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C-VAe-H- ot t coNTRACTIDGODE PAGE OF PAGES AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1 i 3A_ 2. AMENDMENFTIMODWATION NO. 3. EFFECTIVE DATE 4, REQUISITION/PURCHASE REQ. NO. a PROJECT Na (if applicable) 0007 03/29/2016 HRS172863 6. ISSUED BY CODE NHD p 7. ADMINISTERED BY Of other than ltem 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, sounbr, State anti ZIP Curie) 9A_ AMENDMENT OF SOLICITATION NO. M 170UNTY OF MARICOPA 151577 CARICOPA, COUNTY OF 1645 E ROC 9B. DATED (SEE nEm I/ ) 645 E ROOSEVELT ,HOENIX AZ 850063638 .„ iwoMODIFICATION OF CONTRACT/ORDER NO. -' HHS5i2582013000050 1MDKMD(SEEITEM12) CODE 152577 HOMY CODE 08/27/2013 11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS OThe above numbered solicitation is amended as set forth In Item 14. The hour and date specified for receipt of Offers O s extended, pis not extended. Offers must acknowledge receipt of this amendment prior to the hour arid 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: $32,037.25 2016.3280075.25627 13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS. IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14. oHEoK 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: X FAR 52.243 - 1 Changes - Fixed Price D. OTHER (Specify type of modification and authority) E. IMPORTANT: Contractor o is not. El 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.) Tax ID Number: 86-6000472 DUNS Number: 602062515 The purpose of this modification is to: 1. Add funding in the amount of $30,851.25 for the remaining nine (9) months of Option Period Three (April 1, 2016 through December 31, 2016). 2. Revise the Statement of Work and add funding in the amount of $1,186.00 for new Task 12 for NHDP Physicians Meeting in Carville, LA on April 16 - 17, 2016. 3. Change the Contracting Officer (CO) who is assigned to this contract from: Diane Coger to: Jun Ji; Phone (301) 945-9484; Email jji@hrsa.gov . 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 forte and effect, 15A, NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print) JUN JI 158. CONTRACTOR/OFFEROR 150. DATE SIGNED 1813. UNITED STATES OF AMERICA 16C. DATE SIGNED • `."));.-°•gM'''' ." Jun Ji -S 28 Mar 2016 (Signature a! person authorized to sign) (Signature Ole"O'riiiZiing.-Of•ficer) NSN 7540-01-152-6070 STANDARD FORM 30 (REV. 10-831 Previous edition unusable Prescribed by GSA FAR (48 CFR) 53,243 I REFERENCE NO. OF DOCUMENT BENG CONTINUED pAGE OF CONTINUATION SHEET NAME OF OFFEROR OR CONTRACTOR COUNTY OF MARTCOPA 151577 ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT (A) (B) (C) (D) (E) (F) 4. Change the Contracting Officer Representative (COR) who is assigned to this contract from: Irma Guerra to: Mary P. Dudley; Phone (225) 756-3718; Email mdudley@hrsa.gov . This is a Firm Fixed Price contract. 5. The total cost of this contract is $177,782.00. 6. The total obligated amount is increased by the sum of $32,037.25 from $104,164.75 to $136,202.00. V. 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 and $32,037.25 for the period April 1, 2016 through December 31, 2016. 8. Section B.2., Period of Performance, is hereby changed to read August 1, 2013 through December 31, 2016. Delivery Location Code: NHDP/AC NHDP/AC 1770 Physicians Park Drive Baton Rouge LA 70816 US Payment: NHDP/FM0 1770 Physicians Park Drive Financial Management Office Baton Rouge LA 70816 Appr. Yr.: 2016 CAN: 3280075 Object Class: 25627 FOB: Destination Period of Performance: 01/01/2016 to 12/31/2016 9 Travel funds for NHDP Physicians Meeting 1,186.00 Obligated Amount: $1,186.00 NSN 7540.01-182 8067 OPTIONAL FORM 336 (4.36) Sponsored by GSA FAR (46 CFR) 53.110 Page 3 of 3 ATTACHED TO AND A PART OF: Modification 0007 to Hanson's Disease Contract HHSH258201300005C C-86-14-016-3-07 IN WITNESS WHEREOF, the parties agree to enter into this Agreement and its Amendments: FOR AND ON BEHALF OF MARICOPA COUNTY By Clint Hickman, Chairman, Board of Supervisors Date ATTEST: Clerk of the Board Date APPROVED AS TO FORM: Attorney for Maricopa County Date 2