Replicating Pregnancy Prevention Programs · Web viewRequire all health educators delivering the Contractor’s program receive the MITRE webinar training on completing the Health

Replicating Pregnancy Prevention Programs RFP No.: MITRE-19-23

The MITRE CorporationFederally Funded Research and Development Center7515 Colshire DriveMcLean, Virginia 22102

REQUEST FOR PROPOSAL (FINAL)

RFP No.: MITRE-19-23

Issuance Date: August 02, 2019 Date Due: August 19, 2019; Noon EST

Appendices1. Appendix A: Acronym List1. Appendix B: Glossary 2. Appendix C: Proposal Upload Instructions 3. Appendix D: Technical Proposal Template 4. Appendix E: Cost Proposal Template 5. Appendix F: Past Performance Questionnaire 6. Appendix G: Applicable Prime Contract Clause7. Appendix H: (H.4) Clause Business Ethics, Conflicts of Interest, and Compliance 8. Appendix I: (J-3) Contractor Person COI Financial Disclosure Form9. Appendix J: (J-4) Prime and Sub-Contractor 12. Appendix K: Representative Subcontract Agreement Terms and Conditions13. Appendix L: Representations and Certifications

Submission Requirements:The following documents MUST be completed and uploaded in order for a proposal to be considered valid (see Appendix C - Proposal Upload Instructions). The following documents are included in “RFP Download 1 of 2.docx” available on https://teenhealthpartners.org/:

Technical Proposal Template (Appendix D) Cost Proposal Template (Appendix E; Separate file “RFP Download 2 of 2.xlsx”) Past Performance Questionnaire (Appendix F) Resumes – no graphics allowed; maximum 2 pages per person Letters from Developers or Purveyors of Pregnancy Prevention Programs (if

applicable; See Program Requirements) Memorandum of Understanding (MOU) from Partnering Organizations

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The MITRE Corporation (MITRE) has a current requirement to objectively evaluate adolescent pregnancy prevention programs that have been proven effective through rigorous evaluation. This Request for Proposal (hereinafter “RFP” or solicitation”) presents our requirements for these services as defined in Section 1, Statement of Work, below.

MITRE is an independent, not-for-profit company that operates multiple Federally Funded Research and Development Centers (FFRDCs) providing innovative, practical solutions for some of the nation's most critical challenges in defense and intelligence, aviation, civil systems, homeland security, the judiciary, health and cybersecurity.

This solicitation shall not be construed in any manner to create an obligation on the part of MITRE to enter into a Contract with your firm/organizations or to serve as the basis for any claim whatsoever for reimbursement of costs for efforts expended in preparing your Proposal, regardless of whether or not your firm is successful in receiving a Contract as a result of this solicitation.

MITRE reserves the right, as its interests require, to accept or reject any and all Proposals, to make multiple awards pursuant to this RFP. MITRE reserves the right to cancel the procurement at its convenience for any reason.

All information in connection with this RFP is considered MITRE Proprietary Information and should be held in the strictest confidence. The offeror shall not disclose, release or discuss this information outside of offeror’s organization unless written approval is received from those identified in Section 2.5, RFP Questions.

You must submit an electronic copy of your Technical Proposal and your Cost Proposal, between 5, August 2019, Noon ETnd 19, August 2019, Noon ET. Proposals received after that date and time will be considered non-responsive. Proposal preparation instructions can be found in Section 2.

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TABLE OF CONTENTSSection 1 – Statement of Work 5

1.1 Overview 51.2 Objectives of MITRE’s Program Evaluation 61.3 Scope 61.4 MITRE’s Role 71.5 Implementing Organizations’ Role 71.6 Eligible Organizational Categories 71.7 Contract Type / Period of Performance 71.8 Program Requirements 81.9 Letters from Developers or Purveyors of Pregnancy Programs 91.10 Memoranda of Understanding from Partnering Organizations 101.11 Data Collection and Other Evaluation Requirements 101.12 Contractor Requirements 111.13 Task 1: Project Management 121.14 Task 2: Prepare Implementation Plan 131.15 Task 3: Implement Pregnancy Prevention Program 131.16 Task 4: Collection of Program Implementation Data 141.17 Task 5: Data Collection on Youth Participants (Priced Optional Task) 161.18 Task 6: Collection of Baseline and Follow-Up Youth Surveys (Priced Optional Task) 171.19 Task 7: MITRE Contractor Site Visit and/or Youth Focus Groups / Perceptions of Program Components (Priced Optional Task) 191.20 Task 8: Collection of Follow-up Youth Surveys Three Months after Program Completion (Priced Optional Task 201.21 List of Deliverables 211.22 Key Personnel 251.23 MITRE-Furnished Items 281.24 Contractor-Furnished Items 281.25 Reporting 281.26 Organizational Conflicts of Interest 281.27 Security Requirements 281.28 Work Location 281.29 Travel 28

Section 2 – Proposal Preparation Instructions 292.1 General Instructions 292.2 Proposal Submission and Due Date 292.3 Proposal Handling 292.4 Validity of Proposal Terms 292.5 RFP Questions 292.6 Procurement Schedule 302.7 Proposal Delivery 302.8 Proposal Guidelines 302.9 Technical Proposal Instructions 302.10 Cost Proposal Instructions 302.11 Reference Instructions 31

Section 3 - Evaluation Criteria 32

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3.1 Relative Importance of Evaluation Factors 323.2 EVALUATION FACTOR 0: Compliance (PASS/FAIL) 323.3 EVALUATION FACTOR 1: Technical Factor 333.3 EVALUATION FACTOR 2: Management 343.4 EVALUATION FACTOR 3: Past Performance (Confidence Rating) 343.5 EVALUATION FACTOR 4: Cost 35

Appendix A: Acronym List 37Appendix B: Glossary 38Appendix C: Proposal Upload Instructions 45Appendix D: Technical Proposal Template 46Appendix E: Cost Proposal Template 47Appendix F: Past Performance Questionnaire 48Appendix G: Applicable Prime Contract Clause 52Appendix H: (H.4) Clause Business Ethics, Conflicts of Interest, and 70Appendix I: (J-3) Contractor Person COI Financial Disclosure Template 81Appendix J: (J-4) Prime and Sub-Contractor 91Appendix K: Representative Subcontract Agreement Terms and Conditions 98Appendix L: Representations and Certifications 108

LIST OF TABLES

Table 1. Start Dates for Period of Performance...............................................................................8

Table 2. Schedule of Deliverables by Task...................................................................................22

Table 3. Required Level of Effort for Key Personnel...................................................................26

Table 4. Procurement Schedule………………………………………………………………….30

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Section 1 – Statement of Work

Statement of Work for Implementing Organizations

Health Federally Funded Research and Development Center (FFRDC)

Department of Health and Human ServicesOffice of the Assistant Secretary for Health

1.1 OverviewThe U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) sponsor the CMS Alliance to Modernize Healthcare Federally Funded Research and Development Center (The Health FFRDC). FFRDCs are unique organizations that assist the U.S. Government with scientific research and analysis, development and acquisition, and systems engineering and integration.

The Office of the Assistant Secretary of Health (OASH) contracted with The MITRE Corporation (MITRE),1 the operator of the Centers for Medicare and Medicaid Services (CMS) Alliance to Modernize Healthcare (the Health FFRDC), to objectively evaluate replication of pregnancy prevention programs proven effective through rigorous evaluation. MITRE shall have the exclusive authority and responsibility for determining the evaluation design, selecting organizations by independent award of competitive subcontracts, providing appropriate assistance, performing data analysis, and documenting the Health FFRDC operator’s independent findings.

Preventing teen pregnancy is a goal of multiple HHS agencies. Pregnancy prevention programs for adolescents are designed to give youth the information and skills to prevent pregnancy. For the purposes of this Request for Proposal (RFP), pregnancy prevention programs for adolescents include the use of curriculum and associated materials to deliver services, as well as contextual/preparation activities such as staff recruitment and training and youth participant recruitment and enrollment. Although the teen birth rate continues to drop from its peak in the early 1990s, the most recent data (from 2015 and 2016) show continuing disparities in teen birth rates—by age, race and ethnicity, geography, urbanicity, and among especially vulnerable populations. Similarly, youth who are homeless, living in foster care, or involved with the juvenile justice system also experience disproportionately high rates of teen pregnancy.For the purpose of this RFP, implementing organizations (IO) are organizations focused on health, education, and social services that have experience working with community-based organizations to implement pregnancy prevention programs for adolescents. Implementing organizations may include organizations that are developers or purveyors of the program or curriculum that they implement, or organizations that implement a pregnancy prevention program for which another organization is the developer or purveyor.

1.2 Objectives of MITRE’s Program Evaluation

1 MITRE is a not-for-profit company that manages seven FFRDCs, including the Health FFRDC.

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The objectives of the program evaluation are to evaluate the replication of programs proven effective through rigorous evaluation to determine whether these programs can be replicated with the same or similar successful results and with consistency. To evaluate the success of the replications, five research questions developed by the Health FFRDC operator will be answered. The questions focus on replication, needed adaptions, and impact on participants.The five research questions are as follows:

1. Can a proven-effective program be replicated with fidelity in a different population or location?

2. What adaptations, if any, were made to the program to meet the needs of the population or location?

3. What are promising strategies for health educator recruitment, training, and retention?

4. Can a proven-effective program’s impact on knowledge, attitude, beliefs, intentions, and behaviors be replicated with similar results in a different population or location?

5. What perceptions do youth participants have of the relative influence of program components on knowledge, attitudes, beliefs, and intentions related to sexual and reproductive health?

1.3 ScopeMITRE requires that the successful Contractor:

1. Replicate a single pregnancy prevention program for adolescents proven effective through rigorous evaluation. In the context of this opportunity, replication includes implementation of the program and data collection throughout the program implementation.

2. Implement either (a) a Contractor-developed program with documentation demonstrating that any modifications or adaptations are minor, or (b) a program for which another organization is the developer or purveyor, with written permission from the developer or purveyor for any of the Contractor’s proposed minor modifications or adaptations. Minor modifications and adaptions need to align with criteria described in Task 3, item 10.

3. Conduct timely and accurate collection and facilitation of data collection, as directed by MITRE, utilizing standardized questionnaires and forms developed by MITRE and, if needed, approved by MITRE’s Institutional Review Board (IRB).

The Contractor must be willing to collaborate with MITRE throughout planning, program implementation, and data collection of the Contractor’s proposed program. MITRE may require the Contractor to collect additional baseline and/or follow-up youth surveys, if feasible and appropriate.

1.4 MITRE’s Role

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MITRE will subcontract with multiple IOs selected through a competitive acquisition process to replicate previously proven effective teen pregnancy prevention programs. MITRE will independently identify and select eligible organizations using criteria consistent with HHS statutory language and will provide technical assistance for data collection and fulfilling contractual requirements for IOs. Except for furnishing technical assistance for contractual requirements, MITRE will not provide technical assistance for program implementation. MITRE’s independent evaluation will rely on MITRE’s analysis of the data collected from the IOs and program participants.

1.5 Implementing Organizations’ RoleEach selected IO (the “Contractor”) is required to replicate a previously proven effective program with a population or location that differs from the original population or location where the program proved effective. For purposes of this acquisition, replication includes program implementation and collection of data that MITRE will analyze as part of its independent evaluation.

1.6 Eligible Organizational Categories Nonprofit with or without 501(c)3 IRS status (other than institution of higher education) For-profit organizations (other than small business) Small, minority, and women-owned businesses Universities, colleges and research institutions Community-based organizations Faith-based organizations

1.7 Contract Type / Period of PerformanceMITRE intends to issue multiple Firm Fixed Price (FFP) contract awards for this acquisition. The length of the period of performance (PoP), and the start and end dates of the period of performance for this effort, is expected to vary across IOs. MITRE has established the following period of performance and start and end dates for this effort:

Length of period of performance: The length of the period of performance will vary across IOs and will be driven by the time each IO needs to complete the requirements of the Contract, including any planning activities, program implementation, and data collection. The length of the period of performance will be a maximum of 16 months.

Start date of period of performance: The start date of the period of performance will be one of the following as shown in Table 1.

Table 1. Start Dates for Period of Performance

Season Month / Year

Fall October / November 2019

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Season Month / Year

Winter February / March 2020

Spring May / June 2020

End date of the period of performance: No later than January 24, 2021, with program implementation and all data collection completed no later than December 18, 2020.

Length of program delivery to youth: The program must be short enough in duration to permit at least two but no more than three, consecutive and differentiated groups of youth to receive the entire program sequentially from start to finish before December 18, 2020. (Please refer to Task 3). MITRE anticipates the programs may vary significantly in duration. For the purpose of this RFP and resulting Contract, youths and adolescents are defined to be persons no younger than 12 and no older than 16 years of age at time of program enrollment.

1.8 Program RequirementsThe Contractor shall implement a program that meets the following requirements:

1. Priority Populations of Interest. To the fullest extent possible, the Contractors are encouraged to propose implementing programs in high-need populations and/or in hard-to-reach locations in the United States. Priority populations of interest for this opportunity include one or more of the following:

(a) High-risk, vulnerable, and culturally under-represented youth populations, including, but not limited to, adjudicated youth, youth in or aging out of foster care, minority youth, pregnant and parenting youth, and homeless and runaway youth;

(b) Areas and populations that are underserved by other pregnancy prevention programs, including, but not limited to some rural communities, and young people residing in areas with high birth rates for youth.

However, offerors that work with non-priority population are eligible to apply.

2. Age Appropriate, Medically Accurate, and Proven Effective Through Rigorous Evaluation. Previously proven effective programs proposed by Contractors must be age appropriate (for this evaluation, the age range is 12–16 years of age at the time of enrollment), medically accurate, and have been “proven effective through rigorous evaluation to reduce teen pregnancy, behavioral risk factors underlying teen pregnancy, or other associated risk factors.”

3. Rigorous Evaluation Criteria. Specifically, the Contractor must provide at least one but no more than two citations to publicly available publication(s) that demonstrate the proposed program has been proven effective through rigorous evaluation which includes each of the following five elements:

(a) A statistically significant positive behavioral impact

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(b) A control or comparison group

(c) Peer-reviewed research that may be present in either published or grey literature

(d) Research must be conducted by an independent evaluator

(e) Research report must be no older than ten years

MITRE will access the citation(s), download and review the publication(s) to confirm the proposed program has been proven effective through a rigorous evaluation.

4. Different Population or Location than Prior Rigorous Evaluation. The previously proven effective programs must be implemented with a different population or setting than the population or setting in which the rigorous evaluation was found to be effective. Specifically, the Contractor must replicate the proposed program in a context with different demographic variables (such as, a different culture, age group, geographical location) than the population or setting in which the rigorous evaluation found the program to have a statistically significant impact. This approach is common among social science applied research replications and will enable MITRE’s data analysis to examine whether the program yields the same or similar results when tested against different demographic variables.

5. Broad Range of Program Types. A broad range of age-appropriate and medically accurate pregnancy prevention programs previously proven effective will be eligible for this opportunity. This includes, but is not limited to, the following types of programs: sexual health education programs, youth development programs, and sexual risk avoidance programs. The program settings may include schools, after-school programs, community-based programs, and licensed group or residential programs. Programs delivered in private non-group; non-licensed homes are not eligible for replication under this contract. Programs designed or proposed to be delivered to one individual at a time are not eligible.

6. Program Age Range, Length and Number of Youth Participants. Across all locations and addresses of the program, the Contractor’s program shall:

(a) Serve youth who are no younger than 12, but no older than 16 years of age at the time of enrollment

(b) Be short enough in duration so that at least two, but no more than three, consecutive youth groups can sequentially receive the entire program from start to finish prior to December 18, 2020

(c) The program must enroll a minimum of 10 participants prior to program implementation

1.9 Letters from Developers or Purveyors of Pregnancy ProgramsThe Contractor shall obtain the purveyor/developer permission for any modifications or adaptations planned prior to award and the purveyor/developer confirmation that the modifications and adaptations will not compromise fidelity or integrity. This requires finding a balance between the tension of fidelity and adaptation without compromising the underlying elements/components of the program.

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1.10 Memoranda of Understanding from Partnering Organizations The Contractor shall obtain a fully executed memorandum of understanding (MOU) from any partnering organization regarding their role in the program implementation and data collection, including any approvals for the Contractor to implement the program at the partnering organization and approvals for collection of data from participating youth (with appropriate parental consent and youth assent) and the partnering organization’s staff.

1.11 Data Collection and Other Evaluation Requirements1.11.1) Contractor’s Role in Program Evaluation

The Contractor shall not perform a separate evaluation of the program in the same locations or with the key stakeholders, health educators, or youth participants that are included in the MITRE evaluation.

1.11.2) Contractor’s Role in Data Collection and Submission of Data to MITREThe Contractor shall ensure facilitation of timely (see Table 2. Schedule of Deliverables by Task) and accurate data collection utilizing standardized surveys and other forms developed and approved by MITRE and as required, approved by MITRE’s Institutional Review Board (IRB). Under this FFP contract, MITRE’s payments to the Contractor will be associated with completion of key milestones or deliverables, including timely submission of data.

The Contractor is prohibited from utilizing, reporting, disclosing or transmitting any data collected under this project without written approval from MITRE and, as necessary, MITRE’s IRB. The Contractor is required to implement and maintain reasonable and appropriate administrative, physical and technical safeguards to protect the security and confidentially of the information and protect against any unauthorized access to or use of the information. Contractors shall ensure compliance with all applicable privacy laws and regulations.

The Contractor shall ensure that the Contractor’s data collection coordinator(s), health educators, and any other data collection staff complete required training. (see Table 2. Schedule of Deliverables by Task)

The Contractor is required to participate in key stakeholder and health educator interviews and ensure the timely collection and submission, via a MITRE-provided secure web portal or other means as directed by MITRE, of health educator session logs and audio recordings of the program sessions. (Please refer to Task 4.) The Contractor will be required to collect data, at the direction of MITRE to include health educator feedback, session logs and audio recordings.

The Contractor shall be prohibited from collecting any data beyond what MITRE requires from the same locations or from the same key stakeholders, health educators, or youth participants included in the MITRE evaluation.

If MITRE exercises optional Task 5, the Contractor shall ensure timely collection and submission of the MITRE approved parent or legal guardian consent forms, via a MITRE-provided secure web portal or other means as directed by MITRE.

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The Contractor shall coordinate promotion and distribution of the parent or legal guardian consent forms. The parent and legal guardian consent form may be designed to include check boxes that will enable parents and legal guardians to separately provide consent to any youth data collection including youth surveys (if optional Task 6 is exercised) and youth focus groups (if optional Task 7 is exercised).

If MITRE exercises optional Task 6, the Contractor shall ensure the timely collection by Contractor staff of youth assent, and one baseline and one follow-up youth survey per youth participant. The Contractor must administer electronic youth surveys and will be required to upload survey responses to the survey vendor’s server immediately after each participant completes the surveys.

If MITRE exercises optional Task 7, the Contractor shall coordinate and participate in a one- to two-day MITRE site visit to the Contractor’s location(s) and shall coordinate youth focus groups (including recruitment of youth focus group participants and scheduling the focus group).

If MITRE exercises optional Task 8, the Contractor shall ensure the timely collection of multiple baseline and follow-up youth surveys per youth participant. The Contractor must administer electronic youth surveys and upload survey responses.

If MITRE exercises optional Tasks 5, 6, and/or 8, MITRE will require that the Contractor comply with an approved protocol to protect the security of the data collected and privacy of the participants.

1.12 Contractor RequirementsThe Contractor shall be responsible for performing the following four (4) tasks under this Contract:

Task 1: Project Management

Task 2: Prepare Implementation Plan

Task 3: Implement Pregnancy Prevention Program

Task 4: Collect Program Implementation Data from Health Educators and Key Stakeholders

1.13 Task 1: Project ManagementThe Contractor shall provide, within the allocated funding, all necessary labor, skills, material, resources, and support to accomplish the tasks described in this SOW and execute the tasks in full compliance with the relevant MITRE policies and procedures. Contractor employees are expected to have the expertise and training necessary to maintain their technical proficiency and perform the tasks as stated in this SOW.

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The Contractor Program Management Team shall work and collaborate, in the spirit of mutual trust and cooperation, with other MITRE personnel and other Contractors (if necessary) to successfully complete the prescribed work as stated in this SOW.

The MITRE Project Leader or Designee will coordinate project management activities with the Contractor, as necessary. The Contractor shall:

1. Participate in a virtual 90-minute kickoff meeting with MITRE to address required work under this SOW and to ensure all parties understand the work to be performed and respective responsibilities and obligations for this effort.

2. Participate in weekly one-on-one or group virtual meetings up to 90 minutes in length as often as required and in ad hoc phone or e-mail consultations to address issues or questions that may arise throughout the period of performance of this effort.

MITRE will plan and schedule the kickoff, one-on-one, group, or ad hoc meetings. These meetings will be used to provide status updates, receive technical support from MITRE to ensure data collection and program implementation requirements are achieved, and to manage potential contractual issues. Particular attention will be paid to fidelity of programming, recruiting and retaining youth in programming, collection of needed data, and completion of required deliverables. The Contractor shall provide weekly updates, as requested by MITRE.

1.13.1) Monthly Status ReportsThe Contractor shall provide monthly status reports (MSR) throughout the period of performance to communicate progress, key issues and findings in a template provided by MITRE after contract award. In the MSRs, the Contractor shall describe progress on program implementation and data collection and steps taken to resolve any identified program quality or fidelity issues. The final MSR for the project shall summarize the information described in the previous MSRs. The Contractor shall provide monthly invoices to MITRE consistent with the deliverable pricing schedule.

The MSR is due no later than the 14th of each month, If the 14th falls on a weekend, the MSR is due on the following Monday. At a minimum, the MSR shall consist of:

1. Synopsis of accomplishments /work performed during the reporting period shall include updates on fidelity of programming, recruiting and retaining youth in programming, collection of needed data, and completion of required deliverables.

2. Planned activities for the next reporting period

3. Key issues/areas of concern, including any obstacle or barrier and how it may affect the program

4. Potential impacts to cost, time and schedule.

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5. Current roster of personnel supporting the contract, including name and task/area of the staff’s support

6. Inventory of MITRE-furnished equipment

1.13.2) Contract CloseoutThe Contractor shall participate in a closeout briefing. The MITRE Project Leader or Designee and the Contractor will participate in a session designed to transfer knowledge leveraged and/or gained during the project. The Contractor must share all data collected during the Contract with MITRE. The Contractor shall provide a brief final report using a template provided by MITRE.

1.13.3) Deliverables for Task 1: Kickoff Meeting Monthly Status Reports Monthly Invoice Weekly Meetings with MITRE as scheduled List of IO personnel participating in MITRE provided data collection training Contract Closeout Meeting

1.14 Task 2: Prepare Implementation PlanThe Contractor shall provide a summary implementation approach as part of the proposal response to the RFP using the template provided by MITRE (see Appendix D: Technical Proposal Template). After contract award, the Contractor shall work with MITRE to develop a draft implementation plan, which includes a staffing plan and timeline for delivery of the program. Information in the draft implementation plan is required to build on and provide additional details to the information Contractors provide as part of proposal response to the RFP.

MITRE will review and provide feedback on the Contractor’s draft implementation plan prior to the plan being considered final. The Contractor must receive written approval from the MITRE Project Leader or Designee before program implementation.

1.14.1) Deliverables for Task 2: Final Implementation Plan

1.15 Task 3: Implement Pregnancy Prevention ProgramThe Contractor shall implement the pregnancy prevention program as described in their Implementation Plan. The Contractor shall conduct any necessary and appropriate planning activities associated with program implementation, which may include recruitment and enrollment of youth participants and health educator training specific to proposed program delivery.

The Contractor’s program shall meet the requirements listed under Section 1.8, Program Requirements, of this SOW. Specifically, the Contractor’s program shall be:

1. Age appropriate, medically accurate, and proven effective through rigorous evaluation

2. Consistent with requirements for program length, age range, and number of youth participants

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3. Serve youth who are no younger than 12, but no older than 16 years of age at the time of enrollment

4. The program must enroll a minimum of 10 youth prior to program implementation

5. Be delivered sequentially to at least two, but no more than three, consecutive groups of youth. Each replication of the program may be conducted in multiple locations or settings, as needed

6. Be short enough in duration so that at least two, but no more than three, consecutive youth groups can sequentially receive the entire program from start to finish prior to December 18, 2020

7. Implemented in a population or location different than the prior rigorous evaluation

8. Implemented in a manner that is culturally and linguistically appropriate, and trauma sensitive (including but not limited to staff training and program materials)

9. Enhance and not duplicate the services already available in the community.

10. Ensure that planned adaptations are appropriate for the population and align with the “green light” or “yellow light” adaptation criteria in “General Adaptation Guidance: A Guide to Adapting Evidence-Based Sexual Health Curricula” (see link for Adaptation guide: https://www.etr.org/ebi/assets/File/GeneralAdaptationGuidanceFINAL.pdf).

1.15.1) Deliverables for Task 3: Program Implementation Aggregated De-Identified Participant Enrollment Attendance Chart

1.16 Task 4: Collection of Program Implementation DataThe Contractor shall use only those templates provided and approved by MITRE to collect Health Educator surveys and Health Educator session logs. Health Educator surveys will capture data on topics such as the experience level and training of the health educator prior to the program. Except for furnishing technical assistance regarding contractual requirements, MITRE will not provide the Contractor technical assistance for program implementation.To support MITRE’s analysis of program implementation data from multiple IOs, MITRE requires the Contractor to complete the following sub-tasks.

1.16.1) Training for Data CollectionMITRE will train Contractors to collect data required in Task 4. To prepare for the collection of the completed Health Educator session logs and audio recordings of program sessions, the Contractor shall:

1. Ensure the Contractor’s Project Director/Project Lead or Program Manager participates in training on the completion of Health Educator session logs. MITRE will conduct this training via webinar. The webinar is expected to last no more than 120 minutes.

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2. Require all health educators delivering the Contractor’s program receive the MITRE webinar training on completing the Health Educator session logs and audio recordings. The Contractor will ensure that all health educators attend the MITRE training webinar prior to program implementation. The webinar is expected to last no more than 120 minutes.

1.16.2) Health Educator Session LogsThe Contractor shall ensure the proper collection of Health Educator session logs. Health Educator Session Logs will provide real-time documentation of the implemented sessions and any adaptations.

During program implementation, the Contractor shall arrange for the collection and submission of the completed Health Educator Session Log on at least a weekly basis to a MITRE-provided secure web portal.

1.16.3) Audio RecordingsDuring program implementation, the Contractor shall arrange for and ensure the audio recording of all sessions of the program delivered to the participants. For this sub-task, the Contractor shall:

1. Use a tablet for the audio recording and record the sessions in mp4 or another accepted format.

2. Ensure the timely submission of the audio recordings in an mp4 or other approved digital format by uploading the recordings at least weekly to a MITRE-provided secure web portal.

MITRE will randomly select and review at least ten percent of the audio recorded session logs for fidelity.

1.16.4) Key Stakeholder and Health Educators InterviewsThe Contractor shall ensure:

The Contractor’s Project Lead participates in a one-hour telephone interview with MITRE staff before the start and/or at the end of program implementation,

The program Health Educators participate in brief online surveys before and after implementation,

All Health Educators delivering the program participate in post-implementation interviews. The interviews will focus on areas related to staffing and implementation that enabled progress, potential barriers to implementation, and any adaptations made to the program.

1.16.5) Deliverables for Task 4: Completed Health Educator session logs (weekly during program

implementation) Audio recordings of program sessions (weekly during program

implementation)

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Participation in key stakeholder interviews Completed Health Educator Pre/Post surveys

1.17 Task 5: Data Collection on Youth Participants (Priced Optional Task) If MITRE elects to exercise the option for this task, the Contractor shall collect data at the direction of MITRE using templates provided by MITRE. MITRE will provide training to Contractors to collect data required in Task 5.

The Contractor shall provide the data for each of the following required forms to MITRE as specified in this SOW:

1. Parent or legal guardian consent form. The Contractor is responsible for the collection of parent or legal guardian consent forms prior to the first day of implementation for each program replication. The parent or legal guardian consent forms must be approved by MITRE and as required, MITRE’s IRB. The parent or legal guardian consent form will be used to obtain permission from the parent or legal guardian for the youth to participate in the data collection component of the project. The Contractor is responsible for ensuring written parent or legal guardian consent is acquired for each youth participating in the data collection.

2. Coordination, promotion, and distribution of parent or legal guardian forms. Prior to and during the collection of parent or legal guardian consent forms, the Contractor shall:

Coordinate, at the direction of MITRE, distribution of the parental permission forms for the program and the evaluation in the same parent packet, if feasible

Implement appropriate steps to support high rates of parental permission, such as attending parent events organized by the IO or partner organizations (such as parent information sessions)

Participate in MITRE training for the collection of parent or legal guardian consent forms

Submit the scanned, signed parent or legal guardian consent forms on a MITRE-provided secure web portal or other means as directed by MITRE no later than 48 hours from receipt

3. Parent or legal guardian consent for other optional tasks. If MITRE elects to exercise the option for Task 6 or elects to exercise both optional Tasks 6 and 8, the parent or legal guardian consent form will include consent for administration of youth baseline and follow-up surveys. If MITRE elects to exercise the option for Task 7, the parent or legal guardian consent forms will include consent for the youth focus group.

4. Participant roster. Prior to the first day of implementation for each program replication, the Contractor shall provide to MITRE a participant roster using a template provided by MITRE for each physical location in which the program occurs. The participant roster template will include, but may not be limited to, the following data elements: the number

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646647648649


of youths enrolled, physical location where the program occurred, unique identifier for each youth.

The Contractor shall ensure the timely submission of the completed participant rosters on a MITRE-provided secure web portal or other means as directed by MITRE no later than 48 hours from receipt.

5. Attendance forms. The Contractor shall complete an attendance form using a template provided by MITRE for every session of the class offered. The attendance form must indicate which of the participants listed on the roster were in attendance on each day. Participants’ attendance is a key measure of whether the program is implemented as planned.

The Contractor shall ensure the timely submission of the completed attendance forms on a MITRE-provided secure web portal or other means as directed by MITRE no later than 48 hours following completion of each class session.

1.17.1) Deliverables for Task 5: Parent or Legal Guardian Consent Forms Participant Rosters Session Attendance Forms

1.18 Task 6: Collection of Baseline and Follow-Up Youth Surveys (Priced Optional Task) If MITRE elects to exercise the option for this task, the Contractor shall perform the following activities. MITRE will train Contractors to collect data required in Task 6.

1.18.1) Prepare for CollectionTo prepare for the collection of youth survey data, the Contractor shall:

1. Work under the direction of the MITRE Project Leader or Designee to plan the timing of baseline and follow-up survey data collection with youth participants.

2. Designate data collection staff for the youth participant baseline and follow-up surveys.

3. Ensure Health Educators are not involved in the collection of survey data from youth participants.

4. Ensure the Contractor’s designated data collection staff participate in training by MITRE on how to conduct a baseline and follow-up youth participant survey.

5. Ensure one program session is set aside for baseline data collection before the Health Educator begins delivery of the program to youth.

6. Ensure one program session is set aside for follow-up data collection after the Health Educator completes delivery of the program to youth.

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1.18.2) Collect Youth Assent and Baseline SurveyThe baseline surveys will be approximately 25 to 30 minutes in length. MITRE will develop the youth baseline and youth follow-up surveys. Survey questions may include, but may not be limited to, the following topics: attitudes, beliefs, knowledge, intentions, and behaviors around sexual activity. The baseline survey of youth will also include questions about the youth’s age, race/ethnicity, biological sex, and family structure. (Please refer to https://teenhealthpartners.org/ for the Draft Youth Survey Instrument.)

The Contractor’s designated data collection coordinators(s) shall:

1. Ensure a valid Parental or Legal Guardian Consent and Youth Assent is executed before authorizing a youth to participate in the survey.


3. Facilitate the collection of youth participant baseline survey using a template developed by MITRE.

4. Facilitate administration of formatted electronic surveys for completion by the youth participants using a tablet provided by MITRE to the Contractor.

5. Schedule, at a minimum, two opportunities for each youth participant to complete the survey—one initial day and one make-up day.

6. Ensure high rates of youth participant attendance during the days set aside for survey completions.

7. Ensure the baseline survey responses are uploaded to the survey vendor’s server no later than 48 hours after survey administration.

1.18.3) Collect Follow-Up SurveyAt the end of program implementation, the Contractor’s designated data collection coordinator(s) shall facilitate collection of the youth participants’ follow-up survey using a template provided by MITRE. The follow-up survey will be approximately 25 minutes in length and include a subset of questions repeated from the baseline survey.

To capture follow-up survey results, the Contractor shall:

1. Ensure a valid Parental or Legal Guardian Consent, Youth Assent, and baseline survey is executed before authorizing a youth to participate in the follow-up survey.

2. Ensure that Health Educators are not involved in the collection of survey data from youth participants to ensure the independence of MITRE’s evaluation.

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3. Facilitate the collection of youth participant follow-up survey using the template developed by MITRE.

4. Facilitate administration of formatted electronic surveys for completion by youth participants using a tablet provided by MITRE to the Contractor.

5. Schedule, at a minimum, two opportunities for each youth participant to complete the survey—one initial day and one make-up day.

6. Ensure high rates of youth participant attendance during the days set aside for survey completions.

7. Ensure the follow-up survey responses are uploaded to the survey vendor’s server no later than 48 hours after survey administration.

1.18.4) Deliverables for Sub-Task 6: Completed youth baseline surveys Completed youth follow-up surveys

1.19 Task 7: MITRE Contractor Site Visit and/or Youth Focus Groups / Perceptions of Program Components (Priced Optional Task) If MITRE elects to exercise this optional task, the Contractor shall perform the following activities. MITRE will train Contractors to collect data required in Task 7.

1.19.1) Coordinate and Participate in MITRE Site VisitThe Contractor shall coordinate and participate in a one- to two-day MITRE visit to Contractor’s site(s) once during the Contractor’s period of performance. The length of the site visit will be determined by MITRE in consultation with the Contractor. The purpose of the site visit is for MITRE to gain further understanding of IO processes and to collect program implementation data. During the site visit, Contractor staff (for example, representatives from the participating sites and Health Educators) shall participate in one or more meetings with MITRE.

To support the MITRE independent evaluation, the Contractor staff shall collaborate with MITRE to schedule the site visit and ensure Contractor staff members’ participation during the site visit.

The Contractor shall work with MITRE to develop an agenda for the site visit and submit the agenda to the MITRE Project Leader or Designee for review and final approval.

1.19.2) Coordinate Youth Focus Groups/Perceptions of Program ComponentsYouth focus groups will be used to assess participants’ perceptions of program components. The Contractor shall schedule and participate in up to two (2) focus groups to be conducted by MITRE at a mutually agreeable date and time.

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The Contractor shall use only those templates provided by MITRE and approved by the required IRB to obtain parent or legal guardian consent. The Contractor is responsible for ensuring only youth for whom their parent or legal guardian has provided written consent participate in data collection.

For each scheduled focus group, the Contractor shall recruit a minimum of (6) six age-appropriate youth participants, verify their parents or legal guardians have provided consent (as specified in this SOW), make available space conducive to conducting open discussions, and ensure successful conduct of the focus group(s). MITRE will collect MITRE IRB-approved youth assent forms from the youth participants before conducting the focus groups.

The focus group(s) shall be up to 90 minutes in length and will be conducted and facilitated by MITRE or a MITRE Designee.

During the facilitation of focus groups, MITRE will arrange for and ensure the audio recording of all focus group sessions delivered to the participants.

1.19.3) Deliverables for Task 7: Draft Agenda and IO personnel attendee list for MITRE site visit

Documentation of Focus Group logistics and participants

1.20 Task 8: Collection of Follow-up Youth Surveys Three Months after Program Completion (Priced Optional Task If MITRE elects to exercise the option for this task, the Contractor shall perform the following activities. MITRE will train Contractors to collect data required in Task 8.

1.20.1) Prepare for CollectionTo prepare for the collection of youth survey data, the Contractor shall:

1. Work under the direction of the MITRE Project Leader or Designee to plan the timing of the three-month post program follow-up survey data collection sessions (beyond Task 6 administrations) with youth participants.

2. Designate data collection staff for the youth participant three-month follow-up survey.


4. Ensure the Contractor’s designated data collection staff participate in training by MITRE on how to conduct a three-month follow-up youth participant survey.

1.20.2) Collect Additional Youth Assent and Survey ResponsesThe Contractor’s designated data collection coordinators(s) shall:

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1. Ensure a valid Parental or Legal Guardian Consent, Youth Assent, and baseline survey are executed before authorizing a youth to participate in the three-month follow-up survey.


3. Facilitate the collection of youth participant three-month follow-up surveys using the template developed by MITRE.

4. Facilitate administration of formatted electronic surveys for completion by youth participants using a tablet provided by MITRE to the Contractor.

5. If applicable, schedule, at a minimum, two opportunities for each youth participant to complete the survey—one initial day and one make-up day.

6. Participate in outreach to ensure high rates of youth participant responses to the three-month follow-up survey.

7. If applicable, ensure the follow-up survey responses are uploaded to the survey vendor’s server no later than 48 hours after survey administration.

1.20.3) Deliverables for Task 8: Completed Youth 3-Month Follow-Up Surveys

1.21 List of Deliverables Table 2 presents a schedule of deliverables from all tasks to support the work required by MITRE in this SOW. On approval, the Contractor shall incorporate the final deliverable schedule (with calendar dates) into the Contractor’s final Implementation Plan.

The Contractor shall deliver all products following the protocol finalized at award to the MITRE Project Leader or Designee. Electronic transmission shall be the primary delivery mechanism; if requested by the MITRE Project Leader or Designee, the Contractor shall provide hard copies to MITRE.

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823

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Table 2. Schedule of Deliverables by Task

No. Task # Deliverable Description Date Due Frequency

1 1 Kickoff Meeting

Introductions, review subcontracts, and plans

Within fifteen (15) days of contract award

Once

2 1 Monthly Status Reports

Describe progress on program implementation and data collection, steps taken to resolve any identified program quality or fidelity issues

By the 14th of each month (covering the previous month)

Monthly

3 1 Monthly Invoice

Invoice monthly for allowable incurred costs using Deliverable Pricing Template provided by MITRE

No later than the 14th business day of the month

Monthly

4 1 Weekly Meetings

Weekly one-on-one or group virtual meetings with MITRE as scheduled

As directed Weekly

5 1 List of IO Personnel - Data Collection Training

List of participants who complete MITRE-provided training on the forms and process to collect data

No later than 48 hours after training session

Once per training; updated as needed

6 1 Contract Closeout Meeting

Session designed to transfer knowledge and ensure final data and deliverables inventory

Within 4 weeks following final replication

Once

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7 2 Final Implementation Plan

Implementation Plan, with implementation schedule and other implementation details, that builds on the information provided as part of Contractor’s proposal response (MITRE template)

Within one month of award

Once

8 3 Program Implementation

Provide the program as described in the subcontract

As directed As stated in the subcontract award

9 3 Aggregated De-Identified Participant Enrollment

List of youth participants in each program replication

No later than Once; updated as needed

10 3 Attendance Chart

Daily session attendance

Daily for all program sessions

Once per replication

11 4 Health Educator Session Logs

Collect data to measure whether the program was delivered with fidelity to the Implementation Plan

Weekly during program implementation

Weekly

12 4 Audio Recordings of Program Sessions

Audio recording of program session for every class for each of the two to three sequential implementations of the program

A minimum of weekly during program implementation

Weekly

13 4 Key Stakeholder Interviews

Understand factors that enabled progress, barriers to implementation, and discuss any adaptations made to the program

As directed post-implementation

Once – as scheduled

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14 4 Health Educator Surveys

Pre/Post implementation online surveys

Prior to the first implementation

Within 72 hours post-implementation

Once: Prior to implementation

For all replications: Post-implementation

15 5 (Optional)

Parent or Legal Guardian Consent Forms

Consent for youth participation in data collection

Prior to the first day of program implementation for each session

As directed

16 5 (Optional)

Participant Rosters

List of youth/students enrolled in session in each physical location where the program is delivered, along with race/ethnicity, age, grade, sex at birth

The first day of program implementation for each of the two to three sequential implementations of the program

As directed

17 5 (Optional)

Session Attendance Forms

Complete forms for every session of classes offered for each of the two to three sequential implementations of the program

As directed As directed

18 6 (Optional)

Youth Baseline Surveys

Facilitate the collection of youth participant baseline survey using template developed by MITRE

Approximately the first day of each class for each of the two to three sequential implementations of the program

Once per implementation with an additional make-up day

19 6 (Optional)

Youth Follow-Up Surveys

Facilitate the collection of youth participant follow-up survey using template developed by MITRE

Approximately last day of each of the two to three sequential implementations of the program

Up to three (3) times. Once per implementation, with an additional make-up day.

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20 7 (Optional)

Agenda and IO staff participation list for site visit conducted by MITRE

Work with MITRE to develop an agenda for the site visit and submit the agenda to the MITRE Project Leader or Designee for review and final approval. Submit list of IO staff participating in site visit meeting(s).

Agenda: Two (2) weeks prior to site visit

Participant list: No later than 48 hours after site visit

Once

21 7 (Optional)

Focus Group Documentation

Recruit a minimum of (6) six unique age-appropriate youth participants, verify their parents or legal guardians have provided consent as specified in this SOW, make available space conducive to conducting open discussions, and ensure successful conduct of the focus group(s)

Two (2) weeks prior to scheduled focus group

Up to two times per program implementation

22 8 (Optional)

Youth 3-Month Follow-Up Surveys

Facilitate the collection of additional youth participant follow-up survey using template developed by MITRE

Approximately three (3) months after the completion of the program

Once

1.22 Key Personnel The Project Director, Program Manager/Project Lead, Data Collection Coordinator(s), Financial Analyst and the Health Educator are required Key Personnel for performance of this Contract. All Key Personnel positions shall be dedicated to this Contract according to Table 3. Key Personnel shall be assigned for the length of the period of performance, barring circumstances outside the control of the Contractor. Any staff identified as Key Personnel must have a backup who is properly trained and qualified to act as a fully functioning replacement in the temporary absence of the key person. The Contractor may propose additional Key Personnel.

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Table 3. Required Level of Effort for Key Personnel

Key Personnel Role Minimum Percent

Project Director 20 percent+

Program Manager/Project Lead 50 percent +

Data Collection Coordinator 20 percent +

Financial Analyst 20 percent +

Health Educator 50 percent*(+) Throughout the period of performance (*) Minimum percent during program implementation. Other percent beyond program implementation should be proposed by the offeror.() The standard number of work hours per year (e.g.,1920 hours)

Prior approval is required for any change in level of effort or replacement of Key Personnel. To ensure proper and effective knowledge transfer, replacement of Key Personnel requires a 10-day notice to the MITRE Contract Manager and demonstration that the replacement Key Personnel candidate possess the qualifications specified in this Statement of Work (SOW). The Contractor’s proposal shall include a resume for each proposed Key Personnel candidate.

1.22.1) Key Personnel QualificationsThe Contractor shall demonstrate that each Key Personnel candidates possess the following qualifications:

Project Director– Demonstrated experience in managing multiple projects/programs

for youth, including supervising personnel and fiscal accountability and reporting

– Demonstrated experience in recruiting, training, and retaining health educators or their equivalents for at least 18 months

– Demonstrated ability to work with schools, community members, and organizations in planning and implementing youth programs

– A Bachelor’s degree from an accredited institution of higher education or one or more years as a project director in the field of pregnancy prevention programs or sexually transmitted infection prevention programs

Program Manager and/or Project Lead

– Demonstrated experience in recruiting youth participants and ensuring regular youth participant attendance/retention in the program

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867868869870

871

872873874


– Demonstrated experience working with the proposed community(ies) in implementing youth projects at a similar scale in the proposed or similar populations

– Demonstrated experience in implementation of a pregnancy prevention program for adolescents with fidelity and high quality

– A Bachelor’s degree from an accredited institution of higher education or one or more years as a program manager/project lead in the field of pregnancy prevention programs or sexually transmitted infection prevention programs

Data Collection Coordinator

– Demonstrated experience participating in and collecting data for program evaluations conducted by an independent evaluator, and specifically program evaluations that involve collection of active parental consent data

– A Bachelor’s degree from an accredited institution of higher education one or more years as a data collection coordinator lead in the field of pregnancy prevention programs or sexually transmitted infection prevention programs

Financial Analyst

– Demonstrated experience in financial management of a grant or contract of similar size and complexity

– A Bachelor’s degree from an accredited institution of higher education in finance, public administration, business administration, or another related field or an Associate Degree with 2 or more years of experience in the field of finance

Health Educators

– Appropriate training and resources regarding trauma-sensitive approaches

– Appropriate training and expertise to implement the proposed program in an age-appropriate and culturally and linguistically appropriate manner

– Experience implementing a pregnancy prevention program or other health education program for adolescents in the populations targeted by the Contractor

– A Bachelor’s degree from an accredited institution of higher education or 3 or more years of experience as a health educator in the field of pregnancy prevention or sexually transmitted infection prevention

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884

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889890891892

893

894895

896897898899

900

901902

903904905

906907908

909910911912913


1.23 MITRE-Furnished Items MITRE will provide the following materials to the Contractor according to the protocol specified at award:

1. Templates as stated in the SOW to include, monthly status report, brief final report for contract closeout, implementation plan, and other templates as needed.

2. Copies of all data collection tools and materials, including Health Educator session logs, Health Educator surveys and, if applicable, parent permission and youth assent forms, baseline and follow-up youth surveys, attendance forms, and any needed shipping materials (e.g., FedEx envelops and pre-paid labels)

3. Incentives for data collection

4. Tablets for data collection if Task 3, Task 5 or Task 8 is activated and tablets are required

All MITRE-furnished equipment shall be returned upon completion of the survey, unless MITRE provides and exception in writing.

1.24 Contractor-Furnished ItemsThe Contractor shall provide the following materials to MITRE within five (5) business days of award date:

A copy of the proposed curriculum, including any adaptions specific to the IO and/or site(s)

A written statement from the developer or purveyor confirming stated adaptations will not compromise fidelity or integrity of the previously proven effective program

The facilitator manual for the proposed curriculum

1.25 ReportingThe Contractor shall provide plans and status updates for all tasks and activities performed during regular meetings with MITRE listed under Task 1.

1.26 Organizational Conflicts of InterestThe Contractor shall ensure the services provided under this Contract are free, to the greatest extent possible, of all Organizational and Personal Conflicts of Interest, or disclosed with proposed mitigation strategy, as required by Appendices H and I.

1.27 Security RequirementsThis effort and all work products generated through this work are Unclassified.

1.28 Work LocationWork will occur primarily at the Contractor’s locations and the Contractor’s partnering sites.

1.29 Travel MITRE anticipates supporting local travel in a manner consistent with Federal Travel Regulations; however, MITRE does not anticipate supporting long-distance travel, including airfare.

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Section 2 – Proposal Preparation Instructions

This Section provides the offeror with Technical and Business Proposal Preparation Instructions.

2.1 General InstructionsIt is the intent of MITRE, by providing the instructions set forth below, to solicit information that will demonstrate the ability of the offeror to successfully complete the requirements specified in the RFP and to permit a competitive evaluation of each offeror’s proposal. These instructions are not, however, to be considered as all inclusive, and offerors should therefore include in their proposal further discussions they believe to be necessary or useful in demonstrating their ability to perform the work.

2.2 Proposal Submission and Due DateOfferors are required to follow proposal upload instructions contained in Appendix C to submit an electronic copy of the Technical Proposal and Cost Proposal, between 5, August 2019, Noon EST and 19, August 2019, Noon ET (see Table 4). In the case that multiple proposals from a single offeror are uploaded, the most recently uploaded documents will be considered as the offeror’s final submission.

Upon receipt of this RFP, offerors are not permitted to contact any MITRE employees. Should any contact be required, offerors must use the “Ask a Question” link on the https://teenhealthpartners.org/ home page, send email to [email protected] or call 703-983-TEEN. Violation of this may cause automatic elimination from being considered for contract award.

2.3 Proposal HandlingAll proposal information submitted by the offeror will be considered proprietary and held in the strictest confidence. This information will not be released nor discussed outside of the MITRE organization and will be used only for the purpose of evaluating the offeror’s proposal. No proposals will be returned.

2.4 Validity of Proposal Terms

The offeror’s proposal shall remain valid for 120 days following the closing date for proposal submission.

2.5 RFP QuestionsAll questions concerning this RFP shall be submitted no later than 29, July 2019, Noon ET and must be submitted either via the “Ask a Question” link on the https://teenhealthpartners.org/ homepage or via voicemail at 703-983-TEEN. All questions submitted will be answered via the FAQs contained on https://teenhealthpartners.org/and will be available to all potential offerors.

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mailto:[email protected]



2.6 Procurement Schedule

Table 4. Schedule of Procurement Activities

Activity DateRelease of RFP July 23, 2019RFP Questions from offeror to MITRE July 29. 2019 Responses to above questions from MITRE August 2, 2019Portal open to upload offerors’ proposals August 5, 2019, 12 noon () (ET) Deadline to upload offerors’ proposals August 19, 2019, 12 noon ETAnticipated Contract Award Notification October/November 2019

2.7 Proposal DeliveryProposals must be delivered electronically via electronic upload via the https://teenhealthpartners.org/ website. Instructions on how to upload submissions are contained in Appendix C.

From August 5, 2019 12 noon EST through August 19, 2019 12 noon - (ET) , MITRE will provide specific Help Desk coverage solely for this acquisition should any offerors have difficulties with their uploads. This Help Desk will be staffed from 8:00 am to 5:00 pm ET Monday through Friday. After hour and weekend inquiries may be left via voicemail and your call will be returned the next business day. Please note that all conversations will be recorded. If you need technical assistance contact the Help Desk at 703-983-8336 (TEEN).

2.8 Proposal Guidelines A. Offeror costs proposals must be submitted via the TPP Cost Proposal Template that

accompanies this RFP. The file name of the cost proposal template is “RFP Download 2 of 2.xlsx” and is available for download from the https://teenhealthpa rtners.org/ website.

B. The period of performance varies and is based on the approach proposed by each Contractor.

2.9 Technical Proposal InstructionsThe offeror shall provide a Technical Proposal that presents a plan for efficiently and effectively accomplishing all work described in the SOW and shall address each of the questions contained in the Technical Proposal Template in Appendix D.

All submissions must be in 12-point font and either Times New Roman or Arial font. Please note each question contained in this template specifies a maximum character

count. Exceeding the specified character count in any area will result in the proposal being classified as non-compliant and eliminated from the evaluation process.

2.10 Cost Proposal InstructionsThe offeror shall provide a Cost Proposal which presents a financial plan for efficiently and effectively accomplishing all work described in the SOW and shall address each of the questions contained in the Cost Proposal Template available in Appendix E; Separate File: “RFP Download 2 of 2.xlsx”

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All submissions must be in 12-point font and either Times New Roman or Arial font.

Regardless of the duration of the period of performance, all costs should be entered in The Year (TY) costs. This is the cost incurred at the time of the service being provided.

2.11 Reference InstructionsMITRE requests three (3) references of similar scope and size. Each reference shall be within the last three (3) years. Offerors shall ensure the accuracy of the reference information provided and must verify the client’s willingness to discuss its performance with MITRE. Failure to provide accurate or complete reference information may render the proposal incomplete and non-responsive.

Experience Summary Format:Client Corporate NameAddress, Telephone Number, and Points of ContactContract Award DateDuration of the Contract PeriodGeographical Location(s)Description of Services Provided Problems Encountered/Resolutions

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Section 3 - Evaluation Criteria

3.1 Relative Importance of Evaluation Factors

MITRE will consider the following tradeoffs (relative importance) in determining which offerors represent the best value.

Within the non-cost factors (Technical, Management, and Past Performance), the Technical Factor is slightly more important than the Management Factor. Technical and Management Factors are significantly more important than Past Performance.

Non-cost factors (Technical, Management, and Past Performance) when combined are significantly more important than Cost. However, the more closely two or more proposals are rated for the non-cost factors, the more important cost becomes in best value determination and proposal selection for award.

MITRE will make contract awards that will provide optimal opportunity to answer the evaluation research questions. The awarded programs may represent a variety of demographics, program location, adaptations, and geographic locations. In some cases, this could result in the award of a lower-rated proposal that offers such coverage instead of a more highly rated one that does not support achievement of the desired diversity.

The exact number of subcontracts to be awarded is dependent on the number of proposals meeting criteria. MITRE anticipates awarding up to 20 contracts.

3.2 EVALUATION FACTOR 0: Compliance (PASS/FAIL)

Factor 0 will determine whether a proposal meets the requirements for RFP submission and program replication requirements. If met, the offeror’s proposal will advance in the process to Evaluation Factor 1. If not met, the offeror’s proposal will be excluded from the remainder of the evaluation process and will not be eligible for award.

Evaluation Factor 0 will focus on the offeror’s adherence to the following sub-factors:Subfactor 1.0 – RFP submission requirementsSubfactor 2.0 – Replication of previously proven effective program

At least one but no more than two citations to publicly available publication(s) that demonstrate that the program has been proven effective through a rigorous evaluation

Subfactor 3.0 – Different population or location than prior rigorous evaluation provided in the cited publication

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3.3 EVALUATION FACTOR 1: Technical Factor

The offeror will be evaluated on the extent the offeror’s proposal demonstrates an effective approach to aligning appropriate methodology and techniques to provide support across the spectrum of SOW requirements.

Within the Technical Factor, individual subfactors are equal in importance.

Subfactor 1.1: Effective Approach - The offeror will be evaluated on the extent to which the offeror’s proposal demonstrates an understanding and provides an effective approach to the following areas identified in SOW Program Requirements. The areas are listed below:

Populations of Interest

Age Appropriate, Medically Accurate

Program Length, Age Range, and Number of Youth Participants

Subfactor 1.2: Adaptations -The offeror will be evaluated on the rationale for and extent of proposed program adaptations. These include:

Planned Adaptations - To the extent to which the offeror provides sound rationale for planned adaptations to the program are appropriate for the population (SOW Section 1.15)

Adaptation Guidance - To the extent to which the planned adaptations align with the “green light” or “yellow light” adaptation criteria in “General Adaptation Guidance: A Guide to Adapting Evidence-Based Sexual Health Curricula.” (SOW Section 1.15)

Subfactor 1.3: Data Collection - The offeror will be evaluated on the extent to which the offeror’s proposal demonstrates an understanding and a viable approach to the data collection requirements in the SOW.

The offeror will be evaluated on the extent to which the offeror’s proposal demonstrates an effective approach and clear understanding of the data collection elements. (SOW Sections 1.11, 1.12)

Health Educator session logs

Audio recordings of program sessions

Participation in key stakeholder interviews

Data collection from participants

Obtain consent/assent forms

3.3 EVALUATION FACTOR 2: Management

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Within the Management Factor, individual subfactors are equal in importance.

Subfactor 2.1: Implementation Approach - The Offer will be evaluated on the extent to which the offeror’s Implementation Approach addresses an effective management approach, schedule, and staff retention. (SOW Section 1.14)

a. The offeror will be evaluated on the extent to which the offeror’s proposal demonstrates a credible approach to managing the proposed program, staff, and resources, ensuring materials are culturally and linguistically appropriate, and resources to provide trauma-informed programs and possess the expertise to implement the proposed program in an age-appropriate manner. (SOW Sections 1.14, 1.15)

b. The offeror will be evaluated on the extent to which the offeror’s staffing approach demonstrates a sufficient level of effort of key and other staff to accomplish the objectives of the project and addresses recruiting, ensuring positions are quickly filled, ability to identify and acquire well-trained staff, and result in minimal staff turnover. (SOW Sections 1.14, 1.22)

c. The offeror will be evaluated on the extent to which the offeror’s proposed program demonstrates an approach and understanding of the timeline constraints and delivery of the program. (SOW Sections 1.7, 1.15)

d. The offeror will be evaluated on the extent to which the offeror describes meeting the training needs of staff and/or health educators to ensure the offeror’s proposed program will be implemented in accordance with the SOW. (SOW Section 1.16)

Subfactor 2.2: Key Personnel and Staffing - The offeror will be evaluated on the extent that the offeror’s proposed key personnel and additional staff resumes reflect the minimum qualifications and meet any additional target population needs.

a. Key Personnel: The offeror will be evaluated on the extent that the Offeror's proposed key personnel resumes (Project Director, Program Manager and/or Project Lead, Data Collection Coordinator, Financial Analyst, Health Educator) meet the SOW requirements (SOW Section 1.22).

b. Other Staffing: The offeror will be evaluated on the extent to which the offeror’s staffing approach demonstrates a realistic and clear understanding of the staffing roles required to meet target population needs. (SOW Sections 1.13, 1.14, 1.15, 1.16, 1.22)

3.4 EVALUATION FACTOR 3: Past Performance (Confidence Rating)

The offeror’s proposal will be evaluated on the extent to which their past performance demonstrates a sustained history of successful performance in contracts of similar size, scope,

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and/or complexity within the past 5 years. (Appendix F: Past Performance Questionnaire Template)

Within the Past Performance Factor, individual subfactors are of equal importance.

Subfactor 3.1: Business Practices - The offeror will be evaluated on the extent to which its past performance demonstrates ability to manage programs of a similar size, scope, and complexity.

Subfactor 3.2: Experience of Partners and Subcontractors - The offeror will be evaluated on the ability of partners and subcontractors to effectively fulfill their roles and responsibilities as identified in the proposal.

Subfactor 3.3: Technical - The offeror will be evaluated on its past performance and experience with programs of similar size, scope and complexity, particularly experience with rigorously evaluated, evidence-based programs.

Subfactor 3.4: Recruitment and Retention - The offeror will be evaluated on the extent to which its past performance provides evidence of successful recruitment, attendance and retention of adolescent participants in proposed program(s) of similar, size, scope, and/or complexity.

3.5 EVALUATION FACTOR 4: Cost

Cost, while being an important factor, is not in and of itself the determining factor in the selection of the successful offeror for award of the contract contemplated by this solicitation. Cost is not scored/weighted; rather, each offeror’s cost will be evaluated for realism, reasonableness, and completeness of the proposed contract cost. The cost proposal will be evaluated to determine the cost effectiveness of the offeror’s technical approach.

Cost proposals will be assessed to determine the offeror’s understanding of the solicitation requirements, and to assess the validity of the offeror’s approach to performing the work (i.e., the degree of MITRE's confidence in the offeror’s ability to perform at or within the proposed cost). MITRE will develop an independent cost estimate (ICE) as a basis for assessing the realism, reasonableness, and completeness of the proposed cost. For accurate comparisons, cost proposals will be adjusted to account for geographic locations by using a government standard locality factor.

Subfactor 4.1: Realism

MITRE will evaluate the realism of proposed cost by assessing the compatibility of proposed cost with proposal scope and effort. For the cost to be realistic, it must reflect what it would cost the offeror to perform the effort, if performed with reasonable economy and efficiency. The cost realism evaluation relies on the developed ICE and the associated reasonable economy and efficiency it proports. Cost realism evaluation includes a review of the overall costs in the offeror’s proposal to determine:

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If costs are realistic for the work proposed (e.g., are labor rates appropriate for the geographic area that will be served by this contract);

If costs reflect a clear understanding of the scope and requirements; and If costs are consistent with the various elements of the offeror's technical

proposal, (e.g., if the offeror's technical proposal identifies 1 staff-years of effort, then the pricing should also reflect 1 staff-years of cost).

Subfactor 4.2: Reasonableness

MITRE will evaluate the reasonableness of proposed cost by assessing the acceptability of the offeror's methodology used in developing the cost estimates. For the cost to be reasonable, in its nature and amount, it should not exceed that which would be incurred by a prudent person in the conduct of a competitive business. This represents a compromise between the seller's and the buyer’s opinion of what constitutes a fair price. Reasonableness takes into account the context of a given source selection, including current market conditions and other factors that affect the ability of an offeror to perform the contract requirements. What is reasonable depends upon a variety of considerations and circumstances, including:

Sufficiency of costs necessary to cover scope of work (e.g., are the labor hours proposed reasonably sufficient to successfully complete the work?);

Whether it is the type of cost generally recognized as ordinary and necessary for the conduct of the offeror's business or of the contract performance;

Generally accepted sound business practices, Federal and State laws and regulations, etc.; and

Any significant deviations from the offeror's established practices.

Additionally, cost metrics may be used to further determine price reasonableness. These metrics will be calculated for each proposal and compared to industry averages and against the population of other proposals. Such metrics could potentially include:

Sustainability/Best Value – A metric developed to evaluate reasonableness of the program by assessing the programs fixed costs compared to variable costs of enrolling additional participants.

Subfactor 4.3: Completeness

Cost proposals shall be evaluated for completeness by determining whether all proposed costs are clearly traceable to contract requirements. In addition, the cost proposal will be evaluated for completeness based on offerors thorough documentation of the derivation of costs and mathematical recalculation of all proposed costs. For the cost data to be complete, the offeror, or their subcontractors or vendors, must provide all the data necessary to support the offer. The amount of data needed may vary depending on the specifics of the offer.

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Appendix A: Acronym List

Term Definition

CBO Community-based Organization

CDC Centers for Disease Control and Prevention

CFI Contractor-Furnished Items

CMS Centers for Medicare & Medicaid Services

CO Contracting Officer

FBO Faith-based organizations

FFRDC Federally Funded Research and Development Center

FFP Firm Fixed Price

HHS

ICE

Department of Health and Human Services

Independent Cost Estimate

IO

IRB

Implementing Organization

Institutional Review Board

MFE MITRE-Furnished Equipment

MOU Memorandum of Understanding

MSR Monthly Status Report

OASH Office of the Assistant Secretary for Health

OMB Office of Management and Budget

PL Project Lead

PoP Period of Performance

PRA Paperwork Reduction Act

RFP Request for Proposal

SME Subject Matter Expert

SOW Statement of Work

STI Sexually Transmitted Infection

TA Technical Assistance

TPP Teen Pregnancy Prevention

WBS Work Breakdown Structure

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Appendix B: Glossary

Term Definition SourceAdaptation The process of making changes to an evidence-

based program to make it more suitable to a specific population, organization setting, or program structure.

Office of Adolescent Health, Department of Health and Human Services, “Adaptations for Evidence-based Teen Pregnancy Prevention Programs.” Url: https://www.hhs.gov/ash/oah/sites/default/files/adaptations_for_tpp_programs.pdf

Age appropriate Appropriate for the general developmental, social, cognitive, physical, and behavioral maturity of the targeted age group, as described by HHS Office of Adolescent Health in the “Guide for Age Appropriateness” document.

Office of Adolescent Health, Department of Health and Human Services, “A Practical Guide for Assessing Age AppropriatenessAmong Teen Pregnancy Prevention Programs" Url: https://www.hhs.gov/ash/oah/sites/default/files/guide-for-age-appropriateness.pdf

Allowable costs Allowable costs are reimbursable expenses that are determined to be imperative to the performance of contracted work. HHS and MITRE will have the ultimate authority in determining whether an expense will be considered allowable.

Clause 52.216-7 via the U.S. Federal Acquisition Regulations

Comparison or control group

A group of subjects (community sites/schools/groups or classrooms/youth) not exposed to the experimental intervention of interest. Ideally, the comparison or control group is as similar as possible to the participants in the intervention group.

National Institutes for Health, National Cancer Institute, “Dictionary of Cancer Terms: control group,” url: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/control-group

Cost sharing Any project costs voluntarily shared with another entity (e.g., community food partner, existing grant, etc.), and not paid by the MITRE funds (unless otherwise authorized by Federal statute). Note that cost sharing is neither an eligibility requirement nor an evaluation criterion for this contract.

Department of Health and Human Services, “Budget and Budget Narrative Guidance for Non-Competing Continuation Applications." Url: https://www.hhs.gov/opa/title-x-family-planning/training-and-resources/documents-and-tools/budget-guidance/index.html

Culturally and Linguistically Appropriate

Principal Definition from Health and Human Services standards for Culturally and Linguistically Appropriate services in health and health care: “Effective, equitable, understandable, and respectful quality care and

Office of Minority Health, Department of Health and Human Services. “National Standards for Culturally and Linguistically Appropriate

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Term Definition Sourceservices that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.”

Services (CLAS) in Health and Health Care.” Url: https://www.thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf

Evaluation A systematic study designed to assess how well an entire program, intervention, or some specific aspect of a program works. Evaluations can focus either on participant/community outcomes (impact or outcome evaluation) or processes inherent to implementing the program of interest (implementation evaluations). Implementation evaluations can occur concurrently with impact evaluations (termed “hybrid evaluations”) but involve separate activities with different goals. Impact evaluations examine clinical or behavioral factors in participants or a community of interest—such as behavior/knowledge/attitude change, health status, or mortality. Impact evaluations are designed to quantify and describe the degree to which interventions achieved their participant-oriented goals, and the paths to those outcomes. Implementation evaluations examine process-oriented factors—such as fidelity, adoption, feasibility, adaptations, training for health educators, etc.—and are focused on modeling these factors in implementing organizations/systems as outcomes.

Office of Adolescent Health, Department of Health and Human Services, “Evaluation and Quality Improvement in Teen Parenting Prevention and Pregnancy Assistance Funds." Url: https://www.hhs.gov/ash/oah/resources-and-training/tpp-and-paf-resources/evaluation-and-quality-improvement/index.html

Stetler, C. B., Legro, M. W., Wallace, C. M., Bowman, C., Guihan, M., Hagedorn, H., ... & Smith, J. L. (2006). The role of formative evaluation in implementation research and the QUERI experience. Journal of general internal medicine, 21(2), S1.

Fidelity Fidelity is defined as maintaining the core components of a program when an original or innovative program model is replicated. Core components are characteristics or key ingredients determined by the program developer to be related to achieving the program’s stated outcomes. Fidelity is measured across the following domains: content, mode/quality of delivery, participant responsiveness, and dosage.

Office of Adolescent Health, Department of Health and Human Services, “Fidelity Monitoring Guidance for TPP Grantees." https://www.hhs.gov/ash/oah/sites/default/files/fidelity_monitoring_guidance_0.pdf

Firm fixed price contract

Firm-fixed-price (FFP) contracts provide for a firm price that is not subject to adjustment based on the contractor’s costs in performing this contract; in this case, in implementing Teen Pregnancy Prevention programs. Firm fixed price contracts are negotiated where reasonably definite specifications are available,

https://www.acquisition.gov/content/part-16-types-contracts

Federal Acquisitions Regulations, Clause 16.202

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Term Definition Sourceand costs can be estimated with reasonable accuracy.

Fiscal Year The federal fiscal year is the accounting period for the federal government which begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2019 began on October 1, 2018 and ends on September 30, 2019. Congress passes appropriations legislation to fund the government for every fiscal year.

United States Senate Glossary and References. https://www.senate.gov/reference/glossary_term/fiscal_year.htm

Focus group A group of persons (often program participants or program staff) selected for a group discussion around an evaluation question; usually focus groups are facilitated by one or more persons who guide the discussion and record the proceedings.

Health Information Technology, Agency for Health Research and Quality, Department of Health and Human Services. “Focus Group.” Url: https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/focus-group

Grey literature Information produced on all levels of government, academics, business and industry in electronic and print formats not controlled by commercial publishing i.e. where publishing is not the primary activity of the producing body. For the purpose of this RFP, grey literature publications include reports, non-commercially published papers, government reports, committee reports, working papers, and grantee publications.

National Information Center of Health Services Research and Health Care Technology (NICHSR), National Institutes of Health, “Health Economics Information Resources: A Self Study Course, Module 1, Part 2: Key Information Sources.” Url: https://www.nlm.nih.gov/nichsr/edu/healthecon/01_he_12.html

Health educator A health education specialist in adolescent sexual health teaches behaviors that promote wellness. They develop and implement strategies to improve the health of adolescents and communities based on knowledge and understanding of evidence-based models and cognitive, emotional, social, psychological, and physical aspects of adolescent development.

Society for Public Health Education, (2019). “Health Education Specialist.” Url: https://www.sophe.org/careers/health-education-profession/

Implementation The ways in which a program is put into practice, and includes who, what, where, and how a program is set up and run.

MITRE Provided

Implementing Organizations

Organizations focused on health, education, and social services that have experience working with school districts or community-based organizations to implement pregnancy prevention programming.

MITRE Provided

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Term Definition SourceIndependent evaluator

An entity responsible for conducting evaluations of the programs of interest, with a clear separation from the programs and project offices. This clear separation will be evidenced by the independent evaluator not being part of the implementation team, an author of the curriculum chosen, having no pre-existing financial interest to the applying implementation teams or the intervention, and having no conflicts of interest (including, but not limited to being a relative of a director at an implementing organization, or having a financial stake in the intervention or its publisher/vendor).

U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health Office of Adolescent Health, “Rigorous Evaluation of New or Innovative Approaches to Prevent Teen Pregnancy Announcement (AH-TP2-15-002).” (April 2015) Url: https://www.hhs.gov/ash/oah/grant-programs/funding-opportunities/faqs-for-current-foas/index.html

Key Personnel Includes those individuals who will oversee the technical, professional, managerial, and support functions and/or assume responsibility for assuring the validity and quality of the project. This includes at a minimum the Project Director, Program Manager/Project Lead, Data Collection Coordinator(s), a Health Educator, and the Financial Analyst.

Scope of Work, Section 1.

Medical Accuracy

Information that is supported and has been empirically tested by research conducted in compliance with accepted scientific methods. Medically accurate information must also be published in journals (peer-reviewed) wherever applicable and must be recognized by professional organizations and agencies with relevant expertise as being accurate, objective, and complete.

Office of Adolescent Health Teen Pregnancy Prevention Program, Department of Health and Human Services. (Sept 2015) Url: https://www.hhs.gov/ash/oah/sites/default/files/mar_slides.pdf

J.A.G Jensen, E.L. Moreno, T.M. Rice, “Office of Adolescent Health Medical Accuracy Review Processes—Helping ensure the medical accuracy of teen pregnancy prevention program materials,” Journal of Adolescent Health, vol. 54, no. 3, p. S21-S23, Mar 2014.

Peer review Expert review of a draft product for quality by specialists in the field who were not involved in producing the draft, adhering to HHS and NIH policies and practices as described in previous documentation

Department of Health and Human Services Division of Grants. (2018). Grants Policies & Regulations. URL: https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html

Positive impact Positive impact is the improvement in A. Feldman Farb, A. L.

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Term Definition Sourcetreatment group due to the program alone on teen pregnancy reduction, behavioral risk factors underlying teen pregnancy, or other associated risk factors.

Margolis, “The Teen Pregnancy Prevention Program (2010-2015): Synthesis of Impact Findings,” American Journal of Public Health, vol. 106, Supplement 1, p. S9-S15, Sept 2016. Office of Adolescent Health, Department of Health and Human Services

Pregnancy prevention program

Pregnancy prevention program refers to programs designed to serve youth no younger than 10 and no older than 16 years of age in this RFP

Evidence-based teen pregnancy prevention (TPP) programs are programs that have been shown, in at least one program evaluation, to have a positive effect on preventing teen pregnancies, sexually transmitted infections, or sexual risk behaviors.

Office of Adolescent Health, Department of Health and Human Services. (2019). Teen Pregnancy Prevention Program. URL: https://www.hhs.gov/ash/oah/grant-programs/teen-pregnancy-prevention-program-tpp/index.html

Program An organized set of activities directed toward a common purpose or goal. For the purposes of this RFP, the program includes the curricula that youth receive; parental involvement and parental messaging through social media; staff training, recruitment, and retention; youth recruitment and enrollment processes. The curriculum as implemented by the implementing organization (IO), including contextual activities such as staff training, and any other activities provided by the IO.

Program Performance and Evaluation Office (PPEO), Centers for Disease Control and Prevention, U. S. Department of Health and Human Services, (2019) “Program Evaluation.” https://www.cdc.gov/eval/index.htm

Program Component

Part of a program, including the activities, people, materials, structures, and other influencing variables that shape program implementation and impact. Program components may be core components, but not all program components are core components.

A. M. Margolis, A. Y. Roper, “Practical Experience from the Office of Adolescent Health’s Large-Scale Implementation of an Evidence-Based Teen Pregnancy Prevention Program,” Journal of Adolescent Health, vol. 54, no. 1, p. S10-S14, Feb 2014.https://www.hhs.gov/ash/oah/sites/default/files/fidelity_monitoring_guidance_0.pdf

Published literature

For the purpose of this RFP, published literature includes journal articles, peer-reviewed journals, scholarly/empirical articles, review articles (Meta-analysis and systematic

MITRE Provided

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Term Definition Sourcereview), textbooks, encyclopedia articles, and guidebooks or handbooks, and conference papers.

Quasi-Experimental Design

Study structures that use comparison groups to draw causal inferences about the effect of an intervention or exposure on a given outcome, but do not use randomization to create the treatment and control groups. The control group is selected to match the treatment group as closely as possible so that inferences on the incremental impacts of the program can be made.

Program Performance and Evaluation Office (PPEO), Centers for Disease Control and Prevention, U. S. Department of Health and Human Services, (2012)” Glossary: Introduction to Program Evaluation for Public Health Programs: A Self-Study Guide” https://www.cdc.gov/eval/guide/glossary/index.htm

Randomized Controlled Trial

Study structures that use comparison groups to draw causal inferences about the effect of an intervention or exposure on a given outcome and use randomization to create both the treatment and control groups. Randomization ensures that the only expected difference between the intervention and control groups is the intervention or treatment variable itself.

Program Performance and Evaluation Office (PPEO), Centers for Disease Control and Prevention, U. S. Department of Health and Human Services, (2012)” Glossary: Introduction to Program Evaluation for Public Health Programs: A Self-Study Guide” https://www.cdc.gov/eval/guide/glossary/index.htm

Replication The deliberate or conscious repetition of research efforts, intended to confirm or extend previously or simultaneously obtained, but still uncertain, findings.

Institute of Medicine (US) Committee on Co-Administration of Service and Research Programs of the National Institutes of Health, the Alcohol, Drug Abuse, and Mental Health Administration and Related Agencies. Research and Service Programs in the PHS: Challenges in Organization. Washington (DC): National Academies Press (US); 1991. 5, Duplication, Replication, and Complementarity. Available from: https://www.ncbi.nlm.nih.gov/books/NBK234549/

Rigorous evaluation

Chosen programs must be proven effective through rigorous evaluation. Rigorous evaluation includes each of the following five criteria:(a) A statistically significant positive

behavioral impact

Scope of Work, Section 1

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Term Definition Source(b) A control or comparison group(c) Peer-reviewed research that may be present

in either published or grey literature(d) Research must be conducted by anindependent evaluator(e) Research report must be no older than ten years (including published or grey literature)

Statistical significance

In statistical hypothesis testing a statistically significant result is a finding that is larger or smaller than would be expected by chance alone. In hypothesis testing, this is expressed as a probability value or p-value. In the context of this RFP, statistical significance will be assessed with two-tailed hypothesis tests and a specified alpha level of p < .05.

Center for Disease Control and Prevention. (2012). Understanding Scientific Research. URL: https://www.cdc.gov/des/consumers/research/understanding_scientific.html

Trauma-Informed Approach

Refers to how a project, agency, organization, or community thinks about and responds to those who have experienced or may be at risk for experiencing trauma. An approach that: 1) Realizes the widespread impact of trauma and understands potential paths for recovery; 2) Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; 3) Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and 4) Seeks to actively resist re-traumatization. https://www.hhs.gov/ash/oah/sites/default/files/traumainformed-checklist.pdf

Child Trends, Healthy Teen Network, Office of Adolescent Health, US Department of Health and Human Services. (2015). A Checklist for Integrating a Trauma-Informed Approach into Teen Pregnancy Prevention Programs. URL: https://www.hhs.gov/ash/oah/sites/default/files/traumainformed-checklist.pdf

Youth For the purpose of the current project, youth are 12 to 16 years of age at time of program enrollment. These youth may also be identified as adolescents, teens, young people, participants, or youth participants.

Scope of Work, Section 1

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Appendix C: Proposal Upload Instructions

PROPOSAL SUBMISSION INSTRUCTIONS

Proposals will be accepted starting August 5, 2019 at 12:00 pm Eastern Standard Time (EST). All proposals must be received no later than August 19, 2019, 12:00 pm EST, using the “Submit Proposal” form that will be released on the Teen Health Partners website. Detailed instructions will be posted on the website.

Proposals submitted must insert the following information in the header of each document submitted, using single space and 12-point font. Please include the following headings for easy identification.

- Project Director First and Last Name - Name of Program to be Replicated - Organization Abbreviation (Limited to 8 characters)

Offerors are encouraged to submit a proposal early. No proposals will be accepted after 12:00 pm ET, August 19, 2019. For your proposal to be considered, your proposal must be timestamped no later than 12:00 pm ET, August 19, 2019. The timestamp will be applied after you submit the “Submit Proposal” form. The timestamp will appear in a confirmation email.

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Appendix D: Technical Proposal Template

Instructions: Please address each question provided in the Technical Proposal Template. There is a 700 maximum character count for each question. Exceeding the specified character count in any area will result in the proposal being classified as non-compliant and eliminated from the evaluation process. Use 12-point font either Times Roman or Arial font to complete the template.

The Technical Proposal Template with addendum changes must be downloaded and used to apply for this funding opportunity, it is available for download at https://www.teenhealthpartners.org

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Appendix E: Cost Proposal Template

The Cost Proposal Template is available for download at teenhealthpartners.org website under the file “ RFP Download 2 of 2.xlsx”

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Appendix F: Past Performance Questionnaire

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: The offeror shall utilize the Past Performance Template to submit at least 3 references consisting of present or past clients, within the last five years, who are capable of verifying the offeror’s ability to perform work identified in the Statement of Work of similar size, complexity, and scope.

The offeror shall provide client references capable of documenting the offeror’s performance on similar contracts of size scope and complexity. Past performance references shall be provided by utilizing the Past Performance Questionnaire provided by MITRE.

The offeror shall complete the first section of the Past Performance Questionnaire for each reference. Clients must be present or past clients within the last five years. Please ensure that all clients references are made aware that the MITRE Corporation will be contacting all references.

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PAST PERFORMANCE QUESTIONNAIRE

PLEASE RESPOND WITHIN 5 BUSINESS DAYS OF RECEIPT OF THIS REQUEST

Organizations Name: _______________________________Location: _____________________________________________________Program Name: ___________________________Contract Number: ____________ Period of Contract: _______ Brief Description of effort: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Respondent's Name: _________________________Position: _______________________________________________________Phone: ____________________ (FAX) _______________________Business Address: _______________________________________City: _______________________ State: __________ Zip Code: _______Coded Responses and Explanations for Questions:

Code Rating Description

SU Substantial ConfidenceBased on the offeror’s recent/relevant performance record, there is a high expectation that the offeror will successfully perform the required effort.

SA Satisfactory Confidence

Based on the offeror’s recent/relevant performance record, there is a reasonable expectation that the offeror will successfully perform the required effort.

L Limited Confidence

Based on the offeror’s recent/relevant performance record, there is a low expectation that the offeror will successfully perform the required effort.

N No ConfidenceBased on the offeror’s recent/relevant performance record, there is an expectation that the offeror will not be able to successfully perform the required effort.

U Unknown Confidence (Neutral)

No recent/relevant performance record is available, or the offeror’s performance record is so sparse that no meaningful confidence assessment rating can be reasonably assigned.

Please rate the Contractor in the following areas using the above coded responses:

1. Organizations cost control. Did the organization deliver at the agreed-to price/cost? Describe the reasons for changes to contract/award value (e.g., scope changes, overrun/underrun, Government-imposed schedule changes, etc.)

Circle one:

SU SA L N U

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Response:

2. Did the organization deliver according to the agreed-to schedule? What were the causes of any schedule variances?

Circle one:

SU SA L N U

Response:

3. Identify the organizations overall strengths and weaknesses.

Response:

4. Given what you know today about the contractor's ability to execute, would you award to this organization if given the choice? (Circle only one)

Circle one:

Definitely would award

Probably would award

Probably would not award

Definitely would not award

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5. Any additional comments that you feel are important in the evaluation of the organization’s performance.

Response:

6. Please identify any other programs you consider relevant, which might provide us additional insight into this contractor's performance.

Response:

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Appendix G: Applicable Prime Contract Clause

APPLICABLE PRIME CONTRACT CLAUSES

HHSM-500-2012-00008IDepartment of Health and Human Services Flow Down Clauses

(This document may be amended from time to time)

The U.S. Government Contracting Officer under the Prime Contract enforces MITRE to maintain the flow down clauses as provided under the Prime Contract with only changes to the type of contract allowable; therefore, the clauses that are not applicable to this Agreement shall not be enforced.

The following Prime Contract clauses are incorporated by reference, with the same force and effect as if they were given in full text. In each clause, reference to the “Government” or “HHSM” shall mean MITRE, reference to the “Contractor” or “FFRDC” shall mean Contractor, and reference to “contract” or “Contract” shall mean this Agreement.

52.252-2 Clauses Incorporated by Reference. (FEB 1998)SPECIAL CONTRACT REQUIREMENTS

H.2 PRIVACY ACT HHSAR 352.224-70 (DEC 2015)

This contract requires the Contractor to perform one or more of the following: (a) design; (b) develop; or (c) operate a Federal agency system of records to accomplish an agency function in accordance with the Privacy Act of 1974 (Act) (5 U.S.C. 552a(m)(1)) and applicable agency regulations.

The term system of records means a group of any records under the control of any agency from which information is retrieved by the name of the individual or by some identifying number, symbol, or other identifying particular assigned to the individual. Violations of the Act by the Contractor and/or its employees may result in the imposition of criminal penalties (5 U.S.C. 552a(i)).

The Contractor shall ensure that each of its employees knows the prescribed rules of conduct in 45 CFR part 5b and that each employee is aware that he/she is subject to criminal penalties for violation of the Act to the same extent as Department of Health and Human Services employees. These provisions also apply to all subcontracts the Contractor awards under this contract which require the design, development or operation of the designated system(s) of records (5 U.S.C. 552a(m)(1)). The contract work statement:

(a) Identifies the system(s) of records and the design, development, or operation work the Contractor is to perform; and

(b) Specifies the disposition to be made of such records upon completion of contract performance

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H.4 BUSINESS ETHICS, CONFLICT OF INTEREST AND COMPLIANCE

General: It is imperative that the Contractor and the services provided under this contract be free, to the greatest extent possible, of all Organizational and Personal Conflicts of Interest. In this clause, all references to Organizational and/or Personal Conflicts of Interests will be referred to individually or collectively, as the text justifies, as Conflicts of Interest (COI). Except as provided below, the Contracting Officer shall not maintain a contract with a Contractor that the Contracting Officer determines has, or has the potential for, an unresolved COI. However, in accordance with FAR 9.503 Waiver, the Contracting Officer may contract with a Contractor that has an unresolved COI if the Contracting Officer determines that it is in the best interest of the Government to do so.

b. Definitions:

Actual COI– means that the COI is currently in existence as determined by the Offeror’s or Contractor’s Compliance Officer and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Affiliates – As defined in FAR 2.101 means associated business concerns or individual(s) if, directly or indirectly either one controls or can control the other; or a third-party control or can control both.

For purposes of this contract, affiliate control or influence may include, but is not limited to:(a) Interlocking management or ownership (e.g., individuals serving in similar capacities in

several companies); (b) Identity of interests among family members such as spouse/domestic partner and/or any

dependent of the respondent;(c) Shared facilities and equipment;(d) Common use of employees; or (e) A business concern organized just prior to, or immediately following, the release of a

solicitation or request for information, which has the same or similar management, ownership, or principal employees as the offeror or Contractor.

Any business, whether or not it is organized for profit or located in the United States or its outlying areas, or person may be found to be an affiliate. Control may be affirmative or negative and it is immaterial whether it is exercised so long as the power to control exists.

Apparent (Perceived) COI – means that the COI on first observation appears to be an actual or potential COI but may or may not be after analysis. Even if the apparent COI is determined to be non-existent, this perception may still require further explanation.

Avoidance – means Government action taken in one acquisition that is intended to prevent a COI in that acquisition or in a future action. Methods of avoiding COIs include, but are not limited to:

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Drafting the statement of work (SOW) to exclude tasks that require Contractors to utilize subjective judgment; or

Obtaining advice from more than one source on any issue on which there are concerns about an COI so that there is no area in which the Government is relying solely on the advice of any one of the sources; or

Excluding an offeror from participation in a contract award.

Financial Interests/Relationships – means a healthcare related direct or indirect ownership orinvestment interest (including an option or non-vested interest) in any entity that exists through equity, debt, or other means and includes any indirect ownership or investment interest no matter how many levels removed from a direct interest.

A financial interest/relationship may arise from the following non-exclusive examples:

(a) Compensation, including wages, salaries, commissions, professional fees, or fees for business referrals;

(b) Current or known future arrangements or requirements for which you are defined as an interested party, including, but not limited to, an entity that may create one or more of the three forms of COI;

(c) Consulting relationships, including commercial and professional consulting and service arrangements, scientific and technical advisory board memberships, or serving as an expert witness in litigation;

(d) Services provided in exchange for honorariums including travel expense reimbursements;(e) Research funding or other forms of research support;(f) Healthcare related investment in the form of stock or bond ownership, including

healthcare sector investment only mutual funds;(g) Healthcare business ownership or partnership interests;(h) Patents, copyrights, and other intellectual property interests;(i) Seeking or negotiating for prospective employment or business; or(j) Gifts, including travel.

Mitigation– means action taken by the Contractor to reduce the COI risk to a level acceptable to CMS on a present contract.

Neutralization – means excluding or restricting a Contractor from offering, as a prime or subcontractor, on future contracts while allowing the Contractor to perform on the instant contract. This method protects the Government’s interests in cases where the Contractor’s work on the instant contract could be biased or impaired by virtue of its expectation of future work, or when the Contractor would have an unfair advantage in competing for award of the future work.

Organizational Conflict of Interest – In accordance with FAR 2.101 Definitions, means that because of other activities or relationships with other persons, a person is unable, or potentially unable, to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is, or might be, otherwise impaired, or a person has an unfair competitive advantage.

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For purposes of this contract, the conflict of interest definition includes direct or indirect relationships including, but not limited to, the Contractor and its parent company, subsidiaries, affiliates, subcontractors, clients and principals.

Personal Conflicts of Interest – A situation in which a person has a financial interest, personal activity, or relationship that could impair the person’s ability to act impartially and in the best interest of the Government when performing under this contract.

(a) Among the sources of personal conflicts of interest are—i. Financial interests of the person, spouse/domestic partner and/or any other

dependent of the person, as defined for Federal tax purposes;ii. Other employment or financial relationships (including seeking or negotiating for

prospective employment or business) and,iii. Gifts, including travel.

(b) For example, financial interests referred to in paragraph (a)(i) of this definition may arise from—

i. Compensation, including wages, salaries, commissions, professional fees, or fees for business referrals;

ii. Consulting relationships;iii. Services provided in exchange for honoraria or travel expense reimbursements;iv. Research funding or other forms of research support;v. Healthcare related investments;

vi. Real estate investments;vii. Patents, copyrights, and other intellectual property interests; or

viii. Business ownership and investment interests.

Potential COI – means that the COI could become an actual COI due to contingency events and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Principal – As defined in FAR 52.203-13, Contractor Code of Business Ethics and Conduct, means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager, plant manager, head of a division or business segment, and similar positions).

Three (3) Types of COIs include:

Conflict Types Definitions

Biased Ground RulesConsists of situations in which a firm, as part of its performance of a Government contract, has helped (or is in a position to help) set the ground rules for another Government contract by, for example, writing the statement of work or the specifications, or establishing source-selection criteria. In these “biased ground rules” cases, the primary concern is that the firm could skew the competition, whether intentionally or not, in favor of itself and/or its affiliates.

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Impaired ObjectivityConsists of situations where a firm has an interest (typically financial) that may conflict with the interest of the Government to whom the firm has a contractual obligation, and the firm’s work under the Government contract could give the firm the opportunity to benefit its other business interests. If the firm is providing recommendations, judgment or advice, and its other business interests could be affected by that recommendation, judgment or advice, the firm’s objectivity may be impaired. An example is where the firm was evaluating itself, an affiliate or a competitor, either through an assessment of performance under another contract or an evaluation of proposals

Unequal Access to Information“Unfair” access to non-public information – Consists of situations in which a firm has access to nonpublic information (including proprietary information and nonpublic source-selection information) as part of its performance of a Government contract and that information may provide the firm with a competitive advantage in a later competition for a Government contract. In these “unequal access to information” cases, the concern is limited to the risk of the firm gaining an unfair competitive advantage; there is no issue of bias. Note: Incumbency alone does not constitute “unequal access to information.”

Significant Potential Conflict of Interest: The Contracting Officer has determined that this contract may involve significant potential COIs.

1. Nature of Potential Conflict: Although not all inclusive, the Contracting Officer has determined that the following activities are considered to be actual, potential or apparent COIs with the work to be performed under this contract. The Federally Funded Research and Development Contractor (FFRDC) shall promptly notify the Contracting Officer of any relationships, whether direct or indirect, with any of the following entities:

For the purpose of identifying entities with actual, apparent or potential COIs, at a minimum, theentity is one that-

(a) Would review or does review, under the contract, Medicare and/or Medicaid services furnished by a provider or supplier that is a direct competitor of the FFRDC or subcontractor of the FFRDC; or

(b) Prepared work or is under contract to prepare work that would be reviewed by the FFRDC under the contract; or

(c) Is affiliated or has a financial relationship, as these terms are explained above, with an entity to be reviewed under the contract; or

(d) Competes against private industry for work.

2. Proposed Restraint on Future FFRDC Activities: CMS is proposing to restrain or is restraining, as the case may be, future FFRDC activities as follows:

The FFRDC:(a) Shall not compete against private industry for work;(b) May only perform work as defined in Section III. Scope of Work of the Sponsoring

Agreement;

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(c) May only respond to a Federal Government request for proposal or Broad Agency Announcement for other than a task order under the CAMH FFRDC contract with the express written permission of the Sponsor;

(d) May apply for grants only when:

No real or perceived conflict of interest exists between the execution of the grant and the current or planned work of the FFRDC.

The principal purpose of the grant is to stimulate or support research and development in support of the Sponsors’ missions;

(e) May not accept work developing specific components without written approval of the FFRDC Program Manager, who may approve the work when it is directly related to a specific critical government program; or(e) Shall not, unless authorized by legislation and the Contract, undertake quantity

production or manufacturing.

Contractor Business Ethics, Conflict of Interest and Compliance Program Requirements:

FAR 3.10 and FAR 52.203-13, Contractor Code of Business Ethics and Conduct, identify “…policies and procedures for establishment of Contractor codes of business ethics and conduct, and display of agency Office of Inspector General (OIG) hotline posters.” (See Section I, FAR 52.203-14 fill-in information for the website where you can find the HHS OIG fraud hotline poster).

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The following chart is provided to clarify requirements under this contract:


Biased Ground Rules

Consists of situations in which a firm, as part of its performance of a Government contract, has helped (or is in a position to help) set the ground rules for another Government contract by, for example, writing the statement of work or the specifications, or establishing source-selection criteria. In these “biased ground rules” cases, the primary concern is that the firm could skew the competition, whether intentionally or not, in favor of itself and/or its affiliates.

Impaired Objectivity

Consists of situations where a firm has an interest (typically financial) that may conflict with the interest of the Government to whom the firm has a contractual obligation, and the firm’s work under the Government contract could give the firm the opportunity to benefit its other business interests. If the firm is providing recommendations, judgment or advice, and its other business interests could be affected by that recommendation, judgment or advice, the firm’s objectivity may be impaired. An example is where the firm was evaluating itself, an affiliate or a competitor, either through an assessment of performance under another contract or an evaluation of proposals.

Unequal Access to Information

“Unfair” access to non-public information – Consists of situations in which a firm has access to nonpublic information (including proprietary information and non- public source-selection information) as part of its performance of a Government contract and that information may provide the firm with a competitive advantage in a later competition for a Government contract. In these “unequal access to information” cases, the concern is limited to the risk of the firm gaining an unfair competitive advantage; there is no issue of bias. Note: Incumbency alone does not constitute “unequal access to information.”

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1. COI Oversight Program: The Contractor shall maintain an effective COI Oversight Program. As part of the program, the contractor shall implement company business practices, procedures, polices and internal controls for compliance with COI requirements, such as:

(a) Preventing conflicts of interest, prohibiting the use of non-public information accessed through this contract for personal gain, and obtaining a signed non-disclosure agreement to prohibit disclosure of non-public information accessed through this contract

(b) Conducting Internal and External Audits;(c) Policy Enforcement and Employee Disciplinary Actions;(d) Retention of Records;(e) Management of Subcontractors;(f) Internal control systems;(g) Display of Fraud Hotline Poster(s) in accordance with FAR 52.203-14 Display of Hotline

Poster(s).(h) Reviewing the information required by Attachment J-3 Contractor Personal Conflict of

Interest Financial Disclosure Template, for each principal, officer and member of the governing body (e.g., Board of Directors, Trustees, etc.) of the organization, as well as managers and key personnel who would be, or are involved with, the performance of this contract. It is recommended that individuals who have not disclosed changes within the reporting period, submit an annual disclosure update to their Compliance Officer for review;

(i) Informing employees, through an employee education and training program, of their obligation to disclose and prevent conflicts of interest, not to use non-public information accessed through performance of this contract for personal gain, and to avoid even the appearance of personal conflicts of interest; and,

(j) Reporting to the Contracting Officer any conflict of interest violations.

The following details are provided for respective COI disclosure expectations:

2. Conflict of Interest:In accordance with FAR 3.10 and 52.203-13, Contractor Code of Business Ethics and Conduct, and this solicitation/contract, the Contractor shall have procedures in place to monitor and disclose all Organizational and Personal Conflicts of Interest throughout the life of the contract.

COI information shall be submitted as follows:(a) Initial Submission of COI Information: The Contractor shall submit Conflict of Interest information identified in –

• Attachment J-4 Contractor Business Ethics, Conflict of Interest and Compliance ProgramRequirements (follow the format identified in the Attachment J-4). Personal Conflict Information: It is the offeror/contractor’s responsibility to have a COI plan in place (see H.1.d.1. COI Oversight Program) to ensure that actual, potential, or apparent personal conflicts of interest are identified, analyzed and mitigated for performance of this contract.

COI information shall be obtained by the Offeror/Contractor for each:

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Manager or Key personnel who would be, or are involved with, the performance of this contract;

Governing Body Members (e.g., Board of Directors; Trustees, etc.); and, Principals of the organization as defined by FAR 52.203-13, Contractor Code of Business

Ethics and Conduct.

Attachment J-3 Contractor Personal Conflict of Interest Financial Disclosure Template is provided as a “sample” for the Offeror/Contractor to follow when identifying, analyzing and mitigating actual, potential, or apparent Personal COIs for this contract. Notwithstanding, Personal COI information obtained from the above individuals shall not be submitted to the Government. (c) Mitigation/Resolution: The Contracting Officer determines whether a COI has been identified and whether the actual, potential or apparent COI has been mitigated/resolved to the Government’s satisfaction. The Contractor's approved COI Mitigation/Resolution plan shall be incorporated into the contract. In cases whereby a COI cannot be, or has not been, mitigated to the Contracting Officer’s satisfaction, the Contracting Officer may take the following action including, but not limited to:

i. Request a waiver in accordance with FAR 9.503 Waiver, from the Head of theContracting Activity; or

ii. Make changes to the requirements of the contract; oriii. Terminate the contract.

i. Conflict of Interest Disclosure During Contract Performance: COI Disclosure Revisions shall be submitted to the Contracting Officer as follows:

(i) When Revisions are Required: At any time during the performance of this contract, if the Contractor learns of any

actual, potential, or apparent COI, whereby a reasonable business person might equate the COI to one (1) of the three (3) types of COIs identified in H.1.b Definitions, the Contractor shall notify the Contracting Officer in writing within five (5) business days of the identification of the actual, potential, or apparent COI. Within 30 calendar days, or as otherwise negotiated with the Contracting Officer, the Contractor shall submit a COI Disclosure Revision in accordance with H.1.d.2.(d) ii below. If, as a result of the Government or Contractor independent auditor review, any findings require a change in the previous disclosure, submit a COI Disclosure Revision, in accordance (d) ii below, to the Contracting Officer within 30 calendar days of the final audit report.

Within 30 calendar days when the Contracting Officer requests a revision. At least 45 calendar days prior to a change due to proposed or planned business actions,

e.g., acquiring or selling a business or business segment, changes in ownership of the organization holding the contract, etc.

ii. What is Required in a Revision: When COI disclosures require revision, the Contractor shall provide a revised

Attachment J-4, Contractor Business Ethics, Conflict of Interest and Compliance Program Requirements. Red-lined versions are preferred.

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e. Independent Audit: Unless otherwise instructed, when a mitigation plan is required to be submitted, the Contractor shall obtain the services of an External/Independent auditor to conduct an audit of the “Mitigation Strategy.” If the Government chooses to execute the audit in lieu of the contractor independent audit, the Contracting Officer will notify the Contractor within 60 days of the anniversary date of the contract. Such auditor shall have expertise in conducting compliance program and conflict of interest audits. The Contractor’s records may also be subject to audit by the Government to ensure compliance with this contract’s H.1 clause requirements and/or ensure that any corrective action, if necessary, has been implemented.

1. Subcontractors: A COI independent audit shall be required at the discretion of the PrimeContractor. If the Prime Contractor requires an audit of the subcontractor(s), the subcontractor’s audit shall be included with the Prime Contractor’s audit submission

2. First Audit: When a mitigation plan is required, an independent audit of the COI program is due 90 days after the first anniversary date of the contract or as otherwise negotiated with the Contracting Officer. The independent audit will be submitted by the auditor directly to the Contracting Officer with a copy to the Contractor.

3. Subsequent Audits: Additional audits are at the discretion of the Contracting Officer. TheContracting Officer will consider previous audit findings, any corrective action(s) and any new COI information, when making the decision to require subsequent audits.

4. Audit Findings: When Contractor Conflict of Interest Oversight findings are disclosed in anindependent audit, the Contractor shall include in the draft audit report its proposed corrective action plan for each finding. The Contracting Officer may require a revised COI mitigation plan to be submitted as a result of the audit findings.

5. Independent Audit Requirements:(a) The auditor shall decide what processes it will use to review, verify and confirm the

information, processes and policies disclosed by the Contractor to the Government. The audit shall include a process for the contractor to review audit findings and provide a response to the auditor, which shall be included in the final audit submitted to the CMS Contracting Officer.

(b) The audit shall confirm that any and all COI mitigation plans, approved by the Government, have been implemented and are functioning as anticipated. Although not all inclusive, the auditor may also want to consider the following:

(i) Review of all COI disclosures submitted to the Government to validate the accuracy and completeness of such disclosures;

(ii) Conducting appropriate interviews with principals, key personnel and independent members of the board of directors, as appropriate;

(iii) Reviewing the Contractor’s organizational chart(s), articles of incorporation, bylaws and/or other documents, to validate the accuracy and completeness of COI disclosures to the Government;

(iv) Confirming that the Contractor annually, at a minimum, collects and reviews for assessment and appropriate action by the Compliance Officer, personal conflict information from its principals, key personnel (on the relevant contract(s)) and board of director members;

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(v) Confirming whether the Contractor is in compliance with its internal Contractor Conflict of

(vi) Interest Oversight program(s); and, (vii) For its Subcontractors, confirming whether the prime Contractor is monitoring

Subcontractor compliance with the required contract flow-down provisions and disclosed practices, in accordance with contract H.1. The auditor may review other information as it deems appropriate to ensure that COI issues have been identified and resolved, in accordance with Contractor disclosures.

(viii) The auditor will also examine the Contractor’s records to verify that all of the requirements specified in FAR 52.203-13(c)(2)(ii), Contractor Code of Business Ethics and Conduct, are met.

6. Reporting Requirements: The audit report, inclusive of all auditor findings and proposed corrective actions, shall be delivered via e-mail or US Postal Service to the Contracting Officer directly from theauditor.

Subcontractor Flow-Down Clause: The prime Contractor is responsible for avoiding, neutralizing and mitigating all actual, potential, or apparent COIs of its Subcontractors, in accordance with this clause. Therefore, the prime Contractor shall flow-down clause H.1 Business Ethics, Conflict of Interest and Compliance, of this contract in all subcontracts. For Subcontractors, wherever the term “Contractor” is used, insert “Subcontractor.”

H.5 HIPAA BUSINESS ASSOCIATE PROVISION

All Protected Health Information (PHI), as defined in 45 C.F.R. §160.103, that is relevant to this Contract, shall be administered in accordance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA," 42 U.S.C. § 1320d), as amended, as well as the corresponding implementing regulations and this HIPAA Business Associate Clause.

a. Definitions:All terms used herein and not otherwise defined, shall have the same meaning as in HIPAA, as amended, and the corresponding implementing regulations. Non-HIPAA related provisions governing the Contractor's duties and obligations, such as those under the Privacy Act and any applicable data use agreements are generally covered elsewhere in the Contract.

The following definitions apply to this Contract Clause:"Business Associate'' shall mean the Contractor (and/or the Contractor’s subcontractors or agents) if/when it uses individually identifiable health information on behalf of CMS, i.e. PHI, to carry out CMS’ HIPAA-covered functions.

"Covered Entity" shall mean the portions of CMS that are subject to the HIPAA Privacy Rule."Secretary" shall mean the Secretary of the Department of Health & Human Services or the Secretary's designee.

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Obligations and Activities of Business Associate:Except as otherwise provided in this Contract, Business Associate, as defined above, shall only use or disclose PHI on behalf of, or to provide services to, Covered Entity in accordance with this Contract and the HIPAA Privacy and Security Rules.

Business Associate shall document in writing the policies and procedures that will be used to meet HIPAA requirements. The policies and procedures shall include the following, at a minimum:

1. Business Associate shall not:i. Use or disclose PHI that is created, received, maintained or transmitted by Business Associate from, or on behalf of, Covered Entity other than as permitted or required by this Contract or as required by law;

ii. Sell PHI; or,

iii. Threaten, intimidate, coerce, harass, discriminate against, or take any other retaliatory action against any individual for:

a. Filing a complaint under 45 CFR § 160.306;b. Testifying, assisting or participating in an investigation, compliance review,proceeding or hearing under 45 CFR Part 160; or

c. Opposing any act or practice that is unlawful under HIPAA, provided there is a good faith belief that the practice is unlawful, the manner of opposition is reasonable, and the opposition does not involve the disclosure of PHI in violation of subpart E of Part 164.

2. Business Associate shall:

i. Have a security official who will be responsible for development and implementation of its security policies and procedures, including workforce security measures, to ensure proper security awareness and training (including security incident response and reporting), and security incident procedures, in accordance with this Contract, including this HIPAA Business Associate Clause and the Contract’s clause entitled “CMS Information Security.”

ii. Use administrative, physical and technical safeguards to prevent use or disclosure of PHIcreated, received, maintained or transmitted by Business Associate from, or on behalf ofCovered Entity only as provided for by this Contract. In doing so, it shall implementpolicies and procedures to address the following and, where applicable, ensure that suchpolicies and procedures are also in conformance with this Contract’s clause entitled “CMS Information Security:”

A. Prevent, detect, contain and correct security violations through the use of:a) Risk analyses (including periodic technical and nontechnical evaluations);

b) Appropriate risk management strategies, including system activity review;

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c) Information access procedures for approving individual’s access rights toPHI (including the implementation of workforce security measures to ensurecontinued appropriate role-based access to PHI), and technical policies andprocedures to ensure compliance with grants of access (including unique useridentification and tracking of users) and;

d) The imposition of sanctions for violations.

B. Limit physical access to its electronic information systems and the facility orfacilities in which they are housed.

C. Implement policies, procedures and physical security measures that will limit accessto PHI through workstations and other devices, including access through mobile devices.

D. Implement media controls covering the movement of devices containing PHI withinor outside of the Business Associate’s facility as well as the disposal and reuse of mediacontaining PHI.

E. Implement appropriate administrative, physical and technical safeguards thatreasonably and appropriately protect the confidentiality, integrity and availability(including the use of contingency plans) of any electronic protected health information("EPHI") it creates, receives, maintains or transmits from, or on behalf of the CoveredEntity to prevent impermissible use, disclosure, maintenance or transmission of suchEPHI. In the establishment of such safeguards, Business Associate shall consider its size,complexity and capabilities, as well as its technical infrastructure, and its hardware andsoftware security capabilities.

iii. Assess, and implement, where appropriate, any addressable implementation specificationsassociated with applicable PHI security standards.

H.6 HHSAR 352.239-74 ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY (DEC 2015)

(a) Pursuant to Section 508 of the Rehabilitation Act of 1973 (29 U.S.C. 794d), as amended by the Workforce Investment Act of 1998, all electronic and information technology (EIT) supplies and services developed, acquired, or maintained under this contract or order must comply with the “Architectural and Transportation Barriers Compliance Board Electronic and Information Technology (EIT) Accessibility Standards” set forth by the Architectural and Transportation Barriers Compliance Board (also referred to as the “Access Board”) in 36 CFR part 1194. Information about Section 508 is available at http://www.hhs.gov/web/508. The complete text of Section 508 Final Provisions can be accessed at http://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards.

(b) The Section 508 accessibility standards applicable to this contract or order are identified in the Statement of Work or Specification or Performance Work Statement. The contractor must provide any necessary updates to the submitted HHS Product Assessment Template(s) at the end

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http://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards

http://www.access-board.gov/guidelines-and-standards/communications-and-it/about-the-section-508-standards


of each contract or order exceeding the simplified acquisition threshold (see FAR 2.101) when the contract or order duration is one year or less. If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(c) The Section 508 accessibility standards applicable to this contract are:

36 CFR Part 1194.22 (a-p)36 CFR Part 1194.24 (a-e)36 CFR Part 1194.31 (a-f)36 CFR Part 1194.41 (a-c)

NOTE: Additional 508 standards may be identified at the task order level. (See (e) below)In the event of a modification(s) to this contract or order, which adds new EIT supplies or services or revises the type of, or specifications for, supplies or services, the Contracting Officer may require that the contractor submit a completed HHS Section 508 Product Assessment Template and any other additional information necessary to assist the Government in determining that the EIT supplies or services conform to Section 508 accessibility standards. Instructions for documenting accessibility via the HHS Section 508 Product Assessment Template may be found under Section 508 policy on the HHS website:

(http://www.hhs.gov/web/508). If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the contract, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

(d) If this is an Indefinite Delivery contract, a Blanket Purchase Agreement or a Basic Ordering Agreement, the task/delivery order requests that include EIT supplies or services will define the specifications and accessibility standards for the order. In those cases, the Contractor may be required to provide a completed HHS Section 508 Product Assessment Template and any other additional information necessary to assist the Government in determining that the EIT supplies or services conform to Section 508 accessibility standards. Instructions for documenting accessibility via the HHS Section 508 Product Assessment Template may be found at http://www.hhs.gov/web/508. If it is determined by the Government that EIT supplies and services provided by the Contractor do not conform to the described accessibility standards in the provided documentation, remediation of the supplies or services to the level of conformance specified in the contract will be the responsibility of the Contractor at its own expense.

H.7 REHABILITATION ACT, SECTION 508, ACCESSIBILITY STANDARDS

The Contractor shall comply with the Rehabilitation Action, Section 508, Accessibility Standards as referenced below.

Federal Government StandardsRehabilitation Act, Section 508, Accessibility Standards29 U.S.C. 794d (rehabilitation Act as amended)

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36 CFR 1194 (508 standards)w w w . a cc e s s- bo ar d . g o v / s e c 5 0 8 / 5 0 8 s t a nd a r d s . h t m (508 standards)www . s e c t i o n 508.gov (website) FAR 39.2 (Section 508)w w w . a cc e s s- bo ar d . g o v / s e c 5 0 8 / g uid e .h t m (guide for standards)

H.8 RESTRICTIONS ON THE USE OF INFORMATION

The access to and use of data/information under this contract shall be in accordance with FAR clause 52.224-2 (APR 1984), Privacy Act, set forth in Section I.

The contractor and its employees are subject to criminal penalties for violations of the Act (5 U.S.C. 552a(i)) to the same extent as employees of the Government. The contractor shall assure that each contractor employee knows the prescribed rules of conduct and is aware that he/she can be subjected to criminal penalties for violations of the Act.

H.9 CODE OF CONDUCT CMS CLAUSE-07 (JUN 2004) – Omitted Intentionally

H.10 WORK PERFORMED OUTSIDE OF THE UNITED STATES AND ITS TERRITORIES

a. The contractor, and its subcontractors, shall not perform any activities under this contract at a location outside of the United States without the prior written approval of the Contracting Officer. In making a decision to authorize the performance of work outside of the United States, the Contracting Officer will consider the following factors, including but not limited to:

1. All contract terms regarding system security2. All contract terms regarding the confidentiality and privacy requirements

for information and data protection3. All contract terms that are otherwise relevant, including the provisions of

the statement of work4. Corporate compliance5. All laws and regulations applicable to the performance of work outside of the United States6. The best interest of the United States

a. In requesting the Contracting Officer’s authorization to perform work outside of the United States, the contractor must demonstrate that the performance of work outside of the United States satisfies all of the above factors. If, in the Contracting Officer’s judgment, the above factors are not fully satisfied, performance of work outside of the United States will not be authorized.

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http://www.access-board.gov/sec508/guide.htm

http://www.access-board.gov/sec508/508standards.htm


b. In preparing a proposal to meet this requirement, particular attention should be given to:

• System Security• Confidentiality of Information• HIPAA• Privacy Act

H.11 CMS SECURITY CLAUSE (APR 2016)Omitted Intentionally

H.12 SUBCONTRACTING REPORT

The contractor shall be required to report, semiannually, all subcontracts utilized under the contract. The report shall include Task Order number, cumulative Task Order amount (Funded), cumulative dollar value of work completed, subcontractor name, cumulative dollar value of work subcontracted (per subcontractor), cumulative percentage of Task Order work subcontracted.

H.13 DATA USE AGREEMENT

Due to the confidential nature of the information the contractor(s) will have access to, and in order to secure data that reside in a CMS Privacy Act System of Records, CMS mandates that all contractor(s) performing under this contract enter into a Data Use Agreement with CMS. This agreement addresses the conditions under which CMS will disclose and the User will obtain, use, reuse and disclose the CMS data file(s) and/or any derivative file(s) that contain direct individual identifiers or elements that can be used in concert with other information to identify individuals.

H.14 BUSINESS MEALS

It is the Department’s policy that OPDIVS and STAFFDIVS shall not use appropriated funds to purchase food (whether for conference or meetings; for meals, light refreshments, or beverages; or for Federal or non-Federal participants).

NOTE: This contract clause does not pertain to the meals portion of allowable costs incurred as part of the per diem expense allowed under the Federal Travel Regulations (FTRs). However, Contractor employees on travel status must remove the cost of the meal(s) from their allowable per diem reimbursement when attending conference or meetings where meals are included in the cost of a conference or meeting.

H.15 LEVEL OF EFFORT TASK ORDERS

In the event of level of effort task orders (term form within the meaning of FAR 16.306(d)), the contractor shall devote to the requirements not less than 5% of the total direct person hours nor more than 5% of total direct person hours (including subcontractors) for labor category proposed.

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In the event that during the period of the contract task assignments requiring an effort not greater than 5% and not less than 5% of the total hours for each labor category the fixed fee of this contract shall not be adjusted when the estimated costs are not exceeded. However, in the event that the contractor shall be required to furnish effort greater than 5% or less than 5% of the total hours for each labor category the estimated cost and fixed fee shall be adjusted.Effort greater than 5% of the total hours shall not be required unless the task order is modified before the hours are incurred.

Contractor shall notify the government when 75% of LOE hours have been incurred.

Within 30 days after completion of the task order, the Contractor shall submit the following information in writing directly to the Contracting Office:

1. The total number of hours of direct labor expended;2. A breakdown of this total showing the number of hours expended in each direct

labor category listed in the task order schedule, including the identification of the key employees utilized;

3. The Contractor’s estimate of the total allowable cost incurred under the task order;4. In the case of a cost overrun, the amount by which the estimated cost of the task

order may be reduced to recover excess funds.

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PERSONAL CONFLICTS OF INTERESTFINANCIAL DISCLOSURE

EMPLOYEE SIGNATURE PAGE(To Be Retained by Compliance Officer)

Certification of Reporting Employee

I, , certify that the statements I have made herein and on all attachments are true, complete, and correct to the best of my knowledge.

Signature Date (MM/DD/YY)

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MITREReplicating Pregnancy Prevention Programs


Appendix H: (H.4) Clause Business Ethics, Conflicts of Interest, and Compliance

A. General : It is imperative that the Contractor and the services provided under this contract be free, to the greatest extent possible, of all Organizational and Personal Conflicts of Interest. In this clause, all references to Organizational and/or Personal Conflicts of Interests will be referred to individually or collectively, as the text justifies, as Conflicts of Interest (COI). Except as provided below, the Contracting Officer shall not maintain a contract with a Contractor that the Contracting Officer determines has, or has the potential for, an unresolved COI. However, in accordance with FAR 9.503 Waiver, the Contracting Officer may contract with a Contractor that has an unresolved COI if the Contracting Officer determines that it is in the best interest of the Government to do so.

B. Definitions

Actual COI means that the COI is currently in existence as determined by the Offeror’s or Contractor’s Compliance Officer and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Affiliates – As defined in FAR 2.101 means associated business concerns or individual(s) if, directly or indirectly either one controls or can control the other; or a third-party control or can control both.

For purposes of this contract, affiliate control or influence may include, but is not limited to:

a. Interlocking management or ownership (e.g., individuals serving in similar capacities in several companies);

b. Identity of interests among family members such as spouse/domestic partner and/or any dependent of the respondent;

c. Shared facilities and equipment; d. Common use of employees; or e. A business concern organized just prior to, or immediately following, the release of a

solicitation or request for information, which has the same or similar management, ownership, or principal employees as the offeror or Contractor.

Any business, whether or not it is organized for profit or located in the United States or its outlying areas, or person may be found to be an affiliate. Control may be affirmative or negative and it is immaterial whether it is exercised so long as the power to control exists.

Apparent (Perceived) COI – means that the COI on first observation appears to be an actual or potential COI but may or may not be after analysis. Even if the apparent COI is determined to be non-existent, this perception may still require further explanation.

70ACQUISITION SENSITIVE

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Avoidance – means Government action taken in one acquisition that is intended to prevent a COI in that acquisition or in a future action. Methods of avoiding COIs include, but are not limited to:

Drafting the statement of work (SOW) to exclude tasks that require Contractors to utilize subjective judgment; or

Obtaining advice from more than one source on any issue on which there are concerns about an COI so that there is no area in which the Government is relying solely on the advice of any one of the sources; or

Excluding an offeror from participation in a contract award.

Financial Interests/Relationships – means a healthcare related direct or indirect ownership or investment interest (including an option or non-vested interest) in any entity that exists through equity, debt, or other means and includes any indirect ownership or investment interest no matter how many levels removed from a direct interest.

A financial interest/relationship may arise from the following non-exclusive examples: a) Compensation, including wages, salaries, commissions, professional fees, or fees for

business referrals; b) Current or known future arrangements or requirements for which you are defined as

an interested party, including, but not limited to, an entity that may create one or more of the three forms of COI;

c) Consulting relationships, including commercial and professional consulting and service arrangements, scientific and technical advisory board memberships, or serving as an expert witness in litigation;

d) Services provided in exchange for honorariums including travel expense reimbursements;

e) Research funding or other forms of research support; f) Healthcare related investment in the form of stock or bond ownership, including

healthcare sector investment only mutual funds; g) Healthcare business ownership or partnership interests; h) Patents, copyrights, and other intellectual property interests; i) Seeking or negotiating for prospective employment or business; or j) Gifts, including travel.

Mitigation– means action taken by the Contractor to reduce the COI risk to a level acceptable to CMS on a present contract.

Neutralization – means excluding or restricting a Contractor from offering, as a prime or subcontractor, on future contracts while allowing the Contractor to perform on the instant contract. This method protects the Government’s interests in cases where the Contractor’s work on the instant contract could be biased or impaired by virtue of its expectation of future work, or when the Contractor would have an unfair advantage in competing for award of the future work.


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Organizational Conflict of Interest – In accordance with FAR 2.101 Definitions, means that because of other activities or relationships with other persons, a person is unable, or potentially unable, to render impartial assistance or advice to the Government, or the person’s objectivity in performing the contract work is, or might be, otherwise impaired, or a person has an unfair competitive advantage.

For purposes of this contract, the conflict of interest definition includes direct or indirect relationships including, but not limited to, the Contractor and its parent company, subsidiaries, affiliates, subcontractors, clients and principals.

Personal Conflicts of Interest – A situation in which a person has a financial interest, personal activity, or relationship that could impair the person’s ability to act impartially and in the best interest of the Government when performing under this contract.

a. Among the sources of personal conflicts of interest are— i Financial interests of the person, spouse/domestic partner and/or any other

dependent of the person, as defined for Federal tax purposes; ii Other employment or financial relationships (including seeking or negotiating

for prospective employment or business) and, iii Gifts, including travel.

b. For example, financial interests referred to in paragraph (a)(i) of this definition may

arise from— i Compensation, including wages, salaries, commissions, professional fees, or fees

for business referrals; ii Consulting relationships;iii Services provided in exchange for honoraria or travel expense reimbursements; iv Research funding or other forms of research support; v Healthcare related investments; vi Real estate investments; vii Patents, copyrights, and other intellectual property interests; or viii Business ownership and investment interests.

Potential COI – means that the COI could become an actual COI due to contingency events and/or as determined by CMS. This form of COI will require avoidance, neutralization or mitigation acceptable to CMS.

Principal – As defined in FAR 52.203-13, Contractor Code of Business Ethics and Conduct, means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager, plant manager, head of a division or business segment, and similar positions).

Three (3) Types of COIs include: 72

ACQUISITION SENSITIVE

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Biased Ground Rules

Consists of situations in which a firm, as part of its performance of a Government contract, has helped (or is in a position to help) set the ground rules for another Government contract by, for example, writing the statement of work or the specifications, or establishing source-selection criteria. In these “biased ground rules” cases, the primary concern is that the firm could skew the competition, whether intentionally or not, in favor of itself and/or its affiliates.

Impaired Objectivity

Consists of situations where a firm has an interest (typically financial) that may conflict with the interest of the Government to whom the firm has a contractual obligation, and the firm’s work under the Government contract could give the firm the opportunity to benefit its other business interests. If the firm is providing recommendations, judgment or advice, and its other business interests could be affected by that recommendation, judgment or advice, the firm’s objectivity may be impaired. An example is where the firm was evaluating itself, an affiliate or a competitor, either through an assessment of performance under another contract or an evaluation of proposals.

Unequal Access to Information

“Unfair” access to non-public information – Consists of situations in which a firm has access to nonpublic information (including proprietary information and nonpublic source-selection information) as part of its performance of a Government contract and that information may provide the firm with a competitive advantage in a later competition for a Government contract. In these “unequal access to information” cases, the concern is limited to the risk of the firm gaining an unfair competitive advantage; there is no issue of bias. Note: Incumbency alone does not constitute “unequal access to information.”

C. Significant Potential Conflict of Interest : The Contracting Officer has determined that this

contract may involve significant potential COIs.

1. Nature of Potential Conflict : Although not all inclusive, the Contracting Officer has determined that the following activities are considered to be actual, potential or apparent COIs with the work to be performed under this contract. The Federally Funded Research and Development Contractor (FFRDC) shall promptly notify the Contracting Officer of any relationships, whether direct or indirect, with any of the following entities:

For the purpose of identifying entities with actual, apparent or potential COIs, at a minimum, the entity is one that - a. Would review or does review, under the contract, Medicare and/or Medicaid

services furnished by a provider or supplier that is a direct competitor of the FFRDC or subcontractor of the FFRDC; or


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b. Prepared work or is under contract to prepare work that would be reviewed by the FFRDC under the contract; or

c. Is affiliated or has a financial relationship, as these terms are explained above, with an entity to be reviewed under the contract; or

d. Competes against private industry for work.

2. Proposed Restraint on Future FFRDC Activities : CMS is proposing to restrain or is restraining, as the case may be, future FFRDC activities as follows:

The FFRDC: a. Shall not compete against private industry for work; b. May only perform work as defined in Section III. Scope of Work of the

Sponsoring Agreement; c. May only respond to a Federal Government request for proposal or Broad Agency

Announcement for other than a task order under the CAMH FFRDC contract with the express written permission of the Sponsor;

d. May apply for grants only when: No real or perceived conflict of interest exists between the execution of

the grant and the current or planned work of the FFRDC. The principal purpose of the grant is to stimulate or support research and

development in support of the Sponsors’ missions; e. May not accept work developing specific components without written approval

of the FFRDC Program Manager, who may approve the work when it is directly related to a specific critical government program; or

f. Shall not, unless authorized by legislation and the Contract, undertake quantity production or manufacturing.

D. Contractor Business Ethics, Conflict of Interest and Compliance Program Requirements: FAR 3.10 and FAR 52.203-13, Contractor Code of Business Ethics and Conduct, identify “…policies and procedures for establishment of Contractor codes of business ethics and conduct, and display of agency Office of Inspector General (OIG) hotline posters.” (See Section I, FAR 52.203-14 fill-in information for the website where you can find the HHS OIG fraud hotline poster).


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The following chart is provided to clarify requirements under this contract:

FAR 52.203-13 Requirements Applicability (X = Applicable)

Contracts < $5 Million

Contracts ≥$5Million with a

SmallBusiness OR for

Commercial Items(as Defined in FAR

2.101)

Contracts ≥$5Million with a

LargeBusiness (No

Commercial ItemContracts)

CMS COI DISCLOSURES X X XPLAN FOR

MONITORING/REPORTINGCOIs (Large Businesses Shall

Incorporate COIMonitoring/Reporting as Part of

Its Compliance Program)

X X X

CODE OF CONDUCT Not Required X X

COMPLIANCE PROGRAM Not Required Not Required X

1. COI Oversight Program: The Contractor shall maintain an effective COI Oversight Program. As part of the program, the contractor shall implement company business practices, procedures, polices and internal controls for compliance with COI requirements, such as:

a. Preventing conflicts of interest, prohibiting the use of non-public information

accessed through this contract for personal gain, and obtaining a signed non-disclosure agreement to prohibit disclosure of non-public information accessed through this contract;

b. Conducting Internal and External Audits; c. Policy Enforcement and Employee Disciplinary Actions; d. Retention of Records; e. Management of Subcontractors; f. Internal control systems; g. Display of Fraud Hotline Poster(s) in accordance with FAR 52.203-14

Display of Hotline Poster(s). h. Reviewing the information required by Attachment J-3 Contractor Personal

Conflict of Interest Financial Disclosure Template, for each principal, officer and member of the governing body (e.g., Board of Directors, Trustees, etc.) of the organization, as well as managers and key personnel who would be, or are involved with, the performance of this contract. It is recommended that individuals who have not disclosed changes within the reporting period, submit an annual disclosure update to their Compliance Officer for review;


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i. Informing employees, through an employee education and training program, of their obligation to disclose and prevent conflicts of interest, not to use non-public information accessed through performance of this contract for personal gain, and to avoid even the appearance of personal conflicts of interest; and,

j. Reporting to the Contracting Officer any conflict of interest violations.

The following details are provided for respective COI disclosure expectations:

2. Conflict of Interest: In accordance with FAR 3.10 and 52.203-13, Contractor Code of Business Ethics and Conduct, and this solicitation/contract, the Contractor shall have procedures in place to monitor and disclose all Organizational and Personal Conflicts of Interest throughout the life of the contract.

COI information shall be submitted as follows:

a. Initial Submission of COI Information : The Contractor shall submit Conflict of Interest information identified in-

• Attachment J-4 Contractor Business Ethics, Conflict of Interest and Compliance Program Requirements (follow the format identified in the Attachment J-4).

b. Personal Conflict Information : It is the offeror/contractor’s responsibility to have a COI plan in place (see H.1.d.1. COI Oversight Program) to ensure that actual, potential, or apparent personal conflicts of interest are identified, analyzed and mitigated for performance of this contract. COI information shall be obtained by the Offeror/Contractor for each:

Manager or Key personnel who would be, or are involved with, the performance of this contract;

Governing Body Members (e.g., Board of Directors; Trustees, etc.); and,

Principals of the organization as defined by FAR 52.203-13, Contractor Code of Business Ethics and Conduct.

Attachment J-3 Contractor Personal Conflict of Interest Financial Disclosure Template is provided as a “sample” for the Offeror/Contractor to follow when identifying, analyzing and mitigating actual, potential, or apparent Personal COIs for this contract. Notwithstanding, Personal COI information obtained from the above individuals shall not be submitted to the Government.

c. Mitigation/Resolution : The Contracting Officer determines whether a COI has been identified and whether the actual, potential or apparent COI has been mitigated/resolved to the Government’s satisfaction. The Contractor's approved COI Mitigation/Resolution plan shall be incorporated into the contract.


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In cases whereby a COI cannot be, or has not been, mitigated to the Contracting Officer’s satisfaction, the Contracting Officer may take the following action including, but not limited to:

Request a waiver in accordance with FAR 9.503 Waiver, from the Head of the Contracting Activity; or

Make changes to the requirements of the contract; or Terminate the contract.

d. Conflict of Interest Disclosure During Contract Performance : COI Disclosure Revisions shall be submitted to the Contracting Officer as follows:

i. When Revisions are Required : At any time during the performance of this contract, if the

contractor learns of any actual, potential, or apparent COI, whereby a reasonable business person might equate the COI to one (1) of the three (3) types of COIs identified in H.1.b Definitions, the Contractor shall notify the Contracting Officer in writing within five (5) business days of the identification of the actual, potential, or apparent COI. Within 30 calendar days, or as otherwise negotiated with the Contracting Officer, the Contractor shall submit a COI Disclosure Revision in accordance with H.1.d.2.(d) ii below. If, as a result of the Government or Contractor independent auditor review, any findings require a change in the previous disclosure, submit a COI Disclosure Revision, in accordance (d) ii below, to the Contracting Officer within 30 calendar days of the final audit report.

Within 30 calendar days when the Contracting Officer requests a revision.

At least 45 calendar days prior to a change due to proposed or planned business actions, e.g., acquiring or selling a business or business segment, changes in ownership of the organization holding the contract, etc.

ii. What is Required in a Revision: When COI disclosures require revision, the Contractor shall

provide a revised Attachment J-4, Contractor Business Ethics, Conflict of Interest and Compliance Program Requirements. Red-lined versions are preferred.

f. Independent Audit : Unless otherwise instructed, when a mitigation plan is

required to be submitted, the Contractor shall obtain the services of an External/Independent auditor to conduct an audit of the “Mitigation Strategy.” If the Government chooses to execute the audit in lieu of the contractor independent audit, the Contracting Officer will notify the Contractor within 60 days of the anniversary date of the contract. Such auditor shall have expertise in conducting


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compliance program and conflict of interest audits. The Contractor’s records may also be subject to audit by the Government to ensure compliance with this contract’s H.1 clause requirements and/or ensure that any corrective action, if necessary, has been implemented.

1. Subcontractors : A COI independent audit shall be required at the discretion of the Prime Contractor. If the Prime Contractor requires an audit of the subcontractor(s), the subcontractor’s audit shall be included with the Prime Contractor’s audit submission. 2. First Audit : When a mitigation plan is required, an independent audit of the COI program is due 90 days after the first anniversary date of the contract or as otherwise negotiated with the Contracting Officer. The independent audit will be submitted by the auditor directly to the Contracting Officer with a copy to the Contractor. 3. Subsequent Audits : Additional audits are at the discretion of the Contracting Officer. The Contracting Officer will consider previous audit findings, any corrective action(s) and any new COI information, when making the decision to require subsequent audits.4. Audit Findings : When Contractor Conflict of Interest Oversight findings are disclosed in an independent audit, the Contractor shall include in the draft audit report its proposed corrective action plan for each finding. The Contracting Officer may require a revised COI mitigation plan to be submitted as a result of the audit findings.5. Independent Audit Requirements :

a. The auditor shall decide what processes it will use to review, verify and confirm the information, processes and policies disclosed by the Contractor to the Government. The audit shall include a process for the contractor to review audit findings and provide a response to the auditor, which shall be included in the final audit submitted to the CMS Contracting Officer.

b. The audit shall confirm that any and all COI mitigation plans, approved by the Government, have been implemented and are functioning as anticipated. Although not all inclusive, the auditor may also want to consider the following: i. Review of all COI disclosures submitted to the Government to

validate the accuracy and completeness of such disclosures;ii. Conducting appropriate interviews with principals, key personnel

and independent members of the board of directors, as appropriate;

iii. Reviewing the Contractor’s organizational chart(s), articles of incorporation, bylaws and/or other documents, to validate the accuracy and completeness of COI disclosures to the Government;

iv. Confirming that the Contractor annually, at a minimum, collects and reviews for assessment and appropriate action by the


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Compliance Officer, personal conflict information from its principals, key personnel (on the relevant contract(s)) and board of director members;

v. Confirming whether the Contractor is in compliance with its internal Contractor Conflict of Interest Oversight program(s); and,

vi. For its Subcontractors, confirming whether the prime Contractor is monitoring Subcontractor compliance with the required contract flow-down provisions and disclosed practices, in accordance with contract H.1. The auditor may review other information as it deems appropriate to ensure that COI issues have been identified and resolved, in accordance with Contractor disclosures.

vii. The auditor will also examine the Contractor’s records to verify that all of the requirements specified in FAR 52.203-13(c)(2)(ii), Contractor Code of Business Ethics and Conduct, are met.

6. Reporting Requirements : The audit report, inclusive of all auditor findings and proposed corrective actions, shall be delivered via e-mail or US Postal Service to the Contracting Officer directly from the auditor.

g. Subcontractor Flow-Down Clause : The prime Contractor is responsible for avoiding, neutralizing and mitigating all actual, potential, or apparent COIs of its Subcontractors, in accordance with this clause. Therefore, the prime Contractor shall flow-down clause H.1 Business Ethics, Conflict of Interest and Compliance, of this contract in all subcontracts. For Subcontractors, wherever the term “Contractor” is used, insert “Subcontractor.”


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ETHICS AND POLICY COMPLIANCE CERTIFICATION

NOTE: This Appendix is provided for your reference. Should MITRE require completion of the information in this Appendix, MITRE will contact you at the email provided in your technical proposal template.

This is to certify that I, __________________________________________, as an employee of The MITRE Corporation currently assigned to participate in the Background Checking Services (RFP No. MITRE-18-06) procurement initiative:

1. recognize the importance of maintaining the confidential nature of MITRE’s process of procurements and, as a member of the team, I agree not to disclose any details of MITRE’s process, evaluation and ranking to anyone outside of MITRE or to any employee within MITRE who does not have a legitimate need-to-know;

2. have read The MITRE Corporation’s Guidelines on Ethics and Procurement (Procurement Policy 1.3.I) and not have any actual, potential, or perceived conflict of interests;

3. as a member of the technical/cost evaluation team involved in a MITRE procurement, am in compliance with Procurement Policy 1.3.I;

4. understand that making an offer of or accepting a tip, money, a kickback, a gift, a thing of value, or compensation of any kind from a supplier as a condition for obtaining favorable treatment from MITRE is a violation of the Corporation’s procurement policies and may lead to disciplinary action up to and including termination;

5. understand that such offers, or acceptances may also be a violation of federal law for which there may be criminal penalties;

6. will carry out my obligations to obey the principles that control MITRE’s procurement functions.

7. understand that this certification covers all aspects and components of any procurement in which I am a participant.

Signature: ____________________________

Date: _______________________________


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Appendix I: (J-3) Contractor Person COI Financial Disclosure Template


CONTRACTOR PERSONAL CONFLICTS OF INTERESTFINANCIAL DISCLOSURE TEMPLATE

(OCT 2015)Offerors/Contractors:

Use of this actual template is not required . This template is provided as a sample for the kind of information CMS has found to be vital for proper personal COI analysis. If the offeror/contractor uses its own template or form for personal conflict of interest information collection and disclosure, the offeror/contractor should ensure that, at a minimum, the information captured on this template is collected.

Personal Conflict of Interest Financial Disclosure information shall NOT BE submitted to CMS . However, such information shall be collected and annualized for all Governing Body members (e.g., Board of Directors, Trustees, etc.), and principals of the organization as defined by FAR 52.203-13, Contractor Code of Business Ethics and Conduct, and for each manager and key personnel who would be, or are involved with, the performance of the contract. NOTE: References to organizational and/or personal conflicts of interest will be referred to individually and collectively as conflicts of interest (COI).

Compliance Officer Analysis . Offeror/Contractor Compliance Officer Analysis of Individual Personal Conflicts of Interest is required – See end of this template for a sample of Reporting Employee Disclosure and analysis.

Reporting Employee (Also includes Board of Director members or others, as applicable): Please complete the “Reporting Employee Information” below that will identify you as the reporter. None of the below

information will be submitted to the government; it is for interal collection and analysis only. However, if you have concerns regarding personal information requested in this Form, please consult with the company Compliance Officer.

Read the instructions for Parts I through IV (Identified in Blue Headers) on the following pages. General Statements (Below Reporting Employee Information): If you selected “Yes” for a n y statement, you must

describe the reportable interests in the corresponding Parts I, II, III, and/or IV below in the Purple Header Sections. If additional space is required, please expand the space provided or provide additional pages.

Sign and date the disclosure of information. Our Compliance Officer will retain this disclosure information and signature page on file.

Submit completed documents to our Corporate Compliance Officer.


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REPORTING EMPLOYEE INFORMATION

Company

Business/Unit and Address

Updated __

Employee Identification

Reporting StatusInitial ___ Annual ___ Updated ___

General Statements (Reporting Employee - For each statement below, check “Yes” or “No.” For more detail or further instructions, see the following sections I thru IV below.) Yes NoI. I have reportable assets or sources of income for myself, my spouse/domestic partner and/or

any dependent of the respondent.

II. I have reportable liabilities for myself, my spouse/domestic partner and/or any dependent of the respondent.

III. I have reportable outside positions for myself, my spouse/domestic partner and/or any dependent of the respondent.

IV. I have reportable gifts and/or travel reimbursements for myself.


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Part I: ASSETS AND INCOME

I.A. REPORTABLE ASSETSReport for Yourself, Spouse/domestic partner and/or any dependent of the respondent:

Do Not Report:

• Healthcare Related Assets held for investment with a value greater than $10,000 as of the date of disclosure OR assets held for investment which produced more than $2,500 in income, including but not limited to:

Healthcare-related assets, such as stocks, bonds, annuities, trust holdings, partnership interests, investment real estate, or a privately held trade or business;

Healthcare sector mutual funds (report the full name of the fund, not just the general family fund name);

Holdings of Healthcare Related self-directed retirement plans, such as 401(k)s, IRAs or SEPs (list each holding);

Defined benefit pension plans provided by a Healthcare related former employer (include the name of the employer); and,

Type/location of healthcare related real estate.

• Federal Government retirement benefits• Federal Thrift Savings Plan. • Certificates of deposit, savings or checking accounts.• Life Insurance.• Money market mutual funds and money market accounts.• Your personal residence.• Diversified mutual funds, such as ABC Equity

Value Fund or XYZ Large Capital Fund.• U.S. Federal/State/Local Government bonds, bills, notes, and savings bonds.• Money owed to you, your spouse/domestic partner and/or dependent by a spouse/domestic partner, parent, sibling, or child.

I.B. HEALTHCARE-RELATED ANNUAL INCOME, ARRANGEMENTS OR AGREEMENTS Report: Do Not Report:

• For Y o ursel f/ y o ur Spouse/Domestic Partner and/or any Dependent of the respondent for all Healthcare Related: Sources of salary, Severance, Bonuses, Fees, Commissions, Honoraria, and Other earned income, arrangements or

agreements, as well as other non-investment income such as scholarships, patents, royalties, etc.

• For yourself only : Continuing participation in an employee

pension or benefit plan maintained by a former Healthcare Related employer;

A leave of absence in order to perform duties for this present organization; and,

Known future Healthcare Related employment, including date you accepted employment offer.

• Alimony and Child Support• Veterans’ benefits Social Security or disability benefits• Any of the following for spouse/domestic partner and/or any

dependent of the respondent: Continuing participation in an employee pension or

benefit plan maintained by a former employer; A leave of absence to perform duties for this present

organization; and, Known future employment, including date you

accepted employment offer.


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IMPORTANT DEFINITIONS

Dependent – A son, daughter, stepson or stepdaughter who is either unmarried and under age 21 and living in the filer’s house or considered dependent under the U.S. tax code.Diversified Mutual Fund – A mutual fund that does not have a stated policy of concentrating its investments in one industry, business, or single country other than the United States.Sector Mutual Fund – A mutual fund that concentrates its investments in an industry, business, single country other than the United States, or bonds of a single state within the United States.

REPORTABLE ASSETS AND HEALTHCARE RELATED INCOME, ARRANGEMENTS OR AGREEMENTS(I.A and I.B. Information should be provided in the white space below)

Notes: When submitting information, please include the following specific information for reportable assets and income -

Healthcare related stock, bond, sector mutual fund, etc.: Please indicate the full name and dollar amount of each specific Healthcare related asset or investment. You may add the ticker symbol to the full name.

Healthcare related employer or business, source(s) of fees, commissions, or honoraria, please include the name and brief description of each, as applicable.

Healthcare related real estate investment, please include type/location for each.

You may distinguish any entry for a family member by preceding it with “S” for Spouse/Domestic Partner, “D” for Dependent, or “J” for Jointly held.

If additional space is required, please add an addendum to this disclosure.

Reportable Asset # Description of Asset $ Amount

1

2

3

4


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Part II: LIABILITIESReport for Yourself, Spouse/Domestic Partner and/or any Dependent of the respondent: Do Not Report:

• Loans over $10,000 from an individual, such as a friend or a business associate who is employed by a Healthcare related entity or has a business association with a Healthcare related entity. • Loans that you owe to your parent,

spouse/domestic partner, sibling and/or any dependent.

REPORTABLE LIABILITIESName of creditor (include City and State where creditor is located) Type of liability

1

2

3


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Part III: ADDITIONAL POSITIONS

Report for Yourself: Do Not Report: All Healthcare related positions held at any time during

the last 2 years, whether or not you were compensated OR you currently hold that position. Positions include an officer, director, employee, trustee, general partner, proprietor, representative, executor, or consultant of any of the following Healthcare related concerns: Corporation, partnership, trust, lobbying, or other

business entity, Non-profit or volunteer organization, and Educational institution (For instance, teaching

hospital)

Any position with a Religious entity Social entity Fraternal entity

Any position held by yourspouse/domestic partner and/or any dependent of the respondent

Any position that you hold as part of your current official duties

Any positions reported in Part I. B

REPORTABLE POSITIONSOrganization (Include city and state where organization is located) Position1

2

3

4


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Part IV: GIFTS AND/OR TRAVEL REIMBURSEMENTS

Report for Yourself, Spouse/Domestic Partner, and/or anyDependent of the Respondent:

Do Not Report:

• All non-employer Healthcare related travel-related reimbursements totaling more than $250 during the reporting period; include where you traveled, the purpose, and date(s) of the trip(s); and,• Any gift(s) from Healthcare related companies with a fair market value totaling more than $250.

Anything received from relatives, the U.S. Government, D.C., state, or local governments;

Bequests and other forms of inheritance; Gifts and travel reimbursements provided by your

organization in connection with your official travel; Gifts of hospitality (food, lodging, entertainment) at

the donor’s residence or personal premises; or, anything received by your spouse/domestic partner and/or any dependent of the respondent, totally independent of their relationship to you.

REPORTABLE INFORMATION

SourceDescription (For Travel, also include purpose of trip)

1

2

3


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PERSONAL CONFLICTS OF INTERESTFINANCIAL DISCLOSURE

EMPLOYEE SIGNATURE PAGE(To Be Retained By Compliance Officer)

CERTIFICATION OF REPORTING EMPLOYEE:

I,______________________________(Print Name), certify that the statements I have made herein and on all attachments are true, complete, and correct to the best of my knowledge.Signature Date (mm/dd/yy)


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OFFEROR/CONTRACTOR COMPLIANCE OFFICERANALYSIS OF INDIVIDUAL

PERSONAL CONFLICTS OF INTEREST


Description of Project: <Provide a summarized description of the work being performed on the CMS contract.>

Potential Conflicts for this Project: Employee’s Role on Contract: <Provide a high level description of the employee’s

role on the project. Be sure to de-identify any PII.> Description of Conflict(s): <Provide a list of reportable interests that create an actual,

apparent and/or potential conflict for the work described above in Description of Project.>

Compliance Officer Assessment: (If none, state “None”): < Provide the Compliance Officer’s assessment and determination of whether any conflict(s) exist that must be mitigated and how the conflict is/will be resolved.>

(Check here if continued on additional page(s) ___)

CORPORATE COMPLIANCE OFFICER REVIEW:

To the best of my knowledge and belief, based on the information disclosed, all actual, potential and/or apparent COIs have been mitigated. Name & Signature of Corporate Compliance Officer Date (mm/dd/yy)

E-mail Address Phone Number


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EXAMPLE:Delete this Page in Submissions

OFFEROR/CONTRACTOR COMPLIANCE OFFICERANALYSIS OF INDIVIDUAL

PERSONAL CONFLICTS OF INTEREST

Description of Project: The Program Integrity contract is responsible for identifying fraud, waste and abuse in the Medicare Part A, B and HH+H in the state of Texas.

Potential Conflicts for this Project: It is the policy of XYZ to avoid situations that place officers, directors, managers, key employees in positions where their judgment may be biased in any way, or where their responsibilities may give them an unfair competitive advantage with respect to other business ventures.

Provide a description of the employee’s role on the project: Employee #1 (Dr. John Smith has been de-identified) will work as the AB (Medical Director has been de-identified) on the contract. In doing so, Employee #1 will perform review of Medicare Part A, B and HH+H claims in the State of Texas.

Provide a list of reportable activities that create an actual, apparent or potential conflict for the work described above in Description of Project:

o Provides or furnishes products and/or services that are billed to Medicare or Medicaid. Healthcare providers and suppliers include, but are not limited to, hospitals, doctors, skilled nursing facilities, home health agencies, ambulance companies, durable medical equipment companies, physical therapists, pharmacies, pharmacist, and clinical laboratories.

o Conducts audits of health benefit payments or cost reports, or conduct statistical analysis of health benefit utilization.

o Performs work of a Medicare Administrative Contract, Recovery Audit Contract or Qualified Independent Contractor.

Compliance Officer Assessment:

Description of Conflict and Mitigation:

Employee #1 (Dr. Smith has been de-identified) has two conflicts that require a mitigation strategy. Employee #1’s financial disclosure revealed that the spouse (wife is de-identified) is a provider performing emergency room services in in Hospital XYZ located in Houston, TX and that Employee #1 has a position on the Board of QSR Medical Center located in Dallas, TX. The services being performed by Employee #1’s spouse at XYZ hospital may be reviewed under the contract. It is, therefore, determined that Employee #1 could or would be biased in any review of XYZ hospital. As a result, the mitigation is that Employee #1 must self-recuse from any and all work related to XYZ hospital. Regarding the position on the board of QRS Medical Center, Employee #1 could or would be biased in any review of services provided by QRS Medical Center. As a result, the mitigation is that Employee #1 must self-recuse from any and all work related to QRS Medical Center.


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Appendix J: (J-4) Prime and Sub-Contractor


PRIME AND SUB-CONTRACTOR

Prime and Sub-contractor – In accordance with Amendment Contract Section H.4, please include all of the following information contained herein (sections A. through E., plus the Certification) with your proposal submission and during contract performance, as required. Please ensure that you follow this outline format in your submission.

Offeror/Contractor/Subcontractor: Click or tap here to enter text.Date of Submission: Click or tap to enter a date.Submission Type: Choose an item from list.Contract or Solicitation Number: Click or tap here to enter text.Task Order Number: Click or tap here to enter text.Project Number: Click or tap here to enter text.Project Name: Click or tap here to enter text.

A Table of Contents is required with your submission and must include the sections. Information can be inserted in this document or included as an attachment.

A. Description of Corporate and Organizational Structure:

A1. High level organizational charts

A2. Internal Organizational Chart of entity performing the work


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A3. Narrative explanation of structure/ownership.

Click or tap here to enter text.

B. Description of ALL Actual, Potential, and/or Apparent COIs and Financial Interests/Relationships:

B1. COI COMPLIANCE PROCESS – Describe the COI oversight process including, but not limited to, how the contractor identifies and resolves COIs. Per the H.4. clause, “the Contractor shall maintain an effective COI Oversight Program. As part of the program, the contractor shall implement company business practices, procedures, policies, and internal controls for compliance with COI requirements.” The program should include (please address each): Preventing conflicts of interest, prohibiting the use of non-public information

accessed through this contract for personal gain, and obtaining a signed non-disclosure agreement to prohibit disclosure of non-public information accessed through this contract.

Conducting internal and external audits. Policy enforcement and employee disciplinary actions. Retention of Records. Management of subcontractors. Internal control systems. Display of Fraud Hotline Poster(s) in accordance with FAR 52.203-14 Display of

Hotline Poster(s). Reviewing the information required by Attachment J-3 Contractor Personal Conflict

of Interest Financial Disclosure Template, for each principal, officer and member of the governing body (e.g., Board of Directors, Trustees, etc.) of the organization, as well as managers and key personnel who would be, or are involved with, the performance of this contract.

Informing employees, through an employee education and training program, of their obligation to disclose and prevent conflicts of interest, not to use non-public


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information accessed through performance of this contract for personal gain, and to avoid even the appearance of personal conflicts of interest.

Reporting to the Contracting Officer any conflict of interest violations.


B2. DISCLOSURE OF CONTRACTS THAT COULD POSE AN ACTUAL, POTENTIAL, AND/OR APPARENT COI – Disclose all current/active and known future non-foreign contracts that could give rise to an actual, potential, and/or apparent COI, for itself, its parent(s), and affiliate(s), including potential subcontracts. Please address the following for each contract: Type of relationship (prime contractor, subcontractor, or other). Name of customer with which you are under contract. Contract #, period of performance, and total contract value. Description of supplies/services. Unequal Access (UA), Biased Ground Rules (BG), and/or Impaired Objectivity (IO)

COI (see H.4. for definitions). Actual, potential, or apparent COI.

Click or tap here to enter text, enter “N/A” if none.

B3. FINANCIAL INTERESTS/RELATIONSHIPS – As defined in Section H.4, any organizational Financial Interests/Relationships that cause an actual, potential, and/or apparent UA, BG and/or IO conflict of interest shall be disclosed in sufficient detail for the Government’s independent analysis. Please address the following for each instance: Name of entity with which you have a financial interest/relationship. Description of the financial interest/relationship. Does a COI exist? (UA, BG, and/or IO if yes) Explanation why a COI does or does not exist.


B4. CONFLICT OF INTEREST MITIGATION (See Solicitation/Contract Section H.4.b for definition of “Mitigation”) – For each actual, potential, and/or apparent UA, BG and/or IO conflicts of interest identified in B.2. or B.3. above, provide a proposed mitigation plan for Contracting Officer consideration, which will be incorporated into the contract if accepted. The mitigation plan shall include the following, at a minimum: Description of the COI including whether it is actual, potential or apparent. Rationale for identification of one (1) or more of the three (3) types of COIs (UA, BG

and/or IO). Mitigation strategy for COI. Time frames for resolving the COI. Plan for monitoring COIs. Plan for independent audit of COI mitigation (See H.4.e for audit requirements).


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C. Personal Conflicts of Interest (PCI):

C1. PCI DISCLOSURES & ANALYSIS – The offeror/Contractor shall ensure that the organization’s Compliance Officer has analyzed each PCI Financial Disclosure to determine whether actual, potential, and/or apparent PCIs exist. A Form J-3 must be completed for each person identified as “Key Personnel” for this task/project. The J-3 is a template to assist in gathering information from respondents. The template also includes a section for the Compliance Officer to analyze disclosed PCI information. The completed J-3s shall NOT be submitted to MITRE or the Government. The documents shall be maintained by the offeror/Contractor.


C2. MITIGATION PLAN – Any required PCI mitigation strategies shall be disclosed with the required COI Mitigation Plan described in B.4 above.

D. SUBCONTRACTORS:

The Prime Contractor/Offeror shall obtain from all of its proposed subcontractors “Contractor Business Ethics, Conflict of Interest and Compliance Program Requirements” information identified herein, in the same format as specified in this Attachment J-4 for inclusion in the Prime Contractor’s/Offeror’s proposal. Due to proprietary concerns, in some circumstances a Subcontractor may wish to withhold some of the information contained in J-4 from the Prime Contractor/Offeror. In these events, the Subcontractors may submit directly to the Government, proprietary information that cannot be disclosed to the Prime Contractor/Offeror. The Subcontractor shall submit the entire COI submission to the Government and a redacted version to the Prime Contractor/Offeror. These circumstances shall be extremely limited. The Prime Contractor/Offeror shall be responsible for conducting an analysis of each of its Subcontractors’ COI submissions (except for the redacted information that may have been disclosed to the Government) in order to ensure that the Subcontractor can perform services conflict-free. The Prime Contractor/Offeror shall include each of its Subcontractors’ analysis with its proposal. Enter “N/A” below if none if no Subcontractors are to be used for this effort. The Prime Contractor’s/Offeror’s analysis of each Subcontractor’s COI submission shall include: Whether the Subcontractor responded to all of the COI submission criteria stated

herein. A determination of whether an actual, potential and/or apparent UA, BG and/or IO

COI has been, or must be, mitigated.


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An analysis of each Subcontractor’s mitigation strategy. If a COI must be mitigated, a recommendation to the Contracting Officer of the

acceptability of the mitigation strategy.

D1. PRE-AWARD SUBCONTRACTOR INFORMATION AND EVALUATION


D2. POST-AWARD SUBCONTRACTOR INFORMATION AND EVALUATION


E. CONTRACTOR INTEGRITY/MISCONDUCT:

Offeror/Contractor shall disclose any and all known violations and alleged acts, within the past ten (10) years, related to following for itself, its parent and affiliated companies or subcontractors - False Claims Act, Civil Monetary Penalties, Criminal investigations and/or indictments, and Qui tam lawsuits or other administrative misconduct.The Offeror/Contractor shall also disclose in its submission whether the information contained in System for Award Management (SAM) and the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate and complete. If it is not, all such information required herein, that is not reported in SAM or FAPIIS, shall be disclosed with this submission.



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CERTIFICATION: I hereby certify that –

1. This Submission is an ☐ Initial filed with our proposal; or a ☐ Post-award Revision.

To the best of my knowledge and belief, I represent, by submission of this disclosure, that the Offeror/Contractor has disclosed all relevant information of which the Offeror/Contractor is aware regarding all actual, potential, and/or apparent organizational/personal conflicts of interest;I am authorized to bind this entity and attest that the information submitted herein is true, accurate and complete as of this date;If the contract value is >$5million, the entity has ☐ or will ☐ put in place -

Within 30 days of award, a Final Code of Business Ethics and Conduct in accordance with FAR 52.203-13(b), and

If the organization is a large business, within 90 days of award, a Final Business Ethics Awareness and Compliance Program and Internal Control System (Compliance Program) that meets the criteria set forth in FAR 52.203-13(c); and

The requirements for Business Ethics, Conflict of Interest and Compliance have been, or will be, flowed down to all Subcontractor contracts/agreements.

Print name/title here


Print Name / Title / Date Signature


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ETHICS AND POLICY COMPLIANCE CERTIFICATION


This is to certify that I, __________________________________________, as an employee of The MITRE Corporation currently assigned to participate in the Background Checking Services (RFP No. MITRE-18-06) procurement initiative:

8. recognize the importance of maintaining the confidential nature of MITRE’s process of procurements and, as a member of the team, I agree not to disclose any details of MITRE’s process, evaluation and ranking to anyone outside of MITRE or to any employee within MITRE who does not have a legitimate need-to-know;

9. have read The MITRE Corporation’s Guidelines on Ethics and Procurement (Procurement Policy 1.3.I) and not have any actual, potential, or perceived conflict of interests;

10. as a member of the technical/cost evaluation team involved in a MITRE procurement, am in compliance with Procurement Policy 1.3.I;

11. understand that making an offer of or accepting a tip, money, a kickback, a gift, a thing of value, or compensation of any kind from a supplier as a condition for obtaining favorable treatment from MITRE is a violation of the Corporation’s procurement policies and may lead to disciplinary action up to and including termination;

12. understand that such offers, or acceptances may also be a violation of federal law for which there may be criminal penalties;

13. will carry out my obligations to obey the principles that control MITRE’s procurement functions.

14. understand that this certification covers all aspects and components of any procurement in which I am a participant.

Signature: ____________________________

Date: _______________________________


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Appendix K: Representative Subcontract Agreement Terms and Conditions

REPRESENTATIVE SUBCONTRACT AGREEMENT TERMS AND CONDITIONS

B.1 Applicable LawThis Agreement shall be governed, construed, and enforced in accordance with the laws of the Commonwealth of Virginia without regard to Virginia conflicts of laws rules.

B.2 AssignmentContractor may not assign any Task Order or this Agreement without the prior written approval of MITRE.

B.3 AuditContractor shall maintain a complete audit trail of all financial and non-financial transactions. MITRE reserves the right to audit Contractor and any subcontractors or suppliers for the accuracy of charges and invoices. MITRE, at its discretion, may choose to use its internal audit staff or an outside independent audit firm to perform these audits. Contractor will provide MITRE with reasonable access to its documents, facilities, personnel and subcontractors for the purpose of performing such audits.

B.4 Changes to ContractMITRE and Contractor agree to execute an amendment for any change order issued by MITRE’s Contracting Officer to make changes to any Task Order or this Agreement that do not alter its basic purpose. Any and all such changes will be implemented by Contractor and incorporated at the earliest convenience. Contractor and MITRE will assert any claim for an equitable cost adjustment arising from an additive or deductive change within thirty (30) days from the date of the change. Contractor will not be entitled to an equitable adjustment unless it submits its claim within the 30-day period. Adjustments in costs shall be upon the agreement of the parties and incorporated into the applicable Task Order or this Agreement. During pendency of any claim for cost adjustment, Contractor shall proceed with work. If Contractor believes that any oral or written instruction issued by any MITRE representative (or any representative of a professional or consultant retained by MITRE) constitutes a change to a Task Order or this Agreement, it shall promptly notify MITRE’s Contracting Officer and seek guidance before proceeding with that work. Contractor will not be entitled to an equitable adjustment for any work that constitutes a change unless it follows this notice requirement and is instructed by MITRE’s Contracting Officer to proceed with the work.

B.5 Compliance with Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards [TO BE USED FOR NON-PROFITS AND ACADEMIC INSTITUTIONS (UNIVERSITIES)]

A. Award of this Agreement requires the Contractor’s (Subrecipient) acceptance of, and compliance with the provisions of the Code of Federal Regulations, 2 CFR Part 200.

B. By signature of this Agreement, the Contractor (Subrecipient) certifies that it is in compliance with the requirements of 2 CFR 200, Subpart F, and that the Contractor (Subrecipient) has an internal control structure to provide reasonable assurance that it is managing Federal awards


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in compliance with applicable laws, regulations and subcontract terms, and that it safeguards Federal funds.

C. The Contractor (Subrecipient) agrees to permit independent auditors to have access to records and financial statements as necessary for Customer to comply with 2 CFR 200, Subpart F.

D. In the event that the Contractor’s Audit report cannot be obtained on the Federal Audit Clearing house website, the Contractor (Subrecipient) shall furnish Customer a copy of its audit reports in satisfaction of 2 CFR 200, Subpart F upon request from MITRE.

B.6 Confidential InformationDuring the course of performing this Agreement, Contractor may be given access to information which relates to MITRE’s business activities, products, services, technical knowledge, and sponsors all of which are collectively considered Confidential Information and is privileged and proprietary. Contractor may use this Confidential Information only for the purpose of providing services to MITRE in accordance with this Agreement. Contractor shall not, at any time, use the Confidential Information in any other fashion, form, or manner; provided that “Confidential Information” does not include any information that Contractor can demonstrate (a) is or becomes publicly known through no fault of Contractor; (b) is known by Contractor when disclosed by MITRE if Contractor does not then have a duty to maintain its confidentiality; or (c) is rightfully obtained by Contractor from a third party not obligated to preserve its confidentiality who did not receive the material or information directly or indirectly from MITRE. Contractor shall protect the confidentiality of the Confidential Information in at least the same manner that it protects the confidentiality of its own proprietary and confidential information, and in any event shall take all reasonable measures to prevent improper disclosure of the Confidential Information or any portion thereof. If Contractor receives an order, subpoena or other compulsory legal process from a court or other governmental body that requires disclosure of the Confidential Information, then Contractor shall notify MITRE of the order, subpoena or other compulsory legal process (unless prohibited by law from doing so) and shall assist MITRE in seeking an appropriate protective order in advance of making any such disclosure if so requested of it by MITRE in writing and if circumstances so permit. Contractor agrees to furnish only that portion of the Confidential Information which is legally required (in the opinion of its counsel) . All Confidential Information obtained by Contractor from MITRE shall remain the property of MITRE and shall be returned to it, or destroyed, promptly at MITRE’s request, together with all copies made thereof by Contractor. Upon request, Contractor shall promptly submit to MITRE a certificate of destruction. At MITRE’s discretion, Contractor may be required to enter into a separate non-disclosure agreement for the protection of MITRE’s Confidential Information. Contractor must ensure that its employees and any subcontractors who will be providing services under this Agreement, have read, understood, and agree to abide by the terms of the Confidential Information provision herein.

B.7 Conflict of InterestContractor warrants that there is no conflict of interest with the activities to be performed hereunder and Contractor's other activities and Contractor shall advise MITRE if a conflict of interest arises in the future. In the event a conflict of interest is possible or the appearance of a conflict, Contractor shall notify MITRE prior to initiation and MITRE shall make a determination as to whether a conflict of interest exists. Further, the Contractor shall comply with the terms and


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conditions of H.4, Business Ethics, Conflict of Interest and Compliance, under Exhibit C, Applicable Prime Contract Clauses.

B.8 DisputesIf any dispute arises under this Agreement that is not settled promptly in the ordinary course of business, the parties shall seek to resolve any such dispute between them by negotiation promptly with each other in good faith in face-to-face negotiations. The parties’ obligations thereunder shall continue as required during the pendency of any dispute and subsequent legal action.

In no event shall Contractor acquire any direct claim or direct course of action against the U. S. Government.

B.9 Enforceability If any portion or provision of this Agreement shall to any extent be declared illegal or unenforceable by a court of competent jurisdiction, the remainder of this Agreement, or the application of such portion or provision in circumstances other than those as to which it is so declared illegal or unenforceable, shall not be affected thereby, and each portion and provision of this Agreement shall be valid and enforceable to the fullest extent permitted by law.

B.10 Equal Employment Opportunity

A. Contractor shall comply with all federal, state, and local Equal Opportunity and Non-Discrimination laws, rules, and regulations.

B. Affirmative Action and Nondiscrimination Commitments

As applicable, this contractor and subcontractor shall abide by the requirements of 41 CFR §§ 60-1.4(a), 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, sex, or national origin. Moreover, these regulations require that covered prime contractors and subcontractors take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, protected veteran status or disability.

B.11 Export/Import ControlNotwithstanding any other provision of this Agreement, Contractor agrees to comply with all applicable export and import laws and regulations of the United States, including, but not limited to, the International Traffic in Arms Regulations (ITAR) and the Export Administration Regulations (EAR), and the export and import laws and regulations of any other countries having jurisdiction over the activities contemplated under this Agreement. This Agreement may involve information or items that are subject to the ITAR or the EAR and that may not be released to foreign persons, as defined in 22 C.F.R. § 120.16, inside or outside of the United States without proper export authority. Contractor further agrees that, if required under 22 C.F.R. § 122.1, it will maintain a registration as a manufacturer or exporter of defense articles and/or defense services with the Directorate of Defense Trade Controls (DDTC), such registration generally


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being a precondition to the issuance of an export authorization by DDTC or the use of an exemption under the ITAR.

If applicable, Contractor has obtained/confirmed the applicability of, or will obtain/confirm, and properly use any and all required U.S. Government or foreign government export and/or import authorizations that are necessary for Contractor to perform this Agreement. MITRE will cooperate with Contractor in obtaining and/or maintaining any such export authorizations.

Contractor will cooperate with MITRE in obtaining and/or maintaining any export authorizations that may be necessary for MITRE to carry out this Agreement.

Contractor shall indemnify MITRE its officers, directors, trustees, agents and employees, and holds each of them harmless from and against all liabilities, penalties, losses, damages, costs, attorney fees, or other fees or expenses that may be imposed on incurred by MITRE in connection with any violation of applicable export or import laws and regulations by Contractor.

B.12 Force Majeure“Force Majeure” as used herein, shall mean an act of God, strike, lockout, or other industrial disturbance, act of the public enemy, war, terrorist attack, epidemic, blockage, public riot, lightning, fire, flood, explosion, failure to timely receive necessary government approvals, government restraint, unavailability of equipment, and any other cause, whether of the specifically enumerated above or otherwise, which is not reasonably within the control of the party claiming suspension. If either party is rendered unable, wholly or in part, by Force Majeure to carry out its obligations under any Task Order or this Agreement, such party shall give to the other party prompt written notice of the Force Majeure with reasonably full particulars covering it; thereupon, the obligations of the party giving notice, so far as they were affected by Force Majeure, shall be suspended during, but no longer than, the continuance of the Force Majeure. The party experiencing the Force Majeure shall use all possible diligence to remove and have the duty to overcome the effect of the Force Majeure as quickly as possible.

B.13 GratuitiesThis Agreement may be immediately terminated, after reasonable notice and warning, if Contractor, its officers, agents, employees or any of its representatives are found to have extended or received a gratuity of any form to any officer or employee of MITRE.

B.14 IndemnificationContractor agrees to indemnify MITRE, its officers, directors, trustees, agents, and employees and hold each of them forever harmless from and against all claims, costs, damages, attorney’s fees, other fees, expenses, and liabilities of any nature or kind arising out of or in any way connected with Contractor’s performance, acts, or omissions under this Agreement including, but not limited to, the use of MITRE’s premises by Contractor, its officers, agents, employees, subcontractors, business invitees or guests, resulting in injury to persons (including death) or loss of or damage to property; and alleged infringement of third-party property rights in Contractor’s products or services. Contractor shall have no indemnity obligation to the extent such claims, costs, damages, attorney’s fees, other fees, expenses, and liabilities are caused by the negligent acts or omissions of MITRE, its officers, directors, trustees, agents, and employees.


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B.15 Insurance Requirements

A. Workers’ Compensation and Employer’s Liability. Contractor shall maintain Workers’ Compensation insurance that complies with applicable federal and state Worker’s Compensation and occupational disease statutes upon the employment of greater than two employees, including the owner. Such coverage shall also include Employer’s Liability coverage of at least US $1,000,000.

B. Commercial General Liability. Contractor shall secure Commercial General Liability insurance. The policy should be written on an occurrence form, including broad form blanket contractual liability, for claims arising out of work hereunder for bodily injury/property damage, products and completed operations and personal and advertising injury with limits of no less than US $1,000,000 per occurrence and US $2,000,000 in the aggregate. Coverage applies on a primary and non-contributory basis as respects any other insurance, deductible, or self-insurance available to the insured. The limits of liability shall be as stated herein unless prior to commencement of any work written approval is granted by MITRE for variance from those limits.

C. Business Automobile Liability. Contractor shall secure Business Automobile Liability insurance for bodily injury and property damage for the operation of all owned/rented/non-owned automobiles operating in the United States. Coverage shall include a limit of not less than US $1,000,000 combined single limit.

D. Commercial Umbrella. Contractor shall secure Commercial Umbrella coverage providing excess liability insurance for the underlying Employer’s Liability, Commercial General Liability, and Business Automobile Liability with limits of at least US $5,000,000.

E. Commercial Crime (Employee Dishonesty). Contractor shall secure Commercial Crime insurance with limits of at least US $250,000 each loss which includes a third-party endorsement covering theft of MITRE’s property or MITRE’s customer’s property by Contractor’s employees, agents, etc.

F. Professional Liability/Errors and Omissions. Contractor shall secure Professional Liability/Errors and Omissions insurance with limits of at least US $1,000,000 per loss and in the aggregate. If the Professional Liability is written on claims-made form, coverage must be maintained for minimum of three years after completion of work.

G. Cyber/Data Privacy Liability. Contractor shall secure Cyber/Data Privacy liability insurance in an amount not less than US $1,000,000 per occurrence, covering liability arising from or out of the services provided under this Agreement to include coverage for, but not be limited to, the following as applicable, Internet and network liability (providing protection against liability for system attacks; denial or loss of service; introduction, implantation, or spread of malicious software code; and unauthorized access and use), infringement of privacy or


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intellectual property rights, internet advertising and content offenses, defamation, errors or omissions in software and/or systems development, implementation and maintenance.

H. Commercial Property/Transit Insurance. Contractor shall insure against all risks of loss or damage to MITRE property in its care, custody or control or that it transports on behalf of MITRE based on the limit of US $___ (At a minimum this amount will be the funded level and will be filled in at the time of contract execution). Coverage should be written on a replacement cost basis and endorsed to include MITRE as loss payee as its interest may appear.

I. Upon request, certified copies of said policies or certificates evidencing such insurance and naming MITRE as additional insured will be made available to MITRE. Contractor shall include “The MITRE Corporation, their Officers, Trustees and Employees” as an additional insured on these policies relating to the work being performed by Contractor. Certificates shall be current throughout the Term, shall reflect a Waiver of Subrogation in favor of MITRE, and provide for at least thirty (30) days written notice of cancellation or non-renewal by the insurer(s).

B.16 Intellectual Property Ownership

A. For purposes of this Agreement, "Intellectual Property" means any invention, discovery, development, method, process, composition, work of authorship, concept, trade secret, and know how (whether or not patentable or copyrightable) conceived, made, created, authored, developed, or reduced to practice by Contractor under this Agreement that in any way is related to, suggested by, or otherwise results from Contractor’s performance under this Agreement, or from any Confidential Information Contractor obtained pursuant to this Agreement.

B. Contractor shall promptly and fully disclose to MITRE in writing all Intellectual Property upon such Intellectual Property’s creation. The parties understand that any and all Intellectual Property of whatever form developed by Contractor pursuant to this Agreement are works made for hire for the benefit of MITRE. Upon creation such Intellectual Property, as well as corresponding patent applications, patents, and copyrights, are the property of MITRE and Contractor hereby assigns to MITRE Contractor’s full right, title, and interest to all rights in the Intellectual Property.

C. Contractor agrees to execute any and all documents related to domestic and foreign patents, copyrights, or other proprietary rights and to do such other acts (including without limitation the signing of declarations, oaths, and assignments in favor of MITRE and the execution and delivery of instruments of further assurance or confirmation) requested by MITRE to assign the Intellectual Property to MITRE and to permit MITRE to secure, enforce, or convey such Intellectual Property rights. MITRE will reimburse Contractor for reasonable expenses incurred in meeting such obligations.


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D. In the event MITRE waives its title to or ownership in any Intellectual Property, Contractor hereby grants to MITRE and, where this Agreement is a subcontract under a Government contract, to the U.S. Government, and to its officers, agents, and employees acting within the scope of their official duties, a royalty-free, non-exclusive, worldwide, and irrevocable license to reproduce, translate, publish, distribute, use and dispose of, and to authorize others to do so, all Intellectual Property created under this Agreement by Contractor.

E. Contractor agrees to exert all reasonable effort to advise MITRE of any third-party property rights, including patents and copyrights, incorporated into any work product, information, documentation, or supplies furnished by Contractor to MITRE under this Agreement. Contractor further agrees to report to MITRE promptly, in reasonable written detail, any claim or liability made upon or incurred by Contractor related to Contractor’s performance under this Agreement.

B.17 Limitation on Payments to Influence Certain Federal TransactionsIt is prohibited for Contractor to use appropriated funds to pay any person to influence the awarding of any Federal Action which includes a Federal Contract or an extension of any Federal Contract. Any violation of the above shall be considered a breach of this Agreement, grounds for termination, and be subject to Civil Penalties.

B.18 No Waiver of ConditionsNo waiver of any provision hereof shall be effective unless made in writing and signed by the waiving party. The failure of either party to require the performance of any term or obligation of this Agreement, or the waiver by either party of any breach of this Agreement, shall not prevent any subsequent enforcement of such term or obligation or be deemed a waiver of any subsequent breach

B.19 Personnel Requirements -Omitted Intentionally

B.20 Privacy-Information SecurityContractor may from time to time have access to Personal Information (as defined below) stored or maintained by MITRE in connection with services render pursuant to this Agreement. As used herein, the term “Personal Information” shall mean a natural person’s first name and last name, or first initial and last name, in combination with any one or more of the following data elements that relate to such person: (a) Social Security number; (b) driver’s license number or state identification card number issued in lieu of a driver’s license; (c) financial account number, or credit or debit card number (with or without any security code, access code, access device, personal identification number or password that would permit access to the account); or (d) any information regarding the person’s medical history, medical treatment or diagnosis by a health care professional; provided, however, that “Personal Information” shall not include information that is lawfully obtained from publicly available information, or from federal, state or local government records lawfully made available to the general public. Contractor hereby represents and warrants that, with respect to Personal Information that is collected, transmitted or maintained by Contractor on behalf of MITRE or MITRE’s customers/sponsors, Contractor has implemented and will maintain reasonable and appropriate administrative, physical and technical safeguards to (i) protect the security and confidentiality of Personal Information; (ii) protect against any anticipated threats or hazards to the security or integrity of Personal Information; (iii)


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protect against unauthorized access to or use of Personal Information; and (iv) otherwise ensure compliance with the applicable portions of the federal Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), as it may be amended, and any regulations promulgated thereunder, and 201 C.M.R. 17.00 (Standards for The Protection of Personal Information of Residents of the Commonwealth of Massachusetts). MITRE has the right to inspect and assess Contractor’s safeguards upon prior written notice to ensure compliance with MITRE’s required safeguards. If applicable, Contractor agrees to execute within ten (10) business days MITRE’s standard HIPAA business associate agreement. Contractor shall notify MITRE immediately, and in no event later than one (1) business day, after Contractor becomes aware of a possible security breach with respect to such Personal Information. Contractor agrees that MITRE shall have sole control of any data security breach notification regarding its Personal Information required by applicable law. At MITRE’s request, Contractor shall investigate and remediate any data security breach affecting MITRE’s Personal Information caused by Contractor or Contractor’s agents, all at Contractor’s sole expense. Contractor shall return or in writing confirm the cryptographic destruction of all Personal Information within thirty (30) days of the termination or conclusion of the Task Order.

B.21 Relationship of the PartiesThe relationship of the parties is such that Contractor is an independent contractor. The relationship of the parties shall not be deemed to be any other relationship including, but not limited to, partnership, joint employers, joint venture, or principal and agent. Contractor personnel, whether performing Services on-site at MITRE’s premises or off-site at Contractor’s premises, shall be considered at all times employees of Contractor and not employees of MITRE.

B.22 Release of InformationNews releases and media contacts including photographs and films, public announcements or other forms of publicity concerning any part of this Agreement or use of the name of MITRE, The MITRE Corporation, or the Government customer will not be made without the prior approval of the MITRE Contracting Officer.

Prior to release of any information concerning the details, results, or conclusions made during the performance of this Agreement, Contractor shall submit to the Contracting Officer, for review and approval, at least sixty (60) days prior to Contractor’s expected release date, a copy of the full text material to be published or distributed. This provision also applies to any subcontractors or consultants providing technical assistance under this Agreement.

B.23 Safety and Security Regulations Contractor’s employees shall comply with all applicable U.S. Government and MITRE security and safety regulations. Contractor’s employees shall not remove any classified material or MITRE proprietary information from MITRE or U.S. Government facilities. Contractor’s employees shall not disclose classified information to unauthorized persons, either on or off the premises of MITRE.

B.24 Termination Rights and Obligations

A. Termination for Convenience


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MITRE may terminate a Task Order or this Agreement, in whole or in part, at any time, in its sole discretion and without default on the part of Contractor, when MITRE determines that it is in MITRE’s best interest to do so. In such event, MITRE shall terminate the Task Order or this Agreement for convenience by giving Contractor written notice of the termination. Unless the termination notice specifies another date, the termination shall become effective upon Contractor’s receipt of the notice. Contractor shall stop work on the effective date of the termination.

If a Task Order or the Agreement is terminated for convenience, MITRE shall have no obligation to make any payments to Contractor, for any reason, other than the payments expressly described above. Without limiting the generality of this principle, MITRE shall have no obligation to pay any compensation that would have been payable under the Task Order or the Agreement had it not been terminated, or any Contractor liabilities to subcontractors arising out of the termination.

B. Termination for Default

MITRE may terminate a Task Order or this Agreement for default, in whole or in part, subject to the cure provisions set forth below, if Contractor fails to: (1) maintain the standard of performance required by the Task Order and this Agreement; (2) provide adequate staff to perform the Services required by the Task Order; or (3) comply with any covenants, specifications, conditions, procedures, or other requirements of the Task Order or this Agreement. In such event, MITRE shall have the right in its sole discretion to terminate the Task Order or this Agreement for default by giving Contractor written notice of the termination, which will become effective upon Contractor’s receipt of the notice. Contractor shall stop work on the effective date of the termination. In addition, and notwithstanding the foregoing, in the event of Contractor’s filing of bankruptcy or filing for the protection against creditors, MITRE may terminate this Agreement for default without any cure period.

Prior to terminating a Task Order or the Agreement for default, MITRE shall send Contractor a written notice specifying the Contractor’s performance failure. MITRE may terminate for default if the Contractor does not cure the failure within thirty (30) days (or any longer period authorized in writing by MITRE).

If a Task Order or the Agreement is terminated for default by MITRE, MITRE shall have available to it all rights, remedies, and damages available to it at law or otherwise under this Agreement.

If a Task Order or the Agreement is terminated for default, MITRE shall have no obligation to make any payments to Contractor except through the date of termination, for any reason pursuant to this Agreement or otherwise. Contractor shall have no further claims against MITRE. Without limiting the generality of this principle, MITRE shall have no obligation to pay any compensation that would have been payable under the Task Order or the Agreement had it not been terminated, or any Contractor liabilities to subcontractors arising out of the termination. Contractor shall be liable for actual damages incurred by MITRE as a result of Contractor’s default.


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If, after termination, it is finally determined, pursuant to the disputes resolution procedure applicable to this Agreement, that Contractor was not in default, the rights and obligations of the parties shall be the same as if the Task Order or the Agreement had been terminated for convenience as of the date of the termination for default notice.

C. Upon the termination of a Task Order or this Agreement, to the extent directed by MITRE, Contractor shall transfer title to and deliver to MITRE any completed or partially completed supplies, materials, plans, drawings, reports, analyses, information, contract rights, or other items specifically produced or acquired for purposes of the Task Order or this Agreement, and title to such items will automatically vest in MITRE, upon notice from MITRE, to the extent MITRE does not already hold title. All rights and obligations of the parties under the Task Order or this Agreement shall cease, except as expressly provided otherwise in the Task Order or this Agreement and those that by their nature survive termination or expiration of the Task Order or this Agreement.

B.25 WarrantiesNotwithstanding inspection and acceptance by MITRE or any provision concerning the conclusive evidence thereof, Contractor warrants that all Services performed under each Task Order will, at the time of acceptance, be free from defects in workmanship and conform to the requirements of the Task Order or this Agreement. The Contracting Officer shall give written notice of any defect or non-conformance to Contractor within thirty (30) days from the date of receipt by MITRE. This notice shall state either (1) that the Contractor shall correct or re-perform any defective or non-conforming Services, or (2) that MITRE does not require correction or re-performance.

If Contractor is required to correct or re-perform, it shall be at no cost to MITRE, and any Services corrected or re-performed by Contractor shall be subject to this clause to the same extent as work initially performed. If Contractor fails or refuses to correct or re-perform, the Contracting Officer may, by contract or otherwise, correct or replace with similar services and charge to Contractor the cost occasioned to MITRE thereby, or make an equitable adjustment in the contract price of the Task Order.

If MITRE does not require correction or re-performance, the Contracting Officer shall make an equitable adjustment in the contract price.


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Appendix L: Representations and Certifications


Representations and Certifications

IF YOUR FIRM IS REGISTERED ON THE SAM.GOV SITE (SYSTEM FOR AWARD MANAGEMENT) INCLUDE A COPY WITH YOUR PROPOSAL IN LIEU OF COMPLETING THIS EXHIBIT.

Company Name and Address of Offeror:

_ _______________________

_ _______________________

Point of Contact: _______________

Telephone Number: _____________

Facsimile Number: _____________

By signing below, the Offeror certifies, by and through its indicated representative, that all of the Representations and Certifications are accurate, current and complete.

______________Signature of Authorized Representative Date

____________________________________Name and Title of Authorized Representative

An offeror shall complete only paragraph (b) of this provision if the offeror has completed the annual representations and certifications electronically via https://www.acquisition.gov. If an offeror has not


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completed the annual representations and certifications electronically at the System for Award Management (SAM) website, the offeror shall complete only paragraphs (c) through (o) of this provision.

(a) Definitions. As used in this provision—

“Economically disadvantaged women-owned small business (EDWOSB) concern” means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

“Forced or indentured child labor” means all work or service—

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

“Inverted domestic corporation”, as used in this section, means a foreign incorporated entity which is treated as an inverted domestic corporation under 6 U.S.C. 395(b), i.e., a corporation that used to be incorporated in the United States, or used to be a partnership in the United States, but now is incorporated in a foreign country, or is a subsidiary whose parent corporation is incorporated in a foreign country, that meets the criteria specified in 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c). An inverted domestic corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code at 26 U.S.C. 7874.

“Manufactured end product” means any end product in Federal Supply Classes (FSC) 1000-9999, except—

(1) FSC 5510, Lumber and Related Basic Wood Materials;

(2) Federal Supply Group (FSG) 87, Agricultural Supplies;

(3) FSG 88, Live Animals;

(4) FSG 89, Food and Related Consumables;

(5) FSC 9410, Crude Grades of Plant Materials;

(6) FSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) FSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) FSC 9610, Ores;

(9) FSC 9620, Minerals, Natural and Synthetic; and

(10) FSC 9630, Additive Metal Materials.

“Place of manufacture” means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

“Restricted business operations” means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174).


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Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate—

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended.

“Sensitive technology”—

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically—

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

“Service-disabled veteran-owned small business concern”—

(1) Means a small business concern—

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).

“Small business concern” means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

“Subsidiary” means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or


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(2) Through another subsidiary of a parent corporation.

“Veteran-owned small business concern” means a small business concern—

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more veterans.

“Women-owned business concern” means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

“Women-owned small business concern” means a small business concern—

(1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and

(2) Whose management and daily business operations are controlled by one or more women.

“Women-owned small business (WOSB) concern eligible under the WOSB Program” (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States.

(b)

(1) 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 SAM website.

(2) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through https://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of this offer that the representations 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 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 _ _____________.

[Offeror to identify the applicable paragraphs at (c) through (o) 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, accurate, and complete as of the date of this offer.


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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 electronically on SAM.]

(c) Offerors must complete the following representations when the resulting contract will be performed in the United States or its outlying areas. Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that it is, is not a small business concern.

(2) Veteran-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it is, is not a veteran-owned small business concern.

(3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it is, is not a service-disabled veteran-owned small business concern.

(4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, for general statistical purposes, that it is, is not a small disadvantaged business concern as defined in 13 CFR 124.1002.

(5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it is, is not a women-owned small business concern.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that—

(i) It is, is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It is, is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: .] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

(7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that—


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(i) It is, is not an EDWOSB concern, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It is, is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: _____.] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.

Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

(8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it is a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price:_ ______________

(10) [Complete only if the solicitation contains the clause at FAR 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns, or FAR 52.219-25, Small Disadvantaged Business Participation Program—Disadvantaged Status and Reporting, and the offeror desires a benefit based on its disadvantaged status.]

(i) General. The offeror represents that either—

(A) It is, is not certified by the Small Business Administration as a small disadvantaged business concern and identified, on the date of this representation, as a certified small disadvantaged business concern in the SAM Dynamic Small Business Search database maintained by the Small Business Administration, and that no material change in disadvantaged ownership and control has occurred since its certification, and, where the concern is owned by one or more individuals claiming disadvantaged status, the net worth of each individual upon whom the certification is based does not exceed $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); or

(B) It has, has not submitted a completed application to the Small Business Administration or a Private Certifier to be certified as a small disadvantaged business concern in accordance with 13 CFR 124, Subpart B, and a decision on that application is pending, and that no material change in disadvantaged ownership and control has occurred since its application was submitted.

(ii) Joint Ventures under the Price Evaluation Adjustment for Small Disadvantaged Business Concerns. The offeror represents, as part of its offer, that it is a joint venture that complies with the requirements in 13 CFR 124.1002(f) and that the representation in paragraph (c)(10)(i) of this provision is accurate for the small disadvantaged business concern that is participating in the joint venture. [The offeror shall enter the name of the small disadvantaged business concern that is participating in the joint venture: __.]

(11) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that—


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(i) It is, is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR Part 126; and

(ii) It is, is not a HUBZone joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (c)(11)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture. [The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture: ___.] Each HUBZone small business concern participating in the HUBZone joint venture shall submit a separate signed copy of the HUBZone representation.

(d) Representations required to implement provisions of Executive Order 11246—

(1) Previous contracts and compliance. The offeror represents that—

(i) It has, has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; and

(ii) It has, has not filed all required compliance reports.

(2) Affirmative Action Compliance. The offeror represents that—

(i) It has developed and has on file, has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor (41 cfr parts 60-1 and 60-2), or

(ii) It has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

(e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 1352). (Applies only if the contract is expected to exceed $150,000.) By submission of its offer, the offeror certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress on his or her behalf in connection with the award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made.

(f) Buy American Act Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy American Act—Supplies, is included in this solicitation.)

(1) The offeror certifies that each end product, except those listed in paragraph (f)(2) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.” The terms “commercially available off-the-shelf (COTS) item” “component,” “domestic end product,” “end product,” “foreign end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American Act—Supplies.”


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(2) Foreign End Products:

Line Item No. Country of Origin

_ ___________ _______________

_ ____________ ________________

_ ____________ ________________

[List as necessary]

(3) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25.

(g)(1) Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy American Act—Free Trade Agreements—Israeli Trade Act, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms “Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product,” “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” “Free Trade Agreement country,” “Free Trade Agreement country end product,” “Israeli end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American Act—Free Trade Agreements–Israeli Trade Act.”

(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American Act—Free Trade Agreements—Israeli Trade Act”:

Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:


_ ___________ _______________

_ ____________ ________________

_ ____________ ________________

[List as necessary]

(iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(1)(ii) of this provision) as defined in the clause of this solicitation entitled “Buy American Act—Free Trade Agreements—Israeli Trade Act.” The offeror shall list as other foreign end products


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those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.”

Other Foreign End Products:


_ ___________ _______________

_ ____________ ________________

_ ____________ ________________

[List as necessary]

(iv) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25.

(2) Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate, Alternate I. If Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled “Buy American Act—Free Trade Agreements—Israeli Trade Act”:

Canadian End Products:

Line Item No.

___________________________________

___________________________________

___________________________________

[List as necessary]

(3) Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate, Alternate II. If Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled “Buy American Act—Free Trade Agreements—Israeli Trade Act”:

Canadian or Israeli End Products:



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_________ _________________

_________ _________________

_________ _________________

[List as necessary]

(4) Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate, Alternate III. If Alternate III to the clause at 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American Act-Free Trade Agreements-Israeli Trade Act”:

Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:


_________ _________________

_________ _________________

_________ _________________

[List as necessary]

(5) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) of this provision, is a U.S.-made or designated country end product, as defined in the clause of this solicitation entitled “Trade Agreements.”

(ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country end products.

Other End Products:


_________ _________________

_________ _________________

_________ _________________

[List as necessary]


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(iii) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American Act. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fulfill the requirements of the solicitation.

(h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals—

(1) Are, are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(2) Have, have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property;

(3) Are, are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and

(4) Have, have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,000 for which the liability remains unsatisfied.

(i) Taxes are considered delinquent if both of the following criteria apply:

(A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

(ii) Examples.

(A) The taxpayer has received a statutory notice of deficiency, under I.R.C. §6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.


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(B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. §6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(C) The taxpayer has entered into an installment agreement pursuant to I.R.C. §6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment.

(D) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. §362 (the Bankruptcy Code).

(i) Certification Regarding Knowledge of Child Labor for Listed End Products (Executive Order 13126). [The Contracting Officer must list in paragraph (i)(1) any end products being acquired under this solicitation that are included in the List of Products Requiring Contractor Certification as to Forced or Indentured Child Labor, unless excluded at 22.1503(b).]

(1) Listed end products.

Listed End Product Listed Countries of Origin

_ __________________ ___________________

_ __________________ ___________________

(2) Certification. [If the Contracting Officer has identified end products and countries of origin in paragraph (i)(1) of this provision, then the offeror must certify to either (i)(2)(i) or (i)(2)(ii) by checking the appropriate block.]

(i) The offeror will not supply any end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product.

(ii) The offeror may supply an end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. The offeror certifies that it has made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or manufacture any such end product furnished under this contract. On the basis of those efforts, the offeror certifies that it is not aware of any such use of child labor.

(j) Place of manufacture. (Does not apply unless the solicitation is predominantly for the acquisition of manufactured end products.) For statistical purposes only, the offeror shall indicate whether the place of manufacture of the end products it expects to provide in response to this solicitation is predominantly—


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(1) In the United States (Check this box if the total anticipated price of offered end products manufactured in the United States exceeds the total anticipated price of offered end products manufactured outside the United States); or

(2) Outside the United States.

(k) Certificates regarding exemptions from the application of the Service Contract Act. (Certification by the offeror as to its compliance with respect to the contract also constitutes its certification as to compliance by its subcontractor if it subcontracts out the exempt services.) [The contracting officer is to check a box to indicate if paragraph (k)(1) or (k)(2) applies.]

(1) Maintenance, calibration, or repair of certain equipment as described in FAR 22.1003-4(c)(1). The offeror o does or does not certify that—

(i) The items of equipment to be serviced under this contract are used regularly for other than Governmental purposes and are sold or traded by the offeror (or subcontractor in the case of an exempt subcontract) in substantial quantities to the general public in the course of normal business operations;

(ii) The services will be furnished at prices which are, or are based on, established catalog or market prices (see FAR 22.1003-4(c)(2)(ii)) for the maintenance, calibration, or repair of such equipment; and

(iii) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract will be the same as that used for these employees and equivalent employees servicing the same equipment of commercial customers.

(2) Certain services as described in FAR 22.1003-4(d)(1). The offeror o does or does not certify that—

(i) The services under the contract are offered and sold regularly to non-Governmental customers, and are provided by the offeror (or subcontractor in the case of an exempt subcontract) to the general public in substantial quantities in the course of normal business operations;

(ii) The contract services will be furnished at prices that are, or are based on, established catalog or market prices (see FAR 22.1003-4(d)(2)(iii));

(iii) Each service employee who will perform the services under the contract will spend only a small portion of his or her time (a monthly average of less than 20 percent of the available hours on an annualized basis, or less than 20 percent of available hours during the contract period if the contract period is less than a month) servicing the Government contract; and

(iv) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract is the same as that used for these employees and equivalent employees servicing commercial customers.

(3) If paragraph (k)(1) or (k)(2) of this clause applies—


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(i) If the offeror does not certify to the conditions in paragraph (k)(1) or (k)(2) and the Contracting Officer did not attach a Service Contract Act wage determination to the solicitation, the offeror shall notify the Contracting Officer as soon as possible; and

(ii) The Contracting Officer may not make an award to the offeror if the offeror fails to execute the certification in paragraph (k)(1) or (k)(2) of this clause or to contact the Contracting Officer as required in paragraph (k)(3)(i) of this clause.

(l) Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701). (Not applicable if the offeror is required to provide this information to the SAM database to be eligible for award.)

(1) All offerors must submit the information required in paragraphs (l)(3) through (l)(5) of this provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the Internal Revenue Service (IRS).

(2) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror’s relationship with the Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror’s TIN.

(3) Taxpayer Identification Number (TIN).

TIN: _ __.

TIN has been applied for.

TIN is not required because:

Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States;

Offeror is an agency or instrumentality of a foreign government;

Offeror is an agency or instrumentality of the Federal Government.

(4) Type of organization.

Sole proprietorship;

Partnership;

Corporate entity (not tax-exempt);

Corporate entity (tax-exempt);

Government entity (Federal, State, or local);

Foreign government;

International organization per 26 CFR 1.6049-4;


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Other ________________________________.

(5) Common parent.

Offeror is not owned or controlled by a common parent;

Name and TIN of common parent:

Name ____________.

TIN ________.

(m) Restricted business operations in Sudan. By submission of its offer, the offeror certifies that the offeror does not conduct any restricted business operations in Sudan.

(n) Prohibition on Contracting with Inverted Domestic Corporations.

(1) Relation to Internal Revenue Code. An inverted domestic corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code 25 U.S.C. 7874.

(2) Representation. By submission of its offer, the offeror represents that—

(i) It is not an inverted domestic corporation; and

(ii) It is not a subsidiary of an inverted domestic corporation.

(o) Prohibition on contracting with entities engaging in certain activities or transactions relating to Iran.

(1) The offeror shall e-mail questions concerning sensitive technology to the Department of State at [email protected].

(2) Representation and Certifications. Unless a waiver is granted or an exception applies as provided in paragraph (o)(3) of this provision, by submission of its offer, the offeror—

(i) Represents, to the best of its knowledge and belief, that the offeror does not export any sensitive technology to the government of Iran, or any entities or individuals owned or controlled by, or acting on behalf or at the direction of, the government of Iran;

(ii) Certifies that the offeror, or any person owned or controlled by the offeror, does not engage in any activities for which sanctions may be imposed under section 5 of the Iran Sanctions Act; and

(iii) Certifies that the offeror, and any person owned or controlled by the offeror, does not knowingly engage in any transaction that exceeds $3,000 with Iran's Revolutionary Guard Corps or any of its officials, agents, or affiliates, the property and interests in property of which are blocked pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.) (see OFAC's Specially Designated Nationals and Blocked Persons List at http://www.treasury.gov/ofac/downloads/t11sdn.pdf).

(3) The representation and certification requirements of paragraph (o)(2) of this provision do not apply if—


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(i) This solicitation includes a trade agreements certification (e.g., 52.212-3(g) or a comparable agency provision); and

(ii) The offeror has certified that all the offered products to be supplied are designated country end products.

(End of provision)

Alternate I (Apr 2011). As prescribed in 12.301(b)(2), add the following paragraph (c)(12) to the basic provision:

(12) (Complete if the offeror has represented itself as disadvantaged in paragraph (c)(4) or (c)(10) of this provision.)

[The offeror shall check the category in which its ownership falls]:

Black American.

Hispanic American.

Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians).

Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, U.S. Trust Territory of the Pacific Islands (Republic of Palau), Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru).

Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal).

Individual/concern, other than one of the preceding.

Alternate II (Jan 2012). As prescribed in 12.301(b)(2), add the following paragraph (c)(10)(iii) to the basic provision:

(iii) Address. The offeror represents that its address o is, o is not in a region for which a small disadvantaged business procurement mechanism is authorized, and its address has not changed since its certification as a small disadvantaged business concern or submission of its application for certification. The list of authorized small disadvantaged business procurement mechanisms and regions is posted at http://www.acquisition.gov/References/sdbadjustments.htm. The offeror shall use the list in effect on the date of this solicitation. “Address,” as used in this provision, means the address of the offeror as listed on the Small Business Administration’s register of small disadvantaged business concerns or the address on the completed application that the concern has submitted to the Small Business Administration or a Private Certifier in accordance with 13 CFR Part 124, subpart B. For joint ventures, “address” refers to the address of the small disadvantaged business concern that is participating in the joint venture.


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Documents

Replicating Pregnancy Prevention Programs · Web viewRequire all health educators delivering the Contractor’s program receive the MITRE webinar training on completing the Health