5. PROJECT NUMBER (if applicable) CODE 7. ADMINISTERED BY 2. AMENDMENT/MODIFICATION NUMBER CODE 6. ISSUED BY 8. NAME AND ADDRESS OF CONTRACTOR 4. REQUISITION/PURCHASE REQ. NUMBER 3. EFFECTIVE DATE 9A. AMENDMENT OF SOLICITATION NUMBER 9B. DATED PAGE OF PAGES 10A. MODIFICATION OF CONTRACT/ORDER NUMBER 10B. DATED BPA NO. 1. CONTRACT ID CODE FACILITY CODE CODE 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: The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers E. IMPORTANT: is extended, (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 electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended. 12. ACCOUNTING AND APPROPRIATION DATA (REV. 11/2016) is required to sign this document and return ___________ copies to the issuing office. is not, 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. 15C. DATE SIGNED B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b). 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 letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified. C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF: D. OTHER Contractor 16C. DATE SIGNED 14. DESCRIPTION OF AMENDMENT/MODIFICATION 16B. UNITED STATES OF AMERICA 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 16A. NAME AND TITLE OF CONTRACTING OFFICER 15B. CONTRACTOR/OFFEROR STANDARD FORM 30 PREVIOUS EDITION NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.) (Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.) (If required) (SEE ITEM 11) (SEE ITEM 13) (X) CHECK ONE 13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS, IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14. 11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT (Signature of person authorized to sign) (Signature of Contracting Officer) 1 3 0001 12-23-2020 516-21-1-213-0009 None 36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) Room 315, Bldg. 2 10,000 Bay Pines Blvd Bay Pines FL 33744 36C248 Department of Veterans Affairs Network Contracting Office 8 (NCO 8) C.W. Bill Young VA Medical Center 10000 Bay Pines Blvd. Room 315, Bldg. 2 Bay Pines FL 33744 To all Offerors/Bidders 36C24821Q0330 12-23-2020 X x x 0 See CONTINUATION Page 516-3610160-213-824200-3131 010040175 x The purpose of this amendment is to: - Change item description in Attachment B - Schedule - Change CLIN 0002 from Genysis 5CM Applicator to Genysis 10CM Applicator Brett Cook CONTINUATION PAGE A.1 PRICE/COST SCHEDULE ITEM INFORMATION ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 3.00 EA __________________ __________________ NEO-FOUR CHANNEL COMBO PLUS EMG WITH CART LOCAL STOCK NUMBER: 081659648 0002 3.00 EA __________________ __________________ GENISYS 10 CM APPLICATOR LOCAL STOCK NUMBER: 081327717 0003 3.00 EA __________________ __________________ VECTRA NEO LASER MODULE LOCAL STOCK NUMBER: 081630607 0004 3.00 EA __________________ __________________ 9 DIODE CLUSTER APPLCTR 1040MW EER REQUEST #103199 DELIVER TO PM&R/JEFF DEMAYO LOCAL STOCK NUMBER: 081327584 GRAND TOTAL __________________ A.2 DELIVERY SCHEDULE ITEM NUMBER QUANTITY DELIVERY DATE 0001 SHIP TO: Bay Pine VA Healthcare System 10,000 Bay Pines Blvd. Bldg. 110 Warehouse Bay Pines, FL 33744 USA 3.00 03/01/2021 MARK FOR: Demayo, Jeffrey B. (727) 398-6661 15367 [email protected] 0002 SHIP TO: Bay Pine VA Healthcare System 10,000 Bay Pines Blvd. Bldg. 110 Warehouse Bay Pines, FL 33744 USA 3.00 03/01/2021 MARK FOR: Demayo, Jeffrey B. (727) 398-6661 15367 [email protected] 0003 SHIP TO: Bay Pine VA Healthcare System 10,000 Bay Pines Blvd. Bldg. 110 Warehouse Bay Pines, FL 33744 USA 3.00 03/01/2021 MARK FOR: Demayo, Jeffrey B. (727) 398-6661 15367 [email protected] 0004 SHIP TO: Bay Pine VA Healthcare System 10,000 Bay Pines Blvd. Bldg. 110 Warehouse Bay Pines, FL 33744 USA 3.00 03/01/2021 MARK FOR: Demayo, Jeffrey B. (727) 398-6661 15367 [email protected]

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