ADHS18-177694 MARICOPA COUNTY A5.PDF

C-86-18-018-3-10
ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
OFFICE OF PROCUREMENT
AMENDMENT 150 18th Ave Suite 530
Phoenix, Arizona 85007
Contract No.: ADHS18-177694 IGA Amendment No.: 5 Procurement Officer
Anthony Beckum
IMMUNIZATION SERVICES
Effective upon signature of both parties, it is mutually agreed that the Intergovernmental Agreement referenced is
amended as follows:
1. Pursuant to the Terms and Conditions, Provision Six (6), Contract Changes, section 6.1, Amendments Purchase
Orders and Change Orders; the Intergovernmental Agreement is amended to reflect the following:
1.1 Under the Scope of Work, Provision Four (4), Tasks, Section 4.2, Activity Two (2) Child and Adolescent
Immunizations, Sub-section 4.2.1, Section 4.2.1.7, as outlined below, is hereby added by this Amendment Five
(5):
4.2.1.7. Enhance VFC vaccination capacity. Funds can be utilized for staffing, materials/supplies, equipment,
and travel related to efforts to successfully vaccinate children within the community.
--Continued on next page--
All other provisions of this Agreement remain unchanged.
Maricopa County,
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Contractor Name: Authorized Signature
4041 N. CENTRAL AVENUE, SUITE 1400 Jack Sellers
Address: Print Name
PHOENIX ARIZONA 85012 Chairman, Board of Supervisors
City State Zip Title
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has determined This Intergovernmental Agreement Amendment shall be
that this Intergovernmental Agreement is in proper form and is within the powers and effective the date indicated. The Public Agency is hereby
authority granted under the laws of Arizona cautioned not to commence any billable work or provide any
material, service or construction under this IGA until the IGA has
been executed by an authorized ADHS signatory.
State of Arizona
Signature Date
Signed this day of 2021.
Anne Longo, Attorney for County
Print Name
Procurement Officer
Contract No.: ADHS18-177694, which is an Agreement between public agencies, has
been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney,
who has determined that it is in proper form and is within the powers and authority
granted under the laws of the State of Arizona.
Signature Date
Assistant Attorney General
Print Name
Attest:________________________________
Office of the Clerk of the Board Date Page 1 of 5

ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
OFFICE OF PROCUREMENT
AMENDMENT 150 18th Ave Suite 530
Phoenix, Arizona 85007
Contract No.: ADHS18-177694 IGA Amendment No.: 5 Procurement Officer
Anthony Beckum
1.2 Under the Scope of Work, Provision Four (4), Tasks, Section 4.12, Activity Twelve (12) VPD Outbreak and
Pandemic Preparedness, Sub-section 4.12.5, as outlined below, is hereby added by this Amendment Five (5):
4.12.5. Enhance COVID-19 vaccination capability (or capacity). Funds can be utilized for staffing,
materials/supplies, equipment, and travel related to efforts to successfully vaccinate adults and
children within the community.
1.3 The Price Sheet is revised and replaced with the Price Sheet of this Amendment Five (5); and
1.4 Finally, Exhibit Three (3) is revised and replaced by Exhibit Three (3) of this Amendment Five (5).
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
OFFICE OF PROCUREMENT
AMENDMENT 150 18th Ave Suite 530
Phoenix, Arizona 85007
Contract No.: ADHS18-177694 IGA Amendment No.: 5 Procurement Officer
Anthony Beckum
PRICE SHEET
Activity Frequency Unit Rate Unit of Measure Total
Immunization Visit for children
zero (0) to eighteen (18) years of Quarterly
age who meet VFC eligibility $50.00 Per Visit
requirements. Do not include visits
for insured children.
Immunization Visit for adults
nineteen (19) years of age and Quarterly, when
older who meet VFA eligibility specific VFA funds $50.00 Per Visit
requirements. Do not include visits are available
for insured adults
Immunization Completion report
for children zero (0) to twenty-four Quarterly $100.00 Per Series
(24) months of age for the Completion
4:3:1:3:3:1:4 series As approved by ADHS and
Perinatal Hepatitis B Case authorized by purchase
Management – Prenatal Quarterly $300.00 Per Case order
Perinatal Hepatitis B Case Quarterly $200.00 Per Case
Management – Postnatal
Immunization Visit for Flu
Vaccine, in children and adults When specific pan
who meet VFC and VFA eligibility flu vaccine funds are $50.00 Per Visit
requirements. Do not include visits available
for insured children or adults.
IDR Submission – Preparation
and Submittal of School/Child Each/per grade
Care IDR by CHD nurse or in Optional $250.00 level IDR
cooperation with school/child care
personnel
IDR Validation – On-site visit to Each/per grade
schools/child care facilities to Optional $50.00 level validation
validate IDR submission data
Supplemental flu vaccination As needed by June N/A Total Not to exceed allocation=
activities. 30, 2024 $1,005,000
Improve vaccine cold storage
capacity; increase capacity for As needed by June N/A Total Not to exceed allocation=
data entry and reminder recall 30, 2024 $125,000
activities
Enhance VFC/COVID-19 activities As needed by June N/A Total Not to exceed allocation=
30, 2024 $1,216,200
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
OFFICE OF PROCUREMENT
AMENDMENT 150 18th Ave Suite 530
Phoenix, Arizona 85007
Contract No.: ADHS18-177694 IGA Amendment No.: 5 Procurement Officer
Anthony Beckum
EXHIBIT THREE
Exhibit - 2 CFR 200.332
§ 200.332
Requirements for pass-through entities.
All pass-through entities must:
(a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the
following information at the time of the subaward and if any of these data elements change, include the
changes in subsequent subaward modification. When some of this information is not available, the
pass-through entity must provide the best information available to describe the Federal award and
subaward.
Prime Awardee: Arizona Department of Health Services
DUNS # 804745420
Federal Award Identification (Grant Number): 6 NH23IP922599-02-02
Subrecipient name (which must match the
name associated with its unique entity
identifier): Maricopa County
Subrecipient's unique entity identifier (DUNS #):
Federal Award Identification Number (FAIN,
sometimes it’s the same as the Grant Number): NH23IP922599
Federal Award Date (see the definition of
Federal award date in § 200.1 of this part) of
award to the recipient by the Federal agency; 09/23/2020
Subaward Period of Performance Start and End
Date; 07/01/2019 - 06/30/2024
Subaward Budget Period Start and End Date: 07/01/2020 - 06/30/2021
Amount of Federal Funds Obligated by this
action by the pass-through entity to the
subrecipient (this is normally the contract
amount): $1,216,200.00
Total Amount of Federal Funds Obligated to the
subrecipient by the pass-through entity
including the current financial obligation (how
much is available for contracts): $11,298,059.00
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
OFFICE OF PROCUREMENT
AMENDMENT 150 18th Ave Suite 530
Phoenix, Arizona 85007
Contract No.: ADHS18-177694 IGA Amendment No.: 5 Procurement Officer
Anthony Beckum
Total Amount of the Federal Award committed
to the subrecipient by the pass-through entity $15,546,386.00
Federal award project description, as required
to be responsive to the Federal Funding CDC-RFA-IP19-1901 Immunization and Vaccines for
Accountability and Transparency Act (FFATA) Children
Name of Federal awarding agency, pass-
through entity, and contact information for
awarding official of the Pass-through entity Centers for Disease Control and Prevention
Assistance Listings number and Title; the pass-
through entity must identify the dollar amount
made available under each Federal award and
the Assistance Listings Number at time of
disbursement: 93.268 - Immunization Cooperative Agreements
Identification of whether the award is R&D
Indirect cost rate for the Federal award
(including if the de minimis rate is charged) per
§ 200.414
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