A--RCT TELEMEDICINE RESEARCH GRISELMARIE ALEMAR SPECIALIST

TABLE OF CONTENTS SECTION B - CONTINUATION OF SF 1449 BLOCKS 3 B.1 CONTRACT ADMINISTRATION DATA 3 B.2 PRICE/COST SCHEDULE 5 B.3 DELIVERY SCHEDULE 5 B.4 CONTRACTOR PERSONNEL SECURITY REQUIREMENTS 6 B.5 VENDOR SUPPLIED PERSONNEL INFORMATION 8 B.6 STATEMENT OF COMMITMENT AND UNDERSTANDING FOR VA CONTRACTOR EMPLOYEES WHO POSSESS OR HANDLE VA SENSITIVE INFORMATION OR PERSONAL DATA 10 B.7 PRIVACY POLICY TRAINING 11 B.8 INFORMATION SECURITY TRAINING 11 SECTION C - CONTRACT CLAUSES 12 C.1 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS--COMMERCIAL ITEMS (JAN 2011) 12 C.2 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) 18 C.3 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) 18 C.4 52.224-1 PRIVACY ACT NOTIFICATION (APR 1984) 18 C.5 52.224-2 PRIVACY ACT (APR 1984) 19 C.6 52.227-1 AUTHORIZATION AND CONSENT (DEC 2007) 20 C.7 52.227-14 RIGHTS IN DATA--GENERAL (DEC 2007) 20 C.8 52.227-16 ADDITIONAL DATA REQUIREMENTS (JUN 1987) 26 C.9 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984) 26 C.10 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) 26 C.11 VAAR 852.273-75 SECURITY REQUIREMENTS FOR UNCLASSIFIED INFORMATION TECHNOLOGY RESOURCES (Interim - October 2008) 27 C.12 VAAR 852.273-76 ELECTRONIC INVOICE SUBMISSION (Interim - October 2008) 27 SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS 28 D.1 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS-- COMMERCIAL ITEMS (JAN 2011) 28 D.2 ADDENDUM to FAR 52.212-1 Instructions to Offerors --- Commercial Items - Sub-Part 13.5 Test Program 41 SECTION B - CONTINUATION OF SF 1449 BLOCKS B.1 CONTRACT ADMINISTRATION DATA (continuation from Standard Form 1449, block 18A.) 1. Contract Administration: All contract administration matters will be handled by the following individuals: a. CONTRACTOR: b. GOVERNMENT: Contracting Officer 00518 Department of Veterans Affairs Paula L. Poppy VAMC Bedford 200 Springs Road Bedford MA 01730 +1 (555) 000-0000 Contracting Officer's Technical Representative (COTR) Department of Veterans Affairs Deborah Demolles VA Boston Healthcare System 150 Huntington Ave. Boston, MA. 02130 +1 (555) 000-0000 2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: [X] 52.232-34, Payment by Electronic Funds Transfer - Other than Central Contractor Registration, or [] 52.232-36, Payment by Third Party 3. INVOICES: Invoices shall be submitted in arrears: a. Quarterly [] b. Semi-Annually [] c. Other [X] Monthly 4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address: Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows: AMENDMENT NO DATE ______________________________ _____________ ______________________________ _____________ ______________________________ _____________ Statement of Work Griselmarie Alemar. Services are needed to collect the necessary data to determine the impact of interventions on regional fat distribution and upper airway dimension for the research project entitled An RCT of Telemedicine Interventions for OSA. An individual with detailed knowledge of the study protocol, data collection, and quality control procedures is required and shall perform the following: " Measure upper airway cross-sectional area during quiet tidal breathing using acoustic reflection technique. " Determine subjects' abdominal fat using ultrasound and measure weight and height. " Review scientific literature and develop telecommunication dialogue to motivate behavior change in research subjects. " Administer food frequency questionnaire. " Assess physical activity using paper and pencil tests as well as accelerometer. " Review medical charts to determine subject eligibility for research project. " Help enter, process, and clean data collected to get it ready for data analysis. " Perform other duties as needed and as related to the study protocol Services are required Monday through Friday, 8:00am until 12:00pm or as arranged with the lab. The duty station will be the Jamaica Plain facility of VA Boston Healthcare facility located at 150 Huntington Avenue. B.2 PRICE/COST SCHEDULE ITEM DESCRIPTION OF QTY UNIT UNIT AMOUNT NO. SUPPLIES/SVCS PRICE 1 Base Period 6 Months $ $ Part time 20 Hrs. Per week. Monday through Friday, no Holidays or weekends GRAND TOTAL ---$ 2 Option 1 6 Months $ $ Part time 20 Hrs. Per week. Monday through Friday, no Holidays or weekends GRAND TOTAL ---$ 3 Option 2 6 Months $ $ Part time 20 Hrs. Per week. Monday through Friday, no Holidays or weekends GRAND TOTAL ---$ B.2 DELIVERY SCHEDULE ITEM NUMBER QUANTITY DATE OF DELIVERY 1 6 mos SHIP TO : IRM Period of Performance: Base Year: April 1, 2011 through September, 30, 2011 Option 1: October 1, 2011 through March 30, 2012 Option 2: April 1, 2012 through September 30, 2012 This Contract will not exceed 24 Months NTE 24 MON B.3 CONTRACTOR PERSONNEL SECURITY REQUIREMENTS All contractor employees who require access to the Department of Veterans Affairs' computer systems shall be the subject of a background investigation and must receive a favorable adjudication from the VA Office of Security and Law Enforcement prior to contract performance. This requirement is applicable to all subcontractor personnel requiring the same access. If the investigation is not completed prior to the start date of the contract, the contractor will be responsible for the actions of those individuals they provide to perform work for VA. 1. Position Sensitivity - The position sensitivity has been designated as LOW RISK 2. Background Investigation - The level of background investigation commensurate with the required level of access is National Agency Check. 3. Contractor Responsibilities a. The contractor shall bear the expense of obtaining background investigations. If the investigation is conducted by the Office of Personnel Management (OPM), the contractor shall reimburse VA within 30 days. b. The contractor shall prescreen all personnel requiring access to the computer systems to ensure they maintain a U.S. citizenship and are able to read, write, speak and understand the English language. c. The contractor shall submit or have their employees submit the following required forms to the VA Office of Security and Law Enforcement within 30 days of receipt: (i) Standard Form 85P, Questionnaire for Public Trust Positions (ii) Standard Form 85P-S, Supplemental Questionnaire for Selected Positions (iii) FD 258, U.S. Department of Justice Fingerprint Applicant Chart (iv) VA Form 0710, Authority for Release of Information Form (v) Optional Form 306, Declaration for Federal Employment (vi) Optional Form 612, Optional Application for Federal Employment d. The contractor, when notified of an unfavorable determination by the Government, shall withdraw the employee from consideration from working under the contract. e. Failure to comply with the contractor personnel security requirements may result in termination of the contract for default. 4. Government Responsibilities a. The VA Office of Security and Law Enforcement will provide the necessary forms to the contractor or to the contractor's employees after receiving a list of names and addresses. b. Upon receipt, the VA Office of Security and Law Enforcement will review the completed forms for accuracy and forward the forms to OPM to conduct the background investigation. c. The VA facility will pay for investigations conducted by the Office of Personnel Management (OPM) in advance. In these instances, the contractor will reimburse the VA facility within 30 days. d. The VA Office of Security and Law Enforcement will notify the contracting officer and contractor after adjudicating the results of the background investigations received from OPM. e. The contracting officer will ensure that the contractor provides evidence that investigations have been completed or are in the process of being requested. B.4 VENDOR SUPPLIED PERSONNEL INFORMATION Please submit the name, address and social security number of the vendor supplied personnel as well as a person to contact from your company and the phone number and billing address. Contracting Specialist: Telephone: Station: Risk Level: LOW Vendor Name: Vendor POC (Name, Telephone #, E-mail): Vendor Address: Vendor Supplied Personnel FULL Name* & Email Address SSN: Home Address: Date of Birth: Place of Birth: Current Clearance(s) Issued by Other Departments/Agencies *Must include full name, including complete middle name. If there is no middle name, state "NMN." B.5 STATEMENT OF COMMITMENT AND UNDERSTANDING FOR VA CONTRACTOR EMPLOYEES WHO POSSESS OR HANDLE VA SENSITIVE INFORMATION OR PERSONAL DATA As a contractor employee of the Department of Veterans Affairs (VA), I am committed to safeguarding the personal information that veterans and their families have entrusted to the Department. I am also committed to safeguarding the personal information which VA employees and applicants have provided. To ensure that I understand my obligations and responsibilities in handling the personal information of veterans and their families, I have completed both the annual General Privacy Awareness Training (or VHA Privacy Training, as applicable) and the annual VA Information Security Training. I know that I should contact the Contracting Officer whom will then get in touch with the Information Security Officer or Regional or General Counsel, when I am unsure whether or how I may gather or create, maintain, use, disclose or dispose of information about veterans and their families, and VA employees and applicants. I further understand that if I fail to comply with applicable confidentiality statutes and regulations, I may be subject to civil and criminal penalties, including fines and imprisonment. I also recognize that VA may impose sanctions, up to and including termination of contract for violation of applicable confidentiality and security statutes, regulations and policies. I certify that I have completed the training outlined above and am committed to safeguarding personal information about veterans and their families, and VA employees and applicants. _____________________________ ___________________________ [Print or type name] Signature ______________________________ ___________________________ Position Title Date B.6 PRIVACY POLICY TRAINING All contractor and subcontractor employees performing work under this contract and having access to patient records and other privacy act information are required to complete the VHA's mandatory "VHA Privacy Policy" training course. The course is available on-line at the Veteran's Health Administration's (VHA) Employee Education System (EES) website: https://www.ees-learning.net . The basic course is designed to be finished in 50-60 minutes. If you choose to read information behind the MORE buttons, self-test questions, and scenarios, it may take you about 30 more minutes to finish. When the course is successfully completed, a training certificate will be issued on-line. Submittal: Training completion certificates or proof of training for contractor furnished training for all applicable contractor and subcontractor employees shall be forwarded as one submittal package to the Contracting Officer within ten (10) calendar days of Contract or Purchase Order award. B.7 INFORMATION SECURITY TRAINING All contractor and subcontractor employees performing work under this contract and having access to VA computer systems are required to complete the VA's mandatory "VA Information Security Awareness" training course. The course is available on-line at the Veteran's Health Administration's (VHA) Employee Education System (EES) website: https://www.ees-learning.net . The course is designed to take approximately 1 hour. When the course is successfully completed, a training certificate will be issued on-line. Submittal: Training completion certificates for all applicable contractor and subcontractor employees shall be forwarded as one submittal package to the Contracting Officer within ten (10) calendar days of Contract or Purchase Order award.