19GE5025R0010 0002.pdf

19GE5025R0010

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

02/18/2025

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

FRANKCODE

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT

GERMANY

Ielyzaveta M Ishchenko

NAME

TEL.

IshchenkoIM@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.

19GE5025R0010

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)

01/16/2025

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 __1__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.)

The purpose of this amendment is to:

1. Provide a copy of the Pre-Proposal presentation.

2. Offerors shall remove pages: 22 and 25 of the RFP originally provided and it with the one attached hereto. Changes made to the RFP are marked in red font.

3. Offerors shall provide acknowledgment of Amendment 0002 with their proposal.

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)

Brendan C James

(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

02/18/2025

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

CGFS // CGFS

19GE5025R0010

Line Item Summary

Solicitation Number:

19GE5025R0010

Contract Number: Title: FSN Health Insurance Willemstad, Curacao

Date of Solicitation:

02/18/2025

Line Item No.

Description Quantity Unit Unit Price Total Cost

001 BASE YEAR

LES Health Insurance inclusive of Sub CLINs 0001A, 0001B, 0001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 0.00

12.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

1001 OPTION YEAR 1

LES Health Insurance inclusive of Sub CLINs 1001A, 1001B, 1001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 0.00

12.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

2001 OPTION YEAR 2

LES Health Insurance inclusive of Sub CLINs 2001A, 2001B, 2001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 0.00

12.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

3001 OPTION YEAR 3

LES Health Insurance as per attached Pricing Schedule inclusive of Sub CLINs 3001A, 3001B, 3001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 0.00

12.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

4001 OPTION YEAR 4

LES Health Insurance inclusive of Sub CLINs 4001A, 4001B, 4001C Type of Contract Pricing: FFP

Doc Ref No:

Delivery Date FOB:

12.00 0.00

12.00

EA $0.00

$0.00

$0.00

$0.00 $0.00

$0.00

Locally Employed Staff Health Insurance U.S. Embassy Willemstad, Curacao

Solicitation No. 19GE5025R0010 Page 22 of 99

I.3.4 Employee Claims Report 1 monthly COR

I.3.11 Invoice 1 yearly COR /

Designated

Billing

Office

I.3.3 CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMS

General – The contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The contractor shall treat the information provided by the

Embassy concerning employees' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons.

The contractor shall establish procedures for handling medical insurance claims as follows:

a. Administrative Records

(1) The contractor shall maintain medical insurance files for each eligible employee including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per employee per year reimbursement ceiling.

(2) The contractor shall provide the COR with the necessary claim forms for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted.

b. Medical Insurance Claims – Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

Locally Employed Staff Health Insurance U.S. Embassy Willemstad, Curacao

Solicitation No. 19GE5025R0010 Page 25 of 99

The only items that the USG will consider for price adjustments are those that are mandated e.g., changes in the VAT rate (if applicable) or minimum hourly wage rate.

I.3.10 CONTRACT ADMINISTRATION DATA

Authority of the Contracting Officer – All work shall be performed under the general direction of the Contracting Officer, who alone shall have the power to bind the Government and to exercise the rights, responsibilities, authorities and functions vested by the contract, except that the Contracting

Officer and the Procurement Executive shall have the right to designate authorized representatives to act for the Contracting Officer, as specifically provided in the designation of that individual, such as the COR

Government Personnel

Contracting Officer: Nicolas A. Wilhelm

Contract Administrator: Ielyzaveta Ishchenko

E-mail address: IshchenkoIM@state.gov

Contracting Officer's Representative (COR): named at time of award

I.3.11 INVOICES, REVIEW AND PAYMENT

The Contractor shall submit yearly invoices to the Contracting Officer Representative.

• A proper invoice must include the following information:

• Contractor’s name and bank account information for payments by wire transfers

• Invoice Date

• Contract Number

• A summary showing a listing of each member with total monthly price the currency the contract has been issued in. A detailed invoice for each Agency has to be attached to each summary invoice and should include the cost breakdown by each membership fee line according to the pricing schedule

• Value Added Tax (VAT), if applicable, shall be a separate line item on each invoice.

• Each invoice shall include the items listed in Section II.2, FAR 52.212-4 g.1.

• Payment shall be made in the currency the contractor specified in Section I.1.4 Pricing.

• Advance Payment shall not be authorized under this contract.

• Payment will be made via EFT.

I.3.12 CHANGES IN OWNERSHIP

The contractor shall furnish the COR advance notification (90 calendar days prior to the effective date) of any disposition or the change in ownership or terms of lease of any facilities utilized by him for performance of any service under this contract.

mailto:IshchenkoIM@state.gov