CTR061304_Contract_Amendment_No._1.pdf

INTERGOVERNMENTAL AGREEMENT (IGA)

Amendment

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Contract No.: CTR061304 IGA Amendment No: 1 Procurement Officer:

Gracie Torrecillas

Revised 05/29/2024

HIV Care Services

It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:

1. Pursuant to Terms and Conditions, Provision Six (6) Contract Changes, subsection 6.1 Amendments, the Contract is hereby revised with the following:

1.1. The Price Sheet is revised and replaced.

1.2. Exhibit – 2 CFR 200.332 is revised and replaced.

ALL CHANGES ARE REFLECTED IN RED

All other provisions of this agreement remain unchanged.

Maricopa County Department of Public Health - Ryan White Part A Program

Contractor Name: County Authorized Signature

4041 North Central Avenue Address: Print Name

Phoenix AZ 85012 City State Zip Title and Date

Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has determined that this Intergovernmental Agreement is in proper form and is within the powers and authority granted under the laws of Arizona

This Intergovernmental Agreement Amendment shall be effective the date indicated. The Public Agency is hereby cautioned not to commence any billable work or provide any material, service or construction under this IGA until the IGA has been executed by an authorized ADHS signatory.

State of Arizona

Signature Date Signed this day of 202 .

Print Name Procurement Officer

Contract No.: CTR061304, which is an Agreement between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney, who has determined that it is in proper form and is within the powers and authority granted under the laws of the State of Arizona.

Signature Date

Assistant Attorney General Print Name

Elise Phalen

Digitally signed by Elise Phalen DN: cn=Elise Phalen, o, ou=Arizona Attorney General's Office, email=elise.phalen@azag.gov, c=US Date: 2025.03.24 11:56:19 -07'00'

Kristine Newton Digitally signed by Kristine Newton Date: 2025.03.28 16:49:28 -07'00'

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Contract No.: CTR061304 IGA Amendment No: 1 Procurement Officer:

Gracie Torrecillas

Revised 05/29/2024

Cost Reimbursement Contract HIV Care and Services Contract Price Sheet Through 6/30/2027

ACCOUNT CLASSIFICATION LINE-ITEM TOTALS

PERSONNEL SERVICES AND ERE* $0

TRAVEL* $0

PROFESSIONAL & OUTSIDE SERVICES* $3,000,000.00

CAPITAL EXPENSES $0.00

OTHER OPERATING EXPENSES* $0

INDIRECT $0

CONTRACT NOT TO EXCEED (NTE): $3,000,000.00

*Indicates Indirect Cost calculation.

If applicable, the Contractor is authorized to transfer up to a maximum of 25% of the total budget amount between line items with the written approval from an ADHS program representative.

Transfers exceeding 25% or to a non-funded line item shall require an Amendment.

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Contract No.: CTR061304 IGA Amendment No: 1 Procurement Officer:

Gracie Torrecillas

Revised 05/29/2024

2 CFR 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): X07HA00080-34-01

Subrecipient name (which must match the name associated with its unique entity identifier): Maricopa County Department of Public Health

Subrecipient's unique entity identifier (UEI #): LM85MG1513K5

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): X07HA00080

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; 04/01/2023

Subaward Period of Performance Start and End Date; 4/1/24-3/31/25

Subaward Budget Period Start and End Date: 4/1/24-3/31/25

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $3,000,000

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): $3,000,000

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity N/A -no pass through

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA) RYAN WHITE CARE ACT TITLE II

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Contract No.: CTR061304 IGA Amendment No: 1 Procurement Officer:

Gracie Torrecillas

Revised 05/29/2024

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

Health Resources & Services Administration India Smith Grants Management Specialist Office of Federal Assistance Management (OFAM) Division of Grants Management Office (DGMO) ISmith@hrsa.gov (301) 443-2096

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: $17,217,265.00/ CFDA 93.917

Identification of whether the award is R&D Not R & D

Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414 N/A

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MARICOPA, COUNTY OF

Unique Entity ID

LM85MG1513K5

CAGE / NCAGE

3QJA2

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Oct 21, 2025

Physical Address

4041 N Central AVE STE 1400

Phoenix, Arizona 85012-3314

United States

Mailing Address

4041 N Central AVE STE 1400

Phoenix, Arizona 85012-3314

United States

Business Information

Doing Business as

Maricopa County Department of Public Health

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 03

State / Country of Incorporation

(blank) / (blank)

URL

(blank)

Registration Dates

Activation Date

Oct 23, 2024

Submission Date

Oct 21, 2024

Initial Registration Date

Feb 2, 2004

Entity Dates

Entity Start Date

Jul 1, 1957

Fiscal Year End Close Date

Jun 30

Immediate Owner

CAGE

3PZS5

Legal Business Name

MARICOPA COUNTY

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 Nina Lindsey on Oct 21, 2024 at 04:29 PM MARICOPA, COUNTY OF

Apr 02, 2025 03:20:43 PM GMT https://sam.gov/entity/LM85MG1513K5/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

County

Financial Information

Accepts Credit Card Payments

No

Debt Subject To Offset

No

EFT Indicator

CAGE Code

3QJA2

Points of Contact

Electronic Business

Cheryl Bucalo, Purchasing and Contracts

Supervisor

4041 N. Central AVE. Suite 1400

Phoenix, Arizona 85012

United States

Government Business

Cheryl Bucalo, Purchasing and Contracts

Supervisor

4041 N Central AVE Suite 1400

Phoenix, Arizona 85012

United States

Past Performance

Cheryl Bucalo, Purchasing and Contracts

Supervisor

4041 N. Central AVE. Suite 1400

Phoenix, Arizona 85012

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

923120

NAICS Title

Administration Of Public Health Programs

622110 General Medical And Surgical Hospitals

Product and Service Codes

PSC PSC Name

Q201 Medical- General Health Care

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Nina Lindsey on Oct 21, 2024 at 04:29 PM MARICOPA, COUNTY OF

Apr 02, 2025 03:20:43 PM GMT https://sam.gov/entity/LM85MG1513K5/coreData?status=null Page 2 of 2