PE AMEND 4.PDF

Maricopa County — Formal (2023-03-15)

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CONTRACT NO: C-86-19-025-3-04 
AMENDMENT NO: 
4 
AMENDMENT TO CONTRACT 
Between 
MARICOPA COUNTY 
By and Through 
DEPARTMENT OF PUBLIC HEAL TH 
and 
Delta Dental Plan of Arizona 
I.
The above-named contract is hereby amended as specified below:
A The Expiration date shall be extended thru February 28, 2024.
B.
Update to Appendix A, Summary of Benefits to reflect the rates in effect regarding the
Plan Year Benefits Maximum per person:
i.
From 3/01/2023-2/28/2024, the maximum rate shall remain at $2,500 per
person per benefit year.
ii.
Contract amount shall not exceed $2,000,000 over the next year.
11.
All other terms and conditions of the original contract and its amendments shall remain in full
force and effect.
IN WITNESS WHEREOF, the parties agree to the changes Indicated herein: 
FOR AND ON BEHALF OF 
MARICOPA COUNTY 
By: 
Chairman, Board of Supervisors 
Date 
ATTEST 
Clerk of the Board 
Date 
APPROVED AS TO FORM 
Attorney for Maricopa County 
Date 
FOR AND ON BEHALF OF DELTA DENTAL 
PLAN OF ARIZONA 
By:  mtttii?. 
DaDen alofArizona 
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CONTRACT NO: C-86-19-025-3-04 
AMENDMENT NO: 
4 
EXHIBIT A -CONTRACT RENEWAL 
Current Fee() 
Renewal Fee(s) 
Morch I, 20'.''.: lhrough i=ebruarv 23 
/\\orcn l. 202'."l tnrough F,-·bwmy .!.9 2024 
2023 
$3.91 
2