Insurance Statement of Work.doc

ATTACHMENT 1

FA4486-08-R-0011

3 July 2008

STATEMENT OF WORK

FOR

PORTUGUESE CIVILIAN EMPLOYEE INSURANCE COVERAGE

1. DESCRIPTION OF REQUIREMENT: The contractor shall provide all labor, materials, supplies and management to provide insurance coverage required by Portuguese law. Total liability for job related injuries and accidents will be transferred from the United States Government to the contractor for all Portuguese civilian employees of the United States employed by Lajes Field, Terceira, Azores.

1.1 BASIC REQUIREMENT: The contractor shall provide coverage in accordance with Portuguese Law 100/97 dated 13 September 1997 and any/all subsequent revisions, supplements and/or additions to include but not limited to Law 143/99 dated 30 April 1999. The contractor will be responsible to notify the contracting officer of any and all new or updated laws that pertain to this contract. The contractor is also responsible to provide two copies of any such changes, one in English and one in Portuguese, to the contracting office. IAW Portuguese law, the insurance company will be responsible for all initial treatment, follow-up treatment, and any care and/or payments required as a result of any job related injury. Any and all liabilities covered under these Portuguese laws are transferred to the contractor.

The contractor must also provide coverage for Portuguese civilian employees while in a Temporary Duty (TDY) status. The following must be provided:

- Coverage for unexpected illness as well as accidents

- Coverage must run 24 hours a day beginning the day the employee leaves (travel day) to the day the employees returns (travel day).

The contractor must provide coverage when employees need to be away from their normal duty location outside Lajes Field. This may include work performed on another island, which would place the performing their assigned tasks in a different duty location. These cases require 24 hour coverage. Contractor will receive specific information when an employee requires this type of coverage.

1.2 Contractor shall answer specific questions from designated base personnel relating to individual employee status after transfer of liability to contractor. The contracting officer will provide names, in writing, of designated personnel authorized to make inquiries to the contractor, e.g. safety, civilian personnel, medical personnel, etc.

1.3 The coverage pertains to Portuguese civilian employees of both appropriated and non-appropriated fund activities and Portuguese “Indirect Hire” employees over whom the United States Government serves in a manager-utilizer capacity, including but not limited Command Civilian Recruitment Section. Portuguese civilians employed by American personnel on a private basis are not covered by this contract.

1.4 The contractor is responsible to meet all the requirements of this contract, the contractor’s proposal which is considered part of this contract upon award, and the laws identified in paragraph 1.1 of this SOW. The contractor will immediately correct any discrepancies validated by the contracting officer.

1.5 SPECIAL REQUIREMENTS: A monthly report to summarize all incidents occurring during the month, and all open cases, shall be submitted to the contracting officer not later than the 10th day of each month. The following shall be included in the report: name of employee, date of mishap, employee badge number, squadron, nature of mishap, number of lost duty days, and present status of employee.

2. REQUIREMENT SUMMARY:

THRESHOLD

METHOD OF

SURVEILANCE

Monthly Report

3. GOVERNMENT FURNISHED PROPERTY: NONE

4. GENERAL INFORMATION

4.1 QUALITY CONTROL: The contractor shall develop and maintain a quality control program to ensure a smooth process for employees to receive transportation, emergency services and follow-up care in accordance with this contract, the contractor’s proposal, and the laws identified in paragraph 1.1.

4.2 QUALITY ASSURANCE: The government will periodically evaluate the contractor’s performance by appointing a representative(s) to monitor performance to ensure services are received. The government will evaluate the contractor’s performance through the intermittent inspection of the contractor’s quality control program and receipt of valid complaints from base personnel. The government may inspect each case as completed or increase the number of quality control inspections if deemed necessary because of repeated failures discovered during quality control inspections or because of repeated valid complaints. The contracting officer or contract administrator shall make final determination of the validity of customer complaint(s) in cases of disagreement with customer(s).

4.4 HOURS OF OPERATION. The contract manager or alternate and incident Point of Contact (POC) identified in paragraph 4.5 shall be available Monday through Friday during the hours of 0800-1700. The contract manager or alternate must be available, during these hours, within one hour of being called to answer any questions and within three hours meet with government personnel (designated by the contracting officer) to discuss and resolve problems. The incident POC must be available during duty hours within one hour of being called to answer any questions.

4.5 PERSONNEL

4.5.1 CONTRACT MANAGEMENT

4.5.1.1 Contractor shall provide a contract manager who shall be responsible for the performance of work. The name of this person, and any alternate shall be identified in writing. The manager will have the authority to make decisions and agreements on behalf of the contractor.

4.5.1.2 The contract manager or alternate must be able to read, write, speak and understand English or have an interpreter.

4.5.2 INCIDENT POINT OF CONTACT (POC)

4.5.2.1 The contractor will provide the name, or position, and a phone number for a POC that will be able to answer any questions concerning incidents covered by this contract. The information will include, but not be limited to: what care the employee received, the diagnosed injury, follow-up appointments, and estimated time away from duty due to injury.

4.5.2.2 The incident POC should be immediately available by phone Monday through Friday between the hours of 0800 and 1700. However, if not immediately available, they must be available within one hour of being called.

4.6. INCIDENT REPORTING:

4.6.1 A government representative will provide the contractor a copy of the USAFE BASE FORM 50 (appendix C) each time there is a mishap requiring coverage under this contract. This form will be delivered to the contractor within the timeframe specified in the contractor’s proposal.

4.6.2 Any form, other than the USAFE BASE FORM 50, required by the contractor or the personnel providing the service will be the responsibility of the contractor. The Contracting Officer will provide the contractor with a point of contact for any information required to complete such forms.

5. PAYMENTS

Payments will be made on a quarterly basis and will be paid one month after the end of each quarter. Premiums for basic insurance coverage paid by the United States government to the contractor will be ascertained by taking the percentage indicated on the bid schedule of the gross wages earned by all Portuguese civilian employees of the United States in the Azores, except: lump sum leave, leave subsidy, 13th month, cash awards, termination payments in lieu of notice and unpaid compensation at death (gross wages earned include: gross pay, language bonus, overtime, holiday work and night differential.

( Enf of Document)