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ARIZONA DEPARTMENT OF HEALTH SERVICES 150 N. 18th Avenue, Suite 260 INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007 (602) 542-1040 (602) 542-1741 Fax Procurement Specialist Contract No: ADHS18-172575 Amendment No. 5 Delilah Gonzalez STATEWIDE COMPREHENSIVE NEEDS ASSESSMENT It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows: 1. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders and Change Orders; the Contract is changed as follows: 1.2 Per Section 6.3, Assignment and Delegation, Contract ADHS18-172575 (old contract) is changed to new Contract number ADHS18-176230 due to a revision in the ProcureAZ. (CONTINUED ON NEXT PAGE) ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED CONTRACTOR SIGNATURE Maricopa County Employee Benefits and Health Department – Ryan White Part A Program Contractor Name Contractor Authorized Signature 301 W. Jefferson St. Suite 3200 Address Printed Name Phoenix Arizona 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 form any billable work or provide any material, service or construction under and is within the powers and authority granted under the laws of the this IGA until the IGA has been executed by an authorized ADHS 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: 1