SF-33 Health Insurance SNP40012R1716493.docx

SOLICITATION, OFFER AND AWARD

1. THIS CONTRACT IS A RATED ORDER

UNDER DPAS (15 CFR 350)

1 | 56

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

3. SOLICITATION NO.

SNP400-12-R-1716493

4. TYPE OF SOLICITATION

[ ] SEALED BID (IFB)

[x] NEGOTIATED (RFP)

5. DATE ISSUED

July 5, 2012

6. REQUISITION/PURCHASE NO.

7. ISSUED BY CODE

8. ADDRESS OFFER TO (If other than item 7)

American Embassy Kathmandu (GSO) Maharajgunj, Narayan Gopal Road, Kathmandu Phone:4007200 Fax: 4007277 Same as # 7

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

SOLICITATION

9. Sealed offers in original and 1 copy for furnishing the supplies or services in the Schedule will be received at the place specificed, in the depository located in

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

Bhuban B Nakarmi

B. TELEPHONE (NO COLLECT CALLS)

AREA CODE NUMBER EXT

977-1-4007200 4395

C. E-MAIL ADDRESS

NakarmiBB@state.gov

11. TABLE OF CONTENTS

OTHER STATEMENTS OF OFFERORS

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 inseted 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)

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

FACILITY

16. NAME AND TITLE OF PERSON AUTHORIZED

AND

ADDRESS

OF

OFFEROR

TO SIGN OFFER (Type or print)

15B. TELEPHONE NO. (Include area code)

AWARD (To be completed by Government)

19. ACCEPTED AS TO ITEM NUMBERED

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

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

23. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

24. ADMINISTRATION BY (If other than Item 7) CODE

25. PAYMENT WILL BE MADE BY CODE

GENERAL SERVICES OFFICE

AMERICAN EMBASSY KATHMANDU

MAHARAJGUNJ, KATHMANDU

FINANCIAL MANAGEMENT OFFICE

AMERICAN EMBASSY KATHMANDU

MAHARAJGUNJ, KATHMANDU

26. NAME OF CONTRACTING OFFICER (Type of print)

Shelly Kadlec

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