T12 Sol_75H71025Q00290.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

Highway 160, Mile Post 394.3 PO Box 368 Acquisition Department Kayenta Health Center

CODE 16. ADMINISTERED BYCODE

X

X

238210

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR25

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

08/21/2025 1000 ET

08/18/2025

DAISHA RICHARDS

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBER a. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H71025Q00290

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 54 OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

Kayenta AZ 86033

TELEPHONE NO.

17a. CONTRACTOR/

Kayenta AZ 86033 US Hwy 160 South Milepost 394.3 Kayenta Health Center

15. DELIVER TO

Kayenta AZ 86033 Highway 160, Mile Post 394.3 PO Box 368 Acquisition Department

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

$19

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULEX

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Kayenta Health Center

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

This contract is subject to the electronic payment process by the Department of Treasury.

All invoices complying to the requirements at 52.212-4(g) must be submitted through www.ipp.gov. For additional information, refer to the incorporated clause at 352.232-71 Electronic Submission of Payment Requests (FEB 2022).

Period of Performance: 09/01/2025 to 08/31/2026

Continued ...

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

XX

DATED

JERLYN R. BEGAY

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

1 Base Year:

Annual Fire Alarm System Test

Quarterly Fire Sprinkler System Inspection and

Test

Quarterly Pre-Action/Dry Valve System Inspection

Annual Fire Pump Inspection and Test

Annual Backflow Valve Inspection and Test

Fire Hydrant Test and Inspection

Delivery: 08/31/2026

Delivery Location Code: IHSKAYENTA

KAYENTA NAVAJO

Kayenta Health Center

Acquisition Department, PO Box 368

Highway 160, Mile Post 394.3

Kayenta AZ 86033 US

2 Base Year:

Navajo Nation Sales Tax

Delivery: 08/31/2026

Delivery Location Code: IHSKAYENTA

KAYENTA NAVAJO

Kayenta Health Center

Acquisition Department, PO Box 368

Highway 160, Mile Post 394.3

Kayenta AZ 86033 US

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

54 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 54

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H71025Q00290

3 Option Year 1:

Annual Fire Alarm System Test

Quarterly Fire Sprinkler System Inspection and

Test

Quarterly Pre-Action/Dry Valve System Inspection

Annual Fire Pump Inspection and Test

Annual Backflow Valve Inspection and Test

Fire Hydrant Test and Inspection

(Option Line Item)

09/01/2026

Delivery: 08/31/2027

Delivery Location Code: IHSKAYENTA

IHSKAYENTA

Kayenta Health Center

Acquisition Department, PO Box 368

Highway 160, Mile Post 394.3

Kayenta AZ 86033 US

Period of Performance: 09/01/2026 to 08/31/2027

4 Option Year 1:

Navajo Nation Tax

(Option Line Item)

09/01/2026

Delivery: 08/31/2027

Delivery Location Code: IHSKAYENTA

IHSKAYENTA

Kayenta Health Center

Acquisition Department, PO Box 368

Highway 160, Mile Post 394.3

Kayenta AZ 86033 US

Period of Performance: 09/01/2026 to 08/31/2027

5 Option Year 2:

Annual Fire Alarm System Test

Quarterly Fire Sprinkler System Inspection and

Test

Quarterly Pre-Action/Dry Valve System Inspection

Annual Fire Pump Inspection and Test

Annual Backflow Valve Inspection and Test

Fire Hydrant Test and Inspection

(Option Line Item)

09/01/2027

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

4 54

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H71025Q00290

Delivery: 08/31/2028

Delivery Location Code: IHSKAYENTA

IHSKAYENTA

Kayenta Health Center

Acquisition Department, PO Box 368

Highway 160, Mile Post 394.3

Kayenta AZ 86033 US

Period of Performance: 09/01/2027 to 08/31/2028

6 Option Year 2:

Navajo Nation Tax

(Option Line Item)

09/01/2027

Delivery: 08/31/2028

Delivery Location Code: IHSKAYENTA

IHSKAYENTA

Kayenta Health Center

Acquisition Department, PO Box 368

Highway 160, Mile Post 394.3

Kayenta AZ 86033 US

Period of Performance: 09/01/2027 to 08/31/2028

7 Option Year 3:

Annual Fire Alarm System Test

Quarterly Fire Sprinkler System Inspection and

Test

Quarterly Pre-Action/Dry Valve System Inspection

Annual Fire Pump Inspection and Test

Annual Backflow Valve Inspection and Test

Fire Hydrant Test and Inspection

(Option Line Item)

09/01/2028

Delivery: 08/31/2029

Delivery Location Code: IHSKAYENTA

IHSKAYENTA

Kayenta Health Center

Acquisition Department, PO Box 368

Highway 160, Mile Post 394.3

Kayenta AZ 86033 US

Period of Performance: 09/01/2028 to 08/31/2029

8 Option Year 3:

Navajo Nation Tax

(Option Line Item)

09/01/2028

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

5 54

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H71025Q00290

Delivery: 08/31/2029

Delivery Location Code: IHSKAYENTA

IHSKAYENTA

Kayenta Health Center

Acquisition Department, PO Box 368

Highway 160, Mile Post 394.3

Kayenta AZ 86033 US

Period of Performance: 09/01/2028 to 08/31/2029

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

STATEMENT OF WORK

FOR

ANNUAL FIRE ALARM SYSTEM TESTING & INSPECTION

AT

KAYENTA HEALTH CARE CENTER

KAYENTA, ARIZONA

September 30, 2024

KAYENTA HEALTH CARE CENTER

1. Introduction:

1.1. The Annual & Quarterly Fire Alarm Inspection & Testing project will be within the Navajo Reservation at Kayenta, Arizona on 190,000 square feet medical facilities. The Kayenta Health Center (KHC) is located off US Highway 160, 1/2-mile south of MP 394.3. EST3 Fire Alarm System is the existing fire alarm system. This project requires vendor’s expertise for the compliance of Hospital NFPA 72/25, The Joint Commission/CMS Life Safety, and Preventive Maintenance of Fire Alarm System at the Health Care Center. Kayenta Service Unit is at a remote location; the nearest town is a two-hour drive. Contractor must be knowledgeable with current system in place.

2. PROJECT BACKGROUND

2.1. This is a turn-key project for contractor to complete annual and quarterly inspections of the fire alarm system, inspection of fire sprinkler system, inspection/testing of fire pump, pre-action/dry valve system inspection and backflow inspection/testing. Contractor must be knowledgeable of NFPA Codes, Repair EST fire alarm system and proper reporting required by hospital.

2.2. The objective of the EST3 Fire Alarm Annual Inspection & Test project is to have a fully operational fire alarm system and fully compliance with Hospital NFPA 72/25 at Kayenta Health Center. Contractor to provide technical support for maintenance and on-call service at KHC.

3. PROJECT DESCRIPTION:

3.1. The contractor shall prepare a proposal, and upon award, shall provide an accurate timeline to complete the project and following will perform the work to completion.

3.2. Annual Fire Alarm Inspection includes the following work:

a. There should be no standing trouble alarm when contractors leave the KHC premise

b. Annual Fire Alarm Inspection. Contractor to inspect and test once annually in accordance with NFPA 72 2010 edition, NFPA 25 2011 edition and The Joint Commission/CMS regulations.

c. Control Equipment. Contractor to verify correct receipt of input and output signals, and circuit supervision.

d. Batteries. Contractor to inspect and test batteries per manufacture specifications.

e. Annunciators. Contractor to verify correct operation and identification of remote annunciators.

f. Elevator. Contractor to test elevator recall function and other building outputs.

g. Audible & Visual. Contractor to test the functionality of all audible and visual devices. In addition, inventory devices.

h. Lamps and LED. Contractor to inspect and test lamps and LEDs.

i. Smoke Detectors, Duct Detectors, and Heat Detectors. Contractor to perform function tests of smoke detectors, Duct Detectors, and heat detectors. In addition, inventory devices.

j. Duct Detectors. Contractor to perform function test of duct detectors.

k. Pull Station. Contractor to perform function tests of manual pull stations. In addition, inventory devices.

l. Supervisory Signal. Contractor to perform function test of all supervisory signal.

m. Valve Tamper Devices. Contractor to perform function test of valve tamper devices.

n. Water Flow Alarm Devices. Contractor to perform function test of water flow alarm devices

o. Off-site Notification. Contractor to perform function test of off-site notification.

p. System Check. Contractor to verify the alarm, trouble, and supervisory signal receipt and restoral at the monitoring station.

q. Hospital NFPA 72. Contractor to inspect and perform functional testing of fire alarm system required in NFPA 72.

r. A final report based on the NFPA requirements will be completed detailing the results of the test and will be delivered and reviewed with the owner in a timely manner.

s. Every fire alarm device test must be listed to pass or fail. This would include fire detector and smoke detectors.

t. Contractor must inform KHC of any outages needed to perform work.

u. Outage request may take up to 2 days for approval if more than 4 hours is needed.

3.3 Quarterly Fire Sprinkler Inspection. Contractor to inspect and test on a Quarterly basis.

Per NFPA 25:

a. Service will include all control valves being exercised and sealed.

b. Water pressure will be recorded including residual pressure during a main drain flow test.

c. All inspector’s test valves will be exercised and water flow alarms will be confirmed.

d. The fire sprinkler riser will be inspected for signage, valve positions, and a stocked spare sprinkler headbox.

e. All visible distribution piping will be inspected for corrosion and visible sprinkler heads inspected for discharge blockage and foreign material.

3.4 Quarterly Pre-Action/Dry Valve System Inspection

Per NFPA 25:

a. Service will include control valves being exercised and sealed.

b. Water pressure will be recorded including residual pressure during a main drain flow test.

c. All drum drips will be exercised and air pressure will be confirmed at each location.

d. The fire sprinkler riser will be inspected for signage, valve positions, damage, and proper trim piping.

e. Low air and water flow switches will be activated and checked for proper settings and verified at the panel.

f. Internal components (orifices, seat, clapper, and gasket) will be inspected after the trip test.

g. If an accelerator or exhauster is on the system these devices will be tripped, inspected, and reset.

3.5 Annual Fire Pump Test and Inspection

Per NFPA 20:

a. The inspection of the electric/diesel fire pump will be conducted under minimum, rated and peak flows of the fire pump by controlling the quantity of water discharged.

b. The test will be conducted using the available suction water supply.

c. Pump suction and discharge pressure measurements will be used to determine the total pump output.

d. The fire pump and associated control equipment will be energized and suction water will flow for the time required to take the required measurements and meet the requirements of the test.

e. Water drainage and effects from water runoff can be an environmental and safety hazard and is the responsibility of the owner to manage and maintain.

3.6 Annual Backflow Valve Test and Inspection

Per local code requirements:

a. The inspection and functional testing of the backflow check valve including a visual inspection and a mechanical test to ensure the valve is in good operating condition and is operating within the correct parameters.

b. If the backflow valve initial test indicates it is operating out of specifications, the assembly will be inspected for repair viability.

3.7 Fire Hydrant Test and Inspection

a. Fire hydrant will be visually inspected for proper components and general operating conditions.

b. The valve will be fully exercised and a flow test will be performed.

3.8 System and Service Log. The contractor will provide a log to document concerns, system problems and other related items requiring our attention. Each scheduled service visit shall begin with a review of this log.

3.9 Documentation. All equipment testing, manufacture equipment documents, authorized Client representative to verify all work completed and Hospital NFPA 72, NFPA 25, NFPA 20 compliance report.

3.10 All tested and verified fire alarm equipment must be documented on the final inspection report.

4. CRITERIA:

4.1. Codes and Standards: The contractor shall perform work in accordance with best common practices and standards;

a. Safety and Hazard Awareness (PPE, jobs-specific hazards, Electrical isolation).

b. NFPA criteria

c. The Joint Commission standards and regulations

d. CMS standards and regulations

5. GENERAL REQUIREMENTS:

5.1. Contractor shall develop a set engineered plan and accurate timeline to present to the KHC project representative prior to the project start date.

5.2. Contractor is responsible for furnishing all tools, materials, and equipment to complete the project.

5.3. A report and walkthrough of the work area will be necessary after the completion of the project.

5.4. Work area should be well kept and free of trash and debris after workdays.

5.5. Ceiling tiles, flooring, and other “affected by construction” activities need to be repaired/replaced with the project completion.

5.6. The contractor shall perform work between the hours of 8:00 am and 5:00 pm Monday through

Friday excluding Federal Holidays. Alternate hours work must be requested and approved with

KHC.

5.7. The contractor shall furnish a schedule of the dates agreed upon with the project officer and the facility manager at least two weeks in advance.

5.8. Any foreseen or unplanned costs, work hours, or changes that will affect or incur extra costs to KHC, need to be brought to the attention of the KHC project representative before proceeding with this matter.

5.9. Contractor is encouraged to schedule a walkthrough of the project with the KHC maintenance department.

5.10. The Contractor must be mindful of keeping normal business activity uninterrupted.

5.11. The contractor is expected to be professional and efficient with his work.

5.12. The contractor to follow all safety policies and regulations. Provide written safety Method of

Procedure (MOP).

6. SPECIAL REQUIREMENTS

6.1. Any pre-assembly of equipment must be done at the contractor’s facilities, while other work can be done at the hospital.

6.2. Contractor is required to obtain an identification badge (ID) before starting work at KHC. *This process can take up to 4 hours depending on the number of workers.

6.3. Contractor shall wear ID badge on KHC premises and check in with security every day.

7. Period of Performance

7.1. Period of performance from contract award date to December 31, 2025.

8. Contact information:

9. Warranty

10.1 Workmanship warranty one year.