W50S6U21C0001P000001 - AWARD MOD.pdf

SEE SCHEDULE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

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)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

a. The purpose of this modification is to extend the Period of Performance (POP) by 7 days. As a result of this modification, the new POP end date w ill be 1-NOV-2021. b. The contract price increases $28,180 to add additional w ithin scope w ork IAW quote dated 24 Sep 21.

c. No further changes may be made w ithout the express w ritten consent of the Contracting Officer.

d. All remaining contract terms and conditions remain in full force and effect.

e. In consideration of the modification agreed to herein as complete and equitable adjustment for the extension of the period of performance, and the addition of additional w ork; the Contractor hereby releases the Government from any and all liability under the contract for further equitable adjustment attributable to such facts and circumstances.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 4

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

16C. DATE SIGNED

BY 25-Sep-2021

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

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

8. NAME AND ADDRESS OF CONTRACTOR (No., Street , County, State and Zip Code)

9B. DATED (SEE ITEM 11)

X W50S6U21C0001

10B. DATED (SEE ITEM 13)

X

9A. AMENDMENT OF SOLICITATION NO.

08-Sep-2021

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 Offer is extended, is not extended.

Offer 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 amendment; (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)

See Schedule

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

X

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

FAR 52.243-1(b) Changes-Fixed-Price

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, X is required to sign this document and return 1 copies to the issuing office.

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

10A. MOD. OF CONTRACT/ORDER NO.

P00001

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

25-Sep-2021

CODE

USPFO CA 195 MSC

1784 13TH ST

BLDG 2180

BEALE AFB CA 95903-2180

W50S6U 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

LACUSONG, LEILANI

LEIS CONSULTING GROUP

LEILANI LACUSONG

388 W 15TH ST

SAN PEDRO CA 90731-4806

FACILITY CODE7E3Y6CODE

barry.beale.1@us.af.milEMAIL:530-634-9179TEL:

BARRY B. BEALE / CONTRACT OFFICER

Modification Control Number: bealbb0421229

W50S6U21C0001 P00001

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION A - SOLICITATION/CONTRACT FORM

The total cost of this contract was increased by $28,180.00 from $49,600.00 to $77,780.00.

SECTION B - SUPPLIES OR SERVICES AND PRICES

CLIN 0001

The manufacturer part number JOB has been added.

CLIN 0002 is added as follows:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0002 1 Job $28,180.00 $28,180.00 Water Line Repair Additional Work

FFP

Additional work required to complete pipe repair discovered during excavation IAW quote dated 23 Sep 2021. Includes connecting the 4-inch pipe that goes to the South direction for approx. 6 feet turn back east in to the building as a sub-system or emergency to back-up the main system. In addition, this includes another T-couplings 6-inches to 4-inches reducer and excavation.

FOB: Destination

MFR PART NR: JOB

PURCHASE REQUEST NUMBER: F9Y0CC1267AW01

SIGNAL CODE: A

PSC CD: Y1ND

NET AMT $28,180.00

ACRN AB

CIN: 00000000000007052576

$28,180.00

SECTION E - INSPECTION AND ACCEPTANCE

The following Acceptance/Inspection Schedule was added for CLIN 0002:

INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

Destination Government Destination Government

SECTION F - DELIVERIES OR PERFORMANCE

The following Delivery Schedule item for CLIN 0001 has been changed from:

DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

POP 10-SEP-2021 TO

19-OCT-2021

N/A 261 COS

GREGORY GARCIA

15900 VICTORY BLVD.

VAN NUYS CA 91406

(818) 909-2331 FOB: Destination

F9YGC0

To:

DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

POP 10-SEP-2021 TO

01-NOV-2021

N/A 261 COS

GREGORY GARCIA

15900 VICTORY BLVD.

VAN NUYS CA 91406

(818) 909-2331

F9YGC0

The following Delivery Schedule for CLIN 0002 has been added:

DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

POP 27-SEP-2021 TO

01-NOV-2021

N/A F9Y0CC - 195WG/HQ

GREGORY GARCIA

15900 VICTORY BLVD.

VAN NUYS CA 91406-6451

818-909-2331

F9Y0CC

SECTION G - CONTRACT ADMINISTRATION DATA

Accounting and Appropriation

Summary for the Payment Office

As a result of this modification, the total funded amount for this document was increased by $28,180.00 from $49,600.00 to $77,780.00.

CLIN 0002:

Funding on CLIN 0002 is initiated as follows:

ACRN: AB

CIN: 00000000000007052576

Acctng Data: 5713840 581 41A8 300000 01 52103 53056F 387700 F87700

Increase: $28,180.00

Total: $28,180.00

(End of Summary of Changes)