TAB_C_Amendment_SBK80014R0003A005.pdf

NSN 7540-01-152-9070 STANDARD FORM 30 (REV. 10-83)

PREVIOUS EDITION UNUSABLE Prescribed by GSA

FAR (48 CFR) 53.243

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE PAGE OF PAGES

1 3

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

A005 May 21, 2014

6. ISSUED BY CODE 7. ADMINISTERED BY (if other than item 6) CODE

The Embassy of the United States of America Procurement & Contracting Office Roberta C. Frasurea 71000 Sarajevo Bosnia and Herzegovina

8. NAME AND ADDRESS OF THE CONTRACTOR (No., street, country, State and ZIP Code) (x) 9A. AMENDMENT OF SOLICITATION NO.

SBK80014R0003

9B. DATED (SEE ITEM 11)

April 14, 2014

10A. MODIFICATION OF CONTRACT ORDER

NO.

10B. DATED (SEE ITEM 13)

CODE FACILITY CODE

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbers solicitation is amended as set fourth in item 14. The hour and date specified for receipt of Offers is extended, is not extended. Offer 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 ACKNOWLEDGEMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR 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 THE MODIFICATIONS OF CONTRACTS/ORDERS,

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

(X) A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FOURTH 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 change in paying office, Appropriation data, 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.)

Purpose of this Amendment A005 is to provide correction and update to the Request For Proposal (RFP) SBK80014R0003 and subsequent amendments issued previously. The Amendment A005 provides updates to B.3. Administrative Retention Amounts paragraph III and B.3.2.1.

Prospective shall make changes to the RFP and subsequent amendments as per continuation sheet provided as attachment.

This amendment A005 does not extend date and time set for submission of proposals specified in the RFP and subsequent amendments.

Proposals must be submitted on or before 15:00 local time on May 30, 2014 to the address specified on the Standard Form 33, block 9 and section L of the RFP.

Offerors have until Close Of Business (17:00 local time), May 22, 2014 to submit questions. Any questions received after that time will NOT be addressed. The Firm date for receipt of proposals will remain May 30, 2014 at 15:00 local time.

SEE CONTINUATION PAGE

Except as provided herein, all other 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 AND TITLE OF SIGNER (Type or print)

15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 16C. DATE

SIGNED

BY

(Signature of Person authorized to sign) (Signature of Contracting Officer)

Amendment A005 Page 2 of 3

The Request For Proposal (RFP) SBK80014R0003 and subsequent Amendments A001 thru A004 are updated with the Amendment A005 to provide corrections to administrative retention amounts stated in B.3 and B.3.2.1.

Purpose of this Amendment A005 is to ensure consistency with the RFP section B – PRICES and to be more in accordance with the industry business practice of issuing invoices and businesses accounting.

Prospective offerors shall DISCARD page 8 of 60 from the RFP and subsequent amendments and REPLACE with the enclosed page.

Amendment A005

B.3 ADMINISTRATIVE RETENTION AMOUNTS

B.3.1. If the Contractor requests a price adjustment under B.4 below, the Contractor must present cost experience data that includes the retention amount. For purposes of any economic price adjustment, this retention amount is a fixed amount that is a part of the premium amounts in B.2. This retention amount will not be adjusted for any reason.

The retention amount is part of the premium and may include, but not be limited to, such costs as overhead and general and administrative costs. It will also include any profit. Essentially, it includes all costs except the actual portion of the premium intended to fund claims paid to the health care provider/claimant. B.3.2 sets forth the retention amounts per premium paid for each category of premium and for each period of performance.

NOTE TO OFFEROR - Fill in the fixed monthly retention amounts for each period of performance and for each category of premium. This fixed amount must be expressed in the currency in which the premium amount is proposed. The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

B.3.2.1 Monthly Retention Amounts per separate premium paid per single employee and per family plan.

Period of Performance

Single Employees (Self Only)

Family Plan

Base Period

Option Year 1

Option Year 2

Option Year 3

Option Year 4

B.4. ECONOMIC PRICE ADJUSTMENT-HEALTH INSURANCE PREMIUMS

B.4.1. Premium Adjustment based on Experience - For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission(s) covered by this contract. No adjustment will be allowed during the first twelve months. After such time, the contractor or the Government may request an adjustment in premiums on an annual basis.

Before any such adjustment is made, the contractor agrees to provide the Government a balance sheet showing two main components for the time period:

(1) receipts (premiums received) minus the retention amount and

(2) claims paid.

The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and make recommendations regarding the appropriateness of the requested adjustment. Any adjustment shall be subject to mutual agreement of the parties and shall result in a written modification to the contract. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

B.4.2. Premium Adjustment Based on Laws - The rates may also be adjusted during the performance period of the contract as a result of laws enacted by the host Government, if such change in the laws has a direct impact on the cost to the contractor to perform this contract at the contracted rate. In that event, the Contracting Officer may enter into negotiations with the