A~o& ~ ~ blon, L.L.P.

Transcription

1 A~o& ~ ~ blon, L.L.P. ATTORNEYS AND COUNSELORS AT LAW Employment Law I Government Contracts I Business Law I Civil Litigation I ABC Law I Criminal Defense I Family Law March 17, 2016 Cyrus E. Phillips IV Headquarters/ Arlington Office (757) Direct Line (703) Facsimile (703) Mobile lawyer@procurement-lawyer.com VIA ELECTRONIC MAIL Office of General Counsel U.S. Government Accountability Office-PLCG 441 G. Street, N.W. Washington, D.C Re: Second Post-Award Procurement Protest of D.H. Porter Enterprises, LLC (dba Staffing Etc.) Under Defense Health Agency Request for Quotations Number HT Q-OOOI. Gentlemen: This is the second Post-Award Procurement Protest filed on behalf ofd.h. Porter Enterprises, LLC (dba Staffing Etc.), a Maryland for-profit Corporation whose Office is at 9410 Annapolis Road, Suite 200, Lanham, Maryland (Staffing Etc.). This second Post Award Procurement Protest succeeds the matter before your Office as B B was filed on March ist, 2016 and voluntarily withdrawn on March lph, Staffing Etc. challenges the Award to The Royster Group, Atlanta, Georgia (Royster) of a $54,856, Task Order for delivery of twenty-four Anesthesiologist positions at the Walter Reed National Military Medical Center (WRNMMC). The Award is made under Defense Health Agency Request for Quotations HT Q-0001, a Solicitation for a Task Order issued, under Federal Acquisition Regulation (FAR) (a)(l}(i), to qualifying 8(a) Small Businesses holding Federal Supply Schedule Contracts.

2 The Solicitation document is Attachment 1 to this second Post-Award Procurement Protest. Award was made on a Lowest-Price Technically-Acceptable (LPTA) basis. Technical acceptability and price were equal in value. Attachment 1, Request for Quotations Number HT Q-0001, page 102 of 135. Although an Award without discussions was intended, Defense Health Agency reserved the right to initiate discussions/negotiations, but there were no communications with Staffing Etc. before the Award to Royster. Id., at page 117 of 135. Request for Quotations Number HT Q-0001 created subcategories of Anesthesiologist positions that exist in none of the Offeror' s Federal Supply Schedule Contracts. These include a "General Anesthesiologist," a "Pain Anesthesiologist," a "Neuro Anesthesiologist," a "Cardio-Thoracic Anesthesiologist," a Regional Pain Anesthesiologist," and a "Pediatric Anesthesiologist". Id., at pages 3 through 23 of 135. The qualifications and duties/tasks for these subcategories of Anesthesiologist positions are set out in Request for Quotations Number HT Q Id., at pages 76 through 85 of 135. The qualifications and duties/tasks for these subcategories of Anesthesiologist positions likewise exist in none of the Offeror's Federal Supply Schedule Contracts. The Solicitation continues deliveries of three Anesthesiologist positions at WRNMMC being furnished by Staffing Etc. under a Contract with Defense Health Agency. This Contract is in effect from June 2014 through April 2016, and it succeeds an earlier Contract in effect from February 2012 through May Staffing Etc. began in August 2003 providing health care services at WRNMMC. Staffing Etc. received on Tuesday, March 8th, 2016 a written FAR (d) Debriefing from Defense Health Agency. This written Debriefing is Attachment 2. Defense Health Agency asserts, in this written Debriefing, that Staffing Etc.'s compensation rates were unacceptable. Here is that reasoning: Specifically, the Government evaluated the wage rates (base salary+ fringe benefits) proposed to ensure the hourly salary for the Anesthesiologists was realistic in terms of attracting and retaining these essential services for WRNMMC Department of Surgery. Your proposed wage rates (base salary + fringe benefits) ranged between 14% - 24% less than the Independent Government Cost Estimate's rates. In addition, the wage rates (base salary+ fringe benefits) proposed were the same for all labor categories for all periods at $189 per hour and did not reflect a differential for - 2 -

3 the specialized positions with their associated qualifications, which were identified in the performance work statement. This office's assessment was that your proposed rates were not realistic, that the rates proposed were insufficient and that such rates would not successfully attract and retain qualified Anesthesiologists nor minimize employee turnover. Thus, the technical evaluation was that your proposal was unacceptable. Attachment 2, page 2 of 2. As for its First Ground of Protest, Staffing Etc. asserts that FAR Subpart 8.4-Federal Supply Schedules requires that all Items quoted by an Offeror and ordered by an Agency must be available on the Offeror's Schedule Contract. Staffing Etc. has one commercial Price set out for the Anesthesiologist position in its Federal Supply Schedule Contract, and it cannot be technically-unacceptable for Staffing Etc. to, as required by that Federal Supply Schedule Contract, to have used uniformly that commercial Price for each one of the subcategories of Anesthesiologist positions set out only in Request for Quotations Number HT Q Your Office has explained: We note as well that GSA's underlying premise-that SOSI could identify a labor category under its FSS contract that did not meet all of the requirements of the PWS, but could somehow enhance or alter the narrative description and qualifications of that labor category through the technical portion of its quotation-reflects a fundamental misunderstanding of the nature of FSS contracting. The labor categories identified and described in each firm's underlying FSS contract are fixed, discrete, specific labor category descriptions that are contractually binding and not subject to alteration, just as the technical specifications for products available under a firm's FSS contract are fixed, discrete, specific, contractually binding, and not subject to alteration. See American Systems Consulting, Inc., B , Dec. 13, 2004, 2004 Comp. Gen. Proc. Dec.! 247 at To the extent a quoted labor category description under a firm's FSS contract does not, in the words of GSA, "align precisely" with the requirements of a given solicitation, the firm may not properly alter the underlying labor category description through the terms of its quotation. Rather, where a firm's quoted labor category description does not align with the requirements of the solicitation, it means that - 3 -

4 the quoted labor category does not meet the requirements of the solicitation, and therefore cannot serve as the basis for issuing a task order to the firm. American Systems Consulting, Inc., supra. at AllWorld Language Consultants, Inc., B , January 6th, 2016, 2016 U.S. Comp. Gen. LEXIS 19, *11-*12. As for its Second Ground of Protest, Staffing Etc. asserts that it was arbitrary, capricious and unreasonable for Defense Health Agency to have concluded that Staffing Etc.'s pricing was unrealistic "in terms of attracting and retaining these essential services" without first considering whether Staffing Etc. was experiencing, or had experienced, staffing and retention problems for the three Anesthesiologist positions which Staffing Etc. is already providing to Defense Health Agency at WRNMMC. Defense Health Agency could have asked. Had it done so, Staffing Etc. would have explained that Staffing Etc.'s compensation structure (base salary+ fringe benefits) was based on Staffing Etc.'s knowledge of the market and current pricing for Anesthesiologist services at WRNMMC. As an incumbent provider, Staffing Etc. utilized its current compensation plan that has allowed it to maintain a one-hundred percent retention rate on its current Anesthesiologist Contract with Defense Health Agency. Staffing Etc.'s market research demonstrated that all of the subcategories of Anesthesiologist positions set out in Request for Quotations Number HT Q-0001 were priced at similar rates. Again, neither Staffing Etc. nor Royster, nor any other Offeror, offer different commercial pricing on their Federal Supply Schedules for the subcategories of Anesthesiologist positions which are set out only in Request for Quotations Number HT Q Staffing Etc. placed its compensation rate above the fiftieth percentile for Anesthesiology positions in the Bethesda, Maryland area (the location of Task Order performance). Staffing Etc. discounted its Federal Supply Schedule pricing based upon decreasing its overall profit margin but not decreasing compensation or fringe benefits to its current incumbent providers. Under Staffing Etc.'sQuotation, these Anesthesiologists would be compensated at the same rate as their current compensation and in the same manner, and benefits would remain the same

5 JURISDICTION Your Office has been given, under 31 U.S.C. 3552(a), Jurisdiction over Post-Award Procurement Protests concerning Awards, 31 U.S.C. 3551(1)(C), made by Federal Agencies, 31 U.S.C. 3551(3), which are challenged by an Interested Party, 31 U.S.C. 3551(2)(A). The term "Federal Agency" in 31 U.S.C. 3551(3) encompasses, per 40 U.S.C. 102(5), "an executive agency or establishment in the legislative or judicial branch of the Government.... " Defense Health Agency is one such Federal Agency. Staffing Etc. is an Interested Party already furnishing Anesthesiologist services whose continuation was competed under Request for Quotations Number HT Q Staffing Etc. submitted a Quotation and has a direct economic interest which is affected by Award to Royster of the promised Task Order. Your Office's Protest Jurisdiction extends to violations of "a procurement statute or regulation." 31 U.S.C. 3552(a). The Award of the promised Task Order to Royster violates FAR Subpart 8.4-Federal Supply Schedules. TIMELINESS This second Post-Award Procurement Protest is timely filed under 4 C.F.R. 21.2(a)(2) because it is filed before 5:00 p.m. on Friday, March 18th, 2016 and within ten calendar days after the date the required Debriefing was provided to Staffing Etc. SUSPENSION OF AW ARD Defense Health Agency has agreed that it will maintain the "status quo ante" of the three Anesthesiologist positions which Staffing Etc. is furnishing at WRNMCC while this second Post-Award Procurement Protest is before your Office. NOTICE TO CONTRACTING OFFICER The Defense Health Agency's Contracting Officer's name, address, telephone numbers, and electronic mail address are set out below. Under 4 C.F.R. 21.l(e) an electronic copy of this Post-Award Procurement Protest and its Attachments, all in Adobe Acrobat Portable Document Format, is being furnished by electronic mail today to the Contracting Officer

6 REQUESTS FOR PRODUCTION OF DOCUMENTS Under 4 C.F.R. 21.l(d)(2), Staffing Etc. requests that Defense Health Agency produce, besides the documents described in 4 C.F.R. 21.3(d), all documents touching upon the assertion in the written Debriefing that Staffing Etc.'s Quotation is not technically-acceptable. REQUEST FOR RELIEF Staffing, Etc. requests a ruling on the matters by the Comptroller General of the United States, and Staffing Etc. requests that the Comptroller General of the United States decide that the Award to Royster of the promised Task Order is unreasonable, else arbitrary or capricious. The Comptroller General should recommend that the Task Order awarded to Royster be terminated. Additionally, Staffing Etc. requests a ruling it is entitled to an Award of its protest costs and attorney fees, 4 C.F.R. 21.S(d)(l), and should the Request for Quotations be cancelled or substantially revised, to an Award of its proposal preparation costs, 4 C.F.R. 21.8(d)(2). Kind regards, ALBO & OBLON, L.L.P. Attachments ( as stated) - 6 -

7 Cc: Martin Rios Contracting Officer DHA-CODNCR 2900 Crystal Drive, Suite 210 Arlington, Virginia Phone: (301) Electronic Mail: martin.rios l 5.civ@mail.mil (W/cys of attachments) (Via electronic mail) Bridget E. Lyons Associate General Counsel Office of the General Counsel Office of the Assistant Secretary of Defense Health Affairs 7700 Arlington Boulevard, Suite 5101 Falls Church, Virginia Phone: (703) Electronic Mail: Bridget.E.Lyons.civ@mail.mil (W/cys of attachments) (Via electronic mail) - 7 -

8 ATTACHMENT 1

9 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 7. FOR SOLICITATION INFORMATION CALL: 9. ISSUED BY DEFENSE HEALTH AGENCY (COD NCR) 2900 CRYSTAL DRIVE SUITE 210 CRYSTAL CITY VA TEL: FAX: 11. DELIVERY FOR FOB DESTINA- TION UNLESS BLOCK IS MARKED SEE SCHEDULE a. NAME EDGAR DUCHEMIN CODE HT DISCOUNT TERMS 10. THIS ACQUISITION IS SMALL BUSINESS HUBZONE SMALL BUSINESS SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS 1. REQUISITION NUMBER 13a. THIS CONTRACT IS A RATED ORDER UNDER DPAS (15 CFR 700) 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE HT Q-0001 b. TELEPHONE NUMBER UNRESTRICTED OR 13b. RATING (No Collect Calls) X SET ASIDE: WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE UNDER THE WOMEN-OWNED SMALL BUSINESS PROGRAM NAICS: EDWOSB X 8(A) PAGE 1 OF Dec OFFER DUE DATE/LOCAL TIME 09:00 AM 06 Jan % FOR: SIZE STANDARD: $27,500, METHOD OF SOLICITATION X RFQ IFB RFP 15. DELIVER TO CODE HT ADMINISTERED BY WALTER REED NATIONAL MILITARY MEDICAL LANA CLOUSER 8901 WISCONSIN AVE BETHESDA MD TEL: FAX: CODE 17a.CONTRACTOR/ CODE FACILITY OFFEROR CODE 18a. PAYMENT WILL BE MADE BY CODE TELEPHONE NO. 17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK BELOW IS CHECKED SEE ADDENDUM ITEM NO. SCHEDULE OF SUPPLIES/ SERVICES QUANTITY UNIT UNIT PRICE AMOUNT SEE SCHEDULE 25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Gov t. Use Only ) 1X 27a. SOLICITATION INCORPORATES BY REFERENCE FAR FAR ARE ATTACHED. ADDENDA X ARE ARE NOT ATTACHED 27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR FAR IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED X 28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 1 COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED. 29. AWARD OF CONTRACT: REF. OFFER DATED. YOUR OFFER ON SOLICITATION (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS: 30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) TEL: (TYPE OR PRINT) 31c. DATE SIGNED AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION IS NOT USABLE STANDARD FORM 1449 (REV. 2/2012) Prescribed by GSA FAR (48 CFR)

10 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS (CONTINUED) 19. ITEM NO. 20. SCHEDULE OF SUPPLIES/ SERVICES 21. QUANTITY UNIT UNIT PRICE PAGE 2 OF AMOUNT SEE SCHEDULE 32a. QUANTITY IN COLUMN 21 HAS BEEN RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: 32b. SIGNATURE OF AUTHORIZED GOVERNMENT 32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE REPRESENTATIVE 32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32g. OF AUTHORIZED GOVERNMENT REPRESENTATIVE 33. SHIP NUMBER PARTIAL FINAL 34. VOUCHER NUMBER 35. AMOUNT VERIFIED CORRECT FOR 36. PAYMENT COMPLETE PARTIAL FINAL 37. CHECK NUMBER 38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY 41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE 42a. RECEIVED BY (Print) 42b. RECEIVED AT (Location) 42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION IS NOT USABLE STANDARD FORM 1449 (REV. 2/2012) BACK Prescribed by GSA FAR (48 CFR)

11 Page 3 of 135 Section SF CONTINUATION SHEET ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours General Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) General Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-FEB-2016 TO 31-JAN NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,080 Hours Pain Anesthesiologst FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Pain Anesthesiologst under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-FEB-2016 TO 31-JAN NET AMT

12 Page 4 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,080 Hours Neuro Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Neuro Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-FEB-2016 TO 31-JAN NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours Cardio-Thoracic Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Cardio-Thoracic Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-FEB-2016 TO 31-JAN NET AMT

13 Page 5 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,080 Hours Regional Pain Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Regional Pain Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-FEB-2016 TO 31-JAN NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,733 Hours Pediatric Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Pediatric Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-APR-2016 TO 31-JAN NET AMT

14 Page 6 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,398 Hours General Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for for six (6) Full Time Equivalent (FTE) General Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-APR-2016 TO 31-JAN NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,120 Hours General Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) General Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-MAY-2016 TO 31-JAN NET AMT

15 Page 7 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,386 Hours General Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) General Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-OCT-2016 TO 31-JAN NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,044 Hours Pain Anesthesiologst FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2).3 Full Time Equivalent (FTE) Pain Anesthesiologsts under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-APR-2016 TO 31-JAN NET AMT

16 Page 8 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Hours Pain Anesthesiologst FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Pain Anesthesiologst under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-OCT-2016 TO 31-JAN NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,733 Hours Regional Pain Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Regional Pain Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-APR-2016 TO 31-JAN NET AMT

17 Page 9 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,560 Hours Pediatric Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Pediatric Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-MAY-2016 TO 31-JAN NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Hours Pediatric Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Pediatric Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. Period of performance is 01-OCT-2016 TO 31-JAN NET AMT

18 Page 10 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Each CONTRACTOR MANPOWER REPORTING FFP Mandatory Contractor Manpower Reporting in accordance with Performance Work Statement (PWS). This CMR is to collect information for services performed between 1 FEB 30 SEP NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,960 Hours OPTION General Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for 12 Full Time Equivalent (FTE) General Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

19 Page 11 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,013 Hours OPTION Pain Anesthesiologst FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for four (4).3 Full Time Equivalent (FTE) Pain Anesthesiologsts under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,080 Hours OPTION Neuro Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Neuro Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

20 Page 12 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours OPTION Cardio-Thoracic Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Cardio-Thoracic Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours OPTION Regional Pain Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Regional Pain Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

21 Page 13 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,240 Hours OPTION Pediatric Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for three (3) Full Time Equivalent (FTE) Pediatric Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Each OPTION CONTRACTOR MANPOWER REPORTING FFP Mandatory Contractor Manpower Reporting in accordance with Performance Work Statement (PWS). This CMR is to collect information for services performed between 1 OCT SEP NET AMT

22 Page 14 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,960 Hours OPTION General Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for 12 Full Time Equivalent (FTE) General Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,013 Hours OPTION Pain Anesthesiologst FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for four (4).3 Full Time Equivalent (FTE) Pain Anesthesiologsts under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

23 Page 15 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,080 Hours OPTION Neuro Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Neuro Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours OPTION Cardio-Thoracic Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Cardio-Thoracic Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

24 Page 16 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours OPTION Regional Pain Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Regional Pain Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,240 Hours OPTION Pediatric Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for three (3) Full Time Equivalent (FTE) Pediatric Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

25 Page 17 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Each OPTION CONTRACTOR MANPOWER REPORTING FFP Mandatory Contractor Manpower Reporting in accordance with Performance Work Statement (PWS). This CMR is to collect information for services performed between 1 OCT SEP NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,960 Hours OPTION General Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for 12 Full Time Equivalent (FTE) General Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

26 Page 18 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,013 Hours OPTION Pain Anesthesiologst FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for four (4).3 Full Time Equivalent (FTE) Pain Anesthesiologsts under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,080 Hours OPTION Neuro Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Neuro Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

27 Page 19 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours OPTION Cardio-Thoracic Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Cardio-Thoracic Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours OPTION Regional Pain Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Regional Pain Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

28 Page 20 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,240 Hours OPTION Pediatric Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for three (3) Full Time Equivalent (FTE) Pediatric Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Each OPTION CONTRACTOR MANPOWER REPORTING FFP Mandatory Contractor Manpower Reporting in accordance with Performance Work Statement (PWS). This CMR is to collect information for services performed between 1 OCT SEP NET AMT

29 Page 21 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,960 Hours OPTION General Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for 12 Full Time Equivalent (FTE) General Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,013 Hours OPTION Pain Anesthesiologst FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for four (4).3 Full Time Equivalent (FTE) Pain Anesthesiologsts under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

30 Page 22 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,080 Hours OPTION Neuro Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for one (1) Full Time Equivalent (FTE) Neuro Anesthesiologist under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours OPTION Cardio-Thoracic Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Cardio-Thoracic Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

31 Page 23 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,160 Hours OPTION Regional Pain Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for two (2) Full Time Equivalent (FTE) Regional Pain Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT ,240 Hours OPTION Pediatric Anesthesiologist FFP This is a non-personal services contract line item number (CLIN) as defined in FAR for three (3) Full Time Equivalent (FTE) Pediatric Anesthesiologists under the authority of 10 U.S.C and 41 U.S.C Overtime is not authorized for this CLIN. NET AMT

32 Page 24 of 135 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Each OPTION CONTRACTOR MANPOWER REPORTING FFP Mandatory Contractor Manpower Reporting in accordance with Performance Work Statement (PWS). This CMR is to collect information for services performed between 1 OCT SEP NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT Each OPTION CONTRACTOR MANPOWER REPORTING FFP Mandatory Contractor Manpower Reporting in accordance with Performance Work Statement (PWS). This CMR is to collect information for services performed between 1 OCT JAN NET AMT DELIVERY INFORMATION

33 Page 25 of 135 CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC 0001 POP 01-FEB-2016 TO 31-JAN-2017 N/A WALTER REED NATIONAL MILITARY MEDICAL LANA CLOUSER 8901 WISCONSIN AVE BETHESDA MD HT POP 01-FEB-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-APR-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-APR-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-MAY-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-OCT-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-APR-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-OCT-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-APR-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-MAY-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-OCT-2016 TO 31-JAN-2017 N/A (SAME AS PREVIOUS LOCATION) HT0017

34 Page 26 of OCT (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2017 TO 31-JAN-2018 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2017 TO 31-JAN-2018 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2017 TO 31-JAN-2018 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2017 TO 31-JAN-2018 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2017 TO 31-JAN-2018 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2017 TO 31-JAN-2018 N/A (SAME AS PREVIOUS LOCATION) HT OCT (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2018 TO 31-JAN-2019 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2018 TO 31-JAN-2019 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2018 TO 31-JAN-2019 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2018 TO 31-JAN-2019 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2018 TO 31-JAN-2019 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2018 TO 01-FEB-2019 N/A (SAME AS PREVIOUS LOCATION) HT OCT (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2019 TO 31-JAN-2020 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2019 TO 31-JAN-2020 N/A (SAME AS PREVIOUS LOCATION) HT0017

35 Page 27 of POP 01-FEB-2019 TO 31-JAN-2020 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2019 TO 31-JAN-2020 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2019 TO 31-JAN-2020 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2019 TO 31-JAN-2020 N/A (SAME AS PREVIOUS LOCATION) HT OCT (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2020 TO 31-JAN-2021 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2020 TO 31-JAN-2021 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2020 TO 31-JAN-2021 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2020 TO 31-JAN-2021 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2020 TO 31-JAN-2021 N/A (SAME AS PREVIOUS LOCATION) HT POP 01-FEB-2020 TO 31-JAN-2021 N/A (SAME AS PREVIOUS LOCATION) HT OCT (SAME AS PREVIOUS LOCATION) OCT (SAME AS PREVIOUS LOCATION) HT0017 HT0017 INSPECTION AND ACCEPTANCE TERMS Supplies/services will be inspected/accepted at:

36 Page 28 of 135 CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY 0001 Destination Government Destination Government 0002 Destination Government Destination Government 0003 Destination Government Destination Government 0004 Destination Government Destination Government 0005 Destination Government Destination Government 0006 Destination Government Destination Government 0007 Destination Government Destination Government 0008 Destination Government Destination Government 0009 Destination Government Destination Government 0010 Destination Government Destination Government 0011 Destination Government Destination Government 0012 Destination Government Destination Government 0013 Destination Government Destination Government 0014 Destination Government Destination Government 0015 Destination Government Destination Government 1001 Destination Government Destination Government 1002 Destination Government Destination Government 1003 Destination Government Destination Government 1004 Destination Government Destination Government 1005 Destination Government Destination Government 1006 Destination Government Destination Government 1007 Destination Government Destination Government 2001 Destination Government Destination Government 2002 Destination Government Destination Government 2003 Destination Government Destination Government 2004 Destination Government Destination Government 2005 Destination Government Destination Government 2006 Destination Government Destination Government 2007 Destination Government Destination Government 3001 Destination Government Destination Government 3002 Destination Government Destination Government 3003 Destination Government Destination Government 3004 Destination Government Destination Government 3005 Destination Government Destination Government 3006 Destination Government Destination Government 3007 Destination Government Destination Government 4001 Destination Government Destination Government 4002 Destination Government Destination Government 4003 Destination Government Destination Government 4004 Destination Government Destination Government 4005 Destination Government Destination Government 4006 Destination Government Destination Government 4007 Destination Government Destination Government 4008 Destination Government Destination Government CLAUSES INCORPORATED BY REFERENCE

37 Page 29 of Contract Terms and Conditions--Commercial Items MAY 2015 ADDENDUM TO (w) The non-far Part 12 discretionary FAR, DFARS, AFARS, and LOCAL clauses included herein are incorporated into this contract either by reference or in full text. If incorporated by reference, see clause herein for locations where full text can be found. CLAUSES INCORPORATED BY REFERENCE Gratuities APR Alt I Restrictions On Subcontractor Sales To The Government OCT 1995 (Sep 2006) -- Alternate I Limitation On Payments To Influence Certain Federal Transactions OCT Contractor Employee Whistleblower Rights and Requirement APR 2014 To Inform Employees of Whistleblower Rights Printed or Copied Double-Sided on Postconsumer Fiber MAY 2011 Content Paper Personal Identity Verification of Contractor Personnel JAN Reporting Executive Compensation and First-Tier OCT 2015 Subcontract Awards Prohibition on Contracting with Inverted Domestic NOV 2015 Corporations--Representation Protecting the Government's Interest When Subcontracting OCT 2015 With Contractors Debarred, Suspended, or Proposed for Debarment Prohibition on Contracting With Inverted Domestic NOV 2015 Corporations Notice Of Total Small Business Set-Aside NOV Utilization of Small Business Concerns OCT Prohibition Of Segregated Facilities APR Equal Opportunity APR Equal Opportunity for Veterans OCT Equal Opportunity for Workers with Disabilities JUL Employment Reports on Veterans OCT Combating Trafficking in Persons MAR Employment Eligibility Verification OCT Affirmative Procurement of Biobased Products Under Service SEP 2013 and Construction Contracts Hazardous Material Identification And Material Safety Data JAN Pollution Prevention and Right-to-Know Information MAY 2011

38 Page 30 of Encouraging Contractor Policies To Ban Text Messaging AUG 2011 While Driving Privacy Act Notification APR Privacy Act APR Restrictions on Certain Foreign Purchases JUN Insurance - Work On A Government Installation JAN Payment by Electronic Funds Transfer--System for Award JUL 2013 Management Unenforceability of Unauthorized Obligations JUN Providing Accelerated Payments to Small Business DEC 2013 Subcontractors Protest After Award AUG Applicable Law for Breach of Contract Claim OCT Protection Of Government Buildings, Equipment, And APR 1984 Vegetation Continuity Of Services JAN Bankruptcy JUL Contracting Officer's Representative DEC Requirements Relating to Compensation of Former DoD SEP 2011 Officials Requirement to Inform Employees of Whistleblower Rights SEP Agency Office of the Inspector General DEC Disclosure Of Information AUG Control Of Government Personnel Work Product APR Subcontracting With Firms That Are Owned or Controlled By OCT 2015 The Government of a Country that is a State Sponsor of Terrorism Use of Government-Assigned Serial Numbers SEP Preference For Certain Domestic Commodities FEB Export-Controlled Items JUN Electronic Submission of Payment Requests and Receiving JUN 2012 Reports Levies on Contract Payments DEC Pricing Of Contract Modifications DEC Requests for Equitable Adjustment DEC 2012 CLAUSES INCORPORATED BY FULL TEXT CONTRACTOR CODE OF BUSINESS ETHICS AND CONDUCT (OCT 2015) (a) Definitions. As used in this clause-- Agent means any individual, including a director, an officer, an employee, or an independent Contractor, authorized to act on behalf of the organization. Full cooperation

39 Page 31 of 135 (1) Means disclosure to the Government of the information sufficient for law enforcement to identify the nature and extent of the offense and the individuals responsible for the conduct. It includes providing timely and complete response to Government auditors' and investigators' request for documents and access to employees with information; (2) Does not foreclose any Contractor rights arising in law, the FAR, or the terms of the contract. It does not require- - (i) A Contractor to waive its attorney-client privilege or the protections afforded by the attorney work product doctrine; or (ii) Any officer, director, owner, or employee of the Contractor, including a sole proprietor, to waive his or her attorney client privilege or Fifth Amendment rights; and (3) Does not restrict a Contractor from-- (i) Conducting an internal investigation; or (ii) Defending a proceeding or dispute arising under the contract or related to a potential or disclosed violation. 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). Subcontract means any contract entered into by a subcontractor to furnish supplies or services for performance of a prime contract or a subcontract. Subcontractor means any supplier, distributor, vendor, or firm that furnished supplies or services to or for a prime contractor or another subcontractor. United States means the 50 States, the District of Columbia, and outlying areas. (b) Code of business ethics and conduct. (1) Within 30 days after contract award, unless the Contracting Officer establishes a longer time period, the Contractor shall-- (i) Have a written code of business ethics and conduct; (ii) Make a copy of the code available to each employee engaged in performance of the contract. (2) The Contractor shall-- (i) Exercise due diligence to prevent and detect criminal conduct; and (ii) Otherwise promote an organizational culture that encourages ethical conduct and a commitment to compliance with the law. (3)(i) The Contractor shall timely disclose, in writing, to the agency Office of the Inspector General (OIG), with a copy to the Contracting Officer, whenever, in connection with the award, performance, or closeout of this contract or any subcontract thereunder, the Contractor has credible evidence that a principal, employee, agent, or subcontractor of the Contractor has committed--

40 Page 32 of 135 (A) A violation of Federal criminal law involving fraud, conflict of interest, bribery, or gratuity violations found in Title 18 of the United States Code; or (B) A violation of the civil False Claims Act (31 U.S.C ). (ii) The Government, to the extent permitted by law and regulation, will safeguard and treat information obtained pursuant to the Contractor's disclosure as confidential where the information has been marked confidential or proprietary by the company. To the extent permitted by law and regulation, such information will not be released by the Government to the public pursuant to a Freedom of Information Act request, 5 U.S.C. Section 552, without prior notification to the Contractor. The Government may transfer documents provided by the Contractor to any department or agency within the Executive Branch if the information relates to matters within the organization's jurisdiction. (iii) If the violation relates to an order against a Governmentwide acquisition contract, a multi-agency contract, a multiple-award schedule contract such as the Federal Supply Schedule, or any other procurement instrument intended for use by multiple agencies, the Contractor shall notify the OIG of the ordering agency and the IG of the agency responsible for the basic contract. (c) Business ethics awareness and compliance program and internal control system. This paragraph (c) does not apply if the Contractor has represented itself as a small business concern pursuant to the award of this contract or if this contract is for the acquisition of a commercial item as defined at FAR The Contractor shall establish the following within 90 days after contract award, unless the Contracting Officer establishes a longer time period: (1) An ongoing business ethics awareness and compliance program. (i) This program shall include reasonable steps to communicate periodically and in a practical manner the Contractor's standards and procedures and other aspects of the Contractor's business ethics awareness and compliance program and internal control system, by conducting effective training programs and otherwise disseminating information appropriate to an individual's respective roles and responsibilities. (ii) The training conducted under this program shall be provided to the Contractor's principals and employees, and as appropriate, the Contractor's agents and subcontractors. (2) An internal control system. (i) The Contractor's internal control system shall-- (A) Establish standards and procedures to facilitate timely discovery of improper conduct in connection with Government contracts; and (B) Ensure corrective measures are promptly instituted and carried out. (ii) At a minimum, the Contractor's internal control system shall provide for the following: (A) Assignment of responsibility at a sufficiently high level and adequate resources to ensure effectiveness of the business ethics awareness and compliance program and internal control system. (B) Reasonable efforts not to include an individual as a principal, whom due diligence would have exposed as having engaged in conduct that is in conflict with the Contractor's code of business ethics and conduct.

41 Page 33 of 135 (C) Periodic reviews of company business practices, procedures, policies, and internal controls for compliance with the Contractor's code of business ethics and conduct and the special requirements of Government contracting, including-- (1) Monitoring and auditing to detect criminal conduct; (2) Periodic evaluation of the effectiveness of the business ethics awareness and compliance program and internal control system, especially if criminal conduct has been detected; and (3) Periodic assessment of the risk of criminal conduct, with appropriate steps to design, implement, or modify the business ethics awareness and compliance program and the internal control system as necessary to reduce the risk of criminal conduct identified through this process. (D) An internal reporting mechanism, such as a hotline, which allows for anonymity or confidentiality, by which employees may report suspected instances of improper conduct, and instructions that encourage employees to make such reports. (E) Disciplinary action for improper conduct or for failing to take reasonable steps to prevent or detect improper conduct. (F) Timely disclosure, in writing, to the agency OIG, with a copy to the Contracting Officer, whenever, in connection with the award, performance, or closeout of any Government contract performed by the Contractor or a subcontractor thereunder, the Contractor has credible evidence that a principal, employee, agent, or subcontractor of the Contractor has committed a violation of Federal criminal law involving fraud, conflict of interest, bribery, or gratuity violations found in Title 18 U.S.C. or a violation of the civil False Claims Act (31 U.S.C ). (1) If a violation relates to more than one Government contract, the Contractor may make the disclosure to the agency OIG and Contracting Officer responsible for the largest dollar value contract impacted by the violation. (2) If the violation relates to an order against a Governmentwide acquisition contract, a multi-agency contract, a multiple-award schedule contract such as the Federal Supply Schedule, or any other procurement instrument intended for use by multiple agencies, the contractor shall notify the OIG of the ordering agency and the IG of the agency responsible for the basic contract, and the respective agencies' contracting officers. (3) The disclosure requirement for an individual contract continues until at least 3 years after final payment on the contract. (4) The Government will safeguard such disclosures in accordance with paragraph (b)(3)(ii) of this clause. (G) Full cooperation with any Government agencies responsible for audits, investigations, or corrective actions. (d) Subcontracts. (1) The Contractor shall include the substance of this clause, including this paragraph (d), in subcontracts that have a value in excess of $5.5 million and a performance period of more than 120 days. (2) In altering this clause to identify the appropriate parties, all disclosures of violation of the civil False Claims Act or of Federal criminal law shall be directed to the agency Office of the Inspector General, with a copy to the Contracting Officer. (End of clause)

42 Page 34 of UPDATES OF PUBLICLY AVAILABLE INFORMATION REGARDING RESPONSIBILITY MATTERS (JULY 2013) (a) The Contractor shall update the information in the Federal Awardee Performance and Integrity Information System (FAPIIS) on a semi-annual basis, throughout the life of the contract, by posting the required information in the System for Award Management database via (b) As required by section 3010 of the Supplemental Appropriations Act, 2010 (Pub. L ), all information posted in FAPIIS on or after April 15, 2011, except past performance reviews, will be publicly available. FAPIIS consists of two segments-- (1) The non-public segment, into which Government officials and the Contractor post information, which can only be viewed by-- (i) Government personnel and authorized users performing business on behalf of the Government; or (ii) The Contractor, when viewing data on itself; and (2) The publicly-available segment, to which all data in the non-public segment of FAPIIS is automatically transferred after a waiting period of 14 calendar days, except for-- (i) Past performance reviews required by subpart 42.15; (ii) Information that was entered prior to April 15, 2011; or (iii) Information that is withdrawn during the 14-calendar-day waiting period by the Government official who posted it in accordance with paragraph (c)(1) of this clause. (c) The Contractor will receive notification when the Government posts new information to the Contractor's record. (1) If the Contractor asserts in writing within 7 calendar days, to the Government official who posted the information, that some of the information posted to the non-public segment of FAPIIS is covered by a disclosure exemption under the Freedom of Information Act, the Government official who posted the information must within 7 calendar days remove the posting from FAPIIS and resolve the issue in accordance with agency Freedom of Information procedures, prior to reposting the releasable information. The contractor must cite and request removal within 7 calendar days of the posting to FAPIIS. (2) The Contractor will also have an opportunity to post comments regarding information that has been posted by the Government. The comments will be retained as long as the associated information is retained, i.e., for a total period of 6 years. Contractor comments will remain a part of the record unless the Contractor revises them. (3) As required by section 3010 of Pub. L , all information posted in FAPIIS on or after April 15, 2011, except past performance reviews, will be publicly available. (d) Public requests for system information posted prior to April 15, 2011, will be handled under Freedom of Information Act procedures, including, where appropriate, procedures promulgated under E.O (End of clause)

43 Page 35 of 135 CLAUSES INCORPORATED BY FULL TEXT 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 no later than 30 days before the contract expires. (End of clause) CLAUSES INCORPORATED BY FULL TEXT 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 no later than 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 66 months. (End of clause) CLAUSES INCORPORATED BY FULL TEXT NOTIFICATION OF COMPETITION LIMITED TO ELIGIBLE 8(A) CONCERNS (JUN 2003) (a) Offers are solicited only from small business concerns expressly certified by the Small Business Administration (SBA) for participation in the SBA's 8(a) Program and which meet the following criteria at the time of submission of offer-- (1) The Offeror is in conformance with the 8(a) support limitation set forth in its approved business plan; and (2) The Offeror is in conformance with the Business Activity Targets set forth in its approved business plan or any remedial action directed by the SBA.

44 Page 36 of 135 (b) By submission of its offer, the Offeror represents that it meets all of the criteria set forth in paragraph (a) of this clause. (c) Any award resulting from this solicitation will be made to the Small Business Administration, which will subcontract performance to the successful 8(a) offeror selected through the evaluation criteria set forth in this solicitation. (d)(1) Agreement. A small business concern submitting an offer in its own name shall furnish, in performing the contract, only end items manufactured or produced by small business concerns in the United States or its outlying areas. If this procurement is processed under simplified acquisition procedures and the total amount of this contract does not exceed $25,000, a small business concern may furnish the product of any domestic firm. This paragraph does not apply to construction or service contracts. (2) The insert name of SBA's contractor : will notify the Defense Health Agency Contract Operating Division National Capital Region Contracting Officer in writing immediately upon entering an agreement (either oral or written) to transfer all or part of its stock or other ownership interest to any other party. (End of clause) POST-AWARD SMALL BUSINESS PROGRAM REREPRESENTATION (JULY 2013) (a) Definitions. As used in this clause-- Long-term contract means a contract of more than five years in duration, including options. However, the term does not include contracts that exceed five years in duration because the period of performance has been extended for a cumulative period not to exceed six months under the clause at , Option to Extend Services, or other appropriate authority. 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 the size standard in paragraph (c) of this clause. Such a concern is ``not dominant in its field of operation'' when it does not exercise a controlling or major influence on a national basis in a kind of business activity in which a number of business concerns are primarily engaged. In determining whether dominance exists, consideration shall be given to all appropriate factors, including volume of business, number of employees, financial resources, competitive status or position, ownership or control of materials, processes, patents, license agreements, facilities, sales territory, and nature of business activity. (b) If the Contractor represented that it was a small business concern prior to award of this contract, the Contractor shall rerepresent its size status according to paragraph (e) of this clause or, if applicable, paragraph (g) of this clause, upon the occurrence of any of the following: (1) Within 30 days after execution of a novation agreement or within 30 days after modification of the contract to include this clause, if the novation agreement was executed prior to inclusion of this clause in the contract. (2) Within 30 days after a merger or acquisition that does not require a novation or within 30 days after modification of the contract to include this clause, if the merger or acquisition occurred prior to inclusion of this clause in the contract.

45 Page 37 of 135 (3) For long-term contracts-- (i) Within 60 to 120 days prior to the end of the fifth year of the contract; and (ii) Within 60 to 120 days prior to the date specified in the contract for exercising any option thereafter. (c) The Contractor shall rerepresent its size status in accordance with the size standard in effect at the time of this rerepresentation that corresponds to the North American Industry Classification System (NAICS) code assigned to this contract. The small business size standard corresponding to this NAICS code can be found at (d) The small business size standard for a Contractor providing a product which it does not manufacture itself, for a contract other than a construction or service contract, is 500 employees. (e) Except as provided in paragraph (g) of this clause, the Contractor shall make the representation required by paragraph (b) of this clause by validating or updating all its representations in the Representations and Certifications section of the System for Award Management (SAM) and its other data in SAM, as necessary, to ensure that they reflect the Contractor's current status. The Contractor shall notify the contracting office in writing within the timeframes specified in paragraph (b) of this clause that the data have been validated or updated, and provide the date of the validation or update. (f) If the Contractor represented that it was other than a small business concern prior to award of this contract, the Contractor may, but is not required to, take the actions required by paragraphs (e) or (g) of this clause. (g) If the Contractor does not have representations and certifications in SAM, or does not have a representation in SAM for the NAICS code applicable to this contract, the Contractor is required to complete the following rerepresentation and submit it to the contracting office, along with the contract number and the date on which the rerepresentation was completed: The Contractor represents that it ( X) is, ( ) is not a small business concern under NAICS Code assigned to contract numberht q Contractor to sign and date and insert authorized signer's name and title: (End of clause) NONDISPLACEMENT OF QUALIFIED WORKERS (MAY 2014) (a) Service employee, as used in this clause, means any person engaged in the performance of a service contract other than any person employed in a bona fide executive, administrative, or professional capacity, as those terms are defined in 29 CFR part 541. The term ``service employee'' includes all such persons regardless of any contractual relationship that may be alleged to exist between a contractor or subcontractor and such persons. (b) The Contractor and its subcontractors shall, except as otherwise provided herein, in good faith offer those service employees employed under the predecessor contract whose employment will be terminated as a result of award of

46 Page 38 of 135 this contract or the expiration of the contract under which the service employees were hired, a right of first refusal of employment under this contract in positions for which the service employees are qualified. (1) The Contractor and its subcontractors shall determine the number of service employees necessary for efficient performance of this contract and may elect to employ fewer employees than the predecessor Contractor employed in connection with performance of the work. (2) Except as provided in paragraph (c) of this clause, there shall be no employment opening under this contract, and the Contractor and any subcontractors shall not offer employment under this contract, to any person prior to having complied fully with this obligation. (i) The successor Contractor and its subcontractors shall make a bona fide express offer of employment to each service employee as provided herein and shall state the time within which the service employee must accept such offer, but in no case shall the period within which the service employee must accept the offer of employment be less than 10 days. (ii) The successor Contractor and its subcontractors shall decide any question concerning a service employee's qualifications based upon the individual's education and employment history, with particular emphasis on the employee's experience on the predecessor contract, and the Contractor may utilize employment screening processes only when such processes are provided for by the contracting agency, are conditions of the service contract, and are consistent with Executive Order (iii) Where the successor Contractor does not initially offer employment to all the predecessor contract service employees, the obligation to offer employment shall continue for 90 days after the successor contractor's first date of performance on the contract. (iv) An offer of employment will be presumed to be bona fide even if it is not for a position similar to the one the employee previously held, but is one for which the employee is qualified, and even if it is subject to different employment terms and conditions, including changes to pay or benefits. (See 29 CFR 9.12 for a detailed description of a bonafide offer of employment). (c)(1) Notwithstanding the obligation under paragraph (b) of this clause, the successor Contractor and any subcontractors (i) may employ under this contract any service employee who has worked for the contractor or subcontractor for at least three months immediately preceding the commencement of this contract and who would otherwise face lay-off or discharge, (ii) are not required to offer a right of first refusal to any service employee(s) of the predecessor contractor who are not service employees within the meaning of the Service Contract Labor Standards statute, 41 U.S.C. 6701(3), and (iii) are not required to offer a right of first refusal to any service employee(s) of the predecessor contractor whom the Contractor or any of its subcontractors reasonably believes, based on the particular service employee's past performance, has failed to perform suitably on the job (see 29 CFR 9.12(c)(4) for additional information). The successor Contractor bears the responsibility of demonstrating the appropriateness of claiming any of these exceptions. (2) In addition, any Contractor or subcontractor that has been certified by the U.S. Small Business Administration as a HUBZone small business concern must ensure that it complies with the statutory and regulatory requirements of the HUBZone Program (e.g., it must ensure that at least 35 percent of all of its employees reside within a HUBZone). The HUBZone small business Contractor or subcontractor must consider whether it can meet the requirements of this clause and Executive Order while also ensuring it meets the HUBZone Program's requirements.

47 Page 39 of 135 (3) Nothing in this clause shall be construed to permit a Contractor or subcontractor to fail to comply with any provision of any other Executive order or law. For example, the requirements of the HUBZone Program (see FAR subpart 19.13), Executive Order (Equal Employment Opportunity), and the Vietnam Era Veterans' Readjustment Assistance Act of 1974 may conflict, in certain circumstances, with the requirements of Executive Order All applicable laws and Executive orders must be satisfied in tandem with, and if necessary prior to, the requirements of Executive Order 13495, 29 CFR part 9, and this clause. (d)(1) The Contractor shall, not less than 30 days before completion of the Contractor's performance of services on the contract, furnish the Contracting Officer with a certified list of the names of all service employees working under this contract and its subcontracts at the time the list is submitted. The list shall also contain anniversary dates of employment of each service employee under this contract and its predecessor contracts with either the current or predecessor contractors or their subcontractors. Where changes to the workforce are made after the submission of the certified list described in this paragraph, the Contractor shall, in accordance with paragraph (e) of this clause, not less than 10 days before completion of the services on this contract, furnish the Contracting Officer with an updated certified list of the names of all service employees employed within the last month of contract performance. The updated list shall also contain anniversary dates of employment, and, where applicable, dates of separation of each service employee under the contract and its predecessor contracts with either the current or predecessor Contractors or their subcontractors. (2) Immediately upon receipt of the certified service employee list but not before contract award, the contracting officer shall provide the certified service employee list to the successor contractor, and, if requested, to employees of the predecessor contractor or subcontractors or their authorized representatives. (3) The Contracting Officer will direct the predecessor Contractor to provide written notice (Appendix B to 29 CFR chapter 9) to service employees of their possible right to an offer of employment with the successor contractor. Where a significant portion of the predecessor Contractor's workforce is not fluent in English, the notice shall be provided in English and the language(s) with which service employees are more familiar. The written notice shall be (i) Posted in a conspicuous place at the worksite; or (ii) Delivered to the service employees individually. If such delivery is via , the notification must result in an electronic delivery receipt or some other reliable confirmation that the intended recipient received the notice. (e)(1) If required in accordance with (n), the predecessor Contractor shall, not less than 10 days before completion of this contract, furnish the Contracting Officer a certified list of the names of all service employees working under this contract and its subcontracts during the last month of contract performance. The list shall also contain anniversary dates of employment of each service employee under this contract and its predecessor contracts either with the current or predecessor Contractors or their subcontractors. If there are no changes to the workforce before the predecessor contract is completed, then the predecessor Contractor is not required to submit a revised list 10 days prior to completion of performance and the requirements of (n) are met. When there are changes to the workforce after submission of the 30-day list, the predecessor Contractor shall submit a revised certified list not less than 10 days prior to performance completion. (2) Immediately upon receipt of the certified service employee list but not before contract award, the contracting officer shall provide the certified service employee list to the successor contractor, and, if requested, to employees of the predecessor contractor or subcontractors or their authorized representatives. (f) The Contractor and subcontractor shall maintain the following records (regardless of format, e.g., paper or electronic) of its compliance with this clause for not less than a period of three years from the date the records were created.

48 Page 40 of 135 (1) Copies of any written offers of employment or a contemporaneous written record of any oral offers of employment, including the date, location, and attendance roster of any service employee meeting(s) at which the offers were extended, a summary of each meeting, a copy of any written notice that may have been distributed, and the names of the service employees from the predecessor contract to whom an offer was made. (2) A copy of any record that forms the basis for any exemption claimed under this part. (3) A copy of the service employee list provided to or received from the contracting agency. (4) An entry on the pay records of the amount of any retroactive payment of wages or compensation under the supervision of the Administrator of the Wage and Hour Division to each service employee, the period covered by such payment, and the date of payment, and a copy of any receipt form provided by or authorized by the Wage and Hour Division. The Contractor shall also deliver a copy of the receipt to the service employee and file the original, as evidence of payment by the Contractor and receipt by the service employee, with the Administrator or an authorized representative within 10 days after payment is made. (g) Disputes concerning the requirements of this clause shall not be subject to the general disputes clause ( ) of this contract. Such disputes shall be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR part 9. Disputes within the meaning of this clause include disputes between or among any of the following: The Contractor, the contracting agency, the U.S. Department of Labor, and the service employees under the contract or its predecessor contract. The Contracting Officer will refer any service employee who wishes to file a complaint, or ask questions concerning this contract clause, to the: Branch of Government Contracts Enforcement, Wage and Hour Division, U.S. Department of Labor, 200 Constitution Avenue NW., Washington, DC Contact displaced@dol.gov. (h) The Contractor shall cooperate in any review or investigation by the Department of Labor into possible violations of the provisions of this clause and shall make such records requested by such official(s) available for inspection, copying, or transcription upon request. (i) If it is determined, pursuant to regulations issued by the Secretary of Labor (Secretary), that the Contractor or its subcontractors are not in compliance with the requirements of this clause or any regulation or order of the Secretary, appropriate sanctions may be imposed and remedies invoked against the Contractor or its subcontractors, as provided in Executive Order 13495, the regulations, and relevant orders of the Secretary, or as otherwise provided by law. (j) The Contractor shall take such action with respect to any such subcontract as may be directed by the Secretary of Labor as a means of enforcing such provisions, including the imposition of sanctions for noncompliance. However, if the Contractor, as a result of such direction, becomes involved in litigation with a subcontractor, or is threatened with such involvement, the Contractor may request that the United States, through the Secretary, enter into such litigation to protect the interests of the United States. (k) The Contracting Officer will withhold, or cause to be withheld, from the prime Contractor under this or any other Government contract with the same prime Contractor, such sums as an authorized official of the Department of Labor requests, upon a determination by the Administrator, the Administrative Law Judge, or the Administrative Review Board, that there has been a failure to comply with the terms of this clause and that wages lost as a result of the violations are due to service employees or that other monetary relief is appropriate. If the Contracting Officer or the Administrator, upon final order of the Secretary, finds that the Contractor has failed to provide a list of the names of service employees working under the contract, the Contracting Officer may, in his or her discretion, or upon request by the Administrator, take such action as may be necessary to cause the suspension of the payment of contract funds until such time as the list is provided to the Contracting Officer.

49 Page 41 of 135 (l) Subcontracts. In every subcontract over the simplified acquisition threshold entered into in order to perform services under this contract, the Contractor shall include a provision that ensures (1) That each subcontractor will honor the requirements of paragraphs (b) through (c) of this clause with respect to the service employees of a predecessor subcontractor or subcontractors working under this contract, as well as of a predecessor Contractor and its subcontractors; (2) That the subcontractor will provide the Contractor with the information about the service employees of the subcontractor needed by the Contractor to comply with paragraphs (d) and (e) of this clause; and (3) The recordkeeping requirements of paragraph (f) of this clause. CLAUSES INCORPORATED BY FULL TEXT AVAILABILITY OF FUNDS (APR 1984) Funds are not presently available for this contract. The Government's obligation under this contract 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 until funds are made available to the Contracting Officer for this contract and until the Contractor receives notice of such availability, to be confirmed in writing by the Contracting Officer. (End of clause) CLAUSES INCORPORATED BY FULL TEXT PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS SUBCONTRACTORS (DEC 2013) (a) Upon receipt of accelerated payments from the Government, the Contractor shall make accelerated payments to its small business subcontractors under this contract, to the maximum extent practicable and prior to when such payment is otherwise required under the applicable contract or subcontract, after receipt of a proper invoice and all other required documentation from the small business subcontractor. (b) The acceleration of payments under this clause does not provide any new rights under the Prompt Payment Act. (c) Include the substance of this clause, including this paragraph (c), in all subcontracts with small business concerns, including subcontracts with small business concerns for the acquisition of commercial items. (End of clause)

50 Page 42 of INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 1997) (a) It is expressly agreed and understood that this is a nonpersonal services contract, as defined in Federal Acquisition Regulation (FAR) , under which the professional services rendered by the Contractor 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 professional medical judgment, diagnosis, or specific medical treatments. The Contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by it or by its employees or agents. The Contractor shall maintain during the term of this contract liability insurance issued by a responsible insurance carrier of not less than the following amount(s) per specialty per occurrence: $1,000, per occurrence / $3,000, aggregate. (b) An apparently successful offeror, upon request by the Contracting Officer, shall furnish prior to contract award evidence of its insurability concerning the medical liability insurance required by paragraph (a) of this clause. (c) Liability insurance may be on either an occurrences basis or on a claims-made basis. If the policy is on a claimsmade basis, an extended reporting endorsement (tail) for a period of not less than 3 years after the end of the contract term must also be provided. (d) Evidence of insurance documenting the required coverage for each health care provider who will perform under this contract shall be provided to the Contracting Officer prior to the commencement of services under this contract. If the insurance is on a claims-made basis and evidence of an extended reporting endorsement is not provided prior to the commencement of services, evidence of such endorsement shall be provided to the Contracting Officer prior to the expiration of this contract. Final payment under this contract shall be withheld until evidence of the extended reporting endorsement is provided to the Contracting Officer. (e) The policies evidencing required insurance shall also contain an endorsement to the effect 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. If, during the performance period of the contract the Contractor changes insurance providers, the Contractor must provide evidence that the Government will be indemnified to the limits specified in paragraph (a) of this clause, for the entire period of the contract, either under the new policy, or a combination of old and new policies. (f) The Contractor shall insert the substance of this clause, including this paragraph (f), in all subcontracts under this contract for health care services and shall require such subcontractors to provide evidence of and maintain insurance in accordance with paragraph (a) of this clause. At least 5 days before the commencement of work by any subcontractor, the Contractor shall furnish to the Contracting Officer evidence of such insurance. Contracting Officer insert the dollar value(s) of standard coverage(s) prevailing within the local community as to the specific medical specialty, or specialties, concerned, or such higher amount as the Contracting Officer deems necessary to protect the Government's interests. (End of clause) CLAUSES INCORPORATED BY FULL TEXT

51 Page 43 of 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): (End of clause) CLAUSES INCORPORATED BY FULL TEXT AUTHORIZED DEVIATIONS IN CLAUSES (APR 1984) (a) The use in this solicitation or contract of any Federal Acquisition Regulation (48 CFR Chapter 1) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the date of the clause. (b) The use in this solicitation or contract of any DoD Supplement (48 CFR Chapter 2) clause with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation. (End of clause) CLAUSES INCORPORATED BY FULL TEXT SAFEGUARDING COVERED DEFENSE INFORMATION AND CYBER INCIDENT REPORTING (SEPT 2015) (a) Definitions. As used in this clause-- Adequate security means protective measures that are commensurate with the consequences and probability of loss, misuse, or unauthorized access to, or modification of information. Compromise means disclosure of information to unauthorized persons, or a violation of the security policy of a system, in which unauthorized intentional or unintentional disclosure, modification, destruction, or loss of an object, or the copying of information to unauthorized media may have occurred. Contractor attributional/proprietary information means information that identifies the contractor(s), whether directly or indirectly, by the grouping of information that can be traced back to the contractor(s) (e.g., program description, facility locations), personally identifiable information, as well as trade secrets, commercial or financial information, or other commercially sensitive information that is not customarily shared outside of the company. Contractor information system means an information system belonging to, or operated by or for, the Contractor.

52 Page 44 of 135 Controlled technical information means technical information with military or space application that is subject to controls on the access, use, reproduction, modification, performance, display, release, disclosure, or dissemination. Controlled technical information would meet the criteria, if disseminated, for distribution statements B through F using the criteria set forth in DoD Instruction , Distribution Statements on Technical Documents. The term does not include information that is lawfully publicly available without restrictions. Covered contractor information system means an information system that is owned, or operated by or for, a contractor and that processes, stores, or transmits covered defense information. Covered defense information means unclassified information that-- (i) Is-- (A) Provided to the contractor by or on behalf of DoD in connection with the performance of the contract; or (B) Collected, developed, received, transmitted, used, or stored by or on behalf of the contractor in support of the performance of the contract; and (ii) Falls in any of the following categories: (A) Controlled technical information. (B) Critical information (operations security). Specific facts identified through the Operations Security process about friendly intentions, capabilities, and activities vitally needed by adversaries for them to plan and act effectively so as to guarantee failure or unacceptable consequences for friendly mission accomplishment (part of Operations Security process). (C) Export control. Unclassified information concerning certain items, commodities, technology, software, or other information whose export could reasonably be expected to adversely affect the United States national security and nonproliferation objectives. To include dual use items; items identified in export administration regulations, international traffic in arms regulations and munitions list; license applications; and sensitive nuclear technology information. (D) Any other information, marked or otherwise identified in the contract, that requires safeguarding or disseminationcontrols pursuant to and consistent with law, regulations, and Governmentwide policies (e.g., privacy, proprietary business information). Cyber incident means actions taken through the use of computer networks that result in an actual or potentially adverse effect on an information system and/or the information residing therein. Forensic analysis means the practice of gathering, retaining, and analyzing computer-related data for investigative purposes in a manner that maintains the integrity of the data. Malicious software means computer software or firmware intended to perform an unauthorized process that will have adverse impact on the confidentiality, integrity, or availability of an information system. This definition includes a virus, worm, Trojan horse, or other code-based entity that infects a host, as well as spyware and some forms of adware. Media means physical devices or writing surfaces including, but is not limited to, magnetic tapes, optical disks, magnetic disks, large-scale integration memory chips, and printouts onto which information is recorded, stored, or printed within an information system.

53 Page 45 of 135 Operationally critical support means supplies or services designated by the Government as critical for airlift, sealift, intermodal transportation services, or logistical support that is essential to the mobilization, deployment, or sustainment of the Armed Forces in a contingency operation. Rapid(ly) report(ing) means within 72 hours of discovery of any cyber incident. Technical information means technical data or computer software, as those terms are defined in the clause at DFARS , Rights in Technical Data-Non Commercial Items, regardless of whether or not the clause is incorporated in this solicitation or contract. Examples of technical information include research and engineering data, engineering drawings, and associated lists, specifications, standards, process sheets, manuals, technical reports, technical orders, catalog-item identifications, data sets, studies and analyses and related information, and computer software executable code and source code. (b) Adequate security. The Contractor shall provide adequate security for all covered defense information on all covered contractor information systems that support the performance of work under this contract. To provide adequate security, the Contractor shall-- (1) Implement information systems security protections on all covered contractor information systems including, at a minimum-- (i) For covered contractor information systems that are part of an Information Technology (IT) service or system operated on behalf of the Government-- (A) Cloud computing services shall be subject to the security requirements specified in the clause , Cloud Computing Services, of this contract; and (B) Any other such IT service or system (i.e., other than cloud computing) shall be subject to the security requirements specified elsewhere in this contract; or (ii) For covered contractor information systems that are not part of an IT service or system operated on behalf of the Government and therefore are not subject to the security requirement specified at paragraph (b)(1)(i) of this clause-- (A) The security requirements in National Institute of Standards and Technology (NIST) Special Publication (SP) , ``Protecting Controlled Unclassified Information in Nonfederal Information Systems and Organizations, that is in effect at the time the solicitation is issued or as authorized by the Contracting Officer; or (B) Alternative but equally effective security measures used to compensate for the inability to satisfy a particular requirement and achieve equivalent protection approved in writing by an authorized representative of the DoD CIO prior to contract award; and (2) Apply other security measures when the Contractor reasonably determines that such measures, in addition to those identified in paragraph (b)(1) of this clause, may be required to provide adequate security in a dynamic environment based on an assessed risk or vulnerability. (c) Cyber incident reporting requirement. (1) When the Contractor discovers a cyber incident that affects a covered contractor information system or the covered defense information residing therein, or that affects the contractor's ability to perform the requirements of the contract that are designated as operationally critical support, the Contractor shall--

54 Page 46 of 135 (i) Conduct a review for evidence of compromise of covered defense information, including, but not limited to, identifying compromised computers, servers, specific data, and user accounts. This review shall also include analyzing covered contractor information system(s) that were part of the cyber incident, as well as other information systems on the Contractor's network(s), that may have been accessed as a result of the incident in order to identify compromised covered defense information, or that affect the Contractor's ability to provide operationally critical support; and (ii) Rapidly report cyber incidents to DoD at (2) Cyber incident report. The cyber incident report shall be treated as information created by or for DoD and shall include, at a minimum, the required elements at (3) Medium assurance certificate requirement. In order to report cyber incidents in accordance with this clause, the Contractor or subcontractor shall have or acquire a DoD-approved medium assurance certificate to report cyber incidents. For information on obtaining a DoD-approved medium assurance certificate, see (d) Malicious software. The Contractor or subcontractors that discover and isolate malicious software in connection with a reported cyber incident shall submit the malicious software in accordance with instructions provided by the Contracting Officer. (e) Media preservation and protection. When a Contractor discovers a cyber incident has occurred, the Contractor shall preserve and protect images of all known affected information systems identified in paragraph (c)(1)(i) of this clause and all relevant monitoring/packet capture data for at least 90 days from the submission of the cyber incident report to allow DoD to request the media or decline interest. (f) Access to additional information or equipment necessary for forensic analysis. Upon request by DoD, the Contractor shall provide DoD with access to additional information or equipment that is necessary to conduct a forensic analysis. (g) Cyber incident damage assessment activities. If DoD elects to conduct a damage assessment, the Contracting Officer will request that the Contractor provide all of the damage assessment information gathered in accordance with paragraph (e) of this clause. (h) DoD safeguarding and use of contractor attributional/proprietary information. The Government shall protect against the unauthorized use or release of information obtained from the contractor (or derived from information obtained from the contractor) under this clause that includes contractor attributional/proprietary information, including such information submitted in accordance with paragraph (c). To the maximum extent practicable, the Contractor shall identify and mark attributional/proprietary information. In making an authorized release of such information, the Government will implement appropriate procedures to minimize the contractor attributional/proprietary information that is included in such authorized release, seeking to include only that information that is necessary for the authorized purpose(s) for which the information is being released. (i) Use and release of contractor attributional/proprietary information not created by or for DoD. Information that is obtained from the contractor (or derived from information obtained from the contractor) under this clause that is not created by or for DoD is authorized to be released outside of DoD-- (1) To entities with missions that may be affected by such information; (2) To entities that may be called upon to assist in the diagnosis, detection, or mitigation of cyber incidents;

55 Page 47 of 135 (3) To Government entities that conduct counterintelligence or law enforcement investigations; (4) For national security purposes, including cyber situational awareness and defense purposes (including with Defense Industrial Base (DIB) participants in the program at 32 CFR part 236); or (5) To a support services contractor (``recipient'') that is directly supporting Government activities under a contract that includes the clause at , Limitations on the Use or Disclosure of Third-Party Contractor Reported Cyber Incident Information. (j) Use and release of contractor attributional/proprietary information created by or for DoD. Information that is obtained from the contractor (or derived from information obtained from the contractor) under this clause that is created by or for DoD (including the information submitted pursuant to paragraph (c) of this clause) is authorized to be used and released outside of DoD for purposes and activities authorized by paragraph (i) of this clause, and for any other lawful Government purpose or activity, subject to all applicable statutory, regulatory, and policy based restrictions on the Government's use and release of such information. (k) The Contractor shall conduct activities under this clause in accordance with applicable laws and regulations on the interception, monitoring, access, use, and disclosure of electronic communications and data. (l) Other safeguarding or reporting requirements. The safeguarding and cyber incident reporting required by this clause in no way abrogates the Contractor's responsibility for other safeguarding or cyber incident reporting pertaining to its unclassified information systems as required by other applicable clauses of this contract, or as a result of other applicable U.S. Government statutory or regulatory requirements. (m) Subcontracts. The Contractor shall-- (1) Include the substance of this clause, including this paragraph (m), in all subcontracts, including subcontracts for commercial items; and (2) Require subcontractors to rapidly report cyber incidents directly to DoD at and the prime Contractor. This includes providing the incident report number, automatically assigned by DoD, to the prime Contractor (or next higher-tier subcontractor) as soon as practicable. (End of clause) ALTERNATE A (JUN 1998) (a) Offers are solicited only from small business concerns expressly certified by the Small Business Administration (SBA) for participation in the SBA's 8(a) Program and which meet the following criteria at the time of submission of offer-- (1) The Offeror is in conformance with the 8(a) support limitation set forth in its approved business plan; and (2) The Offeror is in conformance with the Business Activity Targets set forth in its approved business plan or any remedial action directed by the SBA.

56 Page 48 of 135 (b) By submission of its offer, the Offeror represents that it meets all of the criteria set forth in paragraph (a) of this clause. (c) Any award resulting from this solicitation will be made directly by the Contracting Officer to the successful 8(a) offeror selected through the evaluation criteria set forth in this solicitation. (d)(1) Agreement. A small business concern submitting an offer in its own name shall furnish, in performing the contract, only end items manufactured or produced by small business concerns in the United States or its outlying areas. If this procurement is processed under simplified acquisition procedures and the total amount of this contract does not exceed $25,000, a small business concern may furnish the product of any domestic firm. This paragraph does not apply to construction or service contracts. (2) The (insert name of SBA's contractor) will notify the Defense Health Agency Contract Operating Division National Capital Region Contracting Officer in writing immediately upon entering an agreement (either oral or written) to transfer all or part of its stock or other ownership interest to any other party. (End of clause) CONTINUATION OF ESSENTIAL CONTRACTOR SERVICES (OCT 2010) (a) Definitions. As used in this clause- (1) Essential contractor service means a service provided by a firm or individual under contract to DoD to support mission-essential functions, such as support of vital systems, including ships owned, leased, or operated in support of military missions or roles at sea; associated support activities, including installation, garrison, and base support services; and similar services provided to foreign military sales customers under the Security Assistance Program. Services are essential if the effectiveness of defense systems or operations has the potential to be seriously impaired by the interruption of these services, as determined by the appropriate functional commander or civilian equivalent. (2) Mission-essential functions means those organizational activities that must be performed under all circumstances to achieve DoD component missions or responsibilities, as determined by the appropriate functional commander or civilian equivalent. Failure to perform or sustain these functions would significantly affect DoD's ability to provide vital services or exercise authority, direction, and control. (b) The Government has identified all or a portion of the contractor services performed under this contract as essential contractor services in support of mission-essential functions. These services are listed below: General Anesthesiologists, Pain Anesthesiologists, Pediatric Anesthesiologists, Cardio-Thoracic Anesthesiologists, Regional Anesthesiologists and Neuro Anesthesiologist. (2) The Contractor shall maintain and update its plan as necessary. The Contractor shall provide all plan updates to the Contracting Officer for approval. (3) As directed by the Contracting Officer, the Contractor shall participate in training events, exercises, and drills associated with Government efforts to test the effectiveness of continuity of operations procedures and practices.

57 Page 49 of 135 (d)(1) Notwithstanding any other clause of this contract, the Contractor shall be responsible to perform those services identified as essential contractor services during crisis situations (as directed by the Contracting Officer), in accordance with its Mission-Essential Contractor Services Plan. (2) In the event the Contractor anticipates not being able to perform any of the essential contractor services identified in accordance with paragraph (b) of this clause during a crisis situation, the Contractor shall notify the Contracting Officer or other designated representative as expeditiously as possible and use its best efforts to cooperate with the Government in the Government's efforts to maintain the continuity of operations. (e) The Government reserves the right in such crisis situations to use Federal employees, military personnel, or contract support from other contractors, or to enter into new contracts for essential contractor services. (f) Changes. The Contractor shall segregate and separately identify all costs incurred in continuing performance of essential services in a crisis situation. The Contractor shall notify the Contracting Officer of an increase or decrease in costs within ninety days after continued performance has been directed by the Contracting Officer, or within any additional period that the Contracting Officer approves in writing, but not later than the date of final payment under the contract. The Contractor's notice shall include the Contractor's proposal for an equitable adjustment and any data supporting the increase or decrease in the form prescribed by the Contracting Officer. The parties shall negotiate an equitable price adjustment to the contract price, delivery schedule, or both as soon as is practicable after receipt of the Contractor's proposal. (g) The Contractor shall include the substance of this clause, including this paragraph (g), in subcontracts for the essential services. (End of clause) SUBCONTRACTS FOR COMMERCIAL ITEMS (JUN 2013) (a) The Contractor is not required to flow down the terms of any Defense Federal Acquisition Regulation Supplement (DFARS) clause in subcontracts for commercial items at any tier under this contract, unless so specified in the particular clause. (b) While not required, the Contractor may flow down to subcontracts for commercial items a minimal number of additional clauses necessary to satisfy its contractual obligation. (c) The Contractor shall include the terms of this clause, including this paragraph (c), in subcontracts awarded under this contract, including subcontracts for the acquisition of commercial items. (End of clause) WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (MAY 2013) (a) Definitions. As used in this clause--

58 Page 50 of 135 Department of Defense Activity Address Code (DoDAAC) is a six position code that uniquely identifies a unit, activity, or organization. Document type means the type of payment request or receiving report available for creation in Wide Area WorkFlow (WAWF). Local processing office (LPO) is the office responsible for payment certification when payment certification is done external to the entitlement system. (b) Electronic invoicing. The WAWF system is the method to electronically process vendor payment requests and receiving reports, as authorized by DFARS , Electronic Submission of Payment Requests and Receiving Reports. (c) WAWF access. To access WAWF, the Contractor shall-- (1) Have a designated electronic business point of contact in the System for Award Management at ; and (2) Be registered to use WAWF at following the step-by-step procedures for self-registration available at this Web site. (d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site before submitting payment requests through WAWF. Both can be accessed by selecting the Web Based Training link on the WAWF home page at (e) WAWF methods of document submission. Document submissions may be via Web entry, Electronic Data Interchange, or File Transfer Protocol. (f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order: (1) Document type. The Contractor shall use the following document type(s). Invoice (2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in WAWF, as specified by the contracting officer. HT0017 (3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system. Routing Data Table* Field Name in WAWF Data to be entered in WAWF Pay Official DoDAAC HQ0490 Issue By DoDAAC HT0014

59 Page 51 of 135 Admin DoDAAC HT0014 Inspect By DoDAAC HT0017 Ship To Code HT0017 Ship From Code Not applicable Mark For Code Not applicable Service Approver (DoDAAC) HT0017 Service Acceptor (DoDAAC) HT0017 Accept at Other DoDAAC Not applicable LPO DoDAAC Not applicable DCAA Auditor DoDAAC Not applicable Other DoDAAC(s) Not applicable (4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back-up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request. (5) WAWF notifications. The Contractor shall enter the address identified below in the Send Additional Notifications field of WAWF once a document is submitted in the system. Commander Lana Clouser: lana.r.clouser.mil@mail.mil (g) WAWF point of contact. (1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact. Commander Lana Clouser: lana.r.clouser.mil@mail.mil (2) For technical WAWF help, contact the WAWF helpdesk at (End of clause) CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS COMMERCIAL ITEMS (DEVIATION 2013-O0019) (NOV 2015) (a) Comptroller General Examination of Record. The Contractor shall comply with the provisions of this paragraph (a) 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 , 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.

60 Page 52 of 135 (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. (b) (1) Notwithstanding the requirements of any other clause in this contract, the Contractor is not required to flow down any FAR clause, other than those in this paragraph (b)(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) , Contractor Code of Business Ethics and Conduct (Apr 2010) (41 U.S.C. 3509). (ii) , Utilization of Small Business Concerns (Oct 2014) (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 in lower tier subcontracts that offer subcontracting opportunities. (iii) , Nondisplacement of Qualified Workers (May 2014) (E.O ). Flow down required in accordance with paragraph (1) of FAR clause (iv) , Prohibition of Segregated Facilities (Apr 2015). (v) , Equal Opportunity (Mar 2007) (E.O ). (vi) , Equal Opportunity for Veterans (Jul 2014) (38 U.S.C. 4212). (vii) , Equal Opportunity for Workers with Disabilities (Jul 2014) (29 U.S.C. 793). (viii) , Employment Reports on Veterans (Jul 2014) (38 U.S.C. 4212). (ix) , Notification of Employee Rights Under the National Labor Relations Act (Dec 2010) (E.O ). Flow down required in accordance with paragraph (f) of FAR clause (x) , Service Contract Labor Standards (May 2014), (41 U.S.C. chapter 67). (xi) X (A) , Combating Trafficking in Persons (Mar 2015) (22 U.S.C. chapter 78 and E.O ).

61 Page 53 of 135 (B) Alternate I (Mar 2015) of (22 U.S.C. chapter 78 E.O ). (xii) , Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements (May 2014) (41 U.S.C. chapter 67.) (xiii) , Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services--Requirements (May 2014) (41 U.S.C. chapter 67) (xiv) , Employment Eligibility Verification (Aug 2013). (xv) , Minimum Wages Under Executive Order (Dec 2014) (E.O ). (xvi) , 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 Note). (xvii) , Promoting Excess Food Donation to Nonprofit Organizations. (May 2014) (42 U.S.C. 1792). Flow down required in accordance with paragraph (e) of FAR clause (xviii) , 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 (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) PERFORMANCE OF WORK STATEMENT PERFORMANCE WORK STATEMENT Anesthesiology Services Walter Reed National Military Medical Center (WRNMMC) Bethesda, Maryland TABLE OF CONTENTS 1.0. Introduction 1.1. General Information Non-Personal Services Contract Scope of Work 1.3. Safety Requirements 1.4. Security Requirements 1.5. Vehicle Registration 1.6. ADP Security 1.7. Personal Security Investigation Requirements 1.8. Standards of Performance

62 Page 54 of Schedule/Period of Performance 1.10 Reserved 1.11 Health and Immunization 1.12 Credentialed Personnel Documentation 1.13 Reserved 1.14 Mobilization and Other Contingency 1.15 Contractor Employee Furnished Supplies/Equipment 1.16 Government Furnished Services/Supplies 1.17 Government Furnished Supplies 1.18 Quality Control Plan 1.19 Description of Work 1.20 Deliverables 2.0 Definitions 3.0 Applicable Technical Orders, Manuals, Regulations, Directives and Forms 4.0 Attachments/Technical Exhibition List 1.0. INTRODUCTION The Contractor shall provide non-personal Anesthesiology services as specified, in accordance with the following Performance Work Statement (PWS) for the Department of Surgery at Walter Reed National Military Medical Center (WRNMMC), Bethesda, Maryland The services will be of a nature and scope described in the paragraphs below. The contractor will work with both Federal and contracted health care providers and medical professionals Contracted employees shall give the highest regard to patient dignity and observe the precepts of the American Hospital Association s Bill of Rights for Patients. The contractor s employees shall abide by relevant WRNMMC rules, regulations and by laws, including Medical Staff By Laws, as well as applicable Department of Defense (DoD) regulations governing such things as medical records. These Anesthesiology positions are to perform in accordance with industry best practices, applicable to DoD guidance Contractor as written/identified throughout this PWS may also be addressed as Health Care Provider (HCP) and or Health Care Worker (HCW). These terms are interchangeable GENERAL This requirement is for non-personal services. The personnel rendering the services are not subject; either by the contract s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the government and its personal services contractors Professional Liability. The government will not be liable for malpractice allegations against contractor employees based upon performance of this contract. The contractor shall be required to carry malpractice insurance for its employees performing on this contract, at a level stated in the solicitation and included in any resulting contract for subject acquisition as written in FAR Clause Upon contract award, the contractor shall provide evidence of insurance demonstrating the required coverage seven (7) days prior to commencement of performance. In accordance with Federal Acquisition Regulation (FAR) Clause , the contractor will indemnify the Government for any liability producing act or omission by the contractor, its employees and agents occurring during contract performance. If the contractor uses subcontractors in the performance of this contract, the contractor is required to ensure that its subcontracts for provisions of healthcare services contain the requirements of FAR , including the maintenance of medical liability insurance Responsibility and Procedures. If any suit or action is filed or any claim is made against the contractor, which

63 Page 55 of 135 occurred as a result of work performed by the contractor under this contract, the contractor shall immediately notify the Contracting Officer Representative (COR) and the Contracting Officer and the chief of the appropriate services and promptly furnish them copies of all pertinent papers received Confidentiality / HIPAA. The Contractor shall abide by Army Regulation 40 3: Medical, Dental, and Veterinary Care (AR 40-3, dated 12 March 2010) and Army Regulation 40-66: Medical Record Administration and Healthcare Documentation (AR 40-66, dated 4 January 2010) concerning the nature of limited privileged communication between patient and hospitality care provider for security and personnel reliability programs. The Contractor shall abide by AR concerning the confidentiality of patient records, as embodied in federal statutes including the Privacy Act of 1974 and the Drug and Alcohol Act, Public Law and Health Insurance Portability and Accountability Act (HIPAA). The Contractor shall direct all requests for medical information on patients to the Chief, Patient Administration Division. The Contractor shall not release any medical or personal information on a patient without first receiving written approval from the government Removal of Contractor employees. At any time during the performance of this contract, the Contracting Officer may direct the contractor to immediately remove any Contractor employee whose actions or impaired state raises reasonable suspicion that clear and present danger of physical harm exists to a patient, other Contractor employees, and government personnel or to the impaired individual. This provision will be used in emergency situations only and not for the purpose of bringing performance issues or other non-urgent concerns to the attention of the contractor. The Contractor must replace removed employees within 15 days, or as agreed upon with the Contracting Officer If the need for a removal occurs, the Contracting Officer will contact the contractor's point of contact and direct the contractor to remove that individual from the military facility and to not use that individual to perform any healthcare services required under this contract until the issue has been resolved by the Contracting Officer. The contractor shall formally meet with the Contracting Officer to discuss further action in accordance with the WRNMMC Quality Assurance and Inspection (QA&I) Plan and Army Regulation AR Medical Services Clinical Quality Management (AR 40-68, dated 22 May 2009). A review of the basis for removal will be made by the Contracting Officer within three (3) working days following the Contracting Officer s directed removal If, after any investigation deemed necessary by the Contracting Officer and discussions with the contractor's representative, the Contracting Officer concludes that the Contractor employee s impairment requires permanent removal from performance under the contract, the Contracting Officer will notify the contractor that permanent removal is required. In the event of disagreements between the government and the contractor's representative concerning matters of impaired Contractor employees, the decision of the Contracting Officer will be final. During the period between the removal and the final decision of the Contracting Officer, the contractor shall provide a backup/replacement Contractor employee in accordance with the terms and conditions of this contract Conflict of Interest Contractor employees shall not use services rendered pursuant to this agreement as a part of a study, research grant, or publication without the prior written consent of the WRNMMC Director Contractor employees shall not bill the patient, an insurer, or anyone else for services rendered Contractor employees shall not, while performing services under this contract advise, recommend, or suggest to persons eligible to receive medical care at Army expense that such persons should receive care from the Contractor at any place other than at the WRNMMC. The Contractor will not refer any patients to any company or service to which they have a direct or indirect involvement (including partnership programs and ancillary services not offered by the WRNMMC).

64 Page 56 of Contractor shall not introduce new procedures or changes in standing operating procedures without first coordinating with the Contracting Officer, who then will coordinate with the COR and the Chief of Services Contractor is not prohibited by reason of his/her employment under this contract from conducting private practice, if there is no conflict with the performance of services under this contract Contractor shall not use Government facilities or other Government property in connection with conducting a private practice The Contractor employee who is an employee of the Department of Defense (DoD), either military or civilian, shall not be employed unless such person seeks and receives approval in accordance with DoD R SCOPE OF WORK See this performance of work statement (PWS) Attachment 1 (PROFESSIONAL QUALIFICATIONS/ SPECIFIC TASKS/RESPONSIBILITIES) The Contractor shall provide qualified personnel (in accordance with PWS Attachment 1 - PROFESSIONAL QUALIFICATIONS/SPECIFIC TASKS/RESPONSIBILITIES), necessary to perform Anesthesiology Services at the WRNMMC Contractor personnel shall perform their services using the English language and will be fluent in reading, writing, and speaking English SAFETY REQUIREMENTS The Contractor shall maintain safety and health standards compliant with requirements of the Occupational Safety and Health Administration (OSHA) SECURITY REQUIREMENTS. The WRNMMC is a restricted access military facility. Contractor employees shall not begin performance until the complete documentation for a Personnel Background Investigation has been submitted. An Identification (ID) badge and the Common Access Card (CAC) will not be issued until complete documentation has been submitted to the WRNMMC Security Manager, as required at the facility. The CAC card is required for access to Government computer databases and also is presented to the security guards when entering the military installation. If a background investigation results in an unfavorable finding, the contracting officer will notify the contractor and the contractor employee(s) will not be granted access to the facility, will not be able to perform services at the facility, and must return all identification badges, CAC cards, and other items issued previously issued by the government (comply with FIPS PUB 201 and OMB Guidance M-05-24, dated August 5, 2005) Upon award of the contract, the contractor will immediately contact the COR for processing procedures to meet the security requirements, for information needed to access WRNMMC, as well as in-processing forms Security Identification Badges. Contractor employees shall comply with WRNMMC personnel identification and access requirements Each contractor employee s shall wear a visible security ID badge, provided by the military installation or the WRNMMC, on the front of his/her outer clothing.

65 Page 57 of The contractor shall be responsible for ensuring all contractor employees timely renew ID, CAC, and access documents. Absences due to the loss or expiration of such badges shall not relieve the contractor of its obligation to perform the health care services required under this contract The contractor employees shall immediately report any lost or stolen security badges to the COR Contractor employees shall turn-in the WRNMMC badge, Common Access Card (CAC), and government issued Civilian ID Card (for purposes of performing on this contract) to the COR upon termination of their services under this contract In accordance with (IAW) Army Regulation (AR ), Military Operations Antiterrorism, paragraph 5-19, all prospective contractor employees serving on this contract will undergo a verification process to determine the trustworthiness and suitability prior to being granted access to federal property. Limited access with escort may be granted (at the installation s discretion) for an interim period while investigations are being conducted IAW Army Regulation (AR 25-2) Information Management Information Assurance (dated 23 March 2009), and Homeland Security Presidential Directive, no. 12 (HSPD-12), Installation Security Office will submit all background investigations on prospective contractor employees requiring Common Access Cards (CAC), network access Upon notification, the Provost Marshal Office will conduct background checks on all other contractor employees when there isn't a requirement for CAC and/or IT requirements in the contract Complete disclosure of any past incidents in the contractor employees professional duties or of incidents which might be considered to impact on his/her professional standing, such as charges (unless acquitted) involving either felonies or misdemeanors (other than minor traffic violations), is a necessary part of the competency process. This disclosure must also specifically include reports of any actions, claims, charges, of malpractice ever brought against the contractor (either individually or as a part of a group), as well as the outcome (or current status) of any such case. WRNMMC will evaluate any such incident and determine whether it should be disqualifying Contractor employees are advised to make full disclosure under this paragraph as a condition of employment. Failure to make a full disclosure will result in a determination that the provider's services were unsatisfactory If at any time during the contract period it is discovered through a medical center investigation or any investigation, that the contractor employee is currently pending charges, or has previously been convicted of any of the aforementioned incidents, that contractor employee may be removed from service under the contract ANTITERRORISM (AT) TRAINING AT Level I Training. All Contract Service Providers (CSPs), to include subcontractor CSPs, requiring access to Army installations, facilities and controlled access areas shall complete AT Level I awareness training within 90 calendar days after contract start date. The contractor shall submit certificates of completion for each affected CSP and subcontractor CSP, to the COR or to the contracting officer, if a COR is not assigned, within 30 calendar days after completion of training by all CSPs and subcontractor CSP. AT Level I awareness training is available at the following website: IWATCH Training. The contractor and all associated sub-contractors shall brief all CSPs on the local iwatch program (training standards provided by the WRNMMC antiterrorism officer). This local developed training will be used to inform CSPs of the types of behavior to watch for and instruct CSPs to report suspicious activity to the COR. This training shall be completed within 14 calendar days of contract award and within 14

66 Page 58 of 135 calendar days of new CSPs commencing performance with the results reported to the COR NLT 30 calendar days after contract award CSPs Who Require Access to Government Information Systems. All CSPs with access to a government information system must successfully complete the DOD Information Assurance Awareness training prior to access to the information systems and then annually thereafter Vehicle Registration Parking is limited, if not completely unavailable on the WRNMMC campus If a parking pass is provided by the government, the contractor employee shall comply with WRNMMC requirements for vehicle registration and operation on the WRNMMC campus All vehicles on the WRNMMC campus are subject to search. Contractor employees may encounter long delays for vehicle inspection and ID checks upon entering and exiting the campus. The Government will not reimburse the contractor for time spent at installation checkpoints or parking off the campus. Contractor employees must plan accordingly and report to work at their scheduled duty time, at their appointed place of duty within the WRNMMC Safeguarding Material and Confidentiality Information - ADP Security The contractor shall be responsible for safeguarding all Government property provided or obtained in connection with this contract. The contractor shall safeguard information of a confidential or sensitive nature. Neither the contractor nor any of its employees performing on this contract shall disclose or cause to be disseminated any information concerning the operation of the WRNMMC that could result in or increase the possibility of a breach in security or interrupt the continuity of operations or which breaches the requirements of the Federal Privacy Act of However, the contractor may be required to provide testimony in legal or administrative procedures. Such participation must be consistent with the disclosure requirements imposed in this contract and coordinated with the contracting officer The contractor employees serving on this contract shall have access to and/or process information requiring protection under the Privacy Act of These positions are considered Automated Data Processing (ADP) Sensitive positions. Compliance with DoD Directive , SUBJECT: DoD Personnel Security Program, (dated April 9, 1999); DoD R, Personal Security Program (dated January 1987); AR 25-2 Information Management Information Assurance (dated 23 March 2009), and AR , Personnel Security Program (for Army, dated 4 August 2011), and applicable regulations for other services, is mandatory for ADP Sensitive positions Unless otherwise specified, all financial, statistical, personnel, and/or technical data which is furnished, produced or otherwise available to the contractor during the performance of this contract are considered confidential business information and shall not be used for purposes other than performance of health care services under this contract. The contractor shall not release any of the above information without prior written consent of the KO. The contractor shall prepare medical records, forms and documents as required, in accordance with the regulations and established guidelines listed in the contract and those established by the WRNMMC Director The contractor and its employees serving on this contract shall abide by federal and local WRNMMC regulations and requirements concerning the nature of privileged communication between patients and the contractor as may be necessary for security and personnel reliability programs; WRNMMC regulations concerning the confidentiality of patient records, to include but not limited to the Privacy Act of 1974 and the Health Insurance

67 Page 59 of 135 Portability & Accountability Act (HIPAA) of All regulations referenced are available for review from the COR, WRNMMC, or the KO. All medical records and reports will remain the property of the Government The contractor shall be responsible for any keys issued by the Government to contractor employees for use at WRNMMC. The keys shall not be duplicated. Lost keys and/or locks shall be reported to the issuing party, Department Chief, or COR immediately upon discovery of the loss Personal Security Investigation Requirements: The following procedures are required as part of the security requirements in paragraph 1.4. Contractor employees may have access to and/or process information requiring protection under the Privacy Act of Contractor employees that have access to this information are considered Sensitive positions. Compliance with DoD Directive , DoD R, AR 25-2, and AR is mandatory for Sensitive positions. Therefore, a National Agency Check with Inquiries (NACI) is required for each contractor under this contract. For JTF CAPMED facilities, a NACLC (National Agency Check with Local Check and Credit Check) will be required in lieu of the NACI. The contractor shall fully adhere with security requirements and the provisions of referenced publications by having each of their contract employees who are performing under this contract make an appointment (through the COR) with the appropriate security organization at the installation. Each individual will be fingerprinted and required to complete the appropriate forms, usually a Standard Form 85-P, Questionnaire for Public Trust Positions, and a SF 86, for NACLC checks. The contractor shall advise their employees serving on this contract that a positive report is needed as a condition of employment under this contract STANDARDS OF PERFORMANCE The government requires that the contractor shall provide technically competent employees at a 100% fill rate no later than 30 days following contract award; who will provide services at a standard enabling the WRNMMC to provide a high level of quality anesthesiology care Joint Commission (JC) Standards. Contractor shall take part in Department or WRNMMC programs as required to meet JC standards Other performance evaluation factors will be monitored that are not quantified by numerical measurements which include: contractor providing personnel exceeding the minimum qualification standards; patient customer service comments; provider and contractor relationship with hospital staff/government contracting personnel; compliance with hospital policy and procedures Performance Reports, will be provided by the COR annually to ensure acceptable performance of the contract; annual reports provided by COR to Contracting Officer after completion of each performance period will be reported to the DOD Contractor Assessment Reporting System (CPARS) The Contractor shall be responsible for the security of all patient information Neither the Contractor nor any of its employees serving on this contract s shall disclose or cause to disseminate any information concerning operations of military activities. Such action(s) could result in violation of the contract and possible legal actions All inquiries, comments or complaints arising from any matter observed, experienced, or learned of as a result of or in connection with the performance of this contract, the resolution of which may require the dissemination of official information, shall be directed to the COR and the KO.

68 Page 60 of The Contractor shall only conduct business with designated government personnel listed as points of contact (POCs). Names of authorized personnel shall be provided to the Contractor by the Government, in writing, and updated as necessary throughout the contract period U.S. Government records, copies of original results and reports, verified original data, corrected data, and corrected supporting final reports are maintained by the Contractor, but remain the property of the U.S. Government. These files/results must be surrendered to the COR Contractor Verification System (CVS) will be utilized for issuance of Common Access Cards for contractors at Army Facilities The Contractor shall comply with agency personal identity verification procedures identified in the contract or which otherwise 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 The Contractor ensure all subcontractors shall comply with agency personal identity verification procedures when the subcontractor is required to have physical access to a federally controlled facility or access to a Federal information system The contractor shall ensure compliance with the provisions set forth below. For purposes of FAR Clause and personal identity verification procedures, the Government will designate a Trusted Agent (TA), and the contractor shall designate a contractor security liaison for this contract. The contractor security liaison does not have to perform only security duties, but can perform other functions for the contractor. The Government reserves the right to amend or supplement these provisions pursuant to the Changes clause in the contract In-processing Requirements. Contractor employees serving on this contract are prohibited from performing services under this contract absent compliance with the in-processing requirements set forth below For every contractor employee serving on this contract, the contractor security liaison shall provide the following information to the TA for input into the Defense Enrollment Eligibility Reporting System/Real-time Automated Personnel Identification System (DEERS/RAPIDS): (a) Last Name (b) First Name (c) Middle Name (d) Social Security Number (e) Date of Birth (f) Address (may be either the address of the incoming individual or the contract security liaison) The contract service provider shall have an Army Knowledge Online (AKO) account in order to submit the application. AKO registration may be accessed via The DEERS/RAPIDS Systems will send a notice to the address provided IAW the above requirement, in which the contract service provider s user ID and password are provided. The COR shall notify the contractor of the contract service provider s user ID and password The contract service provider shall log into the DEERS/RAPIDS System, and submit an application for acceptance into the System, using the user ID and password provided.

69 Page 61 of The application will be accepted, returned, or rejected by the TA. Notice as to whether the application has been accepted, returned or rejected will be provided to the individual s address within 48 hours after submission. If the application is returned or rejected, the contractor shall contact the TA and comply with the TA s guidance to attempt to correct and resolve the issues Upon approval of the application, the contract service provider shall receive an sent to the address provided stating the Common Access Card (CAC) application was approved and to proceed to the Verifying Office (VO) with two photo IDs to obtain a CAC. For CAC issuance, a DD2842 must be completed and taken by the individual with two forms of ID, one must be a picture ID. The will contain a Uniform Resource Locator (URL) to download the form. Acceptable forms of ID to include: Driver s License, Military ID, Contractor Company ID with picture and expiration date, charge card with picture imprinted, and passport Revalidation Requirements. The TA is required to revalidate all contract service providers in DEERS/RAPIDS System, every 6 months. In the event revalidation is denied, the CAC credentials shall be revoked and the card will not be useable to login, and the contractor will be unable to perform contract requirements Out-processing Requirements. When a contract s performance under this contract/task order ceases, the contractor or contract security liaison shall provide written notice to the TA. The TA will remove the contractor from DEERS/RAPIDS System. The contractor shall ensure all CAC s and all Government issued badges and ID cards and vehicle decals are turned in to the Government IAW the WRNMMC s out-processing procedures and further guidance from the contracting officer WRNMMC in/out-processing checklist: When commencing work under this contract, the contractors shall obtain in-processing checklist(s) from the COR or designated office. All contractors are required to complete the applicable items on the checklist and turn it in to the designated office. Upon termination or resignation, the contractor shall complete an out-processing checklist and returns it to the designated office The contractor is responsible for absences of its employees serving on this contract due to expired identification and access documents. Such absences shall not relieve the contractor of its obligation to perform the health care services required under this contract The contractor shall immediately report any lost or stolen badges to the COR IDENTIFICATION OF PRIVACY ACT. This contract requires the development of a system of records in accordance with the Privacy Act of SCHEDULE/PERIOD OF PERFORMANCE WRNMMC provides services 365 days a year, 24 hours a day. The Contractor shall be required to work their designated shifts and weekdays. Scheduling is always based on the needs of WRNMMC, and must be coordinated through the COR. The contractor will work no more than 80 hours in a two-week period under this contract. Contractors will work no more than 8 to 12 hours in a 24-hour period. The contractor may not leave early if the thirty (30) minute lunch break was not taken during the shift. Hours shall be reported daily Absences. When Contractors serving on this contract have not reported for duty, have become ill, or are unable to work during a scheduled shift, they must contact their Contractor leadership who will in turn notify the COR Absences due to emergency shall be called into the COR by the Contractor and if other than regular business hours Contractor must contact the Administrative Officer of the Day (AOD).

70 Page 62 of Absences such as vacations, shall be coordinated and approved at least 30 days in advance and mutually agreed upon by the COR and the Contractor. Scheduled absences shall be limited to two (2) weeks Contractor employees working under this contract shall be paid only for services rendered. These Contractor employees will have a one-hour or 30 minute unpaid lunch period. Contractors shall coordinate lunch periods with site supervisor. Payment to the Contractor will not be made for temporary work stoppage due to circumstances beyond the control of the WRNMMC, such as acts of God, inclement weather, power outages, or temporary closing of facilities Interviews. Interviews may occur as needed for security screening and security department processing. No personal interviews will be conducted by the customer department Closures. During anticipated closure of the WRNMMC due to Command declared training holidays or during unplanned closure of the facility due to natural disasters, military emergencies, severe weather, or otherwise, the contractor shall not invoice the Government for services not performed and the Government will not be liable to the contractors for any such closures Federal Holidays. The Contractor will not be paid on Federal holidays unless the Contractor is scheduled to work on that holiday Holidays. The following is a list of federally recognized holidays. Contractors may be required to work on these holidays as determined by the WRNMMC Department of Surgery Chief: New Year s Day: January 1 st Martin Luther King s Birthday: 3 rd Monday in January President s Day: 3 rd Monday in February Memorial Day: Last Monday in May Independence Day: July 4 th Labor Day: 1 st Monday in September Columbus Day: 2 nd Monday in October Veteran s Day: November 11 th Thanksgiving Day: 4 th Thursday in November Christmas Day: December 25 th NOTE: Any of the above holidays falling on a Saturday will be observed on the preceding Friday; holidays falling on a Sunday will be observed on the following Monday. Any holidays that are declared by Presidential Executive Order shall be observed in the same manner as the holidays listed above. If the area in which a Contractor is scheduled to work is closed due to the Federal holiday and the Contractor is not required to report in, payment will not be made for those hours. Closures of the installation due to inclement weather or other such acts of God shall be handled in the same manner The Contractor may be required to work past a regularly scheduled shift in the event of an emergency OVERTIME IS NOT AUTHORIZED DOD guidance (DOD m, 21 Nov 00) requires the timely collection of manpower data. As a result, the contractor shall dedicate staff to the timely collection and electronic submission of work-hours per this guidance. Uniform Chart of Accounts and Personnel Reporting System (UCAPERS)/Defense Medical Human Resource System-internet (DMHRSi) information on 100% of all contracted employees (serving on this contract) shall be input by the contractor bi-weekly.

71 Page 63 of The contractor shall provide a workforce that is adequately rested and physically and mentally capable of performing the duties required by this performance of work statement If the scheduled contractor cannot perform, the contractor shall provide a qualified replacement, if unable to replace the absent employee, the contractor shall provide the Government with maximum notice but no less than two (2) hours prior to the start of the shift Pre-employment Packet. Prior to WRNMMC orientation, the contractor shall submit to the COR a packet for each potential employee to serve on this contract consisting of name, social security number, home telephone number, physical examination certificate, drug test results, proof of required vaccinations flu shots and tuberculosis screening, copy of life support training cards meeting the American Heart Association Standards as required, background check (Standard Form 86) and any specialty job-related certification the individual may have. The COR will notify the contractor of acceptance or non-acceptance of proposed contractor within five (5)working days of the receipt of packets based on the contents evidencing that all qualification requirements are met. In the event of a 48 hour fill response, the COR will notify the contractor within 24 hours after submission of the pre-employment packet whether or not all qualification requirements are met. E-verify documentation is required prior to the contractor being in-processed. Packets may be conditionally approved, pending receipt of remaining medical documentation prior to start of work; however they must contain the following required documentation prior to employment; TB and drug test results, Basic Life Support training card, and Basic Life Support Certification No later than seven (7) days after notification of award, the Contractor must submit to the COR, for approval the resumes of the applicants and copies of qualifying, trainings, certifications, degrees, BLS training, Flu shot verification, and TB and drug test results, and any other requisite documentation as specified in Attachment 1 to the PWS Professional Qualifications No later than 10 days following notification of acceptance of the contractor employee by the COR, the contractor must submit complete pre-employment packets of those contractors who will be performing services under this contract. Documentation shall be submitted to the COR Joint Training Record (JTR) Folders: The JTR folders are provided by the Government and used to maintain all mandatory training and skill data competency verification. For employees performing on this contract, the contractor shall provide and update their employee information monthly and submit a percent completeness report to the COR on the 5th calendar day of the month. The contractor must provide updated information with appropriate credentials on a continuous basis. The contractor must submit monthly compliance reports, ensuring that Basic Life Support information is current for all contract employees serving on this contract. All costs to receive and maintain current certifications, for basic life support training shall be the responsibility of the contractor at no additional cost to the Government. In the event of noncompliance, the contractor cannot schedule that specific employee for any shifts An Installation Record Check (IRC) shall be conducted by DoD component personnel at the installation level if the contractor employee has a DoD affiliation such as living or working on a military installation, or is a family member of an active duty military. An IRC is not required on individuals that do not have DoD affiliation. Upon favorable completion of the IRC, an individual may be selected to provide services to a minor child under line of sight supervision (LOSS) until the required criminal background checks are completed. Line-of-sight supervision is defined at DoD I The contractor will provide the COR with an ongoing list of all DoD affiliates. If removal of a contractor employee is required, the COR will contact the contractor who will formally meet with the COR to discuss further action in accordance with the WRNMMC Quality Assurance and Inspection (QA&I) Plan The contractor shall replace any contract employee serving on this contract that had to be removed from the workplace, within two weeks (10 working days) for all positions.

72 Page 64 of RESERVED HEALTH AND IMMUNIZATION REQUIREMENTS All contractor employees performing health care services under this contract shall comply with the Health and Immunization requirements identified below at the time of initial request for clinical privileges and annually thereafter (see ATTACHMENT # 2 for Sample Immunization form). a. All contractors performing under this contract shall receive a general physical examination prior to commencement of services. The contractor shall provide the Contracting Officer's Representative, 10 calendar days before beginning services under this contract, a physical examination certificate for each contractor who will be providing services on this contract. The certification shall state the date on which the physical examination was completed and the name of the physician who performed the examination. This certification shall be signed by the physician performing the examination. For the purposes of this paragraph, a physical examination administered more than 45 days prior to performance of the contract will not be considered adequate. The physical examination shall include the following: (1) A history to show that the contractor workforce has completed a primary series of immunization with tetanus and diphtheria toxoids and that a booster dose is current (within the past 10 years). (2) A test for the hepatitis (Type B) virus with documentation of the results. A profile shall be established to show immune status to hepatitis. Non-immune Health Care Workers [lacking anti-hb(c) or anti-hb(s)] shall be required to complete an immunization series with a Hepatitis-B vaccine (e.g., Recombivax, Engerix). (3) The physical examination shall also document serologic evidence of immunity to measles and rubella or to provide documentation of immunization with measles, mumps and rubella (MMR) vaccine using the following guidelines: (a) Contractors born before 1957 without documentation of previous vaccination with MMR should receive one dose. (b) Contractors born in or after 1957 who have received one dose of MMR previously shall receive one booster dose. (c) Contractors born in or after 1957, without documentation of any previous vaccination with MMR, should receive two doses of vaccine, separated by no less than one month. (4) Contractors shall be screened for tuberculosis by a tuberculin skin test using the Mantoux technique. A skin test result of 10 mm of induration or more shall be required to have a chest roentgenogram and an evaluation performed. A tuberculin skin test of 10 mm or more will require documentation providing an assessment of the patient (status of infection- active, inactive; need for preventive treatment or not as determined by age, history of BCG (Bacillus Calmette-Guerin) vaccination; duration of skin test positively, etc). (a) If all of the immunizations and tests set forth in the preceding paragraphs have not been completed, the contractor shall issue a certificate providing evidence of immunizations and tests that have been completed or started and shall provide a schedule for the completion of unfinished immunizations and lab tests. After the schedule is completed, the contractor must provide an updated and complete certificate. (b) All contractors on this contract, who experience a parenteral (e.g., needle-stick or cut) or mucous membrane exposure (e.g., splash to the eye or mouth) to blood or bloody body fluids, shall receive prompt

73 Page 65 of 135 treatment. WRNMMC will evaluate the source of exposure for risk of Hepatitis-B, Hepatitis-C, and Human Immunodeficiency Virus (HIV) and will provide a report of the findings to the contractor and the contract provider. It shall be the contractor's responsibility to provide appropriate treatment as needed to possibly include Tetanus-Diphtheria booster, Immune Globulin, Hepatitis-B vaccine booster, or Hepatitis-B Immune Globulin. The contractor shall be responsible for providing all employees performing on this contract with initial testing and if the source of exposure was unknown, positive, or considered at high risk for HIV infection, follow-up testing 3, 6, and 12 months after exposure. In the event of a confirmed or highly suspected parenteral exposure to HIV, the contractor shall insure that the contract provider receives appropriate counseling and is referred immediately to a private infectious disease specialist for consideration of any experimental therapy (e.g., AZT). The Government may require the contractor to provide evidence of the status of treatment and testing of the individual provider under the contract. (c) Failure to meet the requirements stated herein, or when test results determine a contract provider has a contagious disease, the Contracting Officer may, upon the advice of the WRNMMC Director or his/her clinical staff, determine that such provider is not an acceptable individual to perform services under this contract The contractor is responsible for maintaining the health records of its employees performing on this contract and making them available for inspection by the Government upon request The contractors performing services shall comply with the health and immunization requirements of the Military Treatment Facility in which they are working, at the time of initial request for clinical privileges or employment and annually thereafter. Backup/replacement contractor employees shall be required to provide equally current certification of health at the time of initial request for clinical privileges or employment, and annually thereafter. The expense for all physical examinations and immunizations to comply with the health requirements shall be borne by the contractor at no additional cost to the Government (see Attachment 2) Drug testing at the expense of the contractor for all its employees performing on this contract will be part of the initial requirement for hire as per the Army Substance Abuse Program (ASAP), (AR , dated 28 December 2012). The government reserves the right to Do-Not-Return a contractor at any time the COR has proof a contractor is impaired or unfit for duty Infection Control. The contractor shall adhere to the Centers for Disease Control and all WRNMMC guidelines concerning universal precautions, exposure control plans for Blood Borne Pathogens, and Management of regulated medical waste, at all times while providing services under this contract. The Contractor must abide with WRNMMC Regulation No. 1-2, Artificial Fingernail Regulation. The Infection Control Manual is available for review upon contractor's request. The contractor shall report all PPD converters to Infection Control and comply with guidance provided The contractor will provide proof of compliance for its employees, performing on this contract to the COR at the time of initial request for employment, and annually thereafter Basic Life Support Training All contractors shall have and maintain current Basic Life Support for Healthcare Providers (BLS) training accredited by the American Heart Association utilizing hands-on training. Multiple levels of life support training are available through the American Heart Association. The contractor shall provide documentation of required training for review in the pre-employment packet prior to beginning work and at the expiration date of that training. No contractor will be scheduled to work if their Basic Life Support documentation is expired. The contractor is responsible to backfill all scheduled shifts for the contracted employee that is unable to work due to expired Basic Life Support documentation. BLS certification updates are required monthly.

74 Page 66 of CREDENTIALED PERSONNEL DOCUMENTATION Credentialed Personnel Documentation. Only completed pre-employment packets will be accepted by the Government for processing. The contractor must take specific action to ensure that the contractor s pre-employment packets have the required qualification documentation RESERVED CONTINGENCY PLANNING During emergencies contract personnel may be utilized within their scope of practice as designated in their specific duties/task (see PWS ATTACHMENT # 1, SPECIFIC TASK/ RESPONSIBILITIES) CONTRACTOR FURNISHED SUPPLIES/EQUIPMENT Supplies: The Contractor shall furnish all personnel and services to comply with the requirements of this contract to include uniforms, except where specifically identified as Government-furnished supplies and services (paragraph 1.16) Point of contact. Three calendar days prior to performance of services, the contractor shall designate, in writing, and provide to the COR and Contracting Officer, the name, address, telephone number, of the point of contact for all actions on this requirement GOVERNMENT FURNISHED SERVICES Government Training / Orientation Staff Orientation - New employee. The contracted workforce shall participate in all staff orientation and/or training. The contracted workforce will attend a government-sponsored initial orientation to familiarize them with the policies and procedures of WRNMMC. Orientation attendance will be scheduled by the COR. Such orientation may include instruction on automated processing, standard operating procedures, local in-services, quality improvement policies, communications, and occupational exposure to blood borne pathogens, safety programs, etc. All personnel will receive and adhere to all the policies and profession guidelines in the WRNMMC Professional Standards Booklet Annual Training Updates. The contracted workforce shall be required to complete an annual training update at the WRNMMC Annual training updates may be accomplished via video or classroom instruction, computer-based instruction, or review of written materials Armed Forces Health Longitudinal Technology Application (AHLTA) Training (formerly known as CHCSII). Contractors shall attend training in the use of AHLTA. The length of training will depend upon the computer skills of the individual Contractor. This training will be coordinated and scheduled by the COR if needed. (Access to such patient data systems is an Automated Data Processing Sensitive position requiring compliance with AR 25-2 and AR ) HIPAA Privacy and Security Training (HIPAA 101). The contracted workforce shall be required to complete the On-Line Web-based Training Modules within the first 30 days of performance.

75 Page 67 of In addition to the specified courses listed above, the contracted workforce are required to attend or complete on-line any Department of Defense, Army, or Federal Government directed courses, which are not available to contractors outside of WRNMMC. Contractors will participate in all mandatory training Government unique training. The government may elect to provide unique government training to contractors who are performing services under this contract. If the government elects to provide such training, the government will provide such training at no additional expense to the contractor. When directed by the contracting officer, the contracted workforce shall attend all such training in a paid status as part of the normal services required and billed under the contract Attendance to the aforementioned Government Training / Orientation shall be compensated GOVERNMENT FURNISHED EQUIPMENT The Government will provide the use of all available WRNMMC and support services, materials, publications and forms, and equipment required for contract performance (except as designated). The contracted workforce shall keep Government furnished supplies, equipment and work areas in a safe, orderly and clean condition. The contracted workforce shall notify the Government whenever maintenance of equipment is required. The contracted workforce shall abide by all WRNMMC and DoD requirements for physical security of DoD property and equipment Telephones, facsimile machines, copiers and computer equipment are authorized for transaction of official Government business only and shall not be used for personal business. Personal long distance calls are not authorized and the cost of all personal long distance calls made, may be deducted from the Contractor s invoice payments. Telephones, facsimile machines and computer equipment are subject to communications security monitoring at all times Offices/Space used by the contracted workforce in performance of services may be used by the Government for other purposes during their absence. Items of clothing, personal effects, or equipment cannot be secured during their absence. The Government will not incur any liability for theft, damage to, or loss of such personal items The contracted workforce may be issued keys. The Contractors shall safeguard the keys from loss, theft or destruction, and must display all keys signed for at scheduled or unscheduled key control inspections. The Contractor shall be required to reimburse the Government for lost keys, or lockset (if locksets are required to be replaced) as a result of lost keys Pagers. If pagers are issued, the contractor shall safeguard the pagers from loss, theft or destruction, and must display the pager for a scheduled or unscheduled control inspection Protective Clothing. WRNMMC will supply special protective clothing and shoe covers when required Items issued will remain the property of the Government and will not be removed from the hospital. They are to be used, turned in, or disposed of as directed Emergency Healthcare. WRNMMC will provide emergency healthcare for injuries occurring while on duty. The Contractor shall reimburse the Government for such services Contractors shall safeguard any Government property (examples include but are not limited to pagers, keys, cell phones, computers, hand held radios) from loss, theft or destruction, and must display the equipment upon

76 Page 68 of 135 demand. The contractor shall be required to reimburse the Government for lost or damaged equipment. The cost of replacement equipment may be deducted from payments to the contractor QUALITY CONTROL PLAN Government Quality Assessment and Improvement (QA&I). The Government will monitor the Contractor s performance under this contract using the quality improvement/assessment procedures established by WRNMMC. Additionally, the Contractor s performance is subject to scheduled and unscheduled review by a Quality Assurance Evaluator as defined by the WRNMMC QA Plan & AR The contractor must provide a Quality Control plan within 30 days of contract award DESCRIPTION OF WORK. (See Attachment 1 of the PWS: Professional Qualifications/ Specific Task/Responsibilities) WRNMMC is the Flagship of the Military Health System. WRNMMC ensures patient-friendly access to high Quality health care for all military service members and their dependents, while setting the standard in Readiness, Education and Research. Health Care Providers shall comply with all regulatory guidelines (HIPAA, TJC and OSHA) as well as DoD regulations All contractors must possess all skills necessary to provide elite customer service at the levels established by WRNMMC standards as stipulated by the Command and in the formal newcomers and annual training materials. They must be able to detect and understand when they or the situation has not met service user s expectations. All contractors shall possess sufficient positive attitudes, excellent inter-personal skills, tact, problem solving ability, and the ability to prioritize competing situations in the best interests of WRNMMC and its beneficiary population. When interacting with service users, all contractors must possess the ability to interpret guidance, policy, and direction in such a manner that identifies issues and either resolves them within overall acceptable working standards or elevates them immediately and works with user to closure, providing a plan of resolution that is at least clear and understandable to the user. These contractors should not simply state or recite policy or procedure as the disposition to any issue, unless the service user is satisfied by the explanation. Contractors should have working knowledge of all necessary contacts to problem solve and satisfy the customer/beneficiary expectations. Contractors should have the ability to resolve potential issues with tact and the highest customer service ethic. Excellent customer service should be emphasized at every juncture. For issues that cannot be resolved with patients, the point of contact would be the COR DELIVERABLES: The Contractor shall submit reports to the COR and/or the Contracting Officer as requested for use in monitoring Contractor HCP performance. Such reports will include, but are not limited to, current license status, initial and/or monthly/annually immunizations, BLS status CONTRACTOR MANPOWER REPORTING FOR CONTRACT PERFORMANCE WORK STATEMENTS and Related Background Information The contractor shall report ALL contractor labor hours (including subcontractor labor hours) required for performance of services provided under this contract for the [NAMED COMPONENT] via a secure data collection site. The contractor is required to completely fill in all required data fields using the following web address: Reporting inputs will be for the labor executed during the period of performance during each Government fiscal year (FY), which runs October 1 through September 30. While inputs may be reported any time during the

77 Page 69 of 135 FY, all data shall be reported no later than October 31 of each calendar year, beginning with Contractors may direct questions to the help desk at help desk at: DEFINITIONS AND ACRONYMS DEFINITIONS: ARMED FORCES HEALTH LONGITUDINAL TECHNOLOGY APPLICATION (AHLTA): An automated medical information system that provides integrated support for the functional work centers of inpatient and outpatient care facilities, patient administration, patient appointments and scheduling, nursing, laboratory, pharmacy, radiology, and clinical dietetics. BENEFICIARIES OF THE MILITARY HEALTHCARE SYSTEM: Those individuals entitled to care at the WRNMMC IAW AR BACKUP PERSONNEL: Pre-approved contract personnel designated to move into the position of the primary contract personnel to perform required services for the duration of his/her absence. CLINICAL PRIVILEGES: Authorization by the government body to provide specific patient care and treatment services in the organization, within well-defined limits, based on the individual s education, training, experience, competence, judgment, and physical and mental health. CONTINUING EDUCATION: Education beyond initial professional preparation that is relevant to the type of patient care delivered in the organization, that provides current knowledge relevant to the individual s field of practice, and that is related to findings from quality assurance activities. CONTRACTOR. The term as used in this contract refers to the prime business entity on contract. CONTRACTING OFFICER. (KO) A person with authority to enter into contracts; administer, or terminate contracts. Make related determinations and findings on behalf of the government. Note: The only individual who can legally bind the government. CONTRACTING OFFICER'S REPRESENTATIVE (COR). An employee of the U.S. Government appointed by the contracting officer to monitor contractor performance. Such appointment shall be in writing and shall state the scope of authority and limitations. This individual has authority to provide technical direction to the Contractor as long as that direction is within the scope of the contract, does not constitute a change, and has no funding implications. This individual does NOT have authority to change the terms and conditions of the contract. DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM (DEERS): A computerized system that maintains current eligibility status for all eligible health care beneficiaries. MILITARY TIME is on a 24-hour clock, i.e., 8:00 a.m :10 a.m Noon :00 p.m :10 p.m Midnight :01 a.m.-0001

78 Page 70 of 135 MILITARY DATES are written by placing the day of the month, followed by the first three letters of the month, followed by the last two digits of the year, i.e., September 02, Sep 01 November 10, Nov 04 May 1, May 05 PRIME SOURCE VERIFICATION. Confirmation from a primary source (granting agency) or a service that confirms credentials from a primary source that the information provided by the health care provider is current, correct, and substantiates qualifications. PHYSICAL SECURITY. Actions that prevent the loss or damage of government property. QUALITY ASSURANCE. The government procedures to verify that services being performed by the Contractor are performed according to acceptable standards. QUALITY ASSESSMENT AND IMPROVEMENT (QA& I). An ongoing program designed to objectively and systematically monitor and evaluate the quality and appropriateness of patient care, to pursue opportunities to improve patient care, and to resolve identified problems. QUALITY CONTROL (QC). Those actions taken by the Contractor to control and ensure that performance of duties meet the requirements of the contract. SUBCONTRACTOR. A business entity that enters into a subcontract and assumes some of the obligations of the prime business entity in support of the contract. TRAINING HOLIDAYS. Training holidays are days designated by the WRNMMC Director either the workday preceding or following a legal public holiday. The number of training holidays may vary from year to year. WORK DAY. The number of hours per day the contracted workforce provides services. WORK WEEK. Is defined as Monday through Sunday (dependent on workload and mobilization requirements) ACRONYMS. ACOR - Alternate Contracting Officer's Representative ACS - Army Community Services ADP - Automated Data Processing AHA - American Hospital Association AHLTA - Armed Forces Health Longitudinal Technology Application AR - Army Regulation AMA - American Medical Association AOD - Administrative Officer of the Day BCLS - Basic Cardiac Life Support BLS - Basic Life Support CFR - Code of Federal Regulations CHAMPUS - Civilian Health and Medical Program of the Uniformed Services CHCS - Composite Health Care System CLIN - Contract Line Item Number CME - Continuing Medical Education CONUS - Continental United States (excludes Alaska and Hawaii) COR - Contracting Officer Representative

79 Page 71 of 135 COTR - Contracting Officer's Technical Representative COTS - Commercial Off the Shelf CPGs - Clinical Practice Guidelines CVS - Contractor Verification System DA - Department of Army DEA - Drug Enforcement Administration DA - Department of the Army DCCS - Deputy Commander for Clinical Services DEA - Drug Enforcement Administration DMHRSi - Defense Medical Human Resources System Internet DMRC - Deployment Medical Readiness Clinic DOD - Department of Defense DODI - Department of Defense Instruction ECFMG - Educational Commission for Foreign medical Graduates EFT - Electronic Funds Transfer FAR - Federal Acquisition Regulation FIPS PUB - Federal Information Processing Standards Publication FSO - Facility Security Officer FTE - Full Time Equivalent GS - General Schedule HCAA - Health Care Acquisition Activity HIPAA - Health Insurance Portability & Accountability Act of 1996 HSPD - Homeland Security Presidential Directive JC - Joint Commission JTR - Joint Training Record KO - Contracting Officer MEDCEN - Medical Center MEDCOM - Medical Command MEDDAC - Medical Department Activity MHS - Military Health System MTF - Military Treatment Facility MWR - Morale, Welfare and Recreation NACI - National Agency Check with Inquiries NASW - National Association of Social Workers NCOIC - Noncommissioned Officer in Charge NRP - Neonatal Resuscitation Program OCONUS - Outside Continental United States (includes Alaska and Hawaii) OIC - Officer-in-Charge OMB - Office of Management and Budget OTSG - Office of The Surgeon General, U.S. Army OSHA - Occupational Safety & Health Association PAD - Patient Administration Division PWS - Performance Work Statement PDH-CPG - Post Deployment Health Evaluation and Management - Clinical Practice Guidelines PDHRA - Post-Deployment Health Re-Assessment PIPO - Phase In/Phase Out PL - Public Law POC - Point of Contact PPIMS - Past Performance Information Management System QA&I - Quality Assessment & Improvement

80 Page 72 of 135 QA - Quality Assurance QC - Quality Control QAP - Quality Assurance Program QASP - Quality Assurance Surveillance Plan QCP - Quality Control Program RFP - Request for Proposal RMC - Regional Medical Command SF - Standard Form SRP - Soldier Readiness Processing TA - Trusted Agent TAB - Therapeutic Agents Board 3.0. APPLICABLE TECHNICAL ORDERS, MANUALS, REGULATIONS, DIRECTIVES AND FORMS. All applicable directives and publications {advisory or mandatory}, and supplements or amendments to these directives and publications will be current when furnished to the contractor. Directives will be available to contractor upon request. Current issues of many DA publications and many forms can be accessed at DOD publications and forms can be accessed at Publications and forms not on the websites can be obtained from the WRNMMC The Contractor is required to follow all mandatory documents to the extent they apply to this contract. Any such changes to mandatory publications that cause a change in the scope of performance will not be implemented by the Contractor until the Contracting Officer issues a modification in writing Mandatory: AR 25-1, 30 Nov 98 AR 25-2, 14 Nov 03 AR 40-1, 1 Aug 90 AR 40-2, 3 Mar 78 AR 40-3, 15 Feb 85 AR 40-5, 15 Oct 90 AR 40-25, AR 40-66, 1 Jun 92 - Guidance for Management of Publicly Accessible U.S. Army Websites - Information Assurance - Composition, Mission and Functions of the Army Medical Department - Army Medical Treatment Facilities and General Administration, as currently amended - Medical Services: Medical, Dental and Veterinary Care - Preventive Medicine - Protocol for accepting outside civilian provider requests for laboratory and radiology - Medical Record Administration AR 40-68, 20 Dec 89 - Quality Improvement Administration w/interim Change 1, 26 Jun 91 AR , 30 Sep 93 AR , 15 Oct 83 AR , 27 Feb 98 - Security of Unclassified Army Property, (Sensitive and Nonsensitive) - Dictionary of U.S. Army Terms - Information Systems Security

81 Page 73 of 135 AR , 9 Sep 88 AR , 29 Feb 00 AR , 1 Nov 94 - The Department of the Army Personnel Security Program - The Army Safety Program - Accident Reporting and Records AR , 09 NOV 1999 AR , 1 Oct 01 - Army Substance Abuse Program (ASAP) Public Law Occupation Safety and Health Administration, 29Dec 70 JCAHO Manual - Accreditation Manual for Hospitals, current edition JTR, 1 Jan 00 - Joint Travel Regulations, Volume 2, changes through Aug 2007 DOD Directive DoD Personnel Security Program 9 Apr 99 DOD Directive , - Security Requirements for Automated Information Systems 21 Mar 88 (AISS) HSC Pam 310-1, Jun 84 - Index of HSC Command Administrative Publications MEDDAC Policy and Procedure Memorandums WRNMMC s official abbreviation book WRNMMC Professional Standards 2011 FIPS PUB OMB Guidance M (dated August 5, 2005) Advisory: AR , 15 Oct 83 HSC Pam Sep 82 HSC Pam 310-1, Jun 84 - Dictionary of U.S. Army Terms - Emergency Medical Service Communications - Index of HSC Command Administrative Publications 4.0. ATTACHMENTS/TECHNICAL EXHIBIT LIST: Attachment #1- PROFESSIONAL QUALIFICATIONS, SPECIFIC TASK/ RESPONSIBILITIES Attachment #2 - SAMPLE FORM-IMMUNIZATION Attachment #3 - FILL/VACANCY REPORT (SAMPLE) Attachment #4 - PERFORMANCE REQUIREMENT SUMMARY (PRS) Attachment #5 - QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)

82 Page 74 of 135 Attachment #6 - SUPPLEMENT TO THE PWS Attachment #7- PAST PERFORMANCE QUESTIONAIRE

83 Page 75 of 135 ATTACHMENT # 1 PROFESSIONAL QUALIFICATIONS/SPECIFIC TASKS/RESPONSIBILITIES. A. PROFESSIONAL QUALIFICATIONS: GENERAL QUALIFICATIONS AND REQUIREMENTS THAT APPLY TO ALL HEALTH CARE WORKERS (HCW) UNDER THIS PWS: 1. FAILURE AND/OR INABILITY TO PERFORM: Should the health care worker be unable to perform duties under this contract due to medical or physical disability for more than 13 consecutive days, performance under this contract may be suspended by the Commander until such medical or physical disability is resolved. If performance under this contract is so suspended, no reimbursement shall be made and no other compensation shall accrue to the health care worker so long as performance is suspended. If clinical privileges of a health care worker have been summarily suspended pending an investigation into questions of professional ethics or conduct, performance under the contract may be suspended until clinical privileges are reinstated. No reimbursement shall be made to the contractor for the affected health care worker so long as performance is suspended. The denial, suspension, limitation, or revocation of clinical privileges based upon practitioner impairment or misconduct will be reported to the appropriate licensing authorities of the state in which the license is held. Any health care worker demonstrating impaired judgment will be removed from providing healthcare services. The Government reserves the right to remove any employee who, in the judgment of a licensed physician, is impaired by drugs or alcohol. Any health care worker with alcohol or drug abuse problems may be allowed to return to work under the terms of this contract only with prior Government approval. 2. PERSONNEL QUALIFICATIONS. The contractor shall provide personnel having certain minimum levels of training and experience. Proof that offered candidates possess these traits must be provided with each contractor's proposal for a health care worker. Contractor staff shall participate in executing the Emergency Preparedness Plan (drills and actual emergencies) as scheduled by the MTF (typically semi-annually). Personnel re-call list with personal contact information for all military, civil service and contractor staff is required to prepare in advance for an actual emergency. Upon commencement of performance, the contractor shall provide the COR with a list of personal contact information for a designated contractor representative as well as all contractor staff performing services. The contractor shall provide an updated list to the COR bi-monthly. Should an emergency occur that will affect the HCWs' shifts, the designated contractor representative and the HCWs will be contacted. 3. Health care workers shall read, write, speak, and understand the English language fluently and maintain good communication skills with patients and other health care personnel. Health care workers shall be physically capable of standing and/or sitting for extended periods of time and capable of normal ambulation. Health care workers shall be eligible for U.S. employment. No alien shall be allowed to perform under this contract in violation of the Immigration Laws of the United States. Health care workers shall represent an acceptable malpractice risk to the Government. Health care workers shall be in good standing, and under no restrictions, with the state licensure board in any state in which a license is held or has been held within the last ten (10) years. 4. Health care workers shall maintain current certification in American Heart Association Basic Life Support (BLS) for Health care Providers; American Heart Association Health care Provider Course; American Red Cross CPR (Cardio Pulmonary Resuscitation) for the Professional Rescuer; or equivalent. Health care workers shall be current with and have completed all continuing education requirements specified by their professional licensure or certification. Within seven (7) days prior to performance of services by the HCW, the HCW shall obtain, at contractor expense, documentation of required immunizations and physical testing, and a statement from the HCW s physician or a report of a physical examination. The physical examination and immunization documentation shall indicate that the HCW is free from mental or physical impairments that would restrict the HCW from providing the services described herein. Attachment two (2) of this PWS details the necessary immunizations and physical examinations required. Attachment two (2) shall be completed and signed by the health care worker's physician. The facility shall identify any incumbent HCWs who are not required to complete this documentation after contract award. Declinations shall only be permitted based on either the HCW's religious convictions or medical contraindications (as documented by a qualified healthcare provider). The Hepatitis B vaccine declination can be

84 Page 76 of 135 found at No medical tests or procedures required by the contract may be performed in the MTF. Expenses for all required tests and/or procedures shall be borne by the contractor at no additional expense to the Government. HCWs shall agree to undergo personal health examinations and such other medical and dental examinations at any time during the term of this contract, as the Commanding Officer may deem necessary for preventive medicine, medical surveillance, performance improvement, or privileging purposes. These examinations will be provided by the Government. If the contractor chooses, these examinations may be provided by private physician or dentist, at no expense to the Government. 5. BLOODBORNE PATHOGEN ORIENTATION PROGRAM. HCWs shall participate in the Command's Blood borne Pathogen Orientation Program. The HCW shall also participate in all required annual training' and in periodic training for all procedures that have the potential for occupational exposure to blood borne pathogens. 6. MANAGING THE CLINICAL RISK IN THE WORK ENVIRONMENT. The work environment inherently involves risks typically associated with the performance of clinical oral procedures. The HCW may be exposed to contagious disease, infections and flying dental debris, requiring the wearing of personal protection equipment such as scrub attire, gloves, masks, and eye protection. 7. ORIENTATION. Each health care worker shall undergo an orientation. Orientation shall take place at a mutually agreeable time during the first 30-day period immediately following the commencement of service by the health care worker(s). Orientation may be waived for personnel who have previously provided services at WRNMMC, Bethesda, MD. Orientation shall consist of three (3) days of Command Orientation (which includes annual training requirements for topics such as fire, safety, infection control, and family advocacy) and four (4) hours of information systems orientation (which includes the Composite Health Care System (CHCS)/Armed Forces Health Longitudinal Technology Application (AHLTA), PACS (picture archiving and communication system), teleradiology systems, dictation system and radiology web browser). Orientation will be provided to new contractor employees, as required during initial regularly scheduled shifts. The health care worker shall complete all orientation within 60 days after commencement of services. 8. NO RESEARCH WILL BE CONDUCTED/PERFORMED ON THIS CONTRACT. 9. The contracted GENERAL ANESTHESIOLOGISTS shall have the following qualifications: (a) Education: successfully completed an Undergraduate Program, Medical School (M.D. or D.O.), Internship, and Residency Program. (b) Certification Licensure: Current BLS and ACLS if required by the client Experience. Valid unrestricted medical license in at least 1 state, territory or commonwealth of the U.S. and shall at a minimum be Board Eligible. All contract anesthesiologist must be a diplomat of the American Board of Anesthesiology. In addition they must be participants in the Maintenance of Certification Anesthesia (MOCA) program run by the ABA. (c) Experience: A minimum of five (5) years experience as an Anesthesiologist is required. 10. The PEDIATRIC ANESTHESIOLOGIST must have completed a pediatric fellowship (minimum length of 12 months) or equivalent. A minimum of five (5) years experience in pediatric anesthesia is required. Fellowship Training: Satisfactory completion of a one-year fellowship program in pediatric anesthesiology that was ACGMEaccredited throughout the time of enrollment, with verification from the program director. 11. The REGIONAL ANESTHESIOLOGIST must have completed a regional fellowship (minimum length of 12 months) or equivalent. A minimum of five (5) years experience in regional anesthesia is required.

85 Page 77 of The CARDIAC ANESTHESIOLOGIST must have completed a cardiac fellowship (minimum length of 12 months) or equivalent. A minimum of five (5) years experience in cardiac anesthesia is required. 13. The NEURO ANESTHESIOLOGIST must have completed a neuro anesthesia fellowship (minimum length of 12 months) or equivalent. A minimum of five (5) years experience in neuro anesthesia is required. 14. The PAIN MANAGEMENT ANESTHESIOLOGIST requires Pain Medicine Subspecialty Board Certification form the American Board of Anesthesiology. The anesthesiologist must have completed an Accredited Council for Graduate Medical Education (ACGME) recognized pain medicine fellowship program (minimum length of 12 months) and passed the Pain Medicine Subspecialty Boards) within two years of completing fellowship. A minimum of five years experience in pain medicine is required. Recent experience in working with severely injured trauma patients with co-existing traumatic brain injury, traumatic brain injury, and co-morbid substance abuse disorders is required. Recent experience in teaching pain management best practices to primary care providers is required. The Anesthesiologist-Pain Management shall meet the following qualifications, duties, and requirements specified by this contractual instrument. (1) Possess a current license to practice as an anesthesiologist in any state or the District of Columbia at all times. (2) The license must grant the provider the ability to use diagnostic pharmaceutical agents (DPAs) and therapeutic pharmaceutical agents (TPAs). (3) Shall be Board Certified in Anesthesiology by the American Board of Anesthesiology. (4) Fellowship training in pain management in an accredited ACGME program. (5) The government requires the candidate to have subspecialty certification in Pain Medicine by the American Board of Anesthesiology. (6) Shall have a minimum of five years post-graduate experience in interventional pain management. (7) Shall have current Basic Life Support (BLS) certification from the American Heart Association. (8) Advanced Cardiac Life Support or other advanced certification does not supersede BLS certification. (9) Shall have experience in an academic environment teaching residents and fellows, both in classroom and operating room setting. (10) Recent experience in working with severely injured trauma patients with co-existing traumatic brain injury, traumatic brain injury, and co-morbid substance abuse disorders is required. (11) Recent experience in teaching pain management best practices to primary care providers is required. (12) Serve as a staff physician in pain management clinic. Responsible for diagnosing and treating chronic pain conditions. Treatment includes medical management, and diagnostic and therapeutic interventional therapies.

86 Page 78 of 135 (13) Have experience in an academic environment teaching residents and fellows, both in classroom and operating room setting. (14) Facility with complex cases involving invasive monitoring and vaso-active infusions. (15) Research experience in chronic pain management. (16) Proven ability to interact collegially with colleagues, trainees, and ancillary personnel. (17) Experience with Process Improvement, Medical education planning, or Clinical Patient Simulator environments a plus. (A) Other Qualifications pertaining to ALL Anesthesiologists: a. Shall be able to read, write, speak and understand English well enough to effectively communicate with all patients and other HCPs. b. Shall be knowledgeable of equipment and supply terminology and skill sufficient to identify and use necessary equipment and supplies properly and to communicate proper use with nurses, medical staff, patients, and family members. c. Shall be sufficiently skilled to teach patients proper self-care and to motivate patients and family members to continue the procedures for promoting rapid healing. d. Shall be knowledgeable and possess skills necessary to provide care appropriate to any agerelated needs of the patients. The Contract Anesthesiologist shall demonstrate knowledge of the principles of growth and development appropriate to the appropriate patient population served: Infants, Children, Adolescent, Adults, and Geriatric (>65). e. Assess, coordinate, facilitate, deliver and evaluate care for infant to geriatric patients using the nursing process. f. Possess knowledge of a wide range of medical disorders/conditions, diagnostic studies and treatments related to prevention, and detection of illnesses in adults, is desirable. g. The contracted Anesthesiologist shall be knowledgeable in professional care theories, principles, practices, and procedures to perform nursing assignments of moderate difficulty and experience in assessing adult and geriatric patients, as appropriate. h. Possess knowledge of computer operations and proficiency in the use of basic word processing, data entry and automated medical records, CHCS/AHLTA/Essentris/Innovian. Mandatory use of medical database for keeping records, ordering of ancillary procedures, ordering of medications, writing doctor s orders, schedule follow-up visits and performing other required patient functions. The government will provide training to contract employees. i. All contractor HCPs must have experience in an academic medical center teaching residents and medical students, both in classroom and operating room setting. j. All contractor HCPs must have experience in a facility with complex cases involving invasive monitoring and vasoactive infusions. All HCPs must have been providing this care at

87 Page 79 of 135 least 20% of the time in the last two years. As a member of the WRNMMC Anesthesia Department, the ability to provide perioperative care to both critically injured and a critically ill ASA-4 and ASA-5 patient is a requirement. k. All contractor HCPs must have experience with process Improvement, Medical education planning, or Clinical Patient Simulator environments a plus. l. All contractor HCPs must be able to oversee other contractor (not government employees) Anesthesia residents, interns, medical students and SRNAs in the conduct of general and regional anesthetics. m. Be a U.S. citizen B. SPECIFIC DUTIES/TASKS THE CONTRACT EMPLOYEE SHALL PERFORM (Broken out by Labor Category): 1. General Anesthesiologist (12 FTEs): The contracted General Anesthesiologist shall provide the following services and in strict compliance with standing orders and protocols set forth by the MTF, and IAW JC guidelines to include, but shall not necessarily be limited to the following: (1) Prepare and review case histories and obtain data through interviews of patients. (2) Provide routine and emergent anesthesia care for neonatal through geriatric patients with American Society of Anesthesiologists (ASA) classifications I - VI. (3) Provide regional and/or general anesthesia care for the following subspecialties: general surgery, obstetrics, gynecology, cardiothoracic, vascular, adult dentistry, pediatric dentistry, otolaryngology, neurosurgery, urology, ophthalmology, oral surgery, orthopedics, plastic surgery, podiatry, and dermatology. (4) Administer appropriate diagnostic and therapeutic nerve blocks in the treatment of acute and chronic pain. (5) Provide resuscitative care during a cardiopulmonary arrest, and sedation or general anesthetic care at remote locations. (6) Personally provide this care, or he/she shall collaborate with the simultaneous delivery of anesthesia care by up to four certified registered nurse anesthetists (CRNAs); administer anesthesia in lieu of CRNA to patients whose condition poses a particular anesthetic difficulty. (7) Assist in the activities of the recovery room and administer appropriate drug and respiratory therapy in the recovery room setting. (8) Implement the proper use of mechanical ventilators in the recovery room, and as necessary, in the intensive care units. (9) Interpret tests results and evaluate findings. (10) Work under the general professional direction of the Chief of Anesthesiology Services.

88 Page 80 of 135 (11) Provide consultation services for members of the MTF staff for purposes of specialty area training. As required, the contracted HCP shall serve in a teaching capacity to staff members assigned to the MTF and ambulatory clinics. (12) Maintain accurate clinical records and receiving consultations and laboratory work of specific patients. (13) Shall have documentation of current Drug Enforcement Agency number. (14) The Contract HCP shall demonstrate skills in interviewing, examination, assessment, and management of patients with general medical and surgical health problems. Seriously ill patients shall be managed in consultation with or by direct referral to specialty physicians. (15) In addition the General Anesthesiologist shall also cover duties aligned with Personal and Medical Direction. Both are outlined as follows: (i) (ii) (iii) (iv) (v) (vi) Personal Preanesthetic evaluation of the patient. Personal Plans and implements anesthesia plan. Personal Provide induction of post-anesthesia care. Personal Perform duties as directed by the Chief, Anesthesia and Operative Service. Medical Direction Preanesthetic evaluation of the patient. Medical Direction Prescription of the anesthesia plan. (vii) Medical Direction Personal participation in the most demanding procedures in this plan, especially those of induction and emergence. (viii) intervals. Medical Direction Following the course of anesthesia administration at frequent (ix) Medical Direction Remaining physically available for the immediate diagnosis and treatment of emergencies. (x) (xi) (xii) Medical Direction Providing indicated post anesthesia care. Prepare patients and if necessary, equipment for procedures. Performance of invasive procedures. (16) Maintains professional competency involving clinical skills and knowledge through participation in professional organizations, self-directed journal readings, and attendance at in-service and continuing education programs. (17) Complete all forms and reports accurately and promptly when appropriate.

89 Page 81 of 135 (18) Instruct and teach the Army members as necessary. (19) Provide patient education on therapy, medications, and procedures when necessary. (20) Perform other duties and tasks as assigned from time to time. (21) Participate in the clinic quality assurance, utilization review, risk management, and peer review activities. (22) Attends medical staff meetings as required. 2. PEDIATRIC ANESTHESIOLOGIST (3 FTE). The Pediatric Anesthesiologist shall provide the following services and in strict compliance with standing orders and protocols set forth by the MTF, and IAW JC guidelines to include, but shall not necessarily be limited to the following, in addition to requirements above the Pediatric Anesthesiologist must: (1) Hold an unexpired license to practice medicine or osteopathy in at least one state or jurisdiction of the United States. (2) An anesthesiologist s clinical practice has been devoted primarily to pediatric anesthesiology for the last two (2) years, or at least 30% of an anesthesiologist s clinical practice, averaged over the last five (5) years, has been devoted to pediatric anesthesiology. (3) The anesthesiologist s practice must include neonates and children under the age of two (2) years and procedures considered high-risk. (4) Attestations from the HCP as well as the surgery s Department Anesthesiologist that the HCP meets these practice requirements shall be required. Pediatric anesthesiologists treat children from the newborn period through the teenage years. They choose to make pediatric care the core of their medical practice, and the unique nature of medical and surgical care of children is learned from advanced training and experience in practice. (5) Pediatric Anesthesiology is a discipline of anesthesiology that includes the evaluation, preparation, and management of pediatric patients undergoing diagnostic and therapeutic procedures in operative and critical care settings. In addition, this discipline also entails the evaluation and treatment of children with acute and chronic painful disorders. (6) Be a Diplomat of the ABA; (7) Be participants in the ABA's Maintenance of Certification in Anesthesiology (MOCA) program; (8) Have satisfactorily completed fellowship training in pediatric anesthesiology or possess the required experience in pediatric anesthesiology as described below. (9) Pediatric anesthesiologists are responsible for the general anesthesia, sedation, and pain management needs of infants and children. (10) Evaluation of complex medical problems in infants and children when surgery is needed.

90 Page 82 of 135 (11) Planning and care for before and after surgery. (12) Nonthreatening environment for children in the operating room. (13) Pain control, if needed after surgery, either with intravenous (IV) medications or other anesthetic techniques. (14) Anesthesia and sedation for many procedures out of the operating room such as MRI, CT scan, and radiation therapy. 3. REGIONAL PAIN ANESTHESIOLOGIST (2 FTE).The contracted Regional Pain Anesthesiologist, shall provide the following services and in strict compliance with standing orders and protocols set forth by the MTF, and IAW JC guidelines to include, but shall not necessarily be limited to the following: (1) Shall have a current license to practice as an Anesthesiologist in any state or the District of Columbia at all times. Shall be Board Certified in Anesthesiology by the American Board of Anesthesiology. (2) Shall possess a current Basic Life Support (BLS) certificate and a current Advanced Cardiac Life Support (ACLS) certificate from the American Heart Association or its equivalent. (3) Shall possess a current Drug Enforcement Agency registration for controlled substances. (4) Facilitates complex cases involving invasive monitoring and vasoactive infusions. (5) Have experience in an academic teaching residents and medical students, both in classroom and operating room setting. (6) Experience with process Improvement, Medical education planning, or Clinical Patient Simulator environments a plus. (7) Able to recommend Anesthesia residents, interns, medical students and SRNAs in their training in the conduct of general and regional anesthetics. (8) Successfully completed a Fellowship program or possess documented ability in advanced regional anesthesia techniques. (9) Perform as expert Anesthesiologist. (10) There are two types of duties for an Anesthesiologist and they are Personal and Medical Direction. Both are outlined as follows: (i) Personal Preanesthetic evaluation of the patient. (ii) Personal Plans and implements anesthesia plan. (iii) Personal Provide induction of post-anesthesia care.

91 Page 83 of 135 (iv) Personal Perform duties as directed by the Chief, Anesthesia and Operative Service. (v) Medical Direction Preanesthetic evaluation of the patient. (vi) Medical Direction Prescription of the anesthesia plan. (vii) Medical Direction Personal participation in the most demanding procedures in this plan, especially those of induction and emergence. (viii) Medical Direction Following the course of anesthesia administration at frequent intervals. (ix) Medical Direction Remaining physically available for the immediate diagnosis and treatment of emergencies. (x) Medical Direction Providing indicated post anesthesia care. (11) Prepare patients and if necessary, equipment for procedures. (12) Performance of invasive procedures. (13) Maintains professional competency involving clinical skills and knowledge through participation in professional organizations, self-directed journal readings, and attendance at in-service and continuing education programs. (14) Complete all forms and reports accurately and promptly when appropriate. (15) Instruct and teach the DoD members as necessary. (16) Provide patient education on therapy, medications, and procedures when necessary. (17) Perform other duties and tasks as assigned from time to time. (18) Participate in the clinic quality assurance, utilization review, risk management, and peer review activities. (19) Attends medical staff meetings as required. 4. PAIN MANAGEMENT ANESTHESIOLOGIST (4 FTEs). The contracted Pain Management Anesthesiologist, shall provide the following services and in strict compliance with standing orders and protocols set forth by the MTF, and IAW JC guidelines to include, but shall not necessarily be limited to the following: (1) Serves as an authoritative source of information in the areas of anesthesia care for clinic staff; refers patients for consultation to other HCPs when appropriate; instruct and monitor physician assistants in the areas of anesthesia care. (2) Able to provide clinical recommendations to Anesthesia residents, interns, medical students and SRNAs in the conduct of general and regional anesthetics.

92 Page 84 of 135 (3) There are two types of duties for an Anesthesiologist and they are Personal and Medical Direction. Both are outlined as follows: (i) (ii) (iii) (iv) (v) (vi) Personal Pre-anesthetic evaluation of the patient. Personal Plans and implements anesthesia plan. Personal Provide induction of post-anesthesia care. Personal Perform duties as directed by the Chief, Anesthesia and Operative Service. Medical Direction Pre-anesthetic evaluation of the patient. Medical Direction Prescription of the anesthesia plan. (vii) Medical Direction Personal participation in the most demanding procedures in his plan, especially those of induction and emergence. (viii) Medical Direction Following the course of anesthesia administration at frequent intervals. (ix) Medical Direction remaining physically available for the immediate diagnosis and treatment of emergencies. (x) Medical Direction providing indicated post anesthesia care. (4) Prepare patients and if necessary, equipment for procedures. (5) Performance of invasive procedures. (6) Maintains professional competency involving clinical skills and knowledge through participation in professional organizations, self-directed journal readings, and attendance at in-service and continuing education programs. (7) Complete all forms and reports accurately and promptly when appropriate. (8) Instruct and teach the DoD members as necessary. (9) Provide patient education on therapy, medications, and procedures when necessary. 5. CARDIAC (2FTE) and NEURO ANESTHESIOLOGIST (1 FTE). The contracted Anesthesiologist, shall provide the following services and in strict compliance with standing orders and protocols set forth by the MTF, and IAW JC guidelines to include, but shall not necessarily be limited to the following: (1) Must possess at a minimum a current valid license to legally practice in one of the 50 states in the United States, or the District of Columbia, or the Commonwealth of Puerto Rico, or a U.S. Territory. (2) Ability to effectively communicate with HCPs at all levels and to provide professional assistance to health care finders in making referrals to appropriate HCPs.

93 Page 85 of 135 (3) Shall possess a working knowledge of military culture, customs, and procedures including military profiles and retention of Active Duty personnel. (4) Must be familiar with working with computerized patient care systems, be familiar with working with the Internet, and have a working knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and Explorer. (5) Shall have and maintain current certification in Basic Cardiac Life Support (BCLS). (6) Certification must be by American Heart Association and individual must demonstrate ability to initiate CPR in event of respirator or cardiopulmonary arrest. (7) Certifications must be renewed every year at no additional cost to the Government. (8) The Contract Anesthesiologist shall meet the qualifications for that specialty and perform essentially the same functions, within the scope of acceptable standards for their technical professional discipline, as those required by DoD or government service technical professionals of similar experience and in similar duty assignments. (9) The Contractor employee shall protect patient health information from unauthorized disclosure in accordance with HIPPA requirements. (10) The Contractor employee shall adequately protect the government s interest, retain control of the function involved; or retain full responsibility for the function supported. (11) The Contractor employee shall complete any mandatory annual medical/government required training and stay current. C. OTHER TASK AND RESPONSIBLITIES THE CONTRACT EMPLOYEE SHALL PERFORM BUT NOT LIMITED TO: The HCP shall perform all applicable duties given within the General Duties and Labor Category Specific Duties and the following additional duties: a. The HCP shall perform a full range of Anesthesiologist services for medical staff, support personnel, inpatients and outpatients in support of the Anesthesia Services using Government furnished facilities, equipment, and supplies within the assigned unit of the MTF. The HCP s productivity is expected to be comparable with that of other Anesthesiologists assigned to the same facility and authorized the same scope of practice. b. The HCP shall provide training as applicable to supporting Government (i.e. hospital corpsmen, LPNs, RNs, resident, medical students, interns etc.) assigned to the HCP during the performance of clinical procedures. The HCP shall perform limited administrative duties which include maintaining statistical records of the HCP clinical workload, participating in education programs, and participating in clinical staff quality assurance functions and Process Action Teams, as prescribed by the Commanding Officer. c. Participate in meetings to review and evaluate the care provided to patients, identify opportunities to improve the care delivered, and recommend corrective action when problems exist. Should a meeting occur outside of the HCP s regular working hours, the HCP shall be required to read and initial the minutes of the meeting.

94 Page 86 of 135 d. Participate in the provision of monthly in-service training to non-health care-practitioner members of the clinical and administrative staff on subjects germane to the HCP s specialty. e. Participate in the provision of in-service training to staff members of the clinic and administrative staff on subjects germane to medical care and attend annual renewal of the following Annual Training Requirements provided by WRNMMC: family advocacy, disaster training, infection control, Sexual Harassment and Blood borne Pathogens. f. Participate in the implementation of the Family Advocacy Program as directed. Participation shall include, but not be limited to, appropriate medical examination, documentation and reporting. g. Attend Composite Health care System (CHCS)/Armed Forces Health Longitudinal Technology (AHLTA) training provided by the Government for a minimum of four (4) hours, and up to a maximum of 40 hours. h. Attend all annual training classes required by this command. i. Perform administrative duties that include maintaining statistical records of your workload, operate and manipulate automated systems such as Composite Health Care System (CHCS), participating in education programs, and participating in clinical staff quality assurance functions and Process Action Teams, as prescribed by the Commanding Officer. j. Possess and maintain current certification in American Heart Association Basic Life Support (BLS) for Health care Providers; American Heart Association Health care Provider course; American Red Cross CPR (Cardio Pulmonary Resuscitation) for the Professional Rescuer; or an equivalent MTF course. HCPs, not currently in possession of current certification, must acquire certification prior to initiating contract performance. Web based classes do not meet these standards. A copy of the BLS instruction may be obtained from the World Wide Web at: Renewal of BLS may be done via on-site, WRNMMC classes at the discretion of the Chief of anesthesia when it is deemed to be in the best interests of WRNMMC to do so. k. Comply with the standards of the Joint Commission, applicable provisions of law and the rules and regulations of any and all Governmental authorities pertaining to licensure and regulation of health care personnel and medical treatment facilities, the regulations and standards of medical practice of the MTF and the bylaws of the hospital's medical staff. Adhere to and comply with all DoD and local Clinic instructions and notices that may be in effect during the term of the contract. l. Comply with the HIPAA (Health Insurance Portability and Accountability Act) privacy and security policies of the treatment facility. Providers shall obtain/maintain a National Provider Identifier (NPI) in accordance with DOD and MTF policy/instruction. m. The HCP shall participate in executing the Emergency Preparedness Plan (drills and actual emergencies) as scheduled by the MTF (typically semiannually). A MTF personnel re-call list with personal contact information for all military, civil service and contract employees is required to prepare in advance for an actual emergency. The HCP shall provide personal contact information to the designated supervisor upon commencement of services. n. Should an emergency occur, the HCP shall be contacted with shift information and for accountability purposes. o. Perform a full range of Anesthesiologist services on-site using Government-furnished supplies, facilities and equipment. Productivity is expected to be comparable with that of other contracted individuals performing similar services. p. Give two grand round lectures via a power point presentation annually. In addition, chapter reviews and case conferences will be assigned. The HCP shall share responsibility for preparing residents for their boards and producing a strong academically and clinical sound anesthesiologist. Technically direct, perform, or assist in the instruction of, other health care professionals in accordance with clinical privileges. q. Prescribe and dispense medications as delineated by the Pharmacy and Therapeutics Committee. r. Promote preventive and health maintenance care, including annual physicals, positive health behaviors, and self- care skills through education and counseling.

95 Page 87 of 135 s. Demonstrate awareness and sensitivity to patient/significant others' rights, as identified within the institution. t. Demonstrate awareness of legal issues in all aspects of patient care and unit function and strive to manage situations in a reduced risk manner. u. Participate in peer review and performance improvement activities. v. Demonstrate appropriate delegation of tasks and duties in the direction and coordination of CONTRACTED health care team members, CONTRACTED patient care, and CONTRACTED clinic activities. w. Maintain an awareness of responsibility and accountability for own professional practice. x. Participate in continuing education to meet own professional growth. Participate in the provision of inservice training to clinic staff members, including daily resident teaching conferences. y. Medical services provided shall include, but are not limited to, the following listed Anesthesiology Procedures: (1) Provide comprehensive medical management of patients to be rendered unconscious or insensitive to pain and emotional stress during surgical, obstetrical, dental and certain medical procedures, including preoperative, intraoperative, and postoperative examination, consultation, management, monitoring, evaluation, and treatment; (2) Management of fluid, electrolyte, and metabolic parameters (3) Resuscitation of patients of all ages (4) Management of malignant hyperthermia (5) Manipulation of cardiovascular parameters (6) Diagnostic and therapeutic management of acute and chronic pain (7) Manipulation of body temperature (8) Intravenous conscious sedation (9) Sedation and analgesia (10) Management of hypovolemia from any cause (11) Management of unconscious patients (12) Routine Obstetrical anesthesia with perioperative consultation (13) Local and regional anesthesia with and without sedation, including topical and infiltration, minor and major nerve blocks, intravenous blocks, spinal, epidural, and major plexus blocks. Use advanced regional anesthesia techniques including ultrasound to place blocks and peripheral nerve catheters for both anesthesia and pain management. (14) General anesthesia, including invasive monitoring, respiratory therapy including long term ventilatory support, airway management including cricothyroidotomy. (15) Multidisciplinary direction of pain management ATTACHMENT #2 SAMPLE IMMUNIZATION STATUS EMPLOYEE'S NAME: HEPATITIS B Serologic Testing Hepatitis Vaccine: (Specify Dates and Results) (Specify Dates Doses Given): HbsAG Dose #1 Dose #2 HbsAB Dose #3 Booster Mantoux Test PPD TB STATUS Chest X-ray

96 Page 88 of 135 PPD Given: Date of CXR: PPD Read: CXR Results: Results: Results of Evaluation and Indication for Treatment: MEASLES/MUMPS/RUBELLA Positive Antibody Titer MMR Immunization (Specify Dates and Results): (Specify Dates Doses Given): Measles: Dose #1 Mumps: Dose #2 Rubella: TETANUS & DIPHTHERIA (Specify Dates Given) Dose #1 Dose #2 Dose #3 Booster VARICELLA Positive Antibody Titer (Specify Dates and Results): Varicella Immunization Given: EXAMINING PHYSICIAN: ADDRESS: TELEPHONE: SIGNATURE & DATE:

97 Page 89 of 135 ATTACHMENT #3 FILL/VACANCY REPORT CONTRACTOR: DATE: CONTRACT NUMBER CONTRACT START DATE NO. OF FTE NO. FILLED NO. VACANT ACTIONS TAKEN TO FILL POSITONS

98 Page 90 of 135 ATTACHMENT # 4 PERFORMANCE REQUIREMENT SUMMARY (PRS) The Government will measure the contract s service performance under the performance objectives listed in the following table by applying the corresponding performance standards and acceptable performance quality levels. Performance Objective Submits only complete credentialing for candidates with realistic employment opportunities Contractor workforce shall maintain professional certifications Contracted workforce shall complete mandatory medical/government required training Contractor compliance with Health and Immunization Requirements. Quality Control Plan Performance Standard Contractor obtains all documents required by WRNMMC credentialing office. 100% 100% certificates shall be renewed and maintained in current status during life of contract 100% compliance with mandatory training requirement Comply initially and as required 100% of the time. Within 30 days of contract award. 100% PWS Reference 1.12 and PWS Attachment # 1 PWS Attachment # 1 Method of Assessment Incomplete credentialing packages submitted, candidates not meeting requirements Credentials records 1.16 Attendance rosters 1.11 COR maintain log Contracting Officer will review QCP Comply with Specific Comply at least 99% of the PWS Attachment # 1 COR maintained log. Tasks. time Comply with Comply initially and as 1.4. through COR maintained log. Security Requirements. required 100% of the time. Assure retention of Fill rate of 100% 30 days 1.8 and PWS Attachment Monthly fill/vacancy reports. qualified personnel after contract award. # 1 Combating Trafficking in persons (awareness program) 100% compliance (zero tolerance) regarding trafficking in persons policy FARS AND FAR COR documentation and program review. Any non-compliance must be brought to the immediate attention of the KO INCENTIVES: The contractor is reminded that both positive and negative performance evaluations will be recorded in the Contractor Performance Assessment Reporting System ( ) (in accordnace

99 Page 91 of 135 with FAR Part 42. Negative performance could negatively affect the contractor s ability to perform on any new contract(s) with this (and or other DoD) contracting office. EXCEPTIONAL SATISFACTORY: UNSATISFACTORY: Performance significantly exceeds contract requirements to the Government s benefit. Performance meets contractual requirements. Performance does not meet contractual requirements. Other performance evaluation factors that will be monitored and documented in the contractor s performance records but cannot be quantified by numerical measurements: Contractor providing personnel exceeding the minimum qualification standards Performance above or below the standard, for above factors, will be documented in the Contractor s Performance Assessment Reporting System (CPARS) for the reporting period. ATTACHMENT # 5 - QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) The following minimum Quality Assurance Plan applies. The Government may modify inspection methods in accordance with site-specific requirements. The Government will measure the contract s service performance under the performance objectives listed in the following table by applying the corresponding performance standards and acceptable performance quality levels. Performance Objective Submits only complete credentialing packages for candidates with realistic employment opportunities Contracted workforce shall maintain professional certifications Contractor workforce shall complete any mandatory annual medical/government required training Contracted workforce complies with Health and Immunization Requirements. Performance Standard Contractor obtains all documents required by WRNMMC credentialing office. 100% 100% of certificates shall be renewed and maintained in current status during life of contract 100% compliance with mandatory training requirement REF PBWS 1.12 and PWS Attachment # 1 PWS Attachment # 1 Method of Assessment Incomplete credentialing packages submitted, candidates not meeting requirements Credentials records Corrective Actions to be Taken by Government Document performance in CPARS May result in cure notice being process. Document performance in CPARS 1.16 Attendance rosters Document performance in CPARS Comply initially and as required 100% of the time COR maintain log. May result in cure notice being process. Document performance in CPARS Quality Control Plan Within 30 days of contract Contracting Officer will Document

100 Page 92 of 135 Comply with Specific Tasks. Comply with Security Requirements. Assure retention of qualified personnel Combating Trafficking in persons (awareness program) award. 100% review QCP performance in CPARS Comply at least 99% of the time. Comply initially and as required 100% of the time. Fill rate of 100% 30 days after contract award. 100% compliance (zero tolerance) regarding trafficking in person policy PWS Attachment # 1 COR maintain log. the KO STANDARD MEASUREMENT PAST PERFORMANCE ASSESMENT 99% to 100% Exceptional Document Past Performance 96% to 98% Very Good Assessment Report, paying particular 95% satisfactory attention to performance that exceeds 92% to 94% Marginal the standard 91% or less Unsatisfactory Below 91% may result in cure notice being processed 1.4. through COR maintained log. Document performance in CPARS 1.8 and PWS Attachment # 1 FAR and FAR Monthly fill/vacancy reports. COR documentation and program review. Any non-compliance must be brought to the immediate attention of Document performance in CPARS Document compliance in CPARS. Remedies allowable per FAR will be taken. ATTACHMENT # 6 SUPPLEMENT TO THE PWS: EMPLOYEE CREDENTIALING HISTORY: Contractor shall not hire any employee or subcontractor which is listed on the Excluded Parties List System (EPLS) maintained by the General Services Administration. The Contractor shall not employ any individual to provide direct health care services who, within 5 years prior to employment: a. Has had his/her clinical privileges limited, suspended, or revoked by any health care facility, public or private, anywhere in the world. (1) This prohibition does not apply to any individual whose clinical privileges, although originally limited, suspended or revoked by a health care facility were subsequently fully reinstated by the health care facility. (2) Limitation of clinical privileges, as used in this paragraph, refers to a partial withdrawal/reduction of clinical privileges as a result of a determination that or pending investigation to determine whether an individual has engaged in unprofessional conduct or substandard medical practice or is incompetent to perform certain medical practices.

101 Page 93 of 135 (3) Is the subject of a current or pending hearing or appeal brought by any health care facility, public or private, anywhere in the world, which may result in the limitation, suspension or revocation of the individual s clinical privileges. (4) Is listed on the Health and Human Services (HHS) list of providers excluded from Federally funded health care programs. The list may be found at (5) Requirements for privileging are the same for replacement contract HCPs as for contract HCPs they are replacing. (6) The WRNMMC Director is the sole authority that can revoke or otherwise restrict the privileges of any contract HCP who he/she determines is not qualified to perform the contract services. (7) Once privileges are granted, subsequent actions taken concerning the privileges of contract HCPs, including any limitation on privileges, will be governed by the procedures in AR Action that suspends, revokes, places in abeyance, or otherwise restricts the privileges of the contract HCP results in that contract HCP not being authorized to perform under the contract. Such action does not excuse the contractor from performing. A replacement contract HCP must be provided according to the terms of this contract. (8) Adverse actions on contract HCP privileges, once the Commander takes action, may be appealed locally by the contract HCP under the provisions of AR 40-68, but may not be appealed by the contractor. CRIME CONTROL ACT OF 1990: No performance under this contract will be allowed without full compliance with the Crime Control Act of 1990 and the Department of the Army Circular , 15 November 1992, Criminal History Background Checks on Individuals in Child Care Services. Contractor shall ensure that proposed providers cooperate with and assist the Government in conducting any necessary background checks. COMPLIANCE WITH CRIME CONTROL ACT OF This position requires the contractor to comply with Public Law (Crime Control Act) and submit to a criminal history background check performed by the government. The contractor shall schedule an appointment with the Security & Intelligence Office, WRNMMC within three (3) working days after start of performance under this contract. The contractor will be fingerprinted and complete a Standard Form SF85-P. If the contract employee is in a position that requires access to Critical Sensitive or Classified Information the contract agency Facility Security Office (FSO) is responsible for ensuring that the employee has the required SECURITY clearance to include submitting a SF86 EPSQ questionnaire to DSS and obtaining the necessary SECURITY clearance level through Defense Investigative Security Clearance Office (DISCO) as prescribed by the National Industrial Security Program Operating Manual (NISPOM) The contractor shall be advised that a FAVORABLE report is needed as a condition of employment under Army Contracts. Until the final background checks are completed, line of sight restriction shall apply and access to classified or Critical Sensitive information will be denied until a final SECURITY clearance or an interim SECURITY clearance has been granted by DISCO and the appropriate security verification and visitation letter has been received by the WRNMMC Security and Intelligence office. The security office will notify each department head when line of sight requirement can be lifted. Contract employees who previously received a background check and do not have a two-year break in service must get verification from Security and Intelligence Office. All employees are required to have a record re-verification and internal record check at a minimum of every five years. SECURITY REQUIREMENTS: Since the HCPs under this contract have access to and/or process information requiring protection under the Privacy Act of 1974, these positions are considered IT Sensitive positions. Compliance with Executive Order (EO) 10450, DOD Directive , DOD R, AFI , AR25-2 and

102 Page 94 of 135 AR is mandatory for IT Sensitive positions. Therefore, a National Agency Check for Trustworthiness (NACT) is required for each HCP under this contract. Each individual will be fingerprinted and required to complete the appropriate forms, usually a Standard Form 85-P, Questionnaire for Public Trust Positions. The contractor is responsible for obtaining the Standard Form 85-P, Questionnaire for Public Trust Position, which is available at The contractor shall advise their employees that a favorable report is required as a condition of employment under this contract. The contractor shall apply for the NAC within three (3) workdays after start of performance for each contract HCP. The government will be responsible for all costs associated with the NAC. Offerors shall be advised adjudication constraints may prevent non-u.s. Citizens from performing in a timely manner. No waivers will be contemplated. SMOKING POLICIES WITHIN WRNMMC: The Contractor shall ensure that all employees comply with the DoD and WRNMMC smoking policies while performing services under this contract. Smoking restrictions will apply at any location or building where health care activities are performed under this contract. MOBILIZATION AND CONTINGENCY PLANNING: a. In the event of a general or limited mobilization of reserve forces or an emergency, which impacts upon contract performance, the contractor will be expected to promptly take whatever measures are needed to meet any new demands placed upon it. Such demands could require increases in Contractor-furnished property, as well as extended work hours and expansion of the contract work force. b. To ensure that Government operations which depend upon the services provided hereunder can proceed with no or minimal disruption, the contractor shall during the life of this contract anticipate the possibility of a mobilization or similar emergency and the steps it will need to take to rapidly expand its contract capabilities to meet the emergency. NON-COMPETE CONDITIONS: Contractor and subcontractors shall not include or use non-compete provisions with respect to the performance of Government medical service contracts in their employment, consultant, or third party contract agreements (hereafter agreements) with their Health Care Providers (HCPs) which are effective beyond the period of contract performance, base period and exercised option periods included. Non-compete provisions shall not prevent HCPs from being interviewed, employed, or accepting offers of employment or making other arrangements with potential competitors for follow-on contracts. Additionally, non-compete provisions shall not prevent HCPs from accepting offers of employment or making other arrangements with any contractors who provide services to the Government, or from accepting offers of employment with the US Government, following the period of contract performance. In addition to any other remedies available to the Government, inclusion of such non-compete or similar conditions in agreements with HCPs may result in offeror's proposal being determined unacceptable, termination of any awarded contract or task order, and an entry in the Contractor Performance Assessment Reporting System (CPARS) performance evaluation. Preventing HCPs from accepting these offers will hinder the Government's ability to accomplish the mission of providing medical care to its beneficiaries. UNAUTHORIZED SERVICES: The Contractor shall not undertake any action that will increase the price of the contract without the written approval of the Contracting Officer. Any such unauthorized action taken by the contractor or any Contractor employee, which might be construed to be approved by the Government, shall be the responsibility of the Contractor and shall be resolved by the Contractor at no expense to the Government. Third party claims resulting from such unauthorized actions shall also be resolved by the Contractor without expense to the Government. CRIMINAL HISTORY BACKGROUND CHECK REQUIREMENT: 1. This clause is MANDATORY for those personnel involved in the delivery of healthcare to children under the age of 18 on a frequent and regular basis.

103 Page 95 of The government will conduct criminal background checks on all contract Health Care Providers (HCPs) in accordance with the procedures set forth in Public Law , DOD Directive Enclosure 6 paragraph E , DOD Directive R, DODI The contractor is responsible for ensuring background check submittals are initiated in accordance with the WRNMMC procedures prior to contract HCPs providing services at the WRNMMC, and that they are properly cleared and meet the requirements of the law. Background checks shall be based on fingerprints of individuals obtained by a law enforcement officer designated by the provost marshal on a properly completed FD Form 258 (FBI US Department of Justice Fingerprint Card) together with DD Form (DOD National Agency Questionnaire), and on inquiries conducted through the Federal Bureau of Investigation (FBI) and State Criminal History Repository check, and a local Installation Record Check if required. The procedures for completing the required background check are outline in the Department of Defense Instruction (DODI) Dated January 10, 1993; Subject: Criminal History Background Checks on Individuals in Child Care Services; Enclosure 6, paragraph E6.4, Government Contract Employees. (DODI is available on the Internet at: Time required for contract HCPs to be fingerprinted is billable under the contract. 3. If the contractor has a DOD affiliation such as living or working on an installation within the last 5 years, or is a family member of active duty military, an Installation Record Check (IRC) shall be conducted by DOD Component personnel at the installation level. No IRC is required on individuals without DOD affiliation. Upon favorable completion of the IRC, an individual may be selected to provide services to a minor child under line-of-sight supervision (LOSS) until the required background checks are completed. Line-of-sight supervision is defined at DODI , Enclosure Personnel may be employed under the contract pending completion of the background checks provided the activity uses line-of-sight supervision while minor children are in the care of that individual. The contract HCP shall be within line-of-sight supervision of a staff person whose background check has been successfully completed, or is in the presence of the child's parent or guardian. 5. All clearance requests shall be submitted in accordance with the applicable directives specific to the WRNMMC. The name and address of the WRNMMC security section representative or the COR shall be included in the request as the recipient of the results in accordance with WRNMMC procedures. If neither position exists, the KO shall be designated to receive a copy of the results. 6. Contract HCPs have the right to obtain a copy of the background check report. Contract HCPs should contact their appropriate company representative or individual identified in the previous paragraph for a copy of the results. Contract HCPs may challenge the accuracy and completeness of the information in the report by contacting the individual identified in the previous paragraph. 7. If the contractor has previously received a background check, proof of the check shall be provided or a new one obtained. A new investigation is required if a break in service to the Department of Defense results in a time lapse of more than 2 years. Re-verification shall be accomplished every 5 years. 8. Payment of fees incurred in the conduct of any criminal history background check is the responsibility of the employing activity. HEALTH AND IMMUNIZATION REQUIREMENTS: 1. Health. Contractor individual performing services under this contract shall comply with the health and immunization requirements as stated below at the time of initial request for clinical privileges and annually thereafter. The expense for all physical examinations to comply with the health requirements shall be borne by the contractor individual at no additional cost to the government.

104 Page 96 of Contractor individual performing direct healthcare services under the contract shall receive a general physical examination with their credentialing package. The certificate shall state the date on which the examination was completed, and the name of the physician who performed the examination. The physician performing the examination shall sign this certification. For the purpose of this paragraph, a physical examination administered more than 45 days prior to submitting credentialing package will not be considered adequate. The physical exam shall include the following: a. A history to show that the HCP has completed a primary series of immunization with tetanus and diphtheria toxoids and that a booster dose is current (within the past 10 years.). b. A test for immunity to the hepatitis (Type B) virus with documentation of the results. A profile shall be established to show immune status to hepatitis. Non-immune Healthcare workers (lacking anti-hb(c) or anti-hb(s)) shall be required to complete an immunization series with a Hepatitis B vaccine (e.g., Recombivax, Energix). c. Serologic evidence of immunity to measles and rubella or documentation of immunization with measles, mumps, and rubella (MMR) vaccine using the following guidelines. (1) Employees born before 1957 without documentation of previous vaccination with MMR should receive one dose. (2) Employees born in or after 1957 who have received one dose of MMR previously shall receive on booster dose. (3) Employees born in or after 1957 without documentation of any previous vaccination with MMR should receive two doses of vaccine, separated by no less than one month. d. Serologic evidence of immunity to varicella or documented history of illness or immunization. e. For personnel who do not have proof of having completed a primary series, completion with enhanced potency inactivated poliovirus vaccine (eipv) is recommended. Reliable history of spending early childhood and attending elementary schools in the United States since may suffice as clinical history of polio immunization, but requires physician documentation in the record of the history and examination. f. Contractor individual shall be screened before employment and annually for tuberculosis by a tuberculin skin test using the Mantoux technique. (The TINE test is disallowed as a substitute.) A skin test result of 10 mm of indurations or more shall be required to have a chest roentgenogram and an evaluation performed. A tuberculin skin test of 10 mm of indurations or more will require documentation providing an assessment of the patient (status of infection-active, inactive; need for preventive treatment or not as determined by age, history of BCG (Bacillus Calmette-Guerin) vaccination; duration of skin test positivity, etc). 3. If all of the immunization and test set forth in the preceding paragraphs have been completed, the contractor shall issue a certificate providing evidence of immunizations and tests that have been completed or started and shall provide a schedule for the completion of unfinished immunizations and lab tests. After the schedule is completed, the contractor must provide an updated and complete certificate. Failure to complete the immunizations as scheduled may be grounds for the Contracting Officer, upon the advice of the WRNMMC Director or his/her clinical staff, to determine that such contractor individual is not an acceptable individual to perform services under this contract. 4. The Contracting Officer, with the explicit case-by-case approval of the WRNMMC Director, is empowered to make exceptions to these requirements, for example, in the event of vaccine shortage or bona fide religious

105 Page 97 of 135 exceptions, but nothing herein shall be construed as an imperative or directive upon the Contracting Officer to make such exceptions. 5. Contractor individual performing direct healthcare services under this contract, which experience a parenteral (e.g., needle-stick or cut) or mucous membrane exposure (e.g.. splash to the eye or mouth) to blood or bloody body fluids, shall receive prompt treatment. The medical treatment facility will evaluate the source of exposure for risk of Hepatitis-B, Hepatitis-C. And Human Immunodeficiency virus (HIV) and will provide a report of the findings to the contractor and the contract HCP. It shall be the contractor s responsibility to provide appropriate treatment as needed to possibly include Tetanus-Diphtheria booster, Immune Globulin, Hepatitis-B vaccine booster, or Hepatitis- B Immune Globulin. The contractor shall be responsible for providing the contract HCP with initial testing and if the source of exposure was unknown, positive, or confirmed at high risk for HIV infection, follow-up testing 3, 6, and 12 months after exposure. In event of a confirmed or highly suspected parenteral exposure to HIV, the contractor individual shall receive appropriate counseling and is referred immediately to a private infectious disease specialist for consideration of any post exposure prophylaxis (e.g., AZT). The Government may require the contractor individual to provide evidence of the status of treatment and testing of the individual contractor under the contract. 6. Contractor individual shall receive the current influenza immunization from a non-government physician and present evidence of the shot to the COR unless documented by a physician to be medically contraindicated. 7. Failure to meet the requirements stated herein, or when test results determine a contractor individual has a contagious disease, the Contracting Officer may, upon advice of the WRNMMC Director or his/her clinical staff, determine that such a contractor individual is not an acceptable individual to perform services under this contract. 8. The Government offers vaccine for occupational exposed hazards, i.e., smallpox, anthrax, etc. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (June 2012): In accordance with DoD R Department of Defense Health Information Privacy Regulation, January 24, 2003, the Contractor meets the definition of Business Associate. Therefore, a Business Associate Agreement is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security regulations. This clause serves as that agreement whereby the Contractor agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in this clause, and in DoD R and DoD R, as amended. Additional requirements will be addressed when implemented. (a) Definitions. As used in this clause generally refer to the Code of Federal Regulations (CFR) definition unless a more specific provision exists in DoD R or DoD R. Individual has the same meaning as the term individual in 45 CFR and shall include a person who qualifies as a personal representative in accordance with 45 CFR (g). Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E. Protected Health Information has the same meaning as the term protected health information in 45 CFR , limited to the information created or received by the Contractor from or on behalf of the Government pursuant to the Contract. Electronic Protected Health Information has the same meaning as the term electronic protected health information in 45 CFR Required by Law has the same meaning as the term required by law in 45 CFR

106 Page 98 of 135 Secretary means the Secretary of the Department of Health and Human Services or his/her designee. Security Rule means the Health Insurance Reform: Security Standards at 45 CFR part 160, 162 and part 164, subpart C. Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45 CFR , , , , and (b) The Contractor shall not use or further disclose Protected Health Information other than as permitted or required by the Contract or as Required by Law. (c) The Contractor shall use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract. (d) The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract. (e) The Contractor shall, at their own expense, take action to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Clause. These mitigation actions will include as a minimum those listed in the TMA Breach Notification Standard Operating Procedure (SOP), which is available at: (f) The Contractor shall report to the Government any security incident involving protected health information of which it becomes aware. (g) The Contractor shall report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Contractor becomes aware. (h) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor, on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information. (i) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it. (j) The Contractor shall provide access, at the request of the Government, and in the time and manner reasonably designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR (k) The Contractor shall make any amendment(s) to Protected Health Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR at the request of the Government, and in the time and manner reasonably designated by the Government. (l) The Contractor shall make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor, on behalf of the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner reasonably

107 Page 99 of 135 designated by the Government or the Secretary, for purposes of the Secretary determining the Government s compliance with the Privacy Rule. (m) The Contractor shall document such disclosures of Protected Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR (n) The Contractor shall provide to the Government or an Individual, in time and manner reasonably designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR General Use and Disclosure Provisions: Except as otherwise limited in this Clause, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, the HIPAA Security Rule, DoD R or DoD R if done by the Government. Specific Use and Disclosure Provisions: (a) Except as otherwise limited in this Clause, the Contractor may use Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor. (b) Except as otherwise limited in this Clause, the Contractor may disclose Protected Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached. (c) Except as otherwise limited in this Clause, the Contractor may use Protected Health Information to provide Data Aggregation services to the Government as permitted by 45 CFR (e)(2)(i)(B). (d) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR (j)(1). Obligations of the Government: Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions (a) The Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR (b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect the Contractor s permitted or required uses and disclosures. (c) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR

108 Page 100 of 135 Permissible Requests by the Government: The Government shall not request the Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, the HIPAA Security Rule, or any applicable Government regulations (including without limitation, DoD R and DoD R) if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause. Termination: (a) Termination. A breach by the Contractor of this clause, may subject the Contractor to termination under any applicable default or termination provision of this Contract. (b) Effect of Termination. (1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below (2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information. (3) If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information. Miscellaneous: (a) Regulatory References. A reference in this Clause to a section in DoD R, DoD R, Privacy Rule or Security Rule means the section currently in effect or as amended, and for which compliance is required. (b) Survival. The respective rights and obligations of Business Associate under the Effect of Termination provision of this Clause shall survive the termination of this Contract. (c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DoD R, DoD R, the HIPAA Privacy Rule or the HIPAA Security Rule. (END OF SUPPLEMENT TO THE PWS)

109 Page 101 of 135 CLAUSES INCORPORATED BY FULL TEXT DHA PGI PROPER IDENTIFICATION OF CONTRACTOR PERSONNEL (APRIL 4, 2014) 1. Contractors, including subcontractors at all tiers, shall provide for a clear distinction from Government personnel. Contractor employees shall not act, advertise, or presume to be Government employees, agents, or representatives. Contractor employees are required to appropriately identify themselves as contractor employees at all times, including in telephone conversations, formal and informal written correspondence, paper and electronic, and in any other situation where their actions could be construed as acts of Government officials, unless, in the judgment of the Government, no harm can come from failing to identify themselves. Contractor employees shall be introduced as contractor personnel and display distinguishing visible identification at all times whether in conversations, meetings, or other forms of communication with Government personnel. 2. Contractor personnel, while performing in a contractor capacity, shall refrain from using their retired or reserve component military rank or title (if applicable) in written or verbal communications associated with the contracts for which they provide services. (End of requirements language) DHA PGI PERSONALLY IDENTIFIABLE INFORMATION (PII), PROTECTED HEALTH INFORMATION (PHI), AND FEDERAL INFORMATION REQUIREMENTS (REVISED MAY 6, 2015) The contractor shall comply with the document entitled, Personally Identifiable Information (PII), Protected Health Information (PHI) and Federal Information Requirements, that can be found at which is incorporated by reference in its entirety. (End of requirements language) CLAUSES INCORPORATED BY REFERENCE Instructions to Offerors--Commercial Items OCT 2015 ADDENDUM TO Paragraph (a) is hereby supplemented with the following: (b) Submission of Offers. The following supplements this paragraph with respect to the information and documents required for submission in response to this solicitation:

110 Page 102 of 135 (1). ELECTRONIC OFFERS. All offers in response to this solicitation must be ed directly to Mr. Ed DuChemin (Information Technology Solutions & Consulting, LLC (ITSC)) contractor, directly supporting DHA) at Note: As a reminder all offers must arrive by the time specified in the solicitation. (2). Offerors may request verification by to Ed DuChemin at edgar.r.duchemin.ctr@mail.mil to confirm that their proposal was received by the time specified in the solicitation. (c) This acquisition is being conducted utilizing the policies and procedures of FAR Parts 8 and 12 in conjunction with appropriate parts of FAR Part 13 for the acquisition of commercial services. The Government intends to award a firm fixed-price non-personal services contract under the authority of Section 1091 and 1089 of Title 10, U.S.C. Offerors are instructed to ensure that their offered rates DO NOT include costs associated with medical malpractice liability insurance. Offerors must quote a firm-fixed price for each Contract Line Item. (d) The Government intends to award a task order without further communicating with contractors. Consequently, contractors are highly encouraged to quote their best technical and pricing quotes in their initial submissions. However, the Government reserves the right to communicate with any or all contractors submitting a technical and price quote, if it is determined advantageous to the Government to do so. This statement is not to be construed to mean that the Government is obligated to communicate with every quoter (note that FAR Part 15 procedures do not apply to FSS orders, therefore formal discussions are not applicable). A contractor may be eliminated from consideration without further communication if its technical and/or pricing quotes are not among those Contractors considered most advantageous to the Government. (e) Any questions with respect to the solicitation shall be submitted not later than 30 December 10:00 a.m. EDT to Mr. Ed DuChemin at edgar.r.duchemin.ctr@mail.mil. Responses to questions will be posted on GSA Advantage ebuy via RFP amendment. (f) BASIS FOR AWARD. Award will be made on a Lowest Price Technically Acceptable (LPTA) basis. Award will be made to the responsible offeror provided its technical proposal is Acceptable and conforms to the requirements of this solicitation and has the lowest price that is fair and reasonable. Factors I (Technical) and II (Price) are considered equal in value for rating. (g) Data Universal Numbering System (DUNS) / CAGE Code. The offeror shall obtain these said Codes and submit them to Contracting Center. Register in the System for Award Management (SAM) and the Online Representations and Certifications, if the offeror is a U.S. business entity. Award cannot and shall not be made to an offeror without these codes. (h) Proposal Preparation Costs. The Government will not pay any costs incurred in the submission of an offer, in making any necessary studies for the preparation thereof, or for any visit(s) the Contracting Officer may request for the purpose of clarification of the offer. (i) The offeror is responsible for ensuring that its proposal is complete. The proposal shall be clear, concise, and shall include sufficient detail for effective evaluation and for substantiating the validity of any stated claims. The proposal shall not simply rephrase or restate the Government's requirements, but rather shall provide convincing rationale to address how the offeror intends to perform the requirement. Offerors shall assume that the government has no prior knowledge of their experience and will base its evaluation solely on the information presented in the offeror's proposal. (j) Protests received at a level higher than the contracting officer will be referred to the contracting officer. Protestor may request a review by the contracting officer or an independent review at a level higher than the contracting officer. Requests for appeals or independent review will be addressed to the contracting officer for referral to the review authority. Questions on this process will be referred to the cognizant contracting

111 Page 103 of 135 officer identified in the solicitation. (k) The non-far Part 12 discretionary FAR, DFARS, AFARS, and LOCAL provisions included herein are incorporated into this solicitation either by reference or in full text. If incorporated by reference, see provision herein for locations where full text can be found. (l) The solicitation should be completed, signed and received at this office not later than the date/time specified on page one of the solicitation (Standard Form [SF] 1449). Failure to provide all information requested and in the appropriate format as required may cause the offer to be rejected and no longer considered for award. Please note that your offer must include all of the following information. Submit proposal in three (3) separate parts as follows: I. Technical Sub factor 1: Compensation Matrix Sub factor 2: Recruitment and Retention Plan II. III. Past Performance Price PART I: TECHNICAL INFORMATION: The information provided by the offeror is a significant factor in the Government s determination of technical acceptability as it pertains to the offeror s ability to hire qualified personnel as well as to provide continuous service based on a sufficient incentive to retain those qualified personnel. Offerors are responsible for including sufficient details to permit a complete and accurate evaluation of each proposal. Proprietary information shall be clearly marked. Within the technical portion of the offeror s proposal, the offeror shall provide: Sub factor 1: Compensation. See attachment entitled Compensation Matrix. Offerors are directed to fill-in / populate the Compensation Matrix that includes employee base salary amount, employee fringe benefits, as well as company profit, overhead, and G&A for the geographic area of service (Walter Reed National Military Medical Center, Bethesda, MD ). If the salary is less than the amount paid in the local area, the offeror must demonstrate that its Compensation Matrix is adequate to recruit and retain quality health care providers and ensure uninterrupted performance of services throughout the life of the contract. The escalation factor or other means for price changes in the Option periods must be addressed within the narrative of the Compensation Matrix. Sub factor 2: Recruitment and Retention Plan. The Recruitment and Retention Plan shall describe the offeror s approach to recruit and retain qualified personnel to fill the positions. The Plan should convey the offeror s methods in replacing personnel who abruptly leave or are out of work for an extended period of time so that the position(s) can be filled as quickly as possible, enabling the offeror to maintain or exceed the 95% fill rate identified in the Performance of Work Statement s Quality Assurance Surveillance Plan. This plan must describe any training procedures to maintain required certifications, and include an effective and realistic retention plan for the geographic area of service (Walter Reed National Military Medical Center, Bethesda, MD ). Within this R&RPlan, offerors must address the requirements as written in clause NOTICE OF CONTINUATION OF ESSENTIAL CONTRACTOR SERVICES (OCT 2010) as well as address the requirements as written in clause CONTINUATION OF ESSENTIAL CONTRACTOR SERVICES (OCT 2010). The technical information shall not exceed 10 pages and must be submitted in Microsoft Word compatible format. The technical information shall include the company s name, address, individual names, CAGE Code, DUNS number on the first page.

112 Page 104 of 135 PART II: PAST PERFORMANCE: Offeror is required to submit a past performance listing (PPL) with relevant federal, state and local government and private contracts performed within the past three (3) years, which are similar in scope, type of work, and size (e.g. number of employees by type and anticipated dollar value) to the effort described in this solicitation. If the offeror has no relevant past performance, the offeror should state so for this evaluation factor. In addition to this past performance listing, all offerors must provide a copy of the past performance questionnaire (PPQ), to each individual / company listed in the PPL. The offeror shall inform the person requested to complete the PPQ to it directly to edgar.r.duchemin.ctr@mail.mil. The offeror should instruct POCs not to send a copy back to the offeror. (See PWS Attachment # 7 Past Performance Questionaire). (a) Offerors shall submit the information requested below as part of their proposal for both the offeror and any proposed subcontractors for subcontracts expected to exceed 25% of the requirement. The document shall be submitted in Microsoft Word compatible format and shall not be more than one page for the prime contractor and one additional page for each major subcontractor. (1) Offerors shall submit a list of three (3) contracts and/or subcontracts completed in the last three years, including contracts and subcontracts currently being performed, which are relevant to this requirement. Contracts are relevant if they are similar in scope, type of work, and size to the effort described in this solicitation. (2) Include the following information for each contract and subcontract identified in the PPL: (a) Name of contracting activity. (b) Contract number. (c) Contract title. (d) Contract type. (e) Brief description of contract or subcontract and relevance to this requirement. (f) Total contract value. (g) Period of performance. (h) Contracting Officer, telephone number and address, if available. (i) Program manager/project officer, telephone number and address, if available. (j) Administrative Contracting Officer, if different from (h) above, telephone number and address (if available). (k) List of subcontracts (if applicable). (3) Offerors may provide information on problems encountered and corrective actions taken on the identified contracts and subcontracts. (a) If an offeror has no relevant past performance history, an offeror must affirmatively state that it possesses no relevant past performance history. (b) The completed PPQ s should be ed directly to edgar.r.duchemin.ctr@mail.mil ON OR BEFORE 09:00AM EDT 6 January Please request that any questionnaire submitted includes the following information in the subject line so the is not misconstrued as SPAM or otherwise deleted: Past Performance Questionnaire HT Q (1) Past performance information may be used for both responsibility determinations and as an evaluation factor for award. The Past Performance Questionnaire included with the Attachments will be used to collect information on an offeror s performance under existing and prior contracts/subcontracts for services similar in scope, type of work, and size to this requirement. References other than those identified by the offeror may be contacted by the Government and used in the evaluation of the offeror s past performance. (2) Any information collected concerning an offeror s past performance will be maintained in the official contract file.

113 Page 105 of 135 (3) Offerors with no relevant past performance history or for whom information on past performance is not available, will be evaluated neither favorably nor unfavorably on past performance. PART III: PRICE: Offerors will submit their proposed CLIN prices as presented in the RFQ. If the prices are the same for each contract period, provide one schedule and state that the schedule applies to all contract periods. If the prices are not the same for all contract periods, each CLIN price must be separately identified. DO NOT round figures in the pricing schedule. PART IV: RFQ DOCUMENTS: Solicitation, Offer, and Award Documents, Representations and Certifications, and Offeror s Business Information. (a) Completed and signed SF 1449, page 1, Blocks 17a., 30 a.- c, of the solicitation. Offeror must also put the total amount of the proposal (to include the summation of all CLINs, base and option periods) into Block 26, page 1 of the SF The offeror is not required to submit the entire SF The offeror MUST submit the SF 1449 pages that have been filled out by the offeror. (b) Signed amendments (if any). Only page 1 of the amendment shall be submitted and must be done so in PDF compatible format. The offeror may combine the signed page 1 of the SF 1449 and Amendments into a single PDF file. (c) Representations and Certifications found at FAR Alt 1 and MUST be completed. These must be submitted in Microsoft Word compatible format. The Offeror is encouraged to cut-andpaste these clauses into a separate Microsoft Word document to reduce file size. The Offeror should ensure that the appropriate NAICS Code for this procurement is included in the System for Award Management ( and in the Representations and Certifications for the company. (d) A business information document shall be submitted along with the RFQ documents. At a minimum, this document must include contact information such as addresses and telephone numbers for the principals and other information about the business and major subcontractors as applicable. If there are major subcontractors (performing 25% or more of the work), the offeror must state what percentage of the effort the subcontractor(s) will be performing. This document must be in Microsoft Word or Adobe PDF compatible format. At its discretion, the offeror may provide additional information about the company s history, capabilities, or any other details deemed appropriate. This document must be no more than 3 pages in length. (e) Each volume shall be submitted in an electronic format. Any revisions will be clearly marked (as a result of negotiations or proposal revisions) and should be of a different color. Each file shall be clearly identified (e.g. Volume I Technical, Sub factor 2 Recruitment & Retention Plan ). (f) A standard, 12-point minimum font size applies. Arial or New Times Roman fonts are required. Tables and illustrations may use a reduced font size no less than 8-point and may be landscape. (g) Page limitations shall be counted as maximums. If exceeded, the excess pages will not be read or considered in the evaluation of the proposal. Each page shall be counted except for the following: a) Volume Cover Pages b) Table of Contents c) Summary of Section d) Glossaries e) Blank Pages

114 Page 106 of 135 A summary of electronic proposal documents to be submitted is as follows: Volume Volume Title Number of Electronic Format Copies I I Technical Compensatio n Matrix Technical Recruitment & Retention Plan Maximum Page Limit 1 Microsoft Excel Compensation Matrix furnished by the Government is completed/populated and returned. (1 Sanitized* Microsoft Word 10 pages (combined total for copy via both the Compensation ). Matrix and the Recruitment & Retention Plan) II Price 1 Microsoft Word or Adobe PDF No limit. III RFQ documents 1 Microsoft Word or Adobe PDF No limit, except for the business information document portion which shall not exceed 3 pages. *Note: Sanitized means your company name or the name(s) of any of your employees or staff must NOT appear in your Technical (Recruitment & Retention Plan) proposal. (End of Addendum to ) PD ENCLOSURE 1 IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST (AUGUST 21, 2014) INSTRUCTIONS, CONDITIONS, AND NOTICES TO OFFERORS 1. The Offeror s attention is directed to FAR, Part 3 and DFARS, Part 203, Improper Business Practices and Personal Consultant Conflicts of Interest Representation Relating to Compensation of Former DoD Officials (Nov 2011) (a) Definition. Covered DoD official is defined in the clause at , Requirements Relating to Compensation of Former DoD Officials. (b) By submission of this offer, the offeror represents, to the best of its knowledge and belief, that all covered DoD officials employed by or otherwise receiving compensation from the offeror, and who are expected to undertake activities on behalf of the offeror for any resulting contract, are presently in compliance with all post-employment restrictions covered by 18 U.S.C. 207, 41 U.S.C , and 5 CFR parts 2637 and 2641, including Federal Acquisition Regulation

115 Page 107 of Use of Former DoD/Defense Health Agency (DHA) Employees and Uniformed Service Members in Proposal Preparation. The involvement of a former DoD/DHA employee/member in an offeror s proposal preparation may give rise to an unfair competitive advantage or the appearance thereof, if the former DoD/DHA employee/ member acquired nonpublic, competitively-useful information in his or her former position. Such knowledge could include proprietary information of competitor s performance on past or current contracts with similar requirements or source selection sensitive information pertaining to this procurement. Consequently, the Offeror must notify the Contracting Officer prior to the involvement in the proposal preparation by a former DoD/DHA employee/member reasonably expected to have had access to such information. Based on the notification, the Contracting Officer will make a determination whether involvement of the former DoD/DHA employee/member in proposal preparation could create an unfair competitive advantage or appearance thereof. The Contracting Officer will further determine whether any mitigation measures taken or proposed by the offeror are adequate to alleviate this concern or whether the offeror will be disqualified from the competition. Failure to comply with these procedures may result in the offeror s disqualification for award. (End of provision) PD ENCLOSURE 2 IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST (AUGUST 21, 2014) 1. DFARS , Requirements Relating to Compensation of Former DoD Officials (Sep 2011) (a) Definition. Covered DoD official, as used in this clause, means an individual that (1) Leaves or left DoD service on or after January 28, 2008; and (2) (i) Participated personally and substantially in an acquisition as defined in 41 U.S.C. 131 with a value in excess of $10 million, and serves or served (A) In an Executive Schedule position under subchapter II of chapter 53 of Title 5, United States Code; (B) In a position in the Senior Executive Service under subchapter VIII of chapter 53 of Title 5, United States Code; or (C) In a general or flag officer position compensated at a rate of pay for grade O-7 or above under section 201 of Title 37, United States Code; or (ii) Serves or served in DoD in one of the following positions: program manager, deputy program manager, procuring contracting officer, administrative contracting officer, source selection authority, member of the source selection evaluation board, or chief of a financial or technical evaluation team for a contract in an amount in excess of $10 million. (b) The Contractor shall not knowingly provide compensation to a covered DoD official within 2 years after the official leaves DoD service; without first determining that the official has sought and received, or has not received after 30 days of seeking, a written opinion from the appropriate DoD ethics counselor regarding the applicability of post-employment restrictions to the activities that the official is expected to undertake on behalf of the Contractor. (c) Failure by the Contractor to comply with paragraph (b) of this clause may subject the Contractor to rescission of this contract, suspension, or debarment in accordance with 41 U.S.C. 2105(c). (End of clause) CLAUSES INCORPORATED BY REFERENCE

116 Page 108 of Evaluation Of Compensation For Professional Employees FEB Prohibition on Contracting with Entities Engaging in Certain OCT 2015 Activities or Transactions Relating to Iran-- Representation and Certifications. CLAUSES INCORPORATED BY FULL TEXT CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (APR 1985) (a) The offeror certifies that -- (1) The prices in this offer have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other offeror or competitor relating to (i) Those prices, (ii) The intention to submit an offer, or (iii) The methods of factors used to calculate the prices offered: (2) The prices in this offer have not been and will not be knowingly disclosed by the offeror, directly or indirectly, to any other offeror or competitor before bid opening (in the case of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation) unless otherwise required by law; and (3) No attempt has been made or will be made by the offeror to induce any other concern to submit or not to submit an offer for the purpose of restricting competition. (b) Each signature on the offer is considered to be a certification by the signatory that the signatory -- (1) Is the person in the offeror's organization responsible for determining the prices offered in this bid or proposal, and that the signatory has not participated and will not participate in any action contrary to subparagraphs (a)(1) through (a)(3) of this provision; or (2) (i) Has been authorized, in writing, to act as agent for the following principals in certifying that those principals have not participated, and will not participate in any action contrary to subparagraphs (a)(1) through (a)(3) of this provison (insert full name of person(s) in the offeror's organization responsible for determining the prices offered in this bid or proposal, and the title of his or her position in the offeror's organization); (ii) As an authorized agent, does certify that the principals named in subdivision (b)(2)(i) above have not participated, and will not participate, in any action contrary to subparagraphs (a)(1) through (a)(3) above; and (iii) As an agent, has not personally participated, and will not participate, in any action contrary to subparagraphs (a)(1) through (a)(3) of this provision. (c) If the offeror deletes or modifies subparagraph (a)(2) of this provision, the offeror must furnish with its offer a signed statement setting forth in detail the circumstances of the disclosure.

117 Page 109 of 135 (End of Provision) INFORMATION REGARDING RESPONSIBILITY MATTERS (JULY 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, indefinitequantity, 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.

118 Page 110 of 135 (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 ). (End of provision) TYPE OF CONTRACT (APR 1984) The Government contemplates award of a Firm-Fixed-Price (FFP) contract resulting from this solicitation. (End of provision) SERVICE OF PROTEST (SEP 2006) (a) Protests, as defined in section 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 Mr. Martin Rios Contracting Officer DHA - COD NCR 2900 Crystal Drive, Suite 210 Arlington VA Phone: martin.rios15.civ@mail.mil (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) PD AGENCY LEVEL PROTESTS (APRIL 14, 2014) An interested party filing a protest with Defense Health Agency (DHA) has the option of requesting review by either the Contracting Officer (CO) or an independent review Official (IRO), who is a DHA official at a level above the CO. Alternately, an interested party may request IRO review as an appeal of the CO s protest decision.

119 Page 111 of 135 Where applicable, an interested party must clearly state in the protest that IRO review is requested, and must specify the nature of the independent review sought whether as an alternative to CO review or as an appeal of the CO s decision. Regardless of which review is requested, all protests must be complete and submitted to the CO within the timeframes specified in FAR Subpart (End of requirements language) 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) AUTHORIZED DEVIATIONS IN PROVISIONS (APR 1984) (a) The use in this solicitation of any Federal Acquisition Regulation (48 CFR Chapter 1) provision with an authorized deviation is indicated by the addition of"(deviation)" after the date of the provision. (b) The use in this solicitation of any DoD FAR Supplement (48 CFR Chapter 2) provision with an authorized deviation is indicated by the addition of "(DEVIATION)" after the name of the regulation. (End of provision) DISPLAY OF HOTLINE POSTERS (OCT 2015) (a) Definition. United States, as used in this clause, means the 50 States, the District of Columbia, and outlying areas. (b) Display of fraud hotline poster(s). (1) The Contractor shall display prominently the DoD fraud hotline poster, prepared by the DoD Office of the Inspector General, in common work areas within business segments performing work in the United States under Department of Defense (DoD) contracts. (2) If the contract is funded, in whole or in part, by Department of Homeland Security (DHS) disaster relief funds, the DHS fraud hotline poster shall be displayed in addition to the DoD fraud hotline poster. If a display of a DHS fraud hotline poster is required, the Contractor may obtain such poster from:

120 Page 112 of 135 [Contracting Officer shall insert the appropriate DHS contact information or Web site.] (c) Display of combating trafficking in persons and whistleblower protection hotline posters. The Contractor shall display prominently the DoD Combating Trafficking in Persons and Whistleblower Protection hotline posters, prepared by the DoD Office of the Inspector General, in common work areas within business segments performing work under DoD contracts. (d)(1) These DoD hotline posters may be obtained from: Defense Hotline, The Pentagon, Washington, DC , or are also available via the internet at (2) If a significant portion of the employee workforce does not speak English, then the posters are to be displayed in the foreign languages that a significant portion of the employees speak. Contact the DoD Inspector General at the address provided in paragraph (d)(1) of this clause if there is a requirement for employees to be notified of this clause and assistance with translation is required. (3) Additionally, if the Contractor maintains a company Web site as a method of providing information to employees, the Contractor shall display an electronic version of these required posters at the Web site. (e) Subcontracts. The Contractor shall include the substance of this clause, including this paragraph (e), in all subcontracts that exceed $5.5 million except when the subcontract is for the acquisition of a commercial item. (End of clause) DISCLOSURE OF OWNERSHIP OR CONTROL BY A FOREIGN GOVERNMENT (JUN 2010) (a) Definitions. As used in this provision-- (1) Effectively owned or controlled means that a foreign government or any entity controlled by a foreign government has the power, either directly or indirectly, whether exercised or exercisable, to control the election, appointment, or tenure of the Offeror s officers or a majority of the Offeror s board of directors by any means, e.g., ownership, contract, or operation of law (or equivalent power for unincorporated organizations). (2) Entity controlled by a foreign government (i) Means (A) Any domestic or foreign organization or corporation that is effectively owned or controlled by a foreign government; or (B) Any individual acting on behalf of a foreign government. (ii) Does not include an organization or corporation that is owned, but is not controlled, either directly or indirectly, by a foreign government if the ownership of that organization or corporation by that foreign government was effective before October 23, 1992.

121 Page 113 of 135 (3) Foreign government includes the state and the government of any country (other than the United States and its outlying areas) as well as any political subdivision, agency, or instrumentality thereof. (4) Proscribed information means (i) Top Secret information; (ii) Communications security (COMSEC) material, excluding controlled cryptographic items when unkeyed or utilized with unclassified keys; (iii) Restricted Data as defined in the U.S. Atomic Energy Act of 1954, as amended; (iv) Special Access Program (SAP) information; or (v) Sensitive Compartmented Information (SCI). (b) Prohibition on award. No contract under a national security program may be awarded to an entity controlled by a foreign government if that entity requires access to proscribed information to perform the contract, unless the Secretary of Defense or a designee has waived application of 10 U.S.C. 2536(a). (c) Disclosure. The Offeror shall disclose any interest a foreign government has in the Offeror when that interest constitutes control by a foreign government as defined in this provision. If the Offeror is a subsidiary, it shall also disclose any reportable interest a foreign government has in any entity that owns or controls the subsidiary, including reportable interest concerning the Offeror s immediate parent, intermediate parents, and the ultimate parent. Use separate paper as needed, and provide the information in the following format: Offeror s Point of Contact for Questions about Disclosure (Name and Phone Number with Country Code, City Code and Area Code, as applicable) Name and Address of Offeror Name and Address of Entity Controlled by a Foreign Government Description of Interest, Ownership Percentage, and Identification of Foreign Government (End of provision) NOTICE OF INTENT TO RESOLICIT (JUN 2012) This solicitation provides offerors fewer than 30 days to submit proposals. In the event that only one offer is received in response to this solicitation, the Contracting Officer may cancel the solicitation and resolicit for an additional period of at least 30 days in accordance with (End of provision)

122 Page 114 of ONLY ONE OFFER (OCT 2013) (a) After initial submission of offers, the Offeror agrees to submit any subsequently requested additional cost or pricing data if the Contracting Officer notifies the Offeror that-- (1) Only one offer was received; and (2) Additional cost or pricing data is required in order to determine whether the price is fair and reasonable or to comply with the statutory requirement for certified cost or pricing data (10 U.S.C. 2306a and FAR ). (b) Requirement for submission of additional cost or pricing data. Except as provided in paragraph (c) of this provision, the Offeror shall submit additional cost or pricing data as follows: (1) If the Contracting Officer notifies the Offeror that additional cost or pricing data are required in accordance with paragraph (a) of this clause, the data shall be certified unless an exception applies (FAR (b)). (2) Exceptions from certified cost or pricing data. In lieu of submitting certified cost or pricing data, the Offeror may submit a written request for exception by submitting the information described in the following paragraphs. The Contracting Officer may require additional supporting information, but only to the extent necessary to determine whether an exception should be granted, and whether the price is fair and reasonable. (i) Identification of the law or regulation establishing the price offered. If the price is controlled under law by periodic rulings, reviews, or similar actions of a governmental body, attach a copy of the controlling document, unless it was previously submitted to the contracting office. (ii) Commercial item exception. For a commercial item exception, the Offeror shall submit, at a minimum, information on prices at which the same item or/similar items have previously been sold in the commercial market that is adequate for evaluating the reasonableness of the price for this acquisition. Such information may include (A) For catalog items, a copy of or identification of the catalog and its date, or the appropriate pages for the offered items, or a statement that the catalog is on file in the buying office to which the proposal is being submitted. Provide a copy or describe current discount policies and price lists (published or unpublished), e.g., wholesale, original equipment manufacturer, or reseller. Also explain the basis of each offered price and its relationship to the established catalog price, including how the proposed price relates to the price of recent sales in quantities similar to the proposed quantities; (B) For market-priced items, the source and date or period of the market quotation or other basis for market price, the base amount, and applicable discounts. In addition, describe the nature of the market; or (C) For items included on an active Federal Supply Service Multiple Award Schedule contract, proof that an exception has been granted for the schedule item. (3) The Offeror grants the Contracting Officer or an authorized representative the right to examine, at any time before award, books, records, documents, or other directly pertinent records to verify any request for an exception under this provision, and the reasonableness of price. For items priced using catalog or market prices, or law or regulation, access does not extend to cost or profit information or other data relevant solely to the Offeror's determination of the prices to be offered in the catalog or marketplace. (4) Requirements for certified cost or pricing data. If the Offeror is not granted an exception from the requirement to submit certified cost or pricing data, the following applies:

123 Page 115 of 135 (i) The Offeror shall prepare and submit certified cost or pricing data and supporting attachments in accordance with the instructions contained in Table 15-2 of FAR , which is incorporated by reference with the same force and effect as though it were inserted here in full text. The instructions in Table 15-2 are incorporated as a mandatory format to be used, unless the Contracting Officer and the Offeror agree to a different format. (ii) As soon as practicable after agreement on price, but before contract award (except for unpriced actions such as letter contracts), the offeror shall submit a Certificate of Current Cost or Pricing Data, as prescribed by FAR (c) If the Offeror is the Canadian Commercial Corporation, certified cost or pricing data are not required. If the Contracting Officer notifies the Canadian Commercial Corporation that additional data other than certified cost or pricing data are required in accordance with (c), the Canadian Commercial Corporation shall obtain and provide the following: (1) Profit rate or fee (as applicable). (2) Analysis provided by Public Works and Government Services Canada to the Canadian Commercial Corporation to determine a fair and reasonable price (comparable to the analysis required at FAR ). (3) Data other than certified cost or pricing data necessary to permit a determination by the U.S. Contracting Officer that the proposed price is fair and reasonable [U.S. Contracting Officer to provide description of the data required in accordance with FAR (a)(1) with the notification]. (4) As specified in FAR (a)(4), an offeror who does not comply with a requirement to submit data that the U.S. Contracting Officer has deemed necessary to determine price reasonableness or cost realism is ineligible for award unless the head of the contracting activity determines that it is in the best interest of the Government to make the award to that offeror. (d) If negotiations are conducted, the negotiated price should not exceed the offered price. (End of provision) REPRESENTATION REGARDING COMBATING TRAFFICKING IN PERSONS (JAN 2015) By submission of its offer, the Offeror represents that it-- (a) Will not engage in any trafficking in persons or related activities, including but not limited to the use of forced labor, in the performance of this contract; (b) Has hiring and subcontracting policies to protect the rights of its employees and the rights of subcontractor employees and will comply with those policies in the performance of this contract; and (c) Has notified its employees and subcontractors of-- (1) The responsibility to report trafficking in persons violations by the Contractor, Contractor employees, or subcontractor employees, at any tier; and

124 Page 116 of 135 (2) Employee protection under 10 U.S.C. 2409, as implemented in DFARS subpart 203.9, from reprisal for whistleblowing on trafficking in persons violations. (End of provision) NOTICE OF CONTINUATION OF ESSENTIAL CONTRACTOR SERVICES (OCT 2010) (a) Definitions. Essential contractor service and mission-essential functions have the meanings given in the clause at , Continuation of Essential Contractor Services, in this solicitation. (b) The offeror shall provide with its offer a written plan describing how it will continue to perform the essential contractor services listed in DFAR clause CONTINUATION OF MISSION ESSENTIAL FUNCTIONS paragraph (b), during periods of crisis. The offeror shall-- (1) Identify provisions made for the acquisition of essential personnel and resources, if necessary, for continuity of operations for up to 30 days or until normal operations can be resumed; (2) Address in the plan, at a minimum-- (i) Challenges associated with maintaining essential contractor services during an extended event, such as a pandemic that occurs in repeated waves; (ii) The time lapse associated with the initiation of the acquisition of essential personnel and resources and their actual availability on site; (iii) The components, processes, and requirements for the identification, training, and preparedness of personnel who are capable of relocating to alternate facilities or performing work from home; (iv) Any established alert and notification procedures for mobilizing identified ``essential contractor service'' personnel; and (v) The approach for communicating expectations to contractor employees regarding their roles and responsibilities during a crisis. (End of provision) CLAUSES INCORPORATED BY REFERENCE Evaluation - Commercial Items OCT 2014 ADDENDUM TO Paragraph (a) is hereby supplemented with the following:

125 Page 117 of 135 This acquisition is being conducted utilizing the procedures of FAR Parts 8, 12, 19 and pertinent parts of Part 15. Impartial consideration will be given to all offers received in response to this solicitation. Offers will be reviewed to determine compliance with all requirements of the solicitation, including any attachments and exhibits. Any offer that is not in compliance with the requirements of the solicitation will be unacceptable and ineligible for award. The evaluation criteria will be applied to all offers in the same manner. Each proposal will be evaluated strictly in accordance with its content and the Government will not assume that performance will include areas not specified in the offeror's proposal. Please note the following: a) The Government intends to evaluate proposals and award a contract without discussions with the offerors. However, pursuant to FAR (g), the Government reserves the right to initiate discussions/negotiations with the offerors. The offeror s initial proposal should contain the offeror s best terms from a price and non-price standpoint. b) Alternate proposals will not be considered; the offerors are limited to a single proposal. Multiple solutions, optional solutions, etc., shall not be provided and may render a quotation unacceptable. c) The Government intends to make a single award resulting from this RFQ. FACTORS TO BE EVALUATED Award will be made to the offeror whose proposal is most advantageous to the Government based upon an integrated assessment of the evaluation factors and sub factors described below. The following evaluation factors and subfactors will be used to evaluate each proposal. 1. Technical Factor: Sub factor 1: Compensation Matrix. The Government will evaluate the proposed Compensation Matrix to determine the adequacy of the plan and particularly the hourly wage rate to be paid to health care providers (HCPs) at Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD to successfully attract and retain qualified HCPs with minimum turnover. The Government will evaluate the rate paid to the individual HCP to ensure the rate is realistic in terms of impact upon attracting and retaining HCPs and is commensurate with hourly rates paid for similar health care providers in the local area. Compensation plan will be evaluated as realistic in terms of its impact upon recruitment and retention. A low compensation plan may be viewed as evidence of failure to comprehend the complexity of the contract requirements or appropriate compensation levels of geographic area where performance will take place. Sub factor 2: Recruitment and Retention Plan (R&R). The Government will evaluate the Recruitment and Retention plan to determine the extent to which the plan and its methodology will attract and retain quality HCPs. The Plan will be evaluated as to its ability to achieve the required fill rate, provide a low turnover rate, and replace absent personnel in a timely manner.the training procedures will be evaluated as to their ability to maintain required certifications. The plan should provide a comprehensive and realistic approach to recruit and retain qualified HCPs for Walter Reed National Military Medical Center, Bethesda, MD The offeror s proposed plan shall address how to meet the requirements of DFARS clauses and and will be evaluated for its comprehensiveness and as a realistic approach to fulfill the requirements.

126 Page 118 of 135 The technical information shall not exceed 10 pages and must be submitted in Microsoft Word compatible format. The technical information shall include the company s name, address, individual names, CAGE Code, DUNS number on the first page. The following are the adjectives used in evaluating and rating the Technical proposals. RATING ACCEPTABLE UNACCEPTABLE DESCRIPTION Proposal clearly meets the minimum requirements of the solicitation. Proposal does not clearly meet the minimum requirements of the solicitation. 2. Past Performance Factor. The Government will evaluate the offeror s record of past and current performance to ascertain the probability of successfully performing the required efforts of the PWS. a. The confidence rating will be the overall Factor 2 past performance rating. b. Evaluation of past performance shall be in accordance with this plan utilizing the forms and questionnaires set forth in the Attachments. c. Current (within the past three years) and relevant past performance information will be considered, The Government will focus its inquiries on the offeror s record of performance on relevant and recent prior contracts. The determination of relevancy includes a consideration of recent contracts which are similar in scope, type of work, and price to this solicitation s requirements. The offeror s record of performance will be evaluated for quality of services, timeliness of services, business relations, and other considerations as set forth in the Past Performance Questionnaire. 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. In addition to past performance questionnaires completed on behalf of the offeror, the Government may use data provided by the offeror in its proposal and data obtained from other sources, including data in Government files or data obtained through interviews with personnel familiar with the contractor and their current and past performance under Federal, State or Local government or commercial contracts for same or similar services as compared to the North American Industry Classification System (NAICS) Code d. Each offeror shall be evaluated based upon the relevance and quality of performance. Each offeror shall be rated on an Acceptable, or Unacceptable basis as follows: PAST PERFORMANCE EVALUATION RATINGS ACCEPTABLE/NEUTRAL Based on the offeror s recent/relevant performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the performance record is unknown (See note below).

127 Page 119 of 135 UNACCEPTABLE Based on the offeror s recent/relevant performance record, the Government has no reasonable expectation that the offeror will be able to successfully perform the required effort. Note: In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available, the offeror may not be evaluated favorably or unfavorably on past performance (see FAR (a)(2)(iv)). Therefore, the offeror shall be determined to have unknown past performance. In the context of acceptability/unacceptability, unknown shall be considered acceptable. 3. Price Factor. The contract will be a Firm Fixed Price (FFP) Contract. The Government will conduct a price analysis for fair and reasonable prices. Price will be evaluated separately from the technical and past performance factors. Offerors are cautioned that unbalanced pricing of line items may eliminate an offeror from consideration. a. All vendors prices must be deemed to be fair and reasonable to qualify for award. b. Options: The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the options. c. Given that FAR provides that the Government may exercise the Option to Extend Services at the rates specified in the contract (i.e., the rates in effect when the Extension of Services option is exercised), for purposes of evaluating the Option to Extend Services, the Contracting Officer will consider the prices submitted for the base period and each option period, since those are the binding prices should the Option to Extend be exercised. End of Addendum CLAUSES INCORPORATED BY FULL TEXT OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (NOV 2015) ALTERNATE I (OCT 2014) The offeror shall complete only paragraphs (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) Web site accessed through If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (p) 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

128 Page 120 of 135 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. Highest-level owner means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner. Immediate owner means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: Ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees. Inverted domestic corporation, means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c). Manufactured end product means any end product in product and service codes (PSCs) , except (1) PSC 5510, Lumber and Related Basic Wood Materials; (2) Product or Service Group (PSG) 87, Agricultural Supplies; (3) PSG 88, Live Animals; (4) PSG 89, Subsistence; (5) PSC 9410, Crude Grades of Plant Materials; (6) PSC 9430, Miscellaneous Crude Animal Products, Inedible; (7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products; (8) PSC 9610, Ores; (9) PSC 9620, Minerals, Natural and Synthetic; and (10) PSC 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.

129 Page 121 of 135 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 ). 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.

130 Page 122 of 135 (2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is serviceconnected, 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. Small disadvantaged business concern, consistent with 13 CFR , means a small business concern under the size standard applicable to the acquisition, that-- (1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR ) by-- (i) One or more socially disadvantaged (as defined at 13 CFR ) and economically disadvantaged (as defined at 13 CFR ) individuals who are citizens of the United States; and (ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR (c)(2); and (2) The management and daily business operations of which are controlled (as defined at 13.CFR ) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition. 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 the 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.

131 Page 123 of 135 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 on the SAMwebsite. (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 representation and certifications currently posted electronically at FAR , 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 ), except for paragraphs. [Offeror to identify the applicable paragraphs at (c) through (p) of this provision that the offeror has completed for the purposes of this solicitation only, if any. These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer. Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted electronically on SAM.] (c) Offerors must complete the following representations when the resulting contract is to 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 that it [ ] is, [ ] is not, a small disadvantaged business concern as defined in 13 CFR (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 womenowned small business concern.

132 Page 124 of 135 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 womenowned 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. (8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a womenowned 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) 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--

133 Page 125 of 135 (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 changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR part 126; and (ii) It [ ] is, [ ] is not a HUBZone joint venture that complies with the requirements of 13 CFR part 126, and the representation in paragraph (c)(10)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture. [The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture:.] Each HUBZone small business concern participating in the HUBZone joint venture shall submit a separate signed copy of the HUBZone representation. (11) (Complete if the offeror has represented itself as disadvantaged in paragraph (c)(4) of this provision.) [The offeror shall check the category in which its ownership falls]: Black American. Hispanic American. Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians). Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, Republic of Palau, Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru). Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal). Individual/concern, other than one of the preceding. (d) Representations required to implement provisions of Executive Order (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 --

134 Page 126 of 135 (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 Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) , Buy American 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 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 -- Free Trade Agreements -- Israeli Trade Act Certificate. (Applies only if the clause at FAR , Buy American -- Free Trade Agreements -- Israeli Trade Act, is included in this solicitation.)

135 Page 127 of 135 (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--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 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) or this provision) as defined in the clause of this solicitation entitled Buy American 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 Free Trade Agreements Israeli Trade Act Certificate, Alternate I. If Alternate I to the clause at FAR 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 Free Trade Agreements Israeli Trade Act :

136 Page 128 of 135 Canadian End Products: Line Item No.: [List as necessary] (3) Buy American Free Trade Agreements Israeli Trade Act Certificate, Alternate II. If Alternate II to the clause at FAR 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--Free Trade Agreements--Israeli Trade Act'': Canadian or Israeli End Products: Line Item No.: Country of Origin: [List as necessary] (4) Buy American Free Trade Agreements Israeli Trade Act Certificate, Alternate III. If Alternate III to the clause at 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 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]

137 Page 129 of 135 (5) Trade Agreements Certificate. (Applies only if the clause at FAR , 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 statute. 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; and (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

138 Page 130 of 135 (4) [ ] Have, [ ] have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 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. 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 appear 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 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 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). [The Contracting Officer must list in paragraph (i)(1) any end products being acquired under this solicitation that are included in the List of Products Requiring Contractor Certification as to Forced or Indentured Child Labor, unless excluded at (b).] (1) Listed End Product Listed End Product: Listed Countries of Origin:

139 Page 131 of 135 (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 is 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 Labor Standards. (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.) [The contracting officer is to check a box to indicate if paragraph (k)(1) or (k)(2) applies.] (1) [ ] Maintenance, calibration, or repair of certain equipment as described in FAR (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 (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 (d)(1). The offeror [ ] does [ ] does not certify that

140 Page 132 of 135 (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 (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 Labor Standards 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:

141 Page 133 of 135 [ ] 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 ; [ ] Other. (5) Common parent. [ ] Offeror is not owned or controlled by a common parent: [ ] Name and TIN of common parent: Name TIN

142 Page 134 of 135 (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) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the exception at (b) applies or the requirement is waived in accordance with the procedures at (2) Representation. The Offeror represents that-- (i) It [ ] is, [ ] is not an inverted domestic corporation; and (ii) It [ ] is, [ ] 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 questions concerning sensitive technology to the Department of State at CISADA106@state.gov. (2) Representation and Certification. 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 $3,500 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 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., (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. (p) Ownership or Control of Offeror. (Applies in all solicitations when there is a requirement to be registered in SAM or a requirement to have a DUNS Number in the solicitation.

143 Page 135 of 135 (1) The Offeror represents that it [ ] has or [ ] does not have an immediate owner. If the Offeror has more than one immediate owner (such as a joint venture), then the Offeror shall respond to paragraph (2) and if applicable, paragraph (3) of this provision for each participant in the joint venture. (2) If the Offeror indicates has in paragraph (p)(1) of this provision, enter the following information: Immediate owner CAGE code: Immediate owner legal name: (Do not use a doing business as name) Is the immediate owner owned or controlled by another entity: [ ] Yes or [ ] No. (3) If the Offeror indicates yes in paragraph (p)(2) of this provision, indicating that the immediate owner is owned or controlled by another entity, then enter the following information: Highest level owner CAGE code: Highest level owner legal name: (Do not use a doing business as name) (End of Provision)

144 ATTACHMENT 2

145 OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE HEALTH AFFAIRS 2900 CRYSTAL DRIVE, SUITE 200 ARLINGTON, VIRGINIA DEFENSE HEALTH AGENCY COD-NCR 8 March 2016 David A. Porter Vice President Staffing Etc Annapolis Road, Suite 200 Lanham, Maryland SUBJECT: CONTRACT HT F-0030 ANESTHESIOLOGISTS AT WALTER REED NATIONAL MILITARY MEDICAL CENTER (WRNMMC), BETHESDA, MD, MD Dear Mr. Porter, In response to your request for information on the subject contract, the following is being provided as a brief explanation. This information is being provided to assist in preparing responses to future DHA requirements. Consistent with the solicitation s evaluation criteria, DHA Source Selection guidance, and applicable requirements and authorities, award was made to The Royster Group. In accordance with the Federal Acquisition Regulation FAR the following information is provided: FACTORS YOUR OFFER SUCCESSFUL OFFEROR Technical Sub Factor I: Compensation Matrix Unacceptable Acceptable Technical Sub Factor 2: Recruitment and Retention Plan Acceptable Acceptable Past Performance Acceptable Acceptable Price (Total Evaluated Price) $50,469,963.25* $54,856, *This reflects your total proposed amount for a 12 month base period of performance less one month s cost ($253,668.39) as the base period of performance was reduced to 11 months. Based upon the solicitation s award evaluation criteria and after a complete evaluation of your proposal, your proposal was not selected for award because it was determined to be Unacceptable in Technical Sub Factor I. This determination was made based on the evaluation of your proposed hourly wage rates (base salary + fringe benefits) for the base year and four option years. 1 of 2