36C77026R0006 0005 SF30 - Copy.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) NCO 15 Contracting Ofc - CMOP

762-24-101 36C770 Department of Veterans Affairs NCO 15 Contracting Office - CMOP 3450 S. 4th St. Trafficway

Leavenworth KS 66048-5012

36C770 Department of Veterans Affairs NCO 15 Contracting Office - CMOP 3450 S. 4th St. Trafficway

Leavenworth KS 66048-5012 To all Offerors/Bidders

36C77026R0006 05-11-2026

X

AMENDMENT REASON: TO CORRECT ATTACHMENT NUMBER FOR PAST PERFORMANCE AND TO ADD PAST PERFORMANCE DOCUMENT.

A. PROPOSAL SUBMITTAL INSTRUCTIONS, FACTOR 4, CHANGE ATTACHMENT 5 TO READ ATTACHMENT 9.

B. INCORPORATE PAST PERFORMANCE FORM MARKED AS ATTACHMENT 9.

CHRISTLY PENDLAY

Contracting Officer

***** Begin Word Document - ' SOLICITATION-DESCRIPTION' ***** Attachment 9 – Past Performance INSTRUCTIONS TO PRIME CONTRACTOR: (Contractor submitting proposal):

Complete the CONTRACTOR INFORMATION section. Save the document. Send an electronic or hard copy print of the form to each of your reference contacts, asking them to please complete the form and submit it according to the instructions, below.

Company Name

Street Address

Point of Contact

City

Point of Contact Phone Number

State

E-Mail Address

Zip Code

INSTRUCTIONS TO REFERENCE CONTACT

Please complete the following pages as a past performance Reference Contract for the entity named above. Once completed, please return the form to: Billie.Cherico@va.gov.

RESPONDENT INFORMATION [completed by Reference Contact]

Government Agency or Company name

Street Address

POC Name

City

Phone Number

State

Fax Number

Zip Code

Email

Contract Number

Prime or Subcontractor

Dollar Value

Period of Performance

Description of services provided

Location of services provided

Number of FTEE YOUR FIRM provided

PERFORMANCE INFORMATION: Choose the number on the scale of 0 (Neutral) to 5 (Exceptional) that most accurately describes the contractor’s performance or situation. PLEASE PROVIDE AN EXPLANATION FOR THE OVERALL RATING in the Remarks section, below (text box will expand to whatever extent is necessary).

REMARKS (Please use as much space as is needed – the box will expand as you type).

I hereby certify that the information that I have reported above is accurate to the best of my knowledge.

Printed Name

E-mail address

Business Title

Signature

Date

***** End Word Document - ' SOLICITATION-DESCRIPTION' *****