19GE5025R0003-0001.pdf

19GE5025R0003

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

12/23/2024

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

FRANKCODE

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT

GERMANY

Sarah Pfannkuche

NAME

TEL.

pfannkuches@State.gov

EMAIL

6. ISSUED BY OPEAQMCODE

RPSO Frankfurt OPE/AQM/IP/RPSO Frankfurt Office of Acquisition (AQM) Frankfurt

7. ADMINISTERED BY (If other than Item 6)

9A. AMENDMENT OF SOLICITATION NO.

19GE5025R0003

CONTACT: UEI:

CODE FACILITY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, country, state and ZIP Code) (X)

X 9B. DATED (SEE ITEM 11)

12/04/2024

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

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 telegram 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 telegram or letter, provided each telegram or letter 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 NO. 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 NO. 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.)

Amendment 0001:

This amendment is issued due to the following:

1. Add Attachment 5 - Questions and Answers.

2. Add Attachment 6 - Average Insured Member Count.

3. Add Attachment 7 - Claims Data.

4. Corrected Exhibit A - Employee Statistic.

5. Note: Value Added Tax (VAT) is NOT applicable to this contract. The Embassy holds an exemption letter from the local government.

6. Add DOSAR clause 652.232-72 which is incorporated in full text.

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)

Nicolas Wilhelm

(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

12/23/2024

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

CGFS // CGFS

/S/

Line Item Summary

Solicitation Number:

19GE5025R0003

Contract Number: Title: LES Health Insurance for US Embassy Georgetown

Date of Solicitation:

12/23/2024

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR - LES Health Insurance inclusive of the following Sub CLINs:

0001A Single Employee (Self Only) 0001B Employee + 1 0001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date (Start to End) Date FOB:

05/01/2025 to 04/30/2026

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

002 OPTION YEAR 1 - LES Health Insurance inclusive of the following Sub CLINs:

1001A Single Employee (Self Only) 1001B Employee + 1 1001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date (Start to End) Date FOB:

05/01/2026 to 04/30/2027

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

003 OPTION YEAR 2 - LES Health Insurance inclusive of the following Sub CLINs:

2001A Single Employee (Self Only) 2001B Employee + 1 2001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date (Start to End) Date FOB:

05/01/2027 to 04/30/2028

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

004 OPTION YEAR 3 - LES Health Insurance inclusive of the following Sub CLINs:

3001A Single Employee (Self Only) 3001B Employee + 1 3001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date (Start to End) Date FOB:

05/01/2028 to 04/30/2029

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

005 OPTION YEAR 4 - LES Health Insurance inclusive of the following Sub CLINs:

4001A Single Employee (Self Only) 4001B Employee + 1 4001C Family Plan Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date (Start to End) Date FOB:

05/01/2029 to 04/30/2030

0.00 0.00 0.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

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

Pages 1 RQS 19GE5025R0003.pdf 12/16/2024

652.232-72 - LIMITATION OF FUNDS (AUG 1999)

(a) Of the total price in Section B (or the 'Prices' section), only the amount stated on the contract award document or subsequent modifications is now available for payment and obligated under this contract. It is anticipated that from time to time, additional funds will be obligated under the contract until the total price of the contract is obligated.

(b) The Government is not obligated to pay or reimburse the contractor more than the amount obligated pursuant to this clause. The contractor agrees to perform the contract up to the point at which the total amount paid and payable by the Government (including amounts payable for subcontracts and settlement costs if this contract is terminated for convenience) approximates but does not exceed the total amount obligated.

(c)

(1) It is contemplated that funds now obligated under this contract will cover the work to be performed until [ contracting officer insert date ].

(2) If the contractor considers the funds obligated under this contract to be insufficient to cover the work to be performed until that date, or another date agreed to by the parties, the contractor shall notify the contracting officer in writing and indicate the date on which it expects expended funds to approximate 75 percent of the total amount obligated. The notice shall state the estimated amount of additional funds required to continue performance through the date specified in paragraph (c)(1) of this clause or another date agreed to by the parties.

(3) If, after notification is provided pursuant to paragraph (c)(2) of this clause, additional funds are not obligated, or an earlier date than the date in paragraph (c)(1) of this clause is not agreed to, the contractor shall not be obligated to continue performance under this contract (including actions under the termination clause of this contract) beyond the funds obligated for contract performance.

(d) When additional funds are obligated from time to time for continued performance of this contract, the contract shall be modified to increase the funds obligated and to indicate the period of performance for which funds are applicable. The contractor may notify the contracting officer as provided in paragraph (c)(2) of this clause regarding any additional funds obligated.

(e) If the contractor incurs additional costs or is delayed in the performance of work under this contract, solely by reason of the Government's failure to obligate additional funds in amounts sufficient for the timely performance of this contract, an equitable adjustment may be made to the price, or time of delivery, or both.

(f) This clause shall become inoperative upon obligation of funds sufficient to cover the full price stated in the contract, except for rights and obligations then existing under this clause.

(g) Nothing in this clause shall affect the Government's right to terminate the contract for convenience or default.

(End of clause)