19BK8025R0001_0001_Amendment.pdf

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 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 you 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.

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

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

2. AMENDMENT/MODIFICATION NUMBER 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)

7. ADMINISTERED BY (If other than Item 6) CODE

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The 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.

12. ACCOUNTING AND APPROPRIATION DATA (If required) copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS 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 data, 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)

15C. DATE SIGNED

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

16C. DATE SIGNED

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

PAGE OF PAGES

6. ISSUED BY CODE

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

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

Previous edition unusable

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

The Embassy of the United States of America Roberta C, Frasurea 1 71000 Sarajevo; Bosnia and Herzegovina

The Embassy of the United States of America Attn. Procurement and Contracting Office Roberta C, Frasurea 1 71000 Sarajevo; Bosnia and Herzegovina

9A. AMENDMENT OF SOLICITATION NUMBER

4 (four)

19BK8025R0001

Jan. 31, 2025

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

The purpose of Amendment 0001 is to correct the quantities of insurance categories provided in Section B and to amend paragraph H.8.

1. Pages 3 through 8 of the Request For Proposal (19BK8025R0001) shall be replaced with the attached pages.

2. Paragraph H.8. "Requiring Activity" shall be corrected to read: "H.8. REQUIRING ACTIVITY. The requiring activity under this contract is the Embassy of the United States of America in Sarajevo, Bosnia and Herzegovina."

Accordingly, Daniel J. O'Rourke, Supervisory General Service Officer

Feb. 07, 2025

INSTRUCTIONS (Back Page):

Instructions for items other than those that are self-explanatory, are as follows:

Item 1 (Contract ID Code). Insert the contract type identification code that appears in the title block of the contract being modified.

Item 3 (Effective date).

(1)

(2)

(3)

(4)

(5)

For a solicitation amendment, change order, or administrative change, the effective date shall be the issue date of the amendment, change order, or administrative change.

For a supplemental agreement, the effective date shall be the date agreed to by the contracting parties.

For a modification issued as an initial or confirming notice of termination for the convenience of the Government, the effective date and the modification number of the confirming notice shall be the same as the effective date and modification number of the initial notice.

For a modification converting a termination for default to a termination for the convenience of the Government, the effective date shall be the same as the effective date of the termination for default.

For a modification confirming the contracting officer's determination of the amount due in settlement of a contract termination, the effective date shall be the same as the effective date of the initial decision.

(a)

(b)

(c)

(d)

(e)

(f)

Item 6 (Issued By). Insert the name and address of the issuing office. If applicable, insert the appropriate issuing office code in the code block.

Item 8 (Name and Address of Contractor). For modifications to a contract or order, enter the contractor's name, address, and code as shown in the original contract or order, unless changed by this or a previous modification.

Items 9, (Amendment of Solicitation Number - Dated), and 10, (Modification of Contract/Order Number - Dated). Check the appropriate box and in the corresponding blanks insert the number and date of the original solicitation, contract, or order.

Item 12 (Accounting and Appropriation Data).

When appropriate, indicate the impact of the modification on each affected accounting classification by inserting one of the following entries:

(2) Accounting classification Net decrease $

Include subject matter or short title of solicitation/contract where feasible.

Item 16B. The contracting officer's signature is not required on solicitation amendments. The contracting officer's signature is normally affixed last on supplemental agreements.

(i)

NOTE: If there are changes to multiple accounting classifications that cannot be placed in block 12, insert an asterisk and the words "See continuation sheet".

Item 13. Check the appropriate box to indicate the type of modification. Insert in the corresponding blank the authority under which the modification is issued. Check whether or not contractor must sign this document. (See FAR 43.103.)

Item 14 (Description of Amendment/Modification).

Organize amendments or modifications under the appropriate Uniform Contract Format (UCF) section headings from the applicable solicitation or contract. The UCF table of contents, however, shall not be set forth in this document.

Indicate the impact of the modification on the overall total contract price by inserting one of the following entries:

(i) Total contract price increased by $

(ii) Total contract price decreased by $

(iii) Total contract price unchanged.

State reason for modification.

When removing, reinstating, or adding funds, identify the contract items and accounting classifications.

(g)

(h)

When the SF 30 is used to reflect a determination by the contracting officer of the amount due in settlement of a contract terminated for the convenience of the Government, the entry in Item 14 of the modification may be limited to --

(i) A reference to the letter determination; and

(ii) A statement of the net amount determined to be due in settlement of the contract.

(1)

(2)

(3)

(4)

(5)

(6)

STANDARD FORM 30 (REV. 11/2016) BACK

(1) Accounting classification Net increase $

B.2. PRICES

B.2.1. Value Added Tax

The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

B.2.2. This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3. PREMIUMS - BASE YEAR OF THE CONTRACT

The Contractor shall provide scheduled services for the base year of the contract starting on award date, block 18 Award Date on SF-33, and continuing for period of 12 consecutive months.

LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium. Riders will pay 100% of insurance premiums as per clauses B.1.1.

CLIN INSURE CATEGORY Est. No. of Insures*

MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.3.a. SELF - ONLY:

1 covered individual 60

B.2.3.b. SELF PLUS ONE (two individuals) 79

B.2.3.c FAMILY (three or more individuals) 298

MONTHLY SUBTOTAL FOR ALL INSURE CATEGORY

TOTAL PRICE FOR BASE YEAR**

(MONTHLY SUBTOTAL x 12)

*Estimated number of Locally Employed Staff (LES). Does NOT include Riders.

**TOTAL PRICE FOR BASE YEAR does NOT include any premiums for Riders.

EXCESS COVERAGE

Not included in the Total Price for Base Year Calculation

(See C.1.1.21. for clarification) Item Line Insure Category Per Category

(qty) Monthly Premium

Rate a.001 SELF - ONLY: 1 covered individual 1 a.002 SELF PLUS ONE (two individuals) 1 a.003 FAMILY (three or more individuals) 1

Request For Proposal: 19BK8025R0001 Amendment: 0001

B.2.4. PREMIUMS - OPTION YEAR ONE OF THE CONTRACT

The Contractor shall provide the services for the premiums shown below for the Option Year

One period of the contract, starting one year (12 calendar months) after the contract award date, block 28 Award Date on SF-33, and continuing for a period of 12 months.

LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium. Riders will pay 100% of insurance premiums as per clauses B.1.1.

CLIN INSURE CA TEGORY Est. No.of Insures*

MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.4.a. SELF - ONLY:

1 covered individual 60

B.2.4.b. SELF PLUS ONE (two individuals) 79

B.2.4.c FAMILY (three or more individuals) 298

MONTHLY SUBTOTAL FOR ALL INSURE CATEGORY

TOTAL PRICE FOR OPTION YEAR ONE**

(MONTHLY SUBTOTAL x 12)

*Estimated number of Locally Employed Staff (LES). Does NOT include Riders.

**TOTAL PRICE FOR OPTION YEAR ONE does NOT include any premiums for Riders.

EXCESS COVERAGE

Not included in the Total Price for Option Year One Calculation

(See C.1.1.21. for clarification) Item Line Insure Category Per Category

(qty) Monthly Premium

Rate a.101 SELF - ONLY: 1 covered individual 1 a.102 SELF PLUS ONE (two individuals) 1 a.103 FAMILY (three or more individuals) 1

B.2.5. PREMIUMS - OPTION YEAR TWO OF THE CONTRACT

The Contractor shall provide the services for the premiums shown below for the Option Year

Two period of the contract, starting two years (24 calendar months) after the contract award date, block 28 Award Date on SF-33, and continuing for a period of 12 months.

LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium. Riders will pay 100% of insurance premiums as per clauses B.1.1.

CLIN INSURE CA TEGORY Est. No. of insures*

MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.5.a. SELF - ONLY:

1 covered individual 60

B.2.5.b. SELF PLUS ONE (two individuals) 79

B.2.5.c FAMILY (three or more individuals) 298

MONTHLY SUBTOTAL FOR ALL INSURE CATEGORY

TOTAL PRICE FOR OPTION YEAR TWO**

(MONTHLY SUBTOTAL x 12)

*Estimated number of Locally Employed Staff (LES). Does NOT include Riders.

**TOTAL PRICE FOR OPTION YEAR TWO does NOT include any premiums for Riders.

EXCESS COVERAGE

Not included in the Total Price for Option Year Two Calculation

(See C.1.1.21. for clarification) Item Line Insure Category Per Category

(qty) Monthly Premium

Rate a.201 SELF - ONLY: 1 covered individual 1 a.202 SELF PLUS ONE (two individuals) 1 a.203 FAMILY (three or more individuals) 1

B.2.6. PREMIUMS - OPTION YEAR THREE OF THE CONTRACT

The Contractor shall provide the services for the premiums shown below for the Option Year

Three period of the contract, starting three years (36 calendar months) after the contract award date, block 28 Award Date on SF-33, and continuing for a period of 12 months.

LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium. Riders will pay 100% of insurance premiums as per clauses B.1.1.

CLIN INSURE CATEGORY MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.6.a. SELF - ONLY:

1 covered individual 60

B.2.6.b. SELF PLUS ONE (two individuals) 79

B.2.6.c FAMILY (three or more individuals) 298

MONTHLY SUBTOTAL FOR ALL INSURE CATEGORY

TOTAL PRICE FOR OPTION YEAR THREE**

(MONTHLY SUBTOTAL x 12)

*Estimated number of Locally Employed Staff (LES). Does NOT include Riders.

**TOTAL PRICE FOR OPTION YEAR THREE does NOT include any premiums for Riders.

EXCESS COVERAGE

Not included in the Total Price for Option Year Three Calculation

(See C.1.1.21. for clarification) Item Line Insure Category Per Category

(qty) Monthly Premium

Rate a.301 SELF - ONLY: 1 covered individual 1 a.302 SELF PLUS ONE (two individuals) 1 a.303 FAMILY (three or more individuals) 1

Est. No. of insures*

B.2.7. PREMIUMS - OPTION YEAR FOUR OF THE CONTRACT

The Contractor shall provide the services for the premiums shown below for the Option Year

Four period of the contract, starting four years (48 calendar months) after the contract award date, block 28 Award Date on SF-33, and continuing for a period of 12 months.

LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium. Riders will pay 100% of insurance premiums as per clauses B.1.1.

CLIN INSURE CATEGORY MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.7.a. SELF - ONLY:

1 covered individual 60

B.2.7.b. SELF PLUS ONE (two individuals) 79

B.2.7.c FAMILY (three or more individuals) 298

MONTHLY SUBTOTAL FOR ALL INSURE CATEGORY

TOTAL PRICE FOR OPTION YEAR FOUR**

(MONTHLY SUBTOTAL x 12)

*Estimated number of Locally Employed Staff (LES). Does NOT include Riders.

**TOTAL PRICE FOR OPTION YEAR FOUR does NOT include any premiums for Riders.

EXCESS COVERAGE

Not included in the Total Price for Option Year Four Calculation

(See C.1.1.21. for clarification) Item Line Insure Category Per Category

(qty) Monthly Premium

Rate a.401 SELF - ONLY: 1 covered individual 1 a.402 SELF PLUS ONE (two individuals) 1 a.403 FAMILY (three or more individuals) 1

Est. No. of insures*

B.2.8. 52.217-8 OPTION TO EXTEND SERVICES (Term: Not to Exceed Six (6) Months)

Standard Routine Services. The firm fixed price for every monthly extension of the contract under FAR 52.217-8

CLIN INSURE CA TEGORY MONTHLY

PREMIUM RATE

EXTENDED MONTHLY

PREMIUM TOTAL

B.2.8.a. SELF - ONLY:

1 covered individual 60

B.2.8.b. SELF PLUS ONE (two individuals) 79

B.2.8.c FAMILY (three or more individuals) 298

MONTHLY SUBTOTAL FOR ALL INSURE CATEGORY

TOTAL PRICE FOR OPTION TO EXTEND SERVICES

(FAR 52.217-8)**

(MONTHLY SUBTOTAL x 6) *Estimated number of Locally Employed Staff (LES). Does NOT include Riders.

**TOTAL PRICE FOR OPTION TO EXTEND SERVICES pursuant to FAR 52.217-8, does NOT include any premiums for Riders.

EXCESS COVERAGE

Not included in the Total Price for Option To Extend Services pursuant to FAR 52.217-8

(See C.1.1.21. for clarification) Item Line Insure Category Per Category

(qty) Monthly Premium

Rate a.501 SELF - ONLY: 1 covered individual 1 a.502 SELF PLUS ONE (two individuals) 1 a.503 FAMILY (three or more individuals) 1

B.2.9. GRAND TOTAL

BASE YEAR TOTAL

OPTION YEAR ONE TOTAL

OPTION YEAR TWO TOTAL

OPTION YEAR THREE TOTAL

OPTION YEAR FOUR TOTAL

GRAND TOTAL (Base + all OPTION YEARS)

52.217-8 Price per Month

Est. No. of insures*