ADHS AWARD WITH NICP FOR CONSULTING (00).PDF

ATTACHMENT A
ARIZONA DEPARTMENT OF
, Offer and Acceptance HEALTH SERVICES
;us i n tr "4 150 North 18 1h Avenue, Suite 280
o SOLICITATION NO.: ADHS17-00006719 Phoenix, AZ 85007
' DESCRIPTION: HRPP Community Health Nurse (602) 542-2942
Consulting Services (602) 548-1741
TO THE STATE OF ARIZONA:
The Undersigned hereby offers and agrees to furnish the material, service or construction in compliance with all terms,
conditions, specifications and amendments in the Solicitation and any written exceptions in the offer. Signature also
certifies Small Business status.
DUNS: 6020625150000
Maricopa County
Company Name ature of Person Authorized to Sign Offer
4041 N. Central Avenue, Suite 1400 Bob England, MD, MPH
Address Printed Name
Phoenix AZ 85012 Director
city State Zip Title
Phone: 602-506-6900
bonniedrenth@mail.maricopa.gov Fax' 602-506-6885
Contact Email Address
By signature in the Offer section above, the Offeror certifies:
1. The submission of the Offer did not involve collusion or other anticompetitive practices.
2. The Offeror shall not discriminate against any employee or applicant for employment in violation of Federal Executive Order 11246, State Executive
Order 2009-9 or A.R.S. §§ 41-1461 through 1465.
3. The Offeror has not given, offered to give, nor Intends to give at any time hereafter any economic opportunity. future employment, gift, loan, gratuity,
special discount, trip, favor, or service to a public servant in connection with he submitted offer. Failure to provide a valid signature affirming the
stipulations required by this clause shall result in rejection of the offer. Signing the offer with a false statement shall void the offer, any resulting
contract and may be subject to legal remedies provided by law,
4. The Offeror certifies that the above referenced organization IS! 2L IS NOT a small business with less than 100 employees or has gross revenues
of $4 million or less.
ACCEPTANCE OF OFFER
The Offer is hereby accepted.
The Contractor is now bound to sell the materials or services listed by the attached contract and based upon the
solicitation, including all terms, conditions, specifications, amendments, etc., and the Contractor's Offer as accepted by
the State.
This Contract shall henceforth be referted to as Contract No, 60 H I
The effective date of the Contract is DeCern bit- I 2ogp
The Contractor is cautioned not to commence any billable work or to provide any material or service under this contract
until Contractor receives purchase order, contact release document or written notice to proceed.
State of Arizona
Awarded this ktieknht{ 2016
SPO Form 203.- Offer anti Acceptance (rev 10-2013)
Maricopa County Department of Public Health, ADHS17-00006719
Pak
161 •

MASTER CONTRACT - TERM
Purchase Order No.: ADHS17-154596
Organizational Reference No.:
Effective Date: 12/01/2016
Valid Through: 11/30/2019
V Vendor Number: 000010983 Arizona Department of Health Services
E, Maricopa County Public Health Public Health Prevention
4041 N. Central Avenue, #1400 150 N 18th Avenue
Phoenix, AZ 85012 Phoenix, AZ 85007
Contract No.: ADHS17-154596 Sue Anne Tan
Title: HRPP/NICP Community Health Nurse Consulting Services
The following documents make up the Contract
and are incorporated herein by reference.
Blanket Instructions
17-00006719 Part 2 Notice Page, Scope of Work. Special Terms and
Condition.pdf TERMS AND CONDITIONS set forth in our Bid, Quotation, or Purchase Order
17-00006719 Part 3 Uniform Terms and Conditions.pdf are incorporated herein by reference and become a part of this order,
17-00006719 Part 4 Uniform Instructions to Offerors.pdf
ADHS17-00006719 Proposal-MCDPH
Award Letter--20,pdf
Please refer to the electronic order in Procure.AZ.gov for the
complete list of attachments
Account Code: Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 948-65
1 All Inclusive Hourly Rate for the HRPP Community Health Nurse Consulting 1,00 HR $ 75.00 $ 75.00
services. Pricing shall all be all-inclusive, to include all labor, materials,
labor rate, labor benefits, travel related expenses, payroll burden,
insurances, workmen?s compensation fee, profit, overhead and all other
related cost factors in.
Class-Item 948-65
2 1.00 QTR $ 0.00 $ 0.00
HRPP Community Health Nurse Consulting services.

I U I HL: .1, /0.1.1u
Approved By: Sue Anne Tan
Phone No.: (602) 542-1044

ATTACHED TO AND A PART OF:
Community Health Nursing Consulting Services
MCDPH, Office of Family Health, Newborn Intensive Care, with
Arizona Department of Health Services
ADHS17-154596
C86-17-
IN WITNESS WHEREOF, the parties agree to enter into this Agreement and its Amendments:
FOR AND ON BEHALF
OF MARICOPA COUNTY ("The Group")
By
Clint Hickman, Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date