36C26219R0006-0001001.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) 11-29-2018 00262 Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach

CA

90815 00262 Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach

CA

90815 To all Offerors/Bidders

36C26219R0006 11-29-2018

X

X

1. Please acknowledge reciept of this amendment in Section B.1 (cont. of form SF1449), paragraph 5 as A0001.

2. Please review the technical inquiry responses below and the amended schedule of services.

3. The due date for proposals has been amended to 12-14-2018, 4:00 PM (PDT).

Don Weerasinghe Contracting Officer AMENDMENT (A00001) OF RFP 36C26219R0006—ON-SITE, EMERGENCY PHYSICIAN SERVICES FOR THE VA SAN DIEGO HEALTHCARE SYSTEM (VASDHS), EMERGENCY CARE, 3350 LA JOLLA VILLAGE DR, SAN DIEGO, CA 92161.

ACKNOWLEDGMENT OF AMENDMENTS: The Offeror acknowledges receipt of amendments to Solicitation: RFP 36C26219R0006, numbered and dated as follows (please be sure to include this in your proposal):

PART I: TECHNICAL INQUIRIES.

1. QUESTION (Q): Is this a new requirement or is there an incumbent vendor? If available, can you please send along the incumbent contract number?

1.1. ANSWER (A): HCR-FSS-BPA with Maxim Healthcare Services, Inc.: VA262-13-A-0094; VA262-17-J-4920, and; HCR-FSS-BPA with AB Staffing Solutions, LLC: VA262-15-A-0115; VA262-17-J-4890.

2. Q: What is the trauma designation at VASDHS ER?

2.1. A: Trauma designation: 4.

3. Q: What is the annual volume of patients seen at VASDHS ER?

3.1. A: Approximately 34,000 patients annually.

4. Q: Will the ED physician be supervising Physician Assistants (PAs) or Nurse Practitioners (NPs)?

4.1. A: No supervision of PAs or NPs.

5. Q: Is this for single or double coverage (if double, when is there double coverage)?

5.1. A: There are six (6) physicians between 6AM (PDT) and 12AM (PDT) over staggered shifts on weekdays. Double coverage 12AM (PDT) to 6AM (PDT) all days; four (4) physician staff members on Saturdays, and three (3) on Sundays (lower volume).

6. Q: How many beds are in the VASDHS ER?

6.1. A:21 regular beds, 5 fast track.

7. Q: What type of support staff are available (i.e., nurses, techs) to the ED Physicians?

7.1. A: ICT (Intermediate Care Technician), Licensed Vocational Nurse (LVN), Registered Nurse (RN), health techs.

8. Q: What backup specialties are available?

8.1. A: Everything except pediatrics.

9. Q: If this is 24/7 coverage shouldn’t the estimate quantity of hours be 8,760 instead of 6,240 (24X365=8,760)?

9.1. A: The Estimated quantities of hours are based on what the VASDHS ER anticipates it will need to maintain a continuum of care for Veteran Patients. The Government does not guarantee that it will place any orders under this contract in an amount more than the guaranteed minimum award amount (see section 4 of B.3 Schedule of Services). Furthermore, the Section D.4, Price Worksheet—is the total estimated quantity of hours needed by VASDHS ED. We ask offerors submit pricing based on these estimates. Lastly, the estimated 6,240 hours is not applicable for every option period nor is it guaranteed for the applicable option periods.

10. Q: What is a realistic start date?

10.1. A: Award date and/or effective date of a contract may fluctuate to some extent due to the impending holiday season and the subsequent slowdown. As such, FAR 52.212-1 is tailored to extend the period of acceptance for offers from 30 calendar days to 120 calendar days.

11. Q: Can the VASDHS ED please share information related to the anticipated shift times needing coverage?

11.1. A: Shifts are: 6AM to 6PM; 730AM to 730PM; 8AM to 8PM; 10AM to 10PM; 1130AM to 1130PM; 6PM to 6AM, and; 730PM to 730AM. VASDHS needs are approximately 50% on weekdays and overnights. All shifts are in Pacific Daylight Times (PDT).

12. Q: Related to the above question: can the contracting team please comment on how many shifts will need to be covered per month?

12.1. A: estimated 80-100 shifts.

13. Q: Is the using service able to provide information related to the support services the VASDHS hospital system currently has?

13.1. A: ICT (intermediate care technician), LVN, RN, health techs.

14. Q: Does the VASDHS hospital have a fast track?

14.1. A: Yes.

15. Q: Who performs ER admissions within the VASDHS hospital system?

15.1. A: VASDHS Admitting teams.

16. Q: How many FTE VA Doctors does the VASDHS currently staff?

16.1. A: 15

17. Q: Would the government consider not restricting the contract to Board Certified/Board Eligible (BC/BE) Emergency Medicine only and include BC/BE Internal Medicine and Family Practice providers that are trained in Emergency Medicine?

17.1. A: Yes.

18. Q: Would the government consider including BC/BE Internal Medicine and Family Practice providers that have recent VA experience?

18.1. A: Yes.

19. Q: On page 13, section 2.1.2, Board Certification- it states; “All Contractor’s physician(s) shall be Board-Certified or Board-Eligible in Emergency Medicine and be currently certified in Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) or equivalency.” Can they be BE or BC in Family Practice or Internal Medicine with recent ED experience?

19.1. A: Yes.

20. Q: Would the government consider amending Section D.4 pricing to add a new CLIN to allow pricing for local candidates as well as travel locums providers?

20.1. A: The government asks for an all-inclusive, fixed-price hourly rate, regardless of where the contract ED physician primarily resides.

21. Q: Related to the anticipated coverage: is it anticipated that double coverage will be required?

21.1. A: Sometimes double coverage is required.

22. Q: Does the VASDHS ED currently have an NP or PA to help with seeing patients?

22.1. A: No.

23. Q: Can you please advise on what the acuity for EM patients is?

23.1. A: Moderate to high; no Level 1 trauma.

24. Q: If we identify for submission of our proposal less than six (6) candidates, will our proposal still be accepted for review?

24.1. A: The Contractor shall propose a minimum of SIX (6) key personnel to be credentialed and available for scheduling to meet the requirements of THREE (3) on-site key personnel per the IDIQ for BASE YEAR, OPTION YEAR ONE (1) AND OPTION YEAR TWO (2).

24.2. A: The Contractor shall propose a minimum of FOUR (4) key personnel to be credentialed and available for scheduling to meet the requirements of TWO (2) on-site key personnel per the IDIQ for OPTION YEAR THREE (3) AND OPTION YEAR FOUR (4).

24.3. A: The Contractor shall be required to provide as a minimum, enough appropriately qualified physicians to be credentialed and privileged that meet or exceed twice (2x) the number of Full Time Equivalent Employee (FTEE) required to fulfill contract obligations.

25. Q: In which Volume/Tab would you like the pricing to be placed?

25.1. A: Requirement for Price Offer Submittal: Factor 3. An Offeror’s pricing shall be submitted in a separate envelope with a completed price schedule for all CLINS (Section B.3, pgs. 7-9). Offerors are encouraged submit their price worksheet (Section D.4, pages 79-86) in the separate envelope too. The price worksheet is used by Offerors to draft fixed-pricing in response to estimated quantities of hours needed by VASDHS ED.

26. Q: Does the government seek a group to take over the management of the VASDHS emergency department or just a locums group to staff the emergency room when there isn’t enough coverage?

26.1. A: No—the VASDHS requirement is “as-needed” coverage from emergency Locum Tenens.

27. Q: I see the LOCUM providers are under NAICS 621111, but I thought Locums was under NAICS 561320—would you consider changing the NAICS code?

27.1. A: The VASDHS requirement is “as-needed” coverage from emergency Locum Tenens (establishments of temporary health practitioners having the degree of M.D.) to fill vacancies in the VASDHS ED. Offerors are asked to submit fixed prices in response to the estimated quantities (Section D.4 Price Worksheet). The Dept. of VA, Medical Sharing Office (MSO), advises and recommends in a long-term contract (anticipated Base, Plus Four (4)) to use the applicable 621 NAICS series. If a GSA FSS contractor is concerned because their FSS contract is only with NAICS 561320, they can still submit a proposal and receive an "open market" award of other NAICS—including 621111.

28. Q: In anticipation for the answers to questions regarding this solicitation, I was wondering if there is any way that a short extension could be granted for response to the solicitation in order to have adequate time to search for doctors who meet the requirement after the questions have been answered?

28.1. A: In lieu of the Thanksgiving holiday, the amendment was not posted on or about 11/23/2018 to fbo.gov as planned; an extension is hereby granted. Period of Acceptance of Offers. The Offeror agrees to hold prices in its offer firm for a period of one-hundred-twenty (120) calendar days from the date specified as DECEMBER 14th, 2018, 4:00 PM (PDT) for the receipt of offers. FAR 52.212-1 is tailored to extend the period of acceptance for offers from 30 calendar days to 120 calendar days.

PART II:

ADDENDUM TO B.4 PERFORMANCE WORK STATEMENT (PWS)—ON-SITE EMERGENCY DEPARTMENT PHYSICIAN SERVICES.

2. QUALIFICATIONS:

2.1. Physicians shall be duly licensed in a State, Territory, or Commonwealth of the U.S. or the District of Columbia (D.C.) and residency trained in the specialty of service/Emergency Room Medicine they are providing (THE CONTRACT PHYSICIAN(S) MUST HAVE GRADUATED FROM AN APPROVED SCHOOL AND COMPLETED A RESIDENCY OR FELLOWSHIP ACCEPTABLE TO THE SURGEON GENERAL), credentialed by the appropriate civilian American Medical Association specialty association, and indemnified by an appropriate/legal third party corporate entity for their professional activities.

2.1.1. License – The Contractor’s physician (s) assigned by the Contractor to perform the services covered by this contract shall have a current license to practice medicine in any State, Territory, or Commonwealth of the U.S. or D.C.) when services are performed on-site at the VASDHS facility.

2.1.1.1. All licenses held by the personnel working on this contract shall be full and unrestricted licenses. Contractor’s physician(s) who have current, full and unrestricted licenses in one or more states, but who have, or ever had, a license restricted, suspended, revoked, voluntarily revoked, voluntarily surrendered pending action or denied upon application will not be considered for the purposes of this contract.

2.1.2. Board-Certification.

2.1.2.1. All Contractor’s physician(s) shall be Board-Certified or Board-Eligible in Emergency Medicine and be currently certified in Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) or equivalency. All continuing education courses required for maintaining certification shall be kept up to date always. Documentation verifying current certification shall be provided by the Contractor to the VASDHS COR on an annual basis for each year of contract performance.

2.1.1.1. All Contractor’s physician(s) shall be Board-Certified or Board-Eligible in Internal Medicine or Family Practice with recent and demonstrable Emergency Medicine experience and/or training, and be currently certified in Basic Life Support (BLS) Advanced Cardiac Life Support (ACLS) or equivalency. All continuing education courses required for maintaining certification shall be kept up to date always. Documentation verifying current certification shall be provided by the Contractor to the VASDHS COR on an annual basis for each year of contract performance.

AMENDED E.3 ADDENDUM to FAR 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS.

The following provisions are incorporated into 52.212-1 as an addendum to this solicitation.

1. GENERAL INSTRUCTIONS FOR OFFER SUBMISSIONS.

a) Solicitation questions/technical inquiries. Offeror questions and inquiries concerning the solicitation will be accepted from the solicitation posting date until NOVEMBER 21th, 2018, 3:00 PM (PDT). Questions shall be accepted by email sent to timothy.wanamker@va.gov; NCO-22’s answers to Offeror questions/inquiries will be posted on fbo.gov on or about NOVEMBER 28th, 2018.

b) Period of Acceptance of Offers. The Offeror agrees to hold prices in its offer firm for a period of one-hundred-twenty (120) calendar days from the date specified as DECEMBER 14th, 2018, 4:00 PM (PDT) for the receipt of offers. FAR 52.212-1 is tailored to extend the period of acceptance for offers from 30 calendar days to 120 calendar days.

c) Format. Offerors will present their written offers on 8.5” by 11” paper, single spaced, with 1” margins all around. The offer will not be more than 200 pages including all supporting documentation; bound with a black paper clip or placed in a three-ringed binder to allow for ease of disassembling sections of the offer. Offerors proposals will contain three (3) hard copies, clearly marked with RFP 36C26219R0006. Offerors proposals shall be mailed to:

Department of Veterans Affairs Network Contracting Office 22 Timothy Wanamaker, Contract Specialist 4811 Airport Plaza Drive, Suite 600 Long Beach, CA 90815

d) Requirements for Technical Offer Submittal: Factor 1 and Factor 2.

i) Offerors shall include a table of contents and ensure that each factor is separated within the technical offer by tab or section in such a way an offer can easily be separated by factor (e.g., tab/section identified as PAST PERFORMANCE; SPECIALIZED EXPERIENCE).

(1) Completed and signed SF 1449.

(2) Completed and signed APPENDIX A (Fillable Form from VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST) (Section D.1 on page 81).

(3) Completed and signed Immigration Certification from Section D—Contract Documents, Exhibits, or attachments (Section D.2 on pg. 82).

(4) Completed and signed VA Handbook 6500.6 Appendix D - Contractor Rules of Behavior (Section D.5, pgs. 92-95).

(5) Contingency Plan for emergency substitutions—if key ED Physician personnel are not available.

(6) Copies of all required insurance certificates.

(7) Copy of VETS 4212 Report.

ii) OFFERORS SHALL COMPLETE AND PROVIDE THE FOLLOWING DOCUMENTS (INCLUDE IN A SEPARATE CANDIDATE TAB/SECTION).

(a) Qualification documentation for ED Physicians. This documentation is not an evaluation factor and thus will be contained in a separate volume from Evaluation factors. This separate section shall assist the CO with determining the general responsibility of the successful offeror; please provide the following information with the proposal for all six (6) ED Physician candidates:

(i) Copy Of Curriculum Vitae (CV);

(ii) Copies of Advanced Cardiac Life Support/Basic Life Support (ACLS/BLS) Certifications;

(iii) Board Certification (or documentation demonstrating board eligibility);

(iv) Health Safety Items—Provide Proof of Health Record (as required by solicitation);

(v) Drug Enforcement Agency (DEA) Card (as required by solicitation);

(vi) National Provider ID (NPI).

e) Requirement for Price Offer Submittal: Factor 3. An Offeror’s pricing shall be submitted in a separate envelope with a completed price schedule for all CLINS (Section B.3, pgs. 9-18 and Section D.4, Price Worksheet, pgs. 79-86). Offered pricing will be evaluated based on fairness and reasonableness.

f) OIG List of Excluded Individuals/Entities: Contractors shall review the OIG List of Excluded Individuals/Entities on the OIG web site at https://exclusions.oig.hhs.gov/ to ensure that the proposed Offerors staff and/or firm(s) are not listed.

2) OFFEROR RESPONSE TO EVALUATION FACTORS AND CRITERIA. Offerors should address in detail its approach to each factor.

a. Evaluation Factors and Criteria:

i. Factor 1—Past Performance. This factor will be used to assess an Offeror’s history of successful performance on prior Emergency Department Physician contracts. For this factor:

1. An Offeror shall provide two (2) detailed references documenting performance on prior Emergency Department Physician contracts. Contracts listed may include those entered with the Federal Government, State or local agencies, or commercial customers.

2. The Government reserves the right to obtain past performance information from any available source and may contact customers other than those identified by the Offeror when evaluating past performance.

3. Offerors without relevant past performance or for whom information is not available will not be evaluated favorably or unfavorably, but neutrally.

ii. Factor 2—Specialized Experience. This factor shall evaluate an Offeror’s specialized experience in providing licensed and board-certified Emergency Department Physician services in a healthcare facility or hospital environment, per the PWS. For this factor, an Offeror shall provide a narrative summary in no more than four (4) pages describing their involvement/experience in providing licensed and board-certified Emergency Department physicians in a healthcare facility or hospital environment.

iii. Factor 3—Price. This factor shall evaluate the fairness and reasonableness of an Offerors proposed pricing. The Offeror's initial proposal should contain their best pricing terms.

(cont. below)

AMENDED D.4 PRICE WORKSHEET

BASE YEAR: FEBRUARY 1, 2019 THROUGH JANUARY 31, 2020

CLIN NO.

SUB-CLIN

ESTIMATED COST

Emergency Department (ED) Physician Services

[NOTE: Services to includes ED coverage for weekend; nights; weekday coverages; contingency coverage during call-outs and illnesses]

KEY PERSONNEL

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

OPTION YEAR ONE (1): FEBRUARY 1, 2020 THROUGH JANUARY 31, 2021

CLIN NO.

ESTIMATED COST

Emergency Department (ED) Physician Services

[NOTE: Services to includes ED coverage for weekend; nights; weekday coverages; contingency coverage during call-outs and illnesses]

KEY PERSONNEL

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

OPTION YEAR TWO (2): FEBRUARY 1, 2021 THROUGH JANUARY 31, 2022

CLIN NO.

ESTIMATED COST

Emergency Department (ED) Physician Services

[NOTE: Services to includes ED coverage for weekend; nights; weekday coverages; contingency coverage during call-outs and illnesses]

KEY PERSONNEL

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

OPTION YEAR THREE (3): FEBRUARY 1, 2022 THROUGH JANUARY 31, 2023

CLIN NO.

ESTIMATED COST

Emergency Department (ED) Physician Services

[NOTE: Services to includes ED coverage for weekend; nights; weekday coverages; contingency coverage during call-outs and illnesses]

KEY PERSONNEL

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

OPTION YEAR FOUR (4): FEBRUARY 1, 2023 THROUGH JANUARY 31, 2024

CLIN NO.

ESTIMATED COST

Emergency Department (ED) Physician Services

[NOTE: Services to includes ED coverage for weekend; nights; weekday coverages; contingency coverage during call-outs and illnesses]

KEY PERSONNEL

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

ED Physician Services;

Board-Certified/Board-Eligible Physician

NAME: ______________________

TITLE: ______________________

TOTAL FOR BASE PERIOD AND ALL OPTION YEARS: $________________________

--END OF AMENDMENT--