HC102819R0009 AMD 0004.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83)

Prescribed by GSA

FAR (48 CFR) 53.243

a. The purpose of this Amendment is to provide updated Questions and Answ ers (Attachment L1). As a result of these Q&As, the follow ing attachments have been updated:

1.Attachment L7, Cost Template.

3. Attachment C1, TO 0001 SOW.

b. All else remains unchanged.

1. CONTRACT ID CODE PAGE OF PAGES

S 1 2

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

16C. DATE SIGNED

BY 05-Aug-2020

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street, County, State and Zip Code) X HC102819R0009

X 9B. DATED (SEE ITEM 11)

29-Jun-2020

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

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 Offer is extended, X is not extended.

Offer 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 ITEM 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 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 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.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

05-Aug-2020

CODE

DISA/DITCO-SCOTT-PL83

2300 EAST DRIVE, BUILDING 3600

SCOTT AFB IL 62225-5406

HC1028 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

HC102819R0009

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

(End of Summary of Changes)

ATTACHMENT I: PROBLEM NOTIFICATION REPORT

PNR Subject/Title:

Notification Number:

Date:

Section 1. Should be filled out for all PNR submissions

Description and Cause:

Reference:

Section 2. Should be filled out for Follow up and Final PNR submissions

The identified problem represents potential and/or realized impact to:

a) Cost:

b) Schedule:

c) Performance:

d) Quality:

Section 3. Should be filled out for Follow up and Final PNR submissions

Mitigation Actions:

Section 4. Should be filled out for Follow up and Final PNR

Preventive Actions:

I-1

REQUEST TO INITIATE PURCHASE ODCs (Tools)

Contract Number:

Task Order

Project Title:

RIP Authorization No.

CLIN Number:

Purpose of Request:

Item Description:

Cost to Government:

General & Administrative (G&A) Cost:

Estimated Total Cost:

Approval Date Contractor PM Approval

Local Government Sponsor Approval

AFCENT A6 Approval

COR Approval

All material purchases shall be made in accordance with customer requirements.

All ODCs shall be purchased in accordance with Task Order requirements and shall not exceed the funded amount on this Task Order.

It is the responsibility of the Contractor to ensure that the prices quoted are fair and reasonable at the time of submission and are in the best interest of the Government.

Item Quantity Unit Cost Total Cost Selected Vendor Selection Justification

Total -$

Vendor 1 Vendor 2 Vendor 3 Analysis If needed If needed If needed

Item Price Notes Price Notes Price Notes

RIP Cover Page

Cost Summary (sample)

Price Analysis (If Needed)

CONTRACT INFO

ERROR:#REF! GOVERNMENT FURNISHED PROPERTY * denotes a required field

Attachment Number* 1 Attachment Date* 2019-03-11

GOVERNMENT CONTRACTING OFFICER

Name Email Phone

Document Description* Contract Award Mod Number Amendment No.

CUSTODIAL PROCUREMENT INSTRUMENT IDENTIFICATION

Contract Number Type* DoD Contract (FAR)

SOLICITATION, CONTRACT or UNIFORM PIID NUMBER* Order Number OR

PIID FORMAT (FY16+) Old Order Format

Issuing Office DoDAAC Issuing Year Contract Type Sequence Number Issuing Office DoDAAC Issuing Year Contract Type Sequence Number

Consolidated GFP Attachment Version 2.0

Requisitioned

/xl/drawings/drawing1.xml#Requisition!A1NON-Serially Managed

/xl/drawings/drawing1.xml#'NON-Serially%20Managed%20Items'!A1Serially Managed

/xl/drawings/drawing1.xml#'Serially%20Managed%20Items'!A1

Serially Managed Items

* denotes a required field † A minimum of one of these fields is required for each item record †† If either "Mfr CAGE" or "Part Number" is entered, the other is required.

If any one of duration, time unit, or delivery event are populated, all 3 must be populated.

Serially Managed Items

LINE NUMBER* ITEM NAME* ITEM DESCRIPTION* NSN† MFR CAGE†,†† PART NUMBER†,†† MODEL NUMBER† QTY* UNIT OF MEASURE* UNIT ACQ COST USE AS-IS* DELIVERY DATE DURATION TIME UNIT DELIVERY EVENT NOTES

1 Laptop Laptop with accessories: Power Cord and Mouse Laptop 10-15 Each true

/xl/drawings/drawing2.xml#Requisition!A1NON-Serially Managed

/xl/drawings/drawing2.xml#'NON-Serially%20Managed%20Items'!A1Contract Information

/xl/drawings/drawing2.xml#'CONTRACT%20INFO'!A1

Non-Serially Managed Items

* denotes a required field † A minimum of one of these fields is required for each item record †† If either "Mfr CAGE" or "Part Number" is entered, the other is required.

NON-Serially Managed Items

LINE NUMBER* ITEM NAME* ITEM DESCRIPTION* NSN† MFR CAGE†,†† PART NUMBER†,†† MODEL NUMBER† QTY* UNIT OF MEASURE* UNIT ACQ COST USE AS-IS* DELIVERY DATE DURATION TIME UNIT DELIVERY EVENT NOTES

1 Laptops Laptop with accessories: Power Cord and Mouse Laptop 10 Each true

2 Phones Phone with charging cord Phone 5 Each true

/xl/drawings/drawing3.xml#Requisition!A1Contract Information

/xl/drawings/drawing3.xml#'CONTRACT%20INFO'!A1Serially Managed

/xl/drawings/drawing3.xml#'Serially%20Managed%20Items'!A1

Requisition

* denotes a required field † A minimum of one of these fields is required for each item record †† If either "Mfr CAGE" or "Part Number" is entered, the other is required.

Requisitioned Items

LINE NUMBER* ITEM NAME* ITEM DESCRIPTION* NSN† MFR CAGE†,†† PART NUMBER†,†† QTY* UNIT OF MEASURE* UNIT ACQ COST USE AS-IS*