N0018321Q0075-0001.pdf

0011653867

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

RFQ amended to make corrections to the Performance Work Statement in Section C.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 8

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 09-Jun-2021

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X N0018321Q0075

X 9B. DATED (SEE ITEM 11)

09-Jun-2021

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer is extended, X is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE

RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

09-Jun-2021

CODE

NAVAL MEDICAL CENTER

MMD/CONTRACTING DIVISION

ATTN: MELISSA PEREGRINO-WHITE

54 LEWIS MINOR STREET

PORTSMOUTH VA 23708-2297

N00183 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

N0018321Q0075

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION C - DESCRIPTIONS AND SPECIFICATIONS

The following have been modified:

SECTION C

PERFORMANCE WORK STATEMENT

Contractor must be able to provide full contract support immediately upon award of a resulting order. Contractor will provide delivery of medical gases with the rental and exchange of gas cylinders as described in Section B at

Naval Medical Center Portsmouth (NMCP) and its outlying clinics as needed.

1. Minimum requirements are listed below:

a. The cyclinders / bottles currently in place is Air Gas National Welders. The contractor shall exchange cylinders / bottles within seven days of 01 July 2021. If the exchange of equipment must be coordinated with Air

Gas National Welders, arrangements shall be coordinated to ensure a timely, seamless customer exchange. If the exchange does not need to be coordinated with Air Gas National Welders, Air Gas National Welders shall be notified of the date the exchange will be made so that they may make arrangements to pick up their equipment.

b. End user will contact the contractor with each order via e-mail.

c. Delivery shall be made within two (2) business days of the call to the designated location.

d. The contractor shall deliver full medical gas cylinders to designated locations (see below). The contractor shall exchange the empty cylinders with replenished cylinders during each delivery.

e. All size “E” cylinders must be aluminum cylinders.

f. The contractor shall provide emergency deliveries, which will be e-mailed or faxed to the contractor within two hours during normal working hours (8:00 am to 4:30 pm, Monday through Friday).

g. The contractor shall provide driver(s) to pick up and deliver medical gas cylinders. The driver(s) must have a valid driver’s license and is / are required to comply with Government driving regulations while on Government facilities.

h. The contractor shall use vehicles used for transporting the medical gas must meet Department of

Transportation regulations.

i. The contractor shall provide an accurate invoice, with copies of signed receipt included, of all medical gases delivered / returned when submitting for payment. When delivering gases, contractor must provide a copy of signed receipt from all delivery sites to NMCP building 2. The contractor shall acquire a signature on delivery receipts for each delivery made.

j. The contractor shall affix labels on the medical gas cylinders stating the type of gas inside.

k. The contractor must be physically located within one (1) driving hour, not to exceed 60 miles of NMCP.

l. When medical gas cylinders are requested for NMCP building 2 and the outside gas cage of building 3, the contractor shall disconnect the empty cylinders and install the new cylinders.

2. Delivery Locations:

a. Naval Medical Center Portsmouth -

(1) 54 Lewis Minor Street, Building 250, Portsmouth, VA 23708

(2) 620 John Paul Jones Circle, Buildings 2, 3-215, Portsmouth, VA 23708

(3) 620 John Paul Jones Circle, Building 274, Portsmouth, VA 23708

b. Branch Health Clinics -

(1) Fire District #1 Station #1, 1945 Admiral Taussig, Building CEP-178, Norfolk, VA 23511-2985

Phone: (757) 445-4017

(2) Fire Station #9, Norfolk Naval Shipyard, Building 236 (Code 1125), Portsmouth, VA 23709

Phone: (757) 396-3335

(3) Fire Station #7, Naval Air Station Oceana, Building 220, 220 Hornet Drive, Virginia Beach, VA

23460

3. List of Gases & Quantity (note that this list may change during the period of performance).

The Government shall provide the contractor with written notification of all major changes to this list of gases via a contract modification approved and signed by the Contracting Officer. It is the Government’s intent to keep this list as accurate as possible. The Government shall reserve the right not to make any minor changes to the list of equipment (+/- 10%). Vendor please enter proposed pricing under “UNIT COST” for each gas.

a. Medical gases and cylinders to be delivered to NAVAL MEDICAL CENTER PORTSMOUTH (as needed):

Part Number SUPPLIES/ SERVICES UOM UNIT PRICE

OX USPEA R13A; Oxygen Refill Size E Cylinder $

OX USP200 R5; Oxygen Refill Size 282 CF Cylinder $

OX USP125 R6; Oxygen Refill Size M Cylinder $

OX USPDA R12; Oxygen Refill Size D Cylinder $

NI NF200 R103G2; Nitrogen Refill Size 255 CF Cylinder $

NI NFEA R33E; Nitrogen Refill Size E Cylinder $

CD USP50 R25; Carbon Dioxide Refill 50 lb Cylinder $

CD USPEA R26A; Carbon Dioxide Refill Size E Cylinder $

NS USP56 R45; Nitrous Oxide Refill Size H Cylinder $

NS USPEA R48A; Nitrous Oxide Refill Size E Cylinder $

Z02HE801ME3042 R101DEA; Helox Refill Size E Cylinder $

Z02HE8012003019

R101D2; Helox 80%20% Mixture

Size H Cylinder

Z02HE7012003041

R0122002001; Helox 70%30%

Mixture Size H Cylinder

AI USPEA R61EA; Compressed Air Refill Size E Cylinder $

RRCYLMXS

Rent; Oxygen Cylinder Rental Size E

Per cyl/ per month

RRCYLMLG

Rent; Oxygen Cylinder Rental Size

282 CF

Per cyl/ per month

RRCYLMLG

Rent; Oxygen Cylinder Rental Size M

Per cyl/ per month

RRCYLMXS

Rent; Oxygen Cylinder Rental Size D

Per cyl/ per month

RRCYLMLG

Rent; Nitrogen Cylinder Rental Size

255 CF

Per cyl/ per month

RRCYLMXS

Rent; Nitrogen Cylinder Rental Size

E

Per cyl/ per month

RRCYLMLG

Rent ; Carbon Dioxide Cylinder

Rental Size 50 Lbs.

Per cyl/ per month

RRCYLMXS

Rent; Carbon Dioxide Cylinder

Rental Size E

Per cyl/ per month

RRCYLMLG

Rent; Nitrous Oxide Cylinder Rental

Size H

Per cyl/ per month

RRCYLMXS

Rent; Nitrous Oxide Cylinder Rental

Size E

Per cyl/ per month

RRCYLMXS

Rent; Helox Cylinder Rental Size E

Per cyl/ per month

RRCYLMLG

Rent; Helox 70%30% Mixture

Cylinder Rental Size H

Per cyl/ per month

RRCYLMLG

Rent; Helox 80%20% Mixture

Cylinder Rental Size H

Per cyl/ per month

RRCYLMXS

Rent; Compressed Air Cylinder

Rental Size E

Per cyl/ per month

SECLABOR

DLC; Change Out Nitrous Oxide

Cylinders; Location: Building 2 in accordance to the Statement of Work.

23 Bottles per bank (2 banks) and 14 bottles in reserve = 69 bottles total. Each

SECLABOR

DLC; Change out Nitrogen

Cylinders; Location: Building 2 in accordance to the Statement of Work.

14 Bottles per bank (2 banks) and 14 bottles in reserve = 42 bottles total. Each

SECLABOR

DLC; Change Out Nitrous Oxide

Cylinders - ; Location: Building 2 in accordance to the Statement of Work.

8 Bottles per bank (2 banks) and 8 bottles in reserve = 24 bottles total. Each

SECEXPEDITE

SD02/SD03; Additional Charge For

Emergency Delivery Each

Delivery Charge per delivery Each $

b. Medical gases and cylinders to be delivered to BRANCH CLINICS (as needed):

Part Number SUPPLIES/ SERVICES

UOM

/estimated refills UNIT PRICE

OX USPEA R13A; Oxygen Refill Size E 100 $

OX USP200 R5; Oxygen Refill Size 282 CF 100 $

OX USP125 R6; Oxygen Refill Size M 20 $

OX USPDA R12; Oxygen Refill Size D 100 $

NI NF300 R103G2; Nitrogen Refill Size 304 CF 120 $

NI NFEA R33E; Nitrogen Refill Size E 1 $

AR UHP300 Argon UHP 336cf 16 $

Per cyl/ per month

RRCYLMXS Rent; Oxygen Cylinder Rental Size E 30 $

RRCYLMLG

Rent; Oxygen Cylinder Rental Size

251 CF 40

RRCYLMLG Rent; Oxygen Cylinder Rental Size M 10 $

RRCYLMXS Rent; Oxygen Cylinder Rental Size D 65 $

RRCYLMLG

Rent; Nitrogen Cylinder Rental Size

304 CF 40

RRCYLSGL Rent; Argon UHP 8 $

Delivery Charge per delivery Each $

Contractor Unclassified Access to Federally Controlled Facilities, Sensitive Information, Information

Technology (IT) Systems or Protected Health Information (Jan 2017)

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 text 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 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 Command’s Security Manager upon arrival to the 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) or T5 or T5R equivalent investigation , which is a higher level investigation than the National Agency Check with Law and Credit (NACLC)/T3/T3R described below. Due to the privileged system access, an investigation suitable for High Risk national security 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-N;

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 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 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. Contractor employees under this contract are recognized as Non-

Critical Sensitive [ADP/IT-II] positions 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 as National Security Positions. At a minimum, each contractor employee must be a US citizen and have a favorably completed NACLC or T3 or T3R equivalent investigation to obtain a favorable determination for assignment to a non-critical sensitive or IT-II position. The investigation 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

Command’s Security Manager upon arrival to the 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 Command Security

Manager. The Command’s Security Manager will review the submitted documentation for completeness prior to submitting it to the Office of Personnel Management (OPM); Potential suitability or security issues identified may render the contractor employee ineligible for the assignment. An unfavorable determination 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 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 DoD 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 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.

(End of Summary of Changes)