2_SGE50015R0025.pdf

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24 & 30

1. REQUISITION NUMBER

5. SOLICITATION NUMBER

SGE50015R0025

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER 6. SOLICITATION ISSUE

DATE

06/08/2015

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME Chris Heck

b. TELEPHONE NUMBER (No collect calls)

c. EMAIL heckc@State.gov

8. OFFER DUE DATE / LOCAL

TIME

CODE FRANK

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

FRANKFURT, 60435

GERMANY

9. ISSUED BY X UNRESTRICTED OR SET ASIDE: % FOR

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

10. THE ACQUISITION IS

SEE

SCHEDULE

11. DELIVERY FOR FOB DESTINATION

UNLESS BLOCK IS MARKED

12. DISCOUNT TERMS

13a. THIS CONTRACT IS

RATED ORDER UNDER DPAS

13b. RATING

RFQ IFB X RFP

14. METHOD OF SOLICITATION

AMMANCODE15. DELIVER TO

AMERICAN EMBASSY AMMAN

6050 AMMAN PLACE, WASHINGTON, D.C. 20521

ATTN: IRAQ SUPPORT UNIT

AMMAN, JORDAN

CODE FRANK16. ADMINISTERED BY

AMERICAN CONSULATE GENERAL FRANKFURT

GIESSENER STRASSE 30

ATTN: RPSO

FRANKFURT, 60435

GERMANY

FACILITY

CODE

CODE

Contact Duns Telephone No.

17a. CONTRACTOR/OFFEROR MULTICODE18a. PAYMENT WILL BE MADE BY

SEE Section 1, Paragraph V.11.3

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN

OFFER X SEE ADDENDUM

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED

19. ITEM NO. 20. SCHEDULE OF SUPPLIES/SERVICES

(Use Reverse and/or Attach Additional Sheets as Necessary)

21. QUANTITY 22. UNIT 23. UNIT PRICE 24. AMOUNT

See Line Items Section

25. ACCOUNTING AND APPROPRIATION DATA

See Line Item Detail

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

X 27a. SOLICITATION INCORPORATES BY REFERENCES FAR 52.212-1, 52.212-4, FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA X ARE ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4, 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN __1__ COPIES TO

ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH

OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE

TERMS AND CONDITIONS SPECIFIED.

29. AWARD OF CONTRACT: REF. OFFER DATED . YOUR OFFER ON

SOLICITATION (BLOCK 5) INCLUDING ANY ADDITIONS OR CHANGES WHICH

ARE SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF THE CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 02/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

SGE50015R0025

001 health insurance services, base year 1.00 YR

(Start to End) Date FOB:

03/01/2016 to 02/28/2017 Destination

SGE50015R0025

Line Item Summary

Solicitation Number:

SGE50015R0025

Contract Number: Title: Amman ISU, Health Insurance Date of Solicitation:

06/08/2015

Line Item No. Description Quantity Unit Unit Price Total Cost

SGE50015R0025 Baghdad, Iraq Third Country National (TCN) Health Insurance Page 3 of 73

TABLE OF CONTENTS

Section 1 – The Schedule

SF 1449 cover sheet Continuation To SF-1449, Prices, Block 23 Continuation To SF-1449, Schedule Of Supplies / Services, Block 20 Description /

Specifications / Work Statement

Attachment 1 – Key Personnel Attachment 2 – Prices (will be incorporated as pages 6 through 8) Attachment 3 – Contract Information / Experience Listing Exhibit A – State Department and ORE Employee Data For Health Insurance

Coverage Exhibit C – Sample Invoice

NOTE: Further contractor-provided attachments will be included after award

Section 2 – Contract Clauses

Contract Clauses Addendum to Contract Clauses - FAR and DOSAR Clauses not Prescribed in Part

Section 3 – Solicitation Provisions

Solicitation Provisions Addendum to Solicitation Provisions - FAR and DOSAR Provisions not Prescribed in

Part 12

Section 4 – Evaluation Factors

Evaluation Factors Addendum to Evaluation Factors - FAR and DOSAR Provisions not Prescribed in

Part 12

Section 5 – Representations and Certifications

Offeror Representations and Certifications Addendum to Offeror Representations and Certifications - FAR and DOSAR

Provisions not Prescribed in Part 12

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SECTION 1 – THE SCHEDULE

CONTINUATION TO SF-1449

PRICES – BLOCK 23

I BACKGROUND / SCOPE OF SERVICES

A. The Government of the United States of America requires Health Insurance for its Third Country National (TCN) employees in Baghdad, Iraq.

B. This is a fixed price with economic price adjustment requirements type contract under which annual firm, fixed-price task orders will be issued. The contract shall remain unfunded. The fixed prices / premium rates for the health insurance services as specified in Section IV A and B are listed in III Prices C. The costs of DBA insurance (if applicable) will be reimbursed.

II ACRONYMS AND ABBREVIATIONS

Acronym Definition

CLIN Contract Line Item Number

CO Contracting Officer

COR Contracting Officer Representative (Amman Human Resources Officer)

Employer The United States Government = USG

FMO Financial Management Officer (paying office for all USG agencies except AID)

GSO Officer in charge of the General Services Office at post

LS Lump Sum

QA Quality Assurance

QC Quality Control

QCP Quality Control Plan

QTY Quantity

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SOW Statement of Work

TBD To be determined

USG U.S. Government

III PRICES

A.1 The contractor shall complete all work, including furnishing all labor, material, equipment and services, unless otherwise specified herein, required under this contract for the firm fixed unit prices indicated below and within the time specified herein. These individual project prices shall include all labor, materials, profit, and, if applicable, value added tax (VAT).

Any costs not separately priced will be considered to be included in the individual project prices as overhead or other indirect cost. No additional sums will be payable on account of any escalation in the cost of materials, equipment or labor, or because of the contractor's failure to properly estimate or accurately predict the cost or difficulty of achieving the results required by this contract. Nor will the contract price be adjusted on account of fluctuations in the currency exchange rates.

A.2 The currency shall be fixed and cannot be changed by modification to the contract.

The only reimbursable items shall be the VAT (if applicable) and the Defense Base Act Insurance (DBA) (if applicable).

A.3.1 Economic Price Adjustment, Premium Adjustment Based on Experience – For health insurance, prices may be adjusted upward or downward based on the experience rating of the Mission covered by this contract, and it specifically excludes all riders in B.4.2.c No adjustment will be allowed during the first twelve months.

After such time, the contractor or the USG may request an adjustment in premiums on an annual basis to be effective per contract year. Adjustments are not retroactive to previous contract terms. Before any such adjustment is made, the contractor agrees to provide the USG a balance sheet showing three main components for the previous time period:

(1) receipts (premiums received),

(2) number of insurance plans and

(3) claims paid.

This information shall be provided per type of premium, i.e. per line item.

The USG 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 effective for the following option year. Any failure to reach agreement under this clause shall be subject to the procedures in the Disputes clause.

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A.3.2.1 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(s). The contractor agrees to provide all documentation necessary to support any requested adjustment.

A.3.2.2 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 details setting forth how the pool impacts the request for equitable adjustment.

B. VAT – If applicable, the contractor shall be responsible for paying to the appropriate authority the applicable rate of Value Added Tax (VAT). Offerors shall identify the VAT as a separate line item. The VAT shall also be a separate cost item on all invoices submitted against task orders under the resulting contract. The contractor will be reimbursed for VAT only up to the amount listed in each task order and upon presentation of proof that VAT has been paid to the host country government. If the contractor receives a VAT refund from the host government he shall re-pay the refund amount to the US Government.

C.1 Offeror, insert the currency of prices offered __________________

The fixed prices / premium rates for the health insurance services as specified in

Section IV are as follows:

SPACE INTENTIONALLY LEFT BLANK

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ATTACHMENT 002 – PRICES WILL BE INSERTED HERE

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CONTINUATION TO SF-1449

SCHEDULE OF SUPPLIES / SERVICES, BLOCK 20

DESCRIPTION / SPECIFICATIONS / WORK STATEMENT

IV SPECIFICATIONS

A Health Insurance Services The Government of the United States of America (USG) requires group health insurance for a specific group of its employees in Iraq as further described in Sections 1.IV.B and 1.IV.C below to cover routine medical issues, medical emergencies, and medical evacuation when required. Insurance shall cover injuries sustained in Iraq as a result of an act of war.

The USG has determined that it will bear 100% of the cost of such insurance protection and will directly pay the premiums required. The specific health benefit coverage under the contract is set forth in this section.

The contractor shall ensure that health care under this contract does not exclude HIV / AIDS care. Health insurance shall be provided to employees as stated below for treatment of routine medical issues within Iraq or outside of Iraq.

The USG has determined that at this time there is no acceptable level of care for services / benefits covered in B.1 through B.3. Due to considerations of visa availability, 95% of the out-of-country patients shall be sent to Amman, Jordan for treatment.

Health insurance shall be provided to employees as stated below for:

the treatment of medical emergencies outside of Iraq;

injuries sustained in accidents, including vehicle accidents, no matter the type or reason for occurrence misspelled;

all injuries suffered in Iraq as a result of an act of war or other hostile action;

necessary medical treatment to stabilize the insured;

the cost of medical evacuation (medivac) to Amman, Jordan (including ambulances, medical supervision and follow-on medical treatment);

the insurance company to set up cooperation with a medivac provider

B.1 Employee Health Services Benefits The maximum health benefits under this contract are as follows.

B.1.2 Hospitalization:

100% reimbursement of room and board for a wardroom or semi-private room.

80% reimbursement of room and board for a private room, not to exceed 100% of the cost of a semi-private room.

100% reimbursement of hospital medical expenses including laboratory tests and x-rays, CRT, MRI, nursing care, operating room cost, intensive care, prescription medicines, and physical therapy.

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B.1.3 Surgery: 100% reimbursement of the customary and reasonable cost of surgical expenses, anesthesia, and recovery and intensive care room charges.

B.1.4 Doctor or Specialist Visits: 80% reimbursement for medical services and expenses.

B.1.5 Prescription drugs:

100% reimbursement when hospitalized, and 80% reimbursement when not hospitalized, of the cost of medicines and drugs under the medical plan (to be added to the contract as Attachment 4).

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.

B.1.6 Maternity:

100% (inpatient) 80% (outpatient) reimbursement of obstetrical medical care including prenatal and postnatal care.

This includes 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 (www.who.int) and CDC (www.cdc.gov) guidelines. (This is a rare scenario. Normal procedure is for a pregnant employee to leave post by the 7th to 8th week, or as soon as possible if the pregnancy is confirmed later than that).

B.1.7 Hospital Outpatient Services: 80% reimbursement of doctors’ and surgeons’ fees incurred at a hospital on an outpatient basis, at a clinic or doctor’s office, or at home.

B.1.8 Optical Service: 50% reimbursement for eye examination and treatment. Eyewear (lenses, frames, contact lenses) covered up to 100% up to $200.00 every two years.

No reimbursement for non-prescription lenses, or sunglasses.

B.1.9 Physical Therapy – Covered only under hospitalization.

B.1.10 Mental Health Coverage (In and Out Patient): 50% reimbursement of the customary and reasonable cost of psychiatric care when referred to a psychiatric care specialist for medical reasons.

B.1.11 Ambulance Service: 100% reimbursement of the customary and reasonable cost of ambulance services.

B.1.12 Hearing:

B.1.12.1 Routine Hearing Exam: 100%, includes one exam every 24 months.

B.1.12.2 Hearing Aids: 80% or maximum $1,000 reimbursement per year for adults or every 3 years for patients under the age of 24.

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B.2.13 Expenses Incurred Outside of Iraq: Same rates as inside of Iraq.

B.2.13.1 Expenses Incurred Out-of-Country for necessary medical care related to an act of war as long as the individual was not responsible for the act of war directly or as an assistant. Treatment abroad shall be authorized when the majority of committee members (see B.2.13.3 below) agree that a life-threatening injury exists.

B.2.13.2 Expenses related to Medical Evacuation (Global Emergency Assistance Program):

100% of expenses for medical evacuation via air ambulance (including all required cost e.g. transportation from / to airports, accompanying medical staff, etc.) from Iraq to Amman, Jordan if medically required. The calendar year maximum is $50,000.

B.2.13.3 Treatment abroad decisions for a life-threatening illness, injury or chronic condition shall be made by a committee consisting of a Foreign Service medical provider in the post health unit and the appropriate management officer, who agree that an employee is in grave danger of death or that the medical care cannot be provided in Iraq. The opinion of the committee members shall be binding.

B.2.13.4 Expenses Incurred Out-of Country for routine care: 80% of a pre-established price list of customary and reasonable costs for outside the preferred insurance system.

B.3 Other Benefits

B.3.1 Dental Care: 100% of expenses for dental services including dentists’ fees, examination and treatment (including inflammation of gums), root canal therapy, x-rays, cleaning, fillings, extractions, false teeth, crowns and bridges. Orthodontia treatment is covered only if treatment begins before age 15, unless required as a result of an accident. A maximum of four years of orthodontia treatment per patient shall be covered. The annual maximum per calendar year is $2,000.

B.3.2 HIV / AIDS infections: 100% reimbursement for medications to suppress opportunistic infections, such as tuberculosis and toxoplasmosis for employees who have HIV/AIDS, provide regular laboratory monitoring as deemed necessary by the attending physicians. Medication that is considered experimental may be excluded.

B.3.3 Family Planning: 80% reimbursement of prescribed contraceptive devices and drugs, voluntary sterilization, and diagnosis and treatment of infertility. Not covered is reversal of voluntary sterilization, infertility treatment after voluntary sterilization, genetic counseling, fertility drugs, and assisted reproductive technology. In-vitro fertilization (IVF) is for treatment of infertility.

B.3.4 Laboratory tests, CRT/MRT scans, and X-rays: 80% reimbursement of laboratory tests and x-rays when prescribed in accordance with existing referral procedures and in conjunction with doctor visits and / or hospital out-patient services.

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B.3.5 Routine Exams: 100% for

- Adult Physical Exam (ages 18 – 65, 1 exam per calendar year)

- Gynecological Exam (1 exam and 1 pap smear per calendar year)

- Mammograms (unlimited exams per year)

- Prostrate Specific Antigen (PSA) (males 40+, 1 exam per year)

- Digital Rectal Exam (DRE) (males 40+, 1 exam per year)

- Cancer Screening (1 flex sigmoid and barium contract every 5 years, at 50+ 1 colonoscopy every 10 years)

B.4 Eligible Employees Employees eligible for the health insurance services under this contract are:

B.4.1 All current active third country national (TCN) employees of the U.S. Department of

State, employed within the geographic boundaries of Iraq, paid under the local compensation plan, and certified by the Post HR officer / COR, i.e.

a. Third country nationals (TCNs) employed as direct hires;

b. TCNs employed under PSAs;

c. All current and active employees of the Ambassador and the Deputy Chief of Mission assigned to their respective official Government residences and paid under an ORE account. All costs for ORE employees are the responsibility of the employing officer, not the U.S. Government.

d. Each new employee will be enrolled upon entering on duty with the United States

Government.

An employee is also considered active ("on the rolls") whenever such employee is on annual or sick leave, or leave without pay. During a period of Leave Without Pay or unpaid leave that is one pay period or less, coverage under the insurance contact will continue.

e. Pre-existing Conditions: Employees employed by the Embassy at the time the contract becomes effective who may have pre-existing conditions shall be eligible for health coverage. Each new employee upon entering on duty who may have pre-existing conditions shall be eligible for health coverage during the performance period of this contract.

f. Participants Covered Under a Rider: 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.

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g. Individuals not eligible for coverage under this contract are nonpersonal services contract personnel and any other individual not falling within one of the categories of employees described in this clause.

B.4.2 Other Eligible Participants – The following additional categories of persons are covered by this insurance: None

B.5 Reserved

B.6 Brochure Requirement

B.6.1 The contractor shall provide a document (brochure / pamphlet / other written document) in 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. The contractor shall furnish all copies of the brochures to the COR, who will ensure that appropriate distribution is made.

B.6.2 The contractor shall provide the document described in B.6.1 to the COR for review not later than thirty days (30) after date of contract award. The contractor shall provide additional brochures for new employees within ten (10) days of the COR’s request.

B.6.3 The contractor assumes full responsibility for ensuring that the document described in B.6.1 accurately reflects the requirements of the contract, as implemented by the contractor’s technical proposal. In all cases, the contract shall take precedence.

Should the COR discover that the brochure contains inaccuracies, the contractor will be notified in writing; however, failure on the part of the USG 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.

B.7 Health Benefits Conditions and Limitations

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

Annual Aggregate Maximum Limit: USD 250,000 per individual per year.

Does not include 50% items.

Does include medical evacuation.

Lifetime Maximum: Unlimited.

B.8 Deductible – There shall be no deductible amount.

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V CONTRACT ADMINISTATIVE REQUIREMENTS AND PROCEDURES

V.1 Definitions

COR Contracting Officer’s Representative, the person acting for the contracting officer in matters of invoice approval, technical questions, etc.

Customary and Reasonable Treatment

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

Disability A physical or mental impairment which precludes the individual from performing ordinary motor or bodily functions. 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, or personal services agreement, as further defined in Section 1.IV.A for health insurance. This may also include an ORE employee, if this category of individual is an eligible participant, as defined in B.4.1.

Employer The United States Department of State

FMO Financial Management Office, the office that processes contractor invoices.

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.

GSO The General Services Office and Officer

Maximum Benefit

The total amount that will be paid to any one employee for injury or disease

Medivac Medical Evacuation Provider

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.

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Surgical procedure

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

V.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 USG, is responsible for management and quality control to meet the terms of the contract. The role of the USG is to conduct quality assurance to ensure that contract standards are achieved.

Performance Objective PWS Performance Threshold

Timely payment of benefits (within 21 calendar days)

Section

IV.B

No more than one (1) customer complaint is received per month.

No incorrectly denied claims

Medivac services are performed timely, medically and logistically efficiently and to the most qualified hospital in Amman, Jordan

V.2.1 Surveillance – The COR will receive and document all complaints from USG personnel regarding the services provided. If found valid, the COR will send the complaints to the contractor for corrective action.

V.2.2 Standard – The performance standard is that the USG 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.

V.2.3 Complaint Procedures

a. If USG personnel observe unacceptable services such as but not limited to lack of coordination during medical evacuation, extended referral periods, delays in receipt of payment, etc., they will immediately contact the COR.

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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, provide e-mail notification informing the contractor of any valid complaints.

f. If the contractor disagrees with the complaint and challenges the validity of the complaint, the contractor shall notify the COR by e-mail. 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 complainant.

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.

V.2.4 Employee Claims Report

The contractor shall provide a monthly Employee Claims Report. The report shall be received by the COR no later than the 10th calendar day of each month.

The report shall 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.

V.3 REPORTS AND OTHER DELIVERABLES

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

Iraq Support Unit

6050 Amman Place Washington, DC 20521-6050 ATTN: Human Resources Officer

NOTE: Any and all costs for the preparation, handling, mailing and submission of progress reports or any other required reports and documentation shall be included in the total price of each delivery order.

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Description QTY Submission Date Deliver to and how:

Reference para IV B.6 Brochures

Additional copies

For review 30 days after contract award

After review by the COR

Within 10 calendar days of the COR’s request

COR

hard copy para V.2.4 Employee claims report 1 ea No later than the

10th calendar day of each month

COR

e-mail, pdf document para V.4.a (2)

Claim forms for each type of benefit that can be claimed under the contract

Basic supply

Additional copies

30 days after contract award

Within 10 calendar days of the COR’s request

COR

mail, hard copy para V.4.a(4)

Employee claim reimbursement checks each Within 21 calendar days of the submission of the claim

COR

mail, hard copy para V.8 Draft version of Management

Plan 1 ea As part of the offer

CO

para V.8 Final version of Management

1 ea 15 calendar days after receipt of contract award

COR

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Section 1 paras V.3 and V.15

Attachment

Indemnity Medical

Exclusions

Air Ambulance Evacuation Capacity – Iraq

Contractor Preferred Drug Guide

PPC –

Provider Community Profile

1 ea within 10 days after contract award

CO & COR

documents

V.4 Contractor Responsibility in Claims and Reimbursement to Claims

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 employees' 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 eligible employee 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 employee per year reimbursement ceiling.

(2) The contractor shall provide the COR with the necessary claim forms 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.

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(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 three weeks after the claim has been submitted.

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

(1) The contractor shall accept the employee's choice to go for medical services or surgery to hospitals or clinics designated on the contractor’s preferred providers’ list in order that the contractor will pay the expenses directly to the care facilities.

(2) All medical claims shall be submitted directly to the contractor by employees through the COR.

(3) The contractor shall date stamp and screen all claims submitted on the day of receipt. If the submission is missing any documents or information thereby disallowing said claim to be payable, the contractor shall notify the employee within two days, with a copy to the COR.

(4) The contractor shall settle the claims no later than three weeks from the date a complete claim is submitted to the contractor.

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

V.5 Miscellaneous Contractor Requirements

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 Iraqi 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.

V.6 Erroneous Payment

If the USG 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 USG, whichever the USG prefers. The contractor shall refund any refunds not complete or discovered after the completion date of this contract.

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V.7 Physical and Information Security Requirements

The contractor shall be responsible for safeguarding all government information provided for contractor use. All material / documentation produced for the USG will be the sole property of the USG. The contractor shall not release any documents to anyone unless authorized by the USG. The following considerations shall be followed by the contractor and/or shall be incorporated into the design documents / shop drawings.

V.7.1 All documents received or generated under the contract are the property of the

USG.

V.7.2 All documents shall be controlled and disseminated on a need-to-know basis.

Reproduction and distribution is prohibited without express approval of the USG.

All design documents generated shall be annotated as follows:

WARNING

This document is the property of the US Government.

Further reproduction and / or distribution are prohibited without the express written approval of the US Government.

V.7.3 All documents shall be marked and handled in strict accordance with all applicable requirements and regulations. Proposed and actual contract documents shall only be disseminated on a strict need-to-know basis, and shall not be further disseminated without prior authorization from the USG.

V.7.4 Those receiving any type of proposed and / or actual contract documents shall be responsible for these materials while in their possession, or that of any of their subcontractors. They shall return all documents, including all copies, promptly upon demand by the USG.

V.8 Contractor Management Plan

Offerors shall submit a draft version of their management plan as part of their proposal. The contractor shall submit the final version no later than 15 calendar days after receipt of a contract award.

V.8.1 The contractor’s management plan shall:

describe the organization of the work force, specify the names and responsibilities of the principal manager and the supervisors under this project, indicate the manner in which the contractor assures quality documents and service, state the frequency of inspections and the use of operational records include organizational and functional charts reflecting the line of management responsibility

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V.8.2 Inspection System – The contractor’s management plan shall establish an inspection system covering all services stated in Section 1, The Schedule. The inspection system shall:

a. specify areas to be inspected on a scheduled basis;

b. include a method of identifying deficiencies in the quality of supplies (reports) and

/ or services before the level of performance becomes unacceptable;

c. include a filing system for all inspections conducted by the contractor and the corrective action taken.

This documentation shall be made available to the USG during the term of the contract.

The contractor shall obtain the COR’s approval prior to making any changes in its management plan. If directed by the COR, the contractor shall submit said changes in writing as a proposal for Government review and approval / disapproval.

V.9 Key Personnel

The contractor shall assign to this contract the key personnel to the identified position / function (see Attachment 1 – Key Personnel).

During the entire performance period of this contract, the contractor shall make no substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. The contractor shall notify the Contracting Officer within 15 calendar days after the occurrence of any of these events. The proposed substitute shall possess qualifications comparable to the original key person, as well as satisfying any minimum standards set forth elsewhere in the solicitation / contract. The Contracting Officer will notify the contractor within 15 calendar days after receipt of all required information of the decision on the substitution.

V.10 Laws And Regulations

V.10.1 Compliance Required – If the contractor has or will establish a local office, he shall, without additional expense to the USG, be responsible for complying with all laws, codes, ordinances, and regulations applicable to the performance of the work, including those of the host country, and with the lawful orders of any governmental authority having jurisdiction.

V.10.2 Labor, Health and Safety Laws and Customs – If the contractor has or will establish a local office, he shall comply with all local labor laws, regulations, customs and practices pertaining to labor, safety, and similar matters, to the extent that such compliance is not inconsistent with the requirements of this contract.

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V.10.3 A contract with the USG 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 USG employees. Registration of this contract with the host country 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 USG of the amounts thereof.

V.10.4 The only items that the USG will consider for price adjustments are those that are mandated e.g. changes in the VAT rate (if applicable) or minimum hourly wage rate.

V.11 Contract Administration Data

V.11.1 Authority of the Contracting Officer – All work shall be performed under the general direction of the Contracting Officer, who alone shall have the power to bind the Government and to exercise the rights, responsibilities, authorities and functions vested by the contract, except that the Contracting Officer and the Procurement Executive shall have the right to designate authorized representatives to act for the Contracting Officer, as specifically provided in the designation of that individual, such as the COR.

V.11.2 Government Personnel

Contracting Officer: Frederick Washington

Contract Administrator: Chris Heck E-mail address: HeckC@state.gov

Contracting Officer's Representative (COR): The ISU / HRO Amman, Jordan

V.11.3 Invoices, Review and Payment

Invoices shall be issued monthly. Value Added Tax (VAT), if applicable, shall be a separate line item on each invoice.

The contractor shall e-mail the invoice as pdf document to the COR. The post procurement point of contact will review the invoice and, if it’s correct, forward it to the post FMC for payment. If there are mistakes, the post procurement point of contact shall inform the contractor and the COR which corrections are required.

The post procurement point of contact will confirm to the post finance office that the invoice is correct.

Each invoice shall include the items listed in Section 2, FAR 52.212-4 g.1.

Payment shall be made in the currency the contractor specified in Section I, Prices.

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V.11.4 Advance Payment shall not be authorized under this contract.

V.11.5 Changes In Ownership – The contractor shall furnish the COR advance notification

(90 calendar days prior to the effective date) of any disposition or the change in ownership or terms of lease of any facilities utilized by him for performance of any service under this contract.

V.12 Funding / Task Orders / Procedures

V.12.1 The contract remains unfunded; funding will be provided by issuing an annual task orders with possible modification for staffing changes. Each task order will contain the following information:

Name of contractor Contract number Date of purchase Task order number Name of person placing the order Quantity, unit price, and total price of each service / insurance rate VAT or other taxes as a separate item, if applicable COR and post points of contact, including e-mail addresses applicable contract clauses, either in reference or in full text if necessary

V.12.2 Only an RPSO Contracting Officer may place a written order.

V.12.3 Ordering Procedures – The Government shall issue annual funded task orders to cover all eligible employees with regular and ORE employees listed in separate line items. No task order shall include any names or PII (personally identifyable information). The COR informs the contracting officer if any additions or deletions are required throughout the year and the Contracting Officer will issue funded modifications as required.

V.13 Choice of Law

This contract shall be construed and interpreted in accordance with the substantive laws of the United States of America. By the execution of this contract, the contractor expressly agrees to waive any rights to invoke the jurisdiction of local national courts where this contract is performed and agrees to accept the exclusive jurisdiction of the United States Civilian Board of Contract Appeals and the United States Court of Federal Claims for hearing and determination of any and all disputes that may arise under the Disputes clause of this contract.

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V.14 Start / Period of Performance

Contract performance is estimated to start February 1, 2016. The period of performance is one year, with four possible annual option years. Option years, if exercised, shall be for twelve (12) months each, commencing at the expiration of the previous period of performance.

The Government may extend this contract in accordance with the option clause in Section 2, FAR 52.217-9, Option to Extend the Term of the Contract - Deviation, which also specifies the total duration of this contract.

The Government may exercise the option set forth at Section 2, "FAR 52.217-8, Option to Extend Services", within the currently ongoing period of performance.

Notwithstanding the expressed contract expiration date, this contract shall remain in full force and effect until the last items or services ordered hereunder have been delivered and accepted by the Government.

V.15 List Of Attachments

Exhibit A

TCN and ORE EMPLOYEE STATISTICS

Exhibit B

Sample Invoice

Attachment 1

Key Personnel

Attachment 2

Pricing Spreadsheet

Attachment 3

Contract Information Sheet / Experience Listing

The below attachments shall be submitted by the contractor within 10 DAYS after receipt of contract award.

Attachment 4 Indemnity Medical Plan Exclusions

Attachment 5 MedAire Air Ambulance Evacuation Capacity – Iraq

Attachment 6 Contractor Preferred Drug Guide

Attachment 7 PPC – Provider Community Profile

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SECTION 2 – CONTRACT CLAUSES

52.212-4 – CONTRACT TERMS AND CONDITIONS – COMMERCIAL ITEMS (MAY 2015)

a. Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights --

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

b. Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C.3727). However, when a third party makes payment (e.g.,use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

c. Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

d. Disputes. This contract is subject to 41 U.S.C. chapter 71,Contract Disputes.

Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

e. Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

f. Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common

Third Country National (TCN) Health Insurance Page 27 of 73 carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

g. Invoice.

(1) The Contractor shall submit an original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include --

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, contract line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer— System for Award Management, or 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award Management), or applicable agency procedures.

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(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C.

3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315.

h. Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

i. Payment.

(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.

(2) Prompt Payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR Part 1315.

(3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause.

(4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made.

(5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall—

(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the—

(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment);

(B) Affected contract number and delivery order number, if applicable;

(C) Affected contract line item or subline item, if applicable; and

(D) Contractor point of contact.

(ii) Provide a copy of the…