19GG8025P0475-P00001_Redacted.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE PAGE

OF

PAGES

2. AMENDMENT/MODIFICATION NO.

Modification No. 00001

3. EFFECTIVE DATE

27 Aug 2025

4. REQUISITION/PURCHASE REQ. NO.

PR15336811-V2

5. PROJECT NO.

(If applicable)

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

AMERICAN EMBASSY TBILISI

29 Georgian American Friendship Avenue ATTN: GSO/PROCUREMENT

TBILISI,

GEORGIA

8. NAME AND ADDRESS OF CONTRACTOR (NO., street,city,county,State,and ZIP Code) 9a. AMENDMENT OF SOLICITATION NO.

LASHA KOBAKHIDZE

QUICK SERVICE LLC

9b. DATED (SEE ITEM 11)

BLOCK 16, APT 62, NUTSUBIDZE PL

TBILISI,

GEORGIA

10a. MODIFICATION OF

CONTRACT/ORDER NO.

19GG8025P0475

10b. DATED (SEE ITEM 13) 29 Jul 2025

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 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 _______ copies of the amendment;(b) By acknowledging receipt of this amendment on each copy of the offer submitted; 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 you 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.

12.ACCOUNTING AND APPROPRIATION DATA (If required)

1900-2025--19___X0535000C-2242-OBO--7901-19GG8025P0475-2512-XJZMRSTR--------- $

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

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

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:

Mutual Agreement of Parties D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return _2_ copies to the issuing office.

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

Modification issued for changes: CLIN #1 q-ty decrease from 63 sq.m. to 58 sq.m. CLIN #3 q-ty increase from 550 m to 1870 m. CLIN #4 q-ty decrease from 3400 m to 3385. Total amount increase by

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.

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

15B. NAME OF CONTRACTOR/OFFEROR

BY

(Signature of person authorized to sign)

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA

BY

(Signature of Contracting Officer)

16C.

DATE

SIGNED

26 Aug

NSN 7540-01-152-807

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

Page: 1 of 4

19GG8025P0475-P00001

Line Items 19GG8025P0475-P00001: FAC:7901RSTR:FWP451.01:General Parking Areas Maintenance

ITEM NO. SUPPLIES OR SERVICES QUANTITY

ORDERED UNIT UNIT PRICE AMOUNT

0001 Pedestrian Crossings Painting

8.00 square meter square meter

00USD(

.00USD

(OFF)

0002 Parking Stoppers Change (292 pcs. for change and 8 pcs. for reserve)

300.00

0.00

300.00 each each

___________ (OFF)

0.00USD (OFF)

(OFF)

0003 Parking Space Crack repair 550.00

1,320.00

1,870.00 meter meter

(OFF) 0.00USD

(OFF)

(OFF)

(OFF)

(OFF) ___________

(OFF)

0004 Employee and visitors Parking lines re-paint including electrical (green) and parking for people with disabilities

3,400.00

-15.00

3,385.00 meter meter

(OFF) 0.00USD

(OFF)

(OFF)

(OFF)

(OFF)

Previous Total: USD (OFF) Modification Total: USD (OFF) Grand Total:

(Includes Discounts)

USD (OFF)

Order Comments: Subject to funds availability.

Page: 2 of 4

ORDER FOR SUPPLIES OR SERVICES

IMPORTANT: Mark all packages and papers with contract and/or order numbers. PAGE OF PAGES

1. DATE OF ORDER

23 Jul 2025

2. CONTRACT NO.(If any) 6. SHIP TO:

19GG8025P0475, TBILI

3. ORDER NO.

19GG8025P0475

4. REQUISITION/REFERENCE NO.

PR15336811

a. NAME OF CONSIGNEE

ATTN: WAREHOUSE

5. ISSUING OFFICE (Address correspondence to)

AMERICAN EMBASSY TBILISI

29 Georgian American Friendship Avenue ATTN:

GSO/PROCUREMENT

TBILISI,

Contact Name: Ketevan Abutidze Phone:

Email: AbutidzeK@state.gov

b. STREET ADDRESS 29 Georgian American Friendship Avenue

c. CITY

TBILISI

d. STATE e. ZIP CODE

f. SHIP VIA

7. TO: 8. TYPE OF ORDER

a. NAME OF CONTRACTOR

LASHA KOBAKHIDZE

DUNS NUMBER

506863610

CONTACT PHONE NUMBER

551 51 87 97

E-MAIL:

mtavari@mail.com

FAX:

a. PURCHASE ORDER

REFERENCE YOUR: _______

Please furnish the following on the terms and conditions specified on both sides of this order and on the attached sheet, if any, including delivery as indicated.

b. DELIVERY ORDER -- Except for billing instructions on the reverse, this delivery order is subject to instructions contained on this side only of this form and is issued subject to the terms and conditions of the above-numbered contract.

b. COMPANY NAME

QUICK SERVICE LLC

c. STREET ADDRESS

BLOCK 16, APT 62, NUTSUBIDZE PL

d. CITY

TBILISI

e. STATE f. ZIP CODE 10. REQUISITIONING OFFICE

AMERICAN EMBASSY TBILISI

ATTN: FAC

9.ACCOUNTING AND APPROPRIATION DATA

1900-2025--19___X0535000C-2242-OBO-

-7901-19GG8025P0475-2512-XJZMRSTR--------- $48,792.00USD

Funds Certification Officer Signature:

11. BUSINESS CLASSIFICATION (Check appropriate box(es)) 12. F.O.B. POINT Destinationa. SMALL b. OTHER THAN SMALL c. DISADVANTAGED

d. WOMEN-OWNED e. HUBZone f. SERVICE-DISABLED VETERAN-OWNED

g. WOMEN-OWNED SMALL BUSINESS (WOSB) ELIGIBLE

UNDER THE WOMEN-OWNED SMALL BUSINESS PROGRAM

h. EDWOSB

13. PLACE OF 14. GOVERNMENT B/L NO. 15. DELIVER TO F.O.B. POINT ON OR BEFORE (Date) 30 Jul 2025

16. DISCOUNT TERMS

a. INSPECTION b. ACCEPTANCE

17. SCHEDULE (See reverse for Rejections)

ITEM NO.

(a)

SUPPLIES OR SERVICES

(b)

QUANTITY

ORDERED

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

QUANTITY ACCEPTED

(g)

SEE LINE ITEM DETAIL

SEE BILLING

INSTRUCTIONS ON

REVERSE

18. SHIPPING POINT 19. GROSS SHIPPING

WEIGHT

20. INVOICE NO. 17(h) TOT.

(Cont.

pages)21. MAIL INVOICE TO:

a. NAME

AMERICAN EMBASSY TBILISI

b. STREET ADDRESS (or P.O. Box)

7060 TBILISI PLACE

ATTN: FINANCE OFFICE

(OFF) 17(i)

(GRAND

TOTAL)

c. CITY

WASHINGTON

d. STATE

DC

e. ZIP CODE 20521-7060

22. UNITED STATES OF AMERICA BY (Signature)

23 Jul 2025

23. NAME Typed Anna K. Kosinska

TITLE: CONTRACTING/ORDERING OFFICER

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION NOT USABLE

OPTIONAL FORM 347(REV. 9/2012)

Prescribed by GSA/FAR 48 CFR 53.213(f)

Page: 3 of 4

ORDER FOR SUPPLIES OR SERVICES

SCHEDULE - CONTINUATION

PAGE NO.

IMPORTANT: Mark all packages and papers with contract and/or order numbers.

DATE OF ORDER

23 Jul 2025

TITLE

FAC:7901RSTR:FWP451.01:General Parking Areas Maintenance

CONTRACT NO. ORDER NO.

19GG8025P0475

ITEM NO.

(a)

SUPPLIES OR SERVICES

(b)

QUANTITY

ORDERED

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

QUANTITY

ACCEPTED

(g)

0001 Pedestrian Crossings Painting 63.00 square meter

0002 Parking Stoppers Change (292 pcs. for change and 8 pcs. for reserve)

300.00 each ) F)

0003 Parking Space Crack repair 550.00 meter

0004 Employee and visitors Parking lines re-paint including electrical (green) and parking for people with disabilities

3,400.00 meter

Order Comments:

Subject to funds availability.

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17h)

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION NOT USABLE

OPTIONAL FORM 348 (REV. 9/2012)

Prescribed by GSA - FAR (48 CFR) 53.213(f)

Page: 4 of 4