VA261-17-R-1281-001.docx

VA261-17-R-1281

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

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

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

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

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

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

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

459-18-1-976-0002

VA261-17-R-1281

1-2-2 Denard Fobbs (denard.fobbs@va.gov) 916-923-4507 2-2-2018

1430 PT

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO 21) 3230 Peacekeeper Way, Bldg. 209 McClellan CA 95652 X 621910 $15 Million N/A X "Se Delivery Schedule"

Department of Veterans Affairs VA Sierra Pacific Network (VISN 21) Network Contracting Office (NCO 21) 3230 Peacekeeper Way, Bldg. 209 McClellan CA 95652

Department of Veterans Affairs FMS VA-9(101) Financial Services Center PO Box 149971 Austin TX 78714-9971 The contractor shall provide Air Ambulance Services IAW the Statement of Work in support of the VA Pacific Islands Healthcare System (VAPIHCS), Hawaii.

Proposal instructions are provided in provision 52.212-1.

Evaluation factors are provided in provision 52.212-2.

The Government intends to award a single Indefinite Delivery Indefinite Quantity (IDIQ)Contract. The guaranteed minimum amount for the life of the contract including options is $2,500.00.

Submit all questions via email by

1-12-2018 @ 1300 PT

denard.fobbs@va.gov.

459-3680160-976-829800-2119 010041089 X X x Beverly Quevedo Contracting Officer Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTINUATION OF SF 1449 BLOCKS

Note to Offeror. Submit an electronic copy of your offer to Denard.Fobbs@va.gov or if mailed/hand-carried to the address in Section 1(b) below by the date and time specified in Block 8 of Standard Form 1449. See FAR 52.212-1 for Instructions to Offerors-Commercial Items.

It is imperative that the Solicitation Number be included in the “Subject” line of the email.

1. Contract Administration: Indicate below the names, phone numbers and email addresses of individuals who will handle all contract administration matters:

a. CONTRACTOR: Company Name: ____________________________________ Address: __________________________________________ City & State & Zip: __________________________________ POC & Number: ____________________________________

b. GOVERNMENT: Network Contracting Office (NCO 21) 5342 Dudley Blvd, Bldg 209 McClellan Park, CA 95652

2. Invoice: Contractor shall submit Invoices monthly in arrears to address listed in Block 18(a) of Standard Form 1449 and in accordance with FAR 52.212-4(g). No advanced payments are authorized.

3. Payments: The Government will make all payments to the Contractor in accordance with FAR Clause 52.232-33, Payment by Electronic Funds Transfer - Other Systems for Award Management (SAM) Registration and FAR 52.212-4(i).

4. Acknowledgement of Amendments: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO ____________________ DATE _____________________

AMENDMENT NO ____________________ DATE _____________________

5. DUNS Number: Provide the Duns and Bradstreet Number assigned to your firm in the space provided below:

DUNS#________________________________

6. TAX Identification Number: Provide Company’s Tax ID number: _____________________ Registrations. All offerors must be registered at the System for Award Management (SAM) website at www.sam.gov, and have a tax identification number (TIN) and a Data Universal Numbering System (DUNS) number. DUNS information and/or application can be accessed at www.dnb.com or by calling 1-866-705-5711.

7. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.3 PRICE SCHEDULE

THE DEPARTMENT OF VETERANS AFFAIRS PACIFIC ISLAND HEALTHCARE SYSTEM FIXED AND

ROTARY WING AIR AMBULANCE TRANSPORT

IDIQ Contract Minimum and Maximum Values Referenced FAR Clause, 52.216-22 (Indefinite Quantity), the following minimum and maximum values are provided for the purpose of paragraph (b) of the clause:

(a) The minimum amount for the life of the contract including options is $2,500.00. The Government will obligate the minimum guarantee at the time of awarding the basic contract, by issuing a task order with an amount that is equal to or greater than the minimum guarantee.

(b) The maximum value for the life of the contract including options will be $15.0 Million.

Travel Estimates:

Year Average Statute Miles to Oahu, HI (HNL) (per trip)

Base Period – Apr 01, 2018- Mar 31, 2019

Service for pre-authorized Veterans

ESTIMATED TOTAL BASE PERIOD

First Option Year 1- Apr 01, 2019- Mar 31, 2020

Service for pre-authorized Veterans

ESTIMATED TOTAL OPTION YEAR 1

Second Option Year - Apr 01, 2020- Mar 31, 2021

Service for pre-authorized Veterans

ESTIMATED TOTAL OPTION YEAR 2

Third Option Year - Apr 01, 2021- Mar 31, 2022

Service for pre-authorized Veterans

ESTIMATED TOTAL OPTION YEAR 3

Fourth Option Year - Apr 01, 2022- Mar 31, 2023

Service for pre-authorized Veterans

ESTIMATED TOTAL OPTION YEAR 4

SUMMARY

Base Period - Apr 01, 2018- Mar 31, 2019

First Option Year - Apr 01, 2019- Mar 31, 2020

Second Option Year - Apr 01, 2020- Mar 31, 2021

Third Option Year - Apr 01, 2021- Mar 31, 2022

Fourth Option Year – Apr 01, 2022- Mar 31, 2023

B.4 STATEMENT OF WORK

Veterans Affairs Pacific Island Health Care System Air Ambulance Services

1.0 General Information: This statement of work defines services to provide Air Ambulance (emergent fixed or rotary wing) transportation services under a requirement, firm fixed price contract for the VA Pacific Islands Health Care System (VAPIHCS) beneficiaries. Transportation originates from a medical facility on the islands Maui, Kauai, Molokai, the Big Island of Hawaii (Hilo and Kona), Lanai, Niihau or other location in the pacific and the final destinations will be to the VA Pacific Islands Health Care System, Tripler Army Medical Center or to a local hospital within the city of Honolulu, HI. The price should include all legs of transportation including ground ambulance to and from respective airports.

2.0 Definitions:

2.1 14 CFR Part 119: Title 14 of the Code of Federal Regulations Part 119, issued by the Federal Aviation Administration (FAA), prescribes the certification requirements an operator must meet in order to obtain and hold a certificate authorizing operations under Parts 121 or 135 and operation specifications for each kind of operation to be conducted in each class and size of aircraft.

2.2 14 CFR Part 121: Title 14 of the Code of Federal Regulations Part 121, issued by the Federal Aviation Administration (FAA), prescribes operating requirements governing the domestic, flag, and supplemental operations of each person who holds or is required to hold an Air Carrier certificate or operating certificate under Federal Aviation Regulations Part 119.

2.3 14 CFR Part 135: Title 14 of the Code of Federal Regulations Part 135, issued by the Federal Aviation Administration (FAA), prescribes rules governing commuter and on-demand operations of each person who holds or is required to hold an Air Carrier Certificate or Operating Certificate under FAA Part 119.

2.4 Air Ambulance: Fixed or rotary wing aircraft with a compartment that is designed and constructed to afford relative safety and comfort and to avoid aggravation of the patient’s condition. The aircraft, compartment, and personnel meet all applicable federal and state standards for medical air transport.

2.5 ALS: Advance Life Support.

2.6 AOD: Administrative Officer of the Day. This government employee is the administrative officer in charge during other than normal business hours.

2.7 BLS: Basic Life Support. Basic Life Support should include wheelchair lift and lock downs to transport power wheel chair and stretcher patients when necessary.

2.8 CCT: Critical Care Transport

2.9 CO / Contracting Officer: The person executing this contract on behalf of the Government and the only person authorized to make changes to the contract.

2.10 COR / Contracting Officer’s Representative: Person or persons authorized to act for the Contracting Officer within the limits of his / her authority.

2.11 Federal Acquisition Regulations (FAR): Is established for the codification and publication of uniform policies and procedures for acquisition by all executive agencies. The Federal Acquisition Regulations System consists of the Federal Acquisition Regulation (FAR), which is the primary document, and agency acquisition regulations that implement or supplement the FAR.

2.12 Federal Aviation Regulations (FARs): are rules prescribed by the Federal Aviation Administration (FAA) governing all aviation activities in the United States. The FARs is part of Title 14 of the Code of Federal Regulations (CFR). A wide variety of activities are regulated, such as airplane design, typical airline flights, pilot training activities, hot-air ballooning and even model rocket launches. The rules are designed to promote safe aviation, protecting pilots, passengers and the general public from unnecessary risk. They are also intended to protect the national security of the United States, especially in light of the September 11, 2001 attacks.

2.13 Federal Holidays: New Year’s Day, Martin Luther King Jr. Birthday, Presidents Day, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day, Christmas Day, also any day determined by the President of the United States to be a Federal Holiday.

2.14 Ground Ambulance: Vehicles for emergency medical care which provide a driver compartment and a patient compartment that will accommodate an Emergency Medical Technician (EMT), Paramedic (or RN as needed) and two litter patients, so positioned that at least one patient can be given intensive line support during transit; equipment and supplies for emergency care at the scene as well as during transport, and two-way radio communication and equipment for light rescue procedures. The ambulance is designed and constructed to afford relative safety and comfort and to avoid aggravation of the patient’s condition. Ground Ambulance must be licensed as an ambulance provider in the State of Hawaii.

.15 Neighbor Island(s): A Neighbor Island is Maui, Kauai, Molokai, the Big Island of Hawaii (Hilo and Kona), Lanai, or Niihau.

2.16 Normal Business Hours: Normal business hours are defined as Monday thru Friday, 8:00 a.m. to 4:30 p.m. local time.

2.17 Requesting Official: The requesting official is a medical care provider on the Neighbor Islands that has received authorization from the VAPIHCS to request air ambulance services on behalf of the veteran/patient. This individual is responsible for medically clearing the patient for travel and insuring relevant and necessary medical information is provided to Contractor.

2.18 Trip: A trip is defined as the distance, “ONE WAY ONLY,” over which a beneficiary will be transported. For all one-way trips ordered under this contract, the Contractor shall receive the base rate quoted under the “BASE RATE.” The Contractor shall also receive the mileage charge quoted under the “Mileage RATE.”

2.19 Drop Off Locations:

(1) VAPIHCS / VA Spark M. Matsunaga Medical Center: 459 Patterson Road, Honolulu, HI 96819.

(2) Tripler Army Medical Center (TAMC): located at 1 Jarrett White Road, Honolulu, HI 96859.

(3) Queens Medical Center (QMC) 1301 Punchbowl St. Honolulu HI 96813

(4) Straub Clinic and Hospital Emergency Services, 888 King Street, Honolulu HI 96813

3.0 Demand:

3.1 The demand for the Air Ambulance services is estimated at eight to ten (8 -10) Trips per month.

4.0 Performance Period:

4.1 The period of performance is from April 1, 2018 through March 31, 2019 with four one-year option periods.

4.2 The contractor shall be fully mobilized to begin performance within thirty (7) days of contract award.

5.0 Description of Work:

5.1 The Contractor shall provide ALS/BLS/CCT air ambulance service twenty-four (24) hours per day, seven (7) days per week, including all holidays for beneficiaries of the VA. Please note this includes ground transportation via ground ambulance from medical facility (sending facility) on neighbor island to airport and from airport in Honolulu to accepting medical facility.

5. The Contractor shall provide passenger air charter service and related passenger services to assist the Government in meeting its travel needs from the Neighbor Island to Oahu, HI.

5.3 Contractor shall use contractor-owned stretchers, wheelchairs, linens or any other items required in transporting patient(s) from one place to another.

5.4 This contract shall include BLS, ALS and CCT services as required.

5.5 The contractor shall provide all legs of transportation including ground ambulance to and from respective airports..

5.6 All travel is one-way from a Neighbor Island to Oahu, HI.

6.0 Locations:

6.1 Pick-up location shall be from Maui, Kauai, Molokai, the Big Island of Hawaii (Hilo and Kona), Lanai, or Niihau. In most instances the pick-up location will be at a medical facility.

6.2 Drop-off location will be on the island of Oahu, Hawaii. The contractor shall provide ground transportation to the appropriate receiving medical facility on Oahu.

7. Orders for Service:

7.1 The Requesting Official will place telephone requests (orders) for contract services with the Contractor’s dispatch office. The request for services shall specify the originating point and final destination. The Contractor shall verify that the telephone request has been authorized by the VAPIHCS either by confirming VAPIHCS approval with the Requesting Official at the time of the telephone request or by verifying with any VAPIHCS authorized personnel listed below:

· Supervisory Patient Services Millie LaGrant (808) 433-7718

· Chief of Member Services (David Pangelinan) – (808) 433-7600

· Patient Services Lead- Mary Albert (808) 433 0527

· Clinical RN Jerilyn Ito – (808) 433-0786; pager (808) 363-1785

· Administrative Officer of the Day (AOD) (after hours/weekends) –

808) 433-7864, pager: (808) 577-0922,

· cellular:808 208 4472, or 808 208 2343

· Dr. Maryann Antonelli-pager (808) 577 1496 (For prescheduled pickups, the Contractor will be required to furnish the ground ambulance within ten (10) minutes of the prearranged time.

7.2 For unscheduled pickups, the Contractor dispatch will respond within a reasonable amount of time not to exceed thirty (30) minutes and coordinate the transportation of the beneficiary. The Contractor agrees to have patient prepared and airborne within three (3) hours after the receipt of telephone order or as agreed between the contractor and the authorized Requesting Physician. If the Contractor identifies they cannot furnish the services within the time required, the Government reserves the right to obtain the necessary services from another source. The Government will be the sole judge in determining when to order services from a different source.

7.3 Unscheduled pickups are conducted under 14 CFR Part 121 (supplemental operations) and 14 CFR Part 135 (commuter and on-demand operations).

7.4 In the event of a “NO-SHOW” the Government reserves the right to obtain the necessary services from another source.

8.0 Rate:

8.1 For all one-way trips ordered under this contract, the Contractor shall receive the base rate quoted under the “BASE RATE.” The “BASE RATE” shall constitute full compensation for ONE-WAY trips. The Contractor shall also receive the mileage charge quoted under the “Mileage RATE” for any one-way trip.

9.0 Cancellation:

9.1 If the delivery order is cancelled by the Requesting Physician, the Contractor will be paid for actual statute miles traveled at the time of the cancellation, plus the necessary statute miles the Contractor’s aircraft must travel to return to its starting location. The return mileage is only reimbursable if the contractor does not have another destination on its flight plan.

10.0 Personnel:

10.1 The Contractor shall provide the necessary licenses/certificates, competencies, privilege and credentialing in accordance with applicable State(s) and Federal regulation for each employee that will perform services under this contract.

11.0 Licenses, Certifications and Insurance:

11.1 All work related to this contract will be performed by the Contractor in accordance with any applicable FAA, U.S. Department of Transportation, or OSHA regulations, as well as applicable State health and safety regulations, health care accreditation standards (JCAHO or equivalent accreditation organization) and standard industry practices as defined by the Association of Air Medical Services for air ambulance transportation.

11.2 This solicitation applies to non-scheduled operations of air transportation conducted under:

14 CFR Part 121 (“Supplemental Operations”) http://rgl.faa.gov/RegulatoryandGuidanceLibrary/rgFAR.nsf/MainFrame?OpenFrameSet 14 CFR Part 135 (“Commuter and On-Demand Operations”) http://rgl.faa.gov/RegulatoryandGuidanceLibrary/rgFAR.nsf/MainFrame?OpenFrameSet

11.3 FARs Part 135 Operators must be in compliance with applicable regulations as outlined in Federal Aviation Regulations Part 135: Operating Requirements: Commuter & On-Demand Operations & Rules Governing Persons on Board Such Aircraft.

11.4 FARs Part 121 Operators must be in compliance with applicable regulations as outlined in Federal Aviation Regulations Part 121: Operating Requirements: Domestic, Flag, and Supplemental Operations.

11.5 Medical Standards – refer to Federal Aviation Regulations (FARs) Part 61.23, Subpart A: “Medical Certificates: Requirement and Duration”

· Medical Class (1st, 2nd, or 3rd)

· Medical Date (FAA certified physician check)

11.6 Air Ambulance Pilot - Shall have a valid operator's license in accordance with Federal, State and local government requirements for their place of operation, for the services they perform.

11.7 EMTs - Shall be certified, licensed or otherwise officially recognized by the local, state or regional government or public entity where the emergency ambulance service is operated or by which it is governed.

11.8 Ambulance Driver - Shall have a valid operator's or chauffeur's license in accordance with Federal, State and local government requirements for their place of operation, for the services they perform.

11.9 Maintenance Personnel – Contractor shall insure that contracted maintenance, including repair and overhaul facilities, is performed by maintenance organizations acceptable to the Civil Aviation Regulations (CAR).

11.9.1 Operators, (at their discretion) are expected to hire and train the number of employees that would be reasonably required to safely maintain the company aircraft and support the scope of the maintenance operation both at home station and at en route locations.

11.9.2 Ensure that all maintenance tasks, including required inspections and airworthiness directives, are performed.

11.9.3 Maintenance actions are properly documented, and discrepancies identified between inspections are corrected.

11.9.4 Mechanics must be fit for duty, properly certified with the company’s certification and knowledgeable of the necessary aircraft-specific requirements to accomplish the maintenance tasks.

11.9.5 Non-certified and inexperienced personnel must receive supervision from individuals compliant with FARs Part 43.3. All personnel transporting veteran patients should be immunized against influenza, or wear face masks during the influenza season.

11.9.6 Freedom from alcohol and drug abuse is required as outlined in Federal Aviation Regulations FARs Part 135: Subpart E “Flight Crewmember Requirements.”

11.10 Contractor: Shall maintain personal liability, automobile liability, and property damage insurance, as prescribed by the laws of the state of Hawaii, and in accordance with VAAR 852.228-71, VAAR 852.237-7, and VAAR 852.237-70.

11.10.1 Liability Insurance. The Operator shall maintain, or cause to be maintained at its sole expense, bodily injury and property damage liability insurance.

11.10.2 Hull Insurance. The Operator shall maintain, or cause to be maintained at its sole expense, all risks aircraft hull insurance in an amount equal to the value of the aircraft. Such policy shall designate the Operator and any first lien mortgage holder as loss payees as their interests may appear.

11.10.3 Insurance Certificates. The Operator shall provide the VA with a Certificate of Insurance evidencing the insurance coverage required upon execution hereof and immediately upon the VA’s or ordering agency’s request at any time thereafter.

11.10.4 Workers Compensation. The Operator shall maintain worker’s compensation insurance providing applicable statutory benefits for all employees performing services. The cost of such worker’s compensation insurance premiums is the Operator’s responsibility.

12.0 Training

12.1 Crew Resource Management (CRM) is a best practices measure that is taught, practiced and evaluated during all phases of operations training. There are no general mandates imposed on an operator regarding the frequency of CRM training. However, the expectation is that the frequency of CRM training is sufficient to ensure that the operator meets all Federal Aviation Regulations (all parts) from Title 14 and Code 49 of Federal Regulations. In order to ensure CRM competency, the following minimum areas must be covered:

12.1.1 Role playing scenarios between crew members to ensure clear channels of communication exist.

12.1. Role playing scenarios that demonstrate how to over-ride a senior crew member’s decision if that senior crew member has made an error.

12.1.3 Delegation of duties under normal circumstances and situations where a senior crew member in a decision-making chain-of-command is incapacitated.

12.2 Flight and cabin crews have jet recurrent training as mandated in Federal Aviation Regulations 135.295 and 135.297 respectively.

12.3 Maintenance Personnel Training - Orientation, familiarization, on-the-job, and appropriate initial and recurrent training for all full and part-time personnel is expected. This training should include aircraft familiarization systems, and job specific duties related to avionics and power plant. The use of such training aids as mockups, simulators and computer based training enhances maintenance training efforts, and is desired. Initial and recurrent training requirements and frequency are established for each operator as outlined by Federal Aviation Administration (FAA) Advisory Circular (AC) 120-42. All maintenance employees must be in compliance with Federal Aviation Regulations (FARs) Part 43.

12.4 Information Security Training – See VA Handbook 6500.6, Appendix C, paragraph 9.9

12.4.1 All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems:

12.4.1.1 Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, Appendix E relating to access to VA information and information systems;

12.4.1.2 Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training;

12.4.1.3 Successfully complete the appropriate VA privacy training and annually complete required privacy training; and

12.4.1.4 Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [to be defined by the VA program official and provided to the contracting officer for inclusion in the solicitation document – e.g., any role-based information security training required in accordance with NIST Special Publication 800-16, Information Technology Security Training Requirements.]

12.4.2 The contractor shall provide to the contracting officer and/or the COTR a copy of the training certificates and certification of signing the Contractor Rules of Behavior for each applicable employee within 1 week of the initiation of the contract and annually thereafter, as required.

12.4.3 Failure to complete the mandatory annual training and sign the Rules of Behavior annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete.

13.0 Designation of Contracting Officer’s Representative (COR)

13.1 The Contracting Officer (CO) will appoint a Contracting Officer Representative (COR) to perform tasks related to the execution and surveillance of this contract. The COR will be designated to represent the Contracting Officer (CO) in furnishing technical guidance and advice under this contract. The foregoing is not to be construed as authorization to interpret or furnish advice and information to Contractor relative to the financial or legal aspect of the contract. Those matters are the responsibility of the CO and shall not be delegated.

13.2 The CO is responsible for the administration of this contract. The CO is the only individual authorized, to extent indicated in this contract, to take actions on behalf of the Government, which may result in changes in the contract terms, to include deviation from the statement of work, details, and performance schedules. Communications pertaining to contractual matters shall be addressed to the CO. No changes in or deviation from the statement of work shall be affected without a written modification to the contract executed by the CO. No oral statements of any person whosoever will in any matter or degree, modify or otherwise affect the terms of this contract.

13.3 The Contractor will receive a copy of Delegation Letter which will identify the COR appointed by the CO.

14.0 Inspection, Quality, and Performance Standards:

14.1 The Government has the right to inspect the contractor premises, maintenance records of medical equipment and aircraft(s), flight logs, and dispatch records being used for the contracted services. Furthermore, annually the contractor must provide proof of insurance and copies of any licenses for all staff providing services under this contract upon request of the COR (see also paragraph D).

14.2 Contractor will ensure that each beneficiary is treated in a professional manner, keeping in mind diversity of our beneficiaries. Each beneficiary will be treated with the highest quality of care and standards established in the industry. Some of the areas to be assessed are:

a. Patient safety

b. Medical services

c. Equipment and aircraft maintenance program

14.3 The last month of each contract year the Contracting Officer will review contract compliance reports submitted by the COR. The review will employ various monitoring methods, but will specifically include complaints and timeliness.

14.4. The COR or CO has the right to copies of data or records retrieved from the aircraft’s flight data recorder (a.k.a. “black box”).

14.5 In aircraft containing video devices, the COR or CO has the right to possession and to create copies of such footage.

15.0 Reporting Responsibilities:

15.1 The Contractor shall furnish an in-flight medical attendant report of the patient’s status to the receiving facility. The report should include:

· Patient’s full name and social security number (whenever possible) – if not possible, explain the reasons.

· Time picked up.

· Originating and terminating points.

· Who called (initiator).

· Presenting problem.

· Immediate First Aid Measures (bandages, oxygen, restraints, etc)

· State of consciousness.

· Blood pressure.

· Pulse.

· Respiration.

· Any other noted symptoms or pertinent information, including vital signs not already described, level of consciousness, drugs administered, and details of therapeutic intervention.

· Any unusual circumstances encountered during the flight, including but not limited to inordinate altitudes flown, turbulence, and times associated with these conditions.

15.2 The Contractor shall furnish reports, electronically, on a quarterly basis, based on the government’s fiscal year (October 1 through September 30), the following reports:

The report is due by the 30th calendar day after the end of each three month reporting period based on the effective date of the contract.

Reports shall be submitted, in electronic format, to denard.fobbs@va.gov Richard.velasquez@va.gov

15.3 Maintenance Records – maintenance actions shall be well documented and provide a complete record of maintenance accomplished and, for repetitive actions, maintenance required. Inspection compliance, airworthiness release, and maintenance release records, shall be complete and signed by approved personnel. The COR may request these records at any time during the contract period.

16.0 Invoice Procedures:

16.1 Invoices shall be submitted no later than fifteen (15) calendar days following each trip in which services are rendered. Invoices are to be submitted electronically (IIPS) and a copy will be sent to the Patient Travel Coordinator who placed the service order.

16.2 Invoices are to include all contract services furnished for the preceding month. Invoices shall specify the patient name, 4-digit patient identifier, date of service, time of pick-up, whether the trip was “pre-scheduled” or “unscheduled”, pick-up and delivery point, trip number and separate charges (i.e. toll fee, medications, etc.) per trip for which payment is requested. Separate charges must be itemized.

16.3 All invoices shall include a fixed base-rate line item & a mileage rate line item. Each line item will include rate, quantity, description, and line total.

16.4 Invoices will be reviewed and reconciled with trip tickets and travel logs. Unauthorized charges will be suspended pending investigation. Unauthorized charges are those that are being disputed or have not been pre-approved by authorized VA personnel. A final determination will be made within 30 days after notifying the Contractor of charges being suspended.

16.5 In accordance with VA accounting procedures and in order to provide an audit trail for questions and concerns pertaining to payment, the Contractor shall be furnished, in advance a series of numbers corresponding to the month in which the service is rendered. This number is to be referenced on all invoices as applicable.

16.6 All invoices rendered by the Contractor to VAPIHCS for contract services furnished in accordance with this contract shall be in full. Neither the beneficiary nor any other party shall be required to bear the burden of additional payments, surcharges, tip or other gratuity.

17.0 Authorized invoices shall be faxed to Department of Veterans Affairs, Financial Services Center (512) 460-5540 or entered through the Tungsten electronic claims system.

17.1 Health Insurance Portability and Accountability Act (HIPAA), Privacy Rule, and Security Rule:

17.1.1 Whereas the Contractor will have access to Business Associate Protected Health Information (PHI) and Electronic Protected Health Information (EPHI) that is subject to protection under regulations issued by the Department of Health and Human Services, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, Subparts A and E, the Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”), and 45 CFR Parts 160 and 164, Subparts A and C, the Security Standard (“Security Rule”); and whereas, Department of Veterans Affairs Veterans Health Administration is a “Covered Entity” as that term is defined in the HIPAA implementing regulations, 45 CFR 160.103.

18.0 Patient Privacy and Confidentiality:

18.1 All "patient papers" transported with the patient are confidential in accordance with HIPAA. Contractor's personnel may review these records for assessment and treatment purposes only. Appropriate administrative and medical information will be provided to the Contractor for patient transport. If the medical record is transported with the patient, it may be used as a source of information if the situation warrants (i.e. emergent care while in-route). In all other instances, all documents will remain intact and sealed.

19.0 Information Security:

19.1 The attached Security Appendix C is hereby incorporated by reference to this contract.

20.0 Liquidated Damages for Breach of Data:

20.1 See VA Handbook 6500.6, Appendix C (Attachment C), paragraph 7.a., 7.d.- 7a - Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information, If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract.) 7.d -(Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $ 130.00 per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following:

Notification:

(1) One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports;

(2) Data breach analysis;

(3) Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution;

(4) One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and

(5) Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs.

21.0 Quality Assurance Surveillance Plan (QASP):

21.1 QASP is a systematic method used by the Government to evaluate Contractor’s actions and performance based on Statement of Work requirements. The QASP is designed to provide an effective method of monitoring contractor performance for each listed objective on the SOW. A QASP is based on the premise the Government desires to maintain a quality standard in providing air ambulance services.

21.2 For the tasks listed in the Performance Requirement Table (PRT) below, the COR will follow the methods of surveillance specified in this contract.

21.3 When a required service in the PRT indicates defective performance, the COR will require the contract manager or representative at the site to document the observation and forward to the Contracting Officer to maintain in the file. The documentation of the observation does not necessarily constitute concurrence with the observation, only acknowledgment that he or she has been made aware of the defective performance. Government surveillance of tasks not listed in the PRT or by methods other than those listed in the PRT (such as provided for by the Inspection of Services clause) may occur during the performance period of this contract. Such surveillance will be done according to standard inspection procedures or other contract provisions. Any action taken by the contracting officer as a result of surveillance will be in accordance with the terms of this contract.

Performance Requirements Table:

Surveillance Reduction when AQL Exceeded

Standards and Safety Guidelines

Aircraft Maintenance Program

Aircraft maintenance logs reviewed semi-annually

minutes

Data

travel coordinator

travel coordinator

Satisfaction

travel coordinator

Coordination

VA261-17-R-1281

SECTION C - CONTRACT CLAUSES

C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

http://www.acquisition.gov/far/index.html http://www.va.gov/oal/library/vaar/

(End of Clause)

C.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN 2017)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights --

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C.3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71,Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include --

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer— System for Award Management, or 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award Management), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315.

(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

(i) Payment.

(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.

(2) Prompt Payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR Part 1315.

(3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause.

(4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made.

(5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall—

(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the—

(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment);

(B) Affected contract number and delivery order number, if applicable;

(C) Affected line item or subline item, if applicable; and

(D) Contractor point of contact.