21R0013 Zagreb Health Insurance - original signed.pdf

19GE5021R0013 Zagreb, Croatia

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TABLE OF CONTENTS

Section 1 – The Schedule

• SF 1449 cover sheet

• Continuation To SF-1449, Prices, Block 23

• Continuation To SF-1449, Schedule Of Supplies / Services, Block 20 Description / Specifications / Work Statement

• Attachment 1 – Prices

• Attachment 2 – Contract Information / Experience Listing

• Attachment 3 – W-14 Certificate of Foreign Contracting Party

• Exhibit A – Employee Statistics

NOTE: Further contractor-provided attachments will be included after award

Section 2 – Contract Clauses

• Contract Clauses

• Addendum to Contract Clauses - FAR and DOSAR Clauses not Prescribed in Part 12

Section 3 – Solicitation Provisions

• Solicitation Provisions

• Addendum to Solicitation Provisions - FAR and DOSAR Provisions not Prescribed in Part 12

Section 4 – Evaluation Factors

• Evaluation Factors

• Addendum to Evaluation Factors - FAR and DOSAR Provisions not Prescribed in Part 12

Section 5 – Representations and Certifications

• Offeror Representations and Certifications

• Addendum to Offeror Representations and Certifications - FAR and DOSAR Provisions not

Prescribed in Part 12

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SECTION 1 – THE SCHEDULE

CONTINUATION TO SF-1449

PRICES – BLOCK 23

I BACKGROUND / SCOPE OF SERVICES

A. The Government of the United States of America requires Health Insurance for its Locally

Engaged Staff and their dependents in Zagreb.

The Contractor shall provide the Health Insurance services to employees of the Government of the United States of America in Zagreb, as described in Section 1.IV and the Exhibits attached. The groups of employees who shall be provided this insurance are listed in Section 1.IV.C.

This insurance shall be provided in accordance with Section 1.IV. and the Exhibit attached.

B. This is a fixed price with economic price adjustment requirements type contract under which annual firm, fixed-price task orders will be issued. The contract shall remain unfunded. The fixed prices / premium rates for the health insurance services as specified in Section 1.IV. A are listed in Section1.III.

C MINIMUM (Reference Section I, Clause 52.216-22(b))

During the term of this contract, the Government shall order, as a minimum, services in an amount of at least $5,000.00 or equivalent in local currency.

The Government makes no guarantee as to the number of orders or actual amount of services that will be requested above the guaranteed minimum of $5,000.00 or equivalent in local currency.

The maximum dollar value during the entire life of this contract is $5,000,000.00.

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II ACRONYMS AND ABBREVIATIONS

Acronym Definition

CLIN Contract Line Item Number

Contractor Insurance Company

CO

Contracting Officer

COR

Contracting Officer Representative

Dependent Dependents are defined as the covered employee’s legal spouse as defined by law (limit one) and children (natural, adopted, stepchild, or foster children). 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.

Parents, grandparents, siblings, and other relatives are not eligible dependents

Employer

The United States Government = USG

Employee Staff member of the US Embassy Kuala Lumpur FMO Financial Management Officer 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 Patient An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

LS

Lump Sum

PII

Personally Identifiable Information

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

QA

Quality Assurance

QC

Quality Control

QCP

Quality Control Plan

QTY

Quantity

SOW Statement of Work

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Surgical Procedure

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

TBD

To be determined

USG

U.S. Government

ORE Official Residence Expense

III PRICES

A.1 The contractor shall complete all work, including furnishing all labor, material, equipment and services, unless otherwise specified herein, required under this contract for the firm fixed unit prices indicated below and within the time specified herein. These individual prices shall include all labor, materials, profit, and, if applicable, value added tax (VAT).

Any costs not separately priced will be considered to be included in the individual prices as overhead or other indirect cost. No additional sums will be payable on account of any escalation in the cost of materials, equipment or labor, or because of the contractor's failure to properly estimate or accurately predict the cost or difficulty of achieving the results required by this contract. Nor will the contract price be adjusted on account of fluctuations in the currency exchange rates.

A.2 The currency shall be fixed and cannot be changed by modification to the contract.

A.3.1. Premium Adjustment Based on Experience For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission covered by this contract, and it specifically excludes all riders in IV.C.1 No adjustment will be allowed during the first twelve months.

After such time, the contractor or the USG may request an adjustment in premiums on an annual basis to be effective per contract year. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the contractor agrees to provide the USG a balance sheet showing three main components for the previous time period:

(1) receipts (premiums received),

(2) number of insurance policies and

(3) claims paid.

This information shall be provided per type of premium, i.e. per line item.

The USG 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 effective for the following option year. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

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A.3.2.1. 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.

A.3.2.2. Employee Pool

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

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

B. VAT – if applicable, the contractor shall be responsible for paying to the appropriate authority the applicable rate of Value Added Tax (VAT). Offerors shall identify the VAT as a separate line item. The VAT shall also be a separate cost item on all invoices submitted against task orders under the resulting contract. The contractor will be reimbursed for VAT only up to the amount listed in each task order and upon presentation of proof that VAT has been paid to the host country government. If the contractor receives a VAT refund from the host government he shall re-pay the refund amount to the US Governme

C. 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. Excess Coverage is included under this contract only as rider benefits; the Contractor shall bill the individual covered at the rates specified below.

Note that USG is not responsible, nor liable, for any riders.

D. Offeror, insert the currency of prices offered __________________

The fixed prices / premium rates for the health insurance services as specified in Section IV are as follows:

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ATTACHMENT 001 – PRICES WILL BE INSERTED HERE

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CONTINUATION TO SF-1449

SCHEDULE OF SUPPLIES / SERVICES, BLOCK 20

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

IV SPECIFICATIONS

A. HEALTH INSURANCE SERVICES

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

B. Employee and Dependent Health Service Benefits

B.1. MANDATORY/REQUIRED BENEFITS

B.1.2. Hospitalization (treatment in the hospital for inpatient care):

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

100% Coverage

See Mental Health and Substance Abuse care (below) for details concerning inpatient psychiatric care.

See Outpatient Services (below) for details concerning professional services.

B.1.3. Emergency Services (trips to emergency room):

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

100% Coverage

B.1.4. Ambulance:

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

80% Minimum Coverage

B.1.5. Outpatient Services:

Services provided by a certified healthcare provider on an ambulatory or outpatient basis (without being admitted to a hospital), including surgeon’s fees and other medical services that may be provided in a hospital, clinic, doctor’s office, medical facility, etc. Examples include, but are not limited to:

a. Annual physical examinations

b. Specialist consultations and treatment, including second surgical opinion

c. Minor surgical interventions

d. Chemotherapy and radiation treatments

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e. Immunizations recommended by local authorities and/or the World Health Organization

f. Diagnostic tests and diagnostic imaging

See Rehabilitative and Habilitative Services and Devices (below) for details concerning physical therapy.

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

B.1.6. Obstetric and Newborn Care:

Care and services that women receive during pregnancy (prenatal care), throughout labor and delivery, and post-delivery, and outpatient care for newborn babies. Hospitalization during pregnancy and/or delivery will be covered as Hospitalization (treatment in the hospital for inpatient care). All other treatments will be considered Outpatient Services.

Inpatient: 100% Coverage; Outpatient: 80% Minimum Coverage

B.1.7. Pediatric Services:

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

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

B.1.8. Prescription Drugs:

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

B.1.9. Preventive and Wellness and Chronic Disease Management:

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

B.1.10. Hearing Aids:

Examinations and Treatment: 80% Minimum Coverage

Hearing Aid Apparatus: Limited to one apparatus per ear up to a maximum of USD 1,500 per covered individual per three-year period. 80% Minimum Coverage; with annual cap

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B.1.11. Optical:

Examinations and Treatment: 80% Minimum Coverage

Prescription lenses and frames, or contact lenses: Covered up to a maximum of USD 300 per covered individual every two years. 80% Minimum Coverage; with annual cap

B.1.12. Dental:

Examinations and Treatment: Dentist’s fees, x-rays, examinations and treatment, cleanings, fillings, extractions, false teeth, crowns, and bridges up to a maximum of USD 3,200 per covered individual per contract year. 80% Minimum Coverage; with annual cap

Orthodontia: Treatment is covered only if treatment begins before age 18, or if required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per covered individual up to a maximum of USD 2,400 lifetime limit. 80% Minimum Coverage; with contract lifetime cap

B.1.13. Reproductive Health:

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

B.1.14. Mental Health and Substance Abuse Care:

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

50% Minimum Coverage

B.1.15. Rehabilitative and Habilitative Services and Devices:

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 a chronic condition, and devices needed for habilitative reasons.

50% Minimum Coverage

B.1.16. HIV/AIDS:

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

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Note to Contracting Officer: Post should consider electing this option if HIV/AIDS treatment is not covered as prevailing practice by local medical insurance providers, or is prohibitively expensive.

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

Annual Maximum Limit:

The maximum annual coverage per covered individual per contract year, not including expenses covered under HIV/AIDS benefits if selected by post, is 31,500 HRK.

B.2. Exclusions to Coverage:

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

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

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

C. Eligible Participants

C.1. Eligibility:

To be eligible to participate in the medical plan, LE Staff must be:

• Paid under the terms of the Local Compensation Plan (LCP); and –

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

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

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 Croatia who provides services to other local organizations as well as to the U.S. Mission; employees working on an intermittent or When Actually Employed (WAE) schedule; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

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

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C.1.1. Periods 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 Leave Without Pay (LWOP) or unpaid leave beyond one pay period, the employee is responsible for the full cost of the insurance premiums for self and dependents. The Mission will pay the premiums directly to the Contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if they prefer not to pay the premium.

C.2. Dependents:

LE Staff who are eligible to participate in the medical plan automatically confer coverage to eligible family members who meet the following criteria:

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.

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.2.1. Premium:

All LE Staff covered under post’s medical benefit plan will pay a 10% share of the premium. Premiums will be based on the number of individuals covered:

• Self-Only: 1 covered individual

• Self Plus One (two individuals)

• Family (three or more individuals)

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V CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

V.1 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 USG, is responsible for management and quality control to meet the terms of the contract. The role of the USG is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective Performance Threshold

Timely payment of benefits (within 21 calendar days)

No more than one (1) customer complaint is received per month.

No incorrectly denied claims

No more than one (1) customer complaint is received per month.

V.1.1 Surveillance – The COR will receive and document all complaints from USG personnel regarding the services provided. If found valid, the COR will send the complaints to the contractor for corrective action.

V.1.2 Standard – The performance standard is that the USG receives no more than one (1) 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.

V.1.3 Complaint Procedures

a. If USG personnel observe unacceptable services such as but not limited to lack of coordination during medical evacuation, extended referral periods, delays in receipt of payment, etc., they will 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, provide e-mail notification informing the contractor of any valid complaints.

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f. If the contractor disagrees with the complaint and challenges the validity of the complaint, the contractor shall notify the COR by e-mail. 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 complainant.

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.

V.1.4 Employee Claims Report

The contractor shall provide a monthly Employee Claims Report. The report shall be received by the COR no later than the 10th calendar day of each month. 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.

V.2 REPORTS AND OTHER DELIVERABLES

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

US Embassy Zagreb ATTN: Human Resources Officer

Ul. Thomasa Jeffersona 2, 10000, Zagreb, Croatia

NOTE: Any and all costs for the preparation, handling, mailing and submission of progress reports or any other required reports and documentation shall be included in the total price of each delivery order.

V.3 Contractor Responsibility in Claims and Reimbursement to Claims

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 employees' 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

Locally Employed Staff Health Insurance Page 15 of 64 documents required to be appended to each claim and otherwise provide instructions for claim filing.

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

(4) The Contractor shall send employee claim reimbursement checks to employees not later than two weeks after a claim is submitted.

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

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt.

If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the employee within two days, with a copy to the COR (if notification is written).

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

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

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

V.4 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.

V.5 Miscellaneous Contractor Requirements

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 Croatian 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 Malaysian 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.

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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.

V.6 Erroneous Payment

If the USG 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 USG, whichever the USG prefers. The contractor shall refund any refunds not complete or discovered after the completion date of this contract.

V.7 Requiring Activity The requiring activity under this contract is the U.S. Embassy/Consulate.

V.8 Physical and Information Security Requirements

The contractor shall be responsible for safeguarding all government information provided for contractor use. All material / documentation produced for the USG will be the sole property of the USG. The contractor shall not release any documents to anyone unless authorized by the USG. The following considerations shall be followed by the contractor and/or shall be incorporated into the design documents / shop drawings.

V.8.1 All documents received or generated under the contract are the property of the USG.

V.8.2 All documents shall be controlled and disseminated on a need-to-know basis. Reproduction and distribution is prohibited without express approval of the USG. All design documents generated shall be annotated as follows:

V.8.3 All documents shall be marked and handled in strict accordance with all applicable requirements and regulations. Proposed and actual contract documents shall only be disseminated on a strict need-to-know basis, and shall not be further disseminated without prior authorization from the USG.

V.8.4 Those receiving any type of proposed and / or actual contract documents shall be responsible for these materials while in their possession, or that of any of their subcontractors. They shall return all documents, including all copies, promptly upon demand by the USG.

V.9 Contractor Management Plan

Offerors shall submit a draft version of their management plan as part of their proposal. The contractor shall submit the final version no later than 15 calendar days after receipt of a contract award.

V.9.1 The contractor’s management plan shall:

• describe the organization of the work force,

• specify the names and responsibilities of the principal manager and the supervisors under this project,

• indicate the manner in which the contractor assures quality documents and service,

• state the frequency of inspections and the use of operational records

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• include organizational and functional charts reflecting the line of management responsibility

V.9.2 Inspection System – The contractor’s management plan shall establish an inspection system covering all services stated in Section 1, The Schedule. The inspection system shall:

a. specify areas to be inspected on a scheduled basis;

b. include a method of identifying deficiencies in the quality of supplies (reports) and / or services before the level of performance becomes unacceptable;

c. include a filing system for all inspections conducted by the contractor and the corrective action taken.

This documentation shall be made available to the USG during the term of the contract.

The contractor shall obtain the COR’s approval prior to making any changes in its management plan. If directed by the COR, the contractor shall submit said changes in writing as a proposal for Government review and approval / disapproval.

V.10 Laws And Regulations

V.10.1 Compliance Required – If the contractor has or will establish a local office, he shall, without additional expense to the USG, be responsible for complying with all laws, codes, ordinances, and regulations applicable to the performance of the work, including those of the host country, and with the lawful orders of any governmental authority having jurisdiction.

V.10.2 Labor, Health and Safety Laws and Customs – If the contractor has or will establish a local office, he shall comply with all local labor laws, regulations, customs and practices pertaining to labor, safety, and similar matters, to the extent that such compliance is not inconsistent with the requirements of this contract.

V.10.3 A contract with the USG 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 USG employees. Registration of this contract with the host country 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 USG of the amounts thereof.

V.10.4 The only items that the USG will consider for price adjustments are those that are mandated e.g. changes in the VAT rate (if applicable) or minimum hourly wage rate.

V.11 Contract Administration Data

V.11.1 Authority of the Contracting Officer – All work shall be performed under the general direction of the Contracting Officer, who alone shall have the power to bind the Government and to exercise the rights, responsibilities, authorities and functions vested by the contract, except that the Contracting Officer and the Procurement Executive shall have the right to designate authorized representatives to act for the Contracting Officer, as specifically provided in the designation of that individual, such as the COR.

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V.11.2 Government Personnel

Contracting Officer: Eric N. Moore

Contract Administrator: Nadja Reinmüller E-mail address: ReinmuellerNU@state.gov

Contracting Officer's Representative (COR): Maja Jurcevic

V.11.3 Invoices, Review and Payment

Invoices shall be issued monthly. Value Added Tax (VAT), if applicable, shall be a separate line item on each invoice.

Each invoice shall include the items listed in Section 2, FAR 52.212-4 g.1.

Payment shall be made in the currency the contractor specified in Section1.III.D Prices.

V.11.4 Advance Payment shall not be authorized under this contract.

V.11.5 Changes In Ownership – The contractor shall furnish the COR advance notification (90 calendar days prior to the effective date) of any disposition or the change in ownership or terms of lease of any facilities utilized by him for performance of any service under this contract.

V.12 Funding / Task Orders / Procedures

V.12.1 The contract remains unfunded; funding will be provided by issuing an annual task orders with possible modification for staffing changes. Each task order will contain the following information:

• Name of contractor

• Contract number

• Date of purchase

• Task order number

• Name of person placing the order

• Quantity, unit price, and total price of each service / insurance rate

• VAT or other taxes as a separate item, if applicable

• COR and post points of contact, including e-mail addresses

• applicable contract clauses, either in reference or in full text if necessary

V.12.2 Only an RPSO Contracting Officer may place a written order.

V.12.3 Ordering Procedures – The Government shall issue annual funded task orders to cover all eligible employees and their dependents. No task order shall include any names or PII (personally identifiable information). The COR informs the contracting officer if any additions or deletions are required throughout the year and the Contracting Officer will issue funded modifications as required.

V.12.4 The ORE staff and EA 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

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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).

V.13 Choice of Law

This contract shall be construed and interpreted in accordance with the substantive laws of the United States of America. By the execution of this contract, the contractor expressly agrees to waive any rights to invoke the jurisdiction of local national courts where this contract is performed and agrees to accept the exclusive jurisdiction of the United States Civilian Board of Contract Appeals and the United States Court of Federal Claims for hearing and determination of any and all disputes that may arise under the Disputes clause of this

V.14 Start / Period of Performance

Contract performance is estimated to start on May 1, 2021.

The period of performance is one year, with four possible annual option years. Option years, if exercised, shall be for twelve (12) months each, commencing at the expiration of the previous period of performance.

The Government may extend this contract in accordance with the option clause in Section 2, FAR 52.217-9, Option to Extend the Term of the Contract - Deviation, which also specifies the total duration of this contract.

The Government may exercise the option set forth at Section 2, "FAR 52.217-8, Option to Extend Services", within the currently ongoing period of performance.

Notwithstanding the expressed contract expiration date, this contract shall remain in full force and effect until the last items or services ordered hereunder have been delivered and accepted by the Government.

V.15 List Of Attachments

Exhibit A

Employee Statistic

Attachment 1

Pricing Spreadsheet

Attachment 2

Contract Information Sheet / Experience Listing

Attachment 3 W-14 Certificate of Foreign Contracting Party

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SECTION 2 – CONTRACT CLAUSES

52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment (AUG 2020)

(a) Definitions. As used in this clause—

Backhaul means intermediate links between the core network, or backbone network, and the small subnetworks at the edge of the network (e.g., connecting cell phones/towers to the core telephone network). Backhaul can be wireless (e.g., microwave) or wired (e.g., fiber optic, coaxial cable, Ethernet).

Covered foreign country means The People's Republic of China.

Covered telecommunications equipment or services means—

(1) Telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities);

(2) For the purpose of public safety, security of Government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities);

(3) Telecommunications or video surveillance services provided by such entities or using such equipment; or

(4) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country.

Critical technology means—

(1) Defense articles or defense services included on the United States Munitions List set forth in the International Traffic in Arms Regulations under subchapter M of chapter I of title 22, Code of Federal Regulations;

(2) Items included on the Commerce Control List set forth in Supplement No. 1 to part 774 of the Export Administration Regulations under subchapter C of chapter VII of title 15, Code of Federal Regulations, and controlled—

(i) Pursuant to multilateral regimes, including for reasons relating to national security, chemical and biological weapons proliferation, nuclear nonproliferation, or missile technology;

or

(ii) For reasons relating to regional stability or surreptitious listening;

(3) Specially designed and prepared nuclear equipment, parts and components, materials, software, and technology covered by part 810 of title 10, Code of Federal Regulations (relating to assistance to foreign atomic energy activities);

(4) Nuclear facilities, equipment, and material covered by part 110 of title 10, Code of Federal Regulations (relating to export and import of nuclear equipment and material);

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(5) Select agents and toxins covered by part 331 of title 7, Code of Federal Regulations, part 121 of title 9 of such Code, or part 73 of title 42 of such Code; or

(6) Emerging and foundational technologies controlled pursuant to section 1758 of the Export Control Reform Act of 2018 (50 U.S.C. 4817).

Interconnection arrangements means arrangements governing the physical connection of two or more networks to allow the use of another's network to hand off traffic where it is ultimately delivered (e.g., connection of a customer of telephone provider A to a customer of telephone company B) or sharing data and other information resources.

Reasonable inquiry means an inquiry designed to uncover any information in the entity's possession about the identity of the producer or provider of covered telecommunications equipment or services used by the entity that excludes the need to include an internal or thirdparty audit.

Roaming means cellular communications services (e.g., voice, video, data) received from a visited network when unable to connect to the facilities of the home network either because signal coverage is too weak or because traffic is too high.

Substantial or essential component means any component necessary for the proper function or performance of a piece of equipment, system, or service.

(b) Prohibition. (1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. The Contractor is prohibited from providing to the Government any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system, unless an exception at paragraph (c) of this clause applies or the covered telecommunication equipment or services are covered by a waiver described in FAR 4.2104.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract, or extending or renewing a contract, with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system, unless an exception at paragraph (c) of this clause applies or the covered telecommunication equipment or services are covered by a waiver described in FAR 4.2104.

This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract.

(c) Exceptions. This clause does not prohibit contractors from providing—

(1) A service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(2) Telecommunications equipment that cannot route or redirect user data traffic or permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(d) Reporting requirement. (1) In the event the Contractor identifies covered telecommunications equipment or services used as a substantial or essential component of any system, or as critical technology as part of any system, during contract performance, or the Contractor is notified of such by a subcontractor at any tier or by any other source, the Contractor shall report the information in paragraph (d)(2) of this clause to the Contracting Officer, unless elsewhere in this contract are established procedures for reporting the information; in the case of the Department of Defense, the Contractor shall report to the website

Locally Employed Staff Health Insurance Page 22 of 64 at https://dibnet.dod.mil. For indefinite delivery contracts, the Contractor shall report to the Contracting Officer for the indefinite delivery contract and the Contracting Officer(s) for any affected order or, in the case of the Department of Defense, identify both the indefinite delivery contract and any affected orders in the report provided at https://dibnet.dod.mil.

(2) The Contractor shall report the following information pursuant to paragraph (d)(1) of this clause:

(i) Within one business day from the date of such identification or notification: The contract number; the order number(s), if applicable; supplier name; supplier unique entity identifier (if known); supplier Commercial and Government Entity (CAGE) code (if known); brand; model number (original equipment manufacturer number, manufacturer part number, or wholesaler number); item description; and any readily available information about mitigation actions undertaken or recommended.

(ii) Within 10 business days of submitting the information in paragraph (d)(2)(i) of this clause: Any further available information about mitigation actions undertaken or recommended.

In addition, the Contractor shall describe the efforts it undertook to prevent use or submission of covered telecommunications equipment or services, and any additional efforts that will be incorporated to prevent future use or submission of covered telecommunications equipment or services.

(e) Subcontracts. The Contractor shall insert the substance of this clause, including this paragraph (e) and excluding paragraph (b)(2), in all subcontracts and other contractual instruments, including subcontracts for the acquisition of commercial items.

(End of clause)

52.212-4 Contract Terms and Conditions-Commercial Items (Oct 2018)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights-

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g.,use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The

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Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance…