I, ('O\TR{C'I' ID CODl: PAGEPAGES

OF

tl22. AMENDMENT/MODIFICATION NO.

4000r3. EFFf,CTryE DATE

t/30/201E4. REQUTSITION/PURCI|ASE REQ. NO.

PR70582815. PROJECT No. (U appl ica b te )

6 lsst fD B\ (oDrl

Aherican Embassy, LimaAve. Lima Polo cdra 2, ATTN GSOLima 33Peru

7. ADMTNISTEREL By (fother than lten 6)CODE

American Embassy Lim4Ave. Lima Polo cdra 2. ATTN HRLima 33Peru

8. NAME AND ADDRESS OF CONTRACIOR (NO, steet,city.count ,Sbte,andZIp Code) 9a. AMENDMENT OF SOLICITATION NO.t9PE50t 8R0006

9b. DA'fEIt (SEE |TEM I I )8/6/ t 8

l0a MODI[ICATIO\.' OF COI-TR{('T/ORDER \O.

IOb, DATED (SEE ITEM ]3)

I I. THIS ITIiM ONI,Y APPLIES TO AMf,NDMf,NTS OF SOI,ICITA 't roNs

I x ] The above numbered solicitation is amended as set fonh in ltem 14. The hour and date specified for rcceipt ofoffers[ ] is extended, [x I is nor extended

Offers must ackno*'ledge receipt ofthis amendment prior to the hour and date specified in the solicitation or as amended, by one ofthe followingmethods: (a) B) completing ltems 8 and 15. and rsuming

-

copies ofthe amendment:(b) By acknowledging receipt ofthis amendment oi eachcopy ofthe offer submitted; or(c) By separale letter o. 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 OFOFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN R-EJECTION OF YOUR OFFER. If by vinue of rhisamendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegramor letter makes reference to the solicitation and this amendment. and is received prior to the opening hour and date specified.

l2 ACCOIT'I-TING AND APPROPRIATION DATA (tlrequted)

l3 THIS ITf}I APPLIES O\LY TO }IODIFICATTO\S OT CONTR{CTS/ORDERS.IT }IODIFIfS THE CONTR{CT/ORDER \o. As DESCRIBED I}.' ITE}r I{.

B. THE ABOVE NLMBERED CON'TRACT/ORDER IS MODIFIED TO RFF LECT THE ADMINISTRATIVE CHANCES 6uch as changes in paltngon date, etc.) SET FORTH IN ITEM 14, PURSUANT I'O THE AI.]'TIIORITY OF FAR 43.I03(b)

C, THIS SIJPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORMY OF

D. OTHER (Srycil, D)pe ofnodification and authority)

E IIIPORTANT: Contracror uired to s this document ard retum ies to the issu office.I 1 l) llSCRIP'I' o ot \IE\t) \I ti\T/\to l) TIC l Io\ (Orsan b1' UC s bjecThe purpose ofthis amendmen

(see cont. page No. 2)

t so lc Itatron I 9PE 5 0 I 8R0006 h ereb) mad to reflect rh a fo I In chan8e

herein. all terms and conditions ofthe document referenced in Item 9A or I0A as heretofore cha, remains unchan and in full tbrce and erl crl5A. NAME AND TITLE OF SICNf,R (?"ype orprizr) I6A, NAME OF CONTRACTING OPFICER

Noemi Drvih

I5B NA}If, O}' CONTRA('TOR,iOI'I'EROR

B\(Signatwe olpe$oh aulho :ed to sign)

I5C,DATESIGNED

D STATES O

drfi^iRAMERICA

\.i-l^inq Ofrcet)

I

I]

I6C.DATE SIGNEI)

vfaclrrNSN 7540-01 - l 52-8070Previous edition unusable

Standard Form 30 (revised 10/83)Prescribed by GSA FAR (48 CFR) 53.243

AMENDMENT OF SOLICI ATION/MODIFICATION OF CONTRACT

A.THISCHANcEoRDERIslssUEDPURsUANTTo.1Sp".,},CONTRACT ORDER NO, IN ITEM IOA.

leasible.)of

x

Amendment of Solicitation No. !9PE5015R0006Page 2

l. Replaces Exhibit A - Employcc Statistics - Claini Report entirely widr dre attached documcnt

2. Includes Section C. l. I .25 - Additional benefits covered under EPS law - "Essential Health InsurancePian" as follows:

Paragraph Covcrcd Benefit Employees

c. 1.1.25Additional benefits covered under EPS law"Essential Health Insurance Plan"

Yes

3. Replaces Section M.5 Technical Evaluation entirely *'ith the following

NI.5, TECHN-ICAL EVALUATION"

Offers will be evaluatcd on:

(D Meeting each ofthe indiridual mandatory requirements/minimums for health and life insurancecoverage specified in Sectron C though H and the Exhibit(s) and submitting an acceptable ManagementPlan (L.4.3) indicating how vendor will administer the plan and demonstrate an understanding,knorvledge and tbmiliarity ofthe requirements. The Govemment may reject, as technlcally, unacceptableproposals that:

(a) larl to provide the minimunr benefits required by the solicitatron; or(b) Offcr additional bcncfits not rcquircd by thc solicitation and not under the Additionalbenefrts covered under EPS law - "Essential Health Insurance Plan" (even though there is noincrease in the price)(c) Fail to demonstrate how solicitation requtements will be m€t.

(iii) Acceptable rclevant Experiencc and Past Performance; and

(iv) Nleet all other terms and conditions set forth in this solicitation

All other terms and conditions of original solicitation remain the same and unchanged

Yes

(it) Thc dcrrtonstral.iun that drc uffclor is liccnsc&tcrtificducurcdil.sd or utherwise ;rutlrorizcd by regovemment of Peru or its agent (e.g., insurance commission, board) to provide health insurance @verageto persons (to include organizations, companies, groups) within thc host country. Ifthe offeror is notlicense,ltertifie,:L'accredited or othenvise authorized by the govemment of Peru, it must demonstrat€ thatit is liccnscd/ccrtificd/accrcditcd by a govcmmcnt othcr than thal of thc host countr)* to providc hcalthinsurance for persons in Peru and must demonstrate its capacity to provide health benefig in Peru to meettltv rrilirrum rcrluir crnvnls and odrcr contliLiuus sst furih i-o tlis solioitatiun,

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