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ROWT,117 DEPARTMENT OF ECONOMIC SECURITY Your Partner For A Stronger Arizona Intergovernmental Agreement C-86-10-007-3-13 CONTRACT AMENDMENT 1. CONTRACTOR (Name and address) 2 CONTRACT ID NUMBER DE101038-001 Maricopa County by and through its Department of Public Health 4041 N. Central Ave., Suite 1400 3. AMENDMENT NUMBER Phoenix, AZ 85012 11 4, THE PARTIES AGREE TO THE FOLLOWING AMENDMENT Pursuant to Section 3.0, Term of Agreement, Paragraph 3.2, Extension, the above referenced contract is extended for the period of July 1, 2017 to September 30, 2017. The Health Assessment service rate is not adjusted for the extension period and shall remain the same as for the previous contract term. Pursuant to Section 4.0, Amendments or Modifications, the contract reimbursement ceiling for the "Coordination- Refugee Preventive Health" service for the period of July 1, 2016 through September 30, 20'17 is revised from $1,796,074 to $2,245,092. Therefore, the Itemized Service Budget for the period of July 1, 2016 to September 30, 2017 is revised and attached. 5. EXCEPT AS PROVIDED HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT AS HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL FORCE AND EFFECT. THE AMENDMENT SHALL BECOME EFFECTIVE ON THE DATE OF LAST SIGNATURE UNLESS OTHERWISE SPECIFIED HEREIN. BY SIGNING THIS FORM ON BEHALF OF THE CONTRACTOR, THE SIGNATORY CERTIFIES HE/SHE HAS THE AUTHORITY TO BIND THE CONTRACTOR TO THIS CONTRACT. a. 7. NAME OF CONTRACTOR ARIZONA DEPARTMENT OF ECONOMIC SECURITY Maricopa County SIGNATURE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL TYPED NAME TYPED NAME Denny Barney TITLE TITLE Chairman, Board of Supervisors DATE DATE IN ACCORDANCE WITH ARS §11 -952 THIS CONTRACT AMENDMENT HAS BEEN REVIEWED BY THE UNDERSIGNED WHO HAVE DETERMINED THAT THIS CONTRACT AMENDMENT IS IN APPROPRIATE FORM AND WITHIN THE POWERS AND AUTHORITY GRANTED TO EACH RESPECTIVE PUBLIC BODY. ARIZONA ATTORNEY GENERAL'S OFFICE APPROVED AS TO FORM By: By: Assistant Attorney General Public Agency Legal Counsel, MCAO Date: Date: ATTEST: Clerk of the Board Date C-86-10-007-3-13 ITEMIZED SERVICE BUDGET CONTRACT SERVICE: Coordination - Refugee Preventive Health CONTRACT: DE101038001 PROVIDER NAME: Maricopa County Department of Public Health Services Division of Public Health Clinical Services CONTRACT PERIOD: 0710112016 to 913012017 1. PERSONNEL TOTAL Number of FTE Total Salary for the % Allocated Service SERVICE DAAS Positions Level Position Title Contract Period "A + D = Total COST COST 1 1.00 Registered Nurse $68,930 5% + 95% = 100% $68,930 68,930 1 0.60 Client Service Coordinator $59,593 5% + 95% = 100% $35,756 35,756 1 0.70 X-RAY Tech $69,765 5% + 95% = 100% $48,836 48,836 TOTAL: $153,521 153,522 "A = % Administrative Functions D = % Direct Service Functions 2. EMPLOYEE RELATED EXPENSES TOTAL DAAS ITEM Fixed Variable 19.21% COST COST 1.00 Registered Nurse $11,400 5% + 95% = 100% $ 24,641 $ 24,641 0.60 Client Service Coordinator $11,400 5% + 95% = 100% $ 13,709 $ 13,709 0.70 X-RAY Tech $11,400 5% + 95% = 100% $ 17,361 $ 17,361 TOTAL: 55,711 55,711 3. PROFESSIONAL AND OUTSIDE SERVICES TOTAL DAAS ITEM BASIS COST COST TOTAL: 4.TRAVEL TOTAL DAAS ITEM BASIS COST COST Staff Owned Vehicle Mileage Field visits 3557 miles @.56per mile 1,992 $ 1,992 TOTAL: 1,992.00 $1,992 5.SPACE TOTAL DAPS ITEM BASIS COST COST $0 TOTAL: $0 6. EQUIPMENT TOTAL DAAS ITEM BASIS COST COST $0 TOTAL: $0 7. MATERIALS AND SUPPLIES TOTAL DAAS ITEM BASIS COST COST $0 TOTAL: $0 8. OPERATING SERVICES TOTAL DAAS ITEM BASIS COST COST Translation Services 17,719 $ 17,719 TOTAL: 17,719 $17,719 9. INDIRECT COSTS TOTAL DAAS ITEM BASIS COST COST Allocated Indirect 15.1% 34,571 34,571 TOTAL: 34,571 $34,571 10 SUBTOTAL ADMIN COST 263,515 263,515 11. VOUCHERS TOTAL DAAS 1,981,577.00 1,981,577.00 TOTAL: 1,981,577 1,981,577.00 12. TOTAL SERVICE COST/DAAS TOTAL COST: 2,245,092 2,245,092