RFQ_N00183-15-T-1258_.doc

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Attached to
Multimedia Equipment Maintenance Federal contract opportunity
Solicitation number
N00183-15-T-1258
Issued by
Department of the Navy Bureau of Medicine and Surgery

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Questions regarding this RFQ must be submitted in writing via Email to Contract Specialist doris.w.turner.civ mail.mil

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Section A - Solicitation/Contract Form

CLAUSES INCORPORATED BY FULL TEXT

VENDOR TO COMPLETE THE FOLLOWING:

TIN:

CAGE:

DUNS:

Vendor POC:

Email:

Vendor Phone:

Fax:

VENDOR Check Here: Include a copy your Published or Commercial Price List which contains the items quoted per this Request for Quote.

Naval Medical Center Portsmouth Points of Contact:

Doris Turner, Phone: 757-953-7456 Fax: 757-953-5006 E-Mail: doris.w.turner.civ@mail.mil

Payment in Arrears (Check One): Monthly Quarterly Semi-Annually Annually

Note: Vendor will be required to provide billing electronically via the WAWF Electronic Invoicing Method per Section G of this RFQ. For additional information, a review of the following web sites may be required: https://wawf.eb.mil http://wawftraining

Email: usn.detrick.navmedlogcomftdmd.list.nmlc-wawf@mail.mil

Vendor to reference Request for Quotation (RFQ) Number N00183-15-T-1258 on all correspondence relating to this RFQ.

PROMPT PAYMENT: For Prompt Payment Act purposes, this contract is:

Subject to the 7-calendar day constructive acceptance period.

Government Reserves the right to make an award based on an “All or None” evaluation and/or based on the “Best Value” proposed for this requirement. Evaluation factors are as follows arranged in level of importance:

1. Technical (50%)

2. Past performance (25%)

3. Price (25%)

Contractor’s proposed rates shall be inclusive of all costs including labor, travel, parts, etc.

For evaluation purposes, Contractors may combine their Past Performance and Technical Proposal information in one attachment, preferably in Microsoft Word, with the Pricing information submitted in a separate attachment on or before the closing date stated in this RFQ. Technical proposals shall provide sufficient details of the vendors’ capabilities and qualifications to provide services as required in the Work Statement. Failure to provide the required information may deem the contractor’s proposal as unacceptable.

PURSUANT TO FAR 52.232-18 AVAILABILITY OF FUNDS.

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.

Section B - Supplies or Services and Prices

ITEM NO
SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
12
Months

Maintenance Service Agreement for all

FFP

Multimedia Rooms including Tandberg VTC equipment located at Branch Health Clinics, Naval Medical Center Portsmouth, VA in accordance with the Performance Work Statement, Section C.

Base Year Period of Performance: 01 Oct 2015 through 30 Sep 2016

FOB: Destination

MILSTRIP: N0018316RQTE020

PURCHASE REQUEST NUMBER: N0018316RQTE020

NET AMT

ITEM NO
SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
12
Months
OPTION
Maintenance Service Agreement for all

FFP

Multimedia Rooms including Tandberg VTC equipment located at Branch Health Clinics, Naval Medical Center Portsmouth, VA in accordance with the Performance Work Statement, Section C.

Option Year I Period of Performance: 01 Oct 2016 through 30 Sep 2017

FOB: Destination

MILSTRIP: N0018316RQTE020

PURCHASE REQUEST NUMBER: N0018316RQTE020

NET AMT

MONTHLY PRICING BREAKDOWN

CONTRACTOR TO PROVIDE MONTHLY PRICING PER EACH CLINIC ROOM AND AND LOCATION AS SPECIFIED.

SEE SECTION C - MULTIMEDIA EQUIPMENT LISTING FOR DESCRIPTIONS

NOTE: Equipment for the locations marked with ** were recently installed or upgraded during the past year and currently covered under warranty maintenance until the dates indicated herein. Contractor’s quote for the Base Year shall reflect maintenance services for the 12-month period commencing 01 Oct 2015 through 30 Sep 2016 or at the end of the various warranty expiration dates as specified herein. Effective dates for maintenance coverage less than full months will be as mutually agreed upon by the Contractor and the Government and monthly rates prorated accordingly.

Monthly maintenance costs may be decreased from this agreement by issuance of a written modification from the Contracting Officer with an effective date as mutually agreed.

CLINIC
LOCATION
BUILDING
ROOM #
MONTHLY COST PER LOCATION

BASE YEAR

MONTHLY COST PER LOCATION OPTION YR I

BOONE DENTAL
CONF ROOM
BLDG 1035
RM 220

BOONE MEDICAL VTC

**(Under warranty until 03/12/16

CONF ROOM G-20/LOBBY
BLDG 1035
RM A7

OCEANA VTC

**(Under warranty until 3/2/16))

CONF ROOM/OIC CONF RM
BLDG 285
OIC/MAIN

SEWELLS PT DENTAL VTC

**(Under warranty until 2/24/16)

CONF ROOM
BLDG CD3
RM 175
SEWELLS PT DENTAL
LOBBY
BLDG CD3
2ND FL
SEWELLS PT MEDICAL
CLASSROOM 1X04
BLDG CD3
SEWELLS PT MEDICAL VTC
CLASSROOM 1X06
BLDG CD3
SEWELLS PT MEDICAL
CLASSROOM 1X12
BLDG CD3

SEWELLS PT MEDICAL

**(Under warranty until 2/24/16)

OIC CONFERENCE ROOM
BLDG CD3
SEWELLS PT MEDICAL
CLASSROOM 1Q02
BLDG CD3
SEWELLS PT MEDICAL
CLASSROOM 1Q03
BLDG CD3
SEWELLS PT MEDICAL
CLASSROOM 1Q04
BLDG CD3

BHC DAM NECK VTC

**(Under warranty until 03/02/16)

CONF ROOM
BLDG 130
RM 153

BHC NORTHWEST VTC

**(Under warranty until 03/08/16)

CONF ROOM

1ST FL

TPC CHESAPEAKE VTC

**(Under warranty until 03/8/16)

CONF ROOM

RM 210

TPC VA BEACH VTC

**(Under warranty until 3/8/16)

CONF ROOM

RM 206

BHC YORKTOWN VTC

**(Under warranty until 03/11/16)

CONF ROOM
BLDG 381
RM 400C

NNSY VTC

**(Under warranty until 3/09/16)

CONF ROOM
BLDG 277
RM 201
BOONE HEALTH PROMOTIONS
CLASSROOM
BLDG 3147 ROCKWELL HALL GYM
2ND FLOOR

MONTHLY TOTAL

BASE YR CLIN 0001
OP YR I

CLIN 0002

Section C - Descriptions and Specifications

PERFORMANCE STATEMENT OF WORK FOR MULTIMEDIA MAINTENANCE

1.1 SCOPE

The contractor shall submit a package for maintenance of all multimedia equipment located at Naval Medical Center Portsmouth (NMCP) Branch Clinics. The contractor shall provide on-site hardware and software support, toll free technical telephone support, and product replacement and/or repair services for 9 multimedia rooms and 10 Tandberg VTC rooms. The Multimedia equipment listing by room is provided below. The agreement will also allow the ability to upgrade components to newest technology at any time.

The selected vendor must be able to provide full contract support immediately upon award of a resulting order.

1.2 ASSUMPTIONS

The following assumptions are understood between NMCP Communications Office and the contractor:

· The Contractor shall comply with Federal, State, and Local Laws, plus any Federal Regulations as applicable to the performance of this contract.

· The Contractor shall not accept any instructions issued by any person employed by the U. S. Government, other than: the Contracting Officer or the Communications Division, all acting within the limits of their authority.

· When required, the Contractor shall be qualified / authorized by the Original Equipment Manufacturer (OEM) in the repair of all equipment listed within this contract. Contractor shall maintain current (within 2 years) qualifications throughout entire contract period. The Government shall maintain the right to seek proof of qualification prior to award and anytime during contract period of performance.

· The contractor shall provide all equipment, material handling equipment (i.e., pallet jacks), labor, communications, and anything else required to fulfill this contract.

1.3 DUTIES

a. The contractor shall:

· Provide all maintenance services, to include labor, materials, and replacement parts (up to $1,500.00 per room/per day) necessary to keep the rooms in satisfactory working condition to include all cabling. Repair of equipment is limited to normal and wear and tear and does not cover damage due to user negligence. All equipment will be maintained in accordance with the manufacturer specifications. Only manufacturer repair parts or equivalent will be used.

· Maintenance shall be performed on all existing multimedia equipment and on any equipment that has replaced the existing equipment as part of a previous maintenance action or new purchase.

NOTE: The $1,500.00 (repair parts) is per room, per day. If the vendor services or makes repairs to multiple rooms in a single visit, it is $1,500.00 per room for parts.

· The contractor shall perform bi-annual preventive maintenance visits to all rooms. These visits will be coordinated with Communications personnel. A copy of inspection results for each room shall be provided to the Communications Office.

· The contractor shall provide telephone technical support for service calls and troubleshooting assistance during the hours of 8:00 AM and 4:30 PM during the normal business week.

· The contractor shall respond within one business day of receipt of a trouble call for all other multimedia rooms.

1.4 DEPENDENCIES

a. Work Sites: All work under this contract will be performed at the following locations:

Branch Health Clinic Sewells Point
1647 Adm Taussig Blvd

Bldg CD-2

Norfolk, VA 23511

Branch Dental Clinic Sewells Point
1647 Adm Taussig Blvd

Bldg CD-3

Norfolk, VA 23511

Branch Health Clinic Boone

Branch Dental Clinic Boone 1035 Nider Blvd

Bldg 505

Virignia Beach, VA 23459-2731

Branch Health Clinic Boone Health Promotions
Rockwell Hall Gym, 2nd Floor

Bldg 3147 Nider Blvd

Virginia Beach, VA 23459

Branch Health Clinic Oceana

Branch Dental Clinic Oceana 1550 Tomcat Blvd

Bldg 285

Virginia Beach, VA 23460

Branch Health Clinic Dam Neck
1885 Terrier Ave

Suite 100

Virginia Beach, VA 23461

Branch Health Clinic Yorktown
Naval Weapons Station - Bldg 1806

Yorktown, VA 23691

Branch Health Clinic Northwest
1320 Ballahack Rd

Bldg 145/Suite 100

Chesapeake, VA 23322

Branch Health Clinic Norfolk Naval Shipyard
Norfolk Naval Shipyard

Bldg 277

Portsmouth, VA 23709

Tricare Prime Clinic Virginia Beach
2100 Lynnhaven Pkwy

Virginia Beach, VA 23456

Tricare Prime Clinic Chesapeake
1011 Eden Way North

Chesapeake, VA 23320

b. Equipment

The contractor shall ensure timely maintenance and repair of the equipment covered in this performance statement of work. The Government Project Manager is responsible for coordinating all network-related maintenance/repair and the scheduling of rooms for maintenance and repair. Equipment listed in this contract will be maintained to meet the original equipment manufacturer’s (OEM’s) specifications

c. Facilities

The Communications Office is responsible for providing the contractor with facilities and system access. Communications personnel will be responsible for handling any and all security-related issues pertaining to the maintenance and repair of the equipment specified in this statement of work, to include providing escorted or unescorted access to spaces where the work will be performed.

d. Character of Work and Workforce

The work must conform in all respects with the requirements of the contract:

· A strictly first-class operation will be insisted upon. No incompetence, carelessness, or use of drugs/alcohol will be tolerated.

· 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. In accordance with Section H, Clause 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. Contractors 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.

· Care of Government Facilities and Property – The contractor shall be responsible for care of the premises. The contractor shall not damage Government property or facilities during the performance of this contract. The contractor shall furnish padding and other protective materials as necessary to preclude damage to hallways, doors, door frames, elevators and building fixtures. If damage does occur, the contractor will be responsible for any necessary repair work to include patching and painting of walls. In addition, the contractor shall remove all contractor-generated debris including boxes, packaging, etc.

· NMCP and Clinic Command Regulations – All Contractor personnel must abide by the rules and regulations while in the above mentioned areas. These rules include no firearms, no smoking or tobacco chewing in any government building, no food or beverages except in authorized areas, minimal noise levels and allowing corridor access to non-move involved patient/personnel/carts.

MULTIMEDIA EQUIPMENT LISTING

BRANCH HEALTH CLINICS
DESCRIPTION
SERIAL #
MODEL #
BOONE DENTAL
CONF ROOM
BLDG 1035
RM 220
Panasonic
Projector
PT-D3500
SH6540014
BEI
Projector Screen - Electric
Laminar XL
Unavailable
SMART
Sympodium
ID350
0DFP00720
Atlas
Mixer/Amp
AA35
T5646191191000446
KSI
Ceiling Speakers (2)
801-C
Unavailable
Gyration
Wireless Keyboar/Mouse Combo
GYM1100CKNA
Unavailable
Kramer
Computer Switcher
VP-211K
Unavailable
BOONE MEDICAL VTC
CONF ROOM G-20/LOBBY (New VTC & TV 3/13/15)
BLDG 1035
RM A7
Panasonic
Projector
LB-60U
Unavailable
Unavailable
Projector Screen
Unavailable
Unavailable
SMART Technologies
Sympodium
ID250
6BFP00431
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT190600NN
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT1844001Y
Sharp
60" LCD HDTV
LC-60LE650U
F408822535
Magnavox
DVD Player
MDV 2100
V52023834
OCEANA VTC
CONFERENCE ROOM/OIC CONF RM (New Parts 3/3/15)
BLDG 285
OIC/MAIN
Sharp
60" LCD HDTV
LC-60LE650U
404864647
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT190600KN
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT183800AZ
NEC
Projector
NP-UM361X-WK
5100314EA
SMART
Interactive Smart Board
SB-680i
Unavailable
Panasonic
DVD/VCR recorder
Unavailable
Unavailable
SEWELLS PT DENTAL VTC
CONF ROOM (New Parts 2/25/15)
BLDG CD3
RM 175
Sharp
60" LCD HDTV
LC-60LE650U
402830734
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT190603JN
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT18460198
Smart Technologies, Inc.
sympodium ID350
DTF-521B/01
6EFP00904
Geist
power supply w/ surge protect
Unavailable
AA0609-0583
Toshiba
VCR
Unavailable
Unavailable
Davis
Amplifier
DA-10A
Unavailable
Sony
Trinitron Color TV
KV32S20
7098135
Smart Technologies, Inc.
Whiteboard
Unavailable
SB580 104170
Proxima
Projector
DP8400X
Unavailable
Atlas
Mixer
AA35
Unavailable
SEWELLS PT DENTAL
LOBBY
BLDG CD3
2ND FLOOR
Panasonic
Projector
PT-D3500U
SH6540010
Smart Technologies, Inc.
Sympodium ID350
DTF-521B/01
6IFP01869
Geist
Power Supply w/ Surge Protect
Unavailable
AA0607-0197
Gyration
Wireless Set (4 items)
GC1205FKM
Unavailable
audiotechnica
Wireless Mic Receiver
AEW-R4100
Unavailable
audiotechnica
Wireless Lapel Microphone
AEW-T1000
Unavailable
Kramer
Presentation Scaler/Switcher
VP-740
Unavailable
Sony
DVD/VCR
SLV-D380P
Unavailable
TOA
Integrated Amplifier
BG-1060
Unavailable
Toshiba
TV
CF35050
14574902
Toshiba
VCR
M-653
94101015
Panasonic
VCR
AG-1300P
G5KL01338
Panasonic
Projector
PT-D3500U
Unavailable
SEWELLS PT MEDICAL
CLASSROOM 1X04
BLDG CD3
Panasonic
Plasma
TH-50PH9
Unavailable
SMART
Sympodium ID350
DTF-521B/01
6LFP00152
Extron
Podium Connector
HSA400
Unavailable
Gyration
Wireless Set (4 items)
Unavailable
Unavailable
Sony
DVD/VCR player
SLV-D370P
0952441
Kramer Tools
VGA/Audio Switcher
VP-211DS
Unavailable
SEWELLS PT MEDICAL VTC
CLASSROOM 1X06
BLDG CD3
Panasonic
Plasma
TH-50PH9
Unavailable
Smart Technologies, Inc.
Sympodium ID350
DTF-521B/01
6LFP00058
Extron
Podium Connector
HSA400
Unavailable
Gyration
Wireless Set (4 items)
Unavailable
Unavailable
Sony
DVD/VCR Player
SLV-D370P
0953009
AMX
Control Panel
MVP-7500
596501X0670170
AMX
Control Panel Docking Station
MVP-TDS
596510W4562688
AMX
Netlinx Integrated Controller
NI-3100
Unavailable
audio-technica
UHF-receiver
ATW-R73
Unavailable
Ocean Matrix
VGA/XGA Audio Matrix
OMX-VG4x4
Unavailable
TOA
Amplifier
A-712
068L8787228
audio-technica
Wireless Microphone
AEW-T100
Unavailable
AMX
Power Current Sensor
PCS2
Unavailable
AMX
Volume Control
AXB-VOL3
5756XP3760347
Kramer Tools
1:3 Audio/Stereo/Video DA
103AV
Unavailable
Kramer Tools
Video Audio Standby Switcher
VS-24xl
17010708928
Biamp
Microphone Mixer
AutoTWO MIX
02301634
Tandberg
VTC Unit
3000MXP
33A41659
Tandberg
VTC Camera
WAVE II
Unavailable
SEWELLS PT MEDICAL
CLASSROOM 1X12
BLDG CD3
Panasonic
Plasma
TH-50PH10
Unavailable
Smart Technologies, Inc.
Sympodium ID350
DTF-521B/01
6LFP00028
Extron
Podium Connector
HSA400
Unavailable
Gyration
Wireless Set (4 items)
Unavailable
Unavailable
Sony
DVD/VCR Player
SLV-D370P
953005
Kramer Tools
VGA/Audio Switcher
VP-211DS
Unavailable
SEWELLS PT MEDICAL
OIC CONF RM (NEW PARTS 2/25/15)
BLDG CD3
Dell
Personal Computer
Optiplex 990
Sharp
70" LCD HDTV
LC-70LE650U
304846561
Magnavox
DVD HDD Recorder
MDR557H/F7
J11411297
Rolls
Mixer Amplifer
MA2152
1442162
AMX
AMX Touchpanel
MST-701
226506GX02F0020
AMX
Control Processor
NX-1200
210601GX01F0008
AMX
AMX VOL3
FG5756
5756WE29E6415
Smart
Interactive Monitor
SP518
K012HW03G0002
SEWELLS PT MEDICAL
CLASSROOM 1Q02
BLDG CD3
Panasonic
Plasma
TH-50PH10
Unavailable
Smart Technologies, Inc.
Sympodium ID350
DTF-521B/01
7EFP00327
AMX
Control Panel
MVP-7500
Unavailable
AMX
Netlinx Integrated Controller
NI-2000
Unavailable
Extron
Podium Connector
HSA400
Unavailable
Gyration
Wireless Set (4 items)
Unavailable
Unavailable
Sony
DVD/VCR Player
SLV-D380P
0634708
Geist
Surge Protector
?
Unavailable
Rolls
Mixer/Amplifier
MA2152
Unavailable
Kramer Tools
VGA/Audio Switcher
VP-211DS
Unavailable
Kramer Tools
1:2 High Resolution XGA
VP-200N
Unavailable
AMX
Volume Control
AXB-Vol3
Unavailable
AMX
Power Current Sensor
PCS2
Unavailable
SEWELLS PT MEDICAL
CLASSROOM 1Q03
BLDG CD3
Panasonic
Plasma
TH-50PH10
Unavailable
Smart Technologies, Inc.
Sympodium ID350
DTF-521B/01
7DFP01144
Extron
Podium Connector
HSA400
Unavailable
Gyration
Wireless Set (4 items)
Unavailable
Unavailable
Sony
DVD/VCR Player
SLV-D370P
0634705
Kramer Tools
VGA/Audio Switcher
VP-211DS
Unavailable
SEWELLS PT MEDICAL
CLASSROOM 1Q04
BLDG CD3
Panasonic
Plasma
TH-50PH10
Unavailable
Smart Technologies, Inc.
Sympodium ID350
DTF-521B/01
Unavailable
AMX
Control Panel
MVP-7500
Unavailable
AMX
Netlinx Integrated Controller
NI-2000
Unavailable
Extron
Podium Connector
HSA400
Unavailable
Gyration
Wireless Set (4 items)
Unavailable
Unavailable
Sony
DVD/VCR Player
SLV-D380P
0634708
Rolls
Mixer/Amplifier
MA2152
Unavailable
Kramer Tools
VGA/Audio Switcher
VP-211DS
Unavailable
Kramer Tools
1:2 High Resolution XGA
VP-200N
Unavailable
AMX
Volume Control
AXB-Vol3
Unavailable
AMX
Power Current Sensor
PCS2
Unavailable
BHC DAM NECK VTC
CONF ROOM (New 3/3/15)
BLDG 130
RM 153
Sharp
60" LCD HDTV
LC-60LE650U
F408823364
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT190600NQ
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT183800BG
BHC NORTHWEST VTC
CONF ROOM (NEW 3/9/15)

1ST FLOOR

Sharp
60" LCD HDTV
LC-60LE650U
F408822534
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT190603GJ
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT184500ZM
TPC CHESAPEAKE VTC
CONF ROOM (New 3/9/15)

RM 210

Sharp
60" LCD HDTV
LC-60LE650U
F408823363
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT19060319
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT1844002R
TPC VA BEACH VTC
CONF ROOM (New 3/9/15)

RM 206

Sharp
60" LCD HDTV
LC-60LE650U
304868266
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT1906030S
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT184701AP
BHC YORKTOWN VTC
CONF ROOM New Parts 3/12/15)
BLDG 381
RM 400C
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT190600JT
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT184701AN**
**Communication
Conference Room
Sharp
60" LCD HDTV
LC-60LE650U
F408822533
SMART
Interactive Whiteboard
3000i
PT12P02450
NNSY VTC
CONF ROOM (New 3/10/15)
BLDG 277
RM 201
Sharp
60" LCD HDTV
LC-60LE650U
F408823365
Cisco
SX20 Codec
CTS-SX20CODEC-K9
FTT1906004V
Cisco
ISDN Link
CTS-ISDNLINK-K9
FTT183700YO
BOONE HEALTH PROMOTIONS
CLASSROOM
BLDG 3147 ROCKWELL HALL GYM
2ND FLOOR
PANASONIC
PROJECTOR
PTVW330U
DC2350007

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

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN
DELIVERY DATE
QUANTITY
SHIP TO ADDRESS
DODAAC
0001
POP 01-OCT-2015 TO

30-SEP-2016

N/A
NAVAL MEDICAL CENTER

MANAGEMENT INFORMATION DEPARTMENT

BLDG 2

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708

757-953-0108/6118

FOB: Destination N00183

0002
POP 01-OCT-2016 TO

30-SEP-2017

N/A
(SAME AS PREVIOUS LOCATION)

FOB: Destination N00183

CLAUSES INCORPORATED BY REFERENCE

52.242-15
Stop-Work Order
AUG 1989

Section G - Contract Administration Data

CLAUSES INCORPORATED BY REFERENCE

252.232-7003
Electronic Submission of Payment Requests and Receiving Reports
JUN 2012

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).

2 IN 1 SERVICES ONLY

(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.

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, Phone: 757-953-7553 charles.k.lovell2.civ@mail.mil Edward Gollon, Phone: 757-953-5755 edward.r.gollon.civ@mail.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.

usn.detrick.navmedlogcomftdmd.list.nmlc-wawf@mail.mil

(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

N00183-0004 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.

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.

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."

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

52.203-3
Gratuities
APR 1984
52.204-7
System for Award Management
JUL 2013
52.204-10
Reporting Executive Compensation and First-Tier Subcontract Awards
JUL 2013
52.204-13
System for Award Management Maintenance
JUL 2013
52.204-16
Commercial and Government Entity Code Reporting
JUL 2015
52.204-17
Ownership or Control of Offeror
NOV 2014
52.209-10
Prohibition on Contracting With Inverted Domestic Corporations
DEC 2014
52.215-8
Order of Precedence--Uniform Contract Format
OCT 1997
52.222-50
Combating Trafficking in Persons
MAR 2015
52.223-16 Alt I
Acquisition of EPEAT - Registered Personal Computer Products - Alternate I
JUN 2014
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
52.233-3
Protest After Award
AUG 1996
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
52.244-6
Subcontracts for Commercial Items
APR 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
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
252.204-7012
Safeguarding of Unclassified Controlled Technical Information
NOV 2013
252.211-7003
Item Unique Identification and Valuation
DEC 2013
252.211-7008
Use of Government-Assigned Serial Numbers
SEP 2010
252.225-7001
Buy American And Balance Of Payments Program-- Basic (Nov 2014)
NOV 2014
252.225-7002
Qualifying Country Sources As Subcontractors
DEC 2012
252.233-7001
Choice of Law (Overseas)
JUN 1997
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 within 10 Days..

(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 5 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 10 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 Sep 2017.

(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)

252.203-7998 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements—Representation (DEVIATION 2015-O0010) (FEB 2015)

(a) In accordance with section 743 of Division E, Title VIII, of the Consolidated and Further Continuing Resolution Appropriations Act, 2015 (Pub. L. 113-235), Government agencies are not permitted to use funds appropriated (or otherwise made available) under that or any other Act for contracts with an entity that requires employees or subcontractors of such entity seeking to report fraud, waste, or abuse to sign 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 prohibition in paragraph (a) of this provision 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.

(c) Representation. By submission of its offer, the Offeror represents that it does not require employees or subcontractors of such entity 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.

(End of provision)

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)

Section K - Representations, Certifications and Other Statements of Offerors

CLAUSES INCORPORATED BY REFERENCE

52.209-2
Prohibition on Contracting with Inverted Domestic Corporations--Representation
DEC 2014
52.225-18
Place of Manufacture
MAR 2015
52.225-20
Prohibition on Conducting Restricted Business Operations in Sudan--Certification
AUG 2009

52.219-1 SMALL BUSINESS PROGRAM REPRESENTATIONS (OCT 2014) - ALTERNATE I (MAY 2014)

(a)(1) The North American Industry Classification System (NAICS) code for this acquisition is 811211. .

(2) The small business size standard is $7.5 Mil.

(3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees.

(b) Representations. (1) The offeror represents as part of its offer that it ( ___ ) is, ( ___ ) is not a small business concern.

(2) (Complete only if the offeror represented itself as a small business concern in paragraph (b)(1) of this provision.) The offeror represents, for general statistical purposes, that it ( ___ ) is, ( ___ ) is not a small disadvantaged business concern as defined in 13 CFR 124.1002.

(3) (Complete only if the offeror represented itself as a small business concern in paragraph (b)(1) of this provision.) The offeror represents as part of its offer that it ( ___ ) is, ( ___ ) is not a women-owned small business concern.

(4) Women-owned small business (WOSB) concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (b)(3) of this provision.] The offeror represents as part of its offer that--

(i) It ( ___ ) is, ( ___ ) is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (b)(4)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: ---- ___ ------.] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

(5) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a women-owned small business concern eligible under the WOSB Program in (b)(4) of this provision.] The offeror represents as part of its offer that--

(i) It ( ___ ) is, ( ___ ) is not an EDWOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13…

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