Amendment_3.pdf
PDF 349 KB Posted
- Attached to
- AZ|CTR070044
- Contract number
- CTR070044
- Issued by
- Arizona
About this file
This is a Contract Amendment (Amendment Number Three) issued by the Arizona Department of Economic Security, located at 1789 W Jefferson Street, Mail Drop 1541, Phoenix, Arizona 85007. The amendment modifies Contract Number CTR070044 with the primary contractor Desierto Psychological PLLC for health assessment and consultative examination services.
The amendment authorizes the addition of Kristen Northup Psy.D. as a subcontractor under the original contract to perform consultative examinations and psychological testing as requested. The modification involves replacing the existing Attachment 4 – Facility Location Chart with a revised version that reflects this subcontractor addition. All other requirements, specifications, and terms and conditions of the original contract remain unchanged. The amendment was executed through electronic approval in the state's APP system.
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Text version
CONTRACT AMENDMENT
Arizona Department of Economic Security
1789 W Jefferson Street, Mail Drop 1541, Phoenix, AZ 85007
CONTRACT NUMBER: AMENDMENT NUMBER:
CTR070044 Three (3)
DESCRIPTION/ LABEL: Health Assessment – Consultative Examinations (CE)
CONTRACTOR NAME: Desierto Psychological PLLC
THE ABOVE REFERENCED CONTRACT IS HEREBY MODIFIED AS FOLLOWS:
1. In accordance with the Uniform Terms and Conditions, Section 5.0 Contract Changes, Subsection
5.1 Amendments, Attachment 4 – Facility Location Chart shall be replaced with the revised Attachment 4 – Facility Location Chart to include the following:
a. Add, Kristen Northup Psy.D., as a subcontractor to perform Consultative Examinations and Psychological testing as requested.
ALL OTHER REQUIREMENTS, SPECIFICATIONS, AND TERMS AND CONDITIONS REMAIN UNCHANGED
ACKNOWLEDGEMENT AND AUTHORIZATION
This Amendment shall be fully executed by means of electronic approval in APP.
File details come from the government source that posted it. Updated .