CTR061004_Contract_Amendment_Summary_Two__2_.pdf
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- Attached to
- Master Agreement AZ|CTR061004
- Contract number
- CTR061004
- Issued by
- Arizona
About this file
This document is a Contract Amendment issued by the Arizona Department of Economic Security for Contract No. CTR061004, involving Senior In Home dba A Country Retreat, which provides services for an Assisted Living Facility. The amendment is designated as Amendment Number Two and modifies the existing contract's terms and conditions.
The amendment extends the contract term from July 01, 2024, through April 30, 2025, with no rate adjustments for the extension period. Key modifications include replacing the previous Exhibit B-Level of Care with a new Exhibit B-Spending Plan and removing the ADES Special Terms and Conditions Section 39 regarding Rate Adjustment. The Spending Plan is a standard template for documenting an individual's income sources, assets, and expenses, typically used for tracking financial details of individuals receiving services through the Department of Developmental Disabilities. All other contract requirements, specifications, and terms remain unchanged, and the amendment will be executed through electronic approval in the APP system.
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Text version
CONTRACT AMENDMENT
Arizona Department of Economic Security
1789 W Jefferson Street, Mail Drop 1541, Phoenix, AZ 85007
CONTRACT NUMBER: AMENDMENT NUMBER:
CTR061004 Two (2)
DESCRIPTION/ LABEL: Assisted Living Facility
CONTRACTOR NAME: Senior In Home dba A Country Retreat
THE ABOVE REFERENCED CONTRACT IS HEREBY MODIFIED AS FOLLOWS:
1. In accordance with the Uniform Terms and Conditions, Section 5, Contract Changes, Sub Section
5.1 Amendments, Exhibit B-Level of Care is hereby replaced with Exhibit B-Spending Plan.
2. In accordance with the Uniform Terms and Conditions, Section 5, Contract Changes, Sub Section
5.1 Amendments, ADES Special Terms and Conditions Section 39. Rate Adjustment is hereby removed in its entirety.
3. In accordance with the Special Terms and Conditions, Section 13, Contract Term & Option to
Extend, the Contract, term is extended from July 01, 2024, through April 30, 2025. The rates are not adjusted for the extension period and shall remain the same as the previous Contract term.
ALL OTHER REQUIREMENTS, SPECIFICATIONS, AND TERMS AND CONDITIONS REMAIN UNCHANGED
ACKNOWLEDGEMENT AND AUTHORIZATION
This Amendment shall be fully executed by means of electronic approval in APP.
Exhibit B – Spending Plan
Contract No.: CTR061004
Description: Assisted Living Facility
File details come from the government source that posted it. Updated .