19GE5026R0020_Amendment 001-signed.pdf

Document Number: 19GE5026R0020 DRAFT Page 1

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE RATING

2. AMENDMENT/MODIFICATION NUMBER

3. EFFECTIVE DATE

03/03/2026

4. REQUISITION/PURCHASE REQ. NUMBER 5. PROJECT NUMBER (If applicable)

FRANKCODE

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

60435, FRANKFURT

DE

Alexandra Perez Acevedo

NAME

TEL.

PerezAcevedoA@state.gov

EMAIL

6. ISSUED BY GAAMCODE

RPSO Frankfurt GA/AM/DMS/FAC RPSO Frankfurt Bureau of Global Acquisitions Frankfurt

DE

7. ADMINISTERED BY (If other than Item 6)

9A. AMENDMENT OF SOLICITATION NUMBER

19GE5026R0020

CODE FACILITY CODE

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

X 9B. DATED (SEE ITEM 11)

01/30/2026

10A. MODIFICATION OF CONTRACT/ORDER

NUMBER

10B. DATED (SEE ITEM 11)

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 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 your 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.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION 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 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 ___1____ 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 Questions & Answers letter hereto attached.

2.Provide updated Attachment 1 - Pricing Sheet and revised Exhibit A - Employees Statistic 3.Offerors shall dispose pages 7, 8, 14, 21 and 70 of the combined synopsis originally provided and replace it with those attached hereto. Changes made to the RFP are marked in red font

4. The proposal deadline is hereby extended until no later than 14:00 Hours March 17, 2026.

CLOSING DATE/TIME:

03/17/2026 - 14:00 Europe/Amsterdam

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)

Travis Keon

(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

03/03/2026

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30 (REV.

11/2016) Prescribed by GSA FAR (48 CFR) 53.243

CGFS // CGFS

SBU - CONTRACTING AND ACQUISITIONS

X

RFP No.19GE5026R0020_Amendment 0001 U.S. Embassy Valletta, Malta Health Insurance for LES Page 7 of 103

2. ECONOMIC PRICE ADJUSTMENT, PREMIUM ADJUSTMENT BASED ON

EXPERIENCE

2.1. Basis for Adjustment

Premium Adjustment Based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract, and it specifically excludes all riders.

No adjustment will be allowed during the base year.

2.2 Timing and Procedures for Requesting Adjustments

The Contractor or the Government may request an adjustment 60 days prior to the end of the base year or current option year, to take effect at the start of the following option year.

Either the Contractor or the Contracting Officer may initiate a request for premium adjustment by providing written notice no later than sixty (60) calendar days prior to the end of the current base period or option period. Any approved adjustment shall take effect at the start of the subsequent option period only.

Adjustments are prospective only and shall not be applied retroactively to any prior period of performance. The Contractor may not seek to recover costs incurred during any prior period of performance through an Economic Price Adjustment under this clause. Economic Price

Adjustments shall apply only as a modification to the rates charged by the Contractor for services specified in the contract and shall not be recovered as lump sum adjustments/payments to the Contractor.

2.3 Documentation Requirements

Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period:

(1) receipts (premiums received)

(2) number of insurance plans and

(3) claims paid.

This information shall be provided per type of premium, i.e. per line item for the preceding 12 months.

2.4 Government Review and Independent Audit

The Government reserves the right to engage an independent third-party actuary or auditor to review and verify the Contractor's submitted documentation and to provide recommendations regarding the appropriateness and amount of any requested adjustment. The Contractor shall cooperate fully with any such independent review and shall provide timely access to all relevant records and data.

2.5 Mutual Agreement and Modification

Health Insurance for LES Page 8 of 103

a. Any premium adjustment under this clause requires the mutual written agreement of both parties. The Contracting Officer shall review the Contractor's submission and any independent third-party recommendations and shall notify the Contractor in writing of the Government's position within thirty (30) calendar days of receipt of complete documentation.

b. Should both parties reach agreement on an adjustment, the Contracting Officer shall execute a bilateral contract modification reflecting the adjusted premium rates. The modification shall specify the effective date, adjusted rates by CLIN, and the period of performance to which the adjusted rates apply.

c. The adjusted rates shall become effective after the corresponding modification has been signed by the Contracting Officer, or on the first day of the applicable option period, whichever it is later.

3. PREMIUM ADJUSTMENT BASED ON LAWS

The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host government, if such change in the laws has a direct impact on the cost to the contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the contractor to modify the contract to adjust the premium rate(s). The contractor agrees to provide all documentation necessary to support any requested adjustment.

Employee Pool – This clause is only in effect if the contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

Before any adjustment is made under this price adjustment clause, the contractor must include in its proposal for adjustment details setting forth how the pool impacts the request for equitable adjustment.

4. VAT – VALUE ADDED TAX

Health Insurance Services are VAT exempted in the Republic of Malta.

5. THE CURRENCY OF THIS CONTRACT IS

Offerors shall insert the currency offers are made.

6. OTHER TAXES

Excise Tax: James Zadroga 9/11 Victims Health and Compensation Act of 2010 Notice:

Unless a waiver or exception applies, payments subsequent to this procurement are subject to an excise tax of 2% pursuant to 26 U.S.C. 5000C. The Contractor shall complete attached form W-14 to apply for an exemption of the Excise Tax, if applicable.

Health Insurance for LES Page 14 of 103

C.1.1.17 Pre-existing condition

Pre-existing conditions refer to any disease or health condition arising from injury, illness, congenital or genetic factors, disease caused by sexual transmission, and/or autoimmune conditions. Coverage of pre-existing conditions will be extended to all covered individuals

C.2 OVERALL ANNUAL MAXIMUM LIMIT:

The maximum annual coverage per covered individual per contract year is 47,657 Euros, not including expenses covered under HIV/AIDS.

*The coverage/maximum limit under this section C.2 is provided in euros and shall remain fixed for the length of the contract.

C.3 HEALTH BENEFITS EXCLUSIONS AND LIMITATIONS

There is no reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage;

exercise therapy; long-term rehabilitative therapy; non-medical hospital charges (e.g., telephone, television, etc.); home help, family help, or similar household assistance; fees of persons who are not certified health care providers; advanced reproductive technology (e.g., in-vitro fertilization, intra-cellular sperm injection, artificial insemination, microsurgical epididymal sperm aspiration, testicular sperm extraction, cryopreservation, etc.); or services or supplies which have not been prescribed or approved by a certified health care provider. Exclusions to coverage may be amended if provided in an off-the-shelf plan and meets the evaluation criteria set forth in section

IV. Removal of any exclusions require prior authorization.

There is no reimbursement for expenses that will be reimbursed or paid directly under a host country medical program or workers' compensation program, the U.S. workers’ compensation program, or post’s LE Staff workers’ compensation program.

C.4 ELIGIBLE PARTICIPANTS

C.4.1 Eligible Employees

To be eligible to participate in the medical plan, LE Staff (both full time and part time) must be:

C.4.1.1 Paid under the Local Compensation Plan (LCP); and be-

C.4.1.1.1 Under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or

C.4.1.1.2 Under a temporary direct hire appointment or PSA Fixed Term of one year or more.

C.4.1.1.3 Part-time employees who work more than 20 hours per week are eligible.

Health Insurance for LES Page 21 of 103

I. 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.

II. 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.

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

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

I. All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. Claims may be submitted via online platform or email

II. 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).

III. The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

IV. Settlement/Reimbursement shall be made by EFT from the insurance company directly to the employee.

V. The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals.

D.4 KEY PERSONAL

The US Government considers the contractors Project Manager as Key Personnel for this contract.

Project Manager Name: To be inserted by the Contracting Office at the time of award

During the entire performance period of this contract, the contractor shall make no substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment.

The contractor shall notify the Contracting Officer Representative within 15 calendar days after the occurrence of any of these events. The proposed substitute shall possess qualifications

Health Insurance for LES Page 70 of 103

Offers shall be submitted no later than 14:00 hours Central European Time (C.E.T.) on

March 17, 2026, via email to Ms. Alexandra Perez Acevedo at PerezAcevedoA@state.gov. The email subject line must read “Proposal 19GE5026R0020”.

Delivery via a cloud file storage service (e.g. Google Drive, etc.) is not allowed.

If the proposal is sent in multiple emails, the email shall be labeled accordingly (e.g. file 1 of 2).

Individual emails may not exceed 50MB and shall not include compressed files (zip / .rar).

Late submissions shall not be considered.

i) All documents shall be submitted in the Microsoft word or the Adobe pdf format and shall be named / numbered to appear in the e-mail(s) in the correct sequence. The only Exception is

Pricing Document which may be submitted in Microsoft Excel format. The limit per e-mail is

50MB. Zipped files (zip or .rar) are not permitted. The Government shall not be responsible for an offeror being unable to successfully transmit emails due to due to any file size constraints of e-mail systems. Contractors shall ensure that emails have been transmitted and that messages have not been returned “undeliverable”.

USE OF ELECTRONIC DEPOSITORIES IS NOT PERMITTED (for example “We transfer”, google drive etc.).

• Definition. “Electronic proposal,” as used in this provision, means a proposal, revision, or modification of a proposal, or withdrawal of a proposal that is transmitted to and received by the Government via electronic means.

• Offeror shall submit electronic proposals as responses to this solicitation.

• Individual file names shall include the offeror's name as well as a concise description of the file (e.g., "Company XYZ Technical Proposal"). In the event that the proposal is sent in multiple emails, the email shall be labeled accordingly (e.g., File 1 of 2).

III.6 DOSAR 652.206-70 – ADVOCATE FOR COMPETITION / OMBUDSMAN (FEB

2015) (Deviation)

a. The Department of State's Advocate for Competition is responsible for assisting industry in removing restrictive requirements from Department of State solicitations and removing barriers to full and open competition and use of commercial items. If such a solicitation is considered competitively restrictive or does not appear properly conducive to competition and commercial practices, potential offerors are encouraged first to contact the contracting officer for the solicitation. If concerns remain unresolved, contact the Department of State Advocate for

Competition at cat@state.gov

b. The Department of State's Acquisition Ombudsman has been appointed to hear concerns from potential offerors and contractors during the preaward and postaward phases of this acquisition. The role of the ombudsman is not to diminish the authority of the contracting officer, the Technical Evaluation Panel or Source Evaluation Board, or the selection official. The mailto:PerezAcevedoA@state.gov mailto:cat@state.gov