W81K02-17-T-0437_Amd0001.pdf

W40M PACIFIC RGNL CNTRG OFC

US MEDCOM HCAA

POC: SUSAN M. FUJITA

160 KRUKOWSKI RD BLDG 160

HONOLULU HI 96819

0011080113

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 correct the item numbers for CLINs 0001, 0002 and 0003.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 3

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

16C. DATE SIGNED

BY 05-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 W81K02-17-T-0437

X 9B. DATED (SEE ITEM 11)

05-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 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 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

05-Sep-2017

CODE

W40M PACIFIC RGNL CNTRG OFC

USA MEDCOM HCAA

160 KRUKOWSKI RD BLDG 160

HONOLULU HI 96819-1552

W81K02 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W81K02

FACILITY CODECODE

EMAIL:TEL:

W81K02-17-T-0437

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SUPPLIES OR SERVICES AND PRICES

CLIN 0001

The CLIN extended description has changed from:

Dynaflex G-1065804 (RVG 6200 Size 2 Kit w/install)SHIPPING AND HANDLING – Ship only to the address belowShipping to a different address could delay payment.SPECIAL INSTRUCTIONS:(1) WARRANTY – The warranty will begin on the date that all of the items on the contract arrive at Tripler Army Medical Center, Bldg 161 unless the items need vendor installation. If the items require vendor installation, then the warranty will start upon the date that the equipment is operational at Tripler Army Medical Center.(2) PAYMENT: Payment will be made only after receipt of all items on the contract are accepted. No Partial payments will be made unless authorized by the Property Book Officer or the Contracting Officer. The vendor, upon request from Mr Jerry Peguese or Ms. Stacy Zembik or the Contracting Office will supply proof of delivery within 48 hours after it has been requested.SHIP

TO:TRIPLER ARMY MEDICAL CENTERATTN: PROPERTY BOOK OFFICER161 KRUKOWSKI RD -

UPPER LEVELHONOLULU, HI 96859-5000MARK ALL PACKING LABELS WITH CUSTOMER REF NO.

CEEP 17-097.

To:

Dynaflex 1065804 (RVG 6200 Size 2 complete kit with install)SHIPPING AND HANDLING – Ship only to the address belowShipping to a different address could delay payment.SPECIAL INSTRUCTIONS:(1) WARRANTY – The warranty will begin on the date that all of the items on the contract arrive at Tripler Army Medical Center, Bldg 161 unless the items need vendor installation. If the items require vendor installation, then the warranty will start upon the date that the equipment is operational at Tripler Army Medical Center.(2) PAYMENT: Payment will be made only after receipt of all items on the contract are accepted. No Partial payments will be made unless authorized by the Property Book Officer or the Contracting Officer. The vendor, upon request from Mr Jerry Peguese or Ms.

Stacy Zembik or the Contracting Office will supply proof of delivery within 48 hours after it has been requested.SHIP TO:TRIPLER ARMY MEDICAL CENTERATTN: PROPERTY BOOK OFFICER161

KRUKOWSKI RD - UPPER LEVELHONOLULU, HI 96859-5000MARK ALL PACKING LABELS WITH

CUSTOMER REF NO. CEEP 17-097..

CLIN 0002

Dynaflex G-1065804 (RVG 6200 Size 1 Kit w/install)SHIPPING AND HANDLING – Ship only to the address belowShipping to a different address could delay payment.SPECIAL INSTRUCTIONS:(1) WARRANTY – The warranty will begin on the date that all of the items on the contract arrive at Tripler Army Medical Center, Bldg 161 unless the items need vendor installation. If the items require vendor installation, then the warranty will start upon the date that the equipment is operational at Tripler Army Medical Center.(2) PAYMENT: Payment will be made only after receipt of all items on the contract are accepted. No Partial payments will be made unless authorized by the Property Book Officer or the Contracting Officer. The vendor, upon request from Mr Jerry Peguese or Ms. Stacy Zembik or the Contracting Office will supply proof of delivery within 48 hours after it has been requested.SHIP

TO:TRIPLER ARMY MEDICAL CENTERATTN: PROPERTY BOOK OFFICER161 KRUKOWSKI RD -

UPPER LEVELHONOLULU, HI 96859-5000MARK ALL PACKING LABELS WITH CUSTOMER REF NO.

W81K02-17-T-0437

CEEP 17-097.

To:

Dynaflex 1065796 (RVG 6200 Size 1 complete kit with install)SHIPPING AND HANDLING – Ship only to the address belowShipping to a different address could delay payment.SPECIAL INSTRUCTIONS:(1) WARRANTY – The warranty will begin on the date that all of the items on the contract arrive at Tripler Army Medical Center, Bldg 161 unless the items need vendor installation. If the items require vendor installation, then the warranty will start upon the date that the equipment is operational at Tripler Army Medical Center.(2) PAYMENT: Payment will be made only after receipt of all items on the contract are accepted. No Partial payments will be made unless authorized by the Property Book Officer or the Contracting Officer. The vendor, upon request from Mr Jerry Peguese or Ms.

Stacy Zembik or the Contracting Office will supply proof of delivery within 48 hours after it has been requested.SHIP TO:TRIPLER ARMY MEDICAL CENTERATTN: PROPERTY BOOK OFFICER161

KRUKOWSKI RD - UPPER LEVELHONOLULU, HI 96859-5000MARK ALL PACKING LABELS WITH

CLIN 0003

Dynaflex G-1065804 (RVG 6100 Size 0 Kit w/install)SHIPPING AND HANDLING – Ship only to the address belowShipping to a different address could delay payment.SPECIAL INSTRUCTIONS:(1) WARRANTY – The warranty will begin on the date that all of the items on the contract arrive at Tripler Army Medical Center, Bldg 161 unless the items need vendor installation. If the items require vendor installation, then the warranty will start upon the date that the equipment is operational at Tripler Army Medical Center.(2) PAYMENT: Payment will be made only after receipt of all items on the contract are accepted. No Partial payments will be made unless authorized by the Property Book Officer or the Contracting Officer. The vendor, upon request from Mr Jerry Peguese or Ms. Stacy Zembik or the Contracting Office will supply proof of delivery within 48 hours after it has been requested.SHIP

TO:TRIPLER ARMY MEDICAL CENTERATTN: PROPERTY BOOK OFFICER161 KRUKOWSKI RD -

UPPER LEVELHONOLULU, HI 96859-5000MARK ALL PACKING LABELS WITH CUSTOMER REF NO.

CEEP 17-097.

To:

Dynaflex 1739861 (RVG 6100 Size 0 complete kit with install)SHIPPING AND HANDLING – Ship only to the address belowShipping to a different address could delay payment.SPECIAL INSTRUCTIONS:(1) WARRANTY – The warranty will begin on the date that all of the items on the contract arrive at Tripler Army Medical Center, Bldg 161 unless the items need vendor installation. If the items require vendor installation, then the warranty will start upon the date that the equipment is operational at Tripler Army Medical Center.(2) PAYMENT: Payment will be made only after receipt of all items on the contract are accepted. No Partial payments will be made unless authorized by the Property Book Officer or the Contracting Officer. The vendor, upon request from Mr Jerry Peguese or Ms.

Stacy Zembik or the Contracting Office will supply proof of delivery within 48 hours after it has been requested.SHIP TO:TRIPLER ARMY MEDICAL CENTERATTN: PROPERTY BOOK OFFICER161

KRUKOWSKI RD - UPPER LEVELHONOLULU, HI 96859-5000MARK ALL PACKING LABELS WITH

(End of Summary of Changes)