19RB1026R0002_Solicitation.pdf

U.S. Embassy Belgrade 19RB1026R0002

SECTION B

PRICE

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 Serbia and their eligible dependents as described in Section C. This insurance shall be provided in accordance with Section C.

B.1.1. Official Residence Expense (ORE) Staff and employees of the American Embassy Employee Recreation Association Employees (AEERA) 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), and the American Embassy Employee Recreation Association Employees (AEERA) 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.2.2.1 CO-PAYMENT REQUIREMENTS

The Contractor shall apply the following co-payment structure for all covered individuals under this contract:

Benefit Category Co-Payment Percentage

Hospitalization & Inpatient Services 20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

JAMES ZADROGA 9/11 VICTIMS HEALTH AND COMPENSATION ACT OF

2010 NOTICE: UNLESS A WAIVER OR EXCEPTION APPLIES, PAYMENTS

SUBSEQUENT TO THIS PROCUREMENT ARE SUBJECT TO AN EXCISE TAX

OF 2% PERSUANT TO 26 U.S.C. 5000C.

Benefit Category Co-Payment Percentage

Outpatient Services & Professional Services

20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

Medical Transport Services 20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

Obstetric and Newborn Care 20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

Prescription Drugs 20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

Optical Care 20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

Dental Care 20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

Reproductive Health 20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

Mental Health Care 20% co-pay (employee pays 20%, insurance covers 80% up to sublimits))

Rehabilitative and Habilitative Services and Devices

20% co-pay (employee pays 20%, insurance covers 80% up to sublimits)

The co-payment percentages shall remain fixed throughout the base year and each option year. The co-payment applies to the approved/eligible amount after any applicable sublimits are applied.

Example: If an eligible medical procedure costs 10,000 RSD and falls within the applicable sublimit, the insurance pays 80% (8,000 RSD) and the employee pays 20% (2,000 RSD) as co-payment

B.2.2.2 PREMIUM PAYMENT STRUCTURE

(a) The Government will pay 100% of the premium amounts to the Contractor on a quarterly basis per Section G.4.2.

(b) Employees will pay their 20% co-payment amounts directly to healthcare providers at the time of service, NOT to the Contractor.

(c) The Contractor's premium rates shall include all costs to provide the insurance coverage described in Section C, including:

- Claims payments (80% of eligible costs after sublimits)

- Administrative costs

- Overhead and profit (retention amount per B.3)

- Reserve funds per H.6(7)

(d) Premium rates shall NOT include:

- Employee co-payment amounts (paid directly to providers)

- Value Added Tax (VAT) - see B.2.1 and G.6

B.2.3 BASE YEAR OF CONTRACT

Bi-Weekly Rates Per Premium

Category Estimated Number of Premiums*

Bi-Weekly Rate per Premium**

Bi-Weekly Total (est.# of premiums x rate per premium)

a. Adults 444

b. Dependent Children 309

c. Subtotal (a+b)

Total Price for Base Year (c. x 26)*** RSD

* Based on current enrollment as of February 2026. Actual number of covered individuals may vary. See Section H.3 for ordering procedures.

**Rate per premium is the bi-weekly amount charged per covered individual. There are 26 bi-weekly pay periods per year.

***Total Base Year price is calculated by multiplying the bi-weekly subtotal by 26 pay periods.

B.2.4 FIRST OPTION YEAR OF CONTRACT

Premiums*

Bi-Weekly Rate per Premium**

Bi-Weekly Total (est.# of premiums x rate per premium) d.Adults 444 e.Dependent Children 309

f. Subtotal (d+e)

Total Price for First Option Year (f. x 26)*** RSD

* Based on current enrollment as of February 2026. Actual number of covered individuals may vary. See Section H.3 for ordering procedures.

**Rate per premium is the bi-weekly amount charged per covered individual. There are 26 bi-weekly pay

***Total First Option Year price is calculated by multiplying the bi-weekly subtotal by 26 pay periods.

B.2.5 SECOND OPTION YEAR OF CONTRACT

Premiums*

Bi-Weekly Rate per Premium**

Bi-Weekly Total (est.# of premiums x rate per premium) g.Adults 444 h.Dependent Children 309 i.Subtotal (g+h)

Total Price for Second Option Year (i. x 26)*** RSD

* Based on current enrollment as of February 2026. Actual number of covered individuals may vary. See Section H.3 for ordering procedures.

**Rate per premium is the bi-weekly amount charged per covered individual. There are 26 bi-weekly pay

***Total Second Option Year price is calculated by multiplying the bi-weekly subtotal by 26 pay periods

B.2.6 SIX-MONTH EXTENSION OF CONTRACT

Premiums*

Bi-Weekly Rate per Premium**

Bi-Weekly Total (est.# of premiums x rate per premium) j.Adults 444 k.Dependent Children 309 l.Subtotal (g+h)

Total Price for Six-Month Extension (l. x 13)*** RSD

* Based on current enrollment as of February 2026. Actual number of covered individuals may vary. See Section H.3 for ordering procedures.

**Rate per premium is the bi-weekly amount charged per covered individual. There are 26 bi-weekly pay periods per year; 13 bi-weekly pay periods semi-annually.

***Total Six-Month Extension price is calculated by multiplying the bi-weekly subtotal by 13 bi-weekly pay periods semi-annually

B.2.7. Grand Total of Base plus All Option Years

Base Year Total RSD

First Option Year Total RSD

Second Option Year Total RSD

Six-Month Extension of the Contract RSD

Grand Total of Base plus All Option Years RSD

MINIMUM AND MAXIMUM AMOUNTS

During each period of performance, including the base year and any option years exercised, the United States Government (USG) will satisfy the contract minimum by placing orders totaling at least USD 50,000. The total value of all orders placed over the life of the contract shall not exceed USD 2,402,000.00, which represents the legal ordering ceiling

B.3 ADMINISTRATIVE RETENTION AMOUNTS

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

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 bi-weekly 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 Bi-Weekly Retention Amounts per separate premium paid per adult and per dependent child.

Period of Performance Adult Employee's Dependent Child

Base Period

First Option Year

Second Option Year Six-Month Extension of the Contract

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 claims utilization report 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 submit a proposal for adjustment that includes: (1) details of how the pool impacts the adjustment request; (2) the pool's loss ratio for the relevant period; and (3) calculations demonstrating how the pool's loss ratio directly affects the proposed premium adjustment for this contract.

B.5 – B.8. RESERVED

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

C.1. HEALTH INSURANCE SERVICES

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

C.1.1. Employee and Dependent Health Insurance Benefits

C.1.1.1 Hospitalization & Inpatient Services (Treatment in the Hospital for Inpatient Care):

Offered with sublimit not to exceed 3,000 EUR.

Services and supplies provided during hospitalization include but are not limited to:

• Accommodations in hospital room

• Examinations by a physician

• Diagnostic procedures indicated during treatment

• Therapy during hospital treatment, including o Application of medicinal therapy (injections, infusions, inhalations), o Early physical and rehabilitation therapy, medicines and medical supplies, blood during hospital treatment.

• Surgical interventions including the costs of performing the surgery, cost of preoperative preparation, costs within intensive care and postoperative treatment until discharge from hospital.

• Outpatient hospital treatment, surgical interventions, observations and therapeutic endoscopic procedures, preoperative preparation – covered up to 600 EUR.

• Intraoperative implants and medical technical aids – covered up to

1000 EUR.

C.1.1.2 Outpatient Services & Professional Services:

Examinations provided by general practitioners and physicians of all specialties 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 to include but not limited to:

o General internist exam with ECG o Ultrasound of abdomen o Ultrasound of thyroid gland o Gynecological exam o Breast ultrasound (women) o Urology examination (men up to 40) o Prostate exam (men over 40) o Laboratory analysis o Children age 2-18

Exam by pediatrician Ophthalmologist Physiatrist Dental Laboratory analysis o Children up to 2 years of age Exam by pediatrician before regular vaccination Ultrasound examination of hips Laboratory analysis

• Specialist consultations and treatment, including second surgical opinion

• Minor surgical interventions

• Chemotherapy and radiation treatments

• Diagnostic tests and diagnostic imaging o Laboratory, radiological examinations, endoscopic procedures, biopsies and punctures, ergometry, spirometry, tympanometry audiometry and vestibulometry, EEG, EMNG, ECG, Nuclear diagnostics, MR and CT, PET scan,

• Pediatric services

• Ophthalmology examinations

• Examinations and diagnostic procedures, laboratory tests for preparation for pregnancy, infertility

• Emergency dental interventions resulting from an accident

C.1.1.3 Medical Transport Services

Includes transportation by ambulance due to illness or injury that is justified and medically necessary and ordered by a physician or specialist.

C.1.1.4 Obstetric and Newborn Care Offered with sublimit not to exceed 1,000 EUR Care and services women receive during pregnancy (prenatal care), throughout labor and delivery, post-delivery, including gynecological examinations, ultrasounds, laboratory analysis, prenatal care, outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery are covered as inpatient care. All other treatments are considered outpatient.

C.1.1.5 Prescription Drugs Offered with sublimit not to exceed 200 EUR Medications prescribed by a licensed health care provider that are medically necessary. Examples include prescription antibiotics to treat an infection; medication used to treat an ongoing condition, such as high cholesterol, and prophylaxis, and contraceptive medication.

C.1.1.6 Optical Care Offered with sublimit not to exceed 200 EUR Examples include but are not limited to prescription lenses, frames or contact lenses (ophthalmology examinations covered under outpatient)

C.1.1.7 Dental Care Offered with sublimit not to exceed 200 EUR.

Examinations and Treatment include but are not limited to dentist’s fees, x-rays, exams, treatment, cleanings, fillings, extractions, false teeth, crowns, bridges, orthodontia, teeth cleaning.

C.1.1.8 Reproductive Health Examples include but are not limited to prescribed contraceptive devices, preventive care, routine exams, voluntary sterilization, diagnosis and treatment of conditions which may cause infertility.

C.1.1.9 Mental Health Care Offered with sublimit not to exceed 250 EUR.

Examples include but are not limited to outpatient therapy and counseling, psychiatric evaluations and assessments, medication management, and emergency mental health services.

C.1.1.10 Rehabilitative and Habilitative Services and Devices Offered with sublimit not to exceed 200 EUR.

Examples include but are not limited to outpatient services and physical therapy for chronic disease and therapy after injury.

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) that help develop skills needed for everyday life.

Devices to help gain or recover mental or physical skills lost due to injury, disability or chronic condition, and devices needed for habilitative reasons.

Co-Payment Requirements All benefits listed in sections C.1.1.1 through C.1.1.10 are subject to a 20% co-payment requirement. The employee pays 20% of eligible costs; insurance covers 80% up to the applicable sublimits specified for each benefit category. The co-payment percentages shall remain fixed throughout the base year and each option year. The co-payment applies to the approved/eligible amount after any applicable sublimits are applied.

Annual Maximum Limit – The maximum annual reimbursement per covered individual per contract year is equivalent to EUR 5,000.00.

C.1.2 Health Benefits Conditions and Limitations.

There is no coverage 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.

There is no coverage 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.

There is no reimbursement for medical expenses incurred outside of Republic of Serbia. There is no reimbursement for round trip transportation expenses to travel out of country for medical treatment.

C.1.3 Eligible Participants

C.1.3.1 Identification of Eligible Employees and Dependents: U.S. Mission Belgrade 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 bi-weekly/monthly basis.

C.1.4.1.1 Definition of Dependents

C1.4.1.1.1 Legal Spouse: one legal spouse as defined by local law may be covered. LE Staff with more than one legal spouse must select only one spouse for coverage.

In cases where LE Staff and their legal spouse 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.

C.1.4.1.1.2 Dependent children: a child is defined as the LE Staff’s natural, adopted, stepchild, or foster child. The child 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.1.4.1 must be employed within the geographic boundaries of the Republic of Serbia by:

U. S. Department of State, U.S. Department of Defense, U.S. Department of Justice, U.S. Foreign Commercial Service U.S. Foreign Agriculture Service

C.1.3.3 Participants Covered Under a Rider

a. All current active ORE Staff personally employed by the Chief of Mission and the Deputy Chief of Mission and assigned to their respective official Government residences and paid under an ORE account. All costs for coverage of ORE Staff are the responsibility of the Chief of Mission and the Deputy Chief of Mission, not the U.S. Government.

b. All current active employees of the American Embassy Employee Recreation Association at U.S.Embassy Belgrade. All costs for coverage of AEERA are the responsibility of the Employee Association, not the U.S. Government.

C.1.4. Individuals not Eligible for Coverage .

Not eligible 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 Serbia 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.

C.1.5. Other Eligible Participants

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 contract year in which he/she reaches age 26 if a full time student. 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.

C.1.6. Eligibility

C.1.6.1. 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 rolls") whenever such employee is on approved leave, whether paid or unpaid. During a period of extended (beyond one pay period) leave without pay or unpaid leave where the employee is receiving payments from the LSSS (extended sick leave or maternity leave), the USG will continue to pay for the full cost of the insurance premiums for both the employee and the dependents. The Mission will pay the premiums directly to the contractor, and will collect the employee share of the payment from the employee on a quarterly basis.

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) Leave Without Pay or unpaid leave where the employee is not receiving payments from the LSSS, 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 the 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 Serbian 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.1.6.1 to the COR not later than 10 days 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.1.7.3 The Contractor assumes full responsibility for ensuring that the document described in C.1.7.1 accurately reflects the requirements, coverage, and contract terms 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 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.

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 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.

Performance Objective

PWS

Paragraph Performance Threshold

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

C.1.0 thru C.1.6

All required services are performed and no more than one

(1) one customer complaint is 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 one (1) one customer complaint 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.

https://acquisition.gov/browse/index/far https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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. 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)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

F.2 PERIOD OF PERFORMANCE. The performance period of this contract is one year beginning on the date of award with two 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 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.

(b) 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 Human Resources Office

Bulevar kneza Aleksandra Karadjordjevica 92 11 040 Belgrade, Serbia https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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 or through the broker if the Contractor is a broker, 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 local currency (RSD) at the median exchange reate of the National Bank of Serbia on the date of payment.

G.4 SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted in an original and three (3) copies to the following address (designated billing office only for the purpose of submitting invoices):

a) For the Embassy, excluding AEERA:

Submit electronic invoices to belgradeinvoicesfmc@state.gov

b) For AEERA:

AEERA

Bul.kneza Aleksandra Karadjordjevica 92 mailto:belgradeinvoicesfmc@state.gov

11040 Belgrade, Serbia

The contractor shall include the following statement on invoices submitted for payment:

"Oslobođeno plaćanja PDV-a po članu 24. st.1.16 pod tačka 1. Zakona o PDV (Službeni glasnik RS br.

84/04, 86/04, 61/05, 61/07, 93/12, 108/1368/14-dr. zakon, 142/14, 83/15, 108/16113/17,30/18, 72/18 i 153/20“ (“Exempt from VAT under article 24, paragraph 1.16, item 1 on the Law on VAT” Official Gazette of RS nos. 84/04, 86/04, 61/05, 61/07, 93/12, 108/1368/14-dr. zakon, 142/14, 83/15, 108/16113/17,30/18, 72/18 i 153/20)”.

G.4.2. Frequency of Payments. All funds under this contract for non-rider coverage 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. All payments under this contract will be made at the conclusion of the period covered. Invoices may be submitted quarterly with payments being made quarterly by the Government.

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.

G.4.4 Riders:

a. ORE. 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.

b. AEERA Staff. The American Embassy Employee Association will make payment directly to the Contractor for the entire premium amount of the AEERA employee, whether or not the AEERA 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). Health insurance services are exempt from VAT Exempt from VAT under article 25, paragraph 2, item 1 of the Serbian Law on VAT.

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 [ ] monthly, [ X] 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. The ORE staff, AEERA employees under separate 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 completed within two weeks of claim submission. The Contractor shall issue payment in Serbian Dinars (RSD) using the following method: direct bank transfer to the employee's designated bank account in the Republic of Serbia.

(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 Serbia 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 Serbia 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 in Belgrade, Serbia.

SECTION I

CONTRACT CLAUSES

I.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

52.202-1 DEFINITIONS (JUN 2020)

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 (JUN 2020)

52.203-7 ANTI-KICKBACK PROCEDURES (JUN 2020)

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 (JUN 2020)

52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND REQUIREMENT TO

INFORM EMPLOYEES OF WHISTLEBLOWER RIGHTS (NOV 2023)

52.203-19 PROHIBITION ON REQUIRING CERTAIN INTERNAL CONFIDENTIALITY

AGREEMENTS OR STATEMENTS (JAN 2017)

52.204-4 Reserved

52.204-7 SYSTEM FOR AWARD MANAGEMENT (NOV 2024)

52.204-10 REPORTING EXECUTIVE COMPENSATION AND FIRST-TIER SUBCONTRACT

AWARDS (JUN 2020)

https://gov.ecfr.io/cgi-bin/text-idx?SID=d9a7851186785ba2b1896db79b1b6b29&mc=true&tpl=/ecfrbrowse/Title48/48tab_02.tpl

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 AND OTHER 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)

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

CONTRACTORS DEBARRED, SUSPENDED, OR PROPOSED FOR DEBARMENT (JAN

2025)

52.209-9 UPDATES OF PUBLICLY AVAILABLE INFORMATION REGARDING

RESPONSIBILITY MATTERS (OCT 2018)

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 COST OR PRICING DATA OR INFORMATION OTHER THAN

COST OR PRICING DATA--MODIFICATIONS (NOV 2021)

52.222-19 CHILD LABOR – COOPERATION WITH AUTHORITIES AND REMEDIES (JAN 2025)

52.222-50 COMBATTING TRAFFICKING IN PERSONS (OCT 2025)

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)

52.229-6 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 (JAN 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)

52.233-1 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)

52.242-13 BANKRUPTCY (JULY 1995)

52.243-1 CHANGES (AUG 1987) – ALTERNATE I (APR 1984)

52.244-6 SUBCONTRACTS FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

(OCT 2025)

52.246-25 LIMITATION OF LIABILITY - SERVICES (FEB 1997)

52.246-26 REPORTING NONFORMING ITEMS (AUG 2024)

52.248-1 VALUE ENGINEERING (JUN 2020)

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

52.216-19 ORDER LIMITATIONS (OCT 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than USD 100.00, the Government 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 USD 200,000.00;

(2) Any order for a combination of items in excess of USD 200,000.00 or

(3) A series of orders from the same ordering office within 2 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 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.

(d) 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 2 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.

(End of clause)

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 firsta day of the ongoing performance period through the last day of that performance period.

(b) All delivery orders or tsk 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.

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

(End of clause)

52.216-21 REQUIREMENTS (OCT 1995)

(a) 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.