W912LR-15-T-0050-0001_Laboratory_Services.pdf

0010612177-0001

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

Evaluation method: Low est price and delivery of laboratory test result shall be the same day before 1:00 P.M. as per item 10.2 of the PWS.

Pricing evaluation w ill consist of the total price of one each laboratory test of the list on item “4. Services” of the PWS. See “Detailed Price List.xlsx” for more details. To be taken in consideration contractor shall return solicitation document w ith its amendment (Standard Form 1449 and Standart Form 30).

PWS item 5.1 – Period of Performance shall read September 28, 2015 to September 27, 2016.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 8

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 16-Sep-2015

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W912LR-15-T-0050

X 9B. DATED (SEE ITEM 11)

15-Sep-2015

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer is extended, X is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

16-Sep-2015

CODE

USPFO FOR PUERTO RICO

BLDG 540 / BORINQUENEER ST

FORT BUCHANAN PR 00934-4069

W912LR 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W912LR-15-T-0050

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

The following have been added by full text:

DETAILED PRICE LIST

Test Quantity Price

1. Hematology (CBC) 1 each

2. Urinalysis (U/A) 1 each

3. Chemistry (FBS) 1 each

4. Males over 40 years (PSA) 1 each

5. Lipid Panel (CHOL, LDL, HDL, Triglycerides) 1 each

6. G6PD 1 each

7. Blood Type 1 each

8. Sickle Cell Test 1 each

Total

Note: It is required that all laboratory test results are delivered the same day no later of 1300 hours.

The following have been modified:

PERFORMANCE WORK STATEMENT

Performance Work Statement for

Laboratory Services

Support of Individual Medical Readiness (IMR) and Soldier Readiness Processing (SRP)

Mobilization Support

Puerto Rico Army National Guard

Camp Santiago Joint Maneuver Training Site Salinas, PR, 00751

1. BACKGROUND: Individual Medical Readiness (IMR) is the basic principle of force sustainment for the Puerto Rico Army National Guard (PRARNG) forces. Medical and Dental Health is vital for force health protection. Failure to achieve a standard of level of medical and dental health could preclude a soldier from deploying. Medical and Dental Readiness is a command responsibility. This Performance Work Statement (PWS) covers the various components of IMR to include but not limited to:

2. DESCRIPTION OF SERVICES/INTRODUCTION: The contractor must provide all qualified personnel and supervision, transportation to execute the contract requirements and material to conduct collection, handling and analysis of laboratory specimens. Provides a description of the work to be completed and the required outcomes. The contractor shall provide qualified personnel to perform the services, and /or OSHA, HIPPA, ADA, and Privacy Act Compliant services.

3. OBJECTIVES AND SCOPE: The Statement of Work is intended to establish the proper procedure to conduct and complete the requirements of laboratory services to collect, handle, process and analyze all requested blood and urine test during the Physical Examination , PHA and SRP to soldiers as part of the Medical Readiness requirements

4. SERVICES: The contractor shall provide all management, labor, test material and certification necessary to provide all listed services, HIPAA, Privacy Act, OSHA & ADA compliant. A determined number of laboratory tests for each services member of PRARNG listed in the SOW will be performance, at Camp Santiago Maneuver Site, Building 589A.

Laboratory Test:

1. Hematology (CBC)

2. Urinalysis (U/A)

3. Chemistry (FBS)

4. Males over 40 years (PSA)

5. Lipid Panel (CHOL, LDL, HDL, Triglycerides)

6. G6PD

7. Blood Type

8. Sickle Cell Test

5. PERIOD OF PERFORMANCE:

5.1 The period of performance is from 1 September 2015 to 31 August 2016. September

28, 2015 to September 27, 2016.

5.2 The contractor is responsible for conducting the tests listed in section 4 during regular drill weekends (six days per month). Weekends are considered Friday thru Sunday starting 0630 until the tests are completed or unless special arrangements are made.

5.3 Dates may vary due to mobilization process and contractor will be notified.

6. PLACE OF PERFORMANCE: Camp Santiago Joint Maneuver Site, Salinas, Puerto Rico, Building 589A, Soldier Readiness Processing Site. Government facilities must be provided because this is the site for processing of soldiers for their Periodic Health Assessments (PHA) and Soldier Readiness processing (SRP).

7. GOVERNMENT-FURNISHED PROPERTY AND INFORMATION

7.1. No government furnished property will be provided.

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

CPT Edalia E. Cedeño Puerto Rico Army National Guard Office of the State Surgeon

(787) 289-1400 Ext: 1185 edalia.e.cedeno.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, monitor Contractor's performance and notifies both the Contracting Officer and Contractor of any deficiencies; 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.

9. OTHER CONDITIONS/ SECURITY

9.1 Safety: The contractor must ensure a safe environment to all subcontractors’ workers and Soldiers. All actions must comply with Health Information Portability and Accountability Act (HIPAA), and The Privacy Act.

9.2 Performance work statement: is “UNCLASSIFIED” and under HIPAA regulations. Contractor shall notify the contracting officer if requirement exists for secret classification and circumstances requiring secret classification for Readiness impact reporting.

9.3 Security Requirements: Base security will require all employees and affiliated personnel of the contractor to carry a State recognized identification card or drivers license and all vehicles are subject to search without reason. The contractor will comply with all installation security requirements. All facilities will be cleaned at the end of each day.

9.4 Reporting: The contractor shall provide a final report for all services provided to include a by name, unit, and social security number roster of all soldiers receiving services. This report will also include a by name and hours accountability of personnel in each event. The report must be approved and verified by the POC from the PRARNG State Surgeon’s Office.

9.5 Contract Manager: The contractor shall provide a contract manager who shall be responsible for the performance of the work. The name of this person and an alternate who shall act for the contractor when the manager is absent shall be designated in writing to the contracting officer. The contract manager or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The contractor shall consolidate all medical services performed on an individual event basis and submit an invoice to the Puerto Rico Medical Command Point of Contact (POC) for certification and payment processing. Contractor should understand that there will be no employer-employee relationship between the parties.

10. SPECIFIC TASKS

10.1 Laboratory Tests Services: approximately 100 Soldiers will be processed on every event day. This number can fluctuate according to the needs of the PRARNG. In the event of larger number of soldiers needing evaluation, the number of personnel assigned to the event will also vary.

The event will flow as follows:

- 25 Soldier per team rotation

- Team rotation time will be hourly: 0730 / 0830 / 0930 / 1030…

- Soldiers requiring fasting laboratory will report to the gazebo area by the lake at

0630.

10.2 It is required that all laboratory test results are delivered the same day and no later of 1300 hours.

10.3 Documentation: Roster of participants will be provided by PRARNG prior to the event. The roster will be in MS Excel format and will require the following information: Last Name, First Name and Complete SSN.

11. APPLICABLE DOCUMENTS & PUBLICATIONS

The contractor will ensure that all appropriate DA or DD forms (in accordance with references) are utilized for each service supplied. The forms will be made available through the PRARNG State Surgeon’s Office. All publications listed are available via the Internet at the specified web address. (http://www.usapa.army.mil/). The contractor will provide all documentation concerning medical evaluation to the State Surgeon’s Office and the Contract Administrator.

12. CONTRACTOR MANPOWER REPORTING

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 the ARMY 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

13. 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

(End of Summary of Changes)