RFQ 230120011 Electronic Claims and Eligibility Verification Service B4OY OM.pdf

NOTICE TO QUOTERS

REQUEST FOR QUOTES (RFQ): #23-012-0011

QUOTE DUE DATE: Quotes are due, May 13, 2023 @ 3:00PM CST

RETURN RFQ TO: Woodrow Wilson Keeble Memorial Health Care Center

Indian Health Service

Attn: Shannon Cordell, Purchasing Agent

100 Lake Traverse Drive

Sisseton, South Dakota 57262

Telephone: (605) 742-3830

Fax: (605) 742-3896

Shannon.Cordell@ihs.gov

GENERAL DESCRIPTION: Firm Fixed-Price, Non-Personal Service Purchase Order for

Electronic Claims and Eligibility Verification Service for the Business Office at the Woodrow W. Keeble

Memorial Health Care Center - Sisseton, SD. The Period of Performance will be a base plus four (4) option years.

“All-inclusive cost” is defined to include travel, lodging, per diem, fringe benefits, federal, state and local taxes, plus all other costs pertinent to the performance of this purchase order.

BASIS FOR AWARD: The basis for award will be based on “Lowest Price Technically Acceptable”.

Therefore, in addition to price, the government will consider the evaluation factors in determining the successful quote that represent best value to the government, and the COMPLETED AND SIGNED list of documents below.

INSTRUCTION TO QUOTERS: In order to be determined responsive, your offer/bid must include all of the information above. If offeror/bidder fails to complete and return the forms, your offer/bid will be considered non-responsive.

1. Contractor MUST COMPLETE AND SIGN the attached SF18 Request for Quotation.

2. Past performance – the government reserves the right to conduct their own investigations other than the contractors provided list.

3. Minimum of three (3) references of similar work in the last five (5) years. Include addresses and phone numbers.

4. Contractor must have a UEI (Unique Entity ID) number to be awarded the contract.

5. Contractor must have an “active registration” in SAM (System for Award Management) using the assigned UEI number.

6. Ability to meet the performance schedule.

7. Ability to meet the requirements and qualifications in the Statement of Work.

8. Reasonableness of price

9. Responsiveness to requirement.

ATTACHMENTS:

1. SF-18 Request for Quotation

2. Statement of Work

3. Solicitation Provision incorporated by references and in full text.

4. Clauses Incorporated by Reference and in Full Text

Note to the proposed Contractor:

Quotation must set forth, full, accurate and complete information as required by the Request for Quotation

(RFQ), and be returned no later than the date referenced on Block #10 of the SF-18, Request for Quotation form.

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

In compliance with the Office of Management and Budget (OMB) M-15-19 memorandum “Improving

Government Efficiency and Saving Taxpayer Dollars Through Electronic Invoicing” directing Federal agencies to adopt electronic invoicing as the primary means to disburse payment to vendors. Invoices submitted under any award resulting from this solicitation will be required to utilize the Invoice Processing

Platform (IPP) in accordance with HHSAR 352.232-71, Electronic Submission and Processing of Payment

Requests”

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the Treasury’s

Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis (FRSTL).

Respondents to this solicitation are encouraged to register an account with IPP if they have not already done

so. If your organization is already registered to use IPP, you will not be required to re-register- however, we encourage you make sure your organization and designated IPP user accounts are valid and up to date.

The IPP website address is: https://www.ipp.gov

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at (866) 973-

3131 (M-F 8AM to 6PM ET), or IPPCustomerSupport@fiscal.treasury.gov

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDE PAGE OF PAGES

1. REQUEST NO.

23-012-0011

2. DATE ISSUED

05/03/2023

3. REQUISITION/PURCHASE REQUEST NO.

IHS1470751

4. CERT.FOR NAT. DEF.

UNDER BDSA REG.2

AND/OR DMS REG. 1

RATING

5A. ISSUED BY

W.W. Keeble Memorial Health Care Ctr. – Indian Health Service, 100 Lake Traverse Drive, Sisseton, SD 57262

6. DELIVER BY (Date)

05/31/2028 5b. FOR INFORMATION CALL (NO COLLECT CALLS) 7. DELIVERY OTHER

FOB DESTINATION (See Schedule)

NAME

Shannon Cordell, Purch. Agent Shannon.Cordell@ihs.gov

TELEPHONE NUMBER 9. DESTINATION

AREA CODE

NUMBER

742-3830

a. NAME OF CONSIGNEE

WWKM Health Care Center

8. TO: b. STREET ADDRESS

100 Lake Traverse Drive

a. NAME b. COMPANY c. CITY

Sisseton c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE d. STATE

SD

e. ZIP CODE

57262

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BY 3:00 PM ON (Date)

05/13/2023

IMPORTANT: This is a request for information, and quotations furnished are not offiers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

1.

2.

3.

4.

5.

6.

7.

8.

Firm Fixed-Price, Non-Personal Service Purchase Order for Electronic Claims and Eligibility Verification Service for the Business Office at the Woodrow W. Keeble Memorial Health Care Center - Sisseton, SD.

The Period of Performance will be a base plus 4 option years. Contractor shall perform according to the Statement of Work.

Total Base Year; includes travel time, mileage and expenses Claims/ERA Bundle 12,000 transactions Eligibility 12,000 transactions Claims/Era Bundle Overages over 12,000 Eligibility Overages over 12,000 June 1, 2023 – May 31, 2024

Total Option Year One; includes travel time, mileage and expenses Claims/ERA Bundle 12,000 transactions Eligibility 12,000 transactions Claims/Era Bundle Overages over 12,000 Eligibility Overages over 12,000 June 1, 2024 – May 31, 2025

YR

YR

EA

EA

YR

YR

EA

EA

12. DISCOUNT FOR PROMPT

PAYMENT

a. 10 CALENDAR DAYS

b. 20 CALENDAR DAYS

c. 30 CALENDAR DAYS

d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER 15. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

15. DATE OF

QUOTATIONa. NAME OF QUOTER

b. STREET ADDRESS

c. COUNTY 16. SIGNER

a. NAME (Type of print) b. TELEPHONE

AREA CODE

d. CITY e. STATE f. ZIP CODE c. TITLE (type or print) NUMBER

AUTHORIZED FOR LOCAL REPRODUCTION FormFlow/Delrina Inc. STANDARD FORM 18 (REV 6-95) Previous edition not usable Prescribed by GSA-FAR (48 CFR) 53-215-1(a) mailto:Shannon.Cordell@ihs.gov

Page 2 RFQ-23-012-0011

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Total Option Year Two; includes travel time, mileage and expenses Claims/ERA Bundle 12,000 transactions Eligibility 12,000 transactions Claims/Era Bundle Overages over 12,000 Eligibility Overages over 12,000 June 1, 2025 – May 31, 2026

Total Option Year Three; includes travel time, mileage and expenses Claims/ERA Bundle 12,000 transactions Eligibility 12,000 transactions Claims/Era Bundle Overages over 12,000 Eligibility Overages over 12,000 June 1, 2026 – May 31, 2027

Total Option Year Four; includes travel time, mileage and expenses Claims/ERA Bundle 12,000 transactions Eligibility 12,000 transactions Claims/Era Bundle Overages over 12,000 Eligibility Overages over 12,000 June 1, 2027 – May 31, 2028

Grand Total

The quoted unit price is an “all-inclusive” cost. All-inclusive is defined to include travel, lodging, per diem, fringe benefits, Federal/State/Local taxes, plus any other costs pertinent to the performance of this contract.

UEI (Unique Entity ID) Number

Must be registered with an “Active, Registration” in the System for Award Management (SAM), you can register at www.sam.gov

Federal Tax ID Number:

Email Address:

Net Terms:

The quoter is hereby notified that they must be registered in SAM (System for Award Management) before the Government will issue an award.

YR

YR

EA

EA

YR

YR

EA

EA

YR

YR

EA

EA

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER

SISSETON INDIAN HEALTH SERVICE

STATEMENT OF WORK

Electronic Claims and Eligibility Verification Service

1. INTRODUCTION

Contractor will provide an on-line based electronic technology that will allow our service unit to check third party eligibility, submit electronic claims, and monitor claims status.

Contractor will provides an easy to use electronic claims submission service that allows the service unit to submit and receive transactions for Medicare, Medicaid, VA and private insurance in an 837 HIPAA compliant 5010 format.

2. PURPOSE

The Woodrow Wilson Keeble Memorial Health Care Center(WWKMHCC) requires a service that provides a secure exchange of information of all electronic transactions, as well as a third party eligibility verification system that automates all patient inquiries for the Sisseton IHS facility. Based on HIPAA requirements, and IHS Headquarter mandates, it is required to have all transactions secure, managed, and exchanged, and to be in compliance. Payers also require bills be submitted electronically in the 5010 format.

3. DESCRIPTION OF SERVICES/SUPPLIES

To provide a service that provides a secure exchange, assumes all electronic transactions, which includes access with confidentiality, authentication, integrity, and non-repudiation for the Woodrow Wilson Keeble Memorial Health Care Center, in accordance with the Statement of Work. CONTRACTOR will also provide real-time eligibility verifications for the Woodrow Wilson Keeble Memorial Health Care Center. Services provided serves as a means of enhancing and maximizing third party revenue and collection activities.

Claims will be checked for errors when submitted to Contractor’s clearinghouse. Clean claims are passed on to the clearinghouse in a HIPAA-compliant format. From the clearinghouse, claims are submitted to the appropriate payers for adjudication.

Contractor will provide 12,000 claims transactions per year and 12,000 eligibility transactions per year.

4. DELIVERABLES

Contractor will provide real-time eligibility data from third party insurance databases.

These inquiries and responses will provide accurate and up-to-date eligibility information available to the end user. All information will be uploaded for electronic claims transmissions, in order for clean claim billing and an efficient third-party revenue system.

5. PERIOD OF PERFORMANCE

Contract is for a base year and an additional 4-year option, as follows:

Base year (06/01/2023 – 05/31/2024) Option year 1 (06/01/2024 – 05/31/2025) Option year 2 (06/01/2025 – 05/31/2026) Option year 3 (06/01/2026 – 05/31/2027) Option year 4 (06/01/2027 – 05/31/2028)

6. SCHEDULE

Services are web-based and available 24 hours a day.

This will not require installation of any software or hardware.

7. MINIMUM CONTRACTOR QUALIFICATIONS

Task #1 — Secure Data Exchange Service — Contractor shall provide a secure data exchange service between Woodrow Wilson Keeble Memorial Health Care Center and its payers. This service shall comply with the following constraints:

1.1 The service shall not require Woodrow Wilson Keeble Memorial Health Care Center to install contractor software within the Woodrow Wilson Keeble Health Care Center environment.

1.2 The service shall enable WWKMHCC and its payers (Medicare, VA, and Private Insurance) data exchanges utilizing a secure File Transfer Protocol (FTP) as approved by the Indian Health Service Office of Information Technology.

1.3 The service shall support multiple user access and access shall be workstation independent.

1.4 The service shall not entail development of HIPAA transaction set translation or mapping processes, non-CMS or non-IHS generated data or messages, or data reformatting;

Task#2 — Claims will be checked for errors when submitted through Contractor’s clearinghouse. This includes checking each claim for Correct Coding Initiative (CCI) edits and checking medical necessity between each CPT/HCPCS and ICD-10-CM diagnosis codes.

Task #3 — Maintenance and Support — Contractor shall support end-to-end communication testing, implementation and daily operations of the data transfers from all payers to Woodrow Wilson Keeble Memorial Health Care Center, which shall include, at a minimum:

3.1 The contractor shall provide routine technical support to implement corrections to service occurring as a result of errors, flaws or other failures within their service.

3.2 The contractor shall notify a designated Woodrow Wilson Keeble Memorial Health Care Center point of contact or Contracting Officer's Representative (COR) of any scheduled maintenance that shall result in downtime at least (2) days prior to the maintenance period.

3.3 The contractor shall notify a designated Woodrow Wilson Keeble Memorial Health Care Center point of contact of any issues that result in a disruption of data exchange capabilities. This notification shall occur as soon as the disruption is identified.

3.4 The contractor shall provide customer service support for reporting, documenting, tracking and resolving of service problems, which shall be available via telephone and email to Woodrow Wilson Keeble Memorial Health Care Center technical staff during the period of 8:00am through 5:00pm central time.

Task #4 The Contractor must be able to submit claims to the Veterans Administrations (VA) in the 837 HIPAA compliant 5010 format. This will include establishing a connection with the VA’s clearinghouse, Change Healthcare, to enable the processing of electronic health care claims.

Task #5 — Back Up Site Data Recovery Service: The contractor shall provide Woodrow Wilson Keeble Memorial Health Care Center backup of data transfers in the event of a connectivity disruption disaster.

8. QUALITY ASSURANCE

N/A

9. GOVERNMENT FURNISHED PROPERTY

N/A

10. CONTRACTING OFFICER’S REPRESENTATIVE

Ella Mae Greybuffalo, is hereby designated as Contracting Officer Representative (COR) for this service. The COR’s responsibilities will be to coordinate the technical aspects of this service and the review of performance hereunder with the contractor. The COR does not have the authority to change or alter the order amount, terms and conditions.

The Contracting Officer Representative’s responsibilities include ensuring contractor accountability, monitoring the contractor's technical progress, including the surveillance and assessment of performance and recommending to the Contracting Officer changes in requirements, interpreting the statement of work, performing technical evaluations as required, performing technical inspection and acceptance required, assisting the contractor in the resolution of technical problems encountered during performance and receiving and processing invoices for payment.

Solicitation Provisions Incorporated By Reference (Non-Personal Service)

52.252-1 Solicitation Provisions Incorporated by Reference.

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer.

In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address: www.acquisition.gov/far

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

No. FAR Citation Clause Title Clause Date

1. 52.203-18 Prohibition on Contracting with Entities that Require Certain

Internal Confidentiality Agreements or Statements -Representation January 2017

2. 52.204-7 System for Award Management October 2018

3. 52.204-16 Commercial and Government Entity Code Reporting August 2020

4. 52.204-17 Ownership or Control of Offeror August 2020

5. 52.204-22 Alternative Line Item Proposal January 2017

6. 52.209-2 Prohibition on Contracting with Inverted Domestic

Corporations-Representation November 2015

7. 52.212-1 Instructions to Offerors—Commercial Products and

Commercial Services March 2023

8. 52.222-25 Affirmative Action Compliance April 1984

9. 52.223-22 Public Disclosure of Greenhouse Gas Emissions and Reduction

Goals-Representation December 2016

10. 52.225-25 Prohibition on Contracting With Entities Engaging in Certain

Activities or Transactions Relating to Iran—Representation and Certification June 2020

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

52.204-20 Predecessor of Offeror.

As prescribed in 4.1804(d), insert the following provision:

Predecessor of Offeror (Aug 2020)

(a) Definitions. As used in this provision– Commercial and Government Entity (CAGE) code means–

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity by unique location; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

Predecessor means an entity that is replaced by a successor and includes any predecessors of the predecessor.

Successor means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term "successor" does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

http://www.acquisition.gov/far

(b) The Offeror represents that it □ is or □ is not a successor to a predecessor that held a Federal contract or grant within the last three years.

(c) If the Offeror has indicated "is" in paragraph (b) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order):

Predecessor CAGE code: (or mark "Unknown").

Predecessor legal name: .

(Do not use a "doing business as" name).

(End of provision)

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

(NOV 2021)

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 Products or Commercial Services.

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 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— https://www.acquisition.gov/far/4.2105#FAR_4_2105 https://www.acquisition.gov/far/52.204-26#FAR_52_204_26 https://www.acquisition.gov/far/52.212-3#FAR_52_212_3 https://www.acquisition.gov/far/52.204-26#FAR_52_204_26 https://www.acquisition.gov/far/52.212-3#FAR_52_212_3 https://www.acquisition.gov/far/52.204-25#FAR_52_204_25 https://www.sam.gov/

(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—

(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) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded "does" in the representation in paragraph (d)(2) 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 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)(2) of this provision.

(ii) For covered services—

(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 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)(2) of this provision.

52.204-26 Covered Telecommunications Equipment or Services-Representation.

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

Covered Telecommunications Equipment or Services-Representation (Oct 2020)

(a) Definitions. As used in this provision, "covered telecommunications equipment or services" and "reasonable inquiry" have the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

https://www.acquisition.gov/far/4.2105#FAR_4_2105 https://www.acquisition.gov/far/52.204-25#FAR_52_204_25

(b) 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".

(c)

(1) Representation. The Offeror represents that it □ does, □ 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.

(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 any equipment, system, or service that uses covered telecommunications equipment or services.

(End of provision)

52.209-11 Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law

As prescribed in 9.104-7 (d), insert the following provision:

Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (Feb

2016)

(a) As required by sections 744 and 745 of Division E of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235), and similar provisions, if contained in subsequent appropriations acts, the Government will not enter into a contract with any corporation that–

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that–

(1) It is is not a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is is not a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

(End of provision)

52.219-1 Small Business Program Representations.

As prescribed in 19.309(a)(1), insert the following provision:

Small Business Program Representations (Mar 2023)

(a) Definitions. As used in this provision- Economically disadvantaged women-owned small business (EDWOSB) concern means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127, and the concern is certified by SBA or an approved third-party certifier in accordance with 13 CFR 127.300. It automatically qualifies as a women-owned small business concern eligible under the WOSB Program.

Service-disabled veteran-owned small business concern-

(1) Means a small business concern-

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and https://www.sam.gov/

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) "Service-disabled veteran" means a veteran, as defined in 38 U.S.C.101(2), with a disability that is service-connected, as defined in 38 U.S.C.101(16).

Small business concern—

(1) Means a concern, including its affiliates, that is independently owned and operated, not dominant in its field of operation, and qualified as a small business under the criteria in 13 CFR part 121 and the size standard in paragraph (b) of this provision.

(2) Affiliates, as used in this definition, means business concerns, one of whom directly or indirectly controls or has the power to control the others, or a third party or parties control or have the power to control the others. In determining whether affiliation exists, consideration is given to all appropriate factors including common ownership, common management, and contractual relationships. SBA determines affiliation based on the factors set forth at 13 CFR 121.103.

Small disadvantaged business concern, consistent with 13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that-

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by-

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States, and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13 CFR 124.106) by individuals who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

Veteran-owned small business concern means a small business concern-

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C.101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more veterans.

Women-owned small business concern means a small business concern-

(1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and

(2) Whose management and daily business operations are controlled by one or more women.

Women-owned small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127) means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States, and the concern is certified by SBA or an approved third-party certifier in accordance with 13 CFR 127.300.

(b) (1) The North American Industry Classification System (NAICS) code for this acquisition is ________ [insert NAICS code].

(2) The small business size standard is _______ [insert size standard].

(3) The small business size standard for a concern that submits an offer, other than on a construction or service acquisition, but proposes to furnish an end item that it did not itself manufacture, process, or produce (i.e., nonmanufacturer), is 500 employees, or 150 employees for information technology value-added resellers under NAICS code 541519, if the acquisition—

(i) Is set aside for small business and has a value above the simplified acquisition threshold;

(ii) Uses the HUBZone price evaluation preference regardless of dollar value, unless the offeror waives the price evaluation preference; or

(iii) Is an 8(a), HUBZone, service-disabled veteran-owned, economically disadvantaged women-owned, or women-owned small business set-aside or sole-source award regardless of dollar value.

(c) Representations. (1) The offeror represents as part of its offer that—

(i) it □ is, □ is not a small business concern; or

(ii) It □ is, □ is not a small business joint venture that complies with the requirements of 13 CFR 121.103(h) and 13 CFR 125.8(a) and (b). [ The offeror shall enter the name and unique entity identifier of each party to the joint venture: __.]

(2) [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it □ is, □ is not, a small disadvantaged business concern as defined in 13 CFR 124.1002.

(3) [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it □ is, □ is not a women-owned small business concern.

(4) Women-owned small business (WOSB) joint venture eligible under the WOSB Program. The offeror represents as part of its offer that it □ is, □ is not a joint venture that complies with the requirements of 13 CFR 127.506(a) through (c).

[ The offeror shall enter the name and unique entity identifier of each party to the joint venture: __.]

(5) Economically disadvantaged women-owned small business (EDWOSB) joint venture. The offeror represents as part of its offer that it □ is, □ is not a joint venture that complies with the requirements of 13 CFR 127.506(a) through (c). [ The offeror shall enter the name and unique entity identifier of each party to the joint venture: __.]

(6) [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it □ is, □ is not a veteran-owned small business concern.

(7) [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(6) of this provision.] The offeror represents as part of its offer that

(i) It □ is, □ is not a service-disabled veteran-owned small business concern; or

(ii) It □ is, □ is not a service-disabled veteran-owned joint venture that complies with the requirements of 13 CFR 125.18(b)(1) and (2). [ The offeror shall enter the name and unique entity identifier of each party to the joint venture: __.] Each service-disabled veteran-owned small business concern participating in the joint venture shall provide representation of its service-disabled veteran-owned small business concern status.

(8) [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that-

(i) It □ is, □ is not a HUBZone small business concern listed, on the date of this representation, as having been certified by SBA as a HUBZone small business concern in the Dynamic Small Business Search and SAM, and will attempt to maintain an employment rate of HUBZone residents of 35 percent of its employees during performance of a HUBZone contract (see 13 CFR 126.200(e)(1)); and

(ii) It □ is, □ is not a HUBZone joint venture that complies with the requirements of 13 CFR 126.616(a) through (c). [ The offeror shall enter the name and unique entity identifier of each party to the joint venture: __.] Each HUBZone small business concern participating in the HUBZone joint venture shall provide representation of its HUBZone status.

(d) Notice. Under 15 U.S.C.645(d), any person who misrepresents a firm’s status as a business concern that is small, HUBZone small, small disadvantaged, service-disabled veteran-owned small, economically disadvantaged women-owned small, or women-owned small eligible under the WOSB Program in order to obtain a contract to be awarded under the preference programs established pursuant to section 8, 9, 15, 31, and 36 of the Small Business Act or any other provision of Federal law that specifically references section 8(d) for a definition of program eligibility, shall-

(1) Be punished by imposition of fine, imprisonment, or both;

(2) Be subject to administrative remedies, including suspension and debarment; and

(3) Be ineligible for participation in programs conducted under the authority of the Act.

(End of provision)

III. Department of Health and Human Services Acquisition Regulations (HHSAR)(49 Chapter 3) Clauses Full Text

No. HHSAR Citation Clause Title Clause Date

1. HHSAR 352.239-73 Electronic Information and Technology

Accessibility Notice December 2015

2. HHSAR 352.270-9 Non-Discrimination for Conscience December 2015

352.239-73 Electronic Information and Technology Accessibility Notice.

(a) As prescribed in HHSAR 339.203-70(a), the Contracting Officer shall insert the following provision:

Electronic and Information Technology Accessibility Notice (December 18, 2015)

(a) Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d), as amended by the Workforce Investment Act of 1998 and the Architectural and Transportation Barriers Compliance Board Electronic and Information (EIT) Accessibility Standards (36 CFR part 1194), require that when Federal agencies develop, procure, maintain, or use electronic and information technology, Federal employees with disabilities have access to and use of information and data that is comparable to the access and use by Federal employees who are not individuals with disabilities, unless an undue burden would be imposed on the agency. Section 508 also requires that individuals with disabilities, who are members of the public seeking information or services from a Federal agency, have access to and use of information and data that is comparable to that provided to the public who are not individuals with disabilities, unless an undue burden would be imposed on the agency.

(b) Accordingly, any offeror responding to this solicitation must comply with established HHS EIT accessibility standards. Information about Section 508 is available at http://www.hhs.gov/web/508. The complete text of the Section 508 Final Provisions can be accessed at http://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards.

(c) The Section 508 accessibility standards applicable to this solicitation are stated in the clause at 352.239-74, Electronic and Information Technology Accessibility.

In order to facilitate the Government’s determination whether proposed EIT supplies meet applicable Section 508 accessibility standards, offerors must submit an HHS Section 508 Product Assessment Template, in accordance with its completion instructions. The purpose of the template is to assist HHS acquisition and program officials in determining whether proposed EIT supplies conform to applicable Section 508 accessibility standards. The template allows offerors or developers to self-evaluate their supplies and document—in detail—whether they conform to a specific Section 508 accessibility standard, and any underway remediation efforts addressing conformance issues. Instructions for preparing the HHS Section 508 Evaluation Template are available under Section 508 policy on the HHS website http://www.hhs.gov/web/508.

In order to facilitate the Government’s determination whether proposed EIT services meet applicable Section 508 accessibility standards, offerors must provide enough information to assist the Government in determining that the EIT services conform to Section 508 accessibility standards, including any underway remediation efforts addressing conformance issues.

(d) Respondents to this solicitation must identify any exception to Section 508 requirements. If a offeror claims its supplies or services meet applicable Section 508 accessibility standards, and it is later determined by the Government, i.e., after award of a contract or order, that supplies or services delivered do not conform to the described accessibility standards, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its expense.

352.270-9 Non-Discrimination for Conscience.

As prescribed in HHSAR 370.701, the Contracting Officer shall insert the following provision:

Non-discrimination for Conscience (December 18, 2015)

(a) Section 301(d) of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act, as amended, provides that an organization, including a faith-based organization, that is otherwise eligible to receive assistance under section 104A of the Foreign Assistance Act of 1961, under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, under the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, or under any amendment to the foregoing Acts for HIV/AIDS prevention, treatment, or care—

(1) Shall not be required, as a condition of receiving such assistance, to—

(i) Endorse or utilize a multisectoral or comprehensive approach to combating HIV/AIDS; or

(ii) Endorse, utilize, make a referral to, become integrated with, or otherwise participate in any program or activity to which the organization has a religious or moral objection.

(2) Shall not be discriminated against under the provisions of law in subparagraph (a) for refusing to meet any requirement described in paragraph (a)(1) in this solicitation.

(b) Accordingly, an offeror who believes this solicitation contains work requirements requiring it endorse or utilize a multisectoral or comprehensive approach to combating HIV/AIDS, or endorse, utilize, make referral to, become integrated with, or otherwise participate in a program or activity to which it has a religious or moral objection, shall identify those work requirements it excluded in its technical proposal.

(c) The Government acknowledges that an offeror has specific rights, as cited in paragraph (b), to exclude certain work requirements in this solicitation from its proposal. However, the Government reserves the right to not make an award to an offeror whose proposal does not comply with the salient work requirements of the solicitation. Any exercise of that Government right will be made by the Head of the Contracting Activity.

CLAUSES INCORPORATED BY REFERENCE

(Non-Personal Service)

52.252-2 Clauses Incorporated by Reference Feb 1998 This purchase order incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address: www.acquisition.gov/far

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

No. FAR Citation Clause Title Clause Date

1. 52.204-13 System for Award Management Maintenance. October 2018

2. 52.204-18 Commercial and Government Entity Code Maintenance August 2020

3. 52-204-19 Incorporation by Reference of Representations and Certifications December 2014

4. 52.209-10 Prohibition on Contracting with Inverted Domestic Corporations November 2015

5. 52.212-4 Contract Terms and Conditions—Commercial Products and

Commercial Services December 2022

6. 52.217-2 Cancellation Under Multi-year Contracts October 1997

7. 52.222-1 Notice to the Government of Labor Disputes February 1997

8. 52.223-6 Drug-Free Workplace May 2001

9. 52.224-1 Privacy Act Notification April 1984

10. 52.224-2 Privacy Act April 1984

11. 52.232-1 Payments April 1984

12. 52.232-39 Unenforceability of Unauthorized Obligations June 2013

13. 52.233-1 Disputes May 2014

14. 52.249-1 Termination for Convenience of the Government (Fixed-Price)

(Short Form) April 1984

15. 52.249-8 Default (Fixed-Price Supply and Service) April 1984

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

52.212-5 Contract Terms and Conditions Required To Implement Statutes or Executive Orders—Commercial Products and Commercial Services.

As prescribed in 12.301(b)(4), insert the following clause:

Contract Terms and Conditions Required To Implement Statutes or Executive Orders—Commercial Products and Commercial Services (Mar 2023)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial products and commercial services:

(1) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (Jan 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions)).

(2) 52.204-23, Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities (Nov 2021) (Section 1634 of Pub. L. 115-91).

(3) 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment. (Nov 2021) (Section 889(a)(1)(A) of Pub. L. 115-232).

(4) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (Nov 2015).

(5) 52.232-40, Providing Accelerated Payments to Small Business Subcontractors (Mar 2023) ( 31 U.S.C. 3903 and 10 U.S.C. 3801).

(6) 52.233-3, Protest After Award (Aug 1996) ( 31 U.S.C. 3553).

http://www.acquisition.gov/far

(7) 52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Public Laws 108-77 and 108-78 ( 19 U.S.C.

3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial products and commercial services:

[Contracting Officer check as appropriate.] __ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Jun 2020), with Alternate I (Nov 2021) ( 41 U.S.C. 4704 and 10 U.S.C. 4655).

__ (2) 52.203-13, Contractor Code of Business Ethics and Conduct (Nov 2021) ( 41 U.S.C. 3509)).

__ (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (Jun 2010) (Section 1553 of Pub. L. 111-5).