W56HZV-19-Q-0095_0003.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

0003 2019OCT01

W56HZV

U.S. ARMY CONTRACTING COMMAND

WARREN, MICHIGAN 48397-5000

HARJEET OBEROI

EMAIL: HARJEET.OBEROI.CIV@MAIL.MIL

W56HZV-19-Q-0095

2019JUL22

X

X 2019OCT22 04:00pm

/SIGNED/

2 signed

SEE SECOND PAGE FOR DESCRIPTION

1 10

CONTINUATION SHEET

Reference No. of Document Being Continued Page of

Name of Offeror or Contractor:

PIIN/SIIN MOD/AMD

SUPPLEMENTAL INFORMATION

Buyer Name: HARJEET OBEROI

Buyer Office Symbol/Telephone Number: CCTA-ALS-E/(586)282-9176

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

Weapon System: Detection and Alarm Devices

*** End of Narrative A0000 ***

The purpose of Amendment 0003 to Solicitation W56HZV-19-Q-0095 is to add the following components:

CLIN NSN CLIN Title Qty U/I____ ___ __________ ___ ___

0003AA 4710-01-537-0413 Intake Assembly 11 Each

0003AB 4710-01-537-0413 Unexercised Option 11 Each

0004AA 5930-01-560-5959 Sensitive Switch 66 Each

0004AB 5930-01-560-5959 Unexercised Option 66 Each

0005AA 7240-01-537-1804 Waste Receptacle 175 Each

0005AB 7240-01-537-1804 Waste Receptacle 175 Each

3. Packaging requirements are according to Section D narrative and SPI.

4. First Article Test will be required. Contractor may request a waiver.

5. All shipments will be FOB Destination to the following address:

W22PVJ) XU BLUE GRASS ARMY DEPOT

BLUE GRASS ARMY DEPOT

431 BATTLEFIELD MEMORIAL HIGHWAY

RICHMOND, KY 40475-5070

6. The Contractor is authorized to ship early with no quantity restrictions and at no additional cost to the government.

*** END OF NARRATIVE A0003 ***

2 10

W56HZV-19-Q-0095

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

SUPPLIES OR SERVICES AND PRICES/COSTS

0001 CLAMP ASSEMBLY WING

NSN: 5340-01-545-2941

Mfr CAGE: 19207

Mfr Part Number: 10086336

Inspection/Acceptance at Origin means the contractor

MUST contact DCMA to arrange for a Government inspection BEFORE production under CLIN 0001AA is shipped. Failure to have production inspected and accepted at Origin will result in its rejection at Destination. Rejected production will be returned at the contractor's expense.

(End of narrative A001)

0001AA CLAMP ASSEMBLY WING 10 EA $ $ ____________________ ______________ __________________

COMMODITY NAME: CLAMP ASSEMBLY WING

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: EH9C0297EH PRON AMD: 03

AMS CD: SM2B1100000

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

LEVEL PRESERVATION: Military

LEVEL PACKING: B

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

0002 CABLE ASSEMBLY,SPEC

NSN: 6150-01-539-7175

Mfr CAGE: 19207

Mfr Part Number: 10080141

Inspection/Acceptance at Origin means the contractor

MUST contact DCMA to arrange for a Government inspection BEFORE production under CLIN 0001AA is shipped. Failure to have production inspected and accepted at Origin will result in its rejection at Destination. Rejected production will be returned at the contractor's expense.

(End of narrative A001)

3 10

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0002AA CABLE ASSEMBLY, SPEC 5 EA $ $ ____________________ ______________ __________________

COMMODITY NAME: CABLE ASSEMBLY,SPEC

CLIN CONTRACT TYPE:

Firm Fixed Price

PRON: EH9C0580EH PRON AMD: 01

AMS CD: SM2B1100000

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

LEVEL PRESERVATION: Military

LEVEL PACKING: B

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

0002AB UNEXERCISED OPTION 5 EA $ $ __________________ ______________ __________________

COMMODITY NAME: CABLE ASSEMBLY, SPEC

OPTION QUANTITY, PURSUANT TO THE CLAUSE

ENTITLED OPTION FOR INCREASED QUANTITY---

SEPARATELY PRICED LINE ITEM (FAR 52.217-7).

The quantity stated for the option CLIN DOES

NOT Form a part of the basic contractual quantity. Part or all of it may, however, be added to the contract by exercise of the option clause, at the discretion of the

Government.

The failure of the offeror to insert a unit price applicable to the option quantity shall mean that the offeror will supply all or any part of the option, if exercised by the

Government, at the basic contract unit price, and the offer will be evaluated for award accordingly.

(End of narrative B001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

LEVEL PRESERVATION: Military

LEVEL PACKING: B

4 10

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Origin

0003 INTAKE ASSEMBLY

NSN: 4710-01-537-0413

Mfr CAGE: 19207

Mfr Part Number: 30295-1260-3

Inspection/Acceptance at Origin means the contractor

MUST contact DCMA to arrange for a Government inspection BEFORE production under CLIN 0001AA is shipped. Failure to have production inspected and accepted at Origin will result in its rejection at Destination. Rejected production will be returned at the contractor's expense.

(End of narrative A001)

0003AA INTAKE ASSEMBLY 11 EA $ $ ________________ ______________ __________________

COMMODITY NAME: INTAKE ASSEMBLY

PRON: EH8E1723EH PRON AMD: 02

AMS CD: SM2B1100000

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

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 W56HZV8249V800 W562RM J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 11 01-SEP-2020

FOB POINT: Destination

SHIP TO:

(W562RM) SU W0MC ARMY GENERAL SUPPLY

DLA DISTRIBUTION RED RIVER

HIGHWAY 82 WEST

TEXARKANA,TX,75507-5000

5 10

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

0003AB UNEXERCISED OPTION 11 EA $ $ __________________ ______________ __________________

COMMODITY NAME: INTAKE ASSEMBLY

OPTION QUANTITY, PURSUANT TO THE CLAUSE

ENTITLED OPTION FOR INCREASED QUANTITY---

SEPARATELY PRICED LINE ITEM (FAR 52.217-7).

The quantity stated for the option CLIN DOES

NOT Form a part of the basic contractual quantity. Part or all of it may, however, be added to the contract by exercise of the option clause, at the discretion of the

Government.

The failure of the offeror to insert a unit price applicable to the option quantity shall mean that the offeror will supply all or any part of the option, if exercised by the

Government, at the basic contract unit price, and the offer will be evaluated for award accordingly.

(End of narrative B001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKING REQUIREMENTS CLAUSE

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 ______ ________ ______ ______ ________ _____

DEL REL CD QUANTITY DAYS AFTER AWARD __________ ______________ ________________

001 11 0120

FOB POINT: Destination

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

0004 SWITCH,SENSITIVE

6 10

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

NSN: 5930-01-560-8959

Mfr CAGE: 19207

Mfr Part Number: 30295-1659-007

Inspection/Acceptance at Origin means the contractor

MUST contact DCMA to arrange for a Government inspection BEFORE production under CLIN 0001AA is shipped. Failure to have production inspected and accepted at Origin will result in its rejection at Destination. Rejected production will be returned at the contractor's expense.

(End of narrative A001)

0004AA SENSTIVE SWITCH 66 EA $ $ _________________ ______________ __________________

COMMODITY NAME: SWITCH,SENSITIVE

PRON: EH9C0318EH PRON AMD: 01

AMS CD: SM2B1100000

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

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 W56HZV8334V802 W562RM J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 66 02-MAR-2020

FOB POINT: Destination

SHIP TO:

(W562RM) SU W0MC ARMY GENERAL SUPPLY

DLA DISTRIBUTION RED RIVER

HIGHWAY 82 WEST

TEXARKANA,TX,75507-5000

0004AB UNEXERCISED OPTION 66 EA $ $ __________________ ______________ __________________

COMMODITY NAME: SENSITIVE SWITCH

OPTION QUANTITY, PURSUANT TO THE CLAUSE

7 10

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

ENTITLED OPTION FOR INCREASED QUANTITY---

SEPARATELY PRICED LINE ITEM (FAR 52.217-7).

The quantity stated for the option CLIN DOES

NOT Form a part of the basic contractual quantity. Part or all of it may, however, be added to the contract by exercise of the option clause, at the discretion of the

Government.

The failure of the offeror to insert a unit price applicable to the option quantity shall mean that the offeror will supply all or any part of the option, if exercised by the

Government, at the basic contract unit price, and the offer will be evaluated for award accordingly.

(End of narrative B001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

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 ______ ________ ______ ______ ________ _____

DEL REL CD QUANTITY DAYS AFTER AWARD __________ ______________ ________________

001 66 0120

FOB POINT: Destination

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

0005 WASTE RECEPTACLE

NSN: 7240-01-537-1804

Mfr CAGE: 19207

Mfr Part Number: 10080171

Inspection/Acceptance at Origin means the contractor

8 10

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

MUST contact DCMA to arrange for a Government inspection BEFORE production under CLIN 0001AA is shipped. Failure to have production inspected and accepted at Origin will result in its rejection at Destination. Rejected production will be returned at the contractor's expense.

(End of narrative A001)

0005AA WASTE BOTTLE RECEPTACLE 175 EA $ $ _______________________ ______________ __________________

COMMODITY NAME: WASTE RECEPTACLE

PRON: EH8E1749EH PRON AMD: 04

AMS CD: SM2B1100000

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

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 W56HZV8253V801 W562RM J 2

DEL REL CD QUANTITY DEL DATE __________ ______________ ___________

001 175 01-SEP-2020

FOB POINT: Destination

SHIP TO:

(W562RM) SU W0MC ARMY GENERAL SUPPLY

DLA DISTRIBUTION RED RIVER

HIGHWAY 82 WEST

TEXARKANA,TX,75507-5000

0005AB UNEXERCISED OPTION 175 EA $ $ __________________ ______________ __________________

COMMODITY NAME: WASTE BOTTLE RECEPTACLE

OPTION QUANTITY, PURSUANT TO THE CLAUSE

ENTITLED OPTION FOR INCREASED QUANTITY---

SEPARATELY PRICED LINE ITEM (FAR 52.217-7).

The quantity stated for the option CLIN DOES

NOT Form a part of the basic contractual quantity. Part or all of it may, however, 9 10

Page of

Name of Offeror or Contractor:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

Reference No. of Document Being Continued

MOD/AMD

be added to the contract by exercise of the option clause, at the discretion of the

Government.

The failure of the offeror to insert a unit price applicable to the option quantity shall mean that the offeror will supply all or any part of the option, if exercised by the

Government, at the basic contract unit price, and the offer will be evaluated for award accordingly.

(End of narrative B001)

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING REQUIREMENTS CLAUSE

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 ______ ________ ______ ______ ________ _____

DEL REL CD QUANTITY DAYS AFTER AWARD __________ ______________ ________________

001 175 0120

FOB POINT: Destination

SHIP TO:

(Y00000) SHIPPING INSTRUCTIONS FOR CONSIGNEE

(SHIP-TO) WILL BE FURNISHED PRIOR

TO THE SCHEDULED DELIVERY DATE FOR

ITEMS REQUIRED UNDER THIS

REQUISITION.

10 10