PO RE CONSULTATION SVC WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS17-154596:2
Organizational Reference No.: PO0000248935
Issued: 07/13/2017
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.: ADHS17-154596 (602) 364-1400
Title: HRPP CHN Consultant Services
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--EMSCFH5653--4340--HS2171--HS43010-6841--6841-PHS-WCH---- Payment Terms: Net 30
--------HSA
Shipping Terms:
Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 948-65
1 1.00 TOTAL $ 20,000.00 $ 20,000.00
PO EFFECTIVE 7/1/17 - 6/30/18 *** CONTRACT EFFECTIVE 12/1/16 -
11/30/19 *** HRPP Community Health Nurse Consulting services.
TOTAL: $ 20,000.00
Approved By: Dee Vlahos
Phone No.: (602) 364-1425

C-86-17-029-3-01 ATTACHED TO AND A PART OF
Purchase Order ADHS17-154596:2
High Risk Perinatal Program (HRPP),
Community Health Nursing (CHN),
Consultation Service
IN WITNESS WHEREOF, the parties agree to enter into this Contract:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date