75FCMC18D0045_75FCMC22F0003(executed 07-06-2022).pdf

ORDER FOR SUPPLIES OR SERVICES

3. ORDER NO. 4. REQUISITION/REFERENCE NO.

PAGE OF PAGES

5. ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS

IMPORTANT: Mark all packages and papers with contract and/or order numbers. 1

1. DATE OF ORDER 2. CONTRACT NO. (If any) 6. SHIP TO:

a. NAME OF CONSIGNEE

c. CITY d. STATE e. ZIP CODE

7. TO:

a. NAME OF CONTRACTOR

f. SHIP VIA

8. TYPE OF ORDER

b. COMPANY NAME

c. STREET ADDRESS

d. CITY e. STATE f. ZIP CODE

9. ACCOUNTING AND APPROPRIATION DATA

a. PURCHASE b. DELIVERY

REFERENCE YOUR:

Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.

Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and conditions of the above-numbered contract.

10. REQUISITIONING OFFICE

11. BUSINESS CLASSIFICATION (Check appropriate box(es))

a. SMALL b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED

13. PLACE OF

a. INSPECTION b. ACCEPTANCE

14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT

ON OR BEFORE (Date)

16. DISCOUNT TERMS

17. SCHEDULE (See reverse for Rejections)

75FCMC22F0003 OC-393-2022-0076

CMS,OAGM,AGG,DBSC

7500 SECURITY BLVD., MS: B3-30-03

BALTIMORE MD 21244-1850

Kathy Williams

Porter Novelli Public Services Inc.

805 15th St NW, Suite 300

Washington DC 20005

P-203-22-002720-001

12. F.O.B. POINT

Not Applicable

Strategic Marketing Group

ITEM NO.

(a)

SUPPLIES OR SERVICES

(b)

QUANTITY

ORDERED

(c)

UNIT

(d)

UNIT

PRICE

(e)

AMOUNT

(f)

QUANTITY

ACCEPTED

(g)

X

X

Destination Destination

75FCMC18D0045

f. SERVICE-DISABLED

VETERAN-OWNED

e. HUBZone

g. WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOSB PROGRAM

h. EDWOSB

Tax ID Number: 20-8009526

UEI: QJJVNMLVNAA3

Pursuant to the Terms and Conditions of Contract 75FCMC18D0045, the Contractor shall provide "Health Care Fraud Prevention Outreach and Education Campaign" services Continued ...

19. GROSS SHIPPING WEIGHT18. SHIPPING POINT 20. INVOICE NO.

21. MAIL INVOICE TO:

a. NAME

b. STREET ADDRESS

(or P.O. Box)

c. CITY d. STATE e. ZIP CODE

SEE BILLING

INSTRUCTIONS

ON REVERSE

17(h)

TOTAL

(Cont.

pages)

17(i)

GRAND

TOTAL

$6,997,951.11

22. UNITED STATES OF

AMERICA BY (Signature)

23. NAME (Typed)

TITLE: CONTRACTING/ORDERING OFFICER

HEATHER ROBERTSON

$6,997,951.11

OPTIONAL FORM 347 (Rev. 2/2012)

Prescribed by GSA/FAR 48 CFR 53.213(f)

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION NOT USABLE

DHHS, CMS, OFM

http://www.ipp.gov/

07/06/2022

DATE OF ORDER

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

ORDER NO.

QUANTITY

ACCEPTED

75FCMC22F0003

PAGE NO

(a) (b) (c) (d) (e) (f) (g)

75FCMC18D0045

in accordance with the attached Statement of Work (SOW).

Funds in the amount of $6,997,951.11 are provided to perform Base Services under the

Base Year and are allocated on a Time and

Materials (T&M) basis.

Please see the following attachments:

Attachment D.1 - Task Order Terms and

Conditions

Attachment D.2 - Statement of Work

Attachment D.3 - Contractor/Offeror

Conflict of Interest

Req Identifier: P CAN Number: 5996935

Appropriation: 75-X-8393 Object Class:

25235 Component ID: 203 Fiscal Year: 22

Project #: 002720 Sequence #: 001

Period of Performance: 07/06/2022 to

07/05/2023

0001 Base Year UN 0.00

(Not Separately Priced)

Product/Service Code: R426

0001AA Base Year - Base Services 6,997,951.11

Product/Service Code: R426

0001AB Base Year - Optional Task 1 Option

Amount: $4,999,153.18(Option Line

Item)

Product/Service Code: R426

0001AC Base Year - Optional Task 2 Option

Amount: $2,998,939.76(Option Line

Item)

Product/Service Code: R426

0002 Option Year 1 UN Option

Amount: $0.00(Option Line Item)

(Not Separately Priced)

Product/Service Code: R426

0002AA Option Year 1 - Base Services Option

Continued ...

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

PREVIOUS EDITION NOT USABLE

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $6,997,951.11

DATE OF ORDER

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

CONTRACT NO.

AMOUNTUNIT

PRICE

UNITQUANTITY

ORDERED

SUPPLIES/SERVICESITEM NO.

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

ORDER NO.

QUANTITY

ACCEPTED

75FCMC22F0003

PAGE NO

(a) (b) (c) (d) (e) (f) (g)

75FCMC18D0045

Amount: $6,999,703.46(Option Line

Item)

Product/Service Code: R426

0002AB Option Year 1 - Optional Task 1 Option

Amount: $4,996,750.42(Option Line

Item)

Product/Service Code: R426

0002AC Option Year 1 - Optional Task 2 Option

Amount: $2,999,530.54(Option Line

Item)

Product/Service Code: R426

0003 Option Year 2 UN Option

Amount: $0.00(Option Line Item)

(Not Separately Priced)

Product/Service Code: R426

0003AA Option Year 2 - Base Services Option

Amount: $6,999,579.95(Option Line

Item)

Product/Service Code: R426

0003AB Option Year 2 - Optional Task 1 Option

Amount: $4,996,417.46(Option Line

Item)

Product/Service Code: R426

0003AC Option Year 2 - Optional Task 2 Option

Amount: $2,997,247.17(Option Line

Item)

Product/Service Code: R426

Prescribed by GSA FAR (48 CFR) 53.213(f)

OPTIONAL FORM 348 (Rev. 4/2006)AUTHORIZED FOR LOCAL REPODUCTION

PREVIOUS EDITION NOT USABLE

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) $0.00