PO RE STD MARICOPA IPP WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: HG052195:7
Organizational Reference No.: P00000012236
Issued: 08/05/2015
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health Office of Disease Integration and Services
4041 N. Central Avenue, #1400 150 N. 18th Avenue, Suite 110
Phoenix, AZ 85012 Phoenix, AZ 85007
US
Email: maria,thomas@azdhs.gov
Contract No.: HG052195 (602) 364-3601
Title: STD-MARICOPAIPP 2015-2nd Half
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Office of Disease Integration and Services
150 N. 18th Avenue, Suite 110
Phoenix, AZ 85007
US
Email: maria.thomas@azdhs,gov
(602) 364-3601
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--FEDEDC2287--5129--HS2000--HS20000-6811---PHS-EDC- Payment Terms:
IMPVSTD--1215 HSA
Shipping Terms:
Delivery Calendar Day(s)A.R.O.: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 952-49
Utilization of County Lab: IPP Testing,
1 OFFICE of DISEASE INTEGRATION and SERVICES, 1671.02 EA $ 11.30 $ 18,882,53
PO EFFECTIVE JULY 1, 2015 THRU DEC 31, 2015,
CONTRACT# HG052195,
CFDA# 93.977
(Reference PO# E228380)
TOTAL: $ 18,882.53
Approved By: Leticia Medina
Phone No.: (602) 364-4666

C-86-10-120-3-12 ATTACHED TO AND A PART OF
Purchase Order HG052195:7
Contract No. HG052195
STD-MARICOPA IPP 2015-2nd HalF
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