Medical_contractor_Solicitation_W912MM-17-T-0021.pdf

SEE ADDENDUM

(No Collect Calls)

W912MM-17-T-0021 13-Apr-2017

b. TELEPHONE NUMBER

605-737-6768

8. OFFER DUE DATE/LOCAL TIME

12:00 PM 11 May 2017

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.

W912MM9. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

LORISSA L. WETZLER

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

ARE NOT ATTACHED

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

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

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESS

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

W912MM - USPFO FOR SOUTH DAKOTA

ATTN: LORISSA L. WETZLER -

EMAIL: LORISSA.L.WETZLER.MIL@MAIL.MIL

2823 WEST MAIN ST - BLDG 420

RAPID CITY SD 57702-8170

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 W90YD8 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

DELIVERY SCHEDULE

POC LISTED IN SCHEDULE

DETAILS IN CLIN OR SCHEDULE

. SD .

TEL: SEE POC TELE IN CLIN FAX:

605-737-6752FAX:

TEL: 605-737-6768 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

X 8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$15,000,000

NAICS:

541618

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 OF40

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.

W912MM-17-T-0021

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0010 1 Job Non-Clinical Case Manager

FFP

One (1) Non-clinical Case Manager, professional Occupation. Fully loaded pricing PIM rate equivelent would be similar to a federal GS-9 level. Please see attached Performance Work Statement. (POP 12 JUN 2017 to 11 JUN 2018).

Services requested 10 hours per day, 40 hours per week (Tuesday through Friday).

Overtime is not authorized.

**REQUEST INCUMBENT**

FOB: Destination

NET AMT

0020 1 Job Non-Clinical Care Coordinators

FFP

Three (3) Non-clinical care Coordinators, SCA Employee. Fully loaded pricing pay rate equivilent would be similar to a Federal GS-7 level. Please see attached Performance Work Statement. (POP 12 JUN 2017 to 11 JUN 2018).

Services requested 10 hours per day, 40 hours per week (Tuesday through Friday).

Overtime is not authorized.

**REQUEST INCUMBENTS**

0030 1 Years Travel

FFP

Travel costs for POP. All travel authorized will be provided by contractor and available for reimbursement upon submission of travel receipts/documentation.

Upon award, the SD Army National Guard will provide required travel budget.

*** NO QUOTE / PRICING REQUIRED FOR THIS CLIN ***

0040 1 Job OPTION Non-Clinical Case Manager

FFP

One (1) Non-Clinical Case Manager, professional Occupation. Fully loaded pricing PIM rate equivilent would be similar to a federal GS-9 level. Please see attached Performance Work Statement. (POP 12 JUN 2018 to 11 JUN 2019).

Services requested 10 hours per day, 40 hours per week (Tuesday through Friday).

Overtime is not authorized.

** REQUEST INCUMBENT **

0050 1 Job OPTION Non-Clinical Care Coordinators

FFP

Three (3) Non-clinical care Coordinators, SCA Employee. Fully loaded pricing pay rate equivilent would be similar to a Federal GS-7 level. Please see attached Performance Work Statement. Fully loaded Hourly Rate (POP 12 JUN 2018 to 11

JUN 2019).

Services requested 10 hours per day, 40 hours per week (Tuesday through Friday).

Overtime is not authorized.

** REQUEST INCUMBENT **

0060 1 Years Travel

FFP

Travel costs for POP. All travel authorized will be provided by contractor and available for reimbursement upon submission of travel receipts/documentation.

Upon award, the SD Army National Guard will provide required travel budget.

CMR

FFP

CONTRACTOR MANPOWER REPORTING

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://contractormanpower.army.pentagon.mil or https://cmra.army.mil

The required information includes:

1. Contracting Office and Contracting Officer

2. Contract number, including task and delivery order number (if applicable)

3. Beginning and ending dates covered by reporting period

4. Contractor name, address, phone number, e-mail address, identity of contractor

5. Estimated direct labor hours (including subcontractors)

6. Estimated direct labor dollars paid this reporting period (including subcontractors)

7. Total payments (including subcontractors)

8. Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC for each subcontractor if different) FSC Code R699

9. Estimated data collection cost

10. Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity is W8A7AA.

11. Locations where contractor and subcontractors (if applicable) perform the work (specified by zip code in the United States and nearest city, country, when in an overseas location, using standardized nomenclature provided on website)

12. Presence of deployment or contingency contract language

13. Number of contractor and subcontractor employees deployed in theater this reporting period.

As part of its submission, the contractor will also provide the estimated total cost (if any) incurred to comply with this reporting requirement. Contractors may use a direct XML data transfer to the database server or fill in the fields on the website.

The XML direct transfer is a format for transferring files from a contractor's systems to the secure website without the need for separate data entries for each required data element at the web site. The specific formats for the XML direct transfer may be downloaded from the web site.

The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the Department of Army CMRA via a secure data collection site. The contractor is required to completely fill in all required data fields using the following web address: 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/

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0010 N/A N/A N/A Government 0020 N/A N/A N/A Government 0030 N/A N/A N/A Government 0040 N/A N/A N/A Government 0050 N/A N/A N/A Government 0060 N/A N/A N/A Government 0100 N/A N/A N/A Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0010 POP 12-JUN-2017 TO

11-JUN-2018

N/A DELIVERY SCHEDULE

POC LISTED IN SCHEDULE

DETAILS IN CLIN OR SCHEDULE

. SD .

SEE POC TELE IN CLIN

W90YD8

0020 POP 12-JUN-2017 TO

11-JUN-2018

N/A (SAME AS PREVIOUS LOCATION)

0030 POP 12-JUL-2017 TO

11-JUN-2018

N/A (SAME AS PREVIOUS LOCATION)

0040 POP 12-JUN-2018 TO

11-JUN-2019

N/A (SAME AS PREVIOUS LOCATION)

0050 POP 12-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0060 POP 12-JUN-2018 TO

N/A (SAME AS PREVIOUS LOCATION)

0100 N/A N/A N/A N/A

CLAUSES INCORPORATED BY REFERENCE

52.202-1 Definitions NOV 2013 52.203-3 Gratuities APR 1984 52.203-5 Covenant Against Contingent Fees MAY 2014 52.203-6 Restrictions On Subcontractor Sales To The Government SEP 2006 52.203-7 Anti-Kickback Procedures MAY 2014 52.203-17 Contractor Employee Whistleblower Rights and Requirement

To Inform Employees of Whistleblower Rights

APR 2014

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

Subcontract Awards

OCT 2016

52.204-13 System for Award Management Maintenance OCT 2016 52.204-19 Incorporation by Reference of Representations and

Certifications.

DEC 2014

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

OCT 2015

52.209-9 Updates of Publicly Available Information Regarding Responsibility Matters

JUL 2013

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

Items (JAN 2017) Alternate I

OCT 2014

52.212-4 Contract Terms and Conditions--Commercial Items JAN 2017 52.212-5 (Dev) Contract Terms and Conditions Required to Implement

Statutes or Executive Orders--Commercial Items (Deviation 2013-O0019)

JAN 2017

52.217-5 Evaluation Of Options JUL 1990 52.217-8 Option To Extend Services NOV 1999 52.217-9 Option To Extend The Term Of The Contract MAR 2000 52.219-1 Small Business Program Representations OCT 2014 52.219-6 Notice Of Total Small Business Set-Aside NOV 2011 52.219-8 Utilization of Small Business Concerns NOV 2016 52.219-14 Limitations On Subcontracting JAN 2017 52.219-28 Post-Award Small Business Program Rerepresentation JUL 2013 52.222-3 Convict Labor JUN 2003 52.222-21 Prohibition Of Segregated Facilities APR 2015 52.222-22 Previous Contracts And Compliance Reports FEB 1999 52.222-25 Affirmative Action Compliance APR 1984 52.222-26 Equal Opportunity SEP 2016 52.222-35 Equal Opportunity for Veterans OCT 2015 52.222-36 Equal Opportunity for Workers with Disabilities JUL 2014 52.222-37 Employment Reports on Veterans FEB 2016

52.222-42 Statement Of Equivalent Rates For Federal Hires 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 52.222-54 Employment Eligibility Verification OCT 2015 52.222-55 Minimum Wages Under Executive Order 13658 DEC 2015 52.223-2 Affirmative Procurement of Biobased Products Under Service and Construction Contracts

SEP 2013

52.223-5 Pollution Prevention and Right-to-Know Information MAY 2011 52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

AUG 2011

52.225-13 Restrictions on Certain Foreign Purchases JUN 2008 52.225-25 Prohibition on Contracting with Entities Engaging in Certain

Activities or Transactions Relating to Iran-- Representation and Certifications.

OCT 2015

52.228-5 Insurance - Work On A Government Installation JAN 1997 52.232-1 Payments APR 1984 52.232-33 Payment by Electronic Funds Transfer--System for Award

Management

JUL 2013

52.232-39 Unenforceability of Unauthorized Obligations JUN 2013 52.233-3 Protest After Award AUG 1996 52.233-4 Applicable Law for Breach of Contract Claim OCT 2004 52.237-2 Protection Of Government Buildings, Equipment, And

Vegetation

APR 1984

52.244-6 Subcontracts for Commercial Items JAN 2017 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 252.204-7004 Alt A System for Award Management Alternate A FEB 2014 252.204-7009 Limitations on the Use or Disclosure of Third-Party

Contractor Reported Cyber Incident Information

OCT 2016

252.204-7012 Safeguarding Covered Defense Information and Cyber Incident Reporting

OCT 2016

252.225-7001 Buy American And Balance Of Payments Program-- Basic (Dec 2016)

DEC 2016

252.225-7031 Secondary Arab Boycott Of Israel JUN 2005 252.225-7048 Export-Controlled Items JUN 2013 252.226-7001 Utilization of Indian Organizations and Indian-Owned

Economic Enterprises, and Native Hawaiian Small Business Concerns

SEP 2004

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 252.243-7002 Requests for Equitable Adjustment DEC 2012 252.247-7022 Representation Of Extent Of Transportation Of Supplies By

Sea

AUG 1992

252.247-7023 Transportation of Supplies by Sea APR 2014

CLAUSES INCORPORATED BY FULL TEXT

52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JULY 2013)

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

Administrative proceeding means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.

Federal contracts and grants with total value greater than $10,000,000 means--

(1) The total value of all current, active contracts and grants, including all priced options; and

(2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules).

Principal means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

(b) The offeror ( ) has ( ) does not have current active Federal contracts and grants with total value greater than $10,000,000.

(c) If the offeror checked “has” in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information:

(1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions:

(i) In a criminal proceeding, a conviction.

(ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more.

(iii) In an administrative proceeding, a finding of fault and liability that results in--

(A) The payment of a monetary fine or penalty of $5,000 or more; or

(B) The payment of a reimbursement, restitution, or damages in excess of $100,000.

(iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision.

(2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence.

(d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award Management database via https://www.acquisition.gov (see 52.204-7).

(End of provision)

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

The South Dakota Army National Guard (SDARNG) has a requirement for Non-Clinical Case Manager and Non-Clinical Care Coordinators to support the SD Medical Command.

No award shall be made unless the Contracting Officer makes confirmation or affirmative determination of responsitility for the potential contractor. Potential contractor must be registered in System for Award Management (SAM) prior to award of contract.

(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:

1. Contractor Staffing: Reference PWS and Contractor staffing and requiements.

2. Provide Past Performance / Prior Experience in the last two years that inidcates a minimum level of satisfactory service for similar (Military) type requirements. Provide names, phone numbers, location, and addresses of any contracts previously held for two (2) similar requirements.

a. In the case an offeror is without a record of relevant past performance or for whom information on past performance is not available, the offeror may not be evaluated favorable or unfavorably on past performance.

b. Offerors may provide information on problems encountered on the identified contracts and the offeror corrective actions. The Government shall consider this information, as well as information obtained from any other sources, when evaluating the offeror past performance. The source selection authority shall determine the relevance of similar past performance information.

3. the contracting officer may determine an offer noncompliant with the terms and conditions of the solicitation if the contractor does not provide the information requested, specifically:

- Signed SF 1449

- Service (Location) Pricing

- Contractor staffing per PWS

- 2 References

- Copy of General Liability Incurance Certificate

- Completed Provision 252.209-7991 DEV

- DUNS Number

- CAGE Code

- Tax ID Number

Solicitation response date is: 11 MAY 2017

Please see Performance Work Statement and QASP for complete details.

**Vendor will be paid by Electronic Funds Transfer (EFT) and must invoice Wide Area Work Flow.

Vendor will invoice on a monthly or bimothly basis commensuate with completion of contractor performance.

4. Evaluation Process:

The Government will evalute all proposals for responsiveness; if the proposal is incomplete it may not be evaluated.

The Government will evaluate all price proposals first, determining completeness with regard to price.

After determination of completeness with regard to price, the Government will rank offerors from lowest to highest in price.

At that time, the Government will review eligibility requirements of the apparent awardee for responsibility.

All other proposals will only be evaluated in the case the lowest-priced offeror is determined nonresponsible or is unwilling/unable to enter into a contract with the Government.

To be eligible for award, a proposal must meet all responsibility requirements listed in the Performance Work Statement, conform to all required terms and conditions, and include all information required.

(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.

52.233-2 SERVICE OF PROTEST (SEP 2006)

(a) Protests, as defined in section 33.101 of the Federal Acquisition Regulation, that are filed directly with an agency, and copies of any protests that are filed with the Government Accountability Office (GAO), shall be served on the Contracting Officer (addressed as follows) by obtaining written and dated acknowledgment of receipt from

Camp Rapid Purchasing and Contracting 2823 West Main Street Rapid City, SD 57702

(b) The copy of any protest shall be received in the office designated above within one day of filing a protest with the GAO.

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

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

www.arnet.gov/far www.acq.osd.mil www.deskbook.osdmil

252.209-7999 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID DELINQUENT TAX

LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (DEVIATION 2012-O0004) (JAN 2012)

(a) In accordance with sections 8124 and 8125 of Division A of the Consolidated Appropriations Act, 2012,(Pub. L.

112-74) none of the funds made available by that Act may be used to enter into a contract with any corporation that—

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless the agency has considered suspension or debarment of the corporation and made a determination that this further action is not necessary to protect the interests of the Government.

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless the agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that—

(1) It is [ ___ ] is not [ ___ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability,

(2) It is [ ___ ] is not [ ___ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

COMPLETE THE FOLLOWING AND SUBMIT WITH QUOTE

DATE: _________________________________________

Business Name: __________________________________________________________________________

POC/ Business Representative Name: _____________________________________________________

SIGNATURE: _____________________________________

QASP

Quality Assurance Surveillance Plan (QASP)

1.0 Background: The Department of Defense (DoD) TRICARE Management Activity (TMA) values all staff involved in the delivery of high-quality care to service members. In 2009, a Medical Management Guide was issued by the Office of the Assistant Secretary of Defense for Health Affairs (ASD [HA]) and TMA, Office of the Chief Medical Officer (OCMO), Population Health and Medical Management Division (PHMMD). The Guide covers the components of a Medical Management (MM) program, including applicable principles, implementation concepts, processes, and tools/databases for Utilization Management (UM), Case Management (CM), and Disease Management (DM). It complements the 2001 DoD Population Health Improvement Plan and Guide published by TMA and the Government Printing Office http://www.tricare.mil/ocmo/download/mhs_phi_guide.pdf.

1.1 Under legislative mandates, the ASD (HA) submitted an annual report to Congress regarding healthcare delivery for Military Health System (MHS) beneficiaries. The 2009 report documented the MHS goal to providing highquality care, improving performance through clinical and process outcomes, and increasing patients’ confidence in the care they receive. The Guide describes crucial components of Medical Management within the MHS, including the link between MM and population health and the dynamics between Utilization Management, Case Management and Disease Management in helping reduce unnecessary or inappropriate services and/or duplication of services. In the military setting, Case Management targets Active Duty

Service Members and beneficiaries with complex, multi-system healthcare needs who require care coordination or case management services.

1.1.1. Originally, Case Management almost exclusively targeted in-patients with catastrophic illnesses or injuries. However, a number of developments have served to change that strategy;

notably: - The emergence of the National Committee for Quality Assurance (NCQA):

http://www.ncqa.orgorg/ and the development of accreditation standards by the Utilization Review Accreditation Commission (URAC): http://www.urac.org. While Case Management continues to focus on catastrophic illness or injury, Case Management practices are also intensely directed at addressing chronic conditions that are more prevalent in the general patient population. Case managers can affect patient outcomes through proactive interventions across multiple healthcare settings. Additionally, case managers are expected to engage community resources and facilitate ongoing and consistent patient education.

1.1.2 The MHS has three primary goals for Case Management:

- Improve the care, management, and transition of recovering Service members.

- Broaden the application of CM to include those with complex and at-risk needs before the Soldier requires complex care.

- Evaluate the impact of case management on the quality of military health care.

The Army National Guard, recognizing the importance of Medical Readiness after several years of combat deployments, implemented the Case Manager Support Contract in August 2005. The current contract was originally awarded August 2009 to Skyline Ultd (with 49% subcontract to Sterling Medical). At the end of FY09, case managers in 31 states were using the medical non-deployable module to manage their case loads. During the period of August 2008 to August 2009, 15,292 cases were put into the module; of these, 6734 were closed by return to duty, fit for duty, or forwarded for an MEB/PEB evaluation. Additionally, readiness increased from 35% fully-ready in FY08 to 44% in FY09. This success resulted from increased targeted funding and a concerted effort by the National Guard Bureau. On 29 March 2012, the ARNG achieved the Department of Defense (DoD) goal of 75% Fully Medically Ready (FMR) Soldiers per DoD Instruction (DoDI) 6025.19, Individual Medical Readiness (IMR). This monumental accomplishment marked the highest medical readiness percentage that the ARNG has achieved in documented history. Over the past year, ARNG readiness has continued to increase to over 80%. Continued utilization of medical case managers is essential to maintaining established medical readiness goals for the ARNG.

- Vision: Provide a healthy, resilient, ready and deployable force for federal, state and community missions

- Mission: To Provide a Responsive Medical Force and a Healthy Medically Ready Army National Guard

- Support deployment of a healthy force – Soldiers

- Support deployment of the medical force – Units

- Facilitate Warriors in Transition and Family Care – Beneficiaries

2.0 Purpose: This Quality Assurance Surveillance Plan is a governmentdeveloped document used to determine if the contractor’s performance meets the performance standards contained in the contract. The QASP establishes procedures on how this assessment/inspection process will be conducted. It provides the detailed process for a continuous oversight process:

- What will be monitored

- How monitoring will take place

- Who will conduct the monitoring

- How monitoring efforts and results will be documented

2.1 The contractor is responsible for implementing and delivering performance that meets contract standards using its Quality Control Plan. The QASP provides the structure for the government’s surveillance of the contractor’s performance to assure that it meets contract standards. It is the government’s responsibility to be objective, fair and consistent in evaluating contractor performance.

2.2 The QASP is not part of the contract nor is it intended to duplicate the contractor’s quality control plan. This QASP is a living document. Flexibility in the QASP is required to allow for an increase or decrease in the level of surveillance necessary based on contractor performance.

2.3 The government may provide a copy of the QASP to the contractor to facilitate open communication. In addition, the QASP should recognize that unforeseen or uncontrollable circumstances might occur that are outside the control of the contractor.

2.4 Bottom line, the QASP should ensure early identification and resolution of performance issues to minimize impact on mission performance.

2.4.1 Authority

Authority for issuance of this QASP is provided under Part 46 of the Federal Acquisition Regulation, Inspection of Services clauses, which provide for inspection, acceptance and documentation of the service called for in the contract or order. This acceptance is to be executed by the contracting officer or a duly authorized representative.

2.4.2 Roles and Responsibilities

The following personnel shall oversee and coordinate surveillance activities.

2.4.2.1 Government Program Manager (PM) – The PM (if the individual’s supervisor) nominates (or request the individual’s supervisory nominate the COR using VCE-COR or as directed by the Contracting Officer based upon the dollar value of the action. The PM/Supervisor ensures the COR is meets all COR training requirement outlined by the Contracting Office for the action before taking action regarding the nomination of the COR. The contract shall not be awarded until a qualified COR is appointed in writing by the Contracting Officer. The PM/Supervisor is not authorized to perform any COR duties but provides support to help the COR properly provide the necessary federal government oversight needed. The PM/Supervisor is required to include the performance of the COR in the COR/s annual performance rating. While the PM may serve as a direct conduit to provide Government guidance and feedback to thru the COR to the Contractor on technical matters, they are not empowered to make any contractual commitments or any contract changes on the government’s behalf. It is highly recommended the PM/Supervisor also nominate an alternate COR.

Assigned PM:

Organization or Agency: G1, Deputy Chief of Staff, Personnel Telephone:

Email:

2.4.2.2 Contracting Officer (KO) – The KO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The KO shall also ensure the contractor receives impartial, fair, and equitable treatment under this contract. Determine the final assessment of the contractor’s performance.

Assigned KO:

Organization or Agency: SDANG-USPFO-PC Telephone:

2.4.2.3 Contracting Officer’s Representative (COR) The COR is responsible for providing continuous technical oversight of the contractor’s performance. The COR uses the QASP to conduct the oversight/surveillance process. The COR shall keep a Quality Assurance file that accurately documents the contractor’s actual performance. If required to use VCE-COR by the Contracting Officer, the COR will always make sure these records are accurately and timely uploaded to the VCE-COR system. The purpose is to ensure the contractor meets the performance standards contained in the contract. The COR is responsible for reporting early identification of performance problems to the KO. The COR is required to provide an annual performance assessment (or more frequently as directed by the Contracting Officer) to the KO which will be used in documenting past performance. The QASP is the primary tool for documenting contractor performance. The COR is not empowered to make any contractual commitments or to authorize any contractual change on the Government’s behalf. The COR shall meet with the KO periodically as directed (usually monthly or quarterly at a minimum) to discuss the CORs performance. These meeting are in addition to the progress and similar type meeting involving at a minimum the contractor, COR and KO. The COR and alternate as applicable should communicate frequently to ensure both are aware of the current on-going oversight status and contract performance status.

Assigned COR: __________________________ Organization or Agency: SDANG, Deputy State Surgeon Telephone:

Email:

2.5 Contractor Representatives (STATE: Titles provided may vary – adjust after award);

The following employees of the contractor serve as the contractor’s Program Manager and Task Manager for this contract. (Complete this section after the contract award)

2.5.1 Program Manager - <upon award, enter name>

Telephone: <enter number> Email: <enter address>

2.5.2 Task Manager - <upon award, enter name>

Telephone: <enter number> Email: <enter address>

2.5.3 Other Key Contract Personnel - <upon award, enter name or delete these lines if not applicable> Title: <enter title> Telephone: <enter number> Email: <enter address>

3.0 Government Contract Surveillance

The goal of the QASP is to ensure contractor performance is effectively monitored and documented. The COR is responsible for maintaining quality assurance surveillance for the federal government. The COR will ensure monthly quality assurance inspections are accomplished accurately and timely (frequency may change as determinate by each State KO and customer). All records shall be uploaded to VCE-COR as applicable. (STATES if VCE- COR is not applicable revise)

4.0. Surveillance Matrix

The Surveillance Matrix (end of this section) is the list of performance objectives and standards that must be performed by the government. This matrix details the method of surveillance the COR will use to validate and inspect these performance elements. Inspection of each element will be documented in the COR file.

4.1 Performance Rating Definitions

In evaluating the quality of contractor’s performance, the following performance ratings may be used. Performance objectives define the desired outcomes. Performance Standards define the level of service required under the contract to successfully meet the performance objective. The inspection methodology defines how, when, and what will be assessed in measuring performance. The Government performs surveillance, using this QASP, to determine the quality of the contractor’s performance as it relates to the performance element standards.

4.3 Customer Complaint Form (See attachment 3)

Provides a format for customers who are support by the contractor to report on the contractors performance (For Agency use – Remember customers do not know what the contract requirements are). CORs should use this as method to become aware of issues but these forms are not to be used to evaluate the contractor unless complaint is valid and applicable to the contract (consult with Contracting Office if there are any questions).

4.4 Performance Assessment Report (States are recommended to develop their own local form for use by the COR to report the period (monthly or as directed by the KO) assessments of the contract performance.

Quality Assurance Plan for SD POC/COR:

In your role in this Contract as Point of Contact (POC) and COR, you assume some Quality Assurance duties. You will monitor contractor performance, complete and sign the Quality Assurance Worksheet provided below at least monthly, but you can submit the worksheet more frequently if needed. This worksheet allows you to document compliance with the Contract and fill a regulatory requirement to ensure adequate oversight is being performed. Annotate the period worked, travel and reimbursable costs. Excess of the normal work schedule require prior approval by the Contracting Officer. Please annotate only period of performance worked and approved; do not include holiday, vacation or sick time. Only the actual period the contract employee performed service should be billed.

Quality Assurance Plan Worksheets are to be sent directly to the Schedule Holder and Administering Contracting Office, not later than the 5th day of the month following the service (every month). At a minimum, the POC/COR must send a completed copy of the worksheet to the designated COR after the first month of service and for any months where there is a rating other than Green. The COR/POC will assume a quality performance rating of “Green” on all measured deliverables unless otherwise notified. The quality rating may change from “Green” to “Red” without notice, however we encourage the COR/POC to utilize the “Yellow” quality rating to alert the contracting office of quality issues that have the potential for a “Red” quality rating if corrective action is not taken. Any time the rating is less than Green the COR/POC shall clearly document the worksheet to indicate what did or did not occur per the PWS requirement. When an observation indicates other than a “Green” rating, the COR/POC will require the Contractor to initial the observation. Initialing the observation does not constitute concurrence with the observation; it only acknowledges that they have been made aware of the defective performance. If the Contractor’s response to an identified quality deficiency is unsatisfactory, the Contracting Officer or COR will contact the Schedule Holder to implement a plan of action to remedy the identified deficiency. POC CHANGES: If you desire to delegate these COR/POC oversight duties to another Government employee, you must notify the Contracting Officer or Administrative Contract Office immediately, in writing, with their name, position, email and telephone number. Email notification is acceptable. Each COR/ POC conducting oversight duties must read and sign acknowledgement and provide to the Contracting Office.

CONTRACT EMPLOYEE CHANGES: Ensure that all replacement contract employees, to include short-term temporary replacements, are reported to the Contracting Officer listed in the Contract.

COR DESGINATION: The Contract COR must be appointed in writing by the Contracting Officer and formally trained, which requires courses:

1.) DAU CLC106, COR With a Mission Focus 2.) DAU CLC 107, OPSEC Contract Requirements 3.) DAU CLC 013, Services Acquisition 4.) DAU CLM 003, Overview of Acquisition Ethics 5.) Combating Trafficking in Persons

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

DAU CLC106, COR With a Mission Focus; and CLC 013, Performance-Based Services Acquisition (proof of training certificates are required). New certificates are required every 3 years.

OPERATIONAL SECURITY

OPERATIONAL SECURITY

STANDARD CONTRACT PROVISION, CLAUSE TEXT, AND PWS LANGUAGE

1. AT level I Training. This provision/contract text is for contractor employees with an area of performance within an Army controlled installation, facility or area. All contractor employees, to include subcontractor employees, requiring access to Army installations, facilities and controlled access areas shall complete AT Level I awareness training within 60 calendar days after contract start date or effective date of incorporation of this requirement into the contract, whichever is applicable. The contractor shall submit certificates of completion to the COR and contracting office. AT level I awareness training is available at the following website:

https://jko.jten.mil

2. Access and General Protection/Security Policy and Procedures. This standard language text is for contractor employees with an area of performance within an Army controlled installation, facility or area. Contractor and all associated sub-contractors employees shall comply with applicable installation, facility and area commander installation/facility access and local security policies and procedures (provided by government representative). The contractor shall also provide all information required for background checks to meet installation access requirements to be accomplished by installation Security Office. Contractor workforce must comply with all personal identity verification requirements (FAR clause 52.204-9, Personal Identity Verification of Contractor Personnel) as directed by DOD, HQDA and/or local policy. In addition to the changes otherwise authorized by the changes clause of this contract, should the Force Protection Condition (FPCON) at any individual facility or installation change, the Government may require changes in contractor security matters or processes.

3. Contractor Employees Who Require Access to Government information Systems. All contractor employees with access to a government info system must be registered in the ATCTS (Army Training Certification Tracking System) at commencement of services, and must successfully complete the DOD information Assurance Awareness prior to access to the information systems and then annually thereafter.

4. For Contracts that Require OPSEC training. Per AR 530-1, Operations Security. All contractor employees, to include subcontractor employees, requiring access to Army installations, facilities and controlled access areas shall complete Level I OPSEC training within 30 calendar days of tier reporting for duty and annually thereafter. A copy of completion will be sent to the contracting office and COR.

5. For information assurance (IA)/information technology (IT) training. All contractor employees and associated sub-contractor employees must complete the DoD IA awareness training before issuance of network access and annually thereafter. All contractor employees working IA/IT functions must comply with DoD and Army training requirements in DoDD 8570.01, DoD8570.01-M and AR 25-2 within six months of employment.

OPERATIONAL SECURITY REQUIRMENTS

THE CONTRACTOR WILL PROTECT CONTROLLED UNCLASSIFIED INFORMATION

(I.E. TRAININGTIMES, NUMBER OF PERSONNEL, ETC.) PERTAINING TO DAILY

OPERATIONS. THE COR/POC WILL BRIEF THE VENDOR ON WHAT INFORMATION

NEEDS TO BE PROTECTED, WHY IT NEEDS TO BE PROTECTED, AND HOW TO

PROTECT IT. IF CONTRACTOR IS NOT SUPRIVISED BY AGOVERNMENT EMPLOYEE,

A NATIONAL CRIMINAL INFORMATION CENTER (NCIC) BACKROUNDCHECK IS

REQUIRED. CONTRACTOR WILL ALSO PROVIDE AN EMPLOYEE LIST NO

LATER THAN 30DAYS PRIOR TO PERFORMANCE.

Use of Government Information Systems

Use of Government Information Systems (IS) and access to Government networks is a revocable privilege, not a right. Users are the foundation of the DoD strategy and their actions affect the most vulnerable portion of the AEI. Contractor employees shall have a favorable background investigation or hold a security clearance and access approvals commensurate with the level of information processed or available on the system.

Contractor employees shall: Comply with the command's Acceptable Use Policy (AUP) for Government owned IS and sign an AUP prior to or upon account activation.

Complete initial and/or annual Information Assurance (IA) training as defined in the IA Best Business Practices (BBP) training https://informationassurance.us.army.mil).

Mark and safeguard files, output products, and storage media per classification level and disseminate them only to individuals authorized to receive them with a valid need to know.

Protect IS and IS peripherals located in their respective areas in accordance with physical security and data protection requirements. Practice safe network and Internet operating principles and take no actions threatening the integrity of the system or Network.

Protection of Personally Identifiable Information

Protection of Personally Identifiable Information (PII). The contractor shall protect all Personally Identifiable Information (PII) encountered in the performance of services in accordance with DFARS 224.103 and DoDD 5400.11, Department of Defense Privacy Program, and DoD 5400.11-R. If a PII breach results from the contractor’s violation of the aforementioned policies, the contractor shall bear all notification costs, call-center support costs, and credit monitoring service costs for all individuals who’s PII has been compromised.

CAC Requirements

CAC Requirements: The Common Access Card (CAC) is the Department of Defense (DOD) Federal Personal Identity Verification (PIV) credential. Before CAC issuance, the contractor employee requires, at a minumum, a favorable adjudicated national Agency Check with Inquireies (NACI) or equivalent or higher investigation in accordance with Army Directive 2014-05. The contractor employee will be issued a CAC only if duties involve one of the following: 1. Both physical access to a DoD facility and access, via logon, to DoD networks on-site or remotely 2. Remote access, via logon, to a DoD network using DoD-approved remote access procedures; or 3.

Physical access to multiple DoD facilities or multiple non-DoD federally controlled facilities on behalf of the DoD on a recurring basis for a period of 6 months or more. At the discretion of the sponsoring activity, an initial CAC may be issued based on a favorable review of the FBI fingerprint check and a successfully scheduled NACI at the Office of Personnel Management.

iWATCH Training: The contractor and all associated sub-contractors shall brief all employees on the local iWATCH program (training standards provided by the requiring activity ATO). this local develped training will be used to inform employees of the types of behavior to watch fro and instruct employees to report suspicious activity to the POC/COR. This training shall be completed within 60 calendar days of contract award and the results reported to the POC/COR NLT 60 calendar days after contract award.

Trusted Associate Sponsorship System

Trusted Associate Sponsorship System (TASS): The contractor is responsible forprocessing applications for Common Access Cards (CAC) for every contractor employee who deploys with the military force OR who has need to access any government computer network in accordance with FAR 52.204-9, "Personal Identity Verification of Contractor Personnel." The contractor is responsible for managing requests for new or renewal CAC cards in sufficient time to ensure all contractor employees have them when needed to perform work under this contract. The norm is at least ten calendar days advance notice to the Trusted Agent (TA), unless there are extenuating circumstances approved by the Contracting Officer's Representative (COR) or Contracting Officer. It is recommend a "Corporate Facility Security Officer" (FSO) be designated to serve as your firm's single point of contact for Background Investigation (BI), the TASS application process and other CAC and security related matters.

If a FSO is not established, each contractor employee requiring a CAC will be required to process their own applications. CAC applications shall be processed through the TASS. The contractor's FSO Or contractor employee shall submit requests for a CAC via email to the designated TASS Trusted Agent (TA) before accessing the TASS website.