ADHS17-155496 A1 UNEXECUTED.PDF

Maricopa County — Formal (2017-08-23)

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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: ADHS17-155496 Amendment No. 1
Delilah Gonzalez
IGA - HIV CARE & SERVICES
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 ADHS17-155496 (old contract) is changed to new
Contract number ADHS18-172583 due to a vendor profile change.
(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:
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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: ADHS17-155496 Amendment No. 1 Delilah Gonzalez
1.3 Add provision (20) to Terms and Conditions to read as follows:
20. Contracting; Procurement; Investment; Prohibitions
20.1 A public entity may not enter into a contract with a company to acquire or dispose of services,
supplies, information technology or construction unless the contract includes a written certification
that the company is not currently engaged in, and agrees for the duration of the contract to not
engage in, a boycott of Israel.
20.2 A public entity may not adopt a procurement, investment or other policy that has the effect of
inducing or requiring a person or company to boycott Israel.
20.3 Contractor hereby certifies that it is not currently engaged in, and will not for the duration of this
Contract engage in, a boycott of Israel as defined by A.R.S. § 35-393.01. Violation of this
certification by Contractor may result in action by the State up to and including termination of this
Contract.
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