CTR076674 RWPB HIV Care Services Amendment No. 2.pdf
PDF 249 KB Posted
- Attached to
- Master Agreement AZ|CTR076674
- Contract number
- CTR076674
- Issued by
- Arizona
About this file
This document is an Intergovernmental Agreement (IGA) Amendment between the Arizona Department of Health Services (ADHS) and the Maricopa County Department of Public Health. The amendment involves the Ryan White Part A Program for HIV Care Services and primarily addresses a clerical error in the contract number, changing it from CTR061304 to CTR076674. The document is signed by representatives from Maricopa County, including Thomas Galvin (Chairman of the Board of Supervisors), and authorized by the Arizona Attorney General's office.
The amendment pertains to HIV Care Services and appears to be a continuation of an existing agreement with no substantive changes to the original contract terms. The document includes standard government contract provisions, such as legal review under Arizona Revised Statutes and cautions about commencing work before full execution. The contract involves local government entities and is focused on public health services, specifically HIV care programming. No specific financial amounts or detailed service descriptions are provided in this amendment document.
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Text version
INTERGOVERNMENTAL AGREEMENT (IGA)
Amendment
ARIZONA DEPARTMENT OF
HEALTH SERVICES
OFFICE OF PROCUREMENT
150 N. 18th Ave., Suite 530 Phoenix, Arizona 85007
Contract No.: CTR076674 IGA Amendment No: Procurement Officer:
Ryan Garcia
HIV Care Services
It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
1. Pursuant to Terms and Conditions, Provision Six (6) Contract Changes, subsection 6.1 Amendments, the Contract is hereby revised with the following:
1.1. The Contract number is changed from CTR061304 to CTR076674 due to a clerical error in APP.
All other provisions of this agreement remain unchanged.
Maricopa County Department of Public Health - Ryan White Part A Program Contractor Name: County Authorized Signature
4041 North Central Avenue
Address: Print Name
Phoenix AZ 85012 City State Zip Title and Date
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has determined that this Intergovernmental Agreement is in proper form and is within the powers and authority granted under the laws of Arizona
This Intergovernmental Agreement Amendment shall be effective the date indicated. The Public Agency is hereby cautioned not to commence any billable work or provide any material, service or construction under this IGA until the IGA has been executed by an authorized ADHS signatory.
State of Arizona
Signature Date Signed this day of 2025.
Print Name Procurement Officer
Contract No.: CTR076674, which is an Agreement between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney, who has determined that it is in proper form and is within the powers and authority granted under the laws of the State of Arizona.
Signature Date
Assistant Attorney General Print Name
Revised 5.16.24 Page 1 of 1
Alice Perepech Digitally signed by Alice Perepech DN: cn=Alice Perepech, o=Arizona Attorney General's Office, email=Alice.Perepech@azag.gov, c=US Date: 2025.06.19 10:49:59 -07'00'
Shawna R RogersBaile y
Digitally signed by Shawna R RogersBailey Date: 2025.06.26 11:39:17 -07'00'
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MARICOPA, COUNTY OF
Unique Entity ID
Q2L6HLGFFNV3
CAGE / NCAGE
4KXB9
Purpose of Registration
All Awards
Registration Status
Active Registration
Expiration Date
Jun 17, 2026
Physical Address
43814 N New River RD
Phoenix, Arizona 85087-8617
United States
Mailing Address
41018 N Daisy Mountain DR
Phoenix, Arizona 85086
United States
Business Information
Doing Business as
(blank)
Division Name
Daisy Mountain Fire District
Division Number
(blank)
Congressional District
Arizona 08
State / Country of Incorporation
(blank) / (blank)
URL
www.daisymountainfire.org
Registration Dates
Activation Date
Jun 19, 2025
Submission Date
Jun 17, 2025
Initial Registration Date
Oct 30, 2006
Entity Dates
Entity Start Date
Jan 12, 1989
Fiscal Year End Close Date
Jun 30
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
U.S. Government Entity
Entity Type
US Local Government
Organization Factors
(blank)
Profit Structure
(blank)
Last updated by Tiffany Marik on Jun 17, 2025 at 05:31 PM MARICOPA, COUNTY OF
Jun 26, 2025 08:15:16 PM GMT https://sam.gov/entity/Q2L6HLGFFNV3/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
U.S. Local Government
County
Local Government Owned
Financial Information
Accepts Credit Card Payments
Yes
Debt Subject To Offset
No
EFT Indicator
CAGE Code
4KXB9
Points of Contact
Electronic Business
Tiffany Marik 41018 N. Daisy Mountain DR
Phoenix, Arizona 85086
United States
LAUREN BUZBEE 41018 N. Daisy Mountain DR
Phoenix, Arizona 85086
United States
Government Business
BRIAN TOBIN, CHIEF
41018 N. Daisy Mountain DR
Phoenix, Arizona 85086
United States
TIFFANY MARIK 41018 N. Daisy Mountain DR
Phoenix, Arizona 85086
United States
Service Classifications
NAICS Codes
Primary
Yes
NAICS Codes
922160
NAICS Title
Fire Protection
115310 Support Activities For Forestry
621910 Ambulance Services
922190 Other Justice, Public Order, And Safety Activities
Disaster Response
This entity does not appear in the disaster response registry.
Last updated by Tiffany Marik on Jun 17, 2025 at 05:31 PM MARICOPA, COUNTY OF
Jun 26, 2025 08:15:16 PM GMT https://sam.gov/entity/Q2L6HLGFFNV3/coreData?status=null Page 2 of 2
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