S02 - ATTACHMENT 1 - Honolulu Pkg 219 - SOW - Final v4.0 6.9.23.pdf

FY23-219 Dental Treatment Room Contents

Statement of Work Page 1 of 11

VA Pacific Islands Health Care System Initial Outfitting, Transition & Activation

Statement of Work

Dental Treatment Room Contents (JSN: D2520, D3320, D3380, D3390, D8250, D8250A)

VA Pacific Islands Health Care System New Akaka VA Clinic

91-1051 Franklin D. Roosevelt Avenue Kapolei, Hawaii 96707

Version 4.0 Dated 6/9/2023

Statement of Work Page 2 of 11

INTRODUCTION

The VA Pacific Islands Health Care System has a requirement to purchase Dental Treatment Room Contents (JSN: D2520, D3320, D3380, D3390, D8250, D8250A) with an authorized vendor to supply and deliver the item(s) identified in Table 1 below to properly outfit 5 Dental Treatment Rooms.

This requirement is in support of the activation of the New Akaka VA Clinic. See salient characteristics below. This is a Brand Name or Equal Requirement and A-Dec is the basis of design.

Table 1 – Package Items Summary

Item # JSN Item Description Part # (basis of design) Quantity

1 D2520 Oregon 5744 ASST Cart (or Equal)

Oregon 5744 5

2 D3320 A-dec 511 Chair (or Equal)

511 5

3 D3380 A-dec 521 Doctor's Stool (or Equal)

521 5

4 D3390 A-dec 522 Asst Stool (or Equal)

522 5

5 D8250 A-dec 532 TRAD Delivery System (or Equal)

532 5

6 D8250A

A-dec 551 ASST Instrumentation (or Equal) 551 5

7 D6000 A-dec 572L LED Dental Light, Radius Mt (or Equal)

572L 1

8 Installation Install 1

9 Training for the entire chair-side staff Training 1

Additional Item Requirements

The vendor will provide service manuals that include theory of operation, maintenance requirements, repair information, schematics, part lists and troubleshooting information in electronic format for use by the VA Biomed Department.

Date of manufacture must not be greater than 2 years before the purchase order date. The equipment must not be used or refurbished and must have the latest manufacturer’s software/hardware updates installed. Any batteries provided with the unit will not be manufactured more than 12 months before the purchase order issue date.

Statement of Work Page 3 of 11

GENERAL CONDITIONS

Site Address

The address of the Akaka VA Clinic is provided below.

91-1051 Franklin D. Roosevelt Avenue Kapolei, Hawaii 96707

Delivery Schedule

Items shall be delivered no earlier than the estimated delivery start date and no later than the delivery end date listed in Table 2 below.

Table 2 – Anticipated Building Outfitting Schedule

Building Name Building # & Letter Est. Delivery Start Date Est. Delivery End Date

Akaka VA Clinic 91-1051 15 October 2023 17 November 2023

Schedule and Order Management

2.3.1 The above delivery schedule is based upon the current construction schedule due to the nature of activation efforts and construction timelines and dates may vary and shift. Delivery dates need to be flexible. The delivery of items for installation are dependent upon the completion of applicable areas within the building. If there is a delay, the Contractor may be required to adjust the delivery date at no cost to the Government. The Contractor will coordinate with the on-site POC’s before delivery.

2.3.2 The awardee’s actual delivery dates will be confirmed by VA upon award.

2.3.3 Post-award, the vendor will coordinate delivery identified in this document with the VA prior to beginning any work (See Section 2.4). Once the dates have been confirmed, modifications to the schedule are subject to written approval by the CO, COR, and the vendor.

Delivery and Receiving

Delivery and receipt of the proposed items is anticipated to be directed to the location identified below. Confirmation of delivery location will be provided post-award. Delivery POCs will be provided upon award.

☒ Akaka VA Clinic (Direct Delivery to address detailed in paragraph 2.1) There is no loading dock available. All delivery vehicles must be equipped with a “Tommy Gate” type lift to facilitate unloading to ground level.

☐ IOT&A Contractor Provided warehouse: Address TBD

2.4.1 The vendor is required to define the need for a staging area to accommodate item delivery, if needed. Post-award, this information will be confirmed with the vendor.

Statement of Work Page 4 of 11

2.4.2 The delivery of items identified in this document shall take place during normal loading dock business hours which are defined as: 8:15 AM to 3:00 PM Hawaii Standard Time, Monday through Friday, and excluding Federal Holidays.

2.4.3 Delivery trucks will not be permitted to remain at the receiving area. Trucks shall be unloaded, moved from the receiving area, and then brought back to the receiving area if required to haul out any waste, tools, or excess materials.

2.4.4 Labeling of delivered items shall include the VA facilities contract number and VA purchase order number for identification and reference upon receipt of product.

2.4.5 NOTE: Due to the COVID19 situation, the vendor must follow VA guidelines when on VA property. Any individuals who need to enter the building for installation &/or training will be required to wear a mask and be screened by the site staff prior to entry. Please allow time for this in your schedule.

Clean Up and Disposal

2.5.1 There are no dumpsters available for vendor use.

2.5.2 The removal of waste and/or excess material shall be conducted through the loading dock area.

Assembly, Installation, and Calibration Required (Yes ☒ No ☐)

2.6.1 The vendor is required to manage and coordinate installation at the Akaka VA Clinic with the COR or his representative IOT&A POC.

2.6.2 On-site assembly and installation of items, and performance of services identified in this document shall take place during normal business hours which are defined as: 8:00 AM to 4:00 PM Hawaii Standard Time, Monday through Friday, and excluding Federal Holidays.

Proposed installation date will occur after delivery of equipment. Current timeframe of delivery is October 15, 2023 – November 30, 2023.

2.6.3 The vendor is required to define the need for a staging area to accommodate item assembly and installation, if needed. Post-award, this information will be confirmed with the vendor.

2.6.4 The vendor is required to provide tools, labor and materials to complete assembly and installation of the items detailed in this document.

2.6.5 The vendor shall protect all finished spaces and surfaces as required from delivery and installation damage. The vendor shall use covering and protection to the extent necessary to prevent damage to finished spaces. Any damage occurred during delivery and installation is the responsibility of the vendor. The vendor will be responsible for paying for and repairing any damage or noted deficiencies to finished spaces and surfaces that occur because of the vendor’s (or associated sub-contractors) installation.

Statement of Work Page 5 of 11

2.6.6 During the entire duration of assembly and installation, the vendor will have a competent representative on-site as the vendor’s contact, and to serve as the interface between the vendor and the Akaka VA Clinic. On-site representative can be the installer. All instructions provided from COR to the representative will be binding as if given to the vendor’s main contact.

The COR may provide specific instructions, however, only the Contracting Officer may change the terms or conditions of the contract.

Training Required (Yes ☒ No ☐)

2.7.1 The vendor is required to provide live clinical training at the new clinic on set up, operation, shut down, and troubleshooting procedures to clinical staff to include the dentist, hygienist, and assistant. Each session shall accommodate up to 8 people per session. If more than 8 people require training, then additional sessions shall be provided.

2.7.2 The vendor shall coordinate training dates for each 8-person session with the on-site Project Manager. Post-award, these dates will be confirmed with the vendor to meet the clinical schedule.

Proposed training date will occur after installation of equipment.

Current timeframe of training is March 2024.

2.7.3 The vendor shall provide documentation and/or certification to each staff member that has successfully completed training.

Confidentiality and Non-Disclosure

2.8.1 This equipment does not connect to a VA network. Therefore, in accordance with Appendix A, Handbook 6500.6 Checklist, block 6, the C&A requirements do not apply to this requirement, and a Security Accreditation Package is required.

SALIENT CHARACTERISTICS

Cabinet, Mobile, Storage-Assistant, Dental (JSN: D2520)

Total Quantity: 5 ☐ Network Required if Checked ☒ Manufacturer Certified Installation Required if Checked ☐ BMET Training Required if Checked ☒ End User Training Required if Checked

Basis of Design is A-dec, MFG Item # Oregon 5744

Brand Name or Equal Requirement

Description: Mobile storage cabinet used in dental spaces. Multiple drawer and cupboard configurations are available. Often called Alabama, Oregon, and North Carolina Carts.

Salient Characteristics:

• Cabinet shall be 22” W x 19” D ±2” either direction

Statement of Work Page 6 of 11

• Cabinet shall be between 30” & 35” high

• Top of cabinet shall be smooth worksurface

• Cabinet shall include 4 locking storage drawers o Handles shall be solid aluminum or of equal material

• Inside drawer dimensions: at least 16” D x 15” W ±2” either direction

• Cabinet shall include three (3) drawers that have a depth between 2” and 3.5”

• Cabinet shall include 1 drawer that has a depth between 5.5” & 7.5”

• Cabinet shall include 4 casters

• Laminate color choice: Blond Echo (or similar) for all panels, drawer fronts, worksurface, side and back

Chair, Operating, Dental (JSN: D3320)

Total Quantity: 5

Basis of Design is A-dec, MFG Item # 511

Description: Dental operating chair designed for the treatment and comfort of dental patients. The chair shall be capable of multiple positions, shall swivel, contain an adjustable headrest, and arm rests that pivot out of the entry/exit.

Salient Characteristics:

• Shall include adjustable head rest

• Hydraulic lift system

• Integrated power supply must provide electrical requirements for chair-mounted dental light and ancillary products.

• Chair shall lower to at least 20”

• Chair shall raise to at least 30”

• Chair must swivel at least 15° both directions

• Multi position armrests

Statement of Work Page 7 of 11

• Baseplate shall have a rust and scratch resistant finish

• Must have automatic chair stop sensors

• Minimum capacity of at least 350lbs

• Seamless upholstery – Color Sable (or similar)

• Upholstery must shall be able go through cleaning and disinfecting without causing damage to upholstery

• Include floor box with duplex outlet and quick-disconnects

• Chair shall be designed to operate with the instrumentation and delivery system

Stool, Operating, Dental, Doctor (JSN: D3380)

Total Quantity: 5 ☐ Network Required if Checked ☒Manufacturer Certified Installation Required if Checked ☐ BMET Training Required if Checked ☒ End User Training Required if Checked

Basis of Design is A-dec, MFG Item # 521

Brand Name or Equal Requirement

Description: Used by the dentist in the care and treatment of patients. This chair has a gas cylinder to adjust the height of the chair. It also has backrest as an integral part of the unit. The unit is to be equipped with casters. Various color combinations of vinyl or fabric are available.

Salient Characteristics:

• Contoured backrest with push button or lever height control and adjustable backrest tilt

• Four Points of Adjustability: Seat tilt (multiple degrees of forward and backwards tilt), seat height, backrest tilt, and backrest height

• Labeled adjustment paddles for identification

• Gas cylinder with a minimal height adjustment range of 19.6” to 24.1”

• Powder coat finish

• Base shall have at least 5 casters for tile and carpet use

• Minimum capacity of 350lbs

• Seamless upholstery – Color Sable (or similar)

• Upholstery must shall be able go through cleaning and disinfecting without causing damage to upholstery

Statement of Work Page 8 of 11

Stool, Operating, Dental, Assistant (JSN: D3390)

Total Quantity: 5

Basis of Design is A-dec, MFG Item # 522

Description: Dental assistant's operating stool used in dental operatories during procedures. This chair has a body support arm or abdominal support that can be left or right hand adaptable. It is also gas cylinder operated for height adjustments. The chair is available in multiple vinyl or fabric color combinations.

Salient Characteristics:

• Single swing away curved arm rest

• Points of Adjustability: Seat tilt (multiple degrees of forward and backwards tilt), and seat height

• Labeled adjustment paddles for identification

• Gas cylinder with a minimal height adjustment range of 23.1” to 28.7”

• Powder coat finish

• Base shall have at least 5 casters for tile and carpet use

• Minimum capacity of 350lbs

• Height adjustable footrest

• Seamless upholstery – Color Sable (or similar)

• Upholstery must shall be able go through cleaning and disinfecting without causing damage to upholstery

Statement of Work Page 9 of 11

Delivery System, Dental (JSN: D8250)

Total Quantity: 5

Basis of Design is A-dec, MFG Item # 532

Description: Dental operating unit. The dentist and/or dental hygienist uses the unit for treatment of dental patients. The unit contains the operating connections for handpieces, the water spray and the vacuum system. The unit will be chair mounted.

Salient Characteristics:

• Chair mounted

• Integrated four position control block for use of up to four handpieces. Must be constructed of lead-free brass (per section 14.17 of the Safe Drinking Water Act1). Removable water cartridge valves, tool-less tubing locking mechanism

• Air brake-controlled positioning

• Six position customizable handpiece holder

• Customizable touchpad (Doctor’s)

• Silicone handpiece tubing

• Handpieces include:

1. Autoclavable quick-disconnect air/water syringe

2. 4-hole handpiece tubing

3. 6-pin handpiece tubing

4. Electric motor

5. Ultrasonic scaler

• Capable of using high-speed and low-speed electric handpieces

• Side mounted utility tray with removeable stainless steel tray insert

• Disc foot control

1 EPA Safe Drinking Water Act: https://www.epa.gov/sites/default/files/2020- 05/documents/safe_drinking_water_act-title_xiv_of_public_health_service_act.pdf, Enacted December 20, 2019 https://www.epa.gov/sites/default/files/2020-05/documents/safe_drinking_water_act-title_xiv_of_public_health_service_act.pdf https://www.epa.gov/sites/default/files/2020-05/documents/safe_drinking_water_act-title_xiv_of_public_health_service_act.pdf

Statement of Work Page 10 of 11

• 1.5’ umbilical, minimum

• Must be able to adjust from left-handed use to right-handed use without tools

• Self-contained water system, with 2-liter water bottle, minimum.

• Internal water lines must be made of anti-microbial material

• Must be able to flush system with toggle or push button

• Chair lock-out feature to prevent chair movement while handpiece is in use

• Delivery system shall be designed to operate with the instrumentation and chair

Assistant Instrumentation Arm, Dental (JSN: D8250A)

Total Quantity: 5

Basis of Design is A-dec, MFG Item # 551

Description: Assistant’s Arm is a chair-integrated delivery for Air-Water Syringe, High Volume Evacuator (HVE), Saliva Ejector (SE) and optional ancillaries (curing light or warm water syringe). It is highly flexible and adjustable to accommodate both two and four handed dentistry. Includes Integrated touch pad and built in solids collector.

Salient Characteristics:

• Chair mounted

• Multi-Axis arm for horizontal, and vertical movement with at least 270-degree range of positioning

• Multi-Function touchpad (Assistant’s)

• Long arm length option

• Include the following handpieces:

1. Autoclavable quick-disconnect air/water syringe

2. Mini LED Curing Light

3. Dual Turret with dual High-Volume Evacuators (HVE)

4. Low-speed saliva ejector

• Instrumentation shall be designed to operate with the chair and delivery system

Statement of Work Page 11 of 11

Light, Dental Operating, Chair Mounted (JSN: D6000)

Total Quantity: 5 ☐ Network Required if Checked ☒Manufacturer Certified Installation Required if Checked ☐ BMET Training Required if Checked ☒ End User Training Required if Checked

Basis of Design is A-dec, MFG Item # 572L

Brand Name or Equal Requirement

Description: Chair mounted dental operating light used to illuminate the field of work for the dentist.

Salient Characteristics:

• Must be chair mounted

• Three axis barycentric positioning. Full 540 degrees of horizontal rotation. Light Head rotates

500-600°, the Optics Head rotates 105° ±5 total (0° up, 105° down), the Optics Head rotates 80°

±5° (±40° from vertical)

• Shall have a minimum of three intensity settings

• Shall have a “yellow” light to illuminate the oral cavity without premature curing of photo-initiated dental materials

• Positioning: Rotation axis about the rigid arm to flex arm interface is to be 315±5° of travel. The vertical travel shall be be at least 27.9 inches, minimum

• Shall have fracture resistant handles that stay cool to touch

• No more than 24 BTU/hr nominal energy output at high intensity. No radiant heat. No bulb replacement. 15-Watt maximum power consumption.

• Touchpad control of light modes with auto on/off capabilities

• LED array to minimize any shadowing due to blockage from instruments and the dental team.

• Shall have smooth surface exterior parts for cleaning and disinfecting without damaging the light’s surfaces or markings

• Light shall be designed to operate with the chair

/End SOW/