sf30 Health Insurance M001.doc

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

SMA100-12-R-0017

1. CONTRACT ID CODE

PAGE OF PAGES

1 2

2. AMENDMENT/MODIFICATION NO.

M001

3. EFFECTIVE DATE

05/07/12

4. REQUISITION/PURCHASE REQ. NO.

5. PROJECT NO. (If applicable)

6.

ISSUED BY

CODE

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

Department of State

American Embassy Antananarivo Lot 207A, Andranoro-Antehiroka

105 Antananarivo

See Item # 6

8.

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

9a. AMENDMENT OF SOLICITATION NO.

SMA10012R0017

9b. DATED (SEE ITEM 11)

04/19/12

10a. MODIFICATION OF CONTRACT/ORDER NO.

10b. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

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

[ ] is extended, [ ] is not extended

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing Items 8 and 15, and returning _______ copies of the amendment;(b) By acknowledging receipt of this amendment on each copy of the offer submitted; or(c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers.

FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

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

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b)

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

D. OTHER (Specify type of modification and authority)

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

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

The purpose of this amendement is to correct the currency in Section J, Exhibit E: “Historical Claims Informations” – the currency should be Malagasy Ariary (MGA) and not USD. These amounts represent that of Madagascar only.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

16A. NAME OF CONTRACTING OFFICER

Kumi T. Ikeda

15B. NAME OF CONTRACTOR/OFFEROR

BY

(Signature of person authorized to sign)

BY

(Signature of Contracting Officer)

16C.DATE SIGNED

05/X/12

NSN 7540-01-152-8070

Standard Form 30 (revised 10/83) Previous edition unusable

Prescribed by GSA FAR (48 CFR) 53.243

Exhibit E

HISTORICAL CLAIMS INFORMATION