36C24519Q0156-0005000.docx
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- Solicitation number
- 36C24519Q0156
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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) 05-08-2019 None Department of Veterans Affairs
VAMC (517)
VISN 5 Contract Satellite Office 200 Veterans Avenue Beckley
WV
25801 Department of Veterans Affairs
VAMC (613)
VISN 5 Contract Satellite Office 510 Butler Avenue, Building 308B Martinsburg
WV
25405 To all Offerors/Bidders
36C24519Q0156
X X X
See CONTINUATION Page X This modification is to correct line items within Option Year 1. The updated schedule is attached herein.
All other teams and condions of the original solicitation remain unchanged.
LINDA SMITH
Contracting Officer
CONTINUATION PAGE
A.1 PRICE/COST SCHEDULE
ITEM INFORMATION
| ITEM NUMBER |
| DESCRIPTION OF SUPPLIES/SERVICES |
| QUANTITY |
| UNIT |
| UNIT PRICE |
| AMOUNT |
| 6,520.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 5 LPM Contract Period: Base POP Begin: 07-01-2019 POP End: 06-30-2020
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 10 LPM
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 Rental Ventilator System - PLV or Equivalent
| 84.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - Trilogy or Equivalent
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Missed Patient Visit/Patient Refusal at Home
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Emergency Visit/Setup
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Setup (Primary)
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Refill
| 7,000.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size E Refills
| 7,675.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size D Refills
| 7,500.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M6 Refills
| 60.00 |
| EA |
| __________________ |
| __________________ |
W065 - Compressor - 60 PSI - Rental
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Humidified, Heated - Rental
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Demand Nasal Cannula (e.g. Oxymyzer) Reservoir or Pendant/Equivalent
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Pulse Conserver Device (Purchase)
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Recovery of VA-Owned Equipment
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065- Relocation of Equipment Due to Change in Beneficiary Residence
| 450.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Equipment, Including Setup, Patient Education
| 100.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Downloads
| 120.00 |
| EA |
| __________________ |
| __________________ |
W065 - RT Visits/Followups/RX Changes
| 144.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Single
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Set
| 50.00 |
| EA |
| __________________ |
| __________________ |
W065 - Portable Oxygen Concentrator
| 6,520.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 5 LPM Contract Period: Option 1
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 10 LPM
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - PLV or Equivalent
| 84.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - Trilogy or Equivalent
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Missed Patient Visit/Patient Refusal at Home
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Emergency Visit/Setup
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Setup (Primary)
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Refill
| 7,000.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size E Refills
POP End: 06-23-2020
| 7,675.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size D Refills
| 7,500.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M6 Refills
| 60.00 |
| EA |
| __________________ |
| __________________ |
W065 - Compressor - 60 PSI - Rental
POP Begin: 07-01-2020 POP End: 06-30-2021
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Humidified, Heated - Rental
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Demand Nasal Cannula
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Pulse Conserver Device - Purchase
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065- Recovery of VA Owned Equipment
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Relocation of Equipment Due to Change in Beneficiary Residence
| 450.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Equipment, Including Setup, Patient Education
| 100.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Downloads
| 120.00 |
| EA |
| __________________ |
| __________________ |
Wo65 - RT Visits/Followups/RX Changes
| 144.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Single
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Set
| 50.00 |
| EA |
| __________________ |
| __________________ |
W065 - Portable Oxygen Concentrators
| 6,520.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 5 LPM Contract Period: Option 2 POP Begin: 07-01-2021 POP End: 06-30-2022
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 10 LPM
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - PLV or Equivalent
| 84.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - Trilogy or Equivalent
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Missed Patient Visit/Patient Refusal at Home
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Emergency Visit/Setup
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Setup (Primary)
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Refill
| 7,000.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size E Refills
| 7,675.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size D Refills
| 7,500.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M6 Refills
| 60.00 |
| EA |
| __________________ |
| __________________ |
W065 - Compressor - 60 PSI - Rental
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Humidified, Heated - Rental
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Demand Nasal Cannula (e.g. Oxymyzer) Reservoir or Pendant/Equivalent
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Pulse Conserver Device (Purchase)
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Recovery of VA-Owned Equipment
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065- Relocation of Equipment Due to Change in Beneficiary Residence
| 450.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Equipment, Including Setup, Patient Education
| 100.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Downloads
| 120.00 |
| EA |
| __________________ |
| __________________ |
W065 - RT Visits/Followups/RX Changes
| 144.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Single
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Set
| 50.00 |
| EA |
| __________________ |
| __________________ |
WO65 - Portable Oxygen Concentrators
| 6,520.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 5 LPM Contract Period: Option 3 POP Begin: 07-01-2022 POP End: 06-30-2023
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 10 LPM
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - PLV or Equivalent
| 84.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - Trilogy or Equivalent
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Missed Patient Visit/Patient Refusal at Home
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Emergency Visit/Setup
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Setup (Primary)
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Refill
| 7,000.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size E Refills
| 7,675.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size D Refills
| 7,500.00 |
| EA |
| __________________ |
| __________________ |
WO65 - Cylinder, Size M6 Refills
| 60.00 |
| EA |
| __________________ |
| __________________ |
WO65 - Compressor - 60 PSI - Rental
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Humidified, Heated - Rental
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Demand Nasal Cannula (e.g. Oxymyzer) Reservoir or Pendant/Equivalent
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Pulse Conserver Device (Purchase)
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Recovery of VA-Owned Equipment
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Relocation of Equipment Due to Change in Beneficiary Residence
| 450.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Equipment, Including Setup, Patient Education
| 100.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Downloads
| 120.00 |
| EA |
| __________________ |
| __________________ |
W065 - RT Visits/Followups/RX Changes
| 144.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Single
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Set
| 50.00 |
| EA |
| __________________ |
| __________________ |
WO65 - Portable Oxygen Concentrators
| 6,520.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 5 LPM Contract Period: Option 4 POP Begin: 07-01-2023 POP End: 06-30-2024
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Concentrator System - up to 10 LPM
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - PLV or Equivalent
| 84.00 |
| EA |
| __________________ |
| __________________ |
W065 - Rental Ventilator System - Trilogy or Equivalent
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Missed Patient Visit/Patient Refusal at Home
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Emergency Visit/Setup
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M or H Setup (Primary)
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 -Cylinder, Size M or H Refill
| 7,000.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size E Refills
| 7,675.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size D Refills
| 7,500.00 |
| EA |
| __________________ |
| __________________ |
W065 - Cylinder, Size M6 Refills
| 60.00 |
| EA |
| __________________ |
| __________________ |
W065 - Compressor - 60 PSI - Rental
| 36.00 |
| EA |
| __________________ |
| __________________ |
W065 - Humidified, Heated - Rental
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Demand Nasal Cannula (e.g. Oxymyzer) Reservoir or Pendant/Equivalent
| 1.00 |
| EA |
| __________________ |
| __________________ |
W065 - Pulse Conserver Device (Purchase)
| 200.00 |
| EA |
| __________________ |
| __________________ |
W065 - Recovery of VA-Owned Equipment
| 24.00 |
| EA |
| __________________ |
| __________________ |
W065 - Relocation of Equipment Due to Change in Beneficiary Residence
| 450.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Equipment, Including Setup, Patient Education
| 100.00 |
| EA |
| __________________ |
| __________________ |
W065 - CPAP/BIPAP Downloads
| 120.00 |
| EA |
| __________________ |
| __________________ |
W065 - RT Visits/Followups/RX Changes
| 144.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Single
| 12.00 |
| EA |
| __________________ |
| __________________ |
W065 - Thermal Fuses, Set
| 50.00 |
| EA |
| __________________ |
| __________________ |
WO65 - Portable Oxygen Concentrators
| GRAND TOTAL |
| __________________ |
A.2 DELIVERY SCHEDULE
| ITEM NUMBER |
| QUANTITY |
| DELIVERY DATE |
6,520.00
200.00
1.00
84.00
24.00
12.00
24.00
36.00
7,000.00
7,675.00
7,500.00
60.00
36.00
24.00
1.00
200.00
24.00
450.00
100.00
120.00
144.00
12.00
50.00
6,520.00
200.00
1.00
84.00
24.00
12.00
24.00
36.00
7,000.00
7,675.00
7,500.00
60.00
36.00
24.00
1.00
200.00
24.00
450.00
100.00
120.00
144.00
12.00
50.00
6,520.00
200.00
1.00
84.00
24.00
12.00
24.00
36.00
7,000.00
7,675.00
7,500.00
60.00
36.00
24.00
1.00
200.00
24.00
450.00
100.00
120.00
144.00
12.00
50.00
6,520.00
200.00
1.00
84.00
24.00
12.00
24.00
36.00
7,000.00
7,675.00
7,500.00
60.00
36.00
24.00
1.00
200.00
24.00
450.00
100.00
120.00
144.00
12.00
50.00
6,520.00
200.00
1.00
84.00
24.00
12.00
24.00
36.00
7,000.00
7,675.00
7,500.00
60.00
36.00
24.00
1.00
200.00
24.00
450.00
100.00
120.00
144.00
12.00
50.00
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