ADHS IGA JUSTICE-TOBACCOCESSATION(00).PDF

C-86-18-
ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA)
HEALTH SERVICES
150 North 18th Avenue, Suite 260
Phoenix, Arizona 85007
Contract No. ADHS18-203283
Project Title: Maricopa County Justice Tobacco Cessation Begin Date: July 1, 2018
Geographic Service Area: Maricopa County Termination Date: June 30, 2023
Arizona Department of Health Services has authority to contract for services specified herein in accordance with A.R.S. §§ 11-951, 11-952, 36-
104 and 36-132. The Contractor represents that it has authority to contract for the performance of the services provided herein pursuant to:
X Counties: A.R.S. §§ 11-201, 11-951, 11-952 and 36-182.
Indian Tribes: A.R.S. §§ 11-951, 11-952 and the rules and sovereign authority of the contracting Indian Nation.
School Districts: A.R.S. §§ 11-951, 11-952, and 15-342.
City of Phoenix: Chapter II, §§ 1 & 2, Charter, City of Phoenix.
City of Tempe: Chapter 1, Article 1, §§ 1.01 & 1.03, Charter, City of Tempe.
Amendments signed by each of the parties and attached hereto are hereby adopted by reference as a part of this Contract, from the effective
date of the Amendment, as if fully set out herein.
Arizona Transaction (Sales) Privilege: 07-290-681 D FOR CLARIFICATION, CONTACT:
Federal Employer Identification No.: 86-6000472 Name:
Tax License No.: Phone:
Contractor Name: Maricopa County FAX No:
Address: 4041 N Central Avenue, Suite 1400
Phoenix, AZ 85012 E-mail:
CONTRACTOR SIGNATURE: This Contract shall henceforth be referred to as Contract
The Contractor agrees to perform all the services set forth in the
Agreement and Work Statement. No. ADHS18-203283 The Contractor is hereby cautioned
not to commence any billable work or provide any material,
service or construction under this Contract until Contractor
receives a fully executed copy of the Contract.
State of Arizona
Signature of Person Authorized to Sign Date
Signed this day of , 2018
Steve Chucri, Supervisor, Board of Supervisors
Print Name and Title
Procurement Officer
CONTRACTOR ATTORNEY SIGNATURE: Attorney General Contract, No. P0012014000078, which is an
Agreement between public agencies, has been reviewed pursuant to
Pursuant to A.R.S. § 11-952, the undersigned Contractor’s A.R.S. § 11-952 by the undersigned Assistant Attorney General, who
Attorney has determined that this Intergovernmental Agreement is has determined that it is in the proper form and is within the powers
in proper form and is within the powers and authority granted granted under the laws of the State of Arizona to those parties to the
under the laws of Arizona. Agreement represented by the Attorney General.
The Attorney General, BY:
Signature of Person Authorized to Sign Date
Signature Date
Assistant Attorney General:
Print Name and Title
Maricopa County Attorney's Office
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CONTRACT NUMBER
INTERGOVERNMENTAL AGREEMENT
ADHS18-203283 TERMS AND CONDITIONS
1. Definition of Terms. As used in this Contract, the terms listed below are defined as follows:
1.1 “Attachment” means any document attached to the Contract and incorporated into the Contract.
1.2 “ADHS” means Arizona Department of Health Services.
1.3 “Budget Term” means the period of time for which the contract budget has been created and during which
funds should be expended.
1.4 “Change Order” means a written order that is signed by a Procurement Officer and that directs the
Contractor to make changes authorized by the Uniform Terms and Conditions of the Contract.
1.5 “Contract” means the combination of the Uniform and Special Terms and Conditions, the Specifications and
Statement or Scope of Work, Attachments, Referenced Documents, any Contract Amendments and any
terms applied by law.
1.6 “Contract Amendment” means a written document signed by the Procurement Officer and the Contractor
that is issued for the purpose of making changes in the Contract.
1.7 “Contractor” means any person who has a Contract with the Arizona Department of Health Services.
1.8 “Cost Reimbursement” means a contract under which a contractor is reimbursed for costs, which are
reasonable, allowable and allocable in accordance with the contract terms and approved by ADHS.
1.9 “Days” means calendar days unless otherwise specified.
1.10 “Fixed Price” establishes a set price per unit of service. The set price shall be based on costs, which are
reasonable, allowable and allocable.
1.11 “Gratuity” means a payment, loan, subscription, advance, deposit of money, services, or anything of more
than nominal value, present or promised, unless consideration of substantially equal or greater value is
received.
1.12 “Materials” unless otherwise stated herein, means all property, including but not limited to equipments,
supplies, printing, insurance and leases of property.
1.13 “Procurement Officer” means the person duly authorized by the State to enter into and administer Contracts
and make written determinations with respect to the Contract.
1.14 “Purchase Order” means a written document that is signed by a Procurement Officer, that requests a
vendor to deliver described goods or services at a specific price and that, on delivery and acceptance of the
goods or services by ADHS, becomes an obligation of the State.
1.15 “Services” means the furnishing of labor, time or effort by a Contractor or Subcontractor.
1.16 “Subcontract” means any contract, express or implied, between the Contractor and another party or
between a subcontractor and another party delegating or assigning, in whole or in part, the making or
furnishing of any material or any service required for the performance of this Contract.
1.17 “State” means the State of Arizona and/or the ADHS. For purposes of this Contract, the term “State” shall
not include the Contractor.
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2. Contract Type.
This Contract shall be:
X Cost Reimbursement
3. Contract Interpretation.
3.1. Arizona Law. The law of Arizona applies to this Contract including, where applicable, the Uniform
Commercial Code as adopted by the State of Arizona.
3.2. Implied Contract Terms. Each provision of law and any terms required by law to be in this Contract are a
part of this Contract as if fully stated in it.
3.3. Contract Order of Precedence. In the event of a conflict in the provisions of the Contract, as accepted by
the State and as they may be amended, the following shall prevail in the order set forth below:
3.3.1. Terms and Conditions;
3.3.2. Statement or Scope of Work;
3.3.3. Attachments; and
3.3.4. Referenced Documents.
3.4. Relationship of Parties. The Contractor under this Contract is an independent Contractor. Neither party to
this Contract shall be deemed to be the employee or agent of the other party to the Contract.
3.5. Severability. The provisions of this Contract are severable. Any term or condition deemed illegal or invalid
shall not affect any other term or condition of the Contract.
3.6. No Parole Evidence. This Contract is intended by the parties as a final and complete expression of their
agreement. No course of prior dealings between the parties and no usage of the trade shall supplement or
explain any terms used in this document.
3.7. No Waiver. Either party’s failure to insist on strict performance of any term or condition of the Contract shall
not be deemed a waiver of that term or condition even if the party accepting or acquiescing in the
nonconforming performance knows of the nature of the performance and fails to object to it.
3.8. Headings. Headings are for organizational purposes only and shall not be interpreted as having legal
significance or meaning.
4. Contract Administration and Operation.
4.1. Term. As indicated on the signature page of the Contract, the Contract shall be effective as of the Begin
Date and shall remain effective until the Termination Date.
4.2. Contract Renewal. This Contract shall not bind, nor purport to bind, the State for any contractual
commitment in excess of the original Contract period. The term of the Contract shall not exceed five years.
However, if the original Contract period is for less than five years, the State shall have the right, at its sole
option, to renew the Contract, so long as the original Contract period together with the renewal periods does
not exceed five years. If the State exercises such rights, all terms, conditions and provisions of the original
Contract shall remain the same and apply during the renewal period with the exception of price and Scope
of Work, which may be renegotiated.
4.3. New Budget Term. If a budget term has been completed in a multi-term Contract, the parties may agree to
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change the amount and type of funding to accommodate new circumstances in the next budget term. Any
increase or decrease in funding at the time of the new budget term shall coincide with a change in the
Scope of Work or change in cost of services as approved by the Arizona Department of Health Services.
4.4. Non-Discrimination. The Contractor shall comply with State Executive Order No. 2009-09 and all other
applicable Federal and State laws, rules and regulations, including the Americans with Disabilities Act.
4.5. Records and Audit. Under A.R.S. § 35-214 and A.R.S. § 35-215, the Contractor shall retain and shall
contractually require each subcontractor to retain all data and other records (“records”) relating to the
acquisition and performance of the Contract for a period of five years after the completion of the Contract.
All records shall be subject to inspection and audit by the State and where applicable the Federal
Government at reasonable times. Upon request, the Contractor shall produce a legible copy of any or all
such records.
4.6. Financial Management. For all contracts, the practices, procedures, and standards specified in and
required by the Accounting and Auditing Procedures Manual for the ADHS funded programs shall be used
by the Contractor in the management of Contract funds and by the State when performing a Contract audit.
Funds collected by the Contractor in the form of fees, donations and/or charges for the delivery of these
Contract services shall be accounted for in a separate fund.
4.6.1. Federal Funding. Contractors receiving federal funds under this Contract shall comply with the
certified finance and compliance audit provision of the Office of Management and Budget (OMB)
Circular A-133, if applicable. The federal financial assistance information shall be stated in a
Change Order or Purchase Order.
4.6.2. State Funding. Contractors receiving state funds under this Contract shall comply with the certified
compliance provisions of A.R.S. § 35-181.03.
4.7. Inspection and Testing. The Contractor agrees to permit access, at reasonable times, to its facilities.
4.8. Notices. Notices to the Contractor required by this Contract shall be made by the State to the person
indicated on the signature page by the Contractor, unless otherwise stated in the Contract. Notices to the
State required by the Contract shall be made by the Contractor to an ADHS Procurement Officer, unless
otherwise stated in the Contract. An authorized ADHS Procurement Officer and an authorized Contractor
representative may change their respective person to whom notice shall be given by written notice, and an
amendment to the Contract shall not be necessary.
4.9. Advertising and Promotion of Contract. The Contractor shall not advertise or publish information for
commercial benefit concerning this Contract without the prior written approval of an ADHS Procurement
Officer.
4.10. Property of the State.
4.10.1. Equipment. Except as provided below or otherwise agreed to by the parties, the title to any and all
equipment acquired through the expenditure of funds received from the State shall remain the
property of the State by and through the ADHS and, as such, shall remain under the sole direction,
management and control of the ADHS. When this Contract is terminated, the disposition of all such
property shall be determined by the ADHS. For Fixed Price contracts, when the Contractor
provides the services/materials required by the Contract, any and all equipment purchased by the
Contractor remains the property of the Contractor. All purchases of equipment need to be reported
to the ADHS Office of Inventory Control.
4.10.2. Title and Rights to Materials. As used in this section, the term “Materials” means all products
created or produced by the Contractor under this Contract, including, but not limited to: written and
electronic information, recordings, reports, research, research findings, conclusions, abstracts,
results, software, data and any other intellectual property or deliverables created, prepared, or
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received by the Contractor in performance of this Contract. Contractor acknowledges that all
Materials are the property of the State by and through the ADHS and, as such, shall remain under
the sole direction, management and control of the ADHS. The Contractor is not entitled to a patent
or copyright on these Materials and may not transfer a patent or copyright on them to any other
person or entity. To the extent any copyright in any Materials may originally vest in the Contractor,
the Contractor hereby irrevocably transfers to the ADHS, for and on behalf of the State, all
copyright ownership. The ADHS shall have full, complete and exclusive rights to reproduce,
duplicate, adapt, distribute, display, disclose, publish, release and otherwise use all Materials. The
Contractor shall not use or release these Materials without the prior written consent of the ADHS.
When this Contract is terminated, the disposition of all such Materials shall be determined by the
ADHS. Further, the Contractor agrees to give recognition to the ADHS for its support of any
program when releasing or publishing program Materials.
4.10.3. Notwithstanding the above, if the Contractor is a State agency, the following shall apply instead: It
is the intention of ADHS and Contractor that all material and intellectual property developed under
this Agreement be used and controlled in ways to produce the greatest benefit to the parties to this
Contract and the citizens of the State of Arizona. As used in this paragraph, “Material” means all
written and electronic information, recordings, reports, findings, research information, abstracts,
results, software, data, discoveries, inventions, procedures and processes of services developed by
the Contractor and any other materials created, prepared or received by the Contractor and
subcontractors in performance of this Agreement. “Material” as used herein shall not include any
pre-existing data, information, materials, discoveries, inventions or any form of intellectual property
invented, created, developed or devised by Contractor (or its employees, subcontractors or agents)
prior to the commencement of the services funded by this Agreement or that may result from
Contractor’s involvement in other service activities that are not funded by the Agreement.
4.10.4. Title and exclusive copyright to all Material shall vest in the State of Arizona, subject to any rights
reserved on behalf of the federal government. As State agencies and instrumentalities, both ADHS
and Contractor shall have full, complete, perpetual, irrevocable and non-transferable rights to
reproduce, duplicate, adapt, make derivative works, distribute, display, disclose, publish and
otherwise use any and all Material. The Contractor’s right to use Material shall include the following
rights: the right to use the Material in connection with its internal, non-profit research and
educational activities, the right to present at academic or professional meetings or symposia and
the right to publish in journals, theses, dissertations or otherwise of Contractor’s own choosing.
Contractor agrees to provide ADHS with a right of review prior to any publication or public
presentation of the Material, and ADHS shall be entitled to request the removal of its confidential
information or any other content the disclosure of which would be contrary to the best interest of the
State of Arizona. Neither party shall release confidential information to the public without the prior
expressly written permission of the other, unless required by the State public records statutes or
other law, including a court order. Each party agrees to give recognition to the other party in all
public presentations or publications of any Material, when releasing or publishing them.
4.10.5. In addition, ADHS and Contractor agree that any and all Material shall be made freely available to
the public to the extent it is in the best interest of the State. However, if either party wants to
license or assign an intellectual property interest in the material to a third-party for monetary
compensation, ADHS and Contractor agree to convene to determine the relevant issues of title,
copyright, patent and distribution of revenue. In the event of a controversy as to whether the
Material is being used for monetary compensation or in a way that interferes with the best interest
of the state or ADHS, then the Arizona Department of Administration shall make the final decision.
Notwithstanding the above, “monetary compensation’ does not include compensation paid to an
individual creator for traditional publications in academia (the copyrights to which are Employee-
Excluded Works under ABOR Intellectual Property Policy Section 6-908C.4.), an honorarium or
other reimbursement of expenses for an academic or professional presentation, or an unprofitable
distribution of Material.
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4.11. E-Verify Requirements In accordance with A.R.S. § 41-4401, Contractor warrants compliance with all
Federal immigration laws and regulations relating to employees and warrants its compliance with Section
A.R.S. § 23-214, Subsection A.
4.12. Federal Immigration and Nationality Act The Contractor shall comply with all federal, state and local
immigration laws and regulations relating to the immigration status of their employees during the term of the
Contract. Further, the Contractor shall flow down this requirement to all subcontractors utilized during the
term of the Contract. The State shall retain the right to perform random audits of Contractor and
subcontractor records or to inspect papers of any employee thereof to ensure compliance. Should the State
determine that the Contractor and/or any subcontractors be found noncompliant, the State may pursue all
remedies allowed by law, including, but not limited to; suspension of work, termination of the Contract for
default and suspension and/or debarment of the Contractor.
5. Costs and Payments
5.1. Payments. Payments shall comply with the requirements of A.R.S. Titles 35 and 41, net 30 days. Upon
receipt and acceptance of goods or services, the Contractor shall submit a complete and accurate
Contractor’s Expenditure Report for payment from the State within thirty (30) days, as provided in the
Accounting and Auditing Procedures Manual for the ADHS.
5.2. Recoupment of Contract Payments.
5.2.1. Unearned Advanced Funds. Any unearned State funds that have been advanced to the Contractor
and remain in its possession at the end of each budget term, or at the time of termination of the
Contract, shall be refunded to the ADHS within forty-five (45) days of the end of a budget term or of
the time of termination.
5.2.2. Contracted Services. In a fixed price contract, if the number of services provided is less than the
number of services for which the Contractor received compensation, funds to be returned to the
ADHS shall be determined by the Contract price. Where the price is determined by cost per unit of
service or material, the funds to be returned shall be determined by multiplying the unit of service
cost by the number of services the Contractor did not provide during the Contract term. Where the
price for a deliverable is fixed, but the deliverable has not been completed, the Contractor shall be
paid a pro rata portion of the completed deliverable. In a cost reimbursement contract, the ADHS
shall pay for any costs that the Contractor can document as having been paid by the Contractor
and approved by ADHS. In addition, the Contractor will be paid its reasonable actual costs for work
in progress as determined by Generally Accepted Accounting Procedures up to the date of contract
termination.
5.2.3. Refunds. Within forty-five (45) days after the end of each budget term or of the time of termination
of the Contract, the Contractor shall refund the greater of: i) the amount refundable in accordance
with paragraph 4.2.1, Unearned Advanced Funds; or ii) the amount refundable in accordance with
paragraph 5.2.2, Contracted Services.
5.2.4. Unacceptable Expenditures. The Contractor agrees to reimburse the ADHS for all Contract funds
expended, which are determined by the ADHS not to have been disbursed by the Contractor in
accordance with the terms of this Contract. The Contractor shall reimburse ADHS within 45 days of
the determination of unacceptability.
5.3. Unit Costs/Rates or Fees. Unit costs/rates or fees shall be based on costs, which are determined by ADHS
to be reasonable, allowable and allocable as outlined in the Accounting and Auditing Procedures Manual for
the ADHS.
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5.4. Applicable Taxes.
5.4.1. State and Local Transaction Privilege Taxes. The State of Arizona is subject to all applicable state
and local transaction privilege taxes. Transaction privilege taxes apply to the sale and are the
responsibility of the seller to remit. Failure to collect taxes from the buyer does not relieve the seller
from its obligation to remit taxes.
5.4.2. Tax Indemnification. The Contractor and all subcontractors shall pay all federal, state and local
taxes applicable to its operation and any persons employed by the Contractor. Contractor shall
require all subcontractors to hold the State harmless from any responsibility for taxes, damages and
interest, if applicable, contributions required under Federal, and/or state and local laws and
regulations and any other costs, including transaction privilege taxes, unemployment compensation
insurance, Social Security and Worker’s Compensation.
5.4.3. I.R.S. W9 Form. In order to receive payment under any resulting Contract, the Contractor shall
have a current I.R.S. W9 Form on file with the State of Arizona.
5.5. Availability of Funds for the Next Fiscal Year. Funds may not be presently available for performance under
this Contract beyond the first year of the budget term or Contract term. The State may reduce payments or
terminate this Contract without further recourse, obligation or penalty in the event that insufficient funds are
appropriated in the subsequent budget term. The State shall not be liable for any purchases or
Subcontracts entered into by the Contractor in anticipation of such funding. The Procurement Officer shall
have the discretion in determining the availability of funds.
5.6. Availability of Funds for the Current Contract Term. Should the State Legislature enter back into session
and decrease the appropriations through line item or general fund reductions, or for any other reason these
goods or services are not funded as determined by ADHS, the following actions may be taken by ADHS:
5.6.1. Accept a decrease in price offered by the Contractor;
5.6.2. Reduce the number of goods or units of service and reduce the payments accordingly;
5.6.3. Offer reductions in funding as an alternative to Contract termination; or
5.6.4. Cancel the Contract.
6. Contract Changes
6.1. Amendments, Purchase Orders and Change Orders. This Contract is issued under the authority of the
Procurement Officer who signed this Contract. The Contract may be modified only through a Contract
Amendment, Purchase Order and/or Change Order within the scope of the Contract, unless the change is
administrative or otherwise permitted by the Special Terms and Conditions. Changes to the Contract,
including the addition of work or materials, the revision of payment terms, or the substitution of work or
materials, directed by an unauthorized State employee or made unilaterally by the Contractor are violations
of the Contract and of applicable law. Such changes, including unauthorized Contract Amendments,
Purchase Orders and/or Change Orders, shall be void and without effect, and the Contractor shall not be
entitled to any claim under this Contract based on those changes.
6.2. Subcontracts. The Contractor shall not enter into any subcontract under this Contract without the advance
written approval of the Procurement Officer. The subcontract shall incorporate by reference all material and
applicable terms and conditions of this Contract.
6.3. Assignments and Delegation. The Contractor shall not assign any right nor delegate any duty under this
Contract without the prior written approval of the Procurement Officer. The State shall not unreasonably
withhold approval.
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7. Risk and Liability
7.1. Risk of Loss. The Contractor shall bear all loss of conforming material covered under this Contract until
received and accepted by authorized personnel at the location designated in the Purchase Order, Change
Order or Contract. Mere receipt does not constitute final acceptance. The risk of loss for nonconforming
materials shall remain with the Contractor regardless of receipt.
7.2. Mutual Indemnification. Each party (as “indemnitor”) agrees to indemnify, defend and hold harmless the
other party (as “indemnitee”) from and against any and all claims, losses, liability, costs or expenses
(including reasonable attorney’s fees) (hereinafter collectively referred to as “claims”) arising out of bodily
injury of any person (including death) or property damage, but only to the extent that such claims, which
result in vicarious/derivative liability to the indemnitee, are caused by the act, omission, negligence,
misconduct, or other fault of the indemnitor, its officers, officials, agents, employees or volunteers.
7.3. Force Majeure.
7.3.1. Liability and Definition. Except for payment of sums due, neither party shall be liable to the other
nor deemed in default under this Contract if and to the extent that such party’s performance of this
Contract is prevented by reason of force majeure. The term “force majeure” means an occurrence
that is beyond the control of the party affected and occurs without its fault or negligence. Without
limiting the foregoing, force majeure includes acts of God; acts of the public enemy; acts of
terrorism; war; riots; strikes; mobilization; labor disputes; civil disorders; fire; flood; lockouts;
injunctions-interventions not caused by or resulting from the act or failure to act of the parties;
failures or refusals to act by government authority not caused by or resulting from the act or failure
to act of the parties; and other similar occurrences beyond the control of the party declaring force
majeure, which such party is unable to prevent by exercising reasonable diligence.
7.3.2. Exclusions. Force Majeure shall not include the following occurrences:
7.3.2.1. Late delivery of Materials caused by congestion at a manufacturer’s plant or elsewhere, or
an oversold condition of the market;
7.3.2.2. Late performance by a subcontractor unless the delay arises out of a force majeure
occurrence in accordance with this force majeure term and condition; or
7.3.2.3. Inability of either the Contractor or any subcontractor to acquire or maintain any required
insurance, bonds, licenses or permits.
7.3.3. Notice. If either party is delayed at any time in the progress of the work by force majeure, the
delayed party shall notify the other party in writing of such delay, as soon as is practicable and no
later than the following working day of the commencement thereof, and shall specify the causes of
such delay in such notice. Such notice shall be delivered or mailed certified-return receipt and shall
make a specific reference to this article, thereby invoking its provisions. The delayed party shall
cause such delay to cease as soon as practicable and shall notify the other party in writing when it
has done so. The time of completion shall be extended by Contract Amendment for a period of
time equal to the time that the results or effects of such delay prevent the delayed party from
performing in accordance with this Contract.
7.3.4. Default. Any delay or failure in performance by either party hereto shall not constitute default
hereunder or give rise to any claim for damages or loss of anticipated profits if, and to the extent
that, such delay or failure is caused by force majeure.
7.4. Third Party Antitrust Violations. The Contractor assigns to the State any claim for overcharges resulting
from antitrust violations to the extent that those violations concern materials or services supplied by third
parties to the Contractor for or toward the fulfillment of this Contract.
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8. Description of Materials The following provisions shall apply to Materials only:
8.1. Liens. The Contractor agrees that the Materials supplied under this Contract are free of liens. In the event
the Materials are not free of liens, Contractor shall pay to remove the lien and any associated damages or
replace the Materials with Materials free of liens.
8.2. Quality. Unless otherwise modified elsewhere in these terms and conditions, the Contractor agrees that, for
one year after acceptance by the State of the Materials, they shall be:
8.2.1. Of a quality to pass without objection in the Contract description;
8.2.2. Fit for the intended purposes for which the Materials are used;
8.2.3. Within the variations permitted by the Contract and are of even kind, quantity, and quality within
each unit and among all units;
8.2.4. Adequately contained, packaged and marked as the Contract may require; and
8.2.5. Conform to the written promises or affirmations of fact made by the Contractor.
8.3. Inspection/Testing. Subparagraphs 8.1 through 8.2 of this paragraph are not affected by inspection or
testing of or payment for the Materials by the State.
8.4. Compliance With Applicable Laws. The Materials and services supplied under this Contract shall comply
with all applicable federal, state and local laws, and the Contractor shall maintain all applicable license and
permit requirements.
8.5. Survival of Rights and Obligations After Contract Expiration and Termination.
8.5.1. Contractor’s Representations. All representations and warranties made by the Contractor under
this Contract in paragraphs 7 and 8 shall survive the expiration or termination hereof. In addition,
the parties hereto acknowledge that pursuant to A.R.S. § 12.510, except as provided in A.R.S. §
12-529, the State is not subject to or barred by any limitations of actions prescribed in A.R.S. Title
12, Chapter 5.
8.5.2. Purchase Orders and Change Orders. Unless otherwise directed in writing by the Procurement
Officer, the Contractor shall fully perform and shall be obligated to comply with all Purchase Orders
and Change Orders received by the Contractor prior to the expiration or termination hereof,
including, without limitation, all Purchase Orders and Change Orders received prior to but not fully
performed and satisfied at the expiration or termination of this Contract.
9. State’s Contractual Remedies
9.1. Right to Assurance. If the State, in good faith, has reason to believe that the Contractor does not intend to,
or is unable to, perform or continue performing under this Contract, the Procurement Officer may demand
in writing that the Contractor give a written assurance of intent to perform. Failure by the Contractor to
provide written assurance within the number of Days specified in the demand may, at the State’s option, be
the basis for terminating the Contract.
9.2. Stop Work Order.
9.2.1. Terms. The State may, at any time, by written order to the Contractor, require the Contractor to
stop all or any part of the work called for by this Contract for a period up to ninety (90) Days after
the order is delivered to the Contractor, and for any further period to which the parties may agree.
The order shall be specifically identified as a stop work order issued under this clause. Upon
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receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable
steps to minimize the incurrence of costs allocable to the work covered by the order during the
period of work stoppage.
9.2.2. Cancellation or Expiration. If a stop work order issued under this clause is canceled or the period of
the order or any extension expires, the Contractor shall resume work. The Procurement Officer
shall make an equitable adjustment in the delivery schedule or Contract price, or both, and the
Contract shall be amended in writing accordingly.
9.3. Non-exclusive Remedies. The rights and remedies of ADHS under this Contract are not exclusive, and
ADHS is entitled to all rights and remedies available to it, including those under the Arizona Uniform
Commercial Code and Arizona common law.
9.4. Right of Offset. The State shall be entitled to offset against any sums due the Contractor in any Contract
with the State or damages assessed by the State because of the Contractor’s non-conforming performance
or failure to perform this Contract. The right to offset may include, but is not limited to, a deduction from an
unpaid balance and a collection against the bid and/or performance bonds. Any offset taken for damages
assessed by the State shall represent a fair and reasonable amount for the actual damages and shall not
be a penalty for non-performance.
10. Contract Termination
10.1. Cancellation for Conflict of Interest. Pursuant to A.R.S. § 38-511, the State may cancel this Contract within
three (3) years after Contract execution without penalty or further obligation if any person significantly
involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of the State is, or
becomes at any time while the Contract or an extension of the Contract is in effect, an employee of or a
consultant to any other party to this Contract with respect to the subject matter of the Contract. The
cancellation shall be effective when the Contractor receives written notice of the cancellation, unless the
notice specifies a later time. If the Contractor is a political subdivision of the State, it may also cancel this
Contract as provided in A.R.S. § 38-511.
10.2. Gratuities. The State may, by written notice, terminate this Contract, in whole or in part, if the State
determines that employment or a Gratuity was offered or made by the Contractor or a representative of the
Contractor to any officer or employee of the State for the purpose of influencing the outcome of the
procurement, securing the Contract or an Amendment to the Contract, or receiving favorable treatment
concerning the Contract, including the making of any determination or decision about Contract
performance. The State, in addition to any other rights or remedies, shall be entitled to recover exemplary
damages in the amount of three times the value of the Gratuity offered by the Contractor.
10.3. Suspension or Debarment. The State may, by written notice to the Contractor, immediately terminate this
Contract if the State determines that the Contractor or its subcontractor has been debarred, suspended or
otherwise lawfully prohibited from participating in any public procurement activity, including but not limited
to, being disapproved as a subcontractor of any public procurement unit or other governmental body.
10.4. Termination Without Cause.
10.4.1. Both the State and the Contractor may terminate this Contract at any time with thirty (30) days’
notice in writing specifying the termination date. Such notices shall be given by personal delivery or
by certified mail, return receipt requested.
10.4.2. If the Contractor terminates this Contract, any monies prepaid by the State, for which no service or
benefit was received by the State, shall be refunded to the State within 5 days of the termination
notice. In addition, if the Contractor terminates the Contract, the Contractor shall indemnify the
State for any sanctions imposed by the funding source as a result of the Contractor’s failure to
complete the Contract.
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ADHS18-203283 TERMS AND CONDITIONS
10.4.3. If the State terminates this Contact pursuant to this Section, the State shall pay the Contractor the
Contract price for all Services and Materials completed up to the date of termination. In a fixed
price contract, the State shall pay the amount owed for the Services or Materials by multiplying the
unit of service or item cost by the number of unpaid service units or items. In a cost reimbursement
contract, the ADHS shall pay for any costs that the Contractor can document as having been paid
by the Contractor and approved by ADHS. In addition, the Contractor will be paid its reasonable
actual costs for work in progress as determined by GAAP up to the date of termination. Upon such
termination, the Contractor shall deliver to the ADHS all deliverables completed. ADHS may
require Contractor to negotiate the terms of any remaining deliverables still due.
10.5. Mutual Termination. This Contract may be terminated by mutual written agreement of the parties
specifying the termination date and the terms for disposition of property and, as necessary, submission of
required deliverables and payment therein.
10.6. Termination for Default. The State reserves the right to terminate the Contract in whole or in part due to
the failure of the Contractor to comply with any material obligation, term or condition of the Contract, to
acquire and maintain all required insurance policies, bonds, licenses and permits, or to make satisfactory
progress in performing the Contract. In the event the ADHS terminates the Contract in whole or in part as
provided in this paragraph, the ADHS may procure, upon such terms and in such manner as deemed
appropriate, Services or Materials, similar to those terminated, and Contractor shall be liable to the ADHS
for any excess costs incurred by the ADHS in obtaining such similar Services or Materials.
10.7. Continuation of Performance Through Termination. Upon receipt of the notice of termination and until the
effective date of the notice of termination, the Contractor shall perform work consistent with the
requirements of the Contract and, if applicable, in accordance with a written transition plan approved by the
ADHS. If the Contract is terminated in part, the Contractor shall continue to perform the Contract to the
extent not terminated. After receiving the notice of termination, the Contractor shall immediately notify all
subcontractors, in writing, to stop work on the effective date of termination, and on the effective date of
termination, the Contractor and subcontractors shall stop all work.
10.8. Disposition of Property. Upon termination of this Contract, all property of the State, as defined herein, shall
be delivered to the ADHS upon demand.
11. Arbitration
Pursuant to A.R.S. § 12-1518, disputes under this Contract shall be resolved through the use of arbitration when
the case or lawsuit is subject to mandatory arbitration pursuant to rules adopted under A.R.S. § 12 -133.
12. Communication
12.1. Program Report. When reports are required by the Contract, the Contractor shall provide them in the
format approved by ADHS.
12.2. Information and Coordination. The State will provide information to the Contractor pertaining to activities
that affect the Contractor’s delivery of services, and the Contractor shall be responsible for coordinating
their activities with the State’s in such a manner as not to conflict or unnecessarily duplicate the State’s
activities. As the work of the Contractor progresses, advice and information on matters covered by the
Contract shall be made available by the Contractor to the State throughout the effective period of the
Contract.
13. Client Grievances
If applicable, the Contractor and its subcontractors shall use a procedure through which clients may present
grievances about the operation of the program that result in the denial, suspension or reduction of services
provided pursuant to this Contract and which is acceptable to and approved by the State.
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14. Sovereign Immunity
Pursuant to A.R.S. § 41-621(O), the obtaining of insurance by the State shall not be a waiver of any sovereign
immunity defense in the event of suit.
15. Administrative Changes
The Procurement Officer, or authorized designee, reserves the right to correct any obvious clerical, typographical
or grammatical errors, as well as errors in party contact information (collectively, “Administrative Changes”), prior
to or after the final execution of a Contract or Contract Amendment. Administrative Changes subject to
permissible corrections include: misspellings, grammar errors, incorrect addresses, incorrect Contract
Amendment numbers, pagination and citation errors, mistakes in the labeling of the rate as either extended or
unit, and calendar date errors that are illogical due to typographical error. The Procurement Office shall
subsequently send to the Contractor notice of corrections to administrative errors in a written confirmation letter
with a copy of the corrected Administrative Change attached.
16. Survival of Terms After Termination or Cancellation of Contract
All applicable Contract terms shall survive and apply after Contract termination or cancellation to the extent
necessary for Contractor to complete and for the ADHS to receive and accept any final deliverables that are due
after the date of the termination or cancellation.
17. Health Insurance Portability and Accountability Act of 1996 (HIPAA)
17.1. The Contractor warrants that it is familiar with the requirements of HIPAA, as amended by the Health
Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009, and accompanying
regulations and will comply with all applicable HIPAA requirements in the course of this Contract.
Contractor warrants that it will cooperate with the Arizona Department of Health Services (ADHS) in the
course of performance of the Contract so that both ADHS and Contractor will be in compliance with HIPAA,
including cooperation and coordination with the Arizona Department of Administration-Arizona Strategic
Enterprise Technology (ADOA-ASET) Office, the ADOA-ASET Arizona State Chief Information Security
Officer and HIPAA Coordinator and other compliance officials required by HIPAA and its
regulations. Contractor will sign any documents that are reasonably necessary to keep ADHS and
Contractor in compliance with HIPAA, including, but not limited to, business associate agreements.
17.2. If requested by the ADHS Procurement Office, Contractor agrees to sign a “Pledge To Protect Confidential
Information” and to abide by the statements addressing the creation, use and disclosure of confidential
information, including information designated as protected health information and all other confidential or
sensitive information as defined in policy. In addition, if requested, Contractor agrees to attend or
participate in HIPAA training offered by ADHS or to provide written verification that the Contractor has
attended or participated in job related HIPAA training that is: (1) intended to make the Contractor proficient
in HIPAA for purposes of performing the services required and (2) presented by a HIPAA Privacy Officer or
other person or program knowledgeable and experienced in HIPAA and who has been approved by the
ADOA-ASET Arizona State Chief Information Security Officer and HIPAA Coordinator.
18. Comments Welcome
The ADHS Procurement Office periodically reviews the Uniform Terms and Conditions and welcomes any
comments you may have. Please submit your comments to: ADHS Procurement Administrator, Arizona
Department of Health Services, 150 North 18th Avenue, Suite 280, Phoenix, Arizona 85007.
19. Data Universal Numbering System (DUNS) Requirement
For federal funding, pursuant to 2 CFR 25.100 et seq., no entity (defined as a Governmental organization, which
is a State, local government, or Indian tribe; foreign public entity; domestic or foreign nonprofit organization;
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domestic or foreign for-profit organization; or Federal agency, but only as a subrecipient under an award or
subaward to a non-Federal entity) may receive a subaward from ADHS unless the entity provides its Data
Universal Numbering System (DUNS) Number to ADHS.
20. The Federal Funding Accountability and Transparency Act (FFATA or Transparency Act - P.L.109-282, as
amended by section 6202(a) of P.L. 110-252), found at https://www.fsrs.gov/
If applicable, the Contractor/Grantee shall submit to ADHS via email the Grant Reporting Certification Form. This
form and the instructions can be downloaded from the ADHS Procurement website at
http://www.azdhs.gov/operations/financial-services/procurement/index.php#ffata and must be returned to the
ADHS by the 15th of the month following that in which the award was received. The form shall be completed
electronically, and submitted using the steps outlined in the Grant Reporting Certification Form Instructions to the
following email address: ADHS_Grant@azdhs.gov. All required fields must be filled including Top Employee
Compensation, if applicable. Completing the Grant Reporting Certification Form is required for compliance with
the Office of Management and Budget (OMB), found at http://www.whitehouse.gov/omb/open. Failure to timely
submit the Grant Reporting Certification Form could result in the loss of funds. This requirement applies to all
subcontractors/sub-awardees utilized by the Contractor/Grantee for amounts exceeding $30,000.00 during the
term of the Award.
21. Contracting; Procurement; Investment; Prohibitions
21.1. A public entity may not enter into a contract with a company to acquire or dispose of services,
supplies, information technology or construction unless the contract includes a written certification that
the company is not currently engaged in, and agrees for the duration of the contract to not engage in,
a boycott of Israel.
21.2. A public entity may not adopt a procurement, investment or other policy that has the effect of inducing
or requiring a person or company to boycott Israel.
21.3. Contractor hereby certifies that it is not currently engaged in, and will not for the duration of this Contract
engage in, a boycott of Israel as defined by A.R.S. § 35-393.01. Violation of this certification by Contractor
may result in action by the State up to and including termination of this Contract.
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ADHS18-203283 SCOPE OF WORK
SCOPE OF WORK
1. Background
The mission of the Arizona Department of Health Services, Bureau of Tobacco and Chronic Disease (ADHS-BTCD),
is to work together to build individual, organizational and community capabilities to reduce the impact of commercial
tobacco use. This is accomplished through development of quality programs, policies, and services that include
community network building, youth prevention activities, tobacco cessation services, and integrating community
efforts that establish strategic partnerships and collaborations in order to reduce commercial tobacco use in Arizona.
Commercial tobacco use is the leading preventable cause of death and disease in the United States. Commercial
tobacco use leads to almost 500,000 deaths annually within the Unites States and approximately 7,000 deaths in
Arizona alone. Tobacco control programs are designed to help reduce disease, disability, and early death related to
commercial use.
The tobacco program at ADHS has engaged in intensive anti-smoking and cessation programs statewide, together
with local county health departments/districts and community partners. These programs and collaborative
partnerships have significantly reduced cigarette smoking rates in Arizona.
Maricopa County is the nation’s fourth largest county with a population that is greater than that of 21 states, Maricopa
County has a justice system that is large, complex, and impacts many people. The average daily number of adults in
Maricopa County’s jail system is approximately 8,000 (2015), and the monthly average number of adults on Maricopa
County probation is approximately 52,000 (2015).
As a tobacco-free facility, tobacco-using adults who are booked into Maricopa County jails are required to immediately
stop using tobacco without access to support services for tobacco cessation including Nicotine Replacement
Treatment (NRT). National research has shown that 90% to 97% of detained adults who smoked prior to being
incarcerated return to smoking within 6 months of release. Since tobacco use is the leading preventable cause of
death in the United States and smoking has been identified as a risk factor for recidivism, addressing tobacco
cessation among those involved in Maricopa County’s justice system can positively impact the health of Maricopa
County residents as well as the cost to Maricopa County and its community.
2. Objective
The objective of this Inter Governmental Agreement is to provide Maricopa County Department of Public Health with
funding to develop a pilot project plan to address tobacco use among adults in Maricopa County’s justice system that
incorporates evidence-based practices, evaluation and sustainability.
3. Task
The Contractor shall:
3.1. Identify and utilize best practices in the areas of tobacco cessation that most appropriately can be applied
within the Maricopa County justice system and support the justice-involved population in Maricopa County;
3.2. Continuously assess the Maricopa County justice system to identify tobacco cessation intervention points
within this system and within the larger community that serves this justice-involved population. Identify
resources and needs in Maricopa County to address tobacco use among those involved in the justice system;
3.3. Identify and prioritize opportunities to build tobacco cessation capacity among those Maricopa County
agencies serving the justice involved population both in jail and upon re-entry. Develop systemic solutions to
connect those involved in the justice system to tobacco cessation services in Maricopa County;
3.4. Implement and support tobacco cessation efforts in the Maricopa County justice system and in organizations
that serve those in the justice system;
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3.5. Present a detailed report on all findings from work performed;
3.6. Provide project management services and resources for Maricopa County and other Arizona counties
implementing tobacco cessation justice-involved efforts;
3.7. Coordinate all logistics with multiple Maricopa County pilot sites including the need for Nicotine Replacement
Therapy (NRT);
3.8. Coordinate and attend all training and planning meeting with Maricopa County justice-involved agencies;
3.9. Ensure constant communication between Public Health and its Maricopa County justice-involved agencies;
3.10. Establish a monthly status meeting with ADHS;
3.11. Establish evaluation plans for pilot sites; and
3.12. Participate in a justice involved community of learning with other counties and ADHS.
4. Deliverables
4.1. Submit to ADHS a Quarterly Report of Contract activities due within fifteen (15) days following the end of each
quarter;
4.2. Submit to ADHS a Monthly Contractor Expenditure Report (CER), due thirty (30) days following the month of
service;
4.3. Submit an Annual Report by August 1st; and
4.4. Submit a Final Project Report upon completion of the pilot period.
5. ADHS will provide
5.1. Provide technical assistance as needed;
5.2. Convene quarterly justice involved community of learning discussions; and
5.3. Consulting services by the Behavioral Health & Wellness Program at the University of Colorado Anschutz
Medical Campus School of Medicine.
6. Attachments
6.1. Budget Development Guidelines and Worksheet (see Exhibit 1 as example); and
6.2. Monthly Contractor Expenditure Report (see Exhibit 2 as example).
7. Notices, Correspondence, Reports and Invoices
Notices, Correspondence, Reports and Invoices from Maricopa County Department of Public Health shall be sent to:
Arizona Department of Health Services
Bureau of Tobacco and Chronic Disease
Attn: Karen Boswell, Office Chief of Operations
150 North 18th Avenue, Suite 310
Phoenix, Arizona 85007
Telephone: (602) 364-0832
E-mail: karen.boswell@azdhs.gov
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Notices, Correspondence, Reports and Payments from ADHS to the Contractor shall be sent to:
Maricopa County Department of Public Health
Tracy Cruickshank, MBA, MSW
Office of Healthcare Innovations
4041 North Central Ave, Suite 1400
Phoenix, Arizona 85012
Telephone: (602) 506-6858
E-mail: tracycruickshank@mail.maricopa.gov
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ADHS18-203283 PRICE SHEET
Price Sheet
Effective Date July 1, 2018 to June 30, 2019
Cost Reimbursement Budget Amount
1. Personnel Services/ERE $
2. Professional & Outside Services $
3. Travel Expenses $
4. Other operating Expenses $
5. Capital Outlay Expenses $
6. Other ( Indirect Costs) $
Total Contract Amount (not to exceed) $ 200,000.00
ITEMIZED SERVICE BUDGET (ISB) RESTRICTIONS
The Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total Contract
amount among the categorical line items. Transfers of funds are only allowed among funded line items as
detailed in the original ISB. Transfers exceeding ten percent (10%) of the Contracted amount, or to a non-
funded line item, shall require a Contract Amendment.
Indirect Costs shall not exceed fifteen percent (15%) of the combined total Personnel Services and
Employee Related Expenses as listed on the ISB. For more detailed information regarding indirect costs,
refer to the ADHS Accounting and Auditing Procedures Manual for Contractors of ADHS Funded
Programs. This manual is incorporated into this contract by reference.
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Exhibit One (1)
Budget Development Guidelines and Worksheet
Specific types of Provider costs are to be grouped into six (6) budget categories. Within the total cost for
each budget category, a series of line item costs are to be identified. All budgeted amounts are to be
rounded to the nearest dollar in each line item and budget category. It is essential that category costs
be comprised of the same item costs as specified in these Guidelines. A narrative budget justification of
each budget category is recommended.
The Budget must be based upon the projected client enrollments and the number of services to be
provided as authorized by ADHS and approved by Purchase Order.
1. PERSONNEL SERVICES
a. Compensation for personnel services is an allowable expense for Provider employees
whose work is necessary for the provision of contract services.
b. Salaries to be charged to the service must relate directly to work on the service. Salaries
of employees involved in work on non-contract services must be properly apportioned
and later supported by appropriate time distribution records or any other acceptable
method.
c. Benefits such as vacation, sick and administrative leave, holidays and routine training
participation time are to be included in the amount budgeted for an employee’s salary. In
addition, any salary increases due an employee during the contract period must be
included in the budgeted salary costs.
2. EMPLOYEE RELATED EXPENSES (ERE)
a. Employee related expenses (fringe benefits) are allowances and services offered by the
Provider agency to its employees as compensation in addition to regular salaries. Fringe
benefits must be applied only to that portion of an employee’s salary or wages
attributable to the service. Fringe benefits budgeted in the contract must be earned
during the contract period. Benefits accrued prior to the contract, but not yet paid out, are
not expenses allowed by the Department.
b. Fringe benefits include, but are not limited to Social Security (FICA), Unemployment
Insurance, Worker’s Compensation, health and life insurance, and retirement. The
portion of the cost of these benefits paid by the employee is not an expense of the
Provider agency. The employer’s cost of these benefits is an eligible Provider agency
expense.
3. PROFESSIONAL AND OUTSIDE SERVICES
a. Professional and consultant services, rendered by individuals or organizations, are
allowable expenses if the services are directly related and essential to the contract
service(s). The normal types of professional or outside services which may be placed in
this budget category are those which relate to the legal, accounting, management,
training/education, medical, social service and psychological professions.
b. A written specification, of each of the consultant services to be performed, is to be
available for the purpose of budget estimating and subsequent audits. The specifications
normally will include estimates by item, all consultant costs such as travel, supplies,
meetings or any directly related costs of the consultant. Professional and Outside
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services are frequently purchased on an hourly basis. It is, therefore, recommended that
such services be budgeted on a per hour billing basis.
4. TRAVEL
a. Travel will include the cost of transporting staff and clients during the provision of contract
services. The following allowable travel costs are included within this category:
i. Staff-owned vehicles: mileage reimbursement;
ii. Provider agency-owned vehicles: operating expenses and depreciation;
iii. Sub-contracted travel services;
iv. Rented vehicles;
v. Government motor pool vehicles;
vi. Public transportation; and
vii. Per Diem.
b. Staff-Owned Vehicles
i. The travel cost of a vehicle owned by a Provider employee should be budgeted
no greater than the offerors designated mileage reimbursement rate. In public
Provider agencies, the mileage rate is determined by the branch of government
with which the Provider agency is affiliated. Public Provider agencies may
budget up to the maximum rate allowable in their city, county or municipality. The
actual cost of tolls and parking fees may be budgeted for employees using their
vehicles for contract services.
c. Provider Agency-Owned Vehicles
i. Travel costs for vehicles owned by a Provider agency must be budgeted on an
actual cost method. Actual costs will include fuel, maintenance and repair,
insurance, registration fees, tolls, parking fees and depreciation.
ii. There are two methods to budget motor vehicles with regard to acquisition cost:
iii. The vehicle may be purchased with Provider agency funds. The cost will be
depreciated over the useful life of the vehicle. The current year depreciation
expense is listed in the Travel Category of the Service Budget.
iv. The agency may budget the entire acquisition cost as a first year expense under
the Equipment Category.
d. Rented Vehicles
If either a public or private Provider agency is renting vehicles from a private rental
agency, the actual rental cost plus fuel (unless fuel is included in the rental cost) should
be used to budget the cost. Rental costs will be considered reasonable depending on the
type and degree of use and current fair market value of the model of vehicle. If a vehicle
has been rented by the Provider until its acquisition cost has been reduced to below
$5,000, it may be purchased and budgeted as a current cost.
e. Motor Pool Vehicles
Provider agencies using vehicles supplied by a county or municipal motor pool may
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budget for travel by using the rate fixed by the motor pool.
f. Public Transportation
In cases in which public transportation is used for authorized travel by employees or
clients of the Provider, the actual cost of fares required should be estimated. Fare or any
other expenses for staff members to commute to and from work are not an allowable
cost.
g. Per Diem
While Providers are encouraged to minimize the overnight travel costs, certain contract
services may require occasional overnight travel on the part of employees. In such cases,
per diem expenses should be budgeted no greater than the Offerors designated per diem
reimbursement rate. For public Provider agencies, the per diem rate is determined by the
branch of government with which the Provider is affiliated. Public Provider agencies may
budget up to the maximum rate allowable in their city, county or municipality.
5. OCCUPANCY
a. Occupancy costs include occupancy services. Costs related to space needed for the
delivery of contract services are allowable expenses. Space costs include the expense of
a facility and other expenses directly related to the operation of the facility. Space Costs,
however, do not include the purchase or major modification of land or facilities.
6. OTHER OPERATING
a. Other Operating costs include materials and supplies and general operating services.
a. The costs of materials and supplies, necessary for the delivery of contract services, are
allowable budgeted expenses. Such costs should be calculated by deducting from the
purchase price, all cash and trade discounts, rebates, and allowances to be received by
the Provider agency.
b. Program Supplies
Program supplies include consumable supplies used directly in the provision of contract
services.
i. Materials
(1) Materials are consumable supplies used directly by the clients in the
provision of contract services. Material supplies will include but need not
be limited to:
(a) Arts and Crafts;
(b) Housekeeping Goods (dishes, linens, etc.);
(c) Client Activities Costs;
(d) Toys; and
(e) Literature.
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ii. Medical Items
(1) Medical care is an allowable cost if it is necessary to achieve the
objective of the contract services.
(2) Professional Medical Services: The cost of medical professionals is an
allowable expense. However, the cost should normally appear in the
Personnel or Professional and Outside Services Category contingent
upon the terms of the agreement between the Provider agency and the
medical professional(s).
(3) Pharmaceuticals: Pharmaceuticals should be budgeted on an actual
cost basis.
(4) Medical Supplies: Medical supplies should be budgeted on an actual
cost basis.
c. Office Supplies
i. General Office Supplies
ii. Office supplies are consumable supplies necessary to efficient administrative and
service operations of the service program. The cost of this item may be
budgeted by using a reasonable base cost per employee for the contract term
multiplied by the total number of employees needing office supplies. Justification
of the base cost must be available upon request.
iii. Equipment
Any piece of equipment with an acquisition cost of up to $4,999. 99 will be
budgeted under the Other Operating Category. Budgeting of such pieces of
equipment will be done on an actual cost basis. All Pieces of equipment with an
acquisition cost of $5,000 or more should be budgeted under the Capital Outlay
Category.
iv. Postage
Postage may be budgeted by applying a monthly base to the total number of
months in the contract. When applicable, Provider agencies should apply for and
utilize special bulk mail rates.
v. Reproduction and Printing
The cost of printing and reproduction services, necessary for the performance of
the contract, including but not limited to forms, reports, manuals and
informational literature is allowable. However, if a cost for the rental of a
photocopier has been budgeted, care must be taken to avoid duplication of costs.
When budgeting for reproduction and printing services, enter a reasonable
estimate of actual costs.
d. Maintenance of Space
This item includes costs necessary for the upkeep of the Provider’s facilities which
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neither add to the permanent value of these facilities nor appreciably prolong their
intended life, but keep them in an efficient operating condition. This includes estimates of
the actual costs of material needed for the maintenance and repair of the Provider’s
facilities or for sub-contracted maintenance services.
e. General Operating
i. Central Services: Service costs such as administrative, data processing, payroll,
supply and duplicating facilities on which the expense can be calculated and
segregated as a direct cost are to be entered in this item. Support these
budgeted expenses by indicating the basis of the cost.
ii. Communication: Telephone and answering service costs, as well as telephone
directory listings, which assist the client to identify and contact the Provider
agency for contract services, will be permitted.
iii. Bonding: Premiums for bonding costs will arise when there is a need to protect
the provider agency and government against financial loss. Bonding practices
beyond those which the Provider agency should normally use as good business
practice will not be required. The most common bonding classification is that of a
fidelity bond sufficient to cover the potential loss of accessible funds.
iv. Advertising: To acquire quality goods or services at a low cost; to recruit potential
employee; or to inform the public of the availability of services.
v. Training: Provider agency employees are eligible for training directly related to
the contract services. The necessary and appropriate expense related to training
activities is to be included in this line item. The basis for this budgeted expense
must be documented is the Proposal Itemized Service Budget, and a detailed
description of the training activities must be rendered in the
Program/Administration Section.
vi. Trade, Business, Technical and Professional Activities: A series of costs may be
encountered which assist in providing reference background, updating
employees’ knowledge and maintaining liaison or contact with similar activities.
Expenses in this line item will be allowable when the costs are proven to be of
direct benefit to the contract services. The following types of costs may be part
of this item’s budget expense:
(1) Library - purchases and fees;
(2) Subscriptions - professional literature;
(3) Membership - dues; and
(4) Professional activities, clubs and meetings.
vii. General Liability Insurance: Insurance costs are those insurance costs
which the Provider is required to carry, or which are approved under the terms of
the contract and any other insurance which the Provider maintains in connection
with the general conduct of its business (excluding insurance on the building and
contents which should be listed as a line item under Other Space Costs in the
Space Category). The Provider can ascertain from the Department what types
and amount of insurance coverage should be purchased.
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INTERGOVERNMENTAL AGREEMENT
ADHS18-203283 EXHIBITS
7. CAPITAL OUTLAY (EQUIPMENT)
a. The cost of equipment essential to the delivery of contract services and the maintenance
of that equipment is allowable as a budgeted expense. Equipment which materially
increases the value or useful life of a facility is unallowable.
b. The Equipment Category, which includes office and program equipment, has been
subdivided into two sections: (1) Equipment Costs, and (2) Equipment Maintenance
Costs. (Provider agencies should note that vehicle-operating expenses are to be
budgeted within the Travel Category.)
c. Capital Equipment Costs
Capital equipment costs may be budgeted through one of the following four methods:
(1) Purchase;
(2) Rental/Lease;
(3) Depreciation; and
(4) Use Allowance.
d. Equipment Maintenance Costs
i. To keep equipment at an efficient operating level, various maintenance services
may be necessary.
ii. Maintenance services provided by vendors either under a services subcontract or
as random repairs will be budgeted under this sections. Care must be used that
costs of maintenance services call do not duplicate maintenance fees provided
for in rental agreements. Maintenance costs must be calculated in proportion to
the use of the item by the Provider agency in the delivery of contract services.
8. OTHER
a. Indirect costs - Indirect costs are those incurred for a common or joint purpose benefiting
more than one cost objective or activity and not readily assignable to the cost objectives
specifically benefited, without effort disproportionate to the results achieved. Indirect
costs are subject to approval by ADHS.
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CONTRACT NUMBER
INTERGOVERNMENTAL AGREEMENT
ADHS18-203283 EXHIBITS
Itemized Service Budget
1. Personnel (use additional pages, if necessary) Total
Salary
FTE % Position/Title Name of Employee for % Allocated
$
TOTAL $
2. Employee Related Expenses
Item Basis
FICA $
Unemployment Insurance $
Worker’s Compensation $
Retirement $
Life Insurance $
Health Insurance
TOTAL $
3. Professional and Outside Services
Item Basis
$
TOTAL $
4. Travel Expenses
Item Basis
$
TOTAL $
5. Occupancy Expenses
Item Basis $
TOTAL
6. Other Operating
Item Basis
$
TOTAL $
7. Capital Outlay Expenses
Item Basis
$
TOTAL $
8. Other
Item Basis
$
TOTAL $
GRAND TOTAL $
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CONTRACT NUMBER
INTERGOVERNMENTAL AGREEMENT
ADHS18-203283 EXHIBITS
Exhibit Two (2)
Arizona Department of Health Services CONTRACTOR'S EXPENDITURE REPORT 4A. Cost Reimbursement -
Accounting/Contracts 1. Contract Number P.O. # Cumulative Actual Expenditures
1740 W. Adams Street 2. Contractor Name Fixed Price
Phoenix, Arizona 85007
3. Title of Program 4B. Periodic Report
4. Reporting Period FINAL REPORT
Contractor's Detailed Statement of Expenditures and Fixed Price Invoice #
5. COST REIMBURSEMENT Prior Report Period Year to Current Reporting Period Total Year to Date
(Actual Expenditures) Approved Budget Date Expenditures Expenditures Expenditures
A. Account Classification: ( a ) ( b ) ( c ) ( d )
Personal Services and ERE $ - $ - $ - $ -
Professional and Outside Services $ - $ - $ - $ -
Travel Expenses $ - $ - $ - $ -
Occupancy Expense $ - $ - $ - $ -
Other Operating Expense $ - $ - $ - $ -
Capital Outlay Expense $ - $ - $ - $ -
Other $ - $ - $ - $ -
Total $ - $ - $ - $ -
Approved Match Total Inkind and Cash Total Year to Date and
6. MATCH EXPENDITURES Inkind Match Expenditures Cash Match Expenditures
Budget Match Expenditures Match Expenditures
A. Account Classification: ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 )
Personal Services and ERE $ - $ - $ - $ - $ -
Professional and Outside Services $ - $ - $ - $ - $ -
Travel Expenses $ - $ - $ - $ - $ -
Occupancy Expense $ - $ - $ - $ - $ -
Other Operating Expense $ - $ - $ - $ - $ -
Capital Outlay Expense $ - $ - $ - $ - $ -
Other $ - $ - $ - $ - $ -
TOTAL $ - $ - $ - $ - $ -
ADHS USE ONLY THIS SECTION FOR ADHS ACCOUNTING USE ONLY 7. CONTRACTOR CERTIFICATION
I certify that this report has been examined by me, and to
Total Expenditures or total Fixed Price the best of my knowledge and belief, the reported
ADHS PROGRAM COORDINATOR CERTIFICATION: Adj (if required): expenditures and fixed price information is valid, based
upon our official accounting records (book of account)
Performance satisfactory for payment Less: Year to date payments and consistent with the terms of the contract. It is also
understood that the contract payments are calculated by
Performance unsatisfactory, withhold payment Adj (if required): the Department of Health Services based upon
information provided in this report.
No payment due Net payment due:
Index PCA AY Amount
PROGRAM COORDINATOR SIGNATURE/DATE AUTHORIZED CONTRACTOR'S SIGNATURE/TITLE/DATE
ADHS/BFS/F-110 (Rev. 6/23/2004) Preparer's Name and Phone #
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