National Institutes of Health: FY2004

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HHSN261200400001C

ADB NUMBER: N01CA41234

EXAMPLE

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

1. CONTRACT ID CODE2. AMENDMENT/MODIFICAITON NO.3. EFFECTIVE DATE4. REQUISITION/PURCHASE REQ. NO.5. PROJECT NO.

(If applicble)

7. ADMINISTERED BY

(If other than Item 6)

CODE

STANDARD FORM 30

(REV. 10-83)Prescribed by GSA FAR (48 CFR) 53.243FACILITY CODE9A. AMENDMENT OF SOLICIATION NO.9B. DATED

(SEE ITEM 11)

10A. MODIFICATION OF CONTRACT/ORDER NO.10B. DATED

(SEE ITEM 11)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offersis extended,is not extended.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:(a)By completing items 8 and 15, and returningcopies 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 ACKNOWLEDGMENT TO BE RECEIVED AT 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 amendmentyour 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 thisamendment, and is received prior to the opening hour and date specified.12. ACCOUNTING AND APPROPIRATION DATA

(If required)

13. THIS ITEM ONLY APPLIES TO MODIFICATION OF CONTRACTS/ORDERS.IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

CHECK ONEA.THIS CHANGE ORDER IS ISSUED PURSUANT TO:

(Specify authority)

THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDERNO. IN ITEM 10A.B.THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES

(such as changes in paying office,appropriation date, etc.

) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).C.THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:D.OTHER

(Specify type of modification and authority)

E. IMPORTANT:

Contractoris not,is required to sign this document and returncopies to the issuing office.

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.15C. DATE SIGNED15A. NAME AND TITLE OF SIGNER

(Type or print)

16C. DATE SIGNED16A. NAME AND TITLE OF CONTRACTING OFFICER

(Type or print)

14. DESCRIPTION OF AMENDMENT/MODIFICATION (

Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

PAGE OF PAGES6. ISSUED BYCODE8. NAME AND ADDRESS OF CONTRACTOR

(No., street, county, State and ZIP Code)

(X)

CODE15B. CONTRACTOR/OFFEROR

(Signature of person authorized to sign)

16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer)

NSN 7540-01-152-8070Previous edition unusable

HHSN261200400001C

ADB NUMBER: N01CA41234

EXAMPLE

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RATING

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