W912LR-15-T-0070_DENTAL_TREATMENT_SERVICES_GUAYNABO.pdf

SEE ADDENDUM

(No Collect Calls)

W912LR-15-T-0070 20-Sep-2015

b. TELEPHONE NUMBER

787-277-7697

8. OFFER DUE DATE/LOCAL TIME

02:00 PM 22 Sep 2015

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

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ADDENDA ARE

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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

0010769278

ARE NOT ATTACHED

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(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 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:

$7,000,000

NAICS:

621210

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 OF35

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

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37. CHECK NUMBER

FINALPARTIALCOMPLETE

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PARTIAL

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

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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.

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Job

DENTAL TREATMENT SERVICES (GUAYNABO)

FFP

The contractor shall provide all management, labor, material, equipment, certifications and supplies necessary to provide dental care services at their Personal Office, for the Puerto Rico Army National Guard Soldiers. This service will provide dental treatment, proper documentation for each Soldier’s, as necessary to meet Department of the Army standards and ensure mission capability of the Puerto Rico National Guard. The service will comply with medical/dental readiness and deployability, on converting the Soldier from Dental Class 3 to Dental Class 2. The contractor will ensure that their agents are appropriately trained in the dental classification system. The intent of the Government is to award one (1) contract in the municipality of Guaynabo, Puerto Rico. SFC William Bautista tel. (787) 824-7454 Ext: 7647 e-mail: william.bautista.mil@mail.mil. See Scope of Work for details. Period of performance is September 28, 2015 to September 27, 2016. Award will be issue to the lowest price. See EVALUATION section for details.

FOB: Destination

PURCHASE REQUEST NUMBER: 0010769278

NET AMT

EVALUATION

Award will be issue to the lowest price. Price one each of the services listed in the following list and write down the total.

MEDICAL COMMAND

DENTAL PRECEDURES PRICE LIST

DIAGNOSTIC SERVICES

CODE DESCRIPTION PRICE

D0120 PERIODIC ORAL EVALUATION

D0150 COMPREHENSIVE ORAL; EVALUATION

D0330 DIGITAL PANORAMIC FILM

D0272 BITEWINGS‐ TWO FILMS

D0274 BITEWINGS‐ FOUR FILMS

D0220 PERIAPICAL(FIRST FILMS) LIMITED

D0230 PERIAPICAL (LIMITED)

RESTORATIVE

D2140 AMALGAM ONE SURFACE

D2150 AMALGAM TWO SURFACE

D2160 AMALGAM THREE SURFACES

D2161 AMALGAM FOUR SURFACES OR MORE

D2330 COMPOSITE ONE SURFACE

D2331 COMPOSITE TWO SURFACE

D2332 COMPOSITE THREE SURFACE

D2335 COMPOSITE FOUR SURFACES OR MORE

D2391 COMPOSITE ONE SURFACE

D2392 COMPOSITE TWO SURFACES

D2393 COMPOSITES THREE SURFACES

D2394 COMPOSITE FOUR O MORE SURFACES

D2799 PROVISONAL CROWN

D2931 PREFABRICATED STAINLESS STEEL CROWN

D2950 CORE BUILDUP INCLUDING ANY PINS

D2954 PREFABRICATED POST AND CORE

ENDODONTIC

D3310 ANTERIOR ROOT CANAL THERAPY

D3320 BICUSPID ROOT CANAL THERAPY

D3330 MOLAR ROOT CANAL THERAPY

D3346 ANTERIOR ROOT CANAL RETREATMENT

D3347 BICUSPID ROOT CANAL RETREATMENT

D3348 MOLAR ROOT CANAL RETREATMENT

D4355 FULL MOUTH DEBRIDEMENT

D4342 PERIODONTAL SCALING AND ROOT PLANNING

1 TO 3 TEETH PER QUADRANT

PROSTHODONTIC

D5110 COMPLETE DENTURE‐MAXILLARY

D5120 COMPLETE DENTURE‐ MANDIBULAR

D5211 MAXILLARY PARTIAL DENTURE‐RESIN BASE

D5212 MANDIBULAR PARTIAL DENTURE‐RESIN BASE

ORAL SURGERY

D7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT

D7210 SURGICAL REMOVAL OF ERUPTED TOOTH

D7220 REMOVAL OF IMPACTED TOOTH, SOFT TISSUE

D7230 REMOVAL OF IMPACTED TOOTH, PARTIAL BONY

D7240 REMOVAL OF IMPACTED TOOTH, COMPLETE BONY

ORTHODONTIC

D8680 ORTHODONTIC RETENTION

Total

SCOPE OF WORK

Puerto Rico Army National Guard

Camp Santiago Joint Maneuver Training Site Salinas, PR, 00751

SCOPE OF WORK

FOR

DENTAL TREATMENT SERVICES

1. DESCRIPTION OF SERVICES. The contractor shall provide all management, labor, material, equipment, certifications and supplies necessary to provide dental care services at their Personal Office, for the Puerto Rico Army National Guard Soldiers. This service will provide dental treatment, proper documentation for each Soldier’s, as necessary to meet Department of the Army standards and ensure mission capability of the Puerto Rico Army National Guard.

The service will comply with medical/dental readiness and deployability, on converting the Soldier from Dental Class 3 to Dental Class 2. The contractor will insure that their agents are appropriately trained in the dental classification system. The intent of the Government is to award one (1) contract in the municipality of Guaynabo, Puerto Rico.

2. BASIC SERVICES. The contractor shall provide customized comprehensive dental readiness services to include:

a) Class 3 dental treatments for alerted Soldiers (as identified by the state/territory).

Dental treatment authorized is outlined in Appendix E. These services will be completed by using contractor provided portable/mobile dental equipment (unless otherwise specified in a separate written agreement).

b) Specified Dental Specialty Services to include

1) Oral and Maxillofacial Surgery (to include pathology reports if indicated)

2) Endodontics

3) Periodontics

4) Prosthodontics

5) Other (specify)

c) Prescriptions for pharmaceuticals and controlled substances necessary for the care and treatment Soldiers throughout the event, to include but not limited to analgesics and antibiotics.

Prescriptions for maintenance pharmaceuticals for Soldiers with high caries risk or periodontal disease, as indicated.

d) Radiographs should be taken only for clinical reasons according to FDA and

DENCOM guidelines as determined by the patient’s dentist. Radiographs should be of diagnostic quality, properly identified and dated. A panoramic radiograph of adequate quality for diagnostic/identification purposes is required to be part of the dental record. There is no time requirement on updating panoramic radiographs. However, the panoramic radiograph will adequately represent the current oral condition of the Soldier. Bitewing (or “bitewing slice” at the discretion of the State Dental Officer) radiographs are also required to be part of the dental record. All radiographs provided under this contract will be digital (unless specified in a separate written agreement) and transferred to the Denclass module within 24 hours of exposure.

e) A listing of all DFC 3 conditions

f) Any condition of significance that is not readily apparent on the radiographs.

2.1. Upon completion of services, medical information will be documented in accordance with Department of the Army Policy and be updated in the approved Army National Guard automated system. The contractor shall also ensure the requirements of Occupational Safety and Health Administration (OSHA) and applicable Federal regulations are met. The contractor shall develop and maintain records that fully document serviced performed, examination results, and names of soldiers referred to dental specialists. These records will be made available to the Puerto Rico State Surgeon/PR-Medical Command or Medical representative.

2.2 Documentation. All Soldiers must have a complete military dental record. No dental record is considered complete unless the documentation is complete and in the proper order as outlined in TB MED 250. The contractor shall provide electronic documentation (to include radiographs) in the PRARNG approved system (within 24 hours of exam completion) and a paper copy as outlined below. A complete record includes the following:

a) Military dental record jacket, DA Form 8005 through 8005-9

b) The automated Health History Form or DA Form 5570 (with notations to “yes” answers and signed by both the Soldier and reviewing Doctor), Health Questionnaire envelope

c) DD Form 2005 (signed), Privacy Act Statement

d) SF 603/603A, Record of Dental Exam

e) Supporting radiographs (panoramic and diagnostic bitewing radiographs ((see 2.2.F) documenting existing conditions)

(1) All radiographs will be uploaded into the ARNG automated system.

(2) A diagnostic quality copy of all radiographs must be placed in the Dental Record.

f) The entries on the SF 603/603A will include the following: date, location, “comprehensive oral evaluation” (as defined in current CDT as D0150), indication/date of x-rays taken, indication/date of x-rays consulted, oral cancer screening, caries risk assessment (based upon caries incidence), Periodontal Screening and Reporting (PSR), notation of current Dental Fitness Classification, listing of current oral condition (class 2 issues identified and a listing of class 3 treatment needs, if any), printed name of examining dentist or dental officer and the dentist’s or dental officer’s signature/initials. These required dental documentation elements will be entered in the approved ARNG automated system and printed and placed into the dental record.

3. GENERAL INFORMATION.

3.1. QUALITY CONTROL. The contractor shall adopt a quality assurance program that monitors all service activities and ensures the highest quality customizable dental services available. It is the responsibility of the PRARNG to review and approve dental treatment plans before treatment is performed based on the guidelines provided by NGB.

3.2. QUALITY ASSURANCE. The government will periodically evaluate (Quarterly) the contractor’s performance in accordance with the Quality Assurance Surveillance Plan.

3.3. GOVERNMENT REMEDIES. The contracting officer shall follow the requirements of FAR 52.212-4, Contract Terms and Conditions for Commercial Items (May 1997), for contractor’s failure to correct nonconforming services.

3.4. HOURS OF OPERATION: The contractor shall have the capability of providing dental treatment services seven days a week at their personal office. (By Appointment)

3.5. SECURITY REQUIREMENTS. Security will be in accordance with DD Form

254 (Department of Defense Contract Security Classification Specification).

3.6. SPECIAL QUALIFICATIONS. Contractor must maintain appropriate credentialing files on all employees to include but not limited to Licensure, National Provider, NPI, DEA, Data Base Query results and HIPPA certification. All providers must be licensed in the state in which they are providing services. Contractor will provide binder copies of all credentialing documentation to the PR State Surgeon Office/ Medical Command.

. 3.7. PARTNERING AGREEMENT. The contracting officer may require a partnering agreement between the government and the contractor to ensure joint cooperation and a sound partnership of all parties involved in the execution of this contract. Partnering is the creation of a government-contractor relationship that promotes achievement of mutually beneficial goals. It involves an agreement in principle to share the risks involved in completing the project and to establish and promote a nurturing partnership environment. Representatives from each organization are encouraged to participate in developing the partnering agreement. Suggested representation is the Deputy State Surgeon, the State Dental Officer, the Senior Dental NCO, the government contract administrator, the contractor’s manager and the contractor’s quality control person. All costs for the partnership agreement should be agreed upon in advance. This group is responsible for developing a formal partnering agreement that should be signed by all parties involved. The agreement should contain as a minimum: specific goals to be reached and a list of objectives to reach the goals, a set of metrics to evaluate the objectives, a frequency for meetings to review the metrics, and a statement of cooperation to execute the terms of the agreement.

3.8 Contractors will ensure compliance with the following requirements prior to utilizing any x-ray producing device on Soldiers;

a) Have established written policies and procedures to assure compliance with applicable Federal, State, DOD, and Army radiation safety regulations and directives. These documents include staff emergency reaction plans, as necessary, and procedures for investigating and reporting radiation accidents or incidents, possible radiation overexposures to Soldier patients or contractor staff, and provisions to ensure the safe use of x-ray producing devices on humans.

b) Upon request by the State Surgeon Office/ PR-Medical Command or medical representative, the contractor will provide documentation regarding the Contractor's employee radiation safety training commensurate with potential radiation hazards with the x-ray producing devices they are using.

c) Upon request by the State Surgeon Office/PR-Medical Command or medical representative, the contractor will provide copies of a Qualified Health Physics Expert's acceptance test and most recent health physics survey of each diagnostic x-ray machine. The acceptance test and the most recent survey include tests of electrical, mechanical, image quality and radiation (output) dose tests or measurements. This also includes verification of the adequacy of radiation protection shielding in and around the x-ray machine and x-ray facility (e.g., mobile van).

4. POINT OF CONTACT (POC): The (POC) is identified below:

SSG WILLIAM BAUTISTA

Puerto Rico Army National Guard Medical Command

(787) 824-7454 Ext: 7647

(787) 461-1973 Email: William.bautista.mil@mail.mil

The POC monitors all technical aspects of the contract and assists in contract administration. The POC is authorized to perform the following functions: assure that the Contractor performs the technical requirements of the contract: perform inspections necessary in connection with contract performance: maintain written and oral communications with the Contractor concerning technical aspects of the contract: issue written interpretations of technical requirements, including Government drawings, designs, specifications: monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; coordinate availability of government furnished property, and provide site entry of Contractor personnel. A letter of designation issued to the POC, a copy of which is sent to the Contractor, states the responsibilities and limitations of the POC, especially with regard to changes in cost or price, estimates or changes in delivery dates. The POC is not authorized to change any of the terms and conditions of the resulting order.

5. REFERENCES: Regulations and directives may include the applicable State Radiation Control Regulation, U.S. Food and Drug Administration requirements for certification of x-ray producing devices, and Army requirements for radiation safety and health:

5.1. State Radiation Control Regulation

Applicable State regulations or NGB Directives (e.g., CECOM Radiation Safety Program)

5.2. U.S. Food and Drug Administration

TITLE 21, Code of Federal Regulations (FOOD AND DRUGS), CHAPTER I, (FOOD

AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN

SERVICES), SUBCHAPTER H--MEDICAL DEVICES, PART 872, DENTAL DEVICES.

TITLE 21, Code of Federal Regulations (FOOD AND DRUGS), CHAPTER I, (FOOD

AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN

SERVICE), SUBCHAPTER J

Certain radiation emitting products require the submission of product reports to FDA and the retention of records as included in 21 CFR Part 1002 All manufacturers of electronic products are subject to the reporting of accidental radiation occurrences, as required by 21 CFR 1002.20.

http://www.fda.gov/cdrh/radhlth/xraystandard.html

5.3. Army AR 11-9, The Army Radiation Safety Program, 28 May 1999.

http://www.army.mil/usapa/epubs/pdf/r11_9.pdf AR 40-5, Preventive Medicine, 22 July 2005.

http://www.army.mil/usapa/epubs/pdf/r40_5.pdf

TB MED 52, Occupational and Environmental Health, Management and Control of Diagnostic, Therapeutic, and Medical Research X-Ray Systems and Facilities, 26 February 2002.

http://www.army.mil/usapa/med/DR_pubs/dr_a/pdf/tbmed521.pdf

6. DEFINITIONS & ACRONYMS

AR Army Regulation DA Department of the Army DD (Defense) Department DRC Dental Readiness Category FMR Fully Medically Ready HIPAA Health Insurance Portability and Accountability Act IMR Individual Medical Readiness MEDCOM U.S. Army Medical Command MEDPROS Medical Protection System MMRB Medical MOS Retention Board MODS Medical Operational Data System MRC Medical Readiness Category MWDE Medical Web Data Entry

NGB National Guard Bureau OSArS Office of the State Army Surgeon OSHA Occupational Safety and Health Administration PEB Physical Evaluation Board PHA Periodic Health Assessment SRC Soldier Readiness Check SRP Soldier Readiness Processing STR Soldier Treatment Record SOW Statement of Work TMC Troop Medical Clinic PRARNG Puerto Rico Army National Guard

7. APPENDICES:

A. Estimated Workload Data B. Dental Classification C. Authorized Dental Treatment D. Performance Requirements Summary E. Quality Assurance Surveillance Plan

W912LR-15-T-0070

APPENDIX A

ESTIMATED WORKLOAD DATA

Deputy State Surgeon: 1LT Edalia E Cedeño Senior Dental NCO: SSG William Bautista

Name Last four

SSN

Date of

Procedures ADA Codes

Procedures Description

Cost

Provider Signature: ____________________ State Surgeon Representative Signature:_______________ Date: _______________ Date: _________________

APPENDIX B

Department of Defense Oral Health and Readiness Classification System

The oral health status of uniformed personnel shall be classified as follows:

a. Class 1 (Oral Health): Patients with a current dental examination, who do not require dental treatment or reevaluation. Class 1 patients are worldwide deployable.

b. Class 2: Patients with a current dental examination, which require non-urgent dental treatment or reevaluation for oral conditions, which are unlikely to result in dental emergencies within 12 months. Class 2 patients are worldwide deployable. Patients in dental class 2 may exhibit the following:

(1) Treatment or follow-up indicated for dental caries or minor defective restorations that can be maintained by the patient.

(2) Interim restorations or prosthesis that can be maintained for a 12 month period. This includes teeth that have been restored with permanent restorative materials for which protective cuspal coverage is indicated.

(3) Edentulous areas requiring prostheses but not on an immediate basis.

(4) Periodotium that:

(a) requires oral prophylaxis

(b) requires maintenance therapy

(c) requires treatment for slight to moderate periodontitis and stable cases of more advanced periodontitis

(5) Unerupted partially erupted or malposed teeth that are without historical, clinical or radiographic signs or symptoms of pathosis, but which are recommended for prophylactic removal.

(6) Active orthodontic treatment. The provider should consider placing the patient in passive appliances for deployment up to six months. For longer periods of deployment, the provider should consider removing active appliances and placing the patient in passive retention.

(7) Temporomandibular disorder patients in remission. The provider anticipates the patient can perform duties while deployed without ongoing care and any medications or appliances required for maintenance will not interfere with duties.

c. Class 3: Patients who require urgent or emergent dental treatment. Class 3 patients normally are not considered to be worldwide deployable.

(1) Treatment or follow-up indicated for dental caries, symptomatic tooth fracture or defective restorations that cannot be maintained by the patient.

(2) Interim restorations or prostheses that cannot be maintained for a 12 month period.

(3) Patients requiring treatment for the following periodontal conditions that may result in dental emergencies within the next 12 months.

(a) Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate mastication or communication or acceptable esthetics.

(b) Active progressive moderate or advanced periodontitis.

(c) Periodontontal abscess

(d) Progressive mucogingival condition

(e) Periodontal manifestations of systemic disease or hormonal disturbances

(f) Heavy subgingival calculus

(4) Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate mastication or communication or acceptable esthetics.

(5) Unerupted, partially erupted or malposed teeth with historical, clinical or radiographic signs or symptoms of pathosis that are recommended for removal.

(6) Chronic oral infections or other pathologic lesions including:

(a) Pulpal, periapical or resorptive pathology requiring treatment.

(b) Lesions requiring biopsy or awaiting biopsy report.

(7) Emergency situations requiring therapy to relieve pain, treat trauma, treat acute oral infections or provide timely follow-up care (e.g., drain or suture removal0 until resolved.

(8) Acute Temporomandibular disorders requiring active treatment that may interfere with duties.

d. Class 4. Patients who require periodic dental examinations or patients with unknown dental classifications. Class 4 patients normally are not considered to be worldwide deployable.

APPENDIX C

AUTHORIZED DENTAL TREATMENT

1. The following dental procedures are authorized:

(a) Diagnostic Services which are funded through the NG6H 2065 Medical Readiness or VFRE 2065 Medical & Readiness Funding:

D0120-Periodic Oral Evaluation D0150-Comprehensive Oral Evaluation D0330-Digital Panoramic Film D0272-Bitewings-Two Films D0274-Bitewings-Four Films D0220- Periapical (First films) limited D0230- Periapical (limited)

(b) Restorative Services which are funded through the NG6H 2065 Medical Readiness

(provided only to soldiers non-alerted or VFRE 2020 Dental Treatment Funding (provided only to soldiers alerted to an OCONUS Mission):

D2140-Amalgam-One Surface D2150-Amalgam-Two Surfaces D2160-Amalgam-Three Surfaces D2161-Amalgam-Four or More Surfaces D2330-Composite-One Surface D2331-Composite-Two Surfaces D2332-Composite-Three Surfaces

Posterior composites will be authorized only when a posterior composite is necessary to provide a quality restoration and no other alternative is available.

D2335-Composite-Four or More Surfaces D2391-Composite-One Surface D2392-Composite-Two Surfaces D2393-Composite-Three Surfaces D2394-Composite-Four or More Surfaces D2799-Provisional Crown D2931-Prefabricated Stainless Steel Crown D2950-Core Buildup, including any pins D2954-Prefabricated Post and Core

(c) Endodontic Services which are funded through the NG6H 2065 Medical Readiness or

VFRE 2020 Dental Treatment Funding (provided only to Soldiers alerted to an OCONUS Mission):

D3310-Anterior Root Canal Therapy D3320-Bicuspid Root Canal Therapy D3330-Molar Root Canal Therapy D3346-Anterior Root Canal Retreatment D3347-Bicuspid Root Canal Retreatment D3348-Molar Root Canal Retreatment

(d) Periodontal Services which are funded through the NG6H 2065 Medical Readiness or

D4355-Full Mouth Debridement D4342-Periodontal Scaling and Root Planning, 1 to 3 teeth per quadrant

Periodontal scaling and root planing is authorized only when a periodontal abscess is present)

(e) Prosthodontic Services which are funded through the NG6H 2065 Medical Readiness or VFRE 2020 Dental Treatment Funding (provided only to Soldiers alerted to an OCONUS

D5110-Complete Denture-Maxillary D5120-Complete Denture-Mandibular D5211-Maxillary Partial Denture-Resin Base D5212-Mandibular Partial Denture-Resin Base

(f) Oral Surgery Services which are funded through the NG6H 2065 Medical Readiness or VFRE 2020 Dental Treatment Funding (provided only to Soldiers alerted to an OCONUS

D7140-Extraction, Erupted Tooth or Exposed Root D7210-Surgical Removal of Erupted Tooth D7220-Romoval of Impacted Tooth, Soft Tissue D7230-Removal of Impacted Tooth, Partial Bony D7240-Removal of Impacted Tooth, Completely Bony

(g) Orthodontic Services which are funded through the NG6H 2065 Medical Readiness or

D8680-Orthodontic Retention

2. The following dental procedures are not authorized:

Crown (PFM) or (Gold)

Bridges and/or implants Removal of Asymptomatic third molars Routine Prophylaxes (cleanings) Restorations for aesthetics only Restorations for small (non-class 3) caries Extensive Root plane/scaling Osseous Surgery Other diagnostic services

The above listings are guides to assist the State Dental Officer or his/her designee in determining treatment to be authorized. The treatment provided by the PRARNG is to get the Soldier from a dental class 3 to a dental class 2 only. Comprehensive Treatment (to dental class I) is not authorized.

3. If a Soldier needs all of his/her remaining teeth in an arch extracted and a denture placed, the Soldier will not be available for deployment for at least 6 months and shall be disqualified from immediate deployment. However, if the Soldier is otherwise deployable (passes all medical, personnel and training requirements) and, after extraction and placement of prosthesis, would be deployable, the dental treatment could be provided and the Soldier could be considered as a replacement at a later date.

4. If a Soldier will have a number of teeth extracted to the extent mastication and speech are adversely affected, then an acrylic removable partial denture will be authorized if there is sufficient time for healing and construction of the partial denture prior to departure to Mobilization Station.

5. Soldiers requiring extensive periodontal treatment will be disqualified from deployment and educated on the TRICARE Dental Program. If he/she obtains the required therapy (from his/her private dental provider) and reaches a maintenance level, then he/she would become deployable.

6. The State Dental Officer (or designated representative) will review any dental treatment plan for dental care which exceeds $2000 to insure that the above clinical guidelines are met.

Exceptions can be made, but they must be coordinated with the State Surgeon Office.

APPENDIX E

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

Performance Requirements Summary

Specification Item Performance Objective AQL Method of

Surveillance Sample

Size Frequency

Access for Dental Services

All Dental Pt must receive an appointment in a timely manner.(Within 30 days)

95% Inspection 100% 100%

Dental Treatment Authorization

Treatment provided to SM will be only the one authorized in Memo’s generated by State

Dental Office

100% Inspection 100% 100%

Dental Treatment Procedure

Contractor will assure that procedures are done under Federal

Regulations

95% Inspection 100% 100%

Memorandum of treatment authorization

Contractor will return memorandum to the

State Dental Office once treatment are finished with detail procedure and signature

95% Inspection 100% 100%

Quality Care All providers must be credentialed 100% Inspection 100% 100%

PL Safety PL Safety incidents must be reported 100% Inspection 100% 100%

Invoices

Invoices for treatments should be sent to the

State Dental Office in a timely manner(within 30 days)

100% Inspection 100% 100%

Dental Office

Contractors office should be accessible and have parking access , all ADA

, federal and state certifications updated and available

95% Inspection 100% 100%

APPENDIX F

Quality Assurance Surveillance Plan Date: _______________ Agency: _______________________________ Vendor’s Representative: _____________________________

POC: _________________________________________

Task ID Indicator Standard Acceptable

Quality Level

Method of Surveillance

Obtained

Access for Dental Services

All Dental Pt must receive an appointment in a timely manner.(Within 30 days)

100% Observation and confirmation by phone

Task ID Indicator Standard Acceptable

Quality Level

Method of Surveillance

Obtained

Dental Treatment Authorization

Treatment provided to SM will be only the one authorized in Memo’s generated by State Dental Office

100% Auditing

Dental Treatment Procedure

Contractor will assure that procedures are done under Federal Regulations

100% Observation and random Inspection

Memorandum of treatment authorization

Contractor will return memorandum to the State Dental Office once treatment are finished with detail procedure and signature

100% Auditing

5 Quality Care Providers and staff are familiarized with the process outlined in contract.

90% Observation/rand om question

6 PL Safety PL Safety incidents must be reported

90% Observation and inspection

7 Invoices

Invoices for treatments should be sent to the State Dental Office in a timely manner(within 30 days)

90% Observation and auditing

8 Dental Office

Contractors office should be accessible and have parking access , all ADA , federal and state certifications updated and available

100% Observation and inspection

REMARKS:

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

28-SEP-2015

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

52.212-4 Contract Terms and Conditions--Commercial Items MAY 2015 52.222-19 Child Labor -- Cooperation with Authorities and Remedies JAN 2014 52.222-26 Equal Opportunity APR 2015 52.222-50 Combating Trafficking in Persons MAR 2015 52.222-50 Combating Trafficking in Persons MAR 2015 52.223-6 Drug-Free Workplace MAY 2001 52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

AUG 2011

52.232-33 Payment by Electronic Funds Transfer--System for Award Management

JUL 2013

52.243-1 Changes--Fixed Price AUG 1987 52.252-2 Clauses Incorporated By Reference FEB 1998 252.204-7006 Billing Instructions OCT 2005 252.204-7012 Safeguarding of Unclassified Controlled Technical

Information

AUG 2015

252.232-7003 Electronic Submission of Payment Requests and Receiving Reports

JUN 2012

CLAUSES INCORPORATED BY FULL TEXT

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:

Price

(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).

____ (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).

___ (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]

XX (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.

XX (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.

____ (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).

____ (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)).

____ (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)).

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

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

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

XX (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).

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

13496).

XX (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.

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

13513).

XX (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)).

XX (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).

____ (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).

XXX (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).

_____ (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.

(End of clause)

52.213-4 TERMS AND CONDITIONS--SIMPLIFIED ACQUISITIONS (OTHER THAN COMMERCIAL

ITEMS) (SEP 2015)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses that are ncorporated by reference:

(1) The clauses listed below implement provisions of law or Executive order:

(i) 52.222-3, Convict Labor (JUN 2003) (E.O. 11755).

(ii) 52.222-21, Prohibition of Segregated Facilities (APR 2015).

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

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

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

(vi) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Pub. L. 108-77, 108-78 (19 U.S.C. 3805 note).

(2) Listed below are additional clauses that apply:

(i) 52.232-1, Payments (APR 1984).

(ii) 52.232-8, Discounts for Prompt Payment (FEB 2002).

(iii) 52.232-11, Extras (APR 1984).

(iv) 52.232-25, Prompt Payment (JUL 2013).

(v) 52.232-39, Unenforceability of Unauthorized Obligations (JUN 2013).

(vi) 52.232-40, Providing Accelerated Payments to Small Business Subcontractors (DEC 2013).

(vii) 52.233-1, Disputes (MAY…