W56HZV16R0104-0002.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

0002 2016JUL15

W56HZV

U.S. ARMY CONTRACTING COMMAND

WARREN, MICHIGAN 48397-5000

ANDREW HOOVEN

EMAIL: ANDREW.R.HOOVEN.CIV@MAIL.MIL

W56HZV-16-R-0104

2016JUN17

X

X

/SIGNED/

2 signed

SEE SECOND PAGE FOR DESCRIPTION

1 3

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: ANDREW HOOVEN

Buyer Office Symbol/Telephone Number: CCTA-HTM-A/(586)282-5196

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

*** End of Narrative A0000 ***

AMENDMENT 0002

The purpose of Amendment 0002 is to:

1) Reformat Attachment 0002 - Government Furnished Property.

*** END OF NARRATIVE A0002 ***

2 3

W56HZV-16-R-0104 0002

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SECTION J - LIST OF ATTACHMENTS

List of Number List of Number

Addenda Title Date of Pages Transmitted By Addenda Title Date of Pages Transmitted By________________ ____________________________________________________________ _______________ ____________ _______________________________ ____________________________________________________________ _______________ ____________ _______________

Attachment 0002 GOVERNMENT FURNISHED PROPERTY 18-MAY-2016 001 EMAIL

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W56HZV-16-R-0104 0002

PIIN/SIIN

MOD/AMD

ATT/EXH ID

PAGE

Attachment 0002

Item Description CAGE NSN PART QUANTITY UNIT COST

Number NUMBER

1 Cable Assembly 19207 6150016474518 12599007 50 $275.00

Special Purpose

Electrical (NEO

RED HARNESS

ADAPTOR

2 Analyzer, Network 1YGN2 6625016448382 NEOVI-RED 50 $1195.00

(NEOVI-RED)

3 Socket, Wrench 1N5S7 5120015867435 FP2835 50 $219.87

Face Spanner

4 Wheel, Abrasive 1N5S7 3460015888247 PE2900 50 $38.22

5 Wheel, Abrasive 1N5S7 3460015888245 PE2899 50 $62.49

6 Trowel 1N5S7 5120015594841 FP3062 50 $22.01

7 Wrench, Socket 1N5S7 5120015774141 FD0980 50 $695.11

Inner Cable

Locknut Tool

8 Ink Marking 1N5S7 CSI-011015023 50 $58.01

Nozzle, Holder

Tool

9 Tool Box Accessory 00NS2 5120015986789 KTC 5124- 50 $879.63

Box, OD Green, PRV, 1011RMC-4XHLS

Wheels, Black

Stainless

10 Box, Small Parts, 00NS2 5140015898856 FLA T203 50 $3.98

Tool, 6-Compartment

Parts Box

W56HZV-16-R-0104