DIETETIC INTERNS ADHS IGA AMD 3 (03).PDF

C-86-15-061-3-03
ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA)
150 N. 18th Ave., Ste. No. 260
AMENDMENT Phoenix, AZ 85007
602.542.1040 - Main
602.542.1741 - Fax
PROCUREMENT OFFICER
CONTRACT No.: ADHS15-084210 AMENDMENT No.: 3 JESSICA CANEVARI
DIETETIC INTERNSHIP
Effective October 1, 2017, it is mutually agreed that the Contract referenced is amended as follows:
Pursuant to the Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders and Change
Orders, the following has been revised and replaced with the following:
1. The Dietetic Internship Price Sheet in Amendment Two (2) is hereby replaced with the revised Dietetic Internship Price Sheet of
this Amendment Three (3). The total of the Dietetic Internship Price Sheet is: $150,000.00.
CONTINUED ON NEXT PAGE
CONTRACTOR SIGNATURE
Maricopa County by and through its
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Contractor Name Contractor Authorized Signature
4041 NORTH CENTRAL AVE., STE. 1400 Denny Barney
Address Printed Name
PHOENIX AZ 85012 Chairman, Board of Supervisors
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 _______________________ 20_______
Signature Date
MCAO
Printed Name Procurement Officer
Attorney General Contract No. P0012014000078, which is an RESERVED FOR USE BY THE SECRETARY OF STATE
Agreement between public agencies, has been reviewed pursuant to
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who Under House Bill 2011, A.R.S. § 11-952
has determined that it is in proper form and is within the powers and was amended to remove the requirement
authority granted under the laws of the State of Arizona. that Intergovernmental Agreements be filed
with the Secretary of State.
Signature Date
Assistant Attorney General
Printed Name:
ATTEST:____________________________, Clerk of the Board

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 150 N. 18th Ave., Ste. No. 260
AMENDMENT Phoenix, AZ 85007
602.542.1040 - Main
602.542.1741 - Fax
PROCUREMENT OFFICER
CONTRACT No.: ADHS15-084210 AMENDMENT No.: 3 JESSICA CANEVARI
Agency Name: Maricopa County Department of Public Health
Agency DUNS Number: 602062515
Federal Award Identification Number (FAIN): 187AZAZ7W1003
Federal Award Date: October 1, 2017
CFDA Number and Name: 10.557 Special Supplemental Nutrition Program for Women, Infants and Children
PRICE SHEET
October 1, 2017 to September 30, 2018
Cost Reimbursement Line Item Budget
WIC – TRACK DIETETIC INTERNSHIP
WOMEN, INFANTS AND CHILDREN (WIC)
LINE ITEM BUDGET AMOUNT
PERSONNEL COSTS / SALARY EXPENSES $72,553.00
EMPLOYEE RELATED EXPENSES $30,994.00
PROFESSIONAL AND OUTSIDE EXPENSES $5,000.00
TRAVEL EXPENSES $2,000.00
OCCUPANCY EXPENSES $4,356.00
OTHER OPERATING EXPENSES $13,741.00
CAPITAL OUTLAY EXPENSES $1.00
INDIRECT COST EXPENSES (IF AUTHORIZED) $21,355.00
TOTAL $150,000.00
Additional Terms and Conditions:
With prior written approval from the Program Manager, the Contractor is authorized to transfer up to a maximum of
ten percent (10%) of the total budget amount between funded line items. Transfers of funds are only allowed
between funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall require an
amendment.
Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a Purchase
Order that is signed by an authorized agent. The Purchase Order will indicate the Contract number and the dollar
amount of funds authorized. The Contractor shall only be authorized to perform services up to the amount on the
Purchase Order. ADHS shall not have any legal obligation to pay for services in excess of the amount indicated on
the Purchase Order. No further obligation for payment shall exist on behalf of ADHS unless; a.) Purchase Order is
modified with an official ADHS Procurement Change Order and/or b.) additional Purchase Order is issued for
purchase of services under this Contract.
ADHS reserves the right to adjust awards given to local agencies depending on Federal dollars received.
Adjustments will be at the discretion of ADHS.
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