Loren Data's SAM Daily™

FBO DAILY - FEDBIZOPPS ISSUE OF JANUARY 01, 2016 FBO #5152
DOCUMENT

V -- Ground Ambulance and Paramedic Services to provide transportation to patients at the Department of Veterans Affaris Pittsburgh HealthCare System (VAPHS) University Drive and H. J. Heinz Facility - Attachment

Notice Date

12/30/2015
 

Notice Type

Attachment
 

NAICS

621910 — Ambulance Services
 

Contracting Office

Department of Veterans Affairs;Network Contracting Office 4
 

Solicitation Number

VA24416R0291
 

Response Due

1/15/2016
 

Archive Date

3/15/2016
 

Point of Contact

Angelamarie Scott
 

E-Mail Address

Angelamarie.Scott@va.gov
(Angelamarie.Scott@va.gov)
 

Small Business Set-Aside

N/A
 

Description

This is a Sources Sought for Market Research Purposes Only. If you are interested in this Statement of Work, contact Contracting Officer via email expressing interest. Statement of Work The intent of this Contract is to have an indefinite delivery/requirements Contract for ground ambulance emergency services to provide transportation to Patients at the Department of Veterans Affairs Pittsburgh Healthcare System (VAPHS). Contractor shall provide all vehicles, personnel, management, supplies, transportation, equipment and reports necessary to cover ground ambulance transport service. Contractor care shall cover the full range of paramedic and ambulance services provided in the local community. Paramedics responding to codes will bring equipment/supplies required by state regulations, and Advanced Life Support (ALS) equipment and medication to include, but not limited to, cardiac monitoring, intubation equipment, automated external defibrillator (AED), video laryngoscope, pulse oximetry, glucometer, portable oxygen, protective clothing and written procedures. In addition to the on-site vehicle identified in par. 5, the Contractor shall have available a minimum of four (2) ALS and six (3) BLS vehicles at all times for services under this Contract. Performance shall be in accordance with the requirements contained in this SOW and standards of the Pennsylvania DOH, Bureau of Emergency Medical Services, and The Joint Commission. 5 Year IDIQ VAPHS consists of two campuses/locations: (1) University Drive (UD) - University Drive C, Pittsburgh, PA 15240, which includes the acute medical center and emergency room; (2) Heinz Division (HZ) - 1010 Delafield Road, Pittsburgh, PA 15215, which includes a skilled nursing facility, domiciliary care, residential treatment program ambulatory care clinics, administrative building and other support service buildings The Contractor shall provide 24 hours per day/7 days per week, 365 days per year ambulance coverage and emergency code response at the Heinz Division of the VAPHS. The Contractor shall provide an on-site vehicle at all times; the purpose being to ensure a faster response time to codes in outlying campus buildings. The Contractor shall assign a minimum of two paramedics and the on-site vehicle 24 hours per day, 7 days per week, (365 days per year) to the Heinz Division. Paramedics must be qualified to respond to all emergency conditions as well as be on standby to call for transport of a Code Blue and/or a Behavioral Health patient. The Contractor shall have two (2) video laryngoscopes available at the H.J. Heinz Division. Assigned paramedics will respond, immediately, to all Condition A and Condition C codes, at the Heinz campus.. Paramedics shall respond to codes in less than three (3) minutes at Heinz in building 50 and 51, and less than five (5) minutes at the other campus buildings at the Heinz site.. Contractor shall attend monthly VAPHS ambulance committee meeting. Response times will be recorded and reviewed at the VAPHS ambulance committee. A map showing Buildings 50 and 51 at Heinz is Attachment #1. Expected response times, outside of Buildings 50 and 51, will be less than five (5) minutes. Exceptions, to the 3 or 5 minute expectations will be investigated and analyzed, including the identification of corrective actions if applicable. As determined appropriate, Contractor shall take corrective actions to ensure timely response. When there are simultaneous medical emergencies on the campus, the paramedics will be required to answer calls on an individual basis with communication maintained between each paramedic and the ambulance based center and provide another ambulance immediately for each site when transportation is required for an emergency situation. Ambulance transports will be staffed with a minimum of two (2) Emergency Medical Technicians for Basic Life Support (BLS) ambulance transports and one (1) Paramedic and one (1) Emergency Medical Technician for Advanced Life Support (ALS) ambulance transports. ALS and BLS transport determinations are to be made at the time of the transport request. The ambulance Contractor is required to participate in mock code training with staff. The Contractor shall work with the facility to participate in interactive education with VAPHS personnel to ensure they are familiar with their role as an emergency responder, as well as the rules and regulations that guide the Contractor's actions. Contractor shall participate in Cardiopulmonary Resuscitation (CPR) training with VA personnel, and contribute to educational venues such as: poster presentations, staff education, and mock code participation and training. The ambulance Contractor is required to participate in disaster drills. In the event of an actual disaster, the Contractor is required to participate in the initial response with its available resources and in concert with Allegheny County Emergency Medical Services. Contractor employees shall complete all required training by the VAPHS to include, but not limited to, Privacy Training. Contractor shall participate in monthly roundtable discussions with VA personnel to address issues and/or concerns. These services shall be provided at no additional cost to the Government. The VA Pittsburgh Healthcare System reserves the right to restrict any Contractor employees from performing services under this Contract who do not meet the required qualifications for the services they are to perform, who violate Federal and/or any applicable regulations, or are identified as a potential threat to the security, safety, health and/or operational mission of the VA and its veteran population. The restriction of such Contractor personnel shall not relieve the Contractor from performing all the required services, in accordance with all terms, conditions, and schedules contained herein. The Contractor shall furnish qualified personnel as required by the Contract specifications to accomplish all services under this Contract. The Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S. Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services under this Contract. The Contractor shall complete and sign Attachment #3, Contractor Certification (Immigration), and return it along with his price proposal. Contractor personnel performing services to the VA shall at all times conduct themselves in a professional manner, maintain personal hygiene, wear clean, neat uniforms and be identified by having the company name, and employee name affixed to the uniform. The Contractor shall be responsible for furnishing all vehicles, personnel, equipment and supplies, vehicle fuel, uniforms, nametags and/or badges for performance of services under this Contract. Employee identifications shall be worn in clear view above the waist. Contractor personnel shall not smoke in vehicles while transporting VA Patients. Contractor employees shall not represent themselves as VA employees while performing under this Contract. All Contractor personnel performing Contract services shall meet the qualifications as specified in this Contract, as well as any qualifications required by Federal, State, County and local government entities from the place in which they operate. Contractor personnel shall meet these qualifications at all times while performing Contract services. During the Contract period of performance, if the Contractor proposes to add-on or replace personnel to perform Contract services, the Contractor shall submit required evidence of training, certifications, licensing, background and security clearances, and any other qualifications to the designated COR. At no time shall the Contractor utilize add-on or replacement personnel to perform Contract services who do not meet the qualifications under the terms and conditions of this Contract. Within seven (7) days after receipt of award notification, the Contractor shall provide evidence of required training, certifications, licensing and any other qualifications of any personnel performing services under this Contract. The initial documentation shall be provided to the Contracting Officer. Emergency Medical Technician (EMT) and Paramedic Qualifications: EMTs and paramedics providing services under this Contract shall have the following qualifications, in addition to those required by Federal, State, and Local Government: (1) EMTs shall have completed training in accordance with the standards published by the Pennsylvania DOH with a minimum curriculum of 152 hours of clinical and didactic training or equivalent. Paramedics shall have completed training in accordance with the standards published by the Pennsylvania DOH with a minimum of 1,250 hours of combined clinical and didactic training or equivalent. Such training programs must also be acceptable under the regulating requirements for local EMS Systems supported by the Pennsylvania DOH under PL 93-154. (2) Shall submit evidence of re-certifications and equivalent training program successfully completed to the Contracting Officer. (3) Shall be certified, 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. (4) Shall attend all refresher continuing education, or advance training programs as required by the local or state government entity in which service is rendered. In no instance shall this be less frequent than annually. Such refresher training shall be equivalent to that developed by the Pennsylvania Department of Health Bureau of Emergency Medical Services The Contractor shall be responsible for the training and competency of its paramedics in the use of the video laryngoscope for difficult intubations. The Contractor shall provide a yearly competency verification report(s), for each employee assigned to the VAPHS, of critical skills to include, but not limited to, IV insertion and emergency airway management including intubation. The methodology used to determine that an employee is competent to perform critical emergency functions will be outlined in the competency verification report(s). All personnel assigned to the VAPHS shall be evaluated to be competent to perform critical emergency functions. The Contractor shall submit a competency verification report(s) to the Contracting Officer for each active year of this Contract. Ambulance Driver: Drivers shall have a valid operator's or chauffeur's license in accordance with Federal, State and local government requirements for their place of operation, for the services they perform, be capable of administering oxygen and have successfully completed an Emergency Vehicle Operator course approved by the Department of Health for the State of Pennsylvania and be capable of providing necessary medical assistance to the attending medical care specialist. Should governmental requirements differ on this Contract, then the strictest shall apply. The ambulance Contractor's Medical Director shall certify all EMTs and Paramedics and direct emergency medical response processes. The Contractor will submit the list of paramedics on Medical Command Operation to the CO. All staff of the ambulance Contractor is required to be assessed regarding competence and performance per Pennsylvania DOH, Emergency Medical Services. Contractor Equipment, Vehicles and Inspection: The VA reserves the right to inspect Contractor's equipment and vehicles or require documentation of compliance with Contract specifications, and State laws, rules, regulations and guidelines governing emergency medical transport vehicles (ambulances). VA inspections of Contractor facilities shall in no way constitute a warranty by the VA that the Contractor's vehicles and equipment are properly maintained. The VA reserves the right to restrict the Contractor's use of equipment and vehicles which are in need of repair, unclean, damaged on the interior or exterior body, and are not in compliance with Contract requirements. The restriction of such equipment and vehicles shall not relieve the Contractor from performing in accordance with the strict intent and meaning of the Contract without additional cost to the VA. Ambulances shall meet all current applicable Federal, State and local specifications and regulations including, but not limited to, licensing, registration, and safety standards. Appropriate licensing by the State of Pennsylvania is required. The on-site vehicle(s) shall be clean and maintained in good repair in accordance with manufacturer's instructions and specifications, at all times during the performance of this Contract, and shall contain - 1.An emergency safety kit, 2.Portable oxygen unit (s), 3.Fire suppression equipment, and 4.Appropriate road emergency warning equipment. BLS ambulance transports shall, in conjunction with the above, be equipped with stretchers to accommodate Patients over 500 pounds, have an on-board EMT, and perform basic airway management. If bariatric ambulance services are required, there will be no additional charges to the VAPHS above the rates established in the Schedule of Supplies or Services and Prices/Costs. ALS ambulance transports shall, in conjunction with the above, be equipped with pulse oximetry and on-board Paramedic, perform cardiac monitoring, provide ACLS drugs and procedures, and perform advanced airway management and medication monitoring and administration. Advanced airway management means the ability to intubate a Patient and provide appropriate respiratory care, which does not include tracheotomies, cricoidotomies or cricotracheotomies. The Contractor shall provide oxygen when it is requested by authorized medical facility personnel or required by the Patient's medical condition. Oxygen required for ambulance services shall be at the rate and price shown in the Schedule of Supplies or Services and Prices/Costs. The Contractor shall provide all medications required while in transport, sheets and blankets and other equipment and supplies required for use while in transport, for direct patient care. The Contractor shall at no time and under any circumstances exchange supplies, equipment and/or medications with VA. The prices quoted in the Schedule of Supplies or Services and Prices/Costs shall be inclusive of consumables used in transport. All vehicles used for critical patient care (e.g., ALS, BLS), shall include, but not be limited to, monitors, defibrillator with external pacemaker, intubation equipment, intravenous equipment, medications, patient compartment facilities, oxygen and suction equipment and accessories. Contractor Notification (a)The Contractor shall be responsible for providing all vehicles and personnel, necessary to meet all ALS and BLS transport requirements of this Contract. The Contractor shall be authorized to utilize another ambulance service company, as a subcontractor (certified to be within all requirements of this Contract) to complete these transportation requests only if prior approval for the subcontractor has been received from the Contracting Officer. The Government has a business relationship with the Prime Contractor only. Only the Prime Contractor may bill the Government for services. All bills for this subcontractor service will be paid directly to the Prime Contractor at the Contract rate, and the Prime Contractor shall make payment to the subcontractor at their agreed rate. In the event the Contractor is unable to perform services or have services performed as required, the Contractor shall immediately notify the VA Travel Section and provide a justification for non-performance. The VA reserves the right to re-procure services which cannot be performed by the Contractor, in accordance with the terms, conditions, and schedule of this Contract. The Contractor is responsible for excess re-procurement costs which may result from the Contractor's inability to perform the required service. Payment of re-procurement costs shall not relieve the Contractor from any other provision in this Contract covering inspection, acceptance and deductions from payment. The VA will be the sole judge in determining when services will be re-procured. The failure of the Contractor to perform services within the required time frames and in accordance with terms and conditions may also provide cause for termination of the Contract for "cause," (see FAR clause 52.212-4(m)). (b) Should the VA determine that immediate transportation is essential to prevent loss of life or serious bodily harm, transportation services may be procured without referral to the ambulance Contractor. However, in these extremely rare cases, no charge shall be levied against the Contractor. (c) There are occurrences when a Beneficiary will be scheduled for appointments requiring transportation from different VAPHS facilities, nursing home or Beneficiary place of residence. At no time shall a Beneficiary be required to wait arrival of a pre-scheduled trip beyond twenty (20) minutes. Failure of the vehicle to arrive at the Beneficiary's residence or VA facility /nursing home within the allotted time frame (20 minutes), may result in automatic cancellation of the trip, and services may be secured from other sources with default action to be considered against the Contractor. Escort: VAPHS reserves the right to have an escort, such as a relative or care provider of Patient or staff accompany Patient when VAPHS determines that such an escort is in the best interest of the Patient. VAPHS will also be the sole judge in determining when an escort is required. There shall be no charge to VAPHS when escorts are authorized to travel with Patient. Contractor shall only be required to transport escort with Patient and shall not be required to return the escort back to point of origin. Substitution of Patient: The VA reserves the right to substitute the Patient requiring services at any time during the performance of this Contract, to prevent delays, cancellations, or dry runs. There shall be no additional charge to the VA when such changes occur. Number of Patients: The Contractor shall transport one Patient per trip under ambulance services. Vehicle Response Time: The Contractor shall respond to all calls for ground ambulance transport service by being on-site at the designated point of pick-up within 20 minutes of notification for an Emergency Advanced Life Support (ALS) vehicle and within 35 minutes of notification for an Emergency Basic Life Support Vehicle (BLS).. Exceptions, to the 20 or 35 minute expectation will be investigated and analyzed, including the identification of corrective actions if applicable.. As determined appropriate, Contractor shall take corrective actions to ensure timely response. The Contractor shall respond to all calls immediately for emergency ground ambulance transport service for the Heinz Division.. Contractor shall provide 24 hours per day/7 days a week coverage with an on-site vehicle at the Heinz campus at all times. When there are simultaneous medical emergencies, the paramedics will be required to answer calls on an individual basis with communication maintained between each paramedic and the ambulance based center and provide another ambulance immediately to Heinz site when transportation is required for an emergency situation. VAPHS will supply code pagers for each on-site paramedic which will make the paramedics responsible for handing the pagers to the oncoming paramedics. The paramedics are responsible to routinely check the pagers to ensure they are functioning properly. VAPHS Facilities Management Service is responsible for any pager maintenance/repairs and replacement of batteries. The Contractor shall respond to all calls for ground ambulance transport service by being on site at the designated point of pick-up within 45 minutes of notification for a Non-Emergency Advanced Life Support (ALS) vehicle and/or Non-Emergency Basic Life Support Vehicle (BLS). If the time period for pick-up, stated herein, is physically impossible due to location of Patient, the Contractor shall contact the VA Travel Coordinator and inform him/her of the anticipated time required for pick-up and delivery of said Patient. The Contractor shall provide and respond to all emergency calls in accordance with Federal, State, and Local regulations, governing dispatch of emergency medical (ambulance) vehicles and medical care of on-board Patients, to include the use of sirens and other measures to ensure timely arrival at the designated VA Medical facility. Response Time Compliance Rate: The Contractor shall maintain at a minimum, a 95% compliance rate on responses to pick-up or deliver during the Contract year. Failure of the Contractor to perform in accordance with this compliance rating may constitute sufficient cause for termination of the Contract for "cause," (see FAR clause 52.212-4(m)) or other appropriate contractual action. If the Contractor's place of business is located beyond the local telephone call zone of the VA (area code 412 and 724), the Contractor shall install and provide to the VA, a toll free number for accepting the VA calls. It is estimated that 90% of all requests for service will be placed by telephone. Requests for service may also be in writing or oral from an authorized representative of the VA, and may be completed by telephone, facsimile, mail, e-mail, or in person (by giving a written or verbal request). Electronic Transmissions: The Contractor shall, at all times during the Contract period, have on his/her premises a functioning fax machine to communicate requirements with the VA (i.e., Patient incidents, requests for service, special correspondence, etc.). Each Contractor shall indicate if there is e-mail availability for their company to complete communications with the VA (use of this communication system must be approved by the Contracting Officer before any communications are completed in this manner). Waiting Time: For scheduled trips, waiting charges shall commence fifteen (15) minutes from the time the Contractor actually arrives at the designated pick-up and/or delivery points. For scheduled trips, waiting charges shall commence fifteen (15) minutes from the scheduled pick-up time or from the time the Contractor actually arrives at the designated pick-up point, whichever is later. (b) If the designated pick-up and/or delivery points are at other than the VA Medical facilities and waiting beyond the required fifteen (15) minute grace period is anticipated, the Contractor shall notify the travel section. This call is only for the purpose of verifying the Contractor's time of arrival at pick-up and/or delivery points and is not necessary if the Contractor does not anticipate a delay for which waiting charges will be claimed. The Contractor's failure to notify the Travel Section when waiting beyond the grace period shall result in non-payment for waiting time. Authorized Medical Center Personnel: Prior to performance, the Contracting Officer shall provide the Contractor with a list of names or position titles and phone numbers of authorized Government personnel who may request services and receive calls from Contractor regarding Contract performance. This list will be updated and submitted to the Contractor as changes occur. The Contractor shall ensure that requests for services are received from authorized medical center personnel. Services rendered in response to requests from other than authorized personnel shall be at the risk of the Contractor and any cost related thereto shall be borne by the Contractor. Request for Services: All requests will be placed against pertinent schedule items, on a unit price basis, and will be verified against invoices and Contractor's request for services log submitted under par. 19. When ordering services (whether it is by telephone, facsimile, mail, e-mail and/or person), the VAPHS will provide the Contractor with the following type of information: 1.Mode of transportation required, 2.Required date and time of arrival, 3.Name of Patient, 4.Pick-up and delivery point, and 5.Any other special instructions. The Veteran's Administration will pay transportation costs only for eligible Veteran's Administration patients, as determined by Veteran's Administration regulations. Contractors shall contact the appropriate Veterans' Administration Patient Travel Coordinator if there are any questions concerning the eligibility of the Veteran's Administration patients. The Contractor shall be required to transport non-ambulatory Patients on gurneys, litters, and geriatric chairs who are not in need of emergency transportation or medical attention. Contractor Personnel Security Requirements: a. All Contractor employees who require access to the Department of Veterans Affairs' computer systems shall be the subject of a background investigation. This requirement is applicable to all subcontractor personnel requiring the same access. The Department of Veterans Affairs Memorandum dated February 8th, 2007 (10N1-23) provides additional guidance and clarification specific to Contractors' investigations. In all cases, access (physical and computer) cannot be granted until officially notified by Security Investigations Center (SIC), Little Rock, Arkansas. Access can be granted prior to receiving final adjudication results. (1) Position Sensitivity - The position sensitivity for each Contractor position is determined by the VA utilizing Position Designation Automated Tool (PDAT). Each position will be designated at the high, moderate, or low risk level, depending on the position's potential for adverse impact to the integrity and efficiency of the services (CFR 731.106). NOTE: The Department of Veterans Affairs (VA) PIV Program Office implemented the rollout of the Personal Identity Verification (PIV) program across the enterprise to more than 200 VA sites in 2009. This new policy will most likely require all Contractors to be fingerprinted at a minimum, regardless of their position at the VA. (2) Background Investigation - The level of background investigation commensurate with the required level of access may be either a Special Agreement Check (SAC), National Agency Check with Written Inquiries (NACI) (low risk), Moderate Background Investigation (MBI) (moderate risk), or Background Investigation (high risk). Non-citizen Contract personnel appointed to low risk positions will be subject to a National Agency Check with Local Agency Check and Credit Check (NACLC). (3) Contractor Responsibilities: (a)The Contractor shall bear the expense of the background investigation(s), regardless of the final adjudication determination. A Bill of Collections shall be generated by the VA after final adjudication determination has been received. Final adjudication results may take up to six months but are normally received within 90 days after submission. Level of investigations and associated costs (per person) for on-site paramedics have been determined to be: ___ SAC _X_ NACI ___ NACLC ___ MBI ___ BI (b) All fee schedule questions should be directed to the SIC at 512-257-4469 or 4490 or vhalitsiccontracting@va.gov. (c) The Contractor shall prescreen all personnel requiring access to the computer systems to ensure they are able to read, write, speak, and understand the English language. (d) The Contractor employees shall download, complete, and mail the documents required for any risk positions within forty (40) calendar days of receipt of e-mail or the investigation will be cancelled. E-mail notifications will be received by the Contractor from the VA Security Investigations Center (SIC) explaining specific instructions once an investigation has been ordered. Access to the VA cannot be granted until the SIC has received all the required documents from the Contractor. Documents and instructions can be downloaded from the following website: http://www.va.gov/vabackground_investigations (1) The link above is the VA's Security Investigations Website. Select (left side of the screen) the link for the level of investigation (low, medium, or high) that is listed on the SIC e-mail message. Example Low Risk = Low Risk Contractor Position. (2) The different level of investigation required forms are as follows: Low Risk/NACI - SF85, OF 306 and Fingerprints Moderate Risk/MBI - SF85P and Fingerprints High Risk/BI - SF85P and Fingerprints All forms must be completed entirely and properly. The continuation form should only be used if the employee requires extra space. (3) The employee must be fingerprinted as part of an investigation. Electronic fingerprinting can be performed at the University Drive or H. J. Heinz Division VA Human Resources Offices. Please call 412-360-6125 at University Drive and 412-822-3518 at H. J. Heinz to schedule an appointment. These stations use electronic fingerprint machines which require the employee to fill out the Electronic Fingerprint Verification Letter on the VA's Security Investigations Website. If electronic fingerprinting is not feasible, please contact the local police department. The hard fingerprint card or Verification letter must be included in the same package with all the other forms when sent to the Security Center for processing. Do not send packages without the hard card prints or Verification letter or the package will be returned. (4). When the entire package is complete, please mail it to the address listed below. Do not leave the package with a VA Human Resource Department. Please ensure when mailing the completed package that a traceable method (Fedex, DHL, etc.) is utilized. Allow seven (7) days for SIC processing prior to contacting the SIC Office. VA Security and Investigations Center 2200 Fort Roots Drive Building 192, 07C3/NLR North Little Rock, AR 72114 Please feel free to contact the SIC at 512-257-4469 or 4490 or email vhalitsiccontracting@va.gov with any questions during this process. (e) The Contractor, when notified of an unfavorable determination by the Government, will withdraw the employee from consideration from working under the Contract. (f) Failure to comply with the Contractor personnel security requirements shall result in termination of the Contract for default. (g) Upon Contract award, the Contractor shall furnish the Information Security Office and the Contracting Officer a list of personnel performing work on the Contract. The list will include a brief description of the work to be performed and degree of access to information management systems required. The description of the required degree of access will address if remote access is required. The Contractor will update and submit the list of personnel performing work on the Contract to the Information Security Office every year, throughout the Contract period. Furthermore, it is the Contractor's responsibility to notify the Information Security Office when personnel performing work under this Contract no longer require access to information management systems. (4) Government Responsibilities: (a) 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. (b) 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 of receiving the Bill of Collections.
 

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Document(s)

Attachment
 

File Name: VA244-16-R-0291 VA244-16-R-0291.docx (https://www.vendorportal.ecms.va.gov/FBODocumentServer/DocumentServer.aspx?DocumentId=2486972&FileName=VA244-16-R-0291-000.docx)

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