DCS_Assignment_and_Agreement_Form_-_signed.pdf
PDF 267 KB Posted
- Attached to
- Master Agreement AZ|CTR073800
- Contract number
- CTR073800
- Issued by
- Arizona
About this file
This document is a Department of Child Services Assignment and Agreement Form from the State of Arizona, specifically involving the Department of Child Safety's Office of Procurement. The assignment transfers contract rights and responsibilities from Lifewell to Terros Inc., with the original contract number CTR062899 being assigned a new contract identification number CTR073800. The document is dated 09/26/2024 and was executed by Doris Hotz, President & CEO of Lifewell, and Karen Hoffman Tepper, PhD., President & CEO of Terros Inc., with final consent from the Department of Child Safety's Procurement Manager on 10/2/2024.
While the specific details of the contracted goods or services are not included in this assignment document, the form indicates a transfer of an existing contract between two organizations within the child services sector. The assignee, Terros Inc. (with Federal Employer Identification Number 86-0252067), assumes all terms and conditions of the original contract, with their contact address located at 3003 North Central Avenue, Suite 400, Phoenix, AZ 85012. The assignment becomes effective upon execution by the Department, with Terros Inc. accepting all previously established contract terms and conditions from the original agreement.
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Text version
Department of Child Services Assignment and Agreement Form
State of Arizona Department of Child Safety
Office of Procurement 3003 N. Central Ave., 20th Fl.
Phoenix, AZ 85012
Assignor Lifewell (Company Name) relinquishes and assigns all rights and responsibilities under the terms and conditions of the attached contract CTR062899 to include any executed amendments, to assignee, Terros Inc.
(Company Name)
Effective upon execution by the Department, assignee accepts all the terms and conditions of the assigned (Date) contract. The new contract identification number is CTR073800. The assignee’s address for the purpose of the Agreement is:
3003 North Central Avenue Ste 400 (No. and Street)
(602) 685-6029 (Area Code and Telephone No.)
Phoenix, AZ 85012 (City, State and ZIP Code) (Area Code and FAX No.)
Assignor:
Lifewell (Company Name)
Doris (Vaught) Hotz, President & CEO (Typed Name and Title)
Doris Hotz Doris Hotz (Sep 26, 2024 09:26 PDT)
(Signature)
09/26/2024 (Date)
Assignee:
Terros Inc.
(Company Name)
86-0252067 (FEI No.)
Karen Hoffman Tepper, PhD., President & CEO (Typed Name and Title)
Karen Hoffman Tepper (Sep 26, 2024 09:21 PDT)
(Signature)
09/26/2024 (Date)
Consenting Authority:
Pursuant to the “Assignment and Delegation” section of the Uniform Terms and Conditions, the Department of Child Safety consents to the foregoing assignment.
(DCS Procurement Manager Signature) (Date) 10/2/2024 https://na4.documents.adobe.com/verifier?tx=CBJCHBCAABAAQibQaFDIlcC45EPbUt4v4GTmOej8pjZ-https://na4.documents.adobe.com/verifier?tx=CBJCHBCAABAAQibQaFDIlcC45EPbUt4v4GTmOej8pjZ-https://na4.documents.adobe.com/verifier?tx=CBJCHBCAABAAQibQaFDIlcC45EPbUt4v4GTmOej8pjZ-https://na4.documents.adobe.com/verifier?tx=CBJCHBCAABAAQibQaFDIlcC45EPbUt4v4GTmOej8pjZ-
Created: 2024-09-26
By:
Status:
Transaction ID:
Lorie Birk (Lorie.Birk@terros.org)
Signed
CBJCHBCAABAAQibQaFDIlcC45EPbUt4v4GTmOej8pjZ-
DCS Assignment and Agreement Form Final Audit Report 2024-09-26
"DCS Assignment and Agreement Form" History
Document created by Lorie Birk (Lorie.Birk@terros.org)
2024-09-26 - 4:13:47 PM GMT
Document emailed to Karen Hoffman Tepper (karen.tepper@terros.org) for signature
2024-09-26 - 4:14:56 PM GMT
Email viewed by Karen Hoffman Tepper (karen.tepper@terros.org)
2024-09-26 - 4:21:01 PM GMT
Document e-signed by Karen Hoffman Tepper (karen.tepper@terros.org)
Signature Date: 2024-09-26 - 4:21:17 PM GMT - Time Source: server
Document emailed to dhotz@lifewell.us for signature
2024-09-26 - 4:21:19 PM GMT
Email viewed by dhotz@lifewell.us
2024-09-26 - 4:26:04 PM GMT
Signer dhotz@lifewell.us entered name at signing as Doris Hotz
2024-09-26 - 4:26:36 PM GMT
Document e-signed by Doris Hotz (dhotz@lifewell.us)
Signature Date: 2024-09-26 - 4:26:38 PM GMT - Time Source: server
Agreement completed.
2024-09-26 - 4:26:38 PM GMT
mailto:(Lorie.Birk@terros.org mailto:(Lorie.Birk@terros.org mailto:(karen.tepper@terros.org mailto:(karen.tepper@terros.org mailto:(karen.tepper@terros.org mailto:dhotz@lifewell.us mailto:dhotz@lifewell.us mailto:dhotz@lifewell.us mailto:(dhotz@lifewell.us
| 09/26/2024 |
| 09/26/2024 |
| 2024-10-02T07:50:35-0700 | |
| Shannon Williams |
File details come from the government source that posted it. Updated .