CTR078890_Pre-Contract_Documents.pdf

PDF 12 MB Posted Oct 23, 2025

Attached to: AZ|CTR078890
Contract number: CTR078890
Issued by: Arizona

About this file

Written by GovTribe AI · Oct 28, 2025

The documents represent a procurement assistance (PA) request from the Arizona Department of Economic Security (ADES), specifically the Division of Aging and Adult Services (DAAS), for a direct contract with Catholic Community Services of Southern Arizona to support the Refugee Program-Case Coordination. The procurement involves a Competition Impracticable (CI) authorization for local resettlement agencies in Maricopa and Pima Counties, with multiple procurement disclosure statements completed by key personnel involved in the process.

The contract is for a Refugee Program-Case Coordination service with an estimated aggregate spend of $8 million, covering the period from 10/01/2025 to 09/30/2027. The primary objective is to provide critical stop-gap support for eligible refugee beneficiaries, including case management, emergency support, and services to help refugees achieve self-sufficiency and family stability. The contract is 100% federally funded and will support approximately 9,454 ORR-eligible beneficiaries, with the program experiencing significant changes in refugee support infrastructure that necessitate this targeted procurement approach. The contract will be issued through a direct contract mechanism, with Catholic Community Services of Southern Arizona as the selected contractor.

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Other files

File	Type	Posted
CI26003_Determination.pdf	PDF	Oct 23, 2025
myCOI_Instructions.pdf	PDF	Oct 23, 2025
CTR078890_Contract_Documents.pdf	PDF	Oct 23, 2025

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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:

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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File details come from the government source that posted it. Updated Oct 28, 2025.