Sol_75H70726Q00036 Non-Personal Health Care Optometrist Services for Zuni Comprehensive Community Health Center

Form / Attachment / Pricing Sheet

This document is a pricing table template for Optometry Services. It is intended for bidders to fill in their proposed pricing for various contract line item numbers (CLINs) across different contract periods.

• Item No.: Identifies the Contract Line Item Number (CLIN).
• Contract Period: Specifies the base period and four option periods.
• Profession: Indicates 'Optometrist'.
• Estimate of Usage per Year: Provides minimum and maximum estimated hours per year.
• Hourly Rate: Fields for base period and option periods.
• Overtime Rate: Fields for base period and option periods.
• Fixed Unit Price: Fields for base period and option periods.
• Annual Amount: Fields for base period and option periods.
• Grand Total: A field to sum up all costs.

Bidders must use this template to provide detailed pricing for optometry services. This will be a critical component of their proposal and will likely be used for evaluation and contract award. Completing this table accurately with proposed hourly rates, overtime rates, and annual amounts is essential for responding to the opportunity.

Solicitation / RFP / RFQ

This solicitation (Solicitation No. 75H70726Q00036) is for Non-Personal Healthcare Optometrist Services for the Optometry Clinic at the Zuni Comprehensive Community Health Center (ZCCHC) in Zuni, New Mexico. The Department of Health and Human Services (HHS), Indian Health Service (IHS) is issuing this solicitation.

• Provide comprehensive medical eye examinations in an outpatient setting.

• Diagnose and manage optometric and ocular medical conditions.

• Conduct mandated screenings (e.g., diabetic retinopathy, glaucoma).

• Provide emergency eye care services within scope of licensure.

• Prescribe corrective lenses, contact lenses, visual aids, and therapeutic pharmaceutical agents.

• Order laboratory, diagnostic, and radiologic studies.

• Coordinate care with ZCCHC providers for concurrent systemic and ocular diseases.

• Refer and coordinate Purchased Referred Care (PRC) services.

• Maintain accurate and timely medical documentation per ZCCHC Medical Staff Bylaws and Privacy Act.

• Participate in Quality Assurance and Risk Management activities.

• Deliver services in a culturally sensitive manner, utilizing interpreters when necessary.

• Clinical procedures may include tonometry, gonioscopy, ophthalmoscopy, visual field testing, refraction, retinoscopy, foreign body removal, lacrimal system dilation/irrigation, eyelash epilation, and incision/drainage of hordeolum/chalazion.

• Administrative responsibilities include quality assurance, cultural familiarity, and cross-cultural sensitivity.

• Contract Type: Firm-Fixed-Price (FFP).

• Period of Performance: One base year (TBD/2026 to TBD/2027) with four (4) one-year option periods (TBD/2027 to TBD/2031).

• Total contract award shall not exceed five years.

• Estimated value: $(TBD).

• The Government does not guarantee minimum or maximum hours; payment is for actual hours worked and accepted.

• Offer Due Date: March 19, 2026, 1500 MT.

• Submission Method: Email to shannon.eldridge-shorty@ihs.gov.

• Required Volumes for Submission:

  1. Technical Qualifications (Volume I) - Max 15 pages.
  2. Past Performance (Volume II) - Max 12 pages (up to 3 performance surveys or narratives).
  3. Price Quote (Volume III) - Max 5 pages.

• Evaluation Factors: Award will be made based on the best value determination, considering Technical Qualifications, Past Performance, and Price. Technical Qualifications and Past Performance combined are more important than price.

• Questions Deadline: March 12, 2026, 03:00 PM (MT). Questions should be submitted in writing.

• This solicitation is set aside for Indian Small Business Economic Enterprise (ISBEE) under the Buy Indian Act.

• Cascading set-asides: If no reasonably priced offers from ISBEE, then evaluation will consider Service Disabled Veteran Owned Small Business, then Woman-Owned Small Business, then Other Small Business categories.

• NAICS Code: 621320 with a size standard of $9.0M.

• Government-furnished items include clinical space, shared equipment, IT access, computer, telephone, desk/chair, PIV card, and PPE equipment.

• Contractor shall provide uniforms, laboratory coats, and personal medical instruments not Government-furnished.

• All providers must possess an O.D. degree, current unrestricted license, BLS certification, and professional liability insurance ($1M/3M).

• Required training includes Protecting Children from Sexual Abuse, Trauma-Informed Care, and Information System Security Awareness.

• Fingerprinting and background investigations are required and may take up to six months.

• Health documentation requirements include immunizations and TB screening.

• Contractors must be registered in SAM.gov.

• Pricing remains valid for 90 days from submission.

Form / Attachment / Pricing Sheet

This document is the "Indian Health Service Buy Indian Act Indian Economic Enterprise Representation Form." It serves as a self-certification for offerors to confirm they meet the definition of an "Indian Economic Enterprise" as required by the Buy Indian Act. This form is to be submitted in response to a Sources Sought Notice, Request for Information (RFI), or Solicitation.

• Eligibility Criteria: The form requires the offeror to self-certify whether they meet the definition of an "Indian Economic Enterprise" with "Indian Ownership" under the Buy Indian Act. This definition must be met at the time of offer, contract award, and throughout the contract performance period.
• Required Information: Offerors must provide:
  • Name of Federally Recognized Tribal Entity (if applicable)
  • Name of the 51% owner of the IEE Firm
  • Business Name
  • DUNS Number
  • Certifying Signature and Print Name
• Legal Compliance: The form includes statements regarding the penalties for submitting false or misleading information, referencing 18 U.S.C. 1001 and 31 U.S.C. 3729-3731, and 18 U.S.C. 287.
• Additional Requirements: Successful offerors must also be registered with the System of Award Management (SAM).

This form is critical for any bidder seeking to be considered for contracts or awards under the Buy Indian Act. Bidders must accurately complete and submit this representation to self-certify their eligibility. Failure to meet the definition or provide accurate information can lead to disqualification or penalties. Contracting Officers may require further documentation to verify eligibility.

Form / Attachment / Pricing Sheet

This document is a Past Performance Survey intended to gather feedback on a contractor's performance for a previous contract. It is used by the government to assess a contractor's suitability for Solicitation No. 75H70726Q00036, which pertains to Optometry Services.

Client Information: Fields for Commercial or Federal Client Name, Address, Project Name, Contract Number(s), Total Contract Value, Performance Period, and Teaming Partners.

Contact Information: Sections for Government or Commercial Project Manager Contacts, including Name, Title, Phone Number, Fax Number, and E-mail Address.

Specific Performance Questions: Open-ended questions to understand the scope, complexity, and relevance of the past contract, including:

• Contract type provided
• End goal/product and result
• Type of patients served
• Planning and staffing requirements
• Average timeline and adherence

Past Performance Ratings: A detailed rating system (Excellent, Good, Acceptable, Marginal, Unacceptable) for various aspects of performance, including:

• Quality of Service (Compliance, Accuracy, Personnel, Technical Excellence, Workmanship, Nationwide Service Capability)
• Cost Control (Forecasting, Billings, Cost Relationship, Efficiencies)
• Timeliness of Performance (Milestones, Reliability, Responsiveness, Completion, Schedules, Liquidated Damages)
• Business Relations (Management, Cooperation, Responsiveness, Problem Notification, Flexibility, Pro-activity, Subcontracting, Staff Turnover)
• Customer Satisfaction (Commitment, Recommendation, Overall Rating)

Additional Comments: A section for further remarks.

This survey is crucial for potential bidders as it outlines the specific performance areas and criteria the government will use to evaluate past performance. Bidders should understand how their own past performance aligns with these categories and how to provide relevant information to their references who will complete this survey. The ratings and questions directly inform the evaluation process for the current solicitation.