36C24418R0678-0002000.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

BY

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) 09-18-2018 none 00244 Department of Veterans Affairs Network Contracting Office 4 100 S. Independence Mall West 5th Floor Philadelphia

PA

19106 00244 Department of Veterans Affairs Network Contracting Office 4 See Block #6

To all Offerors/Bidders

36C24418R0678

X X X X

The purpose of this Amendment is to replace the Past Performance Questionnaire that was submitted earlier with this solicitation. Please delete previous version and replace with the one attached.

Proposals are due Friday, September 28, 2018 at 2:00 PM.

MAUREEN JORDAN

CONTRACTING OFFICER

NCO415L3-0823

CONTINUATION PAGE

Past Performance Questionnaire The Department of Veterans Affairs is evaluating a proposal submitted by _________________________ [Offeror’s name], hereafter referred to as “Offeror,” to provide UCC Physician Temporary Services for the Erie VA Medical Center. Offeror has provided this questionnaire to you so that we may ask you questions regarding Offeror’s past performance on a similar contract between your company and Offeror.

Any information you provide in this questionnaire is considered Source Selection Information and is prohibited from disclosure and exempt from release under the Freedom of Information Act; as such, the Department of Veterans affairs will not release the your name or the names of other individuals providing reference information about Offeror’s past performance.

Instructions: Be honest. Provide an assessment of Offeror’s past performance by checking the box of one the following rating options. You are encouraged to write comments as often as you’d like.

Rating Options:

Satisfactory—Offeror’s performance meets (or met) all contractual requirements and performance was accomplished with minor issues or concerns, for which Offeror’s corrective actions were effective.

Unsatisfactory—Offeror’s performance does not meet (or did not meet) contractual requirements and performance was accomplished with significant problems, issues or concerns, for which Offeror’s corrective actions were ineffective.

Not Applicable—Unable to provide a meaningful assessment.

When you are finished, please email your completed questionnaire to: Maureen.Jordan @ Maureen.Jordan@va.gov .

THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!

Performance Assessment

1. Reference Information Company Name: _______________________________________________________________________ Your Name: ___________________________________________________________________________ Contract Number (if Government): ________________________________________________________ Period of Performance: Start Date:_______________________ End Date:________________________ Scope of Services (e.g., contract dollar value, geographic coverage area, frequency of services, etc.):

2. Quality of performance Assess Offeror’s quality of performance in these areas:

Conformance to contract specifications (qualifications of personnel are met; have appropriate personnel to perform positions; capability to deliver timely services, etc.)

Standards of care (technical, professional, safety, and the like)

Timely deliveries of Temporary Personnel

3. Management performance Assess Offeror’s contract management performance in these areas:

Management responsiveness (timeliness, reliability, cooperation, etc.)

Management of personnel (hiring, training, retaining, replacing, etc.)

Management of program (coordination, use of resources, communication, risk management, etc.)

Management of conflicts or issues (reactive, provides good solutions, flexible to changing needs, etc.)

4. General comments

Assessor’s Signature:_____________________________________ Date:_____________________

THANK YOU FOR YOUR SUPPORT AND PARTICIPATION!

End of Document Source Selection Information—See FAR 2.101 and 3.104