Hayat_2023_Renewal.doc.pdf
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- Contract number
- 505505-W22-SPB0005-00
- Issued by
- Wisconsin
About this file
This document is Contract Amendment No. 1 to Contract #505505-W22-SPB0005-08, executed between the State of Wisconsin Department of Administration and Hayat Pharmacy, located at 813 W Layton Ave, Milwaukee, WI 53221, with Hashim Zaibak serving as the principal officer and CEO.
The contract pertains to COVID-19 Testing and Analysis services. The amendment specifically modifies the contract term, establishing that the initial term commenced on the effective date of signature or later pursuant to an executed Purchase Order and concluded on August 29, 2022. The contract includes an initial renewal period that runs from August 30, 2022, through August 29, 2023. The amendment was signed by the contractor on August 26, 2022, and by the State of Wisconsin on August 29, 2022. No pricing information, contract amounts, or specific service details are disclosed in this amendment document.
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Text version
WISCONSIN DEPARTMENT OF ADMINISTRATION
DIVISION OF ENTERPRISE OPERATIONS
DOA-3051 (R 04/2019)
S. 51.01(5) WIS. STATS.; AND
S. 111.32(13M) WIS. STATS
STATE BUREAU OF PROCUREMENT
101 EAST WILSON STREET, 6TH FLOOR
POST OFFICE BOX 7867
MADISON, WI 53707-7867
FAX (608) 267-0600
TTY (608) 267-9629
HTTP://VENDORNET.STATE.WI.US
Contract Amendment
Contract No.: #505505-W22- SPB0005-08 Amendment No.: 1
Contract Title: COVID-19 Testing and Analysis
This Amendment is entered into by and between the State of Wisconsin, Department of Administration, and the Contractor, whose name, address and principal officer appears below.
Contractor Name Hayat Pharmacy____
Contractor Address 813 W Layton Ave
City: Milwaukee State: WI Zip: 53221
Principal Officer: Hashim Zaibak
The parties wish to change the terms of the above-referenced Contract in the following manner:
Section 4 of the Contract is deleted and replaced in its entirety with the following:
4. TERM. The initial term of this Contract shall commence on the effective date of signature, or later pursuant to an executed Purchase Order (PO) or if mutually agreed between the Parties in writing, and the initial term will conclude on
8/29/2022. The Contract is renewed for an initial renewal from 8/30/22 and the initial renewal period will conclude on
8/29/2023.
The Contract number is ratified as #505505-W22-SPB0005-08
Except as expressly changed by this Amendment, the terms, conditions, rights and obligations of Contract No.:
#505505-W22- SPB0005-08 shall remain in effect unchanged. In the event of any inconsistency or conflict in the Contract and this Amendment, the provision of this Amendment shall control.
To Be Completed by Contractor
For State of Wisconsin Department of Administration Cheryl Edgington Director, State Bureau of Procurement
For
Company Name
Address
City State Zip
Signature By
Printed Name
Date
Signature
Title
Date
This document can be made available in alternate formats to individuals with disabilities upon request.
DocuSign Envelope ID: 5FB1094C-EE29-497B-AF83-4B4698829843
Hayat Pharmacy
8/26/2022 | 6:59 AM PDT
CEO
Milwaukee
Hashim Zaibak
813 W Layton Ave
53221WI
DocuSign Envelope ID: 1571A2D3-D86A-42B2-8945-5057807F2513
8/29/2022 | 8:41 AM CDT
| 2022-08-29T10:33:58-0700 | |
| Digitally verifiable PDF exported from www.docusign.com |
File details come from the government source that posted it. Updated .