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Page 1 of 2 ARIZONA STATE CONTRACT CONTRACT RELEASE ProcureAZ Purchase Order No.: ADHS18-177694:1 Organizational Reference No.: P00000325337 Issued: 03108/2018 Vendor Number: 000010983 Arizona Department of Health Services Maricopa County Public Health Epidemiology and Disease Control Immunization 4041 N. Central Avenue, #1400 Program Phoenix, AZ 85012 150 N. 18th Avenue, Suite 120 Phoenix, AZ 85007 US Email: norma.oloughlin@azdhs.gov Contract No.: ADHS18-177694 (602) 364-3630 Title: Maricopa County Immunization Services MAIL INVOICE IN DUPLICATE TO: Arizona Department of Health Services Epidemiology and Disease Control Immunization Program 150 N. 18th Avenue, Suite 120 Phoenix, AZ 85007 US Email: norma.oloughlin@azdhs.gov (602) 364-3630 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. Account Code: 2018--FEDEDC6258--5170--HS2000--HS20000-6811---PHS-E0C- Payment Terms: IVECPPHF--0618 HSA Shipping Terms: N/A Delivery Calendar Day(s) A.R.O.: 0 Item Description I Requisition Quantity Unit Unit Price Total Class-Item 948-92 Immunization Program Services CONTRACT# ADHS18-177694 - MARICOPA COUNTY - Contract End Date - 12/31/2022 - PO Period thru 06/30/2018 , PO for the delivery of Immunization services and activities as follows; * Salary/Fringe - YEARLY $50,000.00 * Immunization visit for 1 children zero (0) to eighteen (18) years of age - UNIT RATE $50.00 " 1.00 TOTAL $ 722,070.00 $ 722,070.00 Immunization Completion for children zero (0) to eighteen (18) years of age - UNIT RATE $100,00 * Perinatal Hepatitis B Case Management - Prenatal - UNIT RATE $300.00 * Perinatal Hepatitis B Case Management - Postnatal - UNIT RATE $200,00 *School/Children 1DR Management-Preparation and submittal - UNIT RATE $250,00 * Immunization Visit for adults nineteen (19) years of age and older - UNIT RATE $50.00 *Immunization Visit for Flu Vaccine, in children and adults - UNIT RATE $50.00 CFDA# 93.539 "FFATA certification is required TOTAL: $ 722,070.00 Approved By: Norma O'Loughlin Phone No.: (602) 364-3649 C-86-18-018-3-01 ATTACHED TO AND A PART OF Purchase Order ADHS18-177694:1 Immunization Services, ADHS IN WITNESS WHEREOF, the parties agree to enter into this Agreement 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