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ARIZONA STATE CONTRACT Page 1 of 2 CONTRACT RELEASE ProcureAZ Purchase Order No.: ADHS14-074958:2 Organizational Reference No.: P00000000206 Issued: 07/08/2015 Vendor Number: 000010983 Arizona Department of Health Services Maricopa County Public Health Bureau of Women and Children's Health 4041 N. Central Avenue, #1400 150 N. 18th Avenue, Suite 320 Phoenix, AZ 85012 Phoenix, AZ 85007 US Email: procure@azdhs.gov Contract No.: ADHS14-074958 (602) 364-1400 Title: HRPP Community Nursing MAIL INVOICE IN DUPLICATE TO: Arizona Department of Health Services Bureau of Women and Children's Health 150 N. 18th Avenue, Suite 320 Phoenix, AZ 85007 US Email: procure@azdhs.gov (602) 364-1400 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—GENCFH0296--4341-1000--H343010-6841---PHS-WCH Payment Terms: Net 30 HSA Shipping Terms: N/A Delivery Calendar Day(s) A.R.O.: 0 Item Description I Requisition Quantity Unit Unit Price Total Class-Item 948-64 1 PO EFFECTIVE 711/15 - 6130/16 *** CONTRACT EFFECTIVE 711114- 1.00 QTR $ 76,500.00 $ 76,500.00 6/30/17*** STATE FUNDING ***CONTRACTOR TO INVOICE ACCORDING TO CONTRACT PRICE SHEET *"* THIS CONTRACT CONTAINS QUARTERLY ENCUMBRANCES "*" THIS LINE TO PAY FROM GENCFH0296/ 2016 ***TOTAL CONTRACT AMOUNT = $466**' 2,11,Q.Q_J:113LeaLC,P__COAIMLINITY_HEA1 TELNURSING SERVICES, Class-Item 948-64 2 1.00 TOTAL $ 116,200.00 $ 116,200.00 THIS LINE TO PAY FROM FEDCFH1781 / 0916 "** FEDERAL FUNDING: MCH BLOCK GRANT CFDA 93.994 *"" HRPP/NICP COMMUNITY HEALTH NURSING SERVICES Class-Item 948-64 3 1.00 TOTAL $ 44,000.00 $ 44,000.00 THIS LINE TO PAY FROM FEDCFH1787 / 0916 *** FEDERAL FUNDING: MCH BLOCK GRANT SPECIAL NEEDS CFDA 93.994 ***HRPP/NICP COMMUMMLHEALTH NURStaBERVICES TOTAL: $ 236,700.00 Approved By: Dee Vlahos Phone No.: (602) 364-1425 C-86-15-021-3-02 ATTACHED TO AND A PART OF Purchase Order ADHS14-074958:2 HRPP Community Nursing 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