CTR059352 Amendment 1.pdf

Alice Perepech Digitally signed by Alice Perepech DN: cn=Alice Perepech, o=Arizona Attorney General's Office, email=Alice.Perepech@azag.gov, c=US Date: 2025.03.26 13:15:20 -07'00'

Kristine Newton Digitally signed by Kristine Newton Date: 2025.03.26 16:40:25 -07'00'

INTERGOVERNMENTAL AGREEMENT (IGA)

Amendment

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR059352 IGA Amendment No: 1 Procurement Officer:

Delilah Gonzalez

Revised 05/29/2024

Annual Price Sheet

Budget Line Items

Cost Reimbursement Line Items Budget Amount

1. Personnel Services* $136,302.00

2. Employee Related Expenses* $47,978.00

2. Professional & Outside Services* $0.00

3. Travel Expenses* $1,001.00

4. Other Operating Expense* $0.00

5. Capital Outlay Expense* $0.00

6. Other (Indirect Costs) $66,701.00

Total Budget Amount $251,982.00

* Indicates indirect cost calculation

ITEMIZED SERVICE BUDGET (ISB) RESTRICTIONS:

With prior written approval from the HIV Prevention Program Manager, the Contractor is authorized to transfer up to a maximum of thirty-six percent (36%) of the total Agreement amount among the categorical line items. Transfers of funds are only allowed among funded line items as detailed in the original ISB. Transfer exceeding thirty-six percent (36%) of the Agreement amount, or to a non-funded line item, shall require a written Agreement.

Exhibit 1 - 2 CFR 200.332

§ 200.332 Requirements for pass-through entities.

All pass-through entities must:

(a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass-through entity must provide the best information available to describe the Federal award and subaward.

Prime Awardee: Arizona Department of Health Services

UEI # QMWUG1AMYF65

Federal Award Identification (Grant Number): NU62PS924627

Subrecipient name (which must match the name associated with its unique entity identifier):

Maricopa County Special Health Care District dba Valleywise Health

Subrecipient's unique entity identifier (UEI #): J2RHHVGKRH11

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): NU62PS924818

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;

07/16/2024

Subaward Period of Performance Start and End Date; 8/01/2024 – 05/31/2025

Subaward Budget Period Start and End Date: 08/01/2024-05/31/2025

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

$251,982.00

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):

$251,982.00

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity $251,982.00

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

(FFATA)

93.940 Integrated Prevention and Surveillance

Programs for Health Departments

Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity

Centers for Disease Control & Prevention

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:

93.940

Identification of whether the award is R&D No award not R&D

Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414 36%

MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Unique Entity ID

J2RHHVGKRH11

CAGE / NCAGE

334W0

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Dec 20, 2025

Physical Address

2601 E Roosevelt ST

Phoenix, Arizona 85008-4973

United States

Mailing Address

2601 E. Roosevelt ST.

Phoenix, Arizona 85008-4973

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 03

State / Country of Incorporation

(blank) / (blank)

URL

http://www.valleywisehealth.org/

Registration Dates

Activation Date

Dec 24, 2024

Submission Date

Dec 20, 2024

Initial Registration Date

Nov 23, 2004

Entity Dates

Entity Start Date

Jan 1, 1877

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

U.S. Government Entity

Entity Type

US Local Government

Organization Factors

(blank)

Profit Structure

(blank)

Last updated by Jennifer Joiner on Dec 20, 2024 at 03:33 PM MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Mar 31, 2025 05:02:43 PM GMT https://sam.gov/entity/J2RHHVGKRH11/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.

Government Types

U.S. Local Government

Local Government Owned

Other Entity Qualifiers

Hospital

Financial Information

Accepts Credit Card Payments

Yes

Debt Subject To Offset

No

EFT Indicator

CAGE Code

334W0

Points of Contact

Electronic Business

Claire Agnew 2601 E. Roosevelt

Phoenix, Arizona 85008

United States

Government Business

Jennifer Joiner 2601 E. Roosevelt ST

Phoenix, Arizona 85008

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

622110

NAICS Title

General Medical And Surgical Hospitals

621498 All Other Outpatient Care Centers

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Jennifer Joiner on Dec 20, 2024 at 03:33 PM MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT

Mar 31, 2025 05:02:43 PM GMT https://sam.gov/entity/J2RHHVGKRH11/coreData?status=null Page 2 of 2

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