36C26018Q0200-00002000.docx

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36C26018Q0200
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36C26018Q0200 00002

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

BY

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) 00002 05-30-2018 none 663A Department of Veterans Affairs Network Contracting Office 20 1495 Wilmington Drive, Suite 360 DuPont WA 98327 663A Department of Veterans Affairs Network Contracting Office 20 1495 Wilmington Drive, Suite 360 DuPont WA 98327 To all Offerors/Bidders

36C26018Q0200 05-10-2018

X X X

THE PURPOSE OF THIS AMENDMENT IS TO REMOVE MOXY FIBER FROM THE PRICE WORKSHEET.

A. Moxy fiber is a disposable that will undergo the one-time vetting mentioned in Amendment 00001. It is now crossed off the Price Worksheet.

B. You may use the resulting Revised D.2 Price Worksheet for your price quote (attached).

C. There are no other changes to the solicitation as a result of this amendment, and all other terms and conditions remain unchanged.

POC at Contracting, Darlene Anderson, 253-888- 4905 darlene.anderson4@va.gov

DARLENE ANDERSON

Contracting Officer

NCO2015L3-2479

CONTINUATION PAGE

Revised D.2 PRICE WORKSHEET

ITEM NUMBER
DESCRIPTION OF SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
0001AA
Laser Services: Rental of Cyber TM Laser - Thulium with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

36.00
EA
$__________
$__________
0001AB
Laser Services: Rental of Cyber TM Scope with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

3.00
EA
$__________
$__________
0001AC
Laser Services: Rental of Holmuim with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

67.00
EA
$__________
$__________
0001AD
Laser Services: Rental of KTP Laser with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

8.00
EA
$__________
$__________
0001AE
Laser Services: Rental of Omniguide (brand name or equal) CO2 with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

36.00
EA
$__________
$__________
0001AF
Laser Services: Rental of CO2 Laser (not Omniguide) with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

3.00
EA
$__________
$__________
0001AG
Laser Services: Rental of GreenLight (brand name or equal) Laser with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

6.00
EA
$__________
$__________
0001AH
Laser Services: Rental of MoXy (brand name or equal) Fiber with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

6.00
EA
$__________
$__________
0001AJ
Laser Services: Rental of Continuous Flow Cystoscope with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

14.00
EA
$__________
$__________
0001AK
Laser Services: Rental of ESWL with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

15.00
EA
$__________
$__________
0001AL
Laser Services: Rental of Transmyocardial Laser Revascularization (TMR) with a technician to run the equipment and to provide technical support during the procedure.

Contract Period: Base POP Begin: 07-01-2018 POP End: 06-30-2023

60.00
EA
$__________
$__________
GRAND TOTAL
$__________
Other laser equipment with a technician to run the equipment and to provide technical support during the procedure
Price Each

Prices for Ancillary Services submitted on your Technical Subfactor 3, Ancillary Services submission (for example, less than 24-hour cancellation fee):

Ancillary Service Description
Price Each

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