36C26322Q0478 0001.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)

Department of Veterans Affairs Network 23 Contracting Office (NCO 23)

113 Comanche Rd.

Fort Meade SD 57741

Department of Veterans Affairs Network 23 Contracting Office (NCO 23)

113 Comanche Rd.

Fort Meade SD 57741 To all Offerors/Bidders

36C26322Q0478 05-09-2022

X

This amendment is to provide for a revised price/performance schedule. Please reference the attached schedule and submit this new schedule with your offer.

Pamela Phillips Contracting Officer

PRICE/COST/ PERFORMANCE SCHEDULE

ITEM INFORMATION

Air ambulance (including all personnel, equipment, and supplies to provide air ambulance service for Minneapolis VAHCS) per trip.

Contract Period: Base POP Begin: 06/01/2022 POP End: 05/31/2023

Additional Attendant per trip

Ground Ambulance per Ground Miles

Medical Van Fee per Ground Miles

Cancellation Fee per event

2.0% Provider Tax (per MN Care Law - 1994)

Air ambulance (including all personnel, equipment, and supplies to provide air ambulance service for Minneapolis VAHCS) per trip Contract Period: Option Year One POP Begin: 06/01/2023 POP End: 05/31/2024

Additional Attendant per trip

Ground Ambulance per Ground Miles

Medical Van Fee per Ground Miles

Cancellation Fee per event

2.0% Provider Tax (per MN Care Law - 1994)

Air ambulance (including all personnel, equipment, and supplies to provide air ambulance service for Minneapolis VAHCS) per trip Contract Period: Option Year Two POP Begin: 06/01/2024 POP End: 05/31/2025

Additional Attendant per trip

Ground Ambulance per Ground Miles

Medical Van Fee per Ground Miles

Cancellation Fee per event

2.0% Provider Tax (per MN Care Law - 1994)

Air ambulance (including all personnel, equipment, and supplies to provide air ambulance service for Minneapolis VAHCS) per trip Contract Period: Option Year Three POP Begin: 06/01/2025 POP End: 05/31/2026

Additional Attendant per trip

Ground Ambulance per Ground Miles

Medical Van Fee per Ground Miles

Cancellation Fee per event

2.0% Provider Tax (per MN Care Law - 1994)

Air ambulance (including all personnel, equipment, and supplies to provide air ambulance service for Minneapolis VAHCS) per trip Contract Period: Option Year Four POP Begin: 06/01/2026 POP End: 05/31/2027

Additional Attendant per trip

Ground Ambulance per Ground Miles

Medical Van Fee per Ground Miles

Cancellation Fee per event

2.0% Provider Tax (per MN Care Law - 1994)

GRAND TOTAL ITEMS 0001 – 4006_________________________________