PO 13 RE IMMUNIZATION SVC WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-041805:13
Organizational Reference No.: P00000024981
Issued: 09/04/2015
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health Epidemiology and Disease Control Immunization
4041 N. Central Avenue, #1400 Program
Phoenix, AZ 85012 150 N. 18th Avenue, Suite 120
Phoenix, AZ 85007
US
Email: procure@azdhs.gov
Contract No.: ADH$13-041805 (602) 364-3630
Title: Maricopa County - Immunization Services MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Epidemiology and Disease Control Immunization
Program
150 N. 18th Avenue, Suite 120
Phoenix, AZ 85007
US
Email: procure@azdhs,gov
(602) 364-3630
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: 2015—FEDEDC6033--5170--HS2000--HS20000-6811---PHS-EDC-HPV-- Payment Terms: Net 30
1215-----HSA
Shipping Terms:
Delivery Calendar Day(s) A.R.O.: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 948-92
Immunization Program Services - MARICOPA COUNTY - CONTRACT#
ADHS13-041805 - Contract End Date - 12/3112017 - PO Period thru
12/31/2015.P0 for the delivery of Immunization services and activities as
follows; * Salary/Fringe - YEARLY $50,000.00 * Immunization visit for
children zero (0) to eighteen (18) years of age - UNIT RATE $50.00 * 1.00 TOTAL $ 272,120.00 $ 272,120.00
Immunization Completion for children zero (0) to eighteen (18) years of age
- UNIT RATE $100.00 * Perinatal Hepatitis B Case Management - Prenatal -
UNIT RATE $300.00* Pen natal Hepatitis B Case Management - Postnatal -
UNIT RATE $200.00* School/Children IDR Management-Preparation and
submittal - UNIT RATE $250.00 * Immunization Visit for adults nineteen (19)
years of age and older - UNIT RATE $50.00* Immunization Visit for Flu
Vaccine, in children and adults - UNIT RATE $50.00 CFDA# 93.268
Class-Item 948-92
2 '1.00 TOTAL 1$ 224,475.00 $ 224,475.00
Immunization Proaram Services CFDA# 93.539

TOTAL: $ 496,595,00
Approved By: Myra Chavez
Phone No.: (602) 364-3649

C-86-13-074-3-07 ATTACHED TO AND A PART OF
Purchase Order ADHS13-041805-13
Contract No. ADHS13-041806
Maricopa County – Immunization Services
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