Performance Work Statement (PWS) Maine VA Healthcare System VELA Move+ Ophthalmology Chair Introduction The VA Maine HCS requires the delivery of thirteen (13) VELA Move+ Ophthalmology Chairs to Togus VA Medical Center, 1 VA Center, Augusta, ME 04330-6796. Background Our goal in the VA is to provide veterans the world-class benefits and services they have earned and to do so by adhering to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship. The Eye clinics do not currently have an appropriate chair to complete testing and move the patients between equipment. This poses a risk to not only our veterans and staff but is also a risk of damaging equipment that is costly. Scope (Provide an overview of the PWS emphasizing the most important aspects of your requirement and defining the boundaries of the contractor s performance responsibilities). The VELA Move+ Ophthalmology Chair is ideal for transporting patients between different examinations quickly and safely especially for patient with mobility difficulties. The patient only needs to sit down and get up from the chair once, which speeds up the examination process. It enhances patient flow for the elderly or patients with a walking impairment who have difficulty walking from one examination to another. Furthermore, the patient chair avoids straining ophthalmic staff in favor of supporting patients when moving from one examination to the next. The VELA Move+ Ophthalmology Chair features the following features such as: Ophthalmology chair improves examination conditions Effective patient flow with an adjustable ophthalmic chair Great service for wheelchair users and weak patients Lockable chair base provides secure patient positioning Large seat and backrest Smooth-running wheels and push bar Applicable Directives (List all documents referenced in the next section 5.0, Performance Requirements, with which the contractor will have to comply in performance of the contract effort. If only portions of a given document apply, specifically identify the applicable portions). The system must meet the manufacturer s specifications and be designed and implemented within the vendors 510K system design as an FDA regulated medical device/system. Performance Requirements (Identify what the contractor is required to do (major tasks and subtasks). The vendor will provide the VELA Move+ Ophthalmology Chair as specified in the quote provided. No additional requirements for these units. Deliverables (List all data required to manage or monitor contractor performance). Vendor will provide a Standard 1-Year Warranty and shipping is included in the cost of the chairs. Records Management Language for Statement of Work (SOW): The following standard items relate to records generated in executing the contract and should be included in a typical procurement contract: 1. Citations to pertinent laws, codes and regulations such as 44 U.S.C chapters 21, 29, 31 and 33; Freedom of Information Act (5 U.S.C. 552); Privacy Act (5 U.S.C. 552a); 36 CFR Part 1222 and Part 1228. 2. Contractor shall treat all deliverables under the contract as the property of the U.S. Government for which the Government Agency shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. 3. Contractor shall not create or maintain any records that are not specifically tied to or authorized by the contract using Government IT equipment and/or Government records. 4. Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected by the Freedom of Information Act. 5. Contractor shall not create or maintain any records containing any Government Agency records that are not specifically tied to or authorized by the contract. 6. The Government Agency owns the rights to all data/records produced as part of this contract. 7. The Government Agency owns the rights to all electronic information (electronic data, electronic information systems, electronic databases, etc.) and all supporting documentation created as part of this contract. Contractor must deliver sufficient technical documentation with all data deliverables to permit the agency to use the data. 8. Contractor agrees to comply with Federal and Agency records management policies, including those policies associated with the safeguarding of records covered by the Privacy Act of 1974. These policies include the preservation of all records created or received regardless of format [paper, electronic, etc.] or mode of transmission [e-mail, fax, etc.] or state of completion [draft, final, etc.]. 9. No disposition of documents will be allowed without the prior written consent of the Contracting Officer. The Agency and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. Records may not be removed from the legal custody of the Agency or destroyed without regard to the provisions of the agency records schedules. 10. Contractor is required to obtain the Contracting Officers approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, this contract. The Contractor (and any sub-contractor) is required to abide by Government and Agency guidance for protecting sensitive and proprietary information.

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