PWS_DISA.Nurse Staffing.pdf

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SOLE SOURCE AWARD TO A-Z MEDICAL SERVICES, PLLC FOR NURSE STAFFING SUPPORT SERVICES
Solicitation number
NJ080720251352
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This Performance Work Statement (PWS) is for Nurse Staffing Support Services for the Defense Information System Agency (DISA) 4th Estate Agencies. The contract is for a 12-month base period from September 29, 2025 to September 28, 2026, with a hybrid contract type including Firm-Fixed Price (FFP) and Time-and-Materials (T&M) components. The contractor will provide clinical occupational health staffing services, including emergency response, walk-in care, immunizations, health screenings, and medical surveillance for DoD employees.

Key requirements include providing 2 Registered Nurses (3,744 estimated hours) and 1 Oversight Physician (468 estimated hours) to operate clinics within the continental United States. Services will include initial care for on-the-job injuries, medical emergencies, preventive care, health education, and screening. The contractor must ensure all personnel are qualified, maintain appropriate licensing, and follow specific medical protocols. The work will be performed primarily at a government-provided office space in Ft. Meade, MD, with potential for alternate location support during emergencies. Deliverables include monthly status reports, non-disclosure agreements, and a quality control plan.

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PERFORMANCE WORK STATEMENT (PWS)

July 23, 2026

Defense Information System Agency (DISA) Agencies

Nurse Staffing Support Services

General Information

1. GENERAL: This is a non-personal services contract to provide clinical occupational health staffing services. Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform clinical occupational health services as defined in this

Performance Work Statement except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: The Department of Defense is a world class employer seeking to hire and retain exceptional quality employees by offering a variety of programs and services. The overall intent is to ensure that the Department can meet mission goals and objectives by ensuring the safety and welfare of its employees. The Defense of Defense (DoD) requires occupational medical examinations to meet the needs of employees that must meet job specific medical standards to safely perform work that is arduous, involves a high degree of sensitivity toward the public or sensitive national security concerns, or puts employees at risk of hazardous exposures while performing essential job duties. These exams may be required to meet requirements for compliance with the standards set by the Occupational Safety and Health

Administration (OSHA) or other regulatory bodies in addition to medical standards developed according to 5 CFR 339. The examinations may be performed prior to employment for applicants, for periodic medical surveillance of incumbents, before returning to work after an injury, or to determine an incumbent’s ongoing fitness for duty when a change in health status has caused concern about the worker’s or others’ safety.

DoD meets its nurse staffing requirements through both on-site clinics as well as contract network providers who operate out of private facilities.

1.3 Objectives:

a. Walk-in care, first aid, and emergency response

b. Provision of short-term prescriptions by licensed personnel as requested

c. Provision of diagnostic testing as prescribed by a personal physician such as blood pressure monitoring, glucose monitoring (utilizing employee provided tester and strips) and allergy immunotherapy (with employee provided medications).

d. Forensic collection for drug testing

d. Health education and training programs (e.g. nutrition, blood borne pathogens, smoking cessation, respirator fit testing)

e. Health screenings as approved by the agency (e.g. cancer, diabetes, blood pressure, vision)

f. Preventive health, medical surveillance provided in conjunction to a personal physicians requested assistance during the workday

g. Administration of immunizations as approved by the agency (e.g. Hepatitis A, Hepatitis B, Anthrax, Smallpox, Flu, etc.) contractor to provide medications/vaccines

h. Physician review, development and approval of standing orders, protocols and medical instructions as required to provide requested services Management of designated lactation space located within the clinic space to include regular cleaning of the room and any agency provided equipment.

i. Clinic staff participation in occupant emergency planning with other tenant agencies;

j. Provide subject matter expertise for all issues related to the operations of the medical clinics

k. Provide general office administration of personnel to ensure contractual requirements are met

l. Provide reports as required for number of services provided, personnel staffing, maintenance requirements and other activities related to the operation of the clinics

m. Ensure that personnel are compliant with current licensing, training and other requirements for the states where the clinic operates

n. Annual program review to assist management in identifying basic safety, health, and wellness opportunities.

o. Provide all required supplies, laboratory services and equipment for delivery of services listed above.

1.4 Scope: The contractor shall provide onsite occupational health staffing services within the continental United States (CONUS) to meet the occupational medical needs of the Department of

Defense (DoD). To meet the DoD’s requirements, the contractor will:

1. Operate several clinics within the United States.

2. Provide the necessary clinical health services, supplies and equipment required to geographically dispersed personnel through a network of clinics or licensed independent practitioners. Provide vaccination services to covered DoD personnel.

1.5 Period of Performance: The period of performance shall be for one (1) twelve-month Base

Period. The Period of Performance reads as follows:

Base Period: September 29th, 2025- September 28th, 2026

General Information:

1.5.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which the contractor is assured that its work complies with the requirement of the contract. As a minimum, the contractor shall develop quality control procedures that address the areas identified in Technical Exhibit 1, “Performance Requirements Summary”. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to the QC system. The contractor’s QC plan must be submitted to the Contracting Officer 10 days after contract award.

1.5.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.5.3 Recognized Holidays: The contractor is not required to perform service on holidays:

• New Year’s Day, January 1.

• Martin Luther King Jr.’s Birthday, the third Monday in January.

• President’s Day, the third Monday in February.

• Memorial Day, the last Monday in May.

• Juneteenth National Independence Day, June 19.

• Independence Day, July 4.

• Labor Day, the first Monday in September.

• Columbus Day, the second Monday in October.

• Veterans Day, November 11.

• Thanksgiving Day, the fourth Thursday in November.

• Christmas Day, December 25.

1.5.4 Hours of Operation: The contractor is responsible for conducting business, between the

WHS core hours of 8:00 AM to 4:30 PM, arriving no earlier than 6:30 AM and departing no later than 6:30 PM Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government direct facility closings. For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential.

1.5.5 Place of Performance: The work to be performed under this contract will be performed in a government-provided office space in Ft. Meade, MD. Contractor personnel may be requested to work at the Governments alternate locations during emergencies and emergency exercises.

Individual Contractor personnel may be designated as essential personnel to support contingency operations at alternate Government locations during actual emergencies and emergency exercises.

1.5.6 Type of Contract: The government will award a hybrid type contract that consist of

Firm-Fixed Priced (FFP) and Time-and-Material (T&M), contract line-item numbers (CLINs).

1.5.7 Security Requirements: If a CAC is required, the Contractor must also have received a favorable National Agency Check with Inquiries (NACI) as well as a favorable response to a

Federal Bureau of Investigation (FBI) fingerprint check.

1.5.8 Special Qualifications: N/A

1.5.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the government.

1.5.10 Contracting Officer Representative (COR): Please see Solicitation/Contract award

Defense Federal Acquisition Regulation Supplement (DFARS) Clause 252.201-7000

“Contracting Officer's Representative.”

1.5.11 Non-Disclosure Agreement (Deliverable #1). In the course of performance pursuant to this contract, the contractor may access nonpublic information, including

Planning, Programming, Budgeting and Execution (PPBE) information. In that event, the contractor shall agree that it will not use or disclose any such information unless authorized by the Contracting Officer’s Representative (COR). The contractor shall further agree that it will use its best efforts to ensure that its employees and others performing services under this contract will not use or disclose any such information unless authorized by the

Contracting Officer’s Representative (COR). The contractor shall protect information in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information

Act (5 U.S.C. 552, as amended). To that end, the contractor shall agree that each of its employees and others performing duties under this contract will sign the Non-Disclosure

Agreement set forth below.

1.5.12 Monthly Status Reports (Deliverable #2): The contractor will submit a monthly status report to the COR containing at a minimum monthly accomplishments and risks to accomplishing tasks in the PWS.

1.5.13 Key Personnel: The personnel identified in each task section are considered essential to the work being performed under this contract. Before removing, replacing, or diverting any of the listed or specified personnel or facilities, the Contractor shall (1) notify the Contracting Officer reasonably in advance and (2) submit justification (including proposed substitutions) in sufficient detail to permit evaluation of the impact on this contract. The Contractor shall make no diversion without the Contracting Officer's written consent; provided that the Contracting Officer may ratify in writing the proposed change, and that ratification shall constitute the Contracting Officer's consent required by this document.

1.5.13.1 Standing Orders/Oversight Physician

Minimum Requirements: Must be board-certified in an appropriate medical specialty (Family

Medicine, Internal Medicine, Occupational Medicine, or Emergency Medicine); Unrestricted license to practice medicine. This license must be in the state where designated OHC(s) is located, when required. Resident Medical Officer (RMOs) must follow the requirements of

State Practice Acts and prevailing local standards of care. Current BLS/AED certification. At least one year of experience providing direct patient care to an adult population.

1.5.14 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed. Contractor personnel will be required to obtain, use, and display a Common Access Card in the performance of this service.

1.5.15 Contractor Travel: Contractor will be required to travel CONUS during the performance of this contract to attend meetings, conferences, etc. All travel shall occur on an “as needed” basis and requires Government approval/authorization and notification to the COR. Travel may be required outside of regular business hours. All travel requests shall be coordinated and pre-approved in writing by the Government COR prior to any trips within five (5) business days.

Requests for approval of costs in excess of maximum per diem rates in accordance with the procedures contained in FAR 31.205-46(a)(3) must be submitted to the COR for final approval prior to commencement of travel. The Contractor is responsible for all travel arrangements including airline, hotel, and rental car reservations. The Contractor should estimate travel costs in accordance with FAR 31.205-46. The contract will designate a separate Contract Line-Item

Number (CLIN) to cover travel costs. Trip reports are required no later than 14 days at the conclusion of each trip and submitted to the COR.

1.5.16 Other Direct Costs: This category includes travel (outlined in 1.6.14), equipment and supplies required to support the PWS.

1.5.17 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart

9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may affect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.5.18 Phase In/Phase Out Period: N/A

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS:

2.1.1 CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2 CONTRACTING OFFICER. A person with authority to enter into, administer and, or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3 CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S.

Government appointed by the contracting officer to administer the contract. Such an appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have the authority to change the terms and conditions of the contract.

2.1.4 DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5 DELIVERABLE. Anything that can be physically delivered but may include non-manufactured things such as meeting minutes or reports.

2.1.6 KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7 PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8 QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9 QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10 QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11 SUBCONTRACTOR. One that enters into a contract with a prime contractor. The

Government does not have privity of contract with the subcontractor.

2.1.12 WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.13 WORK WEEK. Monday through Friday, unless specified otherwise.

2.2 ACRONYMS:

AED Automated External Defibrillator

CAC Common Access Card

CDC Center for Disease Control

CFR Code of Federal Regulations

CLIN Contract Line Item Number

CO Contracting Officer

CONUS Continental United States (excludes Alaska and Hawaii)

COR Contracting Officer Representative

CPR Cardiopulmonary Resuscitation

DD Form 254 Department of Defense Contract Security Requirement List

DFARS Defense Federal Acquisition Regulation Supplement

DMDC Defense Manpower Data Center

DOD Department of Defense

FAR Federal Acquisition Regulation

FBI Federal Bureau of Investigations

HIPAA Health Insurance Portability and Accountability Act of 1996

NLN National League of Nurses

NLT Not Later Than

NACI National Agency Check and Inquiry

OCI Organizational Conflict of Interest

ODC Other Direct Costs

POC Point of Contact

PRS Performance Requirements Summary

PWS Performance Work Statement

QA Quality Assurance

QAP Quality Assurance Program

QASP Quality Assurance Surveillance Plan

QC Quality Control

QCP Quality Control Program

RN Registered Nurse

TD Tetanus Diphtheria

TDAP Tetanus, diphtheria & acellular pertussis vaccine

TE Technical Exhibit

WHS Washington Headquarters Services

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, AND SERVICES

3. GOVERNMENT FURNISHED ITEMS AND SERVICES:

3.1. Services: The government will provide basic services to phones, desks, utilities, information technology, and general office supplies) while working in Government facilities.

3.2. Facilities: Basic facilities such as workspace and its associated operating requirements (i.e., phones, desks, utilities, information technology, and general office supplies) will be provided while working in Government facilities. Tele-workers will only use government furnished equipment to remotely access the WHS network.

3.3. Equipment: The Government will provide basic medical equipment and supplies such as phones, desks, utilities, information technology, and general office and clinic supplies while working in Government facilities. Tele-workers will only use government furnished equipment to remotely access the WHS network.

PART4

CONTRACTOR FURNISHED ITEMS AND SERVICES

4. CONTRACTOR FURNISHED ITEMS AND RESPONSIBILITIES:

4.1. General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS.

4.2. Secret Facility Clearance: Not Applicable

4.3. Materials: NA

4.4. Equipment: NA

PART 5

SPECIFIC TASKS

5. SPECIFIC TASKS:

5.1. Basic Services: The contractor shall provide services for Clinical Occupational Health

Staffing Services for various Department of Defense (DoD) 4th Estate Agencies.

5.2. Occupational Health Staffing Support Services: The contractor shall provide an oversight of the performance of its vendor employees, quality of deliverables, and support the government with current and emergent requirements with Occupational Health Staffing Support Services.

These activities may include, and/or any combination of, the following tasks:

5.2.1 The Contractor employees shall perform the approved Government health services including, but not limited to, initial care and treatment for on-the-job injuries and illnesses; respond to medical emergencies, preventive care, health education and screening, medical surveillance; and promote good health and fitness to eligible beneficiaries of the Government Program who present themselves to the Government centers in accordance with the provider’s qualifications and tasks.

Emergency care shall be provided to anyone injured or experiencing a life-threatening medical emergency at a federal work site regardless of his/her federal employment status in accordance with the Contractor provider’s qualifications and tasks. No final diagnosis or ongoing treatment for chronic or recurrent medical conditions will be rendered. Contractor employees may be required to travel to site other than the normal commuting location to provide outreach services.

Examples of nursing care activities include, but are not limited to: emergency response, administering immunizations, other injections, allergy immunotherapy, and medications;

performing first aid for minor burns, cuts, bruises, and sprains; obtaining histories; and keeping records, writing reports, and maintaining supplies and equipment, and other such basic nursing activities. Venipuncture, forensic testing, vision testing, EKG, audiometry and spirometry are also frequent tasks to be completed. It is the responsibility of the Contractor to ensure all Contractor personnel complete initial Skills Competency Checklists. All professional Contractor employees, including physicians, physician assistants, nurse practitioners, registered nurses (RN), Licensed

Practical Nurses/Licensed Vocational Nurses (LPN/LVN), shall possess skills in interviewing, assessment, basic computer and Microsoft application knowledge, and general management and customer service skills (as they pertain to the Government).

5.2.1.1 Staff Nurse RN Tasks: Provides services at the clinic location under the general supervision/direction of the Area Nurse Manager or the Nurse Coordinator. Enters all services in the appropriate data system.

5.2.1.2 Emergency response, including CPR, first aid or the use of the AED. Emergency response services include responding to life-threatening emergencies by the clinic nurse equipped with emergency supplies during clinic hours of operation.

5.2.1.3 Walk-in care for minor illnesses and injuries that may be work or non-work related;

Routine adult immunizations according to the guidelines from the Centers for Disease Control

(CDC); including Tetanus-diphtheria (TD), Tetanus-diphtheria-acellular pertussis (Tdap), influenza, and pneumococcal (pneumonia) vaccines.

5.2.1.4 Destination specific travel information from the CDC to include RN consultation for questions about the information provided.

5.2.1.5 Care prescribed by an employee's personal physician including administration of medications, administration of allergy immunotherapy, blood pressure and glucose (blood sugar) monitoring, wound care, and periodic bedrest. (Orders for care prescribed by outside physicians are subject to oversight physician review and approval).

5.2.1.6 Health screenings including vision, blood pressure, diabetes, cholesterol, and other risk factors for heart disease.

5.2.1.7 Administration of over-the-counter medication for fever, minor aches/pains, etc...

5.2.1.8 Management of designated lactation space and quiet room located within the clinic space to include regular cleaning of the room, and any agency provided equipment.

5.2.1.9 Clinic staff participation in occupant emergency planning with other tenant agencies.

5.2.1.10 Program review to assist management in identifying basic safety, health, and wellness opportunities.

5.2.1.11 Care to all individuals as described in this performance work statement in the event of a life-threatening emergency; however, contractors and the general public may not otherwise receive routine convenience care services unless a specific exception is granted in advance.

5.3 Oversight Medical/physician Tasks: Provides oversight through the use of standing orders and policies/guidance/procedures is required for the aforementioned services. This oversight must also include guidance on the management of medical charts/records.

PART 6

APPLICABLE PUBLICATIONS

6. APPLICABLE PUBLICATIONS:

6.1. The Contractor must abide by all statutes, applicable regulations, publications, manuals, and federal policies, procedures.

PART 7

ATTACHMENT/TECHNICAL EXHIBIT LISTING

7. ATTACHMENT/TECHNICAL EXHIBIT LIST:

7.1. Attachment 1/Technical Exhibit 1 – Performance Requirements Summary

7.2. Attachment 2/Technical Exhibit 2 – Deliverables Schedule

7.3. Attachment 3/Technical Exhibit 3 – Estimated Workload Data

7.4. Attachment 4/Technical Exhibit 4 – Other Direct Cost Table

TECHNICAL EXHIBIT 1

Performance Requirements Summary

The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Performance Objective

(The Service required—usually a shall statement)

Standard Performance Threshold (This is the maximum error rate.

It could possibly be “Zero deviation from standard”)

Method of

Surveillance

PRS # 1.

Personnel Qualifications/Performance All contractor personnel possess the skills needed to perform the required tasks as specified in the

PWS.

The contractor's personnel are qualified and adept at presenting clear, concise, professional work products free from political conclusions or any judgment of individual journalist(s).

100% COR review / government personnel feedback

PRS # 2

Key Personnel Management

All key personnel are backfilled within 30 days.

100% COR/program review

PRS # 3

Personnel/Workload

Management

The contractor shall ensure that there is sufficient coverage during core business hours to support assigned requirements.

100% COR review / government personnel feedback

PRS # 4

Monthly Reporting Reporting is timely, grammatically correct and professional in appearance

100% COR review

PRS # 5

Administrative Tasks

TECHNICAL EXHIBIT 2

DELIVERABLES SCHEDULE

No. PWS Ref.

Deliverable Due Date Frequency Submit To

1 1.6.11 Non-Disclosure Agreements

Within 3 business days of award notification and within 3 business days of the Government accepting a backfill FTE.

Once after award notification and once per

Government acceptance of a

FTE backfill

COR & CO

2 1.6.1 Quality Control Plan

Due Date

Within 10 business days of award notification.

Once COR & CO

3 5.3 Standing Orders Due 60 days of award notification

Once after award notification

COR & CO

4 1.6.11 Monthly Status Report

NLT the 10th of each month for the preceding month

Monthly COR &CO

5 N/A Limitations on

Sub Contracting

Reporting Data

FAR Clause

52.219-14 (DEV)

NLT 5 business days following the

Contractors’ submission to GSA’s Contract

Payment Module (CPRM)

Annually PDF Copy to the

CO & COR

6 N/A Executive

Compensation

FAR Clause

52.204-10

NLT 5 business days following the

Contractor’s submission to the FFATA Sub-

Award Reporting

System (FSRS)

Annually PDF Copy to the

CO & COR

7 1.6.11 Final Report 5 Days after contract completion

Once after award completion

COR &CO

TECHNICAL EXHIBIT 3

ESTIMATED WORKLOAD DATA

The data provided is an estimate of what it may take to perform the requirements listed in the

Performance Work Statement. The labor categories and hours provided below are only estimates, and should not be viewed as mandated for offerors. All proposals should include the labor mix and hours appropriate and necessary for the quoting performer to complete the required work.

Hours required may be lower or higher than those estimates indicated below; as such, these estimates may not be construed as a guarantee of labor requirements. The contractor shall have in place the capability to fulfill the requirements of the contract. ***Note: 1,872 Hours is equivalent to one Full Time Equivalent (FTE)***on a per annum basis.

BASE PERIOD (12 months)

CLIN Task Labor Category Estimated

FTEs

Estimate

Hours 5.1-5.2 Registered Nurse 2 3744 5.1-5.3 Oversight Physician 1 468

TECHNICAL EXHIBIT 4

TIME & MATERIALS

OTHER SUPPLIES AND EQUIPMENT

The data provided is an estimate of what it may take to perform the requirements listed in the

Performance Work Statement for Other Direct Supplies and Equipment. characteristics.

Equipment

Thermometer, Oral Axillary Mgm120

Chair, Bld Drwng Flip-Arm Uphol Gry Mgm63

Cabinet, Sharps Lock Wall 5qt (2/cs) Mgm128

Scale, Physician Dig W/ht Rod 500lb Pelstr

Wheelchair, Dda Sf 20" 350lbs

Defibrillator, Heartsine Sam Aed 350p

Table, Tram H-Brace Willow/nat

Stethoscope, Sprague Rappaportblk 16" Mgm01

Sphyg, Aneroid Dlx Lf Burg Lg Adlt (1/bx) Mgm01

Sphyg, Aneroid Dlx Lf Blk Adlt(1/bx) Mgm01

Blood Pressure Unit, Surebp Mobile Stand W/usb Wa

Refrigerator, Pharm Undercounter Glass Door Lt Hng 4.6cu

Ft

Diagnostic Sys, Opht/oto/bp W/access

Top, Upholstered Soft Touch F/204 Exam Table Shadow 28"

Table, Exam Ritter Base Only Fixed Height 500lbs F/204

Model

Ecg, Cp150 Interpretive Wa

Spirometry Sys, Easy One Air

Simulator Bio-Acoustic Quest Ba-202

Audiometer Ra300+ W/ht Wizpc

Booth. Hearing/test Enclosure Industrial

Card, Vision Rosenbaum Near Numbers Pckt

Chart, Eye Test Snellen Lf 20'22"x11" (5/bg)

Screener, Vision V 4 Professional Titmus

Holder, Tube Bc (100/bx 10bx/cs)

Model, Sample Safe Lb-10 Foam Insulated

Centrifuge, Clia Approved 6pl

Rack Tube Cube 9pl 8-16mm

Container, Spec W/lid Str 4oz Taped (100/cs) Mgm16

Supplies

Tube, Urine Coll Plas 10ml (100/bx) Bd

Tourniquet, Lf 18"x1" (250/bx 4bx/cs) Mgm16

Bag, Spcmn Biohaz Outside Pckt6"x9" (100/pk 10pk/ Mgm79

Towelette, Castile Soap (100/bx) Prfdis

Needle, Eclipse Bld Coll 21gx11/4" (48/bx) Bd

Needle, Eclipse Bld Coll 22gx11/4" (48/bx) Bd

Cap, Vac Tube Wht 16mm (1000/bg)

Tube, Sst Plus 8.5ml (100/bx)

Tube, Sst Plus 10ml (100/bx) Bd

Tube, Vac/hemogard Plus Gold 4ml (100/bx) Bd

Tube, Vac Sst Plus Str 7.5ml (100/bx) Bd

Engerix-B, Syr Tiplok 20mcg/ml1ml Pf (10/pk) Smklph

Twinrix, Syr 720-20mg/ml 1ml (10/pk) Smklph

Havrix, Syr 1440u/ml 1ml Pf (10/pk) Smklph

Saline, Irr Sol Str 250ml (24/cs)

Compress, Hot Inst 5"x7" Lf (24/cs) Mgm16

Compress, Cold Inst 5"x7" Lf (24/cs) Mgm16

Closure, Skin Reinf Lf 1/4x3" (3/pk 50pk/bx 4bx/cs)

Bandage, Elas Slf-Clsr Prem N/s Lf 6x5yds Mgm16

Pad, Alcohol Prep Str Med (200/bx 20bx/cs)

Sponge, Gauze 8ply N/s 2"x2" (200/bx)

Albuterol Sulfate Hfa, Inh Aerosol 90mcg 8.5gm

M-M-R Ii, Sdv (10/bx) Mrkvac

Lifogen , Disp Bd/s

Vivotif Berna Vacc, Cap 2b Unit (4/bx)

Typhim Vi, Syr 25mcg/0.5ml Snofps

Diphenhydramine, Vl 50mg/ml 1ml (25/bx) 9west

Epinephrine, Amp Pf 1mg/ml 1ml1:1000 (10/bx)

Atovaquo+proguanil, Tab 250-100mg (24/bt) 9glenm

Tank, O2 Disp Cyl 30min W/masktubing & Gauge D/s Alhoxg

Flu Vaccines 10 dose per units (Fluzone)

Needles -100 count

AED Batteries

AED Pads (boxes)

GlucaGen (glucagon) 1 kit 1 mg vials

Nitrostrat (Nitroglycerin) 0.4, 100 Sublingual Tablets per bottle

Ventolin Inhalation Aerosal 18gm HFA Inhaler

Medique Ammonia Inhalant Wipes

Ativan injectable solution 4mg/ml

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