CTR066191_Contract_Amendment_2.pdf

CONTRACT AMENDMENT

Arizona Department of Economic Security

1789 W Jefferson Street, Mail Drop 1541, Phoenix, AZ 85007

CONTRACT NUMBER: AMENDMENT NUMBER:

CTR066191 Two (2)

DESCRIPTION/ LABEL: Domestic Violence - Statewide

CONTRACTOR NAME: Catholic Community Services of Southern Arizona, Inc

THE ABOVE REFERENCED CONTRACT IS HEREBY MODIFIED AS FOLLOWS:

In accordance with the Special Terms and Conditions, Section 13.0, Contract Term and Option to Extend, the Contract term is extended from July 1, 2024, through June 30, 2025.

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.

CATHOLIC COMMUNITY SERVICES OF SOUTHERN

ARIZONA, INC.

Unique Entity ID

D1GHHBBJFKT6

CAGE / NCAGE

3Z364

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Feb 28, 2025

Physical Address

268 W Adams ST

Tucson, Arizona 85705-6534

United States

Mailing Address

268 W Adams ST, Tucson, Arizona 85705-7688

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 07

State / Country of Incorporation

Arizona / United States

URL

(blank)

Registration Dates

Activation Date

Mar 1, 2024

Submission Date

Feb 29, 2024

Initial Registration Date

Apr 10, 2002

Entity Dates

Entity Start Date

Sep 1, 1933

Fiscal Year End Close Date

Jun 30

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 kimberly Trevino on Feb 29, 2024 at 07:28 PM CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.

Apr 10, 2024 07:57:17 PM GMT https://sam.gov/entity/D1GHHBBJFKT6/coreData?status=null Page 1 of 3

Profit Structure

Non-Profit Organization

Socio-Economic Types

AbilityOne Non Profit Agency

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

3Z364

Points of Contact

Electronic Business

ELENA DWYRE

140 W. Speedway BLVD.

Suite 230

Tucson, Arizona 85705

United States

TERESA CAVENDISH 140 W. SPEEDWAY, STE. 230

Tucson, Arizona 85705

United States

Government Business

ELENA DWYRE

140 W. Speedway BLVD.

Suite 230

Tucson, Arizona 85705

United States

TERESA CAVENDISH 140 W Speedway

Suite 230

Tucson, Arizona 85705

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

561720

NAICS Title

Janitorial Services

621498 All Other Outpatient Care Centers

623990 Other Residential Care Facilities

624110 Child And Youth Services

624120 Services For The Elderly And Persons With Disabilities

624190 Other Individual And Family Services

624410 Child Care Services

Product and Service Codes

PSC PSC Name

G005 Social- Geriatric

Q101 Medical- Dependent Medicare

S201 Housekeeping- Custodial Janitorial

V212 Transportation/Travel/Relocation- Travel/Lodging/Recruitment: Motor Passenger

Disaster Response

Last updated by kimberly Trevino on Feb 29, 2024 at 07:28 PM CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.

https://sam.gov/entity/D1GHHBBJFKT6/coreData?status=null Page 2 of 3

Yes, this entity appears in the disaster response registry.

Bonding Levels Dollars

(blank) (blank)

States

Arizona

New Mexico

Counties

(blank)

Metropolitan Statistical Areas

(blank)

Last updated by kimberly Trevino on Feb 29, 2024 at 07:28 PM CATHOLIC COMMUNITY SERVICES OF SOUTHERN ARIZONA, INC.

https://sam.gov/entity/D1GHHBBJFKT6/coreData?status=null Page 3 of 3

4/10/24, 12:55 PM Arizona Corporations Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=00359834 1/3

ENTITY INFORMATION

Search Date and Time: 4/10/2024 12:55:05 PM

Entity Details

Entity Name: CATHOLIC COMMUNITY SERVICES

OF SOUTHERN ARIZONA, INC.

Entity ID: 00359834

Entity Type: Domestic Nonprofit Corporation Entity Status: Active

Formation Date: 9/29/1933 Reason for Status: In Good Standing

Approval Date: 11/8/1933 Status Date: 10/29/2019

Original Incorporation Date:

9/29/1933 Life Period: Perpetual

Business Type: Health Care and Social Assistance

Last Annual Report Filed:

Domicile State: Arizona Annual Report Due Date:

10/29/2024

Years Due:

Original Publish Date: 9/29/1933

Statutory Agent Information

Name: GERARD R O'MEARA Appointed Status: Active

Attention:

Address: 1 S CHURCH AVE #1900 , TUCSON, AZ 85701, USA

Agent Last Updated: 10/18/2023 E-mail:

Attention: Mailing Address:

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< Previous ... 1 2 ... Next > Page 1 of 2, records 1 to 5 of 10 Go to Page

Title Name Attention Address Date of Taking Office

Last Updated

Other Officer

MARYANN

HOCKSTAD

268 W. Adams Street, TUCSON, AZ, 85705, Pima County, USA

10/18/2023

Chairman of the Board of Directors

Anthony Fonze 268 W. Adams Street, TUCSON, AZ, 85705, Pima County, USA

10/18/2023

Director Howard Richard

268 W. Adams Street, TUCSON, AZ, 85705, Pima County, USA

10/28/2021 8/18/2023

CEO (Chief Executive Officer)

ELENA DWYRE

268 W. Adams Street, TUCSON, AZ, 85705, Pima County, USA

10/18/2023

CFO (Chief Financial Officer)

JESUS

FERNANDEZ

268 W. Adams Street, TUCSON, AZ, 85705, Pima County, USA

10/18/2023

County: Pima

Principal Information

Address

Attention:

Catholic

Address: 268 W. Adams Street, TUCSON, AZ, 85705, USA

County: Pima Last Updated:

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Pending Documents Microfilm History

Community Services of Southern Arizona

Entity Principal Office Address

Attention: Address: County: Last Updated:

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