W9114F-16-T-0068-0001.pdf

W40M EUR REGIONAL CONTRACT OFC

CONTRACTING OFFICE KO

POC: DOMENICO MADDALONI

CMR 402

APO AE 09180

0010879470

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

The purposes of this Amendment are: i) to address prospective vendors Q&As; ii) to revise the Period of Performance from April 2017 to 1 thru 31 May 2017.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 13

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 09-Jun-2016

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W9114F-16-T-0068

X 9B. DATED (SEE ITEM 11)

08-Jun-2016

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer is extended, X is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

09-Jun-2016

CODE

W40M EUR REGIONAL CONTRACT OFC

KIRCHBERG KASERNE

BUILDING 3705

LANDSTUHL AE 66849

W9114F 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W9114F

FACILITY CODECODE

EMAIL:TEL:

W9114F-16-T-0068

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

Q & A' S

Prospective Vendors - Q & A s

Q 1 - Has a contractor performed similar work to this for the government in the past? If available, please provide the incumbent contract number.

A 1 - The company American College of Surgeons Inc. was awarded purchase order # W9114F-14-P-0002 on 23 November 2013 for a total price in the amount of $22,000.00.

Q 2 - If you are unable to provide a contract number, is it safe to assume this is a new requirement for the government?

A 2 - See response in A1

SECTION SF 1449 - CONTINUATION SHEET

SUPPLIES OR SERVICES AND PRICES

CLIN 0001

The CLIN extended description has changed from:

Non-Personal services for two (2) ACS Surveyors to perform On-Site Trauma Certification Survey for verification of Landstuhl Regional Medical Center, (LRMC) compliance with ACS Standards as Level III Trauma Center, in accordance with the enclsoed Performance Work Statement (PWS).Level III Trauma Center certification shall have three (3) years validity from 1 July 2017 thru 30 June 2019. Period of Performance: 1-30 April 2017

To:

Non-Personal services for two (2) ACS Surveyors to perform On-Site Trauma Certification Survey for verification of Landstuhl Regional Medical Center, (LRMC) compliance with ACS Standards as Level III Trauma Center, in accordance with the enclsoed Performance Work Statement (PWS).Level III Trauma Center certification shall have three (3) years validity from 1 July 2017 thru 30 June 2019. Period of Performance: 1-31 May 2017 .

CLIN 0002

The CLIN extended description has changed from:

Not-to-exceed (NTE) reimbursement of costs for all travel, transportation, meals, lodging, and incidentals IAW FAR Part 31 and IAW the rates prescribed by the Joint Travel Regulations (JTR) and § 1.8.1 of the PWS.Costs for these expenses will be reviewed, certified and approved by theContracting Officer's Representative (COR). All travel and transportation shall utilize commercial sources and carriers provided the method used for the appropriate geographical area results in reasonable charges to the government. The Government will not pay for business class or first-class travel.Period of Performance: April 2017

To:

Not-to-exceed (NTE) reimbursement of costs for all travel, transportation, meals, lodging, and incidentals IAW FAR Part 31 and IAW the rates prescribed by the Joint Travel Regulations (JTR) and § 1.8.1 of the PWS.Costs for these expenses will be reviewed, certified and approved by theContracting Officer's Representative (COR). All travel and transportation shall utilize commercial sources and carriers provided the method used for the appropriate geographical area results in reasonable charges to the government. The Government will not pay for business class or first-class travel.Period of Performance: 1 May thru 31 May 2017.

DELIVERIES AND PERFORMANCE

The following Delivery Schedule item for CLIN 0001 has been changed from:

DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

POP 01-APR-2017 TO

30-APR-2017

N/A W1HH USA LANDSTUHL RMC

PLACE OF PERFORMANCE

AMERIKANISCHES KRANKENHAUS

KIRCHBERG KASERNE BLDG 3740

LANDSTUHL 66849

FOB: Destination

WK4FW0

To:

DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

POP 01-MAY-2017 TO

31-MAY-2017

N/A W1HH USA LANDSTUHL RMC

PLACE OF PERFORMANCE

AMERIKANISCHES KRANKENHAUS

KIRCHBERG KASERNE BLDG 3740

LANDSTUHL 66849

The following Delivery Schedule item for CLIN 0002 has been changed from:

POP 01-APR-2017 TO

30-APR-2017

N/A W1HH USA LANDSTUHL RMC

PLACE OF PERFORMANCE

AMERIKANISCHES KRANKENHAUS

KIRCHBERG KASERNE BLDG 3740

LANDSTUHL 66849

POP 01-MAY-2017 TO

31-MAY-2017

N/A W1HH USA LANDSTUHL RMC

PLACE OF PERFORMANCE

AMERIKANISCHES KRANKENHAUS

KIRCHBERG KASERNE BLDG 3740

LANDSTUHL 66849

The following Delivery Schedule item for CLIN 0003 has been changed from:

POP 01-APR-2017 TO

30-APR-2017

N/A W1HH USA LANDSTUHL RMC

PLACE OF PERFORMANCE

AMERIKANISCHES KRANKENHAUS

KIRCHBERG KASERNE BLDG 3740

LANDSTUHL 66849

POP 01-MAY-2017 TO

31-MAY-2017

N/A W1HH USA LANDSTUHL RMC

PLACE OF PERFORMANCE

AMERIKANISCHES KRANKENHAUS

KIRCHBERG KASERNE BLDG 3740

LANDSTUHL 66849

The following have been modified:

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT

TRAUMA CERTIFICATION SURVEY 2017-2019

LANDSTUHL REGIONAL MEDICAL CENTER (LRMC)

1. GENERAL.

1.1. DESCRIPTION OF WORK.

1.1.1. Description: Non-Personal services to perform Trauma Certification Survey for verification of Landstuhl Regional Medical Center, (LRMC) compliance with ACS Standards as Level III Trauma Center, in accordance with the American College of Surgeons Committee on Trauma Verification.

1.1.2. The contract does not create an employer-employee relationship between the Government and the Contractor.

Contractor shall provide the services in accordance with the terms and conditions of this Performance Work Statement (PWS).

1.2. QUALIFICATIONS. The Contractor personnel, specifically the Surveyors who will conduct the survey shall be specialized and fully trained ACS physicians, possessing and maintaining current licenses and qualifications to provide Trauma Certification and Verification on behalf of the American College of Surgeons (ACS).

1.2.1. The Surveyors’ licenses shall be: (a) current (not revoked, suspended, or lapsed in registration); (b) valid (the issuing authority accepts and considers QA information (i.e. practitioner professional performance and conduct in determining continued licenses); and (c) unrestricted (not subject to restriction pertaining to the scope, location, or type of practice ordinarily granted to other applicants for similar licenses in granting jurisdiction).

1.2.2 . The Surveyors shall have, at a minimum, three (3) years’ experience as ACS Surveyors during the past five

(5) years.

1.3. ADMINISTRATIVE.

1.3.1. Neither uniformed personnel nor Government civilian employees shall be employed to perform services under this contract.

1.3.2. Safety. Contractor personnel shall comply with all installation safety regulations. As a minimum, such regulations include general safety, fire prevention, and waste disposal.

1.3.3. Security.

1.3.3.1. Contractor personnel shall comply with the local installation requirements for vehicle registration and operation on the military facility. Any vehicle operated by the Surveyor in performance of this contract must have the minimum liability coverage required by the state or country in which the installation is located.

1.3.3.2. Contractor personnel shall comply with installation and MTF personnel identification and access requirements. The Surveyor is responsible for absences due to expired identification and access documents.

1.3.3.3. Safeguarding Material. Contractor personnel shall be responsible for safeguarding all Government property provided for the Surveyor’s use. Contractor personnel shall safeguard information of a confidential or sensitive nature. Contractor personnel shall not disclose or cause to be disseminated any information concerning the operation of the MTF that could result in or increase the likelihood of the possibility of breach of security or interrupt the continuity of operations or which breach the requirements of the Federal Privacy Act of 1974.

However, the Surveyor may be required to provide testimony or disposition in cases of due process action.

1.4. TASK PERFORMANCE: Contractor personnel shall provide services for the duty location as follows:

1.4.1. The Trauma Certification Survey provided under this contract shall be performed for two (2) consecutive days during the month of May 2017.

1.4.2. The COR and TRCO will perform full quality assurance surveillance and hours of performance monitoring tasks performance during survey itinerary described in Technical Exhibit A.

1.4.3. Place of Performance. The Surveyors shall conduct the Trauma Certification Survey at the Landstuhl Regional Medical Center (LRMC) in accordance with the schedule in Technical Exhibit A.

1.5. CONDUCT.

1.5.1. Contractor personnel shall comply with MTF policies regarding personal appearance and conduct.

1.5.2. Contractor personnel shall abide by federal and local MTF regulations and requirements concerning the nature of limited privileged communication between patients and the Contractor personnel as may be necessary for security and personnel reliability programs. Contractor personnel shall also abide by federal and local MTF regulations concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Health Insurance Portability & Accountability Act of 1996. All regulations referenced are available for review from the COR, MTF, or the Contracting Officer. All medical records and reports will remain the property of the Government.

1.5.3. Contractor personnel shall abide by MTF bylaws, JC, DoD and Medical Department regulations with regard to Utilization Review and Quality Assurance directives, including, but not limited to, in-service training, maintenance of records, performance evaluation, release of medical information.

1.5.4. Contractor personnel shall make use of all appropriate equipment; and services made available by the Government and shall seek consultations, as deemed necessary, for the optimal SHARP training.

1.5.5. Impaired contractor personnel.

1.5.5.1. At any time during the performance of this contract, the Contracting Officer, COR, or the SARP manager may direct removal of the Contractor personnel for reasons other than posing danger of physical harm, such as posing a threat to the security or good order and discipline of the Government workplace. This provision will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the Surveyor.

1.5.5.2. If a removal occurs, the COR will contact the Contractor within 24 hours, who will formally meet with the COR and/or other hospital management personnel to discuss further action in accordance with the MTF Quality Assurance and Inspection (QA&I) Plan.

1.5.5.3. If, after any investigation deemed necessary by Government representatives and discussions with the Contractor personnel, the COR and Contracting Officer conclude that the Contractor personnel’s impairment requires permanent removal from performance under the contract, the Contracting Officer will notify the Contractor that permanent removal is required. In the event of disagreements between the Government and the Surveyor concerning matters of impaired Surveyor, the decision of the Contracting Officer will be final.

1.6. QUALITY MANAGEMENT.

1.6.1. Quality Control Plan (QCP): The Contractor is required to follow the current QC program in place at LRMC to ensure that the Surveyor services are provided at a level of quality that meets LRMC standards.

1.6.2. Quality Assessment and Improvement (QA&I). The Government will monitor the Contractor personnel's performance under this contract using the QA&I procedures established by the medical activity and pursuant to the Contract Terms and Conditions - Commercial Items, Inspection/Acceptance clause. Additionally, the Contractor personnel's performance is subject to scheduled and unscheduled review by the QA&I Committee as defined by the medical activity Quality Assurance (QA) Plan and AR 40-68.

1.7. Overseas Emergency Medical Services

1.7.1. In emergencies, transportation in U.S. Government ambulances may be furnished by the U.S. Government on a reimbursable basis. The Contractor personnel may not be authorized occupational health services (defined in AR 40-4 and AR 40-5) in all locations. Locations where occupational health services are available will be identified in the contract. The Contractor personnel may receive emergency first aid and medical treatment subsequent to on the job injuries under the provisions of paragraph 13-1 of AR 40-3. These services will be chargeable to the Surveyor at Rate A-3 as defined in AR 40-330, paragraph 2.3(a).

1.7.2. The U.S. Government may furnish transportation by air for medical reasons. The cost of such transportation to the Surveyor shall be at the rate provided in the HQ Air Mobility Command (AMC) Airlift Tariff Rates guide if the service is on a regular routine flight schedule. Under extreme emergency conditions where a special aircraft must be utilized, the Surveyor shall be charged at the hourly rate for the aircraft as stated in the guide. Rate information may be obtained (as of the date contract preparation) from HQ AMC/FMBT at (618) 229-3870 or on the internet at https://amcpublic.scott.af.mil/index.html under the link “DoD Rates”. The Contractor shall not be reimbursed by this contract for transportation by air for medical reasons. This paragraph shall also apply in the event of the death of a U.S. Contractor or his/her dependent and where transport of remains is involved.

1.8. Reimbursement of transportation and travel costs is limited to expenses incurred by the Surveyors.

1.8.1. Arrangements for and costs of all travel, transportation, meals, lodging, and incidentals are the responsibility of the Contractor. Lodging and meals shall be reimbursed in accordance with regulations defined in FAR PART 31 and the rates prescribed by the Joint Travel Regulations (JTR). Costs for these expenses will be reviewed, certified and approved by the Contracting Office. All travel and transportation shall utilize commercial sources and carriers provided the method used for the appropriate geographical area results in reasonable charges to the government. The Government will not pay for business class or first-class travel.

1.9. PERFORMANCE MEASURES.

1.9.1. Outcome.

1.9.2. Contingent upon the survey and the re-verification results, the Landstuhl Regional Medical Center’s shall receive the ACS certificate of compliance as Level III Trauma Center.

1.9.3. Contingent upon the survey and the re-verification results, the certification shall have, at a minimum, three (3) years validity, from 1 July 2017 until 30 June 2019.

2. DEFINITIONS/ACRONYMS.

2.1. DEFINITIONS. Following is a list of basic definitions. .

2.1.1. Acceptable Quality Level (AQL). AQL is the maximum allowable percentage of deviation from perfect performance for an individual service output.

2.1.2. CONTRACTING OFFICER: A person with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.1.3. CONTRACTING OFFICER'S REPRESENTATIVE (COR): A Government employee selected and designated in writing by the Contracting Officer to act as his/her designated representative in administering a contract, but without authority to change the terms or conditions of the contract.

2.1.4. Performance of Work Statement (PWS): Scope and definition of occupational medical services provided under the contract.

2.1.5. Quality Assurance: Those actions taken by the Government to assure services meet the requirements of the

PWS.

2.1.6. QUALITY CONTROL. Those actions taken by a contractor to control the performance of services to ensure that they meet the requirements of the contract.

2.1.7. TECHNICAL REPRESENTATIVE OF THE CONTRACTING OFFICER (TRCO): A Government employee who is authorized to monitor the contractor’s performance under the contract, serving as technical liaison between the contractor and the Contracting Officer’s Representative (COR).

2.2. ACRONYMS/ABBREVIATIONS. Following is a list of basic acronyms/abbreviations used in the contract.

ADP - Automated Data Processing AR - Army Regulation CFR - Code of Federal Regulations CHAMPUS - Civilian Health and Medical Program of the Uniformed Services CHCS - Composite Health Care System (also known as AHLTA) CEU - Continuing Education CME - Continuing Medical Education CONUS - Continental United States COR - Contracting Officer's Representative DA - Department of the Army DCCS - Deputy Commander for Clinical Services DHCP - Direct Health Care Provider DoD - Department of Defense DODI - Department of Defense Instruction EFT - Electronic Funds Transfer HIPAA - Health Insurance Portability & Accountability Act of 1996 HP - Healthcare Provider ILS - Individual Logistical Support TJC - The Joint Commission LRMC - Landstuhl Regional Medical Center KO - Contracting Officer MEDCOM - Medical Command MEDDAC - Medical Department Activity MTF - Medical Treatment Facility NACI - National Agency Check with Inquiries NACP - National Advocate Credentialing Program NCOIC - Noncommissioned Officer in Charge NOVA - National Organization for Victim Assistance OCONUS - Outside the Continental United States OIC - Officer in Charge OSHA - Occupational Safety and Health Administration PAD - Patient Administration Division Pam - Pamphlet PAR - Performance Assessment Report PWS - Performance Work Statement PL - Public Law PPIMS - Past Performance Information Management System QA - Quality Assurance QA&I - Quality Assessment & Improvement QC - Quality Control

SARC - Sexual Assault Response Coordinator SHARP - Sexual Harassment/Assault Response & Prevention SF - Standard Form TRCO - Technical Representative of the Contracting Officer VA - Victim Advocates

3. GOVERNMENT-FURNISHED PROPERTY AND SERVICES

3.1. The Government will provide use of all available LRMC facilities and support services, materials, publications and forms and equipment for contract performance. Contractor personnel shall keep Government furnished supplies, equipment, and work areas in a safe, orderly and clean condition. Contractor personnel shall notify the Government whenever maintenance of equipment is required.

3.2. Any space used by the Contractor personnel in performance of this contract may be used for other purposes during his/her absence. Items of clothing, personal effects, or equipment may not be able to be secured at all locations. The Government will not incur any liability for theft, damage to, or loss of such personal items.

3.3. Emergency Healthcare for Contractor employees. The MTF will provide Emergency healthcare for injuries occurring while on duty. The Surveyors shall reimburse the Government for such services.

3.4. Contractor personnel shall have received Occupational Safety and Health Administration (OSHA) required training for the position in which they will perform, and that training currency is maintained. Documentation of such training shall be provided to the COR.

3.5. Contractor personnel will be provided with medical material information, as required by the Occupational Safety and Health Administration (OSHA) Standard.

3.6. Nametags. Contractor personnel shall wear a name tag clearly identifying him/her as a contractor.

4. CONTRACTOR FURNISHED SUPPLIES/SERVICES:

4.1. Contractor shall furnish all supplies and services except those described in paragraph 3. above.

4.2. Uniforms. Contractor personnel shall have his/her own professional attire for performance under this contract.

5. SPECIFIC TASKS.

5.1. The Contractor shall provide, at a minimum, two (2) American College Surgeon (ACS) physicians site surveyors to conduct a two day on-site survey to verify Landstuhl Regional Medical Center’s compliance with ACS Standards as Level III Trauma Center.

5.1.1. Areas.

5.1.1.1. The Surveyors shall survey areas in accordance with the itinerary described in Technical Exhibit A.

5.1.2. Tasks. One of the Surveyors shall visit each department listed below and conduct the following tasks:

5.1.2.1. Emergency Department: Review emergency department facility, resuscitation area, equipment protocols, flow sheet, staffing, and trauma call. Interview emergency physician and emergency nurse. Review the prehospital interaction and performance improvement and patient safety feedback mechanism. Review the emergency department log as well as other records requested on-site based on this review.

5.1.2.2. Radiology: Inspect facility. Interview radiologist and technician. Discuss patient triage. Determine patient monitoring policy. Review CT/MRI log.

5.1.2.3. Operating Room/PACU: Interview operating room nurse manager and anesthesiologist/CRNA. Check operating room schedule. Determine how a trauma OR suite is opened STAT. Review equipment availability.

5.1.2.4. ICU: Inspect facility/review equipment. Review flow sheets. Interview medical director/nurse manger/staff nurse. Discuss patient triage and bed availability.

5.1.2.5. Blood Bank: Inspect facility. Interview technicians. Determine availability of blood products and massive transfusion protocols.

5.1.2.6. Conduct Interviews: Hospital administration. Trauma medical director. Neurosurgeon. Orthopedic surgeon. Trauma Program Manager. Chief of Staff.

5.1.2.7. Chart Review/PIPS: Review performance improvement documents. Review medical records. Review Peer Review Committee attendance/minutes.

5.1.2.8. Site Surveyors Prepare for exit interview.

5.1.2.9. Conduct Exit Interview: Hospital administration. Trauma medical director. Trauma program manager.

Others as desired by hospital administration.

5.2. The Contractor shall submit an executive summary of the survey within 10 working days from the site visit. The executive summary shall include, at a minimum, the following narratives:

5.2.1. Review of successful practices including recommendations.

5.2.2. Guidance and recommendations for trauma programs.

5.3. Contingent upon the survey and the re-verification results, ACS shall concede membership to the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®).

6. CONTRACTOR MANPOWER REPORTING (CMR)

6.1. Contractor Manpower Report. The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the Contractor will report ALL contractor manpower (including subcontractor manpower) required for performance of this contract. The Contractor is required to completely fill in all the information in the format using the following web address “https://cmra.army.mil”.

The required information includes:

(1) Contracting Office, Contracting Officer, Contracting Officer’s Technical Representative;

(2) Contract number, including task and delivery order number;

(3) Beginning and ending dates covered by reporting period;

(4) Contractor name, address, phone number, e-mail address, identity of contractor employee entering data;

(5) Estimated direct labor hours (including sub-contractor);

(6) Estimated direct labor dollars paid this reporting period (including sub-contractor);

(7) Total payments (including sub-contractor);

(8) Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC for each sub-contractor if different); R420

(9) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the contractor with its UIC for the purposes of reporting this information); W1HHAA

(10) Locations where contractor and sub-contractors perform the work (specified by zip code in the United States and nearest City, Country, when in an overseas location, using standardized nomenclature provided on website);

(11) Presence of deployment or contingency contract language, and,

(12) Number of Contractor and sub-contractor employees deployed in theater this reporting period (by country).

(13) As part of its submission, the Contractor will also provide the estimated total cost (if any) incurred to comply with this reporting requirement.

6.2. Reporting period will be the period of performance not to exceed 12 months ending September 30 of each Government fiscal year and must be reported by 31 October of each calendar year. The Contractor shall notify the Contracting Officer’s Representative (COR) by the 5th working day of November whether or not they have completed this report. If the COR is unavailable, the contractor will notify the Contracting Officer.

7. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

7.1. PERSONNEL RESPONSIBILITIES

The following definitions for Government resources are applicable to this QASP:

Contracting Officer (KO) – A person duly appointed with the authority to enter into, administer, or terminate contracts and make related determinations and findings on behalf of the Government. The KO ensures performance of all necessary actions for effective contracting, ensures compliance with the terms of the contract or task order and safeguards the interests of the United States in the contractual relationship. It is the KO who assures that the Contractor receives impartial, fair and equitable treatment under the contract. The KO is ultimately responsible for the final determination of the adequacy of the Contractor’s performance.

Contracting Officer Representative (COR) - An individual designated in writing by the KO to act as his/her authorized representative to assist in contract administration. The COR’s duties and limitations are specified in the written letter of designation. The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the Contractor’s performance. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf. Any changes that the Contractor deems may affect the contract, price, terms, or conditions shall be referred to the KO for action.

7.2. METHODS OF SURVEILLANCE

The below listed methods of surveillance may be used in the administration of this QASP. In addition to specific instructions that may be mentioned, the appropriate and standardized form that is to be used for documentation of QA surveillance is the Surveillance Activity Checklist (SAC), included as Attachment A.

Student Feedback – Student feedback may be obtained either from the results of formal student surveys or from Surveyor audits.. The COR shall keep the tabulated results of all student surveys on file and shall enter the summary results into the SAC.

100% Inspection – This level of inspection shall be accomplished by complete monitoring and documentation. The COR, or if so designated the appropriate COR, shall review the generated documentation and enter summary results into the SAC.

7.3. QUALITY ASSURANCE SURVEILLANCE CHECKLIST

Contract Requirements Performance

Standard

Acceptable Quality Level

(AQL)

Method of Surveillance

Compliance

Conduct re-verification Inspection

§ 5.1 100% On-site inspection.

Negative/Positive

Assessment Report

Trauma

ACS NSQIP®

§ 5..3 100% Verified access to program

Full access to tools and updates of program

Provide guidance and recommendations for trauma programs during the site visit process

§ 5.2 100% On-site inspection.

Negative/Positive

Assessment Report

Provide executive summary of the site visit report

§ 5.2 100% On-site inspection.

Negative/Positive

Assessment Report

8. SEXUAL ASSAULT PREVENTION AND RESPONSE PROGRAM (SHARP)

The Contractor shall comply with OTSG/MEDCOM Policy Memo 13-062, Policy for Reporting Incidents of Sexual Assault and Sexual Harassment under the Sexual Assault Prevention and Response Program (SHARP), 12 Nov 2013. The SHARP reporting requirements apply only to knowledge obtained by Contractor personnel while performing services under this contract.

A Contractor with knowledge of an incident of sexual assault occurring on a Government facility, to include a Government leased facility, where the Contractor is providing services under this contract, to report the incident immediately (within 24 hours) in writing to the Government's COR. All incidents shall be reported whether they involve Contractor personnel or Government personnel, or other individuals.

The Contractor shall with knowledge of an incident of sexual harassment occurring on a Government facility, to include a Government leased facility, where the Contractor is providing services under this contract, to report the incident to the immediately (within 24 hours) incident in writing to the Government's COR. All incidents shall be reported whether they involve contractor personnel or Government personnel, or other individuals.

Sexual Assault Reporting. The Contractor will immediately (within 24 hours) report an incident of sexual assault to the COR.

Sexual Harassment Reporting. The Contractor will immediately (within 24 hours) report an incident of sexual harassment to the COR.

Army Regulation 600-20, Army Command Policy, 20 Sep 2012

OTSG/MEDCOM Policy Memo 13-062, Policy for Reporting Incidents of Sexual Assault and Sexual Harassment under the Sexual Assault Prevention and Responses Program (SHARP), 12 Nov 2013.

(End Performance Work Statement)

TECHNICAL EXHIBIT A

AMERICAN COLLEGE OF SURGEONS

LEVEL III TRAUMA CENTER RE-VERIFICATION

ITINERARY 2017

Proposed Itinerary

DAY 1

1300 Meet Surveyor Team, Security Badges 1315-1345 Opening Conference/Commander Briefing 1345-1415 Review the Joint Trauma System & Landstuhl Regional Medical Center 1415-1445 Review Performance Improvement Program 1500-1700 Medical Record Review/PIPS 1830-2030 Pre Review Dinner

DAY 2

0700 Meet Surveyor Team

0715-0815 Facility Tours: ACS Reviewers 0815-1030 Medical records Review/Review of Performance Improvement/PIPS 1030-1100 Site Surveyor Closed Meeting 1100-1200 Exit Interview/Briefing

(End of Summary of Changes)