A.09.03_Soliciation_Amendment_W81K04-17-R-0001_0005_06.07.17.pdf

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 a formatting issue w ith attachments 02, 03, & 04. The original attachments have been removed and replaced w ith the same data. There w ere not changes to the data on these attachments, the correction w as made to f ix the formatting problem.

1. CONTRACT ID CODE PAGE OF PAGES

S 1 6

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

16C. DATE SIGNED

BY 07-Jun-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 W81K04-17-R-0001

X 9B. DATED (SEE ITEM 11)

18-May-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, 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

07-Jun-2017

CODE

W40M USA HLTH CONTRACTING ACT

CTR FOR HEALTH CARE CONTR

2199 STORAGE ST BLDG 4197 STE 68

JBSA FT SAM HOUSTON TX 78234-5074

W81K04 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W81K04-17-R-0001

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

The following have been added by full text:

ATTACHMENT 2

Attachment 2 - Estimated Workload Data - Outpatient Records

Item MTF Year 1 Year 2 Year 3 Year 4 Year 5 Total 5 Years

0001 - FOX AHC-REDSTONE

ARSENAL 81,809 81,809 81,809 81,809 81,809 409,043

0003 - LYSTER AHC-FT.

RUCKER 65,503 65,503 65,503 65,503 65,503 327,516

0005 - BASSETT ACH-FT.

WAINWRIGHT 186,970 186,970 186,970 186,970 186,970 934,850

0008 - R W BLISS AHC-FT.

HUACHUCA 33,673 33,673 33,673 33,673 33,673 168,364

0032 - EVANS ACH-FT.

CARSON 506,803 506,803 506,803 506,803 506,803 2,534,015

0047 - EISENHOWER AMC-

FT. GORDON 554,817 554,817 554,817 554,817 554,817 2,774,083

0048 - MARTIN ACH-FT.

BENNING 606,258 606,258 606,258 606,258 606,258 3,031,290

0049 - WINN ACH-FT.

STEWART 474,675 474,675 474,675 474,675 474,675 2,373,375

0052 - TRIPLER AMC-FT

SHAFTER 970,643 981,410 981,410 981,410 981,410 4,896,283

10 0057 - IRWIN ACH-FT. RILEY 317,548 317,548 317,548 317,548 317,548 1,587,740

0058 - MUNSON AHC-FT.

LEAVENWORTH 48,444 48,444 48,444 48,444 48,444 242,221

0060 - BLANCHFIELD ACH-

FT. CAMPBELL 413,785 756,140 756,140 756,140 756,140 3,438,345

0061 - IRELAND ACH-FT.

KNOX 117,612 117,612 117,612 117,612 117,612 588,060

0064 - BAYNE-JONES ACH-

FT. POLK 191,755 191,755 191,755 191,755 191,755 958,775

0069 - KIMBROUGH AMB

CAR CEN-FT MEADE 310,255 310,255 310,255 310,255 310,255 1,551,275

0075 - L. WOOD ACH-FT.

LEONARD WOOD 281,672 281,672 281,672 281,672 281,672 1,408,359

0086 - KELLER ACH-WEST

POINT 40,343 40,343 40,343 40,343 40,343 201,715

0089 - WOMACK AMC-FT.

BRAGG 857,649 857,649 857,649 857,649 857,649 4,288,245

0098 - REYNOLDS ACH-FT.

SILL 254,540 254,540 254,540 254,540 254,540 1,272,699

0105 - MONCRIEF ACH-FT.

JACKSON 169,581 169,581 169,581 169,581 169,581 847,903

0108 - WILLIAM BEAUMONT

AMC-FT. BLISS 259,034 342,722 342,722 342,722 342,722 1,629,922

0109 - BAMC-SAMMC JBSA

FSH 856,523 1,000,500 1,000,500 1,000,500 1,000,500 4,858,523

0110 - DARNALL AMC-FT.

HOOD 278,030 278,030 278,030 278,030 278,030 1,390,151

0121 - MCDONALD AHC-FT.

EUSTIS 106,694 106,694 106,694 106,694 106,694 533,470

0122 - KENNER AHC-FT. LEE

121,670 121,670 121,670 121,670 121,670 608,350

0125 - MADIGAN AMC-FT.

LEWIS 1,193,707 1,193,707 1,193,707 1,193,707 1,193,707 5,968,535

0131 - WEED ACH-FT. IRWIN

33,935 33,935 33,935 33,935 33,935 169,675

0330 - GUTHRIE AHC-FT.

DRUM 125,209 125,209 125,209 125,209 125,209 626,045

0607-LANDSTUHL

REGIONAL MEDCEN 420,019 420,019 420,019 420,019 420,019 2,100,095

30 0609-BAVARIA MEDDAC 182,251 182,251 286,622 286,622 286,622 1,224,368

0612 - BRIAN ALLGOOD

ACH-SEOUL 52,263 52,263 52,263 52,263 52,263 261,315

0610 - BG CRAWFORD SAMS

AHC-CAMP ZAMA 20,235 20,235 20,235 20,235 20,235 101,176

10,133,903 10,714,691 10,819,062 10,819,062 10,819,062 53,305,779

ATTACHMENT 3

Attachment 3 - Estimated Workload Data - APV

Item MTF Estimated APV Year 1

Estimated APV Year 2

Estimated APV Year 3

Estimated APV Year 4

Estimated APV Year 5 Total 5 Years

0005 - BASSETT ACH-FT.

WAINWRIGHT 253 253 253 253 253 1,265

0032 - EVANS ACH-FT.

CARSON 3,622 3,622 3,622 3,622 3,622 18,109

0047 - EISENHOWER AMC-

FT. GORDON 2,017 2,017 2,017 2,017 2,017 10,085

0048 - MARTIN ACH-FT.

BENNING 1,036 1,036 1,036 1,036 1,036 5,178

0049 - WINN ACH-FT.

STEWART 823 823 823 823 823 4,115

0052 - TRIPLER AMC-FT

SHAFTER 2,170 2,170 2,170 2,170 2,170 10,851

7 0057 - IRWIN ACH-FT. RILEY 488 488 488 488 488 2,440

0058 - MUNSON AHC-FT.

LEAVENWORTH 173 173 173 173 173 863

0060 - BLANCHFIELD ACH-

FT. CAMPBELL 320 3,341 3,341 3,341 3,341 13,684

0064 - BAYNE-JONES ACH-

FT. POLK 1,363 1,363 1,363 1,363 1,363 6,815

0069 - KIMBROUGH AMB

CAR CEN-FT MEADE 1,635 1,635 1,635 1,635 1,635 8,175

0075 - L. WOOD ACH-FT.

LEONARD WOOD 332 332 332 332 332 1,660

0086 - KELLER ACH-WEST

POINT 66 66 66 66 66 330

0089 - WOMACK AMC-FT.

BRAGG 1,193 1,193 1,193 1,193 1,193 5,965

0108 - WILLIAM BEAUMONT

AMC-FT. BLISS 2,986 2,986 2,986 2,986 2,986 14,928

0109 - BAMC-SAMMC JBSA

FSH 2,800 2,800 2,800 2,800 2,800 13,998

0110 - DARNALL AMC-FT.

HOOD 1,457 1,457 1,457 1,457 1,457 7,284

0121 - MCDONALD AHC-FT.

EUSTIS 2,976 2,976 2,976 2,976 2,976 14,878

0125 - MADIGAN AMC-FT.

LEWIS 3,510 3,510 3,510 3,510 3,510 17,550

20 0131 - WEED ACH-FT. IRWIN 189 189 189 189 189 945

0607-LANDSTUHL

REGIONAL MEDCEN 1,252 1,252 1,252 1,252 1,252 6,260

0612 - BRIAN ALLGOOD

ACH-SEOUL 521 521 521 521 521 2,604

31,179 34,200 34,200 34,200 34,200 167,979

ATTACHMENT 4

Attachment 5 - Estimated Workload Data - IPSR

Item MTF Estimated IPSR Year 1

Estimated IPSR Year 2

Estimated IPSR Year 3

Estimated IPSR Year 4

Estimated IPSR Year 5 Total 5 Years

1 0005 - BASSETT ACH-FT.

WAINWRIGHT 1,706 1,706 1,706 1,706 1,706 8,530

2 0032 - EVANS ACH-FT.

CARSON 4,850 4,850 4,850 4,850 4,850 24,250

3 0047 - EISENHOWER

AMC-FT. GORDON 4,547 4,547 4,547 4,547 4,547 22,736

4 0048 - MARTIN ACH-FT.

BENNING 14,905 14,905 14,905 14,905 14,905 74,526

5 0049 - WINN ACH-FT.

STEWART 1,754 1,754 1,754 1,754 1,754 8,769

6 0052 - TRIPLER AMC-FT

SHAFTER 19,481 19,481 19,481 19,481 19,481 97,404

7 0057 - IRWIN ACH-FT.

RILEY 9,235 9,235 9,235 9,235 9,235 46,175

8 0060 - BLANCHFIELD

ACH-FT. CAMPBELL 737 16,744 16,744 16,744 16,744 67,713

9 0064 - BAYNE-JONES

ACH-FT. POLK 5,150 5,150 5,150 5,150 5,150 25,750

10 0075 - L. WOOD ACH-FT.

LEONARD WOOD 4,693 4,693 4,693 4,693 4,693 23,464

11 0086 - KELLER ACH-

WEST POINT 375 375 375 375 375 1,876

12 0089 - WOMACK AMC-

FT. BRAGG 6,174 6,174 6,174 6,174 6,174 30,870

0108 - WILLIAM

BEAUMONT AMC-FT.

BLISS

21,718 21,718 21,718 21,718 21,718 108,589

14 0109 - BAMC-SAMMC

JBSA FSH 1,744 1,744 1,744 1,744 1,744 8,718

15 0110 - DARNALL AMC-

FT. HOOD 8,463 8,463 8,463 8,463 8,463 42,316

16 0125 - MADIGAN AMC-

FT. LEWIS 17,898 17,898 17,898 17,898 17,898 89,489

17 0131 - WEED ACH-FT.

IRWIN 1,388 1,388 1,388 1,388 1,388 6,940

18 0607-LANDSTUHL

REGIONAL MEDCEN 6,507 6,507 6,507 6,507 6,507 32,533

19 0612 - BRIAN ALLGOOD

ACH-SEOUL 1,134 1,134 1,134 1,134 1,134 5,668

132,457 148,464 148,464 148,464 148,464 726,314

The following have been deleted:

ATTACHMENT 2

ATTACHMENT 3

ATTACHMENT 4

(End of Summary of Changes)