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Page 1 of 3 ARIZONA STATE CONTRACT MASTER CONTRACT - TERM Purchase Order No.: ADHS17-141746 C-86-13-003-3-08 Organizational Reference No.: Effective Date: 01/01/2017 Valid Through: 12/31/2021 V Vendor Number: 000010983 I Arizona Department of Health Services E Maricopa County Public Health S Public Health Preparedness EDC N 4041 N. Central Avenue, #1400 S 150 N 18th Avenue D Phoenix, AZ 85012 U Phoenix, AZ 85007 O E R D Contract No.: ADHS17-141746 B Delilah Gonzalez Title: HIV Surveillance Program Y Budget Period 01/01/2018 Through 12/31/2018 The following documents make up the Contract and are incorporated herein by reference. Blanket Instructions ADHS17-141746 Contract Fully Executed.pdf ADHS17-141746 Amd 1 Fully Executed.pdf TERMS AND CONDITIONS set forth in our Bid, Quotation, or Purchase Order are incorporated herein by reference and become a part of this order. Instructional email for MCDPH requisition Account Code: Payment Terms: Net 30 Shipping Terms: Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0 Item Description Requisition Quantity Unit Unit Price Total Class-Item 952-43 1 1.00 YR $ 78,518.00 $ 78,518.00 Personnel Services Class-Item 952-43 2 1.00 YR $ 21,888.00 $ 21,888.00 Employee Related Expenses Class-Item 952-43 3 1.00 YR $ 0.00 $ 0.00 Professional & Outside Services Class-Item 952-43 4 1.00 YR $ 0.00 $ 0.00 Travel Expenses Page 2 of 3 ARIZONA STATE CONTRACT MASTER CONTRACT - TERM Class-Item 952-43 5 1.00 YR $ 341.00 $ 341.00 Other Operating Expenses Class-Item 952-43 6 1.00 YR $ 0.00 $ 0.00 Capital Outlay Expenses Class-Item 952-43 7 1.00 YR $ 15,061.00 $ 15,061.00 Other (Indirect Costs) Class-Item 952-43 8 0.00 EA $ 0.00 $ 0.00 Total Cost TOTAL: $ 115,808.00 Approved By: Delilah Gonzalez Phone No.: (602) 364-1482 Page 3 of 3 ATTACHED TO AND A PART OF: IGA ADHS17-141746 HIV Surveillance Program C-86-13-003-3-08 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