TB CONTROL AMD 4 WITH ADHS13-042100.PDF

Maricopa County — Formal (2016-02-03)

Extracted text (via pymupdf_layout) 4755 characters

ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS13-042100 Amendment No. 4
Delilah Gonzalez
TUBERCULOSIS CONTROL
It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows:
1. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item (6.1), Amendments, Purchase Orders
and Change Orders; the Contract Price Sheet is replaced with the Revised Price Sheet in this Amendment. Pricing
will remain the same for 2016.
(CONTINUED ON NEXT PAGE)
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED.
Maricopa County, By and Through its CONTRACTOR SIGNATURE
MARICOPA COUNTY DEPARTMENT OF PUBLIC
HEALTH
Contractor Name Contractor Authorized Signature
--------------------- Denny Barney
4041 NORTH CENTRAL AVENUE, SUITE #1400
Address Printed Name
Chairman Board of Supervisors
PHOENIX ARIZONA 85012
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has date indicated. The Public Agency is hereby cautioned not to
determined that this Intergovernmental Agreement is in proper form and is commence any billable work or provide any material, service or
within the powers and authority granted under the laws of the State of construction under this IGA until the IGA has been executed by an
Arizona. authorized ADHS signatory.
State of Arizona
Signed this ______ day of _______________________ 201__ 6
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. P0012014000078, which is an RESERVED FOR USE BY THE SECRETARY OF STATE
Agreement between public agencies, has been reviewed pursuant to
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who has
determined that it is in proper form and is within the powers and authority
granted under the laws of the State of Arizona.
Signature Date
Assistant Attorney General
Printed Name:
ATTEST:
1
_______________________________
Clerk of the Board Date

ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS13-042100 Amendment No. 4 Delilah Gonzalez
2. Pursuant to Terms and Conditions, Provision Six (6), Contract Changes, Item (6.1), Amendments, Purchase
Orders and Change Orders; the following is added and made part of the Terms and Conditions:
22. The Federal Funding Accountability and Transparency Act (FFATA or Transparency Act - P.L.109-282,
as amended by section 6202(a) of P.L. 110-252), found at https://www.fsrs.gov/
If applicable, the Contractor/Grantee shall submit to ADHS via email the Grant Reporting Certification Form.
This form and the instructions can be downloaded from the ADHS Procurement website at
http://azdhs.gov/procurement and must be returned to the ADHS by the 15th of the month following that in
which the award was received. The form shall be completed electronically, and submitted using the steps
outlined in the Grant Reporting Certification Form Instructions to the following email address:
ADHS_Grant@azdhs.gov. All required fields must be filled including Top Employee Compensation, if
applicable. Completing the Grant Reporting Certification Form is required for compliance with the Office of
Management and Budget (OMB), found at http://www.whitehouse.gov/omb/open. Failure to timely submit the
Grant Reporting Certification Form could result in the loss of funds. This requirement applies to all
subcontractors/sub-awardees utilized by the Contractor/Grantee for amounts exceeding $30,000.00 during
the term of the Award.
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