FA4889-13-R-0005-0001.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

2. AMENDMENT/MODIFICAITON NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicble)

7. ADMINISTERED BY (If other than Item 6) CODE

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9A. AMENDMENT OF SOLICIATION NO.

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 11)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, 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 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 your 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 APPROPIRATION DATA (If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

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

CHECK ONE 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.

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.

15C. DATE SIGNED

15A. NAME AND TITLE OF SIGNER (Type or print)

16C. DATE SIGNED

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

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

PAGE OF PAGES

6. ISSUED BY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code) (X)

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

NSN 7540-01-152-8070

Previous edition unusable

AMENDMENT OF SOLICITATION NO.

2. AMENDMENT/MODIFICATION NO.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

See Schedule

Zella Johnson 803-885-8814 zella.johnson@afcent.af.mil

FA4889

SEE SCHEDULE

USAFCENT/A7K 524 Shaw Drive Bldg 1130 Suite 235 Shaw AFB, SC 29152

25-Mar-2013

FA4889-13-R-0005

5Firm-Fixed-Price Contract

25-Mar-2013

20-Mar-2013

The purpose of this amendment is to add additional CLINS for Workers' Compensation Insurance

Continues Description

Continues Description

CLINS 0008,1008,2008,3008,4008 have all been added as a Not To Exceed amount for vendors to provide Worker's Compensation Insurance.

CONTRACT PIIN : FA4889-13-R-0005-0001

PRICED CLIN 0008 is added as follows:

LINE ITEM UNIT OF ISSUE ESTIMATED COST EXTENDED PRICE COST CONSTRAINTS

0008 Lot - - NTE NotToExceed

Option: Option Nomenclature: (CR) DBA Workers' Compensation Insurance Nsn:

Noun:

Part Number /

FSCM:

Serial Number:

Contract Type: Cost Contract ACRN: Dollars Obligated: $0.00 PR Number: PR Line Item

Number:

CIN/SDN:

FOB: Inspection: Destination Acceptance: Destination Description: Workers Compensation Insurance (Defense Base Act)

In accordance with Federal Acquisition Regulation 52.228-3(Apr 1984)

The Contractor shall:

(a) provide, before commencing performance under this contract, such workers' compensation insurance or security as the Defense Base Act (42 U.S.C. 1651, et seq.) requires and

(b) continue to maintain it until performance is completed. The Contractor shall insert, in all subcontracts under this contract to which the Defense Base Act applies, a clause similar to this clause (including this sentence) imposing upon those subcontractors this requirement to comply with the Defense Base Act.

In order for the contractor to be reimbursed in full, a copy of the insurance company's receipt shall be provided to the Contracting Officer and Contracting Officer Representative. No fee or profit will be paid on this CLIN.

PRICED CLIN 1008 is added as follows:

1008 Lot - - NTE NotToExceed

Option: Option Nomenclature: (CR) DBA Workers' Compensation Insurance Nsn:

Noun:

Part Number /

FSCM:

Serial Number:

Contract Type: Cost Contract ACRN: Dollars Obligated: $0.00 PR Number: PR Line Item

Number:

CIN/SDN:

FOB: Inspection: Destination Acceptance: Destination

Description: Workers Compensation Insurance (Defense Base Act)

In accordance with Federal Acquisition Regulation 52.228-3(Apr 1984)

The Contractor shall:

(a) provide, before commencing performance under this contract, such workers' compensation insurance or security as the Defense Base Act (42 U.S.C. 1651, et seq.) requires and

(b) continue to maintain it until performance is completed. The Contractor shall insert, in all subcontracts under this contract to which the Defense Base Act applies, a clause similar to this clause (including this sentence) imposing upon those subcontractors this requirement to comply with the Defense Base Act.

In order for the contractor to be reimbursed in full, a copy of the insurance company's receipt shall be provided to the Contracting Officer and Contracting Officer Representative. No fee or

PRICED CLIN 2008 is added as follows:

2008 Lot - - NTE NotToExceed

Option: Option Nomenclature: (CR) DBA Workers' Compensation Insurance Nsn:

Noun:

Part Number /

FSCM:

Serial Number:

Contract Type: Cost Contract ACRN: Dollars Obligated: $0.00 PR Number: PR Line Item

Number:

CIN/SDN:

FOB: Inspection: Destination Acceptance: Destination Description: Workers Compensation Insurance (Defense Base Act)

In accordance with Federal Acquisition Regulation 52.228-3(Apr 1984)

The Contractor shall:

(a) provide, before commencing performance under this contract, such workers' compensation insurance or security as the Defense Base Act (42 U.S.C. 1651, et seq.) requires and

(b) continue to maintain it until performance is completed. The Contractor shall insert, in all subcontracts under this contract to which the Defense Base Act applies, a clause similar to this clause (including this sentence) imposing upon those subcontractors this requirement to comply with the Defense Base Act.

In order for the contractor to be reimbursed in full, a copy of the insurance company's receipt shall be provided to the Contracting Officer and Contracting Officer Representative. No fee or

PRICED CLIN 3008 is added as follows:

3008 Lot - - NTE NotToExceed

Option: Option Nomenclature: (CR) DBA Workers' Compensation Insurance Nsn:

Noun:

Part Number /

FSCM:

Serial Number:

Contract Type: Cost Contract ACRN: Dollars Obligated: $0.00 PR Number: PR Line Item

Number:

CIN/SDN:

FOB: Inspection: Destination Acceptance: Destination Description: Workers Compensation Insurance (Defense Base Act)

In accordance with Federal Acquisition Regulation 52.228-3(Apr 1984)

The Contractor shall:

(a) provide, before commencing performance under this contract, such workers' compensation insurance or security as the Defense Base Act (42 U.S.C. 1651, et seq.) requires and

(b) continue to maintain it until performance is completed. The Contractor shall insert, in all subcontracts under this contract to which the Defense Base Act applies, a clause similar to this clause (including this sentence) imposing upon those subcontractors this requirement to comply with the Defense Base Act.

In order for the contractor to be reimbursed in full, a copy of the insurance company's receipt shall be provided to the Contracting Officer and Contracting Officer Representative. No fee or

PRICED CLIN 4008 is added as follows:

4008 Lot - - NTE NotToExceed

Option: Option Nomenclature: (CR) DBA Workers' Compensation Insurance Nsn:

Noun:

Part Number /

FSCM:

Serial Number:

Contract Type: Cost Contract ACRN: Dollars Obligated: $0.00 PR Number: PR Line Item

Number:

CIN/SDN:

FOB: Inspection: Destination Acceptance: Destination Description: Workers Compensation Insurance (Defense Base Act)

In accordance with Federal Acquisition Regulation 52.228-3(Apr 1984)

The Contractor shall:

(a) provide, before commencing performance under this contract, such workers' compensation insurance or security as the Defense Base Act (42 U.S.C. 1651, et seq.) requires and

(b) continue to maintain it until performance is completed. The Contractor shall insert, in all subcontracts under this contract to which the Defense Base Act applies, a clause similar to this clause (including this sentence) imposing upon those subcontractors this requirement to comply with the Defense Base Act.

In order for the contractor to be reimbursed in full, a copy of the insurance company's receipt shall be provided to the Contracting Officer and Contracting Officer Representative. No fee or profit will be paid on this CLIN.

The following Acceptance/Inspection Schedule was added for PRICED CLIN 0008

FIELD FROM TO

Acceptance Destination Inspection Destination

The following Acceptance/Inspection Schedule was added for PRICED CLIN 1008

FIELD FROM TO

Acceptance Destination Inspection Destination

The following Acceptance/Inspection Schedule was added for PRICED CLIN 2008

FIELD FROM TO

Acceptance Destination Inspection Destination

The following Acceptance/Inspection Schedule was added for PRICED CLIN 3008

FIELD FROM TO

Acceptance Destination Inspection Destination

The following Acceptance/Inspection Schedule was added for PRICED CLIN 4008

FIELD FROM TO

Acceptance Destination Inspection Destination

Period of Performance

The following Period of Performance have been deleted.

CLIN START DATE END DATE

WORK LOCATION

(DoDAAC) WORK LOCATION (ADDRESS)

4008 1-Jun-2013