P01. DRAFT SOW - Medical Gas Inspection Iowa City.docx

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H365--REQUEST FOR INFORMATION / SOURCES SOUGHT Medical Gas Inspection Iowa City VA
Solicitation number
36C26325Q0204
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This document is a Statement of Work (SOW) for providing Annual Medical Gas Inspection Services at the Iowa City VA Health Care System. The contractor will perform purity/cross-connection tests and particulate testing on 10% of the medical gas outlets, with a different 10% inspected each year. The contractor will also provide master alarm activation at all medical gas sources and medical/surgical vacuum pumps annually. The period of performance is a base year from 04/01/2025 to 03/31/2026, with four 1-year option years. The contractor must have specific ASSE certifications for medical gas system inspections and prior experience in Joint Commission reporting requirements. The contractor will submit a detailed inspection report to the VA Medical Center. The Government owns the rights to all data and records produced under this contract.

The related federal contract opportunity is a Request for Information (RFI) / Sources Sought for the Medical Gas Inspection services at the Iowa City VA Health Care System. Responses are due by 08:00 am CST on 12-06-2024 and should be emailed to the specified contracting contact. The solicitation number is 36C26325Q0204.

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STATEMENT OF WORK

Annual Medical Gas Inspection Services

1. Overview:

1.1. The contractor will provide Annual Gas System Inspection Services and Master Alarm Activation as required by the Joint Commission at the Iowa City VA Health Care System

2. Location of Services:

2.1. Iowa City VA Health Care System, 601 Highway 6 West, Iowa City IA 52246

3. Period of Performance:

3.1. Base Year: 04/01/2025 to 03/31/2026

3.2. Option Year 1: 04/01/2026 to 03/31/2027

3.3. Option Year 2: 04/01/2027 to 03/31/2028

3.4. Option Year 3: 04/01/2028 to 03/31/2029

3.5. Option Year 4: 04/01/2030 to 03/31/2031

4. Certification: Proof of certification is required when submitting quotes

4.1. Inspection Certification: American Society of Sanitary Engineering (ASSE) ASSE 6020 for system inspections

4.2. ASSE Certification: ASSE Certification in one of the following: ASSE 6010 for system installations, ASSE 6030 for systems verifier, and ASSE 6040 systems maintenance.

4.3. Experience: Prior Experience in Joint Commission reporting requirement for medical gas inspections preferred.

5. Scope of Work:

5.1. The contractor/inspector will perform a Purity/Cross Connection test and Particulate testing of 10% of all outlets in building 1 of the VA hospital in Iowa City, Iowa.

5.1.1. Each year the inspections will be from a different 10% than the previous year.

5.2. The 10% sampling for inspection is at Contractor discretion with requirement that 10% be different sampling and rotated from previous years.

Gas Number of Outlets Oxygen 374 Medical air 402 Nitrous 17 WAGD (Waste Anesthetic Gas Disposal) 8 Carbon dioxide 15 Nitrogen 15

5.3. The contractor will provide master alarm activation at all medical gas sources and medical/surgical vacuum pumps annually.

6. Reporting:

6.1. The date and time of the annual inspection of the gas system will be coordinated with the Iowa City VA Health Care System Maintenance and Operations Supervisor, HVAC & Plumbing Supervisor, or Maintenance Department Representative.

6.2. The contractor will submit a detailed report of his/her findings to the Maintenance and Operations Supervisor. Report shall follow standards of ASSE for medical gas inspections.

Contact information will be provided to the vendor.

7. National Archives and Records Administration (NARA) Records Management Language for Contracts

7.1. Citations to pertinent laws, codes and regulations such as 44 U.S.C. Chapter 21, 29, 31 and 33;

Freedom of Information Act (5 U.S.C. 552); Privacy Act (5 U.S.C. 552a); 36 CFR Part 1222 and Part 1228.

7.2. Contractor shall treat all deliverables under the contract as the property of the U.S. Government for which the Government Agency shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest.

7.3. Contractor shall not create or maintain any records that are not specifically tied to or authorized by the contract using Government ‘IT’ equipment and/or Government records.

7.4. Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected by the Freedom of Information Act.

7.5. Contractor shall not create or maintain any records containing any Government Agency records that are not specifically tied to or authorized by the contract.

7.6. The Government Agency owns the rights to all data/records produced as part of this contract.

7.7. The Government Agency owns the rights to all electronic information (electronic data, electronic information systems, electronic databases, etc.) and all supporting documentation created as part of this contract. Contractor must deliver sufficient technical documentation with all data deliverables to permit the agency to use the data.

7.8. Contractor agrees to comply with Federal and Agency records management policies, including those policies associated with the safeguarding of records covered by the Privacy Act of 1974.

These policies include the preservation of all records created or received regardless of format [paper, electronic, etc.] or mode of transmission [e-mail, fax, etc.] or state of completion [draft, final, etc.].

7.9. No disposition of documents will be allowed without the prior written consent of the Contracting Officer. The Agency and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. Records may not be removed from the legal custody of the Agency or destroyed without regard to the provisions of the agency records schedules.

7.10. Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under or relating to this contract.

The Contractor (and any sub-contractor) is required to abide by Government and Agency guidance for protecting sensitive and proprietary information.

MEDICAL GAS OUTLET RECORD

Medical Center Overall

AREA/FLOOR
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS
BioMed
6
6
7
Emergency Department (ED)
18
18
18
1st Floor
20
20
20
2nd Floor
33
20
33
3rd Floor
0
0
0
4th Floor
89
44
99
5th Floor
67
66
96
6th Floor
31
31
35
7th Floor
58
43
88
8th Floor
50
34
63
9th Floor
2
0
0
10th Floor
0
0
0
TOTAL
374
282
459

1st Floor, Emergency Department (ED), and Biomed

ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS
ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS

OLD EMERGENCY DEPARTMENT

EMERGENCY DEPARTMENT

1W-172
2
2
2
1W-202
1
1
1
1W-173
1
1
1
1W-204
1
1
1
1W-177
4
4
6
1W-206
1
1
1
1W-178
2
2
2
1W-209
2
2
2
TOTAL
9
9
11
1W-211
2
2
2

1 SOUTH

1W-212
2
2
2
1S-08
1
1
1
1W-215
2
2
2
1S-10
1
1
1
1W-217
2
2
2
1S-12
1
1
1
1W-218
2
2
2
1S-16
1
1
1
1W-219
2
2
2
1S-18
1
1
1
1W-223
1
1
1
1S-45
2
2
0
TOTAL
18
18
18
TOTAL
7
7
5

BIOMED

1 EAST

BE-12
6
6
6
1E-17
1
1
1
BE12C
0
0
1
1E-22
1
1
1
TOTAL
6
6
7
1E-23
1
1
1
1E-24
1
1
1
TOTAL
4
4
4

GRAND TOTAL

1st FLOOR

2nd Floor, Radiology Areas, Old Dental Area, and 1st Floor MRI

ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS
ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS

X-RAY

OLD DENTAL AREA

2W-164
1
0
1
2W-110
1
0
1
2W-169
1
0
1
2W-112
1
0
1
2W-171
1
0
1
2W-118
1
1
1
2W-172
1
1
1
2W-119
1
1
1
2W-173
1
0
1
2W-121
1
1
1
2W-174
1
0
1
2W-122
1
0
1
TOTAL
6
1
6
2W-123
1
0
1

CT

TOTAL
7
3
7
2W-142
2
2
2
2W-143
2
1
2
TOTAL
4
3
4

U/S

2W-147
1
0
1
2W149
1
0
1
TOTAL
2
0
2

IR/CATH

2W-178
3
3
3
2W179
1
1
1
2W180
1
1
1
TOTAL
5
5
5

MAMMO

2W-32
1
1
1
TOTAL
1
1
1

NUC MED

2W-14
1
1
1
2W-23
1
1
1
2W-25
1
1
1
2W-27
1
1
1
2W-33
1
1
1
2W-41
1
1
1
2W-44
1
1
1
TOTAL
7
7
7

GRAND TOTAL

2nd FLOOR

4th Floor

ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS
ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS

4 EAST OUTPATIENT SURGERY

INTENSIVE CARE (ICU)

4E-07
1
0
1
4W-32
3
1
3
4E-08
1
0
1
4W-34
3
1
3
4E-09
1
0
1
4W-36
3
1
3
4E-10
1
0
1
4W-38
3
1
3
4E-11
1
0
1
4W-40
3
1
3
4E-12
1
0
1
4W-41
3
1
3
4E-13
1
0
1
4W-42
3
1
3
4E-14
1
0
1
4W-43
3
1
3
4E-28
1
0
1
4W-44
3
1
3
4E-29
1
0
1
4W-46
3
1
3
4E-30
1
0
1
TOTAL
30
10
30
4E-31
1
0
1

UROLOGY CLINIC

4E-32
1
0
1
4W-18A
1
0
1
4E-33
1
0
1
4W-18C
1
0
1
4E-34
1
0
1
4W-18D
1
0
1
4E-35
1
0
1
4W-18F
1
0
1
4E-36
1
0
1
TOTAL
4
0
4
TOTAL
17
0
17

POST ANESTHESIA RECOVERY UNIT

OPERATING ROOM

Bay 1
2
1
2
OR 8
2
1
2
Bay 2
2
1
2

Cysto Rm

Bay 3
2
1
2
OR 1
3
3
4
Bay 4
2
1
2
OR 2
4
5
6
Bay 5
2
1
2
OR 3
3
3
4
Bariatric Bay
2
1
2
OR 4
4
5
6
Bariatric Bay
2
1
2
OR 5
4
5
6
TOTAL
14
7
14
OR 6
4
5
6
TOTAL
24
27
34

GRAND TOTAL

4th FLOOR

5th Floor

ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS
ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS

5 EAST

5 WEST

5E-04
2
2
3
5W-06
2
2
3
5E-05
2
1
3
5W-08
2
2
3
5E-06
2
2
3
5W-09
2
2
3
5E-08
2
2
3
5W-11
2
2
3
5E-09
2
2
3
5W-17
2
2
3
5E-16
2
2
3
5W-18
2
2
3
5E-18
2
2
3
5W-19
2
2
3
5E-19
2
2
3
5W-20
2
2
3
5E-20
2
2
3
5W-29
2
2
3
5E-27
2
2
3
5W-30
2
2
3
5E-28
2
2
3
5W-31
2
2
3
5E-29
2
2
3
5W-32
2
2
3
5E-30
2
2
3
5W-33
2
2
3
5E-31
2
2
3
5W-34
2
2
3
5E-32
2
2
3
TOTAL
28
28
42
TOTAL
30
29
45

5 CENTER (DIALYSIS)

5S-05
1
1
1
5S-Unit
7
7
7
5S-21
1
1
1
TOTAL
9
9
9

GRAND TOTAL

5th FLOOR

6th Floor

ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS

6 EAST

6E-10
4
4
8
6E-17A
2
2
2
6E-17B
4
4
4
6E-17C
2
2
2
6E-17D
3
3
3
6E-25
1
1
1
6E-26
1
1
1
6E-28
1
1
1
6E-29
1
1
1
6E-30
1
1
1
6E-31
1
1
1
6E-32
1
1
1
6E-33
1
1
1
6E-34
1
1
1
6E-35
1
1
1
6E-36
1
1
1
6E-37
1
1
1
TOTAL
27
27
31

SLEEP LAB

6E-05
1
1
1
6E-06
1
1
1
6E-07
1
1
1
6E-08
1
1
1
TOTAL
4
4
4

6 WEST (VASCULAR & WOMANS CLINIC)

No Outlets
0
0
0

GRAND TOTAL

6th FLOOR

7th Floor

ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS

7 EAST

7E-05
2
2
3
7E-06
2
1
4
7E-07
2
2
3
7E-08
2
2
3
7E-09
2
2
3
7E-16
2
2
3
7E-17
2
2
3
7E-18
2
2
3
7E-19
2
2
3
7E-31
2
2
3
7E-32
2
2
3
7E-33
2
2
3
7E-34
2
2
3
7E-35
2
2
3
7E-36
2
2
3
TOTAL
30
29
46

7 WEST

7W-06
2
1
3
7W-08
2
1
3
7W-09
2
1
3
7W-11
2
1
3
7W-17
2
1
3
7W-18
2
1
3
7W-19
2
1
3
7W-20
2
1
3
7W-28
2
1
3
7W-29
2
1
3
7W-30
2
1
3
7W-31
2
1
3
7W-33
2
1
3
7W-34
2
1
3
TOTAL
28
14
42

GRAND TOTAL FOR 7TH FLOOR

8th Floor

ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS

7 EAST

8W CHEMO
10
10
10
8W-25D
2
2
2
8W-25F
2
2
2
8W-05
4
4
8
8W-07
4
4
8
8W-10
1
1
2
8W-18A
3
3
3
8W-18D
2
2
4
TOTAL
28
28
39

8 EAST

8E-02
1
0
1
8E-06
1
0
1
8E-07
1
1
1
8E-09
1
0
1
8E-10
3
0
3
TOTAL
7
1
7

GE/BRONCH LAB AREA

8E-30
6
0
6
8E-34
4
0
4
8E-37
1
1
1
8E-38
2
2
4
8E-40
1
1
1
8E-41
1
1
1
TOTAL
15
5
17

GRAND TOTAL FOR 8TH FLOOR

9th Floor (9 West)

ROOM
# OF O2 OUTLETS
# OF AIR OUTLETS
# OF SUCTION OUTLETS

7 EAST

9W-40
1
0
0
9W-43
1
0
0
TOTAL
2
0
0

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