W912L119R0031_AMENDMENT_01.pdf

0011272067

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 as follow s:

1. Address the questions submitted via email -the responses to each of the questions are included in the attachment. 2. Change the PWS and Event Summary FROM: 08-10 FEB19 SHOREVIEW FMR PERFORMANCE WORK STATEMENT(Attachment 1), and TXARNG Medical Event Summary TO: REVISED 08-10 FEB19 SHOREVIEW FMR PERFORMANCE WORK STATEMENT, DATED 1.29.19, and REVISED TXARNG Medical Event Summary, DATED 1.29.19

3. Contractor shall sign the document and return 1 copy to the issuing off ice.

All other terms and conditions remain unchanged.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 4

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

16C. DATE SIGNED

BY 30-Jan-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 W912L119R0031

X 9B. DATED (SEE ITEM 11)

24-Jan-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

30-Jan-2019

CODE

USPFO

2200 WEST 35TH STREET, BLDG. 66

AUSTIN TX 78703-1222

W912L1 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

W912L119R0031

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:

QUESTIONS AND ANSWER SHEET

1. Is there room in the armory to complete any of the following:

a. Dental Screening

b. Dental Treatment

c. Vision station

d. Immunizations Station

e. Lab Draws

f. Height Weight and BP

g. Administrative Check in Out

h. Provider

i. Behavioral Health

ANSWER:

SPACE AVAILABLE FOR:

CHET/WT/VITALS/VISION

IMMUNIZATIONS/LABS

PROVIDERS

BEHAVIORAL HEALTH

CASE MANAGEMENT

NO SPACE AVAILABLE FOR:

DENTAL

HEARING

Contractor shall provide Dental and hearing trailers as stated in the attached "Revised" PWS and Event Summary.

2. Will a Behavioral Health Specialist be government or contractor provided?

ANSWER: For all Contracts, the Vendor will provide a Behavioral Health Provider

REVISED MEDICAL EVENT SUMMARY

TXARNG Medical Event Summary As of 20 September 2017 Event Name: FMR/SRP (various units) Event Location: Shoreview Armory, 8111 Shoreview Drive, Fort Worth, TX 76108 Site POC: SSG Kyle Bloodworth, 940-372-0134, kyle.r.bloodworth.mil@mail.mil Event Dates:

(1) Medical Event: 08-10 FEB 19 Set up Date:07 FEB 19 Recovery Date: 11 FEB 19

(2) Case Management/Records Clerk: 11 FEB19 – 11 MAR 19 Estimated Personnel*:

(1) Total:540

(2) PHA: 540

(3) Hearing: 540

(4) Optometry: 0

(5) Dental Exam: 540

(6) Dental Treatment: 135 Additional requirements:

1. Estimate (15 %) Soldiers will need “over 40” requirements of EKG and expanded labs as required by regulation (CVSP, 5 YR EKG, PSA).

2. Estimated (18%) Soldiers receiving dental treatment will need Case Management

3. Estimated (25%) will need Immunizations provided by the vendor. This includes all Routine Adult Immunization with the exception of Influenza. Please be advised, the Routine Adult Immunizations profile now includes Measles, Mumps, and Rubella (MMR), Polio, and Varicella.

Please refer to ALARACT 255/2014 for additional guidance on requirements.

4. HIV Blood Specimens MUST be provided to the TXARNG no later than 2 days after the draw date.

5. SPRINT Testing with Audiologist for identified Hearing Classification 3.

6. Additional labs will include: Urine pregnancy test, HIV, and G6PD.

7. Behavioral Health Clinicians are required to provide assessments and referrals.

8. Post behavioral data entry is required. MEDIUM to HIGH risk Soldiers will be reported to TXARNG event representatives immediately.

9. Providers are not allowed to issue Temporary Profiles during the FMRs/SRPs. All medical conditions must be documented according to allow Military Providers the ability to profile the medical condition or concern. The documentation will be provided to the TXARNG event representative upon completion of the event.

10. Prescription management is required as needed for Soldiers receiving Dental Treatment.

11. Vision screening ONLY.

12. No Medical Warning Tags.

TXARNG Medical Event Summary As of 20 September 2017

13. Request that event information updates are provided at the end of each duty day. Email to Site POC and Tammy L. Harmon @ tammy.l.harmon7.civ.mil@mail.mil

14. Daily FMR Events information/updates required are:

• Number of personnel/PAX seen daily

• Number of personnel/ PAX no-shows daily

• Number of personnel/PAX seen for the specific services daily for the listed Medical and Dental Service (Dental: Dental Exams, Dental Treatment, Bite Wings, and Panos Medical: Visual Acuity, EKGs, PHAs, Vitals, Hearing, Immunizations, and Labs) See below example/format:

TXARNG Medical Event Summary As of 20 September 2017 TXARNG Space Available for Contractor:

Contractor Shall:

Provide Dental/ Hearing Trailers.

*Above totals are estimates and per contract TXARNG requires Contractor to contact TXARNG for actual rosters prior to event in order to adequately provide resources for this event.

ARMORY SPACE AVAILABLEYESNOREMARKCHECK

IN/OUTXHT/WT/VITALS/VISIONXIMMUNIZATION/LABSXDENTALXPROVIDERSXBEHAVIORAL

HEALTHXCASE MANAGEMENTX

SECTION SF 1449 - CONTINUATION SHEET

TABLE OF CONTENTS

The Table of Contents has changed from:

Exhibit/Attachment Table of Contents

DOCUMENT TYPE DESCRIPTION PAGES DATE

Attachment 1 08-10 FEB19

SHOREVIEW FMR

PERFORMANCE

WORK STATEME

Attachment 2 PRICE LIST 15-JAN-2019 to:

Exhibit/Attachment Table of Contents

DOCUMENT TYPE DESCRIPTION PAGES DATE

Attachment 3 REVISED PWS 29-JAN-2019

(End of Summary of Changes)