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Statement of Work Page 7 of 8 STATEMENT OF WORK Hoptel Program Memphis VAMC The Memphis VA Medical Center provides overnight lodging accommodations to Veterans who are receiving health care services t... Statement of Work Page 7 of 8 STATEMENT OF WORK Hoptel Program Memphis VAMC The Memphis VA Medical Center provides overnight lodging accommodations to Veterans who are receiving health care services that require them to have early morning appointments. Arrangements must be made in advance by the referring clinic and confirmed by Hoptel prior to the Veteran s arrival. To receive Hoptel lodging, a Veteran must be required to travel 50 or more miles from their home to the Memphis VA health care facility. At the time of lodging, the Veteran must be clinically stable and capable of self-care. VA does not provide nursing or other medical care for temporary lodgers. Minor children may not be accommodated in temporary lodging facilities. 1.0 GENERAL 1.1 The contractor will furnish rooms to Veteran beneficiaries and allowed guests as referred by authorized personnel of the Memphis Veterans Affairs Medical Center (VAMC), 1030 Jefferson Avenue, Memphis, TN 38104. The contractor shall furnish all standard supplies/services included as minimum room requirements. Lodging shall be provided in accordance with HOPTEL standards to accommodate those Veterans receiving medical care who may have to travel long distances for evaluation the day before or the day after treatment received. Only medically stable patients who would normally be discharged to their home will be considered for lodging. 1.2 Lodging facilities must be located within five (5) miles of the Memphis VAMC located at 1030 Jefferson Avenue, Memphis, TN 38104. 2.0 SCOPE 2.1 The requirement is intended for a five year period. The Memphis VAMC will take occupancy of the rooms no more than 14 calendar days following the award of the contract and rooms must be in full compliance with all requirements of the contract by that date. Daily room rates will include all fees and any other no-charge services offered to guests such as shuttle service and or a continental breakfast when available. The Veteran Transportation Service will provide shuttle services to VA patients from 06:00 a.m. through 17:00 p.m. and must be arranged during business hours. 2.2 The contractor will reserve five (5) rooms per night, three (3) with double beds and two (2) king/queen sized beds with a let-out sofa, at the negotiated rates per the contract, 5 days a week, Sunday through Thursday for Veteran beneficiaries and allowed guest(s) of the Memphis VAMC HOPTEL program. Occasionally, additional rooms may be requested to be reserved by authorized personnel of the Memphis VAMC at the negotiated rates per the contract. Reservation of the additional rooms will be based on the contractor s space availability. The contractor will be paid only for actual rooms nights used in accordance with this contract. 2.3 Each room shall be double occupancy and handicapped accessible or be ADA compliant. Access to rooms shall be from interior hallways that are accessed directly from the front desk/elevator lobby area. There shall be no physical barriers. Rooms shall be in a reasonably quiet or tranquil part of the hotel/motel. 2.4 Breakfast, either full or continental, if available will be provided at no additional charge. On-site parking shall be available at no additional charge. 2.5 The contractor shall allow the occupancy of the room covered by this contract only of the Veteran beneficiary and allowed guest(s) referred by authorized personnel of the Memphis VAMC and will be at the double occupancy rate. Any additional occupants that are not noted as an allowed guest(s) by authorized personnel from the Memphis VAMC are the responsibility of the Veteran beneficiary and shall not lodge at Memphis VAMC s expense. Authorized personnel or the Administrator Officer of the Day (AOD) will call and inform the contractor of the individual s name, allowed guest(s), and the arrival date at the contractor s motel/hotel. Stays will be limited to one night unless additional nights are specifically authorized by the Memphis VAMC. It is the contractor's responsibility to ensure that they have a valid and approved authorization for any Veteran beneficiary and allowed guest(s) occupying a room. 2.6 Services shall be performed 5 days a week, Sunday through Thursday except on any evening preceding a Federal Holiday unless authorized in advance by authorized personnel of the Memphis VAMC. It is agreed by the Contractor that the rooms will be held until 4:00 p.m. each day. The VA will notify the contractor by 4:00 p.m. to release any remaining rooms. All other rooms not reserved by the VA by 4:00 p.m. will be available for the Contractor to place back into their inventory. The contractor shall use its standard check in and checkout times. Applicable holidays are as follows: New Year's Day Martin Luther King's (MLK) Birthday President's Day Memorial Day Independence Day Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day 2.7 Personnel of the Memphis VAMC who are authorized to provide referrals to the contractor will be identified following award of the contract and shall be accessible to the contractor from 8:00 A.M. to 4:30 P.M., Monday through Friday at (901) 523-8990 extensions 7796. An AOD will be assigned for any after hours, weekends, holiday referrals, or contractor issues and shall be accessible to the contractor at (901) 523-8990 extensions 7966 or 6123. If the AOD does not answer, call the Memphis VAMC operator and have the AOD paged. 2.8 The Veteran beneficiary s name allowed guest(s), and authorized dates and length of stay will be documented on the hotel voucher issued by the authorized personnel of the Memphis VAMC and presented to the contractor by the referred Veteran beneficiary. If a Veteran beneficiary or allowed guest(s) refuses to leave the room, the contractor shall immediately notify authorized personnel of the Memphis VAMC, the AOD, or the Contracting Officer Representative (COR). If a Veteran beneficiary checks in the day before treatment is to be received and decides to leave or check out without prior notice, the contractor shall immediately notify authorized personnel of the Memphis VAMC as eligibility for utilizing the HOPTEL service is tied to the Veteran beneficiary keeping his or her appointment. 3.0 REQUIREMENTS 3.1 If the contractor fails to furnish the required lodging services, the Memphis VAMC reserves the right to obtain the service from another source and charge the contractor with any cost that may result there-from. The contractor shall provide signed written documentation with an explanation when contract services are unavailable within 2 calendar days and the Memphis VAMC will issue a Bill of Collections for any costs incurred during the period of service unavailability. Failure to pay as charged within timeframes specified in the Bill of Collections will result in cost deduction from the next month's invoice. 3.2 In the event the Veteran beneficiary is in an emergency of any kind, the contractor shall first contact 911 emergency medical services to respond and then immediately notify authorized personnel of the Memphis VAMC, the AOD, or the COR of the emergency. A list of designated staff and contact information shall be provided to the contractor upon contract award. 3.3 The Memphis VAMC will inspect each room prior to contract award to ensure compliance with all contract requirements. If necessary, a list of noted issues to bring the rooms into full compliance will be provided to the contractor to be corrected no later than 14 calendar days following the award of the contract as referenced in paragraph 2.1 of this document. The award of the contract is contingent upon acceptable air quality test results. Testing is to be at expense of contractor. At any given time but at a minimum of once per quarter, the Government reserves the right to inspect the premises and any accessible areas to ensure a safe and healthy environment for the Veteran beneficiaries and allowed guests. This inspection may be scheduled or unannounced. 3.4. If the Veteran beneficiary is admitted to the Memphis VAMC or any medical center for inpatient medical care, the authorized stay is only valid the first day of check in .Any allowed guest(s) that was residing with the Veteran beneficiary during the authorized period /stay may remain at the contractor s motel/hotel but at his or her own expense. The Memphis VAMC will not authorize payment for rooms occupied by the Veteran beneficiary s allowed guest(s), nor will it count toward the contractor's required lodging services as stated in this document per the contract. The Memphis VAMC is not responsible for lost revenues resulting from terminated authorizations. 3.5 The contractor is to submit monthly invoices per the contract s payment clause instructions. The contractor shall reference the Veteran beneficiary s name in the invoice so it may be matched with the Memphis VAMC s records of authorized stays. 3.6 Ceilings shall be at least 8 feet tall and no more than 11 feet clear from floor to the lowest obstruction. Each room shall have acoustical treatment with a flame spread of "5" or less and smoke development rating of 50 of less (ASTME 84). All type floor coverings shall be clean, free of stains, odor-free, and free of cracks or tears. Shag style carpets used as floor covering shall be ½ or less in length. Exterior doors to rooms shall open into a climate controlled hallway. 4.0 MISCELLANEOUS 4.1 No activity to the building and/or grounds that would cause an increase in dust, dirt or spores to be airborne (i.e., renovation to the building, movement of earth on the grounds) shall take place without the contractor's written notification and confirmed receipt to the Memphis VAMC at least seven (7) calendar days in advance of the event. 4.2 The contractor shall ensure that the premises are free of bugs and pests and provide to the Government monthly a copy of the pest control inspection conducted. 4.3 The contractor shall refer complaints received directly from the Veteran beneficiary to the COR within 2 calendar days. All complaints received by the COR will be forwarded to the Contracting Officer (CO) for documentation in the contract file and shall be promptly investigated within 24 hours upon receipt of complaint. Quality deficiencies identified by the COR shall be remedied promptly by the contractor. 4.4 If at any time the contractor's facilities become unsafe or uninhabitable due to circumstances beyond the contractor's control such as but not limited to severe storms, flooding, renovations, or other extreme weather events, the contractor is responsible for establishing alternative lodging services for the duration of the event. The contractor is responsible for ensuring the quality of the alternative lodging services, that there is no interruption of authorized services, and that all impacted lodgers are provided transportation to the alternative lodging services. 4.5 The contractor shall notify the Memphis VAMC if lodging relocation is required and the alternative lodging arrangements that were established. Verbal notification is required within one (1) hour of the event's origination. Written notification with an accompanying action plan and timeframe for reestablishment of lodging services is required within six (6) hours of the event's origination. 5.0 PERFORMANCE 5.1 The service requirements are summarized into performance objectives that relate directly by mission essential items. The Performance Threshold briefly describes the minimum acceptable levels of service required for each Performance Objective. These thresholds are critical to the contractor's success. PERFORMANCE OBJECTIVE PERFORMANCE THRESHOLD Delivery and response time Services shall be performed with the specified time 95% of the time. Invoice procedures and inspections. Contractor and employees of the contractor will abide by all State and Federal requirements, including any applicable training. Adherence to invoice and reporting requirements as specified 95% of the time. Customer satisfaction. 95% Customer satisfaction rating or higher based on individual customer evaluations reports and independent surveys conducted by the COR. Business Relations. Business and management problems are resolved timely, effectively and efficiently. No more than two (2) unresolved incidents per year. Attachment 1 HOPTEL Voucher January 10, 1996Memphis VAMC Contract Number VA249-18-X-XXXX Contractor s Motel/Hotel Name Contractor s Address Veteran Beneficiary: _____________________________________________________ Allowed Guest(s): _______________________________________________________ Reservation Confirmation #: _______________________________________________ Authorized Stay Dates: ________________ to _________________ The above-named Veteran Beneficiary and allowed guest(s) have been authorized for lodging for the authorized stay dates at the above referenced motel / hotel at the Memphis Veterans Affairs Medical Center s (VAMC) expense. The contractor s standard check-in and check-out times are applicable. There shall be no additional expenses to the Veteran beneficiary or allowed guest(s) for the lodging. Any expenses incurred beyond the terms of the contract (i.e. room service, damages, entertainment purchases, laundry services, long distance calls, etc.) are not the responsibility of the Memphis VAMC and are the responsibility of the Veteran beneficiary. If the Veteran beneficiary is in an emergency of any kind, the procedures in paragraph 3.2 of the contract s statement of work (SOW) shall be followed. Authorized Personnel s Printed Name: _______________________________________ Authorized Personnel s Signature: __________________________________________ Authorized personnel can be reached Monday Friday 8:00 A.M. to 4:30 P.M. Authorized Personnel: (901) 523-8990 extensions 7041 or 2041. Issues occurring after hours, weekends and holidays, please contact the AOD at: (901) 523-8990 extensions 7966 or 6123 Attachment 1 VETERAN BENEFICIARY RESPONSIBILITIES By signing this form, I am confirming that I have read and understand the responsibilities listed below: I am personally responsible for expenses incurred beyond the terms of the contract (i.e. room service, damages, entertainment purchases, laundry services, long distance calls, etc.) Disruptive behavior (i.e. too much noise, theft, vandalism, etc.) could result in my removal from the Memphis VAMC HOPTEL Program. I understand that if have an allowed guest(s), the Memphis VAMC will not be responsible for any expenses incurred (i.e. meals, supplies, any other costs, etc.) I understand that my pets cannot stay with me at the hotel, except for a Licensed Service Animals. If for any reason, I am admitted to the Memphis VAMC or any medical center for medical care, the authorized stay is no longer valid and any allowed guest(s) that are residing with me during the authorized period / stay may remain at the contractor s motel / hotel but at his or her own expense. I understand that I am personally responsible for my own valuables and clothing. If I require emergency medical care while being lodged, I am responsible for taking appropriate action, such as calling 911 or reporting to the Memphis VAMC s Emergency Department. I understand that I must provide my own transportation to and from my appointments while being lodged unless provided the motel / hotel. By law, VA transportation can only be provided for those Veterans who meet the eligibility and medical criteria for special mode transportation. Veteran Beneficiary Printed Name: __________________________________________ Veteran Beneficiary Signature: _____________________________________________ SCHEDULE OF SERVICES - BASE YEAR ESTIMTATED QUANTITY OF DOUBLE-OCCUPANCE ROOMS, WHICH MUST BE HANDICAP ACCESSIBLE. SUNDAY -THURSDAY Night DESCRIPTION ESTIMATED QUANTITY MONTHLY ANNUAL UNIT UNIT PRICE TOTAL PRICE Reserve 3 rooms with double beds per day 5 days/week 3 rooms X 20 days a month=60 720 Reserve 2 rooms with king sized beds per night, 1 sofa bed 5 days/week 2 rooms X 20 days a month = 40 480 ESTIMATED SCHEDULE OF SERVICES - BASE YEAR SCHEDULE OF SERVICES - OPTION YEAR 1 ESTIMTATED QUANTITY OF DOUBLE-OCCUPANCE ROOMS, WHICH MUST BE HANDICAP ACCESSIBLE. SUNDAY -THURSDAY Night DESCRIPTION ESTIMATED QUANTITY MONTHLY ANNUAL UNIT UNIT PRICE TOTAL PRICE Reserve 3 rooms with double beds per day 5 days/week 3 rooms X 20 days a month=60 720 Reserve 3 rooms with king sized beds per night, 1 sofa bed 5 days/week 2 rooms X 20 days a month = 40 480 SCHEDULE OF SERVICES - OPTION YEAR 2 ESTIMTATED QUANTITY OF DOUBLE-OCCUPANCE ROOMS, WHICH MUST BE HANDICAP ACCESSIBLE. SUNDAY -THURSDAY Night DESCRIPTION ESTIMATED QUANTITY MONTHLY ANNUAL UNIT UNIT PRICE TOTAL PRICE Reserve 3 rooms with double beds per day 5 days/week 3 rooms X 20 days a month=60 720 Reserve 3 rooms with king sized beds per night, 1 sofa bed 5 days/week 2 rooms X 20 days a month = 40 480 SCHEDULE OF SERVICES - OPTION YEAR 3 ESTIMTATED QUANTITY OF DOUBLE-OCCUPANCE ROOMS, WHICH MUST BE HANDICAP ACCESSIBLE. SUNDAY -THURSDAY Night DESCRIPTION ESTIMATED QUANTITY MONTHLY ANNUAL UNIT UNIT PRICE TOTAL PRICE Reserve 3 rooms with double beds per day 5 days/week 3 rooms X 20 days a month=60 720 Reserve 3 rooms with king sized beds per night, 1 sofa bed 5 days/week 2 rooms X 20 days a month = 40 480 SCHEDULE OF SERVICES - OPTION YEAR 4 ESTIMTATED QUANTITY OF DOUBLE-OCCUPANCE ROOMS, WHICH MUST BE HANDICAP ACCESSIBLE. SUNDAY -THURSDAY Night DESCRIPTION ESTIMATED QUANTITY MONTHLY ANNUAL UNIT UNIT PRICE TOTAL PRICE Reserve 3 rooms with double beds per day 5 days/week 3 rooms X 20 days a month=60 720 Reserve 3 rooms with king sized beds per night, 1 sofa bed 3 days/week 2 rooms X 20 days a month = 40 480