Posted Sam.gov.pdf

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in FAR (Federal Acquisition Regulations) Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

The solicitation number is RFQ75H7621Q00018. The solicitation document incorporated provisions and clauses are those in effect through FAC (Federal Acquisition Circular) 2021-06 07-12-2021.

This solicitation is a single award IDIQ base plus four (10/01/21-09/30/22 w/4 options), Request for Quote under NAICS code is 621512 Diagnostic Imaging- Unrestricted.

The unit pricing must be all inclusive (to include but not be limited to travel, lodging, per diem, fringe benefits, federal, state, and local taxes) plus all other costs pertinent to the performance of this contract. Utilize your most competitive and reasonable rates. The contractor shall provide Radiology Reads Services in accordance with the Statement of Work.

The period of performance will be from 10/01/2021 for one year with a base period with four option years.

INSTRUCTION TO OFFERORS: Proposal must contain the following documents to be considered responsive and eligible for an award:

Complete the attached FAR and HHSAR (Health and Human Services Acquisition Regulations) provisions and clauses applicable to this acquisition, including:

FAR 52.212-1 - Instructions to Offerors - Commercial Items (Oct 2018). This must be submitted by the Offeror.

Addendum to FAR 52.212-1, Instructions to Offerors - Commercial Items (Oct 2018) Request for Quotation (RFQ) shall contain the following information: RFQ NUMBER; TIME SPECIFIED FOR RECEIPT OF OFFERS; NAME; ADDRESS; CAGE CODE; TELEPHONE NUMBER OF OFFEROR; TERMS OF

THE EXPRESSED WARRANTY; ANY DISCOUNT TERMS AND ACKNOWLEDGEMENT OF ALL

SOLICITATION AMENDMENTS (if applicable). Quotes must indicate quantity, unit price and total amount for each item. Offerors shall include a statement specifying the extent of agreement with all terms, conditions and provisions included in the solicitation. Quotes shall also contain all other documentation specified herein. Addendum to FAR 52.212-l(c), Period for Acceptance of Offers. The paragraph is tailored as follows: "The Offeror agrees to hold the prices in its offer firm for 60 calendar days from the date specified for receipt of offers."

FAR 52.212-2 - Evaluation - Commercial Items (Oct 2014).

The Government will award a contract resulting from this solicitation to the best value in consideration to the government. The following factors shall be used to evaluate offers:

The basis for award will be based on "" Lowest Price Technically Acceptable" in determining the successful quote that serves the best interest of the government. IHS reserves the right to make single award, which is most advantages to the Government. This is a competitive solicitation and the offer your firm submits will be used by the Indian Health Service to determine, which offer is the "Best Value" to the government. Be advised that the quantities listed within are, "estimates only" and it is not the intent of IHS to be obligated to order the "quantities".

Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced or if the SOW in not met. Evaluation of options shall not obligate the Government to exercise the option.

FAR 52.212-3 - Offerors shall include a completed copy of the provision at FAR 52.212-3, Offeror Representations and Certifications -- Commercial Items (Dec 2019), Alternate I (Oct 2014), with their offer, or the offeror shall complete paragraph (b) of FAR 52.212-3, if the offeror has completed the annual representations and certifications electronically at http://www.sam.gov. Vendors must be actively registered in the System for Award Management (SAM); the website is https://www.sam.gov/portaljpublic/SAM/ . Contact SAM at US Calls: 866-606-8220, International Calls: 1-334-206-7828, however, a DUNS number must be known prior to registration. Call Dun and Bradstreet at 1-888-546-0024 to verify or apply for a Duns number; the website is http://fedgov.dnb.com/webform.

FAR 52.212-4 - Contract Terms and Conditions - Commercial Items (October 2018) (Incorporated by Reference; and

FAR 52.212-5 - Contract Terms and Conditions Required to Implement Statutes or Executive Orders

- Commercial Items (October 2019).

additional FAR clauses cited in the clause are:

FAR 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (Nov 2015) FAR 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

FAR 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Public Laws 108-77, 108-78 (19 U.S.C. 3805 note)).

FAR 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (Oct 2016) (Pub. L. 109-282) (31 U.S.C. 6101 note).

FAR 52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (Oct 2015) (31 U.S.C. 6101 note). FAR 52.222-19, Child Labor - Cooperation with Authorities and Remedies (Oct 2016) (E.O. 13126) FAR 52.222-21, Prohibition of Segregated Facilities (Apr 2015). FAR 52.222-26, Equal Opportunity (Sep 2016) (E.O. 11246).

FAR 52.222-50, Combating Trafficking in Persons (Mar 2015) (22 U.S.C. chapter 78 and E.O.

13627).

FAR 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (Aug 2011).

FAR 52.225-13, Restrictions on Certain Foreign Purchases (June 2008) (E.O.'s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury).

FAR 52.232-33, Payment by Electronic Funds Transfer-System for Award Management (Jul 2013) (31 u.s.c. 3332).

FAR 52.204-7, System for Award Management (Oct 2016) FAR 52.204-13, System for Award Management Maintenance (Oct 2016) FAR 52.211-6, Brand Name or Equal (Aug 1999) FAR 52.211-17, Delivery of Excess Quantities (Sept 1989) FAR 52.219-1 Alt I Small Business Program Representations (Oct 2014) FAR 52.222-22 Previous Contracts and Compliance Reports (Feb 1999) FAR 52.225-18 Place of Manufacture (Mar 2015) FAR 52.225-25, Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran-Representation and Certification (Oct 2015) FAR 52.233-1, Disputes (May 2014) FAR 52.243-1 Changes -- Fixed Price (Aug 1987) FAR 52.246-2 Inspection of Supplies -- Fixed-Price (Aug 1996) FAR 52.246-16 Responsibility for Supplies (Apr 1984) FAR 52.247-34, F.O.B. Destination (Nov 1991)FAR 52.252-1, Solicitation Provisions Incorporated by Reference (Feb 1998)

The full text of a clause may be accessed electronically at:

https://www.acquisition.gov/?q=browsefar

Proposals are due on September 15, 2021 @ 12:00 PM CST Submit proposals to:

Quentin N Burdick Memorial Healthcare Facility Attn: Phyllis Gourneau, Contract Specialist PO Box 160 1300 Hospital Loop Belcourt, North Dakota Telephone: 701/477-6111 ext. 8419 Facsimile: 701/477 /2527 E-mail: phyllis.gourneau@ihs.gov

Note to the Proposed Contractor:

OIG Exclusion List

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

2. CONTRACT NO.

7. FOR SOLICITATION

► INFORMATION CALL:

9. ISSUED BY

Belcourt PHS Indian 1300 Hospital Road P.O. Box 160 Belcourt ND 58316 l a, NAME

PHYLLIS

Hospital

EFFECTIVE DATE I

3.AWARD/

4" ORDER NUMBER

GOURNEAU

CODE 1163

11. DELIVERY FOR FOB DESTINA- 12. DISCOUNT TERMS

TION UNLESS BLOCK IS

MARKED

D SEE SCHEDULE

15. DELIVER TO CODE I

17a. CONTRACTOR/ CODE I FACILITY! OFFEROR CODE

TELEPHONE NO.

017b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

19. 20.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES

1. REQUISITION NUMBER

I

PAG

OF

I 6

15'

SOLICITATION NUMBER

6. SOLICITATION

75H70621Q00018 ISSUE DATE

09/02/2021 r TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/LOCAL TIME

701-477-8419 09/16/2021 1200 CT

10. THIS ACQUISITION IS lxl UNRESTRICTED OR DsET ASIDE:

0 SMALL BUSINESS WOMEN-OWNED SMALL BUSINESS

[] (WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

D HUBZONE SMALL SMAI I RI 181NFSS PROr,RAM

BUSINESS □ EDWOSB NAICS:

0 SERVICE-DISABLED 0 B(A)

VETERAN-OWNED SIZE STANDARD:

SMALL BUSINESS

D 13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS ( 15 CFR 700)

16. ADMINISTERED BY

Belcourt PHS Indian 1300 Hospital Road PO Box 160 Belcourt ND 58316

18a. PAYMENT WILL BE MADE BY

13b. RATING

14. METHOD OF SOLICITATION

OORFQ

Hospital

C1FB 0 RFP

CODE 1163

CODE I

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED OsEE ADDENDUM

21. 22, 23, 24.

QUANTITY UNIT UNIT PRICE AMOUNT

%FOR:

Quentin N Burdick Memorial Healthcare Facility (QNBMHF) is requesting a response to this RFQ - (Request for Quote) for Radiology Interpretation for the Indian Heath Service (IHS) in Belcourt, North Dakota 58316. QNBMHF intends to award a single IDIQ - Indefinite Delivery - Indefinite Quantity contracts. This solicitation is unrestricted for NAICS code 621512 - Diagnostic Imaging

The "Unit Price" is an all inclusive cost. All (Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

0 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52,212-4 FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA 0 ARE O ARE NOT ATTACHED.

0 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA 0 ARE OARE NOT ATTACHED.

0 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER (Type or print)

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

I 30c. DATE SIGNED

0 29. AWARD OF CONTRACT: ___________ OFFER

DATED _______ . YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

HEREIN, IS ACCEPTED AS TO ITEMS:

31a. UNITED STATES OF AMERICA(S/GNATURE OF CONTRACTING OFFICER)

31b. NAME OF CONTRACTING OFFICER {Type or print)

I 31c. DATE SIGNED

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA· FAR (48 CFR) 53.212

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

"inclusive cost" is defined to include travel, lodging, per diem, fringe benefits, i.e., life insurance, social security, federal, state, and local taxes, plus all other costs pertinent to the performance of this contract.

This contract provides services for Radiology

Reads at the Quentin N Burdick Memorial

Healthcare Facility in Belcourt, North Dakota.

Orders awarded under this contract shall be performed in accordance with the terms and conditions of this contract.

Task Orders issued under these ID/IQ contracts will be based on pricing submitted with bid.

Task Orders will be issued to the awarded company that can provide radiology reads requirements.

Awardee will be contacted and information will be provided by the Radiology Department as to what is required.

The standards of medical practice and duties of the Contractor shall be determined pursuant to the bylaws of the Service Unit. The regulations of the hospital, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of nurses and hospitals must be followed.

Continued

Also the standards and recommendations

32a. QUANTITY IN COLUMN 21 HAS BEEN

21. 22.

QUANTITY UNIT

0 RECEIVED 0 INSPECTED 0 ACCEPTED AND CONFORMS TO THE CONTRACT EXCEPT AS NOTED

23.

UNIT PRICE

24.

AMOUNT

32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE I

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER 34. VOUCHER NUMBER 35 AMOUNT VERIFIED 36. PAYMENT 37. CHECK NUMBER

CORRECT FOR

0 COMPLETE 0 PARTIAL 0 FINAL

0 PARTIAL 0 FINAL

38. SIR ACCOUNT NUMBER 39. SIR VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print)

41 b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE 42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MMIDD) 142d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

EFERENCE NO, OF DOCUMENT BEING CONTINUED

CONTINUATION SHEET 75H7062lQ000lB

NAME OF OFFEROR OR CONTRACTOR

ITEM NO,

(A)

SUPPLIES/SERVICES

(B) of Centers for Medicare and Medicaid Services (CMS) or the Accreditation Organization must be adhered to.

Period of Performance will be 10/01/2021 to

09/30/2026 (Base year plus four option years).

FAR 52.212-1 - Instructions to Offerors -

Commercial Items (October 2018)

In event the Contractor is unable to fulfill the task order requirements for whatever reason; the government reserves the right to fulfill its need outside of this contract. A written confirmation from the contractor indicating the inability to fulfill the task order is immediately required.

The quantity of hours ordered on the unfilled task order will be applied to the minimum quantity. The governments right to fulfill its need outside this contract(s) does not waive its right to the issuance of a cure notice nor does it waive its right to terminate for default.

This IDIQ contract does not obligate any funds.

Funds will be obligated as individual task orders as placed hereunder. For details please refer to the attached clauses in full text FAR 52.216-18

Ordering, FAR 52.216-22 Indefinite Quantity, Orders may be placed against this contract by issuing task orders and they may be submitted electronically.

This contract is a nonpersonal health care services contract, as defined in FAR 37.101, under which the contractor is an independent contractor.

The Government may evaluate the quality of professional and administrative services iProvided, but retains no control over the

�edical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment).

The Contractor shall indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring

Continued ...

NSN 7540-01-152-8067

QUANTITY UNIT I

(C) (D)

UNIT PRICE

(E)

PAGE OF

3 6

AMOUNT

(F)

OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

EFERENCE NO. OF DOCUMENT BEING CONTINUED

CONTINUATION SHEET 75H7062lQOOOlB

NAME OF OFFEROR OR CONTRACTOR

ITEM NO,

{A)

SUPPLIES/SERVICES

{B) during contract performance.

The Contractor shall maintain medical liability insurance, in a coverage amount acceptable to the Contracting Officer, which is not less than the amount normally prevailing within the local community for the medical specialty contracted for in this contract.

Quotes shall be submitted on company letterhead, signed and dated and it shall include:

1. Solicitation No. 75H70621Q00018

2. Closing Date of September 16, 2021 at 12:00 (Noon) CST

3. Name, address, telephone number of the offerer and email address of the contract person.

4. Technical description of the item/service being offered in sufficient detail to evaluate compliance with the requirements in the solicitation. This may include documents, if necessary;

5. Remit to address, if different than mailing !address;

6. A completed copy of the representations and certification at FAR 52.212-3; see Far 52.212-3(b) for those representations and certifications that the offeror shall complete electronically.

7. Copy of Board Certifications

8. Copy of active, current full and unrestricted license to practice.

9. Copy of Diplomas/Specialty Certification

10. Copies of Continue Education

11. Current CV/resumes

12. Name and phone number of three (3) current professional references

13. Copy of recent Health Examination

FAR 52.212-2 Evaluations - Commercial Items (October 2014)

LPTA (Lowest Price Technically Acceptable) IHS reserves the right to make a single award or �ultiple awards, whichever is most advantageous to the Government. This is a competitive Continued ...

NSN 7540•01-152-8067

QUANTITY UNIT I

{C) (D)

UNIT PRICE

(E)

PAGE OF

4 6

AMOUNT

(F)

OPTIONAL FORM 336 (4-86)

CONTINUATION SHEET 75H7062lQOOOl8

NAME OF OFFEROR OR CONTRACTOR

ITEM NO.

(A)

SUPPLIES/SERVICES

(B) solicitation and the offer your firm submits will be used by the Indian Health Service to determine, which offer is the Best Value to the government.

(a) The Government will award a single contract resulting from this Request for Quote (RFQ) to the responsible offerors whose RFQ's meets all of the requirements and is LPTA - Lowest Price

Technically Acceptable.

FAR 52.212-3 - Offeror Representations and

Certifications - Commercial Items (October 2018)

- See attachment for full text and instruction for completion. An offeror shall complete only paragraph (b) of this provision if the offeror has completed the annual representations and certifications electronically via http://www.sam.gov. If an offeror has completed the annual representations and certifications electronically at the System for Award Management

(SAM) website, the offeror shall complete only paragraph (c) through (o) of this provision. FAR

52.212-4 - Contract Terms and Conditions -

Commercial Items (October 2018)

R 52.212-5 - Contract Terms & Condition's

Required to Implement Statutes or Executive

Orders - Commercial Items (May 2019) - See attachment for full text.

Attached are the Federal Acquisition Regulations

(FAR) and the Health & Human Services Acquisition

Regulation (HHSAR) clauses that are applicable including the in the attachment

Offers will be accepted electronically, Submit via e-mail to the following:

Quentin N Burdick Memorial Healthcare Facility -

Indian Health Service

Phyllis Gourneau, Contract Specialist

PO Box 160

Belcourt, North Dakota 58316 e-mail: Phyllis.gourneau@ihs.gov

Phone: (701) 477-8419

Contractor will need a DUNS number, TIN number and be registered with www.SAM.gov

INVOICE SUBMISSION AND PAYMENT

Continued ...

NSN 7540-01-152-8067

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E) I

PAGE OF

5 6

AMOUNT

(F)

OPTIONAL FORM 336 (4-86)

CONTINUATION SHEET 7587062lQ000lS

NAME OF OFFEROR OR CONTRACTOR

ITEM NO.

(A)

SUPPLIES/SERVICES

(B)

The Contractor shall submit a signed and approved invoice to request payment on at least a monthly basis.

(a) The Contractor shall submit an original invoice to:

Attn: Accounts Payable

Great Plains Area Indian Health Service

Division of Financial Management

115 4th Avenue Southeast

Room 309 Federal Building

Aberdeen, South Dakota 57401

(b) The Contractor shall include the following information on each invoice in accordance with the Prompt Payment Act (5 CFR Part 1315.9(b)):

1. Contractor's name;

2. Invoice number and date;

3. Entire award number or other authorization number for delivery of goods or services;

4. Description (including dates of service), price, and quantity of goods and services rendered;

5. Shipping and payment terms;

6. DUNS number and Taxpayer Identifying Number

(TIN); and

7. Contact name (where practicable), title and telephone number.

Payment shall be made by the Great Plains Area

Financial Management Branch, Room 309 Federal

Building, Aberdeen, South Dakota 57401.

The Government reserves the right to accept or reject services if the level or work is unsatisfactory.

NSN 7540-01-152-8067

QUANTITY UNIT

(C) (D)

UNIT PRICE

(E)

PAGE OF

6 6

AMOUNT

(F)

OPTIONAL FORM 336 (4-86)

RFQ 75H70621Q00018 -Radiology Reads RFQ Quentin N Burdick Memorial Healthcare Facility in Belcourt, North Dakota

Bid Schedule - QNBMHF in Belcourt, ND - Please submit with SF-1449

IHS Service Unit Description Quantity Unit of Issue Unit Price Total Cost

1 Belcourt I.H.S Service Unit Radiology Reads Services

Price per Month _____ X 12 Months ___________ _

POP 10/01/2021 to 09/30/2022 -Base Yr.

2. Belcourt 1.H.S Service Unit Radiology Reads Services

Price per Month _____ X 12 Months

POP 10/01/2022 to 09/30/2023 -Option Yr. One (1)

3. Belcourt 1.H.S Service Unit Radiology Reads Services

Price per Month _____ X 12 Months

POP 10/01/2023 to 09/30/2024 -Option Yr. Two (2)

4. Belcourt 1.H.S Service Unit Radiology Reads Services

Price per Month _____ x 12 Months

POP 10/01/2024 to 09/30/2025 -Option Yr. Three (3)

5. Belcourt 1.H.S Service Unit Radiology Reads Services

Price per Month _____ X 12 Months ------------

POP 10/01/2025 to 09/30/2026 -Option Yr. Four (4)

Total Cost Base Plus Four Option Years .. =

QUENTIN BURDICK MEMORIAL HEALTHCARE FACILITY

US Indian Health Service - Belcourt, North Dakota 58316

STATEMENT OF WORK

Radiology Reading Services

Background

The mission of the QNBMCHF is to provide the best possible Health Care services to the Native American population on the Turtle Mountain Indian Reservation. The 27-bed facility is also known as the Belcourt Indian Health Service or the Belcourt Service Unit.

To meet this mission, the QNBMCHF - IHS has identified a need for a Radiology Reading Services contract.

Purpose

The purpose of this contract is to provide diagnostic radiology interpretation services for all modalities of medical imaging, to include standard x-ray, ultrasound (including breast), computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopic (R/F), and mammography. The number of film/studies can vary from 1,000 to 1,800 per month. Payment shall be on a per study read for each modality.

The contract resulting from this solicitation shall:

1) Be a fixed price non-personal Diagnostic Radiology/Medical Imaging contract.

2) Allow the Government to evaluate the quality of professional and administrative services provided

3) Require the Contractor to indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance

Period of performance

From a Base + 4 year contract.

Hours of Performance

Routine work shall be performed Monday through Sunday, 24 hours a day including weekends and holidays.

STAT reads shall be performed 24 hours a day, including weekends and holidays.

Government Furnished Property, Facilities and Services

None. Full performance of this contract is outside of any government facility. The Indian Health Service does not anticipate the need for Government furnished property, facilities and services.

Statement of Work

The Contractor shall:

1) Adhere to the accepted standards and ethics, and policies and procedures adopted by the profession and the organization and regulated by law

2) Provide interpretation and repo1is for all medical imaging studies sent to the contractor

3) Have all equipment and/or systems necessary to perform the requirements of this contract.

4) Provide a copy of the most recent health physicist's survey report on any diagnostic mammography reading workstations.

5) Provide viewbox illumination test results, if needed

6) Be certified by the American College of Radiology Mammography Accreditation

Program. The interpreting physicians must have documentation showing that they meet minimum MQSA/ACR and FDA qualifications: this would include initial, continuing experience and continuing education. In addition to these requirements' the Radiologist shall have clinical supervision over the QNBMCHF Radiology Department and will be expected to perform as LIP (Lead Interpreting Physician) for MQSA.

7) Provide telephone consultation to the QNBMHCF physician on film interpretations which have unusual findings that may cause immediate health problems for the patient

8) Pmiicipate, when requested, in QNBMHCF quality assurance and peer review activities.

9) Make at least two IHS site visits per year and will schedule visit with the Radiology Supervisor and Clinical Director.

10) Be able to transcribe reports and issue signed documents to the QNBMHCF Radiology department by electronic means.

11) Provide copies of Peer Review, Provide medical licensure and approved privileges for all Radiologists providing services under this contract to the QNBMHCF Radiology Supervisor.

12) Any changes or problems with the transcribing, dictation, typing reports and or equipment will be immediately communicated to the Radiology Supervisor or her designee at the Quentin N. Burdick memorial Health Cm·e Facility.

Reports

The Contractor will be required to provide transcription and electronic signatures for all radiology reports. An electronically signed repmi must be submitted to the QNBMHCF radiology department VIA email port provided or faxed:

1) Four (4) days for all routine studies

2) Twenty (20) minutes for STAT studies transmitting larger studies may take longer. After transmission of images are received.

Interpretive electronic reports signed by reading Radiologist will be transmitted or faxed to QBHCF to be distributed manually or in an EHR by QBHCF radiology personnel.

For mammography studies, if a category 4 or 5 is deemed by the radiologist, the report must be typed and letter sent to the patient within 4 days of initial diagnosis.

Additionally, a copy of the report for category 4 or 5 will be faxed to the Belcourt radiology department. The ordering physician must also be informed of findings.

The Contractor is solely responsible for the completeness and accuracy of medical terminology spelling, grammar and punctuation. Corrections will be the responsibility of the Contractor without any additional charge to the IHS facility

The Contractor shall immediately ref er apparent discrepancies or inconsistencies to the appropriate physician for clarification and/or corrections so reports are still transcribed within the required timeframe

Quality Assurance and Invoice/Payment

The government reserves the right to accept or reject services if the level of performance is unsatisfactory to the IHS. Contractor will be paid when contractor submits payment for studies done

In working with the Chief Technologist/QC coordinator assuring work is satisfactory;

work will be thoroughly monitored and approved. After approval, invoices will be forwarded for payment. Along with this invoice, shall be a record of total plain x-rays, ultrasound and mammography (screening & diagnostic) exams read, signed by office manager or designee.

No direct patient billing will be done by the contractor. The contractor will not do third party billing on its own for any interpretations done under this contract.

Image/Study Delivery

All medical imaging studies will be electronically transmitted using the DI COM protocol via a PACS to PACS send using a persistent LAN to LAN Virtual Private Network (VPN) connection, with the following exceptions:

I) Film screen mammography studies

2) Prior studies that have not been digitized (anal-log film)

3) Large studies that cannot be transmitted in a reasonable amount of time

These images/studies will be sent via either by our facilities drivers who deliver our facilities patients for follow up care every day or if needed use 3rd party shipper (UPS, USPS, FedEX, etc.)

During network interrnptions and/or hardware/software malfunctions that prevent the sending/receiving of an electronic transmission:

1) Routine studies will be held for up to 24 hours and transmitted when connection is reestablished after 24 hours. In some cases (Malfunction/emergencies) the x-rays will be delivered by a driver from the Belcourt service unit to contractor.

2) STAT studies will be sent on CD or printed film via courier, and electronically transmitted if requested by the contractor, when connection is reestablished

Any images/studies returned by the contractor outside of electronic transmission will be at the expense of the contractor, including prior study man1mography films sent for companson purposes

In order to establish a persistent LAN to LAN VPN, a Data Exchange Agreement (DEA) must be maintained or renewed when required

Contractor Qualifications

1) Contractor must be located within the United States and within 120 miles of the

QNBMHCF.

2) Board certification from the American Board of Radiology has comparable qualifications, ACR, FDA and MQSA.

3) Meet the criteria for medical staff membership including:

a. Current and unrestricted medical license from a state, the District of

Puerto Rico, or a temporary of the United States,

b. Diploma indication completion of an approved medical school program.

c. Completion of an approved medical residency-training program in radiology.

d. If applicable, a copy of the Education Commission of Foreign Medical

Graduate certificate (ECFMG).

e. Relevant experience and training in radiology as evidenced by three (3) letters of reference from individuals who can attest to the radiologist's judgment, competence, and character, one letter must be from the chief of staff or department chairperson from a hospital where the applicant has provided radiology services.

f. Provide information on previously successful or currently pending challenges licensures or registration (state or district, DEA) or the voluntary relinquishment of such licensure or registration; voluntary or involuntary termination of medical staff membership or voluntary or involuntary limitation reduction, or loss of clinical privileges at another hospital; and current involvement with professional liability actions.

g. Evidence of medical liability/malpractice coverage.

All required certifications/licensures in this resultant contract must remain current during the life of the contract.

Processes for Privileging Telemedicine Services:

Clinical privileges may be granted for individuals providing services exclusively via telemedicine. These privileges do not extend to care delivered in-person and on-site in IHS facilities. These privileges also do not require appointment to the IHS facility medical staff. (As per a final ruling from CMS released May 5, 2011, the governing body of a hospital or critical access hospital must ensure that a physician or licensed independent practitioner providing telemedicine services from a distant-site telemedicine hospital or entity does so in a manner that enables the hospital receiving the services to comply with all the applicable conditions of participation (CoP) and standards relevant for those services. Compliance with CMS CoP requires that all telemedicine practitioners receive privileges at IHS hospitals prior to delivering telemedicine services. In accordance with CMS regulations at 42 CFR 482.22(a)( 4), the hospital will also rely on the credentialing and privileging decisions of non-hospital entities providing telemedicine services under contract, known as "distant-site telemedicine entities", if the the hospital's governing body ensures, through its written agreement with the distant-site telemedicine entity, that all of the following provisions are met:

1. The distant-site telemedicine entity's medical staff credentialing and privileging process and standards conform with CMS standards §482.12(a)(l) through (a)(7) and §482.22(a)(l) through (a)(2);

2. The practitioner at the distant-site telemedicine entity is privileged at the distant site telemedicine entity;

3. The distant-site telemedicine entity provides a current list of the distant-site telemedicine entity's practitioner's privileges;

4. The practitioner at the distant-site telemedicine entity holds a valid, umestricted license in a U.S. state, territory, or commonwealth of the U.S;

5. The IHS hospital has an internal review of the distant-site telemedicine entity's practitioner's performance and provides this information to the distant-site telemedicine entity. Information sent from the IHS hospital to the distant-site telemedicine entity must include, at a minimum, all adverse events and complaints regarding telemedicine services provided by the distant-site telemedicine entity practitioner to the IHS hospital.

6. The above information is specified in a written agreement between the IHS hospital and the distant-site telemedicine entity. The distant-site telemedicine entity must furnish the contracted telemedicine services in a manner that permits the hospital to comply with all applicable CMS conditions of participation for the contracted services.)

Special Contract Requirements

Contractors cannot serve as witnesses in any suit against the Federal Government.

Many of the IHS patients receiving services may only speak a native language and/or reside on a Native American Reservation, therefore, the Contractor must demonstrate sensitivity to cross-cultural and language differences. The Privacy Act of 1974 mandates that the Contractor maintain complete confidentiality of all administrative, medical & personnel records, & all other pertinent information that comes to his/her attention or knowledge. The Privacy Act carries both civil & criminal penalties for unlawful disclosure of records. Violation of such confidentiality shall be cause for adverse action.

The IHS shall provide training on the Freedom of Information Act & the Privacy Act. All

IHS regulations & policies applicable to these Acts shall be enforced.

Contracting Officer Authority

Authority to negotiate changes in terms, conditions, or amounts cited in this contract is reserved to the Contracting Officer.

Project Officer/Contracting Officer Representative

The Contracting Officer shall designate a Project Officer/Contracting Officer

Representative, in writing, at time of award. The Project Officer shall be responsible for:

1} Monitoring the Contractor's technical progress;

2) Interpreting the SOW;

3} Technical evaluation as required;

4) Technical inspections and acceptance required by this contract; and, 5} Assisting the Contractor in the resolution of technical problems encountered during performance of this contract.

Invoices

The Contractor shall submit a signed and approved invoice to request payment on at least a monthly basis.

The contractor shall submit an original invoice to:

Attn: Accounts Payable

Aberdeen Area Indian Health Service

Division of Financial Management

115 4th Avenue SE, Room 309, Federal Building

Aberdeen, South Dakota 57401

The contractor shall submit two (2) copies of its invoice through the IHS Project Officer and Routed to:

Attn: Contracting Officer

Aberdeen Area Indian Health Service

Division of Acquisition Management

115 4th Avenue SE, Room 309, Federal Building

Aberdeen, South Dakota 57401

The Contractor shall include the following information on each invoice in accordance with the prompt payment act (5 CFR Part 1315.9(b)):

1) Contractor's name;

2) Invoice number and date;

3) Entire award number or other authorization number for delivery of goods or services;

4) Description (including dates of service), price, and quantity of goods and services rendered;

5) Shipping and payment terms;

6) DUNS number and Taxpayer Identifying Number (TIN); and

7) Contact name (where practicable), title and telephone number.

Payment shall be made by the Aberdeen Area Financial Management Branch, Room 309, Federal Building, Aberdeen, South Dakota 57401.

Additional Submission Requirements

The following items/information must be submitted in addition to the submission requirements listed in the bid schedule:

1) Make/Model (software name) of the PACS (i.e. GE Centricity IW; AGFA Impax)

2) Provide a copy of the most recent health physicist's survey report on any diagnostic mammography reading workstations

3) A statement that the IHS Data Exchange Agreement will be signed upon issuance of the contract

CLAUSES IN CORPORA TED BY REFERENCE

(Firm Fixed-Price Service)

FAR CITATION: 52.252-1: Solicitation Provision Incorporated by Reference. (FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and defect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offerer is cautioned that the listed provisions may include blocks that must be completed by the offerer and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offerer may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es): http://arnet.gov/far/index.html.

I. Federal Acquisition Regulations (FAR) ( 48 CFR Chapter 1) Clauses

No.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

FAR Citation

52.202-1

52.203-3

52.203-5

52.203-7

52.203-8

52.203-10

52.203-12

52.203-17

52.204-6

52.204-7

52.204-9

52.204-15

Clause Title

Definitions

Gratuities

Covenant Against Contingent Fees

Anti-Kickback Procedures

Cancellation, Rescission, and Recovery of Funds For Illegal or Improper Activity

Price or Fee Adjustment for Illegal or Improper Activity

Limitation on Payments to Influence Certain Federal Transactions

Contractor Employee Whistleblower Rights and Requirement To Inform Employees of Whistleblower Rights.

Unique Entity Identifier

System for A ward Management

Personal Identify Verification of Contractor Personnel

Service Contract Reporting Requirements for Indefinite-Delivery Contracts

Clause Date

June 2020

April 1984

May 2014

June 2020

May 2014

May 2014

June 2020

June 2020

October 2016

October 2018

January 2011

October 2016

13. 52.204-18

14. 52.210-1

15. 52.215-2

16. 52.216-17

17. 52.216-24

18. 52.216-25

19. 52.217-4

20. 52.217-5

21. 52.217-8

22. 52.222-21

23. 52.222-26

24. 52.222-37

25. 52.222-40

26. 52.222-41

27. 52.222-43

28. 52.222-50

28. 52.223-6

29. 52.223-18

30. 52.224-1

31. 52.224-2

32. 52.225-13

Commercial and Government Entity Code Maintenance

Market Research

Audit and Records-Negotiation

Single or Multiple Awards

Limitation of Government Liability.

Contract Definitization

Evaluation of Options Exercised at Time of Contract A ward

Evaluation of Options

Option to Extend Services

Prohibition of Segregated Facilities

Equal Oppmtunity

Employment Reports on Veterans

Notification of Employee Rights Under the

National Labor Relations Act

Service Contract Labor Standards

Fair Labor Standards Act and Service Contract Labor Standards-Price Adjustment (Multiple Year And Option Contracts)

Combating Trafficking in Persons.

Drug-Free Workplace

Encouraging Contractor Policies to Ban Text Messaging While Driving

Privacy Act Notification

Privacy Act

Restrictions on Certain Foreign Purchases

August 2020

June 2020

June 2020

October 1997

April 1984

June 1988

July 1990

November 1999

April 2015

September 2016

June 2020

December 2010

August 2018

August 2018

October 2020

May 2001

June 2020

April 1984

April 1984

June 2008

33. 52.232-1 Payments April 1984

34. 52.232-8 Discounts for Prompt Payment February 2002

35. 52.232-18 Availability of Funds April 1984

36. 52.232-25 Prompt Payment January 2017

37. 52.232-33 Payment by Electronic Funds Transfer-System October 2018 for A ward Management

38 52.232-9 Unenforceability of Unauthorized June 2013 Obligations.

39. 52.232-40 December 2013 Providing Accelerated Payments to Small

Business Subcontractors

40. 52.233-1 Disputes May 2014

41. 52.233-3 Protest After A ward August 1996

42. 52.233-4 Applicable Law for Breach of Contract Claim October 2004

43. 52.237-1 Site Visit April 1984

44. 52.237-3 Continuity of Services January 1 991

45. 52.237-7 Indemnification and Medical Liability Insurance January 1997

46. 52.243-1 Changes-Fixed-Price August 1987

47. 52.243-4 Changes June 2007

48. 52.244-6 Subcontracts for Commercial Items November 2020

49. 52.249-2 Termination for Convenience of the Government April 2012

(Fixed-Price)

50. 52.249-8 Default (Fixed-Price Supply and Service) April 1984

51. 52.253-1 Computer Generated Forms January 1991

II. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses in Full Text

No. FAR Citation Clause Title Clause Date

1. 52.204-3 Taxpayer Identification March2020

2. 52.204-8 Annual Representations and Certifications

6. 52.217-9 Option to Extend the Term of the Contract

7. 52.222-35 Equal Opportunity for Veterans

8. 52.222-36 Equal Opp01iunity for Workers with Disabilities

9. 52.222-42 Statement of Equivalent Rates for Federal Hires

10. 52.232-19 Availability of Funds for the Next Fiscal Year

11. 52.233-2 Service of Protest

52.204-3 Taxpayer Identification.

As prescribed in 4. 905, inse1i the following provision:

TAXPAYER IDENTIFICATION (OCT 1998)

(a) Definitions.

March 2020

March 2000

June 2020

June 2020

May 2014

April 1984

September 2006

"Common parent," as used in this provision, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member.

"Taxpayer Identification Number (TIN)," as used in this provision, means the number required by the Internal Revenue Service (IRS) to be used by the offeror in reporting income tax and other returns.

The TIN may be either a Social Security Number or an Employer Identification Number.

(b) All offerors must submit the information required in paragraphs (d) through (f) of this provision to comply with debt collection requirements of 31 U.S.C. 7701 (c) and 3325( d), rep01iing requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the IRS. If the resulting contract is subject to the payment rep01iing requirements described in Federal Acquisition Regulation (FAR) 4. 9Q:1, the failure or refusal by the offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the contract.

(c) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror's TIN.

( cl) Taxpayer Identification Number (TIN).

□ TIN:

□ TIN has been applied for.

□ TIN is not required because:

□ Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States;

□ Offeror is an agency or instrumentality of a foreign government;

□ Offeror is an agency or instrumentality of the Federal Government.

( e) Type of organization.

□ Sole proprietorship;

□ Paitnership;

□ Corporate entity (not tax-exempt);

□ Corporate entity (tax-exempt);

□ Government entity (Federal, State, or local);

□ Foreign government;

□ International organization per 26 CFR 1.6049-4;

□ Other

( f) Common parent.

□ Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this prov1s10n.

□ Name and TIN of common parent:

Name

TIN ____________ _

(End of provision)

52.204-8 Annual Revresentations and Certifications.

As prescribed in 4.1202(a), insert the following provision:

ANNUAL REPRESENTATIONS AND CERTIFICATIONS

(March 2020) (a)(l) The North American Industry Classification System (NAICS) code for this acquisition is

622110.

(2) The small business size standard is $38.5 million.

(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 )(1) If the provision at 52.204-7, System for Award Management, is included in this solicitation, paragraph (d) of this provision applies.

(2) If the provision at 52.204-7 is not included in this solicitation, and the offeror is currently registered in the System for Award Management (SAM), and has completed the Representations and Certifications section of SAM electronically, the offeror may choose to use paragraph ( d) of this provision instead of completing the corresponding individual representations and certifications in the solicitation. The offeror shall indicate which option applies by checking one of the following boxes:

□ (i) Paragraph ( d) applies.

□ (ii) Paragraph (d) does not apply and the offeror has completed the individual representations and certifications in the solicitation.

( c )( 1) The following representations or ce11ifications in SAM are applicable to this solicitation as indicated:

(i) 52.203-2, Certificate of Independent Price Determination. This provision applies to solicitations when a firm-fixed-price contract or fixed-price contract with economic price adjustment is contemplated, unless-

(A) The acquisition is to be made under the simplified acquisition procedures in Part 13;

(B) The solicitation is a request for technical proposals under two-step sealed bidding procedures; or

(C) The solicitation is for utility services for which rates are set by law or regulation.

(ii) 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. This provision applies to solicitations expected to exceed $150,000.

(iii) 52.203-18, Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements-Representation. This provision applies to all solicitations.

(iv) 52.204-3, Taxpayer Identification. This provision applies to solicitations that do not include the provision at 52.204-7, System for Award Management.

(v) 52.204-5, Women-Owned Business (Other Than Small Business). This provision applies to solicitations that-

(A) Are not set aside for small business concerns;

(B) Exceed the simplified acquisition threshold; and

(C) Are for contracts that will be performed in the United States or its outlying areas.

(vi) 52.209-2, Prohibition on Contracting with Inverted Domestic Corporations Representati on.

(vii) 52.209-5, Certification Regarding Responsibility Matters. This provision applies to solicitations where the contract value is expected to exceed the simplified acquisition threshold.

(viii) 52.209-11, Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law. This provision applies to all solicitations.

(ix) 52.214-14, Place of Performance-Sealed Bidding. This provision applies to invitations for bids except those in which the place of performance is specified by the Government.

(x) 52.215-6, Place of Performance. This provision applies to solicitations unless the place of performance is specified by the Govermnent.

(xi) 52.219-1, Small Business Program Representations (Basic & Alternate I). This provision applies to solicitations when the contract will be performed in the United States or its outlying areas.

(A) The basic provision applies when the solicitations are issued by other than DoD, NASA, and the Coast Guard.

(B) The provision with its Alternate I applies to solicitations issued by DoD, NASA, or the Coast Guard.

(xii) 52.219-2, Equal Low Bids. This provision applies to solicitations when contracting by sealed bidding and the contract will be performed in the United States or its outlying areas.

(xiii) 52.222-22, Previous Contracts and Compliance Rep01is. This provision applies to solicitations that include the clause at 52.222-26, Equal Oppo1iunity.

(xiv) 52.222-25, Affirmative Action Compliance. This provision applies to solicitations, other than those for construction, when the solicitation includes the clause at 52.222-26, Equal Opportunity.

(xv) 52.222-38, Compliance with Veterans' Employment Reporting Requirements. This provision applies to solicitations when it is anticipated the contract award will exceed the simplified acquisition threshold and the contract is not for acquisition of commercial items.

(xvi) 52.222-57, Representation Regarding Compliance with Labor Laws (Executive Order 13673). This provision applies to solicitations expected to exceed $50 million which are issued from October 25, 2016 tlu·ough April 24, 2017, and solicitations expected to exceed $500,000, which are issued after April 24, 201 7.

Note to paragraph (c)(l)(xvi): By a court order issued on October 24, 2016, 52.222-57 is enjoined indefinitely as of the date of the order. The enjoined paragraph will become effective immediately if the court terminates the injunction. At that time, GSA, DoD and NASA will publish a document in the Federal Register advising the public of the termination of the injunction.

(xvii) 52.223-1, Biobased Product Certification. This provision applies to solicitations that require the delivery or specify the use of USDA-designated items; or include the clause at 52.223-2, Affinnative Procurement of Bio based Products Under Service and Construction Contracts.

(xviii) 52.223-4, Recovered Material Certification. This provision applies to solicitations that are for, or specify the use of, EPA-designated items.

(xix) 52.223-22, Public Disclosure of Greenhouse Gas Emissions and Reduction Goals Representation. This provision applies to solicitation that include the clause at 52.204-7.

(xx) 52.225-2, Buy American Certificate. This provision applies to solicitations containing the clause at 52.225-1.

(xxi) 52.225-4, Buy American-Free Trade Agreements-Israeli Trade Act Ce1iificate. (Basic, Alternates I, II, and III.) This provision applies to solicitations containing the clause at 52.225-3.

(A) If the acquisition value is less than $25,000, the basic provision applies.

(B) If the acquisition value is $25,000 or more but is less than $50,000, the provision with its

Alternate I applies.

(C) If the acquisition value is $50,000 or more but is less than $77,533, the provision with its

Alternate II applies.

(D) If the acquisition value is $77,533 or more but is less than $100,000, the provision with its Alternate III applies.

(xxii) 52.225-6, Trade Agreements Certificate. This provision applies to solicitations containing the clause at 52.225-5.

(xxiii) 52.225-20, Prohibition on Conducting Restricted Business Operations inSudan Certification. This provision applies to all solicitations.

(xxiv) 52.225-25, Prohibition on Contracting with Entities Engaging in Ce1iain Activities or Transactions Relating to Iran-Representation and Certifications. This provision applies to all solicitations.

(xxv) 52.226-2, Historically Black College or University and Minority Institution Representation. This provision applies to solicitations for research, studies, supplies, or services of the type normally acquired from higher educational institutions.

(2) The…