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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: ADHS14-059037 Amendment No. 4 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 ADHS14-059037 (old contract) is changed to new Contract number ADHS18-172575 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: 1 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: ADHS14-059037 Amendment No. 4 Delilah Gonzalez 1.3 Add provision (19) to Terms and Conditions to read as follows: 19. Contracting; Procurement; Investment; Prohibitions 19.1 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. 19.2 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. 19.3 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. 1.4 Add the following to Scope of Services, Section 3, Tasks, to read as follows: 3.1.6 Contractor shall complete the following activities for the “Service Standards Review and Development Gender Identity Survey Administration and Analysis AIDS Drug Assistance Program Staff Training POD Meetings for Service Standards” to read as follows: 3.1.6.1 Component #1: Service Standard Review and Development 3.1.6.1.1 Contractor will work with ADHS Ryan White Part B Program, Ryan White Part B Sub-recipients, and Community Stakeholders in the review and revision of Ryan White Part B Service Standards; 3.1.6.1.2 Contractor will work with ADHS Ryan White Part B Program, Ryan White Part B Sub-recipients, and Community Stakeholders to schedule PODS, key informant focus groups, and work session in reviewing and revising Ryan White Part B Service Standards; 3.1.6.1.3 Contractor will align the ADHS Ryan White Part B Service Standards with the HRSA/HAB performance measures, National Public Health Service Standards (NPHPS), and the Phoenix EMA Ryan White Part A program to ensure continuity of service across the State of Arizona. 3.1.6.1.4 Contractor will develop and deliver to the ADHS Ryan White Part B Program Director, working drafts of reviewed and revised Service Standards. 3.1.6.2 Component #2: Gender Identity Survey Administration and Analysis 3.1.6.2.3 Contractor will develop a survey instrument to be administered Statewide (Arizona), to citizen with special emphasis on “gender identity” with relation to prevention and care; as well as a special section for substance use (e.g. tobacco, alcohol, etc); 3.1.6.2.4 Contractor will work with the ADHS Ryan White Part B, ADHS Prevention, Phoenix EMA Ryan White Part A, and Sub-recipients in developing and identifying a sample client list to be surveyed. The Recipient will be responsible for finalizing the sample list utilizing CAREWare data; 3.1.6.2.5 Contractor will administer the survey instrument to clients identified in the sample list via telephone in conjunction with ADHS Ryan White Part B Sub-recipients; 2 ARIZONA DEPARTMENT OF HEALTH SERVICES INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 260 Phoenix, Arizona 85007 (602) 542-1040 (602) 542-1741 Fax Procurement Specialist Contract No: ADHS14-059037 Amendment No. 4 Delilah Gonzalez 3.1.6.2.6 Contractor will foster a working relationship with ADHS Prevention in the administration of “street” surveys. ADHS Prevention will employ efforts to survey participants at various venues through the State of Arizona identified as “places of interest” for clients with gender identities of focus; 3.1.6.2.7 Contractor will extract substance use data from the survey and make it available to ADHS Department of Tobacco for analysis; 3.1.6.2.8 Contractor will analyze survey results and develop a report to be presented to the AHDS Ryan White Part B, ADHS Prevention, Phoenix EMA Ryan White Part A, Sub-recipients and Community Stakeholders. 3.1.6.3 Component #3: AIDS Drug Assistance Program (ADAP) Staff Training 3.1.6.3.3 Contractor will develop a one-day on-site training program for ADAP staff with an emphasis on the following three components: 3.1.6.3.3.1 Medical Case Management Services 3.1.6.3.3.2 Non-medical Case Management Services 3.1.6.3.3.3 Eligibility Specialists 3.1.6.4 Component #4: POD Meetings for Service Standards 3.1.6.4.3 Contractor will coordinate POD meetings on April 17th and 18th for Medical Case Management, Non-medical Case Management, and Early Intervention Services Service Standards; 3.1.6.4.4 Contractor will schedule and reserves meeting space for the POD meeting; 3.1.6.4.5 Contractor will schedule and coordinate a light breakfast and lunch for April 17th and 18th POD meetings in Phoenix, AZ; 3.1.6.4.6 Contractor will conduct POD meetings to include ADHS Ryan White Part B Sub- recipients input on the development of Medical Case Management, Non-medical Case Management, and Early Intervention Services Service Standards. 3.1.6.5 Component #5: Development of Arizona Standard Forms and Training Documents for Service Delivery 3.1.6.5.3 Contractor will develop Service Delivery Narratives for up to 5 service categories. Service categories will include case management and EIS at a minimum; 3.1.6.5.4 Contractor will create and gather key stakeholder input on a case management acuity scale for Arizona; 3.1.6.5.5 Contractor will work with ADHS to draft and revise standard forms for case management and EIS based on standards, community input and best practices; 3.1.6.5.6 Contractor will participate in up to 10 hours of recorded meetings discussing the standards. 3 ARIZONA DEPARTMENT OF HEALTH SERVICES INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 260 Phoenix, Arizona 85007 (602) 542-1040 (602) 542-1741 Fax Procurement Specialist Contract No: ADHS14-059037 Amendment No. 4 Delilah Gonzalez 1.5 Exhibit two (2) included in this Amendment is hereby made part of the Contract. 1.6 Add Provision nineteen (19) to Terms and Conditions to read as follows: 19. CONTRACTING; PROCUREMENT; INVESTMENT; PROHIBITIONS 19.1 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. 19.2 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. 19.3 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. 1.7 The Price Sheet is revised with the Price Sheet in this Amendment. 4 ARIZONA DEPARTMENT OF HEALTH SERVICES INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 260 Phoenix, Arizona 85007 (602) 542-1040 (602) 542-1741 Fax Procurement Specialist Contract No: ADHS14-059037 Amendment No. 4 Delilah Gonzalez Price Sheet PHASE COMPONENTS Hours Rate Total Component #1: Service Standard Review and 1 1200 $80 $96,000.00 Development Component 2: Gender Identity Survey Administration 2 400 $80 $32,000.00 and Analysis Component 3: AIDS Drug Assistance Program (ADAP) 3 90 $80 $7,200.00 Staff Training 4 Component 4: POD Meetings for Service Standards 200 $80 $16,000.00 Component 5: Development of Arizona Standard Forms 5 330 $80 $ 26,400.00 and Training Documents for Service Delivery Total $2,220.00 $177,600.00 5 ARIZONA DEPARTMENT OF HEALTH SERVICES INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 260 Phoenix, Arizona 85007 (602) 542-1040 Exhibit Two (2) (602) 542-1741 Fax Procurement Specialist Contract No: ADHS14-059037 Amendment No. 4 Delilah Gonzalez Project Calendar April 2017 – October 2018 APR SEP MAY JUNE JULY AUG OCT NOV DEC JAN FEB MAR Phase TASKS 2017 T 2017 2017 2017 2017 2017 2017 2017 2018 2018 2018 2017 Component #1: Service 1 Standard Review and X X X X X X X X X X X X Development Component 2: Gender Identity 2 Survey Administration and X X X X X X X X X X X X Statewide Needs Assessment Component 3: AIDS Drug 3 Assistance Program (ADAP) X X X Staff Training Component 4: POD Meetings 4 X X X X X X X X X X X X for Service Standards Component 5: Development of Arizona Standard Forms and 5 X X X X X X X X X X X X Training Documents for Service Delivery APR MAY JUNE JULY AUG SEPT OCT Phase TASKS 2018 2018 2018 2018 2018 2018 2018 Component #1: Service Standard Review 1 X X X X X X X and Development Component 2: Gender Identity Survey 2 Administration and Statewide Needs X X X X X X X Assessment Component 3: AIDS Drug Assistance 3 X X Program (ADAP) Staff Training Component 4: POD Meetings for Service 4 X X X X X X X Standards Component 5: Development of Arizona 5 Standard Forms and Training Documents for X X X X X X X Service Delivery 6