P01 SOW.pdf

STATEMENT OF WORK

X-Ray Compliance Testing

1. SCOPE: Vendor shall provide Joint Commission Survey required compliance testing for X-Ray, Dental

X-Ray, Nuclear Medicine, Mammography (w/ Tomo and Biopsy), CT, PET/CT and MRI at the Iowa City VA Health Care System.

2. QUALIFICATIONS:

A. Contractor must provide documentation regarding the credentials of every individual that will be coming on site to perform the compliance testing.

• At least one of the contractor employees must be a Medical Physicist, possessing at a minimum a master’s degree in medical physics and evidence of participation in a “Maintenance of Certification” program overseen by a board such as the American Board of Radiology or an equivalent entity.

• Any individual that will be performing testing on site must provide evidence that they have been properly trained and signed off as competent for each testing procedure by the Medical Physicist

• For “special” modalities such as Nuclear Medicine, MRI, Mammography, and CT – additional certifications as required by Joint Commission must be provided by the individuals performing the testing protocols.

• Contractor must complete 75% of any requirements to fulfill obligations.

B. All testing must be supervised by the Medical Physicist

C. Contractor must provide testing protocols that will be used for each modality, and they must cover all criteria required by Joint Commission at a minimum.

D. Additonal Requirements:

1) Training – TMS 20939 No Access will be completed

3. SERVICES TO BE PROVIDED: Provide required compliance testing for all X-ray, Dental X-Ray, Nuclear Medicine, Mammography (w/ Tomo and Biopsy), CT, PET/CT and MRI systems in the Iowa City VA Health Care System to meet Joint Commission requirements, for the period of 12/01/2024 through 11/30/2025 to include four one-year option renewals. See equipment list for details.

4. REPORTS/DOCUMENTATION:

A. All test reports must be signed by the individual performing the testing procedures, and also by the supervising Medical Physicist

B. Any discrepancies or deficiencies noted during compliance testing must be sent to VA in writing within 48 hours. Full compliance reports, including measurements taking during the testing, must be submitted to the VA in writing within 30 days of testing.

B. A documentation package acceptable for Joint Commission purposes will be maintained by the contractor and made available to the Iowa City VA Healthcare System. Required features include, at a minimum:

i. Serial Number of equipment serviced.

ii. Any and all work performed on a particular date

Equipment List

Dental Intra-Oral X-Ray – 13 Units (Federal Building – 400 S. Clinton Street, Iowa City, IA)

1. Focus Intra-Oral Imaging System – 636 MX3007300 – ICFB-IC-187H

2. Focus Intra-Oral Imaging System – 636 EE2977063 – ICFB-IC-181E

3. Focus Intra-Oral Imaging System – 636 EE2977062 – ICFB-IC-181B

4. Focus Intra-Oral Imaging System – 636 EE2977060 – ICFB-IC-181C

5. Focus Intra-Oral Imaging System – 636 EE2977058 – ICFB-IC-187G

6. Focus Intra-Oral Imaging System – 636 EE2977059 – ICFB-IC-187E

7. Focus Intra-Oral Imaging System – 636 EE2977064 – ICFB-IC-187F

8. Focus Intra-Oral Imaging System – 636 MX221488 – ICFB-IC-181A

9. Focus Intra-Oral Imaging System – 636 MX1797711 – ICFB-IC-187B

10. Focus Intra-Oral Imaging System – 636 MX1797720 – ICFB-IC-187C

11. Focus Intra-Oral Imaging System – 636 MX1797721 – ICFB-IC-187A

12. Focus Intra-Oral Imaging System – 636 MX1797724 – ICFB-IC-187D

13. Focus Intra-Oral Imaging System – 636 MX1797723 – ICFB-IC-186

Dental Portable Units – 2 Units (Federal Building – 400 S. Clinton Street, Iowa City, IA)

1. Nomad Pro – 636 MX2703772 – ICFB-IC-181D

2. Nomad Pro 2 – 636 MX2034513 – ICFB-IC-181

Dental Pan-Ceph / Cone Beam CT – 1 unit (Federal Building – 500 S. Clinton Street, Iowa City, IA)

1. Planmeca Promax 3D Imager – 636 MX2749918 – ICFB-IC-184 GY

Digital Radiography – 8 units (Various Locations indicated below)

1. Samsung GC85A – 636 MX1948084 – QCOPC-IC-11 (2826 West Locust St, Ste A, Davenport, IA)

2. Philips Digital Diagnost – 636 EE3011278 – DEC-IC-109 (Decorah, IA)

3. Philips Digital Diagnost – 636 EE3024806 – GLSB-IC-160 (Galesburg, IL)

4. Philips C90 Serial Number 53097310 – Asset Number TBD – WTRLOO-IC-145 (945 Tower Park Dr, Waterloo, IA)

5. Samsung GC85A – 636 MX1984400 – DBQ-IC-122 (2600 Dodge St, Ste A1, Dubuque, IA)

6. Samsung GC85A – 636 MX2032164 – QUINCY-IC-156 (6020 Broadway St, Quincy, IL)

7. Samsung GC85A – 636 MX2455974 – CR clinic (3500 Dalton Way, Cedar Rapids, IA)

8. Samsung GC85A – 636 MX2671974 – (2901 East Lincolnway, Suite M, Sterling IL (Installed 1/22/22)

Mammography – 2 Units – Iowa City VAMC, 601 Hwy 6 West, Iowa City, IA 52246

1. Mammography Unit – GE Senographe Pristina 3D – 636 MX2373687 – 1-IC-2W202

2. Mammography Unit – GE Senographe Pristina 3D – 636 MX2373871 – 1-IC-2W32

CT – 5 Units – Iowa City VAMC, 601 Hwy 6 West, Iowa City, IA 52246

1. CT 64 Slice - Siemens Somatom Definition AS – 636 MX420987 – 1-IC-2W143

2. CT Scanner – Canon Aquilion One Genesis 640 – 636 MX1983202 – 1-IC-2W142B

3. PET/CT – GE Discovery MI – 636 MX2059252 – 1-IC-2W43

4. SPECT/CT – GE Optima NM/CT 640 – 636 MX2394254 – 1-IC-2W25

5. SPECT/CT - Siemens Symbia T6 – 636 MX161428 – 1-IC-2W45

MRI – 2 Units – Iowa City VAMC, 601 Hwy 6 West, Iowa City, IA 52246

1. MRI System – Siemens Magnetom Aera 1.5T – 636 MX2047219 – 1-IC-2W214C

2. MRI System – Siemens Magnetom Skyra 3T – 636 MX2047300 – 1-IC-2W214A

Digital Radiography – 3 Units– Iowa City VAMC, 601 Hwy 6 West, Iowa City, IA 52246

1. Samsung GC85A – 636 MX1932986 – 1-IC-2W164

2. Samsung GC85A – 636 MX1935181 – 1-IC-2W169

3. Samsung GC85A – 636 MX1935193 – 1-IC-2W171

Mobile Radiography – 4 Units– Iowa City VAMC, 601 Hwy 6 West, Iowa City, IA 52246

1. Samsung GM85 - 636 MX1972246 – 1-IC-4S11B

2. Samsung GM85 - 636 MX1972192 – 1-IC-2C02

3. Samsung GM85 - 636 MX1972245 – 1-IC-7C01

4. Samsung GM85 - 636 MX1972244 – 1-IC-2C02

R/F – 1 Unit– Iowa City VAMC, 601 Hwy 6 West, Iowa City, IA 52246 Siemens Axiom Luminos Agile Max – 636 MX1935833 – 1-IC-2W130

Fluoroscopy – 8 Units– Iowa City VAMC, 601 Hwy 6 West, Iowa City, IA 52246

1. Siemens Artis Zee Bi-Plane System – 636 EE3002797 – 1-IC-2W179B

2. Siemens Artis Zee Bi-Plane System – 636 EE3002797 (2nd x-ray tube) – 1-IC-2W179B

3. Siemens Artis Zee Bi-Plane System – 636 EE2996807 – 1-IC-2W180B

4. Siemens Artis Zee Bi-Plane System – 636 EE2996807 (2nd x-ray tube) – 1-IC-2W180B

5. Siemens Axiom Artis MP – 636 MX1935195 – 1-IC-2W172

6. Siemens Axiom Artis MP – 636 MX1935508 – 1-IC-2W131

7. Siemens Uroskop Omnia Max – 636 MX688109 – 1-IC-4S05

8. Philips Allura XPER FD20 – 636 MX645785 – 1-IC-4W108

Mobile Fluoroscopy – 6 Units– Iowa City VAMC, 601 Hwy 6 West, Iowa City, IA 52246

1. GE OEC 9900 Elite – FBXXTE02922 - 636 MX3531341 – 1-IC-8E38

2. GE OEC 9900 Elite – FBXXTE02921 - 636 MX3531268 – 1-IC-4W116

3. GE OEC 9900 Elite – FBXXTE02923 - 636 MX3531342 – 1-IC-4W116

4. GE OEC 9900 Elite – FBXXTE02920 - 636 MX3531353 – 1-IC-4W116

5. Orthoscan FD Pulse – 636 MX1661909 – 1-IC-4W102D

6. Medtronic O-Arm – 636 MX2616641 – 1-IC-4S05

Iowa City Medical Center 601 Highway 6 West

Iowa City, IA 52246-2208

Iowa City Federal Building VA Clinic 400 S Clinton St Iowa City, IA 52240

Quad Cities CBOCC 2826 West Locust Street, Suite A Davenport, IA 52804

Decorah CBOC 915 Short St, Suite 163 Decorah, IA 52101

Galesburg CBOC 310 Home Boulevard Galesburg, IL 61401

Waterloo CBOC 4000 University Avenue, Suite 100 Waterloo, IA 50701

Dubuque CBOC 2600 Dodge St, Suite A1 Dubuque, IA 52001

Quincy CBOC 6020 Broadway Street Quincy, IL 62301

Cedar Rapids CBOC West Town Center 3500 Dalton Way, Suite 400 Cedar Rapids, IA 52404

Sterling CBOC 2901 East Lincolnway, Suite M

Sterling, IL 61081

RECORDS MANAGEMENT OBLIGATIONS

A. Applicability

This clause applies to all Contractors whose employees create, work with, or otherwise handle Federal records, as defined in Section B, regardless of the medium in which the record exists.

B. Definitions

“Federal record” as defined in 44 U.S.C. § 3301, includes all recorded information, regardless of form or characteristics, made or received by a Federal agency under Federal law or in connection with the transaction of public business and preserved or appropriate for preservation by that agency or its legitimate successor as evidence of the organization, functions, policies, decisions, procedures, operations, or other activities of the United States Government or because of the informational value of data in them.

The term Federal record:

1. includes Iowa City VAHCS records.

2. does not include personal materials.

3. applies to records created, received, or maintained by Contractors pursuant to their Iowa City

VAHCS contract.

4. may include deliverables and documentation associated with deliverables.

C. Requirements

1. Contractor shall comply with all applicable records management laws and regulations, as well as

National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII

Subchapter B, and those policies associated with the safeguarding of records covered by the

Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

2. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

3. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for

Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law. Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

4. Iowa City VA HCS and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of Iowa City VAHCS or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to Iowa City VAHCS. The agency must report promptly to NARA in accordance with 36

CFR 1230.

5. The Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. The Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. The Contractor shall not remove material from

Government facilities or systems, or facilities or systems operated or maintained on the

Government’s behalf, without the express written permission of the Head of the Contracting

Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to Iowa City VA HCS control or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the

[contract vehicle]. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with

Paragraph (4).

6. The 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, contracts.

The Contractor (and any sub-contractor) is required to abide by Government and Iowa City VA

HCS guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

7. The Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with Iowa City VAHCS policy.

8. The Contractor shall not create or maintain any records containing any non-public Iowa City

VAHCS information that are not specifically tied to or authorized by the contract.

9. The 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 from public disclosure by an exemption to the Freedom of Information Act.

10. The Iowa City VA HCS owns the rights to all data and records produced as part of this contract.

All deliverables under the contract are the property of the U.S. Government for which Iowa City

VA HCS shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

11. The Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training.

D. Flowdown of requirements to subcontractors

1. The Contractor shall incorporate the substance of this clause, its terms and requirements including this paragraph, in all subcontracts under this [contract vehicle], and require written subcontractor acknowledgment of same.

2. Violation by a subcontractor of any provision set forth in this clause will be attributed to the

Contractor.