CTR078872_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 Stacie DCAD-26-084 09/25/2025

DCAD/DV Teri Ponticello (520) 705-7318

Submitting Direct Contract/SOW for Arizona Foundation for Legal Services - Civil Legal Aid - Statewide for Domestic Violence.

Finance is working to pull Function Code, Object Code, and Department Object Code. This is a rush (Legislative funding)

SS26001

ivil Legal Aid - Statewide TBD

Arizona Foundation for Legal Services & Education 95-3351710

Kevin Ruegg, Chief Executive Officer kevin.ruegg@azflse.com

10/01/2025 09/25/2025

06/30/2026

Legislative funding S.B.1735

Miranda Riojas <mriojas@azdes.gov>

Significant Procurement Notification Form 1 message

Google Forms <forms-receipts-noreply@google.com> Fri, Aug 22, 2025 at 4:09 PM To: mriojas@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 * mriojas@azdes.gov

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

Miranda Riojas

8/25/25, 3:18 PM State of Arizona Mail - Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=d833d0f541&view=pt&search=all&permthid=thread-f:1841198966780654394%7Cmsg-f:1841198966780654394&… 1/3 https://docs.google.com/forms/d/e/1FAIpQLSdxSzWnNvO30KUubljXrDSub3gfqJ1GX15weZF0kbYkDUx3Qw/viewform?usp=mail_form_link https://docs.google.com/forms/d/e/1FAIpQLSdxSzWnNvO30KUubljXrDSub3gfqJ1GX15weZF0kbYkDUx3Qw/viewform?edit2=2_ABaOnud9ojMREdJD3K4HwDEkzfCtlALv47e5zGaARNPNyrmzRKzTE9C0typWLfVCjnUJ8NY 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 mailto:mriojas@azdes.gov

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? *

Civil Legal Assistance - Statewide

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 Practicable to Quote (Determination Template D301(4))

Other:

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

MM

08 /

DD

12 /

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

09 /

DD

26 /

YYYY

What is your name (if different from above)?

8/25/25, 3:18 PM State of Arizona Mail - Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=d833d0f541&view=pt&search=all&permthid=thread-f:1841198966780654394%7Cmsg-f:1841198966780654394&… 2/3

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

Create your own Google Form Does this form look suspicious? Report

NOTICE: This e-mail (and any attachments) may contain PRIVILEGED OR CONFIDENTIAL information and is intended only for the use of the specific individual(s) to whom it is addressed. It may contain information that is privileged and confidential under state and federal law. This information may be used or disclosed only in accordance with law, and you may be subject to penalties under law for improper use or further disclosure of the information in this e-mail and its attachments. If you have received this e-mail in error, please immediately notify the person named above by reply e-mail, and then delete the original e-mail. Thank you.

8/25/25, 3:18 PM State of Arizona Mail - Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=d833d0f541&view=pt&search=all&permthid=thread-f:1841198966780654394%7Cmsg-f:1841198966780654394&… 3/3 https://docs.google.com/forms?usp=mail_form_link http://null/

ARIZONA FOUNDATION FOR LEGAL SERVICES &

EDUCATION

Unique Entity ID

CG4XQZ5LK6B8

CAGE / NCAGE

488A7

Purpose of Registration

All Awards

Registration Status

Active Registration

Expiration Date

Nov 14, 2025

Physical Address

4201 N 24TH ST STE 210

Phoenix, Arizona 85016-6295

United States

Mailing Address

4201 N. 24TH STREET, STE. 210

Phoenix, Arizona 85016-6295

United States

Business Information

Doing Business as

(blank)

Division Name

(blank)

Division Number

(blank)

Congressional District

Arizona 01

State / Country of Incorporation

Arizona / United States

URL

http://www.azbf.org

Registration Dates

Activation Date

Nov 20, 2024

Submission Date

Nov 14, 2024

Initial Registration Date

Dec 1, 2005

Entity Dates

Entity Start Date

Sep 26, 1978

Fiscal Year End Close Date

Dec 31

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

Corporate Entity (Tax Exempt)

Entity Type

Business or Organization

Organization Factors

(blank)

Last updated by Lara Slifko on Nov 14, 2024 at 04:20 PM ARIZONA FOUNDATION FOR LEGAL SERVICES & EDUCATION

Oct 03, 2025 04:18:46 PM GMT https://sam.gov/entity/CG4XQZ5LK6B8/coreData?status=null Page 1 of 2

Profit Structure

Non-Profit Organization

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.

Other Entity Qualifiers

Foundation

Financial Information

Accepts Credit Card Payments

Yes

Debt Subject To Offset

No

EFT Indicator

CAGE Code

488A7

Points of Contact

Electronic Business

Kevin S Ruegg, Executive Director/CEO

4201 N. 24TH STREET, STE. 210

Phoenix, Arizona 85016

United States

Government Business

Kevin Ruegg

4201 N. 24TH STREET, STE. 210

Phoenix, Arizona 85016

United States

Past Performance

Christine L Groninger, CSO

4201 N 24TH ST, STE 210

Phoenix, Arizona 85016

United States

Service Classifications

NAICS Codes

Primary

Yes

NAICS Codes

813211

NAICS Title

Grantmaking Foundations

Disaster Response

This entity does not appear in the disaster response registry.

Last updated by Lara Slifko on Nov 14, 2024 at 04:20 PM ARIZONA FOUNDATION FOR LEGAL SERVICES & EDUCATION

Oct 03, 2025 04:18:46 PM GMT https://sam.gov/entity/CG4XQZ5LK6B8/coreData?status=null Page 2 of 2

Visit our tips page to learn how to best use the Exclusions Database. If you experience technical difficulties, please email the webmaster at webmaster@oig.hhs.gov.

Exclusions Search Results: Exclusions Search Results: EntitiesEntities

No Results were found for

ARIZONA FOUNDATION FOR LEGAL SERVICES & EDUCATION

If no results are found, this individual or entity (if it is an entity search) is not currently excluded. Print this Web page for your documentation

Search Again

Search conducted 10/3/2025 12:16:46 PM EST on OIG LEIE Exclusions database.

Source data updated on 9/10/2025 9:01:00 AM EST

Return to Search

An official website of the United States government. Here's how you know >

10/3/25, 9:16 AM OIG Search Results https://exclusions.oig.hhs.gov/SearchResults.aspx 1/1 https://oig.hhs.gov/exclusions/exclusions-help.asp#generalSearch mailto:webmaster@oig.hhs.gov https://oig.hhs.gov/exclusions/exclusions-help.asp#entitySearch https://oig.hhs.gov/exclusions/exclusions-help.asp#entitySearch javascript:__doPostBack('ctl00$cpExclusions$lbGridBackToSearch','') javascript:__doPostBack('ctl00$cpExclusions$lbBackToSearch','') https://oig.hhs.gov/notices/official-site.asp

Debarred and Suspended Firms

Home / For Agencies / Compliance / Debarred and Suspended Firms

For Agencies

▶Arizona Procurement Portal

▶Trainings

▼Compliance

Agency Procurement Authority

Control Self-Assessment

Procurement Compliance Reviews

Debarred and Suspended Firms

Compliance Hotline

▶Resources and Documents

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.

10/3/25, 9:14 AM Debarred and Suspended Firms | State Procurement Office https://spo.az.gov/for-agencies/compliance/debarred-and-suspended-firms 1/1 https://spo.az.gov/ https://spo.az.gov/ https://spo.az.gov/for-agencies https://spo.az.gov/for-agencies/compliance https://spo.az.gov/for-agencies/arizona-procurement-portal https://spo.az.gov/agency-training https://spo.az.gov/for-agencies/compliance https://spo.az.gov/for-agencies/compliance/agency-procurement-authority https://spo.az.gov/for-agencies/compliance/control-self-assessment-csa https://spo.az.gov/for-agencies/compliance/procurement-compliance-reviews-pcr https://spo.az.gov/for-agencies/compliance/debarred-and-suspended-firms https://spo.az.gov/compliance-hotline https://spo.az.gov/for-agencies/resources

Statements

Statements

Statements