Attachment_1_Performance_Work_Statement.pdf

2/11/2016

PERFORMANCE

WORK

STATEMENT

Tribal Drinking Water System Technical

Assistance and Capacity Development for

Tribal Water Systems in Wisconsin and

Minnesota

Water Division, Ground Water Drinking Water

Branch, Direct Implementation

U.S. ENVIRONMENTAL PROTECTION AGENCY, REGION 5

Table of Contents Acronyms:

Part 1

OVERVIEW

PURPOSE:

Part 2

Performance Work Statement:

General

Part 3

Contractor Furnished Items, Services, and Responsibilities:

Part 4

Specific Tasks

4.1 Task 1, Technical Assistance

4.2 Task 2, Capacity Development Initiative

Part 5

Reference Materials

Part 6

Deliverables Schedule

Part 7

Quality Assurance Surveillance Plan

APPENDIX A

Key Labor Qualifications

APPENDIX B

Project Title - Cross Connection Control Programs

APPENDIX C

Water System Inventory Form

APPENDIX D

Sanitary Survey Form Template

APPENDIX E

Sample Water Loss Tracking

APPENDIX F

Energy Checklist Outline

APPENDIX G

PRELIMINARY GROUND WATER SOURCE TYPE ASSESSMENT WORKSHEET

APPENDIX H

RTCR Level 1 Form

APPENDIX I

RTCR Level 2 Form

APPENDIX J

Active Tribal Water Systems

APPENDIX K

Capacity Development Tracking Sheet

APPENDIX L

CD Snapshots (Annual Data Ending March 2015)

Acronyms:

CBI Confidential Business Information

CCE Contracting Center of Excellence

CCR Consumer Confidence Reports

CD Capacity Development

CFR Code of Federal Regulations

CONUS Continental United States (excludes Alaska and Hawaii)

COR Contracting Officer Representative\

CUPPS Checkup Program for Small Systems

DA Department of the Army

DD250 Department of Defense Form 250 (Receiving Report)

DD254 Department of Defense Contract Security Requirement List

DFARS Defense Federal Acquisition Regulation Supplement

DOD Department of Defense

DWIG Drinking Water Infrastructure Grant

DWIG-TSA Drinking Water Infrastructure Grant-Tribal Set Aside

DWS Drinking Water System ‘same as PWS in this document’

EPA United Stated Environmental Protection Agency Region 5

FAR Federal Acquisition Regulation

GWUDI Groundwater Under the Direct Influence of Surface Water

HIPAA Health Insurance Portability and Accountability Act of 1996

IHS Indian Health Service

CO Contracting Officer

OCI Organizational Conflict of Interest

ODC Other Direct Costs

PIPO Phase In/Phase Out

PN Public Notice

POC Point of Contact

PWS Public Water System

PWSS Public Water System Supervision

QA Quality Assurance

QAP Quality Assurance Program

QASP Quality Assurance Surveillance Plan

QC Quality Control

QCP Quality Control Program

RTCR Revised Total Coliform Rule

TTAP Tribal Technical Assistance Provider also known as Circuit Rider

TE Technical Exhibit

TO Task Order

Part 1

OVERVIEW: The National Drinking Water Program implements the Safe Drinking Water Act

(SDWA), which established a mandatory national program in 1974 to protect public health through drinking water safety. The program is a primary contributor to the EPA’s Strategic Goal 2 Clean and Safe Water, Objective 2.1 Protect Human Health, Subjective 2.1.1 “Water Safe to Drink”. By ensuring public water systems nationwide meet national standards, the public’s exposure to contaminants in drinking water is reduced, and public health is protected. The Act requires the EPA to regulate contaminants that present health risks and are known, or are likely, to occur in public drinking water supplies. For each contaminant identified for regulation, the EPA sets a legal limit on the amount of that contaminant allowed in drinking water or, where a limit is not practicable, it establishes a treatment technique. The EPA is also required to oversee implementation of state and tribal programs.

The 1996 SDWA Amendments expanded the scope of the laws and provided for a “multiple barrier” approach. This approach utilizes a variety of programs and activities to protect public health, starting with protecting ground water and surface water sources of drinking water form contamination; continuing with appropriate treatment at the water plant and proper management of the system; and culminating in efforts to ensure that customers of public water systems are informed about the quality of drinking water they receive from the tap.

PURPOSE: The purpose of this requirement is to provide technical support for implementation of the SDWA. The SDWA mandates that the EPA Office of Water establish national drinking water standards for public water systems to assure water supplied to the public is safe to drink. These standards are implemented through the Public Water System Supervision (PWSS) Program. The

SDWA (Section 1452(a) and (i) and Section 1420) encourages PWS regulatory agencies to ensure that all new community or non-transient, non-community water systems commencing operation after

October 1, 1999, demonstrate technical, managerial, and financial capacity with respect to the national primary drinking water regulations. The tribal PWS regulatory program in EPA Region 5 is implemented by the Water Division.

Part 2

Performance Work Statement:

This Performance Work Statement identifies the full range of contract support required for the purpose of this requirement. In accordance with the contract attachment “Ordering”, Task Orders

(TO) or technical direction will be utilized to further define and describe the details of the Agency’s requirement during contract performance. Each TO issued by the Contracting Officer (CO) will: 1) present critical milestones and schedules, and specify work products; 2) describe project specific quality assurance and travel requirements; and 3) identify contacts and other resources that will assist the contractor in accomplishing the work. The contractor may be required to perform multiple

TO’s concurrently, and at times the TO’s will be of a quick response nature. The contractor shall perform all services under this contract in accordance with approved Agency requirements. If there is a need to deviate from the technical approach under the contractor’s proposal or agency direction, the contractor shall contact the EPA immediately.

General: The non-personnel services provide technical assistance and capacity development services for Tribal public water systems in Wisconsin and Minnesota. The contractor shall work with the tribes to develop the necessary technical, managerial, and financial capacity for tribal

Public Water System (PWS) utility organizations located within the State of Wisconsin and

Minnesota to achieve compliance with the Safe Drinking Water Act. The Government shall not exercise any supervision or control over subcontracted service providers performing the services herein. Such subcontracted service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

2.1 Description of Services/Scope Introduction: The Contractor shall provide all labor, supervision, supplies, materials, equipment and facilities to provide technical assistance and capacity development services to the eleven tribes located in the State of Wisconsin and in the State of Minnesota. The Contractor shall provide technical assistance by working with the tribes to bring the Drinking Water System (DWS) in compliance with the Safe Drinking

Water Act. The EPA Contracting Officer’s Representative (COR) will provide technical clarification to the Contractor, on work to be performed, in accordance with this performance work statement.

Since the Agency is responsible for the direct implementation of the Public Water Supply

Supervision Program, the Agency may request for the Contractor to provide personnel who can make site visits to the various PWSs or to conduct meetings with Wisconsin and

Minnesota’s state and local environmental or public health officials in the event of a high public health risk response. The work may include technical assistance visits to correct a number of compliance issues that the PWSs have identified. Other types of technical assistance may include, but not limited to, assisting the tribes with capacity development, mapping projects, and safety plans.

2.2 Constraints: The Contractor may provide opinions, recommendations, and/or suggestions to the Agency for consideration. The Agency will make all final decisions related to opinions, recommendations, and/or suggestions, as well as work products subject to Agency review and approval. The Contractor shall not interpret Agency policy or regulations. All confidential business information (CBI) shall be handled in accordance with CBI requirements, and all potential conflicts of interest (COI) shall be identified before starting work.

2.3 General Assignment Information:

2.3.1 Quality Control and Assurance Plan criteria: The Contractor shall maintain an effective quality control program to ensure services are performed in accordance with this Performance Work Statement. The Contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The

Contractor’s quality control program is the means by which he assures himself that his work complies with the requirement of the contract.

2.3.2 Quality Assurance Surveillance Plan (QASP): The government will evaluate the

Contractor’s performance under this contract in accordance with the QASP. This plan is primarily focused on what the Government must do to ensure that the

Contractor has performed in accordance with the performance standards. It defines the performance standards, how the performance standards will be applied, the frequency of surveillance as applicable, and the minimum acceptable defect rate(s).

2.3.3 Recognized Federal Holidays:

Month Day Holiday

January 1 New Year’s Day

January Third Monday Martin Luther King Day

February Third Monday Washington’s Birthday

May Last Monday Memorial Day

July 4 Independence Day

September First Monday Labor Day

October Second Monday Columbus Day

November 11 Veterans Day

November Fourth Thursday Thanksgiving Day

December 25 Christmas Day

2.3.4 Hours of Operation: The Contractor is responsible for conducting business during hours that are within the guidelines of its organization or other hours that the

Contractor has coordinated with the public water system(s) or with the EPA COR.

The contractor shall immediately notify by phone the EPA COR for assistance requests received from the tribes or Indian Health Service (IHS) after work hours and/or weekends.

2.3.5 Place of Performance: The work to be performed under this contract will be at a contractor facility and at a Wisconsin or Minnesota tribal Drinking Water facility.

2.3.6 Post Award Conference/Periodic Progress Meetings:

2.3.6.1 The Contractor agrees to attend a post award conference convened by the contracting activity or contract administration office in accordance with

Federal Acquisition Regulation Subpart 42.5.

2.3.6.2 The Contracting Officer, COR, and other Government personnel, as appropriate, may meet periodically via teleconference or in person with the

Contractor to review the Contractor's performance, at a location agreed upon by both EPA COR and Contractor. At these meetings the Contracting Officer will apprise the Contractor of how the government views the Contractor's performance and the Contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues.

2.3.6.3 The Contractor shall participate in quarterly conference calls scheduled by the

EPA COR to discuss and coordinate activities across Region 5 Indian

Country.

2.3.7 Contracting Officer Representative (COR): An authorized Contracting Officer (CO) will appoint a COR for this requirement by a separate letter. The letter of designation issued to the COR and a copy sent to the Contractor, states the responsibilities and limitations of the COR, especially with regard to changes in cost or price, estimates or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting order. The CORs main responsibility is for monitoring all technical aspects of the contract and assisting the CO in contract administration.

Examples of authorized COR functions assuring that the Contractor performs the technical requirements of the contract may include:

Perform inspections necessary in connection with contract performance;

Maintain written and oral communications with the Contractor concerning technical aspects of the contract;

Issue written interpretations of technical requirements, including

Government drawings, designs, specifications; and

Monitor Contractor's performance and notifies both the Contracting

Officer and Contractor of any deficiencies.

2.3.8 Key Personnel: The Contractor shall provide a Program Manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the Contractor when the Manager is absent shall be designated in writing to the contracting officer. The Contract Manager or alternate shall have full authority to act for the Contractor on all contract matters relating to daily operation of this contract. Qualifications for all key personnel shall include past experience with management, working with Tribal leadership, and troubleshooting of small Tribal Drinking Water Systems. For the purpose of official contractor identification, contractors shall wear a company ID badge (preferably with photo), use contractor email signature lines, and identify on phone communication, they are contractors. The contract clause EPA-H-07-103, Notice Regarding Prohibited

Contractor Activities on Environmental Protection Agency (EPA) prohibits contractors from writing documents or represents itself as an authorized representative of the Agency.

2.3.9 Contractor Travel: Contractor will be required to travel during the performance of this contract to attend meetings, to perform technical assistance and capacity development, or training. Fixed-priced line items considered scheduled and routine services shall include travel costs. If an unscheduled, non-routine travel is approved by the Agency, travel expenses shall by consistent with the substantive provisions of the Federal Travel Regulation (FTR). Travel will be billed based on actual costs in accordance with GSA.

Part 3

Contractor Furnished Items, Services, and Responsibilities:

The Contractor shall furnish all labor, supervision, supplies, materials, equipment, facilities and services required to perform the work.

3 Others Special responsibilities:

3.1 Identification of Contractor Employees: All contract personnel attending meetings, and working in other situations where their Contractor status is not obvious to third parties are required to identify themselves as a contractor to avoid a false impression that they are

Government officials to their audience.

3.1.1 In accordance with clause EPA Acquisition Regulation (EPAAR) 1552.211-70, Reports of Work, the contract must ensure all documents or reports produced by contractors are suitably marked as contractor products or that contractor participation is appropriately disclosed.

3.1.2 For all site visits, the Contractor shall inform the PWS owner and utility representatives that they are contract employees (not EPA employees) contracted by

EPA to provide EPA services. At all times, the Contractor shall be courteous to the

PWS and tribal staff and any other personnel involved with the project. If the

Contractor observes that a PWS is not complying with any of the drinking water regulations or, if conditions at the facility pose an immediate public health risk, the

Contractor shall immediately inform the EPA COR.

3.1.3 All work performed by the Contractor shall be done in accordance with pertinent

Occupational Safety and Health Administration requirements.

3.1.4 Confidentiality: Contractor and subcontractor personnel performing work under this contract may receive or have access to confidential and/or sensitive information (e.g., budget, accounting, etc). The contractor is only authorized to share such information for the purpose of the contract with the Agency.

Part 4

Specific Tasks 4 Technical Assistance and Capacity Development”

4.1 Task 1, Technical Assistance: The Contractor shall provide technical assistance to tribal public waters system utilities to assist in the correction of problems or deficiencies identified by monitoring and reporting results or sanitary surveys. The Contractor shall assist the tribes to correct deficiencies that are preventing the effective management and operation of their PWS. Examples of this type of work include, but are not limited to:

Work with water system personnel to bring the PWS into compliance, including disinfection of the system.

Work with operators troubleshooting contamination problems; This includes follow up on compliance of the different SDWA requirements

Provide assistance and maintenance support to operators to ensure the efficient operation of the PWS.

Work with the PWS to ensure accurate record keeping and reporting. This includes establishing or maintaining a record of monthly operation reports for the system.

Assist and oversee if necessary, operators installing, troubleshooting, calibrating, and maintaining equipment, such as turbidity meters and chlorinators.

Provide assistance with specific system needs and identified problems (This includes

RTCR level 1 or 2 assessment, sanitary survey follow-ups and stage 2 operational evaluation reports, Public Notices (PN), and Consumer Confidence Reports (CCRs.).

Assist in training, modifying, and verifying tribal operators of regulated water systems with preparation of drinking water samples, in accordance with EPA approved calendars/schedules and site sampling plans.

Technical Assistance requests received directly from the tribes or IHS between the hours of 3:00 p.m. and 7:00 a.m. and weekends shall be immediately reported to the EPA COR by phone.

4.2 Task 2, Capacity Development Initiative: The Contractor shall meet with the appropriate personnel for each Tribe to verify, maintain, and improve CD needs including past Region 5 CD and training needs assessments. (Refer to CD Snapshot Appendix).

4.2.1 Subtask 2.1 – Current CD Assessment Initiatives: The Contractor shall assist the tribal PWS responsible personnel by reviewing and/or providing suggested improvement recommendations, if necessary, on the CD initiative components.

Quarterly, a teleconference meeting between the contractor and EPA shall occur to discuss the status of ongoing and proposed initiatives. Proposed initiatives may combine more than one CD component, if feasible. Assist Tribes in compiling awarded DWIG project packages. The following are the main CD initiative components:

Tribal Public Water System Utility Ordinances

Source Water Assessment and Protection Plan (SWAPP)

Climate Change Resilience Measures

GWUDI Assessment forms

Plans:

Safety Plan addressing Operation and Maintenance activities

Emergency Response Plan/Vulnerability Plan (ERP/VA)

Budgets for financial management capacity

Cross Connection Control Program

Certified Operator Assistance and/or Educational Program

System-As-Built and/or related records

Energy Efficiency Assessments/Audits of PWS and related Utility Systems

Water Loss Control Activities

Asset Management/Checkup Program for Small Systems (CUPPS) for PWS and related Utility Systems

4.2.2 Subtask 2.2 - Capacity Development Annual Tracking Sheet: The contractor shall annually coordinate and visit with all tribes to track CD. The contractor shall use the

CD tracking sheet (See Appendix) to reflect updates in the CD focal points over the year. The annual CD tracking sheet shall be completed and submitted by the end of each contract year, as described in the deliverables (Refer to Part 6). The purpose of the CD deliverable is to assist EPA to determine priorities for the next year.

4.2.3 Subtask 2.3 - Public Water System Inventory Information Update: All Tribal water systems inventory shall be revised annually to reflect any changes. (Refer to

Appendix). The inventory shall include an on-site visit verifying the number and conditions of the wells, treatment units, flow, population served, and current site sampling plans for RTCR, and LCR (assist if needed to update plans with system submitting updated plan to EPA). EPA will furnish the most recent inventory at time of contract award. The site visit can be performed in conjunction with other tasks or subtask purposes. The inventory will also include scoring the systems with the appropriate state classification for public water systems and verifying certification level of the operators, as well as implementation status of source water protection programs. Detailed inventory information may be requested if the system is selected as part of the Drinking Water Infrastructure Needs Survey and Assessment.

4.2.4 Subtask 2.4 ‑ Training Workshop(s): The Contractor shall provide for each state, two, 2-day workshops, open to all tribes, totaling 4 training events per year. One workshop shall be oriented toward Safe Drinking Water Act rules, new and current rules, reporting and compliance; the other workshops toward basic operator skills and knowledge needed to obtain/renew certification. Other relevant training topics in the workshops can include routine maintenance, troubleshooting, CD topics and additional topics recommended by the contractor and agreed upon by the EPA COR.

Part 5

Reference Materials 5 APPLICABLE PUBLICATIONS (CURRENT EDITIONS). The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures. All guidance documents in this part are subject to change for update. EPA is responsible for delivering the most recent guidance documents and forms used in this work agreement.

5.1 Attachments/Technical Exhibits:

o Deliverables Schedule (Reference Part 6) o Quality Assurance Surveillance Plan (Reference Part 7) o Sanitary Survey Form (Reference Appendix) o Cross Connection Control Program (Reference Appendix) o Water System Inventory form (Reference Appendix) o Water Loss Project example (Reference Appendix) o Energy Checklist Outline (Reference Appendix) o RTCR Level 1 form (Reference Appendix for draft, pending at HQ) o RTCR Level 2 form (Reference Appendix for draft, pending at HQ) o GWUDI assessment form (Reference Appendix) o Active Tribal Public Water System List (Reference Appendix) o Capacity Development Tracking Annual Sheet (Reference Appendix)

5.2 Guidance Documents: can be found online.

o Source Water Assessment and Protection Workbook Guidance

(http://www.epa.gov/sourcewaterprotection) file:///C:/Users/Slosos/Desktop/WI%20%20Progress/POs/Planning/Tribal%20PWS%20MN%20WI%202016/Phase%20I%20Acquisition%20Planning/3%20Requirements%20Document/PWS%20drafts/PWS%20drafts/Source%20Water%20Assessment%20and%20Protection%20Workbook%20Guidance%20(http:/www.epa.gov/sourcewaterprotection) file:///C:/Users/Slosos/Desktop/WI%20%20Progress/POs/Planning/Tribal%20PWS%20MN%20WI%202016/Phase%20I%20Acquisition%20Planning/3%20Requirements%20Document/PWS%20drafts/PWS%20drafts/Source%20Water%20Assessment%20and%20Protection%20Workbook%20Guidance%20(http:/www.epa.gov/sourcewaterprotection)

Part 6

Deliverables Schedule Unless specified, deliverables shall be emailed electronically and a Microsoft Read Format

(Section 508 compliant).

Deliverable Frequency

Submit one copy to each of the following

In person, Kick-Off Meeting

Within 10 days of

Award COR, CO, CS

Teleconference Meetings Quarterly COR, CO, CS

Invoices: Refer to invoice instructions attachment.

Pdf. No later than 15 days after the end of the month

COR, CO, CS

Sanitary Survey Report No later than 30 days after directed.

COR & Direct

Implementation Team.

CD: PWS Inventory updates and GWUDI assessments

Annually COR & Direct

Implementation Team.

CD: Tracking Sheet and narrative summarizing improvements and CD focused initiatives

Annually COR & Direct

Implementation Team.

CD: Training/workshops

Proposed Topic

Agenda

Supporting Training Material and list of attendees

90 days before workshop

30 days before workshop

30 days after workshop

COR & Direct

Implementation Team.

Progress reports (PR), (Pdf format): The monthly reports will report on the work projects and activities conducted including percentage of the project completed, and a description of the work accomplished.

Discussions can include difficulties encountered and action taken during the reporting period, and anticipated activity with a schedule of deliverables for the subsequent reporting period.

No later than 15 days after the end of the month.

COR & Direct

Implementation Team.

PR: TA Sanitary Survey (SS): Indicate in progress report the date EPA provided

Technical Direction, PWSID/tribe, deficiency, and end date

(With monthly progress report) - No later than

15 days after the end of the month.

PR: TA SS deficiency: Indicate in progress report the date EPA provided Technical

Direction, PWSID/tribe, deficiency, and end date.

PR: TA Document revisions: Indicate in progress report the date EPA provided

Technical Direction, PWSID/tribe, document, and end date.

Deliverable Frequency

Submit one copy to each of the following

PR: TA Monthly O&M reports: Indicate in progress report the date EPA provided

Technical Direction, each PWSID/tribe for this

TA support, and end date.

PR: TA Onsite O&M training: Indicate in progress report the date EPA provided

Technical Direction, PWSID/tribe, onsite training, and end date

PR: TA Phone Assistance: Indicate in progress report the date EPA provided

Technical Direction, PWSID/tribe, phone log, and end date

PR: TA PWS RTCR assessments: Indicate in progress report the date EPA provided

Technical Direction, PWSID/tribe, status, and end date.

PR: TA moderate-to-high public health risk:

Indicate in progress report the date EPA provided Technical Direction, PWSID/tribe, status, and end date.

PR: CD initiatives: Indicate in progress report the date EPA authorized Task Order

PWSID/tribe, progress, and end date.

PR: CD DWIG: Indicate in progress report the date EPA provided Technical Direction, PWSID/tribe, status, and end date.

PR: Include Site Visits, purpose (associate with CLIN, task)

Objective, findings and accomplishments, recommendations and conclusions

For reporting period which happened. (With monthly progress report) - No later than

15 days after the end of the month.

COR & Direct

Implementation Team.

6 MONTHLY INVOICE/PROGRESS REPORT

Performance-based payments may be made either on a whole contract or on a deliverable item basis and be commensurate with the value of the performance event or performance criterion.

The monthly progress report requirements identified in the Performance Work Statement

Deliverables section shall support performance payment request and report financial information to support performance for the cumulative period and the cumulative contract life display. In addition to the monthly progress report narrative, financial supporting information shall include the amount obligated, amount originally invoiced for each Contract Line Item

Number (CLIN), quantity directed/ordered for each CLIN, quantity delivered for each CLIN, amount paid, amount suspended, amount disallowed, and remaining approved amount. The remaining approved amount is defined as the total obligated amount, less the total amount originally invoiced, plus total amount disallowed.

(a) The report shall specify financial status at each task order level as follows:

(1) For the current period, display the amount claimed based upon progress/delivery schedule.

(2) For the cumulative period display: amount shown on latest order amendment amount; amount currently claimed; amount paid; amount suspended; amount disallowed; and remaining approved amount. The remaining approved amount is defined as: the amount or latest order amount (whichever is later), less total amounts originally invoiced, plus total amount disallowed.

(3) Support task order progress effort:

(i) For the current reporting period display the expended direct labor hours (by

EPA contract labor category), and the total loaded direct labor hours.

(ii) For the cumulative reporting period and the cumulative contract period display: The negotiated and expended direct labor hours (by EPA labor hour category) and the loaded direct labor rate.

(iii) Display the estimated direct labor hours and travel costs to be expended during the next reporting period.

(iv) Display the remaining direct labor hours and travel costs required to complete the task order.

(4) A list of deliverables for task order during the reporting period.

(b) The report shall specify financial status for Time-and-Material CLIN 0001C TA Moderate-to-High Public Health Risk:

(1) Labor hours.

(i) Date of Authorized Technical Direction and Name of Authorized Individual.

(ii) A list of employees, their labor categories, and the numbers of hours worked for the reporting period.

(iii) For the cumulative contract period display: The expended labor hours (by labor category) and the total travel costs.

(c) The reports shall be submitted to the following addresses on or before the __ of each month following the first complete reporting period of the contract. See EPAAR 1552.232-70, Submission of Invoices, paragraph (e), for details on the timing of submittals. Distribute reports as follows:

No. of copies Addressee Address (email)

2 Contracting Officer's Representative. ***email provided at award***

Contracting Officer/Contracting Specialist ***emails provided at award***

Part 7

Quality Assurance Surveillance Plan

INTRODUCTION: This Quality Assurance Surveillance Plan (QASP) sets forth the procedures and guidance that EPA will use in evaluating the technical performance of the contractor. The

QASP defines how the Government will monitor the contractor’s performance. The QASP provides a systematic method to evaluate the services the contractor is required to perform.

The contractor, and not the Government, is responsible for management and quality control actions to meet the terms of the contract. The role of the government is to ensure quality assurance standards are achieved.

The contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success. Standards and thresholds may be revised every ‘option’ year in order to further specify or accommodate the Regional Safe Drinking Water Program needs and goals;

however, the needs and goals will not be out of the scope previously detailed in the Part 4 of this document.

PURPOSE OF THE QASP: The QASP provides the EPA Contracting Officer Representative

(COR) and EPA Contracting Officer (CO) the ability to conduct surveillance activities of contractor performance during the life of the contract. The QASP details how and when EPA will monitor, evaluate, and document contractor performance in the areas outlined in the

Performance Work Statement. The contractor develops and submits the Quality Plan (QP) for

Government acceptance in order to comply with contract deliverables. Once accepted, the contractor then uses the QP to guide and document the implementation of the required management and quality control actions to achieve the specified results.

QASP is intended to accomplish the following:

(1) Roles and responsibilities of participating Government officials:

Contracting Officer (CO) – The government employee responsible for executing, administering, and providing direction on the Contract. This person is duly appointed with the authority to enter into, administer, or terminate contracts and make related determinations and findings on behalf of the Government.

Contracting Officer Representative (COR) – The government employee who is responsible for oversight of the Contract. The Contracting Officer designates as a

Contracting Officer Representative in writing specific technical and administrative roles and responsibilities to assist in administering the contract. The source of the

COR authority is the Contracting Officer. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the

Government’s behalf. Any changes that the Contractor deems may affect contract, price, terms, or conditions shall be referred to the Contracting Officer for action.

(2) Key deliverables that will be assessed, Rating Elements, and Standards of

Performance against which the Contractor’s performance will be assessed for Key

Deliverables. Though the Government, through its CO/COR will monitor the Contractor’s performance on a continuing basis, the volume of tasks performed by the Contractor makes technical inspections of every task and step impractical. The performance measures summary is located in the matrix below. The summary includes the required service(s), performance standard(s), acceptable quality level(s), and method of surveillance for each work element and is outlined below:

a. Process of quality assurance assessment. A determination of the contractor’s overall performance will be on an annual basis. EPA will provide annual customer feedback to the contractor by summarizing the past year’s surveillance activities using the Contractor Performance Assessment Reporting System

(CPARS) and Past Performance Information Retrieval System (PPIRS) metric tools to measure the quality and timely reporting of past performance information. As soon as noteworthy accomplishments or discrepancies are identified with a deliverable generated by the contract, the COR and CO will notify the contractor.

b. Monitoring quality assurance. The COR will provide documentation to the

Contracting Officer and maintain a complete Quality Assurance file. The file will contain copies of all reports, evaluations, recommendations, and actions related to the Government’s performance of the quality assurance function. All such records will be retained for the life of this contract. The COR shall forward these records to the Contracting Officer at termination or completion of the

Performance

Objective

Standard Performance

Threshold

Method of Surveillance

Assist in correction of problems or deficiencies identified by monitoring and reporting results or sanitary surveys.

Assist in correction of deficiencies needed to effectively manage and operate their systems. (See part

4.1)

1. Assistance will be provided to operator for contamination problems and compliance issues within 24 hours of being notified by

EPA COR

Zero deviation from standard.

EPA contact Tribe & IHS

2. The Contractor conduct sanitary surveys (as needed/ requested from EPA)

Zero deviation from standard.

Sanitary survey reports delivered to EPA.

EPA contact Tribe & IHS

3. Addressing system significant deficiencies, system noncompliance, corrective actions identified in monthly reports or sanitary surveys

Zero deviation from standard.

EPA contact Tribe & IHS

4. 95% of acute contaminants (RTCR

& Nitrate) related with compliance problems will be addressed within 3 days.

Zero deviation from standard EPA contact Tribe & IHS

EPA will monitor compliance with Drinking

Water Requirements to ensure that 95% of acute contamination problems are addressed within 3 days after being identified to the

Contractor.

Capacity

Development (CD) initiatives with each

Tribe as—capacity development tasks and initiatives include all components referenced in section 4.2.

1. Annually update

Public Water System

Inventory

Zero deviation EPA contact Tribe & IHS

EPA Follow up and update on Public Water System

Inventory.

2. Conduct site visits for Drinking water systems in order to assess and update their CD activities

Zero deviation EPA contact Tribe & IHS

EPA DI staff to follow up on reports and check on site visits and contact systems for check- ups.

3. Improve awareness on various CD components

Zero deviation EPA contact Tribe & IHS

Provide list of workshop attendees as well as measure (via survey) improved capacity development awareness after the workshop/training. – EPA

DI staff to follow up directly with PWS operators.

4. Assisting Tribes with DWIG-TSA criteria for infrastructure project funds when the tribe is selected for award review.

Zero deviation EPA contact Tribe & IHS

Help the tribe to complete and submit CD requirements for DWIG

TSA granted projects.

5. Focus on one or more CD components from the list described in part 4.

Each year, EPA will identify the priority

CD initiatives

Zero deviation EPA contact Tribe & IHS

6. Completion of CD annual forms

Zero deviation EPA contact Tribe & IHS

Submit complete forms at end of option year.

APPENDIX A

Key Labor Qualifications

Special Qualifications: Contractor shall have previous technical, managerial, and financial experience and knowledge working with small water systems and Tribal Governments. Contractor(s) should be a licensed operator and have a minimum of a Class C and/or B Water operator certification. It is preferred to have one engineer on the contractor team, whether the manager or the tribal technical assistant provider, or someone with proven past experience to troubleshoot water supply and treatment operations.

Program Manager:

Education: Bachelor’s Degree in any of the following fields: Geology, Engineering, Hydrology, Chemistry, Biology or other related field with a background to be able to identify and evaluate public water supply safety and provide public health protection to drinking water customers located on the Region 5 Indian Community.

General Experience: Two years in environmental policy management, water, wastewater or solid waste. Knowledge of Safe Drinking Water Act.

Skills: Demonstrated minimum project management skills, including but not limited to planning, budgeting, troubleshooting and accomplishment of milestones. Required efficient communication and reporting capabilities.

Tribal Technical Assistant Provider (TTAP):

Education: Bachelor's Degree or Life Experience in any of the following fields:

Geology, Engineering, Hydrology, Chemistry, Biology or other related field with a background to be able to identify and evaluate public water supply safety and provide public health protection to drinking water customers located on the Region 5 Indian

Community.

General Experience: Minimum of 5 years of related experience in water, wastewater or related fields.

APPENDIX B

Project Title - Cross Connection Control Programs Project Description: In order for EPA to reach its national goal of seeing that communities have access to “safe” drinking water, all water Utilities must have Cross Connection Control programs. The bottom line on this type of program is knowing where the testable backflow prevention devices are located on the system and making sure each device is tested on an annual basis. A concerted effort has been made in Region 5 over the last couple of years to help the Tribes develop and implement this part of their program. Being this is still a voluntary program within Indian Country, Region 5 has taken many steps to help the Tribe’s gear up to take this project on.

In 2009 inspections were completed at all of the commercial facilities on the community water systems.

Another step, and probably the most difficult, involved working with each tribal utility to address the deficiencies found. The tribal circuit rider has and is performing this work. There were no outside funds to help the tribes correct the deficiencies found during the surveys. Each tribe was, and is, being expected to budget for the repairs. The managers are working with the various department heads to educate and acquire commitments. Some deficiencies may take a year or two to get corrected. The last step in this project also involved the provision of additional resources. The tribal utilities may need to receive:

- Additional training on how to interrupt backflow device testing reports.

- Sample cross connection control ordinances so that they could amend their utility ordinances.

- Cross connection control videos/DVD’s for staff training and public education.

- EPA’s cross connection control manual.

- State-specific cross connection control guidance

- Names and phone numbers of all licensed plumbers certified to test and repair backflow prevention devices, by county.

- Educational literature for distribution to their customers.

- Assistance in prioritizing deficiencies for repair/replacement.

- Hose bib type vacuum breakers for residential hose bibs.

- Assistance in setting up a master file for all testable backflow devices found on their systems.

- And, on-going assistance from the Circuit Rider.

Benefits:

- Improved Public Health Protection

- Improved Utility Programs

- Improved awareness of cross connection control by the Utility and the public

- Backflow devices are now being tested annually

- Hazardous conditions have been identified and corrected

- Improved awareness of the importance of the Utility Program and staff

- Testable backflow devices have been located and inventoried

- The water systems are safer

Project Duration: The project is a multi-year effort. Getting deficiencies corrected after the surveys are performed is an on-going challenge unless an outside funding source is available to help cover the cost of repairs.

Project Contact, R5, Groundwater & Drinking Water Branch

(***To Be Provided at time of award***)

APPENDIX C

Water System Inventory Form

Basic Information / Annual Operating Period

Water System No. (PWS ID#) System Name

Date System Became Active: (MM/DD/YYYY)

Operating Category (Operator License)

Total Design Capacity In Gallons Per Day Total Emergency Capacity In Gallons Per Day

Start Date MM/DD (Date system begins operating each year)

End Date MM/DD (Date system ends operating each year)

Population Served

Average Daily

Resident Population (Year-round)

Average Daily

Transient Population

Average Daily

Non-Transient

Population

Effective Dates (MM/DD) From:

To:

Effective Dates

(MM/DD)

From:

To:

Effective Dates

(MM/DD)

From:

To:

Service Connections

Total Number of Service

Connections

Number of

Service

Connections by

Type

Residential _______

Commercial _______

Meter Type :

ME - Metered, UM - Unmetered, MU - Metered and Unmetered

Service Area Characteristics

This water system exists to provide drinking water to:

(circle all that apply)

School - (SC)

Mobile Home Park - (MH)

Service Station - (SS)

Day-Care Center - (DC)

Campground - (CA)

Hotel/Motel - (HM)

Other Transient Area - (OT)

Restaurant - (RE)

Medical Facility - (MF)

Residential Area - (RA)

Other Residential Area - (OR)

Tribal Building - (TB)

Recreation Area - (PA)

Casino Resort - (CR)

Other Non-transient Area (ON)

Points of Contact

Contact Type Tribal Chairperson / President Business Phone

Name Emergency

Phone

Address Line 1 Fax Number

Address Line 2 Email Address

City State Zip

Points of Contact

Contact Type Operator Business Phone

City State Zip

Points of Contact (Optional)

Contact Type Choose all that apply from the list below:

Business Phone

City State Zip

Points of Contact (Optional)

Contact Type Choose all that apply from the list below:

Business Phone

City State Zip

IE = Indian Health Service

Engineer

IS = Indian Health Service

Sanitarian

OP = Operator

OW = Owner

PC = Primary Contact

RC = Regulatory

Contact

LC = Legal Contact

TC = Tribal Chairperson / President

TE = Tribal Environmental Dept.

Representative

TG = Tribal Government

Representative

TH = Tribal Health Dept.

Representative

UT = Utility Representative (Tribal)

O= Other

Water System Facilities - Wells

Facility Name

(Well name)

EPA Assigned No.

(Well ID) (i.e.WL01)

Constructed

Date

Active? Yes

No

Activation

Date

/ / Inactivation Reason

Availability P - Permanent E - Emergency S - Seasonal I - Interim

(Well name)

EPA Assigned No.

(Well ID)

No

Activation

Date

(Well name)

EPA Assigned No.

(Well ID)

No

Activation

Date

Treatment Plants

Facility Name (Plant name) EPA Assigned No. (ID #) FINDS No.

Active? Yes

No

Activity Date / / Activity

Reason

Constructed / /

Enter Actual Plant Location Below Availability P - Permanent E - Emergency S - Seasonal I - Interim

Street Address City /

Town

State Zip Code

Treatment Objective Associated Treatment Process

Treatment Objective Associated Treatment Process

Treatment Plants

Facility Name (Plant name)

EPA Assigned No.

(ID #)

FINDS No.

Active ? Y N Activity

Date

/ / Activity

Reason

Constructe d

Enter Actual Plant Location Below Availability P - Permanent E - Emergency S - Seasonal I - Interim

Street Address City /

Town

State Zip

Code

Treatment Objective Types

B = Disinfection By-products Control

C = Corrosion Control

D = Disinfection

E = Dechlorination

F = Iron Removal

I = Inorganics Removal

M = Manganese Removal

O = Organics Removal

P = Particulate Removal

R = Radionuclides Removal

S = Softening (Hardness Removal)

T = Taste/Odor Control

Z = Other

CODE PROCESS

B121 Activated Carbon, Granular

B125 Activated Carbon, Powdered

B141 Aeration, Cascade

B143 Aeration, Diffused

B145 Aeration, Packed Tower

B147 Aeration, Slat Tray

B149 Aeration, Spray

B160 Algae Control

B200 Chloramines

B220 Chlorine Dioxide

B240 Coagulation

B344 Filtration, Pressure Sand

B345 Filtration, Rapid Sand

B360 Flocculation

B500 Lime - Soda Ash Addition

B541 Ozonation, Post

B543 Ozonation, Pre

B600 Rapid Mix

B640 Reverse Osmosis

B660 Sedimentation

B720 Ultraviolet Radiation

B741 pH Adjustment, Post

B742 pH Adjustment, Pre

C441 Inhibitor, Bimetallic Phosphate

C443 Inhibitor, Hexametaphosphate

C445 Inhibitor, Orthophosphate

C447 Inhibitor, Polyphosphate

C449 Inhibitor, Silicate

C680 Sequestration

C740 pH Adjustment

C741 pH Adjustment, Post

D200 Chloramines

D220 Chlorine Dioxide

D346 Filtration, Slow Sand

D401 Gaseous Chlorination, Post

D403 Gaseous Chlorination, Pre

D421 Hypochlorination, Post

D423 Hypochlorination, Pre

D541 Ozonation, Post

D543 Ozonation, Pre

D720 Ultraviolet Radiation

E121 Activated Carbon, Granular

E141 Aeration, Cascade

E143 Aeration, Diffused

E145 Aeration, Packed Tower

E147 Aeration, Slat Tray

E149 Aeration, Spray

E620 Reducing Agents

E623 Reducing Agent, Sodium Bisulfate

E625 Reducing Agent, Sodium Sulfite

E627 Reducing Agent, Sulfur Dioxide

F141 Aeration, Cascade

F143 Aeration, Diffused

F145 Aeration, Packed Tower

F147 Aeration, Slat Tray

F149 Aeration, Spray

F300 Distillation

F343 Filtration, Greensand

F344 Filtration, Pressure Sand

F345 Filtration, Rapid Sand

F403 Gaseous Chlorination, Pre

F423 Hypochlorination, Pre

F543 Ozonation, Pre

F560 Permanganate

F580 Peroxide

F640 Reverse Osmosis

F660 Sedimentation

F680 Sequestration

F700 Sludge Treatment

F740 pH Adjustment

F742 pH Adjustment, Pre

I100 Activated Alumina

I121 Activated Carbon, Granular

I180 Bone Char

I240 Coagulation

I300 Distillation

I320 Electrodialysis

I344 Filtration, Pressure Sand

I345 Filtration, Rapid Sand

I360 Flocculation

I460 Ion Exchange

I500 Lime - Soda Ash Addition

I600 Rapid Mix

I640 Reverse Osmosis

I660 Sedimentation

I680 Sequestration

I700 Sludge Treatment

I742 pH Adjustment, Pre

M300 Distillation

M343 Filtration, Greensand

M403 Gaseous Chlorination, Pre

M423 Hypochlorination, Pre

M543 Ozonation, Pre

M640 Reverse Osmosis

M680 Sequestration

N000 No Treatment / Not Applicable

N997 Treatment Applied at Plant

The first letter of each code is the objective of the treatment:

B = Disinfection By-products Control

C = Corrosion Control

D = Disinfection

E = Dechlorination

F = Iron Removal

I = Inorganics Removal

M = Manganese Removal

O = Organics Removal

P = Particulate Removal

R = Radionuclides Removal

S = Softening (hardness removal)

T = Taste/Odor Control

Z = Other

N998 Treatment Applied at Point of Entry

O121 Activated Carbon, Granular

O125 Activated Carbon, Powdered

O141 Aeration, Cascade

O143 Aeration, Diffused

O145 Aeration, Packed Tower

O147 Aeration, Slat Tray

O149 Aeration, Spray

O160 Algae Control

O240 Coagulation

O300 Distillation

O345 Filtration, Rapid Sand

O360 Flocculation

O403 Gaseous Chlorination, Pre

O423 Hypochlorination, Pre

O543 Ozonation, Pre

O560 Permanganate

O580 Peroxide

O620 Reducing Agents

O640 Reverse Osmosis

O660 Sedimentation

O742 pH Adjustment, Pre

P240 Coagulation

P300 Distillation

P341 Filtration, Cartridge

P342 Filtration, Diatomaceous Earth

P344 Filtration, Pressure Sand

P345 Filtration, Rapid Sand

P346 Filtration, Slow Sand

P347 Filtration, Ultrafiltration

P360 Flocculation

P520 Microscreening

P600 Rapid Mix

P660 Sedimentation

P700 Sludge Treatment

P742 pH Adjustment, Pre

R100 Activated Alumina

R121 Activated Carbon, Granular

R141 Aeration, Cascade

R143 Aeration, Diffused

R145 Aeration, Packed Tower

R147 Aeration, Slat Tray

R149 Aeration, Spray

R180 Bone Char

R240 Coagulation

R300 Distillation

R320 Electrodialysis

R344 Filtration, Pressure Sand

R345 Filtration, Rapid Sand

R360 Flocculation

R460 Ion Exchange

R500 Lime - Soda Ash Addition

R600 Rapid Mix

R640 Reverse Osmosis

R660 Sedimentation

R680 Sequestration

R700 Sludge Treatment

R742 pH Adjustment, Pre

S240 Coagulation

S300 Distillation

S344 Filtration, Pressure Sand

S345 Filtration, Rapid Sand

S360 Flocculation

S460 Ion Exchange

S500 Lime - Soda Ash Addition

S600 Rapid Mix

S640 Reverse Osmosis

S660 Sedimentation

S680 Sequestration

S700 Sludge Treatment

S742 pH Adjustment, Pre

T121 Activated Carbon, Granular

T125 Activated Carbon, Powdered

T141 Aeration, Cascade

T143 Aeration, Diffused

T145 Aeration, Packed Tower

T147 Aeration, Slat Tray

T149 Aeration, Spray

T160 Algae Control

T403 Gaseous Chlorination, Pre

T423 Hypochlorination, Pre

T543 Ozonation, Pre

T560 Permanganate

T580 Peroxide

P348 Filtered

P349 Unfiltered - Successfully Avoiding

N350 Unfiltered, but Required to Filter

Entry Point / Sampling Location

Facility Name

(Entry Point Name)

EPA Assigned

No. (Well ID)

Constructed Date

Active? Yes

No

Activation

Date

Entry Point / Sampling Location

(Entry Point Name)

EPA Assigned

No. (Well ID)

Constructed Date

Active? Yes

No

Activation

Date

Storage Facilities

(Well name)

EPA Assigned

No. (Well ID)

Constructed Date

Active? Yes

No

Activation

Date

/ / Inactivation Reason

Availability P - Permanent E - Emergency S - Seasonal I - Interim

Storage Type BL - Bladder EL - Elevated GR - Ground RS - Reservoir UN - Underground HD - Hydropneumatic ST

- Standpipe

Constructed Material

(Circle One)

Asbestos Cement, Asphalt, Concrete, Copper, Earth, Fiberglass, Plastic, Steel, Wood, Other

Coating Type

(Circle One)

Approved Paint, Epoxy Resin, Fiberglass, Greased, Glass Lined

Steel, Non-Approved Paint, Plastic, Unlined, Other

Storage Capacity in Gallons Total Elevation Head

Signature_______________________________________

Date___________________________________________

Please follow the example diagram given below and draw a diagram of your water system on the next sheet showing the wells, treatment plants, entry points and distribution system and…