ADHS NEEDS ASSESSMENT 14 059037.PDF

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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams. Room 303
Phoenix, Arizona 65007
(602) 542-1040
Contract No. ADHS14-059037 (602) 542-1741 FAX
Project Title: STATEWIDE COMPREHENSIVE NEEDS ASSESSMENT Begin Date; NOVEMBER t 2013
Geographic Service Area: STATEWIDE Termination Date: OCTOBER 31, 2018
Arizona Department of Health Services has authority to contract for services specified herein in accordance with AR S §§ 11-951. 11-952. 36-
104 and 36.132 The Contractor represents that It has authority to contract for the performance of the services provided herein pursuant to:
X Counties: A.R.S. §§ 11-201, 11-951, 11.952 and 36-152.
Indian Tribes: A,R.S. §§ 11-951, 11-952 and the rules and sovereign authority of the contracting Indian Nation.,
School Districts: A.R.S. §§ 11-951, 11-962, and 15-342.,
City of Phoenix: Chapter II, §§ 1 & 2, Charter, City of Phoenix. '- A 3 n
City of Tempe: Chapter 1, Article 1, §§ 1.01 & 1.03, Charter, City of Tempe.
Amendments signed by each of the parties and attached hereto are hereby adopted by reference as a part of this Contract from the effective
dale of the Amendment, as If fully set out herein.
90 .::,-a 1 --b FOR CLARIFICATION, CONTACT:
Arizona Transaction (Sales) Privilege: °I )--
c..._,..,
Name:
Federal Employer Identification No: - U. '—
Telephone: 'V:f-A------
Tax License No: ‘..\.
Fax No:
Contractor Name: Marlcope County Ryan White Part A Program
Address: 301 West Jefferson, 03200 E-mail: \ ` '',- :. ?1/41k-ct-t-1.%. i.z. Cs, AI -‘11-%5-.,
Phoenix, Arizona 85003
CONTRACTOR SIGNATURE: This Contract shall henceforth be retorted to as Contract
The Contractor agrees to perform all the services set forth In the No. ADHS14-059037
Agreement and Work Ai Ste .., .ent
The Contractor is hereby cautioned not to commence any billable
work or provide any material, service or construction under this
Contract until Contractor receives a fully executed copy of the
ej. Contract
0 8 2014 co
gna re of Pars ) n Authorized 1. Sign Dale State of Arizona Q0 ,11
CHAIRMAN BOARD OF SUP RVISORS ._ Signed t is 4/7 day 014/ . 201-3--
Print Name and Title
DENNY BARNEY _...e.--
Pr curement Officer
CONT CTOR ATTORNEY SIGNATURE: RESERVED FOR USE BY THE SECRETARY OF STATE
ant to AR S 11-1352,0Mill isrsigned Contractor's Attorney
haidetermined I t Ihls)rlIergovemr0ental Agreement Is in proper
mi and is n the 6wers end 'a horny granted under the laws Under House Bill 2011, A.R.S. § 11-952 was
AriKe . amended to remove the requirement that
Intergovernmental Agreements be filed
al e of Persop.uUar1zed to Sign Date with the Secretary of State.
0 e Kb) t_t Ivey' attirly
Pr ht Name and Title i . r 7
Attorney General Contract, No. P0012012000033, 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 the proper form and is within the
powers granted under the laws of the State of Arizona to those
parties tot - -ement repro el by e Attorney General
The Alto ay G— .1, BY:
-11.00•1•I.-----.Isr _.,a_rATMOUILVissffNalen... ' ..:A
Sigeetu . : - -
Assistant Attorney Genera; .4 Z. .,„ ,,,, A ii 1,11 in

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-059037
TERMS. As used In this Contract, the terms listed below are defined as follows:
1, DEFINITION OF
document attached to the Contract and incorporated into the Contract
1 1 "Attachment' means any
1.2 "ADHS" means Arizona Department of Health Services
of time for which the contract budget has been created and during which
1.3 "Budget Term" means the period
funds should be expended. and that directs the
"Change Order" means a written order that is signed by a Procurement Conditions Officer of the Contract
1.4 Contractor to make changes authorized by the Uniform Terms and
combination of the Uniform and Special Terms and Conditions, Amendments the Specifications and any and
1.5 "Contract" means the Attachments, Referenced Documents, any Contract
Statement or Scope of Work,
terms applied by law.
document signed by the Procurement Officer and the Contractor
1 6 "Contract Amendment" means a making written changes in the Contract.
that is issued for the purpose of
any person who has a Contract with the Arizona Department of Health Services
1 7 "Contractor" means reimbursed for costs, which are
"Cost Reimbursement" means a contract under which a contractor contract terms is and approved by ADHS.
1.8 reasonable, allowable and allocable in accordance with the
1.9 "Days" means calendar days unless otherwise specified.
per unit of service. The set price shall be based on costs, which are
1 10 "Fixed Price" establishes a set price
reasonable, allowable and allocable
advance, deposit of money, services, or anything of more
1.11 "Gratuity" means a payment, loan, subscription, consideration of substantially equal or greater value Is
than nominal value, present or promised, unless
received. means all property, including but not limited to equipment's,
1.12 "Materials' unless otherwise stated herein,
supplies, printing, insurance and leases of property.
person duly authorized by the State to enter into and administer Contracts
1.13 "Procurement Officer" means the with respect to the Contract
and make written determinations Officer, that requests a
'Purchase Order" means a written document that is signed by and a Procurement that, on delivery and acceptance of the
1.14 vendor to deliver described goods or services at a specific price
goods or services by ADHS, becomes an obligation of the State
means the furnishing of labor, time or effort by a Contractor or Subcontractor.
1.15 "Services" between the Contractor and another party or
1.16 "Subcontract" means any contract, express delegating or implied, or assigning, in whole or in part, the making or
between a subcontractor and another party required for the performance of this Contract
furnishing of any material or any service
and/or the ADHS. For purposes of this Contract, the term *State" shall
1.17 "State" means the State of Arizona
not include the Contractor.

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-059037
2. CONTRACT TYPE,
This Contract shall be:
X Fixed Price
3, CONTRACT INTERPRETATION. where applicable, the Uniform
Law. The law of Arizona applies to this Contract Including,
3.1 Arizona Commercial Code as adopted by the State of Arizona.
and any terms required by law to be In this Contract are a
3.2 implied Contract Terms Each provision of law
part of this Contract as If fully stated in it. by
the event of a conflict in the provisions of the Contract, as accepted
3.3 Contract Order of Precedence. In the following shall prevail in the order set forth below:
the State and as they may be amended,
3.3.1 Terms and Conditions;
3,3.2 Statement or Scope of Work;
3.3.3 Attachments;
3 3.4 Referenced Documents. Contractor. Neither party to
aelpigmbigsf 1:1Iles The Contractor under this Contract is of an the Independent other party to the Contract
34 this Contract shall be deemed to be the employee or agent
severable. Any term or condition deemed illegal or invalid
3.5 Severabilitv. The provisions of this Contract of are the Contract
shall not affect any other term or condition of their
This Contract is intended by the parties as a final and of complete the trade expression shall supplement or
3.6 No Parole Evidence of prior dealings between the parties and no usage
agreement No course
explain any terms used in this document.
performance of any term or condition of the Contract
3.7 No Waiver. Either party's failure to insist on strict condition even if the party accepting or acquiescing in the
shall not be deemed a waiver of that term or of the performance and fails to object to it
nonconforming performance knows of the nature
purposes only and shall not be interpreted as having legal
3.8 Headines Headings are for organizational
significance or meaning,
4. CONTRACT ADMINISTRATION AND OPERATION. effective as of the Begin
on the signature page of the Contract, the Contract shall be
4,1 Term As indicated effective until the Termination Date.
Date and shall remain the State for any contractual
Renewal. This Contract shall not bind, nor purport of to the bind, Contract shall not exceed five years
4.2 Contract commitment in excess of the original Contract period The term years, the State shall have the right, at its sole
However, if the original Contract period is for less than five period together with the renewal periods does
option, to renew the Contract, so long as the original rights, Contract all terms, conditions and provisions of the original
not exceed five years. If the State exercises such renewal period with the exception of price and Scope
Contract shall remain the same and apply during the
of Work, which may be renegotiated parties may agree to
If a budget term has been completed in a multi-term Contract, the
4.3 New Budget Term

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER I TERMS AND CONDITIONS
ADHSi4-059037 new circumstances in the next budget term. Any
change the amount and type of funding to accommodate the new budget term shall coincide with a change In the
increase or decrease in funding at the time of approved by the Arizona Department of Health Services,
Scope of Work or change in cost of services as
shall comply with State Executive Order No. 2009-09 and all other
4.4 Non-Discrimination. The Contractor and regulations, including the Americans with Disabilities Act.
applicable Federal and State laws, rules
Under A R,S, § 35-214 and A R,S. § 35-215, the Contractor shall retain relating and to shall the
4.5 Records and Audit, require each subcontractor to retain all data and other records completion ("records") of the Contract,
contractually acquisition and performance of the Contract for a period of five years after the where applicable the Federal
All records shall be subject to inspection and audit by the State shall produce and a legible copy of any or all
Government at reasonable times. Upon request, the Contractor
such records.
the practices, procedures, and standards specified in and
4.6 Financial Management. For all contracts, Procedures Manual for the ADHS funded programs shall be used
required by the Accounting and Auditing Contract funds and by the State when performing a Contract audit,
by the Contractor in the management of form of fees, donations and/or charges for the delivery of these
Funds collected by the Contractor in the separate fund.
Contract services shall be accounted for in a
receiving federal funds under this Contract shall comply with the
4.6.1 Federal Funding Contractors audit provision of the Office of Management and Budget (OMB)
certified finance and compliance financial assistance information shall be stated in a
Circular A-133, if applicable. The federal
Change Order or Purchase Order.
receiving state funds under this Contract shall comply with the certified
4,6.2 State Funding. provisions Contractors of AR .S. § 36-181 .03
compliance
Contractor agrees to permit access, at reasonable times, to its faoilities
4.7 Inspection and Testing The
required by this Contract shall be made by the State to the person to the
4.8 Notices. Notices to the Contractor Contractor, unless otherwise stated in the Contract Notices
Indicated on the signature page by the made by the Contractor to an ADHS Procurement Officer, unless
State required by the Contract shall be ADHS Procurement Officer and an authorized Contractor
otherwise stated in the Contract. An authorized person to whom notice shall be given by written notice, and an
representative may change their respective
amendment to the Contract shall not be necessary.
Contract, The Contractor shall not advertise or publish information for
49 Advertisina and Promotion of Contract without the prior written approval of an ADHS Procurement
commercial benefit concerning this
Officer.
4.10 Property of the State parties, the title to any and all
4.10.1 Equipment. Except as provided below or otherwise agreed received to by the from the State shall remain the
equipment acquired through the expenditure of and, funds as such, shall remain under the sole direction,
property of the State by and through the ADHS this Contract is terminated, the disposition of all
management and control of the ADHS. When ADHS For Fixed Price contracts, when the Contractor
such property shall be determined by the by the Contract, any and all equipment purchased by the
provides the services/materials required Contractor. All purchases of equipment need to be reported
Contractor remains the property of the
to the ADHS Office of Inventory Control
Title and Rights to Materials. As used in this section, the term "Materials" but not limited means to: all written products and
4.10.2 created or produced by the Contractor under this Contract, research including, findings, conclusions, abstracts,
electronic information, recordings, reports, research, property or deliverables created, prepared, or
results, software, data and any other intellectual of this Contract. Contractor acknowledges that all
received by the Contractor in performance
3

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-059037 State by and through the ADHS and, as such, shall remain under
Materials are the property of the control of the ADHS The Contractor Is not entitled to a patent
the sole direction, management and may not transfer a patent or copyright on them to any other
or copyright on these Materials and copyright in any Materials may originally vest in the Contractor,
person or entity. To the extent any transfers to the ADHS, for and on behalf of the State, all
the Contractor hereby irrevocably shall have full, complete and exclusive rights to reproduce,
copyright ownership. The ADHS disclose, publish, release and otherwise use all Materials The
duplicate, adapt, distribute, display, Materials without the prior written consent of the ADHS
Contractor shall not use or release these disposition of all such Materials shall be determined by the
When this Contract is terminated, the to give recognition to the ADHS for its support of any
ADHS. Further, the Contractor agrees
program when releasing or publishing program Materials
the above, if the Contractor is a State agency, the following shall apply instead: under It
Notwithstanding is the intention of ADHS and Contractor that all material and intellectual greatest benefit property to the developed parties to this
this Agreement be used and controlled in ways to produce used the in this paragraph, 'Material" means all
Contract and the citizens of the State of Arizona As findings, research information, abstracts,
written and electronic information, recordings, reports, procedures and processes of services developed
results, software, data, discoveries, inventions, created, prepared or received by the Contractor and
by the Contractor and any other materials Agreement "Material" as used herein shall not include any
subcontractors in performance of this discoveries, inventions or any form of intellectual property
pre-existing data, information, materials, by Contractor (or Its employees, subcontractors or agents)
invented, created, developed or devised services funded by this Agreement or that may result from
prior to the commencement of the service activities that are not funded by the Agreement.
Contractor's involvement in other
copyright to all Material shall vest in the State of Arizona, subject to both any rights ADHS
Title and on exclusive behalf of the federal government As State agencies and instrumentalities, non-transferable rights to
reserved and Contractor shall have full, complete, perpetual, irrevocable display, and disclose, publish and
reproduce, duplicate, adapt, make derivative works, distribute, right to use Material shall include the
otherwise use any and all Material. The Contractor's connection with its Internal, non-profit research and
following rights: the right to use the Material in academic or professional meetings or symposia and
educational activities, the right to present at or otherwise of Contractor's own choosing
the right to publish in journals, theses, with dissertations a right of review prior to any publication or public
Contractor agrees to provide ADHS ADHS shall be entitled to request the removal of its confidential
presentation of the Materiel, and disclosure of which would be contrary to the best interest of
information or any other content the confidential information to the public without the
the State of Arizona Neither party shall release other, unless required by the State public records statutes
prior expressly written permission of the party agrees to give recognition to the other party in all
or other law, including a court order Each Material, when releasing or publishing them
public presentations or publications of any
and Contractor agree that any and all Material shall be made freely available wants to to
In addition, to ADHS the extent it is in the best interest of the State. However, third-party If either party for monetary
the license public or assign an intellectual property interest in the material to a the relevant issues of title,
compensation, ADHS and Contractor agree to convene event to determine of a controversy as to whether the
copyright, patent and distribution of revenue. In or the in a way that interferes with the best Interest
Material is being used for monetary compensation Department of Administration shall make the final decision.
of the state or ADHS, then the Arizona compensation' does not include compensation paid to an
Notwithstanding the above, "monetary in academia (the copyrights to which are Employee-
individual creator for traditional publications Property Policy Section 6-908C 4.), an honorarium or
Excluded Works under ABM Intellectual academic or professional presentation, or an unprofitable
other reimbursement of expenses for an
distribution of Material,
with A.R.S § 41-4401, Contractor warrants compliance with all
4:11 E-Verify Requirements In accordance relating to employees and warrants Its compliance with Section
Federal Immigration laws and regulations
A.R.S. § 23-214, Subsection A
4

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-059037
Contractor shall comply with all federal, state arid local
4.12 Federal Immigration and Nationality Act The immigration status of their employees during the term of the
immigration laws and regulations relating to the requirement to all subcontractors utilized during the
Contract. Further, the Contractor shall flow down this right to perform random audits of Contractor and
term of the Contract The Slate shall retain the employee thereof to ensure compliance. Should the State
subcontractor records or to inspect papers of any be found noncompliant, the State may pursue all
determine that the Contractor and/or any subcontractors to; suspension of work, termination of the Contract for
remedies allowed by law, including, but not limited
default and suspension and/or debarment of the Contractor
5. COSTS AND PAYMENTS, Titles 35 and 41, net 30 days. Upon
5.1 Payments. Payments shall comply with the requirements Contractor of A,R,S shall submit a complete and accurate
receipt and acceptance of goods or services, the the State within thirty (30) days, as provided in the
Contractor's Expenditure Report for payment from
Accounting and Auditing Procedures Manual for the ADHS
5.2 Recoupment of Contract Payments. Contractor
Funds Any unearned State funds that have been advanced termination to the of the
6 2 1 Unearned Advanced in its possession at the end of each budget term, or at the time end of of a budget term or of
and remain be refunded to the ADHS within forty-flue (45) days of the
Contract, shall
the time of termination
price contract, if the number of services provided is less than the
52.2 Contracted Services In a fixed received compensation, funds to be returned to the
number of services for which the Contractor price Where the price is determined by cost per unit of
ADHS shall be determined by the Contract shall be determined by multiplying the unit of service
service or material, the funds to be returned did not provide during the Contract term Where the
cost by the number of services the Contractor deliverable has not been completed, the Contractor shall be
price for a deliverable is fixed, but the deliverable. In a cost reimbursement contract, the ADHS
paid a pro rata portion of the completed can document as having been paid by the Contractor
shall pay for any costs that the Contractor Contractor will be paid its reasonable actual costs for
and approved by ADHS In addition, the Accepted Accounting Procedures up to the date of
work in progress as determined by Generally
contract termination,
(45) days after the end of each budget terra or of the time of termination accordance
5.2.3 Refunds Within forty-five shall refund the greater of: 0 the amount refundable in with
of the Contract, the Contractor Advanced Funds; or ii) the amount refundable in accordance
with paragraph 4.2,1, Unearned
paragraph 5.2.2, Contracted Services.
Contractor agrees to reimburse the ADHS for all Contract funds
5,2.4 Unacceptable Expenditures The by the ADHS not to have been disbursed by the Contractor in
expended, which are determined The Contractor shall reimburse ADHS within 45 days
accordance with the terms of this Contract.
of the determination of unacceptability.
costs/rates or fees shall be based on costs, which are determined Manual by ADHS
5.3 Unit Costs/Rates or Fees. Unit allocable as outlined in the Accounting and Auditing Procedures
to be reasonable, allowable and
for the ADHS.
5.4 Applicable Taxes State of Arizona is subject to all applicable state
5.4. 1 State and Local Transaction Privilege Taxes. Transaction The privilege taxes apply to the sale and are the
and local transaction privilege taxes Failure to collect taxes from the buyer does not relieve the
responsibility of the seller to remit
seller from its obligation to remit taxes.
5

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-059037
The Contractor and all subcontractors shall pay all federal, state and local shall
5.4.2 Tax Indemnification applicable to its operation and any persons employed by the Contractor for taxes, Contractor damages
taxes require all subcontractors to hold the State harmless from Federal, any responsibility and/or state and local laws and
and interest, if applicable, contributions required transaction under privilege taxes, unemployment compensation
regulations and any other costs, including
insurance, Social Security and Worker's Compensation
in order to receive payment under any resulting Contract, the Contractor shall
5.4.3 I.R.S. have a WO current Form. I R S W9 Form on file with the State of Arizona.
of Funds for the Next Fiscal Year. Funds may not be presently available State may for reduce performance payments under or
5.6 Availability this Contract beyond the first year of the budget term or Contract penalty term. in The the event that Insufficient funds are
terminate this Contract without further recourse, term. obligation The State or shall not be liable for any purchases or
appropriated in the subsequent budget in anticipation of such funding. The Procurement Officer shall
Subcontracts entered into by the Contractor availability of funds
have the discretion In determining the
of Funds for the Current Contract Term. Should the State Legislature or for enter any other back reason into session these
6,6 Availability and decrease the appropriations through line item or general fund following reductions, actions may be taken by ADHS:
goods or services are not funded as determined by ADHS, the
5.6.1 Accept a decrease in price offered by the Contractor;
Reduce the number of goods or units of service and reduce the payments accordingly;
5 6 2
5.6.3 Offer reductions in funding as an alternative to Contract termination; or
5.6.4 Cancel the Contract
6. CONTRACT CHANGES, Contract is Issued under the authority of the
6.1 Amendments, Purchase Orders and Change Orders The Contract This may be modified only through a Contract
Procurement Officer who signed this Contract Order within the scope of the Contract, unless the change Is
Amendment, Purchase Order andfor Change by the Special Terms and Conditions. Changes to the Contract, or
administrative or otherwise permitted materials, the revision of payment terms, or the substitution of work
including the addition of work or State employee or made unilaterally by the Contractor are violations
materials, directed by an applicable unauthorized law. Such changes, including unauthorized Contract Amendments, shall not be
of the Contract and of Change Orders, shall be void and without effect, and the Contractor
Purchase to Orders any claim and/or under this Contract based on those changes.
entitled enter into any subcontract under this Contract without the advance
6.2 Subcontracts. The Contractor shall not Officer. The subcontract shall incorporate by reference all material
written approval of the Procurement conditions of this Contract,
and applicable terms and
The Contractor shall not assign any right nor delegate any duty unreasonably under this
6.3 Assignments and Delegation written approval of the Procurement Officer. The State shall not
Contract without the prior
withhold approval
7, RISK AND LIABILITY. covered under this Contract until
7.1 Risk of Loss The Contractor shall bear all loss of at conforming the location material designated in the Purchase Order, Change
received and accepted by authorized personnel constitute final acceptance The risk of loss for nonconforming
Order or Contract Mere receipt does not regardless of receipt
materials shall remain with the Contractor
6

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-069037
"indemnitor) agrees to indemnify, defend and hold harmless the
7.2 Mutual Indemnification. Each party (as and against any and all claims, losses, liability, costs or expenses
other party (as "indemnitee") from collectively referred to as "claims") arising out of bodily
(including reasonable attorney's fees) (hereinafter property damage, but only to the extent that such claims, which
injury of any person (including death) or to the indemnitee, are caused by the act, omission, negligence,
result in vicarious/derivative liability indemnitor, its officers, officials, agents, employees or volunteers
misconduct, or other fault of the
To the extent permitted by A R S. § 41-621 and A.R.S § 36-154,
7.3 Indemnification - Patent and Copyright hold harmless the State against any liability, including costs and
the Contractor shall indemnify and trademark or copyright arising out of performance of the Contract
expenses, for infringement of any patent, by or work performed under this Contract. The State shall
or use by the State of materials of furnished any claim for which it may be liable under this paragraph
reasonably notify the Contractor
7.4 Force Majeure. due, neither party shall be liable to the other
7 4 1 Liability and Definition. Except for payment if and of sums to the extent that such party's performance of this
nor deemed in default under this Contract majeure. The term 'force majeure" means an occurrence
Contract is prevented by reason of force affected and occurs without its fault or negligence. Without
that is beyond the control of the party includes acts of God; acts of the public enemy; acts of
limiting the foregoing, force majeure labor disputes; civil disorders; fire; flood; lockouts;
terrorism; war; riots; strikes; mobilization; by or resulting from the act or failure to act of the parties;
Injunctions-interventions not caused authority not caused by or resulting from the act or failure
failures or refusals to act by government occurrences beyond the control of the party declaring force
to act of the parties; and other similar to prevent by exercising reasonable diligence.
majeure, which such party is unable
Exclusions. Force Majeure shall not include the following occurrences;
7.4.2 caused by congestion at a manufacturer's plant or elsewhere, or
7.4.2.1 Late delivery of Materials
an oversold condition of the market;
by a subcontractor unless the delay arises out of a force majeure
7 42 2 Late performance accordance with this force majeure term and condition; or
occurrence in
either the Contractor or any subcontractor to acquire or maintain any required
7A. 2.3 Inability of
insurance, bonds, licenses or permits.
either party is delayed at any time in the progress of the work by force practicable majeure, and the no
7.4.3 Notice party If shall notify the other party in writing of such delay, as soon as is specify the causes of
delayed later than the following working day of the commencement thereof, and certified-return shell receipt and
such delay in such notice Such notice shall be delivered invoking or mailed its provisions. The delayed party
shall make a specific reference to this article, practicable thereby and shall notify the other party in writing
shall cause such delay to cease as soon as shall be extended by Contract Amendment for a
when it has done so. The time of completion results or effects of such delay prevent the delayed party
period of time equal to the time that the
from performing in accordance with this Contract
Default. Any delay or failure in performance by either party hereto shall profits not If, constitute and to the default extent
7.4.4 hereunder or give rise to any claim for damages or loss of anticipated
that, such delay or failure is caused by force majeure.
Violations. The Contractor assigns to the State any claim for overcharges supplied resulting by third
7.5 Third Party Antitrust to the extent that those violations concern materials or services
from antitrust Contractor violations for or toward the fulfillment of this Contract
parties to the
7

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-059037
MATERIALS.. The following provisions shall apply to Materials only:
8. DESCRIPTION OF
Materials supplied under this Contract are free of liens. In the event
81 Liens The Contractor agrees that the Contractor shall pay to remove the lien and any associated damages or
the Materials are not free of liens,
replace the Materials with Materials free of liens
elsewhere in these terms and conditions, the Contractor agrees that, for
82 Quality.. Unless otherwise acceptance modified by the State of the Materials, they shall be;
one year after
8.2.1 Of a quality to pass without objection in the Contract description;
8.2.2 Fit for the intended purposes for which the Materials are used;
permitted by the Contract and are of even kind, quantity, and quality within
8.23 Within the variations
each unit and among all units;
contained, packaged and marked as the Contract may require; and
8.2.4 Adequately
Conform to the written promises or affirmations of fact made by the Contractor
82.5
8.1 through 82 of this paragraph are not affected by inspection or
8.3 Inspeotion/Testinq. testing of or payment Subparagraphs for the Materials by the State
J_awa The Materials and services supplied under this Contract shall license comply and
8.4 gampllaam„With,ApplaalAe federal, state and local laws, and the Contractor shall maintain alt applicable
with all applicable
permit requirements
8 5 Survival of Rats and Obligati() a After Contract Expiration and Termination.
All representations and warranties made by the Contractor under
8.5.1 Contractor's Representations. paragraphs 7 and 8 shall survive the expiration or termination hereof. In addition, A.R.S §
this Contract in acknowledge that pursuant to A R.S § 12 510, except as provided in
the parties hereto to or barred by any limitations of actions prescribed in A R S Title
12-529, the State is not subject
12, Chapter 5.
Change Orders. Unless otherwise directed in writing by the Procurement
8.5,2 Purchase Orders and fully perform and shall be obligated to comply with all Purchase Orders
Officer, the Contractor shall by the Contractor prior to the expiration or termination hereof,
and Change Orders received Purchase Orders and Change Orders received prior to but not fully
Including, without limitation, expiration all or termination of this Contract.
performed and satisfied at the
9. STATES CONTRACTUAL REMEDIES.
If the State, in good faith, has reason to believe that the Contractor does may not demand intend to
9.1 Rioht to Assurance. perform or continue performing under this Contract, the Procurement Officer Contractor to
or is unable to, Contractor give a written assurance of intent to perform. Failure by the State's option, be
in writing that the within the number of Days specified in the demand may, at the
provide written assurance
the basis for terminating the Contract.
9.2 Stop Work Order.
Terms The State may, at any time, by written order to the Contractor, require ninety the (90) Contractor Days after to
9.2.1 stop all or any part of the work called for by this Contract for a period to which up to the parties may agree
the order is delivered to the Contractor, and for any further work order period issued under this clause. Upon
The order shall be specifically identified as a stop comply with its terms and take all reasonable
receipt of the order, the Contractor shall immediately
8

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-059037
the incurrence of costs allocable to the work covered by the order during the
steps to minimize
period of work stoppage.
or Expiration. If a stop work order issued under this clause is canceled or the period
0.22 of Cancellation the order or any extension expires, the Contractor shall resume work. The Procurement or both, and Officer the
shall make an equitable adjustmerit in the delivery schedule or Contract price,
Contract shall be amended in writing accordingly.
Remedies. The rights and remedies of ADHS under this Contract are not exclusive, Uniform and
9.3 Non-ex luslve to all rights and remedies available to It. Including those under the Arizona
ADHS is entitled
Commercial Code and Arizona common law.
Offset The State shall be entitled to offset against any sums due the Contractor in any performance Contract
9 4 Right with of the State or damages assessed by the State because of the Contractor's non-conforming to, a deduction from an
or failure to perform this Contract.. The right to offset may include, but bonds. is not limited Any offset taken for damages
unpaid balance and a collection against the bid and/or performance amount for the actual damages and shall not
assessed by the State shall represent a fair and reasonable
be a penalty for non-performance.
10. CONTRACT TERMINATION.
for Conflict of Interest Pursuant to A R.S. § 38-511, the State may cancel this Contract significantly within
10. 1 Cancellation Contract execution without penalty or further obligation if any person
three (3) years after securing, drafting or creating the Contract on behalf of the State is, or
Involved in initiating, negotiating, Contract or an extension of the Contract is in effect, an employee of or a
becomes at any time while the Contract with respect to the subject matter of the Contract The
consultant to any other party to this receives written notice of the cancellation, unless the
cancellation shall be effective when the Contractor is a political subdivision of the State, it may also cancel this
notice specifies a later time. If the Contractor
Contract as provided in A.R.& § 38-511.
by written notice, terminate this Contract, in whole or in part, If the State
10.2 Gratuities The State may, or a Gratuity was offered or made by the Contractor or a representative of the
determines that employment employee of the State for the purpose of influencing the outcome of the
Contractor to any officer or Contract or an Amendment to the Contract, or receiving favorable treatment
procurement, securing the including the making of any determination or decision about Contract
concerning the Contract, In addition to any other rights or remedies, shall be entitled to recover exemplary
performance in the The amount State, of three times the value of the Gratuity offered by the Contractor.
damages
Suspension or Debarment. The State may, by written notice to the Contractor, immediately debarred, terminate suspended this or
10.3 Contract if the State determines that the Contractor or its subcontractor has activity, been including but not limited
otherwise lawfully prohibited from participating in any public procurement unit or other governmental body
to, being disapproved as a subcontractor of any public procurement
10.4 Termination Without Cause.
State and the Contractor may terminate this Contract at any time with thirty (30) days'
10.4 1 Both the specifying the termination date Such notices shall be given by personal delivery
notice in writing
or by certified mail, return receipt requested.
terminates this Contract, any monies prepaid by the State, for which no service
10.4.2 If the Contractor by the State, shall be refunded to the State within 5 days of the
or benefit was received addition, if the Contractor terminates the Contract, the Contractor shall
termination notice. In sanctions imposed by the funding source as a result of the
indemnify the State for any
Contractor's failure to complete the Contract.
terminates this Contact pursuant to this Section, the State shall pay the Contractor the
10.4 3 If the State
9

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER TERMS AND CONDITIONS
ADHS14-059037
Contract price for all Services and Materials completed up to the date of termination In a fixed
price contract, the State shall pay the amount owed for the Services or units Materials or items. by multiplying In a cost
the unit of service or item cost by the number of unpaid costs that service the Contractor can document as
reimbursement contract, the ADHS shall approved pay for any by ADHS. In addition, the Contractor will be
having been paid by the Contractor costs for and work in progress as determined by GAAP up to the date of
paid Rs reasonable such actual termination, the Contractor shall deliver to the ADHS all deliverables
termination. completed ADHS Upon may require Contractor to negotiate the terms of any remaining deliverables
still due
10. 5 MiataLierrjoakn, This Contract may be terminated by mutual written agreement necessary, of submission the parties of
specifying the termination date and the terms for disposition of property and, as
required deliverables and payment therein.
for Default The State reserves the right to terminate the Contract in whole or in part due to to
10.6 Termination the failure of the Contractor to comply with any material obligation, term or condition or to of make the Contract, satisfactory
acquire and maintain all required insurance policies, bonds, terminates licenses and the permits, Contract in whole or in part as
progress in performing the Contract. In the event procure, the ADHS upon such terms and in such manner as deemed
provided in this paragraph, the ADHS similar may to those terminated, and Contractor shall be liable to the ADHS
appropriate, excess Services costs incurred or Materials, by the ADHS in obtaining such similar Services or Materials.
for any
Performance Through Termination, Upon receipt of the notice of termination and until the
10.7 Continuation effective date of of the notice of termination, the Contractor shall perform work consistent approved with by the the
requirements of the Contract and, if applicable, in accordance with a written to transition perform plan the Contract to the
ADHS. lithe Contract is terminated in part, the Contractor shall the continue Contractor shall immediately notify all
extent not terminated. After receiving the notice the effective of termination, date of termination, and on the effective date of
subcontractors, in writing, to stop work on
termination, the Contractor and subcontractors shall stop all work
of Property. Upon termination of this Contract, all properly of the State, as defined herein, shall
10.8 Disposition
be delivered to the ADHS upon demand.
ARBITRATION. Pursuant to A R S § 12-1518, disputes under this Contract shall be resolved adopted through under the AR use 5, of §
IL arbitration when the case or lawsuit is subject to mandatory arbitration pursuant to rules
12-133
12. COMMUNICATION,
When reports are required by the Contract, the Contractor shall provide them in the
12.1 Program Report
format approved by ADHS.
12.2 Information and Coordination. The State will provide information to the Contractor responsible pertaining for coordinating to activities
that affect the Contractor's delivery of services, and the Contractor or shall unnecessarily be duplicate the State's
their activities with the State's in such a manner as not to conflict and Information on matters covered by the
activities. As the work of the Contractor progresses, Contractor to advice the State throughout the effective period of the
Contract shall be made available by the
Contract.
CLIENT GRIEVANCES. If applicable, the Contractor and its subcontractors shall use a procedure denial, suspension through which or
13. clients may present grievances about the operation of the program that result to and in the approved by the State.
reduction of services provided pursuant to this Contract and which is acceptable
Pursuant to A.R S § 41-621(0), the obtaining of insurance by the State shall not be a
U. waiver SOVEREIGN of any sovereign IMMUNITY. immunity defense in the event of suit
10

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
TERMS AND CONDITIONS
ADHS14-059037
CHANGES. The Procurement Officer, or authorized designee, reserves the right to correct
15. ADMINISTRATIVE clerical, typographical or grammatical errors, as well as errors in party contact information
any obvious "Administrative Changes"), prior to or after the final execution of a Contract or Contract Amendment
Administrative (collectively, Changes subject to permissible corrections include: misspellings, grammar errors, incorrect
incorrect Contract Amendment numbers, pagination and citation errors, mistakes In the labeling of the
rate addresses, as either extended or unit, and calendar date errors that are illogical due to typographical errors error. in The a
Procurement Office shall subsequently send to the Contractor notice of corrections to administrative
written confirmation letter with a copy of the corrected Administrative Change attached
16. SURVIVAL OF TERMS AFTER TERMINATION OR CANCELLATION OF CONTRACT,. All applicable Contractor Contract to
terms shall survive and apply after Contract termination or cancellation to the extent that are necessary due after for the date of the
complete and for the ADHS to receive and accept any final deliverables
termination or cancellation
17. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA).
The Contractor wan-ants that it is familiar with the requirements of HIPAA, as amended by the Health Information and will
Technology for Economic and Clinical Health Act (HITECH Act) of 2009, and accompanying warrants regulations that it will
comply with all applicable HIPAA requirements in the course of this Contract Contractor performance of the Contract
cooperate with the Arizona Department of Health Services (ADHS) in the course of and coordination with
so that both ADHS and Contractor will be in compliance with HIPAA, including Information cooperation Security and Privacy Office
the Arizona Strategic Enterprise Technology (ASET) Office, and other Statewide compliance officials required by HIPAA and its
(SISPO) Chief Privacy Officer and HIPAA Coordinator that are reasonably necessary to keep ADHS and Contractor in
regulations. Contractor will sign any documents
compliance with HIPAA, including, but not limited to, business associate agreements.
If requested by the ADHS Procurement Office, Contractor agrees to sign a "Pledge To Protect Confidential confidential
information" and to abide by the statements addressing the creation, use and disclosure of or sensitive
information, Including information designated as protected health information and all other confidential in HIPAA
information as defined in policy. In addition, if requested, Contractor agrees to attend or participate participated in job
training offered by ADHS or to provide written verification that the Contractor has attended for purposes or of performing
related HIPAA training that is: (1) intended to make the Contractor proficient in HIPAA knowledgeable
the services required and (2) presented by a HIPAA Privacy Officer or other person or program Officer and HIPAA
and experienced in HIPAA and who has been approved by the ASET /SISPO Chief Privacy
Coordinator
COMMENTS WELCOME. The ADHS Procurement Office periodically reviews the Uniform Terms and
16. Conditions and welcomes any comments you may have Please submit your comments to: ADHS Proeurement
Administrator, Arizona Department of Health Services, 1740 West Adams, Suite 303, Phoenix, Arizona, 85007
11

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER SCOPE OF SERVICES
ADHS14-059037
1. BACKGROUND:
1.1 The mission of the Arizona Department of Health Services (ADHS), Office of Disease provide Integration medically and
Services, Ryan White Part B HIV Care and Services Program (Program) with HIV is to infection who do not
necessary health care and support services for low-income individuals for coping with HIV/AIDS. The Program
have sufficient health care coverage or financial resources counties of Arizona except Maricopa County, Pinot
provides services to eligible clients residing in all
County, and Mohave County.
1.2 Services to be provided under this Contract are fully funded through the Ryan H1WAIDS White HIV/AIDS Treatment
Treatment Extension Act of 2009, formerly known as the Ryan White Administration (HRSA),
Modernization Act of 2006, administered by the Health Resources care not Services covered by other resources The
HIV/AIDS Bureau (HAB) Ryan White funding fills gaps in authorized administrator of Part B of the
ADHS Office of Disease Integration and Services Act is of the 2009 only and is mandated to ensure the provision of
Ryan White HIV/AIDS Treatment Extension
Core Medical and Support Services as specified by HRSA.
Office of Disease Integration and Services and Office of HIV Prevention have the
1 3 The ADHS
responsibility of administering:
13.1 H1V Surveillance Program Cooperative Agreement funds,
Program Cooperative Agreement funds by the U S Centers for Disease
1.3.2 HIV Prevention
Control Prevention (CDC), and
White HIV/AIDS Treatment Extension Act of 2009 administered by the HRSA, HIV/AIDS
1 3,3 Ryan
Bureau (HAB) Ryan White funding.
1.4 HIV Surveillance funds are provided to State Health Departments to ADHS supplement in a timely HIV manner. Surveillance
efforts. These efforts Include case investigation and reporting of data to
1.6 The current National HIV/AIDS strategy has three (3) goals:
1.5.1 Increase access to care and optimize health outcomes for people living with HIV,
1.5 2 Reduce HIV-related health disparities, and
1.5,3 Reduce the number of people who become infected with HIV
of the Patient Protection and Affordable Care Act (ACA) in March 2010 will result in
1.6 The passage changes to the traditional direct delivery strategy of the Ryan White funded program.
significant Leading up to its full implementation in 2014, HIV care delivery models must need the to Ryan effectively White
coordinate service delivery in coordination with primary payer plans Within Ryan White Arizona, grantees, as well as,
Part B program is responsible for working collaboratively with the other National HIV/AIDS Strategy goals.
with providers in the Healthcare System of Arizona to achieve necessary health care and support services for
in an effort to improve and expand access to who medically do not have sufficient health care coverage or financial
low-income individuals with HIV infection needs assessment and strategic planning process to establish
resources, ADHS requires a statewide
priorities for the Ryan White Part B program
2. SCOPE OF SERVICES:
2.1 Contractor shall achieve the program goals described below:
Integrate planning based on statewide needs assessment findings (Barriers and Gaps in
2.1 1
Care Continuum Completion),
12

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
SCOPE Or SERVICES
AD HS14-059037
2,1 2 Impact of Affordable Care Act Implementation on People Living With HIV/AIDS (PLWHA)
receiving service in Arizona,
2.1.3 Provide findings to inform annual Priority Setting and Resource Allocation process based on
impact of Affordable Care Act,
2.1.4 Establish a "Roadmap" for delivery of Ryan White services for Statewide HIV Care
Continuum completion,
2.1 5 Compare Arizona to other states HIV care and how the Affordable Care Act will impact the
program
2.1.6 Submit Statewide data for policy decision makers Identifying the continued/new role for Ryan
White services,
2.1.7 Update client data to inform Part A, Part B grant applications, comprehensive plans and
Statewide Coordinated Statement of Need (SCSN), and
2 1 8 Provide findings from Newly Diagnosed survey respondents to HIV Prevention.
3, TASKS:
The Contractor shall:
3.1 Conduct a statewide Comprehensive Needs Assessment Detail findings by Hispanics; six (6) severe 4. African need
groups (SNGs): 1. Newly Diagnosed; 2. Men who have Sex with Men; 3
American; 5: American Indians; and 6 Youth
3.11 Meet with key stakeholders to develop the consumer survey instrument in English and
Spanish,
3.1,2 Conduct consumer surveys (n=735); identify barriers/gaps in Care Continuum completion,
Utilize CAREWare data, analyze client level data to show client utilization/impact of the
3.1.3
Affordable Care Act,
3.1.4 Analyze survey data present draft findings, and
315 Complete 2014 Needs Assessment Document/Presentation to key stakeholders
4. DELIVERABLES AND DELIVERY SCHEDULE:
The Contractor shall:
4.1 Phase 1: Submit the survey Instrument; target sample kits by SNG between November 2013 to
December 2013,
4.2 Phase 2: Conduct consumer surveys (n=735); identify barrlers/gaps in HIV Care Continuum
completion,
4.3 Phase 3: Submit care patterns utilizing CAREWare data analyzed client level data to show client
utilization/impact of the Affordable Care by SNG the month of April 2014,
4.4 Phase 4: Submit preliminary findings of analyzed survey data and findings for key stakeholders of
present draft findings between May 2014 to June 2014,
13

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
SCOPE OF SERVICES
ADHS14.059037
4.5 Phase 5: Submit a complete 2014 Needs Assessment Document/Presentation to key stakeholders
and PowerPoint to key stakeholders between July 2014 and August 2014,
4.6 Submit Phase Progress Reports:
46.1 Phase Progress Reports are due within twenty (20) days following the end of each phase
timeframe, and
4.7 invoices:
4.7.1 Invoices shall be received by ADHS thirty (30) days following the end of the project,
47.2 Include all other required information as directed by Program Manager on invoices This
includes Contract Expenditure Report (CER), General Ledger and Phase Summary
(EXHIBIT ONE (1).
4.7.3 Invoices which are being paid must be for services received within the current grant year
April i st to March 31 st. Contractors have until May l 5 to reconcile any payments, which
are received for the previous grant year. Any invoice received after May 15th for the
previous grant year cannot be paid with Ryan White grant funds
Examole: Current grant year is April 1, 2013 to March 31, 2014 Any invoices with a date
of service prior to March 31, 2013 cannot be paid with current grant funds; there are no
exceptions The date of invoice cannot be used; contractors must use the date of service
to determine if an invoice can be paid A contractor who pays for an invoice dated from a
previous grant cycle will be required to reimburse ADHS
5. APPROVALS:
5.1 Phase Report shall be approved by ADHS Program Manager prior to payment,
5,2 Expansion into new service phases under this Contract shall be approved by ADHS,
5.3 All marketing or educational materials, and promotional items, media or forms including, but not
limited to, brochures, posters, publications or journal articles developed using funds awarded under
this Contract shall be approved by the ADHS Program Manager prior to printing,
5.4 All marketing or educational materials shall bear the following: "Funded in part by the Ryan White
Part B Program as made available through the Arizona Department of Health Services, through the
HASA, and
5.5 The Ryan White Part B Program is fully funded by Federal funds so the Health and Human Services when
Appropriations Act requirements shall be followed. The HHS Appropriations Act requires that
issuing statements, press releases, requests for proposals, bid solicitations, and other documents
describing projects or programs funded in whole or in part with Federal money, all grantees receiving
Federal funds, including but not limited to. State and local governments, shall clearly state the
percentage of the total costs of the program or project which will be financed with Federal money, the
dollar amount of Federal funds for the project or program, and percentage and a dollar amount of the
total costs of the project or program that will be financed by non-governmental sources
14

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
SCOPE OF SERVICES
ADHS14.059037
6. NOTICES, CORRESPONDENCE, REPORTS AND INVOICES:
Correspondence, Reports and Invoices/CERs from the contractor to ADHS shall be sent to:
6,1 Notices,
Office of Disease Integration and Services
Arizona Department Fuentes, of Health Ryan White Services Part Care and Service Program Manager
Attn: Lisa M.
150 N. 18,4 Avenue, Suite #110
Phoenix, AZ 85007
Telephone: (602) 364-3606
Fax: (602) 364-3263
E-mail: lisa.fuenteseazdhsmov
Correspondence, Reports and Payments from the ADHS to the Contractor shall be sent to:
6.2 Notices,
Maricopa County Ryan While Part A Program
Attn: Rose Conner, Program Manager
301 West Jefferson, #3200
Phoenix, AZ 85003
Telephone: (602) 372-7091
E-mail: connerr001mall.maricopa.00v
6,3 Payments from ADHS to the Contractor shall be sent to the "Remit To Address listed on the
Contractor's ProcureAZ vendor profile,
15

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
PRICE SHEET
ADHS14-059037
BUDGET
EFFECTIVE: NOVEMBER 1,2013 TO AUGUST 1, 2014
PHASE HOURS COST
Project kick-off: meeting with key stakeholders to develop 62.5 $5,000.00
PHASE 1: survey instrument.
$64,60000 ($57,200.00
Conduct consumer surveys (n=735); identify barriers/gaps in 715 5 professional fee 4.
PHASE 2: Care Continuum Completion $7,360,00 incentives)
Utilize CAREW are data; analyze client level data to show 80 $6,400 00
PHASE 3: client utilization/impact of the Affordable Care Act.
PHASE 4: Analyze survey data and present draft findings, 200 $16,000.00
Complete 2014 Needs Assessment Document/Presentation 250 $20,000.00
PHASE 5: to key stakeholders.
TOTAL HOURS TOTAL COST
1,308 $112,000.00
"n*PROJECT COST BREAK DOWN*"
ARIZONA DEPARTMENT OF HEALTH SERVICES IS RESPONSIBLE FOR 75% OF THE
1. TOTAL COST. THE TOTAL DOLLAR AMOUNT IS $84,000.00
2. MARICOPA COUNTY RYAN WHITE PART A PROGRAM IS RESPONSIBLE FOR 26% OF
THE TOTAL COST. THE TOTAL DOLLAR AMOUNT IS $28,000.00
With prior written approval from the Program manager, the Contractor is authorized to transfer up to
a maximum of ten percent (10%) of the total budget amount between line items. Transfers of funds
are only allowed between funded line items. Transfers exceeding ten percent (10%) or 10 a non-
funded line item shall require an amendment
AUTHORIZATION FOR PROVISION OF SERVICES: Authorization for purchase of services under
this contract shall be made only upon ADHS issuance of a Purchase Order that is signed by an
authorized agent The Purchase Order will indicate the Contract number and the dollar amount on of
funds authorized. The Contractor shall only be authorized to perform services up to the amount
the Purchase Order. ADHS shall not have any legal obligation to pay for services in excess of the
amount indicated on the Purchase Order. No further obligation for payment shall exist on behalf of
ADHS unless: a) the Purchase Order is changed or modified with an official ADHS Procurement under this
Change Order, andlor b) an additional Purchase Order is issued for purchase of services
Contract.
16

- - - - Funds the to official the with contract Services DATE
Expenditures Cate and OXPenditUre5 TITLE!
Reimbursement Report to ) Date Earned ) 5 me, our oonsistent the Health / NUMBER
Actual REPORT Year Expenditures d ( to ( by upon that of report.
Price Year tenoned and SIGNATURE PHONE
Cost Fixed Periodic FINAL -rota) Total examined the based understood Department this in I
El Cumulative 0 0 0 $ $ $ $ $ $ $ $ been belief, valid, account) BY
4A. 48. - - - - - to Year CERTIFICATION has and Is of also is the by provided CONTRACTOR'S PREPARED
Period Earned report information (book It
) Period 4 ) this knoerladge records contract. calculated Information -
Reporting Expenditures ( o Funds ( that price the are PRINT
Report Date CONTRACTOR my fixed or upon AUTHORIZED
Current Prior certify or best and accounting terms payments based PLEASE
$ $ $ $ $ $ $ $ , 7. I
Price to Year - - - - - - - this
AGREEMENT Fixed Earned Period Amount
(1) # Period Expenditures ) b ) 3 ONLY
ONE P.O. To and ( Funds Reporting (
Report Date USE
EXHIBIT enditures Prior $ $ $ $ $ $ $ $ Total AY
INTERGOVERNMENTAL ACCOUNTING
Ex. - - - - - - - - Provided Period 17
REPORT of Budget
Statement a) ( Unita Reporting 2 ( ) ADHS PCA
From Approve.d of Pr=
FOR
EXPENDITURE Number this Fixed
Covered: Detailed $ $ $ $ $ $ SECTION total
or payments
Number Name Program Period Unit THIS date due:
Contractors per i 1 ( Expenditures required): to required): Index
CONTRACTOR'S Contract Contractor of Reporting • Rate Year payment
Title . Total Of Adi Less: of AO Net
1. 2. 3. 4.
NUMBER
CERTIFICA'TION: payment
Services Services
SIGNATURE/DATE
ADHS14-059037 ONLY payment withhold
CONTRACT Health Outside for
Expense USE COORDINATOR 1(2006)
of Street 85007 Classification: Services and Expense satisfactory unsatisfactory,
REIMBURSEMENT Expenses Outlay ADHS due COORDINATOR (Rev.
Department Adams Arizona Expenditures) Professional Operating PRICE Unit: of PROGRAM payment
AccountingiContracts # Account Personnel ERE Travel Capital Other Total Type Performance Performance AD)S/BES/F-110
Arizona 1740W. Phoenix, Irivoice COST (Actual A. FIXED A. ,TOTAL ADHS 0 El 0 No PROGRAM
S. 6. '

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER SCOPE OF SERVICES
ADHS14-059037
Submit a complete 2014 Needs Assessment Document/Presentation to key stakeholders
4.5 Phase 5: PowerPoint to key stakeholders between July 2014 and August 2014,
and
46 Submit Phase Progress Reports:
Reports are due within twenty (20) days following the end of each phase
46.1 Phase Progress
timeframe, and
4.7 invoices:
shall be received by ADHS thirty (30) days following the end of the project
4.7.1 Invoices
required information as directed by Program Manager on invoices This
472 Include all other Report (CER), General Ledger and Phase Summary
includes Contract Expenditure
(EXHIBIT ONE (1),
which are being paid must be for services received within the current grant which year
4.7.3 Invoices have until May le to reconcile any payments,
April 1 5' to March 31. grant year. Any invoice received after May 15 Th for the
are received for the cannot previous be paid with Ryan White grant funds
previous grant year
Current grant year Is April 1, 2013 to March 31, 2014 Any Invoices with are a date no
Exarn0e: of service prior to March 31, 2013 cannot be paid with current grant use funds; the date there of service
exceptions The date of invoice cannot be used; contractors who pays must for an invoice dated from a
to determine if an invoice can be paid A contractor
previous grant cycle will be required to reimburse ADHS
5. APPROVALS:
5.1 Phase Report shall be approved by ADHS Program Manager prior to payment,
into new service phases under this Contract shall be approved by ADHS,
5,2 Expansion
materials, and promotional Items, media or forms including, but not
5.3 All marketing or educational publications or journal articles developed using funds awarded under
limited to, brochures, approved posters, by the ADHS Program Manager prior to printing,
this Contract shall be
materials shall bear the following: "Funded in part by the Ryan White
54 All marketing or educational through the Arizona Department of Health Services, through the
Part B Program as made available
HRSA, and
White Part B Program is fully funded by Federal funds so the Health and requires Human that Services when
5,5 The Ryan Act requirements shall be followed, The HHS Appropriations Act documents
Appropriations statements, press releases, requests for proposals, bid solicitations, and grantees other receiving
issuing describing projects or programs funded in whole or in part with Federal money, shall all clearly state the
Federal funds, including but not limited to, State and local will governments, be financed with Federal money, the
percentage of the total costs of the program or project program, which and percentage and a dollar amount of the
dollar amount of Federal funds for the project or by non-governmental sources
total costs of the project or program that will be financed
14

INTERGOVERNMENTAL AGREEMENT
CONTRACT NUMBER SCOPE OF SERVICES
ADHS14.069037
NOTICES, CORRESPONDENCE, REPORTS AND INVOICES:
6.. Invoices/CERs from the contractor to ADHS shall be sent to:
6.1 Notices, Correspondence, Reports and
Office of Disease Integration and Services
Arizona Department of Ryan Health White Services Part El Care and Sanlice Program Manager
Attn: Lisa M. Fuentes,
150 N. 1e Avenue, Suite #110
Phoenix, AZ 86007
Telephone: (602) 364-3606
Fax; (602) 364-3263
E-mail: lisa.fuentespazdhs.gov
Reports and Payments from the ADHS to the Contractor shall be sent to;
6.2 Notices, Correspondence,
Madcopa County Ryan White Part A Program
Attn: Rose Conner, Program Manager
301 West Jefferson, #3200
Phoenix, AZ 86003
Telephone: (602) 372-7091
connerr001(amail.maricope,gov
to the Contractor shall be sent to the "Remit To" Address listed on the
6.3 Payments from ADHS
Contractor's ProptireAZ vendor profile.
15

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-059037 PRICE SHEET
BUDGET
EFFECTIVE: NOVEMBER 1, 2013 TO AUGUST 1, 2014
PHASE HOURS COST
1: Project kick-off; meeting with key stakeholders to develop 62.5 $5,000.00
PHASE survey instrument.
$64, 600.00 ($57,200.00
PHASE 2: Conduct consumer surveys (n=735); identify barriers/gaps in 715.5 professional fee +
Care Continuum Completion $7,360.00 incentives)
PHASE 3: Utilize CAREWare . . data; analyze client level data to show BO $6,400 00
client utilization/impact b of the Affordable Care Act
PHASE 4: Analyze survey data and present draft findings. 200 $16,000,00
PHASE 5: Complete 2014 Needs Assessment Document/Presentation 250 $20,000.00
to key stakeholders,
TOTAL HOURS TOTAL COST
1,308 $112,000.00
***PROJECT COST BREAK DOWN***
1. ARIZONA DEPARTMENT OF HEALTH SERVICES IS RESPONSIBLE FOR 75% OF THE
TOTAL COST, THE TOTAL DOLLAR AMOUNT IS $84,000.00
2. MARICOPA COUNTY RYAN WHITE PART A PROGRAM IS RESPONSIBLE FOR 25% OF
THE TOTAL COST. THE TOTAL DOLLAR AMOUNT IS $28,000.00
With prior written approval from the Program manager, the Contractor is authorized to transfer up to
a maximum of ten percent (10%) of the total budget amount between line items. Transfers of funds
are only allowed between funded line items Transfers exceeding ten percent (10%) or to a non-
funded line item shall require an amendment
AUTHORIZATION FOR PROVISION OF SERVICES: Authorization for purchase of services under
this contract shall be made only upon ADHS Issuance of a Purchase Order that is signed by an
authorized agent The Purchase Order will indicate the Contract number and the dollar amount of
funds authorized The Contractor shall only be authorized to perform services up to the amount on
the Purchase Order, ADHS shall not have any legal obligation to pay for services in excess of the
amount indicated on the Purchase Order. No further obligation for payment shall exist on behalf of
ADHS unless: a) the Purchase Order is changed or modified with an official ADHS Procurement
Change Order, and/or h) an additional Purchase Order is issued for purchase of services under this
Contract
16