HIV SURV WITH ADHS17-141746 AMD 1.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
C-86-13-003-07 (602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS17-141746 Amendment No. 1
Delilah Gonzalez
HIV SURVEILLANCE PROGRAM
Effective upon final signature, it is mutually agreed that the Contract 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 amended as follows:
1.1 The Price Sheet is revised and replaced with the Price Sheet in this Amendment. The Total Price Sheet
remains the same, the line item changes are due to a decrease in Personnel. New line item added due to
collaboration with other organizations to implement STD promotion and prevention educations activities.
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED.
CONTRACTOR SIGNATURE
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Clint Hickman
Contractor Name Contractor Authorized Signature
4041 NORTH CENTRAL, SUITE 1400 Chairman, Board of Supervisors
Address Printed Name
PHOENIX ARIZONA 85012
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has the date indicated. The Public Agency is hereby cautioned not to
determined that this Intergovernmental Agreement is in proper form and is commence any billable work or provide any material, service or
within the powers and authority granted under the laws of the State of Arizona. construction under this IGA until the IGA has been executed by an
authorized ADHS signatory.
State of Arizona
Signed this ______ day of _______________________ 2016.
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:
ATTEST:___________________________________________
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 150 N. 18th Avenue, Suite 280
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS17-141746 Amendment No. 1 Delilah Gonzalez
Price Sheet
Cost Reimbursement Line Items Budget Amount
1 Personnel Services $78,518.00
2 Employee Related Expenses $21,888.00
3 Professional & Outside Services $0.00
4 Travel Expenses $0.00
5 Other Operating Expenses $341.00
6 Capital Outlay Expenses $0.00
7 Other (Indirect Costs) $15,061.00
Total Contract Amount (not to exceed) $115,808.00
1. Itemized Service Budget (ISB) Restrctions:
1.1 The Contractor is authorized to transfer up to a maximum of 10% of the total contract amount among the
categorical line items. Transfers of funds are only allowed among funded line items as detailed in the
orginal ISB. Transfers exceeding 10% of the contracted amound, or to a non-funded lin item, shall require a
contract amendment;
1.2 Indirect Costs shall not exceed 15% of the combined total of Personnel Services and Employee Related
Expenses as listed on the ISB. For more detailed information regarding indirect costs, refer to the ADHS
Accounting and Auditing Procedures Manual for Contractors fo ADSH Funded Programs. This manual is
incorporated into this contract reference herein.
2. Authorization for Provision of Services
Authorization for purchase of services under this contract shall be made only upon ADHS issuance of Purchase
Order that is signed by an authorized agent. The Purchase Order will indicage the contract number and the dollar
amount of funds authorized. The Contractor shall only bre authorized to perform services up to the amount on the
Purchase Oder. ADHS shall not have any legal obligation to pay for services in excess of the amount indicated on
the Purchase Order. No further obligation for payment shall exist on behalf of ADHS unless a.) the Purchase
Order is changed or modified with an official ADHS Procurement Change Order, and/or b.) and additional
Purchase Order is issued for purchase of services under this contract.
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