PO ADHS13-034910-3 HIV PREV WITH ADHS 04.PDF

Page 1 of 3
ARIZONA STATE CONTRACT
CONTRACT RELEASE
C-86-13-050-3-04
ProcureAZ Purchase Order No.: ADHS13-034910:3
Organizational Reference No.: PO0000017092
Issued: 08/17/2015
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 07/01/15 - 06/30/16)
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 $ 147,394.00 $ 147,394.00
HIV Prevention - Partner Services Part A
Class-Item 952-43
2 1.00 TOTAL $ 68,607.00 $ 68,607.00
HIV Prevention - Testing Part A
Class-Item 952-43
3 HIV Prevention - Supplemental Part B 1.00 TOTAL $ 183,149.00 $ 183,149.00
CFDA# 93.940 (100% Federal Funding)
Purchase Order for the Period 07/01/2015 - 06/30/2016
Items 1 - 3 represent 50% funding

Page 2 of 3
ARIZONA STATE CONTRACT
CONTRACT RELEASE
Class-Item 952-43
4 1.00 TOTAL $ 199,575.00 $ 199,575.00
HIV Prevention - Partner Services Part A
Item 4 Represents an additional 25% funding.
(02.16.16)
TOTAL: $ 598,725.00
Approved By: Byron Homer
Phone No.: (602) 364-1223

C-86-13-050-3-04 Page 3 of 3
ATTACHED TO AND A PART OF
Purchase Order ADHS13-034910:3
Contract No. ADHS13-034919
BTCD Maricopa Prevention (PO 07/01/15-
06/30/16)
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