SS-Insurance_UCF_Solicitation_19PL9019R0001_March_14,_2019.doc

UNDER DPAS (15 CFR 350)

1 | 52

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

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

March 15, 2019

6. REQUISITION/PURCHASE NO.

PR7886321

American Embassy Warsaw, Poland Al. Ujazdowskie 29/31

00-540 Warsaw Phone: (48-22)-504 2000 Fax: (48-22)-504 2484

NOTE: In sealed bid solicitation "offer" and "offeror” mean "bid" and "bidder".

SOLICITATION

9. Sealed offers in original and 2 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in Piekna Street 14a, 00-539 Warsaw, General Services Office until 15:00 local time, May 10th, 2019.

(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.

10. FOR INFORMATION

CALL:

A. NAME

Joel Dylhoff

B. TELEPHONE (NO COLLECT CALLS)\

48-22-5042077

AREA CODE NUMBER EXT

C. E-MAIL ADDRESS

WarsawProc@state.gov

11. TABLE OF CONTENTS

PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

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 120 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 point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT

SEE 14

(See section I, Clause No 52.232-8)

10 CALENDAR DAYS

20 CALENDAR DAYS

30 CALENDAR DAYS

CALENDAR DAYS

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

15A.

NAME

CODE

FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE ADDRESS [ ]

IS DIFFERENT FROM ABOVE - ENTER

SUCH ADDRESS

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

[ ] 10 U.S.C. 2304(c)( ) [ ] 41 U.S.C. 253(c)( )

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7) CODE

25. PAYMENT WILL BE MADE BY CODE

26. NAME OF CONTRACTING OFFICER (Type or print) Joel .A. Dylhoff

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD DATE

IMPORTANT - 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

STANDARD FORM 33 (REV 9-97)

PREVIOUS EDITION NOT USABLE

Prescribed by GSA

SECTION B

PRICE - HEALTH INSURANCE

B.1.

HEALTH INSURANCE SERVICES

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Poland as described in Section C and the Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.3.

B.1.1.

Official Residence Expense (ORE) Staff are 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.

B.2.

PRICES

OFFERS AND PAYMENT IN U.S. DOLLARS - U.S. firms are eligible to be paid in U.S. dollars. U.S. firms desiring to be paid in U.S. dollars should submit their offers in U.S. dollars. A U.S. firm is defined as a company which operates as a corporation incorporated under the laws of a state within the United States.

FOREIGN FIRMS - Any firm, which is not a U.S. firm, is a foreign firm. Any firm that does not meet the above definition of U.S. firm shall submit its prices and receive payment in local currency.

B.2.1 VALUE ADDED TAX.

The Contractor shall include VAT as a separate charge on the Invoice and as a separate line item in Section B.

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:

Monthly Rates Per Employee:

Family Plan

DBA Insurance

VAT

SUBTOTAL

Total Price for Base Year (Subtotal x 12): ___________

B.2.4.

FIRST OPTION YEAR OF CONTRACT:

Family Plan

DBA Insurance

VAT

SUBTOTAL

Total Price for Option Year 1 (Subtotal x 12): __________

B.2.5.

SECOND OPTION YEAR OF CONTRACT:

Family Plan

DBA Insurance

VAT

SUBTOTAL

Total Price for Option Year 2 (Subtotal x 12): __________

B.2.6.

THIRD OPTION YEAR OF CONTRACT:

Family Plan

DBA Insurance

VAT

SUBTOTAL

Total Price for Option Year 3 (Subtotal x 12): ________

B.2.7.

FOURTH OPTION YEAR OF CONTRACT:

Family Plan

DBA Insurance

VAT

SUBTOTAL

Total Price for Option Year 4 (Subtotal x 12): ______________

GRAND TOTAL BASE PERIOD PLUS OPTION YEARS: _______________

B.3

ADMINISTRATIVE RETENTION AMOUNTS

B.3.1 If the Contractor requests a price adjustment under B.4 below, the Contractor must 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.

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 fixed monthly retention amounts for each period of performance and for each category of premium. This fixed amount must 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 Monthly Retention Amounts per separate premium paid per single employee and per family plan.

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.1.1. 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, i.e. 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 must include in its proposal for adjustment, details setting forth how the pool impacts the request for equitable adjustment.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

HEALTH INSURANCE

C.1.

HEALTH INSURANCE SERVICES

The Government of the United States of America requires Health Insurance coverage for its local employees in Poland, as further described in C.1.2. The Government has determined that the prevailing practice by employers in Poland is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer on a shared basis. For active employees and their dependents the premium cost will be paid , regardless of the length of the workweek. Health insurance protection will be representative of locally prevailing compensation practice as further described in C.1.1. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J.

The Contractor shall insure that health care under this contract does not exclude HIV/AIDS care, unless exclusion has been authorized by HR/OE/CM.

C.1.1 Employee and Dependent Health Services Benefits

The health benefits under this contract are as follows. Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs.

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided.

Medical Coverage

The insurance company will reimburse covered medical expenses incurred, subject to the stated limits.

Payment will be made for reasonable and customary costs of covered benefits. The medical treatment must be prescribed or provided by a physician or nurse licensed in Poland or the United States, or in the country in which the treatment or prescription is received. Reimbursement will be made in Zloty.

C.1.1.1. Deductible: None

C.1.1.2. 100% reimbursement of 24 hour medical hot line service (duty, doctor, nurse, advice.)

C.1.1.3. 100% reimbursement of 24 hour ambulance service (first aid, fully equipped reanimation ambulance in emergency cases, transportation and admission to hospital.)

C.1.1.4. 100% reimbursement of 24 hour home visits of primary physicians (internist, pediatrician, family doctor.)

C.1.1.5. 100% reimbursement of primary physician’s consultations (internist, pediatrician, family doctor), unlimited number of appointments available within 24 hours of request.

C.1.1.6. 100% reimbursement of specialist doctor's consultations (full range and each specialization, without written referral from the primary physician), unlimited number of appointments (except for psychologist and psychiatrist) available within 7 workdays of request.

C.1.1.7. 100% reimbursement of routine (preventive) annual physical checkups.

C.1.1.8. 100% reimbursement of protective annual inoculations against influenza (other optional.)

C.1.1.9. 100% reimbursement of outpatient procedures (minor operations and treatment, e.g., injections, wound suturing, nail removal, diagnostic biopsy, ear washing, foreign body removal from eye, dressings, plaster removal, etc.)

C.1.1.10. 100% reimbursement of diagnostic examinations, including laboratory and allergic tests – full range, as referred by a physician.

C.1.1.11. 100% reimbursement of dental emergency cases (x-rays, dressings, incision of abscesses, trepanation, devitalization of the pulp, extraction, partial anesthetics.)

C.1.1.12. 100% reimbursement of dental preventative care (checkups and cleaning twice per year, x-rays, removal of tartar and plaque, fluoride treatment, fissure sealing.)

C.1.1.13. 100% reimbursement of one day surgery (all available procedures, excluding cosmetic surgery)

C.1.1.14. 100% reimbursement of physical therapy and rehabilitation (as referred by a specialist doctor.)

C.1.1.15. Annual Maximum Limit: The annual maximum limit of value of services provided is up to PLN 250,000 per covered individual per contract year.

C.1.1.16. Transportation for out of country treatment: Transportation for out of country treatment will not be covered.

C.1.2 Health Benefits Conditions and Limitations.

The Contractor shall cover all costs of providing the health care services specified under C.1.1 to the eligible employees and their dependents as defined in C.1.3. and C.1.5. The Contractor shall provide professional services under this contract and he/she shall maintain liability insurance during performance of this contract in accordance with FAR 52.237-7 Indemnification and Medical Insurance in Section I.2

Conditions and limitations on the entitlement to health care under this contract are as follows:

No reimbursement for elective cosmetic surgery; spa cures; rejuvenation cures; massage; exercise therapy; long term rehabilitative therapy; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

There is no entitlement to the health care benefit related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self-inflicted wound; or service in the armed forces of any country.

No reimbursement for expenses that will be reimbursed or paid directly under the U.S. workers compensation program, or a post's LE Staff Workers’ compensation program.

C.1.3 Eligible Participants

C.1.3.1 Eligible Employees – Employees eligible for the health insurance services include the following:

C.1.3.1.1 All current active employees of the United States Government, employed within the geographic boundaries of Poland, who are (1) working on a full-time or part-time basis under non-temporary direct hire appointments or under personal services agreements/contracts (PSA/PSC) that are not time limited to less than one year and (2) paid under the Local Compensation Plan, and certified by the Contracting Officer. Participation in health insurance program will be voluntary. Covered employees include:

C.1.3.1.2.

Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.1.3.1.3.

Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.1.3.2 Location of Employment

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of Poland by:

Department of State

Department of Commerce

Department of Agriculture (FAS)

Department of Defense (DAO and ODC)

Department of Justice (FBI)

Department of Justice (DEA)

Department of Homeland Security (TSA)

Federal Benefits Unit (FBU)

ACTIVITYCINCUSAREUR/USFLO/ENTEC (LNO)

C.1.3.3 Participants Covered Under a Rider

C.1.3.3.1 All Official Residence Expense (ORE) employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account may be covered under a rider to the contract (see separate rider, Exhibit B The employing officer, and not the USG, is responsible for the employer's share of the premium costs for an ORE employee.

C.1.4

Individuals Not Eligible for Coverage

Not eligible are those working under temporary direct hire appointments; those working on When Actually Employed (WAE) schedules; 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 Poland who provides services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors; and Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

C.1.5.

Other Eligible Participants

The following additional categories of persons are covered by this insurance:

Dependent Coverage.

Eligible employees may elect to enroll their eligible dependents. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one) and unmarried, economically dependent children who primarily reside with the employee unless away at school. Child is defined as the employee's natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the contract year in which he/she reaches age 18, or age 25 if a full time student and unmarried. The child must be unmarried, economically dependent upon the employee, and reside with the employee unless away at school. There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. Parents, grandparents, siblings, and other relatives are not eligible dependents.

C.1.6.

Eligibility

C.1.6.1.

Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government. An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid. Leave such as sick leave, maternity leave, and family care leave when the employee is paid by ZUS and continues to accrue annual leave is paid leave.

During a period of Leave Without Pay (LWP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

C.1.6.2.

Period of Ineligibility

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 (beyond one pay period) of Leave Without Pay (LWP) or unpaid leave, 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 that employee prefers not to pay the premium.

C.1.7.

BROCHURE REQUIREMENT

C.1.7.1.

The Contractor shall provide a document (brochure/pamphlet/other written document) in English and Polish 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 Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.7.2.

The Contractor shall provide the document described in C.1.7.1 to the COR not later than 15 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.1.7.3.

The Contractor assumes full responsibility for ensuring that the document described in C.1.7.1 accurately reflects the requirements of the contract, as implemented by the Contractor’s technical proposal. In all cases, the contract shall take precedence. Should the COR discover that the brochure contains inaccuracies, the Contractor will be notified in writing; however, failure on the part of the 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.

C.2. Reserved

C.3.0

DEFINITIONS

FMO

The Financial Management Officer or the paying office for all U.S. Government

Agencies except AID.

COR

Contracting Officer's Representative (Human Resources Officer at post).

Contributory Insurance for which the employee contributes toward the premium.

Dependent Covered dependents include the participating employee’s spouse and children. A limit of one spouse per employee is covered. An eligible child is defined as the employee’s natural child, adopted child, stepchild, or foster child. The child must be unmarried, economically dependent upon the employee, and reside with the employee unless away at school. An eligible child will be covered until the end of the month in which he/she reaches age 18, or 25 if a full time student and unmarried. There is no age limit for a child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee. Parents, grandparents, siblings and other relatives are not eligible dependents.

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract, or personal services agreement, as further defined in Section C.1.3 for health insurance. This may also include ORE Staff, if this category of individual is listed as participating under a rider in C.1.3.3.

Employer The United States Government or in the case of ORE, the Chief of Mission/Deputy Chief of Mission.

GSO

General Services Officer in charge of the General Services Office at post. This officer is usually the Contracting Officer for this contract.

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

Hospital An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic

Patient tests or receives treatment for a disease or an injury.

Maximum The total amount that will be paid for any one covered individual for covered medical expenses.

Benefit

Customary A diagnostic test or medical treatment which is usually performed in the usually performed in the and community where the individual is being treated.

Reasonable Treatment

Physician An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty.

Surgical Any invasive medical procedure by manual or instrument operation undertaken for diagnosis Procedure or treatment of a diseased patient.

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

E.1.

52.252‑2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following 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. Also, the full text of a clause may be accessed electronically at this address:

http://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, 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.

Services

Performs all the insurance services set forth in the Performance Work Statement (PWS)

C.1.0 thru C.3.0

All required services are performed and no more than five (5) 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 five (5) 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.

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 will 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.

SECTION F

DELIVERIES OR PERFORMANCE

F.1.

This contract incorporates the following 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. Also, the full text of a clause may be accessed electronically at this address:

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite, Vista) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clauses are incorporated by reference:

TITLE AND DATE

52.242-15 Stop Work Order (AUG 1989)

52.242-17 Government Delay of Work (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning from date of Notice to Proceed…..” with four one-year options to renew.

F.3

OPTIONS

The Government may extend this contract in accordance with the option clause at Section I, clause I.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.

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

F.4

REPORTS AND OTHER DELIVERABLES

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

American Embassy Warsaw

Human Resources Office

Al. Ujazdowskie 29/31

00-540 Warsaw, Poland Attn.: COR

SECTION G

CONTRACT ADMINISTRATION DATA

G.1.

652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

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.

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 the currency that the contract is awarded with.

G.4

SUBMISSION OF INVOICES AND PAYMENT

G.4.1.

Payments via Electronic Funds Transfer. Invoices for U.S. Government shall be sent electronically to WarsawDBO@state.gov and they shall be issued to:

American Embassy in Warsaw

Attn.: DBO

T.O. # ________________

Al. Ujazdowskie 29/31

00-540 Warsaw, Poland

Please make sure that, the invoice, includes Service Provider’s Bank name and address, Task Order (TO) number, 9-digit Bank’s routing code and Service Provider’s Bank account number.

G.4.2. Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. 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 premium amount.

G.4.4. RE 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.5.

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

VALUE ADDED TAX (VAT). The Contractor shall include VAT as a separate charge on the Invoice and as a separate line item in Section B.

SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.1 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. ORE staff, employees under separate riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees. When contacted by the employer, the Contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals. Because more than one employer may have ORE staff, the Contractor may be contacted by more than one employer (typically the Chief of Mission and Deputy Chief of Mission).

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:

Administrative Records

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of services rendered, requests for services (accounting of value of rendered services with balance of amount remaining in the annual per person ceiling.

(2) The Contractor shall provide the COR with the necessary identification system for each employee and his/her eligible dependent allowing the covered employees to receive services under the contract. This system shall allow covered employees and their dependents to request the services and get access to the general information about the subscribed package and personal medical records generated during the course of the contract.

(3) The Contractor shall use the English spelling of the employees' names in all transactions.

(4)

(a) The Contractor shall render all health care services or pay directly to the subcontracted service providers for all medical services subscribed under this contract.

Medical Insurance Services. Provision of medical insurance shall be completed as follows:

(1) The covered employees and their dependents may request health care services as specified in C.1 through the contractor’s call center or on-line.

(2) The Contractor’s call center or on-line system shall generate/set up appointments within the time frame specified in Section C.1. at the medical center selected by the employee.

(3) The Contractor shall accept the employee’s or dependent’s choice of which medical center they go to.

(4) 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 reports monthly. All reports must be received by the COR no later than the 10th day of each month. These reports shall report on the previous month's activities.

(a) Employee Benefits Report. The report will list a full list of names of the covered employees and type of their health insurance coverage (single or family) for a given month.

(b) Utilization Report. The report will specify a quantity and type of services provided by the Contractor to the employees and their dependents. The report will include number of visits set up and not used by the employees and their dependents.

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 Polish 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 Polish 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 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.

SECTION I

CONTRACT CLAUSES

I.1.

This contract incorporates the following 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. Also, the full text of a clause may be accessed electronically at this address:

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at https://www.ecfr.gov/cgi-bin/text-idx?SID=2e978208d0d2aa44fb9502725ecac4e5&mc=true&tpl=/ecfrbrowse/Title48/48chapter6.tpl to see the links to the FAR. You may also use a network “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clauses are incorporated by reference:

TITLE AND DATE

52.202-1

DEFINITIONS (NOV 2013)

52.203-3

GRATUITIES (APR 1984)

52.203-5

COVENANT AGAINST CONTINGENT FEES (MAY 2014)

52.203-6

RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT (SEPT 2006)

52.203-7

ANTI-KICKBACK PROCEDURES (MAY 2014)

52.203-8 CANCELLATION, RESCISSION, AND RECOVERY OF FUNDS FOR ILLEGAL OR IMPROPER ACTIVITY (MAY 2014) 52.203-10

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

52.203-12

LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (OCT 2010)

52.203-17

CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND

REQUIREMENT TO INFORM EMPLOYEES OF WHISTLEBLOWER

RIGHTS (APR 2014)

52.203-19 Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements (JAN 2017) 52.204-4

PRINTED OR COPIED DOUBLE-SIDED ON POSTCONSUMER FIBER CONTENT PAPER (MAY 2011)

52.204-10

REPORTING EXECUTIVE COMPENSATION AND FIRST-TIER SUBCONTRACT AWARDS (OCT 2018)

52.204-13

SYSTEM FOR AWARD MANAGEMENT MAINTENANCE (OCT 2018)

52.204-18

COMMERCIAL LAND GOVERNMENT ENTITY CODE MAINTENANCE (OCT 2018)

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 AND OTHER COVERED ENTITIES (JUL 2018) 52.209-6 PROTECTING THE GOVERNMENT’S INTEREST WHEN SUBCONTRACTING WITH CONTRACTORS DEBARRED, SUSPENDED, OR PROPOSED FOR DEBARMENT (OCT 2015) 52.209-9 UPDATES OF PUBLICLY AVAILABLE INFORMATION REGARDING RESPONSIBILITY MATTERS (JULY 2013) 52.215-2

AUDIT AND RECORDS - NEGOTIATION (OCT 2010)

52.215-8

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

52.215-11

PRICE REDUCTION FOR DEFECTIVE CERTIFIED COST OR

PRICING DATA – MODIFICATIONS (AUG 2011)

52.215-13

SUBCONTRACTOR CERTIFIED COST OR PRICING DATA -

MODIFICATIONS (OCT 2010)

52.215-21 REQUIREMENTS FOR COST OR PRICING DATA OR INFORMATION OTHER THAN COST OR PRICING DATA--MODIFICATIONS (OCT 2010) 52.222-19

CHILD LABOR – COOPERATION WITH AUTHORITIES AND REMEDIES (JAN 2018)

52.222-50

COMBATTING TRAFFICKING IN PERSONS (MAR 2015)

52.223-18

ENCOURAGING CONTRACTOR POLICIES TO BAN TEXT MESSAGING WHILE DRIVING (AUG 2011)

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 (FEB 2016)

52.225-13

RESTRICTIONS ON CERTAIN FOREIGN PURCHASES (JUN 2008)

52.225-14

INCONSISTENCY BETWEEN ENGLISH VERSION AND TRANSLATION OF CONTRACT (FEB 2000)

52.228-3 WORKERS’ COMPENSATION INSURANCE (Defense Base Act) (JUL 2014) 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 (OCT 2010)

52.232-18

AVAILABILITY OF FUNDS (APR 1984)

52.232-24

PROHIBITION OF ASSIGNMENT OF CLAIMS (MAY 2014)

52.232-25

PROMPT PAYMENT (JAN 2017)

52.232-33

PAYMENT BY ELECTRONIC FUNDS TRANSFER - SYSTEM FOR AWARD MANAGEMENT (JULY 2013)

52.232-40 Providing Accelerated Payments to Small Business Subcontractors (Dec 2013)

52.233-1 DISPUTES (MAY 2014) Alternate I (DEC 1991) 52.233-3

PROTEST AFTER AWARD (AUG 1996)

52.233-4

APPLICABLE LAW FOR BREACH OF CONTRACT CLAIM (OCT 2004)

52.237-2

PROTECTION OF GOVERNMENT BUILDINGS, EQUIPMENT, AND VEGETATION (APR 1984)

52.242-13

BANKRUPTCY (JULY 1995)

52.243-1 CHANGES (AUG 1987) – Alternate I (APR 1984) 52.244-06 Subcontracts for Commercial Item (AUG 2018) 52.246-25

LIMITATION OF LIABILITY - SERVICES (FEB 1997)

52.248-1

VALUE ENGINEERING (OCT 2010)

52.249-2

TERMINATION FOR CONVENIENCE OF THE GOVERNMENT (FIXED PRICE) (APRIL 2012)

52.249-8

DEFAULT - FIXED PRICE SUPPLY AND SERVICE (APR 1984)

I.2.

FEDERAL ACQUISITION REGULATION (FAR) CLAUSES INCORPORATED IN

FULL TEXT

52.216-18 ORDERING (OCT 1995)

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.

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.

If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.

(End of clause)

52.216-19 ORDER LIMITATIONS (OCT 1995)

Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than thirty dollars, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract.

Maximum order. The Contractor is not obligated to honor--

(1) Any order for a single item in excess of $75,000.00;

Any order for a combination of items in excess of $75,000.00 or

A series of orders from the same ordering office within 90 days that together call for quantities exceeding the limitation in subparagraph (1) or (2) above.

If this is a requirements contract (such as, includes the Requirement clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) above.

Notwithstanding paragraphs (b) and (c) above, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within 7 days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source.

52.216-21 REQUIREMENTS (OCT 1995)

This is a requirements contract for the supplies or services specified, and effective for the period stated, in the Schedule. The quantities of supplies or services specified in the Schedule are estimates only and are not purchased by this contract. Except as this contract may otherwise provide, if the Government's requirements do not result in orders in the quantities described as "estimated" or "maximum" in the Schedule, that fact shall not constitute the basis for an equitable price adjustment.

Delivery or performance shall be made only as authorized by orders issued in accordance with the Ordering clause. Subject to any limitations in the Order Limitations clause or elsewhere in this contract, the Contractor shall furnish to the Government all supplies or services specified in the Schedule and called for by orders issued in accordance with the Ordering clause. The Government may issue orders requiring delivery to multiple destinations or performance at multiple locations.

Except as this contract otherwise provides, the Government shall order from the Contractor all the supplies or services specified in the Schedule that are required to be purchased by the Government activity or activities specified in the Schedule.

(d) The Government is not required to purchase from the Contractor requirements in excess of any limit on total orders under this contract.

If the Government urgently requires delivery of any quantity of an item before the earliest date that delivery may be specified under this contract, and if the Contractor will not accept an order providing for the accelerated delivery, the Government may acquire the urgently required goods or services from another source.

(f) Any order issued during the effective period of this contract and not completed within that period shall be completed by the Contractor within the time specified in the order. The contract shall govern the Contractor's and Government's rights and obligations with respect to that order to the same extent as if the order were completed during the contract's effective period; provided, that the Contractor shall not be required to make any deliveries under this contract after 120 calendar…