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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 ' SVPS 5 YW I >U-M-- ---0_:LJ J_7 / 0-3--- VJd ¥ Date -JI) u TA- Tr i_ji I ID - D H-i l'\. o 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