CTR053486 A3 Executed.pdf
PDF 975 KB Posted
- Attached to
- Master Agreement AZ|CTR053486
- Contract number
- CTR053486
- Issued by
- Arizona
About this file
The document is a contract amendment issued by the Arizona Department of Health Services' Office of Procurement for Contract No. CTR053486, Amendment No. 3, involving Southwest Ambulance of Tucson. The amendment pertains to the High Risk Perinatal Program (HRPP) Emergency Ground Transportation Services and is signed by the Procurement Officer Ryan Garcia.
The contract amendment extends the existing contract through June 30, 2025, in accordance with the Special Terms and Conditions, Provision Three (3) on Contract Extensions, which allows for a maximum 5-year extension. The amendment maintains all other provisions of the original contract in their entirety. Southwest Ambulance of Tucson, which is a for-profit ambulance services provider incorporated in Arizona, will continue to provide emergency ground transportation services for the high-risk perinatal program under the same terms as the original contract.
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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.: 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
Southwest Ambulance of Tuscon
Contractor’s Name Procurement Officer Signature
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SOUTHWEST AMBULANCE OF SOUTHEASTERN
ARIZONA, INC.
Unique Entity ID
GLZYXAVXD2E4
CAGE / NCAGE
99V07
Purpose of Registration
All Awards
Registration Status
Active Registration
Expiration Date
Apr 10, 2025
Physical Address
9221 E Via Ventura
Scottsdale, Arizona 85258
United States
Mailing Address
6501 S Fiddlers Green CIR, #100
Greenwood Village, Colorado 80111
United States
Business Information
Doing Business as
(blank)
Division Name
(blank)
Division Number
(blank)
Congressional District
Arizona 01
State / Country of Incorporation
Arizona / United States
URL
(blank)
Registration Dates
Activation Date
Apr 17, 2024
Submission Date
Apr 10, 2024
Initial Registration Date
Mar 9, 2022
Entity Dates
Entity Start Date
Oct 1, 2009
Fiscal Year End Close Date
Dec 31
Immediate Owner
CAGE
1NLW5
Legal Business Name
AMERICAN MEDICAL RESPONSE, INC.
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 (Not Tax Exempt)
Entity Type
Business or Organization
Organization Factors
(blank)
Last updated by Aileen Daproza on Apr 10, 2024 at 12:55 PM SOUTHWEST AMBULANCE OF SOUTHEASTERN ARIZONA, INC.
Jun 28, 2024 10:18:40 PM GMT https://sam.gov/entity/GLZYXAVXD2E4/coreData?status=null Page 1 of 2
Profit Structure
For Profit Organization
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
99V07
Points of Contact
Electronic Business
Edward Armijo
1524 W. 14TH ST
Tempe, Arizona 85281
United States
Government Business
Glenn Kasprzyk
1524 W. 14TH ST
Tempe, Arizona 85281
United States
Service Classifications
NAICS Codes
Primary
Yes
NAICS Codes
621910
NAICS Title
Ambulance Services
Disaster Response
Yes, this entity appears in the disaster response registry.
Bonding Levels Dollars
(blank) (blank)
States
Any
Counties
(blank)
Metropolitan Statistical Areas
(blank)
Last updated by Aileen Daproza on Apr 10, 2024 at 12:55 PM SOUTHWEST AMBULANCE OF SOUTHEASTERN ARIZONA, INC.
Jun 28, 2024 10:18:40 PM GMT https://sam.gov/entity/GLZYXAVXD2E4/coreData?status=null Page 2 of 2
File details come from the government source that posted it. Updated .