Amendment 00001.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 electronic communication 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 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.

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

2. AMENDMENT/MODIFICATION NUMBER 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)

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

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

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 APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NUMBER 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

NUMBER IN ITEM 10A.

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

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.

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)

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

PAGE OF PAGES

6. ISSUED BY CODE

8. NAME AND ADDRESS OF CONTRACTOR (Number, 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)

Previous edition unusable

00001

15BFAO

Ben Keim - Contracting Officer

Amendment No. 00001 is issued to incorporate changes to Attachment 1, Contract Pricing & Sub-Contract Certification identified on pages 2-4 of this amendment.

The offer due date of June 6, 2022 at 2:00 PM CST remains unchanged.

15B103 Federal Bureau of Prisons Field Acquisition Office 346 Marine Forces Dr.

Grand Prairie, TX 75051

Federal Bureau of Prisons FCI Beckley 1600 Industrial Park Road Beaver, WV 25813

FAO21-302

15BFA022R00000001

1 4

04/27/2022

04/04/2022

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CONTRACT-CONTINUATION

CONTRACT ID CODE

15B40221R00000001

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Attachment 2 – Performance Work Statement

Within Attachment 1, Contract Pricing & Sub-Contract Certification, the Schedule of Items on pages 3-5 of 5 is hereby removed in its entirety and replaced with the following:

Changes are in red.

Offerors shall complete the following Schedule of Items. All proposed pricing will be evaluated in accordance with Federal Acquisition Regulation (FAR) 52.212-2, Evaluation - Commercial Products and Commercial Services, and Attachment 4, Submission and Evaluation of Proposals, of this solicitation.

Base Year – FCI Beckley

Effective Date of Award (EDOA) through twelve (12) months from EDOA.

1a. Inpatient Facility Services: - Discount or + Premium to Medicare Part A 1b. Outpatient Facility Services: - Discount or + Premium to Medicare Part B 2a. In/Out Patient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Institution Services 2b1. Other Physician Services: - Discount or + Premium to Medicare Part B 2b2. Optometrist Services: $_______________ Per 8 Hour Session 2b3. Mobile MRI Services: $___________________Per 8 Hour Session 2b4. Mobile Ultrasound/Echo Services: $___________________Per 8 Hour Session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

Option Year 1 – FCI Beckley

Thirteen (13) months through twenty-four (24) months from EDOA.

1a. Inpatient Facility Services: - Discount or + Premium to Medicare Part A 1b. Outpatient Facility Services: - Discount or + Premium to Medicare Part B 2a. In/Out Patient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Institution Services 2b1. Other Physician Services: - Discount or + Premium to Medicare Part B 2b2. Optometrist Services: $___________________Per 8 Hour Session 2b3. Mobile MRI Services: $___________________Per 8 Hour Session 2b4. Mobile Ultrasound/Echo Services: $___________________Per 8 Hour Session

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Option Year 2 – FCI Beckley

Twenty-five (25) months through thirty-six (36) months from EDOA.

1b. Outpatient Facility Services: - Discount or + Premium to Medicare Part B 2a. In/Out Patient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Institution Services 2b1. Other Physician Services: - Discount or + Premium to Medicare Part B 2b2. Optometrist Services: $___________________Per 8 Hour Session 2b3. Mobile MRI Services: $___________________Per 8 Hour Session 2b4. Mobile Ultrasound/Echo Services: $___________________Per 8 Hour Session

Option Year 3 – FCI Beckley

Thirty-seven (37) months through forty-eight (48) months from EDOA.

1a. Inpatient Facility Services: - Discount or + Premium to Medicare Part A 1b. Outpatient Facility Services: - Discount or + Premium to Medicare Part B 2a. In/Out Patient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Institution Services 2b1. Other Physician Services: - Discount or + Premium to Medicare Part B 2b2. Optometrist Services: $___________________Per 8 Hour Session 2b3. Mobile MRI Services: $___________________Per 8 Hour Session 2b4. Mobile Ultrasound/Echo Services: $___________________Per 8 Hour Session

Option Year 4 – FCI Beckley

Forty-nine (49) months through sixty (60) months from EDOA.

1a. Inpatient Facility Services: - Discount or + Premium to Medicare Part A 1b. Outpatient Facility Services: - Discount or + Premium to Medicare Part B 2a. In/Out Patient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Institution Services 2b1. Other Physician Services: - Discount or + Premium to Medicare Part B 2b2. Optometrist Services: $___________________Per 8 Hour Session 2b3. Mobile MRI Services: $___________________Per 8 Hour Session 2b4. Mobile Ultrasound/Echo Services: $___________________Per 8 Hour Session

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Option to Extend Services as Authorized by FAR 52.217-8 – FCI Beckley

1b. Outpatient Facility Services: - Discount or + Premium to Medicare Part B 2a. In/Out Patient Physician Services: - Discount or + Premium to Medicare Part B 2b. Outpatient Institution Services 2b1. Other Physician Services: - Discount or + Premium to Medicare Part B 2b2. Optometrist Services: $___________________Per 8 Hour Session 2b3. Mobile MRI Services: $___________________Per 8 Hour Session 2b4. Mobile Ultrasound/Echo Services: $___________________Per 8 Hour Session

NOTE: IF OFFERING A VARIANCE FROM THE BENCHMARK MEDICARE RATE, INSERT

APPLICABLE "-/+" PERCENTAGE. IF NO VARIANCE, ENTER "0".

All offerors are hereby advised that the successful Offeror’s unit pricing (to include discount percentage from or premium percentage to the benchmark Medicare rate) for the base year and all option years is public information, in accordance with Federal Acquisition Regulation (FAR) 15.503(b)(1)(iv).

Accordingly, all successful unit pricing will be released to unsuccessful Offerors with the notification of award as well as to the general public when requested. Any party who objects to the release of their own unit pricing information, should they be awarded a contract in response to this solicitation, should not submit proposal in response to the solicitation.