SPE2D219R00530003 Sched B.pdf

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STANDARD FORM 30 (REV. 10-83)

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED:

PAGE

OF

PAGES

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

6. ISSUED BY

CODE

7. ADMINISTERED BY

(If other than

Item

6)

CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and

ZIP

Code)

10A. MODIFICATION OF CONTRACT/ORDER NO.

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.

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.

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

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. 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).

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

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by

UCF

section headings, including solicitation/contract subject matter where feasible.)

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)

NSN 7540-01-152-8070

Previous edition unusable

STANDARD FORM 30

(REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

16B. UNITED STATES OF AMERICA

15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)

(Signature of person authorized to sign)

16A. NAME AND TITLE OF CONTRACTING OFFICER

(Type or print)

(a) By completing Items 8 and 15, and returning

9A. AMENDMENT OF SOLICITATION NO.

9B. DATED (SEE ITEM 11)

13. THIS APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

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

1.5

Amendment of Solicitation/Modification Contract skim

Standard Form - Amend

Acrobat Distiller 4.0 for Windows

D:20001018094515Z

D:20090422155830-04'00'

CONTINUED ON NEXT PAGE

REFNUMBER:

Z_DEFAULTCONTINUATION_TEXT_1:

SECTIONHEADER:

CURRENTPAGE_1:

PAGECOUNT_1:

SECTION_TITLE:

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Z_DEFAULTCONTINUATION_TEXT_3:

ZSF30_CONTRT_ID_CODE:

ZSF30_AMEND_MOD_NO: 0003

ZSF30_PR_REQ_NO: See Block 14

PROJECT_NO:

ISSUE_CODE:

ADMIN_CODE:

CON_NAME1:

CON_DUNS:

CON_CAGE:

SOL_NO:

A:

ISSUE_DATE:

CON_NO:

ORDER_NO:

EFF_DATE:

X:

Y:

COPIES:

ACCOUNTING:

AA:

BB:

SUPP_AUTH:

DD:

EE:

FF:

GG_COP:

SIGNER_NAME:

SIGNER_TITLE:

AGENCY_NAME1:

ADMIN_NAME1:

MOD_KTR_SIGNDATE:

CO_NAME:

CO_TITLE:

MOD_CO_DATESIGN:

M:

CC:

CO_AUTH:

ZSF30_AGENCY_USR:

OTHER_MOD:

ZS_FORM_SIGNATURE:

ZSF30_EFF_DATE1: 03/24/2020

ZSF30_BLOCK14: Opening/Closing Date Changed to:

2020 JAN 28 / 2020 APR 06

TIME 3:00 PM

See Attached Continuation Sheet(s).

TextField1:

TextField2:

CurrentPage:

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19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

ESTIMATED

QUANTITY

22.

UNIT

23.

UNIT

PRICE

24.

AMOUNT

0001AA

0001AB

0001AC

0001AD

0001AE

0002AA

0002AB

0002AC

0002AD

0002AE

0003AA

0003AB

0003AC

0003AD

0003AE

0004AA

0004AB

0004AC

0004AD

0004AE

0005AA

0005AB

0005AC

0005AD

0005AE

0006AA

0006AB

0006AC

0006AD

0006AE

Fluconazole 50MG – 30 Count

National Drug Code (NDC) ____-___-____

Base Year

Option Year 1

Option Year 2

Option Year 3

Option Year 4

Fluconazole 100MG – 30 Count

Fluconazole 100MG – 100 Count

Fluconazole 200MG – 30 Count

Fluconazole 200MG – 100 Count

Fluconazole 150MG – 12 Count

*BT = One Bottle

**PK = Blister Pack

-The quantities specified in the Schedule are estimates only.

Reference FAR 52.216-21 Requirements for details.

1,144

3,032

5,334

3,112

12,392

48,363

BT*

BT

PK**

PK