AMENDMENT 4 RE CHRONIC DISEASE HEALTH POLICY WITH ADHS.PDF

ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W Adams ST, RM 303
Phoenix, Arizona 85007
AMENDMENT
(602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No: ADHS12-015902 Amendment No. 4
Lorraine Ball-Schwarzwald
Chronic Disease Health Policy
Effective upon signature of both parties, it is mutually agreed that the Agreement referenced above is amended
as follows:
1. Delete current Price Sheet and replace with the Price Sheet in this Amendment for budget adjustment purposes.
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED.
CONTRACTOR SIGNATURE
Maricopa County Health Department
Contractor Name Contractor Authorized Signature
4041 North Central Avenue, #1400
Address Printed Name
Phoenix Arizona 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 attorney date indicated. The Public Agency is hereby cautioned not to commence
has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this IGA, until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this _________ day of ___________________________ 2015
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. PIGA2012000344, which is an
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.
Signature Date
Assistant Attorney General
Printed Name:
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) HEALTH SERVICES
1740 W Adams ST, RM 303
Phoenix, Arizona 85007
AMENDMENT (602) 542-1040
(602) 542-1741 Fax
Procurement Officer
Contract No: ADHS12-015902 Amendment No. 4
Lorraine Ball-Schwarzwald
Price Sheet
Effective April 1, 2015 – June 30, 2015
Current
Proposed New Budget
Cost Reimbursement Line Items Budget
Amount Amount
Amount
1. Personnel Services / ERE $114,212.00 $0.00 $114,212.00
2. Professional and Outside Services $280,129.00 <$43,250.00> $236,879.00
3. Travel Expenses $7,505.00 $0.00 $7,505.00
4. Other Operating Expenses $5,023.00 $3,000.00 $8,023.00
5. Capital Outlay Expenses NOT ALLOWED NOT ALLOWED NOT ALLOWED
6. Other (Indirect Costs) $17,131.00 $0.00 $17,131.00
Total Contract Amount
$424,000.00 <$40,250.00> $383,750.00
(not to exceed)
1. ITEMIZED SERVICE BUDGET (ISB) RESTRICTIONS:
1.1. The Contractor is authorized to transfer up to a maximum of ten percent (10%) of the total Contract
amount among the categorical line items. Transfers of funds are only allowed among funded line
items as detailed in the original ISB. Transfers exceeding ten percent (10%) of the Contracted
amount, or to a non-funded line item, shall require a Contract Amendment.
1.2. Indirect Costs shall not exceed fifteen percent (15%) of the combined total of Personnel Services
and Employee Related Expenses as listed on the ISB. For more detailed information regarding
indirect costs, refer to the ADHS Accounting and Auditing Procedures Manual for Contractors of
ADHS Funded Programs (http://www.azdhs.gov/bhs/finance/account_audit.htm). This manual is
incorporated into this Contract by reference herein.
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