SPRDL119P0114-P00001.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. Contract ID Code Page Of

2. Amendment/Modification No.

3. Effective Date

4. Requisition/Purchase Req No.

5. Project No. (If applicable)

6. Issued By Code 7. Administered By (If other than Item 6) Code

8. Name And Address Of Contractor (No., Street, City, County, State and Zip Code)

9A. Amendment Of Solicitation No.

9B. Dated (See Item 11)

10A. Modification Of Contract/Order No.

10B. Dated (See Item 13) Code Facility Code

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 ____________ copies of the amendments: (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 ONLY APPLIES TO MODIFICATIONS OF CONTRACTS/ORDERS

It Modifies The Contract/Order No. As Described In Item 14.

A. This Change Order is Issued Pursuant To: 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 data, 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.)

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 15C. Date Signed 16B. United States Of America 16C. Date Signed

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

NSN 7540-01-152-8070

PREVIOUS EDITIONS UNUSABLE

30-105-02 STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

SEE SCHEDULE

X

Firm Fixed Price

P00001 2019MAY17

SPRDL1

DLA LAND WARREN

WARREN, MI 48397-5000

MARK HOUSTON

EMAIL: MARK.J.HOUSTON.CIV@MAIL.MIL

S2401A

DCMA TWIN CITIES

5600 WEST AMERICAN BOULEVARD

SUITE 600

BLOOMINGTON MN 55401

2Y430

LCL ELECTRONICS, INC.

8148 INDUSTRIAL PARK RD

BAXTER, MN 56425-8099

SPRDL1-19-P-0114

2019JAN25

ACRN: AA NET INCREASE: $64,560.00

Exercise of Priced OptionX

X

SEE SECOND PAGE FOR DESCRIPTION

/SIGNED/ 2019MAY17

MORRIS BELLEVILLE

MORRIS.A.BELLEVILLE.CIV@MAIL.MIL (586)467-1157

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CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SECTION A - SUPPLEMENTAL INFORMATION

Buyer Name: MARK HOUSTON

Buyer Office Symbol/Telephone Number: ZGAA/(586)467-1251

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

Kind of Modification: N

Type of Business: Other Small Business Performing in U.S.

Surveillance Criticality Designator: C

Paying Office: HQ0339

DFAS - COLUMBUS CENTER

WEST ENTITLEMENT OPERATIONS

P O BOX 182317

COLUMBUS OH 43218-2317

*** End of Narrative A0000 ***

1. The purpose of the Modification P00001 to purchase order SPRDL1-19-P-0114 is to award option CLIN 0002AA. This is in accordance with the Special Provision Clause 52.217-4001 entitled "Separately Priced for Increased Quantity" located in the basic contract.

2. PRON EH9RB216EHis hereby added to Section B as Item 0002AA(CLIN).

3. Original option Quantity: 48 EA

Previous Quantity Exercised: 0 EA

Exercised this Modification: 48 EA

Remaining Option Quantity: 0 EA

4. As a result of this modification P00001 the total dollar value of the contract is increased by $64,560.00 from $64,560.00 to

$129,120.00

5. All other terms and conditions of the basic contract remain unchanged and in full force and effect.

*** END OF NARRATIVE A0003 ***

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SPRDL1-19-P-0114

P00001

LCL ELECTRONICS, INC.

PIIN/SIIN

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

0002 CIRCUIT CARD ASSEMB

NSN: 5998-01-356-6145

Mfr CAGE: 19207

Mfr Part Number: 12347072

0002AA EXERCISED OPTION QUANTITY 48 EA $ 1,345.00000 $ 64,560.00 _________________________ ______________ __________________

COMMODITY NAME: CIRCUIT CARD ASSEMB

CLIN CONTRACT TYPE:

Fixed Price Re-determination Prospective

PRON: EH9RB216EH PRON AMD: 03 ACRN: AA

AMS CD: SM2B1100000

PSC: 5998

(End of narrative B001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

UNIT PACK: 001

LEVEL PRESERVATION: Military

LEVEL PACKING: B

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

REL CD MILSTRIP ADDR SIG CD MARK FOR TP CD ______ ________ ______ ______ ________ _____

001 W56HZV9066051Z W562RP J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 48 14-OCT-2019

FOB POINT: Destination

SHIP TO:

(W562RP) SR ARMY GENERAL SUPPLY LMP STOCK RE

CENTRAL RECEIVING POINT

7 FRANKFORD AVE BLDG 362

ANNISTON,AL,36201-4199

CONTRACT/DELIVERY ORDER NUMBER ______________________________

SPRDL1-19-P-0114/0000

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SPRDL1-19-P-0114

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SECTION G - CONTRACT ADMINISTRATION DATA

PRON/ PRON/

AMS CD/ AMS CD/

LINE MIPR/ OBLG JO NO/ INCREASE/ CUMULATIVELINE MIPR/ OBLG JO NO/ INCREASE/ CUMULATIVE

ITEM GFEBS ATA STAT ACCT ASSIGN ACRN PRIOR AMOUNT DECREASE AMOUNTITEM GFEBS ATA STAT ACCT ASSIGN ACRN PRIOR AMOUNT DECREASE AMOUNT_____ _________ _____ ___________ ____ ____________ __________ ________________ _________ _____ ___________ ____ ____________ __________ ___________

0002AA EH9RB216EH 2 AA $ 0.00 $ 64,560.00 $ 64,560.00

SM2B1100000

NET CHANGE $ 64,560.00

INCREASE/ INCREASE/

ACRN ACCOUNTING CLASSIFICATION DECREASEACRN ACCOUNTING CLASSIFICATION DECREASE____ _________________________ ______________ _________________________ __________

AA 97 X4930AC9D 6D 26KB S20113 W56HZV $ 64,560.00 __________________

NET CHANGE $ 64,560.00

PRIOR AMOUNT INCREASE/DECREASE CUMULATIVE PRIOR AMOUNT INCREASE/DECREASE CUMULATIVE

OF AWARD AMOUNT OBLIG AMT OF AWARD AMOUNT OBLIG AMT _____________ __________________ ___________ _____________ __________________ ___________

NET CHANGE FOR AWARD: $ 64,560.00 $ 64,560.00 $ 129,120.00

LINELINE

ITEM ACRN EDI/SFIS ACCOUNTING CLASSIFICATIONITEM ACRN EDI/SFIS ACCOUNTING CLASSIFICATION_____ ____ _______________________________________ ____ __________________________________

0002AA AA 97 0X0X4930AC9D S20113 6D0000SM2B110000026KB S20113 W56HZV

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SPRDL1-19-P-0114