36C24721R0064 0013.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) 521-22-1-829-0003 n/a Department of Veterans Affairs Central Alabama Veterans Health Care 215 Perry Hill Road Montgomery

AL

36109-3798 Department of Veterans Affairs Ralph H. Johnson VAMC 325 Folly Rd.

Charleston

SC

29412 To all Offerors/Bidders

36C24721R0064 07-23-2021

X x x ** HOUR & DATE for Receipt of Offers is EXTENDED to:

extended till 12/15/2021 @1:00 CST See CONTINUATION Page 521-3610160-829-820100-2580 0100C0088 x The purpose of this amendment is to provide the following;

This amendment includes an updated Price/ Cost schedule.

This amendment includes the clauses associated with an IDIQcontract.

NO ADDITIONAL QUESTIONS WILL BE ACCEPTED.

Latoyer Furbush Contracting Officer

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

Base Rate - Nonemergency Ambulette Wheelchair Transport up to 150 mile radius Contract Period: Base POP Begin: 01-01-2022 POP End: 12-31-2022

Mileage Rate - Nonemergency Ambulette Wheelchair Transport over 150 mile radius

Base Rate - Nonemergency Ambulette Stretcher Transport up to 150 mile radius

Mileage Rate - Nonemergency Ambulance Stretcher Transport (for routinely scheduled outpatient clinic appointments) over 150 mile radius

Base Rate - Basic Life Support (BLS) Stretcher Transport up to 150 mile radius

Mileage Rate - Basic Life Support (BLS) Stretcher Transport over 150 mile radius

Base Rate - Advanced Life Support (ALS) Stretcher Transport up to 150 mile radius

Mileage Rate - Advanced Life Support (ALS) Stretcher Transport over 150 mile radius

Special Mental Health Patient Transport: Mental Health patient transport where two attendants and one driver for a total of three personnel are required. (When Requested)

Dry Run - Ambulette Wheelchair

Dry Run - Nonemergency Ambulance Stretcher Transport(for routinely scheduled outpatient clinic appointments)

Dry Run - Basic Life Support (BLS)

Dry Run -Advanced Life Support (ALS)

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulette Wheelchair

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulance Stretcher (for routinely scheduled outpatient clinic appointments)

Wait Time (After 30 minutes in 15 minute increments) - Basic Life Suppot (BLS) Stretcher

Wait Time (After 30 minutes in 15 minute increments) - Advanced Life Support (ALS) Stretcher

Base Rate - Nonemergency Ambulette Wheelchair Transport up to 150 mile radius Contract Period: Option 1 POP Begin: 01-01-2023 POP End: 12-31-2023

Mileage Rate - Nonemergency Ambulette Wheelchair Transport over 150 mile radius

Base Rate - Nonemergency Ambulance Stretcher Transport up to 150 mile radius

Mileage Rate - Nonemergency Ambulance Stretcher Transport(for routinely scheduled outpatient clinic appointments) over 150 mile radius

Base Rate - Basic Life Support (BLS) Stretcher Transport up to 150 mile radius

Mileage Rate - Basic Life Support (BLS) Stretcher Transport over 150 mile radius

Base Rate - Advanced Life Support (ALS) Stretcher Transport up to 150 mile radius

Mileage Rate - Advanced Life Support (ALS) Stretcher Transport over 150 mile radius

Special Mental Health Patient Transport: Mental Health patient transport where two attendants and one driver for a total of three personnel are required. (When Requested)

Dry Run - Ambulette Wheelchair

Dry Run - Nonemergency Ambulance Stretcher Transport(for routinely scheduled outpatient clinic appointments)

Dry Run - Basic Life Support (BLS)

Dry Run -Advanced Life Support (ALS)

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulette Wheelchair

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulance Stretcher(for routinely scheduled outpatient clinic appointments)

Wait Time (After 30 minutes in 15 minute increments) - Basic Life Suppot (BLS) Stretcher

Wait Time (After 30 minutes in 15 minute increments) - Advanced Life Support (ALS) Stretcher

Base Rate - Nonemergency Ambulette Wheelchair Transport up to 150 mile radius Contract Period: Option 2 POP Begin: 01-01-2024 POP End: 12-31-2024

Mileage Rate - Nonemergency Ambulette Wheelchair Transport over 150 mile radius

Base Rate - Nonemergency Ambulance Stretcher Transport up to 150 mile radius

Mileage Rate - Nonemergency Ambulette Stretcher Transport (for routinely scheduled outpatient clinic appointments)over 150 mile radius

Base Rate - Basic Life Support (BLS) Stretcher Transport up to 150 mile radius

Mileage Rate - Basic Life Support (BLS) Stretcher Transport over 150 mile radius

Base Rate - Advanced Life Support (ALS) Stretcher Transport up to 150 mile radius

Mileage Rate - Advanced Life Support (ALS) Stretcher Transport over 150 mile radius

Special Mental Health Patient Transport: Mental Health patient transport where two attendants and one driver for a total of three personnel are required. (When Requested)

Dry Run - Ambulette Wheelchair

Dry Run - Nonemergency Ambulance Stretcher Transport(for routinely scheduled outpatient clinic appointments)

Dry Run - Basic Life Support (BLS)

Dry Run -Advanced Life Support (ALS)

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulette Wheelchair

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulance Stretcher(for routinely scheduled outpatient clinic appointments)

Wait Time (After 30 minutes in 15 minute increments) - Basic Life Suppot (BLS) Stretcher

Wait Time (After 30 minutes in 15 minute increments) - Advanced Life Support (ALS) Stretcher

Base Rate - Nonemergency Ambulette Wheelchair Transport up to 150 mile radius Contract Period: Option 3 POP Begin: 01-01-2025 POP End: 12-31-2025

Mileage Rate - Nonemergency Ambulette Wheelchair Transport over 150 mile radius

Base Rate - Nonemergency Ambulance Stretcher Transport up to 150 mile radius

Mileage Rate - Nonemergency Ambulette Stretcher Transport over(for routinely scheduled outpatient clinic appointments) 150 mile radius

Base Rate - Basic Life Support (BLS) Stretcher Transport up to 150 mile radius

Mileage Rate - Basic Life Support (BLS) Stretcher Transport over 150 mile radius

Base Rate - Advanced Life Support (ALS) Stretcher Transport up to 150 mile radius

Mileage Rate - Advanced Life Support (ALS) Stretcher Transport over 150 mile radius

Special Mental Health Patient Transport: Mental Health patient transport where two attendants and one driver for a total of three personnel are required. (When Requested)

Dry Run - Ambulette Wheelchair

Dry Run - Nonemergency Ambulance Stretcher Transport(for routinely scheduled outpatient clinic appointments)

Dry Run - Basic Life Support (BLS)

Dry Run -Advanced Life Support (ALS)

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulette Wheelchair

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulance Stretcher(for routinely scheduled outpatient clinic appointments)

Wait Time (After 30 minutes in 15 minute increments) - Basic Life Suppot (BLS) Stretcher

Wait Time (After 30 minutes in 15 minute increments) - Advanced Life Support (ALS) Stretcher

Base Rate - Nonemergency Ambulette Wheelchair Transport up to 150 mile radius Contract Period: Option 4 POP Begin: 01-01-2026 POP End: 12-31-2026

Mileage Rate - Nonemergency Ambulette Wheelchair Transport over 150 mile radius

Base Rate - Nonemergency Ambulance Stretcher Transport up to 150 mile radius

Mileage Rate - Nonemergency Ambulance Stretcher Transport(for routinely scheduled outpatient clinic appointments) over 150 mile radius

Base Rate - Basic Life Support (BLS) Stretcher Transport up to 150 mile radius

Mileage Rate - Basic Life Support (BLS) Stretcher Transport over 150 mile radius

Base Rate - Advanced Life Support (ALS) Stretcher Transport up to 150 mile radius

Mileage Rate - Advanced Life Support (ALS) Stretcher Transport over 150 mile radius

Special Mental Health Patient Transport: Mental Health patient transport where two attendants and one driver for a total of three personnel are required. (When Requested)

Dry Run - Ambulette Wheelchair

Dry Run - Nonemergency Ambulance Stretcher Transport(for routinely scheduled outpatient clinic appointments)

Dry Run - Basic Life Support (BLS)

Dry Run -Advanced Life Support (ALS)

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulette Wheelchair

Wait Time (After 30 minutes in 15 minute increments) - Nonemergency Ambulette Stretcher(for routinely scheduled outpatient clinic appointments)

Wait Time (After 30 minutes in 15 minute increments) - Basic Life Suppot (BLS) Stretcher

Wait Time (After 30 minutes in 15 minute increments) - Advanced Life Support (ALS) Stretcher