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C-86-15-021-3-05 ARIZONA DEPARTMENT OF HEALTH SERVICES CONTRACT AMENDMENT 150 N 18th Ave., Suite 280 Phoenix, Arizona 85007 (602) 542-1040 Procurement Specialist Contract No: ADHS14-074958 Amendment No: 2 Sue-Anne Tan HRPP/NICP Community Health Nursing Services Effective July 1, 2017, it is mutually agreed that the Contract referenced is amended as follows: 1. Pursuant to Uniform Terms and Conditions, Provision Five (5), Contract Change, Item 5.1 Amendments, Provision Three (3) of the Special Terms and Conditions is revised to read as follows: 3. Contract Extension 5 Year Maximum The Contract term is for three (3) year period subject to extensions with a maximum not to exceed five (5) years. 2. Pursuant to Special Terms and Conditions, Provision Three (3), Contract Extensions 5 Year Maximum, the Contract is hereby extended through June 30, 2019. 3. Pursuant to Uniform Terms and Conditions, Provision Five (5), Contract Change, Item 5.1 Amendments, Provisions Twenty-Three (23) and Twenty-Four (24) are added to the Special Terms and Conditions to read as follows: 23. The Federal Funding Accountability and Transparency Act (FFATA or Transparency Act- P.L.109- 282, as amended by section 6202(a) of P.L. 110-252), found at https://www.fsrs.gov/ If applicable, the Contractor/Grantee shall submit to ADHS via email the Grant Reporting Certification Form. This form and the instructions can be downloaded from the ADHS Procurement website at http://www.azdhs.gov/operations/financial-services/procurement/index.php#ffata and must be returned to the ADHS by the 15th of the month following that in which the award was received. The form shall be completed electronically, and submitted using the steps outlined in the Grant Reporting Certification Form Instructions to the following email address: ADHS_Grant@azdhs.gov. All required fields must be filled including Top Employee Compensation, if applicable. Completing the Grant Reporting Certification Form is required for compliance with the Office of Management and Budget (OMB), found at http://www.whitehouse.gov/omb/open. Failure to timely Continued on next page Contractor hereby acknowledges receipt and acceptance of The above referenced Contract Amendment is hereby above amendment and that a signed copy must be filed with executed this _______ day of _____________, 2017 at the Procurement Office before the effective date. Phoenix, Arizona Signature / Date Authorized Signatory’s Name and Title: Procurement Officer Denny Barney, Chairman, Board of Supervisors Contractor’s Name: Maricopa County by and throught its Maricopa County Public Health ATTEST:______________________________, Clerk of the Board County Attorney__________________________________ Page 1 of 3 ARIZONA DEPARTMENT OF HEALTH SERVICES CONTRACT AMENDMENT 150 N 18th Ave., Suite 280 Phoenix, Arizona 85007 (602) 542-1040 Procurement Specialist Contract No: ADHS14-074958 Amendment No: 2 Sue-Anne Tan submit the Grant Reporting Certification Form could result in the loss of funds. This requirement applies to all subcontractors/sub-awardees utilized by the Contractor/Grantee for amounts exceeding $30,000.00 during the term of the Award. 24. Contracting; Procurement; Investment; Prohibitions 24.1 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. 24.2 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. All other provisions shall remain in their entirety. Page 2 of 3 Participation if Boycott of Israel Arizona Department of Contract No.: ADHS14-074958 PAGE Health Services 1 Office of Procurement 150 N.18th Ave., Suite 280 Description: HRPP/NICP Community Health OF Phoenix, AZ 85007 Nursing Services 1 All materials submitted as part of a response to a solicitation are subject to Arizona public records law and will be disclosed if there is an appropriate public records request at the time of or after the award of the contract. Recently legislation has been enacted to prohibit the state from contracting with companies currently engaged in a boycott of Israel. To ensure compliance with A.R.S. §35-393.01 This form must be completed and returned with the response to the solicitation and any supporting information to assist the State in making its determination of compliance. As defined by A.R.S. §35-393.01: 1."Boycott" means engaging in a refusal to deal, terminating business activities or performing other actions that are intended to limit commercial relations with Israel or with persons or entities doing business in Israel or in territories controlled by Israel, if those actions are taken either: (a) In compliance with or adherence to calls for a boycott of Israel other than those boycotts to which 50 United States Code section 4607(c) applies. (b) In a manner that discriminates on the basis of nationality, national origin or religion and that is not based on a valid business reason. 2. "Company" means a sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, and includes a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate. 3. "Direct holdings" means all publicly traded securities of a company that are held directly by the state treasurer or a retirement system in an actively managed account or fund in which the retirement system owns all shares or interests. 4."Indirect holdings" means all securities of a company that are held in an account or fund, including a mutual fund, that is managed by one or more persons who are not employed by the state treasurer or a retirement system, if the state treasurer or retirement system owns shares or interests either: (a) together with other investors that are not subject to this section. (b) that are held in an index fund. 5.”Public entity" means this State, a political subdivision of this STATE or an agency, board, commission or department of this state or a political subdivision of this state. 6. ”Public fund" means the state treasurer or a retirement system. 7. "Restricted companies" means companies that boycott Israel. 8. "Retirement system" means a retirement plan or system that is established by or pursuant to title 38. All offerors must select one of the following: My company does not participate in, and agrees not to participate in during the term of the contract a boycott of Israel in accordance with A.R.S. §35-393.01. I understand that my entire response will become public record in accordance with A.A.C. R2-7-C317. My company does participate in a boycott of Israel as defined by A.R.S. §35-393.01. : By submitting this response, proposer agrees to indemnify and hold the State, its agents and employees, harmless from any claims or causes of action relating to the State’s action based upon reliance on the above representations, including the payment of all costs and attorney fees incurred by the State in defending such an action. Maricopa County By and Through its Maricopa County Public Health Company Name Signature of Person Authorized to Sign 4041 N Central Avenue, Suite 1400 Denny Barney Address Printed Name Phoenix, AZ 85012 Chairman, Board of Supervisors City State Zip Title Page 3 of 3