N00183-15-P-1562.pdf

6. ISSUED BY CODE

N00183-15-P-1562

1. CONTRACT/PURCH. ORDER/

AGREEMENT NO.

N00183

2. DELIVERY ORDER/ CALL NO.

26PAGE 1 OF

5. PRIORITY

CODE

8. DELIVERY FOB

DESTINATIONX

OTHER

(See Schedule if other)

ORDER FOR SUPPLIES OR SERVICES

3. DATE OF ORDER/CALL

2015 May 29

4. REQ./ PURCH. REQUEST NO.

N0018315RQSU069

SEE ITEM 6

NAVAL MEDICAL CENTER

MMD/CONTRACTING DIVISION

ATTN: CHANTAY JOHNSON

54 LEWIS MINOR STREET

PORTSMOUTH VA 23708-2297

7. ADMINISTERED BY (if other than 6)

(YYYYMMMDD)

10. DELIVER TO FOB POINT BY (Date)

(YYYYMMMDD)

SPECIALTYCARE CARDIOVASCULAR RESOURCES,

CARRIE PALMER

3100 WEST END AVENUE; SUITE 800

NASHVILLE TN 37203-5813

CODE 503X99. CONTRACTOR FACILITY

SEE SCHEDULE

12. DISCOUNT TERMS

Net 30 Days

MARK IF BUSINESS IS11.

SMALL

SMALL

DISADVANTAGED

WOMEN-OWNED

13. MAIL INVOICES TO THE ADDRESS IN BLOCK

See Section G for WAWF Info

25. TOTAL $45,797.52

NAVAL MEDICAL CENTER

MAIN OPERATING ROOM

BLDG 2

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708

17. ACCOUNTING AND APPROPRIATION DATA/ LOCAL USE

CODE

18. ITEM NO. 19. SCHEDULE OF SUPPLIES/ SERVICES

* If quantity accepted by the Government is same as quantity accepted below quantity ordered and encircle.

DELIVERY/16.

14. SHIP TO

See Schedule

N00183 HQ0248

MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATIO N

NUMBERS IN

BLO CKS 1 AND 2.

23. AMOUNT

15. PAYMENT WILL BE MADE BY CODE

DFAS-ROME

325 BROOKS ROAD

ROME NY 13441-4527

This delivery order/call is issued on another Government agency or in accordance with and subject to terms and conditions of above numbered contract.

TYPE CALL

OF PURCHASE X

ORDER

SEE SCHEDULE

24. UNITED STATES OF AMERICA

TEL: 757-953-5005

EMAIL: chantay.c.johnson.civ@mail.mil

CONTRACTING / ORDERING OFFICER

quantity ordered, indicate by X. If different, enter actual

BY:CHANTAY C. JOHNSON

1If this box is marked, supplier must sign Acceptance and return the following number of copies:X

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE

(YYYYMMMDD)

DATE SIGNED

ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS

AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME.

Reference your quote dated

Furnish the following on terms specified herein. REF:

20. QUANTITY

ORDERED/

ACCEPTED*

21. UNIT 22. UNIT PRICE

DIFFERENCES

26.

INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO THE

CONTRACT EXCEPT AS NOTED

27a. QUANTITY IN COLUMN 20 HAS BEEN

(YYYYMMMDD)

c. DATE d. PRINTED NAME AND TITLE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

36. I certify this account is correct and proper for payment.

g. E-MAIL ADDRESSf. TELEPHONE NUMBER

a. DATE

(YYYYMMMDD)

b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

28. SHIP NO. 29. DO VOUCHER NO. 30.

INITIALS

32. PAID BY 33. AMOUNT VERIFIED

CORRECT FOR

35. BILL OF LADING NO.

34. CHECK NUMBER

37. RECEIVED AT 38. RECEIVED BY

(YYYYMMMDD)

31. PAYMENT

COMPLETE

PARTIAL

FINAL

PARTIAL

FINAL

DD Form 1155, DEC 2001 PREVIOUS EDITION IS OBSOLETE.

39. DATE RECEIVED 40.TOTAL

CONTAINERS

41. S/R ACCOUNT NO. 42. S/R VOUCHER NO.

ADDRESS

AND

NAME

Section A - Solicitation/Contract Form

CAGE: 503X9

DUNS: 809573251

TIN: 25-1228645

Vendor POC: Carrie Palmer

Vendor Phone: 615-339-3726

Vendor Fax: 615-345-5405

Vendor email: carrie.palmer@specialtycare.net

Naval Medical Center POC:

Main Operating Room, LT Jaime York / Cynthia Bennett, (757) 953-3243 (Technical POCs)

Contracting, Chantay Johnson, (757) 953-5005

Billing / Payment in Arrears: MONTHLY

Vendor to reference contract number N00183-15-P-1562 on all inquires including shipping documents and invoices.

PROMPT PAYMENT

For Prompt Payment Act Purposes, this contract is subject to the 7 calendar-day constructive acceptance period.

NOTE: Reference quote provided via Solicitation# N00183-15-T-1104 dated 27-May-16.

This contract is hereby awarded under the interim bridge period 01 Jun 2015 – 30 Nov

2015. All invoices for services performed during the interim bridge period (as cited herein) shall be submitted in WAWF (see Section G) and shall reference PO# N00183-15-P-1562.

mailto:carrie.palmer@specialtycare.net

Section B - Supplies or Services and Prices

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 6 Months $3,707.17 $22,243.02 Autotransfusion Services

FFP

(Adult and Pediatric) to be performed in accordance with the Performance Work

Statement, Section C for an estimated 59 patient cases per month.

FOB: Destination

MILSTRIP: N0018315RQSU069

PURCHASE REQUEST NUMBER: N0018315RQSU069

NET AMT $22,243.02

ACRN AA

CIN: N0018315RQSU0690001

$22,243.02

0002 6 Months $1,840.75 $11,044.50 Autotransfusion Disposables

FFP

See Section C for disposable equipment to be used in accordance with the

Performance Work Statement for an estimated 59 patient cases per month.

NET AMT $11,044.50

CIN: N0018315RQSU0690002

$11,044.50

0003 6 Months $2,085.00 $12,510.00 Capital Usage Fee/Lease for Three (3)

FFP

Sorin Cat# 007320300 Units or equivalent. Refer to Section C for further specifications.

NET AMT $12,510.00

CIN: N0018315RQSU0690003

$12,510.00

Section C - Descriptions and Specifications

STATEMENT OF WORK

SCOPE AND LOCATION. The contractor shall provide adult auto transfusions and pediatric orthopedic auto transfusion services for the Main Operating Room (MOR) and same day operating areas, Directorate of Surgical Services, located at Naval Medical Center Portsmouth

(NMCP), VA.

HOURS OF COVERAGE

Hours: 0700 to 1830

Days: Monday to Friday

Beeper call: After-Hours, Weekends and Holidays

Services on Federal Holidays? Yes, for emergent cases; 45 minute response time to be in the

MOR

Beeper call response time: 45 minutes to be in the MOR

SPECIFIC DUTIES AND RESPONSIBILITIES. Services are to be performed in operating rooms (OR) and in same day-operating areas. In conjunction with the attending anesthesiologist or nurse anesthetist, contractor shall assist in planning auto transfusion needs and supplies for surgeries. Equipment and supplies shall be provided by the contractor. Contractor duties include but are not limited to:

Provides Intraoperative Autotransfusion Services as requested for elective and emergency procedures. Notification to Service for elective procedures will come from MOR leadership not less than 24 hours prior to day of procedure. Notification to Service for emergent procedures will come from MOR leadership when the case is scheduled.

Contractor shall respond and its employee shall be in the MOR for emergent cases within

45 minutes.

Sets up and troubleshoots the auto transfusion equipment for the collection and processing of autologous blood for reinfusion.

Performs inspection and maintenance of the auto transfusion equipment.

Operates the auto transfusion equipment.

Participates dependably in call coverage for the provision of intraoperative auto transfusion services.

Maintains cleanliness and preparation of auto transfusion equipment and supplies.

Maintains complete records as they apply to auto transfusion for all procedures during which intraoperative auto transfusion is utilized. Maintains quality control documentation.

Sets up auto transfusion equipment in the OR for cases according to equipment licensing restrictions.

Demonstrates detailed technical knowledge and troubleshooting ability for auto transfusion equipment.

Assists licensed medical providers with blood product infusions as directed during intraoperative volume resuscitations.

Provides estimate of blood loss via auto transfusion unit and total volume reinfused in conjunction with Anesthesia staff.

Assists with monitoring and evaluation of auto transfusion service quality and effectiveness.

Maintains an authorized user list of all auto transfusion equipment.

Assists the medical provider with intra-operative fluid management including volume resuscitation.

Assists medical professional staff as requested in anticipating the need for auto transfusion services and monitoring according to daily OR schedule.

Thirty (30) calendar days prior to performance start date, the contractor shall provide documentation that all health care workers utilized to deliver and/or perform auto transfusion services at NMCP have the following required immunizations:

Tetanus/Diphtheria/Pertussis (Tdap); Flu Vaccine/Mist; Hepatitis B vaccines series or

HBsAB+ titer; Measles/Mumps/Rubella (MMR) or positive titers; two-step Tuberculin

Skin Test (TST)/PPD and Varicella (Chickenpox) titer or vaccines x 2. See Attachment

1, “Health Examination and Immunization/Screening Requirement Form”.

Thirty (30) calendar days prior to performance start date, the contractor shall provide all the following documentation and take necessary actions as required by NMCP:

Basic Cardiac Life Support (BCLS). Contractor personnel must maintain current certification in BCLS that can be provided to NMCP upon request. See Attachment

Completed Latex Allergy Screening Questionnaire. Contractor personnel must submit a completed form, Attachment 2, to NMCP.

Criminal History Record Request. Contractor personnel shall undergo Criminal History

Background Check for all healthcare workers utilized to deliver and/or perform auto transfusion services. Contractor personnel must submit a completed Criminal History

Record Form, Attachment 3, to NMCP. The government agency (NMCP) requesting the information and conducting the criminal background check reserves the right to deny access to the NMCP compound. Reasons for denying base access include felony convictions within the last 10 years, any larceny misdemeanor in the last 10 years, and any other valid reason at the sole discretion of the Government.

Additional Requirements:

Contractor Identification Badges. The contractor’s workforce shall be identifiable by picture identification badges which shall be worn and visible on the upper body at all times while on site. The government agency (NMCP) will issue temporary security badges and decals for contract employees utilized by the Contractor to perform services.

All contractor badges and decals shall be turned in to the NMCP Security Department at the end of contract performance.

The following have been modified:

EQUIPMENT LIST

Contractor shall furnish the following items on a per month basis.

Disposables

- Bowl, 10 units per month

- Cardiotomy Reservoir, 10 units per month

- Anticoagulation/Aspiration Assembly, 13 units per month

- Blood Filter: 11 units per month

- Transfer Pack: 25 units per month

Contractor must provide lease of the following Sorin Model with feature set or equivalent:

Lease of Autotransfusion units (3 per month)

Sorin Group USA Inc., Cat# 007320300 BRAT 2 System with Basic Options Printer, RS232, and CRIT-LINE.

SUPPLIES AND SERVICES: 6-MONTH INTERIM BRIDGE CONTRACT (1 June 2015 through

30 November 2015)

PROFESSIONAL SERVICES (CLIN 0001)

ATS Professional Service Fee $377 per patient case x 59 patient cases = $22,243

EQUIPMENT LIST

Contractor shall furnish the following items on a per month basis.

DISPOSABLES (CLIN 0002)

-Bowl: 10 units per month

-Cardiotomy Reservoir: 10 units per month

-Anticoagulation/Aspiration Assembly: 13 units per month

-Blood Filer: 11 units per month

-Transfer Bag: 25 units per month

SpecialtyCare Item# Description Monthly Quantity 6-Month Quantity

10002258 Bowl 250ml BRAT II ATS 10 60

10002261 Reservoir 120 BRAT II ATS 10 60

10003540 Filter, Blood Trans, 40 micron 11 66

10004066 A&A Line & Aspir W/dead Ender 13 78

10004090 Bag Transfer 600ml W/coupler 25 150

Total Quantity 69 414

Total Dollar Value $1,840.75 $11,044.50

CAPITAL EQUIPMENT (CLIN 0003)

Contractor must provide lease of the following Sorin Model with feature set or equivalent:

Lease of Autotransfusion units (3 per month) Sorin Group USA Inc., CAT# 007320300 BRAT 2 System with Basic

Options Printer, RS232, and CRIT-LINE.

ATS Capital Equipment Lease for 3 units $2,085.00 per month x 6 months = $12,510.00

TOTAL 6-MONTHS:

PROFESSIONAL SERVICES: $22,243.00

DISPOSABLES: $11,044.50

CAPITAL: $12,510.00

TOTAL $45,797.50

CLAUSES INCORPORATED BY FULL TEXT

N00183-0024 Contractor Unclassified Access to Federally Controlled Facilities, Sensitive Information, Information Technology (IT) Systems or Protected Health Information (July 2013)

Homeland Security Presidential Directive (HSPD)-12, requires government agencies to develop and implement

Federal security standards for Federal employees and contractors. The Deputy Secretary of Defense Directive-Type

Memorandum (DTM) 08-006 - "DoD Implementation of Homeland Security Presidential Directive - 12 (HSPD-12)" dated November 26, 2008 (or its subsequent DoD instruction) directs implementation of HSPD-12. This clause is in accordance with HSPD-12 and its implementing directives.

APPLICABILITY

This clause applies to contractor employees requiring physical access to any area of a federally controlled base, facility or activity and/or requiring access to a DoN or DoD computer/network/system to perform certain unclassified sensitive duties. This clause also applies to contractor employees who access Privacy Act and Protected

Health Information, provide support associated with fiduciary duties, or perform duties that have been identified by

DON as National Security Position, as advised by the command security manager. It is the responsibility of the responsible security officer of the command/facility where the work is performed to ensure compliance.

Each contractor employee providing services at a Navy Command under this contract is required to obtain a

Department of Defense Common Access Card (DoD CAC). Additionally, depending on the level of computer/network access, the contract employee will require a successful investigation as detailed below.

ACCESS TO FEDERAL FACILITIES

Per HSPD-12 and implementing guidance, all contractor employees working at a federally controlled base, facility or activity under this clause will require a DoD CAC. When access to a base, facility or activity is required contractor employees shall in-process with the Navy Command's Security Manager upon arrival to the Navy

Command and shall out-process prior to their departure at the completion of the individual's performance under the contract.

ACCESS TO DOD IT SYSTEMS

In accordance with SECNAV M-5510.30, contractor employees who require access to DoN or DoD networks are categorized as IT-I, IT-II, or IT-III. The IT-II level, defined in detail in SECNAV M-5510.30, includes positions which require access to information protected under the Privacy Act, to include Protected Health Information (PHI).

All contractor employees under this contract who require access to Privacy Act protected information are therefore categorized no lower than IT-II. IT Levels are determined by the requiring activity's Command Information

Assurance Manager. Contractor employees requiring privileged or IT-I level access, (when specified by the terms of the contract) require a Single Scope Background Investigation (SSBI) which is a higher level investigation than the

National Agency Check with Law and Credit (NACLC) described below. Due to the privileged system access, a

SSBI suitable for High Risk public trusts positions is required. Individuals who have access to system control, monitoring, or administration functions (e.g. system administrator, database administrator) require training and certification to Information Assurance Technical Level 1, and must be trained and certified on the Operating System or Computing Environment they are required to maintain.

Access to sensitive IT systems is contingent upon a favorably adjudicated background investigation. When access to

IT systems is required for performance of the contractor employee's duties, such employees shall in-process with the

Navy Command's Security Manager and Information Assurance Manager upon arrival to the Navy command and shall out-process prior to their departure at the completion of the individual's performance under the contract.

Completion and approval of a System Authorization Access Request Navy (SAAR-N) form is required for all individuals accessing Navy Information Technology resources. The decision to authorize access to a government IT system/network is inherently governmental. The contractor supervisor is not authorized to sign the SAAR-Ni therefore, the government employee with knowledge of the system/network access required or the COR shall sign the SAAR-N as the "supervisor".

The SAAR-N shall be forwarded to the Navy Command's Security Manager at least 30 days prior to the individual's start date. Failure to provide the required documentation at least 30 days prior to the individual's start date may result in delaying the individual's start date.

When required to maintain access to required IT systems or networks, the contractor shall ensure that all employees requiring access complete annual Information Assurance (IA) training, and maintain a current requisite background investigation. The Contractor's Security Representative shall contact the Command Security Manager for guidance when reinvestigations are required.

INTERIM ACCESS

The Navy Command' s Security Manager may authorize issuance of a DoD CAC and interim access to a DoN or

DoD unclassified computer/network upon a favorable review of the investigative questionnaire and advance favorable fingerprint results. When the results of the investigation are received and a favorable determination is not made, the contractor employee working on the contract under interim access will be denied access to the computer network and this denial will not relieve the contractor of his/her responsibility to perform.

DENIAL OR TERMINATION OF ACCESS

The potential consequences of any requirement under this clause including denial or termination of physical or system access in no way relieves the contractor from the requirement to execute performance under the contract within the timeframes specified in the contract. Contractors shall plan ahead in processing their employees and subcontractor employees. The contractor shall insert this clause in all subcontracts when the subcontractor is permitted to have unclassified access to a federally controlled facility, federally-controlled information system/network and/or to government information, meaning information not authorized for public release.

CONTRACTOR'S SECURITY REPRESENTATIVE

The contractor shall designate an employee to serve as the Contractor's Security Representative. Within three work days after contract award, the contractor shall provide to the requiring activity's Security Manager and the

Contracting Officer, in writing, the name, title, address and phone number for the Contractor's Security

Representative. The Contractor's Security Representative shall be the primary point of contact on any security matter. The Contractor's Security Representative shall not be replaced or removed without prior notice to the

Contracting Officer and Command Security Manager.

BACKGROUND INVESTIGATION REQUIREMENTS AND SECURITY APPROVAL PROCESS FOR

CONTRACTORS ASSIGNED TO NATIONAL SECURITY POSITIONS OR PERFORMING SENSITIVE

DUTIES

Navy security policy requires that all positions be given a sensitivity value based on level of risk factors to ensure appropriate protective measures are applied. Navy recognizes contractor employees under this contract as Non-

Critical Sensitive [ADP/IT-II] when the contract scope of work require physical access to a federally controlled base, facility or activity and/or requiring access to a DoD computer/network, to perform unclassified sensitive duties. This designation is also applied to contractor employees who access Privacy Act and Protected Health

Information (PHI), provide support associated with fiduciary duties, or perform duties that have been identified by

DON as National Security Positions. At a minimum, each contractor employee must be a US citizen and have a favorably completed NACLC to obtain a favorable determination for assignment to a non-critical sensitive or IT-II position. The NACLC consists of a standard NAC and a FBI fingerprint check plus law enforcement checks and credit check. Each contractor employee filling a non-critical sensitive or IT-II position is required to complete:

• SF-86 Questionnaire for National Security Positions (or equivalent OPM investigative product)

• Two FD-258 Applicant Fingerprint Cards (or an electronic fingerprint submission)

• Original Signed Release Statements

Failure to provide the required documentation at least 30 days prior to the individual's start date shall result in delaying the individual's start date. Background investigations shall be reinitiated as required to ensure investigations remain current (not older than 10 years) throughout the contract performance period. The Contractor's

Security Representative shall contact the Command Security Manager for guidance when reinvestigations are required.

Regardless of their duties or IT access requirements ALL contractor employees shall in-process with the Navy

Command's Security Manager upon arrival to the Navy command and shall out process prior to their departure at the completion of the individual's performance under the contract. Employees requiring IT access shall also check-in and check-out with the Navy Command's Information Assurance Manager. Completion and approval of a System

Authorization Access Request Navy (SAAR-N) form is required for all individuals accessing Navy Information

Technology resources. The SAAR-N shall be forwarded to the Navy Command's Security Manager at least 30 days prior to the individual's start date. Failure to provide the required documentation at least 30 days prior to the individual's start date shall result in delaying the individual's start date.

The contractor shall ensure that each contract employee requiring access to IT systems or networks complete annual

Information Assurance (IA) training, and maintain a current requisite background investigation. Contractor employees shall accurately complete the required investigative forms prior to submission to the Navy Command

Security Manager. The Navy Command's Security Manager will review the submitted documentation for completeness prior to submitting it to the Office of Personnel Management (OPM). Suitability/security issues identified by the Navy may render the contractor employee ineligible for the assignment. An unfavorable determination made by the Navy is final (subject to SF-86 appeal procedures) and such a determination does not relieve the contractor from meeting any contractual obligation under the contract. The Navy Command's Security

Manager will forward the required forms to OPM for processing. Once the investigation is complete, the results will be forwarded by OPM to the DON Central Adjudication Facility (CAF) for a determination.

If the contractor employee already possesses a current favorably adjudicated investigation, the contractor shall submit a Visit Authorization Request (VAR) via the Joint Personnel Adjudication System (JPAS) or a hard copy

VAR directly from the contractor's Security Representative. Although the contractor will take JPAS "Owning" role over the contractor employee, the Navy Command will take JPAS "Servicing" role over the contractor employee during the hiring process and for the duration of assignment under that contract. The contractor shall include the IT

Position Category per SECNAV M-5510.30 for each employee designated on a VAR. The VAR requires annual renewal for the duration of the employee's performance under the contract.

BACKGROUND INVESTIGATION REQUIREMENTS AND SECURITY APPROVAL PROCESS FOR

CONTRACTORS ASSIGNED TO OR PERFORMING NON-SENSITIVE DUTIES

Contractor employee whose work is unclassified and non-sensitive (e.g., performing certain duties such as lawn maintenance, vendor services, etc ...) and who require physical access to publicly accessible areas to perform those duties shall meet the following minimum requirements:

• Must be either a US citizen or a US permanent resident with a minimum of 3 years legal residency in the United

States (as required by The Deputy Secretary of Defense DTM 08-006 or its subsequent DoD instruction) and

• Must have a favorably completed National Agency Check with Written Inquiries (NACI) including a FBI fingerprint check prior to installation access.

To be considered for a favorable trustworthiness determination, the Contractor's Security Representative must submit for all employees each of the following:

• SF-85 Questionnaire for Non-Sensitive Positions

• Two FD-258 Applicant Fingerprint Cards (or an electronic fingerprint submission)

• Original Signed Release Statements

The contractor shall ensure each individual employee has a current favorably completed National Agency Check with Written Inquiries (NACI) or ensure successful FBI fingerprint results have been gained and investigation has been processed with OPM.

Failure to provide the required documentation at least 30 days prior to the individual's start date may result in delaying the individual's start date.

* Consult with your Command Security Manager and Information Assurance Manager for local policy when IT-III

(non-sensitive) access is required for non-US citizens outside the United States.

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government

0002 Destination Government Destination Government

0003 Destination Government Destination Government

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0001 POP 01-JUN-2015 TO

30-NOV-2015

N/A NAVAL MEDICAL CENTER

MAIN OPERATING ROOM

BLDG 2

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708

953-3129 / 3141

N00183

0002 POP 01-JUN-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

0003 POP 01-JUN-2015 TO

N/A (SAME AS PREVIOUS LOCATION)

CLAUSES INCORPORATED BY REFERENCE

52.242-15 Stop-Work Order AUG 1989

Section G - Contract Administration Data

ACCOUNTING AND APPROPRIATION DATA

AA: 9750130 1882 252 68908 0 068688 2D QSU069

COST CODE: 001835DFBA3Q

AMOUNT: $45,797.52

CIN N0018315RQSU0690001: $22,243.02

CIN N0018315RQSU0690002: $11,044.50

CIN N0018315RQSU0690003: $12,510.00

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).

https://www.acquisition.gov/ https://wawf.eb.mil/ https://wawf.eb.mil/

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*

Field Name in WAWF Data to be entered in WAWF

Pay Official DoDAAC HQ0248

Issue By DoDAAC N00183

Admin DoDAAC N00183

Inspect By DoDAAC N/A

Ship To Code N/A

Ship From Code N/A

Mark For Code N/A

Service Approver (DoDAAC) N/A

Service Acceptor (DoDAAC) N00183

Accept at Other DoDAAC N/A

LPO DoDAAC N00183

DCAA Auditor DoDAAC N/A

Other DoDAAC(s) N/A

(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:

Charles Lovell, charles.k.lovell2.civ@mail.mil, 757-953-7553

Edward Gollon, edward.r.gollon.civ@mail.mil, 757-953-5755

(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 mailto:charles.k.lovell2.civ@mail.mil mailto:edward.r.gollon.civ@mail.mil

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

(End of clause)

Section H - Special Contract Requirements

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 http://www.tricare.mil/tmaprivacy/breach.cfm

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.

N00183-0019 Base Access (NMCP)

Commander, Navy Installations Command (CNIC), has established the Navy Commercial

Access Control System (NCACS), a standardized process for granting unescorted access privileges to vendors, contractors, suppliers and service providers not otherwise entitled to the issuance of a Common Access Card (CAC) who seek access to and can provide justification to enter Navy installations and facilities. Vendors visiting Naval Medical Center Portsmouth

(NMCP) may obtain daily passes directly from Naval Station Norfolk (NSN) Pass and ID office, located at NSN (Bldg CD-9), 9040 Hampton Blvd, Norfolk, Virginia, 23505, by submitting identification credentials for verification and undergoing a criminal screening/ background check. Alternatively, if the vendor so chooses, it may voluntarily elect to obtain long-term credentials through enrollment, registration, background vetting, screening, issuance of credentials, and electronic validation of credentials at its own cost through one of the designated independent contractor NCACS service providers. Credentials will be issued every five years and access privileges will be reviewed / renewed on an annual basis. The costs incurred to obtain

Navy installation access of any kind are not reimbursable, and the price(s) paid for obtaining long-term NCACS credentials will not be approved as a direct cost of this contract. Further information regarding NCACS can be found at http://cnic.navy.mil/CNIC_HQ_Site/index.htm.

http://cnic.navy.mil/CNIC_HQ_Site/index.htm

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."

https://doncmra.nmci.navy.mil/ https://doncmra.nmci.navy.mil/

Section I - Contract Clauses

CLAUSES INCORPORATED BY REFERENCE

52.203-3 Gratuities APR 1984

52.204-13 System for Award Management Maintenance JUL 2013

52.204-19 Incorporation by Reference of Representations and

Certifications.

DEC 2014

52.209-10 Prohibition on Contracting With Inverted Domestic

Corporations

DEC 2014

52.213-2 Invoices APR 1984

52.213-3 Notice to Suppliers APR 1984

52.213-4 Terms and Conditions--Simplified Acquisitions (Other Than

Commercial Items)

MAR 2015

52.215-8 Order of Precedence--Uniform Contract Format OCT 1997

52.219-28 Post-Award Small Business Program Rerepresentation JUL 2013

52.222-50 Combating Trafficking in Persons MAR 2015

52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

AUG 2011

52.225-13 Restrictions on Certain Foreign Purchases JUN 2008

52.232-1 Payments APR 1984

52.232-8 Discounts For Prompt Payment FEB 2002

52.232-19 Availability Of Funds For The Next Fiscal Year APR 1984

52.232-23 Alt I Assignment of Claims (May 2014) - Alternate I APR 1984

52.232-33 Payment by Electronic Funds Transfer--System for Award

Management

JUL 2013

52.232-39 Unenforceability of Unauthorized Obligations JUN 2013

52.233-3 Protest After Award AUG 1996

52.233-4 Applicable Law for Breach of Contract Claim OCT 2004

52.237-2 Protection Of Government Buildings, Equipment, And

Vegetation

APR 1984

52.237-3 Continuity Of Services JAN 1991

52.243-1 Changes--Fixed Price AUG 1987

52.243-1 Alt I Changes--Fixed Price (Aug 1987) - Alternate I APR 1984

52.244-6 Subcontracts for Commercial Items MAR 2015

52.249-1 Termination For Convenience Of The Government (Fixed

Price) (Short Form)

APR 1984

52.249-8 Default (Fixed-Price Supply & Service) APR 1984

52.252-6 Authorized Deviations In Clauses APR 1984

252.203-7000 Requirements Relating to Compensation of Former DoD

Officials

SEP 2011

252.203-7002 Requirement to Inform Employees of Whistleblower Rights SEP 2013

252.204-7003 Control Of Government Personnel Work Product APR 1992

252.204-7004 Alt A System for Award Management Alternate A FEB 2014

252.204-7006 Billing Instructions OCT 2005

252.204-7012 Safeguarding of Unclassified Controlled Technical

Information

NOV 2013

252.225-7002 Qualifying Country Sources As Subcontractors DEC 2012

252.225-7048 Export-Controlled Items JUN 2013

252.232-7001 Disposition Of Payment DEC 1991

252.232-7003 Electronic Submission of Payment Requests and Receiving

Reports

JUN 2012

252.233-7001 Choice of Law (Overseas) JUN 1997

252.237-7010 Prohibition on Interrogation of Detainees by Contractor

Personnel

JUN 2013

252.239-7001 Information Assurance Contractor Training and Certification JAN 2008

252.243-7001 Pricing Of Contract Modifications DEC 1991

252.244-7000 Subcontracts for Commercial Items JUN 2013

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 within15 days.

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

252.203-7999 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY

AGREEMENTS (DEVIATION 2015-O0010)(FEB 2015)

(a) The Contractor shall not require employees or subcontractors seeking to report fraud, waste, or abuse to sign or comply with internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or contactors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information.

(b) The Contractor shall notify employees that the prohibitions and restrictions of any internal confidentiality agreements covered by this clause are no longer in effect. (c) The prohibition in paragraph (a) of this clause does not contravene requirements applicable to Standard Form 312, Form 4414, or any other form issued by a Federal department or agency governing the nondisclosure of classified information.

(d)(1) In accordance with section 743 of Division E, Title VIII, of the Consolidated and Further Continuing

Resolution Appropriations Act, 2015, (Pub. L. 113-235), use of funds appropriated (or otherwise made available) under that or any other Act may be prohibited, if the Government determines that the Contractor is not in compliance with the provisions of this clause.

(2) The Government may seek any available remedies in the event the Contractor fails to perform in accordance with the terms and conditions of the contract as a result of Government action under this clause.

(End of clause) http://acquisition.gov/comp/far/index.