CTR070061 A1.pdf
PDF 171 KB Posted
- Attached to
- Master Agreement AZ|CTR070061
- Contract number
- CTR070061
- Issued by
- Arizona
About this file
This document is a Contract Amendment (Amendment No. 1) for the Well Woman HealthCheck Program (WWHP) between the Arizona Department of Health Services (ADHS), Office of Procurement, and Mountain Park Health Center. The amendment is associated with Contract No. CTR070061 and is effective upon signature by both parties.
The contract is a cost reimbursement agreement covering the period from January 1st through December 31st, with a total annual amount not to exceed $1,028,810.60. The budget is divided into six line items: Personnel Services ($194,558.00), Employee Related Expenses ($33,952.00), Travel Expenses ($1,140.00), Other Operating Expenses ($705,736.00), and Indirect Rate and Costs at 10% ($93,424.60). The contractor is authorized to transfer up to 10% between line items with written ADHS program representative approval, with transfers exceeding 10% or involving non-funded line items requiring a formal Contract Amendment.
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Other files
| File | Type | Posted |
|---|---|---|
| 2025.07.01 GL AL UL WC.pdf | ||
| CTR070061 A1 Pricing.pdf | ||
| CTR070061 A3.pdf | ||
| CTR070061_Contract_Documents.pdf | ||
| CTR070061_Pricing.xlsx | XLSX spreadsheet | |
| 2024-07-01_COI_GL_AL_UL_WC.zip | ZIP file | |
| ADHS_Mountain_Park_Health_Center_2526_Liability_Master_Well_Woman_6-26-2025_102613627.pdf | ||
| CTR070061 A2.pdf |
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Text version
CONTRACT AMENDMENT
ARIZONA DEPARTMENT OF
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
CONTRACT NO.: CTR070061 AMENDMENT NO.: 1 PROCUREMENT OFFICER:
Jacqueline Ortega-Avila
Revised 04.29.2024
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 Uniform Terms and Conditions, Provision Five (5), Contract Changes, Section 5.1, the Contract is hereby revised with the following:
1.1 The Price Sheet is revised and replaced.
ALL CHANGES ARE REFLECTED IN RED
ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY
Contractor hereby acknowledges receipt and acceptance of above the 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 __________ 2024 at Phoenix, Arizona.
(TO BE FILLED OUT BY PROCUREMENT OFFICE)
Contractor Signature
Contractor Signature Date
Authorized Signatory’s Name and Title
MOUNTAIN PARK HEALTH CENTER
Contractor’s Name Procurement Officer Signature
Gina Corwin
Digitally signed by Gina Corwin Date:
2024.08.08 14:52:51 -07'00'
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
January 1st through December 31st
COST REIMBURSEMENT CONTRACT
REVISED ANNUAL PRICE SHEET
APP LINE ITEM ACCOUNT CLASSIFICATION LINE-ITEM TOTALS
CTR070061-01 Well Woman - Personnel Services* $194,558.00
CTR070061-02 Well Woman - Employee Related Expenses (ERE)* $33,952.00
CTR070061-04 Well Woman - Travel (In-State & Out of State) Expenses $1,140.00
CTR070061-05 Well Woman - Other Operating* $705,736.00
CTR070061-06 Well Woman - Indirect Rate and Costs *(10%) $93,424.60
TOTAL ANNUAL AMOUNT (NOT TO EXCEED) $1,028,810.60
If applicable, the Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total budget amount between line items with the written approval from an ADHS program representative.
Transfers exceeding ten percent (10%) or to a non-funded line item shall require a Contract Amendment.
*Indirect Rate ten percent (10%) (asterisk (*) indicates funding lines used to calculate percentage
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N 18th Ave., Ste. #530 Phoenix, Arizona 85007
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