CTR050596 A1.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

Procurem ent D eterm ination:

C om petition Im practicable Authorization R

2-7-E303

SEC

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TH

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PLETED

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SPO

101 - C om petition Im practicable

Authorization (rev 03-21)

Arizona D epartm ent of H ealth Services (AD

H S), Bureau of W om en & C hildren's H ealth (BW

C H

H ealth Start Program

M ohave C ounty H ealth D epartm ent

Kailee G ray

Senior Procurem ent O fficer kailee.gray@ azdhs.gov

(480) 392-4154

C

TR

050596

Through July 5, 2022

Approxim ate total is $10,045.48 for eighteen (18) da

IV0000003546

85000000 - H ealthcare Services

Authorization R equest for a new

C I

BW

C

H requires a hom e visitation program through the developm ent of adm inistrative, m anagem ent, organizational system s and inform ation, and referral netw orks to im plem ent and m anage a H ealth Start Program at the contracted site in targeted com m unities/service areas at risk for pre-term and low birth w eight births and high rates of infant m ortality and high rates of m aternal m orbidity and m ortality.

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

SPO

101 - C om petition Im practicable

Authorization (rev 03-21)

C om pliance w ith A.R

.S. § 41 2533, 41

2534, 41 2538, or 41

2578 is im practicable

The BW C

H H ealth Start Program utilizes com m unity health w orkers to provide education, support, and advocacy services to pregnant/postpartum w om en and their fam ilies in targeted com m unities across the state. The com m unity health w orkers live in and reflect the ethnic, cultural and socioeconom ic characteristics of the com m unities they serve.

Fam ilies receive hom e visits and case m anagem ent w ith oversight by nurses and social w orkers, through the enrolled child's second year of life. Pregnant w om en are connected to prenatal care providers and receive on-going education about fetal developm ent and health behaviors that can im pact birth outcom

es. M others are screened for postpartum depression and receive inform ation regarding inter-conception health. C lients are referred to various services as needed and assistance w ith accessing hose services. The com m unity health w orkers educate parents about child developm ent, im m unizations, hom e safety and vehicle safety. The com m unity health w orkers also screen each child on a periodic basis using the Ages and Stages Q uestionnaire to identify potential developm ental delays and refer the fam ily to the appropriate provider. H ealth Start com m unity health w orkers acquire new skills and know ledge on an on-going basis to ensure they are providing the m ost accurate inform ation.

C ontract #C

TR

050596 for the BW C

H H ealth Start Program w ith M ohave C ounty H ealth D epartm ent is one of the fifteen (15) contracts aw arded under solicitation BPM

002372 on July 6, 2020, w ith an expiration date of July 5, 2021 (and w ith an option to renew annually up to five (5) years). An Am endm ent to extend the C ontract w as sent to the C ontractor for signature on June 3, 2021. AD

H S received the Am endm ent back on July 8, 2021. D ue to an oversight, the Am endm ent did not get finalized until July 23, 2021, leaving an eighteen (18) day gap w ithout a C ontract in place.

As these services are still required, it is in the best interest of the State to approve this G ap C I to ensure any services provided during the eighteen (18) day gap are covered. Pricing is considered fair and reasonable as pricing aw arded under this C ontract 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 determ ination 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

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PLETED

B

Y PR

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T AU

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SECTION IV - Approval

SPO

101 - C om petition Im practicable

Authorization (rev 03-21)

July 5, 2022

R equest Authorized Pursuant to R

E303

This determ ination should have been signed prior to signing the Am endm ent. The C

PO

w as on vacation and signature w as delegated to a Supervisor. The Supervisor signed the Am endm ent but did not request the C I at the sam e tim e.

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

C hristine R uth

C hief Procurem ent O fficer

7.28.2021

SPO

101 Standard W ork

Version

SECTIO

N

II

Background Provide fulldescription of servicesorm aterials

Detailed description ofthe agency need

SECTIO

N

III

Justification Rationale

Selectapplicable option in accordance w ith

A.A.C R2

E303.A and E303.C.1

Com pliance w ith

A.R.S.§

2533,41 2534,41

2538,or41 is im practicable Com pliance w ith

A.R.S.§

2533,41 2534,41

2538,or41 is unnecessary Com pliance w ith

A.R.S.§

2533,41 2534,41

2538,or41 iscontrary to publicinterest Docum ented lack ofsuppliers Procurem entrequiresan open and continuousavailability ofofferors

SECTIO

N

II

Background Com m odity

APP

Com m odity code(s)

SECTIO

N

II

Background CIType

Selectapplicable option:

Authorization Requestfora new

CI

M odification pursuantto R2

E303.E fora CIm odification

SECTIO

N

II

Background Requesting

Term S contractterm orextension period,asapplicable,based on the CIType selected in the previoussection

SECTIO

N

II

Background SupplierID

APP

SupplierID

SECTIO

N

II

Background Estim ated Cost

Forecasted expendituresforthe duration ofthe

CITerm

SECTIO

N

II

Background Supplier

Nam e ofsupplier(s)

SECTIO

N

II

Background ContractID

APP

contractnum ber(ifavailable)

Telephone Telephone num berofthe requestor

SECTIO

N

II

Background

O w ner

Form Num ber

SPO

Com petition Im practicable Authorization rev

SectionsIthrough IIIto becom pleted

Process Standard

W ork

/Instructionsforcom pletion and subm ittalofthe

SPO

form

The form isavailable on the

SPO

w ebsite,section

Resources/Standard Form sand Docum ents.

Section Action

Action Detail/Key

Points

State Procurem entO ffice,Com pliance Unit

SECTIO

N I

Agency Request

Agency Nam e ofthe requesting agency

SECTIO

N I

Agency Request

Requestor Nam e ofthe requestor

SECTIO

N I

Agency Request

Title Job title ofthe requestor

SECTIO

N I

Agency Request

Em ail

Em ailofthe requestor

SECTIO

N I

Agency Request

SPO

ork (rev 03-21)

SPO

ork

SECTIO

N

IV

Approval

Upon com pletion,forw ard the form to the

Procurem entOffice

Ifanticipated expenditure isabove gency'sdelegation, forw ard docum entto

SPOCom pliance@ azdoa.gov.

Approved Expiration

Date

Date S date ofapproval

Signature Signature ofthe approving authority

SECTIO

N

IV

Approval

SECTIO

N

IV

Approval

Printnam e

Title

Printed nam e ofthe approver

Com plete asneeded

SECTIO

N

IV

Approval

Job title ofthe approver

S

SECTIO

N

IV

Approval

SECTIO

N

IV

Approval

Ihave conducted research and determ ined no statew ide solution isavailable forthe goods/services.

SECTIO

N

III

Justification Check the box confirm ing research w asconducted.

Ifthe CIpertainsto m odification pursuantto R2

E303.E,leave field em pty.

SECTIO

N

III

Justification

Provide detailsofthe procurem entneed,the com petition im practicable and how the proposed procurem entisadvantageous to the state

Detailinform ation regarding the rationale selected in the previoussection;

agency use ofthe m aterialsorservices;ifstatew ide contractsw ere explored;

the lim itation w hich led to com petition im practicable and how the state w ould benefitfrom the procurem ent.

Ifthere ispreviouscontractw hich requiresm odification pursuantto

R2 E303.E orcontractthatreached out m ax.5 yearterm ,provide the contractnum berand copy ofthe

CI.

S date

Section

IV

to be com pleted bythe Procurem entAuthority:

SECTIO

N

IV

Approval

SECTIO

N

III

Justification Signature

Signature ofthe authorized requestor

SECTIO

N

III

Justification

Describe the procurem ent process,strategy to prom ote com petition and detailsabout fairand reasonable price determ ination pursuantto

R2

Detailstrategy forthe proposed procurem ent;considered com petition, reason forselecting specific supplierand negotiationsstrategy.

SECTIO

N

III

Justification Date ofrequest

Com m ents,conditionsor restrictions

Determ ination

Selectapplicable option in accordance w ith

A.A.C R2

E303.D:

RequestAuthorized Pursuantto

R2 E303

RequestAuthorized w ith

Conditions/RestrictionsR2 E303

RequestReturned forAdditionalInform ation RequestDenied

Section m ay be used by any party in case the fieldsw ithin the docum entw ere insufficient

Additional section

SPO

ork (rev 03-21)

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N S U nique Entity ID 077531937

SAM

U nique Entity ID

V35YJG

S4W 9Y1

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Purpose of R egistration

Federal A ssistance A w ards O nly Expiration D ate A ug 10, 2021 R egistration Status A ctive

Physical Address 700 W

B eale ST

K ingm an, A rizona 86401-5711

U nited States

M ailing Address

PO

B ox 7000 K ingm an, A rizona 86402-7000 U nited States

B usiness Inform ation

D oing Business as

(blank) D ivision N am e (blank)

D ivision N um ber

(blank)

C ongressional D istrict A rizona 04 State / C ountry of Incorporation (blank) / (blank)

U R

L http://w w w

.m ohavecounty.us

R egistration D ates

Activation D ate

A ug 10, 2020

Subm ission D ate A ug 10, 2020 Initial R egistration D ate

Jun 6, 2005

Entity D ates

Entity Start D ate

Jul 1, 1864 Fiscal Year End C lose D ate

Jun 30

Im m ediate O w ner

C

AG

E (blank)

Legal Business N am e (blank)

H ighest Level O w ner

C

AG

E (blank)

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) respond to the Executive C om pensation questions in accordance w ith Section 6202 of

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R egistrants in the System for A w ard M anagem ent (SA M

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2.C .F.R

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Last updated by Terri Bryant on Aug 10, 2020 at 01:48 PM M

O H

AVE, C

O

U N

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F https://sam .gov/entity/077531937/coreD ata?status= Active

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N o

D ebt Subject To O ffset N o

Points of C ontact

Electronic B usiness

TER

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I B R

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B ox 7000 K ingm an, A rizona 86402 U nited States

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Box 7000 Kingm an, Arizona 86402 U nited States

G overnm ent B usiness

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Box 7000 Kingm an, Arizona 86402 U nited States

Service C lassifications

N A

IC

S C odes

Prim ary

N

AIC

S C odes

N

AIC

S Title

D isaster R esponse

This entity does not appear in the disaster response registry.

Last updated by Terri Bryant on Aug 10, 2020 at 01:48 PM M

O H

AVE, C

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U N

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F https://sam .gov/entity/077531937/coreD ata?status= Active