PWS Med Gas and Air Filters 06-26-2025.docx

CHEYENNE RIVER HEALTH CENTER

Oxygen and Air Filters for Cheyenne River Health Center

Cheyenne River Health Center 24276 166th Street

EAGLE BUTTE, SOUTH DAKOTA 57625

(605) 964-7724

Prepared by:

Erik Twite, Facility Manager Cheyenne River Health Center

(605) 964-0592

PERFORMANCE WORK STATEMENT

FOR MEDICAL GAS AND AIR FILTERS FOR THE CHEYENNE RIVER HEALTH CENTER

A. PURPOSE OF CONTRACT:

The purpose of this contract is to provide a variety of medical and non-medical bottled gas tanks, a variety of reserve bottles, and air filters, in accordance with the applicable NFPA standards for healthcare. The contractor shall provide bottled gases and air filters for the Cheyenne River Health Center monthly for the period of performance for this contract.

B. SPECIFICATIONS OF SERVICES:

The Cheyenne River Health Center has medical gases piped to patient care areas throughout the facility; oxygen is one of those gases. The oxygen is supplied to the facility from a variety of contractor provided medical and non-medical bottled gas tanks and a variety of reserve bottles. The Cheyenne River Health Center also uses a variety of air filters for the air handlers that serve the entire facility, which includes all patient care areas. The quantity and size of bottles varies but all are used to support patient care. The quantity and size of air filters varies but all are used to support patient care.

Purpose

The contractor shall provide the hospital with variety of medical and non-medical bottled gas tanks, a variety of reserve bottles, and air filters in accordance with the applicable NFPA standards for healthcare. The contractor shall provide bottled gases and air filters for the hospital on an as needed basis for the period of performance of this contract, which is 365 days, with 4 option years potentially to follow.

Period of Performance is for:

Scope of Work

Contractor shall be licensed, have appropriate insurance, pay applicable taxes, and follow the applicable NFPA standards for healthcare to provide the hospital with the following portable containers:

· 180L 350psi Liquid Medical Oxygen Dewar

· Medical Oxygen sizes R, E, D, K, and DEY

· Medical Liquid Nitrogen

· Acetylene sizes R, E, D, K, and DEY

· Argon CO2 mix sizes E, D, K, and DEY

Gases Per Month:

· (35) K Medical Oxygen, non-flammable gas cylinders

· (2) DEY Medical Oxygen, non-flammable gas cylinders

· (65) E Medical Oxygen, non-flammable gas cylinders

· (25) D Medical Oxygen, non-flammable gas cylinders

· (10) 180L 350psi Liquid Medical Oxygen Dewars

· (2) 5 Liter Liquid Nitrogen Dewars

· (2) R Oxygen, non-flammable gas cylinders

· DEY Acetylene, flammable gas cylinder

· (2) R Acetylene, flammable gas cylinder

· K Argon CO2 mix, flammable gas cylinder

Contractor shall provide the hospital with the following air filters:

· 20 x 25 x 2 MERV 10 pleated air filter

· 20 x 24 x 2 MERV 10 pleated air filter

· 24 x 24 x 2 MERV 10 pleated air filter

· 12 x 24 x 2 MERV 10 pleated air filter

· 12 x 24 x 4 MERV 15 pleated air filter with plastic header

· 24 x 24 x 4 MERV 15 pleated air filter with plastic header

· 16 x 25 x 4 MERV 15 pleated air filter

· 20 x 25 x 4 MERV 15 pleated air filter

Eight 180L 350psi liquid medical oxygen dewars are the primary oxygen source for the facility and 12 K medical oxygen cylinders are the reserve for the facility.

Contractor shall respond to calls for emergency assistance with repairs or supply within twenty-four (24) hours.

Contractor will be responsible for providing purity of testing results as required by appropriate code.

The contractor shall replenish the cylinders to ensure confirmation of inventory as shown above for each gas.

Collection and Deliveries:

Collections and deliveries of medical and non-medical bottled gas tanks and reserve bottles are required once a month and shall be on the first Monday unless previously arranged by the facility manager or designee and the facility manager or designee will be responsible for signing the pick ticket upon verifying exchange of replacement tanks.

Deliveries of air filters shall be on the first Monday unless previously arranged by the facility manager or designee and the facility manager or designee will be responsible for signing the pick ticket.

Guidance

The government shall furnish as-built drawings showing the oxygen connection to the facility and location of the bulk oxygen system upon request.

Government Furnished Equipment

The government shall provide a storage room or storage area for both the full and the empty cylinders and air filters.

Contractor Submittal Requirements

Submittals have no format requirement but shall contain the following:

· Monthly and annual cost of all medical and non-medical bottled gas tanks rental.

· Total cost for the gases associated with the above quantities.

· Total cost for tank rental charges associated with the above quantities.

· Total cost for the contract period.

· Material Safety Data Sheet for the oxygen, liquid nitrogen, acetylene, and argon.

· Minimum of two (2) verifiable references of past performance.

Workmanship

The contactor is responsible for supplying all gases and ensuring they are handled in accordance with the applicable NFPA codes for healthcare occupancies. The gases shall be transported and handled in accordance with applicable Federal, State, and local laws.

The contractor shall ensure that bottles are securely restrained in the storage area. The contractor shall not deliver more bottles that the storage area can accommodate.

Quality Control

The workmanship will be monitored by the Facility Manager or designee to ensure compliance with NFPA standards for healthcare services. The contractor shall provide a monthly report of cylinders exchanged and number of cylinders at the facility. The facility manager shall monitor the quantity and type of bottled gases delivered, storage of bottled gases, the return of empty bottles to the contractor, and issuing of bottled gases to end users of these gases. Any problems noted shall be brought to the attention of the Facility Manager and the Contracting Officer.

Clean Up

Contractor is responsible for removal of all trash and debris in area where tanks, air filters, and associated equipment are located.

Termination for Default

In the event the contractor should default in their performance of any or all of this contract, or in the event the contractor does not promptly correct unsatisfactory services prior to the next payment to the contractor, and/or terminate their right to proceed with the service.

Payment

Invoices for oxygen and exchange of used bottled gases shall be made monthly to Aberdeen Area Office through IPP with a copy to Erik Twite, Facility Manager or his designee.

Hours of Operation/Period of Performance

The hours of operation will be 6:00 AM to 9:00 PM, Monday through Friday.

Any work conducted outside of the scheduled operation time must be approved by the Facility Manager with ample notification. The period of performance allotted for this project shall be base year plus four option years from the notice to proceed or until funds run out, whichever comes first.

C. GOVERNMENT FURNISHED EQUIPMENT, FACILITIES AND PROPERTY:

Government will provide 2 storage rooms labeled empty and full medical gas for delivery person to deliver to.

D. CONTRACTOR FURNISHED EQUIPMENT, FACILITIES, AND PROPERTY:

Contractors Facilities -Sanitary Inspection:

Award of items listed in the solicitation shall be made only to a bidder whose facilities at which such items are to be processed have been inspected or otherwise meet the requirements of the Indian Health Service Office of Environmental Health.

The Government reserves the right to have the contractor's facilities inspected at all reasonable times during the performance of this contract. If an inspection reveals the existence of unsanitary conditions, the contractor shall be requested in writing by the Contracting Officer to correct such conditions.

Refusal to correct unsanitary conditions shall constitute sufficient cause of the Government to terminate this contract immediately in accordance with clause entitled (default) and without waiting ten (10) days for the correcting of the condition.

E. WORK SCHEDULE/PAYMENT SCHEDULE:

Collection and Deliveries are required at 1 time a month for the bulk tank and 2 times a month for the bottled tanks. They shall be on every other Wednesday unless previously approved by the Contracting Officer Representative (COR).

F. QUALITY ASSURANCE:

SURVEILLANCE ACTIVITIES AND CONTRACTOR INCENTIVES

Performance surveillance monitors will be established to comply with regulatory guidelines and to monitor contract performance. Performance-based incentives are consistent with the intent and purpose of the contract and are outlined on the following grid.

PERFORMANCE

OBJECTIVES

PERFORMANCE STANDARD

PLAN

CONTRACTOR

INCENTIVE

TASK 1

To do monthly inspections of the storage rooms to assure they have secured all tanks delivered to the facility

Assure has adequate tanks for the facility to utilize and that they are secured.

Contractor must demonstrate that their facility meets all the standards on security of all tanks

The project officer and staff will do the minimum of at least 1 inspection monthly.

IHS will then as an acceptable performance approve the use of the option year.

G. REPORTING REQUIREMENTS:

N/A

H. PROFESSIONAL QUALIFICATIONS CRITERIA:

N/A

I. CHARACTER INVESTIGATION FOR CONTRACTORS WHO WILL HAVE CONTACT WITH INDIAN CHILDREN:

N/A

J. REQUIRED MALPRACTICE INSURANCE:

N/A

K. COMPLIANCE WITH IHS RULES AND REGULATIONS:

N/A

L. ANY SPECIAL REQUIREMENTS:

N/A

M. CONTRACTING OFFICER REPRESENTATIVE (COR): (NAME, TITLE, PHONE NUMBER)

Erik Twite Facility Manager

(605) 964-0592