FA820623Q0062_______0001.pdf

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

J

2. AMENDMENT/MODIFICATION NO.

FA8206-23-Q-0062-0001

3. EFFECTIVE DATE

4. REQUISITION/PURCHASE REQ. NO.

FD20202300062

5. PROJECT NO (If applicable)

6. ISSUED BY CODE

DEPARTMENT OF THE AIR FORCE, DIRECTORATE OF CONTRACTING

AFSC PZAAA2

6050 GUM LANE BLDG 1215

HILL AIR FORCE BASE UT 84056-5825

BUYER: Carol Roth/AFSC carol.roth@us.af.mil Phone: (801) 775- 4619

7. ADMINISTERED BY (If other than item 6) CODEFA8206

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

CODE

X

9A. AMENDMENT OF SOLICITATION NO.

FA820623Q0062

9B. DATED (SEE ITEM 11)

15-DEC-2022

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. 27-JAN-2023 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 copies to the issuing office.

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

ROUTINE

The requirement is not an inherently government function. Repair/Buy effort is deemed performance based. Critical Safety Item (CSI) does not apply to this PI.

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

INFORMATION ONLY

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

EA

NSN: 4130-01-116-6260 AH

RECEIVER,LIQUID REF

water tank Cast Aluminimum Manufacturer Part Number 81205 25-66806-1 Associated Document(s) Line Item(s)

FD20202300062 0001

Priority: R IUID Required: Yes Physical Item Markings:

FIRST ARTICLE

Bid A - First Article Required Item No.

0001AA

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0001AA AA

NSN: 4130-01-116-6260 AH

RECEIVER,LIQUID REF

water tank Cast Aluminimum Manufacturer Part Number 81205 25-66806-1 Priority: R

Inspection: Origin Acceptance: Destination Quality Assurance: Higher Level Contract Quality Requirements The Contractor shall comply with the standard(s) listed below. (if more than one, check the appropriate standard.)

Title Number Date Tailoring

ISO 9001-2008 2008

IUID Required: Yes Physical Item Markings:

FIRST ARTICLE

Bid A - First Article Required

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

+ CNOTE DESTINATION

Type / Ship To PACRN Mark For

+ CNOTE PAA

Type / Ship To Quantity (U/I) IAW FA activity

Form 260 Req No / Pri

Required Delivery

+ CNOTE 1 EA IAW FA activity Form

Proposed Delivery

+ CNOTE 1 EA

IAW FA activity Form 260

FIRST ARTICLE TEST REPORT

Bid A - First Article Required Item No.

0001AB

Not Separately Priced Quantity U/I Unit Price

1 LO NSP

CLIN ACRN ACRN Total

0001AB AA

Data This requirement is for First Article Test Data Report.

Priority: R

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

+ CNOTE ORIGIN

Type / Ship To Quantity (U/I) IAW DD Form 1423 Req No / Pri

Required Delivery

+ CNOTE 1 LO IAW DD Form 1423

Proposed Delivery

+ CNOTE 1 LO

IAW DD Form 1423

PRODUCTION

Bid A - First Article Required Item No.

0001AC

Firm Fixed Price Quantity U/I Unit Price Amount

PRODUCTION

Bid A - First Article Required

3 EA

CLIN ACRN ACRN Total

0001AC AA

NSN: 4130-01-116-6260 AH

RECEIVER,LIQUID REF

water tank Cast Aluminimum Manufacturer Part Number 81205 25-66806-1 Priority: R

Inspection: Origin Acceptance: Origin Quality Assurance: Higher Level Contract Quality Requirements The Contractor shall comply with the standard(s) listed below. (if more than one, check the appropriate standard.)

IUID Required: Yes Physical Item Markings:

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FB2029 ORIGIN

Type / Ship To PACRN Mark For A FB2029 PAA account 09 Type / Ship To Quantity (U/I) On or Before Req No / Pri

Required Delivery

A FB2029 3 EA 1 MAY 2023

Proposed Delivery

A FB2029 3 EA

PRODUCTION - FIRST ARTICLE WAIVED

Bid B - First Article NOT Required Item No.

0001AD

Firm Fixed Price Quantity U/I Unit Price Amount

4 EA

CLIN ACRN ACRN Total

0001AD AA

NSN: 4130-01-116-6260 AH

RECEIVER,LIQUID REF

water tank Cast Aluminimum Manufacturer Part Number 81205 25-66806-1 Priority: R

Inspection: Destination Acceptance: Destination Quality Assurance: Higher Level Contract Quality Requirements The Contractor shall comply with the standard(s) listed below. (if more than one, check the appropriate standard.)

Title Number Date Tailoring

PRODUCTION - FIRST ARTICLE WAIVED

Bid B - First Article NOT Required

ISO 9001-2008 2008

IUID Required: Yes Physical Item Markings:

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FB2029 DESTINATION

Type / Ship To PACRN Mark For A FB2029 PAA account 09 Type / Ship To Quantity (U/I) On or Before Req No / Pri

Required Delivery

A FB2029 4 EA 1 MAY 2023

Proposed Delivery

A FB2029 4 EA

SHIP TO / PLACE OF PERFORMANCE

TYPE/CODE: + CNOTE

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

AWARD NUMBER:

TYPE/CODE: A FB2029

FB2029 OO ALC DDHU CNTRL RCV

CENTRAL RECEIVING BLDG 849W

CP 385 519 8898

5851 F AVE BLDG 849W

HILL AFB UT 84056 UT 84056-4056

USA

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

AWARD NUMBER:

IAW FA activity Form 260

PART I - THE SCHEDULE

SECTION G

CONTRACT ADMINISTRATION DATA

ACCOUNTING AND APPROPRIATION DATA (AUG 1998)

Accounting and Appropriation Chargeable ACRN Funds Citation Amount Chargeable

AA 97 X4930 FC04 64 3 47 GH AM133G 01N000 00000 ERRCNP 503000 F03000 $0.00

Accounting and Appropriation Chargeable ACRN Funds Citation Amount Chargeable

PSR: K31039 FSR: 001679 DSR: 070190 CIN: F2DCCW2332A1070000AA

ACRN TOTAL $ 0.00

PART III - LIST OF DOCUMENTS, EXHIBITS, AND OTHER ATTACHMENTS

SECTION J

LIST OF ATTACHMENTS

Form Number Description/File Name Date Number of Pages

807 807 06OCT2022 1

BIDSET 29NOV2022 1

Data_Package 22NOV2022 2

EDL 04OCT2022 1

EDR 29NOV2022 2

FA_REPORT 06OCT2022 2

IUID 29NOV2022 1

Packaging 29NOV2022 2

SOW 01MAR2022 4

Transportation 23NOV2022 3

CDRL_FATR 22NOV2022 3