HANSENS WITH CLIN MOD 0011 (11).PDF

1. CONTRACT ID CODE PAGE OF PAGES
AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT
x4 rA.
l 1
2. AMENDMENTIMODIFICATION NO. a EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (if applicable)
0011 07/01/2017 HRS199345
6, ISSUED BY CODE miDp 7. ADMINISTERED BY Of other than item 6) CODE
HRSA/OAMP/NHDP
Office of Acquisition
Management and Policy
National Hansens Disease Program
Baton Rouge LA 70816
8. NAME AND ADDRESS OF CONTRACTOR (Na., street, county, Stets end ZIP Code) 9A AMENDMENT OF SOLICITATION NO.
(4
30UNTY OF MARICOPA 151577
1ARICOPA, COUNTY OF 1645 E ROO 913. DATED (SEE ITEM 11)
_645 E ROOSEVELT
?HOENIX AZ 850063638
10A. MODIFICATION OF CONTRACT/ORDER NO.
X HHSH258201300005C
C . 0 RO . "
?;16 .L1 . 10B. DATED (SEE ITEM 13)
CODE 151577 FACILITY CODE 02/27/2013
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
n The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers Lie extended. Li is riot 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 YOURACKNOVVLEDGEMENT 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 data specified.
12. ACCOUNTING AND APPROPRIATION DATA (ff required) Net Increase: $20,790.00
2017.3280075.25627
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 FURS LIANTTO: (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 SUP PLEMENTALAGREEMENT IS ENTERED INTO PURSUANTTO AUTHORITY OF:
D. OTHER (Specify type of modification and authority)
X FAR 52.217-9 Option to Extend the Term of the Contract
E. IMPORTANT: Contractor CE s not. CI is required to sign this document and return 0 copies to the issuing office.
14. DESCRIPTION OF AMENDMENT1MODIFICAT1ON (Organized by iJCF section headings, including solicitation/contract subject matter where feasible.)
Tax ID Number: 86-6000472
DUNS Number: 602062515
The purpose of this modification is to obligate funding in the amount of $20,790.00 for the
remaining six (6) months (July 1, 2017 through December 31, 2017), of option period four
(January 1, 2017 through December 31, 2017).
1. The total price of this contract is $177,782.00.
2. The total obligated amount is increased by the sum of $20,790.00 from $156,992.00 to
$177,782.00.
Continued ...
Except as provided herein, all terms and conditions of the document referenced in Item 9 A or 10A, as heretofore changed, remains unchanged and in full force and effect.
15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)
Ste. C JENNIFER M. LOHMEIER ,
i` ,,„... ‘,...."kAANL- \01.0C.1.—.
1513. CONTRACTOR/ F ROR 15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 16C. DATE SIGNED
...,......m.
Jennifer M. LOhMelef -S
4 One lelne70.4.-trutl
(Signature of parson au/ho ? 3sign) , (Signature of CentradIng oared
NSN 7540-01-152-8070 STANDARD FORM 30 (REV. 10-83)
Previous edition unusable Prescribed by GSA
FAR (48 CFR) 53.243

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE
CONTINUATION SHEET
HE3H2582013000050/0011 2 °1/44
NAME OF OFFEROR OR CONTRACTOR
COUNTY OF MARICOPA 151577
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
(A) (B) (C) (D) (E) (El
3. The total funds currently available for
payment and allotted to this contract are
$12,836.00 for the period of September 1, 2013
through December 31, 2013; $10,076.25 for the
period January 1, 2014 through March 31, 2014;
$30,228.75 for the period April 1, 2014 through
December 31, 2014; $10,185.00 for the period
January 1, 2015 through March 31, 2C15;
$30,555.00 for the period April 1, 2015 through
December 31, 2015; $10,283.75 for the period
January 1, 2016 through March 31, 2016;
$32,037.25 for the period April 1, 2016 through
December 31, 2016; $6,930.00 for the period
January 1, 2017 through February 28, 2017;
$6,930.00 for the period March 1, 2017 through
April 30, 2017; $6,930.00 for the period May 1,
2017 through June 30, 2017 and $20,790.00 for the
period July 1, 2017 through December 31, 2017.
4. Section B.2., Period of Performance, is hereby
changed to read September 1, 2013 through
December 31, 2017.
This is a Firm Fixed Price contract.
Delivery Location Code: NHDP/AC
NHDP/AC
1770 Physicians Park Drive
Baton Rouge LA 70816 US
Payment:
NHDP/FMO
1770 Physicians Park Drive
Financial Management Office
Baton Rouge LA 70816
Appr. Yr.: 2017 CAN: 3280075 Object Class: 25627
FOB: Destination
Period of Performance: 01/01/2017 to 12/31/2017
12 NHDP 183 C 1886 Add funding for July 1, 2017 - 20,790.00
December 31, 2017
Obligated Amount: $20,790.00
Contracting Officer Representative (OCR):
Mary P. Dudley RN, MSN, CNS
Telephone: 225-756-3718
Email: mdudley@hrsa.gov
Continued ...
NON 7540-01-152 8067 OPTIONAL FORM 336 (4-86)
Sponsored by GSA
FAR (48 CFR) 53.110

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE
CONTINUATION SHEET
HHSH25820120DOG5C/C011 3
NAME OF OFFEROR OR CONTRACTOR
COUNTY OF MARICOPA 151577
ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
(A) (B) (C) (D) (E) (F)
Contracts Office Point of Contact:
Charisse Whitney
Telephone: 225-756-3785
Email: cwhitney@hrsa.gov
,
NON 7640-01-152 8067 OPTIONAL FORM 338 (4.86)
Sponsored by GSA
FAR (48 CFR) 53,110

Page 4 of 4
ATTACHED TO AND A PART OF:
Modification 0011 to National Hansen's Disease Program
HHSH258201300005C
C-86-14-016-3-11
1N WITNESS WHEREOF, the parties agree to enter into this Agreement and its Amendments:
FOR AND ON BEHALF
OF MARICOPA COUNTY
By
Denny Barney, Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date