W912PQ-22-Q-0025.pdf

SEE ADDENDUM

(No Collect Calls)

W912PQ22Q0025 28-Feb-2022

b. TELEPHONE NUMBER

518-784746

8. OFFER DUE DATE/LOCAL TIME

10:00 AM 08 Mar 2022

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.

W912PQ9. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

MEGHAN A. SHERIDAN

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

0011724626

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 NY PURCHASING & CONTRACTING

330 OLD NISKAYUNA ROAD

LATHAM NY 12110-2224

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 W56PPG 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

W56PPG MNCI

CHUCK AUSTIN

330 OLD NISKAYUNA ROAD

LATHAM NY 12110-2225

TEL: 518-786-6121 FAX:

FAX:

TEL: SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$35,000,000

NAICS:

621511

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 OF67

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.

Section SF 1449 - CONTINUATION SHEET

PWS AND PRS

PERFORMANCE WORK STATEMENT (PWS)

MEDICAL SURVEILLANCE EXAMINATIONS SERVICES

1.0 General

1.1 Scope: The contractor shall provide all personnel, equipment, tools, materials, supervision, and quality control necessary, except as specified in Paragraph 3.0 as Government Furnished, to perform medical surveillance services including examinations and occupational health services to NYARNG qualifying full-time support (FTS), part-time and temporary civilian technicians who are potentially exposed to health hazards in the work environment or who are assigned to positions requiring specific standards of physical fitness, as defined in this PWS.

1.1.1 The medical examinations and procedures shall be the responsibility of the Contractor. The administrative controls shall be the responsibility of the New York Army National Guard (NYARNG) Safety and Occupational Health Manager (SOHM). The contractor will review the roster of employee exams and procedures, sign-off, date the exams and procedures, and return signed document. Any addition or removal of exams or procedures will be in consultation with the NYARNG Occupational Health Nurse (OHN) / Project Officer.

1.1.2 Objectives: The primary focus of FY22 Medical Surveillance is vision exams, PSA for prostate cancer on qualified individuals. Respirator fit testing and medical clearance for approximately twelve (12) individuals. Additional labs or x-rays will be performed as stated in the PWS. (Approx. 40 or fewer employees).

1.2 Background: NYARNG contracts all labor, tools, supervision and supplies to conduct mobile medical surveillance/occupational health services for the NYARNG.

1.3 Period of Performance (PoP): The PoP shall be a total of eight (8) specified days from 19-29 April 2022 during standard hours of operation between 0700 and 1600 or as modified based on Federal and NY State COVID-19 guidance. The contractor shall conduct medical surveillance examination / occupational health services at eight (8) work sites / locations as listed below:

DATE Host

Facility Location Attending

Facilities # of Empl.

Time

19 APR 22 FMS 1 27 Masten Ave Buffalo, NY 14204-

FMS 1, 2, 10,

FMS 2 Sub-shop

30 0730-1430

20 APR 22 CSMS C 1500 E. Henrietta Rd Rochester, NY 14623-3181

AASF 2 CSMS C 35 0700-1330

21 APR 22 FMS 5 6901 Thompson Rd Syracuse, NY 13211-

FMS 4, 5, 6, 13 41 0730-1430

22 APR 22 MATES P4900 Main Tank Rd Fort Drum, NY 13602-5036

MATES and any individuals who missed Medical Surveillance

28 0700-1400

26 APR 22 AASF 3 330 Old Niskayuna Rd Latham, NY 12110-2225

FMS 3, 15, 16,

17, CIF, AASF 3,

USP&FO -

Warehouse

28 0730-1500

27 APR 22 CSMS A Camp Smith, Bldg.

300, Cortlandt Manor, NY 10567-

FMS 7, CSMS A 36 0730-1400

28 APR 22 FMS 14 25 Baiting Place Farmingdale, NY 11735

FMS 8, 9, 14,

AASF 1, and any employees who missed Medical Surveillance

21 0730-1430

29 APR 22 CSMS B 60 Slosson Ave Staten Island, NY 10314-2518

FMS 12, CSMS B 28 0700-1300

New York Army National Guard Project Officer/COR: Valerie A. Schwalbach, OHN, MNAV-OS, 330 Old Niskayuna Rd, Latham, NY 12110-2224 Phone (518) 786-6040, Fax

(518) 786-6032, email: Valerie.a.schwalbach.civ@army.mil.

1.4 General Information

1.4.1 Place and Performance of Services: The contractor shall provide services at the above locations in section 1.3, dates and times, except on recognized US holidays or when the Government facility/installation is closed due to local or national emergencies, administrative closings, or similar Government-directed facility/installation closings.

Performance shall be at the government locations listed in 1.3 The contractor shall at all times maintain an adequate work force for the uninterrupted performance of all tasks defined within this PWS when the Government facility/installation is not closed for the above reasons. When hiring personnel, the contractor shall keep in mind that the stability and continuity of the work force are essential. Teleworking is not authorized.

1.4.1.1 Telework:

The Government does not permit the contractor to telework in support of this requirement.

In furtherance of Continuity of Operations Planning (COOP), a telework program may be enacted to ensure that the Government's mission-critical operations stay operational during times of national emergency or incidents of national significance. Telework shall be at no additional cost to the Government.

1.4.1.2 Unscheduled gate closures by the Security Police may occur at any time causing all personnel entering or exiting a closed installation to experience a delay. This cannot be predicted or prevented. Contractors are not compensated for unexpected closures or delays. Vehicles operated by contractor personnel are subject to search pursuant to applicable regulations. Any moving violation of any applicable motor vehicle regulation may result in the termination of the contractor employee’s installation driving privileges.

1.4.1.3 The contractor’s employees shall become familiar with and obey the regulations of the installation; including fire, traffic, safety and security regulations while on the installation.

Contractor employees should only enter restricted areas when required to do so and only upon prior approval. All contractor employees shall carry proper identification with them at all times, and shall be subject to such checks as may be deemed necessary. The contractor shall ensure compliance with all regulations and orders of the installation, which may affect performance. The Government reserves the right to direct the removal of an employee from Government property or revoke access to Government systems for misconduct, security reasons, or any overt evidence of communicable disease. Removal of contractor employees for reasons stated above does not relieve the Contractor from responsibility for total performance of this contract.

1.4.2 Recognized Holidays: The following are recognized United States (US) holidays. The contractor shall not perform services on these days:

1.4.2.1 New Year’s Day: January 1st

1.4.2.2 Martin Luther King, Jr.’s Birthday

1.4.2.3 President’s Day

1.4.2.4 Memorial Day

1.4.2.5 Juneteenth National Independence Day: June 19th

1.4.2.6 Independence Day: July 4th

1.4.2.7 Labor Day

1.4.2.8 Columbus Day

1.4.2.9 Veteran’s Day: November 11th

1.4.2.10 Thanksgiving Day

1.4.2.11 Christmas Day: December 25th

1.4.3 Quality Control (QC): The contractor shall develop and maintain an effective QC Plan (QCP) to ensure services are performed in accordance with this PWS. The contractor shall develop and implement procedures to identify, prevent, and ensure non-recurrence of defective services. The contractor’s QCP is the means by which it assures itself that its work complies with the requirements of the contract. As a minimum, the contractor shall develop QC procedures that address the areas identified in Technical Exhibit 1, Performance Requirements Summary (PRS). A final QCP shall be submitted to the Contracting Officer Representative (COR) NLT 10 days after contract award. After acceptance of the QCP, the contractor shall obtain the Contracting Officer’s (KO’s) acceptance in writing of any proposed changes to its QCP.

1.4.4 Not Applicable

1.4.5 Installation Access and Security Requirements. The contractor shall comply with all applicable installation/facility access and local security policies and procedures, which may be obtained from the COR. The contractor and all associated subcontractor employees shall provide all information required for background checks to meet installation access requirements to be accomplished by installation Provost Marshal Office, Director of

Emergency Services, or Security Office. The contractor shall ensure compliance with all personal identity verification requirements as directed by Department of Defense (DOD), Headquarters Department of Army (HQDA) and/or local policy (see PWS 6.0). Should the Force Protection Condition (FPCON) change, the Government may require changes in contractor security matters or processes.

1.4.5.2 For contractors that do not require a CAC, but require access to a DoD facility or installation: Contractor and all associated sub-contractors employees shall comply with adjudication standards and procedures using the National Crime Information Center Interstate Identification (NCIC-III) and Terrorist Screening Database (TSDB) (Army Directive 2014-05), and applicable installation, facility and area commander installation/facility access, and local security policies and procedures (provided by a Government representative).

1.4.5.3 Awareness Training (AT) Level 1: All contractor employees, including subcontractor employees, requiring access to Army installations, facilities, and controlled access areas shall complete AT Level 1 training within 30 calendar days after contract start date and within 30 calendar days of new employees commencing performance. The contractor shall submit certificates of completion for each affected contractor and subcontractor employee to the KO within 15 calendar days after completion of training by each employee or subcontractor personnel. AT Level 1 awareness training is available at the following website: https://jko.jten.mil/courses/atl1/launch.html.

1.4.5.4 iWATCH Training: The contractor and all associated subcontractors with an area of performance within an Army-controlled installation, facilities or area shall brief all employees on the local iWATCH program (training standards provided by the requiring activity Antiterrorism Officer (ATO)). This local developed training shall be used to inform employees of the types of behavior to watch for and instruct employees to report suspicious activity to the COR or the KO. This training shall be completed within 30 calendar days of contract award and within 30 calendar days of new employees commencing performance.

The contractor shall report completion for each contractor employee and subcontractor employee to the KO within 15 calendar days after completion of training.

1.4.5.5 Communications Security/Information Technology (COMSEC/IT) Security. All communications with DoD organizations are subject to COMSEC review. All telephone communications networks are continually subject to intercept by unfriendly intelligence organizations. DoD has authorized the military departments to conduct COMSEC monitoring and recording of telephone calls originating from, or terminating at, DoD organizations. Therefore, the contractor is advised that any time contractor personnel place or receive a call they are subject to COMSEC procedures. The contractor shall ensure wide and frequent dissemination of the above information to all employees dealing with DoD information. The contractor shall abide by all Government regulations concerning the authorized use of the Government's computer network, including the restriction against using the network to recruit Government personnel or advertise job openings.

1.4.5.6 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 Army Enterprise Info structure (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:

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

1.4.5.6.2 Complete initial and/or annual Information Assurance (IA) training as defined in the IA Best Business Practices (BBP) training (https://atc.us.army.mil/iastar/docs/Training_BBP.pdf).

1.4.5.6.3 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.

1.4.5.6.4 Protect IS and IS peripherals located in their respective areas in accordance with physical security and data protection requirements.

1.4.5.6.5 Practice safe network and Internet operating principles and take no actions that threaten the integrity of the system or network.

1.4.5.7 Not Applicable

1.4.5.8 Not Applicable

1.4.5.9 Not Applicable

1.4.5.10 Protection of Personally Identifiable Information (PII). The contractor shall protect all PII encountered in the performance of services in accordance with Defense Federal Acquisition Regulation Supplement (DFARS) 224.103 Personally Identifiable Information and Department of Defense Directive (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 whose PII has been compromised.

1.4.5.11 OPSEC Training: In accordance with AR 530-1, Operations Security, new contractor employees shall complete Level I OPSEC training within 30 calendar days of their reporting for duty and annually thereafter. The contractor shall submit certificates of completion for each contractor employee to the KO within 15 calendar days after completion of training. Level 1 OPSEC training is available at https://securityawareness.usalearning.gov/opsec/index.htm.

1.4.6 Physical Security. The contractor shall safeguard all Government property provided for contractor use. At the close of each work period, Government facilities, equipment and materials shall be secured.

1.4.7 Special Qualifications: The contractor shall ensure all employees possess all required licenses and qualifications listed in the PWS (NOTE: The Government does not provide training to contractors. Contractors must ensure that any personnel performing under a contract are fully trained, licensed, certified, and otherwise qualified to provide services.)

1.4.8 Post Award Conference/Periodic Progress Meetings: The contractor agrees to attend any post award conference convened by the KO in accordance with FAR 42.5. The KO, COR, and other Government personnel, as appropriate, may meet periodically with the contractor to review the contactor’s performance. At these meetings, the KO will apprise the contractor of how the Government views the contractor’s performance and the contractor shall apprise the Government of problems, if any, being experienced. The contractor shall resolve outstanding issues raised by the Government. Contractor attendance at these meetings shall be at no additional cost to the Government.

1.4.9 Contract Manager (CM): The contactor shall designate a CM who shall ensure performance under this contract. The name of this person, and an alternate who shall act for the contractor when the CM is absent, shall be designated in writing to the KO. The CM or alternate shall have full authority to act for the contractor on all contract matters relating to daily operation of this contract. The CM shall work through the KO, to resolve issues, receive technical instructions, and ensure adequate performance of services. The CM shall ensure that contractor employees do not perform any services outside the scope of the contract without an official modification issued by the KO. The CM shall ensure contractor employees understand that services performed outside the scope of the contract are performed wholly at the expense of the contractor.

1.4.10 Identification of Contractor Employees: All contractor personnel attending meetings, answering Government telephones and working in other situations where their contractor status is not obvious to third parties are required to identify themselves as such to avoid creating an impression that they are Government employees. The contractor shall ensure that all documents or reports produced by contractor personnel are suitably marked as contractor products or that contractor participation is appropriately disclosed. The contractor’s status as a “contractor” shall be predominantly displayed in all correspondence types (to include signature blocks on e-mail) and dealings with Government or non- Government entities. Contractor personnel shall wear identification badges distinguishing themselves as such. The badges shall have the company name, employee name and the word “contractor” displayed.

1.4.10.1 The contractor shall retrieve all identification media (including vehicle passes) from its employees who depart employment for any reason. The contractor shall return all identification media (i.e., badges and vehicles passes) to the KO within 14 days of an employee’s departure.

1.4.11. Combating Trafficking in Persons: The United States Government has adopted a zero tolerance policy regarding trafficking in persons. Contractors and contractor employees shall not engage in severe forms of trafficking in persons during the period of performance of the contract; procure commercial sex acts during the period of performance of the contract; or use forced labor in the performance of the contract. The Contractor shall notify its employees of the United States Government’s zero tolerance policy, the actions that will be taken against employees for violations of this policy. The contractor shall take appropriate action, up to and including termination, against employees or subcontractors that violate the US Government policy as described at FAR 22.17.

1.4.10 Not Applicable

1.4.11 Not Applicable

1.4.12 Not Applicable

1.4.13 Not Applicable

1.4.14 Organizational Conflicts of Interest (OCI): The contractor and subcontractor personnel performing services under this contract may receive, have access to or participate in the development of proprietary or source selection information (e.g., cost or pricing information, budget information or analyses, specifications or work statements, etc.)

or perform evaluation services which may create a current or subsequent OCIs, as defined in FAR Subpart 9.5. The contractor shall notify the KO immediately whenever it becomes aware that such access or participation may result in any actual or potential OCI and shall promptly submit a plan to the KO to avoid or mitigate any such OCI. The contractor’s mitigation plan will be determined to be acceptable solely at the discretion of the KO. In the event the KO unilaterally determines that any such OCI cannot be satisfactorily avoided or mitigated, the KO may impose other remedies as he or she deems necessary, including prohibiting the contractor from participation in subsequent contracted requirements which may be affected by the OCI.

2.0 Definitions and Acronyms:

2.1 Definitions:

2.1.1 Contractor: A supplier or vendor awarded a contract to provide specific supplies or service to the Government. The term used in this contract refers to the prime.

2.1.2 Defective Service: A service output that does not meet the standard of performance associated with the PWS.

2.1.3 Deliverable: Anything that can be physically delivered and includes non-manufactured things such as meeting minutes or reports.

2.1.4 Key Personnel: Contractor personnel that are evaluated in a source selection process and that may be required to be used in the performance of a contract by the PWS. When key personnel are used as an evaluation factor in best value procurement, an offer can be rejected if it does not have a firm commitment from the persons that are listed in the proposal.

2.1.5 Physical Security: Actions that prevent the loss or damage of Government property.

2.1.6 Quality Assurance: The Government procedures to verify that services being performed by the Contractor are performed according to acceptable standards.

2.1.7 Quality Assurance Surveillance Plan (QASP): An organized written document specifying the surveillance methodology to be used for surveillance of contractor performance.

2.1.8 Quality Control: All necessary measures taken by the Contractor to ensure that the quality of an end product or service shall meet contract requirements.

2.1.9 Subcontractor: One that enters into a contract with a prime contractor. The Government does not have privity of contract with the subcontractor.

2.2 Acronyms:

AEI Army Enterprise Info structure AR Army Regulation AT/OPSEC Antiterrorism/Operational Security BI Background Investigation CM Contract Manager COR Contracting Officer Representative DA Department of the Army DD254 Department of Defense Contract Security Classification Specification DFARS Defense Federal Acquisition Regulation Supplement DoD Department of Defense DoDM Department of Defense Manual DoDI Department of Defense Instructions DSCA Defense Counterintelligence and Security Agency FAR Federal Acquisition Regulation GFP/M/E/S Government Furnished Property/Material/Equipment/Services HQDA Headquarters, Department of the Army HSPD Homeland Security Presidential Directive IA Information Assurance IS Information System(s) KO Contracting Officer NGB National Guard Bureau OCI Organizational Conflict of Interest PII Personally Identifiable Information PIPO Phase In/Phase Out POC Point of Contact PRS Performance Requirements Summary PWS Performance Work Statement QA Quality Assurance QASP Quality Assurance Surveillance Plan QC Quality Control QCP Quality Control Program SCR Service Contract Reporting SSN Social Security Number TE Technical Exhibit USD (I) Under Secretary of Defense for Intelligence

2.3 References:

2.3.1. Department of Defense Instructions 6055.05-M, Change 3: Occupational Medical Examinations and Surveillance Manual.

2.3.2. Army Regulation 40-5, Preventive Medicine.

2.4. Army Regulation 385-10, Army Safety and Occupational Health Program.

2.5. U. S. Department of Labor (DOL) 29 CFR 1910, Occupational Safety and Health Standards for General Industry.

2.6. Headquarters Department of the Army Pamphlet (DA PAM) 40-501, Hearing Conservation.

2.7. Military References made in the Statement of Work (SOW) are available from the COR.

3.0 Government Furnished Property, Material, Equipment and Services (GFP/M/E/S): The Government will provide the property, material, equipment, and/or services listed below solely for the purpose of performance under this contract:

3.1 Property: Not Applicable

3.2 Materials: Not Applicable

3.3 Equipment: Not Applicable

3.4 Services: Not Applicable

3.5 Utilities: All utilities in the facility will be available for the contactor’s use in the performance of this contract. The contractor shall instruct employees in utilities conservation practices. The contractor shall operate under conditions that preclude the waste of utilities, which include turning off the water faucets or valves after using the required amount.

4.0 Contractor Furnished Property, Materials, and Equipment (CFP/M/E):

4.1 General: Except for those items specifically stated to be Government-Furnished in Paragraph 3.0, the contractor shall furnish everything required to perform these services as indicated in Paragraph 1.1.

5.0 Requirements

5.1 The contractor shall ensure that all procedures are conducted in accordance with applicable American Board of Occupational and Environmental Medicine (ABOEM), American Association of Occupational Health Nurses, U. S. Department of Labor, OSHA and NIOSH Standards.

5.1.1 The contractor shall ensure that all clinical laboratory/chemistry services are performed by a laboratory licensed by the U. S. Department of Health and Human Services Health Care Financing Administration pursuant to the terms of the Clinical Laboratories Improvement Act of 1967 (42 U.S.C 263a) and the College of American Pathologists. Only qualified medical technicians will perform medical surveillance screening/testing elements.

Personnel conducting spirometry will be certified through a program approved by the National Institute of Occupational Safety and Health (NIOSH). License and certifications must be available for review.

5.1.2 The contractor shall supply a copy of all service provider certifications/licenses to the government with the contractor’s quote.

5.2 A comprehensive review and evaluation will be performed within thirty (30) days following the conclusion of testing. The NYARNG will contact and schedule a follow-up review and evaluation meeting to discuss overall performance of the purchase order.

5.2.1 The contractor will arrange for initial coordination of services with the Project Officer within fifteen (15) working days after award of the contract.

5.2.2 The contractor will arrange for the opportunity to consult with a representative of the NYARNG SOH or Contracting Office by telephone to coordinate or resolve issues that might arise before, during, and after the testing period. Any issues with testing must be reported immediately and no later than 30 minutes of findings so as not to delay the completion of testing.

5.2.3 Instrumentation must meet or exceed appropriate performance standards, and accuracy must be verified IAW current Occupational Medicine Certification standards.

5.3 The contractor shall safeguard all sensitive/Personally Identifiable Information and adhere to all HIPAA and NYARNG regulations regarding facility and personnel privacy and safety.

5.4 Medical Surveillance:

Physical examination, vital signs (including temperature, pulse, blood pressure, height and weight) or as indicated, vision (Including distance, near, color. Depth perception and field of vision will be performed on drivers only), respiratory clearance (including review of documentation, physical exam for fitness to wear respirator), pulmonary function test if indicated, medical clearance by qualified Board Certified Occupational Health and Medicine Provider, with written report of all findings, recommendations and medical clearance, signed by provider. In lieu of a Board Certified Occupational Health and Medicine Provider, a medically qualified and licensed provider with a minimum of five years military or occupational health experience may be substituted.

5.4.1 Should the medical provider find any employee is not medically cleared to perform the functions of their position, the Project Officer will be notified in writing within twenty-four hours of findings. Notification will be in the form of a written medical orders indicating follow-up clearance requirement that may remove any restriction to work. (Ex. Written prescription. Follow-up vision exam and prescription glasses to correct near vision to better than 20:40 OU, based on employees work requirements). It is essential that an employee is not restricted for a medical condition which will not affect their position.

5.4.2 The contractor shall notify the Project Officer within 30 minutes of any employees who were scheduled to attend medical surveillance but did not do so, thereby providing Program Manager an opportunity to locate the employees to complete medical surveillance, prior to the contractor leaving the facility. The government shall provide a finalized scheduled no less than five days prior to on-site services.

5.5 Laboratory testing: Shall include the drawing of blood, collection of urine and disposal of all waste products generated by the blood draw and urine collection in accordance with the Blood-Borne Pathogen Standard. The waste products will not be disposed of at the testing site. The laboratory tests will consist of urinalysis, CMP, CBC, CBC w/ Diff., lead, ZZP, Hexavalent chromium, blood and urine cadmium, urine beta 2 microglobulin, Urine phenol, muconic acid, S-phenylmercapturic acid, BUN, creatinine.

5.6 Respiratory clearance IAW OSHA Standard 29 CFR 1910.34 for identified employees.

Contractor shall perform pulmonary function tests (PFT) on scheduled technicians.

Contractor may forgo PFTs and only provide medical clearance on employees who have had previous PFTs and medical clearance and have no changes to their health at time of medical surveillance. These employees will be identified on the schedule as needing medical clearance for respirator use but will not be scheduled for PFTs.

5.7 Vital signs:

5.7.1 Vital signs will include height, weight, temperature, pulse and blood pressure as indicated.

5.8 Visual exams:

5.8.1 Visual exams will include, distance, near, color. Depth perception and field of vision will be performed on drivers only. All abnormal findings will be discussed with employee at the time of finding and documented. Project Officer will be notified in writing within twenty-four hours of any abnormal findings by having contract physician provide employee with a written prescription for eye doctor referral with copy of the written prescription being sent to Project Officer.

5.9 Physician Services:

5.9.1 Physician will provide an on-site evaluation of the mobile testing to the (FTS) employees at the time of their testing as indicated in the Medical Surveillance Roster.

5.9.2 The Physician’s evaluations will be provided at the locations delineated in paragraph 1-3.

5.9.3 Physician will review all laboratory tests, x-rays and medical records and determine if the employee requires follow-up and/or is cleared for work duties. Any employee requiring follow-up will receive a written prescription indicating need for follow-up. Each written prescription may include any abnormal findings requiring follow-up. It shall include notification as to whether the employee is restricted in any way from performing they job or requires further evaluation. An employee should not be excluded from working, if the finding is not specifically related to the employees ability to perform their work (ex. Elevated BP, employee should follow up with healthcare provider in three months).

5.10 Medical Records and Reports:

5.10.1 The contractor will ensure three (3) copies of the employee examination findings are furnished. One copy is to be sent to the NYARNG Project Officer in hard copy and on CD, and one copy is to be mailed directly to the individual employee’s home of record within thirty (30) days on completion of testing. Medical examination results shall include all diagnostic tests, graphs, charts, reports, and examination results, written prescriptions (This may be in the form of one document and include all required medical follow-up). Results of medical surveillance testing which are questionable and/or of critical significance will be communicated directly at the end of individual’s exam to the employee and, by telephone and email, to the Project Officer.

5.10.3 The Contractor will provide a comprehensive report that outlines exam results including normal, abnormal, not medically cleared, and medically cleared. A spread sheet with the following is the preferred format.

a. Column # 1 – Personnel Name

b. Column # 2 – SSN

c. Column # 3 – D.O.B.

d. Column # 4 – Sex

e. Column # 5 – Facility of employment

f. Column # 6 – Position

g. Column # 7 – Wage Grade (WG or GS codes)

h. Column # 8 – Physical Exam (PE) and Medical Clearance (MC), (-/-): N = normal, A = abnormal, / C = cleared, O = not cleared,

i. Column # 9 – Vitals: Temp., Pulse, Blood Pressure (B/P), Resp. N = normal, A = abnormal,

j. Column # 10 – Audiology – N=normal w/ no significant threshold shift, A = abnormal with significant threshold shift,

k. Column # 11 – Vision N = normal, A = abnormal,

l. Column # 12 – Spirometry/PFT - N = normal, A = abnormal, TNP – Test Not Performed,

m. Column # 13 – Respirator use clearance P = Pass, F = Fail, TNP – Test Not Performed,

n. Column # 14 – Urinalysis – N = normal, A = abnormal, TNP – Test Not Performed,

o. Column # 15 – Comprehensive Metabolic Panel (CMP) - N = normal, A = abnormal, TNP – Test Not Performed,

p. Column # 16 – Complete Blood Count (CBC) - N = normal, A = abnormal, TNP – Test Not Performed,

q. Column # 17 – CBC w/ Differential (CBC w Diff) – N = normal, A = abnormal, TNP – Test Not Performed,

r. Column # 18 – Lead (Pb) and Zinc Protoporphyrin (ZZP) – N = normal, A = abnormal, TNP – Test Not Performed,

s. Column # 19 – Hexavalent Chromium (CH6) - N = normal, A = abnormal, TNP – Test Not Performed,

t. Column # 20 – Blood Cadmium - N = normal, A = abnormal, TNP – Test Not Performed,

u. Column # 21 – Urine Cadmium - N = normal, A = abnormal, TNP – Test Not Performed,

v. Column # 22 – Urine Beta 2 Microglobulin (B2M) - N = normal, A = abnormal, TNP – Test not performed,

w. Column # 23 – Blood Ureic Nitrogen (BUN) - N = normal, A = abnormal, TNP – Test not performed

x. Column # 24 – Creatinine (Creat) - N = normal, A = abnormal, TNP – Test not performed

y. Column #26 – CXR 2 View PA & Lat - N = normal, A = abnormal, TNP – Test not performed

z. Column #27 – CXR w/ B Reader - N = normal, A = abnormal, TNP – Test not performed AA. Employee Medically Cleared - Y = Yes, N = No AB. Notes: Written prescription copy included – Attach written prescription for referrals

5.11 Logistics:

5.11.1 For the Coordination of scheduling exams shall be a joint effort between the Project Officer and the Contractor, a draft copy of the schedule will be initiated by the Program Office and sent to the Contractor for review and any needed adjustments. One patient/employee per 15 minute intervals. All workdays include a one-hour lunch break. No testing shall be performed between 1130 – 1230 hours.

5.11.2 In the event of a Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period shall be completed at a scheduled time mutually convenient for the Contractor, Project Officer and the Facility (ies) but will be no later than two weeks from the last exam date listed in the Statement of Work.

Unfinished testing / examinations will be completed at no additional cost to the Government.

The option to schedule any component of Medical Surveillance exams not completed due to equipment failure or other contractor related events, through a local occupational medical facility, shall be done at no cost to the Government.

5.11.3 Medical surveillance testing shall be accomplished via a state-of-the-art mobile unit designed to be conducive to an efficient continuous flow of patients, yet maintain the dignity of the patient and achieve complete individual privacy at all times. The unit should be designed to enhance maintenance of hygiene; e.g., running water sources should be distributed throughout the unit so that personnel movement is minimized, but that people undergoing examinations have access to hand washing and hygiene amenities. Features of the unit should include, but are not limited to, a climate -controlled atmosphere, patient waiting/holding area for registration, separate changing room, separate on board restroom, testing/phlebotomy station, an on-board computer system to maintain the quality control during the data entry and physician examination area. The unit should be physically structured such that each examination component can be conducted independently; e.g., with respect to the EKG and the examination conducted by the physician, an EKG and a physician's exam should be able to be conducted concurrently.

5.11.4 The Contractor shall provide a schematic and sufficient interior and exterior photographs of the unit proposed for use under the contract with their quotes, such that the Government can determine the Contractor has met the requirements set forth in this paragraph. Mobile units are to be equipped with separate power source / generator to operate in conditions without access to shore power.

5.12 Personal Protective Equipment (PPE):

5.12.1 Contractor shall furnish and assure health workers are provided with appropriate PPE such as, but not limited to, gloves, protective eyewear etc., where there is a potential for exposure to blood or other potential infectious materials.

5.12.2 Contractor will ensure each health care worker complies with the requirements of 29 CFR 1910.1030 Blood-borne Pathogens Standard 12.0. Infectious Waste Disposal:

5.12.3 Disposal of all infectious waste must be in accordance with local, state, and federal regulation and disposed of by the contractor.

5.14.4 Puncture resistant sharps containers must be readily accessible to health care workers and located in all treatment areas where sharps could potentially be used.

5.13 The contractor will comply with all New York State COVID-19 guidelines. If Medical Surveillance is delayed due to COVID-19, the contractor and Project Officer will determine alternate dates for completion of Medical Surveillance.

5.14 Contractor Manpower Reporting Application (CMRA): Not Applicable

6.0 Applicable Publications: Publications applicable to this PWS are listed below:

Publication (Chapter/Page)

Date of Publication

Mandator y or

Advisory

Website

Federal Acquisition Regulation https://www.acquisition.gov/?q=browsefar Defense Federal Acquisition

Regulation Supplement http://www.acq.osd.mil/dpap/dars/dfarspgi/cu rrent/index.html or https://www.acquisition.gov/dfars

Joint Travel Regulation (JTR) https://www.defensetravel.dod.mil/site/travelr eg.cfm

DoDM 1000.13-M-V1 DoD Identification (ID) Cards (Enclosure 2, paragraph 3.b)

01/23/201

(Change 1:

07/28/202 0) http://www.esd.whs.mil/Directives/issuances/ dodm

Federal Information Processing Standards (FIPS) Publication

201-2 Personal Identity Verification

(PIV) of Federal Employees and Contractors

(paragraph 9)

August http://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FI PS.201-2.pdf

DoDM 5200.2 Procedures for the DoD Personnel Security

Program (PSP)

04/03/201 https://www.esd.whs.mil/Directives/issuances /dodm/

DoDI 5200.46

DoD Investigative and Adjudicative Guidance for

Issuing the Common Access Card (CAC)

09/09/14 (Change

1:

05/04/201

8)

/dodi/

Homeland Security Presidential Directive (HSPD)-12

08/27/200 https://www.dhs.gov/homeland-security-presidential-directive-12

Policy for a Common Identification Standard for Federal Employees and

Contractors DoDI 5400.11

Department of Defense Privacy and Civil Liberties Programs

01/29/201

/dodi/

DoD 5400.11-R

Department of Defense Privacy Program

05/14/200

DoDD 8140.01

Cyberspace Workforce Management

10/05/202

/dodd/

DoD 8570.01-M

Information Assurance Workforce Improvement

Program

12/19/200 5 (Change

4:

11/10/201

5)

DoD 5220.22-M National Industrial Security Program Operating Manual

(NISPOM)

02/28/200

(Change 2:

05/18/201 6)

Army Directive 2014-05 Policy and Implementation

Procedures for Common Access Card Credentialing and

Installation Access for Uncleared Contractors

03/07/201 https://armypubs.army.mil/ProductMaps/Pub Form/ArmyDir.aspx

AR 25-2

Information Assurance

04/04/201 http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

AR 530-1

Operations Security

09/26/201 http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

AR 525-13

Antiterrorism

12/09/201 http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

AR 381-12

Threat Awareness and

Reporting Program (TARP) (Section II, ¶ 2-4.b)

06/01/201 http://armypubs.army.mil/ProductMaps/PubF orm/AR.aspx

TECHNICAL EXHIBIT 1

Performance Requirements Summary (PRS)- - not all inclusive, follow PWS for details

Performance Objective

Performance Standard Acceptable Quality Levels (AQL)

Surveillance Method / By Whom

5.2 Testing issues

The contractor will arrange for the opportunity to consult with a representative of the

NYARNG SOH or Contracting Office by telephone to coordinate or resolve issues that might arise before, during, and after the testing period.

The contractor shall report no later than 30 minutes of finding

Random monitoring

/ COR

5.3.1 PII/Sensitive Information

The contractor shall safeguard all sensitive/Personally Identifiable Information and adhere to all HIPAA and NYARNG regulations regarding facility and personnel privacy and safety.

This shall occur 100% of the time

Random monitoring

/ COR

5.4.2 Missed

Appointments

The contractor must notify the government of employees who were scheduled to attend medical surveillance but did not

The contractor shall notify the Project Officer within 30 minutes

Random monitoring

/ COR

5.11.2 Contractor

onsite issues

In the event of a Contractor equipment failure, specific testing and / or parts of examinations that are not completed during the testing period

No later than two weeks from the last exam date listed in the Statement of Work. Unfinished testing

/ examinations will be completed at no additional cost to the Government.

Random monitoring /

COR

5.11.3 Testing site

State-of-the-art mobile unit designed to be conducive to an efficient continuous flow of patients, yet maintain the dignity of the patient and achieve complete individual privacy at all times.

This shall occur 100% of the time

Random monitoring /

COR

TECHNICAL EXHIBIT 2

Deliverables Schedule- not all inclusive, follow PWS for details

PWS Reference / Deliverable Title

Frequency Number of Copies

Medium/Format Submit To

1.4.5.3 AT Level 1

Awareness Training

Certificates

Provide within 15 calendar days after employee completes training.

1 Electronic Submission COR/KO

1.4.5.4 iWATCH Training Certificates

Provide within 15 calendar days after employee completes training.

1 Electronic Submission COR/KO

1.4.5.11 OPSEC

Training Certificates

Provide within 15 calendar days after employee completes training.

1 Electronic Submission COR/KO

1.4.7 Special

Qualifications

Provide within 5 days of contact award

1 Electronic Submission COR/KO

5.1.2 Service provider

certifications/licenses to the government

With Quote 1 Electronic Submission KO

5.2 A comprehensive

review and evaluation within thirty (30) days following the conclusion of testing

1 Electronic Submission COR

5.4.1 Individuals not

medically cleared

The Project Officer will be notified in writing within twenty-four hours of findings.

Notification will be in the form of a written medical orders indicating follow-up clearance requirement that may remove any restriction to work.

1 Electronic Submission COR

5.10.1 employee examination findings

Due within thirty

(30) days on completion of testing

3 One copy is to be sent to the NYARNG Project Officer in hard copy and on CD, and one copy is to be mailed directly to the individual

COR to monitor employee’s home of record

52.228-5, Insurance—Work on a Government Installation

Provide within 5 days of contact award

1 Electronic Submission KO

TECHNICAL EXHIBIT 3

Estimated Workload Data

DATE Host Facility

Location Attending Facilities

# of Empl.

Time

19 APR 22 FMS 1 27 Masten Ave Buffalo, NY 14204-

FMS 1, 2, 10,

FMS 2 Sub-shop

30 0730-1430

20 APR 22 CSMS C 1500 E. Henrietta Rd Rochester, NY 14623-

AASF 2 CSMS C 35 0700-1330

21 APR 22 FMS 5 6901 Thompson Rd Syracuse, NY 13211-

FMS 4, 5, 6, 13 41 0730-1430

22 APR 22 MATES P4900 Main Tank Rd Fort Drum, NY 13602-

MATES and any individuals who missed Medical Surveillance

28 0700-1400

26 APR 22 AASF 3 330 Old Niskayuna Rd Latham, NY 12110-

FMS 3, 15, 16,

17, CIF, AASF 3,

USP&FO -

Warehouse

28 0730-1500

27 APR 22 CSMS A Camp Smith, Bldg.

300, Cortlandt Manor, NY 10567-5000

FMS 7, CSMS A 36 0730-1400

28 APR 22 FMS 14 25 Baiting Place Farmingdale, NY 11735

FMS 8, 9, 14,

AASF 1, and any employees who missed Medical Surveillance

21 0730-1430

29 APR 22 CSMS B 60 Slosson Ave Staten Island, NY 10314-2518

FMS 12, CSMS

B

28 0700-1300

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Job Medical Surveillance

FFP

Medical Surveillance Medical Examinations per the attached performance work statement (PWS).

Service contract act applies to all non-professional labor categories for each of the areas represented in the PWS available at https://sam.gov/content/wagedeterminations.

FOB: Destination

PURCHASE REQUEST NUMBER: 0011724626

PSC CD: Q403

NET AMT

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

0001 POP 19-APR-2022 TO

29-APR-2022

N/A W56PPG MNCI

CHUCK AUSTIN

330 OLD NISKAYUNA ROAD

LATHAM NY 12110-2225

518-786-6121 FOB: Destination

W56PPG

CLAUSES INCORPORATED BY REFERENCE

52.204-7 System for Award Management OCT 2018 52.204-9 Personal Identity Verification of Contractor Personnel JAN 2011 52.204-10 Reporting Executive Compensation and First-Tier

Subcontract Awards

JUN 2020

52.204-13 System for Award Management Maintenance OCT 2018 52.204-16 Commercial and Government Entity Code Reporting AUG 2020 52.204-18 Commercial and Government Entity Code Maintenance AUG 2020 52.204-22 Alternative Line Item Proposal JAN 2017 52.204-23 Prohibition on Contracting for Hardware, Software, and

Services Developed or Provided by Kaspersky Lab and Other Covered Entities

DEC 2021

52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment

DEC 2021

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

DEC 2021

52.209-10 Prohibition on Contracting With Inverted Domestic Corporations

NOV 2015

52.212-1 Instructions to Offerors--Commercial Products and Commercial Services

DEC 2021

52.212-4 Contract Terms and Conditions--Commercial Products and Commercial Services

DEC 2021

52.212-5 (Dev) Contract Terms and Conditions Required to Implement Statutes or Executive Orders--Commercial Products and Commercial Services (Deviation 2018-O0021)

JAN 2022

52.219-6 (Dev) Notice of Total Small Business Set-Aside (DEVIATION 2020-O0008).

OCT 2020

52.222-3 Convict Labor JUN 2003 52.222-19 Child Labor -- Cooperation with Authorities and Remedies JAN 2022 52.222-21 Prohibition Of Segregated Facilities APR 2015 52.222-26 Equal Opportunity SEP 2016 52.222-41 Service Contract Labor Standards AUG 2018 52.222-50 Combating Trafficking in Persons DEC 2021 52.222-55 Minimum Wages for Contractor Workers Under Executive

Order 14026

JAN 2022

52.222-62 Paid Sick Leave Under Executive Order 13706 JAN 2022 52.223-1 Biobased Product Certification MAY 2012 52.223-5 Pollution Prevention and Right-to-Know Information MAY 2011 52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

JUN 2020

52.225-13 Restrictions on Certain Foreign Purchases DEC 2021 52.232-33 Payment by Electronic Funds Transfer--System for Award

Management

OCT 2018

52.233-1 Disputes MAY 2014 52.233-3 Protest After Award AUG 1996 52.237-1 Site Visit APR 1984 52.237-2 Protection Of Government Buildings, Equipment, And

Vegetation

APR 1984

52.242-15 Stop-Work Order AUG 1989 52.253-1 Computer Generated Forms JAN 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 252.203-7005 Representation Relating to Compensation of Former DoD

Officials

NO…