CTR053476 A3 Executed PDF.pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR053476 AMENDMENT NO.: 3 PROCUREMENT OFFICER:

Ryan Garcia

Revised 04.29.2024

High Risk Perinatal Program (HRPP) Emergency Ground Transportation Services

Effective upon signature by both parties it is mutually agreed that the Contract is amended as follows:

1. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extensions (5 Year Maximum), the Contract is hereby extended through June 30, 2025.

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

Flagstaff Medical Center

Contractor’s Name Procurement Officer Signature

Robert Cofield Chief Operating Officer Gina Corwin

Digitally signed by Gina Corwin Date: 2024.06.21 07:57:07 -07'00'

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FLAGSTAFF MEDICAL CENTER

Unique Entity ID

L8RYDHRHBPW1

CAGE / NCAGE

0Z4N7

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Mar 20, 2025

Physical Address

1200 N Beaver ST

Flagstaff, Arizona 86001-3118

United States

Mailing Address

1200 N Beaver ST

Flagstaff, Arizona 86001-3118

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 02

State / Country of Incorporation

Arizona / United States

URL

www.nahealth.com

Registration Dates

Activation Date

Mar 22, 2024

Submission Date

Mar 20, 2024

Initial Registration Date

Feb 24, 2006

Entity Dates

Entity Start Date

Mar 18, 1984

Fiscal Year End Close Date

Jun 30

Immediate Owner

CAGE

4CB68

Legal Business Name

NORTHERN ARIZONA HEALTHCARE

CORPORATION

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.gov) 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 displayed in the responsibility/qualification section of SAM.gov. Maintaining an active registration in SAM.gov 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 Merle McCabe on Mar 20, 2024 at 07:00 PM FLAGSTAFF MEDICAL CENTER

Jun 27, 2024 06:22:56 PM GMT https://sam.gov/entity/L8RYDHRHBPW1/coreData?status=null Page 1 of 3

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.

Other Entity Qualifiers

Hospital

Financial Information

Accepts Credit Card Payments

Yes

Debt Subject To Offset

No

EFT Indicator

CAGE Code

0Z4N7

Points of Contact

Electronic Business

Merle McCabe, Staff Accountant 1200 N Beaver ST

Flagstaff, Arizona 86001

United States

Clifford Loader, Chief Financial Officer 1200 N Beaver ST

Flagstaff, Arizona 86001

United States

Government Business

Merle McCabe, Staff Accountant 1200 N Beaver ST

Flagstaff, Arizona 86001

United States

Clifford Loader, Chief Financial Officer 1200 N Beaver ST

Flagstaff, Arizona 86001

United States

Past Performance

Harley Gossman, Accountant 1200 N Beaver ST

Flagstaff, Arizona 86001

United States

Willie Felts, Corporate Controller 1200 N Beaver ST

Flagstaff, Arizona 86001

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

622110

NAICS Title

General Medical And Surgical Hospitals

Product and Service Codes

PSC PSC Name

M1DA Operation Of Hospitals And Infirmaries

M1DZ Operation Of Other Hospital Buildings

X1DZ Lease/Rental Of Other Hospital Buildings

Z1DA Maintenance Of Hospitals And Infirmaries

Z1DZ Maintenance Of Other Hospital Buildings

Disaster Response

Yes, this entity appears in the disaster response registry.

Bonding Levels Dollars

Last updated by Merle McCabe on Mar 20, 2024 at 07:00 PM FLAGSTAFF MEDICAL CENTER https://sam.gov/entity/L8RYDHRHBPW1/coreData?status=null Page 2 of 3

(blank) (blank)

States

Arizona

Counties

AZ: Yavapai, Coconino

Metropolitan Statistical Areas

AZ: Phoenix-Mesa, Flagstaff, AZ-UT

Last updated by Merle McCabe on Mar 20, 2024 at 07:00 PM FLAGSTAFF MEDICAL CENTER https://sam.gov/entity/L8RYDHRHBPW1/coreData?status=null Page 3 of 3