Sol_75H70625Q00187.pdf

75H70625Q00187

1. REQUEST NO.

5a. ISSUED BY

NAME

a. NAME

c. STREET ADDRESS

d. CITY

10. PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK 5a ON

OR BEFORE CLOSE OF BUSINESS (Date)

2. DATE ISSUED 3. REQUISITION/PURCHASE REQUEST NO. 4. CERT. FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG.1

RATING

6. DELIVERY BY (Date)

7. DELIVERY

9. DESTINATION

a. NAME OF CONSIGNEE

b. STREET ADDRESS

PAGE OF PAGES

5b. FOR INFORMATION CALL: (No collect calls)

TELEPHONE NUMBER

AREA CODE NUMBER

8. TO:

b. COMPANY

e. STATE f. ZIP CODE

c. CITY

d. STATE e. ZIP CODE

IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5a. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

THIS RFQ

REQUEST FOR QUOTATION

(THIS IS NOT AN ORDER)

IS IS NOT A SMALL BUSINESS SET ASIDEX

08/08/2025 IHS1503098

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Health Care Center Indian Health Service 100 Lake Traverse Drive

Woodrow Wilson Keeble Memorial

Sisseton SD 57262

Multiple

IHSSISSETON

100 LAKE TRAVERSE DRIVE

SISSETON SD 57262

SISSETON

SD 57262

605 268-2022ANDREA WHIPPLE

09/08/2025 1300 CT

FOB DESTINATION

OTHER

(See Schedule)X

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

100% Indian Small Business Economic Enterprise Set-Aside. Firm Fixed-Price, Non-Personal Service Delivery Order to provide Radiological Technologists Services for the Woodrow Wilson Keeble Memorial Health Care Center, Sisseton, South Dakota. Services will be provided as outlined in the Statement of Work. The period of performance will be six (6) months with nine (9) 6-month option periods.

The quoted "unit price" is an all-inclusive cost.

All "inclusive cost" is defined to include travel, lodging, per diem, fringe benefits, federal, state and local taxes plus all other costs pertinent to the performance of this purchase order.

Continued ...

12. DISCOUNT FOR PROMPT PAYMENT

a. 10 CALENDAR DAYS (%) b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS (%) d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations

13. NAME AND ADDRESS OF QUOTER

b. STREET ADDRESS

c. COUNTY

d. CITY e. STATE f. ZIP CODE

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

16. SIGNER

a. NAME (Type or print)

c. TITLE (Type or print)

a. NAME OF QUOTER

AREA CODE

NUMBER

15. DATE OF QUOTATION

b. TELEPHONE are are not attached

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

STANDARD FORM 18 (REV. 6-95)

Prescribed by GSA - FAR (48 CFR) 53.215-1(a)

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70625Q00187

1 Base Period - Radiological Technologists Services

See Scope of Work - 6 months

Delivery: 04/30/2026

Period of Performance: 11/01/2025 to 04/30/2026

2 Option Period One - Radiological Technologists

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 10/31/2026

Period of Performance: 05/01/2026 to 10/31/2026

3 Option Period Two - Radiological Technologists

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 04/30/2027

Period of Performance: 11/01/2026 to 04/30/2027

4 Option Period Three - Radiological Technologists

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 10/31/2027

Period of Performance: 05/01/2027 to 10/31/2027

5 Option Period Four - Radiological Technologists

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 04/30/2028

Period of Performance: 11/01/2027 to 04/30/2028

6 Option Period Five - Radiological Technologists

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 10/31/2028

Period of Performance: 05/01/2028 to 10/31/2028

7 Option Period Six - Radiological Technologists

Continued ...

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

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70625Q00187

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 04/30/2029

Period of Performance: 11/01/2028 to 04/30/2029

8 Option Period Seven - Radiological Technologists

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 10/31/2029

Period of Performance: 05/01/2029 to 10/31/2029

9 Option Period Eight - Radiological Technologists

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 04/30/2030

Period of Performance: 11/01/2029 to 04/30/2030

10 Option Period Nine - Radiological Technologists

Services

See Scope of Work - 6 months

(Option Line Item)

Delivery: 10/31/2030

Period of Performance: 05/01/2030 to 10/31/2030

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 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

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70625Q00187 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 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

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70625Q00187 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).

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 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".

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

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

75H70625Q00187

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

Statement of Work: Radiologic Technologist Page 1 of 16

WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER

INDIAN HEALTH SERVICE

STATEMENT OF WORK

RADIOLOGIC TECHNOLOGIST SERVICES

GENERAL

The Mission of the Sisseton Indian Health Service (IHS)/Woodrow Wilson Keeble Memorial Health Care Center (WWKMHCC) is to provide the best possible healthcare services to the patients on the Lake Traverse Reservation in South Dakota. To meet this mission, the WWKMHCC is requesting an all-inclusive, non-personal service, contract for a Radiologic Technologist.

BACKGROUND

The IHS is an agency within the Department of Health & Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. The Indian Health Service provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives who belong to 567 federally recognized tribes, in 35 states. The Indian Health Service Headquarters is located in Rockville, MD and then divided into twelve (12) physical areas: Alaska, Albuquerque, Bemidji, Billings, California, Great Plains, Nashville, Navajo, Oklahoma, Phoenix, Portland, and Tucson.

The Great Plains Area Office (GPAO) works in conjunction with 19 Indian Health Service Units and Tribal Managed Service Units to provide health care to approximately 130,000 Native American located in North Dakota, South Dakota, Nebraska, and Iowa. The Area Office’s service units include seven hospitals, eight health centers, and several smaller health stations and satellite clinics.

Our facility, the WWKMHCC, falls under the GPAO. WWKMHCC provides medical care for approximately 7,000 tribal members living on the Lake Traverse Reservation. Serving a rural area, many of our patients travel 100 miles round trip to receive care. The WWKMHCC was built in 2007 to provide an expanded level of outpatient health care services specifically designed to meet the needs of the WWKMHCC population.

Services include: Behavioral Health, Community Health, Dental, Laboratory, Nutrition Services, Optometry, Pharmacy, Physical Therapy, Public Health Nursing, Purchased & Referred Care Services, and Radiology Services. The positions to be filled are for Diagnostic Radiologic Technologists.

OBJECTIVES

The Contractor shall provide uninterrupted diagnostic x-ray services in accordance with the Section titled, “Contract Radiologic Technologist Responsibilities” on pages 4-6 of this Statement of Work (SOW).

PERIOD OF PERFORMANCE

Six months from date of award plus nine six-month option periods.

Statement of Work: Radiologic Technologist Page 2 of 16

PLACE OF PERFORMANCE

Woodrow Wilson Keeble Memorial Health Care Center Indian Health Service 100 Lake Traverse Drive Sisseton, SD 57262

DESCRIPTION OF SERVICES

Upon the receipt of an IHS task order, the Contractor shall locate and have available sufficient staffing to provide coverage for a Radiologic Technologist(s) for the Radiology Department at WWKMHCC IHS in Sisseton, SD during periods of permanent staffing absences. The Contractor shall provide a full orientation of this scope of work to the Contract Radiologic Technologist prior to submitting the confirmation service agreement.

The contract resulting from this solicitation shall:

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

2. 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.

3. Require the Contractor to indemnify the Government for any liability producing act or omission by the Contractor, its employees and agents occurring during contract performance.

4. 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 within the local community for the medical specialty concerned.

5. Require the Contractor to assume sole and exclusive responsibility for employee federal taxes, social security, unemployment insurance, and workman’s compensation.

6. Require the Contractor to provide daily compensation and travel reimbursements to each Contract Radiologic Technologist(s) as appropriate.

CANDIDATE PRESENTATION: The Contractor shall present a candidate(s) to the WWKMHCC Contracting Officer’s Representative (COR) for review by the Radiology Supervisor within five (5) business days of the task order and will include the following documentation:

1. Full name

2. Date of birth

3. Social security number

4. Phone number

5. E-mail address

6. Current curriculum vitae with listing of any and all IHS and other work experience, and explanations for any employment gaps

7. Signed Release of information

8. Minimum of three (3) letters of reference (preferably within the past 6 months); must have (1) radiology supervisor and (2) peers from the same discipline.

Statement of Work: Radiologic Technologist Page 3 of 16

In the event the Radiology Supervisor does not accept the Radiologic Technologist(s), the documentation will be sent to the COR for review/comments and the Contractor will have three (3) business days to present a new Radiologic Technologist(s).

Upon acceptance of a Radiologic Technologist(s), a full background investigation shall be sent to the contractor. The Contractor is responsible for ensuring that proposed Radiologic Technologist(s) possess the requisite credentials to allow for performance of all tasks identified. The contractor shall send a fully completed background investigation back within seven (7) days. The entire candidate presentation and paperwork completion shall be accomplished within thirty (30) days.

Once a Contract Radiologic Technologist(s) has been cleared for suitability with a completed eAPP and has been granted privileges, the Contractor shall submit a confirmation service agreement and include the following information:

1. Radiologic Technologist(s) name and phone number

2. Dates of service

3. Confirmation of completion of Contract Radiologic Technologist’s orientation to this scope of work

4. Point of contact and phone number

Prior to assumption of duty on any scheduled work shift, the Contract Radiologic Technologist(s) may be briefed by the Radiology Supervisor or her designee concerning any matter relevant to the Contract Radiologic Technologist’s responsibilities under the terms of this contract. The Contractor shall advise the COR or his/her designee of any problem encountered in connection with meeting the needs of patients treated by the Contract Radiologic Technologist(s).

CONFLICT OF INTEREST. The Contractor shall not employ any person who is an employee of the United States Government if the employment of that person would create a conflict of interest. The Contractor shall not employ any person who is an employee of Health and Human Services (HHS) unless such a person seeks and receives approval in accordance with the Department of HHS.

CONTINUITY OF SERVICES. The Contract Radiologic Technologists’ services are considered vital to the Government and must be continued with minimal interruption. In order to minimize interrupted services, the Contractor shall exercise best efforts and cooperation to provide coverage during periods of permanent staff absences.

In the event the Contractor is unable to fulfill the task order requirements for whatever reason; the government reserves the right to fulfill its needs outside of this contract. A written confirmation from the contractor indicating the inability to fulfill the task order is immediately required. The government’s right to fulfill its need outside this contract(s) does not waive its right to the issuance of a cure notice nor does it waive its right to terminate.

TECHNICAL REQUIREMENTS

The Contractor shall possess the following:

Statement of Work: Radiologic Technologist Page 4 of 16

1. Ability to provide Contract Radiologic Technologists who are currently registered with the American Registry of Radiologic Technologists (ARRT).

2. Ability to provide Contract Radiologic Technologists in a timely manner who provide on-site radiology services to beneficiary patients of all ages that present for care to the WWKMHCC.

3. Ability to assist with completion of background investigation paperwork of Contract Radiologic Technologists in a timely manner prior to assignment.

4. Ability to provide Contract Radiologic Technologists who can interact with patients and clinical staff in a customer friendly and culturally sensitive manner.

5. Ability to provide Contract Radiologic Technologists who possess Electronic Health Record experience.

CONTRACT RADIOLOGIC TECHNOLOGIST REQUIREMENTS

COMPUTER SKILLS. Computer efficiency and Electronic Health Record experience is required.

ENGLISH LANGUAGE REQUIREMENT. The Contract Radiologic Technologist(s) shall read, understand, speak and write English fluently, and communicate with sufficient clarity to be understood by WWKMHCC personnel and patients.

HEALTH REQUIREMENTS. The Contract Radiologic Technologist(s) shall not have any work or health restrictions which interfere with the performance of their services. The Contract Radiologic Technologist(s) shall provide proof of current immunizations (Hep B, MMR, Varicella, Tdap, Flu) status and a current PPD within the past year.

QUALIFICATIONS. Contract Radiologic Technologists shall have a degree from a qualified radiology program, maintain continuing education/certification, and have current Basic Life Support (BLS) certification.

The Contract Radiologic Technologist(s) must have a minimum of 2 years of experience within the past 36 months prior to beginning performance at WWKMHCC and must meet all background investigation requirements. (see page 6)

CONTRACT RADIOLOGIC TECHNOLOGIST RESPONSIBILITIES

APPEARANCE. Contractor Radiologic Technologists are expected to comply with reasonable dress, grooming and hygiene standards based on comfort, productivity, health and type of position occupied as compatible with the expectations of the WWKMHCC IHS and the Native American community. Contract Radiologic Technologists’ attire will be professional and in compliance with the expectations of the WWKMHCC Policy and Procedures, including displaying their identification badge on their outer clothing at all times.

CLINICAL DUTIES: The Contract Radiologic Technologist(s) will perform all x-rays independently and provide optimal images for the off-site Radiologist. The Contract Radiologic Technologist(s) is expected to utilize standard procedural guidelines, technical knowledge and experience to recognize and correct suboptimal imaging; supervisory guidance and technical assistance is available as needed.

Statement of Work: Radiologic Technologist Page 5 of 16

Primary duties will include:

1. Be responsible for performing a variety of x-ray examinations with different caseloads.

2. Provide mammogram services if needed.

3. Provide high quality and efficient care to patients.

4. Participate in Patient Centered Medical Home (PCMH) model and encourage patient engagement.

5. Correctly use EHR and the PACS/Digital Radiography system. Information and training will be provided by the Radiology Supervisor or his/her designate.

This includes:

a) Registering patients with correct exams and codes for billing purposes, department tracing, and reports.

b) Editing exams correctly with film size and number of films used; entering number of repeats

c) Printing requests and/or worksheets

4. Other duties include:

a) Compiles all images taken and other necessary documents for the Radiologist correctly.

b) Correctly stores and sends images via PACS to Radiologist.

c) Schedules patients for mammography, ultrasound, and DEXA exams

d) Performs monthly Quality Assurance and Quality Control duties as assigned.

e) Use safe and correct methods when transporting patients

5. Maintain familiarity and comply with Federal, State, Indian Health Service, accreditation standards, Centers for Medicare & Medicaid Service (CMS) regulations, American Registry of Radiologic Technologists (ARRT) requirements and departmental regulation and requirements.

6. Exhibit professional conduct among staff and patients, and respect and maintain the basic rights of patients, to include but not be limited to, personal dignity, cultural sensitivity, privacy, and confidentiality. Violations of these policies may lead to immediate removal of the Contract Radiologic Technologist from this contract and the facility.

7. Establish interpersonal, intra-departmental relationships and social sensitivity such that he/she can relate constructively to patients from Native American communities to enhance optimal patient care.

8. Participate in committees as assigned.

9. Staff development/education as assigned by the Radiology Supervisor.

10. Peer reviews/competencies as assigned.

COMMUNICATIONS. Contract Radiologic Technologists shall maintain open and professional communication with members of the Radiology Department and the OPD. Complaints validated by the Performance Improvement Coordinator and Radiology Supervisor shall be reported in writing to the COR and the Contractor for action.

When the Radiology Supervisor is absent, the Contract Radiologic Technologist(s) shall follow the delegation of authority and perform duties as assigned by the Radiology Supervisor’s designee.

ORIENTATION. All new Contract Radiologic Technologists will participate in the WWKMHCC facility orientation. The orientation must be completed prior to providing services at the facility, and will be scheduled for the first one (1) to three (3) days of arriving at the facility.

Statement of Work: Radiologic Technologist Page 6 of 16

PRIVACY OF INDIVIDUALLY IDENTIFABLE HEALTH INFORMATION. The Contract Radiologic Technologist(s) shall provide patients with the utmost care and attention. All patients shall be assured of their privacy and personal dignity. The Contract Radiologic Technologist(s) shall ensure strict compliance to the release of Protected Health Information in accordance with the Code of Federal Regulation, Title 45, Public Welfare, Subtitle A, Department of Health and Human Services, Part 164, Security and Privacy (45 CFR 164) and AFI 41-210, Patient Administration Functions, Health Insurance Portability and Accountability Act (HIPAA) and, General Guidelines on Releasing Medical Information.

RECORDS. The Contract Radiologic Technologist(s) shall generate and maintain proper medical record information beneficiaries to whom treatment is provided in accordance with Indian Health Service regulations and policies set forth by the Health Information Management (HIM) Department. Verbal orders are to be used for emergencies only. In the event of a major disaster or code all verbal orders are to be signed off immediately following the code or disaster. The Contract Radiologic Technologist(s) shall prepare all medical record documentation to meet or exceed the established standards of the IHS facility including, but not limited to, timeliness, accuracy, content, and signature.

All deadlines as determined by the facility shall be met including:

1. All chart documentation completed within 72 hours.

2. Notifications received in the Electronic Health Record (EHR) shall be completed within one (1) day.

3. All deficiencies (documentation that is found incomplete by the HIM department) completed within one (1) day after notification.

All medical record information generated in the performance of this contract will remain the property of and subject to the exclusive control of the Indian Health Service.

QUALITY IMPROVEMENT. All Contract Radiologic Technologists shall be required to participate in a quality improvement program, which is consistent with current accreditation standards for ongoing monitoring and evaluation of the quality and appropriateness of care.

CHARACTER INVESTIGATION

CRIMINAL BACKGROUND CHECK REQUIREMENT. The Government will conduct, at the government expense, a Tier 2 with Subject Interview (T2S) and state criminal history checks on individuals providing direct, unsupervised child care services under this contract. This investigation will be conducted at the expense of the Government and will be based upon the Federal Bureau of Investigation (FBI), state and local criminal history repositories.

The Contract Radiologic Technologist(s) is subject to Public Law 101-630, The Indian Child Protection and Family Violence Prevention Act. The Indian Health Service Personnel Office will conduct the criminal background investigations, and obtain fingerprints on each Contract Radiologic Technologist(s) provided by the Contractor immediately following award of the service contract. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contract Radiologic Technologist(s) must not have unsupervised contact with Indian children or access to Federal Information System that contain Personally Identifiable Information (PII) or Protected Health Information (PHI). The investigation may take

Statement of Work: Radiologic Technologist Page 7 of 16 several months to complete. Contract Radiologic Technologists receiving unfavorable background investigations shall not be employed. If at any time the contractor fails to meet or maintain suitability or eligibility for Federal employment, the contractor will be removed from providing services at the WWKMHCC.

The Contractor shall submit completed personnel background check applications within seven (7) working days after candidate acceptance. Any corrections needed to the background investigation process must be completed and resubmitted within seven (7) days.

Individuals shall have the right to obtain a copy of any background check pertaining to themselves and to challenge the accuracy and completeness of the information contained in the report.

WORK SCHEDULE

Radiology Management at WWKMHCC will determine specific tour of duty for each Contractor employee within the scope of the task order. The Contractor employee shall work in accordance with the tour of duty as scheduled to meet the patient care needs of the Service Unit facility. The Contractor must provide coverage for two shifts per day. The Contractor will be scheduled for lunch breaks of thirty minutes to one hour as assigned and/or rotated based upon department scheduling.

Overtime and Holiday hours shall be performed as agreed upon within the limits of the task order. Overtime hours as scheduled where there are departmental coverage gaps, to ensure adequate staffing for patient care.

The Contractor employee shall provide notice of unavailability to their employer (The Contractor) and Radiology Management or designee prior to any absence from work. The Contractor employee shall provide notification at least fifteen (15) days in advance of a desired absence if the length of the absence exceeds eight (8) work hours. Verifiable emergencies are the only exception to the advanced notification requirements.

The Contractor shall provide a qualified replacement within 48 hours from notice of absence.

All Contractor employees shall complete the clearance requirements at the appropriate level before reporting for work.

DELIVERABLES

Monthly Data Report: The Contractor shall provide a monthly data report that identifies the Contract Line- Item Number (CLIN), Contractor employee name, dates of service, quantity of hours worked, and hourly rate.

The Contractor shall provide a summary of task order hours authorized, hours worked, balance of hours remaining, estimated monthly invoice amount, and estimated balance of funds remaining. Electronic timesheets will be completed by the Contractor and submitted to Radiology Management for verification before any invoices for payment will be processed.

Refer to Performance Objective 1 under the “Performance Surveillance Plan” Heading on page 8-9 of this document for how deliverables will be measured.

Statement of Work: Radiologic Technologist Page 8 of 16

EVALUATION AND PERFORMANCE REQUIREMENTS

The Contractor shall allow the Government to evaluate the quality of professional services provided with the technical requirements of this contract. This assessment will include observations of the work system, methods and execution. Examples of monitoring methods include, but are not limited to: appropriateness of candidate placement (e.g. number of removals, number of early termination of assignments due to personality conflict, poor work habits, inadequate skills for the assignment, unprofessional or discourteous behavior). An assessment spreadsheet with these methods will be monitored by the Radiology Supervisor and the Contracting Officers’ Representative (COR). The Contract Radiologic Technologist’s performance will be monitored through peer review/competency, identifying deficiencies in the quality of services performed before the level of performance becomes unacceptable. These evaluations may be used by as a record of contract performance history for the purpose of evaluation in other competitive or non-competitive acquisitions.

It shall be understood that eligible patients, under treatment, will be rendered services that provide the best medical care within the Contract Radiologic Technologist’s professional training and experience. All services rendered shall be in accordance with current standard medical practices to assure quality care. The Contractor must perform at a level that is satisfactory and in accordance to all applicable laws, policies, rules, regulations, and within the Statement of Work.

NEGLIGENT BEHAVIOR. Any negligent behavior or any behavior jeopardizing patient safety will not be tolerated. Professional Review Action may be taken if activity, demeanor or conduct of the member is detrimental to patient care, disruptive to service unit operation, or in violation of IHS policy or is unethical.

Each incident will be evaluated and documented, and the Radiology Supervisor will notify the COR, and provide copies of pertinent documentation as soon as possible when the necessity to exercise such authority becomes apparent. These incidents may be grounds for immediate removal.

PERFORMANCE SURVEILLANCE PLAN. Performance surveillance monitors will be established to comply with regulatory guidelines and to monitor contract performance. The performance surveillance plan has been developed to outline the Indian Health Service’s general plan in providing effective and systematic surveillance and reporting of all aspects of contract performance. This plan recognizes the responsibility of the Contractor to carry out its own quality control obligations in the performance of this contract.

Surveillance will be accomplished through review of the Contractor’s performance against requirements listed in the work statement and performance standards listed in this plan. Performance=based incentives are consistent with the intent and purpose of this contract.

Upon completion of the contract, the Government will complete and keep on record the Contractor’s performance evaluation form based on the following objectives.

OBJECTIVE/

TASK

PERFORMANCE

STANDARD

ACCEPTABLE

QUALITY

LEVEL (AQL)

SURVEILLANCE

METHOD/

MEASURES

CONTRACTOR

INCENTIVE

DISINCENTIVE/

DEDUCT

Statement of Work: Radiologic Technologist Page 9 of 16

PERFORMANCE

OBJECTIVE 1

The Contractor shall provide placement of Radiologic Technologists into temporary assignments at

WWKMHCC

providing coverage when requested

Contractor shall provide seamless coverage for requested time period including replacement for any gaps within 48 hours of notification.

Placement of staff 90% of the time

Radiology Supervisor shall submit monthly spreadsheet of placement dates to the COR to monitor the placement requirement of seamless coverage

Favorable Contractor performance evaluation, 100% of pay would be provided.

Unfavorable Contractor performance evaluation, which would result in a reduction of pay dependent on percentage of shifts not covered.

OBJECTIVE 2

All Contract Radiologic Technologist(s) shall perform in accordance with clinical standards

Care provided is within clinical standards of care

100%

A Radiology competency will be completed performance evaluation

Unfavorable performance evaluation, removal from contract until such time the Contract Radiologic Technologist(s) meet qualification standards

OBJECTIVE 3

Contract Radiologic Technologist(s) are capable and knowledgeable of effective communication

Contract Radiologic Technologist(s) shall be respectful, courteous, and culturally sensitive to IHS patients and staff

No more than two (2) valid complaints per Contract Radiologic Technologist

The Contractor shall respond to the COR in writing whenever they receive notice of more than two complaints against a Contract Radiologic Technologist with an explanation of what was done to address the matter

The invoice will be put on hold until the complaint is investigated and resolved in 7 working days, removal from contract until such time the Contract Radiologic Technologist(s) meet qualification standards

OBJECTIVE 4

Contract Radiologic Technologist(s) shall complete all required trainings on time

All required training is completed on time

95% completion, no deviations

Periodic sampling contract performance evaluation, suspension or termination of all physical and/or electronic access privileges and removal from contract until training is

Statement of Work: Radiologic Technologist Page 10 of 16

SECURITY

PHYSICAL ACCESS. The Contract Radiologic Technologist(s) shall return identification badges to the Radiology Supervisor upon completion/termination of the contract.

PHYSICAL SECURITY. The Contractor Radiologic Technologist(s) shall safeguard all government property, including controlled forms provided for use. All PHI shall be secured at all times and not left unattended in unsecure areas. At the close of each work period, government equipment, facilities, and other valuable materials shall be secured, and all PHI shall be returned to the HIM department.

REPORTING REQUIREMENTS. The Contract Radiologic Technologist(s) shall report to an appropriate authority any information or circumstances of which they are aware that may pose a threat to the security of IHS personnel, personnel or patients.

WEAPONS, FIREARMS, AND AMMUNITION. Contract Radiologic Technologists are prohibited from possessing weapons, firearms, or ammunition, on themselves or within their contractor-owned vehicle or privately-owned vehicle while on the WWKMHCC grounds.

GOVERNMENT FURNISHED PROPERTY AND SERVICES

completed

OBJECTIVE 5

Contract Radiologic Technologist(s) is aware of all laws, regulations and policies related to Privacy, Confidentiality and HIPAA, and complies with all standards of privacy

All Contract Radiologic Technologist(s) comply with all laws, regulations and policies relating to Privacy, Confidentiality and HIPAA compliance, no deviation

Contract Radiologic Technologist shall provide copies of all required trainings to the Radiology Supervisor, HIM will report any violation to the for review

Immediate removal of Contract Radiologic Technologist(s) from contract

OBJECTIVE 6

Provide optimal radiography and/or mammography images to the Radiologist for interpretation

Assures that the Contractor provides optimal images to the Radiologist for interpretation

Imaging will be reviewed by the Radiologist and

Performance Evaluation

Contract Performance Evaluation, could result in termination of the contract

Statement of Work: Radiologic Technologist Page 11 of 16

The WWKMHCC shall provide office space including a desk, chair, computer, printer, and office supplies.

The Contract Radiologic Technologist(s) will be authorized to use all areas of the facility available to civil service and commissioned personnel in similar positions. The same restrictions apply to Contract Radiologic Technologists as any other IHS personnel to use these areas for official business activities only.

The Contract Radiologic Technologist(s) will be authorized to use all administrative and professional support available to IHS personnel. This will include, but not be limited to, copy machines, telefax machines, and telephone service. The same restrictions to use these items for official Indian Health Service business apply.

The WWKMHCC shall provide all medical and non-medical equipment and supplies used in the IHS facility for the care and management of patients.

CONTRACTOR FURNISHED ITEMS AND SERVICES

Except for those items or services specifically stated to be Government furnished, the Contractor shall furnish everything required to perform this contract in accordance with all of its terms. The WWKMHCC does not anticipate a need for Contractor furnished equipment.

HOUSING. The Contractor shall be responsible for all applicable Federal, State, and Local Taxes, Meals, Travel/Transportation, lodging, and per diem.

COMMUNICATION BETWEEN ALL PARTIES

POINT OF CONTACT. The Contractor shall provide a point of contact who shall be responsible for the performance of the work. The point of contact shall have full authority to act for the Contractor on all matters relating to the daily operation of this contract. The Contractor shall designate this individual, in writing, to the Contracting Officer before the contract start date. An alternate may be designated, but the Contract shall identify those times when the alternate shall be the primary point of contact.

Any communication regarding the contract shall be communicated between the Contractor’s designated point of contact and the Contracting Officer’s Representative (COR) at WWKMHCC.

PRIVACY/CLAUSES

FAR 52.225-1 PRIVACY ACT NOTIFICATION (APR 1984)

The Contractor will be required to design, develop, or operate a system of records on individuals, to accomplish an agency function subject to the Privacy Act of 1974, Public Law 93-579, December 31, 1974

(5 U.S.C. 552a) and applicable agency regulations. Violation of the Act may involve the imposition of criminal penalties.

FAR 52-224-2 PRIVACY ACT (APR 1984)

(a) The Contractor agrees to— http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t05t08+2+3++%285%29%20%20AND

Statement of Work: Radiologic Technologist Page 12 of 16

(1) Comply with the Privacy Act of 1974 (the Act) and the agency rules and regulations issued under the Act in the design, development, or operation of any system of records on individuals to accomplish an agency function when the contract specifically identifies—

(i) The systems of records; and

(ii) The design, development, or operation work that the contractor is to perform;

(2) Include the Privacy Act notification contained in this contract in every solicitation and resulting subcontract and in every subcontract awarded without a solicitation, when the work statement in the proposed subcontract requires the redesign, development, or operation of a system of records on individuals that is subject to the Act; and

(3) Include this clause, including this paragraph (3), in all subcontracts awarded under this contract which requires the design, development, or operation of such a system of records.

(b) In the event of violations of the Act, a civil action may be brought against the agency involved when the violation concerns the design, development, or operation of a system of records on individuals to accomplish an agency function, and criminal penalties may be imposed upon the officers or employees of the agency when the violation concerns the operation of a system of records on individuals to accomplish an agency function. For purposes of the Act, when the contract is for the operation of a system of records on individuals to accomplish an agency function, the Contractor is considered to be an employee of the agency.

(c)(1) “Operation of a system of records,” as used in this clause, means performance of any of the activities associated with maintaining the system of records, including the collection, use, and dissemination of records.

(2) “Record,” as used in this clause, means any item, collection, or grouping of information about an individual that is maintained by an agency, including, but not limited to, education, financial transactions, medical history, and criminal or employment history and that contains the person’s name, or the identifying number, symbol, or other identifying particular assigned to the individual, such as a fingerprint or voiceprint or a photograph.

(3) “System of records on individuals,” as used in this clause, means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual.

FAR 52.239-1 Privacy or Security Safeguards (Aug 1996)

(a) The Contractor shall not publish or disclose in any manner, without the Contracting Officer’s written consent, the details of any safeguards either designed or developed by the Contractor under this contract or otherwise provided by the Government.

(b) To the extent required to carry out a program of inspection to safeguard against threats and hazards to the security, integrity, and confidentiality of Government data, the Contractor shall afford the Government

Statement of Work: Radiologic Technologist Page 13 of 16 access to the Contractor’s facilities, installations, technical capabilities, operations, documentation, records, and databases.

(c) If new or unanticipated threats or hazards are discovered by either the Government or the Contractor, or if existing safeguards have ceased to function, the discoverer shall immediately bring the situation to the attention of the other party.

HHSAR 352-224-70 Privacy Act (December 18, 2015)

This contract requires the Contractor to perform one or more of the following: (a) design; (b) develop; or (c) operate a Federal agency system of records to accomplish an agency function in accordance with the Privacy Act of 1974 (Act) (5 U.S.C. 552a(m)(1)) and applicable agency regulations.

The term system of records means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual. Violations of the Act by the Contractor and/or its employees may result in the imposition of criminal penalties (5 U.S.C. 552a(i)).

The Contractor shall ensure that each of its employees knows the prescribed rules of conduct in 45 CFR part 5b and that each employee is aware that he/she is subject to criminal penalties for violation of the Act to the same extent as Department of Health and Human Services employees. These provisions also apply to all subcontracts the Contractor awards under this contract which require the design, development or operation of the designated system(s) of records (5 U.S.C. 552a(m)(1)). The contract work statement:

(a) Identifies the system(s) of records and the design, development, or operation work the Contractor is to perform; and

(b) Specifies the disposition to be made of such records upon completion of contract performance.

Indemnification, Liability, Statute of Limitations: Any provisions in the TOS related to indemnification and filing deadlines are hereby waived, and shall not apply except to the extent expressly authorized by law. Liability for any breach of the TOS as modified by this Amendment, or any claim arising from the TOS as modified by this Amendment, shall be determined under the Federal Tort Claims Act, or other governing federal authority. Federal Statute of Limitations provisions shall apply to any breach or claim.

Governing law: Any arbitration, mediation or similar dispute resolution provision in the TOS is hereby deleted. The TOS and this Amendment shall be governed by and interpreted and enforced in accordance with the laws of the United States of America without reference to conflict of laws. To the extent permitted by federal law, the laws of the State of [Company to insert name of state if one is mentioned in its TOS] (excluding [Company's state] choice of law rules) will apply in the absence of applicable federal law.

CONTRACTING OFFICER’S REPRSENTATIVE DESIGNATION

The Contracting Officer’s Representative (COR) representing the Government for the purpose of this contract shall be designated in writing by the Contracting Officer at the Great Plains Area Indian Health Service.

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The COR is responsible for:

1. Monitoring the Contractor’s technical progress including surveillance, assessment, and performance and recommending to the Contracting Officer changes in requirements,

2. Interpreting Statement of Work,

3. Performing technical evaluation as required,

4. Performing technical inspection and acceptance required by this contract,

5. Assisting the Contractor in the resolution of technical problems encountered during performance, and

6. Serving as systems manager to ensure compliance with the Privacy Act.

The designated COR for this contract is:

Megan Grassel Radiology Supervisor 100 Lake Traverse Drive Sisseton, SD 57262 Direct Phone: (605) 742-3824 Megan.Grassel@ihs.gov

Issuance of changes which affect the articles, terms, or conditions of this contract will be accomplished through the Contracting Officer who is the only party authorized to bind the Government to the contract.

not exceed the hour’s specified and total amount obligated for each task order. The total amount of all task orders shall not exceed the maximum amount negotiated for the contract period.

The Contractor shall not proceed with performance under any task order until such time approval is granted by the Contracting Officer.

COMPLETION OF TASK ORDERS. Upon completion of each task order, the Contractor shall submit invoice as outlined in the payment process.

TASK ORDERS

TASK ORDER AGREEMENTS. This contract type allows the service unit program offices to place an order with the Contractor on an as needed basis. In accordance with the Federal Acquisition Regulation (FAR) 52.216-18, Ordering (OCT 1995), IHS will obligate the funding and order the services by issuing a task order through the Agency’s automated procurement systems, iProcurement and PRISM.

The contract provisions authorize the program offices at WWKMHCC to issue the task orders, within their procurement authority, for the commercial item contract for the services needed during the contract term.

Each task order will reference the contract number and contain a task order number assigned by the automated procurement systems.

TASK ORDER PROCEDURES. The Contractor shall initiate work when directed by a task order issued by the Contracting Officer. No work under any task order shall be performed unless specifically authorized by the Contracting Officer. Approval of a task order shall not constitute approval to exceed any item listed in the mailto:Megan.Grassel@ihs.gov

Statement of Work: Radiologic Technologist Page 15 of 16 contract or general provisions of the contract. The total dollar amount of all task orders shall not exceed the estimated total dollars agreed to for the said task orders. The contractor shall not exceed the estimated task order amount, or change the task order without prior written approval by the Contracting Officer.

ISSUANCE OF TASK ORDERS. Task orders shall be issued on a fixed price basis and shall describe the specific work to be performed and the total cost. Each task order shall make reference to the proper funding document (requisition).

The estimated hours for performance of each task shall be set forth in each task order. Each task order shall not exceed the hour’s specified and total amount obligated for each task order. The total amount of all task orders shall not exceed the maximum amount negotiated for the contract period.

The Contractor shall not proceed with performance under any task order until such time approval is granted by the Contracting Officer.

COMPLETION OF TASK ORDERS. Upon completion of each task order, the Contractor shall submit invoice as outlined in the payment process.

AUTHORITY

1.1. No person other than the Contracting Officer has…