36C24219Q0219-0001000.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

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:

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

E. IMPORTANT:

is extended,

(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 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 is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, 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.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

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.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

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

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

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

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

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 03-14-2019 None Department of Veterans Affairs Samuel S . Stratton VA Medical Center 113 Holland Avenue (2-90NCA) Albany

NY

12208-3410 Department of Veterans Affairs Samuel S . Stratton VA Medical Center Network Contracting Activity 113 Holland Avenue (2-90NCA) Albany

NY

12208-3410 To all Offerors/Bidders

36C24219Q0219 03-14-2019

X X X

The purpose of this amendment is to issue amended Statement of Work (SOW) requireing installation. The requirement is parts only, installation is not required.

Collins, Charles Contracting Officer

VA-VHA-SAOE-2018-6171B029

Statement of Work Door Alarms for Inpatient Psychiatry Stratton VA Medical Center 10/31/18

A. GENERAL INFORMATION

The general scope of this procurement is to purchase bedroom door alarms for the inpatient psychiatric unit. The doors are a vulnerability on the unit because they can be a ligature point for hanging oneself. Door top alarms are designed to detect anything that could be put on top of the door, and then create an alert for the nursing station. The mitigation is done in the interest of patient safety.

Equipment Purchase only **No Installation**

SCOPE

This work involves materials and installation of a Top Door Alarm System at Albany Stratton VA Medical Center, including 8 doors in 8 rooms for 1 unit.

REQUIREMENT/SALIENT CHARACTERISTICS/SPECIFICATIONS

Common Nomenclature:

Top Door Alarm System

Kind of material:

Per door, to include:

‐ 2 each photo electric detection beams with ligature‐resistant covers for TOP of the door protection

- 1 each electrified Full Mortise Continuous Hinge Per room, to include:

‐ 1 each key deactivation switch; with key cylinder for BEST 7-pin system VA will supply core.

‐ 1 each emergency notification strobe ‐ 2 each multi‐door hubs Per system, to include:

- 1 each ‐ Master control unit with remote touch screen interface panel

- 1 each ‐ Auxiliary power supply

- 1 each ‐ Hallway siren

Electrical Data:

110VAC

Dimensions, size, capacity:

1 system with 8 door alarms

Principles of operation:

Door top alarms are designed to detect anything that could be put on top of the door, and then create an alert for the nursing station. Upon detection an audible alarm will sound and a visual alarm will be present at the door and at a remote monitoring panel in the nurse’s station. The alarm must reset at the key switch on the door.

Restrictive environmental conditions:

Intended use:

Mitigate suicide risk to patients.

Equipment with which the item is used, Job related tools:

Best 7-pin core.

End item application:

Monitor door tops to mitigate suicide risk for patients

Original equipment manufacturer part number:

None new system.

Other pertinent information that describes the item, material or service required:

OTHER UNIQUE REQUIREMENTS

Compatibility with Existing Equipment:

Switch cylinders must be compatible with Best 7-pin cores.

Applicable DICOM compliance, Directives or IT Policies:

Warranty: 1 year from date of receipt

Training:

Service and/or Maintenance:

Safety/ISO/IT/BioMed/SPS & Other Departmental Compliance: N/A. Not on network.

B. DELIVERY

Contractor will deliver all components for fully operational system.

Contractor must deliver all components of the system as stated in this solicitation within 30 days of award notice.

Contractor must deliver all items in this solicitation to;

Stratton VAMC, 113 Holland Ave Albany NY 12208 Upon receipt, the Government will inspect items for condition and acknowledge condition within 1 week of receipt.

Standard FOB Destination is required C. Government-Furnished Property, Material, Equipment, or Information (GFP, GFM, GFE, or GFI) N/A

D. SECURITY

N/A

E. SPECIAL MATERIAL REQUIREMENT

N/A F. PLACE OF PERFORMANCE Ward 10B, VAMC Albany NY

G. PERIOD OF PERFORMANCE

The period of performance for this contract will be 45 calendar days from award notice.

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