36C25918R0596-0010000.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) None 36C259 Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village

CO

80111 36C259 Department of Veterans Affairs Network Contracting Office

NCO 19

6162 South Willow Drive, Suite 300 Greenwood Village

CO

80111 To all Offerors/Bidders

36C25918R0596

X

Revised the hours on the Schedule

Due Date to March 6th, 2019 at 3pm CST

Reminder to sign all Amendments in your Proposal

Page 1 of

See the following Price Schedule changes to add Mid-level providers and please check one of following boxes.

______ Amending the Current Pricing Schedule only

______ Amending the Current Pricing Schedule and revising our Technical Proposal

B.3 SCHEDULE OF SERVICES

The Contractor shall furnish all personnel to provide services necessary to perform onsite Orthopedic Surgery Physician Services to eligible beneficiaries of the Department of Veterans Affairs Medical Center, VA Medical Center (hereinafter referred to as VAMC). The contractor’s physician (s)’ care shall cover the range of Orthopedic Surgery Physician Services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards http://www.aaos.org/research/guidelines/guide.asp as established by the American Academy of Orthopedic Surgeons (AOS) http://www.aaos.org/.

Place of Performance: Services shall be provided on site, VAMC 1700 N Wheeling Street, Aurora, CO 80045.

Pricing Instructions:

The offeror is instructed to edit the number of sub-clins to correspond with the number of key personnel submitted for the contract line item number (CLIN). Affiliate Offerors shall include the “title” of the personnel submitted. Other commercial health care Offerors shall identify by title/position or level of experience the key personnel submitted. Also, renumber SUB-CLINs if adding or removing Key Personnel.

The offeror is instructed to include all other than price and cost information supporting the proposed price as directed in Instructions to Offerors addendum to 52.212-1 and/or Section D- Contract Documents, Exhibits, or attachments, VA Directive 1663 Appendix B

The Contractor shall propose 8 FTEE key personnel to be credentialed and be available for scheduling to meet the requirements of the contract.

One FTE is defined by VA as a minimum of 40 hours per week and does not include holidays.

Period of Performance: BASE YEAR: April 1, 2019 to March 31, 2020 Option Year 1: April 1, 2020 to March 31, 2021 Option Year 2: April 1, 2021 to March 31, 2022 Option Year 3: April 1, 2022 to March 31, 2023 Option Year 4: April 1, 2023 to March 31, 2024

Annual Cost

Board Certified or Board Eligible Orthopedic Surgery Physician Services

KEY PERSONNEL

NAME:____________

TITLE/LEVEL OF EXPERIENCE:____________

TOTAL FOR CLIN 0001

Hours

Mid-level Providers

NAME:____________

TITLE/LEVEL OF EXPERIENCE:____________

On-Call

TOTAL FOR BASE

OPTION YEAR 1: April 1, 2020 to March 31, 2021

Annual Cost

Board Certified or Board Eligible Orthopedic Surgery Physician Services

TOTAL

Mid-level Providers

NAME:____________

TITLE/LEVEL OF EXPERIENCE:____________

TOTAL FOR OPTION 1

OPTION YEAR 2: April 1, 2021 to March 31, 2022

Annual Cost

Board Certified or Board Eligible Orthopedic Surgery Physician Services

Mid-level Providers

NAME:____________

TITLE/LEVEL OF EXPERIENCE:____________

TOTAL FOR OPTION 2

Option Year 3: April 1, 2022 to March 31, 2023

Annual Cost

Board Certified or Board Eligible Orthopedic Surgery Physician Services

Mid-level Providers

NAME:____________

TITLE/LEVEL OF EXPERIENCE:____________

TOTAL FOR OPTION 3

Option Year 4: April 1, 2023 to March 31, 2024

Annual Cost

Board Certified or Board Eligible Orthopedic Surgery Physician Services

NAME:____________

TITLE/LEVEL OF EXPERIENCE:____________

Hours

Mid-level Providers

NAME:____________

TITLE/LEVEL OF EXPERIENCE:____________

TOTAL FOR OPTION 4

Total for base performance period and all option years: $________________________

Mid-level practitioners, also called assistant practice clinicians, are health care providers who have received different training and have a more restricted scope of practice than physicians and other health professionals in some states, but who do have a formal certificate and accreditation through the licensing bodies in their jurisdictions