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Page 1 of 1 ARIZONA STATE CONTRACT CONTRACT RELEASE ProcureAZ Purchase Order No.: ADHS13-049253:9 Organizational Reference No.: PO0000012178 Issued: 08/05/2015 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 Tuberculosis Phoenix, AZ 85012 I 150 N. 18th Avenue D Suite 110 O P Phoenix, AZ 85007 R US T Email: mary.gullion@azdhs.gov O Contract No.: ADHS13-049253 (602) 364-3848 Title: MARICOPA COUNTY STATE FUNDS 1ST QUARTER 2016 MAIL INVOICE IN DUPLICATE TO: B Arizona Department of Health Services I Office of Disease Integration and Services - Tuberculosis L 150 N. 18th Avenue L Suite 110 Phoenix, AZ 85007 T US Email: mary.gullion@azdhs.gov O (602) 364-3848 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--GENEDC0406--5137--1000--HS50010-6811---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 948-34 NO CFDA #, STATE FUNDS 1 1.00 QTR $ 70,412.50 $ 70,412.50 Tuberculosis Control CONTRACT # ADHS13-049253 P.O. PERIOD 7/1/15-6/30/16 P.O. TOTAL $281650.00 P.O. QUARTERLY $ 70412.50 THIS REQUISITION TO COVER 1ST QUARTER TOTAL: $ 70,412.50 Approved By: Mary Gullion Phone No.: (602) 364-3848 C-86-14-002-3-02 ATTACHED TO AND A PART OF Purchase Order ADHS13-049253:9 Contract No. ADHS13-049253 MARICOPA COUNTY STATE FUNDS 1ST QUARTER 2016 Tuberculosis Control 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