W91242-18-R-0008-001.pdf

Offers 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 or (c) By separate letter or electronic communication 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 letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

E. IMPORTANT: Contractor is not is required to sign this document and return copies to the issuing office.

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQUISITION NUMBER 5. PROJECT NUMBER (If applicable)

7. ADMINISTERED BY (If other than Item 6) CODE

STANDARD FORM 30 (REV. 11/2016)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended. is not extended.

12. ACCOUNTING AND APPROPRIATION DATA (If required) copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NUMBER AS DESCRIBED IN ITEM 14.

CHECK ONE A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER

NUMBER IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation data, 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)

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.

15C. DATE SIGNED

15A. NAME AND TITLE OF SIGNER (Type or print)

16C. DATE SIGNED

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

PAGE OF PAGES

6. ISSUED BY CODE

8. NAME AND ADDRESS OF CONTRACTOR (Number, street, county, State and ZIP Code) (X)

CODE

15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

Previous edition unusable

2. AMENDMENT/MODIFICATION NUMBER

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

1. This amendment is issued to add CLIN 0007, Greensboro 8-9 Sept 2018. 2-day Medical and Dental PHA event IAW PWS. Address: 110 Franklin Blvd, Greensboro, NC 27401. Total estimated # PAX:

160. See medical event request form for details.

2. Use attached spreadsheet titled 'W91242-18-R-0008 Pricing' to submit pricing.

3. All other terms and conditions remain unchanged.

USPFO FOR NORTH CAROLINA (W91242)

ATTN: HEATHER BUSHOUSE

4201 REEDY CREEK RD

RALEIGH, NC 27607-6412

TEL: 919-664-6021

9A. AMENDMENT OF SOLICITATION NUMBER

W91242-18-R-0008

6/25/2018

9B. DATED (SEE ITEM 11)

6/22/2018

Medical Numbers

G6PD DNA

FLU HEPA HEPB TDAP

MRR VAR Percent Pano

OPTOMERTY

EKG

ENDO

For G1 MEDICAL use only

POC Email

Event Details

Phone Number

Event State: Event Zip:

Primary POC

HIV

NCARNG Medical Event Request Form

G1 Medical

Event Location

Brigade/MSC:

Battalion:

To:

Event Name:

Event Street Address:

Event City:

PREGNANCY TESTS LIPID PANEL

HEARING EXAMS SPRINT TESTS

Dental Treatment Hours:

LIVE DENCLASS

ORAL SUGURY

LIVE HRR

Data Entry: Additional Notes:

Participating Units/UICs:

Number of Females Over 40

Alternate POC

Phone Number

POC Email

Attending Day 1

Attending Day 3 Attending Day 2

Notes

Total Attending

Dental Numbers

Event Start Date/Time

Event Type:

Portable Medical Equipment Portable Dental Exams Mobile Dental Treatment

Event End Date/Time

Griffin Readiness 110 Franklin Blvd.

Greensboro NC 27401 Greensboro Armory

8SEP18/0800 9SEP18/1900

160 27 19

5 5 80 27 10 10

160 10 10 10 Yes Yes Yes

10 10 Yes 35 20 20 Yes

CLIN 0007