W912QR24Q0041 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

Solicitation W912QR24Q0041 for cleaning at Rough River Lake is hereby modified as follow s:

****Amendment 0001 Start *** The Past Performance Forms that are to be filled out and turned in w ith your package are now included. The due date of 26 March 2024 has not been changed ***

***Amendment 0001 End***

1. CONTRACT ID CODE PAGE OF PAGES

1 1

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

16C. DATE SIGNED

BY

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 W912QR24Q0041

X 9B. DATED (SEE ITEM 11)

11-Mar-2024

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.

U0001

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

22-Mar-2024

CODE

U. S. ARMY ENGINEER DISTRICT, LOUISVILLE

600 DR. MARTIN LUTHER KING, JR. PLACE

ROOM 821

LOUISVILLE KY 40202-2239

W912QR 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE

See Item 6

FACILITY CODECODE

EMAIL:TEL:

Offeror Statement Of Contract/Work Experience

Note: Exhibit E forms must be completed and submitted as part of the Offeror’s Quote.

OFFEROR’S STATEMENT OF CONTRACT/WORK EXPERIENCE AND PERFORMANCE

SOLICITATION No: _____________________________________ for Cave Run Lake

Offeror’s Name:

Phone Number:

Address:

1. In the spaces provided below, please list up to five references for which you have performed work that is similar to the specified services contained in this solicitation.

Name of Company Name of Person to Contact Current Phone No.

(1) ( )

(2) ( )

(3) ( )

(4) ( )

(5) ( )

2. Use the “Offeror’s Statement of Contract/Work Experience” forms on the following pages to provide details about your business/work experience.

*** Below is an example of the information requested ***

TYPE of WORK: Mowing, Maintenance & Office Cleaning Services

CONTRACT NO. (IF GOVT.): DACW27-M-01-0000

DOLLAR VALUE: $34,500.00

AGENCY/FIRM FOR WHICH WORK WAS PERFORMED: U.S. Army Corps of Engineers CONTRACT ADMINISTRATOR AT THE SITE: Jane Doe, Park Manager

CONTRACT ADMINISTRATOR’S PHONE NUMBER: 502/477-8882

JOB SITE: Cave Run Lake, Cave Run, KY MO./YR. WORK BEGAN: April 2002 MO./YR. ENDED: December 2004 BRIEF DESCRIPTION OF CONTRACT DUTIES: Mowed recreation areas (22 acres) using riding and push mowers and weedeaters. Mowed downstream slope of dam using tractor and bush hog. Picked up garbage in 5 recreation areas; cleaned tables, grills, and firerings. Cleaned office and restrooms. All work was completed in accordance with contract specifications; no payments were withheld. Used a 5-person crew to accomplish this work. Managed contract and supervised workers during entire contract term.

EXAMPLE

OFFEROR’S STATEMENT OF CONTRACT/WORK EXPERIENCE

SOLICITATION No: _____________________________________ for Cave Run Lake

2. Please List Your Business/Work Experience:

Business/Work Experience No.:

YOUR or COMPANY’S NAME:

NAME USED DURING CONTRACT (if different):

TYPE of WORK:

CONTRACT NO. (IF GOVT.):

DOLLAR VALUE: $

AGENCY/FIRM FOR WHICH WORK WAS PERFORMED:

CONTRACT ADMINISTRATOR AT THE SITE:

CONTRACT ADMINISTRATOR’S PHONE NUMBER:

JOB SITE:

MO./YR. WORK BEGAN: MO./YR. ENDED:

BRIEF DESCRIPTION OF CONTRACT DUTIES:

Attach Additional Sheets if Necessary – Form May Be Copied to List Additional Experiences

2. Please List Your Business/Work Experience:

Business/Work Experience No.:

YOUR or COMPANY’S NAME:

NAME USED DURING CONTRACT (if different):

TYPE of WORK:

CONTRACT NO. (IF GOVT.):

DOLLAR VALUE: $

AGENCY/FIRM FOR WHICH WORK WAS PERFORMED:

CONTRACT ADMINISTRATOR AT THE SITE:

CONTRACT ADMINISTRATOR’S PHONE NUMBER:

JOB SITE:

MO./YR. WORK BEGAN: MO./YR. ENDED:

2. Please List Your Business/Work Experience:

Business/Work Experience No.:

YOUR or COMPANY’S NAME:

NAME USED DURING CONTRACT (if different):

TYPE of CONTRACT WORK:

CONTRACT NO. (IF GOVT.):

DOLLAR VALUE: $

AGENCY/FIRM FOR WHICH WORK WAS PERFORMED:

CONTRACT ADMINISTRATOR AT THE SITE:

CONTRACT ADMINISTRATOR’S PHONE NUMBER:

JOB SITE:

MO./YR. WORK BEGAN: MO./YR. ENDED:

KEY PERSONNEL QUALIFICATIONS

SOLICITATION No: _____________________________________ for Cave Run Lake

3. Please Provide Details about the Qualifications of Key Personnel:

Key Personnel No.:

YOUR or COMPANY’S NAME:

KEY PERSONNEL (PERSON’S NAME):

POSITION TITLE:

NUMBER OF YEARS EMPLOYED:

EDUCATION LEVEL AND DEGREE (if any):

APPLICABLE LICENSES, PERMITS, CERTIFICATIONS:

Description of Key Personnel Experience, Knowledge, Skills and Abilities:

Attach Additional Sheets if Necessary – Form May Be Copied to List Additional Key Personnel

KEY PERSONNEL QUALIFICATIONS

3. Please Provide Details about the Qualifications of Key Personnel:

Key Personnel No.:

YOUR or COMPANY’S NAME:

KEY PERSONNEL (PERSON’S NAME):

POSITION TITLE:

NUMBER OF YEARS EMPLOYED:

EDUCATION LEVEL AND DEGREE (if any):

APPLICABLE LICENSES, PERMITS, CERTIFICATIONS:

Description of Key Personnel Experience, Knowledge, Skills and Abilities:

Attach Additional Sheets if Necessary – Form May Be Copied to List Additional Key Personnel