FA4877-15-R-0001-0003_for_FBO.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)

30-105-04 EXCEPTION 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:

A. Additional information in Response to Question 4 of Amendment 0002.

B. Add Attachment 4, Position Description - Personal / Nonpersonal Information to the solicitation.

C. See Summary of Changes.

Contracting POC: Roxanne Elfering Ph: (520) 228-5448, Email roxanne.elfering@us.af.mil

1. CONTRACT ID CODE PAGE OF PAGES

J 1 3

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

16C. DATE SIGNED

BY 01-Aug-2014

16B. UNITED STATES OF AMERICA 15C. DATE SIGNED 15B. 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 FA4877-15-R-0001

X 9B. DATED (SEE ITEM 11)

11-Jul-2014

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

01-Aug-2014

CODE

355 CONS - FA4877

3180 S. CRAYCROFT RD

DAVIS-MONTHAN AFB AZ 85707

FA4877 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODE CODE

EMAIL: TEL:

FA4877-15-R-0001

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

ATTACHMENT 4 - PDS INFO

Position Description – Personal / Nonpersonal Information Reference: Performance Work Statement (PWS) 1.2.22.1 Personal Services, 1.2.22.5 Non- Personal Services Item Number Position Description Service Type

AA Aerospace Medicine Provider Personal AB Allergist Personal AC Allergy/Immunology Technician Personal AD Beneficiary Services Representative Non-Personal AE Biomedical Equipment Technician Non-personal AF Certified Medical Tech (Assistant) - Outpatient Personal AG Chiropractic Technician Personal AH Chiropractor Personal AI Clinical Nurse - Behavioral Health Personal AJ Clinical Nurse - Family Practice Personal AK Clinical Nurse - Flight Medicine Personal AL Clinical Nurse – Occupational Medicine Personal AM Clinical Nurse - Pediatrics Personal AN Clinical Nurse - Women's Health Personal AO Clinical Social Worker Personal AP Diagnostic Imaging Technician Personal AQ Diagnostic Imaging Tech - Computed Tomography Personal AR Diagnostic Imaging Tech - Mammography Personal AS Diagnostic Imaging Tech - Ultrasound Personal AT Exercise Physiologist Personal AU Family Nurse Practitioner Personal AV Family Practice Physician Personal AW Flight Medicine Provider Personal AX Health and Fitness Specialist Personal AY Licensed Practical Nurse - Outpatient Personal AZ Licensed Vocational Nurse - Outpatient Personal BA Medical Appointment Clerk Non-personal BB Medical Laboratory Technician Personal BC Medical Logistics Supply Technician Non-personal BD Medical Office Clerk Non-personal BE Medical Records Technician Non-personal

FA4877-15-R-0001

BF Mental Health Technician Personal BG Optometrist Personal BH Optometry Technician Personal BI Orthopedic Technician Personal BJ Pediatrician Personal BK Pediatric Nurse Practitioner Personal BL Pharmacist - Clinical Personal BM Pharmacist - Registered Personal BN Pharmacist Technician Personal BO Phlebotomist Personal BP Physical Therapist Personal BQ Physical Therapy Technician - Assistant Personal BR Physician Assistant Personal BS Physician Assistant - Orthopedic Personal BT Psychiatric Nurse Personal BU Psychiatrist Personal BV Psychologist Personal BW Radiologist Personal BX Referral Clerk Non-personal BY Registered Dietician Personal BZ Registered Nurse - Case Manager Personal CA Social Worker - Special Needs Coordinator Personal CB Utilization Management Nurse Personal CC Women's Health Nurse Practitioner Personal

(End of Summary of Changes)