CTR076711_Pre_Contract_Documents.pdf

PDF 2 MB Posted Jul 1, 2025

Attached to: Master Agreement AZ|CTR076711
Contract number: CTR076711
Issued by: Arizona

About this file

Written by GovTribe AI · Oct 9, 2025

The document is a Procurement File Memorandum from the Arizona Department of Economic Security (DES), specifically the Division of Aging and Adult Services (ADES/DAAS), regarding a procurement exemption for Area Agencies on Aging (AAA). The document involves the Western Arizona Council of Governments as the contractor, located in Yuma, Arizona. The procurement is being processed by the Arizona Department of Economic Security, with involvement from the State Unit on Aging (SUA) and various regional Area Agencies on Aging.

The contract is for direct services to support older adults, created under the Older Americans Act of 1965. ADES/DAAS is seeking to enter into one-year direct contracts with eight Area Agencies on Aging across the state, set to expire on June 30, 2025, while preparing for a full five-year contract effective July 1, 2025. These contracts are exempt from the Arizona Procurement Code under A.R.S. § 41-2504(Q)(2) and are intended to ensure a continuum of services for clients served by aging programs. The specific contract with Western Arizona Council of Governments (Contract Number CTR076711) will run from July 1, 2025 to June 30, 2025, with federal and state funding, and an estimated aggregate spend of less than $500,000.

View the file

Other files

File	Type	Posted
CTR076711_myCOI_Instructions.pdf	PDF	Jul 1, 2025
CTR076711_Contract_Document.pdf	PDF	Jul 1, 2025
CTR076711__CGL_Auto_SAM_PL_WC_Exp_7_01_2026.pdf	PDF	Jul 1, 2025
CTR076711_Contract_Amendment_1.pdf	PDF	Jul 1, 2025

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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 Nate DAAS25036 05/13/2025

DAAS Matt LeCrone (480) 2632607

AAA Direct Contracts Routing PA for signature

Aging Services AreaAgencies on Aging CTR076711

Western Arizona Counci of Government

Gina Whittington, Human Services Director ginaw@wacog.com

07/01/2025 06/30/2025

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.

�� !"�#��"!�"$�� %&�%&'(� ��)��$ )� *�%(%��&� (%��%��%&�%&'(� +�"!��,$-��.�"�/��.�"�/��$-��"0�� 1�"�2� $ (%&�%��(&�%&�%&'(�� 3 ��4�5� ��+�� 0��6%��%��17"$ )� �3� ��8�(��9��6�.��"��:�4 ��1�(6:� ��6%��%��1+"�0$�8�+�-��8�;.��!<%%$2��9*�0%!"�0$�8/!�-��8=�>�� $�� ;.��!<%%$2��9*�0%��"!�"$�� %��"!�"$�� /�� $��=

?@A@BAC�DEFD?�GH GIJKLMN�OLIPLINQJLM�OLRRJSSJLM

TQQPSF@@UVLIPWNKVVWXLY@Z[SJMUSS\UNIVT@Z[SJMUSS]M̂L_UMQJQ̀a[RbUIcEEdBeffE D@f

��		�� !��"��#��$��%&��'�(
)�� �+�+�� ,�#�+��&��%&(�'	�
��'&�-�'	��

'�. ��/��!��//� 0� �#$�,��1/��2��3�//��"��#��$��%&��'�( )�� *�+*�+�� ,*�#*�+��2��45��.�-�( 1��3��1�� +��,��1��0!��"��#$,+��!'�&��'�( &�) ��3&66'(�� 7'.��&�� +��5��1��"��#��,,�/&�5&8��'�(

�$�+�39��, �� !��"��#��$�� %& ,*�#*�+��5��&�)�5'<��)��

;=**&8��96'�*;��&�)4;'<��)��>��'(

;=**&8��96'�*�'�;'�& �'(4�'(

?@A@BAC�DEFD?�GH GIJKLMN�OLIPLINQJLM�OLRRJSSJLM

TQQPSF@@UVLIPWNKVVWXLY@Z[SJMUSS\UNIVT@Z[SJMUSS]M̂L_UMQJQ̀a[RbUIcEEdBeffE B@f

()*)+*,�-./-(�01 0234567�8529527:356�85;;3<<356

=::9</))>?529@74??@A5B)CD<36><<E>72?=)CD<36><<F6G5H>6:3:IJD;K>2L..M+NOO. O)O

�� !"#$%&'$�()*+!,�-)$#".$/�0123456785�9:;<2=�>:543?5@��'.%.%)$08?6?6:5��A��B�� C��D��E�� F�� G��HI�JK�LMNOPQN�RLM�IKOJST�QUVN�VJSVWVSORP�KL�MJQVQX�YVI�VQ�VN�RJ�MJQVQX�NMRLZU[�VN�JKQ�ZOLLMJQPX�M\ZPOSMS]�̂LVJQ�QUVN�_M̀�aRbM�IKL�XKOLSKZOcMJQRQVKJd� ��D� ��d� ��efgfhihg�jkjgkjj�lm��dn��o�G�p�� d�� gfqfhihg�jikijkii�Dm��dnB��d�

D��

��r��d� ��s��t��u��vefgfhg��jikjg�Dm o�G�d� ��B��

�� kff�� fd� ��B��

� � jfj

�� !"#��$�%$& %�' (&�)�*+,-�$#�.("�/01��2&#$!-$& %�3-$-4567�89:;<=>?@A�BCD�BEBF/GH-I-!"��, !$&%2�&#�(&J�� %�/01K2 J4567�89:;<=>?@L�MD�BEBF NOO�PQQ�PQORST UVWX YXZ[\] Ẑ_Z�̀Zab Ẑ_Z�YX[cd\Xe UXfg hXijXe_e kV_dld\Z_dVae mV[begZ\X Ydna�oj_p !��3-$-qrstuvss�wuxyz{|}tyu~u}t}��vs�tu|u�t|��wuxyz{|}tyu�ytu}s�yx��yu}|�}�ssvz}tyus�v�s�|u��vz}s �%$&$)��2&#$!-$& %p !��3-$-

�� ¡�¢�¢ ��¢ £�¤¥¦§¥¥̈¦©�ª��«�¬ ��®��̄�°�«�¢� ± �¬² ³́�µ̄ °�¶��·�§ª§̧¹��̧��§¹� ��̧

��	�
��	��
��	�� ! "#$%&'(%)*�+'(,

-./01�//�0123 456031 789:8;<�=;>?@<=�A@B<A>C�@DE@F8;<G8<:9 HIJKJL�MINOPQRJKOIS!�TU��V!��W�XYZ[\][[̂\_̀abc�dVefc�dVaghia j� �klm�knkopqW��r��ss��tuvw�9�;xyz{yz�Ax{|x}�~;��=}��z{��wv�w�u�v��B{�|xy�9|�|x� ��r�!��ss��tuvw�9�;xyz{yz�Ax{|x}�~;��=}��z{��wv�w�u�v��B{�|xy�9|�|x�pU�� !Dxyx}��=��|�{�x�=��}y��@{�� cU��!�� s

¤¥¥¦§��§̈© ¡¢£�ª«¥¬¥¬ª§�£¬ª�® °̄±̄ ²̄°³�́��µ¢¶ª·̈ ¥̧̈ §¥̈¥¹§º�µ¥¬£ª»ª©¶¼ª½¾̈¿¹ªº�À��Á�±́±ÂÃ��Â��±Ã� ��Â

�� !��" #�� $� #% ��&��" �� '(�)*��+� ,��&�� -*�� ))��"��)� !�� )��./0/ �� 1232 4405/6/7 ��"�� 8�"��9 8*�"�� ))�*��:�9�� " ;��&��)� )� $1232 40<5/=/%2 ;�� "��&9��" �� #2 >� �� ?� �&��"��2��+ �� "��&9�� )�� !�� 9��:9� �!��"2 #�� )��+� �� # "�� &��"�" �� -*��2@AB @CADEF AGHFIDJKAHJIL MNOCLHJHP HPQC@

R��

S*��

�TUVWXYZ ?�3TUVWXYZR�+��

[��TUVWXYZ R�+��

[*�:��TUVWXYZ,��9

R��)�A\]̂_XW

̀a ��b,�*��

��

>�)��&��TUVWXYZc

TUVWXYZd!�� , e' 3��9

S*��

[��Jffgh]Wig

IjXg\ TUVWXYZ TUVWXYZF]klgmi

ngogV

IjXg\ TUVWXYZ TUVWXYZ

Dgk]mi\Wi]_X

pWigmCXi]iq

pWigm )��+��

R��rWX

stc

s̀su�*:��

R��rWX

sac

s̀su >��9

��

R��BWq

svc

s̀ v̀

'��

��

R��rwV

xtax 8��)�9

y��

'�"

,9��

R��rwX

z̀

{ |}~��N �� N�~�~��O ��ON�O�~��N ��|~�� ~� �N ��O��|�N� �� }�� ON|�� NO}�~O�

�� ! �"#$%&'(%')�*')+),��-�.� �!��#/01�"#$%&'(%')2�34�� 5610'789�:;��<;��3��=;��3�> 5610'78

?@A�@BCA@�@D�A��EFGHI�JFG�KGLMNJKOPJQN�RGSN�T�EGKJNU�MV�SKGNGPJU�WPXGK�YZR�[\]\̂\_̀aK�YZR�[\]\̂b_̂�Ja�XGJGKcMPG�MV�JFG�GPJMJd�MN�OP�efZ_HGKJMVMGXghfiaPG�NcOjj�kWNMPGNN�HaPHGKP]�ZXXMJMaPOj�NcOjj�kWNMPGNNMPVaKcOJMaP�cOd�kG�VaWPX�MP�JFG�efZQN�ldPOcMH�ecOjj�fWNMPGNNeGOKHF�MV�JFG�GPJMJd�HacSjGJGX�JFG�efZ�NWSSjGcGPJOj�SOLGN�XWKMPLKGLMNJKOJMaP]m@n�o�D��p�� ! ��#/01�"#$%&'(%')q��#r'),q��+),spt�o�m@n�o�D��p�C�p�p��#r'/+1�#u�"#$%&'(%')vw0,(%')v xyzy{z|�}}~�}��

��~yy��y��y��y��xy�� ¡�¢��}£zx{}x¤}��¥¦zz{{¥}��¦z £y¥

�� !�"#$%&'�#(�)#%&*)&+,-./0123.�45632-66

7889:;<�=>9?@;�=A>?�BACD9E;<F-6 G9H;�IJHK98;�LM�NO<9;�%1

PQRSTQU�PVRWX�VY�ZVWXT[X\]̂_̀�abcd̂bef\d]ghbì7??>9<<jklm�'n�o-p12p1�)-2/-0�q03r-F5stu�*03v12t�wmlxmykzl{|23/-p�'/t/-6

��	��	��	��	�� !"#"$$%&&'())*+,-	./	0�1��1�	230/	40/5��67	8�
9��6	:-,;-<�
��1	.�6��=��>	��	��	��	�� !"#"$$%&&'())*+,-	./	0�1��1�	2��	4�
��5��67	8�
9��6	:-,;-?+@,A<�
��1	.�6��	��	��	��BC$"	D CEEC$FEG$

HIJIKJL MMNOM PQ RPQSTUV

WXXYZNIIZ[\STUVI]̂X_X_]ZIV_]̀ IabcdbbecfPgHIhUi]j[X[kZX[XlZmPhX_V]n]\io]pq[rl]mMsJHKMHtMdgduvJJKKuMOdvJ HIu

��	��	��
� �!��"	��#��$�%�&�'(��)+,-.�)/+01�/2�3/01-41567�89:;<=<>>
��	��	��
� �!��"	��#��$�(��?@1A*0-1A�)/+01�/2�3/01-41BC><�D:CEEC>FEG>
��	��	��
� �!��"	��#��$�(��

HIJIKJL�MMNOM�PQ RPQSTUV

WXXYZNIIZ[\STUVI]̂X_X_]ZIV_]̀ IabcdbbecfPgHIhUi]j[X[kZX[XlZmPhX_V]n]\io]pq[rl]mMsJHKMHtMdgduvJJKKuMOdvJ dIu

�� !��"#�$�%�&&�'��()"*"+ "�,��" !( �"&��*"$� ��-.��/��01�� '23�45!�!6"'7�'323�48$+'� 23�49�$"�:+$�'"$ -;<�=��"$& ��>�5 ":$�4+0(�:�*�0()" �$�0�"7�?+�+�5 "@$""7�&��>�A'>�$&+��'��0��00" ��*��(

B��;C��D��E�=�F"*6%�"0G�H'��(�!�+�� @"7"$+*�!"$4�0"�?" GHI�"$'+*�)" ��$0" %�'�+0�JKLM�LM�N�OPQP�RSTSUNV�QSUWLXSM�YZ[LTLM\UN\L]T�̂SZSUNV�R]WSUT[ST\�X][_̀\SU�MaM\S[�\KN\�LM�bcde�dccfgfhi�jkl�dminob�JKLM�MaM\S[�LMM̀pqSX\�\]�[]TL\]ULTrP�sTZLWLZ̀NVM�t]̀TZ�_SUt]U[LTr�̀TǸ\K]ULuSZ�NX\LWL\LSM�NUS�M̀pqSX\�\]�ZLMXL_VLTNUa�NX\L]T�LTXV̀ZLTr�XUL[LTNV_U]MSX̀\L]TPJKLM�MaM\S[�X]T\NLTM�v]T\U]VVSZ�OTXVNMMLtLSZ�sTt]U[N\L]T�wvOsxP�YVV�LTZLWLZ̀NVM�WLSyLTrz�US_U]Z̀XLTr�]U�ZLM_]MLTr�]t�\KLM�LTt]U[N\L]T�NUSUS{̀LUSZ�\]�_U]\SX\�L\�LT�NXX]UZNTXS�yL\K�|}�v̂~��NU\�}��}�NTZ�RQY��UZSU�vs��}��|P}�vOs��]VLXaP

())*+��+,-$%&'�./)0)0.+�'0.1�234533647!8��9&:.;,),<+),)=+>!9)0'.?.-:@.AB,C=.>�D��E�585FG��F� 5G� F�F

��	��	�
	��

��	��
		��

�#�$%&'�()*+,%&-./012'�013�450/1/16�()2%&-./012'*+7'8055'3�013�9:;-'13'3�</5&;�()2%&-./012')3'8055'3=013=;:;-'13'3=>/5&;*?@ABCC@D�BED�FGHI@ED@D�JKCLH�� MN�OPNQRSNMTUP�VRO�WXMSYXMSMSZ�X�UMNY�RV�VMOWN�Y[XY�XOP�N\NQPS]P]�RO�]PTXOOP]�VORW�]RMSZT\NMSPNN�̂MY[�Y[P��YXYP�RV��OM_RSX�� àbac�defghecicja�kllmgc�nopq

�rsrts��t"st�� PTXOOP]�XS]��\NQPS]P]��MOWN�u��YXYP��ORv\OPWPSY� VVMvP

[YYQN"rrNQRMSYOX�X_�ZRwrvRWQUMXSvPr]PTXOOP]xXS]xN\NQPS]P]xVMOWN �rt

File details come from the government source that posted it. Updated Oct 9, 2025.