RFQ-21-101-Medical Gas.pdf

A. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 12.6, as supplemented with additional information included in this notice, FAR Part 12, Acquisition of Commercial Items (Title VIII of the Federal Acquisition Streamlining Act of 1994) (Public Law 103-355).

This announcement constitutes the only solicitation; quotes are being requested and a written solicitation will not be issued.

B. The Great Plains Area Indian Health Service (IHS) intends to award a Firm-Fixed Price, Non-Personal Service Type, Commercial Item, Purchase Order in response to Request for Quote (RFQ) RFQ-21-101.

C. This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2021-05.

D. This RFQ is issued as Unrestricted and the associated NAICS Code is 325120, which has a small business standard of 1,000 employees.

E. The quoted 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.

Complete the attached Price Schedule.

1. Base Year: September 2, 2021 thru September 1, 2022, totaling $____________.

2. Option Year One (1): September 2, 2022 thru September 1, 2023, totaling $__________.

3. Option Year Two (2): September 2, 2023 thru September 1, 2024, totaling $__________.

4. Option Year Three (3): September 2, 2024 thru September 1, 2025, totaling $_________.

5. Option Year Four (4): September 2, 2025 thru September 1, 2026, totaling $__________.

F. Medical Gas Services.

G. Services will be provided at 6 locations (North Dakota and South Dakota) within the Great Plains Area IHS, Aberdeen, South

Dakota. The period of performance will be September 1, 2021 thru October 31, 2022, Base plus Four Option Years.

H. FAR 52.212-1 Instructions to Offerors-Commercial Items (June 2020).

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

1. Solicitation number RFQ-21-101.

2. Closing Date: July 2, 2021 at 12:00 pm CST.

3. Name, address and telephone number of company and email address of contact person.

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

5. Terms of any express warranty.

6. Price and any discount terms.

7. “Remit to” address, if different than mailing address.

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

9. Acknowledgment of Solicitation Amendments (if any issued)

10. Past performance information, when included as an evaluation factor, to include recent and relevant contracts for the same or similar items and other references (including contract numbers, points of contact with telephone numbers and other relevant information).

11. A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation.

Offerors that fail to furnish required representations or information, or reject the terms and conditions of the solicitation may be excluded from consideration.

I. Basis of award is Lowest Price, Technically Acceptable “LPTA” offer. The Government will not use the formal source selection procedures described in FAR part 15. The Government will evaluate quotations utilizing the procedures of FAR 13.106-2 Evaluation of quotations or offers. Offers will be evaluated for acceptability, but not ranked using the non-price factors/sub-factors. All non-price factors and sub-factors will be rated as either “acceptable” or “unacceptable”. The Government intends to evaluate and make award without discussion with the offerors other than minor clarifications, unless discussions are determined to be necessary. A decision on the technical acceptability of each offeror’s quotations will be made. For those offeror’s which are determined to be technically acceptable, award will be made to that vendor with the lowest overall price.

(a) The LPTA evaluation process will be accomplished as follows - Technical Acceptability will be comprised of three subfactors: 1.) Meeting all areas under the Statement of Work, “Contractor Tasks”; 2.) Past Performance; and, 3.) Price.

1.) Each offeror’s technical quotations will be evaluated to determine if the offeror provides a sound, compliant approach that meets the requirements of the Scope of Work.

2.) Past Performance: The offeror shall provide a list of contracts under which they have performed same or similar services to this RFQ requirement within the last three (3) years. The Government shall assess the offeror’s ability to perform the effort described in the Request for Quote (RFQ). The assessment process will result in an overall technical rating of Acceptable/Non Acceptable or Neutral/Unknown. Offerors with no relevant past or present performance history shall receive the rating “neutral or unknown”, meaning the rating is treated neither favorably nor unfavorably.

3.) Price: The Pricing Schedule must be completed for all line items and all option years and will be evaluated as to completeness and reasonableness. The offeror with the lowest Total Estimated Schedule Price represents the best value for the Government.

(b) 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. Evaluation of options shall not obligate the Government to exercise the option(s).

(c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

J. FAR 52.212-3 Offer Representations and Certifications-Commercial Items (February 2021) See attachment for full text. The Offeror shall complete only paragraphs (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) website accessed through http://www.acquisition.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (p) of this provision.

K. FAR 52.212-4 Contract Terms and Conditions-Commercial Item (October 2018) – See attachment; in by reference.

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

Items (January 2021) - See attachment for full text.

M. Attached are the Federal Acquisition Regulations (FAR) & Health & Human Services Acquisition Regulation (HHSAR) clauses that are applicable including below.

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

Great Plains Area Indian Health Service Attn: Wenda Wright, Contract Specialist 115 4th Ave. SE, Room 309 Aberdeen, SD 57401 Or fax to 605-226-7669 or email wenda.wright@ihs.gov

Any questions, please submit by June 29, 2021 by 12:00 pm CST.

Contractors will need a DUNS number, TIN number, and be registered with www.sam.gov.

http://www.acquisition.gov/ mailto:wenda.wright@ihs.gov

Estimated Unit Description Unit Quantity Cost Cost

1 Belcourt, ND EA 1975 2 Eagle Butee, SD EA 1650 3 Ft. Yates, ND EA 1500 4 Pine Ridge, SD EA 2500 5 Rosebud, SD EA 1975 6 Wagner, SD EA 1500

Total for Base Year

Estimated Unit Description Unit Quantity Cost Cost

1 Belcourt, ND EA 1975 2 Eagle Butee, SD EA 1650 3 Ft. Yates, ND EA 1500 4 Pine Ridge, SD EA 2500 5 Rosebud, SD EA 1975 6 Wagner, SD EA 1500

Total for Option Year One (1)

Estimated Unit Description Unit Quantity Cost Cost

1 Belcourt, ND EA 1975 2 Eagle Butee, SD EA 1650 3 Ft. Yates, ND EA 1500 4 Pine Ridge, SD EA 2500 5 Rosebud, SD EA 1975 6 Wagner, SD EA 1500

Total for Option Year Two (2)

Estimated Unit

Base Year -

Price Schedule - Annual Inspection and Testing of the Piped Medical Gas Systems within health care facilites at 6 locations throught the Great Plains Area IHS (North Dakota and South

Dakota).

Option Year One (1) -

Option Year Two (2) -

Option Year Three (3) -

Description Unit Quantity Cost Cost 1 Belcourt, ND EA 1975 2 Eagle Butee, SD EA 1650 3 Ft. Yates, ND EA 1500 4 Pine Ridge, SD EA 2500 5 Rosebud, SD EA 1975 6 Wagner, SD EA 1500

Total for Option Year Three (3)

Estimated Unit Description Unit Quantity Cost Cost

1 Belcourt, ND EA 1975 2 Eagle Butee, SD EA 1650 3 Ft. Yates, ND EA 1500 4 Pine Ridge, SD EA 2500 5 Rosebud, SD EA 1975 6 Wagner, SD EA 1500

Total for Option Year Four (4)

Total of Base plus 4 Option Years - $_______________________

Option Year Four (4) -

Great Plains Area Indian Health Service 1

DESCRIPTION/SPECIFICATIONS/WORK STATEMENT

for

INSPECTION AND TESTING OF THE PIPED MEDICAL GAS SYSTEMS

for the

GREAT PLAINS AREA INDIAN HEALTH SERVICE

1.0 INTRODUCTION

1.1 Purpose.

The purpose of the contract is to provide an annual inspection and testing of the piped medical gas systems within health care facilities located throughout the Great Plains Area Indian Health Service (North Dakota and South Dakota). It is vital to have the inspection and testing required by code to ensure continued accreditation by the Center for Medicare and Medicaid Services and the Joint Commission of our facilities.

1.2 Background.

Piped medical gas system hazards include the ability of piped oxygen and nitrous oxide to violently enhance fires, patient safety concerns which arise from pressurized gas, simple debris in the pipe, restrictions to flow, the significance of vacuum in medical treatments, and a host of other challenges arising from the increasing complexity and variety of applications for gases in medicine.

1.3 Scope.

Perform an annual inspection and test of each piped medical gas system located at selected Great Plains Area facilities.

1.4 Contract Objectives.

Upon completion of the required services at each facility, the contractor shall submit a detailed report of the observations with recommendations. A separate report shall be completed for each individual facility.

1.5 References.

NFPA 99, Standard for Health Care Facilities, 2012 Edition.

1.6 Glossary.

1.6.1 Refer to Chapter 3 of NFPA 99, Standard for Health Care Facilities, 2012

Edition.

2.0 CONTRACTOR TASKS

2.1 Oxygen System.

2.1.1 Inspect oxygen supply system for proper design, installation, identification, and function.

2.1.1.1 Inspect bulk oxygen system location for all applicable standard compliance.

2.1.1.2 Inspect manifold source supply location for all applicable standard compliance.

2.1.2 Inspect source, main, and riser valves for location, labeling, and security.

Great Plains Area Indian Health Service 2

2.1.3 Inspect regulators and pressure relief valves for location and correct values.

2.1.4 Test master alarms for proper pressure switch location and alarm function.

2.1.4.1 Verify alarm panels are in proper location/condition.

2.1.4.2 Verify emergency electrical power.

2.1.4.3 Verify “POWER ON” indication.

2.1.4.4 Verify functional performance of visual and audible signals.

2.1.4.5 Verify proper labeling.

2.1.4.6 Verify proper operation of all required alarms.

2.1.4.7 Verify all set points.

2.1.5 Test area alarms for proper pressure switch location and alarm function.

2.1.5.1 Verify alarm panels are in proper location/condition.

2.1.5.2 Verify emergency electrical power.

2.1.5.3 Verify “POWER ON” indication.

2.1.5.4 Verify functional performance of visual and audible signals.

2.1.5.5 Verify proper labeling.

2.1.5.6 Verify current high/low set points.

2.1.5.7 Verify current pressure/vacuum indications with calibrated gauge.

2.1.6 Test oxygen system for oxygen concentration at each outlet.

2.1.7 Test oxygen for particulate contamination at least once in each zone.

2.1.8 Test oxygen system dew point at first outlet in system.

2.1.9 Test oxygen system for pressure at supply and at each zone.

2.1.10 Test each oxygen outlet for proper function, identification, adaptation, and mechanical integrity.

2.1.10.1 Verify proper operation and condition of each outlet.

2.1.10.2 Verify proper labeling of each outlet.

2.1.10.3 Verify proper operation of valves and that there is no leakage.

2.1.10.3.1 Identify leaking/malfunctioning outlets.

2.1.10.4 Verify proper operation and condition of latching mechanism.

2.1.10.5 Verify proper operational pressures.

2.1.10.5.1 Identify outlets delivering substandard pressure/flow rate.

2.1.10.6 Verify proper static pressures.

2.1.11 Test oxygen zone shut-off valves for proper function, identification, and mechanical integrity.

2.1.11.1 Verify proper location/condition.

2.1.11.2 Verify proper labeling.

Great Plains Area Indian Health Service 3

2.1.11.3 Verify that there is no leakage in zone valve box assembly.

2.1.12 Check oxygen pipeline for proper identification labeling.

2.1.13 Test each zone for maximum available flow.

2.1.13.1 Test outlet flow rate.

2.1.13.2 Test for pressure drop with high demand.

2.1.14 Test each critical care outlet for maximum available flow.

2.1.15 Test oxygen system components for leakage.

2.1.16 Check oxygen system components for proper installation (NFPA 99).

2.1.17 Check for crossed lines.

2.2 Medical Air System.

2.2.1 Inspect medical air source supply for design, installation, location, and identification.

2.2.2 Inspect medical air intake for location and fresh air criteria.

2.2.3 Inspect dryers, filters, regulators, and pressure relief valve for regulator location and correct values.

2.2.4 Inspect source, main, and riser valves for location, labeling, and security.

2.2.5 Test master alarms for proper pressure switch location and alarm function.

2.2.5.1 Verify alarm panels are in proper location/condition.

2.2.5.2 Verify emergency electrical power.

2.2.5.3 Verify “POWER ON” indication.

2.2.5.4 Verify functional performance of visual and audible signals.

2.2.5.5 Verify proper labeling.

2.2.5.6 Verify proper operation of all required alarms.

2.2.5.7 Verify all set points.

2.2.6 Test area alarms for proper pressure switch location and alarm function.

2.2.6.1 Verify alarm panels are in proper location/condition.

2.2.6.2 Verify emergency electrical power.

2.2.6.3 Verify “POWER ON” indication.

2.2.6.4 Verify functional performance of visual and audible signals.

2.2.6.5 Verify proper labeling.

2.2.6.6 Verify current high/low set points.

2.2.6.7 Verify current pressure/vacuum indications with calibrated gauge.

2.2.7 Test medical air system gaseous purity.

2.2.7.1 Test at source supply downstream of filters, dryers, and regulators.

2.2.7.2 Test at source sample valve.

Great Plains Area Indian Health Service 4

2.2.8 Test medical air for particulate contamination at least once in each zone.

2.2.9 Test source for dew point.

2.2.10 Test medical air system for pressure at supply and each zone.

2.2.11 Test each medical air outlet for proper function, identification, and mechanical integrity.

2.2.11.1 Verify proper operation and condition of each outlet.

2.2.11.2 Verify proper labeling of each outlet.

2.2.11.3 Verify proper operation of valves and that there is no leakage.

2.2.11.3.1 Identify leaking/malfunctioning outlets.

2.2.11.4 Verify proper operation and condition of latching mechanism.

2.2.11.5 Verify proper operational pressures.

2.2.11.5.1 Identify outlets delivering substandard pressure/flow rate.

2.2.11.6 Verify proper static pressures.

2.2.12 Test medical air zone shut-off valves for proper function, identification, and mechanical integrity.

2.2.12.1 Verify proper location/condition.

2.2.12.2 Verify proper labeling.

2.2.12.3 Verify that there is no leakage in zone valve box assembly.

2.2.13 Check medical air pipeline for proper identification labeling.

2.2.14 Test each zone for maximum available flow.

2.2.15 Test each critical care outlet for maximum available flow.

2.2.15.1 Test outlet flow rate.

2.2.15.2 Test pressure drop with high demand.

2.2.16 Test medical air system components for leakage.

2.2.17 Check medical air system components for proper installation (NFPA 99).

2.2.18 Check for crossed lines.

2.3 Nitrous Oxide System.

2.3.1 Inspect nitrous oxide supply system for proper design, installation, and function.

2.3.2 Inspect source, main, and riser valves for location, labeling, and security.

2.3.3 Inspect regulators and pressure relief valves for location and correct values.

2.3.4 Test master alarms for proper pressure switch location and alarm function.

2.3.4.1 Verify alarm panels are in proper location/condition.

2.3.4.2 Verify emergency electrical power.

2.3.4.3 Verify “POWER ON” indication.

2.3.4.4 Verify functional performance of visual and audible signals.

Great Plains Area Indian Health Service 5

2.3.4.5 Verify proper labeling.

2.3.4.6 Verify proper operation of all required alarms.

2.3.4.7 Verify all set points.

2.3.5 Test area alarms for proper pressure switch location and alarm function.

2.3.5.1 Verify alarm panels are in proper location/condition.

2.3.5.2 Verify emergency electrical power.

2.3.5.3 Verify “POWER ON” indication.

2.3.5.4 Verify functional performance of visual and audible signals.

2.3.5.5 Verify proper labeling.

2.3.5.6 Verify current high/low set points.

2.3.5.7 Verify current pressure/vacuum indications with calibrated gauge.

2.3.6 Test nitrous oxide system for concentration.

2.3.7 Test nitrous oxide system for particulate contamination.

2.3.8 Test nitrous oxide system for pressure at supply and at each zone.

2.3.9 Test each nitrous oxide outlet for proper function, identification, and mechanical integrity.

2.3.9.1 Verify proper operation and condition of each outlet.

2.3.9.2 Verify proper labeling of each outlet.

2.3.9.3 Verify proper operation of valves and that there is no leakage.

2.3.9.3.1 Identify leaking/malfunctioning outlets.

2.3.9.4 Verify proper operation and condition of latching mechanism.

2.3.9.5 Verify proper operational pressures.

2.3.9.5.1 Identify outlets delivering substandard pressure/flow rate.

2.3.9.6 Verify proper static pressures.

2.3.10 Test nitrous oxide zone shut-off valves for proper function, identification, adaptation, and mechanical integrity.

2.3.10.1 Verify proper location/condition.

2.3.10.2 Verify proper labeling.

2.3.10.3 Verify that there is no leakage in zone valve box assembly.

2.3.11 Check nitrous oxide pipeline for proper labeling.

2.3.12 Test each nitrous oxide outlet for maximum available flow.

2.3.13 Test nitrous oxide pipeline components for leakage.

2.3.14 Check nitrous oxide system components for proper installation (NFPA 99).

2.3.15 Check for crossed lines.

Great Plains Area Indian Health Service 6

2.4 Medical Surgical Vacuum System.

2.4.1 Inspect vacuum exhaust for location and environmental considerations.

2.4.2 Inspect vacuum source equipment for proper design, installation, and function.

2.4.3 Inspect source, main, and riser valves for location, labeling, and security.

2.4.4 Test master alarms for proper pressure switch location and alarm function.

2.4.4.1 Verify alarm panels are in proper location/condition.

2.4.4.2 Verify emergency electrical power.

2.4.4.3 Verify “POWER ON” indication.

2.4.4.4 Verify functional performance of visual and audible signals.

2.4.4.5 Verify proper labeling.

2.4.4.6 Verify proper operation of all required alarms.

2.4.4.7 Verify all set points.

2.4.5 Test area alarms for proper pressure switch location and alarm function.

2.4.5.1 Verify alarm panels are in proper location/condition.

2.4.5.2 Verify emergency electrical power.

2.4.5.3 Verify “POWER ON” indication.

2.4.5.4 Verify functional performance of visual and audible signals.

2.4.5.5 Verify proper labeling.

2.4.5.6 Verify current high/low set points.

2.4.5.7 Verify current pressure/vacuum indications with calibrated gauge.

2.4.6 Test inches of vacuum at source and at each zone.

2.4.7 Test each vacuum inlet for maximum available flow rate SCFM.

2.4.8 Test for maximum available flow in all critical care areas.

2.4.9 Test each vacuum inlet for proper function, identification, adaptation, and mechanical integrity.

2.4.9.1 Verify proper operation and condition of each inlet.

2.4.9.2 Verify proper labeling of each inlet.

2.4.9.3 Verify proper operation of valves and that there is no leakage.

2.4.9.3.1 Identify leaking/malfunctioning inlets.

2.4.9.4 Verify proper operation and condition of latching mechanism.

2.4.9.5 Verify proper operational pressures.

2.4.9.5.1 Identify inlets delivering substandard pressure/flow rate.

2.4.9.6 Verify proper static pressures.

Great Plains Area Indian Health Service 7

2.4.10 Test all vacuum zone valves for proper function, identification, and mechanical integrity.

2.4.10.1 Verify proper location/condition.

2.4.10.2 Verify proper labeling.

2.4.10.3 Verify that there is no leakage in zone valve box assembly.

2.4.11 Check vacuum system components for proper installation (NFPA 99).

2.4.12 Check for crossed lines.

2.5 Dental Air System.

2.5.1 Inspect dental air intake for location and fresh air criteria.

2.5.2 Inspect dryers, filters, regulators, and pressure relief valve for regulator location and correct values.

2.5.3 Inspect source, main, and riser valves for location, labeling, and security.

2.5.4 Test dental air system gaseous purity.

2.5.5 Test dental air for particulate contamination at least once in each zone.

2.5.6 Test each dental air outlet for proper function, identification, adaptation, and mechanical integrity.

2.5.6.1 Verify proper operation and condition of each outlet.

2.5.6.2 Verify proper labeling of each outlet.

2.5.6.3 Verify proper operation of valves and that there is no leakage.

2.5.6.3.1 Identify leaking/malfunctioning outlets.

2.5.6.4 Verify proper operation and condition of latching mechanism.

2.5.6.5 Verify proper operational pressures.

2.5.6.5.1 Identify outlets delivering substandard pressure/flow rate.

2.5.6.6 Verify proper static pressures.

2.5.7 Test dental air system components for leakage.

2.5.8 Check dental air system components for proper installation (NFPA 99).

2.5.9 Check for crossed lines.

2.6 Dental Vacuum System.

2.6.1 Inspect dental vacuum exhaust for location and environmental considerations.

2.6.2 Inspect dental vacuum source equipment for proper design, installation, and function.

2.6.3 Inspect source and riser valves for proper location, labeling, and security.

2.6.4 Test inches of dental vacuum at source and at each zone.

2.6.5 Test dental vacuum inlet for maximum available flow rate SCFM.

2.6.6 Test each dental vacuum inlet for proper function, identification, adaptation, and mechanical integrity.

Great Plains Area Indian Health Service 8

2.6.6.1 Verify proper operation and condition of each inlet.

2.6.6.2 Verify proper labeling of each inlet.

2.6.6.3 Verify proper operation of valves and that there is no leakage.

2.6.6.3.1 Identify leaking/malfunctioning inlets.

2.6.6.4 Verify proper operation and condition of latching mechanism.

2.6.6.5 Verify proper operational pressures.

2.6.6.5.1 Identify inlets delivering substandard pressure/flow rate.

2.6.6.6 Verify proper static pressures.

2.6.7 Check dental vacuum system components for proper installation (NFPA 99).

2.6.8 Check for crossed lines.

2.7 Nitrogen System.

2.7.1 Inspect nitrogen supply system for proper design, installation, and function.

2.7.2 Inspect source, main, and riser valves for location, labeling, and security.

2.7.3 Inspect regulators and pressure relief valves for location and correct values.

2.7.4 Test master alarms for proper pressure switch location and alarm function.

2.7.4.1 Verify alarm panels are in proper location/condition.

2.7.4.2 Verify emergency electrical power.

2.7.4.3 Verify “POWER ON” indication.

2.7.4.4 Verify functional performance of visual and audible signals.

2.7.4.5 Verify proper labeling.

2.7.4.6 Verify proper operation of all required alarms.

2.7.4.7 Verify all set points.

2.7.5 Test area alarms for proper pressure switch location and alarm function.

2.7.5.1 Verify alarm panels are in proper location/condition.

2.7.5.2 Verify emergency electrical power.

2.7.5.3 Verify “POWER ON” indication.

2.7.5.4 Verify functional performance of visual and audible signals.

2.7.5.5 Verify proper labeling.

2.7.5.6 Verify current high/low set points.

2.7.5.7 Verify current pressure/vacuum indications with calibrated gauge.

2.7.6 Test nitrogen system for particulate contamination.

2.7.7 Test nitrogen system for pressure at supply and at each zone.

Great Plains Area Indian Health Service 9

2.7.8 Test nitrogen system outlets for proper function, identification, adaptation, and mechanical integrity.

2.7.8.1 Verify proper operation and condition of each outlet.

2.7.8.2 Verify proper labeling of each outlet.

2.7.8.3 Verify proper operation of valves and that there is no leakage.

2.7.8.3.1 Identify leaking/malfunctioning outlets.

2.7.8.4 Verify proper operation and condition of latching mechanism.

2.7.8.5 Verify proper operational pressures.

2.7.8.5.1 Identify outlets delivering substandard pressure/flow rate.

2.7.8.6 Verify proper static pressures.

2.7.9 Test nitrogen zone shutoff valves for proper function, identification, adaptation, and mechanical integrity.

2.7.9.1 Verify proper location/condition.

2.7.9.2 Verify proper labeling.

2.7.9.3 Verify that there is no leakage in zone valve box assembly.

2.7.10 Check nitrogen pipeline for proper identification labeling.

2.7.11 Test each zone for maximum available flow.

2.7.12 Test nitrogen control console for leakage and proper operation.

2.7.13 Check nitrogen system components for proper installation (NFPA 99).

2.7.14 Check for crossed lines.

2.8 Carbon Dioxide System.

2.8.1 Test area alarms for proper pressure switch location and alarm function.

2.8.1.1 Verify alarm panels are in proper location/condition.

2.8.1.2 Verify emergency electrical power.

2.8.1.3 Verify “POWER ON” indication.

2.8.1.4 Verify functional performance of visual and audible signals.

2.8.1.5 Verify proper labeling.

2.8.1.6 Verify current high/low set points.

2.8.1.7 Verify current pressure/vacuum indications with calibrated gauge.

2.8.2 Test carbon dioxide system for concentration.

2.8.3 Test carbon dioxide system for particulate contamination.

2.8.4 Test carbon dioxide system for pressure at each zone.

2.8.5 Test each carbon dioxide outlet for proper function, identification, adaptation, and mechanical integrity.

2.8.5.1 Verify proper operation and condition of each outlet.

2.8.5.2 Verify proper labeling of each outlet.

Great Plains Area Indian Health Service 10

2.8.5.3 Verify proper operation of valves and that there is no leakage.

2.8.5.3.1 Identify leaking/malfunctioning outlets.

2.8.5.4 Verify proper operation and condition of latching mechanism.

2.8.5.5 Verify proper operational pressures.

2.8.5.5.1 Identify outlets delivering substandard pressure/flow rate.

2.8.5.6 Verify proper static pressures.

2.8.6 Check carbon dioxide zone shut-off valves for proper function, identification, and mechanical integrity.

2.8.6.1 Verify proper location/condition.

2.8.6.2 Verify proper labeling.

2.8.6.3 Verify that there is no leakage in zone valve box assembly.

2.8.7 Check carbon dioxide pipeline for proper identification labeling.

2.8.8 Test each carbon dioxide outlet for maximum available flow.

2.8.9 Test carbon dioxide pipeline components for leakage.

2.8.10 Check carbon dioxide system components for proper installation (NFPA

99).

2.8.11 Check for crossed lines.

3.0 CONTRACTOR RESPONSIBLITIES

3.1 All testing shall be performed by a licensed/certified inspector having no less than seven (7) years experience. Supporting documentation for experience shall be submitted with the bid proposal. The contractor shall provide testing personnel who are familiar with the requirements and recommendations of NFPA 99 and the operation of medical gas systems.

3.2 Following notice to proceed, the contractor shall submit a proposed inspection schedule to the Project Officer for approval. The schedule shall include: facility locations, date of planned inspections, and the name of each technician to perform each inspection. The contractor shall notify the Project Officer immediately concerning any scheduling changes. The contractor shall notify each Facility Manager a minimum of 72 hours prior to performing a service.

3.3 Failed component replacement and repairs will not be included within the contractor’s responsibilities unless the failure of components is the result of the contractor’s activities. However, the contractor is invited to provide recommendations resulting from the contracted service to the Facility Manager and the Project Officer. Any repair, service, or part not included within this contract will require a separate procurement from the local Service Unit before the repair, service or part can be performed, installed, or ordered. Invoices without a corresponding procurement number will not be paid.

3.4 An attempt to test all patient terminals shall be completed. If the terminals are considered to be inaccessible, it shall be verified by the facility manager before completion of the inspection.

Great Plains Area Indian Health Service 11

4.0 GOVERNMENT RESPONSIBLITIES

The Facility Manager will provide an escort to accompany the contractor during the inspection. The escort will provide access to all the required areas needed to perform the contracted services.

5.0 SECTION 508 REQUIREMENTS

Not Applicable.

6.0 RECORDS/DATA

6.1 Following completion of the annual inspections, reports shall be completed together with a memo including comments and recommendations [see attached sample]. A copy of each report shall be provided to the Project Officer for documentation purposes. This documentation shall be provided no later than six weeks following the completion of the final site visit and shall be in an organized, legible format.

6.2 Reports shall include but not limited to the following:

6.2.1 Date of inspection.

6.2.2 Name of personnel performing inspection.

6.2.3 Testing procedures utilized during inspection.

6.2.4 Medical gas inventory summary. [see attached sample]

6.2.5 Data obtained from the evaluation.

6.2.6 List of deficiencies found but not corrected along with recommendations on correction. [see attached sample]

6.3 The contractor shall submit one package, after all sites have been visited, containing one invoice that includes all the locations to the Project Officer itemizing the service performed at each site. The invoice shall include the contract number, facility name, type of service performed at each facility, date of service for each facility, and payment amount per facility. The reports shall accompany the invoice. Individual invoices shall not be submitted to the locations within the contract.

7.0 PACKAGING AND MARKING

Not Applicable

8.0 QUALITY ASSURANCE

Facility Managers will submit vendor evaluations to the Project Officer upon completion of each site visit [see attached sample]. Successful contract completion will be determined by timely submission of schedules, reports, and invoices. Accuracy of schedule and information in reports will also be taken into consideration. Thorough completion of services as indicated in the contractor tasks, vendor evaluations, and in general will also be considered when evaluating the successful completion of the contract.

Great Plains Area Indian Health Service 12

9.0 DELIVERIES OR PERFORMANCE

9.1 Place of Performance/Hours of Operation

9.1.1 Sites to receive service are Eagle Butte (SD), Pine Ridge (SD), Rosebud (SD), Wagner (SD), Belcourt (ND), and Ft. Yates (ND).

9.1.2 Inspection and testing shall be completed between the hours of 8:00 AM and 5:00 PM, M-F unless otherwise approved by the Project Officer. No testing and maintenance shall be performed on a national holiday unless approved by the Project Officer.

9.2 Delivery Dates/Period of Performance

9.2.1 Base Year (2021) – Annual inspections shall be performed before

October 1, 2021 but no earlier than August 1, 2021.

9.2.2 First Option Year (2022) – Annual inspections shall be performed before

October 1, 2022 but no earlier than August 1, 2022. Annual inspections shall also be performed no earlier than 335 days and no later than 395 days after base year inspections.

9.2.3 Second Option Year (2023) – Annual inspections shall be performed before October 1, 2023 but no earlier than August 1, 2023. Annual inspections shall also be performed no earlier than 335 days and no later than 395 days after first option year inspections.

9.2.4 Third Option Year (2024) – Annual inspections shall be performed before October 1, 2024 but no earlier than August 1, 2024. Annual inspections shall also be performed no earlier than 335 days and no later than 395 days after second option year inspections.

9.2.5 Fourth Option Year (2025) – Annual inspections shall be performed before October 1, 2025 but no earlier than August 1, 2025. Annual inspections shall also be performed no earlier than 335 days and no later than 395 days after third option year inspections.

10.0 TECHNICAL EXHIBITS AND ATTACHEMENTS

10.1 Medical Gas Equipment Summary and Locations…………… 13

10.2 Sample Report Memo…………………………………………… 14

10.3 Sample Medical Gas Inventory Summary…………………….. 15

10.4 Sample Deficiency/Recommendation Sheet………………….. 16

10.5 Contract Performance Evaluation……………………………… 17

10.6 Bid Schedule……………..………………………………………. 18

10.7 Vendor Competency Verification……………………………….. 19

Great Plains Area Indian Health Service 13

Location Alarm

Panels Zone Valve Boxes

Zone Valves Patient Terminals System Sources

Belcourt, ND

Area: 9

Oxygen: 12 Oxygen: 63 Oxygen Manifold: 1 Medical Air: 9 Medical Air: 45 Medical Air Comp.: 1 Vacuum: 11 Vacuum: 66 Medical Vacuum Pump: 1

Master: 2

Nitrous Oxide: 2 Nitrous Oxide: 4 Nitrous Oxide Manifold: 1 WAGD: 1 Dental Air Compressor: 1 Dental Vacuum Pump: 1 Total: 34 Total: 179

Eagle Butte, SD

Area: 9

Oxygen: 10 Oxygen: 41 Oxygen Manifold: 1 Medical Air: 10 Medical Air: 38 Medical Air Comp.: 1

Master: 2 Vacuum: 10 Vacuum: 41 Medical Vacuum Pump: 1 Dental Vacuum Pump: 1 Total: 30 Total: 120 Dental Air Compressor: 1

Ft. Yates, ND

Area: 3

Oxygen: 4 Oxygen: 20 Oxygen Manifold: 1 Medical Air: 1 Medical Air: 6 Medical Vacuum Pump: 1

Master: 2 Vacuum: 3 Vacuum: 21 Medical Air Comp.: 1

Total: 8 Total: 47

Pine Ridge, SD

Area: 18

Oxygen: 15 Oxygen: 116 Oxygen Bulk Source: 1 Medical Air: 14 Medical Air: 98 Nitrous Oxide Manifold: 1 Vacuum: 15 Vacuum: 134 Medical Air Comp.: 1

Master: 2

Nitrous Oxide: 3 Nitrous Oxide: 7 Medical Vacuum Pump: 1 WAGD: 3 Dental Air Compressor: 1 Dental Vacuum Pump: 1 Total: 47 Total: 358

Rosebud, SD

Area: 10

Oxygen: 13 Oxygen: 118 Oxygen Bulk Source: 1 Medical Air: 12 Medical Air: 71 Medical Air Comp.: 1 Vacuum: 12 Vacuum: 159 Medical Vacuum Pump: 1

Master: 2

Nitrous Oxide: 3 Nitrous Oxide: 9 Dental Vacuum Pump: 1 WAGD: 3 Nitrous Oxide Manifold: 1 Dental Air Compressor: 1 Total: 39 Total: 360

Wagner, SD Area: 1

Oxygen: 3 Oxygen: 4 Oxygen Manifold: 1 Vacuum: 3 Vacuum: 8 Medical Vacuum Pump: 1

Master: 2 Dental Vacuum Pump: 1 Total: 6 Total: 12 Dental Air Compressor: 1

Great Plains Area Indian Health Service 14

Sample Report Memo

[Contractor Letterhead]

Date:

Facility Manager (Facility Address)

The annual inspection for the (facility name) piped medical gas systems was performed on (date) by (technician) according to NFPA 99 requirements.

The following items were noted:

1. (report any minor items that may require correction by the Service Unit).

The following items were corrected:

1. (report any items corrected on-site that were corrected by the technician).

The following items will need to be corrected/replaced/repaired in the near future:

1. (report any items that need to be corrected outside of the scope of this contract).

Recommendations for upgrades:

1. (provide recommendations for upgrades or replacements that will benefit the Service Unit).

Sincerely, [Contractor Representative]

Cc: [Project Officer, AAO, DFM]

Great Plains Area Indian Health Service 15

HOSPITAL NAME

City, State

MEDICAL GAS INVENTORY SUMMARY

Date

Medical Gas Terminal Count

Oxygen 51 Medical Air 38 Medical Vacuum 62

Total Gas Terminals 151

Zone Valves

Total Zone Valve Boxes 9

Oxygen Zone Valves 8 Medical Air Zone Valves 6 Vacuum Zone Valves 7

Total Zone Valves 21

Alarm Panels

Total Area Alarm Panels 7 Total Master Alarm Panels 2

Sources

Oxygen Manifold 1 Medical Air Compressor 1 Medical Vacuum Pump 1 Dental Air Compressor 1 Dental Vacuum Pump: 1

MEDICAL AIR EQUIPMENT

COMP # MANUFACTURER MODEL # SERIAL # H.P. RPM

1 Ohmeda A490MAFBA JV47485 5 1745 2 Ohmeda A490MAFBA JV47485 5 1745

DRYER # MANUFACTURER MODEL # SERIAL # SCFM

1 Squire-Cogswell A-25 2676 25

LEVEL 3 DENTAL VACUUM EQUIPMENT

PUMP # MANUFACTURER MODEL # SERIAL # H.P.

1 Ram Vac 826E.0800.3 BN0406154 3

MEDICAL VACUUM EQUIPMENT

PUMP # MANUFACTURER MODEL # SERIAL # H.P. RPM HOURS RUN

1 Beacon VAL02-104 2617544 7.5 1725 2388 2 Beacon VAL02-104 26211799 7.5 1725 2395

Great Plains Area Indian Health Service 16

HOSPITAL NAME

City, State

OBSERVATIONS/RECOMMENDATIONS

SYSTEM NAME

Date

LOCATION PROBLEM/DESCREPANCY RECOMMENDATION

IMMEDIATE

CORRECTION

ADVISED

REFERENCE

1 Loading Dock Area

The high/low line pressure master alarm pressure switch is not connected with a demand check fitting.

Connect the high/low line pressure master alarm pressure switch with a gas specific demand check fitting.

NFPA 99, 2005;

5.1.8.2.3

2 Surgery Manifold Room

Electrical wall fixtures are not at least 5 feet above floor.

Relocated the electrical wall fixtures, switches and receptacles in a location five feet above the floor to prevent physical damage from movement of cylinders.

NFPA 99, 2005;

5.31.3.3.2(5)

3 Boiler Room

There is not a Lag Compressor local alarm with audible and visual signals when the last compressor starts.

Install a Lag Compressor alarm with audible and visual signals to indicate when lag compressor is in operation that latches and connect it to the master alarms.

NFPA 99, 2005;

5.1.3.5.14.5 5.1.9.5.4(1)

4 Boiler Room

There is not a gauge installed next to the line pressure low master alarm Vacuum switch.

Install a gauge next to the line pressure low master alarm Vacuum switch.

NFPA 99, 2005;

5.1.8.2.2(1)

5 Loading Dock Area

The source piping is not appropriately labeled for gas served with standard designation colors.

Properly label the Oxygen piping with the name of gas served with standard designation colors.

NFPA 99, 2005;

5.1.11.1 Table 5.1.11

6 Boiler Room

There are not duplexed final line pressure regulators with isolating valves.

Purchase a compliant model when equipment is replaced.

NFPA 99, 2005:

5.1.3.5.11.5

NFPA 99, 2005;

5.1.3.5.11.6

Great Plains Area Indian Health Service 17

Great Plains Area Piped Medical Gas Inspection Performance Evaluation

To be completed by Facility Manager after inspection

Facility Name:________________________________________________________________

Date:______________________________ Contractor Rep onsite:___________________

1. Overall Evaluation Poor Average Good Excellent

2. Performance Poor Average Good Excellent

3. Quality of Services Poor Average Good Excellent

4. Workmanship Poor Average Good Excellent

5. Knowledge Poor Average Good Excellent

Comments:

Signature of person completing evaluation:_________________________________________

Great Plains Area Indian Health Service 18

BID SCHEDULE

for

INSPECTION AND TESTING OF THE PIPED MEDICAL GAS SYSTEMS

for the

GREAT PLAINS AREA INDIAN HEALTH SERVICE

Location Base Year 1st Option

Year 2nd Option

Year 3rd Option

Year 4th Option

Year Total Price

Belcourt

Eagle Butte

Ft. Yates

Pine Ridge

Rosebud

Wagner

Total Bid:

Bidders are required to respond to all items in the bid schedule or the bid will be considered non-responsive. Total prices must include testing equipment, labor, overhead, profit, delivery, mobilization and demobilization, and all applicable taxes and fees (federal, state, local, and Tribal), for all piped medical gas systems at IHS Service Unit locations listed in the work statement.

Great Plains Area Indian Health Service 19

VENDOR COMPETENCY VERIFICATION

Company Name: Contact:

Address: Phone:

FAX:

Number of Years in Business: Service Personnel:

Primary Technician:

Secondary Technician:

Proof of Service Representative Competency Attached:__________

Initial

Signature Date Company Representative

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price, Non-Personal Service Type, Commercial)

FAR CITATION: 52.252-2: Clauses Incorporated by Reference. (FEB 1998) I. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses

No. FAR Citation Clause Title Clause Date ____

1. 52.204-7 System for Award Management October 2018

2. 52.204-9 Personal Identity Verification of Contractor January 2011 Personnel

3. 52.204-13 System for Award Management Maintenance October 2018

4. 52.204-16 Commercial and Government Entity Code July 2016 Reporting

5. 52.204-18 Commercial and Government Entity Code August 2020 Maintenance

6. 52.204-19 Incorporation by Reference of December 2014 Representations and Certifications

7. 52.204-24 Representation Regarding Certain October 2020 Telecommunications and Video Surveillance Services or Equipment

8. 52.212-1 Instructions to Offerors – Commercial Items June 2020

9. 52.212-4 Contract Terms and Conditions October 2018

- Commercial Items

10. 52.217-5 Evaluation of Options July 1990

11. 52.223-1 Biobased Product Certification May 2012

12. 52.223-2 Affirmative Procurement of Biobased Products September 2013 Under Service and Construction Contracts

13. 52.223-3 Hazardous Material Identification and Material February 2021 Safety Data

14. 52.223-10 Waste Reduction Program May 2011

15. 52.223-17 Affirmative Procurement of EPA – designated August 2018 Items in Service and Construction Contracts

16. 52.232-39 Unenforceability of Unauthorized Obligations June 2013

17. 52.232-40 Providing Accelerated Payments to Small December 2013 Business Subcontractors

18. 52.233-3 Protest after Award September 2006

19. 52.233-4 Applicable Law for Breach of Contract Claim October 2004

20. 52.237-1 Site Visit April 1984

21. 52.237-2 Protection of Government Buildings April 1984 Equipment, and Vegetation

22. 52.253-1 Computer Generated Forms January 1991

CLAUSES INCORPORATED IN FULL TEXT

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

No. FAR Citation Clause Title Clause Date ____

1. 52.204-24 Representation Regarding Certain October 2020 Telecommunications and Video Surveillance Services or Equipment

2. 52.209-11 Representation by Corporations Regarding February 2016 Delinquent Tax Liability or a Felony Conviction Under any Federal Law

3. 52.212-3 Offeror Representations and Certifications February 2021 (See attached)

4. 52.212-5 Contract Terms and Conditions Required To January 2021 Implement Statues or Executive Orders – Commercial Items (See attached)

5. 52.217-8 Option to Extend the Services November 1999

6. 52.217-9 Option to Extend the Term of the Contract March 2000

7. 52.225-25 Prohibition Contracting with Entities Engaging June 2020 In Certain Activities or Transactions Relating To Iran-Representation and Certifications

8. 52.232-19 Availability of Funds for the Next Fiscal Year April 1984

9. 52.233-2 Service of Protest September 2006

10. 52.252-1 Solicitation Provisions Incorporated by February 1998 Reference

11. 52.252-2 Clauses Incorporated by Reference February 1998

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment.

As prescribed in 4.2105(a), insert the following provision:

REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Items. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision—

Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition.

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub.

L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered https://www.acquisition.gov/far/part-4#FAR_4_2105 https://www.acquisition.gov/far/part-52#FAR_52_204_26 https://www.acquisition.gov/far/part-52#FAR_52_212_3 https://www.acquisition.gov/far/part-52#FAR_52_204_26 https://www.acquisition.gov/far/part-52#FAR_52_212_3 https://www.acquisition.gov/far/part-52#FAR_52_204_25 telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) (https://www.sam.gov) for entities excluded from receiving federal awards for "covered telecommunications equipment or services".

(d) Representation. The Offeror represents that—

(1) It □ will, □ will not provide covered telecommunications equipment or services to the Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds "will" in paragraph (d)(1) of this section; and

(2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that—

It □ does, □ does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds "does" in paragraph (d)(2) of this section.

(e) Disclosures.

(1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded "will" in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(ii) For covered services— https://www.sam.gov/

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(2)…