FA825021Q0987_0001.pdf

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

J

2. AMENDMENT/MODIFICATION NO.

FA8250-21-Q-0987-0001

3. EFFECTIVE DATE

11 AUG 2021

4. REQUISITION/PURCHASE REQ. NO.

FD20202100987

5. PROJECT NO (If applicable)

FD20202100987

6. ISSUED BY CODE

DEPARTMENT OF THE AIR FORCE, DIRECTORATE OF CONTRACTING

AFSC PZAAA1

6050 GUM LANE BLDG 1215

HILL AIR FORCE BASE UT 84056-5825

BUYER: Nataly Pringle/AFSC nataly.pringle.1@us.af.mil Phone: (801) 777- 6355

7. ADMINISTERED BY (If other than item 6) CODEFA8250

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

CODE

X

9A. AMENDMENT OF SOLICITATION NO.

FA825021Q0987

9B. DATED (SEE ITEM 11)

13-JUL-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. 16-AUG-2021 3:30 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

Requirement restricted to qualified source(s).

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.

FA8250-21-Q-0987-0001

Continuation of block 14. DESCRIPTION OF AMENDMENT/MODIFICATION

ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED.

PART I - THE SCHEDULE

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

INFORMATIONAL CLIN

NSN 5820011958574FD

Item No.

J058 Level 2 Repair Units TT&E and repairs will be conducted in accordance with PWS.

Applicability: None ;

Test, Teardown, and Evaluation (TT&E)

NSN 5820011958574FD

Item No.

0001AA

Test, Teardown, and Evaluation (TT&E)

NSN 5820011958574FD

Firm Fixed Price Quantity U/I Unit Price Amount

1 EA

CLIN ACRN ACRN Total

0001AA AA

NSN: 5820-01-195-8574 FD

RECEIVER,TELEVISION

Manufacturer Part Number

71542-01 715742

Priority: R

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

IUID Required: Yes

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

+ TBD ORIGIN

Type / Ship To PACRN Mark For

+ TBD PAB

Type / Ship To Quantity (U/I) *ARO After Receipt of Carcass Req No / Pri

Required Delivery

+ TBD 1 EA *30 Days

Proposed Delivery

+ TBD 1 EA

Upon completion of CLIN 0001AA a detailed repair quote shall be forwarded to the DCMA ACO.

The ACO is authorized to negotiate and definitize CLIN 0001AB via modification. Work shall not begin under CLIN 0001AB until notice to proceed is provided from DCMA in the form of a definitization modification.

REPAIR

NSN 5820011958574FD

Item No.

0001AB

Not to Exceed Price Quantity U/I Unit Price Not to Exceed Price

1 EA

CLIN ACRN ACRN Total

0001AB AA

NSN: 5820-01-195-8574 FD

REPAIR

NSN 5820011958574FD

RECEIVER,TELEVISION

Manufacturer Part Number

715742 715742-01

Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection Applicability: None ;

IUID Required: Yes

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A W25G1W ORIGIN

Type / Ship To PACRN Mark For

A W25G1W PAB

Type / Ship To Quantity (U/I) *ARO After

Completion of Study Req No / Pri

Required Delivery

A W25G1W 1 EA *90 Days

Proposed Delivery

A W25G1W 1 EA

DATA CLIN

CAVAF

Item No.

Not Separately Priced Quantity U/I Unit Price

1 EA NSP

Data IAW DD Form 1423-1 Data Item No. A001, A002, A003 CAV AF Priority: R

Limitations of Liability: Other Than High Value Item

DATA CLIN

CAVAF

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Letter of Transmittal Quality Assurance: Standard Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FB2029 DESTINATION

Type / Ship To Quantity (U/I) *ARO IAW DD Form

1423-1 Req No / Pri

Required Delivery

A FB2029 1 EA *1 Calendar Days

Proposed Delivery

A FB2029 1 EA

IAW attached DD Form 1423

DCMA shall coordinate with CAVAF monitor to ensure requirements are met prior to Repair Invoice Acceptance. If CAVAF requirements are not met in accordance with the CDRL then payment may be withheld until CAVAF requirements are met. DCMA shall not provide acceptance until receipt of concurrence from CAVAF monitor.

“DATA which is ‘Not Separately Priced’ (NSP). The price of NSP DATA are included in the price of the individual Repair CLIN 0001AB. Failure to comply with contract data requirements may result in the withholding of payment on the aforementioned CLINs.” This allows the government to withhold payment on the repairs if the contractor does not deliver the required data. The data is also important, and it is a material requirement of the contract. The contract is not finished until the data is delivered.

DATA CLIN

Repairable Item Inspection Report (RIIR) Item No.

Not Separately Priced Quantity U/I Unit Price

3 EA NSP

Data IAW DD Form 1423-1 Data Item No. B001 Repairable Item Inspection Report Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection

DATA CLIN

Repairable Item Inspection Report (RIIR)

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FY2073 DESTINATION

Type / Ship To Quantity (U/I) *ARO IAW DD Form

1423-1 Req No / Pri

Required Delivery

A FY2073 3 EA *7 Calendar Days

Proposed Delivery

A FY2073 3 EA

DATA CLIN

Counterfeit Prevention Plan (CPP) Item No.

Not Separately Priced Quantity U/I Unit Price

3 EA NSP

Data IAW DD Form 1423-1 Data Item No. C001 Counterfeit Prevention Plan Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FY2073 DESTINATION

Type / Ship To Quantity (U/I) *ARO IAW DD Form

1423-1 Req No / Pri

Required Delivery

A FY2073 3 EA *30 Calendar Days

Proposed Delivery

DATA CLIN

Counterfeit Prevention Plan (CPP)

A FY2073 3 EA

DATA CLIN

Engineering Change Proposal (ECP) Item No.

Not Separately Priced Quantity U/I Unit Price

3 EA NSP

Data IAW DD Form 1423-1 Data Item No. D001 Engineering Change Proposal Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FY2073 DESTINATION

Type / Ship To Quantity (U/I) *ARO IAW DD Form

1423-1 Req No / Pri

Required Delivery

A FY2073 3 EA *14 Calendar Days

Proposed

A FY2073 3 EA

DATA CLIN

Test Procedure Item No.

Not Separately Priced Quantity U/I Unit Price

3 EA NSP

Data IAW DD Form 1423-1 Data Item No. E001 Test Procedure Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FY2073 DESTINATION

Type / Ship To Quantity (U/I) *ARO IAW DD Form

1423-1 Req No / Pri

Required Delivery

A FY2073 3 EA *45 Calendar Days

Proposed Delivery

A FY2073 3 EA

DATA CLIN

Test/Inspection Report Item No.

Not Separately Priced Quantity U/I Unit Price

3 EA NSP

Data IAW DD Form 1423-1 Data Item No. F001 Test Report Priority: R

Limitations of Liability: Other Than High Value Item

DATA CLIN

Test/Inspection Report

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A FY2073 DESTINATION

Type / Ship To Quantity (U/I) *ARO IAW DD Form

1423-1 Req No / Pri

Required Delivery

A FY2073 3 EA *15 Calendar Days

Proposed

A FY2073 3 EA

SHIP TO / PLACE OF PERFORMANCE

TYPE/CODE: + TBD

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:

TYPE/CODE: A FY2073

FY2073 OO ALC 502 CBSS GBMAA

CP 801 586 1368

6012 FIR AVE BLDG 1239 RM 2

HILL AFB UT 84056

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:

TYPE/CODE: A W25G1W

W1A8 DLA DIST-TOBYANNA

GIBBS AND FIFTH STREETS

WAREHOUSE 6 BAY 4

TOBYHANNA PA 18466-5059 PA 18466-5059

USA

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

AWARD NUMBER:

PART I - THE SCHEDULE

SECTION G

CONTRACT ADMINISTRATION DATA

ACCOUNTING AND APPROPRIATION DATA

Accounting and Appropriation Chargeable ACRN Funds Citation Amount Chargeable

AA 97 X4930 FC04 64 1 47 GH 8M826L 01K010 00000 UJEZDJ 503000 F03000 $0.00

Accounting and Appropriation Chargeable ACRN Funds Citation Amount Chargeable

PSR: K24921 FSR: 001884 DSR: 114841 CIN: F2DCCW1182A1020000AA

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 Attachment 1 PWS 30JUN2021 10

Attachment 2 Item_Description 01JUL2021 1

Attachment 3 PKG 01JUL2021 4

Attachment 4 PKG_SOW 01MAR2021 4

Attachment 5 RDL 05MAR2021 2

Attachment 6 Transportation 30JUN2021 5

Attachment 7 CAVAF 01FEB2018 7

Attachment 8 CDRLs 01FEB2001 21

Attachment 9 RQR 08MAR2021 3

Attachment 10 Instructions 02JUL2021 2

Attachment 11 Evaluation 02JUL2021 2