W56HZV23R0014-0004.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

0004 2023MAR30

W56HZV

ACC-DTA

6501 E. 11 MILE RD.

DETROIT ARSENAL, MI 48397-5000

JUSTINE BROUGHTON

EMAIL: JUSTINE.R.BROUGHTON.CIV@ARMY.MIL

W56HZV-23-R-0014

2022DEC02

X

X

/SIGNED/

2 signed

SEE SECOND PAGE FOR DESCRIPTION

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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: JUSTINE BROUGHTON

Buyer Office Symbol/Telephone Number: CCTA-APS-B/(586)282-7504

Type of Contract 1: Firm Fixed Price

Kind of Contract: Supply Contracts and Priced Orders

*** End of Narrative A0000 ***

SOLICITATION: W56HZV-23-R-0014

AMENDMENT: 0004

1. The purpose of this amendment is to:

SECTION B:

a) Decrease the quantity of CLIN 0001 by 21 EA, from 42 EA to 21 EA. Amendment 000X added a quantity of 21 EA by mistake.

b) Add Narrative to CLIN 0002, First Article Test.

This concludes all Sections affected by this Amendment.

*** END OF NARRATIVE A0004 ***

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W56HZV-23-R-0014

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

0001 Production Quantity 21 EA $ $ ___________________ ______________ __________________

NSN: 5999-01-130-8077

COMMODITY NAME: ELECTRONIC PARTS KIT

CLIN CONTRACT TYPE:

Firm Fixed Price

Mfr CAGE: 19207

Mfr Part Number: 12311066

Packaging and Marking _____________________

PACKAGING/PACKING/SPECIFICATIONS:

SEE PACKAGING CLAUSE D.1

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 21 0600

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

0002 FIRST ARTICLE TEST 1 LO $ __________________ __________________

SERVICE REQUESTED: ELECTRONIC PARTS KIT

First Article Government Approval / Disapproval Days:

First Article Test (FAT), pursuant to the requirements listed in:

SECTION E:

- E.1, Notice Regarding First Article Test Sample;

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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

- E.2, Inspection and Acceptance (First Article

Approval);

- E.4, Notice Regarding First Article; and

SECTION I:

- FAR 52.209-3,

(End of narrative B001)

Inspection and Acceptance _________________________

INSPECTION: Origin ACCEPTANCE: Destination

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