AMENDMENT RE HANSENS DISEASE WITH HRSA.PDF

St2 OLtQ 3 OA
AMENDMENT OF SOLICITATION/MODIRCATiON OF CONTRACT F. CONTRACT ID DODE PAGE OF PAGES
I 1 3
2. AMENDMENTIMODIFICATION NO. 3. EFFECTIVE DATE 4. REQUISiTIOMpURCHASE. Reg. NO. S. PROJECT NO. (I1 appacatfo)
0003 01 /01 /2014 HRS129577
8. ISSUED BY CODE NH OP 7. ADMINISTERED BY (loltrar than dome) CODE
HRSA/OAMP/NHDP
Office of Acquisition
Management and Policy
National Hansens Disease Program
Baton Rouge LA 70816
6. NAME AND ADDRESS OF CONTRACTOR (Na. Ones, cooly Wale enPZlP Com 9A. AMENDMENT OF SOLICITATION NO
COUNTY OF MARICOPA 151577
KARICOPA, COUNTY OF 1645 E BOO 93. DATED (SEE irEm 11)
1645 E ROOSEVELT
PHOENIX AZ 850063639
ashillOghlcidiN3 ,r0C00oNgTCTIORFIER NO.
103. DATED (SEE ITEM 23)
COD 151577 FAcitsrf CODE 08/27/2013
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITARONS
0 The above numbered sole:Balton is amended en set forth In Sera 14. The hour end date spieled ter reeeIpt 04 Wars be extended, ON riot skeet:led
Offers must acynowisdse receipt ot this amend/dant prior to Ma hoof and date spedied In Ole sett -citation dr on areendod, by one sins rationing methods: /11 ararn.p1B14-G
Rems 0 and 15, and Warning copies of the amendment Nay Ey ackncenledging receipt of this amendment on each copy of ther offer subm1114 or (s) By
separate tetter or telegram which treutas a reference to 1,tva solicitation and amendment numbers . FAILURE OF YOUR ACKNOWLEDGEINEAff TO BE RECEIVED AT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUEI OFFER. II by
virtue 51 010 amendment you desire to chanae an Otter already 51)61 -n5/ad, such chanve may be made by telegram et Lathy, fafoatctad each telegram ar Mbar snakes
. tordienc7) to the sotteliallon and this amendment, and Is received prior to the opening hoer end data seeetTesd,
12. ACCOUNTING AND APPROPRIATION DATA Of required) Net Increase: $30,229.75
2014.3280075,25627
02, nos vrem ONLY APPLIES TO MODIFICATION OF corrmAcrsonoess. IT MODIFIES THE CONTRACT/ORDER ND. AS DESCRLLIED IN ITEM 14,
01i6c)c 0145 A THIS CHANGE ORDER 15 ISSUED PURSUANT TO: (Specify authartlyi THE CHANGES SET FORTH N ITEM 14 ARE MADE IN THE CONTRACT
X ORDER NO. IN ITEMTCA.
FAR 52.217-9 — Option to Extend the Term of the Contract (MAR 2000)
B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIE0 TO REELECT THE ADMINISTRATNE CHANGES (such as cizaagss he paying office,
appropriation dale, sic.) SET FORTH IN ITEM 14, PURSUANTTC) THE AUTHOR ry FAR 43,103N,
C. THIS SUPPLEMENTAL ACIREM ENT IS ENTERED INTO PURSUANT TO AUTHORITY CE:
0. OTHER (Speen,/ (vpo si csoddiceuisn and et/Manly)
E. IMPORTANT; Contractor Oh not. 0 is required to sign thts *cement and return 0 copies to the is4u1n9 off1cen.
14. DESCRIPTION OF AMENOMENT/MODIMATION (0,Varsizocl by 1.10,P secfian haaang$, including WicaStioratontract aul,Yoat metier where feasible.)
Tax ID Number: 86-6000472
DONS Number: 602062515
The purpose of this modification is to exercise remaining nine (9) months for Option Period
one (April 1, 2014 through December 31, 2014).
2. Pursuant to the option provision set forth in subject contract, the Government hereby
exercises the remaining nine (9) months for Option Period One for the period of April 1,
2014 through December 31, 2014.
2. The total estimated cost of this contract is $176,596,00.
Continued
Except as provided herein, ail leans and cordlIons of the document (stemmed h hers 3A or 104, as heretofore charged, ramaln3 unc,1-wigeri end In foli tome and adact.
15A. NAME AND TITLE OF SIGNER (Type orprint) lea. NAME AND RILE OF CO TRACTNG OFFICER /Typo arprtn9
DIANV Sc, CODER
156, CONTRACTOR/OFFEROR 15C. DATE SIGNED 1E6. 1,41 EDE TES0FtRbCA 16C. OATE SIGNED
I
(Clonaivre apes.; Whodvid la sipn) 1Sivn.Wre of C.nirn);)0(4sed
NSN 7540.01.152,0070 STANDARD FORM 30 (REV. 10-531
Previous eann unbseble Prescribed by GSA
EAR (45 CFR) 53243

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF
CONTINUATION SHEET
HE3H258201300005C/0003 2
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 obligated amount is increased by the
sum of $30,228.75 from $22,912.25 to $53,141.00.
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 and
$30,228.75 for the period April 1, 2014 through
December 31, 2014. 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
December 31, 2014.
Contracting Officer Representative (COR):
Irma E. Guerra, NSF, MPH
Director, Ambulatory Care
National Eansen's Disease Program
1770 Physician Park Drive
Baton Rouge, LA 70816
Telephone: 1 - 800 - 642 - 2477
Fax: 225 - 756 - 3806 .
Email: 1Guerra@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 CHANCES:
Reason for Modification : Exercise an Option
Period Of Performance End Date changed from
2014 - 03 - 31 .00:00:00 to 2014 - 12 - 31 00:00:00
Delivery Location Code: NHDP/ADM/CONTRACTS
National Hansen's Disease Program A
1770 Physicians Park Drive
Baton. Rouge LA 70816 US
Continued ...
NSN 7540-01-152 8067 OPTIONAL FORM 336 0-86)
Sponsored by GSA
FAR 145 CFR) 53.110

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF
E1-1SH2582013000050/0003 3
NAME OF OFFEROR OR CONTRACTOR
COUNTY OF MARICOPA 151577
ITEM NC. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT
(A) (5) (C) (0) (E) (F)
Payment:
NODP/FM0
1770 Physicians Park Drive
Financial Management Office
Baton Rouge LA 70816
Appr. Yr.: 2014 CAN: 3280075 Object Class: 25627
FOB: Destination
Period of Performance: 09/01/2013 to 12/31/2014
6 NHDP 181 C 1886 Exercise remaining nine (9) 30,228.75
months for Option Period One (April 1, 2014
through December 31, 2014)
Obligated Amount: $30,228.75
NSN 7540-01-152 8067 OPTIONAL FORM 336 (4-50}
Sponsored by GSA
FAR (SE CnR1 53.115

C-86-14-016-3-02 HRSA Amendment
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Maricopa County
Date