W81K00-16-T-0020-0001.pdf

W40M USA MEDCOM HCAA

SOUTHERN REG CONTR OFC

POC: KATHRYN D. ELLIOTT

3551 ROGER BROOK DR BLDG 3600

FORT SAM HOUSTON TX 78234-6200

0010721103

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

The purpose of this amendment is to revise the PWS and extend the offer dute date.

SEE SUMMARY OF CHANGES

1. CONTRACT ID CODE PAGE OF PAGES

J 1 4

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

16C. DATE SIGNED

BY 10-Dec-2015

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) X W81K00-16-T-0020

X 9B. DATED (SEE ITEM 11)

04-Dec-2015

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer X 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)

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

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

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, 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.)

10A. MOD. OF CONTRACT/ORDER NO.

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

6. ISSUED BY

3. EFFECTIVE DATE

10-Dec-2015

CODE

W40M USA MEDCOM HCAA

SOUTHERN REG CONTR OFC

3551 ROGER BROOK DR BLDG 3600

FORT SAM HOUSTON TX 78234-6200

W81K00 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W81K00

FACILITY CODECODE

EMAIL:TEL:

W81K00-16-T-0020

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 11-Dec-2015 10:00 AM to 15-Dec-2015 10:00 AM.

SUPPLIES OR SERVICES AND PRICES

CLIN 0001

The unit of issue has changed from Each to Job.

CLIN 1001

CLIN 2001

CLIN 3001

CLIN 4001

The following have been modified:

PERFORMANCE WORK STATEMENT

Audiology Services

1. GENERAL

1.1 It is expressly agreed and understood that this is a non-personal service contract, as defined in Federal

Acquisition Regulation (FAR) 37.101, under which the professional services rendered by the contractor are rendered in its capacity as an Independent contractor. The Government may evaluate the quality of professional and administrative services provided, but retains no control over professional aspects of the services rendered, including by example, the contractors professional medical judgment, diagnosis, or specific medical treatments. The contractor shall be solely liable for and expressly agrees to indemnify the Government with respect to any liability producing acts or omissions by its employees or agents.

1.2 Description of Work. The Contractor shall provide Audiology Services for Reynolds Army Community Hospital (RACH), McAlester Army Ammunition Plant, US Army Occupational Health Clinic (MCAAP USAOHC), McAlester, Oklahoma.

1.3 The Contract Audiologist shall provide audiology examinations/screenings for Basic Comprehensive Audiometric Evaluation, Tympanometry, Pure Tone-Air, Pure Tone -Air/Bone, HINT and OHSA Screening. These examinations/screenings will be completed for the McAlester Army Ammunition Plant, US Army Occupational Health Clinic, in accordance with established principles, practice and ethics of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the professional standards of RACH, the Oklahoma Board of Examiners in Speech-Language Pathology and Audiology, American Academy of Audiology, the American Board of Audiology, The American Osteopathic Board, or equivalent.

1.4 Contractor shall provide written results of interpretations, and fax results to the MCAAP USAOHC within 5 working days.

1.5 Qualifications:

1.5.1 Audiologist should be Board Eligible/Board Certified in general Audiology.

1.5.2 Have a minimum of two (2) years of experience within the last five (5) years working as an

Audiologist.

1.5.3 Currently licensed in State of Oklahoma and license shall be unrestricted. Be Board Certified by the American Board of Audiology.

1.5.4 All contract Health Care Professionals (HCPS) shall be able to read, write, and speak English well enough to effectively communicate with patients and other HCPs.

2 QUALITY ASSURANCE SURVEILLANCE PLAN (QASP): The following minimum Quality Assurance Surveillance Plan applies. The Government may modify inspection methods in accordance with site specific requirements.

PERFOMANCE

OBJECTIVE

PERFORMANCE

STANDARD

PWS REFERENCE ASSESSMENT

METHOD

Assure continuous High Level of Quality Service

Substantiated customer Complaints no more than 2 per year

1.4 Observation by POC

Possess and Maintain Current Certifications and Licenses.

Comply initially and Annually 100% of the Time

1.5 Observation by POC

Provide audiology examinations/screenings

Comply 100% of the time

1.3 Observation by POC

Retention of Qualified Personnel

Comply 100% of the time

1.4 Observation by POC

STANDARD MEASUREMENT PAST PERFORMANCE ASSESSMENT

99% to 100% Excellent Document Past Performance 96% to 98% Very Good Assessment Report, paying

95% Satisfactory particular attention to 91% to 94% Marginal performance that exceeds 90% or Less Unsatisfactory the standard

3. CONTRACTOR MANPOWER REPORTING: ACCOUNTING FOR CONTRACT SERVICES-The

Office of the Assistant Secretary of the Army (Manpower & Reserve Affairs) operates and maintains a secure Army data collection site where the contractor will report ALL contractor manpower (including subcontractor manpower) required for performance of this contract. The contractor is required to completely fill in all the information in the format using the following web address “https://cmra.army.mil.

The required information includes: (1) Contracting Office, Contracting Officer, Point of Contact (POC); (2) Contract number, including task and delivery order number; (3) Beginning and ending dates covered by reporting period; (4) Contractor name, address, phone number, e-mail address, identity of contractor employee entering data; (5) Estimated direct labor hours (including sub-contractor); (6) Estimated direct labor dollars paid this reporting period (including sub-contractor); (7) Total payments (including sub-contractor); (8) Predominant Federal Service Code (FSC) reflecting services provided by contractor (and separate predominant FSC for each sub-contractor if different); (9) Organizational title associated with the Unit Identification Code (UIC) for the Army Requiring Activity (the Army Requiring Activity is responsible for providing the contractor with its UIC for the purposes of reporting this information); (10) Locations where contractor and sub-contractors perform the work (specified by zip code in the United States and nearest City, Country, when in an overseas location, using standardized nomenclature provided on website); (11) Presence of deployment or contingency contract language, and, (12) Number of contractor and sub-contractor employees deployed in theater this reporting period (by country). (13) As part of its submission, the contractor will also provide the estimated total cost (if any) incurred to comply with this reporting requirement. Reporting period will be the period of performance not to exceed 12 months ending September 30 of each government fiscal year and must be reported by 31 October of each calendar year. The contractor shall notify the POC by the 5th working day of November whether or not they have completed this report. If the POC is unavailable, the contractor will notify the Contracting Officer."

(End of Summary of Changes)