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ARIZONA STATE CONTRACT CONTRACT RELEASE ProcureAZ Purchase Order No.: ADHS13-034910:5 Organizational Reference No.: PO0000137849 Issued: 07/29/2016 C-86-13-050-3-06 V Vendor Number: 000010983 Arizona Department of Health Services E Maricopa County Public Health S Bureau of Tobacco and Chronic Disease N 4041 N. Central Avenue, #1400 H 150 N. 18th Avenue, Suite 310 Phoenix, AZ 85012 I Phoenix, AZ 85007 D US O P Email: procure@azdhs.gov R T O Contract No.: ADHS13-034910 (602) 364-0824 Title: BTCD Maricopa HIV Prevention (PO 07/01/16 - 06/30/17) MAIL INVOICE IN DUPLICATE TO: B Arizona Department of Health Services I Bureau of Tobacco and Chronic Disease 150 N. 18th Avenue, Suite 310 L Phoenix, AZ 85007 L US Email: procure@azdhs.gov T O (602) 364-0824 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--FEDPHS2034--4511--HS2000--HS20000-6811---PHS-EDC- Payment Terms: Net 30 HIVPREV--1216---------HSA Shipping Terms: Delivery Calendar Day(s) A.R.O.: 0 Item Description Requisition Quantity Unit Unit Price Total Class-Item 952-43 1 1.00 TOTAL $ 199,575.00 $ 199,575.00 HIV Prevention Program - Services CFDA# 93.940 Item 1 represents 25% Funding (Approved Budget $798,299) TOTAL: $ 199,575.00 Approved By: Byron Homer Phone No.: (602) 364-1223 1 C-86-13-050-3-06 ATTACHED TO AND A PART OF Purchase Order ADHS13-034910:5 Contract No. ADHS13-034919 BTCD Maricopa Prevention (PO 07/01/16- 06/30/17) IN WITNESS WHEREOF, the parties agree to enter into this Contract: FOR AND ON BEHALF OF MARICOPA COUNTY By Clint Hickman, Chairman, Board of Supervisors Date ATTEST: Clerk of the Board Date APPROVED AS TO FORM: Attorney for Maricopa County Date 2