W81K00-16-T-0036-0001_Amendment.pdf

SEE SCHEDULE

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

Purpose of this amendment is to:

1. Correct CLIN quantities.

2. Correct line item description to fall in line w ith maximum quantity description.

See summary of changes for details.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 10

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

16C. DATE SIGNED

BY 21-Jul-2016

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-0036

X 9B. DATED (SEE ITEM 11)

30-Jun-2016

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 is extended, X 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

21-Jul-2016

CODE

W40M USA HLTH CONTRACTING ACT

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

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W81K00-16-T-0036

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SUPPLIES OR SERVICES AND PRICES

SUBCLIN 0001AA

The CLIN extended description has changed from:

Physician Paper Templates to support 80,000 patient visits per year for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2016 to 30

September 2017.The minimum guarantee is set at $5000.00.

To:

Physician Paper Templates to support up to 88,000 patient visits per year for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2016 to 30

September 2017.The minimum guarantee is set at $5000.00..

The unit of issue has changed from Job to Each.

SUBCLIN 0001AB

Physician Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2016 to 30 September 2017.

Physician Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2016 to 30 September 2017..

SUBCLIN 0001AC

Nursing Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort Hood, Texas. The ordering period for this requirement is 1 October 2016 to 30 September 2017.

Nursing Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

The pricing detail quantity has decreased by 720,000.00 from 800,000.00 to 80,000.00.

SUBCLIN 0001AE

Physician Paper Templates to support 26,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2016 to 30 September 2017.

Physician Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2016 to 30 September 2017..

SUBCLIN 0001AF

Nursing Paper Templates to support 26,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2016 to 30 September 2017.

Nursing Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2016 to 30 September 2017..

SUBCLIN 1001AA

Physician Paper Templates to support 80,000 patient visits per year for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2017 to 30

September 2018.The minimum guarantee is set at $5000.00.

Physician Paper Templates to support up to 88,000 patient visits per year for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2017 to 30

September 2018.The minimum guarantee is set at $5000.00..

SUBCLIN 1001AB

Physician Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2017 to 30 September 2018.

Physician Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

SUBCLIN 1001AC

Nursing Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort Hood, Texas.The ordering period for this requirement is 1 October 2017 to 30 September 2018.

Nursing Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas.The ordering period for this requirement is 1 October 2017 to 30 September 2018..

SUBCLIN 1001AE

Physician Paper Templates to support 26,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2017 to 30 September 2018.

Physician Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2017 to 30 September 2018..

SUBCLIN 1001AF

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2017 to 30 September 2018.

Nursing Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2017 to 30 September 2018..

SUBCLIN 2001AA

Physician Paper Templates to support 80,000 patient visits per year for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2018 to 30

September 2019.The minimum guarantee is set at $5000.00.

Physician Paper Templates to support up to 88,000 patient visits per year for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2018 to 30

September 2019.The minimum guarantee is set at $5000.00..

SUBCLIN 2001AB

Physician Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2018 to 30 September 2019.

Physician Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

SUBCLIN 2001AC

Nursing Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort Hood, Texas. The ordering period for this requirement is 1 October 2018 to 30 September 2019.

Nursing Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2018 to 30 September 2019..

SUBCLIN 2001AE

Physician Paper Templates to support 26,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2018 to 30 September 2019.

Physician Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2018 to 30 September 2019..

The pricing detail quantity has decreased by 50,000.00 from 80,000.00 to 30,000.00.

SUBCLIN 2001AF

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2018 to 30 September 2019.

Nursing Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2018 to 30 September 2019..

SUBCLIN 3001AA

Physician Paper Templates to support 88,000 patient visits per month for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2019 to 30

September 2020.

Physician Paper Templates to support up to 88,000 patient visits per month for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2019 to 30

September 2020..

SUBCLIN 3001AB

Physician Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2019 to 30 September 2020.

Physician Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

SUBCLIN 3001AC

Nursing Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort Hood, Texas. The ordering period for this requirement is 1 October 2019 to 30 September 2020.

Nursing Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2019 to 30 September 2020..

SUBCLIN 3001AE

Physician Paper Templates to support 26,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2019 to 30 September 2020.

Physician Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2019 to 30 September 2020..

SUBCLIN 3001AF

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2019 to 30 September 2020.

Nursing Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2019 to 30 September 2020..

SUBCLIN 4001AA

Physician Paper Templates to support 80,000 patient visits per year for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2020 to 30

September 2021. The minimum guarantee is set at $5000.00.

Physician Paper Templates to support up to 80,000 patient visits per year for San Antonio Military Medical Center

(SAMMC), Emergency, Fort Sam Houston, Texas. The ordering period for this requirement is 1 October 2020 to 30

September 2021. The minimum guarantee is set at $5000.00..

SUBCLIN 4001AB

Physician Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2020 to 30 September 2021.

Physician Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

SUBCLIN 4001AC

Nursing Paper Templates to support 76,000 patient visits per month for Carl R. Darnall Medical Center, Fort Hood, Texas. The ordering period for this requirement is 1 October 2020 to 30 September 2021.

Nursing Paper Templates to support up to 80,000 patient visits per month for Carl R. Darnall Medical Center, Fort

Hood, Texas. The ordering period for this requirement is 1 October 2020 to 30 September 2021..

SUBCLIN 4001AE

Physician Paper Templates to support 26,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2020 to 30 September 2021.

Physician Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2020 to 30 September 2021..

SUBCLIN 4001AF

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2020 to 30 September 2021.

Nursing Paper Templates to support up to 30,000 patient visits per month for for General Leonard Wood Army

Community Hospital (GLWACH), Fort Leonard-Wood, Missouri. The ordering period for this requirement is 1

October 2020 to 30 September 2021..

DELIVERIES AND PERFORMANCE

The following Delivery Schedule item for SUBCLIN 0001AC has been changed from:

DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

POP 01-OCT-2016 TO

30-SEP-2017

N/A W2M5 CARL R DARNELL ARMY MED C

DIRECT DELIVERY

MEDICAL SUPPLY OFFICER DACH

BLDG 36000 RM 0002

FORT HOOD TX 76544-5063

FOB: Destination

W45XTR

POP 01-OCT-2016 TO

30-SEP-2017

N/A W2M5 CARL R DARNELL ARMY MED C

DIRECT DELIVERY

MEDICAL SUPPLY OFFICER DACH

BLDG 36000 RM 0002

FORT HOOD TX 76544-5063

W45XTR

The following Delivery Schedule item for SUBCLIN 2001AE has been changed from:

POP 01-OCT-2018 TO

30-SEP-2019

N/A GENERAL LEONARD WOOD ARMY

COMMUNITY HOSP

GENERAL LEONARD WOOD ARMY

COMMUNITY

4430 MISSO FORT LEONARD WOOD

FORT LEONARD WOOD MO 65473

W58XTU

POP 01-OCT-2018 TO

30-SEP-2019

N/A GENERAL LEONARD WOOD ARMY

COMMUNITY HOSP

GENERAL LEONARD WOOD ARMY

COMMUNITY

4430 MISSO FORT LEONARD WOOD

FORT LEONARD WOOD MO 65473

W58XTU

(End of Summary of Changes)