36C25719Q1135-0004000.docx

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Perfusion Services Federal contract opportunity
Solicitation number
36C25719Q1135
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 17

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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) 02-18-2020 None 36C257 Department of Veterans Affairs VHA RPO West - NCO 17 Health Care Resources Branch I 11495 Turner Road El Paso TX 79936-1372 Christine Bennett - (915) 217-1240 Christine.Bennett2@va.gov 36C257 See block # 6

To all Offerors/Bidders

36C25719Q1135 01-03-2020

X X X

X The purpose of this amendment to update the the Schedule of Services.

a. See continuation page for updated Schedule of Services.

b. All other Terms and C onditions remain in full force and effect.

Carlos Jaquez Contracting Officer

SCHEDULE OF SERVICES

Period of Performance:

Base Year: July 1, 2020 through June 30, 2021

CLIN No.
SUB-CLIN
Description
Quantity
Unit
Unit Cost
Total Annual Cost
1001
None
Certified Clinical Perfusionist, Autotransfusion Technician Services.
1000
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
0001a
None
0001b
0002
None
Surgical First Assistant Services certified to perform Conduit Harvesting services and assist the surgeon during the procedure, under direct supervision.
772
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
0002a
0003
None
Extracorporeal Membrane Oxygenation (ECMO) Services in accordance with paragraph 3.1.2. of the PWS
168
Hour (HR)
$__________
$__________
0004
None
On-Call Weekdays
6264
Hour (HR)
$__________
$__________
0005
None
On-Call Weekends
2496
Hour (HR)
$__________
$__________

Base Year Total: $ Option Year One: July 1, 2021 through June 30, 2022

CLIN No.
SUB-CLIN
Description
Quantity
Unit
Unit Cost
Total Annual Cost
1001
None
Certified Clinical Perfusionist, Autotransfusion Technician Services.
1000
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
1001a
None
1001b
1002
None
Surgical First Assistant Services certified to perform Conduit Harvesting services and assist the surgeon during the procedure, under direct supervision.
772
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
1002a
1003
None
Extracorporeal Membrane Oxygenation (ECMO) Services in accordance with paragraph 3.1.2. of the PWS
168
Hour (HR)
$__________
$__________
1004
None
On-Call Weekdays
6264
Hour (HR)
$__________
$__________
1005
None
On-Call Weekends
2496
Hour (HR)
$__________
$__________

Option Year One Total: $

Option Year Two: July 1, 2022 through June 30, 2023

CLIN No.
SUB-CLIN
Description
Quantity
Unit
Unit Cost
Total Annual Cost
2001
None
Certified Clinical Perfusionist, Autotransfusion Technician Services.
1000
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
2001a
None
2001b
2002
None
Surgical First Assistant Services certified to perform Conduit Harvesting services and assist the surgeon during the procedure, under direct supervision.
772
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
2002a
2003
None
Extracorporeal Membrane Oxygenation (ECMO) Services in accordance with paragraph 3.1.2. of the PWS
168
Hour (HR)
$__________
$__________
2004
None
On-Call Weekdays
6264
Hour (HR)
$__________
$__________
2005
None
On-Call Weekends
2496
Hour (HR)
$__________
$__________

Option Year Two Total: $

Option Year Three: July 1, 2023 through June 30, 2024

CLIN No.
SUB-CLIN
Description
Quantity
Unit
Unit Cost
Total Annual Cost
3001
None
Certified Clinical Perfusionist, Autotransfusion Technician Services.
1000
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
3001a
None
3001b
3002
None
Surgical First Assistant Services certified to perform Conduit Harvesting services and assist the surgeon during the procedure, under direct supervision.
772
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
3002a
3003
None
Extracorporeal Membrane Oxygenation (ECMO) Services in accordance with paragraph 3.1.2. of the PWS
168
Hour (HR)
$__________
$__________
3004
None
On-Call Weekdays
6264
Hour (HR)
$__________
$__________
3005
None
On-Call Weekends
2496
Hour (HR)
$__________
$__________

Option Year Three Total: $

Option Year Four: July 1, 2024 through June 30, 2025

CLIN No.
SUB-CLIN
Description
Quantity
Unit
Unit Cost
Total Annual Cost
4001
None
Certified Clinical Perfusionist, Autotransfusion Technician Services.
1000
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
4001a
None
4001b
4002
None
Surgical First Assistant Services certified to perform Conduit Harvesting services and assist the surgeon during the procedure, under direct supervision.
772
Hour (HR)
$__________
$__________

Key Personnel

CLIN
SUB-CLIN
Name
Title

Level of Experience

None
4002a
4003
None
Extracorporeal Membrane Oxygenation (ECMO) Services in accordance with paragraph 3.1.2. of the PWS
168
Hour (HR)
$__________
$__________
4004
None
On-Call Weekdays
6264
Hour (HR)
$__________
$__________
4005
None
On-Call Weekends
2496
Hour (HR)
$__________
$__________

Option Year Four Total: $

Grand Total: $

End of Document

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