PO RE PROP 201 - 2016 SMOKE FREE WITH ADHS.PDF

ARIZONA STATE CONTRACT Page 1 of 1
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS12-022013:4
Organizational Reference No.: P00000006466
Issued: 07/24/2015
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health Epidemiology and Disease Control
4041 N. Central Avenue, #1400 Office of Environmental Health
Phoenix, AZ 85012 150 N. 18th Avenue, Suite 140
Phoenix, AZ 85007
US
Email: patricia.sauceda@azdhs.gov
Contract No.: ADHS12-022013 (602) 3643118
Title: Prop 201 - 2016 Smoke Free - Maricopa County
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Epidemiology and Disease Control
Office of Environmental Health
150 N. 18th Avenue, Suite 140
Phoenix, AZ 85007
US
Email: patricia.sauceda@azdhs.gov
(602) 364-3118
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--SFAEDC3772-5109--HS2541--HS66007-6811---PHS-TOBCHN Payment Terms: TBD
HSA
Shipping Terms: TOO
Delivery Calendar Day(s) A.R.O.: 0
Item Description j Requisition Quantity Unit Unit Price Total
Class-Item 948-34
Bureau of Epidemiology and Disease Control
Office of Environmental Health
Prop 201 Smoke Free AZ Act
1 Contract # ADHS12-022013 through 6130/17 1.00 YR $ 904,613.00 $ 904,613.00
Purchase Order through 6/30/16
Quarterly @ 6226,153.25
PO Total $904,613
NO CFDA NUMBER
TOTAL: $ 904,613.00
Approved By: Nancy Flores
Phone No.: (602) 364-3292

C-86-12-086-3-03 ATTACHED TO AND A PART OF
Purchase Order ADHS12-022013:4
ADHS12-022013
Prop 201 – 2016 Smoke Free – Maricopa
County
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