W56HZV16P0015-P00004.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

P00004 2016MAR31

W56HZV

U.S. ARMY CONTRACTING COMMAND

WARREN, MICHIGAN 48397-5000

LORI E. FINCHEM

EMAIL: LORI.E.FINCHEM.CIV@MAIL.MIL

S2305A

DCMA DETROIT

35803 MOUND ROAD

STERLING HEIGHTS MI 48310

4DEY3

COORDINATED DEFENSE SUPPLY SYSTEMS INC.

44570 MORLEY DR

CLINTON TOWNSHIP, MI 48036-1358

W56HZV-16-P-0015

2015OCT05

SEE SECTION G (IF APPLICABLE)

21 52.217-4001X

X

SEE SECOND PAGE FOR DESCRIPTION

/SIGNED/ 2016MAR31

SARAH L. DAVIS

SARAH.L.DAVIS.CIV@MAIL.MIL (586)282-7356

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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: LORI E. FINCHEM

Buyer Office Symbol/Telephone Number: CCTA-HCP-A/(586)282-2677

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

Kind of Modification: N

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

Surveillance Criticality Designator: C

Weapon System: Tactical POL Distribution Equipment

Paying Office: HQ0337

DFAS-CO/NORTH ENTITLEMENT OPERATION

P.O. BOX 182266

COLUMBUS OH 43218-2266

*** End of Narrative A0000 ***

1) The purpose of Modification P00004 under Contract W56HZV-16-P-0015 is to exercise the following Option CLINs and extend the option period for an additional period not to exceed 90 days from the expiration date of the original option period in accordance with TACOM

Option Clause 52.217-4001:

CLIN QTY UNIT PRICE CLIN TOTAL____ ___ __________ ___________

0008AA Compression Tool, PN 64CGMP 50 ea. $190.40 $9,520.00

0009AA Compression Tool, PN 51-MJ 50 ea. 159.35 7,967.50

0010AA Crowfoot Attachment, PN FC024A 50 ea. 17.17 858.50

0011AA Crowfoot Attachment, PN FC030A 50 ea. 19.94 997.00

TOTAL AMOUNT OF THIS ACTION: $19,343

2) The option period is extended to June 30, 2016. The remaining quantities available for CLINs 008AA - 0011AA is 50 ea.

3) All other terms and conditions under Contract W56HZV-16-P-0015 remain unchanged and in full force and effect.

*** END OF NARRATIVE A0004 ***

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W56HZV-16-P-0015 P00004

COORDINATED DEFENSE SUPPLY SYSTEMS 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

0008 TRM I Special Tool

NSN: 5120-00-469-7607

Mfr CAGE: 76691

Mfr Part Number: 64CGMP

0008AA PARTIAL EXERCISED OPTION QUANTITY 50 EA $ 190.40000 $ 9,520.00 _________________________________ ______________ __________________

COMMODITY NAME: TRM I Special Tool

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P156G1282T PRON AMD: 01 ACRN: AL

PSC: 5120

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

COMMERCIAL

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W56HZV6090G128 W90KQ2 J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 50 09-JUL-2016

FOB POINT: Destination

SHIP TO:

(W90KQ2) XR W6WR USALRCTR DETROIT AR

DOL

6501 E 11 MILE ROAD BLDG 249

WARREN,MI,48397-5000

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-16-P-0015/0000

3 7

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0009 TRM I Special Tool

NSN: 5120-01-644-4341

Mfr CAGE: 76691

Mfr Part Number: 51-MJ

0009AA PARTIAL EXERCISED OPTION QUANTITY 50 EA $ 159.35000 $ 7,967.50 _________________________________ ______________ __________________

COMMODITY NAME: TRM I Special Tool

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P156G1162T PRON AMD: 01 ACRN: AH

PSC: 5120

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

COMMERCIAL

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W56HZV6087G116 W90KQ2 J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 50 09-JUL-2016

FOB POINT: Destination

SHIP TO:

(W90KQ2) XR W6WR USALRCTR DETROIT AR

DOL

6501 E 11 MILE ROAD BLDG 249

WARREN,MI,48397-5000

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-16-P-0015/0000

4 7

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0010 TRM I Special Tool

NSN: 5120-01-335-1155

Mfr CAGE: 05047

Mfr Part Number: B107.100

0010AA PARTIAL EXERCSIED OPTION QUANTITY 50 EA $ 17.17000 $ 858.50 _________________________________ ______________ __________________

COMMODITY NAME: TRM I Special Tool

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P156G1262T PRON AMD: 01 ACRN: AJ

PSC: 5120

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

COMMERCIAL

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W56HZV6087G126 W90KQ2 J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 50 09-JUL-2016

FOB POINT: Destination

SHIP TO:

(W90KQ2) XR W6WR USALRCTR DETROIT AR

DOL

6501 E 11 MILE ROAD BLDG 249

WARREN,MI,48397-5000

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-16-P-0015/0000

5 7

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0011 TRM I Special Tool

NSN: 5120-01-335-1090

Mfr CAGE: 05047

Mfr Part Number: B107.100

0011AA PARTIAL EXERCISED OPTION QUANTITY 50 EA $ 19.94000 $ 997.00 _________________________________ ______________ __________________

COMMODITY NAME: TRM I Special Tool

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: P156G1272T PRON AMD: 01 ACRN: AK

PSC: 5120

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

COMMERCIAL

LEVEL PRESERVATION: Commercial

LEVEL PACKING: Commercial

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

Deliveries or Performance _________________________

DOC SUPPL

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

001 W56HZV6087G127 W90KQ2 J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 50 09-JUL-2016

FOB POINT: Destination

SHIP TO:

(W90KQ2) XR W6WR USALRCTR DETROIT AR

DOL

6501 E 11 MILE ROAD BLDG 249

WARREN,MI,48397-5000

CONTRACT/DELIVERY ORDER NUMBER ______________________________

W56HZV-16-P-0015/0000

6 7

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_____ _________ _____ ___________ ____ ____________ __________ ________________ _________ _____ ___________ ____ ____________ __________ ___________

0008AA P156G1282T 2 A.0021097.1.1.1.7 AL $ 0.00 $ 9,520.00 $ 9,520.00

0009AA P156G1162T 2 A.0021097.1.1.1.7 AH $ 0.00 $ 7,967.50 $ 7,967.50

0010AA P156G1262T 2 A.0021097.1.1.1.7 AJ $ 0.00 $ 858.50 $ 858.50

0011AA P156G1272T 2 A.0021097.1.1.1.7 AK $ 0.00 $ 997.00 $ 997.00

NET CHANGE $ 19,343.00

INCREASE/ INCREASE/

ACRN ACCOUNTING CLASSIFICATION DECREASEACRN ACCOUNTING CLASSIFICATION DECREASE____ _________________________ ______________ _________________________ __________

AH 021 201520172035 A5XDP R02600ARJL7 3101 L044094705 A.0021097.1.1.1.7 021001 $ 7,967.50

AJ 021 201520172035 A5XDP R02600ARJL7 3101 L044094998 A.0021097.1.1.1.7 021001 $ 858.50

AK 021 201520172035 A5XDP R02600ARJL7 3101 L044095357 A.0021097.1.1.1.7 021001 $ 997.00

AL 021 201520172035 A5XDP R02600ARJL7 3101 L044137373 A.0021097.1.1.1.7 021001 $ 9,520.00 __________________

NET CHANGE $ 19,343.00

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

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

NET CHANGE FOR AWARD: $ 92,490.00 $ 19,343.00 $ 111,833.00

LINELINE

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

0008AA AL 021 201520172035 A5XDP R02600ARJL7 3101 L044137373 A.0021097.1.1.1.7 021001

0009AA AH 021 201520172035 A5XDP R02600ARJL7 3101 L044094705 A.0021097.1.1.1.7 021001

0010AA AJ 021 201520172035 A5XDP R02600ARJL7 3101 L044094998 A.0021097.1.1.1.7 021001

0011AA AK 021 201520172035 A5XDP R02600ARJL7 3101 L044095357 A.0021097.1.1.1.7 021001

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