CTR053478_A2 executed with Debarment.pdf

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Attached to
Master Agreement AZ|CTR053478
Contract number
CTR053478
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 High Risk Perinatal Program (HRPP) Hospital Services. The contract is with Professional Medical Transport, a transportation company based in Mesa, Arizona. The amendment extends the existing contract through June 30, 2024, which represents the third year of the contract term.

The amendment pertains to medical transportation services specifically for high-risk perinatal patients. While specific pricing details are not explicitly stated in the provided documents, the contract appears to be part of a state-level healthcare support service. The company, Professional Medical Transport, is registered with active status in Arizona, with a unique entity ID of R63MNKT1WC45 and a CAGE code of 0ABT1. The contract extension is made pursuant to the Special Terms and Conditions, Provision Three, which allows for contract extensions up to a maximum of five years. The amendment indicates that all other provisions of the original contract remain unchanged.

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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.: CTR053478 AMENDMENT NO.: 2 Procurement Officer Lucas Terry

High Risk Perinatal Program (HRPP) Hospital Services

Effective upon signature by both parties it is mutually agreed that the Contract referenced in this Amendment Two (2) 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, 2024, the third year of the Contract.

ALL CHANGES ARE REFLECTED 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

Professional Medical Transport

Contractor’s Name Procurement Officer Signature

Gina Corwin

Digitally signed by Gina Corwin Date: 2023.05.22 13:49:27 -07'00'

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