W81K0222Q0066-0001.pdf

W40M REGIONAL HEALTH CONTRACTING OF

REGIONAL HEALTH CONTR OFC PACIFIC

POC: MEGUMI KUWADA

BLDG 339 CLARK ROAD

FORT SHAFFER HI 96858-5098

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 update the Manufacturer Part Numbers and Item Description for tw o items in the Delivery Terms and Exhibit A.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 3

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

16C. DATE SIGNED

BY 01-Jul-2022

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 W81K0222Q0066

X 9B. DATED (SEE ITEM 11)

24-Jun-2022

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

01-Jul-2022

CODE

W40M REGIONAL HEALTH CONTRACTING OF

REGIONAL HEALTH CONTR OFC PACIFIC

BLDG 339 CLARK ROAD

FT SHAFTER HI 96858-5098

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

4. REQUISITION/PURCHASE REQ. NO.

CODE W81K02

FACILITY CODECODE

EMAIL:TEL:

W81K0222Q0066

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

The following have been modified:

DELIVERY TERMS

Manufacturer Part Number Item Description

Required Temperature Shelf-Life Delivery Timeframe

Emergency Delivery Timeframe

09P31-25 03M88-01

I-STAT Chem8+ Cartridge 25T

Shall be stored at 2-8℃ at all times.

14 days at room temperature (18 to 30℃)

Shall be delivered within 48 hours of order placed.

Shall be delivered within 24 hours of order placed.

03P79-25 06F04-01

I-STAT IST EG8

EC8+Cartridge

Shall be stored at 2-8℃ at all times.

14 days at room temperature

Shall be delivered within 48 hours of order placed.

Shall be delivered within 24 hours of order placed.

06F23-55 Rechargeable Battery Pack

None N/A Shall be delivered within 48 hours of order placed.

Shall be delivered within 24 hours of order placed.

05P71-01 TriControl Level 1 Shall be stored at 2-8℃ at all times.

5 days at room temperature (18 to 30℃)

Shall be delivered within 48 hours of order placed.

Shall be delivered within 24 hours of order placed.

05P72-01 TriControl Level 2 Shall be stored at 2-8℃ at all times.

5 days at room temperature (18 to 30℃)

Shall be delivered within 48 hours of order placed.

Shall be delivered within 24 hours of order placed.

05P73-01 TriControl Level 3 Shall be stored at 2-8℃ at all times.

5 days at room temperature (18 to 30℃)

Shall be delivered within 48 hours of order placed.

Shall be delivered within 24 hours of order placed.

05P70-01 TriControl Cal Ver Shall be stored at 2-8℃ at all times.

5 days at room temperature (18 to 30℃)

Shall be delivered within 48 hours of order placed.

Shall be delivered within 24 hours of order placed.

MIN / MAX CONSTRAINTS

The minimum guaranteed amount is $5,000.00 and applies only to the base period of performance of 1 Oct 2022 through 30 Sep 2023. The maximum quantity is listed below and applies to the full duration of the contract.

Exhibit A

Item No.

Manufacturer Part Number Item Description

Unit of Issue

Unit Price

Estimated Quantity

Maximum not-to-exceed Quantity

BASE PERIOD: 1 Oct 2022 – 30 Sep 2023 (CLIN 0001) 0001-01 09P31-25

03M88-01 I-STAT Chem8+ Cartridge 25T

Box 450 475

0001-02 03P79-25 06F04-01

I-STAT IST EG8

EC8+Cartridge

Box 1 2

0001-03 06F23-55 Rechargeable Battery Pack EA 2 3 0001-04 05P71-01 TriControl Level 1 Box 200 230 0001-05 05P72-01 TriControl Level 2 Box 200 230

W81K0222Q0066

0001-06 05P73-01 TriControl Level 3 Box 200 230 0001-07 05P70-01 TriControl Cal Ver Box 6 10

OPTION 1: 1 Oct 2023 – 30 Sep 2024 (CLIN 1001) 1001-01 09P31-25

03M88-01 I-STAT Chem8+ Cartridge 25T

Box 450 475

1001-02 03P79-25 06F04-01

I-STAT IST EG8

EC8+Cartridge

Box 1 2

1001-03 06F23-55 Rechargeable Battery Pack EA 2 3 1001-04 05P71-01 TriControl Level 1 Box 200 230 1001-05 05P72-01 TriControl Level 2 Box 200 230 1001-06 05P73-01 TriControl Level 3 Box 200 230 1001-07 05P70-01 TriControl Cal Ver Box 6 10

OPTION 2: 1 Oct 2024 – 30 Sep 2025 (CLIN 2001) 2001-01 09P31-25

03M88-01 I-STAT Chem8+ Cartridge 25T

Box 450 475

2001-02 03P79-25 06F04-01

I-STAT IST EG8

EC8+Cartridge

Box 1 2

2001-03 06F23-55 Rechargeable Battery Pack EA 2 3 2001-04 05P71-01 TriControl Level 1 Box 200 230 2001-05 05P72-01 TriControl Level 2 Box 200 230 2001-06 05P73-01 TriControl Level 3 Box 200 230 2001-07 05P70-01 TriControl Cal Ver Box 6 10

OPTION 3: 1 Oct 2025 – 30 Sep 2026 (CLIN 3001) 3001-01 09P31-25

03M88-01 I-STAT Chem8+ Cartridge 25T

Box 450 475

3001-02 03P79-25 06F04-01

I-STAT IST EG8

EC8+Cartridge

Box 1 2

3001-03 06F23-55 Rechargeable Battery Pack EA 2 3 3001-04 05P71-01 TriControl Level 1 Box 200 230 3001-05 05P72-01 TriControl Level 2 Box 200 230 3001-06 05P73-01 TriControl Level 3 Box 200 230 3001-07 05P70-01 TriControl Cal Ver Box 6 10

OPTION 4: 1 Oct 2026 – 30 Sep 2027 (CLIN 4001) 1001-01 09P31-25

03M88-01 I-STAT Chem8+ Cartridge 25T

Box 450 475

1001-02 03P79-25 06F04-01

I-STAT IST EG8

EC8+Cartridge

Box 1 2

1001-03 06F23-55 Rechargeable Battery Pack EA 2 3 1001-04 05P71-01 TriControl Level 1 Box 200 230 1001-05 05P72-01 TriControl Level 2 Box 200 230 1001-06 05P73-01 TriControl Level 3 Box 200 230 1001-07 05P70-01 TriControl Cal Ver Box 6 10

(End of Summary of Changes)