19LG7524R0001.pdf

SECTION A - MODEL CONTRACT

SOLICIT AnON, OFFER AND AWARD 11. THIS CONTRACT IS A RATED ORDER I RATING I PA~E

OF PAGES

UNDER DPAS (15 CFR 350)

I 69

2. CONTRACT (Proc. lnst. Ident.) NO.

1 ~ ::I~C~:;;;~:O \

TYPE OF SOLICITATION 5. DATE ISSUED 16. REQUISITION/PURCHASE NO.

[ 1SEALED BID (lFB) PRI1966233 [xl NEGOTIATED (RFP) 0\/04/2024

7. ISSUEDBY I 8. ADDRESSOFFERTO (If other than item 7)

CODE

American Embassy Riga American Embassy Riga Samnera Velsa Street I Samnera Velsa Street I Riga, LV -1510, Latvia Riga, LV -1510, Latvia Phone: +371-6710-7187 E-mail: Riga-ProcurementSection @state.gov Phone: +371-6710-7187 E-mail: Riga-ProcurementSection

@state.gov NOTE: In sealed bid solicitation "offer" and "offeror" mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and 1 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in American Embassy Riga until 14:00, February 21, 2024 local time. CAUTION· LATE Submissions, Modifications, and Withdrawals: See Section L. Provision No.

52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

10. FOR A. NAME 8. TELEPHONE (NO COLLECT C. E-MAIL ADDRESS

INFORMATION Christine Lyons CALLS) Riga-ProcurementSection

CALL: AREA CODE NUMBER EXT @state.gov +371 6710 7097

II. TABLE OF CONTENTS

(x) SEC. I DESCRIPTION I PAGE(S) (x) I SEC. DESCRIPTION I PAGE(S)

PART I - THE SCHEDULE PART II - CONTRACTCLAUSES

X A SOLICITATION/CONTRACTFORM I X I CONTRACTCLAUSES 21-33

X B SUPPLIESOR SERVICEAND PRICES/COSTS 2-5 PART 111- LIST OF DOCUMENTS. EXHIBITS, AND OTHER ATTACH

X C DESCRIPTION/SPECS/WORKSTATEMENT 6-11 X J LISTOF ATTACHMENTS 34-42

X D PACKAGINGANDMARKETING 12 PART IV- REPRESENTATIONSAND INSTRUCTIONS

X E INSPECTIONANDACCEPTANCE 13-14 X K REPRESENTATIONS,CERTIFICATIONS,AND

X F DELIVERIESOR PERFORMANCE 15 OTHERSTATEMENTSOFOFFERORS 43-61

X G CONTRACTADMINISTRATION 16-17 X L INSTRS.,COND.,ANDNOTICESTOOFFERORS 62-67

X H SPECIALCONTRACTREQUIREMENTS 18-20 X M EVALUATIONFACTORSFORAWARD 68-69

OFFER (Must be fully completed by offeror) NOTE: ITEM 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within lJill calendar days (120 calendar days unless a different period is inserted by the offer) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the designated pointfs), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT SEE 110 CALENDAR 20 CALENDAR 30 CALENDAR CALENDAR DAYS

14 DAYS DAYS DAYS %

(See section I Clause No 52.232-8) % % %

14. ACKNOWLEDGMENT OF AMENDMENT NO. DATE AMENDMENT NO. DATE

AMENDMENTS

(The offeror acknowledges receipt of amendments to the sol icitation and related documents) numbered and dated:

15A. NAME CODE I FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED

AND TO SIGN OFFER (Type or print)

ADDRESS

OF

OFFEROR

158. TELEPHONE NO. (Include area I [ 15C. CHECK IF REMITTANCE ADDRESS 17. SIGNATURE 118. OFFER DATE code) 1 IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED I 20. AMOUNT I 21. ACCOUNTING AND APPROPRIATION

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN 23. SUBMIT INVOICES TO ADDRESS SHOWN ITEM

COMPETITION: IN

r 1 10 U.S.c. 2304(c)( ) [ 1 41 U.S.c. 253(c)( ) (4 copies unless otherwise specified)

24. ADMINISTRATIONBY (If other than Item 7) I 25. PAYMENTWILLBE MADEBY CODE CODE ri£ca.billin~omc~e.Jlov

26. NAr~~: ~~~~:C"rIL~ O;~C~R (Type or print) 27~6~

128. AWARD DATE

(Siphature 0 ontracti ficer 01-0'-' - 'l()~ IMI)ORTANT - Award will be made on this form, or on the Standard Form 26, or by other authorized official written notice.

NSN 7540-01-152-8064 STANDARDFORM33 (REV9-97)

Page 1 of69

SENSITIVE BUT UNCLASSIFIED

mailto:@state.gov mailto:@state.gov mailto:@state.gov

SECTION B - PRICES

JAMES ZADROGA 9111VICTIMS 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% PERSUANT TO 26 U.S.C. SOOOC.

B.l. HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Riga, Latvia and their eligible dependents as described in Section C and the Exhibits in Section 1. This insurance shall be provided in accordance with Section C and the Exhibits in Section 1.

B.1.1. Official Residence Expense (ORE) Staff is included under this contract only as a rider; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff) at the rates specified below. See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders.

B.2. PRICES

B.2.1 Value Added Tax The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

B.2.2 This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3 Base Year of Contract Annual Rates Per Premium

Category Estimated Number of Rate per Premium Annual Total Premiums*

a. Self 34

b. Self Plus' One 25

c. Self Plus Two 32

d. Self Plus Three 32

e. Self Plus Four 9

f. Self Plus Five 2

g. Subtotal 354

Total Price for Base Year (g)** *estimated number of premiums does not include any Riders (B.1.1) **does not include any premiums for Riders.

Annual Rate er Premium

***not included in the Total Price for Base Year Calculation

Page 2 of69

SENSITIVE BUT UNCLASSIFIED

B.2.4 First Option Year of Contract Annual Rates Per Premium

Category Estimated Number of Rate per Premium Annual Total Premiums* a.l Self 36 b.1 Self Plus One 26 c.l Self Plus Two 33 d.l Self Plus Three 33 e.1 Self Plus Four 9 f.l Self Plus Five 2 g.I Subtotal 365

Total Price for First Option Year (g.1)** *estimated number of premiums does not include any Riders (B.1.I) **does not include any premiums for Riders.

Annual Rate er Premium

***not included in the Total Price for First Option Year Calculation

B.2.5 Second Option Year of Contract Annual Rates Per Premium

Category Estimated Number of Rate per Premium Annual Total Premiums* a.2 Self 38 b.2 Self Plus One 27 c.2 Self Plus Two 34 d.2 Self Plus Three 34 e.2 Self Plus Four 9 f.2 Self Plus Five 2 g.2 Subtotal 376

Total Price for Second Option Year (g.2)** *estimated number of premiums does not include any Riders (B. 1.1) **does not include any premiums for Riders.

Annual Rate er Premium

***not included in the Total Price for Second Option Year Calculation

B.2.6 Third Option Year of Contract Annual Rates Per Premium

Category Estimated Number of Rate per Premium Annual Total Premiums* a.3 Self 40 b.3 Self Plus One 28 c.3 Self Plus Two 35 d.3 Self Plus Three 35 e.3 Self Plus Four 9 f.3 Self Plus Five 2 g.3 Subtotal 387

Page 3 of69

I Total Price for Third Option Year (g.3)** *estimated number of premiums does not include any Riders (B.1.1) **does not include any premiums for Riders.

Annual Rate er Premium

***not included in the Total Price for Third Option Year Calculation

B.2.7 Fourth Option Year of Contract Annual Rates Per Premium

Category Estimated Number of Rate per Premium Annual Total Premiums* aA Self 42 bA Self Plus One 29 cA Self Plus Two 36 dA Self Plus Three 36 eA Self Plus Four 9 fA Self Plus Five 2 gA Subtotal 398

Total Price for Fourth Option Year (gA)** *estimated number of premiums does not include any Riders (B.1.1) **does not include any premiums for Riders.

Annual Rate er Premium

***not included in the Total Price for Fourth Option Year Calculation

B.2.8. Grand Total of Base plus All Option Years Period Total, EUR Base Year First Option Year Second Option Year Third Option Year Fourth Option Year Grand Total of Base plus All Option Years, EUR

MINIMUM AND MAXIMUM AMOUNTS

During the Base Year of the contract, and during the option year that might be exercised, the United States Government (USG) shall place orders totaling a minimum of 70 enrollees. This reflects the contract minimum guarantee for each period of performance. The amount of all orders, for base and all option years shall not exceed 2,500 enrollees. This reflects the contract maximum.

B.3. ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under BA below, the Contractor shall present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.2. This retention amount will not be adjusted for any reason.

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The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR: Fill in the annual retention amounts for each period of performance and for each category of premium. This fixed amount shall be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall not be expressed in terms of a percentage of the premium.

B.3.2 Annual Retention Amounts per separate premium paid per single employee and per family plan.

Employee's Dependent Period of Performance Employee Employee's Spouse Child

Base Period

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1 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 in B.I.I. No adjustment will be allowed during the first twelve months. After such time, the Contractor or the Government may request an adjustment in premiums on an annual basis. Adjustments are not retroactive to previous contract terms. 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) minus the retention amount, (2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2 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. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

B.4.2.1 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 shall include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

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SECTION C

DESCRIPTION/SPECIFICATIONIWORK STATEMENT

c.i. HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its employees as described herein.

C.l.l Employee and Dependent Health Service Benefits

C.1.1.1 Hospitalization (Treatment in the Hospital for Inpatient Care): Minimum Coverage - 100%

Services and supplies provided during hospitalization, including services provided by a licensed healthcare provider, bed & board (semi-private accommodations), operating room, recovery room, intensive care, imaging and diagnostic testing, general hospital nursing care, physical therapy, as well as drugs and medicines administered while in-patient. When private accommodations are provided, coverage will be limited to the cost of a semi-private room unless otherwise covered in an off the shelf plan.

See Mental Health and Substance Abuse care (C.1.1.13) for details concerning inpatient psychiatric care. See Outpatient Services (C.1.1.4.) for details concerning professional services.

C.1.1.2 Emergency Services (Trips to Emergency Room): Minimum Coverage - 100%

Services provided for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness.

C.1.1.3 Ambulance: Minimum Coverage - 80%

Professional ground transport to move a patient from the place where s/he is injured or becomes ill to the nearest hospital able to provide treatment or to move a patient from one medical facility to another.

C.1.1.4 Outpatient Services: Minimum Coverage - 80%

Services provided by a licensed health care provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon's fees and other medical services provided at a hospital, clinic, doctor's office, medical facility, etc. Examples include, but are not limited to:

Annual physical examinations Specialist consultations and treatment, including second surgical opinion Minor surgical interventions Chemotherapy and radiation treatments Immunizations recommended by local authorities and/or the World Health Organization Diagnostic tests and diagnostic imaging

See Rehabilitative and Habilitative Services and Devices (C.l.l.14.) for details concerning physical therapy.

See Mental Health and Substance Abuse Care (C.1.1.13.) for details concerning psychiatric therapy.

C.l.1.5 Obstetric and Newborn Care: Minimum Coverage - Inpatient: 100%; Outpatient: 80% Care and services that women receive during pregnancy (prenatal care), throughout labor and delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be

Page 6 of69 covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

C.1.1.6 Pediatric Services: Minimum Coverage - Inpatient: 100%, Outpatient: 80%

Primary and preventive routine care services for covered dependent children, including, but not limited to:

physical examinations, developmental assessments, laboratory tests, and immunizations recommended by local authorities or the World Health Organization.

C.1.1.7 Prescription Drugs: Minimum Coverage - Inpatient: 100%, Outpatient: 80%

Medications prescribed by a certified health care provider that are medically required. Examples include, but are not limited to prescription antibiotics to treat an infection, medication used to treat an ongoing condition, such as high cholesterol; prophylaxis; or contraceptive medication.

C.1.1.8 Preventive and Wellness Services and Chronic Disease Management:

Minimum Coverage - 80%

Counseling or preventive care designed to prevent or detect medical conditions and care for chronic conditions such as asthma and diabetes. Examples include, but are not limited to: physicals, immunizations, and cancer screenmgs.

C.1.1.9 Hearing Aids: Minimum Coverage - 80%

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear. The maximum coverage is EUR 1,374.00 per covered individual per three-year period. 80% Minimum Coverage: with applicable cap.

C.1.1.10 Optical Care: Minimum Coverage - 80%

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: The maximum coverage is EUR 274.80 per covered individual every two years. 80% Minimum Coverage; with applicable cap.

C.1.1.11 Dental Care: Examinations and Treatment-Minimum Coverage: 80%, with annual cap;

Orthodontia-Minimum Coverage: 80%, with contract lifetime cap

Examinations and Treatment: Dentist's fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges. The maximum coverage is EUR 2,931.20 per covered individual per contract year.

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual. The maximum coverage is EUR 2,198.40 lifetime limit.

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C.l.l.I2 Reproductive Health: Minimum Coverage - 80%

Prescribed contraceptive devices, preventive care and routine examinations, voluntary sterilization, and diagnosis and treatment of conditions which may cause infertility. Assisted reproductive technology (ART), fertility treatments, and reversal of sterilization are not covered (see Exclusions to Coverage).

See also Exclusion to Coverage (b)(C.l.3.)

C.1.1.13 Mental Health and Substance Abuse Care: Minimum Coverage - 50%

Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy. Services must be provided by a licensed psychiatrist, psychoanalyst, psychologist, or psychiatric social worker. Inpatient care for alcohol and substance abuse must be provided at a facility licensed for detoxification and rehabilitation.

C.1.l.14 Rehabilitative and Habilitative Services and Devices: Minimum Coverage - 50%

Rehabilitative services (e.g., recovering skills, such as speech therapy after a stroke or physical therapy after an accident) and habilitative services (e.g., developing skills, such as speech therapy for children, etc.) that help develop skills needed for everyday life. Devices to help gain or recover mental or physical skills lost due to injury, disability or a chronic condition, and devices needed for habilitative reasons.

C.l.l.15 HIV/AIDS

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIVIAIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIVIAIDS to the child. Generally, excludes medication for the long-term suppression of HIV IAIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

See also Exclusion to Coverage (b)(C.l.3.)

C.l.1.16

RESERVED

C.l.l.17

RESERVED

C.1.1.I8

RESERVED

C.1.1.19

RESERVED

C.l.l.20

RESERVED

C.1.1.21

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RESERVED

C.l.2 Annual Maximum Limit - The maximum annual coverage per covered individual (employee, dependents) per contract year, not including expenses covered under C.1.1.15, HIV/AIDS benefits if selected by post, is 6,000 EUR. Breakdown as follows:

--Self Only (Employee): 6,000 EUR --Self Plus One: 12,000 EUR --Self Plus Two: 18,000 EUR --Self Plus Three: 24,000 EUR --Self Plus Four: 30,000 EUR --Self Plus Five: 36,000 EUR

C.l.3 Exclusions and Limitations

(a) 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 is the lowest-cost and technically acceptable. Removal of any exclusions require prior authorization.

(b) 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.I.4 ELIGIBLE PARTICIPANTS

C.l.4.1 Identification of Eligible Employees and Dependents: U.S. Mission Riga, Latvia will provide a list of all eligible employees and dependents with relationship to employee (self/spouse/child) and DOB for each. Updates will be provided to add or remove individuals on a monthly basis.

C.1.4.l.1 Definition of Eligible Employees

C. 1.4.1 .1.1 LE Staff paid under the terms of the Local Compensation Plan (LCP); and under a non-temporary direct hire appointment, personal services agreement (PSA), or personal services contract (PSC); or under a temporary direct hire appointment or PSA Fixed Term of one year or more.

C.1.4.1.2 Definition of Dependents

C 1.4.1.2.1 Legal spouse or domestic partner, to include same-sex domestic partners, as certified by COM:

one legal spouse as defined by local law or one domestic partner may be covered. LE Staff with more than one legal spouse or domestic partner must select only one individual for coverage.

In cases where LE Staff and their legal spouse or domestic partner both work for the mission and both are eligible to participate in the medical plan, one will be designated as the lead for purposes of the medical plan, and the other will be considered a legal spouse or domestic partner.

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C.1.4.1.2.2 Dependent children: a child is defined as the LE Staff s natural, adopted, stepchild, or foster child. Any child of a recognized domestic partner shall be deemed a stepchild of the employee. Children must be unmarried and financially dependent upon the LE Staff. A child will be covered until the end of the contract year in which s/he reaches age 26. An unmarried child determined to be incapable of self-support due to a physical or mental condition will continue to be eligible to participate in the medical plan as long as the condition persists, the child remains unmarried, and the LE Staff maintains coverage.

C.1.4.2 Location of Employment: The eligible employees covered by C.l.4.l must be employed within the geographic boundaries of the Republic of Latvia.

C.l.4.3 Participants Covered Under a Rider

Official Residence Expense (ORE) and Employee Association (EA) employees may be covered under a rider to the contract. The employing officer/EA, not the USG, is responsible for the employer's share of the premium costs for an ORE employee.

C.1.4.4 Individuals not Eligible for Coverage

Individuals not eligible for coverage are those working under temporary appointments; those working under a PSC or PSA that is time limited to less than one year; non-personal services contract personnel and their employees, supplied by an independent contractor licensed to do business in Latvia who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

C.l.S ELIGIBILITY

C.1.S.l Term of Eligibility and Effective Date Each current active eligible employee and their eligible dependents are enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee and eligible dependents will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the roils") whenever such employee is on approved leave, whether paid or unpaid.

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of extended Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor, and will collect the full cost from the employee on a quarterly basis.

Alternatively, the employee may elect to have coverage cease if they prefer not to pay the premium.

C.1.6 Brochure Requirement

C.l.6.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in Latvian and English that sets forth a complete listing of the health insurance benefits to be provided under this contract.

This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. The

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Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.l.6.2 The Contractor shall provide the document described in C.l.6.1 to the COR not later than 30 workdays after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) business days of the COR's request.

C.l.6.3 The Contractor assumes full responsibility for ensuring that the document described in C.l.6.1 accurately reflects the requirements, coverage, and contract terms ofthe contract, as implemented by the Contractor's technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the document contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the U.S. Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

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SECTIOND

PACKAGING AND MARKING

(RESERVED)

SECTIONE

INSPECTION AND ACCEPTANCE

E.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. In addition, the full text of a clause may be accessed electronically at: Acquisition.gov this address is subject to change.

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the Department of State Acquisition website at e-CFR to see the links to the FAR. You may also use an Internet "search engine" (for example, Google, Yahoo or Excite) to obtain the latest location of the most current FAR.

THE FOLLOWING FEDERAL ACQUISITION REGULATION CLAUSE(S) IS/ARE INCORPORATED BY

REFERENCE:

CLAUSE TITLE AND DATE

52.246-4 INSPECTION OF SERVICES - FIXED PRICE (AUG 1996)

E.2. QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

This plan is designed to provide an effective surveillance method to promote effective Contractor performance.

The QASP provides a method for the Contracting Officer's Representative (COR) to monitor Contractor performance, advise the Contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The Contractor, not the Government, is responsible for management and quality control to meet the terms of the contract. The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

PWS

Performance Objective Paragraph Performance Threshold Services Performs all the insurance services set forth C.1.0 thru All required services are in the Performance Work Statement (PWS) C.1.6 performed and no more than two

(2) customer complaints are received per month.

E.2.1 Surveillance. The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

E.2.2 Standard. The performance standard is that the Government receives no more than two (2) customer complaints per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services - Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

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E.2.3 Procedures

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should immediately contact the COR.

(b) The COR will complete appropriate documentation to record the complaint.

(c) If the COR determines the complaint is invalid, the COR will advise the complainant. The COR will retain the annotated copy of the written complaint for his/her files.

(d) If the COR determines the complaint is valid, the COR will inform the Contractor and give the Contractor additional time to correct the defect, if additional time is available. The COR shall determine how much time is reasonable.

(e) The COR shall, as a minimum, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR. The COR wi II review the matter to determine the validity of the complaint.

(g) The COR will consider complaints as resolved unless notified otherwise by the complaint.

(h) Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

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SECTIONF

DELIVERIES OR PERFORMANCE

F.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. In addition, the full text of a clause may be accessed electronically at: Acquisition.gov this address is subject to change.

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the Department of State Acquisition website at e-CFR to see the links to the FAR. You may also use an Internet "search engine" (for example, Google, Yahoo or Excite) to obtain the latest location of the most current FAR.

THE FOLLOWING FEDERAL ACQUISITION REGULATION CLAUSES ARE INCORPORATED BY

REFERENCE:

CLAUSE TITLE AND DATE

52.242-15 STOP WORK ORDER (AUG 1989)

GOVERNMENT DELAY OF WORK (APR 1984)52.242-17

F.2. PERIOD OF PERFORMANCE. The performance period ofthis contract is one year beginning on October 1, 2024, with four one-year options to renew.

F.3. OPTIONS

(a) The Government may extend this contract in accordance with the option clause at Section I, clause 1.2, FAR Clauses Incorporated by Full Text (FAR 52.217-9, Option to Extend the Term of the Contract), which also specifies the total potential duration of the contract.

(b) The Government may exercise the option set forth at Section I, "FAR 52.217-8, Option to Extend Services".

FA. REPORTS AND OTHERDELIVERABLES

All reports and other deliverables required under this contract shall be delivered to the following address:

Samnera Velsa Street 1

American Embassy Riga

Riga, LV-1510

Latvia

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SECTION G

CONTRACT ADMINISTRATION DATA

G.1. 652.242-70 CONTRACTING OFFICER'S REPRESENTATIVE (COR) (AUG 1999)

(a) The Contracting Officer may designate in writing one Government employee, by name or position title, to take action for the Contracting Officer under this contract. This designee shall be identified as a Contracting Officer's Representative (COR). Such designation shall specify the scope and limitations of the authority so delegated; provided, that the designee shall not change the terms or conditions of the contract, unless the COR is a warranted Contracting Officer and this authority is delegated in the designation.

(b) The COR for this contract is the Human Resources Officer.

G.2. COR DUTIES

G.2.1 The COR is responsible for inspection and acceptance of services. These duties include review of Contractor invoices, including the supporting documentation required by the contract. The COR may provide technical advice, substantive guidance, inspections, invoice approval, and other purposes as deemed necessary under the contract.

G.2.2 In addition, the COR shall maintain updated list of employees and dependents insured, which will supersede the initial list provided under this contract and as reported to the insurer, without prejudice to the ineligibility clause.

G.2.3 The COR has the additional responsibility of maintaining the eligible listing of employees and dependents for insurance coverage.

G.2.4 The COR may not change the terms and conditions of the contract. While the COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

G.3. Payment shall be made in EUROS.

G.4. SUBMISSION OF INVOICES AND PAYMENT

G.4.1 Invoices for U.S. Government employees shall be submitted to the following E-mail address (designated billing office only for the purpose of submitting invoices): riga.billing.office@state.gov.

G.4.2 Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3 for all non-rider coverage. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in H.3. Contractor may submit invoices monthly for payment to be made at the beginning of the month for which insurance coverage is provided in accordance with FAR 32.404.

G.4.3 U.S. Government Employees. The Government shall make payments directly to the Contractor for all Government employees, whether or not the employee is contributing to the basic premium amount.

Page 16 of69 mailto:riga.billing.office@state.gov.

G.4.4 Riders:

ORE Staff. The Chief of Mission and/or Deputy Chief of Mission will make payment directly to the Contractor for the entire premium amount of the ORE staff, whether or not the ORE employee is contributing to the premium amount.

G.S. REFUNDS TO THE GOVERNMENT

If at any time during performance of the contract the Government finds that the Contractor has been overpaid because the number of employees and/or dependents covered has decreased, the Contracting Officer may either allow that overpayment to be credited to the Government's account or require that the Contractor refund the overpayment. If the Contracting Officer requests a refund, the Contractor shall make that refund to the Government within ten calendar days of receipt of the request.

G.6. VALUE ADDED TAX

The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption certificate with the host government.

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SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.l. SECURITY. On occasion, a Contractor employee may require entry into U.S. Government-owned or-operated facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility.

H.2. STANDARDS OF CONDUCT. The Contractor shall maintain satisfactory standards of employee competency, conduct, cleanliness, appearance, and integrity and shall be responsible for taking such disciplinary action with respect to employees as may be necessary. Each Contractor employee is to adhere to standards that reflect credit on themselves, their employer, and the United States Government.

H.3. ORDERING PROCEDURES. The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the Government anticipates issuance of a new task order on a [ X] monthly, [ ] quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

H.3.1 Riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, either their employer are themselves are responsible for directly interacting with the Contractor to order any coverage. When contacted, the Contractor shall advise the person of the paperwork and payment that will be necessary to order coverage for the identified individuals. The Contractor may be contacted by more than one individual.

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO CLAIMANTS

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 employee' 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 covered employee and each covered dependent 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 person 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, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(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).

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

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) 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.

H.5. REPORT REQUIREMENTS. The Contractor shall provide the following monthly report. The report shall be received by the COR no later than the 10th day of each month. The report shall report on the previous month's activities.

(a) Employee Claims Report. The report shall list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid. The report shall not include any claims information for riders.

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1 General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Republic of Latvia government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S. Government employees. Registration of this contract with the Republic of Latvia government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

H.6.2 Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

H.7. ERRONEOUS PAYMENTS. If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future

Page 19 of69 payments owed by the Government, whichever the Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8. REQUIRING ACTIVITY. The requiring activity under this contract is the U.S. Embassy/Consulate.

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1.1. 52.252-2

SECTION I

CONTRACT CLAUSES

CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. In addition, the full text of a clause may be accessed electronically at: Acquisition.gov this address is subject to change.

If the Federal Acquisition Regulation (FAR) is not available at the location indicated above, use the Department of State Acquisition website at e-CFR to see the links to the FAR. You may also use an Internet "search engine" (for example, Google, Yahoo or Excite) to obtain the latest location of the most current FAR.

THE FOLLOWING FEDERAL ACQUISITION REGULATION CLAUSES ARE INCORPORATED BY

REFERENCE:

CLAUSE

52.202-1

52.203-3

52.203-5

52.203-6

52.203-7

52.203-8

52.203-10

52.203-12

52.203-13

52.203-17

52.203-19

52.204-4

52.204-7

52.204-9

TITLE AND DATE

DEFINITIONS (JUN 2020)

GRATUITIES (APR 1984)

COVENANT AGAINST CONTINGENT FEES (MAY 2014)

RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT (JUN 2020)

ANTI-KICKBACK PROCEDURES (JUN 2020)

CANCELLATION, RESCISSION, AND RECOVERY OF FUNDS FOR ILLEGAL OR

IMPROPER ACTIVITY (MAY 2014)

PRICE OR FEE ADJUSTMENT FOR ILLEGAL OR IMPROPER ACTIVITY (MAY 2014)

LIMITA TION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS

(JUN 2020)

CONTRACTOR CODE OF BUSINESS ETHICS AND CONDUCT (NOV 2021)

CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS (NOV 2023)

PROHIBITION ON REQUIRING CERTAIN INTERNAL CONFIDENTIALITY

AGREEMENTS OR STATEMENTS (JAN 2017)

PRINTED OR COPIED DOUBLE-SIDED ON POSTCONSUMER FIBER CONTENT PAPER

(MAY 2011)

SYSTEM FOR AWARD MANAGEMENT (OCT 2018)

PERSONAL VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011)

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52.204-10 REPORTING EXECUTIVE COMPENSATION AND FIRST-TIER SUBCONTRACT

AWARDS (JUN 2020)

52.204-13 SYSTEM FOR AWARD MANAGEMENT MAINTENANCE (OCT 2018)

52.204-18 COMMERCIAL LAND GOVERNMENT ENTITY CODE MAINTENANCE

(AUG 2020)

52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND

CERTIFICATIONS (DEC 2014)

52.204-23 PROHIBITION ON CONTRACTING FOR HARDWARE, SOFTWARE, AND SERVICES

DEVELOPED OR PROVIDED BY KASPERSKY LAB COVERED ENTITIES (DEC 2023)

52.204-25 PROHIBITION ON CONTRACTING FOR CERTAIN TELECOMMUNICATION AND

VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (NOV 2021)

52.204-27 PROHIBITION ON A BYTEDANCE COVERED APPLICATION (JUN 2023)

52.204-28 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT ORDERS-FEDERAL

SUPPL Y SCHEDULES, GOVERNMENTWIDE ACQUISITION CONTRACTS, AND

MULTI-AGENCY CONTRACTS (DEC 2023)

52.204-30 FEDERAL ACQUISITION SUPPLY CHAIN SECURITY ACT ORDERS-PROHIBITION

(DEC 2023)

52.209-6 PROTECTING THE GOVERNMENT'S INTEREST WHEN SUBCONTRACTING WITH

CONTRACTORS DEBARRED, SUSPENDED, OR PROPOSED FOR DEBARMENT (NOV

2021)

52.209-9 UPDATES OF PUBLICL Y AVAILABLE INFORMATION REGARDING RESPONSIBILITY

MATTERS (OCT 2018)

52.210-1 MARKET RESEARCH (NOV 2021)

52.215-2 AUDIT AND RECORDS - NEGOTIATION (JUN 2020)

52.215-8 ORDER OF PRECEDENCE--UNIFORM CONTRACT FORMAT (OCT 1997)

52.215-11 PRICE REDUCTION FOR DEFECTIVE CERTIFIED COST OR PRICING DATA-

MODIFICATIONS (JUN 2020)

52.215-13 SUBCONTRACTOR CERTIFIED COST OR PRICING DATA-

MODIFICATIONS (JUN 2020)

52.215-21 REQUIREMENTS FOR CERTIFIED COST OR PRICING DATA AND DATA OTHER

THAN CERTIFIED COST OR PRICING DATA-MODIFICATIONS ((NOV 2021)

52.222-19 CHILD LABOR - COOPERATION WITH AUTHORITIES AND REMEDIES (DEC 2023)

(DEVIATION JAN 2024)

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52.222-50 COMBATTING TRAFFICKING IN PERSONS (NOV 2021)

52.223-18 ENCOURAGING CONTRACTOR POLICIES TO BAN TEXT MESSAGING WHILE

DRIVING (JUN 2020)

52.224-1 PRIVACY ACT NOTIFICATION (APR 1984)

52.224-2 PRIVACY ACT (APR 1984)

52.224-3 PRIVACY TRAINING (JAN 2017)

52.225-5 TRADE AGREEMENTS (NOV 2023)

52.225-13 RESTRICTIONS ON CERTAIN FOREIGN PROCUREMENTS (FEB 2021)

52.225-14 INCONSISTENCY BETWEEN ENGLISH VERSION AND TRANSLATION OF CONTRACT

(FEB 2000)

52.228-4 WORKERS COMPENSATION AND WAR-HAZARD INSURANCE OVERSEAS (APR 1984)

52.228-5 INSURANCE- WORK ON A GOVERNMENT INSTALLATION (JAN 1997)

52.229-6 TAXES - FOREIGN FIXED PRICE CONTRACTS (FEB 2013)

52.232-1 PAYMENTS (APR 1984)

52.232-8 DISCOUNTS FOR PROMPT PAYMENT (FEB 2002)

52.232-11 EXTRAS (APR 1984)

52.232-17 INTEREST (MAY 2014)

52.232-18 AVAILABILITY OF FUNDS (APR 1984)

52.232-24 PROHIBITION OF ASSIGNMENT OF CLAIMS (MAY 2014)

52.232-25 PROMPT PAYMENT (lAN 2017)

52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER - SYSTEM FOR AWARD

MANAGEMENT (OCT 2018)

52.232-34 PAYMENT BY EFT - OTHER THAN SAM (JULY 2013)

52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS (MAR 2023)

52.233-1 DISPUTES (MAY 2014) Alternate I (DEC 1991)

52.233-3 PROTEST AFTER AWARD (AUG 1996)

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52.233-4

52.237-2

52.242-13

52.243-1

52.246-25

52.246-26

52.248-1

52.249-2

52.249-8

APPLICABLE LAW FOR BREACH OF CONTRACT CLAIM (OCT 2004)

PROTECTION OF GOVERNMENT BUILDINGS, EQUIPMENT, AND VEGETATION (APR

1984)

BANKRUPTCY (JULY 1995)

CHANGES (AUG 1987) - ALTERNATE I (APR 1984)

LIMITATION OF LIABILITY - SERVICES (FEB 1997)

REPORTING NONFORMING ITEMS (JON 2020)

VALUE ENGINEERING (JUN 2020)

TERMINATION FOR CONVENIENCE OF THE GOVERNMENT (FIXED PRICE) (APRIL

2012)

DEFAULT - FIXED PRICE SUPPLY AND SERVICE (APR 1984)

1.2. FEDERAL ACQUISITION REGULATION (FAR) CLAUSES INCORPORATED IN FULL TEXT

52.216-18 ORDERING (AUG 2020)

(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from the first day of the ongoing performance period through the last day of that performance period. See F.2.

(b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control.

(c) A delivery order or task order is considered "issued" when -

(1) If sent by mail (includes transmittal by U.S. mail or private delivery service), the Government deposits the order in the mail;

(2) If sent by fax, the Government transmits the order to the Contractor's fax number; or

(3) If sent electronically, the Government either-

(i) Posts a copy of the delivery order or task order to a Government document access system, and notice is sent to the Contractor; or

(ii) Distributes the delivery order or task order via email to the Contractor's email address.

contract.

(d) Orders may be issued by methods other than those enumerated in this clause only if authorized in the

(End of clause)

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52.216-19 ORDER LIMITATIONS (OCT 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than 50,000 USD, the Govermnent is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor-

(1) Any order for a single item in excess of 5,000,000.00 USD

(2) Any order for a combination of items in excess of 25,000,000.00 USD; or

(3) A series of orders from the same ordering office within 30 (thirty) days that together call for quantities exceeding the limitation in subparagraph (1) or (2) above.

(c) If this is a requirements contract (such as, includes the…