Solicitation N6890821Q0056.pdf

SEE ADDENDUM

(No Collect Calls)

N6890821Q0056 20-Aug-2021

b. TELEPHONE NUMBER

757-953-3271

8. OFFER DUE DATE/LOCAL TIME

03:00 PM 20 Sep 2021

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

N689089. ISSUED BY

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

LESLIE B. MITCHELL

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

0 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

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

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED ORX

SMALL BUSINESS

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

NAVY MEDICINE EAST

ATTN: MR. LESLIE B. MITCHELL

SUITE 1400

620 JOHN PAUL JONES CIRCLE

PORTSMOUTH VA 23708-2106

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE HT0443 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

DHA HOSPITAL BEAUFORT-WAWF

DHA HOSPITAL BEAUFORT-WAWF

NAVAL HOSPITAL BOX 6127B

MATERIEL MANAGEMENT DEPARTMENT

BEAUFORT SC 29902

TEL: FAX:

FAX:

TEL: 757-953-3271 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$8,000,000

NAICS:

541930

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF46

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

N6890821Q0056

Section SF 1449 - CONTINUATION SHEET

INFORMATION SHEET

FIRM-FIXED PRICE AWARD

ALL VENDORS ARE TO COMPLETE THE BELOW AND SUBMIT WITH THEIR QUOTE PACKAGE

ALL VENDORS ARE REQUIRED TO HAVE AN ACTIVE REGISTRATION IN https://www.sam.gov

VENDOR NAME: _________________________________________________

CAGE CODE: _________________________

DUNS NUMBER: _________________________

VENDOR POC: _________________________________________________

PHONE: _________________________

EMAIL: _________________________

GSA SCHEDULE NO (IF APPLICABLE): _________________________

EXPIRE DATE: _________________________

MIN/MAX: _________________________

NOTE: The Vendor’s initial response to this RFQ should reflect the Vendor’s Best Price including all allowable discounts that are available to the Federal Government. Please identify all discounts that are being offered as part of the vendor’s quote submission. The Government does not intend to go out for a Best and Final Offer.

PRODUCT/SERVICES FOR: NAVAL HOSPITAL BEAUFORT, SC

CUSTOMER TECHNICAL POC WILL BE PROVIDED AT AWARD.

NAVY MEDICINE EAST CONTRACTING OFFICE

POC: Leslie B Mitchell EMAIL: Leslie.B.Mitchell.civ@mail.mil NOTE: Vendor is required to provide billing electronically via the WAWF Electronic Invoicing method. For additional information, a review of the following web sites may be required:

https://wawf.eb.mil http://wawftraining Prompt Payment: For Prompt Payment Act Purposes, this contract is: Subject to the 7‐ Calendar Day Constructive Acceptance Period.

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 208 Each Early Intervention Service

FFP

Treatment is determined per Individualized Family Service Plan (IFSP) as ordered by the Naval Medical Readiness & Training Command Beaufort, SC (NMRTC Beaufort, SC). Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Family Training shall be made available to include the following as prescribed:

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

FOB: Destination

PSC CD: R608

NET AMT

0002 208 Each Orientation and Mobility

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Orientation and Mobility Training shall be made available to include the following as prescribed:

The contractor must have the ability to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction specifically designed for children diagnosed with visual impairment.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

0003 208 Each Beginning American Sign Lanuage

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Beginning American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

0004 26 Hours American Sign Language Interpreting Serv

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform service with hearing impaired primary care giver during patient/care giver EDIS to ensure primary care member is fully involved with patient training specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 2 hour minimum units. Contractor will be reimbursed only for visits and units actually documented and performed.

Weekday Rate per Unit (per hour / minimum 2 hours): $

Weekend Rate per Unit (per hour / minimum 2 hours): $

Estimated units at 26 for Period of Performance.

0005 52 Each Travel Expenses

FFP

Travel is based on the estimated treatment frequency as determined per IFSP per order by the NMRTC Beaufort, SC. Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

All travel must be in accordance with the Government Joint Travel Regulations

(JTR).

The contractor will only be reimbursed for documented travel as per duties outlined in the SOW.

Flat Rate for Travel (billed per visit) Estimated visits per Period of Performance is 52.

1001 208 Each OPTION Early Intervention Services

FFP

Treatment is determined per Individualized Family Service Plan (IFSP) as ordered by the Naval Medical Readiness & Training Command Beaufort, SC (NMRTC Beaufort, SC). Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Family Training shall be made available to include the following as prescribed:

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

1002 208 Each OPTION Orientation and Mobility

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Orientation and Mobility Training shall be made available to include the following as prescribed:

The contractor must have the ability to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction specifically designed for children diagnosed with visual impairment.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

1003 208 Each OPTION Beginning American Sign Language

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Beginning American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

1004 26 Hours OPTION American sign language interpreting svs

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform service with hearing impaired primary care giver during patient/care giver EDIS to ensure primary care member is fully involved with patient training specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 2 hour minimum units. Contractor will be reimbursed only for visits and units actually documented and performed.

Weekday Rate per Unit (per hour / minimum 2 hours): $ Weekend Rate per Unit (per hour / minimum 2 hours): $ Estimated units at 26 for Period of Performance.

1005 52 Each OPTION Travel Expenses

FFP

Travel is based on the estimated treatment frequency as determined per IFSP per order by the NMRTC Beaufort, SC. Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

All travel must be in accordance with the Government Joint Travel Regulations

(JTR).

The contractor will only be reimbursed for documented travel as per duties outlined in the SOW.

Flat Rate for Travel (billed per visit) Estimated visits per Period of Performance is 52.

2001 208 Each OPTION Early Intervention Services

FFP

Treatment is determined per Individualized Family Service Plan (IFSP) as ordered by the Naval Medical Readiness & Training Command Beaufort, SC (NMRTC Beaufort, SC). Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Family Training shall be made available to include the following as prescribed:

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

2002 208 Each OPTION Orientation and Mobility

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Orientation and Mobility Training shall be made available to include the following as prescribed:

The contractor must have the ability to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction specifically designed for children diagnosed with visual impairment.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

2003 208 Each OPTION Beginning American Sign Language

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Beginning American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

2004 26 Each OPTION American sign language interpreting svs

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform service with hearing impaired primary care giver during patient/care giver EDIS to ensure primary care member is fully involved with patient training specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 2 hour minimum units. Contractor will be reimbursed only for visits and units actually documented and performed.

Weekday Rate per Unit (per hour / minimum 2 hours): $ Weekend Rate per Unit (per hour / minimum 2 hours): $ Estimated units at 26 for Period of Performance.

2005 52 Each OPTION Travel Expenses

FFP

order by the NMRTC Beaufort, SC. Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

All travel must be in accordance with the Government Joint Travel Regulations

(JTR).

The contractor will only be reimbursed for documented travel as per duties outlined in the SOW.

Flat Rate for Travel (billed per visit) Estimated visits per Period of Performance is 52.

3001 208 Each OPTION Early Intervention Services

FFP

Treatment is determined per Individualized Family Service Plan (IFSP) as ordered by the Naval Medical Readiness & Training Command Beaufort, SC (NMRTC Beaufort, SC). Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Family Training shall be made available to include the following as prescribed:

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

3002 208 Each OPTION Orientation and Mobility

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Orientation and Mobility Training shall be made available to include the following as prescribed:

The contractor must have the ability to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction specifically designed for children diagnosed with visual impairment.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

3003 208 Each OPTION Beginning American Sign Language

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Beginning American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

3004 26 Hours OPTION American sign language interpreting svs

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform service with hearing impaired primary care giver during patient/care giver EDIS to ensure primary care member is fully involved with patient training specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 2 hour minimum units. Contractor will be reimbursed only for visits and units actually documented and performed.

Weekday Rate per Unit (per hour / minimum 2 hours): $ Weekend Rate per Unit (per hour / minimum 2 hours): $ Estimated units at 26 for Period of Performance.

3005 52 Each OPTION Travel Expenses

FFP

Travel is based on the estimated treatment frequency as determined per IFSP per order by the NMRTC Beaufort, SC. Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

All travel must be in accordance with the Government Joint Travel Regulations

(JTR).

The contractor will only be reimbursed for documented travel as per duties outlined in the SOW.

Flat Rate for Travel (billed per visit) Estimated visits per Period of Performance is 52.

4001 208 Each OPTION Early Intervention Services

FFP

Treatment is determined per Individualized Family Service Plan (IFSP) as ordered by the Naval Medical Readiness & Training Command Beaufort, SC (NMRTC Beaufort, SC). Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Family Training shall be made available to include the following as prescribed:

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

4002 208 Each OPTION Orientation and Mobility

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Orientation and Mobility Training shall be made available to include the following as prescribed:

The contractor must have the ability to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction specifically designed for children diagnosed with visual impairment.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

4003 208 Each OPTION Beginning American Sign Language

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

Beginning American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform EDIS with patient and/or patient family for evaluation; training; specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 15 minute units. Contractor will be reimbursed only for visits and 15 minute units actually documented and performed.

Rate per Unit (15 minute):

Estimated units at 208 for Period of Performance.

4004 26 Hours OPTION American sign language interpreting svs

FFP

Treatment is determined per IFSP as ordered by the NMRTC Beaufort, SC.

Services are assigned based on patient need and eligibility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

American Sign Language shall be made available to include the following as prescribed:

The contractor must be able to perform service with hearing impaired primary care giver during patient/care giver EDIS to ensure primary care member is fully involved with patient training specialized patient/care provider instruction; or similarly qualifying treatment/information session.

The contractor must adhere to IFSP as specified by the NMRTC Beaufort, SC and the patient family. Contractor may bill in 2 hour minimum units. Contractor will be reimbursed only for visits and units actually documented and performed.

Weekday Rate per Unit (per hour / minimum 2 hours): $ Weekend Rate per Unit (per hour / minimum 2 hours): $ Estimated units at 26 for Period of Performance.

4005 52 Each OPTION Travel Expenses

FFP

Travel is based on the estimated treatment frequency as determined per IFSP per order by the NMRTC Beaufort, SC. Contractor is required to travel to patient normal place of living environment to include but not limited to home, daycare, school, and other therapy facility. Contract Line Item reflects an estimated requirement as a response to current patient needs as prescribed during the period of performance.

All travel must be in accordance with the Government Joint Travel Regulations

(JTR).

The contractor will only be reimbursed for documented travel as per duties outlined in the SOW.

Flat Rate for Travel (billed per visit)

STATEMENT OF WORK

STATEMENT OF WORK (SOW)

Project: Educational and Developmental Intervention Services (EDIS) for Deaf & Blind

GENERAL INFORMATION

1.0 Scope of Work: The Naval Hospital Beaufort (NHB), SC Educational and Developmental Intervention Services (EDIS) Program Manager (PM) has the need for an Early Intervention Service (EIS) Provider. Specifically, the EIS provider will meet the developmental needs of children with a vision and/or hearing impairment, birth through 36 months of age. The EIS Provider shall also work with the family to meet their needs related to having a child with a disability.

2.0 Background: The Contractor shall provide sensory services to infants, toddlers, and their families deemed Eligible by the NHB for EIS through the EDIS PM. Services will be conducted in the patient’s natural environment and no services shall be provided at the NHB.

CONTRACT PERIOD OF PERFORMANCE (POP) REQUIREMENTS:

Requesting One (1) Base Year with Four (4) 1-year option periods.

Table 1

YEAR POP START DATE POP END DATE

Base Year 27 SEP 2021 26 SEP 2022 Option Year 1 27 SEP 2022 26 SEP 2023 Option Year 2 27 SEP 2023 26 SEP 2024 Option Year 3 27 SEP 2024 26 SEP 2025 Option Year 4 27 SEP 2025 26 SEP 2026

3.0 Technical Requirements/Tasks

3.1 The Contractor shall be capable of applying EIS knowledge and skills to meet the developmental needs of children with a vision and/or hearing impairment, birth through 36 months of age, and the family’s needs related to having a child with a vision and/or hearing disability. Services shall be provided in accordance with (IAW) the child’s Individual Family Service Plan (IFSP) to address the child’s physical, cognitive, communication, social, emotional needs, adaptive delays or conditions with a high probability of delay while also addressing the family member’s needs for various conditions resulting in an identified disability or propensity to develop a disability.

3.2 Service to include, but limited to items listed in Table 2:

Table 2

Family Training Service Coordination Medical Services for Diagnostic or Evaluation Purposes Counseling Early Identification Special Education Screening and Assessment Speech Pathology and Audiology Orientation and Mobility Instruction Occupational Therapy Ophthalmology Physical Therapy Social Work Psychology American Sign Language

3.3 Assistive Technology. The Contractor shall make recommendations for technology devices and services necessary to enable an infant or toddler to benefit from the above early intervention services. Recommendations shall made to the family and NHB EDIS Program Service Coordinator to help secure the Assistive Technology.

3.4 Individualized Family Service Plan (IFSP). The contractor shall act as part of the EDIS team to collaborate with the NHB EDIS Program Manager and family to develop an IFSP to measure and achieve specific goals in child progress.

3.5 Treatment/Training Sessions. Contractor shall make certain, to the maximum extent possible patient care is provided in natural environments and across daily routines and activities, which are settings that are natural and normal (e.g. home, preschool, or daycare) for children without disabilities.

3.6 Industry Practices. All EIS shall be conducted in a family-centered, comprehensive, multi-disciplinary, and culturally competent manner. Services shall be community based and foster collaborative partnerships IAW all State, County, Department of Defense, BUMED, and NHB EDIS Program guidelines and reporting requirements.

3.7 Entitlement of Services. Services are provided based on eligibility to enroll in a Domestic Dependent Elementary and Secondary School (DDESS) and meeting DoD development delay eligibility criteria as defined in DODI 1342.12, DoD Inter-Component Operating Procedures (ICOP), and BUMED Instructions 1755.l and 1755.2.

This program is for children age 3 and under but eligibility for the EDIS program and is dependent on the child being eligible to enroll in the schools on base.

4.0 SPECIFIC TASKS

4.1. The Contractor shall provide family training and/or orientation and mobility services to infants, toddlers, and their families who are determined eligible for early intervention services by the Naval Medical Readiness & Training Command Beaufort, SC (NMRTC Beaufort, SC). If the Contractor is evaluating the child for services the evaluation utilized shall be a standardized reference evaluation tool, with documentation of the tool used. The Contractor shall provide written findings of each evaluation to the EDIS Program Manager within 10 business days following the evaluation. Evaluations shall be mailed or faxed IAW all privacy act provisions to the EDIS Program Manager.

4.2. The Contractor shall provide an environment that maintains a family's rights to privacy and confidentiality as embodied under Health Insurance Portability and Accountability Act of 1996, and the Privacy Act of 1974.

Additionally, the contractor and assigned Health Care Worker (HCW) shall abide by EDIS Programs Procedural Safeguards and Due Process Entitlements.

4.3. The assigned HCW(s) shall provide Family Training and/or Orientation and Mobility Services as required by the IFSP to each child and family eligible to receive EIS. No deviation shall be made to the type of frequency of services specified in the IFSP without concurrence of the family and approval by the NMRTC Beaufort, SC EDIS Program Service Coordinator.

4.4. If the Contractor identifies new and available teaching and learning resources for the child and family, they shall make the recommendations to the EDIS Program Service Coordinator so the resources can be purchased and made available through their IFSP.

4.5. The Contractor shall be responsible for the management of all travel and logistical support of HCW in order to provide EIS in the patient's natural environment.

4.6. The Contractor reserves the right to refuse to provide services to any child or their family based upon any concern for safety and wellbeing of the HCW. If the vendor refuse to provide service for any reason, the COR and KO shall be notified immediately.

5.0 CONTRACTOR FURNISHED ITEMS

5.1. The contractor shall furnish the supplies, services, and personnel necessary to perform the requirements of the contract.

5.2. Insurance. The contractor shall comply with applicable provisions of the Federal Acquisition Regulation (FAR 52.237) The contractor shall comply with the Workers Compensation Insurance Laws of the State of South Carolina.

6.0 STANDARDS OF CONDUCT

6.1. Independent Contractor. Services by the contractor are rendered in the capacity of an independent contractor.

The Government shall evaluate the quality of both professional and administrative services for the purposes of contract inspection and acceptance. The Government does not retain any direct control over professional assessments and/or recommendations. The contractor shall be solely responsible for any and all liability cause by the acts or omissions of its agents or employees. The contractor shall not in any manner represent or infer that it is an agent of the United States Government.

6.2. The Contractor shall present a neat, well-groomed, professional appearance at all times.

6.3. Alcohol/Drug use in the workplace will not be tolerated. Any contractor found to be under the influence of, consuming, or using alcohol or drugs while on duty will be subject to removal from the Government established Place of Performance by local and/or Government authorities. Once the contractor employee has been removed the COR shall notify the KO for further direction. See NHB Instruction 5350.6C Substance Abuse Prevention and Control and 5350.7D Voluntary Self-Referral for Drug and Alcohol Abuse Rehabilitation. (See Attached)

7.0 IDENTIFICATION OF CONTRACTOR EMPLOYEES.

7 .1. The Contractor shall provide each employee with an identification (ID) badge, easily readable and including employee's name, contractor's name, functional area of assignment. The assigned HCW shall always have their badge in their possession along with a valid state issued identification card number. The badges are provided by the vendor.

7 .2. Display of ID Badges. Contractor personnel shall wear the ID badge at all times when performing work under this contract. Unless otherwise specified in the contract, each Contractor employee shall wear the ID badge in a conspicuous place on the front of exterior clothing and above the waist except when safety or health reasons prohibit such placement.

8.0 ADMINISTRATIVE MATTERS

8. l. Physical Security. The Contractor shall safeguard all patient information property in and outside of the work area.

8.2. The Contractor shall possess the following credentials and/or comparable qualifications: The HCW must have a BS degree (preferably a MS degree) related to the Human Services field and have a certification in special education, teaching, therapy, or similar specialized training or experience for persons with hearing and/or visual impairment.

8.3. Substitutes. The Contractor shall advise the Contracting Officer's representative (COR) of anticipated absences, for any reason, as far in advance as possible. The Contractor shall provide a suitable and acceptable substitute at their expense for all periods of time that the designated contractor personnel is unable to perform the services during all scheduled IFSP.

8.4. Modifications. The designated Contracting Officer Representative (COR) represents the Contracting Officer (KO) in all technical phases of the work, but is NOT authorized to issue Change Orders, Supplemental Agreements, or direct any contract performance requiring contractual modification or adjustment. Changes in scope of work can only be made by modification properly executed by the KO. Any observations made by persons other than the KO or the COR are strictly advisory and shall not influence the contractor's operation except for administrative requirements and responsibilities specified herein.

9.0 QUALITY ASSURANCE

9.1 Quality of Service. The services specified in this statement of work shall be performed in accordance with established principles and ethics of the medical profession.

9.2 The quality of healthcare provided shall meet or exceed the current recognized standards established by the Joint Commission and the complimentary professional associations, which specify standards of performance for early intervention services.

9.3 The contractor shall comply with applicable provisions of law and rules and regulations of any and all Government authorities pertaining to Licensure and regulation of healthcare personnel and medical treatment facilities, the regulations and standards of the medical practice, and regulations and standards of the treatment location. In all cases, the dignity of the patient will be given the highest regard, and the precepts of the American Hospital Association's "Bill of Rights for Patients" shall be observed.

9. 4 The Quality Assurance method of surveillance will be by periodic inspection and customer feedback. A Past Performance Evaluation will be completed annually by the NMRTC Beaufort, SC EDIS Program Manager and COR and submitted into the Contractor Performance Assessment Reporting System (CPARS).

9.5 The Contractor shall observe, evaluate and provide feedback to the patients, their families and the EDIS Program Manager.

9.6 Failure to correct any adverse findings resulting from observations and feedback, or failure to deliver all services described in this contract, may result in non-acceptance of the services by the Government.

10.0 Performance Measurement

Performance will be measured in accordance with the following table:

Performance Element

Performance Requirement

Surveillance Method Frequency

Acceptable Quality Level

Contract Deliverables

Contract deliverables furnished as prescribed

Inspection by the EDIS staff and COR

As defined in the

>95% of deliverables submitted timely and in the SOW as applicable

Performance Objectives Summary Matrix without rework required

Overall Contract Performance

Overall contract performance of sufficient quality to earn a Satisfactory (or higher) rating in the COR’s annual report on contractor performance

Assessment by the EDIS staff and COR Annual

All performance elements rated Satisfactory (or higher)

Invoicing Monthly invoices per contract procedures are timely and accurate

Review & acceptance of the invoice Monthly 100% accuracy

If performance is within acceptable levels, it will be considered satisfactory. If not, overall performance may be considered unsatisfactory.

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government 0002 Destination Government Destination Government 0003 Destination Government Destination Government 0004 Destination Government Destination Government 0005 Destination Government Destination Government 1001 Destination Government Destination Government 1002 Destination Government Destination Government 1003 Destination Government Destination Government 1004 Destination Government Destination Government 1005 Destination Government Destination Government 2001 Destination Government Destination Government 2002 Destination Government Destination Government 2003 Destination Government Destination Government 2004 Destination Government Destination Government 2005 Destination Government Destination Government 3001 Destination Government Destination Government 3002 Destination Government Destination Government 3003 Destination Government Destination Government 3004 Destination Government Destination Government 3005 Destination Government Destination Government 4001 Destination Government Destination Government 4002 Destination Government Destination Government 4003 Destination Government Destination Government

4004 Destination Government Destination Government 4005 Destination Government Destination Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

0001 POP 27-SEP-2021 TO

26-SEP-2022

N/A DHA HOSPITAL BEAUFORT-WAWF

DHA HOSPITAL BEAUFORT-WAWF

NAVAL HOSPITAL BOX 6127B

MATERIEL MANAGEMENT

DEPARTMENT

BEAUFORT SC 29902

HT0443

0002 POP 27-SEP-2021 TO

26-SEP-2022

N/A (SAME AS PREVIOUS LOCATION)

0003 POP 27-SEP-2021 TO

N/A (SAME AS PREVIOUS LOCATION)

0004 POP 27-SEP-2021 TO

N/A (SAME AS PREVIOUS LOCATION)

0005 POP 27-SEP-2021 TO

N/A (SAME AS PREVIOUS LOCATION)

1001 POP 27-SEP-2022 TO

26-SEP-2023

N/A (SAME AS PREVIOUS LOCATION)

1002 POP 27-SEP-2022 TO

N/A (SAME AS PREVIOUS LOCATION)

1003 POP 27-SEP-2022 TO

N/A (SAME AS PREVIOUS LOCATION)

1004 POP 27-SEP-2022 TO

N/A (SAME AS PREVIOUS LOCATION)

1005 POP 27-SEP-2022 TO

N/A (SAME AS PREVIOUS LOCATION)

2001 POP 27-SEP-2023 TO

26-SEP-2024

N/A (SAME AS PREVIOUS LOCATION)

2002 POP 27-SEP-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

2003 POP 27-SEP-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

2004 POP 27-SEP-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

2005 POP 27-SEP-2023 TO

N/A (SAME AS PREVIOUS LOCATION)

3001 POP 27-SEP-2024 TO

26-SEP-2025

N/A (SAME AS PREVIOUS LOCATION)

3002 POP 27-SEP-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

3003 POP 27-SEP-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

3004 POP 27-SEP-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

3005 POP 27-SEP-2024 TO

N/A (SAME AS PREVIOUS LOCATION)

4001 POP 27-SEP-2025 TO

26-SEP-2026

N/A (SAME AS PREVIOUS LOCATION)

4002 POP 27-SEP-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

4003 POP 27-SEP-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

4004 POP 27-SEP-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

4005 POP 27-SEP-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

CLAUSES INCORPORATED BY REFERENCE

52.204-9 Personal Identity Verification of Contractor Personnel JAN 2011 52.204-10 Reporting Executive Compensation and First-Tier

Subcontract Awards

JUN 2020

52.209-2 Prohibition on Contracting with Inverted Domestic Corporations--Representation

NOV 2015

52.209-6 Protecting the Government's Interest When Subcontracting With Contractors Debarred, Suspended, or Proposed for Debarment

JUN 2020

52.209-10 Prohibition on Contracting With Inverted Domestic Corporations

NOV 2015

52.209-11 Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law

FEB 2016

52.212-3 Offeror Representations and Certifications--Commercial Items

FEB 2021

52.212-4 Contract Terms and Conditions--Commercial Items OCT 2018 52.217-5 Evaluation Of Options JUL 1990 52.222-3 Convict Labor JUN 2003 52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

JUN 2020

52.225-13 Restrictions on Certain Foreign Purchases FEB 2021 52.232-33 Payment by Electronic Funds Transfer--System for Award

Management

OCT 2018

52.232-39 Unenforceability of Unauthorized Obligations JUN 2013 52.232-40 Providing Accelerated Payments to Small Business

Subcontractors

DEC 2013

52.233-3 Protest After Award AUG 1996 52.233-4 Applicable Law for Breach of Contract Claim OCT 2004 52.237-7 Indemnification and Medical Liability Insurance JAN 1997 52.247-34 F.O.B. Destination NOV 1991 252.201-7000 Contracting Officer's Representative DEC 1991 252.203-7000 Requirements Relating to Compensation of Former DoD

Officials

SEP 2011

252.203-7002 Requirement to Inform Employees of Whistleblower Rights SEP 2013 252.204-7003 Control Of Government Personnel Work Product APR 1992 252.204-7008 Compliance With Safeguarding Covered Defense Information

Controls

OCT 2016

252.204-7012 Safeguarding Covered Defense Information and Cyber Incident Reporting

DEC 2019

252.204-7015 Notice of Authorized Disclosure of Information for Litigation Support

MAY 2016

252.225-7000 Buy American--Balance Of Payments Program Certificate-- Basic (Nov 2014)

NOV 2014

252.225-7001 Buy American And Balance Of Payments Program-- Basic DEC 2017 252.225-7002 Qualifying Country Sources As Subcontractors DEC 2017 252.225-7040 Contractor Personnel Supporting U.S. Armed Forces

Deployed Outside the United States

OCT 2015

252.225-7048 Export-Controlled Items JUN 2013 252.232-7003 Electronic Submission of Payment Requests and Receiving

Reports

DEC 2018

252.232-7010 Levies on Contract Payments DEC 2006 252.232-7017 Accelerating Payments to Small Business Subcontractors--

Prohibition on Fees and Consideration

APR 2020

252.237-7010 Prohibition on Interrogation of Detainees by Contractor Personnel

JUN 2013

252.243-7001 Pricing Of Contract Modifications DEC 1991

CLAUSES INCORPORATED BY FULL TEXT

52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS AND VIDEO

SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

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 Items. 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 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision-

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 52.204-25, Prohibition on 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 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) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) (https://www.sam.gov) for entities excluded from receiving federal awards for "covered telecommunications equipment or services."

(d) Representations. The Offeror represents that--

(1) It [] will, [] will not provide…