19GE5026Q0001 Combined Synopsis and Solicitation.pdf

SBU - CONTRACTING AND ACQUISITIONS

COMBINED SYNOPSIS & SOLICITATION

Accident Insurance for Locally Employed Staff (LES)

U.S. Embassy Brussels, Belgium

SOLICITATION NO. 19GE5026Q0001

Issued by:

Regional Procurement Support Office (RPSO)

Giessener Strasse 30

60435 Frankfurt am Main

Germany

The Regional Procurement Support Office Frankfurt, Germany hereby provides the following

Combined Synopsis and Solicitation for: On-The-Job Accidents and Accidents to-and-from Work

Insurance coverage for locally employed U.S. Mission Belgium employees (as further described in Attachment A - Performance work statement).

(i) This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in FAR Subpart 12.6, as supplemented with additional information included in this notice.

This announcement constitutes the only solicitation; offers are being requested, and a written solicitation will not be issued. Any eventual contract award is subject to the current Department of State Lapse in Appropriations Guidance and Restrictions.

(ii) The solicitation number is 19GE5026Q0001 and is issued as a Request for Quotations

(RFQ).

(iii) The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular FAC 2025-06, effective 10/01/2025.

(iv) This is a Full and Open Competition acquisition.

The NAICS code is 524114.

The PSC code is G007.

(v) A list of line item numbers and items, quantities, and units of measure can be found in

"Attachment B - Pricing".

(vi) A detailed description of the services being acquired through this solicitation can be found in

“Attachment A - Performance work statement”.

(vii) The performance period of this contract is one year beginning on January 1, 2026, with four

(4) one-year options to renew.

(viii) Provision at 52.212-1, Instructions to Offerors-Commercial Products and

Commercial Services, applies to this acquisition. Pursuant to FAR 12.302(d), the provision at

FAR 52.212-1 Instructions to Offerors—Commercial Products and Commercial Services (Sep

2023) is augmented as follows:

1. The period for acceptance of offers of 30 calendar days as specified in FAR clause 52.212-1

Instructions to Offerors—Commercial Products and Commercial Services (Sep 2023) is hereby extended to 60 calendar days.

(A) Submission of offers.

Offerors shall prepare and submit their offer in two (2) volumes as set forth below:

• Volume I - Price Offer: One (1) Electronic version sent via email

• Volume II - Technical Offer: One (1) Electronic version sent via email

The information shall be in a format readable by Microsoft (MS) Word, MS Excel or Adobe PDF as applicable.

The complete offer shall be submitted via email to the email addresses provided below:

• gallonea@state.gov

• baltaa@state.gov

The email shall be marked “OFFER 19GE5026Q0001” and must arrive on or before Thursday, December 4, 2025, 15:00 hrs. CET.

NOTE: No offers will be accepted after the time specified above.

All offers must be sent by email. Delivery via a cloud file storage service (eg. Google Drive, etc.) is not allowed. The file size limit for individual emails is 50 Mb. In the event that the offer is sent in multiple emails, the email shall be labeled accordingly (eg. file 1 of 2).

Submission of Questions: Interested parties may submit any questions concerning the solicitation as soon as possible but not later Friday November 21, 2025, 15:00 hrs. CET via email to Andra Balta at baltaa@state.gov. The email subject line must read “Solicitation

19GE5026Q0001”. Late questions may not be considered.

Volume I – Price Offer shall contain the following:

1. The name, address, telephone number of the Offeror and the Offeror’s Unique Entity

Identifier (UEI)

2. Attachment B - Pricing – filled in;

3. Attachment C - Representations and certifications - filled in;

4. Proof of SAM registration: Offeror must be registered in the System for Award

Management (SAM) database before an award can be made to them. If the offeror is not registered in the SAM, it may do so through the SAM website at https://www.sam.gov/portal/public/SAM/;

5. Attachment E - IRS Form W-14 (if applicable, in accordance with 52.229-12).

Volume II – Technical Offer shall contain the following:

1. Strategic Plan

2. Management Plan

3. Past Performance Information

1. Strategic Plan - Provide a Strategic Plan that describes the approach you will use to successfully perform the services as described in the Performance Work Statement (PWS). Your plan shall include, but is not limited to:

a. A thorough and clear description of the methods, processes, and procedures for ensuring performance meets the standards of the PWS.

b. The offeror’s knowledge, history, and familiarity in providing accident insurance to groups of employees.

c. Evidence that your company can provide the necessary personnel, equipment, and financial resources needed to perform the work. This shall include information about the company's history, financial condition and capability. Evidence of financial resources shall include as minimum information on the ownership of the company, a declaration of total debt including both long term and short-term debt, and a declaration of total current sales / revenue. State what percentage of your company's estimated total business the work under this solicitation will represent.

d. Evidence of a functioning document security plan to demonstrate how the company will ensure safe handling and storage of Embassy Staff PII (personal identification information).

e. Tax Identification Certificate (TIN) issued by your country’s Ministry of Finance as well as annual letter of tax clearance.

f. List of Subcontractors (if applicable) – Provide a list of subcontractors indicating what portions of the work will be performed by them. Specify the percentage of work that will be sub-contractor. If the offeror will not use sub-contractors, that shall be stated.

g. A description of the offeror’s claims workflow system and timeframes at each processing point to fully process claims (from initial receipt to final settlement).

h. A description of the offeror’s customer service system and mechanism for receiving and promptly addressing customer inquiries and complaints.

i. Either:

(a) a copy of the Certificate of Insurance, or

(b) a statement that the contractor will get the required insurance, and the name of the insurance provider to be used.

j. Licensing Information: The offeror shall include a certified copy of the most current license/certificate/-accreditation, which demonstrates that the offeror is licensed/certified/accredited or otherwise authorized to provide accident insurance coverage to persons (to include organizations, companies, groups) within Belgium. If the offeror is not licensed/certified/accredited or otherwise authorized by the

Government of Belgium it must demonstrate that it is licensed/certified/accredited by a government other than the Belgium to provide health insurance for persons in

Belgium and must demonstrate its capacity to provide health benefits in Belgium to meet the minimum requirements and other conditions set forth in this solicitation.

This section shall demonstrate that the offeror is licensed/certified/accredited through no less than the final day of the base performance period and that the offeror is eligible for renewal for the option periods. This section shall also summarize and describe any probationary, disciplinary or actions taken upon the offeror, which are in force or are about to be imposed upon the offeror by the Government of Belgium or its agents. Failure to demonstrate that the offeror is an authorized insurance company permitted to write and administer health insurance policies in al Belgium shall be grounds for rejection of the offer.

Note: Vendors shall:

1. Have a registered office in Belgium;

2. Have a company number with the crossroads bank for companies in Belgium

(kruispuntbank voor ondernemingen– carrefour banque entreprise);

3. Be recognized by Fedris and FSMA.

4. Apply Belgian law on occupational accident on the job of April 10, 1971, and its amendments.

If subcontracting, both the prime contractor and all subcontractors shall meet the above-mentioned requirements.

2. Management Plan - Provide a Management Plan that describes how your company will obtain and manage personnel and resources to successfully perform the work detailed in the

PWS. Your plan shall, but is not limited to:

a. Key Personnel: The Government considers the offeror´s Project Manager to be key personnel under the resulting contract from this solicitation. The offeror shall provide a detailed resume and experience of this individual. The Project Manager shall be able to acceptably communicate all matters related to this contract in English.

b. A description of the offeror's Quality Management Plan, which shall ensure that services are rendered as specified in the PWS;

c. The offeror shall demonstrate how it shall fully comply with DOSAR clause 652.242-

73 Authorization and Performance (Aug 1999) - proving that they are authorized to operate and do business in Belgium;

3. Past Performance Information. Provide a minimum of three (3) and a maximum five

(5) references for recent and relevant contracts and/or projects for past performance evaluation.

1. To be considered recent, services must have been provided any time within the last three (3) years of issuance date of the solicitation.

2. To be considered relevant, services must be, or have been, similar scope, magnitude, and complexity as all of the services described in the PWS. To be considered relevant, services shall have been performed within Belgium.

a) For each past performance points of contact provided, offerors must provide the following information to the contracting officer:

• Company/Division name/Contracting Agency/Customer Name

• Description of service provided

• Contract number (if applicable)

• Contract value

• Period of performance

• Verified, up-to-date name, address, email of the company’s point of contact.

b) If a teaming arrangement is contemplated, provide complete information as to the arrangement, including any relevant and recent past performance information on previous teaming arrangements with the same partner. If this is an initial teaming agreement, each party to the arrangement may provide a list of relevant and recent contracts performed independently from the teaming agreement. No more than five (5) total references shall be submitted.

c) Subcontractor Consent: Past performance information pertaining to a subcontractor cannot be disclosed to the prime offeror without the subcontractor’s consent. Provide with the offer a letter from all subcontractors that will perform major or critical aspects of the requirement, consenting to the release of their past performance information to the prime contractor.

(ix) Provision at 52.212-2, Evaluation-Commercial Products and Commercial Services, applies to this acquisition.

Addendum to FAR 52.212-2 Evaluation – Commercial Items (Oct 2014):

(a) The evaluation of offers will be based on the Lowest-Priced, Technically Acceptable

(LPTA) approach. The following factors shall be used to evaluate offers:

I. price – the offeror's price will be determined by multiplying the offered prices times the quantities listed in Attachment B – Pricing, and arriving at a grand total, including all options. All other requirements of Volime I Pricing, as listed in point (viii) of this solicitation, shall be evaluated to determine the offeror’s responsiveness.

II. technical capability: the government will evaluate technical on an acceptable or unacceptable basis. Technical Capability shall be evaluated against the following sub-factors where all sub-factors are considered equal:

• Strategic Plan: This requirement is met when the offeror has thoroughly and successfully demonstrated the ability to meet all the requirements identified in

52.212-1, Strategic Plan paragraphs a through j.

• Management Plan: This requirement is met when the offeror has thoroughly and successfully demonstrated the ability to meet all management activities identified in 52.212-1, Management Plan paragraphs a through c.

III. past performance: this requirement is met when the offeror’s proposal includes a minimum of three (3) and a maximum of five (5) customer references for whom services have been or are being performed that meet the recency and relevancy requirements and demonstrate the offeror’s capability to successfully perform the requirements of the PWS.

The Government will award a contract resulting from this solicitation to the responsible offeror

(as determined within the meaning of FAR Part 9, paragraph 9.104), whose offer conforms to the solicitation and is determined to be the most advantageous solution to the Government, price and other factors considered. Evaluation will be based on offeror’s submission and the provision at

FAR 52.212-2, as provided in this RFQ.

(x) Offerors are required to submit a copy of the completed provision at 52.212-3, Offeror Representations and Certifications-Commercial Products and Commercial

Services, and 52.204-24 Representation Regarding Certain Telecommunications and

Video Surveillance Services or Equipment with its offer (see Attachment C - Representations and certifications).

(xi) The clause 52.212-4, Contract Terms and Conditions-Commercial Products and

Commercial Services (Nov 2023), applies to this acquisition.

(xii) The clause at 52.212-5, Contract Terms and Conditions Required to Implement

Statutes or Executive Orders-Commercial Products and Commercial Services (Oct 2025) applies to this acquisition. The following additional FAR clauses paragraph (b) are also applicable: 52.203-6; 52.203-17; 52.204-10; 52.204-27; 52.204-30; 52.209-6; 52.219-4; 52.226-

8; 52.222-50; 52.225-5; 52.232-33; 52.240-1,

(xiii) Additional Applicable Clauses and Provisions:

• 652.237-72 Observance of Legal Holidays and Administrative Leave (Feb 2015)

• 652.242-70 - Contracting Officer's Representative (COR) (Aug 1999).

• 52.203-12 Limitation on Payments to Influence Certain Federal Transactions (Jun 2020)

• 52.204-13 System for Award Management Maintenance (Oct 2018)

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

• 52.204-19 Incorporation by Reference of Representations and Certifications (Dec 2014)

• 52.232-1 Payments (Apr 1984)

• 52.232-18 Availability of Funds (Apr 1984)

• 52.232-39 Unenforceability of Unauthorized Obligations (Jun 2013)

• 52.233-1 Disputes (May 2014)

• 52.242-13 Bankruptcy (July 1995)

• 52.216-18 Ordering (Aug 2020)

• 52.216-19 Order Limitations (Oct 1995)

• 52.216-21 Requirements (Oct 1995)

• 52.217-8 Option to Extend Services (Nov 1999)

• 52.217-9 Option to Extend the Term of the Contract (Mar 2000)

• 52.224-3 Privacy Training (Jan 2017)

• 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984)

• 52.237-3 Continuity of Services (Jan 1991)

• 652.216-70 Ordering Indefinite-Delivery Contracts (Apr 2004)

• 652.225-71 SECTION 8(a) Of the Export Administration Act Of 1979, as Amended (Aug

1999)

• 652.232-70 Payment Schedule and Invoice Submission (Fixed-Price) (Aug 1999)

• 652.242-73 Authorization and Performance (Aug 1999)

• 52.217-5 Evaluation of Options (July 1990)

• 52.225-17 Evaluation of Foreign Currency Offers (Feb 2000)

The full text of the referenced FAR and DOSAR clauses may be accessed electronically at:

https://www.acquisition.gov/content/regulations.

https://www.acquisition.gov/content/regulations

Attachments:

1. Attachment A - Performance work statement

2. Attachment B - Pricing

3. Attachment C - Representations and certifications

4. Attachment D - Exhibits A, B, C

5. Attachment E - IRS Form W-14

6. Attachment F - W-14 Instructions