C-39-17-006-3-05 - ADHS18-172583 A2 UNEXECUTED.PDF

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. 2
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 6, Contract Changes, Section 6.1, Amendments, Purchase Orders
and Change Orders, the Price Sheet is Revised and replaced with the Price Sheet in this Amendment. The Price
Sheet increase is to allow Maricopa County to provide additional administrative, core and support services to Ryan
White Part B (RWPB) based on approved projects.
(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. 2
Delilah Gonzalez
Price Sheet
Cost Annual Amount
Administrative $151,048.69
Core Services $1,900,000.00
Support Services $948,951.31
Total not to exceed: $3,000,000
1. The Indirect Rate included in the administrative cost is capped at ten percent (10 %).
2. RWPA will provide an annual budget for RWPB review and approved by March 31st of each year.
2