W912BV23Q0083.pdf

SEE ADDENDUM

(No Collect Calls)

W912BV23Q0083 27-Jul-2023

b. TELEPHONE NUMBER

918.669.7277

8. OFFER DUE DATE/LOCAL TIME

10:00 AM 29 Aug 2023

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W912BV9. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

CHRISTOPHER T WRIGHT

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

0 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

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

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

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESSX

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

CONTRACTING DIV

US ARMY CORPS OF ENGINEERS, TULSA DISTRICT

2488 E. 81ST STREET

TULSA OK 74137-4290

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE 16. ADMINISTERED BY

SEE SCHEDULE

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

918-669-7436FAX:

TEL: SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$16,000,000

NAICS:

621111

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

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

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF62

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

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

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

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

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

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

W912BV23Q0083

Section A - Solicitation/Contract Form

INSTRUCTIONS TO OFFERORS

Instructions to Offerors

NEED HELP:

If you need assistance with SAM, NIST or preparing your quote, please contact your local Procurement Technical Assistance Center (PTAC). You may find your PTAC here: https://www.aptac-us.org/contracting-assistance/.

PREPARING YOUR QUOTE:

Your Quote shall consist of ONLY the following list of required items. Do NOT include cover pages, title pages, section page, graphics, company logos, etc. Information not required in this solicitation will not be evaluated:

1) Submit a signed copy of the first page of the solicitation

a. Complete block 17a with your name and telephone number

b. Enter your Unique Entity ID (UEI) in the box labeled “CODE”

c. Sign block 30a (digital signatures are accepted)

d. Complete block 30b

e. Complete block 30c

f. DO NOT SUBMIT A COPY OF THE SOLICITATION IN ITS ENTIRETY

2) Submit a signed copy of all amendments issued, if any. It is your responsibility to monitor SAM.gov for amendments.

a. Complete block 15A

b. Complete block 15B (digital signatures are accepted)

c. Complete block 15C

d. DO NOT SUBMIT A COPY OF THE AMENDMENT IN ITS ENTIRETY. Only pages that require a vendor response shall be submitted.

3) Provide resumes and proof of licensure for Key Personnel demonstrating qualifications in accordance with the PWS.

4) Complete the pricing schedule provided with the solicitation. All items in the pricing schedule must be completed, including optional items. All items must include a dollar value.

5) Complete the subcontractor data worksheet provided with the solicitation. Your quote must identify the business size and percentage of work to be completed by the prime contractor; and the business name, address, the percentage of work to be completed by the subcontractor. Offerors shall identify the business size of any subcontractors based on the NAICS code identified. Offerors must clearly identify whether a subcontractor(s) will be performing work, the percentage of work to be performed by each subcontractor, and the socio-economic category into which each identified subcontractor falls. (FAR 52.219-14

LIMITATIONS ON SUBCONTRACTING FOR SMALL BUSINESS (DEVIATION 2021-O0008) (OCT

2022). Offerors shall also provide a signed and dated Letter of Commitment from each subcontractor. The Subcontractor Letter of Commitment shall be signed by the subcontractor on the subcontractor’s own letterhead.

6) Complete the Representations and Certifications (Reps and Certs) in Section K, unless already completed and current in the System for Awards Management at https://sam.gov/. Notice: Failure to respond to provision 52.204-26 and, if applicable 52.204-24, will deem your offer non-responsive and un-awardable.

7) NOTE: This solicitation does NOT require offerors to provide Past Experience information. DO NOT include this information in your quote.

8) Complete the following Contractor Information Sheet and return it with your quote.

The following information is required with quote submission.

General Contact Information

Offeror’s Name:

Offeror’s Complete Physical Mailing Address:

Offeror’s Telephone Number:

Offeror’s Email Address:

Name of authorized signers for your company: ___________________________________________

Federal Taxpayer Identification (ID) No.:

Commercial and Government Entity (CAGE) Code: ___________________________________________

Unique Entity Identifier (UEI) (12-character): ___________________________________________

Is your company registered online in SAM (www.sam.gov)? YES NO

Has your SAM Registration been marked “Active”? YES NO

SAM Registration Expiration Date _________________

Are your Reps and Certs completed in SAM? YES NO

Have you provided a response to FAR 52.204-24 (NOV 2021) in SAM? YES NO

Have you provided a response to FAR 52.204-26 (OCT 2020) in SAM? YES NO

Offerors must have an active registration in SAM to be eligible for award.

In accordance with AFARS 5132.702(a)(ii)(B): Funds are not presently available for this acquisition. No contract will be awarded until appropriated funds are made available.

Quotes shall be valid through 30 days past the date quotes are due.

SUBMITTING YOUR QUOTE

MAIL, FAX, EMAIL or HAND DELIVER YOUR DOCUMENTS

Offerors shall limit their offer to include ONLY the required items listed in the Instructions to Offerors. Do not include excess information such as audio-visual materials, electronic media, CD’s, thumb drives, etc., or pages of the solicitation that do not contain information provided by the prospective offeror. As previously stated, ADDITIONAL INFORMATION WILL NOT BE EVALUATED. NO cross-outs or strike-through marks. Submit a legible quote with no correction marks.

EMAIL

Emailed quotes are the preferred method for submission.

Quotes must be received in a supported Adobe or Microsoft Office file format. Adobe or Microsoft Office file formats are the only acceptable methods of submitting a quote electronically.

a. Submit all required documents in one file. It may be helpful to reduce file sizes

b. Zip files are not recommended

c. DO NOT USE Cloud storage providers, google docs, web-based drop boxes, OneNote/OneDrive, URLs, web-based format, or any other virtual/web-based memory services are NOT acceptable methods of submitting a quote

d. Reference the solicitation number in the subject line

e. Send quotes to both of the following e-mail addresses:

Christopher.T.Wright@usace.army.mil CESWT‐CT‐SS‐Quotes@usace.army.mil

f. Ensure your quote is received before the due date and time. For your quote to be considered responsive, all required materials must be received before the due date and time. If all required materials are not received, your quote will not be considered. Do not assume that quotes sent by email will be delivered or received immediately after the offeror pushes “send.” Late emails will be analyzed in accordance with FAR 52.212-1(f)(2)(i) to determine if they can be accepted for evaluation. For the purpose of this solicitation, as it relates to email submissions, the term initial point of entry to the Government infrastructure is defined as the Army Server. For the purpose of this solicitation, as it relates to email submissions, the term Government Installation designated for the receipt of offers is defined as the USACE server.

FAX

Include a cover sheet that references the Contract Specialist – Christopher T. Wright and the solicitation number, W912BV23Q0083. Fax to Christopher.T.Wright@usace.army.mil or (918) 669-7436. After faxing document, please contact the contract specialist to confirm receipt.

MAIL

When submitting through mail, please notify the contract specialist and ensure you clearly address the envelope to:

U.S. Army Corps of Engineers, Tulsa District Christopher T. Wright, CESWT-CT-E 2488 E. 81st Street Tulsa, OK 74137-4290

Clearly mark the envelope in the lower left-hand corner with the solicitation number, W912BV23Q0083. All pages should be numbered. Use only 8 ½” x 11” paper for fax or mail submissions. Do not use foldouts (e.g., 11” x 14” or 11” x 17” sheets). Do not use a font size smaller than 10, or condensed print for any submission. Times New Roman or Arial Font are the only acceptable fonts. All page margins must be at least 1 inch wide but may include headers and footers. Illegible handwritten quotes will not be considered. Typed quotes are highly encouraged and the preferred method. Do not use spring clamps, staples, or exceed the recommended capacity of the fastener or binder.

Do not use plastic multi-hole/spiral binding systems, heat binding systems, or other systems which do not facilitate the ready insertion of additional pages or removal of pages. DO NOT use tabbed dividers, flagged tabs, or any divider that extends beyond the paper size to separate sections. The pages must be able to be removed from their binding without ripping or tearing. Ensure to allow enough time to submit your quote before the due date and time.

HAND DELIVER

If your submission will be hand-carried, please provide notification to the Contract Specialist, at least one working day in advance, by e-mailing Christopher.T.Wright@usace.army.mil as unescorted visitors are not allowed in the Contracting Division offices. Please consider that upon arrival, visitors must go through security check points on the 16th floor of the 20-story Building. Offerors can only submit their documents to a Contract Specialist or a Contracting Officer of the Tulsa District Office. The Tulsa District Office is in the 20-story building of the CityPlex towers, address below:

U.S. Army Corps of Engineers, Tulsa District 2488 E. 81st Street Tulsa, OK 74137-4290

INQUIRIES – OFFEROR’S QUESTIONS AND COMMENTS

USE OF BIDDER’S INQUIRY

Prospective offerors shall submit questions and inquiries related to this solicitation in accordance with the following (no other means of questions or inquiries will be answered except through Bidder Inquiry):

For information related to amendments, and the dates set for receipt of proposals, please check https://sam.gov/.

Contractual and Technical inquiries and questions relating to proposal procedures are to be submitted via Bidder Inquiry in ProjNet at https://www.projnet.org/projnet.

1. To submit and review bid inquiry items, offerors will need to be a current registered user or self‐ register into the system. To self‐register go to the aforementioned web page and click on the BID tab.

Select Bidder Inquiry, select agency USACE, and enter the Bidder Inquiry Key for this solicitation listed below, your e‐mail address, and then click login. Fill in all required information and click create user. Verify that information on next screen is correct and click continue.

2. From this page, you may view all bidder inquiries or add an inquiry.

3. Bidders will receive an acknowledgement of their question via e‐mail, followed by an answer to their question after it has been processed.

The Solicitation Number is: W912BV23Q0083

The Bidder Inquiry Key is: MVAS5V-FVUE9Y

The Bidder Inquiry System will be unavailable for new inquiries four (4) business days before the date quotes are due in order to ensure adequate time is allotted to form an appropriate response and amend the solicitation, if necessary.

4. Offerors are requested to review the specification in its entirety and review the Bidder Inquiry System for answers to questions prior to submission of a new inquiry.

5. The call center operates weekdays from 8AM to 5PM U.S. Central Time Zone (Chicago). The telephone number for the Call Center is 800‐428‐HELP.

6. Offers will NOT be publicly opened. Information concerning the status of the evaluation and/or award will NOT be available after receipt of proposals.

PRE-PROPOSAL/SITE VISIT CONFERENCE

A Pre-Proposal/Site Visit Conference is not scheduled for this action.

ANTITERRORISM AND OPERATIONS SECURITY REQUIREMENTS

The Government will provide the successful offeror with the required Army iWatch Antiterrorism Briefing documentation within two (2) business days of Contract Award.

Section B - Supplies or Services and Prices

PRICING SCHEDULE

MEDICAL SURVEILLANCE SERVICES (MEDSERV) USACE TULSA DISTRICT

Boxed marked with an 'X' do not require a response

BASE

YEAR

Provide a response for all blanks, including base and all option years

Pricing schedule includes base plus three option year periods

0001 Physical Examination Unit Unit Price Quantity

Total Price

0001a

Physical Examination performed by Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO).

Total price for Item 0001 is based on pricing for Item 0001a each 225

0001b Physical Examination performed by Nurse Practitioner X X X

0001c Physical Examination performed by Physician's Assistant X X X

Medical Officer (MO) Miscellaneous Consultation/Review (MD or DO) - 15 minutes each 104

Miscellaneous Consultation by Nurse Practitioner - 15 minutes each 40

Miscellaneous Consultation by Physician's Assistant - 15 minutes each 40

Hourly Rate for travel time (only when travel is required from Tulsa office to remote site) each 24

Travel paid in accordance with Joint Travel Regulation

IAW

JTR 1,000.00 1 1,000.00

Total Base Year (Items 0001-0006)

OPTION YEAR 1

Physical Examination (On-Site Occupational Health Clinic, Tulsa District Office) Unit

Unit Price Quantity

Total Price

1001a

Physical Examination performed by Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Total price for Item 0001 is based on pricing for Item 0001a each 225

1001b Physical Examination performed by Nurse Practitioner X X X

1001c Physical Examination performed by Physician's Assistant X X X

Miscellaneous Consultation/Review by Medical Officer (MD or DO) - 15 minutes each 104

Miscellaneous Consultation by NP - 15 minutes each 40

Miscellaneous Consultation by PA - 15 minutes each 40

Hourly Rate for travel time (only when travel is required from Tulsa office to remote site) each 24

Travel paid in accordance with Joint Travel Regulation

IAW

Total Option Year 1 (Items 1001-1006)

OPTION YEAR 2

Physical Examination (On-Site Occupational Health Clinic, Tulsa District Office) Unit

Unit Price Quantity

Total Price

2001a performed by Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Total price for Item 2001 is based on pricing for Item 2001a each 225

2001b performed by Nurse Practitioner X X X

2001c performed by Physician's Assistant X X X

Miscellaneous Consultation/Review by Medical Officer (MD or DO) -15 minutes each 104

Miscellaneous Consultation by NP - 15 minutes each 40

Miscellaneous Consultation by PA - 15 minutes each 40

Hourly Rate for travel time (only when travel is required from Tulsa office to remote site) each 24

Travel paid in accordance with Joint Travel Regulation

IAW

Total Option Year 2 (Items 2001-2006)

OPTION YEAR 3

Physical Examination (On-Site Occupational Health Clinic, Tulsa District Office) Unit

Unit Price Quantity

Total Price

3001a

Physical Examination performed by Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) Total price for Item 3001 is based on pricing for Item 3001a each 225

3001b Physical Examination performed by Nurse Practitioner X X X

3001c Physical Examination performed by Physician's Assistant X X X

Miscellaneous Consultation/Review by Medical Officer (MD or DO) -15 minutes each 104

Miscellaneous Consultation by NP - 15 minutes each 40

Miscellaneous Consultation by PA - 15 minutes each 40

Hourly Rate for travel time (only when travel is required from Tulsa office to remote site) each 24

Travel paid in accordance with Joint Travel Regulation

IAW

JTR 1,000.00 1 1,000.00

Total Option Year 3

TOTAL, BASE PLUS OPTIONS

Profit

SUBCONTRACTING WORKSHEET

SUBCONTRACTING INFORMATION:

Self-Performing:

Percentage of Work to be performed by the Offeror/Prime Contractor’s own forces:

Subcontractor(s) *** - if no subcontractor(s), write NONE:

Name of Subcontractor Address

Business Size based on NAICS Provided in the

Solicitation (Small or Large)

Socio-economic Category ***

Percentage of Work to be

Completed by Sub-

Contractor

***Socio-economic categories for some small businesses include:

Women-Owned Small Business (WOSB) Economically Disabled Women-Owned Small Business (EDWOSB) HUBZone 8(a) Service-Disabled Veteran-Owned Small Business (SDVOSB)

***Offerors using a subcontractor(s) shall provide a signed and dated Letter of Commitment from each subcontractor. Offerors who fail to provide a signed and dated Letter of Commitment from each subcontractor will not be considered for award.

Section C - Descriptions and Specifications

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT

Occupational Health Clinic Medical Surveillance Services Tulsa, OK

21 July 2023

INTRODUCTION

Offeror shall provide occupational health medical services as required for the U.S. Army Corps of Engineers (USACE) on-site Occupational Health Clinic (OHC) located in the Tulsa District (SWT) Office in Tulsa, Oklahoma as outlined in the following Performance Work Statement (PWS).

1. Applicable Publications and Other Pertinent Data

a. 29 CFR 1910, OSHA General Industry Standard

b. AR 40-5, Preventive Medicine (12 May 2020)

c. EM 385-1-1, Corps of Engineers Safety and Health Requirements Manual (30 November 2014 or latest version)

b. Public Law 104-191, Health Insurance Portability and Accountability Act of 1996.

c. ER 385-1-40, Occupational Health Program (20 September 2010)

d. ER 385-1-89, Corps of Engineers Hearing Conversation Program (15 October 2012).

e. ER 385-1-92, Safety and Occupational Health Requirements for Hazardous, Toxic, and Radioactive Waste (HTRW) Activities, (1 November 2018)

f. DoDI 6055.05-M Occupational Medical Examinations and Surveillance Manual (2 May2007, Changes 3, 31 August 2018)

g. AR 600-63, Army Health (14 April 2015).

h. U.S. Army Pamphlet (DA Pam) 40-11, Preventative Medicine (18 May 2020)

i. AR 40-66, Medical Records Administration and Healthcare Documentation (17June 2008), (RAR 4 January 2010)

2. SERVICE AREAS

Medical services are to be performed at Tulsa District (SWT) headquarters office located at 2488 E 81st Street Tulsa, Oklahoma 74137. Tulsa District (SWT) geographical footprint encompasses Kansas, Oklahoma, and Texas.

Travel throughout SWT may be included in this requirement (see section 15).

3. GENERAL

Services to be rendered by the Offeror include but are not limited to the following:

3.1.1 On-site physical examinations for medical surveillance, deployments, pre-placement, travel health, and Fitness for Duty.

3.1.2 Hearing Conservation Program oversight by audiologist or physician trained and experienced in industrial hearing conservation programs.

3.1.3 Automated External Defibrillator (AED) Program oversight.

3.1.4 Provide prescriptive authority and/or standing orders for SWT-OHC nurse.

3.1.5 Telephonic consultation as needed.

3.1.6 Management of medical service providers, if required, to assure services are delivered with quality and in an efficient manner thru adequate provision of trained personnel, supplies, and equipment.

4. PHYSICAL EXAMINATIONS

The USACE Occupational Health Program complies with Occupational Safety and Health Administration (OSHA), Department of Army, U.S. Army Corps of Engineers, and all applicable Federal and State regulations.

Pre-placement examinations are used to ensure that potential employees are fit for duty (e.g., Crane operator, Commercial Driver, U.S. Coast Guard, etc.) and to provide a baseline physical parameter for subsequent medical surveillance comparisons. Periodic physical examinations are utilized to ensure that employees can perform his or her assigned tasks, detect early signs of exposures to workplace hazards, and provide early detection of any physical conditions that could progress to stages resulting in medical disability. Physical examinations and evaluations are conducted prior to reassignment, retirement, resignation, transfer, or termination when employees have been enrolled in medical surveillance or specific Fitness for Duty exams.

4.1.1 Medical examinations typically consist of the following components with variations of regulations and Medical Officer mandates:

a. History and physical examination

b. Vision – Near and Far (Titmus Screening normally required)

c. Audiogram

d. EKG

e. Chest X-Ray – CXR (2 view with interpretation when indicated)

f. B-reader for CXR

g. Blood Chemistry Panel and CBC

h. Urinalysis

i. Pulmonary Function Test (baseline for respirator users)

j. Specific surveillance history (e.g., welding, respiratory, HTRW)

k. General physical assessment will include but not limited to evaluation of personal medical health, along with occupational work and health history. Physical examination including: HEENT, Heart and Lungs, Peripheral Vascular system, Abd, Hernia exam, Spine and Musculoskeletal system, Genitourinary system, Skin, and Nervous system. Prostate, testicular, and digital exam for males and breast exam for females are only performed for deployment exams.

l. The health care examiner shall review and evaluate all medical examinations, tests, and findings for completeness, accuracy, and indicate the need for any additional follow-up examinations to determine the employee's ability to meet the physical requirements of the job. The examiner shall note if abnormal findings are job or exposure related.

m. When job exposures are questionable and/or action levels are uncertain, the examiner shall request the SWT-OHC to coordinate workplace assessments by a USACE Industrial Hygienist to quantify exposure and exposure potential.

n. The examination results shall be discussed with the employee after the examination. The examining Health Care Provider shall note any duty restrictions or job limitations on the provided OH clearance form. The SWT-OHC nurse shall be contacted when duty clarification is needed. Employees with non-work-related health concerns are to be referred to their personal physician, dentist, or other community health resource.

4.1.2 Exit physical examinations and evaluations are conducted prior to reassignment, retirement, resignation, transfer, or termination when employees have been enrolled in medical surveillance or specific Fitness for Duty exams.

4.1.3 Return to work post-injury or illness Fitness for Duty exams may be required in specific incidents.

4.1.4 Physical Exams for Department of Transportation (DOT) – When an employee is required to have a Commercial Driver’s License (CDL), the examining health care provider shall be a Certified Medical Examiner (NRCME). All components of examination and testing shall be as prescribed by 49 CFR Parts 350, 383, 390, and 391 and meet certifications as required by the Federal Motor Carrier Safety Administration (FMCSA) physical qualification standard and guidelines. The examining health care provider shall document driver fitness determination on FMCSA Form MCSA-5875. The examining health care provider shall be certified by FMCSA, and Offeror shall provide proof of certification of such before award.

4.1.5 Physical Exams for Coast Guard License- When employee is required to have a Merchant Mariner Physical Examination, the examiner shall be a certified physician (M.D. or D.O.), or a Physician’s Assistant or Nurse Practitioner. All components of examination and testing shall be as prescribed by Navigation and Vessel Inspection Circular 04-08 (NVIC), Medical and Physical Evaluation Guidelines for Merchant Mariner Credentials. The examining health care provider (HCP) shall document physical evaluations on US Coast Guard Form CG- 719K in conjunction with NVIC 04-08.

4.1.6 Physical Exams for USACE Class I Crane Operators- When an employee is required to have a Crane Operator clearance, the clearance must be reviewed and co-signed by a Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.) stating that the operator has had a physical examination that meets USACE medical requirements when the direct examiner is a physician assistant or nurse practitioner.

5. MEDICAL SERVICES

5.1.1 The Offeror shall provide one physician who shall be either a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) licensed in the state of Oklahoma to serve as the SWT Medical Officer (MO) for oversight and consultation in coordination with the SWT-OHC nurse or another designee from SWT. The Medical Officer shall respond no later than the next business day following any inquiries, requests, or other correspondence from the SWT-OHC. The Medical Officer may perform her or his duties via telephone or email. Services will be billed according to the Medical Officer (MO) rate per examination. Services will not be required during any period when the location is closed, for example, during inclement weather or on a locally observed holiday. Federal Holidays are also excluded.

5.1.2 The Offeror shall provide an On-Site Healthcare Provider (OHP) who shall provide physical examinations for medical surveillance. The OHP can be either an M.D., D.O., Nurse Practitioner (N.P.), or Physician’s Assistant (P.A.) licensed in Oklahoma; however, as stated above, the MO must be an M.D. or a D.O. Whomever serves as the OHP will be paid at the rate listed in the pricing schedule (the pricing schedule includes space to indicate the offeror’s rates for the separate types of medical professionals. Scheduling will be as the need arises (PRN) when physical exams are scheduled and will be coordinated with the on-staff Registered Nurse or another designee from SWT. Services will not be required during any period when the location is closed, for example, during inclement weather or on a locally observed holiday. Federal Holidays are also excluded.

5.1.3 Medical Protocols. The Medical Officer (MO) shall provide or approve medical protocols for the SWT- OHC nurse. The SWT-OHC nurse is a full-time position and shall staff the OHC during normal duty hours regardless of the OHP presence. These protocols shall include but are not limited to injections, vaccines, over-the-counter medications, phlebotomies for specimens, EKGs, audiograms, pulmonary functions testing, applications of dressings, general first aid and response to emergencies. Protocols shall also include the use of emergency prescription medications (i.e., nitroglycerin, oxygen, EpiPen, etc.) and the use of Automated External Defibrillators (AEDs) by employees trained in their use.

5.1.4 Offeror shall provide verification of current CPR (cardiopulmonary resuscitation), BLS (Basic Life Support) and/or ACLS (Advanced Cardiovascular Life Support) for all physicians and health care providers included in the quote; and shall provide proof upon the Government’s request throughout the duration of the contract.

6. HEARING CONSERVATION

6.1.1 The Offeror shall provide an audiologist, otolaryngologist, or a licensed occupational health physician who is trained and experienced in hearing conservation to serve as the Audiometric Data Reviewing Official for medical oversight of the Hearing Conservation Program.

6.1.2 Medical oversight shall comply with Occupational Safety and Health Administration's (OSHA) Occupational Noise Exposure standard 29 CFR 1910.95, ER 385-1-89, DODI 6055, AR 40-5, DA Pam 40- 501, and DA Pam 40-11 and focuses on assuring compliance with appropriate regulations.

6.1.3 Audiometric testing is to be provided by a Council for Accreditation in Occupational Hearing Conservation (CAOHC) certified technician or audiologist.

6.1.4 The Audiometric Data Reviewing Official shall conduct a comparison of the baseline and subsequent audiograms to determination whether a Standard Threshold Shift have occurred and provide a baseline revision when indicated. The comparison will not utilize age adjustment factors. The report shall include a letter to the employee describing the results of his/her evaluation and a report showing the individual’s baseline audiogram in comparison to the current audiogram hearing threshold averages in the speech and high frequencies, as well as the average threshold at 2K, 3K, and 4K.

6.1.5 Timely reporting of Standard Threshold Shifts is essential to permit retesting of the employee within the 30- calendar daytime frame for retesting specified in USACE regulation.

6.1.6 The Audiometric Data Reviewing Official will determine the work-relatedness of the threshold shifts;

identify and communicate potential medical issues; make recommendations if further evaluation is necessary; and identify if the threshold shift meets OSHA 1904.10. If an employee's hearing test (audiogram) reveals that the employee has experienced a work-related Standard Threshold Shift (STS) in hearing in one or both ears, and the employee's total hearing level is 25 decibels (dB) or more above audiometric zero (averaged at 2000, 3000, and 4000 Hz) in the same ear(s) as the STS, the case shall be recorded on the OSHA 300 Log. A Standard Threshold Shift, or STS, is defined in the occupational noise exposure standard at 29 CFR 1910.95(g)(10)(i) as a change in hearing threshold, relative to the baseline audiogram for that employee, of an average of 10 decibels (dB)or more at 2000, 3000, and 4000 hertz (Hz) in one or both ears.

6.1.7 The Audiometric Data Reviewing Official shall review a minimum of 20% of the normal audiograms and all the threshold shift audiograms to ensure they meet OSHA/USACE audiogram standards.

6.1.8 The Audiometric Data Reviewing Official will be available for telephonic and/or email consultation with the SWT-OHC staff as needed.

6.1.9 Employees that experience a Standard Threshold Shift on the annual audiogram, shall be scheduled to see an Audiologist within 30 calendar days for a retest audiogram and audiological evaluation. The OHC will contact the Offeror for scheduling and protocol.

6.1.10 An annual summary report based on calendar year shall be provided to include an employee roster, the number of employees with normal audiograms, the numbers of OSHA standard threshold shifts, and number of OSHA recordable shifts.

6.1.11 Audiological evaluations shall determine and answer the following:

a. Is the hearing loss permanent?

b. Is the hearing loss noise related?

c. Is the hearing loss work related?

d. Is medical follow up indicated?

e. Is alternative hearing protection recommended?

f. Is employee allowed to return to work in hazardous noise areas with hearing protection?

7. BLOODBORNE PATHOGENS Program The Offeror shall provide support for the bloodborne pathogen program for employees who must meet the qualifications for their job requirements.

8. PHYSICIAN OVERSIGHT OF THE AUTOMATED EXTERNAL DEFIBRILLATOR (AED)PROGRAM

8.1.1 The Offeror shall provide AED program that will comply with all current established regulations which includes physician oversight.

8.1.2 The Offeror shall have the ability to provide this oversight, which includes the following:

a. Provide post cardiac event follow-up where AEDs are used. This involves reviewing the response documentation form, rescue data and the electrocardiograph tracing of the victim.

b. When an AED is employed, the post event summary data will be reviewed by the physician providing oversight. Physician will determine overall AED system performance and provide a report to include any recommendations needed within 14 calendar days of receipt of summary data.

c. Provide consultation in all aspects of the program.

d. Review AED program annually and update as needed.

e. Prescription for the AED (Class III Medical Device) for the SWT.

9. GENERAL CONSULTATION

9.1.1 The Offeror shall provide telephonic access to the Medical Officer (MO) for general consultation as needed for all medical-related issues.

9.1.2 The Medical Officer (MO) shall provide guidance to the SWT-OHC nurse, industrial hygienists, safety personnel, and employees in the event of emergency exposures.

9.1.3 Provide medical advice to safety and occupational health staff as needed for exposure determination.

9.1.4 Review specific medical surveillance examinations based on work related exposures.

9.1.5 The OHP shall review physicals performed by other health care providers when the District OHN requests clarification or recommendations on the employee’s ability to perform duties.

9.1.6 The OHP shall render guidance as needed to the OHNs for voluntary wellness physicals, medical surveillance and provide guidance on the formation of new medical policies and procedures.

9.1.7 Charges are to be based on the rate per unit of the physical examination in 15-minute increments.

10. GOVERNMENT PROVIDED EQUIPMENT AND RESOURCES

10.1.1. The government will provide nurse to staff the SWT-OHC and assist in the medical surveillance physical examinations and record keeping.

10.1.2 The SWT-OHC nurse will schedule physical examinations with government employees and will coordinate with Offeror the days and times physical examinations will occur.

10.1.3 The SWT-OHC will be a fully functional occupational health clinic and the government will provide the necessary medical and diagnostic equipment to perform medical surveillance examinations.

10.1.4 SWT-OHC will provide all medical consumables necessary for treatment, health promotions and examinations.

10.1.5 SWT-OHC will provide/procure laboratory services.

11. QUALIFICATIONS

11.1.1 A licensed and Board Eligible/Board Certified Doctor of Medicine or Osteopathy who, by virtue of education, specialized training, and experience, has acquired a minimum of five (5) years and is knowledgeable of regulations and resources relating to occupational medicine such as OSHA, NIOSH, DoD, DA and Occupational Medicine Practice Guidelines (ACOEM).

11.1.2 The Medical Officer (MO) who provides oversight shall be Board Certified in Occupational Medicine or be eligible for certification by the Board. The Medical Officer (MO) shall provide oversight of services and competency of professional staff. The Medical Officer shall be licensed by the state of Oklahoma.

11.1.3 The On-site Healthcare Provider (OHP) (this includes Certified Nurse Practitioners and Certified Physician Assistants) shall perform medical examinations and testing in accordance with this contract. If the On-Site Healthcare Provider is a Nurse Practitioner or Physician’s Assistant, they shall have been professionally employed in the practice of medicine for a minimum of three (3) years using their corresponding license. The On-site Healthcare Provider(s) shall be licensed by the state of Oklahoma.

11.1.4 To perform Commercial Driver License Exams the Occupational Healthcare Provider must be a registered and certified medical examiner with the Federal Motor Carrier Safety Administration.

11.1.5 Proof of medical liability insurance: The Contractor is required to ensure that its subcontractors, if any, for provisions of health care services, contain the requirements of clause 52.237-7, Indemnification and Medical Liability Insurance, including the maintenance of medical liability insurance. Indemnify the Government for any liability-producing act or omission by the Contractor, its employees, and agents occurring during contract performance.

11.1.6 Special Qualifications: The contractor shall ensure all employees possess all required licenses for operating medical surveillance services used in the performance of this contract. A copy of all the required licenses shall be provided to the COR 10 calendar days prior to performance. 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.)

12. MEDICAL RECORDS

12.1.1 All employee records are considered confidential and are maintained and kept on site at the SWT-OHC located in Tulsa, Oklahoma. All original medical records are the property of USACE.

12.1.2 All medical record keeping shall be in accordance with the following regulations:

a. Privacy Act Statement of 1974

b. Health Information Portability and Accountability Act, 1996

c. American Recovery and Reinvestment Act, 23 Sept 2009

d. 29 CFR 1910.1020. Access to Medical and Exposure Records

13. KEY PERSONNEL

13.1.1 Offeror shall notify the Government of any proposed personnel changes throughout the duration of the contract. The Government shall review and approve any personnel changes for the duration of the contract if any physician or other health care provider are to be replaced for any reason. No personnel changes shall occur without written approval by the Government. Offeror shall provide all necessary documentation for any replacement personnel for the Government’s review, including but not limited to the items outlined in section 13, or paragraphs

5.1.5 and 4.1.5, or any other location in this PWS or any applicable local, state, or federal laws, rules, or regulations.

14. ANTICIPATED REQUIRED SERVICES

14.1.1 The Government anticipates the need for the contractor to provide the following required services:

General Physicals Prescribed Burn Physicals Commercial Driver License Physicals Crane Class 1 Operator Physicals Fit for Duty Physicals Pre-employment/Post employment Physicals Audiology Review United States Coast Guard Physicals Physician – Occupational Medicine Consultant Medical Review Officer Miscellaneous Consulting Electrocardiogram Review Exit Physicals Respirator medical evaluation/Pulmonary Function Test Review Telephone Consultation Any Additional or Follow-up Occupational Health Related Examinations/Medical Laboratory Tests

15. CONTRACTOR TRAVEL

15.1.1 The contractor may be required to travel to site locations outside of the Tulsa District Office during the performance of this contract to complete the exams within the SWT district boundaries. The contractor will be authorized travel expenses consistent with the substantive provisions of the Joint Travel Regulation (JTR) and the limitation of funds specified in this contract. All travel requires COR recommendation for approval and/or authorization by the Government prior to travel arrangements being made.

15.1.2 The OHP will be paid at the travel rate listed in the pricing schedule. Travel will only be paid for drive time between the Tulsa District Office to the remote site and back. Travel is not paid for time at the remote clinic; exams performed at a remote site shall be charged at the same rate as the on-site exams. Travel is not paid for hours spent overnight.

16. ATOPSEC

16.1.1 The Contractor shall be responsible for ensuring all personnel, to include sub-contractor personnel, comply with the training requirements and procedures identified on the document titled “Antiterrorism/Operations Security Requirements” in Section H, Special Contract Requirements.

17. GOVERNMENT-FURNISHED PROPERTY

The OHP will use a Government-furnished computer for the performance of this requirement. The approved OHP personnel will be required to obtain a Common Access Card. Coordination of this requirement will be made after award.

18. INVOICING

18.1.1 This requirement includes on-site physical examinations and remote consultations.

18.1.2 The exact number of required exams and consultations is not known.

18.1.3 The estimates included in the pricing schedule do not in any way guarantee minimum amounts.

18.1.4 The pricing schedule includes an estimate of the amounts and may vary from year to year.

18.1.5 All services included in this requirement shall be invoiced according to actual services rendered.

18.1.6 Monthly invoices in the following format shall be submitted only for services that have been provided.

INVOICE: MEDICAL SURVEILLANCE SERVICES – USACE TULSA DISTRICT

CONTRACT NO: W912BV23P____ SHEET __ OF __

CONTRACTOR: _____________________ DATE: _____________

(As shown on contract award and must also match SAM registration)

ADDRESS: ________________________

BILLING PERIOD: ______ THRU _____ INVOICE NO: _________

PAYMENT TERMS: __________________________________

(Payment Discount or N/A)

ITEM NUMBER DESCRIPTION UNIT PRICE QUANTITY AMOUNT

INVOICE TOTAL: $ ___________

Authorized Signature

Section E - Inspection and Acceptance

CLAUSES INCORPORATED BY REFERENCE

52.246-1 Contractor Inspection Requirements APR 1984

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

52.242-15 Stop-Work Order AUG 1989

Section G - Contract Administration Data

252.201-7000 Contracting Officer's Representative DEC 1991 252.232-7003 Electronic Submission of Payment Requests and Receiving

Reports

DEC 2018

Section H - Special Contract Requirements

52.224-3

52.224-3 PRIVACY TRAINING (JAN 2017)

(a) Definition. As used in this clause, personally identifiable information means information that can be used to distinguish or trace an individual's identity, either alone or when combined with other information that is linked or linkable to a specific individual. (See Office of Management and Budget (OMB) Circular A-130, Managing Federal Information as a Strategic Resource).

(b) The Contractor shall ensure that initial privacy training, and annual privacy training thereafter, is completed by contractor employees who--

(1) Have access to a system of records;

(2) Create, collect, use, process, store, maintain, disseminate, disclose, dispose, or otherwise handle personally identifiable information on behalf of an agency; or

(3) Design, develop, maintain, or operate a system of records (see also FAR subpart 24.1 and 39.105).

(c)(1) Privacy training shall address the key elements necessary for ensuring the safeguarding of personally identifiable information or a system of records. The training shall be role-based, provide foundational as well as more advanced levels of training, and have measures in place to test the knowledge level of users. At a minimum, the privacy training shall cover--

(i) The provisions of the Privacy Act of 1974 (5 U.S.C. 552a), including penalties for violations of the Act;

(ii) The appropriate handling and safeguarding of personally identifiable information;

(iii) The authorized and official use of a system of records or any other personally identifiable information;

(iv) The restriction on the use of unauthorized equipment to create, collect, use, process, store, maintain, disseminate, disclose, dispose or otherwise access personally identifiable information;

(v) The prohibition against the unauthorized use of a system of records or unauthorized disclosure, access, handling, or use of personally identifiable information; and

(vi) The procedures to be followed in the event of a suspected or confirmed breach of a system of records or the unauthorized disclosure, access, handling, or use of personally identifiable information (see OMB guidance for Preparing for and Responding to a Breach of Personally Identifiable Information).

(2) Completion of an agency-developed or agency-conducted training course shall be deemed to satisfy these elements.

(d) The Contractor shall maintain and, upon request, provide documentation of completion of privacy training to the Contracting Officer.

(e) The Contractor shall not allow any employee access to a system of records, or permit any employee to create, collect, use, process, store, maintain, disseminate, disclose, dispose or otherwise handle personally identifiable information, or to design, develop, maintain, or operate a system of records unless the employee has completed privacy training, as required by this clause.

(f) The substance of this clause, including this paragraph (f), shall be included in all subcontracts under this contract, when subcontractor employees will--

(1) Have access to a system of records;

(2) Create, collect, use, process, store, maintain, disseminate, disclose, dispose, or otherwise handle personally identifiable information; or

(3) Design, develop, maintain, or operate a system of records.

(End of clause)

CLAUSES INCORPORATED BY FULL TEXT

ANTITERRORISM/OPERATIONS SECURITY REQUIREMENTS, MAY 2022

The Contractor shall comply with the following requirements marked with an “X”.

X

1. General security requirements and guidance: The security requirements described below apply to all contract personnel (including employees of the prime Contractor ("Contractor") and all subcontractor employees) supporting the performance requirements of this contract. The Contractor is responsible for compliance with these security requirements. Questions regarding security matters shall be addressed to the designated Government representative (e.g., Contracting Officer Representative (COR), Requiring Activity (RA) representative, or Contracting Officer (if a COR or other RA representative is not appointed)). Contract personnel are critical to the overall security and safety of US Army Corps of Engineers (USACE) installations. facilities and activities. and security awareness training contributes to those efforts. The Department of Defense (DoD) and Army security training requirements specified below, if applicable, are performance requirements; all applicable contract personnel shall complete initial training within 30 days of contract award or the date new contract personnel begin performance on the contract. Within five business days from the completion of training, the Contractor shall provide written documentation (e.g., email or memorandum) to the Government representative. The documentation shall include the names of contract personnel trained and which training they completed; the Contractor shall maintain training records as part of their contract files and be prepared to provide copies of training certificates to the Government representative. Contractor personnel and vehicles are subject to search when entering federal installations. Additionally, all contract personnel shall comply with Force Protection Condition (FPCON) measures, Random Antiterrorism Measures (commonly referred to as "RAMs"), and Health Protection Condition (HPCON) measures. The Contractor is responsible for meeting performance requirements during elevated FPCON and/or HPCON levels in accordance with applicable RA plans and procedures --this includes identifying mission essential and non-mission essential personnel. In addition to the changes otherwise authorized by the changes clause of this contract.

should the FPCON or HPCON levels at any individual facility or installation change, the Government may implement security changes that affect contract personnel. The Contractor shall ensure all contract personnel are aware of their security responsibilities, including any site-specific requirements identified in local policies or procedures.

2. Antiterrorism (AT) Level I training: All contract personnel requiring routine access to Army installations, facilities. and controlled access areas, or requiring network access shall complete initial and annual refresher AT Level I awareness training. Online AT Level I awareness training is available at https://jko.jten.mil/ (website subject to change).

3. Physical security and access control requirements: All contract personnel requiring physical access to a federal installation or facility shall comply with the access control procedures of that location.

Contract personnel requiring unescorted access to meet contract performance requirements on a DoD installation in the US shall be vetted by the installation/facility Provost Marshal/Directorate of Emergency Services/Security Office using the National Crime Information Center-Interstate Identification Index (commonly referred to as "NCIC-I11") and Terrorist Screening Database (commonly referred…