36C25620Q0910 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) Department of Veterans Affairs Veterans Health Administration Network Contracting Office 16 2575 Keystone Crossing Fayetteville AR 72703 Department of Veterans Affairs Veterans Healthcare System of the Ozarks Network Contracting Office 16 Keystone Crossing Fayetteville AR 72703 To all Offerors/Bidders

36C25620Q0910

X x x

The purpose of this amendment is to add the CT Scanner model and information pertaining to it.

A. The bid due date of 07-22-2020 1400 hours remains the same.

B. CT Scanner model and information is hereby incorporated into the solicitation.

C. All other terms and conditions remain the same.

Kevin D. Pollard Contracting Officer

This list of information is what was found on the badging of all pieces around the CT room. Items mentioned as “Product not stated” are likely added components that are licensed. The recon box where the VA just had a hard drive replaced has no badging of a serial number, nor does the CPU itself. The “odometer” on the gantry/scanner is where the VA took the number for number of tube head scans as it’s more accurate than the software.

Make and Model of the system, including a complete list of all component model names/numbers to be considered for coverage under this agreement, as well as the following Tube information:

Canon Aquilion Prime Gantry:

Scanner - Toshiba (Canon) TSX-303A SN: FLB17X2233 High Voltage Generator - Toshiba (Canon) CXXG-012A SN: 5AC17X4188 Product not stated - Toshiba (Canon) CGGT-032A SN: 2AB17X3393 Product not stated - Toshiba (Canon) CXGS-011A SN: 3BA17Y2992 Couch:

Patient Couch: Toshiba (Canon) CBTB-032A SN: 1AA17X2587 Couch Lateral Movement Unit: Toshiba (Canon) CALU-001A SN: 3CB17X2325 Reconstruction console: No model/serial number available

CPU:

Product not stated - Toshiba (Canon) CKCN-017A SN: 2BA17X2692 Product not stated - Toshiba (Canon) COT-35D SN: 2BA1795682 Product not stated - Toshiba (Canon) COT-32D SN: 2BA17X3992 Product not stated - Toshiba (Canon) CSDP-001A SN: 5BB1852021 Power Distribution module: Toshiba (Canon) CETF-006B SN: 1AA17X3313 CT Tube Model Number (for example CXB-750D/4A, CXB-750G/2A, CXB-750E/4A, etc.)? CBX-750E Current scans on the tube? 55915 Date the tube was last replaced? N/A -If not replaced, when the system was installed? April 9-13-2018