

30-NOV-2013

MAINSIDE DENTAL CLINIC

2D DENTAL BN/2D MLG

BOX 20130

CAMP LEJEUNE NC 28542

910-451-1658

N68093

30-NOV-2014

N68093

30-NOV-2015

N68093

30-NOV-2016

N68093

30-NOV-2017

N68093

CLAUSES INCORPORATED BY REFERENCE

Section G - Contract Administration Data

CLAUSES INCORPORATED BY FULL TEXT

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (JUN 2012)

(a) Definitions. As used in this clause--

“Department of Defense Activity Address Code (DoDAAC)” is a six position code that uniquely identifies a unit, activity, or organization.

“Document type” means the type of payment request or receiving report available for creation in Wide Area WorkFlow (WAWF).

“Local processing office (LPO)” is the office responsible for payment certification when payment certification is done external to the entitlement system.

(b) Electronic invoicing. The WAWF system is the method to electronically process vendor payment requests and receiving reports, as authorized by DFARS 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) WAWF access. To access WAWF, the Contractor shall--

(1) Have a designated electronic business point of contact in the Central Contractor Registration at https://www.acquisition.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this Web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site before submitting payment requests through WAWF. Both can be accessed by selecting the “Web Based Training” link on the WAWF home page at https://wawf.eb.mil/.

(e) WAWF methods of document submission. Document submissions may be via Web entry, Electronic Data Interchange, or File Transfer Protocol.

(f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order:

(1) Document type. The Contractor shall use the following document type(s).

2 IN 1 SERVICES ONLY

(2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in WAWF, as specified by the contracting officer.

DESTINATION / DESTINATION

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table*

(4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back-up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request.

(5) WAWF email notifications. The Contractor shall enter the email address identified below in the “Send Additional Email Notifications” field of WAWF once a document is submitted in the system.

WAWF Acceptor/COR Email Address:

Lance.Wyatt@med.navy.mil

Adriana.Prada@med.navy.mil

(g) WAWF point of contact.

(1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact.

wawf@med.navy.mil

(2) For technical WAWF help, contact the WAWF helpdesk at 866-618-5988.

(End of clause) Section H - Special Contract Requirements

N00183-0023 Service Contracts General (Ref NMCARS 5237.102)

The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the [NAMED COMPONENT] via a secure data collection site. The contractor is required to completely fill in all required data fields using the following web address https://doncmra.nmci.navy.mil .

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

BUSINESS ACCESS SECURITY REQUIREMENTS

NOTE: A NEW BASE ORDER (CAMP LEJEUNE BASE ORDER 5512.1C), REGARDING CONTRACTORS ACCESS TO MARINE CORPS BASE CAMP LEJEUNE, AND MARINE CORPS AIR STATION NEW RIVER, BECAME EFFECTIVE 21 FEBRUARY 2006. IN ORDER TO GAIN ACCESS TO PERFORM CONTRACT FUNCTIONS ABOARD THE BASE OR THE AIR STATION, YOU COMPLY WITH THE REQUIREMENTS BELOW.

1 BUSINESS ACCESS SECURITY REQUIREMENTS.

1.1 BUSINESS ACCESS DEFINITION. Contractor/subcontractor employees requiring installation access for periods from one day to one year to MCB, Camp Lejeune or MCAS New River, NC, must obtain a Business Access Identification Badge for that particular installation. Regularly scheduled delivery personnel, to include FEDEX, UPS, Pick-up and deliveries, should also follow the Business Access guidelines described below. Personnel requiring Business Access Identification Badges shall submit all documentation listed below. Badges are not required if the contracted position requires the employee to obtain a Common Access Card (CAE) which will be identified separately within the Government contract.

1.2 INSTALLATION SECURITY ACCESS REQUIREMENTS. Contractor shall accomplish the security requirements below within 10 days after award or prior to performance under the contract.

1.3 BUSINESS ACCESS IDENTIFICATION BADGE REQUIREMENT. The US Government will issue badges to contractor personnel without charge. Badges will be issued for one year or duration of contract whichever is less. In order to obtain a Business Access Identification Badge and access to MCB, Camp Lejeune, and satellite activities, or MCAS New River, all personnel providing services under this contract shall be required to present the documentation below to the following offices, as applicable:

MCB, Camp Lejeune, NC and its satellite activities. Report as follows:

1. Identification Card Center, 59 Molly Pitcher Road for badge (910-451-2727).

2. Vehicle Registration Office, 60 Molly Pitcher Road for vehicle decal (910-451-1158).

MCAS New River, NC. Report as follows:

1. S-4 (Facilities Office), Bldg AS-211 (l"1Deck) for registration on contractor's list (910-449-6310).

2. Pass and Identification Office, Bldg AS-211 (lst Deck) for badge and vehicle decal (910-449-5427/5428).

1.3.1 Photo ID. Valid state or federal issued picture identification card. Acceptable documents include state drivers license, DMV issued photo identification, or alien registration card.

1.3.2 Proof of Employee Citizenship or Legal Alien Status. Acceptable documents include birth certificate, Social Security Card, Immigration and Naturalization Service (INS) forms and passports.

1.3.3 Proof of Criminal Records Check. Proof of a criminal records check from the county or state where the employee has resided for the previous two years (or length of legal residence for foreign nationals in the U.S. for less than two years). Acceptable sources for criminal records checks include: County Courthouse; Defense Security Service (www.dss.mil); and Inforlink Screening Services, Inc. (www.infolinkscreening.com).Criminal records check shall be conducted annually prior to renewal of badges for reevaluation.

1.3.4 Denial of Access. Installation access shall be denied if it is determined that an employee:

a. Is on the National Terrorist Watch List.

b. Is illegally present in the United States.

c. Is subject to an outstanding warrant.

d. Has knowingly submitted an employment questionnaire with false or fraudulent information.

e. Has been issued a debarment order and is currently banned from military installations.

f. Is a Registered Sexual Offender and Convicted Felon (within the past 15 years); has a conviction of a drug crime within the past 5 years; and DUI within the last year.

1.3.5 Appeal Process. All appeals should be directed to the Base Inspector's Office for any individual that has been denied access to the Base.

1.3.6 Display and Disposition of Badges. Contractor employees shall prominently display their badges on their person at all times. Upon completion or termination of a contract or an individual's employment, the Contractor shall collect and turn in badges to the Pass and ill Office from which it was issued. If the Contractor is unable to obtain the employee's badge for whatever reason, the cognizant Pass and ill Office will be notified within 24 hours. During the contract performance period contractors will immediately report instances of lost or stolen badges to the issuing Pass and Identification Office.

1.3.7 Proof of Valid Government Contract. The Contracting Department shall submit a letter [on department letterhead] from the Contracting Officer to the Pass and Identification Office indicating location of contract work, contract period, and name of prime contractor. For subcontractors, the prime contractor will provide proof of employment on a valid Government contract (e.g., a letter [on company letterhead]) to include contract number and term.

1.4 CONTRACTOR SECURITY REQUIREMENT BUSINESS ACCESS VERIFICATION FORM.

Upon completion of the above process, Contractor shall submit to the Contracting Office the Contractor Security Requirement Business Access Verification form (Attachment #1) filled out in its entirety.

1.5 CONTRACTOR AND SUBCONTRACTOR VEHICLE REQUIREMENTS. Each vehicle to be used in contract performance shall show the Contractor's or subcontractor's name so that it is clearly visible and shall always display a valid state license plate and safety inspection sticker. To obtain a vehicle decal, which will be valid for one year or contract period, whichever is shorter, Contractor or subcontractor vehicle operators shall provide:

a. A copy of the Contracting Officer's authorization letter w/cc to PMO;

b. A valid form of Federal or state government I.D.;

c. If driving a motor vehicle, a valid driver's license, vehicle registration and proof of insurance.

Upon completion/termination of this contract or an individual's employment, the Contractor shall collect and turn in to Vehicle Registration all Government vehicle decals. If any are not collected, the Contractor shall notify the Vehicle Registration Office within 24 hours.

1.6 CONTRACTOR AND SUBCONTRACTOR EMPLOYEE VEHICLE REQUIREMENTS. In order to obtain a vehicle decal for one year, the Contractor and subcontractor employees shall provide to the Vehicle Registration office:

a. A copy of the Contracting Officer's authorization letter w/cc to PMO;

b. Proof of employment on a valid Government contract (e.g., a letter [on company letterhead] from the prime contractor including contract number and term);

c. A valid form of Federal or state government I.D.;

d. If driving a motor vehicle, a valid driver's license, vehicle registration and proof of insurance. Upon completion/termination of this contract or an individual's employment, the Contractor shall collect and turn in to Vehicle Registration all Government vehicle decals. If any are not collected, the Contractor shall notify the Vehicle Registration Office within 24 hours.

1.7 SECURITY CHECKS. Contractor personnel and vehicles shall only be present in locations relevant to contract performance. All Contractor personnel entering the base shall conform to all Government regulations and are subject to such checks as may be deemed necessary to ensure that violations do not occur. Employees shall not be permitted on base when such a check reveals that their presence would be detrimental to the security of the base. Subject to security regulations, the Government will allow access to an area for servicing equipment and/or performing required services. Upon request, the Contractor shall submit to the Contracting Officer questionnaires and other forms as may be required for security purposes.

CONTRACTOR SECURITY REQUIREMENTS

BUSINESS ACCESS

VERIFICATION

The Contractor shall submit this notification to the Naval Hospital Camp Lejeune Technical Point of Contact as reflected in Section B of the contract upon completion of the Security Requirements reflected in Section H of the contract.

CONTRACTOR ACKNOWLEDGEMENT

In accordance with the Security Requirements in Section H of the contract, I acknowledge and certify that all personnel providing services under this contract have been processed for access to Marine Corps Base, Camp Lejeune, North Carolina, and its' satellite activities and/or Marine Corps Air Station, New River, North Carolina, and have furnished the documentation reflected below to obtain personnel badges and vehicle decals.

Proof of employee citizenship or legal alien status.

Proof of a criminal records check.

Proof of employment.

An installation sponsor request forwarded to Provost Marshall Office. A valid form of Federal or state government identification. If driving a motor vehicle, a valid driver's license, vehicle registration and proof of insurance.

I, also, acknowledge and certify in accordance with the contract, that I am responsible, upon completion/termination of this contract or an individual's employment, to collect and turn in all personnel badges and vehicle decals.

CONTRACTOR NAME:

ADDRESS:

CONTRACT NUMBER:

CONTRACTOR'S PRINTED NAME

CONTRACTOR'S SIGNED NAME DATE

CLAUSES INCORPORATED BY FULL TEXT

INFORMATION ONLY: This document has been designated for posting to the Navy Electronic Commerce Online (NECO) at http://www.neco.navy.mil

Section I - Contract Clauses

CLAUSES INCORPORATED BY REFERENCE

CLAUSES INCORPORATED BY FULL TEXT

52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 15 days prior to contract expiration date.

(End of clause)

52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within 15 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 30 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 30 Nov 2017.

(End of clause)

52.219-6 NOTICE OF TOTAL SMALL BUSINESS SET-ASIDE (NOV 2011)

(a) Definition.

"Small business concern," as used in this clause, means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the size standards in this solicitation.

(b) Applicability. This clause applies only to--

(1) Contracts that have been totally set aside or reserved for small business concerns; and

(2) Orders set aside for small business concerns under multiple-award contracts as described in 8.405-5 and 16.505(b)(2)(i)(F).

(c) General. (1) Offers are solicited only from small business concerns. Offers received from concerns that are not small business concerns shall be considered nonresponsive and will be rejected.

(2) Any award resulting from this solicitation will be made to a small business concern.

(d) Agreement. A small business concern submitting an offer in its own name shall furnish, in performing the contract, only end items manufactured or produced by small business concerns in the United States or its outlying areas. If this procurement is processed under simplified acquisition procedures and the total amount of this contract does not exceed $25,000, a small business concern may furnish the product of any domestic firm. This paragraph does not apply to construction or service contracts.

(End of clause)

52.232-18 AVAILABILITY OF FUNDS (APR 1984)

Funds are not presently available for this contract. The Government's obligation under this contract is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise until funds are made available to the Contracting Officer for this contract and until the Contractor receives notice of such availability, to be confirmed in writing by the Contracting Officer.

(End of clause)

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

FAR Clauses http://acquisition.gov/comp/far/index.htm

DFAR Clauses http://www.acq.osd.mil/dpap/dars/dfars/index.htm (End of clause)

N00183-0004 PRIVACY AND SECURITY OF PROTECTED HEALTH INFORMATION

1. Introduction In accordance with DoD 6025.18-R “Department of Defense Health Information Privacy Regulation,” January 24, 2003, the Business Associate meets the definition of Business Associate. Therefore, a Business Associate Agreement is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security regulations. This clause serves as that agreement whereby the Business Associate agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in this clause, and in DoD 6025.18-R and DoD 8580.02-R, as amended. Additional requirements will be addressed when implemented.

a. Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DoD 6025.18-R or DoD 8580.02-R.

(1) HITECH Act shall mean the Health Information Technology for Economic and Clinical Health Act included in the American Recovery and Reinvestment Act of 2009.

(2) Individual has the same meaning as the term “individual” in 45 CFR 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

(3) Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

(4) Protected Health Information has the same meaning as the term “protected health information” in 45 CFR 160.103, limited to the information created or received by the Business Associate from or on behalf of the Government pursuant to the Contract.

(5) Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

(6) Required by Law has the same meaning as the term “required by law” in 45 CFR 164.103.

(7) Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

(8) Security Incident will have the same meaning as the term “security incident” in 45 CFR 164.304, limited to the information created or received by Business Associate from or on behalf of Covered Entity.

(9) Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160, 162 and part 164, subpart C.

(10) Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45 CFR 160.103, 160.502, 164.103, 164.304, and 164.501.

b. The Business Associate shall not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law.

c. The Business Associate shall use appropriate safeguards to maintain the privacy of the Protected Health Information and to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

d. The HIPAA Security administrative, physical, and technical safeguards in 45 CFR 164.308, 164.310, and 164.312, and the requirements for policies and procedures and documentation in 45 CFR 164.316 shall apply to Business Associate. The additional requirements of Title XIII of the HITECH Act that relate to the security and that are made applicable with respect to covered entities shall also be applicable to Business Associate. The Business Associate agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

e. The Business Associate shall, at their own expense, take action to mitigate, to the extent practicable, any harmful effect that is known to the Business Associate of a use or disclosure of Protected Health Information by the Business Associate in violation of the requirements of this Clause. These mitigation actions will include as a minimum those listed in the TMA Breach Notification Standard Operating Procedure (SOP), which is available at: http://www.tricare.mil/tmaprivacy/breach.cfm

f. The Business Associate shall report to the Government any security incident involving protected health information of which it becomes aware.

g. The Business Associate shall report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Business Associate becomes aware.

h. The Business Associate shall ensure that any agent, including a sub Business Associate, to whom it provides Protected Health Information received from, or created or received by the Business Associate, on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Business Associate with respect to such information.

i. The Business Associate shall ensure that any agent, including a subBusiness Associate, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

j. The Business Associate shall provide access, at the request of the Government, and in the time and manner reasonably designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

k. The Business Associate shall make any amendment(s) to Protected Health

Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government, and in the time and manner reasonably designated by the Government.

l. The Business Associate shall make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Business Associate, on behalf of the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner reasonably designated by the Government or the Secretary, for purposes of the Secretary determining the Government’s compliance with the Privacy Rule.

m. The Business Associate shall document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

n. The Business Associate shall provide to the Government or an Individual, in time and manner reasonably designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

2. General Use and Disclosure Provisions Except as otherwise limited in this Clause, the Business Associate may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, the HIPAA Security Rule, DoD 6025.18-R or DoD 8580.02-R if done by the Government. The additional requirements of Title XIII of the HITECH Act that relate to privacy and that are made applicable with respect to covered entities shall also be applicable to Business Associate.

3. Specific Use and Disclosure Provisions

a. Except as otherwise limited in this Clause, the Business Associate may use Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate.

b. Except as otherwise limited in this Clause, the Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate, provided that disclosures are required by law, or the Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

c. Except as otherwise limited in this Clause, the Business Associate may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

d. Business Associate may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

4. Obligations of the Government Provisions for the Government to Inform the Business Associate of Privacy Practices and Restrictions

a. The Government shall provide the Business Associate with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520.

b. The Government shall provide the Business Associate with any changes in, or revocation of, permission by Individual to use or disclose Protected Health

Information, if such changes affect the Business Associate’s permitted or required uses and disclosures.

c. The Government shall notify the Business Associate of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

5. Permissible Requests by the Government The Government shall not request the Business Associate to use or disclose

Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, the HIPAA Security Rule, or any applicable Government regulations (including without limitation, DoD 6025.18-R and DoD 8580.02-R) if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Business Associate as otherwise permitted by this clause.

6. Termination

a. Termination. A breach by the Business Associate of this clause, may subject the Business Associate to termination under any applicable default or termination provision of this Contract.

b. Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Business Associate shall return or destroy all Protected Health Information received from the Government, or created or received by the Business Associate on behalf of the Government. This provision shall apply to Protected Health Information that agents of the Business Associate may come in contact. The Business Associate shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the Business Associate determines that returning or destroying the Protected Health Information is infeasible, the Business Associate shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Business Associate that return or destruction of Protected Health Information is infeasible, the Business Associate shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Business Associate maintains such Protected Health Information.

7. Miscellaneous

a. Regulatory References. A reference in this Clause to a section in DoD 6025.18-R, DoD 8580.02-R, Privacy Rule or Security Rule means the section currently in effect or as amended, and for which compliance is required.

b. Survival. The respective rights and obligations of Business Associate under the “Effect of Termination” provision of this Clause shall survive the termination of this Contract.

c. Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DoD 6025.18-R, DoD 8580.02-R, the HIPAA Privacy Rule or the HIPAA Security Rule.

Section M - Evaluation Factors for Award

CLAUSES INCORPORATED BY REFERENCE