RFP_SDR860-16-R-0003_Package.pdf

NSN 7540-01-152-8064 STANDARD FORM 33 (REV 9-97)

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

RATING PAGE OF PAGES

1 | 69

2. CONTRACT (Proc. Inst. Ident.) NO. 3. SOLICITATION NO.

SDR860-16-R-0003

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[X] NEGOTIATED (RFP)

5. DATE ISSUED

07/05/2016

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE DR860 8. ADDRESS OFFER TO (If other than item 7)

U.S. Embassy Santo Domingo 57 República de Colombia Ave.; Altos de Arroyo Hondo Santo Domingo, DN 10605; Dominican Republic Phone: (809) 567-7775

Shelly Westebbe, Contracting Officer General Services Office U.S. Embassy Santo Domingo DPO/Mailroom Screen, Hwy. La Isabela Back Entrance

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

SOLICITATION

9. Sealed offers in original and 3 copies for furnishing the supplies or services in the Schedule will be received at the place specified, in the depository located in box 8 until 08/12/2016 local time 04:00pm.

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

10. FOR INFORMATION

CALL:

A. NAME

Gabriel J. Sangiovanni

B. TELEPHONE (NO COLLECT

CALLS) (809) 368-7675

C. E-MAIL ADDRESS

SantoDomingoContracts@state.gov

11. TABLE OF CONTENTS

(x) SEC. DESCRIPTION PAGE(s) (x) SEC. DESCRIPTION PAGE(s)

PART I - THE SCHEDULE PART II - CONTRACT CLAUSES

X A SOLICITATION/CONTRACT FORM 1 X I CONTRACT CLAUSES 23

X B SUPPLIES OR SERVICE AND PRICES/COSTS 2 PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACH.

X C DESCRIPTION/SPECS/WORK STATEMENT 7 X J LIST OF ATTACHMENTS 36

X D PACKAGING AND MARKETING 14 PART IV - REPRESENTATIONS AND INSTRUCTIONS

X E INSPECTION AND ACCEPTANCE 15 X K REPRESENTATIONS, CERTIFICATIONS, AND 49

X F DELIVERIES OR PERFORMANCE 17 OTHER STATEMENTS OF OFFERORS

X G CONTRACT ADMINISTRATION 18 X L INSTRS., COND., AND NOTICES TO OFFERORS 60

X H SPECIAL CONTRACT REQUIREMENTS 20 X M EVALUATION FACTORS FOR AWARD 67

OFFER (Must be fully completed by offeror) NOTE: ITEM 12 does not apply if the solicitation includes the provisions at 52.214-16, Minimum Bid Acceptance Period.

12. In compliance with the above, the undersigned agrees, if this offer is accepted within calendar days (120 calendar days unless a different period is inserted by the offer) 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 designated point(s), within the time specified in the schedule.

13. DISCOUNT FOR PROMPT PAYMENT SEE 14

(See section I, Clause No 52.232-8)

10 CALENDAR

DAYS

20 CALENDAR DAYS

30 CALENDAR

DAYS

CALENDAR DAYS

14. ACKNOWLEDGMENT OF AMENDMENTS AMENDMENT NO. DATE AMENDMENT NO. DATE

(The offeror acknowledges receipt of amendments to the solicitation and related documents ) numbered and dated:

15A. NAME CODE FACILITY 16. NAME AND TITLE OF PERSON AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

15C. CHECK IF REMITTANCE

ADDRESS [ ] IS DIFFERENT FROM

ABOVE - ENTER SUCH ADDRESS

17. SIGNATURE 18. OFFER DATE

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED 20. AMOUNT 21. ACCOUNTING AND APPROPRIATION

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

[ ] 10 U.S.C. 2304(c)(1 ) [ ] 41 U.S.C. 253(c)( )

23. SUBMIT INVOICES TO

SantoDomingoFMO@state.gov

ITEM

24. ADMINISTRATION BY (If other than Item 7) CODE 25. PAYMENT WILL BE MADE BY CODE

GSO Procurement Unit U.S. Embassy Santo Domingo

Financial Management Center U.S. Embassy Santo Domingo

26. NAME OF CONTRACTING OFFICER (Type or print)

Shelly Westebbe

27. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

28. AWARD

DATE

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

PREVIOUS EDITION NOT USABLE Prescribed by GSA

SECTION B

PART I: PRICE - HEALTH INSURANCE

B.1. HEALTH INSURANCE SERVICES

B.1.1 The Contractor shall provide the Supplemental Health Insurance services to employees of the Government of the United States of America in the Dominican Republic as described in Section C and the Exhibits in Section J. The groups of employees who shall be provided this insurance are listed in C.1.3. This insurance shall be provided in accordance with Section C and the Exhibits in Section J.

B.1.2 Chief of Mission, Deputy Chief of Mission (for ORE Staff), as well as Embassy Association Employees (EAE) are included under this contract only as riders; the Contractor shall bill the Chief of Mission and Deputy Chief of Mission (for ORE Staff), and the Embassy Association (for EAEs) at the rates specified below. See Section G for billing procedures.

B.2. PRICES

B.2.1 VALUE ADDED TAX (ITBIS).

The Government will not reimburse the Contractor for ITBIS under this contract. The Contractor shall not include a line for ITBIS on Invoices as the U.S. Embassy has tax exemption status with the host government.

B.2.2 This is a fixed price with economic price adjustment requirements type contract under which will be issued firm, fixed-price task orders. The fixed prices/premium rates for the health insurance services as specified in Section C are as follows:

B.2.3. Base Year of Contract

Monthly Rates in RD$ per Employee

Category Estimated Number of Employees

Monthly Rate in RD$ per Employee

Monthly Total in

RD$

a. Single Employees (Self Only) 176

b. Family Plan 272

c. Retirees 40

d. Retirees Dependents 31

e. Subtotal (a+b+c+d)

f. Total Price for Base Year (e x 12)

B.2.4. First Option Year of Contract

Monthly Rates in RD$ per Employee

Category Estimated Number of Employees

Monthly Rate in RD$ per Employee

Monthly Total in

RD$

a. Single Employees (Self Only) 185

b. Family Plan 286

c. Retirees 58

d. Retirees Dependents 31

e. Subtotal (a+b+c+d)

f. Total Price for First Option Year (e x 12)

B.2.5. Second Option Year of Contract

Monthly Rates in RD$ per Employee

Category Estimated Number of Employees

Monthly Rate in RD$ per Employee

Monthly Total in

RD$

a. Single Employees (Self Only) 189

b. Family Plan 292

c. Retirees 60

d. Retirees Dependents 31

e. Subtotal (a+b+c+d)

f. Total Price for Second Option Year (e x 12)

B.2.6. Third Option Year of Contract

Monthly Rates in RD$ per Employee

Category Estimated Number of Employees

Monthly Rate in RD$ per Employee

Monthly Total in

RD$

a. Single Employees (Self Only) 193

b. Family Plan 298

c. Retirees 62

d. Retirees Dependents 31

e. Subtotal (a+b+c)

f. Total Price for Third Option Year (e x 12)

B.2.7. Fourth Option Year of Contract

Monthly Rates in RD$ per Employee

Category Estimated Number of Employees

Monthly Rate in RD$ per Employee

Monthly Total in

RD$

a. Single Employees (Self Only) 196

b. Family Plan 304

c. Retirees 64

d. Retirees Dependents 31

e. Subtotal (a+b+c+d)

f. Total Price for Fourth Option Year (e x 12)

B.2.8. Grand Total of Base plus All Option Years Dominican Pesos (RD$)

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

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, i.e., Dominican Pesos (RD$). The fixed retention amount shall NOT be expressed in terms of a percentage of the premium.

B.3.2 Retention Amounts in RD$ per separate premium paid per single employee and per family plan:

Period of Performance Single Employees (Self Only)

Family Plan

Retirees Retirees Dependents

Base Year

First Option Year

Second Option Year

Third Option Year

Fourth Option Year

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, and it specifically excludes all riders in B.1.2. 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. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the Contractor agrees to provide the Government a balance sheet showing three main components for the time period: (1) receipts (premiums received) minus the retention amount,

(2) number of insurance plans and (3) claims paid. This information shall be provided per type of premium, ie per line item. The retention amount is not subject to adjustment. The Government reserves the right to have an independent third party review the balance sheet and claims 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.

Mutually agreed to adjustments shall be effective thirty days after complete information is received by the Government. 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 Contractor to modify the contract to adjust the premium rate. The Contractor agrees to provide all documentation necessary to support any requested adjustment.

B.4.2.1 Employee Pool – This clause is only in effect if the Contractor included details in its offer regarding a pooling arrangement, of which this contract is a part.

Before any adjustment is made under this price adjustment clause, the Contractor must include in its proposal for adjustment, the details setting forth how the pool impacts the request for equitable adjustment.

SECTION C

DESCRIPTION/SPECIFICATION/WORK STATEMENT

PART I - HEALTH INSURANCE

The Government of the United States of America requires Health Insurance coverage for its Locally Employed Staff (LE Staff) as further described in C.1.2 in the Dominican Republic. The Government has determined that the prevailing practice by employers in the Dominican Republic is to provide for their employees health insurance protection and that the cost of such insurance protection is usually borne by both the employee and the employer. In accordance with the Government of the Dominican Republic Social Security Health Plan effective September 1, 2007, all employees will obtain Basic Coverage directly from the Dominican Government through the Social Security system. The Contractor shall provide supplemental health insurance coverage through this contract so that the covered employees and their dependents attain the total coverage levels further described in C.1.1. The cost of the supplemental health insurance protection is borne by both the employee and the employer.

For active employees who are regularly scheduled to work 30 or more hours per week: the USG will pay 80% of the premium cost and the employee will pay 20% of the premium cost for employee coverage and the USG will pay 75% of the premium cost and the employee will pay 25% of the premium cost for dependent coverage.

For active employees who are regularly scheduled to work less than 30 hours per week: the USG will pay a prorated share of the premium cost for employee and dependent coverage, based on the number of hours the employee is regularly scheduled to work.

The employer will pay the Contractor directly for the supplemental protection and will obtain the employees’ contribution internally. The specific health benefits coverage under this contract is set forth in C.1.1.1. The specific health benefit coverage under this contract is set forth in Section C and the Exhibits in Section J. Health insurance protection will be representative of locally prevailing compensation practice

The Contractor shall ensure that health care under this contract does not exclude HIV/AIDS care.

C.1.1 Employee and Dependent Health Services Benefits

The health benefits under this contract are as specified in the following section. Reimbursement of covered expenses is limited to the stated percentages of reasonable and customary costs. Proposals that contain more benefits (even if there is no increase in cost) or fewer benefits than stated in the solicitation may be deemed technically unacceptable.

Reimbursements or payments shall be made for the following covered benefits, subject to reasonable and customary costs in the locality where treatment was provided. The medical treatment must be prescribed or provided by a physician or nurse licensed in the Dominican Republic. Coverage of expenses will be made in Dominican Pesos (RD$).

Paragraph Covered Benefit Percentage

C.1.1.1 Hospitalization: coverage of room and board expenses for a semi-private room or the room and board expenses for a private room, not to exceed 100% of the cost of a semi-private room. 100%

C.1.1.2 Hospital Medical Expenses: While hospitalized including laboratory tests, x-rays, nursing care, operating room expenses, and intensive care. 80%

C.1.1.3 Doctor Visits:

Coverage of doctors’ and surgeons' fees incurred while hospitalized. 90%

Coverage of doctors’ fees while at a clinic or doctor’s office, 65%

Doctor coverage at home. 50%

C.1.1.4

Prescription Drugs: Coverage of expenses when hospitalized and not hospitalized, of the cost of medicines and drugs for which a prescription is legally required including those that suppress opportunistic infections, such as tuberculosis and toxoplasmosis.

Expenses incurred for medicines, vitamins, cold remedies, etc., that are available over the counter without a prescription will not be reimbursed even if prescribed by a physician.

80%

C.1.1.5 Maternity:

Coverage of expenses when hospitalized. 90%

Coverage of expenses when not hospitalized, of obstetrical medical care including prenatal and postnatal care. 90%

Coverage of expenses incurred during normal and cesarean delivery including for brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee’s child. (Duration of treatment is to be determined by the employee’s personal physician, following WHO and CDC guidelines.)

100%

C.1.1.6 Hospital Outpatient Services: coverage for laboratory tests and x-rays on an out-patient basis. 70%

C.1.1.7 Optical Services: Coverage of expenses for eye examination and treatment. No coverage for prescription eyeglass, frames, or contact lenses. 70%

C.1.1.8 Dental Services: coverage of expenses for dental services including dentists' fees, x-rays, examination and treatment, cleaning, fillings, extractions, false teeth, crowns, and bridges. 80%

C.1.1.9 Orthodontia treatments: Orthodontia treatment is covered only if treatment begins before age 18, unless required as the result of an accident. A maximum of four years of orthodontia treatment will be covered per patient. 45%

C.1.1.10 Physical Therapy 50%

C.1.1.11 Psychiatric Treatment 60%

C.1.1.12 Ambulance Service 100%

C.1.1.13 Hearing Aids Not Covered C.1.1.14 Routine Annual Physical Examinations: one per year for each person covered. 80%

C.1.1.15 Inoculations 85%

C.1.1.16

HIV/AIDS Coverage: Coverage of expenses for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees and dependents who have HIV/AIDS; as well as brief courses of anti-retroviral drugs during childbirth to prevent the transmission of HIV to the employee's child.

100%

C.1.1.17 Transportation for Out of Country Treatment - Transportation for out of country treatment is not a covered expense.

C.1.1.18 Out of the Country Coverage - Medical expenses incurred out of country will not be covered.

C.1.1.19 Annual Maximum Limit - The insurance company will reimburse covered expenses up to a limit of Dominican Pesos RD$736,000.00 per family per contract year. This plan will allow for continued coverage of current retired employees and their dependents as provided under the previous plan.

C.1.1.20 Retirees Coverage Limit - The maximum coverage per calendar year will be reduced 50% for the retirees grandfathered under the previous plan.

C.1.1.21 HIV/AIDS Coverage Limit - The insurance company will reimburse in Dominican Pesos (RD$) covered expenses up to a separate limit equivalent to USD $10,000.00 per individual per contract year.

C.1.1.22 Catastrophic Conditions - The annual aggregate maximum shall be Dominican Pesos RD$500,000.00 per covered individual for medical expenses. Catastrophic conditions shall be defined as major medical conditions occurring as a result of a single illness, accident, or closely related set of major illnesses (or conditions relating to a single accident) that exceed the standard maximum coverage limit.

C.1.1.23 Preexisting Coverage - Preexisting medical conditions are covered.

C.1.2 Health Benefits Conditions and Limitations

Conditions and limitations on the entitlement to health care under this contract are as follows:

Expenses will not be covered for elective cosmetic surgery; spa cures; rejuvenation cures; massage;

exercise therapy; long term rehabilitative therapy; eyeglass frames; non-medical hospital charges such as telephones or television; home help, family help, or similar household assistance; fees of persons who are not licensed physicians or nurses; or services or supplies which have not been prescribed or approved by a physician or nurse.

No coverage will be made for expenses that will be reimbursed or paid directly under a host country medical program, the U.S. workers' compensation program, or any Dominican workers' compensation type program.

No coverage will be made for expenses related to an illness or injury that is a result of an unlawful action on the part of the patient; the practice of a dangerous sport; excessive or illegal use of alcohol or drugs; a self-inflicted wound; or service in the armed forces of any country.

No coverage will be made for expenses incurred after an employee leaves the service of the U.S.

Mission, except in the case of those retired employees who were grandfathered into a healthcare coverage.

C.1.3 Eligible Participants

C.1.3.1 Eligible Employees - The employees eligible to voluntarily enroll for in the supplemental health insurance services include the following:

C.1.3.1.1 All current full or part time employees of the United States Government, employed within the geographic boundaries of the Dominican Republic paid under the Local Compensation Plan, and certified by the Contracting Officer/COR. Covered employees include

C.1.3.1.2 Foreign Service Nationals (FSNs) employed under direct hire appointments, Personal Services Agreements (PSAs) and Personal Services Contracts (PSCs);

C.1.3.1.3 Locally hired U.S. citizens employed under direct hire appointments, PSAs, and PSCs.

C.1.3.2 Location of Employment

The individuals covered by C.1.3.1 must be employed within the geographic boundaries of the Dominican Republic by all United States Agencies.

C.1.3.3 Participants Covered Under a Rider

C.1.3.3.1 All current active employees of the Chief of Mission and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account (see separate rider, Exhibit B). All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

C.1.3.3.2 All current active employees of the Employee Association at Embassy

Santo Domingo (see separate rider, Exhibit C). All costs for American Embassy Recreation Association (AERA) are the responsibility of the Employee Association, not the U.S.

Government.

C.1.4 Individuals Not Eligible for Coverage

Individuals not eligible for coverage under this contract are non-personal services contract personnel;

employees working on a temporary basis less than one year; employees with an intermittent, seasonal, or WAE (when actually employed) schedule; and any other individual not falling within one of the categories of employees described in this clause. Also not eligible are independent contractor licensed to do business in Dominican Republic who provides services to other local organizations as well as to the U.S. Mission; employees of USAID institutional contractors; Peace Corps personal services contractors as indicated in MS 743; and Recreation Association employees.

Official Residence Expense (ORE) employees and Recreation Association (RA) employees may be covered under a rider to the contract. The employing officer, not the USG, is responsible for the employer's share of the premium expenses for an ORE or RA employee.

C.1.5 Other Eligible Participants

The following additional categories of persons are covered by this insurance:

Expenses incurred by an enrolled employee's eligible dependents are covered under this plan. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one) and each unmarried, economically dependent child who primarily resides with the employee unless away at school.

Child is defined as the employee's natural child, adopted child, stepchild, or foster child. An eligible child will be covered until the end of the calendar year in which the child turns age 18, or in the case of a child who is a full-time student, until the end of the calendar year in which the child turns age 25.

There is no age limit for an eligible child who is physically or mentally handicapped so as to be unable to live independently. There is no limit on the number of children covered per employee.

Parents, grandparents, siblings, and other relatives are not eligible dependents.

C.1.6 Eligibility

C.1.6.1 Term of Eligibility and Effective Date

Each current active eligible employee is enrolled for health benefits under this contract upon award and thereafter during the performance period of this contract. Each new eligible employee will be enrolled upon entering on duty with the United States Government (USG). An employee is considered active ("on the rolls") whenever such employee is on approved leave, whether paid or unpaid.

During a period of Leave Without Pay (LWOP) or unpaid leave that is one pay period or less, coverage under the insurance contract will continue. The USG will pay the total premium cost to the Contractor. The employee’s share of the premium will be collected through payroll deduction in that or the subsequent pay period.

C.1.6.2 Period of Ineligibility

Employees and their dependents are not entitled to health benefits during any period of employment for which premiums are not paid.

Additionally, employee's dependents are not entitled to health benefits during any period of employment during which the employee was not eligible to participate.

During a period of extended (beyond one pay period) of Leave Without Pay (LWOP) or unpaid leave, the employee is responsible for the full cost of the insurance premiums for self and dependents.

The Mission will pay the premiums directly to the Contractor, and will collect the full cost from the employee on a quarterly basis. Alternatively, the employee may elect to have coverage cease if that employee prefers not to pay the premium.

C.1.7 BROCHURE REQUIREMENT

C.1.7.1 The Contractor shall provide a document (brochure/pamphlet/other written document) in Spanish and English that sets forth a complete listing of the health insurance benefits to be provided under this contract. This brochure shall be provided in sufficient quantities so that each covered employee receives a copy. Contractor will provide a draft copy of brochure in English and Spanish to the Contracting Officer and Contracting Officer Representative within (4) four weeks of signing the contract. The Contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

C.1.7.2 The Contractor shall provide the approved document described in C.1.7.1 to the COR not later than 60 days after date of contract award. The Contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

C.1.7.3 The Contractor assumes full responsibility for ensuring that the document described in C.1.7.1 accurately reflects the requirements of the contract, as implemented by the Contractor’s technical proposal. In all cases (of dispute/disagreement,) the contract shall take precedence. Should the COR discover that the brochure contains inaccuracies, the Contractor will be notified in writing with instructions to correct inaccuracies; however, failure on the part of the Government to notice any inaccuracies shall in no way limit, revise or otherwise affect the requirement under this contract for the Contractor to fully comply with all contract terms.

DEFINITIONS

FMO The Financial Management Officer (FMO) or the paying office for all U.S.

Government Agencies, except U.S. AID.

CO Contracting Officer (CO) and is typically an officer in GSO (see below).

COR Contracting Officer's Representative (COR) is the Human Resources Officer (HRO) at post.

Contributory Insurance Insurance for which the employee contributes toward the premium.

Customary and Reasonable Treatment

A diagnostic test or medical treatment which is usually performed in the community where the individual is being treated.

Dependent Expenses incurred by an enrolled employee's eligible dependents are covered under this plan. For the purposes of this plan, an employee's dependents are defined as the employee's legal spouse (limit one) and each unmarried, economically dependent child who primarily resides with the employee unless away at school.

Disability - Total and Permanent A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions and which requires separation from employment.

If the impairment is the result of a previous impairment, it shall be considered a continuation of the prior impairment.

Employee An individual employed by the U.S. Government, under a direct-hire appointment, personal services contract (PSC), or personal services agreement (PSA), as further defined in Section C.1.3 for health insurance. This may also include ORE Staff and Peace Corp PSCs, if this category of individual is listed as participating under a rider in C.1.3.3 for health insurance.

Employer The United States Government or in the case of ORE the Chief of Mission/Deputy Chief of Mission, respectively.

Hospital An institution established and operated for the care and treatment of sick and injured persons. It provides 24-hour nursing care and has diagnostic, laboratory, treatment, and surgical facilities. Any institution which does not meet this definition is not considered a hospital.

Hospital Patient An individual who has been admitted to a hospital, is assigned a bed, and is given diagnostic tests or receives treatment for a disease or an injury.

Maximum Benefit The total amount that will be paid to any one covered individual for covered medical expenses or life insurance/disability benefit.

Physician An individual who has graduated from an accredited medical school and is licensed to practice medicine in the jurisdiction in which the contract is to be performed. If the individual is a medical specialist, then he or she is Board Certified in that specialty.

Surgical Procedure Any invasive medical procedure by manual or instrument operation undertaken for diagnosis or treatment of a diseased patient.

EAE Embassy Association Employees.

EA Embassy Association.

ORE Staff Official Residence (Expenses) Employees.

SECTION D

PACKAGING AND MARKING

(RESERVED)

SECTION E

INSPECTION AND ACCEPTANCE

E.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clause(s) is/are incorporated by reference:

CLAUSE TITLE AND DATE

52.246-4 INSPECTION OF SERVICES - FIXED PRICE (AUG 1996)

E.2. QUALITY ASSURANCE AND SURVEILLANCE PLAN (QASP)

This plan is designed to provide an effective surveillance method to promote effective Contractor performance. The QASP provides a method for the Contracting Officer's Representative (COR) to monitor Contractor performance, advise the Contractor of unsatisfactory performance, and notify the Contracting Officer of continued unsatisfactory performance. The Contractor, not the Government, is responsible for management and quality control to meet the terms of the contract. The role of the Government is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective

PWS

Paragraph Performance Threshold Services

Performs all the insurance services set forth in the Performance of Work Statement

(PWS)

C.1.0 thru C.1.7.3

All required services are performed and no more than one

(1) customer complaint is received per month

E.2.1 Surveillance The COR will receive and document all complaints from Government personnel regarding the services provided. If appropriate, the COR will send the complaints to the Contractor for corrective action.

E.2.2 Standard The performance standard is that the Government receives no more than one (1) customer complaint per month. The COR shall notify the Contracting Officer of the complaints so that the Contracting Officer may take appropriate action to enforce the inspection clause (FAR 52.246-4, Inspection of Services – Fixed Price (AUG 1996) or the appropriate Inspection of Services clause), if any of the services exceed the standard.

E.2.3 Procedures

(a) If any Government personnel observe unacceptable services, either incomplete work or required services not being performed, they should immediately contact the COR.

(b) The COR will complete appropriate documentation to record the complaint.

(c) If the COR determines the complaint is invalid, the COR will advise the complainant.

The COR will retain the annotated copy of the written complaint for his/her files.

(d) If the COR determines the complaint is valid, the COR will inform the Contractor and give the Contractor additional time to correct the defect, if additional time is available. The COR shall determine how much time is reasonable.

(e) The COR shall, as a minimum, orally notify the Contractor of any valid complaints.

(f) If the Contractor disagrees with the complaint and challenges the validity of the complaint, the Contractor will notify the COR. The COR will review the matter to determine the validity of the complaint.

(g) The COR will consider complaints as resolved unless notified otherwise by the complaint.

(h) Repeat customer complaints are not permitted for any services. If a repeat customer complaint is received for the same deficiency during the service period, the COR will contact the Contracting Officer for appropriate action under the Inspection clause.

SECTION F

DELIVERIES OR PERFORMANCE

F.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use an internet “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clauses are incorporated by reference:

CLAUSE TITLE AND DATE

52.242-15 STOP WORK ORDER (AUG 1989)

52.242-17 GOVERNMENT DELAY OF WORK (APR 1984)

F.2. PERIOD OF PERFORMANCE The performance period of this contract is one (1) year beginning on the date stated on the Notice to Proceed with four (4) one-year options to renew.

F.3. OPTIONS

(a) The Government may extend this contract in accordance with the option clause at Section I, Clause I.2, FAR Clauses Incorporated by Full Text (FAR 52.217-9, Option to Extend the Term of the Contract), which also specifies the total potential duration of the contract.

(b) The Government may exercise the option set forth at Section I, "FAR 52.217-8, Option to Extend Services".

F.4. REPORTS AND OTHER DELIVERABLES

All reports and other deliverables required under this contract shall be delivered to the following address:

Jared P. Webber Human Resources Office

U.S. Embassy Santo Domingo SantoDomingoHR@state.gov

57 República de Colombia Ave.; Altos de Arroyo Hondo Santo Domingo, DN 10605; Dominican Republic

SECTION G

CONTRACT ADMINISTRATION DATA

G.1. 652.242-70 CONTRACTING OFFICER’S REPRESENTATIVE (COR) (AUG 1999)

(a) The Contracting Officer may designate in writing one Government employee, by name or position title, to take action for the Contracting Officer under this contract. This designee shall be identified as a Contracting Officer’s Representative (COR). Such designation shall specify the scope and limitations of the authority so delegated; provided, that the designee shall not change the terms or conditions of the contract, unless the COR is a warranted Contracting Officer and this authority is delegated in the designation.

(b) The COR for this contract is the Human Resources Officer.

G.2. COR DUTIES

G.2.1 The COR is responsible for inspection and acceptance of services. These duties include review of Contractor invoices, including the supporting documentation required by the contract. The COR may provide technical advice, substantive guidance, inspections, invoice approval, and other purposes as deemed necessary under the contract.

G.2.2 In addition, the COR shall maintain updated list of employees and dependents insured, which will supersede the initial list provided under this contract and as reported to the insurer through the broker, without prejudice to the ineligibility clause.

G.2.3. The COR has the additional responsibility of maintaining the eligible listing of employees and dependents for insurance coverage.

G.2.4 The COR may not change the terms and conditions of the contract. While the COR is authorized to provide the Contractor with updated listings of eligible employees and dependents, only the Contracting Officer may modify existing task orders or issue new task orders, reflecting these changes, since only the Contracting Officer can obligate funding and commit the Government.

G.3. Payment shall be made in Dominican Pesos (RD$).

G.4. SUBMISSION OF INVOICES AND PAYMENT

G.4.1. Invoices for U.S. Government employees shall be submitted in an original and three (3) copies to the following address (Designated Billing Office only for the purpose of submitting invoices):

Financial Management Office U.S. Embassy Santo Domingo

SantoDomingoFMO@state.gov 57 República de Colombia Ave.; Altos de Arroyo Hondo

Santo Domingo, DN 10605; Dominican Republic

Payments at End of Covered Period

G.4.2 Frequency of Payments. All funds under this contract will be obligated by issuance of task orders, as described in H.3. Each task order will fund a specific period of time and number of employees, and the task orders will be issued at the frequency described in H.3. All payments under this contract will be made at the conclusion of the period covered. Invoices may be submitted monthly with payments being made monthly by the Government.

G.4.3 U.S. Government Employees. The Government shall make payments directly to the Contractor for all Government employees, whether or not the employee is contributing to the premium amount.

G.4.4 ORE Staff. The Chief of Mission and/or Deputy Chief of Mission will make payment directly to the Contractor for the entire premium amount of the ORE staff, whether or not the ORE employee is contributing to the premium amount.

G.4.5 EAE Staff. The Employee Association will make payment directly to the Contractor for the entire premium amount of the EA employee, whether or not the EA employee is contributing to the premium amount.

G.5. REFUNDS TO THE GOVERNMENT

If at any time during performance of the contract the Government finds that the Contractor has been overpaid because the number of employees and/or dependents covered has decreased, the Contracting Officer may either allow that overpayment to be credited to the Government’s account or require that the Contractor refund the overpayment. If the Contracting Officer requests a refund, the Contractor shall make that refund to the Government within ten (10) calendar days of receipt of the request.

G.6. VALUE ADDED TAX

VALUE ADDED TAX (ITBIS). The Government will not reimburse the Contractor for VAT under this contract. The Contractor shall not include a line for VAT on Invoices as the U.S. Embassy has a tax exemption status with the host government.

SECTION H

SPECIAL CONTRACT REQUIREMENTS

H.1. SECURITY. On occasion, a Contractor employee may require entry into U.S. Government-owned or -operated facilities. If so, the Contractor should be prepared to provide the necessary identification to permit escorted access within that facility.

H.2. STANDARDS OF CONDUCT. The Contractor shall maintain satisfactory standards of employee competency, conduct, cleanliness, appearance, and integrity and shall be responsible for taking such disciplinary action with respect to employees as may be necessary. Each Contractor employee is to adhere to standards that reflect credit on themselves, their employer, and the United States Government.

H.3. ORDERING PROCEDURES. The Government will issue a task order as soon as possible after contract award to identify all employees to be covered by the insurance described in this contract and the coverage selected by each employee, including dependents to be covered. The COR will make subsequent additions or deletions to this list in writing and provide the revised list to the Contractor. All such revisions shall be consolidated, and a new or modified task order will be issued by the Contracting Officer. If any changes have been made to the coverage listing, the Government anticipates issuance of a new task order on a quarterly basis. This new task order will include all changes made since the previous task order was issued and will include any increase or decrease in necessary funding. The changes to the list of eligible individuals will supersede the initial list provided under prior task orders without prejudice to the ineligibility clause. Task orders will indicate the effective date of employment, for purposes of calculating the premium due.

H.3.1 The ORE staff, EA employees under separate riders are not included under the task orders issued by the Contracting Officer. Because their coverage is under a rider, their employer is responsible for directly interacting with the Contractor to order any coverage for their employees.

When contacted by the employer, the Contractor shall advise the employer of the paperwork and payment that will be necessary to order coverage for the identified individuals. Because more than one employer may have ORE staff, the Contractor may be contacted by more than one employer (typically the Chief of Mission and Deputy Chief of Mission).

H.4. CONTRACTOR RESPONSIBILITY IN CLAIMS AND REIMBURSEMENT TO

CLAIMANTS

General

The Contractor shall be responsible for all planning, estimating, programming, project management, scheduling, dispatching, supervision, and inspection of work. The Contractor shall maintain his own reference library of technical reference works and local laws and regulations, including current tariffs and registries. The Contractor shall treat the information provided by the Embassy concerning employee' personal data, medical information, and salaries as highly sensitive and not divulge any employee information to unauthorized persons. The Contractor shall establish procedures for handling medical insurance claims as follows:

(a) Administrative Records

(1) The Contractor shall maintain medical insurance files for each covered employee and each covered dependent including receipts and proof of paid claims, requests for claim reimbursements, and accounting of paid benefits with balances of amounts remaining in the annual per person reimbursement ceiling.

(2) The Contractor shall provide the COR with the necessary claim forms in English and Spanish for each type of benefit that can be claimed under the contract. These forms shall specify a list of documents required to be appended to each claim and otherwise provide instructions for claim filing.

(3) The Contractor shall use the English spelling of the employees' names in all transactions, including reimbursement checks.

(4) The Contractor shall provide employee claim reimbursement checks to the COR for disbursement to the employee not later than two weeks after a claim is submitted.

(b) Medical Insurance Claims. Settlement of medical insurance shall be completed as follows:

(1) All medical claims shall be submitted directly to the Contractor by employees, through a drop box in the COR's office. The claims shall be picked up from the COR each Tuesday.

(2) The Contractor shall date stamp and screen all claims submitted on the day of receipt. If there are any missing documents or information thereby disallowing said claim to be payable, the Contractor shall notify the COR in writing within two days.

(3) The Contractor shall settle the claims no later than two weeks from the date the claim is submitted to the Contractor.

(4) Settlement shall be by issuance of checks in the name of the employee for each claim submitted. Each check shall be accompanied by a form providing details of the amount reimbursed with an explanation of deductions, if any.

(5) The Contractor shall accept the employee's or dependent's choice to go for surgery to hospitals designated by the Contractor in order that the Contractor will pay the expenses directly to the hospitals. The Contractor will provide the COR copies of the payment receipts statement.

H.5. REPORT REQUIREMENTS. The Contractor shall provide the following reports monthly.

All reports must be received by the COR no later than the 10th day of each month in accordance with F.4. These reports shall report on the previous month's activities.

(a) Employee Claims Report. The report will list all claims paid by the Contractor to a claimant, including the name of the claimant, date claim is received by the Contractor, and the amount claimed. This report shall also include all outstanding claims and a brief description of why claim has not been paid.

(b) Ad hoc reports regarding claims, payments, etc. may be requested by the COR and provided within six (6) days.

H.6. MISCELLANEOUS CONTRACTOR REQUIREMENTS

H.6.1 General. The Contractor shall take all such steps as are necessary, and obtain and pay for all permits, taxes and fees as are required by the Dominican Republic government to establish and/or operate a commercial venture locally. A contract with the U.S. Government conveys no special privileges or immunities to the Contractor. The Contractor is an independent commercial concern and not a part of the U.S. mission. The Contractor's employees are not U.S. Government employees.

Registration of this contract with the Dominican Republic government, if required by law, will be the sole responsibility of the Contractor, and any fees, taxes, or other duties shall be payable by the Contractor without recourse to the Government of the amounts thereof.

H.6.2 Licenses and Local Laws. The Contractor shall possess all permits, licenses, and any other appointments required for the prosecution of work under this contract, all at no additional cost to the Government. The Contractor shall perform this contract in accordance with local laws.

H.7. ERRONEOUS PAYMENTS If the Government becomes eligible for a refund of payment because of erroneous overpayment or other cause, the Contractor shall refund the amounts or use them to offset future payments owed by the Government, whichever the Government prefers. The Contractor shall refund any refunds not complete or discovered after the completion date of this contract.

H.8. REQUIRING ACTIVITY The requiring activity under this contract is the U.S. Embassy Santo Domingo, Dominican Republic.

SECTION I

CONTRACT CLAUSES

I.1. 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates the following clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address:

http://www.acquisition.gov/far/ or http://farsite.hill.af.mil/vffara.htm

These addresses are subject to change. If the Federal Acquisition Regulation (FAR) is not available at the locations indicated above, use the Department of State Acquisition website at http://www.statebuy.state.gov/ to see the links to the FAR. You may also use a network “search engine” (for example, Google, Yahoo, Excite) to obtain the latest location of the most current FAR.

The following Federal Acquisition Regulation clauses are incorporated by reference:

CLAUSE TITLE AND DATE

52.202-1 DEFINITIONS (NOV 2013)

52.203-3 GRATUITIES (APR 1984)

52.203-5 COVENANT AGAINST CONTINGENT FEES (MAY 2014)

52.203-6 RESTRICTIONS ON SUBCONTRACTOR SALES TO THE GOVERNMENT (SEPT

2006)

52.203-7 ANTI-KICKBACK PROCEDURES (MAY 2014)

52.203-8 CANCELLATION, RESCISSION, AND RECOVERY OF FUNDS FOR ILLEGAL

OR IMPROPER ACTIVITY (MAY 2014)

52.203-10 PRICE OR FEE ADJUSTMENT FOR ILLEGAL OR IMPROPER ACTIVITY (MAY

2014)

52.203-12 LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL

TRANSACTIONS (OCT 2010)

52.203-13 CONTRACTOR CODE OF BUSINESS ETHICS (OCT 2015)

52.203-17 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND

REQUIREMENT TO INFORM EMPLOYEES OF WHISTLEBLOWER

RIGHTS (APR 2014)

52.204-4 PRINTED OR COPIED DOUBLE-SIDED ON POSTCONSUMER FIBER

CONTENT PAPER (MAY 2011)

52.204-9 PERSONAL VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011)

52.204-10 REPORTING EXECUTIVE COMPENSATION AND FIRST-TIER SUBCONTRACT

AWARDS (OCT 2015)

52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE (JUL

2015)

52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND

CERTIFICATIONS (DEC 2014)

52.209-6 PROTECTING THE GOVERNMENT’S INTEREST WHEN SUBCONTRACTING

WITH CONTRACTORS DEBARRED, SUSPENDED, OR PROPOSED FOR

DEBARMENT (OCT 2015)

52.209-9 UPDATES OF INFORMATION REGARDING RESPONSIBILITY MATTERS

(JULY 2013)

52.215-2 AUDIT AND RECORDS - NEGOTIATION (OCT 2010)

52.215-8 ORDER OF PRECEDENCE--UNIFORM CONTRACT FORMAT (OCT 1997)

52.215-11 PRICE REDUCTION FOR DEFECTIVE CERTIFIED COST OR PRICING DATA –

MODIFICATIONS (AUG 2011)

52.215-13 SUBCONTRACTOR CERTIFIED COST OR PRICING DATA -

MODIFICATIONS (OCT 2010)

52.215-21 REQUIREMENTS FOR COST OR PRICING DATA OR INFORMATION OTHER

THAN COST OR PRICING DATA--MODIFICATIONS (OCT 2010)

52.222-19 CHILD LABOR – COOPERATION WITH AUTHORITIES AND REMEDIES (FEB

2016)

52.222-50 COMBATTING TRAFFICKING IN PERSONS (MAR 2015)

52.223-18 ENCOURAGING CONTRACTOR POLICIES TO BAN TEXT MESSAGING

WHILE DRIVING (AUG 2011)

52.224-1 PRIVACY ACT NOTIFICATION (APR 1984)

52.224-2 PRIVACY ACT (APR 1984)

52.225-5 TRADE AGREEMENTS (FEB 2016)

52.225-13 RESTRICTIONS ON CERTAIN FOREIGN PURCHASES (JUN 2008)

52.225-14 INCONSISTENCY BETWEEN ENGLISH VERSION AND TRANSLATION OF

CONTRACT (FEB 2000)

52.228-4 WORKERS’ COMPENSATION AND WAR-HAZARD INSURANCE OVERSEAS

(APR 1984)

52.228-5 INSURANCE-WORK ON A GOVERNMENT INSTALLATION (JAN 1997)

52.229-6 TAXES - FOREIGN FIXED PRICE CONTRACTS (FEB 2013)

52.232-1 PAYMENTS (APR 1984)

52.232-8 DISCOUNTS FOR PROMPT PAYMENT (FEB 2002)

52.232-11 EXTRAS (APR 1984)

52.232-17 INTEREST (OCT 2010)

52.232-18 AVAILABILITY OF FUNDS (APR 1984)

52.232-24 PROHIBITION OF ASSIGNMENT OF CLAIMS (MAY 2014)

52.232-25 PROMPT PAYMENT (JULY 2013)

52.232-33 PAYMENT BY ELECTRONIC FUNDS TRANSFER - SYSTEM FOR AWARD

MANAGEMENT (JULY 2013)

52.232-34 PAYMENT BY EFT – OTHER THAN SAM (JULY 2013)

52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS (DEC 2013)

52.233-1 DISPUTES (MAY 2014) Alternate I (DEC 1991)

52.233-3 PROTEST AFTER AWARD (AUG 1996)

52.233-4 APPLICABLE LAW FOR BREACH OF CONTRACT CLAIM (OCT 2004)

52.237-2 PROTECTION OF GOVERNMENT BUILDINGS, EQUIPMENT, AND

VEGETATION (APR 1984)

52.242-13 BANKRUPTCY (JULY 1995)

52.243-1 CHANGES (AUG 1987) – Alternate I (APR 1984)

52.244-6 SUBCONTRACTOR AND COMMERCIAL ITEMS (FEB 2016)

52.246-25 LIMITATION OF…