FA820415Q7010_______0001.pdf

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

J

2. AMENDMENT/MODIFICATION NO.

FA8204-15-Q-7010-0001

3. EFFECTIVE DATE

13 JUL 2015

4. REQUISITION/PURCHASE REQ. NO.

F2DCDG5098B001

5. PROJECT NO (If applicable)

6. ISSUED BY CODE

DEPARTMENT OF THE AIR FORCE, DIRECTORATE OF CONTRACTING

AFNWC PZBA

6008 WARDLEIGH ROAD BLDG 1580

HILL AIR FORCE BASE UT 84056-5837

BUYER: Carrie E. Balactar/AFNWC carrie.balactar@us.af.mil Phone: (801) 777- 8715 Fax: (801) 775-2116 No Collect Calls

7. ADMINISTERED BY (If other than item 6) CODEFA8204

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

CODE

X

9A. AMENDMENT OF SOLICITATION NO.

FA820415Q7010

9B. DATED (SEE ITEM 11)

9-JUL-2015

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.

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 copies to the issuing office.

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

ROUTINE

This is a combined synopsis/solicitation for commercial items prepared in accordance with the format in Subpart 12.6, as supplemented with additional information included in this action.

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.

Amendment/Modification FA8204-15-Q-7010-0001

Continuation of block 14. DESCRIPTION OF AMENDMENT/MODIFICATION

The purpose of this amendment is to add the following ship to address:

F2DCDG

582 MMXS

7874 Connecticut Dr Bldg 1540

HAFB, UT 84056-5814

Request for Quotation FA8204-15-Q-7010-0001

SUPPLIES OR SERVICES AND PRICES/COSTS

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0001 AA

NSN: 6525

Optical Time Domain Reflectometry (TDR) Priority: R ROUTINE

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Commercial Item Inspection Physical Item Markings:

Special Marking Instructions Below

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A F2DCDG DESTINATION

Brand Name

Manufacturer Name: Fluke OFP-100-QI/GLD Brand: UPC #75408209569 Model or Part No.: PN #25420484

Type / Ship To PACRN Mark For

A F2DCDG PAA

Type / Ship To Quantity (U/I) *ARO Written Notice of Award _ Req No / Pri

Required Delivery

A F2DCDG 1 EA *30 Calendar Days

Proposed Delivery

A F2DCDG 1 EA

Special Item Marking Instructions: If unit price is over $5,000.00, UID shall be IAW MIL-STD-130N, construct #2

Item No.

Firm Fixed Price

Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0002 AA

NSN: 6525

Cable Analyzer modules add on Priority: R ROUTINE

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Commercial Item Inspection Physical Item Markings:

Special Marking Instructions Below

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A F2DCDG DESTINATION

Brand Name

Manufacturer Name: Fluke DSX-ADD-R Model or Part No.: PN #25530611

Type / Ship To PACRN Mark For

A F2DCDG PAA

Type / Ship To Quantity (U/I) *ARO Written Notice of Award _ Req No / Pri

Required Delivery

A F2DCDG 1 EA *30 Calendar Days

Proposed Delivery

A F2DCDG 1 EA

Special Item Marking Instructions: If unit price is over $5,000.00, UID shall be IAW MIL-STD-130N, construct #2

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0003 AA

NSN: 6525

Tear Gold Support Priority: R ROUTINE

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Commercial Item Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A F2DCDG DESTINATION

Brand Name

Manufacturer Name: Fluke GLD-DSX-ADD-R 1 Model or Part No.: PN #25530762

Type / Ship To PACRN Mark For

A F2DCDG PAA

Type / Ship To Quantity (U/I) *ARO Written Notice of Award _ Req No / Pri

Required Delivery

A F2DCDG 1 EA *30 Calendar Days

Proposed Delivery

A F2DCDG 1 EA

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0004 AA

NSN: 6525

Workshop Case Priority: R ROUTINE

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Commercial Item Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A F2DCDG DESTINATION

Brand Name

Manufacturer Name: Fluke Versiv-Case 3 Model or Part No.: PN #25530635

Type / Ship To PACRN Mark For

A F2DCDG PAA

Type / Ship To Quantity (U/I) *ARO Written Notice of Award _ Req No / Pri

Required Delivery

A F2DCDG 1 EA *30 Calendar Days

Proposed Delivery

A F2DCDG 1 EA

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0005 AA

NSN: 6525

Versiv Stand Priority: R ROUTINE

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Commercial Item Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A F2DCDG DESTINATION

Brand Name

Manufacturer Name: Fluke Versiv-Stand Model or Part No.: PN #25530638

Type / Ship To PACRN Mark For

A F2DCDG PAA

Type / Ship To Quantity (U/I) *ARO Written Notice of Award _ Req No / Pri

Required Delivery

A F2DCDG 1 EA *30 Calendar Days

Proposed Delivery

A F2DCDG 1 EA

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0006 AA

NSN: 6525

Fiber Optic Cleaning Kit Priority: R ROUTINE

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Commercial Item Inspection Physical Item Markings:

Special Marking Instructions Below

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A F2DCDG DESTINATION

Brand Name

Manufacturer Name: Fluke NFC-KIT-Case Brand: UPC #75408205538 Model or Part No.: PN #25101524

Type / Ship To PACRN Mark For

A F2DCDG PAA

Type / Ship To Quantity (U/I) *ARO Written Notice of Award _ Req No / Pri

Required Delivery

A F2DCDG 1 EA *30 Calendar Days

Proposed Delivery

A F2DCDG 1 EA

SHIP TO / PLACE OF PERFORMANCE

TYPE/CODE: A F2DCDG

582 MMXS

7874 CONNECTICUT DRIVE

BLDG 1540

HILL AFB BASE UT 84056-5814

UNITED STATES

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

AWARD NUMBER:

ADDENDUM TO CLAUSE 52.212-4

ACCOUNTING AND APPROPRIATION DATA (AUG 1998)

Accounting and Appropriation Chargeable ACRN Funds Citation Amount Chargeable

AA 57 3020 . 15 5 47 NT 25133G 3G6B25 81103 11213F 503000 F03000 $0.00

PSR: F55638 FSR: 037964

REFERENCE:

AA CIN: F2DCDG5098B001

ACRN TOTAL $ 0.00

LIST OF DOCUMENTS, EXHIBITS OR ATTACHMENTS

Form Number Description/File Name Date Number of Pages OTDR_BrandNameLtr.docx Brand Name Justification

16JUN2015 1