PERFORMANCE WORK STATEMENT

For

Portuguese Civilian Employee Insurance Coverage

Lajes Field, Azores, Portugal 22 June 2026

1. Description of Services: The contractor shall provide all personnel, equipment, tools, materials, supervision, transportation, safety equipment and any other items or services necessary to provide insurance coverage required by Portuguese law and as defined in this

Performance Work Statement (PWS), including coverage for job-related accidents/injuries and accidents/injuries or unexpected illnesses when employees are in a Temporary Duty

(TDY) status. Total liability for job-related accidents/injuries, unexpected illnesses and accidents/injuries while on TDY shall be transferred from the United States Government to the contractor for all Portuguese civilian employees of the United States, employed by

United States Forces Azores (USFORAZORES) at Lajes Field, Terceira, Azores, from both

Appropriated Fund (APF) and Non-Appropriated Fund (NAF) activities.

2. Government Responsibilities

2.1 CONTRACT POINT OF CONTACT (POC): The Contracting Officer (CO) shall appoint two (2) individuals as contract POCs, upon contract award.

2.1.1 Under the terms and conditions of the contract, the contract POCs are authorized to make inquiries to the contractor relating to an individual employee’s claim status.

2.1.2 The contract POCs shall provide the contractor with a copy of the monthly wage/pay report, throughout the contract period of performance.

2.2 ACCIDENT/INJURY REPORTING: For all job-related accidents/injuries, and for all accidents/injuries or unexpected illnesses when employees are in a TDY status, the accident/injury shall be reported through the issuance of an USAFE Base IMT 50 (Appendix

A). The USAFE Base IMT 50 shall be sent to the contractor via written e-mail notification.

2.2.1 A USFORAZORES employee supervisor shall deliver the USAFE Base IMT

50 to the contractor within twenty-four (24) hours of receipt from the injured/ill employee or management official, except when the accident/injury occurs during non-regular workdays or when employee is in a TDY status. Non-regular workdays include weekends, and legal holidays in accordance with (IAW) Agreement on Cooperation and Defense between the

United States of America and Portugal.

2.2.2 When accident/injury occurs during a non-regular workday, the contractor shall receive the USAFE Base IMT 50 by close of business on the next regular duty day.

When accident/injury or unexpected illness occurs during TDY a USFORAZORES employee supervisor shall provide the contractor with a copy of the USAFE Base IMT 50. The injury report should be provided on the same day management learns of the situation, or within two (2) workdays after the employee returns from TDY, whichever is sooner.

2.2.3 The government POCs shall inform the contractor, via written email notification, when USFORAZORES employee depart the island on a TDY status. This notification shall have the employee’s name, identification number (badge number), work section, TDY location, TDY purpose and TDY dates. A copy of this notification shall also be sent to the

CO.

3. Contractor Responsibilities

3.1 The contractor shall provide coverage IAW applicable Portuguese Law. The contractor shall be responsible to notify the CO of any and all new or updated Portuguese Laws pertaining to on-the-job accidents/injuries which may apply to this contract. This responsibility includes providing the CO with two (2) copies of any updates or changes, one in English and one in Portuguese.

3.2 The contractor is responsible for meeting all of the requirements under the terms of this contract to include the contractor’s offer, which is also considered part of this contract upon award.

3.3 The contractor shall immediately correct any discrepancies validated by the CO.

3.4 The contractor shall ensure that a written medical certification is provided to the employee when a medical release is issued, enabling the injured employee’s return to duty.

3.5 The contractor shall ensure that if the injured employee receives a medical certification to return to work (such as the “boletim de alta” and “relatório médico”), containing physical limitations or work restrictions, that a statement shall be included in the medical certification, clearly stating the extent of the work restrictions to which that employee is subject to.

3.6 The contractor shall provide clarification, when requested, of the standards used to issue a medical release, enabling the injured employee to return to work.

3.7 The contractor shall ensure that injured employees are reimbursed for all transportation/ travel expenses and other expenses associated with the insurance claim.

3.8 The contractor shall ensure medical appointments that are available on Terceira Island take precedence over other demographic locations, except, when urgent and compelling, when an employee is in TDY, and in cases where a certain medical specialty type of exam is not available on Terceira Island.

3.9 The contractor shall schedule medical appointments within 10 calendar days. If 10 calendar days or more go by without the contractor being able to schedule the medical appointment, the contractor shall inform the contract POCs.

3.10 The contractor shall notify the contract POCs, whitin 1 business day, and before providing the same to any third party, every time a medical appointment is scheduled out of Terceira Island.

4. Insurance Coverage

4.1 The contractor shall be responsible for all initial treatment, follow-up treatment, medical exams and any care or payments required as the result of any job-related accident/injury.

4.2 The contractor shall also provide coverage while employees are in a TDY status for official duty, professional training, on-the-job training, conferences, etc. This coverage shall include unexpected illnesses as well as accidents/injuries while in a TDY status and required

TDY interruptions, (for example overnight delays in a different location due to travel itinerary and/or airport locations.).

4.2.1 TDY insurance coverage shall run 24 hours a day, beginning when the employee departs his/her residence and ends when the employee returns to his/her residence.

4.2.2 The contractor shall provide coverage for any medical

appointments/exams/test necessary at the TDY location, necessary to determine an employee’s physical ability to continue as a course attendee, or to travel.

4.3 The contractor shall also provide coverage when employees are required to be away from their normal duty location outside of USFORAZORES main installation. This includes work performed on USFORAZORES infrastructures, work outside of USFORAZORES installation, or work on another island which places the performance of assigned duties in a different duty location.

4.4 The contractor shall also provide coverage to employees who are approved to participate in the USFORAZORES physical fitness program and when employees are participating in commander-authorized sports and morale activities or events at an alternate duty location.

4.4.1 The physical fitness program coverage includes accidents or injuries sustained in the performance of on-base physical fitness activities at the fitness center/gym, designated sport fields or courts (e.g. basketball, soccer, tennis, etc.), approved walking paths and base track, and any activities at an alternate duty location approved IAW paragraph 4.4.2 below.

4.4.2 The alternate duty location coverage shall provide coverage when employees are participating in commander authorized sports, and morale activities/events at an alternate duty location, such as events that are held to enhance unit cohesion and squadron or base functions.

The Civilian Personnel Section shall be informed of any determination of alternate duty location.

5. General Information

5.1 QUALITY CONTROL (QC): The contractor shall develop and maintain a Quality

Control Plan (QCP). The contractor’s QCP shall include at least the following:

5.1.1 Quality Control System and Standards: Describe the comprehensive quality control system to be implemented. Detail the best commercial practices and procedures that will be used to ensure the quality of all services provided. Identify if the proposed system aligns with recognized commercial quality standards (e.g., ISO 9001) or regulatory standards established by the Portuguese Insurance and Pension Funds Supervisory Authority (ASF).

5.1.2 Organizational Structure and Escalation Matrix: Provide a company structure diagram or organizational chart focusing on the team assigned to this contract. This must clearly identify the reporting chain for the QC Representative and outline the management escalation path for unresolved issues.

5.1.3 QC Representative Designation: Provide a written designation of the individual(s) within the company responsible for the implementation and oversight of the

QCP. Include the individual's contact information and a brief summary of their qualifications or experience in managing quality control for corporate or government accounts.

5.1.4 Critical Care and Medical Coordination Procedures: Provide a detailed description of the workflow and procedures to ensure employees receive timely and appropriate transportation, emergency services, and follow-up care in strict accordance with Portuguese labor and health regulations for workplace accidents. This must cover:

• Employees at their primary duty location.

• Employees in a Temporary Duty (TDY) status.

Additionally, describe the procedures for coordinating care between private medical networks and the Portuguese National Health Service (SNS) when necessary.

5.1.5 Describe the workflow and procedure for responding to inquiries from injured employees and U.S. Government administrative staff. This must include proposed target metrics for response times (e.g., acknowledgment within 24 hours), methods of communication, designated Points of Contact (POCs), and procedures for providing fully bilingual (Portuguese and English) support.

5.1.6 Customer Complaint Channels: Identify the various channels your company will provide for Government employees and administrative staff to submit complaints regarding the insurance policy or service. These Channels must be easily accessible, support both Portuguese and English, and may include a dedicated toll-free phone number, a costumer service email address, an online portal, and a physical mailing address.

5.1.7 Continual Process Improvement and Reporting: Describe the company’s procedures to identify, prevent, and correct service deficiencies. Outline the approach to continual process improvement, including the types, frequency, and formats of quality metrics and claims reports that will be provided to the U.S. Government Contracting

Officer to demonstrate contract performance.

5.1.8 Data Security and Privacy (GDPR) Compliance: Briefly describe the best commercial practices and procedures in place to ensure compliance with the General Data

Protection Regulation (GDPR) and the secure handling of sensitive personnel, medical, and claims data during the execution of this contract.

6. Contractor Personnel Requirements

6.1 CONTRACTOR MANAGER: The contractor shall appoint a primary and an alternate contract manager who shall be responsible for the performance of the work.

6.1.1 This designation shall be submitted to the CO within five (5) working days prior to the start of this contract.

6.1.2 The contract manager and the alternate shall have full authority to act for the contractor on all contract matters relating to the daily operation of this contract.

6.2 INCIDENT POC: The contractor shall provide the name, position title, and phone number of an incident POC.

6.2.1 The incident POC shall be able to answer any questions concerning incidents/claims status covered by this contract. The information shall include but may not be limited to: what care the employee received, follow-up appointments, estimated time away from duty due to the injury, shall be able to clarify the amounts to be paid to the injured employee and provide the payment breakdown when requested.

6.3 HOURS OF OPERATION: The contractor shall be available Monday through Friday from 0800 to 1700 hours. The contractor shall be available to respond within one (1) hour of being called or e-mailed by the CO and/or contract POCs. The contractor shall also be available to meet in person with these individuals, or other individuals duly designated by the CO, within three (3) hours, if required. After normal duty hours, the contractor manager or alternate shall be available within three (3) hours of being called by the CO and/or contract POCs, at no additional cost to the government.

7. Special Requirements

7.1 The contractor, contract manager and incident POC shall be able to read, write, speak, and understand English or have a readily available translator/interpreter at no additional cost to the government.

7.2 The contractor shall ensure that all written correspondence is done in English.

7.3 Any form, other than the USAFE Base IMT 50, required by the contractor, shall be the responsibility of the contractor, unless mutually agreed upon in writing. The government POCs are available during normal duty hours (Monday thru Friday, 0800 to 1700) to provide any information required to complete such forms, but are not responsible for completing any contractor forms, unless agreed upon in writing.

7.4 The contractor shall provide a monthly report summarizing all incidents that occurred during the month and all open cases. This report shall be submitted to the Contract Specialist no later than the 10th day of each month. The following shall be included in the report: name of employee, employee identification number (badge number), work section, date of mishap, nature of mishap, number of lost duty days and present status of employee.

8. Payment of Employees Benefits

8.1 In the case where a USFORAZORES injured employee is entitled to any compensation benefits under the terms of this contract, the contractor shall be responsible for such payments.

8.2 Salary payments for any period of time the employee is unable to work shall be paid monthly, from the date the contractor received proof of employee’s inability to work, and

IAW the monthly wage/pay report provided by the government’s POC.

8.3 Reimbursement of any medical/treatment expenses shall be paid no later than thirty

(30) days from the date the contractor received proof of expenses.

8.4 Definition of regular wage/pay. Regular wage/pay are the result of the monthly gross wage, plus Christmas subsidy, leave subsidy, and other wages earned on a regular basis, to include but not limited to: meal subsidy, shift worker’s night differential, language bonus, step increases and firefighter premium pay.

9. Contractor Payment: Payments shall be made on a monthly basis, via the Wide Area

Work Flow, located in the Procurement Integrated Enterprise Environment (PIEE) application.

10. Service Summary: The performance threshold briefly describes the minimally acceptable levels of service required for each requirement. The Services Summary (SS) and the contractor’s QCP provide information on contract requirements, the expected level of contractor performance and the expected method of government validation and confirmation of services provided. These thresholds are critical to mission success. Procedures set forth in the RFO 52.212-4(b), Contract Terms and Conditions - Commercial Items, Inspection/Acceptance, shall be used to remedy all deficiencies.

Surveillance frequency for all performance objectives shall be continuous upon receipt of customer complaints.

Performance

Objective (PO)

PWS

Section Remedy Performance Threshold

Method of

Surveillance

PO-1 - Contractor

Responsibilities

Provide written Excellent: 0 defects

Customer

Complaint

Very Good: 1 defect response* to the CO and Contract POCs Satisfactory : 2 defects

Marginal: 3 defects within 1 duty day.

Unsatisfactory: More than 3 defects

PO-2 - Insurance

Coverage

Very Good: 1 defect response* to the CO and Contract POCs Satisfactory : 2 defects

PO-3 – Contractor

Personnel

Requirements response* to the CO and Contract POCs within 1 duty day.

Very Good: 1 defect

Satisfactory : 2 defects

Marginal: 3 defects

PO-4 - Special

Requirements

Very Good: 1 defect response* to the CO and Contract POCs Satisfactory : 2 defects

PO-5 - Payment of

Employees

Benefits response* to the CO and Contract POCs within 1 duty day.

Excellent: 0 defects

Customer

Complaint

Very Good: 1 defect

Satisfactory : 2 defects

Marginal: 3 defects

*The written response shall address how the deficiency will be remedied/corrected and which procedures will be implemented to ensure non-performance and continual repeat of defective service does not occur.

Appendix A: USAFE BASE IMT 50