W912LP-26-Q-4003 - Iowa National Guard Medical Exams Waterloo, IA

Form / Attachment / Pricing Sheet

This document, "Attachment 5 - Technical Exhibit 3," is an Occupational Health Report for a Medical Examination. It serves as a form to record the results of a medical evaluation for an individual, likely in relation to their job or potential employment.

• Exam Type: Options include Medical Surveillance, Respirator Evaluation, Post-Offer Pre-Placement, Transfer, Termination/Retirement, and Special Exam.
• Examinee Information: Fields for Examinee name, Date of Birth, Work Site, Job Title, and Date of Exam.
• Medical Qualification Assessment: Checkboxes to indicate if the examinee is medically qualified to perform essential job functions, with or without limitations/accommodations, or not qualified.
• Respirator Use: Specific section for assessing qualification to wear a respirator, including restrictions.
• Physical Examination Details: Sections for recording vital signs, vision (corrected and uncorrected), phoria, other procedures (X-ray, Spirometry, EKG, Blood Tests), and a detailed physical exam of various body parts (Skin, Head/Neck, EENT, Chest, Lungs, Heart, Abdomen, Hernia, Spine, Hand/Wrist/Elbow, Knee).
• Medical History Questionnaire: Comprehensive sections covering general history, review of systems (Ear, Nose, Throat; Respiratory; Skin; Neck; Hand/Wrist/Elbow; Knee; Back; Eyes; Heart), tobacco history, occupational history, leisure activities, allergies, medications, immunizations, and diagnostic testing.
• Explanations and Comments: Space for explaining abnormal findings, provider explanations for questionnaire items, additional provider comments, and any required accommodations or limitations.

This document is a standardized form used for occupational health medical examinations. Bidders may need to understand its purpose if the solicitation requires them to provide or facilitate such examinations as part of the contract. It outlines the scope of medical assessments that might be performed on personnel involved in the contract.

Solicitation / RFP / RFQ

This is a combined synopsis/solicitation for commercial services, specifically Waterloo Medical Surveillance Examination Services for the Iowa Army National Guard. A written solicitation will not be issued; offers are being requested via this announcement.

The following services are requested, with quantities specified:

• Physical/Dermatological Exam (23 Each)
• Complete Lab Draw (23 Each)
• Vision Screening (23 Each)
• Chromium Blood Level (19 Each)
• Lead Blood Level (23 Each)
• Cadmium Blood Level (19 Each)
• Zinc Protoporphyrin (23 Each)

All services are further detailed in "PWS Attachment 02".

• This RFQ is being solicited as a small business set-aside.

• NAICS Code: 621111

• Small Business Size Standard: $16,000,000

• Contract type: Firm-fixed price purchase order.

• Basis for Award: Lowest total price to the Government for services meeting PWS requirements.

• Quotations are due by March 26, 2026, 11:00 AM CST.

• Quotations must be submitted electronically to Seth Van Steenwyk (seth.a.vansteenwyk.civ@army.mil) and Kelsey Letcher (kelsey.l.letcher.civ@army.mil).

• Offerors must complete the "Contact Information Table" and "Pricing Table" (Attachment 01).

• Offerors must have a current, active registration in the System for Award Management (SAM).

• Invoices will be submitted electronically via Wide Area WorkFlow (WAWF) and paid via Electronic Funds Transfer (EFT).

• Small business set-aside.

• Offerors must be registered in SAM.

• Service Contract Labor Standards Wage Determination 2015-4985, Revision 28, dated 12/03/2025 is applicable.

• Applicable provisions and clauses are incorporated by reference, with full text available at specified URLs.

• Relevant attachments include: Contractor Information & Pricing Table (ATCH1), PWS (ATCH2), Wage Determination (ATCH3), and PWS Technical Exhibit 3 (ATTCH5).

Form / Attachment / Pricing Sheet

This document is a Wage Determination issued under the Service Contract Act, establishing minimum wage rates and fringe benefits for various occupations in Iowa Counties of Black Hawk, Bremer, and Grundy. It serves as a reference for contractors to ensure compliance with labor standards for federal contracts.

• Lists numerous occupations categorized by general field (e.g., Administrative Support, Automotive Service, Health Occupations, Information Technology).
• Specifies the minimum hourly wage rate for each occupation.
• Indicates that fringe benefits are required and follow the occupational listing.
• Includes notes on Executive Orders 13706 (Paid Sick Leave) and 13658 (minimum wage adjustments).
• Details provisions for vacation, holidays, hazardous pay differentials, and uniform allowances.
• Outlines the conformance process for classifying occupations not explicitly listed.

This wage determination is crucial for bidders to accurately estimate labor costs for their proposals. Bidders must ensure that the wages and benefits offered to employees working on the contract meet or exceed the rates and requirements specified in this document. Failure to comply can lead to contract violations and penalties. It helps bidders understand the minimum labor cost expectations for performing work in the specified geographic area.

Statement of Work (SOW) / Performance Work Statement (PWS)

To provide full-time support for Occupational Health Medical Surveillance Examinations and Occupational Health Services for approximately 90 full-time support (FTS) civilian and uniformed federal technicians employed by the Iowa Army National Guard (IAARNG) who are potentially exposed to health hazards in the work environment.

• Provide all necessary personnel, equipment, tools, materials, supervision, and quality control for these services.

• Services are "Non-Personal Health Care Services" as defined by FAR Subpart 37.101.

• Examinations are for personnel in positions requiring specific physical fitness standards. Excludes Active Guard Reserve (AGR), state employees, civilian contractors, and part-time traditional soldiers.

• Period of Performance (PoP): Date of award through May 31, 2026.

• Place of Performance: Clinical settings within a 40-mile radius of AASF # 2 and FMS# 2, 2245 West Big Rock Rd, Waterloo, Iowa 50036.

• Hours of Service: 0730 - 1630, Monday through Friday, excluding recognized US holidays.

• Telework: Not permitted.

• Quality Control (QC): Contractor must develop and maintain an effective QC Plan (QCP) and submit a final QCP within 10 days of award.

• Quality Assurance (QA): Government will evaluate performance using a Quality Assurance Surveillance Plan (QASP).

• Physical Security: Contractor must safeguard Government property and implement key control procedures.

• Special Qualifications: Employees must possess all required licenses for performing Occupational Health Medical Surveillance Exams. Procedures must comply with applicable standards from ABOEM, AAOHN, OSHA, and NIOSH.

• Laboratory Services: Must be performed by a licensed laboratory and certified personnel.

• Examinations: Conducted by physicians, chiropractors, or mid-level providers experienced in occupational medicine.

• Contract Manager (CM): Contractor must designate a CM with full authority to act on contract matters.

• Combating Trafficking in Persons: Contractor must adhere to the zero-tolerance policy.

• Organizational Conflicts of Interest (OCI): Contractor must notify the KO of any potential OCI and submit a mitigation plan.

• Perform Medical Surveillance Examinations/Occupational Health Services.

• Maintain medical liability insurance.

• Coordinate exam schedules.

• Consult with the Occupational Health Nurse (OHN) regarding issues.

• Perform comprehensive review and evaluation within 30 days post-testing.

• Immediately notify the OHN of abnormal results.

• Provide vital signs, laboratory tests (including vision, blood, and physical/dermatological exams), and job functional analysis.

• Utilize the Occupational Health Report Medical Examination form.

• Report questionable or critical results immediately to the OHN.

• Send documentation (tests, findings, results) to the OHN within 30 days of exam/testing.

• Prepare and distribute two copies of exam results: one to the OHN, one to the individual.

• Service Contract Reporting (Reserved).

Solicitation / RFQ

This Request for Quotation (RFQ) from the Iowa Army National Guard seeks quotes for Waterloo Medical Surveillance Examination Services at the Camp Dodge Joint Maneuver Training Center. The services are intended to meet the requirements outlined in the Performance Work Statement (PWS) Attachment 02.

The following specific services are requested:

• Physical/Dermatological Exam (23 Each)

• Complete Lab Draw (23 Each)

• Vision Screening (23 Each)

• Chromium Blood Level (19 Each)

• Lead Blood Level (23 Each)

• Cadmium Blood Level (19 Each)

• Zinc Protoporphyrin (23 Each)

• This RFQ is being solicited as a small business set-aside.

• NAICS Code: 621111, with a small business size standard of $16,000,000.

• The government intends to award a firm-fixed price purchase order.

• Basis for Award is Price; the lowest total price representing the best value will be selected.

• Quotations are due by 26 March 2026, 11:00 AM CST.

• Submit quotations to Seth Van Steenwyk (seth.a.vansteenwyk.civ@army.mil) and Kelsey Letcher (kelsey.l.letcher.civ@army.mil).

• Offerors must complete the Contact Information Table and Pricing Table (Attachment 01).

• Offerors must have a current, active registration in the System for Award Management (SAM).

• Invoices will be submitted electronically via Wide Area WorkFlow (WAWF).

• This RFQ is a small business set-aside.

• NAICS Code 621111 applies, with a size standard of $16,000,000.

• Service Contract Labor Standards Wage Determination 2015-4985, Revision 28 is applicable (Attachment 03).

• Numerous FAR and DFARS provisions and clauses are incorporated by reference, including those related to SAM registration, commercial products/services, labor standards, and security requirements.

• Relevant attachments include: ATCH1_Contractor Information & Pricing Table, ATCH2_PWS, and ATCH3_Wage Determination.

Form / Attachment / Pricing Sheet

This document serves as Attachment 01 to RFQ # W912LP-26-Q-4003 for Medical Surveillance Examination Services. It requires contractors to complete both the Contractor Information Table and the Pricing Table and submit it as their official quote. If an additional quote document is submitted, this attachment must still be included.

Contractor Information Table:

• Company Name
• Point of Contact (POC) Name, Phone, and Email
• CAGE Code
• SAM Unique Entity ID
• Tax ID Number
• Prompt Payment Discount Terms (Net 30 unless otherwise noted)
• Business Size/Socio-economic Group(s) (must correspond with FAR 52.212-3 Representations and Certifications completed within SAM)
• Period of Performance

Pricing Table:

• Item #
• Description (e.g., Physical / Dermatological Exam, Complete Lab Draw, Vision Screening, Chromium Blood Level, Lead Blood Level, Cadmium Blood Level, Zinc Protoporphyrin)
• Quantity (Qty)
• Unit (EA)
• Unit Price
• Extended Price

Bidders must complete this form to provide essential company information and pricing for the specified medical surveillance services. The pricing table outlines the specific services and quantities for which quotes are required. Failure to complete and submit this attachment may impact the evaluation of the bid.

Statement of Work (SOW) / Performance Work Statement (PWS)

To provide full-time support (FTS) for Occupational Health Medical Surveillance Examinations and Occupational Health Services for approximately 90 Iowa Army National Guard (IAARNG) full-time support (FTS) and/or temporary personnel who are or could potentially be exposed to health hazards in the work environment.

• Provide personnel, equipment, tools, materials, supervision, and quality control for Occupational Health Medical Surveillance Examinations and Services.
• Services are non-personal health care services, with the contractor acting as an independent contractor.
• Examinations are for personnel assigned to positions requiring specific standards of physical fitness.
• Excludes Active Guard Reserve (AGR), state employees, civilian contractors, and part-time traditional soldiers.

Date of award through May 31, 2026.

• Clinical settings within a 40-mile radius of AASF # 2 and FMS# 2, located at 2245 West Big Rock Rd, Waterloo, Iowa 50036.

• Services provided Monday through Friday, 0730-1630, excluding recognized US holidays.

• Telework is not permitted, except for Continuity of Operations Planning (COOP) under specific circumstances.

• Contractor shall develop and maintain an effective Quality Control Plan (QCP).

• Government will evaluate performance using a Quality Assurance Surveillance Plan (QASP).

• Specific performance standards include following PWS procedures (98% of the time) and timely submission of documentation (within 30 days of exam/testing).

• Physical Security: Safeguard all Government property.

• Key Control: Implement methods to ensure no keys/key cards are lost, misplaced, or used by unauthorized persons. No duplication of Government-issued keys.

• Lock Combinations: Ensure combinations are not revealed to unauthorized persons and are changed when necessary.

• Special Qualifications: All employees must possess required licenses for performing Occupational Health Medical Surveillance Exams. Contractors must ensure personnel are fully trained, licensed, certified, and qualified.

• Applicable Standards: Procedures must comply with ABOEM, AAOHN, OSHA, NIOSH Standards, and specific laboratory and personnel certifications.

• Combating Trafficking in Persons: Adherence to zero-tolerance policy.

• Organizational Conflicts of Interest (OCI): Contractor must notify the KO of any potential OCI and submit a mitigation plan.

• Government Furnished Property/Material/Equipment/Services (GFP/M/E/S): NONE.

• Contractor Furnished Property, Materials, and Equipment (CFP/M/E): Contractor shall furnish everything required, except for items specified as Government-Furnished.

• Medical Liability Insurance: Maintain coverage acceptable to the Contracting Officer.

• Reporting: Immediately report questionable or critical test results to the OHN.

• Documentation: Submit all documentation, including test results, within 30 days of exam/testing.

• Exam Results: Prepare two copies of exam results for distribution to the OHN and the individual.

• Estimated Personnel: Approximately 17 personnel to be examined annually, with the right for the Government to increase or decrease this number.

• Final Quality Control Plan (QCP)

• Contract Manager designation

• Comprehensive Review & Evaluation reports

• Lab Results

• Documentation (medical records, reports, questionnaires, etc.)

• Exam Results