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CONTRACT STATUS FORM
1
RECEIVED 856
DATE: December 02, 2024 FRESH
DEC 1, 8 2024
DIVISION(S): Emergency Services
(Lead Division listed first) DEPARTMENT OF PUBLIC
CONTRACTS SECTI
CONTRACTOR: Saint Agnes Medical Center 17P
SERVICES: Paramedic Supervised Clinical Training Experience
CONTRACT TERM: 7/1/20 to 6/30/25
ADDITIONAL INFO:
ORGANIZATION #(s): 56201695
CONTRACT AMOUNT: $0.00
Contract#: P-20-380 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:March 1, 2025
Extend contract through: , 20
With no changes in terms or conditions.
1-1 With the following change(s):
Evergreen: Continue contract through: 20
❑ Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension,
etc.)):
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Approved by:
Program Supervisor/Staff Analyst: Date: (Z/(�/l�I
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090