SF30_Amendment_0002_W9124X-19-Q-0005.pdf

0011316484-0001

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 include the questions and answ ers. The PWS is revised. An additional Test Panel 06 and laboratory tests are required to be individually priced in Item 0001. All other terms and conditions remain unchanged.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 2

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

16C. DATE SIGNED

BY 02-Apr-2019

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 W9124X19Q0005

X 9B. DATED (SEE ITEM 11)

12-Mar-2019

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

02-Apr-2019

CODE

PURCHASING AND CONTRACTING

2452 FAIRVIEW DR.

CARSON CITY NV 89701

W9124X 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W9124X19Q0005

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:

Provide 150 Occupational Health Physicals for Federal Government Employees assigned to the Nevada Army National Guard In Accordance with the Performance Work Statement (PWS). Anticipated Period Of Performance:

1 April 2019 to 31 March 2020.Price Per Exam/Location (North is Carson City/ Reno. South is Las Vegas.

Numbers correspond to personnel receiving exams by type at each location): Test Panel: 01 (North - 50) $_______________Test Panel: 01 (South - 30) $_______________Test Panel: 02 (North - 6) $_______________Test Panel: 02 (South - 4) $_______________Test Panel: 03 (North - 30) $_______________Test Panel: 03 (South - 5) $_______________Test Panel: 04 (North - 10) $_______________Test Panel: 04 (South - 10) $_______________Test Panel: 05 (North - 3) $_______________Test Panel: 05 (South - 2) $_______________Numbers of personnel per location are approximate. Exam pricing shall be inclusive of all costs to include compliance with the Enterprise Contractor Manpower Reporting Application (eCMRA) http://www.ecmra.mil/

To:

Provide 170 Occupational Health Physicals for Federal Government Employees assigned to the Nevada Army National Guard In Accordance with the Performance Work Statement (PWS). Anticipated Period Of Performance:

1 May 2019 to 30 April 2020.Price Per Exam/Location (North consists of two locations - Carson City and Reno.

South consists of a single location in Las Vegas. Numbers correspond to personnel receiving exams by type at each location): Test Panel: 01 (North - 50) $_______________Test Panel: 01 (South - 30) $_______________Test Panel: 02 (North - 6) $_______________Test Panel: 02 (South - 4) $_______________Test Panel: 03 (North - 30) $_______________Test Panel: 03 (South - 5) $_______________Test Panel: 04 (North - 10) $_______________Test Panel: 04 (South - 10) $_______________Test Panel: 05 (North - 3) $_______________Test Panel: 05 (South - 2) $_______________Test Panel: 06 (North - 17) $_______________Test Panel: 06 (South - 3) $_______________Laboratory Tests if required (price per test):Occ Health Profile (Bundle: CBC, liver function test, BUN, Creatinine (Urinalysis) $________________CBC (HGB, HCT, WBC, MCV, MCH, MCHC) with diff $_______________CBC (HGB, HCT, WBC, MCV, MCH, MCHC) without diff $____________ Liver Function Test (AST, ALT, ALB, ALK PHOS, dBil, TBil, Protein) $________BUN /Creatinine $______________ Lipid (TC, LDL, HDL, Trig, VLDL) Panel $_______________ Urinalysis with Micro $_______________Urinalysis without Micro $_______________ Blood Glucose $___________ Blood Ethanol $____________Cadmium Profile $______________Human Chorionic Gonadotropin HCG beta $____________Chromium (Blood) $________________Lead, industrial whole blood $______________ZPP, Blood Protoporphyrins, zinc $_________________Numbers of personnel per location are approximate. Exam pricing shall be inclusive of all costs to include compliance with the Enterprise Contractor Manpower Reporting Application (eCMRA) http://www.ecmra.mil/

(End of Summary of Changes)