B.08 W9114F21Q00030001.pdf

0011693681-0001

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 add CLIN 2001 to the solicitation.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 3

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

16C. DATE SIGNED

BY 27-Oct-2021

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 W9114F22Q0003

X 9B. DATED (SEE ITEM 11)

22-Oct-2021

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

27-Oct-2021

CODE

W40M RHCO USAHCA EUROPE

REGIONAL HEALTH CONTR OFC EUROPE

CMR 402

APO AE 09180

W9114F 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W9114F22Q0003

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SUPPLIES OR SERVICES AND PRICES

CLIN 2001 is added as follows:

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

2001 85 Each

OPTION AMBULANCE SVC (SPORTING EVENTS)

FFP

Non-personal Ambulance Services during High School Sporting Events such as football, basketball, wrestling, soccer, cheerleaders, etc.). The Contractor shall furnish all personnel, equipment, vehicles, supplies, management and supervision necessary to provide/coordinate emergency medical service during DoDDS interscholastic contact sports events within the AFNORTH Netherlands geographical areas of responsibility.

The Contractor shall provide, at a minimum, a properly equipped ambulance vehicle, an ambulance driver and a trained/qualified Emergency Medical Technician, EMT I-85, or equivalent in the Netherlands as described in the Uniform Glossary of Ambulance Care terms based on the perusal Landelijk Protocol Ambulancezorg (LPA) 8.1, dated June 2016, for the duration of all scheduled contact sports events.

All services provided by the Contractor shall be covered by the terms and conditions of this contract, performed in accordance with the PWS, all applicable United States (U.S.) and local laws, regulations, standards, provisions and directives.

The unit of measure “Each” is defined as a 60-minute period, or the fraction thereof.

Second Option Period: 1 December 2023 - 30 November 2024 FOB: Destination

PSC CD: Q201

NET AMT

DELIVERIES AND PERFORMANCE

W9114F22Q0003

The following Delivery Schedule for CLIN 2001 has been added:

DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

POP 01-DEC-2021 TO

30-NOV-2022

N/A SHAPE HEALTHCARE FACILITY

SHAPE HEALTHCARE FACILITY

BLG 401 AVENUE D'OSLO

SHAPE 7010

FOB: Destination

W812BX

INSPECTION AND ACCEPTANCE

The following Acceptance/Inspection Schedule was added for CLIN 2001:

INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

Destination Government Destination Government

(End of Summary of Changes)