36C25619Q1046-0001002.pdf

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)

1 19

0001 07-15-2019

667-19-3-132-0369

None

00502

ALEXANDRIA VA HEALTH CARE SYSTEM

NETWORK CONTRACTING OFFICE 16

ALEXANDRIA VA HEALTH CARE SYSTEM

PO BOX 69004

ALEXANDRIA LA 71306-9004

00502

DEPARTMENT OF VETERANS AFFAIRS

NETWORK CONTRACTING OFFICE 16

ALEXANDRIA VA HEALTH CARE SYSTEM

2495 SHREVEPORT HIGHWAY

PINEVILLE LA 71360-4004

To all Offerors/Bidders

36C25619Q1046

07-15-2019

X

X X

** HOUR & DATE for Receipt of Offers is EXTENDED to:

See CONTINUATION Page

NOT APPLICABLE

THE PURPOSE OF THIS AMENDMENT IS TO EXTEND THE OFFER DUE DATE AND INCLUDE AS AN ATTACHMENT A "BRAND NAME JUSTIFICATION

DOCUMENT". THE CHANGES ARE AS FOLLOW:

A. The SF 1449, Block 8. Offer Due date is hereby changed from "07-02-2019" to read "07-22-2019".

B. Justification for Brand Name is hereby attached to the amendment.

C. All other terms and conditions remain unchanged.

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBE

R

DESCRIPTION OF

SUPPLIES/SERVIC

ES

QUANTIT

Y

UNI

T UNIT PRICE AMOUNT

6.00 EA ________________

CAVITRON JET PLUS

LOCAL STOCK NUMBER: 70365684

20.00 EA ________________

JET-MATE HPC

LOCAL STOCK NUMBER: 72739910

USONIC INSERT #10 PRO+ 30K

LOCAL STOCK NUMBER: 73747805

UL TRSNC INSRT SWVL FLOW 10 UNIV 30KHZ

LOCAL STOCK NUMBER: 73749066

USONIC INSERT UNIV #1000-30K

LOCAL STOCK NUMBER: 73747342

SCALER TIP FSI/SLI 1000 30K

LOCAL STOCK NUMBER: 72723559

40.00 EA ________________

CAVITRON 30K SOFTIP IMPLANT

LOCAL STOCK NUMBER: 72739852

25.00 EA ________________

SOFTIP DISP PROPHY TIPS

LOCAL STOCK NUMBER: 74948204

4.00 EA ________________

SURGITRON DUAL RF 120

LOCAL STOCK NUMBER: 101589518

30.00 EA ________________

SWIVEL 4L F/430KSW TITAN SW

LOCAL STOCK NUMBER: 70472092

30.00 EA ________________

SWIVEL O RING KIT 2SM/2LG

LOCAL STOCK NUMBER: 76597249

70.00 EA ________________

INSTRUMENT CASSETTE SER 7 14

LOCAL STOCK NUMBER: 74980066

25.00 EA ________________

INSTRUMENT CASSETTE SER 14 14

LOCAL STOCK NUMBER: 74980108

SURGICAL CASSETTE MEDIUM

LOCAL STOCK NUMBER: STDBOM

3.00 EA ________________

EXCAVATOR ENDO & GLICK DE#2

LOCAL STOCK NUMBER: 73700911

BUCHANAN HAND PLUGGER #2

LOCAL STOCK NUMBER: 71135755

BUCHANAN HAND PLUGGER #1

LOCAL STOCK NUMBER: 71135748

BUCHANAN HAND PLUGGER SZ 0

LOCAL STOCK NUMBER: 74218442

RUBBER DAM CLAMP SATIN FINISH 1

LOCAL STOCK NUMBER: 73726536

RUBBER DAM CLAMP SATIN FINISH 56S

LOCAL STOCK NUMBER: 73726932

5.00 EA ________________

RUBBER DAM CLAMP SATIN FINISH 3

LOCAL STOCK NUMBER: 73726593

2.00 EA ________________

RUBBER DAM CLAMP SATIN FINISH 26

LOCAL STOCK NUMBER: 73726841

RUBBER DAM CLAMP SATIN FINISH 13A

LOCAL STOCK NUMBER: 73726775

RUBBER DAM CLAMP SATIN FINISH 12A

LOCAL STOCK NUMBER: 73726767

RUBBER DAM CLAMP SATIN FINISH 212SA

LOCAL STOCK NUMBER: 73726973

RUBBER DAM CLAMP SATIN FINISH 00

LOCAL STOCK NUMBER: 73726510

RUBBER DAM CLAMP FORCEP IVORY

LOCAL STOCK NUMBER: 70476432

MIRROR HANDLE OCT CS W/RULE

LOCAL STOCK NUMBER: 74983706

EXPLORER ENDO REAL WORLD POSTERIOR

LOCAL STOCK NUMBER: 75775770

38.00 EA ________________

SCALER U-15 TOWNER SE

LOCAL STOCK NUMBER: 70927608

ELEVATOR SURG 80S ROOT TIP PICK

LOCAL STOCK NUMBER: 75771910

ELEVATOR SURG 80

LOCAL STOCK NUMBER: 75772751

ELEVATOR SURG SCHMKBR APEXO #E-5

LOCAL STOCK NUMBER: 73698289

ELEVATOR SURG SCHMKBR APEXO #E-4

LOCAL STOCK NUMBER: 73698271

ELEVATOR SURG WOODWARD #15

LOCAL STOCK NUMBER: 73693512

ELEVATOR SURG CRYER E25

LOCAL STOCK NUMBER: 73695160

ELEVATOR SURG CRYER E26

LOCAL STOCK NUMBER: 73695178

10.00 EA ________________

LUXATING ELEVATOR 3MM CURVED

LOCAL STOCK NUMBER: 73711926

8.00 EA ________________

LUXATING ELEVATOR 5MM CURVED

LOCAL STOCK NUMBER: 73711942

FORCEPS SURG ROOT #301

LOCAL STOCK NUMBER: 73709136

FORCEPS SURG EXTRACTING BBL

LOCAL STOCK NUMBER: 70864264

FORCEPS SURG EXTRACTING 88R

LOCAL STOCK NUMBER: 70864256

FORCEPS SURG EXTRACTING 53R

LOCAL STOCK NUMBER: 70864181

FORCEPS SURG EXTRACTING 53L

LOCAL STOCK NUMBER: 70864199

APICAL FORCEPS UPR ANTERIOR

LOCAL STOCK NUMBER: 73705712

FORCEPS SURG EXTRACTING ENGL 13

LOCAL STOCK NUMBER: 47

FORCEPS SURG CRYER #151

LOCAL STOCK NUMBER: 73709003

APICAL FORCEPS UPR UNIV

LOCAL STOCK NUMBER: 73705720

FORCEPS SURG SPLIT BK 150AS

LOCAL STOCK NUMBER: 73708955

FORCEPS SURG EXTRACTING 16

LOCAL STOCK NUMBER: 70864074

FORCEPS SURG EXTRACTING 17

LOCAL STOCK NUMBER: 74978813

PERIOSTEAL SURG HOURIGAN #1

LOCAL STOCK NUMBER: 73721446

SCISSORS IRIS CVD

LOCAL STOCK NUMBER: 75437512

15.00 EA ________________

HEMOSTAT KELLY CURVED

LOCAL STOCK NUMBER: 75432588

SCISSORS CRN&GOLD CVD

LOCAL STOCK NUMBER: 73738168

13.00 EA ________________

CROWN REMOVER N134 DE

LOCAL STOCK NUMBER: 75430715

SCALER TOWNER #U15 SE #24 HDL

LOCAL STOCK NUMBER: 73734068

MATRIX RETAINER TOFF UNIV

LOCAL STOCK NUMBER: 73365921

SPATULA CEMENT #24 FLEXIBLE

LOCAL STOCK NUMBER: 70895706

CORD PACK INST #122 NS DE

LOCAL STOCK NUMBER: 75433610

COMPOSITE INST DURALITE RD #1

LOCAL STOCK NUMBER: 75430186

EXCAVATOR DE 42/43 15-8-14

LOCAL STOCK NUMBER: 73166899

AMALGAM WELL SHALLOW

LOCAL STOCK NUMBER: 70838144

CARRIER AMALGAM TARN

LOCAL STOCK NUMBER: 73678034

PLUGGER AMALGAM BLACK 2/3 N-SERR

LOCAL STOCK NUMBER: 70925719

CAVITY LINER PLACER 02-540

LOCAL STOCK NUMBER: 70843359

BURNISHER DE 26/28 BALL-FOOTBALL

LOCAL STOCK NUMBER: 73165826

BURNISHER #28/29 DE

LOCAL STOCK NUMBER: 75430459

BURNISHER #27/29 TITANIUM DE

LOCAL STOCK NUMBER: 73683299

CARVER DISCOID/CLEOID DE 4/5

LOCAL STOCK NUMBER: 73684305

CARVER HOLLENBACK #3

LOCAL STOCK NUMBER: 73596681

27.00 EA ________________

UNI-TIP SYR TIPS

LOCAL STOCK NUMBER: 71592492

ART PAPER FORCEP ECN 08-300

LOCAL STOCK NUMBER: 70838748

PLIERS COLLEGE 317B

LOCAL STOCK NUMBER: 70894691

55.00 EA ________________

EXPLORER DE TU-17/23

LOCAL STOCK NUMBER: 70924712

18.00 EA ________________

MOUTH PROPS RUBBER ADULT

LOCAL STOCK NUMBER: 70854281

RONGEURS HUFRIEDY #1

LOCAL STOCK NUMBER: 73729274

NDL HOLDER DERF

LOCAL STOCK NUMBER: 73715760

FORCEPS HALSTED-MOSQUIT CVD.12

LOCAL STOCK NUMBER: 70476200

SCISSORS LOCKLIN CVD 6 1/4"

LOCAL STOCK NUMBER: 74996922

BONE FILE MILLER #64

LOCAL STOCK NUMBER: 73682994

14.00 EA ________________

CURETTE SURG LUCAS DE #88

LOCAL STOCK NUMBER: 73685849

7.00 EA ________________

MIRROR SIMPLE STEM

LOCAL STOCK NUMBER: 70406330

58.00 EA ________________

MIRROR HANDLE RD SS

LOCAL STOCK NUMBER: 70406371

PERIOSTEAL DE MOLT 9

LOCAL STOCK NUMBER: 75432968

52.00 EA ________________

PROBE SE CC PCP 12 3-6-9-12

LOCAL STOCK NUMBER: 70926022

12.00 EA ________________

PLIER TISSUE ADSON #42

LOCAL STOCK NUMBER: 73752615

42.00 EA ________________

PROBE PERIOWISE 3-5-7-10

LOCAL STOCK NUMBER: 75822523

26.00 EA ________________

SYR ASPIRATING CW TYPE

LOCAL STOCK NUMBER: 73941275

RETRACTOR CHEEK U OF MINN

LOCAL STOCK NUMBER: 75435284

PLIER CLASP ADJUST 3 JAW SS

LOCAL STOCK NUMBER: 74991220

PERIOTOME KIT WI CASSETTE

LOCAL STOCK NUMBER: 71018159

GRAND TOTAL ________________

A.2 DELIVERY SCHEDULE

ITEM NUMBER QUANTITY

DELIVERY

DATE

0001 SHIP TO: DEPARTMENT OF VETERANS

AFFAIRS

Overton Brooks VA Medical Center 510 E. Stoner Ave.

Shreveport, LA 71101

USA

6.00 60 DAYS ARO

MARK

FOR:

Theodis Pickett 318-990-5930 theodis.pickett@va.gov

20.00

40.00

25.00

4.00

30.00

30.00

70.00

25.00

3.00

5.00

2.00

38.00

6.00

10.00

8.00

15.00

13.00

27.00

55.00

18.00

14.00

7.00

58.00

52.00

12.00

42.00

26.00

CONTINUATION PAGE

See attached document: Brand Name Justification.

DEPARTMENT OF VETERANS AFFAIRS

Justification for Single Source (including Brand Name) Awards IAW FAR 13.501

Acquisition Plan Action ID:_36C25619Q1046_________

1. Contracting Activity: Department of Veterans Affairs, VISN 16, Alexandria VA Health Care System, Pineville, LA. Network Contracting Office 16. Purchase request # 667-19-3-132-0369

2. Brief Description of Supplies/ Services required and the intended use:

Cavitron Jet Plus Dental Equipment Parts and Accessories for use by the Dental Clinic at the Overton Brook VAMC, Shreveport, LA.

3. Unique characteristics that limit availability to only one brand name, with the reason no other supplies or services can be used:

This requirement is limited to Cavitron brand name dental products. The Overton Brook VAMC currently has in stock Cavitron Dental products. The dental instruments requested in the request for quotation (RFQ) are compatible to the existing Cavitron products that are used in the Dental Clinic Service and continuous use will maintain a continuity of care in the clinic as well as replacement instruments that are currently used. Also, the Dental Clinic already has an established Standard Operation Procedure (SOP) for this product. Accepting another product that is not compatible/interchangeable with the existing products would render all parts of our resources obsolete.

4. Description of market research conducted and results or statement why it was not conducted:

Market research indicates there are more than one SDVOSB authorized distributor of the Cavitron dental instruments listed in the RFQ line items.

5. Contracting Officer's Certification: Purchase is approved in accordance with FAR13.106-1(b). I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

Name Date Title https://www.acquisition.gov/?q=/browse/far/13 https://acquisition.gov/far/current/html/Subpart%2013_1.html#wp1125466