36C24419Q0885-0002000.docx

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Dental Lab Services - Butler VA Health Care System
Solicitation number
36C24419Q0885
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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) none 00244 Department of Veterans Affairs Network Contracting Office 4

00244 Department of Veterans Affairs Network Contracting Office 4

To all Offerors/Bidders

36C24419Q0885 07-23-2019

X X X

7/25/19 1600hrs X This amendment is to do two things; extend the solicitation due date to 7/25/19 1600hrs and to update and replace the the "B.3 Price Schedule" (Refer to continuation pages).

All other terms and conditions remain the same. ***END OF AMENDMENT***

B.3 PRICE SCHEDULE (Offeror shall complete all fillable information below)

ITEM NUMBER
DESCRIPTION OF SUPPLIES/SERVICES
QUANTITY
UNIT

5 Year Estimated Total (Estimated 12 Month Cost x 5)

0001
Dental Laboratory Services for Veteran Beneficiaries of the VA Butler Health Care System in accordance with the Statement of Work and Fixed Individual Unit Prices.
60.00
MONTHS

TOTAL ESTIMATED 12 MONTH COST (ADDING UP THE 12 MONTH TOTALS BELOW): $___________

*Note 1 - Estimated quantities below are not fixed. Actual usage will depend on actual need. The Individual unit prices will be utilized for each item below.

Description of Supplies/Services
Est. Annual Quantity
Unit
Individual Unit Price
Est. 12 Month Total
Nightguard Hard
2
EA
$________
$________
Nightguard dual laminate
2
EA
$________
$________
Custom tray
35
EA
$________
$________
Stent
2
EA
$________
$________
Final cast denture
2
EA
$________
$________
Final cast fixed Pindex
2
EA
$________
$________
Denture set up
5
EA
$________
$________
Partial set up
5
EA
$________
$________
Denture process
5
EA
$_________
$________
Partial process acrylic
5
EA
$_________
$________
Partial process flexible
5
EA
$_________
$________
Metal framework
15
EA
$_________
$________
Porcelain fused to metal
10
EA
$_________
$________
PFM gold alloy price
10
EA
$_________
$________
Full gold crown
10
EA
$_________
$________
FGC gold alloy price
10
EA
$_________
$________
Full porcelain crown (emax, zirconia)
15
EA
$_________
$________
Add clasp metal framework
4
EA
$_________
$________
Add denture tooth
3
EA
$_________
$________

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