HomeMy WebLinkAboutA-24-128 DPH Misc. Docs.pdf CONTRACT STATUS FORM ti co�,�
RECEIVED g6 O
DATE: June 03, 2024 OCT 0 9 2024ES�
DIVISION(S): Health Policy and Wellness DEPARTMENT OF PUBLIC E
(Lead Division listed first) CONTRACTS SECTI
CONTRACTOR: Centro La Familial Advocacy Services, Inc.
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SERVICES: Health Disparities Intervention Activities
CONTRACT TERM: 3/28/23 to 12/31/24
ADDITIONAL INFO: Term expires, 12/31/2024, Requires a letter to extend.
ORGANIZATION #(s): 56201558 56201019 56201022
CONTRACT AMOUNT: $1,335,000.00
Contract#: A-24-128 State/Vendor#:
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:September 1, 2024
Extend contract through: , 20
With no changes in terms or conditions.
With the following change(s):
❑ Evergreen: Continue contract through: 20
PqCancel contract effective: /V , 20 .
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor/Staff Analyst: Date: ldl71Z4
Division Manager: ) Date: 'o Z
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090