Amendment_0001.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

The purpose of this amendment is to remove language in the Past Performance Questionnaire (PPQ) by correcting smow removal related language and changing it to Utilization and Case Management Nursing services and changing the date for questionnaires due to 20 July 2016.

POC: SSgt Justin Hayes, 509-247-2237

CO: Shane Galles, 509-247-2163

1. CONTRACT ID CODE PAGE OF PAGES

J 1 5

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 12-Jul-2016

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X FA4620-16-R-A011

X 9B. DATED (SEE ITEM 11)

08-Jul-2016

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

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 Offer is extended, X is not extended.

Offer 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)

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.

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).

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

D. OTHER (Specify type of modification and authority)

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

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

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

12-Jul-2016

CODE

92 CONTRACTING SQUADRON

BLDG 2451

110 W ENT ST

STE 200

FAIRCHILD AFB WA 99011-8568

FA4620 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

FA4620-16-R-A011

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

The following have been modified:

ATTACHMENT 4

PRESENT/PAST PERFORMANCE QUESTIONNAIRE

TO:

RETURN TO: 92 CONS/LGCA

Contracting

Officer 110 W.

Ent St

Fairchild AFB WA 99011

SUBJECT: Present/Past Performance: Contract # , Contractor:

1. Your assistance is respectfully requested in providing information on the attached performance questionnaire. The importance of your opinion cannot be overstated. This survey measures the present/past performance of , a prospective offeror for Utilization and Case

Management Nursing services for Fairchild AFB.

2. INSTRUCTIONS FOR COMPLETION: Fill it in by hand or type and please email the results to the Contracting Officer, Shane Galles at shane.galles@us.af.mil and to the Contract Administrator, SSgt Justin

Hayes at justin.hayes.2@us.af.mil. Email submissions are preferred. You can also send by mail to the address listed above. Please direct questions to Shane Galles at (509) 247-2163 or SSgt Justin Hayes at (509) 247-2237.

Your participation is greatly appreciated.

Explanation of codes:

Code PERFORMANCE LEVEL

RATING DEFINITION

E Exceptional Based on the offeror’s performance record, essentially no doubt exists that the offeror will successfully perform the required effort.

G Good Based on the offeror’s performance record, little doubt exists that the offeror will successfully perform the required effort.

S Satisfactory Based on the offeror’s performance record, some doubt exists that the offeror will successfully perform the required effort.

N Neutral No performance record identifiable.

M Marginal Based on the offeror’s performance record, substantial doubt exists that the offeror will successfully perform the required effort. Changes to the offeror’s existing processes may be necessary in order to achieve contract requirements.

Circle the appropriate letter for each item on the questionnaire and provide narrative justification.

PLEASE RETURN NO LATER THAN: 20 July 2016 mailto:shane.galles@us.af.mil mailto:justin.hayes.2@us.af.mil

PRESENT / PAST PERFORMANCE

EVALUATION QUESTIONNAIRE

SOLICITATION NO: FA4620-16-R-A001 UM/CM Nurses

Section A: Contractor Information.

Contractor’s name and address:

a. Point of Contact:

b. Phone #:

c. Contract Number:

d. Project Title:

e. Period of Performance:

SECTION B: RESPONDENT INFORMATION

a. Respondent’s name and address: Organization:

Address:

City: State: Zip: _

b. Respondent’s Name and Title:

Signature:

c. Commercial Phone #: _ DSN Phone #:

Fax #: E-Mail:

d. Contract Type:

e. Award Amount: $ Final Amount: $

f. What was the job title for this position?:

g. Was the position full time on site?:

h. Did the position require clearance to work on classified networks?

i. What duties/responsibilities did this job entail?:

Please email or FAX the completed questionnaire by 20 July 2016 to:

92 CONS/LGCA

ATTN: SSgt Justin Hayes and Shane Galles EMAIL:

justin.hayes.2@us.af.mil/shane.galles@us.af.mil

FAX: (509) 247-8685

DSN FAX: 657-8685

If you have questions regarding this questionnaire, please call SSgt Hayes at (509) 247-2237.

Performance Evaluation Instructions: When responding to the descriptive statements, select the number which most accurately describes the contractor’s performance or situation. If the contractor has no record of past performance relevant to a particular question, select “N/A” for “Neutral”.

Evaluation of the Contractor’s Performance: For any ratings less than satisfactory, please provide explanation in Remarks section below.

PERFORMANCE:

1. How effective was the contractor’s recruitment plan fro filling the required 1 2 3 4 5 N/A positions and providing replacements for personnel that discontinued employment under this contract?

2. How effective was the contractor in maintaining professional business relationships with government personnel and in resolving contract issues?

1 2 3 4 5 N/A

3. How well did the contractor personnel perform assigned healthcare worker duties?

1 2 3 4 5 N/A

4. How was the overall appearance and professionalism of contractor 1 2 3 4 5 N/A personnel?

5. How well did personnel perform records management and documentation?

1 2 3 4 5 N/A

6. Was the contractor personnel knowledgeable and experienced in their position?

1 2 3 4 5 N/A

PAST PERFORMANCE ASSESSMENT

Rating Description

Exceptional (5) Based on the offeror’s performance record, essentially no doubt exists that the offeror will successfully perform the required effort.

Good (4) Based on the offeror’s performance record, little doubt exists that the offeror will successfully perform the required effort.

Satisfactory (2-3) Based on the offeror’s performance record, some doubt exists that the offeror will successfully perform the required effort.

Marginal (1) Based on the offeror’s performance record, substantial doubt exists that the offeror will successfully perform the required effort. Changes to the offeror’s existing processes may be necessary in order to achieve contract requirements.

Neutral (N/A) No performance record identifiable.

CORRECTIVE ACTION HISTORY:

1. Have there been any show cause or cure notices issued or legal actions taken? (circle one) YES NO

If yes, please explain (e.g., inability to meet cost, performance, or delivery schedules).

2. If Contract Discrepancy Reports (CDR) were issued, were they addressed appropriately? If so, how? (circle one) YES NO N/A

If yes, explain and indicate the status.

EVALUATION SUMMARY:

1. Overall evaluation of the contractor. (Circle one and explain.) 1 2 3 4 5

2. Would you enter into another contract with this contractor? (circle one) YES NO N/A

If no, please explain.

Additional Remarks:

(End of Summary of Changes)