CTR054521_Contract_Amendment_No_5 (1).pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR054521 AMENDMENT NO.: 5 Gracie Torrecillas Procurement Officer

TB Treatment Services

Effective upon signature by both parties is mutually agreed that the Contract referenced in this Amendment Five (5) is amended as follows:

1. Pursuant to the Uniform Terms and Conditions, Provision Five (5), Contract Changes, Section 5.1, Amendments, the following changes are made under Amendment Five (5):

1.1. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extensions (5 Year Maximum), the Contract is hereby extended through April 30, 2025.

1.2. The Price Sheet is revised and replaced by the Price Sheet of Amendment Five (5). In the Arizona Procurement Portal (APP), the “Price list” tab of the Contract will be revised to reflect the revised pricing upon execution of this Amendment Five (5),

1.3. Exhibit A is revised and replaced with Exhibit A of this Amendment Five (5).

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

American Lung Association of Arizona

Contractor’s Name Procurement Officer Signature

4/4/24

Deborah P Brown, Chief Mission Officer Gina Corwin

Digitally signed by Gina Corwin Date:

2024.04.04 14:08:27 -07'00'

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

PRICE SHEET

LINE ITEM YEARLY MAXIMUM BUDGET

Personnel Services $15,000.00

ERE $4,595.13

Professional and Outside Services $0.00

Travel Expenses $2,000.00

Other Operating Expenses $75,750.00

Capital Outlay Expenses $0.00

Other $12,654.87

Total Annual Maximum Budget $110,000.00 Note: With prior approval from the ADHS TB Program Manager, the Contractor is authorized to transfer up to a maximum of thirty-five percent (35%) of the total budget amount between line items. Transfers of funds are only allowed between funded line items. Transfers exceeding thirty-five percent (35%) or to a non-funded item shall require a written Contract Amendment.

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Exhibit A – 2 CFR 200.332

§ 200.332

Prime Awardee: Arizona Department of Health Services

DUNS # QMWUG1AMYF65

Federal Award Identification (Grant Number): NU52PS910175-03-07

Subrecipient name (which must match the name associated with its unique entity identifier): American Lung Association of Arizona

Subrecipient's unique entity identifier (DUNS #): 86-0111676

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NU52PS910175

Federal Award Date (see the definition of Federal award date in § 200.1 of this part) of award to the recipient by the Federal agency: 2/23/2024

Subaward Period of Performance Start and End Date: 01/01/2023 - 12/31/2027

Subaward Budget Period Start and End Date: 01/01/2023 - 12/31/2027

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $110,000.00

Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current financial obligation (how much is available for contracts): $110,000.00

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity: $110,000.00

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act

(FFATA):

Tuberculosis Elimination and Laboratory Cooperative Agreement

Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity: Centers for Disease Control and Prevention

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Assistance Listings number and Title; the pass-through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement:

93.116 – Project Grants and Cooperative Agreements for Tuberculosis Control Programs

Identification of whether the award is R&D: NOT R&D

Indirect cost rate for the Federal award (including the de minimis rate is charged) per § 200.414: 13%

ENTITY INFORMATION

Search Date and Time: 4/11/2024 10:06:54 AM

Entity Details

Entity Name:

AMERICAN LUNG ASSOCIATION

Entity ID:

F21893924

Entity Type:

Foreign Nonprofit Corporation

Entity Status:

Active

Formation Date:

5/24/2017

Reason for Status:

In Good Standing

Approval Date:

5/29/2018

Status Date:

7/1/2021

Original Incorporation Date:

5/24/2017

Life Period:

Perpetual

Business Type:

Other - Other - Non profit dedicated to Lung Disease Research and Education.

Last Annual Report Filed:

Domicile State:

Maine

Annual Report Due Date:

5/24/2025

Years Due:

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Title Name Attention Address Date of Taking Office

Last Updated

Director

CHERYL

CALHOUN

55 W WACKER DR STE

1150, CHICAGO, IL, 60601,

Cook County, USA

5/24/2017 3/25/2019

Director

SUMITA

KHATRI

55 W WACKER DR STE

1150, CHICAGO, IL, 60601,

Cook County, USA

5/24/2017 3/25/2019

Secretary

MICHAEL

CARSTENS

55 W WACKER DR STE

1150, CHICAGO, IL, 60601,

Cook County, USA

5/24/2017 7/1/2021

Director

KATHLEEN

SKAMBIS

55 W WACKER DR STE

1150, CHICAGO, IL, 60601,

Cook County, USA

5/24/2017 3/25/2019

Original Publish Date:

Statutory Agent Information

Name:

CORPORATE CREATIONS NETWORK IN

Appointed Status:

Active

Attention:

Address:

3260 N HAYDEN ROAD #210 , SCOTTSDALE, AZ 85251, USA

Agent Last Updated:

4/4/2024

E-mail:

Attention:

Mailing Address:

County:

Maricopa

Principal Information

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Title Name Attention Address Date of Taking Office

Last Updated

CFO (Chief Financial Officer)

LAURA SCOTT

55 W WACKER DR STE

1150, CHICAGO, IL, 60601,

Cook County, USA

5/5/2017 5/29/2018

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Document History Name/Restructuring History

Pending Documents Microfilm History

Address

Attention:

Address: AMERICAN LUNG ASSOCIATION IN A 102 W MCDOWELL RD, PHOENIX, AZ, 85003, USA

County: Maricopa

Last Updated: 4/4/2024

Entity Principal Office Address

Attention: AMERICAN LUNG ASSOCIATION

Address: 55 W. Wacker Dr., Ste. 1150, CHICAGO, IL, 60601, USA

County: Cook

Last Updated: 4/4/2024

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American Lung Association of Arizona

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Source data updated on 4/10/2024 9:00:00 AM EST

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AMERICAN LUNG ASSOCIATION

Unique Entity ID

KNWDMEVEDXL3

CAGE / NCAGE

8L399

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Jan 16, 2025

Physical Address

55 W Wacker DR STE 1150

Chicago, Illinois 60601-1796

United States

Mailing Address

55 W Wacker DR STE 1150

Chicago, Illinois 60601-1796

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Illinois 07

State / Country of Incorporation

Maine / United States

URL

(blank)

Registration Dates

Activation Date

Jan 19, 2024

Submission Date

Jan 17, 2024

Initial Registration Date

Apr 28, 1999

Entity Dates

Entity Start Date

Jan 1, 1904

Fiscal Year End Close Date

Jun 30

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.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 (Tax Exempt)

Entity Type

Business or Organization

Organization Factors

(blank)

Profit Structure

Non-Profit Organization

Last updated by Laura Scott on Jan 17, 2024 at 11:06 AM AMERICAN LUNG ASSOCIATION

Apr 11, 2024 05:16:34 PM GMT https://sam.gov/entity/KNWDMEVEDXL3/coreData?status=null 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

No

Debt Subject To Offset

No

EFT Indicator

CAGE Code

8L399

Points of Contact

Electronic Business

Laura Scott, CFO 3000 Kelly Lane

Springfield, Illinois 62711

United States

Government Business

Joy Meyer 3001 Gettysburg Road

Camp Hill, Pennsylvania 17011

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

813212

NAICS Title

Voluntary Health Organizations

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Laura Scott on Jan 17, 2024 at 11:06 AM AMERICAN LUNG ASSOCIATION

Apr 11, 2024 05:16:34 PM GMT https://sam.gov/entity/KNWDMEVEDXL3/coreData?status=null Page 2 of 2