36C26124Q0943 0001 CLIN Update.pdf

5. PROJECT NUMBER (if applicable)

CODE7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER3. 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 CODECODE

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 None

00261

Department of Veterans Affairs Network Contracting Office 21 VA Southern Nevada Healthcare System 6900 N. Pecos Road, Building 6 North Las Vegas NV 89086

00261

Department of Veterans Affairs Network Contracting Office 21 Southern Nevada Healthcare System 6900 N. Pecos Road, Building 6 North Las Vegas NV 89086

To all Offerors/Bidders

36C26124Q0943

08-07-2024

X

See CONTINUATION Page

The purpose of this amendment is to update the contract line items 0002, 0003, 0004, and 0005 to indicate which are option years.

CONTINUATION PAGE

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVIC

ES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1.00 YR _____________

CarePort Intake Online Portal Annual Subscription Or Equal IAW Salient Characteristics; 2024-2025 PRINCIPAL NAICS CODE: 518210 - Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services PRODUCT/SERVICE CODE: Q602 - Medical Records

0002 1.00 YR _____________

CarePort Intake Online Portal Annual Subscription Or Equal IAW Salient Characteristics; Option Year One; 2025-2026 PRINCIPAL NAICS CODE: 518210 - Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services PRODUCT/SERVICE CODE: Q602 - Medical Records

0003 1.00 YR _____________

CarePort Intake Online Portal Annual Subscription Or Equal IAW Salient Characteristics; Option Year Two; 2026-2027 PRINCIPAL NAICS CODE: 518210 - Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services PRODUCT/SERVICE CODE: Q602 - Medical Records

0004 1.00 YR _____________

CarePort Intake Online Portal Annual Subscription Or Equal IAW Salient Characteristics; Option Year Three; 2027-2028 PRINCIPAL NAICS CODE: 518210 - Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services PRODUCT/SERVICE CODE: Q602 - Medical Records

0005 1.00 YR _____________

CarePort Intake Online Portal Annual Subscription Or Equal IAW Salient Characteristics; Option Year Four; 2028-2029 PRINCIPAL NAICS CODE: 518210 - Computing Infrastructure Providers, Data Processing, Web Hosting, and Related Services PRODUCT/SERVICE CODE: Q602 - Medical Records

GRAND TOTAL _____________

A.2 DELIVERY SCHEDULE

ITEM

NUMBER SHIPPING INFORMATION

QUANTIT

Y

DELIVERY

DATE

0001 SHIP TO: VA Southern Nevada Healthcare System 6900 North Pecos Road North Las Vegas, NV 89086

USA

1.00

0002 SHIP TO: VA Southern Nevada Healthcare System 6900 North Pecos Road North Las Vegas, NV 89086

USA

1.00

0003 SHIP TO: VA Southern Nevada Healthcare System 6900 North Pecos Road North Las Vegas, NV 89086

USA

1.00

0004 SHIP TO: VA Southern Nevada Healthcare System 6900 North Pecos Road North Las Vegas, NV 89086

1.00

USA

0005 SHIP TO: VA Southern Nevada Healthcare System 6900 North Pecos Road North Las Vegas, NV 89086

USA

1.00

A.2 DELIVERY SCHEDULE