Veteran Satisfaction Survey Services Agreement between Department of Veterans Affairs and National Research Corporation
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The Department of Veterans Affairs has entered into a contract with National Research Corporation to provide Veteran Satisfaction Surveys for the Performance Analysis Center for Excellence (PACE) in North Carolina. The contract runs from January 23, 2002, to September 30, 2002, with an estimated value of $4,665,882. National Research Corporation is responsible for delivering survey services as specified, and payment will be made monthly upon invoice. All work must be coordinated through designated VA representatives, and the contract includes standard federal terms and conditions.
EX-10.4 3 pdm291d.txt CONTRACT DEPARTMENT OF VETERANS AFFAIRS Medical Center 508 Fulton Street Durham NC 27705 January 23, 2002 In Reply Refer To: 558/90C National Research Corporation Attn: Patrick E. Beans 1245 Q. Street Lincoln, NE 68508 Dear Mr. Bean: Acceptance is made of your offer submitted in response to our RFQ 558-Q4l-02 to furnish Veteran Satisfaction Surveys for the Performance Analysis Center for Excellence (PACE), located at 615 Davis Drive, Suite 800, Morrisville, NC, under the MOBIS Contract No. GS-1OF-0332L. The period of the contract is established for January 23, 2002 through September 30, 2002 in the estimated annual amount of $4,665,882.00. Purchase Order Number 558-HT1002 has been assigned and must appear on all invoices and future correspondence. An executed copy of the contract is enclosed for your files. In accordance with VAAR Clause 852.270-1, PACE Staff members have been delegated Contracting Officer's Technical Representatives on this contract. All work performed under this contract must be coordinated through the representatives. A copy of the memo of delegation is enclosed. Payment will be made monthly in arrears upon submission of your properly prepared invoice to the Resource Support Service (04), VA Medical Center (558), 1970 Roanoke Blvd., Salem, VA 24153. The contract number must be reflected on your invoice. If there are any questions, please feel free to contact the undersigned at ###-###-####. Sincerely, BERMA K. NORRIS Contracting Officer Enclosures: Purchase Order No. 558-HT1002 Delegation of COTR 1
2 RFQ 558-Q41-02 CONTINUATION BLOCK 2.1 CONTRACT ADMINISTRATION DATA (continuation from Standard Form 1449, block 18A.) 1. Contract Administration: All contract administration matters will be handled by the following individuals: a. CONTRACTOR: National Research Corporation 1245 Q. Street Lincoln, NE 68508 b. GOVERNMENT: Contracting Officer (90C) Berma Norris Dept. of Veterans Affairs Medical Center 508 Fulton Street Durham NC ###-###-#### 2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: [X] 52.232-34, Payment by Electronic Funds Transfer - Other than Central Contractor Registration, or mailed to the following address: ------------------------------------------------ --------------------------------------------- --------------------------------------------- 3. INVOICES: Invoices shall be submitted in arrears: a. Quarterly [ ] b. Semi-Annually [ ] c. Other [X] (please specify) Monthly ------- 4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address: Fiscal Officer (04) Department of Veterans Affairs Medical Center 508 Fulton Street Durham, NC 27705 OFFERORS MUST COMPLETE AND RETURN ALL INFORMATION DESIGNATED IN 52.212-1, INSTRUCTIONS TO OFFERORS - COMMERCIAL ITEMS, PARAGRAPH b, PRIOR TO THE TIME SPECIFIED IN BLOCK 8 OF SF 1449 IN ORDER TO BE CONSIDERED FOR AWARD. ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows: 3 Price/Cost Proposal - VHA RFQ NRC Alternate Approach 4 Price/Cost Proposal - VHA RFQ NRC Alternate Approach Base Year - September 2002 - -------------------------------------------------------------------------------- ITEM TOTAL NO. SURVEY DESCRIPTION QTY UNIT UNIT COST COST - -------------------------------------------------------------------------------- 1. Recently Discharged Inpatient Survey Semi-Annually (* estimated patients) 2 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 2. Ambulatory Care Survey General Primary Care Visits (Quarterly) (* estimated patients) 4 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 3. Ambulatory Care Survey Persian Gulf Era Survey (Deployed and Non-Deployed) Annually 1 Surveys * * (* estimated patients) 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 5 - -------------------------------------------------------------------------------- 4. Ambulatory Care Spinal Cord Patient Survey Annually (* estimated patients) 1 Surveys * * 16 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 5. Home Based Primary Care Survey Annually (* estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 6. Prosthetics and Sensory Aids Patient Survey (* estimated patients) 1 Surveys * * 10 pages approx. (Every other year) Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 7. Diabetic Foot Care (DQIP) Annually (* estimated patients) 1 Surveys * * 20 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 6 The Government may exercise the option to renew this contract for four (4) additional years in accordance with Clause 52.217-9. If the option is exercised, written notice will be provided. SUPPLIES OR SERVICES AND PRICE/COST OPTION YEAR I: Contractor to provide all labor, equipment, materials and supervision to process Patient Surveys as listed herein for the Department of Veterans Affairs for the period of October 1, 2002 through September 30, 2003. - -------------------------------------------------------------------------------- ITEM TOTAL NO. SURVEY DESCRIPTION QTY UNIT UNIT COST COST - -------------------------------------------------------------------------------- 1. Recently Discharged Inpatient Survey Semi-Annually (* estimated patients) 2 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 2. Ambulatory Care Survey General Primary Care Visits (Quarterly) (* estimated patients) 4 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 7 - -------------------------------------------------------------------------------- 3. Ambulatory Care Survey Persian Gulf Era Survey (Deployed and Non-Deployed) Annually (*estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 4. Ambulatory Care Spinal Cord Patient Survey Annually (* estimated patients) 1 Surveys * * 16 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 5. Home Based Primary Care Survey Annually (* estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 6 Diabetic Foot Care (DQIP) Annually (* estimated patients) 1 Surveys * * 20 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 8 SUPPLIES OR SERVICES AND PRICE/COST OPTION YEAR II: Contractor to provide all labor, equipment, materials and supervision to process Patient Surveys as listed herein for the Department of Veterans Affairs for the period of October 1, 2003 through September 30, 2004. - -------------------------------------------------------------------------------- ITEM TOTAL NO. SURVEY DESCRIPTION QTY UNIT UNIT COST COST - -------------------------------------------------------------------------------- 1. Recently Discharged Inpatient Survey Semi-Annually (* estimated patients) 2 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 2. Ambulatory Care Survey General Primary Care Visits (Quarterly) (* estimated patients) 4 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 3. Ambulatory Care Survey Persian Gulf Era Survey (Deployed and Non-Deployed) Annually (*estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 9 - -------------------------------------------------------------------------------- ITEM TOTAL NO. SURVEY DESCRIPTION QTY UNIT UNIT COST COST - -------------------------------------------------------------------------------- 4. Ambulatory Care Spinal Cord Patient Survey Annually (* estimated patients) 1 Surveys * * 16 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 5. Home Based Primary Care Survey Annually (* estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 6. Prosthetics and Sensory Aids Patient Survey (* estimated patients) 1 Surveys * * 10 pages approx. (Every other year) Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 7. Diabetic Foot Care (DQIP) Annually (* estimated patients) 1 Surveys * * 20 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 10 SUPPLIES OR SERVICES AND PRICE/COST OPTION YEAR III: Contractor to provide all labor, equipment, materials and supervision to process Patient Surveys as listed herein for the Department of Veterans Affairs for the period of October 1, 2004 through September 30, 2005. - -------------------------------------------------------------------------------- ITEM TOTAL NO. SURVEY DESCRIPTION QTY UNIT UNIT COST COST - -------------------------------------------------------------------------------- 1. Recently Discharged Inpatient Survey Semi-Annually (* estimated patients) 2 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 2. Ambulatory Care Survey General Primary Care Visits (Quarterly) (* estimated patients) 4 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 3. Ambulatory Care Survey Persian Gulf Era Survey (Deployed and Non-Deployed) Annually (*estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 11 - -------------------------------------------------------------------------------- ITEM TOTAL NO. SURVEY DESCRIPTION QTY UNIT UNIT COST COST - -------------------------------------------------------------------------------- 4. Ambulatory Care Spinal Cord Patient Survey Annually (* estimated patients) 1 Surveys * * 16 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 5. Home Based Primary Care Survey Annually (* estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 6. Diabetic Foot Care (DQIP) Annually (* estimated patients) 1 Surveys * * 20 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 12 SUPPLIES OR SERVICES AND PRICE/COST OPTION YEAR IV: Contractor to provide all labor, equipment, materials and supervision to process Patient Surveys as listed herein for the Department of Veterans Affairs for the period of October 1, 2005 through September 30, 2006. - -------------------------------------------------------------------------------- ITEM TOTAL NO. SURVEY DESCRIPTION QTY UNIT UNIT COST COST - -------------------------------------------------------------------------------- 1. Recently Discharged Inpatient Survey Semi-Annually (* estimated patients) 2 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 2. Ambulatory Care Survey General Primary Care Visits (Quarterly) (* estimated patients) 4 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 3. Ambulatory Care Survey Persian Gulf Era Survey (Deployed and Non-Deployed) Annually (* estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 13 - -------------------------------------------------------------------------------- ITEM TOTAL NO. SURVEY DESCRIPTION QTY UNIT UNIT COST COST - -------------------------------------------------------------------------------- 4. Ambulatory Care Spinal Cord Patient Survey Annually (* estimated patients) 1 Surveys * * 16 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 5. Home Based Primary Care Survey Annually (* estimated patients) 1 Surveys * * 12 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 6. Prosthetics and Sensory Aids Patient Survey (* estimated patients) 1 Surveys * * 10 pages approx. (Every other year) Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- 7. Diabetic Foot Care (DQIP) Annually (* estimated patients) 1 Surveys * * 20 pages approx. Set Up Costs * Printing * Distribution Costs * Receipt and Processing Costs * Comment Capture * Reporting * POSTAGE * - -------------------------------------------------------------------------------- * Indicates that material has been omitted and confidential treatment has been requested therefor. All such omitted material has been filed separately with the SEC pursuant to Rule 24b-2. 14