4 SUPPLEMENT TO THE PWS.pdf

SUPPLEMENT TO THE PWS

Supplement to the PWS

(A) For reporting purposes, FAR Clause 52.204-10 Reporting Executive Compensation and First Tier Subcontract Awards, the Treasury Account Symbol (TAS) is 97 0130.

(B) CME REQUIREMENTS – Applicable to Physicians only

As addressed in AFI 41-117, Chapter 4. Provider credentials file must have:

Evidence of approved continuing medical/health education. Such evidence will be accumulated by the provider for intervals of not less than for each item that follows such as MC: 60 hours every 3 years; NC: 60 hours every 3 years; PAs: 100 hours every 2 years; BSC: (social worker, psychology, etc.) to maintain license requirement or 20 hours each year and made available to the credentials manager for initial privileges/appointment and for biennial renewal. The annual requirement for CME credits according to AFI 41-117 or as determined by the provider’s State of licensure, whichever is more stringent.

If the state has no CME requirements, provide documentation showing this.

(C) HEALTH REQUIREMENTS FOR CONTRACT EMPLOYEES AT 51 MEDICAL GROUP (MDG)

In accordance with Integrated Health Organization Policy #18-59, the 51th MDG COR will ensure that all their contract employees report to Occupational Health Services (OHS) for pre-placement evaluation, annual medical exam, and termination evaluation. The COR will send a list of current contract employees to OHS quarterly.

(D) HEALTH AND IMMUNIZATION REQUIREMENTS

1. All contract Healthcare Providers (HCPs) performing direct healthcare services under this contract shall receive a general physical examination prior to commencement of services. The contractor shall provide the Contracting Officer's Representative, 10 calendar days before beginning services under this contract, a physical examination certificate for each individual HCP who will provide services. The certification shall state the date on which the physical examination was completed and the name of the physician who performed the examination. The physician performing the examination shall sign this certification. For the purposes of this paragraph, a physical examination administered more than 45 days prior to performance of the contract will not be considered adequate. The physical examination shall include the following:

a. A history to show that HCP has completed a primary series of immunization with tetanus and diphtheria toxoids and that a booster dose is current (within the past 10 years).

b. A test for immunity to the hepatitis (Type B) virus with documentation of the results. A profile shall be established to show immune status to hepatitis. Non-immune Healthcare Workers (lacking anti-HB(c) or anti- HB(s)) shall be required to complete an immunization series with a Hepatitis-B vaccine (e.g., Recombivax, Engerix).

c. Serologic evidence of immunity to measles and rubella or documentation of immunization with measles, mumps, and rubella (MMR) vaccine using the following guidelines:

1) Employees born before 1957 without documentation of previous vaccination with MMR should receive one dose.

2) Employees born in or after 1957 who have received one dose of MMR previously shall receive one booster dose.

3) Employees born in or after 1957 without documentation of any previous vaccination with MMR should receive two doses of vaccine, separated by no less than one month.

d. Serologic evidence of immunity to varicella or documented history of illness or immunization.

e. For personnel who do not have proof of having completed a primary series, completion with enhanced potency inactivated poliovirus vaccine (eIPV) is recommended. Reliable history of spending early childhood and attending elementary schools in the United States since may suffice as clinical history of polio immunization, but requires physician documentation in the record of the history and examination.

f. Contractor's HCPs shall be screened before employment and annually for tuberculosis by a tuberculin skin test using the Mantoux technique. (The TINE test is disallowed as a substitute.) A skin test result of 10 mm of induration or more shall be required to have a chest roentgenogram and an evaluation performed. A tuberculin skin test of 10 mm of induration or more will require documentation providing an assessment of the patient (status of infection- active, inactive; need for preventive treatment or not as determined by age, history of BCG (Bacillus Calmette-Guerin) vaccination; duration of skin test positivity, etc).

g. If all of the immunizations and tests set forth in the preceding paragraphs have not been completed, the contractor shall issue a certificate providing evidence of immunizations and tests that have been completed or started and shall provide a schedule for the completion of unfinished immunizations and lab tests. After the schedule is completed, the contractor must provide an updated and complete certificate. Failure to complete the immunizations as scheduled may be grounds for the Contracting Officer, upon the advice of the MTF commander or his clinical staff, to determine that such contract HCP is not an acceptable individual to perform services under this contract.

h. The Contracting Officer, with the explicit case-by-case approval of the MTF commander, is empowered to make exceptions to these requirements, for example, in the event of vaccine shortage or bona fide religious exceptions, but nothing herein shall be construed as an imperative or directive upon the Contracting Officer to make such exceptions.

2. All contract HCPs performing direct healthcare services under this contract, who experience a parenteral (e.g., needle-stick or cut) or mucous membrane exposure (e.g., splash to the eye or mouth) to blood or bloody body fluids, shall receive prompt treatment. The medical treatment facility (MTF) will evaluate the source of exposure for risk of Hepatitis-B, Hepatitis-C, and Human Immunodeficiency virus (HIV) and will provide a report of the findings to the contractor and the contract HCP. It shall be the contractor's responsibility to provide appropriate treatment as needed to possibly include Tetanus-Diphtheria booster, Immune Globulin, Hepatitis-B vaccine booster, or Hepatitis- B Immune Globulin. The contractor shall be responsible for providing the contract HCP with initial testing and if the source of exposure was unknown, positive, or considered at high risk for HIV infection, follow-up testing 3, 6, and 12 months after exposure. In the event of a confirmed or highly suspected parenteral exposure to HIV, the contractor shall insure that the contract HCP receives appropriate counseling and is referred immediately to a private infectious disease specialist for consideration of any post exposure prophylaxis (e.g., AZT). The Government may require the contractor to provide evidence of the status of treatment and testing of the individual contract HCP under the contract.

3. All contract HCPs shall receive an annual influenza immunization unless documented by a physician to be medically contraindicated.

4. Failure to meet the requirements stated herein, or when test results determine a contract HCP has a contagious disease, the Contracting Officer may, upon the advice of the MTF commander or his clinical staff, determine that such contract HCP is not an acceptable individual to perform services under this contract.

(End of Notice)

(E) CRIMINAL HISTORY BACKGROUND CHECK REQUIREMENT

The contractor shall ensure that, as a condition of employment, the contractor personnel providing patient care services under this contract meet the requirements of the Crime Control Act of 1990, as amended. This will be accomplished by successfully completing a Criminal History Background Check consisting of a Federal Bureau of Investigation (FBI) fingerprint check and State Criminal History Repository check. The procedures for completing the required background check are outlined within Department of Defense Instruction (DODI) 1402.5, dated January

10, 1993; Subject: Criminal History Background Checks on Individuals in Child Care Services; Enclosure 6, paragraph D, Government Contract Employees. (DoDI 1402.5 is available on the internet at:

http://web7.whs.osd.mil/).

If the Contractor has a DoD affiliation such as living or working on an installation (within 2 years) or is a family member of active duty military, DoD Component personnel at the installation level shall conduct an Installation Record Check (IRC). No IRC is required on individuals without DoD affiliation. Upon favorable completion of the IRC, an individual may be selected to provide services to a minor child under line-of-sight supervision until the required background checks are completed.

Personnel may be employed under the contract pending completion of background checks provided the activity uses line-of-sight supervision (LOSS) while minor children are in the care of that individual. The contractor provider shall be within-line-of-sight supervision of either military health care professionals, or an individual who has received an approved background check, or is in the presence of the child’s parent or guardian.

All background investigation requests shall be submitted IAW the applicable directive of the specific medical/dental treatment facility. The name of the contracting officer’s representative (COR) shall be included in each request as the recipient of the results.

The individual contract employee has the right to obtain a copy of the background check report from the COR and, if desired, to challenge the accuracy and completeness of the information in the report.

If any contractor personnel have previously received background checks it is the individual’s responsibility to provide proof of the check or obtain a new one. A new investigation is required if a break in service to the Department of Defense results in a time lapse of more than 2 years.

It is the contractor's responsibility to submit background investigation applications to the USA51 MDG Security office who will then submit to the US Office of Personnel Management for personnel who require them. Payment for the conduct of any criminal history background check is the responsibility of the contractor. The contractor will provide verification of submission or completion of the appropriate background investigation, on company letterhead, to the 51 MDG Security Office. The verification document will include the following data on the applicant:

Name ( Last, First, Middle) Date of Birth Place of Birth

SSN

OPM Case #

(F) NATIONAL AGENCY CHECK and INQUIRIES (NACI)

The contractor shall submit the NACI to the US Office of Personnel Management. Applications will include the appropriate items: NACI: SF-85 (Non-Sensitive Position) or SF-85P (Application for Public Trust Position); one set of SF-87(Civilian)/FD-258 (Contractor, Fingerprint Card) and the Optional Form OF-306 (Declaration for Federal Employment) unless otherwise prohibited by their contracting command.

Optional Form (OF) 306 “Declaration for Federal Employment”

The OF 306 form is utilized to collect information during the hiring process to determine an individual’s acceptability for Federal employment and Federal contract employment. The OF 306 must accompany each request for investigation submitted on an SF 85 or SF 85P when the individual to be investigated is a new Federal civilian employee or applicant for Federal employment. The individual and agency should carefully review the OF 306 information and any attached sheets. If additional space is needed the individual may provide material on additional sheets. Any amendments to the OF 306 will require the individual being investigated to initial and date the amendments. Investigations on contractor personnel requested on the SF 85 and SF 85P require the applicant to answer specific questions found on the OF 306: 1, 8, 9, 10, 11, 12, 13, 16 and 17a. To provide the additional information to OPM, the OF306 maybe be used or the specific questions and answers maybe provided on an attachment.

Upon arrival OCONUS to 51 MDG, when in processing the PTMS Security section, they will be required to initiate a local records check in conjunction with a copy of the contractor applicants NACI verification. Any person utilized under the contract that is placed in a Non-(critical) Sensitive position and/or HSPD-12 Credential with proof of an initial favorable NACI completion, and subsequently receives an unfavorable NACI and/or determined disloyal, untrustworthy or unreliable through the Joint Personnel Adjudication System (JPAS) or 51 MDG Commanders discretion, shall be removed from employment by the contractor.

Information Technology III /Non-sensitive Positions.

All personnel utilized under a contract will be placed in positions designated as Information Technology III (users), Non-sensitive positions designated by the Commander, 51 MDG.

Security Investigation for Personnel.

All personnel under a contract shall have a favorable NACI initiate within 90 calendar days prior to arrival in country (South Korea). Requests for NACIs shall be processed per AR 380-67 on SF-85, Questionnaire for Public Trust Positions by the directives of the specific contracting company and/or sub-contracting security administrator located (CONUS) geographically within the individual contractors submission area of responsibility. The Contractor is also required to have all applicants’ present proof of citizenship for a NACI. The contractor will provide verification of FAVORABLE completion of the appropriate NACI background investigation, on company letterhead, to the 51 MDG Security Office.

Waiver of Favorable Completion of NACI

In an emergency, a Non-critical Sensitive position may be occupied pending the completion of the NACI if the Commander, 51 MDG finds that the delay in appointment would be harmful to the national security and/or patient health care. Contract Personnel may be employed under the contract pending completion of the required National Agency Check and Inquiries (NACI) background checks and provided the activity uses line-of-sight supervision (LOSS) while minor children are in the care of that individual. The contractor provider shall be within-line-of-sight supervision of either military health care professionals, or an individual who has received an approved background check, or is in the presence of the child’s parent or guardian. The Contractor company must initiate a separate waiver for each person in writing, through the Contracting Officer, requesting the Commander, 51 MDG, grant a waiver prior to the favorable result; either granting or denying the waiver. Waivers granted under this paragraph will expire 30 calendar days later if not renewed by the Contractor company and/or when the completed NACI is received by the contract company and forwarded to the 51 MDG Security Manager for review.

Security of Classified Items and Information.

There are no requirements for the issuance of security clearances for any of the Contractor’s employees. The Contractor and its employees shall, in the course of their duties, come into contact with patients and staff of 51 MDG. The Contractor and its employees shall become familiar with and adhere to the provisions of the 51 MDG Security Management Program, OPSEC, THREATCON B measures, Freedom of information Act/Privacy Act and HIPAA. The Contractor shall keep in the strictest confidence any information obtained during the performance of work at project sites or furnished by the Government, such information being the sole property of the Government.

Prohibition against Privately-Owned AIS and software at 51 MDG.

The Contractor and all contract employees, is expressly prohibited from introducing or otherwise bringing any privately owned or contractor-owned, leased or rented AIS or software into or out of the 51 MDG work place.

Conforming to Army Regulations with regard to Information Assurance (IA).

The Contractor shall comply with all 51 MDG IA policies and the provisions of AFI 33-202, Information Assurance.

(End of clause)

(G) KOREA – LOCAL CLAUSES

(1) ALERTS, EXERCISES, OTHER SPECIAL OPERATIONS

During alerts, exercises, or special operations, the contractor may not be permitted in the work area. If the contractor is prohibited access to the job site one (1) day or less per month, no adjustment in contract time shall be made. Adjustments shall be made in accordance with applicable clauses of the contract if the contractor is denied access more than one (1) day per month.

(2) REPUBLIC OF KOREA (ROK) HOLIDAYS

(a) ROK legal holidays are as follows:

(1) 1 January (New Year)

(2) Lunar New Year (31 December, 1 and 2 January on the Lunar Calendar)

(3) 1 March (Independence Movement Day)

(4) 1 May (Labor Day)

(5) 5 May (Children's Day)

(6) Buddha's Birthday (8 April on the Lunar calendar)

(7) 6 June (Memorial Day)

(8) 15 August (Liberation Day)

(9) 9 October (Hangul_ Korean Language) Day

(10) Chu-Suk (14, l5 and 16 August on the Lunar Calendar)

(11) 3 October (National Foundation Day)

(12) 25 December (Christmas Day)

(b) In addition to the holidays listed for Army and other projects, contractor performance shall not be required on any other day designated by ROK executive order as a ROK legal holiday.

TAX EXEMPTION INFORMATION

(3) TAX EXEMPTION, CUSTOMS, REPUBLIC OF KOREA

(a) EXEMPTION: This clause is in implementation of Article IX of the Status of Forces Agreement between the Republic of Korea and the United States of America granting contractors exemption from Republic of Korea customs duties and other such charges. At the time this contract is awarded, the Contractor shall certify to the Contracting Officer that all materials, supplies, and equipment to be imported for the contract have been proposed to the Government exclusive of customs duties and other such charges and; further, that the contract price includes no customs duty whatsoever. It shall indicate to the Contracting Officer the total amount of customs duties excluded from the contract price. The USFK Contracting Officer will verify the amount of customs duty that would otherwise be applicable to the contract and will issue USFK Form(s) 75 to the Contractor. The contractor will submit the original USFK Form 75 to the governing ROK Customs Office at the time of import declaration. The Chief of the Customs Office will review the USFK Form 75 and will exempt the Contractor from customs duties and other such charges. During the review process the customs office will post on the Contractor's Import Permit the anticipated submission date for a completed USFK Form 76, which will be prepared by the Contracting Officer and given to the contractor immediately after contract performance. The Contractor will submit the original USFK Form 76 to the governing ROK Customs Office no later than the date posted on the Import Permit. If the USFK Form 76 is not submitted by the anticipated date, the ROK Customs Office will immediately collect the customs duties and other such charges previously exempted.

(b) If for any reason the Contractor has paid customs duties on materials, supplies, or equipment prior to award of this contract and desires to use such materials, supplies, or equipment for performance of this contract, the

Contractor must exclude such duties from the contract price and may obtain refund of such previously paid duties by submitting a completed USFK Form 76 to the governing ROK Customs Office.

(c) Refund: Any Contractor that requires refund of customs duties and other such charges on items used for USFK contracts, can claim refund of such charges by submitting a copy of a completed USFK Form 76 to the governing ROK Customs Office

(d) This entire clause is inapplicable to contracts, or any portions of contracts, funded by the Republic of Korea.

(4) TAX EXEMPTION, SPECIAL EXCISE TAX, REPUBLIC OF KOREA

This clause is in implementation of Article XVI of the Status of Forces Agreement between the Republic of Korea and the United States, granting Contractors exemption from Republic of Korea Special Excise Taxes. At the time this contract is awarded the Contractor shall indicate to the Contracting Officer which items that it will purchase for the contract are subject to Special Excise Tax. It shall indicate the name of the item, the number of units to be purchased, the cost per unit without tax, the percentage of tax, the tax amount per unit, the total tax, and the manufacturer of the item. The Contracting Officer will verify the reasonableness of the quantities claimed and ensure that the Contractor has certified that the contract price excludes Special Excise Tax on those items subject to the tax. The contractor shall purchase the special-excise-taxed items from the manufacturer, tax-inclusive. For construction and single-delivery type supply and service contracts, the contractor shall employ the following procedure: At the time it purchases the items it shall present the manufacturer with a notification letter requesting refund of the Special Excise Tax. (Copies of this letter can be obtained from the USACCK Contracting Officer.) The manufacturer will endorse the letter to the manufacturer's District Tax Office which will make refund to the manufacturer. The manufacturer will make subsequent refund to the Contractor. Requests for refund under requirements-type contracts will be submitted monthly and will be accompanied by copies of the USFK delivery orders issue

(5) TAX EXEMPTION, VALUE ADDED TAX, REPUBLIC OF KOREA

This clause implements Article XVI of the Status of Forces Agreement between the Republic of Korea and the United States of America, which exempts contractors from paying the Republic of Korea Value-Added Taxes. When the contractor submits an offer, it shall certify to the Contracting Officer that all the costs in the offer will be exclusive of any Value-Added Tax and; further, that the proposed contract price includes no Value-Added Tax. The contractor shall also indicate the amount and type of Value-Added Taxes excluded from the contract price. If supplies and/or services which the contractor purchases for this contract include Value-Added Taxes, it can obtain a full refund for the amount of the Value-Added Tax by submitting to the ROK District Tax Office tax invoices which the contractor receives when it purchases materials and/or services for this contract. The contractor must submit a copy of the USFK contract with its first tax invoice submission. Subsequent tax invoice submissions must be accompanied by a letter which references the USFK contract submitted with the first tax invoice submission.

TRANSPORTATION INFORMATION

(6) VEHICLES, CONTRACTOR

(a) Unless specifically stated elsewhere in the contract, the contractor shall provide all motor vehicles and any other transportation equipment required in the performance of this contract.

(b) The motor vehicles shall meet all of the requirements of this contract and shall be subject to inspection and approval by the COR. In the event a COR is not appointed, inspection and approval may be conducted by an individual authorized by the Contracting Officer.

(c) Vehicle Decal - The Contractor shall provide the Contracting Officer with a list of only those vehicles (by type and quantity) that are required in the actual performance of this contract on U.S. Government installations. Decals will only be issued for the geographic area(s) of the contract's performance. For example, a contractor performing only in Pusan will not receive a decal for Yongsan.

(d) The Contractor requiring decals for use of personal vehicles on military installations will be required to provide the Contracting Officer with a written rationale substantiating why the vehicle is needed in connection with satisfactory performance of the contract.

(7) IDENTIFICATION OF CONTRACTOR'S EMPLOYEES

(a) All persons hired by the Contractor for performance under this contract requiring entry to a U.S. Government installation shall be processed through the Contracting Officer, or his representative, and approved for entry as required by: (1) for Contractors requiring entry onto an U.S. Army installation, AR 604-5, AR 606-15 and USFK Reg 190-7; and (2) for Contractors requiring entry onto an U.S. Air Force installation, AFR 125-37, AFR 205-32, and AFR 125-3. Additional requirements may be necessitated by local supplements to the above-mentioned regulations.

(b) In addition, the contractor shall ensure that each of its employees requiring entry possesses an identification badge or pass as may be required: (1) by the Provost Marshall for the area in which the contract work is to be performed, for entry onto U.S. Army installations; or (2) by the Pass and Registration Office (Security Police) for the applicable installations for entry onto the U.S. Air Force installations. Each employee shall be required to wear his badge upon his person at all times while on duty within a U.S. Government installation or at such times and places identification is required. In the event that Contractor’s employment of anyone for performance of this contract terminates or is suspended, or that any contractor employee otherwise is removed from performance of this contract, Contractor shall recover from each such employee all identification items, including passes, that tend to associate the employee with this contract, and shall return to the Contracting Officer any such identification items and passes that the Government previously issued.

(c) In the event that services to be performed entail access to restricted areas, all Contractor personnel requiring such access shall be required to have a background investigation, DD Form 441. The Contractor will submit to the COR (or to the Contracting Officer if a COR is not appointed), within 5 calendar days after date of contract award, a list of it's employees who will require a background investigation in accordance with this provision.

(8) LIMITED APPLICABILITY

The following clauses are applicable only to employees recruited in the United States.

FAR 52.222-21, 52.222-26, 52.222-29, 52.222-35, 52.222-36 and 52.222-37

(9) SECURITY OF EMPLOYEES

(a) The Contractor agrees (1) to submit immediately to the Contracting Officer and/or 51 MDG Security Office a complete confidential report of any information which the Contractor may have concerning existing or threatened espionage, sabotage, or subversive activity; (2) to submit to the Contracting Officer, upon written request, any and all information which the Contractor may have concerning any of his employees engaged in any work at any plant, factory, or site at which work under this contract is being performed; and (3) to exclude from the plant, factory, site, or part thereof at which work under this contract is being performed any person or persons whom the Contracting Officer, in the interest of security, may designate in writing.

(b) In any case, should the continued employment of any such person furnished by the Contractor for work under this contract be determined by the Contracting Officer to be prejudicial to the security interests of the Government, that person shall be immediately removed or transferred from that particular work specified. The decision by the Contracting Officer that such person should not be employed on work being done under this contract will be final.

(c) The Contracting Officer shall consult with the Contractor before final action is taken. It is understood that the decision of the Contracting Officer pursuant to this clause applies only to work under the contract and does not otherwise relate to the employer-employee relationship between the Contractor and its workers. The cost of replacing any contractor employee under the provisions of this clause shall be at no additional cost to the Government.

(10) DEFENSE BASE ACT IMPLEMENTATION

(a) The following clause is applicable only to employees hired in, resident in, or citizens of the United States.

FAR 52.228-3

(b) The following clauses are not applicable with respect to employees hired in, resident in, or citizens of the United States.

FAR 52.228-4

DFARS 252.228-7000

(c) The portion of this contract providing for the Contractor, subcontractor(s), and subordinate contractor(s), if any, to afford to their employees protection against war hazard risks WITHOUT PURCHASING INSURANCE (to the extent that the clauses entitled "Reimbursement for War Hazard Losses,” and “Workers’ Compensation & War Hazard Insurance Overseas" apply) is on a cost-reimbursement, no-fee basis, to be paid only as reimbursement of contractor disbursements in settlement of actual claims by beneficiaries, notwithstanding the basis of the rest of the contract.

(d) War Hazard Compensation generally does not apply to employees who reside at or in the vicinity of the place of employment unless their residence there is solely by virtue of the exigencies of such employment. (42 U.S.C.

1701(d)).

(11) EMPLOYEES RECRUITED FROM THE UNITED STATES

The following provisions are applicable to employees recruited in the United States:

FAR 52.222-22 and 52.222-25

(12) REPRESENTATIONS AND CERTIFICATIONS

(a) SUBCONTRACTING:

If the offeror contemplates subcontracting, it must obtain prior written approval of subcontractor from the PCO or ACO, and list below: (1) the names and addresses of the subcontractor(s), (2) the type of subcontracting, (3) the amount involved, and (4) the estimated price for each subcontract.

(b) AFFILIATED OFFERORS:

(1) Business concerns are affiliates of each other when, either directly or indirectly, one concern controls or has the power to control the other, or a third party controls or has the power to control both.

(2) Each offeror shall furnish, below, the following information:

(i) Whether the offeror has any affiliates;

(ii) The names and addresses of all affiliates of the offeror; and

(iii) The names and addresses of all persons and concerns exercising control or ownership of the offeror and any or all of its affiliates, and whether they are common officers, directors, stockholders holding controlling interest, or otherwise.

AFFILIATED CONCERNS. : (Name, location and, in detail, controlling interest in each)

(c) PRINCIPAL OWNER(S) OR STOCKHOLDER(S):

Each offeror shall list below the name(s) and address(es) of the principal owner(s) or stockholder(s) of the company and percentage of ownership. If a major portion is publicly traded and/or otherwise widely distributed, state that, with the percentage so affected.

(d) STANDARDS OF CONDUCT CERTIFICATION:

This is to certify that, to the best of my knowledge and belief, except as described below, no representative of this firm who deals with US Government employees on any aspect of this procurement is a former US Government employee, to include former US military personnel. I understand that this certification is continuing in nature and places a duty on me and my firm to notify the Contracting Officer of any additional individual(s) who fit the above description prior to the individual's assuming duties.

(i) Name ______________________________________________ Former rank/grade ____________________________________ Last US Government position ___________________________

(ii) Name ______________________________________________ Former rank/grade ____________________________________ Last US Government position ___________________________

(iii) Name ______________________________________________ Former rank/grade ____________________________________ Last US Government position ___________________________

Firm ____________________________________________________ Name _____________________________________________________ Signature __________________________________________________

Title _____________________________________________________ Date of Execution ____________________________________________

(e) TAXES:

(1) References:

(i) Contract clause entitled "FAR 52.229-06 Taxes—Foreign Fixed-Price Contracts (Jan 1991)."

(ii) US-ROK Status of Forces Agreement (SOFA), Articles IX and XVI.

(iii) ROK Customs Law, Law No. 1976, promulgated on 29 November 1967, as amended.

(iv) ROK Value Added Tax Law, Law No. 2934, promulgated on 22 December 1976 (effective date 1 July 1977), as amended.

(v) ROK Special Excise Tax Law, Law No. 2935, promulgated on 22 December 1976 (effective date 1 July 1977), as amended.

(2) Contractor shall state the types and estimated amount of taxes that would normally apply to such transactions but are excluded from this proposal.

(i) Customs Tax (except for ROK MND-funded contracts or delivery orders):

Name Number Cost/Unit of Item of Units w/o Tax % of Tax Tax/Unit Tax Total

This item will be imported specifically for this contract? Yes _____ No _____

(ii) Special Excise Tax:

Name Number Cost/Unit of Item of Units w/o Tax % of Tax Tax/Unit Tax Total

Name of item manufacturer

(iii) Value Added Tax (VAT):

Input VAT on materials purchased for this contract. 10% _____ Input VAT on transportation leased/rented for this contract.10% _____ Input VAT on equipment leased/rented for this contract. 10% _____ Input VAT on services purchased for this contract. 10% _____ Output VAT on total contract amount. 10% _____

(iv) Education Tax.

(v) Special Excise (Petroleum) Tax

No. of U/P Liters w/o Tax Tax/Unit Total Tax

Amount Regular Gasoline ___________ (L) ________ _________ _________ Premium Gasoline ___________ (L) ________ _________ _________ Diesel ___________ (L) ________ _________ _________ Other ___________ (L) ________ _________ _________

(3) Name of the oil company from which POL products will be purchased:

Oil Company: _________________________________________ (Name only)

(End of Supplement)