AMD RE HEALTHY PEOPLE HEALTY COMMUNITIES WITH ADHS.PDF

Maricopa County — Formal (2017-02-15)

Extracted text (via pymupdf_layout) 5123 characters

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT(IGA) 150 N. 18th Ave. Suite 280
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer:
Agreement No: ADHS16-102232 Amendment No. 4
Russell Coplen
Healthy People Healthy Communities
Effective upon signature, it is mutually agreed that the Agreement referenced above is amended as follows:
1. Pursuant to Terms and Conditions, Provision Six (6). Contract Changes, Section 6.1 Amendments, Purchase
Orders and Change Orders, the Price Sheet is revised and replaced by the Price Sheet of this Amendment Four (4)
to provide a one-time increase of $25,000.00 to the Healthy Arizona Worksite Program (HAWP) through June 30,
2017.
Continued on next page.
CONTRACTOR SIGNATURE
Maricopa County
Contractor Name Contractor Authorized Signature
4041 N. Central Ave.
Address Printed Name
Phoenix AZ 85012
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
has determined that this Intergovernmental Agreement is in proper form commence any billable work or provide any material, service or
and is within the powers and authority granted under the laws of the construction under this IGA until the IGA has been executed by an
State of Arizona. authorized ADHS signatory.
State of Arizona
Signed this _________ day of _________________________ 2017
Signature Date
Printed Name Procurement Officer
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:
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT(IGA) 150 N. 18th Ave. Suite 280
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Agreement No: ADHS16-102232 Amendment No. 4 Procurement Officer:
Russell Coplen
PRICE SHEET
HEALTHY PEOPLE HEALTHY COMMUNITIES
MARICOPA - ADHS16-102232
JULY 1, 2016 - JUNE 30, 2017
ACTION PLAN
UNIT OF NUMBER
ITEM/SERVICE DESCRIPTION UNIT RATE TOTAL
MEASURE OF UNITS
Action Plan – All Programs EA 1 $250,366.00 $250,366.00
TOTAL 1 $250,366.00 $250,366.00
TOBACCO
UNIT OF NUMBER
ITEM/SERVICE DESCRIPTION UNIT RATE TOTAL
MEASURE OF UNITS
See SOW for Specific Service
Strategies (i.e. Prevention,
QTR 4 $488,404.38 $1,953,617.52
Cessation, Secondhand Smoke,
Enforcement)
TOTAL 4 $488,404.38 $1,953,617.52
HEALTH IN ARIZONA POLICY INITIATIVE
UNIT OF NUMBER
ITEM/SERVICE DESCRIPTION UNIT RATE TOTAL
MEASURE OF UNITS
See SOW for Specific Service
Strategies (i.e. Alzheimer’s, Chronic
Pulmonary Disease, Hypertension,
Self-Management, Procurement,
QTR 4 $134,183.62 $536,746.48
Healthy Community Design, School
Health, Worksite Wellness, Clinical
Care, and Special Health Care
Needs)
TOTAL 4 $134,183.62 $536,746.48
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT(IGA) 150 N. 18th Ave. Suite 280
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Agreement No: ADHS16-102232 Amendment No. 4 Procurement Officer:
Russell Coplen
HEALTHY ARIZONA WORKSITE PROGRAM
UNIT OF NUMBER
ITEM/SERVICE DESCRIPTION UNIT RATE TOTAL
MEASURE OF UNITS
See SOW for Specific Service
QTR 4 $70,509.50 $282,038.00
Strategies
Amendment 4, MCH Funds 1 $25,000.00 $25,000.00
TOTAL $307,038.00
PREVENTIVE HEALTH AND HEALTH SERVICES BLOCK GRANT
UNIT OF NUMBER
ITEM/SERVICE DESCRIPTION UNIT RATE TOTAL
MEASURE OF UNITS
See SOW for Specific Service Strategies
(i.e. Fees for Accreditation, Quality
Improvement Projects, Workforce
Development Implementation, QTR 1 $80,000.00 $80,000.00
Performance Management
Documentation, Progress Toward County
Health Improvement Plan)
UNIT OF NUMBER
ITEM/SERVICE DESCRIPTION UNIT RATE TOTAL
MEASURE OF UNITS
See SOW for Specific Service Strategies
(i.e. Fees for Accreditation, Quality
Improvement Projects, Workforce
Development Implementation, QTR 3 $81,750.00 $245,250.00
Performance Management
Documentation, Progress Toward County
Health Improvement Plan)
TOTAL 4 $325,250.00
FAMILY PLANNING / MATERNAL and CHILD HEALTH (Title V Block Grant)
UNIT OF NUMBER
ITEM/SERVICE DESCRIPTION UNIT RATE TOTAL
MEASURE OF UNITS
See SOW for Specific Service Strategies QTR 4 $67,676.00 $270,704.00
TOTAL 4 $67,676.00 $270,704.00
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