AMD 4 RE RFP WITH DELTA DENTAL.PDF

CONTRACT NO: C-86-13-061-3-04 AMENDMENT NO: 4
AMENDMENT TO
CONTRACT
Between
MARICOPA COUNTY
By and Through
DEPARTMENT OF PUBLIC HEALTH
and
DELTA DENTAL PLAN OF ARIZONA
The above named contract is hereby amended as specified below:
A. The Contract is renewed for a term of three (3) years, beginning on the 1 st day of
March, 2016 and ending on the 28th day of February, 2019
B. The Contract amount is not-to-exceed $3,900,000.00
All other terms and conditions of the original contract and its amendments shall
remain in full force and effect.
IN WITNESS WHEREOF, the parties agree to the changes indicated herein:
FOR AND ON BEHALF OF FOR AND ON BEHALF OF
MARICOPA COUNTY DELTA DENTAL PLAN OF ARIZONA
By: By:
Chairman, Board of Supervisors
Date Date
ATTEST ATTEST
Clerk of the Board
Date Date
APPROVED AS TO FORM APPROVED AS TO FORM
Attorney for Maricopa County
Date Date
1

INTERDEPARTMENTAL AGREEMENT NUMBER PHA-1503
AMENDMENT No. 4
Between
Maricopa County Employee Benefits and Health,
Maricopa County Ryan White Part A Program
And
Maricopa County Department of Public Health,
Office of Health Promotion and Education
The purpose of this Amendment is to revise the Agreement Amount (Maximum
Reimbursable Amount) to read: The Maximum Reimbursable Amount shall be in
accordance with the fully executed Task Order(s) and Grant Master(s) issued to the
Provider. The maximum amount of reimbursement for this contract is the $3,900,000 over
three years.
The term of this agreement is March 1, 2015 through February 29, 2016. This Amendment
extends the Agreement to February 28, 2017.
All other terms and conditions of this Agreement remain unchanged.
IN WITNESS WHEREOF, THE PARTIES ENTER INTO THIS AMENDMENT:
By: Date: -12-2o14
Bob England, MD, MPH
Director
Maricopa County Department of Public Health
;.•
Date: 2e-1/
Rose Conner
Program Manager
Maricopa County Ryan White Part A Program