FOIA Requested Record #FA-11-0070 

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ORDER FOR SUPPLIES OR SERVICES 'PAGE 1 OF 6 

! _ CONTRACT/P URCH. 0 RDERI . DELIVERY ORDERI CALL NO. I'DATEOPO 4. REQJ P URCH. REQ VEST NO. 5.PRIORln' 

AOREEMENTNO. (YYYYMMMDD) 

V797p·7134A W912KZ-10·F·Q083 2010Sep01 

16. ISSUED BY CODE I W912KZ . ADMINISTERED BY (ifother Iha/1 6) CODE 

USPFO FOR KENTUCKY 8. DELIVERY FOB 

BNGC, SLOG 120 SEE ITEM 6 ~ DEST INAT rON 120 MINUTEMAN PARKWAY 

FRANKFORT KY 40601-6192 OTHER 

(See Schedule if other) 

. CONTRACTOR CODE 14Hz92 FACILITY I 10, DELIVER TO FOB PO [NT BY (0 ale) III MARK IF BUSINESS IS 

Ace CONSULTANTS INC (rYJ'YUMMDD) 

SEE SCHEDULE §"lALL NA]''1E TODD BOWER SMALL 

AND 9008 WASHINGTON ST NE ;; 0 a~ - .5%; Net 30 Days 

DISADVANTAGED 

ADDRESS ALBUQUERQUE NM 87113-2704 WOMEN-OWNED 

13. MAIL INVOICESTO THE IN BLOCK 

....... U$EE BLOCK 6"uu,,** 

4, SHIP TO CODEI 15. PA YMENT WILL BE MADE BY CODE L",'220W6 

USPFO ACCOUNTS PAYABLE MARK ALL 

SEE SCHEDULE 120 MINUTEMAN PKWY PACKAGES AND FRANKFORT KY 40601 PAPERS WITH 

IDENTIFICATION 

NUMBERS IN 

BLO eKS 1 AND 2. 

16. Im~VERY X This deliver}" Qrder/call is issued on another Govcrnment agenc), or in accordance wilh and subject to terms and conditions ofabol'e numbered contract. 

TYPE 

OF P1TRrHASE Reference y 

wnEP furnish the folloll'ing on terms specified herein. REF: 

ACCEPT ANCE. THE CONT RACIOR HEREBY ACCEPT S T HE OFFER REPRESENT ED BY T HE NUMBERED PURCHASE 

ORDER AS IT MA Y PREVIOUSLY HAVE BEEN OR ISNOW MODIFIED, SUBJECT TO ALL OF THE TERMS 

AND CONDlTIONSSET FORTH, AND AGREESTO PERFORM THE SAME. 

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED 

o If this box is marked, supplier must sign and return the following number of copies: 

(l'l'I'YUMMDD) 

17. ACCOUNTING AND APPROPRIA TION OAT AI LOCAL USE 

See Schedule 

18. ITEM NO. 19. SCHEDULE OF SUPPLIESI SERVICES 20. QUANT IT Y 

ORDERED/ 21. UNIT 22. UNIT PRICE 23. AMOUNT 

ACCEPTED' 

SE SCHEDULE 

• Ifquanlil),accepled bylhe Governmenl is same as 1~:~'~~:_'~O;_\A;;2' u, M"",CA 

~TOTAI' 156,100.00 

!quan II/y ordered, Indlcale by X. If dlfferenl, enlcr aClual I""" , bela .... quanilly aIde, cd Gnd encircle 1",1 / , ome" 

7a. QUANTITY IN COLUMN 20 HAS BEEN 

DINSPECTED DRECEIVED D ACCEPTED, AND CONFORMS TO THE 

CONT RACT EXCEPT AS NOT ED 

lb. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE c. DATE d. PRINTED NAME AND TITLE OF AUTHORIZED 

(Yl'l'YMMAfDD) GOVERNMENT REPRESENT ATIVE 

,. ADDRESS OF AUT HORIZED GOVERNMENT REPRESENT A TIVE 28. SHIP NO. 29. DO VOUCHER NO 30. 

INITIALS 

B PARTiAL 

32. PAID BY [33. AMOUNT VERIFIED 

TELEPHONE NUMBER jg. E-MAIL ADDRESS FINAL [CORRECT FOR 

136.1 ce rllfy tl Is account Is correct and prope, for paym ,nl 1. PA YMENT 134. CHECK NUMBER 

la. DATE SIGNATURE AND TITLE OF CERTIFYING OFFICER § COMPLETE 

PARTIAL 35. BILL OF LADING NO. 

FINAL 

37. RECEIVED AT 138. RECEIVED BY 9. DATE RECEIVED O.TOTAL 41. SIR ACCOUNT NO 42. SIR VOUCHER NO. 

(Yl'Yi'MMMDD) CONT AINERS 

DO Form 1155, DEC 2001 PREVIOUS EDIT roN IS OBSOLET E. . 
FOIA Requested Record #FA-11-0070 

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Section B - Supplies or Services and Prices 

ITEM NO SUPPLIES/SERVICES 

0001 

Dental Exam 

FFP 

QUANTITY 

16 

Dental Exam for 16 Class 4 Soldiers 

Per Proposal #RFQ502388 

Minimum of 16 soldiers 

UNIT 

Each 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900D I 0231 0 1 02 

ACRNAA 

CIN: W900D 1 0231 0 1 02000 I 

ITEM NO SUPPLIES/SERVICES 

0002 

Dental Treatment 

FFP 

QUANTITY 

15 

UNIT 

Each 

Dental Treatment for estimated 15 Class 3 Soldiers 

Per Proposal#RFQ502388 

Minimum of 15 soldiers 

Not to Exceed 5% more than contracted amonnt. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900Dl 0231 0 1 02 

ACRNAA 

CIN: W900Dl023 101020002 

W912KZ-IO-F-00S3 

Page 2 of6 

NETAMT 

NETAMT 
FOIA Requested Record #FA-11-0070 

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ITEM NO SUPPLIES/SERVICES QUANTITY 

54 

UNIT 

Each 0003 

Dental EXAM 

FFP 

Dental EXAM estimated 54 Class 4 Soldiers 

Per Proposal#RFQ502388 

Minimum of 54 soldiers 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900D I 0231 0 I 02 

ACRNAA 

CIN: W900D I 0231 0 I 020003 

ITEM NO SUPPLIES/SERVICES QUANTITY 

49 

UNIT 

Each 0004 

Dental Treatment 

FFP 

Dental Treatment for estimated 49 Class 3 Soldiers 

Per Proposal#RFQ502388 

Mininmm of 49 soldiers 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900D I 0231 0 102 

ACRNAA 

CIN: W900DI023 101020004 

W912KZ-IO-F-0083 

Page 3 of6 

NETAMT 

UNIT PRICE AMOUNT 

-

NETAMT 
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Section E - Inspection and Acceptance 

INSPECTION AND ACCEPTANCE 

Supplies/services will be inspected/accepted at: 

CLIN 

0001 

0002 

0003 

0004 

INSPECT AT 

N/A 

N/A 

N/A 

N/A 

INSPECT BY 

N/A 

N/A 

N/A 

N/A 

ACCEPT AT 

N/A 

N/A 

N/A 

N/A 

W912KZ-IO-F-0083 

Page 4 of6 

ACCEPT BY 

Government 

Government 

Government 

Govemment 
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W912KZ-I0-F-OOS3 

Page 5 of6 

Section F ~ Deliveries or Performance 
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Section G - Contract Administration Data 

ACCOUNTING AND APPROPRIATION DATA 

AA: 2102065000001810 15135G680000026EB44KM2GW900D I 0231 0 I 02KM2G440 1505 8 

AMOUNT: £68,100,00 

eIN W900DI02310102000 

eIN W900DI023101020'002: 

eIN W900DI023101 

eIN W900DI023101 

W912KZ-l0-F-0083 

Page 6 of6 
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RFQ - Summary Page 1 of2 

GSA Advantage! Ie-Library 

RFQ 

 were notified 

Reference # 

W900D1-0231-0102 

NT 

. 

Delivery Days 

Period of Performance 09/11/2010 through 09/12/2010 

RFQ Close Date 

:17 AM EDT 08/31/201011:00:00 AM EDT 

Manufacturer Product/Service Name Qty Unit Ship Address 

ENT FOR 10 CLASS 3 SOLDIERS LOCATION GREENVILLE KY 10 EA 1 

EATMENT FOR 16 CLASS 4 SOLDIER LOCATION GREENVILLE KY 16 EA 1 

ENT FOR 32 CLASS 3 SOLDIERS LOCATION FRANKFORT KY 32 EA 2 

EATMENT FOR 54 CLASS 4 SOLDERS LOCATION FRANKFORT KY 54 EA 2 

events occuring on September 11th-12th. Event 1, will consist of: Dental Treatment for 10 Class 3 

m/treatment for 16 class 4 soldiers. This event will take place at the Wendell H Ford Regional Training 

in Greenville KY 42345. Event 2 will consist of Dental Treatment for 32 class 3 soldiers and 54 class 4 

nt will take place at the Boone National Guard Center (BNGC) Frankfort KY 40601. All work wil be 

oble dental facility provided by the vendor/contractor. All Medical staff and supplies will be provided by 

stated in the attached SOW. Email questions t Office: 502-607-1522 

 

._. 

age.gov/advgsaiadvantage/ebuylbuyer/rf<Lsummary.do ?BV _ UseBV Cookie= Y es&rfqld=RFQ5023 88 9117/2010 
FOIA Requested Record #FA-11-0070 

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RFQ - Summary 

 

(2) USPFO for Kentucky: 

Kentucky National Guard 

BOONE NATIONAL GUARD CENTER 

120 MINUTEMAN PKWY 

Frankfort, KY 40601 

" "" Shipment 

?BV _ U seBV Cookie= Y es&rfqld=RFQ 502388 

Page 2 of2 

9117/2010 
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STATEMENT OF WORK FOR DENTAL READINESS 

Introduction: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the 

basic principals of a ready force for Kentucky Army National Guard. Failure to maintain dental 

standards could preclude a soldier from deploying. Dental readiness is a command and soldier 

responsibility. This statement of work covers the dental components ofIMRlFMR to include: 

DEN CLASS data entry of all dental records, treatment of all Class 3 soldiers on alert orders 

andlor in conjunction with the ANG Selected Reserve Dental Readiness System. Services are to 

be completed on site at KYARNG armories. The SOW identifies the purpose of the work to be 

performed by the contractor and provides a description of the work to be completed and the 

required outcomes. The contractor shall provide qualified personnel, material to perform the 

services, and lor OSHA, HIPP A and Privacy Act Compliant Mobile depending on the individual 

site needed for the KY ARNG. 

DoD established a uniform dental classification in HA Policy 02-11. DoD policy requires dental 

screening examinations to be accomplished and documented on 90% of service members. 

Members of the KYARNG shall receive an aliliual dental screening exam to detennine their 

dental classification. Soldiers alelied andlor sourced are eligible for dental treatment if they are 

class 3 status from examination. Dental treatment that may be required is essential to be 

provided at the SRP site to ensure the highest Dental Deployment Rate for the mobilizing 

soldiers. Objective: The contractor shall provide all management, labor, material, equipment, 

celiifications and supplies necessary to provide dental services at designated locations for the 

KY Army National Guard. These services will provide mandated dental treatment and proper 

documentation into the Soldier's dental record and data entry of all records into the DENCLASS 

system, as necessary to meet Depmiment of the Army standards of dental readiness and 

deployability. The contractor will insure that their agents are appropriately trained and have 

access to the DENCLASS system. 

Scope of Practice: Who: contracting personnel to suppOli dental treatment mission in order to 

conveli class 3 soldiers to class 2 soldiers in order to reach deployability standards lAW 

Appendix B, utilizing mobile treatment vans. What, When, and Where: Provide dental 

treatment to a total of 53 soldiers in 2 different locations on 11-12SEP I O. ADT III - Greenville, 

KY has 14 Class 3 and 19 Class 4 soldiers and JFHQ -' FrankfOli, KY has 20 Class 3 soldiers. 

Health Services POC will be ~Deputy State Surgeon. 502-545-8281 

Dental treatment requirement~ 

A) Class 3 dental treatments for Soldiers andl or soldiers who are catorgized in SELRES 

program. Dental treatment authorized is outlined in Appendix E. Any treatment plan greater than 

$2,000.00 requires prior approval from SDO. These services will be completed by using 

contractor provided mobile dental van (unless othelwise specified in a separate written 

agreement). 

B) Specified Dental Specialty Services that requires SDO approval to include 

1) Oral and Maxillofacial Surgery (to include pathology reports if indicated) 
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2) Endodontics 

3) Periodontics 

4) Prosthodontics 

5) Other (specify) 

C) Prescriptions for pharmaceuticals and controlled substances necessary for the care and 

treatment to Soldiers throughout the event, to include but not limited to analgesics and 

antibiotics. Prescriptions for maintenance pharmaceuticals for Soldiers with high caries risk or 

periodontal disease, as indicated will be provided by contractor on site. Emphasis on pain 

control after topical analgesic has resolved. 

Upon completion of services, medical information will be documented in accordance with 

Department of the Army Policy and be updated in the approved Army National Guard automated 

system. The contractor shall also ensure the requirements of Occupational Safety and Health 

Administration (OSHA) and applicable Federal regulations are met. The contractor shall develop 

and maintain records that fully document serviced performed and names of soldiers refe11'ed to 

dental specialists. These records will be made available to the State/Te11'itory Medical 

representative. 

Documentation. All Soldiers must have a complete military dental record. The contractor 

shall provide electronic documentation (to include radiographs) in the ARNG approved system 

(within 24 hours of exam completion) and a paper copy as outlined below. A complete record 

includes the following: 

A. Military dental record jacket, DA Form 8005 through 8005-9 

B. The automated Health History Form or DA Form 5570 (with notations to "yes" answers 

and signed by both the Soldier and reviewing Doctor), Health Questiormaire envelope 

C. DD Form 2005 (signed), Privacy Act Statement 

D. SF 603/603A, Record of Dental Treatment 

E. Supporting radiographs (panoramic and diagnostic bitewing radiographs ((see 1.3.F» 

documenting existing conditions) if necessary for treatment purposes 

(1) All radiographs will be uploaded into the ARNG automated system. 

(2) A diagnostic quality copy of all radiographs must be placed in the Dental Record. 

F. The entries on the SF 603/603A will include the following: date, location, comprehensive 

oral treatment completed, notation of current Dental Fitness Classification, listing of current oral 

condition (class 2 issues identified and a listing of class 3 treatment needs, if any), printed name 

of examining dentist or dental officer and the dentist's or dental officer's signature/initials. 

These required dental documentation elements will be entered in the approved ARNG automated 

system, DENCLASS and printed and placed into the dental record. 
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Record Evaluation. Prior to dental treatment all service members who have a current dental 

exam and have been identified as a class 3, a record review will need to be performed to 

determine the amount of work hours required for those service members. A by name and time 

schedule will be given to state POC to allow for the commanders to better plan for the event. 

Work Guarantee. After completion of dental treatment, all dental work will be guaranteed by 

company completing work for up to one year for minor restorations and two years for major 

restorations. The SDO will coordinate with the general dentist performing treatment for any 

arbitration claims to determine if the problems relating to the dental treatment are in need of 

correction. Health services will be notified of all initial problems to coordinate with SDO. 

GENERAL INFORMATION. 

QUALITY CONTROL. The contractor shall adopt a quality assurance program that monitors 

all service activities and ensures the highest quality customizable dental services available. It is 

the responsibility of the ARNG to review and approve dental treatment plans before treatment is 

perfonned based on the guidelines provided by N GB and the SDO. 

QUALITY ASSURANCE. The government will periodically evaluate the contractor's 

performance in accordance with the Quality Assurance Surveillance Plan. 

GOVERNMENT REMEDIES. The contracting officer shall follow the requirements of FAR 

52.212-4, Contract Terms and Conditions for Commercial Items (May 1997), for contractor's 

failure to correct nonconforming services. 

HOURS OF OPERATION. The contractor shall have the capability of providing dental 

services seven days a week. The contractor will be able to work flexible hours to accommodate 

the commander's training plan. 

SECURITY REQUIREMENTS. Security will be in accordance with DD Form 254 

(Depmiment of Defense Contract Security Classification Specification). 

SPECIAL QUALIFICATIONS. Contractor must maintain appropriate credentialing files on 

all employees to include but not limited to Licensure, National Provider Data Base Query results 

and HIPP A celiification. 

PARTNERING AGREEMENT. The contracting officer may require a pminering agreement 

between the government and the contractor to ensure joint cooperation and a sound pminership 

of all parties involved in the execution of this contract. 

Contractors will ensure compliance with the following requirements prior to utilizing any 

x-ray producing device on Soldiers; 
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A. Have established written policies and procedures to assure compliance with applicable 

Federal, State, DOD, and Army radiation safety regulations and directives. These 

documents include staff emergency reaction plans, as necessary, and procedures for investigating 

and repo11ing radiation accidents or incidents, possible radiation overexposures to Soldier 

patients or contractor staff, and provisions to ensure the safe use of x-ray producing devices on 

humans. 

B. Upon request by the State/TelTitory representative, the contractor will provide 

documentation regarding the Contractor's employee radiation safety training conlllensurate 

with potential radiation hazards with the x-ray producing devices they are using. 

C. Upon request by the State/Tenitory representative, the contractor will provide copies of 

a Qualified Health Physics Expel1's acceptance test and most recent health physics survey of 

each diagnostic x-ray machine. The acceptance test and the most recent survey include tests of 

electrical, mechanical, image quality and radiatiOli (output) dose tests or measurements. 

This also includes verification of the adequacy of radiation protection shielding in and 

around the X-ray machine and x-ray facility (e.g., mobile van). 

APPENDICES. 

A. Estimated Workload Data 

B. Dental Classification 

C. SF 603A and DA Form 5570 (Dental Classification Module Version) 

D. GoYel'llment FUl'llished Property/Sel'vices/Equipment 

E. Authorized Dental Treatment 
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APPENDIX A 

ESTIMATED WORKLOAD DATA 

The following data elements will be reported at the end of an event: 

Date 

Location 

List of contract employees (providers, dental teclmicians and administrative staff) 

Total number of patients scheduled 

Total number of patients examined 

Total number of Soldiers by dental classification: 1, 2, 3 

Total number of bitewing radiographic sets taken 

Total number of panoramic radiographs taken 

Verification of entry into DA or ARNG automated systems 

A by name listing of all Soldiers examined and the dental classification of the Soldier 
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APPENDIXB 

Department of Defense 

Oral Health and Readiness Classification System 

The oral health status of unifonned personnel shall be classified as follows: 

A. Class 1 (Oral Health): Patients with a cunent dental examination, who do not 

require dental treatment or reevaluation. Class 1 patients are worldwide deployable. 

b. Class 2: Patients with a current dental examination, which require non-urgent 

dental treatment or reevaluation for oral conditions, which are unlikely to result in dental 

emergencies within 12 months. Class 2 patients are worldwide deployable. Patients in 

dental class 2 may exhibit the following: 

(1) Treatment or follow-up indicated for dental caries or minor defective 

restorations that can be maintained by the patient. 

(2) Interim restorations or prosthesis that can be maintained for a 12 month 

period. This includes teeth that have been restored with permanent restorative materials 

for which protective cuspal coverage is indicated. 

(3) Edentulous areas requiring prostheses but not on an immediate basis. 

(4) Periodotium that: 

(a) requires oral prophylaxis 

(b) requires maintenance therapy 

( c) requires treatment for slight to moderate periodontitis and stable cases 

of more advanced periodontitis 

(5) Unerupted partially erupted or malposed teeth that are without historical, 

clinical or radiographic signs or symptoms of pathosis, but which are recommended for 

prophylactic removal. 

(6) Active OIihodontic treatment. The provider should consider placing the 

patient in passive appliances for deployment up to six months. For longer periods of 

deployment, the provider should consider removing active appliances and placing the 

patient in passive retention. 

(7) Temporomandibular disorder patients in remission. The provider anticipates 

the patient can perform duties while deployed without ongoing care and any medications 

or appliances required for maintenance will not interfere with duties. 
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c. Class 3: Patients who require urgent or emergent dental treatment. Class 3 patients 

normally are not considered to be worldwide deployable. 

(1) Treatment or follow-up indicated for dental caries, symptomatic tooth fracture 

or defective restorations that cannot be maintained by the patient. 

(2) Interim restorations or prostheses that cannot be maintained for a 12 month 

period. 

(3) Patients requiring treatment for the following periodontal conditions that may 

result in dental emergencies within the next 12 months. 

(a) Edentulous areas or teeth requiring immediate prosthodontic treatment 

for adequate mastication or conmlUnication or acceptable esthetics. 

(b) Active progressive moderate or advanced periodontitis. 

(c) Periodontontal abscess 

(d) Progressive mucogingival condition 

(e) Periodontal manifestations of systemic disease or h0I111onal 

disturbances 

(f) Heavy subgingival calculus 

(4) Edentulous areas or teeth requiring immediate prosthodontic treatment for 

adequate mastication or communication or acceptable esthetics. 

(5) Unerupted, partially erupted or malposed teeth with historical, clinical or 

radiographic signs or symptoms of pathosis that are recommended for removal. 

(6) Chronic oral infections or other pathologic lesions including: 

(a) Pulpal, periapical or resorptive pathology requiring treatment. 

(b) Lesions requiring biopsy or awaiting biopsy report. 

(7) Emergency situations requiring therapy to relieve pain, treat trauma, treat 

acute oral infections or provide timely follow-up care (e.g., drain or suture removalO until 

resolved. 

(8) Acute Temporomandibular disorders requiring active treatment that may 

interfere with duties. 
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d. Class 4. Patients who require periodic dental examinations or patients with 

unknown dental classifications. Class 4 patients normally are not considered to be 

worldwide deployable. 
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APPENDIXC 

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SI3:;"1'~' (1;,1131 n€eds Ic';nll,:",j In b,,):;': 

1 C, 1),,(1,\' 

If'> \'vrHI i,. 1l-}"':-'."f'",.",t,-=,==--:::==--:::==,...,,========:::-:==~=~7.""'" I ~~~~'~'~;~~ ___ 1. ___ -.1.~~r~/.·_~, I.I~~~.:"~\·' 11~t.I'Ji HI M::r~IliI" l~lr.rr.>i HI ~.v:':J~ .. f~o:'· u:~· Ht,),,1 (lL'j~· 

I .... J"'-'.j ~.~ ':JE1l:;l Uat.n tHuh 

1.;>;: :~.n~"i.m.,i~I%iJjJ"!lJ 

(J n.:' 1 t.:u tJ:i t.r.v.h 

I~.: :~.(H'i,..m 1'lJ>i::IiAtJ:j 

l'[JU(tD!C ORAL [,VALUATION' 

aJ' ... r~l~ 

2WX6 J'N ' .. CG Pi":"':: I'.'\. 'IX '0 J4'l ,«" :2 f.2 r " .. 1 

~~DJ T TI!:'StlE I.IINt:!YEl1 tk, ,:2 :::! 11 c."R1I'.:~; Rlt:iL~: IL.{II,\,lo.lLl:\.! lh~1 -

.frrJuAC-('(1: ~ :!;l!:ub: Gil:',,?! Dc6. 

C8rJ.al Clas~,i11c.:rtlor,; 3 

\{J.._;;.nu PtJ'.\ELL C·) 3 

M/,J, JO 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 19 of 223

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APPENDIXD 

GOVERNMENT FURNISHED PROPERTY/SERVICESIEQUIPMENT 

1. General. The Government will provide the following resources: 

2. Facilities, Snpplies, and Services. Space for set-up of an administrative area and 

utilities. Mobile units, provided by the contractor, will be utilized for dental treatment 

unless otherwise specified in the contract. 

3. Information. The Government will provide the following information: 

a. Soldier's dental records if applicable. 

4. The User Agency will provide initial familiarization/orientation. Standard 

Operational Procedures will be available to the contractor at the place of performance. 
FOIA Requested Record #FA-11-0070 

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Page 20 of 223

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APPENDIXE 

AUTHORIZED DENTAL TREATMENT 

1. The following dental procedures are authorized: 

(a) Diagnostic Services which are funded through NG6H 2065 Medical Readiness 

Funding: 

D0120-Periodic Oral Evaluation 

D0150-Comprehensive Oral Evaluation 

D0330-Panoramic Fihu 

D0272-Bitewings-Two Films 

D0274-Bitewings-Four Films 

D02201D0230- Periapical (limited) 

(b) Restorative Services which are funded tlu'ough the VFRE 2020 Dental Treatment 

Funding (provided only to soldiers alelied to an OCONUS Mission): 

D2140-Amalgam-One Surface 

D2150-Amalgam-Two Surfaces 

D2160-Amalgam-Three Surfaces 

D2161-Amalgam-Four or More Surfaces 

D2330-Composite-One Surface 

D2331-Composite-Two Surfaces 

D2332-Coll1posite-Three Surfaces 

Posterior composites will be authorized only when a posterior composite is 

necessary to provide a quality restoration and no other altel'llatiYe is available. 

D2335-Composite-Four or More Surfaces 

D2391-Coll1posite-One Surface 

D2392-Composite-Two Surfaces 

D23 93 -Coll1posite-Three Surfaces 

D2394-Coll1posite-Four or More Surfaces 

D2799-Provisional Crown 

D2931-Prefabricated Stainless Steel Crown 

D2950-Core Buildup, including any pins 

D2954-Prefabricated Post and Core 

(c) Endodontic Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alerted to an OCONUS Mission): 

D331 O-Anterior Root Canal Therapy 

D3320-Bicuspid Root Canal Therapy 

D3330-Molar Root Canal Therapy 
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D3346-Anterior Root Canal Retreatment 

D3347-Bicuspid Root Canal Retreatment 

D3348-Molar Root Canal Retreatment 

(d) Periodontal Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alelted to an OCONUS Mission): 

D4355-Full Mouth Debridement 

D4342-Periodontal Scaling and Root Planing, I to 3 teeth per quadrant 

Periodontal scaling and root planing is authorized only when a periodontal abscess 

is present and SDO approves 

(e) Prosthodontic Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alerted to an OCONUS Mission): 

D5110-Complete Denture-Maxillary 

D5120-Complete Denture-Mandibular 

D5211-Maxillary Partial Denture-Resin Base 

D5212-Mandibular Partial Denture-Resin Base 

(1) Oral Surgery Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alelted to an OCONUS Mission): 

D7140-Extraction, Erupted Tooth or Exposed Root 

D72lO-Surgical Removal of Erupted Tooth 

D7220-Romoval ofImpacted Tooth, Soft Tissue 

D7230-Removal ofImpacted Tooth, Pmiial Bony 

D7240-Removal of Impacted Tooth, Completely Bony 

(g) Orthodontic Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alerted to an OCONUS Mission): 

D8680-01thodontic Retention 

2. The following dental procedures are not authorized: 

Bridges and/or implants 

Removal of Asymptomatic third molars 

Routine Prophylaxes (cleanings) 

Restorations for aesthetics only 

Restorations for small (non-class 3) caries 

Extensive Root plane/scaling 

Osseous Surgery 

Other diagnostic services 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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The above listings are guides to assist the State Dental Officer or his/ller designee in 

determining treatment to be authorized. The treatment provided by the ARNG is to 

get the Soldier from a dental class 3 to a dental class 2 only. Comprehensive 

Treatment (to dental class I) is not authorized. 

3. If a Soldier needs all of his/her remaining teeth in an arch extracted and a denture 

placed, the Soldier will not be available for deployment for at least 6 months and shall be 

disqualified from immediate deployment. However, if the Soldier is otherwise 

deployable (passes all medical, personnel and training requirements) and, after extraction 

and placement of prosthesis, would be deployable, the dental treatment could be provided 

and the Soldier could be considered as a replacement at a later date. 

4. If a Soldier will have a number of teeth extracted to the extent mastication and speech 

are adversely affected, then an acrylic removable pat1ial dentnre will be authorized if 

there is sufficient time for healing and construction of the partial denture prior to 

departure to Mobilization Station. 

5. Soldiers requiring extensive periodontal treatment will be disqualified from 

deployment and educated on the TRICARE Dental Program. If he/she obtains the 

required therapy (from ms/ller private dental provider) and reaches a maintenance level, 

then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental 

treatment plan for dental care which exceeds $2000 to insure that the above clinical 

guidelines are met. Exceptions can be made, but they must be coordinated with the State 

Surgeon. 
FOIA Requested Record #FA-11-0070 

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

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ACC Consultants, Inc. 

August 31, 2010 

J(el1tJlcl(~' Army Natioual Guard 

DenIal Readiness 

RFQ502388-XXX 

Thank you for this opportunity to submit a quote for dental treatment for the Kentucky Army National 

Guard to be provided at WHFTRC in Greenville, Kentucky from September 11-12,2010 and Boone 

National Guard Center Frankfmi, KY. 

ACC Consultants, Inc brings 19 years of providing suppmi services to govemment agencies. ACC offers a 

thorough understanding of individual medical readiness (IMR) and medical readiness classification (MRC) 

requirements and standards. ACC understands the training demands placed on soldiers and individual 

units, and has developed time-tested and fully documented policies and procedures to ensure maximum 

support with minimal impact on the unit training assembly. ACC also has an ongoing working relationship 

and excellent rappOli with ASM Research, the developer and maintainer ofMEDPROS, DENCLASS, and 

other related support applications. ACC is GSA certified. ACC has the availability of the items and 

sen'ices indicated in the SOW and is prepared to begin the contract on the delivery date indicated in 

the SOW. 

Included in our proposal is our technical response, an explanation of how we will deliver services, licensing 

and certification information, portable equipment and portable building capabilities, pricing infol'l1lation, 

and detailed past perfonnances related to the dental needs for KYARNG. 

Should you have any futiher questions, please contact: 

Ginny Berger 

CEO 

ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323-1300 X 681 

ginny@accdental.com 

Todd Bower 

Manager of Business Development 

ACC Consultants, Inc 

(505)323-1300 X 682 

todd@accdental.com 

Page 1 of22 
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ACC Consultants, fllc. 

August 31, 2010 

II AM EST 

RFQ502388-XXX 

Dental Exams and Treahllent 

Kentucky Army National Guard 

ACC Consultants, Inc. 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323-1300 

accdental,com 

A"eJ1tllc/~~t Army National Guard 

Delllal ReadiJless 

RFQ50238S-XXX 

ACC Consultants, Inc. is registered with CCR 

CAGEINCAGE Code: 4HZ92 

DUNS #: 624343463 

GSA Contract #: V797P-7134A 

Expires: 11130/2012 

Woman Owned 

Small Business 

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ACC Consultants, fnc. 

Table of Contents 

A'entllcky Army Natioual Guard 

Dental Readil1ess 

RFQ502388-XXX 

Dental Technical Description' _____________________ ,4 

Mobile/POltable Dental Capabilities, ___________________ 7 

Representations and Certifications, ___________________ 8 

Dental Licensing and Certification, ___________________ 8 

Personnel Qualifications, _______________________ 9 

Dental Radiation Compliance' _____________________ l 0 

Dentalltemized Pricing, _______________________ 12 

Dental Treatment Fee Schedule (Appendix A), _______________ 14 

Past Perfom13nces' _________________________ 16 

Celtificate of Liability, _______________________ ~22 

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ACC Consultants, Illc. 

Dental Technical Description 

Page 4 of22 

I{entlu:/(F A rill)' National Guard 

Delltlll Relldille.\'s 

RFQ502388-XXX 
FOIA Requested Record #FA-11-0070 

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A CC Consultants, Inc. 

Page 5 of22 

Kelliac/I)! Army National Guard 

DelIlal Reatl;lle.\'s 

R FQ5IJ2388-XXX 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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ACC Consultants, Illc. 

Page 6 of22 

/(el1tucfo' Army Natiollal Guard 

Dental Reatliflc.\'S 

II FQ502388-XXX 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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Ace COllsultants, Inc. 

-Greenville, KY September 11-12,2010: quantity (1) bldg 

-Frankfort, KY September 11-12,2010: quantity (2) bldgs 

Size 

• 60' Long 

• 12' Wide 

• 8' Ceiling height 

Interior Finish 

• Paneled walls 

• Vinyl tile floors 

• Pre-finished ceiling 

Electric 

• Fluorescent ceiling lights 

• 100 amp Breaker panel 

'VindowslDoors 

• Horizontal slider windows 

• Steel door with commercial grade lock 

Heating and Cooling 

• Thermostatically controlled cenh'al HV AC unit 

• Supply ducted 

Exterior FinishlFrame 

• Wood siding 

• I-Beam frame 

• Standard drip rail gutters 

Page 70f22 

Hel1(Ilc/~V Army National Guard 

Dental Rcadine.\'s 

RFQ502388-XXX 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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(b) (4)

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ACC Consliltallts, Illc. 11Cl1tllc!(P Arm)' Nmiol1al Guard 

Dental Readiness 

R FQ502388-XXX 

Shollid all e"elll require lIl1/oreseell malerials, addiliollal sllpplies or equipmellijailllre, ACC 

Consultants, Illc works closely witll Hellry Schein Dental to expedite materials, supplies alld service 

tec/wiciGus 10 lite eJlellt site withiu a timely mauuer for slIccess/ul completioll of eve1lts. 

Offeror Representations and Certifications 

52.212-3 Offeror Representations and Ce,·tifieations - Commercial Items (JUN 2008) 

(b) (I) Annual Representations and Certifications, Any changes provided by the offeror in paragraph (b) 

(2) of this provision do not automatically change the representations and certifications posted on the Online 

Representations and Certifications Application (ORCA) website, 

(2) The offeror has completed the annual representations and certifications 

electronically via the ORCA website at http://orcalbpn,gov, After reviewing the 

ORCA data base information, the offeror verifies by submission of this offer that 

the representation and certifications currently posted electronically at FAR 

52,212-3, Offeror Representations and Certifications-Commercial items, have been 

entered or updated in the last 12 months, are current, accurate, complete, and applicable 

to this solicitation (including the business size standard applicable to the NArCS code 

referenced for this solicitation), as of the date of this offer and are incorporated in this 

offer by reference (see FAR4,1201), except for paragraphs N/A , [Offeror to 

identify the applicable paragraphs at (c) through (m) ofthis provision that the offeror has 

completed for the purposes of this solicitation only, ifany, These amended 

representation(s) andior certification(s) are also incorporated in this offer and are current, 

accurate, and complete as of the date of this offer, Any changes provided by the offeror 

are applicable to this solicitation only, and do not result in an update to the 

representations and certifications posted on ORCA,] 

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(b) (4)

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A CC Consultants, Illc. 

Personnel Qualifications 

ACC Consultants Purpose Statement 

[{l!l1t/lc/~I' Army Natiolla/ GUllrt! 

Dental Readiness 

Ii PQ502388-XXX 

It is ACe Consultants purpose to continually improve our model and delivelJI 0/ quality oral healthcGre in 

settings with demanding logistical requirements, in a way that our patients receive competent and 

compassionate care regardless a/their drcul1Istances, so that they hm'e healthier sm;/es, healthier bodies and a 

healthier quality o/Iife. 

ACC Consultants Core Values 

• Honesty, Integrity and trustworthiness 

• Listening, hearing, and understanding our co workers, patients, and communities in order to 

establish paths for improvement 

• Ethical decisions based on individualized circumstances 

• Encourage Creativity ~ in solving problems, making improvements and working toward our 

purpose 

• Empower patients to improve their health 

• Compassion as a mind set 

• Practicing non-judgmental attitudes 

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ACC Consllltants, Inc. A'elltncl(}) Army Natiol1a/ Guard 

Delltal Readiness 

Ii FQ5112388-XXX 

ACC Consultants, Inc Dental Mobile/Portable Radiation compliance 

CompallY Policy 

To ensure that information about the dangers that may occur during exposure by dental x-ray 

equipment, ACC Denial has established the following program. Under this program, all employees 

participating in Military Events,Exam and Treatment Services, Temping Services, Private Pay Services and 

Contract Agreements, will be informed of the contents of the Radiation Standard. Safe exposure practices 

for patient and provider and New Mexico Safety Regulations for x-ray technicians. 

The Safety Manager is the program coordinator, with overall responsibility for the program, 

including reviewing and updating this plan as necessary. 

ACC Denial will comply with the New Mexico State Regulations for the use of x-ray equipment. 

This certificate is displayed in the garage. A copy of this license will be in each of the MSDS books that 

h'avel on Military events. 

X-ray equipment will be repaired by a certified repairman and maintained as required by the 

manufacturer and the Safety Manager. 

Employee Ill/ormatioll alld Respollsibility 

All x-ray tecluricians will be responsible to keep their licenses current to comply with the 

standards of the New Mexico Deparlmenl a/Denial Health and/or state that they reside in and keep copies 

with them. 

X-ray tecluricians will be provided an exposure safety monitor dosimeter badge. A 3-month 

waiting period may occur, as the billing/monitoring cycle is renewed. 

A lead apron will be placed over each patient receiving any radiation exposure. All x-ray 

technicians will be required to wear an operator lead apron and thyroid collar when any x-rays are being 

taken. 

All x-ray teclmicians will stand behind the cone head and at least 6 ft away from the patient. 

Situations of mUltiple x-rays (Logistic Trips), indicator markers will mark off 6 ft around work area. The 

patient must always be in sight of the operator when taking an x-ray. 

In situations that an x-ray processor is used, the processor should be outside of the x-ray exposure 

room. 

All cords left out in the open, will be secured to the floor with tape to prevent obstruction offoot 

traffc. 

Workplace Allalysis 

ACC Denial will comply with State regulations in the operations of x-ray equipment. 

Employees working off site will notify the Team Leader or ACC Office ifthe workplace they are 

assigned to is not consistent with ACC safety standards. 

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Ace COllsultal1ts, If1c. llel1tlldy Army National Guard 

DenIal Readiness 

RFQSII2388-XXX 

In temporary work sites, in which x~ray exposure will occur, caution radiation signs will be posted 

accordingly. 

Radiation Safety Control 

Personal Protective Equipment (PPE's) listed below, will be provided for employees working in 

such areas listed below, any additional PPE's requested or needed will be put in writing and submitted to 

the Safety Manager. 

Gloves 

Masks 

Lead Apron 

Thyroid Collar 

Contract Services 

* On April 29, 2009, a medical physics survey was performed by a Certified Medical Nuclear Physicist and 

member of the American Board of Radiology on ACC Consultants portable X-ray dental units. The units 

meet the Food and Drug Administration, 21 CFR, Subchapter J, medical X-ray equipment requirements. 

The results of the medical physics survey can be viewed upon request. 

Page 11 of22 
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(b) (4) (b) (4) (b) (4) (b) (4) (b) (4)

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

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc, !{(!IlIUc/.y A 1'110-' National Guard 

Dell tal Readiness 

RFQ502388-XX,\' 

Dental Itemized Pricing (Greenville): 

Item SUPPLIES/SERVICES MINIMUM 

NO 

UNIT UNIT 

PRICE 

0001 Dental Exam 16 Service Service -

Total for Minimum 

***Prompt Payment Discount within 10 days of completion of 

event at ,5% 

Total Price for 16 Service Member Exams Less Early Payment 

Discount 

**ACC requires a minimum of 16 service member guarantee for exam services** 

Item SUPPLIES/SERVICES MINIMUM UNIT UNIT 

NO NET. PRICE 

Price 

Price 

0002 Dental Treatment 15 Sel'vice Sel'vice 

Members Member 

-

Total for Minimum 

***Prompt Paymeut Discount within 10 days of completion 

Total Price for 15 Service Member Exams Less Early Payment 

Discount 

** Ace requires a minimum of 15 service member guarantee for treatment services** 

**15 service members was calculated by taking the previously identified 10 catego,'y 3 service 

members and adding in the estimated (30%) ,'esulting categOl')' 3 service members that will result 

from the exams-this adds an additional 5 service members. This results in a total of 15 service 

members who will require treatment. ** 

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

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc. !lel1tllelly Army National Guard 

Dental Readilless 

RFQ5112388-XXX 

Dental Itemized PI"icing (Frankfort): 

Item SUPPLIES/SERVICES 

NO NET 

UNIT UNIT 

PRICE 

0003 Dental Exam 54 Service Service -

Total for Minimum 

***Prompt Paymeut Discount within 10 days of completion of 

event at .5% 

Total Price for 54 Service Member Exams Less Early Payment 

Discount 

** Ace requires a minimum of 54 sen'ice member guarantee for exam sCl'vices** 

Item 

NO 

0004 

SUPPLIES/SERVICES MINIMUM UNIT UNIT 

NET PRICE 

Dental Treatment 49 Service Sel'Vice 

Members Member 

Total for Minimum 

***Prompt Payment Discount within 10 days of completion of 

Total Price for 49 Service Member Exams Less Early Payment 

Discount 

**ACC requires a minimum of 49 sel'vice member guarantee for treatment sCl'vices** 

Price 

Price 

**49 service members was calculated by taking the previously identified 32 category 3 service 

members and adding in the estimated (30%) category 3 service members that will result from the 

exams-this adds an additional 17 service members. This results in a total of 49 service members who 

will require treatment. ** 

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Page 36 of 223

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

(b) (4)

(b) (4)

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June 22, 2011

ACC Consultants, Inc. 

APPENDIX A 

J{eJ1tllcf~p Army Natiol1al Guart! 

DenIal Readiness 

RFQ5112388-XXX 

AUTHORIZED DENTAL TREATMENT 

1. The following dental procedures are authorized: 

A. Diagnostic Services which are funded through NG6H 2065 Medical Readiness Funding: 

1. DOl20-Periodic Oral Evaluation 

2. DOl50-Comprehensive Oral Evaluation 

3. D0330-Panoramic Film 

4. D0272-Bitewings-Two Films 

5. D0274-Bitewings-Four Films 

6. D0220-First Periapical Xray 

6a. D0230-Each Additional Periapical 

B. Restorative Services which are funded through the VFRE 2020 Dental Treatment Funding (provided 

only to soldiers alelted to an OCOCNUS Mission): 

1. D2140-Amalgam-One Surface 

2. D2150-Amalgam-Two Surfaces 

3. D2160-Amalgam-Three Surfaces 

4. D2161-Alllalgalll-Four or More Surfaces 

5. D2330-Composite-One Surface 

6. D2331-Composite-Two Surfaces 

7. D2332-Composite-Three Surfaces 

Posterior composites will be authorized only when a posteriOl' composite is necessary to provide a 

quality restoration and no other alternative is available. 

8. D2335-Colllposite-Four or More Surfaces 

9. D2391-Composite-One Surface 

10. D2392-Composite-Two Surfaces 

I!. D2393-Composite-Tlu'ee Surfaces 

12. D2394-Composite-Four or More Surfaces 

13. D2799-Provisional Crown 

14. D293 I-Prefabricated Stainless Steel Crown 

IS. D2950-Core Buildup, including any pins 

16. D2954-Prefabricated Post and Core 

C. Endodontic Services which are funded through the VFRE 2020 Dental Treatment Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

I. D3310-Anterior Root Canal Therapy 

2. D3320-Bicuspid Root Canal Therapy 

3. D3330-Molal' Root Canal Therapy 

4. D3346-Anterior Root Canal Retreatment 

5. D3347-Bicuspid Root Canal Retreatlllent 

6. D3348-Molar Root Canal Retreatment 

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(b) (4)

(b) (4)

(b) (4)

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ACC Consultants, Inc. l(entflcky Army National Guart! 

Dental Readiness 

I1FQ502J88-XXX 

D. Periodontal Services which are funded through the VFRE 2020 Dental Treaonen! Funding (provided 

only to Soldiers alerted to an OCOCNUS Mission): 

I. D43SS-Full Mouth Debridement 

2. D4342-Periodontal Scaling and Root PlaIllling, I to 3 teeth per quadrant 

Periodontal scaling and root planning is authorized only when a periodontal abscess is present 

E. Prosthodontic Services which are funded through the VFRE 2020 Dental Treatment Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

I. DSIIO-Complete Denture-Maxillary 

2. DSl20-Complete Denture-Mandibular 

3. D5211-Maxillary Partial Denture-Resin Base 

4. D5212-Mandibular Partial Denture-Resin Base 

F. Oral Surgery Services which are funded through the VFRE 2020 Dental Treatment Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

I. D7140-Extraction, Erupted Tooth or Exposed Root 

2. D7210-Surgical Removal of Erupted Tooth 

3. D7220-Removal ofImpacted Tooth, Soft Tissue 

4. D7230-Removal ofImpacted Tooth, Partial Bony 

5. D7240-Removal of Impacted Tooth, Completely Bony 

G. OI1hodontic Services which are funded through the VFRE 2020 Dental Treaonent Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

FEE 

I. D8680-0I1hodontic Retention 

The following dental procedures are not authorized: 

-

A. Bridges and/or implants 

B. Removal of Asymptomatic third molars 

C. Routine Prophylaxes (cleanings) 

D. Restorations for aesthetics only 

E. Restorations for small (non-class 3) caries 

F. Extensive Root plane/scaling 

G. Osseous Surgery 

H. Other diagnostic services 

The above listings are guides to assist the State Dental Officer or his/her designee in deteI'mining treatment to 

be authorized. The treatment provided by the ARNG is to get the Soldier from a dental class 3 to a dental class 

2 only. Comprehensive Treatment (to dental class I) is not authorized. 

3. If a Soldier needs all of his/her remaining teeth in an arch extracted and a denture placed, the Soldier will not be 

available for deployment for at least 6 months and shall be disqualified from immediate deployment. However, if the 

Soldier is otherwise deployable (passes all medical, personnel and o'aining requirements) and, after extraction and 

placement of prosthesis, would be deployable, the dental treatment could be provided and the Soldier could be 

considered as a replacement at a later date. 

Page 15 of22 
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ACC Consultants, Illc. J{el1tllcl~p AI'I1I)' Natiol1al Guart! 

Dental Readiness 

RFQ5023S8-XXX 

4. Ifa Soldier will have a number of teeth extracted to the extent mastication and speech are adversely affected, then 

an acrylic removable pmtial dentme will be authorized ifthere is sufficieut time for healing and construction of the 

partial denture prior to departure to Mobilization Station. 

5. Soldiers requiring extensive periodontal treatment wil! be disqualified from deployment and educated on the 

TRICARE Dental Program. If he/she obtains the required therapy (from hisn,er private dental provider) and reaches a 

maintenance level, then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental treatment plan for dental care which 

exceeds $2000 to insure that the above clinical guidelines are met. Exceptions can be made, but they must be 

coordinated with the State Smgeon. 

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ACC Consultants, Inc. Kentlle/o' Army Natiollal Guard 

Dell/til Readiness 

RFQ51J2388-XXX 

Past Pel"formances: 

1. 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Otricer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

The state of Kentucky awarded ACC Consultants Inc the contract to provide dental treatment to the Kentucky Army 

National Guard at WHFTRC in Greenville, Kentucky. ACC Consultants, Inc. furnished all labor, tools, equipment, 

material, transportation and supervision for Dental Treatments for approximately 243 service members 

o 

o 

o 

o 

o 

243 Service Members seen during even! 

225 Converted to Class 1 or 2 status 

18 Were not converted onsi!e 

o 

__ 

~o see civilian DDS b~(7), was discharged 1 OJUN201 0 per 

need prosthetics mad~1), need oral surgery referral due to 

complexity of case and need for full sedation (8), need endodontist referral due to 

curvature of roots (1) 

Overall Exam + Treatment Conversion Rate not including 3C's: 100% 

o 225 conversions/225 Cat 3's (not including "civ DDS", "discharge", "prosth", "oral 

sedation needs", "root curvature" 

Overall Exam + Treatment Conversion Rate including 3C's: 96% 

o 225 conversions/235 Cat 3's (not including "civ DDS", "discharge") 

All DENC 

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ACC Consultants, Illc. f{el1tf{cI(~' Army National Gutrrd 

Delllal Relltlil1ess 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

o of 3's converted to Cat 1 or 2: 100% 

o 391 Members seen during event 

o 327 Converted to Class 1 or 2 status 

o 64 Were not converted onsite 

RFQ502388-XXX 

~1IJ!1II'l':~!Im1 

o Unless these patients refused treatment (1) or are seeing their own private dentist (7), ACC 

is case managing them and they will be converted and their 2813 uploaded to DENCLASS. 

o Overall Exam + Treatment Conversion Rate not including 3C's: 100% 

o 326 conversions/327 Cat 3's (not including 3C's, no·shows, refusals/prefer civilian dentist, 

high blood pressure, future event scheduling 

o 

o Number of Cat 4's presented to clinic that were examined and given new readiness dates: 291 

o Automatic converted/identified as Cat 1 or 2: 242 

o The following is a breakdown of the soldiers that presented to clinic as Cat 3 that were not able to be 

converted on site. These soldiers will be Case managed or invited back to future events and all should be 

upgraded to Cat 1 or 2 after case management is completed. 

o Number of Cat 3's requiring oral surgery referrals due to needing oral sedation in oral surgery 

office:9 

o Cat 3's not converted due to endodontic specialty needs (retreatment of existing RCTs, calcified 

canals): 7 

o Cat 3 not converted due to prosthetic lab case need: 8 

o Cat 3 not converted due to extreme high blood pressure: 1 

o Cat 3 not converted due to pending appointment with civilian DDS (approved by event paC): 7 

o Number of Cat 3's identified that will be scheduled to be converted at next OHS or Dobbins event: 

26 

o Cat 3 patients identified as Cat 3 during exam that no-showed or did not have time for treatment 

appointments: 3 

a Cat 3 patient that became to shaky to complete treatment: 1 

All Cat 3 patients are being case managed and appointed with the appropriate specialists to complete their Cat 3 

needs. All will be converted to Cat 1 or 2 status after case management is through. 

I i 

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Ace Consultants, Inc. l\'el1tllc/\Y Army N((lional Guard 

Dental Readiness 

RFQ502388-XXX 

1. 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, telephone 

number and Email: 

5. Project Officer's Name, Address, Telephone Number, 

FaxNumbcl' and Email Address: 

or delays encountered and any 

was management, 

materials, equipment, cCltifications and supplies to provide dental exams and treatments per identified treatment plan 

to upgrade Class 3 soldiers to a Class 2 status Jaoua!)' 19-21, 2010. 

All dental treatment that was ide'ntified in the patient's treatment plan was accomplished based on the National Gurads Bureau's 

statistics that 30% of soldiers examined were classification 3. Contract was awarded on December 15, 2009; ACC personnel 

and mobile equipment arrived on site January 18, 20 I O. 

Dental Event Numbers and Data: 

o Percentage of Cat 3's converted to Cat I or 2: 100"/., 

o 1031 Service Members seen during event 

o 911 COIlvertcd to Class 1 01' 2 status 

o 120 Were not converted onsite 

o See below for information regarding these patients. 

o Overall Exam + Treatment Conversion Rate not including 3C's: 100% 

o 911 conversions/911 Cat 3's (not including 3C's, no-shows, refusals/prefer civilian dentist, 

vouchers for treatment that was not allowed by contract) 

o Cat 4 soldiers that were identified as Cat 1 or 2: 710 

o There was about a 63% conversion of Cat 3 soldiers (after examination) at the evcnt site, Had the 

contract allowed ACC's providers to treat more conditions and have an oral surgeon included, the 

conversion rate of Cat 3 patients would have been around 90% by the end of the event. 

o The following is a breakdown of the soldiers that presented to clinic as Cat 3 that were not able to be 

converted on site. These soldiers will be case managed or invited back to future events and all should be 

upgraded to Cat I or 2 afier case management is completed. 

o The contract did not allow ACC to treat many of the Cat 3 conditions present. There were 

65 3C's, 7 Full Ortho patients, 1 woman was pregnant, 47 were approved for vouchers by 

POC as they had conditions that the contract did not allow ACC to treat. 

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ACC Consultants, Illc. Kell/llChY Arm)' National Guanl 

Dell tal Readiness 

RFQ502388-XXX 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

7. Final Contract Price/Cost to Date: 

March o 

00 

The New Mexico awarded ACC Consultants Inc the 5 year contract to provide dental treatment to the New Mexico 

Army National Guard at armories in both Albuquerque and Santa Fe, NM. ACC Consultants, Inc. furnished all labor, 

equipment, material, transportation and supervision for dental treatment for approximately 87 service 

Category 3 Upgrade Report: 

o Percentage of Cat 3'$ converted to Cat 1 or 2: 98% 

(That were willing andlor available for treatment and had conditions that needed treatment 

outlined in the contract requirements) 

o 87 Service Members seen during event 

o 78 Converted to Class 1 or 2 status 

o 9 Were not converted onsite 

o These patients are either: 

• Seeing their own private dentist (OK'd by event POC) (2), 

• Blood Pressure was too high to have oral surgery done (1), 

• 3C's (4): 

• Need a Root Canal ReTreatment (1) 

• Need removable prosthetics (2) 

• Need to see an Orthodontist to have fixed appliance removed (1) 

• Had extensive full mouth treatment that requires another day of treatment (2). 

o These patients could all be case managed by ACC to ensure their conversion if funding 

is procured by DSS for private office dental fees. 

• Please let us know if you would like to utilize this service 

o Overall Exam + Treatment Conversion Rate not including 3C's: 98% 

o 78 conversions/80 Cat 3's (not including "prefer civilian dentist", "bood pressure high" or 

3C's) 

o Overall Exam + Treatment Conversion Rate including 3 C's (8): 94% 

All DENCLASS patient data was uploaded by COB 3/25/2010. 

This 2 day restorative event was carried out without any problems or delays or any corrective actions 

taken in ards to , schedule or technical 

Page 20 of22 
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Ace Consult((nts, Inc. 

1. Contract Title: 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number.and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

o 

were i 

o Total Number Cat 3's presented to clinic: 192 

o Total Number of Cat 3's upgraded at clinic: 169 

llentIlC/(}) ,1I'JIlY Natiol1al GilaI'd 

DClltal Readilless 

IIFQ502388-XXX 

Services 

USPFO for len·[uc"y 

BNGC Bldg 120 

120 Minuteman Parkway 

Frankfort, KY 

40601-6192 

o Total Number of Cat 3's not upgraded due to circumstances beyond contracted capabilities: 11 

o 3 Cat 3 Soldiers refused treatment and requested to have treatment by their civilian dentist 

o 1 Cat 3 Soldier taking Coumadin; not able to discontinue for oral surgery 

o 1 Cat 3 Soldier needed apicoectomy (specialized endodontic surgery) 

o 1 Cat 3 Soldier awaiting lip biopsy 

o 1 Cat 3 Soldier needs full upper and lower dentures (all extractions were done on-site) 

o 4 Cat 3 Soldiers need specialized IV sedation at oral surgery clinic (determined by oral surgeon 

on-site) 

Page 21 of22 
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ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

USA 

Voice: 505-323-1300 

Fax: 505-323-1400 

Bill To: 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

Customer 10 

USPFOKY 

Sales Rep 10 . 

1.00 

Check/Credit Memo No: 

Invoice Number: 17823 

Invoice Date: 

Page: 

Sep 15, 2010 

1 

Customer PO 

W912KZ-10-F-0083 

Ship to: 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

.. 

Frankfort, KY 40601-6192 

Payment Terms 

Net 7 Da s 

Shipping Method Ship Date Due Date 

Courier 

KY SEPT. 11-12,2010 

CIN # W900D10231 01020003 

MINIMUM TREATMENTS 

DENTAL-FRANKFORT, KY SEPT. 11-12, 

2010 

CIN # W900D10231 01020004 

DISCOUNT AVAILABLE.5% 10 DAYS 

($261) 

Subtotal 

9/22/10 
FOIA Requested Record #FA-11-0070 

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ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

USA 

Voice: 505-323-1300 

Fax: 505-323-1400 

Bill To: 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

Customer ID 

USPFOKY 

Sales Rep 10 

O"onlliv 

1,00 

1,00 

Check/Credit Memo No: 

Item 

Customer PO 

W912 KZ-1 0-F-0083 

Shipping Method 

Courier 

.n 

Invoice Number: 17822 

Invoice Date: 

Page: 

Ship to: 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

Sep 15, 2010 

1 

. Payment Terms ' .. 

Net 7 Days 

Ship Date Due Date 

9/22/10 

FXAMS DENTAL-Gkt=t=",vILLE, 

CIN 

KYSEPT, 

# W900D102310102001 

11-12,2010 ""'-, --

MINIMUM TREATMENTS 

DENTAL-GREENVILLE, KY SEPT, 11-12, 

2010 

CIN # W900D1023101020002 

DISCOUNT AVAILABLE ,5% 10 DAYS 

($79,50) 

""hlnlol 10 Qnn nn 

Sales Tax 

Total Invoice Amn"n! 15,900,00 

Payment/Credit I 

TOTAL , 15,900.00 
FOIA Requested Record #FA-11-0070 

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ORDER FOR SUPPLIES OR SERVICES IPAGE 1 OF 21 

I. CONTRACTIPURCH. ORDER! 2. DELIVERY ORDERI CALL NO .DATE 14 ,REQ.lPURCH REQUEST NO. S. PRIORITY 

AGREEMENT NO. rYJTYMMMDD) 

V797P-7134A W912 KZ-1 O-F·OO55 2010JulO7 See Sohedule 

. ISSUED BY CODE I W912KZ 17. ADMINISTERED BY {Ifother (hall 6) CODE I 

USPFO FOR KENTUCKY 8. DELIVERY FOB 

BNGe, BLDG 120 SEE ITEM 6 ~ DESTINA T ION 120 MINUTEMAN PARKWAY 

FRANKFORT KY 40601-6192 OTHER 

(See Schedule if other) 

19. CONTRACTOR CODE [4HZ92 FACILITY I IO,DELIVER TO FOB POINTBY (Date) 11 MARK IF BUSINESS IS 

ACe CONSULTANTS INC (YrrfMMMDD) RSMALL SEE SCHEDULE 

NAME TODD BOWER SMALL )ED 

AND 9008 WASHINGTON ST NE I ~ [) 0-;;;;' .5%; N et 3~~1;'~; D1SADVANTAG 

ADDRESS ALBUQUERQUE NM 87113-2704 WOMEN-OWNED 

3. MAIL INVOICES TO THE IN BLOCK 

U~H**H*SEE BLOCK #6******" 

14.SHIP TO CODEI 15. PAYMENT WILL BE MADE BY CODE I W22QW6 

USPFO ACCOUNTS PAYABLE MARK ALL 

SEE SCHEDULE 120 MINUTEMAN PKWY PACKAGES AND FRANKFORT KY 40601 PAPERS W 1m 

IDENTIFICATION 

NUMBERS IN 

BLO CKS I AND 2. 

16. I~;;UVERY' X This delivery order/call is issued on anotherGovemment agency or in accordance with and subject to terms and conditions ofabove numbered contract. 

TYPE 

OF [PURCHASE Refuren quote dated 

10RDER I 'om;,h ,h. fullow;" 00 1,,= 'p.d'.d h",;,. REF, 

ACCEPT ANCE. T HE CONTRACTOR HEREBY ACCEPT S THE OFFER REPRESENT ED BY THE NUMBERED PURCHASE 

ORDER AS IT MA Y PREVIOUSLY HAVE BEEN OR IS NOW MODIFIED, SUBJECT TO ALL OF THE TERMS 

AND CONDIT IONS SET FORTH, AND AGREES T 0 PERFORM T HE SAME. 

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED 

o If this box is marked, supplier must sign Acceptance and return the nurn beT of copies: 

(rrrrMMMDD) 

17. i I H'iV AND APPROPRIAT ION OAT AI LOCAL USE 

See Schedule 

IS. ITEM NO. i9. SCHEDULE OF SUPPLIES/SERVICES 20. QUANTITY 

ORDERED/ 21. UNIT (22. UNIT PRICE 23. AMOUNT 

ACCEPTED+ 

SEE SCHEDULE 

I". UNncD 'TAT'S OF ,"oem 

If quanrlr)' 

. . 

acceptcd 

"die'" 

beloH' 

by 

qualltlty, 

rhr 

byX. 

G(J\'ernlllcnr 

Ifdiff",",. 

ts sallie 

""" 

I encircle. 

as 

"'",' 

ITEL...: 

~ BY, , / 

,~I~TOTAL 'OFm," . 12~ QUANTITY IN COLUMN 20 HAS BEEN 

DINSPECTED DRECEIVED D ACCEPTED, AND CONFORMS TO THE 

CONT RACT EXCEPT AS NOTED, 

'b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE c. DATE d. PRINTED NAME AND TITLE OF AUTHORIZED 

(YYYYMMMDD) GOVERNMENT REPRESENTATIVE 

e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENT AT IVE 128. SHIP NO. 29. DO VOUCHER NO 130 

INIT IALS 

B PARTIAL 

32. PAID BY 133.AMOUNT. VERIFIED 

r. TELEPHONE NUMBER [g. E·MAIL ADDRESS !CORRECT FOR 

FINAL 

~rtlIytl ds account Is CDrrect and prDper for paym ent. i. PAYMENT 34. CHECK NUMBER 

. DATE lb. SIGNATURE AND TITLE OF CERTIFYING OFFICER § COMPLETE 

PARTIAL 35. BILL OF LADING NO. 

FINAL 

7. RECEIVED AT 138. RECEIVED BY 9. DATE RECEIVED 140 TOT.U 41. SiR ACCOUNT NO 42. SIR VOUCHER NO. 

(nTYUU}.fDD) CONTA'h~o 

DD Form 1155, DEC 2001 PREVIOUS EDIT ION IS OBSOLETE. 

",, 
FOIA Requested Record #FA-11-0070 

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(b) (4)

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

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Section B - Supplies or Services and Prices 

ITEM NO SUPPLIES/SERVICES 

0001 

Dental Exam 

FFP 

QUANTITY 

660 

Dental Exam for 660 Class 4 Soldiers 

Per Proposal #RFQ471108 

Minimum of 660 soldiers 

UNIT 

Each 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900D I 0 131 0 I 03 

ACRNAA 

ClN: W900DIOl3101030001 

ITEM NO SUPPLIES/SERVICES 

0002 

Dental Treatment 

FFP 

QUANTITY 

760 

UNIT 

Each 

Dental Treatment for estimated 760 Class 3 Soldiers 

Per Proposal#RFQ47 I I 08 

Minimnm of760 soldiers 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900D I 0 131 0 I 03 

ACRNAA 

ClN: W900DlOl3101030002 

UNIT PRICE AMOUNT 

- -

NETAMT 

UNITPRlCE AMOUNT 

-

NETAMT 
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(b) (4)

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ITEM NO SUPPLIES/SERVICES 

0003 

Dental Exam 

FFP 

QUANTITY 

43 

Dental Exam for 43 Class 4 Soldiers 

Per Proposal #RFQ4711 08 

Minimum of 43 soldiers 

UNIT 

Each 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900D 1 0 131 0 1 04 

ACRNAB. 

CIN: W900DI013101040001 

ITEM NO SUPPLIES/SERVICES 

0004 

Dental Treatment 

FFP 

QUANTITY 

72 

UNIT 

Each 

Dental Treatment for estimated 72 Class 3 Soldiers 

Per Proposal#RFQ47 I I 08 

Minimum of72 soldiers 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900D I 0 131 0 1 04 

ACRNAB 

CIN: W900Dl 0 131 0 1 040002 

UNITPRlCE AMOUNT 

- -

NETAMT 

UNIT PRlCE AMOUNT 

- -

NETAMT 
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Section C - Descriptions and Specifications 

STATEMENT OF WORK 

STATEMENT OF WORK FOR DENTAL READINESS 

Introduction: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the 

basic principals of a ready force for Kentucky Army National Guard. Failure to maintain dental 

standards could preclude a soldier from deploying. Dental readiness is a command and soldier 

responsibility. This statement of work covers the dental components ofIMR!FMR to include: 

DENCLASS data entry of all dental records, treatment of all Class 3 soldiers on aleli orders 

andlor in conjunction with the ANG Selected Reserve Dental Readiness System. Services are to 

be completed on site at KY ARNG armories. The SOW identifies the purpose of the work to be 

performed by the contractor and provides a description of the work to be completed and the 

required outcomes. The contractor shall provide qualified persOlmel, material to perfOlTIl the 

services, and lor OSHA, HIPP A and Privacy Act Compliant Mobile depending on the individual 

site needed for the KY ARNG. 

DoD established a uniform dental classification in HA Policy 02-11. DoD policy requires dental 

screening examinations to be accomplished and documented on 90% of service members. 

Members of the KY ARNG shall receive an annual dental screening exam to determine their 

dental classification. Soldiers alerted andlor sourced are eligible for dental treatment if they are 

class 3 status from examination. Dental treatment that may be required is essential to be 

provided at the SRP site to ensure the highest Dental Deployment Rate for the mobili:<;ing 

soldiers. Objective: The contractor shall provide all management, labor, material, equipment, 

celiifications and supplies necessary to provide dental services at designated locations for the KY 

Army National Guard. These services will provide mandated dental treatment and proper 

documentation into the Soldier's dental record and data entry of all records into the DENCLASS 

system, as necessary to meet Department of the Army standards of dental readiness and 

deployability. The contractor will insure that their agents are appropriately trained and have 

access to the DEN CLASS system. 

Scope of Practice: Who: contracting personnel to suppOli dental treatment mission in order to 

conveli class 3 soldiers to class 2 soldiers in order to reach deployability standards lAW 

Appendix B, utilizing mobile treatment vans. What, When, and '''hcrc: See attached 

spreadsheet of layout of events. 

Health Services POC will be 

Dental treatment requirements as 

Jp.nlltv State Surgeon. 

A) Class 3 dental treatments for Soldiers andl or soldiers who are catorgized in SELRES 

program. Dental treatment authorized is outlined in Appendix E. Any treatment plan greater than 

$2,000.00 requires prior approval from SDO. These services will be completed by using 

contractor provided mobile dental van (unless otherwise specified in a separate written 

agreement). 

B) Specified Dental Specialty Services that requires SDO approval to include 
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I) Oral and Maxillofacial SurgelY (to include pathology reports if indicated) 

2) Endodontics 

3) Periodontics 

4) Prosthodontics 

5) Other (specify) 

C) Prescriptions for pharmaceuticals and controlled substances necessalY for the care and 

treatment to Soldiers throughout the event, to include but not limited to analgesics and 

antibiotics. Prescriptions for maintenance pharmaceuticals for Soldiers with high caries risk or 

periodontal disease, as indicated will be provided by contractor on site. Emphasis on pain 

control after topical analgesic has resolved. 

Upon completion of services, medical infoIDlation will be documented in accordance with 

Depmiment of the Army Policy and be updated in the approved AmIY National Guard automated 

system. The contractor shall also ensure the requirements of Occupational Safety and Health 

Administration (OSHA) and applicable Federal regulations are met. The contractor shall develop 

and maintain records that fully document serviced perfoIDled and names of soldiers referred to 

dental specialists. These records will be made available to the State/TelTitolY Medical 

representative. 

Documentation. All Soldiers must have a complete military dental record. The contractor 

shall provide electronic documentation (to include radiographs) in the ARNG approved system 

(within 24 hours of exam completion) and a paper copy as outlined below. A complete record 

includes the following: 

A. Militmy dental record jacket, DA Form 8005 through 8005-9 

B. The automated Health History Form or DA Form 5570 (with notations to "yes" answers 

and signed by both the Soldier and reviewing Doctor), Health Questionnaire envelope 

C. DD Form 2005 (signed), Privacy Act Statement 

D. SF 603/603A, Record of Dental Treatment 

E. Supporting radiographs (panoramic and diagnostic bitewing radiographs ((see 1.3.F)) 

documenting existing conditions) if necessary for treatment purposes 

(1) All radiographs will be uploaded into the ARNG automated system. 

(2) A diagnostic quality copy of all radiographs must be placed in the Dental Record. 

F. The entries on the SF 603/603A will include the following: date, location, comprehensive 

oral treatment completed, notation of current Dental Fitness Classification, listing of cUl1'ent oral 

condition (class 2 issues identified and a listing of class 3 treatment needs, if any), printed name 
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of examining dentist or dental officer and the dentist's or dental officer's signatnre/initials. 

These required dental documentation elements will be entered in the approved ARNG automated 

system, DEN CLASS and printed and placed into the dental record. 

Record Evaluation. Prior to dental treatment all service members who have a current dental 

exam and have been identified as a class 3, a record review will need to be performed to 

determine the amount of work hours required for those service members. A by name and time 

schedule will be given to state POC to allow for the commanders to better plan for the event. 

Work Guarantee. After completion of dental treatment, all dental work will be guaranteed by 

company completing work for up to one year for minor restorations and two years for major 

restorations. The SOO will coordinate with the general dentist perfol1uing treatment for any 

arbitration claims to determine if the problems relating to the dental treatment are in need of 

cOl1'ection. Health services will be notified of all initial problems to coordinate with SOO. 

GENERAL INFORMATION. 

QUALITY CONTROL. The contractor shall adopt a quality assurance program that monitors 

all service activities and ensures the highest quality customizable dental services available. It is 

the responsibility of the ARNG to review and approve dental treatment plans before treatment is 

performed based on the guidelines provided by NGB and the SOO. 

QUALITY ASSURANCE. The govermuent will periodically evaluate the contractor's 

performance in accordance with the Quality Assurance Surveillance Plan. 

GOVERNMENT REMEDIES. The contracting officer shall follow the requirements of FAR 

52.212-4, Contract Tenus and Conditions for Conl1l1ercial Items (May 1997), for contractor's 

failure to conect nonconforming services. 

HOURS OF OPERATION. The contractor shall have the capability of providing dental 

services seven days a week. The contractor will be able to work flexible hours to acconl1l1odate 

the commander's training plan. 

SECURITY REQUIREMENTS. Security will be in accordance with OD Form 254 

(Department of Defense Contract Security Classification Specification). 

SPECIAL QUALIFICATIONS. Contractor must maintain appropriate credentialing files on 

all employees to include but not limited to Licensure, National Provider Data Base Query results 

and HIPP A certification. 

PARTNERING AGREEMENT. The contracting officer may require a partnering agreement 

between the govermllent and the contractor to ensure joint cooperation and a sound patinership 

of all patiies involved in the execution of this contract. 
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Contractors will ensnre compliance with the following reqnirements prior to ntilizing any 

x-ray prodncing device on Soldiers; 

A. Have established written policies and procednres to assure compliance with applicable 

Federal, State, DOD, and Army radiation safety regnlations and directives. These 

docnments include staff emergency reaction plans, as necessaty, and procedures for investigating 

and reporting radiation accidents or incidents, possible radiation overexposnres to Soldier 

patients or contractor staff, and provisions to ensure the safe use of x-ray producing devices on 

humans. 

B. Upon request by the State/Tenitory representative, the contractor will provide 

documentation regarding the Contractor's employee radiation safety training commensurate 

with potential radiation hazards with the x-ray prodncing devices they are nsing. 

C. Upon request by the State/TerritOlY representative, the contractor will provide copies of 

a Qualified Health Physics Expert's acceptance test and most recent health physics survey of each 

diagnostic x-ray machine. The acceptance test and the most recent survey include tests of 

electrical, mechanical, image quality and radiation (output) dose tests or measurements. 

This also includes verification of the adequacy of radiation protection shielding in and 

around the X-ray machine and x-ray facility (e.g., mobile van). 

APPENDICES. 

A. Estimated Worlcload Data 

B. Dental Classification 

C. SF 603A and DA Form 5570 (Dental Classification Modnle Version) 

D. Government Furnished Property/Services/Eqnipment 

E. Anthorized Dental Treatment 
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APPENDIX A 

ESTIMATED WORKLOAD DATA 

The following data elements will be reported at the end of an event: 

Date 

Location 

List of contract employees (providers, dental technicians and administrative staff) 

Total number of patients scheduled 

Total number of patients examined 

Total number of Soldiers by dental classification: I, 2, 3 

Total number of bitewing radiographic sets taken 

Total number of panoramic radiographs taken 

Verification of entry into DA or ARNG automated systems 

A by name listing of all Soldiers examined and the dental classification of the Soldier 

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APPENDIXB 

Department of Defense 

Oral Health and Readiness Classification System 

The oral health status of uniformed persOlmel shall be classified as follows: 

A. Class I (Oral Health): Patients with a cutTent dental examination, who do not require 

dental treatment or reevaluation. Class 1 patients are worldwide deployable. 

b. Class 2: Patients with a cutTent dental examination, which require non-urgent dental 

treatment or reevaluation for oral conditions, which are unlikely to result in dental emergencies 

within 12 months. Class 2 patients are worldwide deployable. Patients in dental class 2 may 

. exhibit the following: 

(I) Treatment or follow-up indicated for dental caries or minor defective restorations that 

can be maintained by the patient. 

(2) Interim restorations or prosthesis that can be maintained for a 12 month period. This 

includes teeth that have been restored with permanent restorative materials for which protective 

cuspal coverage is indicated. 

(3) Edentulous areas requiring prostheses but not on an ilmllediate basis. 

(4) Periodotium that: 

(a) requires oral prophylaxis 

(b) requires maintenance therapy 

( c) requires treatment for slight to moderate periodontitis and stable cases of more 

advanced periodontitis 

(5) Unerupted partially erupted or malposed teeth that are without historical, clinical or 

radiographic signs or symptoms of pathosis, but which are reconmlended for prophylactic 

removal. 

(6) Active olihodontic treatment. The provider should consider placing the patient in 

passive appliances for deployment up to six months. For longer periods of deployment, the 

provider should consider removing active appliances and placing the patient in passive retention. 
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(7) Temporomandibular disorder patients in remission. The provider anticipates the 

patient can perform duties while deployed without ongoing care and any medications or 

appliances required for maintenance will not interfere with duties. 

c. Class 3: Patients who require urgent or emergent dental treatment. Class 3 patients 

normally are not considered to be worldwide deployable. 

(1) Treatment or follow-up indicated for dental caries, symptomatic tooth fracture or 

defective restorations that CalliOt be maintained by the patient. 

(2) Interim restorations or prostheses that cannot be maintained for a 12 month period. 

(3) Patients requiring treatment for the following periodontal conditions that may result in 

dental emergencies within the next 12 months. 

(a) Edentulous areas or teeth requiring immediate prosthodontic treatment for 

adequate mastication or communication or acceptable esthetics. 

(b) Active progressive moderate or advanced periodontitis. 

(c) Periodontontal abscess 

(d) Progressive mucogingival condition 

(e) Periodontal manifestations of systemic disease or hormonal disturbances 

(f) Heavy subgingival calculus 

(4) Edentulous areas or teeth requiring immediate prosthodontic treatment for adequate 

mastication or communication or acceptable esthetics. 

(5) Unerupted, partially erupted or malposed teeth with historical, clinical or radiographic 

signs or symptoms of pathosis that are recolmnended for removal. 

(6) Chronic oral infections or other pathologic lesions including: 

(a) Pulpal, periapical or resorptive pathology requiring treatment. 

(b) Lesions requiring biopsy or awaiting biopsy repOli. 

(7) Emergency situations requiring therapy to relieve pain, treat trauma, treat acute oral 

infections or provide timely follow-up care (e.g., drain or suture removalO until resolved. 
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(8) Acute Temporomandibular disorders requiring active treatment that may interfere 

with duties. 

d. Class 4. Patients who require periodic dental examinations or patients with unknown 

dental classifications. Class 4 patients normally are not considered to be worldwide deployable. 
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APPENDIXC 

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, . . . 
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APl'ENDIXD 

GOVERNMENT FURNISHED l'ROl'ERTY/SERVICESIEQUIPMENT 

1. General. The Government will provide the following resources: 

2. Facilities, Supplies, and Services. Space for set-up of an administrative area and utilities. 

Mobile units, provided by the contractor, will be utilized for dental treatment unless otherwise 

specified in the contract. 

3. Information. The Govel11ment will provide the following information: 

a. Soldier's dental records if applicable. 

4. The User Agency will provide initial familiarization/orientation. Standard Operational 

Procedures will be available to the contractor at the place of perfot111ance. 
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APPENDIXE 

AUTHORIZED DENTAL TREATMENT 

I. The foHowing dental procedures are authorized: 

(a) Diagnostic Services which are funded through NG6H 2065 Medical Readiness Funding: 

D0120-Periodic Oral Evaluation 

DO I 50-Comprehensive Oral Evaluation 

D0330-Panoramic Film 

D0272-Bitewings-Two Films 

D0274-Bitewings-Four Films 

D0220/D0230- Periapical (limited) 

(b) Restorative Services which are funded through the VFRE 2020 Dental Treatment Funding 

(provided only to soldiers alerted to an OCONUS Mission): 

D2140-Amalgam-One Surface 

D2 I 50-Amalgam-Two Surfaces 

D2160-Amalgall1-Three Surfaces 

D2161-Amalgall1-Four or More Surfaces 

D2330-Composite-One Surface 

D2331-Composite-Two Surfaces 

D2332-Coll1posite-Three Surfaces 

Posterior composites will be authorized only when a posterior composite is necessary to 

proyide a quality restoration and no other alternative is available. 

D2335-Composite-Four or More Surfaces 

D2391-Coll1posite-One Surface 

D2392-Composite-Two Surfaces 

D2393-Composite-Three Surfaces 

D2394-Composite-Four or More Surfaces 

D2799-Provisional Crown 

D293 I-Prefabricated Stainless Steel Crown 

D2950-Core Buildup, including any pins 

D2954-Prefabricated Post and Core 

(c) Endodontic Services which are funded through the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers alerted to an OCONUS Mission): 

D331 O-Anterior Root Canal Therapy 

D3320-Bicuspid Root Canal Therapy 
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D3330-Molar Root Canal Therapy 

D3346-Anterior Root Canal Retreatment 

D3347-Bicuspid Root Canal Retreatment 

D3348-Molar Root Canal Retreatment 

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(d) Periodontal Services which are funded through the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers aletied to an OCONUS Mission): 

D4355-Full Mouth Debridement 

D4342-Pel'iodontal Scaling and Root Planing, 1 to 3 teeth per quadrant 

Periodontal scaling and root planing is authorized only when a periodontal abscess is 

present and SDO approves 

(e) Prosthodontic Services which are funded through the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers aletied to an OCONUS Mission): 

D511 O-Complete Denture-Maxillary 

D5l20-Complete Denture-Mandibular 

D521l-Maxillmy Partial Denture-Resin Base 

D5212-Mandibular Pmiial Denture-Resin Base 

(f) Oral Surgety Services which are funded through the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers aletied to an OCONUS Mission): 

D7140-Extraction, Erupted Tooth or Exposed Root 

D721 O-Surgical Removal of Erupted Tooth 

D7220-Romoval ofImpacted Tooth, Soft Tissue 

D7230-Removal ofImpacted Tooth, Patiial Bony 

D7240-Removal ofImpacted Tooth, Completely Bony 

(g) Orthodontic Services which are funded through the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers aletied to an OCONUS Mission): 

D8680-0tihodontic Retention 

2. The following dental procedures are not authorized: 

Bridges and/or implants 

Removal of Asymptomatic third molars 

Routine Prophylaxes (cleanings) 

Restorations for aesthetics only 

Restorations for small (non-class 3) caries 

Extensive Root plane/scaling 
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Osseous Surgery 

Other diagnostic services 

The above listings are guides to assist the State Dental Officer 01' his/her designee in 

determining treatment to be authorized. The treatment provided by the ARNG is to get the 

Soldier from a dental class 3 to a dental class 2 only. Comprehensive Treatment (to dental 

class I) is not authodzed. 

3. If a Soldier needs all of his/her remaining teeth in an arch extracted and a denture placed, the 

Soldier will not be available for deployment for at least 6 months and shall be disqualified from 

immediate deployment. However, if the Soldier is otherwise deployable (passes all medical, 

personnel and training requirements) and, after extraction and placement of prosthesis, would be 

deployable, the dental treatment could be provided and the Soldier could be considered as a 

replacement at a later date. 

4. If a Soldier will have a number of teeth extracted to the extent mastication and speech are 

adversely affected, then an acrylic removable paliial denture will be authorized if there is 

sufficient time for healing and construction of the paliial denture prior to depatiure to 

Mobilization Station. 

5. Soldiers requiring extensive periodontal treatment will be disqualified from deployment and 

educated on the TRICARE Dental Program. If he/she obtains the required therapy (from his/her 

private dental provider) and reaches a maintenance level, then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental treatment plan 

for dental care which exceeds $2000 to insure that the above clinical guidelines are met. 

Exceptions can be made, but they must be coordinated with the State Surgeon. 
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Section E - Inspection and Acceptance 

INSPECTION AND ACCEPTANCE TERlvIS 

Supplies/services will be inspected/accepted at: 

CLlN 

0001 

0002 

0003 

0004 

INSPECT AT 

N/A 

N/A 

N/A 

N/A 

INSPECT BY 

N/A 

N/A 

N/A 

N/A 

ACCEPT AT 

N/A 

N/A 

N/A 

N/A 

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ACCEPT BY 

Government 

Government 

Government 

Government 
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Section F - Deliveries or Perfonnance 

DELIVERY INFORMATION 

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS UIC 

0001 POP 10-JUL-2010 TO N/A WENDELL FORD REGIONAL TRAINING W22MQV 

13-AUG-20 1 0 

BUILDING 332 

GREENVILLE KY 42345 

270-338-8947 

FOB: Destination 

0002 POP 10-JUL-2010 TO N/A (SAME AS PREVIOUS LOCATION) W22MQV 

13-AUG-2010 FOB: Destination 

0003 POP 28-JUL-2010 TO N/A ARMED FORCES RESERVE CENTER 

29-JUL-20 1 0 

233 BATTLE FIELD MEMORJAL HWY 

RICHMOND KY 40475-8338 

502-607-2738 

FOB: Destination 

0004 POP 28-JUL-2010 TO N/A (SAME AS PREVIOUS LOCATION) 

29-JUL-20 1 0 FOB: Destination 
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(b) (4)

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Section G - Contract Administration Data 

ACCOUNTING AND APPROPRIATION DATA 

AA: 2 J 0206j5~00iiO~OiiO J~8i1J 0,15 133G92R300026EB44KMOEW900D J 0 J 3 J 0 1 03KMOE440 15058 

AMOUNT: 

CIN W900DI013101030001: 

CIN W900D 1 0 131 01'030'002: 

J 35G680000026EB44KM2GII'900D J 0 J 31 0 I04KM2G44015058 
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STATEMENT OF WORK FOR DENTAL READINESS 

Introduction: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the 

basic principals of a ready force for Kentucky Army National Guard. Failure to maintain dental 

standards could preclude a soldier from deploying. Dental readiness is a command and soldier 

responsibility. This statement of work covers the dental components ofIMRJFMR to include: 

DENCLASS data entry of all dental records, treatment of all Class 3 soldiers on alert orders 

andlor in conjunction with the ANG Selected Reserve Dental Readiness System. Services are to 

be completed on site at KYARNG armories. The SOW identifies the purpose of the work to be 

performed by the contractor and provides a description of the work to be completed and the 

required outcomes. The contractor shall provide qualified persorlllel, material to perform the 

services, and lor OSHA, HIPP A and Privacy Act Compliant Mobile depending on the individual 

site needed for the KY ARNG. 

DoD established a uniform dental classification in HA Policy 02-11. DoD policy requires dental 

screening examinations to be accomplished and documented on 90% of service members. 

Members of the KYARNG shall receive an annual dental screening exam to determine their 

dental classification. Soldiers alelied andlor sourced are eligible for dental treatment ifthey are 

class 3 status from examination. Dental treatment that may be required is essential to be 

provided at the SRP site to ensure the highest Dental Deployment Rate for the mobilizing 

soldiers. Objective: The contractor shall provide all management, labor, material, equipment, 

certifications and supplies necessary to provide dental services at designated locations for the 

KY Army National Guard. These services will provide mandated dental treatment and proper 

documentation into the Soldier's dental record and data entry of all records into the DENCLASS 

system, as necessary to meet Depaliment of the Army standards of dental readiness and 

deployability. The contractor will insure that their agents are appropriately trained and have 

access to the DENCLASS system. 

Scope of Practice: Who: contracting personnel to suppOli dental treatment mission in order to 

convert class 3 soldiers to class 2 soldiers in order to reach deployability standards lAW 

Appendix B, utilizing mobile treatment vans. What, When, and Where: See attached 

spreadsheet of layout of events. 

Health Services POC will Deputy State Surgeon. 

A) Class 3 dental treatments for Soldiers andl or soldiers who are catorgized in SELRES 

program. Dental treatment authorized is outlined in Appendix E. Any treatment plan greater than 

$2,000.00 requires prior approval from SDO. These services will be completed by using 

contractor provided mobile dental van (unless otherwise specified in a separate written 

agreement). 

B) Specified Dental Specialty Services that requires SDO approval to inclnde 

I) Oral and Maxillofacial Surgery (to include pathology repOlis if indicated) 

2) Endodontics 
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3) Periodontics 

4) Prosthodontics 

5) Other (specify) 

C) Prescriptions for pharmaceuticals and controlled substances necessary for the care and 

treatment to Soldiers tlHoughout the event, to include but not limited to analgesics and 

antibiotics. Prescriptions for maintenance pharmaceuticals for Soldiers with high caries risk or 

periodontal disease, as indicated will be provided by contractor on site. Emphasis on pain 

control after topical analgesic has resolved. 

Upon completion of services, medical infOlmation will be documented in accordance with 

Department of the Army Policy and be updated in the approved Army National Guard automated 

system. The contractor shall also ensure the requirements of Occupational Safety and Health 

Administration (OSHA) and applicable Federal regulations are met. The contractor shall develop 

and maintain records that fully document serviced performed and names of soldiers refened to 

dental specialists. These records will be made available to the State/Territory Medical 

representative. 

Documentation. All Soldiers must have a complete military dental record. The contractor 

shall provide electronic documentation (to include radiographs) in the ARNG approved system 

(within 24 hours of exam completion) and a paper copy as outlined below. A complete record 

includes the following: 

A. Military dental record jacket, DA Form 8005 through 8005-9 

B. The automated Health History Form or DA Form 5570 (with notations to "yes" answers 

and signed by both the Soldier and reviewing Doctor), Health Questionnaire envelope 

C. DD Form 2005 (signed), Privacy Act Statement 

D. SF 603/603A, Record of Dental Treatment 

E. Supporting radiographs (panoramic and diagnostic bitewing radiographs ((see 1.3.F» 

documenting existing conditions) if necessary for treatment purposes 

(1) All radiographs will be uploaded into the ARNG automated system. 

(2) A diagnostic quality copy of all radiographs must be placed in the Dental Record. 

F. The entries on the SF 603/603A will include the following: date, location, comprehensive 

oral treatment completed, notation of current Dental Fitness Classification, listing of current oral 

condition (class 2 issues identified and a listing of class 3 treatment needs, if any), printed name 

of examining dentist or dental officer and the dentist's or dental officer's signature/initials. 

These required dental documentation elements will be entered in the approved ARNG automated 

system, DENCLASS and printed and placed into the dental record. 
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Record Evaluation. Prior to dental treatment all service members who have a current dental 

exam and have been identified as a class 3, a record review will need to be performed to 

determine the amount of work hours required for those service members. A by name and time 

schedule will be given to state POC to allow for the commanders to better plan for the event. 

Work Guarantee. After completion of dental treatment, all dental work will be guaranteed by 

company completing work for up to one year for minor restorations and two years for major 

restorations. The SDO will coordinate with the general dentist performing treatment for any 

arbitration claims to determine if the problems relating to the dental treatment are in need of 

correction. Health services will be notified of all initial problems to coordinate with SDO. 

GENERAL INFORMATION. 

QUALITY CONTROL. The contractor shall adopt a quality assurance program that monitors 

all service activities and ensures the highest quality customizable dental services available. It is 

the responsibility of the ARNO to review and approve dental treatment plans before treatment is 

performed based on the guidelines provided by NOB and the SDO. 

QUALITY ASSURANCE. The government will periodically evaluate the contractor's 

performance in accordance with the Quality Assurance Surveillance Plan. 

GOVERNMENT REMEDIES. The contracting officer shall follow the requirements of FAR 

52.212-4, Contract Terms and Conditions for Commercial Items (May 1997), for contractor's 

failure to correct nonconforming services. 

HOURS OF OPERATION. The contractor shall have the capability of providing dental 

services seven days a week. The contractor will be able to work flexible hours to accommodate 

the commander's training plan. 

SECURITY REQUIREMENTS. Security will be in accordance with DD Form 254 

(Department of Defense Contract Security Classification Specification). 

SPECIAL QUALIFICATIONS. Contractor must maintain appropriate credentialing files on 

all employees to include but not limited to Licensure, National Provider Data Base Query results 

and HIPPA celtification. 

PARTNERING AGREEMENT. The contracting officer may require a pminering agreement 

between the government and the contractor to ensure joint cooperation and a sound partnership 

of all pmiies involved in the execution of this contract. 

Contractors will ensure compliance with the following requirements prior to utilizing any 

x-ray producing dcvice on Soldicrs; 

A. Have established written policies and procedures to assure compliance with applicable 

Federal, State, DOD, and Army radiation safety regulations and directives. These 
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documents include staff emergency reaction plans, as necessary, and procedures for investigating 

and reporting radiation accidents or incidents, possible radiation overexposures to Soldier 

patients or contractor staff, and provisions to ensure the safe use of x-ray producing devices on 

humans. 

B. Upon request by the State/Te11'itory representative, the contractor will provide 

documentation regarding the Contractor's employee radiation safety training commensurate 

with potential radiation hazards with the x-ray producing devices they are using. 

C. Upon request by the State/Te11'itory representative, the contractor will provide copies of 

a Qualified Health Physics Expert's acceptance test and most recent health physics survey of 

each diagnostic x-ray machine. The acceptance test and the most recent survey include tests of 

electrical, mechanical, image quality and radiation (output) dose tests or measurements. 

This also includes verification of the adequacy of radiation protection shielding in and 

around the X-ray machine and x-ray facility (e.g., mobile van). 

APPENDICES. 

A. Estimated Workload Data 

B. Dental Classification 

C. SF 603A and DA Form 5570 (Dental Classification Module Version) 

D. Government Furnished Property/Services/Equipment 

E. Authorized Dental Treatment 
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APPENDIX A 

ESTIMATED \VORKLOAD DATA 

The following data elements will be reported at the end of an event: 

Date 

Location 

List of contract employees (providers, dental technicians and administrative staff) 

Total number of patients scheduled 

Total number of patients examined 

Total number of Soldiers by dental classification: 1,2,3 

Total number of bitewing radiographic sets taken 

Total number of panoramic radiographs iaken 

Verification of entry into DA or ARNG automated systems 

A by name listing of all Soldiers examined and the dental classification of the Soldier 
FOIA Requested Record #FA-11-0070 

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APPENDIXB 

Department of Defense 

Oral Health and Readiness Classification System 

The oral health status of uniformed personnel shall be classified as follows: 

A. Class 1 (Oral Health): Patients with a current dental examination, who do not 

require dental treatment or reevaluation. Class I patients are worldwide deployable. 

b. Class 2: Patients with a cunent dental examination, which require non-urgent 

dental treatment or reevaluation for oral conditions, which are unlikely to result in dental 

emergencies within 12 months. Class 2 patients are worldwide deployable. Patients in 

dental class 2 may exhibit the following: 

(1) Treatment or follow-up indicated for dental caries or minor defective 

restorations that can be maintained by the patient. 

(2) Interim restorations or prosthesis that can be maintained for a 12 month 

period. This includes teeth that have been restored with permanent restorative materials 

for which protective cuspal coverage is indicated. 

(3) Edentulous areas requiring prostheses but not on an immediate basis. 

(4) Periodotium that: 

(a) requires oral prophylaxis 

(b) requires maintenance therapy 

(c) requires treatment for slight to moderate periodontitis and stable cases 

of more advanced periodontitis 

(5) Unerupted partially erupted or malposed teeth that are without historical, 

clinical or radiographic signs or symptoms of pathosis, but which are recommended for 

prophylactic removal. 

(6) Active olthodontic treatment. The provider should consider placing the 

patient in passive appliances for deployment up to six months. For longer periods of 

deployment, the provider should consider removing active appliances and placing the 

patient in passive retention. 

(7) Temporomandibular disorder patients in remission. The provider anticipates 

the patient can perform duties while deployed without ongoing care and any medications 

or appliances required for maintenance will not interfere with duties. 
FOIA Requested Record #FA-11-0070 

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c. Class 3: Patients who require urgent or emergent dental treatment. Class 3 patients 

normally are not considered to be worldwide deployable. 

(1) Treatment or follow-up indicated 'for dental caries, symptomatic tooth fracture 

or defective restorations that cannot be maintained by the patient. 

(2) Interim restorations or prostheses that cannot be maintained for a 12 month 

period. 

(3) Patients requiring treatment for the following periodontal conditions that may 

result in dental emergencies within the next 12 months. 

(a) Edentulous areas or teeth requiring immediate prosthodontic treatment 

for adequate mastication or communication or acceptable esthetics. 

(b) Active progressive moderate or advanced periodontitis. 

( c) Periodontontal abscess 

(d) Progressive mucogingival condition 

(e) Periodontal manifestations of systemic disease or h0I111onal 

disturbances 

(f) Heavy subgingival calculus 

(4) Edentulous areas or teeth requiring immediate prosthodontic treatment for 

adequate mastication or communication or acceptable esthetics. 

(5) Unerupted, partially erupted or malposed teeth with historical, clinical or 

radiographic signs or symptoms of pathosis that are recommended for removal. 

(6) Chronic oral infections or other pathologic lesions including: 

(a) Pulpal, periapical or resorptive pathology requiring treatment. 

(b) Lesions requiring biopsy or awaiting biopsy repOli. 

(7) Emergency situations requiring therapy to relieve pain, treat trauma, treat 

acute oral infections or provide timely follow-up care (e.g., drain or suture removalO until 

resolved. 

(8) Acute Temporomandibular disorders requiring active treatment that may 

interfere with duties. 
FOIA Requested Record #FA-11-0070 

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d. Class 4. Patients who require periodic dental examinations or patients with 

unlalO\\~l dental classifications. Class 4 patients normally are not considered to be 

worldwide deployable. 
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APPENDIXC 

!-lEAL 11-1 OlJf.S1 K1NIIAUW.kiR IlE.NIAL 1 RE.A 1MI!>.'l'f H.H tUl IJ'UI~" (1...1111, :+AH .tP.4;'8:!, UN IJrq::u\~llHf1m.:( I~ ill, (:~Ul uiLllY S.J~.IILHlI::MI~HI 

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DOEJOHtl 111111111 

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.r~!A~;E A (HE:'?: ...... ' "!8E YES 08,"~~)C';)LU.lrl\' ";£~!i rt:..~ 

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L7.TE £; ';"f.I.r. TlJFE .::.= f·J.II8'~T 

L.;t,1~ :.; ·,.;.r4].IIJIt !.:of- U.X: I r...l1 

f(S~HE,::·.'< 

-", TE O"',('T{'P::;::': ,''J'j en t:r.:; Po EM"" KS 

... 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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_~_~~ L l~!';_~',,-I_~~_J:~%lI"~ In .... uvl·HI M'.:r"'JJI~ hlr.Jr.l'l-t1 ~N:!!.I~' I 

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sr I rSR 

!lWX 6 J'N ;«!'. J'.ILX T'.'''-\'X I~ l"~ ~{ .. " ':. Z.f"-f.~1 ~Drl"L1:-::~VI!: WNL: [YEJI No .:;:: :!. 1 

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'11:)[lA("(·'): m£I ::'''.uk. Cli~w DotJ. 

1.---------------------1 ,::fh':-l d '!ilL' £:riJ.lJ 8MIIJI:o'.JF, _\;!\ ~\r~~.G 

Il.!OPA""T.!!.IF"'~T2'_'_'N"'.,_'_'/rc...: ,""O"'Q""f;,"".J.g"'l:l"-'t.,.l...... ,~_,u.,,.,'",C'- .• '"', .. "" ..... "'--'-. ~_~.,~C~~_[ll«~1Jjt1JJul.L-l ___ -l ~r 'KIl A -u tt"P_lm.-:II1-a:n..... 
FOIA Requested Record #FA-11-0070 

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APPENDIXD 

GOVERNMENT FURNISHED PROPERTY/SERVICESIEQUIPMENT 

1. General. The Government will provide the following resources: 

2. Facilities, Supplies, and Sen'ices. Space for set-up of an administrative area and 

utilities. Mobile units, provided by the contractor, will be utilized for dental treatment 

unless otherwise specified in the contract. 

3. Information. The Government will provide the following information: 

a. Soldier's dental records if applicable. 

4. The User Agency wiII provide initial familiarization/orientation. Standard 

Operational Procedures will be available to the contractor at the place of performance. 
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APPENDIXE 

AUTHORIZED DENTAL TREATMENT 

I, The following dental procedures are authorized: 

(a) Diagnostic Services which are funded through NG6H 2065 Medical Readiness 

Funding: 

DO 120-Periodic Oral Evaluation 

DO ISO-Comprehensive Oral Evaluation 

D0330-Panoramic Film 

D0272-Bitewings-Two Films 

D0274-Bitewings-Four Films 

D0220ID0230- Periapical (limited) 

(b) Restorative Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to soldiers aIetted to an OCONUS Mission): 

D2140-Amalgam-One Surface 

D2150-Amalgam-Two Surfaces 

D2160-Amalgam-TIU'ee Surfaces 

D2 16 I-Amalgam-Four or More Surfaces 

D2330-Composite-One Surface 

D2331-Composite-Two Surfaces 

D2332-Composite-Tlu'ee Surfaces 

Posterior composites will be authorized only when a posterior composite is 

necessalY to provide a quality restoration and no other alternative is available. 

D2335-Composite-Four or More Surfaces 

D2391-Colllposite-One Surface 

D23 92-Composite-Two Surfaces 

D2393-Colllposite-Tln'ee Surfaces 

D23 94-Composite-Four or More Surfaces 

D2799-Provisional Crown 

D2931-Prefabricated Stainless Steel Crown 

D2950-Core Buildup, including any pins 

D2954-Prefabricated Post and Core 

( c) Endodontic Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alerted to an OCONUS Mission): 

D331 O-Anterior Root Canal Therapy 

D3320-Bicuspid Root Canal Therapy 

D3330-Molar Root Canal Therapy 
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D3346-Anterior Root Canal Retreatment 

D3347-Bicnspid Root Canal Retreatment 

D3348-Molar Root Canal Retreatment 

(d) Periodontal Services which are funded tlll'ough the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alerted to an OCONUS Mission): 

D4355-Full Mouth Debridement 

D4342-Periodontal Scaling and Root Planing, 1 to 3 teeth per quadrant 

Periodontal scaling and root planing is authorized only when a periodontal abscess 

is present and SDO approves 

(e) Prosthodontic Services which are funded throngh the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alerted to an OCOl\TUS Mission): 

D 511 O-Complete Denture-Maxillary 

D5120-Complete Denture-Mandibular 

D5211-Maxillary Pmiial Denture-Resin Base 

D5212-Mandibular Partial Denture-Resin Base 

(f) Oral Surgery Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alelied to an OCOl\TUS Mission): 

D7140-Extraction, ElUpted Tooth or Exposed Root 

D7210-Surgical Removal of Erupted Tooth 

D7220-Romoval ofImpacted Tooth, Soft Tissue 

D7230-Removal ofImpacted Tooth, Pmiial Bony 

D7240-Removal ofImpacted Tooth, Completely Bony 

(g) Olihodontic Services which are funded tln·ough the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alelied to an OCONUS Mission): 

D8680-01ihodontic Retention 

2. The following dental procedures are not authorized: 

Bridges and/or implants 

Removal of Asymptomatic third molars 

Routine Prophylaxes (cleanings) 

Restorations for aesthetics only 

Restorations for small (non-class 3) caries 

Extensive Root plane/scaling 

Osseous Surgery 

Other diagnostic services 
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The above listings are gnides to assist the State Dental Officer or his/her designee in 

determining treatment to be authorized. The treatment provided hy the ARNG is to 

get the Soldier from a dental class 3 to a dental class 2 only. Comprehensive 

Treatment (to dental class J) is not authorized. 

3. Ifa Soldier needs all of his/her remaining teeth in an arch extracted and a denture 

placed, the Soldier wiII not be available for deployment for at least 6 months and shall be 

disqualified from inIDlediate deployment. However, if the Soldier is otherwise 

deployable (passes all medical, personnel and training requirements) and, after extraction 

and placement of prosthesis, would be deployable, the dental treatment could be provided 

and the Soldier could be considered as a replacement at a later date. 

4. If a Soldier wiII have a number of teeth extracted to the extent mastication and speech 

are adversely affected, then an acrylic removable partial denture wiII be authorized if 

there is sufficient time for healing and constlUction of the pm1ial denture prior to 

departure to Mobilization Station. 

5. Soldiers requiring extensive periodontal treatment wiII be disqualified from 

deployment and educated on the TRICARE Dental Program. If he/she obtains the 

required therapy (from his/her private dental provider) and reaches a maintenance level, 

then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental 

treatment plan for dental care which exceeds $2000 to insure that the above clinical 

guidelines are met. Exceptions can be made, but they must be coordinated with the State 

Surgeon. 
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START DATE END DATE UNIT LOCATION CLASS III CLASS IV 

lO-Jul-lO 18-Jul-1O 138TH GREENVILLE 161 261 

19-Jul-10 23-Jul-10 2/138TH GREENVILLE 97 308 

24-Jul-10 13-Aug-10 149TH GREENVILLE 238 91 

28-Jul-1O 29-Jul-10 1204TH BGAD 55 43 
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RFQ -Summary Page 1 of2 

GSA Advantage! Ie-Library 

Forward RFQ 

were notified 

Reference # 

W9100D101310103 

NT i 

Delivery Days 

Period of Performance 07/10/2010 I through 08/13/2010 

RFQ Close Date I 

:59 AM EDT 06/28/201002:00:00 PM EDT 

Manufacturer Product/Service Name Qty Unit Ship Address 

 10-29 July Class 3 Soldiers 496 EA 2 

 10-29 July Class 4 Soldiers 660 EA 2  BGAD 28-29 July Class 3 Soldiers 55 EA 3 

 BGAD 28-29 July Class 4 Solders 43 EA 3 

or proposal for dental treatment for approximately 551 Class 3 and 703 Class 4 soldiers. Work is to be 

TRC in Greenville Ky from 10 July - 13 August 2010 (See Schedule) and Bluegrass Army Depot, 

 28-29. Soldiers will be onsite training during times stated in schedule. Selected offeror will provide 

ers to receive treatment during that time. All treatment/services will be completed in a mobile vehicle or 

the offeror. Offeror will provide all equipment and personell as stated in the SOW. See attachment for 

l information. Award will be made to the lowest priced, technically acceptable offer. Award will include a 

n total number of soldiers. 

 

k 

age.gov/advgsaJadvantage/ebuylbuyer/rfCLsummary.do ?BV _ UseBV Cookie= Y es&rfqld=RFQ4 71 108 9117/2010 
FOIA Requested Record #FA-11-0070 

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

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

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RFQ - Summary 

cky: 

(2) WHFRTC: 

WHFRTC 

HWY 181 N 

GREENVILLE, 

KY 42345 

(3) ARMED FORCES RESERVE: 

1204TH ASB 

BLUEGRASS 

ARMY DEPOT 

233 BATTLE 

FIELD 

MEMORIAL 

Richmond, KY 

40475-8338 

?BV _ U seBVCookie= Y es&rfqld=RFQ4 71108 

Page 2 of2 

9117/2010 
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(b) (6) (b) (6) (b) (6)

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Ace Consultants, Inc. 

-

l\e"tllcl~)l Army N((tiuJlal Guard 

Delltal Readilless 

IIFQ471108 

Thank you for this oppOltunity to submit a quote for dental treatment for the Kentucky Army National 

Guard to be provided at WHFTRC in Greenville, Kentucky from July lOth -August 13 th and the Blue Grass 

Army Depot in Richmond, KentucL-y from July 28th -July 29th. 

ACC Consultants, Inc brings 19 years of providing SUppOlt services to govel'llll1ent agencies. ACC offers a 

thorough understanding of individual medical readiness (IMR) and fully medical ready (FMR) 

requirements and standards. ACC understands the training demands placed on soldiers and individual 

units, and has developed time-tested and fully documented policies and procedures to ensure maximum 

support with minimal impact on the unit training assembly. ACC also has an ongoing working relationship 

and excellent rapP0l1with ASM Research, the developer and maintainer ofMEDPROS, DENCLASS, and 

other related support applications. ACC is GSA certified. ACC has the availability of the items and 

services indicated in the SOW and is prepared to begin the contract on the delivery date indicated in 

the SOW. 

Included in our proposal is our teclmical response, an explanation of how ,ve will deliver services, licensing 

and certification information, portable equipment and portable building capabilities, pricing information, 

and detailed past performances related to the dental needs for KY ARNG. 

Should you have any further questions, please contact: 

Ginny Berger 

CEO 

ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323-1300 X 681 

ginny@accdental.com 

Todd Bower 

Manager of Business Development 

A CC Consultants, Inc 

(505)323-1300 X 682 

to d d@accdental.com 

Page 1 of23 
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ACC Consultants, fllc. 

June 28, 20 I 0 

2:00PM 

RFQ47 I 108 

Dental Exams and Treatment 

Kentucky Army National Guard 

ACC Consultants, Inc. 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323-1300 

accdentaJ.com 

llel1fllc/(}~ Arm)' NflfioJ1a{ Guard 

Dental Readilless 

RFQ471108 

ACC Consultants, Inc. is registered with CCR 

CAGEfNCAGE Code: 4HZ92 

DUNS #: 624343463 

GSA Contract #: V797P-7134A 

Expires: 1113012012 

Woman Owned 

Small Business 

Page 2 of23 
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A CC Consultants, fllc. Kelltllcky Army N({tional Guart! 

Table of Contents 

Delllal [{(!([(/hzess 

RFQ471108 

Dental Technical Description _____________________ ,4 

Mobile/Portable Dental Capabilities ___________________ 7 

Representations and Certifications, ___________________ 8 

Case Management Capabilities (Dental) _________________ 8 

Dental Licensing and Certification, ___________________ 9 

Personnel Qua Ii fications, _______________________ l 0 

Dental Radiation Compliance _____________________ lO 

Dental Itemized Pricing, _______________________ 13 

Dental Treatment Fee Schedule (Appendix A) _______________ 15 

Past Performances _________________________ 18 

Certificate of Liability _______________________ 23 

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(b) (4)

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ACC COllsurtants, Inc. 

Dental Technical Descl'iption 

Page 4 of23 

Ilel1tnc/(p Army Natiollal Guard 

Delila/ Rt!([(/iJl(!,\'s 

RFQ47110S 
FOIA Requested Record #FA-11-0070 

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(b) (4)

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ACC Consultants, Inc. 

Page 5 of23 

l(el1tucl(F Army Natiol1al GUll!'d 

Dell/al Readiness 

RFQ471108 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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(b) (4)

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June 22, 2011

ACC Consultants, file. 

Page 6 of23 

Jlellt/leky Arm)' National Guard 

Delltal Readiness 

RFQ471108 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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(b) (4)

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ACC Consultants, fnc. 

·Greenville 1381h (July 10-18): quantity (3) bldgs 

llelltlldy Army Natiol1al Guard 

DClllat Readiness 

RFQ471I118 

-Greenville 2/1381h (July 19-23): quantity (4) bldgs- add one bldg to the bldgs previously delivered for 

fu·st event- (delivery of the additional bldg on the July 17ili) 

-Greenville 1491h (July 24-August 13): quantity (4) buildings 

-Richmond BGAD (July 28-29): quantity (4) buildings 

Size 

• 60' Long 

• 12' Wide 

• 8' Ceiling height 

Interior Finish 

· Paneled walls 

• Vinyl tile floors 

• Pre-fmished ceiling 

Electric 

• Fluorescent ceiling lights 

• 100 amp Breaker panel 

\VindowslDoors 

• Horizontal slider windows 

• Steel door with commercial grade lock 

Heating and Cooling 

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(b) (4)

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ACC COllsu/tants, Illc. keJltllc/O~ A rilly Natio11al Guard 

Dell tal Readiness 

IIFQ471108 

• Thermostatically controlled central HV AC unit 

• Supply ducted 

Exterior FinishlFl'ame 

• Wood siding 

• I-Beam frame 

• Standard drip rail gutters 

Offeror Representations and Certifications 

52.212-3 Offeror Representations and Certifications - Commercial Items (JUN 2008) 

(b) (I) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b) 

(2) of this provision do not automatically change the representations and celtifications posted on the Online 

Representations and Certifications Application (ORCA) website. 

(2) The offeror has completed the annual representations and certifications 

electronically via the ORCA website at http://orca/bpn.gov. After reviewing the 

ORCA data base information, the offeror verifies by submission of this offer that 

the representation and certifications currently posted electronically at FAR 

52.212-3, Offeror Representations and Certifications-Commercial Items, have been 

entered or updated in the last 12 months, are current, accurate, complete, and applicable 

to this solicitation (including the business size standard applicable to the NArCS code 

referenced for this solicitation), as of tile date of this offer and are incorporated in this 

offer by reference (see FAR 4.120 I), except for paragraphs N/A. [Offeror to 

identify the applicable paragraphs at (c) through (m) of this provision that the offeror has 

completed for the purposes of this solicitation only, if any. These amended 

representation(s) andlor certification(s) are also incorporated in this offer and are cun'ent, 

accurate, and complete as of the date of this offer. Any changes provided by the offeror 

are applicable to this solicitation only, and do not result in an update to the 

representations and certifications posted on ORCA.) 

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(b) (4)

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ACC Consultants, Inc. 

Dental Licensing and certification 

Page 9 of23 

A'eJlfflc/\Y A rilly NMiollal Guard 

{Jellial Reaililless 

RFQ471108 
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(b) (4)

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ACC Consultants, fllc. 

Personnel Qualifications 

ACC Consultants Purpose Statement 

/{Clltllcll)' Army National Guard 

DClllat ReatUlIcss 

IIFQ471 /08 

It is ACe Consultants purpose to continually improve our model and del/vel)' 0/ quality oral healthcQre ill 

settings with demanding logistical requirements, in a way that our patients receive competent and 

compassionate care regardless a/their circumstances, so that they hmJe healthier smiles, healthier bodies 

alld a "ealthie,. quality 0/ life. 

ACC Consultants Core Values 

• Honesty, Integrity and trushvOlihiness 

• Listening, hearing, and understanding our co workers, patients, and communities in order to 

establish paths for improvement 

• Ethical decisions based on individualized circumstances 

• Encourage Creativity - in solving problems, making improvements and working toward our 

purpose 

• Empower patients to improve their health 

• Compassion as a mind set 

• Practicing non-judgmental attitudes 

ACC Consultants, Inc Dental Mobile/Portable Radiation compliance 

Radiation Safety Standard 

CompallY Policy 

To ensure that information about the dangers that may occur during exposure by dental x-ray 

equipment, ACC Dental has established the following program. Under this program, all employees 

participating in Logistic Trips, Restorative Services, Temping Services, Private Pay Services and Contract 

Agreements, will be informed of the contents of the Radiation Standard. Safe exposure practices for 

patient and provider and New Mexico Safety Regulations for x-ray technicians and (in applicable) Logistic 

regulations for Logistic Personal. 

The Safety Manager is the program coordinator, with overall responsibility for the program, 

including reviewing and updating this plan as necessary. 

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ACC COl1slIltants, Illc. Keutucl(p Army National Guard 

Delllal Readiness 

RFQ471108 

ACC Dental will comply with the New Mexico State Regulations for the use of x-ray equipment. 

This cel1ificate is displayed in the garage. A copy of this license will be in each ofthe MSDS books that 

travel on logistic trips. 

X-ray equipment will be repaired by a cel1ified repairman and maintained as required by the 

manufacturer and the Safety Manager. 

Employee Inforlllation and Responsibility 

All x-ray technicians will be responsible to upkeep their licenses current to comply with the 

standards of the New Mexico Department o/Dental Healtlt and/or state that they reside in and keep copies 

with them. 

X-ray teclmicians will be provided an exposure safety monitor dosimeter badge. A 3-month 

waiting period may occur, as the billing/monitoring cycle is renewed. 

A lead apron will be placed over each patient receiving any radiation exposure. All x-ray 

teclmicians will be required to wear an operator lead apron and thyroid collar when any x-rays are being 

taken. 

All x-ray technicians will stand behind the cone head and at least 6 ft away from the patient. 

Situations of multiple x-rays (Logistic Trips), indicator markers will mark off6 ft around work area. The 

patient must always be in sight of the operator when taking an x-ray. 

In situations that an x-ray processor is used, the processor should be outside ofthe x-ray exposure 

room. 

All cords left out in the open, will be secured to the floor with tape to prevent obstruction offoot 

traffic. 

Workplace Analysis 

ACC Dental will comply with State regulations in the operations of x-ray equipment. 

Employees working off site will notifY the Team Leader or ACC Office if the workplace they are 

assigned to is not consistent with ACC safety standards. 

In temporal)' work sites, in which x-ray exposure will occur, caution radiation signs will be posted 

accordingly. 

Radiation Safety Control 

Personal Protective Equipment (PPE's) listed below, will be provided for employees working in 

such areas listed below, any additional PPE's requested or needed will be put in writing and submitted to 

the Safety Manager. 

Gloves 

Masks 

Lead Apron 

Thyroid Collar 

Contract Services 

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Page 95 of 223

Posted to NGB Reading Room 

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ACC Consultants, Inc, l(eltfncky Army Nafiollal Guard 

Dell/al Reat/incss 

RFQ471108 

* On April 29, 2009, a medical physics survey was performed by a Certified Medical Nuclear Physicist and 

member of the American Board of Radiology on ACC Consultants portable X-ray dental units, The units 

meet the Food and Drug Administration, 21 CFR, Subchapter J, medical X-ray equipment requirements, 

The results of the medical physics survey can be viewed upon request. 

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June 22, 2011

A CC Consultants, Inc. f(eJltf(cf~r Army N{(fiona/ Guard 

Delllal HemlineS's 

RFQ4711118 

Dental Itemized Pricing (Greenville): 

Item SUPPLIES/SERVICES 

NO 

MINIMUM 

NET 

UNIT UNIT 

PRICE 

0001 Dental Exam 660 Service Service -

Total for Minimum 

***Prompt Payment Discount within 10 days of completion of 

event at.5% 

Total Price for 660 Service Member Exams Less Early Payment 

Discount 

** Ace requires a minimum of 660 service member guarantee for exam services** 

Price 

Item SUPPLIES/SERVICES MINIMUM UNIT UNIT Price 

NO 

0002 

PRICE 

Dental n'eatment 760 Service Service 

Members Member 

-

Total for Minimum 

***Prompt Payment Discount within 10 days of completion of 

event at .5% 

Total Price for 760 Service Member Exams Less Early Payment 

Discount 

** Ace requires a minimum of 760 service member guarantee for treatment sel'vices** 

**760 service members was calculated by taking the previously identified 496 category 3 service 

members and adding in the estimated (30%) resulting catergory 3 service members that will result 

from the exams-this adds an additional 264 service members. This results in a total of760 service 

members who will require treatment. ** 

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Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc. Kentucky Army NatioJlal Guard 

Dentul Readiness 

IIFQ471108 

Dental Itemized Pricing (BGAD): 

Item 

NO 

0003 

SUPPLIES/SERVICES MINIMUM U1\'lT UNIT 

NET PRICE 

Dental Exam (BGAD) 43 Service Sen'ice 

Members Member 

Total for Minimum 

***Prompt Payment Discount within 10 days of completion of 

event at .5% 

Total Price for 43 Service Member Exams Less Early Payment 

Discount 

** Ace rcquil'es a minimum of 43 service member guarantee for exam services** 

Item SUPPLIES/SERVICES MINIMUM UNIT UNIT 

NO NET PRICE 

Price 

Price 

0004 Dental Treatment 72 Service Service 

Members Member - --

Total for 

***Prompt Payment Discount within 10 days of completion of 

event at .5% 

Total Price for 72 Sen'ice Member Exams Less Early Payment 

Discount 

**ACC requires a minimum of72 service member guarantee for treatment services** 

**72 serl'ice members was calculated by taking the prel'iously identified 55 category 3 serl'ice 

members and adding in the estimated (30%) resulting category 3 serl'ice member's that willr'esult 

from the exams-this adds an additional 11 service members. This results in a total of72 sel'vice 

members who will require treatment. ** 

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ACC COl/sultants, Inc. 

APPENDIX A 

/{ellfuc/IY ArlJlY National Guard 

Delllal Readiness 

RFQ471108 

AUTHORIZED DENTAL TREATMENT 

I. The following dental procedures are authorized: 

A. Diagnostic Services which are funded through NG6H 2065 Medical Readiness Funding: 

1. DOl20-Periodic Oral Evaluation 

2. DO I 50-Comprehensive Oral Evaluation 

3. D0330-Panoramic Film 

4. D0272-Bitewings-Two Films 

5. D0274-Bitewings-Follr Films 

6. D0220-First Periapical Xray 

6a. D0230-Each Additional Periapical 

B. Restorative Services which are funded through the VFRE 2020 Dental Treatment Funding (provided 

only to soldiers alelied to an OCOCNUS Mission): 

1. D2140-Amalgam-One Surface 

2. D2150-Amalgam-Two Surfaces 

3. D2160-Amalgam-Three Surfaces 

4. D2161-Amalgam-Four or More Surfaces 

5. D2330-Composite-One Surface 

6. D2331-Composite-Two Surfaces 

7. D23 32-Composite-Three Surfaces 

Posterior composites will be authorized only when a posterior composite is necessary to provide a 

quality restoration and no other alternative is available. 

8. D2335-Composite-Four or More Surfaces 

9. D2391-Composite-One Surface 

10. D2392-Composite-Two Surfaces 

II. D2393-Composite-Three Surfaces 

12. D2394-Composite-Four or More Surfaces 

13. D2799-Provisional Crown 

14. D293 I-Prefabricated Stainless Steel Crown 

IS. D2950-Core Buildup, including any pins 

16. D2954-Prefabricated Post and Core 

C. Endodontic Services which are funded through the VFRE 2020 Dental Treatment Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

I. D3310-Anterior Root Canal Therapy 

2. D3320-Bicuspid Root Canal Therapy 

3. D3330-Molar Root Canal Therapy 

4. D3346-Anterior Root Canal Retreatment 

5. D3347-Bicllspid Root Canal Retreatment 

6. D3348-Molar Root Canal Retreatment 

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A CC Consultants, illC, lil!l1tllc/(F Army Nm;ol1a/ Guard 

DeJltat Reatlille,\'S 

RFQ471108 

D. Periodontal Services which are funded through the YFRE 2020 Dental Treannent Funding (provided 

only to Soldiers alerted to an OCOCNUS Mission): 

I. D4355-Full Mouth Debridement 

2. D4342-Periodontal Scaling and Root Planning, I to 3 teeth per quadrant 

Periodontal scaling and root planning is authOl'ized only when a periodontal abscess is present 

E. Prosthodontic Services which are funded through the YFRE 2020 Dental Treannent Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

I. D511 O-Complete Denture-Maxillary 

2. D5120-Complete Denture-Mandibular 

3. D5211-Maxillary Partial Denture-Resin Base 

4. D5212-Mandibular Partial Denture-Resin Base 

F. Oral Surgery Services which are funded through the YFRE 2020 Dental Treannent Funding (provided 

only to Soldiers alelted to an OCONUS Mission): 

I. D7140-Extraction, El1lpted Tooth or Exposed Root 

2. D7210-Surgical Removal ofEl1lpted Tooth 

3. D7220-Removal ofImpacted Tooth, Soft Tissue 

4. D7230-Removal ofImpacted Tooth, Partial Bony 

5. D7240-Removal ofImpacted Tooth, Completely Bony 

G. Orthodontic Services which are funded through the YFRE 2020 Dental Treatment Funding (provided 

only to Soldiers alelted to an OCONUS Mission): 

I. D8680-0rthodontic Retention 

The following dental procedures are not authorized: 

A. Bridges and/or implants 

B. Removal of Asymptomatic third molars 

C. Routine Prophylaxes ( cleanings) 

D. Restorations for aesthetics only 

E. Restorations for small (non-class 3) caries 

F. Extensive Root plane/scaling 

G. Osseous Surgery 

H. Other diagnostic services 

The above listings are guides to assist the State Dental Officel' or his/her designee in determining treatment to 

be authorized. The treatment provided by the ARNG is to get the Soldier from a dental class 3 to a dental class 

2 only, Comprehensive Treatment (to dental class I) is not authorized. 

3. Ifa Soldier needs all ofhislher remaining teeth in an arch extracted and a denture placed, the Soldier will not be 

available for deployment for at least 6 months and shall be disqualified from inunediate deployment. However, if the 

Soldier is otherwise deployable (passes all medical, personnel and training requirements) and, after extraction and 

placement of prosthesis, would be deployable, the dental treatment could be provided and the Soldier could be 

considered as a replacement at a later date. 

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A CC Consultants, lltc. Ken/lIc!01 Arm.J' Nalivl1a/ Guard 

Delltal Readiness 

RFQ4711118 

4. If a Soldier will have a number of teeth extracted to the extent mastication and speech are adversely affected, then 

an acrylic removable partial denture will be authorized if there is sufficient time for healing and construction of the 

partial denture prior to departure to Mobilization Station. 

5. Soldiers requiring extensive periodontal treatment will be disqualified fi'olll deployment and educated on the 

TRICARE Dental Program. Ifhe/she obtains the required therapy (fi'olll hislher private dental provider) and reaches a 

maintenance level, then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental treatment plan for dental care which 

exceeds $2000 to insme that the above clinical guidelines are met. Exceptions can be made, but they must be 

coordinated with the State Smgeon. 

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June 22, 2011

Ace Consultants, Inc. /(elltud(r Arn~r NatioNal Guard 

Delltal Re(l(Ulle,\',\' 

IIFQ471l08 

Past Performances: 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

The state of Kentucky awarded ACC Consultants Inc the contract to provide dental treatment to the Kentucky Army 

National Guard at WHFTRC in Greenville, Kentucky. ACC Consultants, Inc. furnished all labor. tools, equipment, 

material, transportation and supervision for Dental Treatments for approximately 243 service members 

o 

o 

o 

o 

o 

243 Service Members seen during event 

225 Converted to Class 1 or 2 status 

of any problems 

or 

18 Were not converted onsite 

o ~to see civilian DDS by_7), was discharged 10JUN2010 per 

_ need prosthetics made by a lab (1), need oral surgery referral due to 

complexity of case and need for full sedation (8), need endodontist referral due to 

curvature of roots (1) 

Overall Exam + Treatment Conversion Rate not including 3C's: 100% 

o 225 conversions/225 Cat 3's (not including "civ DDS", "discharge", "prosth", "oral 

sedation needs", "root curvature" 

Overall Exam + Treatment Conversion Rate including 3C's: 96% 

o 225 conversions/235 Cat 3's (not including "civ DDS", "discharge") 

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June 22, 2011

ACC Consultallts, Inc. A"ell/uell)' Army NatioNal Guart! 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

of 

Dental ReadilIess 

RFQ471108 

The state of Georgia awarded ACC Consultants Inc the 5 year contract to provide dental treatment to the Georgia 

National Guard at Ogelthorpe Armory in Ellenwood, GA. ACC Consultants, Inc. furnished all labor, tools, 

i for Dental 391 service 

o 3's converted to Cat 1 or 2: 100% 

o 391 Members seen during event 

o 327 Converted to Class 1 or 2 status 

o 64 Were not converted onsite 

o Unless these patients refused treatment (1) or are seeing their own private dentist (7), ACC 

is case managing them and they will be converted and their 2813 uploaded to DENCLASS. 

o Overall Exam + Treatment Conversion Rate not including 3C's: 100% 

o 326 converslons/327 Cat 3's (not including 3C's, no·shows, refusals/prefer civilian dentist, 

high blood pressure, future event scheduling 

o 

o Number of Cat 4's presented to clinic that were examined and given new readiness dates: 291 

o Automatic convertedlidentified as Cat 1 or 2: 242 

o The following is a breakdown of the soldiers that presented to clinic as Cat 3 that were not able to be 

converted on site. These soldiers will be case managed or invited back to future events and all should be 

upgraded to Cat 1 or 2 after case management is completed. 

o Number of Cat 3's requiring oral surgery referrals due to needing oral sedation in oral surgery 

office:9 

o Cat 3's not converted due to endodontic specialty needs (retreatment of existing RCTs, calcified 

canals): 7 

o Cat 3 not converted due to prosthetic lab case need: 8 

o Cat 3 not converted due to extreme high blood pressure: 1 

o Cat 3 not converted due to pending appointment with civilian DDS (approved by event POC): 7 

o Number of Cat 3's identified that will be scheduled to be converted at next OHS or Dobbins event: 

26 

o Cat 3 patients identified as Cat 3 during exam that no-showed or did not have time for treatment 

appointments: 3 

o Cat 3 patient that became to shaky to complete treatment: 1 

All Cat 3 patients are being case managed and aPPointed with the appropriate specialists to complete their Cat 3 

needs. All will be converted to Cat 1 or 2 status after case management is through. 

I I 

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June 22, 2011

ACC COI/su/tants, Illc. lleJ1fuc/(p Army National Guard 

Dental Readiness 

IIFQ471108 

Dental Treatment and Exam Services for Roberts 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, telephone 

number and Email: 

5. Project Officer's Name, Address, Telephone Number, 

Fax Number and Email Address: 

or delays encountered and any 

The requ was to management, examination 

materials, equipment, cCliifications and supplies required to provide dental exams and treatments per identified treatment plan 

to upgrade Class 3 soldiers to a Class 2 status January 19-21,2010, 

All dental treatment that was identified in the patient's treatment plan was accomplished based on the National Gurads Bureau's 

statistics that 30% of soldiers examined were classification 3. Contract was awarded on December 15, 2009; ACe personnel 

and mobile equipment arrived on site January J 8,2010. 

Dental Event . and Data: 

o Percentage of Cat 3's converted to Cat 101'2: JOO°;', 

o 1031 Service Members seen during event 

o 911 Converted to Class 1 or 2 status 

o 120 Were not converted onsite 

o See below for information ,'egarding these patients. 

o Overall Exam + Treatment Conversion Rate not including 3C's: 100% 

o 911 conversions/911 Cat 3's (not including 3C's, no-shows, refusals/prefer civilian dentist, 

vouchers for treatment that was not allowed by contract) 

o Cat 4 soldiers that were identified as Cat 1 01' 2: 710 

o The,'e was about a 63% conversion of Cat 3 soldiers (after examination) at the event site. Had the 

contract allowed ACC's providers to treat mOl'e conditions and have an oral surgeon included, the 

conversion rate of Cat 3 patients would have been around 90% by the end of the event. 

o The following is a breakdown of the soldiers that presented to clinic as Cat 3 that were not able to be 

converted on site, These soldiers will be case managed or invited back to future events and all should be 

upgraded to Cat I or 2 after case management is completed. 

o The contract did not allow ACC to treat many of the Cat 3 conditions present. There were 

65 3C's, 7 Full Ortho patients, 1 woman was pregnant, 47 were approved for vouchers by 

POC as they had conditions that the contract did not allow ACC to treat. 

Page 20 of23 
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Released by Army National Guard 

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Posted to NGB Reading Room 

June 22, 2011

Ace Consultants, fllc. 

1. Contract Title: 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

l{eJ1tllcl~p AI'IIlJ' Natiollal Guard 

Dellfal Readilless 

RFQ471108 

The New Mexico awarded ACC Consultants Inc the contract to provide dental treatment to the New Mexico Army 

National Guard at armories in both Albuquerque and Santa Fe, NM. ACC Consultants, Inc. furnished all labor. 

tools, equipment, material, transportation and supervision for dental treatment for approximately 87 service 

Category 3 Report: 

o Percentage of Cat 3's converted to Cat 1 or 2: 98% 

(That were willing andlor available for treatment and had conditions that needed treatment 

outlined in the contract requirements) 

o 87 Service Members seen during event 

o 78 Converted to Class 1 or 2 status 

o 9 Were not converted onsile 

o These patients are either: 

• Seeing their own private dentist (OK'd by event POC) (2), 

• Blood Pressure was too high to have oral surgery done (1), 

3C's (4): 

• Need a Root Canal ReTreatment (1) 

• Need removable prosthetics (2) 

• Need to see an Orthodontist to have fixed appliance removed (1) 

• Had extensive full mouth treatment that requires another day of treatment (2). 

o These patients could all be case managed by ACC to ensure their conversion if funding 

is procured by DSS for private office dental fees. 

Please let us know if you would like to utilize this service 

o Overall Exam + Treatment Conversion Rate not including 3C's: 98% 

o 78 conversionsl80 Cat 3's (not including "prefer civilian dentist", "bood pressure high" or 

3C's) 

o Overall Exam + Treatment Conversion Rate including 3 C's (8): 94 % 

All DENCLASS patient data was uploaded by COB 312512010. 

This 2 day restorative event was carried out without any problems or delays or any corrective actions 

taken in schedule or technical 

Page 21 of23 
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Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc, 

1, Contract Title: 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4, Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

9. Final Contract Price/Cost to Date: 

Ilel1tllcl~r Army National Guard 

Dental Readiness 

RFQ471/08 

Treatment Services for KYARNG in Indiantown 

USPFO Kentucky 

Frankfort, KY 40601 

BNGC Bldg 120 

120 Minuteman Parkway 

Frankfort, KY 

40601-6192 

The state of Kentucky awarded ACC Consullants Inc the contract to provide dental treatment to the Kentucky Army 

National Guard at Fort Indiantown Gap in Annville, PA. ACC Consultants, Inc. furnished all labor, tools, equipment, 

material, transportation and supervision for Dental Treatments for approximately 250 service members 

were i a""I,au,e 

o Total Number of Cat 3's presented to clinic: 192 

o Total Number of Cat 3's upgraded at clinic: 169 

o Total Number of Cat 3's not upgraded due to circumstances beyond contracted capabilities: 11 

o 3 Cat 3 Soldiers refused treatment and requested to have treatment by their civilian dentist 

o 1 Cat 3 Soldier taking Coumadin; not able to discontinue for oral surgery 

o 1 Cat 3 Soldier needed apicoectomy (specialized endodontic surgery) 

o 1 Cat 3 Soldier awaiting lip biopsy 

o 1 Cat 3 Soldier needs full upper and lower dentures (all extractions were done on-site) 

o 4 Cat 3 Soldiers need specialized IV sedation at oral surgery clinic (determined by oral surgeon 

on-site) 

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June 22, 2011

ACC COl/sultants, Inc. A'el1fflcf~1' ArlllY National Guard 

Dell tal Readilless 

RFQ471I08 

CERTIFICATE OF LIABILITY INSURANCE 

II~SURE[) 

Ace Consultants, Inc. 

9008 Washington NE 

NM 

., 

A 

O~SCfl,pnOIl OF OPEI1'" liONS IlOC 4TIONS I 

CERTIFICATE HOLDER 

For Bid Furposes Only 

ACORD 25 (2009/01) 

INS025IZOO,Jt) 

CANCELLATION 

eOO'LYINjURI' 

(P., P'<"O'l) 

lIVrT 

OFSUCH 

i' 

SHOULD Aff( OFTH~ .... BOV~ DESCRIBED POUCIES BE CAHCELLW aUORET"HE EXFIRA nON 

DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO ~~AIL ~ DAYS WRmOl 

NOnCe TO mE CEI1TIFlCATE HOLOEI1I~A~'EO TO THE LEFT, SlIT FAIlURE TO DO SO SflALL 

IMPOSE NO OBUOATIOII OR liABIlITY OF AllY KIND UPON THE INSURER, ITS AGEHTS OR 

-200 ACORD CO PORATION. All rights reserved, 

The ACORD name and logo are registered marks of ACORD 

Page 23 of23 
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Posted to NGB Reading Room 

June 22, 2011

From: 

Sent: 

To: 

Cc: 

Subject: 

All, 

SSG NGKY 

Friday, July 02, 20104:49 PM 

Todd Bower 

carly@accdental.com; Ginny Berger; _ LTC NGKY 

RE: Any word on Dental Services for . 

Due to the dollar amount this award has to be sent to NGB for approval. You are the 

apparent low bidder but I cannot tell you to proceed until we get conformation back from 

NGB. We hope to have an answer Tuesday and award will follow very soon. Thanks for your 

patience. 

From: Todd Bower [mailto:Todd@accdental.com] 

Sent: Fri 7/2/2010 3:10 PM 

To: 

Cc: carly@accdental.coffi; Ginny Berger 

Subject: Any \'lord on Dental Services for KYARNG? 

SSG. Valentine, 

Can you please give me a status on the Dental Services solicitation? 

Thank you, 

Todd Bower 

ACe Consultants 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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(6)

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(b) (5)

(b) (5)

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

Posted to NGB Reading Room 

June 22, 2011

From: 

Sent: 

To: 

Subject: 

Attachments: 

2010070210322331 

3.pdf (839 KB) ... 

20100702103223313.pdf 

Classification, UNCLASSIFIED 

Caveats: FOUQ 

-

Supervisory Contract specialist 

USPFO for KY 

Comm, 502-607-1367 

DSN, 667-1367 

Cell , 

FAX, 502--607-1424 

Classification, UNCLASSIFIED 

Caveats: FOUa 

Supervisory Contract Specialist 

USPFO for KY 

Comm, 5.02 -607 -13 67 

DSN, 667-1367 

Cell, 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 109 of 223

Posted to NGB Reading Room 

June 22, 2011

FAX, 502-607-1424 

Classification: m~CLASSIFIED 

Caveats: FOUO 

Classification, UNCLASSIFIED 

Caveats: Foue 

2 
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June 22, 2011

ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

USA 

Voice: 505-323-1300 

Fax: 505-323-1400 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

1,00 

Check/Credit Memo No: 

Invoice Number: 17717 

w-It"'Vii1iOOIJ1 0131 01 030002 

lJU(J['U-A v'AIL ,5% 

I nvo ice Date: 

Page: 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

PiECE/VEE 

Subtotal 

Aug 13, 2010 

1 

1 
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June 22, 2011

ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

USA 

Voice: 5O~323·1300 

Fax: 50~323-1400 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601·6192 

1.00 

Check/Credit Memo No: 

INVOICE 

Invoice Number: 17714 

Invoice Date: Aug 9, 2010 

Page: 1 

Duplicale 

USPFO lor Kentucky 

# W900D1013101030001 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601·6192 

TREATMENT PORTION OF WEEK FOUR 

OF FIVE, GREENVILLE KY. AUGUST 

1·8·2010. CIN# W900D1013101 030002 

DISCOUNT .5% 10 DAYS 

; .' ~ , 

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ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

USA 

Voice: 505-323-1300 

Fax: 505-323-1400 

Bill To: 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

INVOICE 

Invoice Number: 17682 

Invoice Date: 

Page: 

Ship to: . 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

Jul 30, 2010 

1 

L __________________ ~ 

Customer ID 

USPFOKY 

Sales Rep ID 

1.00 I 

ChecrJCredit Memo No: 

ustomer PO Payment Terms .. -

W912KZ-1O-F-0055 Net 7 Days 

Shipping Method Ship Date· . Due Date· 

Courier 

KY JULY 28,29,201 O. CIN# 

W900D1013101040001 

MINIMUM TREATMENTS DENTAL 

RICHMOND KY JULY28,29,2010. CIN# 

W900D1013101040002 

DISCOUNT AVAILABLE .5% 10 DAYS 

($428.25) 

.< '-' '-':; 

SPFC) P 

,,{I01tJu"- '0 -lOIS8/6/10 

u F r? f' If tI (f 11-A. fWf 131)7) S"[j !("! r? rr 

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FOIA Requested Record #FA-11-0070 

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Posted to NGB Reading Room 

June 22, 2011

I 

ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

USA 

Voice: 505·323·1300 

Fax: 505·323·1400 

. Bill To: 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601·6192 

Customer ID 

USPFOKY 

Sales Rep 10 

1.00 

1.00 I 

! 

! 

1.00 

Checl1Credit Memo No: 

INVOICE 

Invoice Number: 17662 

Invoice Date: Ju126,2010 

Page: 1 

Duplicate 

Shlp!o:. . -

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601·6192 

7- . _. Customer PO ~ ... ' Payment Terms ' .. 

\. . 

W912KZ·10·F·0055 ) 

9 ,,,ethod. ' .. '. .. 

Courier I 

CIN # W900D10131 01030001 , EXAM 

PORTION, JULY 10·17·2010 

..... 

WEEK ONE OF TREATMENT· 

GREENVILLE, CIN # 

W900D1013101030002, JULY 10·17·2010. 

WEEK TWO OF 

FIVE ,CI N#W900D1 0131 01 030001 EXAM 

PORTION ,GREENVILLE KY JULY 

18·25·2010 

WEEK TWO OF FIVE TREATMENT 

PORTION CIN # 

W900D1013101030002,JULY 18·25·2010. 

GREENVILLE KY 

DISCOUNT AVAILABLE.5 % 

($1566) 

Net 7 Days 

Ship Date' I' . Due Date 

f 812/10 

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, 

I 
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Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NIvI 87113 

USA 

Voice: 505-323-1300 

Fax: 505-323-1400 

Bill To: 

USPFO for Kentucky 

120 lvIinuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

customer 10 -

USPFOKY 

Sales Rep ID 

1.00 

Check/Credit lvIemo No: 

Courier 

Ship to: 

INVOICE 

Invoice Number: 17681 

Invoice Date: 

Page: 

Duplicate 

Jul 31,2010 

1 

USPFO for Kentucky _ I 120 lvIinuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 -

'---------~ 

Payment Terms -~---

Net 7 Days 

Ship Date "-Due Dale ... -

8m10 

PORTlON,JUL Y 26-JULY 31 ,2010 

GREENVILLE KY 

WEEK THREE OF FIVE, 

CIN#W900D1013101030002, JULY 

26-31,2010. GREENVILLE KY, 

TREATIvIENT PORTION 

DISCOUNT AVAILABLE, .5% 10 DAY. 

) lo,,?Ou. > ;9 -lui'> I.?N- 9,)£ > ",ft 

/,ff6l-1 IN glUM ol>O)Y ;:'p«oE 

016'~!J/ - 0/3/ -- 01 ~3 
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ORDER FOR SUPPLIES OR SERVICES IPAGE I OF 21 

I. CONTRACT!P U RCH ORDERI 2.DEL1VERY ORDER/CALL NO. 3. DATE OF ORDER/CALL 4.REQ.lPURCH REQUESTNO 5. P RTORln' 

AGREEMENT NO (nI'YMMMDDj 

V797P-7134A W912Kz-10-F-6P02 2010Jun04 WeOOD 1013101 01 

6. ISSUED BY CODE I W912KZ 7. ADMINISTERED BY (i/o/her Ihan 6) CODE! 

USPFQ FOR KENTUCKY 8. DELIVERY FOB 

BNGC, BLDG 120 SEE ITEM 6 ~ DESTJNA nON 120 MINUTEMAN PARKWAY , FRANKFORT KY 40601·6192 OTHER 

(See Schedule if other) 

9. CONTRACTOR CODE !4HZ92 FACILITY! 10.0 ELIVER TO FOB P OINT BY (0 ale) 11 . MARK If BUSINESS IS 

ACe CONSULTANTS INC (YrYJ'A1MMDD) OSMALL SEE SCHEDULE NAME TODD BOWER SMALL 

9008 WASHINGTON S1 NE 12. DISCOUNT TERMS DISADVANTAGED 

AND 

ADDRESS ALBUQUERQUE NM 67113-2704 10 Oays •. 5%; Nel30 o a,'S WOMEN-OWNED 

13. MAIL INVOICES TO THE ADDRESS IN BLOCK 

*****H***HSEE BLOCK 6·****** 

14.SHIPTO CODE LW22MQV 15. PAYMENT WILL BE MADE BY CODE I W22QW6 

WENDELL FORO REGIONAL TRAINING CENTER USPFO ACCOUNTS PAYABLE ~IARK ALL WILLIAM GOSSOM 

4765 STATE ROUTE 161 NORTH 120 MINUTEMAN PKWY PACKAGES AND FRANKFORT KY 40601 PAPERS \VITII BUILDING 332 

GREENVILLE KY 42345 ID ENTIFIC A TIO N 

NUMBERS IN 

BLOCKS 1 AND 2, 

16. DELIVERYI X This delivery order/call is issued on another Goremmen\ agency or in a~cordance with nnd subject to terms and conditions ofaboye numberd contract 

TYPE CALL 

OF PURCHASE Reference )"our quote dated 

ORDER furnish the following on terms specified herein. REF: 

ACCEPT ANCE, THE CONTRACT OR HEREBY ACCEPT S THE OFFER REPRESENTED BY THE NUMBERED PURCHASE 

ORDER ASIT MAY PREVIOUSLY HAVE BEEN OR ISNOW MODIFIED, SUBJECT TO ALL OF THE TERMS 

AND CONDITIONS SET FORTH, AND AGREES TO PERFORM THE SAME. 

NAME OF CONTRACTOR SIGNATURE TYPED NAME AND TITLE DATE SIGNED 

o If this box is marked, supplier m us! sign Acceptance and return the following n um ber of copies: 

(yrrrAfMMDD) 

17. ACCOUNT INO AND APPROPRIA TION DAT AI LOCAL USE 

See Schedule 

18. ITEM NO. 19. SCHEDULE OF SUPPLIES! SERVICES 20. QUANTITY 

ORDEREDI 21. UNIT 22. UNIT PRICE 23. AMOUNT 

ACCEPTED· 

SEE SCHEDULE 

24. UNITED STATES OF A~!ERICA 

COl"~ • If ql1anllly accepled by Ih e 0 owrn m enll. sam e as TEL,502-601-1390 25.TOTAL $159,~50.00 

q uan Illy ordered, Indica Ie by X. If dlfferenl. en ler aCll1al HlAIL, 26. q l1anlll), (I creplcd b dow qllan Illy ordered alld en circle. BY, DIFFERENCES 

27a. QUANTITY IN COLUMN 20 HAS BEEN 

DrNSPECTED DRECEIVED D ACCEPTED, AND CONFORMS TO THE 

CONTRACT EXCEPT AS NOT ED 

b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE c. DATE d. PRINTED NAME AND TITLE OF AUTHORIZED 

(nHMMAfDD) GOVERNMENT REPRESENT A TIVE 

e. MAILING ADDRESS OF AUT HORIZED GOVERNMENT REPRESENT A TIVE 28. SHIP NO. 29. DO VOUCHER NO. J O. 

INIT IALS 

B PARTIAL 

32.PAIDBY 33. AMOUNT VERIFIED 

f. TELEPHONE NUMBER !g. E-MAIL ADDRESS CORRECT FOR 

FINAL 

36, I certify this account Is correct and proper for payment. 31, PAYMENT 34. CHECK NUMBER 

a. DATE b. SIGNATURE AND TITLE OF CERTIFYING OFFICER § COMPLETE 

(nrYMMMDD) PARTIAL 35. BILL OF LADING NO. 

FINAL 

37. RECEIVED AT 38. RECEIVED BY J 9. DAT E RECEIVED 40.TOT AL 4 I. SIR ACCOUNT NO 42. SiR VOUCHER NO. 

(rrr)"J.fMAfDD) CONTAINERS 

DO Form 1155, DEC 2001 PREVIOUS EDITION IS OBSOLET E. 
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W912KZ-IO-F-6P02 

Page 2 of21 

Section B - Supplies or Services and Prices 

Thank you for this opportunity to submit a quote for dental treahnent for the Kentucky Anny National Guard to be 

provided at WHFTRC in Greenville Kentucl), from June 7th- 13th. 

ACC Consultants, Inc brings 19 years of providing support services to govennnent agencies. ACC offers a thorough 

understanding of individual medical readiness (IMR) and fully medical ready (FMR) requirements and standards. 

ACC understands the training demands placed on soldiers and individual units, and has developed tune-tested and 

fully documented policies and procedures to ensure maxunul11 support with minimal inlpact on the unit training 

assembly. ACC also has an ongoing working relationship and excellent rappOli with ASM Research, the developer 

and maintainer ofMEDPROS, DENCLASS, and other related suppOli applications. ACC is GSA certified. ACe 

has the availability of the items and services indicated in the SOW and is prepared to begin the contmct on 

the delivery date indicated in the SOW. 

Included in our proposal is our teclmical response, an explanation of how we will deliver services, licensing and 

certification infonnation, pOliable equipment and pOltable buildulg capabilities, pricing infonnation, and detailed 

past perfonnances related to the dental needs for KYARNG. 

Should you have any futiher questions, please contact: 

GimlY Berger 

CEO 

ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323-1300 X 681 

ginny@accdental.com 
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June 1,2010 

11:00 AM 

RFQ464244-XXX 

Dental Treatment 

Kentucl), Anny National Guard 

ACC Consultants, Inc, 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323- 1300 

accdental.com 

ACC Consultants, Inc, is registered with CCR 

CAGEINCAGE Code: 4HZ92 

DUNS #: 624343463 

GSA Contract #: V797P-7134A 

Expires: 11/30/2012 

Woman Owned 

Small Business 

W912KZ-IO-F-6P02 

Page 3 of21 
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Table of Contents 

Dental Technical Description, _____________________ 4 

Mobile/Portable Dental Capabilities 7 

Representations and Celtifications 8 

Case Management Capabilities (Dental) 8 

Dental Licensing and Celtification 9 

Persol1llel Qualifications 10 

Dental Radiation Compliance 10 

Dental Itemized Pricing 13 

Dental Treatment Fee Schedule (Appendix A) 18 

Past Perfonnances 21 

Certificate of Liability 26 

Dental Technical Description 

W912KZ-IO-F-6P02 

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W912KZ-IO-F-6P02 
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Size(s) 

• 60' Long 

• 12' Wide 

• 8' Ceiling height 

Interior Finish 

• Paneled walls 

• Vinyl tile floors 

• Pre-finished ceiling 

Electric 

• Fluorescent ceiling lights 

• 100 amp Breaker panel 

\VindowslDoors 

· Horizontal slider windows 

• Steel door with cOllullercial grade lock 

Heating and Cooling 

• Thermostatically call trolled central HV AC unit 

• Supply ducted 

Exterior FinishlFl'ame 

• Wood siding 

• I-Beam frame 

• Standard drip rail gutters 

W912KZ-I0-F-6P02 

Should flll event require lIu/oreSeelllltflteria/s, additional supplies or equipmellt/ai/ure, Ace Consulta1lts, Illc 

works closely witlt Henry Schein Delltal to expedite materials, supplies aud senJice (eeflllicialls fa the el'ent site 

withill a timely mallller for sl/ccess/ul complelioll of events. 

Offeror Representations and Certifications 

52.212-3 Offeror Representations and Certifications - Commercial Items (JUN 2008) 

(b) (1) Annllal Representations and Certifications. Any changes provided by the offeror in paragraph (b) (2) of this 

pro'vision do not automatically change the representations and certifications posted on the Online Representations 

and Certifications Application (ORCA) website. 
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W912KZ-10-F-6P02 

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(2) The offeror has completed the annual representations and certifications electronically via 

the ORCA website at http://orcalbpn.gov. After reviewing the 

ORCA data base infomlation, the offeror verifies by submission of this offer that the 

representation and celiifications cUlTently posted electronically at FAR 

52.212-3, Offeror Representations and Celiifications-Commercial Items, have been entered or 

updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation 

(including the business size standard applicable to the NAICS code referenced for this 

solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 

4.1201), except for paragraphs N/A . [Offeror to identity the applicable paragraphs at (c) 

through (m) of this provision that the offeror has completed for the purposes of this solicitation 

only, if any. These amended representation(s) and/or certification(s) are also incorporated in this 

offer and are current, accnrate, and complete as of the date of this offer. Any changes provided by 

the offeror are applicable to this solicitation only, and do not result in an update to the 

representations and certifications posted on ORCA.) 

Dental Licensing and certification 
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\V912KZ-IO-F-6P02 

Personnel Qualifications 

ACC Consultants is a dental oral healthcare provider that only practices with on-site care. ACC Consultants has 

approximately 750 dental professionals throughout the United States who are traincd to provide care with mobile 

portable equipment in a caring professional way. ACC has dental professionals in 40 states. Twenty (20) of our team 

leads have undergone the ACe "Train the trainer" program and are extremely well versed on how to manage and 

have quality standardized outcomes at mass events in order to train ne\v employees so that our results are 

standardized. 

Ace Consultants has written protocols to assure standardized care for our military service members. The HACC 

Protocol for Military Site events" answers every question that has come up since starting the SRP programs in 2003. 

This document is the "bible)) for our operations. 

ACC Consultants Purpose Statement 
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W912KZ-1O-F-6P02 

Page II of21 

It is ACe Consultants purpose to continually improve our model and delivery of quality oral health care in settings 

with demanding logistical requirements, in a way that our patients receive competent and compassionate care 

regardless of their circulllstances, so that they hm'e healthier smiles, healthier bodies and a healthier quality of life. 

ACC Consultants Core Values 

• Honesty, Integrity and trustworthiness 

• Listening, hearing, and understanding our co workers, patients, and communities in order to establish paths 

for improvement 

• Ethical decisions based on individualized circumstances 

• Encourage Creativity - in solving problems, making improvements and working toward our purpose 

• Empower patients to improve their health 

• Compassion as a mind set 

• Practicing non-judgmental attitudes 

ACC Consultants, Inc Dental Mobile/Portable Radiation compliance 

Radiation Safety Standard 

CompallY Policy 

To ensure that infonnation about the dangers that may occur during exposure by dental x-ray equipment, 

ACC Dental has established the following program. Under this program, all employees participating in Logistic 

Trips, Restorative Services, Temping Services, Private Pay Services and Contract Agreements, will be infOlmed of 

the contents of the Radiation Standard. Safe exposure practices for patient and provider and New Mexico Safety 

Regulations for x-ray technicians and (in applicable) Logistic regulations for Logistic Personal. 

The Safety Manager is the program coordinator, with overall responsibility for the program, including 

reviewing and updating this plan as necessa!)'. 

ACC Dental will comply with the New Mexico State Regulations for the use of x-ray equipment. This 

celtificate is displayed in the garage. A copy of this license will be in each of the MSDS books that travel on logistic 

trips. 

X-ray equipment will be repaired by a celtified repainnan and maintained as required by the manufacturer 

and the Safety Manager. 

Employee Ill/ormatioll alld Respollsibility 

All x-ray tecllllicians will be responsible to upkeep their licenses current to comply with the standards of the 

Nell' Mexico Department of Dental Health and/or state that they reside in and keep copies with them. 

X-ray tecllllicians will be provided an exposure safety monitor dosimeter badge. A 3-month waiting period 

may occur, as the billing/monitoring cycle is renewed. 

A lead apron will be placed over each patient receiving any radiation exposure. All x-ray technicians will 

be required to wear an operator lead apron and thyroid collar when any x-rays are being taken. 
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All x-ray technicians will stand behind the cone head and at least 6 ft away from the patient. Situations of 

multiple x-rays (Logistic Trips), indicator markers will mark off 6 ft around work area, The patient must always be 

in sight of the operator when taking an x-ray. 

In situations that an x-ray processor is used, the processor should be outside of the x-ray exposure room. 

All cords left out in the open, will be secured to the floor with tape to prevent obstruction of foot traffic, 

Workplace AI/alysis 

ACC Denlaiwill comply with State regulations in the operations of x-ray equipment. 

Employees working off site will notifY the Team Leader or ACC Office if the workplace they are assigned 

to is not consistent with ACC safety standards, 

In temporary work sites) in which x-ray exposure will occur, caution radiation signs will be posted 

accordingly. 

Radiatiol/ Safety COl/trol 

Personal Protective Equipment (PPE's) listed below, will be provided for employees WorkUlg in such areas 

listed below, any additional PPE's requested or needed will be put in writing and submitted to the Safety Manager, 

Gloves 

Masks 

Lead Apron 

Thyroid Collar 

Contract Services 

* On April 29, 2009, a medical physics survey was perfonned by a Certified Medical Nuclear Physicist and member 

of the American Board of Radiology on ACC Consultants portable X-ray dental units, The units meet the Food and 

Dmg Administration, 21 CFR, Subchapter J, medical X-ray equipment requirements, The results of the medical 

physics survey can be viewed upon request. 
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Dental Itemized Pricing 

Item 

NO 

0001 

SUPPLIES/SERVICES MINIMUM UNIT UNIT 

NET PRICE 

Dental Exam 193 Service Service 

Members Member 

-

Total for Minimum 

***Prompt Payment Discount within 10 days of completion of 

event at .5% 

Total Price for 183 Service Member Exams Less Early Payment 

Discount 

** Ace requires a minimum of 193 service member guarantee for exam seJ'vices** 

Treatment: 

W912KZ-10-F-6P02 

Page 13 of21 

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

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Item SUPPLIES/SERVICES MINIMUM 

NO 

Ul\'1T UNIT 

PRICE 

0002 Dental Treatment 145 Service Service 

Members Member 

-

Total for Minimum 

***Prompt Payment Discount within 10 days of completion of 

event at .5% 

Total Price for 183 Service Member Exams Less Early Payment 

**ACC requires a minimum of 145 service member guarantee for treatment sen'ices** 

W912KZ-IO-F-6P02 

Page 14 of21 

Price 

**145 service members was calculated by taking the previously identified 87 category 3 service members and 

adding in the estimated (30%) resulting eatergory 3 service members that will result from the exams-this adds 

an additional 58 service members. This results in a total of 145 service members who will require treatment. 

APPENDIX A 

AUTHORIZED DENTAL TREATMENT 

I. The following dental procedures are authorized: 

A. Diagnostic Services which are funded through NG6H 2065 Medical Readiness Funding: 

I. DOl20-Periodic Oral Evaluation 

2. DOl50-Comprehensive Oral Evaluation 

3. D0330-Panoramic Fibn 

4. D0272-Bitewings-Two Fibns 

5. D0274-Bitewings-Four Films 

6. D0220-First Periapical Xray 

6a. D0230-Each Additional Periapical 

B. Restorative Services which are funded through the VFRE 2020 Dental Treatment Funding (provided only to 

soldiers alerted to an OCOCNUS Mission): 

I. D2140-Amalgam-One Surface 

2. D2150-Amalgam-Two Surfaces 

3. D2160-Amalgam-Three Surfaces 

4. D2161-Amalgam-Four or More Surfaces 

5. D2330-Composite-One Surface 

6. D2331-Composite-Two Surfaces 

7. D2332-Composite-Three Surfaces 

Posterior composites will be authorized only when a posterior composite is necessary to provide a quality 

restoration and no other alternative is available. 

8. D2335-Composite-Four or More Surfaces 
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(b) (4)

(b) (4)

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9. D2391-Composite-One Surface 

10. D2392-Composite-Two Surfaces 

II. D2393-Composite-Three Surfaces 

12. D2394-Composite-Four or More Surfaces 

13. D2799-Provisional Crown 

14. D293 I-Prefabricated Stainless Steel Crown 

IS. D29S0-Core Buildup, including any pins 

16. D2954-Prefabricated Post and Core 

W912KZ-IO-F-6P02 

Page IS of21 

C. Endodontic Services which are funded through the VFRE 2020 Dental Treatment Funding (provided only to 

Soldiers alerted to an OCONUS Mission): 

1. D33l O-Anterior Root Canal Therapy 

2. D3320-Bicuspid Root Canal Therapy 

3. D3330-Molar Root Canal Therapy 

4. D3346-Anterior Root Canal Retreaonent 

5. D3347-Bicuspid Root Canal Retreaonent 

6. D3348-Molar Root Canal Retreatment 

D. Periodontal Services which are funded through the VFRE 2020 Dental Treaonent Funding (provided only to 

Soldiers alerted to an OCOCNUS Mission): 

I. D43S5-Full Mouth Debridement 

2. D4342-Periodontal Scaling and Root Planning, I to 3 teeth per quadrant 

Periodontal scaling and root planning is authorized only when a periodontal abscess is present 

E. Prosthodontic Services which are funded through the VFRE 2020 Dental Treatment Funding (provided only to 

Soldiers alelled to an OCONUS Mission): 

I. DSI IO-Complete Denture-MaxilialY 

2. DSl20-Complete Denture-Mandibular 

3. D5211-Maxillary Partial Denorre-Resin Base 

4. DS212-Mandibular Pallial Denture-Resin Base 

F. Oral Surgery Services which are funded tlrrough the VFRE 2020 Dental Treatment Funding (provided only to 

Soldiers alerted to an OCONUS Mission): 

1. D7140-Extraction, Elupted Tooth or Exposed Root 

2. D7210-Surgical Removal of Erupted Tooth 

3. D7220-Removal of Impacted Tooth, Soft Tissue 

4. D7230-Removal ofimpacted Tooth, Pallial Bony 

S. D7240-Removal of Impacted Tooth, Completely Bony 

G. Orthodontic Services which are funded through the VFRE 2020 Dental Treatulent Flmding (provided only to 

Soldiers alerted to an OCONUS Mission): 

I. D8680-0rthodontic Retention 

The following dental procedures are not authorized: 

A. Bridges and/or implants 
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B. Removal of Asymptomatic third molars 

C. Routine Prophylaxes (cleanings) 

D. Restorations for aesthetics only 

E. Restorations for small (non-class 3) caries 

F. Extensive Root plane/scaling 

G. Osseous Surgery 

H. Other diagnostic services 

The above listings are guides to assist the State Dental Officer or his/her designee in determining t,·eatment to be 

authorized. The treatment provided by the ARNG is to get the Soldier from a dental class 3 to a dental class 2 only. 

ComprehensiYe Treatment (to dental class I) is not authorized. 

3. If a Soldier needs all ofhisllier remaining teeth in an arch extracted and a denture placed, the Soldier will not be available for 

deplo)"nent for at least 6 months and shall be disqualified fi·om umnediate deployment. However, if the Soldier is otherwise 

deployable (passes all medical, personnel and training requirements) and, after extraction and placement of prosthesis, would be 

deployable, the dental treatment could be provided and the Soldier could be considered as a replacement at a later date. 

4. If a Soldier will have a number of teeth extracted to the extent mastication and speech are adversely affected, then an acrylic 

removable partial denture will be authorized if there is sufficient tune for healulg and construction of the partial denture prior to 

departure to Mobilization Station. 

5. Soldiers requiring extensive periodontal treannent will be disqualified fi·om deployment and educated on the TRICARE 

Dental Program. lfhe/she obtains the requu·ed therapy (fi·om hislher private dental provider) and reaches a maintenance level, 

then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental treannent plan for dental care which exceeds 

$2000 to insure that the above clinical guidelines are met. Exceptions can be made, but they must be coordinated with the State 

Surgeon. 
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W912KZ-10-F-6P02 

Page 17 of21 

CERTIFICATE OF LIABILITY INSURANCE 

, . 

COr:u:l-.:l,;;;;;..,tll, lno. 

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UH 07113 

A 5/20/2009 

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FOIA Requested Record #FA-11-0070 

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(b) (4)

(b) (4)

(b) (4)

(b) (4)

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ITEM NO SUPPLIES/SERVICES 

0001 

QUANTITY 

193 

UNIT 

Job 

Dental Exam 

FFP 

Dental Exam for 193 Class 4 Soldiers 

Per Proposal #RFQ464244 

Minimum of 193 soldiers 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900DIOUIOlOI 

ACRNAA 

C1N: W900DlOl3101010001 

ITEM NO SUPPLIES/SERVICES QUANTITY 

145 

UNIT 

0002 Job 

Dental Treahnent 

FFP 

Dental Treahnent for estimated 145 Class 4 Soldiers 

Per Proposal #RFQ464244 

Minimum of 145 soldiers 

Not to Exceed 5% more than contracted amount. 

FOB: Destination 

PURCHASE REQUEST NUMBER: W900Dl 0 131 0 101 

ACRNAA 

C1N: W900DI0UIOIOI0002 

W912KZ-I0-F-6P02 

Page 18 of21 

NETAMT 

UNITPRJCE AMOUNT 

NETAMT 
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Section E - Inspection and Acceptance 

INSPECTION AND ACCEPTANCE TERMS 

Supplies/services will be inspected/accepted at: 

CLIN 

0001 

0002 

INSPECT AT 

N/A 

N/A 

INSPECT BY 

N/A 

N/A 

ACCEPT AT 

N/A 

N/A 

W912KZ-IO-F-6P02 

Page 19 of21 

ACCEPT BY 

Government 

Government 
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W912KZ-l 0-F -6P02 

Page 20 of21 

Section F - Deliveries or Performance 

DELIVERY INFORl'vfATION 

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS VIC 

0001 POP 07-JUN-20 1 0 TO N/A WENDELL FORD REGIONAL TRAINING W22MQV 

ll-JUN-2010 

4765 STATE ROUTE 181 NORTH 

BUILDING 332 

GREENVILLE KY 42345 

270-338-8947 

FOB: Destination 

0002 POP 07-JUN-2010 TO N/A (SAME AS PREVIOUS LOCATION) W22MQV 

II-JUN-2010 FOB: Destination 
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(b) (4)

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Section G - Contract Administration Data 

ACCOUNTING AND APPROPRIATION DATA 

AA: 2102065000001810 15133G92R300026EB44KMOEIV900DI 0131 0101KMOE440 15058 AMOUNT:.IIIIIIIII .. CIN 1V900DI013101O 

ClN W900DIOl31010 

W912KZ-10-F-6P02 

Page 21 of21 
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STATEMENT OF WORK FOR DENTAL READINESS 

Introduction: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the 

basic principals of a ready force for Kentucky Army National Guard. Failure to maintain dental 

standards could preclude a soldier from deploying. Dental readiness is a conmland and soldier 

responsibility. This statement of work covers the dental components ofIMRlFMR to include: 

DENCLASS data entry of all dental records, treatment of all Class 3 soldiers on aleli orders 

andlor in conjunction with the ANG Selected Reserve Dental Readiness System. Services are to 

be completed on site at KYARNG armories. The SOW identifies the purpose of the work to be 

performed by the contractor and provides a description ofthe work to be completed and the 

required outcomes. The contractor shall provide qualified personnel, material to perform the 

services, and lor OSHA, HIPP A and Privacy Act Compliant Mobile depending on the individual 

site needed for the KY ARNG. 

DoD established a uniform dental classification in HA Policy 02-11. DoD policy requires dental 

screening examinations to be accomplished and documented on 90% of service members. 

Members of the KYARNG shall receive an annual dental screening exam to dete!111ine their 

dental classification. Soldiers alelied andlor sourced are eligible for dental treatment if they are 

class 3 status from examination. Dental treatment that may be required is essential to be 

provided at the SRP site to ensure the highest Dental Deployment Rate for the mobilizing 

soldiers. Objective: The contractor shall provide all management, labor, material, equipment, 

celiifications and supplies necessary to provide dental services at designated locations for the 

KY Army National Guard. These services will provide mandated dental treatment and proper 

documentation into the Soldier's dental record and data entry of all records into the DENCLASS 

system, as necessary to meet Depmiment of the Army standards of dental readiness and 

deployability. The contractor will insure that their agents are appropriately trained and have 

access to the DENCLASS system. 

Scope of Practice: '''ho: contracting personnel to suppOli dental treatment mission in order to 

convert class 3 soldiers to class 2 soldiers in order to reach deployability standards IA W 

Appendix B, utilizing mobile treatment vans. What, When, and '''here: See attached 

spreadsheet oflayout of events. 

Health Services POC will Deputy State Surgeon. 502-545-8281 

Dental treatment requirements as listed below. 

A) Class 3 dental treatments for Soldiers andl or soldiers who are catorgized in SELRES 

program. Dental treatment authorized is outlined in Appendix E. Any treatment plan greater than 

$2,000.00 requires prior approval from SDO. These services will be completed by using 

contractor provided mobile dental van (unless otherwise specified in a separate written 

agreement). 

B) Specified Dental Specialty Services that requires SDO approval to include 

1) Oral and Maxillofacial Surgery (to include pathology repolis if indicated) 

2) Endodontics 
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3) Periodontics 

4) Prosthodontics 

5) Other (specify) 

C) Prescriptions for pharmaceuticals and controlled substances necessary for the care and 

treatment to Soldiers throughout the event, to include but not limited to analgesics and 

antibiotics. Prescriptions for maintenance pharmaceuticals for Soldiers with high caries risk or 

periodontal disease, as indicated will be provided by contractor on site. Emphasis on pain 

control after topical analgesic has resolved. 

Upon completion of services, medical information will be documented in accordance with 

Department of the Army Policy and be updated in the approved Army National Guard automated 

system. The contractor shall also ensure the requirements of Occupational Safety and Health 

Administration (OSHA) and applicable Federal regulations are met. The contractor shall develop 

and maintain records that fully document serviced performed and names of soldiers referred to 

dental specialists. These records will be made available to the State/Tenitory Medical 

representative. 

Documentation. All Soldiers must have a complete military dental record. The contractor 

shall provide electronic documentation (to include radiographs) in the ARNG approved system 

(within 24 hours of exam completion) and a paper copy as outlined below. A complete record 

includes the following: 

A. Military dental record jacket, DA Form 8005 through 8005-9 

B. The automated Health History Form or DA Form 5570 (with notations to "yes" answers 

and signed by both the Soldier and reviewing Doctor), Health Questionnaire envelope 

C. DD Form 2005 (signed), Privacy Act Statement 

D. SF 603/603A, Record of Dental Treatment 

E. SuppOlting radiographs (panoramic and diagnostic bitewing radiographs ((see 1.3.F» 

documenting existing conditions) if necessary for treatment purposes 

(I) All radiographs will be uploaded into the ARNG automated system. 

(2) A diagnostic quality copy of all radiographs must be placed in the Dental Record. 

F. The entries on the SF 603/603A will include the following: date, location, comprehensive 

oral treatment completed, notation of current Dental Fitness Classification, listing of current oral 

condition (class 2 issues identified and a listing of class 3 treatment needs, if any), printed name 

of examining dentist or dental officer and the dentist's or dental officer's signature/initials. 

These required dental documentation elements will be entered in the approved ARNG automated 

system, DENCLASS and printed and placed into the dental record. 
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Record Evaluation. Prior to dental treatment all service members who have a current dental 

exam and have been identified as a class 3, a record review will need to be performed to 

determine the amount of work hours required for those service members. A by name and time 

schedule will be given to state POC to allow for the commanders to better plan for the event. 

'York Guarantee. After completion of dental treatment, all dental work will be guaranteed by 

company completing work for up to one year for minor restorations and two years for major 

restorations. The SDO will coordinate with the general dentist performing treatment for any 

arbitration claims to detenl1ine if the problems relating to the dental treatment are in need of 

correction. Health services will be notified of all initial problems to coordinate with SDO. 

GENERAL INFORMATION. 

QUALITY CONTROL. The contractor shall adopt a quality assurance program that monitors 

all service activities and ensures the highest quality customizable dental services available. It is 

the responsibility of the ARNG to review and approve dental treatment plans before treatment is 

performed based on the guidelines provided by NGB and the SDO. 

QUALITY ASSURANCE. The government will periodically evaluate the contractor's 

performance in accordance with the Quality Assurance Surveillance Plan. 

GOVERNMENT REMEDIES. The contracting officer shall follow the requirements of FAR 

52.212-4, Contract Terms and Conditions for Commercial Items (lvfay 1997), for contractor's 

failure to correct nonconforming services. 

HOURS OF OPERATION. The contractor shall have the capability of providing dental 

services seven days a week. The contractor will be able to work flexible hours to accommodate 

the commander's training plan. 

SECURITY REQUIREMENTS. Security will be in accordance with DD Form 254 

(Department of Defense Contract Security Classification Specification). 

SPECIAL QUALIFICATIONS. Contractor must maintain appropriate credentialing files on 

all employees to include but not limited to Licensure, National Provider Data Base Query results 

and HIPPA celiification. 

PARTNERING AGREEMENT. The contracting officer may require a pminering agreement 

between the govenmlent and the contractor to ensure joint cooperation and a sound pminership 

of all pmiies involved in the execution of this contract. 

Contractors will ensure compliance with the following requirements prior to utilizing any 

x-ray producing device on Soldiers; 

A. Have established written policies and procedures to assure compliance with applicable 

Federal, State, DOD, and Army radiation safety regulations and directives. These 
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documents include staff emergency reaction plans, as necessary, and procedures for investigating 

and reporting radiation accidents or incidents, possible radiation overexposures to Soldier 

patients or contractor staff, and provisions to ensure the safe use of x-ray producing devices on 

humans. 

B. Upon request by the StatelTerritory representative, the contractor will provide 

documentation regarding the Contractor's employee radiation safety training commensurate 

with potential radiation hazards with the x-ray producing devices they are using. 

C. Upon request by the StatelTerritory representative, the contractor will provide copies of 

a Qualified Health Physics Expel1's acceptance test and most recent health physics survey of 

each diagnostic x-ray machine. The acceptance test and the most recent survey include tests of 

electrical, mechanical, image quality and radiation (output) dose tests or measurements. 

This also includes verification of the adequacy of radiation protection shielding in and 

around the X-ray machine and x-ray facility (e.g., mobile van). 

APPENDICES. 

A. Estimated Worldoad Data 

B. Deiltal Classification 

C. SF 603A and DA Form 5570 (Dental Classification Module Version) 

D. Govel'llmeut Furnished Property/ServicesfEquipment 

E. Authorized Dental Treatment 
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APPENDIX A 

ESTIMATED WORKLOAD DATA 

The following data elements will be reported at the end of an event: 

Date 

Location 

List of contract employees (providers, dental technicians and administrative staff) 

Total number of patients scheduled 

Total number of patients examined 

Total number of Soldiers by dental classification: 1, 2, 3 

Total number of bitewing radiographic sets taken 

Total number of panoramic radiographs taken 

Verification of entry into DA or ARNG automated systems 

A by name listing of all Soldiers examined and the dental classification of the Soldier 
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APPENDIXB 

Department of Defense 

Oral Health and Readiness Classification System 

The oral health status of unifonned personnel shall be classified as follows: 

A. Class 1 (Oral Health): Patients with a cunent dental examination, who do not 

require dental treatment or reevaluation. Class 1 patients are worldwide deployable. 

b. Class 2: Patients with a cunent dental examination, which require non-urgent 

dental treatment or reevaluation for oral conditions, which are unlikely to result in dental 

emergencies within 12 months. Class 2 patients are worldwide deployable. Patients in 

dental class 2 may exhibit the following: 

(1) Treatment or follow-up indicated for dental caries or minor defective 

restorations that can be maintained by the patient. 

(2) Interim restorations or prosthesis that can be maintained for a 12 month 

period. TIlls includes teeth that have been restored with permanent restorative materials 

for which protective cuspal coverage is indicated. 

(3) Edentulous areas requiring prostheses but not on an immediate basis. 

(4) Periodotium that: 

(a) requires oral prophylaxis 

(b) requires maintenance therapy 

(c) requires treatment for slight to moderate periodontitis and stable cases 

of more advanced periodontitis 

(5) Unerupted partially erupted or malposed teeth that are without historical, 

clinical or radiographic signs or symptoms of pathosis, but which are reconmlended for 

prophylactic removal. 

(6) Active Olihodontic treatment. The provider should consider placing the 

patient in passive appliances for deployment up to six months. For longer periods of 

deployment, the provider should consider removing active appliances and placing the 

patient in passive retention. 

(7) Temporomandibular disorder patients in remission. The provider anticipates 

the patient can perform duties while deployed without ongoing care and any medications 

or appliances required for maintenance will not interfere with duties. 
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c. Class 3: Patients who require urgent or emergent dental treatment. Class 3 patients 

normally are not considered to be worldwide deployable. 

(I) Treatment or follow-up indicated for dental caries, symptomatic tooth fracture 

or defective restorations that cannot be maintained by the patient. 

(2) Interim restorations or prostheses that cmmot be maintained for a 12 month 

period. 

(3) Patients requiring treatment for the following periodontal conditions that may 

result in dental emergencies within the next 12 months. 

(a) Edentulous areas or teeth requiring immediate prosthodontic treatment 

for adequate mastication or communication or acceptable esthetics. 

(b) Active progressive moderate or advanced periodontitis. 

( c) Periodontontal abscess 

(d) Progressive mucogingival condition 

(e) Periodontal manifestations of systemic disease or hormonal 

disturbances 

(f) Heavy subgingival calculus 

(4) Edentulous areas or teeth requiring immediate prosthodontic treatment for 

adequate mastication or communication or acceptable esthetics. 

(5) Unerupted, pmiially erupted or malposed teeth with historical, clinical or 

radiographic signs or symptoms of pathosis that are recommended for removal. 

(6) Clu'onic oral infections or other pathologic lesions including: 

(a) Pulpal, periapical or resorptive pathology requiring treatment. 

(b) Lesions requiring biopsy or awaiting biopsy report. 

(7) Emergency situations requiring therapy to relieve pain, treat trauma, treat 

acute oral infections or provide timely follow-up care (e.g., drain or suture removalO until 

resolved. 

(8) Acute Temporomandibular disorders requiring active treatment that may 

interfere with duties. 
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d. Class 4. Patients who require periodic dental examinations or patients with 

unknown dental classifications. Class 4 patients normally are not considered to be 

worldwide deployable. 
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APPENDIXC 

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APPENDIXD 

GOVERNJ\illNT FURNISHED PROPERTY/SERVICESIEQUIPMENT 

1. General. The Government will provide the following resources: 

2. Facilities, Supplies, and Services. Space for set-up of an administrative area and 

utilities. Mobile units, provided by the contractor, will be utilized for dental treatment 

unless otherwise specified in the contract. 

3. Information. The Govermuent will provide the following information: 

a. Soldier's dental records if applicable. 

4. The User Agency will provide initial familial'ization/ol'ientation. Standard 

Operational Procedures will be available to the contractor at the place of performance. 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 147 of 223

Posted to NGB Reading Room 

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APPENDIXE 

AUTHORIZED DENTAL TREATMENT 

I. The following dental procedures are authorized: 

(a) Diagnostic Services which are funded through NG6H 2065 Medical Readiness 

Funding: 

D0l20-Periodic Oral Evaluation 

DO 1 50-Comprehensive Oral Evaluation 

D0330-Panoramic Film 

D0272-Bitewings-Two Films 

D0274-Bitewings-Four Films 

DOnO/D0230- Periapical (limited) 

(b) Restorative Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to soldiers-aletted to an OCONUS Mission): 

D2l40-Amalgam-One Surface 

D2l50-Amalgam-Two Surfaces 

D2l60-Amalgam-Three Surfaces 

D2l61-Amalgam-Four or More Surfaces 

D2330-Composite-One Surface 

D2331-Composite-Two Surfaces 

D23 32-Composite-Three Surfaces 

Posterior composites will be authorized only when a posterior composite is 

necessal}' to provide a quality restoration and no other alternative is available. 

D2335-Composite-Four or More Surfaces 

D2391-Composite-One Surface 

D23 92-Composite-Two Surfaces 

D2393-Composite-Three Surfaces 

D2394-Composite-Four or More Surfaces 

D2799-Provisional Crown 

D293 I-Prefabricated Stainless Steel Crown 

D2950-Core Buildup, including any pins 

D2954-Prefabricated Post and Core 

(c) Endodontic Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alerted to an OCONUS Mission): 

D3310-Anterior Root Canal Therapy 

D3320-Bicuspid Root Canal Therapy 

D3330-Molar Root Canal Therapy 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 148 of 223

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D3346-Anterior Root Canal Retreatment 

D3347-Bicuspid Root Canal Retreatment 

D3348-Molar Root Canal Retreatment 

(d) Periodontal Services which are TImded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alerted to an OCONUS Mission): 

D4355-Full Mouth Debridement 

D4342-Periodontal Scaling and Root Planing, 1 to 3 teeth per quadrant 

Periodontal scaling and root planing is authorized only when a periodontal abscess 

is present and SDO approves 

(e) Prosthodontic Services which are TImded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alelied to an OCONUS Mission): 

D511 O-Complete Denture-Maxillary 

D5120-Complete Denture-Mandibular 

D521 I-Maxillary Patiial Denture-Resin Base 

D5212-Mandibular Patiial Denture-Resin Base 

(f) Oral Surgery Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alelied to an OCONUS Mission): 

D7140-Extraction, Erupted Tooth or Exposed Root 

D72lO-Surgical Removal of ElUpted Tooth 

D7220-Romoval ofImpacted Tooth, Soft Tissue 

D7230-Removal ofImpacted Tooth, Patiial Bony 

D7240-Removal ofImpacted Tooth, Completely Bony 

(g) Olihodontic Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided only to Soldiers alelied to an OCONUS Mission): 

D8680-0lihodontic Retention 

2. The following dental procedures are not authorized: 

Bridges and/or implants 

Removal of Asymptomatic third molars 

Routine Prophylaxes (cleanings) 

Restorations for aesthetics only 

Restorations for small (non-class 3) caries 

Extensive Root plane/scaling 

Osseous Surgery 

Other diagnostic services 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 149 of 223

Posted to NGB Reading Room 

June 22, 2011

The above listings are guides to assist the State Dental Officer or his/ller designee in 

determining treatment to be authorized. The treatment provided by the ARNG is to 

get the Soldier from a dental class 3 to a dental class 2 only. Comprehensive 

Treatment (to dental class I) is not authorized. 

3. Ifa Soldier needs all of his/her remaining teeth in an arch extracted and a denture 

placed, the Soldier will not be available for deployment for at least 6 months and shall be 

disqualified from immediate deployment. However, if the Soldier is otherwise 

deployable (passes all medical, personnel and training requirements) and, after extraction 

and placement of prosthesis, would be deployable, the dental treatment could be provided 

and the Soldier could be considered as a replacement at a later date. 

4. Ifa Soldier will have a number of teeth extracted to the extent mastication and speech 

are adversely affected, then an acrylic removable partial denture will be authorized if 

there is sufficient time for healing and constmction of the partial denture prior to 

depmiure to Mobilization Station. 

5. Soldiers requiring extensive periodontal treatment will be disqualified from 

deployment and educated on the TRICARE Dental Program. If he/she obtains the 

required therapy (from his/her private dental provider) and reaches a maintenance level, 

then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental 

treatment plan for dental care which exceeds $2000 to insure that the above clinical 

guidelines are met. Exceptions can be made, but they must be coordinated with the State 

Surgeon. 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 150 of 223

(b) (6)

(b) (6)

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RFQ - Summary Page 1 of2 

GSA Advantage! e-Ubrary Im)}1 

] 

were notified 

Reference # I 

! 

W900D1-0131-0101 

NT 

Delivery Days 

Deliver 0 Days After Receipt Of Order 

RFQ Close Date 

:25 AM EDT 06/01/2010 11:00:00 AM EDT 

Manufacturer I Product/Service Name Qty Unit Ship Address 

 class 3 87 EA 2 

 class 4 193 EA 2 

or proposal for dental treatment for 87 Class 3 soldiers and 193 Class 4 soldiers. Work is to be 

TRC in Greenville Ky from June 7th- 13th. Soldiers will be onsite training during that week selected 

e schedule for soldiers to receive treatment. All treatment/services will be completed in a moble vehicle 

by the offeror. See attachment for SOW. Award will be made to the lowest price technically acceptable. 

% +/- varriance in quantity of soldiers. 

ORK FOR DENTAL WORK. doc 

cky: (2) WHFRTC: 

d Individual Receivin Shipment WHFRTC Individual Receiving Shipment 

RD CENTER HWY 181 N 

age.gov/advgsaiadvantage/ebuylbuyer/rfCLsummary _do ?BV _ U seBV Cookie= Y es&rfqld=RFQ464244 9117/2010 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 151 of 223

(b) (6)

(b) (6)

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RFQ - Summary 

GREENVILLE, KY 42345 . . .. 

?BV _ U seBVCookie= Y es&rfqld=RFQ464244 

Page 2 of2 

9117/2010 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 152 of 223

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

Posted to NGB Reading Room 

June 22, 2011

Ace Consultants, Inc. 

Mr._ 

f{eJ1tllcl~p Army National Guart! 

Delila! Readiness 

RFQ464244-XXX 

Thank you for this opportunity to submit a quote for dental treatment for the Kentucky Army National 

Guard to be provided at WHFTRC in Greenville Kentucky from June 7th- 13th. 

ACC Consultants, Inc brings 19 years of providing support services to government agencies, ACC offers a 

thorough understanding of individual medical readiness (IMR) and fillly medical ready (FMR) 

requirements and standards. ACC understands the training demands placed on soldiers and individual 

units, and has developed time-tested and fully documented policies and procedures to ensure maximum 

support with minimal impact on the unit training assembly. ACC also has an ongoing working relationship 

and excellent rapport with ASM Research, the developer and mailltainer ofMEDPROS, DENCLASS, and 

other related support applications. ACC is GSA certified. ACC has the availability of the items and 

services indicated in the SOW and is prepared to begin the contl'act on the delivery date indicated in 

the SOW. 

Included in our proposal is our teclll1ical response, an explanation of how \ve ,vill deliver services, licensing 

and certification information, portable equipment and portable building capabilities, pricing illformation, 

and detailed past perfonnances related to the dental needs for KY ARNG. 

Should you have any further questions, please contact: 

Ginny Berger 

CEO 

ACC Consultants, IllC 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323-1300 X 681 

ginny@accdental.com 

Todd Bowel' 

Manager of Business Development 

ACC Consultants, Inc 

(505)323-1300 X 682 

todd@accdental.com 

Page 1 of22 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 153 of 223

Posted to NGB Reading Room 

June 22, 2011

ACC Consu/tallts, Inc. 

June 1,2010 

11:00 AM 

RFQ464244-XXX 

Dental Treatment 

Kentucl), Arm)' National Guard 

ACC Consultants, Inc. 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323-1300 

accdental.com 

{{elltucl(p Army National Guard 

DenIal Readilless 

RFQ464244-XXX 

ACC Consultants, Inc. is registered with CCR 

CAGEINCAGE Code: 4HZ92 

DUNS #: 624343463 

GSA Contract #: V797P-7134A 

Expires: 11/3012012 

\Voman Owned 

Small Business 

Page 2 of22 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 154 of 223

Posted to NGB Reading Room 

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A CC Consultants, Inc, 

Table of Contents 

Ken/uell)' Arm)' National GlIal'd 

Dell tal ReadilIess 

RFQ464244-XXX 

Dental Technical Description ____________________ ~4 

Mobile/POltable Dental Capabilities ___________________ 7 

Representations and Celtifications,~ __________________ 8 

Case Management Capabilities (Dental),~ ________________ 8 

Dental Licensing and Certification,~_~ _______________ ~9 

Personnel Qualifications _______________________ 1 0 

Dental Radiation Compliance _____________________ 1 0 

Dental Itemized Pricing _______________________ 13 

Dental Treatment Fee Schedule (Appendix A) _______________ 18 

Past Performances _________________________ ·

21 

Celtificate of Liability ________________________ ,26 

Page 3 of22 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 155 of 223

(b) (4)

Posted to NGB Reading Room 

June 22, 2011

ACC Consult([nts, fnc. 

Dental Technical Description 

Page 4 of22 

f{CJ1(/{c!(P Army Nflliol1111 Guard 

DenIal Readiness 

RFQ464244-XXX 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 156 of 223

(b) (4)

Posted to NGB Reading Room 

June 22, 2011

Ace Consultants, fnc. 

Page 5 of22 

l{enIUc/(l' ArlllY Natiollal Guard 

Dental Readiness 

RFQ464244-XXX 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 157 of 223

(b) (4)

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc. 

Page 6of22 

f{el1t/lc/~l' Army Nmiol1{f/ GilaI'd 

Dental Readiness 

IIFQ464244-XXX 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 158 of 223

(b) (4)

Posted to NGB Reading Room 

June 22, 2011

Ace Consultants, Illc. 

Size(s) 

• 60' Long 

• 12' Wide 

• 8' Ceiling height 

Interior Finish 

• Paneled walls 

• Vinyl tile floors 

• Pre-finished ceiling 

Electric 

• Fluorescent ceiling lights 

• 100 amp Breaker panel 

WindowslDoors 

• Horizontal slider windows 

• Steel door with commercial grade lock 

Heating and Cooling 

• Thermostatically controlled central HV AC unit 

• Supply ducted 

Exterior FinishlFrame 

• Wood siding 

• I-Beam frame 

• Standard drip rail gutters 

f{el1(llc/~V Army N({tiol1al Gllart! 

Delllal Readiness 

RFQ464244-XXX 

Sholiid (Ill el'elll reqllire IIII/oreseell lIIalerials, addiliollal sllpplies or eqllipmelli/ai/llre, ACC 

Consultants, lllc works closely "'ith Hellry Schein Dell/al fa expedite materials, supplies awl service 

technicia1ls to lite el'ellt site "'ithin a time(l' manlier for success/ul completion of C)lellts. 

Page 7 of22 
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Released by Army National Guard 

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Posted to NGB Reading Room 

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ACC Consllltants, Inc. 

Offeror Representations and Certifications 

kel1tuc/(p AI'I1{J1 National Guard 

Delllal Readiness 

RFQ464244-XXX 

52.212-3 OfferOl' Representations and Certifications - Commercial Items (JUN 2008) 

(b) (I) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b) 

(2) ofthis provision do not automatically change the representations and certifications posted on the Online 

Representations and Certifications Application (ORCA) website. 

(2) The offeror has completed the annual representations and cel1ifications 

electronically via the ORCA website at http://orcalbpn.gov. After reviewing the 

ORCA data base information, the offeror verifies by submission of this offer that 

the representation and certifications currently posted electronically at FAR 

52.212-3, Offeror Representations and Certifications-Commercial Items, have been 

entered or updated in the last 12 months, are current, accurate, complete, and applicable 

to this solicitation (including the business size standard applicable to the NArCS code 

referenced for this solicitation), as of the date of this offer and are incorporated in this 

offer by reference (see FAR 4.120 I), except for paragraphs N/ A . [Offeror to 

identify the applicable paragraphs at (c) through (m) of this provision that the offeror has 

completed for the purposes of this solicitation only, if any. These amended 

representation(s) andlor certification(s) are also incorporated in this offer and are current, 

accurate, and complete as of the date of this offer. Any changes provided by the offeror 

are applicable to this solicitation only, and do not result ill an update to the 

representations and certifications posted on ORCA.] 

Page 8 of22 
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Released by Army National Guard 

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(b) (4)

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ACC Consultants, Inc. 

Page 9 of22 

lleutllcl(ll Army NatioJ1al Guard 

DCIllal Readilless 

RFQ464244-XXX 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 161 of 223

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, lltc. 

Personnel Qualifications 

A'elltuc/(p A rilly Natiollal Gual't! 

DelIlal ReadiltC!ss 

II I'Q464244-XXX 

ACC Consultants is a dental oral healthcare provider that only practices with on-site care. ACC 

Consultants has approximately 750 dental professionals throughout the United States who are trained to 

provide care with mobile pOltable equipment in a caring professional way. ACC has dental professionals in 

40 states. Twenty (20) of our team leads have undergone the ACC "Train the trainer" program and are 

extremely well versed on how to manage and have quality standardized outcomes at mass events in order to 

train new employees so that our results are standardized. 

Ace Consultants has written protocols to assure standardized care for our military service members. The 

"ACC Protocol for Military Site events" answers every question that has come up since starting the SRP 

programs in 2003. This document is the "bible" for our operations. 

ACC Consultants Purpose Statement 

It is ACe Consultants purpose to continually improve our model and delivery of quality oral healthcare in 

settings with demanding logistical requirements, in a way that our patients receive competent and 

compassionate care regardless a/their circumstances, so that they hm1e healthier smiles, healthier bodies 

and a healthier quality of life. 

ACC Consultants Core Values 

• Honesty) Integrity and trustwolihiness 

• Listening, hearing, and understanding our co workers, patients, and communities in order to 

establish paths for improvement 

• Ethical decisions based on individualized circumstances 

• Encourage Creativity - in solving problems, making improvements and working toward our 

purpose 

• Empower patients to improve their health 

• Compassion as a mind set 

• Practicing non-judgmental attitudes 

ACC Consultants, Inc Dental Mobile/Pol'table Radiation compliance 

Radiation Safety Standard 

Company Policy 

To ensure that information about the dangers that may occur during exposure by dental x-ray 

equipment, ACC Delltal has established the following program. Under this program, all employees 

participating in Logistic Trips, Restorative Services, Temping Services, Private Pay Services and Contract 

Agreements, will be informed of the contents of the Radiation Standard. Safe exposure practices for 

patient and provider and New Mexico Safety Regulations for x-ray teclmicians and (in applicable) Logistic 

regulations for Logistic Personal. 

Page 10 of22 
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Released by Army National Guard 

Page 162 of 223

Posted to NGB Reading Room 

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ACC Consultants, Inc. Ilel1tllc/(l' Army National Guard 

Deutal Rea(/inc,\'s 

RFQ464244-XXX 

The Safety Manager is the program coordulator, with overall responsibility for the program, 

including reviewing and updating this plan as necessaty. 

ACC Denial will comply with the New Mexico State Regulations for the use of x-ray equipment. 

This certificate is displayed in the garage. A copy of this license will be in each of the MSDS books that 

travel on logistic trips. 

X-ray equipment will be repaired by a celiified repairman and maintained as required by the 

manufacturer and the Safety Manager. 

Employee Illformation amI Respollsibility 

All x-ray technicians will be responsible to upkeep their licenses current to comply with the 

standards of the New Mexico Deparlment o[ Dental Heallh and/or state that they reside in and keep copies 

with them. 

X-ray technicians will be provided an exposure safety monitor dosimeter badge. A 3-month 

waiting period may occur, as the billing/monitoring cycle is renewed. 

A lead apron will be placed over each patient receiving any radiation exposure. All x-ray 

technicians will be required to wear an operator lead apron and thyroid collar when any x-rays are being 

taken. 

All x-ray technicians will stand behuld the cone head and at least 6 ft away from the patient. 

Situations of multiple x-rays (Logistic Trips), indicator markers will mark off6 ft around work area. The 

patient must always be in sight of the operator when takulg an x-ray. 

In situations that an x-ray processor is used, the processor should be outside of the x-ray exposure 

room. 

All cords left out in the open, will be secured to the floor with tape to prevent obstruction offoot 

traffic. 

Workplace Allalysis 

ACC Dental will comply with State regulations Ul the operations of x-ray equipment. 

Employees working off site will notify the Team Leader or ACC Office if the workplace they are 

assigned to is not consistent with ACC safety standards. 

In temporary work sites, in which x-ray exposure will occur, caution radiation signs will be posted 

accordulgly. 

Radiation Safety Control 

Personal Protective Equipment (PPE's) listed below, will be provided for employees working in 

such areas listed below, any additional PPE's requested or needed will be put Ul writing and submitted to 

the Safety Manager. 

Gloves 

Masks 

Page 11 of22 
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Released by Army National Guard 

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ACC Consultonts, Illc. 

Lead Apron 

Thyroid Collar 

Contract Services 

Ilenflld,y Army NafioJ1a/ Glllll'd 

Delila/ Readiness 

II FQ464244-XXX 

• On April 29, 2009, a medical physics survey was performed by a Celiified Medical Nuclear Physicist and 

member of the American Board of Radiology on ACC Consultants pOliable X-ray dental units. The units 

meet the Food and Drug Administration, 21 CFR, Subchapter J, medical X-ray equipment requirements. 

The results of the medical physics survey can be viewed upon request. 

Page 12 of22 
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Released by Army National Guard 

Page 164 of 223

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

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

Posted to NGB Reading Room 

June 22, 2011

Ace Consultants, fnc, lleJ1tuc!IY Army N({tioJ1al Guard 

Delllat ReadilIess 

IIFQ464244-XXX 

Dental Itemized Pricing 

Item 

NO 

0001 

SUPPLIES/SERVICES MINIMUM UNIT UNIT 

NET PRICE 

Dental Exam 193 Service Service 

Members Mem bel' 

Total for Minimum 

***Prompt Payment Discount within 10 days of completion of 

Total Price for 183 Service Member Exams Less Early Payment 

Discount 

** Ace requires a minimum of 193 service member guarantee for exam services** 

Trea tmen t, 

Item SUPPLIES/SERVICES MINIMUM UNIT UNIT 

NO NET PRICE 

0002 - Dental Treatment 145 Service Service 

ers Member 

Total for Minimum 

***Pl'ompt Payment Discount within 10 days of completion of 

event at ,5% 

Total Price for 183 Service Member Exams Less Early Payment 

Discount 

**ACC requires a minimum of 145 service member guarantee for treatment services** 

Price 

Price 

**145 service members was calculated by taking the previously identified 87 category 3 service 

members and adding in the estimated (30%) resulting catergory 3 service members that willl'esult 

from the exams-this adds an additional 58 service members, This results in a total of 145 service 

members who will require treatment. ** 

Page 13 of22 
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Released by Army National Guard 

Page 165 of 223

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

(b) (4)

(b) (4)

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc. 

APPENDIX A 

/(eJltlldo' Ar111)' National Guard 

Delllal Readiness 

RFQ464244-XXX 

AUTHORIZED DENTAL TREATMENT 

I. The following dental procedures are authorized: 

A. Diagnostic Services which are funded through NG6H 2065 Medical Readiness Funding: 

1. DOl20-Periodic Oral Evaluation 

2. DO ISO-Comprehensive Oral Evaluation 

3. D0330-Panoramic Film 

4. D0272-Bitewings-Two Films 

5. D0274-Bitewings-Four Films 

6. D0220-First Periapical Xray 

6a. D0230-Each Additional Periapical 

B. Restorative Services which are funded through the VFRE 2020 Dental Treaonent Funding (provided 

only to soldiers alerted to an OCOCNUS Mission): 

1. D2140-Amalgam-One Surface 

2. D2150-Amalgam-Two Surfaces 

3. D2160-Amalgam-Three Surfaces 

4. D2161-Amalgam-Four or More Surfaces 

5. D2330-Composite-One Surface 

6. D2331-Composite-Two Surfaces 

7. D2332-Composite-Three Surfaces 

Posterior composites wil1 be authorized only when a posterior composite is necessary to provide a 

quality restoration and no other alternative is ayailable. 

8. D2335-Composite-Four or More Surfaces 

9. D2391-Composite-One Surface 

10. D2392-Composite-Two Surfaces 

II. D2393-Composite-Three Surfaces 

12. D2394-Composite-Four or More Surfaces 

13. D2799-Provisional Crown 

14. D293 I-Prefabricated Stainless Steel Crown 

IS. D2950-Core Buildup, including any pins 

16. D2954-Prefabricated Post and Core 

C. Endodontic Services which are funded through the VFRE 2020 Dental Treatment 

only to Soldiers alerted to an OCONUS Mission): 

I. D331 O-Anterior Root Canal Therapy 

2. D3320-Bicuspid Root Canal Therapy 

3. D3330-Molar Root Canal Therapy 

4. D3346-Anterior Root Canal Retreatment 

5. D3347-Bicuspid Root Canal Retreatment 

6. D3348-Molar Root Canal Retreatment 

Page 14 of22 
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(b) (4)

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

(b) (4)

Posted to NGB Reading Room 

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Ace COl/sultallts, Inc. l\el1(ffc/~V A rill)' National Guard 

Dellllli Readiness 

RFQ464244-XXX 

D. Periodontal Services which are funded through the VFRE 2020 Dental TreaDnent Funding (provided 

only to Soldiers alelted to an OCOCNUS Mission): 

1. D4355-Full Mouth Debridement 

2. D4342-Periodontal Scaling and Root Planning, I to 3 teeth per quadrant 

Periodontal scaling and root planning is authorized only when a periodontal abscess is present 

E. Prosthodontic Services which are funded through the VFRE 2020 Dental TreaDnent Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

I. DSIIO-Complete Denture-Maxillary 

2. D5120-Complete Denture-Mandibular 

3. D5211-Maxillary Partial Denture-Resin Base 

4. D5212-Mandibular Partial Denture-Resin Base 

F. Oral Surgery Services which are funded through the VFRE 2020 Dental Treatment Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

1. D7140-Extraction, Erupted Tooth or Exposed Root 

2. D7210-Surgical Removal of Erupted Tooth 

3. D7220-RemO\:al ofImpacted Tooth, Soft Tissue 

4. D7230-Removal oflmpacted Tooth, Partial Bony 

5. D7240-Removal of Impacted Tooth, Completely Bony 

G. Orthodontic Services which are funded through the VFRE 2020 Dental Treatment Funding (provided 

only to Soldiers alerted to an OCONUS Mission): 

I. D8680-0lthodontic Retention 

The following dental procedures are not authorized: 

A. Bridges andlor implants 

B. Removal of Asymptomatic third molars 

C. Routine Prophylaxes (cleanings) 

D. Restorations for aesthetics only 

E. Restorations for small (non-class 3) caries 

F. Extensive Root plane/scaling 

G. Osseous Surgery 

H. Other diagnostic services 

The above listings are guides to assist the State Dental Officer 01' his/her designee in detet'luining treatment to 

be authorized. The treatment provided by the ARNG is to get the Soldier from a dental class 3 to a dental class 

2 only. Comprehensive Treatment (to dental class I) is not authorized. 

3. If a Soldier needs all of his/her remaining teeth in an arch extracted and a denture placed, the Soldier will not be 

available for deployment for at least 6 months and shall be disqualified from immediate deployment. However, if the 

Soldier is otherwise deployable (passes all medical, personnel and training requirements) and, after extraction and 

placement of prosthesis, would be deployable, the dental treatment could be provided and the Soldier could be 

considered as a replacement at a later date. 

Page 15 of22 
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Released by Army National Guard 

Page 167 of 223

Posted to NGB Reading Room 

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Ace Consultants, Inc. I(ent/lcl~l' AI'I1IY National Cuart! 

Den la/ Real/illess 

/I FQ464244-XXX 

4. Ifa Soldier will have a number of teeth extracted to the extent mastication and speech are adversely affected, then 

an acrylic removable pattial denture will be authorized if there is sufficient time for healing and construction of the 

pattial denture prior to depaJture to Mobilization Station. 

5. Soldiers requiring extensive periodontal treatment will be disqualified fi'om deployment and educated on the 

TRICARE Dental Program. If he/she obtains the required therapy (from his/her private dental provider) and reaches a 

maintenance level, then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental treatment plan for dental care which 

exceeds $2000 to insure that the above clinical guidelines are met. Exceptions can be made, but they must be 

coordinated with the State Surgeon. 

Page 16 of22 
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Released by Army National Guard 

Page 168 of 223

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

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A CC Consultants, Inc. /(entfU:l,y /1rmy N({tiollal Guard 

Dental Readiness 

RFQ464244-XXX 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

of 

2010 

The state of Georgia awarded ACC Consultants Inc the 5 year contract to provide dental trealmenllo the Georgia 

Army National Guard al Ogellhorpe Armory in Ellenwood, GA. ACC Consullanls, Inc. furnished all labor, lools, 

i malerial, i for 

o at 3's converted to Cat 1 or 2: 100% 

o 391 Members seen during event 

o 327 Converted to Class 1 or 2 status 

o 64 Were not converted onsile 

o Unless these patients refused treatment (1) or are seeing their own private dentist (7), ACC 

is case managing them and they will be converted and their 2813 uploaded to DENCLASS. 

o Overall Exam + Treatment Conversion Rate not including 3C's: 100% 

o 326 conversions/327 Cat 3's (not including 3C's, no-shows, refusals/prefer civilian dentist, 

high blood pressure, future event scheduling 

o 

o Number of Cat 4's presented to clinic that were examined and given new readiness dates: 291 

o Automatic convertedlidentified as Cat 1 or 2: 242 

o The following is a breakdown of Ihe soldiers Ihat presenled to clinic as Cat 3 Ihat were not able to be 

converted on site. These soldiers will be case managed or invited back to future events and all should be 

upgraded to Cal1 or 2 after case management is completed. 

o Number of Cal 3's requiring oral surgery referrals due to needing oral sedation in oral surgery 

office:9 

o Cat 3's not converted due to endodontic specialty needs (retreatment of eXisting RCTs, calcified 

canals): 7 

o Cat 3 not converted due to prosthetic lab case need: 8 

o Cat 3 nol converted due to extreme high blood pressure: 1 

o Cat 3 not converted due to pending appointment wilh civilian DDS (approved by event paC): 7 

o Number of Cat 3's identified that will be scheduled to be converted at next OHS or Dobbins event: 

26 

o Cal 3 patients identified as Cat 3 during exam that no-showed or did nol have time for treatment 

appoinlmenls: 3 

o Cat 3 patient that became to shaky to complete treatment: 1 

All Cat 3 palients are being case managed and appointed wilh the appropriate specialists to complete their Cal 3 

needs. All will be converted 10 Cat 1 or 2 status after case management is through. 

I 

Page 17 of22 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 169 of 223

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

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, fllc. 

Title: 

3. Nnme, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, telephone 

number and Email: 

5. Project Officer's Name, Address, Telephone Number, 

Fax Number and Email Address: 

lI:el1tuc/IY Arllt)' National Guard 

Dell/al Readiness 

RFQ464244-XXX 

Roberts 

or delays encountered and any 

was to management, 

materials, equipment, certifications and supplies required to provide dental exams and treatments per identified treatment plan 

to upgrade Class 3 soldiers to a Class 2 status January 19-21, 2010, 

All dental treatment that was identified in the patient's treatment plan was accomplished based on the National Gurads Bureau's 

statistics that 30% of soldiers examined were classification 3. Contract was awarded on December 15, 2009; Ace personnel 

and mobile equipment arrived on site January 18, 2010. 

Dental Event Numbers and Data: 

o Percentage of Cat 3's converted to Cat I or 2: 100% 

o 1031 Service Members seen during event 

o 911 Converted to Class 1 or i status 

o 120 Were not converted onsite 

o See below for information I'egarding these patients. 

o Overall Exam + Treatment Convel'sion Rate not including 3C's: 100% 

o 911 conversions/911 Cat 3's (not including 3C's, no-shows, refusals/prefer civilian dentist, 

vouchers for treatment that was not allowed by contract) 

o Cat 4 soldiers that were identified as Cat 1 or 2: 710 

o There was about a 63% conversion of Cat 3 soldiers (after examination) at the event site. Had the 

contract allowed ACC's providers to treat mOl'e conditions and have an oral surgeon included, the 

conversion rate of Cat 3 patients would have been around 90% by the end of the event. 

o The following is a breakdown of the soldiers that presented to clinic as Cat 3 that were not able to be 

convelied on site, These soldiers will be case managed or invited back to future events and all should be 

upgraded to Cat I or 2 after case management is completed, 

o The contract did not allow ACC to treat many of the Cat 3 conditions present. There were 

65 3C's, 7 Full Ortho patients, 1 woman was pregnant, 47 were approved for vouchers by 

POC as they had conditions that the contract did not allow ACC to treat. 

All DENCLASS data was the event. 

Page 18of22 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 170 of 223

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

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc, 

3, Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

li.'eJ1tf{d~1' AI'I1I,)' /Vmiol1a/ Guard 

Delltal Readiness 

RFQ464144-XXX 

The New Mexico awarded ACC Consultants Inc the contract to provide dental treatment to the New Mexico Army 

National Guard at armories in both Albuquerque and Santa Fe, NM. ACC Consultants, Inc. furnished all labor, 

tools, equipment, material, transportation and supervision for dental treatment for approximately 87 service 

members on two separate days and locations. 

i 

Category 3 Upg e Report: 

o Percentage of Cat 3's converted to Cat 1 or 2: 98% 

(That were willing andlor available for treatment and had conditions that needed treatment 

outlined in the contract requirements) 

o 87 Service Members seen during event 

o 78 Converted to Class 1 or 2 status 

o 9 Were not converted onsile 

o These patients are either: 

Seeing their own private dentist (OK'd by event POC) (2), 

• Blood Pressure was too high to have oral surgery done (1), 

• 3C's (4): 

• Need a Root Canal ReTreatment (1) 

• Need removable prosthetics (2) 

• Need to see an Orthodontist to have fixed appliance removed (1) 

• Had extensive full mouth treatment that requires another day of treatment (2). 

o These patients could all be case managed by ACC to ensure their conversion if funding 

is procured by DSS for private office dental fees. 

Please let us know if you would like to utilize this service 

o Overall Exam + Treatment Conversion Rate not including 3C's: 98% 

o 78 conversions/80 Cat 3's (not including "prefer civilian dentist", "bood pressure high" or 

3C's) 

o Overall Exam + Treatment Conversion Rate including 3 C's (8): 94% 

All DENCLASS patient data was uploaded by COB 3/25/2010. 

This 2 day restorative event was carried out without any problems or delays or any corrective actions 

taken in , schedule or technical 

Page 19 of22 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 171 of 223

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

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc. 

1. Contract Title: 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

of 

9. Final Contract Price/Cost to Date: 

f(elltllcflY Army NatiuJ1al Guartl 

Denlat Readiness 

R FQ464244-XXX 

USPFO for Kentucky 

Frankfort, KY 40601 

502-507-1390 

USPFO for 

BNGC Bldg 120 

120 Minuteman Parkway 

Frankfort, KY 

40601-6192 

Specialist 

The state of Kentucky awarded ACC Consultants Inc the contract to provide dental treatment to the Kentucky Army 

National Guard at Fort Indiantown Gap in Annville, PA. ACC Consultants, Inc. furnished all labor, tools, equipment, 

material, transportation and supervision for Dental Treatments for approximately 250 service members 

Report: 

o Percentage of Cat 3'5 converted to Cat 1 or 2: 94% 

(That were willing and/or available for treatment) 

o Total Number of Cat 3's presented to clinic: 192 

o Total Number of Cat 3's upgraded at clinic: 169 

o Total Number of Cat 3's not upgraded due to circumstances beyond contracted capabilities: 11 

o 12 

o 3 Cat 3 Soldiers refused treatment and requested to have treatment by their civilian dentist 

o 1 Cat 3 Soldier taking Coumadin; not able to discontinue for oral surgery 

o 1 Cat 3 Soldier needed apicoectomy (specialized endodontic surgery) 

o 1 Cat 3 Soldier awaiting lip biopsy 

o 1 Cat 3 Soldier needs full upper and lower dentures (all extractions were done on·site) 

o 4 Cat 3 Soldiers need specialized IV sedation at oral surgery clinic (determined by oral surgeon 

on-site) 

Page 20 of22 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 172 of 223

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

Posted to NGB Reading Room 

June 22, 2011

ACC COl1sultants, fllc. 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

9. Final Contract Price/Cost to Date: 

llel1tllc!~r Army N((/iollal GlIlIl'd 

Delllal Readilless 

RFQ464244-XXX 

Dental treatment for 69 Service Members 

Washington i I 

USPFO for Washington Building 32 

Camp Murray, Tacoma WA 

98430-5170 

Washilnotl)n "ullcllna 32 

9-102009 

The state of Washington Army National Guard awarded ACC Con.sultants Inc the contract to provide dental 

treatment to the Washington Army National Guard at the Yakima Readiness Center. The Yakima readiness Center 

required a mobile van alII abor, tools, equpment, material, transportatin and supervison for approximately 69 dental 

treatments. 

This 2 day restorative event was carried out without any problems or delays or any corrective actions taken in 

regards to cost, schedule or technical performance. 

Category 3 Upgrade Report: 

o Percentage of Cat 3'$ converted to Cat 1 or 2: 96% 

(That were willing and/or available for treatment) 

o Total Number of Cat 3's presented to clinic: 27 

o Total Number of Cat 3's upgraded at clinic: 21 

o Number of Cat 3's refusing treatment offered at SRP: 5 

o Cat 3's not converted due to other reasons: 1 

(need prosth tx to complete cat 3 needs/unable to return to clinic!etc.) 

All DENCLASS patient data-both exam and treatment-are entered. 

Page 21 of22 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 173 of 223

(b) (4)

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc 

9008 Washinglon NE 

Albuquerque, NM 87113 

USA 

Voice: 

Fax: 

505-32:>-1300 

505-323·1400 

1~lll}!~~i?4~~~$~1~1:';;~i~j;"iit!~'\&;$~~~t~tiij]£'t:i 

USPFO for Kenlucky 

120 Minuteman Pkwy 

Frankfort, KY 40601·6192 

INVOICE 

Invoice Number: 17560 

Invoice Dale: 

Page: 

Duplicate 

USPFO for Kenlucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40301·6192 

Jun 14, 2010 

1 

I 

I 

BNGC, Bldg 120 J ~-. 

"---__ . _______ J 

1.00 TXTEAMS·NG 

CheckfCredil Memo No: 

Training Center, Greenville KY event 

07June-13 June, 2010. 

Treatment Teams I same event Greenville 

KY07 June·13June, 2010 . 

. 5 % discount 10 day 

THANK YOU KY GUARD 

'f---"'--~'--' ._ ..... _ .. ___ ._~~_ .•.. L 

: Subtotal I 159,450.00 i 

I 

: Sales Tax 

I Total ";v~'-Ic-e-'A:-m-o-u-n-;-t-' .-------i--~~15'g,"456.60 : 

I _" _________ n__, I 

: PaymenUCredit Applied ; i 

~1~1l~Fj'i~~,i¥~~t~i}t?;if~11~~~ii1~~r~~Tfici~{~+~ !t~iit~[§;§';~~[W:Q! 

,«"eCO"'r>t~ ~ f'C'j"'c.J ~ ~~. 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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

Posted to NGB Reading Room 

June 22, 2011

AMENDMENT OF SOLICITATIONIMODIFICATION OF CONTRACT 

2. AMENDl\.fENT/MODIFICATION NO. EFFECTIVE DAlE 

RJ0001 10-Jul-2009 

BY CODE . ADMINISTERED BY ([fOlller than item6) 

USPFO FOR KENTUCKY 

BNGC, BLDG 120 

120MINUTEMAN PAAI\.I,VAY 

FRANKFORT KY 400:11-6192 

8, NM1E AND ADDRESS OF CONTRACTOR (No., Street, COlmty, State and Zip Code) 

AGe CONSULTANTS INC 

TODD BOVVER 

9Xl9WASHINGTON STNE 

AlBUQUERQUENM 67113-2704 

See Item 6 

l.CONlRACTID 

J 

.I 

PAGES 

2 

lOA. MOD. OF CONTRACT/ORDER NO. 

W912KZ-09-F-0063 

is anended as set furlh in Item 14. The hour and date specified mrreccipt ofOf!er o is extended, DiS uot extellded. 

OBer nust acknowledge receipt oftbis ancndrrent prior to the hour and date specified in the solicitatioll oras uIJJ.Ouded by one ofthe bllowing Jl1~thDds; 

Ca) By cOllpletillg Item; 8 and 1.5, and retuming copies oftheam:lldm:ut; (b) By acknowledging receipt oftbis am:udrrellt ou CJch copy unhe olEr subrrittcd; 

or(c)By separate letter or telegramwhiclJ includes a reitrenceto the solicitation and rmendzrent nUIIDcrs. FAILURE OF YOUR ACKNOWLEDGMENTTO BE 

RECEiVED ATTHE PLACE DESIGNATED FOR TIlE RECBIPTOFOFFERS PRlOR 'IO THE HOUR AND DA'IE SPECIFIED MAY RESUL TIN 

REJECTION OF YOUR OFFER lfby virtue of this a..rttudmeut you desire to Cllange an of!eralready submitted. such change nny berrndeby telegramor letter, 

provided each leiegramor letter nakes rerrence to the solicitation and this arrrndrrrni. aJld is received prior to the opening hour and date specified, 

12. ACCOUNTING AND APPROPRIATION DATA (Ifrequked) 

See Schedule 

13. ONLY TO MODIFICATIONS OF 

NO. 

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE 

CONTRACf ORDER NO. IN ITEM lOA. 

clause 52.243-1 

TO REFLECT THE ADMINISfRATIVE.,,~~',.,:,,:,~\'~U as changes in paying 

TO THE AUTHORITY OF FAR 

eUl<.'>U.I\W TO AUTHORITY OF: 

OTHER (Specify type and 

IMPORT ANT: Contractor 0 is not, 0 is required to sign. this document and return copies to the issuing office, 

14, DESCRIPTION OF AMENDMENTIMODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter 

\vhere feasible,) 

Modification Conlrol Number: hulchd1509163 

1, Une item # 1 is changed to read 1 ~IS increase covers the use of 4 treatrrent tearns for 

the period of perforl1l3nca 10 provide treallll3nl of 250 soldiers 10 bring Ihem from CAT 310 CAT 2. Option Ihree • usa of Wobile RV is deleled. 

2. Block # 25, lolal is changed 10 

3. Total contract price is increased 

provided herein. all term> :wd conditions afthe docunfllt reheuced in Item9 A or lOA, as aud ill full fnee and e~(t. 

I 5A. NAME AND TITLE OF SIGNER (Type or prinl) OFFfCER (Type or print) 

I 5B. CONTRACfORIOFFEROR 15C. DATE STGNED 16C. DATE SIGNED 

10-Jul-2009 

30-105-04 Sf ANDARD FOl~\130 (Rev. 1O-~3) 

APPROVED BY OIRM 11-84 Prescribed by GSA ( _ 

FAR (48 CPR) 53.243 ,-:,( ) 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

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

Posted to NGB Reading Room 

June 22, 2011

SECTION SF 30 BLOCK 14 CONTINUATION PAGE 

SUMMARY OF CHANGES 

SECTION A - SOLICITATION/CONTRACT FORM 

The total cost of this contract was increased 

SECTION B - SUPPLIES OR SERVICES AND PRICES 

W9 I 2KZ-09-F -0063 

POOOOI 

Page 2 of2 

CLIN 0001 

The CLIN extended description has changed from Performance per Statement of WorkOption Three 

"Mobile Dental RV" selected from options Statement of Work. 

The unit price amount has increased by 

. The total cost of this line item has increased 

SECTION G - CONTRACT ADMINISTRATION DATA 

Accounting and Appropriation 

Summary for the Payment Office 

As a result of this modification, the total funded amount for this document was increased by 

CLIN 0001: 

AA: 219206518IOI5133G92RL2512Nt}6frM'18A2! 

(CIN W900D 190370 I 000001) was increased 

(End of Summary of Changes) 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 176 of 223

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

Posted to NGB Reading Room 

June 22, 2011

From: 

Sent: 

To: 

Subject: 

""--NGKY; ~4:35 PMII"'~!IIIIII_. NGKY 

ACC Proposal Dental Treatment (UNCLASSIFIED) 

Attachments: ACC Proposal.doc 

ACC Proposal.doc 

(298 KB) 

Classification: UNCLASSIFIED 

Caveats: NONE 

I will need one or both of you to review the attached proposal submitted by ACe 

Consultants in response to the request for quote issued for the Dental Class III treatment 

in PA. 

As the price offered is considerably lower than the funded amount, please insure the 

contractor presents a clear understanding of the requirement. I \1i11 need a written 

response that you feel the contractor is capable of performing and has an understanding of 

the requirement. 

Contract Specialist 

USPFO for Kentucky 

Frankfort, KY 40601 

502-607-1390, fax 502-607-1424 

Classification: UNCLASSIFIED 

Caveats: NONE 

1 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 177 of 223

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

Posted to NGB Reading Room 

June 22, 2011

From: 

Sent: 

To: 

Subject: 

PM ~~_lii!iiiltNGKY GSA E-Buy Request For Quote RFQ371688 has CLOSED 

Subject RFQ for: "Class III Dental Restoration Team" is noVl closed. '1 quotes were 

received. 

To view and evaluate quotes, please login at www.ebuy.gsa.gov. Once logged-in, click on 

the e-Buy logo to proceed to e-Buy then click on liMy RFQsl!, As a courtesy to sellers, 

please evaluate all quotes so that all sellers l,I,1ho made an offer are notified. 

e-Buy will provide information to contact sellers if needed. 

You may contact GSA at gsa.advantage@gsa.gov or call 1-877-472-3777 (select option 2) if 

there are questions concerning e-Buy operation. 

NOTE: PLEASE DO NOT REPLY TO THIS E-MAIL. 

Thank you! 

1 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 178 of 223

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

Posted to NGB Reading Room 

June 22, 2011

AGREEMENT NO. 

V797P-7134A 

ORDER! 

ORD ER FOR SUPPLIES OR SER VICES 

12.DELlVERY ORDERI CALL NO. 

W912KZ-09·F·0063 

3. DATE OF ORDER/CALL 4. REQ.I PURCH. REQUEST NO. 

(rrYYMMMDD) 

2009 Jul 08 W9000190370100 

PAGE 1 OF 22 

5. P RIO RITI' 

. ISSUED BY 

USPFO FOR KENTUCKY 

SNGC, BLDG 120 

CODE I IV912KZ 17. ADMINISTERED BY (lfoffler/hall 6) CODEIL-______ ~~----~~--~ 8. DELIVERY FOB 

120 MINUTEMAN PARKWAY 

FRANKFORT KY 40601-6192 

9. CONTRACTOR CODE 14HZ92 

Ace CONSULTANTS'INC 

NN,IE TODD BOWER 

AND 9008 WASHINGTON ST NE 

ADDRESS ALBUQUERQUE NM 87113·2704 

SEE ITEM 6 

FACILITY IL ____ ---11 O. DELIVER TO FOB PO!NTBY (Dale) 

(J'YYY}.{}'{UDD) 

SEE SCHEDULE 

I",DISCOUNTTERMS 

10 Da,s - .5% 

/xl DESTINATION 

DOTHER 

(See Schedule ifolher) 

11. MARK IF BUSINESS IS 

SMALL 

SMALL 

DISADVANTAGED 

X WOMEN.OWNED 

3. MAIL INVOICESTO THE ADDRESSIN BLOCK 

14. SHIP TO CODEL 

SEE SCHEDULE 

15. PAYMENT WILLBE MADE BY CODEj015058 

DEFENSE FINANCE & ACCOUNnNG OFFICE.IN '------------1 

DO NOT SEND INVOICES HERE 

ATTN; DFAS·)N 

INDIANAPOLIS IN 46249 

MARK ALL 

PACKAGES AND 

PAPERS WITH 

ID ENTIFIC A TIO N 

NUMBERS IN 

BLO CKS 1 AND 2. 

16. Th is delivery older/call is issued on an Other GOY ern men I agency or in accordance wilh and subj eel to teons and conditions 0 (above numb ered contract. 

TYPE 

OF PIJRrHASE , '>I,' . Furnish the rollo~'ing_ on terms specified herein, REF~R~~_# 371668 

ACCEPT ANCE. THE CONTRACT OR HEREBY ACCEPTSTHE OFFER REPRESENTED BY THE NUMBERED PURCHASE 

ORDER ASIT MAY PREVIOUSLY HAVE BEEN OR ISNOW MODIFIED, SUBJECT TO ALL OF THE TERMS 

AND CONDITIONS SET FORTH, AND AGREEST 0 PERFORM THE SAME. 

NAME OF CONTRACTOR SIGNATURE 

o Ifth;, box ;, muk,d, ,"ppH" mu" ,;gn ond co'um tho , 

7, ACCOUNTING AND APPROPRIATION DAT AI LOCAL USE 

See Schedule 

18. ITEM NO, 19, SCHEDULE OF SUPPLIES' SERVICES 

TYPED NAME AND TITLE 

20. QUANTITY 

ORDEREDI 21. UNIT 22, UNIT PRrCE 

ACCEPTED" 

DATE SIGNED 

(YYYr,\fUMDD) 

23. AMOUNT 

SE SCHEDULE 

". umm "'·Am w· MlmCA _ 

Ifquanlity acceprcd by the Governmenllssame as ~I •••• I 1,2",-,' .. -'-' T O,,-,-TJ: .A'>"-Lt-__ .:.::!922::o::,,500,, .. OO "-----1 

I" Iquan ,",a')'on'""d, Illy 0 ccep ted Indlwle helo w qu;nlily' b)' X, If 0 different, rdered and enler Cl!circ/e, aClual BY, :=====--"",'Ei~~~j::;-;;~;::;---~--~--==-~"~~~C£I~=======1 un H;".K .:': ::'-=-

12~ QUANTITY IN COLUMN 20 HAS BEEN 

DINSPECTED DRECEIVED 0 ACCEPTED, AND CONFORMSTO THE 

CONTRACT EXCEPT AS NOTED 

lb. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE c, DATE d, PRINTED NAME AND TITLE OF AUTHORIZED 

(!'YJ'YMMMDD) GOVERNMENT REPRESENT ATIVE 

e. MAILING ADDRESS OF A UTHORIZED GOVERNMENT REPRESENT AT IVE 128. SHIP NO, 29. DO VOUCHER N0.I'O. 

'TWT> " , 

TELEPHONE NUMBER /g, E-MAIL ADDRESS 

36.1 certify's account is correct an prope, paym en 

. DATE [), SIGNATURE AND TITLE OF CERTIFYING OFFICER 

, DJ 

7, RECEIVED AT 138, RECEIVED BY 9, DATE RECEIVED 

(YrJ'YMMMDD) 

8 PARTIAL 

FINAL 

I. PAYMENT 

§ COMPLETE 

PARTIAL 

FINAL 

32.PALDBY 3. AMOUNT VERIFIED 

CORRECT FOR 

!34. CHECK NUMBER 

5. BILL OF LADING NO, 

140.TOTAL 41. SIR ACCOUNT NO 42. S'R. VOUCHER NO. 

CONTAINERS 

DDForm 1155, DEC 2001 P REVl OUS EDIT rON IS OBSOLET E. 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 179 of 223

Posted to NGB Reading Room 

June 22, 2011

Section B . Supplies or Services and Prices 

STATEMENT OF WORK 

STATEMENT OF WORK FOR DENTAL READINESS 

. Introduction: Individual Medical Readiness (IMR) and Fully Medically Ready (Flv[R) are the 

basic principals of a ready force for KY ARNG. Failure to maintain dental standards could 

preclude a soldier from deploying. Dental readiness is a command and soldier responsibility. 

This statement of work covers the dental components ofIMR/FMR to include: annual dental 

exams, digital bitewing xrays, digital panoramic xrays, DENCLASS data en!1y of all xrays and 

dental records, identification and treatment of all Class 3 soldiers on alert orders and/or in 

conjunction with the ANG Selected Reserve Dental Readiness System. Services are to be 

completed on site at Fort Indiantown Gap, Annville, P A. The SOW identifies the purpose ofthe 

work to be perfonned by the contractors and provides a description of the work to be completed 

and the required outcomes. The contractor shall provide qualified persomlel, material to perform 

the services,. and lor OSHA, HIPPA and Privacy Act Compliant Mobile depending on the 

individual site needed for the KY ARNG. 

1. DoD established a unifonn dental classification in HA Policy 02-11. DoD policy requires 

dental screening examinations to be accomplished and documented on 90% of service members. 

Members ofthe KY ARNG shall receive an annual dental screening exam to detennine their 

dental classification. As well, soldiers alerted and/or sourced are eligible for dental treatment if 

they are class ill status from exanlination. The results of that screening exam should be entered 

into denclass no later than 5 days from the date of the exanl. The DENCLASS database updates 

the Anny Medical Protection System, Medpros. Dental treatment that may be required is 

essential to be provided at the SRP site to ensure the highest Dental Deployment Rate for the 

mobilizing soldier. 

2. Objective: The contractor shall provide all management, labor, material, equipment, 

certifications and snpplies necessary to provide dental services at designated locations for the 

Anny National Guard. These services will provide mandated dental examinations andlor 

radiographic studies and lor dental treatment, proper documentation into the Soldier's record, and 

data entry of all records into the DENCLASS system, as necessary to meet Dep31tment of the 

Anny st311dards of medical readiness and deployability, to ensure mission capability of the Army 

National Guard. The contractor will insure that their agents are appropriately trained 3l1d have 

access to the DENCLASS system. 

3. Scope of Practice: The contractor shall provide customized comprehensive dental readiness 

services to the KY ARNG in conjunction with their training schedule to include site location and 

time to accommodate unit: Event to be held 12-19 July at Ft Indiantown Gap, P A for an 

estimated 250 soldiers. Any incomplete treatment will need to be case managed and completed 

by company awarded contract when service members return to home of record if required. 

A) Comprehensive dental examinations (exams) as per CDA Code D0150 and clinically 

indicated radiologic studies (to include panoramic) and oral health education. 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 180 of 223

Posted to NGB Reading Room 

June 22, 2011

B) Class ill dental treatments for alerted Soldiers and! or soldiers who are catorgized in 

SELRES program (as identified by the state/ten1tory). Dental treatment autho11zed is outlined in 

Appendix E. Any treatment plan greater than $2000.00 requires prior approval from State Dental 

Officer (SDO). These services will be completed by using contractor provided portable/mobile 

dental equipment (unless othenvise specified in a separate written agreement). 

C) Specified Dental Specialty Services that requires SDO approval to include 

1) Oral and Maxillofacial Surgery (to include pathology reports if indicated) 

2) Endodontics 

3) Periodontics 

4) Prosthodontics 

5) Other (specify) 

D) Prescriptions for pharmaceuticals and controlled substances necessary for the care and 

treatment to Soldiers throughout the event, to include but not limited to analgesics and 

antibiotics. Prescriptions for maintenance phannaceuticals for Soldiers with high caries risk or 

periodontal disease, as indicated will be provided by contractor on site. Emphasis on pain 

control after topical analgesic has resolved. 

3.l. Upon completion of services, medical infonnation will be documented in accordance with 

Department of the Anny Policy and be updated in the approved Army National Guard automated 

system. The contractor shall also ensure the requirements of Occupational Safety and Health 

Administration (OSHA) and applicable Federal regulations are met. The contractor shall develop 

and maintain records that fully document sen'iced perfonned, examination results, and names of 

soldiers referred to dental specialists. These records will be made available to the State/TerritolY 

Medical representative. 

3.2. Exam. A comprehensive oral evaluation shall assess the current state of oral health, risk for 

future dental disease as well as assessing general health factors that relate to the treatment of the 

patient. The following measures are required for each comprehensive oral evaluation: 

A. Blood pressure assessment - Screen Soldiers for hypertension, appropI1ately refer 

hypeliensive patients to the state/ten1tory medical authoI1ty. 

B. Caries risk assessment - Classify Soldiers as low, moderate or high risk for caries as 

descdbed by the American Dental Association's 1995 Special Supplement. This assessment will 

allow the ADCS to identify those at high risk for future disease and appropriately manage their 

care. 

C. Periodontal assessment - Pedodontal Screening and Recording (PSR), a screening 

procedure endorsed by the American Dental Association and the Ame11can Academy of 

Pe110dontology, should be utilized to detennine the need for periodontal treatment. 
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D, Tobacco risk assessment - Classify Soldiers as a smoker, user of smokeless tobacco or as 

both, 

E. Oral cancer screening - Perfonn a thorough oral cancer screening on all patients as part of 

all mmual examinations, 

F, Radiographs should be taken only for clinical reasons according to FDA and DENCOM 

guidelines as detennined by the patient's dentist. Radiographs should be of diagnostic quality, 

properly identified and dated, A panoramic radiograph of adequate quality for 

diagnostic/identification purposes is required to be part of the dental record, There is no time 

requirement on updating pauoramic radiographs, However, the panoramic radiograph will 

adequately represent the current oral condition of the Soldier, Bitewing (or "bitewing slice" at 

the discretion ofthe State Dental Officer) radiographs are also required to be part of the dental 

record, All radiographs provided under this contract will be digital (unless specified in a separate 

written agreement) and transferred to the Denclass module within 24 hours of exposure, 

G, A listing of all DFC 3 conditions, 

H, Any condition of significance that is not readily apparent on the radiographs, 

3.3, Documentation, All Soldiers must have a complete military dental record, No dental record 

is considered complete unless the documentation is complete and in the proper order as outlined 

in TB MED 250, The contractor shall provide electronic documentation (to iuclude radiographs) 

in the ARNG approved system (within 24 hours of exam completion) and a paper copy as 

outlined below, A complete record includes the followiug: 

A :Military dental record jacket, DA FOlID 8005 through 8005-9 

B, The automated Health HistOlY Fonn or DA Fonn 5570 (with notations to "yes" answers 

and signed by both the Soldier and reviewing Doctor), Health Questiolmaire envelope 

C. DD Fonn 2005 (signed), Plivacy Act Statement 

D, SF 603/603A, Record of Dental Exam 

E, Supporting radiographs (panoramic and diagnostic bitewing radiographs ((see l.3,F» 

documenting existing conditions) 

(1) All radiographs will be uploaded into the ARNG automated system, 

(2) A diagnostic quality copy of all radiographs must be placed in the Dental Record, 

F. The entries on the SF 603/603A will include the following: date, location, "comprehensive 

oral evaluation" (as defined in CUtTent CDT as D0150), indication/date of x-rays taken, 
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indication/date of x-rays consulted, oral cancer screening, caries tisk assessment (based 

upon caries incidence), Petiodontal Screening and Reporting (PSR), notation of current Dental 

Fitness Classification, listing of current oral condition (class 2 issues identified and a listing of 

class 3 treatment needs, if any), ptinted name of examining dentist or dental officer and the 

dentist's or dental officer's signature/initials. These required dental documentation elements will 

be entered in the approved ARNG automated system and ptinted and placed into the dental 

record. 

3.4 Record Evaluation. Prior to dental treahnent all service members who have a current dental 

exam and have been identified as a class III a record review needs to be done to detelmine the 

amount of work hours will be needed for those service members. A by name and time schedule 

will be given to state POC to allow for the commanders to better plan for the event. 

3.5 \Vork Guarantee. After completion of dental treahnent all dental work will be guaranteed 

by company completing work for up to one year for minor restorations and two years for major 

restorations. The SDO will coordinate with the general dentist perfonning treatment for any 

arbitration claims to detennine ifthe problems relating to the dental treatment are in need of 

correction. Health services will be notified of all initial problems to coordinate with SDO. 

2. GENERAL INFORMATION. 

2.1. QUALITY CONTROL. The contractor shall adopt a quality assurance program that 

monitors all service activities and ensures the highest quality customizable dental services 

available. It is the responsibility of the ARNG to review and approve dental treatment plans 

before treatment is performed based on the guidelines provided by NGB and the SDO. 

2.2. QUALITY ASSURANCE. The goverl111lent will petiodically evaluate the contractor's 

performance in accordance with the Quality Assurance Surveillance Plan. 

2.3. GOVERNMENT REMEDIES. The contracting officer shall follow the requirements of 

FAR 52.212-4, Contract Terms and Conditions for Commercial Items (May 1997), for 

contractor's failure to COlTect nonconforming services. 

2.4. HOURS OF OPERATION. The contractor shall have the capability of providing dental 

services seven days a week. The contractor will be able to work flexible hours to accommodate 

the commander's training plan. 

2.5. SECURITY REQUIREMENTS. Secutity will be in accordance with DD Form 254 

(Department of Defense Contract Security Classification Specification). 

2.6. SPECIAL QUALIFICATIONS. Contractor must maintain approptiate credentialing files 

on all employees to include but not limited to Licensure, National Provider Data Base Query 

results and HIPP A certification. 
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2.7. PARTNERING AGREEMENT. The contracting officer may require a partnering 

agreement between the govermnent and the contractor to ensure joint cooperation and a sOlUld 

partnership of all parties involved in the execution of this contract. Partnering is the creation of a 

govermnent-contractor relationship that promotes achievement ofmutually beneficial goals. It 

involves an agreement in principle to share the risks involved in completing the project and to 

establish and promote a nurturing partnership environment. Representatives from each 

organization are encouraged to participate in developing thepartuering agreement. Suggested 

representation is the Deputy State Surgeon, the StateDenfal Offic~r; the govemment contract 

administrator, the contractor's manager and the contractor's quality control person. All costs for 

the partnership agreement should be agreed upon in advance. This group is responsible for 

developing a formal partnering agreement that should be signed by all parties involved. The 

agreement should contain as a minimum: specific goals to be reached and a list of objectives to 

reach the goals, a set of me tries to evaluate the objectives, a frequency for meetings to review the 

metrics, and a statement of cooperation to execute the terms of the agreement. 

2.8 Contractors will ensure compliance with the following requirements prior to utilizing 

any x-ray pl'oducing device on Soldiers; 

A. Have established written policies and procedures to assure compliance with applicable 

Federal, State, DOD, and AmlY radiation safety regulations and directives. These 

documents include staff emergency reaction plans, as necessary, and procedures for investigating 

and reporting radiation accidents or incidents, possible radiation overexposures to Soldier 

patients or contractor staff, and provisions to ensure the safe use of x-ray producing devices on 

humans. 

B. Upon request by the State/Territory representative, the contractor will provide 

documentation regarding the Contractor's employee radiation safety training commensurate 

with potential radiation hazards with the x-ray producing devices they are using. 

C. Upon request by the State/Territory representative, the contractor will provide copies of 

a Qualified Health Physics Expert's acceptance test and most recent health physics survey of each 

diagnostic x-ray machine. The acceptance test and the most recent survey include tests of 

electrical, mechanical, image quality and radiation (output) dose tests or measurements. 

This also includes verification of the adequacy of radiation protection shielding in and 

arowld the 

X-ray machine and x-ray facility (e.g., mobile van). 

S. APPENDICES. 

A. Estimated IVorkload Data 

B. Dental Classification 

C. SF 603A and DA Form SS70 (Dental Classification Modnie Version) 
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D. Government Furnished Pl'operty/Services/Equipment 

E. Authorized Dental Treatment 
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APPEl'I'DIX A 

ESTIMATED iVORKLOAD DATA 

The following data elements will be reported at the end of an event: 

Date 

Location 

List of contract employees (providers, dental technicians and administrative staff) 

Total number of patients scheduled 

Total number of patients examined 

Total number of Soldiers by dental classification: 1, 2, 3 

Total number of bitewing radiographic sets taken 

Total number of panoramic radiographs taken 

Verification of entry into DA or ARNG automated systems 

A by name listing of all Soldiers examined and the dental classification of the Soldier 

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APPENDIXB 

Department of Defense 

Oral Health and Readiness Classification System 

The oral health status of uniformed personnel shall be classified as follows: 

A. Class I (Oral Health): Patients with a cun-ent dental examination, who do not require 

dental treatment or reevaluation. Class 1 patients are worldwide deployable. 

b. Class 2: Patients with a cun-ent dental examination, which require non-urgent dental 

treatment or reevaluation for oral conditions, which are unlikely to result in dental emergencies 

within 12 months. Class 2 patients are worldwide deployable. Patients in dental class 2 may 

exhibit the following: 

(1) Treatment or follow-up indicated for dental caries or minor defective restorations that 

can be maintained by the patient. 

(2) lnterim restorations or prosthesis that can be maintained for a 12 month peliod. This 

includes teeth that have been restored with permanent restorative materials for which protective 

cuspal coverage is indicated. 

(3) Edentulous areas requiling prostheses but not on an ilmnediate basis. 

(4) Periodotium that: 

(a) requires oral prophylaxis 

(b) requires maintenance therapy 

(c) requires treatment for slight to moderate periodontitis mId stable cases of more 

advanced periodontitis 

(5) Unerupted partially erupted or malposed teeth that are without historical, clinical or 

radiographic signs or symptoms of pathosis, but which are recommended for prophylactic 

removal. 

(6) Active olihodontic treatment. The provider should consider placing the patient in 

passive appliances for deployment up to six months. For longer periods of deplo)ment, the 

provider should consider removing active appliances and placing the patient in passive retention. 
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(7) Temporomandibular disorder patients in remission. The provider anticipates the 

patient can perfonn duties while deployed without ongoing care and any medications or 

appliances required for maintenance will not interfere with duties. 

c. Class 3: Patients who require urgent or emergent dental treatment. Class 3 patients 

nonnally are not considered to be worldwide deployable. 

(l) Treatment or follow-up indicated for dental caries, symptomatic tooth fracture or 

defective restorations that call11ot be maintained by the patient. 

(2) Interim restorations or prostheses that Call1lot be maintained for a 12 month petiod. 

(3) Patients requiting treatment for the follo,ving petiodontal conditions that may result in 

dental emergencies within the next 12 months. 

(a) Edentulous areas or teeth requiring innnediate prosthodontic treatment for 

adequate mastication or communication or acceptable esthetics. 

(b) Active progressive moderate or advanced petiodontitis. 

(c) Petiodontontal abscess 

(d) Progressive mucogingival condition 

(e) Petiodontal manifestations of systemic disease or honnonal disturbances 

(f) Heavy subgingival calcnlus 

(4) Edentulous areas or teeth requiting immediate prosthodontic treatment for adequate 

mastication or communication or acceptable esthetics. 

(5) Unerupted, partially erupted or malposed teeth with histotical, clinical or radiographic 

signs or symptoms of pathosis that are recoll1lnended for removal. 

(6) Chronic oral infections or other pathologic lesions including: 

(a) Pulpal, periapical or resorptive pathology requiting treatment. 

(b) Lesions requiting biopsy or awaiting biopsy report. 

(7) Emergency situations requiring therapy to relieve pain, treat trauma, treat acute oral 

infections or provide timely follow-up care (e.g., drain or suture removalO until resolved. 
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(8) Acute Temporomandibular disorders requiring active treatment that may interfere 

with duties. 

d. Class 4. Patients who require periodic dental examinations or patients with unknown 

dental classifications. Class 4 patients nonnally are not considered to be worldwide deployable. 
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APPENDIXC 

"'lEAL 'fH QU£S'fI9NilAlR£. roR IJENJAL riREA JME."If 

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;:lrjj,a [D-I'li h~' 

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W9 I 2KZ-09-F -0063 

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APPENDIXD 

GOVERNMENT FURNISHED PROPERTY/SERVICESIEQUIPMENT 

1. General. The Government will provide the following resources: 

2. Facilities, Supplies, aud Services. Space for set-up of a dental exam, radiology and 

administrative area and utilities. 

3. Informatiou. The Government will provide the following infonnation: 

a. Soldier's medical records if applicable. 

4. The User Ageucy will provide initial familiadzatiou/orieutatiou. Standard Operational 

Procedures will be available to the contractor at the place of perfonnance. 
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APPENDIXE 

AUTHORIZED DENTAL TREATMENT 

1. The following dental procedures are authorized: 

(a) Diagnostic Services which are funded through NG6H 2065 Medical Readiness Funding: 

D0120cPeriodic OralEvaluatioll 

D0150~C011lpr~11bhsNe 6;aIEv~luation D0330:Panbramid Film .. 

P0272-BiteWhlgs-1\yo FiiiYls 

D()2 7 4~Bite)ying~-F9ur Filins 

D0220;P0230-periapical(limited) 

(b) Restorative SerVices wbichare funded through theVF'I3B 2920 Dental TreatnientFuilding• 

(proVided 01llytosoldiersalertedto an oem-rus Mission):· .. . - . 

])214()-Afu~I~;UiVQhe$urface 

r)2150-Nna@t!h'.T\\r(jSurfac~s 

))21.60: AtriaIg<ill1~Tllr~e$llrface$ D2161 cA.'ti:taJgfuii'Fol,t0rl\1()r~ Suifaces 

D233p~¢omposite-On~:S\lIface .. 

D23~1-Composife-:rwo·Surface~ 

D2332CCoIl1posite~ TfueeSurfaqes 

Posterior composites wiII be authorized only when a posterior composite is necessary to 

provide a qnality restoration and uo other alternative is available. 

D2~{5.-C()m]Josite-foll(orMo~'e.Surfaces 

D239LConlpOsity~One $ui"face 

D239:1~Coll1ppsite-T\\'o Surfaces, 

D.2393-Co6posit7~Three.·SUrfaces 

D2394-CompOslte-FoUr of l\1:ore Surfaces 

D2799-ProvisiclJlal Crowll . D293 (PrefabricatedSia~essSteeJ Crown 

D2950-Core Bliildup, incijldmg any pins 

D2954~Pi<3fabricated Posfand Core 

(c) Endodontic Services which are funded through the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers alerted to an OCONUS Mission): 

D331 O-Anterior Root Canal Therapy 

D3320-Bicuspid Root Canal Therapy 
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D3330-Molar Root Canal Therapy 

D3346-Anterior Root Canal Retreatment 

D3347-Bicuspid Root Canal Retreatment 

D3348-Molar Root Canal Retreahnent 

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(d) Periodontal Services which aloe funded through the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers alerted to an OCONUS Mission): 

D435{:FuU Mouth pet)]iclell1ent 

D4342c,PerlodontaIScali!lgandRoot Planirig, 1 to 3 teeth per quadrant 

Periodontal scaling and root planing is anthorized only when a periodontal abscess is . 

present and SDO approves 

(e) Prosthodontic Services which are funded through the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers alerted to an OCONUS Mission): 

D511 O-Complete Denture-Maxillary 

D5120-Complete Denture-Mandibular 

D5211-Maxillary Partial Denture-Resin Base 

D5212-Mandibular Partial Denture-Resin Base 

(f) Oral Surgery Services which are funded through the VFRE 2020 Dental Treahnent Funding 

(provided only to Soldiers alerted to an OCONUS Mission): 

D714,()-E~tra9tibn,ElUpted Tooth orE~posed Root 

D721Q~SurglCaIRein:6Val.ofElUpied,Tqotll 

D7i2d"Roih~Vaiof.rm~actedtoothi-Soft •. Tisslle 

D123 Q-Rbuioyali 

~fJ1llp<\ctedJ ooth, P aiii~l ~cmy 

D7240'Removii,6f:rippactedTooth, Coll1pletelyJ30ny 

(g) Olthodontic Services which are funded throngh the VFRE 2020 Dental Treatment Funding 

(provided only to Soldiers alerted to an OCONUS Mission): 

D8680-0rthodontic Retention 

20 The following dental procedures are not authorized: 

Bridges and/or implants 

Removal of Asymptomatic third molars 

Routine Prophylaxes (cleanings) 

Restorations for aesthetics only 

Restorations for small (non-class 3) caries 

Extensive Root plane/scaling 
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Osseous Surgery 

Other diagnostic services 

The above listings are guides to assist the State Dental Officer or his/her designee in 

determining treatment to be authorized. The treatment provided by the ARNG is to get the 

Soldier from a dental class 3 to a dental class 2 ouly. Comprehensive Treatment (to dental 

class I) is uot authorized. 

3. If a Soldier needs all ofhislher remaining teeth in an arch extracted and a denture placed, the 

Soldier will not be available for deployment for at least 6 months and shall be disqualified from 

immediate deployment. However, if the Soldier is otherwise deployable (passes all medical, 

personnel and training requirements) and, after extraction and placement of prosthesis, would be 

deployable, the dental treatment could be provided and the Soldier could be considered as a 

replacement at a later date. 

4. If a Soldier will have a number of teeth extracted to the extent mastication and speech are 

adversely affected, then an acrylic removable partial denture ,vill be authorized if there is 

sufficient time for healing and construction ofthe partial denture prior to departure to 

Mobilization Station. 

5. Soldiers requiring extensive periodontal treatment will be disqualified from deployment and 

educated on the TRlCARE Dental Program. If he/she obtains the required therapy (:6.·om hislher 

private dental provider) and reaches a maintenance level, then he/shewould become deployable. 

6. The State Dental Officer (or designated representative) will review any dental treatment plan 

for dental care which exceeds $2000 to insure that the above clinical guidelines are met. 

Exceptions can be made, but they must be coordinated with the State Surgeon. 
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(b) (4)

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ITEM NO SUPPLIES/SERVICES 

0001 

Dental Restoration Team 

FFP 

QUANTITY 

I 

Performance per Statement of Work 

UNIT 

Job 

UNITPRJCE 

Option Three "Mobile Dental RV" selected from options offered on RFQ 371688. 

FOB: Destination 

PURCHASE REQUEST l\'UMBER: W900D 190370 I 00 

NETAMT 

ACRNAA 

CIN: W900D1903701000001 

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AMOUNT 
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Section E - lnspection and Acceptance 

INSPECTION AND ACCEPTANCE TERMS 

Supplies/services will be inspected/accepted at: 

CLIN INSPECT AT INSPECT BY ACCEPT AT 

0001 Destination Government Destination 

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ACCEPT BY 

Government 
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Section F - Deliveries or Perfonnance 

DELIVERY INFORMATION 

CLIN DELIVERY DATE 

0001 POP 12·JUL·2009 TO 

19·JUL-2009 

QUANTITY 

N/A 

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SHIP TO ADDRESS mc 

N/A 

POB: Destination 
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Section G - Contract Administration Data 

ACCOUNTING AND APPROPRIATION DATA 

AA: 21920651810 15133G92RL2512NG6HM48A2AAO 1505 8KMOEW900D 1 0903701 00KMOE4444KMOE 

AMOUNT:_ 

CIN W900DI90370JO00001:_ 

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STATEMENT OF \VORK FOR DENTAL READINESS 

. Introduction: Individual Medical Readiness (IMR) and Fully Medically Ready (FMR) are the 

basic principals of a ready force for KY ARNG. Failure to maintain dental standards could 

preclude a soldier from deploying. Dental readiness is a command and soldier responsibility. 

Tlus statement of work covers the dental components ofIMRlFMR to include: 3lmual dental 

exams, digital bitewing xrays, digital panoranIic xrays, DENCLASS data entry of all xrays and 

dental records, identification and treatment of all Class 3 soldiers on alert orders and/or in 

conjunction with the ANG Selected Reserve Dental Readiness System. Services are to be 

completed on site at Fort Indiantown Gap, AImville, PA. The SOW identifies the purpose of the 

work to be performed by the contractors and provides a description of the v{Qrk to be completed 

and the required outcomes. The contractor shall provide qualified personnel, material to perform 

the services, and lor OSHA, RIPP A and Privacy Act Compliant Mobile depending on the 

individual site needed for the KYARNG. 

1. DoD established a uniform dental classification in HA Policy 02-11. DoD policy requires 

dental screening examinations to be accomplished and documented on 90% of service members. 

Members of the KY ARNG shall receive an annual dental screening exam to deternIine their 

dental classification. As well, soldiers alerted and/or sourced are eligible for dental treatment if 

they are class III status ii'om examination. The results of that screening exam should be entered 

into denclass no later than 5 days from the date of the exam. The DENCLASS database updates 

the Army Medical Protection System, Medpros. Dental tTeatment that may be required is 

essential to be provided at the SRP site to ensure the highest Dental Deployment Rate for the 

mobilizing soldier. 

2. Objective: The contractor shall provide all management, labor, material, equipment, 

certifications and supplies necessary to provide dental services at designated locations for the 

Anny National Guard. These sen'ices will provide mandated dental examinations and/or 

radiographic studies and lor dental treatment, proper documentation into the Soldier's record, 

and data entry of all records into the DENCLASS system, as necessary to meet Dep31iment of 

the AImy standards of medical readiness and deployability, to ensure mission capability of the 

Anny National Guard. The contractor will insure that therr agents are appropriately trained and 

have access to the DENCLASS system. 

3. Scope of Practice: The contractor shall provide customized comprehensive dental readiness 

sen'ices to the KYARNG in conjunction with their trailung schedule to include site location and 

tinle to accommodate unit: Event to be held 12-19 July at Ft Indiantown Gap, PA for an 

estimated 250 soldiers. AIl)' incomplete treatment will need to be case managed and completed 

by company awarded contract when service members retum to home of record ifrequired. 

A) Comprehensive dental examinations (exams) as per CDA Code D0150 and clinically 

indicated radiologic studies (to include panoramic) and oral health education. 

B) Class III dental treatments for alerted Soldiers and/ or soldiers who are catorgized in 

SELRES program (as identified by the state/territory). Dental treatment authorized is outlined in 

Appendix E. Any treatment plan greater than $2000.00 requires prior approval ii-om State Dental 
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F. Radiographs should be taken only for clinical reasons according to FDA'and DENCOM 

guidelines as determined by the patient's dentist. Radiographs should be of diagnostic quality, 

properly identified and dated. A panoramic radiograph of adequate quality for 

diagnostic/identification purposes is required to be part of the dental record. There is no time 

requirement on updating panoramic radiographs. However, the panoramic radiograph will 

adequately represent the current oral condition of the Soldier. Bitewing (or ''bitewing slice" at 

the discretion of the State Dental Officer) radiographs are also required to be part of the dental 

record. All radiographs provided under this contract will be digital (unless specified in a 

separate written agreement) and transferred to the Denclass module within 24 hours of exposure. 

G. A listing of all DFC 3 conditions 

H. Any condition of significance that is not readily apparent on the radiographs. 

3.3. Documentation. All Soldiers must have a complete military dental record. No dental record 

is considered complete unless the documentation is complete and in the proper order as outlined 

in TB MED 250. The contractor shall provide electronic documentation (to include radiographs) 

in the ARNG approved system (within 24 hours of exam completion) and a paper copy as 

outlined below. A complete record includes the following: 

A. Military dental record jacket, DA Fonn 8005 through 8005-9 

B. The automated Health History Form or DA Form 5570 (with notations to "yes" answers 

and signed by both the Soldier and reviewing Doctor), Health Questionnaire envelope 

C. DD Form 2005 (signed), Privacy Act Statement 

D. SF 603/603A, Record of Dental Exam 

E. Supporting radiographs (panoramic and diagnostic bitewing radiographs «see l.3.F)) 

documenting existing conditions) 

(1) All radiographs will be uploaded into the ARNG automated system. 

(2) A diagnostic qnality copy of all radiographs must be placed in the Dental Record. 

F. The entries on the SF 603/603A will include the following: date, location, "comprehensive 

oral evaluation" (as defmed in cnrrent CDT as D0150), indication/date of x-rays taken, 

indication/date of x-rays consulted, oral cancer screening, caries risk assessment (based 

upon caries incidence), Petiodontal Screening and Reporting (PSR), notation of current Dental 

Fitness Classification, listing of current oral condition (class 2 issues identified and a listing of 

class 3 treatment needs, if any), ptinted name of examining dentist or dental officer and the 

dentist's or dental officer's signaturelinitials. These required dental documentation elements will 
FOIA Requested Record #FA-11-0070 

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organization are encouraged to participate in developing the parinering agreement. Suggested 

representation is the Deputy State Surgeon, the State Dental Officer, the govemment contract . . 

administrator, the contractor's manager and the contractor's quality control person. All costs for 

the partnership agreement should be agreed upon in advance. This group is responsible for 

developing a formal palineling agreement that should be signed by all parties involved. The 

agreement should contain as a minimum: specific goals to be reached and a list of objectives to 

reach the goals, a set of metrics to evaluate the objectives, a frequency for meetings to review the 

metrics, and a statement of cooperation to execute the terms of the agreement. 

2.8 Contractors will ensure compliance with the following requirements prior to utilizing 

any x-ray producing device on Soldiers; 

A. Have established written policies and procedures to assure compliance with applicable 

Federal, State, DOD, and Army radiation safety regulations and directives. These 

documents include staff emergency reaction plans, as necessary, and procedures for investigating 

and repOliing radiation accidents or incidents, possible radiation overexposures to Soldier 

patients or contractor staff, and provisions to ensure the safe use of x-ray producing devices on 

humans. 

B. Upon request by the State/Territory representative, the contractor will provide 

documentation regarding the ContTactor's employee radiation safety training commensurate 

with potential radiation hazards with the x-ray producing devices they are using. 

C. Upon request by the State/Tenitory representative, the contractor will provide copies of 

a Qualified Health Physics Expert's acceptance test and most recent health physics survey of 

each diagnostic x-ray machine. The acceptance test and the most recent survey include tests of 

electrical, mechanical, image quality and radiation (output) dose tests or measurements. 

This also includes verification of the (jdequacy of radiation protection shielding in and 

around the 

X-ray machine and x-ray facility (e.g., mobile van). 

5. APPENDICES. 

A. Estimated 'VorIdoad Data 

B. Dental Classification 

C. SF 603A and DA Form 5570 (Dental Classification Module Version) 

D. Government Furnished Property/Services/Equipment 

E. Authorized Dental Treatment 
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APPENDIXB 

Department of Defense 

Oral Health and Readiness Classification System 

The oral health status of un if on ned personnel shall be classified as follows: 

A. Class I (Oral Health): Patients with a current dental examination, who do not 

require dental treatment or reevaluation. Class I patients are worldwide deployable. 

b. Class 2: Patients with a cUlTent dental examination, which require non-urgent 

dental treatment or reevaluation for oral conditions, which are unlikely to result in dental 

emergencies within 12 months. Class 2 patients are worldwide deployable. Patients in 

dental class 2 may exhibit the following: 

(1) Treatment or follow-up indicated for dental caries or minor defective 

restorations that can be maintained by the patient. 

(2) Interim restorations or prosthesis that can be maintained for a 12 month 

period. This includes teeth that have been restored with pennanent restorative materials 

for which protective cuspal coverage is indicated. 

(3) Edentulous areas requiring prostheses but not on an immediate basis. 

(4) Periodotium that: 

(a) requires oral prophylaxis 

(b) requires maintenance therapy 

(c) requires treatment for slight to moderate periodontitis and stable cases 

of more advanced periodontitis ' 

(5) Unerupted partially erupted or malposed teeth that are without historical, 

clinical or radiographic signs or symptoms of pathosis, but which are reconnnended for 

prophylactic removal. 

(6) Active orthodontic h'eatment. The provider should consider placing the 

patient in passive appliances for deployment up to six months. For longer periods of 

deployment, the provider should consider removing active appliances and placing the, 

patient in passive retention. 

(7) Temporomandibular disorder patients in remission. The provider anticipates 

the patient can perfolTll duties while deployed without ongoing care and any medications 

or appliances required for maintenance will not interfere with duties. 
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d. Class 4. Patients who require peliodic dental examinations or patients with 

unknown dental classifications. Class 4 patients nonnally are not considered to be 

worldwide deployable. 
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FOIA Requested Record #FA-11-0070 

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APPENDIXE 

AUTHORIZED DENTAL TREATMENT 

1. The following dental procedures are authorized: 

(a) Diagnostic Services which are funded through NG6H 2065 Medical Readiness 

Funding: 

Do120:PeriodicOialEvaluation 

DO 150-Compreliensi,'eOM Evaluation. 

D03"30-Panorar11.ic FiIm: 

D0272cBitewingscTwoFilms: 

D0274-Bitewings-F'ourF"iIms. .. 

D02:20!.[)023 Q: .. j>eriapical (lilllite_d) 

(b ) Restorative. ServIces \vhlch are. funded tbIough the VFRE 2020 Dental Treatlllent 

Fundillg(provided only to soldiers alerted to an OCONUSMission): . ----- . 

D2140'.Aillalgiilli.~Qne Sw'face 

D2150-Anialgam-T'yo·.Surfaqe~ 

D2160-Amalgam-Jhree Suiface{ 

D2161cAinalgam'Pouror.Morestiifaces 

J:)4330:c:omposite-9neSurface .......... -

D233 i:CompositecT\vo Sl)Ifaces 

D2332-Composlte-TJn:ee .. Surfaces 

Posterior composites wiII be authorized only when a posterior composite is 

necessary to provide a quality restoration and no other alternative is available. 

D2335cC(lmp(lSlte"-fo\iFor"Mb!~§Brface~ 

P2391-Cornpqsite-()neSuqace 

n2322-COluposite-T\~o Surfaces 

b2393~Compos{te-1J:rree·Surfaces 

D2394:Compositecto.uIor)\1.oreSulfuy",§ 

D2799:Provisional.Crown: 

)}2931-Pref~bdcated StaullessSteeT Crown D2950-Co~eBt!ildup, including anypU;s 

D2954:Prefabricilted Post and Core - --- - - - ------- ----

(c) Endodontic Services which are funded through the VFRE 2020 Dental Treatment 

Funding (provided Ollly to Soldiers alerted to an OCONUS Mission): 

D331 O-Antelior Root Canal Therapy 

D3320-Bicuspid Root Canal Therapy 

D3330-Molar Root Canal Therapy 
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The above listings are guides to assist the State Dental Officer or his/her designee in 

determining treatment to be authorized. The treatment provided by the ARNG is to 

get the Soldier from a dental class 3 to a dental class 2 only. Comprehensive 

Treatment (to dental class I) is not authorized. 

3. Ifa Soldier needs all ofhislher remaining teeth in an arch extracted and a denture 

placed, the Soldier will not be available for deployment for at least 6 months and shall be 

disqualified from innnediate deployment. However, if the Soldier is othenvise 

deployable (passes all medical, personuel and training requirements) and, after exh'action 

and placement of prosthesis, would be deployable, the dental treahuent could be provided 

and the Soldier could be considered as a replacement at a later date. 

4. If a Soldier will have a number of teeth extracted to the extent mastication and speech 

are adversely affected, then an acrylic removable partial denture will be authorized if 

there is sufficient time for healing and construction of the pmtial denture prior to 

departure to Mobilization Station. 

5. Soldiers requiIing extensive periodontal treatment will be disqualified from 

deployment and educated on the TRlCARE Dental Program. Ifhe/she obtains the 

required therapy (from his/her private dental provider) and reaches a maintenance level, 

then he/she would become deployable. 

6. The State Dental Officer (or designated representative) will review any dental 

h'eahuent plan for dental care which exceeds $2000 to insure that the above clinical 

guidelines are met. Exceptions can be made, but they must be coordinated with the State 

Surgeon. 
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Ace COflsa{((mts, lrIc, 

June 30, 2009 

Department of the AImy 

ltelftfU:/(}, Army NmioJEal Gultrd 

Jlllle 30,2009 

RFQ 371688 

Thank you for thls opportunity to submit our response to RFQ ID: RFQ371688 Dental Treatment and 

Exam Sen'ices for service members at Fort Indiantmvll Gap, Annville, PA, 

Ace Consultants, Inc brings 19 years of providing support services to government agencies. ACe offers a 

thorough understanding of individual medical readiness (IMR) and fuUy medical ready (FMR) 

requirements and standards, under the guidance of advice of a recognized expert in medical and dental 

readiness. ACC understands the training demands placed on soldiers and individual units, and has 

developed time-tested and fuUy docnmented policies and procedures to ensure maximum suppOli with 

minimal impact on the unit training assembly. ACC also has an ongoing working relationship and 

excellent rapport with ASM Research, the developer and maintainer ofMEDPROS, DENCLASS, and 

other related support applications. 

Included in our proposal is our technical response, an explanation of how \ve \vill deliver services in FOli 

Indianto\vTI Gap, licensing and certification information, mobile equipment capabilities, pricing for the 

event and detailed past performances related to the dental needs for KY ARNG. We have also included an 

overvie\v of our company. 

Should you have any further questions, please contact: 

Ginny Berger 

9008 Washington NE 

Albuquerque, NM 87113 

(505)323-1300 X 14 

larry0~accdental.com 

Kind regards, 

Todd Bower 

Business Development 

ACC Consultants, Inc 

todd(i'i1accdental.colll 

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A CC CONsultants, Inc. 

June 30, 2009 

2:00 P.M. (EST) 

RFQ 

371688 

Dental Treatment and EXAM Services 

FOli Indiantown Gap 

Annville, PA 

ACC Consultants, Inc. 

9008 Washington NE 

Albuquerque, :NM 87113 

(505)323-1300 

accdental.com 

iLC'lItuchy ArtilY Natiollal Guard 

J/I"P 30,211119 

RFQ 371688 

ACC Consultants, Inc. is registered with CCR 

CAGEINCAGE Code: 4HZ92 

DUNS #: 624343463 

\Voman Owned 

Small Business 

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Ace Cmlsa[tarrfs, II1C. 

Page.3 of J 4 

ll('ufUc!IJ' Al'tIly Narioflu/ GUlll'd 

June 30, 2£109 

RFQ 371688 
FOIA Requested Record #FA-11-0070 

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Ace COllsuftarrts, Inc. 

Page 4 of 14 

ILf!lltuc!(V Army N(f(iollal Guard 

JUlie 30, 2009 
FOIA Requested Record #FA-11-0070 

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Ace Co llsultrfllts, [IIC. iCelltflcky Al'my Nmiollal Gual't! 

JUlie 31i, 2009 

RFQ 371688 
FOIA Requested Record #FA-11-0070 

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A CC Consultants, inc. 

Page 6 of 14 

f~(,lIt{{c1(y ArlilY /VatiOllllr Gl!ard 

Jlllle 30,2009 

RFQ 371688 
FOIA Requested Record #FA-11-0070 

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

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

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

Posted to NGB Reading Room 

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Ace COllsultants, Inc. kelltucky Arllty Natiollal GlWf'd 

Juue 30,2009 

RFQ 371688 

PRICING 

Dental Itemized Pricing 

Item 

NO 

OR 

SUPPLES/SERVICES l\1Il\1Jl\fUM UNIT UNIT 

l\'ET PRICE 

Military Screenings 250 Each 

Exam, bitewings and 

Panograph 

Portable supplies 1 Each 

equipment / Staff 

Portable digital bitewing Each 

stations 

Portable digital Each 

panoramic stations 

DENCLASS ENTRY 250 Each 

Mininulln Screening 

-

Net Eyent 250 Each 

Military Restoratiye 

CAT 3 to CAT 2 EACH 

Portable Equipment, 

supplies/Staff 

Minimum Restorative 

Net Amount 

I Treatment team daily 

for 8 days 

Portable Supplies 

Equipment / Staff 

Fee for Service 

"\vhichever is greater 

l\1inimum Net Amount 

Military ScreeninglRestoratiYe Eyent 

1 Treatment Team, 1 Exam team daily for 8 days 

l\1Il\'Il\1Ul\1 

AlIWUNT 

APPENDIXE 

J ul y 12-19, 2009 I ~""''''''''''''''''''' 

***Pro~yment Discount within 10 days of completion of 

evcntat_ 

Total minimum price less early payment discollnt 

*** Any incomplete treatment will need to be case managed and completed by ACC Consultants 

when service members return to home of record if required. ACe "i'ill be reimbursed by government 

at cost. 

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(b) (4)

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A CC Consultants, lllc. 

APPENDIXE 

Kelltuc1(v Arw}' Natiollal Guard 

Ju"" 30,2009 

RFQ 371688 

AUTHORIZED DENTAL TREATMENT 

FEE SCHEDULE 

1. The following dental procedures are authorized: 

(a) Diagnostic Services: 

DOl20-Periodic Oral Evaluation 

DO 1 50-Comprehensive Oral Evaluation 

D0330-Panorex Fihn 

D0272-Bitewings-Two Films 

D0274-Bitewings-Four Films 

D0220-First Periapical Xray 

D0230-Each Additional Periapical 

(b) Restorative Services: 

D2140-Amalgam-One Surface 

D2150-Amalgam-Two Surfaces 

D2160-Amalgam-Three Surfaces 

D2161-Amalgam-Four or More Surfaces 

D2330-Composite 1 Surface 

D233 I-Composite 2 Surfaces 

D2332-Composite 3 Surfaces 

Posterior composites will be authorized onl" ,"hen a posterior composite is necessary to provide a 

quality restoration and no other alternative is available. 

D2335-Composite-Four or More Surfaces 

D2391-COlllposite-One Surface 

D2392-Composite-Two Surfaces 

D2393-Composite-Three Surfaces 

D2394-Composite-Four or More Surfaces 

D2799-Provisional Crown 

D293 I-Prefabricated Stainless Steel Crown 

D2950-Core Buildup, including any pins 

D2954-Prefabricated Post and Core 

(c) Endodontic Services: 

D3310-Anterior Root Canal Therapy 

D3320-Bicuspid Root Canal Therapy 

D3330-Molar Root Canal Therapy 

D3346-Anterior Root Canal Retreatment 

D3347-Bicuspid Root Canal Retreatment 

D3348-Molar Root Canal Retreatment 

(d) Periodontal Sen'ices: 

D4355-Full Mouth Debridement 

D4342-Periodontal Scaling and Root Planing, 

1 to 3 teeth per quadrant 

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Ace COTlsuitrmts, lllc. KeutucA), Artily /VmiOfl(l[ Guard 

.lillie 30, 2009 

RFQ 377688 

Periodontal scaling and root planning is authorized only when a periodontal abscess is present and 

SDO approves 

(e) Prosthodontic Services: 

D5110-Complete Denture-Maxillary 

D5120-Complete Denture-Mandibular 

D5211-Maxillary Partial Denture-Resin Base 

D5212-Mandibular Partial Denture-Resin Base 

(f) Oral Surgery Services: 

D7140-Extraction, Erupted Tooth or Exposed Root 

D7210-Surgical Removal of Erupted Tooth 

D7220-Romoval of Impacted Tooth, Soft Tissue 

D7230-Removal ofImpacted Tooth, Partial Bony 

D7240-Removal ofImpacted Tooth, Completely Bony 

(g) Orthodontic Sen'ices: 

D8680-0rthodontic Retention 

2, The following dental procedures are not authorized: 

Bridges and/or implants 

Removal of Asymptomatic third molars 

Routine Prophylaxes (cleanings) 

Restorations for aesthetics only 

Restorations for small (non-class 3) caries 

Extensive Root planelscaling 

Osseous Surgery & Other diagnostic services 

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Ace Cansa/twrts, Inc. 

ACC Consultallts .• Inc Similar Dental Past performallces 

Military Dental Past Performance 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's nameJ 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

IleJltlldy AI'IilY National GlIard 

Juue 30. 2009 

RFQ 371688 

was I on , 

examination I equipment, certifications supplies required to provide dental exams treatments per 

identified treatment plan to upgrade Class 3 soldiers to a Class 2 status March 25·30109. Contract required all 

soldiers be seen daily by 1300, and all lines to be kept to a minimum. ACC Consultants, Inc. provided 

customized comprehensive dental readiness services that included dental examinations (ADA Code 0120) at a rate 

of 12 soldiers per hour and clinically indicated radiologic studies done digitally and specified treatment outlined in 

the patients treatment plan. Denclass was entered and completed into database no later than 5 days from 

examination. 

All dental treatment that was identified in the patient's treatment plan was accomplished based on the National 

Gurads Bureau's statistics that 30% of soldiers examined were classification 3. Contract was awarded on March 

20,2009; ACC personnel and mobile equipment arrived on site 3/23109. Equipped to begin treatment and exams 

on contract start date of 3/25/09; this start date was susequently changed by pac to 3/26/09 

11. Description of contract performance .. 

After Action Report: SRP Camp Roberts, CA 

3/26-3/31/09 

Dental Event Numbers and Data: 

o Percentage of Cat 3's converted to Cat 1 or 2: 90% 

o Total Number of Dental Cat 3's presented to ACC Clinic: 101 

o Total Number of Dental Cat 3's upgraded: 18 

o Total Number of Cat 3'sunaailable for necessary treatment (no show): 1 

o Number of Cat 3's that were categorized as such due to active full orthodontic treatment in progress: 3 

o Number of Cat 3's refusing treatment offered at SRP: 7 

o Cat 3 's not convened due to other reasons: 9 

(referred to oral surgeon for bony impacted wisdom teeth·no on site oral surgeon requested in contract) 

All DENCLASS patient data· both exam and treatment entered and sent for State Dental Surqeon approval as of 

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Ace COllsultants, fllc. EL'llt{{cky Al'IIlY Nmiol!al Gu{[rd 

Jlllle 30,21109 

RFQ 371688 

April 4, 2009. INDIVIDUAL Procedure Counts by Date and Total for Event: 

Date Restorations Full mouth ReT Extractions Pano BWX Exam 

Debridement's TX 

3/26/2009 No TX NoTX No TX No TX 115 115 115 

3/27/2009 42 2 0 11 85 115 115 

3/28/2009 34 1 1 7 99 99 99 

3/29/2009 37 5 0 3 135 135 135 

3/30/2009 43 1 0 8 89 89 89 

3/31/2009 20 1 0 6 None None None 

TOTALS: 176 10 1 35 523 553 553 

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Ace Cousultants, [IiC. 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5_ Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

IlC'J1tuclt)' Army Natiollal Guard 

Jane 30, 2009 

RFQ 371688 

Washington National Guard 

USPFO for Washington Building 32 

Camp Murray, Tacoma WA 

98430-5170 

The state of Washington Army National Guard awarded ACC Consultants Inc the contract to provide dental 

treatment to the Washington Army National Guard at the Yakima Readiness Center. ACC Consultants, Inc. 

furnished all labor, tools, equipment, material, transportation and supervision for Dental Treatments for 

approximately 69 service members 

Category 3 Upgrade Report: 

o Percentage of Cat 3'5 converted to Cat 1 or 2: 96% 

(That were willing and/or available for treatment) 

o Total Number of Cat 3's presented to clinic: 27 

o Total Number of Cat 3's upgraded at clinic: 21 

o Number of Cat 3's refusing treatment offered at SRP: 5 

o Cat 3's not converted due to other reasons: 1 

(need prosth Ix to complete cat 3 needslunable to return to clinic/etc.) 

All DENCLASS patient data-both exam and treatment-are entered. 

This 2 day restorative event was carried out without any problems or delays or any corrective actions taken in 

regards to cost, schedule or technical pertomance 

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A CC Causa/taMs, fllc. 

3. Name, Address and Telephone Number of 

Government Contracting Organization: 

4. Procuring Contracting Officer's name, 

telephone number and Email: 

5. Project Officer's Name, Address, Telephone 

Number, Fax Number and Email Address: 

Ilr!f!illcliy Army Nat/olla! Guard 

Jllile 30,2009 

RFQ 371688 

Building 9000 

Riverton, UT 84065 

The USPFO for Utah issued a requirement to contract for MedicallDental services for January 23-25 2009 for the 

Utah Army National Guard. This contract was issued as part of a 5 year IDIQ request that resulted in a one time 

contract. The Issuing office requested a quote to accommodate 400 soldiers for individual medical readiness (IMR) 

and Fully Medically Ready (FMR). 

ACC Consultants, Inc partnered with Comprehensive Health Care Services (CHS) to provide all medical 

requirements. On January 10, 2009 1 L T Puro decreased orginal working days from 3 days to 2 days. ACC 

Consultants, Inc was able to accommodate the Utah Army National Guard by adding addiitional portable 

dentallmedical buildings and switch over to an accelarated schedule to accommodate the 400 service members in a 

2 day period rather than in 3 days. 

January 14, 2009 1 L T Puro requested services for an additional 100 Service Members to receive dental screenings 

and ACC Consultants was able to provide additional work force to accommodate the Utah Army National Guard. 

After Action Report: SRP Mass Event Riverton, UT 1124-25/09 

Dental Event Numbers and Data: 

o Total Number of Dental Categorization Exams and Bitewing Radiographs: 690 

o Total Number of Pan a Radiographs: 194 

Medical Event Numbers and Data: 

o Total Number of Medical Exams: 391 

o Total Number of Immunizations: 302 

o Total Number of Audio Exams: 117 

o Total Number of Referrals: 46 

All DENCLASS and MEDPROS patient data are entered as of 2/9/09. 

Almost 700 service members were processed through both medical and dental combined. All service members 

present at event had their medical and dental charts inspected for their individual medicalldental needs. The 

services were performed using 6 portable buildings and 3 vehicles equipped for treatments. We provided dental 

exams, bitewings, panos, PHA's (including immunizations, blood draws, hearing and vision exams). 

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Ace COTIS[{[((ll1ts, [fiCo 

ACORD 

Ace Consultants, Inc. 

9008 .... 'ashington NE 

Albuquerque, NM 87113 

ANY AlJTO 

AlL OWNED AUTOS 

SCHEOl}LED AUTOS 

HIREDAVTOS 

N:JtH)'MJ£D AUTOS 

OCCUR 

CLAJI.'SMADE 

Di:OUCTIBLE 

WORKERS COLlPENSATlOH:ANO 

EMPLOYERS' UAaIUTY 

fNY PROPRlETORIPARn,ER!EX£CUTTVE OFFlCERmEMB£REXCLUDED7 

CERTlFJ ATE H LDER 

FOR BID PURPOSES ONLY 

ACORD 25 (2001/08) 

fCel!tuc/ty Al'my Nariolla/ Guard 

Jrllle 30, 2009 

RFQ 371688 

BIUTY INSURANCE 

Page 14 of 14 

ANC LATrON 

COMlHNEDS!NGLEUf.4IT 

(81 2ocli~nl) 

BOOlLYlr-U-JRY 

(Per pa.'sM) 

eODllY1WUR,Y 

(Pe.rud:lenl) 

f'RDP;;'RTY OAU""GE (Per I<c<:Mer>I) 

OTHER THAN AVTOO1'.'LY: 

NAIC# 

I • 

$ 

$ 

$ 

SHOULD ANY OF THE ABOVE DESCRIBED POUCIES I>E CANCELLED BEFORE ruE 

EXPIRATION DATI; THEREOF, THE ISSUING INSURER .... 'LL ENDEAVOR TO JI.NL 

~ DAYS WRITTEN 110TlCETOTfU;; CERnFICATE HOLDER NAMED TO THE LEFT, 

©ACORD CORPORATiON 1988 
FOIA Requested Record #FA-11-0070 

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ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

USA 

Voice: 505-323-1300 

Fax: 505-323-1400 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601·6192 

4.00 CONT-RESTORE 

4.00 COtH·RESTORE 

4.00 CONT·RESTORE 

4.00 CONT·RESTORE 

4.00 CONT-RESTORE 

4.00 CONT-RESTORE 

ChecrJCredit Memo No: 

RECEIVED INVOICE 

JUt :L 1 .20W) Invoice Number: 16641 

Invoice Date: Ju119,2009 

Page: 

Duplicate 

Indiantown Gap, PA 

4 TrealmenlTeams Daily for 8 Days per 

Modification #W912KZ-09-F-0063 -

Indiantown Gap PA - 7/13/09 

4 Trealment Teams Daily for 8 Days per 

Modification #W912KZ-09-F-0063-

Indiantown Gap PA· 7/14/09 

4 TrealmenlTeams Daily for 8 Days per 

Modification #W912KZ-09-F-0063· 

Indiantown Gap PA-7I15/09 

4 Trealment Teams Daily for 8 Days per 

Modification #W912KZ-09-F-0063-

Indiantown Gap PA-7/16/09 

4 TrealmenlTeams Daily for 8 Days per 

Modification #W912KZ-09-F-0063-

Indiantown Gap PA-7/17/09 

4 Trealment Teams Daily for 8 Days per 

Modification #W912KZ-09-F-0063-

Indiantown Gap PA - 7/18/09 
FOIA Requested Record #FA-11-0070 

Released by Army National Guard 

Page 223 of 223

(b) (4)

(b) (4)

Posted to NGB Reading Room 

June 22, 2011

ACC Consultants, Inc 

9008 Washington NE 

Albuquerque, NM 87113 

USA 

Voice: 505-323-1300 

Fax: 505-323-1400 

USPFO for Kentucky 

120 Minuteman Pkwy 

BNGC, Bldg 120 

Frankfort, KY 40601-6192 

CheckiCredlt Memo No: 

INVOICE 

Invoice Number: 16541 

Invoice Date: 

Page: 

Duplicate 

Ju119,2009 

2 

Indlantown'Gap, PA 

Modification #W912KZ-09-F-0063-

Indiantown Gap PA- 7/19/09 

Please apply the discount of 0.5% for early 

payment, Thank you.