A002_MATOC_RFP.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

N/A

PAGE

1 of X

2. AMENDMENT/MODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE NO. 5. PROJECT NO. (If applicable)

A002 12/11/2017 N/A Western Region Pavement Preservation MATOC

6. ISSUED BY CODE N/A 7. ADMINISTERED BY (If other than Item 6) CODE N/A

Department of Transportation Federal Highway Administration 610 East Fifth Street Vancouver WA 98661-3801

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and Zip Code) 9A. AMENDMENT OF SOLICITATION NO.

X DTFH7017R00002

9B. DATED (SEE ITEM 11)

11/30/2017

10A. MODIFICATION OF CONTRACT/ORDER NO.

N/A

10B. DATED (SEE ITEM 13)

CODE: N/A FACILITY CODE: N/A

N/A

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

| X | The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

(__ ) is extended, ( x ) is not extended.

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:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram 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 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 telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

N/A

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

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.

N/A

B THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (Such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

N/A

C THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

N/A

D OTHER (Specify type of modification and authority)

N/A

E. IMPORTANT: Contractor n/a is not, n/a is required to sign this document and return n/a copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

Amendment A002 of the Western Region Pavement Preservation MATOC is issued to correct an omission on Technical Form 1 in the Appendix.

ENCLOSURES: Appendix Page 1

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 (Type or print) 15a. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

N/A

15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 16C. DATE SIGNED

BY_________________________________________ BY N/A___________________________ N/A (Signature of person authorized to sign) (Signature of Contracting Officer)

NSN 7540-01-152-8070

PREVIOUS EDITION NOT USABLE

30-105 STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

Technical Information Form 1 Technical Evaluation Factor 1 - Recent and Relevant Experience Project Information

Prime Contractor Name:_____________________________________________

Project Name/Number: ______________________________________________

Project Contract Number: ____________________________________________

Owner/Organization Name: ___________________________________________

Address: ________________________________

P.O. Box/Street

City, State, Zip Code

Owner/Organization Point of Contact: _______________________________________

Owner/Organization Phone Number: _______________________________________

Owner/Organization Email: _______________________________________

Award Amount: $_________________ Completion Date: _______________

If project is ongoing, has at least 50% of the onsite work been completed? (__)Yes (__)No

What percentage of the project was completed by the Prime? _______ 1Public Works Contract completed using Public Works Standard Specifications (__)Yes (__)No

Did work require lane closure and accommodating of access to businesses, residences, or other users under a typical public traffic delay of 30 minutes or less? (__)Yes (__)No 2Was project adjacent to or in Recreational Area or Rural Area? (__)Yes (__)No

How many square yards of microsurfacing and/or chip seal applied by the prime?________________

Project Description. Include a description of the major work items, location of project, original and actual completion date, surfacing type(s), type of work completed by prime, list of submittals required by the contract, list of suppliers:

1 Public Work means any federal, local, or state Government Agency 2 Recreational Area means any federal, local, or state managed area used typically for outdoor recreational purposes;

Rural Area means any open country or settlement with fewer than 2,500 residents; or open country or settlement with a population density between 1 300 people per square mile.