Combine Solicitation – 65– FIELD ANALYZER
Notice Type: Combine Solicitation
Posted Date:
Office Address:
Subject: 65-- FIELD ANALYZER
Classification Code: 65 - Medical, dental & veterinary equipment & supplies
Solicitation Number: VA24417Q1654
Contact:
Setaside: Service-Disabled Veteran-Owned Small BusinessService-Disabled Veteran-Owned Small Business
Place of Performance (address): DEPT OF VA - HCC;
Place of Performance (zipcode): 16001
Place of Performance Country:
Description:
Network Contracting Office 4
Veterans Integrated Service Network 4 Facilities
COMBINED SYNOPSIS SOLICITATION(i) This is a combined synopsis/solicitation for Field Anaylzer, BRAND NAME OR EQUAL, as prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; quotes are being requested and a written solicitation will not be issued. A firm-fixed price purchase order is anticipated.
(ii) The solicitation number is VA244-17-Q-1654 and is issued as a request for quotation (RFQ).
(iii) The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular 2005-95
(iv) This solicitation is set aside 100% for Service-Disabled Veteran-Owned Small Businesses and the associated NAICS 339112 code has a small business size standard of 1000.
(v) Contract Line Items (CLIN):
ITEM NUMBER
DESCRIPTION OF SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
0001
266002-1145-773-PRO, Humphrey Field Analyzer 3 (HFA3) Model 860 W/ Liquid Trial Lens Printer & Table or Equivalent
1.00
EA
__________________
__________________
0002
Installation
1.00
JB
__________________
__________________
0003
Staff Training, 2 hours Included
1.00
JB
__________________
__________________
0004
Operator manuals x 2 Service manuals x 2
2.00
EA
__________________
__________________
GRAND TOTAL
__________________
(vi) Comparable products must be brand name or equal in the following specifications:
STATEMENT OF WORK
Humphrey Field Analyzer 3 with Liquid Trial Lens, Printer & Table or equivalent Delivery, Installation and Training
STATEMENT OF WORK PART A GENERAL INFORMATION
A.1 INTRODUCTION This contract is for the delivery, installation, and training of a (1) Humphrey Field Analyzer 3 with Liquid Trail Lens, Printer & Table or equivalent to meet the needs of
A.2 BACKGROUND A visual field test is an eye examination that can detect dysfunction in central and peripheral vision which may be caused by various medical conditions such as glaucoma, stroke, pituitary disease, brain tumors or other neurological deficits. Visual field testing can be performed clinically by keeping the subject's gaze fixed while presenting objects at various places within their visual field. Simple manual equipment can be used such as in the tangent screen test or the
A.3 SCOPE OF WORK One (1) Humphrey Field Analyzer 3 with Liquid Trail Lens, Printer & Table or equivalent will be delivered to the
STATEMENT OF WORK PART B WORK REQUIREMENTS
The vendor:
Will provide delivery, installation and training to the
The one (1) Humphrey Field Analyzer 3 with Liquid Trail Lens, Printer & Table or equivalent must have the following specifications:
B1.2.1 Liquid Lens using Liquid pressure, 1 trail lens for patients
B1.2.2 Must have the ability to import and integrate with OCT 5000/HFA 750i at VA
Glaucoma protocol: 24-2 with progression
Neurology protocol: 30-2
Plaquenil screening: 10-2
Driving eval: Esterman Binocular
Comp and pension eval: III4E or Kenetic 45
B1.2.3 Kinetic testing emulates standard Goldmann perimetry
B1.2.4 Guided Progression Analysis (GPA) Individualized patient management
B1.2.5 Visual Field Index (Summary measurement of visual field status expressed as a percent of a normal age-adjusted visual field)
B1.2.6 SITA-SWAP
B1.2.7 SITA (Swedish Interactive Threshold Algorithm)
B2.3.8 Specialty test libraray: Social Security Disability, monocular, binocular, Esterman monocular, binocular, superior 36, 64 Kenetic testing, Custom Kinetic testing, custom static testing
B2.3.9 General testing features- Stimulus sizes, Foveal threshold testing, Automatic pupil measurement, Liquid Trial Lens (AutoTLC), eye review
B1.2.10
List
B2.3.11 Electrical requirements: 100-120v
B2.3.12 Connectivity with FORUM--
B2.3.13 Migrate test data from current Humphrey Visual Fields model 5000 onto new visual fields machine
B2.3.14 1 year warranty
B2.3.15 C drive or memory card will be removed before turn in
STATEMENT OF WORK GENERAL REQUIREMENTS
C.1. The contractor shall adhere to the job site requirements listed below:
C.1.1. All personnel to adhere to site safety requirements PPE at a minimum to include hard hats, safety glasses, high-visibility clothing, hard sole shoes.
C.1.2. All personnel subject to a 30-minute site safety orientation conducted by
C.1.3. Vendor responsible for unloading, handling, unpacking; clean up to dumpster provided by GC
C.1.4. Vendor to schedule deliveries through
C.1.5.
C.1.6. Vendor responsible for protecting product after installation
C.1.7. Standard work hours are Monday Friday,
C.1.8. Contractor shall provide proof of insurance to COR before any work starts
STATEMENT OF WORK PART D SUPPORTING INFORMATION
D.1. Place of
D.2. Period of Performance Period covers installation and verification/testing of operations to ensure the equipment operate as marketed.
D.3. Special Considerations
D.3.1. Contractor Furnished Materials and Services
D.3.1.1. Equipment to transport equipment (e.g., dollies, pallet jacks, etc.)
D.3.1.2. Tools necessary to finalize installation of equipment (e.g., installation of casters, setup of shelving)
D.3.2. Government Furnished Materials and Services
D.3.2.1. Elevator access, power, and as optimal an operating environment as can be reasonably achieved.
D.3.3. Qualifications of Key Personnel Each party will determine the level of skills and adequate training for personnel supplied.
______________________________________
Authorized Company Representative Signature
D.3.4. Contractor s Statement of Release - In consideration of the modification agreed to herein as complete equitable adjustment, the Contractor hereby releases the Government from any and all liability under this contract for further equitable adjustments attributable to this modification.
D.3.5.
STATEMENT OF NEED
CLIN #1
266002-1145-773-PRO, Humphrey Field Analyzer 3 (HFA3) Model 860 W/ Liquid Trial Lens Printer & Table or equivalent must have the following specifications
110-120 volts
Windows 7-64 bit
Visual field index expressed as a percent of a normal age adjusted visual field
Liquid Lens using Liquid pressure, 1 trail lens for patients
SITA (Swedish Interactive Threshold Algorithm)
SITA-SWAP / Blue-Yellow Perimetry
STATPAC
Kinetic Testing Emulates manual standard Goldmann perimetry, with option of custom scan
Glaucoma Hemifield Test
Social Security Disability Test
Capable of combined report with cirrus OCT
Be on Vista Imaging Approved DICOM Modality Interfaces List
Must have 1 year warranty parts and labor
Must be compatible with FORUM software
Must be capable of import all patient test data from old Visual Fields machine onto new machine
Must have the ability to import and integrate with OCT 5000/HFA 750i at VA
Glaucoma protocol: 24-2 with progression
Neurology protocol: 30-2
Plaquenil screening: 10-2
Driving eval: Esterman Binocular
Comp and pension eval: III4E or Kenetic 45
1 EA $____________________
CLIN #2
Installation Included 1 EA $____________________
CLIN #3
Training Included 1 EA $___________________
CLIN #4
Operator Manuals Included 2 EA $____________________
Service Manuals Included 2 EA $____________________
SECURITY REQUIREMENTS:
Contractor will be required to comply with physical security guidelines by either checking in with the
If the Contractor requires access to the VA Network, then the appropriate level of background investigation must be completed as well as the Mandatory TMS trainings for VA Privacy & Information Security and also Privacy & HIPAA, prior to access being granted.
A Medical Device Risk Analysis may need completed prior to connecting it to the VA Network
**A Business Associate Agreement will be required using the VHABAA template (See below) must be returned with quote. **
PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL
All personnel employed by the Contractor and performing work VAPHS must comply with Homeland Security Presidential Directive 12 (HSPD-12).----
a.--------------All Contractor employees who require access to the
i.------------Position Sensitivity - The position sensitivity has been designated as low risk.
ii.------------Background Investigation - The level of background investigation commensurate with the required level of access is T1, form required is a SF85
iii.------------Contractor Responsibilities
1.--------------The contractor shall bear the expense of obtaining background investigations, regardless of the final adjudication determination. A Bill of Collections shall be generated by the
2.--------------The Contractor shall review the packet of information provided by the
3.--------------The Contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract.
4.--------------Contractor shall provide names of backup personnel to COR for investigation within two weeks of replacement.
5.--------------Failure to comply with the Contractor personnel security requirements may result in termination of the contract for default.
iv.------------Government Responsibilities
1.--------------Upon contract award, the
2.--------------The
3.--------------
(viii) The provision at 52.212-1, Instructions to Offerors -- Commercial, applies to this acquisition and the following clauses AND instructions are added as addenda:
CLAUSES:
52.211-6 Brand Name or Equal (
52.214-21 Descriptive Literature (
852.211-73 Brand Name or Equal. (
852-219-10 VA Notice of Total Service-Disabled Veteran-Owned Small Business Set-Aside
(ix) Evaluation of this requirement will be based on PRICE ONLY.
(x) Offerors are advised to include a completed copy of the provision at 52.212-3, Offeror Representations and Certifications -- Commercial Items, with its offer if has not been completed on SAM.gov.
(xi) The clause at 52.212-4, Contract Terms and Conditions -- Commercial Items, applies to this acquisition and the following clauses are added as addenda:
52.252-2 CLAUSES INCORPORATED BY REFERENCE (
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):
852.203-70
852.232-72 Electronic Submission of Payment Request
852.246-70 Guarantee
852.246-71 Inspection (
(xii) The clause at 52.212-5, Contract Terms and Conditions Required To Implement Statutes Or Executive Orders -- Commercial Items, applies to this acquisition and the following additional FAR clauses cited in the clause are applicable to the acquisition:
52.204-10 Reporting Executive Compensation & First-Tier Subcontract Awards (
52.209-6 Protecting the Government s Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment (
52.219-28 Post Award Small Business Program Representation (
52.222-19 Child Labor--Cooperation with Authorities and Remedies (
52.222-21 Prohibition of Segregated Facilities (
52.222-26 Equal Opportunity (
52.222-36 Equal Opportunity for Workers with Disabilities (
52.222-50 Combating Trafficking in Persons (
52.223-18 Encouraging Contractor Policies to Ban Text Messaging While Driving (
52.225-3 Buy American--Free Trade Agreements--Israeli Trade Act (
52.225-13 Restrictions on Certain Foreign Purchases (
52.232-34 Payment by Electronic Funds Transfer--Other than System for Award Management (
52.232-40 Providing Accelerated Payments to Small Business Subcontractors
(xiii) There are no additional contract requirements, terms or conditions.
(xiv) The Defense Priorities and Allocations System (DPAS) ratings are NOT APPLICABLE.
(xv) Quotes must be emailed to [email protected] and received no later than
NO LATES WILL BE ACCEPTED
(xvi) For information regarding the solicitation, please contact
BUSINESS ASSOCIATE AGREEMENT
**Needed when submitting a quote **
Purpose. The purpose of this Business Associate Agreement (Agreement) is to establish requirements for the
Scope. Under this Agreement and other applicable contracts or agreements, will provide FIELD ANALYZER services to, for, or on behalf of BUTLER HCC
In order for to provide such services, BUTLER HCC will disclose PHI to , and will use or disclose PHI in accordance with this Agreement.
Definitions. Unless otherwise provided, the following terms used in this Agreement have the same meaning as defined by the HIPAA Rules: Breach, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information (PHI), Required by Law, Secretary, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use.
Business Associate shall have the same meaning as described at 45 C.F.R. '' 160.103. For the purposes of this Agreement, Business Associate shall refer to , including its employees, officers, or any other agents that create, receive, maintain, or transmit PHI as described below.
Covered Entity shall have the same meaning as the term is defined at 45 C.F.R. '' 160.103. For the purposes of this Agreement, Covered Entity shall refer to BUTLER HCC.
Protected Health Information or PHI shall have the same meaning as described at 45 C.F.R. '' 160.103. Protected Health Information and PHI as used in this Agreement include Electronic Protected Health Information and EPHI. For the purposes of this Agreement and unless otherwise provided, the term shall also refer to PHI that Business Associate creates, receives, maintains, or transmits on behalf of Covered Entity or receives from Covered Entity or another Business Associate.
Subcontractor shall have the same meaning as the term is defined at 45 C.F.R. '' 160.103. For the purposes of this Agreement, Subcontractor shall refer to a contractor of any person or entity, other than Covered Entity, that creates, receives, maintains, or transmits PHI under the terms of this Agreement.
Terms and Conditions. Covered Entity and Business Associate agree as follows:
1. Ownership of PHI. PHI is and remains the property of Covered Entity as long as Business Associate creates, receives, maintains, or transmits PHI, regardless of whether a compliant Business Associate agreement is in place.
2. Use and Disclosure of PHI by Business Associate. Unless otherwise provided, Business Associate:
A. May not use or disclose PHI other than as permitted or required by this Agreement, or in a manner that would violate the HIPAA Privacy Rule if done by Covered Entity, except that it may use or disclose PHI:
(1) As required by law or to carry out its legal responsibilities;
(2) For the proper management and administration of Business Associate; or
(3) To provide Data Aggregation services relating to the health care operations of Covered Entity.
3. Obligations of Business Associate. In connection with any Use or Disclosure of PHI, Business Associate must:
A. Consult with Covered Entity before using or disclosing PHI whenever Business Associate is uncertain whether the Use or Disclosure is authorized under this Agreement.
B. Implement appropriate administrative, physical, and technical safeguards and controls to protect PHI and document applicable policies and procedures to prevent any Use or Disclosure of PHI other than as provided by this Agreement.
C. Provide satisfactory assurances that PHI created or received by Business Associate under this Agreement is protected to the greatest extent feasible.
D. Notify Covered Entity within twenty-four (24) hours of Business Associate s discovery of any potential access, acquisition, use, disclosure, modification, or destruction of either secured or unsecured PHI in violation of this Agreement, including any Breach of PHI.
(1) Any incident as described above will be treated as discovered as of the first day on which such event is known to Business Associate or, by exercising reasonable diligence, would have been known to Business Associate.
(2) Notification shall be sent to the ELAINE RAY, BUTLER VAMC; [email protected] and to the VHA Health Information Access Office, Business Associate Program Manager by email at [email protected].
(3) Business Associate shall not notify individuals or the
E. Provide a written report to Covered Entity of any potential access, acquisition, use, disclosure, modification, or destruction of either secured or unsecured PHI in violation of this Agreement, including any Breach of PHI, within ten (10) business days of the initial notification.
(1) The written report of an incident as described above will document the following:
(a) The identity of each Individual whose PHI has been, or is reasonably believed by Business Associate to have been, accessed, acquired, used, disclosed, modified, or destroyed;
(b) A description of what occurred, including the date of the incident and the date of the discovery of the incident (if known);
(c) A description of the types of secured or unsecured PHI that was involved;
(d) A description of what is being done to investigate the incident, to mitigate further harm to Individuals, and to protect against future incidents; and
(e) Any other information as required by 45 C.F.R. '--' 164.404(c) and 164.410.
(2) The written report shall be addressed to:
F. To the greatest extent feasible, mitigate any harm due to a Use or Disclosure of PHI by Business Associate in violation of this Agreement that is known or, by exercising reasonable diligence, should have been known to Business Associate.
G. Use only contractors and Subcontractors that are physically located within a jurisdiction subject to the laws of
(1) Must ensure that the terms of any Agreement between Business Associate and a contractor or Subcontractor are at least as restrictive as Business Associate Agreement between Business Associate and Covered Entity.
(2) Must ensure that contractors and Subcontractors agree to the same restrictions and conditions that apply to Business Associate and obtain satisfactory written assurances from them that they agree to those restrictions and conditions.
(3) May not amend any terms of such Agreement without Covered Entity s prior written approval.
I. Within five (5) business days of a written request from Covered Entity:
(1) Make available information for Covered Entity to respond to an Individual s request for access to PHI about him/her.
(2) Make available information for Covered Entity to respond to an Individual s request for amendment of PHI about him/her and, as determined by and under the direction of Covered Entity, incorporate any amendment to the PHI.
(3) Make available PHI for Covered Entity to respond to an Individual s request for an accounting of Disclosures of PHI about him/her.
J. Business Associate may not take any action concerning an individual s request for access, amendment, or accounting other than as instructed by Covered Entity.
K. To the extent Business Associate is required to carry out Covered Entity's obligations under Subpart E of 45 CFR Part 164, comply with the provisions that apply to Covered Entity in the performance of such obligations.
L. Provide to the Secretary of
M. Upon completion or termination of the applicable contract(s) or agreement(s), return or destroy, as determined by and under the direction of Covered Entity, all PHI and other
N. Be liable to Covered Entity for civil or criminal penalties imposed on Covered Entity, in accordance with 45 C.F.R. '--' 164.402 and 164.410, and with the HITECH Act, 42 U.S.C. '--' 17931(b), 17934(c), for any violation of the HIPAA Rules or this Agreement by Business Associate.
4. Obligations of Covered Entity. Covered Entity agrees that it:
A. Will not request Business Associate to make any Use or Disclosure of PHI in a manner that would not be permissible under Subpart E of 45 C.F.R. Part 164 if made by Covered Entity, except as permitted under Section 2 of this Agreement.
C. Has obtained or will obtain from Individuals any authorization necessary for Business Associate to fulfill its obligations under this Agreement.
5. Amendment. Business Associate and Covered Entity will take such action as is necessary to amend this Agreement for Covered Entity to comply with the requirements of the HIPAA Rules or other applicable law.
6. Termination.
A. Automatic Termination. This Agreement will automatically terminate upon completion of Business Associate s duties under all underlying Agreements or by termination of such underlying Agreements.
B. Termination Upon Review. This Agreement may be terminated by Covered Entity, at its discretion, upon review as provided by Section 9 of this Agreement.
C. Termination for Cause. In the event of a material breach by Business Associate, Covered Entity:
(1) Will provide an opportunity for Business Associate to cure the breach or end the violation within the time specified by Covered Entity, and;
(2) May terminate this Agreement and underlying contract(s) if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity.
D. Effect of Termination. Termination of this Agreement will result in cessation of activities by Business Associate involving PHI under this Agreement.
E. Survival. The obligations of Business Associate under this Section shall survive the termination of this Agreement as long as Business Associate creates, receives, maintains, or transmits PHI, regardless of whether a compliant Business Associate Agreement is in place.
7. No Third Party Beneficiaries. Nothing expressed or implied in this Agreement confers any rights, remedies, obligations, or liabilities whatsoever upon any person or entity other than Covered Entity and Business Associate, including their respective successors or assigns.
8. Other Applicable Law. This Agreement does not abrogate any responsibilities of the parties under any other applicable law.
9. Review Date. The provisions of this Agreement will be reviewed by Covered Entity every two years from Effective Date to determine the applicability and accuracy of the Agreement based on the circumstances that exist at the time of review.
10. Effective Date. This Agreement shall be effective on the last signature date below.
BUTLER HCC
By: By:
Title: Title:
Date: Date:
Link/URL: https://www.fbo.gov/spg/VA/PiVAMC646/PiVAMC646/VA24417Q1654/listing.html
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Combine Solicitation – 65– CIRRUS PHOTO WITH PRINTER
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