INTERVIEW AND INVESTIGATION A4.PDF

C-86-16-115-3-04
ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
AMENDMENT 150 N. 18th Avenue, Suite 260
Phoenix, Arizona 85007
Contract No.: ADHS16-130023 Amendment No.: 4 Procurement Specialist:
Carlos Carranza Jr.
INTERVIEW and INVESTIGATIONS of INFECTIOUS DISEASES
Effective upon signature, it is mutually agreed that the Contract 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 Contract is hereby amended as follows:
1.1 The Scope of Services, Provision Five (5) Deliverables is amended to add the following:
5.6 Deliverable 6: Outbreak Management
5.6.1. Develop and disseminate monthly outbreak reports as well as an annual outbreak report
summary to statewide partners, and
5.6.2. Manage statewide outbreak module in MEDSIS, conduct quality checks, and clean data.
Update and clean National Outbreak Reporting System (NORS) data as needed.
1.2 The Price Sheet is revised and replaced by this Amendment Four (4).
(CONTINUED ON NEXT PAGE)
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED.
CONTRACTOR SIGNATURE
Maricopa County by and through its
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
4041 North Central Bill Gates
Address Printed Name
Phoenix ARIZONA 85012 Chairman, Board of Supervisors
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has the date indicated. The Public Agency is hereby cautioned not to
determined that this Intergovernmental Agreement is in proper form and is commence any billable work or provide any material, service or
within the powers and authority granted under the laws of the State of Arizona. construction under this IGA until the IGA has been executed by an
authorized ADHS signatory.
State of Arizona
Signed this ______ day of _______________________ 20_____
Signature Date
Printed Name Attorney for County Procurement Officer
Contract No. ADHS16-130023, which is an Agreement between public
agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned
Assistant Attorney General, 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
Printed Name:
ATTEST:___________________________________
Office of the Clerk of the Board Date
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
AMENDMENT 150 N. 18th Avenue, Suite 260
Phoenix, Arizona 85007
Contract No.: ADHS16-130023 Amendment No.: 4 Procurement Specialist:
Carlos Carranza Jr.
For budget period May 1, 2019 through April 30, 2020
Price Sheet
Description Quantity Unit Amount
Outbreak management 1 Year $61,029.28
Valley fever surveillance and education 1 Year $5,900
NOTE: With prior approval from the Infectious Disease Program Manager, the MCDPH is authorized to transfer up to a
maximum of 10% of the total budget amount between line items. Transfers of funds are only allowed between funded line
items. Transfers exceeding 10% or to a non-funded item shall require an amendment.
Unspent funds may be extended into the following budget period to conduct tasks/deliverables into the next year as
needed, if approved by the program.
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