A22a_W912EE23Q0069-Amendment 0001.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

Reference Solicitation W912EE23Q0069 for Exterior Painting and Repairs as described herein: the soliciation is amendmed as follow s: see continuation page for amendment 0001 details.

The quote due date of 25Aug2023 at 3:30 p.m. remains unchanged.

1. CONTRACT ID CODE PAGE OF PAGES

1 2

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

16C. DATE SIGNED

BY 08-Aug-2023

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 W912EE23Q0069

X 9B. DATED (SEE ITEM 11)

07-Aug-2023

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 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

08-Aug-2023

CODE

VICKSBURG CONTRACTING OFFICE

4155 CLAY ST

VICKSBURG MS 39183-3435

W912EE 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

ellis.screws@usace.army.milEMAIL:601-631-7527TEL:

ELLIS SCREWS / ADDED BY SUMI

W912EE23Q0069

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 30 - BLOCK 14 CONTINUATION PAGE

The following have been added by full text:

AMENDMENT 0001

When physical access to controlled facility or area is required:

The attached Authorization to Release Information form will need to be completed by all contract employees who will be performing work under this contract and returned to the Security Office via the COR for the purpose of conducting a criminal history check/fingerprints/background investigation, PRIOR to beginning work under this contract.

(End of Summary of Changes)

US Army Corps of Engineers – Vicksburg District – Security and Law Enforcement Office Fax: 601.631.7918

Proponent: CEMVK-CEMVK FL 620 Apr

Authorization to Release Information

I Authorize any investigator, special agent, or other duly accredited representative of the authorized Federal agency conducting my background investigation, to obtain any information relating to my activities from schools, residential management agents, employers, criminal justice agencies, retail business establishments, or other sources of information. This information may include, but is not limited to, my academic, residential, achievement, performance, attendance, disciplinary, employment history, and criminal history record information.

I Understand that, for some sources of information, a separate specific release will be needed, and I may be contacted for such a release at a later date.

I Authorize custodians of records and sources of information pertaining to me to release such information upon request of the investigator, special agent, or other duly accredited representative of any Federal agency authorized above regardless of any previous agreement to the contrary.

I Understand that the information released by records custodians and sources of information is for official use by the Federal Government only for the purposes stated above and may be redisclosed by the Government only as authorized by law.

Copies of this authorization that show my signature are as valid as the original release signed by me. This authorization is valid for two (2) years from the date signed.

NAME (PRINT): _____________________________________________________________________________

ALIASES: __________________________________________________________________________________

PRESENT STREET ADDRESS:_________________________________________________________________

COUNTY:________________CITY:___________________________STATE: ______ ZIP:_________________

PREVIOUS ADDRESS: _______________________________________________________________________ (If moved in past 2 years)

COUNTY:________________CITY:___________________________STATE: ______ ZIP:_________________

SOCIAL SECURITY NUMBER: ________________________________________________________________

DATE OF BIRTH:____________________PLACE OF BIRTH:________________________________________

DRIVER’S LICENSE NUMBER:_________________________________________STATE:________________

HOME PHONE:_____________________________OTHER PHONE:___________________________________

DATE OF HIRE:_________________POSITION/JOB TITLE:_________________________________________

COMPANY:_________________________________________________________________________________

SUPERVISOR:___________________________SUPERVISOR’S PHONE:______________________________

Signature Date

Signature of Witness Date