Sources Sought Dental Servicses.pdf

Sources Sought Information Request Form

Project Name: Arizona Medical Readiness Detachment (AZMEDRED) Dental Services

Brief Description:

AZARNG has a requirement to ensure medical readiness for 5,100 Service Members by providing services directly promoting comprehensive medical readiness, ensuring global deployability. Dental readiness directly impacts deployability of soldiers. Soldiers coded as Dental Readiness Code (DRC) 3 are non-deployable due to having oral conditions that will most likely result in a dental emergency within 12 months if not treated. Utilizing a contracted dental office for extensive treatment services would greatly improve the AZARNG’s ability to deploy soldiers and prevent oral conditions from worsening.

The contracted dental office, at a minimum, must be able to provide the following dental treatments: Root Canal Therapy, Crowns, surgical extractions of teeth with exposed roots/impacted teeth/erupted teeth, Resin Based Composites, Amalgam, and Core Build-Up.

Dental services shall be performed by licensed professionals. The Contractor shall be held liable and are responsible for ensuring and verifying the appropriate level of Credentialing Privileging (see attached PWS) for all contract providers in support of the AZARNG. Providers must not have existing open board complaints. Previous disciplinary action against a dentist by the Arizona or other States Board of Dentistry may preclude them from being a provider under this contract, unless approved by the State Dental Officer or Deputy State Surgeon.

The chart below represents the estimated procedures to be completed in a 12 month period of performance. (approximately 160 patients).

Quantity ADA Code

Cost Procedure Description Total

3 D0140 LIMITED ORAL EVALUATION

1 D0220 Intraoral- Periapical First Film

1 D0230 30; Intraoral- Periapical Each Additional Film

1 D1110 Prophylaxis-Adult

21 D2140 AMALGAM-One Surface

39 D2150 Amalgam-Two Surfaces

15 D2160 Amalgam-Three Surfaces

2 D2161 Amalgam-Four or more Surfaces

13 D2330 Resin Based Composite-One Surface

8 D2331 Resin Based Composite-Two Surfaces

5 D2332 Resin Based Composite-Three Surfaces

9 D2335 Resin Based Composite-Four or more Surfaces

6 D2391 Resin Based Composite-One Surface

20 D2392 Resin Based Composite-Two Surfaces

11 D2393 Resin-3 surfaces, posterior

6 D2394 Resin Based Composite-Four or more

2 D2740 Crown-porcelin/cermanic

2 D2750 Crown-Porcelin Fused to High Noble Metal;

6 D2931 Prefabricated Stainless Steel Crown- Permanent Tooth

38 D2950 Core buildup [including any pins]

1 D2952 Cast Post and Core in Addition to Crown

4 D3120 Pulp Cap-Indirect [Excluding Final Restoration]

2 D3310 Anterior Root Canal Therapy

4 D3320 Bicuspid Root Canal Therapy

13 D3330 Molar Root Canal Therapy

1 D3347 Bicuspid Root Canal Retreatment

5 D3348 Molar Root Canal Retreatment

1 D4212

Gingivectomy or gingivoplasty to allow for restorative procedure per tooth

5 D4355 Full Mouth Debridement

15 D7140 Extraction[Erupted Tooth or Exposed Root]

41 D7210 SURGICAL REMOVAL OF ERUPTED TOOTH

23 D7230

Removal of Impacted Tooth-Partial Bony

6 D7240 Removal of Impacted Tooth-Completely Bony;

Symptomatic

1 D7250 SURGICAL REMOVAL OF RESIDUAL

TOOTH ROOTS

NAICS Code: 621210 Offices of Dentists

Interested firms please respond with this information form and the following requested information. Please complete all sections of the document.

1. Company Information:

Company Name:

Company Address as registered in System for Award Management (SAM):

( ) I have confirmed that my address listed above is exactly the same as listed in

(SAM)

( ) The above address is not the same in (SAM), but registration is being corrected to the above listed address

UEI ID: ________________________________

2. Socio-economic status for the listed NAICS code - please check all that apply:

( ) Large Business ( ) Small Business

( ) Small Disadvantaged Business ( ) 8(a) program participant

( ) HUB Zone Business ( ) Woman-Owned Business

( ) Service-Disabled Veteran-Owned Small Business (SDVOSB)

The firm must be registered entity in System for Award Management (SAM):

https://sam.gov/ with the socio-economic status identified above and the NAICS code specified in the sources sought notice. If the firm’s (SAM) record does not include this project’s NAICS code, the firm will not be considered.

( ) I have confirmed that my firm is registered in SAM for the NAICS code and business type selected

( ) My firm is not registered in SAM with the NAICS code and business status selected, but the firm qualifies and registration is in process

( ) My firm is not registered in SAM for the identified NAICS code

3. Examples of similar work: Provide At least three but no more than five projects completed within the last three years that are similar in nature to the work being referenced to. Include the following information:

Type of project

Dollar value of the project https://sam.gov/

Contract number (if applicable)

Location of the work Reference

Brief description (1-2 paragraphs)

Identify if the project was performed for a government or private entity. Indicate if your firm was a prime contractor or subcontractor. If you firm was a subcontractor, provide the percentage of work that was awarded and completed on the project by your firm.

4. Resources: Provide a brief outline of resources, subcontractors, and key personnel to include credentials of personnel that your firm would use to complete this project.

Please keep this documentation to 1 page.

5. Certification:

In the event our firm meets the criteria listed in the solicitation when advertised and because of the submission of this documentation, it is our firm’s intention to submit a quote as a prime contractor.

Signature: ___________________________ Printed Name:

Title:

Phone No. _____________________ E-mail Address:

Please e-mail the completed form and attachments to christopher.l.rogers.mil@army.mil Submission of this form and attachments will not qualify your firm for the referenced project. The Information being requested and received is strictly for the purposes of market research and intended for Government use only. THIS IS NOT A REQUEST

FOR QUOTES. NO SOLICITATION, PLANS OR SPECIFICATIONS ARE AVAILABLE

FOR THIS PROJECT AT THIS TIME. THERE WILL BE NO “SUCCESSFUL

OFFEROR” AS A RESULT OF THE RECEIPT OF THIS INFORMATION.

Commonly asked Questions

Q1: What is a Sources Sought?

A1: The intent of a sources sought is to assist the government contract activity to identify potential qualified Small Business, Small Disadvantaged Business, 8(a) program participant, HUB Zone Business, Woman-Owned Business and Service- Disabled Veteran-Owned Small Business (SDVOSB) that can perform a specific service. Following a review of the responses to this synopsis the Government identifies potential contract set asides or stipulations to bolster opportunities for small and disadvantage businesses.

Q2: When can I submit a quote?

A2: When the USPFO for Arizona issues a synopsis it will have information regarding the date the solicitation will be available as well as other pertinent information regarding the project. The solicitation will be available during this Fiscal Year. Interested offerors should follow this announcement on the Federal Business Opportunities to ensure they received updated information regarding this project.

Q3: I am subcontractor. Will I be able to submit a quote for this project?

A3: Any contractor can submit a quote and it will be evaluated in accordance with the evaluation criteria in the solicitation. Reference A1, the solicitation has not been issued yet.