CTR066099_Las_Palmas_Assisted_Living_Home_Amendment_1.pdf
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- Attached to
- Master Agreement AZ|CTR066099
- Contract number
- CTR066099
- Issued by
- Arizona
About this file
This is a Contract Amendment issued by the Arizona Department of Economic Security (DES) for Contract No. CTR066099, involving Las Palmas Assisted Living Home LLC. The amendment, designated as Amendment Number One (1), pertains to an Assisted Living Facility contract and specifically adds a new Attachment 7 - Contractor Facility Location Chart to the existing contract.
The amendment does not detail specific pricing or service terms, but provides a template for the contractor to document critical facility and administrative information, including facility location details, contact information, and administrative office operational parameters. The document includes sections for listing the assisted living facility's address, contact details, and administrative office information, as well as a comprehensive list of holidays during which the administrative office will be closed. The amendment maintains all other existing contract requirements, specifications, and terms, with the sole modification being the addition of the facility location chart attachment.
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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:
CTR066099 One (1)
DESCRIPTION/ LABEL: Assisted Living Facility
CONTRACTOR NAME: Las Palmas Assisted Living Home LLC.
THE ABOVE REFERENCED CONTRACT IS HEREBY MODIFIED AS FOLLOWS:
In accordance with the Uniform Terms and Conditions, Section 5, Contract Changes Subsection 5.1 Amendments, the Contractor Facility Location Chart is being added to the Contract as Attachment 7
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.
Attachment 7 - Contractor Facility Location Chart
Contract No.: CTR066099
Description: Assisted Living Facility
Attachment 7 - Contractor Facility Location Chart
Assisted Living Home
Information where Assisted Living Center services will be provided Name of Assisted Living Facility
Address of Facility City State Zip Code
Mailing Address of Facility (If Different) City State Zip Code
Facility Phone Facility Fax Facility Email Address
Contact Name and Title Contact Phone Contact Email Address
Information of Administrative Office
Name
Address Zip Code
City State
Mailing Address (If Different) Zip Code
City State
Phone Number Fax Number Email Address
Contact Name and Title Contact Phone Contact Email Address
Administrative Office Days and Hours of Operation
The Administrative Office listed above will not be open on the holidays below:
New Year’s Day Martin Luther King Jr.’s Birthday Lincoln’s Birthday President’s Day Washington’s Birthday Good Friday Memorial Day Independence Day Labor Day Rosh Hashanah Yom Kippur Columbus Day Veteran’s Day
Other:
Other:
Thanksgiving Day Christmas Day
File details come from the government source that posted it. Updated .