5. PROJECT NO. (if applicable) CODE 7. ADMINISTERED BY 2. AMENDMENT/MODIFICATION NO. CODE 6. ISSUED BY 8. NAME AND ADDRESS OF CONTRACTOR 4. REQUISITION/PURCHASE REQ. NO. 3. EFFECTIVE DATE 9A. AMENDMENT OF SOLICITATION NO. 9B. DATED PAGE OF PAGES 10A. MODIFICATION OF CONTRACT/ORDER NO. 10B. DATED BPA NO. 1. CONTRACT ID CODE FACILITY CODE CODE Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers E. IMPORTANT: is extended, (a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR AC- KNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended. 12. ACCOUNTING AND APPROPRIATION DATA (REV. 10-83) is required to sign this document and return ___________ copies to the issuing office. is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A. 15C. DATE SIGNED B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b). RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified. C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF: D. OTHER BY Contractor 16C. DATE SIGNED 14. DESCRIPTION OF AMENDMENT/MODIFICATION 16B. UNITED STATES OF AMERICA Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect. 15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER 15B. CONTRACTOR/OFFEROR STANDARD FORM 30 NSN 7540-01-152-8070 PREVIOUS EDITION NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.) (No., street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.) (If required) (SEE ITEM 11) (SEE ITEM 13) (X) CHECK ONE 13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS, IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14. 11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT (Signature of person authorized to sign) (Signature of Contracting Officer) 1 2 A00001 01-11-2017 636-17-2-1049-0003 None Department of Veterans Affairs NCO 23 - Minneapolis 708 S. Third St., Suite 200E Attention: Patrick Karelis Minneapolis MN 55415 Department of Veterans Affairs NCO 23 - Minneapolis Attention: Patrick Karelis 708 S. Third St., Suite 200E Minneapolis MN 55415 To all Offerors/Bidders VA263-17-R-0056 12-22-2016 X X X 1 Pursuant to FAR 15.201 Exchanges with Industry Before Receipt of Proposals, the attached document addresses those questions in which answers have been received as of this date. All other solicitation terms and conditions remain unchanged. Scott Hendrix Contracting Officer CONTINUATION PAGE Vendor Questions and Answers (Q&A) Q: How many total annual cases/procedures do you anticipate at the VA Nebraska Western Iowa Healthcare facility? In the Price Schedule (page 9), it states a need for estimated quantity of 250 Hours. I wanted to confirm this is true in that there are roughly 250 Hours vs. 250 Annual Cases? In the Option Year periods, the 250 figure increases to 263, 276, 290, and 290, respectively. This makes me believe these are actual procedures. Our national average is roughly 4 hours per case, so based on the 250 Hours we are assuming 60+ cases per year. Can you please confirm? This number is very important in putting together our proposal and staffing plan. A: The Average OR time for these services at NWIHCS is 6-8 hours per procedure. It can be estimated 20 25 procedures per year. Q: Would you happen to have any insight on the concurrency of cases on a daily/weekly basis? i.e. are there any overlap case scenarios which would require more than one Technician monitoring at a given time? A: No Q: Would you be able to provide the specific surgical procedure types that are in need of monitoring at this facility? Our assumption is cervical/lumbar spine, possibly craniotomy, ENT, and vascular procedures? A: Cervical / Lumbar Spine and Vascular Procedures. Q: Do you foresee a need for pedicle screw stimulator probes or any special probes? This would be based on procedure type. I only notice Subdermal Needles referenced but the number is low and doesn t seem to coincide with the case volume/hours listed A: Do not foresee the need for pedicle screw stimulator probes or any special probes at this time. Q: Our group provides a Remote Neurologist (MD) for real-time consultation and support for the Technician and Surgeon. I did not see any reference to Remote Oversight in the Solicitation which leads me to assume the current services provider only provides the Technical component. Are we able to provide this as standard of care for the VA patients? Notably, the Solicitation states there shall be no billing to the patient insurance so we would roll this service component into our overall pricing per case/hour. A: Remote Oversight is not part of the requirement.

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