OMB No. 0990-0115
1. C O N T R AC T ID C O D E P A G E O F P AG E S
AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1 1
2. A M E N D M E N T /MO D IFIC A T IO N N O . 3. E FFE C T IV E D A T E 4. R E Q U IS IT IO N /P U R C H A S E R E Q . N O . 5. P R O JE C T N O . (If applicable)
002 See Block 16C
6. IS S U ED B Y 7. A D MIN IS T E R E D B Y (If other than Item 6)
CODE CODE
National Heart, Lung, & Blood Institute, NIH
Rockledge II Building, Room 6016
6701 ROCKLEDGE DR MSC 7902
BETHESDA MD 20892-7902
8. N A M E AN D A D D R E S S O F C O N TR A C TO R (N o., street, county, State and ZIP C ode) ( T) 9A . A M E N D M E N T O F S O LIC IT A T IO N N O .
NHLBI-HR-05-05
Recipients of RFP NHLBI-HR-05-05 T 9B . D A T E D (S E E ITE M 13)
Clinical Coordinating Center for a Clinical Research Network for the
6/21/04
Treatment of Acute Lung Injury and Acute Respiratory Distress 10A . M O D IFIC A T IO N O F C O N T R A C T/O R D E R N O .
Syndrome
10B . D A T E D (S E E ITE M 13)
CODE FA C ILIT Y C O D E
11. THIS ITEM APPLIES TO AMENDMENTS OF SOLICITATIONS
T T he above num bered solicitation is am ended as set forth in Item 14. The hour and date specified for receipt of O ffers is extended, T
is not extended.
O ffers m ust ackn ow ledge receipt of this am endm ent prior to the hour and date specified in the solicitation or as am ended , by one of the follow ing m ethods:
(a) By com pleting Item s 8 and 15, and returning 2 copies of the am endm ent; (b) B y ack nowledging receipt of this am endm ent on each copy of the offer subm itted; or (c) B y
separate letter or telegram which includes a reference to the solicitation and am endm ent num bers. FA ILU R E O F YO U R A C K N O W LE D G M E N T T O B E R E C E IV E D A T T H E P LA C E
D E S IG N A T E D FO R R E C E IP T O F O FFE R S PR IO R TO TH E H O U R AN D D A T E SP E C IFIE D MA Y R E S U LT IN R E JEC T IO N O F YO U R O FFE R . If by virtue of this am endm ent you
desire to change an offer already subm itted, such change m ay be m ade by telegram or letter, provided each telegram or letter m ak es reference to the solicitation and this am endm ent,
and is received prior to the opening hour and date specified.
12. AC C O U N T IN G A N D A P P R O PR IA T IO N D A T A (If required)
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,
IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.
( T) A . T H IS C H A N G E O R D E R IS IS S U E D P U R S U A N T T O : (S pecify authority) T H E C H A N G E S SE T FO R T H IN IT EM 14 A R E MA D E IN TH E C O N T R AC T O R D E R N O . IN IT E M 10A .
B . T H E A B O V E N U M B E R ED C O N T R A C T/O R D E R IS M O D IFIE D T O R E FLE C T T H E A D MIN IS T R A T IV E C H A N G E S (such as changes in paying office, appropriation date, etc.) S ET
FO R T H IN IT E M 14, PU R S U A N T T O T H E A U T H O R IT Y O F FA R 43.103(b).
C . T H IS SU P P LE M E N T A L AG R E E M E N T IS EN T E R E D IN T O PU R S U A N T TO AU T H O R IT Y O F:
D . O T H E R (S pecify type of modification and authority)
E. IMPORTANT: Contractor is not, 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.)
SECTION C: DESCRIPTION OF REQUIREMENT, Part i. Travel, Phase II, 3) is revised to read:
the Nurse Coordinator visiting five clinical centers each year during years 1-5, and three clinical centers during year 6,
Note: When using the spread sheet included in SECTION J, BUSINESS PROPOSAL ATTACHMENTS, Summary
of Proposed Estimated Cost and Labor Hours, offerors are reminded to update estimated Travel Costs, C. SITE
VISITS - Chart Review by Nurse Coordinator to include the additional site visits.
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)
Pamela S. Lew
Contracting Officer, HLVD Contracts Section
15B. CONTRACTOR/OFFEROR 15C . D ATE SIG N ED 16B. UNITED STATES OF AMERICA 16C . D ATE SIG N ED
BY /S/ 9/15/2004
(Signature of person authorized to sign.) (Signature of Contracting Officer)
NSN 7540-01-152-8070 30-105 STANDARD FORM 30 RAJ (REV. 10-83)
PREVIOUS EDITION UNUSABLE Prescribed by GSA
FAR (48 CFR) 53.243