EXH 4 TO-004 MED RFP and PWS

ALiSS – TO-004 Request SAQMMA14R0042

Exhibit 4 (A003) Page 1 of 23

Task Order Request Performance Work Statement

TASK ORDER REQUEST

MEDICAL SERVICES

The Department of State requests you submit a proposal in response to the attached Performance Work Statement.

The Contractor may choose to subcontract for personnel support services, which include, but are not limited to: food services; operation, maintenance, repair; housing with associated services; and medical services. The Contractor shall support this effort with the appropriate infrastructure to provide for logistics support for its employees and subcontractor employees, including billeting, subsistence and protection of the contractor work force. The management structure used by the Contractor shall ensure efficient and effective accomplishment of all tasks. A key task is to ensure that proper staffing levels are maintained at all times.

The Contractor may also choose to subcontract the functional work for the Task Order in all or in part.

Where the work is subcontracted, the Contractor shall provide past performance and experience information for the subcontractor.

1.0 ANTICIPATED TASK ORDER PERIOD OF PERFORMANCE

This Task Order shall include a base period of one (1) year and four one-year option periods. For pricing purposes, use a start date of December 1, 2014.

2.0 TRANSITION PROCESS

The transition-in period shall not exceed 120 calendar days and full performance shall commence at the date specified in Section 3.0 of the PWS. Transition costs will be covered under CLIN 0001.

3.0 TASK ORDER TYPE

The Government contemplates a hybrid task order type consisting FFP, CPFF, and cost reimbursable arrangements. See Section 7.0 for specific contract type breakdown by CLIN.

4.0 PROPOSAL VALIDITY PERIOD:

Proposals shall be valid for a period of 150 days.

5.0 TASK ORDER FUNDING:

Task Order will be incrementally funded.

6.0 FACILITY CLEARANCE REQUIREMENT

Pursuant to the terms and conditions of the IDIQ, all prime contractors shall submit evidence of their current Secret Facility Clearance. Should services under this task order, TO-004, be provided by a subcontractor, the facility clearance of the subcontractor shall be submitted as well.

A facility clearance at the level of Secret of above is required for this task order.

Exhibit 4 (A003) Page 2 of 23

7.0 PRICING INFORMATION AND INSTRUCTIONS:

The Offeror shall complete Attachment 7, tab TO-004.

Breakdown of CLIN by Unit Type CLIN No. Description Unit Type

STANDARD

0001 Transition Operations FFP X002 Medical Facilities Operations – Camp Seitz FFP X003 EMT Operations – Embassy Compound FFP X004 Medical Supplies (Seitz) CPFF (cost) X005 Equipment (Contractor Acquired) (Seitz) CPFF (cost) X006 Travel CR

X007 DBA CR

x008 Fixed Fee (for x004 and x005) CPFF (fixed fee)

OPTIONAL

X009 Medical Facilities Operations – Camp Eggers FFP X010 Medical Supplies (Eggers) CPFF (cost) X011 Equipment (Eggers) CPFF (cost) X012 Fixed Fee (for x010 and x011) CPFF (fixed fee)

For the base year only, the sequence of CLIN execution is as follows:

• CLIN 0001, Period of Performance: 12/01/2014 – 03/31/2015 (120 days)

• CLIN 0002, 0003, and 0004, Period of Performance: 04/01/2015 – 11/30/2015 (For pricing purposes, assume that the Operations and Provisions will begin after the successful conclusion of the transition.)

• All other CLIN are billable as associated costs are incurred and documented on the monthly invoice.

In addition to the completed Attachment 7, the Offeror shall include a corresponding price narrative.

7.1 STANDARD

Transition Operations (FFP) CLIN: 0001 (only applicable to the base year)

The transition CLIN will include: advance party trips (not to include travel costs), vetting, etc. Transition operations shall not exceed 120 calendar days. CLIN 0001 pertains only to the initial phase-in operations.

Medical Facilities Operations (FFP) CLIN: x002

Medical Facilities Operations are defined as costs, including labor costs, related to providing services in the designated locations. Labor shall be accordance with Section B.4.2 of the IDIQ. The Offeror shall propose FFP rates for the base year and all option years.

EMT Operations – Embassy Compound (FFP)

Exhibit 4 (A003) Page 3 of 23

CLIN x003

EMT operations are defined as costs, including labor costs, related to providing services in the designated locations. Labor shall be accordance with Section B.4.2 of the IDIQ. The Offeror shall propose FFP rates for the base year and all option years.

Medical Supplies (Cost Plus Fixed Fee – Base Year) CLIN: x004 (Camp Seitz) and x010 (Camp Eggers)

Medical supplies are defined as the medicines, and related consumable supplies, purchased for this contract. Due to the difficulty in estimating the provisions, there is a plug figure for provisions under this task order.

The Offeror shall propose the fixed fee associated with CLIN x004, under CLIN x008. Should the option for Camp Eggers be exercised, the fixed fee associated with CLIN x010 shall be negotiated and included in CLIN x012.

NOTE: For invoice purposes, the medical supply costs will need to be displayed by location (e.g.

Embassy Compound vs Camp Seitz).

Equipment (Cost Plus Fixed Fee) CLIN: x005 (Camp Seitz) and x011 (Camp Eggers)

Equipment shall be in accordance with Section B.4.7 of the IDIQ. Due to the difficulty in estimating the equipment, there is a plug figure for equipment under this task order.

The Offeror shall propose the fixed fee associated with CLIN x005, under CLIN x008. Should the option for Camp Eggers be exercised, the fixed fee associated with CLIN x011 shall be negotiated and included in CLIN x012.

NOTE: For invoice purposes, the equipment costs will need to be displayed by location of issuance (e.g.

Embassy Compound vs Camp Seitz).

Travel (Cost Reimbursable) CLIN: x007

Travel shall be in accordance with Section B.4.3 of the IDIQ.

The Offeror shall show for each contract year the breakdown of the proposed Travel costs. The breakdown shall consist of at least the following:

a) Contract-specified labor category (if applicable)

b) Traveler name (if known)

c) Title of traveler or relationship of traveler to Contractor (if traveler is known)

d) Purpose of trip

e) Proposed dates of travel (if known)

f) Proposed number of days of travel

g) Origin

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h) Destination

i) Proposed airfare or train fare

j) Proposed lodging cost per night

k) Lodging per diem, as indicated in FTR, JTR, or DSSR

l) Proposed meals and incidental expenses (M&IE) cost per day

m) Meals and incidental expenses (M&IE) per diem, as indicated in FTR, JTR, or DSSR

n) Proposed ground transportation cost per day

o) Proposed parking cost per day

p) Proposed tolls cost per day

q) Subtotal

The Contractor shall note that, pursuant to FAR 31.205-46(a)(1), the contractor’s costs for lodging, and meals and incidental expenses may be based on actual costs incurred, per diem, or a combination thereof, as long as the method used results in a reasonable charge. Similarly, the contractor’s costs for transportation may be based on actual costs incurred, mileage rates, or a combination thereof, as long as the method used results in a reasonable charge. The Contractor shall note in its proposal the respective methods used and/or intended to be used.

Pursuant to FAR 47.402, 47.403, and the Fly America Act, the Contractor shall use a U.S.-flag air carrier service unless specific conditions exist. If such conditions exist, the Contractor shall submit with its task order proposal a memorandum explaining why it does not intend to use a U.S.-flag air carrier service.

Inclusion of such costs in the awarded fixed-price is contingent upon Government acceptance of such explanation.

Due to the difficulty in estimating the provisions, there is a plug figure for provisions under this task order.

Note that only travel associated with (1) in and out processing, and (2) other official contract business (i.e. directly related to task order requirements) that has been approved in writing by the COR, shall be included under this CLIN.

DBA (Cost Reimbursable) CLIN: x007

DBA shall be in accordance with Section B.4.5 of the IDIQ.

As required by Section G.3.7 of the IDIQ, The first invoice for each task order shall include a copy of the DBA Insurance policy negotiated between the Contractor and the DBA Insurance carrier, or copy of the self-insured program and Department of Labor approval if the Contractor is a Department of Labor-approved self-insurer. In either case, such copy shall show that sufficient DBA Insurance coverage has been obtained for the entire period of performance for the task order.

The Offeror shall explain the basis for the proposed DBA rate.

The estimated amount may be adjusted throughout the contract periods as necessary using projected and actual labor expenditures.

Exhibit 4 (A003) Page 5 of 23

The contractor shall be reimbursed for DBA costs only upon submission of proof of payment to the insurance provider.

DOSAR 652.228-70 DEFENSE BASE ACT- COVERED CONTRACTOR EMPLOYEES (JUN 2006)

(a) Bidders/Offerors shall indicate below whether or not any of the following categories of employees will be employed on the resultant contract, and, if so, the number of such employees:

CATEGORY YES/NO NUMBER

(1) United States citizens or residents

(2) Individuals hired in the United States, regardless of citizenship

(3) Local nationals or third country nationals where contract performance takes place in a country where there are no local worker’s compensation laws

Local Nationals:

Third Country Nationals:

(4) Local nationals or third country nationals where performance takes place in a country where there are local worker’s compensation laws

Local Nationals:

Third Country Nationals:

(b) The CO has determined that for performance in the country of Afghanistan –

☐ Worker’s compensation laws exist that will cover local nationals and third country nationals.

Worker’s compensation laws do not exist that will cover local nationals and third country nationals.

(c) If the bidder/Offeror has indicated “yes” in block (a)(4) of this provision, the bidder/Offeror shall not purchase Defense Base Act insurance for those employees. However, the bidder/Offeror shall assume liability toward the employees and their beneficiaries for war-hazard injury, death, capture, or detention, in accordance with the clause at FAR 52.228-4.

(d) RESERVED.

Fixed Fee (FFP) CLIN: x008 and x012

The Offeror shall provide their proposed fixed fees for the following three CLIN:

• CLIN x004, Medical Supplies

• CLIN x005, Equipment

Though a single composite rate shall be displayed in the pricing table, the Offeror shall provide in their price proposal a breakdown clearly showing the fixed fee associated with the three above mentioned

CLIN.

Should the option for Camp Eggers be exercised, the fixed fee associated with CLIN x009 and x010 will be negotiated at the time of the modification and included in CLIN x012.

7.2 OPTIONAL

Exhibit 4 (A003) Page 6 of 23

Medical Facilities Operations (FFP)– Camp Eggers CLIN: x009

The Contracting Officer may exercise the option for medical facilities operations at Camp Eggers by written notice to the Contractor within the period of performance of this task order. Unless otherwise specified, performance of the services shall commence no later than 30 days after such notice is given.

If the Government exercises the optional services for Camp Eggers, the services shall be considered part of the standard services for all remaining option years. Therefore, no advance notice is required for the medical facilities operations at Camp Eggers other than the contracting officer’s notice to exercise remaining option years per FAR 52.217-9.

The FFP rate associated with CLIN x008 will be negotiated with the issuing modification. It is the Government’s intention to exercise this option within the base year of this task order. Offerors shall note that though the Government has stated intent to exercise CLIN x009 within the base year, this notice does not commit the Government to an extension.

7.3 RESERVED

8.0 TECHNICAL INFORMATION AND INSTRUCTIONS:

The Offeror shall address the following within their technical proposal response.

• Task Order Management Plan o Preliminary Transition Plan

8.1 TASK ORDER MANAGEMENT PLAN (TOMP)

As required by Section H.23.2.1 of the IDIQ, the Offeror shall provide a Task Order Management Plan (TOMP) detailing its technical and management approach for accomplishing the task order objectives.

Failure to address all requirements as described in Section H.23.2.1 of the IDIQ, Task Order Management Plan, will render Contractor’s Task Order Management Plan as non-responsive and may not be considered for evaluation.

8.1.1 Preliminary Transition Plan

As part of the TOMP, the Offeror shall address the transition-in plans. The Preliminary Transition Plan shall include a detailed timeline showing transition activities and their durations beginning as of December 1, 2014 (projected). The Preliminary Transition Plan should be as complete as possible and clearly establish that the Offeror has a well-thought out plan ready to be finalized upon contract award.

The Offeror shall provide a comprehensive explanation detailing how it expects to accomplish the transition in the allotted timeframe, to include steps to acquire all necessary equipment, licenses, permits, insurance, staff, and to train the staff.

The Offeror shall identify any other risks that may hinder their ability to stand up and perform the new contract, and shall provide their contingency plans for those situations.

Exhibit 4 (A003) Page 7 of 23

8.1.2 Staffing

The Contractor shall provide, as part of their TOMP, their proposed staffing plan. In an effort to assist the Contractor in the creation of the staffing plan, the Government has provided a sample estimate of staffing below, based on the TO-004 Section 8.1 population figures.

++ Denotes Key Personnel

* Denotes additional medical augmentation personnel, dependent on PAR/site requirements ** Denotes additional surgical augmentation personnel, dependent on PAR/site requirements

Medical Specialty MACC eMACC SMACC General Medical Officer (Family, Emergency or Internal Medical Specialist) ++ * 1 2

General Surgical Officer++ ** 2

Physician Assistant / Nurse Practitioner ++ 1 1 1

Operating Room (OR) Nurse or OR Technician ** 2 Critical Care/Med Surgical Nurse (with recent ER/ICU/CCU Experience) * ** 6

Anesthesiologist ++

Nurse Anesthetist ** 1

Medical Technologist, MLS (ASCP)CM * 1

Medical Lab Technician 1 1

Radiologist

Radiology Technician (competence with general radiology, ultrasound and CT) 1 1

Medical Assistant or EMT-P * * 4

Pharmacy Specialist

* 1

Biomedical Equipment Technician

Social Worker

Admin / Log Support * * 2

Public Health Oversight

Dentist 1

Dental Technician 1

Total < 5 < 16 31

For Ambulance services, the Government provides the following notional model of staffing:

• Program, quality assurance, chart review and administration

Exhibit 4 (A003) Page 8 of 23

• 1 EMT-P (provider and/or driver – except as noted in TO-004 section 8.6)

• 1 BLS or ILS (provider and/or driver – except as noted in TO-004 section 8.6)

Back-up staffing for days off should be included in the staffing pattern.

8.1.3 SMACC Staffing

The table presented in the above Section 8.1.2 displays the sample staffing for each of the facilities.

The Government will not initially require MACC or eMACC facilities or services. As discussed in Section 7.2, it is the Government’s intention to exercise MACC (Camp Eggers) option within the base year of this task order.

A SMACC facility will be provided at Camp Seitz. Though the facility will be fully equipped to meet the SMACC level requirements (see Section C.4.1.3.2.2 of the IDIQ), the Contractor will not be responsible for providing staff for the surgical component of the SMACC. The Contractor will not be responsible for providing the following standard SMACC staff: General Surgeon, OR Nurse/Tech, Anesthesiologist, and Nurse Anesthetist. Should the Government require surgical services in the future, a modification to this task order will be issued.

8.1.4 EMT Services on Embassy Compound

Though there is not a contractor medical facility located on the Embassy compound, the Contractor shall be responsible for providing EMT services at the Embassy compound. The Government will provide basic office space, furnishing, and equipment for these positions. See Section 8.6.4 for additional information.

9.0 EVALUATION CRITERIA

The Government may award the task order on the basis of initial offers received, without discussions.

In award without discussions, any proposal (i.e., technical or price) that contains assumptions of any nature that is identified as a significant risk or weakness, may not be eligible for award. Therefore, each initial offer should contain the Offeror's best terms from a price and technical standpoint. The Government does, however, reserve the right to elect to make award with discussions.

9.1 EVALUATION CRITERIA - TECHNICAL

The technical approach factor is an assessment of the Offeror’s comprehensive ability to successfully perform all aspects of the task order based on the Offeror’s Technical Proposal (including attachments).

The Technical Approach factor is comprised of the below:

• Task Order Management Plan

The Government will evaluate the non-price related proposal to ensure that the Contractor can satisfy the non-price-related requirements of the task order.

Task Order Management Plan

Elements of the technical proposal (TOMP) will be reviewed to the extent that they adequately address the elements of the SOO and the criteria found in IDIQ Section H.23.2.1.

Exhibit 4 (A003) Page 9 of 23

• Management Approach: The proposal must address all IDIQ Section H.23.2.1(a) elements. The proposal must be complete, clear, demonstrate a thorough understanding of the program management needs, and demonstrate the ability to perform the needed oversight.

Key Personnel: Experience, capabilities, and availability of key personnel are critical. The DOS shall consider the resumes proposed as a clear indication of the Offeror’s level of commitment to the overall success of this service.

• Transition-in Plans: The proposal must address all IDIQ Section H.23.2.1(b) elements. The transition plan must be complete, clear, comply with the requirements of the solicitation, demonstrate a thorough understanding of the requirements and demonstrate the ability provide a smooth transition within the contract allotted timeframe.

The Government considers a smooth transition and continuity of services to be critical to the DOS mission. The Plan shall address the elements of H.23.2.1(b) and should be as complete as possible, thorough and realistic. The plan should anticipate problems that could be encountered and address how they would be resolved. The Offeror must illustrate a comprehensive approach to transitioning the program from the current incumbent, if applicable. The Transition Plan will be evaluated to determine the Offeror’s ability to identify the tasks that will be performed during transition and to accomplish them successfully.

• Personnel Plans: The proposal must address all IDIQ Section H.23.2.1(c) elements. The proposal must be complete, clear, comply with the requirements of the solicitation, demonstrate a thorough understanding of the requirements and demonstrate the ability to perform the prospective contract successfully in the area of personnel.

The Government will examine and evaluate the Offeror’s approach to comprehensively providing and retaining qualified and suitable candidates that can successfully perform under the task order to meet both anticipated and unanticipated requirements. During this process the government may examine the Offeror’s proposed: methods, personnel, facilities, systems, personnel compensation, equipment, and other components of the Offeror’s approach related to providing effective comprehensive personnel staffing, recruitment, screening / vetting, and retention.

• Logistics Management Plan: The proposal must address all IDIQ Section H.23.2.1(d) elements.

The proposal must be complete, clear, comply with the requirements of the solicitation, demonstrate a thorough understanding of the requirements and demonstrate the ability to perform the prospective contract successfully in the area of logistics.

The government will examine and evaluate the Offeror’s approach to providing effective comprehensive logistics management to support all aspects of performance based on task order requirements. During this process the government may examine the Offeror’s proposed: methods, planning, facilities, systems, equipment, property management including inventory control / tracking and stewardship of government property, in-house procurement of supplies and services at competitive prices, shipping / freight management, and other components of the Offeror’s approach related to providing effective comprehensive Logistics management.

9.2 EVALUATION CRITERIA - PRICE

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The Government will conduct an evaluation to determine ultimately that the final agreed-to price from Pricing Table T-004 of Attachment 7 is fair and reasonable. In doing so, the Government will examine the completeness and accuracy of the Contractor’s proposed prices and estimated costs in Pricing Table T-004 of Attachment 7.

The Government will use one or more of the proposal analysis techniques stipulated in FAR 15.404 to conduct the evaluation.

Questions and proposals should be submitted to Christina Black via email at blackce@state.gov.

TASK ORDER – PERFORMANCE WORK STATEMENT

MEDICAL SERVICES

1.0 TASK ORDER NUMBER AND TITLE

• Task Order Number: TO-004

• Title: Medical Services

2.0 CONTRACTING OFFICERS REPRESENTATIVE

TBD

3.0 PERIOD OF CONTRACT PERFORMANCE

This task order shall include a base period of one (1) year and four (4) 1-year option periods. The first four months (120 days) of the base year have been designated as the transition period. The transition period is anticipated to begin December 1, 2014. The anticipated standard performance start would then be April 1, 2014.

The anticipated performance period is as follows:

Base Year 12/1/2014 – 11/30/2015 Option Year 1 12/1/2015 – 11/30/2016 Option Year 2 12/1/2016 – 11/30/2017 Option Year 3 12/1/2017 – 11/30/2018 Option Year 4 12/1/2018 – 11/30/2019

The Government is not obligated to exercise the option(s).

4.0 LOCATION OF CONTRACT PERFORMANCE

The Contractor shall provide medical services in the following locations:

• Kabul - Camp Seitz

• Kabul - Camp Eggers mailto:blackce@state.gov

Exhibit 4 (A003) Page 11 of 23

5.0 BACKGROUND

The health care support mission will transition from NATO and the U. S. Department of Defense to the U. S. Department of State over a period of time which may coincide with the end of the current International Security Assistance Force mission ending on 31 December 2014. After NATO and U.S.

military forces withdraw from Afghanistan, the U.S. Embassy and constituent posts and sites will be comprised of approximately 5,000 personnel supporting the U.S. Diplomatic Mission in Afghanistan, which includes U.S. Government civilians, U.S. military, local national employees, and supporting Contractors (American Nationals (ANs), third country nationals (TCNs) , and Local Nationals (LNs)). The Contractor will provide medical care to all ANs and TCN personnel within this pool as well as critical trauma care for all Chief of Mission (COM) and contractor personnel. LNs will be treated only in emergencies or for work-related injuries. Extraordinary circumstances may result in treatment of some Afghan nationals at the direction of the COM; however, it is expected that this would be a rare occurrence.

The Contractor will establish and provide primary health care as well as resuscitative surgical and medical care in accordance with U.S. or equivalent medical standards on a 24 hour basis, 365 days of the year for a population consisting of approximately 5,000 adult personnel. This is a predominantly middle-aged civilian work force. Specific beneficiary eligibility will be determined by the COM or his or her designee. The Contractor will be allowed to treat non-Chief of Mission personnel (active duty military, NATO personnel, Department of Defense civilians, and contractors) on a case-by-case basis through the final draw down. Local nationals will be treated if injured or ill on the job; otherwise, locals will be treated only on an emergency basis and if authorized by the Chief of Mission. Other diplomatic corps may be allowed to subscribe to critical medical care services on a cost-reimbursable basis.

6.0 LICENSES, PERMITS, AND OTHER OFFICIAL DOCUMENTATION

At the time the Contractor proposes on this effort, the Contractor shall provide copies of all current required medical licenses and certifications, and proof of ACLS and ATLS training (see Section C.4.1.3.1.2 of the IDIQ), and proof of medical malpractice insurance.

Additionally, the Contractor will be responsible for being familiar with Afghan laws and possess demonstrated ability to obtain all licenses, permits and other official requirements required for full performance of this task order. In the Task Order, bidders will identify GIRoA’s requirements and assumptions regarding DOS/Embassy involvement. Assumptions should be in a separately labeled Section and pertain specifically to this Task Order.

The Contractor is responsible for maintaining all contract-required and host country-required licenses and permits throughout the life of this task order.

7.0 SUPPORT SERVICES

The Contractor may choose to subcontract for personnel support services, which include, but are not limited to: food services; operation, maintenance, repair; housing with associated services; and medical services. The Contractor shall support this effort with the appropriate infrastructure to provide logistical support for its employees and subcontractor employees, including billeting, subsistence and

Exhibit 4 (A003) Page 12 of 23 protection of the contractor work force. The management structure used by the Contractor shall ensure efficient and effective accomplishment of all tasks. A key task is to ensure that proper staffing levels are maintained at all times.

The Government shall provide basic housing and dining for only those personnel designated as critical (See Section 13.0).

8.0 TYPES OF SERVICE

8.1 ESTABLISHING FACILITIES

The Contractor will be responsible establishing facilities as indicated below:

Location Facility Type Estimated Population at Risk (PAR)* Kabul – Camp Seitz SMACC** 783 Kabul – Camp Eggers MACC 1592

* Location population requiring primary care ** Should the surgical elements of the SMACC be required in the future, the SMACC will would also serve as the surgical referral center for an additional population of up to 3,000

The physical structures to be supplied and/or constructed/renovated by the U.S. Government for use as the Medical & Acute Care Clinics (both MACC & eMACC) and the Surgical, Medical & Acute Care Center (SMACC). The U.S. Government will be responsible for any modifications required, and such modifications may be done before, during, or after arrival of the Contractor. They will be serviceable for initial use.

Health care facilities will be sufficient in size to meet the staffing requirements, but may not have an abundance of space for warehousing more than 60 days of supplies to support the facilities. MACC, eMACC, and SMACC facilities will vary slightly in size and configuration depending on the location.

See Section C.4.1.3.1.2 of the IDIQ for MACC, eMACC, and SMACC capability requirements. The Contractor will not be responsible for providing the surgical staff at the SMACC. Though the facility will be fully equipped to meet the SMACC level requirements (see Section C.4.1.3.2.2 of the IDIQ), the Contractor will not be responsible for providing surgical services initially. Should the Government require surgical services in the future, a modification to this task order will be issued.

8.1.1 Facility Hours of Operation

See Section C.4.1.3.1.4 of the IDIQ.

8.1.2 Facility Upkeep Services

8.1.2.1 Housekeeping

Housekeeping services, as described in Section C.4.1.3.1.5 of the IDIQ, are required.

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8.1.3 Drug Testing

As described in Section C.4.1.3.1.2 of the IDIQ, the Contractor shall provide drug testing and steroid testing services. The Contractor shall be prepared to test for the following drugs utilizing* a rapid urine test:

• Cannabinoids

• Opioids

• Cocaine

• Amphetamine and Methamphetamine

• Phencyclidine (PCP)

• Methadone

• Benzodiazepines

• Propoxyphene

• Methaqualone***

• Barbiturates

• Oxycodone***

• Tricyclic Antidressants***

• Synthetic marijuana

Steroid testing shall, at a minimum, ** include testing for:

• Oxymetholone

• Oxandrolone

• Methandrostenolone

• Stanozolol

• Nandrolone decanoate

• Nandrolone phenpropionate

• Testosterone cypionate

• Boldenone undecylenate

• Tetrahydrogestrinone (THG)

* The Government reserves the right to change the substances tested for at no additional cost to the government.

**The Contractor will not use a rapid test for steroids, but will prepare a separate steroid urine specimen utilizing strict custody and control procedures. The urine specimen will be transported to a certified CONUS SAMHSA laboratory for analysis and confirmation.

***The Contractor will perform 12 panel testing.

8.2 MEDICAL TREATMENT – RESUSCITATIVE, GENERAL SURGICAL CARE AND MEDICAL CARE

Emergency Response

i. Within Embassy Compounds: When there is a medical emergency within a DOS support area, the Tactical Operations Center (TOC) shall arrange for medical response and transportation to the nearest health care facility which can treat the patient’s condition.

Driver and medical attendants during evacuation will be provided by the Contractor, except as noted in paragraph iii below.

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ii. Outside Embassy Compounds: When there is an emergency outside a DOS support area due to injury and/or a medical condition, the Tactical Operations Center (TOC) shall arrange for medical response and transportation to the nearest health care facility. Medical care at the point of injury and initial response is part of another contract and not a requirement of this contract. Additional medical attendants during evacuation may be provided by the Contractor, as required.

iii. Enroute Care for an Emergent Patient: Contractor will provide enroute care for an emergent patient, to include patient movement outside of the Diplomatic Zone. Medical attendants will consist of at least one EMT-P or higher level provider. Additional medical attendants may be necessary based on patient status. Should the transport require movement to another location via Government-provided ground and air (fixed or rotary wing) assets, all medical attendants are required to wear body armor during the patient movement. Ground patient movement outside of the Diplomatic Zone requires the patient and medical attendant to be in an up-armored vehicle with a Government-provided driver and Private Security Detail Escort at all times. Ground patient movement outside of the Diplomatic Zone requires local Regional Security Officer (RSO) and Contractor Program Manager and/or the Deputy Program Manager approval prior to transport. Additionally, notification of movement, times, and arrival to gaining facility is required as early as practically possible.

Medical Evacuation

i. Medical Evacuation within Afghanistan (Intra-theater Evacuation): When a patient’s medical condition requires a higher level of care than available at the location, the designated medical director will notify the TOC and place a request for evacuation. As the Contractor will coordinate medical evacuations for employees of other USG contractors, said employees will be evacuated in country IAW their employer’s standard operating procedures. Should the requirement be for U.S. government direct hire employees, the medical director will additionally notify and coordinate with the Regional Medical Officer (RMO) in Kabul. The medical director will also inform the TOC if there is a requirement for additional medical equipment or a requirement for en route/on site medical care. The TOC will coordinate with the MEDEVAC team and will provide them the patient’s information and any additional requirements for medical equipment. The transfer will be documented via the Department of Defense (DoD) 9-line evacuation form (see Exhibit 3b for sample), or a similar form containing the same data.

ii. Medical Team Movement: When a patient’s medical condition requires the forward-positioning of a medical and/or surgical team located at the SMACC, the designated medical director will notify the TOC and place a request for team movement.

iii. Medical Evacuation from Afghanistan (Inter-theater Evacuation): The medical director at the SMACC will be responsible for making the determination that medical evacuation out of Afghanistan is necessary, and ensuring compliance with the Embassy’s MEDEVAC protocol. The RMO will arrange all out of country MEDEVACs for U.S. direct hire Chief of Mission employees. The medical director will coordinate with the employing company’s local supervisor to arrange out of country MEDEVACs for other USG contractors. All contractors shall hold private medical evacuation insurance.

iv. Mental Health Evacuation from Afghanistan: Government direct hire mental health patients will be evacuated to Washington, D.C. in accordance with current Department of State guidelines and in coordination with the RMO and the Regional Medical Officer /

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Psychiatrist (RMO/P). Contractor mental health cases will be evacuated in accordance with policies established by the contractor’s/patients' medical evacuation insurance company.

Mental health evacuations for USG contractors will be in accordance with said contractor’s employer’s policies and insurance plans.

Dental

Dental services will be limited to performance at the designated facility in Kabul for emergency general dentistry for all COM designated personnel in Afghanistan. The Contractor shall provide emergency dental services on a full-time basis within the scope of practice of general dentistry to eligible patients.

Patients will be moved to this location using Embassy resources.

Public Health

This contract shall require tracking and reporting of occupational injuries, disease trends (e.g. influenza-like illness), blood-borne pathogen and needle stick exposure programs, periodic health education and disease prevention programs, and other services in accordance with industry standards and as determined by the Department of State.

8.3 EQUIPMENT AND SUPPLIES

8.3.1 Equipment

See TO-004, Exhibit 4a. The Contractor is responsible for informing the COR, in writing, of Government furnished equipment malfunctions within 24 hours of the occurrence.

8.3.2 Emergency Supplies

Even though it is unlikely that an emergency would cut off the medical supply chain for a prolonged amount of time, it is considered important that the Embassy maintain a supply that will last for a minimum of 60 days. The Contractor shall ensure that it maintains a minimum of a 60-day supply of common maintenance medications and medical supplies at all times. The Contractor shall provide an emergency supply management plan within 60 days of award, which details their emergency medical supply plan. The Contractor shall ensure it is utilization best practices, such as checking expiration dates and following the practice of first-in, first-out.

8.4 MEDICAL COMMUNICATIONS AND AUTOMATION SUPPORT

The Contractor will provide computers, peripherals, and automation support required to meet the TO- 004 health care requirements. Internet services for the purposes of conducting work under this contract are the responsibility of the Contractor. Should there be a requirement for a connection to the DoS OpenNet, internet service responsibility will be shared between the Government and the Contractor. Anything that maintains patient data shall become the property of the Government.

Exhibit 4 (A003) Page 16 of 23

The Contractor is responsible for providing a COR-approved solution for transmission of CT and other digital images from other locations to the Kabul-based1 radiologist for “real time” (emergency) readings and non-emergency readings.

Any PC connected to OpenNet (the DoS unclassified secure system) has to be purchased by DoS and remains DoS property. The Contractor shall not connect a personal or corporately owned computer to OpenNet. This restriction also applies to computers with HIPAA (Health Insurance Portability and Accountability Act of 1996) covered data.

8.5 MORTUARY AFFAIRS

The contractor shall provide mortuary affairs services, as described in Section C.4.1.3.5 of the IDIQ, in Kabul.

Required mortuary services include the following:

• Processing of Remains (see Section C.4.1.3.5.1A of the IDIQ)

• Treatment of Remains (see Section C.4.1.3.5.1B of the IDIQ)

• Transportation of Remains (see Section C.4.1.3.5.1C of the IDIQ)

8.6 AMBULANCE SERVICES/ EMERGENCY MEDICAL RESPONSE

The Contractor shall provide Emergency Medical Response on compounds as designated by COM at various locations in Afghanistan. All compounds fall under the Chief of Mission “umbrella” and, as such, represent diplomatic entities constituent to US Embassy Kabul.

Services will include a timely response to medical emergencies with equipment that is appropriate to manage the initial evaluation and treatment of the patient and resuscitation from any life-threatening conditions. Patient transportation will be to the closest MACC, eMACC or SMACC. Transportation may involve movement by ambulance. The ambulance service will be Government provided.

The level of response, equipment and staffing shall take into account the size of the individual compound, population at risk, historical or estimated number of ambulance calls and other data that may be available to inform these requirements. The level of response should include provision of ACLS care and Combat Life Support (or equivalent) to the compound perimeter to include the controlled access entry points. Each site will have base station communications with the Tactical Operations Center (TOC) or Base Defense Operations Center (BDOC).

8.6.1 Background and Overview

Activity will be primarily within T-walls or double stacked HESCO barriers, i.e., within the site perimeter.

However, there may be instances where it is required to transport a patient from an incident site to a higher level of medical care on a different compound or to an aerial port of debarkation for evacuation out of theater. In this case, the patient will be transported in an armored vehicle/ambulance which will be operated by a DoS –provided driver (GSO or DS hire), but staffed for patient care by the Contract medical personnel.

1 The main radiology service will be located at the Camp Seitz SMACC and must be able to provide readings 24/7;

however, the radiologist does not have to be in-theater.

Exhibit 4 (A003) Page 17 of 23

As previously detailed in Section 8.2, the Contractor will additionally provide enroute care for an emergent patient and may require movement to another Embassy compound via both Government-provided ground and air (fixed or rotary wing) assets. Medical attendants will consist of at least one EMT-P or higher level provider. Additional medical attendants may be necessary based on patient status. All medical attendants are required to wear body armor during patient movements off secured compounds. Ground patient movement in these areas also requires the patient and medical attendant to be in an up-armored vehicle, with Private Security Detail Escort at all times.

8.6.2 Operational Concept

• EMS Dispatch – will come from the Tactical Operations Center (TOC) or equivalent o TOC will log the time of receiving the call, time of the call out to the EMS duty officers, and the time of contact with the EMS duty officer o TOC will notify the on-call Medical Duty Officer of an ambulance dispatch

• EMS duty officers will respond forthwith

• EMS duty officers arrive on scene, perform triage, initial resuscitation, and any advanced services required by medical necessity.

• EMS duty officers will communicate with a Base Station (MACC or SMACC) as needed;

otherwise, operate under established protocols (which will also serve as the communication failure tools)

• EMS duty officers will deliver the patients to the MACC or SMACC

• EMS duty officers will replace unusable equipment, restock expendables with supplies from the

SMACC or MACC, and complete standard EMS run sheet

8.6.3 Scope

• EMS response with capabilities at an EMT-P/ACLS/ PHTLS level

• Develop, review, and update written protocols utilizing existing standards for the most common medical conditions

• Logistics, supply, and resupply

• Documentation, quality assurance

• Participation in Mass Casualty exercises

• Participating in teaching and outreach programs on compound

• Periodically review placement, inventory, and maintain “MASCAL” boxes on compounds

• Inventory and maintain basic EMS supplies on ambulances on site which will be used for CLS

(combat life support)– this will likely include only backboard, collars, dressings).

8.6.4 EMT Services on Embassy Compound (East & West sides)

Though there is not a contractor medical facility located on the Embassy compound, the Contractor shall be responsible for providing EMT services at the Embassy compound. The Government will provide basic office space, furnishing, and equipment on the Embassy compound for these positions.

The Contractor shall provide EMT services 24 hour, 365 days per year. The Contractor shall staff with 2 EMT-Ps on the East and 2 EMT-Ps on the West sides of the Embassy (for a total of 4 EMT-Ps) at all times of the day.

Exhibit 4 (A003) Page 18 of 23

8.7 FOOD, WATER AND FACILITY INSPECTIONS/ASSESSMENTS, INVESTIGATIONS AND TRAINING

The contractor shall provide public health oversight for all Department of State (DoS) food facilities, public facilities, Meals Ready to Eat (MREs), incoming food shipments, foodborne illness outbreaks, food handler medical clearance and training requirements, and vulnerability assessments of food facilities in Afghanistan. The contractor shall also respond to and investigate all foodborne illness outbreaks and provide guidance to DoS and other contractors as necessary.

Required services include the following:

• Quality Control and Trending (see Section C.4.1.3.7.1.2A of the IDIQ)

• Facility Inspections (see Section C.4.1.3.7.1.2B of the IDIQ)

• Public Facility Inspections (see Section C.4.1.3.7.1.2C of the IDIQ)

• Foodborne Illness Investigation (see Section C.4.1.3.7.1.2D of the IDIQ)

• Freezer Power Outage (see Section C.4.1.3.7.1.2E of the IDIQ)

• Medical Evaluation of Food Services (see Section C.4.1.3.7.1.2F of the IDIQ)

• Vulnerability Assessments (see Section C.4.1.3.7.1.2G of the IDIQ)

• Meals Ready to Eat (MREs) (see Section C.4.1.3.7.1.2H of the IDIQ)

• Bottled and Potable Water Safety (see Section C.4.1.3.7.1.2I of the IDIQ)

8.8 MORTUARY AFFAIRS

The contractor shall provide mortuary affairs services, as described in Section C.4.1.3.5 of the IDIQ, in Kabul.

8.9 PATIENT ADMINISTRATION

The contractor shall provide all records and patient administration services as described in Section C.4.1.3.4.1 of the IDIQ.

Required services and records include the following:

• Medical Records (see Section C.4.1.3.4.2A of the IDIQ)

• Patient Tracking (see Section C.4.1.3.4.2B of the IDIQ)

• Patient Reporting (see Section C.4.1.3.4.2C of the IDIQ)

• Morgue/Mortuary Affairs (see Section C.4.1.3.4.2D of the IDIQ)

8.10 REPORTING

8.10.1 Monthly Status Reports

The Contractor shall provide a Monthly Status Report (MSR) to the COR that briefly summarizes the management and technical progress to date, as well as provides the current accounting information indicated below. The Contractor shall provide at a minimum the following information:

• Status of all activities/requirements by program,

• Progress against milestones and estimated cost,

• Deliverables submitted for the period,

• Name, rate, and total billed hours by individual, Exhibit 4 (A003) Page 19 of 23

• Travel costs,

• ODC costs, and

• Defense Base Act Insurance

The Contractor shall reconcile the MSR with invoices such that they can be matched month by month.

9.0 BLOOD

The Contractor will staff the eMACC and SMACC with at least one Medical Technologist OR Medical Laboratory Scientist who will have oversight responsibility for blood management at that facility and oversight of emergency whole blood collection/transfusion. The eMACC and SMACC facilities will have a lab technician who will be trained to perform emergency cross-matching.

The SMACC will have the ability to receive, inventory, store, thaw and transfuse as needed up to 20 units of a combination of O positive and O negative blood (10 units in the eMACC if a permanent surgical capability is added) and up to 12 bags of a combination of AB and AO Fresh Frozen Plasma (6 at the eMACC if a permanent surgical capability is added). The Contractor will maintain an inventory of supplies needed to provide transfusion services. Transfusion of blood products will be done in accordance with common nursing practice standards at the direction of one of the General Medical or Surgical Officers and in conjunction with the RMO.

The Government will make blood products available at no cost through Al Udeid Air Force Base, Qatar.

The Contractor will be responsible for periodic (monthly or more often as needed) retrieval of these products, transportation to the SMACC and redistribution to the eMACC as required, to be performed in accordance with standards prescribed by the American Association of Blood Banks and the FDA for transport and storage of blood products. The provision of this supply by the Department of Defense is contingent upon the SMACC reporting the daily blood product inventory to the DoD Blood Service (with each eMACC facility reporting its inventory daily as required) (further details to be provided at a later date).

A Mass Casualty Incident could result in an immediate need for blood and blood products in excess of the supply at hand. In case of an emergency immediately requiring blood and blood products beyond what is available as noted in the preceding paragraphs, each eMACC and the SMACC will have the capacity to perform fresh whole blood collection and transfusion. This capacity, often referred to as a “walking blood bank”, should include the solicitation of potential volunteers well in advance of an emergency, appropriate screening at the time of solicitation, rapid HIV, HBV and HCV donor screening at the time of collection, necessary collection bags and filters and adherence to a well-defined protocol.

It is understood that such a program would constitute an extraordinary measure to be used only under extraordinary circumstances. Contractor should provide in detail the plan to establish, implement and follow-up such a program.

10.0 PERSONNEL

10.1 POSITION DESCRIPTION AND QUALIFICATIONS

For the following TO-004 required positions, see Attachment 1:

Exhibit 4 (A003) Page 20 of 23

• General Medical Officer o Emergency Medicine Specialist o Family Medicine Specialist o Internal Medicine Specialist

• General Surgical Officer

• Physician Assistants, Adult or Family Nurse Practitioners (Primary Care Providers)

• General Anesthesiologist

• Medical Technologist

• Medical Laboratory Technician

• General Radiologist

• EMT-P (AKA Paramedics), Registered Nurses (RNs)

• Specialty Nursing / Technical Staff

• Pharmacy Specialist

• Biomedical Equipment Technician

• Social Worker

• Dentist

• Dental Technician

• EMT

• Food, Water and Facility Inspections/Assessments, Investigations and Training Personnel o Public Health Officer/Program Director o Public Health Technicians o Food Inspector

10.2 CHIEF MEDICAL OFFICER

The Contractor shall designate one of the General Medical Officers as the Chief Medical Officer for the task order. This individual shall hold a SECRET clearance.

NOTE: In place of the Chief Medical Officer holding a SECRET clearance, the Contractor may choose to require the TO-001 Program Manager (who is dedicated to TO-004), to hold the SECRET clearance.

Should this be the case, the SECRET facility clearance requirement for TO-004 would be removed. The TO-001 Program Manager (PM), however, would then be designated as key personnel. If the Contractor chooses to have the TO-001 PM hold the SECRET clearance, it must be clearly communicated to the Contracting Officer, and a resume for the PM (key personnel) must be presented in the TO-001 proposal package.

11.0 KEY PERSONNEL

The key personnel specified in this contract are considered to be essential to work performance. The Contractor shall assign the following key personnel to this task order:

The following labor categories have been designated as key personnel:

• General Medical Officer (Family, Emergency and Internal Medical Specialist)

• General Surgical Officer

• Physician Assistant / Nurse Practitioner

• Anesthesiologist

Exhibit 4 (A003) Page 21 of 23

Position Location (e.g. Camp Seitz) Name

During the first 180 days of performance (after transition), the Contractor shall make no substitutions of key personnel unless the substitution is required due to illness, death, or termination of employment. The Contractor shall notify the Contracting Officer within 5-calendar days after the occurrence of any of these events and provide the IDIQ Section H.19 required information.

After the first 180 days of performance, the Contractor may substitute a key person if the Contractor determines that it is necessary. The Contractor shall provide notice at least 45 days prior to diverting any of the specified individuals to other programs or contracts (or as soon as possible, if an individual must be replaced, for example, as a result of leaving the employ of the Contractor), the Contractor shall notify the Contracting Officer and shall submit comprehensive justification for the diversion or replacement request…