FA821021R5002_______0005.pdf

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

J

2. AMENDMENT/MODIFICATION NO.

FA8210-21-R-5002-0005

3. EFFECTIVE DATE

15 JUL 2021

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO (If applicable)

6. ISSUED BY CODE

DEPARTMENT OF THE AIR FORCE, DIRECTORATE OF CONTRACTING

AFLCMC PZZKA

6039 WARDLEIGH RD BLDG 1206

HILL AIR FORCE BASE UT 84056-5838

BUYER: Carlos Michel/AFLCMC carlos.michel@us.af.mil Phone: (801) 777- 6077

7. ADMINISTERED BY (If other than item 6) CODEFA8210

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

CODE

X

9A. AMENDMENT OF SOLICITATION NO.

FA821021R5002

9B. DATED (SEE ITEM 11)

22-APR-2021

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. 22-JUL-2021 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.)

ROUTINE

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.

FA8210-21-R-5002-0005

Continuation of block 14. DESCRIPTION OF AMENDMENT/MODIFICATION

The Purpose of this amendment is to perform the following:

A) Update and replace Section L in its entirety in section J.

B) Update CLINs 0004 and 0005 to reflect the reference to the Pricing Workbook.

PART I - THE SCHEDULE

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

Airborne Subsystem (AS) Retrofit Kits (FMS)

Item No.

Estimated Quantity

U/I Unit Price Amount

100 KT See Pricing Workbook

NSN: 1680

P5 CTS SSU Airborne Subsystem (AS) Retrofit Kit (FMS) FMS Baseline P5 SSU Retrofit Kits IAW SOW paragraph 4.3 and the Pricing Worksheet.

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection Foreign Military Sales :FMS Case:

Buy American Act/Balance of Payments Program IUID Required: Yes Physical Item Markings:

IAW MIL-STD-130

Serial Number Required

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

+ TBC ORIGIN

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

+ TBC 100 KT TBC

Proposed Delivery

+ TBC 100 KT

Provisional Spares (USAF)

Item No.

Firm Fixed Price Estimated Quantity

U/I Unit Price Amount

Provisional Spares (USAF)

1 LO See Pricing Workbook

NSN: 1680

Provisional Spares (USAF) Provisional Spares IAW SOW paragraph 4.3

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection Buy American Act/Balance of Payments Program IUID Required: Yes Physical Item Markings:

IAW MIL-STD-130

Serial Number Required

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

+ TBC DESTINATION

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

+ TBC 1 LO TBC

Proposed Delivery

+ TBC 1 LO

SHIP TO / PLACE OF PERFORMANCE

TYPE/CODE: + TBC

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

AWARD NUMBER:

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

SECTION J

LIST OF ATTACHMENTS

Form Number Description/File Name Date Number of Pages Section L UNDATED 15