SF 33 75R60222R00001 CAF.pdf

75R60222R00001

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

1 5

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

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

10/22/2021 X

OAMP

HHS/HRSA/OO/OAMP

Office of Acquisition Management and Policy 5600 Fishers Lane, Rm 14W26B Rockville MD 20857

1400 ET 11/16/2021

CURTIS LAM 301

CLam@hrsa.gov

443-0061

X

X

X

X

X

X

X

X

X

X

X

X

X

PAGE(S)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is unusable

STANDARD FORM 33 (Rev. 9-97)

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

2-3

6-7 8-14 15-19 20-22

23-32

34-47

48-55

56-61

12. In compliance with the above, the undersigned agrees, if this offer is accepted within _____0_________ calendar days (60 calendar days unless a different period is inserted

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

2 5

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

75R60222R00001

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

Title: COVID-19 Coverage Assistance Fund (CAF)

Program

Procurement ID#: PRB184 C 3826

Award Type: Firm-Fixed Price

HHS reserves the right to exercise priorities and allocations authority with respect to this contract, to include rating this order in accordance with 45 CFR Part 101, Subpart A-Health

Resources Priorities and Allocations System.

Title: COVID-19 Coverage Assistance Fund (CAF)

Program

Procurement ID #: PRB184 C 3826

Award Type: Firm Fixed Price

This is a combined synopsis/solicitation for commercial items. This requirement is issued pursuant to Federal Acquisition Regulation (FAR)

5.203 and Part 15 Contracting by Negotiation under NAICS Code 524292 - Third Party

Administration of Insurance and Pension Funds, with a small business size standard of $35.0M with PSC Code Q701 Specialized Medical Support.

This announcement constitutes the only solicitation; proposals are being requested and a separate solicitation will not be issued.

The contractor shall provide services in accordance with the attached Performance Work

Statement (PWS), Attachment A.

This is a Firm Fixed Price requirement.

Provide the following information:

1. Contact Name, Phone and Fax Number:

2. Email Address: _______________________

3. DUNS Number: _______________________

Note the following attachments with this form:

Attachment A - Performance Work Statement (PWS)

PWS Attachment A - Contractor Nondisclosure

Agreement

Attachment B - CPARS Information Sheet

Continued ...

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Sponsored by GSA

FAR (48 CFR) 53.110

NSN 7540-01-152-8067

3 5

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

75R60222R00001

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

Attachment C - Billing Instructions

Attachment D - Disclosure of Lobbying Activities

Attachment E - HHS Subcontracting Plan Template

The proposal must be signed by an official authorized to bind your organization. Submit your proposal via email to Curtis Lam at clam@hrsa.gov no later than 2:00 P.M. Eastern Time on November

16, 2021. The volumes must be submitted separately and clearly labeled. Each of these parts shall be separate and complete in itself.

Volume Titles

Volume I - Technical

Volume II - Past Performance

Volume III - Section 508 Voluntary Product

Accessibility Template

Volume IV - Cost/Price

Questions regarding this solicitation shall be submitted electronically via email to Curtis Lam at clam@hrsa.gov no later than 5:00 P.M. Eastern

Time on October 27, 2021. Questions received after the due date and time will not be considered, no exceptions.

Delivery Location Code: HRSA

HRSA

Health Resources and Services Admin

5600 Fishers Lane

Rockville MD 20852 US

1 Base Period: Management and Administration Fees

2 Base Period: Submitted Claim Processing Fee

3 Base Period: Paid Claim Processing Fee

4 Base Period: Optional Task 1 - Administration and

Management for Testing Claims

(Option Line Item)

5 Base Period: Optional Task 2 - Processing Billed

Testing Claims

(Option Line Item)

Continued ...

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Sponsored by GSA

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

75R60222R00001

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

6 Base Period: Optional Task 3 - Processing Paid

Testing Claims

(Option Line Item)

7 Option Period 1: Management and Administration

Fees

(Option Line Item)

0 Days After Award

8 Option Period 1: Submitted Claim Processing Fee

(Option Line Item)

0 Days After Award

9 Option Period 1: Paid Claim Processing Fee

(Option Line Item)

0 Days After Award

10 Option Period 1: Optional Task 1 - Administration and Management for Testing Claims

(Option Line Item)

0 Days After Award

11 Option Period 1: Optional Task 2 - Processing

Billed Testing Claims

(Option Line Item)

0 Days After Award

12 Option Period 1: Optional Task 3 - Processing

Paid Testing Claims

(Option Line Item)

0 Days After Award

13 Option Period 2: Management and Administration

Fees

(Option Line Item)

0 Days After Award

14 Option Period 2: Submitted Claim Processing Fee

(Option Line Item)

0 Days After Award

Continued ...

OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

75R60222R00001

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

15 Option Period 2: Paid Claim Processing Fee

(Option Line Item)

0 Days After Award

16 Option Period 2: Optional Task 1 - Administration and Management for Testing Claims

(Option Line Item)

0 Days After Award

17 Option Period 2: Optional Task 2 - Processing

Billed Testing Claims

(Option Line Item)

0 Days After Award

18 Option Period 2: Optional Task 3 - Processing

Paid Testing Claims

(Option Line Item)

0 Days After Award

Contracting Officer Representative (COR):

TBD

Health Resources and Services Administration

TBD

5600 Fishers Lane, Rm. TBD

Rockville, MD 20857

Phone: TBD

Email: TBD

Contracting Office Point of Contact:

Curtis Lam

Health Resources and Services Administration

Office of Acquisition Management and Policy

5600 Fishers Lane

Rockville, MD 20857

Phone: (301) 443-0061

Email: clam@hrsa.gov

OPTIONAL FORM 336 (4-86)

Sponsored by GSA