CTR067942 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: 2024.07.15 10:09:25 -07'00'

Moniqu e B Harris

Digitally signed by Monique B Harris Date: 2024.07.15 17:51:19 -07'00'

INTERGOVERNMENTAL AGREEMENT (IGA)

Amendment

ARIZONA DEPARTMENT

OF HEALTH SERVICES

150 18th Ave Suite 530 Phoenix, Arizona 85007

Contract No.: CTR067942 IGA Amendment No: 1 Procurement Officer

Kailee Gray

PRICE SHEET

October 1, 2023 to September 30, 2024 Agency Name: Apache County

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 $71,464.00 Employee Related Expenses $31,762.00 Professional & Outside Services $0.00 Travel Expense $1,443.00 Occupancy Expenses $0.00 Other Operating Expenses $3,483.00 Capital Expenditures $0.00 Indirect Cost $0.00

Total $108,152.00

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 $0.00 Employee Related Expenses $0.00 Professional & Outside Services $0.00 Travel Expense $0.00 Occupancy Expenses $0.00 Other Operating Expenses $0.00 Capital Expenditures $0.00 Indirect Costs $0.00

Total $0.00

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.

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: 400

Exhibit A - 2 CFR 200.332

Exhibit - 2 CFR 200.332 § 200.332 Requirements for pass-through entities. All pass-through entities must:

(a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass-through entity must provide the best information available to describe the Federal award and subaward.

Prime Awardee: Arizona Department of Health Services

UEI#

QMWUG1AMYF65

Federal Award Identification (Grant Number): 216AZ008W1003

Subrecipient name (which must match the name associated with its unique entity identifier):

Apache County Public Health Services District

Subrecipient's unique entity identifier (DUNS #): 804745420

Federal Award Identification Number (FAIN, sometimes it’s the same as the Grant Number):

216AZ008W1003

Federal Award Date (see the definition of Federal award date in § 200.1 of this part) of award to the recipient by the Federal agency;

10/1/2023

Subaward Period of Performance Start and End Date; 10/01/2023-9/30/2024 Subaward Budget Period Start and End Date: 10/01/2023-9/30/2024 Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient (this is normally the contract amount):

$108,152.00

Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current financial obligation (how much is available for contracts):

Total Amount of the Federal Award committed to the subrecipient by the pass-through entity

Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act

(FFATA)

Arizona local implementation of the WIC Special Supplemental Nutrition Program for Women, Infants, and Children

Name of Federal awarding agency, pass-through entity, and contact information for awarding official of the Pass-through entity

United States Department of Agriculture, FNS Southwest Regional Office, Food and Nutrition Service, 1100 Commerce Street Room 522, Dallas, TX 75242-9980, Telephone: (214)290-9810

Assistance Listings number and Title; the pass- through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement:

10.557 WIC Special Supplemental Nutrition

Program for Women, Infants, and Children

Identification of whether the award is R&D Not R&D award Indirect cost rate for the Federal award (including the de minimis rate is charged) per § 200.414

0.00%

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APACHE COUNTY

Unique Entity ID

DJ1FMTLJL4V6

CAGE / NCAGE

3S6W2

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Nov 14, 2024

Physical Address

75 W Cleveland

Saint Johns, Arizona 85936-4699

United States

Mailing Address

P. O. Box 428

St Johns, Arizona 85936-0428

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 02

State / Country of Incorporation

(blank) / (blank)

URL

(blank)

Registration Dates

Activation Date

Nov 20, 2023

Submission Date

Nov 15, 2023

Initial Registration Date

Mar 23, 2004

Entity Dates

Entity Start Date

Feb 24, 1879

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

U.S. Government Entity

Entity Type

US Local Government

Organization Factors

(blank)

Profit Structure

(blank)

Last updated by Timothy Hinton on Nov 15, 2023 at 04:29 PM APACHE COUNTY

Aug 02, 2024 04:06:57 PM GMT https://sam.gov/entity/DJ1FMTLJL4V6/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.

Government Types

U.S. Local Government

County

Financial Information

Accepts Credit Card Payments

No

Debt Subject To Offset

No

EFT Indicator

CAGE Code

3S6W2

Points of Contact

Electronic Business

Timothy Hinton, Finance Director 75 West Cleveland

85936, Arizona 85936

United States

STEVE KIZER P. O. Box 428

St Johns, Arizona 85936

United States

Government Business

RYAN PATTERSON, COUNTY MANAGER

P. O. Box 428

St Johns, Arizona 85936

United States

Past Performance

RYAN PATTERSON

P. O. Box 428

St Johns, Arizona 85936

United States

RYAN PATTERSON P. O. Box 428

St Johns, Arizona 85936

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

921190

NAICS Title

Other General Government Support

922110 Courts

922130 Legal Counsel And Prosecution

922140 Correctional Institutions

922150 Parole Offices And Probation Offices

923120 Administration Of Public Health Programs

923130 Administration Of Human Resource Programs (Except Education, Public Health, And Veterans' Affairs Programs)

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Timothy Hinton on Nov 15, 2023 at 04:29 PM APACHE COUNTY

Aug 02, 2024 04:06:57 PM GMT https://sam.gov/entity/DJ1FMTLJL4V6/coreData?status=null Page 2 of 2

CTR067942 WIC and BFPC Services (Apache County), A1_For Supplier Signature