Attachment_1_-_Performance_Work_Statement_-_20_Jul_2017.pdf

PERFORMANCE WORK STATEMENT

Performance Work Statement

For

Portuguese Civilian Employee Insurance Coverage

Lajes Field, Azores, Portugal

20 July 2017

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 and/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 TDY 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 (65 Air Base Group), from both Appropriated Fund (AF) and Non-

Appropriated Fund (NAF) activities.

1.1 Government Responsibilities

1.1.1 A government representative, in the majority of cases a management official, will provide the contractor a copy of the USAFE Base Form 50 (attachment 1) each time there is a job related accident/injury, unexpected illness and/or an accident/injury while on TDY status that requires coverage under this contract.

1.1.2 ACCIDENT/INJURY REPORTING – The 65 ABG will deliver the USAFE Base Form 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 work days (weekends) or when employee is in a TDY status.

1.1.2.1 When accident/injury occurs during a non-regular work day (weekends), the contractor will receive the form by close of business on the next regular duty day.

1.1.2.2 When accident/injury or unexpected illness occurs during TDY, the contractor will receive the USAFE Base

Form 50 on the same day management learns of the situation or within two (2) workdays after the employee returns from TDY, whichever is sooner.

1.1.3 The USAFE Base Form 50 will be provided to the contractor via fax or email.

1.1.4 GOVERNMENT POINT OF CONTACT (POC) - The government will appoint two individuals as point of contacts for this contract.

1.1.4.1 Under the terms of this contract, the government appointees are authorized to make inquires to the contractor relating to an individual employee’s claim status.

1.1.4.1 The government appointees will inform the contractor, via written email notification or fax, when 65 Air Base

Group employee depart the island on a TDY status. This notification will have the employee’s name, identification number (badge number), work section, TDY location, TDY purpose and TDY dates. A copy of this notification will also be sent to the Contracting Officer.

1.1.4.2 The government appointees will provide the contractor, thru the Contracting Officer, a copy of the yearly salary payment schedule, no later than 31 Dec.

1.2 Contractor Responsibilities

1.2.1 The contractor will provide coverage in accordance with applicable Portuguese Law. The contractor will be responsible to notify the Contracting Officer of any and all new or updated Portuguese Laws pertaining to on the job accidents/injuries which may apply to this contract. The contractor is also responsible to provide the Contracting

Officer with two copies of any updates or changes, one in English and one in Portuguese.

1.2.2 The contractor is responsible to meet all of the requirements under the terms of this contract which includes the contractor’s proposal, which is also considered part of this contract upon award, as well as the Portuguese Law.

1.2.3 The contractor will immediately correct any discrepancies validated by the Contracting Officer.

1.3 Insurance Coverage

1.3.1 The contractor will be responsible for all initial treatment, follow-up treatment, medical exams and any care and/or payment(s) required as the result of any job related accident/injury.

1.3.2 The contractor will also provide coverage while employee(s) are in a TDY status for official duty, professional training, on-the-job training, conferences, etc. This coverage must 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.) Coverage must run 24 hours a day, beginning when the employee departs his/her residence and ends when the employee returns to his/her residence.

1.3.3 The contractor will also provide coverage when employees need to be away from their normal duty location, outside of 65 Air Base Group main installation. This may include work performed on 65 Air Base Group infrastructures, work not located on 65 Air Base Group main quarters, work outside of 65 Air Base Group installation, or work on another island which would place the performance of employee’s assigned duties in a different duty location.

1.3.4 The contractor will also provide coverage to employees who are approved to participate in the 65 Air Base Group

Physical Fitness Program. This coverage includes accidents/injuries sustained in the performance of physical fitness activities at the fitness center (gym), designated sport fields/courts (basketball, soccer, tennis, etc.), approved walking paths and base track. Coverage includes any commander approved, on base fitness program or alternate duty locations approved IAW 1.3.5 below.

1.3.5 The contractor will also provide coverage for employees approved to participate in the physical fitness program, when employees are participating in commander authorized sports activities at an “alternate duty location”, such as events that are held to enhance unit cohesion and squadron or base functions. Determination of “alternate duty location” will be made in coordination with the Civilian Personnel Section.

1.3.6 The contractor will provide coverage for any medical appointments/exams/test necessary at the TDY location to determine an employee’s physical ability to continue as a course attendee or to travel.

1.4 General Information

1.4.1 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 and Portuguese Law.

1.4.2 QUALITY ASSURANCE – The government will appoint a representative(s) to ensure the insurance package provided by the contractor is accomplished accordingly, in support of the Portuguese 65 Air Base Group employees.

Although this is an insurance package, the government will verify the contractor’s performance of the process within the insurance package provided in support of the Portuguese 65 Air Base Group employees. The government may verify each case as they are completed or incomplete cases depending on the occurrence. The Contracting Officer shall make final determination of the validity of a particular employee incident in cases of disagreement between contractor and 65 Air Base Group.

1.4.3 HOURS OF OPERATION- The contractor must be available Monday through Friday from 0800 to 1700 hours.

The contractor must be available during these hours, within one (1) hour of being called to answer any questions and within three (3) hours to meet with government personnel (designated by the Contracting Officer) to discuss and resolve problems.

1.5 Contractor Personnel Requirements

1.5.1 CONTRACT MANAGER - The contractor must provide a contract manager who will be responsible for the performance of the work. The name of this person, and an alternate(s), who will act for the contractor when the contract manager is absent, must be designated in writing to the Contracting Officer five (5) working days prior to the start of this contract. The contract manager or alternate will have full authority to act for the contractor on all contract matters relating to the daily operation of this contract. The contract manager or alternate will be available during normal duty hours, within two (2) hour of being called, to meet on the 65 Air Base Group installation with the POC(s) to discuss problem areas. After normal duty hours, the manager or alternate must be available within three (3) hours (at no additional cost to the government).

1.6 Incident Point of Contact (POC)

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

1.6.2. 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 (1) hour of being called.

1.7 Special Requirement

1.7.1. The contractor, contract manager or alternate(s) and incident POC must be able to read, write, speak, and understand English or have a translator/interpreter at no additional cost to the government.

1.7.2. Any form, other than the USAFE Base Form 50, required by the contractor, will be the responsibility of the contractor. 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.

1.7.3 The contractor will provide a monthly report summarizing all incidents that occurred during the month and all open cases. This report must be submitted to the Contracting Administrator no later than the 10th day of each month.

The Contracting Administrator will provide a copy of this report to the government POCs. 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.

1.8 Payment of Employees Benefits

1.8.1 In the case where a 65 Air Base Group employee is entitled to any compensation benefits under the terms of this contract, the contractor is responsible for such payments.

1.8.2 Salary payments for any period of time the employee is unable to work will be paid biweekly, from the date the contractor received proof of employee’s inability to work, and in accordance with the yearly salary payment schedule provided by the government’s POC.

1.8.3 Reimbursement of any medical/treatment expenses will be paid no later than fifteen (15) days from the date the contractor received proof of expenses.

1.9 Contractor Payment

1.9.1 Payments will be made on a monthly basis, payable at the end of the following month. 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 65 Air Base Group Portuguese civilian employees, excluding: lump sum leave, leave subsidy, Christmas subsidy (13th month), cash awards, severance pay, termination payments in lieu of notice (temporary appointments) and unpaid compensation at death. Gross wages earned includes:

gross pay, language bonus, overtime, holiday work and night differential.

1 ATTACHMENT:

USAFE Base Form 50