HomeMy WebLinkAboutP-24-175 DPH Misc. Doc.pdf CO U�
CONTRACT STATUS FORM
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DATE: December 02, 2024 RECEIVE 56 56
DIVISION(S): Administration MAC 2 2025
(Lead Division listed first) OF PUBLIC HEA
CONTRACTOR: Poverello House DEPFRCO NRACTSSECZ�CN
SERVICES: Data Sharing, Data User Census Work and Consultation Services
CONTRACT TERM: 4/15/24 to 6/30/25
ADDITIONAL INFO:
ORGANIZATION #(s): 56201508
CONTRACT AMOUNT: $26,000.00
Contract#: P-24-175 State/Vendor #:
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:March 1, 2025
F1Extend contract through: , 20
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: 20
nCancel contract effective: (AAAt, 36 , 20 2L
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Date: , ��� Tit'
Program Supervisor/Staff Analyst:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090