PO RE WIC SPECIAL PROJECTS WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
C-86-14-023-3-22
ProcureAZ Purchase Order No.: ADHS14-053007:24
Organizational Reference No.: PO0000286504
Issued: 10/27/2017
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Bureau of Nutrition and Physical Activity
N 4041 N. Central Avenue, #1400 H 150 N. 18th Avenue, Suite 310
Phoenix, AZ 85012 I Phoenix, AZ 85007
D US
O P Email: procure@azdhs.gov
R
T
O
Contract No.: ADHS14-053007 (800) 252-5942
Title: Maricopa WIC Special Projects
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I AP Services
150 N 18th Avenue, Ste 260
L Phoenix, AZ 85007
L US
Email: INVOICES@azdhs.gov
T
O
(602) 542-6354
Release Instructions
TERMS AND CONDITIONS set forth in our Bid, Quotation, or Purchase Order
are incorporated herein by reference and become a part of this order.
Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 952-26
Maricopa WIC Special Projects PO EFFECTIVE 10/1/17 - 9/30/18
CONTRACT # ADHS14-053007, CFDA# 10.557
1 1.00 YR $ 162,953.52 $ 162,953.52
LN/FY/Account Code Dollar Amount
1/18/2018--FEDCFH1919--4410-- $ 162,953.52
HS2000--HS20000-6811---PHS-NPA-
WICADM--0918---------HSA
Class-Item 952-26
Maricopa WIC Special Projects PO EFFECTIVE 10/1/17 - 9/30/18
2 CONTRACT # ADHS14-053007, CFDA# 10.557 1.00 YR $ 38,472.48 $ 38,472.48
LN/FY/Account Code Dollar Amount
2/18/2018--LOTCFH4190--4410-- $ 38,472.48
HS4250-LOTWIC-HS25000-6811---PHS-
NPA------------HSA

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
Class-Item 952-26
Maricopa WIC Special Projects PO EFFECTIVE 10/1/17 - 9/30/18
3 CONTRACT # ADHS14-053007, CFDA# 10.557 1.00 YR $ 125,435.00 $ 125,435.00
LN/FY/Account Code Dollar Amount
3/18/2018--FEDCFH1919--4410-- $ 125,435.00
HS2000--HS20000-6811---PHS-NPA-
WICADM--0918---------HSA
Class-Item 952-26
Maricopa WIC Special Projects PO EFFECTIVE 10/1/17 - 9/30/18
CONTRACT # ADHS14-053007, CFDA# 10.557
4 1.00 YR $ 10,000.00 $ 10,000.00
LN/FY/Account Code Dollar Amount
4/18/2019--LOTCFH4190--4410-- $ 10,000.00
HS4250-LOTWIC-HS25000-6811---PHS-
NPA-WICADM--0918---------HSA
TOTAL: $ 336,861.00
Approved By: Gladys Lovera
Phone No.: (602) 364-1649

C-86-14-023-3-22 ATTACHED TO AND A PART OF
Purchase Order: ADHS14-053007:24
Maricopa WIC Special Projects
IN WITNESS WHEREOF, the parties agree to enter into this IGA and its
Amendments:
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