36C25719Q0293-0001001.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 4

0001 01-31-2019

549-19-1-081-1814

N/A

Department of Veterans Affairs VISN17 Network Contracting Activity 7400 Merton Minter Blvd. (10N17/90C) San Antonio TX 78229

Department of Veterans Affairs VISN17 Network Contracting Activity 7400 Merton Minter Blvd. (10N17/90C) San Antonio TX 78229

To all Offerors/Bidders

36C25719Q0293

01-30-2019

X

X X

See CONTINUATION Page

X 1

Solicitation Amendment done to make the following changes:

1. Line Items descriptions are being changed to include the percentage of the possible increase in Quantity.

2. Fistula On/Off Kit supply list is being added to the solicitation as an attachment.

Michael J. Tisinger Contracting Officer

CONTINUATION PAGE

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

40.00 CS _____________ _______________

FISTULA ON/OFF KIT. QUANTITY CAN BE INCREASED UP

TO 50 PERCENT AT THE SAME COST.

Contract Period: Base POP Begin: 02-07-2019 POP End: 02-06-2020

MANUFACTURER PART NUMBER (MPN): DYKM1512

NATIONAL STOCK NUMBER: 7530-01-387-7626

LOCAL STOCK NUMBER: DYKM1512

TO 50 PERCENT AT THE SAME COST.

Contract Period: Option 1 POP Begin: 02-07-2020 POP End: 02-06-2021

MANUFACTURER PART NUMBER (MPN): DYKM1512

TO 50 PERCENT AT THE SAME COST.

Contract Period: Option 2 POP Begin: 02-07-2021 POP End: 02-06-2022

MANUFACTURER PART NUMBER (MPN): DYKM1512

TO 50 PERCENT AT THE SAME COST.

Contract Period: Option 3 POP Begin: 02-07-2022 POP End: 02-06-2023

MANUFACTURER PART NUMBER (MPN): DYKM1512

TO 50 PERCENT AT THE SAME COST.

Contract Period: Option 4 POP Begin: 02-07-2023 POP End: 02-06-2024

MANUFACTURER PART NUMBER (MPN): DYKM1512

GRAND TOTAL

A.2 DELIVERY SCHEDULE

ITEM NUMBER QUANTITY DELIVERY DATE

0001 SHIP TO: Department of Veterans Affairs North Texas VA Health Care System 4500 South Lancaster Road Dallas, TX 75216 United States

40.00 02/07/2019 to 02/06/2020

MARK

FOR:

Logistics Service POC: Jorge Davila-Alicea 214-857-0420 Jorge.Davila-Alicea@va.gov

1001 SHIP TO: Department of Veterans Affairs North Texas VA Health Care System 4500 South Lancaster Road

40.00 02/07/2020 to 02/06/2021

FOR:

Logistics Service POC: Jorge Davila-Alicea

2001 SHIP TO: Department of Veterans Affairs

System 4500 South Lancaster Road

40.00 02/07/2021 to 02/06/2022

FOR:

Logistics Service POC: Jorge Davila-Alicea

3001 SHIP TO: Department of Veterans Affairs

40.00 02/07/2022 to 02/06/2023

System 4500 South Lancaster Road

FOR:

Logistics Service POC: Jorge Davila-Alicea

4001 SHIP TO: Department of Veterans Affairs

System 4500 South Lancaster Road

40.00 02/07/2023 to 02/06/2024

FOR:

Logistics Service POC: Jorge Davila-Alicea

See attached document: FISTULA KIT ITEMS 549-19-1-081-1814.

A.2 DELIVERY SCHEDULE