ADHS14-071224 IGA AMD 2 - MARICOPA COUNTY.PDF

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 West Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 FAX
Procurement Officer:
Contract No.: ADHS14-071224 Amendment No.: 2
Yesenia Sandoval
(STD) SEXUALLY TRANSMITTED DISEASE SERVICES
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 Scope of Work is amended as follows:
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED.
Contractor Name: Authorized Signature
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
.
4041 NORTH CENTRAL, SUITE 1400
Address: Print Name
PHOENIX ARIZONA 85012
City State Zip Title
This Intergovernmental Agreement Amendment shall be
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has determined effective the date indicated. The Public Agency is hereby
that this Intergovernmental Agreement is in proper form and is within the powers and cautioned not to commence any billable work or provide any
authority granted under the laws of Arizona material, service or construction under this IGA until the IGA
has been executed by an authorized ADHS signatory.
State of Arizona
Signature Date
Signed this day of 2015.
Print Name Title
Procurement Officer
Attorney General Contract No.: P0012014000078 _, which is an Agreement RESERVED FOR USE BY THE SECRETARY OF STATE
between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by
the undersigned Assistant Attorney, who has determined that it is in proper Under House Bill 2011, A.R.S. § 11-952
form and is within the powers and authority granted under the laws of the was amended to remove the
State of Arizona. requirement that Intergovernmental
Agreements be filed with the
Secretary of State.
Signature Date
Assistant Attorney General
Print Name Title
ATTEST:________________________
Clerk of the Board Date

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 West Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 FAX
Contract No.: ADHS14-071224 Amendment No.: 2 Procurement Officer:
Yesenia Sandoval
1.1 Provision Three (3) Scope of Services is revised to add the following:
3.3 In accordance with the CDC “Improving Sexually Transmitted Disease Programs through
Assessment, Assurance, Policy Development and Prevention Strategies (STD AAPPS)”, CDC-
RFA-PS14-1402, and in collaboration with ADHS and its Contractor, develop and implement
an evaluation of MCDPH’s efforts to “collaborate with other organizations to implement STD
health promotion and prevention education activities for at-risk populations or communities”.
These activities include but are not limited to the following:
3.3.1 Identify venues frequented by men who have sex with men (MSM) who are at high-
risk of syphilis infection for targeted education and screening;
3.3.2 Identify potential partners to assist MCDPH with their efforts to implement STD health
promotion and prevention activities targeting high-risk MSM;
3.3.3 Print vouchers for free STD/HIV testing at the MCDPH STD clinic for distribution at
outreach events targeting high-risk MSM. Vouchers shall be coded by outreach event;
and
3.3.4 Maintain a record of vouchers that are redeemed, the event code on each voucher,
tests that are administered with the results for each voucher, as well as any other
indicator required by the ADHS contractor and / or CDC to ensure an effective
evaluation is implemented.
1.2 Provision Seven (7) State Provided Items is revised to add the following:
7.8 Payment for voucher / card production; and
7.9 Payment for clinic visits for clients redeeming a voucher.
1.3 Provision Eight (8) Reporting Requirements/Deliverables and Schedules is revised to add the following:
8.5 Complete template provided by ADHS contractor with data required for the evaluation on a
quarterly basis as required in the Evaluation Plan Gantt Chart submitted to CDC.
2. The Contract Price Sheet is revised and replaced with the Price Sheet of this Amendment Number Two (2).

ARIZONA DEPARTMENT
OF HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT 1740 West Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 FAX
Contract No.: ADHS14-071224 Amendment No.: 2 Procurement Officer:
Yesenia Sandoval
PRICE SHEET
Effective January 1, 2015
ACCOUNT CLASSIFICATION AMOUNT
Personnel Services and ERE $403,852
Professional & Outside Services $ 0.00
Travel Expense $ 0.00
Occupancy Expense $ 0.00
Other Operating Expenses $ 0.00
Capital $ 0.00
Other $ 60,578
TOTAL $464,430
Effective December 1, 2015 – June 30, 2016
Description QTY. Rate per unit Unit Amount
Vouchers / Cards 20,000 $0.05 Each $1,000.00
Clinic Visits 1,450 $20.00 Each $29,000.00