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SCHEDULE OF SERVICES
The contractor shall provide emergent and non-emergency medical care vehicle service to beneficiaries of the Department of Veterans Affairs cared for by the Omaha VA Medical Center, 4101 Woolworth Avenue, Omaha, NE, 68105, in accordance with all terms, conditions, provisions and the Schedule of this solicitation.
BASE PERIOD: February 29, 2024 – February 28, 2025
| CLIN |
| Description |
| Estimated Annual Quantity |
| Unit Amount |
| Total Amount |
| 0001 |
| A0434 – Specialty Care Transport (SCT) |
| 5 trips |
| 0002 |
| A0433 – ALS, Level 2 (ALS 2) – |
Emergency & Non-Emergency 50 trips
| 0003 |
| A0426 – ALS, Level 1 (ALS 1) – Non-Emergency |
| 250 trips |
| 0004 |
| A0427 – ALS, Level 1, (ALS 1 – Emergency) |
Emergency 20 trips
| 0005 |
| A0428 - BLS (BLS) - Non-Emergency |
| 560 trips |
| 0006 |
| A0429 – BLS (BLS – Emergency) - Emergency |
| 20 trips |
| 0007 |
| A0420 – Ambulance Waiting Time, ½ hour (ALS or BLS) |
| 30 half hours |
| 0008 |
| A0422 – Oxygen & Oxygen Supplies (ALS or BLS) |
| 30 trips |
| 0009 |
| A0424 – Extra Ambulance Attendant (Right Along) |
| 5 trips |
| 0010 |
| A0424 – Extra Ambulance Attendant (Lift Assist) |
| 20 trips |
| 0011 |
| A0425 – Ground Mileage |
| 36,000 miles |
| 0012 |
| A0999 – Unlisted Ambulance Service |
(Trip Cancellation / Dry Run) 25 trips
TOTAL – BASE PERIOD
OPTION YEAR I PERIOD: March 1, 2025 – February 28, 2026
| CLIN |
| Description |
| Estimated Annual Quantity |
| Unit Amount |
| Total Amount |
| 1001 |
| A0434 – Specialty Care Transport (SCT) |
| 5 trips |
| 1002 |
| A0433 – ALS, Level 2 (ALS 2) – |
50 trips
| 1003 |
| A0426 – ALS, Level 1 (ALS 1) – Non-Emergency |
| 250 trips |
| 1004 |
| A0427 – ALS, Level 1, (ALS 1 – Emergency) |
20 trips
| 1005 |
| A0428 - BLS (BLS) - Non-Emergency |
| 560 trips |
| 1006 |
| A0429 – BLS (BLS – Emergency) - Emergency |
| 20 trips |
| 1007 |
| A0420 – Ambulance Waiting Time, ½ hour (ALS or BLS) |
| 30 half hours |
| 1008 |
| A0422 – Oxygen & Oxygen Supplies (ALS or BLS) |
| 30 trips |
| 1009 |
| A0424 – Extra Ambulance Attendant (Right Along) |
| 5 trips |
| 1010 |
| A0424 – Extra Ambulance Attendant (Lift Assist) |
| 20 trips |
| 1011 |
| A0425 – Ground Mileage |
| 36,000 miles |
| 1012 |
| A0999 – Unlisted Ambulance Service |
25 trips
TOTAL – OPTION YEAR I PERIOD
OPTION YEAR II PERIOD: March 1, 2026 – February 28, 2027
| CLIN |
| Description |
| Estimated Annual Quantity |
| Unit Amount |
| Total Amount |
| 2001 |
| A0434 – Specialty Care Transport (SCT) |
| 5 trips |
| 2002 |
| A0433 – ALS, Level 2 (ALS 2) – |
50 trips
| 2003 |
| A0426 – ALS, Level 1 (ALS 1) – Non-Emergency |
| 250 trips |
| 2004 |
| A0427 – ALS, Level 1, (ALS 1 – Emergency) |
20 trips
| 2005 |
| A0428 - BLS (BLS) - Non-Emergency |
| 560 trips |
| 2006 |
| A0429 – BLS (BLS – Emergency) - Emergency |
| 20 trips |
| 2007 |
| A0420 – Ambulance Waiting Time, ½ hour (ALS or BLS) |
| 30 half hours |
| 2008 |
| A0422 – Oxygen & Oxygen Supplies (ALS or BLS) |
| 30 trips |
| 2009 |
| A0424 – Extra Ambulance Attendant (Right Along) |
| 5 trips |
| 2010 |
| A0424 – Extra Ambulance Attendant (Lift Assist) |
| 20 trips |
| 2011 |
| A0425 – Ground Mileage |
| 36,000 miles |
| 2012 |
| A0999 – Unlisted Ambulance Service |
25 trips
TOTAL – OPTION YEAR II PERIOD
OPTION YEAR III PERIOD: March 1, 2027 – February 29, 2028
| CLIN |
| Description |
| Estimated Annual Quantity |
| Unit Amount |
| Total Amount |
| 3001 |
| A0434 – Specialty Care Transport (SCT) |
| 5 trips |
| 3002 |
| A0433 – ALS, Level 2 (ALS 2) – |
50 trips
| 3003 |
| A0426 – ALS, Level 1 (ALS 1) – Non-Emergency |
| 250 trips |
| 3004 |
| A0427 – ALS, Level 1, (ALS 1 – Emergency) |
20 trips
| 3005 |
| A0428 - BLS (BLS) - Non-Emergency |
| 560 trips |
| 3006 |
| A0429 – BLS (BLS – Emergency) - Emergency |
| 20 trips |
| 3007 |
| A0420 – Ambulance Waiting Time, ½ hour (ALS or BLS) |
| 30 half hours |
| 3008 |
| A0422 – Oxygen & Oxygen Supplies (ALS or BLS) |
| 30 trips |
| 3009 |
| A0424 – Extra Ambulance Attendant (Right Along) |
| 5 trips |
| 3010 |
| A0424 – Extra Ambulance Attendant (Lift Assist) |
| 20 trips |
| 3011 |
| A0425 – Ground Mileage |
| 36,000 miles |
| 3012 |
| A0999 – Unlisted Ambulance Service |
25 trips
TOTAL – OPTION YEAR III PERIOD
OPTION PERIOD IV: March 1, 2028 – February 28, 2029
| CLIN |
| Description |
| Estimated Annual Quantity |
| Unit Amount |
| Total Amount |
| 4001 |
| A0434 – Specialty Care Transport (SCT) |
| 5 trips |
| 4002 |
| A0433 – ALS, Level 2 (ALS 2) – |
50 trips
| 4003 |
| A0426 – ALS, Level 1 (ALS 1) – Non-Emergency |
| 250 trips |
| 4004 |
| A0427 – ALS, Level 1, (ALS 1 – Emergency) |
20 trips
| 4005 |
| A0428 - BLS (BLS) - Non-Emergency |
| 560 trips |
| 4006 |
| A0429 – BLS (BLS – Emergency) - Emergency |
| 20 trips |
| 4007 |
| A0420 – Ambulance Waiting Time, ½ hour (ALS or BLS) |
| 30 half hours |
| 4008 |
| A0422 – Oxygen & Oxygen Supplies (ALS or BLS) |
| 30 trips |
| 4009 |
| A0424 – Extra Ambulance Attendant (Right Along) |
| 5 trips |
| 4010 |
| A0424 – Extra Ambulance Attendant (Lift Assist) |
| 20 trips |
| 4011 |
| A0425 – Ground Mileage |
| 36,000 miles |
| 4012 |
| A0999 – Unlisted Ambulance Service |
25 trips
TOTAL – OPTION PERIOD IV
