W81K00-17-T-0484-02.pdf

0011090835

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 upper limb prosthetic devices. See Summary of Changes.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 3

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

16C. DATE SIGNED

BY 25-Sep-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-0484

X 9B. DATED (SEE ITEM 11)

19-Sep-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 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 1 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

25-Sep-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

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W81K00-17-T-0484

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 25-Sep-2017 12:00 PM to 25-Sep-2017 04:00 PM.

The following have been added by full text:

ITEM LIST

ITEM NUMBER DESCRIPTION PRICE

PL380007 I-LIMB SKIN CONTOUR LH EXTRA SMALL LIGHT

PL380007A I-LIMB SKIN CONTOUR RH EXTRA SMALL LIGHT

PL380006A I-LIMB QUANTUM QUICK WRIST DISCONNECT

PL348000A I-LIMB QUANTUM FLEXION WRIST EXTRA SMALL

PL349000A VIRTULIMB TOUCH PAD

SA188010A DC CHARGER

PL000227A INITIAL FABRICATION

CFAB-CHK SER I-DIGITS QUANTUM MEDIUM KIT 1 DIGIT - RH

PL483000A DEFINITIVE FABRICATION

CFAB-DFNTV SRVC I-LIMB SKIN CONTOUR LH EXTRA SMALL LIGHT

PL288000A REVOLUTION THUMB

DHA DERMA HAIR ARM

FORCOVCUSBAMC3 CUSTOM FOREARM COVER OPTION 3

ILIMBCOVPS MYO SILICONE I-LIMB COVER

PL163000 DIGIT PPMS #2 BLACK FINGER

PL245000A ILIMB ULTRA W ELEC PWRD ROTATING THUMB

PL277001B ILIMB REVOLUTION BLACK LEFT SMALL WITH M

PL285000A I-LIMB ULTRA REVOLUTION FLEX SMALL LH BL

MP092025B I-LIMB SKIN ACTIVE ULTRA SMALL RH CLEAR

MP092026B I-LIMB SKIN ACTIVE ULTRA SMALL LH CLEAR

W81K00-17-T-0484

PL165001B FINGER PPMS 5 BLACK TS

PL348000A I-LIMB QUANTUM QUICK WRIST DISCONNECT

PL353003A SIZE XS, ACTIVE GLOVE, LEFT HAND, CLEAR

PL349000A I-LIMB QUANTUM FLEXION WRIST EXTRA SMALL

SA188010A VIRTULIMB TOUCH PAD

SA000230B LOW PROFILE 1300MAH BATTERY SLIMLINE

(End of Summary of Changes)