AMD RE DIETETIIC INTERNSHIP PRGM WITH ADHS.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 FAX
Procurement Officer:
Contract No.: ADHS15-084210 Amendment No.: 1
Jacqueline Ortega-Avila
DIETETIC INTERNSHIP PROGRAM
Effective October 1, 2015, it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. The Original Price Sheet is hereby amended with the Price Sheet of this Amendment One (1). The total budget amount
remains unchanged at is $150,000.00 with the following changes:
1.1 Personnel Costs Salary increased by $2,400.00 due to under budgeting in fiscal year FY15;
1.2 Employee Related Expenses increased by $2,080.00 due to under budgeting in fiscal year FY15;
1.3 Professional & Outside Services decreased by $265.00 due to over budgeting in fiscal year FY15;
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Maricopa County by and through its, CONTRACTOR SIGNATURE
MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
Contractor Name Contractor Authorized Signature
4041 NORTH CENTRAL AVENUE, SUITE 1400 Steve Chucri
Address Printed Name
PHOENIX ARIZONA 85012 Chairman, Maricopa County Board of Supervisors
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the date
indicated. The Public Agency is hereby cautioned not to commence any
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has billable work or provide any material, service or construction under this
determined that this Intergovernmental Agreement is in proper form and is IGA until the IGA has been executed by an authorized ADHS signatory.
within the powers and authority granted under the laws of Arizona.
State of Arizona
Signed this day of 2015
Signature Date
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
form and is within the powers and authority granted under the laws of the
State of Arizona. Under House Bill 2011, A.R.S. § 11-952 was amended to
remove the 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
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 FAX
Contract No.: ADHS15-084210 Amendment No.: 1 Procurement Officer:
Jacqueline Ortega-Avila
DIETETIC INTERNSHIP PROGRAM
1.4 Travel Expenses decreased by $1,000.00 due to over budgeting in fiscal year FY15;
1.5 Occupancy Expenses increased by $4,000.00 due to under budgeting in fiscal year FY15.
1.6 Other Operating Expenses decreased by $4,343.00 due to over budgeting in fiscal year FY15
1.7 Capital Outlay remains the same.
1.8 Indirect (If Authorized) increased by $1,128.00 due to under budgeting in fiscal year FY15.
In ProcureAZ the Contract pricing “Items” tab will be updated upon execution of this Amendment One (1).
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 FAX
Contract No.: ADHS15-084210 Amendment No.: 1 Procurement Officer:
Jacqueline Ortega-Avila
REVISED PRICE SHEET
Effective: October 1, 2015 to September 30, 2016
LINE ITEM BUDGET AMOUNT
1.1 PERSONNEL SERVICES $75,366.00
1.2 EMPLOYEE RELATED EXPENSES $29,526.00
1.3 PROFESSIONAL & OUTSIDE SERVICES $4,735.00
1.4 TRAVEL EXPENSES $3,000.00
1.5 OCCUPANCY EXPENSES $4,000.00
1.6 OTHER OPERATING EXPENSES $12,907.00
1.7 CAPITAL OUTLAY EXPENSES $0.00
1.8 INDIRECT (IF AUTHORIZED) $20,466.00
TOTAL $150,000.00
LINE ITEM BUDGET TRANSFERS
Upon receipt of written authorization from the ADHS Program Manager, the Contractor is authorized to transfer up to a
maximum of ten percent (10%) of the Total Budgeted Amount between funded line items. Transfers of funds are only
allowed between funded line items. Transfers exceeding ten percent (10%) or to a non-funded line item shall require a
Contract Amendment.
INDIRECT COSTS EXPENSES
Any changes in indirect expenses will require submission of supporting documentation and written approval from ADHS.
ALL OTHER PROVISIONS OF THIS AGREEMENT SHALL REMAIN IN THEIR ENTIRETY.
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