FA821221R0016_______0002.pdf

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

J

2. AMENDMENT/MODIFICATION NO.

FA8212-21-R-0016-0002

3. EFFECTIVE DATE

4. REQUISITION/PURCHASE REQ. NO.

FD20202100331 02

5. PROJECT NO (If applicable)

FD2020210033102

6. ISSUED BY CODE

DEPARTMENT OF THE AIR FORCE, DIRECTORATE OF CONTRACTING

AFSC PZABA

6050 GUM LANE BLDG 1215

HILL AIR FORCE BASE UT 84056-5825

BUYER: Ben J. Davies/AFSC ben.davies@us.af.mil Phone: (801) 777- 6502

7. ADMINISTERED BY (If other than item 6) CODEFA8212

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

CODE

X

9A. AMENDMENT OF SOLICITATION NO.

FA821221R0016

9B. DATED (SEE ITEM 11)

31-JUL-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-JUL-2022 5:00 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

CSI DOES NOT APPLY. CPP DOES APPLY. GPP NOT REQUIRED. Compliance Database has been checked.

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

The following changes were made to the solicitation:

1) Adjust production quantities from 18 to 12

2) Clarify first article delivery as ship-in-place at contractor site and identified as a modified acceptance IAW SOW

3) Other changes were made to SOW and CDRLs as coordinated with customer

4) The following clauses were added:

252.223-7002 Safety Precautions for Ammunition and Explosives 252.223-7003 Change in Place of Performance—Ammunition and Explosives

All other terms and conditions remain the same.

PART I - THE SCHEDULE

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

Batteries Squib Activated GAP-4157

Item No.

NSN: 6135-00-992-8750 AH

BATTERY,SQUIB ACTUA

This battery is used to power the Premature Stage Separation System for Glory Flight Launches Numerous materials are used in the construction of this battery.

Manufacturer Part Number 08903 10-20942-3 79318 200744 81205 10-20942-3 81855 200613210

81855 GAP4157

98747 200613210 98747 201128232 Associated Document(s) Line Item(s)

FD20202100331 02 0001

Priority: R Applicability: None ;

IUID Required: Yes Physical Item Markings:

Serial Number Required Class I ODS Substance Application/Use Quantity None None None

CDRL - DATA

Item No.

0001AA

Not Separately Priced Quantity U/I Unit Price

1 LO NSP

Data

CDRL - DATA

A001 Integrated Master Schedule (IMS); A002 Meeting Agenda; A003 Briefing Material; A004 Report, Record of Meeting/Minutes; A014 Counterfeit Prevention Plan; A015 Quality Assurance Program Plan (QAPP); A027 SOW Paras 1.3, 2.2, 3.1.2, 3.1.2.2, 3.1.3.4.2.7, 3.1.3.4.4.6; A030 Specification Change Notice (SCN); A031 Engineering Change Proposal (ECP); A038 Technical Data Package (TDP); A059, A059-2, A059-3, A059-4 Technical Report - Studies/Services; A060 SOW Paras 1.3, 3.1.3.4.1.6, 3.1.3.4.2.5, 3.1.4.1; A061 Test Procedure; A062 Test/Inspection Report; A088 Technical Report - Study/Services;

A103 Item Unique Identification (IUID) Marking Plan; A104 Item Unique Identification (IUID) Marking Activity, Validation and Verification Report; A108 SOW Paras 2.7, 3.1.3.6; A109 Commercial Off-The-Shelf (COTS) Manuals and Associated; Supplemental Data; A110 SOW Paras 2.9, 3.1.2.3; A111 Data Accession List (DAL); A114 Report, Production or Delivery Problem (S); A127 Bill of Materials (BOM) for Logistics and Supply Chain Risk Management;

Associated Document(s) Line Item(s)

FD20202100331 02 0002

Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: IAW SOW & CDRLs Quality Assurance: Standard Inspection Type / Ship To Quantity (U/I) IAW DD1423 Req No / Pri

Required Delivery

+ IAW1423 1 LO IAW DD1423

Proposed Delivery

+ IAW1423 1 LO

IAW DD1423

First Articles

Item No.

0001AB

Firm Fixed Price Quantity U/I Unit Price Amount

3 EA

CLIN ACRN ACRN Total

0001AB AA

NSN: 6135-00-992-8750 AH

BATTERY,SQUIB ACTUA

Manufacturer Part Number 08903 10-20942-3 79318 200744 81205 10-20942-3 81855 200613210

81855 GAP4157

98747 200613210 98747 201128232 Associated Document(s) Line Item(s)

FD20202100331 02 0001AA

Priority: R

First Articles

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Modified Lot Acceptance Testing, IAW SOW Quality Assurance: Standard Inspection Applicability: None ;

IUID Required: Yes Type / Ship To PACRN Mark For

D 81855 PAA

Type / Ship To Quantity (U/I) First Article delivery schedule same as production and ship to Contractors location.

Req No / Pri

Required Delivery

D 81855 3 EA First Article delivery sc

Proposed Delivery

D 81855 3 EA

First Article delivery schedule same as production and ship-in-place at contractors location. Cage Code:

81855

Production Articles

Item No.

0001AC

Firm Fixed Price Quantity U/I Unit Price Amount

12 EA

CLIN ACRN ACRN Total

0001AC AA

NSN: 6135-00-992-8750 AH

BATTERY,SQUIB ACTUA

This battery is used to power the Premature Stage Separation System for Glory Flight Launches Numerous materials are used in the construction of this battery.

Manufacturer Part Number 08903 10-20942-3 79318 200744 81205 10-20942-3 81855 200613210

81855 GAP4157

98747 200613210 98747 201128232 Associated Document(s) Line Item(s)

Production Articles

FD20202100331 02 0001

Priority: R

Inspection: Origin Acceptance: Origin Quality Assurance: Standard Inspection Applicability: None ;

IUID Required: Yes Physical Item Markings:

Serial Number Required

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 12 EA 27 DEC 2023

Proposed Delivery

A FB2029 12 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: + IAW1423

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

CP 385 519 8898

5851 F AVE BLDG 849W

HILL AFB UT 84056

HILL AFB UT 84056 UT 84056-5713

USA

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

AWARD NUMBER:

TYPE/CODE: D 81855

EAGLEPICHER TECHNOLOGIES, LLC

1215 W C ST

JOPLIN MO 64801-2816

UNITED STATES

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

AWARD NUMBER:

First Article delivery schedule same as production and ship to contractors location. Cage Code: 4Y7U1

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 2 47 GH AM133G 01N000 00000 ERRCNP 503000 F03000 $0.00

Accounting and Appropriation Chargeable ACRN Funds Citation Amount Chargeable

PSR: K24754 FSR: 001679 DSR: 346822 CIN: F2DCCW1175A1020000AA

ACRN TOTAL $ 0.00

PART II - CONTRACT CLAUSES

SECTION I

CONTRACT CLAUSES

252.223-7002 SAFETY PRECAUTIONS FOR AMMUNITION AND EXPLOSIVES (MAY 1994)

(IAW DFARS 223.370-5)

252.223-7003 CHANGE IN PLACE OF PERFORMANCE--AMMUNITION AND EXPLOSIVES

(DEC 1991)

(IAW DFARS 223.370-5)

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

SECTION J

LIST OF ATTACHMENTS

Form Number Description/File Name Date Number of Pages CDRL.docx Contract Data Requirements List - Text Activity

07JUL2022

Packaging.pdf Report

07JUL2022

Packaging_SPI.pdf

SPI

07JUL2022

Transportation.pdf Report

07JUL2022

SOW.docx Statement of Work

27MAY2021