NGB-ZC-AQ - W9133L

1411 JEFFERSON DAVIS HWY

ARLINGTON VA 22202-3231

703-607-1742

UNDER DPAS (15 CFR 700)

11. DELIVERY FOR FOB

RFQ

SEE SCHEDULE

14. METHOD OF SOLICITATION

IFB RFP

CODE

SEE ADDENDUM

BLOCK IS MARKED

DESTINATION UNLESS

12. DISCOUNT TERMS

0 Days - 0%

HQ0105

(No Collect Calls)

13b. RATING

13a. THIS CONTRACT IS A RATED ORDER 

CODE

SEE ITEM 9

b. TELEPHONE NUMBER 8. OFFER DUE DATE/LOCAL TIME

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION 

 PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV 3/2005)

Prescr bed by GSA

FAR (48 CFR) 53.212

(TYPE OR PRINT)

13-Aug-2009

(SIGNATURE OF CONTRACTING OFFICER) 31c. DATE SIGNED

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

SKYLINE ULTD INC.

JAMES M. GEHRING

16333 S GREAT OAKS DR STE 121

ROUND ROCK TX 78681-3661

CODE 10. THIS ACQUISITION IS

UNRESTRICTED

FAX: NAICS:

TEL:

OFFEROR CODE 18a. PAYMENT WILL BE MADE BY

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT 

BELOW IS CHECKED

1VAN5

TEL. 703-373-8228

W9133L

SIZE STD:

9. ISSUED BY

FACILITY 

CODE

17a.CONTRACTOR/

DFAS-INDIANAPOLIS-HQ0105

DFAS INDIANAPOLIS

VENDOR PAY DEPT 3800

8899 E. 56TH ST.

INDIANAPOLIS IN 46249-3800

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

15. DELIVER TO CODE SCHED1 16. ADMINISTERED BY

SEE SCHEDULE

N/A

N/A AA N/A

GS00F0001U 12-Aug-2009 W9133L-09-F-0132

7. FOR SOLICITATION 

 INFORMATION CALL:

a. NAME

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/ SERVICES

SEE SCHEDULE

TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS

SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS

SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED HEREIN. 

SB

HUBZONE SB

SET ASIDE: % FOR

PAGE 1 OF 26

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS W909UJ90911000

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

/ CONTRACTING OFFICER

TEL: 703 607-2089 EMAIL: patrick.staresina@us.army.mil

See Schedule

COPIES

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS: 

OFFER DATED . YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN 29. AWARD OF CONTRACT: REFERENCE

8(A)

SVC-DISABLED VET-OWNED SB

EMERGING SB

X

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(b) (4) (b) (6)

(b) (6)

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32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

 (CONTINUED)

SEE SCHEDULE

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/ SERVICES 21. QUANTITY 22. UNIT 24. AMOUNT

PAGE 2 OF

23. UNIT PRICE

26

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT 

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

COMPLETE PARTIAL FINAL

35. AMOUNT VERIFIED 36. PAYMENT

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV 3/2005) BACK

Prescribed by GSA

FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION 

 PREVIOUS EDITION IS NOT USABLE FOIA Requested Record #J-12-0103 

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Section SF 1449 - CONTINUATION SHEET 

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 Dollars, 

U.S.

$1.00

Base Year - Labor

FFP

Firm Fixed Price - The Contractor shall provide direct labor services in accordance 

with the performance work statement and the governing GSA Schedule

FOB: Destination

PURCHASE REQUEST NUMBER: W909UJ90911000

NET AMT

ACRN AA

CIN: W909UJ909110000001

 

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0002 Dollars, 

U.S.

$1.00

Base Year - Travel & ODCs

T&M

Time & Materials - The Contractor shall provide travel and ODCs services in 

accordance with the attached performance work statement and the governing 

GSA Schedule. This a cost-reimbursable line item.

FOB: Destination

PURCHASE REQUEST NUMBER: W909UJ90911000

TOT ESTIMATED PRICE

CEILING PRICE

ACRN AA

CIN: W909UJ909110000002

 

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(b) (4) (b) (4) (b) (4) (b) (4) (b) (4) (b) (4) (b) (4) (b) (4)

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ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

1001 Dollars, 

U.S.

$1.00

OPTION Option Year #1 - Labor

FFP

Firm Fixed Price - The Contractor shall provide direct labor services in accordance 

with the performance work statement and the governing GSA Schedule

FOB: Destination

NET AMT

 

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

1002 Dollars, 

U.S.

$1.00

OPTION Option Year #1 - Travel & ODCs

T&M

Time & Materials - The Contractor shall provide travel and ODCs services in 

accordance with the attached performance work statement and the governing 

GSA Schedule. This a cost-reimbursable line item.

FOB: Destination

TOT ESTIMATED PRICE $

CEILING PRICE

 

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(b) (4) (b) (4) (b) (4) (b) (4) (b) (4) (b) (4)

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ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

2001 Dollars, 

U.S.

$1.00 $

OPTION Option Year #2 - Labor

FFP

Firm Fixed Price - The Contractor shall provide direct labor services in accordance 

with the performance work statement and the governing GSA Schedule

FOB: Destination

NET AMT $

 

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

2002 Dollars, 

U.S.

$1.00 $

OPTION Option Year #2 - Travel & ODCs

T&M

Time & Materials - The Contractor shall provide travel and ODCs services in 

accordance with the attached performance work statement and the governing 

GSA Schedule. This a cost-reimbursable line item.

FOB: Destination

TOT ESTIMATED PRICE $

CEILING PRICE

 

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ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

3001 Dollars, 

U.S.

$1.00 $

OPTION Option Year #3 - Labor

FFP

Firm Fixed Price - The Contractor shall provide direct labor services in accordance 

with the performance work statement and the governing GSA Schedule

FOB: Destination

NET AMT $

 

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

3002 Dollars, 

U.S.

$1.00 $

OPTION Option Year #3 - Travel & ODCs

T&M

Time & Materials - The Contractor shall provide travel and ODCs services in 

accordance with the attached performance work statement and the governing 

GSA Schedule. This a cost-reimbursable line item.

FOB: Destination

TOT ESTIMATED PRICE $

CEILING PRICE

 

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ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

4001 Dollars, 

U.S.

$1.00 $

OPTION Option Year #4 - Labor

FFP

Firm Fixed Price - The Contractor shall provide direct labor services in accordance 

with the performance work statement and the governing GSA Schedule

FOB: Destination

NET AMT $

 

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

4002 Dollars, 

U.S.

$1.00 $

OPTION Option Year #4 - Travel & ODCs

T&M

Time & Materials - The Contractor shall provide travel and ODCs services in 

accordance with the attached performance work statement and the governing 

GSA Schedule. This a cost-reimbursable line item.

FOB: Destination

TOT ESTIMATED PRICE $

CEILING PRICE

 

INSPECTION AND ACCEPTANCE TERMS 

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY 

0001 Destination Government Destination Government 

0002 Destination Government Destination Government 

1001 Destination Government Destination Government 

1002 Destination Government Destination Government 

2001 Destination Government Destination Government 

2002 Destination Government Destination Government 

3001 Destination Government Destination Government 

3002 Destination Government Destination Government 

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(b) (4) (b) (4) (b) (4) (b) (4) (b) (4) (b) (4)

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4001 Destination Government Destination Government 

4002 Destination Government Destination Government 

DELIVERY INFORMATION 

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS UIC 

0001 POP 13-AUG-2009 TO

12-AUG-2010 

N/A SEE SCHEDULE

N/A

N/A AA N/A

FOB: Destination 

SCHED1 

0002 POP 13-AUG-2009 TO

12-AUG-2010 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

1001 POP 13-AUG-2010 TO

12-AUG-2011 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

1002 POP 13-AUG-2010 TO

12-AUG-2011 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

2001 POP 13-AUG-2011 TO

12-AUG-2012 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

2002 POP 13-AUG-2011 TO

12-AUG-2012 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

3001 POP 13-AUG-2012 TO

12-AUG-2013 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

3002 POP 13-AUG-2012 TO

12-AUG-2013 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

4001 POP 13-AUG-2013 TO

12-AUG-2014 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

4002 POP 13-AUG-2013 TO

12-AUG-2014 

N/A (SAME AS PREVIOUS LOCATION)

FOB: Destination 

SCHED1 

ACCOUNTING AND APPROPRIATION DATA 

AA: 

AMOUNT: $

CIN W909UJ909110000001: $

CIN W909UJ909110000002: $

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CLAUSES INCORPORATED BY FULL TEXT 

52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) 

The Government may require continued performance of any services within the limits and at the rates specified in the 

contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary 

of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder 

shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor 

within 30 Days (insert the period of time within which the Contracting Officer may exercise the option). 

(End of clause) 

52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) 

(a) The Government may extend the term of this contract by written notice to the Contractor within 30 Days ; 

provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 

Days days before the contract expires. The preliminary notice does not commit the Government to an extension. 

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause. 

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 5 

years. 

(End of clause) 

PERFORMANCE WORK STATEMENT

Performance Work Statement (PWS) 

Medical Case Management Support 

National Guard Bureau 

1. PURPOSE. The purpose of this contract is to provide Medical and Dental Non-clinical Case Management and 

Administrative Assistant staffing in support of Individual Medical Readiness (IMR) to the 54 States and Territories. 

This contract is designed to be flexible, responsive, and meets the ever-evolving needs of the NGB and the 54 states 

and territories. This is a firm fixed-priced contract with time and materials CLINs for Travel and ODCs. 

2. SCOPE 

a. The Army National Guard (ARNG) Surgeon’s Office requires a highly responsive process whereby the National 

Guard Bureau, individual states and territories can quickly obtain needed support and services. This PWS reflects 

existing National Guard Bureau policies and regulations. 

b. The Contractor shall furnish all labor and services required to provide a wide range of Medical and Dental Nonclinical Case Management and Administrative support services, including Periodic Health Assessment (PHA) 

support, Soldier Readiness Processing (SRP) support, Soldier Readiness Certification (SRC) support, Non-clinical 

Case management of certain Soldier’s found to be in need of advanced medical screening as determined by the State 

Review Decision Panel. (Staff will not serve on the State Review Decision Panel, or in any way be a part of the 

determination process). Line of Duty (LOD) non-clinical case management, to include Return to Duty (RTD) status, 

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or referral to a medical evaluation board (MEB). Non-Clinical Case management related to the Line of Duty (LOD) 

will be secondary to any SRP and IMR focus. 

c. The Contractor shall prepare and submit a Performance Metrics and Management Plan (PMMP) as part of the 

proposal. The PMMP shall include measurable milestones that demonstrate progress towards objective attainment. 

Proposed milestones must address both administrative requirements such as completion of plans and reports, and 

milestones that are tied to progress towards meeting the objective. The PMMP shall document how the proposed 

milestones will be measured and the performance metrics determining the milestone’s success or failure. 

d. The Contractor shall establish a Quality Control Plan (QCP) within 30 days of award to facilitate successful 

performance of the project. The QCP shall include a detailed discussion of the steps proposed to ensure quality, 

adherence to schedule, proactive communication, and adherence to budget. The QCP shall include a description of 

corrective action steps to take should the Contractor performance be substandard. An organizational depiction of the 

project team and chain(s)-of-command shall also be included in the QCP. The QCP shall be submitted for review 

and acceptance no later than 30 days after contract award. 

e. The Contractor shall provide a draft Quality Assurance Surveillance Plan (QASP) for Government’s consideration 

in development of the government’s plan. The Government will develop the performance requirement summary after 

the development of the QASP. The plan shall specify the work requiring surveillance and the method of 

surveillance. The Contract will provide place(s) of performance where the government reserves the right to perform 

the quality assurance. The government inspection will be performed by or under supervision of government 

employees. 

3. PLACE of PERFORMANCE. The Contractor shall provide these services in multiple locations throughout 

the United States. See Appendix A and Appendix B for recommended staffing levels and locations for work to be 

performed. The Contractor may be required to deploy and execute any missions to support and augment the ARNG 

consistent with all services described within the PWS as shown below. Specifically, in the event of a mobilization, 

the Contractor shall ensure that adequate non-clinical case management support is deployed to locations to best 

support these activities (i.e. work at armories.) Additionally, the staffing levels and locations may change to remain 

responsiveness to the ARNG’s evolving case-management requirements. 

4. BACKGROUND 

ARNG Surgeon’s Office requires both Registered Nurse (RN) or Social Worker Non-clinical Case Managers, and 

Administrative support services. 

5. PROGRAM OBJECTIVES 

a. Non-clinical Case Management Support - Contractor shall provide Registered Nurses (RN) who have graduated 

from an accredited school or licensed Social Workers as Non-clinical Case Managers to provide pre-mobilization 

IMR support to include identification and tracking of Soldiers who are not Fully Medically Ready (FMR) either for 

dental or medical concerns. Cases will be obtained from home station (HS) or mobilization station (MOBSTA) SRP 

events or those Soldiers determined non-medically or non-dentally ready through other means (e.g. during their 

annual PHA.) Case Managers shall assist Soldiers to become FMR by assisting with and tracking medical and dental 

appointments, maintaining communication as required with the Soldiers they are managing. All cases managed, 

regardless of type (medical or dental) or duration, must be documented in the Medical Non-Deployable (MND) 

Module of the Medical Operational Data System (MODS). Case Managers shall have a monthly team meeting with 

the Deputy State Surgeon (DSS), the State Surgeon (SS) and the State Dental Officer (SDO) to review all cases in 

progress. The Case Manager shall be responsible to know the following ARNG web-based electronic data systems 

via MODS: MND, Dental Classification Module (DENCLASS), Health Readiness Record (HRR), Medical Data 

Protection System (MEDPROS), Soldier Patient Locator (SPL), and the Warrior Transition Report (WTR). The 

Case Managers shall be familiar with the regulations and policies that apply to Individual Medical Readiness (IMR) 

and deployment. The Contractor Case Managers (CMs) shall perform the following tasks for the ARNG in the 

execution of Non-clinical Case Management Support: 

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1. Maintains appropriate licensure and credentials (current Registered Nurse (RN) License/Basic Life Support 

(BLS), or the Clinical Social Work Certification. 

2. Coordinates with Soldier to assess and arrange for the treatment of Soldiers with conditions that have or 

will result in them being Medically/Dentally non-deployable. Such services include outreach, assisting 

with appointment scheduling, and going to SRPs, (both for mobilization/deployment and routine readiness). 

3. Manages Soldier’s in the Medical Screening program in conjunction with the DSS and Admin Assistant. 

Assists with appointments and ensures documentation is retrieved from appointments and placed in 

appropriate electronic record, as well as the Soldier’s hard copy medical record. 

4. Manages a Soldier’s care from the receipt of the condition to when the Soldier is deployable or the 

documentation is sent to the Health Services Specialist (HSS) for a Fitness for Duty evaluation where 

appropriate or to a MEB or Personnel Board. 

5. Performs initial interviews with Soldiers regarding the deployment limiting condition within 48 hours of 

notification of a Soldier with a deployment limiting condition. Ensures the Soldier understands his/her 

responsibilities, obtain a release of information form. Provide information to Soldiers about their privacy 

rights and how their information can be used (have Soldiers sign consents). The Contractor shall also be 

responsible for protecting the confidential nature of Soldiers’ files and medical issues. 

6. During follow-up interviews the Case Manager shall coordinate treatment plans and all referrals when the 

care is being resourced by the government (Dental Treatment using Reserve Health Readiness Program 

(RHRP) or local contracts with 2020/VFRE funds).

7. Maintains Soldier medical records in accordance with Army Regulation (AR) 40-66.

8. Supervises the Contractor Admin Assistant.

9. Coordinates care received by TRICARE and by the Military Medical Support Office (MMSO) to obtain 

prior authorization for treatment during the Early TRICARE period, up to 90 days prior to Mobilization 

(They (CMs) do not establish eligibility, this is a personnel function).

10. Provides the State Medical Detachment Patient Administration (PAD) Officer or delegate with all relevant 

medical/dental documentation. 

11. Operates a personal computer to input, store, retrieve and manipulate data for various reports as required 

by this SOW. Uses various software programs to maintain database files and prepare reports. Must be 

proficient in Microsoft Word, Excel, PowerPoint and Outlook, and is familiar with and become proficient 

with the use of the following MODS modules: MND, HRR, DENCLASS, MEDPROS, SPL and WTR. 

Maintains a state-level management reporting system.

12. Documents results of a Bi-weekly case review in the referrals tab of the MND Module .These reviews will 

be used in the monthly meeting with the DSS, State Surgeon, and the State Dental Officer (SDO).

13. CM shall inform state ARNG provider(s) responsible to evaluate follow up of the Soldiers’ status and 

furnish them with the mandatory information/documentation. 

14. Coordinates Soldiers’ health care including consults for those initially using Military Treatment Facilities 

(MTF), VA, TRICARE network provider, and non-network providers. 

15. Establishes a list of available local resources within their state to ensure Soldier’s have alternative options 

available to receive medical or dental care if not eligible for military health benefits.

16. Educates Soldiers on resources available to improve medical and dental readiness (TRICARE Dental 

Program (TDP), local community resources, ARNG sponsored programs, e.g., Decade of Health, 

Hooah4Health.com, State Medical and Dental programs, etc.). 

17. The Case Manager shall NOT assist in preparing Line of Duty (LOD) paperwork or perform other 

personnel procedures. Additionally, the Contractor shall notify the COR of any events in which 

Government personnel direct CMs to perform administrative work not included in this Case 

Management Support section. 

18. The Contractor shall provide the aforementioned Case Manager personnel to all states within the ARNG as 

required. Case Managers shall support the Deputy State Surgeon. See Attachment #1 – Manning 

Requirements, for individual state requirements. In the event of a state lacking a Deputy State Surgeon the 

Case Manager will report through medical channels as directed by the State Surgeon. 

19. The Case Manager will provide a monthly MND Case Report to their employer who will then forward the 

reports by state up to the NGB Program Manager. The report will include: State and number of new 

referrals initiated, active cases and number of closed cases. 

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b. Administrative Assistants – The Contractor shall provide qualified candidates to provide Administrative 

Assistance support to the Case Managers. The Admin Assistants must be competent with Microsoft Word and Excel 

and the internet and able to learn new computer programs. Admin Assistants shall provide the Case Managers with 

administrative support, which shall include but not be limited to the following: Telephoning Soldiers and 

Physician/Dental offices to obtain information as directed by the Case Manager; obtaining Soldiers’ signatures on the 

release of information form; Filing and/or scanning Medical/Dental documents; preparing the weekly SITREP and 

DENTAL Treatment Reports; Maintenance of Soldiers Medical and Dental records; Scrubbing MEDPROS data 

before SRPs to assist for early identification of non-deployable Soldiers; Automated Voucher System (AVS) 

Voucher entry; Tracking of Medical and Dental Class 3 Soldiers needing treatment in the AVS system and reporting 

to the Case Manager to assist in the management of their care. Admin Assistants will be required to be 

knowledgeable and become proficient in the following ARNG web-based electronic data systems: MEDPROS, 

DENCLASS, MND, AVS, HRR, SPL, and the WTR. The Admin Assistant shall be familiar with the regulations and 

policies that apply to Individual Medical Readiness (IMR) and deployment. The Administrative Assistant shall assist 

the Case Manager and the Deputy State Surgeon by providing support services to include but not limited to; 

telephone support, maintaining the weekly Dental Treatment Report and the Weekly SITREP. Admin Assistant shall 

work with the Case Manager in calling and maintaining Soldiers’ medical and dental records. The Administrative 

Assistant must exceptional organizational skills, must be able to type 40 WPM, PC proficiency, specifically Word 

and Excel. They must have two or more years of office experience,. 

The Administrative Assistants shall perform the following tasks for the ARNG in the execution of Non-clinical Case 

Management Support: 

1. Provide medical and dental administrative support and submit actions as required. 

2. Maintain Soldier medical and dental records IAW AR 40-66.

3. Perform data base systems as required to include but not limited to MODS and the medical functions in 

Mobilization Planner Data Viewer (MPDV). 

4. Review correspondence for format accuracy and content in accordance with AR 25-50 and Department of 

the Army Memo 25-52.

5. Prepare and submit Weekly Dental Treatment Reports (DTR) once approved by the DSS. (Deliverable #1) 

6. Prepare and submit, once approve by the DSS the weekly Situational Report (SITREP) report for assigned 

office. (Deliverable #2) 

7. Assist in resolving scheduling conflicts for Soldiers needing Medical or Dental care as assigned by the Case 

Manager. 

8. Handle all contacts and work closely with other offices on related medical issues. 

9. Prepare reports and answer ad hoc queries using data from the ARNG Patient Tracking Report on GKO and 

Soldier Patient Locator (SPL) modules in MODS. 

10. Perform administrative support to medical portions of the State Soldier Readiness Processing (SRP) 

Program. 

11. The Contractor shall provide the aforementioned administrative support personnel to all states and 

territories in the Army National Guard as required. Administrative support personnel shall directly support 

the Deputy State Surgeon. See Attachment #1 – Manning Requirements, for individual state requirements. 

12. The Admin Assistant shall NOT assist in preparing Line of Duty (LOD) paperwork or perform other 

personnel procedures. Additionally, the Contractor shall notify the COR of any events in which 

Government personnel direct AAs to perform administrative work not included in this Admin 

Assistant Support section. 

6. SKILLS. Personnel assigned to this contract shall possess the required technical skills and expertise to perform the 

functions with minimum guidance. The personnel will be experienced in all aspects and qualified in their respective 

functional areas. Contactor personnel must be capable of working, but shall not perform inherently governmental functions 

(i.e., representation of government, decision authority, etc.) Personnel shall have a working knowledge of Military dynamics 

and organizational management. Contractor personnel shall be proficient in Microsoft Word, Excel, PowerPoint, and 

Outlook, and have a working knowledge of desktop computer operations. 

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7. CONTRACT TYPE. This contract is a Performance Based Statement of Work (PBSOW) award. In the performance of 

this contract, the contractor shall meet all deliverables listed in Appendix C. 

8. MANDITORY TRAINING. There will a mandatory training conference for which attendance will be required. All 

contracted staff will attend this conference. Contractor staff will also be required to attend a 3 day training course on the 

MODS modules if not already trained on these modules. The location for this training is usually in Arkansas at the ARNG 

Professional Education Center (PEC). 

9. TRAVEL. Travel may be required for all Contractor personnel performing on this contract. There will be a mandatory 

yearly national training requirement for the staff, which will require travel. Other travel (to SRPs) may also be required. As 

such, the Government will designate an overall travel Contract Line Item (CLIN) for the base and each of the option years. 

States may require additional travel to Medical Conferences within the state if the state pays for it. The Contractor personnel 

shall be required to comply with travel policies as outlined in the DoD Financial Management Regulation and the Joint Travel 

Regulation (JTR). All requests for travel shall be submitted via e-mail to the COR and no travel shall commence until receipt 

of e-mail approval from the COR. All employees should be aware of this requirement and be prepared for it if required by 

their state. 

10. TELECOMMUTING. 

a. In certain instances, telecommuting may be required for Contractor employees. In this case, each Deputy State 

Surgeon/State Surgeon will determine the need for telecommuting. The state will determine the appropriate equipment and 

services required to accomplish the mission and provide those to the involved contracted Case Manager employees at no cost. 

Equipment will include items such as cell phones and/or computer terminals that will be loaded with all software required to 

accomplish the mission. The Government and the Contractor are not responsible for any operating costs that are associated 

with the employee using his or her personal residence as an alternative worksite, including home maintenance, office 

furniture, insurance, internet and phone service providers or other utilities. 

b. The Contractor will ensure that employees who telecommute understand that they must be available to work at the 

traditional designated government or SRP worksite on an occasional basis if necessitated by work requirements as well as 

government or company directive. Each State’s Deputy State Surgeon/State Surgeon will determine the need for 

telecommuting. The state will determine the appropriate equipment and services required to accomplish the mission and 

provide those to the involved contracted Case Manager employees at no cost. Equipment will include items such as cell 

phones and/or computer terminals that will be loaded with all software required to accomplish the mission. The Government 

and the Contractor are not responsible for any operating costs that are associated with the employee using his or her personal 

residence as an alternative worksite, including home maintenance, insurance, internet and phone service or other utilities 

c. No classified documents (hard copy or electronic) may be taken to an employee’s telecommute worksite. For a regular and 

recurring telecommute, sensitive unclassified material, including Soldiers’ Protected Health Information (PHI), Privacy Act 

and For Official Use Only (FOUO) data, will only be processed on Government-furnished equipment. Soldiers’ PHI is not to 

be stored on automation equipment located at the telecommute site. The employee will be responsible for the security of all 

official data, protection of any Government-furnished equipment and property, and accomplishing the Government designated 

mission at the telecommute worksite. It is important to emphasize that Government-furnished equipment must only be used 

for official duties and therefore family members and friends of telecommuters are not authorized to use any Government 

furnished equipment 

d. In cases where an employee may be approved to use their personal computers and equipment for telecommute on nonsensitive unclassified data; remote access software must not be loaded into employee’s personal computers for other than 

official government purposes. The employee is responsible for the installation, repair and maintenance of all personal 

equipment and to provide high-speed internet access, voice telephone, and fax capabilities. 

e. Each State will be responsible for the maintenance of all Government-furnished equipment. The employee may be required 

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furnished equipment and materials to the Government at the conclusion of any telecommuting arrangements or at the 

Government’s request. 

f. The Contractor will ensure and document that the requirements of the Health Insurance Portability and Accountability Act 

(HIPAA) and the Privacy Act have been briefed to the contract employees; and that they understand how to protect all 

personal and PHI data that they process, and that they must ensure that information is not available to unauthorized persons as 

required by the Privacy Act and HIPAA. The contractor shall submit a report to the Government verifying compliance with 

the annual HIPAA requirements. 

g. If telecommuting is allowed it will only be allowed for the Case Manager staff. The Case Manager must live within a 

reasonable commuting distance from their primary worksite. No Admin Assistants will be allowed to telecommute. 

h. Travel to and from the primary worksite will not be reimbursed. Reimbursement of travel expenses while telecommuting 

will be for travel to SRPs only. 

11. STAFFING LEVELS. The intent of this contract is to provide case management services for the Army National Guard 

in support of surge and contingency requirements as well as its steady-state mission. As such, the Government may consider 

increasing the case management requirements, to include increases in staffing numbers, (as mission dictates) to be within the 

scope of this contract. Any changes to the initial staffing will be completed through a bilateral supplemental agreement. 

However, the Contractor is only expected to provide for initial staffing levels listed in Appendix A. 

12. SECURITY REQUIREMENTS. Each Contractor personnel will possess an 85P National Agency 

Check(NAC); this will be initiated by the contractor prior to starting work, and sent to appropriate state security 

office for processing. Staff who already proccess a higher level of clearance do not require a NAC. This will need to 

be verified by the vendor prior to the employee starting work and the proof of clearance sent to the state security 

office. 

13. RELEASE OF DATA. The Contractor is prohibited from releasing any medical, personnel, financial or 

supporting data provided by the Army National Guard to any government, non-government agency, or individual 

unless specifically authorized, in writing, by the Contracting Officer (COR). This includes any proprietary 

contractor information. 

14. ADMINISTRATION. All contracting actions and/or correspondence should be forwarded through the COR 

designated by letter of appointment. 

ONLY THE CONTRACTING OFFICER HAS THE AUTHORITY TO REPRESENT THE GOVERNMENT IN CASES 

WHERE THE CONTRACT REQUIRES A CHANGE IN TERMS AND CONDITIONS, DELIVERY SCHEDULE, 

SCOPE OF WORK, AND/OR PRICE OF THE PRODUCTS AND/OR SERVICES AQUIRED. THE CONTRACTOR 

SHALL IMMEDIATELY NOTIFY THE CONTRACTING OFFICER IF ANYONE ATTEMPTS TO CHANGE THE 

TERMS OF THE CONTRACT. 

15. INVOICING AND PAYMENT. The contactor must submit invoices monthly for work completed each month. 

Invoices will show CLINS separately, to include. Any travel by name, date, location, and final cost of the trip. The 

designated billing office for this contract is located in Block 18 of this contract. The Contractor shall submit 

invoices in accordance with” Using the Wide Area Workflow. Additionally, the Contractor shall submit copies of 

each invoice electronically to the COR. 

16. OTHER ADMINISTRATIVE CONSIDERATIONS 

a. Normal Hours of Operation - Unless otherwise specified in individual task orders the contractor shall perform 

the activities and services required under this contract during normal working hours established by the requiring 

organization. Any deviation from that norm must be requested by the contractor and approved in advance by the 

contracting officer. 

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b. Travel – Travel shall be in accordance with the Joint Travel Regulation and will be prescribed in each individual 

task order. Travel will be restricted to the following: Solider Readiness Processing (SRP). Travel to Post 

Deployment Health Reassessments (PDHRA) is not authorized 

c. Privacy and Security. Work on this project requires that personnel have access to Privacy Information. All 

Contractor personnel shall adhere to the Privacy Act, Title 5 of the U.S. Code, Section 552a and applicable agency 

rules and regulations. Each staff member must have a 85P National Agency Check (NAC) (or interim clearance) 

intitiated prior to their first day of work. The Offer will provide the COR with each new hires Last Name, First 

Name, Middle name , SSN , Date of Birth and Army Knowledge Online (AKO) e-mail address as soon as it is 

available in order to facilitate the staffs entry into the Contractor Verification System CVS. This information must be 

sent to the COR as soon as the contractor is hired. The COR at NGB is the only authorized person to enter the staff 

into this system. 

d. General. All documents and deliverables described in this SOW and amendments or modifications shall be 

submitted in a professional manner and on the appropriate cover or action sheet in accordance with the DA Memo 

25-52, or as otherwise specified by the Government. 

e. Holidays - Unless otherwise specified in individual task orders, the contractor shall observe the 10 annual Federal 

holidays specified by the Department of Defense. During any of these holidays not observed by the contractor and in 

other cases where individual state, local governmental, or Unit-mandated holidays (e.g., unscheduled “training 

holidays”) precludes work by the contractor at the usual and customary work site, where appropriate, contractor 

personnel may perform at an alternate location, upon approval of the Deputy State Surgeon (DSS). Contractors shall 

not have access to government sites and facilities without proper coordination of responsible government personnel. 

f. Work Hours. No Contracted staff should work more than 40 hours per pay period without prior approval from 

the COR. Comp time is authorized to minimize overtime for contracted staff required to work SRPs. If Due to 

mobilization/demobilization activities of the ARNG units, the government may require more than 40 hours per week 

outside the scope of the standard duty hours. In such cases where workflow surges occur, the Government shall 

coordinate with the Contractor Project Manager to provide adequate support. The contractor shall support all 

workflow surges as directed by the Government. All requests for overtime shall be submitted via e-mail to the COR 

and no overtime shall be performed unless pre-approved by the COR. 

g. Security Requirements – All Contractor employees shall be required to complete an 85P National Agency Check 

prior to their first day of work, which will be processed at the state level. 

ACCESS TO SENSITIVE INFO - ATTACHMENT A - SPECIAL INSTRUCTIONS REQUIRED FOR ACCESS 

TO SENSITIVE INFORMATION 

All personnel assigned to positions on this contract are required to have at least a current NACI, NAC, NACLC, or 

favorable review of a trustworthiness/suitability investigation (SF 85P). Note: A current NACI, NAC, or NACLC is 

an investigation that is not older than 10 years. 

Persons who do not have a current NACI, NAC or NACLC must submit a trustworthiness/suitability investigation 

(SF 85P) to his/her ARNG State Personnel Security Manager for submission to OPM for investigation. Contractor 

Security Officers are only responsible for submitted investigations for security clearances on their personnel. 

ARNG State Security Managers are responsible for submitting SF 85Ps to OPM using OPAC-ALC code. 

OPM will adjudicate investigations for a trustworthiness determination using the national adjudicative guidelines for 

access to classified information. If the adjudication is favorable, OPM will issue a letter of trustworthiness to the 

requesting activity (ARNG State Security Manager). 

If a favorable trustworthiness is indeterminate, OPM will forward the case to the Defense Office of Hearings and 

Appeals (DOHA) for further processing under DODD 5220.6. A final unfavorable decision precludes assignment to 

a position on this contractor. 

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h. Progress Reports. Progress reports must be submitted to the COR no later than the 10th day of every month. 

Reports shall be discussed during the monthly task management review meeting. Status reports must be submitted 

on the prime contractor’s letterhead and be accompanied by a copy of that month’s invoice, with written approval of 

the invoice by the client representative. Failure to provide reports correctly will cause resubmission by your 

company. The monthly Progress Report will include, but not be limited to: 

Status 

Activities Accomplished in Month/Year 

Deliverables 

Support Events (including travel) 

Projected Activities for Month/Year 

Areas of Concern and Risk Management 

Travel 

Hires/terminations 

17. DELIVERABLES. See Appendix C.

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APPENDIX A

State 

Base 

Mission 

for Case 

Manager

Base 

Mission 

for 

Admin 

Support 

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of 

Columbia

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

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North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

U.S. Virgin 

Islands

Utah

Vermont

Virginia

Washington State

West Virginia

Wisconsin

Wyoming

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APPENDIX B

State/Province Address City

Postal 

Code

ALABAMA

1. 5300 57th Street N., 

2.1730 Congressman WL Dickinson Drive 

1. BIRMINGHAM

2. MONTGOMERY

1. 35217

2. 36109

ALASKA PO Box 5800, Bldg 4900, FT. RICHARDSON

99505-

0800

ARIZONA 5636 E. McDowell Road PHOENIX

85008-

3423

ARKANSAS Bldg 6401, Box 011, Camp Robinson N. LITTLE ROCK

72199-

9600

CALIFORNIA

9800 Goethe Road, Box 33

SACROMENTO 95827

COLORADO

19070 Sunlight Way, Bldg 1000, MS #7, Buckley 

Air Force Base AURORA

80011-

9551

CONNECTICUT

Medical Detachment, HARTFORD 

ARMORY,360 Broad ST HARTFORD

06105-

3779

DELAWARE JFHQ DEARNG, 1st Regiment Road WILMINGTON

19808-

2191

DISTRICT OF 

COLUMBIA

DC Army National Guard

2001 East Capitol Street, SE WASHINGTON

20373-

5814

FLORIDA

State Surgeon-DSS, FL ARNG, Robert F. Ensslin, 

JR. Armory, 2306 SR 207 ST. AUGUSTINE 32086

GEORGIA

HQ's Georgia Army National Guard, Oglethorpe 

Armory, 5019 Highway 42 S. ELLENWOOD 30294

GUAM

MEDICAL DETACHMENT, GUAM ARMY 

NATIONAL GUARD, 622 EAST HARMON 

INDUSTRIAL PARK ROAD

FORT JUAN MUNA, 

TAMUNING

96911-

4421

HAWAII

91-1227 Enterprise Ave

KAPOLEI 96707

IDAHO IDMD-SS, 4228 W Guard St BOISE

83705-

8049

ILLINOIS 1301 N. MacArthur Blvd., Springfield SPRINGFIELD

62702-

2399

INDIANA

Military DEPARTMENT OF INDIANA, ATTN: 

MDI-DSCPER-MD, 9301 E. 59th Street, Suite 

112, INDIANAPOLIS

46241-

4839

IOWA

IOWA AMEDD, 7105 NW 70th Avenue., 

Johnston, JOHNSTON

50131-

1824 

KANSAS JF HQ KS-LC- OTSS, 2800 SW Topeka Blvd TOPEKA

66611-

1298

KENTUCKY KG-J1-DSS, BNGC, 100 Minuteman Pkwy FRANKFORT

40601-

6192

LOUISIANA Bldg 805, F Street Camp Beauregard PINEVILLE

71360

MAINE CAMP KEYES BLDG 39 AUGUSTA

04333-

0032

MARYLAND

5555 Rue Saint Lo DriveBuilding 205 Camp 

Fretterd Military Reservation REISTERTOWN 21136

MASSACHUSE

TTS

Massachusetts Medical Command, 55 Grenier 

Street, Building 1503 Hanscom AFB Hanson AFB 7131

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MICHIGAN State Medical Command, 4400 E. 8 Mile Rd. DETROIT 48234

MINNESOTA MN J1 Medical Readiness Team, 600 Cedar Street St. PAUL 55101

MISSISSIPPI

MS Military Dept

Occupational Health

1410 Riverside Dr. JACKSON 39202

MISSOURI

Missouri National Guard

JFMO-DPP-H

2302 Militia Drive JEFFERSON CITY

65101-

1200

MONTANA 1900 William St. HELENA 59602

NEBRASKA

2400 NW 24th Street, 

LINCOLN 68524

NEVADA 2460 Fairview Drive CARSON CITY

89701-

6807

NEW 

HAMPSHIRE

NEW HAMPSHIRE ARMY NATIONAL 

GUARD, Medical Command, VAMC, 718 

Soldieryth Road, Building 5, MANCHESTER

03104-

4048

NEW JERSEY

NJARNG Medical Detachment, PO Box 277, 

Building 64 Academy Way, 3650 Saylors Pond 

Road

FT. DIX

NEW MEXICO

Office of the State Surgeon ARNG 600 Wyoming 

Blvd NE ALBURQUERQUE 87123

NEW YORK Watervliet Arsenal, MNAG-SURG, Building 40-4 WATERVIELT

12189-

4050

NORTH 

CAROLINA Medical Detachment, 2050 National Guard Drive MORRISVILLE

27607-

6412

NORTH 

DAKOTA RJB Armory, 4200 E Divide Ave BISMARK

58506-

5511

OHIO

Ohio Army National Guard ATTN: AGOH-SUR, 

2825 West Dublin Granville Road COLUMBUS

43235-

2788

OKLAHOMA

Oklahoma Military Department, , ATTN: 

DCSPER-DSS, , 3501 Military Circle OKLAHOMA CITY

73111-

4398

OREGON

Commander, Oregon Medical Command, 3225 

State St NE, PO Box 14350 SALEM

97309-

5047

PENNSYLVANI

A Bldg 4-115, FTIG ANNVILLE

17003-

5003 

PUERTO RICO

1.Arrillaga Street Bldg # 586

2. General Esteves Parada 3 1/2

1. Salinas 

2. SAN JUAN

1. 00751

2. 00909

RHODE 

ISLAND

RIARNG

Warwick Armory

541 Airport Road WARWICK 02886

SOUTH 

CAROLINA

1325 South Carolina Road

Bldg 984, Suite 29

Eastover 29044

SOUTH 

DAKOTA 2823 W Main St RAPID CITY

57702-

8186

TENNESSEE

8th Ave, Bldg 250

Volunteer Training Site

SMYRNA

37167

TEXAS 2210 West 35th Street, Bldg 10 AUSTIN

78703-

2210 

UTAH 12953 S. Minuteman Drive DRAPER 84020

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VERMONT

Medical Detachment

789 National Guard Rd COLCHESTER

05446-

3099 

VIRGIN 

ISLANDS

4031 La Grande Princess, Lot 1B

Christiansted, VI 23824-9000 CHRISTINASTED

00820-

4353

VIRGINIA

Virginia Army National, BLDG 306, FT. 

PICKETT BLACKSTONE 23824

WASHINGTON Det 3 STARC WA Bldg 34, Camp Murray TACOMA

98430-

5184

WEST 

VIRGINIA

WVARNG Medical Command, 1740 Coonskin 

Drive CHARLESTON

25311-

1085

WISCONSIN 2400 Wright Street MADISON 53704

WYOMING 5500 Bishop Blvd CHEYENNE

82009-

3320

APPENDIX C - Deliverables: 

Performance Metrics and Management Plan (Deliverable #1) 

Quality Control Plan (Deliverable #2) 

Quality Assurance Surveillance Plan (Deliverable #3) 

Dental Treatment Report (Deliverable #4) 

Situation Report SITREP (Deliverable #5) 

Monthly MND use report (Deliverable #6) 

Monthly Progress report (Deliverable #7) 

HIPAA Training Report (Deliverable #8) 

Travel Request Report (Deliverable #9) 

Monitor and track Soldier/Case manager ratio: Max 150/CM (Deliverable #10) 

NAC (85P) report (Deliverable #11) 

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PRS

Performance Requirements Summary 

At minimum contractors must address the following metrics and describe how they will achieve and maintain the 

government minimum acceptable quality levels. The attached Inspection Questionnaire will be used to 

periodically assess that contract requirements are being met: 

Require-ment Indicators Standards-Criteria 

for Acceptance

Minimum Acceptable 

Quality Level

Method

of 

Surveillan

ce

Corrective 

Actions*

Incentives 

(negative or 

positive)

Track Dental 

Appointments

Completeness 90% of cases from 

Mobilization roster 

(Dental class 3) will be 

logged into the Medical 

Non-Deployable 

Module (MND)

Periodic 

inspection

s

If staff is not 

imputing into 

MND, corrective 

action will be 

taken to input 

records. 

Past Performance 

Evaluation/

Reporting

Dental 

Treatment 

Report 

Timeliness Report will be turned 

in Weekly (Friday) 

90% compliance with

turn in during 1st week 

of alert. 100% every 

week thereafter.

Random 

Sampling

Corrective 

actions taken to 

achieve 100% of 

the minimum 

acceptable 

standard 100% of 

the time

Past Performance 

Evaluation/

Reporting

SITREP 

(Situation 

Report)

Quality Report turned in 

weekly and written 

according to Army 

standards.

90% of states turning in 

report, and following 

SOW.

Reading 

SITREPS

Staff will turn in 

SITREPS

Past Performance 

Evaluation/

Reporting

Travel 

Requests 

1. Timeliness

2. Quality

1. Deliverables are 

submitted as 

prescribed in the 

PWS

2. Information/

data submitted is 

valid and verifiable

3. Travel is relevant 

to PWS

1. 95% of time 

deliverables are 

submitted on time

2. 99% 

information/data 

reported is valid and 

verifiable

3. Travel is relevant 

1. 

Inspection 

2. 

Random 

sampling

1. Corrective 

actions to ensure 

that deliverables 

are submitted on 

time for future 

due dates

2. Corrective 

actions taken 

within two 

workings days 

after errors found 

Past Performance 

Evaluation/

Reporting

Quality 

Control Plan

1. Quality 1. Ensures contractor 

will be responsible 

and maintain a high 

degree of expertise, 

and maintain staff 

who are qualified to 

perform the jobs for 

which they are hired.

1. QCP will be in place 

within 60 days post 

award.

1. 

Inspection

1. Corrective 

action will be 

taken if plan if 

found to be 

lacking in any 

areas.

Past Performance 

Evaluation/

Reporting

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Medical 

Records 

Administration

1.Completeness

2. Quality 

1. The vendor will 

perform quarterly or 

more frequent spot 

checks of sites to 

ensure accuracy of 

work, in conjuction 

with the state PAD 

personnel.

1. Admin Assitant will 

maintain a 95% 

accuracy of charts.

Inspection 1. Correction 

action will be 

taken to retrain 

or rehire 

positions as 

needed. 

Past Performance 

Evaluation/

Reporting

NAC (85P)

Sent to state 

secutity office 

prior to 

contractor’s 

first day

1.Completeness

2. Deliverable 

requirement

1. The vendor will 

ensure the contracted 

staff fill out forms 

and forms are sent to 

state security offices

2. Report will be 

turned in monthly

1. 100% compliance 

with this is critical

Inspection 1. Corrective 

action will be 

taken to ensure 

reason for noncompliance is 

corrected. 

Past Performance 

Evaluation/

Reporting

Non-clinical 

Case 

Management 

Plan

1. Completeness

2. Quality

1. The vender will 

include in proposal a 

Non-clinical 

Management plan, to 

demonstrate know of 

requirements.

Non-clinical case 

management plan will 

be included in proposal 

Inspection 1. Corrective 

action will be 

taken if plan if 

found to be 

lacking in any 

areas.

Past Performance

Evaluation/

Reporting

 

Corrective actions may include recommendations involving changes in personnel, processes, 

SOPs, or training as appropriate to prevent re-occurrence of the error(s). 

ADMINISTRATION/PAYMENT

1. GOVERNMENT CONTRACTING PERSONNEL: 

a. The Contracting point(s) of contact for this contract will be the following: 

Contract Specialist: Address: 

Ms @ng.army mil National Guard Bureau (NGB-ZC-AQ) 

Office: 703-607-1266 1411 Jefferson Davis Highway, Suite 8100 

 Arlington, VA 22202-3232 

 Fax 703-606-1742 

b. All contracting actions and/or correspondence should be forwarded through the COR designated by 

letter of appointment. 

2. CONTRACTING OFFICER’S REPRESENTATIVE (COR): 

a. The COR will act as the Contracting Officer’s representative for technical matters, providing technical 

direction and discussion as necessary with respect to the specification or statement of work, and 

monitoring the progress and quality of the contractor’s performance. The COR is NOT an 

Administrative Contracting Officer (ACO) and does not have authority to take any action, either 

directly or indirectly, that would change the pricing, quantity, quality, place of performance, delivery 

schedule, or any other term and condition of the contract, or to direct the accomplishment of effort that 

goes beyond the scope the statement of work in the contract. 

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b. When, in the opinion of the contractor, the COR requests efforts outside the existing scope of the 

contract, the contractor shall promptly notify the contracting officer in writing. The contractor under 

such direction shall take no action until the contracting officer has resolved the issue or has otherwise 

issued a modification to the contract. 

3. LABOR WAGE DETERMINATIONS 

Compliance with all applicable Department of Labor wage determinations is required. The website on Service 

Contract Act wage determinations may be found at http://www.wdol.gov/sca.aspx. 

4. ACCOUNTING FOR CONTRACT SERVICES: 

The Secretary of the Army has implemented Accounting for Contract Services. This initiative has been put in place 

to obtain better visibility of the contractor service workforce. The Assistant Secretary of the Army (Manpower and 

Reserve Affairs) and the Assistant Secretary of the Army (Acquisition, Logistics and Technology) have implemented 

guidance to comply with this DoD Business Initiative Council (BIC) sponsored initiative. These contract reporting 

requirements are mandatory. By acceptance of this contract and performance under this contract, the contractor 

agrees to comply with these reporting requirements. 

The Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure 

Army data collection site [Contractor Manpower Reporting (CMR) System] where the contractor will report ALL 

contractor manpower (including sub-contractor manpower) required for performance of this contract. The contractor 

is required to completely fill in all the information in the format using the following web address: 

 https://contractormanpower.army.pentagon.mil 

The required information includes: (1) Contracting Office, Contracting Officer, Contracting Officer's Technical 

Representative; (2) Contract number, including task and delivery order number; (3) Beginning and ending dates 

covered by reporting period; (4) Contractor name, address, phone number, e-mail address, identity of contractor 

employee entering data; (5) Estimated direct labor hours (including sub-contractors); (6) Estimated direct labor 

dollars paid this reporting period (including sub-contractors); (7) Total payments (including sub-contractors); (8) 

Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC 

for each sub-contractor if different); (9) Estimated data collection cost; (10) Organizational title associated with the 

Unit Identification Code (UIC) for the Army Requiring Activity (National Guard Bureau UIC is W00QFF); (11) 

Locations where contractor and sub-contractors perform the work (specified by zip code in the United States and 

nearest city, country, when in an overseas location, using standardized nomenclature provided on website); (12) 

Presence of deployment or contingency contract language; and (13) Number of contractor and sub-contractor 

employees deployed in theater this reporting period (by country). As part of its submission, the contractor will also 

provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period will be 

the period of performance not to exceed 12 months ending September 30 of each government fiscal year and must be 

reported by 31 October of each calendar year. Contractors may use a direct XML data transfer to the database server 

or fill in the fields on the website. The XML direct transfer is a format for transferring files from a contractor's 

systems to the secure web site without the need for separate data entries for each required data element at the web 

site. The specific formats for the XML direct transfer may be downloaded from the web site. 

5. GENERAL INVOICE PREPARATION & SUBMITTAL INSTRUCTIONS: 

a. An invoice is a written and/or electronic request for payment under the contract for supplies delivered 

or for services rendered. In order to be proper, an invoice must include, as applicable, the following: 

i. Name and address of the contractor 

ii. Invoice Date 

iii. Contract Number, or other authorization for supplies delivered or services performed 

(including order number and contract line item number) 

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iv. Name and address of contractor official to who payment is to be sent (must be the same as that 

in the contract or on a proper notice of assignment) 

v. Name (where practical), title, phone number and mailing address of person to notified in the 

event of a defective invoice. 

vi. Any other information or documentation required by other requirements of the contract (such 

as evidence of shipment) 

b. Invoices should match terms and CLIN structure of the contract for ease of payment by Defense 

Finance and Accounting Service (DFAS). 

c. Invoices shall be processed for approval and payment within 5 working days of the completion of 

work. 

d. Receipt of payments by a representative of the contractor’s designated bank shall constitute a full 

accord and satisfaction of the Government’s obligation under the contract to the extent of the amount of 

the payment made. 

e. This contract requires invoice submittal in accordance with Wide Area Workflow (WAWF). Submit 

one electronic original of all invoices to DFAS. IMPORTANT: DFAS must receive electronic 

submittal from the contractor in compliance with DFARS 252.232-7003. The COR(s) will certify all 

invoices for payment. For payment inquiries after submittal, please contact the DFAS Customer 

Service Desk or visit the Vendor Pay Inquiry System at the following web address: 

http://www.dfas mil/money/vendor/ 

6. WIDE AREA WORKFLOW INVOICE INSTRUCTIONS: 

Contractor shall submit payment request using the following method(s) as mutually agreed to by the Contractor, the 

Contracting Officer, the contract administration office, and the payment office. 

Wide Area Workflow (WAWF) (see instructions below)

Web Invoicing System (WInS)(https://ecweb.dfas.mil) 

American National Standards Institute (ANSI) X.12 electronic data interchange (EDI) formats 

(http://www.X12.org and http://www.dfas mil/ecedi) 

Other (please specify)____________________________________

DFAS POC and Phone: DFAS INDIANAPOLIS, 1-888-332-7366

WAWF is the preferred method to electronically process vendor request for payment. This application allows DOD 

vendors to submit and track Invoices and Receipt/Acceptance documents electronically. Contractors electing to use 

WAWF shall (i) register to use WAWF at https://wawf.eb mil and (ii) ensure an electronic business point of contact 

(POC) is designated in the Central Contractor Registration site at http://www.ccr.gov within ten (10) calendar days 

after award of this contract/order. 

Questions concerning payments should be directed to the Defense Finance and Accounting Service (DFAS) DFAS 

INDIANAPOLIS, 1-888-332-7366. Please have your purchase order/contract number ready when calling about 

payments. 

You can easily access payment and receipt information using the DFAS web site at 

http://www.dfas mil/contractorpay html . Your purchase order/contract number or invoice number will be required 

to inquire about the status of your payment. 

The following codes and information will be required to assure successful flow of WAWF documents. 

TYPE OF DOCUMENT [Check the appropriate block] 

Commercial Item Financing

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Construction Invoice (Contractor Only) 

Invoice (Contractor Only) 

 Invoice and Receiving Report (COMBO)

Invoice as 2-in-1 (Services Only)

Performance Based Payment (Government Only) 

Progress Payment (Government Only) 

Cost Voucher (Government Only) 

Receiving Report (Government Only) 

Receiving Report With Unique Identification (UID) Data (Government Only) 

 UID is a new globally unique “part identifier” containing data elements used to track DoD parts 

through their life cycle. 

Summary Cost Voucher (Government Only) 

 CAGE CODE: DUN NUMBER: TAX ID: 

 ISSUE BY DODAAC: W9133L 

 ADMIN BY DODAAC: W9133L

 INSPECT BY DODAAC: W909UJ

 ACCEPT BY DODAAC: W909UJ 

 SHIP TO DODAAC: W909UJ 

 LOCAL PROCESSING OFFICE DODDAC: N/A

 PAYMENT OFFICE FISCAL STATION CODE: HQ0105 

 EMAIL POINTS OF CONTACT LISTING: (Use Group e-mail accounts if applicable) 

 INSPECTOR: @us.army mil

 ACCEPTOR: @us.army mil

 RECEIVING OFFICE POC: @us.army.mil

 CONTRACT ADMINISTRATOR: @ng.army.mil 

 CONTRACTING OFFICER: @us.army mil

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(b) (4) (b) (4) (b) (4) (b) (6) (b) (6) (b) (6)(b) (6) (b) (6)

Record Posted to NGB Reading Room 

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