A21_W91QVN1600380005.pdf

411TH CSB, KOREA - SERVICE TEAM

POC: MR. KING, ALTON VAN

TEL: (02) 7914-7161

ALTON.V.KING.CIV@MAIL.MIL

APO AP 96205-5289

UNITED STATES OF AMERICA (THE)

0010776047

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

a. The purpose of this amendment is to add Local Clause 5152.204-4032 REPRESENTATIONS, AND CERTIFICATION.

b. Extend solicitation closing date and time to 06 June 2016 1300 (Local Korea Time or 2400 Eastern Daylight Time/EDT).

c. 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 01-Jun-2016

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 W91QVN-16-R-0038

X 9B. DATED (SEE ITEM 11)

19-Apr-2016

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 X is extended, 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

01-Jun-2016

CODE

411TH CONTRACTING SUPPORT BRIGADE, KOREA

RCC YONGSAN, UNIT #15289

APO AP 96205-5289

UNITED STATES OF AMERICA (THE)

W91QVN 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W91QVN

FACILITY CODECODE

EMAIL:TEL:

W91QVN-16-R-0038

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 03-Jun-2016 01:00 PM to 06-Jun-2016 01:00 PM.

The following have been added by full text:

5152.204-4032 REPRESENTATIONS AND CERTIFICATIONS

(a) SUBCONTRACTING:

If the offeror contemplates subcontracting, it must obtain prior written approval of subcontractor from the PCO or ACO, and list below: (1) the names and addresses of the subcontractor(s), (2) the type of subcontracting, and (3) the estimated price for each subcontract.

(b) AFFILIATED OFFERORS:

(1) Business concerns are affiliates of each other when, either directly or indirectly, one concern controls or has the power to control the other, or a third party controls or has the power to control both.

(2) Each offeror shall furnish, below, the following information:

(i) Whether the offeror has any affiliates;

(ii) The names and addresses of all affiliates of the offeror; and

(iii) The names and addresses of all persons and concerns exercising control or ownership of the offeror and any or all of its affiliates, and whether they are common officers, directors, stockholders holding controlling interest, or otherwise.

AFFILIATED CONCERNS. : (Name, location and, in detail, controlling interest in each)

(c) PRINCIPAL OWNER(S) OR STOCKHOLDER(S):

Each offeror shall list below the name(s) and address(es) of the principal owner(s) or stockholder(s) of the company and percentage of ownership. If a major portion is publicly traded and/or otherwise widely distributed, state that, with the percentage so affected.

(d) STANDARDS OF CONDUCT CERTIFICATION:

This is to certify that, to the best of my knowledge and belief, except as described below, no representative of this firm who deals with US Government employees on any aspect of this procurement is a former US Government employee, to include former US military personnel. I understand that this certification is continuing in nature and places a duty on me and my firm to notify the Contracting Officer of any additional individual(s) who fit the above description prior to the individual's assuming duties.

(i) Name ______________________________________________ Former rank/grade ____________________________________ Last US Government position ___________________________

(ii) Name ______________________________________________ Former rank/grade ____________________________________ Last US Government position ___________________________

(iii) Name ______________________________________________ Former rank/grade ____________________________________ Last US Government position ___________________________

Firm ____________________________________________________ Name _____________________________________________________ Signature __________________________________________________

Title _____________________________________________________ Date of Execution ____________________________________________

(e) TAXES:

(1) References:

(i) Contract clause entitled "FAR 52.229-06 Taxes—Foreign Fixed-Price Contracts (Jan 1991)."

(ii) US-ROK Status of Forces Agreement (SOFA), Articles IX and XVI.

(iii) ROK Customs Law, Law No. 1976, promulgated on 29 November 1967, as amended.

(iv) ROK Value Added Tax Law, Law No. 2934, promulgated on 22 December 1976 (effective date 1 July 1977), as amended.

(v) ROK Special Excise Tax Law, Law No. 2935, promulgated on 22 December 1976 (effective date 1 July 1977), as amended.

(2) Contractor shall state the types and estimated amount of taxes that would normally apply to such transactions but are excluded from this proposal.

(i) Customs Tax (except for ROK MND-funded contracts or delivery orders):

Name Number Cost/Unit of Item of Units w/o Tax % of Tax Tax/Unit Tax Total

This item will be imported specifically for this contract? Yes _____ No _____

(ii) Special Excise Tax:

Name Number Cost/Unit of Item of Units w/o Tax % of Tax Tax/Unit Tax Total

Name of item manufacturer

(iii) Value Added Tax (VAT):

Input VAT on materials purchased for this contract. 10% _____ Input VAT on transportation leased/rented for this contract.10% _____ Input VAT on equipment leased/rented for this contract. 10% _____ Input VAT on services purchased for this contract. 10% _____ Output VAT on total contract amount. 10% _____

(iv) Special Excise (Petroleum) Tax:

No. of U/P Liters w/o Tax Tax/Unit Total Tax Amount Regular Gasoline ________ (L) ________ w________ w_____________ Premium Gasoline ________ (L) ________ w________ w_____________ Diesel ________ (L) ________ w________ w_____________ Other ________ (L) ________ w________ w_____________

(v) Education Tax.

(3) Name of the oil company from which POL products will be purchased:

Oil Company: _________________________________________ (Name only)

(4) I certify by this submission that all supplies and services to be purchased for this contract have been proposed exclusive of Value Added Tax, applicable Customs Tax (except ROK MND-funded contracts and delivery orders), Special Excise Tax, and Education Tax.

Signed (Chop)

(f) CERTIFICATIONS AND REPRESENTATIONS

By submitting an offer, each offeror agrees to be bound by all certifications and representations in this solicitation.

The Government reserves the right to require any and all certifications and representations to be completed and signed in hard copy by the successful offeror prior to contract award. Failure of an offeror to complete the certifications and representations within the time directed by the Contracting Officer may result in a determination that the contractor is not a responsible offeror for this acquisition.

(End of Summary of Changes)