Inactive Service-Disabled Veteran-Owned Small Business (SDVOSB) Set-Aside (FAR 19.14)

5. PROJECT NUMBER (if applicable) CODE 7. ADMINISTERED BY 2. AMENDMENT/MODIFICATION NUMBER CODE 6. ISSUED BY 8. NAME AND ADDRESS OF CONTRACTOR 4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE 9A.... 5. PROJECT NUMBER (if applicable) CODE 7. ADMINISTERED BY 2. AMENDMENT/MODIFICATION NUMBER CODE 6. ISSUED BY 8. NAME AND ADDRESS OF CONTRACTOR 4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE 9A. AMENDMENT OF SOLICITATION NUMBER 9B. DATED PAGE OF PAGES 10A. MODIFICATION OF CONTRACT/ORDER NUMBER 10B. DATED BPA NO. 1. CONTRACT ID CODE FACILITY CODE CODE Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers E. IMPORTANT: is extended, (a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended. 12. ACCOUNTING AND APPROPRIATION DATA (REV. 11/2016) is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A. 15C. DATE SIGNED B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b). RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified. C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF: D. OTHER Contractor 16C. DATE SIGNED 14. DESCRIPTION OF AMENDMENT/MODIFICATION 16B. UNITED STATES OF AMERICA Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect. 15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER 15B. CONTRACTOR/OFFEROR STANDARD FORM 30 PREVIOUS EDITION NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.) (Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.) (If required) (SEE ITEM 11) (SEE ITEM 13) (X) CHECK ONE 13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS, IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14. 11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT (Signature of person authorized to sign) (Signature of Contracting Officer) 1 8 0001 10/13/2021 528-22-1-7896-0007 Department of Veterans Affairs Network Contracting Office (NCO) 2 2875 Union Road Suite 3500 Cheektowaga NY 14227 Department of Veterans Affairs Network Contracting Office (NCO) 2 2875 Union Road Suite 3500 Cheektowaga NY 14227 To all Offerors/Bidders 36C24222Q0022 10-13-2021 X x x x One The purpose of this amendment is to add a clause and an updated Statement of Work. All other terms and conditions remain unchanged. Kimberly Wiatrowski Contracting Officer 8 Page 8 of 8 B.3 Statement of Work (SOW) B.3.1 Scope This firm fixed-price requirement is for the comprehensive Medical Gas System testing and maintenance at the Syracuse VA Medical Center located at 800 Irving Avenue, Syracuse, NY 13210. Period of Performance is 11-1-2021 to 10-31-2022 with a provision of four (4) options years. The Inspection is to be performed and completed annually within the month of November. B.3.2 General Contractor Shall furnish all materials and labor to provide the testing/evaluation of the Medical Gas System at the Syracuse VA Medical Center. All inspections and testing shall be conducted per the Original Equipment Manufacturers (OEM) guidelines and in accordance with the standards set forth in NFPA 99, 2012 Edition, NFPA 55, 2010 Edition, and as recommended in the ASSE 6000 Professional Qualifications Standard for Medical Gas Systems. Contractor shall be authorized/trained to manipulate, troubleshoot, and repair OEM brands including Chemetron, Tri-Tech, Amico, Beacon Madaes, Ohio Medical, and Stryker for all listed equipment (section B.3.4), and have the ability to purchase OEM parts from said manufacturers. Contractor shall, upon completion of all testing, prepare a detailed and specific report of results from all tests on all systems. Reports shall consist of date, time, location, system identification, test performed, technician name, test result, and corrective action (if necessary). Test reports shall be expected and delivered no later than 14 days after completion of testing. The following system(s) shall be inspected/tested: Medical-surgical vacuum systems: Inspect for proper installation, configuration, labeling, signage, function and operation. Inspect all medical-surgical vacuum locations for proper design, construction, and ventilation Inspect vacuum exhaust for medical-surgical vacuum pumps to ensure proper installation and location Inspect all vacuum indicators for proper labeling and function Test local alarm signals for proper operation and activation Test master alarm signals, pressure switches, and associated system monitoring components for proper operation and activation Test all service and alarm indicator lamps and audible signals for proper operation and activation Inspect and assess all medical-surgical vacuum systems for compliance with current applicable codes and standards Provide recommendations for medical-surgical vacuum system improvements on a separate Medical Gas System Recommendations Report All warning systems: Inspect all master alarm panels for proper installation, location, configuration, labeling, function, and operation Test all alarm points being monitored for proper operation and function Inspect and assess master alarm panels for compliance with current applicable codes and standards Inspect all area alarm panels for proper installation, location, configuration, labeling, function, and operation Test all high-pressure and low-pressure area alarms for proper operation and function Inspect and assess area alarm panels for compliance with current applicable codes and standards Medical Gas Manifold Systems: Inspect all medical gas manifold systems for proper installation, configuration, labeling, signage, function, and operation Inspect all medical gas manifold system locations for proper design, construction, and ventilation requirements Inspect vent discharge for medical gas manifold systems to ensure proper installation and location Inspect all pressure indicators for proper labeling and function Test local alarm signals for proper operation and activation Test master alarm signals, pressure switches, and associated system monitoring components for proper operation and activation Test all service and alarm indicator lamps and audible signals for proper operation and activation Inspect and assess medical gas manifold systems for compliance with current applicable codes and standards Valves and Valve Boxes: Inspect all source valves for proper location, configuration, labeling, and function Test all source valves for leakage Inspect and assess all source valves for compliance with current applicable codes and standards Inspect all main line valves for proper location, configuration, labeling, and function Test all main line valves for leakage Inspect and assess all main line valves for compliance with current applicable codes and standards Inspect all zone valves and zone valve boxes for proper location, configuration, pressure and vacuum indicators, labeling, and function Test all zone valves for leakage Inspect and assess all zone valves and zone valve boxes for compliance with current applicable codes and standards Station Outlets and Inlets (Including Drop Hoses): Inspect all station outlets and inlets for proper location, labeling, function, and operation Test all station outlets and inlets for leakage Testing of at least 90 percent of station outlets and inlets shall be achieved in order to fulfill the requirements of this program Inspect and assess all station outlets and inlets for compliance with current applicable codes and standards Provide recommendations for station outlet and inlet improvements on a separate Medical Gas Systems Recommendations Report Medical Gas Pipeline Testing: The medical gas pipeline shall be tested for particulates The medical gas pipeline shall be tested for purity Assess pipeline particulate and purity test results for compliance with current applicable codes and standards Booms, Flexible Ceiling Columns and Orbiter Medical Gas Hose: Verify hose connections/DISS, ensure no leaks are present and check hose condition 5.1.14.2.3.1 Manufactured Assemblies Employing Flexible Connection(s) Between the User Terminal and the Piping System Non-stationary booms and articulating assemblies, other than head walls utilizing flexible connectors, shall be tested for leaks, per manufacturer s recommendations, every 18 months or at a duration as determined by a risk assessment The system pressure to non-stationary booms and articulating arms shall be maintained at operating pressure until each joint has been examined for leakage by effective means of leak detection that is safe for use with oxygen Safe working condition of the flexible assemblies shall be confirmed D.I.S.S. connectors internal to the boom and assemblies shall be checked for leakage Leaks, if any, shall be repaired (if permitted), or the components replaced (if required), and the equipment retested prior to placing the equipment back into service Additional testing of non-stationary booms or articulating arms shall be performed at intervals defined by documented performance data Anesthetic Gases Environmental evaluation per OSHA, Department of Health and Human Services (DHHS), National Fire Protection Association (NFPA), The Joint Commission (TJC), and National Institute for Occupational Safety and Health (NIOSH) specs and recommendations High- and low-pressure leaks, ambient levels, vacuum inlets and ventilation (positive negative pressure and N2O recirculation) Each anesthetizing area shall be tested using a patient simulation on a breathing circuit A 50 percent O2/N2O fresh gas delivery along with 1 or more anesthetizing agents shall be activated during the simulation All nitrous oxide supply connections, anesthetic vaporizers, flow meters and the anesthesia machine components shall be tested for leaks A TWA of the anesthetic fugitive gases shall be recorded for the breathing zone. All leaks shall be documented, and plant operators shall be notified immediately for any areas which exceed the NIOSH/OSHA maximum allowable concentrations for waste gases B.3.3 Schedule All work shall be performed during normal business hours Monday through Friday, from 7:00am to 4:00pm, excluding federal holidays. Unless emergency work is required, no work shall be planned on federal holidays. All work shall not interfere with patient and/or staff operations. The Syracuse VA Medical Center must maintain its operation 24 hours per day, 7 days per week. Therefore, any work must be scheduled and coordinated with the facility point of contact. Federal holidays are listed below: New Year s Day Memorial Day Columbus Day Christmas Day Martin Luther King Day Independence Day Veteran s Day President s Day Labor Day Thanksgiving Day Juneteenth To also include any day the President declares a holiday. B.3.4 Equipment List DESCRIPTION QUANTITY Medical Gas Inlets/Outlets 1,537 Hose/Booms 34 Waste Anesthetic Gas Systems 8 B.3.5 Safety a) No tools or equipment shall be left unattended. All work areas must be clean at the close of the day and shall be left in the same condition as before work started. Contractor shall obtain all necessary licenses and/or permits associated with this procurement. Contractor shall take all precautions necessary to protect persons and property from injury or damage. B.3.6 Contractor shall follow all Centers for Disease Control (CDC) COVID-19 Prevention recommendations at all times while at the Syracuse facility. This shall include but not be limited to handwashing, social distancing and wearing a CDC approved face covering at all times. B.3.7 VHA Supplemental Contract Requirements for Ensuring Adequate COVID-19 Safety Protocols for Federal Contractors 1. Contractor employees who work in or travel to VHA locations must comply with the following: a. Documentation requirements: 1) If fully vaccinated, shall show proof of vaccination i. NOTE: Acceptable proof of vaccination includes a signed record of immunization from a health care provider or pharmacy, a copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published on September 3, 2020), or a copy of medical records documenting the vaccination 2) If unvaccinated and granted a medical or religious exception, shall show negative COVID-19 test results dated within three calendar days prior to desired entry date. Test must be approved by the Food and Drug Administration (FDA) for emergency use or full approval. This includes tests available by a doctor s order or an FDA approved over-the-counter test. 3) Documentation cited in this section shall be digitally or physically maintained on each contractor employee while in a VA facility and is subject to inspection prior to entry to VA facilities and after entry for spot inspections by Contracting Officer Representatives (CORs) or other hospital personnel. 4) Documentation will not be collected by the VA; contractors shall, at all times, adhere to and ensure compliance with federal laws designed to protect contractor employee health information and personally identifiable information. 52.223-99 Ensuring Adequate COVID-19 Safety Protocols for Federal Contractors. ENSURING ADEQUATE COVID-19 SAFETY PROTOCOLS FOR FEDERAL CONTRACTORS (OCT 2021) (DEVIATION) Definition. As used in this clause - United States or its outlying areas means The fifty States; The District of Columbia; The commonwealths of Puerto Rico and the Northern Mariana Islands; The territories of American Samoa, Guam, and the United States Virgin Islands; and The minor outlying islands of Baker Island, Howland Island, Jarvis Island, Johnston Atoll, Kingman Reef, Midway Islands, Navassa Island, Palmyra Atoll, and Wake Atoll. Authority. This clause implements Executive Order 14042, Ensuring Adequate COVID Safety Protocols for Federal Contractors, dated September 9, 2021 (published in the Federal Register on September 14, 2021, 86 FR 50985). Compliance. The Contractor shall comply with all guidance, including guidance conveyed through Frequently Asked Questions, as amended during the performance of this contract, for contractor workplace locations published by the Safer Federal Workforce Task Force (Task Force Guidance) at https:/www.saferfederalworkforce.gov/contractors/. Subcontracts. The Contractor shall include the substance of this clause, including this paragraph (d), in subcontracts at any tier that exceed the simplified acquisition threshold, as defined in Federal Acquisition Regulation 2.101 on the date of subcontract award, and are for services, including construction, performed in whole or in part within the United States or its outlying areas. (End of clause)