SF 30 - 19AQMM26Q0155 - Amendment 2.pdf

Document Number: 19AQMM26Q0155 PROCESSED Page 1 of 47

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NUMBER

3. EFFECTIVE DATE

06/09/2026

4. REQUISITION/PURCHASE REQ. NUMBER 5. PROJECT NUMBER (If applicable)

CODE

Adrienne L Shade

NAME

TEL.

ShadeAL@state.gov

EMAIL

6. ISSUED BY CODE7. ADMINISTERED BY (If other than Item 6)

9A. AMENDMENT OF SOLICITATION NUMBER

19AQMM26Q0155

CODE FACILITY CODE

8. NAME AND ADDRESS OF CONTRACTOR (Number, street, country, state and ZIP Code) (X)

X 9B. DATED (SEE ITEM 11)

06/09/2026

10A. MODIFICATION OF CONTRACT/ORDER

NUMBER

10B. DATED (SEE ITEM 11)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X XThe above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers is extended, is not extended, Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing items 8 and 15, and returning ____copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment your desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14.

CHECK ONE

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

ORDER NUMBER IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return _______ copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

The purpose of this amendment is to extend the due date.

CLOSING DATE/TIME:

08/31/2026 - 13:00 ET US/Eastern

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

Patricia Steckler

(Signature of person authorized to sign)

15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED

By (Signature of Contracting Officer)

16B. UNITED STATES OF AMERICA 16C. DATE SIGNED

07/15/2026

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV.

11/2016) Prescribed by GSA FAR (48 CFR) 53.243

CGFS // CGFS

Document Number: 19AQMM26Q0155 PROCESSED Page 2 of 47

Section A - Solicitation/Contract Form

Line Item Summary

Solicitation Number:

19AQMM26Q0155

Contract Number: Title:

Defense Base Act (DBA) Rate Agreement

Date of Solicitation:

07/15/2026

Number Supplies or Services Qty Unit Unit Price Total (Inc. disc., tax, and fees)

PSC: G006

PSC Description: SOCIAL- GOVERNMENT LIFE

INSURANCE PROGRAMS

Type of Contract Pricing: Other

Original: 0.0

Change: 0.0

Current: 0.0

EA Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

CLIN Funding: Cost:

Base Totals: Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Exercised Options Totals: Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Unexercised Options Totals: Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Base and Options Totals: Original: $0.00

Change: $0.00

Current: $0.00

Original: $0.00

Change: $0.00

Current: $0.00

Section A - Solicitation/Contract Form Identifier Title Date Number of

Pages 1 AQS 19AQMM26Q0155.pdf 07/15/2026

Clause Title Fill-ins

52.204-13 System for Award Management-Maintenance (DEVIATION JAN 2026)

52.212-4 Terms and Conditions-Commercial Products and Commercial Services

(DEVIATION JAN 2026)

52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Mar

2023)

52.245-9 Use and Charges (Apr 2012)

Document Number: 19AQMM26Q0155 PROCESSED Page 3 of 47

Clause Title Fill-ins

252.225-7043 Antiterrorism/Force Protection for Defense Contractors Outside the United

States (Jun 2015)

252.232-7003 Electronic Submission of Payment Requests and Receiving Reports (Jun

2012)

252.232-7006 Wide Area WorkFlow Payment Instructions (May 2013)

252.232-7009 Mandatory Payment by Governmentwide Commercial Purchase Card (Dec

2006)

252.244-7000 Subcontracts for Commercial Items (Jun 2013)

52.204-7 System for Award Management - REGISTRATION (DEVIATION JAN

2026)

52.212-1 Instructions to Offerors-Commercial Products and Commercial Services

(DEVIATION JAN 2026)

52.214-35 Submission of Offers in U.S. Currency (Apr 1991)

B-01 - PURPOSE

The purpose of this award is to enter into a contract in which the contractor, hereafter referred to as the Insurer, will be the source of Worker's Compensation Insurance as required by the Defense Base Act (DBA) for all Department of State (DoS) managed contracts.

B-02 - CONTRACT TYPE

This is a No Cost, Fixed Rate Type Contract.

B-03 - RATE SCHEDULE

The Insurer will use the following rates for this contract:

Rates will be separated into four categories, the categories will be dependent on the travel advisory listed by the state department (https://travel.state.gov/en/international-travel/travel-advisories.html).

Travel Advisory Level 1: Exercise normal precautions BASE – 2 years CLIN Description Price Application 011A Services $TBD Per $100 of#employee salary 011B Construction $TBD Per $100 of employee salary 011C Security $TBD Per $100 of employee salary

OPTION PERIOD 1 (1 YEAR)

Document Number: 19AQMM26Q0155 PROCESSED Page 4 of 47

# Scenario A. If, as of 3 months prior to Option Year 1 Inception, total loss ratio on the program is less than or equal to 32% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply OPTION#PERIOD 1–#1#year CLIN Description Price Application 111A Services $TBD Per $100 of#employee salary 111B Construction $TBD Per $100 of#employee salary 111C Security $TBD Per $100 of#employee salary

##Scenario B. If, as of 3 months prior to Option Year 1 Inception, total loss ratio on the program is greater than 32% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 1– 1 year CLIN Description Price Application 111D Services $TBD Per $100 of#employee salary 111E Construction $TBD Per $100 of#employee salary 111F Security $TBD Per $100 of#employee salary

OPTION PERIOD 2 (1 YEAR)

# Scenario A. If Option Period 1, Scenario A is not exercised, but as of 3 months prior to Option Year#2#inception, total loss ratio on the program is less than or equal to 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD#2#– 1 year CLIN Description Price Application 211A Services $TBD Per $100 of#employee salary 211B Construction $TBD Per $100 of#employee salary 211C Security $TBD Per $100 of#employee salary

# Scenario B. If Option Period 1, Scenario A is not exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is greater than 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 211D Services $TBD Per $100 of#employee salary 211E Construction $TBD Per $100 of#employee salary 211F Security $TBD Per $100 of#employee salary

# Scenario C. If Option Period 1, Scenario A is exercised and as of as of 3 months prior to Option Year 2#inception, the total loss ratio on the program is less than or equal to 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 211D Services $TBD Per $100 of#employee salary 211E Construction $TBD Per $100 of#employee salary 211F Security $TBD Per $100 of#employee salary

##Scenario D. If Option Period 1, Scenario A is exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is greater than 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 211G Services $TBD Per $100 of#employee salary 211H Construction $TBD Per $100 of#employee salary 211G Security $TBD Per $100 of#employee salary

OPTION PERIOD 3 (1 YEAR)

Document Number: 19AQMM26Q0155 PROCESSED Page 5 of 47

# Scenario A. If Option Period 2, Scenario A, Scenario C, or Scenario D are exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is less than or equal to 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the#following rates will apply, regardless of the incurred loss ratio:

OPTION PERIOD#3#– 1 year CLIN Description Price Application 311A Services $TBD Per $100 of#employee salary 311B Construction $TBD Per $100 of#employee salary 311C Security $TBD Per $100 of#employee salary

#Scenario B. If Option Period 2, Scenario A, Scenario C, or Scenario D are not exercised, but as of 3 months prior to Option Year 3#inception, total loss ratio on the program is less than or equal to 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 3 – 1 year CLIN Description Price Application 311D Services $TBD Per $100 of#employee salary 311E Construction $TBD Per $100 of#employee salary 311F Security $TBD Per $100 of#employee salary

# Scenario C. If Option Period 2, Scenario A or Scenario C are not exercised, but as of 3 months prior to Option Year 3#inception, total loss ratio on the program is greater than 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 3 – 1 year CLIN Description Price Application 311G Services $TBD Per $100 of#employee salary 311H Construction $TBD Per $100 of#employee salary 311I Security $TBD Per $100 of#employee salary

Rates for countries with a Travel Advisory Level 2: Exercise increased caution

The Insurer will use the following rates for this contract:

BASE – 2 years CLIN Description Price Application 021A Services $TBD Per $100 of#employee salary 021B Construction $TBD Per $100 of employee salary 021C Security $TBD Per $100 of employee salary

OPTION PERIOD 1 (1 YEAR)

# Scenario A. If, as of 3 months prior to Option Year 1 Inception, total loss ratio on the program is less than or equal to 32% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply

OPTION#PERIOD 1–#1#year CLIN Description Price Application 121A Services $TBD Per $100 of#employee salary 121B Construction $TBD Per $100 of#employee salary 121C Security $TBD Per $100 of#employee salary

##Scenario B. If, as of 3 months prior to Option Year 1 Inception, total loss ratio on the program is greater than 32% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 1– 1 year CLIN Description Price Application 121D Services $TBD Per $100 of#employee salary 121E Construction $TBD Per $100 of#employee salary 121F Security $TBD Per $100 of#employee salary

Document Number: 19AQMM26Q0155 PROCESSED Page 6 of 47

OPTION PERIOD 2 (1 YEAR)

# Scenario A. If Option Period 1, Scenario A is not exercised, but as of 3 months prior to Option Year#2#inception, total loss ratio on the program is less than or equal to 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD#2#– 1 year CLIN Description Price Application 221A Services $TBD Per $100 of#employee salary 221B Construction $TBD Per $100 of#employee salary 221C Security $TBD Per $100 of#employee salary

# Scenario B. If Option Period 1, Scenario A is not exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is greater than 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 221D Services $TBD Per $100 of#employee salary 221E Construction $TBD Per $100 of#employee salary 221F Security $TBD Per $100 of#employee salary

# Scenario C. If Option Period 1, Scenario A is exercised and as of as of 3 months prior to Option Year 2#inception, the total loss ratio on the program is less than or equal to 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 221D Services $TBD Per $100 of#employee salary 221E Construction $TBD Per $100 of#employee salary 221F Security $TBD Per $100 of#employee salary

##Scenario D. If Option Period 1, Scenario A is exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is greater than 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 221G Services $TBD Per $100 of#employee salary 221H Construction $TBD Per $100 of#employee salary 221G Security $TBD Per $100 of#employee salary

OPTION PERIOD 3 (1 YEAR)

# Scenario A. If Option Period 2, Scenario A, Scenario C, or Scenario D are exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is less than or equal to 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the#following rates will apply, regardless of the incurred loss ratio:

OPTION PERIOD#3#– 1 year CLIN Description Price Application 321A Services $TBD Per $100 of#employee salary 321B Construction $TBD Per $100 of#employee salary 321C Security $TBD Per $100 of#employee salary

Document Number: 19AQMM26Q0155 PROCESSED Page 7 of 47

#Scenario B. If Option Period 2, Scenario A, Scenario C, or Scenario D are not exercised, but as of 3 months prior to Option Year 3#inception, total loss ratio on the program is less than or equal to 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 3 – 1 year CLIN Description Price Application 321D Services $TBD Per $100 of#employee salary 321E Construction $TBD Per $100 of#employee salary 321F Security $TBD Per $100 of#employee salary

# Scenario C. If Option Period 2, Scenario A or Scenario C are not exercised, but as of 3 months prior to Option Year 3#inception, total loss ratio on the program is greater than 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 3 – 1 year CLIN Description Price Application 321G Services $TBD Per $100 of#employee salary 321H Construction $TBD Per $100 of#employee salary 321I Security $TBD Per $100 of#employee salary

Rates for countries with a Travel Advisory Level 3: Reconsider Travel

The Insurer will use the following rates for this contract:

BASE – 2 years CLIN Description Price Application 031A Services $TBD Per $100 of#employee salary 031B Construction $TBD Per $100 of employee salary 031C Security $TBD Per $100 of employee salary

OPTION PERIOD 1 (1 YEAR)

# Scenario A. If, as of 3 months prior to Option Year 1 Inception, total loss ratio on the program is less than or equal to 32% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply

OPTION#PERIOD 1–#1#year CLIN Description Price Application 131A Services $TBD Per $100 of#employee salary 131B Construction $TBD Per $100 of#employee salary 131C Security $TBD Per $100 of#employee salary

##Scenario B. If, as of 3 months prior to Option Year 1 Inception, total loss ratio on the program is greater than 32% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 1– 1 year CLIN Description Price Application 131D Services $TBD Per $100 of#employee salary 131E Construction $TBD Per $100 of#employee salary 131F Security $TBD Per $100 of#employee salary

OPTION PERIOD 2 (1 YEAR)

# Scenario A. If Option Period 1, Scenario A is not exercised, but as of 3 months prior to Option Year#2#inception, total loss ratio on the program is less than or equal to 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD#2#– 1 year CLIN Description Price Application 231A Services $TBD Per $100 of#employee salary

Document Number: 19AQMM26Q0155 PROCESSED Page 8 of 47

231B Construction $TBD Per $100 of#employee salary 231C Security $TBD Per $100 of#employee salary

# Scenario B. If Option Period 1, Scenario A is not exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is greater than 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 231D Services $TBD Per $100 of#employee salary 231E Construction $TBD Per $100 of#employee salary 231F Security $TBD Per $100 of#employee salary

# Scenario C. If Option Period 1, Scenario A is exercised and as of as of 3 months prior to Option Year 2#inception, the total loss ratio on the program is less than or equal to 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 231D Services $TBD Per $100 of#employee salary 231E Construction $TBD Per $100 of#employee salary 231F Security $TBD Per $100 of#employee salary

##Scenario D. If Option Period 1, Scenario A is exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is greater than 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 231G Services $TBD Per $100 of#employee salary 231H Construction $TBD Per $100 of#employee salary 231G Security $TBD Per $100 of#employee salary

OPTION PERIOD 3 (1 YEAR)

# Scenario A. If Option Period 2, Scenario A, Scenario C, or Scenario D are exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is less than or equal to 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the#following rates will apply, regardless of the incurred loss ratio:

OPTION PERIOD#3#– 1 year CLIN Description Price Application 331A Services $TBD Per $100 of#employee salary 331B Construction $TBD Per $100 of#employee salary 331C Security $TBD Per $100 of#employee salary

#Scenario B. If Option Period 2, Scenario A, Scenario C, or Scenario D are not exercised, but as of 3 months prior to Option Year 3#inception, total loss ratio on the program is less than or equal to 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 3 – 1 year CLIN Description Price Application 331D Services $TBD Per $100 of#employee salary 331E Construction $TBD Per $100 of#employee salary 331F Security $TBD Per $100 of#employee salary

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# Scenario C. If Option Period 2, Scenario A or Scenario C are not exercised, but as of 3 months prior to Option Year 3#inception, total loss ratio on the program is greater than 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 3 – 1 year CLIN Description Price Application 331G Services $TBD Per $100 of#employee salary 331H Construction $TBD Per $100 of#employee salary 331I Security $TBD Per $100 of#employee salary

Rates for countries with a Travel Advisory Level 4: Do Not Travel

The Insurer will use the following rates for this contract:

BASE – 2 years CLIN Description Price Application 041A Services $TBD Per $100 of#employee salary 041B Construction $TBD Per $100 of employee salary 041C Security $TBD Per $100 of employee salary

OPTION PERIOD 1 (1 YEAR)

# Scenario A. If, as of 3 months prior to Option Year 1 Inception, total loss ratio on the program is less than or equal to 32% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply

OPTION#PERIOD 1–#1#year CLIN Description Price Application 141A Services $TBD Per $100 of#employee salary 141B Construction $TBD Per $100 of#employee salary 141C Security $TBD Per $100 of#employee salary

##Scenario B. If, as of 3 months prior to Option Year 1 Inception, total loss ratio on the program is greater than 32% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 1– 1 year CLIN Description Price Application 141D Services $TBD Per $100 of#employee salary 141E Construction $TBD Per $100 of#employee salary 141F Security $TBD Per $100 of#employee salary

OPTION PERIOD 2 (1 YEAR)

# Scenario A. If Option Period 1, Scenario A is not exercised, but as of 3 months prior to Option Year#2#inception, total loss ratio on the program is less than or equal to 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD#2#– 1 year CLIN Description Price Application 241A Services $TBD Per $100 of#employee salary 241B Construction $TBD Per $100 of#employee salary 241C Security $TBD Per $100 of#employee salary

# Scenario B. If Option Period 1, Scenario A is not exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is greater than 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 241D Services $TBD Per $100 of#employee salary

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241E Construction $TBD Per $100 of#employee salary 241F Security $TBD Per $100 of#employee salary

# Scenario C. If Option Period 1, Scenario A is exercised and as of as of 3 months prior to Option Year 2#inception, the total loss ratio on the program is less than or equal to 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 241D Services $TBD Per $100 of#employee salary 241E Construction $TBD Per $100 of#employee salary 241F Security $TBD Per $100 of#employee salary

##Scenario D. If Option Period 1, Scenario A is exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is greater than 37% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 2 – 1 year CLIN Description Price Application 241G Services $TBD Per $100 of#employee salary 241H Construction $TBD Per $100 of#employee salary 241G Security $TBD Per $100 of#employee salary

OPTION PERIOD 3 (1 YEAR)

# Scenario A. If Option Period 2, Scenario A, Scenario C, or Scenario D are exercised, but as of as of 3 months prior to Option Year 2#inception, total loss ratio on the program is less than or equal to 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the#following rates will apply, regardless of the incurred loss ratio:

OPTION PERIOD#3#– 1 year CLIN Description Price Application 341A Services $TBD Per $100 of#employee salary 341B Construction $TBD Per $100 of#employee salary 341C Security $TBD Per $100 of#employee salary

#Scenario B. If Option Period 2, Scenario A, Scenario C, or Scenario D are not exercised, but as of 3 months prior to Option Year 3#inception, total loss ratio on the program is less than or equal to 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 3 – 1 year CLIN Description Price Application 341D Services $TBD Per $100 of#employee salary 341E Construction $TBD Per $100 of#employee salary 341F Security $TBD Per $100 of#employee salary

# Scenario C. If Option Period 2, Scenario A or Scenario C are not exercised, but as of 3 months prior to Option Year 3#inception, total loss ratio on the program is greater than 42% (excluding any losses reimbursable through the War Hazard Compensation Act), the following rates apply:

OPTION PERIOD 3 – 1 year CLIN Description Price Application 341G Services $TBD Per $100 of#employee salary 341H Construction $TBD Per $100 of#employee salary 341I Security $TBD Per $100 of#employee salary

The Insurer shall categorize employees using the following descriptions:

Document Number: 19AQMM26Q0155 PROCESSED Page 11 of 47

SERVICES EMPLOYEES(excluding Security Employees, Construction Employees, and Aviation Employees): Workers, either professional (e.g., registered#professional##engineers, licensed medical personnel, etc.) or non-professional, whose efforts are#to##accomplish#discrete, often recurring, tasks that are not intended to result in an end-item#of##supply#or a complete and useable facility. Such workers include, but are not limited to,#information technology systems operators, consultants in any discipline, unarmed#security personnel, architects, office administrators, researchers, cafeteria workers, nurses, maintenance personnel, drivers, housekeepers, medical technicians,#groundskeepers, hospital administrators, doctors, nurses, etc.

CONSTRUCTION EMPLOYEES: Workers whose efforts are customarily associated with construction projects for complete and useable facilities or complete and useable alterations to existing facilities. Such workers include, but are not limited to, laborers, equipment operators, electricians, carpenters, painters, welders, concrete workers, steel workers, roofers, interior finishers, plumbers, glazers, etc.

SECURITY EMPLOYEES:#Workers who are armed and charged with the security of specific persons; property and/or facilities, including movement or transportation of persons and/or property between secure locations.

AVIATION EMPLOYEES:For contracts that include aviation, ground crew shall be categorized as Construction, and flight crew shall be categorized as Security.

NOTE 1:#For purposes of#Contract#No.#TBD, employee salary includes wages, meaning the money rate at which the service rendered by an employee is compensated by an employer under the contract of hiring in force at the time of the injury, including the reasonable value of any advantage which is received from the employer and included for purposes of any withholding of tax under subtitle C of the Internal Revenue Code of 1954 [26 USC §§ 3 1 01#et seq.] (relating to employee taxes). The term wages#does#not include fringe benefits, including (but not limited to) employer payments for or contribution to a retirement, pension, health and welfare, life insurance, training, social security or other employee or dependent benefit plan for the employee's or dependent's benefit, or any other employee's dependent entitlement.

NOTE 2: The Secretary of Labor’s current National Average Weekly Wage (NAWW) shall be used as the maximum applicable salary to#determine#premium rates. DoS limits the maximum compensation rate to claimants to 200 percent of the NAWW. The current NAWW can be found athttp://www.dol.gov/owcp/dlhwc/nawwinfo.html.

Section C - Scope of Work

C.1. PURPOSE:

The purpose of this award is to enter into a contract in which the contractor, hereafter referred to as the Insurer, will be the source of Workers’ Compensation Insurance as required by the Defense Base Act (DBA) for all DoS managed contracts.

Defense Base Act (42 U.S.C. 1651 “DBA”.) requires federal contractors and subcontractors working outside the continental United States to provide the equivalent of workers’ compensation insurance to their employees. The U.S. Government reimburses DBA insurance carriers for claims paid in connection with injuries or deaths from war hazards.

According to the Federal Acquisition Regulation (FAR 28.305), contracting officers must include DBA (workers’ compensation) insurance in each contract approved or financed under the Foreign Assistance Act of 1961, as amended (Public Law 87-195) unless the Secretary of Labor approves a waiver of coverage.

C.2. STATEMENT OF WORK:

Under all Department of State (DoS) managed contracts involving any overseas performance, the Insurer is required by law to provide overseas employees with insurance coverage pursuant to the Longshoremen's and Harbor Workers' Compensation Act (commonly called the "Defense Base Act" or DBA) (42 U.S.C. 1651 et seq.). DBA coverage applies to individuals employed under DoS contracts or subcontracts or subordinate contracts regardless of the duration of their assignment. Insurance coverage is required for employees of contractors (and their subcontractors) unless a waiver has been obtained from the U.S. Department of Labor. However, the waiver does not apply to any employee who is:

1. Hired in the United States;

2. A resident of the United States; or

3. A citizen of the United States.

All DoS contractors shall procure DBA Insurance through the Insurer (whether renewing coverage or obtaining new coverage) for every DoS funded contract. DoS contracts for services with individuals working outside the United States are also subject to DBA coverage. However, personal services contractors (PSCs) are exempt from Defense Base Act coverage. PSCs are covered by the Federal Employees Compensation Act.

DoS agrees to insert language into its contracts requiring eligible awardees under those instruments to procure DBA insurance exclusively from the Insurer.

The Insurer fully understands, acknowledges, accepts and agrees that the United States Government is not liable for any payments whatsoever to the contractor of the DoS award under, or related to, or as a result of, this Agreement, including breach thereof.

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The Insurer also fully understands, acknowledges, accepts and agrees that the United States Government does not warrant the payment of insurance premiums (to the Insurer by eligible contractors that purchase DBA insurance from the Insurer).

No United States funds whatsoever are, or will be, obligated or expended by DoS under, or related to, or as a result of this Agreement, including breach thereof.

DoS does not make any representation as to the amount of premiums the Insurer will eventually collect from eligible contractors or the number of eligible contractors that will purchase insurance from the Insurer during the term of this Agreement.

DoS will not order coverage on behalf of, or for, any contractor or subcontractor.

C.3 CLAIMS HANDLING STANDARDS:

The Insurer shall handle all DBA claims arising under the policies issued pursuant to this Agreement with the reasonable standard of care. This includes, without limitation, the following:

• Timely acknowledgment, investigation, and adjudication of claims in accordance with LHWCA/DBA and applicable OWCP procedures;

• Appropriate and timely contesting of claims that lack merit or involve fraud, misrepresentation, or non-covered injuries;

• Avoidance of unreasonable claim payments, inflated settlements, or decisions that would increase DoS’s indirect exposure through WHCA reimbursement obligations; and

• Compliance with all OWCP reporting and filing deadlines.

C.4 WAIVERS:

Waivers from Defense Base Act can be requested from the District Director, U.S. Department of Labor, Longshore District Office 5, Norfolk at the following address:

U.S. Department of Labor

OWCP/DLHWC

Federal Building, Room 212 200 Granby Mall Norfolk, VA 23510 Phone: (757) 441-3071 Fax: (757) 441-6909 http://www.dol.gov/owcp/dlhwc/lscontac.htm Existing waivers can be found on the Department of Labor website.

C.5 GRANTS AND COOPERATIVE AGREEMENTS:

DBA coverage is not required for grants and cooperative agreements. However, DBA coverage is required for contracts awarded under grants and cooperative agreements. Though DoS cannot compel recipients of grants and cooperative agreements to purchase DBA coverage, DoS encourages recipients of grants and cooperative agreements to purchase DBA coverage. The Insurer will provide DBA coverage to recipients at the same rates as provided to DoS contractors.

C. 6 SUBCONTRACTORS:

Insurance policies sold by the Insurer shall contain a provision that subcontractors at any tier of the DoS contractor under the same DoS contract shall be covered by the policy if those subcontractors have been scheduled on the policy, at issuance or later by endorsement, and for whom premiums have been paid.

C.7 MINIMUM PREMIUM:

The Insurer shall not assess minimum premiums. Insurer will apply the agreed upon rates regardless of number of employees on policy.

C.8 FIXED RATES:

The Insurer shall sell policies to eligible contractors at rates no higher than the fixed rates established under Section B.4 of this Contract.

C.9 WAR HAZARDS COMPENSATION ACT (WHCA):

The War Hazards Compensation Act (WHCA) completes the protection provided to Government contractors' employees and certain other selected employees performing work outside the United States. All liability for injury, death and detention benefits under the WHCA is assumed by the Federal Government and is paid from the Employees' Compensation Fund established by 5 U.S.C. 8147.

Under Section 104 of the WHCA, an insurance carrier, self-insured employer, or a compensation fund may claim reimbursement from the Employees' Compensation Fund for benefits paid on cases approved under the Defense Base Act (DBA) if it can be shown that the injury or death was due to a war-risk hazard.

The U.S. Government assumes all liability for injury or death that results from a war-risk hazard. A claim for reimbursement filed by the Insurer will be denied if it is found that the benefits paid or payable were on account of injury, detention or death which arose from a war-risk hazard for which a premium (which included an additional charge or loading for such hazard) was charged; or where the Insurer has been reimbursed, paid, or compensated for the loss for which reimbursement is claimed.

The Insurer agrees and certifies that the rates in this contract are not loaded for war risk hazards or claim administration related to war-risk hazards.

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C.10 Indemnification for Carrier Negligence or Misconduct:

C.10.1. The Insurer shall indemnify, defend, and hold harmless the Department of State, its officers employees, and agents from and against any losses, costs, penalties, or damages (including reasonable attorney fees) incurred by DOS that arise from:

• The Insurer’s negligent or wrongful handling of any DBA claim arising under a policy issued pursuant to this Agreement;

• The Insurer’s failure to contest a claim that a reasonable, experienced DBA insurer would have contested, resulting in an improper WHCA reimbursement obligation;

• The Insurer’s submission of a WHCA reimbursement claim that is inaccurate, inflated, or not properly attributable to a war-risk hazard;

• The Insurer’s failure to maintain required insurance or financial security is required; or

• The Insurer’s material breach of any provision of this Agreement.

C.10.2. Exclusions. This indemnification does not extend to: a) DBA benefits lawfully paid by the Insurer on behalf of a covered contractor pursuant to a valid claim; (b) WHCA reimbursement obligations arising from a properly documented war-risk hazard claim; or (c) losses attributable to the Department’s own acts or omissions.

F-01 - Deliverables

The Insurer shall submit the following deliverables to the COR within 20 days of the end of the reporting period. The contractor must use Fiscal Years for reporting purposes. The first annual report will cover from the date of the contract to the end of the fiscal year.

The last report will cover from the start of the final fiscal year to the end of the contract period.

Quarterly Plain English Report to include:

A. Summary of the past quarter and year to date indicating premiums paid, claims filed, losses incurred.

B. Brief explanation of the circumstances of each claim (two-four sentences such as car crash, construction accident) for the quarter and to date.

C. Plain English definition of industry terms contained in all submitted reports.

D. Current loss ratio to date under the contract along with the ratios that would cause a premium increase or decrease.

E. Number of war hazard claims per quarter and to date.

Quarterly Premium Report to include:

A. Name of each contractor B. State or USAID contract number C. Contractor’s DBA insurance policy number D. Listing by the contractor of total premiums paid for the quarter E. Listing by the contractor of the total premiums paid to date

Quarterly Refund Report to include:

A. Name of contractor B. Amount and date of refund C. State or USAID award number D. Reason for Refund

Semi-Annual Premium/Loss Experience Report to include:

A. Name of contractor B. Nature and date of loss C. Categorization of Loss by Labor Category D. Claim amount for each individual loss (amount paid to date and amount held in reserve) E. Nature of each loss whether loss is medical claim of accident claim

Annual Loss Experience Report to include:

A. Name of each contractor B. State or USAID contract number C. Contractor’s DBA insurance policy number D. Listing by the contractor of total premiums paid for the previous 12-month period E. Listing by the contractor of the total premiums paid to date F. Listing by the contractor of the nature and date of each loss

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G. Listing by contractor of total claim amount for each individual loss (amount paid to date and amount held in reserve) (the listing should reflect adjustments, premiums and reserves) H. Total premiums paid to date I. Total loss to date J. In the event that the risk/loss ratio claim is under 50%, Insurer will provide a report up to one page explaining the reason for the percentage as an annex to this report K. Summary of challenges, accomplishments, areas that may need additional focus, and any adjustments in rates per the National Average Weekly Wages (NAWW) (https://www.dol.gov/agencies/owcp/dlhwc/NAWWinfo) L. Total amount dollar amount of refunds given to contractors identified by State or USAID contract number

Award Close-out Adjusted Premium Amount Reports to include:

A. Listing of contractor B. State or USAID award number C. Listing of total adjusted premiums paid for term of contractor’s award with State or USAID D. Listing of total refunds provided by Insurer to contractor for term of contractor’s award with State or USAID E. Dates of refunds made to contractor F. Listing of adjusted premiums and refunds based on the policy period with contractor

01INV - DEPARTMENT OF STATE INVOICE INSTRUCTIONS

Invoice submission is only via the Office of Claims’ Commercial Claims Operations fax server, toll-free number: 866-483-3436, or DOSPayments@state.gov, unless otherwise indicated. Each invoice must be transmitted separately.

To constitute a proper invoice, the invoice must include the following information and/or attached documentation:

(1) Name and Address of the Contractor

(2) Dun and Bradstreet Universal Number System (DUNS)

(3) Date of invoice

(4) Unique Vendor Invoice Number - Our Financial System cannot accept the following characters: @ (at symbol), ~ (Tilde), & (Ampersand), ' (Apostrophe), " (Quotation) and spaces. Please do not include any of these characters as part of your invoice number.

(5) Remittance Contact Information

(6) Shipping Terms, Ship to Address

(7) Payment Terms

(8) Total Quantity of Items

(9) Total Invoice Amount

(10) Requisition Number, Contract Number and Order/Award Number, with modification number if applicable.

(11) Order line item number and information (see below instructions) The name and DUNS of the contractor on the invoice must match the information indicated on the order/award for proper payment.

IMPORTANT: For proper payment, the invoice must detail products and/or services delivered on a line item basis in direct accordance with the corresponding order/award/contract. Each line item must contain the following information:

(1) Description of the services rendered for each line item

(2) Line Item Quantity

(3) Line Item Unit Price

(4) Total Line Item Invoicing Amount

(5) Delivery Date

(6) Contract Line Item Number (CLIN)

(7) Order/Award Line Item Number if invoicing against a task or delivery order or Blanket Purchase Agreement (BPA) Please note that many task or delivery orders against Department of State or GSA contracts or blanket purchase agreements may have a separate and unique line item number in addition to the umbrella Contract Line Item Number (CLIN). The order line item number as well as the umbrella award CLIN must be referenced at each invoice line item level in such cases.

All payment to domestic claims will be disbursed by electronic funds transfer EFT. Vendors who are registered in the System for Award Management (SAM) should verify and re-confirm their financial information in the database prior to invoicing.

Vendors who wish to request a waiver of SAM or payment by check must submit their justification to their assigned contracting officer for consideration at least 30 days prior to billing. For vendors who are granted an EFT exception, the payment address on the invoice must match the remittance address in the vendor record cited in the award.

Additional correspondence should be addressed to:

Name:

U.S. Department of State Global Financial Services

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Attn: Office of Claims (RM/GFS/F/C) Charleston Financial Service Center Mailing Address:

Post Office Box 150008 Charleston, SC 29415-5008 Telephone Numbers:

Director’s Secretary Voice 843-202-3761 Official Office Hours: 8:00 am – 5:00 pm To request Payment Status on a Past Due Invoice contact:

Office of Claims Customer Service Email: commercialclaims@state.gov Phone: 877-704-9473 Toll Free Person to Contact: Supervisor, Vendor Claims Email: GFS-ChiefVC@state.gov (End of clause)

G-001 - ORDERING PROCEDURES

(a) In accordance with FAR 52.216-18 "ORDERING," the following individuals and activities are authorized to issue delivery orders or task orders hereunder:

Department of State Contracting Officer

(b) Orders placed under this contract shall contain the following information:

(1) Date of order;

(2) Contract number and order number;

(3) Item number and description, quantity, and unit price;

(4) Delivery or performance date;

(5) Place of delivery or performance (including consignee);

(6) Packaging, packing, and shipping instructions, if any;

(7) Accounting and appropriation data;

(8) Security clearance level(s), applicable to the order, if any; and

(9) Any other pertinent information.

(c) Issuance of orders by facsimile is authorized in accordance with FAR 52.216-18 "ORDERING."

(end of clause)

SATCOMINV - DEPARTMENT OF STATE INVOICE INSTRUCTIONS FOR SATELLITE COMMUNICATIONS

Invoice must be submitted to _________________ at the address in block :

To constitute a proper invoice, the invoice must include the following information and/or attached documentation:

(1) Name and Address of the Contractor

(2) Dun and Bradstreet Universal Number System (DUNS)

(3) Date of invoice

(4) Unique Vendor Invoice Number - Our Financial System cannot accept the following characters: @ (at symbol), ~ (Tilde), & (Ampersand), ' (Apostrophe), " (Quotation) and spaces. Please do not include any of these characters as part of your invoice number.

(5) Remittance Contact Information

(6) Shipping Terms, Ship to Address

(7) Payment Terms

(8) Total Quantity of Items

(9) Total Invoice Amount

(10) Requisition Number, Contract Number and Order/Award Number, with modification number if applicable.

(11) Order line item number and information (see below instructions) The name and DUNS of the contractor on the invoice must match the information indicated on the order/award for proper payment.

IMPORTANT: For proper payment, the invoice must detail products and/or services delivered on a line item basis in direct accordance with the corresponding order/award/contract. Each line item must contain the following information:

(1) Description of the services rendered for each line item

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(2) Line Item Quantity

(3) Line Item Unit Price

(4) Total Line Item Invoicing Amount

(5) Delivery Date

(6) Contract Line Item Number (CLIN)

(7) Order/Award Line Item Number if invoicing against a task or delivery order or Blanket Purchase Agreement (BPA) Please note that many task or delivery orders against Department of State or GSA contracts or blanket purchase agreements may have a separate and unique line item number in addition to the umbrella Contract Line Item Number (CLIN). The order line item number as well as the umbrella award CLIN must be referenced at each invoice line item level in such cases.

All payment to domestic claims will be disbursed by electronic funds transfer EFT. Vendors who are registered in the Central Contractor Registration (CCR) should verify and re-confirm their financial information in the database prior to invoicing. Vendors who wish to request a waiver of CCR or payment by check must submit their justification to their assigned contracting officer for consideration at least 30 days prior to billing. For vendors who are granted an EFT exception, the payment address on the invoice must match the remittance address in the vendor record cited in the award.

(End of clause)

52.204-18 - Commercial and Government Entity Code Maintenance (Aug 2020)

(a) Definition. As used in this clause--

"Commercial and Government Entity (CAGE) code" means--

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity by unique location; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

(b) Contractors shall ensure that the CAGE code is maintained throughout the life of the contract for each location of contract, including subcontract, performance. For contractors registered in the System for Award Management (SAM), the DLA Commercial and Government Entity (CAGE) Branch shall only modify data received from SAM in the CAGE master file if the contractor initiates those changes via update of its SAM registration. Contractors undergoing a novation or change-of-name agreement shall notify the contracting officer in accordance with subpart 42.12. The contractor shall communicate any change to the CAGE code to the contracting officer within 30 days after the change, so that a modification can be issued to update the CAGE code on the contract.

(c) Contractors located in the United States or its outlying areas that are not registered in SAM shall submit written change requests to the DLA Commercial and Government Entity (CAGE) Branch. Requests for changes shall be provided at https://cage.dla.mil. Change requests to the CAGE master file are accepted from the entity identified by the code.

(d) Contractors located outside the United States and its outlying areas that are not registered in SAM shall contact the appropriate National Codification Bureau (points of contact available at http://www.nato.int/structur/AC/135/main/links/contacts.htm) or NSPA at https://eportal.nspa.nato.int/AC135Public/scage/CageList.aspx to request CAGE changes.

(e) Additional guidance for maintaining CAGE codes is available at https://cage.dla.mil.

(f) If the contract includes Federal Acquisition Regulation clause 52.204-2, Security Requirements, the contractor shall ensure that subcontractors maintain their CAGE code(s) throughout the life of the contract.

(End of clause)

52.204-27 - Prohibition on a ByteDance Covered Application (Jun 2023)

(a) Definitions. As used in this clause--

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Covered application means the social networking service TikTok or any successor application or service developed or provided by ByteDance Limited or an entity owned by ByteDance Limited.

Information technology, as defined in 40 U.S.C. 11101(6)--

(1) Means any equipment or interconnected system or subsystem of equipment, used in the automatic acquisition, storage, analysis, evaluation, manipulation, management, movement, control, display, switching, interchange, transmission, or reception of data or information by the executive agency, if the equipment is used by the executive agency directly or is used by a contractor under a contract with the executive agency that requires the use--

(i) Of that equipment; or

(ii) Of that equipment to a significant extent in the performance of a service or the furnishing of a product;

(2) Includes computers, ancillary equipment (including imaging peripherals, input, output, and storage devices necessary…