FA825121Q0004_______0002.pdf

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

J

2. AMENDMENT/MODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO.

FD20202100171

5. PROJECT NO (If applicable)

FA8251-21-Q-0004

6. ISSUED BY CODE

DEPARTMENT OF THE AIR FORCE, DIRECTORATE OF CONTRACTING

AFSC PZABB

6050 GUM LANE BLDG 1215

HILL AIR FORCE BASE UT 84056-5825

BUYER: Timothy Howard/AFSC timothy.howard.27@us.af.mil Phone: (801) 586- 8242

7. ADMINISTERED BY (If other than item 6) CODEFA8251

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

CODE

X

9A. AMENDMENT OF SOLICITATION NO.

FA825121Q0004

9B. DATED (SEE ITEM 11)

7-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.

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

FA825121Q0004 - Amendment 2

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.

FA8251-21-Q-0004 - 0002

Continuation of block 14. DESCRIPTION OF AMENDMENT/MODIFICATION

The purpose of this amendment is to:

A) CLIN 0001 BER CLIN - Added alternate part number 79-049-13

B) CLIN 0001 BER CLIN - Change Inspection and Acceptance report:

From: IAW DD 1423-1

To: Receiving Report Required

C) CLIN 0002 - Change Inspection and Acceptance report:

From: IAW DD 1423-1

To: Receiving Report Required

D) CLIN 0003- Change Inspection and Acceptance report:

From: Receiving Report Required

To: IAW DD 1423-1

E) CLIN 0004 - Change Inspection and Acceptance report:

From: Receiving Report Required

To: IAW DD 1423-1

PART I - THE SCHEDULE

SECTION B

SUPPLIES OR SERVICES AND PRICES/COSTS

Condemnation/Beyound Economical Repair (BER)

Item No.

To Be Negotiated Quantity U/I Unit Price

2 EA TBN

NSN: 1270-01-199-7430 WF

Condemnation/Beyound Economical Repair (BER) IAW the PWS section 4.12 Manufacturer Part Number

16VE017001-13

K0656 79-049-13 Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required Quality Assurance: Standard Inspection Buy American Act/Balance of Payments Program IUID Required: Yes Type / Ship To PACRN Mark For

+ TBD PAD

Type / Ship To Quantity (U/I) Disposition work with IPT. BER ship in place.

Req No / Pri

Required Delivery

+ TBD 2 EA Disposition work with

IPT

Proposed Delivery

+ TBD 2 EA

Disposition work with IPT. BER ship in place.

Repair Heads-Up Display

Item No.

Firm Fixed Price Quantity U/I Unit Price Amount

Repair Heads-Up Display

4 EA

NSN: 1270-01-199-7430 WF

DISPLAY UNIT,HEAD-U

Displays information through the lens system from the CRT onto a combiner glass for flight info.

Aluminum Chassis containing multiple circuit cards and a CRT connected to an optical module Manufacturer Part Number 449T3 79-049-13 50218 79-049-13

6LLP4 79-049-13

81755 16VE017001-13

K0656 79-049-13

KO656 79-049-13

Priority: R

Inspection: Origin Acceptance: Origin Inspection/Acceptance Report: Receiving Report Required 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:

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

A SW3210 ORIGIN

Type / Ship To PACRN Mark For A SW3210 PAE 09 account Type / Ship To Quantity (U/I) *ARO After Receipt of Carcass Req No / Pri

Required Delivery

A SW3210 4 EA *60 Days

Proposed Delivery

A SW3210 4 EA

60 calendar days

RECURRING DATA

Not Separately Priced Quantity U/I Unit Price

1 LO NSP

Data A001 CAV AF REPORT, A002 CONTRACT MAINTENANCE PRODCTION REPORT, A004 MAINTENANCE DATA

COLLECTION REPORT.

Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: IAW DD 1423-1 Quality Assurance: Standard Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

+ CNOTE ORIGIN

Type / Ship To Quantity (U/I) IAW DD1423-1 Req No / Pri

Required Delivery

+ CNOTE 1 LO IAW DD1423-1

Proposed Delivery

+ CNOTE 1 LO

IAW DD1423-1

Not Separately Priced Quantity U/I Unit Price

1 LO NSP

Data

B001 CPP-COUNTERFIET PREVENTION PLAN/B002 IUID

Priority: R

Limitations of Liability: Other Than High Value Item

Inspection: Destination Acceptance: Destination Inspection/Acceptance Report: IAW DD 1423-1 Quality Assurance: Standard Inspection

Transportation From Continental United States CONUS (CONUS) Sources

TYPE / SHIP TO CODE F.O.B.

+ CNOTE ORIGIN

Type / Ship To Quantity (U/I) IAW DD1423-1 Req No / Pri

Required Delivery

+ CNOTE 1 LO IAW DD1423-1

Proposed Delivery

+ CNOTE 1 LO

IAW DD1423-1

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: + TBD

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

AWARD NUMBER:

TYPE/CODE: A SW3210

DLA DISTRIBUTION DEPOT HILL

7537 WARDLEIGH RD BLDG 849W

CML 385 519 8898

HILL AFB UT 84056-5734 49 84056-5734

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 E

INSPECTION AND ACCEPTANCE

52.246-4 INSPECTION OF SERVICES--FIXED-PRICE (AUG 1996)

(IAW FAR 46.304)

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

SECTION J

LIST OF ATTACHMENTS

Form Number Description/File Name Date Number of Pages 1423-1 CDRL B002-IUID Plan 31MAR2021 2

1423-1 Combined CDRLs A001-A004-B001 16FEB2021 9

AFMC 158 Packaging 02MAR2021 2

RQR RQR 25JUN2020 3

DD FORM 2169 Special Packing Instructions 1-7 31MAR2021 7

DD FORM 1653 Transportation 02MAR2021 3

WAGE DET WAGE DET 03MAY2020 19

CAVAF REPORTING

REQ

CAV Instructions 01FEB2018 7

PWS_HUD_PDU

PWS

06MAY2021 14