PERFORMANCE WORK STATEMENT 2024.docx

PERFORMANCE WORK STATEMENT (PWS)

FOR

Occupational Medical Surveillance Examination Services

1.0 General:

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform Occupational Medical Surveillance Examination Program Services, as defined in this PWS.

1.1.1 Objectives The purpose of the Occupational Medical Surveillance Examination Program is to provide job-related Occupational Health Examinations and Medical Surveillance Services to approximately 180 NVARNG Federal Technician full-time support (FTS) and/or temporary personnel who are exposed to OSHA level PEL health hazards in the work environment. The examination shall include personnel assigned to positions requiring specific standards of physical fitness. Personnel not included under these examinations are State Employees, civilian contractors, Active Guard Reserve, Active Duty for Operational Support (ADOS) and part-time traditional Soldiers.

1.2 Background: This contract is for “Non-Personal” Health Care “Services”, as defined in 37.101. In accordance with FAR Part 37.4 the Government may enter into a non-personal health care services contract with physicians, dentists and other health care providers under authority of 10 U.S.C. 2304 and 41 U.S.C. 253.

1.3 Period of Performance (PoP): The anticipated basic PoP is from 01 August 2024 through 31 July 2025 with an option to extend services in 12-month periods. The total of the basic and any option periods exercised shall not exceed 4 years.

1.4 General Information:

1.4.1 Place and Performance of Services: Contractor must maintain a facility within the 50 mile radius of Reno Nevada and of Las Vegas Nevada (meaning at least one facility in each location) that provides Occupational Health Exams. On-site mobile exam unit(s) must be able to service Las Vegas, Nevada and the Stead, NV facilities. Mobile services must be able to provide hearing testing, spirometry, respirator fit testing and phlebotomy. In case all personnel are not able to attend the onsite events (or require a repeat exam), having local facilities to provide exams is required.

1.4.1.1 Telework: Not Applicable.

1.4.1.2 Reserved.

1.4.1.3 Reserved.

1.4.2 Recognized Holidays: The following are recognized United States (US) holidays. The contractor will not be requested to perform services on these days:

1.4.3.1 New Year’s Day: January 1st

1.4.3.2 Martin Luther King, Jr.’s Birthday

1.4.3.3 President’s Day

1.4.3.4 Memorial Day

1.4.3.5 Juneteenth

1.4.3.6 Independence Day: July 4th

1.4.3.7 Labor Day

1.4.3.8 Columbus Day

1.4.3.9 Veteran’s Day: November 11th

1.4.3.10 Thanksgiving Day

1.4.3.11 Christmas Day: December 25th

1.4.3 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in Technical Exhibit 1, Performance Requirements Summary (PRS). A final QCP shall be submitted to the Contracting Officer Technical Representative (COTR) NLT 10 days after contract award. After acceptance of the QCP, the contractor shall obtain the Contracting Officer’s (KO’s) acceptance in writing of any proposed changes to its QCP.

1.4.4 Quality Assurance (QA): The Government will evaluate the contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan (QASP). This plan is primarily focused on what the Government will do to ensure that the contractor has performed in accordance with the performance standards. It defines how the performance standards will be applied, the frequency of surveillance, and acceptable quality level(s) or defect rate(s).

1.4.5 Reserved.

1.4.5.1.3 Reserved.

1.4.5.1.4 Reserved.

1.4.5.1.5.1 Reserved.

1.4.5.1.6 Reserved.

1.4.5.5 Reserved.

1.4.5.6 Reserved.

1.4.5.6.1 Reserved.

1.4.5.6.2 Reserved.

1.4.5.6.3 Reserved.

1.4.5.6.4 Reserved.

1.4.5.6.5 Reserved.

1.4.5.7 Reserved.

1.4.5.10 Protection of Personally Identifiable Information (PII). The contractor shall protect all PII encountered in the performance of services in accordance with Defense Federal Acquisition Regulation Supplement (DFARS) 224.103 Personally Identifiable Information and Department of Defense Directive (DoDD) 5400.11, Department of Defense Privacy Program, and DoD 5400.11-R. If a PII breach results from the contractor’s violation of the aforementioned policies, the contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals whose PII has been compromised.

1.4.5.11 Reserved.

1.4.6 Reserved.

1.4.7 Special Qualifications: The contractor shall ensure all employees possess all required licenses for OHSA Occupational Health Exams. This does not include education or other qualifications for the position in which the contractor employee is performing, dress codes, or other information. (NOTE: The Government does not provide training to contractors. Contractors must ensure that any personnel performing under a contract are fully trained, licensed, certified, and otherwise qualified to provide services.)

1.4.8 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with FAR 42.5. The KO, COR and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the KO will apprise the contractor of how the Government views the contractor’s performance and the contractor shall apprise the Government of problems, if any, being experienced. The contractor shall resolve outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

1.4.9 Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO. The CM or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM shall work through the COTR, CPT Brian Bullian (775) 887-7336, to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

1.4.11. Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. The contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at FAR 22.17.

1.4.13 Data Rights: The Government has unlimited rights to all documents/materials produced under this contract. All documents and materials, to include the source codes of any software, produced under this contract shall be Government owned and are the property of the Government with all rights and privileges of ownership/copyright belonging exclusively to the Government. These documents and materials may not be used or sold by the contractor without written permission from the KO. All materials supplied to the Government shall be the sole property of the Government and may not be used for any other purpose. This right does not abrogate any other Government rights.

1.4.14 Reserved.

2.0 Definitions and Acronyms:

2.1 Definitions:

2.1.1 Contractor: A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.

2.1.2 Defective Service: A service output that does not meet the standard of performance associated with the PWS.

2.1.3 Deliverable: Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.1.4 Key Personnel: Not Applicable.

2.1.5 Physical Security: Actions that prevent the loss or damage of Government property.

2.1.6 Quality Assurance: The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.7 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.8 Quality Control: All necessary measures taken by the Contractor to ensure that the quality of an end product or service shall meet contract requirements.

2.1.9 Subcontractor: One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.2 Acronyms:

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S): The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:

3.1 Property: None

3.2 Materials: None

3.3 Equipment: None

3.4 Services: None

3.5 Utilities: None

4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1.

5.0 Requirements: The contractor shall:

5.1 The contractor shall provide the following Medical Surveillance Examinations to NVARNG federal employees that are exposed to toxic workplace hazards: baseline exams, periodic health exams and termination exams. The contractor shall be in the primary business of, or have an agreement with an entity that is in the primary business of, conducting Occupational Health Exams at a facility within a 50 mile radius of Reno Nevada, and at a facility within a 50 mile radius of Las Vegas Nevada. The contractor shall be compliant with HIPAA, Privacy Act, OSHA & ADA.

5.2 Provide the following physical exam types:

Occupational Health Audiogram, Vision, Occupational Health Full Physical Exam (H&P) for approximately: 180 personnel.

Motor Vehicle Operator Medical Certification Exam for approximately: 4 personnel.

5.2.1 Provide additional exams and laboratory tests as required:

Electrocardiogram (EKG): estimated exams 0

Spirometry: estimated exams 34

Respirator Fit Testing: estimated exams 30

FOH Profile including: Lipid panel, Bili (direct), GGT, LD, ALT, glucose, BUN, creat, GFR, BUN/creat ratio, Na, K, Cl, Ca, total protein, albumin, globulin, albumin/globulin ratio, bili (total), Alk Phos, AST, (CBC with diff & plt), UA: estimated exams 5

Lead, industrial whole blood: estimated exams 4

ZPP, Blood Protoporphyrins, zinc: estimated exams 4

6.0 Applicable Publications: Publications applicable to this PWS are listed below:

Publication (Chapter/Page)

Federal Acquisition Regulation https://www.acquisition.gov/?q=browsefar

Defense Federal Acquisition Regulation Supplement http://www.acq.osd.mil/dpap/dars/dfarspgi/current/index.html or https://www.acquisition.gov/dfars

Joint Travel Regulation (JTR) https://www.defensetravel.dod.mil/site/travelreg.cfm

DoDM 1000.13-M-V1 DoD Identification (ID) Cards (Enclosure 2, paragraph 3.b) 01/23/2014 (Change 1: 07/28/2020) http://www.esd.whs.mil/Directives/issuances/dodm

Federal Information Processing Standards (FIPS) Publication 201-2 Personal Identity Verification (PIV) of Federal Employees and Contractors (paragraph 9) August 2013 http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.201-2.pdf

https://www.esd.whs.mil/Directives/issuances/dodm/

DoDI 5200.46 DoD Investigative and Adjudicative Guidance for Issuing the Common Access Card (CAC) 09/09/14 (Change 1: 05/04/2018) https://www.esd.whs.mil/Directives/issuances/dodi/

Homeland Security Presidential Directive (HSPD)-12 Policy for a Common Identification Standard for Federal Employees and Contractors 08/27/2004 https://www.dhs.gov/homeland-security-presidential-directive-12

DoDI 5400.11 Department of Defense Privacy and Civil Liberties Programs 01/29/2019 https://www.esd.whs.mil/Directives/issuances/dodi/

DoD 5400.11-R Department of Defense Privacy Program 05/14/2007 https://www.esd.whs.mil/Directives/issuances/dodm/

DoDD 8140.01 Cyberspace Workforce Management

10/05/2020 https://www.esd.whs.mil/Directives/issuances/dodd/

DoD 8570.01-M Information Assurance Workforce Improvement Program 12/19/2005 (Change 4: 11/10/2015) https://www.esd.whs.mil/Directives/issuances/dodm/

DoD 5220.22-M National Industrial Security Program Operating Manual (NISPOM) 02/28/2006 (Change 2: 05/18/2016) https://www.esd.whs.mil/Directives/issuances/dodm/

Army Directive 2014-05 Policy and Implementation Procedures for Common Access Card Credentialing and Installation Access for Uncleared Contractors 03/07/2014 https://armypubs.army.mil/ProductMaps/PubForm/ArmyDir.aspx

AR 25-2

Information Assurance 04/04/2019 http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx

AR 530-1

Operations Security 09/26/2014 http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx

AR 525-13

Antiterrorism 12/09/2019 http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx

AR 381-12

Threat Awareness and Reporting Program (TARP) (Section II, ¶ 2-4.b) 06/01/2016 http://armypubs.army.mil/ProductMaps/PubForm/AR.aspx

https://www.osha.gov/laws-regs/regulations/standardnumber/1910

https://www.osha.gov/laws-regs/regulations/standardnumber/1960

https://www.osha.gov/annotated-pels

https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=1006800

(Change 3: 08/31/2018) https://phc.amedd.army.mil/topics/workplacehealth/ih/Pages/Regulations-and-Policy.aspx

https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.120

https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=67365

https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=68571

https://armypubs.army.mil/ProductMaps/PubForm/Details.aspx?PUB_ID=78813

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6.1 Applicable Forms: Forms applicable to the PWS are listed below:

DD 1172-2

Application for Identification Card/DEERS Enrollment

I-9 Employment Eligibility Verification 10/21/2019 https://www.uscis.gov/sites/default/files/files/form/i-9.pdf

DD 441

Department of Defense Security Agreement Feb 2020 http://www.dtic.mil/whs/directives/forms/dd/ddforms0001-0499.htm

DD 250

Material Inspection and Receiving Report

QUALITY ASSURANCE WORKSHEET

Below

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)

This PRS includes performance objectives the Government will use to determine contractor performance and will compare contractor performance to the Acceptable Quality Level (AQL).

@ all sites specified 100%

TECHNICAL EXHIBIT 2

Deliverables Schedule

TECHNICAL EXHIBIT 3

Estimated Workload Data

This information is provided for historical background only. It is not a guarantee of workload quantities.

Ver. January 2021