CTR053486 A2 SW Ambulance of Tucson executed with Debarment.pdf

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Master Agreement AZ|CTR053486
Contract number
CTR053486
Issued by
Arizona

About this file

The document is a Contract Amendment from the Arizona Department of Health Services, Office of Procurement, specifically Amendment No. 2 for Contract No. CTR053486 involving the High Risk Perinatal Program (HRPP) Hospital Services. The contract is between the Arizona Department of Health Services and Southwest Ambulance, a company incorporated in Arizona with its primary address in Scottsdale and registered in the System for Award Management (SAM).

The amendment extends the existing contract through June 30, 2024, which represents the third year of the contract, in accordance with the Special Terms and Conditions, Provision Three regarding Contract Extensions. The contract is limited to a maximum of five years. Southwest Ambulance is registered for "All Awards" purposes and has an active registration set to expire on March 23, 2024. The company is classified as a for-profit organization specializing in emergency medical transportation, with its entity start date being October 1, 2009. The amendment maintains all other existing provisions of the original contract in their entirety.

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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.: CTR053486 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

Southwest Ambulance

Contractor’s Name Procurement Officer Signature

Gina Corwin

Digitally signed by Gina Corwin Date: 2023.05.23 14:05:32 -07'00'

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