CTR065343 Amendment 2 w debarments.docx.pdf

REQUEST FOR PROPOSAL

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

CONTRACT NO.: CTR065343 AMENDMENT NO.: 2

PROCUREMENT OFFICER:

Emily Ngo

High Risk Perinatal Program (HRPP) Developmental Consultant

Effective upon signature by both parties it is mutually agreed that the Contract is amended as follows:

1. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extension (5 Year Maximum) the Contract is hereby extended through April 19, 2026.

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

Dignity Health - H&L Antenatal

Contractor’s Name Procurement Officer Signature

Revised 06.18.2024

Kristine Newton

Digitally signed by Kristine Newton Date: 2025.04.14 11:19:48 -07'00'

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DIGNITY HEALTH

F10035680

Foreign Nonprofit Corporation

9/24/2001

In Good Standing

9/24/2001

7/26/2021

9/24/2001

Perpetual

Other - Other - HOSPITAL/HEALTH CARE

California

5/24/2025

Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts)

4/17/25, 2:32 PM Arizona Corporation Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=F10035680 1/3

President Terika Richardson

185 BERRY ST #200, SAN

FRANCISCO, CA, 94107, San Francisco County, USA

4/5/2024 5/14/2024

Secretary

MITCH H.

MELFI

444 W. Lake Street, Suite 2500, CHICAGO, IL, 60606, Cook County, USA

2/8/2019 5/14/2024

Director Mitch H. Melfi 444 W. Lake Street, Suite 2500, CHICAGO, IL, 60606, Cook County, USA

1/27/2021 5/14/2024

Director Michelle Johnson- Tidjani

185 BERRY STREET, SUITE 200,

SAN FRANCISCO, CA, 94107, San Francisco County, USA

5/14/2024

10/29/2001

C T CORPORATION SYSTEM

Active 8/23/2019

3800 NORTH CENTRAL AVENUE SUITE 460, PHOENIX, AZ 85012, USA

5/14/2024

Maricopa

Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=F10035680 2/3

Director Scott Carswell

185 BERRY STREET, SUITE 200,

SAN FRANCISCO, CA, 94107, San Francisco County, USA

7/26/2021

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3200 N. Central Avenue, 23rd Floor, PHOENIX, AZ, 85012, USA

Maricopa

11/25/2020

185 BERRY STREET, SUITE 200, SAN FRANCISCO, CA, 94107, USA

San Francisco

5/14/2024

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