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ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES AMENDMENT 150 N. 18th Avenue, Ste. No 260 Phoenix, Arizona 85007 PROCUREMENT OFFICER CONTRACT No.: ADHS15-084210 AMENDMENT No.:4 Merrilyn Forbin C-86-15-061-3-04 DIETETIC INTERNSHIP Effective upon signature, it is mutually agreed that the Intergovernmental Agreement (IGA) referenced is amended as follows: 1. Pursuant to the Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders and Change Orders, the Price Sheet of Amendment Three (3) is hereby revised and replaced by the Price Sheet of this Amendment Four (4). The total budget amount remains at $150,000.00. ALL OTHER PROVISIONS OF THIS AGREEMENT SHALL REMAIN IN THEIR ENTIRETY. CONTINUED ON NEXT PAGE CONTRACTOR SIGNATURE MARICOPA COUNTY BY AND THROUGH ITS MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH Contractor Name Contractor Authorized Signature 4041 NORTH CENTRAL AVE, SUITE 1400 Steve Chucri Address Printed Name PHOENIX ARIZONA 85012 Chairman, Board of Supervisors City State Zip Title CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the Pursuant to A.R.S. § 11-952, the undersigned public agency attorney date indicated. The Public Agency is hereby cautioned not to commence has determined that this Intergovernmental Agreement is in proper form any billable work or provide any material, service or construction under and is within the powers and authority granted under the laws of the this IGA until the IGA has been executed by an authorized ADHS State of Arizona. signatory. State of Arizona Signed this ________ day of _______________________ 20_____ Signature Date MCAO Printed Name Procurement Officer Attorney for County Contract No. ADHS15-084210, which is an Agreement between public RESERVED FOR USE BY THE SECRETARY OF STATE agencies, has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant Attorney General, who has determined that it is in the proper form and is within the powers granted under the laws of the State of Arizona to those parties to the Agreement represented by Under House Bill 2011, A.R.S. § 11-952 was amended the Attorney General. to remove the requirement that Intergovernmental The Attorney General, BY: Agreements be filed with the Secretary of State. Signature Date Assistant Attorney General Printed Name: ATTEST:_____________________________, Office of the Clerk of the Board 1 ARIZONA DEPARTMENT OF INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES AMENDMENT 150 N. 18th Avenue, Suite #260 Phoenix, Arizona 85007 PROCUREMENT OFFICER CONTRACT No.: ADHS15-084210 AMENDMENT No.: 4 Merrilyn Forbin Dietetic Internship Program REVISED PRICE SHEET Effective October 1, 2018 Cost Reimbursement Line Item Budget Account Classification Amount Personnel $74,735.00 Employee Related Expenses $32,320.00 Professional & Outside Services $1.00 Travel Expense $2,000.00 Occupancy Expenses $5,931.00 Other Operating Expenses $11,168.00 Capital Expenditures $1.00 Indirect Cost $23,844.00 Total $150,000.00 2