Attachment I - Price schedule_updated March 18 2024.xlsx
XLSX spreadsheet 21 KB Posted
- Solicitation number
- 19GE5024R0025
About this file
This solicitation requests pricing for health insurance services for locally employed staff at the US Embassy in Baku, Azerbaijan. The solicitation includes pricing tables for the base year and four option years, with sub-categories for self-only coverage, self-plus-one coverage, and family coverage. Estimated employee counts are provided for each category and year. Offerors are instructed to provide monthly and annual rates for each category, though at this stage all rates are listed as $0.00. The Department of State Office of Acquisition Management issued the solicitation under number 19GE5024R0025 to obtain these health insurance services.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment VI - Loss data for vendors 04-25-2024.xlsx | XLSX spreadsheet | |
| QUESTIONS AND ANSWERS.pdf | ||
| Attachment V - Employees and dependents data April 25 2024.xlsx | XLSX spreadsheet | |
| 19GE5024R0025 0002.pdf | ||
| 19GE5024R0025 0001.pdf | ||
| 19GE5024R0025- Pre-proposal presentation.pdf | ||
| Attachment II - Employee data.pdf | ||
| Attachment III - W14 Form.pdf | ||
| Attachment I - Price schedule.xlsx | XLSX spreadsheet | |
| Attachment IV - Instructions for W14 Form.pdf | ||
| 19GE5024R0025.pdf | ||
| 19GE5024R0025 Cover Letter.pdf |
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Pricing Tables
| BASE YEAR | |||||
| Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal |
| 0001 | Self Only | 42 | 0.00 | 0.00 | |
| 0002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 0003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |
| 0004 | Self Only - Excess Coverage/covered individual | 1 | 0.00 | 0.00 | |
| 0005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 2 | 0.00 | 0.00 | |
| 0006 | Family (three or more individuals) - Excess Coverage/covered individual | 2 | 0.00 | 0.00 | |
| BASE YEAR TOTAL | 0.00 |
| OPTION YEAR 1 | |||||
| Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal |
| 1001 | Self Only | 42 | 0.00 | 0.00 | |
| 1002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 1003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |
| 1004 | Self Only - Excess Coverage/covered individual | 2 | 0.00 | 0.00 | |
| 1005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 3 | 0.00 | 0.00 | |
| 1006 | Family (three or more individuals) - Excess Coverage/covered individual | 3 | 0.00 | 0.00 | |
| OPTION YEAR 1 TOTAL | 0.00 |
| OPTION YEAR 2 | |||||
| Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal |
| 2001 | Self Only | 42 | 0.00 | 0.00 | |
| 2002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 2003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |
| 2004 | Self Only - Excess Coverage/covered individual | 3 | 0.00 | 0.00 | |
| 2005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 4 | 0.00 | 0.00 | |
| 2006 | Family (three or more individuals) - Excess Coverage/covered individual | 4 | 0.00 | 0.00 | |
| OPTION YEAR 2 TOTAL | 0.00 |
| OPTION YEAR 3 | |||||
| Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal |
| 3001 | Self Only | 42 | 0.00 | 0.00 | |
| 3002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 3003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |
| 3004 | Self Only - Excess Coverage/covered individual | 4 | 0.00 | 0.00 | |
| 3005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 5 | 0.00 | 0.00 | |
| 3006 | Family (three or more individuals) - Excess Coverage/covered individual | 5 | 0.00 | 0.00 | |
| OPTION YEAR 3 TOTAL | 0.00 |
| OPTION YEAR 4 | |||||
| Sub-CLIN | Description | Estimated number of Employees | Rate per month | Rate per Year | Subtotal |
| 4001 | Self Only | 42 | 0.00 | 0.00 | |
| 4002 | Self Plus One (two individuals) | 152 | 0.00 | 0.00 | |
| 4003 | Family (three or more individuals) | 143 | 0.00 | 0.00 | |
| 4004 | Self Only - Excess Coverage/covered individual | 4 | 0.00 | 0.00 | |
| 4005 | Self Plus One (two individuals) - Excess Coverage/covered individual | 5 | 0.00 | 0.00 | |
| 4006 | Family (three or more individuals) - Excess Coverage/covered individual | 5 | 0.00 | 0.00 | |
| OPTION YEAR 4 TOTAL | 0.00 |
ESTIMATED GRAND TOTAL (BASE + ALL OPTIONS) 0.00
19GE5024R0025
Locally Employed Staff Health Insurance
File details come from the government source that posted it. Updated .