Amendment_0003.pdf

W40M RHCO-ATLANTIC USAHCA

NORTHERN REG CONTR OFC NRCO

POC: TIFFANY M. NARBONE

P-11050 MT BELVEDERE BLVD

FORT DRUM NY 13602

0011101720

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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

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

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

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

FAR (48 CFR) 53.243

The purpose of this amendment is to increase the radius requirement from 50 to 120 miles as reflected in PWS paragraph 1.1.1 and to extend the closing date until 4:00 pm eastern on 13 April 2018.

All other terms and conditions remain the same.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 18

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

16C. DATE SIGNED

BY 16-Mar-2018

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

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

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X W91YTZ-18-R-0011

X 9B. DATED (SEE ITEM 11)

16-Jan-2018

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

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

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

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

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

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

12. ACCOUNTING AND APPROPRIATION DATA (If required)

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

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

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

CONTRACT ORDER NO. IN ITEM 10A.

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

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

D. OTHER (Specify type of modification and authority)

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

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

10A. MOD. OF CONTRACT/ORDER NO.

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

6. ISSUED BY

3. EFFECTIVE DATE

16-Mar-2018

CODE

W40M RHCO-ATLANTIC USAHCA

NORTHERN REG CONTR OFC NRCO

6021 5TH ST BLDG 1467

FORT BELVOIR VA 22060-5580

W91YTZ 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W91YTZ

FACILITY CODECODE

EMAIL:TEL:

W91YTZ-18-R-0011

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 16-Mar-2018 04:00 PM to 13-Apr-2018 04:00 PM.

The following have been modified:

52.212-1 ADDENDUM

FAR 52.212-1 is hereby amended to reflect the changes shown below as to the specific paragraph revised.

Para (b) Submission of Offers. The following amends this paragraph with respect to the information and documents required for submission in response to this solicitation.

(1) ELECTRONIC OFFERS. Offerors may submit electronic offers in response to this solicitation. The offer must arrive by 13 April 2018 @ 4:00 PM Eastern to the following email address: tiffany.m.narbone.civ@mail.mil.

(2) The Offerors must request verification by email to Tiffany Narbone to confirm that their proposal was received by the time specified in the solicitation. The Government will not be responsible for any failure of transmission or receipt of the offer, or any failure of the offeror to verify receipt of the emailed offer.

(3) The Government intends to award a firm fixed price contract for services as listed in the Performance Work Statement. Proposals shall include technical documentation that states the services conform to the requirements listed in the Performance Work Statement.

(4) All questions pertaining to this requirement must be received electronically no later than 10 April 2018, 4:00 PM Eastern. No telephonic request will be honored. Responses will be posted to FBO via an Amendment to the solicitation.

(5) The technical information required for evaluation purposes shall not exceed 10 pages.

(6) BASIS FOR AWARD: Awards will be considered based on a lowest price, technically acceptable basis (LPTA).

Discussions may be conducted whenever the Contracting Officer deems it appropriate. The contract will be awarded strictly in accordance with the criteria and process established in FAR Part 12.

(7) Please complete and return FAR 52.212-3 ALT I Offeror Representations and Certifications - Commercial Items.

(8) SUBMISSION OF OFFERS. Please note that your offer shall include all of the following information. Submit proposal in three separate parts as follows:

PART I: TECHNICAL INFORMATION. The information provided by the offeror will be a significant factor in the Government's determination of technical acceptability. (Refer to Addendum 52.212-2). The offeror shall submit technical documentation that displays the proposed services conform to the requirements listed in the Performance Work Statement. Technical capability should include product literature; Federal and State licenses; warranties;

guarantees; technical specifications and delivery information. Technical will be evaluated as either Acceptable or Unacceptable. Best value is expected to result from selection of the technically acceptable proposal with the lowest evaluated price. Definitions are as follows:

ACCEPTABLE: To be rated acceptable, the offeror's technical proposal must demonstrate it can meet all specifications as required in the Performance Work Statement.

UNACCEPTABLE: A technical proposal that fails to demonstrate it can meet one or more requirements will be determined unacceptable.

PART II: PAST PERFORMANCE. Offeror is required to submit information, on a single page, identifying federal, state and local government and private contracts performed within the past three years from the date this solicitation is issued, which are similar in scope and complexity to the effort described in this solicitation. If none, offeror should so state and provide information on references.

a. Information provided by the contractor shall state: Name, telephone and fax numbers of a point of contact in the administering contracting office, the award/contract number, the term of the contract (1 year, 2 years etc), and the total quantity furnished annually.

b. Discussion may be conducted whenever the Contracting Officer deems it appropriate.

c. The Government may reject a proposal if it is found that any information that has a negative impact on the offeror's past performance record has been deleted, misrepresented, or withheld.

d. Past Performance documentation will be checked for information on the prospective contractor's capability to provide the required equipment and reagents and that they have an acceptable past performance record.

The government may consult other sources of past performance information including but not limited to the Contractor Performance Assessment Reporting System (CPARS) and Past Performance Information Retrieval System (PPIRS).

Past performance shall be used as an evaluation factor within the LPTA process, unless waived by the PCO in accordance with FAR 15.101- 2(b). It shall be evaluated in accordance with FAR 15.305 and DFARS 215.305.

However, the comparative assessment in FAR 15.305(a)(2)(i) does not apply. Therefore, past performance will be rated on an "acceptable" or "unacceptable" basis using the ratings below.

ACCEPTABLE: Based on the offeror's performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror's performance record is unknown. (See note below.)

UNACCEPTABLE: Based on the offeror's performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

Note: In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance (see FAR 15.305 (a)(2)(iv)). Therefore, the offeror shall be determined to have unknown past performance. In the context of acceptability/unacceptability, "unknown" shall be considered "acceptable".

PART III: PRICE. The offeror shall submit the CLIN Structure with the price for services for the base year and four options year. Any additional prices shall be listed with details explaining the price. This information will be used to assist in the price analysis described in EVALUATION OF THE PROPOSED PRICES, in ADDENDUM TO FAR

52.212-2, EVALUATION - COMMERCIAL ITEMS.

Representations and Certifications found at FAR 52.212-3 ALT I SHALL be completed and submitted with the offer.

Para (g) Contract award. This is amended to state that the Government may conduct discussions prior to contract award.

Para (j) Data Universal Numbering System (DUNS) / CAGE Code. The offeror shall obtain these said Codes and submit them to Contracting Center. Registration in the System for Award Management (SAM), if you are a US firm.

Award cannot and shall not be made to an offeror without these codes.

Para (n) Bid Preparation Costs. This solicitation does not commit the Government to pay any costs incurred in the submission of an offer, in making any necessary studies for the preparation thereof, or for any visit(s) the Contracting Officer may request for the purpose of clarification of the offer. The Government may reject a proposal if it is found that any information that has a negative impact on the offeror's past performance record has been deleted, misrepresented, or withheld.

Para (o) Protest received at a level higher than the contracting officer will be referred to the contracting officer.

Protestor may request a review by the contracting officer or an independent review at a level higher than the contracting officer. Requests for appeals or independent review will be addressed to the contracting officer for referral to the review authority. Questions on this process will be referred to the cognizant contracting officer identified in the solicitation.

Para (p) The non-FAR Part 12 discretionary FAR, DFARS, AFARS, and LOCAL provisions included herein are incorporated into this solicitation either by reference or in full text. If incorporated by reference, see provision 52.252-1 herein for locations where full text can be found.

PROCESS FOR AWARD. Awarded will be made to the offeror who is most advantageous to the Government, not using discussions but reserves the right to do so at his or her sole discretion.

BASIS FOR AWARD. Award will be made to the lowest priced technically acceptable (LPTA) offeror with an acceptable record of past performance. An unknown rating will be considered as acceptable past performance.

(m) The non-FAR Part 12 discretionary FAR, DFARS, AFARS, and LOCAL provisions included herein are incorporated into this solicitation either by reference or in full text. If incorporated by reference, see provision 52.252-1 herein for locations where full text can be found.

(End of Addendum)

PWS

PERFORMANCE WORK STATEMENT (PWS)

DIAGNOSTIC SERVICES SUPPORTING

MEDICAL SURVEILLANCE PROGRAM

AT

U.S. ARMY MEDICAL DEPARTMENT ACTIVITY (MEDDAC),

OCCUPATIONAL HEALTH (OH) CLINIC LOCATED AT

WATERVLIET ARSENAL (WVA),

WATERVLIET, NY

PWS PART 1

GENERAL

1. SCOPE OF WORK:

1.1.1. The contractor shall provide all resources, labor, travel, material, and equipment services necessary to perform the following Radiology and Cardiovascular (CV) Screening services for USA MEDDAC, Fort Drum, NY OH Clinic located at WVA, Watervliet, NY in accordance with the Statement of Work Herein. Quantity is estimated. Payments will be made for actual quantities ordered, received, and accepted by the Government. Orders to be placed by the Government representative. Delivery of each service shall be within 5 working days after the order is placed. Distance from USA MEDDAC OH Clinic located at WVA, Watervliet, NY to responding contractor should be no more than 120 miles: Address for USA MEDDAC, OH Clinic at WVA is Watervliet Arsenal, 1 Buffington Street, Watervliet, NY 12189.

1.1.2. The object of this task is to support the Army Occupational Health Program providing Routine CV Screening, Routine Radiological Screening to include chest x-rays to Department of Defense (DOD) police/security personnel assigned to WVA, and Routine Radiological Screening for employees with a positive Tuberculin Skin Test or employees who have been or are exposed to asbestos and/or other chemicals while working at Watervliet Arsenal as indicated by OSHA guidelines. DOD Reg. 6055.05MP In addition to mandatory exams under the OSHA, occupational medical surveillance is usually initiated for workplace exposures greater than one half the permissible exposure limit (PEL) (OSHA Table Z substances) or greater than one half the threshold limit value (subpart Z of part 1910 and part 1910.1000 of title 29 Code of Federal Regulations (reference F). Medical surveillance activity should consider all relevant occupational exposure limits pursuant to Reference (a) of the DOD 6055.05MP.

Reference A is DoDI 6055.05 November 11, 2008. DoDI 6055.05 states the health of workers must be monitored to determine if work-related exposures have resulted in adverse health effects. This task is also to provide Routine Radiological Screening to include chest x-rays to all applicable Federal employees assigned to WVA requiring surveillance based on job requirements. OH Medical examinations are conducted to determine if workers are medically and physically able to perform the assigned duties without substantial risk of harm to themselves, others or the mission (fitness for duty examinations). Also conducted to determine whether the workplace is causing workers injury or illness due to an occupational exposure (medical surveillance examinations).

Preplacement/Initial/New Hire examinations are performed before placement in a specific job to medically assess if the worker will be able to perform the job safely. May be combined with occupational medical surveillance to record a baseline of values for future comparison. Medical surveillance examinations provide baseline and periodic assessments or measurements to detect abnormalities in workers exposed to work-related health hazards. Three ways to identify workers at risk of work related health problems are by job title, workplace and by individual exposure. At implementation of this contract, the amount of WVA employees who are eligible for periodic Baseline Chest x-rays are approximately 193 and those in Police and Security positions eligible for Routine CV Stress Tests are approximately 27. The number of eligible employees is subject to change depending on WVA mission requirements and staffing needs.

The need for CV and Radiological Screenings will continue to be contracted to a Qualified Health Provider (QHP) in the local community as long as the USA MEDDAC OH Clinic does not have qualified medical staff or equipment to perform these services at the WVA.

1.1.3. The Army Occupational Health Program includes those evaluations necessary to determine fitness to perform the essential job functions. All medical therapeutic measures or additional medical evaluations (that are not required to determine fitness to perform the essential job functions) are the responsibility of the individual. All tentative selectees for an appointment as a DACP/SG will be required to undergo a medical examination at Government expense to determine if they can perform the essential functions of the job, with or without reasonable accommodation. The examining provider will note on the Optional Form (OF) 178 or other appropriate documentation of the medical examination if the individual is medically cleared to participate in an exercise program and take Physical Ability Tests (PATs). The examining provider will identify work restrictions, if appropriate, and suggest practices, aids, or devices that would allow the individual to perform the essential job functions under reasonable accommodation.

1.2 CONTRACTOR PERSONNEL: For the purpose of this contract, the term “Contractor “personnel” applies to all Contractor employees, subcontractor employees, or any other person(s) acting for or on behalf of the Contractor to perform work on this contract.

1.3. CONTRACTOR EMPLOYEES: General Qualifications: Contractor employees shall be trained, qualified, certified and/or licensed to perform services required for this contract. The contractor shall maintain records of training qualifications, certifications, and licenses and provide them to the Contracting Officer upon request. The Contractor shall ensure that the employees remain fully qualified to perform work under this contract. The Contractor shall maintain the work force in such a manner as to ensure that the employees remain fully qualified.

The Contractor shall only employ persons able to speak, read, write, and understand English for those positions interacting with Government personnel, and where English is used or essential to provide the product, record, data, information, or service.

1.3.1. All work shall be performed in a professional manner by an authorized service representative. The service representative shall be manufacturer trained and have no less than 24 months work experience on the equipment. If any deficiencies are found due to negligence of the service representative, the Contractor shall be required to correct the deficiency to a fully operational status in accordance with manufacturer specifications at no additional cost to the US Government.

1.4. NONPERSONAL SERVICES: This contract is a non-personal services contract under which the personnel rendering the services are not subject, either by the contract’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the government and its employees.

PWS PART 2

DEFINITIONS AND ACRONYMS

2.1. DEFINITIONS: The definitions set forth below are those unique to this contract. Definitions for technical terms or words that are included in this contract can be found in the technical documents referenced in the individual functional areas of the PWS. The definitions provided below are oriented to Fort Drum’s PWS. In many cases, definitions are specific by situation. The listing of definitions is not all-inclusive, but it has been derived from official publications (e.g., regulations and technical manuals) when available.

Acceptable Quality Level (AQL): The AQL is a designated value (percent) of defective outcomes/service that the Government indicates will be accepted using acceptable sampling techniques and procedures.

Alternate Contracting Officer’s Representative (ACOR): An alternate individual from the functional activity appointed by the Contracting Officer and delegated specific authority to monitor contract performance and to perform specific contract administration functions in the absence of the COR .

Business Day: Monday through Friday, except for government recognized holidays and days the Fort Drum installation has been closed for all but emergency business.

Contracting Officer (KO): An individual with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

Contracting Officer's Representative (COR): An individual from the functional activity appointed by the Contracting Officer and delegated specific authority to monitor contract performance and to perform specific contract administration functions.

Federal Acquisition Regulation (FAR): Provides uniform policies and procedures for acquisitions by executive agencies of the federal Government.

Government Furnished Property: All tangible property of Government furnished to Contractor.

Performance Standard: A measurable output or result associated with the performance-based description of a requirement found in the PWS.

Quality Control: Those actions taken by the Contractor to control the in-process performance of goods or services to ensure that contract quality standards are met.

2.2. ACRONYMS: For the purpose of the resultant contract, the acronyms listed below shall apply:

AR Army Regulation DA Department of the Army DA Cir Department of the Army Circular DA Pam Department of the Army Pamphlet ACC American College of Cardiology

AHA American Heart Association CP/SG Civilian Police/Security Guards CV Cardiovascular CAD Coronary Artery Disease CHD Coronary Heart Disease DA Department of the Army DOD Department of Defense EMF Employee Medical File JC Joint Commission OPM Office of Personnel Management QHP Qualified Health Provider PAT Physical Ability Test OH Occupational Health OHCP Occupational Health Clinic Provider

PWS PART 3

CONTRACTOR-FURNISHED ITEMS AND SERVICES

3.1. GENERAL: With the exception of items specifically identified as Government furnished in 3. the Contractor shall furnish all supplies, equipment and labor necessary to perform the requirements of this contract.

3.2. PERMITS, TAXES, LICENSES, ORDINANCES, AND REGULATIONS: The Contractor shall, at his own expense, obtain all necessary permits, give all notices, pay all license fees and applicable taxes, comply with municipal, State, and Federal laws, ordinances, rules and regulations applicable to the business carried on under this contract.

3.3. CONTRACTOR OWNED PROPERTY:

3.3.1. Condition of Property: All property utilized on this contract shall be in an operable condition and shall meet all applicable Federal, State, Local, and requirements for its operation.

3.3.2. Operation: All Contractor owned equipment shall be operated according to applicable Federal, State, Local, and Installation laws and regulations as they apply to the equipment. This includes the requirement that Contractor personnel shall be adequately trained and possesses all necessary licenses, certification, or other required documents to operate the equipment.

3.3.3. The contractor shall provide a medical staff whose qualifications are derived from an accredited learning institution (United States Professional Accreditation Standards), with experience in CV Evaluations/Screenings and currently licensed to practice in the State of New York. The QHP must possess a Doctor of Medicine (M.D.) or a Doctor of Osteopathy (D.O.) degree and be board certified in cardiology. The clinical competence to perform Exercise Stress Testing is usually granted by staff privileges at the institution and should conform to the Joint Commission (JC) standards. Additionally, standards recommended by the American College of Cardiology (ACC);

American College of Physicians and the American Heart Association (AHA) must be met by the Contractor. The QHP must be trained in advanced cardiac life support and a medical crash cart with a defibrillator must be available during the examination procedure.

3.3.4. The contractor shall provide a medical staff whose qualifications are derived from an accredited learning institution (United States Professional Accreditation Standards), with experience in Radiological Screenings and currently licensed to practice in the State of New York. Contractor responsibility of Routine Chest x-rays.

PWS PART 4

GOVERNMENT-FURNISHED ITEMS AND SERVICES

4.1. The cost for Routine CV Screenings and Routine Chest x-rays will be paid for by the U.S. Government.

4.2. The Government will provide contractor employee referrals for Routine CV Screenings and Routine Chest x-rays only after employees following medical evaluation determining there is a need for specialized testing by another medical provider (DO, MD, NP or PA).

4.3. Report provided by contractor following Routine CV Screenings will be utilized by the Government to determine if an employee can perform the essential functions, with or without reasonable accommodation.

4.4. The Government will not provide any equipment, supplies and services as all work shall be completed in the contractors institution.

PWS PART 5

SPECIFIC TASKS

5.1. A CV Stress Test shall be scheduled within five (5) working days following a request by the Army OH provider (DO, MD, NP or PA). After performance of the CV Stress Test, the contracting provider shall orally provide preliminary examination results within 48 hours to the Army’s OH provider requesting the examination.

Within five (5) working days following the CV examination, a written report including the reading, interpretation and report shall be provided to the Army’s OH provider. The contractor shall provide in a written medical opinion any temporary or long term medical restrictions as a result of their CV examination. DACP/SG individuals must be able to perform the essential elements of their job.

5.2. Exercise Stress Testing shall be provided as determined by applicable OPM administrative requirements linked to job descriptions for Department of the Army Civilian Police (DACP)/Security Guards (SG) referred to as DACP/SG; The Department of the Army’s Medical Command (MEDCOM) CV guidelines: and Army Regulation (AR) 190-56, 15 October 2009. The following instructions (from AR 190-56) must be followed by the QHP:

5.3. Exercise Stress Testing for DACP/SG new hires and current employees will be conducted in accordance with prescribed OPM medical evaluation standards, appendix C, and MEDCOM CV evaluation guidelines. These medical standards and evaluation guidelines are designed to ensure the new hires for a guard or police position and current employees are capable of performing the essential functions of the position with or without reasonable accommodation.

5.4. A licensed physician will conduct the evaluation, review and evaluate the diagnostic results of CV Screening, Current Procedural Terminology (CPT) code 93015, Stress Test Treadmill/Bike. For DACP/SG, when the examining physician is not in Federal service, the evaluation must be forwarded to a provider (DO, MD, NP, PA) with a Federal status for review and approval in accordance with appendix C.

5.5. CV evaluation of DACP/SG will be accomplished in accordance with all applicable references identified in this contract. These documents assist the examining provider (DO, MD, NP, PA) with identifying conditions that ordinarily might be expected to interfere with the performance of one or more essential job functions.

5.6. The supplier shall provide the necessary medical services to all Department of Defense (DOD) DACP/SG employees referred to them for the CV Screening Program. Such medical services shall include either a Level II type screening as requested.

5.7. The Army Cardiovascular Screening Program (CVSP) per AR 40-501, Level II Screening. Those employees with the following findings on the ECG will require a Level II screening independent of the Framingham risk score:

(a) Any supraventricular tachycardia (3 or more beats at a rate greater than 100) to include atrial fibrillation/flutter, multifocal atrial tachycardia, junctional tachycardia, and persistent sinus tachycardia.

(b) Conduction disturbances of left bundle branch block (QRS duration more than 120 msec), Mobitz type II second degree atrioventricular (AV) block, and third degree AV block.

(c) Short PR interval (PR interval less than 120 milliseconds (msec) in all 12 leads).

(d) Sinus pause or asystole greater than 2 seconds in duration.

The Level II evaluation will consist of noninvasive testing using one (or more, when medically indicated) of the following tests:

(1) The Graded Exercise Stress Test (GXT; Bruce or modified Bruce protocols). If, during the GXT, blood pressure increases to greater than 200 mmHg systolic or 100 mmHg diastolic during or after exercise, an echocardiogram is recommended to rule out pathologic ventricular hypertrophy.

(2) Exercise and/or pharmacologic stress echocardiography.

Graded Exercise Stress Test (GXT) – Level II Stress tests are performed to see how the heart performs under physical stress. The heart can be stressed with exercise on a treadmill or in a few instances, a bicycle.

Other names for Stress Testing Exercise test Treadmill/Bike test

Standard Format for Reporting CV Screening Results. At a minimum, the following results must be included in the medical interpretation of the results by the Cardiologist’s (Contract physician):

a. Level II CV results. The physician’s medical opinion regarding the employees ability to perform the essential elements of their job in relation to their CV evaluation.

b. Symptoms reported during stress testing

c. Reasons for ending the test

d. Estimate of exercise capacity in metabolic equivalents (METS)

e. Blood pressure response

f. Presence and frequency of arrhythmias or ectopy

g. EKG changes (type and location) observed during the test

h. Conclusions:

(1) Positive

(2) Negative

(3) Equivocal

(4) Uninterruptable

(5) Goal Achieved – maximal or sub maximal

5.8. Routine Chest x-rays services are noninvasive diagnostic studies to aid in the diagnosis of lung disease, cardiac conditions, bony abnormalities and chest wall conditions. Other than as directed by OSHA or the Navy’s Medical Matrix, routine use of chest x-rays is not indicated for medical surveillance. History and physical exam are superior tools for identifying occupational lung problems and may support the directed use of other tests when there are positive clinical findings. These other tests may include chest x-ray CPT code 71020.

5.9. A Radiological Test including chest x-rays shall be scheduled within five (5) working days following a request by the Army OH provider. After performance of the chest x-rays, the contractor will provide all results/reports to Army OH provider within 72 hours following procedure. Imaging discs will be provided to Government upon request if determined additional B Reading is required based on results.

5.10. Contractor will provide chest x-rays ILO Standard Digital Images (ILO 2011-D) in DICOM format. These images are digitized versions of the 2000 ILO standard radiographs that were adapted to allow pneumoconiosis classification of digital (digitally acquired) radiographs using diagnostic monitors. Examinee digital chest images should always be classified based on side by side comparison with the new ILO 2011-D standard reference images.

The National Institute for Occupational Safety and Health (NIOSH) does not recommend use in the U.S. of film-based ILO reference radiographs for comparison with examinee digital chest images.

5.11. Cardiac Stress Testing and Chest X-rays (2 view), CPT Codes for Services Required TEST – Evaluation and Management Code (E&M)

CPT CODE* INDICATION

Standard Exercise Stress Test (bicycle, treadmill)

*93015

Angina, (typical and atypical) normal EKG in a patient with risk of

CHD/CAD

Routine Chest X-ray (14” x 17” PA 2 view only)

*71020 History of Asbestosis, Pneumonia, Tuberculosis, Silicosis, Lung Cancer, Broken ribs, Any chest injuries or surgeries, or other chemical exposure as indicated by OSHA guidelines.

5.12. The examining provider will make a recommendation to the employer as to whether the individual can perform the essential functions of the job, with or without reasonable accommodation, and take the PAT. If needed, the examining provider may consult with the Occupational Health Clinic provider (DO, MD, NP, or PA).

5.13. The QHP at the contracting facility shall authorize and sign all medical documentation as well as any medically related correspondence.

5.14. All testing are performed on equipment that has been thoroughly examined and calibrated prior to testing.

The contractor will provide equipment calibration reports upon request.

5.15. The Contractor shall submit to the Contracting Officer Representative (COR) monthly billing invoice reports no later than the 15th of the subsequent month. The invoice period covered by the report shall be from the first through the last day of the previous month. Contractor format is acceptable. The Contractor shall also be responsible for providing a detailed report on patients’ diagnosis, procedures, outcomes and recommendations performed at their facility to the Army’s OH provider and COR.

5.16. Management reports shall include but not limited to, services performed and all associated costs, to include:

International Coding of Disease 10 (ICD-10) and evaluation and management (E&M) coding diagnosis reports associated with patient visit. Reports may be in Contractor format and agreed to by both Government and contractor.

5.17. Place of Performance. Primary work is to be performed at an institution identified by the contractor.

5.18. Hours of Work. MEDDAC OH Clinic at WVA normal duty hours are between 7:00 a.m. – 4:30 p.m., Monday through Thursday, and every other Friday 7:00 a.m. – 3:30 p.m., excluding federal holidays. Referrals for selected testing will be provided within these hours of operation to the contractor.

6.0 SECURITY.

6.1. INFORMATION SECURITY. All contract personnel shall comply with DOD, DA, and the Medical Command policies, regulations, and directives concerning the security of information and information systems. All financial, statistical, personnel, and/or technical data that are furnished, produced, or otherwise made available to the Contractor or its personnel are considered confidential and proprietary and shall not be used for purposes other than the performance of work under this contract. The Contractor’s personnel shall release none of this information.

7.0. LEVEL OF EFFORT.

7.1. The level of effort is based on the current and projected CV needs of DACP/SG personnel assigned to WVA. Contractors will constantly review their performance based on meeting the Army’s regulatory requirements for CV screening. If the Contractor can establish that the Government’s Workload Estimates are inadequate to provide the required service level, they may make a recommendation for an increase in manpower allocations to the contracting officer or designated representative.

8.0 MAINTENANCE OF MEDICAL RECORDS.

8.1. The DOD shall maintain all Employee Medical Files (EMF) for DOD civilian employees in accordance with the Privacy Act of 1974, The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104-

191) [HIPAA], AR 40-66, and AR 40-68. Medical documentation related to episodes of treatment for DOD employees will be forwarded to the Department of the Army’s Arsenal address; ATTN: Occupational Health Clinic

Provider (OHCP). The health care provider shall cooperate with established methods to ensure that Protected Health Information (PHI) forwarded for inclusion in the EMF’s is not revealed to unauthorized persons during the forwarding process.

8.2. The health care provider/OH Clinic shall not disclose nor cause to be disseminated any PHI information contained in the EMF’s to anyone other than the employee without the employee’s prior written consent.

8.2.1 The OH medical authority may release to the Arsenal’s designated command security/law enforcement representative recommended medical restrictions regarding the employee’s ability to perform their duty.

Recommendations are based on the results of the CV examination without disclosing the employee’s medical information. It also may be appropriate to consult with Army medical personnel and the Civilian Personnel Advisory Center (CPAC) to obtain any additional documentation necessary for this determination.

8.2.2. The Provost Marshal or designated command security/law enforcement representative will determine whether an individual with a disability or long-term medical restrictions due to their CV screening results can take the PAT (including through the use of alternate events) and perform the essential functions of the job. Often, this determination may be made based upon written information from an employee’s own health care provider. It also may be appropriate to consult with Army medical personnel to obtain any additional documentation necessary for this determination.

9.0 QUALITY CONTROL.

9.1. The OHCP is responsible for providing quality control to assure requirements of the contract are provided as specified. The government will monitor the OHCP’s performance under this contract using the Quality Assurance Provisions in AR 40-68 and AR 40-66.

10.0 APPLICABLE PUBLICATIONS, REFERENCES AND REGULATIONS

REFERENCE TITLE DATE

OPM Medical Evaluation Standards, Appendix C 1 Jul 1999

AR 40-68 Clinical Quality Management 26 Feb 2004

AR 40-66 Medical Records Administration 17 Jun 2008

AR 40-501 Standards of Medical Fitness 14 Dec 2007 Rapid Action Revision Issue Date 23 Aug 2010

DoD Directive The Joint Ethics Regulation (JER) 17 Nov 2011 5500.7R

AR 190-56 The Army Civilian Police and Security Guard Program 15 Mar 2013

SECTION 1

INSPECTION AND ACCEPTANCE

1. INSPECTIONS: Government inspections are for the sole benefit of the Government and do not relieve the Contractor of his responsibility for providing adequate quality control measures. The Government will perform quality assurance (QA) of the Contractor's performance under this contract using the method of surveillance specified in the Quality Assurance Surveillance Plan (QASP). The Government’s QASP will be provided to the contractor after contract award. The COR may compare results of inspections performed by the Contractor’s inspectors with the actual conditions observed during Government inspections. In addition for Performance Improvement (PI): The Infection Control Officer (ICO) or his designated representative will monitor contractor compliance and evaluate services performed in accordance with The Joint Commission standards. The ICO may request certain documentation from the contractor in the conduct of Contract Performance Surveillance

2. ACCEPTANCE: The Government will accept all work when the Contractor performs and completes the work within the standards described in the PWS.

3. NON-CONFORMANCE: Failure by the Contractor to perform the work in accordance with the Performance Work Statement shall be considered a non-conformance, shall constitute a contract deficiency, and may be grounds for contract deduction in accordance with the QASP.

4. GOVERNMENT'S RIGHTS: The rights of the Government and remedies described in this section are in addition to all other rights and remedies set forth in this solicitation. Specifically, the Government reserves its rights under the Terms and Conditions clause, reference FAR Clause 52.212-4. Any deductions shall reflect the reduced value of services performed under the contract. The Contractor shall not be relieved of full performance of the services hereunder. The Government may modify the type and frequency of inspection of items.

SECTION 2

DELIVERIES OR PERFORMANCE

1. PERFORMANCE: Refer to Section 1, the Performance Work Statement.

2. FEDERAL HOLIDAYS: Beyond the observance of Federal Holidays or uniquely occurring national events, the Contractor may observe other dates of public or religious significance; however, the occurrence and observation of such shall not relieve the Contractor from full performance of any contract requirement. Federal Holidays are as follows:

New Year's Day 1 January Martin Luther King's Birthday Third Monday in January President's Day Third Monday in February Memorial Day Last Monday in May Independence Day 4 July Labor Day First Monday in September Columbus Day Second Monday in October Veteran's Day 11 November Thanksgiving Day Fourth Thursday in November Christmas Day 25 December

NOTE: Any of the above holidays falling on a Saturday will be observed on the Friday preceding the holiday;

holidays falling on a Sunday will be observed on the following Monday.

SECTION 3

CONTRACT ADMINISTRATION DATA

1. CONTRACT ADMINISTRATION: After award, NRCO, Fort Drum Contracting Cell will administer the contract. The Contractor shall, after receipt of the contract, direct all questions concerning the contract to:

NRCO, Fort Drum Contracting Cell BLDG P-11056 MT. Belvedere BLVD

Fort Drum NY 13602-5220 Telephone: 315-772-1559

Fax: 315-772-1941

2. IMPORTANT NOTICE: The Contractor will not accept any instructions issued by any person other than the Contracting Officer or his/her authorized representative acting within the limits of his/her authority. No information other than that which may be contained in any authorized amendment to this solicitation or any authorized modification to any resulting contract issued by the Contracting Officer, which may be received from any person employed by the U.S. Government or otherwise, shall be considered as grounds for deviation from any provisions, conditions or other terms of this solicitation or any resulting contract.

3. CONTRACTING OFFICER'S REPRESENTATIVES AND THEIR AUTHORITY:

3.1. The Contracting Officer will designate individual(s) to act as the Contracting Officer’s Representative (COR) under this contract. Such designations will be made by letter from the Contracting Officer with an information copy furnished to the Contractor. The COR’s staff will represent the Contracting Officer in the administration of the contract but will not be authorized to change any of the terms and conditions of the contract.

3.2. No oral statements of any person, whomsoever, will in any manner or degrees modify or otherwise affect the terms and conditions of this contract. The Contracting Officer shall be the only person authorized to approve changes in any of the requirements under this contract, and notwithstanding any provisions contained elsewhere in this contract, said authority shall remain solely with the Contracting Officer. Otherwise, the COR's authority shall be limited to that authority specified in his letter of appointment.

4. 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 shall report ALL Contractor labor (including subcontractor labor) required for performance of services under this contract. The Contractor is required to provide all of the information requested and in the format required, using the following web address https://cmra.army.mil. The requirement is: Data must be entered into the CMR application after completion of each fiscal year (30 September), the deadline to enter data is 31 October.

4.1. Contract Manpower: 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 www.ecmra.mil The required information includes: (1) Contracting Office, Contracting Officer, Contracting Officer’s Technical Representative; (2) Contract number, including task and delivery order number; (3) Beginning and ending dates covered by reporting period; (4) Contractor name, address, phone number, e-mail address, identity of Contractor employee entering data; (5) Estimated direct labor hours (including sub-Contractor); (6) Estimated direct labor dollars paid this reporting period (including sub-Contractor); (7) Total payments (including sub-Contractor); (8) Predominant Federal Service Code (FSC) reflecting services provided by Contractor (and separate predominant FSC for each sub-Contractor if different); (9) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the Contractor with its UIC for the purposes of reporting this information); (10) Locations where Contractor and sub-Contractors 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); (11) Presence of deployment or contingency contract language, and, (12) Number of Contractor and sub-Contractor employees deployed in theater this reporting period (by country). (13) As part of its submission, the Contractor will also provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period will be the period of performance not to exceed 12 months ending September 30 of each Government fiscal year and must be reported by 31 October of each calendar year. The Contractor shall notify the Contracting Officer’s Representative (COR) by the 5th working day of November whether or not they have completed this report. If the COR is unavailable, the Contractor will notify the Contracting Officer.

5. CONFIDENTIALITY OF INFORMATION: Unless otherwise specified all financial, statistical, personnel and or technical data which is furnished, produced or otherwise available to the contractor during the performance of this contract is considered confidential and shall not be used for purposes other than the performance of work under this order.

6. CONTRACT PAYMENT/ELECTRONIC FUNDS TRANSFER: Reference FAR clause 52.232-33 Mandatory Information for Electronic Funds Transfer Payment (OCT 2003). This clause requires that contract payments be made by electronic funds transfer by the Finance Office. The contractor shall provide information required concerning the financial institution to receive electronic funds transfers to the designated payment office.

ATTACHMENT #1 AT/OPSEC

Procedures: AT & OPSEC in the Contract Support Process Table Phase

Step Office of Primary Responsibility (OPR):

Major Tasks

In it ia l P la n n in g

Determine Initial requirements/De velop requirements package

Requiring activity commander and staff:

o Conduct initial risk assessment to determine if commercial sector support is appropriate based on AT/OPSEC risks/considerations.

o Determine current and potential future threat assessment levels on contract performance o Develop an OPSEC critical information list.

ATO, OPSEC and personnel who possess the 3C

ASI Integrate current AT/OPSEC and operational contract support, and related HQDA and local command policy and procedures (e.g. AR 525-13, ATTP 4-10, ALARACT message 110/2011) into routine staff planning

2. Perform AT/OPSEC related risk analysis

Requiring activity 3C Staff Officer/NCO or staff equivalent:

o Obtain proper unit/organization ATO review as required by HQDA and local command policy.

o Work with appropriate staff to develop other support alternatives if risk of contract support is deemed unacceptable for this service.

ATO:

o Review draft PWS ( for service contract) and item description/product description in the purchase request (for supply contract), QASP (for services contracts), and any evaluation factors to determine if current protection measures, installation/facility access, contractor verification, physical security procedures are sufficiently identified to mitigate AT risks.

o Determine if contract AT/OPSEC language/clauses are applicable and if so, are they sufficient without additional PWS and QASP elements o Coordinate draft requirements package with other protection function staff members as appropriate for additional risk analysis.

OPSEC Officer: ensure review of the requirements package for OPSEC matters by OPSEC level II certified individual

3. Finalize AT/OPSEC related measures in the requirements package (or contract modification

Requiring activity 3C Staff Officer/NCO or staff equivalent, the ATO, and as necessary other AT/protection staff:

Include any work site specific AT related requirements in the PWS, QASP, solicitation evaluation criteria as appropriate.

o Stipulate applicability of the standard contract language/clause on the requests) and adjust installation/facility and contract service performance site security measures (as required)

AT/OPSEC cover sheet o Include DD Form 254 if the contract is classified or if contractor will require access to classified information and/or systems.

o Be prepared to appoint a Contractor

Verification System trusted agent (CVS TA) to approve contractor requests for CAC

ATO:

o Coordinate with appropriate staff or command to ensure AT/OPSEC procedures are modified as necessary to mitigate any specific contract support related AT risks

• At a minimum, ensure the following matters are reviewed /considered: 1) personnel identification requirements are in the PWS, 2) reason for access is validated, 3) type of access and privileges are appropriate. 4) The contract awardee (vendor or contractors employer) must conduct background checks that vets contract employees using NCIC and terrorist screening databases (see background check in glossary)

• OPSEC Officer:

o Ensure review of final version of requirements package by OPSEC level II certified individual o Sign AT/OPSEC coversheet

ATO:

o Review requirements package o Sign AT/OPSEC coversheet

Requiring activity 3C Staff Officer/NCO or staff equivalent o Ensure signed AT/OPSEC cover sheet is included in the…