C-86-13-003-3-04 HIV SURV PO.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS12-016584:16
Organizational Reference No.: PO0000070000
Issued: 01/21/2016
C-86-13-003-3-04
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Office of Disease Integration and Services
N 4041 N. Central Avenue, #1400 H 150 N. 18th Avenue, Suite 110
Phoenix, AZ 85012 I Phoenix, AZ 85007
D US
O P Email: maria.thomas@azdhs.gov
R
T
O
Contract No.: ADHS12-016584 (602) 364-3601
Title: EDC/ODIS/HIV Surveillance - Maricopa County 2016
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I Office of Disease Integration and Services
150 N. 18th Avenue, Suite 110
L Phoenix, AZ 85007
L US
Email: maria.thomas@azdhs.gov
T
O
(602) 364-3601
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--GENEDC0401--5133--1000--HS50060-6811---PHS-EDC------------ Payment Terms: Net 30
HSA
Shipping Terms:
Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 952-43
1 HIV Surveillance Activities 1.00 TOTAL $ 20,403.25 $ 20,403.25
Contract # ADHS12-016584. PO Budget Period 01/01/2016 - 12/31/2016.
This PO is for the First Quarter of contract $28,952.
Contract Total is $115,808
Class-Item 952-43
2 1.00 TOTAL $ 7,362.50 $ 7,362.50
HIV Surveillance Activities
Contract # ADHS12-016584. CFDA 93.944 PO Budget Period 01/01/2016 -
12/31/2016.
This PO is for the first quarter of contract.
Class-Item 952-43
3 1.00 TOTAL $ 1,186.25 $ 1,186.25
HIV Surveillance Activities
Contract # ADHS12-016584. CFDA 93.944 PO Budget Period 01/01/2016 -
12/31/2016.

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
This PO is for the first quarter of the contract.
TOTAL: $ 28,952.00
Approved By: Maria Thomas
Phone No.: (602) 364-3601

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ATTACHED TO AND A PART OF:
Purchase Order ADHS12-016584:16
EDC/ODIS/HIV Surveillance 2016
C-86-13-003-3-04
IN WITNESS WHEREOF, the parties agree to enter into this Agreement and its Amendments:
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