Amendment_1_Document.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE

See Block #2

PAGE OF PAGES

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

4. REQUISITION/PURCHASE REQ.NO.

5. PROJECT NO. (If applicable)

6. ISSUED BY AFLCMC/PZIEB CODE FA8604 7. ADMINISTERED BY (If other than Item 6) CODE

USAF/AFMC/AFLCMC

AF LIFE CYCLE MANAGEMENT CENTER

2275 D STREET, BLDG 16, RM 128

WRIGHT-PATTERSON AFB OH 45433-7228

JUSTIN C. ORR 9376567488

JUSTIN.ORR.2@US.AF.MIL

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code) (X) 9A. AMENDMENT OF SOLICITATION NO.

FA8604-19-R-8109

X

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

CODE FACILITY CODE

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers X 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 0 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 ITEM APPLIES ONLY TO MODIFICATION OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

(X )

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: ( ) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. ITEM

10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation data, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE 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 X 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.)

NON-ACAT Materials Handling System, Yokota Japan - Additional Attchments included, Notification of Compliance with Insurance Requirements and Acknowledgement of Compliance.

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.

15A. NAME AND TITLE OF SIGNER (Type or print).

16A. NAME AND TITLE OF SIGNER (Type or print)

15B. CONTRACTOR/OFFEROR

15C. DATE SIGNED 16B. UNITED STATES OF AMERICA

16C. DATE SIGNED

(Signature of person authorized to sign)

BY________________________________________

(Signature of Contracting Officer)

NSN 7540-01-152-8070 30-105 STANDARD FORM 30 (REV.10-83)

PREVIOUS EDITION UNUSABLE Prescribed by GSA ConWrite Version 7.2.1.9 FAR (48 CFR) 53.243 Created 16 Aug 2019 10:31 AM

CONTRACT DOCUMENTS, EXHIBITS AND ATTACHMENTS

FA8604-19-R-8109 0001 PAGE 2 OF 3

1. Updated Attachments Included

a. Notification of Compliance with Insurance Requirements

b. Acknowledgement of Compliance

2. All other tems and conditions remain unchanged.

SCHEDULE

FA8604-19-R-8109 0001

DOCUMENT PGS DATE TITLE

ATTACHMENT 15 1 15 AUG 2019 ATTACHMENT 15 - NOTIFICATION OF

COMPLIANCE

ATTACHMENT 16 1 15 AUG 2019 ATTACHMENT 16 - ACKNOWLEDGEMENT OF

COMPLIANCE

Notification of Compliance with Contract Insurance Requirements

The undersigned Contractor hereby acknowledges that he/she has read and understands the insurance requirements specified in this contract and hereby provides notification (1) that such insurance shall be maintained in at least the amounts and types as stated in FAR 28.307-2 and during any modifications and/or time extensions granted thereto; (2) that the required insurance policies shall contain an endorsement to the effect that any cancellation of material changes adversely affecting the Government's interest shall not be effective for such period as the laws of the State in which this contract is to be performed prescribe, or until thirty (30) calendar days after the insurer or contractor gives written notice to the Contracting Officer, whichever period is longer; (3) that _____________ (state) Workers' Compensation Insurance, or letter of reciprocal agreement with another state, shall be maintained on this contract for and during the entire performance period and for any modifications and/or time extensions granted thereto; and (4) that a copy of all subcontractors' proofs of required insurance shall be maintained and shall be made available to the Contracting Officer upon request. This agreement shall be a part of subject contract and shall be legally binding and enforceable at law.

INSURANCE COMPANY(S):

Name:

Address:

Policy #:

Telephone #:

CONTRACTOR:

Company Name:

Address:

(Typed Name and Title) (Date)

(Authorized Signature)

FA8604-19-R-8109 Attachment 15 Page 1 of 1

FA8604-19-R-8109 Attachment 16 Page 1 of 1

ACKNOWLEDGEMENT OF COMPLIANCE WITH COVER PURCHASE DESCRIPTION

AND PURCHASE DESCRIPTION APPENDICIES

Offeror:

Project Title: Material handling System at Yokota AB, Japan Base: Yokota AB, Japan CSN: PYK706 Cover Purchase Description, Appendices A-F, dated 1 May 2019

We have read the requirements of the Cover Purchase Description and Purchase Description Appendices and will comply with all paragraphs as written, with exceptions taken only to those items indicated on the attached exception sheets.

Offeror's Signature Date

TYPED NAME:

COMPANY NAME:

ADDRESS:

PHONE:

EMAIL: