Amend_0001F.pdf

R FQP03021600018/0001 Page 1 of 3

T ID CODE

I

1. CONTRAC

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

SE REO. NO. 15. PROJECT NO. (If applicable) 2. AMENDMENT/MODIFICATION NO.

000 1 11 /01/2016

3. EFFECTIVE DATE 4. REQUISITION/PlJRCHA

6. ISSUED BY CODE BFAO 7. ADMINISTERED BY (If o /her than Item 6) CODE I BCOX

Federal Bureau of Prisons Field Acquisition Office U.S. Armed Forces Reserve Complex 346 Marine Forces Drive Grand Prairie, TX 75051

Edna Perry-Carter

(0) 972-352-4569

(F) 972-352-4545 eperry@bop.gov

Federal Bureau of P FCC Coleman risons ce 846 NE 54th Terra Co leman, FL 3352 1-1029

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

RFOP03021600018

x 9B. DATED (SEE ITEM 11)

10/19/2016

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

CODE FACILITY CODE

11 . THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLIC ITATIONS

ffers D is extended , D is not extended.

nded, by one of the following methods: (a) By

[RI The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of 0

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as ame completing items 8 and 15, and returning copies of the amendment; {b) By acknowledging receipt of this amen separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YO PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RES this amendment your desire to change an offer already submitted, such change may be made by telegram or letter, dment on each copy of the offer submitted; or (c) By

UR ACKNOWLEDGMENT TO BE RECEIVED AT THE

ULT IN REJECTION OF YOUR OFFER. If by virtue of 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)

TS/ORDERS. 13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRAC

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

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FO RTH IN ITEM 14 ARE MADE IN THE CONTRACT

------1 ORDER NO. IN ITEM 10A.

TIVE CHANGES (such as changes in paying office, B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRA appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.10 3(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor ice. o is not, o is required to sign this document and return ___ copies to the issuing offi where feasible.)

at 9:00 a.m. Eastern Standard Time

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

RFQP030216000 18 is hereby amended to schedule a site visit for Wednesday, November 30, 2016, and to extend the closing date to Wednesday, November 16, 2016, at 2:00 p.m. Eastern Standard Tim e. All interested vendors are welcol!Je to attend.

All other items remain unchanged.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains uncha nged and in full force and effect.

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

15B. CONTRACTOR/OFFEROR

(Signa ture of person authorized to sign)

NSN 7540-01-152-8070

Previous edition unusable

15C. DATE SIGNED

16A. NAME AND TITLE 0 F CONTRACTING OFFICER (Type or print)

Edna Perry-Carter

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

of Contracting Officer) 11 /0 1/2016 (Signature By

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

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

RFQP03021600018

2. AMENDMENT/MODIFICATION NO. 3. EFF DATE 4. REQUISITION/PURCHASE REQ. NO. PAGE OF PAGE

0001 11/01/2016 2 of 3

An organized site visit has been scheduled for 9:00 a.m. Eastern Standard Time on Wednesday, November 30, 2016. The site visit will be held at the Federal Correctional Complex (FCC) , 846 NE 54th Terrace, Coleman, FL 33521-1029.

Given the time required to comply with the security requirements associated with visiting the FCC, anyone interested in attending this site visit must complete and submit the attached BP-S660.012, NCIC Check Form to David Barr, Engineering Technician at FCC Coleman, P. 0 .

Box 1029, Coleman, FL 33521. Hard copies only, no e-mail or faxed copies will be accepted. The form must be received no later than 3:00 p.m. EST on Monday, November 21 , 2016. All forms shall be filled out legibly in dark ink or typewritten and shall be submitted in a timely fashion to be received by Mr. Barr on or before 3:00 p.m. EST on Monday, November 21, 2016. This will allow the Bureau of Prisons ample time to conduct a limited background security clearance (NCIC) for ALL persons who will be attending this site visit and to be allowed access to enter the institution on November 30, 2016. Persons who are not deemed suitable to enter the institution will be contacted by phone as soon as practicable. No person will be allowed in the institution until a NCIC check is completed and approved. All prospective quoters who plan to attend this site visit are required to bring picture identification and meet at the Training Center of the FCC, no later than 8:30 a.m. EST. This will be the only site visit scheduled . This site visit is NOT MANDATORY. Any issues or concerns expressed during this site visit, which are not addressed in the solicitation document, will be addressed in writing and posted along with the original solicitation document. David Barr is the point of contact for th is site visit. If you have any questions please contact Mr. Barr at (352) 689-3037.

Quoters who previously submitted a quote for this solicitation need only sign and return this amendment if they intend to have their quote considered as is. All quoters may submit revised quotes as they deem necessary.

BP-A0660

JUN 10

U.S. DEPARTMENT OF JUSTICE

NCIC CHECK CDFRM

FEDERAL BUREAU OF PRISONS

AUTHORIZATION FOR RELEASE OF INFORMATION

NCIC (National Crime Information Center) CHECK

I hereby authorize a representative of the Federal Bureau of Prisons to obtain any information on my criminal history background . I understand that this check must be done before I am allowed to enter/serve a t any Bureau facility . I also understand that refusal to provide all necessary information may result in 1) denial of entry into a Bureau facility and 2) denial of volunteer/contract status.

1. Name (Last , First , Middle)

2 . Address (Street address) (City , State , County , Zip Code)

3. Home Telephone Number (Area Code , Number)

4 . Aliases/Nickname :

5 . Citizenship (List the country you are a citizen of)

6. Social Security Number :

7. Date of Birth (Month , day , year)

Ba. Sex: Bb . Race :

Be. Height : Bd . Weight :

Be. Color of Eyes: 9f . Color of Hair :

9 . Place of Birth (City , State , County) , (List city , county and country if outside the U.S . A)

10 . The above listed information is true and correct. Applicant ' s Signature lOa . Date

PRIVACY ACT NOTICE

Authority for Collecting Information : E . O . 10450 ; 5 USC 1303-1305 ; 42 USC 2165 and 2455 ;

22 USC 25B5 and 2519 ; a n d 5 USC 3301

Purposes and Uses: Info r mation prov i ded on this form will be furnished to individuals in order to obtain informa t ion regarding activities in connection with an investigation to determine (1) fitness for Federal employment , (2) clearance to perform contractual service for the Federal Government , (3) security clearance or access . The information obtained may be furnished to third parties as necessary in the fulfillment of official responsibilities .

Effects of Non-disclosures: Furnishing the requested information is voluntary , but failure to provide all or of part the information may result in lack of further consideration for employment , clearance or access , or in the termination of your employment.

PDF Prescribed by P12BO

BP - A0660

JUNIO 10

DEPARTAMENTO DE JUSTICIA DE EE . UU.

CHEQUEO DE NCIC CDFRM

AGENCIA FEDERAL DE PRISIONES

**This template is provided to assist Spanish-speaking persons who are not fluent in English to complete the corresponding Bureau form. It is a template only for instructional purposes, and should not be filled in . **

**Este modelo se provee para ayudar a las personas .que hablan espanol y no dominan el ingles para que completen el formulario correspondiente de la Agencia. Es solo un modelo que sirve como ejemplo, y no se debe completar.**

AUTORIZACION PARA LA DISTRIBUCION DE INFORMACION

CHEQUEO DE NCIC (Centro Nacional de Informaci6n sobre el Crimen)

Par este media autorizo a un representante de la Agencia Federal de Prisiones a obtener cualquier informaci6n sabre los antecedentes de mi historial criminal. Entiendo que este chequeo debe ser hecho antes de recibir permiso para entrar/servir en cualquier instalaci6n de la Agencia Federal de Prisiones. Tambien entiendo que la negaci6n a proveer toda la informaci6n necesaria puede resultar en 1) la negaci6n de mi entrada a una instalaci6n de la Agencia Federal de Prisiones y 2) la negaci6n de mi clasificaci6n coma voluntar io /contratista .

1. Nombre (Apellido, Nombre, Segundo Nombre)

2. Direcci6n (Numero de Domicilio y Calle) (Ciudad , Estado , Condado, C6digo Postal)

3. Numero de Telefono de Casa (C6digo de Area, Numero):

4. Alias/Apodos :

5. Ciudadania (Indique el pais de su ciudadania)

6. Numero de Seguridad Social:

7. Fecha de Nacimiento (Mes , dia, ai'lo)

Sa. Sexo: Sb . Raza :

Sc . Estatura : Sd . Peso:

Se . Color de Ojos : 9f . Color de Cabello :

9 . Lugar de Nacimiento (Ciudad, la ciudad , el condado y el pais, Estado, Condado), (Indique si es afuera de EE.UU.)

10. La informaci6n anteriormente listada es verdadera y correcta.

Firma de Solicitante lOa. Fecha

AVISO SOBRE LA LEY DE PRIVACIDAD

Autoridad para Obtener Informaci6n: E . O. 10450 ; 5 USC 1303-1305 ; 42 USC 2165 y 2455; 22 USC 25S5 y 2519; y 5 USC 3301

Objetivos y Usos: La informaci6n provista en este formulario sera entregada a individuos, con el fin de obtener informaci6n en cuanto a actividades como parte de una investigaci6n realizada para determinar (1) la aptitud para ob tener empleo Federal , (2) la autorizaci6n para realizar servicio contratado para el Gobierno Federal, (3) la autorizaci6n de seguridad o acceso. La informaci6n obtenida puede ser entregada a terceras partes, coma lo sea necesario , para realizar las responsabilidades oficiales.

Efectos de Informaci6n No Divulgada: El proveer la informaci6n solicitada es voluntario , pero la falta de proveer toda o parte de la informaci6n puede resultar en la privaci6n de futura consideraci6n para empleo, para autorizaci6n o acceso , o puede resultar en la terminaci6n de su empleo.

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