HomeMy WebLinkAboutBLM 2016 Grant ModAMENDMENT OF 80UCITATIONlMODIFICATION OF CONTRACT 11. CONTRACT ID CODe 1 ".>,(): i PAGES 2
2. MlENOMEIIU rlC DIF IC>\TIOH NO. 3. EFFECTIVE DATE 4. REaUISrTlONIPURCHASE REa NO. la. PROJECT NO. (11 applicable)
0001 See Block 16C
6.ISSllE D BV CODE LHW 7. ADMINISTERED BY III other than Item 8) cQOI! jLBW
BLM OR-SPOKANE DIST BLM OR SPOKANE D1ST OFC(ORWOO)
1103 N FANCHER ROAD 1103 N FANCHER ROAD
SPOKANE WA 99212 SPOKANE WA 99212
OFC(ORWOO) ReCEIVE
DEC '; 20'
o
6
KITTITAS COUNTVL'
B, NAM E-ANo ADDRESS OF CONTRACTOR tNo., I/r8eI, 1l0II1I)', _ ond ZIP Code) ,!& GII.II MENDM OOT OF SOllcm~'nON I'ICl
ITTITAS, COUNTY OF
ttn: ATTN GOVERNMENT
K
A
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POC 91,': OA1<OjSEI'lITe,I /I)
05 W 5TH AVE STE 108
LLENSBURG WA 98926-2887
'1011,. MO D IFl.'~~N or: CO ~mv..Cl1OR [)~A /lU, x L151;'KO
1011. CAT ED /,s""1TE'M I~
CODe 0070136992 FACILITY CODE 09/21/2015
1~. THI5oI'Tl;M OrlLl "pr~lEIIlO ~ ME IlMHHfII OF lItIUCITA1101«1
OTheIbcm runbered 1OI1cIt1l1on 11 amended .... 1 forth In lem 14, The h<uand dill. opeclfIed!or recelpl of 0fIer. Oil extended, Ola nclllldandod,
OIIm mlai ~. receipt 0I1h1l emendmont prlor to 111. hour and cia .pedflod In Ihe sollcllalion or al ","""ded , by one of Ihe fal\owl1a mel1od.: (a) By campletlnv
Mamt a and 16, II'Id returnlng oopIaa 01111. ImendmenI; (h) By laMowledglng reoalpl of 11111 amendment on each copy cl Ihe ofIar aubmMlad; Ill' (0) By
aepII'B\e letter or 1eIegram..t1loh InolIdn • rer.,.._lo the IOlIcilalion II'Id amendmonl n.mber.. FAILURE OF YOUR ACKNO'M.EDGEMENT TO BE RECEIVED AT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AHD DATE SPECIFIED MAY RESIJI. T IN REJECTION OF YOUR OFFER If by
vii .. 0I1hIo MIIfldmIfll ~ deolr. to cI\angIt ., elrer shady IUbmllled , ouch ch8ngo may be made by telegram Ill' letter, provIdad IIIIdllfilgnlm or lI\Ier mew
!'!!!IJng! IQ Iht !C!Ic!!I!!on Q1 !ha trn!I1<ImA and 11 ay!!! !!!1or 10 II1a !Pllno hour and de!! aoacI!!td,
12. ACCOUNTlNG AHD APPROPRIATION DATA (WreqlJl8d) Net Decrease: -$ 4 65.00
01
13. THIIITI!II ONLY APPUES TO MODlPICAnllN OF CONTRACTSIORDERB. IT MODIFIES THE CON'IlIACTIORIlER NO, AS DESCRIBED IN ITEM 14.
Clq!~k O~E A.1r:[R~~~ ~E~J ISSUED PURSUANT TO: (S~ eu/horlty) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
B, THE ASOIIE NUMBERED CONTRACTIORDER IS MODIFIEO TO REFLECT THE ADMINISTRATIVE CHANGES (1UCh 88 chenga.ln peylnv oHIce,
Ippmp1IeIion dale, I!/p,) SET FORTH IN ITEM t4, PURSUAHTTO THE AUTHORITY OF FAR 43.103(b),
c. TtllS S\JI'Pl.EMENTALAIDlEIi"1E.NT 18 E.r~EO INTO PUfU!UAtlfWIIV'THOfUfY OF
0 , oTHER (8p~ (1p.. Of ~ Ilil/J tullJtClJlj)
X Cloae-out FAR Part 4.804-5 (a) (l5)
E.IMPORTANT: ConIr8clor 011 not. I&J I1 reqWad to .Ign l11li docunent and ~urn 1 copI .. lo lI1allllJlng oIIIc8,
1~ DESCRIPT10N OF AMENDMENTIMODlFICATlON 10t;anI2811 by UCFeactJon hMdIngl, Inclutfng aoIIcIIe/JcnIConInJct tWbjacl meJter wheI8 MaIIb/e.)
The period of performance for Supplemental Law Enforcement patrol services under this award
has ended; the final payment has been completed, This modification is initiated to
de-obligate the remaining funds in the amount of $465,00 and close out this award.
LIST OF CHANGES: ~
v,,<; A/FP
Reason for Modification : Cloae Out
Total Amount for this Modification: -$465.00 RECEIVED
New Total Obligated Amount for this Award: $24,535.00
CHANGES FOR LINE ITEM NUMBER: 10
Total Amount changed
from $25,000.00 to $24,535.00
Obligated Amount for thia modification: -$465.00
Continued .. .
KITTITAS COUNTY ~H~~lFf
ACCOUNTING
~ 88' pr~ I ... "" .. lann. and concIIlona 0/ I/1e doeunanl rw/.,.."ced In ~am 9 A 0, 10,," •• hereto/ore cI!~, rem"'. ,,'laIlnoocI lI'Id In tu. foroa and eIIect .
18.<\ NAIl", AND TTTLE OF 91OflI~R ffioPII 0I1/111rJJ leA. tlAME AND TITLE OF CONTRAC n NO O~F1CEIl (Type orprlnt)
Donald Vicena
lSC. DATE SIGNED
\ -It-lOll
S'(,\NDIlRO FORM 30 (REV. 1Q.8S)
Preaeribed by GSA
FAR (4B CFR) 63,243
REF EREN CE NO . OF DOCUMENT BEING CONTINUED
CONTINUATION SHEET Ll5E'X01278/0001
NAME OF OFFEROR OR CONTRACTOR
KITTITAS, COUNTY OF
ITEM NO
lA)
00010
SUPPLIES/SERVICES
(B)
CHANGES FOR DELIVERY LOCATION: 0004276620
Amount changed from $25,000.00 to $24,535.00
CHANGES FOR ACCOUNTING CODE:
01
Amount changed from $25,000.00 to $24,535.00
Delivery: 09/30/2016
Payment Terms:
PP30
Delivery Location Code: 0004276620
BLM-OR SPOKANE DISTRICT OFFICE*
11 03 N FANCHER
SPOKANE WA 99212-1275 US
Account Assignment: K G/L Account: 6100.252RO
Business Area: LOOO Commitment Item: 252ROO Cost
Center: LLORWOOOOO Functional Area:
L12200000.NUOOOO Fund: 15XLl109AF Fund Center:
LLORWOOOOO PR Acct Assign Line: 01
FOB: Destination
Period of Performance: 10 /01/2015 to 09/30/2016
Change Item 00010 to read as follows I amount shown
is the obligated amount) :
ACQ-LAW ENFORCEMENT PATROLS KCSO
NSN , .. G-Ol·1620808'
QUANTITY ~NIT UNIT PRICE
IC) [D) (E)
AMOUNT
IF)
2
-465.00
RECt:iVED
KITTITAS COUNTY SHERIFF
ACCOUNTING
OPTIONAL FORM JJ6 ( .. ee)
Spontored by QSA
FAR '.8 CFR163.110