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1. CONTRACT ID CODE PAGE OF PAGES AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1 3 2. AMENDMENT/MODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable) 0009 03/01/2017 HRS192174 6. ISSUED BY CODE NHDP 7. ADMINISTERED BY (If 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 (No., street, county, State and ZIP Code) 9A. AMENDMENT OF SOLICITATION NO. (x) COUNTY OF MARICOPA 151577 MARICOPA, COUNTY OF 1645 E ROO 9B. DATED (SEE ITEM 11) 1645 E ROOSEVELT PHOENIX AZ 850063638 10A. MODIFICATION OF CONTRACT/ORDER NO. x HHSH258201300005C 10B. DATED (SEE ITEM 13) CODE 151577 FACILITY CODE 08/27/2013 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 ACKNOWLEDGEMENT 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) Net Increase: $6,930.00 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 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) X FAR 52.217-9 Option to Extend the Term of the Contract E. IMPORTANT: Contractor x is not, is required to sign this document and return __________________ 0 copies to the issuing office. 14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF 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 $6,930.00 for two (2) months (March 1, 2017 through April 30, 2017), for option period four (January 1, 2017 through December 31, 2017). Funding for the remaining portion of option period four shall only be obligated once a new continuing resolution or budget is authorized. 1. The total price of this contract is $177,782.00. 2. The total obligated amount is increased by the sum of $6,930.00 from $143,132.00 to $150,062.00. Continued ... 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) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print) RUSSELL J. GRABILL 15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 16C. DATE SIGNED Digitally signed by Russell J. Grabill -S Russell J. Grabill -S DN: c=US, o=U.S. Government, ou=HHS, ou=HRSA, ou=People, 0.9.2342.19200300.100.1.1=2001799083, cn=Russell J. Grabill -S Date: 2017.02.17 14:08:19 -05'00' 02/17/2017 (Signature of person authorized to sign) (Signature of Contracting Officer) 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 OF CONTINUATION SHEET HHSH258201300005C/0009 2 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) 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, 2015; $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 and $6,930.00 for the period March 1, 2017 through April 30, 2017. 4. Section B.2., Period of Performance, is hereby changed to read September 1, 2013 through April 30, 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 10 NHDP 183 C 1886 Add funding for March 1, 2017 - 6,930.00 April 30, 2017 Obligated Amount: $6,930.00 Contracting Officer Representative (COR): Mary P. Dudley RN, MSN, CNS Director of Nursing Telephone: 225-756-3718 Email: mdudley@hrsa.gov Continued ... NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86) Sponsored by GSA FAR (48 CFR) 53.110 REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF CONTINUATION SHEET HHSH258201300005C/0009 3 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 NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86) Sponsored by GSA FAR (48 CFR) 53.110