Solicitation - 75FCMC26Q0071.pdf

31b. NAME OF CONTRACTING OFFICER (Type or print) 30c. DATE SIGNED

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

NOTE: OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30. 1. REQUISITION NUMBER PAGE 1 OF

2. CONTRACT NUMBER 3. AWARD/EFFECTIVE

DATE

4. ORDER NUMBER 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE

DATE

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME b. TELEPHONE NUMBER (No collect calls)

8. OFFER DUE DATE/

LOCAL TIME

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

11. DELIVERY FOR FREE ON 12. DISCOUNT TERMS

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

(SDVOSB)

13a. THIS CONTRACT IS A

WOMEN-OWNED SMALL

BUSINESS (WOSB)

ECONOMICALLY

DISADVANTAGED

WOMEN-OWNED SMALL

BUSINESS (EDWOSB)

8(A)

13b. RATING

NORTH AMERICAN

INDUSTRY CLASSIFICATION

STANDARD (NAICS):

SIZE STANDARD:

BOARD (FOB) DESTINATION RATED ORDER UNDER 14. METHOD OF SOLICITATION

REQUEST

SAL

17a. CONTRACTOR/

OFFEROR

CODE FACILITY

CODE

18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NUMBER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

OFFER BELOW IS CHECKED SEE ADDENDUM

19.

ITEM NUMBER

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Government Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE (FEDERAL ACQUISITION REGULATION) FAR 52.212-1, 52.212-4. FAR 52.212-3

AND 52.212-5 ARE ATTACHED. ADDENDA

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE ARE NOT ATTACHED

ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH

AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND

ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS

SPECIFIED

29. AWARD OF CONTRACT: REFERENCE OFFER

DATED . . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR

30b. NAME AND TITLE OF SIGNER (Type or print)

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 11/2021)

Prescribed by GSA - FAR (48 CFR) 53.212

UNLESS BLOCK IS MARKED

SEE SCHEDULE

THE DEFENSE PRIORITIES

AND ALLOCATIONS

SYSTEM - DPAS (15 CFR 700)

REQUEST

FOR QUOTE

(RFQ)

INVITATION FOR

FOR BID PROPO

(IFB) (RFP)

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

Solicitation/Contract Form

HPSA Zip Code Crosswalk

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Supplies or Services and Prices/Cost

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Description/Specifications/Statement of Work

Requirements

The Purpose of this contract is to develop and provide The Centers for Medicare and Medicaid Services (CMS) a crosswalk of geographic Health Professional Shortage Area (HPSA) designations as determined by the Health Resources and Services Administration (HRSA) to United State Postal Service (USPS) ZIP Codes to be used to determine the payment of the Medicare HPSA bonus per section 413 (a) of the Medicare Prescription Drug and Modernization Act (MMA) of 2003.

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Packaging and Marking

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Inspection and Acceptance

(End of Section)

Deliveries or Performance

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Contract Administration Data

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Special Contract Requirements

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Contract Clauses

FAR Clauses Incorporated by Reference

Number Title Effective Date

52.204-19 Incorporation by Reference of Representations and Certifications.

Dec 2014

52.204-23 Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab Covered Entities.

Dec 2023

52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

Nov 2021

52.222-50 Combating Trafficking in Persons. Oct 2025

52.222-50 Combating Trafficking in Persons.-Alternate I Mar 2015

52.226-8 Encouraging Contractor Policies to Ban Text Messaging While Driving.

MAY 2024

52.232-1 Payments. Apr 1984

52.232-39 Unenforceability of Unauthorized Obligations. Jun 2013

52.232-40 Providing Accelerated Payments to Small Business Subcontractors.

Mar 2023

52.233-3 Protest after Award. Aug 1996

52.233-3 Protest after Award.-Alternate I Jun 1985

52.233-4 Applicable Law for Breach of Contract Claim. Oct 2004

52.240-1 Prohibition on Unmanned Aircraft Systems Manufactured or Assembled by American Security Drone Act-Covered Foreign Entities.

Nov 2024

52.244-6 Subcontracts for Commercial Products and Commercial Services.

Oct 2025

List of Attachments

Number Attachment Name Attachment Description Reference Number

Date

01 Attachment J.1 - HPSA Zip Code Crosswalk Statement of Work (SOW)

Statement of Work 15 APR 2026

(End of Section)

Representations, Certification, and other Statements of Offerors

FAR Clauses Incorporated by Reference

Number Title Effective Date

52.225-25 Prohibition on Contracting With Entities Engaging in Certain Activities or Transactions Relating to Iran—Representation and Certifications.

Jun 2020

FAR Clauses Incorporated by Full Text

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment. Nov 2021

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at , 52.204-26 Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at , 52.212-3 Offeror Representations and Certifications-Commercial Products or Commercial Services. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at , or in paragraph (v)(2)(ii) of the provision at .52.204-26 52.212-3

(a) As used in this provision—Definitions.

Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause , Prohibition on 52.204-25 Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) .Prohibition

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L.

115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or

52.204-26.html#FAR_52_204_26 52.212-3.html#FAR_52_212_3 52.204-26.html#FAR_52_204_26 52.212-3.html#FAR_52_212_3 52.204-25.html#FAR_52_204_25 extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L.

115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) The Offeror shall review the list of excluded parties in the System for Award Management (SAM) (Procedures. https://www.

) for entities excluded from receiving federal awards for "covered telecommunications equipment or services".sam.gov

(d) The Offeror represents that—Representation.

(1) It will, will not provide covered telecommunications equipment or services to the Government in the _ _ performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds "will" in paragraph (d)(1) of this section; and

(2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that—

It does, does not use covered telecommunications equipment or services, or use any equipment, system, or _ _ service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds "does" in paragraph (d)(2) of this section.

(e) Disclosures.

(1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded "will" in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand;

model number, such as OEM number, manufacturer part number, or wholesaler number;

and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

https://www.sam.gov

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(2) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded "does" in the representation in paragraph (d)(2) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand;

model number, such as OEM number, manufacturer part number, or wholesaler number;

and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the PSC of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(End of provision)

52.204-26 Covered Telecommunications Equipment or Services-Representation. Oct 2020

(a) As used in this provision, "covered telecommunications equipment or services" and "reasonable inquiry" have Definitions.

the meaning provided in the clause , Prohibition on Contracting for Certain Telecommunications and Video 52.204-25 Surveillance Services or Equipment.

(b) The Offeror shall review the list of excluded parties in the System for Award Management (SAM) (Procedures. https://www.

) for entities excluded from receiving federal awards for "covered telecommunications equipment or services".sam.gov

(c)

(1) The Offeror represents that it does, does not provide covered telecommunications Representation. _ _ equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument.

52.204-25.html#FAR_52_204_25

(2) After conducting a reasonable inquiry for purposes of this representation, the offeror represents that it does, _ _ does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services.

(End of provision)

52.204-29 Federal Acquisition Supply Chain Security Act Orders—Representation and Disclosures. Dec 2023

(a) As used in this provision, Definitions. Covered article, FASCSA order, Intelligence community, National security system, and have the Reasonable inquiry, Sensitive compartmented information, Sensitive compartmented information system, Source meaning provided in the clause , Federal Acquisition Supply Chain Security Act Orders—Prohibition.52.204-30

(b) Contractors are prohibited from providing or using as part of the performance of the contract any covered Prohibition.

article, or any products or services produced or provided by a source, if the prohibition is set out in an applicable Federal Acquisition Supply Chain Security Act (FASCSA) order, as described in paragraph (b)(1) of FAR , Federal 52.204-30 Acquisition Supply Chain Security Act Orders—Prohibition.

(c) .Procedures

(1) The Offeror shall search for the phrase “FASCSA order” in the System for Award Management (SAM)( for any covered article, or any products or services produced or provided by a source, if there )https://www.sam.gov is an applicable FASCSA order described in paragraph (b)(1) of FAR , Federal Acquisition Supply Chain 52.204-30 Security Act Orders—Prohibition.

(2) The Offeror shall review the solicitation for any FASCSA orders that are not in SAM, but are effective and do apply to the solicitation and resultant contract (see FAR (c)(2)).4.2303

(3) FASCSA orders issued after the date of solicitation do not apply unless added by an amendment to the solicitation.

(d) By submission of this offer, the offeror represents that it has conducted a reasonable inquiry, and that the Representation.

offeror does not propose to provide or use in response to this solicitation any covered article, or any products or services produced or provided by a source, if the covered article or the source is prohibited by an applicable FASCSA order in effect on the date the solicitation was issued, except as waived by the solicitation, or as disclosed in paragraph (e).

(e) The purpose for this disclosure is so the Government may decide whether to issue a waiver. For any covered Disclosures.

article, or any products or services produced or provided by a source, if the covered article or the source is subject to an applicable FASCSA order, and the Offeror is unable to represent compliance, then the Offeror shall provide the following information as part of the offer:

(1) Name of the product or service provided to the Government;

(2) Name of the covered article or source subject to a FASCSA order;

(3) If applicable, name of the vendor, including the Commercial and Government Entity code and unique entity identifier (if known), that supplied the covered article or the product or service to the Offeror;

(4) Brand;

(5) Model number (original equipment manufacturer number, manufacturer part number, or wholesaler number);

(6) Item description;

(7) Reason why the applicable covered article or the product or service is being provided or used;

(f) The contracting officer will review disclosures provided in paragraph (e) to Executive agency review of disclosures.

determine if any waiver may be sought. A contracting officer may choose not to pursue a waiver for covered articles or sources otherwise subject to a FASCSA order and may instead make an award to an offeror that does not require a waiver.

52.204-30.html#FAR_52_204_30 52.204-30.html#FAR_52_204_30 https://www.sam.gov 52.204-30.html#FAR_52_204_30 4.2303.html#FAR_4_2303

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Instrs., Conds., and Notices to Offerors

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Evaluation Factors for Award

CMS - OAGM

7500 SECURITY BOULEVARD, MS: B3-30-03

BALTIMORE, MD 21244-1850

Courtney Garnes, Contracting Officer Winnie Tenekam, Contract Specialist