Amendment 0004 - Health insurance.pdf

SBU - CONTRACTING AND ACQUISITIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGE OF PAGES

1 19

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

December 9, 2020

4. REQUISITION/PURCHASE REQ. NO.

5. PROJECT NO. (If applicable)

6. ISSUED BY CODE 7. ADMINISTERED BY (If other than Item 6) CODE

U.S. Embassy Mexico City

General Services Office/Contracts

Paseo de la Reforma No. 305

Colonia Cuauhtémoc

06500 Ciudad de Mexico

U.S. Embassy Mexico City

Human Resources Office

Paseo de la Reforma No. 305

Colonia Cuauhtémoc

06500 Mexico, D. F.

8. NAME AND ADDRESS OF CONTRACTOR (Number, street, city, county, State, and ZIP Code)

9A. AMENDMENT OF SOLICITATION NO.

19MX53-20-R-0001 ☒☒☒☒ 9B. DATED (SEE ITEM 11)

September 17, 2020

10A. MODIFICATION OF CONTRACT/ORDER NO.

☐☐☐☐ 10B. DATED (SEE ITEM 13)

CODE: FACILITY CODE:

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

☒☒☒☒ The 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

Offerors 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 you 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 APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14. ☐☐☐☐ 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 _______ original(s) 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 delete APHIS and Excess Coverage, as riders from the solicitation, update the estimated number of employees in section B Prices, adding a cap to HIV/AIDS coverage, correcting the hour validity of Insurance policies, and extending the closing date. Additionally, Section J, List of Exhibits, is deleted in its entirety and replaced with revised Section J, List of Exhibits enclosed herein. See attached continuation to this SF-30 with the specific changes to this Solicitation.

15A. NAME AND TITLE OF SIGNER (Type or print)

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

C. Melora Johnston

General Services Officer

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

16C. DATE SIGNED

NSN 7540-01-152-8070 STANDARD FORM 30 (revised 11/2016)

Previous edition unusable Prescribed by GSA FAR (48 CFR) 53.243

Continuation to SF-1449, Block 14

Amendment 0004 to

Solicitation Number 19MX53-20-R-0001

SF-33

1. Proposal Delivery Date

Proposal delivery date is hereby extended to December 28, 2020. Therefore, block 9 of SF-33 shall be replaced in its entirety to read as follows.

“9. Sealed offers in original and N/A copies for furnishing the supplies or services in the Schedule will be received at the email specified in section L.3.2 until 17:00 local time December 28, 2020 .

(hour) (date)

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. “

SECTION B - PRICE

2. B.1.1. RIDERS

APHIS employees will not be considered riders under this solicitation; they will be considered U.S.G. employees. Additionally, Excess Coverage is being removed from this requirement. Therefore, sections B.1.1.2 and B.1.1.3 are hereby deleted in its entirety and replaced with “RESERVED”.

As a result, section B.1.1, RIDERS, shall read as follows:

“B.1.1. RIDERS

B.1.1.1. Official Residence Expense (ORE) are included under this contract only as rider; the Contractor shall bill Chief of Mission, Deputy Chief of Mission, and Management/Principal Officer (for ORE Staff) separately, at the rates specified below.

B.1.1.2. RESERVED.

B.1.1.3. RESERVED.

See Section G for billing procedures. Note that USG is not responsible, nor liable, for any riders”

3. Estimated Number of Employees and Rider Category

The estimated number of employees for the Base year and each Option years are updated to reflect a recent update on the list of employees attached herein and the addition of Aphis employees. Additionally, since Excess Coverage is being removed from this requirement, the table to add the Yearly Rate per Premium for B.2.1.2. Rider Category*** is hereby being deleted.

Therefore, sections B.2.1. through B.2.5. are hereby deleted in its entirety and replaced to read as follows:

“B.2.1. BASE YEAR OF CONTRACT (12 MONTH)

As per paragraphs B.1.3. above, prices are in __________ [Insert Currency].

B.2.1.1. Yearly Rates per Premium

Category Estimated Number of Employees* Rate per Premium

Estimated Yearly Total

a. Single 552 $ $

b. Family 1,088 $ $

Subtotal: $

Value Added Tax (I.V.A.): $

Total Price for Base Year: $

*estimated number of employees does not include any Riders (B.1.1) **does not include any premiums for Riders.

B.2.2. FIRST OPTION YEAR OF CONTRACT (12 MONTH)

B.2.2.1. Yearly Rates per Premium

Estimated Number of

Employees*

Rate per Premium

Estimated Yearly Total

a. Single 562 $ $

b. Family 1,109 $ $

Subtotal: $

Value Added Tax (I.V.A.): $

Total Price for First Option Year: $

B.2.3. SECOND OPTION YEAR OF CONTRACT (12 MONTH)

B.2.3.1. Yearly Rates per Premium

Estimated Number of

Employees*

Rate per Premium

Estimated Yearly Total

a. Single 572 $ $

b. Family 1,132 $ $

Subtotal: $

Value Added Tax (I.V.A.): $

Total Price for Second Option Year: $

B.2.4. THIRD OPTION YEAR OF CONTRACT (12 MONTH)

B.2.4.1. Yearly Rates per Premium

Estimated Number of

Employees*

Rate per Premium

Estimated Yearly Total

a. Single 582 $ $

b. Family 1,145 $ $

Subtotal: $

Value Added Tax (I.V.A.): $

Total Price for Third Option Year: $

B.2.5. FOURTH OPTION YEAR OF CONTRACT (12 MONTH)

B.2.4.1. Yearly Rates per Premium

Estimated Number of

Employees*

Rate per Premium

Estimated Yearly Total

a. Single 592 $ $

b. Family 1,159 $ $

Subtotal: $

Value Added Tax (I.V.A.): $

Total Price for Fourth Option Year: $

SECTION C – DESCRIPTION/SPECIFICATION/WORK STATEMENT

4. C.1.1.15 HIV/AIDS

A cap of USD 10,000 per contract year per covered individual is being added to HIV/AIDS coverage. Therefore, paragraph C.1.1.15 shall read as follows:

“C.1.1.15. HIV/AIDS:

Minimum Coverage 100% up to USD 10,000 per contract year per covered individual

Medications to suppress opportunistic infections (such as tuberculosis or toxoplasmosis for covered individuals who have HIV/AIDS). Brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV/AIDS to the child.

Generally excludes medication for the long-term suppression of HIV/AIDS through the combination of anti-retroviral drugs in locations with inadequate local healthcare infrastructures.

Coverage under this benefit is excluded from the annual maximum limit (C.1.2).”

5. C.1.1.16. Catastrophic Coverage

Catastrophic Coverage is being removed from this solicitation. Therefore, paragraph C.1.1.16, Catastrophic Coverage, is deleted in its entirety and replaced with “RESERVED” to read as follows:

“C.1.1.16. RESERVED”

6. C.1.1.21. Excess Coverage

Excess Coverage is being removed from this solicitation. Therefore, paragraph C.1.1.21, Excess Coverage, is deleted in its entirety and replaced with “RESERVED” to read as follows:

“C.1.1.21. RESERVED”

SECTION F – DELIVERIES OR PERFORMANCE

7. Insurance Policies

Insurance policies validity is hereby specified to eliminate any ambiguities that may arise. As a result, second paragraph of section F.5, Insurance Policies, is hereby deleted in its entirety to read as follows:

“Insurance policies validity shall start at 00:00 hours on the period of performance start date and shall end at 23:59 hours on the period of performance end date of the base year and each option year that is exercised.”

Therefore, section F.5, Insurance Policies shall read as follows:

“F.5. INSURANCE POLICIES

The Contractor shall provide individual insurance policies for all U.S.

Government employees within (14) fourteen calendar days of receiving the corresponding Task Order. Insurance Policies shall be provided in electronic and paper format.

Insurance policies validity shall start at 00:00 hours on the period of performance start date and shall end at 23:59 hours on the period of performance end date of the base year and each option year that is exercised.”

SECTION J – LIST OF EXHIBITS

8. The following actions were made to Section J:

• APHIS will not be considered riders under this solicitation; they will be considered U.S.G. employees. The information provided in exhibit 2 - APHIS employees riders is merging with information provided in exhibit 1 - U.S.G. employees. As a result, exhibit 2 – APHIS Employees riders is hereby deleted in its entirety and replaced with “RESERVED”; and

• Employee Statistics and Employee Census tables provided in exhibit 1 are hereby deleted and replaced with the detailed list of employees.

Therefore, Section J, List of Exhibits is hereby deleted in its entirety and replaced to read as follows:

SECTION J

LIST OF EXHIBITS

Exhibit 1 – U.S.G. Employees

Exhibit 2 – ORE Employees Riders

Exhibit 3 – RESERVED

Exhibit 4 – Payment Registration Forms

• Pesos

• U.S. dollars

• U.S.D. in Mexican Bank

Exhibit 5 – How to Obtain a DUNS Number and Register to SAM

Exhibit 6 – Delivery/Task Order Form Sample

Exhibit 7 –Claims Report – For Information Purposes

EXHIBIT 1

U.S.G. EMPLOYEES

1. LIST OF EMPLOYEES AND DEPENDENTS

USG - Detailed List of Employees and Dependents.xlsx

Note to Offerors: Please note the list is updated periodically.

2. NUMBER OF EMPLOYEES INSURED AND PREMIUM AMOUNTS

Contract Year**** No. of

Employees

Annual

Premium

End of Year

Revisions Total

2020 - 2021 1,744 $59,127,801.14 - $59,127,801.14

2019 - 2020 1,733 $56,078,591.33 $158,161.18 $56,236,752.51

2018 - 2019 1,714 $51,465,862.74 -$73,155.57 $51,392,707.17

2017 - 2018 1,664 $47,234,100.32 $1,170,077.24 $48,404,177.56

2016 - 2017 1,619 $44,273,251.65 $271,934.24 $44,545,185.89

3. CUMULATIVE HISTORICAL CLAIMS PAID/TREATMENT AMOUNTS

Contract Year**** Claims Amount without IVA

2020 – 2021 $9,720,004.76

2019 - 2020 $40,046,910.00

2018 - 2019 $36,945,584.00

2017 - 2018 $34,472,379.11

2016 - 2017 $20,431,486.80

****Contract Year refers to March 1 to February 28.

EXHIBIT 2

ORE EMPLOYEES RIDERS

NOTE TO OFFERORS: Included for informational purposes only.

1. LIST OF EMPLOYEES AND DEPENDENTS

ORE - Detailed List of Employees and Dependents.xlsx

Note to Offerors: Please note the list is updated periodically.

2. NUMBER OF EMPLOYEES INSURED AND PREMIUM AMOUNTS

Contract Year**** No. of Employees Annual Premium End of Year

Revisions Total

2020 - 2021 28 $1,100,632.20 - $1,100,632.20

2019 - 2020 29 $1,057,057.32 $5,868.27 $1,062,925.59

2018 - 2019 29 $925,068.72 $-17,010.36 $908,058.36

2017 - 2018 29 $914,083.48 $7,434.21 $921,517.69

2016 - 2017 29 $728,952.01 $44,613.90 $773,565.91

3. CUMULATIVE HISTORICAL CLAIMS PAID/TREATMENT AMOUNTS

Contract Year**** Claims Amount without IVA

2020 – 2021 $69,669.33

2019 - 2020 $43,574.00

2018 - 2019 $47,146.00

2017 - 2018 $0.00

2016 - 2017 $30,660.74

****Contract Year refers to March 1 to February 28.

EXHIBIT 3

APHIS EMPLOYEES RIDERS

(RESERVED)

EXHIBIT 4

PAYMENT REGISTRATION FORMS

PAYMENT REGISTRATION FORM - PESOS

Company Information

New Registration of Account Change of Account

Fiscal Name of the account holder

RFC (for Mexican Companies)

Name - Point of Contact

Telephone Number(s)

E-mail Address

Company Address

Bank information needed for EFT transfers in Pesos, Mexican Currency.

BANK INFORMATION

Bank Name

CLABE Interbancaria (18 digits)

Currency of Account MXN

If it is a collection account, please include the reference number:

Numeric reference:

Alphanumeric reference:

Signature Date

FMC approval

Note to Offeror: This form has to be signed and attached in PDF format.

PAYMENT REGISTRATION FORM – U.S. DOLLARS

PAYMENT REGISTRATION

TO A BANK IN THE UNITED STATES

Name of the account holder

Name - Point of Contact

Telephone Number

Address

DUNS Number

Vendor US Tax ID

Bank information needed for EFT transfers in U.S. Dollars to a Bank in the United

States

Bank Name

Bank Routing Number (must be 9 digits beginning with a 0,1,2 or 3)

Account Number

Currency of Account USD

FMC approval

Note to Offeror: This form has to be signed and attached in PDF format.

PAYMENT REGISTRATION - U.S. DOLLARS IN MEXICAN BANK

PAYMENT REGISTRATION

TO A BANK IN MEXICO

U. S. Dollars Bank Account

Name of the account holder

RFC (for Mexican Companies)

Name - Point of Contact

Telephone Number

Address

DUNS no.

Bank information needed for EFT transfers in U.S. Dollars to a U.S. Dollar Bank

Account in Mexico.

SWIFT Bank Mexico (Different from SWIFT Intermediate Bank)

CLABE Interbancaria (18 digits)

Currency of Account USD

INTERMEDIATE BANK

INFORMATION

SWIFT Intermediate Bank (Different from SWIFT Bank Mexico)

FMC approval _____________________________________

EXHIBIT 5

GUIDE FOR DUNS, NCAGE AND SAM REGISTRATION

1. BACKGROUND

To be eligible for an award, all prospective Offerors shall have a unique nine digit Data Universal Numbering System (DUNS) number; a Commercial and Government Entity (Cage)/North Atlantic Treaty Organization (NATO) = (NCage) Code; and register to System for Award Management (SAM). Refer to FAR 4.605(b). For further guidance, see the two attachments at the end of this Attachment.

Vendors have experienced difficulty registering in SAM. One of the most common issues is inaccurate address validation. SAM first validates that NATO Commercial and Government Entities (NCAGE) and Dun & Bradstreet (DUNS) addresses match. Following that, there is a check that the DUNS address matches what the entity has on file with their national central bank (NCB). The NCB address is pulled from the vendor’s primary bank account. Because SAM compares NCAGE and DUNS addresses before comparing DUNS and NCB addresses, entities occasionally correct addresses in both DUNS and NCAGE systems only to find out that they have to change those addresses again to match their NCB address.

NOTE: it is very important that each company/entity register with their fiscal company name and address in DUNS, NCAGE as well as in SAM and without misspelling/typos. The information shall match and be an exact copy in all registrations; otherwise, the process might take a minimum of four months.

2. DUNS NUMBER:

Offerors need a Data Universal Numbering System (DUNS) number to register their entity in SAM. DUNS numbers are unique for each physical location to be registered.

Offerors can request a DUNS number for free to do business with the U.S. Federal government by visiting Dun & Bradstreet (D&B) at http://fedgov.dnb.com/webform

It takes up to five (5) business days to obtain an international DUNS number.

3. NATO COMMERCIAL AND GOVERNMENT ENTITY (NCAGE) CODE:

Foreign entities shall obtain a NCAGE code for each DUNS number they plan to register in SAM before you start the registration process. Make sure the name and address information provided to obtain the NCAGE code matches that of the DUNS number. Allow up to three (3) business days to receive the NCAGE code.

The direct link to an online NCAGE request form is:

https://eportal.nspa.nato.int/AC135Public/scage/CageList.aspx

4. SYSTEM FOR AWARD MANAGEMENT (SAM)

Offerors should open an Individual User Account, (being sure to validate their email address to activate the user account), then Login and Register the entity in SAM at – www.sam.gov

Please allow plenty of time before the contract application deadline. Allow up to 10 business days after submission before the registration is active in SAM.

For further guidance, refer to the following attachments.

Qu ick G u id e fo r In te rn a tio n a l E n tity R e g is tra n ts .p d f

SAM-ForOrg_NewRe g.pdf

EXHIBIT 6

TASK ORDER FORM (OF 347)

EXHIBIT 7

CLAIMS REPORT – FOR INFORMATION PURPOSES

Claims Report - For Information Purposes Only.xlsx

SECTION L – INSTRUCTIONS, CONDITIONS AND NOTICES TO OFFERORS

1. Section L.3.2. Closing Date is hereby extended from Friday, December 18, 2020 to

Monday, December 28, 2020. Therefore, section L.3.2. is deleted in its entirety and replaced to read as follows:

“L.3.2. Closing Date

The complete offer shall be received via e-mail no later than Monday, December 28, 2020, 17:00 hours, central time, to the following e-mail address:

MexicoCityGSOContracts@state.gov