SOW_FY25_FIRE ALARM_BASE PLUS FOUR-updated.pdf

STATEMENT OF WORK

INSPECTION AND TESTING OF THE FIRE ALARM SYSTEMS

INDIAN HEALTH SERVICE

GREAT PLAINS AREA INDIAN HEALTH SERVICE LOCATIONS:

BELCOURT, ND

EAGLE BUTTE, SD

FT. THOMPSON, SD

FT. YATES, ND

KYLE, SD

LOWER BRULE, SD

MOBRIDGE, SD

McLAUGHLIN, SD

PINE RIDGE, SD

ROSEBUD, SD

SISSETON, SD

WAGNER, SD

WANBLEE, SD

FEBRUARY 2025

Statement of Work Page 2 Inspection and Testing of the Fire Alarm Systems - GPA February 2025

Table of Contents

1. Project Description

2. Scope of Work (SOW):

3. Period of Performance

4. Contractor Responsibilities

5. Government Responsibilities

6. Records/Data

7. Quality Assurance

8. Deliveries or Performance

9. Payments to the Contractor

10. IHS Personnel

11. Invoice Format

12. Authority

Appendix A – Fire Alarm Equipment Summary and Locations

Appendix B – Quote Schedule

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix C – Report of Inspection and Testing Form

Appendix D – Contract Performance Evaluation

Statement of Work Page 3

February 2025

STATEMENT OF WORK

Inspection and Testing of the Fire Alarm Systems Great Plains Area

Belcourt & Ft. Yates, ND, Eagle Butte, Ft. Thompson, Kyle, Lower Brule, McLaughlin, Mobridge, Pine Ridge, Rosebud, Sisseton, Wagner & Wanblee, SD

1. Project Description A. Title: Inspection and Testing of the Fire Alarm Systems

B. Location: This service is to be provided at multiple locations: Belcourt & Ft. Yates, ND, Eagle Butte, Ft.

Thompson, Kyle, Lower Brule, McLaughlin, Mobridge, Pine Ridge, Rosebud, Sisseton, Wagner & Wanblee, SD.

C. Period of Performance: Base Year Annual Tests and Inspections shall be performed within a 30 day period starting May 1, 2026 and ending 60 days from the Notice to Proceed.

D. Description: The purpose of the contract is to provide an annual inspection and testing of the fire alarm systems within health care facilities located throughout the Great Plains Area Indian Health Service (North Dakota and South Dakota). It is vital to have the inspection and testing required by code to ensure continued accreditation by the Center for Medicare and Medicaid Services and the Joint Commission of our facilities.

E. Background: The purpose for periodic inspections is to assure that obvious damages or changes that might affect the system(s) operability are visually identified. The purpose for periodic testing is to statistically assure operational reliability.

F. Related Documents

1) This SOW and any other standard government or IHS documents are included and considered a part of this contract.

2) NFPA 72, National Fire Alarm Code, 2010 Edition

3) NFPA 99, Standard for Healthcare Facilities, 2012 Edition

4) NFPA 101, Life Safety Code, 2012 Edition

G. Common Acronyms or Definitions

1) IHS – Indian Health Service

2) CMS – Centers for Medicare & Medicaid Services

3) CO – Contracting Officer

4) COR – Contracting Officer’s Representative

5) PM – Project Manager

6) IGCE – Independent Government Cost Estimate

7) RFI – Request For Information

Statement of Work Page 4

February 2025

2. Scope of Work (SOW): Perform an annual inspection and test of each fire alarm system located at selected Great Plains Area facilities.

The contractor shall provide all material, labor, equipment and supervision required to accomplish the following:

A. Contractor Tasks

1) Property Information. Provide all property information including: name of property, address, name of property representative, phone, fax, and e-mail.

2) Testing and Monitoring Information.

a) Provide all testing organization information including: organization name, name of technician, address, phone, fax, and e-mail.

b) Provide all monitoring organization information including: organization name, phone, fax, e-mail, entity to which alarms are retransmitted, and phone number of the entity to which alarms are retransmitted.

3) Type of System or Service. Identify type of system(s) installed.

a) Control Unit. Provide control unit manufacturer and model number.

b) Mass Notification System.

(1) System Type. Identify type of MNS installed where applicable.

(2) System Features. Identify MNS features where applicable.

c) System Software. Provide firmware revision number, location, and date software was last updated where applicable.

d) System Documentation.

(1) Obtain detailed device listing/inventory from the property representative.

(2) Obtain a NFPA 72 record of completion from the property representative.

(3) Obtain record (as-built) drawings of the fire alarm system from the property representative.

e) Alarm Verification. Provide alarm verification information where applicable.

4) System Power.

a) Control Unit.

(1) Primary (Main) Power. Provide input voltage and amperage of control panel.

(2) Batteries. Provide battery information including: location, type, quantity, nominal voltage, amp/hour rating, date of manufacture, and the calculated capacity of batteries to drive the system in both standby and alarm mode.

b) In-Building Fire Emergency Voice Alarm Communication System or MNS.

(1) Primary (Main) Power. Provide input voltage and amperage of EVACS or MNS panel where applicable.

Statement of Work Page 5

February 2025

(2) Batteries. Provide battery information including: location, type, quantity, nominal voltage, amp/hour rating, date of manufacture, and the calculated capacity of batteries to drive the system in both standby and alarm mode where applicable.

c) Notification Appliance Power Extender Panels.

(1) Primary (Main) Power. Provide input voltage and amperage of the notification appliance power extender panels where applicable.

(2) Batteries. Provide battery information including: location, type, quantity, nominal voltage, amp/hour rating, date of manufacture, and the calculated capacity of batteries to drive the system in both standby and alarm mode where applicable.

5) Annunciators.

a) Location and Description of Annunciators. Provide the location and description of all annunciators within the system.

6) Notifications Made Prior to Testing. Before proceeding with any testing; the monitoring organization, building management, and all building occupants shall be notified of the testing to prevent unnecessary response.

7) System Inspection.

a) Verify the location and condition of all remote annunciator(s) where applicable.

b) Verify the location and condition of all notification appliance circuit power extender panel(s) where applicable.

c) Verify the location and condition of all initiating device(s) where applicable.

d) Verify the location and condition of all notification appliance(s) where applicable.

e) Verify documents provided by the property representative match what is actually installed.

Provide any additions and/or subtractions that need to be made to the device listing/inventory.

8) Control Panel Test.

a) Verify smoke detector at the control panel.

b) Verify location of branch circuit breaker permanently identified at control panel.

c) Verify panel is in normal condition.

(1) Verify power indicator lamp is on.

(2) Verify no trouble or alarm indicator lamps are on.

d) Operate the lamp test switch.

(1) Verify all indicator lamps illuminate.

e) Check for ground fault indications by connecting a jumper from an initiating or signaling circuit to ground.

(1) Verify ground fault indicator lamp illuminates.

f) Battery verification.

(1) Verify batteries are dated.

Statement of Work Page 6

February 2025

(a) Provide date on batteries.

(b) Verify batteries are not more than 3 years old.

(2) Verify batteries are same rating (or larger) as battery calculations in Record of Completion.

g) Disconnect battery lead.

(1) Verify audible and visual trouble indicators illuminate.

(2) Reconnect batteries.

h) Complete the Annual Emergency Services Notification Transmission Equipment Test Report.

(1) Trouble Signal.

(a) Trip main breaker to disconnect AC power.

i. Verify power indicator turns off.

ii. Verify audible and visual trouble indicators sound and illuminate.

(b) Operate trouble silence switch.

i. Verify trouble sounder silences.

ii. Verify trouble indicator stays on.

iii. Verify receipt of trouble signal at the monitoring facility within 90 seconds.

(c) Restore normal power.

i. Verify power indicator illuminates.

ii. Verify audible and visible trouble indicators turn off.

(2) Supervisory Signal.

(a) Close main control valve to fire suppression system.

i. Verify audible and visual supervisory indicators sound and illuminate.

(b) Operate supervisory silence switch.

i. Verify supervisory sounder silences.

ii. Verify supervisory indicator stays on.

iii. Verify receipt of supervisory signal at the monitoring facility within 90 seconds.

(c) Open main control valve to fire suppression system.

i. Verify audible and visible supervisory indicators turn off.

(3) Alarm Signal.

(a) Initiate an alarm from any device in the system.

i. Verify alarm sounds.

ii. Verify proper identification of actuated device.

(b) Operate alarm silence switch.

i. Verify alarm silences.

Statement of Work Page 7

February 2025

ii. Verify zone light or display stays on.

iii. Verify receipt of alarm signal at the monitoring facility within 90 seconds.

(c) Initiate another alarm device on a different initiating device circuit.

i. Verify alarms resound.

(4) System Restoration.

(a) Reset devices and operate system reset switch.

i. Verify system resets.

ii. Verify trouble indicators activate until alarm silence switch is returned to normal.

9) Emergency Voice Alarm Communications Equipment Test.

a) Manually place the system in general alarm where applicable.

(1) Verify alarms sound throughout building.

(2) Verify each speaker zone for proper operation and identification.

(3) Verify clarity (intelligibility) of prerecorded voice message.

(4) Verify clarity (intelligibility) of live voice signal.

10) Notification Appliance Power Extender Panel(s) Test. Complete the Notification Appliance Power Extender Panel Test Report where applicable.

a) Verify smoke detector protecting the power extender panel.

b) Verify power extender panel is in normal condition.

(1) Verify power indicator on.

(2) Verify no trouble or alarm indicators on.

(3) Verify batteries are no more than 3 years old.

11) Auxiliary Function Test.

a) Perform a functional test of the door-releasing device relay(s) where applicable.

b) Perform a functional test of the fan shutdown relay(s) where applicable.

c) Perform a functional test of the smoke management / smoke control relay(s) where applicable.

d) Perform a functional test of the smoke damper relay(s) where applicable.

e) Perform a functional test of the smoke shutter release relay(s) where applicable.

f) Perform a functional test of the door unlocking relay(s) where applicable.

g) Perform a functional test of the elevator recall relay(s) where applicable.

h) Perform a functional test of the elevator shunt trip relay(s) where applicable.

i) Test and verify MNS override of FA signals.

12) Initiating Device Test. Complete the Initiating Device Test Report where applicable.

a) Manual Fire Alarm Boxes (Pull Stations).

Statement of Work Page 8

February 2025

(1) Actuate pull station where applicable.

(a) Verify alarm signal at panel.

(b) Verify proper identification of actuated device.

(2) Repeat for each manual pull station in the system.

b) Smoke Detectors (where applicable).

(1) Smoke Test.

(a) Actuate smoke detector using magnet, smoke, or aerosol acceptable to the manufacturer.

i. Verify alarm signal at panel.

ii. Verify proper identification of the actuated device.

(b) Repeat test for each smoke detector in the system.

(2) Sensitivity Test. Smoke detector sensitivity testing shall be performed in even-numbered years (2026, 2028, 2030, etc.).

(a) Follow the manufacturer's recommended sensitivity test methods.

c) Air Sampling Smoke Detectors (where applicable). Follow the manufacturer's recommended test methods.

d) Duct Detectors (where applicable).

(1) Smoke Test.

(a) Actuate smoke detector using magnet, smoke, or aerosol acceptable to the manufacturer.

i. Verify alarm signal at panel.

ii. Verify proper identification of the actuated device.

(b) Repeat the test for each smoke detector in the system.

(2) Sensitivity Test. Smoke detector sensitivity testing shall be performed in even-numbered years (2026, 2028, 2030, etc.).

(a) Follow the manufacturer's recommended sensitivity test methods.

(3) Test duct smoke detectors that use sampling tubes to ensure they will properly sample airstream in the duct using a method acceptable to the manufacturer or per their published instructions.

e) Projected Beam Smoke Detectors (where applicable). Test the detector by introducing smoke, other aerosol, or an optical filter into the beam path.

f) Non-Restorable Fixed Temperature Heat Detectors (where applicable).

(1) Remove the device from its mounting plate and short across the alarm contracts.

(a) Verify alarm signal at panel.

(b) Verify proper identification of actuated device.

(2) Replace device.

Statement of Work Page 9

February 2025

(3) Repeat for each non-restorable heat detector in the system.

g) Restorable Fixed Temperature Heat Detectors (where applicable).

(1) Heat test using a hair dryer or approved heat detector tester.

(a) Verify alarm signal at panel.

(b) Verify proper identification of actuated device.

(2) Repeat for each restorable heat detector in the system.

h) Rate-of-Rise Heat Detectors (where applicable).

(1) Heat test using a hair dryer or approved heat detector tester.

(a) Verify alarm signal at panel.

(b) Verify proper identification of actuated device.

(2) Repeat for each rate-of-rise heat detector in the system.

i) Rate Compensation Heat Detectors (where applicable).

(1) Heat test using a hair dryer or approved heat detector tester.

(a) Verify alarm signal at panel.

(b) Verify proper identification of actuated device.

(2) Repeat for each rate compensation heat detector in the system.

j) Restorable Line-Type Heat Detectors (where applicable).

(1) Short across the conductors at the end of the heat detector cable.

(a) Verify alarm signal at panel.

(b) Verify proper identification of actuated device.

(2) Repeat for each non-restorable line-type heat detector in the system.

k) Non-Restorable Line-Type Heat Detectors (where applicable).

l) Flame Detectors (where applicable). Follow the manufacturer's recommended test methods.

13) Alarm Notification Appliance and Door-Releasing Device Test (where applicable). Complete the Alarm Notification Appliance and Door-Releasing Device Test Report.

a) Place the system in alarm condition.

(1) Verify audible signal devices sound throughout the building.

(2) Verify visual signal devices activated throughout the building.

(3) Verify all door-release devices release throughout the building.

14) Smoke Detection Shutdown Devices for HVAC Test (where applicable). Complete the Smoke Detection Shutdown Devices for HVAC Test Report.

a) Actuate duct smoke detector using magnet, smoke, or aerosol acceptable to the manufacturer.

(1) Verify damper closure and/or air handler shutdown.

Statement of Work Page 10

February 2025

15) Notifications that Testing is Complete. After testing, those previously notified (and others, as necessary) shall be notified that testing has been concluded.

16) System Restored to Normal Operation. After testing, the fire alarm system shall be restored to normal operation.

17) Certification. Upon completion of testing, the inspector shall certify with signature that the system was inspected and tested according to NFPA 72.

18) Additional Facility Requirements: The contractor shall comply with the requirements of the hospital’s Facility Manager and clean up after themselves, including any tools and equipment needed to complete the testing.

3. Period of Performance.

1) Base Year - Annual tests and inspections shall be performed within 30 days starting May 1, 2026, and ending 60 days from the Notice to Proceed.

2) Option Years – Annual tests and inspections shall be performed 1 year from the last inspection/test, plus or minus 30 days.

3) Following completion of the annual inspections, a copy of each report shall be provided to the Project

Officer for documentation purposes. This documentation shall be provided no later than 20 workdays following the completion of the final site visit and shall be in an organized, legible format. See Section 6 for additional information.

4. Contractor Responsibilities

1) Contractor personnel performing the testing/inspections shall possess appropriate credentials from a certifying organization, such as the National Fire Protection Association (NFPA 101, 99, 70, 72) and National Institute for Certification in Engineering Technologies (NICET) certification in ‘Inspection and Testing of Fire Alarm Systems.’ All testing shall be performed by personnel, either individually or through their affiliation with an organization that is registered, licensed, or certified by a state or local authority, and shall be recognized as qualified and experienced in the inspection, testing, and maintenance of systems addressed within the scope of work. Supporting documentation for credentials shall be submitted with the bid proposal.

2) Following notice to proceed, the contractor shall submit a proposed inspection/test schedule to the Project Officer for approval. The schedule shall include facility locations, the date of planned inspections, and the name of each technician to perform each inspection. The contractor shall notify the Project Officer immediately concerning any scheduling changes. The contractor shall notify each Facility Manager a minimum of 72 hours before performing a service.

3) Failed component replacement and repairs will not be included within the contractor’s responsibilities unless the failure of components is the result of the contractor’s activities. However, the contractor is invited to provide recommendations resulting from the contracted service to the Facility Manager and the Project Officer. Any repair, service, or part not included within this contract will require a separate procurement from the local Service Unit before the repair, service, or part can be performed, installed, or ordered. Invoices without a corresponding procurement number will not be paid.

4) The contractor shall utilize the device inventory provided by the facility/contract point of contact. The contractor shall verify the accuracy of the devise listing and note any additions or subtractions to the inventory. If the device inventories are not provided by the facility/contract point of contact, the contractor shall perform an entire walk-through of the facility and develop a detailed listing of the fire alarm devices. The equipment summaries provided in this document are an approximate list and are only to be used as a tool to provide a bid for the contract.

Statement of Work Page 11

5. Government Responsibilities A. The Property Representative shall provide access to all areas of the facility.

B. The Property Representative shall provide the most up-to-date device listing of the facility fire alarm system components.

C. Pre-Inspection Meeting: One Pre-Inspection Meeting shall be conducted before the start of the inspections/tests of the contract.

6. Records/Data

A. Record of Inspection and Testing. Following the completion of the annual inspections, reports shall be completed for each facility. All testing data shall be recorded on the attached applicable “RECORD OF INSPECTION AND TESTING” forms or another form approved by the Project Officer. Reports shall be electronically completed utilizing a fillable PDF form provided by IHS. A copy of each report shall be provided to the Project Officer for documentation purposes. This documentation shall be provided no later than 20 workdays following the completion of the final site visit.

B. The contractor shall submit one package, after all sites have been visited, containing one invoice to the Project Officer itemizing the service(s) performed at each site. The invoice shall include the contract number, facility name, type of service performed at each facility, date of invoice submission, and payment amount per facility. The reports shall accompany the invoice. Individual invoices shall not be submitted to the locations within the contract.

7. Quality Assurance A. Facility Managers will submit vendor evaluations to the Project Officer upon completion of each site visit. Successful contract completion will be determined by the timely submission of schedules, reports, and invoices. Accuracy of schedule and information in reports will also be taken into consideration.

Thorough completion of services as indicated in the contractor tasks, vendor evaluations, and in general will also be considered when evaluating the successful completion of the contract.

8. Deliveries or Performance

A. Place of Performance/Hours of Operation

1) Sites to receive service are Belcourt (ND), Eagle Butte (SD), Ft. Thompson (SD), Ft. Yates (ND), Kyle (SD), Lower Brule (SD), Mobridge (SD), McLaughlin (SD), Pine Ridge (SD), Rosebud (SD), Sisseton (SD), Wagner (SD), and Wanblee (SD).

a) Belcourt, ND

(1) Hospital

(2) Behavioral Health / PHN Building

b) Eagle Butte, SD

(1) Hospital

c) Ft. Thompson, SD

(1) Health Center

Statement of Work Page 12

February 2025

(2) Substance Abuse Center

(3) Wellness Center

d) Ft. Yates, ND

(1) Hospital

(2) Dental Clinic

(3) Optometry/Mental Health Center

(4) Remote Clinic (Cannonball)

e) Kyle, SD

(1) Health Center

f) Lower Brule, SD

(1) Health Center

g) Mobridge, SD (YRTC)

(1) Treatment Center

h) McLaughlin, SD

(1) Health Center

(2) Dental Clinic

(3) Remote Clinic (Wakpala)

i) Pine Ridge, SD

(1) Hospital

(2) Public Health Nursing

(3) Lacreek Clinic (Martin)

j) Rosebud, SD

(1) Hospital

k) Sisseton, SD

(1) Health Center

l) Wagner, SD

(1) Health Center

m) Wanblee, SD

(1) Health Center

2) Inspection and testing shall be completed between the hours of 8:00 AM and 5:00 PM, M-F, unless otherwise approved by the Project Officer. No testing and maintenance shall be performed on a national holiday unless approved by the Project Officer.

9. Payments to the Contractor A. The Government will pay the Contractor a fixed price, as indicated below, which will constitute full compensation for all Contractor professional and incidental services, travel expenses, and materials necessary to furnish the complete project as required and specified in this SOW.

B. Progress payments will be paid following acceptance by the Government of that particular schedule item and a properly submitted and approved invoice.

Statement of Work Page 13

10. IHS Personnel Contracting Officer’s Representative (COR)

Provided to the awardee.

Any change in COR designation will be documented by the Contracting Officer in writing.

Project Officer (PO)

Provided to the awardee.

11. Invoice Format Invoice Processing Platform (IPP)

Invoicing under this order shall be processed through the Invoice Payment Platform (IPP), located at www.ipp.gov.

IPP is a secure, web-based electronic invoicing system provided by the U.S. Department of the Treasury's Bureau of the Fiscal Service, in partnership with the Federal Reserve Bank of St. Louis (FRSTL). The Office of Management and Budget (OMB) M-15-19 Memorandum "Improving Government Efficiency and Saving Taxpayer Dollars Through Electronic Invoicing" directs Federal agencies to adopt electronic invoicing as the primary means to disburse payment to vendors.

If your organization is not currently utilizing IPP, following award of an order, your organization will be automatically enrolled by IHS. Your company's IPP POC will be determined by the information listed in your SAM.gov account, and will receive two e-mails from the Bureau of Fiscal Service, one with a username and one with a temporary password. Please ensure your SAM.gov information is up to date.

If you are currently enrolled in IPP, either from a previous award with IHS or another Federal Agency utilizing IPP- you may use your existing IPP credentials for this order.

If you require assistance registering or IPP account access, please contact the IPP Helpdesk at (866) 973- 3131 (M-F 8AM to 6PM ET), or IPPCustomerSupport@fiscal.treasury.gov.

12. Authority

A. No person other than the Contracting Officer has authority to bind the Government concerning this contract.

B. No action or omission of any government employee or representative other than the Contracting Officer shall increase or decrease the scope of this contract or shall otherwise modify the terms and conditions of this contract.

C. In no event shall any of the following be effective or binding on the Government or imputed to the Contracting Officer concerning this contract:

1) An understanding or agreement between the Contractor and anyone other than the Contracting

Officer;

2) A purported modification or change order issued by anyone other than the Contracting Officer;

http://www.ipp.gov/ mailto:IPPCustomerSupport@fiscal.treasury.gov

Statement of Work Page 14

February 2025

3) A promise by anyone other than the Contracting Officer to provide additional funding or make payments or

4) An order, direction, consent, or permission from anyone other than the Contracting Officer to:

a) Incur costs over a specified estimated cost, allotment of funds, or other ceiling; or

b) Expend hours over a specified level of effort.

Appendix A – Fire Alarm Equipment Summary and Locations

Appendix B – Quote Schedule

Appendix C – Report of Inspection and Testing Form

Statement of Work Page 15

Appendix A – Fire Alarm Equipment Summary and Locations

Fi re

A la rm E qu ip m en t S um m ar y Fa n Sh ut do w n

D ev ic es

8 0 0 10

0 0 0 0 49

0 3 10

1 15

0 2 10

0 3 0 2 0

* T hi s eq ui pm en t s um m ar y is a n ap pr ox im at e lis t a nd is o nl y to b e us ed a s a to ol to p ro vi de a n ac cu ra te b id fo r t he c on tr ac t.

D oo r H ol d- O pe n

D ev

6 0 0 0 0 6 0 0 73

0 0 36

0 2 0 10

1 11

0 0 0

A ud ib le

Vi su al pp lia nc

5 1 6 19 7 4 11

D uc t Sm ok e

D et ec to rs

8 0 0 10

0 0 0 0 49

0 0 10

1 15

0 2 10

0 3 0 2 0

B ea m

Sm ok e D et ec

(s et s)

0 0 0 0 0 0 0 0 0 0 0

(s et

0 0 0 0 0 0 0 0 0 0

Sm ok e D et ec

9 11

2 10

4 31 0 9 10

6 26

2 77

9 10

H ea t D et ec

0 0 28

5 6 10

7 33

1 0 26

0 22

1 10

4 0 22

0 2 0

M an ua l

St at io ns

6 2 4 9 9 7 3 3 28

2 1 21

8 14

4 14

2 3 2 nn un ci at or s

3 1 0 1 2 1 0 0 0 3 0 1 3 2 2 0 1 3 0 2 0 0 0

B oo st er

Po w er

Pa ne ls

0 0 0 1 0 0 0 0 4 0 0 5 9 1 1 0 2 0 1 0 0 0

C on tr ol

Pa ne ls

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

Fa ci lit y

Ea gl e Bu tte

H os pi ta l

Ft . T ho m ps on

H ea lth

C en te r

Ft . T ho m ps on

S ub st an ce

A bu se

Ft . T ho m ps on

W el ln es s

C en te r

Ky le

H ea lth

C en te r

Lo w er B ru le

H ea lth

C en te r

M cL au gh lin

H ea lth C en te r

M cL au gh lin

D en ta l C lin

M cL au gh lin

C lin ic (W ak pa la

Pi ne

R id ge

H os pi ta l

Pi ne

R id ge

P ub lic H ea lth

C en te r

Pi ne

R id ge

L ac re ek

C

R os eb ud

H os pi ta l

Si ss et on

H ea lth

C en te r

W ag ne r –

H ea lth C en te r

W an bl ee

H ea lth

C en te r

M ob rid ge

T re at m en t C en te r

Be lc ou rt

H os pi ta l

Be lc ou rt

Be ha vi or al

H ea lth

PH

N

. Y at es

H os pi ta l

Ft . Y at es

D en ta l C at es

O pt om et ry

/M en ta l H ea lth at es

C lin ic

(C an no nb al l)

Statement of Work Page 16

February 2025

Appendix B – Quote Schedule

QUOTE SCHEDULE

for

INSPECTION AND TESTING OF THE FIRE ALARM SYSTEMS

for the

GREAT PLAINS AREA INDIAN HEALTH SERVICE

LOCATION BUILDING BASE YEAR OPTION

YEAR #1

OPTION

YEAR #2

OPTION

YEAR #3

OPTION

YEAR #4 TOTAL

Belcourt Hospital $ $ $ $ $ $

Behavioral Health / PHN Building $ $ $ $ $ $

Eagle Butte Hospital $ $ $ $ $ $

Ft. Thompson

Health Center $ $ $ $ $ $

Substance Abuse Center $ $ $ $ $ $

Wellness Center $ $ $ $ $ $

Ft. Yates

Hospital $ $ $ $ $ $

Dental Clinic $ $ $ $ $ $

Optometry / Mental Health Center $ $ $ $ $ $

Cannonball Clinic $ $ $ $ $ $

Kyle Health Center $ $ $ $ $ $

Lower Brule Health Center $ $ $ $ $ $

McLaughlin

Health Center $ $ $ $ $ $

Dental Clinic $ $ $ $ $ $

Wakpala Clinic $ $ $ $ $ $

Mobridge Treatment Center (YRTC) $ $ $ $ $ $

Pine Ridge

Hospital $ $ $ $ $ $

Public Health Nursing $ $ $ $ $ $

Lacreek Clinic $ $ $ $ $ $

Rosebud Hospital $ $ $ $ $ $

Sisseton Health Center $ $ $ $ $ $

Wagner Health Center $ $ $ $ $ $

Wanblee Health Center $ $ $ $ $ $

GRAND TOTAL: $

Bidders are required to respond to all items in the quote schedule, including the base and all four option years, or the bid will be considered non-responsive. Total prices must include testing equipment, labor, overhead, profit, delivery, mobilization and demobilization, and all applicable taxes and fees (federal, state, local, and Tribal) for all piped medical gas systems at IHS Service Unit locations listed in the work statement.

Statement of Work Page 17

Statement of Work Page 18

Statement of Work Page 19

Statement of Work Page 20

Statement of Work Page 21

Statement of Work Page 22

Statement of Work Page 23

Statement of Work Page 24

Statement of Work Page 25

Statement of Work Page 26

Statement of Work Page 27

Appendix D – Contract Performance Evaluation

Great Plains Area Fire Alarm Testing Performance Evaluation

To be completed by the Facility Manager after inspection

Facility Name:________________________________________________________________

Date:______________________________ Contractor Rep onsite:___________________

1. Overall Evaluation Poor Average Good Excellent

2. Performance Poor Average Good Excellent

3. Quality of Services Poor Average Good Excellent

4. Workmanship Poor Average Good Excellent

5. Knowledge Poor Average Good Excellent

Comments: