CONTRACT AMD RE HANSENS DISEASE WITH NATL HANSENS DISEASE.PDF

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)
0004 01/01/2015 HRS147093
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: $10,185.00
..2015.3280075.25627
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
X ORDER NO. IN ITEM 10A.
FAR 52.217-9 - Option to Extend the Term of the Contract (MAR 2000)
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 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 exercise Option Period Two for a three-month period
(January 1, 2015 - March 31, 2015).
1. Pursuant to the option provision set forth in subject contract, the Government hereby
exercises Option Period Two for the period of January 1, 2015 through March 31, 2015.
2. The total estimated cost of this contract is $176,596.00.
3. The total obligated amount is increased by the sum of $10,185.00 from $53,141.00 to
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)
DIANE L. COGER
15B. CONTRACTOR/OFFEROR 15C. DATE SIGNED 16B. UNITED STATES OF AMERICA 16C. DATE SIGNED
Electronically Signed 12/30/2014
(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/0004 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)
$63,326.00.
4. 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 and $10,185.00 for the period
January 1, 2015 - March 31, 2015. For further
provisions on funding, see Limitation of Costs
clause (FAR 52.232-20).
5. The Contracting Officer may allot additional
funds to the contract without concurrence of the
contractor.
6. Section B.2., Period of Performance, is hereby
changed to read September 1, 2013 through March
31, 2015.
Contracting Officer Representative (COR):
Irma E. Guerra, BSN, MPH
Director, Ambulatory Care
National Hansen's Disease Program
1770 Physician Park Drive
Baton Rouge, LA 70816
Telephone: 1-800-642-2477
Fax: 225-756-3806
Email: IGuerra@hrsa.gov
Contracts Office Point of Contact:
Charisse Whitney
National Hansen's Disease Program
1770 Physician Park Drive
Baton Rouge, LA 70816
Telephone: 225-756-3785
Fax: 225-756-3786
LIST OF CHANGES:
Reason for Modification : Exercise an Option
Period Of Performance End Date changed from
2014-12-31 00:00:00 to 2015-03-31 00:00:00
New Total Amount for this Version: $10,185.00
New Total Amount for this Award: $146,041.00
Obligated Amount for this Modification: $10,185.00
New Total Obligated Amount for this Award:
$63,326.00
End Date changed from 2015-12-31 00:00:00 to
2015-03-31 00:00:00
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/0004 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)
Exercised option
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.: 2015 CAN: 3280075 Object Class: 25627
FOB: Destination
Period of Performance: 09/01/2013 to 03/31/2015
NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)
Sponsored by GSA
FAR (48 CFR) 53.110

C-86-14-016-3-04 ATTACHED TO AND A PART OF
CONTRACT AMENDMENT/MODIFICATION 00004
CONTRACT NO. HHSH258210300005C
IN WITNESS WHEREOF, the parties agree to enter into this Contract and its
Amendments:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date