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Page 1 of 2 ARIZONA STATE CONTRACT CONTRACT RELEASE C-86-16-071-3-02 ProcureAZ Purchase Order No.: ADHS16-116340:2 Organizational Reference No.: PO0000269052 Issued: 10/02/2017 V Vendor Number: 000010983 Arizona Department of Health Services E Maricopa County Public Health S Office of Disease Integration and Services N 4041 N. Central Avenue, #1400 H 150 N. 18th Avenue, Suite 110 Phoenix, AZ 85012 I Phoenix, AZ 85007 D US O P Email: maria.thomas@azdhs.gov R T O Contract No.: ADHS16-116340 (602) 364-3601 Title: STD-MARICOPA COUNTY LABORATORY 2017 MAIL INVOICE IN DUPLICATE TO: B Arizona Department of Health Services I Office of Disease Integration and Services 150 N. 18th Avenue, Suite 110 L Phoenix, AZ 85007 L US Email: maria.thomas@azdhs.gov T O (602) 364-3601 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: 2017--FEDEDC2287--5129--HS2000--HS20000-6811---PHS-EDC- Payment Terms: Net 30 IMPVSTD--1217---------HSA Shipping Terms: Delivery Calendar Day(s) A.R.O.: 0 Item Description Requisition Quantity Unit Unit Price Total Class-Item 948-55 1 NAAT Chlamydia/Gonorrhea Combination Test 976.00 EA $ 12.30 $ 12,004.80 OFFICE of DISEASE INTEGRATION and SERVICES, STD PROGRAM, CONTRACT# ADHS16-116340, CFDA# 93.977 TOTAL: $ 12,004.80 Approved By: Leticia Medina Phone No.: (602) 364-4666 Page 2 of 2 ATTACHED TO AND A PART OF: IGA ADHS16-116340 STD-Maricopa County Laboratory 2017 C-86-16-071-3-02 IN WITNESS WHEREOF, the parties agree to enter into this Agreement and its Amendments: FOR AND ON BEHALF OF MARICOPA COUNTY By_____________________________ Denny Barney, Chairman, Board of Supervisors _______________________________ Date ATTEST: _______________________________ Clerk of the Board _______________________________ Date APPROVED AS TO FORM: _______________________________ Attorney for Maricopa County _______________________________ Date