36C25621R0122 0003.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 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)

08/24/2021 667-21-4-513-0226

667-15-104 00502

DEPARTMENT OF VETERANS AFFAIRS

NETWORK CONTRACTING OFFICE 16

ALEXANDRIA VA HEALTH CARE SYSTEM

2495 SHREVEPORT HIGHWAY, 71N

PINEVILLE LA 71360

00502

DEPARTMENT OF VETERANS AFFAIRS

NETWORK CONTRACTING OFFICE 16

ALEXANDRIA VA HEALTH CARE SYSTEM

2495 SHREVEPORT HIGHWAY, 71N

PINEVILLE LA 71360

To all Offerors/Bidders

36C25621R0122 08-02-2021

X

The purpose of this amendment is to inform offerors of a requirement to comply with VHA Directive 1193 Coronavirus Disease 2019 Vaccination Program for VHA Health Care Personnel. In accordance with VHA VHA Directive 1193, it is VHA’s policy that VA medical facilities will implement a mandatory COVID-19 vaccination program by requiring all VHA Health Care Personnel (HCP) to receive a COVID-19 vaccination or obtain an exemption for medical or religious reasons.

See Continuation Page and attached VHA Directive 1193.

All other terms and conditions remain unchanged.

Kaitlyn West

NCO 16

Continuation of Block 14.

HCP Contractor personnel employed by your company and working at VA medical facilities, are required to comply with VHA Directive 1193 and requirements outlined in the directive. Please see the specific requirements below and ensure action is taken within 8 weeks of publication of this Directive. The effective date of the directive is 13 August 2021. Therefore, the deadline for compliance is on/about 8 October 2021.

VHA Health Care Personnel. VHA HCP are required to comply with VHA Directive 1193 by:

(1) Receiving a complete COVID-19 immunization series or obtaining an exemption for medical or religious reasons.

(2) Submitting the Health Care Personnel COVID-19 Vaccination Form, VA Form 10-263 (See Appendix B of the Directive) to Employee Occupational Health (EOH).

(a) If a VHA HCP is vaccinated at a VHA location, by VHA EOH, they are not required to complete and submit VA Form 10-263 to EOH.

(b) If a VHA HCP is vaccinated outside of EOH and has submitted acceptable and complete documentation of vaccination, as prescribed in Appendix A, to EOH, they are not required to complete and submit VA Form 10-263 to EOH.

(c) If a VHA HCP is vaccinated outside of EOH, but has not submitted acceptable and complete documentation of vaccination, as prescribed in Appendix A, to EOH, they must complete and submit VA Form 10-263 to EOH with all required documentation and within the timelines as prescribed in this directive.

(d) If a VHA HCP is exempt from COVID-19 vaccination for medical or religious reasons, they must complete the COVID-19 Vaccination VA Form 10-263 (Appendix B), declaring the exemption and acknowledging the requirement to wear a face mask when under conditions in the work environment described (See Appendix A, paragraph 5.a and Appendix B).

List of Attachments

See attached document: VHA Directive 1193 COVID 2019 Vaccination August 13 2021.