Sol_140F0621Q0041_Amd_0001.pdf

(x)

140F0621Q0041 x x copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted ; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT 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 letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

x

F09

Falls Church VA 22041-3803

MS: BMO

5275 Leesburg Pike

FWS, DIVISION OF CONTRACTING AND FA

F06

LAKEWOOD CO 80228-1807

134 UNION BOULEVARD

LAKE PLAZA NORTH

FWS, DIVISION OF CONTRACTING AND GE

03/31/20210001

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

12. ACCOUNTING AND APPROPRIATION DATA (If required) is not extended.is extended, Items 8 and 15, and returning

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

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

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

FACILITY CODE CODE

10B. DATED (SEE ITEM 13)

10A. MODIFICATION OF CONTRACT/ORDER NO.

9B. DATED (SEE ITEM 11)

9A. AMENDMENT OF SOLICITATION NO.

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

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

PAGE OF PAGES

4. REQUISITION/PURCHASE REQ. NO.3. EFFECTIVE DATE2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO. (If applicable)

1. CONTRACT ID CODE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

03/31/2021

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

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority) appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

E. IMPORTANT: Contractor is not is required to sign this document and return __________________ copies to the issuing office.

ORDER NO. IN ITEM 10A.

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

The purpose of this Amendment is to provide the Questionnaire to be submitted with the

Solicitation.

ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME

Legacy Doc #: FWS

Period of Performance: 04/26/2021 to 03/25/2026

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)15A. NAME AND TITLE OF SIGNER (Type or print)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 15B. CONTRACTOR/OFFEROR 16C. DATE SIGNED

(Signature of person authorized to sign) (Signature of Contracting Officer)

Tonia Ellen

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

Previous edition unusable

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

PILOT INFO RESPONSE HERE

Name of Pilot REDACTED Date of Birth REDACTED Address REDACTED Present Employer USFWS Date Employed 1/17/2017 Position Held Aviation Operations Specialist/Pilot Address 3833 S Development Ave, Boise, ID 83 Previous Employer 1 US Army Previous Employer 1 Dates Employed 5/2/2002 - 2/27/2017 Previous Employer 1 Position Held Pilot Previous Employer 2 Previous Employer 2 Dates Employed Previous Employer 2 Position Held Previous Employer 3 Previous Employer 3 Dates Employed Previous Employer 3 Position Held Have you ever been discharged or asked to resign? No

PILOT CERTIFICATE AND RATINIGS CURRENTLY HELD

Student [S], Private [P], Commercial [C], ATP [A], Instructor [I], SEL, SES, MEL, MES, Helo, Instrument [IR] FAA Certificate Number Date first Certificated Medical certificate number Medical certificate type Medical certificate date Physical Impairments Waivers and Limitations Date of last biennial flight review Make and Model of primary aircraft Have you attended manufacturers ground and flight training course?

If yes above, Date, Facility and Location

MAKE AND MODEL YRS FLOWN PIC SIC DUAL TOTAL TIME LAST 90 DAYS LAST 12 MONTHS

C172 C182

Single KODI Engine PA28

C206

BE30

BE58

Multi BE20 Engine & PA44 Jet

C172L

TH67

Seaplanes UH-60A/L & Helos OH58C

0 0 0GRAND TOTALS

Highest Year Completed?

Code as a) High School 1-4 yrs, b) College 1-4 yrs, c ) Graduate School 1-4 yrs

Name of College(s) Years Attended Did you graduate?

Level and

Have you ever been involved in an accident? If yes, explain below

NO

Accident Location Date Make/Model Registration Number

Explain circumstances if you have any:

a) Physical impairments

b) waivers or limitations on your medical

c) An FAA, Transport Canada, or Military pilot certificate held by you has been revoked or suspended

d) you have been cited for violation of an aviation regulation in any country

e) you have ever been convicted or pleaded guilty to a felony or DUI

Probable Cause

Explanation