W91YTZ19R0025_Amendment_1.pdf

W40M RHCO-ATLANTIC USAHCA

WOMACK ARMY MEDICAL CENTER

POC: NAOMI R. WILLIAMS

BLDG 4-2817 REILLY RD

FORT BRAGG NC 28310

0011272769-0003

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 reason for the amendment is to correct an administrative error in w hich appendix D Past Performance Questionnnaire w as left out of the solicitation, this amendment adds the PPQ to the solicitation as show n on the summary of changes. b. All other fators remain the same and 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-Mar-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 W91YTZ19R0025

X 9B. DATED (SEE ITEM 11)

28-Feb-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 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-Mar-2019

CODE

W40M RHCO-ATLANTIC USAHCA

NORTHERN REG CONTR OFC NRCO

6021 5TH ST BLDG 1467

FORT BELVOIR VA 22060-5580

W91YTZ 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W91YTZ

FACILITY CODECODE

EMAIL:TEL:

W91YTZ19R0025

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

The following have been added by full text:

APPENDIX D

PAST PERFORMANCE SURVEY QUESTIONNAIRE – Attachment 6 Hello:

The offeror has identified you as a reference to validate the offeror’s past performance. Past Performance is an important part of the evaluation criteria for this acquisition, so your input is very important. Please respond no later than the closing of the solicitation date and time to Ms. Naomi Williams by email:

naomi.r.williams8.civ@mail.mil.

Handwritten responses are sufficient. If you need more space than that provided, please attach additional pages. If contractor has held more than one contract with you, please note the information. Responses will be treated as "source selection sensitive information."

Contract Identification:

A. CONTRACTOR: ________________________________________________________

CONTRACT NUMBER: __________________________________________________

DELIVERY ORDER(s) (if applicable) _______________________________________

PERIOD OF PERFORMANCE:

__________________________ OPTIONS_________

TOTAL CONTRACT AMOUNT: $______________________________________________

DESCRIBE SERVICES acquired. Please include number and type of providers:

____________Competed? ___ Yes ___ No Type of Contract: Negotiated ________ Sealed Bid ________ Fixed Price ________

Other (specify) _________ Complexity of Work: __________ Difficult Routine _____________ Explain: ______________________________________________________________________ B. Please provide name, title, address and phone number of the person completing this questionnaire.

Name___________________________________________________________________ Title ________________________________________________________________________ Company/Government Address ___________________________________________________________

Phone: ______________________ Ext # ______________ Email Address: _________________________________________________________________________

Is there anyone else we should send this questionnaire to? Please identify by name, organization and phone number.

Past Performance Survey Questionnaire

C. ASSESSMENT ELEMENTS. The following begins the survey questionnaire on Offeror’s (Contractor) performance. Based on definitions at the end of the questionnaire, please assess offeror's performance regarding:

Offeror: _____________________________________Contract Number__________________________

1. Quality of Service. Assess the offeror's conformance to contract requirements, specifications, and standards of good workmanship. Did the service meet the required level of quality.

Performance Rating _______________________ Risk Factor Rating (H) (M) (L) (U) Reason

2. Schedule. Assess the offeror's adherence to contract schedules, including administrative aspects of performance, timeliness of completion of the contract, milestones, delivery schedules, administrative requirements.

Reason_____________________________________________________________

3. Business Relations. Assess the integration and coordination of all activity needed to execute the contract, specifically the timeliness, anticipation of problems, completeness and quality of problem identification, corrective action plans, the offeror's history of reasonable and cooperative behavior in resolving issues, commitment to customer satisfaction, and management of subcontracts (if any).

Reason______________________________________________________________

4. Key Personnel. Assess the offeror's performance, experience in management, in retaining, supporting, and replacing, when necessary, key personnel.

Reason _________________________________________________________________

5. Offeror's Cost Control. Did the contractor deliver at the agreed-to price/cost? Describe the reasons for changes to contract value (e.g., scope changes, overrun/under run, government-imposed schedule changes, etc.)

Reason _________________________________________________________________

6. Any reservations about recommending a future contract award to this offeror? No ___ Yes___, Why?

(good business relations, very organized, very responsive, etc.)

(End of Summary of Changes)