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C-86-17-049-3-03 for ADHS17-155910 ARIZONA PURCHASE ORDER DELIVERY CONDITIONS ARIZONA Page 2 of 4 Order details: Buyer Arizona Purchase Order HEADER DELIVERY ADDRESS INVOICING ADDRESS Short Description: MARICOPA COUNTY- Home visiting Services-MARICOPA COUNTY 150 N 18th Ave Ste 320 150N 18th Ave #320 Supplier : MARiC. OPA COUNTY 85007 Phoenix 85007 Phoenix Arizona Arizona Order Date : 11/21/2018 UNITED STATES UNITED STATES Supplier Contact : RENTSCHELER CHERYL Legal Company: State of Arizona Agency : Arizona Department of Health Services DELIVERY & PAYMENT Division : Public Health Prevention Department PREV_Women & Childrens Health Payment terms : Net 30 Site: PREV_ Worrier and Childrens Health r- ORDER'S AMENDMENT m Original order : P00000010501 - MARlCOPA COUNTY- Home Visiting Services-MARICOPA COUNTY Amendment nal : P00000010501-1 -Amendment request 11/26/2018 P00000010501-MARICOPA COUNTY 1 Short Description Supplier Total Ordered Quantity UOM I Price Tax Amount Nurse Family Partnership for ( MARI COPA : ADHS17- 1MIECHV - PD COUNTY ) 11478-2 155910-9 EFFECHVETHRU MARICOPA 9/30719 COUNTY FEDOR-11770/ 0919 I !Nurse Family ( MARiCOPA 1ADHS17- Partnership for COUNTY) 11478-1 1.00 , Quarter 407,880.75 0.00% 407,880.75. USD i 155910-9 MIECHV - ! MARICOPA FEDCFH1770/ 0920 COUNTY 2 Result(s) Amount (tax excl.): 815,761.50 USD ; Non-Taxable - 0 % : 0.00 USD Amount (tax incl.) : 815,761.50 USD L. . Date (your local time) : Sent to Attachement 1 2018-11-26 RENTSCHELER CHERYL P00000010501 „Req. MARICOPA_COUNTY_.-_H ome_Visiting_Servires- 08:02:59.857 (CHERYLRENTSCHELER@MAILMARICOPA.GOV ) , MARI COPA_CDUNTY.pdf 12018-11-21 1RENTSCHELER CHERYL P00000010501„Req._MARICOPA_C0UN1Y -_Home Visiting_Servires.- 15;20:46.263 • lCHERYLRENTSCHELER@MAILMARICOPA.GOV ) : MARICOPA_COUNTY.pdf : CORRECTIVE ACTION REQUEST(S) Result(s) Deliveries https :llapp. az. g ov/print.aspdentordJorderjuanage_extranet/10501 11/27/2018 C-86-17-049-3-03 ATTACHED TO AND A PART OF Purchase Order PO0000010501 for ADHS17-155910:2 Nurse Family Partnership for MIECHV 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