HSHQW9-11-R-00001 Amend 0004.pdf

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 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 your 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.

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

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

2. AMENDMENT/MODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

7. ADMINISTERED BY (If other than Item 6) CODE

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9A. AMENDMENT OF SOLICITATION

NO.

9B. DATED (SEE ITEM 11)

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.

12. ACCOUNTING AND APPROPRIATION DATA (If required) copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.

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

CHECK ONE 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)

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.

15C. DATE SIGNED

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

16C. DATE SIGNED

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

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

PAGE OF PAGES

6. ISSUED BY CODE

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

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

NSN 7540-01-152-8070

Previous edition unusable

A. The purpose of this amendment is to incorporate changes to the STATEMENT OF WORK and ATTACHMENT 2.

B. Solicitation HSHQW9-11-R-00001 has re-established a proposal due date of MAY 4, 2011 at 1400 HOURS PACIFIC TIME.

C. In reference to the STATEMENT OF WORK, Paragraph 6.7.3, the Computer-Based Training (CBT) is not active and is not applicable at this time. Until such time as CBT becomes active, the government will provide 8 hours of x-ray/magnetometer training at the following government training locations:

US Department of Homeland Security Federal Protective Service/West CCG/Region 9 Office of Procurement Operations 3125 32nd Ave S Federal Way, WA 98001

HSHQW9-11-R-00001

1 3

04/27/2011

03/18/2011

HSHQW9-R-11-00001, Amendment 0004 Page 2 of 3 SF 30 – Continuation Sheet

Training locations:

450 Golden Gate Avenue San Francisco, CA 94102

Or other location mutually agreed upon by the government and the contractor.

D. Replace existing paragraph 13.5 within the STATEMENT OF WORK with the following revised paragraph 13.5:

13.5 HSPD-12 Personal Identity Verification (PIV) Cards

13.5.1 PSOs working under contracts, with a period of performance of 6-months or longer, will be required to complete PIV card process.

13.5.2 PIV Cards are valid for three years from date issue, unless lost, surrendered, or revoked.

13.5.3 Valid PIV cards previously issued to PSO, by a DHS component, will be accepted. PIV cards issued by a non-DHS component will not be recognized by DHS and PSOs must complete PIV card process.

13.5.4 Contractor shall follow procedures contained in Exhibit 9E, Government Provided Property HSPD-12 Personal Identity Verification (PIV) Card Employee Application Process, to obtain a PIV card for each contract employee (prime and subcontracted).

13.5.5 In instances where an employee requires a new PIV card, due to a name change, Contractor shall contact COTR and Region Suitability Office to initiate action. Employee will be required to provide legal documentation showing official name change.

13.5.6 CO shall have express authority to demand return of PIV card for any contract employee who does not maintain contract compliance, qualification, and/or certification standards.

13.5.7 Contractor shall follow established procedures for reporting lost/stolen PIV cards, in accordance with section 13.3.5

E. Deleted existing Page “Attachment 2 – Page 2” and replace with the enclosed revised page “Attachment 2 – Page 2”.

F. Insert the following NEW Exhibits:

Exhibit 2I (Attachment 2 – Page 23A) – Identification Access Control Card Request.

HSHQW9-R-11-00001, Amendment 0004 Page 3 of 3 SF 30 – Continuation Sheet

Exhibit 2J (Attachment 2 – Page 23B) – Federal Response Official Designation Request.

Exhibit 9E (Attachment 2 – Page 108A) – Government-Provided Property HSPD- 12 Personal Identity Verification (PIV) Card Employee Application Process.

Exhibit 9F (Attachment 2 – Page 108C) – Lists of Acceptable Documents.

G. There are NO other changes as a result of this amendment.

JULY 20 10 HSHQW9-1 I- R-OOOO 1 (Amend 0004)

EXHIBIT

SOW

TITLE PAGE

REF.

8C 14.4 Contractor Provided Firearms and Ammunition 95 80 14.5 Contractor Provided Personal Protective Equipment 99 8E 14.2 Contractor Provided Communications Equipment 100 8F 14.3 Contractor Provided Vehicles 102 9 Government Provided Uniforms and Equipment

9A 13.1.1 Government Provided Uniform Items 103 98 13.1.1 Government Provided Supplementary Equipment 104 9C 13.1 .1 Government Provided Personal Protective Equipment 105 90 13.1.1 Government Provided Communications Equipment 106

10 9.12.1 Federal Management Regulations Subpart C, Conduct on 107 Federal Propertv (41 CFR 102-74)

21 Exhibit 9E DHS Form 11000-14, Identification Access Control Card Request 23A

2J Exhibit 9E DHS Form 11000-27, Federal Emergency Response Official 238

Designation Request

9E 13. Government-Provided HSPD-1 2 Personal Identification Verification 108A

(PIV) Card

9F 13. Form 1-9 List of Acceptable Documents 108C

ATTACHMENT2- PAGE2

APRIL 2011 J-JSHQW9-II -R-0000 1 (Amend 0004)

EXHIBIT 21: IDENTIFICATION ACCESS CONTROL

CARD REQUEST

DEPARTMEIlT OF HOMELANO SECURITY

IDENTIFICATIO N ACCESS CONTROL

CARD REQUEST

SECTION I - PERSONAL INFORMATION (Completed by IndivJdu:J l)

~'~'R~S~T~~~,7.EC------------ I MIDDLE ~1AA1E

SOCIAL SECUR ITY NUMBER I DATE OF BIR TH

HOME ADDRESS

Clf Y I STATE HOMe PHONE

-L-___ _ SECTION II • EMPLOYEE INFORMA liON (Completed by Dircc tortJtc! Authorized Rcprcscnt:Jlive)

TYPE OF EMPLOYEE (Cnec~ 000)

C FEDERAL Ef',1PLOYEE FEDERAL OETAllEE CONTRACTOR L OTHER

DIRECTORATElQFF ICE HOI.~E AGENCY (Der.lkeJ i COMPANY (COIIIt.CIa)

I LOCATION (Ch«k o~, C NEBRASKA AVENUE

OF FICE LOCATION (Floor)

7TH &. 0 STREETS :J VER~1ONT AVENUE r OTHER I O'FOCE "UMllER T O' CO"'AC~T========='--

START DATE E~IDDATE

5IGfiATURE AUTHORITY 0" FilE WITH DHS OF FICE OF SECURITY DATE

SECTION III · SECURITY INFORMATION (Completed by Secu rity Office) SECURITY ClEAAAHCE LEVEL

NONE :J SECRET

TOP SECRET ~ OTHER :::-_--===--==-====-===_

----------------r.;-BA"OG=E~H· UMBER---- -----BADGE T'r'PE

ISSUE DATE ! eXPIRATIOfl CATE STATUS

I SIGII"rURE OHS OFFICE Of SECURITY REPRESENTATIVE PHONE flO

SIG' tATURE OF PHYSICAL SECURllY REPRESENTATIVE I PHONE NO.

AUTHORITY 5 USC 5101-5133, SeCllOtlS 5121·5133 arid ExeCUIIVe OrtMr 9397 DISCLOSURE OIwosure oI ln~tlon .s.manO&loty PURPOSE To celie.;!. IrI form&licn pefunent Ie venfymg bcch ir!\1!!>t.gatlon .nd clt'llnca Inform.lion lei' poltntl!ll dcl.iltes. cmp!oyees. and c cnlf,).;!.~ wno have b~ prefenCcd 10 DHS HU.dquilr1~f 1m duly Th", d)la mu ~1 be INe and accllf~ l e Vank.l~cn of Ihi ~ IIl fermalicn k pllemounllo .ccaplance

OHS FO/m 11000·1 4 (12·03)

ATTACHMENT 2 - PAGE 23A

APRIL 2011 HSHQW9- II -R-0000 I (Amend 0004)

EXHIBIT 2J: FEDERAL EMERGENCY RESPONSE

OFFICIAL DESIGNATION REQUEST

FIRST r~AME

DATE OF BIRTH

ADDRESS '2

ZIP

"''ORK PI~O/"E NUMBER

OEPARTMENT OF HOMELAND SECURITY

FEDERAL EMERGENCY RESPONSE OFFIC IA L DESIGNATION

REQUEST

FOR FEDERAL EMERGENCY RESPONSE O FFICIAL

SECTION t - PERSONAL INFORMATION (Completed by Individual)

IIJDDLE ~'AJ,'E I lAST NAME

S EX HOME ADDR ESS

CITY

I HOME PHONE COMPONE rlT r~AME

WORK EMAIL

SECTION II COMPLETED BY FERO A PPROVING A UTHORITY

STATE.

APPROVAL

FEDERAL EMERG ENCY RESPONS E OFFICIAL DESIGNATION 0

DESIGUATEO FERO OfFICIAL I IAME I DE$jGNATED FERO OFFICIAL TElEPHOIIE I FERO OF FICIAl EMAIL I,DDRESS

SIGIIATURE AUTHORIT'( DESIGNATED FO R FERO APPROVAl DATE

SECTION III ACCESS CONTROL OFFICE

FERO STRIPE AUTfiQRIZ EO I FERO Designation

FERO STRIPE AUTHORIZED CARD NUMBER

FERO STRIPE AUTH ORIZED

Issue DATE I EXPIRATlO" OI,TE STATUS

SICIIATURE OHS OFFICE OF SECURITY REPRESEIlTATIVE PHOIIE IIUMSe:R

SIGNATURE OF PHYSICAL SE:CURITY REPRESEIITATIVE PHONE ~IUMBER

PR IVACY ACT STATEMENT

AUTHORITY; 5 USC 5iOI .5733, H Snl .573J lind E~ccut.~ Otdet' IIJII7

PRINCIPAL PURPOSE(S): This infamtJIKm IS oelrJf} cottKled fu Ih e so~ purpose of idenlltlN9 Iha l llU requlemer.:s I'IlIve been no:-110 tJppty!tV lind leecrlve Fedr:.rltIEn,,:m;ency ResfJOfl~ OffleIDIDeSll1rn1 /1OO

ROl/TlNE USE(S); ' Th~ IfIl'crmo1l()11 on IIIls,t)tm nuy be d,lc)Q,~ u rprw:r.J:/ pCtn1UecJ Und~1 5 USC. § 552:1(bj of me Pl fv:.cy Acr of '914, lIl l1nlend~.

Thil tneludes UII1l'Q lhis tnfotnlo,llion 4$ nece!J!JIlfY lind tJlJrllCJ'i:~ by rho loullfll.t usel pubfished in OHSfALL· OJ 4 emeff}rmcy Penonne/locllllOll Recads SyJ/cmofRocadJ (73 FR 61888. Oc:oJ:Jt:t 17. 2006).'

DISCLOSURE: The disclosure of m!oJm;:'f){)(f 0/'1 /his lam Is \1Q'unl llly; hot .... : IICf, ' /lOOte 10 prOI7de /he In!ormlllJOn tequcsled wl/l pre~m /he IfldMdulil !rom leceMng Fedef~Enlelgcf'ICY ReJpotl~ Officilll De sOr1natioo

DHS Form 1100().27 (1I10)

ATTACHM ENT 2 - PAGE 23B

APRIL 2010

EXHIBIT 9E: GOVERNMENT-PROVIDED PROPERTY

HSPD-12 PERSONAL IDENTITY VERIFICATION (PIV)

CARD EMPLOYEE APPLICATION PROCESS

A. Application.

1. Contractor shall provide employee forms listed below after employee receives favorable suitability determination from FPS; employee shall complete each form and return to Contractor.

a. DHS Form 1100-14, Identification Access Control Card Request (Exhibit 2I)

b. DHS Form 11000-27, Federal Emergency Response Official Designation Request (Exhibit 2J)

2. Contractor shall review forms identified in 1 (a) and (b) for completeness, then provide to

COTR.

B. Sponsorship.

1. COTR will review forms for completeness, once verified, forward forms to HSPD-12 Program Office.

2. COTR will notify designated contractor representative regarding employee’s sponsorship determination and provide information for enrollment. (See example below section C. 5)

C. Enrollment.

1. Government will notify Contractor of specific dates/times available for enrollment.

Contractor shall schedule its employee(s) within those dates/times and ensure employee reports to enrollment station at scheduled time.

2. Employee must bring two valid forms of identification. Acceptable forms of identification can be found in Form I-9, OMB No. 1115-0136, Employment Eligibility Verification. (Exhibit 9F). At least one form of identification must be a Federal or State government issued photo identification.

3. If employee does not present acceptable forms of identification, appointment will be cancelled. Designated contractor representative is responsible for notifying COTR of cancelled appointment and re-scheduling appointment.

4. After enrollment process is complete, PIV card will be issued and activated. To activate PIV card, employee will be fingerprinted and required to provide a 6 to 8 numeric Personal Identification Number (PIN). PIN should be created to mitigate unauthorized use of PIV card.

HSHQW9-11-R-00001 (Amend 0004)

ATTACMENT 2 - PAGE 108A

5. Estimated Processing Time: 20 min/per person

Address* Operating Days* Hours* Point of Contact

* Information will be provided by COTR

HSHQW9-11-R-00001 (Amend 0004)

ATTACMENT 2 - PAGE 108B

KHJohns1 Typewritten Text Address: 450 Golden Gate Avenue, San Francisco, CA Operating Days: To be determined Hours: To be determined

Address: 2500 Tulare Street, Fresno, CA Operating Days: To be determined Hours: To be determined

Address: 280 South 1st Street, San Jose, CA Operating Days: To be determined Hours: To be determined

Point of Contact:

Tamara Peterson 450 Golden Gate Ave, #5474, San Francisco, CA

(415) 436-8007

NOTE: PIV Cards are issued for a three (3) year period and then must be re-issued.

EXHIBIT 9F: FORM I-9

LISTS OF ACCEPTABLE DOCUMENTS

HSHQW9-11-R-00001 (Amend 0004)

ATTACMENT 2 - PAGE 108C

HSHQW9-11-R-00001 Amend 0004 - DRAFT.pdf

Exhibit I & J