PRS-4aaf0bed.pdf
PDF 132 KB Posted
- Attached to
- Master Agreement AZ|CTR068856
- Contract number
- CTR068856
- Issued by
- Arizona
About this file
This document is a Procurement Request Form from the Arizona Department of Health Services (AZDHS), specifically for an Intergovernmental Agreement (IGA) amendment with Yuma County. The procurement request is associated with Contract Number CTR040483 and involves the BIDS (Bureau) procurement team. The document details a multi-year agreement and includes participants from the Arizona state health services, with key contacts being Meagan Surgenor and other agency personnel.
The IGA amendment is for Sexually Transmitted Infection investigations, with an estimated annual amount of $29,297.50. The funding is federal in nature and designated for a sub-recipient. The contract is structured as a multi-year agreement covering the period 2023-2028. The procurement process is currently in progress, with the status noted as "With Procurement Officer" and awaiting template approval from the Attorney General's office. The document indicates that funding is confirmed available, and the procurement follows 2 CFR 200.332 guidelines for sub-recipient funding.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR068856 OIG.pdf | ||
| CTR068856 Contract Amendment 1.pdf | ||
| CTR068856 Contract Amedment No. 2.pdf | ||
| CTR068856 Pricing A1.pdf | ||
| CTR068856_Pricing.pdf | ||
| CTR068856 SAM Debarment.pdf | ||
| STI_Investigations_CTR068856_PDF.pdf | ||
| CTR068856 Pricing A2.pdf | ||
| CTR068856.pdf |
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Text version
150 N. 18th Avenue, Phoenix, AZ 85007
Procurement Request Form PMS ID# PRS-4aaf0bed
Basic Information:
Title: CTR040483 Yuma County IGA
Bureau: BIDS
Procurement Request Type: IGA - Amendment
Description: Sexually Transmitted Infection investigations
Existing Contract Number:
CTR040483
Supplier Name: Yuma County
Supplier ID#
Requestor Information:
Requestor: meagan.surgenor@azdhs.gov
Phone: 4804079854
Estimated date needed: 11/22/2023
Program Information:
Program contact: meagan.surgenor@azdhs.gov
Program contact phone:
4804079854
Other Participants: kassandra.rios@azdhs.gov,christine.wampler@azdhs.gov
Financial Information:
Estimated Annual Amount: $29,297.50
Funding Available?: Y
Funding Type: Federal
Are funds for a sub-recipient or contractor?
Sub-Recipient
2 CFR 200.332 Form: Y tel:4804079854 tel:4804079854
Contract Term: Multi-year agreement
PMS ID# PRS-4aaf0bed
Supplemental Information:
Created Date: 7/25/2023
Procurement Status: With Procurement Officer
Assigned Officer: darrnell.welch@azdhs.gov
Date Assigned: 7/31/2023 9:33:17 AM
Amendment#:
Date Completed:
Chosen Supplier: Yuma County
Effective Date:
Max End Date:
Attachments:
File Description/Lab el Comments Added By Date Added e7d2d173.File.1 70105
CTR040483 Yuma
2023-2028 IGA
meagan.surgeno r@azdhs.gov
7/25/2023 a0b2bc5e.File.1 70113.332
Yuma IGA CFR meagan.surgeno r@azdhs.gov
7/25/2023
Procurement Comments:
PMSID# Comment Added By Date Entered
PRS-4aaf0bed Assigned Officer anthony.beckum@az dhs.gov michelle.fink@azdhs.
gov
7/25/2023 3:19 PM
PRS-4aaf0bed STATUS UPDATE:
Assignment Acknowledged by Procurement Officer.
anthony.beckum@az dhs.gov
7/26/2023 8:44 AM
PRS-4aaf0bed Reassigned to LT on 7.31.2023.mf michelle.fink@azdhs.
gov
7/31/2023 9:32 AM
PRS-4aaf0bed Awaiting Template Approval by AG lucas.terry@azdhs.g ov
9/7/2023 9:05 AM
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