36C25226Q0180 0001.docx

36C25226Q0180 0001

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 06-10-2026 None 36C252 Department of Veterans Affairs Great Lakes Acquisition Center 115 South 84th Street, Suite 101 Milwaukee WI 53214-1476 36C252 Department of Veterans Affairs Great Lakes Acquisition Center 115 South 84th Street, Suite 101 Milwaukee WI 53214-1476 To all Offerors/Bidders

36C25226Q0180 05-29-2026

X X X ** HOUR & DATE for Receipt of Offers is EXTENDED to: 06-19-2026 11:00 CDT Reference Solicitation 36C25226Q0180 to provide Contracted Residential Services-Medical Respite Services to the Edward Hines, Jr. VA Hospital (Hines VAH):

This amendment extends the time for when offers are due. See Continuation Pages...

Carrie DeSwarte Contracting Officer

CONTINUATION PAGE

The Offeror must provide the following when submitting its quote.

1. Completed SF-1449 (Boxes 17a, 30a, 30b, and 30c).

1. Completed Contract Administration Data on Page 5.

1. Completed Additional Contractor Information on Page 7.

1. Completed Price Schedule on Page 9.

1. Complete and sign the VA Notice of Limitations on Subcontracting (Attachment C).

1. Complete section 3 and sign the Quality Assurance Surveillance Plan (QASP) (Attachment B).

1. Signed Contractor Certification Immigration & Nationality Act (Attachment A).

1. Completed FAR Clause 52.212-3 or Annual Representations and Certifications record completed online at https://sam.gov/.

1. Copies of all required insurance certificates (including any vehicle insurance certificates that are for vehicles that provide transportation to veteran placements in the program and Certificate of Liability Insurance).

1. Listing of all Key Personnel who will be performing services under the contract and their roles.

1. Copies of all relevant permits/licenses/accreditations and certifications as described on Pages 26-27 – Contractor & Staff Qualifications.

1. Copies of written policies and procedures as described on Pages 27-28 – Required Contractor Policies & Procedures

1. Documentation demonstrating site control for proposed facility (e.g., title, lease agreement).

1. Per the PWS, the Contractor must seek VA approval to terminate/discharge veterans from the CERS program prior to the designated discharge date unless there is a mitigating and allowable reason (e.g., veteran represents a danger to him/herself or others, or is suffering from medical issues needing medical attention, or creating a disturbance, or if the veteran is AWOL). Provide a written statement confirming the Contractor’s ability to adhere to the requirement.

1. Contractor must submit one copy of its quote with all supporting documentation to the Contracting Officer no later than June 19, 2026 at 11:00 central time via e-mail at carrie.deswarte@va.gov.

-END OF AMENDMENT-

Contracted Residential Services-Medical Respite services Page 1 of