CTR050593_Health_Start_Program__A1_-_Apache_County_fully_executed.pdf

Provide full description of services or materials

Estimated Cost Commodity

Requesting Term Supplier ID

Supplier

Contract ID CI Type

SECTION II - Background

Requestor Email

Title Telephone

SECTION I - Agency Request

Agency

Procurement Determination:

Competition Impracticable Authorization R2-7-E303

SECTIONS 1 THROUGH 3 MUST BE COMPLETED BY THE REQUESTOR

USE ADDITIONAL PAGE AS NECESSARY

Page 1 of 3 SPO 101 - Competition Impracticable Authorization (rev 03-21)

Arizona Department of Health Services (ADHS), Bureau of Women & Children's Health (BWCH)

Health Start Program

Mohave County Health Department

Kailee Gray

Senior Procurement Officer kailee.gray@azdhs.gov

(480) 392-4154

CTR050596

Through July 5, 2022

Approximate total is $10,045.48 for eighteen (18) days

IV0000003546

85000000 - Healthcare Services

Authorization Request for a new CI

BWCH requires a home visitation program through the development of administrative, management, organizational systems and information, and referral networks to implement and manage a Health Start Program at the contracted site in targeted communities/service areas at risk for pre-term and low birth weight births and high rates of infant mortality and high rates of maternal morbidity and mortality.

In accordance with the Procurement Rules, the Arizona Uniform Terms and Conditions must be made a part of all Contracts. If you will be required to sign a software licensing agreement or sign any other agreement containing terms and conditions, which will be made part of the final Contract, you must receive prior approval from the Office of the Attorney General. Approval of this request does not allow for agencies to exceed their dollar acquisition amount of delegated authority.

Date of request Signature

Describe the procurement process, strategy to promote competition and details about fair and reasonable price determination pursuant to R2-7-702

Provide details of the procurement need, the competition impracticable and how the proposed procurement is advantageous to the State

I have conducted research and determined no statewide solution is available for the goods / servcies.

SECTION III - Justification

Rationale

Page 2 of 3 SPO 101 - Competition Impracticable Authorization (rev 03-21)

Compliance with A.R.S. § 41 2533, 41 2534, 41 2538, or 41 2578 is impracticable

The BWCH Health Start Program utilizes community health workers to provide education, support, and advocacy services to pregnant/postpartum women and their families in targeted communities across the state. The community health workers live in and reflect the ethnic, cultural and socioeconomic characteristics of the communities they serve.

Families receive home visits and case management with oversight by nurses and social workers, through the enrolled child's second year of life. Pregnant women are connected to prenatal care providers and receive on-going education about fetal development and health behaviors that can impact birth outcomes. Mothers are screened for postpartum depression and receive information regarding inter-conception health. Clients are referred to various services as needed and assistance with accessing hose services. The community health workers educate parents about child development, immunizations, home safety and vehicle safety. The community health workers also screen each child on a periodic basis using the Ages and Stages Questionnaire to identify potential developmental delays and refer the family to the appropriate provider. Health Start community health workers acquire new skills and knowledge on an on-going basis to ensure they are providing the most accurate information.

Contract #CTR050596 for the BWCH Health Start Program with Mohave County Health Department is one of the fifteen (15) contracts awarded under solicitation BPM002372 on July 6, 2020, with an expiration date of July 5, 2021 (and with an option to renew annually up to five (5) years). An Amendment to extend the Contract was sent to the Contractor for signature on June 3, 2021. ADHS received the Amendment back on July 8, 2021. Due to an oversight, the Amendment did not get finalized until July 23, 2021, leaving an eighteen (18) day gap without a Contract in place.

As these services are still required, it is in the best interest of the State to approve this Gap CI to ensure any services provided during the eighteen (18) day gap are covered. Pricing is considered fair and reasonable as pricing awarded under this Contract is not being changed.

July 27, 2021

Title

Approved Expiration Date

Comments, conditions or restrictions (as applicable)

Use section as necessary

Signature

AGENCY NOTICE: This is an official written determination in response to a procurement authorization request. A copy of the request shall be maintained by the State Procurement Office.

Print name Date

Determination

TO BE COMPLETED BY PROCUREMENT AUTHORITY

SECTION IV - Approval

Page 3 of 3 SPO 101 - Competition Impracticable Authorization (rev 03-21)

July 5, 2022

Request Authorized Pursuant to R2 7 E303

This determination should have been signed prior to signing the Amendment. The CPO was on vacation and signature was delegated to a Supervisor. The Supervisor signed the Amendment but did not request the CI at the same time.

Signature today is to correct the error and cover the gap in service.

Christine Ruth

Chief Procurement Officer

7.28.2021

SPO 101 Standard Work

Version

SECTION II

Background

Provide full description of services or materials

Detailed description of the agency need

SECTION III

Justification

Rationale

Select applicable option in accordance with A.A.C R2 7 E303.A and E303.C.1 Compliance with A.R.S. § 41 2533, 41 2534, 41 2538, or 41 2578 is impracticable Compliance with A.R.S. § 41 2533, 41 2534, 41 2538, or 41 2578 is unnecessary Compliance with A.R.S. § 41 2533, 41 2534, 41 2538, or 41 2578 is contrary to public interest Documented lack of suppliers Procurement requires an open and continuous availability of offerors

SECTION II

Background

Commodity APP Commodity code(s)

SECTION II

Background

CI Type Select applicable option:

Authorization Request for a new CI Modification pursuant to R2 7 E303.E for a CI modification

SECTION II

Background

Requesting Term S contract term or extension period, as applicable, based on the CI Type selected in the previous section

SECTION II

Background

Supplier ID APP Supplier ID

SECTION II

Background

Estimated Cost Forecasted expenditures for the duration of the CI Term

SECTION II

Background

Supplier Name of supplier(s)

SECTION II

Background

Contract ID APP contract number (if available)

Telephone Telephone number of the requestor

SECTION II

Background

Owner

Form Number SPO 101 Competition Impracticable Authorization rev 03 21

Sections I through III to be completed

Process Standard Work / Instructions for completion and submittal of the SPO 101 form. The form is available on the SPO website, section Resources / Standard Forms and Documents.

Section Action Action Detail / Key Points

State Procurement Office, Compliance Unit

SECTION I

Agency Request

Agency Name of the requesting agency

SECTION I

Agency Request

Requestor Name of the requestor

SECTION I

Agency Request

Title Job title of the requestor

SECTION I

Agency Request

Email Email of the requestor

SECTION I

Agency Request

Page 1 of 2 SPO 101 Standard Work (rev 03-21)

SPO 101 Standard Work

SECTION IV

Approval

Upon completion, forward the form to the Procurement Office If anticipated expenditure is above gency's delegation, forward document to SPOCompliance@azdoa.gov.

Approved Expiration Date

Date S date of approval

Signature Signature of the approving authority

SECTION IV

Approval

SECTION IV

Approval

Print name

Title

Printed name of the approver

Complete as needed

SECTION IV

Approval

Job title of the approver

S

SECTION IV

Approval

SECTION IV

Approval

I have conducted research and determined no statewide solution is available for the goods / services.

SECTION III

Justification

Check the box confirming research was conducted. If the CI pertains to modification pursuant to R2 7 E303.E, leave field empty.

SECTION III

Justification

Provide details of the procurement need, the competition impracticable and how the proposed procurement is advantageous to the state

Detail information regarding the rationale selected in the previous section;

agency use of the materials or services; if statewide contracts were explored;

the limitation which led to competition impracticable and how the state would benefit from the procurement. If there is previous contract which requires modification pursuant to R2 7 E303.E or contract that reached out max. 5 year term, provide the contract number and copy of the CI.

S date

Section IV to be completed by the Procurement Authority:

SECTION IV

Approval

SECTION III

Justification

Signature Signature of the authorized requestor

SECTION III

Justification

Describe the procurement process, strategy to promote competition and details about fair and reasonable price determination pursuant to R2 7 702

Detail strategy for the proposed procurement; considered competition, reason for selecting specific supplier and negotiations strategy.

SECTION III

Justification

Date of request

Comments, conditions or restrictions

Determination

Select applicable option in accordance with A.A.C R2 7 E303.D:

Request Authorized Pursuant to R2 7 E303 Request Authorized with Conditions/Restrictions R2 7 E303 Request Returned for Additional Information Request Denied

Section may be used by any party in case the fields within the document were insufficient

Additional section

Page 2 of 2 SPO 101 Standard Work (rev 03-21)

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MOHAVE, COUNTY OF

DUNS Unique Entity ID

077531937

SAM Unique Entity ID

V35YJGS4W9Y1

CAGE / NCAGE

4ANR9

Purpose of Registration

Federal Assistance Awards Only

Expiration Date

Aug 10, 2021

Registration Status

Active

Physical Address

700 W Beale ST

Kingman, Arizona 86401-5711

United States

Mailing Address

PO Box 7000

Kingman, Arizona 86402-7000

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 04

State / Country of Incorporation

(blank) / (blank)

URL

http://www.mohavecounty.us

Registration Dates

Activation Date

Aug 10, 2020

Submission Date

Aug 10, 2020

Initial Registration Date

Jun 6, 2005

Entity Dates

Entity Start Date

Jul 1, 1864

Fiscal Year End Close Date

Jun 30

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.

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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.

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Entity Types

Business Types

Entity Structure

U.S. Government Entity

Entity Type

US Local Government

Organization Factors

(blank)

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(blank)

Government Types

U.S. Local Government

County

Financial Information

Last updated by Terri Bryant on Aug 10, 2020 at 01:48 PM MOHAVE, COUNTY OF https://sam.gov/entity/077531937/coreData?status=Active Page 1 of 2

Accepts Credit Card Payments

No

Debt Subject To Offset

No

Points of Contact

Electronic Business

TERRI BRYANT, ACCOUNTING MANAGER

PO Box 7000

Kingman, Arizona 86402

United States

SHERYL RALPH, ACCOUNTING MANAGER PO Box 7000

Kingman, Arizona 86402

United States

Government Business

TERRI BRYANT, ACCOUNTING MANAGER

PO Box 7000

Kingman, Arizona 86402

United States

SHERYL RALPH, ACCOUNTING MANAGER PO Box 7000

Kingman, Arizona 86402

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 Terri Bryant on Aug 10, 2020 at 01:48 PM MOHAVE, COUNTY OF https://sam.gov/entity/077531937/coreData?status=Active Page 2 of 2