CTR063729_Contract_A1_Executed_PDF.pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR063729 AMENDMENT NO.: ONE (1) PROCUREMENT OFFICER:

MICHELLE FINK

Arizona Hearing and Vision Screening Training Program

Effective on January 1, 2024, it is mutually agreed that the Contract referenced in this Amendment One (1) is amended as follows:

1. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extensions Five (5) Year Maximum, the Contract is hereby extended through December 31, 2024.

2. Pursuant to the Uniform Terms and Conditions, Provision Five (5), Contract Changes, Section 5.1. Amendments, the Contract is revised as follows:

1.1. The Price Sheet is revised and replaced.

1.2. The Exhibit Five (5) - Exhibit Five (5) - 2 CFR 200.332 is added.

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

Arizona Chapter of the American Academy of Pediatrics (AzAAP)

Contractor’s Name Procurement Officer Signature

Michel le Fink

Digitally signed by Michelle Fink Date: 2023.12.27 12:16:24 -07'00'

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR063729 AMENDMENT NO.: ONE (1) PROCUREMENT OFFICER:

MICHELLE FINK

PRICE SHEET

ACCOUNT CLASSIFICATION AMOUNT

Personnel $70,240.00

ERE $15,452.80

Professional & Outside Services $28,310.04

Travel Expense (In-State) $500.00

Out of State Travel $0.00

Occupancy $8,622.16

Operating Expenses/ Other Operating $1,000.00

Capital Outlay Expense $0.00

Indirect Costs (17.25% of total, if authorized) $25,875.00

TOTAL ANNUAL (NOT TO EXCEED AMOUNT) * $150,000.00

*Indicates Indirect Costs calculation.

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR063729 AMENDMENT NO.: ONE (1) PROCUREMENT OFFICER:

MICHELLE FINK

Exhibit Five (5) - 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): 1 B04MC52908-01-01

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

Arizona Chapter of the American Academy of Pediatrics

Subrecipient's unique entity identifier (DUNS #): V38AYDMTN1S4

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number): B0452908

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; 12/11/2023

Subaward Period of Performance Start and End Date; 1/1/2024-12/31/2024

Subaward Budget Period Start and End Date: 1/1/2024-12/31/2024

Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount): $150,000.00

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): N/A

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity $150,000.00

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR063729 AMENDMENT NO.: ONE (1) PROCUREMENT OFFICER:

MICHELLE FINK

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA) Maternal and Child Health Services

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

Human Resources and Services Administration

(HRSA)

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: 93.994

Identification of whether the award is R&D N/A

Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414 17.25%

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ARIZONA CHAPTER OF THE AMERICAN ACADEMY OF

PEDIATRICS

Unique Entity ID

UV6DNATKXJB6

CAGE / NCAGE

4RZC2

Purpose of Registration

Federal Assistance Awards Only

Registration Status

Active Registration

Expiration Date

Jun 14, 2024

Physical Address

2600 N Central AVE STE 670

Phoenix, Arizona 85004-1242

United States

Mailing Address

2600 N Central AVE STE 670

Phoenix, Arizona 85004-1242

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 03

State / Country of Incorporation

Arizona / United States

URL

http://www.azaap.org/

Registration Dates

Activation Date

Jun 19, 2023

Submission Date

Jun 15, 2023

Initial Registration Date

May 29, 2007

Entity Dates

Entity Start Date

Feb 23, 1977

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.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)

Last updated by Anne Stafford on Jun 15, 2023 at 03:17 PM ARIZONA CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS

Dec 27, 2023 10:11:56 PM GMT https://sam.gov/entity/UV6DNATKXJB6/coreData?status=null Page 1 of 2

Profit Structure

Non-Profit Organization

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

4RZC2

Points of Contact

Electronic Business

Anne Stafford, Chief Executive Officer 2600 N Central AVE

Suite 670

Phoenix, Arizona 85004

United States

Government Business

Anne Stafford, Chief Executive Officer 2600 N Central AVE

Suite 670

Phoenix, Arizona 85004

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 Anne Stafford on Jun 15, 2023 at 03:17 PM ARIZONA CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS

Dec 27, 2023 10:11:56 PM GMT https://sam.gov/entity/UV6DNATKXJB6/coreData?status=null Page 2 of 2

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