Statement of Work (SOW)

1. PROJECT TITLE: Preventive Maintenance Services for Dental Equipment

2. BACKGROUND/PURPOSE: The Northern Cheyenne Service Unit requires preventive maintenance (PM) and minor repair services for dental equipment to ensure continuous, safe, and effective operation of clinical dental services. The dental program supports direct patient care and must maintain equipment in accordance with manufacturer recommendations, accreditation standards, and infection control requirements.

3. SCOPE: The Contractor shall provide preventive maintenance, inspection, testing, and minor repair services for dental equipment located at the Northern Cheyenne Service

Unit. Services shall be performed in accordance with original equipment manufacturer

(OEM) specifications for equipment including, but not limited to, A-dec, Dentsply, and

Cavitron systems.

The objective is to ensure all dental equipment remains fully operational, compliant with manufacturer and regulatory standards, and minimizes downtime impacting patient care.

The Contractor must be authorized or certified to service OEM equipment and provide qualified technicians and OEM-compliant parts.

4. APPLICABLE DOCUMENTS:

a. OSHA Standards (29 CFR 1910) – Occupational Safety and Health

b. CDC Guidelines for Infection Control in Dental Health-Care Settings

c. Joint Commission accreditation standards

d. Manufacturer Operation & Maintenance Manuals (A-dec, Dentsply, Cavitron)

e. NCSU Infection Control Policy

f. NCSU Quality Control of Sterilized Items Policy

5. TASKS: The Contractor shall provide:

Task 1 – Preventive Maintenance Services

The Contractor shall perform scheduled preventive maintenance on all covered dental equipment in accordance with OEM recommendations. PM services shall generally be performed on a quarterly basis or less frequently as are required per the manufacturer’s instructions. Services include inspection, calibration, lubrication, adjustments, and functional testing.

Task 2 – Inspection and Compliance

The Contractor shall inspect equipment to ensure compliance with safety, infection control, and operational standards. The Contractor shall identify deficiencies and recommend corrective actions.

Task 3 – Minor Repairs and Parts Replacement

The Contractor shall perform minor repairs and replace worn or defective parts as necessary to maintain operational readiness. All replacement parts shall be OEM or OEM-equivalent and meet manufacturer standards.

Task 4 – OEM Authorization Requirement

The Contractor shall be authorized or certified to service (but not limited to) A-dec, Dentsply, and Cavitron equipment. Documentation of authorization shall be provided upon request. Services must comply with manufacturer warranty and servicing requirements.

Task 5 – Service Documentation and Reporting

The Contractor shall provide service reports for each visit, documenting work performed, equipment condition, parts replaced, and any recommended follow-up actions. Reports shall be submitted to the Government within 10 business days of service completion.

Task 6 – Emergency/Unscheduled Service Calls

The Contractor shall provide on-call support for emergency repairs as requested by the Government. Response time shall be within 48 hours unless otherwise coordinated.

Task 7 – Coordination with Government Personnel

The Contractor shall coordinate all services with the designated Technical Point of Contact (TPOC) to minimize disruption to clinical operations.

6. REQUIREMENTS:

a. No remote connectivity will be required or allowed for the completion of required services.

7. DELIVERABLES AND DELIVERY SCHEDULE:

a. The first Preventive Maintenance (PM) Services will be completed within 30 days of contract award and then completed quarterly thereafter.

b. Services are to be completed during normal business hours. Monday – Friday

8:00 am – 4:30 pm Mountain Time except for Federal Holidays. Any after-hours services will require preauthorization by the Technical Point of Contact, COR or

CO.

c. Service Reports are to be submitted within 10 business days after each service visit.

d. Repair Services: Completed within mutually agreed timeframe based on severity

e. Emergency Service Response: Within 48 hours of notification.

8. GOVERNMENT-FURNISHED EQUIPMENT AND INFORMATION: The Government will provide access to all dental equipment, facility space, and relevant equipment inventories necessary to perform services. The Government will also provide access to equipment maintenance records, if available. All Government-furnished property shall be used solely for contract performance.

9. PLACE OF PERFORMANCE: Services shall be provided at:

Northern Cheyenne Service Unit

420 N. Cheyenne Ave

Lame Deer, MT 59043

10. PERIOD OF PERFORMANCE: The period of performance is for a one-year base period plus four one-year option periods.

11. SECURITY: N/A

12. DENTAL EQUIPMENT INVENTORY TO BE SERVICED:

Dental Equipment Inventory

Category Unit /

Description Model # Serial # Notes

M11 Sterilizer

#1 9A259001 V1918649

M11 Sterilizer

#2 9A259001 V1918648

M11 Sterilizer

#3 M11-042 V2730215

M11 Sterilizer

#4 M11-042 V2730219

Ultrasonic Small H Schein

15034 - 151125

Ultrasonic Large ESMA E889 88935 X-Ray Arm A 537 F37601 X-Ray Arm B-C 537 F37606 X-Ray Arm D-E 537 F37413 X-Ray Arm F-G 537 F3715 X-Ray Arm H-I 537 F37602 X-Ray Arm J-K 537 F37604 Pro Clean Suction

1 PC2800 2020938

Pro Clean Suction

2 PC2800 20201952

Pro Clean Suction

3 PC2800 20201937

Pro Clean Suction

4 PC2800 20201935

Unit /

Description Model # Serial # Notes

Pro Clean Suction

5 PC2800 20201955

Pro Clean Suction

6 PC2800 20201633

Pro Clean Suction

7 PC2800 20201710

Pro Clean Suction

8 PC2800 20203376

Pro Clean Suction

9 PC2800 20203370

Pro Clean Suction

10 PC2800 20203355

Additional Equipment

Vacuum and Compressor

Maintenance included;

serial numbers not provided

Additional Equipment

Cabinetry Components

Some parts of cabinetry

Radiology Equip

Cone Beam CT / Pano Machine

Orthopantomograph OP 3D Type: PCX-1

DB2419655

Dentsply Rotary and Reciprocation Drive

AEU-27T

EMT1662017-

Dentsply Rotary and Reciprocation Drive

AEU-27T

EMT1662017-

Ultrasonic Scaler

Cavitron Plus GEN131 G131-30461

Ultrasonic Scaler

Cavitron Plus GEN-136 G136-26402

Ultrasonic Scaler

Cavitron Plus GEN-136 G136-36503

Dental Chair

Operatory A 511A 19H511- A16658

Dental Chair

Operatory B 511A

A16583

Operatory C 511A 17j511- A14357

Operatory D 511A

17J511- A13288

Description Model # Serial # Notes

Dental Chair

Operatory E 511A

A13276

Operatory F 511A

A13301

Operatory G 511A

A15256

Operatory H 511A

A16577

Operatory I 511A

A15222

Operatory J 511A

A16639

Operatory K 511A

A15237

Operatory L 511A

A16671

Operatory M 511A

A15210

Overhead Light

Operatory A 572L 19H572L- A16356

Operatory B 572L

A16359

Operatory C 575L

171575L- A18250

Operatory D 575L

A18244

Operatory E 575L

A11891

Operatory F 575L

17J575L- A18260

Operatory G 575L

A10877

Operatory H 572L

A16369

Operatory I 575L

A10883

Operatory J 572L

A16374

Operatory K 575L

A12897

Operatory L 572L

A16378

Description Model # Serial # Notes

Overhead Light

Operatory M 575L

A10907

Delivery Unit/Table

Operatory A 4635 A954473

Delivery Unit/Table

Operatory B 4635 A954467

Delivery Unit/Table

Operatory C 4635 A954470

Delivery Unit/Table

Operatory D 4635 A954466

Delivery Unit/Table

Operatory E 4635 A954468

Delivery Unit/Table

Operatory F 4635 A954465

Delivery Unit/Table

Operatory G 4635 A954461

Delivery Unit/Table

Operatory H 4635 A954462

Delivery Unit/Table

Operatory I 4635 A954464

Delivery Unit/Table

Operatory J 4635 A954469

Delivery Unit/Table

Operatory K 4635 A954471

Delivery Unit/Table

Operatory L 4635 A954463

Delivery Unit/Table

Operatory M 4635 A954472