36C25223Q0561 0001.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 NUMBERE

D 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 amendmen t, 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) 5/10/2023 676-23-3-559-0088 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

36C25223Q0561 05-10-2023

X X X

MAY 17, 2023 10:00 AM LOCAL

X

REFERENCE SOLICITATION 36C25223Q0561 FOR BOILER INSPECTIO

N SERVICE AT TOMAH VA MEDICAL CENTER, TOMAH, WI AND AMEND TO

REFLECT THE FOLLOWING: ADD Boiler to list of equipment and update statement of work language to reflect additional boiler per pages 2-3 of the amendment.

ALL OTHER TERMS AND CONDITIONS OF SOLICITATION REMAIN THE SAME.

OFFEORS SHALL RETURN A SIGNED COPY OF THIS AMENDMENT WITH THEIR QUOTE.

CC: COR; FILE

SUSAN PASHOLK

CONTRACTING OFFICER

BOILER ANNUAL INTERNAL/EXTERNAL OPERATIONAL INSPECIONS

STATEMENT OF WORK

Contractor shall provide all equipment, material, labor, travel costs and supervision, to perform annual internal and external, operational boiler inspections at the Tomah VA Medical Center, according to the following scope of work.

1. SCOPE

A. Inspection shall be performed in accordance with the most current version of the American Society of Mechanical Engineers (ASME) Boiler and Pressure Vessel Code., and shall follow AF Form 1222, Boiler or Pressure Vessel Inspection Report.

1) AF Form 1222 shall be provided by the Contractor.

B. Service shall involve three (3) inspections on three separate occasions. Services shall be scheduled with Boiler Plant Supervisor during the period of May through September for each contract year.

C. Each high-pressure boiler, de-aerating feed tank and condensate storage tank will receive one internal-external inspection during each contract period of performance. The VA will prepare steam boilers for internal and external inspection.

D. Visit one will have an internal inspection on a Main Plant high Pressure water tube boiler and an external (operational ) inspection done on a second boiler. It will also include an internal inspection of one of the tanks or the Cemline unfired Boiler. Visit two will include internal and external inspection of a high pressure Water tube boiler along with the second internal tank inspection or the Cemline unfired Boiler. Visit three will include the internal and external inspections of the final high pressure water tube boilers as well as the remaining tank or Cemline unfired Boiler.

E. See Table 1 below for list of equipment to be inspected under this contract.

Table 1:

STEAM BOILER 1

STEAM BOILER 2

STEAM BOILER 3

STEAM BOILER 4

DE-AERATING FEED WATER HEATER

CONDENSATE STORAGE TANK