36C25220Q0093-0001017.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)

695-20-2-133-0295

NONE

36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101

Milwaukee WI 53214-1476

36C252 Department of Veterans Affairs Great Lakes Acquisition Center (GLAC) 115 S 84th Street, Suite 101

Milwaukee WI 53214-1476 To all Offerors/Bidders

36C25220Q0093 11-18-2019

X

X

11/26/19 NOON LOCAL TIME

REFERENCE SOLICITATION 36C25220Q0093 AND AMEND THE FOLLOWING:

1.) REMOVE ALL REFERENCE TO EMERGENCY (UNSCHEDULED) REPAIRS ON THE 1449.

2.) REPLACE PAGES 6 THROUGH 17 OF THE SOLICITATION. SEE CONTINUATION PAGES.

ALL OTHER TERMS AND CONDITIONS OF THE SOLICITATION REMAIN THE SAME.

SUSAN PASHOLK

CONTRACTING OFFICER

PREVENTIVE MAINTENANCE

FOR ANESTHESIA AND VENTILATOR MACHINES

SUPPLIES OR SERVICES AND PRICES/COSTS

The contractor shall furnish all labor, transportation, parts, and expertise necessary to provide preventive maintenance of the anesthesia and ventilator machines at the Edward Hines, Jr. VA Hospital as identified on the attached equipment list (Attachment A).

PRICE/COST SCHEDULE

ITEM INFORMATIONPage 2 of 13

Contractor shall furnish all labor, transportation, parts per SOW APOLLO Anesthesia Units Serial Numbers: ASDJ-0278, ASDJ-0279, ASDJ-0275 Contract Period: Base POP Begin: 01-01-2020 POP End: 12-31-2020

Contractor shall furnish all labor, transportation, parts per SOW D-Vapor 2000 Vaporizors Serial Numbers: ASEC-0396, ASEC-0397, ASEC-0398, ASEC-0399, ASEC-0400, ASEC-0401, ASEC-0402, ASEC-0403, ASEC-0404 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW D-Vapor 3000 Vaporizors Serial Numbers: ASFD-0017, ASFD-0021, ASFD-0033, ASKJ-0291 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW EVITA INFINITY V500 Ventilators Serial Numbers: ASLK-0159, ASLK-0160, ASLK-0161, ASLK-0162, ASLK-0163, ASLK-0164, ASLK-0165, ASLK-0166, ASLK-0167, ASLK-0168 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW FABIUS GS PREM Anesthesia Units Serial Numbers: ASDK-0108, ASDK-0109, ASDK-0110, ASDK-0111, ASDK-0112, ASDK-0113 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW FABIUS TIRO Anesthesia Units Serial Numbers: ARXK-0026, ARXK-0027, ARXK-0028, ARYK-0065 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW PERSEUS A500 Anesthesia Units Serial Numbers: ASMH-0228, ASMH-0229, ASMH-0230, ASMH-0231 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW Vapor 2000 - ISO Vaporizors Serial Numbers: ASED-0055, ASED-0056, ASED-0057, ASED-0058, ASED-0059, ASED-0060, ASDJ-0974, ASDJ-0977, ASDJ-0978 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW Vapor 2000 - SEVO Vaporizors Serial Numbers: ASED-0261, ASED-0262, ASED-0263, ASED-0264, ASED-0265, ASED-0266, ASED-0267, ASED-0268, ASED-0269 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW Vapor 3000 - SEVO Vaporizors Serial Numbers: ASFD-1545, ASFE-0862, ASFE-0869, ASFE-0873 Contract Period: Base

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASDJ-0278, ASDJ-0279, ASDJ-0275 Contract Period: Option 1 POP Begin: 01-01-2021 POP End: 12-31-2021

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASEC-0396, ASEC-0397, ASEC-0398, ASEC-0399, ASEC-0400, ASEC-0401, ASEC-0402, ASEC-0403, ASEC-0404 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASFD-0017, ASFD-0021, ASFD-0033, ASKJ-0291 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASLK-0159, ASLK-0160, ASLK-0161, ASLK-0162, ASLK-0163, ASLK-0164, ASLK-0165, ASLK-0166, ASLK-0167, ASLK-0168 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASDK-0108, ASDK-0109, ASDK-0110, ASDK-0111, ASDK-0112, ASDK-0113 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ARXK-0026, ARXK-0027, ARXK-0028, ARYK-0065 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASMH-0228, ASMH-0229, ASMH-0230, ASMH-0231 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASED-0055, ASED-0056, ASED-0057, ASED-0058, ASED-0059, ASED-0060, ASDJ-0974, ASDJ-0977, ASDJ-0978 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASED-0261, ASED-0262, ASED-0263, ASED-0264, ASED-0265, ASED-0266, ASED-0267, ASED-0268, ASED-0269 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASFD-1545, ASFE-0862, ASFE-0869, ASFE-0873 Contract Period: Option 1

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASDJ-0278, ASDJ-0279, ASDJ-0275 Contract Period: Option 2 POP Begin: 01-01-2022 POP End: 12-31-2022

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASEC-0396, ASEC-0397, ASEC-0398, ASEC-0399, ASEC-0400, ASEC-0401, ASEC-0402, ASEC-0403, ASEC-0404 Contract Period: Option 2 POP Begin: 01-01-2022

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASFD-0017, ASFD-0021, ASFD-0033, ASKJ-0291 Contract Period: Option 2

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASLK-0159, ASLK-0160, ASLK-0161, ASLK-0162, ASLK-0163, ASLK-0164, ASLK-0165, ASLK-0166, ASLK-0167, ASLK-0168 Contract Period: Option 2

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASDK-0108, ASDK-0109, ASDK-0110, ASDK-0111, ASDK-0112, ASDK-0113 Contract Period: Option 2

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ARXK-0026, ARXK-0027, ARXK-0028, ARYK-0065 Contract Period: Option 2

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASMH-0228, ASMH-0229, ASMH-0230, ASMH-0231 Contract Period: Option 2

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASED-0055, ASED-0056, ASED-0057, ASED-0058, ASED-0059, ASED-0060, ASDJ-0974, ASDJ-0977, ASDJ-0978 Contract Period: Option 2 POP Begin: 01-01-2022

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASED-0261, ASED-0262, ASED-0263, ASED-0264, ASED-0265, ASED-0266, ASED-0267, ASED-0268, ASED-0269 Contract Period: Option 2

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASFD-1545, ASFE-0862, ASFE-0869, ASFE-0873 Contract Period: Option 2

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASDJ-0278, ASDJ-0279, ASDJ-0275 Contract Period: Option 3 POP Begin: 01-01-2023 POP End: 12-31-2023

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASEC-0396, ASEC-0397, ASEC-0398, ASEC-0399, ASEC-0400, ASEC-0401, ASEC-0402, ASEC-0403, ASEC-0404 Contract Period: Option 3

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASFD-0017, ASFD-0021, ASFD-0033, ASKJ-0291 Contract Period: Option 3

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASLK-0159, ASLK-0160, ASLK-0161, ASLK-0162, ASLK-0163, ASLK-0164, ASLK-0165, ASLK-0166, ASLK-0167, ASLK-0168 Contract Period: Option 3 POP Begin: 01-01-2023

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASDK-0108, ASDK-0109, ASDK-0110, ASDK-0111, ASDK-0112, ASDK-0113 Contract Period: Option 3

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ARXK-0026, ARXK-0027, ARXK-0028, ARYK-0065 Contract Period: Option 3

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASMH-0228, ASMH-0229, ASMH-0230, ASMH-0231 Contract Period: Option 3

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASED-0055, ASED-0056, ASED-0057, ASED-0058, ASED-0059, ASED-0060, ASDJ-0974, ASDJ-0977, ASDJ-0978 Contract Period: Option 3

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASED-0261, ASED-0262, ASED-0263, ASED-0264, ASED-0265, ASED-0266, ASED-0267, ASED-0268, ASED-0269 Contract Period: Option 3

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASFD-1545, ASFE-0862, ASFE-0869, ASFE-0873 Contract Period: Option 3 POP Begin: 01-01-2023

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASDJ-0278, ASDJ-0279, ASDJ-0275 Contract Period: Option 4 POP Begin: 01-01-2024 POP End: 12-31-2024

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASEC-0396, ASEC-0397, ASEC-0398, ASEC-0399, ASEC-0400, ASEC-0401, ASEC-0402, ASEC-0403, ASEC-0404 Contract Period: Option 4

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASFD-0017, ASFD-0021, ASFD-0033, ASKJ-0291 Contract Period: Option 4

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASLK-0159, ASLK-0160, ASLK-0161, ASLK-0162, ASLK-0163, ASLK-0164, ASLK-0165, ASLK-0166, ASLK-0167, ASLK-0168 Contract Period: Option 4

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASDK-0108, ASDK-0109, ASDK-0110, ASDK-0111, ASDK-0112, ASDK-0113 Contract Period: Option 4

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ARXK-0026, ARXK-0027, ARXK-0028, ARYK-0065 Contract Period: Option 4 POP Begin: 01-01-2024

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASMH-0228, ASMH-0229, ASMH-0230, ASMH-0231 Contract Period: Option 4

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASED-0055, ASED-0056, ASED-0057, ASED-0058, ASED-0059, ASED-0060, ASDJ-0974, ASDJ-0977, ASDJ-0978 Contract Period: Option 4

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASED-0261, ASED-0262, ASED-0263, ASED-0264, ASED-0265, ASED-0266, ASED-0267, ASED-0268, ASED-0269 Contract Period: Option 4

Contractor shall furnish all labor, transportation, parts per SOW

Serial Numbers: ASFD-1545, ASFE-0862, ASFE-0869, ASFE-0873 Contract Period: Option 4

STATEMENT OF WORK

Edward Hines, JR. VA Hospital Anesthesia and Ventilator Preventative Maintenance Service Contract

1. SCOPE: Contractor shall furnish all labor, transportation, parts, and expertise necessary to provide preventive maintenance of anesthesia and ventilator machines at the Edward Hines, Jr. VA Hospital, as identified on the attached equipment list (Attachment A). No access to sensitive information or the VA network will be required as part of this service.

2. CONTRACT PERIOD: Base contract period shall be 01/01/2020-12/31/2020

3. QUALIFICATIONS: To be considered eligible for consideration, offerors must have a field service representative that has been trained by the Original Equipment Manufacturer (OEM) on the specific model of equipment he/she is being asked to work on. Offerors must provide, upon request, documentation of factory certified service/maintenance training on the specific equipment under the terms of this contract. Offerors must also provide points of contact at three other medical centers with which they are or have been contracted to service surgical equipment of the same or similar models as those listed in Attachment A in the last three years. Subcontracting of any ensuing award of this solicitation will not be allowed without written permission of the Contracting Officer.

4. SERVICES TO BE PROVIDED:

A. General:

1) Contractor will provide the necessary manpower and supervision to properly execute the preventative maintenance of the equipment listed in Attachment A.

2) A “Field Service Report” (FSR) must be generated and a copy given to the Hines VA Hospital’s Contracting Officer’s Representative (COR) or designee after completion of the preventative maintenance. It is preferred that this FSR be provided electronically, if possible.

B. Repair:

1) All maintenance will be performed during normal VA business hours, 8:00am to 4:30pm, Monday thru Friday, except Federal Holidays, which include: Page 11 of 13

New Year's Day Birthday of Martin Luther King, Jr.

Washington's Birthday

Memorial Day

Independence Day

Labor Day

Columbus Day

Veterans Day

Thanksgiving Day

Christmas Day

If after hours emergency service is required, it will be paid separate from this contract. Work shall not commence without prior approval from the COR and a separate Purchase Order.

2) If the contractor’s telephones are not answered by technical personnel, a technical maintenance representative will respond by telephone to the VA within 4 hours of a maintenance call from the Hines VA.

3) Contractor must furnish all tools and materials (e.g. service manuals, diagnostic software, etc.) required to perform manufacturer recommended preventative maintenance.

C. Preventive Maintenance:

1) Preventive Maintenance will be performed by the contractor at the intervals that are in accordance with the manufacturer’s recommendations, but no less than annually.

2) Contractor will furnish any required parts, supplies, or “PM kits” needed to perform Preventive Maintenance.

3) At the conclusion of each repair and maintenance visit, the contractor will provide a written service report indicating the date of service, the model, serial number, and location of equipment serviced; the name of the representative, and the services performed, and parts replaced. The reports will be delivered to the Biomedical Engineering Office, Building 228, Room B1024 or electronically to the COR/designee.

D. Documentation: A documentation package acceptable for Joint Commission purposes will be maintained by the contractor and made available to the Hines VA Hospital. Documentation shall include, at a minimum:

1) Serial Number of equipment serviced

2) Any and all work performed on a particular date

3) Model, serial number and location of equipment serviced.

4) Details of preventative maintenance including the name of the representative, steps that were performed during the PM to include test and performance results as well as any parts replaced.

5. FACILITY CHECK IN/CHECK OUT REQUIREMENTS:

A. Vendor shall check in with the COR or designated representative, prior to beginning any work. Due to the nature of working at a Government facility, the Contractor's staff shall be required to sign in and out each day at Bldg. 228, Biomedical Engineering. This sign-in is MANDATORY.

COR: Ryan Kammerer Location: Building 228 Room B1024 Telephone Number & Extension(s): (708) 202-8387, ext. 21167

6. TERMS AND CONDITIONS:Page 12 of 13

A. User Responsibility: The contractor will not be held responsible under the terms of this contract for repairs to equipment necessitated by user abuse and/or misuse of equipment.

B. Exclusions: Service does not include electrical work external to the equipment.

7. IDENTIFICATION, PARKING, SMOKING, AND VA REGULATIONS:

A. No contractor or sub-contractor employee shall be permitted to perform work or access non-public areas unescorted without an ID card obtained from the VA Police. Contractor's and any Subcontractor's employees will be required to provide 2 forms of ID and be accompanied by the COR to obtain ID.

B. It is the responsibility of the Contractor to park in the appropriate designated parking areas. Information on parking is available from the VA Police Section. The VAMC will not invalidate or make reimbursement for parking violations of the Contractor under any conditions.

C. Effective January 1, 2019, smoking is prohibited both inside and outside (entire campus) at the VAMC.

D. Possession of weapons is prohibited. Enclosed containers, including tool kits, shall be subject to search. Violations of VA regulations may result in citation answerable in the United States (Federal) District Court, not a local district, state, or municipal court.

8. DEFINITIONS/ACRONYMS:

Revised