36C26321Q0802 A0001.pdf

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)

1 5

A0001 UNCHANGED NONE

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

1303 5th St, Suite 300 Coralville IA 52241

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

1303 5th St, Suite 300 Coralville IA 52241

36C26321Q0802

08-10-2021 X

X X

See CONTINUATION Page

UNCHANGED

X 1

THE PURPOSE OF THIS AMENDMENT IS TO:

1. UPDATE THE ITEM SCHEDULE WITH THE NEW SCHEDULE ON PAGE 3.

2. ADD 2 CBOC STATION ADDRESSES TO SECTION B.2 PARAGRAPH 3 FOR INSTALLATION AND TRAINING. SEE PAGE 2 FOR DETAILS.

3. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.

JOSHUA IMDACHA

CONTRACTING OFFICER

8/13/2021

CONTINUATION PAGE

A.1 SECTION B.2 PARAGRAPH III STATEMENT OF WORK

IS UPDATED TO READ:

Statement of Work a. Description of Work: Vendor to deliver and install 3D OCT-1 Optical Coherence Tomography equipment to the following Health Care Systems within VISN 23:

1. Minneapolis VA Health Care System, One Veterans Drive Minneapolis, MN 55417.

2. Black Hills Health Care System, 113 Comanche Rd, FORT MEADE, SD 57741.

3. Nebraska Western Iowa Omaha VA, 4101 Woolworth Ave, Omaha, NE 68105.

4. VA Central Iowa - Des Moines, 3600 30th Street Des Moines, IA 50310

5. North Platte CBOC – 300 east 3rd street suite 302, North Platte NE 69101

6. Norfolk CBOC – 3204 Raasch Dr, Norfolk, NE 68701 as outlined in quote/contract. After set-up, the contractor will be required to demonstrate that the System works as designed. Once this is completed and accepted by the COR, or designee, the contractor will provide no cost on-site training for the clinical staff upon delivery and installation for each of the following facilities: Minneapolis, MN; Rochester, MN; Fort Meade, SD; Rapid City, SD; Omaha, NE; Mason City, IA, Norfolk, NE, North Platte, NE and Fort Dodge, IA. The contractor will be required to dispose of all packing materials.

A.2 PRICE/COST SCHEDULE

**CLIN 0001AC WILL BE DELIVERED TO OMAHA VAHCS AND AFTER INSPECTION THE

VA WILL DELIVERY TO North Platte CBOC & Norfolk CBOC FOR THE VENDOR TO

INSTALL.

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

11.00 EA __________________ __________________

Mydriatic/Non mydriatic retinal imaging cameras with OCT PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing PRODUCT/SERVICE CODE: 6540 - Ophthalmic Instruments, Equipment, and Supplies

0001AA

3.00 EA __________________ __________________

PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing PRODUCT/SERVICE CODE: 6540 - Ophthalmic

Minneapolis VA Health Care System

0001AB

2.00 EA __________________ __________________

PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing PRODUCT/SERVICE CODE: 6540 - Ophthalmic

Black Hills Health Care System

0001AC

4.00 EA __________________ __________________

PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing PRODUCT/SERVICE CODE: 6540 - Ophthalmic

Nebraska Western Iowa Omaha

0001AD

PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing PRODUCT/SERVICE CODE: 6540 - Ophthalmic

VA Central Iowa - Des Moines

11.00 EA __________________ __________________

20x36 Top wheelchair accessible instrument table PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing

0002AA

3.00 EA __________________ __________________

PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing

Minneapolis VA Health Care System

0002AB

PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing PRODUCT/SERVICE CODE: 6540 - Ophthalmic

Black Hills Health Care System

0002AC

4.00 EA __________________ __________________

PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing PRODUCT/SERVICE CODE: 6540 - Ophthalmic

Nebraska Western Iowa Omaha

0002AD

PRINCIPAL NAICS CODE: 333314 - Optical Instrument and Lens Manufacturing PRODUCT/SERVICE CODE: 6540 - Ophthalmic

VA Central Iowa - Des Moines

GRAND TOTAL __________________

A.3 DELIVERY SCHEDULE

ITEM NUMBER QUANTITY

DELIVERY

DATE

11.00

0001AA SHIP TO: Minneapolis VA Health Care System One Veterans Drive Minneapolis, MN 55417

3.00

0001AB SHIP TO: Black Hills VA Health Care System 2.00

113 Comanche Rd

FORT MEADE, SD 57741

0001AC SHIP TO: Nebraska Western Iowa Omaha VA 4101 Woolworth Ave Omaha, NE 68105

4.00

0001AD SHIP TO: Central Iowa VA Health Care

3600 30th Street Des Moines, IA 50310

2.00

11.00

0002AA SHIP TO: Minneapolis VA Health Care

One Veterans Drive Minneapolis, MN 55417

3.00

0002AB SHIP TO: Black Hills VA Health Care System 113 Comanche Rd

FORT MEADE, SD 57741

0002AC SHIP TO: Nebraska Western Iowa Omaha VA 4101 Woolworth Ave Omaha, NE 68105

4.00

0002AD SHIP TO: Central Iowa VA Health Care

3600 30th Street Des Moines, IA 50310