FA7000-14-R-0022_Amendment_0004.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

1. The purpose of this Amendment is to:

a. Replace Attachment 2 of the PWS w ith Wage Determination (2005-2079, Revision 15, dated 07/25/2014) incorporated in Amendment 0003.

b. Add Administrative Clerk (Medical Logistics) to FAR 52.222-42, Statement of Equivalent Hires.

2. All other terms and conditions remain unchanged.

1. CONTRACT ID CODE PAGE OF PAGES

S 1 3

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

16C. DATE SIGNED

BY 18-Aug-2014

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 FA7000-14-R-0022

X 9B. DATED (SEE ITEM 11)

23-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 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

18-Aug-2014

CODE

10 CONS - FA7000

THRASHER, D.

8110 INDUSTRIAL DRIVE, STE 200

LGCB

USAF ACADEMY CO 80840-2315

FA7000 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

FA7000-14-R-0022

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

The following have been modified:

52.222-42 STATEMENT OF EQUIVALENT RATES FOR FEDERAL HIRES (MAY 2014)

In compliance with the Service Contract Labor Standards statute and the regulations of the Secretary of Labor (29

CFR part 4), this clause identifies the classes of service employees expected to be employed under the contract and states the wages and fringe benefits payable to each if they were employed by the contracting agency subject to the provisions of 5 U.S.C. 5341 or 5332.

THIS STATEMENT IS FOR INFORMATION ONLY: IT IS NOT A WAGE DETERMINATION

Employee Class Grade Monetary Wage Fringe Benefits

Administrative Clerk (Medical Logistics) GS-05 $28,269.00 36.17%

Administrative Clerks (Clinic) GS-05 $31,628.00 36.17%

Ambulatory Procedure Visit - Medical Coder GS-05 $31,628.00 36.17%

Central Referral Center Medical Support Assistant GS-05 $39,179.00 36.17%

Chiropractic Clinic Administrative Clerk GS-05 $35,256.00 36.17%

Data Analyst GS-11 $57,982.00 36.17%

Information Technology Support Services GS-07 $39,179.00 36.17%

Inpatient Medical Coder GS-05 $28,269.00 36.17%

Laser Eye Clinic Manager GS-11 $57,982.00 36.17%

Licensed Practical Nurse (LPN) GS-05 $28,269.00 36.17%

Medical Records Technicians GS-05 $28,269.00 36.17%

Medical Transcriptionist GS-05 $28,269.00 36.17%

OCO Administrative Clerks (Clinic, Office) GS-05 $28,269.00 36.17%

Office Administrator Service GS-12 $69,497.00 36.17%

Outpatient Medical Coder GS-05 $28,269.00 36.17%

Refractive Laser Clinic Surgical Coordinator GS-06 $35,256.00 36.17%

Right Of First Refusal Licensed Practical Nurse (ROFR LPN) GS-05 $28,269.00 36.17%

TOPA Administrative Clerks (Medical Office Clerk, Clear and Legible Report (CLR) Processing, and Referral Management)

GS-05 $28,269.00 36.17%

Utilization Management - Registered Nurse GS-11 $57,982.00 36.17%

(End of clause)

(End of Summary of Changes)

FA7000-14-R-0022