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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