A002.docx

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

PAGES

2. AMENDMENT/MODIFICATION NO.

A002

3. EFFECTIVE DATE

05-03-2017

4. REQUISITION/PURCHASE REQ. NO.

5. PROJECT NO. (If applicable)

6. ISSUED BY CODE

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

U.S. Embassy Cotonou Marina Avenue Cotonou, Republic of Benin

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

9a. AMENDMENT OF SOLICITATION NO.

SBN150-17-R-0001

X

9b. DATED (SEE ITEM 11)

03-24-2017

10a. MODIFICATION OF CONTRACT/ORDER NO.

10b. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

[ X] The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers [ ] is extended, [X] 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 __1__ 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.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor [ X] is not, [ ] is required to sign this document and return 1 original copies to the issuing office.

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

The purpose of this amendment is to provide the list of examinations required under Routine Annual Physical Examination, C.1.1.2 Professional Services and Treatment.

Accordingly (see next page)

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

Sarah E Kahnt

15B. NAME OF CONTRACTOR/OFFEROR

SIGNED BY

May 3, 2017

Page 2 of 2 - A002

1. Delete C.1.1 2 Professional Services and Treatment.

2. Replace with C.1.1.2 Professional Services and Treatment: 90% coverage of doctors’ and surgeons’ fees incurred while hospitalized, at a hospital on an out-patient basis, at a clinic or doctor’s office, or at home. 100% coverage of medical services and expenses when not hospitalized such as laboratory tests and x-rays and routine annual physical examinations. 90% coverage of prescription medicines and inoculations. 90% coverage for physical therapy.

The routine annual physical examination shall cover the following examinations:

Hygiene and Dietary Counseling

Complete Blood Cell Count Fasting Blood Sugar Full Chemistry Profile (Total Cholesterol, HDL, LDL, AST, AST, BUN, Creatinine), Complete Blood Cell Count, and Prostate Specific Antigen (PSA) every 3 years

Fasting Blood Sugar Full Chemistry Profile (Total Cholesterol, HDL, LDL, AST, AST, BUN, Creatinine), Complete Blood Cell Count, and mammogram once every 3 years

* Adult is defined as 17 years and older.

+ Means “To Be Done” at the time of the physical examination.