W912LR-18-T-0013.pdf

SEE ADDENDUM

(No Collect Calls)

W912LR-18-T-0013 09-May-2018

b. TELEPHONE NUMBER 8. OFFER DUE DATE/LOCAL TIME

01:00 PM 08 Jun 2018

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

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

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W912LR9. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

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

0011133793-0001

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

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

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESSX

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

USPFO FOR PUERTO RICO

BLDG 540 / BORINQUENEER ST

FORT 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

SFC FELIX RIVERA

CAMP SANTIAGO JOINT TRAINING SITE

ARRILLAGA ST BLDG 587

SALINAS PR 00751

TEL: 787-260-8015 FAX:

787-277-7690FAX:

TEL: 787-277-7600 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$11,000,000

NAICS:

621111

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

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

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

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

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF43

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-18-T-0013

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0010 624 Each Registered Nurse (RN Team Leader)

FFP

Up to one Register Nurse per event One Register Nurse per event Registered Nurse (1 each) shall have knowledge of all areas and be able to act as a liaison between the Medical Command administration and the working team. Special reporting to the State Surgeon/Deputy State Surgeon for case management post event. Responsible for authentication of personnel attendance and submit an After Action Report (AAR).

The contractor must have knowledge and skill to perform a variety of tasks specific to outpatient primary care.

Period of performance: 29 June 2018 to 28 June 2019 FOB: Destination

PURCHASE REQUEST NUMBER: 0011133793-0001

PSC CD: Q201

NET AMT

0020 3,120 Each Licensed Practitioner Nurse (LPN)

FFP

Up to five LPN per event LPN will use of medical equipment, medical materials and supplies for the purpose of carrying out vital signs monitoring, referrals and identification of illness in patients whose age may range from 17 years to 60 years. Also administer and obtain immunization, vital signs (BP, Pulse, Respiration), obtaining and recording height and weight measurements, EKG, and taking active part of the patient counseling and guidance in the process of PHA, SRP. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document.

Period of performance: 29 June 2018 to 28 June 2019 FOB: Destination

0030 624 Each Medical Provider

FFP

One Medical Provider per event Responsible for performing Periodic Health Assessment, review and all referrals.

Will provide determination of returning soldiers to duty following an absence.

Identify duty related injuries, accidents, illness and impairment. Order routine laboratories and x-rays when necessary. Refers to Fort Fuchanan RAHC, VA and other hospitals as necessary. Complete all Electronic Medical Profiling in the EProfile Module. Medically clears Soldier when proper medical evidence is provided by the Service Member. Provides information to soldiers on medical conditions that may limit the soldiers’ performance. All annotation and entry of services into the DD Form 2766 Adult Preventive and Chronic Care Flow sheet or appropriate document.

Period of performance: 29 June 2018 to 28 June 2019 FOB: Destination

0040 624 Each Dental Provider

FFP

One Dental Provider per event Contractor functions in the areas of Oral Dentistry, Radiology and Oral Diagnosis, receives soldiers for examination during evaluation events in the CSJTC Dental Clinic. Maintains and properly stores an adequate level of supplies. Positions soldier and film for proper exposure of intra and extra-oral x-rays. Processes exposed films, using either automatic or manual processing techniques. All annotation and entry of services into the DD Form 2766 Adult Preventive and Chronic Care Flow sheet or appropriate document and medical/dental readiness modules.

Period of performance: 29 June 2018 to 28 June 2019 FOB: Destination

0050 1,872 Each

DENTAL ASISTANCE

FFP

Up to three Dental Assistance per event Prepares the evaluation area using proper infection control techniques as prescribed in service policies and by properly laying out all instruments and materials in the sequence of use and then prepares the soldier. Obtains and records information related to the medical and dental history of the patient including temperature, pulse and blood pressure. Charts information relayed by the Dental Provider. Will provide support to dental care provider at chair side. Passes instruments and materials to, and retrieves them from the dental provider, keeps the field maintains dental equipment and dental operatory in a clean and operable condition. Processes exposed films, using either automatic or manual processing techniques. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document and medical/dental readiness modules.

Period of performance: 29 June 2018 to 28 June 2019 FOB: Destination

0060 1,248 Each Optical Technician

FFP

Up to two Optical Technician per event The Contractor performs routine clinical procedures and tasks, to include patient history for review. Measures visual acuity, distance and ear, corrected and uncorrected vision. Performs visual field evaluations using automated and manual visual field analyzers independently. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document.

Period of performance: 29 June 2018 to 28 June 2019 FOB: Destination

0070 3,120 Each Medical Record Clerk

FFP

Up to five Patient Administration Services Technicians Clerk per event Patient Administration Services Technicians reviews referrals and refers more difficult requests to appropriate levels; receives telephone calls, relays messages to appropriate staff. Updates files for medical reports; generates statistical report. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document. Handles Medical Records, updates filling of same. Handles with the Service Member update of the electronic medical forms.

Period of performance: 29 June 2018 to 28 June 2019 FOB: Destination

0080 1 Each Army Contract Manpower Report

FFP

The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the contractor will report ALL contractor manpower (including subcontractor manpower) required for performance of this contract. The contractor is required to completely fill in all the information in the format using the following web address:

https://cmra.army.mil/.

The required information includes: (1) Contracting Office, Contracting Officer, Contracting Officer’s Technical Representative; (2) Contract number, including task and delivery order number; (3) Beginning and ending dates covered by reporting period; (4) contractor name, address, phone number, e-mail address, identity of contractor employee entering data; (5) Estimated direct labor hours (including sub-contractors); (6) Estimated direct labor dollars paid this reporting period (including sub-contractors); (7) total payments (including sub-contractors);

(8) Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC for each Sub-contractor if different); (9) Estimated data collection cost; (10) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the contractor with its UIC for the purposes of reporting this information); (11) Locations where contractor and sub-contractors perform the work (specified by zip code in the Untied States and nearest city, country, when in an overseas location, using standardized nomenclature provided on website); (12) Presence of deployment or contingency contract language; and

(13) Number of contractor and sub-contractor employees deployed in theater this reporting period (by country).

As part of its submission, the contractor will also provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period will be the period of performance not to exceed 12 months ending September 30 of each government fiscal year and must be reported by 31 Oct of each calendar year.

Contracting Office: W912LR-USPFO for Puerto Rico Contracting Officer: SGM Myriam Perez myriam.perezsantos.mil@mail.mil Contracting Officer’s Representative COR: TBD Requiring Activity Unit Identification Code (UIC): TBD FOB: Destination

1010 624 Each OPTION Registered Nurse (RN Team Leader)

FFP

One Register Nurse per event Registered Nurse (1 each) shall have knowledge of all areas and be able to act as a liaison between the Medical Command administration and the working team.

Special reporting to the State Surgeon/Deputy State Surgeon for case management post event. Responsible for authentication of personnel attendance and submit an After Action Report (AAR). The contractor must have knowledge and skill to perform a variety of tasks specific to outpatient primary care.

Period of performance: 29 June 2019 to 28 June 2020 FOB: Destination

1020 3,120 Each OPTION Licensed Practitioner Nurse (LPN)

FFP

Up to five LPN per event LPN will use of medical equipment, medical materials and supplies for the purpose of carrying out vital signs monitoring, referrals and identification of illness in patients whose age may range from 17 years to 60 years. Also administer and obtain immunization, vital signs (BP, Pulse, Respiration), obtaining and recording height and weight measurements, EKG, and taking active part of the patient counseling and guidance in the process of PHA, SRP. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document.

Period of performance: 29 June 2019 to 28 June 2020 FOB: Destination

1030 624 Each OPTION Medical Provider

FFP

One Medical Provicer per event Responsible for performing Periodic Health Assessment, review and all referrals.

Will provide determination of returning soldiers to duty following an absence.

Identify duty related injuries, accidents, illness and impairment. Order routine laboratories and x-rays when necessary. Refers to Fort Buchanan RAHC, VA and other hospitals as necessary. Complete all Electronic Medical Profiling in the EProfile Module. Medically clears Soldier when proper medical evidence is provided by the Service Member. Provides information to soldiers on medical conditions that may limit the soldiers’ performance. All annotation and entry of services into the DD Form 2766 Adult Preventive and Chronic Care Flow sheet or appropriate document.

Period of performance: 29 June 2019 to 28 June 2020 FOB: Destination

1040 624 Each OPTION Dental Provider

FFP

One Dental Provider per event Contractor functions in the areas of Oral Dentistry, Radiology and Oral Diagnosis, receives soldiers for examination during evaluation events in the CSJTC Dental Clinic. Maintains and properly stores an adequate level of supplies. Positions soldier and film for proper exposure of intra and extra-oral x-rays. Processes exposed films, using either automatic or manual processing techniques. All annotation and entry of services into the DD Form 2766 Adult Preventive and Chronic Care Flow sheet or appropriate document and medical/dental readiness modules.

Period of performance:29 June 2019 to 28 June 2020 FOB: Destination

1050 1,872 Each OPTION Dental Assistant

FFP

Up to three Dental Assistance per event Prepares the evaluation area using proper infection control techniques as prescribed in service policies and by properly laying out all instruments and materials in the sequence of use and then prepares the soldier. Obtains and records information related to the medical and dental history of the patient including temperature, pulse and blood pressure. Charts information relayed by the Dental Provider. Will provide support to dental care provider at chair side. Passes instruments and materials to, and retrieves them from the dental provider, keeps the field maintains dental equipment and dental operatory in a clean and operable condition. Processes exposed films, using either automatic or manual processing techniques. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document and medical/dental readiness modules.

Period of performance: 29 June 2019 to 28 June 2020 FOB: Destination

1060 1,248 Each OPTION Optical Technician

FFP

Up to two Optical Technician per event The Contractor performs routine clinical procedures and tasks, to include patient history for review. Measures visual acuity, distance and near, corrected and uncorrected vision. Performs visual field evaluations using automated and manual visual field analyzers independently. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document Period of performance: 29 June 2019 to 28 June 2020 FOB: Destination

1070 3,120 Each OPTION Medical Record Clerk

FFP

Up to five Patient Administration Services Technicians Clerk per event Patient Administration Services Technicians reviews referrals and refers more difficult requests to appropriate levels; receives telephone calls, relays messages to appropriate staff. Updates files for medical reports; generates statistical report. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document. Handles Medical Records, updates filling of same. Handles with the Service Member update of the electronic medical forms.

Period of performance: 29 June 2019 to 28 June 2020 FOB: Destination

1080 1 Each OPTION Army Contract Manpower Report

FFP

The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the contractor will report ALL contractor manpower (including subcontractor manpower) required for performance of this contract. The contractor is required to completely fill in all the information in the format using the following web address:

https://cmra.army.mil/.

The required information includes: (1) Contracting Office, Contracting Officer, Contracting Officer’s Technical Representative; (2) Contract number, including task and delivery order number; (3) Beginning and ending dates covered by reporting period; (4) contractor name, address, phone number, e-mail address, identity of contractor employee entering data; (5) Estimated direct labor hours (including sub-contractors); (6) Estimated direct labor dollars paid this reporting period (including sub-contractors); (7) total payments (including sub-contractors);

(8) Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC for each Sub-contractor if different); (9) Estimated data collection cost; (10) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the contractor with its UIC for the purposes of reporting this information); (11) Locations where contractor and sub-contractors perform the work (specified by zip code in the Untied States and nearest city, country, when in an overseas location, using standardized nomenclature provided on website); (12) Presence of deployment or contingency contract language; and

(13) Number of contractor and sub-contractor employees deployed in theater this reporting period (by country).

As part of its submission, the contractor will also provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period will be the period of performance not to exceed 12 months ending September 30 of each government fiscal year and must be reported by 31 Oct of each calendar year.

Contracting Office: W912LR-USPFO for Puerto Rico Contracting Officer: SGM Myriam Perez myriam.perezsantos.mil@mail.mil Contracting Officer’s Representative COR: TBD Requiring Activity Unit Identification Code (UIC): TBD FOB: Destination

2010 624 Each OPTION Registered Nurse (RN Team Leader)

FFP

Up to one Register Nurse per event One Register Nurse per event Registered Nurse (1 each) shall have knowledge of all areas and be able to act as a liaison between the Medical Command administration and the working team. Special reporting to the State Surgeon/Deputy State Surgeon for case management post event. Responsible for authentication of personnel attendance and submit an After Action Report (AAR).

The contractor must have knowledge and skill to perform a variety of tasks specific to outpatient primary care.

Period of performance: 29 June 2020 to 28 June 2021 FOB: Destination

2020 3,120 Each OPTION Licensed Practitioner Nurse (LPN)

FFP

Up to five LPN per event LPN will use of medical equipment, medical materials and supplies for the purpose of carrying out vital signs monitoring, referrals and identification of illness in patients whose age may range from 17 years to 60 years. Also administer and obtain immunization, vital signs (BP, Pulse, Respiration), obtaining and recording height and weight measurements, EKG, and taking active part of the patient counseling and guidance in the process of PHA, SRP. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document.

Period of performance: 29 June 2020 to 28 June 2021 FOB: Destination

2030 624 Each OPTION Medical Provider

FFP

One Medical Provicer per event Responsible for performing Periodic Health Assessment, review and all referrals.

Will provide determination of returning soldiers to duty following an absence.

Identify duty related injuries, accidents, illness and impairment. Order routine laboratories and x-rays when necessary. Refers to Fort Buchanan RAHC, VA and other hospitals as necessary. Complete all Electronic Medical Profiling in the EProfile Module. Medically clears Soldier when proper medical evidence is provided by the Service Member. Provides information to soldiers on medical conditions that may limit the soldiers’ performance. All annotation and entry of services into the DD Form 2766 Adult Preventive and Chronic Care Flow sheet or appropriate document.

Period of performance: 29 June 2020 to 28 June 2021 FOB: Destination

2040 624 Each OPTION Dental Provider

FFP

One Dental Provider per event Contractor functions in the areas of Oral Dentistry, Radiology and Oral Diagnosis, receives soldiers for examination during evaluation events in the CSJTC Dental Clinic. Maintains and properly stores an adequate level of supplies. Positions soldier and film for proper exposure of intra and extra-oral x-rays. Processes exposed films, using either automatic or manual processing techniques.

Allannotation and entry of services into the DD Form 2766 Adult Preventive and Chronic Care Flow sheet or appropriate document and medical/dental readiness modules.

Period of performance: 29 June 2020 to 28 June 2021 FOB: Destination

2050 1,872 Each OPTION Dental Assistant

FFP

Up to three Dental Assistance per event Prepares the evaluation area using proper infection control techniques as prescribed in service policies and by properly laying out all instruments and materials in the sequence of use and then prepares the soldier. Obtains and records information related to the medical and dental history of the patient including temperature, pulse and blood pressure. Charts information relayed by the Dental Provider. Will provide support to dental care provider at chair side. Passes instruments and materials to, and retrieves them from the dental provider, keeps the field maintains dental equipment and dental operatory in a clean and operable condition. Processes exposed films, using either automatic or manual processing techniques. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document and medical/dental readiness modules.

Period of performance: 29 June 2020 to 28 June 2021 FOB: Destination

2060 1,248 Each OPTION Optical Technician

FFP

Up to two Optical Technician per event The Contractor performs routine clinical procedures and tasks, to include patient history for review. Measures visual acuity, distance and near, corrected and uncorrected vision. Performs visual field evaluations using automated and manual visual field analyzers independently. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document.

Period of performance: 29 June 2020 to 28 June 2021 FOB: Destination

2070 3,120 Each OPTION Medical Record Clerk

FFP

Up to five Patient Administration Services Technicians Clerk per event Patient Administration Services Technicians reviews referrals and refers more difficult requests to appropriate levels; receives telephone calls, relays messages to appropriate staff. Updates files for medical reports; generates statistical report. All annotation and entry of services into the DD Form 2766- Adult Preventive and Chronic Care Flow sheet or appropriate document. Handles Medical Records, updates filling of same. Handles with the Service Member update of the electronic medical forms.

Period of performance: 29 June 2020 to 28 June 2021 FOB: Destination

2080 1 Each OPTION Army Contract Manpower Report

FFP

The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the contractor will report ALL contractor manpower (including subcontractor manpower) required for performance of this contract. The contractor is required to completely fill in all the information in the format using the following web address:

https://cmra.army.mil/.

The required information includes: (1) Contracting Office, Contracting Officer, Contracting Officer’s Technical Representative; (2) Contract number, including task and delivery order number; (3) Beginning and ending dates covered by reporting period; (4) contractor name, address, phone number, e-mail address, identity of contractor employee entering data; (5) Estimated direct labor hours (including sub-contractors); (6) Estimated direct labor dollars paid this reporting period (including sub-contractors); (7) total payments (including sub-contractors);

(8) Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC for each Sub-contractor if different); (9) Estimated data collection cost; (10) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the contractor with its UIC for the purposes of reporting this information); (11) Locations where contractor and sub-contractors perform the work (specified by zip code in the Untied States and nearest city, country, when in an overseas location, using standardized nomenclature provided on website); (12) Presence of deployment or contingency contract language; and

(13) Number of contractor and sub-contractor employees deployed in theater this reporting period (by country).

As part of its submission, the contractor will also provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period will be the period of performance not to exceed 12 months ending September 30 of each government fiscal year and must be reported by 31 Oct of each calendar year.

Contracting Office: W912LR-USPFO for Puerto Rico Contracting Officer: SGM Myriam Perez myriam.perezsantos.mil@mail.mil Contracting Officer’s Representative COR: TBD Requiring Activity Unit Identification Code (UIC): TBD FOB: Destination

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0010 Destination Government Destination Government 0020 Destination Government Destination Government 0030 Destination Government Destination Government 0040 Destination Government Destination Government 0050 Destination Government Destination Government 0060 Destination Government Destination Government 0070 Destination Government Destination Government 0080 Destination Government Destination Government 1010 Destination Government Destination Government 1020 Destination Government Destination Government 1030 Destination Government Destination Government 1040 Destination Government Destination Government 1050 Destination Government Destination Government 1060 Destination Government Destination Government 1070 Destination Government Destination Government 1080 Destination Government Destination Government 2010 Destination Government Destination Government 2020 Destination Government Destination Government 2030 Destination Government Destination Government 2040 Destination Government Destination Government 2050 Destination Government Destination Government 2060 Destination Government Destination Government 2070 Destination Government Destination Government 2080 Destination Government Destination Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

0010 POP 29-JUN-2018 TO

28-JUN-2019

N/A W8ZV PR ARNG MED DET

SFC FELIX RIVERA

CAMP SANTIAGO JOINT TRAINING SITE

ARRILLAGA ST BLDG 587

SALINAS PR 00751

787-260-8015 FOB: Destination

W56SCX

0020 POP 29-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0030 POP 29-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0040 POP 29-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0050 POP 29-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0060 POP 29-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0070 POP 29-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0080 POP 29-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

1010 POP 29-JUN-2019 TO

28-JUN-2020

N/A (SAME AS PREVIOUS LOCATION)

1020 POP 29-JUN-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

1030 POP 29-JUN-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

1040 POP 29-JUN-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

1050 POP 29-JUN-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

1060 POP 29-JUN-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

1070 POP 29-JUN-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

1080 POP 29-JUN-2019 TO

N/A (SAME AS PREVIOUS LOCATION)

2010 POP 29-JUN-2020 TO

28-JUN-2021

N/A (SAME AS PREVIOUS LOCATION)

2020 POP 29-JUN-2020 TO

N/A (SAME AS PREVIOUS LOCATION)

2030 POP 29-JUN-2020 TO

N/A (SAME AS PREVIOUS LOCATION)

2040 POP 29-JUN-2020 TO

N/A (SAME AS PREVIOUS LOCATION)

2050 POP 29-JUN-2020 TO

N/A (SAME AS PREVIOUS LOCATION)

2060 POP 29-JUN-2020 TO

N/A (SAME AS PREVIOUS LOCATION)

2070 POP 29-JUN-2020 TO

N/A (SAME AS PREVIOUS LOCATION)

2080 POP 29-JUN-2020 TO

N/A (SAME AS PREVIOUS LOCATION)

CLAUSES INCORPORATED BY REFERENCE

52.203-3 Gratuities APR 1984 52.203-19 Prohibition on Requiring Certain Internal Confidentiality

Agreements or Statements

JAN 2017

52.204-2 Security Requirements AUG 1996 52.204-9 Personal Identity Verification of Contractor Personnel JAN 2011 52.209-6 Protecting the Government's Interest When Subcontracting

With Contractors Debarred, Suspended, or Proposed for Debarment

OCT 2015

52.209-7 Information Regarding Responsibility Matters JUL 2013 52.209-7 Information Regarding Responsibility Matters JUL 2013 52.209-9 Updates of Publicly Available Information Regarding

Responsibility Matters

JUL 2013

52.209-10 Prohibition on Contracting With Inverted Domestic Corporations

NOV 2015

52.212-1 Instructions to Offerors--Commercial Items JAN 2017 52.212-3 Offeror Representations and Certifications--Commercial

Items

NOV 2017

52.212-4 Contract Terms and Conditions--Commercial Items JAN 2017 52.216-31 Time-and-Materials/Labor-Hour Proposal Requirements--

Commercial Item Acquisition

FEB 2007

52.217-2 Cancellation Under Multiyear Contracts OCT 1997 52.219-6 Notice Of Total Small Business Set-Aside NOV 2011 52.219-8 Utilization of Small Business Concerns NOV 2016 52.219-28 Post-Award Small Business Program Rerepresentation JUL 2013 52.222-1 Notice To The Government Of Labor Disputes FEB 1997 52.222-1 Notice To The Government Of Labor Disputes FEB 1997

52.222-3 Convict Labor JUN 2003 52.222-19 Child Labor -- Cooperation with Authorities and Remedies JAN 2018 52.222-21 Prohibition Of Segregated Facilities APR 2015 52.222-26 Equal Opportunity SEP 2016 52.222-41 Service Contract Labor Standards MAY 2014 52.222-43 Fair Labor Standards Act And Service Contract Labor

Standards - Price Adjustment (Multiple Year And Option Contracts)

MAY 2014

52.222-50 Combating Trafficking in Persons MAR 2015 52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

AUG 2011

52.223-19 Compliance with Environmental Management Systems MAY 2011 52.228-5 Insurance - Work On A Government Installation JAN 1997 52.232-18 Availability Of Funds APR 1984 52.232-33 Payment by Electronic Funds Transfer--System for Award

Management

JUL 2013

52.233-2 Service Of Protest SEP 2006 52.233-3 Protest After Award AUG 1996 52.233-4 Applicable Law for Breach of Contract Claim OCT 2004 52.237-3 Continuity Of Services JAN 1991 52.245-1 Government Property JAN 2017 52.246-1 Contractor Inspection Requirements APR 1984 52.246-4 Inspection Of Services--Fixed Price AUG 1996 52.246-6 Inspection--Time-And-Material And Labor-Hour MAY 2001 52.247-34 F.O.B. Destination NOV 1991 52.249-4 Termination For Convenience Of The Government (Services)

(Short Form)

APR 1984

252.201-7000 Contracting Officer's Representative DEC 1991 252.203-7000 Requirements Relating to Compensation of Former DoD

Officials

SEP 2011

252.203-7002 Requirement to Inform Employees of Whistleblower Rights SEP 2013 252.204-7000 Disclosure Of Information OCT 2016 252.204-7003 Control Of Government Personnel Work Product APR 1992 252.211-7007 Reporting of Government-Furnished Property AUG 2012 252.232-7003 Electronic Submission of Payment Requests and Receiving

Reports

JUN 2012

252.232-7006 Wide Area WorkFlow Payment Instructions MAY 2013 252.232-7010 Levies on Contract Payments DEC 2006 252.239-7001 Information Assurance Contractor Training and Certification JAN 2008 252.243-7002 Requests for Equitable Adjustment DEC 2012 252.245-7001 Tagging, Labeling, and Marking of Government-Furnished

Property

APR 2012

252.245-7002 Reporting Loss of Government Property DEC 2017

CLAUSES INCORPORATED BY FULL TEXT

52.203-16 Preventing Personal Conflicts of Interest (DEC 2011)

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

Acquisition function closely associated with inherently governmental functions means supporting or providing advice or recommendations with regard to the following activities of a Federal agency:

(1) Planning acquisitions.

(2) Determining what supplies or services are to be acquired by the Government, including developing statements of work.

(3) Developing or approving any contractual documents, to include documents defining requirements, incentive plans, and evaluation criteria.

(4) Evaluating contract proposals.

(5) Awarding Government contracts.

(6) Administering contracts (including ordering changes or giving technical direction in contract performance or contract quantities, evaluating contractor performance, and accepting or rejecting contractor products or services).

(7) Terminating contracts.

(8) Determining whether contract costs are reasonable, allocable, and allowable.

Covered employee means an individual who performs an acquisition function closely associated with inherently governmental functions and is--

(1) An employee of the contractor; or

(2) A subcontractor that is a self-employed individual treated as a covered employee of the contractor because there is no employer to whom such an individual could submit the required disclosures.

Non-public information means any Government or third-party information that--

(1) Is exempt from disclosure under the Freedom of Information Act (5 U.S.C. 552) or otherwise protected from disclosure by statute, Executive order, or regulation; or

(2) Has not been disseminated to the general public and the Government has not yet determined whether the information can or will be made available to the public.

Personal conflict of interest means a situation in which a covered employee has a financial interest, personal activity, or relationship that could impair the employee's ability to act impartially and in the best interest of the Government when performing under the contract. (A de minimis interest that would not ``impair the employee's ability to act impartially and in the best interest of the Government'' is not covered under this definition.)

(1) Among the sources of personal conflicts of interest are--

(i) Financial interests of the covered employee, of close family members, or of other members of the covered employee's household;

(ii) Other employment or financial relationships (including seeking or negotiating for prospective employment or business); and

(iii) Gifts, including travel.

(2) For example, financial interests referred to in paragraph (1) of this definition may arise from--

(i) Compensation, including wages, salaries, commissions, professional fees, or fees for business referrals;

(ii) Consulting relationships (including commercial and professional consulting and service arrangements, scientific and technical advisory board memberships, or serving as an expert witness in litigation);

(iii) Services provided in exchange for honorariums or travel expense reimbursements;

(iv) Research funding or other forms of research support;

(v) Investment in the form of stock or bond ownership or partnership interest (excluding diversified mutual fund investments);

(vi) Real estate investments;

(vii) Patents, copyrights, and other intellectual property interests; or

(viii) Business ownership and investment interests.

(b) Requirements. The Contractor shall--

(1) Have procedures in place to screen covered employees for potential personal conflicts of interest, by--

(i) Obtaining and maintaining from each covered employee, when the employee is initially assigned to the task under the contract, a disclosure of interests that might be affected by the task to which the employee has been assigned, as follows:

(A) Financial interests of the covered employee, of close family members, or of other members of the covered employee's household.

(B) Other employment or financial relationships of the covered employee (including seeking or negotiating for prospective employment or business).

(C) Gifts, including travel; and

(ii) Requiring each covered employee to update the disclosure statement whenever the employee's personal or financial circumstances change in such a way that a new personal conflict of interest might occur because of the task the covered employee is performing.

(2) For each covered employee--

(i) Prevent personal conflicts of interest, including not assigning or allowing a covered employee to perform any task under the contract for which the Contractor has identified a personal conflict of interest for the employee that the Contractor or employee cannot satisfactorily prevent or mitigate in consultation with the contracting agency;

(ii) Prohibit use of non-public information accessed through performance of a Government contract for personal gain; and

(iii) Obtain a signed non-disclosure agreement to prohibit disclosure of non-public information accessed through performance of a Government contract.

(3) Inform covered employees of their obligation--

(i) To disclose and prevent personal conflicts of interest;

(ii) Not to use non-public information accessed through performance of a Government contract for personal gain;

and

(iii) To avoid even the appearance of personal conflicts of interest;

(4) Maintain effective oversight to verify compliance with personal conflict-of-interest safeguards;

(5) Take appropriate disciplinary action in the case of covered employees who fail to comply with policies established pursuant to this clause; and

(6) Report to the Contracting Officer any personal conflict-of-interest violation by a covered employee as soon as it is identified. This report shall include a description of the violation and the proposed actions to be taken by the Contractor in response to the violation. Provide follow-up reports of corrective actions taken, as necessary. Personal conflict-of-interest violations include--

(i) Failure by a covered employee to disclose a personal conflict of interest;

(ii) Use by a covered employee of non-public information accessed through performance of a Government contract for personal gain; and

(iii) Failure of a covered employee to comply with the terms of a non-disclosure agreement.

(c) Mitigation or waiver. (1) In exceptional circumstances, if the Contractor cannot satisfactorily prevent a personal conflict of interest as required by paragraph (b)(2)(i) of this clause, the Contractor may submit a request through the Contracting Officer to the Head of the Contracting Activity for--

(i) Agreement to a plan to mitigate the personal conflict of interest; or

(ii) A waiver of the requirement.

(2) The Contractor shall include in the request any proposed mitigation of the personal conflict of interest.

(3) The Contractor shall--

(i) Comply, and require compliance by the covered employee, with any conditions imposed by the Government as necessary to mitigate the personal conflict of interest; or

(ii) Remove the Contractor employee or subcontractor employee from performance of the contract or terminate the applicable subcontract.

(d) Subcontract flowdown. The Contractor shall include the substance of this clause, including this paragraph (d), in subcontracts--

(1) That exceed $150,000; and

(2) In which subcontractor employees will perform acquisition functions closely associated with inherently governmental functions (i.e., instead of performance only by a self-employed individual).

(End of clause)

52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND REQUIREMENT TO INFORM

EMPLOYEES OF WHISTLEBLOWER RIGHTS (APR 2014)

(a) This contract and employees working on this contract will be subject to the whistleblower rights and remedies in the pilot program on Contractor employee whistleblower protections established at 41 U.S.C. 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2013 (Pub. L. 112-239) and FAR 3.908.

(b) The Contractor shall inform its employees in writing, in the predominant language of the workforce, of employee whistleblower rights and protections under 41 U.S.C. 4712, as described in section 3.908 of the Federal Acquisition Regulation.

(c) The Contractor shall insert the substance of this clause, including this paragraph (c), in all subcontracts over the simplified acquisition threshold.

52.204-1 APPROVAL OF CONTRACT (DEC 1989)

This contract is subject to the written approval of CoCO and shall not be binding until so approved.

52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS (OCT 2016)

(a) Definition. First-tier subcontract means a subcontract awarded directly by the Contractor for the purpose of acquiring supplies or services (including construction) for performance of a prime contract. It does not include the Contractor's supplier agreements with vendors, such as long-term arrangements for materials or supplies that benefit multiple contracts and/or the costs of which are normally applied to a Contractor's general and administrative expenses or indirect costs.

(b) The Contractor shall report, in accordance with paragraphs (c) and (d) of this clause, annually by October 31, for services performed under this contract during the preceding Government fiscal year (October 1-September 30).

(c) The Contractor shall report the following information:

(1) Contract number and, as applicable, order number.

(2) The total dollar amount invoiced for services performed during the previous Government fiscal year under the contract.

(3) The number of Contractor direct labor hours expended on the services performed during the previous Government fiscal year.

(4) Data reported by subcontractors under paragraph (f) of this clause.

(d) The information required in paragraph (c) of this clause shall be submitted via the internet at www.sam.gov. (See SAM User Guide). If the Contractor fails to submit the report in a timely manner, the contracting officer will exercise appropriate contractual remedies. In addition, the Contracting Officer will make the Contractor's failure to comply with the reporting requirements a part of the Contractor's performance information under FAR subpart 42.15.

(e) Agencies will review Contractor reported information for reasonableness and consistency with available contract information. In the event the agency believes that revisions to the Contractor reported information are warranted, the agency will notify the Contractor no later than November 15. By November 30, the Contractor shall revise the report, or document its rationale for the agency.

(f)(1) The Contractor shall require each first-tier subcontractor providing services under this contract, with subcontract(s) each valued at or above the thresholds set forth in 4.1703(a)(2), to provide the following detailed information to the Contractor in sufficient time to submit the report:

(i) Subcontract number (including subcontractor name and unique entity identifier); and

(ii) The number of first-tier subcontractor direct-labor hours expended on the services performed during the previous Government fiscal year.

(2) The Contractor shall advise the subcontractor that the information will be made available to the public as required by section 743 of Division C of the Consolidated Appropriations Act, 2010.

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 Technically Acceptable

To be considered technically acceptable, offerors shall accomplish the following:

- Provide state licenses for Medical Provider, Dentists, Nurses (Registered and Practitioner) and Dental Technicians.

- Provide evidence of understanding of the requirement through either a written proposal that addresses PWS requirements or through demonstrated Past Performance on recent and relevant contracts with same or similar scope, the offeror shall provide references for similar services performed, to include contract number (Federal, State, and local governmetn and private), and point of contact information.

The Government will review the offeror’s recent and relevant past performance to include System For Award Management (SAM) and Past Performance Information Retrieval System (PPIRS) among others. Evaluation factors will receive an acceptable or unacceptable rating. In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned the offeror will be determined to have unknown (or "neutral") past performance. In the context of acceptability/unacceptability, a neutral rating shall be considered "acceptable”.

(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.

Requirements for your quote:

1. Fill in accordance with FAR Clause 52.212‐1 Instruction to Offerors – Commercial Item

2. Quote hourly rate shall include the followings:

‐ Labor rate ‐ Benefits ‐ Taxes ‐ Insurances ‐ Profit ‐ Overhead ‐ Any other related operating expense

3. Quotes shall include a price breakdown per individual discipline (Line Item Number) on a separate document.

(End of provision)

52.217-5 EVALUATION OF OPTIONS (JUL 1990)

Except when it is determined in accordance with FAR 17.206(b) not to be in the Government's best interests, the Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. Evaluation of options will not obligate the Government to exercise the option(s).

(End of provision)

52.217-6 OPTION FOR INCREASED QUANTITY (MAR 1989)

The Government may increase the quantity of supplies called for in the Schedule at the unit price specified. The Contracting Officer may exercise the option by written notice to the Contractor within 30 days. Delivery of the added items shall continue at the same rate as the like items called for under the contract, unless the parties otherwise agree.

52.217-7 OPTION FOR INCREASED QUANTITY--SEPARATELY PRICED LINE ITEM (MAR 1989)

The Government may require the delivery of the numbered line item, identified in the Schedule as an option item, in the quantity and at the price stated in the Schedule. The Contracting Officer may exercise the option by written notice to the Contractor within 30 days. Delivery of added items shall continue at the same rate that like items are called for under the contract, unless the parties otherwise agree.

52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30days before period expires.

52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 5 years. (End of clause)

52.222-35 EQUAL OPPORTUNITY FOR VETERANS (OCT 2015)

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

``Active duty wartime or campaign badge veteran,'' ``Armed Forces service medal veteran,'' ``disabled veteran,'' ``protected veteran,'' ``qualified disabled veteran,'' and ``recently separated…