ACAA AMENDMENT 3 APS FUNDS.PDF

wildfire
igniting Community Action
to End Poverty in Arizona
Amendment No. Three (3) to the 2018-2019
Independent Contractor Agreement
Contract No. 07012018-19
The Independent Contract Agreement dated July 1, 2018, between Arizona Community Action
Association (dba Wildfire) and Maricopa County, administered by its Human Services
Department (hereinafter "Contractor") to conduct application intake and eligibility determination
for utility bill assistance and deposits is hereby amended as follows:
Purpose of the Amendment:
1. To provide Maricopa County, administered by its Human Services Department $16000.00
for the administration of APS Crisis Bill Federal Employee Assistance. Funds must be
utilized as outlined in Exhibit A, attached below. These funds will expire 2 months after
the Federal Government shutdown ends, at which time, any unused funds will be rolled
into the Contractor's already existing Arizona Public Service Crisis Bill Assistance
Program (referred to as APS BA).
Amendment to:
Section I. Services and Programs — 1.2 Fund Sources:
APS Crisis Bill Federal Employee Assistance Program: To provide Direct Service funding
in the amount of $13,333.33 and Program Delivery amount of $2,666.67. The allocation
for APS Crisis Bill Federal Employee Assistance will be $16000.00 (Direct Service +
Program Delivery).
Whole Agreement:
Unless otherwise noted herein, all other provisions of the original Agreement will remain in place
for the duration of the original Agreement.
[Signature page follows]

IN WITNESS WHEREOF, the undersigned have executed this Amendment No. Three (3),
effective as of the effective date.
CONTRACTOR: Arizona Community Action Association (dba
Maricopa County Wildfire), an Arizona nonprofit corporation
By: By:
Name: Name: Cynthia
Title: Chairman, Board of Supervisors Title: Executive Director
Date: Date: 1. LI -19
Address:
Attested to: 340 E Palm Lane, Suite 315
Phoenix, Arizona 85004
By: Fax No.: 602-604-0644
E -mail: czwick(a),wildfireaz.org
Name:
Title: Clerk of the Board
Date:
Approved as to Form:
By:
Name:
Title: Deputy County Attorney
Date:
Address:
234 N Central Ave, Suite 3000
Phoenix, AZ 85004
Email: mendezs002@mail.maricopa.gov

Exhibit A
APS CRISIS BILL FEDERAL EMPLOYEE ASSISTANCE
PROGRAM SUMMARY
CAN PAY: Utility bills at the discretion of the Participating Agency.
MAXIMUM GRANT AMOUNT: $400
ELIGIBILITY CRITERIA: If anyone in the household is an employee of the Federal Government
and can show evidence such as a Federal Government identification
card or pay stub, the income requirement can be waived if they have
been out of work due to a Federal Government shutdown during the
2019 Term of this agreement.
EMERGENCY: A Federal employee who has been out of work due to a Federal
Government shutdown during 2019.
INCOME VERIFICATION: Household member must supply Federal Government identification
card or pay stub.
SERVICE PERIOD: A household may be assisted twice with these funds. Service must be
provided within two months after the Federal Government shutdown.
SUBSTITUTE SSN (if necessary): Zip code + Birthday (for example: if zip code is 85203 and birthday is
May 1,1980 then the substitute SSN will be 852-03-0501)
ACCEPTABLE EMERGENCIES (examples):
1. A Federal employee who has been out of work due to a Federal
Government shutdown during 2019.
CLIENT ALES MUST CONTAIN:
1. Client Name
2. Client Address
3. APS Account Number
4. Assistance Amount
5. Copy of Federal Government Employee's identification or paystub
1.11.2019