CTR050592 A1.pdf
PDF 332 KB Posted
- Attached to
- Master Agreement AZ|CTR050592
- Contract number
- CTR050592
- Issued by
- Arizona
About this file
The document is a Contract Amendment issued by the Arizona Department of Health Services, Office of Procurement, for Contract No. CTR050592 with Adelante Healthcare, a nonprofit healthcare organization based in Phoenix, Arizona. The amendment is specifically for the Health Start Program and involves extending the existing contract for its second year.
The contract amendment extends the original agreement through July 5, 2022, in accordance with the contract's Special Terms and Conditions, specifically Provision Three regarding Contract Extensions with a five-year maximum. All other provisions of the original contract remain unchanged. Adelante Healthcare is a registered nonprofit healthcare entity with a DUNS Unique Entity ID of 001703789, located at 3033 N. Central Avenue in Phoenix, and is active in the System for Award Management (SAM) for federal assistance awards. The amendment was signed on June 11, 2021, by Robert Babyar, the Chief Medical Officer of Adelante Healthcare, and is effective upon signature by both parties.
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CONTRACT AMENDMENT
ARIZONA DEPARTMENT OF
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
CONTRACT NO.: CTR050592 AMENDMENT NO.: 1 Procurement Officer Kailee Gray
HEALTH START PROGRAM
Effective upon signature by both parties, it is mutually agreed that the Contract referenced in this amendment is amended as follows:
1. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extensions Five (5) Year Maximum, the Contract shall be extended for the second (2nd) year through July 5, 2022.
ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY
Contractor hereby acknowledges receipt and acceptance of above amendment and that a signed copy must be filed with the Procurement Office before the effective date
The above referenced Contract Amendment is hereby executed this _____ day of __________ 20______ at Phoenix, Arizona
(To be filled out by Procurement Office)
Contractor Signature
Contractor Signature Date
Authorized Signatory’s Name and Title
Adelante Healthcare
Contractor’s Name Procurement Officer Signature
11th June 21
7/7/2021 Arizona Corporation Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01284694 1/3
ENTITY INFORMATION
Search Date and Time: 7/7/2021 2:06:07 PM
Entity Details
Entity Name:
ADELANTE HEALTHCARE, INC.
Entity ID:
01284694
Entity Type:
Domestic Nonprofit Corporation
Entity Status:
Active
Formation Date:
2/19/1980
Reason for Status:
In Good Standing
Approval Date:
2/27/1980
Status Date:
10/22/2019
Original Incorporation Date:
2/19/1980
Life Period:
Perpetual
Business Type:
Health Care and Social Assistance
Last Annual Report Filed:
Domicile State:
Arizona
Annual Report Due Date:
3/19/2022
Years Due:
Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01284694 2/3
Title Name Attention Address Date of Taking Office
Last Updated
Director
DARRELL
LEONARD
3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, Maricopa County, USA
1/22/2015 3/19/2019
Director
LAWRENCE
SANDS
3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, Maricopa County, USA
5/23/2013 3/13/2020
Officer
ROBERT
BABYAR
3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, Maricopa County, USA
9/23/2019 3/2/2021
Treasurer
JASON
REED
3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, Maricopa County, USA
12/21/2017 3/13/2020
Director
GABRIEL
RAMIREZ
3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, Maricopa County, USA
9/28/2017 3/19/2019
Original Publish Date:
3/12/1980
Statutory Agent Information
Name:
Pedro Cons
Appointed Status:
Active 1/5/2021
Attention:
Address:
3033 N. Central Ave. , Suite 145, PHOENIX, AZ 85012, USA
Agent Last Updated:
3/2/2021
E-mail:
Attention:
Mailing Address:
County:
Maricopa
Principal Information
Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01284694 3/3
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Document History Name/Restructuring History
Pending Documents Microfilm History
Address
Attention:
Angela Robinson
Address:
3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, USA
County:
Maricopa
Last Updated:
3/2/2021
Entity Principal Office Address
Attention:
Address:
County:
Last Updated:
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ADELANTE HEALTHCARE, INC.
DUNS Unique Entity ID
001703789
SAM Unique Entity ID
MP1FF2KFALV3
CAGE / NCAGE
3L3T9
Purpose of Registration
Federal Assistance Awards Only
Expiration Date
Feb 12, 2022
Registration Status
Active
Physical Address
3033 N. Central AVE STE 145
Phoenix, Arizona 85012-2808
United States
Mailing Address
3033 N. Central Avenue
STE 145
Phoenix, Arizona 85012-2808
United States
Business Information
Doing Business as
(blank)
Division Name
(blank)
Division Number
(blank)
Congressional District
Arizona 09
State / Country of Incorporation
Arizona / United States
URL
www.adelantehealthcare.com
Registration Dates
Activation Date
Mar 3, 2021
Submission Date
Feb 12, 2021
Initial Registration Date
Nov 3, 2003
Entity Dates
Entity Start Date
Jul 14, 1980
Fiscal Year End Close Date
Dec 31
Immediate Owner
CAGE
(blank)
Legal Business Name
(blank)
Highest Level Owner
CAGE
(blank)
Legal Business Name
(blank)
Executive Compensation
Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of
P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions.
Proceedings Questions
Registrants in the System for Award Management (SAM) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or
2.C.F.R. 200 Appendix XII. Their responses are not displayed in SAM. They are sent to FAPIIS.gov for display as applicable. Maintaining an active registration in SAM demonstrates the registrant responded to the proceedings questions.
SAM Search Authorization
I authorize my entity's non-sensitive information to be displayed in SAM public search results:
Yes
Entity Types
Business Types
Entity Structure
Corporate Entity (Tax Exempt)
Entity Type
Business or Organization
Organization Factors
(blank)
Profit Structure
Non-Profit Organization
Government Types
(blank)
Financial Information
Last updated by Jesse O Garcia on Feb 12, 2021 at 01:04 PM ADELANTE HEALTHCARE, INC.
https://sam.gov/entity/001703789/coreData?status=Active Page 1 of 2
Accepts Credit Card Payments
Yes
Debt Subject To Offset
No
Points of Contact
Electronic Business
Pedro Cons, CEO 3033 N. Central Avenue
STE 145
Phoenix, Arizona 85012
United States
Jesse Garcia, Chief Strategy Officer 3033 N. Central Avenue
STE 145
Phoenix, Arizona 85012
United States
Government Business
Karen Gaumer, Sr Strategic Programs Mgr 3033 N Central Avenue
STE 145
Phoenix, Arizona 85012
United States
Katia Lopes-Gilbert, Executive Assistant 3033 N. Central AVE, STE 145
Phoenix, Arizona 85012
United States
Past Performance
Angela Robinson, Finance Director 3033 N Central Avenue
STE 145
Phoenix, Arizona 85012
United States
Service Classifications
NAICS Codes
Primary NAICS Codes NAICS Title
Disaster Response
This entity does not appear in the disaster response registry.
Last updated by Jesse O Garcia on Feb 12, 2021 at 01:04 PM ADELANTE HEALTHCARE, INC.
https://sam.gov/entity/001703789/coreData?status=Active Page 2 of 2
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