36C25523Q0661 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) 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

36C25523Q0661 08-24-2023

X X X

X 1 (one) The purpose of Amendment A0001 to Solicitation 36C25523Q0661 is to change the Statement of Work (SOW) in Section 3. SCOPE OF WORK. Please refer to the Revised Statement of Work that is attached to this document.

This requirement is Brand Name Only.

The due date for this solicitation remains August 31,2023 at 3:00 pm CST.

Susan D. Miller Contracting Officer

STATEMENT OF WORK (SOW)

FOR

Exam Table

VETERANS HEATH ADMINISTRATION

1. INTRODUCTION

This solicitation is to provide the Veterans Health Administration, Marion, IL VA with ten (10) Exam Tables with electric motors for the Vincennes CBOC activation. The exam table is needed to be able to allow patient support during examinations with their primary care provider.

2. BACKGROUND

The Marion VAMC currently uses the exam beds in all their primary care rooms to see patients. This is an effect way to see patients and to support them throughout their appointments. Without the use of the exam bed, position and manipulation of the table will not be able support the patient for different exams.

3. SCOPE OF WORK

The contractor shall provide all tools, materials, and non-personal services necessary to install and assemble the exam bed for the Vincennes CBOC rooms.

This equipment is for a new facility that is running behind schedule. The exam tables will be shipped to Marion VA Medical Center per the directions located under #5 of this document.

4. TECHNICAL REQUIREMENTS

A. New and Unused: All goods shall be new, unused, produced from current production components, and shall be delivered ready for use.

B. Minimum Technical Specifications: EXAM TABLES:

1. Patient assist grab bars

2. Adjustable stirrups

3. Laptop work surface

4. seamless upholstery

5. Return-to-chair feature

6. Adjustable backrest

7. Sensors to minimize possibility of injuries during table movement

8. Anti-tamper on/off switch

9. Foot control

10. Low voltage actuators

11. Single power cord design

12. Weight capacity: 700 lbs.

13. Seat Height: 18”-37”

14. Length: 57”; extendable to 78”

15. Safe Glide™ leg extension length: 21”

16. Lies flat at 28”

17. Upholstery width: 28”

18. Front storage drawer: 19.7” x 19.2” x 4”

19. Side storage drawer: 22.6” x 20.2” x 7”

20. Paper storage capacity: 23”x 23”x 3.25”

21. Slide through paper holder accepts 21” & 18”

22. Pelvic Tilt

23. Drawer Warmer

24. Color-Gun Metal

25. 3-year warranty

5. DELIVERY & LOCATION INFORMATION

Delivery of exam beds will be provided to:

Marion VAMC Warehouse Bldg. 16 2401 West Main St Marion, IL 62959