FE_11-22-ED_Amendment_16.pdf
PDF 538 KB Posted
- Attached to
- Master Agreement AZ|CTR041692
- Contract number
- CTR041692
- Issued by
- Arizona
About this file
This document is a Contract/Agreement Amendment issued by the Arizona Department of Education (ADE) for an Interagency Service Agreement with Northern Arizona University (NAU). The amendment is identified by Agreement No. 11-22-ED and Amendment No. 16, with an effective date upon execution. The agreement falls under the ESS (Exceptional Student Services) program and specifically relates to Speech Language Pathologist services.
The amendment modifies the budget for the period from 10/1/2024 to 9/30/2025, with a total contract value of $289,823. Key budget adjustments include changes to salaries for instructional and non-instructional staff, specifically Sandra Stewart (Coordinator/Instructor) and Anna Sosa (Project Investigator/Project Director). The budget line items show modifications to salaries (-$4,560), employee benefits (+$1,629), and tuition (+$3,165). The funding source is identified as IDEA200FAY20 with CFDA No. 84.027A, indicating this is likely related to special education services. The contract covers staff salaries, benefits, and student tuition, with an 8% indirect cost rate applied.
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Text version
1. ISA AGREEMENT NO.:
11-22-ED
2. AMENDMENT NO.:
3. EFFECTIVE DATE:
Upon Execution
4. PROGRAM:
ESS
5. CONTRACTOR NAME:
Northern Arizona University P.O. Box 4130 Flagstaff, AZ 86011-4130
6. AUTHORITY FOR AMENDMENT Paragraph 7, “Changes”
7. PURPOSE OF AMENDMENT: Budget
8. DESCRIPTION OF THE SERVICE: Speech Language Pathologist
9. THE ABOVE REFERENCED AGREEMENT IS HEREBY AMENDED AS FOLLOWS:
A. In accordance with the provisions of the agreement, paragraph 7 Changes, the following have replaced with the attachments as follows:
• Attachment B Budget
10. EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND
CONDITIONS O HERETOFORE CHANGED AND/OR AMENDED REMAIN
UNCHANGED A
IN WITNESS WHEREOF THE PARTIES HERETO SIGN
THE D
IN
THEIR
ORIGINAL CONTRACT/AGREEMENT NOT
FULL EFFECT.
NAMES IN AGREEMENT.
CONTRACTOR ARIZONA DEPARTMENT OF EDUCATION
(SIGNATURE OF AUTHORIZED INDIVIDUAL)
NAME (Typed/Printed): NAME:
(SIGNATURE)
Braulio Garcia
TITLE: TITLE:
Chief Procurement Officer
DATE: DATE:
ARIZONA DEPARTMENT OF EDUCATION
Procurement Section
1535 West Jefferson Street, Bin #37 Phoenix, Arizona 85007-3209
CONTRACT/AGREEMENT AMENDMENT
Ivan Ochsner
Asst. Director, Post-award Research Administration
7/10/2025
ADE FORM-701d (99)
ARIZONA DEPARTMENT OF EDUCATION INTERAGENCY
SERVICE/INTERGOVERNMENTAL AGREEMENT BUDGET/
ESTIMATED NEEDS PAYMENT SCHEDULE FOR
INSTITUTIONS OF HIGHER EDUCATION, STATE AGENCIES
AND OTHER AGENCIES
INSTRUCTIONS
Submit original to ADE Contracts Management Unit as part of proposed Agreement/amendment. Final Agreement will contain instructions for submission of periodic/completion reports
A. AGREEMENT IDENTIFICATION FOR THE BUDGET PERIOD FROM : 10/1/2024 TO: 9/30/2025
1. Applicant Agency:
Northern Arizona University
2. Contact Person: Anna Sosa Phone No: 928-523-3845
3. Agreement No.: 11-22-ED
Index No.: IDEA200FAY204. Funding Source (Chapter 1, etc.)
CFDA No: 84.027A
5. Date submitted:
06/2/2024
6. Proposal Name (if any):
Speech Language Pathologists
7. Check ONE ☐ New ☐ Renewal Application ☐ Completion Report ☒ Amendment ☐ADE Revision
B. AGREEMENT BUDGET
*EXPENDITURE CATEGORIES
BUDGET
(1)
REQUEST
CHANGES
(2)
AMENDED
BUDGET
(3)
EXPENDITURE
TO DATE
(4)
BUDGET
BALANCE
(5)
8. Salaries – Instructional 90,980 -3,537 87,443
9. Salaries – Non-Instructional 14,744 -1,023 13,721
10. Employee Benefits 23,742 +1,629 25,371
11. Travel
12. Supplies and Materials
13. Purch Services/Consultant Fees
14. Tuition 150,000 +3,165 153,165
15. Printing and Reproduction
16. Utilities and Communications
17. Other:
18. SUBTOTAL
279,466 279,700
19. Indirect Cost (8% of subtotal less tuition expenses) 10,357 -234 10,123
20. Capital Outlay
21. TOTAL
289,823 289,823
22. Administrative Costs
23. Cash Balance (For Completion Purposes)
*SEE INSTRUCTIONS ON REVERSE SIDE
C. COMPLETION REPORT SIGNATURE (Blue Ink Only)
I hereby certify that this is a reasonable statement of total expenditures for this contract.
Applicant Authorized Agent Date
D. SUMMARY OF AVAILABLE FUNDS INCLUDED IN BUDGET ABOVE
Prior FY C/O + FY State C/O + FY (New)+ Other = TOTAL FY
E. ESTIMATED NEEDS PAYMENT SCHEDULE ☐ Original ☐Revised Date:
FY State C/O FY FY
Jul: Jan: Jul: Jan: Jul: Jan:
Aug: Feb: Aug: Feb: Aug: Feb:
Sep: Mar: Sep: Mar: Sep: Mar:
Oct: Apr: Oct: Apr: Oct: Apr:
Nov: May: Nov: May: Nov: May:
7/10/2025
ADE FORM-701d (99)
Dec: Jun: Dec: Jun: Dec: Jun:
TOTAL TOTAL TOTAL
ADE FORM-701b (01)
ARIZONA DEPARTMENT OF EDUCATION
DETAILED INTERAGENCY SERVICE AGREEMENT BUDGET
(1) Applicant Name/Agency: Northern Arizona University (2) Agreement No. 11-22-ED
(3)
EXPENDITURE
CATEGORY
NUMBER
(4)
AGREEMENT
BUDGET
LINE ITEM NAME
(5)
NAME AND TITLE OF STAFF AND/OR BREAKDOWN OF INDIVIDUAL ITEMS
INCLUDED IN AGREEMENT BUDGET LINE ITEM TOTAL
(6)
100% COST OF
EACH ITEM LISTED
COLUMN (3)
(7)
% ASSIGNED
TO THIS
AGREEMENT
(8)
AGREEMENT
COST
8 Salaries Instructional Sandra Stewart, Coordinator/Instructor 90,980 90% 87,443
9 Salaries - Non- Anna Sosa, Project Investigator/Project Director 137,205 10% 13,721
Instructional
Student Wages 0 0% 0
Wages –Student
Employee Benefits Benefits for Anna Sosa, Principal Investigator/Project Director 52,042 10% 5,204
Benefits for Sandra Stewart, Coordinator/Instructor 20,592 90% 20,167 Benefits for student wages 0 0% 0
Tuition Student Tuition
153,165 100% 153,165
Indirect Cost (8%) 10,123 100% 10,123
TOTAL: 289,823
ADE FORM-701b (01)
| DATE: 7/21/2025 | |
| 2025-07-21T07:59:59-0700 | |
| Braulio Garcia |
File details come from the government source that posted it. Updated .