W81K00-17-T-0181-02.pdf

W40M USA HLTH CONTRACTING ACT

SOUTHERN REG CONTR OFC

POC: KATHY CLAYTON

3551 ROGER BROOK DR BLDG 3600

FORT SAM HOUSTON TX 78234-6200

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

This amendment is issued to add Questions and Answ ers to the solicitation for consideration. 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 06-Apr-2017

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 W81K00-17-T-0181

X 9B. DATED (SEE ITEM 11)

30-Mar-2017

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

06-Apr-2017

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 W81K00

FACILITY CODECODE

EMAIL:TEL:

W81K00-17-T-0181

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

The following have been added by full text:

QUESTIONS AND ANSWERS

Does it matter what state the vendor is licensed in?

no but the amount of time it takes to reach us is a consideration.

Dosages and Measurements Dexamethasone 24mg/mL (1mL Syringe PF)- 1ml Jessner’s Topical Solution 14%- 100ml Glycerin 99% Sterile Anhydrous SW- 2ml Dilating Ophthalmic drops- 12ml Phenol 6% (10mL SWFI)- 10ml Tetracaine HCl 6% Topical Viscous SW- 10ml BLT cream (Benzoca20%/Lidoca 20%/Tetraca10%/D MSO) 1lb jar- 454grams Boric Acid (ear Capsule)- CASH Capsules (Chloramphenical 50mg/ Amphotercin 5mg/Sulfanilamide 0.05gm/Hydrocortiso ne Acetate 0.001gm)- the ingredients are listed here.

Burn ointment- 1lb jar- 454gm -Bacitracin 250Units/GM, Polymixin B 5,000Units/GM, Nystatin 50,000Units/GM in White Petroleum

Item Name Description Preservative Sterile

Dexamethasone 24mg/mL (1mL Syringe PF)

24mg/1mL(1mL Syringe)*Preservative Free No Yes

Jessner’s Topical Solution 14% Rescorcinol 8.4GM, Salicylic Acid 8.4GM, Lactic Acid 8.4mL, Ethanol

Yes No

Glycerin 99% Sterile Anhydrous SW Sterile Anhydrous in Sterile No Yes

Dilating Ophthalmic drops 12mL of Tropicamide 1% and Phenylephrine 5% with Edetate Disodium as a buffer and Benzalkonium Chloride as a preservative. total of 15mL in a sterile eye dropper bottle

Yes Yes

Phenol 6% (10mL SWFI) 10 ml Phenol crystals In Sterile Water for Injection (SWFI) 10mL vials or Syringe

No Yes

Tetracaine HCl 6% Topical Viscous

SW

Tetracaine HCL Hydroxyethyl Cellulose in sterile water (SW)

Yes Yes

BLT cream (Benzoca20%/Lidoca 20%/Tetraca10%/D MSO) 1lb jar

Benzocaine 0.2 grams per gram(20%), Lidocaine 0.2 grams per gram(20%), Tetracaine 0.1 grams per gram(10%), and DMSO 0.2ml per gram or 10%, and packaged in a jar

Boric Acid (ear Capsule) Boric Acid 150mg per cap and packaged in #4 size clear gelatin caps

Yes No

CASH Capsules (Chloramphenical 50mg/ Amphotercin 5mg/Sulfanilamide 0.05gm/Hydrocortiso ne Acetate 0.001gm)

Chloramphenicol 0.05gm or 5% per cap, Sulfanilamide 0.05gm or 5% per cap, Amphotericin B 0.005gm or 0.5%, Hydrocortisone Acetate 0.001gm or 0.1% per cap packaged in #3 white capsules

Yes No

Burn ointment Bacitracin 250 U/gm, Polymyxin B 5,000 U/gm, Nystatin 50,000 U/gm in White Petrolatum, NF and packaged in a dispensing 1pound jar

(End of Summary of Changes)