CTR050592_Contract_Amendment_Summary_2.pdf
PDF 529 KB Posted
- Attached to
- Master Agreement AZ|CTR050592
- Contract number
- CTR050592
- Issued by
- Arizona
About this file
This document is a Contract Amendment issued by the Arizona Department of Health Services, Office of Procurement, for the Health Start Program. The contract is with Adelante Healthcare, a non-profit healthcare organization based in Phoenix, Arizona. The amendment (Amendment No. 2) is for Contract No. CTR050592 and involves extending the contract for its third year through July 5, 2023.
The amendment includes a detailed Price Sheet for Annual Health Start Services from July 1, 2022 to June 30, 2023. The contract covers a range of required services with specific unit rates, including data preparation ($250 per month), client enrollments ($190 per person), prenatal and family follow-up visits ($115 per person), multiple-child visits ($75 per child), substance screening ($80 per class), and various consultations and assessments. The total annual contract amount is $91,960, which includes $90,670 for required services and $1,290 for optional services such as classes for clients. The pricing structure allows for a defined number of units for each service type, providing a comprehensive framework for healthcare service delivery.
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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.: 2 Procurement Officer Mitchell Goldberg
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 Uniform Terms and Conditions, Provision Five (5), Contract Changes, Section 5.1, Amendments, the Contract is hereby revised with the following:
1.1. The Price Sheet is revised and replaced.
2. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extensions Five (5) Year Maximum, the Contract shall be extended for the third (3rd) year through July 5, 2023.
ALL CHANGES ARE IDENTIFIED BELOW IN RED
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
Pedro Cons, CEO
5/31/2022
Gina Corwin
Digitally signed by Gina Corwin Date: 2022.06.01 12:07:36 -07'00'
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
CONTRACT NO.: CTR050592 AMENDMENT NO.: 2 Procurement Officer Mitchell Goldberg
PRICE SHEET
Annual Health Start Services Projection Form 7/1/2022 - 6/30/2023
FREQUENCY
FUNDING
LINES
REQUIRED SERVICES
UNIT OF
MEASURE
UNIT
RATE
HEALTH
START
HEALTH
START $
Required Services
TOTAL $
Data Preparation Per Month $250.00 12 $3,000.00 $3,000.00
Client Enrollments Per Person $190.00 20 $3,800.00 $3,800.00
Client Visits Prenatal Per Person $115.00 240 $27,600.00 $27,600.00 Client Visits Family Follow up Mom/Caregiver Per Person $115.00 200 $23,000.00 $23,000.00
Client Family Follow-up Child Per Child $115.00 160 $18,400.00 $18,400.00
Multiple-Child Visits Per Child $75.00 20 $1,500.00 $1,500.00 Alcohol, Tobacco, Other Drugs Screening Visits Per Class $80.00 23 $1,840.00 $1,840.00
Brief Intervention Visits Per Person $60.00 9 $540.00 $540.00
Healthy @ Home Assessments Per Person $60.00 45 $2,700.00 $2,700.00
Nurse Consultation Per Hour $90.00 12 $1,080.00 $1,080.00
Social Work/LPC Consultation Per Hour $80.00 12 $960.00 $960.00
Social Work/LPC Consultation Per Hour $0.00 0 $0.00 $0.00
Training - CHW/ CHN/ Coordinator Per Day $250.00 25 $6,250.00 $6,250.00
TOTAL $90,670.00
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
CONTRACT NO.: CTR050592 AMENDMENT NO.: 2 Procurement Officer Mitchell Goldberg
OPTIONAL SERVICES
UNIT OF
MEASURE
UNIT
RATE
HEALTH
START
HEALTH
START $
OPTIONAL
Services
TOTAL $
Pregnancy Test Visits Per Person $80.00 0 $0.00 $0.00
Classes for Community Per Class $215.00 0 $0.00 $0.00
Prenatal Visits - Birth Doula Support Per Person $0.00 0 $0.00 $0.00
Classes for Clients Per Class $215.00 6 $1,290.00 $1,290.00
TOTAL $1,290.00
TOTAL ANNUAL CONTRACT AMOUNT $91,960.00
**Per Person/Per Day/Per the ADHS General Accounting Office guidelines www.gao.az.gov/travel
ADELANTE HEALTHCARE, INC.
Unique Entity ID
MP1FF2KFALV3
CAGE / NCAGE
3L3T9
Purpose of Registration
Federal Assistance Awards Only
Registration Status
Active Registration
Expiration Date
Jan 24, 2023
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
Jan 26, 2022
Submission Date
Jan 24, 2022
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.
Exclusion Summary
Active Exclusions Records?
No
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
Last updated by Vanessa Figueroa on Jan 24, 2022 at 04:52 PM ADELANTE HEALTHCARE, INC.
https://sam.gov/entity/MP1FF2KFALV3/coreData?status=Active Page 1 of 2
Socio-Economic Types
Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the
SBA supplemental pages during registration.
Financial Information
Accepts Credit Card Payments
Yes
Debt Subject To Offset
No
EFT Indicator
CAGE Code
3L3T9
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
Vanessa Figueroa, Grants Manager 3033 N. Central AVE Suite 145
Phoenix, Arizona 85012
United States
Past Performance
Vanessa Figueroa, Grants Manager 3033 N. Central AVE Suite 145
Phoenix, Arizona 85012
United States
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 Vanessa Figueroa on Jan 24, 2022 at 04:52 PM ADELANTE HEALTHCARE, INC.
https://sam.gov/entity/MP1FF2KFALV3/coreData?status=Active Page 2 of 2
Arizona Corporation Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01284694[6/2/2022 7:34:01 AM]
ENTITY INFORMATION
Search Date and Time: 6/2/2022 7:33:50 AM
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
ROBERT 3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, 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: 2022
Domicile State: Arizona Annual Report Due Date: 3/19/2023
Years Due:
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: 2/25/2022 E-mail:
Attention: Mailing Address:
County: Maricopa
Principal Information
Privacy Policy ǀ Contact Us
ACC
eCorp Search File FAQ http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts http://www.azcc.gov/ http://www.azcc.gov/ http://www.azcc.gov/ https://ecorp.azcc.gov/ https://ecorp.azcc.gov/EntitySearch/Index https://ecorp.azcc.gov/OnlineMenu/Index http://azcc.gov/corporations/faqs
Arizona Corporation Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01284694[6/2/2022 7:34:01 AM]
< Previous ... 1 2 3 4 5 ... Next > Page 1 of 5, records 1 to 5 of 22 Go to Page
Officer BABYAR Maricopa County, USA
9/23/2019 3/2/2021
Director JASON REED 3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, Maricopa County, USA
12/21/2017 2/25/2022
Director
GABRIEL
RAMIREZ
3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, Maricopa County, USA
9/28/2017 3/19/2019
Address
Attention:
Angela Robinson
Address:
3033 N. Central Ave., Ste. 145, PHOENIX, AZ, 85012, USA
County:
Maricopa
Last Updated:
2/25/2022
Entity Principal Office Address
Attention: Address: County: Last Updated:
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