CTR053486_Contract_Amendment_Summary_1.pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR053486 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 June 30, 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

SOUTHWEST AMBULANCE OF TUCSON INC

Contractor’s Name Procurement Officer Signature

Christine Ruth

Digitally signed by Christine Ruth Date: 2022.04.26 16:47:29 -07'00'

SOUTHWEST AMBULANCE OF SOUTHEASTERN

ARIZONA INC

DUNS Unique Entity ID

079093163

SAM Unique Entity ID

GLZYXAVXD2E4

CAGE / NCAGE

99V07

Purpose of Registration

All Awards

Registration Status

Active

Expiration Date

Mar 9, 2023

Physical Address

9221 E Via De Ventura

Scottsdale, Arizona 85258-3370

United States

Mailing Address

6363 S Fiddler's Green Circle

STE. 1400

Greenwood Village, Colorado 80111

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 06

State / Country of Incorporation

Arizona / United States

URL

(blank)

Registration Dates

Activation Date

Mar 18, 2022

Submission Date

Mar 9, 2022

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) 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)

Last updated by Aileen Daproza on Mar 09, 2022 at 06:13 PM SOUTHWEST AMBULANCE OF SOUTHEASTERN ARIZONA INC https://sam.gov/entity/079093163/coreData?status=Active 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 Mar 09, 2022 at 06:13 PM SOUTHWEST AMBULANCE OF SOUTHEASTERN ARIZONA INC https://sam.gov/entity/079093163/coreData?status=Active Page 2 of 2

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