CTR050597_Health_Start_Program_Mariposa_CHC_A2_Fully_Executed.pdf
PDF 449 KB Posted
- Attached to
- Master Agreement AZ|CTR050597
- Contract number
- CTR050597
- Issued by
- Arizona
About this file
This is a Contract Amendment for the Arizona Department of Health Services' Health Start Program, specifically Amendment No. 2 to Contract No. CTR050597. The amendment involves Mariposa Community Health Center, Inc., a nonprofit organization based in Nogales, Arizona, and the Arizona Department of Health Services' Office of Procurement. The document is issued by the state of Arizona and involves a contract with a local community health center.
The amendment extends the contract for the third year through July 5, 2023, in accordance with the Special Terms and Conditions, Provision Three (3), which allows Contract Extensions Five (5) Year Maximum. Mariposa Community Health Center, Inc. is a tax-exempt, nonprofit organization founded in 1985, located in Santa Cruz County, Arizona, with its principal office at 825 N. Grand Avenue in Nogales. The organization is registered for federal assistance awards and has an active registration in the System for Award Management (SAM) with a Unique Entity ID of T7KJKFWEKNR9, expiring on September 27, 2022.
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Text version
Christopher Balderrama
Digitally signed by Christopher Balderrama Date: 2022.05.09 17:42:07 -07'00'
Arizona Corporation Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01773351[5/10/2022 5:12:28 PM]
ENTITY INFORMATION
Search Date and Time: 5/10/2022 5:09:52 PM
Title Name Attention Address Date of Taking Office
Last Updated
CEO (Chief Executive Officer)
ED
SICURELLO
825 N. Grand Avenue, Suite 100, NOGALES, AZ, 85621, Santa Cruz County, USA
7/18/2015 9/21/2018
Entity Details
Entity Name: MARIPOSA COMMUNITY HEALTH
CENTER, INC.
Entity ID: 01773351
Entity Type: Domestic Nonprofit Corporation Entity Status: Active
Formation Date: 7/22/1985 Reason for Status: In Good Standing
Approval Date: 7/25/1985 Status Date:
Original Incorporation Date: 7/22/1985 Life Period: Perpetual
Business Type: Health Care and Social Assistance
Last Annual Report Filed: 2021
Domicile State: Arizona Annual Report Due Date: 9/22/2022
Years Due:
Original Publish Date: 8/26/1985
Statutory Agent Information
Name: ED SICUREELLO Appointed Status: Active
Attention:
Address: 825 N. Grand Avenue, Suite 100, NOGALES, AZ 85621, USA
Agent Last Updated: 9/17/2021 E-mail:
Attention: Mailing Address: 825 N GRAND AVE STE
100, NOGALES, AZ 85621,
USA
County: Santa Cruz
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=01773351[5/10/2022 5:12:28 PM]
< Previous ... 1 2 3 ... Next > Page 1 of 3, records 1 to 5 of 13 Go to Page
Director
JAMES B
MANSON
825 N. Grand Avenue, Suite 100, NOGALES, AZ, 85621, Santa Cruz County, USA
4/8/2015 9/21/2018
Director
ANN
MIHALIK
825 N. Grand Avenue, Suite 100, NOGALES, AZ, 85621, Santa Cruz County, USA
4/16/2014 9/21/2018
Director
JUDITH
CLAREMON
825 N. Grand Avenue, Suite 100, NOGALES, AZ, 85621, Santa Cruz County, USA
8/5/2005 9/21/2018
Director
SIGRID
MAITREJEAN
825 N. Grand Avenue, Suite 100, NOGALES, AZ, 85621, Santa Cruz County, USA
7/7/2005 9/21/2018
Address
Attention:
Ed Sicurello
Address:
825 N Grand Ave., Suite 100, NOGALES, AZ, 85621, USA
County:
Santa Cruz
Last Updated:
9/17/2021
Entity Principal Office Address
Attention: Address: County: Last Updated:
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MARIPOSA COMMUNITY HEALTH CENTER, INC.
Unique Entity ID
T7KJKFWEKNR9
CAGE / NCAGE
3LPV8
Purpose of Registration
Federal Assistance Awards Only
Registration Status
Active Registration
Expiration Date
Sep 27, 2022
Physical Address
825 N Grand AVE STE 100
Nogales, Arizona 85621-2385
United States
Mailing Address
825 N. Grand Avenue
Nogales, Arizona 85621-1063
United States
Business Information
Doing Business as no DBA
Division Name
(blank)
Division Number
(blank)
Congressional District
Arizona 03
State / Country of Incorporation
Arizona / United States
URL
www.mariposachc.net
Registration Dates
Activation Date
Sep 29, 2021
Submission Date
Sep 27, 2021
Initial Registration Date
Nov 12, 2003
Entity Dates
Entity Start Date
Dec 1, 1985
Fiscal Year End Close Date
May 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 null on Sep 27, 2021 at 03:05 PM MARIPOSA COMMUNITY HEALTH CENTER, INC.
https://sam.gov/entity/T7KJKFWEKNR9/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
3LPV8
Points of Contact
Electronic Business
Tia Duncan 1852 N. Mastick WAY
Nogales, Arizona 85621
United States
ED SICURELLO 1852 N. Mastick WAY
Nogales, Arizona 85621
United States
Government Business
ED SICURELLO
1852 N. Mastick WAY
Nogales, Arizona 85621
United States
ED SICURELLO 1852 N. Mastick WAY
Nogales, Arizona 85621
United States
Past Performance
ED SICURELLO
1852 N. Mastick WAY
Nogales, Arizona 85621
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 null on Sep 27, 2021 at 03:05 PM MARIPOSA COMMUNITY HEALTH CENTER, INC.
https://sam.gov/entity/T7KJKFWEKNR9/coreData?status=Active Page 2 of 2
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