CTR066193_Contract_Amendment_1.pdf

CONTRACT AMENDMENT

Arizona Department of Economic Security

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

CONTRACT NUMBER: AMENDMENT NUMBER:

CTR066193 One (1)

DESCRIPTION/ LABEL: Domestic Violence - Statewide

CONTRACTOR NAME: Chrysalis Shelter for Victims of Domestic Violence, Inc.

THE ABOVE REFERENCED CONTRACT IS HEREBY MODIFIED AS FOLLOWS:

In accordance with the ADES Special Terms and Conditions, Section 13. 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.

CHRYSALIS SHELTER FOR VICTIMS OF DOMESTIC

VIOLENCE, INC.

Unique Entity ID

JG1MYXAQLNJ5

CAGE / NCAGE

5PPR4

Purpose of Registration

Federal Assistance Awards Only

Registration Status

Active Registration

Expiration Date

Dec 6, 2024

Physical Address

2055 W Northern AVE

Phoenix, Arizona 85021-5157

United States

Mailing Address

2055 W. Northern

Phoenix, Arizona 85021-5157

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 08

State / Country of Incorporation

Arizona / United States

URL

www.noabuse.org

Registration Dates

Activation Date

Dec 11, 2023

Submission Date

Dec 7, 2023

Initial Registration Date

Sep 14, 2009

Entity Dates

Entity Start Date

Apr 9, 1981

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 Patricia Klahr on Dec 07, 2023 at 05:57 PM CHRYSALIS SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE, INC.

Apr 10, 2024 09:27:20 PM GMT https://sam.gov/entity/JG1MYXAQLNJ5/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.

Other Entity Qualifiers

Domestic Shelter

Financial Information

Accepts Credit Card Payments

Yes

Debt Subject To Offset

No

EFT Indicator

CAGE Code

5PPR4

Points of Contact

Electronic Business

Becky Martin, Financial Leader 2055 W. Northern Avenue

Phoenix, Arizona 85021

United States

Government Business

PATRICIA KLAHR, CEO

2055 W. Northern Avenue

Phoenix, Arizona 85021

United States

Becky Martin, Financial Leader 2055 W. Northern Avenue

Phoenix, Arizona 85021

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 Patricia Klahr on Dec 07, 2023 at 05:57 PM CHRYSALIS SHELTER FOR VICTIMS OF DOMESTIC VIOLENCE, INC.

Apr 10, 2024 09:27:20 PM GMT https://sam.gov/entity/JG1MYXAQLNJ5/coreData?status=null Page 2 of 2

4/10/24, 2:23 PM Arizona Corporations Commission https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01375891 1/3

ENTITY INFORMATION

Search Date and Time: 4/10/2024 2:23:15 PM

Entity Details

Entity Name: CHRYSALIS SHELTER FOR

VICTIMS OF DOMESTIC VIOLENCE,

INC.

Entity ID: 01375891

Entity Type: Domestic Nonprofit Corporation Entity Status: Active

Formation Date: 4/9/1981 Reason for Status: In Good Standing

Approval Date: 5/7/1981 Status Date: 2/5/2021

Original Incorporation Date:

4/9/2018 Life Period: Perpetual

Business Type: Other - CHARITABLE Last Annual Report Filed:

Domicile State: Arizona Annual Report Due Date:

10/9/2024

Years Due:

Original Publish Date: 6/9/1981

Statutory Agent Information

Name: CT CORPORATION

SYSTEM

Appointed Status: Active

Attention:

Address: 3800 N CENTRAL AVE SUITE 460 , PHOENIX, AZ 85012, USAPrivacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts http://azcc.gov/corporations/corporation-contacts https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01375891 2/3

< Previous ... 1 2 ... Next > Page 1 of 2, records 1 to 5 of 8 Go to Page

Title Name Attention Address Date of Taking Office

Last Updated

Other Officer

CESAR

CRAMTON

2055 W NORTHERN AVE,

PHOENIX, AZ, 85021,

Maricopa County, USA

6/18/2015 9/16/2021

Chairman of the Board of Directors

JEN KUENZLI

2055 W NORTHERN AVE,

PHOENIX, AZ, 85021,

Maricopa County, USA

11/19/2009 10/9/2023

President/CEO

PATRICIA J

KLAHR

2055 W NORTHERN AVE,

PHOENIX, AZ, 85021,

Maricopa County, USA

3/12/1998 10/8/2019

Other Officer Mallory Miranda

2055 W NORTHERN AVE,

PHOENIX, AZ, 85021,

Maricopa County, USA

5/1/2019 10/9/2023

Other Officer Mark Krivoruchka

2055 W NORTHERN AVE,

PHOENIX, AZ, 85021,

Maricopa County, USA

5/1/2019 9/16/2021

Agent Last Updated: 10/9/2023 E-mail:

Attention: Mailing Address: 3800 N CENTRAL AVE

SUITE 460 , PHOENIX,

AZ 85012, USA

County: Maricopa

Principal Information

Privacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts) javascript:$xhtml.paging(2) javascript:$xhtml.paging(2) http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/privacy-policy http://azcc.gov/corporations/corporation-contacts https://ecorp.azcc.gov/BusinessSearch/BusinessInfo?entityNumber=01375891 3/3

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Document History Name/Restructuring History

Pending Documents Microfilm History

Address

Attention: Address: 2055 W NORTHERN AVE, PHOENIX, AZ, 85021, USA

County:

Maricopa

Last Updated:

10/9/2023

Entity Principal Office Address

Attention: Address: County: Last Updated:

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