CTR075669_Pre-Contract_Documents.pdf

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 Gina DAAS-25-051 01/28/2025

DAAS/APS Nate Hudson (602) 815-0055

Emergent Cleaning Services new direct contract with Mon-Ami Cleaning Services (IV0000079967)

CI24010

Emergent Cleaning Services

Mon-Ami Cleaning Services IV0000079967

Miriam Lopez miriamlopez081976@gmail.com // 928-446-5617

12/31/2025

12/31/2025

2/16/24, 11:13 AM State of Arizona Mail - Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=0fd4f98358&view=pt&search=all&permthid=thread-f:1791080121380745322%7Cmsg-f:1791080121380745322&… 1/3

Myla Eldredge <meldredge@azdes.gov>

Significant Procurement Notification Form 1 message

Google Forms <forms-receipts-noreply@google.com> Fri, Feb 16, 2024 at 11:11 AM To: meldredge@azdes.gov

Thanks for filling out Significant Procurement Notification Form Here's what was received.

Edit response

Significant Procurement Notification Form The following information is required to be provided to the State Procurement Administrator by all state governmental units (SGU; agencies, boards, and commissions) as per Standard Procedure 003 - Significant Procurement Role (SP 003 link).

Notes about this Google Form to provide notification of a SPR:

• You will receive a copy of your response via email

• You may edit your response after it is submitted in two ways. To ensure there's no duplication of efforts, please do one of the following:

1) Once you submit the form, you may click on "Edit you response" in the same browser; or

2) If some time has passed and it's necessary to make edits, please check your email for the original submission as it will have an "Edit response" link. If you don’t remember when you originally submitted your SPR notification, you may check the date and time on the spreadsheet via https://spo.az.gov/contracts/significant-procurement-roles and match it to the email.

• If your entry needs to be deleted, email SPOCompliance@azdoa.gov to provide an explanation for the deletion. If accepted, SPO Compliance will delete the entry.

Please contact the State Procurement Office (SPO) at SPOCompliance@azdoa.gov for any questions.

Email * https://docs.google.com/forms/d/e/1FAIpQLSdxSzWnNvO30KUubljXrDSub3gfqJ1GX15weZF0kbYkDUx3Qw/viewform?usp=mail_form_link https://docs.google.com/forms/d/e/1FAIpQLSdxSzWnNvO30KUubljXrDSub3gfqJ1GX15weZF0kbYkDUx3Qw/viewform?edit2=2_ABaOnueM2pnD4U0SkvH6IPLEeoOlPvXZ5SB2tzO8MRi2cueg40IQnM4tyBnrzeP2jki418g https://spointra.az.gov/resources/standard-procedures https://spo.az.gov/contracts/significant-procurement-roles https://spo.az.gov/contracts/significant-procurement-roles mailto:SPOCompliance@azdoa.gov mailto:SPOCompliance@azdoa.gov https://mail.google.com/mail/u/0/?ik=0fd4f98358&view=pt&search=all&permthid=thread-f:1791080121380745322%7Cmsg-f:1791080121380745322&… 2/3 meldredge@azdes.gov

What is the name of the person leading the procurement? *

Myla Eldredge

Which agency is the procurement for? If it is a mandatory statewide contract, select your agency. *

Economic Security, Department of

What is the title of the procurement? *

Emergent Services - Adult Protective Services

What is the procurement type? *

RFQ - Request for Quotation

IFB - Invitation for Bid

RFP - Request for Proposal

✓ CI - Competition Impracticable (SPO Form 101)

Emergency Procurement (SPO Form 102)

SS - Sole Source (SPO Form 103)

NPTQ - Not Practical to Quote (Determination Template D301(4))

Other:

mailto:meldredge@azdes.gov https://mail.google.com/mail/u/0/?ik=0fd4f98358&view=pt&search=all&permthid=thread-f:1791080121380745322%7Cmsg-f:1791080121380745322&… 3/3

What is the date when the first procurement disclosure statement (PDS) was signed (i.e. SPO Form 120 or SPO Form 130)? *

MM

02 /

DD

13 /

YYYY

What is the actual date or estimated date that the purchased materials will be delivered or the purchase of services or construction will begin, per A.R.S. § 41- 753(D)? *

MM

03 /

DD

01 /

YYYY

What is your name (if different from above)?

What is your e-mail address (if different from above)?

Create your own Google Form Report Abuse

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ENTITY INFORMATION

Search Date and Time: 8/22/2025 11:18:02 AM

Entity Details

Entity Name: MON AMI CLEANING SERVICES AZ

LLC

Entity ID: 23673390

Entity Type: Domestic LLC Entity Status: Active

Formation Date: 4/25/2024 Reason for Status: In Good Standing

Approval Date: 4/25/2024 Status Date: 4/25/2024

Original Incorporation

Date:

4/25/2024 Life Period: Perpetual

Business Type: Other - Janitorial services

Last Annual Report

Filed:

Domicile State: Arizona Annual Report Due

Date:

Years Due:

Original Publish Date:

Statutory Agent Information

Name: Miriam Guevara Appointed Status: Active 4/25/2024

Attention:

Address: 10320 S Typhoon Ave, YUMA, AZ 85365, USA

Agent Last Updated: 4/25/2024 E-mail:

Attention: Mailing Address: 10320 S Typhoon Ave, YUMA, AZ 85365, USAPrivacy Policy (http://azcc.gov/privacy-policy) ǀ Contact Us (http://azcc.gov/corporations/corporation-contacts)

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Page 1 of 1, records 1 to 1 of 1

Title Name Attention Address Date of Taking

Office

Last

Updated

Member Miriam Guevara

10320 S Typhoon Ave, YUMA, AZ, 85365, Yuma County, USA

4/25/2024

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County: Yuma

Principal Information

Address

Attention: Address: 10320 S Typhoon Ave, YUMA, AZ, 85365, USA

County: Yuma Last Updated:

4/25/2024

Entity Principal Office Address

Attention: Address: County: Last Updated:

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Debarred and Suspended Firms

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Debarred and Suspended Firms SPO is responsible for maintaining a list of firms that are suspended or debarred from doing business with the State of Arizona.

THERE ARE NO SUSPENDED OR DEBARRED FIRMS AT THIS TIME.

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