W912LP-26-Q-4004 Iowa National Guard Medical Exams Davenport, IA

Form / Attachment / Pricing Sheet

This document is Attachment 5 - Technical Exhibit 3, an Occupational Health Report for a Medical Examination. It is used to assess an individual's medical qualifications for a job, including their ability to perform essential functions with or without limitations, and their suitability for wearing respiratory equipment.

• Exam Type: Medical Surveillance, Respirator Evaluation, Post-Offer, Pre-Placement, Transfer, Termination/Retirement, Special Exam.
• Examinee Information: Name, Date of Birth, Work Site, Job Title, Date of Exam.
• Medical Qualification Assessment: Determines if the examinee is medically qualified for the job, with or without limitations, or not qualified due to temporary conditions.
• Respirator Qualification: Assesses medical qualification to wear a respirator, with options for different types (Negative Pressure, SCBA, PAPR) and restrictions.
• Physical Examination Details: Includes sections for Vitals, Vision (corrected and uncorrected), Phoria, Other Procedures (X-Ray, Spirometry, EKG, Blood Tests), and a detailed Physical Exam checklist for various body parts and systems (Skin, Head/Neck, EENT, Chest, Lungs, Heart, Abdomen, Hernia, Spine, Hand, Extremities).
• Medical History Questionnaire: Gathers information on general health, past medical history (respiratory, cardiovascular, musculoskeletal, etc.), occupational history, allergies, medications, and immunizations.
• Explanation of Findings: Space for providers to explain abnormal findings, provide comments, and detail any items marked "Yes" on the questionnaire.
• Disclaimer: States the examination is for job placement and not a complete physical exam.

This document is a form that would likely be required for individuals being considered for employment or a specific role within an opportunity. Bidders may need to understand the scope of these medical examinations if the solicitation requires them to facilitate or provide such assessments for their employees or subcontractors.

Solicitation / RFP / RFQ

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

The following services are requested, each with a quantity of 8 Each:

• Physical/Dermatological Exam (Reference PWS Attachment 02)

• Complete Lab Draw (Reference PWS Attachment 02)

• Vision Screening (Reference PWS Attachment 02)

• Chromium Blood Level (Reference PWS Attachment 02)

• Lead Blood Level (Reference PWS Attachment 02)

• Cadmium Blood Level (Reference PWS Attachment 02)

• Zinc Protoporphyrin (Reference PWS Attachment 02)

• This RFQ is being solicited as a small business set-aside under NAICS Code 621111 with a small business size standard of $16,000,000.

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

• Service Contract Labor Standards Wage Determination 2015-5011, Revision 27, dated 12/03/2025 is applicable.

• Quotations are due by 30 March 2026, 11:00 AM CST.

• Quotations shall be submitted electronically to Seth Van Steenwyk and Kelsey Letcher via email.

• Basis for Award is Price; the lowest total price to the Government for services meeting the PWS requirements will be selected.

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

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

• Small business set-aside.

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

• Referenced attachments include: ATCH1_Contractor Information & Pricing Table, ATCH2_PWS, ATCH3_Wage Determination, and ATTCH5_PWS Technical Exhibit 3.

Solicitation / RFP / RFQ

This is a Request for Quotation (RFQ) from the Iowa Army National Guard for Waterloo Medical Surveillance Examination Services at the Camp Dodge Joint Maneuver Training Center. The government intends to award a firm-fixed-price purchase order to the responsible offeror with the lowest total price.

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 to be performed in accordance with Reference PWS Attachment 02.

• Contract Type: Firm-fixed-price purchase order.

• Period of Performance: Not explicitly stated, but implied by the due date for quotations.

• Estimated Value: Not stated, but the NAICS Code 621111 has a small business size standard of $16,000,000.

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

• Submission Method: Electronically to Seth Van Steenwyk (seth.a.vansteenwyk.civ@army.mil) and Kelsey Letcher (kelsey.l.letcher.civ@army.mil).

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

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

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

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

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

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

• Service Contract Labor Standards Wage Determination 2015-4985, Revision 28, dated 12/03/2025 is applicable (Reference Attachment #3).

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

• Attachments include: Contractor Information & Pricing Table (ATCH1), PWS (ATCH2), and Wage Determination (ATCH3).

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 completed and 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 accurately and thoroughly to be considered for this opportunity. The pricing table requires specific details for each listed service, which will form part of the official quote submission.

Form / Attachment / Pricing Sheet

This document is a Wage Determination issued by the U.S. Department of Labor, Employment Standards Administration, Wage and Hour Division. It establishes the minimum wage rates and fringe benefits required for various occupations performing contract work in the specified geographic area.

• Geographic Area: Iowa Counties of Black Hawk, Bremer, and Grundy.
• Occupational Listings: Provides a comprehensive list of job titles (e.g., Accounting Clerk, Administrative Assistant, Automotive Electrician, Nurse, Technician, etc.) along with their corresponding minimum hourly wage rates.
• Fringe Benefits: Indicates that fringe benefits are required and follow the occupational listing. Specific benefits like Health & Welfare are detailed, including rates and conditions for application (e.g., Executive Orders 13706 and 13658).
• Executive Orders: Notes the applicability of Executive Order 13706 (Paid Sick Leave) and Executive Order 13658 (minimum wage rate adjustments).
• Vacation and Holidays: Outlines paid vacation and holiday provisions based on years of service.
• Conformance Process: Details the process for contractors to request additional classifications and wage rates if a required occupation is not listed.

This wage determination is critical for bidders to accurately estimate labor costs for their proposals. Bidders must ensure their proposed wages and benefits meet or exceed these minimum requirements for all covered employees working on the contract in the specified area. Failure to comply can lead to contract violations and penalties.

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

To provide full-time support (FTS) for job-related Occupational Health examinations and services to 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 include medical surveillance examinations, occupational health services, and job-related medical surveillance physical examinations.

• Specific tasks include vital signs, laboratory tests (e.g., vision screenings, blood tests for chromium, lead, cadmium, zinc protoporphyrin), physical/dermatological exams, and job functional analysis.

• Contractor is responsible for furnishing all necessary items except for Government Furnished Property (GFP), of which there is none listed.

• Services must be performed in accordance with the PWS, meeting identified procedures and standards 98% of the time.

• Quality Control (QC) Plan required, addressing areas in Technical Exhibit 1 (Performance Requirements Summary).

• Quality Assurance (QA) will be conducted by the Government per the Quality Assurance Surveillance Plan (QASP).

• Medical liability insurance is required.

• Reporting of abnormal test results and exam findings to the Occupational Health Nurse (OHN) is required.

• Documentation (diagnostic tests, reports, findings, etc.) must be sent to the OHN within 30 days of exam/testing.

• Exam results must be provided to the OHN and the individual within 30 days of completion.

• 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, located at 2245 West Big Rock Rd, Waterloo, Iowa 50036.

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

• This is a "Non-Personal Health Care Services" contract.

• Contractor employees must possess all required licenses for performing Occupational Health Medical Surveillance Exams.

• Services must comply with applicable standards from ABOEM, AAOHN, OSHA, and NIOSH.

• Clinical laboratory services must be performed by DHHS-licensed laboratories and ASCP-certified personnel.

• Physical/dermatological exams must be performed by a physician or mid-level provider.

• Physical security and key control procedures are required.

• Telework is not permitted.

• A Contract Manager (CM) must be designated.

• Zero-tolerance policy regarding trafficking in persons must be adhered to.

• Organizational Conflicts of Interest (OCI) must be managed and reported.