Solicitation W912WJ23A0007.pdf

25. TOTAL

CODE

17. ACCOUNTING AND APPROPRIATION DAT A/ LOCAL USE

36. I cert ify this account is correct and proper for payment.

6. ISSUED BY CODE

9. CONTRACTOR

CODE

18. ITEM NO. 19. SCHEDULE OF SUPPLIES/ SERVICES

26. QUANTITY IN COLUMN 20 HAS BEEN

SIGNATURE OF AUTHORIZED GOVT. REP.DATE

DAT E SIGNATURE AND TITLE OF CERTIFYING OFFICER

INSPECTED RECEIVED ACCEPTED, AND CONFORMS TO THE

CONTRACT EXCEPT AS NOTED

37. RECEIVED AT 38. RECEIVED BY 39. DATE RECEIVED

(YYYYMMMDD)

W912WJ23A0007

1. CONTRACT/PURCH. ORDER/

AGREEMENT NO.

* If quantity accepted by the Government is same as quantity accepted below quantity ordered and encircle.

DELIVERY/16.

14. SHIP TO

W912WJ

DD Form 1155, JAN 1998 (EG) PREVIOUS EDITION MAY BE USED.

SEE SCHEDULE

2. DELIVERY ORDER/ CALL NO.

44PAGE 1 OF

5. PRIORITY

CODE

8. DELIVERY FOB

DEST

OTHER

(See Schedule if other)

MARK IF BUSINESS IS11.

SMALL

SMALL

DISADVANTAGED

WOMEN-OWNED

964145

MARK ALL

PACKAGES AND

PAPERS WITH

IDENTIFICATIO N

NUMBERS IN

BLO CKS 1 AND 2.

23. AMOUNT

27. SHIP NO. 28. DO VOUCHER NO.

PARTIAL

FINAL

32. PAID BY 33. AMOUNT VERIFIED

CORRECT FOR

31. PAYMENT

COMPLETE

34. CHECK NUMBER

PARTIAL

FINAL 35. BILL OF LADING NO.

40.TOTAL

CONTAINERS

41. S/R ACCOUNT NO. 42. S/R VOUCHER NO.

ORDER FOR SUPPLIES OR SERVICES

3. DATE OF ORDER/CALL

2022 Dec 12

4. REQ./ PURCH. REQUEST NO.

SEE ITEM 6

FACILITY 10. DELIVER TO FOB POINT BY (Date)

SEE SCHEDULE

12. DISCOUNT TERMS

Net 30 Days

13. MAIL INVOICES TO THE ADDRESS IN BLOCK

See Performamce Work Statememt

15. PAYMENT WILL BE MADE BY CODE

FINANCE AND ACCOUNTING OFFICER

US ARMY CORPS OF ENGRS FINANCE CENTER

5722 INTEGRITY DRIVE

MILLINGTON TN 38054-5005

This delivery order/call is issued on another Govt. agency or in accordance with and subject to terms and conditions of above numbered contract.

TYPE CALL

OF PURCHASE

ORDER

SEE SCHEDULE

X

7. ADMINISTERED BY

U S ARMY ENGR DISTRICT, NEW ENGLAND

696 VIRGINIA RD

CONCORD MA 01742-2751

24. UNITED STATES OF AMERICA

TEL:

EMAIL:

CONTRACTING / ORDERING OFFICER

quantity ordered, indicate by X. If different, enter actual

BY:

1If this box is marked, supplier must sign Acceptance and return the following number of copies:X

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE

(YYYYMMMDD)

DATE SIGNED

ACCEPTANCE. THE CONTRACTOR HEREBY ACCEPTS THE OFFER REPRESENTED BY THE NUMBERED PURCHASE ORDER AS IT MAY PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS

AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME.

Reference your quote dated

Furnish the following on terms specified herein. REF:

20. QUANTITY

ORDERED/

ACCEPTED*

21. UNIT 22. UNIT PRICE

DIFFERENCES

29.

30.

INITIALS

Section B - Supplies or Services and Prices

BPA Master Dollar Limit: $200,000.00 BPA Call Limit: $25,000.00

Period of Performance: 12-Dec-2022 to 11-Dec-2027

PSC Codes:

Q403

INSTRUCTIONS TO VENDORS

PLEASE DIRECT QUESTIONS TO JENNIFER M. SAMELA AT (978) 318-8324 OR

JENNIFER.M.SAMELA@USACE.ARMY.MIL. THE SOLICITATION AND RESULTING CONTRACT

SHALL BE THE GOVERNING DOCUMENT IN ALL CASES.

** QUOTES CAN BE E-MAILED TO JENNIFER M. SAMELA AT

JENNIFER.M.SAMELA@USACE.ARMY.MIL.

THE BID SCHEDULE MUST BE COMPLETED AND SUBMITTED FOR A QUOTE TO BE

CONSIDERED COMPLETE.

THE GOVERNMENT INTENDS TO AWARD NO MORE THAN THREE (3) BLANKET PURCHASE

AGREEMENTS FROM THIS ONE SOLICITATION.

In accordance with FAR Part 52.204-7(b)(1) Contractors must be registered in the System for Award Management (SAM) database (www.SAM.gov) to submit a quote (formerly the Central Contractor Registration (CCR) database and the On-Line Representations and Certifications (ORCA)). Any reference to CCR or ORCA in any clause or provision is referring to the www.sam.gov website.

NOTE: SAM.gov registration takes approximately 3 weeks (DUNS registration 1-2 business days; CAGE code validation up to 10 business days; IRS validation and overall submission 7-10 business days). It is the contractor’s responsibility to track SAM.gov registration and follow-up with required tasks.

In addition, if you are registering a new entity in SAM.gov, you must provide an original, signed notarized letter stating that you are the authorized Entity Administrator. The Entity Administrator must establish a LOGIN.GOV account using the e-mail address that will be associated with the SAM registration. See https://www.gsa.gov/about-us/organization/federal-acquisition-service/office-of-systems-management/integrated-award-environment-iae/sam-update for additional information.

Provide Unique Entity Identifier (UEI): ___________________________ Provide CAGE code: ____________________________ Provide TAX ID: __________________________ Per FAR Part 52.212-3 Alt I, the Contractor is required to complete the On-line Representations and Certifications Application (www.SAM.gov) and paragraph (b) if applicable, OR to complete paragraphs (c) thru (m) of this clause and return with quote.

POTENTIAL VENDORS ARE NOTIFIED THAT THE BASIS ON WHICH AWARD WILL BE MADE IS

PRICE ALONE.

ALL RESPONSIBLE SOURCES MAY SUBMIT A RESPONSE WHICH, IF TIMELY RECEIVED, MUST BE

CONSIDERED BY THE AGENCY.

INVOICES SHALL BE SENT TO TECHNICAL POINT OF CONTACT.

BID SCHEDULE

OCCUPATIONAL MEDICAL SERVICES

BLANKET PURCHASE AGREEMENT

U.S. ARMY CORPS OF ENGINEERS

PERFORMANCE WORK STATEMENT

NEW ENGLAND DISTRICT

TEST EST QTY PER

YEAR

UNIT PRICE

01 Chest X-Ray PA & Lat 10

02 Audiometry 250

03 EKG 20

04 Serum PCB 20

05 Arsenic Level – Urine 20

06 Mercury Level – Urine 20

07 Blood Lead/ZPP 20

08 Heavy Metals Profile 20

09 Cadmium Profile 20

10 Enhanced Musculoskeletal Evaluation 10

11 Pulmonary Function Test 20

12 Respirator Questionnaire 20

13 General Medical Questionnaire 20

14 Chemistry Profile 20

15 CBC with Differential 20

16 Dipstick Urinalysis 20

17 Height/Weight 20

18 Vision – Modified (Near/Distance/Color) 20

19 M.D. Physical Exam 30

20 Vital Signs 20

21 Tetanus Diphtheria 20

22 TB Mantoux 10

23 Hepatitis B Injection #1 5

24 Psychological Eval 2

25 Hepatitis A Injection #1 5

26 Influenza Vaccine 5

27 DOT Form/Driver Card 15

28 Sickle Cell Screen 2

29 Long Bone X-Ray Series 2

30 Company Specific Form 30

31 Blood Collection 20

32 Neurological Sensory Exam 2

33 Cardiac Stress Test 5

34 Chemzyme 20

35 Complete Urinalysis 20

36 Periodic Questionnaire 10

37 M.D. Exam - Intermediate 10

38 Lipids Profile 20

39 Chart Review 30

40 Vision Test (Complete) 30

41 Urine Collection 20

42 Combined Medical Surv Questionnaire 20

43 Occupational Health Physician Consult (30-minute session)

*The quantity of each service/test listed is an estimate of the number required by the Government, however, shall not be perceived as the total number required. The Government may require less services than listed or more services than listed.

Section C - Descriptions and Specifications

PERFORMANCE WORK STATEMENT

OCCUPATIONAL MEDICAL SERVICES

BLANKET PURCHASE AGREEMENT

U.S. ARMY CORPS OF ENGINEERS

PERFORMANCE WORK STATEMENT

NEW ENGLAND DISTRICT

I. BPA TERMS AND CONDITIONS (IAW FAR 13.303-3)

1. Description of Agreement: The Agency enters into this agreement pursuant to 5

U.S.C 7901- Health Services Programs (PL 79-658) and USACE Occupational Health Programs (ER 385-1-40) that authorizes the heads of agencies to establish health services and programs.

2. Extent of Obligation: In accordance with FAR 13.303-3(a)(2), the Government is obligated only to the extent of authorized purchases (Calls) made under the BPA. The establishment of the BPA does not imply any agreement on the part of the Government to place future Calls with the BPA holder. The Government makes no representation as to the number of Calls or actual amount of work to be ordered.

3. Purchase Limitation: The Contractor shall furnish all labor, equipment, and materials necessary to execute the Occupational Medical Services for each BPA Call under this agreement. No single BPA Call may exceed $25,000 in total cost of labor and materials. The Contractor-Furnished Materials and Supplies shall not exceed $5,000 for each individual BPA Call. The BPA Master Dollar Limit is $200,000.

4. Individuals authorized to purchase under the BPA: Only the Contracting

Officer is authorized to purchase under the BPA.

a. Call Procedures:

i. USACE may have multiple BPAs in place with various Contractors for the same Services. USACE intends to compete each Call among a pool of up to three BPA holders to determine if a contractor can provide the services in the required time frame and the price. Award will be based on the lowest price that will provide the services in the required time frame.

ii. The Contractor shall provide a quote for each BPA Call request within 14 days of the initial contact by the Technical Point of Contact. The Contractor may receive additional time to provide the quote if it is pre-approved by the Technical Point of Contact.

iii. Upon notification of an executed BPA Call from the Government, the Contractor shall coordinate with the Technical Point of Contact within 14 calendar days to schedule the work.

5. Delivery Tickets: All deliverables provided under the agreement shall be identified by the following minimum information:

Name of Contractor/Supplier BPA number Date of purchase (Call) Purchase (Call) number Itemized list of items or services furnished Quantity, unit price, and extension for each item, less applicable discounts (unit prices and extensions need not be shown when incompatible with the use of automated systems, provided that the invoice is itemized to show this information)

Date of delivery or shipment

6. Invoices: An itemized invoice shall be submitted at completion of call, at least monthly or upon expiration of this BPA, whichever occurs first, for all deliverables provided against this BPA during a billing period and for which payment has not been received.

Invoices will be paid based on deliverables that have been received and approved by the Call’s Technical Point of Contact. These invoices need not be supported by copies of delivery tickets; however, invoices must indicate the BPA Number, Call Number, Invoice Date; Contract Number; Dates of Service; Description of Work; Quantities;

Material/Supply Back-Up, and total amount due per line item. For services exceeding 30 days the Contractor may request multiple payments. The invoices for each service will be sent (via mail, email or fax) to the appropriate Technical Point of Contact.

7. Technical Point of Contact: The Technical Point of Contact is:

Sheila Harvey Safety and Occupational Health Manager U.S. Army Corps of Engineers New England District 696 Virginia Rd Concord, MA 01742

(978) 318-8504 Sheila.Harvey@usace.army.mil

II. STATEMENT OF WORK:

1. Available Services

Services provided under this agreement are detailed in the attached Medical Services Matrix (Appendix A) and shall be made available by the Contractor within an 80-mile radius of the Customer’s physical address detailed in Appendix B. Available services shall be provided under a direct line relationship between the Contractor and Customer. The Contractor shall provide occupational health examinations to meet the Customer identified medical surveillance program requirements composed of periodic examinations that are provided to Customer personnel exposed to physical and/or chemical health hazards in the work environment.

In case of emergency conditions (e.g., significant emergencies due to inclement weather or power outages) which may affect the Contractor’s ability to provided services, this agreement will remain in force only within the extent of the Contractor’s capabilities at the time of the reported emergency.

2. Management The Contractor shall oversee service operations, monitor medical staff performance, provide quality control, and perform all service management functions associated with the delivery of the services identified in this agreement. Contractor management operations and oversight shall occur at the Contractor’s site location.

3. Confidentiality The Contractor shall adhere to professional and legal standards of confidentiality of records consistent with the needs and requirements related to specific services and in accordance with enforceable Privacy Act of 1974, as amended, 5 U.S.C. § 552a. Requirements related to each service transfer of information shall conform to the items in this PWS.

4. Security and Privacy Requirements

a. NIST Compliance: The contractor shall comply with industry standard security requirements established by NIST Special Publication 800.53 rev 5 to ensure proper and confidential handling of data and information. The contractor shall refer to NIST 800- 53r4 industry standards for Information Systems Security and Privacy which may be found at the following link: https://csrc.nist.gov/publications/detail/sp/800-53/rev-4/final.

b. Information Security and Privacy Requirements: The documentation managed under this contract is considered sensitive and typically contains Personal Identity Information (PII) and/or Personal Health Information (PHI). The contractor shall comply with Federal Information Security Management Act of 2002 (FISMA), Title III, E-Government Act of 2002, Pub. L. No. 107-347 (Dec. 17, 2002); http://csrc.nist.gov/policies/FISMA-final.pdf

c. Data obtained for this contract shall not be used to create databases or any other product not intended for use specifically in this project. All data containing personal identifiers shall be handled in accordance with the Privacy Act of 1974 (Public Law 93-579). No data is to be released to anyone without the specific approval of the Technical Point of Contact.

5. Recognized Customer Holidays

The contractor is not required to perform services on the below Federal Holidays:

New Year’s Day, Birthday of Martin Luther King, Jr., Washington’s Birthday, Memorial Day, Juneteenth Day, Independence Day, Labor Day, Columbus Day, Veterans Day, Thanksgiving Day, and Christmas Day.

6. Points of Contact (POCs)

The list of POCs shall be provided to USACE immediately upon award of the blank purchase agreement and shall be updated annually.

Customer Funding

POC

Customer Scheduling POC

Customer Technical POC

Customer Billing

TBD TBD Kathryn Gonzalez Emily Berry

Contractor Funding POC

Contractor Scheduling POC

Contractor Technical POC

Contractor Billing

7. Contractor Personnel Requirements

The Contractor shall maintain a workforce that is qualified and adequate to provide uninterrupted services defined in this PWS. The Contractor shall, without additional expense to the Government, be responsible for obtaining any necessary licenses, permits, and letters of certification. The Contractor shall comply with any applicable Federal, State, County, and Municipal laws, codes, and regulations in connection with the performance of the work specified under this contract. The Contractor shall obtain and maintain all licenses and permits with federal, state, and local laws, codes, and regulations, as they apply to the services under this agreement. An initial list of the following personnel and laboratory(ies) shall be provided to the Technical Point of Contact no later than thirty (30) calendar days after the initial award date.

a. Occupational Health Physician. Contractor shall maintain on staff Occupational

Health Physicians (OHPs) that are licensed and bonded as Board Eligible (BE) and/or Board Certified (BC) Doctor of Medicine to provide consultation and oversight of the medical services executed under this contract. The BE/BC Occupational Health Physician shall be identified by virtue of education, specialized training, and experience acquired over a period of no less than five (5) years in occupational medicine. BE/BC Occupational Health Physician shall be knowledgeable of the regulations relating to occupational medicine and any other applicable peer-reviewed supplemental resources known and recognized in the occupational medicine community. The BE/BC Occupational Health Physician shall have overall signatory authority and responsibility for all medical exams and medical opinions. Contractor shall identify a primary and secondary BE/BC Occupational Health Physician who will be assigned to perform medical services for the Customer. Provide documentation of their qualifications and licenses.

b. Physician, Physician Assistant and/or Nurse Practitioner. Contractor may obtain and maintain, on staff, licensed and bonded Physician, Physician Assistant (PA) and/or Nurse Practitioner (NP). However, the designated BE/BC Occupational Health Physician shall have overall signatory authority and responsibility for all medical examinations and medical opinions. All Contractor reports and/or results transmitted to the Customer’s Technical Point of Contact shall clearly identify the BE/BC Occupational Health Physician’s printed name and a dated hardcopy or digital signature. Contractor shall ensure that all ancillary medical personnel such as nurses and technicians performing services are credentialed as required by this PWS as well as applicable federal, state, and local laws. The Contractor shall provide a list of all Physician, PAs, and NPs along with their license numbers who will perform medical services under this agreement.

c. Audiologist. The Contractor shall obtain and maintain audiologists who are licensed in the State in which services are provided. Audiologists must maintain certification as a Certified Occupational Hearing Conservationist from the Council for Accreditation in Occupational Hearing Conservation and board certification from the American Academy of Audiology (AAA). The Contractor shall provide a list of all Audiologists along with their license numbers and certificates who will perform medical services under this agreement.

d. Ancillary Medical Personnel. The Contractor shall ensure that all ancillary medical personnel such as technicians performing services are credentialed as required by applicable federal, state, and local laws. The Contractor shall provide a list of all ancillary medical personnel performing medical services under this contract.

e. Clinical Laboratory. The Contractor shall ensure all clinical laboratory services are performed by a laboratory licensed through the Department of Health and Human

Services (DHHS) and the College of American Pathologies (CAP). The Contractor shall provide a list of DHHS and CAP approved laboratories who will perform medical services under this agreement.

8. Subcontracting

Compliance with the provisions of this contract by subcontractors shall be the responsibility of the Contractor. The rates included in the Bid Schedule shall be the rate for services whether performed by the Contractor or a subcontractor.

9. Questionnaires and Forms

Upon receipt of an awarded call, Contractor shall supply the Customer with Medical or Occupational Health History forms to be used. The Customer will ensure employee arrives to the Contractor site with the applicable forms completed at the designated day/time of the examination appointment. Reference Appendix C for applicable forms.

10. Records Review

a. Comprehensive Examination Records Review. The designated BE/BC Physician shall perform a thorough review of the employee’s comprehensive exam and related information, provide a written medical opinion addressing the results of the exam, and a completed Report to Employer Form (Appendix C) within fifteen (15) calendar days from the exam. The records review complexity shall align with the comprehensive exam complexity.

b. Transmitting Examination Results (Records Processing). The Contractor shall complete and return the Report to Employer Form (Appendix C) and include all medical information to include medical examination results, laboratory analyses, medical records, letters of opinion, clearances, and medical reports to the Technical Point of Contact within fifteen (15) calendar days upon the final review and signature by a BE/BC Physician. All reports and/or results transmitted to the Technical Point of Contact shall clearly identify the BE/BC Physician’s printed name, location of service, and a dated hardcopy or digital signature. Hard-copy records containing medical written clearances, opinions, and ALL medical results shall be submitted in separate packages for each individual employee. The package shall be appropriately labeled with the employee’s name and the following: “Confidential Information to be opened by the addressee only”.

Packages shall be mailed to the Technical Point of Contact.

11. Performance

Contractor Acceptable Level of Performance (ALP): The maximum percent defective, the maximum number of defects per hundred (100) units shall be no more than ten (10) units. A unit shall be representative of a single service line item identified under the Medical Services Matrix (Appendix A). There is no allowable variance from this ALP standard. The Customer’s Technical Point of Contact will inspect and evaluate completion of work and communicate deficiencies to the Customer Funding POC, within 10 calendar days of inadequate performance.

If Customer employee (patient) refuses Customer requested medical service(s) during the time of the medical examination, the Contractor may charge a missed examination fee. The employee shall return to their work location without receiving all necessary medical services.

The Contractor shall notify the Customer Technical Point of Contact by phone or fax of any missed examination within 48 hours.

12. Billing The Contractor agrees to charge the Customer the service line-item prices reflected on a awarded blanket purchase agreement. The Contractor’s prices shall be fixed for the period listed on the blanket purchase agreement and the Contractor shall not charge the Customer additional fees.

The Contractor will provide the Customer an invoice for all services rendered at the completion of services for each call (See BPA Part 1, Section 6.0). The Customer’s Billing POC shall be responsible for making payment to the Contractor within 30 days of receipt of a proper invoice.

III. Technical Requirements:

1. Scope of Work

a. Regulations

Contractor shall perform Occupational Health Services meeting the requirements listed in the below standards:

American Association of Occupational Health Nurses (AAOHN) American Board of Occupational and Environmental Medicine (ABOEM) Code of Federal Register (CFR), Medical Qualification Determination (5 CFR 339) Department of Army (DA), Preventative Medicine (AR 40-5) Department of Defense (DoD), Occupational Medical Examination Manual (DoD

6055.05-M) Department of Health and Human Services (DHHS), Clinical Laboratories

Improvement Act of 1967 (42 U.S.C. 263) Department of Homeland Security (DHS), U.S. Coast Guard (USCG), Requirements for Rating Endorsement (46 CFR, Chapter 1, Subpart B.

Department of Transportation (DOT), Federal Motor Carrier Safety Administration

(49 CFR 391.41)

National Institute for Occupational Safety and Health (NIOSH) Occupational Safety and Health Administration (OSHA) General Industry (29 CFR

1910) OSHA Basic Program Elements for Federal Employees (29 CFR 1960) OSHA Construction Industry (29 CFR 1926) U.S Army Corps of Engineers (USACE) Regulation, Occupational Health Program

(ER 385-1-40)

USACE Manual, Safety and Health Requirements (EM 385-1-1) USACE Regulation, Dive Program (ER 385-1-86) USCG, Navigation and Vessel Inspection, Medical and Physical Evaluation

Guidelines for Merchant Mariner Credentials (NVIC 04-08)

The above references may be obtained directly from the Departments listed above or may be provided by the Customer Technical Point of Contact listed in Part II, Section 7.0 within 15 calendar days after Contractor’s request.

b. Medical Service Requests

The Customer Scheduling POC shall be responsible to provide a request for medical services to Contractor utilizing the Contractor electronic portal or Contractor-provided Request for Medical Services Form. A request for medical services will be based on the employee’s individual position, tasks, and exposures. The Request for Medical Services form shall be used by the Customer Scheduling POC to transmit to the Contractor at the time of scheduling medical examination appointments. All examination components shall be performed at the Contractor’s facility, unless otherwise agreed upon by both parties and within this agreement.

If it is determined that additional testing services are required to provide a final disposition, the Contractor shall notify the Customer (USACE) of the tests required and the associated prices from the Bid Schedule, including an additional office visit if necessary. No work outside that listed on the Bid Schedule is permitted. The Customer TPOC shall review the additional tests and pricing and request that a modification to the awarded BPA call be issued. The Contractor shall not perform any additional tests or services until a modification to the BPA call, signed by the Contracting Officer, is received. If the Contractor proceeds without a signed modification, the Government is under no obligation to reimburse the Contractor for these tests and/or services.

The Customer and Contractor Scheduling POCs shall coordinate examination appointments and ensure required Customer forms are received by the Contractor prior to each service request/appointment. When multiple positions, tasks, or exposures require the same medical services, duplicate services should only be performed once.

c. Additional Guidance for Select Medical Services.

Commercial Driver’s License Holder. Contractor shall use the most recent guidance from the Department of Transportation (DOT), Federal Motor Carrier Safety Administration (49 CFR 391.41) when performing examination requirements for Customer’s Commercial Driver’s License Holders.

Diver. Divers shall be medically fit to dive as attested by a Diving Physician.

Contractor shall utilize the Customer provided Diver Authorization Form (Appendix C) when performing examination requirements for Divers. Contractor shall use the most recent guidance from 29 CFR 1910 Subpart T (Commercial Diving Operations), and U.S. Army Corps of Engineers Dive Program (ER 385-1-86). Requirements for Diver Physical Qualifications/Examination can be found in the Appendix D.

Hearing Conservation Program. For Hearing Conservation Program implementation, the Contractor shall utilize an audiologist who has completed an audiology program accredited by American Speech-Language-Hearing Association (ASHA) and who is certified by the Council for Accreditation in Occupational Hearing Conservation (CAOHC).

W912WJ23A0007

The Contractor’s audiologist will evaluate Customer audiograms to determine if hearing changes exist by calculating and analyzing for Standard Threshold Shift (STS). Determine if any hearing changes are work-related. The audiologist will update the employee’s individual hearing record and send analysis to the BE/BC. The BE/BC shall summarize the results on the Customer’s Report to Employer Form (Appendix C). All clinic and audiologist records shall be provided to the Customer Technical Point of Contact in a finalized medical packet.

When the audiologist notes a potential Standard Threshold Shift (STS), the audiologist will make a recommendation to obtain repeat audiograms by contacting the CustomerTechnical Point of Contact directly. The Customer Scheduling POC will coordinate with the Contractor Scheduling POC for the employee to be seen for additional audiogram(s).

U.S. Coast Guard License Holder. Contractor shall use the most recent guidance from the Department of Homeland Security, U.S. Coast Guard (USCG), Navigation and Vessel Inspection, Medical and Physical Evaluation Guidelines for Merchant Mariner Credentials (NVIC 04-08) when performing examination requirements for U.S. Coast Guard License Holder.

ATTACHMENTS

PLEASE REFER TO THE ATTACHMENTS INCLUDED WITH THIS SOLICITATION OR AS SEPARATE

ATTACHMENTS FOR ADDITIONAL INFORMATION.

Section H - Special Contract Requirements

SECURITY REQUIREMENTS

General security requirements and guidance: The security requirements described below apply to all contract personnel (including employees of the prime Contractor (“Contractor”) and all subcontractor employees) supporting the performance requirements of this contract. The Contractor is responsible for compliance with these security requirements. Questions regarding security matters shall be addressed to the designated Government representative (eg., Contracting Officer Representative (COR), Requiring Activity (RA) representative, or Contracting Officer (if a COR or other RA representative is not appointed)). Contract personnel are critical to the overall security and safety of US Army Corps of Engineers (USACE) installations, facilities and activities, and security awareness training contributes to those efforts. The Department of Defense (DoD) and Army security training requirements specified below, if applicable, are performance requirements; all applicable contract personnel shall complete initial training within 30 days of contract award or the date new contract personnel begin performance on the contract. Within five business days from the completion of training, the Contractor shall provide written documentation (e.g., email or memorandum) to the Government representative. The documentation shall include the names of contract personnel trained and which training they completed; the Contractor shall maintain training records as part of their contract files and be prepared to provide copies of training certificates to the Government representative. Contractor personnel and vehicles are subject to search when entering federal installations. Additionally, all contract personnel shall comply with Force Protection Condition (FPCON) measures, Random Antiterrorism Measures (commonly referred to as “RAMs”), and Health Protection Condition (HPCON) measures. The Contractor is responsible for meeting performance requirements during elevated FPCON and/or HPCON levels in accordance with applicable RA plans and procedures –this includes identifying mission essential and non-mission essential personnel. In addition to the changes otherwise authorized by the changes clauses of this contract, should FPCON or HPCON levels at any individual facility or installation change, the Government may implement security changes that affect contract personnel. The Contractor shall ensure all contract personnel are aware of their security responsibilities, including any site-specific requirements identified in local policies or procedures.

Suspicious Activity Reporting training (e.g. iWATCH, CorpsWatch, or See Something, Say Something): All contract personnel shall receive initial and annual refresher training from the RA representative on the local suspicious activity reporting program. This locally developed training provides contract personnel with general information on suspicious behavior, and guidance on reporting suspicious activity to the project manager, security representative or law enforcement entity.

Training Requirements for the Protection of Sensitive Information: All contract personnel with access to critical information (as identified in the RA’s OPSEC program) shall complete initial and refresher OPSEC Level I Awareness training, which is available at the following websites: https://www.iad/ioss/, or http://www.cdse.edu/catalog/operations-security.html (websites subject to change). All contract personnel with access to Controlled Unclassified Information (CUI) shall complete initial and refresher CUI training in accordance with applicable Army policy.

WAGE DETERMINATION

WAGE DETERMINATION WILL BE INCLUDED AT AWARD AND WILL BE BASED ON THE AWARDED

CONTRACTOR’S PLACE OF PERFORMANCE (STATE AND COUNTY). SEE CLAUSE 52.222-49 FOR

ADDITIONAL INFORMATION.

Section I - Contract Clauses

CLAUSES INCORPORATED BY REFERENCE

52.204-9 Personal Identity Verification of Contractor Personnel JAN 2011 52.204-13 System for Award Management Maintenance OCT 2018 52.204-18 Commercial and Government Entity Code Maintenance AUG 2020 52.204-19 Incorporation by Reference of Representations and

Certifications.

DEC 2014

52.212-1 Instructions to Offerors--Commercial Products and Commercial Services

NOV 2021

52.212-4 Contract Terms and Conditions--Commercial Products and Commercial Services

NOV 2021

52.223-5 Pollution Prevention and Right-to-Know Information MAY 2011 52.225-25 Prohibition on Contracting with Entities Engaging in Certain

Activities or Transactions Relating to Iran-- Representation and Certifications.

JUN 2020

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

Subcontractors

NOV 2021

52.242-15 Stop-Work Order AUG 1989 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 252.203-7003 Agency Office of the Inspector General AUG 2019 252.204-7003 Control Of Government Personnel Work Product APR 1992 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

252.204-7018 Prohibition on the Acquisition of Covered Defense Telecommunications Equipment or Services

JAN 2021

252.204-7019 Notice of NIST SP 800-171 DoD Assessment Requirements MAR 2022 252.204-7020 NIST SP 800-171 DoD Assessment Requirements MAR 2022 252.223-7006 Prohibition On Storage, Treatment, and Disposal of Toxic or

Hazardous Materials

SEP 2014

252.225-7048 Export-Controlled Items JUN 2013 252.232-7010 Levies on Contract Payments DEC 2006 252.243-7001 Pricing Of Contract Modifications DEC 1991 252.244-7000 Subcontracts for Commercial Items JAN 2021

CLAUSES INCORPORATED BY FULL TEXT

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (OCT 2022)

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v) of this provision.

(a) Definitions. As used in this provision --

“Covered telecommunications equipment or services” has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

“Economically disadvantaged women-owned small business (EDWOSB) concern” means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127, and the concern is certified by SBA or an approved third-party certifier in accordance with 13 CFR 127.300. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

"Forced or indentured child labor" means all work or service-

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

“Highest-level owner” means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

“Immediate owner” means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: Ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

“Inverted domestic corporation” means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

“Manufactured end product” means any end product in product and service codes (PSCs) 1000-9999, except--

(1) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

“Place of manufacture” means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

“Predecessor” means an entity that is replaced by a successor and includes any predecessors of the predecessor.

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

“Restricted business operations” means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate--

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended.

“Sensitive technology”--

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically--

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

“Service-disabled veteran-owned small business concern”--

(1) Means a small business concern--

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).

"Small business concern"--

(1) Means a concern, including its affiliates, that is independently owned and operated, not dominant in its field of operation, and qualified as a small business under the criteria in 13 CFR part 121 and size standards in this solicitation.

(2) Affiliates, as used in this definition, means business concerns, one of whom directly or indirectly controls or has the power to control the others, or a third party or parties control or have the power to control the others. In determining whether affiliation exists, consideration is given to all appropriate factors including common ownership, common management, and contractual relationships. SBA determines affiliation based on the factors set forth at 13 CFR 121.103.

“Small disadvantaged business concern”, consistent with 13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that--

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by--

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13 CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

“Subsidiary” means an entity in which more than 50 percent of the entity is owned--

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

“Successor” means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name.

The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

“Veteran-owned small business concern” means a small business concern--

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more veterans.

"Women-owned business concern" means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

“Women-owned small business concern” means a small business concern--

(1) That is at least 51 percent owned by one or more women or, in the case of any publicly owned business, at least 51 percent of its stock is owned by one or more women; or

(2) Whose management and daily business operations are controlled by one or more women.

"Women-owned small business (WOSB) concern eligible under the WOSB Program" (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States, and the concern is certified by SBA or an approved third-party certifier in accordance with 13 CFR 127.300.

(b) (1) Annual Representations and Certifications. Any changes provided by the Offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications in SAM.

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed through http://www.sam.gov. After reviewing SAM information, the Offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications--Commercial Products and Commercial Services, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard(s) applicable to the NAICS code(s) referenced for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ___

[Offeror to identify the applicable paragraphs at (c) through (v) of this provision that the offeror has completed for the purposes of this solicitation only, if any.

These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.

Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted electronically on SAM.]

(c) Offerors must complete the following representations when the resulting contract is for supplies to be delivered or services to be performed in the United States or its outlying areas, or when the contracting officer has applied part 19 in accordance with 19.000(b)(1)(ii). Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that--

(i) It [ ___ ] is, [ ___ ] is not a small business concern; or

(ii) It [ ___ ] is, [ ___ ] is not a small business joint venture that complies with the requirements of 13 CFR 121.103(h) and 13 CFR 125.8(a) and (b). [The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ ]

Small business concern. The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a small business concern.

(2) Veteran-owned small business concern. (Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.) The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a veteran-owned small business concern.

(3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that--

(i) It [ ___ ] is, [ ___ ] is not a service-disabled veteran-owned small business concern; or

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR 125.18(b)(1) and (2).

[The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ .] Each service-disabled veteran-owned small business concern participating in the joint venture shall provide representation of its service-disabled veteran-owned small business concern status.

(4) Small disadvantaged business concern. (Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.) The offeror represents that it [ ___ ] is, [ ___ ] is not a small disadvantaged business concern as defined in 13 CFR 124.1002.

(5) Women-owned small business concern. (Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.) The offeror represents that it [ ___ ] is, [ ___ ] is not a women-owned small business concern.

(6) WOSB joint venture eligible under the WOSB Program. The offeror represents that it [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR 127.506(a) through (c). [The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ .

(7) Economically disadvantaged women-owned small business (EDWOSB) joint venture. The offeror represents that it [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR 127.506(a) through (c).

[The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ .]

(8) Women-owned business concern (other than small business concern). (Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.) The offeror represents that it ( ___ ) is, a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price:

(10) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that--

(i) It [ ___ ] is, [ ___ ] is not a HUBZone small business concern listed, on the date of this representation, as having been certified by SBA as a HUBZone small business concern in the Dynamic Small Business Search and SAM, and will attempt to maintain an employment rate of HUBZone residents of 35 percent of its employees during performance of a HUBZone contract (see 13 CFR 126.200(e)(1));

and

(ii) It [ ___ ] is, [ ___ ] is not a HUBZone joint venture that complies with the requirements of 13 CFR 126.616(a) through (c). [The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ .] Each HUBZone small business concern participating in the HUBZone joint venture shall provide representation of its HUBZone status.

(d) Certifications and representations required to implement provisions of Executive Order 11246--

(1) Previous Contracts and Compliance. The offeror represents that--

(i) It ( ___ ) has, ( ___ ) has not, participated in a previous contract or subcontract subject either to the Equal Opportunity clause of this solicitation, and

(ii) It ( ___ ) has, ( ___ ) has not, filed all required compliance reports.

(2) Affirmative Action Compliance. The offeror represents that--

(i) It ( ___ ) has developed and has on file, ( ___ ) has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the…