CC14HQR0010_Amendment_0001 _Dental_Insurance _SF_30.pdf

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

(a) By completing items 8 and 15, and returning or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment your desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

2. AMENDMENT/MODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

7. ADMINISTERED BY (If other than Item 6) CODE

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9A. AMENDMENT OF SOLICITATION

NO.

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, is not extended.

12. ACCOUNTING AND APPROPRIATION DATA (If required) copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO.

IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15C. DATE SIGNED

15A. NAME AND TITLE OF SIGNER (Type or print)

16C. DATE SIGNED

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

PAGE OF PAGES

6. ISSUED BY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code) (X)

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

NSN 7540-01-152-8070

Previous edition unusable

OCC

The purpose of this amendment, 0001, is to:

1. Amend RFP sections B, H, J, and L.

2. Provide Government response to offeror's questions.

3. Incorporate revised RFP Attachments 1 (Census Data), 3 (Claims History), and 8 (Price Proposal Spreadsheet)

4. Provide the MS Word version of Attachment 5 - IT Accessibility Questionnaire.

5. Provide additional information as Attachments 10 (Dental PPO Summary), 11 (DHMO Fee Schedule), 12 (DPPO Coverage Certificate).

OCC

Comptroller of the Currency Acquisitions Management 400 7th Street SW Washington, DC 20219

Comptroller of the Currency Acquisitions Management 400 7th Street SW Washington, DC 20219

CC14HQR0010

1 2

06/24/2014

06/12/2014

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGES

NAME OF OFFEROR OR CONTRACTOR

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA FAR (48 CFR) 53.110

Amendment Attachments:

Attachment 1 - RFP Amendment CC14HQR0010/0001 Attachment 2 - RFP Amendment CC14HQR0010/0001 (with track changes) Attachment 3 - Government response to offeror's questions Attachment 4 - RFP Attachment 1 - Census Data (revised) Attachment 5 - RFP Attachment 3 - Claims History (revised) Attachment 6 - RFP Attachment 8 - Price Proposal Spread-sheet (revised) Attachment 7 - RFP Attachment 5 - IT Accessibility Questionnaire Attachment 8 - RFP Attachment 10 - Dental PPO Summary Attachment 9 - RFP Attachment 11 - DHMO Fee Schedule Attachment 10 - RFP Attachment 12 - DPPO Coverage Certificate

CC14HQR0010/0001 2 of 2