FA811917Q0020_______0001.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

J

2. AMENDMENT/MODIFICATION NO.

FA8119-17-Q-0020-0001

3. EFFECTIVE DATE

4. REQUISITION/PURCHASE REQ. NO.

FD20301700777

5. PROJECT NO (If applicable)

6. ISSUED BY CODE

DEPARTMENT OF THE AIR FORCE, AFSC PZABC

3001 STAFF DR STE 1AD2 99A

TINKER AFB OK 73145-3015

BUYER: Matthew McKnight/AFSC/PZABC matthew.mcknight.1@us.af.mil Phone: (405) 739- 2126 No Collect Calls

7. ADMINISTERED BY (If other than item 6) CODEFA8119

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

CODE

X

9A. AMENDMENT OF SOLICITATION NO.

FA811917Q0020

9B. DATED (SEE ITEM 11)

24-OCT-2017

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

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 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. 8-DEC-2017 4:00 PM

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS 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 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 1 copies to the issuing office.

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

Restructured CLIN Quantity. Continue to Page 3

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

15B. CONTRACTOR/OFFEROR

BY ________________________________________________________

(Signature of person authorized to sign)

15C. DATE SIGNED

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

16B. UNITED STATES OF AMERICA

BY ____________________________________________________

(Signature of Contracting Officer)

16C. DATE SIGNED

FACILITY CODE

NSN 7540-01-152-8070

PREVIOUS EDITION UNUSABLE

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

PRESCRIBED BY GSA

FAR (48 CFR) 53.243

X

X X

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.

Continuation of block 14. DESCRIPTION OF AMENDMENT/MODIFICATION

PART I - THE SCHEDULE

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

Convert Power Supply - Repair

Basic Year Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

4 EA

CLIN ACRN ACRN Total

0001 AA

NSN: 6130-01-022-4887 IM

POWER SUPPLY

Power Supply for the Convert-Power Supply (CV-4075/GPN) Various metals.

Manufacturer Part Number

G300278S7 Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection IUID Required: Yes Physical Item Markings:

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A SW3211 ORIGIN

Type / Ship To PACRN Mark For A SW3211 PAC Acct 09 Type / Ship To Quantity (U/I) Each Delivery order should be delivered within 180 calendar days

Req No / Pri

Required Delivery

A SW3211 4 EA Each Delivery order shoul

Proposed Delivery

A SW3211 4 EA

Convert Power Supply - Repair

Basic Year Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

4 EA

CLIN ACRN ACRN Total

1001 AA

NSN: 6130-01-022-4887 IM

POWER SUPPLY

Power Supply for the Convert-Power Supply (CV-4075/GPN) Various metals.

Manufacturer Part Number

G300278S7 Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection IUID Required: Yes Physical Item Markings:

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A SW3211 ORIGIN

Type / Ship To PACRN Mark For A SW3211 PAC Acct 09 Type / Ship To Quantity (U/I) Each Delivery order should be delivered within 180 calendar days

Req No / Pri

Required Delivery

A SW3211 4 EA Each Delivery order shoul

Proposed Delivery

A SW3211 4 EA

Convert Power Supply - Repair

Basic Year Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

7 EA

CLIN ACRN ACRN Total

2001 AA

NSN: 6130-01-022-4887 IM

POWER SUPPLY

Power Supply for the Convert-Power Supply (CV-4075/GPN) Various metals.

Convert Power Supply - Repair

Basic Year Manufacturer Part Number

G300278S7 Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection IUID Required: Yes Physical Item Markings:

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A SW3211 ORIGIN

Type / Ship To PACRN Mark For A SW3211 PAC Acct 09 Type / Ship To Quantity (U/I) Each Delivery order should be delivered within 180 calendar days

Req No / Pri

Required Delivery

A SW3211 7 EA Each Delivery order shoul

Proposed Delivery

A SW3211 7 EA

Convert Power Supply - Repair

Basic Year Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

4 EA

CLIN ACRN ACRN Total

3001 AA

NSN: 6130-01-022-4887 IM

POWER SUPPLY

Power Supply for the Convert-Power Supply (CV-4075/GPN) Various metals.

Manufacturer Part Number

G300278S7 Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection IUID Required: Yes Physical Item Markings:

Convert Power Supply - Repair

Basic Year

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A SW3211 ORIGIN

Type / Ship To PACRN Mark For A SW3211 PAC Acct 09 Type / Ship To Quantity (U/I) Each Delivery order should be delivered within 180 calendar days

Req No / Pri

Required Delivery

A SW3211 4 EA Each Delivery order shoul

Proposed Delivery

A SW3211 4 EA

Convert Power Supply - Repair

Basic Year Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

4 EA

CLIN ACRN ACRN Total

4001 AA

NSN: 6130-01-022-4887 IM

POWER SUPPLY

Power Supply for the Convert-Power Supply (CV-4075/GPN) Various metals.

Manufacturer Part Number

G300278S7 Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection IUID Required: Yes Physical Item Markings:

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A SW3211 ORIGIN

Type / Ship To PACRN Mark For A SW3211 PAC Acct 09 Type / Ship To Quantity (U/I) Each Delivery order should be delivered within 180 calendar days

Req No / Pri

Convert Power Supply - Repair

Basic Year Required Delivery

A SW3211 4 EA Each Delivery order shoul

Proposed Delivery

A SW3211 4 EA

SHIP TO / PLACE OF PERFORMANCE

TYPE/CODE: A SW3211

DLA DISTRIBUTION DEPOT OKLAHOMA

3301 F AVE CEN REC BLDG 506 DR 22

3301 F AVE CEN REC BLDG 506 DR 22

TINKER AFB OK 73145-8000

TINKER AFB OK 73145-8000

USA

MARK FOR: (See Individual Line Item) REQUISITION NUMBER: (See Individual Line Item) REQUISITION PRIORITY: (See Individual Line Item)

AWARD NUMBER: