PRS-0b9dbf13.pdf
PDF 122 KB Posted
- Attached to
- Master Agreement AZ|CTR068539
- Contract number
- CTR068539
- Issued by
- Arizona
About this file
This document is a Procurement Request Form from the Arizona Department of Health Services (ADHS) for a new two-year contract with La Paz County Health Department. The procurement request is associated with the Public Health Emergency Preparedness (PHEP) bureau and is classified as a grant-based procurement with a federal funding source.
The contract has an estimated annual amount of $12,650.00, totaling $126,500 over the two-year period. It is structured as a sub-recipient agreement with an annual renewal term. The procurement was initiated on 8/18/2023 with a rush request and is marked as a new procurement. The chosen supplier is La Paz County Health Department, located at 1014 11th Street in Parker, Arizona. The contract involves MRC STRONG program-related documents, including a CFR, grant guide, statement of work, and an email to proceed, all added to the procurement file on the same date by the requestor.
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Other files
| File | Type | Posted |
|---|---|---|
| CTR068539 A2 Pricing.pdf | ||
| CTR068539 A2.pdf | ||
| CTR068539_fully_executed.pdf | ||
| CTR068539 A1.pdf | ||
| CTR068539_Pricing.pdf |
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Text version
150 N. 18th Avenue, Phoenix, AZ 85007
Procurement Request Form PMS ID# PRS-0b9dbf13
Basic Information:
Title: RUSH - New 2-Year Contract Request La Paz
County Health Department_$126,500
Bureau: PHEP
Procurement Request Type: Grant
Description: RUSH - NEED ASAP New 2-Year Contract Request La Paz County Health Department_$126,500
Existing Contract Number:
Supplier Name: La Paz County Health Department - 1014 11th Street, Parker, AZ 85344, gbachmann@lapazcounty.org 928 699-9364
Supplier ID#
Requestor Information:
Requestor: sylvia.puente-araiza@azdhs.gov
Phone: 480 521-9961
Estimated date needed: 10/17/2023
Program Information:
Program contact: ruth.penn@azdhs.gov
Program contact phone:
602 768-1624
Other Participants:
Financial Information:
Estimated Annual Amount: $12,650.00
Funding Available?: Y
Funding Type: Federal tel:480 521-9961 tel:602 768-1624
Are funds for a sub-recipient or contractor?
Sub-Recipient
2 CFR 200.332 Form: Y
Contract Term: Annual renewal
PMS ID# PRS-0b9dbf13
Supplemental Information:
Created Date: 8/18/2023
Procurement Status: NEW
Assigned Officer: hana.hehman@azdhs.gov
Date Assigned:
Amendment#:
Date Completed:
Chosen Supplier: La Paz County Health Department - 1014 11th Street, Parker, AZ 85344, gbachmann@lapazcounty.org 928 699-
Effective Date:
Max End Date:
Attachments:
File Description/Lab el Comments Added By Date Added
48f35634.File.19
MRC STTRONG
CFR - La Paz sylvia.puente-araiza@azdhs.g ov
8/18/2023
345af89f.File.19 3813.v1
MRC STTRONG
Grant Guide - La Paz sylvia.puente-araiza@azdhs.g ov
8/18/2023
8d1be17d.File.1 93818
MRC STTRONG
SOW - La Paz sylvia.puente-araiza@azdhs.g ov
8/18/2023 a0602dc7.File.1 93823
MRC STTRONG
Email to Proceed - La Paz sylvia.puente-araiza@azdhs.g ov
8/18/2023
Procurement Comments:
PMSID# Comment Added By Date Entered
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