SOURCES SOUGHT
V -- Ambulance Boise SOURCES SOUGHT AND REQUEEST FOR INFORMATION RESPONDERS PLEASE INDICATE IF SMALL BUSINESS OR SDVOB
- Notice Date
- 12/19/2011
- Notice Type
- Sources Sought
- NAICS
- 621910
— Ambulance Services
- Contracting Office
- Department of Veterans Affairs;Contracting & Purchasing (90C);4815 N Assembly ST;Spokane WA 99205-6197
- ZIP Code
- 99205-6197
- Solicitation Number
- VA26012I0222
- Response Due
- 1/18/2012
- Archive Date
- 3/18/2012
- Point of Contact
- SCOTT PETRIN
- Small Business Set-Aside
- N/A
- Description
- Performance Work Statement Ground Ambulance Services Advanced Life Support (ALS) as of 12/10/2011 1. Title/Location. 1.1Ground Ambulance Services - Advanced Life Support (ALS) and Basic Life Support (BLS). The Department of Veterans Affairs Medical Center, Boise, Idaho (BVAMC) has a requirement for ground ambulance services for eligible beneficiaries. The contract is inclusive and shall include all personnel, vehicles, equipment, supplies, to provide service provide ambulance services 24 hours per day, 7 days per week, as required. For the purpose of the contract, the BVAMC requires that the contractor meet or exceed the Accreditation Standards of Commission on Accreditation of Medical Transport and/or the Commission on Accreditation of Ambulance Services Systems (herein known as CAMTS http://www.camts.org/ or CAAS, Current Editions) http://www.caas.org/ Location of Work. The BVAMC Ground Ambulance Services requirement will be performed primarily in ADA county with occasional transports from Canyon county Idaho. Ambulance Service may be to and from the facility or to another facility as designated at the time of service.. 2. Definitions and Acronyms. AMBULANCE - Vehicles for emergency medical care which provide a driver compartment and a patient compartment that will accommodate an Emergency Medical Technician (EMT), Paramedic (or RN as needed) and one or two litter patients, so positioned that at least one patient can be given intensive line support during transit; equipment and supplies for emergency care at the scene as well as during transport, and two-way radio communication and equipment for light rescue procedures. The ambulance is designed and constructed to afford safety and comfort and to avoid aggravation of patient's condition. ALS - Advanced Life Support AOD - Administrative Officer of the Day. This employee is administrative officer in charge during other than normal business hours. BLS - Basic Life Support BVAMC - Boise Veterans Affairs Medical Center CCT - Critical Care Transport CO - Contracting Officer. The person executing this contract on behalf of the Government and is the only person authorized to make changes to the contract affecting scope, schedule and price. COTR - Contracting Officer's Technical Representative. Any person or persons authorized to act for the Contracting Officer within the limits of his/her authority as delegated in writing by the Contracting Officer. 3. Scope. The contractor agrees to provide all services specified in this contract for any person determined eligible by the Under Secretary for Health, or designee, regardless of race, color, religion, sex or national origin of the person for whom such services are ordered. The contractor further warrants that he/she shall not resort to subcontracting as a means of circumventing this provision. Contractor will provide prompt, timely and courteous service in accordance with this performance work statement. Contractor will bring to the CO and COTR's attention any major changes to the industry that may be required. Contractor will provide accurate and timely billing and work diligently with COTR to validate invoices to ensure accurate and timely payment each month for services rendered. Contractor will respond in a timely manner to any questions regarding the performance of work, or invoicing concerns. Only one patient will be transported in a trip unless specifically authorized by the BVAMC. No more than one psychiatric patient will be transported at a time. When more than one patient is transported on a trip, reimbursement will be made at the rate not exceeding the cost of transporting a single patient; however, when travel beyond the specified distance is involved, the longest distance over which a patient is transported may be claimed when more than one patient is transported in a single ambulance concurrently. The contractor must ensure that the "pick-ups" and "drop-off's" are scheduled so that the total distance traveled will result in the most economical charge to the Government. For the purpose of this contract, all patients are to be transported by critical care ground transport. It is further understood that at least one of the attendants will be a licensed trained physician, registered nurse or Paramedic in accordance to the standards of CAMTS or CAAS. The Department of Boise Veterans Affairs Medical Center (BVAMC) will not be obligated to make any special agreements with the Contractor to obtain services in excess of the stated requirements and neither shall the contractor be penalized for refusal to provide services in excess of the stated requirements. However, the contractor shall advise of refusal at the time the request is made by BVAMC. Once the contractor accepts such a request, the request then becomes subject to all terms and conditions of the contract. The BVAMC does not guarantee or imply that any fixed number "exceeding the minimum quantity" of orders/referrals for services will be placed under this contract. The quantities identified herein are annual estimates only. The actual quantities will be based upon the number of patients who are determined to be eligible by BVAMC to receive such services. The Government will order an estimated 2,100 in ALS Ground Ambulance transports during the base period of the contract. Contractor shall furnish any additional quantities, not to exceed 3500 Ground Ambulance Transports per year. 4. Performance Requirements. 4.1 Contractor personnel to perform services in accordance with the State of Idaho, "RULES FOR EMS PERSONNEL", effective July 1, 1996 (and any subsequent updated standards as issued) which meets or exceeds the standards of CAMTS or CAAS. Protocols and standing written guidelines which meet/exceed standards of CAMTS or CAAS will be provided by the Contractor to the BVAMC initially and updated annually and as changes occur. 4.2 Vehicle Requirement. a.Under the terms of the contract, the ambulance will meet or exceed the minimum vehicle requirements as described in CAMTS or CAAS. All contractor vehicles will be licensed by the State of Idaho, Ada County, City of Boise, or Department of Transportation. b.All ground ambulance equipment must meet the requirements to meet/exceed the standards of CAMTS or CAAS. c.Sanitation: All ambulances shall be kept in a sanitary condition both inside and outside. d.Maintenance: All ambulances must be reasonably maintained and maintenance records must be kept and made available for inspection by the COTR. 4.3 Ambulance Medical Equipment. Each emergency care vehicle-ambulance will meet the requirements to meet/exceed standards of CAMTS or CAAS. Additional communications capabilities, such as cellular telephones, will be available. 5. Orders. 5.1 Requests for services will be made by BVAMC authorized personnel as listed in the contract. The request will specify a date and time for acceptable delivery/pickup of a patient to be transported. The contractor will respond at that time whether service can be provided. In the event of an emergent ground transport, Contractor will contact the sending unit (ICU, ER, and SDU) for report within 10 minutes of initial call as well as relaying estimated time of arrival. Contractor will contact sending unit for report for non-emergency transports within 30 minutes of initial call as well as relaying estimated time of arrival. **Any Extreme emergency requiring transport in less than 30 minutes will be treated as a 911 emergency call.** 5.2 Telephone orders for service shall be placed by the Chief, Medical Administration Service, or designee. The telephone authorization shall be confirmed in writing on a Report of Contact VA Form 119. 5.3 The contractor shall inform the BVAMC if it can provide service within stated time frame. Emergency ground transports require a 30 minute arrival at destination time. Non-emergency transports require a 60 minute arrival at destination time, unless a later time is specified by the BVAMC. If the contractor cannot provide services as requested, the BVAMC reserves the right to obtain required services from another source and to charge the contractor with any excess cost which may result. The BVAMC will be the sole judge in determining when to order service from another source. However, in no instance will the contractor be required to furnish more than two (2) ambulances at one time. 5.4 The contractor will be informed on the condition of the patient at the time services are requested. The contractor will send the appropriate Emergency Medical Personnel. The Contractor shall furnish CAMTS or CAAS certified personnel on all requests. If the contractor fails to comply, the BVAMC reserves the right to obtain required services from another source and to charge the contractor with any excess cost which may result. 5.5 The contractor will bill at the full contract amount for "dry runs" (trips made by the contractor when the BVAMC beneficiary is not available for pick-up). The charge will not be allowed if the trip is canceled by authorized BVAMC personnel within one (1) hour of the scheduled pick-up time. 6.Patient Rights. a.For emergent transport, the contractor shall arrive at the patient's location within 30 minutes of initial receipt of call requesting transport. b.For non-emergent transport, the contractor shall arrive at the patient's location within 60 minutes of initial receipt of call requesting transport. c.The contractor shall be respectful and courteous at all times to VA beneficiaries. Patients may bring a reasonable amount of equipment, such as folding wheelchair, consumable medical supplies and a personal suitcase. When transporting patients to or from Medical facilities, the driver, acting for the contractor, will ensure that the patient's luggage, medical records, medications, and prosthetic devices are properly accounted for and delivered with the patient as required. d.The contractor shall immediately notify the VA of any incidents involving injury to VA patients during transport and promptly complete and submit to the COTR any requested documentation regarding the incident. e.The contractor shall notify the COTR, in writing, within 24 hours of any complaints made by the patients with regards to the ambulance service. The contractor may provide recommendations for improved services along with the patient complaints for the VA's review. No recommendation shall be construed as being effective until and unless it is provided as a written modification to the contract from the CO. f.Upon delivery of a patient to the VA emergency room or patient ward, contractor personnel shall log in the patient on a log sheet at the front desk. The contractor shall follow the same procedure contained herein when removing a patient from any VA unit for transport to other medical facility destinations. The contractor shall provide the following information AS FOLLOWS: Using the VA Form 2511 (OR CO APPROVED EQUIVELENT FORM) be provided within 24 hours also will serve as an invoice. All billing shall include items 1 through 7 below: 1.patient's name and last four of Social Security Number; 2.trip date; 3.pick-up point and time; 4.drop-off point and time; 5.number of miles if outside contract geographic area of coverage; 6.Contract Number; 7.base charge plus an itemization of additional charges if applicable, and name of VA Official who authorized trip; 8. Copies of the Request to Coordinate with the Travel Office for subtotaling Other costs under 826 and Inter-facility costs under 921 9.Requirements Summary. The contractor service delivery requirements are summarized into performance objectives that relate directly to standards of performance required to meet mission essential needs. The performance threshold briefly describes the minimum acceptable overall levels of service required for each required service. These thresholds are critical to mission success. In the Requirement Summary, the Performance Objective is a summary statement of all performance standards that apply for a unit of service delivery. For the service output to be acceptable to the Government, the unit of service that is offered by the contractor for acceptance must be in substantial compliance with all specified performance standards or be suitable for use as intended under the terms of the contract. If a unit of service is not in substantial compliance with these requirements, it is unsatisfactory and re-performance is required or payment reductions are necessary. Each unit of service delivered is evaluated as being satisfactory or unsatisfactory using this performance objective as the basis for that decision. At the end of any observation period, generally one month, an overall evaluation is made of the contractor's quality control for each required service. The measure of quality control is expressed as the Performance Threshold. If the overall performance during the observation period for a required service meets the specified Performance Threshold, then the contractor's control of quality for the required service for the observation period is satisfactory. Otherwise, it is unsatisfactory. See below delivery Summary DELIVERY SUMMARY TASKREF PARSTANDARDSURV METHOD TRANSPORT PATIENTS PROPERLY3100%RANDOM SURVEY/INVOICE VALIDATIONS MEET REQUIRED GUIDELINES FOR PERSONNEL AND EQUIPMENT4100%RANDOM INSPECTION RESPOND ON TIME 595%PATIENT COMPLAINTS/MONTHLY SURVEILLANCE ADHERE TO PATIENT RIGHTS6100%PATIENT COMPLAINTS/MONTHLY SURVEILLANCE PROVIDE ACCURATE AND TIMELY DOCUMENTATION INCLUDING INVOICING698%MONTHLY VALIDATION/INVOICING 8. Personnel/Key Position Qualifications. ALS Level of Service: Emergency Medical Personnel/Critical Care Transport Emergency Medical Personnel (Registered Nurse, Emergency Medical Technician-Paramedic, Emergency Medical Technician-Basic and Aide and licensed trained physician) providing emergency services on ambulances serving the BVAMC under this contract must have qualifications which meets or exceeds the standards of CAMTS or CAAS. 1.Have completed training in accordance with the Standards published by the Idaho Department of Health and Human Services. Evidence of "equivalent" training program successfully completed by the health care provider(s) must be submitted with offer. 2.All health care providers must be certified, licensed or otherwise officially recognized by the local, state or regional Government or public entity where the emergency ambulance service is operated or by which it is governed. 3.All health care providers must be enrolled periodically in "refresher" continuing education, or advanced training programs as required by the local or state government entity which the service is rendered to veterans but in no instance shall be less frequently than every two years. Such "refresher" training must be equivalent to that developed by the Department of Health and Welfare. Evidence of successful completion of refresher training must be submitted with offer. 4.Advanced Cardiac Life Support is required for Registered Nurses, Emergency Medical Technician-Paramedics, and licensed trained physicians. For the purpose of this contract, personnel must meet qualifications that meet or exceed standards of CAMTS or CAAS. Documentation of annual competency assessments will be provided for all medical attendants. 5.Emergency Medical Technician-Paramedics must demonstrate completion of periodic refresher continued education courses that meet or exceed the standards of CAMTS or CAAS. Registered Nurse and Licensed Trained Physician. 1)A critical care registered nurse or critical care Emergency Medical Technician Paramedic (EMT-P) will be provided by contractor for all transports under this contract unless specifically authorized not to by the BVAMC, in writing. In the event that the contractor is unable to provide a critical care registered nurse or EMT-P for a particular trip, the contractor will immediately notify the BVAMC official who is requesting transport. 2)All nursing personnel must be a graduate of a National League of Nursing (NLN) accredited School of Nursing. 3)All contractor critical care nursing personnel and licensed Critical Care EMT-P personnel must hold a current State of Idaho license for their specified area of practice which meets or exceeds the standards of CAMTS or CAAS. 4)Contractor critical care nursing personnel must possess documentation of Critical Care Nursing education which meets or exceeds the standards of CAMTS or CAAS. 5)Must possess current Advanced Cardiac Life Support provider certificate and must provide written proof of annual certification. NON-EMERGENCY MEDICAL PERSONNEL/NON-CRITICAL CARE GROUND TRANSPORTS: 1)Prices include non-emergency medical technicians and/or drivers as appropriate. Technicians and drivers must be capable to administer oxygen and must have successfully completed the Standard and Advanced First Aid Courses of the American Red Cross or U.S. Bureau of mines, or equivalent. Proof in the form of a current certificate must be submitted with offer. 2)All Basic Life Support ground ambulances in service, in accordance with the State of Idaho Licensed Ambulance Requirements, must have a staff of two (2) persons. A state-certified person or any person who otherwise by license is authorized to attend patients must be in the patient compartment when a patient is being transported which meets or exceeds the standards of CAMTS or CAAS. 3)All Advanced Life Support ground ambulances in service must have a minimum staff of two (2) persons at levels dictated by the BVAMC and the State of Idaho, Department of Health and Welfare Licensed Ambulance requirements and standards which meet or exceed the standards of CAMTS or CAAS. 4)An authorized official of the BVAMC may, in the best interest of the beneficiary, allow a relative to accompany the patient. 8.1 Personnel Records. A record of each employee's background, clinical experience and appropriate certifications that meet or exceed standards in CAMTS or CAAS as well as the character and physical capabilities of performing the duties of a ground ambulance operator or attendant shall be maintained and made available for inspection upon request. The BVAMC reserves the right to request qualifications prior to award. Proposals shall include personnel qualifications, certifications, and a record of each employee's character and physical capabilities. Awarded contractor shall provide the BVAMC with updated records on an annual basis and when changes in personnel occur. 9. Security Requirements. There are mandatory clauses we will add once a contract is identified to be security sensitive, such as when a contractor has access to patient records, data or VA computer systems, but it is important to include what the access or vulnerability is in this PWS. This clearly identifies to the potential contractor (and our Information Security Officer ISO) what the specific vulnerabilities are. This is important because the clauses are very general in nature. Even a simple custodial service will have to deal with security because contract employees may require unescorted access to facilities. If you have any questions about if security requirements should be set forth in the SOW talk to your ISO or Physical Security Manager. VA Form 2280. If the work involves access you will have to fill out a VA Form 2280. This document is submitted by you and certified by your ISO. It has to be complete and signed by the ISO and submitted with your request package. The VA 2280 describes what limitation and special requirements exist, such as identification cards, escorts, or background checks. The COTR should identify which tasks in the SOW involve security limitations identified in the 2280. REMINDER - the 2237 and SOW must be free of any patient information or personal protected or proprietary data such as spec sheets. 10. Government-Furnished Equipment (GFE)/Government-Furnished Information (GFI). NONE 11. Other Pertinent Information or Special Considerations. a. Identification of Possible Follow-on Work. NONE c. Identification of Non-Disclosure Requirements. The contractor will only have access to the patient information that is provided to them at the time of the request for transport. d. Waiting Time. 1.For time lost in waiting at either or both ends of a trip due to causes beyond his/her control, the contractor will be reimbursed at the rate quoted in the bid for each minute in excess of the first quarter hour from the time the contractor reports to pick up the designated person. 2.If the pick-up is other than at the BVAMC, the contractor shall call the Patient Travel Unit or Medical Administration Service designee on duty when delays are anticipated for which he/she expects to claim reimbursement. This call is only for the purpose of verifying his/her arrival time at the pick-up point and is not necessary if the contractor anticipates no delay for which reimbursement will be claimed. 12. Period of Performance. The period of performance is from the award of contract to 12 months from award date with four, one-year option periods. 13. Quality Control and Quality Assurance. 13.1 The policy of the Government for Contractor Quality Control and Government Quality Assurance and applicable definitions are provided in the Federal Acquisition Regulations (FAR) in Part 46. The contractor is required to control the quality of service delivery and offer to the Government for acceptance only services which conform to contract requirements. Perfect performance is not required for the control of quality to be satisfactory; however, specific service delivery must be in substantial compliance with contract requirements and be suitable for the intended purpose of the contract. The overall control of quality must meet or exceed industry standards for the required service. The contractor shall immediately respond in writing to any Contract Discrepancy Report issued by the CO, explaining why the discrepancy occurred and how it will be prevented in the future. 13.2 The Government will periodically evaluate the Contractor's performance using a Government Quality Assurance Surveillance Plan (QASP). The Government will measure the contractor's control of quality against the Performance Thresholds specified in the Requirements Summary. If re-performance of a service delivery is required, the original inspection results will be recorded as unsatisfactory. When overall monthly performance for a required service meets or exceeds the performance threshold, quality control is satisfactory. Only the original inspection results by the Government will be used to make this evaluation. Failure to meet the performance threshold for a required service means that quality control for that service for the observation period is unsatisfactory. Each service will be evaluated each observation period, which is generally one month. The BVAMC reserves the right to thoroughly inspect and investigate the establishment, business reputation, and other qualifications of any contractor and to reject any proposal, irrespective of price, that shall be administratively determined lacking in any of the essentials necessary to assure acceptable standards of performance. If any ambulance equipment is added after inspection, subsequent to award of contract, it shall be inspected and approved by the Contracting Officer before being placed in use under this contract. 15. Additional info and price schedule Contract Administration: The contractor shall contact the CO on all matters pertaining to administration. Only the CO is authorized to make commitments or issue changes which will affect the price, quantity, quality, or delivery terms of the contract. Payment and invoicing is usually not discussed in the PWS. I am not yet sure where to move this. Invoice Procedures: a.Complete and deliver or mail VA Form 2511 to address in Paragraph ___, Page ___ for certification and payment. VA Form 2511 to be provided within 24 hours and will serve as an invoice. All billing shall include items 1 through 9 listed below. 1.Patient's name and last four of Social Security Number; 2.Trip date; 3.Pick-up point and time; 4.Drop-off point and time; 5.Number of miles if beyond the 15 mile radius; 6.Contract Number; 7.Base charge plus an itemization of additional charges if applicable, and name of VA Official who authorized trip; 9. Copies of the Request for Services Log (as required in QCP) that correspond to the trips included in the invoice; 10. Coordinate with the Travel Office for subtotaling other costs under 826 and Inter-facility costs under 921 (Travel office will clarify number requirements). b.Invoices will be reviewed and reconciled to tickets and travel logs. Unauthorized charges will be suspended pending investigation. Unauthorized charges are those that are being disputed or have not been pre-approved by authorized VA personnel. Supporting documentation may be provided and submitted for payment consideration. Suspended charges will be reviewed and the determination will be made by the Contracting Officer as to the validity of the charges and as to whether or not payment will be made. A final determination will be made within 30 days after notifying the Contractor of charges which are being suspended. PRICE SCHEDULE -- BASE YEAR ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9Triangle Bandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel300each0$.00 Background Investigations ESTIMATED BASE YEAR TOTAL$0.00 PRICE SCHEDULE -- OPTION YEAR 1 ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9Triangle Bandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel20each$0.00$.00 Background Investigations ESTIMATED OPTION 1 TOTAL$0.00 ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9Triangle Bandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel20each$0.00$.00 Background Investigations ESTIMATED OPTION 1 TOTAL$0.00 PRICE SCHEDULE -- OPTION YEAR 2 ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9TriangleBandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel20each$0.00$.00 Background Investigations ESTIMATED OPTION 2 TOTAL$0.00 PRICE SCHEDULE -- OPTION YEAR 3 ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9Triangle Bandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel20each$0.00$.00 Background Investigations ESTIMATED OPTION 3 TOTAL$0.00 PRICE SCHEDULE -- OPTION YEAR 4 ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9Triangle Bandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel20each$0.00$.00 Background Investigations ESTIMATED OPTION 4 TOTAL $__________ TOTAL ESTIMATED CONTRACT AMOUNT 5 YEARS $___________________ PRICE SCHEDULE -- OPTION YEAR 1 ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9Triangle Bandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel20each$0.00$.00 Background Investigations ESTIMATED OPTION 2 TOTAL$0.00 PRICE SCHEDULE -- OPTION YEAR 3 ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9Triangle Bandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel20each$0.00$.00 Background Investigations ESTIMATED OPTION 3 TOTAL$0.00 PRICE SCHEDULE -- OPTION YEAR 4 ITEMSDESCRIPTIONESTIMATED QUANTITYUNIT OF PURCHASEUNIT PRICETOTAL PRICE ABase Ambulance Cost, Mileage and Waiting Time Rates 1Basic Life Support550trips$.00$.00 HCPCS Code A0425 2Advanced Life Support250trips$.00$.00 3Critical Care Transport100trips$.00$.00 4aRate per mile, one way, first passenger only, 1 to 50 miles11,000mile$.00$.00 4b51 miles and greater6,700mile$.00$.00 5Waiting time per hour40hours$.00$.00 (billed in 1/4 hr increments; only paid in excess of 30 minutes) 6Basic Life Support with Lift for Power65trips$.00$.00 Wheel Chair BAdditional Supplies when Authorized 1Aspirator1each$.00$.00 2Suction Catheter12each$.00$.00 3Resuscitation / Oxygen1each$.00$.00 4Oxygen Mask / Cannula508each$.00$.00 5Splint, cardboard1each$.00$.00 6Dressing822each$.00$.00 7Cervical Collar3each$.00$.00 8Trauma or Battle Dressing1each$.00$.00 9Triangle Bandage1each$.00$.00 10Ice Pack1each$.00$.00 11Establishing / Restarting IV and supplies112each$.00$.00 (all inclusive fee for each instance) (monitoring of existing IV site is included in ambulance base fee) 12O.B. Kit8each$.00$.00 13Heart Monitor262each$.00$.00 14Restraints6set$.00$.00 15VA-Required Contractor Personnel20each$0.00$.00 Background Investigations ESTIMATED OPTION 4 TOTAL $__________ TOTAL ESTIMATED CONTRACT AMOUNT 5 YEARS $___________________ END PWS
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