SF-30-0002.pdf

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 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 your 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.

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

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

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

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

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.

12. ACCOUNTING AND APPROPRIATION DATA (If required) copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

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

CHECK ONE 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.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying 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)

15C. DATE SIGNED

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

16C. DATE SIGNED

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

PAGE OF PAGES

6. ISSUED BY CODE

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

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

NSN 7540-01-152-8070

Previous edition unusable

2. AMENDMENT/MODIFICATION NO.

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

Solicitation # 15B21122R00000003 is hereby modified by Amendment 0002 to revise Attachment 8: Technical Proposal Summary Sheets by Hospital Networks. On-site Clinics at the Institution (Located on page 2/2) has been revised.

All other terms and conditions remain unchanged.

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.

US Department of Justice Federal Bureau of Prisons, Field Acquisition Office 346 Marine Forces Drive Grand Prairie, TX 75051

9A. AMENDMENT OF SOLICITATION

NO.

15B21122R00000003

1 1

12/23/2022

9B. DATED (SEE ITEM 11)

12/09/2022

X

Attachment 8: Technical Proposal Summary Sheets by Hospital Networks

FCI Otisville – Comprehensive Medical Services 15B21122R00000003

Each offeror shall complete this two-page attachment for each hospital network proposed, without altering the format or the information sought by the form. The completed attachment supersedes any information described in the technical proposal. In the event of any conflicts between the completed attachment and the technical proposal, the information provided in this attachment shall take precedence.

Offeror:

Hospital provider (name, address):

Type of facility (e.g., acute, tertiary, ambulatory surgery):

Accreditation type/date:

Proximity of hospital to Institution (in miles):

Number/type of beds:

Any exclusions on hospital services offered? (if so, describe):

Emergency Room trauma level:

Based on proximity and/or capability, is this hospital the primary Emergency Room provider for Institution inmates, as recognized by the local emergency medical service responder?

Summarize enhancements available at this hospital:

Describe how this hospital network would be utilized within the offeror’s overall provider network (e.g., primary provider, secondary provider, etc.):

Attachment 8: Technical Proposal Summary Sheets by Hospital Networks

FCI Otisville – Comprehensive Medical Services 15B21122R00000003

Physician Specialties in this hospital network Offered? # of Physicians Physician Specialties in this hospital network Offered? # of

Physicians Anesthesiology Other:

Cardiology/Surgery Other:

Dermatology Other:

Emergency Room Other:

ENT/Surgery Other:

Endocrinology Other:

Family Medicine Other:

Gastroenterology Other:

General Surgery Other:

Gynecology (if female) Other:

Hematology Other:

Infectious Disease Other:

Internal Medicine Other:

Nephrology Other:

Neurology Other:

Obstetrics (if female) Other:

Oncology Other:

Ophthalmology Other:

Optometry Other:

Orthopedics/Surgery Other:

Pathology Other:

Psychiatry Other:

Pulmonology Other:

Radiology Other:

Urology Other:

Proximity of physician offices to the Institution: Minimum __________ miles Maximum __________ miles

On-site Clinics at the Institution

Offered?

Privileges at this hospital?

Privileges at another hospital in the offeror’s network?

Will the provider also perform services within an inpatient, outpatient, or office setting? Please indicate.

Optometry