CTR070060 Mariposa CHC (WWHP) A2_EXECUTED w Debarments Memo.pdf

CONTRACT AMENDMENT

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007

CONTRACT NO.: CTR070060 AMENDMENT NO.: 2 PROCUREMENT OFFICER:

Karla Varela

Revised 06.18.2024

WELL WOMAN HEALTHCHECK PROGRAM (WWHP)

Effective upon signature by both parties it is mutually agreed that the Contract is amended as follows:

1. Pursuant to the Special Terms and Conditions, Provision Three (3), Contract Extensions 5 Year Maximum, the Contract is hereby extended through February 25, 2026.

ALL CHANGES ARE REFLECTED IN RED

ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY

Contractor hereby acknowledges receipt and acceptance of above amendment and that a signed copy must be filed with the Procurement Office before the effective date

The above referenced Contract Amendment is hereby executed this _____ day of __________ 20______ at Phoenix, Arizona

(To be filled out by Procurement Office)

Contractor Signature

Contractor Signature Date

Authorized Signatory’s Name and Title

MARIPOSA COMMUNITY HEALTH CENTER

Contractor’s Name Procurement Officer Signature

Contractor Signatu

3/7/25

Amy Taylor, CEO

Gina Corwin

Digitally signed by Gina Corwin Date: 2025.03.24 09:04:53 -07'00'

���������������������������� �!" !"���#$%����&������'( %����&�)����$*+,#-.*�/-$$01,23�45*624�/5125+7�,1/8 %����&�9���!::�� ! %����&��&;��<=>?@ABC�1=DEF=GBA�/=FE=FHAB=D %����&�

���I(�J���K� LM�����M�������:����!NO P��(M��QM��

���I(�,D�R==S�.AHDSBDT J;;�MK�'������:�� �!NO

���I(������U��V���'�9��M�;M����M�������:����!NO W�Q��X���M��#?FE?AYHZ [I(���((��&;��4?HZA\�/HF?�HDS�.=CBHZ�*@@B@AHDC? W�(��J��I�'�P�;M���L�'������� �M����'�� �����*FB]=DH J��I�'�P�;M����I�������N������� �̂��(��I��#FB_HC̀�#=ZBC̀�a\AAE"��H]CC8T=_�EFB_HC̀bE=ZBC̀c�d�/=DAHCA�0@�a\AAE"��H]CC8T=_�C=FE=FHAB=D@�C=FE=FHAB=DbC=DAHCA@c efghfgij�klik�mn o �p ���q r ��� ��q ���ss� � t��rslffuv

��k��eeik����v� ���� ��v������ign���u�{��rxy��i��t����� kfh

������� �������������������� �!�"#$�%��� �"�&' ()*�+&�%,-$ ./0�12�3&)*4�5%�*#�6�7#�$��89961�35:�76�5;6�.0</86�=75 89>/<>/9// /><>/9/?(�&�"$,& @=(ABC�:5D�E�1 ./0�12�3&)*4�5%�*#�6�7#�$��89961�35:�76�5;6�.0</86�=75 .>0>/990 F>/8>/98.(�&�"$,& :�=�@��13 ./0�12�3&)*4�5%�*#�6�7#�$��89961�35:�76�5;6�.0</86�=75 .>8<>/998 F>8G>/9/8(�&�"$,& D=(H�+A15 ./0�12�3&)*4�5%�*#�6�7#�$��89961�35:�76�5;6�.0</86�=75 />/.>8F.. F>/8>/98.(�&�"$,& D�I�DB�:A1�AD� ./0�12�3&)*4�5%�*#�6�7#�$��89961�35:�76�5;6�.0</86�=75 J>8/>/98G F>8G>/9/8B&�)-#&�& :�A7�E�DDA7 ./0�12�3&)*4�5%�*#�6�7#�$��89961�35:�76�5;6�.0</86�=75 J>8/>/98G F>8G>/9/8

���KLM���N�����OP���L��

Q� �� ��R

OX����

���OY�L

�QO7)*$)��&#ZK

������R

+&�%)"T�+,U�"T���$$[\>>)Z""2],%>[&�%)"T̂[,U�"T'�_��,*$)"$�=-���$$[\>>)Z""2],%>",&[,&)$�,*->",&[,&)$�,*̂",*$)"$-' àbcabde�fgdf�hi jklmnop�qnkrnkpslno�qnttluulno vssrugaawxnkrypmxxyzn{ah|}~lx�|ulowuu�wpkxvah|}~lx�|ulowuu�o�n�wosls��|t}wk��f��̀ d̀f���ox�nktlo�n��x�l���sdbi���w�}��rz{t�d��v����� bac

�'(�����)*+,-./+ 012034567890: ;

��2<�=+>?@�8A,?B,C�3B*.,�DEEC25=8F03C�8:C�;�G

DC�H38 �ID

I

EDJ KID�I

E �L+,M*@,?. 452N�98145F8 ;

��2<�=+>?@�8A,?B,C�3B*.,�DEEC25=8F03C�8:C�;�G

DC�H38 JID�I

EDK KID�I

E

�3,-+,.>+O 681F53PH348Q8240 ;

��2<�=+>?@�8A,?B,C�3B*.,�DEEC25=8F03C�8:C�;�G

DC�H38 JID�I

EDK KI

�I E

�9*-,RL+,M*@,?. 6S+*M�N/B?T ;

��2�=+>?@�8A,<C�3B*.,�DEEC25=8F03C�8:C�;�G

DC�H38 KI

�I E

�)*+,-./+ U/S?�V,WX*?T,+ ;

��2�=+>?@�8A,<C�3B*.,�DEEC25=8F03C�8:C�;�G

DC�H38 KI

�I E

�)*+,-./+ 8>+O?�=*YX*? ;

��2�=+>?@�8A,<C�3B*.,�DEEC25=8F03C�8:C�;�G

DC�H38 KI

�I E �)*+,-./+ U,??*Z,+�3.<�U/S? ;

��2�=+>?@�8A,<C�3B*.,�DEEC25=8F03C�8:C�;�G

DC�H38 KI

�I E

!���"���"̀�8WO�4>OX/+!����

��2�=+>?@�8A,<C�25=8F03C�8:C�;�G DC�H38a� "�\̀�3>?.>�6+Bb&�

��'(�����̀�KI

�I E

̀a� "�\̀&� ��'(�����̀P>-c �1,.B+?�./�3,>+-S �1,.B+?�./�1,MBX.M)/-BW,?.�7*M./+O �2>W,I1,M.+B-.B+*?T�7*M./+O �L,?@*?T�)/-BW,?.M �Q*-+/Z*XW�7*M./+OL+*A>-O�L/X*-O�dS..efII>b--<T/AIe+*A>-ORe/X*-Og�h�6/?.>-.�HM�dS..efII>b--<T/AI-/+e/+>.*/?MI-/+e/+>.*/?R-/?.>-.Mg ijkljkmn�opmo�qr stuvwxy�zwt{wty|uwx�zw}}u~~uwx

�||{~pjj��wt{�yv����w�jq���u���~ux�~~��yt��jq���u���~ux�~~�x�w��x|u|���}��t��o��iimo���x��wt}ux�w����u���|mkr��������{��}�m�������� ijl

������� �!"�!�#$ %&'()*+�,)&-)&+.')*�,)//'00')*

1..-0"��23)&-4+(3345)6�#789'3:70'*200;2+&31�#789'3:70'*200<*=)>2*.'.?@7/82&AB!CC���!DEE*3=)&/'*=)AF3F'GHI.��$HJK2J8IK-56/L�MH1NOHPQ ���

������������������ !"#$%&'$�()*+!,�-)$#".$/�0123456785�9:;<2=�>:543?5@��'.%.%)$08?6?6:5��A��B��� �����������������C �D���������E�

���D������FG�HI�JKLMNOL�PJK�GIMHQR�OSTL�THQTUTQMPN�IJ�KHOTOV�WTG�TO�TL�PH�KHOTOV�LKPJXSY�TL�HIO�XMJJKHONV�KZXNMQKQ[�\JTHO�OSTL�]K̂�_P̀K�GIJ�VIMJQIXMaKHOPOTIHb� ����c� ��b� ��������������defgefhfi�fjdhjkg�lC��bm����n�o�p������� ���b������� �������dekhefhfi�khjhkjhh�cC��bmB���������b� c��������

����������������q������b� ����������������E���r����������s����tdefgefi��kkjdh�cC n�o�b� ����B���

��� �jee��� ������������������eb� ���B��� � � kek

MARIPOSA COMMUNITY HEALTH CENTER, INC.

Unique Entity ID

T7KJKFWEKNR9

CAGE / NCAGE

3LPV8

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Jan 14, 2026

Physical Address

825 N Grand AVE

STE 100

Nogales, Arizona 85621-2385

United States

Mailing Address

825 N Grand AVE STE 100

Nogales, Arizona 85621-2385

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

www.mariposachc.net

Registration Dates

Activation Date

Jan 16, 2025

Submission Date

Jan 14, 2025

Initial Registration Date

Nov 12, 2003

Entity Dates

Entity Start Date

Dec 1, 1985

Fiscal Year End Close Date

May 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

Corporate Entity (Tax Exempt)

Entity Type

Business or Organization

Organization Factors

(blank)

Profit Structure

Non-Profit Organization

Last updated by Amanda Webster on Jan 14, 2025 at 10:56 AM MARIPOSA COMMUNITY HEALTH CENTER, INC.

Mar 28, 2025 06:32:41 PM GMT https://sam.gov/entity/T7KJKFWEKNR9/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

3LPV8

Points of Contact

Electronic Business

Dan Prevost, CEO 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Jonathan Beltran, Project Manager 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Government Business

Dan Prevost, CEO 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Tia Duncan, COA 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Past Performance

Jonathan Beltran, Project Manager 825 N Grand AVE STE 100

Nogales, Arizona 85621

United States

Humberto Duran 1852 N. Mastick WAY

Nogales, Arizona 85621

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

621498

NAICS Title

All Other Outpatient Care Centers

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Amanda Webster on Jan 14, 2025 at 10:56 AM MARIPOSA COMMUNITY HEALTH CENTER, INC.

Mar 28, 2025 06:32:41 PM GMT https://sam.gov/entity/T7KJKFWEKNR9/coreData?status=null Page 2 of 2

Katie Hobbs | Governor Jennifer Cunico, MC |

Director

150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 P | 602-542-1025 F | 602-542-0883 W | azhealth.gov Health and Wellness for all Arizonans

Memorandum | Office of Procurement

Date: March 24, 2025

To: Procurement File

From: Karla Varela, Procurement Specialist

Regarding: Well Woman Healthcheck Program

A1 for CTR070058 - Chiricahua Community Health Centers, Inc.

A2 for CTR070059 - Maricopa County Special Health Care District dba Valleywise Health A2 for CTR070060 - Mariposa Community Health Center A2 for CTR070061 - Mountain Park Health Center A1 for CTR070062 - North Country HealthCare – APACHE COUNTY A1 for CTR070063 - Pima County A1 for CTR070064 - Wesley Community and Health Centers A1 for CTR070066 - North Country HealthCare – COCONINO COUNTY A1 for CTR070067 - North Country HealthCare – GILA COUNTY A1 for CTR070068 - North Country HealthCare – MOHAVE COUNTY A1 for CTR070069 - North Country HealthCare – NAVAJO COUNTY A1 for CTR070070 - Pinal County Public Health Services District A1 for CTR070071 – Regional Center for Border Health, Inc.

Subject: Annual Extension Amendments Determination

The Contracts listed above were awarded on February 26, 2024, to the respective suppliers through Request for Proposal (RFP) BPM005681 for a one-year term with the option to renew annually not to exceed five (5) years. Between November 24th and 25th, 2025, the program submitted multiple PRS requests to update the Price sheets and extend the contracts.

Due to federal funding uncertainties and the need for additional approval for federally funded projects, final approval to proceed was not obtained until March 5, 2025, after the contracts expired on February 25, 2025.

The contract amendments were sent for signature on March 5, 2025 with an effective date of February 26, 2025 for a one-year term.

As the program’s intent was to extend these contracts, it is in the best interest of the State to reinstate these contracts for one year.

Prepared By: Karla Varela, Procurement Officer Date

Approved By: Gina Corwin, Chief Procurement Officer Date

Karla Varela Digitally signed by Karla Varela Date: 2025.03.24 11:28:44 -07'00'

Gina Corwin Digitally signed by Gina Corwin Date: 2025.03.24 11:36:14 -07'00'