W912P5-15-T-0004-0001.pdf

CONTRACTING DIVISION (JWP)

JAMES.W.PURCELL@USACE.ARMY.MIL

(615) 736-7674

(615) 736-7124

NASHVILLE TN 37202-1070

W38XDD42694596

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 Exhibits A through G to the Performance Work Statement, and the maintenance manual for the composting toilet at the Overlook restroom.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 11

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

16C. DATE SIGNED

BY 12-Feb-2015

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 W912P5-15-T-0004

X 9B. DATED (SEE ITEM 11)

26-Jan-2015

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

12-Feb-2015

CODE

CONTRACTING DIVISION (JEC)

JAMES.E.CHOATE@USACE.ARMY.MIL

(615) 736-7946

(615) 736-7124

NASHVILLE TN 37202

W912P5 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W912P5

FACILITY CODECODE

EMAIL:TEL:

W912P5-15-T-0004

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:

EXHIBITS A –G

EXHIBIT A

CONTRACT DISCREPANCY REPORT

For use of this form, see DA PAM 715-15; the proponent agency is DCSLOG. 1. CONTRACT NUMBER

2. TO: (Contractor and Manager Name)

3. FROM: (Name of QAE)

DATES

PREPARED ORAL NOTIFICATION

RETURNED BY

CONTRACTOR ACTION COMPLETE

4. DISCREPANCY OR PROBLEM (Describe in Detail: Include reference in PWS/Directive: Attach continuation sheet if necessary.)

5. SIGNATURE OF CONTRACTING OFFICER

TO: (Contracting Officer) 7. FROM: (Contractor)

8. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT

RECURRENCE. ATTACH CONTINUATION SHEET IF NECESSARY. (Cite applicable Q.A. program procedures or new A.W. procedures.)

9. SIGNATURE OF CONTRACTOR REPRESENTATIVE 10. DATE

11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, rejection: attach continuation sheet if necessary)

12. GOVERNMENT ACTIONS (Payment deduction, cure notice, show cause, other.)

CLOSE OUT

CONTRACTOR

NOTIFIED

NAME AND TITLE SIGNATURE DATE

QAE

CONTRACTING

OFFICER

EXHIBIT B

I N V O I C E DATE

FIRM NAME and ADDRESS (GIVE COMPLETE ADDRESS TO WHICH CHECK SHOULD BE MAILED)

SOLD TO

U.S. ARMY ENGINEER DISTRICT, NASHVILLE

P.O. BOX 1070

NASHVILLE, TENN. 37202

DELIVERED TO

PURCHASE ORDER

NUMBER

TERMS

DELIVERY

DATE ARTICLES or SERVICES QUANTITY UNIT

UNIT

PRICE AMOUNT

I certify that the above bill is correct and just; that payment therefore has not been received;

that all statutory requirements as to American production and labor standards, and all conditions of purchase applicable to the transactions have been compiled with; and that State and local sales taxes are not included in the amounts billed.

FIRM NAME BY (Signature) TITLE

INSTRUCTIONS to SUPPLIERS:

1. Render invoice in (DUPLICATE) (QUADRUPLICATE)

2. Invoices written in pencil (unless indelible) will not be accepted.

3. If delivered on more than one date, fill out such dates in first column to left.

4. If shipment is made by parcel post, the point of origin and the weight shall be shown on the invoice.

5. Sign certificate in ink on original copy only. If two or more pages are used for invoicing, the totals are to be carried forward from one page to the next and the certification should be signed in ink on the original copy of the last page only.

ORD Form 5 Previous Edition may be used. DC-F 17-Jul-68

EXHIBIT C

Exhibit D

EXHIBIT E

CEORN-OR-R (200-1C)

NASHVILLE DISTRICT

RECREATION AREA SAFETY INSPECTION CHECKLIST

PROJECT___________DATE__________OBSERVER’S NAME________________________

RECREATION AREA_______________INSPECTION COMPLETED (HOUR)____________

Fill in this checklist with “Yes” or “No” as appropriate and list any remarks on the back of this checklist.

1. TELEPHONE

a) Are repairs needed?_____

b) Is location optimum?_____

c) Are emergency numbers posted?_____

2. TREES

a) Are dead trees, limbs or suspected falling objects noted?_____

3. TRIPPING HAZARDS

a) Are guy wires or stakes for poles, trees, floats, etc. posing hazards?_____

b) Are holes, drop-offs, unsafe ditches, etc. noted?_____

4. PLAYGROUND EQUIPMENT

a) Impacted around equipment with sand, sawdust, etc.?_____

b) Are parts excessively worn, or other repairs needed?_____

c) Are sharp objects, pinch points or unsafe equipment noted?_____

5. GENERAL SAFETY

a) Are sharp objects, glass, fallen rocks or litter noted?_____

b) Are construction areas properly restricted?_____

c) Are first aid kits and fire extinguishers with park attendant?_____

d) Are cables and gates marked for visibility?_____

e) Are curbing and guardrails installed/in good condition?_____

f) Are slick floors or tripping hazards noted?_____

g) Are tables and benches safe and clean?_____

h) Is algae on boat ramps or debris on or in vicinity of ramps?_____

6. ELECTRIC WIRING

a) Are overhead power line crossings dangling/sagging low?_____

b) Is unguarded or unburied temporary wiring noted?_____

7. FLOATS

a) Are repairs needed or slippery surfaces noted?_____

b) Are sharp edges noted or flotation needed?_____

8. SECURITY

a) Is this area covered by law enforcement contract?_____

b) Are gates, doors, storage areas, etc. secured?_____

c) Are boat ramps lighted?_____

9. SIGNS

a) Are signs needed?_____

b) Are signs legible and in good state of repair?_____

Give description of safety hazards or problems, with exact location and any recommended corrective action on the back of this checklist.

ORN Form Revised April 1991 CEORN-OR-R

EXHIBIT F-1

APPROXIMATE QUANTITIES BY AREA

Res. Mgr. Maintenance Floating LAU/R Rd.

Office Shop Pier Area Turnaround Item

Bulletin Boards 1 1 -- --

Fishing Piers -- -- 1 --

Garbage Cans 8 4 3 --

Grills -- -- -- --

Mow, Trim & Litter 2 2 1 2 Removal (acres)

Parking Area (sq. yd.) 220 1750 650 --

Picnic Shelters -- -- -- --

Picnic Sites -- -- -- --

Plant Beds/Sign Bases 2 -- 1 --

Trees w/Mulch 30 -- 8 --

Overlook Structure -- -- -- --

Playground Areas -- -- -- --

Portable Toilets -- -- -- --

Restrooms 2 1 -- --

Roads (miles) 0.1 0.1 -- 0.2

Ditch-rows (miles) 0.3 0.3 0.1 0.1

Water Fountains 1 1 -- --

EXHIBIT F-2

APPROXIMATE QUANTITIES BY AREA

LAU/P Rd Picnic Overlook Spillway, Intake Tailrace Area Bridge, Hwy 1193, Steps

Beach Item

Bulletin Boards 1 3 -- -- --

Fishing Piers -- 1 -- -- --

Garbage Cans 4 27 8 15 1

Grills 1 23 -- -- --

Mow, Trim & Litter 3 2.5 2 * .5 Removal (acres)

Parking Area (sq. yd) 250 450 2450 -- --

Picnic Shelters -- 2 -- -- --

Picnic Sites 1 19 -- -- --

Plant Beds/Sign Bases 2 4 -- 1 --

Specimen Trees w/Mulch -- -- -- -- --

Overlook Structure -- -- 1 -- --

Playground Areas -- 1 -- -- --

Portable Toilets -- -- 2 -- --

Restrooms 1 1 1 -- --

Roads (miles) 1.1 0.7 -- 2.5 --

Ditch-rows (miles) 2.2 1.2 -- -- --

Water Fountains 1 2 -- -- --

*Litter Removal only – 10 acres, Mow and Litter Removal – 5 acres (No mowing – sand beach)

EXHIBIT G

JANITORIAL SERVICES

FLOOR AREAS FOR RESOURCE MANAGER’S OFFICE

& MAINTENANCE SHOP

Approx. Dimensions Sq. Ft.

Resource Manager’s Office

Secretary’s Office 15x20 300 Conference Room 12x15 180 Manager’s Office 12x25 300 Communications Room 8x14 112 Visitor Center 12x15 180

Break Room 10x11 110 Restrooms, 2 each with 5x6 60 1 toilet, 1 basin

TOTAL FLOOR AREA 1242

Approx. Dimensions Sq. Ft.

Maintenance Shop Area

Paved Shop Yard w/Fence 105x150 15,750 Main Shop Building Exterior 24x105 2,520 Foyer 4x8 32 Office 10x16 160 Restroom (1 toilet, 1 basin) 5x6 30 Break/Storage Room 12x24 288 Work Bays 24x54 1,296 Metal Storage Building 6x9 54 Wooden Storage Shed 8x8 64 Wooden Storage Shed 12x18 216

(End of Summary of Changes)