PO RE NURSE FAM PARTNRSHP WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS17-155910:2
Organizational Reference No.: PO0000278084
Issued: 10/02/2017
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Bureau of Women and Children's Health
N 4041 N. Central Avenue, #1400 H 150 N. 18th Avenue, Suite 320
Phoenix, AZ 85012 I Phoenix, AZ 85007
D US
O P Email: procure@azdhs.gov
R
T
O
Contract No.: ADHS17-155910 (602) 364-1400
Title: Nurse Family Partnership for MIECHV
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I Bureau of Women and Children's Health
150 N. 18th Avenue, Suite 320
L Phoenix, AZ 85007
L US
Email: procure@azdhs.gov
T
O
(602) 364-1400
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--FEDCFH6423--4340--HS2000--HS20000-6811--6811-PHS-WCH- Payment Terms: Net 30
MIECHFOR3--0918---------HSA
Shipping Terms:
Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 952-81
PO EFFECTIVE 10/1/17 - 9/30/18 *** CONTRACT EFFECTIVE 1/1/14 -
12/31/18 *** THIS LINE TO PAY FROM FEDCFH6423 0918*** CFDA
93.870 *** CONTRACTOR TO INVOICE ACCORDING TO PRICE SHEET
1 ****** CONTRACTOR TO INVOICE ACCORDING TO CONTRACT PRICE 1.00 TOTAL $ 130,874.67 $ 130,874.67
SHEET AS FOLLOWS: PERSONNEL = $55,222.380; ERE = $19,125.09;
PROFESSIONAL & OUTSIDE SERVICES = $39,981.67; TRAVEL
EXPENSE = $955.33 OCCUPANCY EXPENSES = $1,411.75; OTHER
OPERATING EXPENSE = $1,098.38; CAPITAL OUTLAY EXPENSE =
$41.67; OTHER (INDIRECT IF APPROVED) = $13,038.40; TOTAL THIS
LINE = $130874.67 **** THIS PO TOTAL = $785,2247.79
**************Nurse Family Partnership for MIECHV -
Class-Item 952-81
2 THIS LINE TO PAY FROM FEDCFH1770 / 0919 *** CFDA 93.870 ****** 1.00 QTR $ 654,373.12 $ 654,373.12
CONTRACTOR TO INVOICE ACCORDING TO CONTRACT PRICE
SHEET AS FOLLOWS: PERSONNEL = $276,111.90; ERE = $95,625.43;
PROFESSIONAL & OUTSIDE SERVICES = $199,908.33; TRAVEL
EXPENSE = $4,776.66; OCCUPANCY EXPENSES = $7,058.75; OTHER
OPERATING EXPENSE = $5,491.90; CAPITAL OUTLAY EXPENSE =

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
$208.13; OTHER (INDIRECT IF APPROVED) = $65,192.02; TOTAL THIS
LINE = $654,373.12********Nurse Family Partnership for MIECHV -
TOTAL: $ 785,247.79
Approved By: Dee Vlahos
Phone No.: (602) 364-1425

C-86-17-049-3-01 ATTACHED TO AND A PART OF
Purchase Order ADHS17-155910:2
Nurse Family Partnership for MIECHV
Arizona Department of Health Services
IN WITNESS WHEREOF, the parties agree to enter into this contract:
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