Veterans Affairs



PAGE 1 OF1. REQUISITION NO.2. CONTRACT NO.3. AWARD/EFFECTIVE DATE4. ORDER NO.5. SOLICITATION NUMBER6. SOLICITATION ISSUE DATEa. NAMEb. TELEPHONE NO. (No Collect Calls)8. OFFER DUE DATE/LOCALTIME9. ISSUED BYCODE10. THIS ACQUISITION IS UNRESTRICTED ORSET ASIDE:% FOR:SMALL BUSINESSHUBZONE SMALLBUSINESSSERVICE-DISABLEDVETERAN-OWNEDSMALL BUSINESSWOMEN-OWNED SMALL BUSINESS(WOSB) ELIGIBLE UNDER THE WOMEN-OWNEDSMALL BUSINESS PROGRAMEDWOSB8(A)NAICS:SIZE STANDARD:11. DELIVERY FOR FOB DESTINA-TION UNLESS BLOCK ISMARKEDSEE SCHEDULE12. DISCOUNT TERMS 13a. THIS CONTRACT IS ARATED ORDER UNDERDPAS (15 CFR 700)13b. RATING14. METHOD OF SOLICITATIONRFQIFBRFP15. DELIVER TOCODE16. ADMINISTERED BYCODE17a. CONTRACTOR/OFFERORCODEFACILITY CODE18a. PAYMENT WILL BE MADE BYCODETELEPHONE NO.DUNS:DUNS+4:PHONE:FAX:17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKEDSEE ADDENDUM19.20.21.22.23.24.ITEM NO.SCHEDULE OF SUPPLIES/SERVICESQUANTITYUNITUNIT PRICEAMOUNT(Use Reverse and/or Attach Additional Sheets as Necessary)25. ACCOUNTING AND APPROPRIATION DATA26. TOTAL AWARD AMOUNT (For Govt. Use Only)27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDAAREARE NOT ATTACHED.27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDAAREARE NOT ATTACHED28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________29. AWARD OF CONTRACT: REF. ___________________________________ OFFERCOPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH ANDDATED ________________________________. YOUR OFFER ON SOLICITATIONDELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH AREADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIEDSET FORTH HEREIN IS ACCEPTED AS TO ITEMS:30a. SIGNATURE OF OFFEROR/CONTRACTOR31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT)30c. DATE SIGNED31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT)31c. DATE SIGNEDAUTHORIZED FOR LOCAL REPRODUCTION(REV. 2/2012)PREVIOUS EDITION IS NOT USABLEPrescribed by GSA - FAR (48 CFR) 53.2127. FOR SOLICITATIONINFORMATION CALL:STANDARD FORM 1449OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 92658-14-1-029-0001VA246-14-R-106203-20-2014Angel C Rhone757-315-396404-21-201400246Department of Veterans AffairsNetwork Contracting Office 6100 Emancipation DriveHampton VA 23667X622110$35.5 Million N/AX00246Department of Veterans AffairsNetwork Contracting Office 61970 Roanoke Blvd.Salem VA 2415300246Department of Veterans AffairsNetwork Contracting Office 6100 Emancipation DriveHampton VA 2366700246Department of Veterans AffairsFinancial Services CenterP.O. Box 149971Austin TX 78714-9971SEE ATTACHED SCHEDULE OF SUPPLIES/SERVICESXXX 1Angel C RhoneContracting OfficerSECTION AA.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMSTable of Contents TOC \o &quot;1-4&quot; \f \h \z \u \x SECTION A PAGEREF _Toc381086027 \h 1A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS PAGEREF _Toc381086028 \h 1SECTION B - CONTINUATION OF SF 1449 BLOCKS PAGEREF _Toc381086029 \h 4B.1 CONTRACT ADMINISTRATION DATA PAGEREF _Toc381086030 \h 4B.2 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011) PAGEREF _Toc381086031 \h 5B.3 SUBCONTRACTING PLAN--MONITORING AND COMPLIANCE (JUN 2011) PAGEREF _Toc381086032 \h 5B.4 SCHEDULE OF SUPPLIES/SERVICES PAGEREF _Toc381086033 \h 5B.5 PERFORMANCE WORK STATEMENT (PWS) PAGEREF _Toc381086034 \h 23B.7 SPECIAL CONTRACT REQUIREMENTS PAGEREF _Toc381086035 \h 26B.8 EPA Clause for Per-Procedure Based Acquisitions Using Medicare Rates PAGEREF _Toc381086036 \h 39SECTION C - CONTRACT CLAUSES PAGEREF _Toc381086037 \h 40C.1 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011) PAGEREF _Toc381086038 \h 40C.2 52.216-18 ORDERING (OCT 1995) PAGEREF _Toc381086039 \h 40C.3 52.216-19 ORDER LIMITATIONS (OCT 1995) PAGEREF _Toc381086040 \h 40C.4 52.216-22 INDEFINITE QUANTITY (OCT 1995) PAGEREF _Toc381086041 \h 41C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) PAGEREF _Toc381086042 \h 41C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) PAGEREF _Toc381086043 \h 41C.7 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) PAGEREF _Toc381086044 \h 41C.8 52.232-99 PROVIDING ACCELERATED PAYMENT TO SMALL BUSINESS SUBCONTRACTORS (DEVIATION) (AUG 2012) PAGEREF _Toc381086045 \h 42C.9 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) PAGEREF _Toc381086046 \h 42C.10 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE POSTER (DEC 1992) PAGEREF _Toc381086047 \h 42C.11 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (DEC 2009) PAGEREF _Toc381086048 \h 42C.12 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009) PAGEREF _Toc381086049 \h 43C.13 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM REQUIREMENTS (DEC 2009) PAGEREF _Toc381086050 \h 43C.14 VAAR 852.219-71 VA MENTOR-PROT?G? PROGRAM (DEC 2009) PAGEREF _Toc381086051 \h 43C.15 VAAR 852.219-72 EVALUATION FACTOR FOR PARTICIPATION IN THE VA MENTOR-PROT?G? PROGRAM (DEC 2009) PAGEREF _Toc381086052 \h 44C.16 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012) PAGEREF _Toc381086053 \h 44C.17 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 2008) PAGEREF _Toc381086054 \h 45C.18 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) PAGEREF _Toc381086055 \h 45C.19 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS--COMMERCIAL ITEMS (JAN 2014) PAGEREF _Toc381086056 \h 46C.20 MANDATORY WRITTEN DISCLOSURES PAGEREF _Toc381086057 \h 50SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS PAGEREF _Toc381086058 \h 51D.1 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) PAGEREF _Toc381086059 \h 51D.2 PAST PERFORMANCE SURVEY PAGEREF _Toc381086060 \h 58D.3 CONTRACTOR CERTIFICATION: Immigration and Nationality Act of 1952, As Amended PAGEREF _Toc381086061 \h 63D.4 SUBCONTRACTING PLAN MODEL PAGEREF _Toc381086062 \h 64D.5 WAGE DETERMINATION PAGEREF _Toc381086063 \h 74SECTION E - SOLICITATION PROVISIONS PAGEREF _Toc381086064 \h 75E.1 SPECIFIC INSTRUCTIONS TO OFFERORS REGARDING PROPOSAL PREPARATION PAGEREF _Toc381086065 \h 75E.2 52.209-5 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (DEVIATION)(MAR 2012) PAGEREF _Toc381086066 \h 78E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013) PAGEREF _Toc381086067 \h 79E.4 52.216-1 TYPE OF CONTRACT (APR 1984) PAGEREF _Toc381086068 \h 80E.5 52.233-2 SERVICE OF PROTEST (SEP 2006) PAGEREF _Toc381086069 \h 80E.6 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008) PAGEREF _Toc381086070 \h 80E.7 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998) PAGEREF _Toc381086071 \h 81E.8 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) PAGEREF _Toc381086072 \h 81E.9 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008) PAGEREF _Toc381086073 \h 81E.10 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) PAGEREF _Toc381086074 \h 81E.11 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (NOV 2013) PAGEREF _Toc381086075 \h 82SECTION B - CONTINUATION OF SF 1449 BLOCKSB.1 CONTRACT ADMINISTRATION DATA (continuation from Standard Form 1449, block 18A.) 1. Contract Administration: All contract administration matters will be handled by the following individuals: a. CONTRACTOR: b. GOVERNMENT: Contracting Officer Angel C RhoneDepartment of Veterans AffairsNetwork Contracting Office 6100 Emancipation DriveHampton VA 23667 2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: [X]52.232-34, Payment by Electronic Funds Transfer -Other than Central Contractor Registration, or []52.232-36, Payment by Third Party 3. INVOICES: Invoices shall be submitted in arrears: a. Quarterly[] b. Semi-Annually[] c. Other[X]Monthly In Arrears 4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address:Department of Veterans AffairsFinancial Services CenterP.O. Box 149971Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:AMENDMENT NODATEB.2 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011)This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.B.3 SUBCONTRACTING PLAN--MONITORING AND COMPLIANCE (JUN 2011)This solicitation includes FAR 52.219-9, Small Business Subcontracting Plan, and VAAR 852.219-9, VA Small Business Subcontracting Plan Minimum Requirement. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing the contractor's compliance with the plan, including reviewing the contractor's accomplishments in achieving the subcontracting goals in the plan. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting plan.B.4 SCHEDULE OF SUPPLIES/SERVICESThe VA Medical Center (VAMC), Salem, VA has the need for radiation therapy consultation and treatment services. All services shall be performed at the Contractor’s facility. Contractor shall provide professional and technical radiation therapy services to include materials, supplies, equipment and qualified supervision s specified herein for eligible veterans of the Department of Veterans Affairs Medical Center Contractors shall furnish all labor, materials, supplies, equipment, and qualified supervision for Veterans residing in the following counties, cities, and/or towns in Virginia: Alleghany County, City of Bedford, Bedford County, Clifton Forge, City of Covington, Franklin County, Montgomery County, City of Radford, Roanoke County, City of Salem and Wythe County. All professionals providing services under the terms of this contract shall be appropriately certified and/or licensed as described herein and possess the requisite skills and experience to perform radiation therapy services. The Contractor’s facility must be centrally located within 35 miles to the above mentioned areas.The VA Radiation Oncology Services are currently accredited by ACR and follow the standards & guidelines set forth by American College of Radiology (ACR). If an outside facility wishes to bid on a contract to provide equivalent radiation therapy services to Veterans, then that outside facility must provide evidence the practice meets this standard. This standard may be evidenced through ACR accreditation or through accreditation by another nationally recognized accrediting organization, which specifically accredits radiation oncology practices. The burden of proof that the program used by the outside facility examines standards set by the ACR lies with the outside facility responding to the requirements set forth in the contract Request for Proposal (RFP).A contractor providing off-site radiation oncology services must provide evidence the radiation oncology practice meets or exceeds the American College of Radiology Guidelines for Radiation Oncology.” YEAR: (TWELVE MONTHS FROM DATE OF AWARD) **Identify the proposed percentage rate of Medicare in the space provided.** The VA will pay, per episode of care, at the Medicare rate at the time the patient is treated.**Task Orders for services shall be authorized by the COR or designated representativeThe guaranteed minimum contract amount, including the base year and any option years exercised, is $1,000,000 and the maximum amount, including the base year and any option years exercised, shall not exceed $6,000,000.??CPT Code?Professional Medicare Price per CodeTechnical Medicare Price per CodePercent of MedicareTotal Extended Cost All CellsCLINPrice Schedule SourceEst. Qty0001?76873-Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)5$_________$_______________%$_______0002?77261-Radiation Therapy Planning 160$_________$_______________%$_______0003?77262-Radiation Therapy Planning 5$_________$_______________%$_______0004?77263-Radiation Therapy Planning 5$_________$_______________%$_______0005?77280-Simple Therapeutic Radiation140$_________$_______________%$_______0006?77285-Set Radiation Field140$_________$_______________%$_______0007?77290-Set Radiation Field5$_________$_______________%$_______0008?77295-Set Radiation Field110$_________$_______________%$_______0009?77300-Basic Dose Plan60$_________$_______________%$_______0010?77301-Radiation Dose Plan IMRT-70$_________$_______________%$_______0011?77305-Teletx Isodose Plan Simple5$_________$_______________%$_______0012?77310-Teletx Isodose Plan Intermediate5$_________$_______________%$_______0013?77321-Special Teletx Port Plan90$_________$_______________%$_______0014?77326-Brachytx Isodose Calc Simp5$_________$_______________%$_______0015?77327-Brachytx Isodose Calc Interm5$_________$_______________%$_______0016?77328-Brachytx Isodose Calc Icomp5$_________$_______________%$_______0017?77331-Special Radiation dosimetry5$_________$_______________%$_______0018?77332-Radiation Treatment Aid(s)80$_________$_______________%$_______0019?77333-Radiation Treatment Aid(s)30$_________$_______________%$_______0020?77334-Radiation Treatment Aid(s)5$_________$_______________%$_______0021?77336-Radiation Physics Consultant280$_________$_______________%$_______0022?77338-IMRT MLC Treatment Device 190$_________$_______________%$_______0023?77370-Radiation Physics Consults 5$_________$_______________%$_______0024?77401-Radiation Therapy Delivery 30$_________$_______________%$_______0025?77402-Radiation Therapy Delivery 5$_________$_______________%$_______0026?77403-Radiation treatment delivery, single treatment area5$_________$_______________%$_______0027?77404-Radiation Therapy Delivery100$_________$_______________%$_______0028?77406-Radiation Therapy Delivery5$_________$_______________%$_______0029?77407-Radiation Therapy Delivery5$_________$_______________%$_______0030?77408-Radiation Therapy Delivery5$_________$_______________%$_______0031?77409-Radiation Therapy Delivery180$_________$_______________%$_______0032?77411-Radiation Therapy Delivery-r5$_________$_______________%$_______0033?77412-Radiation Therapy Delivery5$_________$_______________%$_______0034?77413-Radiation Treatment Delivery220$_________$_______________%$_______0035?77414-Radiation Treatment Delivery 160$_________$_______________%$_______0036?77416-Radiation Treatment Delivery 180$_________$_______________%$_______0037?77417-Radiology Port Film(s)5$_________$_______________%$_______0038?77418-Intensity Modulated Treatment Delivery (IMRT) 170$_________$_______________%$_______0039?77421-Stereoscopic x-ray guidance 5$_________$_______________%$_______0040?77427-Rasiation tx mgmt170$_________$_______________%$_______0041?77431-Rasiation Therapy Mgmt220$_________$_______________%$_______0042?77432-Stereotatic Radiation Trmt5$_________$_______________%$_______0043?77435-Sterotatic Body Radiation Therapy30$_________$_______________%$_______0044?77470-Special Treatment Total Body Irradiation, Hemi body per oral, endocavity, or infra operative core 5$_________$_______________%$_______0045?77750-Infuse Radioactive Materials70$_________$_______________%$_______0046?77785-HDR Brachytx 1 channel 5$_________$_______________%$_______0047?77786-HDR Brachytx 2-12 channels-5$_________$_______________%$_______0048?77787-HDR Brachytx 13+ channels-5$_________$_______________%$_______0049?77789-Apply Surface Radiation5$_________$_______________%$_______0050?79101-Radiopharm Treatment by IV Admin5$_________$_______________%$_______0051?79403-Radiopharm Monoclonal Antibody5$_________$_______________%$_______0052?93041-EKG Rhythm Strip5$_________$_______________%$_______0053? 99201-Office/Outpatient Visit, New(10 minutes) 5$_________$_______________%$_______0054? 99202-Office/Outpatient Visit, New (20 minutes) 5$_________$_______________%$_______0055?99203-Office/Outpatient Visit, New (30 minutes) 5$_________$_______________%$_______0056?99204-Office/Outpatient Visit, New (45 minutes) 5$_________$_______________%$_______0057?99205-Office/Outpatient Visit, New 5$_________$_______________%$_______0058?99211-F/U visit Simple5$_________$_______________%$_______0059?99212-F/U Visit Expanded5$_________$_______________%$_______0060?99213-F/U Visit Expanded210$_________$_______________%$_______0061?99214-F/U Visit Expanded60$_________$_______________%$_______0062?99215-F/U Visit Expanded40$_________$_______________%$_______0063?A9543-Ytrrium 90 (ibritumomab)-Zevalin1$_________$_______________%$_______0064?A9545-Iodine-131 (Tositumomab)-Bexxar1$_________$_______________%$_______0065?A9605-Samarium 153 (Lexidronam)1$_________$_______________%$_______0066?G0339-Cyberknife First Treatment 1$_________$_______________%$_______0067?G0340-Cyberknife 2nd-5th Fraction 1$_________$_______________%$_______0068Tumor Board Conference (the first and third Tuesdays of each month at 3:00 P.M.) @ VAMC Salem24$_________$_______________%$_______TOTAL BASE YEAR COST $_______________OPTION YEAR ONE: (TWELVE MONTHS FROM END OF BASE YEAR)**Identify the proposed percentage rate of Medicare in the space provided.** The VA will pay, per episode of care, at the Medicare rate at the time the patient is treated.**Task Orders for services shall be authorized by the COR or designated representative??CPT Code?Professional Medicare Price per CodeTechnical Medicare Price per CodePercent of MedicareTotal Extended Cost All CellsCLINPrice Schedule SourceEst. Qty1001?76873-Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)5$_________$_______________%$_______1002?77261-Radiation Therapy Planning 160$_________$_______________%$_______1003?77262-Radiation Therapy Planning 5$_________$_______________%$_______1004?77263-Radiation Therapy Planning 5$_________$_______________%$_______1005?77280-Simple Therapeutic Radiation140$_________$_______________%$_______1006?77285-Set Radiation Field140$_________$_______________%$_______1007?77290-Set Radiation Field5$_________$_______________%$_______1008?77295-Set Radiation Field110$_________$_______________%$_______1009?77300-Basic Dose Plan60$_________$_______________%$_______1010?77301-Radiation Dose Plan IMRT-70$_________$_______________%$_______1011?77305-Teletx Isodose Plan Simple5$_________$_______________%$_______1012?77310-Teletx Isodose Plan Intermediate5$_________$_______________%$_______1013?77321-Special Teletx Port Plan90$_________$_______________%$_______1014?77326-Brachytx Isodose Calc Simp5$_________$_______________%$_______1015?77327-Brachytx Isodose Calc Interm5$_________$_______________%$_______1016?77328-Brachytx Isodose Calc Icomp5$_________$_______________%$_______1017?77331-Special Radiation dosimetry5$_________$_______________%$_______1018?77332-Radiation Treatment Aid(s)80$_________$_______________%$_______1019?77333-Radiation Treatment Aid(s)30$_________$_______________%$_______1020?77334-Radiation Treatment Aid(s)5$_________$_______________%$_______1021?77336-Radiation Physics Consultant280$_________$_______________%$_______1022?77338-IMRT MLC Treatment Device 190$_________$_______________%$_______1023?77370-Radiation Physics Consults 5$_________$_______________%$_______1024?77401-Radiation Therapy Delivery 30$_________$_______________%$_______1025?77402-Radiation Therapy Delivery 5$_________$_______________%$_______1026?77403-Radiation treatment delivery, single treatment area5$_________$_______________%$_______1027?77404-Radiation Therapy Delivery100$_________$_______________%$_______1028?77406-Radiation Therapy Delivery5$_________$_______________%$_______1029?77407-Radiation Therapy Delivery5$_________$_______________%$_______1030?77408-Radiation Therapy Delivery5$_________$_______________%$_______1031?77409-Radiation Therapy Delivery180$_________$_______________%$_______1032?77411-Radiation Therapy Delivery-r5$_________$_______________%$_______1033?77412-Radiation Therapy Delivery5$_________$_______________%$_______1034?77413-Radiation Treatment Delivery220$_________$_______________%$_______1035?77414-Radiation Treatment Delivery 160$_________$_______________%$_______1036?77416-Radiation Treatment Delivery 180$_________$_______________%$_______1037?77417-Radiology Port Film(s)5$_________$_______________%$_______1038?77418-Intensity Modulated Treatment Delivery (IMRT) 170$_________$_______________%$_______1039?77421-Stereoscopic x-ray guidance 5$_________$_______________%$_______1040?77427-Rasiation tx mgmt170$_________$_______________%$_______1041?77431-Rasiation Therapy Mgmt220$_________$_______________%$_______1042?77432-Stereotatic Radiation Trmt5$_________$_______________%$_______1043?77435-Sterotatic Body Radiation Therapy30$_________$_______________%$_______1044?77470-Special Treatment Total Body Irradiation, Hemi body per oral, endocavity, or infra operative core 5$_________$_______________%$_______1045?77750-Infuse Radioactive Materials70$_________$_______________%$_______1046?77785-HDR Brachytx 1 channel 5$_________$_______________%$_______1047?77786-HDR Brachytx 2-12 channels-5$_________$_______________%$_______1048?77787-HDR Brachytx 13+ channels-5$_________$_______________%$_______1049?77789-Apply Surface Radiation5$_________$_______________%$_______1050?79101-Radiopharm Treatment by IV Admin5$_________$_______________%$_______1051?79403-Radiopharm Monoclonal Antibody5$_________$_______________%$_______1052?93041-EKG Rhythm Strip5$_________$_______________%$_______1053? 99201-Office/Outpatient Visit, New(10 minutes) 5$_________$_______________%$_______1054? 99202-Office/Outpatient Visit, New (20 minutes) 5$_________$_______________%$_______1055?99203-Office/Outpatient Visit, New (30 minutes) 5$_________$_______________%$_______1056?99204-Office/Outpatient Visit, New (45 minutes) 5$_________$_______________%$_______1057?99205-Office/Outpatient Visit, New 5$_________$_______________%$_______1058?99211-F/U visit Simple5$_________$_______________%$_______1059?99212-F/U Visit Expanded5$_________$_______________%$_______1060?99213-F/U Visit Expanded210$_________$_______________%$_______1061?99214-F/U Visit Expanded60$_________$_______________%$_______1062?99215-F/U Visit Expanded40$_________$_______________%$_______1063?A9543-Ytrrium 90 (ibritumomab)-Zevalin1$_________$_______________%$_______1064?A9545-Iodine-131 (Tositumomab)-Bexxar1$_________$_______________%$_______1065?A9605-Samarium 153 (Lexidronam)1$_________$_______________%$_______1066?G0339-Cyberknife First Treatment 1$_________$_______________%$_______1067?G0340-Cyberknife 2nd-5th Fraction 1$_________$_______________%$_______1068Tumor Board Conference (the first and third Tuesdays of each month at 3:00 P.M.) @ VAMC Salem24$_________$_______________%$_______TOTAL OPTION YEAR ONE COST $_______________OPTION YEAR TWO: (TWELVE MONTHS FROM END OF OPTION YEAR ONE)**Identify the proposed percentage rate of Medicare in the space provided.** The VA will pay, per episode of care, at the Medicare rate at the time the patient is treated.**Task Orders for services shall be authorized by the COR or designated representative?CPT Code?Professional Medicare Price per CodeTechnical Medicare Price per CodePercent of MedicareTotal Extended Cost All CellsCLINPrice Schedule SourceEst. Qty2001?76873-Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)5$_________$_______________%$_______2002?77261-Radiation Therapy Planning 160$_________$_______________%$_______2003?77262-Radiation Therapy Planning 5$_________$_______________%$_______2004?77263-Radiation Therapy Planning 5$_________$_______________%$_______2005?77280-Simple Therapeutic Radiation140$_________$_______________%$_______2006?77285-Set Radiation Field140$_________$_______________%$_______2007?77290-Set Radiation Field5$_________$_______________%$_______2008?77295-Set Radiation Field110$_________$_______________%$_______2009?77300-Basic Dose Plan60$_________$_______________%$_______2010?77301-Radiation Dose Plan IMRT-70$_________$_______________%$_______2011?77305-Teletx Isodose Plan Simple5$_________$_______________%$_______2012?77310-Teletx Isodose Plan Intermediate5$_________$_______________%$_______2013?77321-Special Teletx Port Plan90$_________$_______________%$_______2014?77326-Brachytx Isodose Calc Simp5$_________$_______________%$_______2015?77327-Brachytx Isodose Calc Interm5$_________$_______________%$_______2016?77328-Brachytx Isodose Calc Icomp5$_________$_______________%$_______2017?77331-Special Radiation dosimetry5$_________$_______________%$_______2018?77332-Radiation Treatment Aid(s)80$_________$_______________%$_______2019?77333-Radiation Treatment Aid(s)30$_________$_______________%$_______2020?77334-Radiation Treatment Aid(s)5$_________$_______________%$_______2021?77336-Radiation Physics Consultant280$_________$_______________%$_______2022?77338-IMRT MLC Treatment Device 190$_________$_______________%$_______2023?77370-Radiation Physics Consults 5$_________$_______________%$_______2024?77401-Radiation Therapy Delivery 30$_________$_______________%$_______2025?77402-Radiation Therapy Delivery 5$_________$_______________%$_______2026?77403-Radiation treatment delivery, single treatment area5$_________$_______________%$_______2027?77404-Radiation Therapy Delivery100$_________$_______________%$_______2028?77406-Radiation Therapy Delivery5$_________$_______________%$_______2029?77407-Radiation Therapy Delivery5$_________$_______________%$_______2030?77408-Radiation Therapy Delivery5$_________$_______________%$_______2031?77409-Radiation Therapy Delivery180$_________$_______________%$_______2032?77411-Radiation Therapy Delivery-r5$_________$_______________%$_______2033?77412-Radiation Therapy Delivery5$_________$_______________%$_______2034?77413-Radiation Treatment Delivery220$_________$_______________%$_______2035?77414-Radiation Treatment Delivery 160$_________$_______________%$_______2036?77416-Radiation Treatment Delivery 180$_________$_______________%$_______2037?77417-Radiology Port Film(s)5$_________$_______________%$_______2038?77418-Intensity Modulated Treatment Delivery (IMRT) 170$_________$_______________%$_______2039?77421-Stereoscopic x-ray guidance 5$_________$_______________%$_______2040?77427-Rasiation tx mgmt170$_________$_______________%$_______2041?77431-Rasiation Therapy Mgmt220$_________$_______________%$_______2042?77432-Stereotatic Radiation Trmt5$_________$_______________%$_______2043?77435-Sterotatic Body Radiation Therapy30$_________$_______________%$_______2044?77470-Special Treatment Total Body Irradiation, Hemi body per oral, endocavity, or infra operative core 5$_________$_______________%$_______2045?77750-Infuse Radioactive Materials70$_________$_______________%$_______2046?77785-HDR Brachytx 1 channel 5$_________$_______________%$_______2047?77786-HDR Brachytx 2-12 channels-5$_________$_______________%$_______2048?77787-HDR Brachytx 13+ channels-5$_________$_______________%$_______2049?77789-Apply Surface Radiation5$_________$_______________%$_______2050?79101-Radiopharm Treatment by IV Admin5$_________$_______________%$_______2051?79403-Radiopharm Monoclonal Antibody5$_________$_______________%$_______2052?93041-EKG Rhythm Strip5$_________$_______________%$_______2053? 99201-Office/Outpatient Visit, New(10 minutes) 5$_________$_______________%$_______2054? 99202-Office/Outpatient Visit, New (20 minutes) 5$_________$_______________%$_______2055?99203-Office/Outpatient Visit, New (30 minutes) 5$_________$_______________%$_______2056?99204-Office/Outpatient Visit, New (45 minutes) 5$_________$_______________%$_______2057?99205-Office/Outpatient Visit, New 5$_________$_______________%$_______2058?99211-F/U visit Simple5$_________$_______________%$_______2059?99212-F/U Visit Expanded5$_________$_______________%$_______2060?99213-F/U Visit Expanded210$_________$_______________%$_______2061?99214-F/U Visit Expanded60$_________$_______________%$_______2062?99215-F/U Visit Expanded40$_________$_______________%$_______2063?A9543-Ytrrium 90 (ibritumomab)-Zevalin1$_________$_______________%$_______2064?A9545-Iodine-131 (Tositumomab)-Bexxar1$_________$_______________%$_______2065?A9605-Samarium 153 (Lexidronam)1$_________$_______________%$_______2066?G0339-Cyberknife First Treatment 1$_________$_______________%$_______2067?G0340-Cyberknife 2nd-5th Fraction 1$_________$_______________%$_______2068Tumor Board Conference (the first and third Tuesdays of each month at 3:00 P.M.) @ VAMC Salem24$_________$_______________%$_______TOTAL OPTION YEAR TWO COST $_______________OPTION YEAR THREE: (TWELVE MONTHS FROM END OF OPTION YEAR TWO)**Identify the proposed percentage rate of Medicare in the space provided.** The VA will pay, per episode of care, at the Medicare rate at the time the patient is treated.**Task Orders for services shall be authorized by the COR or designated representative??CPT Code?Professional Medicare Price per CodeTechnical Medicare Price per CodePercent of MedicareTotal Extended Cost All CellsCLINPrice Schedule SourceEst. Qty3001?76873-Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)5$_________$_______________%$_______3002?77261-Radiation Therapy Planning 160$_________$_______________%$_______3003?77262-Radiation Therapy Planning 5$_________$_______________%$_______3004?77263-Radiation Therapy Planning 5$_________$_______________%$_______3005?77280-Simple Therapeutic Radiation140$_________$_______________%$_______3006?77285-Set Radiation Field140$_________$_______________%$_______3007?77290-Set Radiation Field5$_________$_______________%$_______3008?77295-Set Radiation Field110$_________$_______________%$_______3009?77300-Basic Dose Plan60$_________$_______________%$_______3010?77301-Radiation Dose Plan IMRT-70$_________$_______________%$_______3011?77305-Teletx Isodose Plan Simple5$_________$_______________%$_______3012?77310-Teletx Isodose Plan Intermediate5$_________$_______________%$_______3013?77321-Special Teletx Port Plan90$_________$_______________%$_______3014?77326-Brachytx Isodose Calc Simp5$_________$_______________%$_______3015?77327-Brachytx Isodose Calc Interm5$_________$_______________%$_______3016?77328-Brachytx Isodose Calc Icomp5$_________$_______________%$_______3017?77331-Special Radiation dosimetry5$_________$_______________%$_______3018?77332-Radiation Treatment Aid(s)80$_________$_______________%$_______3019?77333-Radiation Treatment Aid(s)30$_________$_______________%$_______3020?77334-Radiation Treatment Aid(s)5$_________$_______________%$_______3021?77336-Radiation Physics Consultant280$_________$_______________%$_______3022?77338-IMRT MLC Treatment Device 190$_________$_______________%$_______3023?77370-Radiation Physics Consults 5$_________$_______________%$_______3024?77401-Radiation Therapy Delivery 30$_________$_______________%$_______3025?77402-Radiation Therapy Delivery 5$_________$_______________%$_______3026?77403-Radiation treatment delivery, single treatment area5$_________$_______________%$_______3027?77404-Radiation Therapy Delivery100$_________$_______________%$_______3028?77406-Radiation Therapy Delivery5$_________$_______________%$_______3029?77407-Radiation Therapy Delivery5$_________$_______________%$_______3030?77408-Radiation Therapy Delivery5$_________$_______________%$_______3031?77409-Radiation Therapy Delivery180$_________$_______________%$_______3032?77411-Radiation Therapy Delivery-r5$_________$_______________%$_______3033?77412-Radiation Therapy Delivery5$_________$_______________%$_______3034?77413-Radiation Treatment Delivery220$_________$_______________%$_______3035?77414-Radiation Treatment Delivery 160$_________$_______________%$_______3036?77416-Radiation Treatment Delivery 180$_________$_______________%$_______3037?77417-Radiology Port Film(s)5$_________$_______________%$_______3038?77418-Intensity Modulated Treatment Delivery (IMRT) 170$_________$_______________%$_______3039?77421-Stereoscopic x-ray guidance 5$_________$_______________%$_______3040?77427-Rasiation tx mgmt170$_________$_______________%$_______3041?77431-Rasiation Therapy Mgmt220$_________$_______________%$_______3042?77432-Stereotatic Radiation Trmt5$_________$_______________%$_______3043?77435-Sterotatic Body Radiation Therapy30$_________$_______________%$_______3044?77470-Special Treatment Total Body Irradiation, Hemi body per oral, endocavity, or infra operative core 5$_________$_______________%$_______3045?77750-Infuse Radioactive Materials70$_________$_______________%$_______3046?77785-HDR Brachytx 1 channel 5$_________$_______________%$_______3047?77786-HDR Brachytx 2-12 channels-5$_________$_______________%$_______3048?77787-HDR Brachytx 13+ channels-5$_________$_______________%$_______3049?77789-Apply Surface Radiation5$_________$_______________%$_______3050?79101-Radiopharm Treatment by IV Admin5$_________$_______________%$_______3051?79403-Radiopharm Monoclonal Antibody5$_________$_______________%$_______3052?93041-EKG Rhythm Strip5$_________$_______________%$_______3053? 99201-Office/Outpatient Visit, New(10 minutes) 5$_________$_______________%$_______3054? 99202-Office/Outpatient Visit, New (20 minutes) 5$_________$_______________%$_______3055?99203-Office/Outpatient Visit, New (30 minutes) 5$_________$_______________%$_______3056?99204-Office/Outpatient Visit, New (45 minutes) 5$_________$_______________%$_______3057?99205-Office/Outpatient Visit, New 5$_________$_______________%$_______3058?99211-F/U visit Simple5$_________$_______________%$_______3059?99212-F/U Visit Expanded5$_________$_______________%$_______3060?99213-F/U Visit Expanded210$_________$_______________%$_______3061?99214-F/U Visit Expanded60$_________$_______________%$_______3062?99215-F/U Visit Expanded40$_________$_______________%$_______3063?A9543-Ytrrium 90 (ibritumomab)-Zevalin1$_________$_______________%$_______3064?A9545-Iodine-131 (Tositumomab)-Bexxar1$_________$_______________%$_______3065?A9605-Samarium 153 (Lexidronam)1$_________$_______________%$_______3066?G0339-Cyberknife First Treatment 1$_________$_______________%$_______3067?G0340-Cyberknife 2nd-5th Fraction 1$_________$_______________%$_______3068Tumor Board Conference (the first and third Tuesdays of each month at 3:00 P.M.) @ VAMC Salem24$_________$_______________%$_______TOTAL OPTION YEAR THREE COST$_______________ TOTAL CONTRACT COST (BASE AND ALL OPTIONS): $_______________________PRICING INSTRUCTIONS: Proposed rate reimbursement shall be based on current Medicare rate in effect at the time of procedure. Therefore, for pricing purposes, identify the percentage of Medicare for each CLIN. In order to be considered responsive, offerors must fill out the cells in the following columns in the Price Schedule for each Contract Line Item Number (CLIN).For pricing and evaluation purposes, the current CMS rates should be used in completing each CLIN for the base year and option years.- Price Schedule shall be completed for each listed CLIN to include the source (version of CMS, etc.) where pricing was obtained.- PRICE PER CODE: Unit pricing should be supplied for each code listed for all components (Professional, Technical, and Facility-Non Facility).- Percent of Medicare for the base year and all option years: offerors must enter a "Percent of Medicare" that the "Price per Code" amount represents.- TOTAL EXTENDED: Total extended cost per CLIN. For example, in CLIN 0001 Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning Services, one of the CPT codes to be priced is 76873. The 2013 Medicare in facility participating price for this service in the locality labeled "Virginia" was Non Facility $169.65 and Facility was $169.65 for the technical component and professional services. Therefore if the offeror enters 100% in the column labeled Percent of Medicare, the Price per code column should match to this and would be equal to Non Facility $169.65 and Facility $169.65. The Total Extended column for Non Facility would show a value of $848.25 Price per code x Quantity ($169.65 x 5). If the offeror entered a value of 90% under the Percent of Medicare column, then the Price per code column should contain the value of $763.43 (.9 x $169.65 x 5). If the Medicare rate or other standard rate is not used when completing the Pricing Model, the Offeror shall explain any differences. The Percent of Medicare entry is extremely important since the contract award will be at that rate. Correspondingly, all work obtained under this contract will be priced at the Percent of Medicare rate. Throughout the life of the contract the VA shall pay the percentage of the Medicare rate effective at the time the service is provided by the Contractor. The Offeror shall complete the attached price schedule for the location(s) proposed. The Offeror shall document in its proposal any assumptions. The Offeror may propose on one or more locations. The Offeror shall provide any information in its proposal that it feels may assist the contracting officer to determine whether the price is fair and reasonable. The VA intends to purchase all services related to the (CLIN) listed in the price/cost schedule. If after award the services change based on the CMS rates the Contracting Officer may negotiate a modification to add those services. Each prospective offerors shall complete all CLINs for the specific geographic area in order to be considered responsive. Offers must include all services listed within each CLIN. Unit pricing should be supplied for each code listed, as well as the extended cost per CLIN. No codes should be left blank. If for some reason a code on the schedule has expired or is for any other reason unusable, offerors should annotate the Price per Code block with “N/A”. Prices listed on the schedule should be based on Medicare rates in effect at the time of proposal due date.At the end of each Specialty Area Section Offerors must enter a Percent of Medicare that the proposed price represents. The Percent of Medicare entry is extremely important since the contract award will be at that rate. Throughout contract administration, all codes reasonably considered to be included under the specialty areas will be considered in scope. Again, the total extended price figure will be used only to evaluate pricing on all offers in a uniform manner. The rationale for this approach is that codes and pricing change over time and an award based on Percent of Medicare accounts for those changes. At the end of each CLIN, extended pricing for all cells will be totaled and entered into the box entitled “Total Extended Cost All Cells”.The Offeror shall base pricing on the application of Medicare reimbursement rules. For routine care, it is expected that VAMC patients will have prescriptions filled at VA pharmacies. Emergency situations and medication provided during outpatient visits and epoetin provided during analysis are the exception.While this solicitation requires a single percent of Medicare per CLIN it is recognized that there are circumstances where a given percent of Medicare could result in different prices. These situations include: multiple outpatient Medicare rate structures within a CLIN, Multiple places of performance of outpatient work within a CLIN, and the varying rates for each hospital facility within a CLIN. Therefore, Offerors must attach the corresponding fee schedules showing the percent of Medicare; the Government must understand the basis for the pricing proposed to determine if fair and reasonable. The price schedule should be annotated and cross referenced to supporting information as necessary in order to facilitate the contracting officer’s determination of fair and reasonable pricing. The information and results provided in the proposal must be verified and traceable back to the Medicare rate from the information provided in the proposal. For reference purposes, the offeror must use the CMS 2013-fill-in schedule to calculate prices. Links to the specific schedules are as follows:CPT Code/Relative Value Search: Physician Fee Schedule(All 2014 codes- November 2013 release) Please make sure to include the latest revisions in your pricing. Keep in mind that the revisions are cumulative. Lab Pathology ScheduleCMS- 13CLAB (Revision to 2013) Therapy Services and Other Diagnostic Procedures:Radiation Therapy Services / Diagnostic Procedures (Medicare Claims Processing Manual) (Rev. 2750, 08-02-13) must use the appropriate section to price Radiation Therapy Services according to the setting in which the services will be provided. These references will be used to evaluate and verify pricing.Section 20: General Radiation Therapy Services/Diagnostic Pricing and ProceduresReference Title 42 CFR 415.170 as a condition of payment IAW VA Directive 4b(8)CMS Outpatient Pricer CMS Outpatient Pricer Use the latest version for 2012/2013Per VA Directive 1663 Title 42 CFR 415.170 shall be followed as a condition of payment. Outpatient and Diagnostic Services performed in a facility. For outpatient services performed in a facility, offerors must include the price for both the technical, professional, and facility component in the appropriate “price per code” block on the price schedule. In these additional rows the offeror will insert an APC schedule consisting of APC codes that correspond to the workload presented above in the CPT code portion of the price schedule. If workload is accounted for in an APC schedule, then the offeror must include supporting documentation that shows how the APC code correlates to CPT codes in the respective section of the price schedule. For outpatient and diagnostic pricing, Offerors must indicate on the price schedule by sub-CLIN the type of facility offered (facility or non-facility and participating or non-participating).Offerors are reminded that they will not be reimbursed for costs incurred in an outpatient facility if outpatient facility charges are not included in the submitted price proposal. For line items which use APC codes for pricing purposes, Offerors must use the quantity of the underlying procedure.Offerors are reminded that, when applicable, they may use the Outpatient Perspective Payment System (OPPS) cap amount for certain diagnostic services, as prescribed by Medicare.Outpatient services Outpatient Services must include any related ancillary charges that are normally considered part of reimbursable expenses under a DRG (If Applicable). Additionally, the Base Payment Rate plus Disproportionate Share and Medical Educational add-ons must be included in the price. Outliers will not be accepted. Again, see previous comments if you intend not to allow outliers, it must be stated. Professional Outpatient Fees must be recorded in the appropriate section of the Price Schedule. (Note: Sample codes for evaluation and management only have been provided on the price schedule for outpatient professional services. It is intended that the percent of Medicare rates offered in relation to these codes would cover all services normally provided as outpatient professional services.) Services such as initial consults and rehabilitation therapy will be authorized and billed separately if purchased via this contract. All outpatient medical/surgical pricing must be entered using the Medicare Geometric Mean Length of procedure. Do not use transfer pricing. For each outpatient facility offered the list of facilities and their respective Medicare provider numbers must be provided by sub-CLIN as an attachment to the schedule. The list must be provided in a manner that will allow the Government to validate proposed rates.Offerors are reminded to use the Outpatient Radiation Therapy Services Pricer () Diagnostic ServicesOfferors must provide complete pricing which includes both technical and professional components. Outpatient Radiation Therapy Services:Outpatient Radiation Therapy Services are paid by per diem. Per diems are calculated using the base rate and several adjustment factors. These factors have been provided on the schedule for use in expressing prices. The unit price for outpatient rate should be placed in the box, labeled percent of Medicare. Any resulting contract awards will be at this percent of Medicare rate.Offerors must show all formulas, calculations, links and additional spreadsheets which are used to calculate the price in order that the contracting officer may determine that the price is fair and reasonable. All calculations used in determining weights must be shown. All links and formulas must be active such that the Government can validate calculations from the material provided by the Offerors. This basis of estimate will be used by the Government for future pricing of additional codes/procedures and for reimbursement under the contract. All spreadsheets must be submitted in Microsoft Excel and without protected/locked portions or other methods which prevent or do not facilitate expeditious pricing validation. PDF files and similarly constructed files are not acceptable.In Column labeled “Price Schedule Source”, offeror must provide the name of the price or fee schedule used to derive Medicare prices for each line item. Fax InformationIndividual task orders shall be faxed, given verbally over the phone or by referral letter from designated representatives of the Salem VAMC. If using secure fax included include the following information: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”B.5 PERFORMANCE WORK STATEMENT (PWS)1. This contract is for outpatient Radiation Oncology Consultation and Treatment services to eligible VA beneficiaries in accordance with the terms and conditions stated herein. Upon written authorization (VAF 10-7078 Authorization and Invoice for Medical and Hospital Services), the Contractor shall provide to the authorized VA patient a medical evaluation, a treatment plan, the series of radiation treatment indicated by the plan, follow up evaluation and other examinations, evaluations and procedures which are necessary to accomplish the course of radiation oncology treatment.2. Contractor shall provide outpatient professional and technical radiation therapy services at the contractor’s facility. Contractors shall furnish all labor, materials, supplies, equipment, and qualified supervision for Veterans residing in the following counties, cities, and/or towns in Virginia: Alleghany County, City of Bedford, Bedford County, Clifton Forge, City of Covington, Franklin County, Montgomery County, City of Radford, Roanoke County, City of Salem and Wythe County. All professionals providing services under the terms of this contract shall be certified and/or licensed as described herein and possess the requisite skills and experience to perform radiation therapy services. The Contractor’s facility must be located within 35 miles to the above mentioned areas. The unit costs in the Schedule of Supplies/Services represent total payments by the VA for all services (professional, technical, and hospital), supplies, facilities and equipment necessary for each course of treatment and consultation. It is estimated that (120) patients will require Radiation Therapy Services during each 12 –month period.Current Procedural Terminology (CPT) codes and estimated quantities are provided for all possible procedures allowed under this contract. If the Offeror anticipates that additional CPT codes shall be required in the course of providing radiation therapy services under this contract, the offeror must notify the Contracting Officer prior to award. The definitions of Simple, Intermediate, Complex, Three-Dimensional and Conformal are the definitions utilized by Medicare.Proposed rate reimbursement shall be based on current Medicare rate in effect at the time of procedure. Therefore, for pricing purposes, identify the percentage of Medicare for each CLIN.2. LOCATION OF PROCEDURES:All examinations/procedures are performed on an outpatient basis at the Contractor’s facility. Radiation Oncologists will have remote access to electronic files containing sensitive data, which must be protected under the provisions of the Privacy Act of 1974 (5 USC 552a), and other applicable laws, Federal Regulations, Veterans Affairs statutes and policies. The Contractor’s employee(s) are responsible for (1) protecting that data from unauthorized release or from loss, alteration, or unauthorized deletion and (2) following all applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in a computer access agreement which the Contractor’s employee(s) sign.3. RADIATION THERAPY SERVICES: 1. Patient Consultation: A radiation therapy consultation is defined as a comprehensive patient evaluation provided at the request of the referring physician. A consultation shall consist of a meeting of the patient and a radiation oncologist at the contracting facility, a history and physical examination, and a review of pertinent x-rays and laboratory results as well as the patient’s medical record. All procedures conducted shall be documented in a written report (consult) which shall become a permanent part of the patient’s VA medical record. The written consult shall indicate whether or not radiation therapy is recommended for the patient. When radiation therapy is not recommended, no further action is required except documentation of this determination. This documentation is to be completed within 48 hours of consultation. All consults are to be scheduled within 14 workdays of patient’s desired date.a.A board certified radiation oncologist shall be available for consultation with VA physicians and/or patients as follows: 1) emergency cases - 24 hours/day, 7 days/week; 2) routine cases - contracting facility’s normal business hours.A board certified radiation oncologist shall attend and participate in the VAMC Salem Tumor Board Conferences and Cancer Committees. Tumor Board conferences are held the first and third Tuesdays of each month at 3 P.M. in room 1fg-145, Building 143. The Cancer Committee meets quarterly, the third Thursday of January, April, July, and October, at 3 P.M. in room 3J-149, Building 143.2. Treatment Plan: When it is determined radiation therapy is appropriate, a goal-oriented treatment plan shall be developed by the radiation oncologist for each patient and made a part of the VA medical record. The treatment plan shall include the type of radiation to be administered, the dosages, the treatment dates, and the follow-up examination date(s). Treatment plans may be altered as necessary during the course of the patient’s treatment.Use of the following modalities: IMRT, IGRT, Stereotactic Radiosurgery, Stereotactic Body Radiotherapy, Cyberknife, Gammaknife and/or HDR brachytherapy shall be fully justified in accordance with the Appropriateness Criteria ? of the American College of Radiology (ACR). Use of an unjustified or inappropriate modality shall be reimbursed at the rate indicated for conventional radiation therapy. . Treatments: Radiation therapy provided will follow ACR Guidelines for Radiation Oncology Practice. Each patient will have access to a full range of radiation therapy eservices. Each patient will receive treatment at the contracting facility in accordance with his/her treatment plan. Treatments shall be delivered by a certified therapeutic radiologist technologist (ARRT) as prescribed and approved by a Board Certified Radiation Oncologist and shall consist of one or more of the following to include: external beam, brachytherapy, 3-D simulation/Rx or Gamma Knife. If an additional course of treatment is indicated, a new authorization will be sought and further treatment under this arrangement will be provided upon subsequent authorizations.a. Prior to beginning radiation treatment, contractor shall instruct the patient and care givers on the risks involved including symptom management and symptoms requiring immediate intervention. This instruction must be documented in the medical record within 24 hours. The patient shall be given names and telephone numbers of persons to contact to report these symptoms. Informed consent shall be completed prior to implementation of initial treatments.b. Each patient will be evaluated for treatment management at a minimum of once per five treatments. These treatment management evaluations, addressing tumor response and side effects of therapy, include pertinent laboratory and imaging studies. Patient’s progress will be reported to the referring physician using the electronic medical record, Computerized Patient Record System (CPRS).Contractor shall provide the patient with written guidelines regarding their rights and responsibilities. This includes keeping the patient informed of all issues affecting care and inviting full participation in planning and implementing care. Patient expectations of the contractor should also be outlined. The patient must be advised of their right to submit complaints and procedures concerning such. This instruction must be documented in the medical record within 24 hours.c. The contractor shall maintain written policies and procedures that clearly define guidelines for protecting patients and employees from all unnecessary radiation exposure, provisions for the safe use, removal, handling and storage of radiation and other radioactive elements.d. All VA medical records copies shall be safeguarded in accordance with the contracting facility’s normal procedures. The Contracting Officer’s Representative (COR)/ VA Directive 1663 only requires that you identify the COR by title – optional to include individual Administrative Officer is authorized to review, either by on-site surveys and/or records review, the quality of care rendered under this contract. The contractor shall furnish specific clinical information when it is professionally considered necessary by the VAMC. Clinical or other medical records of VA beneficiaries treated by the contractor shall be forwarded to the VAMC Salem within 48 hours after treatment. The progress notes and other documentation shall include the full name of the patient and the full social security number.4. Follow up Examination: A board certified radiation oncologist must see each patient at least one (1) time following the radiation therapy treatment series within 30-60 calendar days of the end of a treatment series unless the VAMC Salem attending oncology physician determines this is not necessary (e.g., after a simple palliative treatment). The follow-up examination shall consist of a physical examination of the patient and a review of the current medical record including appropriate imaging. The purpose of this examination is to evaluate the patient’s response to therapy and a written evaluation shall be completed for the patient’s medical record within 48 hours. Prior to any initiation of new treatment, approval must be obtained from the VAMC COR.5. Emergency Treatment: In the event a patient required emergency care while at the contracted facility; appropriate treatment will be provided by the contracted facility staff. The Contracting Officer shall be notified immediately should a death occur or hospitalization is necessary. When hospitalization is required, the patient will be transferred to the VAMC Salem as soon as she/she is deemed medically stable. All emergency treatment costs incurred at the contracting facility by a VA outpatient are the responsibility of the patient unless such emergency care is provided for the treatment of a Veteran’s service connected rated disability, in which case the VA will be responsible for payment. The VA shall assume full financial responsibility for the emergency treatment of VA inpatients.Patient safety incidents, including medical events involving radioactive material and misadministration, shall be reported within 24 hours of discovery.B.6 SPECIAL CONTRACT REQUIREMENTS1. Under the authority of Public Law 104262 and 38 USC 8153, the contractor agrees to provide Health Care Resources in accordance with the terms and conditions stated herein, to furnish for the Department of Veterans Affairs Medical Center, Salem VA located 1970 Roanoke Blvd. Salem VA 24153. The services shall be provided at the Contractor’s facility. The services and prices specified in the Section entitled Schedule of Supplies/Services of this contract.a. Contractor shall provide scheduled services specified in Schedule of Supplies/Services throughout the contract period. Other necessary personnel for the operation of the services contracted for at the VA will be provided by the Contractor at levels mutually agreed upon which are compatible with the safety of the patient and personnel and with quality medical care programming.b. The services to be performed by the contractor shall be performed in accordance with VA policies, procedures and regulations of the medical staff by laws of the VA facility. SALEM VA MEDICAL CENTERc. The Government reserves the right to refuse acceptance of Contractor, if personal or professional conduct jeopardizes patient care. Breaches of conduct include intoxication or debilitation resulting from drug use, theft, patient abuse, dereliction or negligence in performing directed tasks, or other conduct resulting in formal complaints by patient. Standards for conduct shall mirror those prescribed by current federal personnel regulations. The Contracting Officer and Contracting Officer’s Representative shall deal with issues raised concerning contract personnel’s conduct. The final arbiter on questions of acceptability is the Contracting Officer.d. The Contracting Officer shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is the final authority on validating complaints. In the event that the Contractor is involved and named in a validated patient complaint, the Government reserves the right to refuse acceptance of the services of such personnel. This does not preclude refusal in the event of incidents involving physical or verbal abuse.e. Contractor shall, in writing, keep the Contracting Officer informed of any unusual circumstances in conjunction with the contract.2. DESCRIPTION OF FACILITIES/EQUIPMENT/INSTRUMENTS:The Contractors’ facility shall meet all federal, state and local fire and life safety codes and must be accessible and convenient for wheelchair patients and other handicapped or disabled Veterans. . QUALIFICATIONS:a. Personnel assigned by the Contractor to perform the services covered by this contract shall be a Board Certified Radiation Oncologist, licensed in a State, Territory, or Commonwealth of the United States or the District of Columbia, a Board Certified Therapeutic Medical Physicist and a certified Dosimetrist. Qualified personnel must be proficient in the English language.b. Applicants must provide evidence of at least one full, active, current and unrestricted licensure, registration, certification, and/or other relevant credentials for verification prior to appointment and throughout the employment process, as requested. They must agree to accept the professional obligations delineated in the Medical Staff Bylaws, Rules and Regulations provide to them. Medical Staff Bylaws, Rules and Regulations can be found at the following websites . Physicians must maintain current and active Basic Life Support (BLS) certification, and provide copy of BLS certification to the COR every two years.c. Radiation Therapy services shall be directed by a Board Certified Radiation Oncologist. A qualified, full-time Board Certified Medical Physicist must be part of the Radiation Therapy Oncology Team.4. WORK HOURS: (Veterans Administration (VA))The services covered by this contract shall be furnished by the contractor as defined herein.? The contractor shall not be required, except in case of emergency, to furnish such services on a Federal Holiday or during off duty hours as described below. ?b. The following terms have the following meanings:?(1)? Normal working hours:?Monday through Friday, 8:00 a.m. – 4:30 p.m., excluding federal holidays.?(2)? Federal Holidays:? The 10 holidays observed by the Federal Government are:??????? New Year’s Day??????? Martin Luther King’s Birthday??????? President’s Day??????? Memorial Day??????? Independence Day??????? Labor Day??????? Columbus Day??????? Veterans Day??????? Thanksgiving??????? Christmas AND?any other day specifically declared by the President of the United States to be a federal holiday.When one of the holidays falls on Sunday, the following Monday shall be observed as a Federal Holiday. When a holiday falls on a Saturday, the preceding Friday shall be observed as a Federal Holiday.5. TERMS OF THE CONTRACT:The contract is effective Twelve Months from Date of Award with three (3) one (1) year option renewal periods. 6. NATIONAL PROVIDER IDENTIFIER:a. The National provider identifier (NPI) is a standard, unique 10-digit numeric identifier required by HIPAA. The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers). The contractor shall ensure that the health care practitioners and/or medical center providing service under the contract obtains a NPI and provides it to the Contracting Officer.b. Prior to acceptance, all contract providers must comply with hospital credentialing guidelines, providing all required information on the timeline established by the Medical Center Credentialing Officer. Credentialing and privileging shall be completed in accordance with the provisions of VHA Handbook 1100.19 dated October 2, 2007 found at the web address below.. This Veterans Health Administration (VHA) Handbook provides updated VHA procedures regarding credentialing and privileging, to include incorporating: VHA policy concerning VetPro; the Expedited Medical Staff Appointment Process; credentialing during activation of the facility Disaster Plan; requirements for querying the Federation of State Medical Boards (FSMB); credentialing and privileging requirements for Telemedicine and remote health care; clarifications for the Summary Suspension of Privileges process in order to ensure both patient safety and practitioner rights; and the credentialing requirements for physician assistants (PAs) and advanced practice registered nurses (APRNs). The credentialing, but not privileging, requirements of this Handbook apply to physicians, dentists, and other practitioners allowed by law and the facility to practice independently who are assigned to Research or administrative positions not involved in patient care.7. CONTRACTING WITH PARTIES LISTED ON THE OIG LIST OF EXCLUDED INDIVIDUALS/ENTITIES: a. In accordance with The Health Insurance Portability and Accountability Act (HIPAA) and the Balanced Budget Act (BBA) of 1977, the Office of Inspector General has established a list of parties and entities excluded from Federal health care programs. Specifically, the listed parties and entities may not receive Federal Health Care program payments due to fraud and/or abuse of the Medicare and Medicaid programs. b. Therefore, all offerors shall review the OIG List of Excluded Individuals/Entities on the OIG web site at oig to ensure that the proposed candidate(s) and/or firm(s) are not listed. Offerors should note that any excluded individual or entity that submits a claim for reimbursement to a Federal health care program, or causes such a claim to be submitted, may be subject to a minimum and maximum Civil Monetary Penalty (CMP) for each item or service furnished during a period that the person or entity was excluded and may also be subject to treble damages for the amount claimed for each item or service. CMP’s may also be imposed against health care providers and entities that employ or enter into contracts with excluded individuals or entities to provide items or services to Federal program beneficiaries.By signing the offer the Contractor certifies that he/she has reviewed the OIG List of Excluded Individuals/Entities and that the proposed candidate(s) and/or firm are not listed as of the date the offer was signed.8. MEDICAL LIABILITY: a. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g. professional judgments, diagnosis for specific medical treatment), in accordance with FAR 37.401(b) (Non-personal Health Care Services.)b. The Contractor is required to ensure that its subcontracts for provisions of health care services contain the requirements set by the State.c. Medical Liability: See VAAR Clause 852.237-7 – The Contractor is required to ensure that his subcontractor’s provisions of health care services contain the requirement of the VAAR Clause 852.237-7, including the maintenance of medical liability insurance. The contractor shall be responsible for providing the VAMC with an active Insurance Certificate from their subcontractor(s) on a yearly basis.9. TORT CLAIMS:Contractor employees are not covered by the Federal Tort Claims Act. When a Contractor employee has been identified as a provider in a tort claim, the Contractor employee is responsible for notifying the Contractor’s legal counsel and/or insurance carrier. Any settlement or judgment arising from a Contractor employee’s action or non-action is the responsibility of the Contractor and/or insurance carrier.10. PERSONNEL POLICY:a. The Contractor shall assume full responsibility for the protection of its personnel furnishing services under this contract. To carry this out the Contractor shall provide the following for these personnel:General Liability Insurance Worker’s compensationProfessional liability insuranceHealth examinationsIncome tax withholding, and Social Security payments b. The parties agree that the contractor, its employees, agents and subcontractors shall not be considered VA employees for any purpose.11. PAYMENT:a. Timely shall be submitted within 30 days of the end of each month services. Payment to the Contractor shall be made monthly, in arrears, upon receipt of a properly prepared invoice. Payment for services will be at the rates specified in the Schedule of Supplies/Services.The invoices shall contain the following information:(i) Name and address of the Contractor; (ii) Invoice date and number; (iii) Contract number, contract line item number and, if applicable, the order number; (iv) Description, quantity, unit of measure, unit price and extended price of the items delivered; Itemized statement of services rendered by CPT Code and Rates (v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading; (vi) Terms of any discount for prompt payment offered; (vii) Name and address of official to whom payment is to be sent; (viii) Name, title, and phone number of person to notify in event of defective invoice; and (ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract. (x) Electronic funds transfer (EFT) banking information: Invoices for payment may be rejected if all information required by FAR Clause 52.212-4(g) is not included. Invoices without the required information will be returned.Billings rendered by the Contractor to the VAMC for services furnished a VAMC beneficiary under the terms of this contract shall be billings in full. Neither the beneficiary his insurer, nor any third party shall be billed. ?Payment Address: Department of Veterans Affairs Financial Services CenterPO Box 149971Austin, TX 78714-8971Invoices can also be faxed to the Commercial Payment Section at (512) 460-5540. With one copy submitted directly to the COR TBD The Department of Veterans Affairs Financial Service Center (FSC) is the designated agency office for invoice receipt in accordance with the Prompt Payment Act (5 CFR Part 1315). FSC or its designated representative may contact the vendor to provide specific instructions for electronic submission of invoices. The vendor shall be responsible for any associated expenses. FSC may utilize third-party contractors to facilitate invoice processing.12. MANAGEMENT AND SUPERVISION:a. The Contractor shall be responsible for supervising the daily services provided under this contract by the Contractor’s staff.b. The Contractor shall have written policies and procedures regarding staff credentials. c. The Contractor shall complete background investigations to insure that employees do not have a record of criminal offenses or substantiated incidents of patient abuse.13. QUALITY IMPROVEMENT: The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, diagnosis for specific medical treatment), in accordance with Federal Acquisition Regulation (FAR) 37.401(b).14. QUALITY ASSURANCE: a. The Contractor shall provide accreditations that meet or exceed VA standards and at a minimum, the standards set by The Joint Commission (TJC). b. The Department of Veterans Affairs is allowed according to public law 99-272 and 101-508, to seek reimbursement from health insurance carriers for the cost of medical care and treatment provided to veterans for their non-service connected conditions. The contractor may not bill any veteran or their health insurance carrier for care provided to a veteran while employed by or working under contract with the Department of Veterans Affairs.15. ADP SECURITY RESPONSIBILITIES:In performance of official duties, the Contractor’s employee(s) have regular access to printed and electronic files containing sensitive data, which must be protected under the provisions of the Privacy Act of 1974 (5 U.S.C. 552a), and other applicable laws, Federal Regulations, Veterans Affairs statutes and policies. The Contractor’s employee(s) are responsible for (1) protecting that data from unauthorized release or from loss, alteration, or unauthorized deletion and (2) following all applicable regulations and instructions regarding access to computerized files, release of access codes, etc., as set out in a computer access agreement which the Contractor’s employee(s) signs.16. COMPUTERIZED PATIENT MEDICAL RECORD SYSTEM: a. Contractor’s employee(s) shall document all patient services through Electronic Medical Record, and scanned into the VA Computerized Patient Record System (CPRS). All documentation must be accurate, complete, signed by attending physicians and submitted within 24 hours of electronic approval by the physicians. The record consists of a paper legacy system, with new records being scanned into CPRS by designated Contractor’s employees. Contractor shall designate a primary and alternate person who shall be scanning records into the CPRS system. Contractor shall provide the full names of those persons to the Contracting Officer for training and background investigation purposes.b. The Contractor's employee(s) shall be required to utilize the VA CPRS system to obtain all necessary medical records of the Veterans authorized for treatment (including lab reports, imaging reports, pathology, demographics and prior medical history) to determine appropriate course of treatment. Contractor’s employees shall be required to enter prescriptions, additional diagnostic imaging, and/or laboratory orders necessary for patient’s treatment plan into VA’s CPRS, and shall instruct patients to report to the FILL IN VAMC for any written orders/requests. 17. CONFIDENTIALITY OF PATIENT RECORDS:a. The Contractor is a VA contractor and shall assist in the provision of health care to patients seeking such care from or through VA. As such, the Contractor is considered as being part of the Department health care activity. Contractor is considered to be a VA contractor for purposes of the Privacy Act, Title 5 U.S.C. 552a. Further, for the purpose of VA records access and patient confidentiality, Contractor is considered to be a VA contractor for the following provisions: Title 38 U.S.C. 5701, 5705, and 7362. Therefore, Contractor may have access as would other appropriate components of VA, to patient medical records including patient treatment records pertaining to drug and alcohol abuse, HIV and sickle cell anemia, to the extent necessary to perform its contractual responsibilities. However, like other components of the Department and not withstanding any other provisions of the contract, the Contractor is restricted from making disclosures of VA records, or information contained in such records, to which it may have access, except to the extent that explicit disclosure authority from VA has been received. The Contractor is subject to the same penalties and liabilities for unauthorized disclosures of such records as VA.b. The records referred to above shall be and remain the property of the VA and shall not be removed or transferred from VA except in accordance with U.S.C. 551a (Privacy Act), 38 U.S.C. 5701 (Confidentiality of claimants records), 5 U.S.C. 552 (FOIA), 38 U.S.C. 5705 (Confidentiality of Medical quality Assurance Records), 38 U.S.C. 7332 (Confidentiality of Certain Medical Records) and federal laws, rules and regulations. Subject to applicable federal confidentiality or privacy laws, the Contractor, or their designated representatives of federal regulatory agencies having jurisdiction over Contractor, may have access to VA’s records, at VA’s place of business on request during normal business hours, to inspect and review and make copies of such records.18. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA):In accordance with 45 CFR 164.502(e), the Privacy Rule includes exceptions to the Business Associate standard. This contract and its requirements meet the following exception and do not require a Business Associate agreement in order for Covered Entity to disclose Protected Health Information to: a health care provider for treatment. Based on this exception, a Business Associate agreement is not required for this contract. The Contractor must adhere to all VA security policies and applicable confidentiality statutes, include 38 U.S.C. 5701, 38 U.S.C. 5705, 38 U.S.C. 7332, 5 U.S.C. 552a (Privacy Act), as well as 45 U.S.C. Parts 160, 162 and 164 (Health Insurance Portability and Accountability Act).19. CONTRACTOR SECURITY REQUIREMENTS:Security VA Information and Information System Security/Privacy Requirements for ITGeneral:a. All Contractors and Contractor personnel shall be subject to the same Federal laws, regulations, standards and VA policies as VA, and VA personnel, regarding information and information system security. Contractor must follow policies and procedures outlined in VA Directive 6500, Information Security Program and its handbooks to ensure appropriate security controls are in place.? VA INFORMATION AND INFORMATION SYSTEM SECURITY/PRIVACY LANGUAGE 1. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMSa. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program . The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.c. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.d. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.e. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.2. VA INFORMATION CUSTODIAL LANGUAGEa. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data- General, FAR 52.227-14(d) (1).b. VA information should not be co-mingled, if possible, with any other data on the Contractors/subcontractor’s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA’s information is returned to the VA or destroyed in accordance with VA’s sanitization requirements. VA reserves the right to conduct on-site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements.c. Prior to termination or completion of this contract, contractor/subcontractor must not destroy information received from VA, or gathered/created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization. Self-certification by the contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract. Handbook 6300-1.pdf . The contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations and policies in this contract.e. The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the contractor/subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed.f. If VA determines that the contractor has violated any of the information confidentiality, privacy, and security provisions of the contract, it shall be sufficient grounds for VA to withhold payment to the contractor or third party or terminate the contract for default or terminate for cause under Federal Acquisition Regulation (FAR) part 12.g. The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated.h. The contractor/subcontractor’s firewall and Web services security controls, if applicable, shall meet or exceed VA’s minimum requirements. VA Configuration Guidelines are available upon request.i. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA’s prior written approval. The contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response.j. Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the contractor/subcontractor is in receipt of a court order or other requests for the above mentioned information, that contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response.k. For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or an MOU-ISA for system interconnection, the contractor/subcontractor must complete a Contractor Security Control Assessment (CSCA) on a yearly basis and provide it to the COR.3. INFORMATION SYSTEM HOSTING, OPERATION, MAINTENANCE, OR USEa. For information systems that are hosted, operated, maintained, or used on behalf of VA at non-VA facilities, contractors/subcontractors are fully responsible and accountable for ensuring compliance with all HIPAA, Privacy Act, FISMA, NIST, FIPS, and VA security and privacy directives and handbooks. This includes conducting compliant risk assessments, routine vulnerability scanning, system patching and change management procedures, and the completion of an acceptable contingency plan for each system. The contractor’s security control procedures must be equivalent, to those procedures used to secure VA systems. A Privacy Impact Assessment (PIA) must also be provided to the COR and approved by VA Privacy Service prior to operational approval. All external Internet connections to VA’s network involving VA information must be reviewed and approved by VA prior to implementation.b. Adequate security controls for collecting, processing, transmitting, and storing of Personally Identifiable Information (PII), as determined by the VA Privacy Service, must be in place, tested, and approved by VA prior to hosting, operation, maintenance, or use of the information system, or systems by or on behalf of VA. These security controls are to be assessed and stated within the PIA and if these controls are determined not to be in place, or inadequate, a Plan of Action and Milestones (POA&M) must be submitted and approved prior to the collection of PII.Outsourcing (contractor facility, contractor equipment or contractor staff) of systems or network operations, telecommunications services, or other managed services requires certification and accreditation (authorization) (C&A) of the contractor’s systems in accordance with VA Handbook 6500.3, Certification and Accreditation and/or the VA OCS Certification Program Office (government facility or government equipment) contractor-operated systems, third party or business partner networks require memorandums of understanding and interconnection agreements (MOU-ISA) which detail what data types are shared, who has access, and the appropriate level of security controls for all systems connected to VA networks.d. The contractor/subcontractor’s system must adhere to all FISMA, FIPS, and NIST standards related to the annual FISMA security controls assessment and review and update the PIA. Any deficiencies noted during this assessment must be provided to the VA contracting officer and the ISO for entry into VA’s POA&M management process. The contractor/subcontractor must use VA’s POA&M process to document planned remedial actions to address any deficiencies in information security policies, procedures, and practices, and the completion of those activities. Security deficiencies must be corrected within the timeframes approved by the government. Contractor/subcontractor procedures are subject to periodic, unannounced assessments by VA officials, including the VA Office of Inspector General. The physical security aspects associated with contractor/subcontractor activities must also be subject to such assessments. If major changes to the system occur that may affect the privacy or security of the data or the system, the C&A of the system may need to be reviewed, retested and re-authorized per VA Handbook 6500.3. This may require reviewing and updating all of the documentation (PIA, System Security Plan, and Contingency Plan). The Certification Program Office can provide guidance on whether a new C&A would be necessary. e. The contractor/subcontractor must conduct an annual self-assessment on all systems and outsourced services as required. Both hard copy and electronic copies of the assessment must be provided to the COR. The government reserves the right to conduct such an assessment using government personnel or another contractor/subcontractor. The contractor/subcontractor must take appropriate and timely action (this can be specified in the contract) to correct or mitigate any weaknesses discovered during such testing, generally at no additional cost.f. VA prohibits the installation and use of personally-owned or contractor/subcontractor owned equipment or software on VA’s network. If non-VA owned equipment must be used to fulfill the requirements of a contract, it must be stated in the service agreement, SOW or contract. All of the security controls required for government furnished equipment (GFE) must be utilized in approved other equipment (OE) and must be funded by the owner of the equipment. All remote systems must be equipped with, and use, a VA-approved antivirus (AV) software and a personal (host-based or enclave based) firewall that is configured with a VA approved configuration. Software must be kept current, including all critical updates and patches. Owners of approved OE are responsible for providing and maintaining the anti-viral software and the firewall on the non-VA owned OE.g. All electronic storage media used on non-VA leased or non-VA owned IT equipment that is used to store, process, or access VA information must be handled in adherence with VA Handbook 6500.1, Electronic Media Sanitization upon: (i) completion or termination of the contract or (ii) disposal or return of the IT equipment by the contractor/subcontractor or any person acting on behalf of the contractor/subcontractor, whichever is earlier. Media (hard drives, optical disks, CDs, back-up tapes, etc.) used by the contractors/subcontractors that contain VA information must be returned to the VA for sanitization or destruction or the contractor/subcontractor must self-certify that the media has been disposed of per 6500.1 requirements. This must be completed within 30 days of termination of the contract.h. Bio-Medical devices and other equipment or systems containing media (hard drives, optical disks, etc.) with VA sensitive information must not be returned to the vendor at the end of lease, for trade-in, or other purposes. The options are:(1) Vendor must accept the system without the drive;(2) VA’s initial medical device purchase includes a spare drive which must be installed in place of the original drive at time of turn-in; or(3) VA must reimburse the company for media at a reasonable open market replacement cost at time of purchase.(4) Due to the highly specialized and sometimes proprietary hardware and software associated with medical equipment/systems, if it is not possible for the VA to retain the hard drive, then;(a) The equipment vendor must have an existing BAA if the device being traded in has sensitive information stored on it and hard drive(s) from the system are being returned physically intact; and(b) Any fixed hard drive on the device must be non-destructively sanitized to the greatest extent possible without negatively impacting system operation. Selective clearing down to patient data folder level is recommended using VA approved and validated overwriting technologies/methods/tools. Applicable media sanitization specifications need to be preapproved and described in the purchase order or contract.(c) A statement needs to be signed by the Director (System Owner) that states that the drive could not be removed and that (a) and (b) controls above are in place and completed. The ISO needs to maintain the documentation.4. SECURITY INCIDENT INVESTIGATIONa. The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.b. To the extent known by the contractor/subcontractor, the contractor/subcontractor’s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant.c. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement.d. In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.5. LIQUIDATED DAMAGES FOR DATA BREACHa. Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract.b. The contractor/subcontractor shall provide notice to VA of a “security incident” as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.c. Each risk analysis shall address all relevant information concerning the data breach, including the following:(1) Nature of the event (loss, theft, unauthorized access);(2) Description of the event, including:(a) date of occurrence;(b) data elements involved, including any PII, such as full name, social security number, date of birth, home address, account number, disability code;(3) Number of individuals affected or potentially affected;(4) Names of individuals or groups affected or potentially affected;(5) Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text;(6) Amount of time the data has been out of VA control;(7) The likelihood that the sensitive personal information will or has been compromised(made accessible to and usable by unauthorized persons); (8) Known misuses of data containing sensitive personal information, if any;(9) Assessment of the potential harm to the affected individuals;(10) Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate; and(11) Whether credit protection services may assist record subjects in avoiding or mitigating the results of identity theft based on the sensitive personal information that may have been compromised.d. Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following:(1) Notification;(2) One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports;(3) Data breach analysis;(4) Fraud resolution services, including writing dispute letters, initiating fraud alerts andcredit freezes, to assist affected individuals to bring matters to resolution;(5) One year of identity theft insurance with $20,000.00 coverage at $0 deductible; andNecessary legal expenses the subjects of an SPI data breach may incur to repair falsified or damaged creditare not included in the liquidated damages amount and will be handled as actual damages, which thecontractor should anticipate as among the costs of doing business, and should consider in developing itscost estimates.6. SECURITY CONTROLS COMPLIANCE TESTINGOn a periodic basis, VA, including the Office of Inspector General, reserves the right to evaluate any or all of the security controls and privacy practices implemented by the contractor under the clauses contained within the contract. With 10 working-days’ notice, at the request of the government, the contractor must fully cooperate and assist in a government-sponsored security controls assessment at each location wherein VA information is processed or stored, or information systems are developed, operated, maintained, or used on behalf of VA, including those initiated by the Office of Inspector General. The government may conduct a security control assessment on shorter notice (to include unannounced assessments) as determined by VA in the event of a security incident or at any other time.? 24. CONTRACT ADMINISTRATION DATA:The Contracting Officer is the only person authorized to approve changes or modify any of the requirements of this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue changes that shall affect price, quantity or quality of performance of this contract.The Contracting Officer shall resolve complaints concerning Contractor relations with the Government employees or patients. The Contracting Officer is final authority on validating complaints. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer without authority, no adjustment shall be made in the contract price to cover an increase in costs incurred as a result thereof. 25. ORDERING Orders shall be placed either by issuance of individual purchase/delivery orders or verbal orders and may be transmitted electronically, via mail or in any manner consistent with accepted business practices. Verbal orders may be placed by an individual other than a Contracting Officer, identified as the COR. Verbal orders shall be followed with a written request. 26. REQUIRED REGISTRATION WITH CONTRACTOR PERFORMANCE ASSESSMENT REPORTING SYSTEM (CPARS)FAR 42.1502 direct all Federal agencies to collect past performance information on contracts. The Department of Veterans Affairs has implemented use of the Contractor Performance Assessment Reporting System (CPARS) to comply with this regulation. One or more past performance evaluations will be conducted in order to record your contract performance as required by FAR 42.15(b) The past performance evaluation process is a totally paperless process using CPARS. CPARS is a web-based system that allows for electronic processing of the performance evaluation report. Once the report is processed, it is available in the Past Performance Information Retrieval System (PPIRS) for Government use in evaluating past performance as part of a source selection action.(c) Please furnish the Contracting Officer with the name, position title, phone number, and email address for each person designated to have access to your firm’s past performance evaluation(s) for the contract no later than 30 days after award. Each person granted access will have the ability to provide comments in the Contractor portion of the report and state whether or not the Contractor agrees with the evaluation, before returning the report to the Assessing Official. The report information must be protected as source selection sensitive information not releasable to the public. (d) When your Contractor Representative(s) (Past Performance Points of Contact) are registered in CPARS, they will receive an automatically-generated email with detailed login instructions. Further details, system requirements, and training information for CPARS are available at . The CPARS User Manual, registration for online training for Contractor Representatives may be found at this site.(e) Within 60 days after the end of a performance period, the Contracting Officer will complete an interim or final past performance evaluation and the report will be accessible at Contractor Representatives may then provide comments in response to the evaluation, or return the evaluation without comment. Comments are limited to the space provided in Block 22. Your comments should focus on objective facts in the Assessing Official’s narrative and should provide your views on the causes and ramifications of the assessed performance. In addition to the ratings and supporting narratives, blocks 1-17 should be reviewed for accuracy, as these include key fields that will be used by the Government to identify your firm in future source selection evaluations. If you elect not to provide comments, please acknowledge receipt of the evaluation by indicating, “No Comment” in Block 22, and then signing and dating Block 23 of the form. Without a statement in Block 22, you will be unable to sign and submit the evaluation back to the Government. If you do not sign and submit the CPAR within 30 days, it will automatically be returned to the Government and will be annotated: “The report was delivered/received by the contractor on (date). The contractor neither signed nor offered comment in response to this assessment.” Your response is due within 30 calendar days after receipt of the CPAR.(f) The following guidelines apply concerning your use of the past performance evaluation: (1) Protect the evaluation as “source selection information.” After review, transit the evaluation by completing and submitting the form through CPARS. If for some reason you are unable to view and/or submit the form through CPARS, contact the Contracting Officer for instructions. (2) Strictly control access to the evaluation within your organization. Ensure the evaluation is never released to persons or entities outside of your control. (3) Prohibit the use of or reference to evaluation data for advertising, promotional material, preaward surveys, responsibility determination, production readiness reviews, or other similar purposes.(g) If you wish to discuss a past performance evaluation, you should request a meeting in writing to the Contracting Officer no later than seven days following your receipt of the evaluation. The meeting will be held in person or via telephone or other means during your 30-day review period.(h) A copy of the completed past performance evaluation will be available in CPARS for your viewing and for Government use supporting source selection actions after it has been completed.B.7 EPA Clause for Per-Procedure Based Acquisitions Using Medicare Rates The Per-Procedure rates for the base year and any option years, should they be renewed, will correspond to the most current and active published Medicare rates at the time services are rendered under the contract. Corresponding Per- Procedure rate adjustments could result in either a decrease or increase in payment to the Contractor depending on the rates published by Medicare for any given time period. The burden of notifying the VA Contracting Officer of any changes in Medicare rates lies with the Contractor. The Contractor’s notification to the VA Contracting Officer should include a list detailing the new Medicare rates and published documentation that substantiates that these rates are currently effective or will be effective at a future date. Within seven (7) calendar days of being properly notified of the change(s) in Medicare rates by the Contractor, the VA Contracting Officer will attempt to verily the change(s) with the Centers for Medicare and Medicaid Services (CMS). If the change(s) cannot be verified, the VA Contracting Officer will notify the Contractor of this determination, and will work with the Contractor to identify the issue(s) preventing verification. If the change(s) can be verified, the VA Contracting Officer will implement the corresponding adjustments within fourteen (14) calendar days of verification unless the effective date has not yet arrived. In the latter case, the VA Contracting Officer will implement the change(s) on the effective date unless the effective date falls within the fourteen (14) calendar days the VA Contracting Officer is afforded to implement the change(s) after verification. The VA Contracting Officer reserves the right to retain any of the remaining fourteen (14) calendar days between verification and implementation regardless of the effective date of the change(s). The Contractor is not entitled to retroactive payment rate adjustments prior to implementation of the change(s) in Medicare rates by the VA Contracting Officer. “Piecemeal” changes to Medicare rates, such as only seeking per-procedure rate adjustments for select codes or a select group of codes, will not be permitted under any circumstance. The Contractor shall accept all Medicare rate changes for the period in which they are effective. VA reserves the right to adjust the Per-Procedure rates under this contract at anytime should Medicare rates change regardless of whether the Contractor notified the VA Contracting Officer of the change(s). The Contractor will be given a notice of such actions at east seven (7) calendar days prior to the effective date of the change(s). Should there be any disagreement with the VA Contracting Officer’s proposed change, the Contractor must submit a response outlining those areas in which the Contractor disagrees. This response must be provided to the Contracting Officer within seven (7) calendar days of notification of the anticipated change. The VA Contracting Officer reserves the right to make the final determination with regard to any change. Should the VA Contracting Officer implement any change(s) in Medicare rates under this contract, the Contractor shall accept all corresponding adjustments for the time period in which they are effective. SECTION C - CONTRACT CLAUSESADDENDUM to FAR 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMSClauses that are incorporated by reference; (by Citation Number, Title, and Date), have the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.The following clauses are incorporated into 52.212-4 as an addendum to this contract:C.1 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011) (a) The Contractor shall comply with agency personal identity verification procedures identified in the contract that implement Homeland Security Presidential Directive-12 (HSPD-12), Office of Management and Budget (OMB) guidance M-05-24, and Federal Information Processing Standards Publication (FIPS PUB) Number 201. (b) The Contractor shall account for all forms of Government-provided identification issued to the Contractor employees in connection with performance under this contract. The Contractor shall return such identification to the issuing agency at the earliest of any of the following, unless otherwise determined by the Government: (1) When no longer needed for contract performance. (2) Upon completion of the Contractor employee's employment. (3) Upon contract completion or termination. (c) The Contracting Officer may delay final payment under a contract if the Contractor fails to comply with these requirements. (d) The Contractor shall insert the substance of this clause, including this paragraph (d), in all subcontracts when the subcontractor's employees are required to have routine physical access to a Federally-controlled facility and/or routine access to a Federally-controlled information system. It shall be the responsibility of the prime Contractor to return such identification to the issuing agency in accordance with the terms set forth in paragraph (b) of this section, unless otherwise approved in writing by the Contracting Officer.(End of Clause)C.2 52.216-18 ORDERING (OCT 1995) (a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from Effective Date Of Award through the end of the effective period. (b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control. (c) If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.(End of Clause)C.3 52.216-19 ORDER LIMITATIONS (OCT 1995) (a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than One (1), the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract. (b) Maximum order. The Contractor is not obligated to honor-- (1) Any order for a single item in excess of the quantities of base year; (2) Any order for a combination of items in excess of the base and all option years; or (3) A series of orders from the same ordering office within 30 days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section. (c) If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section. (d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within 30 days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.(End of Clause)C.4 52.216-22 INDEFINITE QUANTITY (OCT 1995) (a) This is an indefinite-quantity contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies and services specified in the Schedule are estimates only and are not purchased by this contract. (b) Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause. The Contractor shall furnish to the Government, when and if ordered, the supplies or services specified in the Schedule up to and including the quantity designated in the Schedule as the "maximum." The Government shall order at least the quantity of supplies or services designated in the Schedule as the "minimum." (c) Except for any limitations on quantities in the Order Limitations clause or in the Schedule, there is no limit on the number of orders that may be issued. The Government may issue orders requiring delivery to multiple destinations or performance at multiple locations. (d) Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after 31 October 2018.(End of Clause)C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30 days.(End of Clause)C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) (a) The Government may extend the term of this contract by written notice to the Contractor within 30 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 days before the contract expires. The preliminary notice does not commit the Government to an extension. (b) If the Government exercises this option, the extended contract shall be considered to include this option clause. (c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed five (5) years.(End of Clause)C.7 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) Funds are not presently available for performance under this contract beyond 30 September. The Government’s obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond 30 September, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer. (End of clause)C.8 52.232-99 PROVIDING ACCELERATED PAYMENT TO SMALL BUSINESS SUBCONTRACTORS (DEVIATION) (AUG 2012) This clause implements the temporary policy provided by OMB Policy Memorandum M-12-16, Providing Prompt Payment to Small Business Subcontractors, dated July 11, 2012. (a) Upon receipt of accelerated payments from the Government, the contractor is required to make accelerated payments to small business subcontractors to the maximum extent practicable after receipt of a proper invoice and all proper documentation from the small business subcontractor. (b) Include the substance of this clause, including this paragraph (b), in all subcontracts with small business concerns. (c) The acceleration of payments under this clause does not provide any new rights under the Prompt Payment Act.(End of Clause)C.9 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) The bidder or offeror agrees that if a contract is awarded to him/her, as a result of this solicitation, he/she will not advertise the award of the contract in his/her commercial advertising in such a manner as to state or imply that the Department of Veterans Affairs endorses a product, project or commercial line of endeavor.(End of Clause)C.10 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE POSTER (DEC 1992) (a) Except as provided in paragraph (c) below, the Contractor shall display prominently, in common work areas within business segments performing work under VA contracts, Department of Veterans Affairs Hotline posters prepared by the VA Office of Inspector General. (b) Department of Veterans Affairs Hotline posters may be obtained from the VA Office of Inspector General (53E), P.O. Box 34647, Washington, DC 20043-4647. (c) The Contractor need not comply with paragraph (a) above if the Contractor has established a mechanism, such as a hotline, by which employees may report suspected instances of improper conduct, and instructions that encourage employees to make such reports.(End of Clause)C.11 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (DEC 2009) (a) In an effort to achieve socioeconomic small business goals, depending on the evaluation factors included in the solicitation, VA shall evaluate offerors based on their service-disabled veteran-owned or veteran-owned small business status and their proposed use of eligible service-disabled veteran-owned small businesses and veteran-owned small businesses as subcontractors. (b) Eligible service-disabled veteran-owned offerors will receive full credit, and offerors qualifying as veteran-owned small businesses will receive partial credit for the Service-Disabled Veteran-Owned and Veteran-owned Small Business Status evaluation factor. To receive credit, an offeror must be registered and verified in Vendor Information Pages (VIP) database. (). (c) Non-veteran offerors proposing to use service-disabled veteran-owned small businesses or veteran-owned small businesses as subcontractors will receive some consideration under this evaluation factor. Offerors must state in their proposals the names of the SDVOSBs and VOSBs with whom they intend to subcontract and provide a brief description of the proposed subcontracts and the approximate dollar values of the proposed subcontracts. In addition, the proposed subcontractors must be registered and verified in the VIP database ().(End of Clause)C.12 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009) The offeror agrees, if awarded a contract, to use the service-disabled veteran-owned small businesses or veteran-owned small businesses proposed as subcontractors in accordance with 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, or to substitute one or more service-disabled veteran-owned small businesses or veteran-owned small businesses for subcontract work of the same or similar value.(End of Clause)C.13 VAAR 852.219-9 VA SMALL BUSINESS SUBCONTRACTING PLAN MINIMUM REQUIREMENTS (DEC 2009) (a) This clause does not apply to small business concerns. (b) If the offeror is required to submit an individual subcontracting plan, the minimum goals for award of subcontracts to service-disabled veteran-owned small business concerns and veteran-owned small business concerns shall be at least commensurate with the Department's annual service-disabled veteran-owned small business and veteran-owned small business prime contracting goals for the total dollars planned to be subcontracted. (c) For a commercial plan, the minimum goals for award of subcontracts to service-disabled veteran-owned small business concerns and veteran-owned small businesses shall be at least commensurate with the Department's annual service-disabled veteran-owned small business and veteran-owned small business prime contracting goals for the total value of projected subcontracts to support the sales for the commercial plan. (d) To be credited toward goal achievements, businesses must be verified as eligible in the Vendor Information Pages database. The contractor shall annually submit a listing of service-disabled veteran-owned small businesses and veteran-owned small businesses for which credit toward goal achievement is to be applied for the review of personnel in the Office of Small and Disadvantaged Business Utilization. (e) The contractor may appeal any businesses determined not eligible for crediting toward goal achievements by following the procedures contained in 819.407.(End of Clause)C.14 VAAR 852.219-71 VA MENTOR-PROT?G? PROGRAM (DEC 2009) (a) Large businesses are encouraged to participate in the VA Mentor-Protégé Program for the purpose of providing developmental assistance to eligible service-disabled veteran-owned small businesses and veteran-owned small businesses to enhance the small businesses' capabilities and increase their participation as VA prime contractors and as subcontractors. (b) The program consists of: (1) Mentor firms, which are contractors capable of providing developmental assistance; (2) Protégé firms, which are service-disabled veteran-owned small business concerns or veteran-owned small business concerns; and (3) Mentor-Protégé Agreements approved by the VA Office of Small and Disadvantaged Business Utilization. (c) Mentor participation in the program means providing business developmental assistance to aid protégés in developing the requisite expertise to effectively compete for and successfully perform VA prime contracts and subcontracts. (d) Large business prime contractors serving as mentors in the VA Mentor-Protégé Program are eligible for an incentive for subcontracting plan credit. VA will recognize the costs incurred by a mentor firm in providing assistance to a protégé firm and apply those costs for purposes of determining whether the mentor firm attains its subcontracting plan participation goals under a VA contract. The amount of credit given to a mentor firm for these protégé developmental assistance costs shall be calculated on a dollar-for-dollar basis and reported by the large business prime contractor via the Electronic Subcontracting Reporting System (eSRS). (e) Contractors interested in participating in the program are encouraged to contact the VA Office of Small and Disadvantaged Business Utilization for more information.(End of Clause)C.15 VAAR 852.219-72 EVALUATION FACTOR FOR PARTICIPATION IN THE VA MENTOR-PROT?G? PROGRAM (DEC 2009) This solicitation contains an evaluation factor or sub-factor regarding participation in the VA Mentor-Protégé Program. In order to receive credit under the evaluation factor or sub-factor, the offeror must provide with its proposal a copy of a signed letter issued by the VA Office of Small and Disadvantaged Business Utilization approving the offeror's Mentor-Protégé Agreement.(End of Clause)C.16 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012) (a) Definitions. As used in this clause— (1) Contract financing payment has the meaning given in FAR 32.001. (2) Designated agency office has the meaning given in 5 CFR 1315.2(m). (3) Electronic form means an automated system transmitting information electronically according to the Accepted electronic data transmission methods and formats identified in paragraph (c) of this clause. Facsimile, email, and scanned documents are not acceptable electronic forms for submission of payment requests. (4) Invoice payment has the meaning given in FAR 32.001. (5) Payment request means any request for contract financing payment or invoice payment submitted by the contractor under this contract. (b) Electronic payment requests. Except as provided in paragraph (e) of this clause, the contractor shall submit payment requests in electronic form. Purchases paid with a Government-wide commercial purchase card are considered to be an electronic transaction for purposes of this rule, and therefore no additional electronic invoice submission is required. (c) Data transmission. A contractor must ensure that the data transmission method and format are through one of the following: (1) VA’s Electronic Invoice Presentment and Payment System. (See Web site at .) (2) Any system that conforms to the X12 electronic data interchange (EDI) formats established by the Accredited Standards Center (ASC) and chartered by the American National Standards Institute (ANSI). The X12 EDI Web site () includes additional information on EDI 810 and 811 formats. (d) Invoice requirements. Invoices shall comply with FAR 32.905. (e) Exceptions. If, based on one of the circumstances below, the contracting officer directs that payment requests be made by mail, the contractor shall submit payment requests by mail through the United States Postal Service to the designated agency office. Submission of payment requests by mail may be required for: (1) Awards made to foreign vendors for work performed outside the United States; (2) Classified contracts or purchases when electronic submission and processing of payment requests could compromise the safeguarding of classified or privacy information; (3) Contracts awarded by contracting officers in the conduct of emergency operations, such as responses to national emergencies; (4) Solicitations or contracts in which the designated agency office is a VA entity other than the VA Financial Services Center in Austin, Texas; or (5) Solicitations or contracts in which the VA designated agency office does not have electronic invoicing capability as described above.(End of Clause)C.17 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 2008) (a) It is expressly agreed and understood that this is a non- personal services contract, as defined in Federal Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the Contractor or its health-care providers are rendered in its capacity as an independent contractor. The Government may evaluate the quality of professional and administrative services provided but retains no control over professional aspects of the services rendered, including by example, the Contractor's or its health-care providers' professional medical judgment, diagnosis, or specific medical treatments. The Contractor and its health-care providers shall be liable for their liability-producing acts or omissions. The Contractor shall maintain or require all health-care providers performing under this contract to maintain, during the term of this contract, professional liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: *__________________. However, if the Contractor is an entity or a subdivision of a State that either provides for self-insurance or limits the liability or the amount of insurance purchased by State entities, then the insurance requirement of this contract shall be fulfilled by incorporating the provisions of the applicable State law.* Amounts are listed below: (b) An apparently successful offeror, upon request of the Contracting Officer, shall, prior to contract award, furnish evidence of the insurability of the offeror and/or of all health- care providers who will perform under this contract. The submission shall provide evidence of insurability concerning the medical liability insurance required by paragraph (a) of this clause or the provisions of State law as to self-insurance, or limitations on liability or insurance. (c) The Contractor shall, prior to commencement of services under the contract, provide to the Contracting Officer Certificates of Insurance or insurance policies evidencing the required insurance coverage and an endorsement stating that any cancellation or material change adversely affecting the Government's interest shall not be effective until 30 days after the insurer or the Contractor gives written notice to the Contracting Officer. Certificates or policies shall be provided for the Contractor and/or each health- care provider who will perform under this contract. (d) The Contractor shall notify the Contracting Officer if it, or any of the health-care providers performing under this contract, change insurance providers during the performance period of this contract. The notification shall provide evidence that the Contractor and/or health-care providers will meet all the requirements of this clause, including those concerning liability insurance and endorsements. These requirements may be met either under the new policy, or a combination of old and new policies, if applicable. (e) The Contractor shall insert the substance of this clause, including this paragraph (e), in all subcontracts for health-care services under this contract. The Contractor shall be responsible for compliance by any subcontractor or lower-tier subcontractor with the provisions set forth in paragraph (a) of this clause.* Amounts from paragraph (a) above:$1,000,000.00 per occurrence (End of Clause)C.18 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): FAR NumberTitleDate52.204-4PRINTED OR COPIED DOUBLE-SIDED ON RECYCLED PAPERMAY 201152.204-752.219-9SYSTEM FOR AWARD MANAGEMENTSMALL BUSINESS SUBCONTRACTING PLANJUL 2013JUL 201352.224-1PRIVACY ACT NOTIFICATIONAPR 198452.224-2PRIVACY ACTAPR 198452.227-1452.232-152.232-18RIGHTS IN DATA-GENERALPAYMENTSAVAILIBILITY OF FUNDSDEC 2007APR 1984APR 198452.237-3CONTINUITY OF SERVICESJAN 1991(End of Clause)(End of Addendum to 52.212-4)C.19 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS--COMMERCIAL ITEMS (JAN 2014) (a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (1) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)). Alternate I (AUG 2007) of 52.222-50 (22 U.S.C. 7104 (g)). (2) 52.233-3, Protest After Award (Aug 1996) (31 U.S.C. 3553). (3) 52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Pub. L. 108-77, 108-78) (b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: [X] (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 253g and 10 U.S.C. 2402). [X] (2) 52.203-13, Contractor Code of Business Ethics and Conduct (APR 2010)(Pub. L. 110-252, Title VI, Chapter 1 (41 U.S.C. 251 note)). [] (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (JUN 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.) [X] (4) 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (Jul 2013) (Pub. L. 109-282) (31 U.S.C. 6101 note). [] (5) 52.204-11, American Recovery and Reinvestment Act-Reporting Requirements (JUL 2010) (Pub. L. 111-5). [X] (6) 52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (Aug 2013) (31 U.S.C. 6101 note). [X] (7) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Jul 2013) (41 U.S.C. 2313). [] (8) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (MAY 2012) (section 738 of Division C of Pub. L. 112-74, section 740 of Division C of Pub. L. 111-117, section 743 of Division D of Pub. L. 111-8, and section 745 of Division D of Pub. L. 110-161). [] (9) 52.219-3, Notice of HUBZone Set-Aside or Sole Source Award (NOV 2011) (15 U.S.C. 657a). [X] (10) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (JAN 2011) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a). [] (11) [Reserved] [] (12)(i) 52.219-6, Notice of Total Small Business Set-Aside (NOV 2011) (15 U.S.C. 644). [] (ii) Alternate I (NOV 2011). [] (iii) Alternate II (NOV 2011). [] (13)(i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644). [] (ii) Alternate I (Oct 1995) of 52.219-7. [] (iii) Alternate II (Mar 2004) of 52.219-7. [X] (14) 52.219-8, Utilization of Small Business Concerns (Jul 2013) (15 U.S.C. 637(d)(2) and (3)). [] (15)(i) 52.219-9, Small Business Subcontracting Plan (Jul 2013) (15 U.S.C. 637(d)(4)). [] (ii) Alternate I (Oct 2001) of 52.219-9. [X] (iii) Alternate II (Oct 2001) of 52.219-9. [] (iv) Alternate III (JUL 2010) of 52.219-9. [] (16) 52.219-13, Notice of Set-Aside of Orders (NOV 2011) (15 U.S.C. 644(r)). [] (17) 52.219-14, Limitations on Subcontracting (NOV 2011) (15 U.S.C. 637(a)(14)). [X] (18) 52.219-16, Liquidated Damages--Subcontracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)). [] (19)(i) 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns (OCT 2008) (10 U.S.C. 2323) (if the offeror elects to waive the adjustment, it shall so indicate in its offer.) [] (ii) Alternate I (June 2003) of 52.219-23. [X] (20) 52.219-25, Small Disadvantaged Business Participation Program--Disadvantaged Status and Reporting (Jul 2013) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323). [X] (21) 52.219-26, Small Disadvantaged Business Participation Program--Incentive Subcontracting (Oct 2000) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323). [] (22) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (NOV 2011) (15 U.S.C. 657f). [X] (23) 52.219-28, Post Award Small Business Program Rerepresentation (Jul 2013) (15 U.S.C 632(a)(2)). [] (24) 52.219-29, Notice of Set-Aside for Economically Disadvantaged Women-Owned Small Business (EDWOSB) Concerns (Jul 2013) (15 U.S.C. 637(m)). [] (25) 52.219-30, Notice of Set-Aside for Women-Owned Small Business (WOSB) Concerns Eligible Under the WOSB Program (Jul 2013) (15 U.S.C. 637(m)). [X] (26) 52.222-3, Convict Labor (June 2003) (E.O. 11755). [] (27) 52.222-19, Child Labor--Cooperation with Authorities and Remedies (NOV 2013) (E.O. 13126). [X] (28) 52.222-21, Prohibition of Segregated Facilities (Feb 1999). [X] (29) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246). [X] (30) 52.222-35, Equal Opportunity for Veterans (SEP 2010) (38 U.S.C. 4212). [X] (31) 52.222-36, Affirmative Action for Workers with Disabilities (Oct 2010) (29 U.S.C. 793). [X] (32) 52.222-37, Employment Reports on Veterans (SEP 2010) (38 U.S.C. 4212). [X] (33) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O. 13496). [X] (34) 52.222-54, Employment Eligibility Verification (AUG 2013). (Executive Order 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.) [] (35)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA-Designated Items (May 2008) (42 U.S.C.6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.) [] (ii) Alternate I (MAY 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.) [] (36) 52.223-15, Energy Efficiency in Energy-Consuming Products (DEC 2007)(42 U.S.C. 8259b). [] (37)(i) 52.223-16, IEEE 1680 Standard for the Environmental Assessment of Personal Computer Products (DEC 2007) (E.O. 13423). [] (ii) Alternate I (DEC 2007) of 52.223-16. [X] (38) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (AUG 2011) [] (39) 52.225-1, Buy American Act--Supplies (FEB 2009) (41 U.S.C. 10a-10d). [] (40)(i) 52.225-3, Buy American Act--Free Trade Agreements-- Israeli Trade Act (NOV 2012) (41 U.S.C. chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001 note, Pub. L. 103-182, 108-77, 108-78, 108-286, 108-302, 109-53, 109-169, 109-283, 110-138, 112-41, 112-42, and 112-43). [] (ii) Alternate I (MAR 2012) of 52.225-3. [] (iii) Alternate II (MAR 2012) of 52.225-3. [] (iv) Alternate III (NOV 2012) of 52.225-3. [] (41) 52.225-5, Trade Agreements (NOV 2013) (19 U.S.C. 2501, et seq., 19 U.S.C. 3301 note). [] (42) 52.225-13, Restrictions on Certain Foreign Purchases (JUN 2008) (E.O.'s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury). [] (43) 52.225-26, Contractors Performing Private Security Functions Outside the United States (Jul 2013) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note). [] (44) 52.226-4, Notice of Disaster or Emergency Area Set-Aside (Nov 2007) (42 U.S.C. 5150). [] (45) 52.226-5, Restrictions on Subcontracting Outside Disaster or Emergency Area (Nov 2007) (42 U.S.C. 5150). [] (46) 52.232-29, Terms for Financing of Purchases of Commercial Items (Feb 2002) (41 U.S.C. 255(f), 10 U.S.C. 2307(f)). [] (47) 52.232-30, Installment Payments for Commercial Items (Oct 1995) (41 U.S.C. 255(f), 10 U.S.C. 2307(f)). [] (48) 52.232-33, Payment by Electronic Funds Transfer--System for Award Management (Jul 2013) (31 U.S.C. 3332). [X] (49) 52.232-34, Payment by Electronic Funds Transfer--Other than System for Award Management (Jul 2013) (31 U.S.C. 3332). [] (50) 52.232-36, Payment by Third Party (Jul 2013) (31 U.S.C. 3332). [] (51) 52.239-1, Privacy or Security Safeguards (Aug 1996) (5 U.S.C. 552a). [] (52)(i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). [] (ii) Alternate I (Apr 2003) of 52.247-64. (c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial services, that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: [X] (1) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.). [X] (2) 52.222-42, Statement of Equivalent Rates for Federal Hires (May 1989) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). ~Employee Class ~Monetary Wage-Fringe Benefits ~Radiologic Technologist ~24.79/hr~Registered Nurse II, Specialist ~$24.74/hr ~ Medical Assistant ~$17.27/hr ~ ~ [X] (3) 52.222-43, Fair Labor Standards Act and Service Contract Act--Price Adjustment (Multiple Year and Option Contracts) (Sep 2009) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). [] (4) 52.222-44, Fair Labor Standards Act and Service Contract Act--Price Adjustment (Sep 2009) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). [] (5) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements (Nov 2007) (41 U.S.C. 351, et seq.). [] (6) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services--Requirements (FEB 2009) (41 U.S.C. 351, et seq.). [] (7) 52.222-17, Nondisplacement of Qualified Workers (JAN 2013) (E.O.13495). [] (8) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (MAR 2009)(Pub. L. 110-247) [] (9) 52.237-11, Accepting and Dispensing of $1 Coin (SEP 2008) (31 U.S.C. 5112(p)(1)). (d) Comptroller General Examination of Record. The Contractor shall comply with the provisions of this paragraph (d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition threshold, and does not contain the clause at 52.215-2, Audit and Records--Negotiation. (1) The Comptroller General of the United States, or an authorized representative of the Comptroller General, shall have access to and right to examine any of the Contractor's directly pertinent records involving transactions related to this contract. (2) The Contractor shall make available at its offices at all reasonable times the records, materials, and other evidence for examination, audit, or reproduction, until 3 years after final payment under this contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the other clauses of this contract. If this contract is completely or partially terminated, the records relating to the work terminated shall be made available for 3 years after any resulting final termination settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising under or relating to this contract shall be made available until such appeals, litigation, or claims are finally resolved. (3) As used in this clause, records include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of form. This does not require the Contractor to create or maintain any record that the Contractor does not maintain in the ordinary course of business or pursuant to a provision of law. (e)(1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c), and (d) of this clause, the Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1) in a subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down shall be as required by the clause-- (i) 52.203-13, Contractor Code of Business Ethics and Conduct (APR 2010) (Pub. L. 110-252, Title VI, Chapter 1 (41 U.S.C. 251 note)). (ii) 52.219-8, Utilization of Small Business Concerns (Jul 2013) (15 U.S.C. 637(d)(2) and (3)), in all subcontracts that offer further subcontracting opportunities. If the subcontract (except subcontracts to small business concerns) exceeds $650,000 ($1.5 million for construction of any public facility), the subcontractor must include 52.219-8 in lower tier subcontracts that offer subcontracting opportunities. (iii) 52.222-17, Nondisplacement of Qualified Workers (JAN 2013) (E.O. 13495). Flow down required in accordance with paragraph (l) of FAR clause 52.222-17. (iv) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246). (v) 52.222-35, Equal Opportunity for Veterans (SEP 2010) (38 U.S.C. 4212). (vi) 52.222-36, Affirmative Action for Workers with Disabilities (Oct 2010) (29 U.S.C. 793). (vii) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O. 13496). Flow down required in accordance with paragraph (f) of FAR clause 52.222-40. (viii) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.). (ix) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)). Alternate I (AUG 2007) of 52.222-50 (22 U.S.C. 7104(g)). (x) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements "(Nov 2007)" (41 U.S.C. 351, et seq.). (xi) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services-Requirements (FEB 2009)(41 U.S.C. 351, et seq.). (xii) 52.222-54, Employment Eligibility Verification (AUG 2013) (xiii) 52.225-26, Contractors Performing Private Security Functions Outside the United States (Jul 2013) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 U.S.C. 2302 Note). (xiv) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (MAR 2009)(Pub. L. 110-247). Flow down required in accordance with paragraph (e) of FAR clause 52.226-6. (xv) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). Flow down required in accordance with paragraph (d) of FAR clause 52.247-64. (2) While not required, the contractor may include in its subcontracts for commercial items a minimal number of additional clauses necessary to satisfy its contractual obligations.(End of Clause)C.20 MANDATORY WRITTEN DISCLOSURES Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instructions.SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTSD.1 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)The contractor will be evaluated in accordance with the following:1. PURPOSEThis Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following:What will be monitored.How monitoring will take place.Who will conduct the monitoring.How monitoring efforts and results will be documented.This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance.This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor through contract modification. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance ernment Roles and ResponsibilitiesThe following personnel shall oversee and coordinate surveillance activities.a.Contracting Officer (CO) – The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.Assigned CO: Angel C. Rhone, Contracting Officer Organization or Agency: VISN 6 NCOb.Contracting Officer’s Technical Representative (COR) – The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.Assigned COR: Lane A. Zetty, Administrative Officer, Medical ServiceOrganization or Agency: Salem VAMC (658)3.Contractor RepresentativesThe following employees of the contractor serve as the contractor’s program manager for this contract.Primary: TBDAlternate: TBD4.Performance StandardsThe contractor is responsible for performance of ALL terms and conditions of the contract. CORs will provide contract progress reports quarterly to the CO reflecting performance on this plan and all other aspects of the resultant contract. The performance standards outlined in this QASP shall be used to determine the level of contractor performance in the elements defined.Performance standards define desired services. The Government performs surveillance to determine the level of Contractor performance to these standards.The Performance Requirements are listed below in Section 6. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the standard and assign a rating. At the end of the performance period, these ratings will be used, in part, to establish the past performance of the contractor on the contract.5. Incentives/DEDUCTSThe Government shall use past performance as incentives. Incentives shall be based on exceeding, meeting, or not meeting performance standards.6. Methods of QA Surveillance Various methods exist to monitor performance. The COR shall use the surveillance methods listed below in the administration of this QASP. a. DIRECT OBSERVATION. 100% surveillanceb. PERIODIC INSPECTION. Inspections scheduled annually or as needed. 10 randomly selected patient files per inspection period.c. VALIDATED USER/CUSTOMER COMPLAINTS. Customer complaint data is compiled quarterly and reviewed by Service Chief – any validated complaints against a Contractor that are not resolved within the required seven day period will be further investigated. d. RANDOM SAMPLING. Patient treatment files to be reviewed will be randomly selected and cover the period of service.e. Verification and/or documentation provided by Contractor.MeasuresPWSReferencePerformanceRequirementStandardAcceptable Quality LevelSurveillanceMethodIncentiveDisincentive(Deduct)Clinic Informationparagraph 3 Radiation Therapy ServicesAdequate History and Physical to confirm initial diagnosis. Appropriate treatment plan and follow-up.Patient progress notes written within 48-hours At initial consultation , at the review of the patient response of treatment and after completion of final treatment95%Random Inspection, Time and Attendance Sheets, Quality Assurance ReportsFavorable contactor performance evaluation.Unfavorable contractor performance evaluationQuality Assurance DocumentationSpecial Contract Requirements para. 21.2Reviewable records of device quality assurance shall be maintained.Daily, monthly and annual QA documentation for linear accelerators and CT Sim are accessible.100%Periodic sampling.Favorable contractor performance evaluations.Unfavorable contractor performance evaluationStandard Operating Procedures (SOP) for all radiotherapy techniquesparagraph 3.2 Radiation Therapy ServicesReviewable documentation of all SOPs shall be maintained.All radiotherapy techniques such as 3DCRT, IMRT, IGRT, SBRT, SRS, Brachytherapy have written procedures. These procedures are reviewed and updated annually100%Periodic sampling.Favorable contractor performance evaluationsUnfavorable contractor performance evaluationTreatment Plan Paragraph B.6.3Advance technology modalities Advanced technology modalities shall be consistent with ASTRO/ACR Appropriateness Criteria there sampling.Favorable contractor performance evaluationsUse of an unjustified or inappropriate modality shall be reimbursed at the rate indicated for conventional radiation therapy.Productivity of Initial Consultparagraph 3 Radiation Therapy ServicesSeen within the prescribed time framePatients will be scheduled and seen within14 workdays of patient’s desired date95%Direct ObservationFavorable contactor performance evaluation.Unfavorable contractor performance evaluationPhysician QualificationsSpecial Contract Requirements para. 4.a. QualificationsActive LicenseTrained and licensed board certified radiation oncologist and physicistContract Provider records will be kept 100% up-to-dateVerified with Medical Staff OfficeFavorable contactor performance evaluation.Unfavorable contractor performance evaluationPatient Safetyparagraph 5 Radiation Therapy ServicesPatient safety incidents, including medical events involving radioactive material and misadministrations, must be reported.All incidents reported promptly (within 24 hours of discovery.)100%Direct Observation Favorable contactor performance evaluation.Unfavorable contractor performance evaluationPatient Follow-upPatient shall have at least one follow-up after treatment Contractors shall see each patient following the radiation therapy treatment series within 30-60 calendar days of the end of a treatment series unless the VAMC Salem attending oncology physician determines this is not necessaryMaintains licensing, registration, and certificationsSpecial Contract Requirements para. 4.a. and b. QualificationsUpdated Licensing, registration and certifications will be provided as they are renewed.Licensing and registration information kept current.Contract Provider records will be kept 100% up-to-datePeriodic Sampling and Random SamplingFavorable contactor performance evaluation.Unfavorable contractor performance evaluationPrivacy, Confidentiality and HIPAASpecial Contract Requirements para. 21.3Contractor is aware of all laws, regulations, policies and procedures relating to Privacy, Confidentiality and HIPPA and complies with all standardsZero breaches of privacy or confidentiality100%Contractor to provide evidence of annual training required by VAMC, reports violations per policyFavorable contactor performance evaluationDepending on severity of offense, suspension or termination of all physical and/or electronic access privileges and removal from contract. Until such time as the training is complete.Timely Invoicing Special Contract Requirements para. 11Within 30 days of the end of each month services were provided, as described above, the vendor shall provide itemized invoicingAll itemized invoices provided within 30 days of end of each month services delivered95%InspectionFavorable contactor performance evaluation.Unfavorable contractor performance evaluationDocumentation Special Contract Requirements para. 21.3Contractor shall document in the patient’s medical record any instructions provided to patients regarding right, responsibility and risk with 24 hours. Medical records shall be documented within 24 hours. 95% Periodic Sampling and Random SamplingFavorable contactor performance evaluation.Unfavorable contractor performance evaluation7.RatingsMetrics and methods are designed to determine rating for a given standard and acceptable quality level. The following ratings shall be used:Exceptional:Performance meets contractual requirements and exceeds many to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.VERY GOOD:Performance meets contractual requirements and exceeds some to the Government’s benefit. The contractual performance of the element or sub-element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.Satisfactory:Performance meets contractual requirements. The contractual performance of the element or sub-element contains some minor problems for which corrective actions taken by the contractor appear or wereb satisfactory.MARGINAL:Performance does not meet some contractual requirements. The contractual performance of the element or sub-element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions. The contractor’s proposed actions appear only marginally effective or were not fully implemented.Unsatisfactory:Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The contractual performance of the element or sub-element being assessed contains serious problem(s) for which the contractor’s corrective actions appear or were ineffective.8.DOCUMENTING PERFORMANCEa.The Government shall document positive and/or negative performance. Any report may become a part of the supporting documentation for any contractual action and perparing annual past performance using CONTRACTOR PERFORMANCE ASSESSMENT REPORT (CPAR).b. If contractor performance does not meet the Acceptable Quality level, the CO shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the CO shall document the discussion and place it in the contract file. When the COR and the CO determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to CO. The CO will in turn review and will present to the contractor's program manager for corrective action.The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the CO. The Government shall review the contractor's corrective action plan to determine acceptability. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance and the acceptability of the Contractor’s corrective action plan.Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO. 9. Frequency of Measurementa.Frequency of Measurement.The frequency of measurement is defined in the contract or otherwise in this document. The government (COR or CO) will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed. b.Frequency of Performance Reporting.The COR shall communicate with the Contractor and will provide written reports to the Contracting Officer quarterly (or as outlined in the contract or COR delegation) to review Contractor performance. 10. COR AND CONTRACTOR ACKNOWLEDGEMENT OF QASPSIGNED:________________________________________COR NAME/TITLEDATESIGNED:________________________________________CONTRACTOR NAME/TITLE DATED.2 PAST PERFORMANCE SURVEYPast Performance Questionnaire This form is used to evaluate the past performance and experience of a prospective medical service provider pleted form must be e-mailed prior proposal closing date to angel.rhone@ or Fax 757-728-3132 directly to:Name of Contract Specialist: Angel C Rhone SECTION I - Details of Company Being Evaluated1. Company Name:2. Service Provided:3. Number and type of Contracts:SECTION II - Details of Evaluator1. Evaluator’s Company:2.Evaluator’s Name:3.Evaluators Title:4.Evaluator’s Phone #:5.Evaluator’s Email:6. Start Date of Contract:SECTION III - Customer Satisfaction/Quality of Service QuestionsRate the company’s product and service performance using the scale indicated for each question1. How would you rate satisfaction with the overall performance of this Company?3= Excellent 2= Very Good 1= Acceptable 0= Unacceptable FORMCHECKBOX 3 FORMCHECKBOX 2 FORMCHECKBOX 1 FORMCHECKBOX 02. How would you rate the extent that the Company responded to and attempted to correct any concerns, issues, or problems that appeared during performance of your contract?3= Excellent 2= Very Good 1= Acceptable 0= Unacceptable FORMCHECKBOX 3 FORMCHECKBOX 2 FORMCHECKBOX 1 FORMCHECKBOX 03. How would you rate the professionalism of the Company?3= Excellent 2= Very Good 1= Acceptable 0= Unacceptable FORMCHECKBOX 3 FORMCHECKBOX 2 FORMCHECKBOX 1 FORMCHECKBOX 04. What percentage of time did the Company provide on time services in accordance with contract requirements?3= 90% of the time 2= 85-89% of the time1= 80-84% of the time 0= <80% of the time FORMCHECKBOX 3 FORMCHECKBOX 2 FORMCHECKBOX 1 FORMCHECKBOX 05. If given an opportunity, how likely is it you would conduct business with this Company again?3= Very Likely 2= Likely 0= Not Likely FORMCHECKBOX 3 FORMCHECKBOX 2 FORMCHECKBOX 0Please provide an explanation of all unacceptable ratings and make additional comments as applicable on all ratings in Section III.SECTION IV – Service Performance QuestionsRate the company’s product and service performance using the scale indicated for each question4 = Excellent3 = Very Good2 = Acceptable1 = Unacceptable0 = Not Applicable1. How would you rate satisfaction with the overall performance of the services provided? FORMCHECKBOX 4 FORMCHECKBOX 3 FORMCHECKBOX 2 FORMCHECKBOX 1 FORMCHECKBOX 02.Overall User Satisfaction with service: FORMCHECKBOX 4 FORMCHECKBOX 3 FORMCHECKBOX 2 FORMCHECKBOX 1 FORMCHECKBOX 03.Overall User Satisfaction with continuity of service: FORMCHECKBOX 4 FORMCHECKBOX 3 FORMCHECKBOX 2 FORMCHECKBOX 1 FORMCHECKBOX 04.Was the Monthly/Daily Effectiveness Level Consistently Met? FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX Not Applicable5.Is this Radiation Therapy services? FORMCHECKBOX YES FORMCHECKBOX NOWas full range medical service capability required? FORMCHECKBOX YES FORMCHECKBOX NODid contractor meet established performance standards? FORMCHECKBOX YES FORMCHECKBOX NOPlease provide an explanation of all unacceptable ratings and make additional comments as applicable on all ratings in Section IV or give any other comments regarding your Medical Services.SECTION IV - Closing CommentsPertinent comments regarding past performance of this company:D.3 CONTRACTOR CERTIFICATION: Immigration and Nationality Act of 1952, As AmendedThe Contractor must certify that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;Citizenship-related requirements. Each affected contractor employee as described in paragraph shall be: A United States (U.S.) citizen; orA national of the United States (see 8 U.S.C. 1408); orAn alien lawfully admitted into the United States for permanent residence as evidenced by an Alien Registration Receipt Card Form I–151.While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.The Contractor must obtain a similar certification from its sub Contractors.Signature:____________________________________________Date: ____________________________________________Typed Name and Title: __________________________________________Company Name:___________________________________________This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.This document must be returned with the contractor’s proposal and signed by the President of the organization or their authorized representative. D.4 SUBCONTRACTING PLAN MODELU.S. Department of Veterans Affairs (VA)Office of Small and Disadvantaged Business Utilization (00SB)Subcontracting Plan ModelAugust 2011 In accordance with FAR 19.704, 52.219 and P.L. 109-461Prime Contractor: Address: City: State: Zip code:Solicitation/Contract Number: Description of Requirement: Total Contract Amount (Including Option Years): $Period of Contract Performance Including Option Years (Month and Year): Activity Awarding Contract: Contracting Officer Name:Prime Contractor is:[ ] Architect-Engineer [ ] Janitorial[ ] Blood[ ] Laboratory Testing Services[ ] Bulk Oxygen Services [ ] Laundry and Linen Services[ ] Clinical Diagnostic Equipment[ ] Medical Equipment[ ] Community Based Outpatient Clinic [ ] Medical Equipment and Supplies[ ] Construction [ ] Medical Equipment and Supplies[ ] Consulting Services and Pharmaceuticals[ ] Dental Equipment[ ] Medical Gas and Medical Bulk[ ] Dental Equipment and Supplies Oxygen[ ] Dental Supplies[ ] Medical Healthcare Services[ ] Diagnostic Imaging Equipment and Supplies[ ] Medical Surgical Prime Vendor[ ] Diagnostic X-Ray and Related Systems and Equipment[ ] Niche Markers Including Installation[ ] Pharmaceuticals[ ] Dietary Supplements[ ] Pharmaceutical and Cost Per Test[ ] Digital Hearing Aids and Batteries[ ] Prosthetics[ ] Elevator Maintenance[ ] Publisher/Subscription Services[ ] External Peer Review [ ] Radiation Therapy Systems[ ] Healthcare Staffing[ ] Real Estate[ ] Home Healthcare Services[ ] Studies[ ] Home Medical Equipment[ ] Support Services[ ] Home Oxygen[ ] Telephone System Hardware/[ ] Information Technology Software Maintenance[ ] In-Vitro Diagnostics Reagents[ ] Transportation[ ] In-Vitro Diagnostics Substances Reagents, Test Kits and[ ] Other (Not Checked) Blood Laboratory ___________________________Prime Contractor (Please check if you are):[ ] Manufacturer[ ] Distributor[ ] Manufacturer/DistributorType of Plan (Check One)___Commercial Plan - means a subcontracting plan (including goals) that covers the offeror’s fiscal year and that applies to the entire production of commercial items sold by either the entire company or a portion thereof (e.g., division, plant, or product line).(Represents ______% of Total Annual Sales)____Individual Plan - means a subcontracting plan that covers the entire contract period (including option periods), applies to a specific contract, and has goals that are based on the offeror’s planned subcontracting in support of the specific contract, except that indirect costs incurred for common or joint purposes may be allocated on a prorated basis to the contract.1 - 2.GOALS - Please state separate dollar and percentage goals for Small Business (including Alaska Native Corporation’s (ANCs)); Service-Disabled Veteran-Owned Small Business, Veteran-Owned Small Business; Small Disadvantaged, Women-Owned, and Historically Underutilized Business Zone (HUBZone) Small Business Concerns. QUESTION: What level of subcontracting tier counts towards the prime contractor subcontracting plan goals?”? Example: The prime subcontract’s to a large business at a value of $5.0 mil.? The subcontracted large business then, subcontract to a VOSB for $1.5mil.? Does this 2nd tier subcontract amount count towards the prime contractor’s subcontracting goals?ANSWER: FAR 52.219-9(l): The Contractor shall submit ISRs and SSRs using the web-based eSRS at . Purchases from a corporation, company, or subdivision that is an affiliate of the prime Contractor or subcontractor are not included in these reports. Subcontract award data reported by prime Contractors and subcontractors shall be limited to awards made to their immediate next-tier subcontractors. Credit cannot be taken for awards made to lower tier subcontractors, unless the Contractor or subcontractor has been designated to receive a small business or small disadvantaged business credit from an ANC or Indian tribe. Only direct subcontracting can be counted. For instance, the prime contractor can only count what it directly subcontracts. If the prime contractor subcontracts to a LB over $650,000 and there is flow down subcontracting plan, this LB subcontractor can only count who they directly subcontract too.NOTE: VA’s required percentage goals are shown below. “Zero” percent value for goals or “N/A” are unacceptable. Goals and percentages must be rounded to the nearst dollar and tenth of a percent. Example of how to calculate the goals:DOLLARSPERCENTTotal Contract Price$1,500,000Total to be Subcontracted1,000,000100%Subcontract to Small Business (including Alaska Native Corporations (ANC) and Indian tribes)177,00017.7%Subcontract to Service Disabled Veteran-Owned Small Business30,0003.0%Subcontract to Veteran-Owned Small Business50,0005.0%Small Disadvantaged Business (including ANC and Indian tribes)50,0005.0%Women-Owned Small Business50,0005.0%Subcontract to HUBZone Small Businesses30,0003.0%If percentage goals below are lower than example above, please submit justification as to why.Please enter the information listed below:Total dollars to be subcontracted:$____________________________ Total dollars to be subcontracted to Small Business (SB) (including Alaska Native Corporation’s (ANCs) and Indian tribes):$_______________ ______%Total dollars to be subcontracted to Service-Disabled Veteran-Owned Small Business (SDVOSB) – P.L. 109-461 signed by the President December 22, 2006. Goal shall not be less than 3.0%. NOTE: In accordance with VA Acquisition Regulations 852.219-9(d): To be credited toward goal achievements, businesses must be verified as eligible in the Vendor Information Pages database.? The contractor shall annually submit a listing of service-disabled veteran-owned small businesses and veteran-owned small businesses for which credit toward goal achievement is to be applied for the review of personnel in the Office of Small and Disadvantaged Business Utilization.$_______________ ______%Total dollars to be subcontracted to Veteran-Owned Small Business (VOSB) – P.L. 109-461 signed by the President December 22, 2006. Goal shall not be less than the 7.0% as mandated by the Secretary, Department of Veterans Affairs: NOTE: In accordance with VA Acquisition Regulations 852.219-9(d): To be credited toward goal achievements, businesses must be verified as eligible in the Vendor Information Pages database.? The contractor shall annually submit a listing of service-disabled veteran-owned small businesses and veteran-owned small businesses for which credit toward goal achievement is to be applied for the review of personnel in the Office of Small and Disadvantaged Business Utilization. $_______________ ______%Total dollars to be subcontracted to Small Disadvantaged Business (SDB) (including Alaska Native Corporation’s (ANCs) and Indian tribes): $_______________ ______%Total dollars to be subcontracted to Women-Owned Small Business (WOSB): $_______________ ______%Total dollars to be subcontracted to HUBZone Small Business Concerns: $_______________ ______%Total dollars to be subcontracted to Large Business: $_______________ ______%3.Provide a description of the principal types of supplies and services to be subcontracted under this contract, and an identification of the types planned for subcontracting to small (including ANCs and Indian tribes), service-disabled veteran-owned and veteran-owned small business concerns), small disadvantaged (including ANCs and Indian tribes), women-owned, HUBZone.You must identify the products/services to be subcontracted in each category. (Example: office supplies, maintenance and repair)Products/ServicesLarge BusinessSmall businessSmall disadvantaged businessWomen-Owned Small businessHUBZone Small businessService-Disabled Veteran-Owned Small Business (sdvosb) – in accordance with P.L. 109-461, signed by the President December 22, 2006, please list the name, address, and telephone number for each service-disabled and veteran-owned small business concerns as follows. Please ensure that the service-disabled veteran-owned small business concerns are registered in the System for Award Management and the Vendor Information Pages . If more than one, please utilize the format listed below to indicate additional service-disabled veteran-owned small business: NOTE: In accordance with VA Acquisition Regulations 852.219-9(d): To be credited toward goal achievements, businesses must be verified as eligible in the Vendor Information Pages database.? The contractor shall annually submit a listing of service-disabled veteran-owned small businesses and veteran-owned small businesses for which credit toward goal achievement is to be applied for the review of personnel in the Office of Small and Disadvantaged Business Utilization.Name of SDVOSB:Address:City/State/Zipcode:Email address of point of contact:Telephone: FAX: Veteran-Owned Small Business (vosb) - In accordance with P.L. 109-461, signed by President December 22, 3006, please list the name, address, and telephone number for each veteran-owned small business concerns as follows. Please ensure that the veteran-owned small business concerns are registered in the System for Award Management and the Vendor Information Pages .. If more than one, please utilize the format listed below to indicate additional veteran-owned small business: NOTE: In accordance with VA Acquisition Regulations 852.219-9(d): To be credited toward goal achievements, businesses must be verified as eligible in the Vendor Information Pages database.? The contractor shall annually submit a listing of service-disabled veteran-owned small businesses and veteran-owned small businesses for which credit toward goal achievement is to be applied for the review of personnel in the Office of Small and Disadvantaged Business Utilization.Name of VOSB:Address:City/State/Zipcode:Email address of point of contact:Telephone: FAX: In accordance with P.L. 109-461, verification process is mandated to certify that the service-disabled and veteran-owned small business concerns listed for subcontracting opportunities do have a subcontract with you as the prime contractor.This information will be a report to the Department of Veterans Affairs, Office of Small and Disadvantaged Business Utilization (00SB) on a quarterly basis, (form attached) for the service-disabled and veteran-owned small business concerns to report.4. A description of the method used to develop the subcontracting goals. 5. A description of the method used to identify potential sources for solicitation purposes (e.g., existing company source lists, the Central Contractor Registration database (CCR), veterans service organizations, the National Minority Purchasing Council Vendor Information Service, the Research and Information Division of the Minority Business Development Agency in the U.S. Department of Commerce, or small, HUBZone, small disadvantaged and women-owned small business trade associations). A firm may rely on the information contained in CCR as an accurate representation of a concern’s size and ownership characteristics for the purposes of maintaining a small, veteran-owned small, service-disabled veteran-owned small, HUBZone small, small disadvantaged, and women-owned small business source list. Use of CCR as its source list does not relieve a firm of its responsibilities (e.g., outreach, assistance, counseling, or publicizing subcontracting opportunities)NOTE: VA expects contractors to advertise subcontracting opportunities at: . Contractors should also search the Vendor Information Pages (VIP) Database at the web portal ), to ensure maximum practicable consideration in subcontracting with Veteran-Owned and Service-Disabled Veteran-Owned Small Businesses. 6. A statement as to whether or not the offeror included indirect costs in establishing subcontracting goals, and a description of the method used to determine the proportionate share of indirect costs to be incurred with small business (including ANC and Indian tribes); service-disabled veteran-owned small business; veteran-owned small business; small disadvantaged business concern (including ANC and Indian tribes); women-owned small business, and HUBZone small business concerns.[ ] Yes[ ] No7.Name of the individual employed by the offeror who will administer the offeror’s subcontracting program and a description of the duties of the individual.SUBCONTRACTING PLAN ADMINISTRATORNAME:TITLE:ADDRESS:CITY: STATE: ZIPCODE: TELEPHONE: FAX NUMBER:E-MAIL: DUTIES: List duties and responsibilities of the Plan Administrator and a statement of the extent and scope of the Plan Administrator’s authority in subcontracting source selections: Attach duties of the Subcontracting Plan Administrator8. A description of the efforts the offeror will make to assure that small business, service-disabled veteran-owned small business; veteran-owned small business, small disadvantaged business, women-owned small business and HUBZone small business concerns have an equitable opportunity to compete for subcontracts.9. Assurances that the offeror will include the clause of this contract entitled “Utilization of Small Business Concerns” in all subcontracts that offer further subcontracting opportunities, and that the offeror will require all subcontractors (except small business concerns) that receive subcontracts in excess of $650,000 ($1,5000,000 for construction) to adopt a subcontracting plan that complies with the requirements of this clause.[ ] Yes[ ] No10. Assurances that the offeror will—(i) cooperate in any studies or surveys as may be required; (ii) Submit periodic reports so that the Government can determine the extent of compliance by the offeror with the subcontracting plan; Submit the Subcontracting Report for Individual Contracts (ISR) and/or the Summary Subcontract Report (SSR), in accordance using the Electronic Subcontracting Reporting System (eSRS) at following the instruction in the eSRS;Ensure that its subcontractors with subcontracting plans agree to submit the ISR and/or the SSR using eSRS; (v) Provide its prime contract number, its DUNS number, and the e-mail address of the Government or Contractor official responsible for acknowledging or rejecting the reports, to all first-tier subcontractors with subcontracting plans so they can enter this information into the eSRS when submitting their reports; and Require that each subcontractor with a subcontracting plan provide the prime contract number, its own DUNS number, and the e-mail address of the Government or Contractor official responsible for acknowledging or rejecting the reports, to its subcontractors with subcontracting plans. [ ] Yes[ ] NoNOTE:When entering your subcontracting information, you must include the email address of the following individuals whom will be reviewing the Subcontracting Report for Individual Contracts ISR 294, as well as, SSR 295 “Summary Subcontracting Report”.Reporting Agency (Veterans Affairs, Department of (3600)Please enter the contracting officer’s email address: ____________________________________11. A description of the types of records that will be maintained concerning procedures that have been adopted to comply with the requirements and goals in the plan, includingestablishing source lists; and a description of the offeror’s efforts to locate small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns and award subcontracts to them. The records shall include at least the following (on a plant-wide or company-wide basis, unless otherwise indicated): (i) Source lists (e.g., CCR, Vendor Information Pages (VIP) Database at the web portal (), to ensure maximum practicable consideration of Veteran-Owned and Service-Disabled Veteran-Owned Small Businesses:), guides, and other data that identify small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns. (ii) Organizations contacted in an attempt to locate sources that are small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, or women-owned small business concerns. (iii) Records on each subcontract solicitation resulting in an award of more than $150,000, indicating:(A) Whether small business concerns were solicited and, if not, why not;(B) Whether veteran-owned small business concerns were solicited and, if not, why not; (C) Whether service-disabled veteran-owned small business concerns were solicited and, if not, why not; (D) Whether HUBZone small business concerns were solicited and, if not, why not;(E) Whether small disadvantaged business concerns were solicited and, if not, why not;(F) Whether women-owned small business concerns were solicited and, if not, why not; and (G) If applicable, the reason award was not made to a small business concern. (iv) Records of any outreach efforts to contact:(A) Trade associations;(B) Business development organizations;(C) Conferences and trade fairs to locate small, HUBZone small, small disadvantaged, and women-owned small business sources; and (D) Veterans service organizations. (v) Records of internal guidance and encouragement provided to buyers through:Workshops, seminars, training, etc.; Monitoring performance to evaluate compliance with the program’s requirements.(vi) On a contract-by-contract basis, records to support award data submitted by the offeror to the Government, including the name, address, and business size of each subcontractor.(vii) Contractors having commercial plans need not comply with this requirement. (e) In order to effectively implement this plan to the extent consistent with efficient contract performance, the Contractor shall perform the following functions:(1) Assist small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns by arranging solicitations, time for the preparation of bids, quantities, specifications, and delivery schedules so as to facilitate the participation by such concerns. Where the Contractor’s lists of potential small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business subcontractors are excessively long, reasonable effort shall be made to give all such small business concerns an opportunity to compete over a period of time. (2) Provide adequate and timely consideration of the potentialities of small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business concerns in all “make-or-buy” decisions. (3) Counsel and discuss subcontracting opportunities with representatives of small business, veteran-owned small business, service-disabled veteran-owned small business, HUBZone small business, small disadvantaged business, and women-owned small business firms. (4) Confirm that a subcontractor representing itself as a HUBZone small business concern is identified as a certified HUBZone small business concern by accessing the Central Contractor Registration (CCR) database or by contacting SBA. (5) Provide notice to subcontractors concerning penalties and remedies for misrepresentations of business status as small, veteran-owned small business, HUBZone small, small disadvantaged, or women-owned small business for the purpose of obtaining a subcontract that is to be included as part or all of a goal contained in the Contractor’s subcontracting plan.SIGNATURES REQUIREDPRIME CONTRACTOR: _____________________________DATE: ______________PRINT/TYPE NAME: TITLE: DATE: EMAIL: CONTRACTING OFFICER NAME WHOAPPROVED BY: __________________________________DATE: _________TYPE NAME: TITLE: EMAIL: For Commercial Plans OnlyEffective period of this subcontracting plan is:______________________________________thru__________________________CONTRACTING OFFICER NAME WHOAPPROVED BY: __________________________________DATE: _________TYPE NAME: TITLE: EMAIL: PAST PERFORMANCESUBCONTRACTING ACCOMPLISHMENTS PRIOR YEAR PRIOR YEAR GOALS ACCOMPLISHMENTSTOTAL SUBCONTRACTING $______________$__________________SMALL BUSINESS $______________$__________________PERCENT ______________% __________________%SMALL DISADVANTAGED $______________$__________________PERCENT ______________% __________________%WOMEN-OWNED SMALL BUSINESS$______________$__________________PERCENT ______________% __________________%HUBZONE SMALL BUSINESS $ ______________$__________________PERCENT ______________% __________________%SERVICE-DISABLED VETERAN-OWNED$______________$__________________PERCENT ______________% __________________%VETERAN-OWNED $______________$__________________PERCENT ______________% __________________%CERTIFY THAT THE ABOVE SUBCONTRACTING ACCOMPLISHMENTS ARE ACCURATE AND WAS ALSO ENTERED IN THE ELECTRONIC SUBCONTRACTING REPORTING SYSTEM (eSRS) FOR REPORT PERIOD:YEAR: ___________________[ ] YES[ ] NOD.5 WAGE DETERMINATIONThe DOL Wage Determination for the specific locality applies to this solicitation and any contract awarded is available at . Please note the listing below is not all inclusive wage determination of each area of performance. It is the contractor’s responsible to obtain and evaluate each wage determination locality. Wage Determination No.: WD 05-2547 (Rev.-14) was first posted on on 06/25/2013SECTION E - SOLICITATION PROVISIONSADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS--COMMERCIAL ITEMSProvisions that are incorporated by reference; (by Citation Number, Title, and Date), have the same force and affect as if they were given in full text. Upon request, the Contracting Officer will make their full text available.The following provisions are incorporated into 52.212-1 as an addendum to this solicitation:E.1 SPECIFIC INSTRUCTIONS TO OFFERORS REGARDING PROPOSAL PREPARATION INSTRUCTIONS FOR PROPOSAL SUBMISSIONThe contractor shall submit their proposal on CD (Compact Disk) in (MS Word) and shall be assembled as follows:Section I – Offer Form (Standard Form 1449) – original signature, and; Contract Administration Data; DUNS Number and Solicitation complete with acknowledgement of Solicitation Amendments Section II - PRICING shall be submitted as requested in the Schedule of Supplies/Services which is comprised within the solicitation document in section B. Section III - TECHNICAL PROPOSAL - Submit technical proposal in a format which clearly addresses the evaluation factors. Each response shall address each factor in the sequence listed below under the factors to be used to evaluate offers. The response must clearly identify which factor is being addressed. Include resumes of key personnel.? Identify key subcontractors, if any, and provide relevant qualifications. Also include the Quality Assurance Surveillance Plan (QASP) provided in this solicitation under SECTION D”.The Technical Volume shall not exceed fifty (50) pages in length (minimum 12-point font). Page limitation includes any drawings, charts, etc., and excludes section dividers, table of contents, list of figures/tables, glossary of terms, resumes, appendices and the QASP (all of which are not considered content pages). Page size shall not exceed 8 1/2 x 11. The evaluators will read only up to the maximum number of pages as specified.Section IV – Subcontracting Plan Model - Pursuant to the requirements of FAR part 19.702(a)(1), if the total amount of the proposal exceeds $650,000, and there are subcontracting possibilities, offerors must submit a subcontracting plan. FAR part 52.219-9 defines a subcontracting plan and its requirements. Provided in this solicitation under SECTION “D” is a Subcontracting Plan Outline Model. Additional information regarding subcontracting can be found on the DVA’s Office of Small and Disadvantaged Business Utilization website: : Before the Contracting Officer determines the responsibility of an offeror the subcontracting plan submitted with the offer shall be reviewed for compliance. For Large Businesses, failure to submit a plan, which shows good faith effort to use small business, small disadvantaged business, women-owned business, HUBZone business, service connected disabled business and Veteran-Owned small business concerns, SHALL BE a factor in determining the responsiveness of the offeror. A determination of non-responsive shall result in disqualification of the offer.Failure to submit a complete proposal may result in the proposal being deemed non-responsive.Section V – Past Performance: Identify a minimum of three federal, state, and local government contracts as well as any private/commercial contracts of similar scope, size, complexity that are ongoing or have been completed within the last three years after the insurance date of the solicitation. Reference information must be submitted in the following format:List the following information for each contract:Company Name and addressDescription of services performed Name, telephone number and e-mail address of responsible individuals who have first- hand knowledge of performance relative to the same type of services Description of services performed Dates of contract performanceContract type(e.g. fixed-price, cost reimbursable) and total contract valueFailure to submit a complete proposal may result in the proposal being deemed technically unacceptable.TECHNICAL QUESTIONS: Offerors shall submit all technical questions regarding this solicitation to the Contracting Officer in writing on or before April 7, 2014. Questions may be sent via e-mail to angel.rhone@. Telephonic (verbal) questions Will Not be addressed. All responses to questions, which may affect offers, will be incorporated into a written amendment to the Request for Proposal.PROPOSAL EVALUATION AND BASIS FOR AWARDThe Government will award a firm fixed priced contract to the responsible offeror whose offer, conforming to the requirements in this request for proposal, will be most advantageous to the Government, price and other factors considered. A best value award will be made based upon the following factors: Technical Capability, Facility/Geographic Location, Past Performance, Price, and Socio-Economic Status. Technical, Past Performance and Facility/Geographic Location factors are of equal importance, and when combined, are more important than price and socioeconomic usage. Single or multiple awards may be awarded from this requirement.The following factors shall be used to evaluate offers:FACTOR 1: EVIDENCE OF TECHNICAL CAPABILITY – Offeror should provide a narrative addressing its relevant technical capabilities (as it applies to the requirement), addressing such items as:(Standard Form 1449) – Original signature, and; Contract Administration Data; DUNS Number, socio-economic status and Solicitation complete with acknowledgement of Solicitation Amendments. Describe firm’s ability to provide the full range of services as outlined in the performance work statement. Provide a written plan on how Offeror intends to implement and manage this contract. Describe firm’s equipment available at the facility where the treatment is rendered. Provide evidence of adhering to standards to protect the Privacy and Security of Protected Health Information (PHI) as required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). Provide evidence of facility’s accreditation by The Joint Commission or proof of meeting or exceeding all Joint Commission standards. You may access The Joint Commission standard at . Accreditation must be maintained through the term of the contract. Provide evidence of a comprehensive quality assurance/control plan including methodology and any action plans to improve areas as well as data regarding customer satisfaction for the last five years. Provide a staffing plan demonstrating that the contractor employs sufficient professional staff and other personnel to carry out the policies and procedures of the program. Provide evidence of documentation that contractor staff has received an orientation, licensure (if applicable), initial and ongoing competencies and training references. FACTOR 2: PAST PERFORMANCE Describe past contracts of a similar nature listed in chronological order of most recent project, including name, address, contact person and current telephone number, a brief description of work performed, and total contract value. The Government may use past performance information obtained from other sources. Evaluation will consider the Offeror’s reputation for conforming to specifications and standards of quality workmanship, adherence to contract schedules, depth, breath, and relevancy of current work experience in providing similar services for similar customers as indicated by the Offeror and verifiable references. In the case of an Offeror without a record of relevant past performance or for whom information on past performance is not available, the Offeror may not be evaluated favorably or unfavorably on past performance. FACTOR 3- FACILITY\GEOGRAPHIC LOCATIONContractor's facilities must serve (11) geographical locations in Virginia, (Alleghany County, City of Bedford, Bedford County, Clifton Forge, City of Covington, Franklin County, Montgomery County, City of Radford, Roanoke County, City of Salem and Wythe County), providing the materials, supplies, equipment and qualified supervision as specified herein. The Contractor’s facility must be centrally located within 35 miles of the Salem VAMC.FACTOR 4 - PRICETotal price will be evaluated by the Government. In evaluating the Offeror’s proposal price for this requirement, the Government’s concern includes determining whether:It reflects the prospective Contractors understanding of the project and ability to successfully organize and perform the contract;It is based on adequate estimating procedures, supported by backup documentation and is realistic in terms of the offeror’s proposed technical approach; andIt reasonably reflects affordability when compared to the Government Cost Estimate.Unrealistically low proposed prices, initially or subsequently, may be grounds for eliminating a Proposal from competition either on the basis that the offeror does not understand the requirement or the offeror has provided an unrealistic Proposal. Price analysis techniques may include a comparison of proposed prices received in response to the solicitation, comparison with other contract prices for similar services, and/or a comparison of proposed prices with the Independent Government Cost Estimate. The Contracting Officer reserves the right to eliminate an Offeror from the competitive range if their prices are determined to be either extremely low or extremely high. FACTOR 5 – SOCIOECONOMIC STATUSVA recognizes the contributions of our Nation’s veterans, and we strive to make contract awards to small businesses owned by veteran-and service-disabled veterans. In an effort to achieve socioeconomic small business goals, VA will evaluate offerors based on their service-disabled veteran-owned small business (SDVOSB) or veteran-owned small business (VOSB) status, and their proposed use of eligible service-disabled veteran-owned small businesses and veteran-owned small businesses as subcontractors. Eligible service-disabled veteran-owned offerors will receive the highest rating of outstanding, and offerors qualifying as veteran-owned small businesses will receive the next highest rating of excellent for this Service-Disabled Veteran-Owned and Veteran-Owned Small Business Status evaluation factor. To receive evaluation credit, an offeror must be registered in Vendor Information Pages ( ).Non-veteran offerors proposing to use service-disabled veteran-owned small businesses or veteran-owned small businesses as subcontractors in proportions which meet or exceed the VA subcontracting goals for these firms (regardless of business size) will receive the lowest amount of credit of acceptable under this evaluation factor. Offerors must state in their proposals the names of the SDVOSBs and VOSBs with whom they intend to subcontract and provide a brief description of the proposed subcontracts and the approximate dollar values of the proposed subcontracts. In addition, the proposed subcontractors must be registered in the Vendor Information Pages (VIP) ( ).Non-veteran offerors which use no service-disabled veteran-owned or veteran-owned small businesses as subcontractors shall receive no credit under this evaluation factor. (End of provision)E.2 52.209-5 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (DEVIATION)(MAR 2012) (a) In accordance with Division H, sections 8124 and 8125 of P.L. 112-74 and sections 738 and 739 of P.L. 112-55 none of the funds made available by either Act may be used to enter into a contract with any corporation that— (1) Has an unpaid federal tax liability, unless the agency has considered suspension or debarment of the corporation and the Suspension and Debarment Official has made a determination that this action is not necessary to protect the interests of the Government. (2) Has a felony criminal violation under any Federal or State law within the preceding 24 months, unless the agency has considered suspension or debarment of the corporation and Suspension and Debarment Official has made a determination that this action is not necessary to protect the interests of the Government. (b) The Offeror represents that— (1) The offeror does [ ] does not [ ] have any unpaid Federal tax liability that has been assessed and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability. (2) The offeror, its officers or agents acting on its behalf have [ ] have not [ ] been convicted of a felony criminal violation under a Federal or State law within the preceding 24 months.(End of Provision)E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013) (a) Definitions. As used in this provision— "Administrative proceeding" means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables. "Federal contracts and grants with total value greater than $10,000,000" means— (1) The total value of all current, active contracts and grants, including all priced options; and (2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules). "Principal" means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions). (b) The offeror [ ] has [ ] does not have current active Federal contracts and grants with total value greater than $10,000,000. (c) If the offeror checked "has" in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information: (1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions: (i) In a criminal proceeding, a conviction. (ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more. (iii) In an administrative proceeding, a finding of fault and liability that results in— (A) The payment of a monetary fine or penalty of $5,000 or more; or (B) The payment of a reimbursement, restitution, or damages in excess of $100,000. (iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision. (2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence. (d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award Management database via (see 52.204-7).(End of Provision)E.4 52.216-1 TYPE OF CONTRACT (APR 1984) The Government contemplates award of a Firm Fixed-Price with Economic Price Adjustment, Indefinite Delivery Indefinite Quantity contract resulting from this solicitation.(End of Provision)E.5 52.233-2 SERVICE OF PROTEST (SEP 2006) Protests, as defined in section 33.101 of the Federal Acquisition Regulation, that are filed directly with an agency, and copies of any protests that are filed with the Government Accountability Office (GAO), shall be served on the Contracting Officer (addressed as follows) by obtaining written and dated acknowledgment of receipt from: Angel C Rhone Contract Specialist Hand-Carried Address: Department of Veterans Affairs Contracting Office Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 Mailing Address: Department of Veterans Affairs Contracting Office Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 (b) The copy of any protest shall be received in the office designated above within one day of filing a protest with the GAO.(End of Provision)E.6 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008) (a) Any protest filed by an interested party shall: (1) Include the name, address, fax number, and telephone number of the protester; (2) Identify the solicitation and/or contract number; (3) Include an original signed by the protester or the protester's representative and at least one copy; (4) Set forth a detailed statement of the legal and factual grounds of the protest, including a description of resulting prejudice to the protester, and provide copies of relevant documents; (5) Specifically request a ruling of the individual upon whom the protest is served; (6) State the form of relief requested; and (7) Provide all information establishing the timeliness of the protest. (b) Failure to comply with the above may result in dismissal of the protest without further consideration. (c) Bidders/offerors and contracting officers are encouraged to use alternative dispute resolution (ADR) procedures to resolve protests at any stage in the protest process. If ADR is used, the Department of Veterans Affairs will not furnish any documentation in an ADR proceeding beyond what is allowed by the Federal Acquisition Regulation.(End of Provision)E.7 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998) As an alternative to filing a protest with the contracting officer, an interested party may file a protest with the Deputy Assistant Secretary for Acquisition and Materiel Management, Acquisition Administration Team, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, or for solicitations issued by the Office of Construction and Facilities Management, the Director, Office of Construction and Facilities Management, 810 Vermont Avenue, NW., Washington, DC 20420. The protest will not be considered if the interested party has a protest on the same or similar issues pending with the contracting officer.(End of Provision) PLEASE NOTE: The correct mailing information for filing alternate protests is as follows:Deputy Assistant Secretary for Acquisition and Logistics,Risk Management Team, Department of Veterans Affairs810 Vermont Avenue, N.W.Washington, DC 20420 Or for solicitations issued by the Office of Construction and Facilities Management:Director, Office of Construction and Facilities Management811 Vermont Avenue, N.W.Washington, DC 20420E.8 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) The contracting officer reserves the right to designate representatives to act for him/her in furnishing technical guidance and advice or generally monitor the work to be performed under this contract. Such designation will be in writing and will define the scope and limitation of the designee's authority. A copy of the designation shall be furnished to the contractor.(End of Provision)E.9 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008) The contractor agrees to provide all services specified in this contract for any person determined eligible by the Department of Veterans Affairs, regardless of the race, color, religion, sex, or national origin of the person for whom such services are ordered. The contractor further warrants that he/she will not resort to subcontracting as a means of circumventing this provision.(End of Provision)E.10 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es): (End of Provision)FAR NumberTitleDate52.216-2752.217-5SINGLE OR MULTIPLE AWARDSEVALUATION OF OPTIONSOCT 1995JUL 199052.219-24SMALL DISADVANTAGED BUSINESS PARTICIPATION PROGRAM—TARGETSOCT 200052.225-25PROHIBITION ON CONTRACTING WITH ENTITIES ENGAGING IN CERTAIN ACTIVITIES OR TRANSACTIONS RELATING TO IRAN-- REPRESENTATION AND CERTIFICATIONSDEC 2012(End of Addendum to 52.212-1)E.11 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (NOV 2013)An offeror shall complete only paragraph (b) of this provision if the offeror has completed the annual representations and certifications electronically via . If an offeror has not completed the annual representations and certifications electronically at the System for Award Management (SAM) website, the offeror shall complete only paragraphs (c) through (o) of this provision. (a) Definitions. As used in this provision-- "Economically disadvantaged women-owned small business (EDWOSB) concern" means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program. "Forced or indentured child labor" means all work or service-- (1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or (2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties. "Inverted domestic corporation", as used in this section, means a foreign incorporated entity which is treated as an inverted domestic corporation under 6 U.S.C. 395(b), i.e., a corporation that used to be incorporated in the United States, or used to be a partnership in the United States, but now is incorporated in a foreign country, or is a subsidiary whose parent corporation is incorporated in a foreign country, that meets the criteria specified in 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c). An inverted domestic corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code at 26 U.S.C. 7874. "Manufactured end product" means any end product in Federal Supply Classes (FSC) 1000-9999, except-- (1) FSC 5510, Lumber and Related Basic Wood Materials; (2) Federal Supply Group (FSG) 87, Agricultural Supplies; (3) FSG 88, Live Animals; (4) FSG 89, Food and Related Consumables; (5) FSC 9410, Crude Grades of Plant Materials; (6) FSC 9430, Miscellaneous Crude Animal Products, Inedible; (7) FSC 9440, Miscellaneous Crude Agricultural and Forestry Products; (8) FSC 9610, Ores; (9) FSC 9620, Minerals, Natural and Synthetic; and (10) FSC 9630, Additive Metal Materials. "Place of manufacture" means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture. "Restricted business operations" means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate- (1) Are conducted under contract directly and exclusively with the regional government of southern Sudan; (2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization; (3) Consist of providing goods or services to marginalized populations of Sudan; (4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization; (5) Consist of providing goods or services that are used only to promote health or education; or (6) Have been voluntarily suspended. "Sensitive technology"-- (1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically-- (i) To restrict the free flow of unbiased information in Iran; or (ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and (2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)). "Service-disabled veteran-owned small business concern"-- (1) Means a small business concern-- (i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and (ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran. (2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16). "Small business concern" means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation. "Subsidiary" means an entity in which more than 50 percent of the entity is owned-- (1) Directly by a parent corporation; or (2) Through another subsidiary of a parent corporation. "Veteran-owned small business concern" means a small business concern-- (1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and (2) The management and daily business operations of which are controlled by one or more veterans. "Women-owned business concern" means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women. "Women-owned small business concern" means a small business concern-- (1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and (2) Whose management and daily business operations are controlled by one or more women. "Women-owned small business (WOSB) concern eligible under the WOSB Program" (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States. (b)(1) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications posted electronically on the SAM website. (2) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through . After reviewing the SAM database information, the offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications--Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs __________________. (c) Offerors must complete the following representations when the resulting contract will be performed in the United States or its outlying areas. Check all that apply. (1) Small business concern. The offeror represents as part of its offer that it [ ] is, [ ] is not a small business concern. (2) Veteran-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not a veteran-owned small business concern. (3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not a service-disabled veteran-owned small business concern. (4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, for general statistical purposes, that it [ ] is, [ ] is not a small disadvantaged business concern as defined in 13 CFR 124.1002. (5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ] is, [ ] is not a women-owned small business concern.Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold. (6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that-- (i) It [ ] is, [ ] is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture:_________________.] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation. (7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that-- (i) It [ ] is, [ ] is not an EDWOSB concern, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: __________________.] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.Note to paragraphs (c)(8) and (9): Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold. (8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ] is a women-owned business concern. (9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price: ___________________________________________ (10) [Complete only if the solicitation contains the clause at FAR 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns, or FAR 52.219-25, Small Disadvantaged Business Participation Program--Disadvantaged Status and Reporting, and the offeror desires a benefit based on its disadvantaged status.] (i) General. The offeror represents that either-- (A) It [ ] is, [ ] is not certified by the Small Business Administration as a small disadvantaged business concern and identified, on the date of this representation, as a certified small disadvantaged business concern in the SAM Dynamic Small Business Search database maintained by the Small Business Administration, and that no material change in disadvantaged ownership and control has occurred since its certification, and, where the concern is owned by one or more individuals claiming disadvantaged status, the net worth of each individual upon whom the certification is based does not exceed $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); or (B) It [ ] has, [ ] has not submitted a completed application to the Small Business Administration or a Private Certifier to be certified as a small disadvantaged business concern in accordance with 13 CFR 124, Subpart B, and a decision on that application is pending, and that no material change in disadvantaged ownership and control has occurred since its application was submitted. (ii) [ ] Joint Ventures under the Price Evaluation Adjustment for Small Disadvantaged Business Concerns. The offeror represents, as part of its offer, that it is a joint venture that complies with the requirements in 13 CFR 124.1002(f) and that the representation in paragraph (c)(10)(i) of this provision is accurate for the small disadvantaged business concern that is participating in the joint venture. [The offeror shall enter the name of the small disadvantaged business concern that is participating in the joint venture: ___________________.] (11) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that-- (i) It [ ] is, [ ] is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material change in ownership and control, principal office, or HUBZone employee percentage has occurred since it was certified by the Small Business Administration in accordance with 13 CFR Part 126; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (c)(11)(i) of this provision is accurate for the HUBZone small business concern or concerns that are participating in the joint venture. [The offeror shall enter the name or names of the HUBZone small business concern or concerns that are participating in the joint venture:____________.] Each HUBZone small business concern participating in the joint venture shall submit a separate signed copy of the HUBZone representation. (d) Representations required to implement provisions of Executive Order 11246-- (1) Previous contracts and compliance. The offeror represents that-- (i) It [ ] has, [ ] has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; and (ii) It [ ] has, [ ] has not filed all required compliance reports. (2) Affirmative Action Compliance. The offeror represents that-- (i) It [ ] has developed and has on file, [ ] has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor (41 CFR parts 60-1 and 60-2), or (ii) It [ ] has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor. (e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 1352). (Applies only if the contract is expected to exceed $150,000.) By submission of its offer, the offeror certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress on his or her behalf in connection with the award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made. (f) Buy American Act Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy American Act--Supplies, is included in this solicitation.) (1) The offeror certifies that each end product, except those listed in paragraph (f)(2) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of "domestic end product." The terms "commercially available off-the-shelf (COTS) item," "component," "domestic end product," "end product," "foreign end product," and "United States" are defined in the clause of this solicitation entitled "Buy American Act--Supplies." (2) Foreign End Products: Line Item No Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (3) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. (g)(1) Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy American Act--Free Trade Agreements--Israeli Trade Act, is included in this solicitation.) (i) The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms "Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product," "commercially available off the-shelf (COTS) item," "component," "domestic end product," "end product," "foreign end product," "Free Trade Agreement country," "Free Trade Agreement country end product," "Israeli end product," and "United States" are defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act." (ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act": Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(1)(ii) of this provision) as defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act." The offeror shall list as other foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of "domestic end product." Other Foreign End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (iv) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. (2) Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate, Alternate I. If Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision: (g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act": Canadian End Products: Line Item No. __________________________________________ __________________________________________ __________________________________________[List as necessary] (3) Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate, Alternate II. If Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision: (g)(1)(ii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act": Canadian or Israeli End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (4) Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate, Alternate III. If Alternate III to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision: (g)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled "Buy American Act-- Free Trade Agreements--Israeli Trade Act": Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (5) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.) (i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) of this provision, is a U.S.-made or designated country end product, as defined in the clause of this solicitation entitled "Trade Agreements". (ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country end products. Other End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________[List as necessary] (iii) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American Act. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fulfill the requirements of the solicitation. (h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals-- (1) [ ] Are, [ ] are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; (2) [ ] Have, [ ] have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property; (3) [ ] Are, [ ] are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and (4) [ ] Have, [ ] have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,000 for which the liability remains unsatisfied. (i) Taxes are considered delinquent if both of the following criteria apply: (A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted. (B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded. (ii) Examples. (A) The taxpayer has received a statutory notice of deficiency, under I.R.C. Sec. 6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. Sec. 6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (C) The taxpayer has entered into an installment agreement pursuant to I.R.C. Sec. 6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment. (D) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code). (i) Certification Regarding Knowledge of Child Labor for Listed End Products (Executive Order 13126). (1) Listed end products.Listed End ProductListed Countries of Origin ______________ _________________ ______________ _________________ ______________ _________________ (2) Certification. [If the Contracting Officer has identified end products and countries of origin in paragraph (i)(1) of this provision, then the offeror must certify to either (i)(2)(i) or (i)(2)(ii) by checking the appropriate block.] [ ] (i) The offeror will not supply any end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. [ ] (ii) The offeror may supply an end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. The offeror certifies that it has made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or manufacture any such end product furnished under this contract. On the basis of those efforts, the offeror certifies that it is not aware of any such use of child labor. (j) Place of manufacture. (Does not apply unless the solicitation is predominantly for the acquisition of manufactured end products.) For statistical purposes only, the offeror shall indicate whether the place of manufacture of the end products it expects to provide in response to this solicitation is predominantly-- (1) __ In the United States (Check this box if the total anticipated price of offered end products manufactured in the United States exceeds the total anticipated price of offered end products manufactured outside the United States); or (2) __ Outside the United States. (k) Certificates regarding exemptions from the application of the Service Contract Act. (Certification by the offeror as to its compliance with respect to the contract also constitutes its certification as to compliance by its subcontractor if it subcontracts out the exempt services.) [ ] (1) Maintenance, calibration, or repair of certain equipment as described in FAR 22.1003-4(c)(1). The offeror [ ] does [ ] does not certify that-- (i) The items of equipment to be serviced under this contract are used regularly for other than Governmental purposes and are sold or traded by the offeror (or subcontractor in the case of an exempt subcontract) in substantial quantities to the general public in the course of normal business operations; (ii) The services will be furnished at prices which are, or are based on, established catalog or market prices (see FAR 22.1003- 4(c)(2)(ii)) for the maintenance, calibration, or repair of such equipment; and (iii) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract will be the same as that used for these employees and equivalent employees servicing the same equipment of commercial customers. [ ] (2) Certain services as described in FAR 22.1003- 4(d)(1). The offeror [ ] does [ ] does not certify that-- (i) The services under the contract are offered and sold regularly to non-Governmental customers, and are provided by the offeror (or subcontractor in the case of an exempt subcontract) to the general public in substantial quantities in the course of normal business operations; (ii) The contract services will be furnished at prices that are, or are based on, established catalog or market prices (see FAR 22.1003-4(d)(2)(iii)); (iii) Each service employee who will perform the services under the contract will spend only a small portion of his or her time (a monthly average of less than 20 percent of the available hours on an annualized basis, or less than 20 percent of available hours during the contract period if the contract period is less than a month) servicing the Government contract; and (iv) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract is the same as that used for these employees and equivalent employees servicing commercial customers. (3) If paragraph (k)(1) or (k)(2) of this clause applies-- (i) If the offeror does not certify to the conditions in paragraph (k)(1) or (k)(2) and the Contracting Officer did not attach a Service Contract Act wage determination to the solicitation, the offeror shall notify the Contracting Officer as soon as possible; and (ii) The Contracting Officer may not make an award to the offeror if the offeror fails to execute the certification in paragraph (k)(1) or (k)(2) of this clause or to contact the Contracting Officer as required in paragraph (k)(3)(i) of this clause. (l) Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701). (Not applicable if the offeror is required to provide this information to the SAM database to be eligible for award.) (1) All offerors must submit the information required in paragraphs (l)(3) through (l)(5) of this provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the Internal Revenue Service (IRS). (2) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror's TIN. (3) Taxpayer Identification Number (TIN). [ ] TIN: _____________________. [ ] TIN has been applied for. [ ] TIN is not required because: [ ] Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States; [ ] Offeror is an agency or instrumentality of a foreign government; [ ] Offeror is an agency or instrumentality of the Federal Government. (4) Type of organization. [ ] Sole proprietorship; [ ] Partnership; [ ] Corporate entity (not tax-exempt); [ ] Corporate entity (tax-exempt); [ ] Government entity (Federal, State, or local); [ ] Foreign government; [ ] International organization per 26 CFR 1.6049-4; [ ] Other _________________________. (5) Common parent. [ ] Offeror is not owned or controlled by a common parent; [ ] Name and TIN of common parent: Name _____________________. TIN _____________________. (m) Restricted business operations in Sudan. By submission of its offer, the offeror certifies that the offeror does not conduct any restricted business operations in Sudan. (n) Prohibition on Contracting with Inverted Domestic Corporations--(1) Relation to Internal Revenue Code. An inverted domestic corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code 25 U.S.C. 7874. (2) Representation. By submission of its offer, the offeror represents that-- (i) It is not an inverted domestic corporation; and (ii) It is not a subsidiary of an inverted domestic corporation. (o) Prohibition on contracting with entities engaging in certain activities or transactions relating to Iran. (1) The offeror shall email questions concerning sensitive technology to the Department of State at CISADA106@. (2) Representation and Certifications. Unless a waiver is granted or an exception applies as provided in paragraph (o)(3) of this provision, by submission of its offer, the offeror-- (i) Represents, to the best of its knowledge and belief, that the offeror does not export any sensitive technology to the government of Iran or any entities or individuals owned or controlled by, or acting on behalf or at the direction of, the government of Iran; (ii) Certifies that the offeror, or any person owned or controlled by the offeror, does not engage in any activities for which sanctions may be imposed under section 5 of the Iran Sanctions Act; and (iii) Certifies that the offeror, and any person owned or controlled by the offeror, does not knowingly engage in any transaction that exceeds $3,000 with Iran's Revolutionary Guard Corps or any of its officials, agents, or affiliates, the property and interests in property of which are blocked pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.) (see OFAC's Specially Designated Nationals and Blocked Persons List at ). (3) The representation and certification requirements of paragraph (o)(2) of this provision do not apply if-- (i) This solicitation includes a trade agreements certification (e.g., 52.212-3(g) or a comparable agency provision); and (ii) The offeror has certified that all the offered products to be supplied are designated country end products. (End of Provision) ................
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