RFQ 75H70623R00004 EMS Solicitation Supporting Documents.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

Aberdeen SD 57401 115 Fourth Ave, SE Federal Building Aberdeen Area Indian Health Servic

IHSPINERIDGE CODE 16. ADMINISTERED BYCODE

X

X

X

621910

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR159

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

02/23/2023 1200 CT

02/01/2023

605-226-7274URSULA MASLONKA

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70623R00004

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 3 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

PINE RIDGE SD 57770

E. Hwy 18 607 Indian Health Road

IHSPINERIDGE

15. DELIVER TO

Aberdeen SD 57401 115 Fourth Ave, SE Federal Building

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$20.0

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Aberdeen Area Indian Health Servic

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

100% Indian Small Business Economic Enterprise

(ISBEE)

Firm Fixed-Unit Price, Labor Hours, Non-Personal Healthcare Service, Single Award ID/IQ Commercial Contract to provide a minimum of six (6) Paramedics for the Pine Ridge IHS Hospital located in Pine Ridge, South Dakota and their outlying clinics and mobile units at the following locations:

-Pine Ridge IHS Hospital located in Pine Ridge, SD -LaCreek IHS Clinic located in Martin, SD

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

X

XX

DATED . YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

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

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

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

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

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

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

-Kyle IHS Health Center located in Kyle, SD

-Wanblee IHS Health Center located in Wanblee, SD

-Mobile Unit parked at Pine Ridge Hospital and deployed throughout the Pine Ridge Reservation.

The period of performance will be for one (1) year from the Date of Award, with four (4), one

(1) option year periods.

The award resulting from this solicitation will not obligate funds; funds must be obligated prior to the starting performance through a task order.

1 Paramedic Regular Hours 26298 HR

Base Year

2 Paramedic Overtime Hours 3156 HR

Base Year

5 Paramedic Regular Hours 26298 HR

OY1

6 Paramedic Overtime Hours 3156 HR

OY1

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

3 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 3

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70623R00004

9 Paramedic Regular Hours 26298 HR

OY2

10 Paramedic Overtime Hours 3156 HR

OY2

13 Paramedic Regular Hours 26298 HR

OY3

14 Paramedic Overtime Hours 3156 HR

OY3

17 Paramedic Regular Hours 26298 HR

OY4

18 Paramedic Overtime Hours 3156 HR

OY4

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

Pine Ridge Indian Health Service Emergency Medical Services Performance Work Statement

Performance Work Statement (PWS) Emergency Medical Services (EMS)

Background

The mission of the Pine Ridge Indian Health Service (PRIHS) is to raise the physical, mental, social & spiritual health of American Indians and Alaska Natives to the highest level. Pine Ridge Reservation is located in the southwestern corner of South Dakota, approximately 100 miles from Rapid City.

Surrounded by rolling plains, Badlands and Black Hills, the Pine Ridge Reservation is home to the Oglala Lakota Nation.

At a maximum, the Government may order six (6) Paramedics under each task order during a specific period of time. At a minimum, the Government may order one (1) Paramedic under each task order during a specific period of time. The Contractor shall provide the amount of staff required under each task order during a specific period of time.

Pine Ridge Reservation possesses low life expectancy in the United States. Unemployment is very high in this population. Closest higher level of care is 35 minutes away by life flight and 1 hour & 30 minutes by ground ambulance. Transfer weather conditions at times can be challenging thus precluding air or even ground transfer.

The Indian Health Service (IHS), an agency within the Department of Health and Human Services, is responsible for providing federal health services to American Indians and Alaska Natives. PRIHS is linked to the Great Plains Area Office (IHS) in Aberdeen, South Dakota.

PRIHS is comprised of one hospital, three outlying clinics and a mobile unit.

1. Pine Ridge Hospital (located in Pine Ridge, SD)

2. LaCreek Clinic (outlying clinic, located in Martin, SD)

3. Kyle Health Center (outlying clinic, located in Kyle, SD)

4. Wanblee Health Center (outlying clinic, located in Wanblee, SD)

5. Mobile Unit (parked at PRH, deployed throughout Pine Ridge Reservation)

The Pine Ridge Hospital provides an expanded level of health care services including, but not limited to:

Emergency Room Department, Pharmacy, Physical Therapy, Public Health Nursing, Radiology, Inpatient Care, Laboratory, Dental, Optometry, Purchased Referred Care, Mental Health, Outpatient Clinic, Pediatric Clinic, Dietitians, Cardiology, Ear Nose & Throat, OB/GYN, Podiatry and Orthopedics.

Requirements

Purpose of Contract The purpose of this non-personal service contract is to provide uninterrupted Emergency Medical Services (EMS), supporting current Emergency Medical personnel. The Contractor shall provide licensed, experienced, competent, qualified & adequately trained personnel to perform the assigned duties. Pine Ridge Indian Health Service (PRIHS) shall not exercise any supervision over the contract Providers performing the services herein. Such contract Providers shall be accountable solely to the Contractor who, in turn is responsible to PRIHS. The Contractor shall perform the services required under this contract within PRIHS’ bylaws, policies and procedures.

Contractor shall submit a Curriculum Vitae (CV), including licensure, for each contract Provider as a prerequisite to the Pine Ridge Indian Health Service (PRIHS) EMS Director & Contract Officer Representative. Curriculum Vitae (CV), including licensure, shall be delivered before contract Provider deployment to Pine Ridge for acceptance or denial. Pine Ridge EMS Director will review CV/licensure and provide response to Contractor via email.

Contract Type Performance based, Indefinite Delivery, Indefinite Quantity (IDIQ), labor hour service contract with a firm fixed unit price (hourly rate).

The contract will be administered by issuing Task Orders (TOs) for the performance of work. Only an authorized Government Contracting Officer (CO) can issue a TO under this contract. Task Orders (TOs) shall be issued in accordance with Federal Acquisition Regulation provisions. Task Order periods may vary and will be no longer than a 12-month period.

Scheduled contract Providers who show up for work, will be paid based upon hours worked indicated on their approved timesheet & Health Information Management Clearance form.

Performance Period The contract performance period will be base year plus four option years. Every 12 months, dependent upon the need of Pine Ridge Indian Health Service (PRIHS), is the option to extend the term of the contract. If PRIHS needs the service, an authorized Government Contracting Officer shall request to exercise a new option year. A preliminary written notice shall be delivered to the Contractor, at least sixty (60) days before the current option year expires.

Business Relations The Contractor shall successfully integrate and coordinate all activity needed to execute the requirement. The Contractor is required to provide quality assurance services. The Contractor shall seek to ensure customer satisfaction and professional & ethical behavior of all contract Providers.

Contract Management The Contractor shall establish clear organizational lines of authority and responsibility to ensure effective management of the resources assigned to the requirement. The Contractor shall convene a contract kick-off meeting with the Contract Officer Representative (COR) and necessary Indian Health Service officials no later than five (5) business days from the effective date of this contract. In addition, the Contractor shall participate in status update calls & ad-hoc meetings when requested by Pine Ridge Indian Health Service. Meetings provide opportunity to discuss contract activity including, but not limited to, issues, corrective actions and/or challenges. The Contractor shall identify key personnel responsible for accomplishing each task, alternates and identify challenges that may impede success.

PRIHS may request status reports from the Contractor for action items obtained from meetings. The status reports shall identify Contractor leads responsible for completing tasks and how challenges or delays are being mitigated. Contractor status reports shall be submitted electronically to the COR and PRIHS EMS Director.

The Contractor shall deliver a quality control plan (QCP) describing specific activities planned to meet the requirements of this contract. The QCP shall include how quality assurance will be accomplished and monitored, based on the quality assurance surveillance plan provided by PRIHS. QCP shall be submitted no later than thirty (30) calendar days from the effective date of contract award. The Contractor shall describe the use of any consultants or subcontractors hired to carry out elements within the Performance Work Statement (PWS) under this contract. The Contractor shall notify the Contract Officer and Contract Officer Representative in writing within five (5) business days of any new subcontractors or consultants retained to perform services required under this contract. Subcontractors retained for purposes of this contract must comply will all provisions, terms & conditions of this contract. The QCP shall include an estimated turn around time for filling vacancies for Paramedics but not to exceed five

(5) calendar days. The Contractor shall provide specifics regarding recruitment and retaining contract Providers.

Conflict of Interest The Contractor and all contract Provider(s) are responsible for identifying and communicating to the CO and COR conflicts of interest at the time of proposal and during the entirety of contract performance. At the time of proposal, the Contractor shall provide a statement which describes, in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) or actual or potential organizational conflicts of interest relating to the services to be provided. The Contractor shall also provide statements containing the same information for any identified consultants or subcontractors who shall provide services. The Contractor must also provide relevant facts that show how it’s organizational and/or management system or other actions would avoid or mitigate any actual or potential organizational conflicts of interest.

Inherent Government Functions Contractor and contract Provider(s) shall not perform inherently governmental functions. This includes, but is not limited to, determination of agency policy, determination of Federal program priorities for budget requests, direction and control of government employees (outside a clinical context), selection or non-selection of individuals for Federal Government employment including the interviewing of individuals for employment, approval of position descriptions and performance standards for Federal employees, approving any contractual documents, approval of Federal licensing actions and inspections, and/or determination of budget policy, guidance, and strategy, as wells as other functions specified under FAR 7.503 (c).

Contract Administration The Contractor shall assign effort and maintain proper and accurate time keeping records of contract providers assigned to work on the requirement.

Contract Provider Administration The Contractor shall make necessary travel arrangements for contract Providers and maintain adequate infrastructure to support contract tasks. Labor hours worked does not include travel time to reach Pine Ridge Indian Health Service (PRIHS).

The Contractor shall fulfill staffing requirements under each task order throughout the specified timeframe.

Location and Hours of Work Pine Ridge Indian Health Service 607 Indian Health Road PO Box 1201 Pine Ridge, SD 57770

Accomplishment of the results contained in this PWS requires work at various PRIHS facilities, throughout the Pine Ridge Reservation and includes transports to off-reservations medical facilities for patients needing higher level of care. EMS base stations are located in Pine Ridge, Kyle & Wanblee, South Dakota.

Work shifts will be:

Assignments shall require shifts of no more than sixteen (16) hours in a 24- hour period for a maximum total of 96 hours in a 14-day period. 80 hours in a 14-day period is considered Regular Hours, any hours over 80 hours is considered overtime. Holidays and weekends shall be considered regular hours.

Overtime shall be pre-approved by the PRIHS EMS Director or designee where overtime hours in a 14-day period is expected to exceed 16 hours (that is, exceed 96 total hours in a 14-day period). A 30-minute unpaid meal break is required with each shift & must be documented on the timesheet. Lunch breaks are to be taken at the approximate midpoint of the shift and will not be saved in order to leave 30 minutes early.

PRIHS work schedules are subject to change as directed by the PRIHS EMS Director or designee to correspond with the needs of Pine Ridge Indian Health Service. Contract Providers shall adhere to their PRIHS assigned hours of responsibility & will paid based upon hours worked of their PRIHS assigned work scheduled.

In the event a contract Provider is not scheduled for work by Pine Ridge Indian Health Service (PRIHS) & has a day off, day off hours are not billable to PRIHS. PRIHS shall not request contract Providers to be on-call/standby. On-call hours/standby hours or on-site status is not billable to Pine Ridge Indian Health Service. Pine Ridge Indian Health Service may call contract Provider(s) & ask if they are willing to pick up an unscheduled work shift. If an unscheduled work shift is accepted by a contract Provider, the hours are billable. If unscheduled work shift causes the contract Provider to exceed 80 hours in a 14-day period, this will be classified as overtime hours. However, Pine Ridge Indian Health Service is not requiring contract Provider(s) to be on-call/stand-by.

Scope The Contractor shall furnish Providers to support PRIHS Emergency Medical Services (EMS) which operates three (3) to four (4) ambulances. Pine Ridge Indian Health Service (PRIHS) primarily expects & relies on six (6) Paramedics (three in am and three in pm) every calendar day.

Emergency Medical Services (EMS) include, but are not limited to: advance life support ambulance service, PRIHS administrative transfers, transports to and from aero-medical evacuation sites, patient transports and field ambulance services as defined in Indian Health Manual Part 3 Chapter 17 – Emergency Medical Services and by the state of South Dakota. (see attachment)

Services provided by the contract Provider shall be in accordance with the PRIHS policies & procedures, quality assurance, The Joint Commission (TJC) and Centers for Medicaid & Medicare Service (CMS) standards. Contractor shall adhere to all operational rules, standards, clinical standards and directives of the PRIHS EMS Director or designee. Contract Providers will meet and maintain a high level of patient and customer satisfaction at all times.

PRIHS reserves the right to refuse acceptance of any contract Provider at any time after performance begins, if personal or professional conduct jeopardizes patient care, counters the I.H.S Standards of

Conduct, or interferes with the regular and ordinary operation of the facility. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by the patient or other staff members to designated Government representatives. Standards of conduct shall mirror those prescribed by current federal personnel regulations at 5 CFR part 2635. Should the PRIHS EMS Director or designee show documented clinical problems or continual unprofessional behavior/actions with any contract health care Provider(s), s/he may request, without cause, immediate replacement of said contract Provider. Each complaint will be addressed on an ad-hoc basis, based on the outcome, may be grounds for immediate removal of the contract Provider.

Quality assurance procedures established by PRIHS shall be used for continuous monitoring. The performance by the contract Provider, the quality of services rendered, and any documentation or written material in support of same, shall be subject to continuous inspection, surveillance and review for acceptance by the Contracting Officer Representative (COR) or designated representative.

Qualifications Contract Providers shall be certified and/or licensed through National Registry of Emergency Medical Technicians or recognized state licensing agency. All contract Providers shall possess cardiopulmonary resuscitation (CPR)/basic life support (BLS) certification. Paramedics are required to have Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications. Certifications and licensure shall be kept current throughout the contract lifecycle. Contract Providers shall be technically proficient in the skills necessary to fulfill PRIHS requirements, including the ability to speak, understand, read and write English fluently. Possess sufficient initiative, interpersonal relationship skills and social sensitivity such that the contract Provider can relate to a variety of patients from diverse backgrounds.

Able to operate a computer utilizing Microsoft applications such as, Word, Excel, etc. Contract Providers shall meet Continuing Education (CE) requirements as determined by the Emergency Medical Technicians (EMT) State of Licensure. PRIHS will not reimburse or cover these costs.

New Employee Orientation (NEO) & Trainings After receiving a favorable adjudicated security clearance, the New Employee Orientation (NEO) process is to begin. NEO is required for all new staff, occurs every other week and is held at the PRIHS Nursing Library. NEO must be completed before performing any services of this contract. NEO labor hours are billable to PRIHS.

In addition, contract Providers shall complete all PRIHS mandatory trainings on time & submit certificate of completion to the PRIHS EMS Director or designee.

Pine Ridge Indian Health Service New Employee Orientation Point of Contact:

1) Heather Brehmer, Staff Development 2) Jacklyn Miller, Nurse Educator Office: 605 867 3334 Office: 605 867 3261 Email: Heather.Brehmer@ihs.gov Email: Jacklyn.Miller@ihs.gov

Health Information Management / Electronic Health Record Contract Providers shall use PRIHS Electronic Health Record (EHR) system, Imagetrend, to maintain accurate and up-to-date information on clinical care provided to patients. Experience with EHR is highly recommended. This includes completing all coding and purpose of visit diagnoses. All patient health record documentation initiated by the Contractor shall be completed to the satisfaction of PRIHS. The PRIHS approving authority of the Contractor’s timesheets will not sign off on/approve timesheets unless mailto:Heather.Brehmer@ihs.gov mailto:Jacklyn.Miller@ihs.gov the Contractor has successfully completed all required patient medical encounter documentation (medical records). To ensure medical records are complete with no deficiencies, the Contractor shall submit a Health Information Management Clearance From (HIMCF) with each timesheet. The Contract Officer Representative (COR) shall be notified within two business days, should the HIMCF indicate deficiency.

Medical documentation shall be completed within 12 hours after assigned shift. All medical record documentation shall meet or exceed established standards for PRIHS to include, but not limited to:

timeliness, legibility, accuracy, content and signature. All medical record information generated in the performance of this contract will remain the property of and subject to the exclusive control of Pine Ridge Indian Health Service.

Medical quality assurance records created by or for any Indian Health program or a health program of an urban Indian organization as part of a medical quality assurance program are confidential and privileged. Such records may not be disclosed to any person or entity, except as provided in subsection

(d) 25 USC 1675 attached.

Patient Safety Compliance and Reporting The contract Provider(s) shall follow all established patient safety and infection control standards of care. The contract Provider(s) shall make every effort to prevent medication errors, falls, and patient injury caused by acts of commission or omission in the delivery of care. All events related to patient injury, medication errors, and other breeches of patient safety shall be reported to PRIHS Risk Manager via iStar reporting system, per IHS Safety Policy. As soon as practicable (but within 24 hours), the contract Provider shall notify PRIHS EMS Director or designee & COR of incident.

Customer Service Contract Provider(s) shall refer all patient/customer service issues to the PRIHS EMS Director or designee and COR.

Employee Health Requirements The Contractor shall adhere to PRIHS Employee Health Program policy. The purpose is to provide uniform guidelines for ensuring all staff are free from communicable disease or any other diseases, which may be debilitating or render the Contractor not able to perform his/her assigned duties. The Contractor shall also adhere to receiving annual vaccinations required. The immunization records are required to be turned into the Employee Health Department within 7 days of employment. (see attached policy for full details)

PRIHS Employee Health Nurse Point of Contact:

1) JoDee Bettelyoun Office: 605 867 3286 Email: Jodee.Bettelyoun@ihs.gov

Security – Character Investigation Contractor staff will be required to follow PRIHS procedures for obtaining a full Federal background investigation and preliminary clearance. Favorable security clearance must be granted prior to beginning any aspect of the contract requirements. Contractor must ensure every contract Provider possess and maintains sufficient suitability while performing under this contract. The preliminary clearance process ranges from 5-30 business days. Most Contractors initially experience a Federal background mailto:Jodee.Bettelyoun@ihs.gov investigation that provides security clearance for 120 days. When 120 days is exceeded, the security clearance expires and a reinvestigation is to occur. The reinvestigation is a lengthier, more in-depth, time consuming process that involves Electronic Questionnaires for Investigations Processing (e-QIP). In order to obtain a Personal Identity Verification (PIV) card, Contractor staff shall complete e-QIP and pass a Federal background investigation conducted by the Office of Personnel Management. PRIHS will process the investigations through the Office of Personnel Management on all Contractor staff. If the Contractor completes the e-QIP background investigation in its entirety and receives a favorable adjudication, security clearance is active for five (5) years. Please work with the point of contacts below in advance, to ensure every Contractor has & maintains active security clearance while performing under this contract.

Processing of PIV cards shall be completed by Great Plains Area HSPD-12/Suitability Office in conjunction with PRIHS PIV card stations. The contractors will be required to be physically present at one of the HSPD-12 enrollment and issuance workstations to obtain a PIV Card. Two forms of identification are needed for PIV related matters.

Each Contractor shall complete each of the requirements below and receive pre-employment clearance from GPA/PRIHS prior to performing services under this contract.

1) Fingerprints must be captured for digital processing. Contractor may have fingerprints captured via hard copy, then sent to PRIHS by postal service (at Contractor’s expense), tracking is highly recommended. Note, FD-258 fingerprint card is the only acceptable hard copy. Please consult with PRIHS HSPD-12 representatives located in the Procurement and Administration Departments at Pine Ridge Hospital;

2) The OF-306, Declaration for Federal Employment shall be completed;

3) The Addendum to the OF-306, shall be completed;

4) Provisional Waiver form shall be completed;

5) Copy of Curriculum Vitae/Resume;

6) 86 C form shall be completed;

7) General Release form shall be completed;

8) eQIP (if applicable initially otherwise, required after 120 days of PRIHS employment);

9) The Contractor shall be enrolled for PIV if eQIP is completed;

10) State Requirements, individualized documents shall be completed, please consult with PRIHS HSPD- 12 representative for guidance.

The Contractor shall ensure that the employees it proposes for work under this contract have a reasonable chance for approval. If at any point during the investigation process a Contractor staff is deemed ineligible or found to have other than favorable suitability, the individual must be removed from providing services under this contract. PRIHS shall investigate Contract Providers at no cost to the Contractor.

PRIHS security clearance is a pre-requisite. It is imperative to note; all Contract Providers must receive a favorable adjudicated security clearance in order to perform any services/requirements of this contract.

Contract personnel are not permitted to wait in any PRIHS facility while awaiting adjudication.

If pre-security clearance is deemed unfavorable, the contract company shall submit a replacement provider immediately or risk breaching the terms and conditions of this contract.

Please address (FD-258) hard copy fingerprint card to:

Pine Ridge I.H.S Hospital Attn: Lois Cross 607 Indian Health Road P.O. Box 1201 Pine Ridge SD, 57770

PRIHS Purchasing Agent/Character Investigation - Primary Point of Contact

1) Lois Cross Office: 605 867 3020 Email: Lois.Cross@ihs.gov

PRIHS Character Investigation - Secondary Point of Contact

1) Annie Means 2) Diane Little Hawk Office: 605 867 3403 Office: 605 867 3390 Email: Annie.Means@ihs.gov Email: Diane.LittleHawk@ihs.gov

PRIHS Information Technology In order for a Contractor to gain Indian Health Service electronic access, the person must obtain a favorable adjudicated security clearance. Indian Health Service (I.H.S) electronic access will automatically disable after fourteen (14) calendar days of inactivity and their electronic account will delete after ninety (90) calendar days of inactivity. When a Contract Provider returns after being away & their electronic access is disabled/deleted, most times this leads to a service delay. It is very important to ensure the Contract Provider has computer access upon arrival. The Contractor shall reach and work with the PRIHS Information Technology Department in advance to ensure the Contract Provider has active access prior to arrival.

Information Technology Department Contact Information:

Email: ABR_PRHITAdminsDL@ihs.gov Office: 605 867 3244

Work Identification Badge When the contract Provider receives a favorable adjudicated security clearance & is cleared to start providing service, upon arrival, he/she shall obtain a PRIHS work identification badge from PRIHS Information Technology. The Contractor is required to wear the work identification badge at all times when in working status. If the contract Provider terminates their service at PRIHS, the work identification badge must be returned to PRIHS Information Technology.

Contractor Furnished Property PRIHS requires the Contractor to carry a working form of communication (i.e. cellular phone or pager) at their expense.

Contractor Line Item Numbers (CLINs) #1 Regular Hours Scheduled working hours, Monday through Sunday up to 80 hours in a 14-day pay period.

#2 Overtime Hours

Scheduled working hours greater than 80 hours but less than 96 hours in a 14-day period does not require prior approval. However, scheduled working hours exceeding 96 hours in a 14-day mailto:Lois.Cross@ihs.gov mailto:Annie.Means@ihs.gov mailto:Diane.LittleHawk@ihs.gov mailto:ABR_PRHITAdminsDL@ihs.gov period does require prior approval from the Pine Ridge Indian Health Service EMS Director or designee. To the extent total scheduled working hours cannot exceed 96 hours in a 14-day period, this means the contract Provider cannot exceed 16 overtime hours in a 14-day period.

In the event a contract Provider is not scheduled for work by Pine Ridge Indian Health Service (PRIHS) & has a day off, day off hours are not billable to PRIHS. PRIHS shall not request contract Providers to be on-call/standby. On-call hours/standby hours or on-site status is not billable to Pine Ridge Indian Health Service.

Timesheet Timesheets shall capture daily time in and time out of PRIHS’ assigned hours of responsibility per their PRIHS scheduled shift. Please tally time on timesheet in 15-minute increments. Contractor time from 1 to 7 minutes shall be rounded down, and thus not counted as hours worked, but Contractor time from 8 to 14 minutes must be rounded up and counted as a quarter hour of time worked. Overtime exceeding 96 hours in a 14-day period requires prior approval from the PRIHS EMS Director or designee. A 30 minute unpaid lunch break is required each shift and shall be documented on the timesheet. A Health Information Management Clearance Form (HIMCF) shall be submitted by the contractor Provider with each timesheet. All timesheets & HIMCFs shall be signed by the PRIHS EMS director or designee. No invoices will be processed unless the timesheet & HIMCF have been approved. The contractor Provider shall send a copy of these approved records to their company & all originals are to be delivered to the PRIHS EMS Director or designee.

The contract Provider shall adhere to their PRIHS work schedule and will be paid for hours of work within their assigned PRIHS work schedule. Hours worked includes overtime hours. Work schedule hours shall be reflected on their timesheet. Contractor invoices are based off approved timesheets & approved HIMCFs. It is important to note; no timesheets or invoices will be processed is the contract Provider has an unapproved HIMCF(s).

Contract Providers shall be responsible for reporting time worked accurately. Contract Providers shall not be paid for time documented prior to their assigned work schedule hours, unless early arrival is requested by the PRIHS EMS Director or designee. Documentation for all overtime shall be displayed in writing on the timesheet. If assigned to work at 0600 hours or 1800 hours, the expectation is be ready for work at that exact time, time sheet shall reflect this.

Invoicing The Contractor shall submit an invoice on a minimum monthly basis via the Invoice Processing Platform (IPP). Contractor shall include the approved timesheet(s) and approved HICF(s) with each invoice. The Contractor will be paid for their hours worked, at the fixed hourly rate, by labor category. Hours worked includes overtime hours. It is important to note; no invoices will be processed for unapproved timesheets and/or unapproved HIMCFs.

Pine Ridge Indian Health Service will verify every invoice before paying. Verification requirements consist of ensuring contract Providers possess I.H.S approved security clearance, timesheet is approved by PRIHS EMS Director & Health Information Clearance form is approved by PRIHS EMS Director.

The Contractor shall group all contract Providers to one invoice per billing cycle. Pine Ridge I.H.S will not accept one invoice for each individual contract Provider.

Invoice Processing Platform (IPP) The Indian Health Service (IHS) has implemented an electronic invoicing system.

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 payments to vendors. Invoices submitted under any award 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 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: https://www.ipp.gov

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at (866) 973- 3131 (M-F 8 AM to 6 PM ET), or IPPCustomerSupport@fiscal.treasury.gov

Should the Contractor feel that use of the IPP would be unduly burdensome, their response to this solicitation should include an explanation of this position for a determination by the Contracting Officer.

PRIHS Furnished Property PRIHS will provide all medical (including ambulances), non-medical equipment and supplies for the care and maintenance of patients as per the standards of care.

Work Environment Exposure to contagious diseases is possible while working for PRIHS. Potential exposure to bodily fluids may occur in the course of caring for trauma patients. Contract Providers shall expect long transport times; encompassing extended patient care. Encountering numerous high acuity patients within a limited resource environment (i.e. first responders).

Weather Pine Ridge, South Dakota, is a geographic area with wide temperature span. The winters can be very cold and windy. Contractors should expect to drive in weather conditions for which they may not be accustomed. The sole authority to close PRH or outlying clinics rests with the Chief Executive Officer (CEO). If the hospital remains open, the Contractor will be expected to report to work on time, as all other hospital employees will be required. Reliable transportation to report for duty within the specified timeframe of this contract is the contractor’s responsibility and at their expense.

Meals Breakfast, lunch and dinner (supper) is available in the PRIHS hospital cafeteria with the purchase of a meal ticket. Meal tickets can be purchased in the Finance Department between the hours of 09:30 am to 11:30 am and 2:00 pm to 4:00 pm, Monday through Friday. Cash, check or money order are the https://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov acceptable payment options. PRIHS Hospital is not equipped to perform credit/debit card transactions.

Tort Liability The Federal Tort Claims Act does not cover Contractor or contract provider(s). When a Contractor or contractor provider(s) has been identified as a provider in a tort claim, the Contractor shall be responsible for notifying their legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor’s (or contract provider(s)) action or non- action shall be the responsibility of the Contractor and/or insurance carrier.

Housing If available, Pine Ridge Indian Health Service (PRIHS) housing can be offered. The Contractor is required to pay rent timely for offered housing. The rental rate is determined by PRIHS Guidelines. PRIHS will invoice the individual renting.

PRH Housing point of contact:

Martin “Marty” Zephier Office: (605) 867-3071 Email: Martin.Zephier@ihs.gov

Contract Officer Responsibilities The Contracting Officer (CO) is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the CO on all matters pertaining to contract administration. Only the CO is authorized to make commitments or issue any modification to include (but not limited to) terms affecting price, quantity or quality performance of this contract. The Contracting Officer, Contract Officer Representative and PRIHS EMS Director shall deal with issues raised concerning contract Provider(s).

Quality Assurance Surveillance Plan (QASP) The QASP is based on the premise that the Contractor is responsible for managing and ensuring quality control meets the terms of the contract. The QASP is an evergreen Government document that specifies how the Government will verify and document that the Government is receiving quality of services called for under the contract. The Contractor’s performance will be measured based on the following requirements. (see attached QASP)

Contractor Performance Assessment Reporting System (CPARS) During the life of this contract, Contractor performance will be evaluated on an interim and final basis pursuant to FAR subpart 42.15. This evaluation shall become a part of the contract file and shall be used as past performance information in evaluating the Contractor’s past performance on future contracts.

Contract Performance Assessment Reporting System (CPARS) is an online reporting system www.cpars.gov.

As prescribed in the Federal Acquisition Regulation (FAR), Indian Health Service evaluates Contractor past performance on all contracts that exceed the simplified acquisition threshold and shares those evaluations with other Federal Government Contract Specialists & Procurement officials. The FAR requires that the Contractor be provided an opportunity to comment on past performance evaluations mailto:Martin.Zephier@ihs.gov prior to each report closing. This report becomes a permanent record for the Contractors past performance.

Deliverables

Deliverable Frequency Number of copies to

PRIHS

Delivery format to

PRIHS

Submit to at

PRIHS

Curriculum Vitae (must include education documentation)

Once, prior to contract performance.

1 copy Email Carl Occhipinti, EMS Director

National Registry of Emergency Medical Technicians -certification(s), licensure and qualification(s)

Once, prior to contract performance & as needed thereafter

1 copy Email Carl Occhipinti, EMS Director

Health Information Management Clearance Form

Every other week 1 original Hand deliver Carl Occhipinti, EMS Director

Employee Health Requirements

Within 7 days of contract performance & annually thereafter.

1 copy Hand deliver Employee Health Nurse

Character Investigation Requirements

Once, prior to contract performance & as needed thereafter

1 copy Via fax or via secure data transfer email

Lois Cross, Purchasing Agent

Timesheet Every other week 1 original Hand deliver Carl Occhipinti, EMS Director

Invoice Minimum monthly 1 copy Via Invoice Processing Platform (IPP)

EMS Director, GPA

Accountant &

COR

Quality Control Plan no later than 30 calendar days from the effective date of contract award

1 copy Via email Contract Officer Representative

New subcontractors or consultants retained to perform services

In writing within 5 business days of any new subcontractors or consultants retained

1 copy Via email Contract Officer Representative

Mandatory Training Upon arrival after receiving favorable Character Investigation adjudication and as required thereafter

1 copy Hand Deliver Carl Occhipinti, EMS Director

Technical Evaluation Factors include: Technical Capabilities, Key Personnel & Past Performance.

Declaration for Federal Employment* (*This form may also be used to assess fitness for federal contract employment)

Form Approved:

OMB No. 3206-0182

U.S. Office of Personnel Management

5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306 Revised October 2019

Previous editions obsolete and unusable

Instructions The information collected on this form is used to determine your acceptability for Federal and Federal contract employment and your enrollment status in the Government's Life Insurance program. You may be asked to complete this form at any time during the hiring process. Follow instructions that the agency provides. If you are selected, before you are appointed you will be asked to update your responses on this form and on other materials submitted during the application process and then to recertify that your answers are true.

All your answers must be truthful and complete. A false statement on any part of this declaration or attached forms or sheets may be grounds for not hiring you, or for firing you after you begin work. Also, you may be punished by a fine or imprisonment (U.S. Code, title 18, section 1001).

Either type your responses on this form or print clearly in dark ink. If you need additional space, attach letter-size sheets (8.5" X 11").

Include your name, Social Security Number, and item number on each sheet. We recommend that you keep a photocopy of your completed form for your records.

Privacy Act Statement The Office of Personnel Management is authorized to request this information under sections 1302, 3301, 3304, 3328, and 8716 of title 5, U. S. Code. Section 1104 of title 5 allows the Office of Personnel Management to delegate personnel management functions to other Federal agencies. If necessary, and usually in conjunction with another form or forms, this form may be used in conducting an investigation to determine your suitability or your ability to hold a security clearance, and it may be disclosed to authorized officials making similar, subsequent determinations.

Your Social Security Number (SSN) is needed to keep our records accurate, because other people may have the same name and birth date. Public Law 104-134 (April 26, 1996) asks Federal agencies to use this number to help identify individuals in agency records. Giving us your SSN or any other information is voluntary. However, if you do not give us your SSN or any other information requested, we cannot process your application. Incomplete addresses and ZIP Codes may also slow processing.

ROUTINE USES: Any disclosure of this record or information in this record is in accordance with routine uses found in System Notice OPM/GOVT-1, General Personnel Records. This system allows disclosure of information to: training facilities; organizations deciding claims for retirement, insurance, unemployment, or health benefits; officials in litigation or administrative proceedings where the Government is a party; law enforcement agencies concerning a violation of law or regulation; Federal agencies for statistical reports and studies; officials of labor organizations recognized by law in connection with representation of employees; Federal agencies or other sources requesting information for Federal agencies in connection with hiring or retaining, security clearance, security or suitability investigations, classifying jobs, contracting, or issuing licenses, grants, or other benefits; public and private organizations, including news media, which grant or publicize employee recognitions and awards; the Merit Systems Protection Board, the Office of Special Counsel, the Equal Employment Opportunity Commission, the Federal Labor Relations Authority, the National Archives and Records Administration, and Congressional offices in connection with their official functions; prospective non-Federal employers concerning tenure of employment, civil service status, length of service, and the date and nature of action for separation as shown on the SF 50 (or authorized exception) of a specifically identified individual; requesting organizations or individuals concerning the home address and other relevant information on those who might have contracted an illness or been exposed to a health hazard; authorized Federal and non-Federal agencies for use in computer matching; spouses or dependent children asking whether the employee has changed from a self-and-family to a self-only health benefits enrollment; individuals working on a contract, service, grant, cooperative agreement, or job for the Federal government; non-agency members of an agency's performance or other panel; and agency-appointed representatives of employees concerning information issued to the employees about fitness-for-duty or agency-filed disability retirement procedures.

Public Burden Statement Public burden reporting for this collection of information is estimated to vary from 5 to 30 minutes with an average of 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to the U.S. Office of Personnel Management, Reports and Forms Manager (3206-0182), Washington, DC 20415-7900. The OMB number, 3206-0182, is valid. OPM may not collect this information, and you are not required to respond, unless this number is displayed.

Form Approved:

OMB No. 3206-0182

U.S. Office of Personnel Management

5 U.S.C. 1302, 3301, 3304, 3328 & 8716

Optional Form 306 Revised October 2019

Previous editions obsolete and unusable

General Information

1. FULL NAME (Provide your full name. If you have only initials in your name, provide them and indicate "Initial only". If you do not have a middle name, indicate "No Middle Name". If you are a "Jr.," "Sr.," etc. enter this under Suffix. First, Middle, Last, Suffix)

2. SOCIAL SECURITY NUMBER

3a. PLACE OF BIRTH (Include city and state or country)

3b. ARE YOU A U.S. CITIZEN?

YES NO (If "NO", provide country of citizenship) ♦

4. DATE OF BIRTH (MM / DD / YYYY)

5. OTHER NAMES EVER USED (For example, maiden name, nickname, etc.)

6. PHONE NUMBERS (Include area codes)

Day ♦ Night ♦

Selective Service Registration If you are a male born after December 31, 1959, and are at least 18 years of age, civil service employment law (5 U.S.C. 3328) requires that you must register with the Selective Service System, unless you meet certain exemptions.

7a. Were you born a male after December 31, 1959? YES NO (If "NO", proceed to 8.)

7b. Have you registered with the Selective Service System? YES (If "YES", proceed to 8.) NO (If "NO", proceed to 7c.)

7c. If "NO," describe your reason(s) in item 16.

Military Service

8. Have you ever served in the United States military? YES (If "YES", provide information below) NO

If your only active duty was training in the Reserves or National Guard, answer "NO.”

If you answered "YES," list the branch, dates, and type of discharge for all active duty.

Branch From (MM/DD/YYYY) To (MM/DD/YYYY) Type of Discharge

Background Information For all questions, provide all additional requested information under item 16 or on attached sheets. The circumstances of each event you list will be considered. However, in most cases you can still be considered for Federal jobs.

For questions 9,10, and 11, your answers should include convictions resulting from a plea of nolo contendere (no contest), but omit (1) traffic fines of $300 or less, (2) any violation of law committed before your 16th birthday, (3) any violation of law committed before your 18th birthday if finally decided in juvenile court or under a Youth Offender law, (4) any conviction set aside under the Federal Youth Corrections Act or similar state law, and (5) any conviction for which the record was expunged under Federal or state law .

9. During the last 7 years, have you been convicted, been imprisoned, been on probation, or been on parole?

(Includes…