IGA AMD FOR HEALTH PEOPLE HEALTHY COMM WITH ADHS.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT(IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer:
Contract No: ADHS15-094977 Amendment No. 1
Lorraine Ball-Schwarzwald
Healthy People Healthy Communities
Effective upon signature of both parties, it is mutually agreed that the Agreement referenced above is amended
as follows:
1. Pursuant to Terms and Conditions, Provision 6. Contract Changes, Section 6.1 Amendments, Purchase Orders and
Change Orders the following is amended:
1.1. Due to a system change Agreement No. ADHS15-094977 is changed to Agreement No. ADHS16-102232.
1.2. Delete the Scope of Work, Provision 9. Deliverables and replace with the following:
9. Deliverables
9.1. The County shall submit the deliverables listed below to the ADHS Program Coordinator:
9.1.1. Contractor Expenditure Report (CER), an electronic version will be provided, upon
request, to ADHS, due thirty (30) days after each quarter end (Q1: July – September; Q2:
October – December; Q3: January – March; and Q4: April – June);
9.1.2. A written Quarterly Report, due thirty (30) days after each quarter end (Q1: July –
September; Q2: October – December; Q3: January – March; and Q4: April – June);
Continued on next page.
CONTRACTOR SIGNATURE
Maricopa County
Contractor Name Contractor Authorized Signature
4041 N. Central Avenue, #1400
Address Printed Name
Phoenix, AZ 85012
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the
Pursuant to A.R.S. § 11-952, the undersigned public agency date indicated. The Public Agency is hereby cautioned not to commence
attorney has determined that this Intergovernmental Agreement is in any billable work or provide any material, service or construction under
proper form and is within the powers and authority granted under this IGA until the IGA has been executed by an authorized ADHS
the laws of the State of Arizona. signatory.
State of Arizona
Signed this _________ day of _________________________ 20_____
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. P00120143000078, which is an Reserved for use by the Secretary of State
Agreement between public agencies, has been reviewed pursuant
to A.R.S. § 11-952 by the undersigned Assistant Attorney General,
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
Signature Date
Assistant Attorney General with the Secretary of State.
Printed Name:

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT(IGA) 1740 W. Adams, Room 303
AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS15-094977 Amendment No. 1 Procurement Officer:
Lorraine Ball-Schwarzwald
9.1.3. A final CER invoice not later than forty-five (45) days following the
end of each contract year;
9.1.4. Provide the name, email address and phone numbers of all program
staff funded under this Agreement within thirty (30) days of hire;
9.1.5. Notify ADHS Program Coordinator of any change in program staff
under this Agreement within fifteen (15) days of the change;
9.1.6. Collaborate and participate with ADHS on the development of a logic
model;
9.1.7. For YEAR 1 Phase I, submit an annual action plan and budget plan
by August 15 for programs selected in Phase I (Tobacco, Chronic
Disease, and HAPI).
9.1.8. For YEAR 1 Phase II, submit an annual action plan and budget plan
by November 15 for programs selected in Phase II (Preventive
Health and Health Services Block Grant/Public Health Accreditation).
9.1.9. For Year 1 Phase III, submit an annual action plan and budget plan
by February 15 for programs selected in Phase III (Teen Pregnancy
Prevention, Family Planning, Maternal and Child Health)
9.1.10. For Years 2 – 5, submit an annual action plan and budget plan by
August 15.
9.1.11. Submit an Annual Report forty-five (45) days following the end of
each Contract year;
9.1.12. Submit a written request to use the ADHS Logo in any print, web
documents, publications and video recordings prior to use; and
9.1.13. Submit a written request for the development of brochures, posters,
public service announcements, paid media, videos, sponsorships,
etc., to be paid for with funds from this Agreement prior to
development.
ALL OTHER PROVISIONS SHALL REMAIN IN THEIR ENTIRETY.