PRS-478d40082 Request (BIDS).pdf
PDF 122 KB Posted
- Attached to
- Master Agreement AZ|CTR076674
- Contract number
- CTR076674
- Issued by
- Arizona
About this file
This is a Procurement Request Form from the Arizona Department of Health Services (ADHS), specifically for an Intergovernmental Agreement (IGA) with the Maricopa County Department of Public Health regarding the Ryan White Part A program. The document was created on 6/19/2023 and involves a new procurement with a federal funding source, submitted through a new portal as the previous Sharepoint system is being shut down.
The contract is a multi-year agreement with an estimated annual amount of $500,000.00 in federal funds, designated as a sub-recipient arrangement. The procurement is for the Ryan White Part A program, with three attachments included: a 2 CFR 200.332 form, a new IGA updated to the current ADHS template, and the original IGA submission for reference. The document indicates this is a new procurement with no existing contract number, and the estimated date needed is 10/17/2023. The program contact is Ricardo Fernandez, who can be reached at ricardo.fernandez@azdhs.gov or 602-527-7923.
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Text version
150 N. 18th Avenue, Phoenix, AZ 85007
Procurement Request Form
PMS ID# PRS-47840082
Basic Information:
Title: Maricopa County Ryan White Part A
Bureau: BIDS
Contract/Agreement Type:
IGA
Description: Duplicate Maricopa County Ryan White Part A IGA submitted into new portal as old Sharepoint is being shutdown. Old IGA (original submission) and new IGA templates submitted. The old IGA form has expired so new IGA with updated template drafted and uploaded.
Existing Contract Number:
N/A
Supplier ID# n/a
Requestor Information:
Requestor: ricardo.fernandez@azdhs.gov
Phone: 602-527-7923
Estimated date needed:
10/17/2023
Program Information:
Program contact: ricardo.fernandez@azdhs.gov
Program contact phone:
6025277923
Other Participants:
Financial Information:
Estimated Annual Amount: $500,000.00
Funding Available?: Y
Funding Type: Federal
Are funds for a sub-recipient or contractor?
Sub-Recipient tel:602-527-7923 tel:6025277923
2 CFR 200.332 Form: Y
Contract Term: Multi-year agreement
PMS ID# PRS-47840082
Supplemental Information:
Created Date: 6/19/2023
Procurement Status: NEW
Assigned Officer: kailee.gray@azdhs.gov
Date Assigned:
Amendment#:
Date Completed:
Chosen Supplier: Maricopa County Department of Public Health Ryan White Part A
Effective Date:
Max End Date:
Attachments:
File Description/Lab el Comments Added By Date Added
8707c4e6.File.1 22209
MCDPH Ryan White Part A 2 CFR 200 Form ricardo.fernande z@azdhs.gov
6/19/2023 b94bfea6.File.12
MCDPH Ryan White Part A IGA
Use this IGA, updated to current ADHS IGA template ricardo.fernande z@azdhs.gov
6/19/2023 d61f59cc.File.12
2220.22 edits (1) (2)
Original IGA Submission (old template for reference only) use for reference only, IGA template has expired ricardo.fernande z@azdhs.gov
6/19/2023
Procurement Comments:
PMSID# Comment Added By Date Entered
Page https://www.appsheet.com/template/gettablefileurl?appName=FY23ContractTrackingLog-5762669&tableName=Attachments&fileName=Attachments_Files_%2F8707c4e6.File.122209.docx&appVersion=1.000439&signature=ccc43beddda7088d262a5419c8457a8a09dadee6df9c7a3f1ba11108f1f1e20893670e9c76c20a91bd213387ce5202e5 https://www.appsheet.com/template/gettablefileurl?appName=FY23ContractTrackingLog-5762669&tableName=Attachments&fileName=Attachments_Files_%2Fb94bfea6.File.122214.docx&appVersion=1.000439&signature=0fa177729a15a962cf5d242936bac13a174dc8b06eb10c1cbf144d746391d6c67ce36e9c1c7f5f2d3ef49df0f4662da7 https://www.appsheet.com/template/gettablefileurl?appName=FY23ContractTrackingLog-5762669&tableName=Attachments&fileName=Attachments_Files_%2Fd61f59cc.File.122220.22%20edits%20%281%29%20%282%29.docx&appVersion=1.000439&signature=08de933747f5d2ece28c71c3064ffc72cfb547069625149f18fda0a23ba4ee4d5296de24a767b5a27a9e9976bcdad99f
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