PO 17 RE IMMUNIZATION SVCS PAN FLU WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-041805:17
Organizational Reference No.: PO0000125143
Issued: 06/29/2016
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Epidemiology and Disease Control Immunization
N 4041 N. Central Avenue, #1400 H Program
Phoenix, AZ 85012 I 150 N. 18th Avenue, Suite 120
D Phoenix, AZ 85007
O P US
R Email: procure@azdhs.gov
T
O
Contract No.: ADHS13-041805 (602) 364-3630
Title: Maricopa County - Pan Flu Immunization Activities
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I Epidemiology and Disease Control Immunization
Program
L 150 N. 18th Avenue, Suite 120
L Phoenix, AZ 85007
US
T Email: procure@azdhs.gov
O
(602) 364-3630
Release Instructions
TERMS AND CONDITIONS set forth in our Bid, Quotation, or Purchase Order
are incorporated herein by reference and become a part of this order.
Account Code: 2016--FEDEDC2540--5171--HS2000--HS20000-6811---PHS-EDC- Payment Terms: Net 30
IMMUVFC--1216---------HSA
Shipping Terms:
Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 948-92
Immunization Program - PO for the delivery of Seasonal Pan Flu
1 Immunization Services & Activities necessary to aid MARICOPA COUNTY 1.00 TOTAL $ 141,544.00 $ 141,544.00
PO Period thru 12/31/16. Contract# ADHS13-041805 Contract period
12/31/2017. CFDA# 93.268 **FFATA certification required
** FFATA Certification is required
TOTAL: $ 141,544.00
Approved By: Myra Chavez
Phone No.: (602) 364-3649

C-86-13-074-3-08 ATTACHED TO AND A PART OF
Purchase Order ADHS13-041805:17
Maricopa County – Pan Flu Immunizations
Activities
Arizona Department of Health Services
IN WITNESS WHEREOF, the parties agree to enter into this Contract:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date