621II_R3_Amend_0011_23OCT2025_FINAL.docx

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

2. AMENDMENT/MODIFICATION NO.

3. EFFECTIVE DATE

6. ISSUED BY:

Department of Veterans Affairs CODE: 003B6B OPAL / National Acquisition Center 1st Avenue, One Block North of Cermak, Bldg. 37 Hines, IL 60141

7. ADMINISTERED BY (If other than Item 6) Department of Veterans Affairs CODE: 003B6B

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

797-FSS-04-0001-R3

06/06/2018

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 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT 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 letter or electronic communication, provided each letter or electronic communication 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.)

SOLICITATION UPDATES

This amendment incorporates GSAM Clause 552.238-120 Economic Price Adjustment – Federal Supply Schedule Contracts (Tailored) (Sep 2024), updates Responsibility Evaluation dated October 2025, and updates the Signature Authority form dated August 2025.

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 CONTRACTING OFFICER (Type or print)

15B. CONTRACTOR/OFFEROR

_______________________________________________ (Signature of person authorized to sign)

15C. DATE SIGNED

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

16C. DATE SIGNED

EXCEPTION TO SF30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

SUMMARY OF CHANGES, REFERENCING THE NEW AND OLD VERSIONS OF REGULATIONS

ADDED CLAUSE

GSAM 552.238-120 Economic Price Adjustment – Federal Supply Schedule Contracts (Tailored) (Sep 2024).

Economic Price Adjustment—Federal Supply Schedule Contracts (Sep 2024)

(a) Definition. "Economic price adjustment method", as used in this clause, means the agreed upon procedures by which pricing may be adjusted throughout the contract period to include, but not limited to, the mechanism(s) to be used to adjust pricing (e.g., adjustments based on established pricing), the pricing subject to adjustment, and any other requirements (e.g., timing, frequency)

(b) General. This contract provides for economic price adjustment (EPA) to contract pricing based on the established EPA method. EPA provides for the increase and decrease to stated contract pricing upon the occurrence of specified conditions described in the EPA method, such as market index changes or unforeseeable significant changes in market conditions.

(c) Exceptions. This clause does not cover—

(1) Adjustments based on statute, Executive Order, or regulation (e.g., Service Contract Labor Standards ( 41 U.S.C. chapter 67) and AbilityOne procurements ( FAR subpart 8.7));

(2) Adjustments based on a change clause (e.g., paragraph (c) of GSAR clause 552.212-4, Contract Terms and Conditions—Commercial Products and Commercial Services (FAR DEVIATION 52.212-4));

(3) Price reductions made under GSAR clause 552.238-81, Price Reductions;

(4) Adjustments based on GSAR clause 552.238-117, Price Adjustment-Failure to Provide Accurate Information; and

(5) Adjustments based on a contract clause that authorizes an adjustment based on specified actions or conditions.

(d) Economic price adjustment method - The following is FSS’ economic price adjustment method:

(1) Note 1: For Special Item Number (SIN) 42-2A, paragraph (b) is no longer controlling for covered drugs listed on the FSS at their federal ceiling prices (FCPs). Any request for an economic price adjustment under SIN 42-2A will be determined in accordance with the MA and PPA entered into between the contractor and the VA pursuant to Public Law 102-585. Contractors with dual SIN 42-2A pricelists may apply paragraph (b) to covered drug items on their OGA pricelists. Please see clause AS212 Generic Item Modifications for additional requirements for price increases and decreases for SIN 42-2b.

(2) Note 2: The tracking customer’s price must be disclosed with your request for increases. The awarded tracking customer and the established ratio at the time of award will affect your ability to receive an increase.

(3) Note 3: Commercial Price Lists will use labor statistics indices (such as Bureau of Labor and Statistics) for Service type contracts. Schedule 621 I, as used in this clause means the originally released Consumer Price Index – All Urban Consumers (CPI-U), not seasonally adjusted, U.S. City average, published by the Bureau of Labor Statistics, U.S. Department of Labor for Series ID CUUR0000SEMC and CUUS0000SEMC, Medical Care Services, Professional Services, published by the US Bureau of Labor Statistics, and made available at . If the market indicator is discontinued or deemed no longer available or reliable by the Government, the Government and the Contractor will mutually agree to a substitute.

(4) Note 4: Schedule 66 III, Producer Price Index (PPI), as used in this clause means the index, not seasonally adjusted, published by the Bureau of Labor Statistics, U.S. Department of Labor for Series ID PCU325413325413, In Vitro Diagnostic Substance Manufacturing available at . If the market indicator is discontinued or deemed no longer available or reliable by the Government, the Government and the Contractor will mutually agree to a substitute.

(4) Price adjustments include price increases and price decreases. Adjustments will be considered as follows:

(i) Contractors shall submit price decreases anytime during the contract period in which they occur. Price decreases will be handled in accordance with the provisions of the Price Reduction Clause.

(ii) Contractors may request a price increase resulting from a reissue or other modification of the Contractor's commercial catalog/pricelist that was used as the basis for the contract award.

(iii) The following material shall be submitted with the request for a price increase: a copy of the commercial catalog/pricelist showing the price increase and the effective date for commercial customers.

(e) Submission requirements. The Contractor shall submit EPA requests to the Federal Supply Schedule (FSS) Contracting Officer pursuant to the EPA method. EPA requests shall fully conform to the requirements of the EPA method and include sufficient information to support the request. The FSS Contracting Officer may request additional information from the Contractor.

(f) Contracting Officer responsibilities. The FSS Contracting Officer will—

(1) Review the EPA request to ensure conformance with the EPA method,

(2) Make a determination. The FSS Contracting Officer may use any information (e.g., market research) deemed necessary to support their determination. The FSS Contracting Officer may determine to—

(i) Accept the EPA request either in whole or in part,

(ii) Reject the EPA request either in whole or in part, or

(iii) Take any other action deemed to be in the best interest of the Government (e.g., negotiate a more favorable EPA).

(3) Notify the Contractor of their determination, and

(4) Modify the contract, as applicable, to reflect the determination. Contract items that need to be removed from the contract as a result of rejection or an inability to reach agreement are to be removed in accordance with 552.238-79, Cancellation.

(g) Effective date. EPA requests approved by the FSS Contracting Officer under this clause shall apply to orders issued on or after the effective date of the contract modification. Blanket Purchase Agreements (BPAs) may be modified by the ordering agency in accordance with the terms and conditions of the BPA.

(h) Update of contract pricing and catalog data. The Contractor shall update its FSS pricing and any other FSS catalog data in accordance with the terms and conditions of this contract.

(End of clause)

RESPONSIBILITY EVALUATION

(October 2025)

COMPLETE THIS SECTION IF THIS IS A

NEW DEPARTMENT OF VETERANS AFFAIRS (VA)

FEDERAL SUPPLY SCHEDULE (FSS) OFFER

New Offers

1. Applicable to both product and service offers for new Federal Supply Schedule (FSS) contractors, the offeror must complete the Contractor’s Qualifications and Financial Information Form or provide annual financial statements for the previous two-years* (audited, if available). At a minimum, each financial statement must consist of a balance sheet and income statement. FSS will use this information to determine financial responsibility. On an attachment or in Section IV of the Contractor’s Qualifications and Financial Information Form, please provide an explanation for any negative financial information disclosed, including negative equity or income. Offerors may be required to provide letters of credit or other documentation to demonstrate that adequate financial resources are available. In accordance with Federal Acquisition Regulation (FAR) 9.104-1(a), contracts will only be awarded to responsible prospective contractors. To be determined responsible, an offeror must have adequate financial resources to perform the contract or the ability to obtain them. Offerors must NOT submit tax returns.

*If new FSS contractors have less than two years of financial statements or corporate experience (Alternative Method). Then you must provide financial documentation demonstrating financial responsibility, such as:

· Bank references.

· Certificate of Competency from the Small Business Administration.

· Corporate guarantee — available for subsidiary companies.

· Documents showing assets versus liabilities.

· Evidence of a line of credit with a bank or the Small Business Administration.

· Evidence of an irrevocable letter of credit.

· Financial data that demonstrates financial capability.

· Interim or comprehensive financial statements.

· Signed AngelList investors.

· Signed venture capital agreements.

*Information demonstrating ability to manage a company or adequate resources and provide the products and services described under the contract, such as:

· Relevant corporate experience of key personnel. Proposed and accepted key personnel are expected to remain dedicated to the contract. The resumes of the initially proposed key personnel will become the minimum requirement for qualifications for the rest of the total contract term.

CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION

VA Federal Supply Schedule

SECTION I - GENERAL INFORMATION

I. OTHER (Specify below)

A. LIFO

C. AVERAGE COST

9. KIND OF BUSINESS

B. FIFO

D. OTHER (Specify)

D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCONTINUED BUSINESS

OPERATIONS WITH OUTSTANDING DEBTS?

October 2025

SECTION II - GOVERNMENT FINANCIAL AID AND INDEBTEDNESS

12A. ARE YOU DELINQUENT ON ANY FEDERAL DEBT (OMB CIRCULAR A-129)

(If "Yes", provide detailed information, Section V, Remarks)

YES |_| NO |_|

BALANCE

14. ARE YOU CURRENTLY RECEIVING GOVERNMENT FINANCING?

|_| YES

|_| NO (Go to Section III )

15. COMPLETE ITEMS BELOW IF APPLICABLE

SECTION III - FINANCIAL STATEMENTS

Prepared Financial Statements with notes may be provided in lieu of completing Section III

LISTED FIGURES ARE:

17B. STREET ADDRESS

|_| ARE ATTACHED

Investments in and advance to affiliated company

D. TOTAL ASSETS

24. From (Month, Day, Year) 25. TO(Month, Day, Year)

SECTION IV - INCOME STATEMENT

26. INCOME

Cost of Goods Sold

SECTION V - REMARKS

REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).)

CERTIFICATION

For the purpose of establishing financial responsibility with the VA Federal Supply Schedules we furnish the above as a true and correct statement of our financial condition as of the date of certification.

NAME OF BUSINESS

BY (Signature of Authorized Official)

NAME OF AUTHORIZED OFFICIAL (Type or print)

DATE

TITLE OF AUTHORIZED OFFICIAL (Type or print)

SIGNATORY AUTHORITY FOR OFFERS AND CONTRACTS / COMPANY INFORMATION

The purpose of this document is to clearly identify who has been delegated the authority to sign your Federal Supply Schedule (FSS) offer or contract on behalf of the named firm as well as identify pertinent company information. Pursuant to our policy, the only person(s) with the ability to delegate authority is an officer of the company. Therefore, please list the officers of the company in block 6 of the form. In block 7, please list those persons to whom authority has been delegated to sign, negotiate and/or administer your Federal Supply Schedule (FSS) offer or contract. Finally, blocks 15, 16, 17 must be signed by an officer of the company (individual listed in block 6) in order for our office to accept the authority. If you require additional space, you may use a properly titled attachment.

NOTE: All items must be completed; insert N/A if information is not applicable.

5. COMPANY INFORMATION

A. NAME

B. STREET ADDRESS

C. CITY

D. STATE

E. ZIP CODE

6. NAMES OF OFFICERS, OWNERS, OR PARTNERS

A. PRESIDENT

B. VICE PRESIDENT

C. SECRETARY

D. TREASURER

E. OTHER OFFICERS, OWNERS OR PARTNERS (add attachments if necessary)

7. ADDITIONAL PERSONS (other than block 6) AUTHORIZED TO SIGN OFFERS AND CONTRACTS ON BEHALF OF THE COMPANY (Indicate if Agent)

8. BUSINESS INFORMATION (Refer to FAR 52.212-1(a), 19.101 and 19.102)

A. SIZE OF BUSINESS

|_| SMALL BUSINESS (Complete block 9)

|_| OTHER THAN SMALL BUSINESS

B. AVERAGE NUMBER OF EMPLOYEES

(Including affiliates) FOR THE PRECEDING 12 MONTHS C. AVERAGE ANNUAL COMPANY SALES OR RECEIPTS (Including affiliates) FOR PRECEDING 3 OR 5 FISCAL YRS (see 13 CFR 121.104) $

|_| DISADVANTAGED

|_| WOMEN-OWNED

|_| HUBZONE

|_| VETERAN-OWNED

|_| SERVICE DISABLED VETERAN-OWNED

|_| 8(A)

|_| MANUFACTURER / PRODUCER

|_| DEALER

|_| DISTRIBUTOR

|_| SERVICE ESTABLISHMENT

|_| RESELLER

TAX IDENTIFICATION NUMBER:

DUNS: UEI:

B. AMOUNT

CERTIFICATION -- I certify that information supplied herein (including all pages attached) is correct and that neither the company nor any person (for concern) in any connection with the company as a principal or officer, so far as it known, is now debarred or otherwise declared ineligible by any agency of the Federal Government from making offers for furnishing materials, supplies, or services to the Government or any agency thereof.

08/2025