STATEMENT OF WORK

HVAC Preventative Maintenance

INDIAN HEALTH SERVICE

BASE + 4 CONTRACT

FORT YATES HOSPITAL

FORT YATES, NORTH DAKOTA

DECEMBER 2025

Statement of Work Page 2 HVAC Preventative Maintenance Contract

Table of Contents

1. Project Description

2. Scope of Work (SOW)

3. Period of Performance

4. Submittals

5. Schedule/Meetings

6. Miscellaneous

7. Payments to the Contractor

8. IHS Personnel

9. Invoice Format

10. Closeout Documents

Appendix A – Equipment Inventory

Appendix B – Bid Schedule

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DECEMBER 2025

STATEMENT OF WORK

HVAC Preventative Maintenance Standing Rock Service Unit Fort Yates, North Dakota

1. Project Description A. Title: HVAC Preventative Maintenance

B. Location: This project is at the Fort Yates Hospital, in Fort Yates, North Dakota

C. Period of Performance: 365 calendar days from Notice to Proceed. With four option years.

D. Description: The project defined within this Scope of Work is to establish a comprehensive preventative maintenance contract.

E. Background: The hospital does not have enough man-hours available to perform routine maintenance on the HVAC system.

F. Related Documents

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

2. IHS Architecture and Engineering Design Manual – 2022

3. FGI 2022 – Healthcare Facility Design Guide

4. NFPA 101 Life Safety Code – 2012

5. NFPA 70 National Electric Code (NEC)

6. ASHRAE 170

7. ASHRAE Fundamentals Handbook 2017

8. NFPA 99 Healthcare Facilities Codebook, 2012

G. Common Acronyms or Definitions

1. IHS – Indian Health Service

2. CMS – Centers for Medicare & Medicaid Services

3. SR – Standing Rock

4. BAS – Building Automation System

5. Metasys – Name of the existing BAS

6. CO – Contracting Officer

7. COR – Contracting Officer’s Representative

8. PM – Project Manager

9. IGCE – Independent Government Cost Estimate

10. RFI – Request For Information

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2. Scope of Work (SOW) - The contractor shall provide all material, labor, equipment and supervision required to accomplish the following:

A. Equipment and Parts Inventory: Verify the accuracy of the equipment inventory provided in Appendix A. Develop a list of consumable material and a preventative maintenance schedule for each equipment based on manufactures O&M. Submit schedule within 30 days after award.

B. Preventative Maintenance Tasks: At a minimum, the following task shall be completed unless the manufactures recommendations require additional task or intervals.

a. Air Handlers Units

i. Operational – Minimum 3 per year Check with appropriate customer representative for operational deficiencies Inspect motor mounting isolators Check for integrity of cabinet hardware Visually inspect damper(s) Verify damper operation Check condition of pulleys and belts Check for proper fan operation Check condition of coils Check condition of filters Record temperatures and pressures (if applicable) Check condensate drain Visually inspect electrical connections Check for unusual noise and vibration Check overall condition of unit Visually inspect for fluid leaks of coils and connecting piping Document tasks performed during visit and report any observations to appropriate customer representative

ii. Filter Change - Minimum 3 per year Check with appropriate customer representative for operational deficiencies Turn equipment off Remove dirty filters Install new filters Turn equipment on Dispose of dirty filter appropriately Document tasks performed during visit and report any observations to appropriate customer representative

iii. Comprehensive – Minimum 1 per year Check with appropriate customer representative for operational deficiencies Visually inspect damper(s) Check condition of pulleys and belts Check for proper fan operation Check condition of coils Check condition of filters Record temperatures and pressures (if applicable)

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Check for unusual noise and vibration Check for deterioration of gaskets and seals Check overall condition of unit Visually inspect for fluid leaks of coils and connecting piping Check starter/contactor Check and tighten electrical connections Check damper operation and lubricate as required Visually check control valve(s) Lubricate blower and motor bearings Clean condensate pan and clear drain line Check condition of blower assembly Remove and dispose any debris from any maintenance activity

iv. Coil Cleaning – Minimum 1 per year

Clean condensate drain (if necessary) Spray coil(s) with chemical solution Rinse coil(s) thoroughly with water Remove and dispose any debris from any maintenance activity

b. Boilers

i. Startup – Minimum 1 per year Check with appropriate customer representative for operational deficiencies Inspect burner/oil pump contactors for wear Check and tighten electrical connections Check for proper gas supply pressure Check oil pump for proper operation Check and clean pilot assembly Clean combustion fan wheel Visually inspect combustion chamber, draft diverter and flue for accumulation of soot -clean as needed Check burner for proper sequence of operation Check operating controls Check all safety controls Lift relief valve to ensure proper operation Check boiler relief valves for leakage Check combustion blower motor operation and lubricate as needed Check for proper operation of oil preheaters (if applicable) Check factory supplied oil and gas piping and components for leakage Drain boiler, open hand hole covers and clean as needed (if applicable) Disassemble and clean low water cut-out Fill boiler and check for proper operation of make-up water valve Verify proper operation of low water cut-out control

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Check overall condition of unit Record and log all operating parameters (including pressures and temperatures) Remove and dispose any debris from any maintenance activity

ii. Combustion Analysis/Smoke Test - Minimum 1 per year Perform combustion analysis/smoke test procedures and perform minor burner adjustments as needed

iii. Tube Brushing – Minimum 1 per year

Open boiler doors Mechanically brush tubes Close boiler doors Remove and dispose any debris from any maintenance activity

iv. Operational – Minimum 1 during winter season

Blow down boiler Check oil pump for proper operation Check factory supplied oil and gas piping and components for leakage Check burner for proper sequence of operation Check flame quality Visually inspect combustion chamber, draft diverter and flue for accumulation of soot Check boiler relief valves for leakage Verify proper operation of low water cut-out control Check combustion blower motor operation Check for proper operation of oil preheaters (if applicable) Check hot water/steam temperature and pressure Check proper operation of make-up water valve Check overall condition of unit

c. Chiller

i. Startup – Minimum 1 per year Check with appropriate customer representative for operational deficiencies Check for visual signs of refrigerant/oil leaks Conduct refrigerant leak check Check for proper crank case heater operation (if applicable) Inspect condenser fan and compressor contactors for wear Check and tighten electrical connections

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Perform preventative procedures to flow proving devices Check for unusual noise and vibration Check overall condition of unit Remove and dispose of any debris from any maintenance activity

ii. Operational – Minimum 1 during heating season

Check for proper chilled water flow Check system pressures and temperatures Check refrigerant charge (sign glass) Check for proper capacity control operation Check for proper crank case heater operation (if applicable) Check for visual signs of refrigerant/oil leaks Check for unusual noise and vibration Check for proper condenser fan operation Check overall condition of unit

iii. Coil Cleaning – Minimum 1 per year

Spray coil(s) with chemical solution Rinse coil(s) thoroughly with water Remove and dispose any debris from any maintenance activity

d. Pumps

i. Operational – Minimum 3 per year Check with appropriate customer representative for operational deficiencies Check for leaks Check couplings Lubricate pump and motor bearings per manufacturer’s recommendations Record and log all operating parameters Check for unusual noise and vibration Check overall condition of pump

e. Variable Air Volume Box

i. Comprehensive – Minimum 1 per year Check with appropriate customer representative for operational deficiencies Create local back up of existing program and store on on-site computer and on-site media

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Run VAV box flow test and visually inspect suspect boxes (coordinate access with customer) Verify unit is controlling to set points by checking sequences of operations and PID loops Check that the damper actuators, valve actuators, variable speed drives, and protections (as applicable) are responding appropriately to control signals. Notify customer of any issues with those devices Verify sensor readings and field calibrate critical sensors used in control loops and alarming functions (as sensor type and controller options allow) on suspect boxes Visually validate system outputs on suspect boxes from the field controller Validate controls safety circuit and alarm verification on suspect boxes (coordinate with customer) Tighten electrical connections on suspect boxes Check overall condition of panel and perform visual inspection of unit and surrounding area

f. Building Automation System (JCI Metasys)

i. Comprehensive (all equipment) – Minimum 1 per year Create local back up of existing program and store on on-site computer and on-site media Verify unit is controlling to set points by checking sequences of operations and PID loops Check that the damper actuators, valve actuators, variable speed drives, and protections (as applicable) are responding appropriately to control signals. Notify customer of any issues with those devices Identify and notify customer of abnormal point communications Identify and notify customer of current overrides (e.g. out of service) and negative impacts Identify and notify customer of all current alarms and negative impacts Verify sensor readings and field calibrate critical sensors used in control loops and alarming functions (as sensor type and controller options allow) Visually validate system outputs from the field controller Validate controls safety circuit and alarm verification (coordinate with customer) Tighten electrical connections Check overall condition of panel and perform visual inspection of unit and surrounding area

C. Emergency Service and Equipment Replacement: Contractor shall provide emergency services to troubleshoot and diagnose failed equipment. Contractor will be required to respond to emergency call within 4 hours. Equipment that needs to be replaced due to life expectancy or obsolete, contractor shall provide a quote prior to replacing. It is anticipated that there will be eight emergency calls/year at around twenty-five hundred per call. This line item will be a Not To Exceed.

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3. Period of Performance.

A. Time of the Essence: All time limits for Milestones, if any, Substantial Completion, and completion and readiness for final payment as stated in the Contract Documents are of the essence of the Contract.

B. The Work will be substantially completed within Three Hundred sixty-five (365) calendar days after the date when the Contract Times commence to run.

4. Submittals A. Submittals or shop drawings shall be submitted for the following items and shall be delivered electronically to the COR or designated PM for final approval before ordering any new material or equipment.

1. Equipment Inventory

2. Consumable Parts Inventory

3. Equipment Preventative Maintenance Schedule

5. Schedule/Meetings A. Kickoff Meeting: One Kickoff Meeting shall be conducted prior to the start of the contract. This will be onsite to introduce contractor to maintenance staff. Exchange contract information for emergency calls.

B. Final Completion: One final completion meeting shall be held following determination that the project is complete.

6. Miscellaneous A. Occupancy of Government Facilities. The contractor shall be responsible for properly informing the

COR of any condition which would jeopardize the building or its contents, such as loss of heat, air conditioning, danger of pipes freezing, loss of electrical power, water, sewer or loss of building security.

B. Correspondence. All correspondence shall be addressed to the COR. Each letter, document, etc., shall contain the following information:

1. Date

2. Project Numbers, Contract Number, Delivery Order Number and Service Unit Name/Location.

3. Name of those who were sent copies.

C. Superintendent. The prime contractor shall have an onsite superintendent for this project while any and all work is being performed unless prior approval is granted from the COR.

D. Tribal Requirements.

1. The Contractor and all subcontractors engaging in work on the Standing Rock Indian Reservation will be required to comply with the Indian preference and Indian preference program requirements administered by the Standing Rock Sioux Tribe Tribal Employment Rights Office

(TERO).

2. Before commencing work, contractors and sub-contractors are required to submit an acceptable “Compliance Agreement” to the TERO office. Copies of this form can be obtained from the TERO office. Typical requirements of TERO include a fee of 2.5% on the total contract price, and submission of weekly certified payroll reports to TERO.

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3. Additionally, the rules and regulations of the TERO Ordinance require that no person who is not a local Indian shall be employed by a covered employer until a work permit has been obtained for them from TERO. The annual work permit fee for each employee is $250.00.

4. Contractors are strongly encouraged to contact the TERO office at (701) 854-7295 for an explanation of tribal requirements. Other fees may apply.

E. Construction Materials and Storage

1. All materials shall be stored and handled according the manufacturers’ recommendations.

2. All materials shall be submitted to the COR prior to ordering, for approval by the project engineer.

3. The contractor(s) shall be present and on site to receive all construction material, equipment, or products. IHS staff will not be present, responsible, nor receive, or provide any type of offloading equipment for construction materials, products, or equipment. It is solely the contractor(s) responsibility to properly receive any and all construction equipment, products, and materials on site.

4. The contractor(s) shall provide their own means of storing any and all construction materials, products, or equipment required for installation. IHS staff will not be responsible or provide any means of storing construction material, products, or equipment before or during construction.

All material, products, or equipment remain the contractor(s) property until the project has been deemed substantially completed by all parties.

F. Hours Of Operation

1. The project shall start after award and receipt of the Notice to Proceed

2. The work hours shall be 8:00am – 5:00pm, Monday – Friday. Weekends and after hours work may be available upon request.

G. Contracting Officer Authority

1. No person other than the Contracting Officer has authority to bind the Government concerning any contract.

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

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

i. An understanding or agreement between the Contractor and anyone other than the Contracting Officer;

ii. A purported modification or change order issued by anyone other than the Contracting Officer;

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

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iv. 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.

7. Payments to the Contractor

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

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

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

Will be provided with any award.

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

Facility Manager (FM)

Will be provided with any award.

9. 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).

Respondents to this solicitation are encouraged to register an account with IPP if they have not already done so. If your organization is already registered to use IPP, you will not be required to re-register-however, we encourage you make sure your organization and designated IPP user accounts are valid and up to date.

The IPP website address is: https://www.ipp.gov 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 Should the contractor feel that use of the IPP would be unduly burdensome, their response to this solicitation should include an explanation of this position for a determination by the contracting officer.

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

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10. Closeout Documents The Contractor shall submit one hard copy set of all final, installed submittal items, accessories, and all installation/operation/maintenance documents to the facility manager/engineer. The final installed submittal package and O&M shall also be sent electronically to the COR and/or PM.

Appendix A – Equipment Inventory TAG# Location Asset Type Manufacture/Components AHU-1 Penthouse Air Handler Unit Trane

Pre & Final Filters

Heating Coil

Cooling Coil

Return Fan - Belt (above Lab - Cook

150WMX

Supply Fan - Belt AHU-2 Penthouse Air Handler Unit Trane

Pre & Final Filters

Pre-Heat - Trane E-42-DS Coil

Heating Coil

Cooling Coil

Supply Fan - Belt

Return Fan - Belt AHU-3 Penthouse Air Handler Trane

Pre & Final Filters

Pre-Heat - Trane A-36-DS Coil

Heating Coil

Cooling Coil

Supply Fan - Belt AHU-4 Roof Dialysis Air Handler Trane

Heating Coil

Cooling Coil

Supply Fan - Belt

AHU-5

Roof Inpatient Air Handler Trane

Heating Coil

Cooling Coil

Supply Fan - Belt

RTU-1

Roof Pharmacy Air Handler Trane

Pre & Final Filters

Cooling Coil

Supply Fan - Direct RTU-6 Roof ER Air Handler Temtrol ITF-RDHRE16

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Pre & Final Filters

Heating Coil

Cooling Coil

(2) Supply Fan - Direct

(2) Return Fan - Direct TAG# Location Asset Type Manufacture Model B-1 Boiler Room Boiler Fulton VTG2000DF B-2 Boiler Room Boiler L. E. S. Inc. LES HW3000 B-3 Boiler Room Boiler L. E. S. Inc. LES HW3000 CH-1 Out Door Chiller York inc./JCI YLAA0070SE17XCBSDTQ HWP-1 Boiler Room Pump Bell and Gossett 60 3x5-1/4 HWP-2 Boiler Room Pump Bell and Gossett 80 4x4x7 HWP-3 Boiler Room Pump Bell and Gossett 80 4x4x7 HWP-4 Boiler Room Pump Bell and Gossett 1510 3BC HWP-5 Boiler Room Pump Bell and Gossett 1510 3BC CWP-1 Boiler Room Pump Taco FE-2007 CWP-2 Boiler Room Pump Bell and Gossett 1510 2-1/2BB FOP-1 Boiler Room Pump Smith-Koch SFPD 3-10-L FOP-2 Boiler Room Pump Smith-Koch SFPD 3-10-L AS-1 Boiler Room Air Seperator Bell and Gossett RL-5 HC-1 Exam 3 Heating Coil Mcquay 5BS1301C HC-2 Exam 4 Heating Coil Mcquay 5BS1301C HC-3 Exam 5 Heating Coil Mcquay 5BS1301C HC-4 Exam 6 Heating Coil Mcquay 5BS1301C

VAV-1 Waiting Variable Air Volume Box Titus DESV

VAV-2 Medical Records Variable Air Volume Box Titus DESV

VAV-3 Exam Variable Air Volume Box Titus DESV

VAV-4 Pharmacy 17 Variable Air Volume Box Titus DESV

VAV-5 Pharmacy 17 Variable Air Volume Box Titus DESV

VAV-6 Pharmacy 17 Variable Air Volume Box Titus DESV

VAV-7 Conference 107 Variable Air Volume Box Titus DESV

VAV-8 ER Waiting 109 Variable Air Volume Box Titus DESV

VAV-9 ER Waiting 109 Variable Air Volume Box Titus DESV

VAV-10 ER Waiting 109 Variable Air Volume Box Titus DESV

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VAV-11 ER Waiting 109 Variable Air Volume Box Titus DESV

VAV-12 ER Waiting 109 Variable Air Volume Box Titus DESV

VAV-13 ER Waiting 109 Variable Air Volume Box Titus DESV

VAV-14 ER Waiting 109 Variable Air Volume Box Titus DESV

VAV-15 Corridor 100E Variable Air Volume Box Titus DESV

VAV-16

Dialysis Corridor 100N

Variable Air Volume Box Titus DESV

VAV-17

Dialysis Corridor 100N

Variable Air Volume Box Titus DESV

VAV-31 Corridor 100E Variable Air Volume Box Titus DESV

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Appendix B – Bid Schedule

NOT PROVIDED FOR SOURCES SOUGHT