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Page 1 of 2 ARIZONA STATE CONTRACT CONTRACT RELEASE C-86-16-039-3-03 ProcureAZ Purchase Order No.: ADHS16-109742:3 Organizational Reference No.: RQ0000364558 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.: ADHS16-109742 (602) 364-1400 Title: AZ Prescription Drug Overdose Prevention 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--FEDCFH6060--4360--HS2000--HS20000-6811---PHS-WCH- Payment Terms: Net 30 RXPREVPROG--0818---------HSA Shipping Terms: Delivery Calendar Day(s) A.R.O.: 0 Item Description Requisition Quantity Unit Unit Price Total Class-Item 948-47 1 PO EFFECTIVE 9/1/17 - 8/31/18 **** CONTRACT EFFECTIVE 9/1/15 - 1.00 YR $ 97,136.00 $ 97,136.00 8/31/20 **** TO PAY FROM FEDCFH6060 / 0818 **** FEDERAL FUNDING **** CFDA: 93.136 **** WORK TO BE PERFORMED PER CONTRACT SCOPE OF WORK AND PRICE SHEET **** Implementation of Prescription Drug Toolkit (Quarterly is $24,284.00) TOTAL: $ 97,136.00 Approved By: Cynthia Ronquillo Phone No.: (602) 364-1513 Page 2 of 2 C-86-16-039-3-03 ATTACHED TO AND A PART OF Purchase Order ADHS16-109742:3 AZ Prescription Drug Overdose Prevention IN WITNESS WHEREOF, the parties agree to enter into this Contract: 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