W912JV-18-Q-2001.pdf

SEE ADDENDUM

(No Collect Calls)

W912JV-18-Q-2001 03-Aug-2018

b. TELEPHONE NUMBER

503-584-3763

8. OFFER DUE DATE/LOCAL TIME

12:00 AM 31 Aug 2018

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.

W912JV9. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

BRIAN JOHNSON

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

PHAFY18

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

USPFO FOR OREGON - CONTRACTING OFFICE

ATTN: USPFO-P

PO BOX 14350

1776 MILITIA WAY

SALEM OR 97309-5047

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 W90KNA 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

MED CMD

MAJ JOEL HAWLEY

15300 SE MINUTEMAN WAY

CLACKAMAS OR 97015-9150

TEL: 503-584-2285 FAX:

503-584-3771FAX:

TEL: 503-584-3929 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$11,000,000

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 OF84

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.

W912JV-18-Q-2001

Section B - Supplies or Services and Prices

ITEM NO SUPPLIES/SERVICES MAX

QUANTITY

UNIT UNIT PRICE MAX AMOUNT

0001 1 Job Base Year-PHA Support Services

FFP

1. Description: Perform services as requested per IDIQ task order per the Performance Work Statement located in Section C.

2. Period of Performance: 01SEPT18- 31AUG19

FOB: Destination

PURCHASE REQUEST NUMBER: PHAFY18

PSC CD: Q403

MAX

NET AMT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0002 1 Each Manpower Reporting

FFP

Complete the manpower reporting requirements in accordance with section 5.6 of the performance work statement in section C.

Unit Identification Code (UIC) for the Requiring Activity: W8BAAA FOB: Destination

UNIT UNIT PRICE MAX AMOUNT

1001 1 Job OPTION Option Year 1- PHA Support Services

FFP

1. Description: Perform services as requested per IDIQ task order per the

2. Period of Performance: 01SEPT19- 31AUG20

1002 1 Each OPTION Manpower Reporting

FFP

Complete the manpower reporting requirements in accordance with section 5.6 of the performance work statement in section C.

Unit Identification Code (UIC) for the Requiring Activity: W8BAAA FOB: Destination

UNIT UNIT PRICE MAX AMOUNT

2001 1 Job OPTION Option Year 2- PHA Support Services

FFP

1. Description: Perform services as requested per IDIQ task order per the

2. Period of Performance: 01SEPT20- 31AUG21

2002 1 Each OPTION Manpower Reporting

FFP

Complete the manpower reporting requirements in accordance with section 5.6 of the performance work statement in section C.

Unit Identification Code (UIC) for the Requiring Activity: W8BAAA FOB: Destination

UNIT UNIT PRICE MAX AMOUNT

3001 1 Job OPTION Option Year 3-PHA Support Services

FFP

1. Description: Perform services as requested per IDIQ task order per the

2. Period of Performance: 01SEPT21- 31AUG22

3002 1 Each OPTION Manpower Reporting

FFP

Complete the manpower reporting requirements in accordance with section 5.6 of the performance work statement in section C.

Unit Identification Code (UIC) for the Requiring Activity: W8BAAA FOB: Destination

Section C - Descriptions and Specifications

PERFORMANCE WORK STATEMENT

Medical Assessment Services

In Support of Individual Medical Readiness (IMR) And

Fully Medically Ready (FMR), Periodic Health Assessment (PHA), Soldier Readiness Check (SRC), Soldier Readiness Processing (SRP), and

Mobilization Support

PART 1

GENERAL INFORMATION

1. General Information:

1. General: This is a non-personal services indefinite delivery indefinitie quanitity contract to provide annual medical and hearing assessment services. The Government shall not exercise any supervision or control over the contract service providers performing the services herein. Such contract service providers shall be accountable solely to the Contractor who, in turn is responsible to the Government.

1.1. Description of Services/Introduction: The Contractor shall provide all personnel, equipment, supplies, facilities, transportation, tools, materials, supervision, and other items and services necessary to perform annual hearing and medical assessment services as defined in this Performance Work Statement except for those items specified as Government furnished property. The Contractor shall perform to the standards in this contract.

1.2. Background: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the basic principles of force-sustainment for Army National Guard (ARNG) forces. Medical health is vital for force health protection, and failure to achieve a standard of level of medical health could preclude a Soldier from deploying. Medical Readiness is a command responsibility. The purpose of this Performance Work Statement (PWS) is to cover the various components of IMR/FMR, to include, questionnaire screening, Periodic Health Assessments (PHAs, in accordance with Army Regulation (AR) 40-501, Standards of Medical Fitness Defense Occupations and Environmental Health Readiness System (DOEHRS) direct computer upload compatible audiometry exams, comprehensive audio evaluations, and SPRINT testing completion of the electronic PHA in the Medical Protection System (MEDPROS) online module during an event by providers trained in completing the e-PHA online

1.3. Objectives: The purpose is to convert all Soldiers due or identified as needing annual medical, hearing

1.4. Scope: The objective of this contract is to conduct and complete the requirements of ARNG IMR/FMR medical and hearing. On all eligible (mobilizing or not) Service Members (SMs) in the ARNG utilizing Health Insurance Portability and Accountability Act (HIPAA), Americans with Disability Act (ADA) and Occupational Safety and Health Administration (OSHA)-Compliant Contractor set up in Oregon National Guard Facilities or mobile health facilities. Medical services shall be performed by Oregon licensed professionals. The Contractor shall be held liable and are responsible for ensuring and verifying the appropriate level of Credentialing /Privileging (Licensure, Diploma, background checks, etc.) for all contract providers in support of ARNG.

1.5. General Information

1.5.1. Quality Control: The Contractor shall provide a preliminary Quality Control Plan (QCP) with their proposal.

The level of detail, management controls, and processes to ensure responsiveness to corrective actions will be used in evaluating potential Contractors. The QCP shall include a detailed discussion of the steps proposed to ensure quality, adherence to schedule, proactive communication and adherence to budget. The QCP shall include a description of corrective action steps to take should the Contractor performance be substandard. An organizational depiction of the project team and chain(s)-of-command shall also be included in the QCP. The QCP shall be submitted as part of the proposal.

1.5.2. Quality Assurance: The Government shall evaluate the Contractor’s performance under this contract in accordance with the Quality Assurance Surveillance Plan. This plan is primarily focused on what the Government must 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 the minimum acceptable defect rate(s).

1.5.3. Hours of Operation: The Contractor is responsible for providing services at the time and location as specified in the exhibits. The exhibits indicate the number of soldiers, services to be provided, location, dates and times. The Contractor must at all times maintain an adequate workforce for the uninterrupted performance of all tasks defined within this PWS.

1.5.4. Place of Performance: The work to be performed under this contract will be performed at government facility or site. Conditions may occasionally be austere and the Contractor must be able to perform all the tasks defined in the PWS in a stand-alone environment. Contractor travel will be the sole responsibility of the Contractor and should be included in the price schedule for services. Possible locations are Salem, Clackamas, Bend, Pendleton, Medford and La Grande Oregon. Up to two locations may be active at any given time.

1.5.5. Security Requirements: Contractors performing work under this contract must maintain a list of all personnel performing services at event for access on government and military facilities.

1.5.6. Anti-Terrorism (AT)/Operational Security (OPSEC): Contractors require level I OPSEC training and know the Oregon National Guard Critical Information List (CIL) IAW AR 530-1. Applicability statement: Contractors must comply with contractually imposed operations security requirements. Also, if Contractors have access to government information they are required to follow the same requirements for protection of sensitive, unclassified government information per Joint Ethics Regulation and Public Law. Contracts that Require OPSEC Training. Per AR 530-1, Operations Security, new Contractor employees must complete Level I OPSEC training within 30 calendar days of their reporting for duty. All Contractor employees must complete annual OPSEC awareness training.

1.5.7. AT Level 1 Awareness Training (AT): Security Requirements. The Contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the Contracting Officer’s Representative (COR). The Contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of Emergency Services or Security Office. The Contractor shall ensure compliance with all personal identity verification requirements as directed by Department of Defense (DOD), Headquarters Department of the Army (HQDA) and/or local policy. Should the Force Protection Condition (FPCON) change, the Government may require changes in Contractor security matters or processes.

1.5.8. AT Level I Training. All Contractor employees, to include subcontractor employees, requiring access Army installations, facilities and controlled access areas shall complete AT Level I awareness training within 30 calendar days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. The Contractor shall submit certificates of completion for each affected Contractor employee and subcontractor employee, to the COR or to the Contracting Officer, if a COR is not assigned, within 30 calendar days after completion of training by all employees and subcontractor personnel. AT level I awareness training is available at the following website: https://atlevel1.dtic.mil/at.

1.5.9. iWATCH Training. The Contractor and all associated sub-contractors shall brief all employees on the local iWATCH program (training standards provided by the requiring activity ATO). This local developed training will be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR. This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance with the results reported to the COR NLT 5 calendar days after contract award.

1.5.10. Pre‐screen candidates using E‐Verify Program. The Contractor must pre‐screen Candidates using the E‐ Verify Program (http://www.dhs.gov/E‐Verify) website to meet the established employment eligibility requirements.

The vendor must ensure that the candidate has two valid forms of Government issued identification prior to entering the correct information into the E‐Verify system. An initial list of verified/eligible candidates must be provided to the COR no later than 3 business days after the initial contract award. When contracts are with individuals, the individuals will be required to complete a Form I‐9, Employment Eligibility Verification, with the designated Government representative. This Form will be provided to the Contracting Officer and shall become part of the official contract file.

1.5.11. Protection of Personally Identifiable Information (PII). The Contractor shall protect all PII encountered in the performance of services in accordance with DFARS 224.103 and 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 who’s PII has been compromised.

1.5.12. Common Access Card (CAC) Requirements: The CAC is the DoD Federal Personal Identity Verification credential. In accordance with Directive Type Memorandum (DTM) 08-003, December 1, 2008, incorporating Change 5, October 8, 2013, Initial issuance of a CAC requires at a minimum, the completion of FBI fingerprint check with favorable results reflecting "No Record" and submission of a National Agency Check with Inquiries (NACI) to the Office of Personnel Management (OPM), or a DoD-determined equivalent investigation. The issuance of a CAC will be based on four criteria; (a) eligibility for a CAC; (b) verification of DoD affiliation from an authoritative data source; (c) completion of background vetting requirements according to the Federal Information Processing Standards Publication 201-1, Personal Identity Verification of Federal Employees and Contractors, March 2006, and DoD Regulation 5200.2-R, Department of Defense Personnel Security Program, January 1987, and (d) verification of a claimed identity. CAC eligible personnel must be registered in the Defense Enrollment Eligibility Reporting System (DEERS) through either an authoritative personnel data feed from the appropriate Service or Agency or Trusted Associate Sponsorship System (TASS).

1.5.12.1. HSPD-12 Background Investigation Requirements: The Contractor will ensure CACs are obtained by all contract or subcontract personnel assigned to work on the Government site and by personnel requiring access to a DoD network (and other eligible populations as specified in DTM-08-003 Attachment 3, paragraph 3a.) are required to, at a minimum, have received a favorable FBI fingerprint check and must have submitted to the OPM a NACI or equivalent/higher investigation. It is the responsibility of the Contractor to ensure all employees requiring an initial background investigation complete a Personnel Security Investigation Portal (PSIP) form at the earliest possible date and that this form is forwarded to the COR immediately. The COR will review the form for completeness and accuracy and forward to the National Guard Bureau Personnel Security manager who will initiate the investigation process via the PSIP. Contractor personnel will then receive two e-mail messages; the first will confirm the request has been received by the Office of Personnel Management, and the second will provide instructions for the completion of the appropriate form via the Electronic Questionnaires for Investigations Processing (e-QIP) system.

Upon completion of the e-QIP questionnaire and submittal of all required documents, including fingerprint card to the security manager, the BI will be initiated. The Contractor shall ensure all instructions regarding background investigation processing, including those provided verbally, by e-mail or via a Government system are complied with immediately. The Contractor is cautioned the entire process from submittal of the PSIP form to return of the FBI fingerprint check may routinely take from 2-6 weeks and shall factor this lead time into its hiring/placement process. The Contractor shall make all reasonable efforts to ensure Contractor employees meet CAC eligibility standards upon assignment to the contract and shall be held responsible for delays, failure to meet performance requirements or decreases in efficiency in accordance with the applicable inspection clause.

1.5.12.2. Trusted Associate Sponsorship System (TASS): The Contractor is responsible for processing applications for CACs for every Contractor employee who deploys with the military force OR who has need to access any government computer network in accordance with FAR 52.204-9, "Personal Identity Verification of Contractor Personnel." The Contractor is responsible for managing requests for new or renewal CAC cards in sufficient time to ensure all Contractor employees have them when needed to perform work under this contract. The norm is at least ten calendar days advance notice to the Trusted Agent (TA), unless there are extenuating circumstances approved by the COR or KO. It is recommend a "Corporate Facility Security Officer" (FSO) be designated to serve as your firm's single point of contact for Background Investigation (BI), the TASS application process and other CAC and security related matters. If a FSO is not established, each Contractor employee requiring a CAC will be required to process their own applications. CAC applications shall be processed through the TASS. The Contractor's FSO Or Contractor employee shall submit requests for a CAC via email to the designated TASS TA before accessing the TASS website. The TASS TA for this requirement will be: The government will establish a TASS application account for each CAC Request and will provide each Contractor employee a USER ID and Password, via email, to the FSO. The FSO or Contractor employee shall access the TASS account and complete the CAC application (entering/editing Contractor information as applicable) https://www.dmdc.osd.mil/tass/.

The FSO or Contractor employee will submit completed applications in TASS and will follow up to ensure the TA is processing the request. A CAC cannot be issued without evidence the FSO has initiated a NACI. The government will inform the Contractor's applicant, via email, of one of the following: Approved.* Upon approval, the information is transferred to the Defense Enrollment Eligibility Reporting System (DEERS) database and an email notification is sent to the Contractor with instructions on obtaining their CAC. The Contractor proceeds to a Real- Time Automated Personnel Identification System (RAPIDS) station (RAPIDS Site Locator:

http://www.dmdc.osd.mil/rsl/). Rejected.* The Government, in separate correspondence, will provide reason(s) for rejection. Returned. Additional information or correction to the application required by the Contractor employee.*The Contractor shall maintain records of all approved and rejected applications. At the RAPIDS station, the RAPIDS Verification Officer will verify the Contractor by SSN and two forms of identification. Identity source Documents must come from the list of acceptable documents included in Form I-9, OMB No. 115-0136, "Employment Eligibility Verification." Consistent with applicable law, at least one document from the Form I-9 list shall be a valid (unexpired) State or Federal Government-issued picture identification (ID). The Identity documents will be inspected for authenticity and scanned and stored in the DEERS upon issuance of an ID. The photo ID requirement cannot be waived, consistent with applicable statutory requirements. The Verification Officer will capture primary and alternate fingerprints, picture, and updates to DEERS and will then issue a CAC. Issued CACs shall be for a period of performance not longer than three (3) years or the individual's contract end date (inclusive of any options), whichever is earlier. The Contractor shall return issued CAC's to the COR/KO office upon departure or dismissal of each Contractor employee. Obtain a receipt for each card.

1.5.12.3. The Contractor shall register with Army Knowledge Online (AKO) each Contractor employee, including subcontractors, who may be require logical access to a government website, application or network. This can be done by going to: http://www.us.army.mil and register as an "Army Guest," with the sponsor being the COR or a COR designated individual if the COR is ineligible to Serve as an AKO Sponsor. Note: If an employee of a Contractor loses the Privilege to access AKO, they lose the ability to renew their CAC. Therefore it is critical Contractor employees maintain their AKO accounts.

1.5.13. Credentialing and Insurance: The Contractor is responsible for providing the credentialing service to document that medical personnel meet the standards directed by Army Regulation (AR) 40-68. Further, Contractors are required to provide proof of Professional Liability Insurance for all Medical Personnel supporting clinical requirements. Non-clinical personnel may be covered by the Contractor’s General Liability Insurance Policy.

1.5.14. PHYSICAL Security: The Contractor shall be responsible for safeguarding all Government information for Contractor use. At the close of each work period, Government facilities, equipment, and materials shall be secured.

Contractor will be responsible for security of equipment and material uses to complete the PWS.

1.5.15. Special Qualifications: HIPAA Training, access and familiarization to Medical Operational Data System (MODS), Medical Electronic Data (for) Care History and Readiness Tracking (MEDCHART) and DOEHRS databases.

1.5.16. Post Award Conference/Periodic Progress Meetings: The Contractor shall attend any post award conference convened by the contracting activity or contract administration office in accordance with Federal Acquisition Regulation Subpart 42.5. The Contracting Officer, COR, and other Government personnel, as appropriate, may meet periodically with the Contractor to review the Contractor's performance. At these meetings the Contracting Officer or COR will apprise the Contractor of how the Government views the Contractor's performance and the Contractor will apprise the Government of problems, if any, being experienced. Appropriate action shall be taken to resolve outstanding issues. These meetings shall be at no additional cost to the Government.

1.5.17. Key Personnel: The Contractor shall provide personnel qualified, certified and/or licensed in the State services are to be provided in depending on the task order . The follow personnel are considered key personnel by the Government:

1.5.17.1. Contract Manager: The Contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the Contractor when the manager is absent shall be designated in writing to the Contracting Officer. The contract manager or alternate shall have full authority to act for the Contractor on all contract matters relating to daily operation of this contract. The contract manager or alternate shall be available between the dates/times specified in the task order. Within 48 hours of any event, the Contract Manager will contact the COR to confirm number of contract providers that will be supporting the event.

1.5.17.2. Physician (General and Family Practice):

Years of experience in specialty: minimum 1 year practice experience Minimum education: Possess MD or DO from accredited school Certification/License: active unrestricted state medical license Advanced Cardiovascular Life Support (ACLS): preferred Basic Cardiac Life Support (BCLS): preferred.

1.5.17.4. Audiologist:

Years of experience in specialty: minimum 1 year practice experience Minimum education: possess MA or AuD from accredited school Certification/License: active/unrestricted state licensure required ACLS: preferred BCLS: preferred.

1.5.17.5. Physician’s Assistant:

Years of Experience in Specialty: minimum 1 year experience Minimum education: master’s level degree and accredited PA program Certification/License: licensure required for state employment BCLS: preferred.

1.5.17.7. Nurse Practitioner:

Years of Experience in Specialty: minimum 1 year experience Minimum education: MSN or Advanced Certification Certification/License: required for state employment ACLS: preferred BCLS: required for state employment.

1.5.17.10. Hearing Conservationist:

Years of experience in specialty: minimum 1 year experience Minimum education: DOEHRS Certified Certification: required.

1.5.18. Identification of Contractor Employees: All contract personnel attending meetings, answering Government telephones, and working in other situations where their Contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression in the minds of members of the public that they are Government officials. They must also ensure that all documents or reports produced by Contractors are suitably marked as Contractor products or that Contractor participation is appropriately disclosed

PART 2

DEFINITIONS & ACRONYMS

2. Definitions & 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. CONTRACTING OFFICER. A person with authority to enter into, administer, and or terminate contracts, and make related determinations and findings on behalf of the Government. Note: The only individual who can legally bind the Government.

2.1.3. CONTRACTING OFFICER’S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the Contracting Officer to administer the contract. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract.

2.1.4. DEFECTIVE SERVICE. A service output that does not meet the standard of performance associated with the Performance Work Statement.

2.1.5. DELIVERABLE. Anything that can be physically delivered, but may include non-manufactured things such as meeting minutes or reports.

2.1.6. KEY PERSONNEL. Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the Key Personnel listed in the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.7. PHYSICAL SECURITY. Actions that prevent the loss or damage of Government property.

2.1.8. QUALITY ASSURANCE. The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.9. QUALITY ASSURANCE Surveillance Plan (QASP). An organized written document specifying the surveillance methodology to be used for surveillance of Contractor performance.

2.1.10. QUALITY CONTROL. All necessary measures taken by the Contractor to assure that the quality of an end product or service shall meet contract requirements.

2.1.11. SUBCONTRACTOR. One that enters into a contract with a prime Contractor. The Government does not have privities of contract with the subcontractor.

2.1.12. WORK DAY. The number of hours per day the Contractor provides services in accordance with the contract.

2.2. ACRONYMS:

ADCS Army Dental Care System ADA American Dental Association ADDR Active Duty Dental Repository ALARACTS All Army Activities ACOR Alternate Contracting Officer’s Representative

AFARS Army Federal Acquisition Regulation Supplement AR Army Regulation ARNG Army National Guard CAC Common Access Card CLIA Clinical Laboratory Improvement Amendments CCE Contracting Center of Excellence CFR Code of Federal Regulations CONUS Continental United States (excludes Alaska and Hawaii) COR Contracting Officer Representative ’COTS Commercial-Off-the-Shelf DA Department of the Army DD250 Department of Defense Form 250 (Receiving Report) DD254 Department of Defense Contract Security Requirement List DENCLASS Dental Classification Application DENCOM Dental Command DFARS Defense Federal Acquisition Regulation Supplement DMDC Defense Manpower Data Center DOD Department of Defense DNA Deoxyribonucleic Acid DOEHRS Defense Occupations and Environmental Health Readiness System DRC Dental Readiness Classification DRE Digital Rectal Exam DTR Dental Treatment Record FAR Federal Acquisition Regulation FMR Fully Medically Ready G6PD Glucose – 6 – Phosphate Dehydrogenate HCG Human Chorionic Gonadotropin HIPAA Health Insurance Portability and Accountability Act of 1996 HIV Human Immunodeficiency Virus HRR Health Readiness Record IAW In Accordance With IMR Individual Medical Readiness ISO Isolation KO Contracting Officer MEB Medical Evaluation Board MEDCOM U.S. Army Medical Command MEDCHART Medical Electronic Data (for) Care History and Readiness Tracking MEDPROS Medical Protection System MMRB Medical MOS Retention Board MND Medical Non-deployment Module MWDE MEDPROS Wed Data Entry MODS Medical Operational Data System MOS Military Occupational Specialty MRC Medical Readiness Classification NGB National Guard Bureau OCI Organizational Conflict of Interest OCONUS Outside Continental United States (includes Alaska and Hawaii) ODC Other Direct Costs ORARNG Oregon Army National Guard OSS Office of the State Surgeon OSHA Occupational Safety and Health Administration PDHRA Post Deployment Health Reassessment PEB Physical Evaluation Board PHA Periodic Health Assessment PIPO Phase In/Phase Out

POC Point of Contact PPD Tuberculosis/Tuberculin Skin Test PPE Personal Protective Equipment PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QAP Quality Assurance Program QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program RDA Registered Dental Assistant RPR Rapid Plasma Reagin SPRINT Speech in Noise Recognition Test SRC Soldier Readiness Check SRP Soldier Readiness Processing STR Soldier Treatment Record SOW Statement of Work TE Technical Exhibit TITMUS Vision Testing Equipment Manufacturer’s Name TMC Troop Medical Clinic

PART 3

GOVERNMENT FURNISHED PROPERTY, EQUIPMENT, MATERIALS AND SERVICES

3. Government Furnished:

3.1. Facilities: The Government will coordinate the availability of work space as necessary for the contactor. A government representative will be designated to provide the Contractor access and to secure the facility at the conclusion of each day. Parking will be provided for mobile facilities. No armory, troop medical clinic, or office space will be provided or utilized unless prior approval is received from the Office of the State Surgeon.

3.2. Equipment: The Government will not provide equipment.

3.3. Materials

3.4. Services: The Government will provide a pre-event point of contact to coordinate services, an on-site POC to coordinate entry to the facility and assist with providing access to government provided tables, chairs, and spaces to be used when applicable. The Government will also be responsible for packaging and shipping of lab work and/or specimens.

3.5. Utilities: If utilities are furnished the Contractor shall instruct employees in utilities conservation and environmental practices. Trash and hazmat disposal are not provided. Utilities to include water and electricity are not provided for mobile facilities. The Contractor shall be responsible for operating under conditions that preclude the waste of utilities which include turning off the water faucets or valves after using the required amount to accomplish cleaning vehicles and equipment.

PART 4

CONTRACTOR FURNISHED PROPERTY, EQUIPMENT, AND MATERIALS

4. Contractor Furnished:

4.1. General: The Contractor shall furnish all supplies, equipment, facilities and services required to perform work under this contract that are not listed under Section 3 of this PWS. Service operations shall meet all OSHA, HIPPA and Privacy Act standards.

4.2. Property: Generally when mobile facilities are required only parking for those facilities will be available.

4.3. Equipment:

4.3.1. The Contractor shall furnish medical equipment to provide the services to meet the requirements under this

PWS.

4.3.2. The Contractor shall have the capability to meet the requirements either with or without government facility space.

4.3.3. Setup of Contractor’s equipment is to be completed by 17:00 hours the day prior to event commencement.

Setup of Contractor’s equipment is the sole responsibility of the Contractor. Breakdown of the Contractor’s equipment is the sole responsibility of the Contractor.

4.3.4. The Contractor must have capability for real-time, point of service Dental Classification Application (DENCLASS), MEDPROS and DOEHRS upload. This requires Contractor to have high-speed broadband, bar-code scanning capability and CAC enabled staff.

4.4. Materials: The Contractor shall furnish medical service materials and supplies necessary to meet the requirements under this PWS and which are not listed under Section 3 of this PWS.

PART 5

CONTRACTOR SPECIFIC TASKS & REQUIREMENTS

5. Specific Tasks and Requirements:

5.1. General Requirements:

5.1.1. The Contractor shall provide services for Individual Medical Readiness IAW with AR 40-501 and DoDI 6025.19.

5.1.2. As required, provide timely feedback and work progress/ status of number of examinations completed to the Office of the State Surgeon's POC (or designated representative) as to timelines or factors that may negatively impact processing the required number of Soldier exams in the number of days allowed for the event.

5.1.3. Contractor must notify the Office of the State Surgeon's POC (or designated representative) at the end of the event.

5.1.4. Contractor shall be licensed on any services rendered and equipment operated during mission.

5.1.5. The Contractor shall be prepared to provide services as indicated in the exhibits.

5.2. Medical Services:

5.2.1. Periodic Health Assessments (PHA): The Contractor shall conduct PHAs in accordance with the PHA guidance set forth by AR 40-501. Contractors must have the ability to complete the applicable MEDPROs module during the event. The Contractor must utilize either OSHA-Compliant Mobile Health Practices and/or sites determined by the ARNG. Compliance with OSHA, State & Federal Regulations is mandatory.

5.2.2. Post Deployment Health Re-Assessments (PDHRA): The Contractor shall conduct PDHRAs in accordance with AR 40-501. The Contractor must utilize sites determined by the ORARNG. Compliance with OSHA, State & Federal Regulations is mandatory.

5.2.3. Periodic Health Assessments and Physical Exams: The Contractor shall conduct PHA and other physical exams (Over-40, Chapter 2, Flight, etc.) in accordance with AR 40-501. The Contractor shall conduct physicals in an HIPAA, Privacy Act and/or OSHA Compliant facility to include visual acuity (Snellan/near vision), American National Standards Institute (ANSI) certified and DOEHRS compatible audiometer, on-site laboratory testing for lipids, glucose, urinalysis, human chorionic gonadotropin (HCG), titer and hemoglobin, a complete physical exam by certified clinician, tonometry, and vital signs, DOEHRS, and Health Readiness Record (HRR) input. All professionals shall be licensed and adhere to all requirements of OSHA, State & Federal Regulations is mandatory.

Any counseling conducted during the PHA provider interview will be documented on the electronic PHA survey and on Government provided forms such as a SF 600.

5.2.4. Temporary and Permanent Profiles: Licensed provider(s) will identify the recommended Temporary and Permanent Profiles (T2 and T3, P2 and P3) and submit supporting documentation to the Office of the State Surgeon or designated representative. Contractor will ensure any profiles are seen and processed by ORARNG credentialed providers. If no credentialed provider is available, Contractor will consult with the Office of the State Surgeon and coordinate as advised.

5.2.5. Audiometric Testing: Portable testing is not approved. Mobile testing is allowed if the trailer has individual double or single walled booths per each audiometer or a double walled booth with eight audiometers on one side, and the audiologist has a separate booth to themselves, i.e. an office space between them. All audiometers will be the DoD approved Benson Audiometers.

All testing shall use the Defense Occupational and Environmental Health Readiness System Hearing Conservation (DOEHRS-HC), per AR 40-501 and use real time uploading. If there is a significant threshold shift (STS) the certified DOEHRS specialist will determine if the Soldier is to be educated and needs to sign a DD2216. If the Soldier is H2 or an H3 the DOEHRS specialist will then send the Soldier to the Audiologist.

When a Soldier becomes an H2 they must see the Audiologist. The audiologist will be prepared to perform the following tests:

1. Pure tone air conduction

2. Pure tone bone

3. Conduction

4. Speech reception thresholds

5. Speech discrimination results

6. Acoustic immittance testing, including acoustic reflex measurements,

7. Masking, when indicated

8. Otoacoustic emissions (OAE) if applicable If the Soldier becomes an H3 they receive all of the above testing in addition to the Speech Recognition in Noise Test (SPRINT) using the new 100 word test in accordance with DA PAM 40-501.

At the end of each business day the DOEHRS specialist will run an H2/H3 report and give it to the ORARNG representative.

5.2.6. Follow-On Prescription Services: Contractor shall provide for any appropriate prescription medication or local follow-on services at no cost to the state for any Soldier issues directly related to services performed at an event by the Contractor. These will be addressed on a case by case basis between the Contractor, the Contracting Officer Representative, the Contracting Officer and the ORARNG.

5.2.12. PHA Screening:

5.3. Place of Performance: The place of performance is indicated in each Task Order. No more than two events will be active at any given time.

5.4. Administrative: The Contractor shall ensure that all appropriate DA, DD or SF forms (in accordance with references) are utilized for each service supplied. The forms will be made available through the State Medical or Detachment office. The Contractor shall provide all documentation concerning medical treatment to the

ORARNG.

5.5. Reporting of Services

5.5.1. Event Summary Report will include at a minimum the total number of Soldiers that had a focused physical exam that was annotated on an SF 600, and the roster of a Soldiers that had a routine screening hearing exam. This report is due to the COR within 5 business days of the event.

5.6. Contractor Manpower Reporting (CMR)

5.6.1. The Contractor shall report ALL Contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the National Guard Bureau via a secure data collection site.

5.6.2. The Contractor shall completely fill in all required data fields using the following web address:

http://www.ecmra.mil/. Reporting inputs shall be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the FY, all data shall be reported no later than October 31 of each calendar year, beginning with 2013.

Contractors may direct questions to the help desk at http://www.ecmra.mil

PART 6

APPLICABLE PUBLICATIONS

6. Applicable Publications (Current Editions)

6.1. The Contractor must abide by all applicable regulations, publications, manuals, and local policies and procedures.

AR 40-501 (Standards of Medical Fitness) http://www.usapa.army.mil AR 40-66 (Medical Record Administration and Health Care Documentation) http://www.usapa.army.mil AR 40-562 (Immunizations and Chemoprophylaxis) http://www.usapa.army.mil DoDI 6025.19 (Individual Medical Readiness) http://www.dtic.mil/whs/directives/corres/ Applicable DOD Directives, Instructions, and Publications http://www.dtic.mil/whs/directives/corres/ Applicable Medical & Dental ALARACTS https://www.us.army.mil/suite/page/550282 Applicable MILPER Messages https://perscomnd04.army.mil/milpermsgs.nsf

PART 7

APPENDICES

A. Performance Requirements Summary

B. Deliverables Schedule

APPENDIX A

Performance Requirements Summary

The Contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

The Contractor service requirements are summarized into performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimum acceptable levels of service required for each requirement. These thresholds are critical to mission success.

Performance Objective:

Standard Performance Threshold Method of Surveillance

PRS # 1: Contractor shall have a medical provider sign all ePHA for each Service Member. (paragraph 5.2.3)

Each Service Members' ePHA will be signed at the event.

Zero deviation from standard.

A PHA report will be run using the MEDPROS taskforce created for each event.

PRS # 2: Contactor shall update vision, vitals, height, and weight.

(paragraph 5.2.3)

All SF 600s with vision, vitals, height, weight, and lab results will be updated on the ePHA at the event

Zero deviation from standard.

State Surgeon's Staff or Case Management/Care Coordinators will review Service Members Records using the MEDPROS taskforce and HRR

PRS# 3: Contract shall document and upload hearing exams and Sprint Test results.(paragraph 5.2.5)

All hearing exam will be automatically uploaded in DOEHRS at the event

Zero deviation from standard.

State Surgeon's Staff or Case Management/Care Coordinators will review Service Members Records using the MEDPROS taskforce and HRR

APPENDIX B

DELIVERABLES SCHEDULE

Deliverable Frequency # of Copies Medium/Format Submit To

5.5.1 Contractor

will provide at the conclusion of onsite services a report summary of all screening hearing exams provided

One report will be generated at the conclusion of the event after all services are complete.

1 Digital copy for the State Surgeon's Representative within 5 business days of event.

Digital or Paper Copies

Contracting Officer Representative

5.2.4 Contractor

will provide a copy of each Individual Service Member's Standard Form 600 when they receive a focused examination for profiling medical

Per Individual Service Member

2 copies of the Standard Form 600 and Department of Army Form 3349 will be generated

Paper Copy One Copy will be provided to the individual Service Member and the Second will be for the States Surgeon's Office

5.6 Contractor will

log into ECMRA to report contractor manpower hours worked during the POP of this contract.

Once during the POP, but reported no later than October 31 of each calendar year

N/A Digital. See Paragraph 5.6 for hyperlink and website instructions.

ECMRA

Section D - Packaging and Marking

CONTRACT MINIMUM/MAXIMUM QUANTITY AND CONTRACT VALUE

The minimum quantity and contract value for all orders issued against this contract shall not be less than the minimum quantity and contract value stated in the following table. The maximum quantity and contract value for all orders issued against this contract shall not exceed the maximum quantity and contract value stated in the following table.

MINIMUM

QUANTITY

MINIMUM

AMOUNT

MAXIMUM

QUANTITY

MAXIMUM

AMOUNT

$2,500.00 $1,700,000.00

CLIN MINIMUM/MAXIMUM QUANTITY AND CLIN VALUE

The minimum quantity(s) and CLIN value(s) for all orders issued against the CLIN(s) on this contract shall not be less than the minimum quantity(s) and CLIN value(s) stated in the following table. The maximum quantity(s) and CLIN value(s) for all orders issued against the CLIN(s) on this contract shall not exceed the maximum quantity(s) and CLIN value(s) stated in the following table.

CLIN

MINIMUM

QUANTITY

MINIMUM

AMOUNT

MAXIMUM

QUANTITY

MAXIMUM

AMOUNT

0001 1.00 200.00 1001 1.00 200.00 2001 1.00 200.00 3001 1.00 200.00

CLIN DELIVERY/TASK ORDER MINIMUM/MAXIMUM QUANTITY AND CLIN ORDER VALUE

The minimum quantity and order value for the given Delivery/Task Order issued for this CLIN shall not be less than the minimum quantity and order value stated in the following table. The maximum quantity and order value for the given Delivery/Task Order issued for this CLIN shall not exceed the maximum quantity and order value stated in the following table.

CLIN

MINIMUM

QUANTITY

MINIMUM

AMOUNT

MAXIMUM

QUANTITY

MAXIMUM

AMOUNT

$2,500.00

$75,000.00

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government 0002 Destination Government Destination Government 1001 Destination Government Destination Government 1002 Destination Government Destination Government 2001 Destination Government Destination Government 2002 Destination Government Destination Government 3001 Destination Government Destination Government 3002 Destination Government Destination Government

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

0001 POP 01-SEP-2018 TO

31-AUG-2019

N/A MED CMD

MAJ JOEL HAWLEY

15300 SE MINUTEMAN WAY

CLACKAMAS OR 97015-9150

503-584-2285

W90KNA

0002 POP 01-SEP-2018 TO

31-AUG-2019

N/A (SAME AS PREVIOUS LOCATION)

1001 POP 01-SEP-2019 TO

31-AUG-2020

N/A (SAME AS PREVIOUS LOCATION)

1002 POP 01-SEP-2019 TO

31-AUG-2020

N/A (SAME AS PREVIOUS LOCATION)

2001 POP 01-SEP-2020 TO

31-AUG-2021

N/A (SAME AS PREVIOUS LOCATION)

2002 POP 01-SEP-2020 TO

31-AUG-2021

N/A (SAME AS PREVIOUS LOCATION)

3001 POP 01-SEP-2021 TO

31-AUG-2022

N/A (SAME AS PREVIOUS LOCATION)

3002 POP 01-SEP-2021 TO

31-AUG-2022

N/A (SAME AS PREVIOUS LOCATION)

Section G - Contract Administration Data

Section I - Contract Clauses

CLAUSES INCORPORATED BY REFERENCE

52.203-3 Gratuities APR 1984 52.203-6 Alt I Restrictions On Subcontractor Sales To The Government

(Sep 2006) -- Alternate I

OCT 1995

52.203-13 Contractor Code of Business Ethics and Conduct APR 2010 52.204-4 Printed or Copied Double-Sided on Postconsumer Fiber

Content Paper

MAY 2011

52.204-7 System for Award Management OCT 2016 52.204-9 Personal Identity Verification of Contractor Personnel JAN 2011 52.204-10 Reporting Executive Compensation and First-Tier

Subcontract Awards

AUG 2012

52.204-13 System for Award Management Maintenance OCT 2016 52.204-18 Commercial and Government Entity Code Maintenance JUL 2016 52.204-21 Basic Safeguarding of Covered Contractor Information

Systems

JUN 2016

52.204-23 Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities.

JUL 2018

52.209-6 Protecting the Government's Interest When Subcontracting With Contractors Debarred, Suspended, or Proposed for Debarment

DEC 2010

52.209-10 Prohibition on Contracting With Inverted Domestic Corporations

NOV 2015

52.212-4 Contract Terms and Conditions--Commercial Items FEB 2012 52.217-5 Evaluation Of Options JUL 1990 52.219-6 Notice Of Total Small Business Set-Aside NOV 2011 52.219-8 Utilization of Small Business Concerns JAN 2011 52.222-3 Convict Labor JUN 2003 52.222-19 Child Labor -- Cooperation with Authorities and Remedies MAR…