CTR057882 A1.pdf
PDF 382 KB Posted
- Attached to
- Master Agreement AZ|CTR057882
- Contract number
- CTR057882
- Issued by
- Arizona
About this file
This document is a Contract Amendment issued by the Arizona Department of Health Services' Office of Procurement for Contract No. CTR057882 with VeriTrace Inc. The amendment pertains to a statewide contract for Certified Paper Stock and Warehousing for Birth and Death Certificates. The contract amendment is specifically Amendment No. 1, and it extends the existing contract through November 8, 2023.
The amendment includes a revised Price Sheet that specifies pricing for cartons of certified paper. Each carton contains 2,000 certified sheets with an engraved intaglio printed blue ink border, based on a total volume of 1,000,000 sheets. The price per carton is set at $593.09. The amendment maintains all other existing provisions of the original contract, with the only changes being the contract extension and the updated price sheet. The contract was signed by Wayne P. Krueger Jr., V.P. of Operations for VeriTrace Inc., on August 18, 2022, and digitally countersigned by a procurement officer on August 30, 2022.
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Text version
CONTRACT AMENDMENT
ARIZONA DEPARTMENT OF
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
CONTRACT NO.: CTR057882 AMENDMENT NO.: 1 Procurement Officer Diana Landeros
Certified Paper Stock and Warehousing for Birth and Death Certificates
Effective upon signature by both parties it is mutually agreed that the Contract referenced in this Amendment One (1) is amended as follows:
1. Pursuant to the Uniform Terms and Conditions, Provision Five (5), Contract Changes, Section 5.1, Amendments, the Contract is hereby revised as follows:
1.1 The Contract is extended through November 8, 2023; and
1.2 The Price Sheet is revised and replaced by this Amendment One (1).
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
VeriTrace Inc.
Contractor’s Name Procurement Officer Signature
Contractor Signature
30th August 22
Kristine Newton
Digitally signed by Kristine Newton Date: 2022.08.30 09:33:59 -07'00'
CONTRACT AMENDMENT
ARIZONA DEPARTMENT OF
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
CONTRACT NO.: CTR057882 AMENDMENT NO.: 1 Procurement Officer Diana Landeros
PRICE SHEET
DESCRIPTION QTY UNIT AMOUNT
Carton of Certified Paper as required in the Scope of Work. Cartons are to contain 2,000 certified sheets with engraved intaglio printed blue ink border based on 1,000,000 sheets.
1 Carton $593.09
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ARIZONA HEALTH CARE ASSOCIATION, INC.
Unique Entity ID
NENKZKA74HA9
CAGE / NCAGE
7Y5Y9
Purpose of Registration
Federal Assistance Awards Only
Registration Status
Active Registration
Expiration Date
Dec 17, 2022
Physical Address
1440 E Missouri AVE STE C102
Phoenix, Arizona 85014-2459
United States
Mailing Address
1440 E Missouri AVE STE C102
Phoenix, Arizona 85014-2459
United States
Business Information
Doing Business as
AHCA
Division Name
(blank)
Division Number
(blank)
Congressional District
Arizona 09
State / Country of Incorporation
Arizona / United States
URL
WWW.AZHCA.ORG
Registration Dates
Activation Date
Nov 19, 2021
Submission Date
Nov 17, 2021
Initial Registration Date
Jun 10, 2017
Entity Dates
Entity Start Date
Jul 1, 1956
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
Non-Profit Organization
Last updated by Frank Caruso on Nov 17, 2021 at 01:55 PM ARIZONA HEALTH CARE ASSOCIATION, INC.
https://sam.gov/entity/NENKZKA74HA9/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
7Y5Y9
Points of Contact
Electronic Business
FRANK CARUSO, DIRECTOR OF FINANCE AND
OPERATIONS
1440 E Missouri AVE
Suite C-102
Phoenix, Arizona 85014
United States
Government Business
FRANK CARUSO, DIRECTOR OF FINANCE AND
OPERATIONS
1440 E Missouri AVE
Suite C-102
Phoenix, Arizona 85014
United States
Past Performance
DAVID VOEPEL, CEO
1440 E Missouri AVE
Suite C-102
Phoenix, Arizona 85014
United States
Service Classifications
NAICS Codes
Primary NAICS Codes NAICS Title
Disaster Response
This entity does not appear in the disaster response registry.
Last updated by Frank Caruso on Nov 17, 2021 at 01:55 PM ARIZONA HEALTH CARE ASSOCIATION, INC.
https://sam.gov/entity/NENKZKA74HA9/coreData?status=Active Page 2 of 2
| CTR057882 Paper Stock Warehousing Veritrace A1 p.pdf |
| OIG Search Results.pdf |
| Arizona Corporation Commission.pdf |
| EntityInformation-20220829-023608 |
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