ADHS WITH WIC SPECC PRJTS AMD 6 (11).PDF

Maricopa County — Formal (2016-11-16)

Extracted text (via pymupdf_layout) 11564 characters

C-86-14-023-3-11
ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
150 N. 18th Ave., #280
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040 MAIN
(602) 542-1741 FAX
CONTRACT No.: ADHS14-053007 AMENDMENT No.: 6 Jacqueline PROCUREMENT S. Ortega-Avila OFFICER
WIC, BFPC, FMNP and ONEDS SERVICES
Effective upon signature, it is mutually agreed that the Contract referenced is amended as follows:
1. Pursuant to the Terms and Conditions, Provision Six (6), Contract Changes, Item 6.1, Amendments, Purchase Orders
and Change Orders, the following has been revised and replaced to add the following:
ADDITIONAL WIC PROGRAM:
WIC SPECIAL PROJECTS:
Additional monies are provided to Maricopa County for WIC Special Projects that will include the following:
1.1 Provide a Bachelor degreed nutrition graduate to facilitate majority of WIC online classes of intervention clinics
and coordinate WIC online outreach and referrals outlined in the agreed upon job description document.
1.2 Provide a Master’s Level Social Worker or Licensed Clinical Social Worker to implement the Enhanced WIC
Services pilot as outlined and agreed upon in the Enhanced WIC Services proposal document.
CONTINUED ON NEXT PAGE
CONTRACTOR SIGNATURE
MARICOPA COUNTY By and through its
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Contractor Name Contractor Authorized Signature
4041 NORTH CENTRAL AVENUE, SUITE 1400 Clint Hickman
Address Printed Name
PHOENIX ARIZONA 85012 Chairman, Board of Supervisors
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 commence
has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this IGA until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this ______ day of _______________________ 20_______
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. P0012014000078, which is an RESERVED FOR USE BY THE SECRETARY OF STATE
Agreement between public agencies, has been reviewed pursuant to
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who Under House Bill 2011, A.R.S. § 11-952
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona. was amended to remove the requirement
that Intergovernmental Agreements be filed
with the Secretary of State.
Signature Date
Assistant Attorney General
Printed Name:
ATTEST:________________________________, Clerk of Court

ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
150 N. 18th Ave., #280
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040 MAIN
(602) 542-1741 FAX
CONTRACT No.: ADHS14-053007 AMENDMENT No.: 6 Jacqueline PROCUREMENT S. Ortega-Avila OFFICER
ADDITIONAL TERMS AND CONDITIONS:
With prior written approval from the Program Manager, the Contractor is authorized to transfer up to a maximum of ten
percent (10%) of the total budget amount between funded line items except for Registered Dietitian Expenses. Transfers of
funds are only allowed between funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall
require an amendment. The Registered Dietitian line item is meant to fund additional Registered Dietitian position(s) to meet
high-risk counseling requirements.
Authorization for purchase of services under this Contract shall be made only upon ADHS issuance of a Purchase Order
that is signed by an authorized agent. The Purchase Order will indicate the Contract number and the dollar amount of funds
authorized. The Contractor shall only be authorized to perform services up to the amount on the Purchase Order. 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 modified with an official ADHS
Procurement Change Order, and/or b.) an additional Purchase Order is issued for purchase of services under this Contract.
ADHS reserves the right to adjust awards given to local agencies depending on federal dollars received. Adjustments will
be at the discretion of ADHS.
ADDITIONAL WIC PROGRAM:
Should additional administrative monies become available through state or federal grants, ADHS may increase the
purchase order to increase the number of participants served and increase the total of this contract.
The assigned caseload for FFY 2017 is: 65,000
Additional administrative monies are provided to the Contractor to assist in their participation in the Online Nutrition
Education Discussion Sessions (ONEDS). The Contractor shall perform all work required to support the WIC Special Grant
ONEDS project ensuring that all ONEDS-related activities required of the intervention and control clinics are performed on a
timely basis. These activities include but are not limited to staff attendance in required trainings, recruitment of participants
to the study, and ensure completion of evaluation and questionnaires by both participants and staff.
WIC SPECIAL PROJECTS:
Monies are provided for WIC Special Projects that will include the following:
Provide a Bachelor degreed nutrition graduate to facilitate majority of WIC online classes of intervention clinics and
coordinate WIC online outreach and referrals outlined in the agreed upon job description document.
Provide a Master’s Level Social Worker or Licensed Clinical Social Worker to implement the Enhanced WIC Services pilot
as outlined and agreed upon in the Enhanced WIC Services proposal document.
Cover occupancy, security, and cleaning services costs for an ADHS WIC computer lab training room housing up to forty
(40) computers at 2737 West Southern Ave, Suite 10, Tempe, Arizona 85282. The WIC computer lab training room will be
for the priority use of the Arizona State WIC Program and be made available to other Arizona WIC local agencies’. ADHS
Information Technology (ITS) staff will be responsible for installation and maintenance of computer and networking
hardware and software. The training room computers will not be connected to the Maricopa internal network, but the training
room will share the same internet line as the adjacent WIC clinic.
Cover tenant improvement costs for an ADHS WIC computer lab training room housing up to forty (40) computers at 2737
West Southern Ave, Suite 10, Tempe, Arizona 85282.
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