Sol_75H70625Q00082.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

Belcourt ND 58316 PO Box 160 1300 Hospital Road Belcourt PHS Indian Hospital

IHSBELCOURT CODE 16. ADMINISTERED BYCODE

X

X

621111

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR163

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

08/28/2025 1200 CT

08/14/2025

701-477-8416JODY LONGIE

(No collect calls)

INFORMATION CALL:

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

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70625Q00082

5. SOLICITATION NUMBER

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

1 98 IHS1512474OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Belcourt ND 58316 PO Box 160 1300 Hospital Road Q.N.B.M.H.C.F

BELCOURT SERVICE UNIT

15. DELIVER TO

Belcourt ND 58316 P.O. Box 160 1300 Hospital Road

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$16

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)

Belcourt PHS Indian Hospital

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.

Firm Fixed Priced, Non-Personal, Healthcare Service, Commercial Item, Purchase Order for Temporary CRNA Provider, for the Quentin N Burdick Memorial Healthcare Facility, 1300 Hospital Loop, located in Belcourt, North Dakota.

The period of performance will be TBD for 60 months after the award.

The Unit Price is an all-inclusive cost.

All-inclusive cost is defined to include travel, (Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

NICHOLE R. LEREW

. 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.

lodging, per diem, fringe benefits, i.e., life insurance, social security, federal, state, and local taxes, plus all other costs pertinent to the performance of this purchase.

Attachments:

*Performance Work Statement (PWS)

*SF-1449

*Clauses Incorporated by Reference and Full Text

*Contractors Performance Conditions &

Responsibilities

*Indian Firm Representative Form

*Business Associates Agreement

*Wage Grade Determination

Delivery: 09/30/2030

Period of Performance: 10/01/2025 to 09/30/2030

1 CRNA Provider Services-Quentin N Burdick Memorial

Healthcare Facility Estimated 3,080 hours for a

12-month period overall capacity of 15,400 hours for the ordering period of 60 months.

Invoice Processing Platform (IPP)

The Indian Health Service (IHS) is in the process of implementing an electronic invoicing system.

In compliance with the Office of Management and

Budget (OMB) M-15-19 memorandum, Improving

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

98 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 98

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70625Q00082

Government Efficiency and Saving Taxpayer Dollars

Through Electronic Invoicing, directing Federal agencies to adopt electronic invoicing as the primary means to disburse payment to vendors.

Invoices submitted under any award resulting from this solicitation will be required to utilize the

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

Processing of Payment Requests.

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

Treasurys Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St.

Louis (FRSTL). Respondents to this solicitation are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register- however, we encourage you make sure your organization and designated IPP user accounts are valid and up to date.

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

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

IPPCustomerSupport@fiscal.treasury.gov

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.

SECURITY CLEARANCE

A security pre-clearance must be performed for any employees referred to IHS through this contract. Fingerprints must be completed and adjudicated prior to services being performed under this contract.

No contract award shall be made to any vendor or provider listed on the OIG Exclusion List http://exclusions.oig.hhs.gov throughout the

Continued ...

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

Sponsored by GSA

FAR (48 CFR) 53.110

4 98

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70625Q00082 duration of the contract. It shall be the responsibility of the contractor to notify the acquisition official if there is a change in provider.

Performance of this contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (I.H.S.).

Before starting work requiring routine access to

I.H.S. facilities or systems each person must complete a FBI National Criminal History Check

(Fingerprint Check) adjudicated by an I.H.S.

employee using the Office of Personnel Management

Personnel Investigations Processing System.

Contractors shall allow five business days for

I.H.S. processing of fingerprints taken electronically at an I.H.S. site and thirty business days for non-electronic processing of fingerprints using FBI Form FD-258. A list of

I.H.S. sites with electronic fingerprint capability is available from the Contracting

Officer.

In addition, no Contractor or subcontractor employee shall be permitted to perform work under this contract if listed on the HHS Office of

Inspector General List of Excluded

Individuals/Entities (LEIE), http://exclusions.oig.hhs.gov. As soon as practicable prior to the start of work, the performance of the work the Contractor shall provide to the Contracting Officer the names of all individuals to be used in performance of work for screening against the LEIE. During the performance, the Contractor shall provide the

Contracting Officer the names of any additional or substitute employees for screening before they begin work.

The Contractor is responsible for conducting security preclearance investigations in sufficient depth to ensure that each Contractor or subcontractor employee referred to I.H.S. is not on the LEIE and can obtain a favorable fingerprint clearance. Each security preclearance shall be conducted sufficiently in advance of the

Continued ...

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

5 98

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70625Q00082 start of performance to avoid delays caused by denial of access. If this is a Time and

Materials, Labor-Hour or Cost Reimbursement contract, the contractor shall not charge for or be reimbursed for labor hours or other costs incurred for employees who are unable to perform due to denial or access or the excess time required to resolve and clear unfavorable security clearance findings. If this is a Fixed

Price contract, denial of access due to security clearance findings shall not be a basis for excusable delay or an increase to the contract amount.

Government will pay for the cost to process the contractors suitability clearances. However, multiple investigations for the same position may, at the Contracting Officers discretion, lead to reduction(s) in the contract price of no more than the cost of the extra investigation(s).

Employees that DO NOT have access to LMS, contractors, volunteers, or IHS employees with

IPA?s or MOA?s to tribal organizations please, click here IHS Sexual Abuse Prevention website.

When the contractors have completed and passed the training, please have them send a copy of the last page of the training with Name, Date, and

Time to their Supervisor, COR, and Kimmen LeBeau, e-mail: Kimmen.LeBeau@ihs.gov

The Government reserves the right to accept or reject services, if the level of performance is unacceptable.

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

A. This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Federal Acquisition Regulation (FAR) Subpart 13.106-2(a)(2). Evaluation of quotations or offers. Quotations or offers shall be evaluated on the basis established in the solicitation. This announcement constitutes the only solicitation; quotes are being requested, and a written solicitation will not be issued.

B. The Great Plains Area Indian Health Service (IHS) intends to award a Firm- Fixed Price, Non- Personal Temporary Certified Registered Nurse Anesthetist (CRNA), Purchase Order with an Estimated 3,080 hours for a 12-month period overall capacity of 15,400 hours for the ordering period of 60 months in response to Request for Quote (RFQ) 75H70625Q00082.

C. This solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2025-04 on June 11, 2025.

D. This RFQ is issued as 100% Indian Small Business Economic Enterprises (ISBEE) Set-Aside, and the associated NAICS Code is #621111, code for Offices of Physicians (except Mental Health Specialists), including CRNA practices, is 621111. This means that for a business to be considered a small business under this NAICS code, its average annual receipts cannot exceed $16.0 million. Quoter is required to fill out the attached INDIAN FIRM

REPRESENTATION FORM.

E. The quoted unit pricing must be all inclusive (including, but not be limited to, travel, lodging, per diem, fringe benefits, federal, state and local taxes) plus all other costs pertinent to the performance of this contract. Utilize your most competitive and reasonable rates.

See the attached SF-1449: Complete, sign and return the SF-1449 along with the Business Associates Agreement for the Quote #75H70625Q00082 for Temporary Certified Registered Nurse Anesthetist (CRNA).

Quotes will be valid until September 30, 2025.

F. Firm Fixed Price, Non-Personal Temporary Certified Registered Nurse Anesthetist (CRNA) to be provided for the Quentin N Burdick Memorial Healthcare Facility 1300 Hospital Loop Belcourt North Dakota 58316. See the Performance Work Statement (PWS) attached. The period of performance will be 60 months.

G. FAR 52.212-1 Instructions to Offerors-Commercial Products and

Commercial Services (SEP 2023).

Quotes shall be submitted on company letterhead stationery, signed, dated and it shall include:

1. Solicitation number: 75H70625Q00082

2. Closing Date: August 28, 2025 , at 12:00 pm CST.

3. Name, address and telephone number of company and email address of contact person.

4. Technical description of the item/service being offered in sufficient detail to evaluate compliance with the requirements of the solicitation. This may include product literature, or other documents, if necessary.

5. Terms of any express warranty.

6. Price and any discount terms.

7. “Remit to” address, if different than mailing address.

8. A completed copy of the representations and certifications at FAR

52.212-3 (see FAR 52.212-3(b) for those representations and certifications that the offeror shall complete electronically).

9. Acknowledgment of Solicitation Amendments (if any issued)

10. Past performance information, when included as an evaluation factor, to include recent and relevant contracts for the same or similar items and other references (including contract numbers, points of contact with telephone numbers and other relevant information).

11. A statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offerors that fail to furnish required representations or information or reject the terms and conditions of the solicitation may be excluded from consideration.

H. FAR 52.212-2 Evaluation-Commercial Products and Commercial Services (Nov 2021);

attached in full text.

Basis of Award: Best Value with Lowest Price Technical Acceptable.

The Government will evaluate quotations utilizing the procedures of FAR 13.106-2 Evaluation of quotations or offers. Offers will be evaluated for acceptability but not ranked using the non-price factors/sub-factors. All non-price factors and sub-factors will be rated as either “acceptable” or “unacceptable”. The Government intends to evaluate and make an award without discussion with the offerors other than minor clarifications, unless discussions are determined to be necessary. A decision on the technical acceptability of each offeror’s quotations will be made. For those offerors which are determined to be technically acceptable, awards will be made to that vendor with the lowest overall prices.

The LPTA evaluation process will be accomplished as follows - Technical Acceptability will be comprised of five subfactors:

1. TECHNICAL CAPABILITIES

The technical capabilities evaluation factor will assess the depth and breadth of the offeror’s experience in providing CRNA services to the Outpatient/Inpatient Units at the Quentin N. Burdick Health Care Facility, Belcourt, ND-Indian Health Service. The technical proposal shall indicate how the Contract services are compliant with rules, regulations, and policies prescribed by regulatory agencies and bodies such as the Joint Commission (TJC), Department of Health and Human Services, HIS Headquarters, Centers for Medicare and Medicaid Services (CMS). In assessing the offeror’s technical capabilities, the proposal will be judged solely on the written material provided by the offeror.

2. TECHNICAL APPROACH

(a) Solicitation Submittal Requirements:

Proposals, which merely offer a statement to conduct/provide services in accordance with the requirements in the Governments SOW, will not be eligible for award. The offeror must submit an explanation that meet the requirements identified under Performance-Based Service Delivery Summary; Completion of documentation of patient record, Prompt and continuous coverage and Credentialing.

3. MANAGEMENT CAPABILITIES

Proposals, which merely offer a statement to conduct/provide services in accordance with the requirements in the Governments SOW, will not be eligible for award. The offeror must submit an explanation that identifies the offeror’s management capabilities and responsibilities to meet the following: Tour of Duty/Schedule, Description of Services, Contractor Responsibility and Personnel Requirement.

4. PAST PERFORMANCE AND EXPERIENCE

Offerors do not need to provide any information under this factor as the US

Government will base the evaluation on all INTERIM and FINAL Contractor Performance

Assessment Reports (CPARs) that are recent and relevant. The CPARs will be retrieved from official US

Government sources, including, but not limited to, the Contractor Performance Assessment Reporting System and the Past Performance Information Retrieval System.

(b) Basis of Evaluation:

Recency:

For the purposes of this solicitation, a past performance record is recent if the CPAR final date of assessment listed in the “Period of Performance Being Assessed” block is within the 24 month period preceding the proposal due date.

Relevancy:

For the purposes of this solicitation, a past performance record is relevant if the CPAR business sector is listed as “Services ”.

In order to receive an "acceptable" rating for this factor, an Offer's recent and relevant CPARs must NOT include one or more INTERIM and/or FINAL CPARs with a rating of "UNSATISFACTORY" in one or more categories OR one or more INTERIM and/or FINAL CPARs with a rating of "MARGINAL" in two or more categories. If an Offeror has one or more CPARs with a rating of "UNSATISFACTORY" in one or more categories OR one or more CPARs with a rating of "MARGINAL" in two or more categories, the Offeror's past performance will be evaluated as "UNACCEPTABLE".

In the case of an Offeror without a record of recent and relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the Offeror may not be evaluated favorably or unfavorably on past performance. Therefore, the Offeror shall be determined to have unknown past performance. In the context of acceptability/unacceptability, “unknown” shall be considered “acceptable.” An “UNACCEPTABLE” rating for a single factor will result in the Offeror’s entire proposal being rated “UNACCEPTABLE”.

5. PRICE

Completed Price Schedule Sheet

(b) Basis of Evaluation:

The Government will evaluate price based on the total proposed price calculated as the sum of bid item Estimated 3,100 hours for a 12-month period overall capacity of 15,500 hours for the ordering period of 60 months that includes Contract cost, Subcontractor cost, Overhead and Profit. Analysis will be performed by one or more of the following techniques to ensure a fair and reasonable price:

(i) Comparison of proposed prices received in response to the RFP.

(ii) Comparison of proposed prices with the IGE.

(iii) Comparison of proposed prices with available historical information.

Note: A price that is found to be either unreasonable high or unrealistically low in relation to the proposed work may be indicative of an inherent lack of understanding of the solicitation requirements and may result in the overall proposal being considered unacceptable.

I. FAR 52.212-3 Offer Representations and Certifications-Commercial Products and Commercial Services (May 2024). See attachment for full text. The Offeror shall complete only paragraphs

(b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) website accessed through http://www.acquisition.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (p) of this provision.

J. FAR 52.212-4 Contract Terms and Conditions-Commercial Products and Commercial

Services (Nov 2023). Applied to this acquisition and it’s by reference.

K. FAR 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders Commercial Products and Commercial Services (Jan 2025).

See attachment for full text.

L. FAR 52.214-16 Minimum Bid Acceptance Period (April 1984). See attachment for full text.

M. Attached are the Federal Acquisition Regulations (FAR) & Health & Human Services Acquisition Regulation (HHSAR) clauses that are applicable, including below.

N. Submit proposal to:

Quentin N Burdick Memorial Healthcare Facility Attn: Jody Keplin, Purchasing Agent 1300 Hospital Loop Belcourt, ND 58316 Email: jody.keplin@ihs.gov

Questions regarding to this solicitation shall be submitted in writing by either email to jody.keplin@ihs.gov. The last day to submit questions is August 8/20/2025, before 12:00 pm, CT.

Will only accept 10 pages for the CRNA services proposal.

SECURITY CLEARANCE

A security pre-clearance must be provided for any employees referred to IHS through this contract.

Fingerprints must be completed and adjudicated prior to services being performed under this contract.

No contract award shall be made to any vendor or provider listed on the OIG Exclusion List http://exclusions.oig.hhs.gov throughout the duration of the contract. It shall be the responsibility of the contractor to notify the acquisition official if there is a change in provider.

Performance of this contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (I.H.S.). Before starting work requiring routine access to I.H.S. facilities or systems, each person must complete a FBI National Criminal History Check (Fingerprint Check) adjudicated by an I.H.S. employee using the Office of Personnel Management Personnel Investigations Processing System. Contractors shall allow five business days for I.H.S. processing of fingerprints taken electronically at an I.H.S. site and thirty business days for non-electronic processing of http://www.acquisition.gov/ mailto:jody.keplin@ihs.gov mailto:jody.keplin@ihs.gov http://exclusions.oig.hhs.gov/ fingerprints using FBI Form FD-258. A list of I.H.S. sites with electronic fingerprint capability is available from the Contracting Officer.

In addition, no Contractor or subcontractor employee shall be permitted to perform work under this contract if listed on the HHS Office of Inspector General List of Excluded Individuals/Entities (LEIE), http://exclusions.oig.hhs.gov. As soon as practicable prior to the start of work, the performance of the work the Contractor shall provide to the Contracting Officer the names of all individuals to be used in performance of work for screening against the LEIE. During the performance, the Contractor shall provide the Contracting Officer the names of any additional or substitute employees for screening before they begin work.

The Contractor is responsible for conducting security pre-clearance investigations in sufficient depth to ensure that each Contractor or subcontractor employee referred to I.H.S. is not on the LEIE and can obtain a favorable fingerprint clearance. Each security preclearance shall be conducted sufficiently in advance of the start of performance to avoid delays caused by denial of access. If this is a Time and Materials, Labor-Hour or Cost Reimbursement contract, the contractor shall not charge for or be reimbursed for labor hours or other costs incurred for employees who are unable to perform due to denial or access, or the excess time required to resolve and clear unfavorable security clearance findings. If this is a Fixed Price contract, denial of access due to security clearance findings shall not be a basis for excusable delay or an increase to the contract amount.

Government will pay for the cost to process the contractor’s suitability clearances. However, multiple investigations for the same position may, at the Contracting Officers discretion, lead to reduction(s) in the contract price of no more than the cost of the extra investigation(s).

Employees that DO NOT have access to LMS, contractors, volunteers, or IHS employees with IPA’s or MOA’s to tribal organizations please, click here IHS Sexual Abuse Prevention website. When the contractors have completed and passed the training, please have them send a copy of the last page of the training with Name, Date, and Time to their Supervisor, COR, and Kimmen LeBeau, e-mail: Kimmen.LeBeau@ihs.gov.

Invoice Processing Platform (IPP)

The Indian Health Service (IHS) is in the process of implementing 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 payment to vendors. Invoices submitted under any award resulting from this solicitation will be required to utilize the Invoice Processing Platform (IPP) in accordance with HHSAR 352.232-71, Electronic Submission and Processing of Payment Requests.

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the Treasury’s Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis (FRSTL). Respondents to this solicitation are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register- however, we encourage you to make sure your organization, and designated IPP user accounts are valid and up to date.

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

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

“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”.

http://exclusions.oig.hhs.gov/ https://www.ihs.gov/sexualabuseprevention/training/ mailto:Kimmen.LeBeau@ihs.gov https://obamawhitehouse.archives.gov/sites/default/files/omb/memoranda/2015/m-15-19.pdf https://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov

ATTACHMENTS:

Combined Synopsis Notice SF-1449 Request for Quotes Performance Work Statement Provisions and Clauses Contractor’s Performance Conditions Indian Firm Representative Form Business Associate Agreement

Wage Determination Number # 2015-5385

PERFORMANCE WORK STATEMENT

Certified Registered Nurse Anesthetist (CRNA) Quentin N. Burdick Memorial Health Care Facility.

Part 1

General Information

1. GENERAL: This is a non-personnel services contract to provide a Certified Registered Nurse Anesthetist (CRNA). The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1 Description of Services/Introduction: The contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and non-personal services necessary to perform the duties of a Certified Registered Nurse Anesthetist (CRNA) as defined in this Performance Work Statement, except for those items specified as government furnished property and services. The contractor shall perform to the standards in this contract.

1.2 Background: The Mission of the Quentin Burdick Memorial Healthcare Facility Indian Health Service is to provide the best possible healthcare services to the patients of the Quentin Burdick Memorial Healthcare Facility Indian Health Hospital. To meet this mission, the Quentin Burdick Memorial Healthcare Facility Service Unit has identified a need for a Non-Personal Service Contract for providing medical services for a Certified Registered Nurse Anesthetist (CRNA)).

1.3 Objectives: The contract Certified Registered Nurse Anesthetist (CRNA) agrees, to provide all necessary covered services within the Certified Registered Nurse Anesthetist (CRNA) scope of practice, under the direction of the Clinical Director or designee.

• The Contracted Certified Registered Nurse Anesthetist (CRNA) shall provide a full scope of Anesthetic services to include patients of all ages at the Quentin Burdick Memorial Healthcare Facility Service Unit

1.4 Scope: Provide medical care services for Anesthetic services. Services include providing direct care to patients of all ages with a variety of medical, surgical, pediatric, geriatric, gynecological, and health maintenance needs. The Indian Health Service requires Certified Registered Nurse Anesthetist (CRNA) services as described above to continue without interruption during the term of this contract. The contractor shall accomplish medical care provided by the Contracted Certified Registered Nurse Anesthetist (CRNA) and shall be as comprehensive as the Indian Health Service supplied facilities, equipment, and support services permit.

The contract resulting from this solicitation shall:

a. Be a non-personal health care services contract under which the contractor is an independent contractor;

b. Require the contractor to promptly provide any and all requested information to allow for the proper credentialing and privileging of medical providers.

c. Allow the government to evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of the services rendered, (e.g., professional judgments, diagnosis for specific medical treatment);

d. Require the contractor to indemnify the government for any liability producing act of omission by the contractor, its employees and agents occurring during contract performance;

e. Require the contractor to maintain medical liability insurance, in the coverage amount acceptable to the contracting officer, which is not less than the amount normally prevailing with the local community for the medical specialty concerned; and

f. Require the contractor to ensure its subcontracts for provisions of health care services, contain the requirements of the clause at FAR 52.237-7 (Indemnification and Medical Liability Insurance), including the maintenance of medical liability insurance and meet the Quentin Burdick Memorial Healthcare Facility Indian Health Hospital’s accreditation requirements with regard to professional credentials including any support staff.

g. Candidates with prior Advanced Nursing Licensure actions are not eligible for temporary privileges. The process of granting of privileges by the facility Governing Body may take up to 3 months.

h. The standards of medical practice and duties of the contractor through its provider shall be determined pursuant to the bylaws of the Belcourt I.H.S. Hospital. The regulations of the hospital, applicable provisions of law, other rules and regulations of any and all governmental authorities relating to licensure and regulation of anesthesia providers and hospitals must be followed

1.5 Period of Performance: The Period of Performance shall be listed on the Task Order as scheduled with the Clinical Director or designated representative. The Certified Registered Nurse Anesthetist (CRNA) shall provide Anesthesia services, for the entire Period of Performance at the Quentin Burdick Memorial Healthcare Facility. The usual work day will be from 7:00 am to 3:30 pm weekdays. The CRNA shall schedule and perform procedures as appropriate.

1.6 The contractor will provide all call-back services including weeknights, weekends and holidays.

1.6.1 Quality Control: The contractor shall develop and maintain an effective quality control program to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract. The QCP is to be delivered within 30 days after contract award or with the contractors proposal if it is an evaluation factor, three copies of a comprehensive written QCP shall be submitted to the CO and COR within 5 working days when changes are made thereafter. After acceptance of the quality control plan the contractor shall receive the contracting officer’s acceptance in writing of any proposed change to his QC system.

1.6.2 Quality Assurance: The government shall evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and the minimum acceptable defect rate(s).

1.6.3 Recognized Holidays: The provider will be required to be on-call for Federal Government holidays, weeknights and weekends as depicted in schedules provided upon issuance of Task Order.

New Year’s Day Labor Day Martin Luther King Jr.’s Birthday Columbus Day President’s Day Veteran’s Day Memorial Day Thanksgiving Day Independence Day Christmas Day Juneteenth

1.6.4 Hours of Operation: The contractor is responsible for conducting business, between the hours of 7:00 am-3:30 pm Monday thru Friday except Federal holidays or when the Government facility is closed due to local or national emergencies, administrative closings, or similar Government directed facility closings.

For other than firm fixed price contracts, the contractor will not be reimbursed when the government facility is closed for the above reasons. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS when the Government facility is not closed for the above reasons. When hiring personnel, the Contractor shall keep in mind that the stability and continuity of the workforce are essential. On call is for a 24 hour time period, commencing 7:00 am on day of call and ending 7:00 am the next day.

1.6.5 Place of Performance: The work to be performed under this contract will be performed at Quentin N.

Burdick Health care facility, Belcourt, ND which is an Indian Health Service government facility.

1.6.6 Type of Contract: The government will award a firm-fixed price, non-personal service contract.

1.6.7 Security Requirements: The Contracted Certified Registered Nurse Anesthetist (CRNA) is subject to a background investigation and shall comply with Section 231 of the Crime Control Act of 1990, P.L. 101- 647; and the Indian Child Protection and Family Violence Prevention Act, P.L. 101-630. In addition, the nurse shall also comply with the Privacy Act of 1974 and the HIPPA Act of 1996. Failure to comply with these statutes will result in immediate removal.

a. Contractor personnel performing work under this contract, which involve regular contact with, or control over, Indian children, are subject to a character investigation in accordance with the “Indian Child Protection and Family Violence Prevention Act” P.L.

101-630. The Indian Health Service Personnel Office will conduct these investigations following award of a contract unless in the judgment of the Contracting Officer, in consultation with the Personnel Officer, investigation may be waived based on prior investigations on file. Until the character investigation has been completed and the Contracting Officer notified, such individual shall not have unsupervised contact with Indian children.

b. The Contracting Officer has the authority to temporarily waive the character investigation of a contractor. The “Agreement to a Temporary Waiver of Character Investigation” (See Attachment B) authorizes an agency to hire a contractor prior to the completion of a background check provided that at all times the contractor is within the sight and under the supervision of a government employee who has successfully completed the National Agency Check with written Inquiries (NACI).

c. This level of security is required, and must be maintained for the life of the contract.

1.6.7.1 PHYSICAL Security: The contractor shall be responsible for safeguarding all government equipment, information and property provided for contractor use. At the close of each work period, government facilities, equipment, and materials shall be secured. The contracted Medical-Surgical RN shall generate and maintain proper medical record information on beneficiaries to whom treatment is provided, in accordance with Indian Health Service regulations. The contracted nurse shall prepare all medical records documentation to meet or exceed the established standards of the I.H.S. facility to include, but not be limited to: timeliness, legibility, accuracy, content, and signature. All medical record information generated in the performance of the contract will be subject to the exclusive control of the Indian Health Service.

1.6.7.2 Key Control: The Contractor shall establish and implement methods of making sure all keys/key cards issued to the Contractor by the Government are not lost or misplaced and are not used by unauthorized persons. NOTE: All references to keys include key cards. No keys issued to the Contractor by the Government shall be duplicated. The Contractor shall develop procedures covering key control that shall be included in the Quality Control Plan. Such procedures shall include turn-in of any issued keys by personnel who no longer require access to locked areas. The Contractor shall immediately report any occurrences of lost or duplicate keys/key cards to the Contracting Officer.

1.6.7.2.1. In the event keys, other than master keys, are lost or duplicated, the Contractor shall, upon direction of the Contracting Officer, re-key or replace the affected lock or locks; however, the Government, at its option, may replace the affected lock or locks or perform re-keying. When the replacement of locks or re-keying is performed by the Government, the total cost of re-keying or the replacement of the lock or locks shall be deducted from the monthly payment due the Contractor. In the event a master key is lost or duplicated, all locks and keys for that system shall be replaced by the Government and the total cost deducted from the monthly payment due the Contractor.

1.6.7.2.2. The Contractor shall prohibit the use of Government issued keys/key cards by any persons other than the Contractor’s employees. The Contractor shall prohibit the opening of locked areas by Contractor employees to permit entrance of persons other than Contractor employees engaged in the performance of assigned work in those areas, or personnel authorized entrance by the Contracting Officer.

1.6.8 Special Qualifications: It is a condition of this contract that all required certifications remain current during the life of this contract.

The contractor is responsible for ensuring the contracted Certified Registered Nurse Anesthetist (CRNA)) shall possess a current, unrestricted state Nursing license from any of the 50 United States or the Commonwealth of Puerto Rico, be registered with a Professional Certification Board and registered with a State Licensure.

Possess current (BLS) Basic Life Support certification, (PALS) Pediatric Advanced Life Support, (NRP) Neonatal Resuscitation Program, and (ACLS) Advanced Cardiac Life Support is required.

The contractor is responsible for ensuring the contracted Certified Registered Nurse Anesthetist (CRNA) shall

a. Not have any work or health restrictions, which interfere with the performance of general medical services.

b. Have actively provided Anesthesia within the past year.

c. Have skill and knowledge in providing medical care with full consideration of the mental, emotional, physical, and cultural factors involved, such that he/she can relate constructively to patients from the Native American community.

d. Ability to work with patients, the public, and hospital staff.

1.6.9 Post Award Conference/Periodic Progress Meetings: The Contractor agrees to attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The contracting officer, Contracting Officers Representative (COR), and other Government personnel, as appropriate, may meet periodically with the contractor to review the contractor's performance. At these meetings the contracting officer will apprise the contractor of how the government views the contractor's performance and the contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues.

These meetings shall be at no additional cost to the government.

1.6.10 Contracting Officer Representative (COR): The (COR) will be identified by separate letter. The COR monitors all technical aspects of the contract and assists in contract administration The COR is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance:

maintain written and oral communications with the Contractor concerning technical aspects of the contract:

issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the COR, a copy of which is sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order.

1.6.11 Key Personnel: The follow personnel are considered key personnel by the government:

MD/Clinical Director - Dr. Gilbert Falcon or Dr. Shyleen Hall

Credentialing Coordinator – Jennilee Blue

COR – Yvette Wallette

The contractor shall provide a contract manager who shall be responsible for the performance of the work.

The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between 8:00 a.m. to 4:30p.m., Monday thru Friday except Federal holidays or when the government facility is closed for administrative reasons.

1.6.12 Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed. The contractor personnel will be required to obtain and wear badges in the performance of this service.

1.6.13 Contractor Travel: The Contractor shall be responsible for arranging travel and all associated costs related to the performance of this contract.

1.6.14 Other Direct Costs: The Contractor shall be responsible for arranging travel, lodging, per diem, labor, fringe benefits, and any applicable Federal, State, and Local taxes, plus any other costs pertinent to the performance of this contract.

1.6.15 Data Rights: The Government has unlimited rights to all documents/material produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the Contracting Officer. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.6.16 Organizational Conflict of Interest: Contractor and subcontractor personnel performing work under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.) or perform evaluation services which may create a current or subsequent Organizational Conflict of Interests (OCI) as defined in FAR Subpart 9.5. The Contractor shall notify the Contracting Officer immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the Contracting Officer to avoid or mitigate any such OCI. The Contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the Contracting Officer and in the event the Contracting Officer unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the Contracting Officer may effect other remedies as he or she deems necessary, including prohibiting the Contractor from participation in subsequent contracted requirements which may be affected by the OCI.

1.7 General Information:

1.7.1 Credentialing Requirements:

• Verification of Professional references will be completed by the Clinical Director or Designee prior to acceptance of contract CRNA. An Initial presentation form will be sent to the contractor to be completed. Required information on the form must be entered and returned to the Credentialing Coordinator of the I.H.S facility.

Jennilee Blue, Credentialing Coordinator Jennilee.Blue@ihs.gov Quentin N. Burdick Memorial Health Care Facility 1300 Hospital Loop PO Box 160 Belcourt, ND 58316 Main Line: (701)477-6111 Direct Line: (701)477-8427 Fax: (701)477-2539 mailto:Jennilee.Blue@ihs.gov

PART 2

DEFINITIONS & ACRONYMS

2. DEFINITIONS AND ACRONYMS:

2.1. DEFINITIONS:

2.1.1. CONTRACTOR. A supplier or vendor awarded a contract to provide specific supplies or service to the government. The term used in this contract refers to the prime.

2.1.2. CONTRACTING OFFICER(CO). A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.1.12. WORK WEEK. As specified otherwise.

2.2. ACRONYMS:

ACOR Alternate Contracting Officer's Representative AFARS Army Federal Acquisition Regulation Supplement CRNA Certified Registered Nurse Anesthetist

CCE Contracting Center of Excellence CFR Code of Federal Regulations CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative COTR Contracting Officer's Technical Representative COTS Commercial-Off-the-Shelf IHS Indian Health Service DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List…