C-39-17-006-3-07 ADHS18-172583 A4 UNEXECUTED.DOC

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 260
Phoenix, Arizona 85007
Procurement Specialist
Contract No: ADHS18-172583 Amendment No. 4
Delilah Gonzalez
HIV Care Services
Effective upon signature, it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. Pursuant to Terms and Conditions, Provision 4, Contract Administration and Operation, Section 4.1, Term, the
termination date is extended to March 31, 2022.
2. Pursuant to Terms and Conditions, Contract Changes, 6.1, Amendments, Purchase Orders, and Change Orders, the
Contract is amended as follows:
2.1 Scope of Work, Provision Three (3), Scope of Service, 3.1.2, Support Services, the following shall be added and
made part of the contract:
3.1.2.6 Support Service categories that are approved by the Health Resources & Services Administration (HRSA)
and RWPB, and be provided in accordance with HRSA Program Monitoring Standards.
(Continued on Next Page)
All other provisions of this agreement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County Master Record
Contractor Name Contractor Authorized Signature
301 W. Jefferson Street, Suite 3200
Address Printed Name
Phoenix AZ 85003
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 any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this IGA until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this ______ day of _______________________ 201__
Signature Date
Printed Name Procurement Officer
RESERVED FOR USE BY THE SECRETARY OF STATE
Attorney General Contract No. P0012014000078, 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:
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 260
Phoenix, Arizona 85007
Procurement Specialist
Contract No: ADHS18-172583 Amendment No. 4
Delilah Gonzalez
2.2 Scope of Work, Provision (3), Scope of Service, the following shall be added to read as follows:
3.1.18 Conduct a statewide Comprehensive Needs Assessment. Detail findings by six (6) severe need groups
(SNGs): 1. Newly Diagnosed; 2. Men who have Sex with Men; 3. Hispanics; 4. African American; 5:
American Indians; and 6. Youth.
3.1.18.1 Meet with key stakeholders to develop the consumer survey instrument in English and Spanish;
3.1.18.2 Conduct consumer surveys (n=735); identify barriers/gaps in Care Continuum completion;
3.1.18.3 Utilize CAREWare data, analyze client level data to show client utilization/impact of the
Affordable Care Act;
3.1.18.4 Analyze survey data, present draft findings, and
3.1.18.5 Complete Needs Assessment Document/Presentation to key stakeholders.
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