CTR075550_Pre-Contract_Documents.pdf

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Master Agreement AZ|CTR075550
Contract number
CTR075550
Issued by
Arizona

About this file

Written by GovTribe AI ·

The document is a Procurement Assistance (PA) Request from the Arizona Department of Economic Security's Division of Financial Operations and Office of Procurement. The request involves a direct contract with the Northern Arizona Council of Governments (NACOG) for the Community Action Services Program for State Fiscal Year 2026 (SFY26). The contractor, NACOG, is a domestic nonprofit corporation established in 1975 and located in Flagstaff, Arizona, with Maria Garcia serving as the Director.

The procurement request is for Community Action Services, with the contract number currently marked as "TBD". The funding source is marked as "Other" with an estimated aggregate spend of $499K or less. The contract is being submitted for Scope of Work review, and the document indicates this is a direct contract for the upcoming fiscal year. While specific service details are not extensively elaborated, the document suggests this is a renewal or continuation of services related to community action programming. The contractor's Federal Employer Identification Number (FEIN) is 860262631, and the contract is being processed by the DCAD/CAPS division with Teri Ponticello as the division contact.

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Other files

File Type Posted
CTR075550_COI_exp7.1.26.pdf PDF
CTR075550_Contract_Amendment_1.pdf PDF
Exhibit_A_-_Contractor_s_Equipment_List.doc DOC document
Exhibit_I_-_Social_Services_Block_Grant_Report.docx DOCX document
CTR075550_Exhibit_F_Monthly_Navigation_Report.pdf PDF
CTR075550_ISB.pdf PDF
CTR075550_Scope_of_Work_Revised_via_Amendment_2.pdf PDF
CTR075550_-_COI_and_Endorsements.pdf PDF
CTR075550_Contract_Documents.pdf PDF
Exhibit_B_-_Itemized_Service_Budget__ISB_.xlsx XLSX spreadsheet
Exhibit_C_-_Certification_of_De_Minimis.pdf PDF
Exhibit_D_-_Monthly_CAPS_Household_Report.xlsx XLSX spreadsheet
Exhibit_G_-_Monthly_Navigation_Report.xlsx XLSX spreadsheet
Exhibit_J_-_CAA_Executive_Summary_for_A16_Activities.pdf PDF
Exhibit_H_-_Monthly_CCSD_Community_Action_Inquire_Tracking_Sheet.xlsx XLSX spreadsheet
Exhibit_K_-_CAA_Executive_Summary_for_Community_Navigation.pdf PDF
CTR075550_Contract_Amendment_2.pdf PDF
Exhibit_E_-_Monthly_Tribal_Heating_Assistance_Program_Client_Log.docx DOCX document
Exhibit_F_-_SSBG_Post_Expenditure_Data_Report.xlsx XLSX spreadsheet
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Page 1 of 2PUR-1031A FORFF (5-24) ARIZONA DEPARTMENT OF ECONOMIC SECURITY Division of Financial Operations

Office of Procurement

PROCUREMENT ASSISTANCE (PA) REQUEST

1. PROCUREMENT UNIT NAME: 2. PA NUMBER/SUB-NUMBER: 3. REQUEST DATE:

4. DIVISION/ADMINISTRATION/PROGRAM: 5. DIVISION CONTACT PERSON: 6. TELEPHONE NUMBER:

7. TYPE OF REQUEST/AGREEMENT (check all that apply):

Scope of Work Review

Solicitation

CI /SS /NPTQ Review

Amendment

Extension Yrs/Mos

Corrective Action

Assignment

Contract (Competitive Award)

Direct Contract

Intergovernmental Agreement (IGA)

Interagency Service Agreement (ISA)

Memorandum of Understanding (MOU)

Task Order

IT Agreement/EULA

Set-Aside

COOP

Grant Agreement

If Exempt by Statute A.R.S. No.:

Other

8. DETAILED DESCRIPTION OF REQUEST OR NEED:

9. OTHER DOCUMENTS AND INFORMATION:

Certificate of Insurance (COI) Compliant and Included If CI /SS /NPTQ, No.:

Business Associate Agreement/Data Sharing Agreement Central Registry Check/Fingerprinting Sign and Date when Checked

10. FUNDING SOURCE & AMOUNT (check the appropriate boxes):

Federal State Grant Other Estimated aggregate spend $499K or less

Estimated aggregate spend $500K or more

11. DESCRIPTION OF SERVICES OR CONTRACT TITLE: 12. CONTRACT NUMBER:

13. CONTRACTOR NAME/DBA: 14. FEIN NUMBER:

15. CONTRACTOR CONTACT PERSON’S NAME AND TITLE:

16. E-MAIL ADDRESS/TELEPHONE NO.:

17. CONTRACT ORIGINAL START DATE: 18. MAXIMUM END DATE:

19. CONTRACT CURRENT END DATE: 20. AMENDED END DATE:

21. SINGLE AUDIT STATUS:

Contractor/Vendor

Subrecipient N/A

22. LEGAL AD AUTHORIZATION:

FUNCTION CODE: OBJECT CODE: DEPARTMENT OBJECT CODE:

BA SIGNATURE FOR APPROVAL (Legal Ads):

23. AUTHORIZATIONS (Signatures, NO Initials) & DATES:

24. AUTHORIZED DIVISION REQUESTOR: 25. FINANCIAL SERVICES ADMINISTRATION:

26. ATTORNEY GENERAL (IGA, 3rd Party, etc.): 27. PROCUREMENT OFFICER:

28. PROCUREMENT OFFICER COMMENTS:

Team Stacie DCAD 25-113 08/07/2024

DCAD/CAPS Teri Ponticello (520) 705-7318

Submitting SOW for review for the new SFY26 Direct Contract with Northern Arizona Council of Governments (Community Action Services Program)

Community Action Services TBD

Northern Arizona Council of Governments 860262631

Maria Garcia, Director mgarcia@nacog.org

Page 2 of 2PUR-1031A FORFF (5-24) INSTRUCTIONS

1. PROCUREMENT UNIT NAME – enter name of the assigned procurement team.

2. PA NUMBER / SUB-NUMBER – enter the Program-assigned Procurement Assistance (PA) number, and Sub-number number, if applicable.

Examples: After the SOW is finalized, if there are multiple contracts / agreements awarded for the same service; or a solicitation results in multiple awards, the procurement officer adds /1, /2, /3, etc.

3. REQUEST DATE – enter date program contracts officer begins processing.

4. DIVISION / ADMINISTRATION / PROGRAM – enter abbreviations for the division, administration and program submitting the request to OP.

5. DIVISION CONTACT PERSON – enter the name of the program contracts officer associated with this request.

6. TELEPHONE NUMBER – enter the telephone number of the of the contact person.

7. TYPE OF REQUEST / AGREEMENT – Check ALL applicable boxes considering there should be one PA per procurement action from the moment a need has been identified, until the action is completed i.e. solicitation awarded, contract fully executed, assignment completed.

Examples:

a) For a new solicitation, under section seven (7), the following boxes should be checked:

Scope of Work Review Solicitation

b) For new direct contract, under section seven (7), the following boxes should be checked:

Cl /SS /NPTQ Review Scope of Work Review Direct Contract

c) For new task order, under section seven (7), the following boxes should be checked:

Scope of Work Review Task Order

d) For a direct contract amendment which requires SOW revision, under section seven (7), the following boxes should be checked:

Cl /SS /NPTQ Review Scope of Work Review Amendment Direct Contract

e) For an IGA extension, under section seven (7), the following boxes should be checked:

Extension Yrs/Mos Intergovernmental Agreement (IGA)

f) For a contract action against competitively awarded contract, under section seven (7), the following boxes should be checked:

Contract Action Contract (competitive award)

g) For a competitively awarded contract amendment, under section seven (7), the following boxes should be checked:

Amendment Contract (competitive award)

8. DETAILED DESCRIPTION OF REQUEST OR NEED – provide details of the request. Use memo to expand if necessary.

9. OTHER DOCUMENTS & INFORMATION:

Certificate of Insurance (COI) Compliant and Included – Mark that the certificate of insurance is included and compliant, if applicable.

Business Associate Agreement / Data Sharing Agreement – Check if BAA / DSA is required for the request.

If CI / SS / NPTQ, No – If there is an existing limited competition determination, specify the number and provide electronic copy.

Central Registry Check / Fingerprinting – Division’s contracts officer shall sign and date when check has been completed, if applicable.

10. FUNDING SOURCE & AMOUNT – check the appropriate funding source(s) for the request & check if the total value of the Agreement/Contract. Is estimated aggregate spend $499K or less OR $500K or more?

11. DESCRIPTION OF SERVICES OR CONTRACT TITLE – provide service description or title of contract, as defined in the SOW.

12. CONTRACT NUMBER – enter the contract number, if applicable. If multiple contracts, create separate PAs for each contract.

13. CONTRACTOR NAME / DBA – enter the Contractor name and the doing business as (DBA) name, if applicable.

14. FEIN NUMBER – enter the Federal Employer Identification Number of the contractor, if applicable.

15. CONTRACTOR CONTACT PERSON’S NAME AND TITLE – enter the name and title of the contractor’s designated contact person.

16. E-MAIL ADDRESS / TELEPHONE NUMBER – enter the e-mail address and telephone number of the contractor’s designated contact person.

17. CONTRACT ORIGINAL START DATE – enter the first date when services can be rendered against the contract, if applicable.

18. MAXIMUM END DATE – enter the last possible date that service can be rendered against the contract, if applicable.

19. CONTRACT CURRENT END DATE – enter the last date of the current contract term, if applicable.

20. AMENDED END DATE – enter the amended term end date, if applicable.

21. SINGLE AUDIT STATUS – division staff check the appropriate box. Required only for service/taxonomy contracts

22. LEGAL AD AUTHORIZATION – function code, object code, and department object code provide from the Business Administrator (BA) and BA’s signature for funding approval

23. AUTHORIZATIONS & DATES – signatures of authorized individuals from the respective areas & dates of authorized individuals from the respective areas.

24. AUTHORIZED DIVISION REQUESTOR – signatures and dates of authorized individuals from the respective areas.

25. FINANCIAL SERVICES ADMINISTRATOR (IGA, ISA, IT Projects (including agreements, software, hardware, contractors (Non- FTE)), and non IT procurements with an aggregated spend of $500K and more) - signatures and dates of authorized individuals from the respective areas.

26. ATTORNEY GENRAL (IGA, 3rd PARTY, ETC) – signatures and dates of authorized individuals from the respective areas.

27. PROCUREMENT OFFICER – signatures and dates of authorized individuals from the respective areas.

28. PROCUREMENT OFFICER COMMENTS – Complete as needed.

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