I

ORDER FOR SUPPLIES OR SERVICES 1 i :>;s -7 "ZS

I M P O R T A N T : M a r k a l l p a c k a g e s a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e r s 1 ' : -. -.
1. DATE OF ORDER 2 CONTRACT NO. (11 any) r: SHIP TC /
a. NAME OF CONSIGNEE
09/13/2003
3. ORDER NO. 4 REQUISITIONrREFERENCE NO.
DHHS/OPXS/OM?
03T48021001D 03T480210
5, ISSUING OFFICE (Address conespondence lo)
DHHS/PSC/AOS/D AM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857 1
c. ClTY
WASHINGTON
7.T o : CAP.ME11 O.~l.lOS
-WATSOP! f SHIP VIA

a. NAME OF CONTRACTOR I
QUALITY MANAGEMENT RESOURCES, INC.
b. COMPANY NAME
8. TYPE OF ORDER 1
C DELIVERY

c. STREET ADDRESS REFERFNCE YOUR: 1 I

1333 GREEN COURT NW
2ND FLOOR
. .. Ireune. :nls dellvey criie: 1s
I:
Suo!ect li~nsrruc:~ons covlalned 03
-.--.

t h ~ ssjce only of tnis l o r n and IS

Please furnish the follow8ngon Ihe t e r m ~ssuedsuqec: to lne $ e m sano
and conditions specified on both sides o: condltlons of In? aoove-numoered
d. CITY
WASHINGTON 1 e STATE
DC
f. ZIP CODE
20005
this order and on Ihe atlachw sheets, i:
any, including dellvery as lnd~caled.
I I
contra::

9.ACCOUNTING AND APPROPRIATIONS DATA 10 REQUISITIONING OFFICE

7530120 DHHS/OPHS/OHAP
11. BUSINESS
-- CLASSIFICATION (Check aopropnale boxF)) I
~)i_ a. SMALL -. b. OTHER THAN SMALL
-
X c DISADVANTAGED I - d WIOMEN-OWNED

12. F.O.B. POINT Destination

13 PLACE OF
' '-: 1 14. GOVERNMENT B/UNO.
I
I
15. DELIVER TO F O.B. POINT
, , , , RO , RO i O
I i 1 5 . D ~ O U N TERMS
T

Net 30
a. INSPECTION I b. ACCEPTANCE I
Desti~ation I~estination I ( . . . . . -- ..,
17. SCHEDULE (See reverse ior Rerecl~onst 1
QUANTITY QUANTITY
ITEM NO. SUPPLIES OR SERVICES ORDERED UNIT PRICE . = ACCEPTED
(a) (b) (c) (d) i e ~ (1) (g)

Tz:.: ID Number.
DUNS Number:
CAM: 1990450 Obj. Class: 2522 FI: 2003
'iJ+
. -..
.-- ..

If you have questions,- call Jo Lask:o at 301-443-3539.

1
- .. . .. .. -- ... - --. ....

Continued . . .

17(h).

I
19. GROSS SHIPPING WEIGHT 2 0 . INVOICE NO
TOTAL
I (Conr.
1
i
I
21. MAIL l N v o l c E T o :
I
I

~
SEE BILLING
INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILD ING, ROOM 16A-12
ON REVERSE (or P O . BOX) 5600FISHERSLANE .
:.

I -
c. CITY Id: STATE 1 e ZIP CODE $50
I ROcKvILLE i 1.1~ 20857 I
22. UNITED STATES OF AMERICA : < ., , . ...,.%, 23 NAME (Typed)

BY (S~gnalure)
~ 2.
, . .
.
-
,

...,.
8. . ,,- .
ir- '
JO LASKO
TITLE: CONTRACTINGIORDERING XER

NSN 7540-01-152-8083 OPTIONAL FORM 347 i R s r -51

PREVIOUS EDITION NOT USABLE

C0:JTFACT l J 3 . !i$ any) .-.:-.-.
....
SUPPLEMENTAL'INVOICING INFORMATION
- -
If desired, this order (or a copy thereof) may be used by the Contractor as the contractor's invoice. ~nsteadof a separate in\ )Ice, provided
the following statement. (signed and dated) is on (or attached to) the order: "Payment is requested in the amount of S No
other invo~cewill be submitted." However, if the Contractor wishes to submit an ~nvoice,the following information must be PI )vlded;
contract number (if any), order number, item number(s), description of supplies or service. sizes, quantities, unit prices, and :xtended
totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed SlO (except or parcel
post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering activity d u ~ng the same
billing period, consolidated periodic billings are encouraged

Quantity in the "Quantity Accepted" column on the face of this order has been: inspected, . '0a :cepted. C] received
by me and conforms to th~scontract Items hsted below have been rejected for the reasons tndlcated
SHIPMENT
- DATE RECEIVE? SIGNATURE OF AUTHORIZED U S GOVT REP
NUMBER FINAL
TOTAL CONTAINERS RECEIVED AT I TITLE
I I I
REPORT OF REJECTIONS
I
ITEM NO. SUPPLIES OR SERVICES UNIT QUANTITY REASOI
I REJECTED 1

PTIONAL FORM 347 (Rev 6195) (BACK)

 3:s'
%
.. I
ORDER FOR SUPPLIES OR SERVICES I?<= =; , Gzs
!
SCHEDULE - CONTINUATION.. ; -1 , _.
- ^ .

IMPORTANT: Mark all pacxaaes and papers wiin cnntran andlor oroer numbers i
1
DATEOFORDER CONTRACTNO ORDER NO
09/13/2003. ,. .. @?T48@710013
ITEM NO. SUPPLlESiSERVlCES O U A N T I V UNIT UNIT AI.OUI!T OLIANTI7

(A) (0)
ORDERED
(C! IC~
PRICE
iE! (Fi I
I
-. -----
--- - -
IG'

1 Professional Service Contract f c r th5 52,~ J S2 3.

O f f i c e o f HIV/AIDS P o l i c y , O f f i c e o f P u b l i c
Health and S c i e n c e , O f f i c e of t h e
S e c r e t a r y , DSHS - ..
..

1 . P r o j e c t T i t l e : Radio Unica

2 . P e r i o d o f P e r f o r m a n c e : S e p t e m b e r 1 5 , 2'303 t h r o u ~ h1:lecernber 3 0 , :003.

- . ..
*
3 . P u r p o s e o f . P-greement
. . - - +-
. _ .- --
. .
. .

The p u r p o s e o f t h i s a g z e e m e n t i s t o s u p p o r t t h e a r r a n c e m e n t , s e t u p a n 3 manaaeRen: zf
I.
7; ' .

a n O f f i c e o f HI:!/AIDS P o l i c y (OHA?! b o o t h w i t h h e a . t h - - r e l a c e d m a t e r i a l s z c :;.is-,.?iz P-.

h e a l t h f a i r s i n 12 c i t i e s . The f a i r s a r e b e i n g s p , n s ? r e d by R a d i o U n i c a , a?ci w ~ l l
b e h e l d i n WalMart p a r k i n g l o t s . The v e n d o r w i l l )ray-ido s e r v i c e s a n d v o i c Ie t a l e r t
- ,
f o r t h e d e v e l o p m e n t , p r o m o t i o n , a n d b r o a d c a s : o f P;P. h e a l t h m e s s a g e s t a r o e t l n g t n e
1.
H i s p a n i c c o m m u n i t y . The PSAs w i l l f o c u s on t h e s i . ~c : - i t i c a l h e a l t . 1 a r e a s i ' d e n c i f i e d
b y H e a l t h y P e o p l e 2 0 1 0 : d i a b e t e s , c a r d i o v a s z u l a r l i s i a s e a n d s t r o c e , HIV/.;?IIDS,
i n f a n t m o r t a l i t y , immunization, asthma, and c a n c e r .
.
a
\\
4. Background
--
A c c o r d i n g t o t h e 2000 C e n s u s , t h e H i s p a n i c p s p u l a t - o n h a s r i s e n 60 p e r c e n t s i n c e
1 9 9 0 , a n d i s cugg~ttl\l a_t_35 m i l l i o n . H i s p a n i c s a r ? now t h e nation:^ l a r o e s t . . .

minority group. The p o p u l a t i o n e x p e r i e n c e s d i s e a s ? , : . l l n e s s a n d d e a t h a t

d i s p r o p o r t i o n a t e l y h i g h e r r a t e s t h a n non-Hispanics. :.n a n e f f o r t -:o e l i m i n a t e t h e s e
h e a l t h d i s p a r i t i e s , t h e Whit-e House a n d t h e 3 e p a r t l n e n ' : o f H e a l t h a n d - H u m a r S e r - v i c e s
(HHS) h a v e c a l l e d f o r F e d e r a l a g e n c i e s t o i n - r e a s e t h t r i r c a p a c i t y 10 r e a c h o u t t o
a n d s e r v e t h i s community. Fundamental t o t h o s u c c ? s s of t h i s e f f o r t i s t h e a b i l i t y
t o c r a f t and d e l i v e r y h e a l t h messages t h a t a r e cu1;ur; l l y and l i n g l i s t i c a l l ~ y
a p p r o p r i a - t e ..

The HHS I n i t i a t i v e to-Eliminate R a c i a l ar.d E S h n i c iea:.th D i s p a r l t i ? z - h a s - S e T - t h ~-

g o a l f o r elimination o f r a c i a l a n d e t h n i c d i s p a r i t - e s i n h e a l c h by t h e a 0 1 . ~n
- 1 ,
--
c o n j u n c t i o n w i t h t h i s i n i t i a t i v e , a r e p o r t r e l e a s e 3 1;isc y e a r p l a c e d t h e e l l m l n a t l o n
o f healrrh. disparities among t h e n a t i o r , chi-.: h e a - t h o b l e c t i v e s f o r t h e 21lst
centur::. P u b l i c i n f o r m a t i o n a n d comrnunlty c u t r o a c ? i:: clne o f t h e c h r e e m a j o r a r e a s
f o r e m p h a s i s . OHAP p a r t i c i p a t i o n i n t h e WalM?rr/F.aiio U n l c a H i s p a n - c h e a l t h f a i r s i s
i n d l r e c t response t o t h l s goal.

.]AT :3IkLC, COI'lPIU IICATIOPI 'PRODUCTS,

IMFGRTAI~IT iIOTE: F.LL MEDIA SELECTIOL~I, ?F.OMOTIOf~l~I.
DISTRIBUTION PLAN, ETC., MUST BE SUBMITTSD T'J THE GO"ERNMEI,lT PROJ2CT OFFICE3 FOF
D9HS, PUBLIC 4FFAIP.S OFFICE CLEP.R%bICE .:
Continued . . .

TOTAL CARRIED FORWARD TO I S T PAGE (ITEM 17(H)) I

NSN 7560.01-152-8082 Yi3-4910: OPTKIWIL F W M l48 (fir, 6 3 5 1
PI.- D I GS"
F A P ~ ~ ' ~ C F R I ~ I ~ I Y ~ :
 .. . . 'I
ORDER FOR SUPPLIES OR SERVICES
SCHEDLILE - CONTINUATION ...
ii ; !
.-
--
IMPORTANT: Mark all pawages and papers w ~ t hcontran and/or oraer numoers 1/
DATE OF ORDER CONTRACT NO.

09/13/2003

ITEM NO.

(A)
SUPPLIESISERVICES

(B)
:. . .. ..

QUANTITY VN!T
ORDERED
(Cj iD!
UNIT
PRICE
(El
AI~IO "'1
(Fi
QUSNTiT':
. -------
-('-_=-.:_
IG.

IiIGHTS 1I.l D.a.TA: The G o v e r n m e n t r e t a i x a2.l . r i a h ? s :.>

.-
11 d a c ~z n i r---.--- ----"-
---... - 2 - 4...-- A=:
a s a r e s u l t of t h i s purchase order. 140 i r f c r ~ a t i o ; f r n i s h e i r s o r i e n s r s : 4 i ' r ; - t-r
c o n t r a c t ; r i r i h e p e r f o r m a n c e nf i h ~ p s u r i h a s e o r d z r 5-11 b e r s i e i s t :xi
;,:kliz
by t h e c o n t r a c t o r r i t h o u i p r i o r appr;;aib :he Gc.:er r e x i ? r o j e c i Cfiic?: 11'2;.
. .
A l l p r o d u c t s u n d e r t h i s p u r c h a s s c r d e r , i n c l ~ d i n c j,,:ri. t f ? . r e p o r r s In: :c=ucz:!:;z:c:.
r e l a t i n g ; rco t h e p u r c h a s e o r d e r a r e t o b e t h e p r o p e r t y c f t h e US Go..-sznne-r, v?i=?
I
w l l l e:.:ercise e x c l u s i v e c o n t r o l o v e r r h e . a s e a n d d . s c i - i b u t i o n o f t l e s e p r c i 2 2 ~ 5 .

. -
5 . S t a C e m e n t o f Work .
.-

See Attachmsnt Schedule tiealth F a i r s

-': -L-%,. . ...:-

,

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

NSN 754&01.152-8082 50~-aa:o1 OPTIONAL FORM ld0 I R n 6351
P r . m # b d by G S 1
FAR448 CFRl5J 71)lri
 , . .'
-- ,
I
14
,
?JGE C.- D;zE
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION. ~
, -. .-

the contractor will be paid as follows:

- Final report on the Health Tour

TOTAL CARRIED FORWARDTO 1ST PAGE (ITEM 17iH))

NSN 754001-152-8082 5~3.48101 OPTIONAL F W M 348 lc.v 6-35,
P t e w t b d Dv GSb
F r R l l d CFR15171Sr:
 ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION. ; 3 i ..
-.
IMPORTANT: Mar* all oackages and paDers w ~ t hm n t r a n andlor order numBers i
DATE OF ORDER CONTRACT NO. ORDER NO
09/13/2003 . _.. ,~
03T48021051D
ITEM NO. SUPPLIESISERVICES QUlNTlTY UNIT
ORDERED
UNIT
DRICE
A~~OUN)
--
CU;::i7
. - ---
-.'..z-, =--
(A I (0) iC) (Dl (€1 ;G,

912 DESIGNATION O F PROJECT OFFICZ?.

M l g u e l Gorner, S e n i o r P o l i c y ~ n a l ~ s O t ,f f i c e 3f HIV.'AIi;S P s L i z y , ?f f i z e :f "..-:;-
.-(---I-
H e a l t h S c i e n c e , OS/DHHS -T,OCATZD AT HHH E i l l l i i n g , 'eon 7 3 5 5 , 7 C i r :?.i~as>ce~::e
A v e n u e , S .W., W a s h i n g t o n , D . C . Z O i 0 1 I S HESEB'L' :ES::GNhTZD TEE P ? G J J Z P 3 7 : i:t?
' TC
l l 9 N I T O D THE PERFOP.1'ANCE OF T H I S ORDER ON E Z H i L F 01 THi: GO'jiRNbiil<T. 7 i.23ii~ZT
OFFICE?, WILL PROVIDE NO SUPERVISOP,Y OR i N S T R 3 C T I O N . i L

938 PARTIAL PAYMENTS

Project Offlcer f o r approval-of payment.

COMMEP.CIAL I T E M S ) (JUNE 2 0 0 3 )

1 2 7 2 4 , 13.059, 1 3 0 6 7 , 1 3 1 2 1 . AND 1 3 1 2 9 ) .

( I ) 52.232-1, PAYMENTS (APF. 1 9 8 4 ) .

(111) 5 2 . 2 3 2 - 1 1 , E:<TPL\S (APR 1 9 8 4 ) .

( I V ) 5 2 . 2 3 2 - 2 5 , PROMPT PAYMENT ( F E E 2 0 0 2 ) .
( V ) . 5 2 . 2 3 3 - 1 , D I S P U T Z S (DEC 1 9 9 8 ) .
Continued ...

NSN 754CL01-152-8082 OPTlON4L FDRM 34.E lrr. 6951

Preul-0 b y G5'
F*T( IUI c19153213ir:
- I
I z=s:=;.:
' 1
DACE
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTINUATION. , ! - - .
. .

IMPORTANT: Mark all Damages and Daoers wrth Contract andlor order nurnoers
DATE OF ORDER

09/13/2003
ITEM NO.
CONTRACT NO.

SUPPLlESiSERVlCES
. . . .

QUANTITY UNIT UNIT

! ORDER NO.

C3T4@3210"31D
ALIOUN? oLlA;:m-.
- --- -
- - -. -- --
IA)

;?I! 5 2 . 2 4 4 - 6 ,
(B)
SIJaCO)]TMCTS c.s?, COI.!tjEi?CI.2..I ITE!.:; ! )xz
ORDERED
(C! (Dl
PRICE
(E!

2321 : .
(F) I . ---
-,

I;.

5 2 . 2 5 3 - 1 , COMPUTER GENEI)&?TED FO?.!!S

1 ; d ' I I ) iJ A S 1 G C 1 .
(B! THE CONTPACTOP. SHALL COI.IPL'i
T,ZFEF,EI.ICE, UNLESS THE CIRCUEIST.?NCES DO NOT .%?PLY:
( 1 ) THE CLAUSES L I S T E D EELOW IMPLEI.ICi.iT P R O V I S I O N S 1,i.b' 0:. Z\:E.:3TI:.:Z O?.C52.!
I
( 1 ) 5 2 . 2 2 2 - 2 0 , WP.LSY-HEALEY PUET,IC.COl.ITP.~.CTS ACT ( 1 3 C 1 3 ' 3 6 ) (4; U . . 3 .C. ZS-iS 8

( A P P L I E S TO SUPPLY COI~ITRRCTS O1.IE?. $ 1 0 , 0 0 0 I N THE U 1ITI:S. S T A T E S , PUIRTrJ ""^I ?? Tlf

U. S . V I R G I N I S L A N D S ! .
( I 11 5 2 . 2 2 2 - 3 5 ,
-.---
EQUAL OPPORTUNITY FOR S P E C I A L DISA3LEI! V E T E R W S , VZTEF..=.i.IS O F 7:s:
i
COIJTP-KTS or $ 2 5 , G O O OP NF.E! .

.-

VIRGIN ISLANDS, AND WAKE I S L A N D . i

CONTRACTS O F $ 2 5 , 0 0 0 OR MORE1 -.

THRESHOLD.)

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

NSN 7540-01-152.8082 313-AE-101
/I OPTIONAL FORM YB I
.."w.t.e..,
R 695,
~
GS"
FAR 8 4 8 C F R I 5 1 2 1 3 L 1
 ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION-
,i
1 z
_,-
,
,
-_<-.
--
. -
1.

IMPORTANT: Mark ail oacxages ana papers witn cnntran andlor order numbers I
DATE OF ORDER

09/13/2013?
CONTRACT NO.

... . .
ORDER NO
03T480210?1P ;I
i
ITEM NO. SUPPLIESISERVICES OUANTITY UFllT AMOUAT
UNIT
--
0~1:t:iiT'

(A) (0)
ORDEXED
(C) ID)
PRICE
IF, I
i/l
. -----
-.,-=- =-
;G;
2 0 0 3 ) (46 U . S . C . p.pp:,: 1 2 4 1 ) . ( . q p F L I r S T ~ Js ~ J ? ? ; I ~ :~-:.;:S_~C~.TE>
s 2.: ~:~.z..i.i'.:zsj~i:
( E X C E P T FOP, THE T Y P E S Of SUBCOI~ITFACTS L I S T E D AT 1 7 . 5 0 ' ( 3 ) . )
( 2 ) L I S T E D BELOK AEZ ADDITI0NP.L CLAUSES THAT tl.2.Y A ? P L - ' :
( I) 5 2 . 2 0 5 - 6 , PROTECTIiiG THE. GOVERNMENT ' S I N T E R E S T i d t i :[,I SUBZOilT?b=.C'"Iii3 ?:IT:-:
(,.
'
C0NTRACTOP.S DEB&P.RED, SU-S?ENDED, OR PROFOSED FOP. D3E.a. i?lZPiT [JLILV 1 2 3 )
CCP!TRACTS OVER $ 2 5 , 0 0 0 1 .
(11) 5 2 . 2 1 1 - 1 7 , DELIVERY O F EXCESS Q U A N T I T I Z S ( S E P T 1 1 ? 5 9 ) ( 3 P E ; L I Z S T C FI:,:E;-?212f
SUPPLIES) .
I1
Llf3 TZ

(111) 5 2 . 2 3 7 - 2 9 , F . O . B . O R I G I N ( J U N E 1 0 8 % ) ( ' I P P L I E ; TO S U P P L I E S I F DZLI:.'E?.:i IS

r . o . 3 . OP.IGI1.I) .

AT T H I S / T H E S E ADDRESS ( E S ) :
HTTP://WWW.ARNET.GOV

HAVE BEEN DISCOVERED:-'ANB

CHANGE I S DUE TO THE DEFECT I N THE I T E M .

TOTALCARRIED FORWARD TO 1ST PAGE (ITEM 17lH))

NSN 754C-01-152.8082 501-4810: 1 O P T O W L F ( R M 34B i R r , -51
-
ORDER FOR SUPPLIES OR SERVICES 1 ";-
j=2;;;:
. -
SCHEDULE - CONTINUATION I I' , -.

.--- --

CON7ENIEMCS.

ORDER. CONTACTS ARE A S FOLLOWS:

PSC J E A N E T T E PANG (301) 443-3030
FDA DAVID C A I N E (30i'j e27-5090
CDC PATTY E7dERETTE (404) 639-744 1
NIH M I C H E L L E SHORTER ( 3 0 1 ) 4 9 6 - 6 0 8 8

TOTAL CARRIED FORWARD TO ?ST PAGE (ITEM 17(H))

NSN 754C-01-152-8082 503-48-101 OPTIONAL FaRM 348 (R.. 6911
P.c- D, GSP
rARIdB CFRI53213C.
 1
ORDER FOR SUPPLIES OR SERVICES I
-
SCHEDULE CONTINUATION I -

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17jH)) 1

NSN 754CL01-152-8082 %3 r~ 151 OPTlON4L FORM M l n r 655)
Prewmml by G 5 L
FARIU) CFR153214r.
 ORDER FOR SUPPLIES OR SERVICES
I1 / PAGE GF PkGES

IMPORTANT: Mark all packages and p a p e n whh contract andlor order numbers 11 1 1 -,
1 DATE OF ORDER 2 C O N l R A NO (If any) 6 SHIP TO

09/15/2001
3 ORDER NO 4 REQUISITIONREFERENCE NO
a NAME OF CONSIGNEE

HHS/SAMHSA/CMH S
I
9,'4; h3 ; ,
01M00872801D
I
01M008728 I
n
5. ISSUING OFFICE (Address ocnespcmdence to)
DHHS/PSC/AOS/DAM/ADP
PARKLAWN B U I L D I N G , ROOM 5 - 9 5
ACQ.
b. STREET ADDRESS
PARKLAWN BLDG, ROOM 1 7 c - 0 s
5 6 0 0 F I S H E R S LANE
I 1

5 6 0 0 F I S H E R S LANE ATTN: M . COWAN, 3 0 1 - 4 4 3 - 4 . 1 1 4 i(

ROCKVILLE MD 2 0 8 5 7 /I
- - c. CITY 0.STATE eZlPCODE
ROCKVILLE 1 MD ,20:57
7.TO: RAY QUALLS I.SHIP VIA
a. NAME OF CONTRACTOR !
S O C I A L & HEALTH S E R V I C E S , LTD.
8. TYPE OF ORDER ,
--I
b. COMPANY NAME
Ea. PURCHASE -'b. DELNERY '

- . . .- REFERENCE YOUR:
!
c. STREET ADDRESS
1 1 4 2 6 ROCKVILLE P I K E , S U I T E 1 0 .0 : - -- . .
. -- ...
-. .
-.
1
Except
, .-
~ c ubill~w~nstnmaymson Ihe
this ddWry m e r IS
xl6jecl lo ~nslruciimscmlained on
- -
tnisude m l y of lhis form and IS
Please furn~shthe f d l m n g on the lerms issued subjm to the ~wmsano
and cond~l~ons speahed on both sldes of mrid~t~orrs d h e abovenumbered
tn~sorder and on the attached sheets. 11 contract.
d CrrY 6 STATE f ZIP CODE
any. ~ncludlngd e l l v q as ~nd~cdled
ROCKVILLE MD 20852
9. ACCOUNTING AND APPROPRIATIONS DATA 1 10. REQUISITIONING OFFCE
11. BUSINESS CLASSIFICATION (Check appropriate boxies))
C a SMALL '.: .'@. b. OWER THAN SMALL
-
I-' C. DISADVA~AGED
-
I
'I
d. WOMEN-OWED
%. . . I
12. F.O.B. POINT Destination 14. GOVERNMENT BIVNO. 15. DELIVER TO F.O.B. POINT 16. DISCOUNT TERMS

1
ON OR BEFORE (Dale)
-
1
.
13. PLACE OF
02/04/2002 Net 30
a. lNsPEcTIoN 1 b. ACCEPTANCE
D e s t i n a t ion I D e S t i ~ d b i 0 ..,;~ I -. . . . ,. -- :.
17. SCHEDULE (See mverse for Rejections)

QUANTITY UNrr I QUANTITY

ITEM NO. ORDERED UNrr PRICE :- :- AMO*." ;--' ' ACCEPTED
SUPPLIES OR SERVICES '
(a) @) (c) (d) (el (0 ;j (g)

T a x I D Number
!
DUNS N u m b e r :
CAN: C 9 6 C 0 5 J , O b j . C l a s s : Z b Z Z FY: 2001 ,,
P e r i o d of P e r f o r m a n c e : 0 9 / 1 7 / 2 0 0 1 t o 02/04/2302 I

Del'ivery L o c a t i o n C o d e . P17C-05 . .:- .. ...,I .- *... .-. ....

HHS/SAMHSA/CMHS
c o n t i n u e d . ..

. .
18 SHIPPING POINT

1
19. GROSS SHIPPING WEIGHT

21. MAIL INVOICE TO

I
I
20. INVOICE NO.
TOTAL

a. NAME PSC/FMS (301) 443-3020

PARKLAWN B U I L D I N G , ROOM 1 6 A z 1 2
SEE BILUNG
INSTRUCTlONS b. STREET ADDRESS 5 6 0 0 F I S H E R S LANE
ON REVERSE (or P.O. Box) ROCKVILLE MD 2 0 8 5 7 '

1 TOTAL
c. CITY d. STATE e. ZIP CODE

22. UNITED STATES OF AMERICA 23. NAME (TW)

BY (Signature) ?. - MARIE L . SUNDAY
. ) f f l G l f r ' &d?,.{~i-
~~ TITLE: C0NTPACTINGX)RMRING OFFICER
NSN 154001-152-8083 ': O m D W FORM Y l IRm -51

PREVIOUS EDITION NOT USABLE R-AOOMARIM WRl SlZlX.)

 ..
CONTRACT NO. t if a n y
SUPPLEMENTAL INVOICING INFORMATION
If desired, this order (or a copy thereof) may be used by the Contractor as the Contractofs invoice, instead of a separate invoice! provided
the following statement. (signed and dated) is on (or attached to) the order. 'Payment is requested in the amount of S . No
other invoice will be submitted.' However, the Contractor wishes to submit an invoice, the following information must be provided;
contract number (if any). order number, item number(s), description of supplies or service, sizes. quantities, unit prices, and ext&ded
totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs exceed S10 (except for parcel
post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an ordering activity during tbe same
billing period, consolidated periodic billings are encouraged. I
RECEIVING REPORT

Quantity in the 'Quantity Accepted' column on the face of this order has been: inspected. acceited. rece~ved
by me and conforms to this contract. Items listed below have been rejected for the reasons indicated. 1
SHIPMENT 1 DATE RECEIVED SIGNATUREOF AUTHORIZED U.S. GOVT REP DATE
NUMBER FINAL I
TOTAL CONTAINERS 1 GROSS WEIGHT 1 RECEIVED AT 1 TITLE
I
I
REPORT OF REJECTIONS
..
ITEM NO. SUPPLIES OR SERWCES UNIT QUANTITY REASON FOR,REJECnON
- . ....... REJECTED I
I
. . .-- :. -
_ _ = _ . . .~-
. --
~..
. ~.

OPTIONAL FORM Y 7 (Rev 6195) (BACK)

 .-
ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES

SCHEDULE - CONTINUATION 3 1
I
1 4
IMPORTANT: M a h all padcages and papers wim mntrad and/or order numbers. I
DATE OF ORDER CONTRACT NO. ORDER NO. /I
09/15/2001 01M00872801D !
ITEM NO. SUPPLlESfSERVlCES QUANTITY UNm UNIT AMOUNT 1 QUAKTIT,'
ORDERED PRICE I ACCEPTE3
(A) (0) (C) (G) (E) (F) 4 (Gi
PARKLAWN BLDG, ROOM 17C-05 ?
5600 FISHERS LANE
ATTN: M. COWAN, 301-443-4114 I

ROCRVILLE MD 20857
- -
I1

For information or assistance call Narie L. Sunday

msunday@psc.gov
(:;01)443-7061 o r Emaii:
i
.
1
'1

Professional Service - ., - --

conditions.

FAR 32.102(D).

-i.-
-.id -
.+.-

1. INVOICE I N F O ~ T I O N

Number) or Social Security Number.

.NOTICE.. .
Continued . . .

TOTAL CARRIED FORWARD TO 1 ST PAGE (ITEM 17(H)) I

NSN 7YWl-152-3082 Y134&101 ' OFTIOWL FORM S4U IRI -51

P-b,(iY
FAP(MCFRlU113(rl
 TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 7Y001.1528082 ~ 1 ~ 1 ~ 1
-by GSA
FAR I* F I R 1 5 3 1 I Y c l
Purchase Order: 01~00872801~ I1 6
Page 1 of
Attachment A R

School Violence Prevention Comunication and Media

Materials - - Design and Development

-
BACKGROUND :

The Center for Mental Health Sewices (CMHS) provides nat

leadership for policies, programs and activities assigned to
improve mental health treatment and prevention services fkr
adults and children-with mental illnesses and their families, and
adults .and chi.ldren at-risk for psychiatric diagnoses. &day
CMHS is guiding a service system in transition, stimulating
capacity at the national, State, and local levels to improve and
enhance mental health treatment and support services and to
promote prevention and foster the mental health of all Americans.
CMHS works to develop, implement an evaluate state-of-the~art
approaches to meet the most challenging mental health service
issues for children, adolescents, and adults. I
-.-%=
rJ' .A

Acknowledging the mission of CMHS and the key role it plays in

fostering a public health approach to nationwide health-related
issues, the FY 2001 Department of Health and Human Servicks
law, included $90.0 million for school-.
appropriation---B.i:~lZ.,.-.:now
violence prevention activities to be undertaken by CMHS. ! The
-Conference language accompanying the appropriation specif,ied- - -that
-
CMHS use the funds specifically to "improve mental"healt~1-
services for children with emotional and behavioral disorders who
are at risk of violent behavior." The House-Senate ~onfe!rence
report (1998) continued that "there are concerns about the recent .. . . . .
~
outbreaks of ..viol-encein our Nation's schools,and it is delieved ---
. .
that one important tool to address^-this problem 'is to imfi;rrov&
children's mental health services . . . . " Reducing the risk for
violence.either as a perpetrator, victim or witness is a~major
focus of the CMHS plan to utilize the school violence prevention
dollars. 1

A significant amount is now known about the rlsk factors &hat are
reliable predictors of adolescent violence such as e8rly and
persistent antisocial behaviors, academic failure, allenation and
rebelliousness, family conflict, extreme economic deprivation and
availability of firearms. These risk factors have been I
correlated with the diagnosis of conduct disorder in children.
I
The recent Surgeon General's Report on Youth Violence views
violence from a developmental perspective. The developmental
perspective has enabled scientists to identify two general onset
trajectories of violence: one in which violent behaviors,emerge
Purchase Order: 01M00872801D
Attachment A

before puberty, and one in which they appear after

early onset trajectory shows stronger links between childhood
factors and persistent, even lifelong involvement in vlolknce
behavior, (page viii, Executive Summary, Surgeon General 'is Report
on Youth Violence, 2001). 1
i
These important research findings need LO be dissemlnatedl to the
American public and CMHS has lahched a major communicati(ons
campaign to inform parents and other caregivers of childqen and.
1
youth about activit-ies they can take to decrease violence.
1
PURPOSE :

The goal of this project is to design a minimum of two p$oducts

n
to be made available to the public-at-large, based on cuyrent and
relevant bullying and anti-bullying research in the field. The
products will be designed as complimentary products to odher
I
media-based work currently being conducted by CMHS on youth
violence prevenQiqn and anti-bullying strategies. These Iproducts
will have messag& about School and Youth Violence Prevention and
Anti-Bullying Strategies to be piloted locally and then <or use
nationally to advance the goals and objectives of the CMHS Antl-
I
Bullying Initiae-ive ,
l
STATEMENT OF WORK:
. .*

Specifically, the Contractor shall:

I
1. ~ e v i e wexisting information about public perceptions on
b u l l y i n g a n d - i t s - r e l a t i o n s h i p to children's mental health and
/ ...
. .

. . - - - - .. .
school/youth violence. i
1
2. Utilize the above information to develop, write and provide a
graphic design for a minimum of two separate products -
parents and one for youth - on ways to communicate about1llnate
concept of bullying and strategies to reduce and/or elim!,'
peer to peer bullying. :I
the

..-,. .
re
I!I/
Using the information gathered above, as well as in-deptih
knowledge of communication strategies, the Contractor &all Il
review the data and craft unique messages suitable for p;utting on
print materials. The Contractor shall pre-test these me\ssages
with the target audience (s), revise and provide CMHS witllh
1
relevant designs of effective messages and medium to mee,t the
needs of the target audience(s). A certain amount of f1;iexibility
will be critical to the success of this work. It is beqieved
that research information may also suggest other elemenes
1"
Purchase Order: 01M00872801D
Attachment A

essential to building awareness and to motivating for behavior I

change. The Contractor will build in the ability to respbnd to
these ideas within the context of the scope of work. !/
1I
3. Finalize the messages and develop the graphics for the final
product(s). The Contractor will not be required to print the
products under this acquisition. I
I
I
1
4. Once messages are crafted and reviewed by CMHS for accuracy.
and input, the Cont-ractor shall develop the final camera-Leady --
graphics needed to produce the final products. -
.- I
-. I - 7 7

I
5. Develop a final report providing data and information'l on the
research, design and implementation phases of the overall
communication activities. This report will be provided t,o the I
Project Officer (PO) in hard copy and electronically in 1
I
WordPerfect 6.0 or higher.
I,
General Requireypegts: 11
-'\%

I1
1
Independently, and not as an agent of the Government, the
Contractor shall exert its best efforts and furnishlithe
i
necessary-pers.~~nelto perform the work set forth below.
IY
All work under this project shall be monitored by the
Prolect Officer. All work will be submitted to thel~0-ir.I
Wordperfect 6.0 or higher format. 1
II
All -reports,graphics and products developed and.pr&duced ... ..
under this project shall be the property of the ~overnment
which includes the Center for-Mental Health service6 -. (CMHS-
and the Substance Abuse and Mental Health Services
Administration (SAMHSA). SAMHSA and CMHS may utilize,
1
print, or disseminate such materials without further charge.
I
Specific Requirement:

Task 1: The Contractor shall develop a detailed work @an

I to
1
meet the goals of this contract and to carry out its
specific, delineated tasks. This plan must specify
- available resources to be utilized and include1 a
detailed projected schedule of all activities ,;tobe
undertaken under this contract. 1
a. At a minimum the work plan shall describe: a
proposed strategy for reviewing informati':on
I! for
I
Purchase Order: 01M00872801D
Attachment A

the message development, appropriate

graphic design of final products.

b. /
A work schedule showing specific tasks, including
the delivery of specific product (s), i.e. Lesearch
IF
information analysis, messages creation, flramework
for producing messages necessary to cornplebe the
project, personnel assigned to each task,
project completion dates of each task.
1I
--
c. The Caaractor shall meet with the Pa-eitli_.z in
person or telephonically to review the work plan.

d. Within one week of meeting with the PO, the I

Contractor shall revise the work plan to 1 1
incorporate comments from the PO.
I/ to
i
Task 2: The Contractor shall review existing informati0,n
deter@ne messages and perceptions with key audiences,
i.e. $@ents/caregivers and youth are seen as dey
target audiences. This information will be compiled in .-
1
summary form for inclusion in the final product! report.
-I-4--. .
1- - 1
1
-.
Task 3: The Contractor shall review the information gat3hered in
'I
Task 2 and craft actual messages to be tested and
.. -
revised for final actual messages.
I
- --
* -I
Task 4: The Contractor shall collaborate with CMHS on final
I
-review of messages and materials development format.
Once approved the contractor will create the g:aI phic
design and lay-out, pre-test, make revisions and -
I
-
provide final graphics in reproducible form forI
production. The contractor will not be required to
reproduce these materials. I
Task 5: The Contractor shall provide a final report to
on the activities undertaken in this contract.
..-..
DELIVERABLES:
NUMBER DUE DATE AFTER
ITEM - DESCRIPTION OF COPIES CONTRACT AWARD
1
/I
Task 1 Develop Work Plan 3 2 weeks
I

Task 2 Complete Information

Gathering Phase
 I

Purchase Order: 01M00872801D Page 5 b f

Attachment A
1~

Task 3 Develop concepts/ 10 weeks

i
.messages
.-

Task 4 Develop graphics with

messages 16 weeks
I
Task 5 Write final reports 20 weeks
..

PERIOD OF PERFORMANCE:

The anticipat~edp.e,riad..of performance is September 17.,....&Q . ..1.

. .

through February 4, 2002, approximately a 20 week period.,

I
PROJECT OFFICER:

Louise Peloquin, Ph.D.

Center for Mental Health Services
Special Programs Development
5600 %is-hers Lane, Room 17C-05
~ockvi??fe, Maryland 20857
Tel: (301)443-3898
FAX: (301)443-7912
Emaih .Lpeloqui@sarnhsa.gov

The Project Off ice will provide no supervisory or instruJtiona1

- -- ,- . ..
.-
assistance to contractor personnel. The Project of~icef's
1
function is primarily to provide the Contractor with working
data. The Project Officer is not empowered to make any -.

commitme.nt-s,
nor authorized to make any changes which affect
- 1
.- ...
..

prices, terms, or delivery as specified in this order. Any such

proposed changes -shall be brought t o the immediate afttnfiOriof.--
the Contracting Officer for action. The acceptance of ady
changes,by the Contractor without specific approval and written
consent of.the Contracting Officer will be at the contra$torls
own risk. I

1
PAYMENT SCHEDULE:
-..a. ..

Five equal partial payments of $4,999.80 each are authorjzed

after completion and acceptance by the Project Officer of Tasks
1-5 for a total contract amount of $24,999.00. I

The Contractor shall submit invoices, in an original and two (2)

copies to the PO. The Project Officer shall submit the lnvoice
and a signed receiving report to the Program Support Center,
I
I
Purchase Order: 01M00872801D
Attachment A

Financial Management Service, Division of Financial Operapions,

Parklawn Building, Room 16A-12, 5600 Fishers Lane, ~ockvible,
I
Maryland 20857, Phone: (301)443-3020 for payment. i\
Invoices shall inclidk the following minimum information:I
a Contractor's name and address 'I
a Purchase order number
a Description of the services and price I1

a Invoice period . - . .-

a Cqntractor's:Inte~nalRevenue Service "Tax dent if iiation -

.--
...
Number" (TIN)
it
INSPECTION AND ACCEPTANCE:

..ThePO as a duly authorized agent of the ordering/contrac~ing

officer is responsible --forthe review and acceptance of ail1
I
.?I

FEDERAL A C Q U I S I ~ ~REGULATION
B (FAR) 5 2 . 2 5 2 - 2 CLAUSES I
INCORPORATED BY REFERENCE ( FEB 19 9 8 )

This contract.-j-aco.rp~ratesone or more clauses by reference, with I

the same force and effect as if! they were given in full qext.
Upon request, the Contracting Officer will make their full text - -- .

available. ~ l s o ,the
. full text: of a clause may be a>cessled
electronically at this address: htt~://www.arnet.aov/far
.. -...
52.21'3-4 -... Terms and Conditions - Simplified - 1
,. . ..
.. - :

Acquisitions - -
(Other Than Commercial Items) (MAY 200~1)
II
il
52.243-1 Changes-Fixed Price (AUG 1987), Altennate
(APR 1984)
 1r
I

,:.,,.?.
I
AMENDMENT OF SOLlCrrATlONlMODlFlCATlON OF CONTRACT I. CONTRACT ID CODE 1 PAGE Of PAGES
I

5 PROJECT NO (If applicable,

II
000001 l ~ e eBlock 16C X
6 ISSUED BY CODE 7 ADMINISTERED BY ((Idher than Item 6)
~ADP 1

II
DHHS/PSC/AOS/DAM/ADP ACQ. DHHS/PSC/AOS/DAM/ADP
PARKLAWN BUILD ING, ROOM 5-95 PARKLAWN BUILDING, RM 5-95
5600 FISHERS L A N E 5600 FISHERS L A N E
ROCKVILLE MD 20857 ROCKVILLE MD 2 0857

I
8 NAME AND ADDRESS OF CONTRACTOR (No sreer county. S f a and
~ ZIP Code) (x) 9A AMENDMENT OF SOLICITATION NO

SOCIAL & HEALTH SERVICES, LTD

Attn: RAY QUALLS 90 DATED (SEE ITEM 1 1 )
:I
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 20852

.- . . ..- -. I

-
CODE
i
.? 4 - .
.. .
I FACILITY COW- .
100. DATED (SEE ITEM 1 1 )

09/15/2001
-
. , . - it-
:I.
I
. .

-
~

I./ ( '

11.THlS ITEM ONLY APPUES TO AMENDMEWS OF SOUCITATIONS II

2 The above nurrbered sd~alalron1s amended as set forth in Item 14
he hour and date ~ e of Offers
~ for receipt d G 1s eaended -1s not einended -
Offem must adtnmedge rempt of th~samendment pnor to the hour and date speofied In the sdiolalron or as amended, by me ofh e fdlomng methods (a) By cziqX:etlng
I t w 8 and 15. and returning copes of the amendmen!. (b) By a d t n d e d g n g recap1 of thls af'nendmenl cn each copy of the offer subrntted, or (c) By
separate letter or telegram v h ~ c hlndudes a reference to the s d ~ a l a l mand amendment numbers FAILURE OF YOUR ACKNOWLEDGEMEM TO BE RECEIVED AT
M E PLACE DESIGNATED FORTHE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If bJ
nrtue of mls amendment you deslre to change an offer already subrntted, wch change m y be made by telegram a lener, pfunded each telegram or letter makes
reference to the sollatatton and thls amendment, and IS recelved pnor to the openlnq hour and date specmed
12 ACCOUMING AND APPROPRIATION DATA (Ilrequrred)
I
13. THlS ITEM ONLY APPUES TO M~&J,I,oN
OF CONTRACTSIORDERS. MODlFlES THE CONTRACTIORDER NO. AS DESCRIBED IN ITEM h.
!Id
CHECK ONE
A THlS CHANGE ORDER IS ISSUED PURSUANT TO: (Speefyauthority) THE CHANGES SET FORTH IN ITEM 14 ARE W D E IN THE CONTRACT
ORDER NO. IN ITEM IOA.

I
I
8. THE ABOVE NUMBERED CONTFUCTiORDER IS MODIFIEDTO REFLECT THE ADMINISTFUTNE CHANGES (such as changes in paying ofcie.
appmpnaf~ondate e k ) SETFOWWlM ITEM ICPURSUANT TO THE AUTHORITY OF FAR 43103(b).
/
!I
4,
.

C. THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

. . . . . .. .-

I D. OTHER (Specify type olmodifrcaflon and aulhorify)

iI
X I
FAR 52.213-4(e) Terms and Conditions--S irnplified Acquisitions. . . . . . 'I
E. IMPORTANT: Conmctor 1s not 3 1s requ~redto rgn th~sd m m e n l and return copes to h e lssulng ofice R
14. DESCRIPTION OF AMENDMEM/MODIFICATlON (Organized by UCF sedion headings, ~ndudrngsoliafation/mnffad subject maner where leasrble.)
T a x I D Number: - - - ..
D U N S Number.:

T h e above referenced purchase order i s modified t o extend the period of performaice at no

.. .
additional cost.

T h e period of performance is changed from September 1 7 , 2001 through February 4 ,

September 17, 2001 through September 3 0 , 2002.
.. -- 1
T h e anticipated due date for each t a s k shall be revised by mutual agreement b e t w ~ e nthe
Project Officer and the Contractor. T h e Payment Schedule remains consistent witfi
Continued . . '. 1
Except as provlded heren an terms and umd~t~ons
of the document referenced In ltem 9A M IOA, as heretofore changed, remlns unchanged and In full force and effeCl(
15A NAME AND TITLE OF SIGNER (Type or pnnf) 16A NAME AND TITLE OF CONTRACTING OFFICER (Type or pnnt)
1
MARIE L. SUNDAY I
158 CONTRACTORIOFFEROR 15C DATE SIGNED 168 UNITED STATESOF AMERICA 16C DATE SIGNED
I
'jAIGIEi;. Ld'. ;.L_ 1
03~01~200,
(Sgnahrre dpermn surnonzed wnl (S~gnehned Conwamng O m e r ) 1
NSN 7540-01-1528070 STANDARD FORM'% (REV 1083)
Prenous edLm unusable Presmbed by GSA(/
FAR (48 CFR) 53.2$3
 j
REFERENCE NO OF DOCUMENT BEING CONTINUED AGE OF
CONTINUATlON
01M00872801D/O 00001 PI ..
NAME OF OFFEROR OR CONTRACTOR
AMENDMENT OF SOLlClTATlONlMODlFlCAllON OF CONTRACT
1 CONTRACT ID CODE / PAGE O F
I PAGES

2 AMENDMENTMDIFICATION NO
I l l -3
3 EFFECTIVE DATE 4 REOUIS1TK)NPURCHASEREQ NO 5 PROJECT NO (If applrcaue:
I
0002 I I I

6. ISSUED BY CODE 7 ADMINISTERED BY (If orher fhan nem 6) CODE

ADp ADF
I
DHHS/PSC/AOS/DAM/ADP ACQ. DHHS/ PSC/ASS/DAM/AD?
PARKLAWN BUILDING, ROOM 5-95 PARKLAWN BUILDING, RM 5-95
5600 FISHERS LANE 5600 FISHERS L A N E li
ROCKVILLE MD 20857 ROCKVILLE MD 2 0857
I

!I
8. NAME AND ADDRESS OF CONTRACTOR (No.; meer am&.Iate m d Z 2 , P ) (x, 1 9 ~AMENDMENT
. OF SOLICITATION NO
),

SOCIAL & HEALTH SERVICES, LTD.

Attn: RAY QUALLS 90. DATED (SEE ITEM 11)

11426 ROCKVILLE PIKE, SUITE 100

ROCKVILLE MD 2 0852 I
10A. MODIFICATIONOF CONTRACTIORDER NO. I
01M00872801D
1i
- 108. DATED (SEE ITEM 11)
.-?..-- . .. ..-,:
I
-. .
, .
CODE
1 ,., FACILKY CODE
09/15/2001
- t
L:;
I I I I
11. THlS ITEM ONLY APPLIES TO AMENDMENTS OF SOLlClTAllONS
I

- -
7The above numbered sollotason IS amended as set forth h Hem 14
- The h w r and date speofied for recapt d ORers -1s extended - 1s not enended
Offers must acknowledge rempt of this amendment p n a lothe hour and date speafied In the sd~olabona as amended, by one d the f d l m n g methods (a) By ~ a n p l d t l n ~
Items 8 and 15. and relumlng copes ol me amendment, (b) By acknowledging recept d mls amendment m each copy of the Dner subrntted. or (c) By
separate letter a telegram wh~chlndudes a referenceto me s d ~ a l a t ~and
m amendment numbers FAILURE OF YOUR ACKNOWLEDGEMEM TO BE RECEIVED AT3
THE P U C E DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by
n m e of l h ~ amendment
s you d a r e lo change an Dner already subnuneLsuch change may be made by Wegam a letter, pmnded ea& telegram or lener makes
reference to the sotlulat~onand this amendment, and 1s reaelved Dnor to the openlnq nour and date speuPed 1
12 ACCOUMING AND APPROPRIATION DATA (If rqurred)
See Schedule ,,.
13. THlS ITEM ONLY APPLIES TO MO~I&ION OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTIORDER NO. AS DESCRIBED IN ITEM 11
- . -

A. THlS CHANGE ORDER IS ISSUED PMRSUANT TO: (Spwwfyauthorify) THE CHANGES S E l FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NO. IN ITEM 10A.
I

II
I
B THE ABOVE NUMBERED COP11&46.V0l?DERS MODIFIED TO REFLECT THE ADMlNlSTRATNE CHANGES (such as changes m payng oflice.
appmpnabon dale. efc) SET FORTH IN ITEM 14. PURSUANT TO THE AUTHORITY OF FAR 43.103(b)

C. THlS SUPPLEMENTALAGREEMENT IS ENTERED INTO PURSUANT TO AUTHORKY OF:

I!

I D. OTHER (Speufy type of rmMcalion and authority) I

X I FAR 52.213-4(e) Terms and ~ o n d i t i b n s - - Simplified Acquisitions. . . . . . !
E. IMPORTANT: Conlrada is m t . D is required to sign this document and retum coples to the lssulng office
il
14. DESCRIPTIONOF AMENDMENT/MODIFICATION(Olganized by UCF sedron headings, induding sd;&alionr'mnfrad subject maner m e r e feasrble.)
T a x ID Number:
DUNS Number:
T h e above referenced purchase order is modified to extend the period of performance at no
I
additional cost.. .

Verbal authorization for the extension was provided Ray Qualls, Social & Health Services,
Ltd by Marie L . Sunday, Contracting/Ordering Officer.
li
T h e period of performance is changed from September 17, 2001 through September 3.4, 2002 t o
September 17, 2001 through September 30, 2003.
I

Continued . .. ,.
Except as prmded herein, all t d t h e document referenced in Hem 9A a 1 0 4 as heretdae changed, remins unchangedand in full faceand effect,
w and cond~t~ons
1%. NAME AND T I R E OF SIGNER (Type cfprint) 16A. NAME AND TITLE OF CONTPACTINGOFFICER (Type a o n n i )

156. CONTRACTORlOFFEROR 1%. DATE SIGNED

.~
168. UNITED STATES OF AMERICA 1% DATE SIGNED

iRlGl@; &G?,:.J:.-: - ?1/14/2002

(jpnalvre ol p e r m eumonzed to upnJ ~~unalure
ol ~oraaccino A
NSN 754041-1528070 STANDARD FORM 30 (REV. 1083)
P r e n w s edition unusable Prescribed by GSA]
FAR (48 CFR) 53.243
 11
CONnNUAT'ON SHEET
REFERENCE NO OF D O C U M E U BEING COFFTlNUED
01M00872801D/O 002
NAME OF OFFEROR OR CONTRACTOR
I AGE

P2
OF

-
 1. CONTRACT ID CODE 1 PAGE
:I
051 PAGES
AMENDMENT OF SOLlCITATlONiMODlFlCATlON OF CONTRACT

1 4. REQUISITIONPURCHASEREQ
I i I 9
L

2. AMENDMENTlMODlFlCATlON NO 3 EFFECTIVE DATE NO )5 PROJECT NO/(I1app"caWe)

0003 1 1f
6 ISSUED BY CODE 7 ADMINISTERED BY (IIaher than Hem 6)
ADp 'ODE ~ADP j

1
DHHS/PSC/AOS/DAM/ADP ACQ. DHHS/PSC/AOS/DAM/ADP
PARKLAWN BUILDING, ROOM 5-95 PARKLAWN BUILDING, IUn. 5-95
5600 FISHERS LANE 5600 FISHERS L A N E I
ROCKVILLE MD 20857 1 ROCKVILLE MD 2 0857

i
I
8. NAME AND ADDRESS OF CONTRACTOR (No.. sweer, counw. Sfae mdZIP Code) 9A. AMENDMENT OF SOLICITATIONNO.
. (x)
SOCIAL & HEALTH SERVICES, LTD.
Attn: RAY QUALLS
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 20852
1 0 ~MODiFlCATlON
. OF CONTRACTIORDER NO.
01M03872801D
I'
- . I
- - (100 DATED (SEE ITEM 7 7 ) I
CODE
- i? 4
V I
~ -
I FACILITY c~DE-
.
- 1
I
09/15/2001
__._
-7:
I .-
.- - -

11. THlS ITEM ONLY APPUES TO AMENDMENTS OF SOUCITATIONS

-
3 T h e above numbered sollatabon 1s amended as set fcdh ln Item 14 The h w r and date speofied for recetpt of ORw j l s extended 3 1 snot ehendea
Offers must acknowledge r e w p t of th~samendment p n a to the hour and date speaf~edIn the sdlatabon or asamended, by one of the tdluung methods (a) By mmplkng
Items 8 and 15 and retumlng a p e s of the amendment: (b) By advlmledg~ngm p t d lhls anendmnt on each m p y of the offer submlled, a (cj By
separate lener a lelegram wh~ch~ndudesa reference lo h e soltatallon and amendment numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVEDAT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER Ifby
1
urlue of this amendment you derre to change an offer already submned. w c h change m y be made by telegram alener, prouded each telegram or lenermkes
reference to the soliatation and this amendment, and is rewfved pnor to me openinq hour and date specilied.
11
12. ACCOUKTING AND APPROPRIATION DATA (Ifrequired) I
See Schedule I

,
13. THlS ITEM ONLY APPUES TO MO~I&ION OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTIORDER NO. AS DESCRIBED IN ITEM 14.

A THIS CHANGE ORDER IS ISSUED PURSUAKT TO: ( S p e w authonfy) m E CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NO. IN ITEM 10A.

.
I
0. THE ABOVE NUMBERED C O ~ U O B D E MODIFIED R ~ TO REFLECT THE ADMINISTRATNE CHANGES (su& as changes in payrng oflie. . . ..
app-c,?nalIcm date, ek.) SET FORTH IN ITEM 14. PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type olmodification and authority)

I
X I FAR 52.213-4(e) Terms and conditions--~implifiedAcquisitions.. . . . .
E. IMPORTANT: Conlraclor is not. !2is requ~redto stgn this document and return a p e s to (he issuing office.
.-. .
14. DESCRIPTION OF AMENDMENTIMODIFICATION (Organized bv IICF seclion headings, Induding soliutalfm/amtrad subject matter M e r e IeasIble.)
- I
T a x I D Number: -- .. ....
DUNS Number:
T h e above referenced purchase order is modified t o extend the period of
additional cost ., ,

T h e period of performance is changed from September 17, 2001 through September 30, 2003 t o
I
September 17, 2001 through March 31, 2 0 0 4 .

T h e anticipated due date for each task shall be revised by mutual agreement-between the
Project Officer and the Contractor. T h e Payment Schedule remains consistent with
completion and acceptance of the each task. '.
Continued . . .
Excepl as provlded heran, a i l l e m and condit~onsof the document r e f e r e n d In Item 9A or IOA as heretoforechanged, r e m i n s unchanged and In MI force and effect!
15k. NAME ANDTITLE OF SIGNER pwecwpnnt) 1 6 A NAME AND TITLE OF CONTRACTING OFFICER (Twe orpnnij
I
15C. DATE SIGNED 168. UNITED I

Previa~sedltton unusable Presaibed by GSA~

FAR (48 CFR) 53.243
 'I

cONTINuATlON SHE"^ REFERENCE NO. OF DOCUMENT BEING CONTINUED

01M0072000DD/0 0 0 3
NAME OF OFFEROR OR CONTRACTOR
AGE OF

SOCIAL & HEALTH SERVICES, LTD.

FAR';^^ CFRl 53 110

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT
1. CONTRACT ID CODE I PAGE OF PAGES
I 1 1 1
I
-
2. AMENDMEMIMODIFICATION NO., 3 EFFECTIVE DATE 4. REOUISITK)N/PURCHASER M . NO. 5 . PROJECT NO( (If apcJrcdbie:
0004 1
6. ISSUED BY CODE
mp 7. ADMINISTERED BY (If other than Hem 6 )
CODE Imp :I

I
DHHS/PSC/AOS/DAM/ADPACQ. DHHS/PSC/A@S/ DAY/ADF
PARKLAWN BUILD ING , ROOM 5- 95 PARKLAWN BUILDING, RM 5-95
5600 FISHERS LANE 5600 FISHERS LANE
ROCKVILLE MD 2 0857 ROCKVILLE MD 20857

I I
8. NAME AND ADDRESS OF CONTRACTOR ( N o . sweet county. Sob andZlP Code)
. . (XI
9A. AMENDMENT OF SOLICITATION NO.
'I
SOCIAL & ,HEALTH SERVICES, LTD.
11426 ROCKVILLE PIKE, SUITE 100
ROCKVILLE MD 2 0852
I
10A. MODIFICATIONOF CONTRACTIORDER NO.
01M00872801D
-
-
CODE
-
I
i1 -I
. - , -
CODE
FACIL~
:,- lOB.DAED(SEEITEMf1)

09/15/2001 --
I

. .
.- .

11. THlS ITEM ONLY APPUES TO AMENDMENTS OF SOUCITATIONS I

3 The above numbered sd~olationis amended as set forlh'ln Item 14. The h w r and date speafied for receipt of Offers is enenaed
2 1 snot &ended
Offers must ackncmledge receipt of this amendment p n a to the hcur and date rpWrted in the sdidlation or as amended, by ooe d the f d l w n g methods: (a) By cand/elfng
Items 8 and 15. and relumlng a p e s of h e amendmenl: @) By acknmledg~ngreceipl of lhls amendment on e a d copy of the offer subrntted: or ( c ) By
separate letter a teiegram which indudes a reference 10me s d ~ d l a l i maniamendmenl numbws. FAILURE OF YOUR ACKNOMEDGEMENT TO BE RECEIVED AS
M E PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO M E HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If b i
rime 01 this amendmenl you desire to mange an Mer already submined, wch change may be made by wegram or letter, pronded earn teiegram or lener makes
reference to the solicitation and this amendment, and IS received pnor to me openinq hour and date specfied ,I
12. ACCOUNTING AND APPROPRIATION DATA (If repu'red) 1
I
See Schedule
13. THlS ITEM ONLY APPUES TO M&I$~TIoN OF CONTRACTSIORDERS. IT MODIFIESTHE CONTRACTIORDERNO. AS DESCRIBED IN ITEM 14.

ONE A M I S CHANGE ORDER IS ISSUED-PURSUANTTO: (SpwWfyauthority)THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NO. IN ITEM 10A.

' 1
I
B M E ABOVE NUMBERED C O b l l Z A X l O R D W S MODIFIED TO REFLECT THE ADMINISTRATWE CHANGES (such as changes In payng ofice.
appmpa11on dale. etc ) SET FORTH IN ITEM 14. PURSUANT TO THE AUTHORITY OF FAR 43 103b)
I
1 C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANTTO ALITHORm OF: ;II
. - 1 - --
I D OTHER (Speafy type of mod~iicabonand authority)

X I FAR 52.213-4(e) implified Acquisitions. . .

Terms and conditions--~ . . . ' 1I
E. IMPORTANT Conlrada 1s not IS requfred to rgn t h ~ sd m m e n l and relum mpes to h e lssutng ofice 1
14 DESCRIPTION OF AMENDMEM~MODIFICATION(Oganrzed by UCF s d m n headings, mdudtng solrc!tatron/mntmd sutyed m n e r m e r e feas~ble) - 1
Tax ID Number . . - -- 1- .+ . .. ,I
--. ~. .-

DUNS Number:
'~
The above referenced purchase order is modified to extend the period of performance at no
additional cost and to incorporate manadatory clause changes that were effective:December
31, 2003.

1. The perlod of performance is changed from September 17, 2001 through March
. I
'I
September 17, 2001 through July 30, 2004.

2. The anticipated due date for each task still to be completed shall be revised by mutual
. - . I - -.I
,I
agreement between the Project Officer and the'contractor. The Payment Schedule :remains
Continued . . . _
Except as provided heren, all I- and ca~d!lionsofthe document referenced In Item 9A or 1 0 4 as heretdae danged, remtns unchanged and In h l l forceand effedt
15A NAME AND TITLE OF SlGhER (Type crpnnl) 16A NAME AND TITLE OF CONTRACTING OFFICER ( T m orpnnti

150. CONTRACTORIOFFEROR I 15C. DATE SIGNED

MARIE L. SUNDAY
168. UNITED STATES OF AMERICA
'I
I 1,;6C.DATE SIGNED
(Slpnatun dperpn eumonzed m wnl
3f11G1h1.
(Slpnafure d COn8acMo Cffi=erl
,"-L
Lm II
I /'9/03/2003
I

NSN 7540-01-1528070 STANDARD FORM 30 (REV 1083)

Pr&ws edition unusable
 !I
REFERENCE NO OF DOCUMENT BEING CONTlNUED
CONT'NUAT'ON SHEET
01M00872801D/O 0 0 4
- --
-
NAME OF OFFEROR OR CONTRACTOR :I
SOCIAL
ITEM NO.

(A)
& HEALTH SERVICES, LTD.
SUPPLIESSERVICES
(B)
OUANTITY UNIT

(C) (0)
UN.PRICE

(E)
/I AMOUNT

(F)
c o n s i s t e n t w i t h c o m p l e t i o n a n d a c r e p t a n c e o f t h e e.ich t a : k .

3 . C l a u s e 9 2 9 , P a g e s 3 a n d 4 o f 4 , O p t i o n a l Form 3 4 6 o f t h c 0 r l g i n a 1 ' 0 r
modified t o :
- .
..

a. D e l e t e "FAR C l a u s e 5 2 . 2 3 2 - 3 4 P a y m e n t b y E 1 e c t : : o n i c E'uncs T r a n s f e r -
. I.
Central Contractor Registration (!,lay 1 9 9 9 ) " a n d t i e f o 1 : o w i n q s e c t i o n w 15:: sc;r:s
w i t h " N o t i c e . . . . . . . t h r o u g h . . . . . . . N::H - - - - - M i c h e l l e S o d c e r
( 3 0 1 )496-6088."
.
b. Add FAR C l a u s e s 5 2 . 2 0 4 - 0 7 Cent-ra-l_ C o n t r a c t o r 1 : e g i s t r a t i o ~ ( O c t o b e r
A l t e r n a t e I ( O c t o b e r 2 6 3 ) a n d 52.232-23 P a y m e n t b y E l ~ c t r o n i cF u n d s T
. .
I.-
. ,
C e n t r a l Contractor Rggistfafion -(October 2003).

4. A l l o t h e r t e r m s a n d c o n d i t i o n s o f t h e p u r c h a s e o r d e r relrain unchanaeci.

P e r i o d o f P e r f o r m a n c e : 09/17/2.001 t o 07/30/2004

. . . .

..... - .... .- -

....................

. . . . . . .

NSN 754041-151-8087 ~PTIONUFORM 33E 14-86)

~ b - r a d by GSA
FAR U 8 CFR153 110
I
 I
ORDER FOR SUPPLIES OR SERVICES 1 PAGE OF PAGES
IMPORTANT: Mark all packages a n d papers wkh c o n t r a c t andlor o r d e r numbers I I I i
1 DATE OF ORDER 2 CONTRACT NO (If any) 6 SHIP TO 1
09/15/2001 a NAME OF CONSIGNEE 1

1
1
3 ORDER NO 4 REQUISITDNIREFERENCE NO
HHS/SAMHSA/CMHS/SPDB
I OMB No. 0993-01 i
01M00879601D 01M008796
I
5 ISSUING OFFICE (Address OrYreSpMdenoe lo) b STREET ADDRESS
DHHS/pSC/AOS/DAM/ADP ACQ. PARKLAWN BLDG, ROOM 1 7 C - 0 5 I

PARKLAWN BUILD I N G , ROOM 5 - 95 5 6 0 0 F I S H E R S LANE

5 6 0 0 F I S H E R S LANE ATTN: M. COWAN, 3 0 1 - 4 4 3 - 4 1 1 4
ROCKVILLE MD 2 0 8 5 7 1
c. CITY / d. STATE ' e. ZIP CODE
ROCWILLE !I 1 MD 7 n s ~ -

'.TO: R A Y QUALLS f. SHIP VIA

a NAME OF CONTRACTOR
SOCIAL & HEALTH S E R V I C E S , L T D . 8 TYPE OF ORDER 1
b COMPANY NAME a PURCHASE I 11 b DELIVERY .
c. STREET ADDRESS
1 1 4 2 6 ROCKVILLE PIKE, SUITE. 1 0 0
. ~

- --
. - REFERENCE YOUR:
.
I
Except ta b~lllng~nstmc(Tmsm the
I .-
. .

:. ...
--
, ilns ael~very order IS
x t o insmdicas mtainec on
l h d side m l y d this I- and is
Please furnish the M l e n g on the l e m s id?ed wbjecl lo the terms and
and m d ~ t i w speafied on both sides of a+d~t~omof the abow-numbered
this ader and m me attached Sh.33B. rf ogtraa.
d. CrrY e. STATE I.ZIP CODE
any, including delivery as ~nd~cated.
ROCKVILLE MD 20852
9. A C C O U ~ I N GAND APPROPRIATIONS DATA l o . REQUISITLONING OFFICE
'I
7511362 HHS/SAMHSA/CMHS I
11. BUSINESS CLASSIFICATION (Check appmpnatebox(es))
G a. SMALL .r'
. .
b.OlHERTHANSMALL r, c. DISADVANTAGED
.-I
-I ' d. WOMEN-OWNED

12. F.O.B. POINT Destination 14. GOVERNMENT BD

I NO. 15. DELIVER TO F.O.B. POINT 16. DIYWNTTERMS

1
.. ON OR BEFORE (Date) . -
13. PLACE OF
01/16/2002 Net 30
a. INSPECTION I b. ACCEPTANCE
~estination IDestihattur -'- 'I
I - . . .. . --:

17. SCHEDULE (See reverse for Rejedions) :I

ITEM NO. SUPPLIES OR SERVICES
QUANTITY
ORDERED UNIT
UNIT
PRICE ..--
'I
A M O F T : - - -- --
QUANTITY
ACCEPTED
(a)
Tax I D Number
DUNS N u m b e r :
(b)

\7 4
CAN: C 9 6 C 0 5 1 0 b j . C l a s s : 2 5 2 2 FY: 2 0 0 1
(c) (d) (e) (0 I

1 (9)

. . ..
..
P e r i o d of P e r f o r m a n c e : 0 9 / 1 7 / 2 0 0 1 t o 0 1 / 1 6 / 2 3 0 2
D e l i v e r y L o c a t i o n Coder- P 1 7 C - 0 5
HHS/SAMHSA/CMHS/SPDB
.. .. ~ 1
-*.>. ..-.

Continued ;..

1 . . 1 I I 1 I 1
18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT M . INVOICE NO. 17(h).
TOTAL

7-=--,
21. MAIL INVOICE TO.

PSC/FMS (3011 443-3020

a. NAME
PARKLAWN B U I L D I N G , ROOM 1 6 A - 1 2
, ..
I 2 4 , 911.00
...
SEE BILLING
INS7RUCTIONS b. STREET ADDRESS 5 6 0 0 FISHERS LANE
O N REVERSE (or P.O. Box) ROCKVILLE MD 2 0 8 5 7
1 GRAND
TOTAL

d. STA'rE e. ZIP CODE

4
22. UNITED STATES OF AMERICA
BY (Sgnature)
.
flRIGINRi ~ G I E D
1 23. NAME ( T W )
1
I
MARIEL.SUNDAY
T l n E CONTRACTlNWORDERlNG OFFICER
~
NSN 754Wl-tU4fb33 1J O P T O W L FORM LU7 I& -5)
, R-~OS**ARI~~FRIUII~.I
PREVIOUS EDITION NOT USABLE
CONTRACT NO. (if a n y ) p2,G: 2 37 ;
SUPPLEMENTAL INVOICING INFORMATION I
'I provided
If desired, this order (or a copy thereof) may be used by the Contractor as the Contractots invoice, instead of a separate invoice,
the following statement. (signed and dated) is on (or attached to) the order: 'Payment is requested in the amount of $ 1 . No
other invoice will be submitted.' However, a the Contractor wishes to submit an invoice. the following information must be provi'ded;
I
contract number (if any), order number. item number(s), description of supplies or service, sues, quantities, unit prices, and extended
totals. Prepaid shipping costs will be indicated as a separate item on the invoice. Where shipping costs
post), the billing must be supported by a bill of lading or receipt. When several orders are invoiced to an
billing period, consolidated periodic billings are encouraged.
RECEIVING REPORT i
Quantity in the 'Quantity Accepted' column on the face of thi; order has been: inspected. acckpted. received
by me and conforms to this contract. Items listed below have been rejected for the reasons indicated. . -
SHIPMENT PART'AL I DATE RECENED SIGNATURE OF AUTHORIZED U.S. GOVT REP.
NUMBER FINAL I
TOTAL CONTAINERS ( GROSS WEIGHT 1 RECENEDAT
I 1
REPORT OF REJECTIONS !I
QUANm I
ITEM NO. SUPPLIES OR SERVICES UNIT REASON FOR REJECTION
- . . : ..* REJECTED
I

O P ~ O N A LFORM 347 (Rev. U95) (BACK)

 ORDER FOR SUPPLIES OR SERVICES AGEor PAGES

SCHEDULE CONTINUATION - 1 ;
IMPORTANT: Mark all paekages and papers with mntrad andlor order numbers
DATE OF ORDER
09/15/2001
CONTRACT NO. ORDER NO.
01M00879601D I
ITEM NO.

(A)
SUPPLIEYSERVKES

PARKLAWN BLDG, ROOM 17C-05

(B)
QUANTI'TY UNIT
ORDERED
(C) (D1
UNIT
PRICE
(E) (F) #I OUANTIlY
ACCECTES
(Gi

5600 FISHERS LANE

ATTN: M. COWAN, 301-443-4114
ROCKVILLE MD 20857
. -
..

For information or assistance call Marie L. Sunday. (:!01)443-7081 o r Email:

msunday@psc.gov

PROFESSIONAL SERVICE
- ..
..
. . . --
See Attachment A, 7 Pages, for the Statem
conditions.

Disregard information in Block 21 of Opti

A, "Payment and Invoicing ~rovikions"for

922 PARTIAL PAYMENTS

Recurring service -,Pactial payment autho
FAR 32.102 (D). \>,

. .. . -
929 INVOICE INFORMATION/CLAUSES INCORP
. ,..A. . . -. ... ,
.-<. == <.
1. INVOICE INFORMATION
In addition to the information required by
must contain the foliowing: f ax
Number) or Social Security Number.

2. CLAUSES INCORPORATED BY REFERENCE (FAR

This contra& incorporates one or more
effect as if they were--givenin full text.
will make their full text available. Also,
accessed electronically at this

FEDERAL ACQUISITION REGULATION

FAR 52.232-34 PAYMENT BY ELECTRONIC FUNDS

REGISTRATION (MAY 1999)

NOTICE. . .
IN ACCORDANCE WITH THE REQUIREMENTS OF THE
THE.DEPARTMENT OF HEALTH AND HU
Continued . . .

TOTAL CARRIED FORWARD TO IST PAGE (ITEM 17(H))

NSN 754M)l-152-80BZ 5034&IOt

I ( W T W FORM a48 I-
-P
-51
DI (is1
I A R ( V c l R ) U IlYci
 1
1
ORDER FOR SUPPLIES OR SERVICES ) PAGE O F P4GES
Purchase Order: 0 lM00879601D Page 1 o
Attachment A

PACKAGING OF YOUTH VIOLENCE PREXENTION AND ANTI-BUL: YING

EDUCATION MATERIAL

BACKGROUND :

The Center for Mental Health Services (CMHS) provides nE .ional

leadership for policies, programs and activities assign€ 1 to ..
improve mental health treatment and prevention services :or
adults and children with mental illnesses and their fami .ies, arid
.-
Q
adults and children -at risk for psychiatric diagnoses. ,~day
CMHS is guiding a service system in transition, stimulat - ng
capacity at the national, State, and local levels to i m ~rove and
enhance mental health treatment and support services anc
promote prevention and foster the mental health of all I
CMHS works to develop, implement an evaluate state-of-tl
approaches to meet the most challenging mental health sc
issues for children, adolescents, and adults.
,r" c
- at
Acknowledging the mission of CMHS and the key role it p: iys in
fostering a public health approach to nationwide health. related
-. . Department of Health and Human Serv: :es
issues, the FY 2001
-rr- -*. +

appropriation bill, now law, included $90.0 million for ;chool

violence prevention activities to be undertaken by CMHS The
Conference language accompanying the appropriation -spec: F - i ed-that
CMHS use the funds specifically to "improve mental heal1 I
services for children with emotional and behavioral disc cders who
are at rjsk of violent behavior." The House-Senate Con: 2rence
report (1998) continued that "there are concerns about-1le recent
outbreaks of viol-ence in our Nation's schools and it is 2elieved
that one important tool to address this problem is to ii ?rove
children's mental health services. . . . " Reducing the ri c for
violence either as a perpetrator, victim or witness is ma jor
focus of the CMHS plan to utilize the school violence p evention
dollars.

A significant amount is now known about the risk factor that are
reliable predictors of adolescent violence such as earl and
persistent antisocial behaviors, academic failure, alie ation and
rebelliousness, family conflict, extreme economic depri ation and
availability of firearms. These risk factors have been
correlated with the diagnosis of conduct disorder in ch ldren.

The recent Surgeon General's Report on Youth Violence v ews

violence from a developmental perspective. The develop ental
perspective has enabled scientists to identify two gene a1 onset
Purchase Order: 01M00879601D
Attachment A

trajectories of violence: one in which violent behaviors emerge

before puberty, and one in which they appear after pubeky . The
early onset trajectory shows stronger links between chilbhood
factors and persistent, even lifelong involvement in vioaence
behavior, (page viii, Executive Summary, Surgeon Generay1s Report
on Youth Violence, 2001).

In order to compliment the message development around

violence prevention and anti-bullying messages, CMHS neebs to .
engage with commu~ications'and marketing experts for helb wlth
developing a persuasive marketing package to "sellrf
messages. It has long been evldent that print
pamphlets, are o£ limited interest and
on ways to enhance and motivate "real"

PURPOSE :

The goal of this project is to expand the reach, awareness and

utilization of-r'cy~~'
messages and behavior change activities by

nI
creating ancillary communication products and dissemination
avenues which will support and enhance the reasons to egage
more healthy behaviors.
.

STATEMENT OF WORK:

The Contractor shall review all current literature,

products and supporting promotional items which
..
'uniform" and "branding" look for the youth -. ..
and anti~bullyinginitiative. Upon review of all the pdoposed
elements of -a promotional package -of violence prevention.and
anti-bullying tools, the Contractor shall recommend and test
various products with key target audiences (latency aged youth
and parents/care givers) . Utilizing that research, the '~

Contractor shall design a consistent look to the communication

products for the Initiative as well as design a minimum of 4
products (including ancillary products) that can be utilized to
promote violence prevention and anti -bullying act iy=tie.$. The
Contractor shall also research distribution venues such as 800
numbers and fulfillment procedures for getting these maherials
out to the target audiences (parents and school-age yout'h).

Specifically, the Contractor shall:

1. Review all materials, produced to dare, on youth violence

~
prevention and anti -bullying strategies, within the condext of
relevant the Substance Abuse and Mental Health Services
Purchase Order: 01M00879601D
(I
Page 3 087
Attachment A

Administration (SAMHSA), CMHS and other nationally and

internationally designated programs. Many of these materials
will be provided by the Project Officer (PO) and CMHS. 1~

2. !I
Design and develop a \\consistent"look for the materlials and
suggest ancillary materials which could be used to enhanlice and
promote these messages.

3. Use the information gathered above, as well as in-deb~h

knowledge of communication arid marketing strategies, to bevelop =
--
an innovative.look and design for the Initiative a d pr&~est
these with the target audiences. In collaboration and
consultation with CMHS, the Contractor shall make revisions and
conduct final graphic development for production of the approved
products. A certain amount of flexibility will be criti,calto
the success of this work.

4. Finalize the proposed graphics and design elements for each

final product €&pent. Some production elements will be included
in this procurement.
-
.

'
5.

5
Research and present to CMHS a variety of mechanism that can
be used for -diiQffibationand fulfillment to disseminate these-
products to the public in a timely manner.

Once the products are crafted and reviewed by CMHS for accuracy
-- .-

and input, the contractor will develop the graphics and design
elements needed to produce the final products.

General Requirements:
- II - - =
-- ..

Independently, and not as an agent of the ~overnrnent,the

Contractor shall exert its best efforts and furnisi the
necessary personnel to perform the work set forth delow.
All work under this project shall be monitored by the
Project Officer. All work will be submitted to the PO In
Wordperfect 6.0 or hlgher format.
All reports, graphics and products developed and produced
hnder this project shall be the property of the ~ofernment
which includes the CMHS and SAMHSA. SAMHSA and CMHS may
utilize, print, or disseminate such materials without
further charge.
Purchase Order: 01MOO879601D Page 4 o 7
Attachment A

Specific Requirements:

Task 1: The Contractor shall develop a detailed work F .an to

meet the goals of this contract and to carry c it its
specific, delineated tasks. This plan must SF 2cify
available resources to be utilized and include a
detailed projected saedule of all activities :o be
undertaken under this contract.

a. At.a minimumi:the work plan shall describe a --

, - proposed strategy for reviewing inf--at+ xi for
product development and potential graphic design
elements for the "branding" piece.

b. A work schedule showing specific tasks, F ~tential

review and completion dates.

c. The Contractor shall meet with the PO eit ler in

pqgson or telephonically to review the wc rk plan.

d. Within one week of meeting with the PO, t

contractor shall revise the work plan to
----%nco.~orate comments from the PO.

.. .- 4- -
.-

Task 2: The Contractor shall review existing research, messages

and current youth violence prevention and anti -bullying
materials to begin strategic planning for "brc iding" of
. products into a consistent, recognizable-fxmat for
--.our
the puhlic. This information will be compiled LT! -
summary form for inclusion in the final produc : report.
-
The Contractor shall present this preliminary report to
CMHS for review and approval.

Task 3: The Contractor shall review the information g; thered in

Task 2 and suggest designs for key elements ar
products,. "..-.. .

Task 4: The Contractor shall collaborate with CMHS on final

review of suggested graphics and product desic n and
development. Once approved the contractor wi: 1 create
the graphic design and lay-out, pre-test, rev: se and
complete for production. Some production elemc nts will
be included with this task.
 1

Purchase Order: 0 1MOO87960 1D Page 5 of17

Attachment A 1
,
I

il
Task 5 : The Contractor shall research various distribunion
methods including 800 numbers and fulfillment
mechanisms for getting these products out to the target
1
audiences, - The contractor will pyesent the prodosed
distribution mechanisms for review and approvaj by
CMHS .
I

Task 6: The Contractor shall provide a final report tothe CMHS

Project Officer on the activities undertaken in this
. -.
contract.; - - L-.

_%.. _
/. . . - - . .. *
. . - s::
-. -.
' .

DELIVERABLES:
NUMBER DUE DATE AFTER
ITEM DESCRIPTION OF COPIES CONTRACT AWARD

Task 1 Develop Work Plan 3 2 weeks

Task 2 Information Gathering

.>-'- ,
Task 3 Craft sages/
Graphics/~roduct
s

Task 4
12 wdeks
I.

Task 5 Develop Final

Product (s)

Task 6 " Write and Submit

Final Report

PERIOD OF PERFORMANCE:

The period of performance is September 17, 2001 through January

I
16, 2002.

PROJECT OFFICER: ....

Louise Peloquin, Ph.D.

Center for Mental Health Services, DPDSPP, SPDB
5600 Fishers Lane, Room 17C-05
Rockvilie, Maryland 20857
Tel: (301)443-3898
FAX: (301)443-7912
Email: Lpeloauin@samhsa.qov
Purchase Order: 01M00879601D
Attachment A

The Project Off ice will provide no supervisory or instrudtion-1

assistance to Contractor personnel. The Project 0ffi.certIs
function is primarily to provide the Contractor with wor$ing I
data. The Project Officer is not empowered to make any :I
commitments, nor authorized to make any changes which affiect
prices, terms, or delivery as specified in this order. Any such
proposed changes shall be brought to the immediate attendion of
the Contracting Officer for action. The acceptance of aJy
changes by the Contractor without spacific approval and dritten
consent of the Confracting Officer will be at the ~ontrac~tor's --
.. .- --. .
own risk. 7:
PAYMENT SCHEDULE:

Six equal partial payments of $4,166.50 each are authoriz'edafter

completion and acceptance by the Project Officer of Tasks 1-6 for
a total contract amount of $24,999.00.
I

PAYMENT AND I N V q a N G PROVISIONS:

The Contractor shall submit invoices, in an original and two (2)

copies to the PO. The Project Officer shall submit the invoice
and a signed P e e i v I R g report to the Program Support ~ent&r,
Financial Management Service, Division of Financial oper+ions,
Parklawn Building, Room 16A-12, 5600 Fishers Lane, -&ckvl'll-le;=
Maryland 20857, Phone: (301)443-3020 for payment.

Invoices shall include the following minimum information:

-
Contractor's --nameand address -
Purchase order number - I----
Description of the services and price
Invoice perlod
Contractor's Internal Revenue Service "Tax Identlfication
I
Number" (TIN)
I
INSPECTION AND ACCEPTANCE:

The PO as a duly authorized agent of the ordering/contracbing

officer is responsible for the review and acceptance of all
deliverables.
!
 ji
Purchase Order: 0 1MOO879601D Page 7 0 4 7
Attachment A

I
FEDERAL ACQUISITION REGULATION (FAR) 52.252-2 CLAUSES
INCORPORATED BY REFERENCE .(FEB 1998)
'I
This contract incorporates one .or more clauses by reference, with
the same force and effect as if they were given in full iext.
Upon request, the Contracting Officer will make their full te'xt
available. Also, the full text-of a clause may be accesbed
electronically at this address: htto://www.arnet.ao~/fa-r
- - --

--.
. . - .. ,I .-
52.213-4- TeYms -andConditions - Simplified-
Acquisitions 'I
(Other Than Commercial 1tems) (MAY 2001)
7; ' .

Changes-Fixed Price (AUG 1987), ~lteknate

(APR 1984)
:
 (I
1 CONTRACT ID CODE PAGE 0%P A G E S
AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

2 AMENWENT/MODIFICATION NO 3 EFFECTIVE DATE 4 REOUlSlTlOWURCHASE R E 0 NO

i I,
5 PROJECT NO! (11 apdrwbie

000001 l ~ e eBlock 16C ;I

6. ISSUEDBY , CODE ADP 7 ADMINISTERED BY (Ifother than nem 6)
CODE lADF I
DHHS/PSC/AOS/DAM/ADP ACQ. DHHS/PSC/AOS/DAM/ADP
PARKLAWN BUILDING, ROOM 5-95 PARKLAWN BUILDING, RM 5-95
5600 FISHERS LANE 5600 FISHERS L A N E
ROCKVILLE MD 20857 ROCKVILLE MD 2 08 57

8 NAME AND ADDRESS OF CONTRACTOR l N a . s@eel.county. SLale mdZlP Code) 9A. AMENDMENT OF SOLICITATION NO.
(x)

SOCIAL & HEALTH SERVICES, LTD.

Attn: RAY QUALLS 9B DATED (SEE ITEM 11)

11426 ROCKVILLE PIKE, SUITE 100

ROCKVILLE MD 2 0852 1OA MODIFICATIONOF CONTRACTIORDER NO
01M00879601D

-
+ CDor
-.--. I -
CODE
-
1-,
I
FACILITY 09/15/2001
11. THlS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
7' I
3 The above numbered sd~olat~on -
IS amended as set fwlh In Item 14 The h w r and date speafied for rece~ptof ORerS -11sBnended -IS not ehended
Offers must ackwwdedge rempt of lhls amendment pnor to the h w r and date speofied In Me sollotason or as amended by m e of Ihe f d l w n g methods (a) By CanplLllng
Item 8 and 15, and returning copes of the amendment. (b) By a c k M e d p n g receipt ofthls amendment m each mpy of (he offer submtled or (c} By
separate letter a lelegram h c h Indudesa reference lo the sol~otat~m and amendment n u m b FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT
M E PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO M E HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by
nrtue of this amendmenl yau desre lo change an offer already subrmtted. such change m y be made by telegram a letter, pmnded each telegram or letter m k e s
referenca to the M l ~ d a t ~ oand
n thls amendment, and IS reoelved pnor to the openlnq hour and date speCmed
12. ACCOUNTING AND APPROPRIATION DATA (If requrred)
See Schedule
13. THlS ITEM ONLY APPLIES TO M&&TION OF CONTRACTWRDERS. IT MODIRES THE CONTRACTIORDER NO. ASDESCRIBED IN ITEM 1i.
I

-1 A FiCp;GI;s\EE ISSUEDORSUANT TO: (SWfyavlhoriiyJ M E CHANGES SET FORTH IN ITEM 14 ARE M4DE IN THE CONTRACT . -
.. B. M E ABOVE NUMBERED CO --- ..
appropriatim dale, e1c.J S E T P O IN
~ ITEM PURSUANT
CTIQRDER 1 MODIFIED TO REFLECT M E ADMINISTRATNE CHANGES (such as charges In payng ofc
TO M E A U M O R l l Y OF FAR 43.1031b).
i e. . . -
I I
C. THlS SUPPLEMENTALAGREEMENT IS ENTERED INTO PURSUANT TO ALrmORrPl OF:
-. ..- 1~
. . .- -
.- -

D. O M E R (Specify type of modificafion and authority) I

X I FAR 52.213-4(e) Terms and conditions--S irnplified ~ c ~ u i s i t i b n s .. . . . . . '1
E. IMPORTANT: CMlraaa is not. 1s required to sgn this document and return m p e s lo the n w n g ofice ~l .. -. .
14. DESCRIPTION OF AMENDMENTWODIFICATION(Organized by UCF section headrrgs, including soli~taborr/mnl~ad
sobjecf maner *ere feasrble.) .-

T a x I D Number: --..
DUNS Number:

T h e above referenced purchase order is modified t o extend the period of

additional cost.

T h e period o f performance is changed from September 1 7 , 2001 through January 16, 2002 to
~ at n o

September 17, 2001 through September 3 0 , 2002.

The anticipated due date for each task shall be revised by mutual agreement betwden the
I
Project Officer and the Contractor. The Payment Schedule remains consistent wit?
Continued . . . . '1
Except as pronded heran, allierms and u n d ~ t l m sof the document referenced In ltem 9A or 1 0 4 as heretoforechanged, remlns unchanged and ln full force and etfecll
15A NAME AND TITLE OF SIGNER (Type or pnnt) 16A NAME AND TITLE OF CONTPACTING OFFICER (Type orpnnl)

MARIE L. SUNDAY 1~

150 CONTRACTORIOFFEROR 1 15C DATE SIGNED 168 UNITED STATES OF AMERICA 1 16C DATE SIGNED
. 03/01/2002
(.S&-nanahrred person nuionzed lo sgn) I.S&-nafure d CmIracMp Omerl

NSN 754001-1528070 STANDARD FORM 30 (REV 1043)

Prenws ed~timunusable Presmbed by GSA~
FAR (48 CFR) 53.243
'I
 il

I
REFERENCE NO OF DOCUMENT BEING CONTlNUEO
SHE*
CONT'NUATlON
01M00879601D/O 00001
Oi 2
1
NAME OF OFFEROR OR CONlR4CTOR
SOCIAL & HEALTH SERVICES. LTD . n

Scanmar wG S ~
FAR 148 CFRI 5 3 / 1 0
 REFERENCE NO. OF DOCUMENT BEING CONTINUED
01MOO879601D/O002
NAME OF OFFEROR OR CONTRACTOR
1 AGE

I 2
OF

SOCIAL & HEALTH SERVICES, LTD.

 1 CONTPACTIDCOM PAGE OF PAGES
AMENDMENT OF SOLlClTATlONlMODlFlCAnON OF CONTRACT
1 1 2
2 AMENDMENTIMODIFICATION NO 3 EFFECTIVE DATE 4 REQUISITK)NPURCHASE REQ NO 15 PROJECT NO/ (/fanp~,,carne:

0003 I
6. ISSUED BY CODE
ADp 7. ADMINISTERED BY ( f a r than Hem 6)
ADP 1
DHHS/PSC/AOS/DAM/ADP ACQ. DHHS/PSC/AOS/DAM/ADP
PARKLAWN BUILDING, ROOM 5-95 PARKLAWN BUILDING, RM 5 - 95
5600 FISHERS LANE 5600 FISHERS LANE 3M3 No. G r j : ) . , :
ROCKVILLE MD 2 0857 ROCKVILLE MD 2 0857

8. NAME AND ADDRESS OF CONTRACTOR (No.. streef. county. Sf* mdZfP Code) 9A. AMENDMENT OF SOLlClTATlON NO
i
I i!
SOCIAL & HEALTH SERVICES, LTD.
Attn: RAY QUALLS 90. DATED (SEE ITEM 11)

11426 ROCKVILLE PIKE, SUITE 100

..
ROCKVILLE MD 20852 10A. MODIFICATIONOF CONTRACT/ORDER NO
01M00879601D
-
i
-
CODE I??J FAClLlNC bK
- 100 DATED (SEE ITEM 11) -- -
09/15/2001 -.-
- r.. I I 1 THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOUCITATIONS I
D m e above numbered sollotabon1s amended as set falh h Item 14. The hour and date spedfiedfor r-pt of Offers SISexlendea. -is not ;?tended
Offers must acknowledge receipt of this amendmenl pnw to the hour and date speafied In the solidlationwas amended, by one d lhe follmMng methods: (a) By
I t e m 8 and 15, and returning copies of lhe amendment: (b) By advlowledging recelpt of Ihls amwimenl m each copy of the offer wbmned: or (c) By
separate lener w telegarnwhich indudes a referenceto lhe sdititatim andamendmnt numbers. FAILURE OF YOUR ACKNOWLEDGEMENTTO BE RECEIVED
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If
virtue of I ~aImS w i m n t yw desire to change an offer already submilled. such change may be made by Uegrarn w lener. puvided each Wegrarn or lener makes
reference lo the solidtation and thls amendment, and is rece~vedprior to me opening hour and date specified
12. ACCOUNTING AND APPROPRIATION DATA (If required)

11. THlS ITEM ONLY APPLIES TO M&IW@TION OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTIORDERNO. AS DESCRIBED IN ITEM 114.
. .. ,I
A. THlS CHANGE ORDER IS ISSUEDPJJRSUANT TO: (Speufy authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTFWCT
ORDER NO. IN ITEM 10A.
. -

1
I

1
0. THE ABOVE NUMBERED C
appropriation dale, elt.) SE#b%
C.TQ .DER IS MODIFIED TO REFLECT THE ADMINISTRATNE CHANGES (such as charges in payng ome.
IN ?m.r~;PURSUANT TO THE AUTHORIN OF FAR43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANTTO AUTHORW OF: 1

-. P
-7 --
I
--
D OTHER (Speufy type of modrficatfon and authonly)
I
X I FAR 52.213-4 (e ) Terms and Conditions--S implified Acquisitions. . . . . . . 1
E. IMWRTAHT: Contrador a IS not 3 IS requlredto rgn th~sdocument and return mpes to lhe lssulng ofice 1
14 DESCRIPTION OF AMENDMENTlMODlFlCATlON (Oqanrzed by UCF sedron headrrgs. ~lcludrrgsol~ulatronlmnlradsutyed maner *ere feasfble ) _ 1
T a x I D Number: -- -
DUNS Number : . \fl 1 ' -

T h e above referenced purchase order is modified to extend the period of perforrnaRce at no

additional cost., ,,

The period of performance is changed from September 17, 2001 through September
September 17, 2001 through March 3 1 , 2004.

T h e anticipated due date for each task shall be revised by mutual agreement. betd&en the
11
Project Officer and the Contractor. The Payment Schedule remains consistent witlh
completion and acceptance of each task. /I
Continued . . . I
Except as ponded heren, all terms and u n d ~ t ~ m
ofsthe document referenced In Itern 9A or 10A, as heretoforechanged. rerralns unchanged and In full face and eff&t
1% NAME ANDTITLE OF SIGNER (Type orpnnt) 1
16A NAME AND TITLE OF CONTRACTING OFFICER (Tpe or pnyt)

150. CONTRACTORIOFFEROR 1%. DATE SIGNED 160. UNITED STATES OF AMERICA

-
ISlpnaluredperson euihonledfosign) d~ o n b a c l i w ~ > e r l
(Sw~alon

NSN 7540-01-1528070 STANDARD FORM 30 (REV. 1083)

Prenous editim unusable Presmbed by G S t
FAR (48 CFR) 53243
REFERENCE NO. OF DOCUMEKT BEING CONnNUED
 ORDER FOR SUPPLIES OR SERVICES 1 PAGE, OF PAGES
-
IMPORTAM: Mark all packages and papers with contnct andlor order numbers I/ 1
1. M T E OF ORDER 2. COMPACT NO. (fldny) 8. SHIP TO. 1
09/16/2004
I
2630100174 ICS-194
a. M E OF CONSIGNEE
I
3 ORbERNO 4. REaULSTrlOWREFERENCENO
DHHS / O P H S / O H A P
HHSP233200400125U 04T999915

5 ISSUING OFFICE ( A h - cons- to) b. STREETADDRESS

DHHS/PSC/SAS/DAM HHH B U I L D I N G , ROOY 136E
PARKLAWN B U I L D I N G , ROOM 5-101 200 INDEPSNDENCE AVE., SW ..

5600 FISHERS LANE

R O C K V I L L E MD 2 0 8 5 7
c cm
WASHINGTON

P a u l Lvnch
7.m
a NAME OF CONTRACTOR -. I. SHIP V L ~

MACRO I N T E R N A T I O N A L , INC.
8 lYP!2OFORDER 1
b COMPANY NAME
- ~ ~- Ia,T ?URCWE I k 'b DELMRY '

c. S T R m ADORESS REFERENCE YOUR

1 1 4 2 0 Rockvill-e Pike .- - - -- - RFTOP194 -: . .
revnp, t i s ddmv ordef k

Pksse hmish me ldwi-gon h e lsrms

and amdlons rpecifted m b d h sides or
his arder and cm ltm alached sheets. i f
d. ClPl w. STATE. 1. ZIP CODE
any. indudhg d e l i as indicated.
Rockville MD 20852
8. ACCOUNllMG AND APPROPRUTWWIS DATA 10. REQUISITK)NING OFFICE

11. BUSINESS CLASSIFICATION (Chsdr sppmpriote tor(es)j

r m.SMALL '?%.% b. OTHER THAN SMALL FI L DISDVANTAGED
-
2, (I.W O M E N W E D

12. F.O.B. POINT Destination 14. GOVERNMEHT MAO. 15. D E L M R TO F.O.B. W I N 1 1 6 . D I S C O F TERMS
ON OR BEFORE Ds(d. . - -

a. INSPECTION
13. PLACE OF
b. ACCEPTANCE
I N e t 30
.j
Destination D e ~ f n 3 t i a ..L-
n .. ----...
17. SCHEDULE p e e nmKIe t a R o j u c f h s ) ,I
ITEM NO. SL'PPLIES OR SERVICES
OUANTITY
ORDERED W T
UNrf
PRICE .. .? -9 'I -'- = --
WANTlTY
ACCEPTED
[a) (b) k) W) IS I 10 1 (e)
Tax I D Number:
D U N S Number:
Commissioned Corps Cornminication
CAN:
i. 3
1992598 O b j . C l a s s : 2512 F Y : 2004
and R e c r u i t n e n t P.rogl'am
I : -* .
Period o f P e r f e r ~ a n c s - - 0 9 / 2 1 / 2 0 0 4 t o 09/20/2305

I
I
Continued

I 18 SHIPPING POINT
...
I
18. GROSS SHIPPINGWElGHl
I I
20 INVO1CE NO.
I

I I
21 MAIL INVOICE TO

a NAME
2,029,
SEE BIUING
PSC/FMS (3011 443-3020 . . a

NSTRUC~ONS b STREET ADDRESS PARKLAWN B U I L D I N G , ROOM 1 6 A - 1 2

mREVEf?sE (aP 0 BOX) 5600 FISHERS LANE
GRAND
TOTAL

c. CIIY
ROCKVILLE
STATE
MD
e ZIP CODE
p857
2,029,587.00
4
22 UNITE0 STATES OF AUERICA 4W E (Typed)
BY Cmalors) PATRICK A. JOY 1
T m E CONTRACTING'ORDERING OFFICER
USN 7WOl-lPb063 1 OPIIONALFORUUIIR~~

FUMOUS -ON ~ Q T VSAB~.E -ACY*YI,~CFR~OI~X.)

Department.

--....-
-'d.-Uu..

TOTAL CARRIED FORWARD TO i s PAGE

~ (~EM
IT(~))
~m+a-im O m n um u YI w . * m )
c-crGU
V Y I I48 cm, 63>IXCl
 A

I M P O R t A m Ma*
ORDER FOR SUPPLIES OR SERVlCES
-
SCHEDULE CONTINUATION
04 packages and papen M h cmnad and101 adn rurnben.
! PA&

3 1
I1
OF PAGES

I 7

DATE OF ORDER CONTRACT NO

09/16/2004 26301D0174 ICS-194

ORDER NO
HHSP23320040012>U
1I
ITEM NO.

W)
SUPPLlESlSERViCES

(8)
QUANTITY UNK
ORDERED
It) (D)
UNIT
PRICE
(E! O (F) U I QUAh'TiTY
ACCEPTED
(Gj

This task order ernphasipes the development of a cel.trt.l image or i'ientity that
I
il
connects with the public about how the Comissionei Corps serves t > e public hea1:k
'I
needs of the American people. Equally impor:zn: is t:.at this image form tne basis
'I
of 2 new recruitment program for new officers from th: natlonal po~>lof health
professions students, residents, graduates, post-gradrates and pratticing- ,
professionals.
1

~...* . .

TOTAL CARRIED FORWARD TO !ST PAGE (ITEM 17(H]) 'I

-101 1 W W A L FORM 34a vu. &=I
 II
ORDER,FOR SUPPLIES OR SERVICES 1 SAGE OF PAGES

SCHEDULE - CONTINUAIION 1 4 1 7

- .- . . --

!
!
1
i
!
,
I
i
!
I

..--.. ..

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) '1

HW 7-1-1- )OYCle~ . O n m M L IORY Y l h -I
r*ynD.aL"GY
IYI W C I P I D l I X c I
 I
ORDER FOR SUPPLIES OR SERVlCES PAGE OF PAGES

-
SCHEDULE CONTINU.ATION i I 7
IMPORTANT: Ma* aR pacAages and p a p m wlth con(nct andlor d w numbers. I
DATE OF ORDER
09/16/2004
CONTRACT NO.
26301D0174 ICS-194
mDER NO.
HHSP233200400125,U
1
ITEM YO. SUPPLIESERVICES QUANTIW UNll UNIT I AMOUNT 1 1 PUANTIn
ORDERED PRICE ACCEPTED
(B) (C) ID) (E) (F) (G!
i t s e s s e n t i a l a c t i v i t i e s i n o t h e r departments anc ige ~ c i e s (DOJ, UPDA, DOC.
DHS, EPA), d e v e l o p b r a n d s , t h e m e s , m e s s a g e s , ( s t o r y b i n
c o m m u n i c a t i o n s which s u ' c c i n c t l y d e i c r i b e the( work bf
!s a n d o t h e r ' c r i t t e n
. h e PHS Commi ; s i o n e d C o r p s , 1
what i t i s a c c o m p l i s h i n g , - t h e c a r e e r o p p o r t u J i t i e s b i t o f f e r s , t h e Zypes o f
a s s i g n m e n t s i t s u p p o r t s , t h e p r i n c i p a l com? e n t s f . t s t r a n s f o r r n d t i o r . , a n d i!ts
p r o f e s s i o n a l rewards. T h e s e b r a n d s , t h e m e s ,I rnessabes s t o r y l i n e s dnd o c h e r macer
must b e b u n d l e d s o t h a t t h e y a r e a t t r a c t i v e b n d e f l e c ive both a s 'eneral
i n f o r m a t i o n a n d r e c r u i t m e n t t o o l s a n d s u b m i t b e d to1 t h ! task order :fficer both i n
d r a f t f o r m f o r comment and i n f i n a l form f o d a c c e p k a n
b.Develop g r a p h i c s
m a t e r i a l developed
c.Develpp p h o t o a n d
s t o r y l i n e s and o t h e r m a t e r i a l
by t h e t a s k o r d e r o f f ~ i c e r .
1 1
d.Based o n t h e m a t e r i a l p r o d u c e d i n i t e m 3 a , b , a n c

t
a d v e r t i s e m e n t s , r a d i o s p o t s a n d t e l e v i s i o n a v e r t i em

4. Media S t r a t e g y

i n g t h e gene a 1 p u b l i c about
l i t m e n t o f h e l t h profes!ion 1s.
n
u eos u tf loer t sr et ah i ti n agr et h e g e - e r a 1 ,

a b o u t t h e PH Commissioned
Corps.
c . I d e n t i f y and

5 . Media Campaign

n g t h e materdals develoded I
ign.
- --
6 . - M e e t i n g s w i t h t h e TOO

II I
a . W i t h i n 2 weeks o f t h e a w a r d o f t h i s c o n t r a t, me t 1 i t h t h e TOO d o d i s c u s s a
proposed. p l a n of work u n d e r t h i s c o n t r a c t , i cludi g .he t i m i n g f o b d e l i v e r a b l e s . 1
b W i t h i n o n e month from t h e a w a r d o f t h i s c o
w i t h t h e TOO t o d i s c u s s p r o g r e s s , a c t i v i t i e s
contract.
tract
and p 1
a n ( e a c h month h e r e a f t e r ,
od ~ c t sr e q u i r e d a s p a r t o f

c A t t h e c o n c l u s i o n of t h e c o n t r a c t , meet w i h t h e TO( t o r e v i e w p d o d u c t s g e n + r a t e / i
under t h e c o n t r a c t and recommendations f o r ture c t

Commissioned Corps C o m m i n i c a t i o n a n d .'

Continued . . .
 ORDER FOR SUPPLIES OR SERVICES
-
SCHEDULE CONTINUATION
IMPORTAHT: Mark a l packaqn ad papm wnh canncl m&or order m m b m 1
DATE OF ORDER CONTRACT NO ORDER HO
09/16/2004 26301C0174 1C5-194
ITEM W.

(A)
SUPPLlEYSERVlCES

R e c r u i t m e n t Program
101
QUANTTf UNIT
ORDERED
IC; (D)
UNIT
PRICE
IE) wNTi
(0
1
i
CIUAVTTTV
ACCEPEC
IG!

: 8

The C o n t r a c t o r S h a l l i n v o i c e o n a m o n t h l y basis

1
I
. .-
..

DESIGNATION OF PROJECT OFFICERS

D r . R o b e r t Knouss a n d D r . R o b e r r Williams LOCATED .AT :202)205-1842 and (301):
443-4000 r e s p e c t i v e l y ARE HEREBY
I

RNET.GOV/FAR

Continued .. .

TOTAL CARRIED FORWARD TO.1ST PffiE (ITEM 17(H))

I
WSN 7 W t - 1 5 2 6 0 8 1 , Sm4c101 0FIY)NAL P O W Y( C- wa~
-,l*rllY
*.
(U
I cm, U I , * C l
 ORDER FOR SUPPLIES OR SERVICES
SCHEDULE - CONTlNUATlON
IMPORTANT: Mart el packaqes and papers vllh cmtract andor order numben
1 71
PLE
OF PAGES

DATE OF ORDER
09/16/2004
CONTRACT NO
26301D0174 ICS-194
ORDER NO
HHSP233200400:25C 1
ITEM NO SUPPUESISERVICES QUANTIW UNIT UNIT AM3UN-T' OUANTllY
ti ORDERED MICE ACCEDED
- (A1 1 (El IC) 101 (E) Q) (Gt
2 NIt :ee
b
, - ' I
I

T o t a l amount of award: $ 2 , 0 2 9 , 5 8 7 . 0 0 . T h e o b l i g a t i m :'or t h i s awart: 1s show4 i n b c x

17 ( i ) . I

-
.
I

- 4-
-- -.- .

i
II

---- .

-- f -- - _ _

-.

- - - =-

.-..

TOTAL CARRIED FORWARD TO 1ST P A M (ITEM 17(HI) I

NSN 7YM)l-l52dW2 mw1 OmOULHlRYWIn-M)
r-*a
**a W C m m I l y t ,
 --
09/15/04 mD 1 6 : 28- PAX-
@I002
\
&

RFTOP# 194 TITLE: Commissioned Corps Communication add

Recruitment Program
PART I1 - CONTRACTOR'S REPLY: CONTRACT #263-01-D-0174
TO # ICS-194
Contractor: Macro International Inc.
Points of Contact: Paul Lynch, Contracts Administrator
Phone- 240-747-4769 Fax- 301-984-3972
*

Address: 11420 Rockville Pike, Rockville, rvlD 20852

.-

Pricing Method: TFM - --

MH Admir =--
--< . -. -
Total Cost: IT i
Grand Total: 82,U29,586
ESTIMATED NUMBER OF HOURS: 9,360
PROPOSED COMPLETION DATE: 1 year from signing

FOR THE C O ~ E T O R : September 15.2004

Signature Date 1
.-
SOURCE SE&EFION:
-- .
WE HAVE REMEWED ALL SUBMITTED PROPOSALS HAVE DETERMMED THIS FIRM
SUBMITTED THE BEST OVERALL PROPOSAL AND THE PRICE/COST IS REASONABLE_. c
1 - --
Billing Reference # N N IF233 2 0 0 ~ ~ 5~V/ 2
Appropriations Data: 7ry01 : 4-/??
Y O ccr& 3 ~7 S/

I'vu
I -
RECOMMENDED:
71s
FAX Y

APPROVED:
FAX# %I ~'/3-276/ Signature - ~ o h i r a c tOfficer
i~~ /i ~ a t 6

I
~35-
NIH APPROVAL el,) -
i CONTRACTOR SHALL NOT EXCEED THE ESTLMATEDLABOR HOURS OR E ~ T E TASK D ORDER
AMOUNT WITHOUT THE WRITTEN APPROVAL OF THE CONTRACTING OFFICER & PICS
COORDINATOR

APPROVED:
Signature-Leny Mannmg, NIH-PICS Coordinator Date
 1
AMENDMENT OF soucrrAnONllrloWFlcAnoN OF CONTRACT
1. 00HTAICT1DCOOE

1 PA&€ OFPUKS

Ill

-
1 1
2 m m J C m C * T Y I l WO 13 B E C l W E M E 14 ~ R E O . U D 5 PROJECT (Ilapdrcsbls)

0001 09/24/2004 I I
0. ISSUED BT
D A ~ 7. AD*(INISTEREDBY (I/ W h a r abm 8)
IDAHII

I
DHHS/PSC/SAS/DAH
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857

I
DHHS/PSC/SAS/DAM
PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE
RKKVILLE MD 20857 '1
L - U ~ ~ D O E S C ( U I T U C T O R ~ M . C - . ~ W L I P C ~ ~ ) 9A AMENDMENT OF SOCICITATION NO.
'I
MACRO INTERNATIONAL, INC
Attn: Paul Lynch
11420 Rockville Pike 1- 1 I
I I
Rockville MD 20852 1 M MOOlFlCITlONOF COHTRACTIOROERNO.
26301D0174 ICS-194
I'I1
AH5P233200100125U 1
-
CODF 52
,. , .
la DATED l?X€
09/16/2004
ITEM fa ..
9
11
. - ..
.
I

~mustadm~srsaptdhts~menanentprlcrb~h.hourdd.(oopd~hh~u~rmnded.bl~~~~llam~msthodm:(~)~DDmdW~g
!4mmIrrJ15,adnhm~ c o p b . d h ~ @ ) ~ y ~ r e c s b ( d h t s ~ o n u c h ~ d t h s ~ ~ u d ) ~
a p r s b U b u t . b p n m r v h l c h h 6 d . . a ~ t o h m a k i l a U m m d ~ n s n b aFNLUEOFYOURACKNOWLDWJEMENTT~BEAECENDDA~
.
THEPUCE DESlGM4TED FOR THE R E M P T OF OFFERS PRtCR TO THE HOUR DATE SPECIFIED MAY RESULT IN RWECllONOF YOUR OFFER H by
v t h a o t m b u n a r ~ m l p u ~ ~ c h ~ m o ( h t . h . d l r ~ . a r h ~ m r ) . ~ m a d a b y ~ a k ( t w , p r a 3 J d . s d r ~ r m a ~ m a L a

I See Schedule
15. THBITOI APWES O W L Y-~WNSOF
~ C ~ ITYaMREB TM W ~W l U C T ~ I ( Q
AIT
~ DE-ED IN l l d .l 4 .
'II
1

I M ATHIS C W G E ORDER LS ISSUED P V R S U M TO: ( s m s c a h o r d y ) THE CWNGES SET FORM IN ITW 14 *RE MADE IN THE CONTRACT
dRDER NO. IN ITEM 10A.

I
I
0 THE ABQVE NUMBERED WNTRACTIDW)ER IS MODIFIED TO REFLECT THE *DUINISTRATM CHANGES (sod?n UWlpU b, P4"0 &,
wkvwmbon dsh,.Ic)SET FORRTllsrn $4.w w TO ME UrmORlfY OF FAR U.1cqb). .
"

I
A I
ClMS~KAGAEEMENlI8enekDWTO
P U R S W T O WEAUTHORilY OF.
.. - I
-7 -- -- -
D. OTHER (Sp- &pa dm&Xxlkn md u#m?yj

Tax ID Number:
DUNS Number: 5
!4- ---. - . . . . -. [. . - - I; . .-. .. .

The above referenced order is herby modified to add Tracy Self, Director, Secretarial
Initiates (202) 401-2305 as co-project officer.

All other terms and conditions of the original order remain unchanged by reason of this
modification.

.. -.a .. -

11
 (I
I 1
Sep 0 6 05 1 0 : 4 4 a I P- 2
I
'I I
AMENDMENT OF SOLlCl'rATlONlMODlFlCATlON OF CONTRACT 1. COMRACT ID CODE PAGE OF PAGES !
I1II 3
2. WENOMENTMODIFICAllON NO. 13. EFFECT~VEDATE 4. REOUIS~~ONIPURC%E REO.NO. 16. PROJECT NO. (IIapcric&el

0002
8. LSSUEO BY
(09/05/2005
IDLY
105~5259~2
( 7. MMlNlSlERED BY (11 other man U r n UJ ~nnu'l
\I
,-..., ,
DHHS/PSC/SAS/DAH DHHS/PSC/SAS/DAM I
PARKLA'HN BUILDING, ROOM 5-101 PKLN. BLDG., ROOM 5-101
5600 FISHZRS LANE
ROCKVILLE MD 20857
5600 FISHERS LANE
ROCKVILLE M D 20857 1
I I I
6. NAME AND ADDRESS OF CONTRACTOR (M.. .err( m t y . -fa mdZIPCod.) 9A AhlENOMENT OF SOLICITATION NO

I1 MACRO INTERNATIONAL, INC.

Attn: Paul Lynch
11520 Rockville Pike
1- -1 E6. M E 0 {SEE lTEM 11)

I R o c k v i l l e MD 20852 -- 1 IDA MODlFlCATlOHOF CONTRACTIORDER NO. I _- ,

I zzF
- 1 4
;1
F ~ I U N CODE 09/16/2004
11. THIS ITEM ONLY APPUES TO AMENDMENTS OF SOLICITATIONS
I I
I

I
nferenmla h o sanalallon and h i s msndmml, and ir rmlvsd orbr to ftw o o ~ n h pb u r and dale weCjfibd
12 ACCOUNTING AND APPROPRIATIONM T A
1 I
$999.986.001
--- --..---A-
S O L St-harltll P kW * Net Increase:
I I T H I S rrEH APPUES ONLY TO UODIFICAllONS OF COKTRAWSIORDERS, ITMODIFIES THE COMlRACIIORDER ND. AS DESCRIBED IN ITEM 14.
I
A THIS CHANGE ~ E IS ISSUED
W E R NO IN ITEM 1PA
R PURSUANT TO: (SpedEy OUUWIIY)
___
_.- .. .--
THE CHANGESs n FORTH IN ITEM 14 AREMADE INTHE CONTRACT
1
(1 I
--
-

8. THE ABOVE NUMBERED COKTRACTK)RDER tS MODIFIED TO REFLECT 'ME ADMlMSTRATlM CHANGES fanhsr chlnger br p p l g ~ .
ammmolrrul delo, o1c.J SET FDRTH IN I l E M 14. PURSUWJTTOTHE AUTnDRrlY OF FAR 43.103(3).
. -- -
I
- .- ---

X
C THIS SUPPLEMEMAL AGREEMENTIS ENTERED 1KfO PURSUANTTO THE AUWDRITY OF.
FAR 43.103(a)
I 0. OTHER (Spodfy type Y
I
d ~ l snd
h *dhon(y)
:I I. --

.'
L MPORTMT: Cn~dmctm 1':; b no^ 3. m mquiiud lo d01 hlr dalnaonl and nlwn 1 ~ r to uu
n omm. - (I
14. DESCRIPTION OF AA~ENDMENTIWODIFICATION
( O q u d z e d by UCF ndim headinpr, incb&g t ~ t ~ ~ rvbjvci
b mUWwhOm
l d Isa9bIs.J - - - -- . ... - .- - - . .

Tax I D Number:
DUNS Number: \- j I

THE ABOVE REFERENCED ORDER IS HEREBY MODIFIED TO EXPAND THE STATEMENT OF WORK AND :EXTEND I
THE PERIOC OF PERFORMANCE THROUGH SEPTEMBER 30, 2006.

CHANGES FOR LINE ITEM WUMBER: 1

Total Amount changed
from $2,009,492.00 t o $2,999,577.00
End Date changed from 20-SEP-05 to 20-SEP-06
I
CHAYGES FOR LINE ITEM NUMBER: 2
Contlaued ... -
+~ l ) b m
EXQOPL . tanm and c m d ~ l o n rot ~ h docurrat
da c ~ na1
as ~ m v h h
1 s . NAME NUJ TITLE OF SIGNER (Typo crpn'nl]

T ~ o lc ~ E R / v / N , EKEC. c / P
o rokmncod ~nion M or 10h sr M I O I ~ dlulp.d.
~
16A W E AND f m E OF M N T

PATRICK A. JOY
h m d .~lsd. 1
NG OFFlC R (Type orpllnl)

,'
'I I I
158. COHTRACTORIOFF OR 16C. DATE SIGNED

a . o ~ < L
7Yw1-1516010

Working Copy
- I
09/07/2005
STWJDIRD FORM 30 (REV 10d.3)

-. -PI by GSA
FAR (48 CFR) 53143
I
Sep 0 6 0 5 1 0 : 4 S a
1 P.3

CONTlNUATlON SHEET IREFEREEICE NO. OF OOCUUENT BEWG COKnNUED

I
26301D0174 ICS-l94/HHSP233200400125U/0002 I I I
NAME OF OFFEROR OR CONTRACTOR
W.CRO INTERNATIONAL, INC . - - -

ITEM NO. SWPUEYSEFMCES OWANTIT

(A) (8) 1C)

T o t a l Amount c h a n g e d ;
from 520,095.00 t o $ 2 9 , 9 9 6 - 0 0
- -
The S t a t e m e n t of work i s r e v i s e d t o i n c l u d e t h e f o . l o w i n
performance:

1 1. Update a n d c o n t i n u e a s m o d i f i e d Task 3, 4, a n d 5 and

Develop a n d t e s t a d d i t i o n a l m e s s a g e s a n d m a t e r .als a
2 .
i n f o r m a t i o n and r e c r u i t m e n t c a m p a i g n a p p r o v e d b y t ie TOO
m a t e r i a l s s h a l l i n c l u d e a - t a minimum:--
T r a v e l i n g r y ? c r u i t , & & n tq-z h i b i t s ;
I: ~ b v e rpoinC p r e s e n t a t i o n s ; ''

c. R e c r u i t m e n t and p u b l i c i n f o r m a t i o n v i d e o s ;
M a t e r i a l s a n d me'ssages s u i t a b l e f o r u e b s i t e p r ! s e n t a
I: Kedia b r i e f i n g m a t e r i a l .
3 . E x e c u t e a new p r o g r a m . ..
a. T o c o l l e c t o f t i c e r p r o f i l e s s u i t a b l e f o r u s e i I h i g h
c o n t r i b u t i o n s and a c h i e v e m e n t s ;
I b . U s i n g t h e s e p r o f i l e s , t o d e v e l o p stories s u i t a ) l e . f a
o u t l e t s ; and,
c . To d i s t r i b u t e t e~ a n d e n c o u r a g e t h e i r p u b l i c a : i o n .
k
4 . Develop a n d c o n d o m a f t e r TOOs a p p r o v a l a new rromot
include : .. ..

a . A program t o i m p r o v e r e c o g n i t i o n o f t h e C o r p s ~mong
p o t e n t i a l r e c r u.;-i.t--sa,;.. ...
b. Media o a t l e t s p e c i f i c promotional, news and fe l t u r e
p u b l i c a t i o n s u i t a b l e m a t e z i a l f o r e n h a n c i n g p u b l i c aware
r e c r u i t s ; and,
c. M a t e r i a l s u i t a b l e f o r s p e a k e r s a n d p r o m o t e r s o i t h e
p u b l i c e d u c a t i o n and i n f o r m a t i o n . e f f o r t s .
5 . C o n t i n u e m e e t i n g s w i t h t h e TOOS a n d t h e PHs Re i o u r c e
b a s i s . Ac+the f i r s t meeting d u r i n g t h e extended p :riod
r e v i s e d b o r k p l a n f o r the p e r i o d t h r o u g h S e p t e m b e r 3 0 , 2
a p p r o v e d by t h e T0Os.---

FOB: D e s t i n a t i o n
D i s c o u n t Terms:
. .
Net 30
P e r i o d of Performance: 09/21/2004 t o 09/30/2006

Change I t e m 1 t o r e a d a s f o l l o w s ( a m o u n t shown i s t le o b 1

Commissioned C o r p s C o n m i n i c a t i o n a n d R e c r u i t m e n t
Program
Accounting I n f o :
7540140 CAN: 1992598 O b j . C l a s s : 2512 FY: 2004
Funded: 5 0 . 0 0
Accounting Info:
7550140 CAN: 1992598 Obj. C l a s s : 2512 FY: 2005
C o n r i n s e d ...

a17 Working Copy

Scp 0 6 0 5 10: 4 5 a P-4
 I
I COhTfUCl IDCODE PAGE OF PAQES
AMENDMENT OF SOUCTTAflONIM001FICA~ONOF CONTRACT
I
2 AMENDMENTNODIFII%TION NO. IS.EFFECTIVE M E 1 4 . REOUISITIONIPURCHABE REP. NO. 15. P R M C T N3. (n;r&hbb)

DHKS/PSC/SAS/DAM DHHS/PSC/SAS/DAN
PARKLAWN BUILDING, ROOM 5-101 , P E N . BLDG., ROOM 5-101
5600 FISSERS LANE 5600 FISHERS LANE
ROCKVILLE MD 20857 - .. ROCKVILLE MD 20857

I I
8. W E AND ADDRESS OF COMRACTOR Pa.m.
m*, Slak WZP cads) %AMENDMENT OF SOUCITATION NO.
- I
MACRO INTERNATIONAL, INC . I
A r m : Paul Lynch
11420 Rgckville P i k e
R o c k v i l l e MD 20852
80. MTED IS= lTEM 11)
1
1 -
CWE r?! IFACIUTY CODE 1 ( 09/16/;004 ' 1
I - I I I
li.THIS ITENONLY ARUEBTO AMENDHEHT~OF mutrr~nOUS
+dad,
I
/
t
@TM w e nunaenld wmdb~bIS -d ~ I I biih h norm i r . m nour snd dml=rpocmcdla rscdpcol Offm onlandad ~ l ml s
Onon muar rcZRornedge mprlplalrnts m n d m n l prbr lo Ul. haur and dmta rpodlbd h me sdllullbn cw an mondod by OM of bllalng r r p l h k ( 0 ) By mmvle)lnp
i ~ h m8s wcl I*ad nlurdq d tho ornardmar; b)By tmtwml~egirqr m ~ of~I ~ ~ Ismsndnronl
rI ~ on mct~m p y d ~hou k r submlu~:or (c) BY
~sperclrsMa ortDh@mmmkh lnduCo a d m n m ta ths roldst4n m d msrrdmsnt ~ m b e r p .FCILURE OF YOURAEKNOWLEEGEMENlTO B E RECElKD AT
D THE R6CEIPT OF OFFERS PRIOR TO ThE HOUR WD MTE SPECIFIED MAY RESULT IN R M C l 7 D N OF YOUR OFFER ll by
THE PLMX O E S I U L U ~ ~FOR
vVPle d fils amendmnlyoudealm to d w j o mn d w ~ ruDmtrsd,
y e s h rhmga mmy ba ma& by l s k g ~ bbar.u prwldd o r h Dbgnrn m b b r mkaa
a n m b Me Wlda0orwId We a n a m mnd ahr b IRE apsrmn- M a w&d
t L ACCOUNTING ANDWPROPRUTION M T A I f f & & Nec Increase: $499.977.006

I See Schedule
uT H I ~IVY ONLY APW TO MoDlnunoN OF C O N T R A ~ R D I R S . IT MOPIFEB THE C O ~ C T K I R D E RNO. AB o u c m e e o IN rrar rl/
I

I I
8 . THE ABOVE NUUBERED COHTRACTKlRDEU IS UODlFlEb TO REFLECT TWEMUmISlW7'lkE CHANGES I r u c ) , a # w h ~rllhO
&
pppmp'latbn Un,r y 9 E l FORTH IN ITEM H.PUR8UAHl TO THE AUlWORm OF P N ? 43.Imlbl.
I I
1 C. TH18 SUPPLEMENTAL AGREEMENT IS ENTERED WrU PURBUANl TO M H f J R i T Y OF: > -a =,= - =

X
(
FAR 52.212-4 Contracc Term and C o n d i r i o n s
0. OTHER (Scedfy llp0 d mO(nflSBU~nmd rubmyj
-
C o m m e r c i a l Item I
:I

Tax ID Number:
DUNS Number: :[ 4 - - -
The above referenced c o n t r a c t is m o d i f l r d t o expand the l e v e l of effort and extend t h e
p e r i o d of performance.
I *

The Secretary h a s decided t o s t r e n g t h e n t h e Corps' h e a l t h p r o f e s s i o n r e c r u i t m e n t e f f o r t s ,

particularly for p h y s i c i a n s and n u r s e s . The Corp will begin s t a f f i n g s 210 person h e a l t h
and medical response (HAMR) team w i t h active d u t y personnel.. Therefore the l e v d l o f
e f f o r t f o x t h e c o n t r a c t needs t o b e increased particularly in I t e m 4 of ~ G * S O W . . & Oh e l p
with t h i s eff~rt.

Continued ... I
'1
=. l Dmvldmd h a m , a lamu md cmdtbs efUn bOCUwmfn
E x a ~m
NAME AH! TITLE OF SIGNER mr wp&l)
k lan OC, w IOA. 8r h d m & a g e d , mwmlnr mduqd md h
I TEA.w%ME AND T R € OF C ~ C ~ N O ~
md mhd.
~ unijU
F w C E ~ Y ~

W b s d bv O(I+
FAR (U CFR) 53.243
:I
 R€FERENCE NO. OF DoCVMEFCr BEING CDKnMJED
COmNUAT'ON 2630100174 ICS-394/8HSP23320040O125U/O003
U E OF OFFEROR OR CVUTRACTOR
Message

Joy, Patrick (PSC)

From: Joy, Patrick

Sent: Monday, September 20,2004 3:34 PM
To: 'Paul Lynch'
Subject: RE: HHSP233200400125U, RFTOP 194
- -

I have received a copy of a fax letter Larry sent to you. I assume you will receive it also.
- 1I

Patrick A. Jo?, CACRl

Contracting Officer - . ..- *L . -.
Program Support Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
F a (301) 443-2761
I n an eflort to evaluate customer satisfactiolz, the staflof the PSC would appreciate your takirzg a feu,
nloments to complete ourCy~tonrerComment Card by clicking on the lirlk belon-. you? til~leand eflort
in providirlg this valuable feedback pertairling to the products or services vou received is great!\.
appreciated.

-----Original Message----- -
From: Paul Lynch [mailto:plynch@shs.net]
Sent: Monday, September 20,2004 3:09 PM
To: Joy, Patrick
Subject: RE: HHSP233200400125U, RFTOP 194
-. ... .. -1. >

Thank you, Patrick! We are.very excited about the opportunity to work on this project. This is very nice-way to
start off the week!

Does this require Larry Manning's approval as well before we begin work?

Thanks again,
Paul I

.-.
From: Joy, Patrick [mailto:PJoy@psc.gov]
Sent: Monday, September 20, 2004 2:38 PM
To: Knouss, ~ o b e r t ;Williams, Robert C; 'Paul Lynch'
Subject: HHSP233200400125U, RFTOP 194

Attached is the fully executed order for Commissioned Corp Communication and Recruitment #rogram.
Message

<<HHSP233200400125U.pdf>>
Patrick A. JOY,CACRl
Contracting Officer -

Progleam Support Center, S.4S

5600 Fishel*sLane, Rm 5-101
Rockville, RID 20857
(301) 443-9265
Fax (301) 443-2761
Irz ail effort to evaluate cztstorrler satisfaction, the staff of the PSC would appr-eciate yo
morrzerzts to coniplete o w Customer-Coiiziize~ztCard by clickiizg or1 tlze link below. Yw
irl providi~zgtlzis valziable feedback pertairzing to tlze products or senices y o i ~receivea
appreciated.
Jov. Patrick (PSC)
From: Joy, Patrick
Sent: Monday, September 27,2004 8.1 1 PM
To: 'Paul Lynch'; Self, Tracy (0s); Knouss, Robert
Subject: HHSP233200400125U Modification 1

Attachments: HHSP233200400125U MOD 1.pdf

Attached is Modification 1 to the above~eferencedorder. Please ensure that it is made a part of th ~fficialfile.
-
HHSP2332004001
!5U MOD 1 .pdf (8..

-
- -..
Patrick A. Joy, CACM -2
7-

Contracting Officer
Program Support Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
Fax (301) 443-2761 "<=:
ln an effort to evalllate custonter-satisfaction, the staff of the PSC wolild appreciate vour taking a \v rnor?lerrtsto .. . -
conlplete our Clistomer Comment Card by clicking on tlte link belo~v. Yolo. tinte and effort in prc 'ding tl~isvalliable
feedback pertaining to the pmdactror~servicesyou received is greatljl appreciated.
 I
Joy, Patrick (PSC) :~
!I
I

From: Joy, Patrick A. (PSC)

Sent: Friday, June 17,2005 11:13 AM
To: 'Paul Lynch'
Subject: PlCS Order ICS-194 HHSP233200400125U

Paul,
~
'
'I . -
I hope you can help me. ~ccordingto our finance office we have only paid you $139,606.07 so far. Are you that behind on
billing or have we messed up. We need to get a handle on the amount lest due to future work and p/oposed modifications.

Also, please ensure that Dr. Knouss's name and phone nupber is on all the invoices so they will be
finance office.

Patrick A. Joy, CACM

Contracting Officer
Frog~-amSupport Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265

bl an effort to evaluate cusron7er s&ifnction.the staff of the PSC wo~cldoppreciare your tnking n feb, nlonzenu to
complete our Customer Corninerlt Card by clicki~lgon the link below. Yolir time and effort in provj:di17~this r)ulrrtlble
.feedbuck perruining to the products or senices you received is greatly appreciated.
2 i . - . ....- .-. ... '-
Message

Joy, Patrick (PSC)

From: Joy, Patrick A. (PSC)

Sent: Friday, June 17, 2005 2:32 PM
To : 'Paul Lynch'
Subject: RE: PlCS Order ICS'194 HHSP233200400125U

Please fax any outstanding invoices to me on 301 -443-2761

Patrick .4. Joy, CACRl - .

Contracting officer -
Program Support Center, S:S
5600 Fishers Lane, Rm 5-101
Rockville, RID 20857
(301) 443-9265
F a (301) 443-2761
In an efSort to evaluate customer satisfaction, the staflof tlze PSC woztld appreciate ?JOLtctkirzg a felts
ntomelzts to complete our.@gtonter Comme~ttCard by clickirlg on the l i d below. You tirue and e f i r t
in providing this valuable fxdback pertainirlg to the prodzlcts or services vou received s greatly
appreciated. - .

-----Original Message----- .-
From: Paul Lynch [mailto:plynch@shs.net]
Sent: Friday, June 17, 2005 11:37 AM
To: Joy, Patrick A. (PSC)
Subject: RE: PIC5 Order ICS-194 HHSP233200400125U
-- .. ... .. .
Hi Patrick,

Our records indicate that you have paid us for Invoices #3, #5, and #7 (total = $139,606.07).
. .

We just mailed Invoice #9 which will take us through May 31, 2005. Once you receive this invc ce, we will have
billed you $417,442.07 (of which $277,836 will be outstand~ng).

.-.
Beginning with Invoice # l o , we will add Dr. Knouss's name and phone number to the invoice.

I hope that this helps. Please let me know if you would like us to resubmit any invo~ces.

Thank you, --
Paul Lynch
Business Operations & Contracts Specialist

From: Joy, Patrick A. (PSC) [mailto: PJoy@psc.gov]

Sent: Friday, June 17, 2005 11:13 AM
Message Page 2 of 2

To: 'Paul Lynch'

Subject: PICS Order ICS-194 HHSP233200400125U

Paul,

I hope you can help me. According to our finance office we have only paid you $139,606.07 sc 11.Are you that
behind on billing or have we messed up. We need to get a handle on the amount lest due to f~ re work and
proposed modifications.
.- .-

Also, please ensure that Dr. Knouss's name and phone number is on all the invoices so they h be sent to him by
our finance office.

Patrick A. Joy, CACRl

Corltracting Officer -.

Program Support Center, S44& --. a

5600 Fishers Lane, Rm 5-101

Rockville, RlD 20857
(301) 443-9265
F a (301) 443-2761
In an efSort to evaluate clrstol7zer satisfaction, the stafS of the PSC would appreciate yo raking n feIt1
moments to conzplere our Custorrzer Comment Card by clicking on the link belo~t-.Yo1 tirne and efSort
in providing this valuable,fe&back pertaining to the products or services you recriveu greatly
w-
appreciated.

c c H t t ~ ~ : / / ~ t ~ w ~ . p ~ ~ . g o ~ ~ / ~ ~ r v e y / C z ~I .htm>>
stoerl/cstoer
>.--.A -. - /
 Page 1 of 1

Joy, Patrick (PSC)

From: Paul Lynch [paul.f.lynch@orcmacro.com]

Sent: Friday, July 08, 2005 2 5 7 PM
To : Joy, Patrick A. (PSC)
Cc: 'JIII Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U
Attachments: Commissioned Corps Modification Budget CL.xls

Patrick,

ORC Macro is pleased to submit the attached budget in response to your June 24 e-mail. We look forward to
continuing our work with the Commissioned Corps through September 30, 2006.
. . -. ., . +. - - . ..- -:: -
--;
. .
~
I
-
.- ....

If you experience any problems ,w~ththe file or if you have any questions, please feel free to contact me.
I
Thank you,
Paul Lynch
Business Operations & Contracts Specialist
ORC Macro
240-747-4769

- --

From: Joy, Patrick A. (PSC) [mailto:PJoy@psc.gov]

Sent: Friday, June 24, 2005 8:39 AM
-,-*a -. . #

To: 'Paul Lynch'

Subject: HHSP233200400125U

Paul,

Please provide a budget for the attached.

<<proposed modification.pdf>> . .
thanks .. . - ..

Patrick A. Joy,
. .
CACRI '

Contracting Officer
Program Support Center, SAS
5600 Fishers Lane, Rnl 5-101
Rockville, RID 20857 .. - .
(301) 443-9265
Fax (301) 443-2761
In an r f ~ o r t t oevaluate customer surisfuctior~,the stujj'of the PSC bvould uppreciulr
urornents to co~rlpleteour Custorner Cornrnerrr Card by clicki~rg011 the link below.
in providirlg this valuable feedback pertairlirtg to the products or services you rcceivedis greatly
uppreci~rted.
ORC Macro, SHS Division !
Extension of PlCS Contract #26301D0174. ICS-194
July 8. 2005 - 1
Period of Performance: September 20,2005 - September 30. 2006
i!
Message Page 1 of 2

Joy, Patrick (PSC)

From: Joy, Patrick A. (PSC)

Sent: Monday, September 05,2005 12:04 PM
To : 'Paul Lynch'
Cc: 'Jill Herzog'; 'Flay Qualls' -
Subject: RE: HHSP233200400125U
Attachments: HHSP233200400125U Mod 2.pdf

Attached is proposed modification number 2 to Order HHSP233200400125U. Please review, rint, sign and fax
back to my attention.

.- .
.
: -. . .--
..
-.

Patrick A. Joy, CACM

Contracting Officer
Program Support Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857 ,--;
(301) 443-9265
Fax (301) 443-2761 -
. custonzer
In an effort to evaluate -
. .. . satisfactiorz, the staflof the PSC would appreciate yo r taking a few I-_.
-

nzoments to conzplete our Customer Comment Card by clicking on the link below. Yo1 r tiltle and effort
in providirzg this valuable feedback pertaining to the products or services you receive6 is greatly
appreciated. , - . --*

-----Original Message-----
From: Paul Lynch [mailto:paui.f.lynch@orcmacro.com] -
Sent: Friday, July 08, 2005 2:57 PM
To: Joy, Patrick A. (PSC)
Cc: 'Jill Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U

Patrick.

ORC Macro is pleased to submit the attached budget in response to your June 24 e-maii. We ook forward to
continuing our work with the Commissioned Corps through September 30, 2006.

If you experience any problems with the file or if you have any questions, please feel free to cc ltact me.

Thank you,
Paul Lynch
Business Operations & Contracts Specialist
ORC Macro
240-747-4769
Message

From: Joy, Patrick A. (PSC) [mailto:PJoy@psc.gov]

Sent: Friday, June 24, 2005 8:39 AM
To: 'Paul Lynch'
Subject: HHSP233200400125U

Paul,
.- ..

Please provide a budget for the attached.

<<proposed modification.pdf>>
thanks

Patrick A. Joy, CACRl

Contracting Officer -.-
- -.
Program Support Center, S&
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
F'm (301) 443-2761
In an effort to evaluatr customer satisfaction, the staff of the PSC would appreciate your taking a Jew
nlonlents to co~npleteour cwtonter Cornrnent Card by clicking on the link belo*,. ~ o u jtinle
- and effort
in providirrg this valuable$%dback pertaining to the products or services you received $ greatlx
appreciated.
I

<< H t t ~ : / / ~ u v ~ ' w . ~ p s ~ . g o ~ , w ~ p ~ e v / ~ - ~ ~1.~htm

t ~ m>e>r ~ / ~ s t o n e r
I
--
I
Joy, Patrick (PSC)
From: Joy, Patrick A. (PSC)
Sent: Wednesday, September 21,2005 10:07 AM
To: 'paul.f.lynch @orcmacro.com'
Subject: Re: HHSP233200400125U

Thought I already sent.it will-resend on thurs Patrick Joy, ( ACM

Contracting Officer - .

..........................
Sent from my BlackBerry Wireless Handheld -

- - - - -Original Message-----
From: Paul Lynch <paul.f.lynch@orcmacro.com>
To: Joy, Patrick A-. (PSC)-cPJoy@psc .gov> -
. .. :
2;-
..
Sent: Wed Sep 21 09:48:13 2005
Subject: RE: HHSP233200400125U

Hi Patrick,

Do you know when we can expect to receive a signed, fully exc cuted copy of
Modification #2?

Thank you, \= -
d' e

Paul Lynch
Fax # - - 301-984-3972

From: Paul Lynch [maslto:paul.f.lynch@orcmacro.com] . -

Sent: Tuesday, September 06, 2005 11:41 AM
To: 'Joy, Patrick A . (PSC)'
Cc: 'Jill Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U
-.- . *. .--

Hi Patrick,

I faxed a signed copy to your attention. Please let me know if you do not
receive it.

Thank you,
Paul Lynch

From: Joy, Patrick A . (PSC) [mailto:PJoy@psc.govl

Sent: Monday, September 05, 2005 12:04 PM
To: 'Paul Lynch'
Cc: 'Jill Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U
Attached is proposed modification number 2 to Order ~ ~ ~ ~ 2 3 3 2 0 0 4 0 0 1 2 5 ~ .
Please review, print, sign and fax back to my attention. 1
I

Patrick A. Joy, CACM

Contracting Officer
Program Support Center, SAS
5600 Fishers Lane, Rm 5-101
Rockville, MD 20857
(301) 443-9265
Fax (301) 443-2761
In an effort to evaluate customer satisfaction, the staff of the PSC would
appreciate your taking a few moments to complete our customer CommentwCard
- --
by clicking on the link bklbw. Your time and effort in .f;rov&ing this
valuable feedback pertaining to the products or services you keceived is
greatly appreciated. '

- - - - -Original Message-----
From: Paul Lynch [mailto:paul.f.lynch@orcmacro.corn]
Sent: Friday, July 0$,\2005 2:57 PM
To: Joy, Patrick A. (PSC)
Cc: 'Jill Herzog'; 'Ray Qualls'
Subject: RE: HHSP233200400125U
...--.* - .. . ,
Patrick, .. .-
1:I .'- ---.-

ORC Macro is pleased to submit the attached budget in responsib to your June
24 e-mail. We look forward to continuing our work
Corps through*~eptember30, 2006.
-- , . .. -. -*.-. -.

If you experience any problems with the file or if questions,

please feel free to contact me.

Thank you,
Paul Lynch
Business Operations & Contracts Specialist
ORC Macro
240-747-4769

From: Joy, Patrick A. (PSC) [mailto:PJoy@psc.gov]

Sent: Friday, June 24, 2005 8:39 AM
To: 'Paul Lynch'
Subject: HHSP233200400125U
Paul,

Please provide a budget for the attached.

<<proposed modification.pdf>>
thanks

Patrick A. Joy, CACM

Contracting Officer .
Program Support Center, SAS
5600 Fishers Lane, Rrn 5-101
Rockville, MD 20857 -
(301) 443-9265
Fax (301) 443-2761
In an effort to evaluate customer satisfaction, the staff of he PSC would
appreciate your taking a few moments to complete our Customer comment Card
by clicking on the link-below. your time and effort in provi ing thi's
.--
eceived is
valuable feedback pertain'iKg t6 the products or servi~es=--~ou' - --
greatly appreciated.
 Joy, Patrick (PSC)

From: Ray B. Qualls [rqualls@shs.net]

Sent: Monday, June 26,2006 3:37 PM
To: Joy, Patrick (PSC)
Cc: Knouss, Robert (HHSJOPHS);Jill Herzog; Paul Lynch i~
Subject: 1
RE: Labor Categories: ICS-194 Commissioned Corps Communication and Recruitment
Program
I
Attachments: Rate Justification - Jun 2 0 0 6 . ~ 1 ~
.
Patrick,
-
Thank you for your guidance on this issue.
- . - --
. .
=+ - , I~
7;- --.
.--
.

I have added my responses below:

1~
iIl
From: Joy, Patrick (PSC) [mailto:Patrick.J~y@psc.hhs.gov]
Sent: Tuesday, June 20, 2006 3:53 PM i
!
TO: Ray B. Qualls
Cc: Knouss, Robert (HHSIOPHS); Jill Herzog
Subject: RE: Labor Categories: ICS-194 Commissioned Corps Communication and
. x.?:
C c

Ray, . -
thanks for the explana.tion.
.<*-.-..+. - -. .., .. . .. . == :.

I have some issueslconfusion on my part.

/I
1) we only have one project director you can not bill under that category for more then one
individual.
I I .. --. ..

individual. -- .. . .-.I _ _
Adding labor categories will allow us to use the project director and media director categories for only one
. ..-. .. .

2) The same goes for media director.

See above.

3) if you want to modify the order to include the other labor categories, that is fine. Please
I
submit supporting documentation for the rates proposed and we can modify. .-.
Supporting documentation is attached. Please revie,w and provide approval if they are acceptable.
1I
4) Include a statement that these changes will not increase the total amount of the order.
;I
Statement is included with the supporting documentation. 1
5) resubmit the invoice re-allocating all the hours to the correct indivuals (i.e. mddia specialist I
& II) with the correct new proposed rates.
Re-allocated invoices will follow once the rates are approved.
'I
Thanks!

Ray Qualls
Contracts Manager
240-747-4765

Patrick A. JOY, CACRl . '

Procurement Analyst .

P~*ogram Support Center, SAS -

5600 Fishe1.s Lane, Rm 5C-18
Rockville, RID 20857
(301) 443-9265
-
F a (301) 594-0736 -

In an effort to evaluate czlstolrler satisfaction, tlze stafSof the PSC ~louldapprec7ate ya aking a.few - -
---. .

monzents to complete our Customer Corrtntent Card by clickilzg 011 the link below. Yozl 'nlc and effort
ilz providing this \~alziablefeedback pertaining to the products or senlices you I-ecelved ~reatly
appreciated.

From: Ray B. Qualls [mailto!rqual\s@shs.net]

Sent: Tuesday, June 20,2006 2:58 PM
To: Joy, Patrick (PSC)
.
---".,.%<, -%. -
Cc: Knouss, Robert (HHSIOPHS); Jill Herzog
Subject: FW: Labor Categories: ICS-194 Commissioned Corps Communication and Recruitme

Patrick,
-
The attached document was prepared upon request of Robert Knouss for ICS-194. He asked
.. ~twe forward it -- .= -..
to you for your review.
--.

Please let us know if you have any questions.

Ray Qualls
Contracts Manager
240-747-4765

From: Ray B. Qualls .-...

Sent: Wednesday, June 14, 2006 1 1 : O l AM
To: Rknauss@osophs.dhhs.gov
Cc: Jill Herzog; Tina Sweep; Paul Lynch
Subject: Labor Categories: ICS-194 Commissioned Corps Communication and Recruitment PI ram

Mr. Knouss,

We recently discussed some issues regarding labor categories for this project. You requestecj 4 detailed
description of the work completed under labor categories with more than full time hours for thc? rq,arch and April
periods. You also requested updated labor categories that better fit the functions being perf01rmed.
1~

I
 Page 3 of 3

Please find our justification and proposed categories attached. Please let me know if you have
categories are acceptable we will apply them to the May costs.

Thank you for your guidance on these issues. 1

~l
Ray Qualls
Contracts Manager
240-747-4765
Joy, Patrick (PSC)
From: Joy, Patrick (PSC)
Sent: Wednesday, September 13,2006 2.1 6 PM
To: Paul F. Lynch
Subject: HHSP233200400125U ICS-194

Please provide a budget for the following:--

.. . -
The Secretary has decided to strengthen the Corps' health profession recruitment forts, particularly
for physicians and nurses. The Corp will begin staffing a 210 person health and m lical response
(HAMR) team with active duty personnel.. Therefore the level of effort for the cont zt needs to be
increased particularly in Item 4 of the SOW to help with this effort.

You proposal should not exceed $500,000.00:~

.. ?--

Patrick A. Joy, CACM .

P~*ocul*ement Analyst
Program Suppol0tCenter, SAS
5600 Fishers Lane, Rm 5C-18
Rockville, MD 20857
.<..'\>>
(301) 443-9265 .-a-

F~IX(301) 594-0736
the staff of the PSC would appreciate your t a k i ~ ~a gj rnonle~ltsto
In an effort to evaluate cust~p?,e~sayisf~~tion, I --. .
complete our Customer Comment Card by clicking on the link below. Your time and effort in pro. ling this valutlble
feedback pertaining to the products or services you received is greatly appreciated.
.. .. .:- --
HHSP233200400 125U ICS- 194 / ~agelofl

Joy, Patrick (PSC)

From: Paul.F.Lynch @orcmacro.com

Sent: Thursday, September 14, 2006 4.1 1 PM
To : Joy, Patrick (PSC)
Subject: RE: ~ ~ ~ ~ 2 3 ' 3 2 0 0 4 0 0
ICS-194
125~
Attachments: HHSP233200400.125U ICS-194 Modification Budget CL.xls
I
!

'
II
Good afternoon, Patrick - We are pleased that the Commissioned Corps has dec~dedto continue our contract
We have attached a budget estimate for the work as requested below.
-. I
Please let me know if you have any questions.
- .. . . - .- I --
Thank you,
Paul Lynch , - . .. . . . . . . . - . .
---. .......
7 z . : -
:I . - -

Business Operations & Contracts Specialist

ORC Macro .. I
240-747-4769

From: Joy, Patrick (PSC) [mailto:Patrick.Joy@psc.hhs.gov]

Sent: Wednesday, September 13, 2006 2:16 PM
To: Paul F. Lynch
Subject: HHSP23320040012'QICS-194

Please provide a budget

:--+-+,.
.
for
.....the following:
.--

The Secretary has decided to strengthen the Corps' health profession recruitmeht efforts,
particularly for physicians and nurses. The Corp will begin staffing a 210-person,health and
medical response 1HAMR)-team with active duty personnel.. Therefore the level of effort for
the contract needs to be increased particularly in Item 4 of the SOW to help with this effort. --
..
. .-..
-..
You proposal should not exceed $500,000.00.
.. . .
....

Patrick A. Joy, CACM

Procurement Analyst
Program Support Center, SAS
5600 Fishers Lane, Rm 5C-18
Rockville, MD 20857 .--.
(301) 443-9265
F a (301) 594-0736
In an e80or.t to evaluate clistoriler sarifiction, the stuf of the PSC \could appreciate you
monienrs to complete our Customer Comntent Card by clickirtg oil the link below. Yourtime and efort
in providing this vulriable feedback pertaining to the products or services you received i? greutly
appreciated.
ORC Macro. SHS Division
Extension of PlCS Contract #26301~0174,ICS-196
July 8.2005
Penod of Performance: September 20,2005 - September 30,2006
From: Joy, Patrick (PSC)
Sent: Friday, September 22,2006 11:36 AM
To: Knouss, Robert (HHS/OPHS); 'Paul.F.Lynch@orcmacro.com'
Cc: PSC PSC-Finance
Subject: HHSP233200400125U

Attachments: HHSP233200400125tl Modifcation 3.pdf

Attached is a fully executed copy of Modification 3

.
HHSP233200400 1
25U Modifcation ... :
- -.
. -
-- - --
Patrick A. Joy, CACM
Procurement Analyst =
-
7-
~
I -

Program Support Center, SAS

5600 Fishers Lane, Rm 5C-18
Rockville, MD 20857
(301) 443-9265 .' --
Fax (301) 594-0736 x'

In an effort to evaluate customer-satisfactio~z,the staff of the PSC would appreciate yolir t a k i ~ ~ag elz*rllonlents to
complere our Customer Comment .. by clickilzg on the link belou: Your time and effort ill prc riding this ,!allcable
-.-.-&.Card
feedback pertaining to the products or services yo11 received is greatly clypreciated.
 Joy, Patrick (PSC)

From: Paul F. Lynch [plynch@shs.net]

Sent: Friday, September 22, 2006 2:00 PM
To: Joy, Patrick (PSC)
Subject: RE: ~ ~ ~ ~ 2 3 3 2 0 0 4 0 0 1 2 5 ~

Thank you, Patrick!

From: Joy, Patrick (PSC) [mailto:Patrick.Joy@psc.hh~gov]

Sent: Friday, September 22, 2006 11:36 AM
To: Knouss, Robert (HHSJOPHS);- Paul
.
F. Lynch
Cc: PSC PSC-Finance . .

Subject: HHSP233200400125U. ' "

Attached is a fully executed copy of Modification 3

<<HHSP233200400125U Modifcation 3.pdf>>
Patrick A. Joy, CACM
Procurement Analyst
Program Support Cqnt.er, SAS
5600 Fishers Lane, R A ' ~ c - 1 8
Rockville, MD 20857'
(301) 443-9265 ... -,,. -. .. -
FXK(301) 594-0736
In an effort to evaluate customer satisfaction, the staff of the PSC would appreciate y~ ' ~ a k i l ga few
molnellts to complete our Customer Comment Card by clicking on the link below. Yo, time and effort
in providing this valuable feedback pertaining to the products or services you receivec s greatly
appreciated.
. *. ->
--
 I

ORDER FOR SUPPLIES OR SERVICES r - . ,

-. - .-- _ 1 j PAGE 07 PAGES
IMPORTANT: Mark all packages and papers w l t h contract andlor order numbers I - , , I l l I 1
1 DATE OF ORDER 2 CONTRACT NO (11 any1 6 SHIP TO 1
HHSP23320042008RB
10/28/2003
3 ORDER NO 4 REOUlSlTlONlREFERENCE NO

04R000037
Indicated
a NAME OF CONSIGNEE

on Call

I
5. ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS
DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857
c CITY 1 d STATE e ZIP CODE

I I
7 TO TOM SWEENEY
a NAME OF CONTRACTOR
- I SHIP VIA

NORTH AMERICAN NETWORK, INC.

8 TYPE OF ORDER
- 1
b COMPANY NAME
O a PURCHASE / _I b DELIVERY =
c STREET ADDRESS .. . .. .. ~:-
REFERENCE YOUR: -:
'I - . .-
. .
.--
Exdebt for billi?ginstrucbonson the
7910 WOODMONT AVE, SUITE 1400
revine, th~sdellvery ordw 5s
sublect to ~nstmcbonsmnta~nedon

Please furnish the following on the terms

and conditions speafied on both s~desof
1 lu8
th~ss~deonty of this form and IS
subect lo the nrms and
conlddnns of the above-numbered
d. CITY e. STATE I.ZIP CODE
mis order and on the anached sheets. fi mitt
any. including delivery as indicated.
BETHESDA MD 20814
9. ACCOUNTING AND APPROPRIATIONS DATA 10. REOUlSlTlONlNG OFFICE
Indicated On Call DHHS/AHRQ
11. BUSINESS CLASSIFICATION (Check appropriate t& ee3$1
E a. SMALL b; b. OTHER THAN SMALL E C. DlsAovANTAcEo

12. F.O.B. POINT Destination 14. GOVERNMENT BIUNO. 15. DELIVER TO F.O.B. POINT 16 DISCOUNT TERMS . -
ON OR BEFORE (Date)
13. PLACE OF
a. INSPECTION b, ACCEmrJC:p... - ." h
Indicated On Call
I
Indicated On Call . ==,

Destination Destination
17. SCHEDULE
(See reverse lor Rejed,onsJ
8
I . _ _
OUANTITY UNIT
:I OUANTlrY
ITEM NO SUPPLIES OR SERVICES
.
ORDERED UNIT PRICE
AM;;Nl ACC; PTED

-! ~
(a) (b) (c) (d) lei (9)
Period of Performance: 10/01/2003 to
- . - ..
..

:.
09/30/2004
.. .- ". . -. ....
I

II

. ..
I I I I I I I
18. SHIPPING POINT I 19. GROSS SHIPPING WEIGHT 20. INVOICE NO. I 17(h).

I
;I TOTAL

-.
I
21 MAIL INVOICETO

a NAME Indicated On Call $50,000.00

I
SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE (or P O . Box) - NTE 17(i).
GRAND
TOTAL

c. CITY d. STATE e. ZIP CODE $So,oo0) oo

I

22. UNITED STATES OF AMERICA . 1 23. NAME (TvoedJ '1

BY (Slgnarure) JO LASKO
TITLE CONTRACTlNGlORDERlNG OFFICER
NSN 754C-01-752-8083 /
/
- 1 OPTIONAL FORM 347 IR.r 6351

PREVIOUS EDITION NOT USABLE d1-Dal4 GSMAR (48 CFR, 53 PIX.)

T
Public Affairs BPA - North American
I
JUSTIFICATION
1
Successful marketing of AHRQ to professionals and consumers is critical to the mission, image,
and visibility of AHRQ. Part of AHRQ's marketing effort involves producing audio hews
releases (ANRs) and public ssrvice announcements (PSAs) written specifically for rahio. These
are self-contained radio stories which include a sound bite fiom AHRQ's director or dther expert.
They are sent only to radio stations, networks or talk shows whose listeners are our takget
audience. To produce these properly we have a need for professional audio taping of the ANRs
and PSAs and subsequent dishbution to the a&ropriate radio avenues. AHRQ has no facility for
this kind of production. NORTH AMERICAN NETWORK is a professional, indenebdently ..
owned and operated radio bioadcasting ageiicy located in Bethesda, Maryland. specisllzing --
exclusively in radio news serviices, they have been providing quality news arid p u b d f f a i r s
programming to radio stations and networks since 1984. In addition to ANRs and ~ d A s ,
NORTH AMERICAN NETWORK can arrange radio tours, and produce monthly of
consumer information. They upload the spots to their Web site fiom which radio stations can
download broadcast quality versions.
I

SCOPE OF WORK
.. <-..
,+,

NORTH AMERICAN NETWORK will record the sound bites fiom experts provided by AHRQ.
These may be recorded in person or over the phone as availability of the expert permits.
NORTH AMERICANXETWRK will work with public affairs staff to produce a s k p t for the ---- .
radio spot (usually 60 seconds in length) that incorporates the sound bite. Then N O ~ T H
AMERICAN NETWORK will have a professional voice record the text of th_e scripI>
will add the sound bite, editing when needed to remove extraneous sounds or tighten
length. The finished piece and the written script will be uploaded to www.radiospacd.corn.
From language provided by AHRQ public affairs, NORTH AMERICAN NETWORK then will
produce and distribute an advisory to radio stations alerting them to the finished pieck, and
provide audiotapes to stations that require them. NORTH AMERICAN ~ ~ ~ ~ ~ R K h i l l f o l l o w
up with all stationslnetworks that accepted the tape or download to see how the spots were used.
They will provide a written report to AHRQ of the total usage (including gross audience
impressions) within 6 weeks of first distribution of the radio spot. No single call o r d b is to
exceed $2,500.00. Pickup and delivery will be made dunng normal office hours bedeen 9 a.m.
and 5 p.m. Turnaround times will be determined at the time of call order. ~
 , - ,---
ORDER FOR SUPPLIES OR SERVICES , ,I . , , I PAGE OF PAGES
I
IMPORTANT: Mark all packages and papers w ~ t hcontract and/or order numbers 1 1:
, I
1. DATE OF ORDER 2. CONTRACT NO. (If
any) 6 SHlP TO:
HHSP23320042008RB
10/29/2003
I
a. NAME OF CONSIGNEE
I
3. ORDER NO. 4. REQUlSlTlONlREFERENCE NO.
DHHS/ AHRQ
00

II
5. ISSUING OFFICE (Address correspondence lo) b. STREET ADDRESS
DHHS/PSC/SAS/DAM REDLANTJ TECHNOLOGY CENTER
PARKLAWN BUILDING, ROOM 5-101 1ST FLOOR
: .
5600 FISHERS LANE 540 GAITHER ROAD
ROCKVILLE MD 20857 . -
.. .
r CITY d. STATE e. ZIP CODE
ROCKVILLE MD 20850
TOM SWEENEY f. SHIP VLA
7. TO:
a. NAME OF CONTRACTOR
NORTH AMERICAN NETWORK, INC.
i

B. TYPE OF ORDER,^
j
b. COMPANY NAME 'a
-~-:
a. PURCHASE b. DELIVERY
- . . - --
. ~

c. STREET ADDRESS
7910 WOODMONTAVE, SUITEl40D --
REFERENCE YOUR:
...~-- -,,, . -.

1.
. - . .
; reverse. this delivery ader D
subjea lo ins-ns mntained on
this side cmiy of this lam and is
Pkase furnish the following on terms ,sued subpc( to the I m n s and
and f o o d i l h s specified on both sides c4 wnd~bms01 the above-numbered
this order and on the atlad& thee&, il conlrad
d. CITY e. STATE 1. ZIP CODE ;
any, induding delivery as indicated.
BETHESDA MD 20814
9. ACCOUNTING AND APPROPRIATIONS DATA 10. REQUISITIONING OFFICE
DHHS/AHRQ
11. BUSINESS CLASSIFICATION (Check appmpn;de $x(es))
E a. SMALL \fC b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED

12. F.O.B. POINT Destination

-
1 14. GOVERNMENT WUNO 15. DELIVER TO F.O.B. POINT
ON OR BEFORE (Dale)
! ' 16. DISCOUNT TERMS
. -
13. PLACE OF
09/30/2004 Net 30
a. INSPECTION b.ACcEmLmL -, - . . -
-
-
\
.

Destination Destination 'I

17. SCHEDULE (See reverse for Rejedrons) 1
1 QUANTITY UNIT , .-# - - -- - QUANTITY
ITEM NO. SUPPLIES OR SERVICES ORDERED PRICE AMTUNT ACCEPTED
(a) (b) ie) cn (9)

Tax ID Number -.
DUNS Numbsr : ~ .....
CAN: 0000000 Obj. Class: 0000 FY: 2004
Period of . . .. . .; -1 .< - - - . .--

If you have questions, call Jo Lasko at 30

Continued . . .
. .,
I I I 1 I I
19. GROSS SHIPPING WEIGHT 2 0 INVOICE NO. 17(h).
18. SHIPPING POINT
TOTAL

21. MAIL INVOICE TO:

V
a. NAME ---+
$0.07
SEE BILLING
PSC/FMS (301) 443-3020
INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or P.O. Box) 5600 FISHERS LANE 17(i).
GRAND
TOTAL
I

c. CITY Id. STATE 1 e. ZIP CODE

ROCKVILLE
22. UNITED STATES OF AMERICA
BY (Signature)
&(kd.chdpaITLE:
MD 20857
23. NAME (Typed)

JO LASKO
CoNTRAcTINmoRDERING o;fIcEI
1
I
NSN 7540-01-1526083 OVW3NAL FORM Y 7 1R.r 6S5l
FILE
R
- q W * R ( M CJRlS3.211.1
PREVIOUS EDITION NOT USABLE
 1
!

ORDER FOR SLIPPLIES OR SERVICES

IMPORTANT: Mark all packages and papers rrifh wnbact and/or wder numbers ;I
DATE OF ORDER CONTRACT NO. ORDER NO
10/29/2003
ITEM NO.
MSP23320042008RB
SUPPLlESlSERVlCES QUANTITY UNIT UNIT
00 i~
AMO"NT QUANTITY
ORDERED PRICE ACCEPTED
(A) (6) (C) (Dl (E) /Fl'~ (GI

I
1 Renew Blanket Purchase Agreement (BPA)
for the period October 1, 2003 through
September 30, 2004.
- .-
..
'~
IMPORTANT NOTE: YOUR BPA NUMBER HAS C W G E 3 FROM 20333R TO M ~ ~ 2 : , 3 2 0 0 4 2 0 0 ~ 8 ~ ~ .

This BPA Is for audio production services.

. See Statemznt of Work below.

Call Limitation: $2500.00

.-
. -
Authorized Callers: ~ a r e nCarp
. - . . . - --

981 BLANKET..PURCHASE AGREEMENT

Government or accepted by the Vendor.

invoices for payment.

Continued ...

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

NSN 7540.01.152-8082 50yblot OPTlONAL FORM l44 ( R r b95l
-trrGU
FILE FAR faCFR) 5311YCl
 I
ORDER FOR SUPPLIES OR SERVICES ' PAGE OF PAGES

SCHEDULE CONTINUATION-
IMPORTANT: Mark all packages and papers mth o m b a a andlw order numbers: 1
DATE OF ORDER CONTRACT NO. ORDER NO.

10/29/2003 HHSP23320042008RB 00

Government A u t h o r i z e d . C a l l e r .
6 . A l l s h i p m e n t s under t h i s A g r e e m e n t s h . . .-.
-..

a copy o f t h e o r d e r s l i p s h o w i n g . t h e £ 0 1 1
A. Name o f S u p p l i e r
B. BPA n u m b e r
C. D a t e o f purchase
D. Callordernumber
E. An i t e m i z e d l i s t of s u p p l i e s o r
F. Q u a n t i t y , u n i t p r i c e & extension
G. D a t e of d e l i v e r y
7. S e r v i c e s / s u p p I , i e ~ n o t covered by B l o c
under t h i s BPA. 1h%%ubtfu1 c a s e s , the C
C o n t r a c t i n g O f f i c e r prior t o p e r f o r m i n g a

8. FAILURE ON THE PART O F THE CONTRACTOR

I N C A N C E L L A T I O ~ ~TFIIS''BPA.
'~~

A S PRESCRIBED I N 3 2 . 1 1 1 0 ( A ) ( 1 ) , I N S E R T TH
PAYMENT BY ELECTRONIC FUNDS TRANSFER - CE
--
( A ) METHOD O F PAYMENT. (1) ALL PAYMENTS B -,

O F T H I S CLAUSE- A S USED I N T H I S CLAUSE, T

AND MAY ALSO INCLUDE THE PAYMENT INFORMAT
( 2 ) I N THE EVENT THE GOVERNMENT I S UNABLE
THE CONTRACTOR AGREES TO E I T H E R -
( I ) ACCE'PT PAYMENT BY CHECK OR SOME OTHER
(11) REQUEST THE GOVERNMENT TO EXTEND THE
GOVERNMENT CAN MAKE PAYMENT BY E F T (BUT S

CONTRACTOR U S I N G THE E F T INFORMATION CO

REGISTRATION (CCR ) DATABASE. I N THE EV

DATABASE.

Continued ... , .

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

NSN 75dC41-152-8082 y 1 ~ 1 0 1 'I OPTDUAL FORY Y(I I&. b95)
R I o m4 G U
FAR i 4 I C F ~ l 5 3 2 1 3 ( r l
FILE
 1
11
ORDER FOR SUPPLIES OR SERVICES
-
SCHEDULE CONTINUATION
Il PAGE OF PAGES

11
IMPORTANT. Mark all packaqes and p a p with mnbad andlor ordw numben

I
DATE OF ORDER CONTRACT NO ORDER NO

10/29/2003 HHSP2332004200BRB 00 1
ITEM NO SUPPLlESlSERVlCES OUANTlrY UNIT UNIT QUANTIn
ORDERED PRICE ACCEPTED
(A) (8) (c) (0) (E) (GI

EITHER THE AUTOMATED CLEARING HOUSE (ACH) NETWORK, SUBJECT TO T

(D) SUSPENSION OF PAYMENT- IF THE CONTRACTOR'S EFT INF3RMATION

THIS CONTRACT UNTIL CORRECT EFT INFORMATION IS ENTERED INTO THE

OF INTEREST PENALTIES APPLY.

(E) LIABILITY FOR UNCOMPLETED OR ERRONEOUS

(I) MAKING A CORRECT, PAYMENT;

GOVERNMENT IS D E E W Z O HAVE MADE PAYMENT

RECOVERY OF ANY ER~OMOUSLY DIRECTED F
-
APPLY.
-..

FEDERAL RESERVE SYSTEM.

-
-
4

CONTRACT AS PROVIDED FOR IN THE ASSIGNMENT

CONTRACTOR SHALL REQULRE AS A CONDITION OF

SHALL APPLY TO THE ASSIGNEE AS IF IT WERE T

CONTRACTOR'S FINANCIAL AGENT.cP>

Continued . . .

I
I

TOTAL CARRIED FORWARD TO IST PAGE (ITEM 17(H))

I
;I
NSN 754WJ1-152-8082 50W&101
I( OPTWNAL FORU 2 4 I R r . €A51
m m t y
FILE F l l 14OffRjUZIXCI
 'I
ORDER FOR SUPPLIES OR SERVICES 1 1 PAGE OF PAGES

SCHEDULE CONTINUATION- I 1 5
I
1 11
IMPORTANT: Mark all padrages and papers with m a a d andlw order numbers. '1
DATE OF ORDER CONTRACT NO. ORDER NO :I
10/29/2003 HHSP23320042008RB 00
ITEM NO SUPPLIES~SERVICES QUANTITY UNIT UNIT AM~UNT OUANTIP
ORDERED PRICE '1 ACCEPTED
(A) (0) (c) (D) (E) (5) (G)
(I) PAYMENT INFORMATION. THE PAYMENT OR DIS3URSING OFFICE SHAL
CONTRACTOR AVAILABLE PAYMENT INFORMATION THAT IS SUITA3LE FOR
THE DATE OF RELEASE OF THE EFT INSTRUCTION r 0 THE FEDERAL RESE
GOVERNMENT MAY REQUEST THE CONTRACTOR TO DESIGN AT^ A AESIRED FO
FOR DELIVERY OF PAYMENT INFORMATION FROM A LIST OF FORWTS AND
OFFICE IS CAPABLE OF EXECUTING. HOWEVER, TH3 GOVERNMENT DOES N
PARTICULAR FORMAT OR METHOD OF DELIVERY IS PVAILABLE A'r ANY PART1
OFFICE AND RETAINS THE LATITUDE TO USE
CONVENIENT TO THE GOVERNMENT. IF THE GOVE
ACCORDANCE WITH PARAGRAPH (A) OF THIS
INFORMATION TO THE REMITTANCE ADDRESS
( END OF CLAUSE)- - - . .-

(A) DEFINITIONS. AS USED IN THIS CLAUSE--

GOVERNMENT.

DUN AND BRADST

DATA UNIVERSAL NUMBERING SYSTEM +4 (DUN

ASSIGNED AT THE-DBCRETTON OF THE BUS1

REGISTERED IN THE CCR DATABASE MEANS T ~ T -

RECORD "ACTIVE".

PROSPECTIVE AWARDEE SHALL BE REGIST

PERFORMANCE, AND THROUGH FINAL PAYM

SOLICITATION.

PAGE OF ITS OFFER, THE ANNOTATION -

BRADSTREET DIRECTLY TO OBTAIN ONE

(1) AN OFFEROR MAY OBTAIN A DUNS NUMBER--
Continued . . .

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) d

NSN 741Ml-152-8082 50~4-101 OPTtOtUL FORM 348 1 C r (1951
R
- bl GSb
FILE EM (M cFR1U213Irl
 ORDER FOR SUPPLIES OR SERVICES ( PAGE OF PAGES

IMPORTANT: Mark all packages and papen with mntracl andlor order numbers. '1
DATE OF ORDER CONTRACT NO ORDER NO
10/29/2003 HHSP23320042008RB 00
ITEM NO
ORDERED PRICE '1 . ACCEPTED
(8) (C) (D) (El cF1 (GI
(I) IF LOCATED WITHIN THE UNITED STATES, BY CALL& AND BRADS:*REET AT '1
DU~

BRADSTREET OFFICE.

(I) COMPANY LEGAL BUSINESS.

RECOGNIZED.

(IV) COMPANY MAILING ADDRESS, CITY, STATE

(V) COMPANY TELEPHONE NUMBER.
(VI) DATE THE COMPANY WAS STARTED.
(VII) NUMBER OF EMPLOYEES AT YOUR LOCATION.
(VIII) CHIEF EXECUTIVE OFFICER/KEY MANAGER.
(IX) LINE OF BUSINESS (INDUSTRY).

ENTITY) .
(D) IF THE OFFEROR DOES NOT BECOME REGIS

CONSIDERATION WHEK
~ G I S T E R I N G. OFFE
APPLYING FOR REGISTRATION IMMEDIATEL

DATABASE AFTER THE INITIAL REGIST

OF THIS CONTRACT AND IS NOT A SUB

DOCUMENT.

TRANSFERRED THE ASSETS USED IN PERFORMING

NECESSARY REQUIREMENTS REGARDING NOVATION

IN THE CCR DATABASE; (B) COMPLY

Continued .

I I 1 1 I 1
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))
NSN 7540-91-1526082 5034&101 OPTIONAL FORM 348 I R n Wl
P m s M b#GSA
FILE
 - 1
I

ORDER FOR SUPPLIES OR SERVICES I PAGE OF PAGES

-
SCHEDULE CONTINUATION 7 1 1 1
IMPORTANT: Mark all packages and papen mth oDntrad a d w order numben
DATE OF ORDER C O K I W C T NO ORDER NO I
10/29/2003 HHSP23320042008RB 00 ' <I - -

ITEM NO.

(A)
SUPPLIES/SERVICES

(8)
OTHER THAN THE CONTRACTOR INDICATE
1 QUANTITY UNIT

, 1 'RICE
IE) (Gi

INCORRECT INFORMATION WITHIN T H E M

OF THE ELECTRONIC FUNDS TRANSFER (
(2) THE CONTRACTOR SHALL NOT CHANGE THE
PAYMENTS, AS APPROPRIATE, IN THE C
OF ASSIGNMENT OF CLAIMS (SEE FAR S
SHALL BE SEPARATELY REGISTERED IN
CONTRACTOR'S CCR RECORD THAT INDI
AN ULTIMATE RECIPIENT OTHER THAN
INCORRECT INFORMATION WITHIN THE M
OF THE EFT CLAUSE OF THIS CONTRACT. -
(H) OFFERORS AND CONT-RACTORGMAY OBTAIN IN
CONFIRMATION REQUIREMENTS VIA THE
1-888-227-2423,OR 269-961-5757.
(END OF CLAUSE)

948 - SIMP
52.213-4 TERMS AND CON~~ITIONS
COMMERCIAL ITEMS). (AUG 20031

'IVE ORDER:
I

13) (E.O.!S 1272

12724, 13059, 13067, 13121, 13129).
I

(I) 52.232-1, PAYMENTS (APR 1984).

(111) 52.232-11, EXTRAS (APR 1984).

(IV) 52.232-25, PROMPT PAYMENT (FEB 2002) .
(V) 52.233-1, DISPUTES (JUL 2002).

ICORPORATEDBY

'IVE ORDER:
1
)IES (SEPT 2002)
I/
:RO-PURCIYjlSE
THRESHOLD.) 9
I
I . . 35j45)
lERTO RICO, OR T
U.S . VIRGIN ISLANDS) .

Continued . . .

J I I I I
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17rH)) I1

-- - - --
NSN 75rC-01 -1574nR7
. 50-101 '1 OPTIONAL FORM 1- 695)
R
- 4G U
FAR 1.8 WRL U 1 1 X C I
FILE
 ORDER FOR SUPPLIES OR SERVICES
-
SCHEDULE CONTINUATION
-. , I1 PAGE OF PAGES

VIRGIN ISLANDS, AND WAKE ISLAND.)

. .
--
..--

EXCEED $25 , 000 y:'"".. - -"" -z __i

-, .

SUPPLIES) .

F.O.B. ORIGIN).

F .O.B ,DESTINATION) .
Continued . . .

TOTAL CARRIED FORWARD TO ?STPAGE (ITEM 17(H))

NSN 75dW1-152-8082 SOYklOl
:I OFTONAL FORM l48 I&. -1
P7ncnD.b4 GSA
F I R V I I CSR1U3lXc)
FILE
 1
ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES

SCHEDULE CONTINUATION - ! ? 1 1 1
~1
1
IMPORTANT: M a n all packages and papers 4th ambad and/or order numbers.
DATE OF ORDER CONTRACT NO. ORDER NO.
HHSP2332004200BRB
1
10/29/2003 00
ITEM NO.

(A)
SUPRIESISERVICES

(8)
QUANTITY
ORDERED
(C)

(C) FAR 52.252-2, CLAUSES INCORPORATED BY REFERENCE (F3B 1998). Tk.IS C O N T ~ C T

UNIT

(D)
UNIT
PRICE
(E)
AMO%NT

1 QUANTl7
ACCEPTEC
(Gl

INCORPORATES ONE OR MORE CLAUSES BY REFERENIE, WITH THZ SAME FORC:: rn EF~ECI.AS IF
THEY WERE GIVEN IN FULL TEXT. UPON REQUEST, THE CCNTRAZTING OFFIC~RWILL MAKE THEIR
FULL TEXT AVAILABLE. ALSO, THE FULL TEXT OF A CLAUSE M4Y BE ACCESSED ELEC~RONICALLY
..
AT THIS/THESE ADDRESS (ES):
[INSERT ONE OR MORE INTERNET ADDRESSES]
(D) INSPECTION/ACCEPTANCE. THE CONTRACTOR S : W L TENDER FOR ACCEPTJLNCE

THE RIGHT TO INSPECT OR TEST ANY

ACCEPTANCE. THE GOVERNMENT MAY REQUIRE REP

PRICE, THE GOVERNMENT .MUST-EXERCISE ITS P -.

-.
.

(1) WITHIN A REASONABLE PERIOD OF TIME AF

HAVE BEEN DISCOVERED; AND
12 ) BEFORE ANY SUBSTANTIAL
CHANGE O C ~ S
CHANGE IS DUE TO THE DEFECT IN THE ITEM.

. -
"

WRITTEN NOTICE-TYUIWB COtdTRACTING OFFIC

. . --- ...

TO TERMINATE THIS CONTRACT, OR ANY PART

EVENT OF SUCH TERMINATION, *THE CO~TPACT
AND SHALL IMMEDIATELY CAUSE ANY AND ALL OF
CEASE WORK. SUBJECT TO THE TERMS OF THI
..-. .
PRIOR TO THE NOTICE OF TERMINATION, PLU
....

FOR THIS PURPOSE. THIS PARAGRAPH DOES

THE CONTRACTOR'S RECORDS. THE CONTRAC

HEREOF, FOR CAUSE IN THE EVENT OF

CONTRACTOR FAILS TO COMPLY WITH AN
PROVIDE THE GOVERNMENT, UPON REQUE

LIABLE TO THE CONTRACTOR FOR ANY

Continued . . .
!

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

1'~I
NSN 754041-152-8082 Ma I-.
90116101 OPTIONAL FORM
*- * osr
6%)

FILE F I R (43 CFRI 53113(cI

 1
I

ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES

SCHEDULE - CONTINUATION I 3.0 1 11

IMPORTANT: Mark all packages and papers mm m a a c t andlor order numberr. i
DATE OF ORDER CONTRACT NO. ORDER NO.
10/29/2003 HHSP23320042008RB 00
ITEM NO SUPPLlESlSERVlCES / QUANTITY 1 UNIT 1 UNrr 1 AMOUNT I1 OULVJTITY
ORDERED
1
PRICE ;I ACCEPTED
(8) (C) (D) IE) (9 (GI

TERMINATION FOR CONVENIENCE. 1 1 1 1 1 I

HEREUNDER ARE MERCHANTABLE AND FIT FOR USE
THIS CONTRACT.
(END OF CLAUSE)
NOTICE. . .
IN ACCORDANCE WITH THE REQUIREMENTS OF MENT ACT OF 199
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
TRANSFER (EFT). YOUR .FAILURE TO PROVIDE FU
APPROPRIATE STI ~ N S CONCERN IN^
EPT+L BE
DIRECTED TO THE SHOWN IN BLOCK 21 01 THIS
ORDER. CONTACTS ARE, AS FOLLOWS:
PSC JEANETTEPANG (301) 443-3020
FDA DAVID CAINE (301) 827-5090
CDC PATTYEVERETTE (404) 639-7441
NIH MICHELLE SHORTER (301) 496-6088

MUST CONTAIN THE FOLLOWING: TAX IDENTIFICAT ON

NLR.1BER) OR SOCIAL-'5ECURITY NUMBER.
1 jER
IN ADDITION TO THE.-INFORMATION REQUIRED BY 2.232-25 ( ROMPT PAYM NT), YO& INVOI 1
~EMpLoyER sfI D E N T I F ~ I o N 4
THIS CONTRACT INCORPORATES THE FOLLOWING C
AND EFFECT AS IF THEY WERE GIVEN IN FULL

FEDERAL ACQUISITION REGULATION (48 CFR CHAP

FAR 52.213-4 TERMS AND CONDITIONS - - SIMPL [ER THAN

COMMERCIAL ITEMS) (JUNE 2003 )

FAR 52.243-1 CHANGES - FIXED PRICE

(AUG 1987)
NOTICE. . .
IN ACCORDANCE WITH THE REQUIREMENTS OF THE 'ION IMPRO
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES 'AYMENT BY :LECTRONI FUNDS
,ETE INFOR LTION TO THE
)NS CONCER N G EFT S ~ L BE
L
continued . . .

I I I I I I I
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) ~1
NSN 75dC-01 -152.8082 Y)~~%IOI 1 OPT- FORM YII (Rr 6351
R-bd 4 GSA
FILE FAR I48CFRI U 2 1 3 1 F I
 1. CONTRACT ID CODE PAGE 0%PAGES
AMENDMENT OF SOLICITATION/MODIFICATlON OF CONTRACT I
1 1 1' 2
2. AMENDMENTlMODlFlCATlON NO. 3. EFFECTIVE DATE 1 4. REQUlSlTIONlPURCHASE REQ.NO. 15. PROJECT NO! (~appl~cable)

0001 07/22/2004 04R000213 I

6 ISSUED BY CODE
GAB 7. ADMINISTERED BY (If dher man Item 6)
GAB )I I
DHHS/PSC/SAS/DAM DHHS/PSC/SAS/DAM I
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
Ii
ROCKVILLE MD 20857 ROCKVILLE MD 20857

8. NAME AND ADDRESS OF CONTRACTOR ( N o .

NORTH AMERICAN NETWORK, INC.

mmy, stare end ZIP w e )
- .
4 9A. AMENDMENT OF SOLICITATION NO.

,I
Attn: TOM SWEENEY 90. DATED (SEE ITEM 11)
:I
7910 WOODMONT AVE, SUITE 1400
BETHESDA MD 20814
- 10A MODIFICATIONOF CONTRACTIORDER NO.
HHSP23320042008RB

-
CODE
-
-- I /lOB. DATED (SEE ITEM 13) 1 -
- I? J1
',I I I I
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS ;I
O T h e abwe numbered solicitation is amended as set forth h Item 14. The hour and date spes~ed
(or receipt of 0Hef-s is exten6ed. is not eiitended.
OHers must acknowledge receipt of lhis amendment priu lo the hour and date specified in the s o l i n or as amended, by one ofthe (olbwing m e w s : (a) By mmpdting
I t e m 8 and 15, and rehuning W e s of the amendment (b) By aclrnowledgingreceipt of Lhii amendment on ekh copy ol the offer summed; or (c) By
separale kner or telegram which indudes a reference to the solcitation andamendment number. FAILURE OF YOUR ACKNOWLEDGEMENTTO BE RECEIVEDAT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. llby:
v+'lue of this amendment y w desire to change an offer already submitted, such change may be made by telegram or letter, pmvided each telegmn or letter makes !

reference to the solicitation and this amendment, and is received prior to me openinq hour and date specified. 1
12. ACCOUNTING AND APPROPRlATlON DATA (Hrequired.) 'I
See Schedule
13. THlS ITEM APPLIES ONLY TO MO$;<~ONS OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTlORDER NO. AS DESCRIBED IN ITEM 14.
. . :I
cX A. THlS CHANGE ORDER IS ISSUED PURSUANT TO: (Specifyaulhority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT
ORDER NO. IN ITEM 10A.
X FAR 52.243-1 CHANGES (DECREASE FUNDS)
1 0. THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in payinO office.
apprcpnabon date, efc) SET F O R W C f f E M 74. PURSUANT TO THE AUTHORITY OF FAR 43 103(b). 1
I
C. THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO THE AUTHORITY OF:
I
D. OTHER (Specrfy type of modifrcatim and authority)
''II
E. IMPORTANT: Contractor is not. is required to sign this document and retum copies to the issu~ngoffice.
;I
14. DESCRIPTION OF AMENDMENTMODIFICATION (Organizedby UCF seclion headings, including sol~itationlmntract
subject maffer where feasible.) -
Tax ID Number:
DUNS Number:
Modification to BPA HHSP23320042008RB 1
Prior Order Total . . . . . . . . . . . $ 50,000
Decrease Order ~ o t a l . . . . . . . . . 6,290
New Order Total . . . . . . . . . . . . . . 43,710
Funds not needed in FY04. 1'
7541700 CAN #4-K7225YM O/C: 25.22
Z
1
Not T o Exceed Amount changed to: $43,710.00 ..-.. 1
Contracting Officer changed from J O LASKO to JULIA C SAVOY
Period of Performance: 10/01/2003 t o 09/30/2004
Continued . . . :'I1
Except as pmvided heren, all terms and conditions of the document referencedin ltem 9A or 10A. as heretoforechanged, remains unchanged and in full f- and effed
15A. NAME AND TITLE OF SIGNER (Type orprint) 16A. NAME AND TITLE OF CONT
YCTlNG OFFICER (Type
I

150. CONTRACTOWOFFEROR 16C'. DATE SIGNED

07/22/2004
(Signature olpenw avmoped la sign) 1
NSN 754001-152-8070 STANDARD FORM 30 (REV. 1 M 3 )
Previous edition unusable Presmbedby GSA '1
FAR (48 CFR) 53.243
 OM6 No. 0990-0115
ORDER FOR SUPPLIES OR SERVICES / PAGE OF PAGES
I
IMPORTANT: M a r k all p a c k a g e s a n d p a p e r s w i t h c o n t r a c t a n d l o r o r d e r n u m b e r s / I 1 -
1 DATE OF ORDER 2 CONTRACT NO (IlanyJ 6 SHIP TO 1
HHSP23320042008RB a NAME OF CONSIGNEE
01/12/2004

3. ORDER NO 4 REOUISITIONIREFERENCE NO
DHHS / A H R Q
001
1
5 ISSUING OFFICE (Address conespondence lo) b. STREET ADDRESS I
DHHS/PSC/SAS/DAM REDLAND T E C H N O L O G Y C E N T E R
PARKLAWN BUILDING, ROOM 5-101 1ST F L O O R
5 6 0 0 FISHERS LANE 5 4 0 GAITHER ROAD

ROCKVILLE MD 2 0 8 5 7
c. ClTY d. STATE e. ZIPCODE
ROCKVILLE MD 2 0 8 1 0

7.TO: TOM SWEENEY

a NAME OF CONTRACTOR
1. SHIP VIA
'II
NORTH A M E R I C A N N E T W O R K , INC.
8 TYPE OF ORDER 1
b COMPANY NAME DELIVERY
O a PURCHASE _i

c STREET ADDRESS . ,- REFERENCE YOUR - -. * 1- -=-

T x c e p t lor bdl~nglnsmcbons on the
7 9 1 0 W O O D M O N T AVE, SUITE 1400
reverse th~sdellvery order IS
dubject to InslruCbons contained on
tLls wde only oi trvs form and e
Please fumlsh the follomng on Ihe terms
and cnndlbons speafied on both s~desof
l h ~ order
s and on the anached sheets I(
+hens
ksued subled to me 1-s and
ofthe above-numbered
d CITY e STATE f ZIP CODE cmtracL
any lnclud~ngdellvery as lndlcaled
BETHESDA
MD 20814
9 ACCOUNTING AND APPROPRIATIONS DATA 10 REOUlSlTlONlNG OFFICE

7541700 DHHS/AHRQ

11 BUSINESS CLASSIFICATION (Check apprupnagQ$fes))

a SMALL 0 b OTHER THAN SMALL c DISADVANTAGED d WOMENQWNED

12 F O B POINT Destlnatlon - 14 GOVERNMENT W ~ N O 15 DELIVER TO F o B POINT

ON OR BEFORE (Date)
j 16 DISCOUNT TERMS

a INSPECTION
13 PLACE OF
--.
b ACCEPTANCE
#.x. - .- 11/30/2003 Net 3 0 -=..

Destination Destination
17 SCHEDULE (See reverse lor Rejechons)

ITEM NO SUPPLIES OR SERVICES 1 OUANTITY

ORDERED 1 UIdIT
PRICE
OUANTlrY
ACCEPTED
(9)

Tax I D Number:
D U N S Number:
C A N : K 7 2 2 5 Y M Ob]. C l a s s : 2 5 2 2 F Y : 2004
Period of Performanc6i 10/01/2003 t o 09/30 2004

1 4 CALLS COMPLETED FOR THE M O N T H O F

C o n t i n u e d ...

18 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO 17(h)

TOTAL
(Con1
pages)
21 MAIL INVOICE TO

SEE BILLING
a NAME
PSC/FMS (301) 443-3020
i
sg,soo.oo 4
INSTRUCTIONS b STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or P 0 Box)
5 6 0 0 F I S H E R S LANE 17(1)
GRAND
TOTAL
11
c. CITY d STATE e. ZIP CODE $9.80~0.00
I ROCKVILLE - I MD 1 20857 I 1 1
22. UNITED STATES OF AMERICA . 23 NAME (Typed)
BY (S~gnature) JULIA C . SAVOY
TITLE: CONTRACTINGIORDERING OFF,ICER .
NSN 754041-152-8083
// 1 OPTIONAL FORM 1 4 1 I R r

:
6.35)

PREVIOUS EDITION NOT USABLE R-bdqGSMW7I.d CTR) 53 21x.l

 -
ORDER FOR SUPPLIES OR SERVICES i PAGE OF PAGES

SCHEDULE CONTINUATION -
IMPORTANT: Mar* all packages and papers wth contract and/or order numbers ;I
DATE OF ORDER CONTRACT NO.
1
1
ORDER NO
01/12/2004 HHSP23320042008RB 001
ITEM NO. SUPPLlESlSERVlCES OUANTITY UNIT UNIT AMOUNi OUANilN
ORDERED PRICE ACCEPTED
(A) (0) (C) (D) (E) (F) IG)

NOVEMBER 2003

1
Total amount o f award: $9,80-0.00. The o b l i g a t i o n for tlis award i ~ . i n box
shown
17 ( i ).

-
!
- . . ..
.
, -
.
. . .. - *-
=-'. . -:-.
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-
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I

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-
7 -
il .- -. .- - . .-
.....

i
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9
I
;

NSN 154&01.152.8082
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) A
wm-loi OPTIONAL FORM Y B I R r ma)
Rmmm q G S r
F A R I I I C F R ) !AllYrl
 c No. 0990-0175
I
11
ORDER FOR SUPPLIES OR SERVICES 1 j PAGE OF JAG::

IMPORTANT: Mark a l l p a c k a g e s a n d p a p e r s w l t h c o n t r a c t a n d l o r o r d e r n u m b e r s 1 : 1
I
I -
1 DATE OF ORDER 2 CONTRACT NO (If any) 6 SHIP TO (
HHSP23320042008RB a NAh4E OF CONSIGNEE
01/14/2004
3. ORDER NO. 4. REQUISITIONIREFERENCE NO

002
5, ISSUING OFFICE (Address correspondence to)
DHHS/PSC/SAS/DAM
b. STREET ADDRESS
REDLAND TECHNOLOGY CENTER
;I
PARKLAWN BUILDING, ROOM 5-101 1ST FLOOR
5600 FISHERS LANE 540 GAITHER ROAD
ROCKVILLE MD 20857 - -
.- .
. -
c. ClTY
ROCKVILLE
7 TO TOM SWEENEY f SHIPVIA
Y
a NAME OF CONTRACTOR
NORTH AMERICAN NETWORK, INC. B TYPE OF ORDER I
b COMPANY NAME
- . . - I m a PURCHASE ( /Zb DELIVERY -
c. STREET ADDRESS .. - <-
REFERENCE YOUR:
xcept for b'illnng ~nstrucbonson Ihe ;--?
..

7 91 0 WOODMONT -AVE, SUITE 14 00 /eveme. thrr delwery order 1s

I ( subject lo !nsvucsons contained on

d. CITY
BETHESDA
e. STATE I.ZIP CODE
1 Please lurnish the Idlowing on the terms
and mndibons s p e f l ~ e don both sides of
this order and o n the attached sheets, 8
any, mcluding delivery as indicated.
1
11 [his side only ofthis form and 1s
ssued subiect to the t e n s and
, * i f me above-oumbefed
'ontract.

9. ACCOUNTING AND APPROPRIATIONS DATA ( 10. REQUISITIONING OFFICE ;I

,
I
11. BUSINESS CLASSIFICATION (Check appmpri* wes))
a. SMALL 'D b. OTHER THAN SMALL C. DISADVANTAGED
1
d WOMEN-OWNED

12. F O B . POINT Destination - 14. GOVERNMENT BIUNO IS. DELIVER TO F.O.B. POINT 16. DI~COUNTTERMS . -
ON OR BEFORE (Date)
13 P U C E OF
a. INSPECTION ( b ACCWTRWE- -'+

Destination ~estination
17 SCHEDULE (See reverse for Re~ect~onsl 1
-
.

ITEM NO. SUPPLIES OR SERVICES

QUANTITY
ORDERED UNIT PRICE 1 AMOUNT
OUANTIN
ACCEPTED
(a) (b) Ic) -
Tax ID Number:
DUNS Number:
CAN: K7225YM Obj . Class: 2522 FY: 2004
b4
Period of Perfurmance: 10/01/2003 to 09/30/2004

1 2 CALLS COMPLETED FOR THE MONTH OF

Continued . . .
.. ..
I 1
18 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO I 17(h)
TOTAL
(Con!.
lpaw,
21. MAIL INVOICE TO:
.--.
b
a. NAME ~ . 1
$4,00:0.00
SEE BILLING
PSC/FMS (301) 443-3020 ' '1
lNSTRUCTlONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or P.0 BOX) 5600 'FISHERS LANE 17(i).
GRAND
TOTAL

$4.00'0.00
c. ClTY

ROCKVILLE 1d. STATE

MD
1 e. ZIP CODE
20857
:I
,I
1
22. UNITED STATES OF AMERICA
BY (Signature)
23. NAME (Typed)

J U L I A C . SAVOY
TITLE. CONTRACTINGIORDERING OFFICER
1
NSN 154041-152-8083
77 ' I OPTDNAL FORM 361 (R.V 695)

PREVIOUS EDITION NOT USABLE

Y
 ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES

IMPORTANT: Mark all packages and papers with mntract andlor order numbers. I
DATE OF ORDER CONTRACT NO. ORDER NO.

01/14/2004 HHSP23320042008RB 002

ITEM NO SUPPLIES~SERVICES QUANTITY UNIT UNIT AMO+ OUAIU'T~F

(A) (8)
ORDERED
(C) (0)
PRICE
(E)
#I
(F) 1
ACCEPTED
IGi

DECEMBER 2 0 03

Total amount o f award: $4,000.00. The o b l i g 3 t i o n for tnis award ie;

- -
17(i). :

-
--.- . -. - ..q:: . .
I

-.,-
..

.~.~
..

-. .-
J

I
I

i
..
. -.- ~ .. . . .. .-., -
. - ..> . .a-.
I

TOTAL CARRIED FORWARD TO IST PAGE (ITEM 17(H)) 1

NSN 790-01.1524082 YJw-101 OPTIONAL FORM 348 ( ~ ( -51
n

R m t d bl GSA
FAR (48 CFR) YPIYcI
 INSTRUCTIONS FOR USE: This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acqui-
si\ion Management, ASC, Room 5-77, Parklawn Bldg., no later than c.o.b., the 5th day of each month.
, (degative reports are required.)
,
!
'I

BLANKET PURCHASE AGREEME~T

I
M0nth:,~ecernber-2003- RECORD-OWALL- ~ontractor~N~rth~~merican~~etwork,~lnc.
i
-

'I

1 1 Pages BPA.# 2008RB

I
1 : CAN #4-K7225YM
Date of Call Ordered General Description Dollar Balance (Do NOT use)
Call Number By of Items Amount Remaining For Program Use

Initial Amount or Balance Carried ~owa-rd.. . . . . . . . . . . . . . . . . . . . . . . . . . . . -.. . . . . . . . . . .

I I I I
I
I
40,200.00 1
I

12118 5 KC Tobacco PSA Monitoring English GAS . I il

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12118 6 KC Tobacco PSA Monitoring Spanish GAS . -
I I

!
,. .
:"9
i:
,
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I
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I I I I hereby certify that the above supplieslservices are authorized purchase under the above referenced BPA and were
procured by Authorized Callers. ,
Signature of Authorized Program Official: [
 ORDER FOR SUPPLIES OR SERVICES / PAGE D i PAGES

IMPORTANT: Mark all packages and papers w i t h contract andlor order numbers 1 1 ;
I
/ -
1. DATE OF ORDER 2. CONTRACT NO. (Ilany) 6. SHIP T O !I
HHSP23320042008RB a. NAME OF CONSIGNEE
03/17/2004
3. ORDER NO 14.REOUISITIONIREFERENCE NO.
003 I

5. ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS

DHHS/PSC/SAS/DAM REDLAND TECHNOLOGY CENTER ,
PARKLAWN BUILDING, ROOM 5-101 1ST FLOOR
5600 FISHERS LANE 540 GAITHER ROAD
ROCKVILLE MD 20857 - -

C. ClTY
ROCKVILLE
7. '0: TOM SWEENEY 1. SHIP VIA

a. NAME OF CONTRACTOR
NORTH AMERICAN NETWORK, INC. 8.TYPE OF ORDER ,I
b. COMPANY NAME - .
. . 1 m a . PURCHASE ( & b. DELIVERY =
c. STREET ADDRESS . -- .
REFERENCE YOUR: ~ ..

7910 WOODMONT AVE, SUITE 1400 ~

=Lbjecl to insvucoons mnlatned on

ttils side on4 of l h ~ sl o r n and is
Please furnish the following on (he terms idsued subject to the lenns and
and conditions specified on both sldes of dbnditbons ol the above-numbered
this order and on the anached sheets, il +tract.
d. CITY e. STATE I. ZIP CODE
any, including delivery as indicated.
BETHESDA MD 20814 1
9. ACCOUNTING AND APPROPRIATIONS DATA
7541700
11. BUSINESS CLASSIFICATION (Check appmpriad bo@s))
10. REQUISITIONING OFFICE

DHHS/AHRQ 1
;I
a. SMALL 'D b. OTHER THAN SMALL C. DISADVANTAGED d. WOMEN-OWNED

12. F.O.B. POINT Destination -- 14. GOVERNMENT BIUNO. IS. DELIVER TO F.O.B. POINT
I
16. DISCOUNT TERMS . -
/
ON OR BEFORE (Dale)
13 PLACE OF
a INSPECTION "-
1 b ACEFIX?$CE - 02/29/2004 Net 3.0 .= ==..

Destination l~estination ,I i
17 SCHEDULE (See reverse lor Rejecbons)

ITEM NO
(a)
SUPPLIES OR SERVICES
(b)
ORDERED 1 QUANTIM
ACCEPTED

Tax ID Number:
DUNS Number: '5'- -1
CAN: K7225YM Obj. Class: 2522 FY: ~ u u 4
1
-.

-.
1 CALL COMPLETED FOR THE MONTH OF FEB 2004

(continued . .

18. SHIPPING POINT 1 19. GROSS SHIPPING WEIGHT 120.INVOICE NO.

I

SEE BILLING
INSTRUCTIONS
ON REVERSE
a. NAME

b. STREET ADDRESS
(or P.0. Box)
PSC/FMS (301) 443-3020
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE
21. MAIL INVOICE TO:
I
.
. . -
$000
..

1 (Conr
pages)

'
17(i).

I GRAND
TOTAL

d. STATE e ZIP CODE S1.71d.00

1 4
22. UNITED STATES OF AMERICA 23. NAME (Typed)
BY (Signature) JULIA C. SAVOY
TITLE: CONTRACTINGIORDERING OFFICER
NSN 754&0l-152-8083 OPTDYAL FORM 347 18- -51

PREVIOUS EDITION NOT USABLE R~-~GS~*LI((UICFRIS~~~Y~)

 I
ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES

-
SCHEDLILE CONTlNUATlON
IMPORTANT: Mark all packages and papers mlh wnbad andlor order numbers /I
DATE OF ORDER CONTRACT NO ORDER NO 1
03/17/2004 HHSP23320042008RB 003 1

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) I

NSN 754041-152-8082 Ww&10( OPTCJNAL FORM Y l In-

1 R- 4 GSA
F I R I ~ C F R ) 5321%~)
 INSTRUCTIONS FOR USE: This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acqui-
sition Management, ASC, Room 5-77, Parklawn Bldg., no later than c.o.b., the 5th day of each month.
(Negative reports are required.) .

BLANKET PURCHASE AGREEMENT

Month: February 2004 RECORD OF CALL Contractor North American Network, Inc.
I

1 1 Pages BPA # HHSP23320042008RB

I I
I CAN #4-K7225YM
Date of Call Ordered General Descripti* Dollar Balance (Do NOT use)
Call Number BY I of ltems
L
1i Amount , ,
I
Remaining For Program Use

\
Initial Amount or Balance Carried Forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :
I
36,200.00

213 7 KC Monitoring ANR Spanish PPlP Adult C

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< 1
1

cr - :
\
I
1 1

! I
li
1

I hereby kertlfy that the above suppliesl~ervicesare authorized purchase wder the above referenced BPA and were
procured by Authorized Callers.
S~gnatureof Aulhorlzed Program Offic~al
 I

ORDER FOR SUPPLIES OR SERVICES 1 PAGE oi PAGES

IMPORTANT: Mark all packages a n d p a p e n with c o n t r a c t andlor o r d e r n u m b e r s /I

1. DATE OF ORDER 2. CONTRACT NO. (#any) 6. SHIP TO:(I
HHSP23320042008RB a. NAME OF CONSIGNEE
05/13/2004
3. ORDER NO. 4. REQUISITIONIREFERENCE NO.

004 DHHS/AHRQ

5 ISSUING OFFICE (Address conespondenm lo)

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857
/b STREET ADDRESS
REDLAND TECHNOLOGY CENTER
1ST FLOOR
540 CAITHER ROAD

c. UTY
II

I d STATE e ZIP CODE

ROCKVILLE MD 20850
7,'O: TOM SWEENEY 1. SHIP VIA
. . .
a. NAME OF CONTRACTOR
NORTH AMERICAN NETWORK, INC. 8 T<PE OF ORDER I
I
b COMPANY NAME
. ,
O a PURCHASE I ffiI
b DELIVERY =
c. STREET ADDRESS . . .. . REFERENCE YOUR: ----
.~.. . ... . =zI .-
Except fo/bl'ing m s t r u c M n s on the
-.-.
7910 WOODMONT AVE, SUITE 1400
irevene. this dellvery order is
I,sublect lo insmrtions contained a

:Ims srde oniy 01 mu formand is

I
P k 5 e furnish the follming on the terms ;sued sutjecl lo the lerms and
and o D n d i r soecjhed on both sides of lc~dztiau of the atme-numbered
this order and on the attached thee&, if :kmkct
d. CITY e. STATE 1. ZIP CODE
any, incluling d e l i as i n d i t e d .
BETHESDA MD 20814
9. ACCOUNTING AND APPROPRIATIONSDATA 10. REQUISITIONINGOFFICE
7541700 DHHS/AHRQ
11. BUSINESS CLASSIFICATION (Check appmpfi&
a. SMALL b. OTHER THAN SMALL c. DISADVANTAGED b d. WOMENQWNED

12. F.O.B. POINT

a. INSPECTION
Destination
Destination
13. PLACE OF
b, -
ACem.A~cE
Destination
--

.-j4
14. GOVERNMENT BIUNO. 15. DELIVER TO F.0.8. POINT
ON OR BEFORE (Dale)

04/30/2004 1I 1 ?6.DISCOUNT TERMS

. Net .30.. .

17. SCHEDULE (See reverse tor Rejedions) 'I

QiANTlM UNlT QUANTITY
ITEM NO SUPPLIES OR SERVICES ORDERED UNlT PRICE ACCEPTED
-.
(c) -
(4 (e) (9)
.--.

DUNS Number-:
.. ..
.- -

CAN: K7225YM Obj. Class: 2522 FY': 2004

4CALLS COMPLETED FOR THE MONTH APR -04

I I I I I I
18, SHIPPING POINT 19. GROSS SHIPPING WEIGHT 20. INVOICE NO. 17(h).
TOTAL
(Con!.
pages)
21. MAIL INVOICE TO.
. . -
a. NAME $0.00,
SEE BlUlNG
PSC/FMS (301) 443-3020 I
INSlRUCTIONS b. SIREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or P.O. Box) 5600 FISHERS LANE 17(i).
GRAND
TOTAL
'I
e. ZIP CODE $7,800.OO
c. CITY d. STATE

I
~
\
ROCKVILLE MD 20857
- . I
22. UNITED STATES OF AMERICA 23. NAME (Typed)
BY (Signature) JULIA C. SAVOY
TITLE: CONTRACTINGIORDERING OF~ICER
$
NSN 754001-152-8083 O n W L FORM Y7 1 % ~hm

PREVIOUS EDITION NOT USABLE Ra- 4 G S M I R 1- CFR113 21X.1

 I
ORDER FOR SUPPLIES OR SERVlCES 1 PAGE OF PAGES

-
SCHEDULE CONTINUATION 2 1 2

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) '1

NSN 754W1-1524082 %+..6101 O P T I O W FORM Y I&. b951
-)*m
FAR 148 C I R I U I 1 X c l
 lNSTRUCTlONS FOR USE: This form is to be maintained on a monthly basis, with a copy'to be submitted to the Division of Acqui-
sition Management, ASC, Room 5-77, Parklawn Bldg., no later than c.o.b., the 5th day of each month.
(Negative reports are required.)
'
BLANKET PURCHASE AGREEMENT
Month: April 2004 RECORD OF CALL Contractor North American Network, Inc.
I
I
-
-
--
- -b --
I-

1 1 ~abes BPA # HHSP23320042008RB

11,
: CAN #4-K7225YM
Date of Call Ordered General Description Dollar Balance (Do NOT use)
Call Number By of Items Amount Remalning For Program Use

lnitial Amount or ~alancecarried ~oiward.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . I 34.490.00 1

I I I I I

KC Monitoring BMI Spanish Holiday Consumer Featurc ' \ I

I I : I
I i
KC Monitoring BMI English Holiday Consumer Feature I L
\
I
I ,I
KC Monitoring English Safe Medications
\
I' I
KC Monitoring Spanlsh Safe Medications
I
I

1 I hereby certify that the above supplieslservicesare authorized purchase under the above referenced=~ and were
- -

procured by Authorized Callers.

- Signature of Authorized Program Offlclal:
 I

ORDEI. J R SUPPLIES OR SERVICES

I 7
1. DATE OF ORDER 2 CONTRACT NO (Iany)
f
HHSP23320042008RB
09/06/2004 a. NAME OF CONSIGNEE

3. ORDER NO. 4.REQUISITION/REFERENCE NO.

005 DHHS/AHRQ
5. ISSUING OFFICE (Address conespondence lo)
DHHs/Psc/sAs/DAM
PARKLAWN BUILDING, ROOM 5-101
I
b. STREET ADDRESS
REDLAND TECmOLOGY CENTER
1ST FLOOR,
i
5600 FISHERS LANE - , 540 GAITHER ROAD
ROCKVILLE MD 20857
.. .. c. CITY d. STATE e. DP CODE
ROCKVILLE MD 20850
7.TO: TOM SWEENEY 1. SHIP VIA
a. NAME OF CONTRACTOR
NORTH AMERICAN NETWORK, INC. .. . . . . .
8. TYPE OF ORDER . 1
b. COMPANY NAME
C a. PURCHASE B 4.DELIVERY ..
c. STREET ADDRESS .- . ... .-. REFERENCE YOUR:
Excepl f a biding insrruct&s on the
7910 WOODMONT AVE, SUITE 1400 . -
- -
. ,.. . . C
-&:thk delivery order IS
subjkt to inslructions cnnlained on
this s/de only of this lam and a
Please furnish the following o n n t terms IS+ subled to the terms and
and c m d I o n s spe*~ed on both sides 0t conditions of the above-numbered
d. CITY this order and on the aanached sheets, it
e. STATE f. ZIP CODE
any, including delivery as indimled.
BETHESDA MD .20814 I
9. ACCOUNTING AND APPROPRIATIONS DATA 10. REQUISITIONING OFFICE
7541700 DHHS/ ~ R Q
~p -
I -

11.BUSINESS CLASSIFICATION (Check appropnale box(es))

a. SMALL
.-,'. .U
...- b. OTHER THAN SMALL - d. WOMEN-OWNED
- wl:
12.F.O.B. POINT Destination 14.GOVERNMENT BRINO. IS.DELIVER TO F.O.B. POINT 16. DISCOUNT TERMS
ON OR BEFORE (Dale)
13. PLACE OF . .. .
05/31/2004 Net 30
a. INSPECTION I b. ACCEPTANCE
Destination . ..
17. SCHEDULE (See reverse tor Rejedions) 1
ITEM NO.
(a)
SUPPLIES ORSERVICES . .
!b) (CI td) (el (0 I
!-J- QUANTITY
ACCEPTED
(a
Tax ID Numbel
DUNS Number:
CAN: K7225YM Ob]. Class:
b4 L>La r l : LUU;

- !
2 CALLS COMPLETED-.FOR T H E MONTH OF MAY 2004
.-
Continued . . .
I 1 I
18.SHIPPING POINT 19. GROSS SHIPPING WEIGHT 20. INVOICE NO. 17fh).
TOTAL

21.MAIL INVOICE TO.

1
I

SEE BILLING
a. NAME
PSC/FMS (301) 443-3020 so:00 7
INSTRUCTIONS
ON R N E R S E
b. STREET ADDRESS
(or P.O. BOX)
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE
I 17(i).
GRAND
TOTAL

c. CITY
ROCKVILLE
d. STATE
MD
e. ZIP CODE

20857
$4,400.00
1 4
22. UNITED STATES OF AMERICA . fl /1 1 23. NAME frmedi
. .. . 1
BY (Signature)

NSN ~ Y W I - ~ S Z ~ O B ~
JULIA C. SAVOY
TITLE: CONTRACTlNGlORDERlNG OFFICER I / O P ~ O W LFORM 347 msj
PREVIOUS EDITIONNOT USABLE
/'
 - I

ORDEfi it SUPPLlES OR SERVICES PAGE OF PAGES

-
SCHEDULE CONTINUATION
IMPORTANT: Mark all packages and papers with mntrad andlor order numbers 1
DATE OF ORDER CONTRACT NO ORDER NO I
 INSTRUCTIONS FOR USE: This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acqui-
sition Management, ASC, Room 5-77, Parklawn ~ l d ~no. ,later than c.o.b., the 5th day of each month.
(Negative reports are required.)

BLANKET PURCHASE AGREEMENT

Month: May 2004 RECORD OF CALL Contractor North American Network, Inc.
1

1 1 Pages BPA # HHSP23320042008RB

i
4 CAN #4-K7225Y M
1%
Date of Call Ordered General ~ e s c r i ~ t i o i Dollar , Balance (Do NOT use)
I ! I

Call Number BY I
of Items , . (8 Amount <Fernaining For Program Use
t 8

Initial Amount or Balance Carried Forward. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,. . . . . . . . . 1 : 26,690.00)

ptI
I I

5/20 12 KC Production/Distribution English Childre

iT - I

5/20 13 KC Production/Distribution Spanish Childr 4

1 !

- b - = =
- -- -? 1
I
L

a cace
1

i
1), Y I

I hereby certify that the above supplieslservices are authorizeb purchase u d ~ e the
r above referenced BPA and were
procured by Authorized Callers.
Signature of Authorized Program Official.
-
,
 I

1 DATE OF ORDER 2 CONTRACT NO (11any)

ORE. 3 R SUPPLIES OR SERVICES
c o n t r a c t a n d l o r o r d e r numbers
IMPORTANT: M a r k all packages a n d papers w ~ t h
6 SHIP TO
\i(1 ' PAGE OF PAGES

1
HHSP23320042008RB a NAME OF CONSIGNEE
09/06/2004 I

3 ORDER NO 4 REQUISITIONIREFERENCENO
I
DHHS/AHRQ
006
5 ISSUING OFFICE (Address conespondenat lo) b STREET ADDRESS
DHHS/PSC/SAS/DAM REDLAND TECHNOLOGY CENTER
PARKLAWN BUILDING, ROOM 5-101 1ST FLOOR
5600 FISHERS LANE 540 GAITHER ROAD
ROCKVILLE MD 20857
c CITY
ROCKVILLE llm
d STATE
I e ZIP CODE
20850
7. TO: TOM SWEENEY
a. NAME OF CONTRACTOR
NORTH AMERICAN NETWORK, INC.
I. SHIP VIA

B. TYPE OF ORDER
II
b. COMPANY NAME
a. PURCHASE ( d. DELIVERY -.
c. STREET ADDRESS - . .- REFEREKCE YOUR:
E x l fw bii\ing instrucb%nsm the
7910 WOODMONT AVE, SUITE 1400 . - --.--
.. &: ----
. .
, . / . - -- . .
~ ;
hs dellvery order is
subikt to inslructions contained on
.

this slide oniy of mis form and is

Please furnish lhe following on the terms iss+ subject to me terms and
and wnddms speM~edon both sides of conditions 01 me aboue-numbered

-?
order and on the anached sheets, il
d. C I M e. STATE 1. ZIP CODE
any, including delivery as indlcaled.
BETHESDA MD 20814
9. ACCOUNJING AND APPROPRIATIONS DATA
7541700
10. REQUlSrllONlNG OFFICE
DHHS/AHRQ 1
31
l l . BUSINESS CLASSIFICATION (Check appmpriate box(es))
a. SMALL
# -- b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN-OWNED

12. F.O.B. POINT Destination X.". 14. GOVERNMENT BRMO. 1s. DELIVER TO F.O.B. POINT '6. DISCOUNT TERMS
ON OR BEFORE (Date) . -
13. PLACE OF --
07/31/2004 Net 30
a. INSPECTION b. ACCEPTANCE
. .. .. . . . -- .
--
Destination Destination - , ,

17. SCHEDULE (See reverse for Rejecl~ms) 1

QUANTITY . UNIT QUANTITY
ITEM NO. SUPPLIES OR-SERVICES ;, ORDERED UNIT PRICE .. .-cAMOUNT, F . == ACCEPTED
(a) (b) IC) (d) le) ( f) (9) -
Tax ID Number:
DUNS Number: b -,
CAN: K7225YM C u j . u a s s : 2522 FY: 2004 . .. -. -
..
- .

1 2 CALLS COMPLETED FOR THE MONTH OF J U L Y 2004 -- .. 4,4%@._qO_.. ~ - .

Continued . . .
. .
I
I
18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT 20 INVOICE NO.
I 17(h).
TOTAL

a. NAME
21 MAIL INVOlCE TO:

$0.00
.. - .
s l
PSC/FMS ' (301) 443-3020 .. I
I

SEE BILLING
INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE
(01P.O. Box) 5600 FISHERS LANE 171;).
GRAND
TOTAL
-
I
c. CITY

ROCKVILLE
d. S
MD
~ ke. ZIP~CODE
20857
~ 4
A $4'4000'p
22. UNITED STATES OF AMERICA 23. NAME (Typed)

BY (S~gnature) JULIA C . SAVOY

TITLE. CONTRACTINGIORDERINGOFFICER
r
NSN 754041-152-8083 OPTIONAL FORM 347 f R n 0 5 1
R
I e 17 G S M m l e CFRIJI 2lX.l
PREVIOUS EOlTlON NOT USABLE
 ORDER A SUPPLIES OR SERVICES
I
PAGE OF PAGES

SCHEDULE CoNTlNuATloN- 2 I i
--
IMPORTANT: Mark all packages and papers mth conbad and/or order numbers I
I
DATE OF ORDER CONTRACT NO ORDER NO
09/06/2004 HHSP23320042008RB I 006
ITEM NO SUPPLIESISERVICES QUANTITY UNIT UNrT A M(F)
OuNT~ OUANTiPi
ORDERED PRICE ACCEDTED
(GI
(A) (8) (C) ( 0 (E)
T o t a l amount of award: $4,400.00. The ob1lga:lon f ~ t:hls
r award 1 s shown I n box
17 (i). I
I
I

,~
I

-
.
- - - -
- -- -.-- il.
-

I
I

. ..-

I
I

I
--

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

NSN 754M)l-152-8082 SO-101 OPTIONAL FORM U d l b 6951
Rn- 4 GS*
FLRI48CFRI 5 3 2 I X c I
 lNSTRUCTlONS FOR USE: This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acqui-
sition Management, ASC, Room 5-77, Parklawn Bldg, no later than c.o.b., the 5th day of each month.
(Negative reports are required.)

BLANKET PURCHASE AGREEMENT

Month: July 2004 RECORD OF CALL Contractor North American Network, Inc.

I 1 Pages , BPA # HHSP23320042008RB

CAN #4-K7225YM ,

Date of Call Ordered General ~e~criptiod *t Dollar Balance (Do NOT use)
Call Number BY of Items ' 5 Amount , .Remaining For Program Use
I

Initial Amount or Balance Carried Forward. . . . . . . . . . . . . . . .,.. . . . . . . . . . . . . . . . ,. . . . . . . . . : 22,290.001

I I I I
I
I I

14

15 -
KC

KC
Monitoring English Children's Vision

Monitoring Spanish Children's Vision

1I/- 'I' I
/

I \ 1

I 1

-- -- - - --
b- I ' -- - _- - - -
I i I

I
I
1

I hereby certify that the above supplieslservices are authorized purchase uMer the above referenced BPA and were
procured by Authorized Callers.
-
Signature of Authorized Program Offic~al ( I
7
 ORDt. .-OR SUPPLIES OR SERVICES
IMPORTANT: M a r k all packages a n d papers w i t h c o n t r a c t a n d l o r o r d e r numbers .-
1 DATE OF ORDER 2 CONTRACT NO (If any) 6 SHIP TO
HHSP23320042008RB
09/06/2004 a NAME OF CONSIGNEE

3. ORDER NO

007
5 ISSUING OFFICE (Address conespondenw loJ
I
4. REOUlSlTlONREFERENCE NO.

b. STREET ADDRESS
DHHS/PSC/SAS/DAM REDLAND TECHNOLOGY CENTER
PARKLAWN BUILDING, ROOM 5-101 1ST FLOOR
5600 FISHERS LANE I 540 GAITHER ROAD

ROCKVILLE MD 20857

7.TO: TOM SWEENEY

- -
c. ClTY
ROCKVILLE
I. SHIP A
VI
Lxz-
d. STATE e. ZIP CODE

-
a. NAME OF CONTRACTOR
NORTH AMERICAN NETWORK, INC. - - 8 TYPE OF ORDER
b COMPANY NAME
m a PURCHASE k
c . .-. -.
REFERENCE YOUR

I
pt l
a bdl~ngl n s ~ b o n on
s the
7910 WOODMONT AVE, SUITE 1400.:
, _ . .. .- se m a delwery order IS
ct to tnsuxbons mntalned on
--

Ide only of thls fwm and IS

Pleaselumish the following on the terms d s u b 6 1 to the terms and
and m d i b o n s w e d on both sides of lbons of the above-numbwed ,
the order and on allached sheets, if act
d. CITY e. STATE 1. ZIP CODE
any, including delivery as i n d i t e d .
BETHESDA MD . 20814
9. ACCOUNTING AND APPROPRIATIONS DATA 10. REOUlSrrlONlNG OFFICE
7541700 DHHS/AHRQ
11. BUSINESS CLASSIFICATION (Check appropriate box(esJJ
a. SMALL b. OTHER THAN SMALL - c. DISADVANTAGED d. WOMEN-OWNED

12. F.0.B. POINT Destination ' \?. 1

1
14. GOVERNMENT w u N o . 15. DELIVER T o F 0.0. POINT
ON OR BEFORE (Dale)
16. DISCOUNT TERMS

13. PLACE OF I ~ e 3t 0 . -
a. INSPECTION I b. ACCEPTANCE I
Destination (~estination
.%.-*. . .-. ..,c
---
17. SCHEDULE (See reverse tor RejedionsJ

ITEM NO.
(a)
I
SUPPLIES OR SERVICES
Ib)
IOUANTITY~
; ;u
ORDERED~
(c) ,
I UNIT
PRICE
ie)
I
-F
AMO!
(r:
. ..-. 1 OUANTlTY
ACCEPTED

Tax ID Number: I
DUNS Number :
CAN: K7225YM Ob]. ..--- . : 2004
. -.
2 CALLS COMPLETED FOR THE MONTH OF
SEPTEMBER 2004 - - -
Continued . . .
I I I I

la. SHIPPING POINT 19. GROSS SHIPPING WEIGHT 20. INVOICE NO.
TOTAL
I I I
(Conf

21. MAlL INVOKE TO:

a. NAME $0.00
SEE BILLING
PSC/FMS (301) 443-3020 - -. . .
INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE
(or P.O. BOX) 5600 FISHERS LANE 17(i).
GRAND
TOTAL

c. CITY d. STATE
MD
e. ZIP CODE
20857
$4,40
4
ROCKVILLE
22. UNITED STATES OF AMERICA . / 1
-. A
' 1 / 23. NAME (Typed)
BY (S~gnarure) JULIA C. SAVOY
TITLE: CONTRACTlNGlORDERlNG OF1 R

NSN 754C-01-152-8083 OPTIONAL F O W 347 IRr Wl

Y
PREVIOUS EDITION NOT USABLE
 ORDER .< SUPPLIES OR SERVICES 1
:
I
PAGE OF PAGES

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) 11

NSN 7540-01-152-8082 YI?-U101 OPTIONAL FORM 2 4 law. -51
R- Q GSL
FAR (48 CFRI 511131c1
 INSTRUCTIONS FOR USE: This form is to be maintained on a monthly basis, with a copy to be submitted to the Division of Acqui-
sition Management, ASC, Rooms-77, Parklawn Bldg., no later than c.o.b., the 5th day of each month.
(Negative reports are required.)

BLANKET PURCHASE AGREEMENT

Month: September 2004 RECORD OF CALL Contractor North American Network, Inc.

1 1 Pages , BPA # HHSP23320042008RB

CAN #4-K7225YM
Date of Call Ordered General ~escri~tidh :+ Dollar Balance (Do NOT use)
Call Number BY
I
of Items ! . 4, Amount Remaining For Program Use
\ . ,
Initial Amount or Balance Carried Forward. . . . . . . . . . . . . . .:. . . . . . . . . . . . . . . . . . . . . . . . . . , 11,600.00

9115 16 KC . Production/Distrit~utionEnglish I
I

9115 17 KC ProductionIDistribution Spanish

#'

I
Amendment to Decrease -

pppp

----
. .
I

--- -- ---- --
r.
~

! I
i

I
I

I hereby certify that the above ~ ~ ~ ~ l i e s l s e r vare

i c eauthorized
s purchase h d e r the above referenced BPA and were
procured by Authorized Callers.
, Signature of Authorized Program Oflic~al: 4
 AWARD 1 CONTRACT
1 THISCONTRACT IS A RATED ORDER
UNDER DPAS (15 CFR 350)
RATING 1 I
d
P
A
; o;Pms

2 CONTRACT (Proc lnsf ldenl ) NO 3 EFFECTIVE DATE 4 REQUISITION 1 PURCHASE, REQUEST PROJECT NO
HHSP23320032201TC 04T276356
5 ISSUED BY CODE 6 ADMINISTERED BY (If other than Item 5)
cdDE1
Program Support Center, HHS
Division of Acquisition Mana ement,SAS
Parklawn Buildmg, Rmm 5-18]
5600 Fishers Lane
Rochrille, MD 20857

American Urban Radio Networks

.

432 Park Avenue, South, 14th Floor

New York, NY 10016
-

7. NAME AND ADDRESS OF CONTRACTOR (No.. street, city, county, State a n d ZIP Code)
I

1 8. DELIVERY

9
FOB ORIGIN

DISCOUNT FOR P R O ~ P T

Net 30
PAYh1ENT
I1

1
~ ~ H E R ~ e e b e l o w )

EIN: DUNS:
, -- ~. ... -
.:.
1 10. SUBMIT INVOICES A 1 ITEM
-

CODE FACILITY C O D E See Sect~onG 2 --

11 SHIP TOIMARK FOR CODE l 12 PAYMENT
- w ~ L LBE MADE BY
Financ~alManagement Service
CODE

Parklawn Buildmg, Room 16A-12

5600 Fishers Lane
!~
Rockville. MD 20857 1
13. AUTHORITY FOR USING OTHER THAN FULL AND OPEN 14. ACCOUNTING AND APPROPRIATION DATA
COMPETITION:
7540120
10 U.S.C. 2304(c) ( ) @ 41 U.S.C. 253(c) ( 01 ) 4-1990123 252V $200,000.00

Title: 1 1 1 4 f ant ort tali-ty and Health ~ i s ~ a j i t i e s ad id campai$ll I

Period of kerformance: June 11, 2004 to J$e 10, 2 0 0 4
- i - 4.-. -

Contract e: Firm ~ixe-&~rice

I I I
ISG. TOTAL AMOUNT OF CO~TRACT--~~./$
16. T A B L E OF CONTENTS
=
I
l l
_
(x)SEC. I DESCRIPTION I PAGE(S) I(x3l SEC. 1 DESCRIPTION 1 I PAGE(S)
-
PART I THE SCHEDULE PART II - CONTRACT CLAUSES
XI A SOLICITATION ICONTRACT FORM 1 / X I I CONTRACT CLAUSES - I ;
. .....

x/ B 1 SUPPLIES OR SE,RVICES 8 PRICES ICOSTS 2 1 -

PART III LIST OF DOCUMENTS. EXHIBITS~ANDOTHER A T ~ A C H
X I C DESCRIPTION ISPECS.,/ WORK STATEMENT 1 1 J I LIST OF ATTACHMENTS - - '- I --- ....

x D PACKAGING AND MARKING PART IV -

REPRESENTATIVES AND I~-JSTRUCTIONS
I
X E INSPECTION AND ACCEPTANCE REPRESENTATIVES, CERTIFICATIONS AND
x F DELIVERIES OR PERFORMANCE OTHER STATEMENTS OF OFFERORS;

x G CONTRACT ADMINISTRATION DATA L INSTRS.. CONDS.. 8 NOTICES TO OFFERORS

H SPECIAL CONTRACT REQUIREMENTS M EVALUATION FACTORS FOR AWARD:\
CONTRACTING OFFICER W L L COMPLETE ITEM 17 OR 18 AS APPLICABLE 1
17. CONTRACTOR'S NEGOTIATED AGREEMENT (Contrador is requrred
to sign this documenl and relum copies to issuing ofice.)
18.
... . . -..
AWARD (Conlnctor i s not required to sip;
I
&s document.) Your

Contract. agrees to h r i s h and deliver all items w p d o m all the senices set lo* or
othervnse identified above and on any continuallon sheers for the consideratlon.slated
~ ~ ~ ~ $ ~ ~
*rbe ~ you ~
by oL m ~ or~_nges ~ set fin;
~ are ~
in fullamve,is h e r e y acceved as to the items listed a&,ve and on any conenua~ion
n g e s

herein. The nghls and obligations ol the ParlleS to this Contract shall be subject to and
govemed by the follcwing documents: (a) this awardlconlracf, (b) the solicitation, rf any.
and (c) such povis~ons,represenlalions,certrficaltons,and spedficat~ons.as are attached
or ~ncorvoratedbv reference heretn, lAIfachments are listed herein.)
19A NAME AND TITLE OF SIGNER p y p e orpnnt)
sheers. This award consurnwales the conlract which consis'k of Ihe fdlowmg documents:
(a) the Govemmenl's soliotat~onand your offer, and (b) ttils awardkontract. NO furlher
document necessary.
20A. NAME OF CONTRACTING OFFICER

Janet H. Miller
I 19C DATE SIGNED 20s UNITED STATES OF AMERICA 19C DATE SIGNED

BY I BY
(S~gnafureof p e w authorized to sfgn) (Sfgnature of Conlractrng Officer) '1
-
NSN 7540 - 01 152 8069 - STANDARD FORM 26 (REV 4. BS.
PREVIOUS EDITION UNUSABLE PlesmWd GSA
FAR I48 CFR153 2I4lar
CnBtrd b ? . P s M~ d r An. B8mch(1011141-2454 IEF
,I
PART I
THE SCHEDULE

SECTION B - SUPPLIES OR SERVICES AND PRICES/COSTS

B.l In consideration of performance of the work descri !d in

Section.C, ~escription/Specifications/WorkStateme . , the
Contractor shall be reimbursed as follows:

Firm Fixed Price: $200,00Q.00

 I
~
HHSP23320042201TC
I1
P a g e 2 of 1 5
~l
PART I
THE SCHEDULE

C.l PROJECT T I T L E

Il
Infant Mortality and ~ e a l t hDisparities Radio Campdign

C.2 PURPOSE OF THE CONTRACT

The overall goal of the-project is to provide a media base

to support the technical assistance efforts of...th:e&iilot . .
The contractor '&all". assist OMH in the development o f the
-

media campaign effort based upon their expertise in

reaching the African American population.

In light of these overarching goals, the specific ~

objectives of this program are to:

Develop,a, structure for a national media

~
I

those id?~widuals in the pilot locations

reduction i n infant deaths amongst the African ~i,brican
populat :on. I
-L.- -iL - - ,#
Support HRSA and its community- and 'I
state-based p'artners
--
-- :

in reaching those at risk through a mass media efkort. It

is well documented that the more people heai inf4inatfon
through as many communications channels as possiblle, the
W
greater the likelihood for change. African Americans use
.radio as one of their primary modes of communicatkon.

provide am-frameworkfor information to be delivered To a'n

I
entire African American family through one media Houtlet
and various formats for music and to reach variousH ages of
those who might have a role in infant care.

Create a relationship with the existing talent wibh an

interest and appeal for issues related-to infant brtality
and other disparities initiatives. The cont;actbr shall
have the ability to connect with the kind of celebrities
that have credibility and standing regarding such issues
within the African American community. I

I
I
'I
Enhance participation of families in playing a rble from
the beginning of one's pregnancy through
ensure that infants are properly cared foT and

!~
PART I
THE SCHEDULE

expectant mother receives proper prenatal care. ~ h e s ePSA

awareness messages serve to reinforce work at theI
community level through HRSA.
1~
Create the capacity to develop an expertise in developing
messages around this initiative and the ~epartmeAt
-
s
entire health dispariti-es initiative.

The primary focus of this first phase of the national -

campaign will..focus on laying a strategic found-qion up& --

which additional outreach by communities can re1

Y
build support to bring about a change in behavior to thus
reduce the rate of infant mortality amongst ~frldan
Americans. The messages will enhance the effords of the
pilot states in developing their initiatives. I
I

C.3 OVERVIEW
.-.-
'\< --
rJ.'

The Department of Health and Human Services (HHS) has a

I
long history in the fight to eliminate racial and eihnic
disparities in health. While gains have been made,
signific2"ri't-"dfSparities in some health outcomes for racial
and ethnic minorities remain. To address this challenge,
the Secretary charged the Deputy Secretary with mar$hal-*ng
the Department's resources and talents to achieve
reductions in disparities.
- < .
I ..
..- .

~ t - t h request
e
I
1-
of the Deputy Secretary, a plan of-aition to
address-rac-fa1 and ethnic disparities in health-was.. .> - - .~ -.
--. ....

recently finalized. The plan establishes the Closiyg the

Health Gap Initiative and calls for new and expande@.
activities to address disparities using a targeted And
'I
coordinated Departmental approach. As a first measyre, the
Closing the Health Gap Initiative will focus on raclal and
'I
ethnic infant mortality, cancer screening and managgment,
cardiovascular disease and stroke, diabetes, H.~V/AI$S,and
child and adult immunization disparities. Other hehth
issue areas requiring Departmental action will be
-i'ncorporatedin the future.
1
Under the Closing the Health Gap Initiative, HHS acbions
targeting the elimination of racial and ethnic healFh
disparities must address one or more of the
objectives:
PART I
THE SCHEDULE

Strengthening the science

Connecting people with services
Helping pe0~1e take charge of their health
Establishing partnerships that matter

To ensure momentum in meeting these objectives, th Closing

the Health Gap Initiative also calls for developme t of .'
focused initiaEives around each of the six dispari y health
areas. -This program, Closing the Health Gap -?miti Live 'on .
.-.-
. ..

Infant Mortality, was developed in response to thi

directive. For more than 20 years, research has s own that
some racial and ethnic minorities experience great r rates
of infant mortality. In 2001, in the U.S., infant of
black mothers had a mortality rate of 13.3, more t an four
times the rate for infants of Chinese mothers who
experienced the lowest rate of 3.2. The mortality rate for
infants o f ~ i l i ~ i nmothers
o was 5.5 and 5.7 for in ants of
non-Hispanic white mothers. Both of these rates w re lower
than the rates for infants of Hawaiian (7.3) and A erican
-**- - - -
Indian --mothers (9.7). At the same time, some raci 1 and --__
ethnic minorities continued to experience the high st rates
of infant mortality from low birth weight (LBW) an SIDS.
Infants of-black and Puerto Rican mothers had'the - i-gliest
infant mortality rates from low birth weight. The r rates
were approximately four and two times, respective1 , that
of infants born to white mothers. With respect to SIDS, -..-
infants of black mothers had a rate that was 2.5 t mes that
of white mothers.
-- -
This project supports the implementation of the Af ican
American-focused Risk Reduction component of the H S
Closing the Health Gap Initiative on Infant Mortal tY
through the communication and media outreach compo ent .
The goal is to accelerate the rate of change among African
American populations and reduce the significant di parity
in infant mortality for African Americans through
national campaign centered around education and aw reness
messages. The primary areas of infant mortality di parities
for the African American population are related to low
birth weight (LBW)/preterm birth (PTB) and Sudden nfant
Death Syndrome (SIDS). This media effort will supp rt the
current pilot projects to be funded through HRSA i a pilot
PART I
THE SCHEDULE

to four States selected on the basis of having significant

11
African American births and high infant mortality rates due
11
to LBW/PTB and s ~ D S ; - t h states
e identified are South
Carolina, Michigan, Mississippi, and Illinois. ~ h dmedia
component is key to the overall program initiative which
will serve to reinforce the work of the local
partners. .
Each state will ocus attention on imp1
projects in-.-one
. .
.
-

. .
. .. .
0 two communities to: ( 1 ) build
.=:.-
::
. .'
04
existing act ivi es that contribute to infant m~ri?$~i
reduction; and (2) employ evidence-based interventdons that
could cont;ibute to reductions in LBW/PTB and infaAt
mortality that arq associated with LBW/PTB or SIDS. In
support of these states, the Contractor must have d strong
base for outreach in these areas specific to ~frican
Americans 1~

f =
The office%£ Minority Health (OMH) is a collaborative
partner i n this project with HRSA and has the
responsibility for providing media support to the riational
11
campaigzlr--The media buy and production of publlc service -_-
announcements (PSAs) are part of the national
support the overall initiative. ..-
C. 4 STATEMENT OF WORK 1
I
-- ..

This national campaign is unique in that it not only_ -

I
4

provides awareness messages but calls for a change in

behaviors. Given this need, the community needs to
perceive this as more than merely playing-a radio Jpot.
11

Working with the Project Officer and other individyals

1
(possibly other Contractors associated with varioud aspects
of the campaign) assigned to the program, the ~ont!~ctor
I
shall provide all necessary personnel, materials, services
and otherwise do all thihgs necessary to perform the tasks
Jisted below:

4.1 Provide Talent.

1
Strategically recommend an,d secure
'I
individuals for talent to reach this audien~e;
PART I
THE SCHEDULE

4.2 Writing Assistance.

II
Assist OMH in writing a PSA and
be able to articulate culturally appropriate
messages to African Americans in a way that' allows
for receptive receipt of information;
I
4.3 Production. Produce a professional , quali!y,
educational piece;. 8'

4.4 PSA CDS. Provide copies via CD ( 2 0 ) of eadh PSA,

4.5 Airtime. The-Cbntractor shall allocate ai4time on-a
-network'bf stations for a five - week-perk to
include the pilot states through various m?sic
genres. (see Attachment 1 for schedule of
broadcasts) ;
I
4.6 Community Outreach. The Contractor shall blay a
role in assisting OMH in impacting the lives of
African Americans. The Contractor must ha+e
cdpsiderable reach into the community throkgh its
'
network of stations to effectively reach i dividuals
P
at all levels and all ages with the focus on African -
-+-.&- -
Americans
- - and infarit ncrtality.
-.-
PART I
THE SCHEDULE

SECTION D - PACKAGING AND MARKING

D.l PAYMENT OF POSTAGE AND FEES

All postage and fees related to submitting informatlion

including forms, reports, etc . , to the Contracting 10:ficer
or the Project Officer shall be paid by the Contractor.

MARKING - . . --
-- .-
7;-
e

All infdrmation -submitted to the Contracting Officer or

Project Off-icer shall clearly indicate the contract number
and deliverable for which the information is being 1
submitted.
PART I
THE SCHEDULE

SECTION E - INSPECTION AND ACCEPTANCE

E.l INSPECTION
- -
. .

Inspection and acceptance of all services called : )r by the

contract shall be made by the Project Officer in
conjunction with the PSC--ContractingOfficer.

E.2 - 3-
52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 19
.
) .. .

This contract incorporates one or more clauses by

reference, with the same force and effect as if tl ty were
given in full text. Upon request, the Contracting )fficer
will make their full text available. Also, the fu: text of
a clause may be -accessed electronically at this/tl !se
address (es):

FAR C M W 3 E -NO? TITLE AND DATE

52.246-4 Inspection of Services - Fixed
PART I
THE SCHEDULE

SECTION F - DELIVERIES OR PERFORMANCE

The period of performance for this contract shall e

June 11, 2004 through June 10, 2005, unless the pe iod is
extended by modification to this contract.

DELIVERY SCHEDULE . .

The ~ontractor'shallwork with the Project ofrice? a-rid .

other sourFes to develop Public Service Announceme ts and

other media as for the "Closing the Gap" media can aign.
The Contractor shall produce and deliver the apprc riate
announcements as indicated in Attachment 1 - Deli1 rable
Tablc. In addition the Contractor shall prepare ar
distribute 20 compact disks (CDs) of each approvec PSA .
?,
,J

*One (1) hardcopy of each PSA shall be submitted t the'

Contracting Officer, Division of Acquisition Manas ment ,
AOS, General -AcquisitionsBranch, Parklawn Buildir , Room
5-101, 5600 Fishers Lane, Rockville, MD 20857.
.-- ...-- -
-

F.3 5 2 . 2 5 2 - 2 CLAUSES INCORPORATED BY REFERENCE (FEB 15 -

8
.--..
his contract incorporates one or more clauses by
reference, with the same force and effect as if tk y7 .yere.=.. . ....
given in full text. Upon request, the Contracting fficer
will make their full text available. Also, the ful text of
a clause may be accessed electronically at this/tf se
address (es):

h t t p : //www. a r n e t . g o v / f a r /
. -d
FAR CLAUSE NO. TITLE AND DATE
52.242-15 stop-work Order. (AUG 1989)
PART I
THE SCHEDULE

SECTION G - CONTRACT ADMINISTRATION

The Contractor shall forward electronic funds tranAfer

in£ormation in writing to HHS Program Support center,
Division of Financial Operations, Parklawn ~uildind,Room
16-05, 5600 Fishers Lane, Rockville, Maryland

G.2
accordance with Section I, Clause 52.232-34.

INVOICE~SU=MISSI~N
- .
20857t
Jr
----.
-
In

In addition to the information required by Section I ,

Clause 52.232-25 the following information is also required
for submission of a proper invoice.

a) Signature of an authorized official certifyingI the

-
invoicg to be correct and proper for payment;
%,

'I
b) Peri~dof performance for which costs are claimed:' and
I
c) Tax--4denLif
ication number (employer's identification
number) or social security number.
I
,? . =_

d) The voucheis shall show the Contract ~&-&er, game, and

telephone number of the Government Project Of5icer on
the face page of the voucher.
.
e) The Contractor shall submit vouchers monthly.+_One
-
-.I
original voucher complete with all required backup
~
documentation shall be forwarded to the contracting
Officer and addressed as follows:

Department of Health and Human Services

Division of Acquisition Management,
~
Parklawn Building, Room 5-101
5600 Fishers Lane
Rockville, ~ a r ~ l a n d20857

Three copies of the voucher with copies of ali

required backup documentation shall be submitied
directly to the Finance office for payment. All calls
concerning payment shall be directed to the
helpline on (301) 443-6766.
PART I
THE SCHEDULE

Payment Office:
- -

Department of Health and Human Services,

PSC/FMS/DFO Commercial Payments Section
Parklawn Building, Room 16A-2
5500 Fishers Lane
Rockville, Maryland
--
20857
- .
. -
----
G. 3 Project- o f f i c e r - -

The project Officer responsible for the technical

requirements covered by this contract, as contempl
Section [G.41 , "Technical Monitoringt'hereof, will
designated by separate correspondence.

- \.?.

Performance of the work under this contract shall I e

subject to the technical monitoring of the Project Officer.
The te~m--!!Tec'knical Monitoring" is defined to incl ~ d e ,- --
-- .
without limitation, the following:
. .- ,. = =

a) Technical directions to the Contractor which rec irect the

contract effort, shift work emphasis between wo: k areas
or tasks, require pursuit of certain lines of ii w i r y 1
. -- .
fill in details or otherwise serve to accomplisl
contractual scope of work, .-

b) Providing information to the Contractor for ass.stance in

the interpretation of drawings, specifications (

technical portions of the work description.

C) Review and, where specified by the Contract, apl roval of

technical reports, drawings, specifications-bandtGchnica1
information to be delivered by the Contractor tc the
Government under the contract.

Technical direction must be within the general scc )e of

work stated in the contract. The Project Officer ioes not
have the authority to and may not issue any techni :a1
direction which (i) constitutes an assignment of a iditional
work outside the general scope of the Contract; (i - )
PART I
THE SCHEDULE
1
constitutes a change as defined in the Contract clduse
entitled "Changes;" (iii) in any manner causes an increase
or decrease in the total estimated Contract cost, the fixed
fee or the time required for Contract performance; or (iv)
changes any of the expressed terms, conditions or
specifications of the Contract.
\ I
All technical direction shall be issued in wrlting b y the
Project Officer or shall be confirmed in writing withln
. -- days. a'fter issuance by the ~ r-- o ~ e c t '
five (5) working z
--
Officer . -.r -

The Contractor shall proceed promptly with the performance

of technical directions duly issued by the Project Offlcer
in the manner prescribed within his authority under this
provision.

If, in the gpinion of the Contractor any instructidn or

direction x.sued by the Project Officer is within &ne of
the categaries as defined in (i) through (iv) above, the
Contractor shall not proceed but shall notify the ' 1
Contracting-OPf icer in writing within five (5) working days - . . . == .‘)

after the receipt of any such instruction or direckion and

I
shall request the Contracting Officer to modify the
I := .-:= =
contract accordingly. Upon receiving such nbtif ication for
the Contractor, the - Contracting Officer shall issue an
appropriate contract modification or advise the cohtractor
-. -. .
in kriting that, in his opinion, the technical direction is
within-the scope of this art-icle and does not .con.siituteg ....
change under the Changes Clause of the contract. The
Contractor shall thereupon proceed immediately with the
direction given. A failure of the parties to agreL upon
the nature of the instruction or direction or upon the
contract action to be taken with respect thereto shall be
subject to the provisions of the Contract clause
"Disputes." .. . ..
PART I1
CONTRACT CLAUSES

SECTION I - CONTRACT CLAUSES

1. ACQUISITION REGULATIONS (FAR) 4 8 cFR CHAP=&

- .~
CLAUSES)
.. .

I. 1 5 2 - 2 5 2 - 2 CLAUSES INCORPORATED BY REFERENCE. ( FEB 149 8 )

. -- I
This contract incorporates one or more clauses by
:~
reference, with the same force and effect as if they were
df~icer--
given i n fui-1 L e t . Upon request, the Contracf=kfig, ...
.--. -
will make their full text available. Also, the-fidT't-ext of ~

a clause may be accessed electronically at this/these

address (es):

h t tp ://www. a r n e t .gov/fa r /

Clause Title and Date

-4'
" x:.
.
L
I

52.202-1 ::Definitions. (DEC 2001)

52.203-3 Gratuities. (APR 1984) . -
52.203-5 Covenant Against Contingent Fees. (A~R 1984)
. ;-g""'. ... Restrictions on Subcontractor Sales to:the

52.203-8
Government. (JUL 1995)
52.203-7 - - 'Anti-KickbackProcedures. (JvLJ1995j.;-.
Car~cellation,Rescission, and ~ e c o v e r
=
,
-

of~ Funds
I ~ ... . .\

for Illegal or Improper Activity. (JAN 1997)

52.203-10 Price or Fee Adjustment for Illegal or;Improper -- -. .
Activity. (JAN 1997)
52.203-12 ---Limitation on Payments to Influence -Cqtain.,. ....

Federal Transactions. (JUN 2003) *I

52.204-4 Printed or Copied Double-Sided on Recyled

52.209-6
Paper. (AUG 2000) ,

Protecting the Government's Interests ,When

I
Subcontracting with Contractors ~ebarrLd,

52.215-2
Suspended, or Proposed for Debarment.
(JUL 1995) . ..
-

Audit and Records - Negotiation. (JUN ,1999)

. -
1 9

52.215-8 Order of Precedence - Uniform Contract, Format.

(OCT 1997)
52.219-8 Utilization of Small Business Concerns1.(May
2004)
52.222-3 Convict Labor. (JUN 2003)
52.222-21 Prohibition of Segregated Facilities. (FEB
I
1999)
 HHSP23320042201TC
Page 14 of 15
'I
PART I1 I
CONTRACT CLAUSES 1
I
I
Clause Title and Date
-
52.222-26 Equal Opportunity. (APR2002)
52.222-35 Equal Opportunity for Special Disabled
Veterans, Veterans of the Vietnam Era, and
Other Eligible Veterans. (DEC 2001)
52.222-36 Affirmative Action for Workers with
Disabilities. (JUN 1998)
52.222-37 Employment Reports on Special Disabled
Veterans, Veterans of the Vietnam Era, and --

52.222-38
other- Eligible Veterans. (DEC 2001) -
Compliance with Veterans Employment ~edortlng
--

Requirements. (DEC 2001)

52.223-6 Drug-Free Workplace. (MAY 2001)
52.223-14 Toxlc Chemical Release Reporting. (JUN 2003)
52.225-13 Restr~ctionson Certain Foreign Purchases.
(JAN 2004)
52.227-1 ;- authorization and Consent. (JUL 1995)
52.227-2 xotice and Assistance Regarding Patent and
Copyright Infringement. (AUG 1996)
52.227-14 Rights in Data - General. (JUN 1987)
52.227-17" Rig-hts in Data - Special Works. (JUN 1907) -- -
52.229-4 Federal, State, and Local Taxes (State and
Local Adjustments) . (APR 2003) - - -- __
52.232-1 Payments. (APR 1984)
52.232-8 Discounts for Prompt Payment. (FEB 2002)
52.232-23 Assignment of Claims. (JAN 1986)
52.232-25 Prompt payment. (FEB 2002)
52.232-33 Payment by Electronic Funds Transfer - GentraL
Contractor Registratlon. (OCT 2003)
52.233-1 Disputes. (JUL 2002)
52.233-3 Protest after Award. (AUG 1996)
52.242-13 Bankruptcy. (JUL 1995)
52.243-1 Changes - Fixed-Price. (AUG 1987) - Alt

52.244-5
(APR 1984)
Competition In Subcontracting. (DEC-1994
I
52 -244-6 Subcontracts for Commercial Items. (MAY12004)
52.249-4 Termination for Convenience of the Government
(Services) (Short Form) . (APR 1984)
52.249-8 Default (Fixed-Price Supply and
1984)
52.249-14 ExcusableDelays. ( ~ ~ R 1 9 8 4 )
 1 CONTRACT ID CODE
1 PAGE OF PAGES
AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT I - I- 1- 1
2 AMENDMENTlMODlFlCATlON NO

MODIFICATION #
6 ISSUEDBY
1 1 3 EFFECTIVE DATE

05/02/2005
4 REOUISITIOWPURCHASE RE0 NO

N/A
7 ADMINISTERED BY (Ilother than Item 6)
11
5 PROJECT NO i,:aod 3 3 , .

'I1
CODE CODE -
DHHSlProgram S u p p o r t C e n t e r
D i v i s i o n o f A c q u i s ~ t o nM a n a g e m e n t , SAS OMB No. 0990-01 15
5600 F i s h e r s L a n e
Parklawn Build~ng,Room 5-101
R o c k v i l l e , MD 20857

8 NAME AND ADDRESS OF CONTRACTOR ( N o . sfreel, county. Slate, andZIP Code) 9A AMENDhIENT OP SOLICITATION NO

American Urban Radio Networks

432 Park Avenue, South, 14th Floor
New York, NY 10016 I -
90 DATED (SEE ITEM 11)
I
EM:
10A MODIFICATIONOF CONTRACTIQRDER NO
DUN

--

CODE
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
10B DATED (See Item 13)

0611 112004 ~ --
The above numbered sol~cltatlonIS amended as set forth In Item 14 The hour and date spectbed for recelpt of Offers IS extended, d IS not extended

Offersmust acknowledge receipt of this amendment prior to the hour and date specified in the solidtation or as amended. by one of the follo$lng methods

(a) By completing Items 8 and 15, and retumlng coples of the amendment. (bi By acknowledgmg rece~ptof th. amendment on edch copy of the offer subm, or ( c )
By separate letter or telegram whlch Includes a reference to the sol~c~tat~on
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 RESULT IN REJECTION OF YOUR OFFER If by vlrtue of thls
amendment you des~reto change an offer al&q@ubm~tted such change may be made by telegram or letter, provlded each telegram or letter makes reference to the sollc~tat~on
and th~samendment, and IS recelved pnor to the openlng hour and date spec~fied
12 ACCOUNTING AND APPROPRIATION DATA (If repu~red) 1

~
Appro. No.: CAN: --- OBI. Class:
-EtrWSiTEMAPPLlES ONLY TO MODIFICATIONS OF CONTRACTSIORDERS. --- _ _
IT MODIFIES THE CONTRACTMRDER NO. AS DESCRIBED IN ITEM 14.
A THIS CHANGE ORDER IS ISSUED PURSUANT TO (Speafy aufhonfyl THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN M E CONTRACT ORDER NO IN ITEM 10A

I I
B THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (Such as changes tn payrng ofice, appwnatron date e l c ) SET FORTH IN
ITEM 14 PURSUANT TO THE AUTHORITY OF FAR 43 103(b) 1
/I
x 1I C.THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORllY OF-
Mutual Ageement o f the Parhes
-
I
I -
-
..
. ...

1 D. OTHER (Specify fype o l m o d ~ f i c a t ~aad

n authonfyL
:... k -.

I A
E. IMPORTANT: Contractor is not. is required to sign this document and return 3 copies to the issuing office. I
14. DESCRIPTION OF AMENOMENT/MODIFICATION ( O y a n ~ z e dby UCF seclron headtngs. tnduding soliwlalionfcontrad subject matter where leasrble.)
-I
Subject contract i s modified as follows:
I
il
1. Section F.1 - Period o f Performance, i s modified to change the period o f performance from June 1 1,2004 through June 10,2005 to
June 1 1,2004 through August 3 1,2005. 1 9

2. Section F.2 - Schedule o f Deliverables, i s modified as follows: See Attachment A.

3. The total contract amount and all other terms and conditiohs remain unchanged by reason o f this modifica~ion.
I
1
Except as provided herein. all terms and conditions of the document referenced in item 9A or 10A, as heretofore changed, remains unchanged an'd in full force and effect.
15A. NAME AND TITLE OF SIGNER (Type or print) 16A. NAME AND TITLE OF CONTRACTING OFFICEP (Type or print)
Janet H. Miller

158. CONTRACTOFUOFFEROR / 1 5 C DATE SIGNED 1 6 B UNITED STATES OF AMERICA

. ~IGNEL~~
1 1 1 6 ~ .DATE SIGNED

NSN 7540-01-152-8070 STAFDARD FORM 30 (REV. 10-83)

PREVIOUS EDITION UNUSABLE
0011441.2454
Presmbeo by GSA
. ... .ldR
FAR ,. CERI - . ,--
-.. . 57 .7A7
.-
IEF G c n d b) Elcruon!r Davnlcnl ~~~~~VSDHHS
,I
{.<& DEPARTMENT OF HJ3"TH & """1" SERVICES Proprr
Dl\ lslon
rppon Cmrsr

Room 5
6
-4 5600 FIS
14-,,, Rock\ 111

Mr. Basil Murrain

American Urban Radio Networks
432 Park Avenue - South, 14th Floor
New York, NY 10016

Subject: Modification No. 1, Contract No. HHSP23320042

. , - . . / .- - --
Dear Mr. Murrain:

There is transmitted herewith one completely executed cl

Contract Number HHSP23320042201TC, Modification No. 1 e:
_ into between the Program Support Center and your organi

Please ensure that this modification is attached to and nade

part of the cogtract file.
\-

If you have any-questions, please call me on (301) 443-

Sincerely yours,

Paula Conner
- Contract Specialist

Enclosures -
..-
Message I Page 1 of 1

Conner, Paula (PSC)

From: Conner, Paula L. (PSC)

Sent:
To:
Tuesday, May 24,2005 1.21 PM
'EDoherty@aurn.com'
I1
L
Subject: RE: Help
. /
1/j
Thanks Ed, I understand from Basil that : this week. He will take care ofi gett~ngthat s~gnedand
53
faxed back to me. - -

/
I
Paula
..
-----Original Message----- I
I
From: Ed Doherty [mailto:edoherty@aurn.com]
~. . 1
Sent: Tuesday, May 24,2035 1 1 3 7 AM
To: Conner, Paula L. (PSC-) - - - -- -.- a I
I, ;
'I
.-.. - . .
*
. .--
--
Subject: RE: Help
I
.
Jorgeann Tamburo (412) 456 401 5, Fax (412) 456 4022 E- mail jtamburo@sbcol.com . .Main #1I (412) 456 4000 ...Ed

-----Original Message-----
From: Conner, Paula L. (PSC) [mailto:PConner@psc.gov]
Sent: Tuesday, May 24, 2005 10:15 AM
To: 'edoherty@aurn.cqml
Subject: Help L \=.

/1 that the number is not

Hi Edward, I just tried to call Jeorgianne on the number you gave me but the operator says .-
set up. Can you please provide me with a new number.
-.-4. - _- I -_.
Thanks
I
I

- About American Urban Radio Networks - ,1

American Urban Radio Networks reaches 25 million weekly listeners, which makks it tlie largest network
reaching Urban American. AURN broadcasts news, entertainment, and sports p r o g r a d i n g to more than 475
radio stations nationwide. It is the only African-American owned network radio c 0 m ~ a in4 ~the United States.

The contents of this email are the property of the American Urban Radio Networks and b e to be viewed only
by the email's addressed recipient(s). If you have received this email in error, please notify the email's sender.
Do not forward or copy this email or any attachment from this email without the permiskion of the sender. If
you would like to be opted out of future emails from this sender, please email your requbst to
noemail@sbcol.com.
i
 DEPARTMENT OF HEALTH & HUMAN SERVICES Proyram support Center
Dlvislon (f ~ c ~ u l s ~hlanagemeni
t~on S .\\
Room 5 - 101. Parh1av.n Bu~ldlng
5600 ~ I s h i r sLane
Rockvllle~MD 20857
APR 2 5 2055 li

Mr. Ed Doherty,Regional Director

American Urban Radio Networks..
432 Park Avenue - South, Fl.oor
New ' ~ o r kNY
, 10016
- . . --

H
Subject : Contract Number: HHSP23320042201TCI Modification 1
I/
Dear Mr. Doherty:

Enclosed are four copies of Modification 1 to Contract )

HHSP2332004220JTC for signature by an authorized offi .A1 of
I
your organiza&G.. Upon acceptance by the Government gne f
executed copy .will
... . be returned to you for your files.

If additional-2anformation is required, please contact the

II
.

undersigned at the above address, or by phone at (301) 443-2475.

.. -
il
Sincerely yours,

-
Paula Conner -.. . .

Contract Specialist
. . .,

Enclosure
(+#<$ DEPARTMENT OF HEALTH & HUMAN SE"CES
..

~.
I

Pro,pm;Suppon Center
~ ~ \ ~ ~ s i o n ~ o i ~ c a uhlanarcmtr,r.
i s i r ~ o r i S..\.<
Koclrn 5jll01. Parklaurn Buildln;
-+
8
5600 Fishers L n e
B*a. ~ockville.MD 20s-7
I

-
Mr. Ed Doherty, Regional Director
American Urban Radio Networks
432 Park Avenue - South, 14th Floor
New York, NY 10016
\

Subject: Contract Nurnber: HHSP23320042201TC

.- .. -
Dear Mr. Doherty:

This is to inform you that the designated Project officer for this
project has been changed. I

The new Project Officer respons=ble for the acceptance of work is Ms. i
Monique La Rocque, Department of Health and Human servites, Off ice of
Minority HealtN<kOffice of Public Health and Science, 1i01 Wootten
Parkway, Suite 600, Rockville, MD 20850. Ms. La Rocque may be
contacted on (3-01)443-3471 for any technical questions jwhich may .. . -
arise. . ...
..A- .A,. .
A. ,- -. :. . --
I . . . . ..

To ensure proper administration of this contract as well as to protect

k-
the interest of- both .-theContractor and the Government,-;la1
correspondence relating to contractual terms of this contract should be
prepared in duplicate, addressed to the attention of the Contracting
- -

I
Officer,-.andmailed to the address indicated above. i :
.. . ... ..

Thank you for assistance, and we look forward to.tl

completion of this requirement.

Paula L. Conner
 DEPARTMENT OF HEALTH & HUMAN SERVICES
I
P r o m Support Center
hima:emen~. S 4s
D ~ \ i s ~ oofn Acqu~s~non
1
Room 5-10]. ParMaxn Bu~ldinr

JUN 2 5 2304

American Urban Radio Networks

Attn: Mr. Ed Doherty
432 Park Avenue, South, 1 4 Floar
~ ~
New York, NY 10016

.
-.

Dear Mr. Doherty:

.--. ..
I
There is transmitted-herewith.one completely executed copy df
Contract Number-HHSP233ZD042201TC entered into between-~~hi?&~qram
I -
Support Center and your organization. 1
1
Please ensure that this contract is attached to and made part of
the contract file.
I 1I
I have been assigned as the Contract Administrator to assis7 yo^
in any administration problems which may arise. I may be
I
contacted on (30$.&;43-2475, Fax (301) 443-1004, for any matders
which involve contractual decisions.
-.

It is the desire of this office, as I am sure it is your de&ire,

to adhere striZtYy towthe terms and provisions of the contr$ct . - --. .

Close cooperation between you and the Contract ~dministratodwill

facilitate this adherence, as well as the satisfactori.rom~eti~-~
of the contract. * 1
2 I *,
'I
The Project Officer responsible for the acceptance of work is Ms.
Love11 ~rieham,Office of Minority Health, 1101 Wootton ~ a r k w a ~ ,
Suite 600, Roekvil&e MD 20852. Ms. Brigham may be contacted --on
-- -- 1
I
(301) 443-3386 for any technical questions which may arise. (I
1
11
To ensure proper administration of this contract as well as !to
/I
protect the interest of both the Contractor and the Government,
(I
all correspondence relating to contractual terms of this contract
should be prepared in duplicate, addressed to the attentionlof the
.. abo~e.
Contracting Officer, and mailed to the address indicated
/I
Thank you for your assistance, and we look forward to the I1

successful completion of this requirement.

!
1

Paula Conner
Contract Specialist

Attachment
 I

ORDER FOR SUPPLIES OR SERVICES /I PAGE OF PAGES

IMPORTANT: Mark all-packages and papen with contract andlor order numbers (I1 1 2
1 DATE OF ORDER 2 CONTRACT NO (//any) 6 SHIP TO 1
a N4ME OF CONSIGNEE
09/29/2004
3 ORDER NO.

HHSP233200400822P 1 ,I

5 ISSUING OFFICE (Address correspondence lo)

DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101
b STREET ADDRESS
233 N. MICHIGAN AVE, SUITE 13001 Ii
5600 FISHERS LANE I
ROCKVILLE MD 20857 I
- I
-
C CrrY 1 d STATE e ZIP CODE
CHICAGO '! IL 60601
7 TO APARNA SEN-YELDANDI
a NAME OF CONTRACTOR
APNA GHAR, INC
-
f SHIP VLA

8 TYPE OF ORDER
- 11
I
I
b COMPANY N4ME Ea PURCHASE b DELIVERY
- - REFERENCE YOUR
c STREET ADDRESS *
4753 NORTH BROADWAY - -- Quote Attached --=.
~ x c d pla
m+-rn~s
l b l l q tnslrucucns on the
ae(~wryader 1s
SUITE 518 sub){n lo ~nstrucuonsnnmtnec or
this &de only of ~ h l sl a m and us
Please furnish tne ~ ~ l ~ on w the
n gt e n s ~ u u J subject
d lo the terms and
and condibons specdied on boIh sides d c o n d j t l w ol Ihe abovenumbered
I~IS a d w and on Ihe attadled sheets, a ccntbct
d CITY e. STATE f. ZIP CODE
CHICAGO
9 ACCOUNTING AND APPROPRIATIONS DATA
1 IL 60640
any. ~ n d u d ~ nddiveryas
g irdiiled.
1,
10. REQUISITIONINGOFFICE
?I
7540120 HHS/OPHS/OWH/REGION v /I
11. BUSINESS CLASSIFICATION (Check appropriale box(es))
- i
a. SMLL c. DISADVANTAGED I j! d WOMEN€IWNED

Destination 14. GOVERNMENT BNNO. 15 DELIVER TO F 0.0. POINT ' I 6 DlSCOUplTTERMS

I
12. F O B POINT
.. .. ON OR BEFORE (Dale) . .-

a. INSPECTION.
13. PLACE OF

b. ACCEPTANCE
1
Il
Net 30
. .. _ _ >
Destination ~estiriiri%n- -"+ I
17 SCHEDULE (See reverse lor Rqedrons) ;I
ITEM NO
la)
SUPPLIES ORSERVICES
lbl
'
QUANTln
OSDEREC u N m l
Ic)
UNIT
PRICE 1 - *- auouGj;( '- -
QUANTITY
ACCEPTED

Tax ID Number:
DUNS Number: ' ;7 d
Questions Concerning this order should be re
--
PLEASE REFERENCE PAGES 1 THOUGH 6 OF THE ATT CHED
Continued . . .
. .,

10. SHIPPING POINT

h
I
19. GROSS SHIPPING WEIGHT
-
I
20. INVOICE NO
I I
I
17(hI
TOTAL

I I 1 pages)

a NAME
21 MAIL INVOICE TO

$4.. 500.80
1 4
SEE BILLING
PSC/FMS (301) 443-3020 I

INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM..16A-12

ON REVERSE (or P 0. Box) 5600 FISHERS LANE 17(1).
GRAND
TOTAL
iI
C CITY d STATE e ZIP CODE $4,500.00
ROCKVILLE MD 20857 I
n ,I
I
22 UNITED STATES OF AMERICA 23 NAME (Typed)

BY (S~gnature) JACQUELINE R. JONES

TITLE CONTWCTINWORDERING OFFICER

NSN 754C-01-152-8083 ( OPTIONAL FOW 347 (R- m51

I
v
PREVIOUS EDITION NOT USABLE
 --
ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES

-
SCHEDULE CONTINUATION 21 1 2

Proposed fee is detaile?

.---
. .
- --

--.$4,500.00

Project Officer:
Michelle Hoersch
Phone: (312) 353-8122

1. INVOICE INFORMATION

NUMBER) OR SOCIAL SECURITY NUMBER.

.... ..

REGISTRATION (OCT 2003)

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) I

NSN 754G01-152-8082 5oYCIOI FORM 348 I R n t-951

O P ~ W L
R-OVGY
F M I48 WRI 53 213lrJ
 page 1 of 6
U.S. DEPARTMENT OF HEALTH AND HLJMANSERVI
I
OFFICE OF WOMEN'S HEALTH - REGION V

STATEMENT OF WORK

I.

11.
PROJECT TITLE: ~ e a l t h
Awareness Program

BACKGROUND: Domestic violence has a profoundly negative impac,; on the

I
health and well-being of millions of American women and children. While
i
awareness of the domestic violence epidemic has been increasing over the past
'I
decade or so, it is still kept nearly silent in many immigrant communities.
Domestic violen-ce has been a socio-cultural taboo for centuries in the ~ h u t h
Asian co-mmunity. Hi_storically, bringing up the issue of domestic-vio~encehad-;. . :

been considered as "speaking t h e ~ n s ~ e a k a b l e Aware

." of this problem, ' h d
recognizing the high incidence of domestic violence going unreported in: the
/I
South Asian Community in Chicago, a group of activist women undertook to
address this problem. . 1i

Apna Ghar, which translates to "Our Home," was founded in 1990 to privide
supportive services to South Asian victims of domestic violence, primariily
women andyc&ldren. Apna Ghar has established itself as an institution inIl
Chicago's South Asian Community where mentioning domestic violencd
traditionallyis a socio-cultural taboo. Apna Ghar's mission is to providk I

comprehensive- multi-lingual, multi-cultural services including shelter tolSouth

.I r-l-...,.. . . . . . . . --I..

Asian women a a t h e i r children seeking lives free from violence.

I 1
Today, Apna Ghar helps these women who have been victims of-domes$ - - -
violence pave their way to "Self-Empowerment" through the provision o,ka home-
like shelter, counseling, life-skills development developing and sharpening their -
1
job skills, legal advice and extending affordable housing. From the time women -,

enter the emergency shelter, trained case managers work with and pro;ide support
for the clients-for an average of twenty months, to get them to a point w h F they
-
lives are away from violence and self sufficient. Apna Ghar also runs other
programs for this population. All services are free of charge. 1
I
One of the major needs of this population is basic women's health and hygiene
I.
education. Often times due to lack of health and sex education and manybultural
barriers in the countries where they grew up the women are not aware of basic
/I
health and hygiene issues. This impacts them in their everyday living as well as
/I
their long-term health maintenance. Apna Ghar helps these women prepafe for an
- independent life with various life-skills development from maintaining a bank
account to becoming familiar with public transportation. Providing knowledge
and awareness about their health to the women will complete the life-skilils
,I
development program and help them live a healthy life. 1
I
I
 Page 2 o f 6
I
111. PURPOSE: The purpose of this contract is to assist Apna Ghar in impl'ernenting
a "Health Awareness Program" - a 12-month health education program bn health
I
and hygiene for their clients who reside in the emergency shelter and suqportive
housing. The Contractor shall develop twenty-four culturally-sensitive I
information sessions for the 12-month program. The primary focus of theY program
will be in the areas of personal hygiene, knowledge of woman's own boby.
reproductive health; child-birth and child care. Additionally, in light of &me
1I
HIV positive clients that the agency is receiving and the total lack of knowledge
about HIVIAIDS in their community, Apna Ghar shall schedule information
sessions on HIVIAIDS. The Contractor shall also develop a manual on bbsic

IV.
health and hygiene for their clients for reference purposes.

PERIOD OFPERFORMANCE: The Period of Performance sh-al-1 &em

I - --

September 30,2004 through September 29,2005.

I
V. TYPE OF CONTRACT: This is a Firm, Fixed-Price purchase order. /
li
VI. DELIVERABLES AND TIMEFRAME: The Contractor shall coordi*ate with
il
the Project Officer of thls effort in order to:
I
~oordi&it$ develop and implement all aspects of the "Health Awareness I
Program," which is a 12-month health education program on health &d -

hygiene for their clients; I I

Resea&, develop and implement a culturally-sensitive cuniculum on .. .. . . .. --

personal hygiene, knowledge of woman's own body, reproductive he'alth,
Il
HIVIAIQS, childSbirth and child care; .. .-
.- -,,- ..- . _ _ I ~
. .

Develop and provide educational materials for instructors and participants in

'I
the 12-month program; (I

- Develop and implement an evaluation tool to assess the effectivenessof the

Health Awareness Program on their client population; /j -
Develop and provide a manual on basic health and hygiene for client$ --
il
reference; I

.. ,.
Schedule and administer 12-month program for clients in the emergehcy shelter
and supportive housing; - I

Develop and provide program progress reports to the Project Officer [PO);
1
Develop and provide a final program evaluation report to the PO.
- . 1
II
The due dates and delivery methods for these deliverables are to be decided
following the award of this effort. 1lI
\I
VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized agent of the
Contracting Officer is responsible for the review and acceptance of all 1
deliverables. I
I
I/
 100822P
;e3 o f 6
VIII. INVOICE SUBMISSION: Upon inspection and acceptance of the dell erables
described in Section VI., the Contractor shall submit an original and two
copies of its proper invoices to the PO. For payment, the PO shall submi .he
invoice and a signed receiving report to:

Department of Health & Human Services

PSC/Financial Management Service
Division of ~inancialOperations
Parklawn Building, Room 16A-12
5600 Fishers Lane
Rockville, Maryland 20857-
Telephone: (301) 443-3020
- . . I.. ;-
5

The invoice mast contain the following minimum information: =-z - =

Contractor's name and address;

Purchase order number;

Description and price of services provided;

f -;
1nvoick.period; and
.-
The Contractor's Internal Revenue Service (IRS) ~ a x p a ~Identi
er cation
Fhlmber. -,-

IX. GOVERNMENT-FURNISHED MATERIALS: The Government wil

furnish any materials to the Contractor for this requirement.

X. RIGHTS TO DATA: The Contractor is prohibited from using data pro(

obtained under this contract for any purpose without prior, written appro7
the PO.- --
XI. TECHNICAL MONITORING:

A. Performance of the work under this purchase order shall be subjec to the
technical monitoring of the Project Officer. The term "Technical
Monitoring" is defined to include, without limitation, the followir
.-,

1. Technical directions to the Contractor, which redirect the 1 lrchase

order effort, shift work emphasis between work areas or ta KS,
require pursuit of certain lines of inquiry, fill in details or
otherwise serve to accomplish the contractual scope of wo
 /I
2. providing information to the Contractor for assistance in the
interpretation of drawings, specifications or technical podions of

3.
the work description.

Review and, where required by the purchase order, approjal of

I
technical reports, drawings, specifications and technical
information to be delivered by the Contractor to the ~ o v e ! n m e n t
1I
under the purchase order.
l
ti
B. Technical direction must be within the general scope of work stated in the
purchase order. The Projeciofficer does not have the authority tb and
may not issue any technical direction which (i) constitutes an assil'gnment .-
of additional work outside the general scope of the purchase orde/; (ii) --
constitutes a Aange as defined in the purchase order clause en&
"Changes;" (iii) causes, in any manner, an increase or decrease in/the total
estimated purchase order cost, the fixed fee or the time required for
purchase order performance; or (iv) changes any of the
conditions, or specifications of the purchase order.

C. All technical direction shall be issued in writing by the Project

I/
Officer or shall be confirmed by himiher in writing within 5
%#, L
.-

worR-g days after issuance. 11

I
D. The contractor shall proceed promptly with the performance of
technical-duection duly issued by the Project Officer in the manner
/ -.-
I
prescribed by this clause and within hisher authority under the
provisions of this clause. . -
I
-1il .- - -
11
E. If, in the opinion of the Contractor, any instruction or direction issued by
the Project Officer is within one of the categories as defined in (i)lthrough
(iv) above, the Contractor shall not proceed but shall notify the; 1
4 . - .-
..

C o n t r a i n g Officer in writing within 5 working days after the rekipt of

il
-- , .-
any such instruction or direction and shall request the Contracting Officer
to modify the purchase order accordingly. Upon receiving such 1
notification from the Contractor, the Contracting Officer shall isshe an
appropriate purchase order modification or advise the Contractor in
writing that, in histher opinion, the technical direction is within t$ scope
of this clause and does not constitute a change under the changes/c1ause
of the purchase order. The Contractor shall thereupon proceed - 1
immediately with the direction given. A failure of the parties to I
agree upon the nature of the instruction or direction or upon the purchase
order action to be taken with respect thereto shall be subject to thd
provisions of the purchase order clause entitled "Disputes."
 HHSP23320(
P,?i
XII. POINTS OF CONTACT: 1
The Project Officer (PO) for this effort is:

Ms. Michelle Hoersch, M.S. I

Office on Women's Health - 1

U.S. Department of Health and Human Services I
233 N. Michigan Avenue, Suite 1300 il
Chicago, lllinois 60601
Phone: (312) 353-8122
-
Iil'
I
Fax: (312) 353-7800 1;
Email: ~hoersch@osophs.dhhs.o,o~~ 1
- . - Ii
The Contracting Offigr (CO) for this effort is:
j
e:

Ms. Jacqueline R. Jones I

Program Support Center 1
U.S. Department of Health and Human Services I
Parklawn Building, Room 5- 101
5600 Fishers Lane
Rockville, MD 20857
Phone: (30l'$4$3-6413 I
1I
Fax: (301) 443-8488 1
li
il

The Con^t%t.Specialist for this effort is:

!'
I
I
Mr. Gene H. Calvert !
Program Support ~ e r k e r i
I
Phone: (301) 443-7077 'hI
1
XI. FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEI&
- -- I; *". - ....
!I
This contract incorporates one or more clauses by reference, with the samIe force
4
and effect as if they were given in full text. Upon request, the Contracting (3fficer
I

will make their full text available. Also, the full text of a clause may be acc: :essed

1
1
electronically at thislthese address(es): l~ttp://\~\c~v.an~et.gov/far.
!
The following FAR contract clauses are incorporated by reference:
.-..
No. CLAUSE NO. TITLE AND DATE
/I
1I
I
-- 1. FAR 52.204-6 Data Universal Numbering 1
System (DUNS) Number !
(OCT 2003) 1
!1
2. FAR 52.204-7 Central Contractor Registrat.i'o
(OCT 2003) !I
I)
/I
iI
1
I
;I
1
1
 I
HHSP233200300822P
il
Page 6 of 6
1
-
No. CLAUSE NO. TITLE AND DATE

FAR 52.212-1 Instructions t o Offerors - 1'

Commercial Items (JAN 2004)
I
FAR 52.212-4 Contract Terms and Conditions -
Commercial hems (OCT 20'03)
FAR 52.222-3 Convict Labor (June 2003) 1
~ A k 5 2 . 2 2 219
- Child Labor-Cooperation w l ~ h
Authorities and Remedies I
(June 2004) i
FAR 52.222-21
I/ . . .
Prohibition of Segregated Facllltles
(Feb 1999). 1
FAR 52.222-26 -: Equal Opportunity (Apr 200:2) --
FAR-5-2.223-6 . . Drug Free WorkplacE-(MW.200 \I
Ij
FAR 52.225-1 Buy American Act-Supplies(
/I
(June 2003) 1 11
FAR 52.225-1 3 Restrictions on Certain Foreign
Purchases (JUN 2003) 1
FAR 52,232-1 Payments (APR 1984) 1
FAR 52.232-33 Payment by Electronic Funds
Transfer-Central
-
.+I -5
%u. Registration (Oct 2003)
FAR 52.233-1 Disputes (JUL 2002) I --
FAR 52.233-3 Protest After Award (AUG 1996)
i

* * *END OF STATEMENT OF WORK * *..*-

1!,
Crown. Ruth

From: Hoersch, Michelle

Sent: Friday, September 03,2004 3:53 PM
To : Crown, Ruth
Subject: Another DUNS#

Importance: High

- -
. .
HI Ruth,

The DUNS# for requisition #s OWHV05 and OWHV12 are the same: 4
I hope this is all you need for this contract.
. -

Thanks,
. -- - --
M

Michelle D. Hoersch, M.S.

Office o n Women's Health Region V -
U.S. Department o f Health and Human Services
233 N. Michigan Ave, Suite 1300
Chicago, lL 60601 .;<J,-
312-353-8122
312-353-7800 fax .-
mhoersch@osophs.dhhs.gov
-!.-.-.A. . - ..>A

Please visit the National Women's Health Information Center at www.4woma

, .*

-----Original Message-----
From: Aparna Sen [mailto:asen@apnaghar.org]
Sent: Friday, September 03;-2004 2:33 PM .-
To: Hoersch, Michelle
Subject: FW: U.S. Government Customer DLlNS Number Request LlNlTED - 'ATES OF
-
AMERICA Apna Ghar, Inc.(Our Home)
Importance: High

Michelle - . - 4

Here is the. DUNS numbel rt we received o n August 06, and had sent to you
pL/
immediatey. I-also left you a msg t o tollow u p o n the funding and next steps ' any to be taken,
but never heard from you. I know you must be incrediblly busy, but please Ic me know where
are we i n the process.

'Thank you,

Aparna Sen
Executive Director
Apna Ghar, Inc.
Tel: 773.334.01 73 X(229)
email: asen@apnaghar.org

-----Original Message-----
From: customerservice@dnb.com [mailto:customerservice@dnb.com]
Sent: Friday, August 06,2004 9:12 AM - I !
To: asen@apnaghar.org
-
1
Subject: RE: U.S. ~overnment-customerDUNS Number Request UNITED STATES OF
-
AMERICA Apna Ghar, Inc.(Our Home)
I

I
The assignp--' -' 3&B DUNS Number has been completed. Your D&B/DUNS
Number is hq 'This number wilt become active i n our system I
tomorrow morning. If you have -any questions please contact D&B at 7366-5-5711.
I
Sincerely,
1
Kalel Edward
Internet Customer Support
emaii: customerservice@dnb.com.
www.dnb.com

[Message #855908] .-

.,.-,+..+. . - .,,>
S~P-20-04 12:31pn Frolrm-U S DEPT W '4 HS 31 2-353-0718

Awareness Program on their client population. Co

health and hygiene for climrs' reference.

Tasks: il
II
The contractor will be risponsible for the following activiues: 4

Research current health and hygiene information for Pmgam marenalsj

I
I
r Develop 24-session Health Awareness P r o p
8 Develop evaluanon t w l for progrim 1
Develop manual on basic health and hygene for clients' reference. 1(1
Schedule wd &mister 12;menrh program for clients in the emergency shelter and
supporcivr housing -- -- -- I - i[

X-session Health Awuencss Program curriculum and materials. mncludng

evaluation tool I
I
Manual on basic healdl and hygiene 1
Progress reports on program /I
Final report & program and evaluanon
,-
Ii <

Period uf Frrbutmauce:, I
I
1
Award of conuact - September 30,2005
. -*
1
-1, - - - -
-
p!$iTiE-
.Aps m
~14tifirn~(~=~$
s a co&&t$:based
I/I
'YI
organization rhar is rmsted by the commuqity and has a --
-
-
long h~storyserving South Asian women m rhc Chcago metropolitan area. Apna Ghar -
has earned the m a of South Asian women and as such has access ro a populatToii of
women in rremendous need, thar no orher communitqlbased organization can ctaim. This
organization also has strong ties to the community and good worlung relarionshlps wirh
other social service providers servmg rhc Soulh Asian community. Wirh the exberience
and quality of s*rvices. Apna Char has earned a leadership role in the commwli1[:ychat
provides services to the victims of domestic violence. Apha Ghar his been indyted into
the finr class of Asian American Hall of Fame. Thc lacallsuperstation television sranon,
WGN,has recognized Apna Ghar as one of the 2002 "unsung Heroes." Apna Ghar's
supervised visitation center was featured in the New Y ork Times and more recently in the
Chcago Tribune. Apna Ghar has been honored with an "Excellence in Services' award in
2004 by rhr ~ n o r n c yGeneral of lllinois and was recenrly chosen ilr one of rhe bilor snes
for "safe havens" program by b e Ciry of Chicago, Mayor's Office for Violence
R v w t i ~ n' .h s valuable integration in the community will greatly facilirate rde efficient
and cost-effccuve planning ad implementation of this Health Awareness program which
will result in substantial cost savings ro the government. i;
Message Page 1 of 2

Calvert, Gene

From: Calvert, Gene

Sent: Tuesday, September 21,2004 12:OO PM
To: 'info@apnaghar.orgl
-
Subject: Request for Quotation (RFQ) From the U.S. Department of Health & Human Serv es. Office on
Women's Health - Health Awareness Program
~.

Good day,

Attached is a Request for Proposal (RFQ) package for contractor support for the Depart lent of Health
and Human Services, Office on Women's Health, Region V, Health Awareness Prograrr
- 7- --. -==a
This email contains three files:

Cover Letter - Apna ~ h a r . d o c-- Contains contact information and directions on s bmitting your
completed RFQ.
.. SF-1 8 Apna Ghar.doc -- Is the SF-1 8 to be used to note your quoted price for this ffort.
Michelle Hoersch -- Health Awareness Program RFQ SOW.doc -- Is the Statemei of Work for
this effort. It contains the Scope of Work, invoicing information, and other infon ation pertaining
to this effort. c,
%

The files are are MS-Word.documents. In order to expedite the process, feel free to pro ide . -
responses directly into the necessary documents and email them back to me. If you prel r, you may also
print out the documents;md &-,back the completed package to my attention at (301) 41 r-8488.--~.. . .-

If your organization has not already done so, please register your organization inthe Ce :ral Csntractor
Registration (CCR) database. Registration is easy to complete and can be accomplishec ~nlineat
http://www.ccr.go_~.Active registration in the CCR is required to be awarded procurem nts with the
Federal Government.
-
The RFQ package may seema little intimidating, but it really isn't. The questionsare VI
straightforward, and you should not have any trouble completing the package.

We are hoping to make this award by the end of our fiscal year with is September 30th.. f you have any
questions at all, please feel free to contact me by return email, or by phone at (301) 443. '077.

When you have an opportunity, please confirm receipt of this package by sending me a
.- ..
Regards,

Gene

Gene Calvert
Contract Specialist
Department of Health and Human Services
Program Support Center
Phone: (301) 443-7077
Fax: (301) 443-8488
DEPARTMENT OF HEAL', -- & HUMAN SERVICES I
Pro-eram Support Center

I
I h b ~ s ~ o nf A c q u ~ s ~ t ~blanaeerneni
on
Room 5-101. ~ i h k l a a mB u ~ l d l n ~
.\AS

5600 F ~ s h e r sLa!ne
Rockv~lle.M D 20857

September 2 1, 2004

Apna Ghar, Inc.

Attn: Aparna Sen-Yeldaridi
4753 North Broadway, Suite 5 18
Chicago, Illinois 60640

SUBJECT: Request for Quote (RFQ) No. 04T0000 12

- . . -
Ms. Sen-Yeldandi, - . .-

The United States Department of Health and ~ u m a nServices, Office on Womed's Health,
Region V has a requirement for Contractor support regarding their project titled b//ice of
Women's Health, Region V-- Health Awareness Program. Your firm has been identified as
having the predominant capabilities required to provide the required solutions fof this project.
You are invited to submit a quotation in response to the enclosed Request for Qdotation
(WQ). The Government anticipates making an award based on your technical dbderstanding
of the requirement &?he reasonableness of your proposed price. 1i
Please submit your quotation for the services as described in the attached ~tatemkntof Work
to Gene Calvert,,C9~tracJ$pecialist, Department of Health and Human Services,!
i
---_
Program Support Center, Division of Acquisition Management, Room 5-101, Pa!klawn
Building, 5600 Fishers Lane, Rockville, Maryland, 20857 by no later than , -*3:00 RI.M. __
Eastern Standard Time, Thursday, September 23, 2004. 1
1
Your quote must include a detailed description of the work to be accomplished a; described .-r
in the refefenced Statement of Work, and it must also include a detailed explanation of the
your price breakdown; -If you have recently performed work of a similar nature described 4
in the referenced Statement of Work, please include a copy of the invoice for that effort.
Disclosure of your client's identity is not required on the invoice.

Please submit your completed Request for Quotation Standard Form 18, and your; completed
Offeror Representations and Certifications - Commercial Items. To expedite the process,
your completed quotation package may be sent via email to me, Gene H. Calvert,
Contract Specialist, at qcalvert6)psc.gov, or via fax to my attention at (301 744323488.
I I
9
If jmur organization has not already registered with in the Central Contractor Registration
(CCR), please do so as soon as possible. Registration is easy and can be accomp(ished online
at ht~p:,iwwwt.ccr.gov.Registration in the CCR is required in order to be awarded
procurements with the Federal Government. /I ,I

1
I
Questions concerning this RFQ shall be referred to Gene Calvert by phone at
or by email at gcalvertfi~psc.u,ov.

Sincerely,

Gene H. Calvert
Contract Specialist
 REQUEST FOR QUOTATION 1 PAGE OF
I
OY- I 1 PAGES
THIS RFQ 0 IS X IS NOT A SMALL BUSINESS SET-ASI!E
(THIS IS NOT AN ORDER)
1. REQUEST NO.

5.a ISSUED BY
2. DATE ISSUED
September 21,2004
3. REQUISTIONIPURCHASE REQUEST NO.
04T000012

DHHSIPSCIAOSISASIDAM, PARKLAWN BUILDING, ROOM 5-101.5600 FISHERS LANE, ROCKVIUE. MD 20857

4. CERT. FOR NAT. DEF
UNDER BDSA REG 2
AND/OR DMS REG. 1
6. DELIVER BY (Date)
I
1
See Attached Statement of Work
* RATING

1
I

NAME
5.b. FOR INFORMATION CALL (NO COLLECTCIILLS)
TELEPHONE NUMBER
7. DELIVERY
X FOB DESTINATION
1 OTHER
(See schedule)
AREA CODE NUMBER 9.i DESTINATION
Gene H. Calvert, Contract Specialist 443-7077 a. NAME OF CONSIGNEE 1
8. TO:.
(301)
I
Ms. Michelle Hoersch, 1M.S.
.--
a. NAME
Apama Sen-Yeldandi, Executive Director
b. COMPANY
Apna Ghar, Inc.
b. STREET ADDRESS
1
233 North Michigan Avenue, Suite 1300
c. STREET ADDRESS
4753 North Broadway, Suite 518
c. CITY
Chicago
I
1I
1
d. CITY
..
- . e. STATE -- f. ZIP CODE d. STATE e. ZIP CODE
Chicago . . . .. Illinois' 60640 Illinois . .60601!i- -
.-. .
.. --
10. PLESE FURNISH QUOTATIONS TO THE IMPORTANT: This is-arequest for information, and quotations furnished are not officers. Iliyou are unable to quote.
ISSUING OFFICE IN BLOCK 5a ON please so indicate on thii form and retum it to the address in Bkck Sa. This request does not commit the Government to
OR BEFORE CLOSE OF BUSINESS (Date) pay any costs inarmed in the preparation of the submission of this quotation or to contact f & s u w l i or service.
3100 PM EST 'Thursday, September 23, 2004 Supplies are of domestic origin unless otherwise indicated by qwter. Any representabonshd/or certifhtions attached
To this Request for Quotation must be completed by the qwter. 1
11. SCHEDULE (Include applicable Federal, state and local taxes) 1
ITEM NO.
(a)
SUPPLlESlSERVlCES.
(b)
QUANTITY
(c)
UNIT
(d)
UNIT PRICE
(e)
1 AMOUNT
(9

The Contrad'4pr shall

provide assistance in
implementing a "Health
Awareness Program"
- ..,- in
.*+-.-.,A,.

accordance with the

Attached Statement of
Work titled-"Offi'ce of
Women's Health, Regi0.n V
- Health Awareness
Progxam.

a. 10 CALENDAR DAYS b. 20 CALENDAR DAYS c. 30 CALENDARQAYS 1 d. CALENDAR DAYS

12. DISCOUNT FOR PROMPT PAYMEKT

* (%) PERCENTAI

I
NOTE: Additional provisions and representations X are are not attached. I
'13. NAME AND ADDRESS OF QUOTER 14. SIGNATURE OF PERSON AUTHORIZED TO 15. DATE OF QUOTATION
a. NAME OF QUOTER SIGN QUOTATION
(II 1
b. STREET ADDRESS 16. SIGNER I
a. NAME (Type or print) ;I b. TELEPHONE
c. COUNTY ?; AREACODE
,I
il
d. CITY e. STATE f. ZIP CODE c. TITLE (Type or print) !I NUMBER
/I

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM l a (REV 6-95

Previous edition not usable Presaibei by GSA-FAR (48 CFR) 53.215-1(a'
1
 U.S. DEPARTMENT OF HEALTH AND HUMAN S E R V I ~ E S
OFFICE OF WOMEN'S HEALTH - REGION V I

STATEMENT OF WORK

I. PROJECT TITLE: Health Awareness Program

I
11. BACKGROUND: Domestic violence has a profoundly negative impaction the
health and well-being of millions of American women and children. While
ri
awareness of the domestic violence epidemic has been increasing over the past-
decade or so, it is still kept nearly silent in many immigrant communities\
Domestic violence has been a socio-cultural taboo for centuries iathe --
.-

Asian community. Historically, bringing up the issue of domestic violencie had

been considered as "speaking the unspeakable." Aware of this problem, y d
recognizing the high incidence of domestic violence going unreported in the
South Asian Community in Chicago, a group of activist women undertook to
address this problem. 1
Apna Ghar, which translates to "Our Home," was founded in 1990 to - I

supportive Sepices to South Asian victims of domestic violence, primarity

women and children. Apna Ghar has established itself as an institution in
Chicago's South Asian Community where mentioning domestic violence,
traditionalp
-'-C.. -
is-a .socio-cultural
.
i
taboo. Apna Ghar's mission is to provide11
comprehensive multi-lingual, multi-cultural services including shelter to South
--
-- .

Asian women and their children seeking lives fiee from violence. 1
. -- =// .- = =
I
Today, Apna Ghar helps these women who have been victims of domestic
violence pave their way to "Self-Empowerment" through the provision of a home-
-.
like shelter, counseling, life-skills development developing and sharper& their
job skills, legql, advice and extending affordable housing. From the time women
enter the emergency shelter, trained case managers work with and provide support
I/
for the clients for an average of twenty months, to get them to a point where they
lives are away from violence and self sufficient. Apna Ghar also runs other
programs for this population. All services are free of charge. II
U
One of the major needs of this population is basic women's health and hygiene
education. Often times due to lack of health and sex education and many kultural
barriers in the countries where they grew up the women are not aware of basic
I
health and hygiene issues. This impacts them in their everyday living as well as
It
- their long-term health maintenance. Apna Ghar helps these women prepTe for an
independent life with various life-skills development fiom maintaining a bank
(I

account to becoming familiar with public transportation. Providing knowledge

and awareness about their health to the women will complete the life-skil'/s
1,
development program and help them live a healthy life. I
I
111. PURPOSE: The purpose bf this contract is to assist Apna Ghar in implbmenting
I
a "Health Awareness Program" - a 12-month health education program on health
Y
and hygiene for their clients who reside in the emergency shelter and supportive
housing. The Contractor shall develop twenty-four culturally-sensitive
I
information sessions for the 12-month program. The primary focus of thy program
will be in the areas of personal hygiene, knowledge of woman's own body,
reproductive health, child-birth and child care. Additionally, in light of sbme
HIV positive clients that the agency is receiving and the total lack of kndwledge
about HIVIAIDS in their community, Apna Ghar shall schedule informalion
sessions on HIVIAIDS. The Contractor shall also develop a manual on b s i c
health and hygiene for their clients for reference purposes. 1
z
IV. PEFUOD OF PERFORMANCE: The Period of Performance shall be&m the --

date of award through September 30,2005. '1I

I
V. TYPE OF CONTRACT: The Government anticipates the award of a ~ j r m ,
Fixed-Price purchase order as a response to this Request for Quote (RFQ$.

VI. DELIVERABLES AND TIMEFRAME: The Contractor shall coordinate with

I
the Project Officer of this effort in order to:
f=.,
Coordinate, develop and implement all aspects of the "Health Awareriess
!
'I

Prograni," which is a 12-month health education program on health A d

1
hygiene
----*- -
for-their
- clients;
Research, develop and implement a culturally-sensitive curriculum on
/1 --- -

- -
personal hygiene, knowledge of woman's own body, reproductive hehth, - -
HIVIAIDS, child-birth and child care;
&-

1
Develop and provide educational materials for instructors and particibants in
the 12-month program; I
-Develop and implement an evaluation tool to assess the effectivenessi:ofthe
....

Health Awareness Program on their client population; 1 - .

Develop and provide a manual on basic health and hygiene for client
reference;
Schedule and administer 12-month program for clients in the emerge
and supportive housing; 1
i provide program progress reports to the Project Officer PO);
~ e v e l oand
.. .
Develop and provide a final program evaluation report to the PO.
.
The due dates and delivery methods for these deliverables are to be decided
I
0
following the award of this effort.
I1
I

VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized agent of the

Contracting Officer is responsible for the review and acceptance of all !
deliverables. ,
li
 RFQ - 0 h ~ 0 0 0 12
0
I
Page 3 of 18
I
MII. INVOICE SUBMISSION: Upon inspection and acceptance of the deliverables
described in Section VI., the Contractor shall submit an original and two
copies of its proper invoices to the PO. For payment, the PO shall submit the I
invoice and a signed receiving report to:

Department of ~ e a l t h& Human Services

PSC/Financial Management Service
Division of Financial Operations
Parklawn Building, Room 16A-12
5600 Fishers Lane
Rockville, Maryland 20857
Telephone:. (301) 443-3020 i/
. <-
=- - -:-

The invoice must contain the following minimum information: I

Contractor's name and address;

Purchase order number;

Description and price of services provided;

,J
\>.
Invoice
.-
period; and
I
TheLontractor's Internal Revenue Service (IRS) Taxpayer Identilification == .
Number.
-
1
=>I ' = r

IX. GOVERNMENT-FURNISHED MATERIALS: The Government will1I not

fimish any materials to the Contractor for h s requirement. /I
..

X. RIGHTS TO DATA: The Contractor is prohibited from using data pro1 luced or
obtained under this contract for any purpose without prior, written-appro la1 from -- ....

the PO.

XI. . TECHNICAL MONITORING:

A. Performance of the work under this purchase order shall be subje :t to the
technical monitoring of the Project Officer. The term "Technical
Monitoring" is defined to include, without limitation, the followil g:

1. Technical directions to the Contractor, which redirect the purchase

order effort, shift work emphasis between work areas or tasks,
1I
require pursuit of certain lines of inquiry, fill in details or 1
otherwise serve to accomplish the contractual scope of work.
1
 RFQ - 0;4~000012
Page 4 o f 18
R
1
2. Providing information to the Contractor for assistance in the
interpretation of drawings, specifications or technical po
the work description.

3. Review and, where required by the purchase order, app

technical reforts, drawings, specifications and t e c h c a l
information to be delivered by the Contractor to the G
under the purchase order.

B. Technical direction must bewithin the general scope of work staded in the
purchase order. The Project Officer does not have the authority and . $
may not issue any technical direction whlch (i) constitutes an assignment
of additional work outside the general scope of the purchase or&;jii) --
constitutes a change as defined in the purchase order clause entitl'ed,
"Changes;" (iii) causes, in any manner, an increase or decrease ini the total
estimated purchase order cost, the fixed fee or the time required for
purchase order performance; or (iv) changes any of the expressed terms,
conditions, or specifications of the purchase order. 1
I
C. All technical direction shall be issued in writing by the Project
OffiCqar shall be confirmed by h i d e r in writing within 5 1
working days after issuance.

D. The Contractor shall proceed promptly with the performance of ,II

-'*-I-.*.. ^ -- .
technical .d?rection duly issued by the Project Officer in the mannbr
I
prescribed by this clause and within hisher authority under. .- the -1 .- .. .- . -
provisions of this clause.
!
E. If, in the opinion of the Contractor, any instruction or direction issued by
1
- the Project Officer is within one of the categories as defined in-(ijI through
(iv) abgye, the Contractor shall not proceed but shall notify the -. - - 1
Contracting Officer in writing within 5 working days after the reclkiptof
any such instruction or direction and shall request the ~ontractindOfficer
1
to modify the purchase order accordingly. Upon receiving such
notification fiom the Contractor, the Contracting Officer shall issje an
appropriate purchase order modification or advise the Contractor in
writing that, in hisher opinion, the technical direction is within the scope
of this clause and does not constitute a change under the Changes Clause
of the purchase order. The Contractor shall thereupon proceed 'I
immediately with the direction given. A failure of the parties to II
agree upon the nature of the instruction or direction or upon the pirchase
order action to be taken with respect thereto shall be subject to the11
provisions of the purchase order clause entitled "Disputes." U
XII. POINTS OF CONTACT:

The Project Officer (PO) for t h s effort is:

Ms. Michelle Hoersch, M.S.

Office on Women's Health-
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago, Illinois 6060 1
Phone: (312) 353-8122
Fax: (312) 353-7800
Email: rnhoersch@osophs.dhhs.gov

The ~onkictingofficer (CO) forthis effort is:

Ms. Jacqueline R. Jones

Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5-101
5600 Fishers Lane'
Rockville, MP;20857
Phone: (301) 443-6413
Fax: (301) 443-8488

The contiact Spec<alistfor this effort is:

, .-
Mr. Gene H. Calvert '

Program Support Center

Phone: (301) 443-7077

XI. FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (&

T h s contract incorporates one or more clauses by reference, with the s a ~:force

and effect as if they were given in full text. Upon request, the Contractin Officer
will make their full text available. Also, the full text of a clause may be i cessed
electronically at thislthese address(es): http:ll~v.arnet.govlfar.

The following FAR contract clauses are incorporated by reference: .

-
No. CLAUSE NO. ' TITLE AND DATE

1. FAR 52.204-6 Data Universal Numbering

System (DUNS) Number
(OCT 2003)
2. FAR 52.204-7 Central Contractor Registrz
(OCT 2003)
 I
RFQ - 04T000012
Page6of
I 18
-
No. CLAUSE NO.

FAR 52.212-1 Instructions to Offerors - I

Commercial Items (JAN 2004)
FAR 52.2 12-4 Contract Terms and ~ondi!jons -
Commercial Items (OCT 2003)
FAR 52.222-3 Convict Labor (June 2003)l
FAR52.222-19 Child Labor-Cooperation with
Authorities and Remedies I
(June 2004)
Il
1
FAR 52.222-21 Prohibition of Segregated fiacilities -

- F m 52.222-26
. . (Feb 1999).
Equal Opportunity (Apr 2@2-J
1 z

-
.- -
FAR 52.223-6 Drug Free Workplace (MAR 2001)
. FAR 52.225-1 Buy American ~ c t - ~ u ~ ~ l i e k
(June 2003) 1
FAR 52.225-13 Restrictions on Certain ~ o r & i ~ n
I
Purchases (JUN 2003)
FAR 52.232-1 Payments (APR 1984) I1
FAR 52.232-33 Payment by Electronic Funds
rJ t

\.=.
Transfer-Central Contractor1
Registration (Oct 2003) li
14. - - FAR 52.233-1 Disputes (JUL 2002) 1
15. -..-.-... - 52.233-3
. -FAR -, Protest After Award (AUG 996) ---- -
I
CONTRACT CLAUSES

1. FAR 52.212-3 OFFEROR REPRESENTATIONS AND CERTFICATI~NS-

COMMERCIAL ITEMS (MAY 2004) I//I
- ..
-
--.
.
~.

a) Definitions. As used in this provision: , . . . ~ .-!I

ij -..
I/
"Emerging small business" means a small business concern whose size is no I
greater than 50 percent of the numerical size standard for the NAICS code1
designated.

"Forced or indentured child labor" means all work or service-

. -.
(1) Exacted fiom any person under the age of 18 under the menace of any
penalty for its nonperfo&ance and for which the worker does nodoffer
himself voluntarily; or 'I
1 (I
(2) Performed by any person under the age of 18 pursuant to a codtract the
enforcement of which can be accomplished by process or penaltieb.

"Service-disabled veteran-owned small business concernw-

 (1) Means a small business concern- . .
I1
(i) Not less than 51 percent of which is owned by one or more
service-disabled veterans or, in the case of any publicly 1
owned business, not less than 5 1 percent of the stock of wlhich
is owned by one or more service-disabled veterans; and 1
.,

I
(ii) The management and daily business operations of which are
controlled by one or more service-disabled veterans or, inlthe case
of a service-disabled veteran with permanent and severe disability,
the spouse or permanent caregiver of such veteran. I
h
I
/I ,.
(2) Service-d&abled veteran means a veteran, as defined in 38 UJS;IC.
101(2), with a disability that is service-connected, as defined in 38 U.S.C.

1
"Small business concern" means a concern, including its affiliates, that is/
independently owned and operated, not dominant in the field of operation in
which it is bidding onsGovernmentcontracts, and qualified as a small business
under the criteria in 13 CFR part 121 and size standards in this solicitation.
? ,,,?
"Veteran-owned small business concern" means a small business concern-
--
I

'/
,
(1) Not. less than 5 1 percent of which is owned by one or more veterans
i
-4- --P.

(as defined at 38 U.S.C. 101(2)) or, in the case of any publicly odned
business, not less than 5 1 percent of the stock of which is owned bjy one or
moreireterans; and
s =,I 5 _
/I
1
(2) The management and daily business operations of which are controlled
- by one or more veterans. _ (1
il
. * 'I - -
-. *
"Women-owned business concern" me& a concern which is at least 5 1 bercent
owned by one or more women; or in the case of any publicly owned busi
least 5 1 percent of its stock is owned by one or more women; and whos
management and daily business operations are controlled by one or mor

"Women-owned small business concern" means a small business concern"-

--*
(1) That is at least 51 percent owned by one or more women; or, in the
I
case of any publicly ownid business, at least 5 1 percent of the stobk of
which is owned by one or more women; and

(2) Whose management and daily business operations are control1:~dby

one or more women. ,
!
I/

,I

/i
 I
RFQ - 04T0000 12
r
Page8of 18
(b) Taxpayer IdentificationNumber (TIN) (26 U.S.C.
6109, 31 U.S.C. I .
7701). (Not applicable
if the offeror is required to provide this information to a central contractdr
registration database to be eligible for award.)
1
(1) All offerors must submit the information required in paragraphs (b)(3)
through (b)(5) of this provision to comply with debt collection
I
requirements of 3 1 U.S.C. 770 1(c) and 3325(d), reporting requirements of
26 U.S.C. 6041,6041A, and 6050M, and implementing re gulatiohs issued
by the Internal Revenue Service QIRS). (I
I/
i
(2) The TIN may be used by the Government to collect and report on any :

delinquent amounts arising out of the offeror's relationship with the

Govergnent (31 U.S.C. 7701(c)(3)). -- -. 1 - --

If the resulting contract is subject to the payment reporting requirements

described in FAR 4.904, the TIN provided hereunder may be madFhed
with IRS records to verify the accuracy of the offeror's TIN. 1
I
(3) Taxpayer Identification Number (TIN). il
[ ] TIN:
[ ] TIN has been applied for.
[ ] :2@Jis not required because:
[ ] Offeror is a nonresident alien, foreign corporation, or foreign,
partnership that does not have income effectively connected with ?he
1
conduct.. of
.I.- -.A. -
. a trade or business in the United States and does not have an -
office or place of business or a fiscal paying agent in the United States;
(1
[ ] Offeror is an agency or instrumentality of a foreign government;
[ ] Offeror iS an agency or instrumentality of the Federal ~ o v e r i $ n e n'
i
I
(4) Type of organization.
. [ ] Sole proprietorship;
1 ] Partnership;
[ ] Corporate entity (not tax-exempt);
[ ] Corporate entity (tax-exempt);
[ ] Government entity (Federal, State, or local);
[ ] Foreign government;
[ ] Lntemational organization per 26 CFR 1.6049-4; 1
[ ] Other I
* - , 1
( 5 ) Common parent. 1
I

[ ] Offeror is not owned'or controlled by a common parent;

[ ] Name and TIN of common parent:
i
I

Name
TIN
 RFQ - q 4 ~ 0 0 0 12
0
Page 9 o f 18
I
(c) Offerors must complete the following representations when the resul'ting
contract will be performed in the United States or its outlying areas. ~ h J c kall that
apply.

(1) Small business concern. The offeror represents as part of its @er
I
that it [ ] is, [ ] is not a small business concern.

(2) Veteran-owned small business concern. [Complete only ifthelofferor

represented itselfas a small business concern in paragraph (c)(l?)of thrs
1 -

provision.] The offeror represents as part of its offer that it [ ] is,i [ ] is not
a veteran-owned small business concern.

(3) Sevice-di~abledveteran-owned small business concern. [C&plete

i --
only i f the offeror represented itselfas a veteran-owned small buimess
concern in paragraph (c)(2) of this provision .] 1
'I
The offeror represents as part of its offer that it [ ] is, [ ] is not a service-
disabled veteran-owned small business concern.
I
i

(4) Small disadvantaged business concern. [Contplete only i f the bferor

represented itselfas a small business concern in paragraph (c)(l) of this
proldq&n.] The offeror represents, for general statistical purposes\ that it
[ ] is, [ -1 is not a small disadvantaged business concern as define'd in 13
1
CFR-I 24.1002. 1
.<.-.-.A,. - -
(5) Women-owned small business concern. [Complete only ifthe q?fferor
I/ .. . . . . -- --

represented itselfas a small business concern in paragraph (c)(l) of

this provision.] The offsror represents that it [ ] is, [ ] is Kot a women: =

-
owned small business concern.

~ o t e Complete
: paragraphs (c)(6) and (c)(7) only if this solicitatibn is
I
1

I
expected to exceed the simplified acquisition threshold.
. . . . .il ~. ~ ..=.

il
(6) Women-owned business concern (other than small business c
[Complete only if the offkror is a women-owned business concer
did not represent itself as a small business concern in paragrap
of this provision.] The offeror represents that it [ ] is a women-
business concern.
.. + I
(7) Tie bid priority for labor surplus area concerns. If this is an invitation
for bid, small business offerors may identify the labor surplus are&
in which costs to be incurred on account of manufacturing or production
(by offeror or first-tier subcontractors) amount to more than 50 percent of
the contract price: i
/
 WQ - O ~ T O O O O12
Page 10 of 18
I
(8) Small Business Size for the Small Business Competitiveness
Demonstration Program and for the Targeted Industry Categories under I
Y
the Small Business Competitiveness Demonstration Program. [Complete
only if the oferor has represented itselfto be a small business cohcern
under the size standards for this solicitation.] I
1
1%
(i) [Complete only for solicitations indicated in an addendum as bezng set-
aside for emerging small businesses in one of thefour designated
1
industry groups (DIGs).] The offeror represents as part of its offer that it
[ ] is, [ ] is not an emerging small business.

(ii) [Complete only for solicitations indicated in an addendum as

one of the targeted industry categories (TICS) or four designated -
industry groups (DIGS).]Offeror represents as follows: ;I
(A) Offeror's number of employees for the past 12 months
Employees column if size standard stated in the solicitation is exdressed
1
in
terms of number of employees); or II
I
(B) Offeror's average annual gross revenue for the last 3 fiscal ye+rs
(check&e Average Annual Gross Number of Revenues column i( size
standard stated in the solicitation is expressed in terms of annual receipts).
1
.2.--.A... -.. .-.,- (Check one of the following):

i
Number of Employees Average Annual Gross Revenues_
I

I -71
/
1
--
-
-
-
-
- 50 or fewer 1 - $1 million or less 1 I/
iI
:
i -
51-100 1 -$1,000,001-$2 million 1 - 1 . ..
..

i- - . 101-250 1 -$2,0.00,001-$3.5million /I --
. . ..

-25 1-500
!

I
( - $3,500,001-$5 million
1
1(I
i. - 501-750 1I - $5,000,001-$lo million I
.
I
'
.
- 751-1,000 iI - $10,000,001-$I7 million 1
I
1
;. -Over 1,000 !, -Over $17 million 1
'f-
1
- 1 1It
/I
/I
( 9 ) [Complete only zfthe solicitation contains the clause at FAR 52.219-
23, Notice of Price Evaluation Adjurtment for Small ~ i s a d v a n t a ~ e ~ b
I
Business Concerns, or FAR 52.219-25, Small Disadvantaged Business
Participation Program-Disadvantaged Status and Reporting, and !he I

offeror desires a benefit based on its disadvantaged status.] (1

/I
,I

;
(i) General. The offeror represents that either- \
Yi
 RFQ - 04T0000 12
pag+ 11 o f 1 8

I
(A) It [ ] is, [ ] is not certified by the Small Business Administration as a
1
small disadvantaged business concern and identified, on the date of this
representation, as a certified small disadvantaged business concerh in the
database maintained by the Small Business Administration ( P R O ~ N ~ ~ ) ,
and that no materialchange in disadvantaged ownership and control 'I has
occurred since its certification, and, where the concern is owned dy one or
more individuals claiming disadvantaged status, the net worth of each
individual upon whom the certification is based does not exceed $,750,000
after taking into account theapplicable exclusions set forth at 13 CFR
124.104(~)(2);or 1
(B) It [ rhas, ] has noGubmitted a completed applicati~nto tESmall i --
~ ; s i n e s~dministration
~ or a Private Certifier to be certified as a $mall
disadvantaged business concern in accordance with 13 CFR 124, Subpart
B, and a decision on that application is pending, and that no mate4al
change in disadvantaged ownership and control has occurred sinc: its
application was submitted. i
I/
(ii) [ ] Joint Ventures under the Price Evaluation Adjustment for small
D i s d _ntagedBusiness Concerns. The offeror represents, as
P
offer, t at it is a joint venture that complies with the
13 CFR 124.1002(f) and that the representation in paragraph (c)(9)(i)
of this provision is accurate for the small disadvantaged business /
iiiriiem thaf is participating in the joint venture. [The offeror shalljenter
the name of the small disadvantaged business concern that is
participating in the joint venture: ...r -1 1,
.- ---
(10) HUBZone small business concern. [Complete only ifthe offeibr
I
- represented itself as a small business concern in paragraph (c)(l) I,of
this provision.]
-- The offeror represents, as part of its offer, that- 1 -
'7 - -

(i) It [ ] is, [ ] is not a HUBZone small business concern listed, on the

I
date of this representation, on the List of Qualified HUBZone Small
Business Concerns maintained by the Small Business Administrati
no material change in ownership and control, principal office, or
HUBZone employee percentage has occurred since it was certi
the Small Business Administration in accordance with 13 CER p
and
(ii) It [ ] is, [ ] is not a joint venture that complies with the requ
of 13 CFR part 126, and the representation in paragraph (c)(10)
provision is accurate for the HUBZone small business concern
that are participating in the joint venture. [The offeror shall enter the name
or names of the HUBZone small business concern or concerns thatiare
I

participatzng in thejoint venture: .I I

1
,I

I
i
1
 I
I

RFQ - 0 4 ~ 0 0 0 102
pag&12 of 18
Each HUBZone small business concern participating in the joint venture I
I/
shall submit a separate signed copy of the HUBZone representation.
il
(d) Representations required to implement provisions of Executive 0rde4 11246-

(1) Previous contracis and compliance. The offeror represents that- I

. .

(i) It [ ] has, [ ] has not participated in a previous contract or subcontract il

subject to the Equal Opportunity clause of this solicitation; and 1
(ii) It [ ] has, [ ] has not filed all required compliance reports.
, -
(2) ~ f i + a t i v- e Action Compliance. The offeror represent~lhat---
*- 1 -
--

(i) It [ -1 has developed and has on file, [ ] has not developed and Foes not 1
have on file, at each establishment, affirmative action programs required
by rules and regulations of the Secretary of Labor (41 CFR parts 60-1 and
60-2), or 1
/I
(ii) It [ ] has not previously had contracts subject to the written affirmative
acticm~ograrnsrequirement of the rules and regulations of the se.kretary
of Labor,
--
(e) Certificat~onRegard~ngPayments to Influence Federal Transactions (31 U.S C 13512).
I
(Applies-CiTy if the' contract is expected to exceed $100,000.) By submission of
/I
its offer, the offeror certifies to the best of its knowledge and belief that no
Federal appropriated funds have been paid or will be paid to any prson fir- - =
'I
influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress or an employeelof a
Member of Congress on his or her behalf in connection with the award ofiany
resultant contract.
-
< - - I *- i-

il
(9 BUY American ~ cCertificate.
t (Applies only if the clause at Federal ~ c ~ u i s l t i o n
Regulation (FAR) 52.225-1, Buy American Act-Supplies, is included in
solicitation.)

(1) The offeror certifies that each end product, except those listed in
1
paragraph (f)(2) of this provision, is a domestic end product .and that the
1
offeror has considered components of unknown origin to have been
mined, produced, or manufactured outside the United States.
The offeror shall list as foreign end products those end products
11
manufactured in the United States that do not qualify as domestic end
products. The terms "component," "domestic end product," "end p:oduct,"
i
"foreign end product," and "United States" are defined in the clause of this
solicitation entitled "Buy American Act-Supplies." i
I
 (2) Foreign End Products:

[List as necessary]

(3) The Government~wi~~-evaluate

offers in accordance with the policies
I --
..- 4.-
and procedures of FAR Part 25. - .~ -
::
: .

1
(g)(l ) Buy Anterican Act-Free Trade Agreements-Israeli Trade Act Certhcate.
(Applies only if the clause at FAR 52.225-3, Buy American Act-Free Trade
Agreements-Israeli Trade Act, is included in this solicitation.) !
II/
(i) The offeror certifies that each end product, except those listed in
par?p?ph (g)(l)(ii) or (g)(l)(iii) of this provision, is a domestic ebd
p r o d ~ a n dthat the offeror has considered components of u n k n o h origin
to have been mined, produced, or manufactured outside the unites States.
The terms "component," "domestic end product," "end product," "foreign
endproduct," and "United States" are defined in the clause of this/
solicitation entitled "Buy American Act-Free Trade ~greements-1braeli
Trade Act." -- - -- - -I
(ii) The offeror certifies that the following supplies are FTA c o u n b end
1
..
products or Israeli end products as defined in the clause of this sol'icitation .-. .
entitled "Buy American Act-Free Trade Agreements-Israeli Trade1( 'I Act":
-..- . .. .. 1/I
..- ' - .. - . -
.--

FTA Country or Israeli End Products: 1

[List as necessary].
. . II
1
I
(iii) The offeror shall list those supplies that are foreign end 1
I

products (other than those listed in paragraph (g)(l)(ii) of this pro~ision)

as defined in the clause of this solicitation entitled " B UAmerican!
~ Act-
 Free Trade Agreements-Israeli Trade Act." The offeror
foreign end products those end products manufactured in the ~ d t e States
d
that do not qualify as domestic end products.

Other Foreign End Products:

[List as necessary]

(iv) The Govemhent will evaluate offers in accordance with the policies
1
I)
and procedures of FAR Part 25. /I
I
(2) Byy American Act-Free Trade Agreements-Israeli Trade Act Certificate, Alternate I
(Jan 162).If Alternate I to the clause at FAR 52.225-3 is included in this
solicitation; substitute the following paragraph (g)(l)(ii) for para*aph '
(g)(l)(ii) of the basic provision:
:.-.-..,..
.+ ..,+
1
I
1
(g)(l)(ii) The offeror certifies that the following supplies are Canadian edd
products as defined in the clause of t h s solicitation entitled " ~ u ~ . ~ m e r i fAct;
ian
Free Trade Agreements-Israeli Trade Act": 1It
li
II/
- ..
Canadian End Products:
- l

iI
I
I
I
I
I
--/
I
[L~stas necessary] 1
1
(3) Buy American Act-Free Trade Agreements-lsraelr Trade Act Certificate, A(ternate I1
(Jan 2004). If Alternate I1 to the clause at FAR 52.225-3 is included in this
solicitation, substitute the following paragraph (g)(l)(ii) for para6aph
I
(g)(l)(ii) of the basic provision: I
,
1,
I
 RFQ - C '0000 12
Pai 15 of 18
(g)(l)(ii) The offeror certifies that the following supplies are Canadian c
products or Israeli end products as defined in the clause of this solicitati entitled
"Buy American Act-Free Trade Agreements-Israeli Trade Act":

Canadian or Israeli End Products:

- -

a
-
. ~
. .

[List as necessary]

( 4 ) Trade Agreements Certificate. (Applies only if the clause at I R

52.225-5, Trade Agreements, is included in this solicitation.)

(i) TJe offeror certifies that each end product, except those listec
para'ghljlh (g)(4)(ii) of this provision, is a U.S.-made, designated
Caribbek Basin country, or FTA country end product, as define
clause of this solicitation entitled "Trade Agreements."
-*-r* -.4 -
(ii) The offeror shall list as other end products those end product lat are
not U.S.-made, designated country, Caribbean Basin coun&y, or 'A - -
country end products.

Other End Products:

[List as necessary]

(iii) The Government will evaluate offers in accordance with the llicies
and procedures of FAR Part 25.
For line items subject to the Trade Agreements Act, the Governr It
will evaluate offers of U.S.-made, designated country, Caribbear asin
country, or FTA country end products without regard to the rest tions of
the Buy American Act.
 /I
The Government will consider for award only offers of U.S.-made,
designated country, Caribbean Basin country, or FTA country end
products unless the Contracting Officer determines that there are ho offers
for such products or that the offers for such products are
fulfill the requirements of the solicitation.

(h) Certfication Regarding Debarment, Suspension or Ineligibilrqfor ~ i v a r d

1
(Executive Order 12549). (Applies only if the contract value is expected to exceed
the simplified acquisition threshold.) The offeror certifies, to the best of
knowledge and belief, that the offeror and/or any of its principals-

(1) [ ] Are, I ] are not presently debarred, suspended, proposed for

I
--
debarment, or declared ineligible for the award of contracts by any'I Federal
agency; and- --
!
(2) [ ] Have, [ ] have not, within a three-year period preceding this offer,
been convicted of or had a civil judgment rendered against them for:
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a Federal, state or local goveniment
I
contract or subcontract; violation of Federal or state antitrust statutes
r e l a t w o the submission of offers; or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, makhg false
statements, tax evasion, or receiving stolen property; and
(3) [ ] Are, [ ] are not presently indicted for, or otherwise
I
cGfly chaeed by a Government entity with, commission of any
offenses.
-.-

(i) Certification Regarding Knowledge of Child Labor for Listed End

Products (Executrve Order 13126). [The Contracting Officer
- paragraph (i)(l) any end products being acquired under this
solicitation that are included in the List of Products Requiring - - -
~ertfi&tionas to Forced or Indentured Child Labor, unless
tractor A

excluded at 22.1503(b) .]
. ,

(1 ) Listed end products.

1
I I
-d
1

(2) Certfication. [Ifthe Contracting Ojficer has identljied endpro~ucts

and countries of origin in paragraph (i)(l) of this provision, then the
oferor must certrfi to either (i)(2)(0 or (i)(2)(ii) by checking the j:
appropriate block.] 11
1I
i
I
I
 RFQ - 0 4 ~ 0 0 0 12
0
Page 17 of 18
!I
[ ] (i) The offeror will not supply any end product listed in parag$aph
(i)(l) of this provision that was mined, produced, or manufacturedr in the
corresponding country as listed for that product. I
iI
[ 1 (ii) The offeror may supply an end product listed in paragraph/(i)(l) of
this provision that was mined, produced, or manufactured in the 1
corresponding country as listed for that product. The offeror certifies that
it has made a good faith effort to determine whether forced or indkntured
child labor was used to mine, produce, or manufacture any such ehd
product furnished under this contract. On the basis of those
offeror certifies that it is not aware of any such use of child

2. P.L. 103-227 THE PRO-CHILDREN ACT OF 1994 CERTIFICATION 1 -

R E G ~ I N G EN\~@ONMENTAL TOBACCO SMOKE -[

I

1
Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), *quires
that smoking not be permitted in any portion of any indoor facility owned or
leased or contracted for or by an entity and used routinely or regularly fo? the
provision of health, day care, early childhood development services, educ,ationI or
library services to children under the age of 18, if the services are funded by
grant, contract,' loan, or loan guarantee.
,
Federal p r o g r F s either directly or through State of local governments, b$ Federal
!I
The law also-applies to children's services that are provided in indoor facilities
that are constructed, operated, or maintained with such Federal funds. T& law
does nof~~~j5Tyto~Children's services provided in private residences; porti&nsof
facilities used for inpatient drug or alcohol treatment; service whose
sole source of applicable Federal funds is Medicare or Medicaid; -mfaciEties---=
where WIC coupons are redeemed. I
Failure to comply with the provisions of the law may result in the imposition of a
civil monetary penalty of up to $1000.00 for each violation andor the irndosition
-. - - -
of an administrative compliance order on the responsible entity. 1I11
1
By signing this certification, the offeror/contractor (for acquisitions) or I
applicant/grantee (for grants) certifies that the submitting organization wi1,l
1
comply with the requirements of the Act and will not allow smoking within any
portion of any indoor facility used for the provisions of services for childrkn as
'I
defined by the Act. ._..
1I
(1
The submitting organization agrees that it will require that the language of this
certification be included in any subawards which contain provisions for children's
services and that all subrecipients shall certify accordingly. :I
1
 I
RFQ - 04T000012
pagk 18 of18
;I
[ ] The following certification to be completed bv the Offeror:
(The Representations and Certifications must be executed by an
individual authorized to bind the Offeror.)

The Offeror makes the following Representations and Certifications as I

part of its proposal. 1
- -
II
(Name of Offeror)

--
(Signatufe of- Authorized Individual)

(TypedlPrinted Name of Authorized Individual)

Note: The penalty for making false statements in offers is prescribedl in 18

 il
ORDER FOR SUPPLIES OR SERVICES /I PAGE OZ PAGES
I
b.dPORTANT: Mark all packages and papers with contract andlor order numbers 11 I ! -
1 DATE OF ORDER 2 CONTRACT NO (If
any) 6 SHIP TO 1
09/29/2004 a NAME OF CONSIGNEE I
3. ORDER NO.

HHSP233200400828P I Ii
5 l5SUlNG OFFICE (Adhess correspondence lo)
DHHS/PSC/SAS/DAM
b STREET ADDRESS
233 N. MICHIGAN AVE, SUITE 1300 1
I
P W W N BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857
- - c ClTY
CHICAGO
I IL d STATE e ZIP CODE

) 60601
7 TO: DIA SATORI I.SHIP VIA
a NAME OF CONTRACTOR
SATORI AND ASSOCIATES
LI WPE OF ORDER jl
b COMPANY NAME 7 l
E a PURCHASE , b DELIVERY =
c STREET ADDRESS
5921 DUPONT AVENUE S
- REFERENCE YOUR
(I
~xcebl frr blrllng ~nsrruca*-s on the
- /-
Quote Attached -
.-
-
. &% debve~ crder 1s
sub&cl lo ,nslrucllw m b l n e d on
ths sjde only d ttus l a m and 0s
Please furnish the fdlamng cn the terms ~ssuebsubect to me terms and
and cmdlbms speofied m both s~desof condtbm 01me abovenumbered
STATE CODE . t h s wder and on the attached sheets, d mtract
d ClTY
any. lndudlng dellvery as lndraled 1
I
MINNEAPOLIS MN 55419-2110
9 ACCOUNTMG AND APPROPRIATIONS DATA 10 REQUISITIONINGOFFICE

7540120 HHS/OPHS/OWH/REGION v

D a. SMALL
..
1 1 BUSINESS CLASSIFICATION (Check a ~ ~ r. o ~ nbox(esJJ
ale
,g L b . OTHER THAN SMALL C. DISADVANTAGED
- i1l
1 d. WOMEN-OWNED

12. F 0 . B POINT Destination 14. GOVERNMENT BRMO. 15. D E L M R TO F.0.8 POINT i 6 . OISCOUYT T E ~ M S

.. - ON OR BEFORE (Dale) 1 . -
13 PLACE OF
Net 30
a INSPECTION b ACCEPTANCE
Destination 1DestinUn .- ...., I I /I . - . . . .. -- .
17. SCHEDULE (See rwerse lor Rqeu~ons) 1
ITEM NO. SUPPLIES OR SERVICES .,
QUANTITY
ORDERED UNIT
UNK
PRICE
. --AMoum-l /I
- -..-
=
QUANTITY
ACCEPTED
(a) IC) (d) (el (1) /! (9)
Tax ID Number:
DUNS Number:
d .
b;' ~ ...
Questions concerning this order should be referred to Gene Calvert at (301)--443-7C77.
.- -- .. ~. jJ - --
PLEASE REFERENCE PAGES 1 THROUGH 6 OF THE ATTACHED STATEMENT OF WO:<K TITLED ""FFICE
0
!i
Continued . . . i
I
18. SHIPPING POINT 19. GROSS SHIPPING WElGKT 20 INVOICE NO
1 I
17(h)
TOTAL
(Con!.

21. MAIL INVOICE TO

I pages)

a. NAME
SP_,.?S5.~OO
I 4
SEE BILLING
PSC/FMS (301) 443-3020 /I
INSTRUCTIONS b STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12 I
O N REVERSE
5600 FISHERS LANE I
(or P O BOX)

j1
170)
GRAND
TOTAL
/I
c. CITY

ROCKVILLE
d STATE

M D
e. ZIP CODE
20857
$4,985.00
il
I
4
It
22. UNITED STATES OF AMERICA 23 NAME (Typed)

BY (Signature) JACQUELINE R. JONES

i;!
TITLE: CONTRACTINWORDERINGDFF~CER;~
NSN 7540D1.152-8083 !OPTIONAL FORM 147 (Rrr

PREVIOUS EDITION NOT USABLE D* Oswm (a~ R Y J2l24.j

;I
I
/I
II
!
 ORDER FOR SUPPLIES OR SERVICES
I
P A ~ EOF PAGES
SCHEDULE CONTINUATION -
IMPORTANT: Mark all packages and papers mlh conlrad and/or a d e r numbers I
DATEOFORDER CONTRACTNO ORDER NO 1
09/29/2004 1 I~~~~23320040082~~
ITEM NO SUPPLIEYSERVICES QUANTITY UNIT UNm AMOUNT QUANTIT,
ORDERED PRlCE ACCEPTED
(A) (8) (C) (Dl (E) (F) IG)
ON WOMEN'S HEALTH, REGION v - HEART TRCTH CAYPAIGN, FOR SCOPE OF WORK, INVOICING
PROCEDURES, AND TERMS AND CONDITIONS REGARDI'JG THIS E 'FORT.
CAN: 1990110 FY: 2004 --
1
1
Period of Performance: 09/30/2004 to 09/29/2305

The Contractor shall provide support ~n

promoting the "Heart Truth Campalgnu In
1 LT 4,985.00 4,985 00
I
accordance wlth the attached Statement of I
Work tltled "Office on Women's Health, Reglbn V - - Heirt Truth Cam>algn." I
[
Proposed fee is detailed as follc,=. I

Event Coordinator .. --
Transporatlon & Parklng --
Postage --
Supplies --

I Total

Project Officer:
- - $4,965.00
.-

Michelle Hoersch
Phone: (312) 353-8122,+,>.--
= , .., .

1. INVOICE INFORMATION

NUMBER) OR SOCIAL SECURITY NUMBER.

.-

FEDERAL ACQUISITION REGULATION (48 CFR CHAP

t R 1)

FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS

REGISTRATION (OCT 2003)
TSFE

TOTAL CARRIED FORWARDTO 1ST PA

NSN 754001-152-8082 50348-101
 ~~~~23320$008?8~
Page 1 of 6
1
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVIC!ES
OFFICE ON WOMEN'S HEALTH - REGION V 1
STATEMENT OF WORK
I:
I. PROJECT TITLE: Office on Women 's Health, Region V - Heart Truth
I
Campaign
I
11. BACKGROUND: The Office on Women's Health (OWH) is the focal +nt for
women's health within the Department of Health and Human Services (HHS).
The OWH, under the direction of the Deputy Assistant Secretary for ~ e a l / h
(Women's Health), improves the health and well-being of women across the
lifespan by coordinating women's health programs, promoting health edu&tion --

and disease prevention, and leading efforts and fostering partnerships to eliminate
health disparities. 1
The Heart Truth Campaign, sponsored by the National Heart, Lung, and $lood
I/
Institute (NHLBI) and partner organizations is intended to make women more
aware of the danger of heart disease. The campaign's goal is to give womdn a
personal and urgent wake-up call about their risk of heart disease. The caApaign
.+'...
is especiallye-d at women ages 40 to 60, the time when a woman's risk!of
'I
heart disease starts to rise. But its messages are also important for younger
women, sinceheart disease develops gradually and can start at a young a g1 e ~ v e n
-
in the teej-a~eyears..- Older women have an interest too-it's never too late!to take
action to prevent and control the risk factors for heart disease. Even those b h o
have heart disease can improve their heart health and quality of life.
. -
- - --
- I
1 - -

'I
111. PURPOSE: The purpose of this contract is to provide contractor support [o help
promote the Heart Truth Campaign by coordinating a series of activities in the
-.
Mimeapolis/St. Paul area. These events will include a symposium on wo4en and
heart disease and the Heart Truth Campaign for health care providers, and training --
on the Heart Truth Speakers Kit for lay women from community-based I
'I
organizations. The participants will be taught how to use the speakers' kit fnd
they will then be expected to do presentations in their respective communities.
'I

IV. PEFUOD OF PERFORMANCE: The Period of Performance shall be from the

B
September 29, 2004 through September 30, 2005.
... I

V. TYPE OF CONTRACT: This is a Firm, Fixed-Price purchase order.

VI. - DELIVERABLES AND TIMEFRAME: The Contractor shall work in (

collaboration with the Project Officer (PO) to create the referenced Heart Truth
Campaign
- - events. This will include convening and planning conference calls,
coordinating logistics, identifying other potential partners and sponsors and
managing all aspects of the events. i
 1
To ensure coordination with the goals and policies of the Office on Women's
Health and the Department of Health and Human Services, the Contractor1 shall
provide regular progress reports to the PO and shall submit all proposed {vritten
materials to the PO for appropriate Departmental clearances. I
The Contractor shall coordinate with the PO of this effort and provide theI
following services and deliverables: I
Symposium for health care providers; I)
Contact organizations and companies to identify additional partners akd
It
sponsors;
Coordinate all volunteers and committee activities and keep all partners I
informed of progress and time line; I/

Convene weekly meetings via conference call; _ _ II- ;I-

a
Act as local contact in Minneapolis for the Region V OWH staff;
Establish timeline and assign responsibilities as appropriate;
/
/I

il
a Develop and implement marketing and media efforts;
a Coordinate logisticsfor symposium/training;
1
Regular project updates with timeline, logistics and partner confirmations;
A partner roster;
I
1
Use netyo& connections for maximize community involvement;
a- j
Contract with vendors to supply services and equipment as needed, such as,..
but not limited to, the following: i
o Audio visual . -- ..:
o MSEfials-pieparation - .

o Speakers
.. ---
- - - -
o Training kits .. I
On-site coordination for the events;
I
a

Speaker's training kits;

a -Post-event summary report. - j 1
- -- IL/ - - --
The due dates and delivery methods for these deliverable~are to be 1'
determined following the award of this effort.

VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized agent of the

iI
Contracting Officer is responsible for the review and acceptance of all
deliverables.
. .. 1

VIII. PAYMENT SCHEDULE: The Contractor shall submit a proper invoick for
services performed related to the first planning conference call, submissic!:n of
- partner roster, and confirmation of the venue's logistics to the PO within P o
weeks of the PO'S acceptance of those deliverables. The Contractor shalllsubmit
a proper invoice for the balance of the proposed fee within two weeks of (he PO'S
!
acceptance of the completed event and post-event summary. ,I
(I
IX. INVOICE SUBMISSION: Upon inspection and acceptance of the delkerables
described in Section VI., the Contractor shall submit an original and two
I
copies of its proper invoices to the PO. For payment, the PO shall submit; the
invoice and a signed receiving report to:
I
I

Department of Health & Human Services 1

PSCFinancial Management Service
Division of Financial Operations I
I
Parklawn Building, Room 16A-12 ,
5600 Fishers Lane
Rockville, Maryland 20857
Telephone: (30 1) 443-3020 I --
.. . .. . - - . . - i l -

The invoice must contain the following minimum information: -7; ..

:I
Contractor's name and address; !I
1
Purchase order number; 1
1
Description
-a and price of services provided;
- <=:: (I
Invoice period; and
j
T-heCmtractor's Internal Revenue Service (IRS) Taxpayer Identification
Number. 1
.---
I)
7-
X. GOVERN~~ENT-FURNISHED MATERIALS: The Guvrnlrncn~willlnot

XI.
hrnish any materials to the Contractor for this requirement. !I

RIGHTS TO DATA: The Contractor is prohibited from using data prodiked or

I ..
--
:.-..

obtained underthis contract for any purpose without prior, written .appro<al--from ~- --.

4
the PO.
!I
XII. TECHNICAL MONITORING:

A. Performance of the work under this purchase order shall be subjeci to the
technical monitoring of the Project Officer. The term "Technical I
'I
Monitoring" is defined to include, without limitation, the following:

1.
I
Technical directions to the Contractor, which redirect the purchase
order effort, shift work emphasis between work areas or taAks,
require pursuit of certain lines oiinquiry, fill in details or 1
otherwise serve to accomplish the contractual scope of w o ~ k .
1
I
2. Providing information to the Contractor for assistance in tl
interpretation of drawings, specifications or technical port
the work description.

3. Review and, where required by the purchase order, appro\

technical reports, drawings, specifications and technical
inhrmation to be .delivered by the Contractor to the Gove~ ment
under the purchase order.

Technical direction must bewithin the general scope of work statc in the
purchase order. The Project Officer does not have the authority tc ind -.
may not issue any technical direction which (i) constitutes an ass] lment --
of additional work outside the general scope of the purchase o r b ti;) . -
-. .

constitutes a change as defined in the purchase order clause entitlc 3

"Changes;" (iii) causes, in any manner, an increase or decrease in le total

estimated purchase order cost, the fixed fee or the time required fi
purchase order performance; or (iv) changes any of the expressed
conditions, or specifications of the purchase order.

All technical direction shall be issued in writing by the Project

0ffi$@%r shall be confirmed by himher in writing within 5
w o r k i n ~ d a y safter issuance.

The_~~,ontra~torshall proceed promptly with the performance of

technical direction duly issued by the Project Officer in the mannl
prescribed by this clause and within hisher authority under
.. .--
the
provisions of this ciause.

If, in the opinion of the Contractor, any instruction or direction is!

the Project Officer is within one of the categories as defined in (i)
(iv) above, the Contractor shall not proceed but shall notify. the
Contracting Officer in writing within 5 working days after the rec
any such instruction or direction and shall request the Contractin!
to modify the purchase order accordingly. Upon receiving such
notification from the Contractor, the Contracting Officer shall iss'
appropriate purchase order modification or advise the Contractor
writing that, in hisher opinion, the technical direction is within tl- scope
of this clause and does not constitute a change under the Changes llause
of the purchase order. The Contractor shall thereupon proceed
immediately with the direction given. A failure of the parties to
agree upon the nature of the instruction or direction or upon the p chase
order action to be taken with respect thereto shall be subject to thc
provisions of the purchase order clause entitled "Disputes."
XIII. POINTS OF CONTACT:

The Project Officer (PO) for this effort is:

Ms. Michelle Hoersch, M.S.

Office on Women's Health
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago, Illinois 6060 1
Phone: (3 12) 353-8122
Fax: (3 12) 353-7800
Email: mhoersch@osophs.dhhs.~ov
- v-

The Contracting Officer (CO) for this effort is:

Ms. Jacqueline R. Jones

Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5-101
5600 Fishers Lane
Rockville, NfQ52085 7
Phone: (301) 44.3-6413
Fax: (301) 443-8488
.s=-,-. . -.. ... ,-
The Contract Specialist for this effort is:
- -- -
Mr. Gene H. Calvert
Program Support Center
Phone: (301) 443-7077

XIV. FAR 52.252-2.GLAUSES INCORPORATED BY REFERENCE (FEI

This contract incorporates one or more clauses by reference, with the sarr force
and effect as if they were given in full text. Upon request, the Contracting )fficer
will make their full text available. AIso, the full text of a clause may be ac essed
electronically at thisithese address(es): http://\\ww.arnet.ov/far.

The following FAR contract clauses are incorporated by reference:-.'

' -
No. CLAUSE NO. TITLE AND DATE

1. FAR 52.204-6 - Data Universal Numbering

System (DUNS) Number
(OCT 2003)
2. FAR 52.204-7 Central Contractor Registrat
(OCT 2003)
 ~~~~233206400828~
R
Page 6 of 6
I
-
No. CLAUSE NO. TITLE AND DATE

3. FAR 52.212-1 Instructions to Offerors - I

Commercial Items (JAN 2064)
4. FAR 52.212-4 Contract Terms and ~ o n d l t i b n -
s
Commercial Items (OCT 2003)
5. FAR 52.222-3 Convict Labor (June 2003) I 1
6. FAR52.222-19 Child Labor-Cooperation uri:)h

7. FAR' 52.222-21
Authorities and Remedies
(June 2004) 1
Prohibition of Segregated ~acilities .-

8. . FAR.-52222-26
(Feb 1999).
Equal Opportunity (Apr 2QQ.Q
1 --

9. FAR 52.223-6 Drug Free Workplace (MA$ 2001)

10. .FAR 52.225-1 Buy American Act-Supplies1
(June 2003) h
11. FAR 52.2.25-13 Restrictions on Certain Foreign

12.
13.
-,
;
.+'
FAR 521232-1
FAR 52.232-33
-L
Purchases (JUN 2003)
Payments (APR 1984)
Payment by Electronic Funds
Transfer-Central Contractor
i
Registration (Oct 2003)
14. -'. FAR 52.233-1 Disputes (JUL 2002)
15. ..Ad-. ...FAR
...- 52.233-3 i
Protest After Award (AUG 996) -
I
--
ORDER FOR SUPPLIES OR SERVICES
.- I PAGE OF PAGES

IMPORTANT: M a r k all p a c k a g e s a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e n /I 2

1 DATE OF ORDER 2 CONTRACT NO (Ifany) 6 SHIP TO /j
09/29/2004
3. ORDER NO. 4. REQUlSlTlONlREFERENCE NO.
a NAME OF CONSIGNEE
I
HHSP233200400832P 04T000014
Y

5 ISSUING OFFICE {Address correspondence to) b STREET ADDRESS I

DHHS/PSC/SAS/DAM 233 N. MICHIGAN AVE, SUITE 1300 'I
PARKLAWN BUILDING, ROOM 5- 101 1
11
-
5600 FISHERS LANE
ROCKVILLE MD 20857
c CITY d STATE e ZIP COPE
-
CHICAGO IL
1 60601
f SHIP VIA /I
7 TO DIA SATORI
a NAME OF CONTRACTOR
BLACK HEART, INC
I
8 TYPE OF ORDER '1
b. COhqPANY W M E
Ea PURCHASE I r
b? DELNERY
c STREET ADDRESS REFERENCE YOUR: --
~xceaf t mbrlltng lnslructlons m Ihe .
3010 HENNPIN AVENLTE S .. T- Quote Attached .
:-
rew?e. this delbery crder 4s
SUITE NO. 121 Subjecd to !nSlNdlonS conlalned on
th~sSjide only 01t h ~ sI- and Is
Please furnish h e f d l m n g on the terms sssueb subject l o h e terms and
and condllims speofied m both sides d ~ M d l l l m S01 the acme-numbered
Lhis Order and on lbe anached sheets, il cmtract
d. CITY e. STATE !.,ZIP CODE
MINNEAPOLIS MN 55408-2641
any. ~ndudingdellvery a5 indicated
1
9 ACCOUNTING AND APPROPRIATIONS DATA 10. REQUISITIONING OFFICE

,
7540120 HHS/OPHS/OWH/REGION V
- -

11. BUSINESS CLASSIFICATION {Check appmpriale Dox(es))

a a. SMALL %&%. OTHER THAN SMALL c DISADVANTAGED , - ( d WOMEN-OWNED

12 F o B POINT Destinatlon - .' 114 GOVERNMENTB/UNO 15 DELIVER TO F 08 . POINT l 6 DISCOUW TERMS

O N OR BEFORE (Dale)
I 3 PLACE OF
Net 30
a INSPECTION
Destlnation
b ACCEPTANCE
Destin.2TT"o.fi-.'
--' -
-i
- - -

17 SCHEDULE (See reverse lor Rejeclrons)

I
ITEM NO SUPPLIES OR SERVICES
I
QUANTITY
ORDERED UNIT
UNIT
PRICE
.- - AMOUNT
.- - - QUANTITY
ACCEPTED
ia) (b) (c) (d) (el (0 (g)

472700738
I -..

Questions concerning thls order should be re

-.-

PLEASE REFERENCE PAGES 1 THROUGH 6 OF THE AT

Continued . . .
.. ..

18. SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20. INVOICE NO.

I '7(h)
TOTAL

21. MAIL INVOICE TO

a NAME
PSC/FMS (301) 443-3020
SEE BILLING
INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or P.O. B ~ X ) 5600 FISHERS LANE

TOTAL

c CITY d STATE e ZIP CODE $4,975.00

I
ROCKVILLE MD 20857
ii
22. UNITED STATES OF AMERICA 23 NAME (Typed)
I

BY (Signature)

-
JACQUELINE R. JONES
TITLE: CONTRACTlNGlOROERlNG OFFICER
I,
,I
NSN 754&01-152-8083 OPTIONAL FORM 347 R
(.I 6351

PREVIOUS EDITION NOT USABLE R

-
I by GYIFbB((ICFRlS32131.)
1
 . .. ,
I
ORDER FOR SUPPLIES OR SERVICES P ~ G EOF DAGES

g
IMPORTANT: Man all packages and papers mth anvan and/a a d e r numbers i
DATE OF ORDER CONTRACT NO ORDER NO 1H
09/29/2004 HHSP233200400872P

1
ITEMNO SUPRIESISERVICES a u m m UNIT UNIT QUANTITY
ORDEREC PRICE ACCEPTED
(Dl (E) l"OYM
(F) 1G)
, MALL OF AMERIC.; VENUE" FOR SCCPE
!I
OF WORK, INVOICING PROCEDURES, AND TZRMS rIorrs REGARDING THIS EFFORT,.
CAN: 1050116 FY: 2004 i
!I
lThe Contractor shall provide support in
- ..

I 1 LT 4,975.00 4,975.00
1
Iprbrnoting the "Heart Truth Campaign" in I /I
!I
laccordance with the attached Statement of 1 I
Work titled "Office on Women's Health, He: rt Truth Carn:,aign, Mall/of
America Venue." 1

lThe proposed price is detailed as follows:

. , --
I 1
. , . . < .. . <-
. .
----
. . .. . - + .
~ I=.. ..

bS
Event Coordinator
Materials -.
AV Technician / Disc Jockey --
In-Town Transporation & Parking . -

otal - - $4,975. I

roject Officer: f t-
ichelle Hoersch \.*.
hone (312) 8122 --

29 INVOICE INFORMATION/CLAUSES
-r<-.-.*- -'i -
INCORPOW ID BY RE 'ERENCE

. INVOICE INFORMATION
N ADDITION TO THE INFORMATION.'REQUIRED BY E .232-!5 PROMPT PAYME IT), .YOUR &QI
k
KJST CONTAIN TEE FOLLOWING: TAX IDENTIFICATI m 3ER (EMPLOYER'S DENT1FICAT1;ON
'UMBER) OR SOCIAL SECURITY NUMBER. 1
11
II
. CLAUSES IflCORPORATED BY REFERENCE (FAR E .252-? ) ( 'EB 1998) I
'HIS CONTRACT INCORPORATES ONE OR MORE CLAWS ; BY ZEF :RENCE, WITH 'HE SAME FO+E
:FFECTAS IF THEY -WERE @WEN IN FULL TEXT. ?ON R 2QI: :ST,THE C O N ACTING OFFICER
[ILL MAKE THEIR FULL TEXT AVAILABLE. ALSO,
CCESSED ELECTRONICALLY AT THIS ADDRESS: H1
-IE:FU JL
? : //W J W .
'EXT OF A CLI ISE MAY BE
XNET .GOV/FAF I
. ..
'EDERALACQUISITION REGULATION (48 CFR CHAPl i 1) :LP

'AR 52.232-33 PAYMENT BY ELECTRONIC FUNDS 'I WSFE t - CENTRAL CON7 ACTOR
:EGISTRATION (OCT 2 003 )
. ..
'otal amount of award: $4,975.00. The oblige ion f )r his award is shown in box
7(i).

TOTAL CARRIEDFORWARD TO (STPAGE(ITEM

I~(H)) e
NSN 754G01-152-8082 nne-101 OPTIONAL FORM l48 (b6 9 5 )

!'II R . d bvGY
FAR ( I 8 CFRI %
213(c!
I

1
!I
 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE ON WOMEN'S HEALTH - REGION V
1a
STATEMENT OF WORK 1il
I. PROJECT TITLE: Office on Women 'sHealth, Region V - Heart Trzrth
1
Campaign, Mall of ~rnericaVenue. i
TI. BACKGROUND: The Office on Women's Health (OWH) is the focal
women's health within the ~ e ~ a r t m kof
n tHealth and Human Services (HYS).
The OWH, under the direction of the Deputy Assistant Secretary for Health
(Women's Health), improves thehealth and well-being of women across the
lifespan by coordinating women's health programs, promoting heiifih e d a ~ i o n
and disease prevention, and leading efforts and fostering partnerships to eliminate
health disparities. I
The Hean Truth Carnpai& sponsored by the National Heart, Lung, and ~ l l o o d
Institute W L B Q and partner organizations is intended to make women mbre
aware of the danger of heart disease. The campaign's goal is to give womek a
1
personal and urgent wake-up call about their risk of heart disease. The campaign
is especially"a~edat women ages 40 to 60, the time when a woman's risk pf
heart disease starts to rise. But its messages are also important for younger'
women, since-heart disease develops gradually and can start at a young agg-even 1
in the tee-years Older women have an interest too-it's never too late )totake -
action to prevent and control the risk factors for heart disease. Even those yI h o
have heart disease can improve their heart health and quality of l i f e =/ - = .-

111. PURPOSE: The purpose of this contract is to provide contractor support to help
i
promote the Heart Truth Campaign by coordinating a two-part event at the llMall
of America in the MinneapolisISt. Paul area. This Heart Truth event win include
an afternoon of-heart health screenings followed by a Red Dress Fashion Show; -
The Red Dress is the symbol for the Heart Truth Campaign. On an averagelday,
over 100,000 people pass through the Mall of America. By having Heart '1
Truth/Red Dress events in this high traffichigh visibility venue, we increaJe the
number of women we can screen for heart disease risk factors and the total/
number of individuals we can educate about women and heart disease. Further,
by having a high visibility event such as the Red Dress fashion show,
'r
- . .we increase
-11
the chances that the media will pick up on the story and further increase I'

awareness of women and heart disease. 1i

IV. -PERIOD OF PERFORMANCE: The period of performance shall be froh
September 30, 2004 through September 29, 2005. 1I
V. TYPE OF CONTRACT: This is a Firm, Fixed-Pnce purchase order. 1
I
!
VI. DELIVERABLES AND TIMEFRAME: The Contractor shall work i4
collaboration with the Region V Office on Women's Health Project 0fdcer (PO)
. il
to create these Heart Truth Campaign events. This shall include convening
planning conference calls, coordinating logistics, identifying other poteitial
partners and sponsors and manage all aspects of the events. To ensure
1
coordination with the goals-and policies of the Office on Women's Health and the
Department of Heakh and Human Services, Contractor shall provide reghar
progress reports to the Region V Office on Women's Health and submit ~ I I
'I
proposed written materials to the Office for appropriate Departmental clearances.
II
I

In coordination with the PO, the Contractor shall provide the following services
1 .
and deliverables:
.. , - .
. -

. - :.
-
. ..
-
1
11
./I
-.:.:
- .

Contact drganizations and companies to identify additional partners and .dponsors;

I/
Coordinate allvolunteers and -committee activities and keep all partners informed
of progress and time line;
Oversee the work of subcommittees to plan the screenings and fashion sdow;
!
Secure vendor to conduct cholesterol screenings;
Act as local contact in -Minneapolis for the OWH, Region V staff;
Function as a liaison with the Mall of America Community Relations
~oordinatoE ;.\'
Function as a liaison with Macy's department store;
Develop and-implement marketing and media efforts;
I
Coordirnebgistics for screenings and fashion show; 11

1
I
Use network connections in order to maximize community involvement;
Coordinate with vendors to supply services and equipment as needed, suc4:as,&ut
!I
not limited to, the following: i
0 Audio visual I
Materials preparation
Speakers
Floral, tfecoration, etc.
Gift bags
Health screenings
Fashion show
Music
Photography
Models
Speakers
Provide on-site coordination for the events; 1
Identify and coordinate advertising of events with a major media sponsor {either
broadcast or print); 6 '!Ii

Provide regular project updates with timeline and logistics confirmations as

,I
specified by the PO; I

Provide screening event at Mall of America; i

Coordinate and execute Red Dress Fashion Show at Mall of America {
 Provide program for the Red Dress Fashion Show;
Provide post-event summary report with data on screenings to PO.
j
The due dates and delivery methods for these deliverables are to be
determined following the award of this effort. !i
I
VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized adent of the
Contracting Officer is responsible for the review and acceptance of all
deliverables.

VIII. PAYMENT SCHEDULE: Within two weeks of acceptance by the PO for

1
services related to the confirmation of logistics with the Mall of America? -
securing pf the vend?! for cholesterol screenings and the d e l i v e w f fu&mgress
report, the contractor shall submit a proper invoice for those related services.
The Contractor shall submit a proper invoice for the balance of the propoked fee
within two weeks of the PO'S acceptance of the completed event and post-event
summary. I1/
IX. INVOICE SUBMISSION: Upon inspection and acceptance of deliverdbles,
I
the Contractor shall submit an original and two copies of its proper invoices to the
I
PO. For p a q q t , the PO shall submit the invoice and a signed receiving report
to:
Department of Health &: Human Services
.. 1
1
PSCFinancial Management Service 'I
1
.

Ev'sioiiof~inancialOperations
Parklawn Building, Room 16A-12
5600 Fishers Lane .. .-
.+ '-- I- 1 r .

Rockville, Maryland 20857 1

Telephone: (301) 443-3020
+, .. i

The invoice must - i

- - contain the following minimum information:
< .. .. >

1
. - -- .

Ij
Contractor's name and address; 1
I
I
. ..
Purchase order number;

Description and price of services provided;

1
... !I/
Invoice period; and 1
The Contractor's Internal Revenue Service ( R S ) Taxpayer Identification I
Number. 111
11
Y

X. GOVERNMENT-FURNISHED MATERIALS: The Government will iot

li
furnish any materials to the Contractor for this requirement.
!
XI. RIGHTS TO DATA: The Contractor is prohibited from using data produced or
obtained under this contract for any purpose without prior, written appro;al from
the PO.
I
;I
XII. TECHNICAL MONITORING:

A. Performance of the work under this purchase order shall be subje{t to the
technical monitoring of the Project Officer. The term "Technical 1
Monitoring" is defined to include, without limitation, the f~llowin"'~:

1.
I
Technical directions to the Contractor, which redirect the purchase.
order effort, shift-work emphasis between work areas or tasks,
require pursuit of certain lines of inquiry, fill in det.ails.0~1.- --
.-
othe-&se serve to accomplish the contractual scope of

2. Providing information to the Contractor for assistance

interpretation of drawings, specifications or technical
the work description.

3. Review and, where required by the purchase order,

r aechnical reports, drawings, specifications and technical
\:
mformation to be delivered by the Contractor to
-- under the purchase order.
I -. .

B. Ec%iEaStTirection must be within the general scope of work

purchase order. The Project Officer does not have the
may not issue.any technical direction which (i)
of additional work outside the general scope of the purchase order) (ii)
I/
constitutes a change as defined in the purchase order clause entitled,
. "Changes;" (iii) causes, in any manner, an increase or decrease in ihe total
estimated purchase order cost, the fixed fee or the time required
. ~
fo!... . - -
burchase order performance; or (iv) changes any of the expressed (ems,
-
I
conditions, or specifications of the purchase order. 1
I
1
I,

C. All technical direction shall be issued in writing by the Project 1

Officer or shall be confirmed by himher in writing within 5
working days after issuance.
11
- .. 1
I
D. The Contractor shall proceed promptly with the performance of
technical direction duly issued by the Project Officer in the manner
I
- prescribed by this clause and within hisher authority under the
provisions of this clause.
I
 I
If, in the opinion of the Contractor, any instruction or direction issued by
the Project Officer is within one of the categories as defined in (ijthrough
(iv) above, the Contractor shall not proceed but shall notify the 1
Contracting Officer in writing within 5 working days after the receipt of
any such instruction or direction and shall request the ~ o n t r a c t i n ~ \ ~ f f i c e r
to modify the purchase order accordingly. Upon receiving such 1
notification from the Contractor, the Contracting Officer shall issde an
appropriate purchase order modification or advise the Contractor in
writing that, in hisher opinion, the technical direction is within the scope
of this clause and does not constitute a change under the Changes
of the purchase order. The Contractor shall thereupon proceed
immediately with the direction given. A failure of the parties to
agree upon the nature ofihe instruction or direction or upo-Q.
ofder a i i o n t 6 b e takenwith respect thereto shall be subjeit
provis,ons of the purchase order clause entitled "Disputes."

XIII. POINTS OF CONTACT:

The Project Officer (PO) for this effort is:

Ms. MichelLg H-oersch, M.S.

Office on WO>&'s Health
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago,TWhois 6060 1
Phone: (312) 353-8122
Fax: (312) 353-7800
Email: rnhoersch@osophs.dhhs..ov

The Contracting Officer (CO) for this effort is:

Ms. Jacqueline=. Jones

Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5- 10 1
5600 Fishers Lane
Rockville, MD 20857
Phone: (301) 443-641 3
Fax: (301) 443-8488

The Contract Specialist for this effort is:

Mr. Gene H. Calvert

Program Support Center
Phone: (301) 443-7077
XIV. FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)
I
i
This contract incorporates one or more clauses by reference, with the saqe force
and effect as if they were given in full text. Upon request, the Contractink Officer
will make their full text available. Also, the full text of a clause may be abcessed
electronically at this/these address(es): http://www.arnet.~ov/far.
I
-
The following FAR contract clauses are incorporated by reference:
I
1
-
No. CLAUSE NO. . ... TITLE AND DATE
n
1. FAR 52.204-6 - -
- .
Data Universal Numbering j
System (DUNS) Number I - -7

(OCT 2003) I
Y
2. - FAR 52.204-7 Central Contractor Registration
(OCT 2003) 1
3. FAR 52.212-1 Instructions to Offerors -
Commercial Items (JAN 2004) !
4. FAR 52.2 12-4 Contract Terms and ~onditidns-
Commercial Items (OCT 2003)
Convict Labor (June 2003) 1
Child Labor-Cooperation wi\h
Authorities and Remedies
(June 2004) 1
Prohibition of Segregated Fadilities
(Feb 1999). 1
FAR 52.222-26 Equal Opportunity {Apr 2 0 d f - -- ;

FAR 52.223-5 Drug Free Workplace ( ~ ~ ~ 1 2 ~ 0 1 )

FAR 52.229-1 Buy American Act-Supplies I1
(June 2003)
FAR 52.225-13 Restrictions on Certain Foreign
1
--.. -
Purchases (JUN 2003)
FAR 52.232-1 Payments (APR 1984)
FAR 52.232-33 Payment by Electronic ~undsl
Transfer-Central Contractor 1
Reglstratlon (Oct 2003) 1
FAR 52.233-1 Disputes (JUL 2002)
FAR 52.233-3 Protest After Award (AUG 1q96)
 H
C:
ORDER FOR SUPPLIES OR SERVICES j( F'-:
7---

I
2;:;;

IMPORTANT: Mark all packages and papers w ~ t hcontract andlor order numbers 1 '
r DATE OF ORDER 2 CONTRACT NO (11 any) 6 SHIDTO 1
a NAME OF CONSIGNEE
09/29/2004
3 ORDER NO. 4 REQUISITIONREFERENCE NO

HHSP233200400837P )04T000016
I
5 ISSUING OFFICE (Address correspondence lo) b STREET ADDRESS
DHHS/PSC/SAS/DAM 233 N. MICHIGAN AVE, SUYTE
PARKLAWN BUILDING, ROOM 5-101
.-
I
I
I

5600 FISHERS LANE

I
ROCKVILLE MD 20857 . -
c CITY
CHICAGO
:/ d STATE e ZIP CODE
-

) IL 60601
7 TO DR. STEPHANIE COVINGTON f SHIP VIA 1
a NAME OF CONTRACTOR
CENTER FOR GENDER AND JUSTICE
.. I
8 TYPE O r ORDER /
b COMPANY NAME
- -
G a PURCHASE -lib DE,IVER\

c. STREET ADDRESS
.- ~.
..
. . . .--
REFERENCE YOUR. --
7946 IVANHOE AVENUE, #201B. . . . ... . .. -.- Quote Attached
sutject to instructtons contalnea on
thls/side only of lhcs form and IS
. . Please furnish the following on Ihe terms lssued subject to the terms and

d CITY
LA JOLLA
1 e. STATE I. ZIP CODE
and condit~onsspecified on bolh s~desof
l h ~ sorder and on the allached sheets. lf
any. lncludlng delivery as ~nd~cated.
cOnr'c:
co"h1110nsof lhe above-numbered
d

CA 92037
9. ACCOUNTING AND APPROPRIATIONS DATA
. - 10 REQUISITIONING OFFICE I
7540120 HHS/OPHS/OWH/REGION V 1
11 BUSINESS CLASSlilCATlON (Check appropriate box(es)i -!I1I
a. SMALL :":L@:~~b OTHER THAN SMALL fl c DISADVANTAGED E!il a WOMEN-OWNED
- -

12. F o B POINT Destination

..
. .
.. 14. GOVERNMENT BIUNO 15 DELIVER TO F o B POINT
ON OR BEFORE (Date)
) 16 DSCQUNT TERMS

13 PLACE OF
Net 30
a INSPECTION I b ACCEPTANCE
Des~ination Dest in*'orr- ...+
'
i - . . - - . A ? .

17. SCHEDULE (See reverse for Rejectrons) il

-)-
I
.. QUANTITY UNIT .:.- - AMo"-NT;i QUANTITY
ITEM NO SUPPLIES OR-SERVICES ORDERED UNIT PRICE ACCEPTED
(c) (d) tei (g)

..
DUNSNumber:
. :,.
Questions .ccecerning this order should be referred to Gene Calvert at (301) 443-7C77.
I
PLEASE REFERENCE PAGES-1-THROUGH 6 OF THE AT
WOMEN'S HEALTH, REGION V - - ISSUES OF INCARC
Continued . . .

1 1 8 SHIPPING POINT / 19 GROSS SHIPPING WEIGHT 2 0 INVOICE NO 171h)

TOTAL
(Con1
I I I pages)
24 MAIL INVOICE TO
1
a NAME PSC/FMS (301) 443-3020 . $5,995 .'b0
SEE BILLING
PARKLAWN BUILDING, ROOM 16A-12 /I
INSTRUCTIONS b STREET ADDRESS 5600 FISHERS LANE
ON REVERSE (or P 0 Box) ROCKVILLE MD 20857
I GRAND
i
!I
1TOTAL

-$5,995.00
I
c ClTY
Id
I
STATE 1
I
e. ZIP CODE

I
1/I
I
11
I
22 UNITED STATES OF AMERICA 23 NAME (Typed)
(I
BY (Signature)
b JACQUELINE R. JONES
1 TITLE CONTRACTINGIORDERING OFFICER
1
NSN 754C-01-152.8083 I OPTIONAL FORM 147 IRDW 6351

PREVIOUS EDITION NOT USABLE ~ ! s s m . a n ~ G148 r ~ ~53 Zlx.,

~ cFR)
 ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION -
IMPORTANT: Mark all packages and papers w ~ t hcontract andlor order numbers /
DATEOFORDER CONTRACTNO
09/29/2004
ORDER NO
HHSP233200400637P
t
ITEM NO SUPPLIESISERVICES QUANTI
ORDER
(A) is) (C)
INVOICING PROCEDURES, AND TERMS ANG CONDITICNS RE
CAN: 1050116 FY: 2004
Period of Performance: 09/30/2004 to 09/29/2005
Dellvery Location code: 60601F
HHS/OPHS/OWH/REGION v -
233 N. MICHIGAN AVE, SUITE 1300
CHICAGO Ii 60601
-
1 The Contractor shall provide training servic s
and materials in accordance-with the-attache
Statement of Work titled "Office on Women's
Health, -Region'V..:-. Issues bf-Incarcerated

IProposed price is detailed as follows:

Pre-Meeting Planning with OWH Region V

Materials on Trauma and Substance Abuse
men
i I I
sium."
I -- - .-.dl,=
I
.. . .

Planning and Preparation for t~heRegion

Project Officer: \-=.

a
.
-

+ It
Michelle Hoersch
Phone: (312) 353-8122

929 INVOICE II?@o-R"~A~I~~~-/cLAusEs

INCORPO ED BY RE

it
1. INVOICE INFORMATION
IN ADDITION TO THE INFORMATION REQUIRED BY 5 .232- 5
MUST CONTAIN THE FOLLOWING: TAX IDENTIFICATI N NUM ER
NUMBER) OR SOCIAL SECURITY NUMBER.

2. CLAUSES -INCORPORATED BY REFERENCE (FAR 5

THIS CONTRACT IKORFORATES ONE OR MORE CLAUS
EFFECT AS IF THEY WERE GIVEN IN FULL TEXT.
WILL MAKE THEIR FULL TEXT AVAILABLE. ALSO,
ACCESSED . ELECTRONICALLY
. AT THIS ADDRESS: H

FEDERAL ACQUISITION REGULATION (48 CFR CHAP

FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS

i ii .252-
S BY
PON R QU
HE FU L
P://W W.

TR" ILA!
) (
EF

REGISTRATION (OCT 2 003)

TOTAL CARRIED FORWARD TO I S T PAGE (ITEM17(H)) !!

NSN 754&01.152-8082 5l2-48-101 OPTIONAL FORM 148 law ~ 5 ,
1
I R.so8b.d by G5"
F A R I48 CFRI51 2lxcl
- I 1 CONTRACT ID CODE
AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT
I A

2 AMENDMENT/MODIFICATION NO 3 EFFECTIVE DATE (4 REOUlSlTlOtVPURCHASE R E 0 NO 5 PROJECT h0 (Ilappr~caoie)

I
0001 108/09/2006 U
6 ISSUED BY CODE DAM 7 ADMINISTERED BY (I1 olner rnan /!em 6) CODE IDA
DHHS/PSC/SAS/DAM DHHS/PSC/SAS/DAM
PARKLAWN BUILDING, ROOM 5-101 PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE 5600 FISHERS iANE
ROCKVILLE MD 20857 ROCKVILLE MD 20857
I
I1
8 NAME AND ADDRESS OF CONTRACTOR (No srreel counry StaleandZIP CWel N g 4 AMENDMENT OF SOLICITATION NO /I

CENTER FOR GENDER AND JUSTICE

Attn: DR. STEPHANIE COVINGTON 9B DATED (SEE ITEM 17)

7946 IVANHOE AVENUE, #201B

LA JOLLA CA 92037 IOA. MODIFICATION OF CONTRACTIORDER NO /i
HHSP233200400837P !I
- - - -
10B DATED (SEE ITEM 11)
I <

'ODE 565506892
. - -
I FACILITY do6F - - 09/29/2004
.--- - .. -.;:
I/
:I
..

I
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS I
2 Tne above numbered sol~olal~on
0s amended as sel fonh'ln Item 14 The hour and dale speofled for rece~plof Offers IS extended 3
1s no! extended
Olfers musl acknowledge recelpl of l h ~ amendment
s pnor lo the hour and dale speul~edIn the sol~alat~on
or as amended by one of the follow!ng methods (a) By comblelmg
Items 8 and 15, and relumrng mples of Ine amendmen! (b) By acknowledg~ngrecetpt of lh!s amendment on each m p y of ttte offer subm~ltedor (lc) By
separate letter or telegram which Includes a reference to the sollotallon and amendment numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT
THE PLACE DESIGNATED FORTHE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If i y
vtnue of thts amendment you destre 10change an oner already subm~ned.sucn change may be made by telegram or letter, provlded each telegram or lener makes 1
reference to Ihe soltc~tal~on
and thls amendment, and 1s recetved pnor to the openlnq hour and date specified I
12 ACCOUNTING AND APPROPRIATION DATA (I1 required) i
See Schedule 1
13 THlS ITEM ONLY APPLIES TO M&&TION OF CONTRACTSIORDERS IT MODIFIES THE CONTRACTIORDER NO AS DESCRIBED IN l T E ~ y 1 4
- - - -

Z&Z/i/ A T H s CHANGE ORDER I s ISSUED PURSUANT T o ( s p ~ 1 1ausonty)

y THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT?
1
ORDER NO IN ITEM 10A
I
B THE ABOVE NUMBERED C U L T C T I Q R D MODIFIED ~ TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes inpayingofice.
approprialron dale, etc.) SET FORTH IN ITEM 14. PURSUANTTO THE AUTHORITY OF FAR 43103(b).
1
!I
.. . . .

1
I
1
II
C. THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANTTO AUTHORITY OF:
.- .- -!I li
-- .. .- -
I
( D. OTHER (Specily type 01 modificalfon and authonly) /I
X 1 UNILATERAL - FAR 52.243-1 CHANGES-FIXED-PRICE (AUG 1987) /I:i
E IMPORTANT Contractor L l s not I?1s requ~redto slgn thls document and return copies l o the lssulng olfice
1 - ..
14 DESCRIPTION OF AMENDMENTlMODlFlCATlON /Oman!zed by UCF seclron headfngs, rncludrng solrc~latron/contraclsubjecl maner where leasrble )
- 1
Tax ID Number: -
The above referenced Purchase Order is hereby modified as follows:
/I
1. Reference the Statement of Work, item IV. Perlod of Performance 1s changed F R ~ M
11
"September 30, 2004 - September 29, 2005" TO "September 30, 2004 - December 31, 2006".

2. The total obligated amount of $5,995.00 remains unchanged.

1
Except as provlded here~nall lerms and cond~llonsol the document referenced In llem 9A or 10A as heretofore changed remalns unchanged and In full force and effect' 1
15A NAME AND TITLE OF SIGNER (Tyoe or onnr) 16A NAME AND TITLE OF CONTRACTING OFFICER (Tyoe orpnnl)
I
JACQUELINE R. JONES 1
155 CONTRACTOWOFFEROR 15C DATE SIGNED 168 UNITED STATES OF AMERICA 16; DATE SIGNED
I

ISignalure olperson aulharrzed lo srpni

;,8/09/2006
I
lSlgnature of Cootracbng Dficerj
NSN 7540-01-152-8070 STANDARD FORM130 (REV 10.83)
Prevlous ed111on
unusable Prescribed by GSAl
FAR (48 CFR) 53 2f3

1
 PAGE O i PAGES

HHS/OPHS/OWH/REGION V
HHSP233200400846P 04T000017
--

5, ISSUING OFFICE (Address correspondence lo)

DHHS/PSC/SAS/DAM
b STREET ADDRESS
233 N. MICHIGAN AVE, SUITE
I
1300
-

PARKLAWN BUILDING, ROOM 5-101

5600 FISHERS LANE
ROCKVILLE MD 20857 -
c CITY d ST4TE e ZIP CODE
CHICAGO IL 60601
7. TO: 1 1. SHIPVIA i
a. NAME OF CONTRACTOR .. I
i I
CHICAGO HEALTH CONNECTION 8. TYPE OF ORDER I
b. COMPANY NAME Ea. PURCHASE I
b. DELIVERY
- .
c. STREET ADDRESS .... . REFERENCE YOUR I
954 W WASHINGTON BLVD
~ ~

. . . . . .. - ... Quote Attached _,,_.

~.....
EX'&I~
y+;se.
b~ll~nglnslr~cbmsm the
Ih&-ddivery order 1s
subject 10 InSIrUmms mntalned m
ttn: side only of lhis f m and IS
~. Please fumlsh (he lollmwng m Ihe terms idbed subjen to \he terms and
. .
and conditions specified on t v l h sides d txridlt~msof me above-num,bered
this ader and on the attached sheea, d U
d . CITY e. STATE . CODE . antract
any, indudlng deCvery as indicated. II
CHICAGO . . IL 60607 - - . . - - . . . . . . ~1
. . .
9 ACCOUNTING AND APPROPR(ATI0NS DATA

7540120
.. 10,~REQUlSlTlONlNGOFFlCE
HHS/OPHS/OWH/REGION v [
1 1 BUSINESS CLASSIFICATION [Check appropnale box(es)j
-.. -. OTHER THAN SMALL . . . . .- Ii
- .
. . .. .
Cl
.
a. SMALL
. ..
..
.+' & .
. .
. C. D I ~ \ D ~ A. ~ ~ .~ A- .G E.D
. .
. . .
d. WOMEN-OWNED
.. . . . . . . .
12. F.O.B. POIKT Destination 14. GOVERNMENT
. .
BR/NO
.
15. DELIVER TO F.O B POINT 16. DISCOUNT TERMS ,.

. . ONOR BEFORE (DaleJ

13 PLACE OF
1 Net- 30
.- -

-
.
a INSPECTION

-
Destination
bACCEFTPJ@,C4,.
~estinatlon' -- ---- -<

17 S C H E W t E /See reverse lor Reledrons) li

.
. .:. . . . . . . . . "

GIJANTITY
ORDERED UNIT
. .....
. - UNIT
PRICE
. , --
..,. .-
AMOUY
- /I .<-:.;.. OUANTm'
ACCEPTED
-
(c) (dj (e) (1) 1) (9)

<-

-.
. . . . . .
- 1

Questions concerning this

-.-
order should be re

PLEASE REFERENCE PAGES 1 THROUGH 7 OF THE AT

Continued . . .
I
18 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO 1704
TOTAL
(Con1
pages)
21 MAIL INVOICE TO

SEE BILLING
a NAME
PSC/FMS (301) 443-3020
-$@,500.00
i;
11
4
lNsTRuC7rONs b STREET ADDRESS PARKLAWN BUILDING, ROOM. 16A-12 11
ON REVERSE (or P 0 Box) 5600 FISHERS LANE 1U 17(1)
1 GRAND
I. 1 TOTAL

c CITY
ROCKVILLE
d STATE

MD
e ZIP CODE

20857
$4,500.00
II
I
4
II
22 UNITED STATES OF AMERICA 23 NAME (Typed) I

B y (S~gnature) JACQUELINE R. JONES ]

TITLE CONTRACTINGIORDERING OFFICER
NSN 754001.152.8083 f OP-L FORM Y 7 IRN -51

PREVIOUS EDITION NOT USABLE R!& 4 MU( I- CFRI 53 1131.1

/I
I1
Il
 ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES
SCHEDULE CONTINUATION - 2 1/ 2
IMPORTANT: Mark all packages and papers with mbad and/ororder numbers. I
DATE OF ORDER CONTRACTNO
09/30/2004
ORDER NO. 1
!I
~~~~2332004008$6~
YTEM NO.

(A)
SUPPLlESlSERVlCES
(0)
QUANTWU
ORDERED
(C)
N ~

(0)
UNIT
PRICE
(E)
AMOuNi
fF)
/
II
OUAICTITY
ACCEPTED
(Gi

ON WOMEN'S HEALTH REGION V - - INDIANA PERINATAL N E W 0 K D O U U MODE', PROGRAM.;'

CAN: 1050116 FY: 2004 -

Period of Performance: 09/30/2004 to 09/29/2005
!1I
The Contractor shall provide support to
- .~

1 LT 4,500.00
!
I

assist in initiating a community-based

doula model program in accordance with the

Perinatal Network Doula Model Program."

Project Officer:
Michelle--Hoersch .- -
Phone (312) 353-8122

.. . .
.. . .-

. ..

. -. .

. . . . .

. -

TOTAL CARRIEDFORWARD TO ISTPAGE (ITEM

I~(H)) I'i
NSN 7YDOl-152-8082 Wl4blOl

IIi OPTIONAL FORY YI i R r -11

~ . l o . ~ bGyY
FAB (48 ffRl53 2131c:

!I
 U.S. DEPARTMENT OF HEALTH AND HUMAN S E R V I ~ E S
OFFICE OF WOMEN'S HEALTH - REGION V

STATEMENT OF WORK
i
I/
I. PROJECT TITLE: Ofice of Women 's Health, Region V - Ind~anaPerlnatal
Network Doula Model Program. 1
11

11. BACKGROUND: Research shows that the time immediately surrounding labor
'I
'I
and delivery is a critical period in thedevelopment of a young family. Women in
I
difficult circumstances (adolescents, women experiencing violence, women in .-
low-income communities) are particularly vulnerable during this period, but may =
also be openduring this time to interventions which support t h e i m e w . 4 .and
~
competencies. Programs which use doulas for support in childbirth have /
demonstrated Tewer labor and delivery complications, fewer medical
interventions, and increased well-being for both mothers and babies. h others
1
who receive emotional and educational support during pregnancy, labor, helivery
. andtheearly postpartum period are more knowledgeable and confident, &d are
better able to bond and care for their children. Doula support has also bekn shown
........

to increase beastfeeding rates, facilitate optimal mother-infant interactiot,

. . .
. . decrease rate&f p - t e r n j birth, and delay
-
subsequentpregnancy. .
1j
. . ... . -. .
. .
.
. . .
. . . . . .
. . . . . . . . .
. . . .. ... ... ... .. 1.. . . .
. .-
. .
...
. . . . . . . ~ h i c a ~ o ~ e z t h c o n n e ~initiated
t i o n the:Chi&go Doula ~ i o j e c inJuly
t of;1996 . . . . . . . .
:.
.. . . whenit +ee&ved a-four-year:grant from TheRobert Wood J o b s o n Foundation.
. . .
,. ,:
. .. . .. .

- . . . and four-years of funding from The Hams Foundation. In collaboration yith . .

.
. . . . . . .
. .
threechicago-community-based organizations; ~ a r i l l a ~ouse,.~&ristop.h~.
c =.i .-I' ...
.:. ,' ': .

. .
.

House, and Alivi6 Medical. Center, and with assistance from The Ounce df . . . . . .
Prevention Fund, CHC conducted a four-year pilot proJect in pennatal subport fbi-.''
pregnant
.. ..
-,
teens in low-income communities. The model is based on
components:
- -- .. . . . . . - . . .-
-
... .-.
.- -.I
......

It is community-based: doulas are lay women recruited from the communities 'I
being served
It is relationship-based: the intervention begins as early as possible in
pregnancy, and is based on a long-term, trusting, nurturing relationshib
between the doula and the pregnant woman (and her family) i
It is collaborative: the project requires active partnerships of community
members, social service providers, health care providers, and donator$ to be
successful. I
1
1/

Research about doula support shows that when doulas provided continuous
li
emotional support to young, low-income mothers, the women had significantly
shorter labors, were more likely to be awake after labor, and were more likely to
interact and talk to their babies immediately following labor than women kho had
not received doula support. In a study of 229 births in the Chicago ~ o u l a ! ~ r o j e c t ,
II
 C-section rates were 8% for single births (compared to 14.5% for US teehs and
12.8% for Chicago teens), epidural rates were 11.4% (compared to 50%
nationwide), and only 10.5% of participants received inadequate prenatal care
(compared to 17.6% for Chicago teens). Breastfeeding initiation rates were I 80%
A
(compared to 47.3% for US teens and 42% for all Illinois women). The pilot
sites report that their teen moms are holding their babies more, talking
more, and are more-comfortable talking about their births.
/1
Chicago Health Connection's community-based doula model is rooted in/the
service community and is a cultura!ly sensitive approach to pregnancy, c$ildbirth,
infant development and family support. The doula intervention provides (
"

opportunities prior to labor and delivery to enhance the mother's knowledge of

proper prenatal c%re,early braindevelopment and the critical role they plky in --
shaping the emotioiiaf; social and cognitive development of t h e i i ~ h i l d & : ~ c
i
Doula program is one component of an array of support services that are offered
to pregnant a i d birthing women by the partner agency In many cases, ddula
participants are also receiving health services, pre-natal care and social sekvices.
$1
Follow-up services by the partner agencies are provided, such as l o n g - t e ~home
visiting, post-natal care and Head Start programs. /I I
1
PURPOSEil The purpose of this contract is to provide contractor supper( to assist
in initiating albmmunity-based doula model program with the Indiana ~trinatal
Network, in two sites in Indianapolis, serving Hispanic and Ahcan-American
- teen mothers. This collaborative project will develop creative partnershiis in the
area of womerr's-health in Region V, specifically for women ofchildbearing age, -

with the ultimate goal of integrating and improving behavioral health sedices to
women of childbearing age. ._- -I-- - -- I
I
Establishment of this program will:
..
....
.. -.
I
Help to eliminate racial, ethnic and socioeconomic health disparities ip
--. ..,.
peri-natal oiitcomes. Access to high quality and affordable prevention7 *.. -..-
measures, including screening and appropriate follow-up, is essential if we are
.. ,. to save lives and reduce medical care costs.
Promote a health and wellness program in community-based settings.
Community-based programs are effective in getting people culturally
appropriate health information and changing behaviors.
Educate the public effectively about maternal and child health-including
necessary prevention messages. 1
il
- These objectives reflect priorities identified in the Steps to a Healthier
would help to further the prevention and public education agenda of
initiative.
I

IV. PEFUOD OF PERFORMANCE: The Period of Performance shall be f{?m

September 29,2004 through September 30,2005. (I
I
 V. TYPE OF CONTRACT: This is a Firm, Fixed-Price purchase order.

V1. DELIVERABLES AND TIMEFRAME: The Contractor shall work i i

collaboration with the Project Officer (PO) to provide a one-day Program
Workshop and a two-day Training of Trainers for the Indiana Perinatal 1
Network in Indianapolis. The Contractor shall also work collaboratively kith the
Indiana Perinatal Network to develop a project plan, form a local
body, provide hiring and training advice for program supervisor and
provide other technical assistance as required.

In coordination with the PO, the cdntractor shall provide the following skrvices
and deliverables:
. -
- .. - -- Ii
Collabdrate with f i e Indiana Perinatal Network to establish tliE'C6riikUriity- --
...
.-.

Based Doula Model program in Indianapolis; I

. . .

. . .
. Provide one-day Program Workshop in Indianapolis, Indiana;
i Provide two-day."Training of Trainers"' in Indianapolis,3ndiana;
I
-
11 . . . .

. Provide technical assistance by telephone; e-mail andlor fix'for the fdrmation

. . . . . . . . . .
- .

of a local project advisory body and development o f program plan; ...

. . . . . .

. . ..
* provide technical assistance by telephone, e-mail and/or fax for the 1
.
r e c r u i m q Q n d the
......
hiring of pro:gram
pfoviaelo& project 'ad~is&ry'~~dyparticipant
.supervisor and
. . .. . . . . . . . . .
doulas;
listto &&PO;
1 . . . . . ... . ,
I ,
i , : .
,.
.

.
. . .

I/ . %

..
. .

.... .
.
,
.

.
. .
. .
. . . . . . . .
.. .
.
~ ~ ~ ~
. . . . . . .
~ d ~ ' ~ ~program
~. . ~plan;
.. . . . .
~.. . . ::~ '

.. . . .
'
..::...
~ i
".
:
I

,
. .

~. . I, . .~. . . . . . . .':.~.:..: b .
, ,
. ..
~. . ..
~
. . . .
&
....:..
. . . . . .
~.

. .. .. . . . . ...
. . . . .. . . .
. . . . . . .
. . .....
. . .: .. . . . .
.
, . 1... -. ,-..-:. ........
. - .
:..; .: .-r ._
.. , . . . .. . . . . . . . . ..,-!I. :,:.>.. . . . .....
...... . . . ..,

.
. : :
. -
. .
. . . .. . . .
. .. .. . .:. .. . . - . hed due dates abd .delivery iet'hodsf o r these deliverables are.-to be .>
. . . . .. ... ... . . . .
. .
. .

. . determined followidg the award of thii effort. ....

VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized

.. .
Contracting Officer is responsible for the review and acceptance of.-all, ,-- --., . -. ....

deliverables.
- .

VI11. PAYMENT SCHEDULE: Within two weeks of the completion and acdeptance
of the one-day Program Workshop to be conducted in Indianapolis, Indida, the
Contractor shall submit a proper invoice for those related services to the PO.
Upon completion and acceptance of the two-day "Training of Trainers"
workshop, the Contractor shall submit a proper invoice to the PO for the b 1
I
of the proposed amount.
i a
 ~~~~23320q400846~
Page 4 of 7
I
X. INVOICE SUBMISSION: Upon inspection and acceptance of deliverdbles,
I to the
the Contractor shall submit an original and two copies of its proper invoices
PO. For payment, the PO shall submit the invoice and a signed receiving Ireport
to:
Department of Health & Human Services
PSCFinancial Management Service
Division of Financial Operations I
Parklawn Building, Room 16A-12 I
5600 Fishers Lane
Rockville, Maryland 20857,
Telephone: (301) 443-3020
I
1
1
The invoice must contain thefonowing minimum information:
.. .- -.--
. -,

Contractor's name and address;

. .
---.. - ..-
- y:.-I
11
. ~ - -

Purchase order number;

Description and price of services provided;

Invofqperiod; and
- I
\ - .--
. -. The Contractor's Internal Revenueservice (IRS) Taxpayer
Number.
- .-
A . M . /
---- ---
.
? * -. X. GOVERNMENT-FURNISHED MATERIALS: The Government willinot
- - --
- furnish any materials&._t_heContractor for this requirement. --- - - --
I
.

XI. RIGHTS TO DATA: The Contractor is prohibited from using data produced or
I ..
obtained under this contract for any purpose without prior, written approval from
the PO.. --. . .- . . ..

XII. TECHNICAL MONITORING:

A. Performance of the work under this purchase order shall be subjectI to the
technical monitoring of the Project Officer. The term "Technical
Monitoring" is defined to include, without limitation, the following:
- ,- - I
1. Technical directions to the Contractor, which redirect the purchase
I
order effort, shift work emphasis between work areas or tasks,
require pursuit of certain lines of inquiry, fill in details or
otherwise serve to accomplish the contractual scope of wbrk.
I
1
2. Providing information to the Contractor for assistance in the
interpretation of drawings, specifications or technical portibns of
I]
the work description. (I
Il

I
II/
 400846P
ge5of7
3. Review and, where required by the purchase order, appro! i1 of
technical reports, drawings, specifications and technical
information to be delivered by the Contractor to the Gove nment
under the purchase order.

B. Technical direction must be within the general scope of work stat d in the
purchase order. The Project Officer does not have the authority t and
may not issue any technical direction whlch (i) constitutes an ass] w e n t
of additional work outside the general scope of the purchase orde (ii)
constitutes a change as defined in the purchase order clause entitl d,
"Changes;" (iii) causes, in any manner, an increase or decrease In he total
estimated purchase order cost, the fixed fee or the time required f r
purchaserder performance; or (iv) changes any of the expressed .ems,
conditions, or'specifications of the purchase order.
- -=-
-
C. All technical direction shall be issued in writing by the Project
Officer or shall be confirmed by himher in writing within 5
working days after issuance.

The Contractor shall proceed promptly with the performance of

tecbicgl direction duly issued by the Project Officer in the mann
pres&6ed by this clause and within hisher a;thority under the
provisions of this clause.

I ~ ~the
I Topinion of the Contractor, any instruction or direction is
the Project Officer is within one of the categories as defined in (i) through
- -. -
- >.
(iv) above, the Contractor shall riot proceed but s h d l notif-y the - -- ---- -.

Contracting Officer in writing wlthin 5 working days after the rec ipt of
any such instruction or direction and shall request the Contractini Officer
to modify the purchase order accordingly. Upon receiving such
notification from the Contractor, the Contracting Officer shall iss
approp5ate purchase order modification or advise the Contractor
writing that, in hisher opinion, the technical direction is within tl : scope
of this clause and does not constitute a change under the Changes Zlause
of the purchase order. The Contractor shall thereupon proceed
immediately with the direction given. A failure of the parties to
agree upon the nature of the instruction or direction or upon the p rchase
order action to be taken with respect thereto shall be subject~o. thl
.

provisions of the purchase order clause entitled "Disputes."

 XIII. POINTS OF CONTACT:

The Project Officer (PO) for this effort is:

Ms. Michelle Hoersch, M.S.

Office on Women's Health --
U.S. Department of Health and Human Services
233 N. Michlgan Avenue, Suite 1300
Chicago, Illinois 60601
Phone: (3 12) 353-8122
Fax: (3 12) 353-7800
Email: n~hoerscl~@,osophs.dhhs.gov
. . . . . . .

The Contracting Offic~r(CO) for this effort is: --- - --

Ms. Jacqueline R. Jones
Program Support Center
U.S. Department of Health and Human Services
Parklawn Building, Room 5- 101
5600 Fishers Lane
Rockville, MD,20857
Phone: (301j'a3-6413
Fax: (301) 443-8488
.... ..
.: . . . . -.
. ... . . . . .. . ::. . . :The con^-Specklistfor this effort is: . .: . . . . . .. .. '.
. . . . ..
. .
. . . . . .
. . .
....... . . . . . . . . . .. . . . .
. . . . .
~

.. .. . . . . . . . . . . .

M - ~ . - G & ~.calve* r'

. . . .. . . . . . . . .. . . . . . . .. .. . . . . .
. . . H. .. - - ... .... . . _ . _ _. . . -
. . . . .. . .. . . . . . . .
Program Support Center
Phone: (301) 443-7077

X I . ~ ~ ~ ' 5--2 . 2 5.CLAUSES

2-2
-..
INCORPORATED BY REFERENCE (FEI
. . . . . - .. . .

This contract incorporates one or more clauses by reference, with the Sam force
and
. . effect as if they were given in full text. Upon request, the Contracting Ifficer
will make their full text available. Also, the full text of a clause may beac essed
electronically at thislthese address(es): http://www.arnet.zovifar.

The following FAR contract clauses are incorporated by reference:,

-
No. CLAUSENO. .. TITLE AND DATE
..
1. FAR 52.204-6 Data Universal Numbering 5

System (DUNS) Number

(OCT 2003)
2. FAR 52.204-7 Central Contractor Registrati
(OCT 2003)
 I
HHSP233200400846P
11
Page 7 of 7
U
& CLAUSE NO. TITLE AND DATE

3. FAR 52.2 12- 1 Instructions to Offerors - b1

Commercial Items (JAN 2004)
4. FAR 52.212-4 Contract Terms and Conditilpns -
Commercial Items (OCT 2003)
5. FAR 52.222-3 Convict Labor (June 2003) 1
6. ~Ak52.222-19 Child Labor-Cooperation with

7. FAR 52.222-2 1
Authorities and Remedies I
(June 2004)
I1
Prohibition of Segregated ~acilities
(Feb 1999).
8. FAR 52.222-26 -- Equal Opportunity (Apr 2002)
9. Fm52.223-6 Drug Free ~ o r k ~ l a c ~ ~ ( ~ ~ ~ 0 0 1 )
10. FAR 52.225-1 Buy American Act-Supplies;

11. FAR 52.225-13

(June 2003) I
Restrictions on Certain Foreign
-

Purchases (JUN 2003) 1

12. FAR 52.232-1 Payments (APR 1984) 1
13. FAR 52.232-33 Payment by Electronic Funds

14.
15.
-
-
.4/ %.&
:.

FAR 52.233-1
FAR 52.233-3
-
Registration (Oct 2003)
Disputes (KTL 2002) I
Transfer-Central Contractor1

Protest After Award (AUG 1996)

i
1 - -

.^'--X. -.. ..
I -
 W
ORDER FOR SUPPLIES OR SERVICES 1 PAGE OF PAGES

IMPORTAHT: Mark all packages a n d papers with c o n h a c t andlor order numbers I 1 2

1 DATE OF ORDER 2. CONTRACT NO (llany) 6SHlPTO I

09/30/2004 .
3 ORDER NO 4. REQUlSlTlONlREFERENCE NO.
a. NAME OF CONSIGNEE
I
HHSP233200400853P 04T000013
--

5 ISSUING OFFICE (Address comspondenca to) b. STREET ADDRESS

DHHS/PSC/SAS/DAM 233 N. MICHIGAN AVE, SUITE 130
-
PARKLAWN BUILDING, ROOM 5-101
li
5600 FISHERS LANE
ROCKVILLE MD 20857
il--F~;ATE-] e. ZIP CODE

-
11
7 TO Jason Jacobs I SHIPVLA
!I
a NAME OF CONTRACTOR 1
UNIVERSITY OF MINNESOTA 8 TYPE OF ORDER '1
b COMPANY NAME
I Tji --
-
a PURCHASE b DELIVERY

c. STREET ADDRESS -
.. . .- . - .- REFERENCE YOUR- .-.--. . 1 - .
-
Except fabln~ng~nsl~cIJons cn the
University of Minnesota Quote Attached
re?ene tha dellvery crdw IS
Sponsored Projects ~dministration sublea to ~nsmc~~cms mntalned on
200 Oak Street SE, Suite 450 ~uis~deonly 01 ths I- and a
Please furmsh the fdl&ng on the terms sutqec( lo the terms and
and cmdibons speafied on both wdes d c$d~ttcmsof the abe-numbered
this Order and on Ihe atlached sheets, d dtraa
d. CITY e. STATE f. ZIP CODE
any, ~ndvdingdellvery as ~ndmted. !I
MINNEAPOLIS MN .. 55455-2070 /I
9 ACCOUNTING AND APPROPRIATIONS DATA 10 REQUISITIONING OFFICE 1
7540120 HHS/OPHS/OWH/REGION V I
tl- WSINESS CtASSlFlCATlON (Checkappmpnale
a SMALL *?$? b OTHER THAN SMALL - c DISADVANTAGED
$1
d WOMENOWNED

1s DELIVER TO F o B POINT 16 DISCOUNT TERMS --

12 F o B POINT Destination 14 GOVERNMENT BNNO
ON OR BEFORE (Dale)
/j
11

a INSPECTION
Destination
- . 13 W C E O F L

b ACCEPTANCE
Destination
.. -
I
17 SCHEDULE (See reverse lor Releclrons)
- -111 --. --
. Net 30 --.

ITEM NO SUPPLIES OR SERVICES

QUANTITY
ORDERED UNIT
UNIT
PRICE
!I
AMOUY
QUANTITY
ACCEPTED
(a) (b) ' ic) (d) le\ (1) I[ (9)

Tax ID Number:
DUNS Number:

Questions concerning this order should be re erred to Gene Calvert

PLEASE REFERENCE PAGES 1 THROUGH 6 OF THE AT~ACHED~

k I STATEMENT
I OF W O ~ KTITLED ~ " O F F I ~ E
continued . . . .

1
18 SHIPPING POINT

a. NAME
19 GROSS SHIPPING WEIGHT

21. MAIL INVOICE TO

20 INVOICE NO

7 17(h)
TOTAL
(Cont
pages)

SEE BILLING
PSC/FMS (301) 443-3029
INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE
(W p 0 8~ 5600 FISHERS LANE
GRAND
TOTAL
I
c CITY d STATE e ZIP CODE $4,500/.
00

- - I

i)mm
ROCKVILLE MD 20857 I
rl I
/I
22 UNITED STATES OF AMERICA 23 NAME (Typed)
BY (Slgnafure)

[- U JACQUELINE R. JONES
TITLE CONTRACTINWORDERINGOFFICER
i \

NSN 7 5 4 0 0 1 152 8083

PREVIOUS EDITION NOT UWBLE

u 1
I
1

1 I
R.M
OPTIONAL FORM Y 7 (Rr, 6951

b 1 G s M u 7 I48 CIRI 5 1 llL.1

 I

j
ORDER FOR SUPPLIES OR SERVICES PAGE OF PAGES
SCHEDULE CONTINUATION- "I
2 11 7
IMPORTANT: Ma& all padcages and p a w rnlh anlracl andlor order numbers 1
DATE OF ORDER
09/30/2004
CONTRACTNO ORDER NO 1
HHSP233200400853P
ITEM NO.

ON WOMEN'S HEALTH, REGION V - HEART

FOR SCOPE OF WORK, INVOICING PROCEDURES, TERMS
h
EFFORT.
- -

CAN: 1050116 FY: 2004

Period of Performance: 09/30/2004 to

The Contractor shall provide support in .

promoting the "Heart Truth Campaign" in
accordance with the attached Statement of
Work tltled "Office on Women's Health,Regi
- St. Paul Venue - --

Project Officer:
Michelle Hoersch
Phone (312) 353-8122

: :1 INVOICE INFORMATION/CLAUSES INCORPO

INVOICE INFORMATION
IN ADDITION TO THE INFORMATION REQUIRED BY 5
MUST CONTAIN THE FO~QOP;MG: TAX IDENTIFICATI
"T ED Bk

FAR 52.232-33 PAYMENT BY ELECTRONIC FUNDS SFE

REGISTRATION (OCT 2003)
--

TOTAL CARRIED FORWARD TO ? S TPP lM 17(H)) !

NSN 754001-152-8082 WMB.IOI
! OPTIONAL FORM 141 ( R n M O
 HHS~233200400853~
Page 1 of 6
il
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
OFFICE ON WOMEN'S HEALTH - REGION V 1
1
!I
STATEMENT
-
OF WORK IIi/
I. PROJECT TITLE: Oflce on Women 's Health, Region V - Heart Truth
I
I
Campaign, Minneapolis - St. Paul Venue.
I'I
11. BACKGROUND: The Office on-Women's Health (OWH) is the focal/~ointfor
women's health within the Department of Health and Human Services (HHS). .
The OWH, under the direction of the Deputy Assistant Secretary for ~ e s l t h
(Women's Health)., igproves the health and well-being of women acrossl the
lifespan by coordinating women's health programs, promoting health gucation

health disparities. I
and disease prevention, and leading efforts and fostering partnerships toleliminate
1I

/I
The Heart Truth Campaign, sponsored by the National Heart, Lung, and Blood
Institute (NHLBI) and partner organizations is intended to make womed more
aware of the danger of heart disease. The campaign's goal is to give wo$en a
personal *!gent wake-up call about their risk of heart disease. The campaign
is especially aimed at women ages 40 to 60, the time when a woman's rihk of ..
heart disease starts to rise. But its messages are also important for younder
women, .,---.,.,..
since...heart
..._ disease develops gradually and can start at a young age-even
- . .---. ...
in the teenage years. Older women have an interest too-it's never too lite to take
/I
action to prevent and control the risk factors for heart disease. Even those who
have heart disease can improve their heart health and quality of Me. II ;------=
1

1I
111. PURPOSE: The purpose of this contract is to provide contractor suppdlrt to help
il

the Mi.nneapfis-St. Paul metropolitan area. These events will include

symposium on women and heart disease and the Heart Truth CampaignBor health-.
4
.promote the Heart Truth Campaign coordinating a series of activities tolbe held in -

. ..
.:-_.

care providers. The events will also include training on the Heart ~ r u t h i s ~ e a k e r s
/I
-.Kitfor lay women from community-based organizations. The participants will be
taught how to use the speakers' kit and they will then be expected to do
'I
1
presentations in their respective communities. Also included will be an /afternoon
of screening of women at the Mall of America for heart disease risk fac& and a
Red Dress fashion show to heighten awareness of women and he4l-t dis<ase.
I
i
IV.
.-
PERIOD OF PERFORMANCE: The Period of Performance shall beifrom
September 30, 2004 through September 29,2005. I I1
I

V. TYPE OF CONTRACT: This is Firm, Fixed-Price purchase order. ,

0
(1,I
VI. DELIVERABLES AND TIMEFRAME: The Contractor shall work ih
collaboration with the Region V Office on Women's Health Project 0ffiCer (PO)
to create these Heart Truth Campaign events. The Contractor's tasks sha1:linclude
chairing the screening subcommittee; coordinating logistics with the of all
America; securing materials; and identifyng and coordinating speakers $Id
1
models from the University. To ensure coordination with the goals and policies of
the Office on Women's Health and the Department of Health and Humanll
Services, the Contractor shall provide regular progress reports to the PO And
submit all proposed written materials to the PO for appropriate ~ e ~ a r t m e h a l
clearances. II
1
In coordination with the PO, .the.Contractor shall provide the following strvices
. -
--
and deliverab 1es.i. .. ..-- _ _ % .. . -:,. il .-- .. .-
..
!I
;I
Function as the initial contact with the Mall of America and secure date for

a
use of the Mall for events;
Provide a chairperson for the screening subcommittee;
l
I
1
a Identify and provide speakers for the health care provider symposium]
Identify and secure-apresenter for the fashion show; 1
a Secure materials
,+I %.. and items to be provided to screening participants anb
volunteei*?:: iI!
a Contact organizations
-. and companies to identify additional partners a(id .

sponsors;
Part-ieipate-on:-theoverall planning committee; i
!
..

Use community networks to maximize community involvement; I

ij
a Serve as a liaisonwith the CME office at the University of M-knesotd~ ----
a Recruit participants from the community to participate in Heart Truth /
Speaker's Kit training;
Confirrn date to use the Mall of America for activities; .
'I

-
j .. . *

Provide regular project updates for the screening subcommittee; 1/I -. ..-.
a ~ o n L e n eregular screening subcommittee planning conference calls; I
I
a Provide the necessary training materials for the program's participants;
/I
Provide keynote speaker for the symposium;
. i
.a.
a Provide speaker for the fashion show;
Secure the participation of at least two "high-profile" women from
University to model in the fashion show.
. ..-..
The due dates and delivery methods for these deliverables are to be
.: determined following the award'of this effort.
..
VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized dgent \ of the
Contracting Officer is responsible for the review and acceptance of all
deliverables. 1"
VIII. PAYMENT SCHEDULE: Within two weeks of acceptance by the P 4 of
I
services related to securing the use of the Mall of America, confirming the
symposium's keynote speaker and convening the first screening subconhittee
meeting, the Contractor shall submit a proper invoice for those related skrvices.
The Contractor shall submit a proper invoice for the balance of the pro&sed fee
within two weeks of the PO'S acceptance of the completed event. I/ 1
IX. INVOICE SUBMISSION: Upon inspection and acceptance of deliverables,
1
the Contractor shall submit an original and two copies of its proper invdces to the =
PO. For payment, the PO shall submit the invoice and a signed receiving report
to:
Department of Health & Human Services
PSCFinancial Management Service
j
Division of Financial Operations
Parklawn Building, Room 16A-12
II
5600 Fishers Lane
~ o & $ % l lMaryland
--
e, 20857
Telephone: (30 1) 443-3020
1
1i
The in.vsis=e.must-contain the following minimum information:

Contractor's name and address;

.- --s I
Z
'I
_- _ =

Purchase order number;

.. - .
Description and price of services provided;

Lnvoice period; and

The Contractor's Internal Revenue Service ( R S ) Taxpayer Ide

Number.

X. GOVERNMENT-FURNISHED MATERIALS: The Government will not

furnish any materials to the Contractor for this requirement. --
..- I
XI. RIGHTS TO DATA: The Contractor is prohibited from using data produced or
I
l
obtained under this contract for any purpose without prior, written approval from

II
the PO.
I
 I
i
(I
0:p
fi,a
TECHNICAL MONITORING:

A. Performance of the work under this purchase order shall be sub].I4c t to the
II
technical monitoring of the Project Officer. The term "Technic;a1
.I/
Monitoring" is defined to include, without limitation, the follom'In g:

1.
order effort, shift work emphasis between work areas or ta!sks,
I
Technical directions to the Contractor, which redirect thl=!I:burchase

require pursuit of certain lines of inquiry, fill in details or 1

otherwise serve to accomplish the contractual scope of vv01-k.
I/
I/
2. P~ovidinginformation to the Contractor for assistance in tih e
-rtl~I .onsof
- internretation of drawings, specifications or t e c k a 1 . p
5-
-
the work description. /
3. . Review and, where required by the purchase order, apprcIVi11 of
technical reports, drawings, specifications and technical /
information to be delivered by the Contractor to the Gob'er 1 nrnent
1
under the purchase order.
I/
B. Technical direction must be within the general scope of work st;~ tdein the
1
pudl$$se order. The Project Officer does not have the authorityt o and 1

may not issue any technical direction which (i) constitutes an ass:ilw e n t
of additional work outside the general scope of the purchase orcler; (ii)
constitutes
-:--. -*- - -. a change as defined in the purchase order clause enti tie
.
:d,
----
I .-
"Changes;" (iii) causes, in any manner, an increase or decrease :in the total
estimated purchase order cost, the fixed fee or the time required falr
purchase order performance; or (iv) changes any of the.eXpressird:I ferrfis,
conditions, or specifications of the purchase order. I
-G All technical direction shall be issued in writing by the Project
- Officer or shall be confirmed by himher in writing within 5
I
iIl
,...
working days after issuance. 1
D. The Contractor shall proceed promptly with the performance of
I
technical direction duly issued by the Project Officer in the marme:r
(I
prescribed by this clause and within hislher authority under the
provisions of this clause.
. - ..
E. If, in the opinion of the Contractor, any instruction or direction !I ued by
the Project Officer is within one of the categories as defined in I(1) through
(iv) above, the Contractor shall not proceed but shall notify the 1
1
Contracting Officer in writing within 5 working days after the r ect:ipt of
any such instruction or direction and shall request the Contracti nk Officer
to modify the purchase order accordingly. 11
,
I
I

/I
1
1I/
iJ
I/
11
 Upon receiving such notification from the Contractor, the Cont: ling
Officer shall issue an appropriate purchase order modification idvise
the Contractor in writing that, in hisher opinion,-thetechnical c ction is
within the scope of this clause and does not constitute a change der the
Changes Clause of the purchase order. The Contractor shall-thr lpon
proceed immediatel; with the direction given.
- .-
. .

A failure of the parties to agree upon the nature of the instructic )r

direction or upon the purchase order action to be taken with res] t
thereto shall be subject to the provisions of the purchase order c .se
entitled "Disputes."
P
.

The Project Officer (PO) for this effort is:

Ms. Michelle Hoersch, .M.S.

Office on Women's Health
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 1300
Chicago, 1lGqbis 60601
Phone: (3 12) 353-8 122
Fax: (3 12) 353-7800
Email: ~_mhoersch@osophs.dhhs.ov
..

The Contracting Officer (CO) for this effort is:

,. .-

Ms. Jacqueline R. Jones

Program Support Center
U:S. Department of Health and Human Services
Parklawn Building, Room 5- 10 1
5600 Fishers Lane
Rockville, MD 20857
Phone: (301) 443-6413
Fax: (301) 443-8488

The Contract Specialist for this effort is:

. -..
Mr. Gene H. Calvert
Program Support Center
-- Phone: (301) 443-7077
 I
XIV. FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEE? 1998)
'I
/I
This contract incorporates one or more clauses by reference, with the same force
and effect as if they were given in full text. Upon request, the Contracting Officer
will make their full text available. Also, the full text of a clause may be dbcessed
electronically at thislthese address(es): http:llv.w~.arnet.gov/far.
-. ..

The following FAR contract clauses are incorporated by reference:

No.
- CLAUSE NO. TITLE AND DATE

1. FAR 52.204-6-
..-
.- Data Universal Numbering
System (DUNS) Number
(OCT 2003)
- 11

2. FAR 52.204-7 Central Contractor Reghalion

3. FAR 52212-1
(OCT 2003)
Instructions to Offerors -
I
Commercial Items (JAN 2004)
4. FAR 52.2 12-4 Contract Terms and ~onditibns-
Commercial Items (OCT 2q,03)
Convict Labor (June 2003) 1
Child Labor-Cooperation with
Authorities and Remedies 1
(June 2004)
I
Prohibition of Segregated ~acilities-
(Feb 1999). )I

8. -- FAR'52.222-26 Equal Opportunity (Apr 20027 ----

9. FAR 52.223:6 Drug Free Workplace (MA$ 200 1)
10. FAR 52.225-1 Buy American Act-Supplies
->
(June 2003)
11. .. --FAR 52.225-1 3 Restrictions on Certain ~or(ign
7 -- - - --
Purchases (JUN 2003)
1
12. FAR 52.232-1 Payments (APR 1984) i
.13. FAR 52.232-33 Payment by Electronic Funds
Transfer-Central ~ontractod
Registration (Oct 2003) 1
14. FAR 52.233-1 Disputes (JUL 2002) 1
15. FAR 52.233-3 Protest After Award (AUG ,1996)
I
1
* * * END OF STATEMENT OF WORK * * *
 ORDER FOR SUPPLIES OR SERVICES
I
1) PASE O= PAGES

IMPORTANT: M a r k all packages a n d p a p e r s with c o n t r a c t and/or order numbers Ill1 /

1 DATE OF ORDER 2 CONTRACT NO (I1 any) 6 SHIP TO ;/
09/30/2004
3 ORDER NO

HHSP233200400883P
4 REQUlSlTlOtVREFERENCE NO

04T000019
a NAME OF CONSIGNEE

HHS/OPHS/OWH/REGION v
iI
1I
5. ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS i
DHHS/PSC/SAS/DAM 233 N. MICHIGAN AVE, SUITE 1300
PARKLAWN BUILDING, ROOM 5-101 1
5600 FISHERS LANE
ROCKVILLE MD 20857 I
. .
c CITY
CHICAGO
1 d STATE e zlPcoDE

1 IL 60601
1 SHIP VIA
a. NAME OF CONTRACTOR
NORTHPOINT HEALTH & WELLNESS CENTER 8 TYPE OF ORDER I/
b COMPANY N4ME

. --
I Ea. PURCHASE ,F { /
.I D E L ~ E R Y . '

c~ STREET ADDRESS . .. . REFERENCE YOUR:

1313 PENN AVENUE NORTH , . . - - . <- -_ ._. . .. .. . . I,. . .
E x k p l lor billing Ins1ruc;rns ar Ine
- .-
.--
~~.
-
-: Ihlsdekvery ader ts
SUbjlea to lnslrucbm antamed on
. . lht; side cmly d thts form and IS
Please fum~snlhe fblcnnng on lhe terms ! u ~ , e durblecl lo Ihe terms and
- .. - . . . - . . .. . . .~.
. . . . . ......... . . .
. . . . - andfWRlilkms spedfiedrn bomstdesof- - . .
. . . . - . -- ca+!ions ol-me.ab;ove4urnbered-
this Order and on the attached sheets, miilract
d. CITY .... - . . e, S. T A. T.E . 1. .ZIPCODE .
- . . . .
-MINNEAPOLIS'. .
. ~

any. including delivery as r i f s l e d . ' .' ' . 1 . .

. -MN 55411 -. . . . . . . ~ . .
il
"

. ....> .. . . .
9. ACCOUNTING AND APPROPRIATIONS DATA
. .
7540120
, , .

. .
-

~.
. .
- .- . . . . . .
.
.
~.
10. REQUISITIONING OFFICE
HHS/OpHS/OWH/REGION
. . .
V
. . .
1
I(
..
. . . . . . .

... . . . . . . . . . . . ~ . - . .
!i
I ,

11 BUSINESS CLASSIFICATION (Check approptiaie box(esJJ . .. .. . .. . . . . ....

. . . .
. . . .

. . .
. . . . 0 SMALL - - .-:' & b. OTHER THAN SMALL . . . .
. .
' ' 0-
--i.
DISADVANTAGED
. . . .
1 d. WOMENWNED
. . . . . . . . .. . . . . . . . .
- ' ~ ~ : F . ~ ~ . . P o I N T' ~ ~estination 14. MVERNMENTWUNO.
-- ....-.
15. DELIMR
TO %B. POINT j 16. DISCQUNTTERMS
-
. . .. .. .. +.. .. .. .. .. .. .
- . . . . . . .
. .
I~.'PLACEOF
-- . . .:....
. . . . . .
. . .
. .. . . . ..... ,
< .
, .
:. ....-OF OR.BE-cWi(.paM)
. . . . . . . . . . .
, . . : . : . . . . . . .. - .
~:~NSPECTION b. ACCEPTANCE
. . . .
..
....
~

_ -
. .
....
. i
. .. . .- . . .
. . . . . I Net 30
...
'

----
'

...... - - Destination DestfnaTYorr -'- . ~

...
-. . . . . . . .. :
.:
. . . ..........-..
. . . . . . :. -. .-
. .. .. . . .I , .. .
-. ... ... - . :. .-
. ......
.... . . . . .. . ':.-.
17. SCHEDULE (~&&uerse lor ~ejecl~ans) . . . . II.
. .
-
-a
.. . . . ".. . . . . .
- ITEM NO.
. .
'.SUPPLIES OR SERVICES *
. .
.

.-- . . . . &&RED
.
- . . ;.. ... O W N T I N - -
.:::
.
I
--.MR.
PRICE- ..
. .
I
. .
.. ...
AMOUT'
_II .r . = ;?
QUANTITY
ACCEPTED
. . (a) @) . . . ~ IK) (dl . lei (1) I) (g)

Tax ID Number
DUNS Number:
.. - .
I
Questions concerning this to Gene Calvert at (301) 443-7C77.
-- . . . . . . . . /I * :*.
il
PLEASE REFERENCE STAYEMENT OF WORK TITLED
Continued . . .

1 I 8 SHIPPING POINT 1 19 GROSS SHIPPING WElGW

21 MAIL INVOICE TO

a. NAME -154. 990 100

SEE BILLING
PSC/FMS (301) 443-3020 I

INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12

ON REVERSE (w P.O. Box) 5600 FISHERS LANE

TOTAL
cL ;I

1
c. CITY
ROCKVILLE - A -
( d STATE e. ZIP CODE

I
$4,990 .it00
il I -

NSN 754@01-152-8003 I/ / /
PREVIOUS EDITION NOT USABLE
v L/ I
R . W sv W L R 148 CFRJ53 21X.1
I
 (I
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION-
IMPORTANT: M a n au packages and papers Hnth anma andfa- a d e r numbers
1.1 11 PAGE OF PAGES

DATE OF ORDER
09/30/2004
CONTRACT NO ORDER NO
'I
~ ~ ~ ~ 2 3 3 2 0 0 4 0 0 ~ ~ 8 3 ~
ITEM NO.

(A)
SUPPLIEYSERVICES
(8) ]
ON WOMEN'S HEALTH, REGION v - HEART TRUTH CAYPAIGN NORTH POINT.HEALTH & WELLNESS
I
QUANTITY UNIT
ORDERED
(C) (Dl
UNIT
PRICE
(El """7
(F)
OUANTITY
ACCEPTED
(GI

CENTER" FOR SCOPE OF WORK, INVOICING PROCEDURES, XJIJ TERMS AND C0N:IITIONS REGARDIKZ
/I
THIS EFFORT.
CAN: 1 0 5 0 1 1 6 Fy: 2 0 0 4 iJ

1
Period of Performance: 0 9 / 3 0 / 2 0 0 4 to 0 9 / 2 9 / 2 0 0 5

The Contractor shall provide training in 1 LT 4,990.00

1
/I
4,990.00
accordance with the attached Statement of !
Work titled "Office on Women's Health, - 1

.. ... . . ..

-..

REGISTRATION (OCT 2 0 0 3 )
.- ...

TOTALCARRIED FORWARDTO I S T PAGE (ITEM 17(H)) ;I

NSN 754G01-152.8082 WYI-IOI ;i OPTIONAL FORM M I I R r 63%
I R-by G Y
FAR I48CFRIU21310:
 U.S DEPARTMENT OF HEALTH AND HUMAN SERVIC;ES
OFFICE ON WOMEN'S HEALTH - REGION V

STATEMENT OF WORK
I1
I. PROJECT TITLE: Office on Women 's Health, Region V - Heart Truth
i
Campaign, North Point Health & Wellness Center. I/

I/1
11. BACKGROUND: The Office on.Women7s Health (OWH) is the focal ioint for
women's health within the Department of Health and Human Services (HHS).
.-
The OWH, under the direction of the Deputy Assistant Secretary for ~ e a i t h
(Women's Health), improves the health and well-being of women acrossithe --
lifespan by cdordilialing women's health programs, promoting hG1th d ~ a t i o n --
.-

and disease prevention, and leading efforts and fostering partnerships to kliminate
I)
health &spa&es.
I
-
. The Heart Tmth c a m i i g n , sponsored by the.Nationa1 Heart, Lung, and blood
Institute (NHLBI) and partner organizations is intended to make women bore
- aware of thedanger of heart-disease. The campaign's goal is to give w o d F a
personal a@ qrgent wake-up call about their risk of heart disease. The ca,mpaign
is especially%med at women ages 40 to 60;the time when a woman's risk of
heart disease starts to rise. But its messages a_re also important for young&
1
women, since heart disease develops gradually and can start at a young age--even '

b.
. .
- in the tecn3geyears.-Older- women have-an interest t o e i t ' s never too laic to take, - -- ..
action to prevent and control-the risk factors for heart disease. Even thost! who -
-1
-

. . have heart disease can improve their heart healih and quality of life. -- = -L-

1
In 2001, The Office on Women's Health awarded the first four National '
Cpmmunity Centers of Excellence in Women's Health (CCOEs) to provibe
integrated health and social services to women in their communities. heCCOEs
-
coordinate alraspects of issues related to women's health at every stageq'f-iifk,
including active management of socioeconomic and cultural obstacles to equality
. .,health care for underserved women. The centers of excellence provide r(al help
to women who otherwise would face serious challenges in getting needed health
care and social services," Secretary Thompson said. These projects are intended to
serve as models for how best to meet the health needs of women in local
communities. I
,111. PURPOSE: The purpose of this contract is to provide contractor suppod to train
- - .. - I
lay women from community-based organizations to conduct Heart Truth!/
Campaign presentations in their respective communities. To achieve thi4
objective this contract shall support the efforts of the North Point Health ki
Wellness Center, a national Community Center of Excellence (CCOE) id!
Women's Health in Minneapolis, to partner in the Heart Truth campaign:/
1
Minnesota activities and specifically to coordinate a training for lay wom'en from
'I
community-based organizations to become familiar with the Hearth Truth
I
 /I
HHSP2332004OOSS3P
I
Page 2 of 6
I
i
Speaker's Kit and ultimately generate at least 20 community presentations on the
Heart Truth Campaign. The CCOE will follow up with these to
ensure that community presentations are conducted. This training and subsequent
presentations, will be part of a larger series of activities and events to be :held in
the Minneapolis-St. Paul metropolitan area to promote the Heart Truth Campaign.
;I
t
IV. PERIOD OF PERFORMACE: The Period of Performance shall be from
Y
September 30, 2004 through September 29,2005. !
i
V. TYPE OF CONTRACT: This is.a Firm, Fixed-Price purchase order. 1
il

VI.
DELIVERABLES AND TIMEFRAME: The Contractor shall work in
I
collaboration with the Region V Office on Women's Health Project offiber (PO) =
to create these Heid-Truth Campaign events. The Contractor sh3l co&hate and . -

convene the-training of 20 women from community-based organizationsj These

. . . .
1
- women will then be expected to;.and will commit to-conducting a presentationin
.

. . their respective communities. The Contractor shall identify appropriate \$omen to

. . . . .. . . . . . . . . . . . i
. . . . . .
- p'articipate in the training and shall also conduct the training. and follow up on . .
. . . .. .. .. . /I
the progress of.those:trained;-To-ensurecoordination with the goals-andpolicies.
. . . i. . I ...:...: ..+\
. . . . .
.. . . . .. . . . .. . . ..
:
.. :..oftheOffice on Women,s -Healthand the Department of Health and H d a n : . . . . . .
-:. .:-
. . . . . . . . . .
. . .
::L,
:
.......... Services, tke Contractor shall provide.regulai progresS.repofs .to the ~ e h o V: n ..
.....
. .. .. . . . .. -.. ... . . . 3,: \
. . .. --. :.I. . :.:: I . -':Office on . w o ~ e n ' s H e a l t h subm~tial.l.propos~d:wr~~~en~~ate~als.. to the Office . -

..-

. .
:.. . . .
... ..; .: . . .' . . .
- . .. . ; .
. . .. . :. ..... . . ..
.:.
< -, .... .>>..,
. -I.-;-
. . : . . .
.
-
.
:.:: - 7 . . 1 ~ : : ~ ~ ~ ~'i;v?th
.
~ f ithe~ ,PO,
i i 6the
and-deliverables: . . . . . . . .
n ~ontracto~shalj-~rovidc:t.hefollaw.in~skrvic~s~.:-
.
...... . . . _. . . ... . . . .: .. . . . .. ... . .. . .. .. . .: ._.. ..~
. . . - :. . ... ri . .. .....
. . .

-
. . . lj " ' '
. . . .
. . . . .
...... .
.
.
.
. . . . . . .
. . ... . .. , .
. . . . . . .. . .:. ...
:
.-.
. .. . .. .. . .. . .. . ........
: . , ...
. . ....:. , S . -
:?L. j l.W
. . .. . .
. .
- Provide trainers to conduct the trainingdn the Heart ~ r u i hspeakei7s/IQt;
Recruit appropriate participants from the community to participate id the
- . training;
1:
;I
Identify, Secure and provide an appropriate venue for conducting theitraining
program;
-.. -
1
> -
Secure materials and items to be provided to participants; I/
, Monitor the implementation of community presentations following the
training;
Provide a stipend to the participants and their respective organizatioqs for
I
their participation and subsequent community presentations;
Provide a chairperson to the training subcommittee;
Participate on the overall planning committee;
1 1
Use community networks to maximize community involvement;
Train 20 Community based presentation on the Heart Truth Campaign; , .
i
1
Provide regular project updates to the training subcommittee; I
Provide training agenda; I U

Provide final report on community presentations to PO. ,

i
I(
 The due dates and delivery methods for these deliverables are to be
determined following the award of this effort.

VII. INSPECTION AND ACCEPTANCE: The PO as a duly authorized abent of the

Contracting Officer is responsible for the review and acceptance of all I)
/
deliverables.
I
1
VIII. PAYMENT SCHEDULE: Within two weeks of acceptance by the PO of
services related to acquiring the trainer's names, list of program particlp'ants, and
training agenda, the Contractor shall submit a proper invoice to the PO those
services. The Contractor shall submit a proper invoice for the balance of the
proposed fee within two weeks of the PO'S acceptance of the completedl event and
final report on the .community
... presentations. ----- il - -. -.
.-
/I
IX. INVOICE SUBMISSION: Upon inspection and acceptance of delivelables,
the a n t r a c t o r shall submit an original and two copies of its proper invoices to the-
1I
PO. For payment, the PO shall submit the invoice and a signed receiving report
to: -
Department of Health & Human Services
PSC/Financial Management Service
Diyisbn of Financial Operations -
-
..
--

!
5'I
I
-m-

parkTim Building, Room 16A-12 I -- . .

5600 Fishers Lane -
Rockville, Maryland 20857
.

- -'TP;tephcjii:- (30 1) 443 -3 020 - - . :-

-1 -
. ?, - .. ---- .-
,
The invoice must contain the following minimum information: .- -- 1 -- -_ --

il
Contractor's name and address; I
-.

_ Purchase order number;

.. 1
I
--..

. ~
/I ..-.
...-
. - . . ..

/I
Description and price of services provided; /I
1
Invoice period; and
il
The Contractor's Internal Revenue Service (IRS) Taxpayer Identification
1
Number.
' . I
X. GOVERNMENT-FURNISHED MATERIALS: The Government will not
- furnish any materials to the Contractor for this requirement.
%
. I
XI. RIGHTS TO DATA: The Contractor is prohibited from using data prdduced or
obtained under this contract for any purpose without prior, written appr4val fiom
the PO. !/
I
 HHSP23320p400883P
Page 5 of 6
I
I
Upon receiving such notification fiom the Contractor. the ~ o n t r d c t i n ~
Officer shall issue an appropriate purchase order modification or advise
the Contractor in writing that, in hisher opinion, the technical
direction is within the scope of this clause and does not constitute a
I
change under the Changes Clause of the purchase order. The Contractor
shall thereupon proceed immediately with the direction given. A(
failure ofthe parties to agree upon the nature of the instruction o!
I
direction or upon the purchase order action to be taken with respect
thereto shall be subject to the provisions of the purchase order clluse
entitled "Disputes." 1I
11

XIII. POINTS OF CONTACT:

The Project Officer (PO) for this effort is:

I
. . . . : :MS.~ i c h e l l ~
k o e r s c hM.S.
, . . . . . . . . . . . . ... . . . . . . . .
~ - .. . , .. I - . . = .
.... I
Office on Women's Health . . . . . .
. . .
i
. . U S . Department.of Health and Human Services . . . I - .
. .
2 3 3 N. Michigan b . n u e ; Suite 1300 . . .
. . Ii
.
............
. .. . ,. . . .. . Chicago, Illinois-6b601. . ....................
.: . . . . . ... . . ... . . .. . .
i .
:
. .
. . . . .. . . . . . . .
. ._ . .. . . II
. . ....
- . . .
.. . ,.. ..
. . .
.
.

.
_
.
.
. . .
. . . . . Phone:,(-3w 453.8122- . . . , I - : ..;.i: .:.: >.. . . . . . ..

i- ..
.. : . . ,, . - . . . . .:.. .: . . . . . . .. . .. . . .
. . . . . . . .
1
. . . . . . . . .
. . .. . -.Fax::(3 12)'3 3-7800,..;- ~:: ........ < ',::... ...... .;.:.. .,.I.:. . . . . .. . .. .. . . . .. . .
. . . . .
1.: .... ..:. -:.::-. . . . . . . . . ......
. . . . .
.
!
--
.
.
.. . . .. . . . . . . Email:. mhoersch@,osophs.dhhs;~ov : . . . , . . ; . , . . . . .. . .. . . .
. I
. . . . . . I . .. . .
. . . . . .. .. .. . . . . -.
. . . . -..:. .- -.: :
.
. .

...
. . .
. .
.
.
. .. . . .. . . .. I . . . . . . . .
.. . . .. .. . . . .
,'
. . . .. . .. . . . . .
~

... . . . ~

.. . . . . .. . .. . .
-
..... this effortis: -
:~he-~~~f~~tii.1g'6fficer:.(~Oj1f~~ , , .
. ~
. ~ . . - - . . :. . . . . . . .
. .. . . . . . . . . . .
. .

. . . . . .Ms;-JacquelineR. .ones . . . . . . i . . . . .: . . - : . . .

Program Support Center -

U.S. Department of ~ea1t.hand Human Services

. Parklawn Building, Room 5-101 . . . . . ..

5600 Fishers Lane

.. ......... ....
~ockville,.MD 20857
Phone: (301) 443-6413
. .,Fax:(301) 443-8488

The Contract Specialist for this effort is:

Mr. Gene H. Calvert ..-.+ . .

Program Support Center

Phone: (301) 443-7077
I
 l
XIV. FAR 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)
11

This contract incorporates one or more clauses by reference, with the same I force
and effect as if they were given in fill text. Upon request, the ~ontracti&Officer
will make their full text available. Also, the full text of a clause may be Accessed
I
electronically at this/theseaddress(es): h t t p : l l ~ v . a m e t . ~ o v l f a r . j
The following FAR contract clauses are incorporated by reference:
- I
-
No. CLAUSE NO. TITLE AND DATE /
2
1. ..
-FAR 52.204-6
- - -- System . . .--7. .

(OCT 2003)
. . . . .... 2.. . . FAR 52.204-7 - . . Central Contractor
. . . . . .
. . . .

. . . . . . 3. . ~~~152-;212-1
.-. . .
... ...
Comm6rcial Items (JAN 20b4)
. . . .........
. . 4.. .:. FAR 52.2 12-4 .:-: Contract T W s and ~ondit.{ons- ...
. . : :. . .

..
. .
.- ..........
............
. .. . : ..
.'
4 &
:
- : :.1:. .. . . . Commercial:Items(OCT 2d03) . . .
. . . .

.
., .
.
. . . . . .::. .:. .
.
. . . . .. . .
5.. . . %;FAR
. 52.222-3 . . . . .. . . . .. . . . . .+;.Convicf-Labor(June 2003)/ , . . . . . . .,

. . . . . . ... .
...
'
- .. . .
. .. . . -." . < . . . . ''
, 6. : - . FAR52.222-19 ::; . i . : ; . -~hi~ld~.&or~~.o.o~eratiofi~.w~th
. . . . . . . .
... . . Authorities and Remedies ..
. . .. . .- . . . ... .. . . .
11
. ,
~

, . . . . . . .- - . .

. .:-.:. . . . . . . . ->-.-..A,.
. -. ... . . .. .
3-
. . .. . .. . . ............. (June :20M)*<:::.... ... . . . . . . . . -::/.<:;.::,.:
:: , , . . . . . . . . .-.-.:
.. . ...:. . . ........
. ............. . . ... :.:. .,. - ...
. . . . . ... . .,
7 : .. . . . FAR 52.222-2.1 - Prohibition of Segregated ~bcilities--,
-.:(.F&
. . . . .. ..

1999)-_r.,-: --
. . . . 1
. .- . .. . . .
...
~
_... . . .
. . . .
. .
. . . .. - . . . . . .. .. . . . :- .- :, ..-.. .: ...:.- .- ..

. .
8. FAR 52.222-26 Equal Opportunity (Apr 2092)
9. FAR 52.223-6 Drug Free Workplace (MAR 2001) - -..
I
-10.. FAR 52.225-1 Buy American Act-Supplies . . . .
. .-

11.
- - .-
FAR 52.225- 13
(June 2003) --
Restrictions oncertain ForCign
-!
. . .- - .. * -. - .-
Purchases (JUN 2003)
. . . 12. FAR 52.232-1 Payments (APR 1984)
13. FAR 52.232-33 Payment by Electronic Funds
Transfer-Central Contract0
Registration (Oct 2003)
14. FAR 52.233-1 Disputes (KJL 2002) ..
15. FAR 52.233-3 Protest After Award (AUG g996)

* * * END OF STATEMENT OF WORK * * *. 1

11
I
(1
 I/
Main Content
I
/
I
Page 1 of 1

Summary Report
Requested by: JULIA SAVOY
Award Number: HHSP23320042807MB
Award Date: 08!26/2004
EffectiveDate: 08/26/2004
Expiration Date: 09/30/2004 -
Closeout Date: - ..
Period of Performance: 10/01/2003 to 09/30/2004
Vendor: 165567914 ROBJN L. CLEMENS
Contact:
Phone: 717-236-6850
Buyer: JULIA SAVOY - -
Phone: 30;-4-43-1386
Contracting Officer: JULIASAVOY
Phone: -301-443-1386
Minimum Amount Per Call: $0.00
Maximum Amount Per Call: $0.00 .
Total Calls Not to Exceed: $195,000.00
Number of Modifications: 5
Last Modification Date: 08/26/2004
Modification ~umb&\b005
Invoiced Amount: $0.00

-+
,..--
: . ;.. -
..-
Call Summary
Order Number Award Date Buyer . Total Amount Total Obligation '
Amount -- -_ I1, -- --
:

1
-'

00 JO LASKO $0.00 $0.00

00 1 JO LASKO $1 1,000.00
002 JULIA SAVOY $20,900.00
003 JULIA C SAVOY
004 JULIA C SAVOY
005 JULIA SAVOY
006 JULIA SAVOY
007 JULIA SAVOY
008 JULIA SAVOY
009 JULIA SAVOY
010 JULIA SAVOY
01 1 JULIA SAVOY .
012 JULIA SAVOY
013 JULIA SAVOY
- %
Totals

Total Number of Orders: i,:

 ORDER FOR SUPPLIES OR SERVICES
II 1 Phi:
'-- CZ F A Z E

IMPORTANT: Mark all acka es and apers with contract andlor order numbers 1 1 1 I - 7

----I--
- L

1 DATE OF OPDER 2 CONTRACT NO (If any) 6 SHIP TO /I

HHSP23220042807MB
10/30/2003 I a NAME OF CONSIGNEE
- 1
3 ORDER NO 4 REQUISlTlOhUREFERENCE NO
SAMHSA/OA
00
5 ISSUING OFFICE (Address correspondence to)
DHHS/PSC/AOS/DAM
b STREET ADDRESS
PARKLAWN BLDG . , ROOM 6 - 101
/I
PARKLAWN BUILDING, ROOM 5 -101 5600 FISHERS LANE i/Il
5600 FISHERS LANE
ROCKVILLE MD 20857
I
- -
c CIW
I1 d STATE e ZIP CODE

7 TO
ROCKVILLE
f SHIP VIA
/ 20857

a NAME OF CONTRACTOR
ROBIN L. CLEMENS? 8.TYPE OF ORDER /
.-
b. COMPANY NAME
\ [?a PURCHASE M_i b. DELIVERY
c STREET ADDRESS
3205 NORTH FRONT STREET - . .
.-
. .,

-
.

/-
. -
REFERENCE YOUR
----
... .~:.
I-
E x g p l for blldng ~ n s & n i m s c n the
-
---
<%wse, U - 6 dellwry order IS .
APT. # 5 ?ubject to ~ n s v u n t wcmra~nedm
thjs side m l y d this form and IS
Please furnish lhe f d l o l n g M me lm /sued subjecl to the [ems and
and c ~ d i t l m specified
u on both s~desof & n d ~ t O( i ~me above-numbem
~ ~~

1
this a d e r a n d M the anached sheels, if
d ClW e. STATE 1. ZIP CODE
any, including dellvery a s lndicaled.
KARRISBURG PA 17110
9. ACCOUNTING AND APPROPRIATIONS DATA 10 REQUISITIONING OFFICE
SAMHSA/OC
11. BUSINESS CLASSIFICATION (Check appropriate box(es)) ?I
I$ a. SMALL ,C .a b. OTHER THAN SMALL C. DISADVANTAGED d WOMEN-OWNED

12. F 0.B POINT Destination

.~..
14 GOVERNMENT B/UNO. 15. DELIVER TO F.O.B. POINT
ON OR BEFORE (Date)
//II 16. DISCOUNT TERMS

13 PLACE OF 1
Net 15

1
09/30/2004
a INSPECTION Ib ACCEPTANCE
-
Destination Destirfi3tl6'n ' +
17 SCHEDULE (See reverse for Relections) 1
UNIT QUANTITY
ACCEFTED
(a) (b)

A Tax ID Number
DUNS Number:
CAN: OOOODOO Ob]. Class:' 0000 FY: 2004
Period of Performance:

If you have questions,

I I I I 1 I
18 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO 17(h)
I TOTAL

21 MAIL INVOICE TO

a NAME PSCIFMS (301) 443-3020

SEE BILLING
INSTRUCTIONS b. STREET ADDRESS PARKLkWN BUILDING, ROOM 16A-12
ON REVERSE (or.P.0. Box) 5600 FISHERS LANE 17(1).
GRAND
TOTAL

-
1 ROCKVILLE
22 UNITED STATES OF AMERICA
1 d STATE

MD 1
1
e ZIP CODE

20857
23 NAME (Typed)
$0.00

BY (S~gnalure)
) CIRIGNAL SIGNED TITLE LASKO
JOCONTRACTIN~ORDERINGOFFICER I
NSN 754041-152-8083
PREVIOUS EDITION NOT USABLE
 I
--
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION-
IMPORTANT: Mark all packages and papen w~thcontract andlor order numbers
jI2I PAGE O r GASES

1 , :

DATEOFORDER

ITEM NO
CONTRACTNO

10/30/2003 HHSP23320042807MB
SUPPLIEYSERVIC~S OUANTITY UNIT UNIT
ORDER NO
00 I
AMO~NT auib.~!~~
ORDERED PRICE A~CEDTE>
(A1 (B) :C1 (Dl (E) (Fl (G)

1 Renew Blanket Purchase Agreement for the

period October 1, 2003 through September
1
!I
000

30, 2004.
1
1I

IMPORTANT NOTE: FROM i0418M TO HHSP2312001280~WB.

YOUR BPA NUMBER HAS C ~ G E D
1
This BPA is for speech writing and editorial servi :es for the SAMH,;A ~dmihstratcr
on an as needed basis. . ilI

the following authorized callers:

Mark Weber and-Daryl -Kade--

Call Limitation: $2500.00

invoices for payment.

A. Name of Supplier

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H))

NSN 754001-152-8082 50348 I D ! 1
I OPTIONAL FORM 344 (b-51

/i R..oOsd by Gs.
FAR (48 CFRI5311XCI
!
 I
I

ORDER FOR SUPPLIES OR SERVICES 1 1 , PAGE CF C ~ E L I

SCHEDULE CONTINUATION - I j'3 10

IMPORTANT: M a h all packages and papers wlth mntran andlor order numbers I
I
DATE OF ORDER CONTRACT NO. ORDER NO
10/30/2003 HHSP23320042807MB 00
\ ITEM NO SUPPLlESiSERVlCES QUANTITY UNIT UNIT , AMO& OU;h'iiT?
ORDERED PRICE ACZSDTEG
(A) (B) (C) (D) (E) 1F1) !G:
C.
D.
E.
F.
Date of purchase
Call order number
An itemized list of supplies or services fu:-nished .. ,
Quantity,unit price & extension of each .ten, less applizable discounts
'1
I
.,
G. Date of delivef-y
7. Services/supplies not covered by Block #17 of :hi:; BPA shall not be procured
I
under this BPA. In doubtful cases, the Contractor is encouraged t, confer'with tte
Contracting Officer prior to performing any servic2s or providing iny articles in
I
quest ion.

. .
--

(A) METHOD OF PAYMENT. (1) ALL- PAYMENTS BY

>.

EITHER -
THE CONTRACTOR A G R & ~ ~ O .
(I) ACCEPT PAYMENT BY CHECK OR SOME OTHER

-- .-
--

-- -. .

PENALTIES APPLY.
(E) LIABILITY FOR UNCOMPLETED OR ERRONEOUS
ERRONEOUS TRANSFER OCCURS BECAUSE THE GOVE

(11) PAYING ANY PROMPT PAYMENT PENALTY DUE;

continued . . .

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) I/

NSN 756&01-152 8082 5
aw 101 I O P ~ O M LFORM ud IRH a 5 1

1 R
-
FAR148
b"Gyl
CFRI 51 113lcI

I
 I
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION -
IMPORTANT Mark all padrages and papers wltn contract andlw order numbers
II
1 4
PAC O= ?-CEC

I - -L

I
DATEOFORDER CONTRACTNO ORDER NO
10/30/2003 ~ ~ ~ ~ 2 3 3 2 0 0 4 2 8 0 7 ~ ~ 00

Ah'3T au~~.-,-\
ITEM NO SUPPLIEYSERVICES QUANTITY UNIT UNIT
ORDERED PRICE ACCEFTEI
(A) (6) (C) (D) (El <G

(111) RECOVERING ANY ERRONEOUSLY DIRECTED FUDS.

( 2 ) IF AN UNCOMPLETED OR ERRONEOUS TRANSFER 3CCURS BECXUSE THE CON'7RACTOR'S EFT
8.
INFORMATION WAS INCORRECT, OR WAS REVISED WITHIN 3 1 DirYS OF GOVERKdENT RELEASE OF
THE EFT PAYMENT TRANSACTION INSTRUCTION TO TXE F E D ~ F W IRESERVE SYSa-EM,
AND/-
(1) IF THE FUNDS ARE NO LONGER UNDER THE CONTROL OF T1.E PAYMENT OF'ICE, THY
GOVERNMENT IS DEEMED TO HAVE MADE PAYMENT AND THE ZOKIRACTOR IS REjPONSIBLE FOR
RECOVERY OF ANY ERRONEOUSLY DIRECTED FUNDS; 3R
(11) IF THE FUNDS REMAIN UNDER THE CONTROL OF THE 'AITIENT OFFICE, THE GOVERNMENT
I
SHALL NOT MAKE PAYMENT, AND THE PROVISIO~SOF PARA:RA.)H (D) OF THI,; CLAUSE SHALL
APPLY.
(F) EFT AND PROMPT PAYMENT. A PAYMENT SHALL BE DEE4ED TO HAVE BEEN MADE I N , A TIMELY
MANNER IN ACCORDANCE WITH THE PROMPT PAYMENT TERMS OF THIS CONTRAC': IF, IN EFT
= ITHE --
PAYMENT TRANSACTION IFISTRUCTlON RELEASED TO THE FE.IERIL RESERVE SY,;TEM, --DATE
SPECIFIED FOR SETTLEMENT OF THE PAYMENT IS ON OR B.:FOILETHE PROMPT PAYMENT DATE, /IDUE
PROVIDED THE SPECIFIED PAYMENT DATE IS A VALID DAT: WDER THE RULE,; OF THE /FEDERAL
RESERVE SYSTEM. 1
(GI EFT AND ASSIGNMENT OF CLAIMS. IF THE CONIRACTO:? XiSIGNS THE PROCEEDS OF;THIS
CONTRACT AS PROVIDED FOR IN THE
CONTRACTOR SHALL REQUIRE AS A CONDITION OF ANY
SHALL REGISTER SEPARATELY IN THE CCR DATABASE
ACCORDANCE WITH THE TERMS OF THIS CLAUSE. NOTWI
THIS CONTRACT, PAYMENT-TO AN UL
FINANCIAL INSTITUTIO? PROPERLY
SUBPART 32.8, IS NOT PERMITTED. IN ALL RESPEZT
SHALL APPLY TO THE ASSIGNEE AS

ABSENCE OF A PROPER
_- ASSIG~ENT
THE ULTIMATE RECIPIENT OF THE T
* L C
---- -
EFT INFORMATION WITHIN THE MEAN
(H) LIABILITY FOR CHANGE OF EFT
NOT LIABLE FOR ERRORS RESULTING
CONTRACTOR'S FINANCIkL AGENT.<P>
(I) PAYMENT INFORMATION. THE PAYMENT OR DISB
CONTRACTOR4VAILABLE PAYMENT INFORMATION THA
DATE OF RELEASE OF THE EFT INST
MAY REQUEST THFCONTRACTOR TO DESIGNATE A
OF PAYMENT INFORMATION FROM A L
CAPABLE OF EXECUTING. HOWEVER, THE GOVERNMENT DOES NO:' GUARANTEE T:WT ANY PFTICULAR
FORMAT OR METHOD OF DELIVERY IS AVAILABLE AT ANY P.ZRT::CULARPAYMEN'? OFFICE P D
RETAINS THE LATITUDE TO USE THE FORMAT AND DELIVER[ M~THODMOST CUJVENIENT O; THE
GOVERNMENT. IF THE GOVERNMENT MAKES PAYMENT BY CHETK :N ACCORDANCE WITH P Y G R A P H
(A) OF THIS CLAUSE, THE GOVERNMENT SHALL MAIL THE ?AYr'IENT1NFORMAT:ON TO THE
REMITTANCE ADDRESS CONTAINED IN THE CCR DATABASE.
(END OF CLAUSE)

52.204-7 CENTRAL CONTRACTOR REGISTRATION. (3CT 2013)

AS PRESCRIBED IN 4.1104, USE THE FOLLOWING CLAUSE:
Continued . . .

I,

/-
I
il
1
I
li
TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) i
NSN 754&01-152-8082 50246101
1 OPnONAL FORM U( ( R r &951

1 R.urDcd by G Y
FI\R141 C F R 1 5 3 2 l l c :
1
 1
i
psr, 5- ' ; C 5
ORDER FOR SLIPPLIES OR SERVICES
SCHEDULE - CON'TINUA'I'ION I
8 --
. ^

IMPORTANT Mark ail pa&ages and papers wltn m n v a n anuor order numbers 1
1
DATEOFORDER CONTRACTNO ORDER NO
10/30/2003 I HHSP23320042807MB I
00
I
ITEM NO SUPPLIEYSERVICES QUANTITY UNIT UNIT AhQUhT OUAk-IT,
ORDERED PRICE ACC5qTE3
(A1 (6) (Cl (01 !El IF1 tG

CENTRAL CONTRACTOR REGISTRATION (OCT 2003)- $1

(A) DEFINITIONS. AS USED IN THIS CLAUSE--
CENTRAL CONTNCTOR REGISTRATION (CCR ) DATAB9SE M E W S THE PRIMARY GOVERNMENT
REPOSITORY FOR CONTRACTOR INFORMATION REQUIRED FOR TH.: CONDUCT OF :3USINESS'WITH TEE
GOVERNMENT.
DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER MEAN; T .E 9-DIGIT NLT4BER ASSIGNED BY
DUN AND BRADSTREET, INC. (D&B) TO IDENTIFY U\JIQUE.3US::NESS ENTITIES.
DATA UNIVERSAL NUMBERING SYSTEM +4 (DUNS;+4) . W B E R MEiNS THE DUNS IJUMBER ASSIGNED BY
3&L!PLUS A 4 -CHARACTER SUFFIX THAT MAY BE ASSIGNED BY A BUSINESS CIINCERN. (D&B HAS

* .ACTI'JE ' ' .

PERFORMANCE, AND THROUGH FINAL PAYMENT OF

(1) AN OFFEROR MAY OBTAIN A DUNS NUMBER--

BRADSTREET OFFICE.

( I ) COMPANY LEGAL BUSINESS.

RECOGNIZED.

(IV) COMPANY MAILING ADDRESS, CITY, STATE

(V) COMPANY TELEPHONE NUMBER.
(VI) DATE THE COMPANY WAS STARTED.
(VII) NUMBER OF EMPLOYEES AT YOUR LOCATION.
(VIII) CHIEF EXECUTIVE OFFICER/KEY MANAGER.
(1x1 LINE OF BUSINESS (INDUSTRY).

Continued ...

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)1 I

NSN 754C-01 152 BOB2 SOY8 101 OPTIONAL FORM l4M I R n 6'351
F 7 . d b" Gsa
FARI48CFR)53213(c)
 ORDER FOR SUPPLIES OR SERVICES / PAGE 0- PAGES

IMPORTANT: Mark all packages and papen with mnuacl andla order numbers 1
DATEOFORDER CONTRACTNO

1 0 / 3 0 / 2 0 0 3 HHSP23320042807MB
ORDER NO
00 I

( 2 ) THE COWfRACTOR SHALL NOT CHANGE THE

CLAUSE OF THIS CONT&CT.

1 - 8 8 8 - 2 2 7 - 2 4 2 3 , OR 2 6 9 - 9 6 1 - 5 7 5 7 .
(END OF CLAUSE)

continued ...

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) /

NSN 754&01-152.8082 $3~.101 1
I OPTIONAL FORM 2.48 Ir(n -51

!i R . d b" GSPi
F A R ( I 8 CFRI53 I l X r i
 ORDER FOR SUPPLIES OR SERVICES PAGE OF DA,GES

-
SCHEDULE CONTINUATION w;

12724, 13059, 13067, 13121, 13129).

(V) 52.233-3, PROTEST AFTER AWARD (AUG 19
(2) LISTED BELOW ARE ADDITIONAL CLAUSEST
(I) 52.232-1, P A Y M E ~ S ' ~ ( A P R ~ ? ~- -~ ~ ) :
---
. -
..

(11) 52.232-8, DISCOUNTS FOR PROMPT PAYME

(111) 52.232-11, EXTRAS (APR 1984) .
(IV) 52.232-25, PROMPT PAYMENT (FEB 2002).
(V) 52.233-1, DISPUTES (JUL 20.02).
(VI: 52.244-6, SUBCONTRACTS FOR COMMERCIAL
(VII) 52.253-1, COMPUTER GENERATED FORMS (
(B) THE CONTRACTOR SHALL COMPLY WITH THE F
REFERENCE, UNLESS THE CIRCUMSTANCES DO NOT
(1) THE CLAUSES LI&~.BELOW IMPLEMENT PRO
(I) 52.222-19, CHILD LABOR--COOPERATIONWI
(E.O. 13126) . (APPLIES TO CONTRACTS FOR SU . .
THRESHOLD.)
.: .. . -- .

U.S. VIRGIN ISLANDS).

(111) 52.222-35, EQUAL OPPORTUNITY FOR SFE
VIETNAM ERA, AND OTHER ELIGIBLE'VETERANS (
C0N''RACTS OF $25,000 OR MORE) . .

.~ .
. .. - .

VIRGIN ISLANDS, AND WAKE ISLAND.)

CONTRACTS OF $25,000 OR MORE).

TOTAL CARRIED FORWARD TO I S T PAGE (ITEM 171H))

!
NSN 7540.01-152.8082 YIYB.101 OPTIONAL FORM Ma ill- 6%)
R . L . ~b" G s
FAR148 CFR153 2131ri
 ORDER FOR SUPPLIES OR SERVICES 1 1 PAGE c; ~ 4 ~ : s
SCHEDULE CONTINUATION - 1 6 -.,-
IMPORTANT: Mark all packages and papers w ~ l hw n t r a n and/or order numbers 1
DATE OF ORDER

10/30/2003
CONTRACT NO
HHSP23320042807MB
SUPPLIE3SERVICES
ORDER NO

00 I
.CI I T I E S ) .
004) ( 4 1 U.S.C. 1 0 A - 10D)'I (APPL
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CENTRAL CON RACTOF!
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-7

( X ) 5 2 . 2 3 2 - 3 4 , PAYMENT BY ELECTRONIC FUNDS NTRU C O ~ R A C T

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j
PAYMENT O F F I C E DOES NOT U S E THE CCR DATAE 1NFORMAT;ION. )
, VZSSELS/ (APR
EAN VESSlELS
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I N G WITH;
II
9 5 ) ( A P P L I E S 'I

SUPPLIES) .
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li

F . 0. B. DESTINATION) .
>IE
t TO S U P P L I E S I F DELIVERY I S
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AND E F F E C T A S
I!
: WILL MAKE THE
:D E L E C - T ~ ~ N I C A I
AT T H I S / T H E S E A D D R E S S ( E S ) :
- -
II! -
[ I N S E R T ONE OR MORE INTERNET ADDRESSES] (1
1

i
JDE FOR ACCEPT? ICE ONLY (THOSE
'RA T . THE GOVEF IMENT RESILRVES/I
'HA HAVE BEEN 'I :NDERED FOR
II
:P CEMENT O F NC JCONFORM ING
; A NO INCREASE I N C O N T Y C T
iNC R I G H T S - /I
CFE T WAS D I S C O 1
HAVE BEEN DISCOVERED; AND

CHANGE I S DUE TO THE DEFECT I N THE I T E M . T

J D I I O N O F THE I

Continued ...
AE

I OR DEFAULT I

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) 1

NSN 754C-01-152-8082 Y)YbtOI ;I O P l W M A L FDRM M i R u M S )
 ORDER FOR SLIPPLIES OR SERVICES
, I~IPAGE
C= PAGE5

SCHEDULE - CONTINUATION
II

SHALL REMEDY SUCH OCCURRENCE WITH A L L R T

HEREOF, FOR CAUSE I S T H E EVENT O F ANY D E F

-- ..

CONTRACT FOR DEFAULT, SUCH TERMINATION S

(END OF CLAUSE)'-
NOTICE. ..

ORDER. CONTACTS ARE AS FOLLOWS:

PSC JEANETTE PANG (301) 443-3020
FDA DAVID CAINE (301) 827-5090
CDC. PATTY EVERETTE (404) 639-7441"
NIH --MICHELLE SHORTER (301) 496-6088
Continued ...

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) I

NSN 7540-01-152-8082 5QYClOI I OPTIONAL FORM 2 4 I& h95,
:I R.wrM by G S
!i FARIdB C F R i 5 3 2 l Y ~ )

iI
~i
 ORDER FOR SLIPPLIES OR SERVICES
SCHEDULE - CONTINUATION

MS) (JUNE 2003)

NOTICE. . .

NTACTS ARE AS FOLLOWS:

C JEANETTE PANG (301) 443-3020
A DAVID CAINE (301) 827-5090
C CUSTOMER SERVICE --4404) 687-6666
H MICHELLE SHORTER (301) 456-6088

TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) 1

NSN 754001-152-8082 %Ha-I01 11 OPTIONAL FORM 344 ( R n b95!
Reurcde)~ GSA

I
II
FAR 148 CFR) 53 2(3!cl
g 1 PAGf QZ 2;;:s

IMPORTANT: M a r k a l l packages a n d papers with c o n t r a c t and/or o r d e r n u m b e r s 1 I 1

1 DATE OF ORDER 2 CONTRACT NO (Ilany) 6 SHIPTO I
HHSP23320042807MB
12/02/2003 a NAME OF CONSIGNEE
I
3 ORDER NO

001
5 ISSUING OFFICE (Address conespondence lo)
DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
b STREET ADDRESS
PARKLAWN BLDG . , ROOM 6 - 101
5600 FISHERS LANE I
;I

5600 FISHERS LANE

ROCKVILLE MD 20857
c CITY d STATE e ZIP CODE
ROCKVILLE MD 20857
7 TO. f SHIP VIA
a NAME OF CONTRACTOR 1/
ROBIN L . CLEMENS 8 TYPE OF ORDER !
b COMPANY NAME m a . PURCHASE @ b DELNERY
- . , - REFERENCE YOUR
!I
c STREET ADDRESS /I
Except for btll~ng~nstruhonson the
3205 NORTH FRONT STREET. - 2 - -- - 7 . . . . . , -
w e . ltus dellvery order IS -
-~.
.. --
APT. # 5
Please furnish the fdlcming on me terms
and m d ~ t ~ o speafied
ns on bom sldes of
th~sOrder and on the attached sheets. 11 &ntma
d CITY e STATE f ZIP CODE
HARRISBL'YG PA 17110
any, lndud~ngdellvery as lndlcaled
1
9 ACCOUNTIkG AND APPROPRIATIONS DATA 10 REQUISITIONING OFFICE i/
7541362 SAMHSA/OC I
11

11 BUSINESS CLASSIFICATION (Check appmpriale box(esjj 1

I? U
a SMALL

12 F 0 B POINT Destination
. b OTHER THAN SMALL

14 GOVERNMENT BlVNO
c DISADVANTAGED

15 DELIVER TO F 0 B POINT
d WOMEN-OWNED

ON OR BEFORE (Dale)
13 PLACE OF
. -
Net 3G
a INSPECTION ( b . ACCEPTANCE 1 'I
Destination Destination -., 4 -. . . .

17 SCHEDULE (Seereverse lor Rejeclionsj I/

I 1
QUANTITY QUANTITY
ITEM NO SUPPLIESOR SERVICES ORDERED UNll PRICE ACCEPTED
(a) (b) (c) (d) ::u
, (g)
Tax ID Number:
'DUNS Number: N ;-L1
,:AN: C96A5Q0 Obi. Class: 2522 FY: 2004
Perlod of Performance: 10/01/2003 to 09/30/2004
- --
1 5 CALLS COMPLETED FOR THE MONTH OF OCTOBER
continued . . .

18 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO 17(h)

TOTAL
(Con1
pages)
21 MAIL INVOICE TO

a. NAME

SEE BILUNG -

INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12

O N REVERSE (or P.0. Box) 5600FISHERSLANE .'
17(1) ,
GRAND

c ClTY

ROCKVILLE
22 UNITED STATES OF A ~ ~ E R ~ C A
1 d. STATE

MD
e. ZIP COCE

20857
23 NAME (Typed) /II

BY (Slgnalurej
) ORIGINAL SIGNED JO LASKO
TITLE CONTRACTING'ORDERING OFFICER
I
NSN 751&01.152-8083 OPTIONAL FORM 347 (bb 3 5 1

PREVIOUS EDITION NOT USABLE R . d b y G W A R ( 4 I C F R I 53213.1

 TOTAL CARRIED FORWARD TO (ST PAGE (ITEM 17IH)) /I
1

NSN 754C-01.152-8082 Y)M.IOI OPTlONAL FORM W IRW 6951

R . . d b"OM
I! FAR(&5CFR)S3 212+)
E
 0
ORDER FOR SUPPLIES OR SERVICES ( I Dr;E ,^= C - 2 5 :

IMPORTANT Mark all packages a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e r s i i '

1 DATE OF ORDER 2 CONTRACT NO (If any) 5 SHIP TO 1
MSP23320042807MB )a NAME OF CONSIGNEE
01/08/2004 1
3 ORDER NO 4 REOUlSlTlONiREFERENCE NO
SAMHSA/OA
003
5 ISSUING OFFICE (Address correspondence to) b STREET ADDRESS
DHHS/PSC/AOS/DAM PARKLAWN BLDG . , ROOM 6 - 101
PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE
5600 FISHERS LANE
ROCKVILLE MD 20857
- - c ClTY
ROCKVILLE
7 TO f SHIP VIA
a NAME OF CONTPACTOR I
ROBIN L. CLEMENS 8. TYPE OF ORDER !/
b COMPANY NAME b. DELIVE*

c STREET ADDRESS REFERENCE YOUR:

. - t &llong i n s t G ~ m m
~ ? c e pfor s the
3205 NORTH FRONT STREET .. __=. . . - - th!s ael~veryorder IS
!Iverse. --
..
.- --
.
APT. # 5 skbjecl to ~nslrudimsmn1arne3a,
Itis srde m l y ol lhts lm and 1s
Please furnish the ldlomng on the terms i<sueci sualecl lo Ine terms and
and c o n d i t i w specified on both sides ol I d b n d i l l w of lhe abovenumbered
I
this Order and on the anached sheets. lf contract
d CITY e STATE f ZIP CODE
any, lnciudlng dellvery as l n d ~ e t e d !
HARRISRURG PA 17110 I!
9. ACCOUNTING AND APPROPRIATIONS DATP. 1 10. REOUlSlTlONlNG OFFICE 1
?541362 SAMHSA/OC 11I
11 BUSINESS CLASSIFICATION (Check appropriate box(es)) 1
a. SMALL

12. F.O.B. POINT Destination

-.a--
,>;, b. OTHER THAN SMALL

14. GOVERNMENT B/L/NO.

c. DISADVANTAGED

15. DELIVER TO F.0.B POINT iI

d. WOMEN-OWNED

16. D I Y ~ U N T
TERMS
ON OR BEFORE (Date) -
... .
13 PLACE OF
Net 30
a INSPECTION b ACCEPTANCE
Destifiation I DesLination ...- II -. . . ----.
.

/I
17. SCHEDULE (See reverse for Rejectfons) i
ITEM NO SUPPLIE9OR SERVICES
QUANTITY
ORDERED UNIT
UNIT
PRICE .-
--
..- AMBOW-.
1 OUANTITY
ACCEPTED
(a) (b) (c) (d) (el (f)1 (g)

Tax ID Number 1
DUNS Number:
CAV: C96A5.QO OD> class. ---L FY: 2004
I. i ..
..
Period of Performance: 10/01/2003 to 09/30/2004
-. --.
i
1 5CALLS COMPLETED FOR THE MONTH OF DECEMBER
Continued . . .
I I I I
I
17(h).
i s SHIPPING POINT. 19. GROSS SHIPPING WEIGHT 20 INVOICE NO.
I TOTAL

21 MAIL INVOICE TO

a NAME PSC/FMS (301) 443-3020

SEE BILLING
INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or p,O Box) 5600 FISHERS LANE "

I
c. CITY
.-
d. STPTE e. ZIP CODE $12,500.05)
I TOTAL

4
ROCKVILLE
22 UNITED STATES OF AMERICA
BY (Slgnafure)
.A ) /7 - MD 20857
1 23. NAME (Typed)
JULIA C. SAVOY
11
I
I
TITLE: CONTRACTINWORDERING OFFICER

NSN 754001-152-8083 OPTIONAL FORM 34l I R m 655)

PREVIOUS EDITION NOTUSABLE ~.,-b~cswmtr8 VRI ~z1x.1

!
 TOTAL CARRIED FORWARD TO tST PAGE (ITEM 17(H))
NSN 7540-01-152-8082 YIM-101
! OPTIONAL FORM IN 1R.r -51
R.um.d b" GLn
FAR140 C F R J 5 3 2>)(c)
 :f': /I
ORDER FOR SUPPLIES OR SERVICES 1 / FACIE @= F;;ES
I
IMPORTANT. M a r k a l l p a c k a g e s a n d p a p e r s with c o n t r a e l a n d l o r o r d e r n u m b e r s ! 1 '
1 DATE OF ORDER 2 CONTRACT NO (11 any) 6 SHlP TO I
HHSP23320042807MB
02/04/2004 a NAME OF CONSIGNEE
I
3 ORDER NO 4 REQUISITIONREFERENCE NO

004
5 ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS
DHHS/PSC/AOS/DAM PARKLAWN BLDG., ROOM 6-101
PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE
5600 FISHERS LANE
ROCKVILLE MD 20857 il
- .
c. CITY
ROCKVILLE 1
I 1 d STATE
1 MD
e. ZIP CODE
120857
7 TO f SHIP VIA
a NAME OF CONTRACTOR
ROBIN L. CLEMENS 8 TYPE OF ORDER 1
b COMPANY NAME I O a PURCHASE

c. STREET ADDRESS - .. , REFERENCE YOUR:

.
3205 NORTH FRONT STREET. -
. .
.
. - -- . .
-.-
- .. .
...- .-
Except f a billing 1nsl6ci1onsM the
--
.
...
--
APT. # 5
Please furnlsh the I d l w i n g on the terms
and ~ o n d ~ t ~ spenfied
ons o n both s!deS of
this Order and on the altaded sheets, if mntracl.
d CITY e STATE f ZIP CODE
any. including dellvery as I n d ~ e t e d .
HARRISBURG PA 17110
9 ACCOUNTING AND APPROPRIATIONS DATA 10. REQUISITIONING OFFICE
SAMHSA/OC
11 BUSINESS CLASSIFICATION (Check appropnale box(es)) !I
-.. 17 .
7

L! a. SMALL
- b. OTHER THAN SMALL c DISDVANTAGED d WOMENaWNED

1 16. DlSC.OUNT TERMS

12 F O.B. POINT Destination 14. GOVERNMENT B U N O . 15 DELIVER TO F.O.B. P O l N l

.. - ON OR BEFORE (Date] . -
13 PLACE OF
01/31/2004 Net 30
a. INSPECTION
Destination
b. ACCEPTANCE
DestB.na.Lion.,
i . . - - ..
I 7 SCHEDULE (See reverse lor Rejections) I
ITEM NO. SUPPLIESOR SERVICES
QUANTITY
ORDERED UNIT
UNIT
PRICE
. ..-
- A M ~ N
il QUANTITY
ACCEPTED
(c) (d) (el
Tax ID Number
DUNS Number:
CAN: C96A5QO UUJ. class: 2522 FY: 2004

1 4 CALLS COMPLETED FOR-THE MONTH OF JANUARY

2004
Continued . . .

I9 GROSS SHIPPING WEIGHT 2 0 . INVOICE NO.

I
-

PSC/FMS
I
21 MAIL INVOICE TO

1301) 443-3020
I
a NAME
.. .$0.00
.
SEE BILLING
INSTRUCTIONS b STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or P.0 BOX) 5600 FISHERS LANE 770)
GRAND
TOTAL
il
c. CITY d. STATE e. ZIP CODE $9,300.00
ROCKVILLE MD 20857
(i
22. UNITED STATES OF AMERICA 23. NAME (Twed)
i/
I

BY (Signature) -JULIA C. SAVOY

TITLE- CONTRACTIN~ORDERINGOFF!CER
NSN 754001-152-8083 OPTIONAL FORM 347 I R r r M 5 i
1
PREVIOUS EDITION NOT USABLE
I
 . .
1
I

ORDER FOR SUPPLIES OR SERVICES .-.z

-. -.---
--c=>

IMPORTANT: Mark all packages and papers with contract andlor order numbers
I
j/ i 1 i

1 DATE OF ORDER 2. CONTRACT NO. (If any) 6.SHIP TO. 1

HHSP23320042807MB a NAME OF CONSIGNEE
12/02/2003
I
3 ORDER NO 4 REQUISITIONREFERENCE NO
I
002
5 ISSUING OFFICE (Address conespondence lo)
SAMHSA/OA

b STREET ADDRESS
II
DHHS/PSC/AOS/DAM PARKLAWN BLDG . , ROOM 6 - 101 1
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
5600 FISHERS LANE
1
I/
ROCKVILLE MD 20857

1 C. ClTY
ROCKVILLE
f. SHIP VIA ;I
1
7 TO:
a. NAME OF CONTRACTOR
ROBIN L. CLEMENS 8.TYPE OF ORDER (/
b COMPANY NAME

c. STREET ADDRESS
3205 NORTH FRONT STREET - .
.
..
-
.
~

- /-
.- 1 n a PURCHASE
REFERENCEYOUR
/@ b. DELIVER^

Excepl lor blll~ngI N W > I ~ S

.
v l ~ sdellvery W e r IS
cm Ine
..
--
-.
1
~

APT. # 5
thls S~deonly of lhls form and IS
m the lerms
Please furnish the f d l m ~ r g tisued subjea lo the lerms and
and c m d ~ b wspedhed cm bolh sldes of dbnd~l~onsol lhe above-numbered
1h1sOrder and m the anached sheers, Cf Contract
d. CITY e. STATE f. ZIP CODE
any, indudlng dellvery as indlcaled
HARRISBURG
- PA ,17110
9 ACCOUNTING AND APPROPRIATIONS DATA 10. REQUISITIONING OFFICE

7541362 SAMHSAiOC
- -

11 BUSINESS CLASSIFICATION (Check appmpnale box(es)) 1

n a SMALL b OTHER THAN s w L L U c DISADVANTAGED d WOMEN-OWNED

I1
.,I,

=
12 F o B POINT Destlnation 14 GOVERNMENT B ~ O 15 DELIVER TO F o B POINT 16 DISCOUNT TERMS
ON OR BEFORE (Dale)
13 PLACE OF .... I Net 30
a. INSPECTION Ib. ACCEPTANCE f
Destination I Dest-im ...,- 1I ..
- ... . -- ...
17. SCHEDULE (See reverse lor Rq'ections) 1I
ITEM NO. SUPPLIESOR SERVICES, /:::::I I
(C)
' "Nml
04 1
UNIT
PRICE
(el
.= A
i
cn !
M --
QUANTITY
ACCEPTED
(g)

DUNS Nurnbe r :
CAN: C96A500 .C,, class: 2522 FY: 2004 . ..
...
Period of-Performance: 10/01/2003 to 09/30/2304
-. --.-
1 9 CALLS COMPLETED FOR THE MONTH OF
Continued . . .

SEE BILLING
INSTRUCTIONS b STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or P 0 Box) 5600 FISHERS LANE
I1 17(1)
GRAND
TOTAL
I

c CITY
ROCKVILLE
d STATE
MD
e ZIP CODE
20857
$20.90~0.00
1 4
22 UNITED STATES OF AMERICA 23 NAME (Typed) (I
I
BY (SfgnalureJ JULIA C. SAVOY I
TITLE CONTRACTINOORDERINGOFFICER
NSN 754G01-152-8083 1 O W N A L F M M lll b 6351

PREVIOUS EDITION NOT USABLE R-D~GW~AMI WRI 5111Y.l

U
11
 ORDER FOR SUPPLIES OR SERVlCES 1 c z -.---
r-..,t>

IMPORTANT: Mark a l l p a c k a g e s a n d p a p e r s with c o n t r a c t a n d l o r o r d e r numbers ] ! -

2 i -
6 SHIP TO 1
a NAME OF CONSIGNEE

3. ORDER NO.

005
4 REQUISITIONREFERENCE NG
1 o m s /s m s A / o c
I/
5 ISSUING OFFICE (Address correspondence lo) b STREET ADDRESS
DHHS/PSC/AOS/DAM FARKLAWN BUILDING, ROOM 13C-05 /
PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE ./
. .
5600 FISHERS LANE !:II
ROCKVILLE MD 20857
.. .. c. CITY
ROCKVILLE
11 L STATE
MD
e. ZIP CODE
20857
7 TO f. SHIP VIA
!I
a. NAME OF CONTRACTOR
.. I
ROBIN L. CLEMENS 8 TYPE OF ORDER
b COMPANY NAME O a PURCHASE / b DELIVERY-
- .. . .. . REFERENCE YOUR
c. STREET ADDRESS . .- fa bill~ngi n s l r u f i w on the
3205 NORTH FRONT STREET , .. . . . . .. . . .. - --
--:.-.. - e.-Kh~sdel~vevader IS
APT. # 5 suijject to 1n5trua~ons mta~ned on
thl! Side 04" d lhls lam and 1s
Please furnish the fdlowing on the terms ~ssbedsublecl to the lerms and
and c ~ ~ t ~ specified
c n s on both s m s of
this Order and on Ihe anadwd sheell, if
I miidtr~onsof the aDove4umbered
d CITY e STATE I.ZIP CODE antract
KWRISBURG
any, tnduding delivery as indicated. !
-- PA 17110 P
1
11
9 . 9 10. REQUISITIONING OFFICE
i
7541362 SAMHSA/OC ij
11 BUSINESS CLASSIFICATION (Check appmpriate boxfes)) ;I
O-- -
a SMALL .>*, b OTHER THAN SMALL c DISADVANTAGED d WOMENOWNED
-2c
12 F O B POINT Destlnatlon 14 GOVERNMENT BUNG 15 DELIVER TO F 0 B POINT I( 16 D S i O U N T TERMS
. ....
ON OR BEFORE (Dare) i
13 PLACE OF
02/29/2004 Net 30
a INSPECTION b ACCEPTANCE
Destination 1 Destinattjna ...- , .
I
11 1 . ..
17. SCHEDULE (See reverse for Rejecl~ons) (I
:I
/I QUANTITY
QUAMIN UNIT I
ITEM NO. SUPPLIES OR SERVICES-. ORDERED UNIT PRICE ..-.- AMTT,.-. -.--- ACCEPTED
(a) (b) (c) (d) (el (0 1 (g)

Tax ID Number
DUNS Number: b 1
I,

CAN< C96A5O.Q U D J . class: z ~ Z LFY: 2004 i(

- j j
3 CALLS COMPLETED FOR-THE MONTH OF FEB 2004

Continued ... I

i/
18 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO I 17(h)
1 TOTAL

21. MAIL INVOICE TO.

SEE BILLING
a. NAME PSC/FMS (301) 443-3020
. ^$0.00
. . /I
I
3

INSTRUCTIONS b STREET ADDRESS PARKLAWN .BUILDING, ROOM 16A-12

ON REVERSE (or P O . BOX) 5600 FISHERS LANE .. !?(I).
GRAND
..
;I TOTAL

c CITY d STATE e ZIP CODE $7,500! 00

ROCKVILLE MD 20857 li
22 UNITED STATES OF AMERICA 23 NAME (Typed) 1
BY (S~gnaturel JULIAC.SAVOY I/
ONTRACTINGIORDERING OFFICER
NSN 7YC-01 152-8083 'I OPTIONAL FORM J47 I R n 6951

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NSN 754C-01-152-8082 Y)llb101 '1 OPTlONAL FORM 148 1 R n WSI
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1 DATE OF ORDER 2 CONTRACT NO (Ilany) 6 SHIP TO 1
HHSP23320042807MB
05/11/2004 a NAME OF CONSIGNEE
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3 ORDER NO 4 REOUISITIONREFERENCE NO

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5 ISSUING OFFICE (Address correspondence lo) b STREET ADDRESS il
DHHS/PSC/AOS/DAM PARKLAWN BLDG . , ROOM 6 - 101 (1

5600 FISHERS LANE I

PARKLAWN BUILDING, ROOM 5-101
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5600 FISHERS LANE
ROCKVILLE MD 20857
c ClTY 1/ d STATE 1 e ZIP CODE
ROCKVILLE MD 20~5i
f SHIP VIA
a NAME OF CONTRACTOR
ROBIN L. CLEMENS
..
8 TYPE OF ORDER ;I
b COMPANY NAME
IJa PURCHASE

c STREET ADDRESS -- REFERENCE YOUR

Except for blllng ~nstruslonson the
3205 NORTH FRONT STREET .- .. - +tie. V l ~ r d d w e vaoer 4 -
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APT. # 5 s~$j€Ct10 lnSLTunoMs mnla~nedon
thi; slde only of lhls Imand IS
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and cond~t~ons speafied on born sldes of coXdjltons of Ihe above-numbered
l h ~ sorder and on the attached shee(s, 11 mntran
d CITY e STATE 1. ZIP CODE
HARRISBURG any. tncludlng dellvery as ~ndlcated 1
PA 17110 I ;I
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9 ACCOU~TINGAND APPROPRIATIONS DATA 10 REOUlSlTlONlNG OFFICE Il
7541362 SAMHSA/OC 1
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12 F o B POINT Destlnation
13 PLACE OF
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1 16 DISCOUNTTERMS
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1 b ACCEPTANCE I
a INSPECTION
Destination ~estrn-on. - I
17 SCHEDULE (See reverse for Relecfrons)
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ITEM NO SUPPLIES OR SERVICES

QUANTITY
ORDERED UNIT
UNIT
PRICE
- AMOU?T--
I/ *-a'
QUANTITY
ACCEPTED
-
-
-
-(a)
- (b) (c) (d) le) (1) 1 LQ)
Tax ID Numbel
DUNS Number:
CAN: C96A50Q Ob]. Class: 2522 FY: 2004
1. .I 1I/
11

1 3 CALLS COMPLETED FOR -THE MONTH OF MARCH

2004
Continued ...

18 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO

TOTAL
(Con1
pages)
21 MAIL INVOICE TO

a NAME PSC/FMS (301) 443-3020 s p . 00

SEE BILLING U
INSTRUCTIONS b STREET ADDRESS
ON REVERSE (or P 0 Box)
PARKLAWN BUILDING, ROOM 16A-12 I/
5600 FISHERS LANE

$6,300!00
I
:I
170)
GRAND
TOTAL

C CITY d STATE e ZIP CODE

ROCKVILLE MD 20857 /
-- 8I
22 UNITED STATES OF AMERICA 23 NAME (Typed)
I
BY (Slgnafure) I
q U L I A C. SAVOY (,

TITLE CONTRACTINWORDERING OFFICIER

NSN 754001-152 8083 4 OPTIONAL FORM 147 (Rn 6 9 5 )

PREVIOUS EDITION NOT USABLE

 ORDER FOR SUPPLIES OR SERVI
SCHEDULE - CONTINUATION
1 21i'"'
1 '
IMPORTANT: Mar+ all packages and papem vnth w n l r a a andiw wder numbers Y
DATEOFORDER CONTRACTNO

05/11/2004 HHSP23320042807MB
ITEM NO SUPPLIESISERVICES

amount of award: $6,300.00. .The oblige

TOTAL CARRIED FORWARI

NSN 754Cb01-152-8082 YIY nOHAL FORM 348 ( R r 6951
R.- by GSA
FAR (40 CFRI 51 213(cl
 i
ORDER FOR SUPPLIES OR SERVICES 1; / PAGE ZZ P.CEj
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IMPORTANT: Mark all packages and papen with contract andlor order numbers 1; 1
1 DATE OF ORDER 2 CONTRACT NO (If any) 6 SHlP TO j(
05/11/2004
HHSP23320042807MB 1 a NAME OF CONSIGNEE
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3 ORDER NO

007
- ~ - p p ~ ~

5 ISSUING OFFICE (Address wneqondence to) b STREET ADDRESS I

DHHS/PSC/AOS/DAM PARKLAWN BLDG . , ROOM 6 - 101 '
1
PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE II

5600 FISHERS LANE 1

I
ROCKVILLE MD 20857
- - c. CITY
ROCKVILLE I
j / MD
STATE e Z!PCODE

20557
- -
7 TO f SHIP VIA
a NAME OF CONTRACTOR

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.f-
c STREET ADDRESS .. REFERENCE YOUR-
3205 NORTH FRONT STREET .. . . . . .. . - - =
.- - .
.
Except lor billtng 1nsl6mtmsm the
rse. thts dellvery ader a -
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APT. # 5 <ublecl to ~nstrucllonsm l a l n e d On
&IS side only of thls lam and is
Please furnish the fdlhnng an the terms ksued subjecl to the lerms and
and mndrlicns speafied on bolh sides d & n d t t ~ wof the above-numberea
this Order and on the allached sheels, il mntran
d CITY e. STATE f ZIP CODE
HARR ISBURG any, indud~ngdelivev as indlcaled. Il
PA 17110 11
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9. ACCOUNTING AND APPROPRIATIONS DATA 10. REQUISITIONING OFFICE
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11. BUSINESS CLASSIFICATION (Check appmpnale box(esJJ 1
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12 F oB
a. SMALL

POINT Destination
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IA GOVERNMENT B I ~ O
c. DISADVANTAGED

15 DELIVER TO F 0 B POINT //
d WOMEN-OWNED

16 DISCOUNTTERMS
ON OR BEFORE (Dale)
-.
13 PLACE OF
Net 30
a INSPECTION
Destination I b. ACCEPTANCE
DesthaLion ..:- I 1

i,lr
17 SCHEDULE (Seereverse lor Rejections) (I

1TE;yi SuPPLlEsoR sERvlcES .

UNIT
PRICE 1- A M A w ---4 QUANllW
ACCEPTED

Tax ID Number
DUNS Number:
CAN: C96A5Q.O Obj. Class: 2 3 . 4 ~s'Y: 2004

6 CALLS COMPLETED FOR-THE MONTH OF APRIL

2004
Continued . . .
1 I 1 I I

18 SHIPPING POINT 19. GROSS SHIPPING W E I G H 20. INVOICE NO. 17(h)

TOTAL

!
21 MAIL INVOICE TO
!I
/I
a NAME PSC/FMS (301) 443-3020
- -$0.001
. !I r
SEE BILLING
INSTRUCTIONS b STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12 It
ON REVERSE (or p 0 Box) 5600 FISHERS LANE .'
1
1
TOTAL
4
c. CITY
ROCKVILLE
d. STATE
MD
e. ZIP CODE
20857
S12.5f8.00
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22. UNITED STATES OF AMERICA

BY (Slgnalure) d
23. NAME (Typed)

I A C. SAVOY
11
TITLE CONTRACTlNWORDERlNG OFFjCER
NSN 754001-152-8083 I/ OPTIONAL FORM 147 ( R n 6%)

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OF

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DATE OF ORDER CONTRACT NO ORDER NO.
05/11/2004 HHSP23320042807MB 007
ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT AMOUNT CUANTIT\

(A) (8)
ORDERED
(C) (D)
PRICE
(0 (F) I. I
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ACCE?TE?
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Total amount of award: $12,518.00 -.The obligation lor this award i; shbwn it box
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NSN 754C-01-152.8082 %Yo-101 1 OPTIONAL FORM S48 IRN -51

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IMPORTANT: M a r k a l l packages a n d p a p e r s w i t h c o n t r a c t a n d l o r o r d e r n u m b e r s I l l j -
1 DATE OF ORDER 2. CONTRACT NO (I1 any) 6 SHIPTC. 1
HHSP23320042807MB a. NAME OF CONSIGNEE X
06/15/2004
3. ORDER NO.

008
A. REQUlSITlOUaEFERENCE NO.
SAMHSA/OA
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5 ISSUING OFFICE (Address correspondence lo) b. STREET ADDRESS
DHHS/PSC/AOS/DAM PARKLAWN BLDG . , ROOM 6 - 10 1
PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE
5600 FISHERS LANE
ROCKVILLE MD 20857
- - c ClTY 1 1 d STATE I e ZIP CODE
ROCKVILLE 1 1 120857
7 TO
a NAME OF CONTRACTOR
f SHiP VIA
j
ROBIN L. CLEMENS 8. TYPE OF ORDER 1
b COMPANY NAME
g a PURCHASE
- REFERENCE YOUR-
c STREET ADDRESS
3205 NORTH FRONT STREET - A .. .- --. -~.
7
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Please fumisn the fdlow~ngon the terms ~&uedsubjecl to the lerms and
and COndltlons spenfied on both s~desof a!ndr(zauof me above-numbered
lhls Order and on the anached sheeb. if m ntract
d. CITY e. STATE I.
ZIP CODE
any, inauding delivery as indicated.
HARRISBURG PA 17110
9. A C C O L ~ T I N G
AND APPROPRIATIONS DATA 10. REQUISITIONING OFFICE
7540120 SAMHSA/O C
11 BUSINESS CLASSIFICATION (Check appropriate box(es))
I3 a SMALL *I a b OTHER THAN SMALL 0 c. DISADVANTAGED

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12 F0B POINT Destlnatlon 14 GOVERNMENT B / M O 15. DELIVER TO F O B. POINT 16. DI-NTTERMS
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- ON OR BEFORE (Date) . -.
13. PLACE OF
05/31/2004 Net 30
8. INSPECTION b. ACCEPTANCE
Destination Dest-i.nakion .--- It -. . .. . . .. . . -- ,_:

17. SCHEDULE (See reverse lor Rejecf~ons) I

QUANTITY QUAMITY
ITEM NO SUPPLIES OR SERVICES ' ORDEREC ACCEPTED

DUNS Number: --.

.

CAN:' C96A500 Obj. Class: L ~ L L , r'Y: 2004 . .

4 CALLS COMPLETED FOR-THE MONTH MAY 2004

(continued
I
I 1 I I
18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT 20 INVOICE NO.
TOTAL
(Con!.

21 MAIL INVOICE TO

a NAME PSC/FMS (301) 443-3020

d
SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE
(or P 0 Box)
PARKLAWN BUILDING, ROOM 16A-12
5600 FISHERS LANE 1
4 17b)
1I GRAND
TOTAL

c CITY d STATE e ZIP CODE

ROCKVILLE MD 20857
22 UNITED STATES OF AMERICA 23 NAME (Tfled) I
BY (Srgnalurel
!
TITLE CONTRACTINWORDERING OFFICER
NSN 754&01 152-8083 " OPTIONAL FORM 347 I R r 6951

PREVIOUS EDITION NOT USABLE IIR-D~C~~*R(~OCFRIY 21X.1

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 I
ORDER FOR SUPPLIES OR SERVICES
SCHEDULE CONTINUATION -
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\PAGE

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[
DATEOFORDER CONTWCTNO ORDER NO
06/15/2004 HHSP23320042807MB 008
ITEM NO SUPPLIEYSERVICES QUANTITY UNIT UNIT AMOUNT QilANiiT .'
(A1 (01
ORDERED
(Cl (Dl
PRICE
(El (F)
I1 ACZECTE3
(G)
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T o t a l amount o f award: $10,000.00.. The o b l i g a t i o n f o r t h i s a w a r d i ; shown in box

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NSN 754C-01-152-8082 53346101 ' OPTIONAL FORM M I I&. -5,
 ORDER FOR SUPPLIES OR SERVICES /I I PAGE ~ j : D;C:S
IMPORTANT: Mark a l l packages a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e r s 1 7 1 /
1 DATE OF ORDER 2 CONTRACT NO (Ifany) 6 SHIP TO /
HHSP23323042807MB a Nah4E OF CONSIGNEE
06/15/2004
3 ORDER NO

009
5 ISSUING OFFICE (Address correspondence to) b STREET ADDRESS
DHHS/PSC/AOS/DAI", PEJZKLAWN BLDG . , ROOM 6 - 101
PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE

-=r
5600 FISHERS LANE
/I
ROCKVILLE MD 20857
1/ 1 e ZIP CODE
c CITY
ROCKVILLE I d STATE

MD 120857
7 TO f SHIP VIA
a NAME OF COKTRACTOR \
ROBIN L. CLEMENS 8 TYPE OF ORDER :/
b COMPANY NAME
m a PURCHASE DEL
. . REFERENCE YOUR
c STREET ADDRESS
3205 NORTH FRONT STREET,.. ...
. .-
. .- - .. . .
-.- Exceet for b~lltnglnstrunlons cn the
.-me,h$dellvery aoer IS --.
-
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APT. # 5 $Ibject to ~nsmralonsmnlafned on

tkis side only cf l h ~ sfmana 15
Please furnish the fdlowlng on the terms sued
sublen lothe lerms and
and c o n d ~ ~ ~ ospeuRed
ns on both s~desof &nd!tlons 01the aoove-numwred
th~sa d e r and on the anached sheets. 11 contract
d CITY e. STATE 1. ZIP CODE
any, ~ncludingdellvery as ~ndlcated.
HARRISBURG PA 17110
9. ACCOUNTING AND APPROPRIATIONS DATA 10 REQUISIT!ONING OFFICE
7540120 ! SAMHSA!OC
- - - - - -

11
11. BUSINESS CLASSIFICATION (Check appropnate box(es))
O a SMALL .:'.' -a b. OTHER THAN SMALL C. DISADVANTAGED 0. WOMEN-OWNED

12. F.O B POINT Destination I 14. GOVERNMENT BAJWO. 15. DELIVER TO F O B PO~M
ON OR BEFORE (Dale)
13 PLACE OF
06/30/2004 1 Net 30
a INSPECTION
Destlnatlon
b ACCEPTANCE
Destz&.lm - 1 ---
- .

ITEM NO.
(a)
SUPPLIES-OR SERVICES"
(bl
17 SCHEDULE (See reverse for Rejeclrons)

QUAMITY
UNIT
PRICE
I.? (0,1
I
-- -- QUANTITY
ACCEPTED

Tax ID Number
DUNS Number:
CAN: C96A5aOObj. Class: L>LL FY: 2004

6 CALLS COMPLETED FOR--THEMONTH JUNE 2004

Continued ...

18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT

I Z 0 lNVOCE TOTAL
IiCont

21. MAIL INVOICE TO

a NAME PSC/FMS (301) 443-3020

SEE BILLING
INSTRUCTIONS b. STREET ADDRESS PARKLAWN BUILDING, ROOM
..
16A-12
ON REVERSE (or P 0. Box)
5600 FISHERS LANE
1 GRAND
TOTAL

c CllY
ROCKVILLE n I
d. STATE
MD
e. ZIP CODE
20857
4
2 2 UNITED STATES OF AMERICA /I
23 NAME (Typed)
BY (Sgnature) JULIA C. SAVOY 1
/~COKTRACTINGIORDERING OFFI~ER
NSN 7540-01-152-8083 OPTIONAL FORM 347 ( R r W5)
PREVIOUS EDITION NOT USABLE
 ORDER FOR SLIPPLIES OR SERVICES PAGE 0- p - 3 ~ ~

SCHEDULE CONTINUATION - 1 2 1 1 :
IMPORTANT' Mark all packages and paoen wlth mnrraa andlor order numbers i
DATEOFORDER

06/15/2004
ITEM NO
CONTRACTNO

HHSP23320042807MB
SUPPLIESISERVICES QUANTITY UNIT UNIT
ORDER NO
009
AMOUNi
1 Oh..- 7,

(A) (a)
ORDERED
(C) (D)
PRICE
(El (F) I
11
ACCEP-E?
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T o t a l amount o f award: $12,200.00. The o b l l g a t l o n Eor t h l s a w a r d 1; s h o w n In box
1 7 ( 1 ).
1
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TOTAL CARRIED FORWARD TO 1ST PAGE (ITEM 17(H)) ,II

NSN 754C-01 152 8082 50YO 101 I OPTIONAL FORM 348 ( R v , -51
I R . d bv GSa
I FlR(r8 CFRI 53 2131~1

1
11
 ORDER FOR SUPPLIES OR SERVICES 1' I ?LC: c = =:sfis
IMPORTANT: Mark all packages and papers wrth contract andlor order numbers 1 1 1 : I
1 DATE OF ORDER 2 CONTRACT NO (If any) 5 SHIP TO
HHSP23320042807MB
a NAME OF CONSIGNEE
10/30/2003
3 ORDER NO 4 REOUISITIONREFERENCE NO
Indicated On Call
See Schedule
5 . ISSUING OFFICE (Address correspondenceto) 1 b STREET ADDRESS I/

DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101 .., .
5600 FISHERS LANE
ROCKVILLE MD 20857 1
I
- -
c CITY il ( d STATE / e ZIP CODE

7 TO f SHIP VIA
a NAME OF CONTRACTOR /I

c STREET ADDRESS REFERENCE YOUR I

3205 NORTH FRONT STREET - . - - -- -. .
?--
t billing !nsrru&ons on Ine
~ ? c e pfor
verse Ihls dellvery order IS
APT. # 5 1 sublecl to ~nSVUn~ms mnta~nedon
~ h l ss~dem ~ ofy thts form and 1s
Please krnish the Idlowing on me terms Isiued subjecl to !he terms and
and andit~onsspeafied on both s~desof &lndlsm d the above*umbered
this Order and on the attamed sheets. rf m'n~ract
d. CITY e. STATE.. f. ZIP CODE
any, including dellvery as ind~mled
HARRISBURG PA 17110 I!

9. ACCOUNTING AND APPROPRIATIONS DATA lo. REOUISITIONING OFFICE I/

Indicated On Call I SAMHSA/OC I!

11. BUSINESS CLASSIFICATION (Check appmpnale box(es)J i/
a. SMALL 'f @ b OTHER THAN SMALL 0 c. DISADVANTAGED 0 d WOMEN-OWNED

12. F 0.8 POINT Destination 14. GOVERNMENT BRMO. 15. DELIVER TO F O B POINT $I:1 16 DISCOUNT TERMS
.... 1 ON OR BEFORE (Dale) 1

I
1 Indicated
13 PLACE OF
I Indicated On Call On Call
a. INSPECTION b. ACCEPTANCE
--.
--.
Destination 1
~esrin~f?'fo?i
.+-'-
I I
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-
17 SCHEDULE (See reverse lor Relectrons) 'I
1 _-
ITEM YO SUPPLIES OR SERVICES
QUANTITY
0RC)ERED UNIT
UNIT
PRICE
-- --I :
;-
OUANTlPi
ACCEPTED

I.
Tax ID Number
DUNS Number:
-
.
/period of performance: 10/01/2003 to 09/30/2b04 ( / I

I I I I I I
18 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO . 1 17(h)
1 TOTAL
I
I
21 MAIL INVOICE TO
I
a NAME Indicated O n Call - $35, OOt. 00
SEE BILLING
INSTRUCTIONS b STREET ADDRESS
ON REVERSE (or P.0 Box)
17(1)
GRAND
TOTAL

c ClPi d STATE e. ZIP CODE

22. UNITED STATES OF AMERICA 23. NAME (7ypxIJ

!
BY (Srgnalurql JO LASKO 1
TITLE: CONTRACTINGIORDERINGOFFICER
NSN 754~01-15z.ao81 i OPTIONAL FQ(Y M II R ~
~ 5 1

PREVIOUS EDITJON NOT USABLE b.-bG-m,aacF~,=zla.)

!!
 ORDER FOR SUPPLIES OR SERVICES
IMPORTANT: M a r k a l l p a c k a g e s a n d p a p e r s with c o n t r a c t a n d l o r o r d e r n u m b e r s
I
1. DATE OF ORDER 2. C O M P A C T NO (If any) 6 SHlP TO I
HHSP23320042807MB
09/27/2004 a NAME OF CONSIGNEE
I
3. ORDER NO

011
5 ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS
DHHS/PSC/AOS/DAM PARKLAWN BLDG . , ROOM 6 - 101
PARKLAWN BUILDING, ROOM 5:lOl 5600 FISHERS LANE
5600 FISHERS LANE
ROCKVILLE MD 20857
c CITY
ROCKVILLE
7 TO: I.SHIP VIA
a. NAME OF CONTRACTOR
ROBIN L . CLZMENS
b COMPANY NAME
. -
1 E a PURCHASE
- . REFERENCE YOUR:
c. STREET ADDRESS
3205 NORTH FRONT STREET - . . . . - -- =?: -- :.
Exc_eplf a bill~nginstruntons on the
erse, lnfs deltvev ader 1s
-.
--
.--

APT. # 5
th~sside only 01 this form and IS
Please furnish the fdloulng ca the rem $sue0 subject to the terms and
and m o d ~ t ~ o nspecified
s on boM s~desof $nd111ms of lhe above+urnbered
l h ~ cfder
s and m the attamed sheea. 11
d CITY e STATE f ZIP CODE
any. lndudlng dellvery as ~ n d l m t e d
HARRISBURG
-- - -

9 ACCOUNTING AND APPROPRIATIONS DATA 10 REQUISITIONING OFFICE

7541362 SAMHSA/OC
1I BUSINESS CLASSIFICATION (Check appmpnale box(es))
a SMALL . ': 9 b OTHER THAN SMALL c DIWDVAMAGED ? d. WOMEN 3WNED

12 F 0 B POINT Destination 14 GOVERNMENT BUT40 15 DELIVER TO F 0 B FOlM 16. DISCOUNT TERMS

O N OR BEFORE (Date)
13 PLACE OF I
Net 30
a INSPECTION b ACCEPTANCE
- - ==:
Destination I I I
17. SCHEDULE (See mverse for Rejeclrons)
R
ITEM NO. SUPPLIES~RSEXVICES ORDERED UNIT ACCEPTED
(a) (b) lc) Id) le) (9)

Tax ID Number:
DUNS Number: L/
CAN: C96A590 Obj. Class:' ~3~~ ,T:2004
b I . .. ... ..

1. 4 CALLS COMPLETED FOR-THE MONTH OF JULY 2004-

...
Continued
I
I I I

i
I I I
18 SHIPPING P O I M 19 GROSS SHIPPING WEIGHT 17lh)
TOTAL

SEE BILLING
a NAME PSC/FMS
21. MAIL INVOICE TO:

(301) 443-3020 -- 60.00 /

INSTRUCTIONS b STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE (or P O Box) 5600 FISHERS LANE
170)
GRAND
TOTAL

C. CITY d. STATE e. ZIP CODE

ROCKVILLE MD 1 20857
I I I I

22 UNITED STATES OF AMERICA 23 NAME (Typed) 1

BY (S~gnalureJ JULIA C. SAVOY il
1I
GOMRACTIN
OFFICER
NSN ~ S ~ C - O I - ~ ~ Z - B W I I/ OPTIONAL FORM ~7 ( ~mrj

PREVIOUS EDITION NOT USABLE 1 R..ambv(iMnRc.a cFR1l121%.)

!I
i
 Xr 1
ORDER FOR SUPPLIES OR SERV~CES
I
SCHEDULE - CONTINUATION I -
?
 ORDER FOR SUPPLIES OR SERVICES 1 / P;GE CZ ZAGCS

IMPORTANT: M a r k a l l packages a n d papers w ~ t ch o n t r a c t a n d l o r o r d e r n u m b e r s / (

I
II
--
1 DATE OF ORDER 2 CONTRACT NO (If any1 6 SHIDTC jl
HHSP23320042807MB
09/27/2004 a NAME OF CONSIGNEE 'I
3 ORDER NO

012
5 ISSUING OFFICE (Address correspondence lo)
DHHS/ PSC/AOS/DAM
4 REQUISITIONIREFERENCE NO
SAMHSA/OA

b STREET ADDRESS
PARKLAWN BLDG . , ROOM 6 - 10 1
i
(11I
I
PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE 1
5600 FISHERS LANE
ROCKVILLE MD 20857
c CITY
ROCKVILLE
7 TO f SHIP VIA
a NAME OF CONTRACTOR

c STREET ADDRESS . .
. . . .-
REFERENCE YOUR /I --
32 05 NORTH FRONT STREET, .. .. . .. .- --- . €?
:I
-&me
for blllng Insmnjcns on Ine
mrs d e l ~ v e vw e r 1s --
APT. # 5 sJbjecI to !nslrunlms cmla~nedon
t+ Side only of ~ 1 1Is- and 1s
Please furnish the f d l w l n g on lhe terms I S ~ Wsublec~
~ 10 the lerrns and
and c o n d ~ l ~speufied
w on boVI sldes of od/ndlbons of the aboe-numbered
th~sOrder and on Ihe attathed sheels. 11 dnmct
d. CITY e. STATE f ZIP CODE
I
HARRISBURG PA 17110
any, lndud~ngdellvery as lndlcated
1
9 ACCOUNTING AND APPSOPRIATIONS DATA 10 REQUISITIONING OFFICE
7541362 SAMHSA/OC
/I
11 BUSINESS CLASSIFICATION (Check appmpnale box(eS)) Il
@ a SMALL ?./Q b OTHER THAN SMALL 9 d WOMEN-OWNED

12 F 0 B. POINT Destination 1 14 GOVERNMENT BAR40 115. DELIVER TO F 0 B. POINT

I
... ON OR BEFORE (Dale)
13 PLACEOF
a INSPECTION
Destination
b ACCEPTANCE
t : t : 6fi .
~ %' j ~
~ ~ ~
I 17 SCHEDULE (See revene lor Rejections) 1
ITEM NO SUPPLIES OR SERVICES'
I
QUANTITY
ORDERED UNIT
(c) (d)
UNIT
PRIC;
[el
- - A
(1) I/
-4 I
QUANTITY
ACCEPTED
(g)

DUNS. Number :
i
CAN: C96A500 Gb]. Class: 2522 FY: 2004 -.-

1 4 CALLS COMPLETED FOR'-THE MONTH OF AUGUST --

2004
Continued . . .
I I I 1
I 8 SHIPPING POINT 19 GROSS SHIPPING WEIGHT 20 INVOICE NO
I 17(h)
TOTAL

21. MAIL INVOICE TO

a. NAME PSC/FMS (301) 443-3020 ..

SEE BILLING
INSTRUCTIONS b STREET ADDRESS PARKLAWN BUILDING, ROOM 16A-12
ON REVERSE
(or P:O. Box) 5600 FISHERS LANE

1 GRAND
TOTAL

c CITY d STATE e ZIP CODE

ROChTI LLE MD 20857

22. UNITED STATES OF AMERICA 23. NAME r y p e d ) i
BY (Signalure) JULIA C. SAVOY '1
IGf+TtFCONTRACTINWORDERING
I!
OFFIFER
NSN ~ s~~oI.~sz-~LM~ 1 OPTIONALFOUM 147 m)
I R.smoabrOSMU1148 CFRI 53213(.)
!I
 ORDER FOR SUPPLIES OR SERVICES
.
IMPORTANT: Mark all packages a n d papers with c o n t r a c t a n d l o r o r d e r n u m b e r s ( I ! :
,
/ -
1 DATE OF ORDER 2. CONTRACT NO (11 any) 6 SHIFTO jl
HHSP23320042807MB
09/28/2004 a NAME OF CONSIGNEE
I
3. ORDER NO 4. REOUISITIONREFERENCE NO.
SAMHSA/OA
013
5 ISSUING OFFICE (Address correspondence to) b. STREET ADDRESS
DHHSIPSC/AOS/DAM PARKLAWN BLDG . , ROOM 6 -101
PARKLAWN BUILDING, ROOM 5-101 5600 FISHERS LANE
5600 FISHERS LANE
ROCKVILLE MD 20857

1MD
c. ClTY d STATE e ZIP CODE
ROCKVILLE ---
7. TO: 1. SHIP VIA

a. NAME OF CONTRACTOR
ROBIN L. CLEMENS 8 TYPE OF ORDER I/
b COMPANY NAME Da. PURCHASE
c STREET ADDRESS - . - REFERENCE YOUR
~ i c e pfor
l bill~ng~nsuubfms on Ihe
3205 NORTH FRONT STREET . . . . . - <- &e: th~s.del~very wder IS --
.. -.
..
APT. # 5 sdb~eclto t n s l r u n l w amtamed on
th;s Slde only ot thus I- and 1s
Please Iumlsh the f d l w n g on me lerms i s i d subjed to Ihe lerms and
and u n d t t ~ a speafied
v on boVl sldes of c&ddtlons of n e above4umbered
V~ISorder and on the attached sheeb. 11
d CITY e STATE 1. ZIP CODE
any. lncludlng delivery as lndlcated
HARRI SBURG PA 17110 -

9 ACCOUNTING AND APPROPRIATIONS DATA 10. REOUlSlTlONlNG OFFICE

7541362
. -

SAMHSA/OC I/
11. BUSINESS CLASSIFICATION (Check appropriate box(es)) /I
1
I

[? a SMALL i~ .f" b OTHER THAN SMALL c. DISADVANTAGED d WOMENaWNED

12 F 0 . 0 POINT Destination
-
? ..
14. GOVERNMENT BlVNO 15 DELIVER TO F 0 B POINT
ON OR BEFORE (Date)
I/ 16 DISCOUNTTERMS

13. PLACE OF
..
I Net 30
a. INSPECTION I b ACCEPTANCE I
Destination (DestFnatioa -., I I
17. SCHEDULE (See ravene for Rejections)

ITEM NO
(a)
SUPPLIES 8 R SERVICES-
(b)
QUANTITY
ORDERED UNIT
(c) (dl
PRICE
(e)
1. . AM-i-
(1) It
... 1 OUANTITY
ACCEPTED
(9)

Tax ID Number:
1. r I
Number:
CAN: C96A50-0 Obj. Class: 2522 FY: 2004 1' . . . .. ..

1 6 CALLS COMPLETED FOR-THE MONTH OF

-I
12,~OO.OO
............... .-. ....
SEPTEMBER 2004
Continued . . .

r e SHIPPING POIKC 19. GROSS SHIPPING WEIGHT 20. INVOICE NO 17(h)

TOTAL
(Con!.
pages)
21. M I L INVOICE TO

SEE BILLING
a. NAME PSC/FMS (301) 443-3020
.. ~ .$0.00
... a 4
PARKLAWN BUILDING, ROOM i6A-12

I
INSTRUCTIONS b STREET ADDRESS

~
ON REVERSE
(or P,O Box) 5600 FISHERS LANE 17(i).
GRAND
I/ TOTAL
- Il
C. CITY
ROCKVILLE
d. STATE
MD
e. ZIP CODE
20857
$12,80)?.00
1
4
22 UNITED STATES OF AMERICA 23. NAME (Typed) i/
BY (Signature) JULIA C. SAVOY {I/
-TITLE CONTRACTING/ORDERINGOFFICER
NSN 754001-152.8083 OPTIONAL F M l Y 347 1RN. -1

PREVIOUS EDITION NOT USABLE j/ R.-L~ G S M L d (48 CFRI 53 21Y.)

!I
I
 , I . 1
ORDER FOR SUPPLIES OR SERVICES 1 ~ ~ D A G EO i PAGES
READ INSTRUCTIONS ON NEXT PAGE ?as5 : :f z
I

REQUISITION
PROCUREMENT REOUEST NO

04M000259
1
I ii
1 NAME PHONE NUMBER. AND ROUTING SYMBOL OF PERSON TO CONTACT
REQUISITION DATE
/I
HARRIET PoLSTER/301-443-8956
07/26/2004
i
3 ORIGINATING OFFICE DATA 2 TYPE OF REQUEST (Chech one)
il I
SAMHSA/OC
4 ADDITIONAL INFORMATION (Suggesled supply swrces, secunly data, elc )
A N E W REOUEST

8 =CHANGE TO 1 I
i

PENDING PR NO
I
I
~ M o D I F I C A T l o NTO KHSP2 3 3 2004 26 07MB
CONTRACT OR I!

5 APPROVALS 6 CONSIGNEE AND DESTiNATlOl

APPROVING OFFICIALS
RWTlNG
DATE %
INERNAL RWTING 1
, SYMBOL INTLliS R a n ffi
IA) (CI
(8) (Dl SYUsOL (El

11) AUTHORIZED REOUlSlTlONER I

1
HARRIET POLSTER
. , . , ..
.SGSA
. I.
--- - . .. ..A;=
!Z) i!I
1I

-- 1
(31 7. DATE(S) REOUIRED
I See Schedule

1 8. GOVERNMENT FURNISHED PROPERPI.

YES N O (R,s:-,,w
I ~drns+~-.mmn-i

1 9. DESCRIPTIONOF ITEMS OR SERVICES I

ITEM NO
(A)
1
I
ITEM OR &VEE
\:
(~ncludeS ~
(8)
C ~ ~ and ~ S ~mbur~lm)
I OSWCGII OUANIIP,
(C)

I
THIS MODIFICATION IS TO FOR ROBIN CLEMENTS THE AB VE REF RE CE BLANKET
AGREEMENT (BPA) IN ORDER TO INCREASE FUNDS.
ORIGINAL .SlQ.L,
000-00
INCREASE AMOUNT $35,000.00
NEW TOTAL $140,000.00
Period of performance: 16/01/2003 to 09/30/2004

4L ESTIMATED COST

I $0.00
10 ACCOUNTING DATA

See Schedule
 I

AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT

) 1 CONTRACT ID CODE / PAGE PAGES

1 :' I -
2 Ah~ENDhlENTIhlODIFICATlONNO 13 EFFECTIVE DATE 14 REOUISITIONPURCHASE R E 0 NO 15 PROJECT P4O riiapoi~caore
il
0005 08/26/2004 04M000256 I
6 ISSUED BY CODE 7 ADMINISTERED BY (If otner fnan lrem 6) CODE IDMj
DAM
DHHS/PSC/AOS/DAM DHHS/PSC/AOS/DAM ;I
PARKLAWN BUILDING, ROOM 5-101 PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE 5600 FISHERS LANE ;i
ROCKVILLE MD 20857 ROCKVILLE MD 20857

1
8 NAME AND ADDRESS OF CONTRACTOR (No sueeL counly.ilaF andZIP Code) 9A AMENDMENT OF SOLICITATION NO
(x) I
ROBIN L: CLEMENS
3205 NORTH FRONT STREET 9B DATED (SEE ITEM 111
!I
APT. # 5 1 1
HARRISBURG P A 17110

- . .
IOB DATED (SEE ITEM I f J 1
--
- --a .- .-.:-: .. ..
.e
CODE . - FACILI~ODE . . 10/30/2003
- I I I
11. THlS ITEM ONLY APPLIES TO AMENDMENTS OF-SOLICITATIONS
O T h e above numbered ~0llcitall0n1s amended as sel lo& ~nItem 14. The hour and date spetilied lor recelpt of O f l e ~ qis exlended. GISnot extended
Offers must adtnowledge receipl of lhis amendmenl p n w l o the hour and date specified In the sdidlabon or as amended, by m e of the f o l l m n g melhods: (a) By m $ e l i n g
Items 8 and 15, and returning m p e s of the amendmenl, (b) By adtnowledg~ngreceipt d thls amendmenl on each m p y of the offer subm~aed.or (c) By
separate letier or lelegram which indudes a reference l o the s d ~ t i t a b marid amendment numbers. FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If dy

*
wnuent mis amendmenl you desire l o change an offer already submitled, such m q g e may be made by telegram w letter, probided each telegram orlener makes
to
reference lo the sdicitalion and th~samendment, and IS reoeived prior the openjnq hour and dale spedfied.
I
12. ACCOUNTING AND APPROPRIATION DATA (If required)
7541362 C96A500 2522 INCREASE 20,000. D O

CHECK ONE A THIS CHANGE ORDER IS ISSUE0 PURSUANT TO: (Specify aufhonly) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT, . -
ORDER NO. IN ITEM 10A
F A R 5 2 . 2 4 3 - 1 CHANGES
I
. B THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTWTIVE CHANGES (such as changes in pafing OfIice.
appropr~af~on
dare, elc.) SETTBPP)W IPTlTEM74, PURSUANT TO THE AUTHORITYOF FAR 43103(b)
,; .. . . - .. . . - ..
'I
C THlS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO ALITHORIW OF
.. - -1 .- - 0

D UTHER (Speoly fype olmodflicat~onand authonfy)

X ( FAR 52.243-1 CHANGES - INCREASE FUNDS I)

E. IMPORTANT: C,ontrador H i s no!. u i s required l o Sign lhls documenl and retuni copies to the issulng once
,. .- . ..
14. DESCRIPTION OF AMENDMENT/MODIFICATION (Orpanned by UCF section headmngs, tndudtng aol#ulatron/wnlrad subjecl mafler m e r e feasible ) - 1
T a x ID Number:
DUNS Number: - bj .. . -. --
1
.-- ..,.

THIS MODIFICATION IS FOR ROBIN CLEMENS THE ABOVE REFERENCE BLANKET PURCHASE AGREEMENT (BPA)
IN ORDER TO INCREASE FUNDS. li
CAN NUMBER ~ 9 6 ~ ' 5 0 0
OBJ
, CLASS NO. 2522, APPRO NO. 7541362 i
ORIGINAL AMOUNT $175,000. il
INCREASE AMOUNT $20,000.
NEW TOTAL $195,000. !!
,Z
Not T o Exceed Amount changed to: $195,000.00 .. -.. . ,, .

Period of Performance: 10/01/2003 to 09/30/2004

il
of the document relerenced In Item 9A a. 10A. as herelofore changed, remalns unchanged and In full force and efied,
Except as provlded hereln. aiilerms and cond~l~ons
15A NAME AND TITLE OF SIGNER (Type orpnnt) 16A NAME AND TITLE OF CONTRACTING OFFICER (Type orpnrit)
'I
, I
150. CONTRACTORIOFFEROR 16p DATE SIGNED

iSigna(ore olperxln aurnorized (0 &oJ

NSN 754041-152-8070 WANDARD

FORM 30 (REV 10-83)
Previous ed~lionunusable Presmbed by GSA
FAR (48 CFR) 53 2 i 3
READ INSTRUCTIONS ON NEXT PAGE
I/I ?azc '- -' - -

I
L.-

PROCUREMENT REQUEST NO I
REQUISITION 04M000258
REQUISITION DATE
li I
1
1. NAME. PHONE NUMBER. AND ROUTING SYMBOL O F PERSON TO CONTACT
HARRIET POLSTER/301-443-8956
07/26/2004
!i I
I/
3 ORIGINATING OFFICE DATA

SAMHSA/OC
2
A
.Z P E OF REQUEST (Check m e )
NEW REOUEST 1 I
4. ADDITIONAL INFORMATION (Suggested supply SaJrCes, security data, etc.) B E~CHANGETO1 , II
PENDING PR NO '
I i
C, ~ M o D I F I C A T l o N To ~~~~23320042807~5
CONTRACT OR
ORDER NO.
i
1I
5 APPROVALS 6 CONSIGNEE AND DESTINATION^
APPROVING OFFICIALS
(A)
ROUTING
SYMBOL
IKTERNAL ROUTING
1
I

( I ) AUTHORIZED REOUISITIONER
P
(0)
I
. . . -. .. . ..
(2)

SHERI KRETSCHMAIER - PSc 08/06./2004

(3) 7 DATE(S) REOUIRED

I/
ANNA MARSH SAMHSA 08/04/2004 See Schedule 1
(4)

CYNTIIIA COOKE SAMHSA - 08/03/2004

-
8 GOVERNMENT FURNISHED PROPE<N
UYES
UNU (nw,.-&
I
a , . ~ . m n n D s i

1 9. DESCRIPTION OF ITEMS OR SERVICES 1

 I/
1 CONTRACT ID CODE PAGE 3' PAGES
AMENDMENT OF SOLlCITATIONIMODIFICATlON OF CONTRACT 11

2 AMENDMENTiMODlFlCATlON NO 3 EFFECTIVE DATE

I
1 4 REOUlSlTlONiPURCHkSE REQ NO
: :I 1
15 PROJECT YO ill aDD,icab c
04M000214 I
6 ISSUED BY CODE
DM 7 ADMINISTERED BY (11 ofner lnan lrem 6) COE
,&
DHHS/PSC/AOS/DAM DHHS/ PSC/AOS./DAM
PARKLAWN BUILDING, ROOM 5-101 PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE 5600 FISHERS LANE
ROCKVILLE MD 20857 ROCKVILLE MD 20857

1
8. NAME AND ADDRESS OF COWRACTOR (No.. sbeel. counry, State and ZIP Code)
-
(x,
9A. AMENDMENT OF SOLICITATION NO. 1
ROBIN L. CLEMENS 1
3205 NORTH FRONT STREET 98.DATED (SEE ITEM II) !I
APT. # 5 1il
HARRISBURG PA 17110 1OA MOClFlCkTlON OF CONTRACTIORDER NO /.

- .. . .
HHSP23320042807MB
I
1
- , . . .
..
-. lOB.DATED(SEElTEM11)
1(I..- *
CODE PAClLlTYCOBE .: . 10/30/2003
* 7 = ~
-5: .
- I
11. M I S ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS 11
The above numbered sol~cilationIS amended as set foim in ltem 14. The hour and date specified for receipt of Offers 0 1 s extended. 0 1 s nol extenoea.
Oilers must acknmledge receipt of lhis amendment pnor to the hour and date speahed In the sd~cimtionor as amended. by m e of the fdlomng methods. (a) By mirjpleung
Items 8 and 15, and returning copies of the amendment; (b) By ackndedging receipt of this amendment on each copy of the offer submitled, o/(c) By
11
separate letter or telegram which indudes a reference l o the sdidtation and amenamenl numbers. FAILURE OF YOUR ACKNOWLEDGEMEW TO BE RECEIVEDIAT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND D A l E SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER (by
wnue of this amendment you desire l o change an offer already submlned, such change may be made by telegram or lenw, prowded each telegram or lener makes '1
reference to the sdicitat~onand this amendment, and is recelved p n w i o the operlinq hour and dale s~eclfied !I
12. ACCOUNTING AND APPROPRIATION DATA (If requrred) I
7541362 C96A500 2522 INCREASE $35,000.00
13. THlS ITEM ONLY APPLIES TO h 6 q ~ ~ T
OF lCONTRACTSIORDERS.
~ ~ IT YlODlFlESME CONTRACTIORDER NO. AS DESCRIBEDIN ITEM 14.
..

B THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying offrcel
approprialron dale, eft.) S W O R H it4 l T E h 4 l 4 PURSUANT TO THE AUTHORITY OF FAR 43703(b). il
1 I/
C THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF /
I)
I - ** -11 , ,,
I D OTHER (Speoly lype o/rnodrlrcalron and aulhonly] '1
X I FAR 52.243-1 CHANGES - INCREASE FUNDS
E. IMPORTANT: Contractor @is not. is required to sign thls document and return copies to the Issuing ofllce. /I .....
I4 DESCRIPTIONOF AMENDME~TIMODIFICATION(Oqanized by UCF seclron headmgs, including Sobdlalron/mnlrad subject maner m e r e leasible.)
_ 1
T a x ID Number:
DUNS Number: --b? ,.
I
- - - . . . - - .3 . . - . - . -- . ..

THI s MOD1 FI CATION 1 s FOR ROB IN CLiEMENs FOR T H E m o m REFERENCE B m N K E T PURCHASE AGREEMENT
I
l,
( B P A ) IN ORDER T O INCREASE FUNDS : 1
ORIGINAL AMOUNT "$140,000.00
INCREASED AMOUNT $35,000.00
NEW TOTAL AMOUNT $175,000.00
CAN NUMBER C96A500, OBJ CLASS # 2522, APPRO # 7541362 I
Not T o Exceed Amount changed to: $175,000.00 _-.. - i3
R e q ' n . Total changed t o : 35000.00 i
Period of Performance: 10/01/2003 t o 09/30/2004 i
:!
II
Except as provlded herein a l l terms and m d l t ~ o n sof the document referenced In ltem 9A or IOA as heretofore changed remains unchanged and In full force and effhcl

I
1-C. SAVOY

NSN 7540-01-152-8070
Previous edition unusable
FAR (48 CFR) 53 243
/I
i
 I
READ INSTRUCTIONS ON NEXT PAGE pz.ze :
- c:- --
r I
PROCUREMENT REOUEST NO I(
04M000214

1 NAME PHONE NUMBER. AND ROUTING SYMBOL OF PERSON TO CONTACT

REOUlSlTlON DATE
06/08/2004
;/II
HARRIET POLSTER/301-443-8956 !

1
3 ORIGINATING OFFICE DATA 2 TYPE OF REOUEST (Check m e ,
EINEW
SAMHSA/OC
4 ADDITIONAL INFORMATION (Suggested supply sources, secunty &la, etc )
A

B
REOUEST

CHANGE TO I
i
I PENDING PR NO I

I
MODIFICATION TO H H S F 3~3 2 0 0 4 2 8 0 7 M B
CONTRACT OR 1
'I
ORDER NO
1 --

(1)
APPROVING OFFICIALS
(A)

AUTHORIZED REQUISITIONER
,
5 APPROVALS
RWTING
SYMBOL
(B)
DATE
tC) ,
INERNAL RWTlNG
L 1 T W
10)
RWlNG
SY-(El
6 CONSIGNEE AND DESTINATION

I
I

:(1I
H A R R I E T POLSTER
. ' .
-.&wH&
-.. .- . 6.
06/28/2b;04
. - -
-
I
I -
-;.- ;

12) !I

1
1 7 . DATEIS) REQUIRED :I
ANNA
(3)

141.
MARSH 1 S ~ H S A/06/17/2004 1
1 I
See S c h e d u l e
1 8 GOVERNMENT FURNISHED Pl'r,PERTY
1

9. DESCRIPTION OF ITEMS OR SERVICES

 1
1 CONTRACT ID CODE
AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT
I -
2 AMENDMENTIMODIFICATION NO 3 EFFECTIVE DATE 1 4 REQUISITIONPURCHASE REQ NO / 5 PROJECT~~NO
/I/ aoobiaD:r

0003 10/30/2003 04M000065 1

6 ISSUED BY CODE
DAM ( 7 ADMINISTERED BY (I( other than Ifem 6:
CODE jD& . .
DHHS/PSC/AOS/DAM DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101 PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE 5600 FISHERS LANE
ROCKVILLE MD 20857 ROCKVILLE MD 20857

ROBIN L.. CLEMENS 1:

3205 NORTH FRONT STREET 9B. DATED (SEE ITEM 1 1 )
ij
APT. # 5 /I
11
HARRISBURG PA 17110 10A MODIFICATION OF CONTRACTIORDER NO
HHSP23320042807MB
I/
100 DATED (SEE ITEM 11)
- --
CODE 10/30/2003
11. THIS ITEM ONLY APPUES TO AMENDMENTS OF SOLICITATIONS 11
The above numbered sol~otabonIS amended as set fuXh ln Item 14 The h w r and date spwAed for recelpt d Offers 0 1 sextended f i l s n i l extended
Offers must acknowledge recelpl of lhls amendmenl pnor to the h w r and dale spwRed In the sdlolabon w as amended by one of the ldlornng methods (a) By azynpletlng
Items 8 and 15. and retumlng mptes of the amendment. (b) By ackndedglng recelpt of l h ~ samendment on each mpy of the offer subm~ttedor (c) By
separate letter or telegram whim ~ndudesa reference to the s d ~ o t a t ~ oand
n amendmenl numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVED AT
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by
wrtue of th~samendment you deslre to mange an offer already submlned, s u m thange may be made by telegram a lener, pmvlded each telegram or lener makes 1
and this amendment, and is recelved pnof l o the openlnq h w r and date specrfied
reference to the sol~c~tatton 1
I
12 ACCOUNTING AND APPROPRIATION DATA (Ilrequrredj I
7541362 C96A500 2522 INCREASE $35,000.00 1
13. THlS ITEM ONLY APPUES TO'X;Q~CATION OF CONTRACTSIORDERS. IT MODIFIES THE CONTRACTIORDER NO. AS DESCRIBED IN ITEM 14

C H E C K O ~ E A THIS CHANGE ORDER IS ISSUED PURSUANT TO (Speofyaulhontyj THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRA^;^
ORDER NO IN ITEM 10A
FAR52.243-1 CHANGES I/

B THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes In payng offrc2,
appropnalfon date, elc) SFTfORlktTN I W 1 4 . PURSUANT 10 THE AUTHORITY OF FAR 43 103(b) -
-. .
I
j/
I
1 C THlS SUPPLEMENTALAGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF 'I
I
-..* -, > - .. :-

I D OTHER (Speafy l p e of modrfication and aulhonty) I

I FAR 52.243 - 1 CHANGES - INCREASE FUNDS 1
'I
E. IMPORTANT Contractor E j s not 1s requlred to sign thls document 2nd return cnples to the Issuing office 1
. .. . .
14 DESCRIPTION OF AMENDME~TIMODIFICATION (Organized by UCF section headings. includ~ngsolfulalron/mntrad subject matier where leasfble.) _ j
T a x ID Number:
DUNS Number:

( B P A ) IN ORDER T O INCREASE FUNDS.

ORIGINAL AMOUNT' $105,000.00
INCREASE AMOUNT $35,000.00 11
NEW TOTAL $140,000.00
Not T o Exceed Amount changed to: $140,000.00
Perlod of Performance: 10/01/2003 to 09/30/2004

11
Except as provlded herem,-all lerms and condltlms of the document referenced In llem 9A or 10A. as heretofore changed, remalns unchanged and In full f m and effect
15A NAME AND TITLE OF SIGNER (Tjpe or pnntj 16A NAME AND TITLE OF CONTRACTING OFFICER ( T p e or ~ n n l )
* I

/
$UlY€+
, C. SAVOY ;I
158 CONTRACTORsOFFEROR 16C. DATE SIGNED

-/2004
(bgnafvre 01person aurhorrzed lo sign]
NSN 754061 -152-8070 // s~U&D FORM 30 (REV 1083)
Previous edil~onunusable Presmbed by GSA
FAR (48 CFR) 53.243
READ INSTRUCTIONS ON NEXT PAGE J
Pas-? -
- :r . :
H I

I
PROCUREMENT REQUEST NO 1

REQUISITION 04M000153
REQUISITION DATE
i
/1

1
1 NAME PHONE NUMBER AND ROUTING SYMBOL OF PERSON TO CONTACT
HARRIET POLSTER/301-443-8956
04/02/2004 1
3 ORIGINATING OFFICE DATA

SAMHSA/OC
4 ADDITIONAL INFORMATION (Suggesled supply scurces, secunly data, elc )
2 TYPE OF REQUEST (Check m e )
A NEW
B GCHANGE
TO
REQUEST
1i!
j

1
I

- 1 PENDING PR NO I I

~ M O D I F I C A T I O NTO ~ ~ ~ ~ 2 $ 3 2 0 0 4 2 8 0 7 ~ ~ 1
CONTRACT OR
ORDER NO
il I --
il
APPROVING OFFICIALS
5 APPROVALS
ROUTING
SYMBOL DATE
lNUN.3
IhmRNAL ROUTING
RUING
6. CONSIGNEE AND DESTINATION ''

1
1
tC)
1
(A)
(8) (D! s v m a (€1
( I ) AUTMORIZED REOUISITIONER
!I
HARRIET PoLsTER 1 SMHSA0 6 / 2 8 , 2 o a n l 1
I

(3) 7 DATE(S) REQUIRED

ANNA MARSF
(4) -
~AMHSA 0 4 / 1 2 / 2 0 0 4 See Schedule
B GOVERNMENT FURNISHED ?ROYERTY
I
I
t
ci'NTHIA COOKE

!?EM NO 1
SAMHSA 04/12/2004
9 DESCRIPTION OF ITEMS OR SERVICES

ITEM OR SS$VIg (Include SmofcaI~nsand Special lratrudons)

DYESNO

QUANTITY UNIT
WIT
( H h . ~

I)
Y

ESTIMATED COST
,
. ~ s ~ m ~ .

.youKI
m ~ - :

(A) 1 (0) (C) (Dl IEI (1 IFI

i c a t i o n i s t o i n c r e a s e t h i s BPA f o r - R o b i r
I T h i s t h i r d m o d i f.-. Clemens b y anokher $35,000
i w h l c h w i l l give a t o t a l o f $ 1 4 0 , 0 0 0 . 0 0 . T h e period o f p e : r f c r m a n c e IS thk~ugh
-. 09/30/04frq~--t,&e~date+of t h e a p p r o v a l o f thisrecyest. i/
Period o f Performance: 10/01/2003 t o 09/30/2004
1 ~.... .

T h e CAN n u m b e r i s C 9 6 A 5 0 0 . T h e o b j e c t c l a s s code i s 2 5 . 2 2 . Ms. Clemens/ W 111

, be
II
s e r v i n g i n t h e c a p a c i t y b f doing s p e e c h w r i t i n g f o r M r . C u r i e , SWHSA ~ ~ k i n i s t r a t o r .
Il

I/

I . - - .

-
1
I

1I
.. . -. .. I
1
.-.

. .

..- .. . ..
JB

1 $0.00
10 ACCOUNTING DATA
See Schedule
1
I
 1 CONTRACT ID CODE I Pr*,Zf
I O= PAGE5
AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT
I l,i I
2 AMENDhfENTlMODIFlCATION NO. 13. EFFECTIVE DATE 14 REOUISITIONPURCHASE REO NO 15 PRC)JECT[NO.lliaopi~caons:

0 0 02 10/30/2003 04M000065
6. ISSUED BY CODE 7. ADMINISTERED BY 111otner than Item 6;
DAM CODE

DHHS/PSC/AOS/DAM DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101 PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE 5600 FISHERS LANE
ROCKVILLE ME 20857 ROCKVILLE MD 20857

I
8. NAME AND ADDRESS OF CONTRACTOR jbio.. sneer, counry: Slate and ZIP Code) 9A. AMENDMENT OF SOLICITATION NO I
. .

ROBIN L . CLEMENS I
3205 NORTH FRONT STREET 90 DATED (SEE ITEM f 1 )

APT. # 5
I
HARRISBURG PA 17110 1OA. MODIFICATION OF CONTRACTORDER NO.

,
-
HHSP23320042807MB
i~
- . 10B DATED (SEElTEM 11) *
- . , . . . 10/30/2003 . --
CODE F A C I L ~CODE . -
.. ....:;- .
I I I I
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS :I

The above numbered solicitabon IS amended as set f o m ~nItem 14. The hoor and dale spedfied for receipt of Ofiers n i s extended. 3 0 snbt exlendel
Offers must a&nmledge recelpt of this amendment pnor to the hour and date spedfied In the sditilabon or as amended, by m e ol the fdlwnng methods: (a) By mmpleting
Items 8 and 15, and returning copies of lhe amendment; (b) By a&nowledglng receipt of this amendmenl m each copy of the offer submitted. or (c) By
separate letter or telegram h i c h indudes a reference to the sdiatatim and amendment numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE AT RECEIVE^
THEPLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER If by
virtue of this amendment you desire to change an olfer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes ,
reference to the solicilalion and thls amendment, and is received pnor!o the openlnq hour and date specified 18

12. ACCOUNTING AND APPROPRIATION DATA (Ilrequired) I

7541362 C96A500 2522 INCREASE $35,000.00

13. THIS ITEM ONLY APPLIES TOG S CATION OF CONTRACTSIORDERS. IT MODIFIESTHE CONTRACT~ORDERNO. AS DESCRIBED IN ITEM 14.
q. I

-1 A g&CH;;q:ppp:Eof 1SSUE.D PURSUANT TO: (Specifya~!lhor~?y)THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRAC'T

B. THE ABOVE NUMBERED CONTRACTIORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in papng office.
appropnal~ondale, elc.) 9eTPORTHlN ITEM 14. PURSUANT TO THE AUTHORITY OF FAR 43.103(b). .- .. . . .. . . - c..

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

.. -- -:I
!I
1 - '. - -
I D. OTHER (Specrly lype 01 modilication and aulhonfy)

X 1 FAR 52.243 - 1 CHANGES - INCREASE -FUNDS

E. IMPORTANT: ,Co~tractrr m i s not. 1s rewired to sign th~sd o ~ u m ~ .and
n t return copies to the issuing olftce. -.

14. DESCRIPTION OF AMENDMN/MODIFlCATION (Oyanizedby UCF section heaolngs, including Solic!lafion/cuntrad subjecl matter where leasible.)
.. .- *
- '
T a x ID Number:
DUNS Number:
.- . .. -Y - . - .-.

ORIGINAL AMOUNT $ 70,000.00 1

INCREASE AMOUNT'$ 35,000.00
NEW TOTAL: $105,000.00
I
Not T o Exceed Amount changed to: $105,000.00
.-- .
, .. ..
' 9

Period of Performance: 10/01/2003 t o 09/30/2004 1

I
Excepl as provlded herem: all terms and c m d ~ t ~ofmIhe document referenced In llem 9A or 10A. as herelofme changed, remalns unchanged and In full force and eflect
15A NAME AND TITLE OF SIGNER (Type orpnnf) 16A NAME AND TITLE OF CONTRACTING OFFICER (Type orpnnl)

C . SAVOY

NSN 754001-1528070
Previous ed~t~on
unusable
Seer 30 (RW 1043)

FAR (48 CFR) 53 243

READ INSTRUCTIONS ON NEXT PAGE Page 1 cf 2

n ( R 9 m u R E M N T REQUEST N o . 1

I
REQUISITION DATE
I NAME PHONE NUMBER AND ROLlTlNG SYMBOL OF PERSON TO CONTACT
12/16/2003
HARRIET POLSTER/301-443-8956

I1
3 ORIGINATING OFFICE DATA 2 Y E OF REQUEST (Check one)
A U N E W REQUEST
SAMHSA/OC
4 ADDITIONAL INFORMATION (Suggested supply s u m s , secunty data, elc ) B ECHANGE
TO
PENDING PR NO . 1
I
MODIFICATION TO ~ ~ ~ ~ 0 021 2 38 0 3 72 ~ ~
CONTRACT OR
ORDER NO 1li
5 APPROVALS 6 CONSIGNEE AND DESTINATION

APPROVING OFFICIALS
ROUTING
OATE
, INTERNAL ROUTING

1-1
SYMBOL
ICI
- 0HllU.S RanrnG
(8) (Dl SYUBOL (€1

(11 ArnHORIZED REQUISITIONER

HARRIET POLSTER
. .
-S&SA
- ,-
06/28/2004 I
'=* ..
-
1 -
li
1
, : ..
4:-
-
(2)
I
SHERI KRETSCHMAIER PSC 12/24/2003
1
i

I 7. DATE(S) REQUIRED
See S c h e d u l e
8.GOVERNMENT FURNIP~EDPROPERTY
i
I

SAMH~A - 12/23/2003 DYESNO ,nys:& ~ . t ~ m u m m . ~ ~ -

9.D E S C R I P T I O N O F I T E M S O R S E R V I C E S
 1 CONTRACT ID CODE PAGE
AMENDMENT OF SOLlClTATlONlMODlFlCATlON OF CONTRACT
1
2 AhlENDMENlMODlFlCAT10N NO 13 EFFECTIVE DATE 14 REQUISITIONPURCHASE REQ NO 5 PROJEC.

0001 10/30/2003
6 ISSUED BY 'ODE
DAM 7 ADMINISTERED BY (If other than Item 6: CODE DJ
DHHS/ PSC/AOS/DAM DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101 PKLN. BLDG., ROOM 5-101
5600 FISHERS LANE 5600 FISHERS LANE
ROCKVILLE MD 20857 ROCKVILLE MD 20857

8 NAME AND ADDRESS OF CONTRACTOR (No s u e e ~counry. Stare am ZIP Codej 9A AMENDMENT OF SOLICITATION NO

ROBIN L: CLEMENS
3205 NORTH FRONT STREET
APT. # 5
HARRISBURG PA 17110 1CA MODIFICATON OF CONTRACTIORDER NO
'HHSP23320042807MB
- . . . --
CODE . . .
P

FACILITY CQBE ..
. -
I I
108 DATED (SEE ITEM II)

10/30/2003
--- :. -
11. THIS ITEM ONLY APPUES TO AMENDMENTS OF SOUCITATIONS

The above numbered s d ~ o t a t ~ o

ISnamended as set f& In Item 14 The hour and date speofied for recelpt of Ofiers IS extended G 1s r
Offers must admawledge recelpt of UIS amendment pnor to (he hour and date speofied In lhe sd10laDonor as amended, by one of the f d l m n g methods (a) By a
Items 8 and 15, and relumlng coples of the amendment. (b) By admcmledglng recelpt of lhls amendment on each copy of the offer submlned.
separate letter w telegram wh~chlndudes a reference lo the s d ~ o t a t ~and
m amendment numbers FAILURE OF YOUR ACKNOWLEDGEMENT TO BE RECEIVE
THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER
v~nue'of(his amendment y o u deslre to change an offer already subm~ued,such change may be made by telegram w letter, prowded each telegram or letter makes
and t h ~ samendment, and 1s rece~vedprior io the openlna hour and date specified
reference to the sol~cilat~on
12 ACCOUNTING AND APPROPRIATION DATA (Ilrequrred)
7541362 C96A500 2522
13. THIS ITEM ONLY APPUES TO OF CONTRACTSIORDERS. r'f MODIFIES THE CONTRACTIORDER NO. AS DESCRIBED IN ITE

A THlS CHANGE ORDER IS ISSUED PURSUANl TO: (Speufyaulhontyl THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRA(
ORDER NO IN ITEM 10A --

TrlE ABOVE NUhlBERED COhTRACTKlRDER IS MODIF.ED TO REFLECT THE ADMIKISTFWTIVE CHANGES (such a s changes
appropnaoon dale. erc, SW-F0!3Tfi I h I T E L l 4 . PURSUAhT TO TrlE AUTrlORITY OF FAR 43 103(0)

. -*
G OTHER (Specify type of modifiwlron and aulhonly)
X: FAR 52.243-1 CHANGES - INCREASE FWIIS
E IMPORTANT Contranor IS not 1s requ~redl o slgn lhls doc1 nent and return wples to the lssulng ofice

14 DESCRIPTION OF AMENDMEHT/MODIFICATION(Organized by UCF section headings rnclud~ngsolictfatron/mntracf sub~ectmaner where leasrble )

Tax ID Number:
DUNS Number: .

THE ABOVE REFERENCED BPA IS HEREBY MODIFIED TO INCREASE FUNDS IN THE AMOiTNT OF
. .
ORIGINAL AMOUNT ON THIS BPA: $35,000.00
INCREASE AMOUNT ON THIS BPA: $35,000.00
NEW TOTAL AMOUNT ON THIS BPA: $70,000.00
...
ALL OTHER TERMS AND CONDITIONS ON THIS BPA REMAIN UNCHANGED.

Continued .
Except as prov~dedhereln, all terms and cmdltlons of the document referenced In Item 9A w 10A. as herelofwe changed. remalns unchanged and in full force and el
15A NAME AND TITLE OF SIGNER (Type or pnnl) 16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or

I JO LASKO
15B CONTRACTORIOFFEROR 1K: DATE SIGNED 16B UNITED STATES OF AMERICA iC DATE SIGNED

(Srgnatvre d p e r m aulhonzed to ygn)

NSN 754001-1528070 STANDARD F( d 30 (REV 1083)

Prev~ouse d ~ l ~ ounusable
n Presmbed by (
FAR (48 CFR)
 REFERENCE NO OF M3CUMENT BEING CONTINUED

cONT'NuAT'On s"EET~HHSP23320012807MB/OO01
NAME OF OFFEROR OR CONTRACTOR
ROEIN L . CLEMENS

N S N 754N1-152-8061 OPTIONAL FORM 336 (4-06)

IlSmnsored by GSA
FAR ( 4 8 CFR153 110
READ INSTRUCTIONS ON NEXT PAGE

PROCUREMENT REQUEST NO

PENDING PR NO

~ H O D I F I C A T I O NTO H H S ? ~ ?3 7 004 2 8 0 7 ~ 5
i
CONTRACT OR
ORDER NO.
!j
\I
I i/
5.APPROVALS 1 6 CONSIGNEE AND DESTINATION
APPROVING OFFICIALS
ROVTING
SYMBOL
DATE .. emm.sINTERNAL
.
ROVTING
ROUTUKi
(A) (C)
.
( 8 1. ID) SIUsOL (El

I
I I
AUTHORIZED REQUISFIONER
11
(I)
!
H A R R I E T POLSTER S-~HSA 06/28/2%04
. --
(2)

I I
(3) 7 DATE(S) REQUIRED
P A T R I C I A BRANSFORD SAMHSA '-11/21/2003 See Schedule
14) 8 GOVERNMENT FURNISHED PROPERTY
1 CYNTHIA COOKE (SAMHSA - 11/21/20031 1 I BYES
DNO
i
,H~...+.~
11
a,nsuramsmna-r I
1 9 DESCRIPTION OF ITEMS OR SERVICES !I I

10 ACCOUNTING DATA

See Schedule
READ INSTRUCTIONS ON NEXT PAGE

REQUISITION
PROCUREMENT REQUEST NO

04M000005 I
1 NAME PHONE NUMBER AND ROUTING SYMBOL OF PERSON TO CONTACT
HARRIET P O L S T E R / 3 0 1 - 4 4 3 - 8 9 5 6
3 ORIGINATING OFFICE DATA
REQUISITION DATE
12/16/2003
2 TYPE OF REQUEST (Check ax,
I'I
SAMHSA/OC
4 ADDITIONAL INFORMATION (Suggested supply sources. secunty dab. etc )
A ~ I N E W
REQUEST

B [?CHANGE TD
II
PENDING PR NO
~ M O D I F l c A T I O NTO H H S P 320042807M9
~~
CONTRACT OR
ORDER NO
Y
1
5 APPROVALS 6 CONSIGNEE AND DESTINATION

APPROVING OFFICIALS
ROUTING
'.
INTERNAL ROUTING /I
1
DATE
SYMBOL RMLYS
IA)
(B)
(c) (Dl SVU%X(E)
(1)AUMORIZEDREOUlSlTlONER 1

HARRIET POLSTER

SHERI KRETSCHMAIER PSC

I
:I

(4):
1
I
SAMHSA .12/24/2003
17 DATE(S) REQUIRED
See Schedule
I 8 GOVERNMENT FURNISHED PROPERTY
/

CYNTSIA COOKE SAMHSA - 12/23/2003 1 DYES

-.
=NO
I
sot..-m.-.*-~

9.DESCRIPTION OF ITEMSOR SERVICES I

ITEM NO ITEM OR T R V Y E ilnckde S p e d f ~ ~ a~r dn Speaal

r )R
II~IV
U
~
(I QUANTITI UNIT 1 ESTIMATED COST
(A I N, : (8) (C) (D) ;II *WI)HT
IF)

This second modification

..
is to increase this BPA or Rob n Clemens by another
I,
$35,000 which will give a total of $105,000.00. he per od of performance is
through 09/!,P.(,9,4. f.?o.m+the date of the approval of this r quest. 11
I
11
Period of Performance: 10/01/2003 to 09/30/2004 I
The CAN number is C96A500. The object class code is 25. z . ] MS. ~ e e n i l be
l
serving in the cdpacity'of doing speech writing f r Mr. ur e, 'SRMHSA Ad riisfrator.

10 ACCOUNTING DATA

See Schedule
 ORDER FOR SUPPLIES OR SERVICES 1 I PC
:: CZ 2-3:s

IMPORTANT Mark all packages and papers wlth contract and/or order numbers 1 1 ' I

1 DATE OF ORDER 2 CONTRACT NO (If any)

HHSP23320042807MB
10/30/2003
I
3 ORDER NO 4 REQUISITIONREFERENCE NO
Indicated On Call
See Schedule
5 ISSUING OFFICE /Address correspondence to) b STREET ADDRESS
DHHS/PSC/AOS/DAM
PARKLAWN BUILDING, ROOM 5-101
5600 FISHERS LANE
ROCKVILLE MD 20857
i
- c CITY

I
7 TO f SHIP VIA
a. NAME OF CONTRKTOR
ROBIN L. CLEMENS 8 TYPE OF ORDER :I
b. COMPANY NAME
m a PURCHASE 1
1
0 DELIVE~~Y
- . . .- . REFERENCE YOUR. . .
c STREET ADDRESS . ..
32 05 NORTH FRONT STREET,.. . .. .. -- lExcepl lor billtng ~ r & u n l o n son Ihe
m e . m~sdel~veryorder 1s --..
. --
APT. # 5 subject to InSINcllOnS contained on

d CITY
HARRISBURG
e STATE f ZIP CODE
Please fumlsh the f d l w i n g on the t e n s
and ccmd~konsspec~fiwon both sides 01
lnls order and on the attached sheell ~f
any, tnclud~ngdellvery as lndlcaled
1 illhis stde only of th~slam and 1s
!issued suPlect
, I -n !he lenns and
;mndttlons of lhe above-numbered
ic~nlrac~

9 . ACCOUNTING AND APPROPRIATIONS DATA 10. REQUISITIONING OFFICE

Indicated On Call SAMHSA/OC

11 BUSINESS CLASSIFICATION (Check appmpnate box(es))
td a SMALL
..
..rr* .. b OTHER THAN SMALL c DISADVANTAGED 1
0
I
d WOMEN-OWNED

12 F oB POINT Destination 14 GOVERNMENT B I ~ O 15 DELIVER TO F o B POINT 16 DISCOUNTTERMS

ON OR BEFORE (Date)
13 PLACE OF

a. INSPECTION b. ACCEPTANCE

17. SCHEDULE (See reverse for Rejeclions)

QUANTITY UNIT QUANTITY

ITEM NO. SUPPLIES OR SERVICES ORDERED UNIT PRICE -- A ~ ( O U F- :-I-.: I ACCEPTED
(a) ;b) (c) (dl fe) (f) (g)

Tax ID Number: t

DUNS Number: .-..

I
I

beriod dt
-., ..
~erfirmance:10/01/2003 to 09/30/2b01
---
I
..
1 . -
- ....
.-
1

18. SHIPPING POINT 19. GROSS SHIPPING WEIGHT 2 0 INVOICE NO. 11 17(h)
'1 TOTAL
(Cont.
pages)
21 MAIL INVOICE TO
1
a NAME Indicated On Call $35,or&. 00
....a . .
SEE BILLING
INSTRUCTfONS b, STREET ADDRESS !

TOTAL

c CITY d. STATE 1 e ZIP CODE $35,000.00

I

22 UNITED STATES OF AMERICA 1 23. NAME (Typed)

BY (Signarure) JO LASKO
TITLE. CoNTrncTlNWoRDERlNG OiFIcER
NSN 754601-152.8083 OPTIONAL FORM 347 (an€a51
PREVIOUS EDITION NOT USABLE R.u.W by O W A R l a 8 CFR) U 211.1
READ INSTRUCTIONSON NEXT PAGE

PROCUREMENT REQUEST NO.

PENDING PR NO. '.

ROBIN L. CLEMENS
c MODIFICATION TO
C O N r n C T OR

5 APPROVALS 1 6 CONSIGNEE AND DESTINATION II

BLDG., R O ~ M6 - 1 0 1
( I ) AUTHORIZED REOUiSlTlONER I 5600 FISHERS LANE \
HARRIET POLSTER SAMHSA 06/28/2504 ( ,
ROCKVILLE MD 20857
I

(3) 7 DATE(S) REOUIRED I

SHY-:RIKRETSCHMAIER 49/15/2003 I!
psc :I
(4)-- 8. GOVERNMENT FURNISHED PROPERN

ANNA MARSH ~AMHSA - 09/12/2003 : DYES

ENOl+~Y.:-Lsd-rn--,
I 9.DESCRIPTION OF ITEMS OR SERVICES ! I
ITEM NO OUANTIT'I TIMATED COST
ITEM OR S e f f V c E (Incue Speafmuom and Speml Imrmaam)
Mum
(A) '8" (B) (C) IF1

RENEWAL OF BPA 50438M

...
FOR MS. ROBIN CLEMENS WHO I A FOR SAMHSA AND ..

HAS FIRSTHAND KNOWLEDGE OF SAMHSA AND IS QUALIFIE I TO PE

JUSTIFICATIOE-THERE,+IS AN URGENT NEED FOR SPEEC WRITER
ADMINISTRATOR. HE HAS NUMEROUS SPEAKING ENGAGEME 'TS ANI: REQUESTS
TO SPEAK. IT IS CRUCIAL THAT WE ESTABLISH THIS E 'A WITH ZED WITH
SAMHSA ISSUES. .- . --
CAN: C96A500 Obj. Class: 2 5 2 2 FY: 2004
FOB: Destination
-Period. of
..
Performance: 10/01/2003 to 09/30/2004

1 RENEWAL OF BPA TO-DO SPEECHWRITING FOR THE SAMHSP -. -35,0.M. 0 0 -.

ADMINISTRATOR

Period of Performance: 09/30/2003 to 10/01/2004

GOVERNMENT IS OBLIGED ONLY TO THE EXTENT OF ORDEE PLACE BY THE
FOLLOWING: MARK WEBER-OA, DARYL KADE - OPPB
COST LIMIT NTE $ 2 , 5 0 0 .
Subject to Availability of FY "04" Funds

TOTAL ESTIMATEDCOST
'I
$35,000.00
10 ACCOUNTING DATA 1
Accounting Info : 7541362 :I
li