W912LR-15-P-0046_MEDICAL_PROVIDER.pdf

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Attached to: MDEICAL PROVIDER
Solicitation number: W912LR-15-P-0046
Issued by: Department of the Army Puerto Rico Army National Guard

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SEE ADDENDUM

(No Collect Calls)

W912LR-15-T-0046 11-Sep-2015

b. TELEPHONE NUMBER

787-277-7697

8. OFFER DUE DATE/LOCAL TIME

02:00 PM 18 Sep 2015

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.

W912LR9. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

ANGEL MARTINEZ

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

0010714734

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 BUSINESS

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

USPFO FOR PUERTO RICO

P.O. BOX 34069

FT BUCHANAN PR 00934-4069

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 W56SCX 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

W8ZV PR ARNG MED DET

SSG WILLIAM BAUTISTA

CAMP STGO TNG SITE

ARRILLAGA ST BLDG 587

SALINAS PR 00751

TEL: (787) 824-7454 FAX:

787 277-7659FAX:

TEL: 787 277-7657 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$10,000,000

NAICS:

621111

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 OF21

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.

W912LR-15-T-0046

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Job

ADMIN MEDICAL PROVIDER CONTRACT

FFP

The contractor shall provide Administrative Assistant Support Services to the Puerto Rico National Guard. The Contractor shall serve as the medical administrative provider and liaison between the chain of command and the chain of concern, providing assistance to Soldiers with all aspects of medical readiness and mobilization as detailed in the attached Performance Work Statement. Point of contact SFC Armando Flores (787) 824-7454, armando.floresgarcia.mil@mail.mil FOB: Destination

PURCHASE REQUEST NUMBER: 0010714734

NET AMT

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

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0001 POP 28-SEP-2015 TO

27-SEP-2016

N/A W8ZV PR ARNG MED DET

SSG WILLIAM BAUTISTA

CAMP STGO TNG SITE

ARRILLAGA ST BLDG 587

SALINAS PR 00751

(787) 824-7454 FOB: Destination

W56SCX

CLAUSES INCORPORATED BY REFERENCE

52.212-1 Instructions to Offerors--Commercial Items APR 2014 52.212-3 Offeror Representations and Certification--Commercial Items MAR 2015 52.219-28 Post-Award Small Business Program Rerepresentation JUL 2013 52.219-30 Notice of Set-Aside for Women-Owned Small Business

Concerns Eligible Under the Women-Owned Small Business Program

JUL 2013

52.222-1 Notice To The Government Of Labor Disputes FEB 1997 52.222-18 Certification Regarding Knowledge of Child Labor for Listed

End Products

FEB 2001

52.222-50 Combating Trafficking in Persons MAR 2015 52.222-56 Certification Regarding Trafficking in Persons Compliance

Plan.

MAR 2015

52.223-6 Drug-Free Workplace MAY 2001 52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

AUG 2011

52.232-9 Limitation On Withholding Of Payments APR 1984 52.237-3 Continuity Of Services JAN 1991 52.242-15 Stop-Work Order AUG 1989 52.252-4 Alterations in Contract APR 1984 252.204-7012 Safeguarding of Unclassified Controlled Technical

Information

NOV 2013

252.232-7003 Electronic Submission of Payment Requests and Receiving Reports

JUN 2012

252.239-7001 Information Assurance Contractor Training and Certification JAN 2008 252.244-7000 Subcontracts for Commercial Items JUN 2013

CLAUSES INCORPORATED BY FULL TEXT

52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND CERTIFICATIONS (DEC

2014)

The Contractor's representations and certifications, including those completed electronically via the System for Award Management (SAM), are incorporated by reference into the contract.

(End of clause)

52.212-2 EVALUATION--COMMERCIAL ITEMS (OCT 2014)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

Lowest price that can conform with solicitation performace work statement.

(b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

(c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of provision)

52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR

EXECUTIVE ORDERS--COMMERCIAL ITEMS (MAY 2015)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items:

(1) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (Dec 2014)

(2) 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

(3) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Public Laws 108-77 and 108-78 (19 U.S.C. 3805 note)).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (Contracting Officer check as appropriate.)

___ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 4704 and 10 U.S.C. 2402).

XXX (2) 52.203-13, Contractor Code of Business Ethics and Conduct (Apr 2010) (41 U.S.C. 3509).

(3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (June 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.)

___ (4) 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (July 2013) (Pub. L. 109-

282) (31 U.S.C. 6101 note).

___ (5) [Reserved]

___ (6) 52.204-14, Service Contract Reporting Requirements (JAN 2014) (Pub. L. 111-117, section 743 of Div. C).

XXX (7) 52.204-15, Service Contract Reporting Requirements for Indefinite-Delivery Contracts (JAN 2014) (Pub.

L. 111-117, section 743 of Div. C).

___ (8) 52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (Aug, 2013) (31 U.S.C. 6101 note).

____ (9) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (July 2013) (41 U.S.C. 2313).

____ (10) [Reserved]

____ (11)(i) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (NOV 2011) (15 U.S.C. 657a).

____ (ii) Alternate I (NOV 2011) of 52.219-3.

____ (12) (i) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (OCT 2014) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a).

____ (ii) Alternate I (JAN 2011) of 52.219-4.

____ (13) [Reserved]

XXX (14)(i) 52.219-6, Notice of Total Small Business Set-Aside (NOV 2011) (15 U.S.C. 644).

____ (ii) Alternate I (NOV 2011).

____ (iii) Alternate II (NOV 2011).

____ (15)(i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644).

____ (ii) Alternate I (Oct 1995) of 52.219-7.

____ (iii) Alternate II (Mar 2004) of 52.219-7.

XXX (16) 52.219-8, Utilization of Small Business Concerns (OCT 2014) (15 U.S.C. 637(d)(2) and (3)).

____ (17)(i) 52.219-9, Small Business Subcontracting Plan (OCT 2014) (15 U.S.C. 637(d)(4)).

____ (ii) Alternate I (Oct 2001) of 52.219-9.

____ (iii) Alternate II (Oct 2001) of 52.219-9.

____ (iv) Alternate III (OCT 2014) of 52.219-9.

XXX (18) 52.219-13, Notice of Set-Aside of Orders (NOV 2011) (15 U.S.C. 644(r)).

____ (19) 52.219-14, Limitations on Subcontracting (NOV 2011) (15 U.S.C. 637(a)(14)).

____ (20) 52.219-16, Liquidated Damages—Subcon-tracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)).

____ (21) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (NOV 2011) (15 U.S.C.

657f).

XXX (22) 52.219-28, Post Award Small Business Program Rerepresentation (July 2013) (15 U.S.C. 632(a)(2)).

____ (23) 52.219-29, Notice of Set-Aside for Economically Disadvantaged Women-Owned Small Business (EDWOSB) Concerns (July 2013) (15 U.S.C. 637(m)).

XXX (24) 52.219-30, Notice of Set-Aside for Women-Owned Small Business (WOSB) Concerns Eligible Under the WOSB Program (July 2013) (15 U.S.C. 637(m)).

XXX (25) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

XXX (26) 52.222-19, Child Labor—Cooperation with Authorities and Remedies (JAN 2014) (E.O. 3126).

XXX (27) 52.222-21, Prohibition of Segregated Facilities (Apr 2015).

XXX (28) 52.222-26, Equal Opportunity (Apr 2015) (E.O. 11246).

____ (29) 52.222-35, Equal Opportunity for Veterans (Jul 2014)(38 U.S.C. 4212).

____ (30) 52.222-36, Equal Opportunity for Workers with Disabilities (July 2014) (29 U.S.C. 793).

____ (31) 52.222-37, Employment Reports on Veterans (July 2014) (38 U.S.C. 4212).

XXX (32) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (Dec 2010) (E.O.

13496).

____ (33)(i) 52.222-50, Combating Trafficking in Persons (March 2, 2015) (22 U.S.C. chapter 78 and E.O. 13627).

____ (ii) Alternate I (March 2, 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627).

____ (34) 52.222-54, Employment Eligibility Verification (Aug 2013). (Executive Order 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.)

____ (35)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA–Designated Items (May 2008) (42 U.S.C. 6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

____ (ii) Alternate I (May 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.)

____ (36) (i) 52.223-13, Acquisition of EPEAT® Registered Imaging Equipment (Jun 2014) (E.O.s 13423 and 13514).

____ (ii) Alternate I (Jun 2014) of 52.223-13.

____ (37)(i) 52.223-14, Acquisition of EPEAT® Registered Televisions (Jun 2014) (E.O.s 13423 and 13514).

____ (ii) Alternate I (Jun 2014) of 52.223-14.

____ (38) 52.223-15, Energy Efficiency in Energy-Consuming Products (Dec 2007) (42 U.S.C. 8259b).

____ (39)(i) (i) 52.223-16, Acquisition of EPEAT® -Registered Personal Computer Products (Jun 2014) (E.O.s 13423 and 13514).

____ (ii) Alternate I (Jun 2014) of 52.223-16.

XXX (40) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (Aug 2011) (E.O.

13513).

____ (41) 52.225-1, Buy American--Supplies (May 2014) (41 U.S.C. chapter 83).

____(42) (i) 52.225-3, Buy American--Free Trade Agreements--Israeli Trade Act (May 2014) (41 U.S.C. chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001 note, Pub. L.

103-182, 108-77, 108-78, 108-286, 108-302, 109-53, 109-169, 109-283, 110-138, 112-41, 112-42, and 112-43.

____ (ii) Alternate I (May 2014) of 52.225-3.

____ (iii) Alternate II (May 2014) of 52.225-3.

____ (iv) Alternate III (May 2014) of 52.225-3.

____ (43) 52.225-5, Trade Agreements (Nov 2013) (19 U.S.C. 2501, et seq., 19 U.S.C. 3301 note).

____ (44) 52.225-13, Restrictions on Certain Foreign Purchases (June 2008) (E.O.’s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury).

____ (45) 52.225-26, Contractors Performing Private Security Functions Outside the United States (Jul 2013) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note).

____ (46) 52.226-4, Notice of Disaster or Emergency Area Set-Aside (Nov 2007) (42 U.S.C. 5150

____ (47) 52.226-5, Restrictions on Subcontracting Outside Disaster or Emergency Area (Nov 2007) (42 U.S.C.

5150).

____ (48) 52.232-29, Terms for Financing of Purchases of Commercial Items (Feb 2002) (41 U.S.C. 4505, 10 U.S.C. 2307(f)).

____ (49) 52.232-30, Installment Payments for Commercial Items (Oct 1995) (41 U.S.C. 4505, 10 U.S.C. 2307(f)).

XXX (50) 52.232-33, Payment by Electronic Funds Transfer—System for Award Management (July 2013) (31 U.S.C. 3332).

____ (51) 52.232-34, Payment by Electronic Funds Transfer—Other than System for Award Management (July 2013) (31 U.S.C. 3332).

____ (52) 52.232-36, Payment by Third Party (MAY 2014) (31 U.S.C. 3332).

XXX (53) 52.239-1, Privacy or Security Safeguards (Aug 1996) (5 U.S.C. 552a).

____ (54)(i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C.

Appx. 1241(b) and 10 U.S.C. 2631).

____ (ii) Alternate I (Apr 2003) of 52.247-64.

(c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial services, that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (Contracting Officer check as appropriate.)

XXX(1) 52.222-17, Nondisplacement of Qualified Workers (May 2014) (E.O. 13495).

XXX (2) 52.222-41, Service Contract Labor Standards (MAY 2014) (41 U.S.C. chapter 67).

_____ (3) 52.222-42, Statement of Equivalent Rates for Federal Hires (MAY 2014) (29 U.S.C. 206 and 41 U.S.C.

chapter 67).

_____ (4) 52.222-43, Fair Labor Standards Act and Service Contract Labor Standards--Price Adjustment (Multiple Year and Option Contracts) (MAY 2014) (29 U.S.C. 206 and 41 U.S.C. chapter 67).

_____ (5) 52.222-44, Fair Labor Standards Act and Service Contract Labor Standards--Price Adjustment (MAY 2014) (29 U.S.C 206 and 41 U.S.C. chapter 67).

_____ (6) 52.222-51, Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements (MAY 2014) (41 U.S.C. chapter 67).

_____ (7) 52.222-53, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services--Requirements (MAY 2014) (41 U.S.C. chapter 67).

XXX (8) 52.222-55, Minimum Wages Under Executive Order 13658 (Dec 2014) (E.O. 13658).

_____ (9) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations (MAY 2014) (42 U.S.C. 1792).

_____ (10) 52.237-11, Accepting and Dispensing of $1 Coin (Sept 2008) (31 U.S.C. 5112(p)(1)).

(d) Comptroller General Examination of Record. The Contractor shall comply with the provisions of this paragraph

(d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition threshold, and does not contain the clause at 52.215-2, Audit and Records--Negotiation.

(1) The Comptroller General of the United States, or an authorized representative of the Comptroller General, shall have access to and right to examine any of the Contractor's directly pertinent records involving transactions related to this contract.

(2) The Contractor shall make available at its offices at all reasonable times the records, materials, and other evidence for examination, audit, or reproduction, until 3 years after final payment under this contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the other clauses of this contract. If this contract is completely or partially terminated, the records relating to the work terminated shall be made available for 3 years after any resulting final termination settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising under or relating to this contract shall be made available until such appeals, litigation, or claims are finally resolved.

(3) As used in this clause, records include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of form. This does not require the Contractor to create or maintain any record that the Contractor does not maintain in the ordinary course of business or pursuant to a provision of law.

(e) (1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c), and (d) of this clause, the Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1)in a subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down shall be as required by the clause—

(i) 52.203-13, Contractor Code of Business Ethics and Conduct (APR 2010) (41 U.S.C. 3509).

(ii) 52.219-8, Utilization of Small Business Concerns (OCT 2014) (15 U.S.C. 637(d)(2) and (3)), in all subcontracts that offer further subcontracting opportunities. If the subcontract (except subcontracts to small business concerns) exceeds $650,000 ($1.5 million for construction of any public facility), the subcontractor must include 52.219-8 in lower tier subcontracts that offer subcontracting opportunities.

(iii) 52.222-17, Nondisplacement of Qualified Workers (MAY 2014) (E.O. 13495). Flow down required in accordance with paragraph (l) of FAR clause 52.222-17.

(iv) 52.222-21, Prohibition of Segregated Facilities (Apr 2015).

(v) 52.222-26, Equal Opportunity (APR 2015) (E.O. 11246).

(vi) 52.222-35, Equal Opportunity for Veterans (JUL 2014) (38 U.S.C. 4212).

(vii) 52.222-36, Equal Opportunity for Workers with Disabilities (Jul 2014) (29 U.S.C. 793).

(viii) 52.222-37, Employment Reports on Veterans (Jul 2014) (38 U.S.C. 4212).

(ix) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (Dec 2010) (E.O. 13496).

Flow down required in accordance with paragraph (f) of FAR clause 52.222-40.

(x) 52.222-41, Service Contract Labor Standards (May 2014), (41 U.S.C. chapter 67).

(xi) _____ (A) 52.222-50, Combating Trafficking in Persons (March 2, 2015) (22 U.S.C. chapter 78 and E.O.

13627).

_____ (B) Alternate I (March 2, 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627).

(xii) 52.222-51, Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements (May 2014) (41 U.S.C. chapter 67.)

(xiii) 52.222-53, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services--Requirements (May 2014) (41 U.S.C. chapter 67)

(xiv) 52.222-54, Employment Eligibility Verification (Aug 2013).

(xv) 52.222-55, Minimum Wages Under Executive Order 13658 (Dec 2014) (E.O. 13658).

(xvi) 52.225-26, Contractors Performing Private Security Functions Outside the United States (Jul 2013) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note).

(xvii) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (May 2014) (42 U.S.C. 1792). Flow down required in accordance with paragraph (e) of FAR clause 52.226-6.

(xviii) 52.247-64, Preference for Privately-Owned U.S. Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx 1241(b) and 10 U.S.C. 2631). Flow down required in accordance with paragraph (d) of FAR clause 52.247-64.

(2) While not required, the contractor May include in its subcontracts for commercial items a minimal number of additional clauses necessary to satisfy its contractual obligations.

52.214-34 SUBMISSION OF OFFERS IN THE ENGLISH LANGUAGE (APR 1991)

Offers submitted in response to this solicitation shall be in the English language. Offers received in other than English shall be rejected.

52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

http://www.acq.osd.mil/dpap/dars/index.html; https://www.acquisition.gov/?q=browsefar; http://farsite.hill.af.mil/

252.204-7006 BILLING INSTRUCTIONS (OCT 2005)

When submitting a request for payment, the Contractor shall--

(a) Identify the contract line item(s) on the payment request that reasonably reflect contract work performance; and

(b) Separately identify a payment amount for each contract line item included in the payment request.

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (MAY 2013)

(a) Definitions. As used in this clause--

Department of Defense Activity Address Code (DoDAAC) is a six position code that uniquely identifies a unit, activity, or organization.

Document type means the type of payment request or receiving report available for creation in Wide Area WorkFlow (WAWF).

Local processing office (LPO) is the office responsible for payment certification when payment certification is done external to the entitlement system.

(b) Electronic invoicing. The WAWF system is the method to electronically process vendor payment requests and receiving reports, as authorized by DFARS 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(1) Have a designated electronic business point of contact in the System for Award Management at https://www.acquisition.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this Web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site before submitting payment requests through WAWF. Both can be accessed by selecting the “Web Based Training” link on the WAWF home page at https://wawf.eb.mil/.

(e) WAWF methods of document submission. Document submissions may be via Web entry, Electronic Data Interchange, or File Transfer Protocol.

(f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order:

(1) Document type. The Contractor shall use the following document type(s).

2 in 1 Invoice

(2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in WAWF, as specified by the contracting officer.

W56SCX

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table* Field Name in WAWF Data to be entered in WAWF Pay Official DoDAAC HQ0670 Issue By DoDAAC W912LR Admin DoDAAC ____ Inspect By DoDAAC W56SCX Ship To Code W56SCX Ship From Code ____ Mark For Code W56SCX Service Approver (DoDAAC) ____ Service Acceptor (DoDAAC) W56SCX Accept at Other DoDAAC ____ LPO DoDAAC ____ DCAA Auditor DoDAAC ____ Other DoDAAC(s) ____

(4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back-up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request.

(5) WAWF email notifications. The Contractor shall enter the email address identified below in the “Send Additional Email Notifications” field of WAWF once a document is submitted in the system.

tomas.e.plazaquinones.mil@mail.mil; jessica.melendez-sanchez.mil@mail.mil;

angel.j.martinezguzman.mil@mail.mil

(g) WAWF point of contact. (1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact.

tomas.e.plazaquinones.mil@mail.mil; jessica.melendez-sanchez.mil@mail.mil;

angel.j.martinezguzman.mil@mail.mil

(2) For technical WAWF help, contact the WAWF helpdesk at 866-618-5988.

PERFORMANCE WORK STATEMENT

1.0 Background: The purpose of this contract is to provide Administrative Assistant Support Services to the

Puerto Rico National Guard. The Contractor shall serve as the medical administrative provider and liaison between the chain of command and the chain of concern, providing assistance to Soldiers with all aspects of medical readiness and mobilization as detailed in this PWS. Historically, the State Medical Detachment has accomplished the tasks associated with re-deployment medical and dental readiness and medical records maintenance. Rapid increase in deployments and injuries/illnesses incurred by soldiers during the OEF/OIF and other war campaigns, with loss of organic human resources (soldiers) due to downsizing of the military and/or, injury/illness have added an increased burden to the current human resources at the medical detachment to accomplish the Medical readiness mission mandated by DOD and Army regulation.

Increased requirements from DOD and OPTEMPO has resulted in a requirement to increase the infrastructure needed.

2.0 Technical Specifications:

The following technical specifications are provided to the Company to demonstrate the task environment in which the service will be delivered. The following specifications are not directives on how the services are to be provided but an example of what will be required to successfully support the task order objective.

The Company/contractor is encouraged to surpass the minimal technical specifications as well as demonstrate technical, operational, and administrative expertise to support the customer in exceeding organizational and departmental objectives. All plans, reports and program changes/updates shall be reviewed and approved by a government official prior to release or any action by the contractor.

2.1 Administrative Provider:

Provide non-clinical support to include identification and tracking of Members who are not Fully Medically Ready (FMR) either for dental or medical concerns. Handle Service Member case to become FMR by going through medical documentation provided by Service Member and documenting in a military medical/administrative document the documentation considered, maintaining communication as required with the Service Members; all shall be documented in the Electronic Profile (e-profile) module of the Medical Operational Data System (MODS).

2.1.1 Provide information, referral, and outreach services to military members for all services and components per Army and DoD guidelines. The standard expectation for response to Member issues shall be two (2) business days with a resolution or follow-up contact.

2.1.2 Coordinates with Member & Units to arrange for the treatment of Members with conditions that have or shall result in them being Medically/Dentally non-deployable. Such services include outreach, coordinating with appointment scheduling, and going through the readiness process, (both for mobilization/ deployment and routine readiness).

2.1.3 Utilizing checklists contractor conducts records review of health and dental records, information will be used by the government to determine deployability of service members. Coordinates with members to schedule any medical requirements necessary to meet and maintain eligibility for deployment status.

Ensure documentation is retrieved from appointments and placed in appropriate electronic record, as well as the Member’s hard copy medical record.

2.1.4 Contractor shall ensure the Member understands his/her responsibilities, obtain signed release of information form. Provide information to Members about their privacy rights and how their information can be used. The Contractor shall abide by Privacy Act and HIPAA regulations and guidelines.

2.1.5 Document results of a Bi-monthly (at a minimum) case review in the referrals tab of the MND/e-Profile or applicable Module .These reviews shall be used in the monthly meeting with the Flight Surgeon, and the Dental Officer (DO).

2.1.6 Provide a monthly MND/e-Profile Case Report to the State Surgeon/Deputy State Surgeon and applicable unit personnel. The report shall include: Status of medical actions and return to duties to maintain the highest state of medical readiness. Coordination of care of soldiers found medically disqualified for duty until returned to green medical status. Prepare initial/renewal waivers for approval to the State Surgeon, prior to being sent to higher headquarters.

2.1.7 Apply all regulations and guidance that are applicable to medical operations and programs of the Puerto Rico Army National Guard.

2.2 Referral and Coordination of Care Services:

2.2.1 The Company/Contractor shall assist in coordinating treatment plans and all referrals that are being resourced by the government (Dental Treatment with Senior Dental NCO with local contracts).

2.2.2 Company/Contractor shall obtain pre-authorizations as required for member’s treatments (Coordinated through the Health Systems Specialist).

2.2.3 Coordinate with members in scheduling health care services including consults for those initially using

Military Treatment Facilities (MTF), VA, TRICARE network provider, and non-network providers.

2.2.4 Establish a list of available local resources within their state to coordinate care and ensure Members have alternative options available to receive medical or dental care if not eligible for military health benefits.

2.2.5 Inform Member of resources available to improve medical and dental readiness (TRICARE Dental

Program (TDP), local community resources, Decade of Health, Hooah4Health.com, State Medical and Dental programs, etc.).

2.3 Automation Services:

2.3.1 Apply all regulations pertaining to the medical records program and act as the medical records custodian.

Prepare, safeguard, and maintain medical and dental records.

2.3.2 Route correspondence, including e-mail; and in the correct format. Completing and forwarding, on time, all required reports in the correct format.

2.3.3 Provide reports and updates to State Surgeon/Deputy State Surgeon so that they can make their decisions on the deployability and readiness of each member as applicable.

2.3.4 Secure and safeguard all government property, including documents that are provided for or created by case management and medical operations. It is understood that all records, documents and resources utilized in within the scope of this work are for official government use only, and shall remain government property on termination of the contract.

2.3.5 Respond to and effectively handle time-sensitive calls as they are received.

2.3.6 Operate a government computer to input, store, retrieve and manipulate data for various reports as required by this PWS. The Computers, scanners and printers that the company/contractors will use to provide services necessary to process confidential/sensitive documents of soldiers of the PRARNG will be provided by the government. This will be a safeguard to prevent breach of protected health information

2.3.7 Document and complete case records, reports, intake sheets, logs and communications records. All deliverables shall meet required professional and technical standards.

2.3.8 Provides review of studies on medical issues such as: patient satisfaction surveys, review of medical records for content and structure, reviews laboratory results for validity and application, and generates readiness reports for review of the State Surgeon/Deputy State Surgeon.

3.0 Additional Requirements and Notes:

3.1 The Contractor shall have a minimum of two years practical experience and possess knowledge of military procedures, and regulations and must possess a professional license to practice medicine in the Island of Puerto Rico. A medical specialty is not required to be contracted in this position. Medical Administrative decisions will be based on AR 40-501 Standards of Medical Fitness following its modifications and updates. Contractor is able interpret laboratory findings, x-ray results, and interprets nuclear medicine reports, and able to consult those results unable to interpret. Contractor can make proper referrals for those service members in need of follow up. Incumbent must understands the principles of medical administration and patient administration. Is able to work with electronic forms and has access to medical modules, and computer knowledgeable. Contractor must submit their personal information in order to obtain a Common Access Card (CAC) and sponsorship for an Army Knowledge Online (AKO) Account;

which is a requirement for access to MODS Module. Contractor will have 14 days from time of award to submit all pertinent information for system access to AKO.

3.1.2 Highly desired knowledge of medical terminology, anatomy, and physiology; skill in applying, an extensive body of rules, regulations, procedures and precedents relating to the physical standards program and ability to resolve complex procedural and substantive problems. Knowledge of the organization and its functions and programs to answer inquires of a general nature or to refer them to a responsible staff member.

3.2 The Contractor shall comply with the following Government guidelines in order to successfully complete the tasks:

Service shall be performed in an office environment. This office is located within a medical clinic, and therefore a small potential for exposure to blood borne pathogens exists. The contractor shall obtain appropriate blood borne pathogen training in accordance with OSHA 1910.1030.

Privacy Act of 1974, and must be familiar with the proper management of this type of information.

Health Information Portability and Accountability Act (HIPAA), and must be familiar with the proper management of this type of information.

Familiarize and comply with “For Official Use Only” (FOUO) procedures.

Operational Security (OPSEC) principles and the proper management of Privacy Act, HIPAA and

FOUO information.

3.3 Suggested Skill Set: In order to successfully meet the performance objectives of this task order, the Contractor employee should possess the following knowledge/skills:

Strong effective organizational skills Strong communication skills, both written and verbal Thorough knowledge of standard office procedures and the ability to interpret general direction The Contractor shall have the knowledge and experience needed to use Microsoft Office Suite including but not limited to Excel, Word, PowerPoint and Outlook.

Use various software programs to maintain database files and prepare reports.

3.4 Location: Camp Santiago, Arrillaga ST, Building 588, Salinas, PR 00751. The contractor shall perform the services required under this contract within facility operating hours which are 0730-1630, Monday through Friday. The PRARNG will not be responsible to provide a work schedule for the contractor, hours worked should take place within facility operating hours.

3.5 Anticipated number of weekly man-hours for this position is 32 hours per week. Time in excess of 32 hours must be pre-approved by the Contracting Officer.

3.6 No travel is anticipated for this task order. If required, the Contracting Officer has to pre-approve it.

3.7 The company/contractor will be provided with Computers, scanners and printers that the contractors will use to provide services necessary to process confidential/sensitive documents of soldiers of the PRARNG.

This will be a safeguard to prevent breach of protected health information. All Government furnished equipment shall be for official use only and will not be taken off the premises to prevent breach in confidentiality and protect Personal Health information (PHI).

3.7.1 The Company/contractor and Government representative shall conduct an inventory of all Government furnished equipment within 3 days of commencement. The contractor shall sign a receipt for all furnished equipment. The contractor and Government representative shall determine the working condition of all equipment. The Government will replace and/or repair any item not in working order through no fault of the contractor.

4.0 Security Requirements:

4.1 A National Agency Check with Inquiries (NACI) is required and a favorable completion of FBI fingerprint

History Check must be completed. A Common Access Card (CAC) is required for Base access and the Local Access Network (LAN). Submission of Standard Form 86 by the Requesting Official shall be accomplished within 5 calendar days of Task Order award. Contractor shall work with the sponsoring office to complete local requirements for gaining access to the network.

4.2 Contractor shall work with the contracting office for processing into the Trusted Associate Sponsorship System (TASS) if required.

4.3 Health Insurance Portability and Accountability Act (HIPAA) and Privacy Act Regulations will be strictly followed to ensure confidentiality and right to privacy is maintained 100% of the time.

5.0 Miscellaneous:

5.1 Performance of Services during Crisis Declared by the National Command Authority or Overseas

Combatant Commander is Not Applicable this Task Order.

5.2. The contractor is cautioned that if off-duty active military personnel are hired under this contract, they may be subject to permanent change of station, change in duty hours, or deployment. Military Reservists and National Guard members may be subject to recall to active duty. The absence of such contractors shall not constitute an excuse for nonperformance under this contract.

5.3 Hours of Operation: The contractor shall perform the services required under this contract within core operating hours which are 0730-1630, Monday thru Friday.

5.4 Contractor Manpower Reporting (CMR): The contractor shall report ALL contractor labor hours

(including subcontractor labor hours) required for performance of services provided under this contract for PRARNG collection site. The contractor is required to completely fill in all required data fields using the following web ad-dress: http://www.ecmra.mil/.

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

Unit Identification Code (UIC) for the Requiring Activity: W8ZVAA Issuing Office DoDAAC: W912LR

5.5 With the awarding of this Contract the Company/contractor will have no employer/employee relationship with the PRARNG, and said contract is being awarded due to the fact that there are no comparable services within the agency, and there will be no continuous supervision of the contractor.

5.6 Invoice Submittal Procedures: Company/Contractor shall submit invoice to WAWF between the 25th and the 30th of each month.

QASP

QUALITY ASSURANCE PLAN SURVEILLANCE – POC INFORMATION

1. In your role as Point of Contact (POC) you assume some Quality Assurance duties. You will monitor contractor performance, complete and sign the Quality Assurance Worksheet provided below along with the contractor invoice at least monthly. This worksheet allows you to document compliance with the task order and fill a regulatory requirement to ensure adequate oversight is being performed.

2. Annotate the number of hours worked and overtime (if applicable) worked, travel and reimbursable costs incurred. Hours worked in excess of the normal work schedule require prior approval by the Contracting Officer. Please annotate only the actual hours worked and approved; do not include holiday, vacation or sick hours. Only the actual time the contract employee was on the job should be submitted as billed hours.

3. Quality Assurance Plan Worksheets are to be sent directly to the Contractor and Administering Contracting Office, not later than the 5th day of the month following the service (every month).

4. The following chart explains the rating method for this task order.

Rating Description Green Yes, performance and technical specifications are being met.

Yellow

Yes, performance and technical specifications are currently being met at the minimum, but the following service / deliverable needs contractor attention.

The Customer must identify what component of the deliverable and/or service requires attention.

Red

No, performance and technical specifications are not being met and the following service / deliverable needs immediate contractor resolution.

The Customer must identify what component of the deliverable and/or service is below the minimum.

5. The quality rating may change from “Green” to “Red” without notice, however we encourage the POC to utilize the “Yellow” quality rating to alert the contracting office and the Contractor of quality issues that have the potential for a “Red” quality rating if corrective action is not taken.

6. Any time the rating is less than “Green” the POC shall clearly document the worksheet to indicate what did or did not occur per the PWS requirement. When an observation indicates other than a “Green” rating, the POC will require the Contractor to initial the observation.

Initialing the observation does not constitute concurrence with the observation; it only acknowledges that they have been made aware of the defective performance. Notify the Contracting Officer if there is a deficiency. If the Contractor’s response to an identified quality deficiency is unsatisfactory, the Contracting Officer along with the POC will contact the Contractor to implement a plan of action to remedy the identified deficiency.

7. Contractor’s changes: Ensure that all replacement contract employees, to include short-term temporary replacements, are reported to the Contracting Officer.

8. POC Changes: If your supervisor decides to re-assign these POC oversight duties to another Government employee, you must notify the Contracting Officer immediately, in writing, with their name, position, email and telephone number. Email notification is acceptable. Each POC conducting oversight duties must provide the Contracting Office a copy of the certificates from the required courses below BEFORE services start on the task order or before they can be assigned as the POC. The POC must be nominated by their supervisor, appointed in writing by the Contracting Officer and formally trained, which requires the following courses:

a. DAU CLC106, POC With a Mission Focus – Required every 3 years

b. DAU CLC 013, Services Acquisition - Required every 3 years

c. DAU CLM 003, Overview of Acquisition Ethics - Required annually

d. DAU CLC 107, OPSEC Contract Requirements - Required one time

e. Combating Trafficking in Persons - Required annually:

1) Air Guard Personnel complete course Human Relations ZZ133080 in ADLS.

2) Army Guard personnel go to http://ctip.defense.gov/ and complete J3TA-US030 course.

9. The POC Nomination Letter and Appointment Letter and proof of training certificates are required to be submitted to the contracting office BEFORE services start on the task order.

10. Monitor trafficking in persons: The POC shall monitor the contractor’s performance for non-compliance with FAR 52.222-50, Combating Trafficking in Persons (CTIP). At a minimum, the POC shall:

a. Read and understand the Combat Trafficking in Persons clause, FAR 52.222-50.

b. Monitor the contractor’s performance for noncompliance with the Combat Trafficking in Person clause through contractor inspection and reported information or complaints.

c. Document any observed non-compliance.

d. Bring any potential issue in this area to the immediate attention of the contracting officer before engaging the contractor in reference to these activities.

11. The POC for this task order is: SFC Armando Flores, armando.floresgarcia.mil@mail.mil, Office Phone Number (787) 824-7454, ext 7669.

Note: Attach Time Card Period of Performance: From _________________________to_________________________ Number of Hours Actually Worked: ____________ (Include only actual hours worked. Do not include non worked holidays, leave, etc. these are included in the rate the Government pays and are not paid as hours worked.)

Overtime (if applicable to the TO): _____________ Reimbursable Expenses (include receipts): _______________ Travel (include approval sheet): ________________ NOTE: Time in excess of 32 hours must be pre-approved by the Contracting Officer.

Approved by: _____________________________________________ Date: _______________________________

QUALITY ASSURANCE WORKSHEET

Task Order #_______________ Medical Admin Provider Name:___________________________ Performance Rating

Deliverable/Service Quality Rating

Causative Factors Effect on Mission Action Required / Date

Maintain (MODS) system