W912PL-17-R-0025_AMEND_0001.pdf

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

2. AMENDMENT/MODIFICAITON NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicble)

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

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

FACILITY CODE

9A. AMENDMENT OF SOLICIATION NO.

9B. DATED (SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NO.

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.

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 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 your 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 APPROPIRATION DATA (If required)

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

IT MODIFIES THE CONTRACT/ORDER NO. 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

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.

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)

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

PAGE OF PAGES

6. ISSUED BY CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., 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)

NSN 7540-01-152-8070

Previous edition unusable Amendment 0001

1 3

0001 14Feb17

W912PL

U.S Army Corps of Engineers,Los Angeles Dist CESPL-CTE, East Region Branch 915 Wilshire Blvd.

Los Angeles, CA 90017

W912PL-17-R-0025

9 February 2017

FY16 DESIGN/BUILD F-35A BOMB BUILD-UP FACILITY, LUKE AFB, AZ

The purpose of this amendment is to add the following documents to SECTION 00 73 00 SUPPLEMENTARY CONDITIONS for the Site Visit:

1. I-9 Acceptable Document - LIST OF ACCEPTALBE DOCUMENTS

2. Luke AFB Form 338 - INSTALLATION ACCESS AFFIDAVIT All other terms and conditions remain unchanged.

INSTALLATION ACCESS AFFIDAVIT

AUTHORITY: 5 U.S.C. 301 Departmental regulations; 10 U.S.C. 113, Secretary of Defense, Note at Pub.L. 106-65; 10 U.S.C. 136, Under Secretary of Defense for Personnel and Readiness; 18 U.S.C. 1029, Fraud and related activity in connection with access devices; 18 U.S.C. 1030, Fraud and related activity in connection with computers; 40 U.S.C. Chapter 25, Information technology management; 50 U.S.C. Chapter 23, Internal Security; Pub.L. 106-398, Government Information Security Act; Pub.L. 100-235, Computer Security Act of 1987; Pub. L. 99-474, Computer Fraud and Abuse Act; E.O. 12958, Classified National Security Information as amended by E.O.13142 and 13292; E.O. 10450, Security Requirements for Government Employees; and E.O. 9397 (SSN).

PRINCIPAL PURPOSE: The records are maintained to support DoD physical security and information assurance programs and are used for identity verification purposes, to record personal property registered with the Department, and for producing facility management reports.

ROUTINE USE: DISCLOSURE WHEN REQUESTING INFORMATION ROUTINE USE: A record from a system of records maintained by this component may be disclosed as a routine use to a Federal, state, or local agency maintaining civil, criminal, or other relevant enforcement information or other pertinent information, such as current licenses, if necessary to obtain information relevant to a component decision concerning the hiring or retention of an employee, the issuance of a security clearance, the letting of a contract, or the issuance of a license, grant or other benefit.

LAW ENFORCEMENT ROUTINE USE: In the event that a system of records maintained by this component to carry out its functions indicates a violation or potential violation of law, whether civil, criminal or regulatory in nature, and whether arising by general statute or by regulation, rule or order issued pursuant thereto, the relevant records in the system of records may be referred, as a routine use, to the appropriate agency, whether Federal, state, local, or foreign, charged with the responsibility of investigating or prosecuting such violation or charged with enforcing or implementing the statute, rule, regulation or order issued pursuant thereto.

DISCLOSURE: Voluntary; however failure to provide complete and accurate information may result in you denied access to Luke Air Force Base.

SPONSOR/AGENCY: PHONE #: PURPOSE FOR PASS:

LAST NAME: FIRST NAME: MI: COMPANY:

Contractor Non Recurring Long Term

DRIVER LICENSE NUMBER: ISSUING STATE: DATE OF BIRTH (mm/dd/yyyy): BIRTHPLACE (City, State): GENDER:

M F

CURRENT STREET ADDRESS (No P.O. Boxes): CITY: STATE: COUNTRY (If outside U.S.):

HAIR COLOR: EYE COLOR: HEIGHT: WEIGHT: U.S. CITIZEN:

YES NO

PASSPORT OR USCIS FORM I-551 NUMBER AND EXPIRATION DATE (If Applicable):

Have you ever been arrested or convicted in any jurisdiction or country of a Misdemeanor or Felony crime (Excluding minor traffic citations)?

YES NO (If you answered yes, please provide a full explanation/year).

The information you provide will be verified through state and federal criminal history record checks:

NOTE TO APPLICANT: Completion of this Installation Access Request Affidavit does not guarantee/validate entry authorization onto Luke Air Force Base. All Contractors must coordinate this affidavit through Sponsoring agency. Long term pass applicants coordinate through Sponsor. Submit this affidavit along with

(1) two forms of identification; One form must be from the DHS Form I-9, List B and the other form can be from either list A or C,

(2) a memorandum from the Sponsoring agency or Sponsor validating need for entry.

Completed package requires a minimum of 3 business days to process. Sponsoring agency or Sponsor will notify applicant when pass is ready for issue.

56 SFS APP. OFFICER: DATE:

APPLICANT SIGNATURE: DATE:

I understand that willfully falsifying this application can result in barment and/or denied access to the installation.

APPROVAL/DENIAL DETERMINATION:

LUKE AFB FORM 338, 20131104

ALL INFORMATION WILL BE PROTECTED IAW PRIVACY ACT 1974, 5 U.S.C. § 552a