CTR067935 A1.pdf

Elise Phalen

Digitally signed by Elise Phalen DN: cn=Elise Phalen, o=Arizona Attorney General's Office, ou, email=elise.phalen@azag .gov, c=US Date: 2024.07.01 13:37:43 -07'00'

Selena Leon Digitally signed by Selena Leon Date: 2024.07.11 16:03:51 -07'00'

INTERGOVERNMENTAL AGREEMENT (IGA)

Amendment

ARIZONA DEPARTMENT OF

HEALTH SERVICES

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR067935 IGA Amendment No: 1 Procurement Officer:

Karla Varela

Revised 04/08/2024

PRICE SHEET

October 1, 2023, to September 30, 2024

Agency Name: Yavapai County Community Health Services

Cost Reimbursement Line Item Budget WIC Services

Federal Award Date: October 1, 2023 CFDA number and name: 10.557 Special Supplemental Nutrition Program for Women, Infants, and Children

WIC Services Account Classification

Amount

Personnel * $416,927.00

Employee Related Expenses * $169,264.00

Professional & Outside Services $0.00

Travel Expense 7,071.00

Occupancy Expenses $2,052.00

Other Operating Expenses $14,899.00

Capital Expenditures $0.00

Indirect Cost* (24.66%) $144,555.00

Total $754,768.00

Breastfeeding Peer Counseling Services

Federal Award Date: October 1, 2023 CFDA number and name: 10.557 Special Supplemental Nutrition Program for Women, Infants, and Children

Breastfeeding Peer Counseling Services Account Classification

Amount

Personnel * $40,942.09

Employee Related Expenses * $20,289.00

Professional & Outside Services $0.00

Travel Expense $2,419.00

Occupancy Expenses $0.00

Other Operating Expenses $1,250.00

Capital Expenditures $0.00

Indirect Costs* (24.66%) $15,099.59

Total $80,000.00

INTERGOVERNMENTAL AGREEMENT (IGA)

Amendment

ARIZONA DEPARTMENT OF

HEALTH SERVICES

150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007

Contract No.: CTR067935 IGA Amendment No: 1 Procurement Officer:

Karla Varela

Revised 04/08/2024

Additional Terms and Conditions:

With prior written approval from the Program Manager, the Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between funded line items. Transfers of funds are only allowed between funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall require an amendment.

ADHS reserves the right to adjust awards given to local agencies depending on federal dollars received. Adjustments will be at the discretion of ADHS.

*Indicated indirect rate calculation

Additional WIC Program:

Should additional administrative monies become available through state or federal grants, ADHS may increase the purchase order to increase the number of participants served and increase the total of this contract.

The assigned caseload for FFY 2024 is: 3,600

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YAVAPAI, COUNTY OF

Unique Entity ID

GYC9VVG4QAH1

CAGE / NCAGE

3WGB7

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Mar 28, 2025

Physical Address

2860 Southwest DR

Sedona, Arizona 86336-3728

United States

Mailing Address

2860 Southwest Drive

Sedona, Arizona 86336-3728

United States

Business Information

Doing Business as

(blank)

Division Name

Sedona Fire District

Division Number

(blank)

Congressional District

Arizona 02

State / Country of Incorporation

Arizona / United States

URL

(blank)

Registration Dates

Activation Date

Apr 1, 2024

Submission Date

Mar 28, 2024

Initial Registration Date

Jun 3, 2004

Entity Dates

Entity Start Date

Apr 7, 1957

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

Other

Entity Type

Business or Organization

Organization Factors

(blank)

Profit Structure

Non-Profit Organization

Last updated by Heidi Robinson on Mar 28, 2024 at 01:47 PM YAVAPAI, COUNTY OF

Jul 15, 2024 09:53:53 PM GMT https://sam.gov/entity/GYC9VVG4QAH1/coreData?status=null Page 1 of 2

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

3WGB7

Points of Contact

Electronic Business

Heidi Robinson, Director 2860 Southwest Drive

Sedona, Arizona 86336

United States

Joshua Clounch, USER SUPPORT LEAD TECH 2860 Southwest Drive

Sedona, Arizona 86336

United States

Government Business

Ed Mezulis, Fire Chief 2860 Southwest Drive

Sedona, Arizona 86336

United States

Jayson Coil 2860 Southwest DR.

Sedona, Arizona 86336

United States

Past Performance

Heidi Robinson 2860 Southwest DR.

Sedona, Arizona 86336

United States

Kimberly Smathers 2860 Southwest DR.

Sedona, Arizona 86336

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

922160

NAICS Title

Fire Protection

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Heidi Robinson on Mar 28, 2024 at 01:47 PM YAVAPAI, COUNTY OF

Jul 15, 2024 09:53:53 PM GMT https://sam.gov/entity/GYC9VVG4QAH1/coreData?status=null Page 2 of 2