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Page 1 of 2 ARIZONA STATE CONTRACT CONTRACT RELEASE ProcureAZ Purchase Order No.: ADHS14-053007:20 Organizational Reference No.: PO0000206917 Issued: 03/07/2017 C-86-14-023-3-12 V Vendor Number: 000010983 Arizona Department of Health Services E Maricopa County Public Health S Bureau of Nutrition and Physical Activity N 4041 N. Central Avenue, #1400 H 150 N. 18th Avenue, Suite 310 Phoenix, AZ 85012 I Phoenix, AZ 85007 D US O P Email: procure@azdhs.gov R T O Contract No.: ADHS14-053007 (800) 252-5942 Title: Maricopa FFY 2017 FMNP Services MAIL INVOICE IN DUPLICATE TO: B Arizona Department of Health Services I AP Services 150 N 18th Avenue, Ste 280 L Phoenix, AZ 85007 L US Email: INVOICES@azdhs.gov T O (602) 542-6354 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: 2017--LOTCFH4190--4410--HS4250-LOTWIC-HS25000-6811---PHS- Payment Terms: Net 30 NPA------------HSA Shipping Terms: Delivery Calendar Day(s) A.R.O.: 0 Item Description Requisition Quantity Unit Unit Price Total Class-Item 952-26 1 1996.00 EACH $ 1.25 $ 2,495.00 WIC FMNP CHECK ISSUANCE PER PARTICIPANT $1.25 TOTAL: $ 2,495.00 Approved By: America Coles Phone No.: (602) 542-2878 Page 2 of 2 C-86-14-023-3-12 ATTACHED TO AND A PART OF Purchase Order ADHS14-053007:20 Farmer’s Market Nutrition Program Service Combined WIC Services ADHS14-053007 IN WITNESS WHEREOF, the parties agree to enter into this Contract and its Amendments: FOR AND ON BEHALF OF MARICOPA COUNTY By Denny Barney Chairman, Board of Supervisors Date ATTEST: Clerk of the Board Date APPROVED AS TO FORM: Attorney for Maricopa County Date