13-t-0467.doc

Section A - Solicitation/Contract Form

CLAUSES INCORPORATED BY FULL TEXT

Fill in Blanks:

TIN (tax ID): ________________

CAGE: ________________

DUNS: __________________

Vendor Point of Contact: ______________________Phone: ____________________

Vendor email: ______________________

Naval Medical Center Portsmouth POC: Psychiatry Dept.

Vendors quoted price shall be inclusive of all cost including labor, material and travel

Payment Monthly, Quarterly, Annually (please circle) in Arrears Note: vendor will be required to provide billing electronically via the WAWF Electronic Invoicing method. For additional information, a review of the following web sites may be required: https://wawf.eb.mil http://wawftraining (email) wawf@nmlc.med.navy.mil Vendor to reference N00183-13-T-0467 on all inquires.

Government reserves the right to:

(1) award based on an "All or Nothing Evaluation".

(2) award a “Best Value” requirement. Vendors with superior past performance histories may be given 1st consideration.

Evaluation Factors

· Past Performance

· Qualifications of vendor to include experience and training in the repair of all items listed

· Qualification of vendors technicians to include experience and training in the repair of all items listed

· Price

· Ability to begin work / provide full support on the 1st day of performance

· Ability to performed required services / repairs

· Physical location of vendor’s facility within a 90 mile radius in an effort to provide timely support

PROMPT PAYMENT

For Prompt Payment Act Purposes, this contract is:

Subject to the 7-calender day constructive acceptance period.

“AVAILABILITY OF FUNDS. Pursuant to Section I, Availability of Funds (FAR 52.232-18), of the contract, 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 to the Contracting Officer.

Section B - Supplies or Services and Prices

Each

Maintenance of HP Printer for the Period

FFP

1 Oct 113 - 30 Sep 14

See Section C for details of requirements

FOB: Destination

MILSTRIP: N0018314RQTB006

PURCHASE REQUEST NUMBER: N0018314RQTB006

NET AMT

0001AA

Maintenance in Accordance with Section C on 11ea Laserjet P3005X Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AB

Maintenance in Accordance with Section C on 2 ea Laserjet 2430DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AC

Maintenance in Accordance with Section C on 16 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AD

Maintenance in Accordance with Section C on 19 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AE

Maintenance in Accordance with Section C on 1 ea Laserjet 3500 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AF

Maintenance in Accordance with Section C on 1 ea Laserjet 3500P Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AG

Maintenance in Accordance with Section C on 7 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AH

Maintenance in Accordance with Section C on 1 ea Laserjet 5940 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AJ

Maintenance in Accordance with Section C on 3 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AK

Maintenance in Accordance with Section C on 2 ea Laserjet P3005N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0001AL

Maintenance in Accordance with Section C on 3 ea Laserjet 2300DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

Each

FFP

1 Oct 14 - 30 Sep 15

See Section C for details of requirements

FOB: Destination

NET AMT

0002AA

FFP

on 11ea Laserjet P3005X Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AB

FFP

on 2 ea Laserjet 2430DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AC

FFP

on 16 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AD

FFP

on 19 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AE

FFP

on 1 ea Laserjet 3500 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AF

FFP

on 1 ea Laserjet 3500P Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AG

FFP

on 7 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AH

FFP

on 1 ea Laserjet 5940 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AJ

FFP

on 3 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AK

FFP

on 2 ea Laserjet P3005N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0002AL

FFP

on 3 ea Laserjet 2300DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

Each

FFP

1 Oct 15 - 30 Sep 16

See Section C for details of requirements

FOB: Destination

NET AMT

0003AA

FFP

on 11ea Laserjet P3005X Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AB

FFP

on 2 ea Laserjet 2430DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AC

FFP

on 16 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AD

FFP

on 19 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AE

FFP

on 1 ea Laserjet 3500 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AF

FFP

on 1 ea Laserjet 3500P Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AG

FFP

on 7 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AH

FFP

on 1 ea Laserjet 5940 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AJ

FFP

on 3 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AK

FFP

on 2 ea Laserjet P3005N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

0003AL

FFP

on 3 ea Laserjet 2300DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

FOB: Destination

NET AMT

Each

FFP

1 Oct 16 - 30 Sep 17

See Section C for details of requirements

FOB: Destination

NET AMT

0004AA

FFP

on 11ea Laserjet P3005X Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AB

FFP

on 2 ea Laserjet 2430DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AC

FFP

on 16 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AD

FFP

on 19 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AE

FFP

on 1 ea Laserjet 3500 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AF

FFP

on 1 ea Laserjet 3500P Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AG

FFP

on 7 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AH

FFP

on 1 ea Laserjet 5940 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AJ

FFP

on 3 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AK

FFP

on 2 ea Laserjet P3005N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0004AL

FFP

on 3 ea Laserjet 2300DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

Each

FFP

1 Oct 17 - 30 Sep 18

See Section C for details of requirements

NET AMT

0005AA

FFP

on 11ea Laserjet P3005X Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AB

FFP

on 2 ea Laserjet 2430DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AC

FFP

on 16 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AD

FFP

on 19 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AE

FFP

on 1 ea Laserjet 3500 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AF

FFP

on 1 ea Laserjet 3500P Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AG

FFP

on 7 ea Laserjet P4014N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AH

FFP

on 1 ea Laserjet 5940 Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AJ

FFP

on 3 ea Laserjet 4240N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AK

FFP

on 2 ea Laserjet P3005N Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

0005AL

FFP

on 3 ea Laserjet 2300DTN Printers

End User: Psychiatry Dept.

See Section C for details of requirements, location & serial #.

Unit Price $_______________ (fill in)

NET AMT

Section C - Descriptions and Specifications

STATEMENT OF WORK

As a minimum contractor shall:

This contract shall provide total maintenance services, which include on-site corrective repairs (i.e. unlimited Service Calls) during normal working hours of 7:00 AM to 3:30 PM, Monday through Friday excluding Federal holidays and 1 ea preventative maintenance service / inspection. Vendor shall not be responsible for consumable items (paper, ink, toner). Vendors price to be inclusive of all cost including labor, travel and all repair parts including maintenance kits. Note that the vendor will be responsible for the replacement / repair of diffusers. Note for color printers vendor will not be required to replace / supply consumables items (IE: colorsphere, toner / print / diffuser units).

The vendor shall be fully qualified in the repair of all items listed in this requirement. The Government reserves the right to seek proof of qualification prior to contract award and at any time during the period of performance.

Response time for service calls shall be within 48 hours of Government notification. The Government shall reserve the right to request an “emergency response” for dedicated networked printers and “one of a kind” printers (Deskjet 5940). Response time shall not exceed 4-hours after notification. For bidding purposes vendor shall expect 20% of all service calls to be rated as an emergency. Maintenance cost shall be inclusive of all charges including labor, parts, travel, shipping (of parts) and one onsite preventive maintenance. The contractor shall maintain all printers per manufacture's guidelines. All replaced parts shall be new. If new parts are not available the use of rebuilt parts will be allowed providing they meet or exceed manufactures specifications (for new parts). The preventive maintenance visit shall be performed as soon as possible after receipt of contract. All PM’s are to be completed no later than 31 Dec 13 (31 Dec 14 & 31 Dec 15 of option years). The contractor shall contact Naval Medical Center Technical Point of Contact (2 weeks prior) to schedule preventative maintenance visit. During annual preventative maintenance as a minimum the contractor shall clean and adjust all equipment per manufactures recommendations. Upon arrival contractor required to check in with appropriate Naval Medical Center point of contact (see Section A). Prior to departure contractor required to check out with point of contact and provide status of repairs made. Contractor required to provide a completed service report within 2 business days to Naval Medical Center Point of Contact.

Vendor to note that printers are located in multiple locations. All locations have restricted access. At the Governments discretion, escorts on access badges will be made available to the vendor (within work areas). The vendor is encouraged to participate in the RapidGate Program as the Government will not provide facility escorts except in the case of emergent service. (see local clause: N00183-0019 for alternate facility access). Vendor’s price shall include any delay in obtaining escorts and or access badges (IE: Government will not compensate vendor for time required to obtain access badges or wait times for escorts). Vendor should expect a delay of up to 1 hour for escorts and 3 hours for day pass access badge processing. In an effort to minimize wait times; vendor will be required to schedule access in a timely manner. All vendor employees will be required to have the ability to obtain access badges.

Printers may be located in any one of the NMCP Clinic Psychiatry Dept.; all located within the Greater Tidewater VA area. For reference the NMCP Clinics / facilities are as follows:

Naval Medical Center

Portsmouth, VA

Boone Clinic

Norfolk, VA

Tricare VA Beach

Virginia Beach, VA

BioMedical Photo

Portsmouth, VA

Inventory of Equipment to be Covered:

Psychiatry Dept Printers

CLIN AA

CLIN AB

CLIN AC

CLIN AD

CLIN AE

CLIN AF

CLIN AG

CLIN AH

CLIN AJ

CLIN AK

CLIN AL

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

Section F - Deliveries or Performance

DELIVERY INFORMATION

30-SEP-2014

30-SEP-2014

PSYCHIATRY DEPARTMENT/1ST FLOOR

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708-2297

757-953-5258

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2014

N00183

30-SEP-2015

30-SEP-2015

PSYCHIATRY DEPARTMENT/1ST FLOOR

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708-2297

757-953-5258

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2015

N00183

30-SEP-2016

30-SEP-2016

PSYCHIATRY DEPARTMENT/1ST FLOOR

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708-2297

757-953-5258

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2016

N00183

30-SEP-2017

30-SEP-2017

PSYCHIATRY DEPARTMENT/1ST FLOOR

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708-2297

757-953-5258

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2017

N00183

30-SEP-2018

30-SEP-2018

PSYCHIATRY DEPARTMENT/1ST FLOOR

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708-2297

757-953-5258

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

30-SEP-2018

N00183

CLAUSES INCORPORATED BY REFERENCE

Section G - Contract Administration Data

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (MAY 2013)

(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 System for Award Management 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).

(Contracting Officer: Insert applicable document type(s). Note: If a “Combo” document type is identified but not supportable by the Contractor's business systems, an “Invoice” (stand-alone) and

“Receiving Report” (stand-alone) document type may be used instead.)

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

(Contracting Officer: Insert inspection and acceptance locations or “Not applicable”.)

(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*

Field Name in WAWF

Data to be entered in WAWF

Pay Official DoDAAC

Issue By DoDAAC

Admin DoDAAC

Inspect By DoDAAC

Ship To Code

Ship From Code

Mark For Code

Service Approver (DoDAAC)

Service Acceptor (DoDAAC)

Accept at Other DoDAAC

LPO DoDAAC

DCAA Auditor DoDAAC

Other DoDAAC(s)

(*Contracting Officer: Insert applicable DoDAAC information or “See schedule” if multiple ship to/acceptance locations apply, or “Not applicable.”)

(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.

(Contracting Officer: Insert applicable email addresses or “Not applicable.”)

(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.

(Contracting Officer: Insert applicable information or “Not applicable.”)

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

(End of clause)

Section H - Special Contract Requirements

CLAUSES INCORPORATED BY FULL TEXT

N00183-0003 Authorized Callers (Non-Medical) Only persons authorized by the contracting officer or his designated representative located in/at the Materiel Management Department, Naval Medical Center, Portsmouth, VA, telephone (757) 953-5751 are to place trouble or repair calls against this maintenance agreement. Calls placed by unauthorized personnel may result in non-payment of services.

In each instance that the contractor or his agent reports to Naval Medical Center, Portsmouth or subordinate command in response to terms of this order, he shall log in and out with the Department Head or his representative in the Department. When inspections and/or repairs have been completed, the contractor or his agent shall obtain the signature of the Department Head or his representative as applicable, on a detailed service ticket and shall leave the customer copy of the service ticket when checking out. A copy of the service ticket shall be submitted with invoice for payment. In case of inquiries, call Materiel Management Department, Naval Medical Center, Portsmouth Telephone (757) 953-5751.

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.

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