SF-30_doc_Health_RFP_Amendment_-004.doc

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGE OF PAGES

1 5

2. AMENDMENT/MODIFICATION NO.

M004

3. EFFECTIVE DATE

01/26/2016

4. REQUISITION/PURCHASE REQ. NO.

5. PROJECT NO. (If applicable)

6.

ISSUED BY

CODE

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

US Embassy Tirana Rruga e Elbasanit, Nr. 103

Tirane, ALBANIA

8.

NAME AND ADDRESS OF CONTRACTOR (NO., street,city,county,State,and ZIP Code)

9a. AMENDMENT OF SOLICITATION NO.

SAL60016R0001

9b. DATED (SEE ITEM 11)

10/23/2015

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

[X ] is extended, [] is not extended

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 _______ copies of the amendment;(b) By acknowledging receipt of this amendment on each copy of the offer submitted; 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 you 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.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

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

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)

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

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

Section B Part 2 - Prices

Section J – List of Exhibits/Attachments (and) is revised to read as follows:

Exhibit A - Employee Statistics: Total number of insures (Empl + Dependents - 1028) Exhibit C - Employee Association Employees Rider: Total Number of Insures (Empl + Dependents - 12) Deadline to submit proposals is revised to read as follows:

Deadline to submit proposals is hereby extended to February 2, 2016 at hrs 5:00PM local time.

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.

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

16A. NAME OF CONTRACTING OFFICER

Jay Thompson

15B. NAME OF CONTRACTOR/OFFEROR

BY

(Signature of person authorized to sign)

BY

(Signature of Contracting Officer)

16C.DATE SIGNED

01/26/2016

NSN 7540-01-152-8070

Standard Form 30 (revised 10/83) Previous edition unusable

Prescribed by GSA FAR (48 CFR) 53.243

Section B

SECTION J

LIST OF EXHIBITS/ATTACHMENTS

Exhibit A – EMPLOYEE STATISTICS

Exhibit C – EMPLOYEE ASSOCIATION EMPLOYEES RIDER

� EMBED Excel.Sheet.12 ���

Sheet1

B.2.4. First Option Year of Contract

Bi-Weekly Rates per Employee

[Note to Contracting Officer: Fill in “Estimated Number of Employees” column.]

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 81

b. Family Plan 297

c. Subtotal (a + b)

d. Total Price for First Option Year (c x 26)

Sheet2

Sheet3

B.2.6. Third Option Year of Contract

Bi-Weekly Rates per Employee

[Note to Contracting Officer: Fill in “Estimated Number of Employees” column.]

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 81

b. Family Plan 297

c. Subtotal (a + b)

d. Total Price for Third Option Year (c x 26)

B.2.7. Fourth Option Year of Contract

Bi-Weekly Rates per Employee

[Note to Contracting Officer: Fill in “Estimated Number of Employees” column.]

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 81

b. Family Plan 297

c. Subtotal (a + b)

d. Total Price for Fourth Option Year (c x 26)

B.2.5. Second Option Year of Contract

Bi-Weekly Rates per Employee

[Note to Contracting Officer: Fill in “Estimated Number of Employees” column.]

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 81

b. Family Plan 297

c. Subtotal (a + b)

d. Total Price for Second Option Year (c x 26)

B.2.3. Base Year of Contract

Bi-Weekly Rates per Employee

[Note to Contracting Officer: Fill in “Estimated Number of Employees” column.]

Category Estimated Number of Employees Rate per Employee Bi-Weekly Total

a. Single Employees ( Self Only) 81

b. Family Plan 297

c. Subtotal (a + b)

d. Total Price for Base Year (c x 26)

B.9 Option Year 4 Prices (Option Term: Twelve (12) Months)

(a) Standard Services. The fixed price for Option Year 4 of the contract is:

Price per Month 12 months Price per Year

X 12

(b) Temporary Additional Services. The hourly fixed rate for temporary additional services is:

Hourly Rate Estimated Number of Hours per Year Ceiling Price per Year

[Note to Contracting Officer: Fill in estimated hours]

(c) Materials or Equipment. The Government will reimburse the Contractor for any materials or equipment that the Government orders to be delivered in conjunction with any order for Temporary Additional Services. All reimbursements shall be at the Contractor's out of pocket cost, with no overhead, profit, or other charge added. [Note to Contracting Officer: You may change material/equipment amount to reflect post needs]

Material/Equipment Not to Exceed per Year: $100.00 [Note to Contracting Officer: Show equivalent in local currency]

Total Not to Exceed Price for Option Year 4 (a + b + c)

Grand Total

B.2.8. Grand Total of Base plus All Option Years

Base Year Total

First Option Year Total

Second Option Year Total

Third Option Year Total

Fourth Option Year Total

Grand Total of Base plus All Option Years