CTR079509__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-26-120 11/07/2025

ADES/DCAD/HML Teri Ponticello (520) 705-7318

Submitting Direct Contract for Tempe Community Action Agency - Homeless Youth and Family Services (Emergency Shelter/RRH)

CI2008

TP checked 12/01/25

Homeless Youth and Family Services TBD

Tempe Community Action Agency 86-0254820

Phillip Scharf, Chief Executive Officer phillips@tempeaction.org / 480.422.8922 ext. 5883

06/30/2026

Arizona S.B.1735

Stacie Dearinure <sdearinure@azdes.gov>

Significant Procurement Notification Form 1 message

Google Forms <forms-receipts-noreply@google.com> Mon, Sep 22, 2025 at 3:31 PM To: frubio@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 *

10/17/25, 9:40 PM State of Arizona Mail - Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=5bda0cdb29&view=pt&search=all&permthid=thread-f:1844005057106763975&simpl=msg-f:1844005057106763975 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_ABaOnufqlFmMlVjQ9kGRhVM083DzC11ZNU0M9FGZ-pnObw8o5V8KnSBi4XoZa80d4vE0-Ds 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 frubio@azdes.gov

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

Frances Rubio

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? *

Homeless Youth and Families Eviction Prevention, Emergency Shelter and Rapid Rehousing

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:

10/17/25, 9:40 PM State of Arizona Mail - Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=5bda0cdb29&view=pt&search=all&permthid=thread-f:1844005057106763975&simpl=msg-f:1844005057106763975 2/3 mailto:frubio@azdes.gov

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

MM

09 /

DD

04 /

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

10 /

DD

15 /

YYYY

What is your name (if different from above)?

Stacie Dearinure

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

sdearinure@azdes.gov

Create your own Google Form

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.

10/17/25, 9:40 PM State of Arizona Mail - Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=5bda0cdb29&view=pt&search=all&permthid=thread-f:1844005057106763975&simpl=msg-f:1844005057106763975 3/3 mailto:sdearinure@azdes.gov https://docs.google.com/forms?usp=mail_form_link

CI2008

An official website of the United States government Here’s how you know

Revolutionary FAR Overhaul Impacts to SAM.gov Show Details Aug 15, 2025

Records Retention Policy Impacts Old SAM Registration Data Show Details May 21, 2025

See All Alerts

Home Search Data Bank Data Services Help

Exclusions

Entity Registration

Active Exclusions

Responsibility / Qualification

Exclusions

Active Registration

Expiration Date

TEMPE COMMUNITY ACTION

AGENCY INC

Entity Information

Unique Entity ID

KVHUJMNWSUJ9

CAGE/NCAGE

6JP98 Mar 31, 2026

Physical Address

1208 E Broadway RD STE 111 Tempe, Arizona 85282-1513, United States

Mailing Address 1208 E. Broadway Suite 111 Tempe, Arizona 85282, United States

Purpose of Registration All Awards

Version

Current Record

12/4/25, 1:55 PM SAM.gov https://sam.gov/entities/view/KVHUJMNWSUJ9/exclusionInfo?status=Active&emrKeyValue=1303758~1743426283030548 1/3 https://sam.gov/ https://sam.gov/ javascript:void(0) javascript:void(0) https://sam.gov/ https://sam.gov/search/ https://sam.gov/reports/awards/standard https://sam.gov/data-services https://sam.gov/help https://sam.gov/workspace/profile/feeds https://sam.gov/workspace/profile/feeds/notification https://sam.gov/workspace/profile/workspace javascript:void(0) javascript:void(0);

javascript:void(0);

javascript:void(0);

javascript:void(0);

EXCLUSIONS

Active Exclusions There are no active exclusion records associated to this entity by its Unique Entity ID.

There may be instances when an individual or firm has the same or similar name as your search criteria, but is actually a different party. Therefore, it is important that you verify a potential match with the excluding agency identified in the exclusion's details. To confirm or obtain additional information, contact the federal agency that took the action against the listed party. Agency points of contact, including name and telephone number, may be found by navigating to the Agency Exclusion POCs page within Help.

Our Website

About This Site

Our Community

Release Notes

System Alerts

Our Partners

Acquisition.gov

USASpending.gov

Grants.gov

More Partners

Policies

Terms of Use

Privacy Policy

Customer Service

Help

Check Entity Status

12/4/25, 1:55 PM SAM.gov https://sam.gov/entities/view/KVHUJMNWSUJ9/exclusionInfo?status=Active&emrKeyValue=1303758~1743426283030548 2/3 https://sam.gov/about/this-site https://interact.gsa.gov/group/integrated-award-environment-iae-industry-community https://www.fsd.gov/gsafsd_sp?id=kb_category&kb_category=ccf4380a1ba67410fe314000f54bcb16&kb_id=f66d8e6cdb76d4100d73f81d0f9619c https://sam.gov/alerts https://acquisition.gov/ https://usaspending.gov/ https://grants.gov/ https://sam.gov/about/partners https://sam.gov/about/terms-of-use https://sam.gov/about/terms-of-use#privacy https://sam.gov/help https://sam.gov/content/status-tracker

WARNING

SAM.gov An official website of the U.S. General Services Administration

Restricted Data Use

Freedom of Information Act

Accessibility

Federal Service Desk

External Resources

Contact

This is a U.S. General Services Administration Federal Government computer system that is "FOR OFFICIAL USE ONLY."

This system is subject to monitoring. Individuals found performing unauthorized activities are subject to disciplinary action including criminal prosecution.

This system contains Controlled Unclassified Information (CUI). All individuals viewing, reproducing or disposing of this information are required to protect it in accordance with 32 CFR Part 2002 and GSA Order CIO 2103.2 CUI Policy.

12/4/25, 1:55 PM SAM.gov https://sam.gov/entities/view/KVHUJMNWSUJ9/exclusionInfo?status=Active&emrKeyValue=1303758~1743426283030548 3/3 https://sam.gov/about/terms-of-use#restricted https://www.gsa.gov/reference/freedom-of-information-act-foia https://sam.gov/about/accessibility https://www.fsd.gov/gsafsd_sp https://sam.gov/about/external-resources https://sam.gov/about/contact https://www.gsa.gov/