CTR053478_Contract_Amendment_Summary_1 (1).pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR053478 AMENDMENT NO.: 1 Procurement Officer Mitchell Goldberg

High Risk Perinatal Program (HRPP) Emergency Ground Transportation Services

Effective upon signature of both parties, it is mutually agreed that the Contract referenced in this amendment 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 August 17, 2023, the second year of the Contract.

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR INTIRETY

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 (PMT)

Contractor’s Name Procurement Officer Signature

Christine Ruth Digitally signed by Christine Ruth Date: 2022.05.10 08:32:57 -07'00'

PROFESSIONAL MEDICAL TRANSPORT, INC.

Unique Entity ID

R63MNKT1WC45

CAGE / NCAGE

0ABT1

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Nov 17, 2022

Physical Address

222 E Main ST

Mesa, Arizona 85201-7410

United States

Mailing Address

222 E Main ST

Mesa, Arizona 85201-7410

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 09

State / Country of Incorporation

Arizona / United States

URL

(blank)

Registration Dates

Activation Date

Nov 19, 2021

Submission Date

Nov 17, 2021

Initial Registration Date

Oct 2, 2014

Entity Dates

Entity Start Date

Jun 1, 2011

Fiscal Year End Close Date

Dec 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 (Not Tax Exempt)

Entity Type

Business or Organization

Organization Factors

(blank)

Profit Structure

For Profit Organization

Last updated by Aileen Daproza on Nov 17, 2021 at 12:54 PM PROFESSIONAL MEDICAL TRANSPORT, INC.

https://sam.gov/entity/R63MNKT1WC45/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

0ABT1

Points of Contact

Electronic Business

John Valentine, Regional Director 8465 N. Pima Road

Scottsdale, Arizona 85258

United States

Government Business

John Valentine 222 E. Main ST

Mesa, Arizona 85203

United States

Past Performance

Alison Skinner, Account Executive 222 E. Main ST

Mesa, Arizona 85201

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

621910

NAICS Title

Ambulance Services

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Aileen Daproza on Nov 17, 2021 at 12:54 PM PROFESSIONAL MEDICAL TRANSPORT, INC.

https://sam.gov/entity/R63MNKT1WC45/coreData?status=Active Page 2 of 2

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