CTR069518 THT TEPS A1 FEwDEB.pdf

INTERGOVERNMENTAL AGREEMENT (IGA)

Amendment

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

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

Contract No.: CTR069518 IGA Amendment No: 1 Procurement Officer:

Brandon Durick

Revised 05/29/2024

REVISED PRICE SHEET

Hopi Tobacco Program Annual Price Sheet

Cost Reimbursement Line Items Budget Amount

1. Personnel Services* $38,251.00

2. Employee Related Expenses* $9,494.00

3. Professional & Outside Services $9,500.00

4. Travel Expenses $11,450.00

5. Other Operating Expenses $23,880.00

6. Capital Outlay Expenses $1,800.00

7. Other (Indirect Costs 24.72%) $11,803.00

TOTAL CONTRACT (ANNUAL NOT TO EXCEED) $106,178.00

*Indicated direct rate calculation.

HOPI TRIBE

Unique Entity ID

CXTLBKAXP5Y7

CAGE / NCAGE

1G5A2

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Aug 27, 2025

Physical Address

123 Main ST

Kykotsmovi Village, Arizona 86039

United States

Mailing Address

P. O. Box 123

Kykotsmovi, Arizona 86039-0123

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

www.hopi-nsn.gov

Registration Dates

Activation Date

Aug 30, 2024

Submission Date

Aug 27, 2024

Initial Registration Date

Jul 30, 2001

Entity Dates

Entity Start Date

Dec 19, 1936

Fiscal Year End Close Date

Dec 31

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

Tribal Government

Organization Factors

(blank)

Profit Structure

(blank)

Last updated by Trudy Ami on Aug 27, 2024 at 06:43 PM HOPI TRIBE

Jun 03, 2025 07:07:20 PM GMT https://sam.gov/entity/CXTLBKAXP5Y7/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

Tribal Government

Other Government Entities

Council of Governments

Federally Recognized Native American Entity

Indian Tribe (Federally Recognized)

Financial Information

Accepts Credit Card Payments

No

Debt Subject To Offset

No

EFT Indicator

CAGE Code

1G5A2

Points of Contact

Electronic Business

Trudy Ami, Grant and Contract Specialist P. O. Box 123

Kykotsmovi, Arizona 86039

United States

Government Business

Don Jim Davis, Finance Director P. O. Box 123

Kykotsmovi, Arizona 86039

United States

Anthony Laban, Jr., Assistant Finance Director P.O. Box 123

Kykotsmovi, Arizona 86039

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

921150

NAICS Title

American Indian And Alaska Native Tribal Governments

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Trudy Ami on Aug 27, 2024 at 06:43 PM HOPI TRIBE

Jun 03, 2025 07:07:20 PM GMT https://sam.gov/entity/CXTLBKAXP5Y7/coreData?status=null Page 2 of 2

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