1_SF_33_4-5-13.pdf

HT9402-12-R-0005

SOLICITATION, OFFER AND AWARD

4. TYPE OF SOLICITATION2. CONTRACT NUMBER 3. SOLICITATION NUMBER

7. ISSUED BY CODE 8. ADDRESS OFFER TO (If other than Item 7)

ORDER UNDER DPAS (15 CFR 700)

6. REQUISITION/PURCHASE NUMBER

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

NEGOTIATED (RFP)

SEALED BID (IFB)

5. DATE ISSUED

1. THIS CONTRACT IS A RATED RATING PAGE OF PAGES

DO - C9 1 91

C. E-MAIL ADDRESS

EXT.NUMBERAREA CODE

B. TELEPHONE (NO COLLECT CALLS)A. NAME

10. FOR

INFORMATION

CALL:

CAUTION: LATE Submissions, Modifications, and Withdrawals: See Section L, Provision No. 52.214-7 or 52.215-1. All offers are subject to all terms and conditions contained in this solicitation.

(Date)(Hour) local timeuntildepository located in copies for furnishing the supplies or services in the Schedule will be received at the place specified in Item 8, or if hand carried, in the

SOLICITATION

9. Sealed offers in original and

PART IV - REPRESENTATIONS AND INSTRUCTIONS

OTHER STATEMENTS OF OFFERORS

EVALUATION FACTORS FOR AWARD

INSTRS., CONDS., AND NOTICES TO OFFERORS

REPRESENTATIONS, CERTIFICATIONS AND

LIST OF ATTACHMENTS

CONTRACT CLAUSES

PART III - LIST OF DOCUMENTS, EXHIBITS AND OTHER ATTACH.

I

J

K

L

M SPECIAL CONTRACT REQUIREMENTS

CONTRACT ADMINISTRATION DATA

DELIVERIES OR PERFORMANCE

INSPECTION AND ACCEPTANCE

PACKAGING AND MARKING

DESCRIPTION/SPECS./WORK STATEMENT

SUPPLIES OR SERVICES AND PRICES/COSTS

SOLICITATION/CONTRACT FORM

PART II - CONTRACT CLAUSESPART I - THE SCHEDULE

H

G

F

E

D

C

B

A

SEC. DESCRIPTION PAGE(S) (X) DESCRIPTION SEC. (X)

11. TABLE OF CONTENTS

18. OFFER DATE17. SIGNATURE

SUCH ADDRESS IN SCHEDULE.

IS DIFFERENT FROM ABOVE - ENTER

15C. CHECK IF REMITTANCE ADDRESS

EXT.NUMBERAREA CODE

15B. TELEPHONE NUMBER

(Type or print)AND

ADDRESS

OF

OFFEROR

CODE FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED TO SIGN OFFER15A. NAME

DATEAMENDMENT NO.DATEAMENDMENT NO.

and related documents numbered and dated):

amendments to the SOLICITATION for offerors

(The offeror acknowledges receipt of

14. ACKNOWLEDGEMENT OF AMENDMENTS

CALENDAR DAYS (%)30 CALENDAR DAYS (%)20 CALENDAR DAYS (%)10 CALENDAR DAYS (%)

(See Section I, Clause No. 52.232.8)

13. DISCOUNT FOR PROMPT PAYMENT

designated point(s), within the time specified in the schedule.

by the offeror) from the date for receipt of offers specified above, to furnish any or all items upon which prices are offered at the price set opposite each item, delivered at the

12. In compliance with the above, the undersigned agrees, if this offer is accepted within ______________ calendar days (60 calendar days unless a different period is inserted

NOTE: Item 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

OFFER (Must be fully completed by offeror)

IMPORTANT - Award will be made on this Form, or on Standard Form 26, or by other authorized official written notice.

28. AWARD DATE

(Signature of Contracting Officer)

27. UNITED STATES OF AMERICA

25. PAYMENT WILL BE MADE BY

26. NAME OF CONTRACTING OFFICER (Type or print)

CODE 24. ADMINISTERED BY (If other than Item 7)

ITEM

(4 copies unless otherwise specified)

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

41 U.S.C. 253 (c) ( 10 U.S.C. 2304 (c) (

22. AUTHORITY FOR USING OTHER THAN FULL AND OPEN COMPETITION:

21. ACCOUNTING AND APPROPRIATION20. AMOUNT19. ACCEPTED AS TO ITEMS NUMBERED

AWARD (To be completed by government)

CODE

04/05/2013 X

HT9402

DEPARTMENT OF DEFENSE

TRICARE MANAGEMENT ACTIVITY COD

16401 E CENTRETECH PARKWAY

AURORA CO 80011-9066

1200 MT 06/03/2013

MARGARET ZANCANELLA 303

MARGARET.ZANCANELLA@TMA.OSD.

MIL676-3451

X

X

X

X

X

X

X

X

X

X

X

X

X

PAGE(S)

Scott Lamond

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

Prescribed by GSA - FAR (48 CFR) 53.214(c)

1-1 2-7

8-13 14-14 15-15 16-17 18-31 32-40

41-51

52-52

53-63

64-82

83-91

303.676.3649 scott.lamond@tma.osd.mil

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 91

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT9402-12-R-0005

(A) (B) (C) (D) (E) (F)

TRANSITION

Date of Award for a minimum of 10 months From: 1 September 2013 Through 30 June 2014

0001 TRANSITION/PHASE-IN: to include 1 LT Security (Physical, Personnel and NIST) Certifications

0002 DATA. Proposed and delivered in accordance with Section C and Section J (CDRLs) (Not Separately Priced)

OPTION PERIOD 1:

12 months From July 1, 2014 through June 30, 2015

0100 ELECTRONIC CLAIMS PROCESSING 44000000 CL

(All quantities are estimated)

0101 PAPER CLAIMS PROCESSING 185000 CL

(All quantities are estimated)

0102 ADMINISTRATION. Includes all costs not included 12 MO within Electronic and Paper Claims Processing

CLINS

010201 DATA. Proposed and delivered in accordance with Section C and Section J (CDRLs) (Not Separately Priced) (Qty:0 and Amt: $0.00)

0103 TRANSITION-OUT 1 LT

OPTION PERIOD 2:

Continued ...

3 91

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT9402-12-R-0005

(A) (B) (C) (D) (E) (F)

12 months From July 1, 2015 through June 30, 2016

0200 ELECTRONIC CLAIMS PROCESSING 44220000 CL

(All quantities are estimated)

0201 PAPER CLAIMS PROCESSING 185000 CL

(All quantities are estimated)

0202 ADMINISTRATION. Includes all costs not included 12 MO in Electronic and Paper Claims Processing CLINs

020201 DATA. Proposed and delivered in accordance with Section C and Section J (CDRLs) (Qty:0 and Amt: $0.00)

0203 TRANSITION-OUT 1 LT

OPTION PERIOD 3:

12 months From July 1, 2016 through June 30, 2017

0300 ELECTRONIC CLAIMS PROCESSING 44441100 CL

(All quantities are estimated)

0301 PAPER CLAIMS PROCESSING 180000 CL

(All quantities are estimated)

0302 ADMINISTRATION. Includes all costs not included 12 MO in Electronic and Paper Claims Processing CLINs.

030201 DATA. Proposed and delivered in accordance with Section C and Section J (CDRLs)(Not separately Priced)

4 91

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT9402-12-R-0005

(A) (B) (C) (D) (E) (F)

(Qty:0 and Amt: $0.00)

0303 TRANSITION-OUT 1 LT

OPTION PERIOD 4:

12 months From July 1, 2017 through June 30, 2018

0400 ELECTRONIC CLAIMS PROCESSING 44886621 CL

(All quantities are estimated)

0401 PAPER CLAIMS PROCESSING 180000 CL

(All quantities are estimated)

0402 ADMINISTRATION. Includes all costs not included 12 MO in Electronic and Paper Claims Processing CLINs.

040201 DATA. Proposed and delivered in accordance with Section C and Section J (CDRLs) (Qty:0 and Amt: $0.00)

0403 TRANSITION-OUT 1 LT

OPTION PERIOD 5:

12 Months From: July 1, 2018 Through: June 30, 2019

0500 ELECTRONIC CLAIMS PROCESSING 45111621 CL

(All quantities are estimated)

0501 PAPER CLAIMS PROCESSING 180000 CL

(All quantities are estimated)

0502 ADMINISTRATION. Includes all costs not included 12 MO

5 91

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

HT9402-12-R-0005

(A) (B) (C) (D) (E) (F) in Electronic and Paper Claims Processing CLINs.

050201 DATA. Proposed and delivered in accordance with Section C and Section J (CDRLs).

(Qty:0 and Amt: $0.00)

0503 TRANSITION-OUT 1 LT

OPTION PERIOD 6:

12 Months From: July 1, 2019 Through: June 30, 2020

0600 ELECTRONIC CLAIMS PROCESSING 45336609 CL

(All quantities are estimated)

0601 PAPER CLAIMS PROCESSING 180000 CL

(All quantities are estimated)

0602 ADMINISTRATION. Includes all costs not included 12 MO in Electronic or Paper Claims Processing CLINS.

060201 DATA. Proposed and delivered in accordance with Section C and Section J (CDRLs) (Not Separately Priced) (Qty:0 and Amt: $0.00)

0603 TRANSITION-OUT 1 LT