AMENDMENT RE TREATMENT OF HANSENS DISEASE WITH NATIONAL HANSENS DISEASE PROGRAM.PDF

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE PAGE OF PAGES
2, AMENDMENT/MODIFICATION NO, 3. EFFECTIVE DATE 4. 1 1 3
REQUISITION/PURCHASE REQ NO, , !! 5, PROJECT NO. (If applicable)
0001 01/01/2014 HRS124755
D. ISSUED BY
CODE NHDP T. ADMINISTERED BY Of other lhan ilem 0) i.• CODE I
HRSA/OAMP/NHDP
Office of Acquisition ,
Management and Policy , •
National Hansens Disease Program
Baton Rouge LA 70816 .
8, NAME AND ADDRESS OF CONTRACTOR (Aro., steer, county, Slate and ZIP Code) 00 9A, AMENDMENT OF SOUCITATION: NO.•: ;
2.0UNTY OF MARICOPA 151577 ' . r 2:
4ARICOPA, COUNTY OF 1645 E ROO 9B. DATED (SEE /TErNf
L645 E ROOSEVELT
?HOENIX AZ 850063638 ' , 3
, iialsnitiofficron8F0e00071ACT1ORDER NO. •
; : ' f : . • . : ' '
10B, DATED (SEE ITEM 13)
CODE 151577 FACILITY CODE
08/27/2613'
11.-f HIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
0 The above numbered solicitation is amended as set forth In Hem 14. The hour and date 3pecried for receipt of Offers , .„ D 3 extended.
Offers must acknowledge receipt of this amendment pilot to the hour and date specified In the solicitation or as amended, by one of the fallowing methods: (a) By Die not extended.
Items 8 and 15, and returning copies of the amendment (b) By acknowledging receipt of this amendment on each copy of the . offer submitted; completing or (a) By
separate letter or telegram which includes a reference M the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED
THE PLACE DESIGNATED FOR THE RECEIPT Or OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION. OF:YOUR OFFER: if AT by
virtue of this amendment you desire lo change en offer already submitted, such change may be made by telegram or letter, provlded 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(1/ required) 1.: • !,,,
..2014.3280075.25627 Net IncreaSe: $10,076'...2t
13, THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS, IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.
CHECK X ONE A. THIS ORDER CHANGE NO. IN ITEM ORDER 10A. IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
FAR 52.217 -9 — Option to Extend the Term of the Contr46t (MAR: 2000)
B. THE appropriation ABOVE NUMBERED dale, eta) SET CONTRACT/ORDER FORTH IN ITEM 14, IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office,
PURSUANT TO THE AUTHORITY OF FAR 43.103(b). ,
C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:
• : r• '• • .
O. OTHER (Specify type of modification and authority) I T
. ,
•
E. IMPORTANT: Contractor Fits not, Din required to sign this document and return copies to the issuing office,
14. DESCRIPTION OF AMENDMENT1MODIFICATION (agonized by UCF section headings, Including sericite gen/contract striziect matter whena'aMe.)
Tax ID Number: 86-6000472 11. • •
DUNS Number: 602062515
The purpose of this modification is to exercise Option Period One , forge three-month
period,
1. Pursuant to the option provision set forth in subj.ett!lcontr,:t4..q0ihnMOn
-( -:hereby
exercises Option Period One for the period of January 1,r2014 throug04arch,31, 2014.
1. The total estimated cost of this contract is $176,59600.-
2. The total obligated amount is increased by the sum of $10,,076.12.5 r • t. '
from0.2,836.00 to
$22,912.25.
1 l"
Continued ...
Except as provided herein, all terms and conditions of the document referenced In Hem 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.
15A. NAME AND TITLE OF SIGNER (Type or pdnt) 18A_ NAME AND TITLE OF CONTRACTING OFFICER
(Type or print)
, . • •' . 1 • • •
DIANE COGER'
150. CONTRACTOR/OFFEROR 150. DATE SIGNED
10C. DATE SIGNED
(Signature of person authorized to sigrt)
NSN 7540-01-152-8070
Previous edition unusable STANDARD FORM 300 (CRREC/.. 1100-83 -83:
Prescribed by GSA
FAR (48 CFR) 53.243
•I II it
i

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED RAGE OF
HHSH258201300005C/0001 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)
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 and $10,076.25 for the
period January 1, 2014 through March 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 3.2., Period of Performance, is hereby
changed to read September 1, 2013 through March
31, 2014.
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
UFMS Receiver:
Dean Hooker
Telephone: 225-756-3763
Delivery Location Code: NHDP/ADM/CONTRACTS
NHDP/ADM/CONTRACTS
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.: 2014 CAN: 3280075 Object Class: 25627
FOB: Destination
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/0001 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)
Period of Performance: 09/01/2013 to 03/31/2014
NSN 7540-01-152 8067
OPTIONAL FORM 336 (4-86)
Sponsored by GSA
FAR (48 CFR) 53.110