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Wheelchair Services | STL
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36C25519Q0382
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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 ADM

INISTRATIVE 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 d ate 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 3

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

36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048 To all Offerors/Bidders

36C25519Q0382 06-26-2019

X X July 12, 2019 X

1(ONE)

The Request for Qoute (RFQ) 36C25519Q0382 is here by amended as follows:

1. The price schedule (B2) as been amended to reflect corrections in line item numbering and to add addtional information.

2. Please refer to page s below.

3. All other terms and conditions remain the same.

Frank Novello

CONTINUATION PAGE

B.2 SUPPLIES OR SERVICES AND PRICES/COSTS:

Contractor shall furnish assisted wheelchair van transportation for eligible beneficiaries of the VA Medical Center, St. Louis, Missouri (herein after referred to as VAMC). The VAMC St. Louis has two divisions located as follows: John Cochran Division (JC), 915 North Grand Blvd., St. Louis, MO 63106 and Jefferson Barracks Division (JB), #1 Jefferson Barracks Drive, St. Louis, MO 63125. Services shall be provided in accordance with all terms, conditions, provisions and the schedule of this solicitation. The primary intent of this contract is for prearranged non-emergency transportation.

BASE YEAR:

ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
EST ANNUAL QUANTITY
UNIT
UNIT PRICE
EXTENDED AMOUNT
% OF UNIT PRICE FOR FUEL
0001
Base Rate for transportation of one (1) beneficiary, one way only within the city limits of St. Louis, MO.
3000
Trips

n/a

0002
Rate per mile beyond city limits of St. Louis, MO, one way only (This rate in addition to base rate in CLIN 0001.)

24,000

Miles

0003
Trip rate for wheelchair transportation between VAMC, John Cochran Division and VAMC, Jefferson Barracks Division

1,200

Trips n/a

0004
Trip rate for wheelchair transportation between VAMC, John Cochran Division and St. Louis University Medical Center

nter

0005
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and St. Louis University Medical Center
0006
Trip rate for wheelchair transportation between VAMC, John Cochran Division and Barnes-Jewish Hospital
0007
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and Barnes-Jewish Hospital
0008
Trip rate for wheelchair transportation between VASTLHCS, John Cochran Division or Jefferson Barracks Division and VAMC Poplar Bluff, MO
0009
Trip rate for wheelchair transportation between VAMC, John Cochran Division or Jefferson Barracks Division and VAMC Marion, IL
0010
Excess waiting Time per quarter hour (15 minutes) Must be pre-approved

Hour

0011
Rate for additional wheelchair patient transported on any trip

Job

0012
Rate for attendance (in addition to driver) needed to transport patient with prior VA authorization
0013
No load charge/trip within St. Louis City

Trip

Base Year Total: $

OPTION YEAR I:

ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
EST ANNUAL QUANTITY
UNIT
UNIT PRICE
EXTENDED AMOUNT
% OF UNIT PRICE FOR FUEL
1001
Base Rate for transportation of one (1) beneficiary, one way only within the city limits of St. Louis, MO.
3000
Trips

n/a

1002
Rate per mile beyond city limits of St. Louis, MO, one way only (This rate in addition to base rate in CLIN1001.)
1003
Trip rate for wheelchair transportation between VAMC, John Cochran Division and VAMC, Jefferson Barracks Division
1004
Trip rate for wheelchair transportation between VAMC, John Cochran Division and St. Louis University Medical Center
1005
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and St. Louis University Medical Center
1006
Trip rate for wheelchair transportation between VAMC, John Cochran Division and Barnes-Jewish Hospital
1007
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and Barnes-Jewish Hospital
1008
Trip rate for wheelchair transportation between VASTLHCS, John Cochran Division or Jefferson Barracks Division and VAMC Poplar Bluff, MO
1009
Trip rate for wheelchair transportation between VAMC, John Cochran Division or Jefferson Barracks Division and VAMC Marion, IL
1010
Excess waiting Time per quarter hour (15 minutes) Must be pre-approved
1011
Rate for additional wheelchair patient transported on any trip
1012
Rate for attendance (in addition to driver) needed to transport patient with prior VA authorization
1013
No load charge/trip within St. Louis City

Option Year I Total: $

OPTION YEAR II:

ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
EST ANNUAL QUANTITY
UNIT
UNIT PRICE
EXTENDED AMOUNT
% OF UNIT PRICE FOR FUEL
2001
Base Rate for transportation of one (1) beneficiary, one way only within the city limits of St. Louis, MO.
3000
Trips

n/a

2002
Rate per mile beyond city limits of St. Louis, MO, one way only (This rate in addition to base rate in CLIN 2001.)
2003
Trip rate for wheelchair transportation between VAMC, John Cochran Division and VAMC, Jefferson Barracks Division
2004
Trip rate for wheelchair transportation between VAMC, John Cochran Division and St. Louis University Medical Center
2005
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and St. Louis University Medical Center
2006
Trip rate for wheelchair transportation between VAMC, John Cochran Division and Barnes-Jewish Hospital
2007
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and Barnes-Jewish Hospital
2008
Trip rate for wheelchair transportation between VASTLHCS, John Cochran Division or Jefferson Barracks Division and VAMC Poplar Bluff, MO
2009
Trip rate for wheelchair transportation between VAMC, John Cochran Division or Jefferson Barracks Division and VAMC Marion, IL
2010
Excess waiting Time per quarter hour (15 minutes) Must be pre-approved
2011
Rate for additional wheelchair patient transported on any trip
2012
Rate for attendance (in addition to driver) needed to transport patient with prior VA authorization
2013
No load charge/trip within St. Louis City

Option Year II Total: $

OPTION YEAR III:

ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
EST ANNUAL QUANTITY
UNIT
UNIT PRICE
EXTENDED AMOUNT
% OF UNIT PRICE FOR FUEL
3001
Base Rate for transportation of one (1) beneficiary, one way only within the city limits of St. Louis, MO.
3000
Trips

n/a

3002
Rate per mile beyond city limits of St. Louis, MO, one way only (This rate in addition to base rate in CLIN 3001.)
3003
Trip rate for wheelchair transportation between VAMC, John Cochran Division and VAMC, Jefferson Barracks Division
3004
Trip rate for wheelchair transportation between VAMC, John Cochran Division and St. Louis University Medical Center
3005
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and St. Louis University Medical Center
3006
Trip rate for wheelchair transportation between VAMC, John Cochran Division and Barnes-Jewish Hospital
3007
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and Barnes-Jewish Hospital
3008
Trip rate for wheelchair transportation between VASTLHCS, John Cochran Division or Jefferson Barracks Division and VAMC Poplar Bluff, MO
3009
Trip rate for wheelchair transportation between VAMC, John Cochran Division or Jefferson Barracks Division and VAMC Marion, IL
3010
Excess waiting Time per quarter hour (15 minutes) Must be pre-approved
3011
Rate for additional wheelchair patient transported on any trip
3012
Rate for attendance (in addition to driver) needed to transport patient with prior VA authorization
3013
No load charge/trip within St. Louis City

Option Year III Total: $

OPTION YEAR IV:

ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
EST ANNUAL QUANTITY
UNIT
UNIT PRICE
EXTENDED AMOUNT
% OF UNIT PRICE FOR FUEL
4001
Base Rate for transportation of one (1) beneficiary, one way only within the city limits of St. Louis, MO.
3000
Trips

n/a

4002
Rate per mile beyond city limits of St. Louis, MO, one way only (This rate in addition to base rate in CLIN 4001.)
4003
Trip rate for wheelchair transportation between VAMC, John Cochran Division and VAMC, Jefferson Barracks Division
4004
Trip rate for wheelchair transportation between VAMC, John Cochran Division and St. Louis University Medical Center
4005
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and St. Louis University Medical Center
4006
Trip rate for wheelchair transportation between VAMC, John Cochran Division and Barnes-Jewish Hospital
4007
Trip rate for wheelchair transportation between VAMC, Jefferson Barracks Division and Barnes-Jewish Hospital
4008
Trip rate for wheelchair transportation between VASTLHCS, John Cochran Division or Jefferson Barracks Division and VAMC Poplar Bluff, MO
4009
Trip rate for wheelchair transportation between VAMC, John Cochran Division or Jefferson Barracks Division and VAMC Marion, IL
4010
Excess waiting Time per quarter hour (15 minutes) Must be pre-approved
4011
Rate for additional wheelchair patient transported on any trip
4012
Rate for attendance (in addition to driver) needed to transport patient with prior VA authorization
4013
No load charge/trip within St. Louis City

Option Year IV Total: $

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