36C26324R0009 0003.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. 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 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 3

0003 None

36C263

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

Daniel Vagts

316 Robert Street N. STE. 506

St. Paul MN 55101

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

316 Robert Street N. STE. 506

St. Paul MN 55101

To all Offerors/Bidders 36C26324R0009

X

X 1

Purpose of this amendment is to lower the FTE from 4.0 to 2.0. Please see below update PWS sections and

Schedule of Services.

1.1 Services Provided: The contractor shall provide up to two (2.0 FTE) Certified Registered Nurse on site in accordance with the specifications contained herein to beneficiaries of the Department of Veterans Affairs (VA) and the Minneapolis

VA Health Care System (MVAHCS).

4.1 - Clinical Personnel Required: The Contractor shall provide the services of up to two (2) full-time (2.0 FTE)

CRNA(s) who are competent, qualified per this performance work statement and adequately trained to perform assigned duties.

Daniel Vagts

Contract Officer

VA-VHA-SAOC-2019-161D3612

The Contractor shall furnish all key personnel to provide services necessary to perform onsite Anesthesiology CRNA Services (2,080 hours x 2 FTE) to eligible beneficiaries of the Department of Veterans Affairs Medical Center Minneapolis VA Health Care System (hereinafter referred to as MVAHCS). The Contractor’s CRNA(s) care shall cover the range of Anesthesiology services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by: American Society of Anesthesiologist (ASA) Guidelines: https://www.asahq.org/standards-and-guidelines

Place of Performance: Services shall be provided on site, Minneapolis VA Health Care System, One Veterans Drive, Minneapolis, MN 55417.

Pricing Instructions:

The offeror is instructed to edit the number of sub-line item numbers (SLIN) to correspond with the number of key personnel submitted for the line item number (LIN). Other commercial health care Offerors shall identify by title/position or level of experience the key personnel submitted. Also, renumber SLINs if adding or removing Key Personnel.

The Contractor shall propose a minimum of two (2) key personnel to be credentialed and be available for scheduling to meet the requirements of the contract.

Period of Performance: BASE PERIOD: 10/17/2024 to 10/16/2025

CLIN

No.

SUB-

CLIN Description Qty. Unit Unit Cost

Total Annual Cost

0001 None Certified Registered Nurse Anesthetist Services

4160 Hours

KEY PERSONNEL

None 0001a

Certified Registered Nurse Anesthetist

NAME:____________

TITLE:____________

2080 Hours $/hr $

None 0001b

Certified Registered Nurse Anesthetist

NAME:____________

TITLE:____________

2080 Hours $/hr $

TOTAL FOR Base Period 4160 Hours $

2 of 3 pages https://www.asahq.org/standards-and-guidelines

OPTION PERIOD ONE: 10/17/2025 to 10/16/2026

CLIN

No.

SUB-

CLIN Description Qty. Unit Unit Cost

Total Annual Cost

1001 None Certified Registered Nurse Anesthetist Services

4160 Hours

KEY PERSONNEL

None 1001a

Certified Registered Nurse Anesthetist

NAME:____________

TITLE:____________

2080 Hours $/hr $

None 1001b

Certified Registered Nurse Anesthetist

NAME:____________

TITLE:____________

2080 Hours $/hr $

TOTAL FOR Option Period One 4160 Hours $

OPTION PERIOD TWO: 10/17/2026 to 10/16/2027

CLIN

No.

SUB-

CLIN Description Qty. Unit Unit Cost

Total Annual Cost

2001 None Certified Registered Nurse Anesthetist Services

4160 Hours

KEY PERSONNEL

None 2001a

Certified Registered Nurse Anesthetist

NAME:____________

TITLE:____________

2080 Hours $/hr $

None 2001b

Certified Registered Nurse Anesthetist

NAME:____________

TITLE:____________

2080 Hours $/hr $

TOTAL FOR Option Period Two 4160 Hours $

Total for base performance period and all option periods: $

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