AMENDMENT 8 RE REFUGEE MAP WITH ADES.PDF

Intergovernmental Agreement
CONTRACT AMENDMENT
1. CONTRACTOR (Name and address) 2. CONTRACT ID NUMBER
DE101038-001
Maricopa County Department of Public Health
4041 N. Central Ave., Suite 1400 3. AMENDMENT NUMBER
Phoenix, AZ 85012 8
4. THE PARTIES AGREE TO THE FOLLOWING AMENDMENT
Pursuant to Section 4.0, Amendments or Modifications, the contract reimbursement ceiling for the “Coordination-
Refugee Preventive Health” service for the period of July 1, 2015 through June 30, 2016 is increased from $167,342
to $1,752,604.
The cumulative reimbursement ceiling is revised to $2,737,353.
Therefore, the revised Itemized Service Budget for the period of July 1, 2015 to June 30, 2016 is attached.
5. EXCEPT AS PROVIDED HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT AS HERETOFORE CHANGED AND/OR
AMENDED REMAIN UNCHANGED AND IN FULL FORCE AND EFFECT. THE AMENDMENT SHALL BECOME EFFECTIVE ON THE DATE
OF LAST SIGNATURE UNLESS OTHERWISE SPECIFIED HEREIN. BY SIGNING THIS FORM ON BEHALF OF THE CONTRACTOR, THE
SIGNATORY CERTIFIES HE/SHE HAS THE AUTHORITY TO BIND THE CONTRACTOR TO THIS CONTRACT.
6. 7. NAME OF CONTRACTOR Maricopa County by and through its
ARIZONA DEPARTMENT OF ECONOMIC SECURITY Maricopa County Department of Public Health
SIGNATURE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL
TYPED NAME TYPED NAME
Pam Giroux
Steve Chucri
TITLE TITLE
Procurement Manager
Chairman, Maricopa County Board of Supervisors
DATE DATE
IN ACCORDANCE WITH ARS §11-952 THIS CONTRACT AMENDMENT HAS BEEN REVIEWED BY THE UNDERSIGNED WHO HAVE DETERMINED THAT THIS
CONTRACT AMENDMENT IS IN APPROPRIATE FORM AND WITHIN THE POWERS AND AUTHORITY GRANTED TO EACH RESPECTIVE PUBLIC BODY.
ARIZONA ATTORNEY GENERAL’S OFFICE APPROVED AS TO FORM
By: _________________________________________ By: ____________________________________
Assistant Attorney General Public Agency Legal Counsel
Attorney for Maricopa County
Date: _______________________________________ Date: __________________________________
ATTEST: Clerk of the Board Date
_______________________________________

ITEMIZED SERVICE BUDGET
CONTRACT SERVICE: Coordination - Refugee Preventiv Health
CONTRACT: DE101038001
PROVIDER NAME: Maricopa County Department of Public Health Services
Division of Public Health Clinical Services
CONTRACT PERIOD: 07/01/2015 to 6/30/2016
1. PERSONNEL
TOTAL
Number of FTE Total Salary for the % Allocated Service SERVICE DAAS
Positions Level Position Title Contract Period *A + D = Total COST COST
1 1.00 Registered Nurse $54,098 5% + 95% = 100% 54,098 54,098
1 0.70 X-RAY Tech $38,250 5% + 95% = 100% 38,250 38,250
TOTAL: 92,348 92,348
*A = % Administrative Functions D = % Direct Service Functions
2. EMPLOYEE RELATED EXPENSES TOTAL DAAS
ITEM Fixed Variable 19.21% COST COST
1 1.00 Registered Nurse $10,032 5% + 95% = 100% 25,244 25,244
1 0.70 X-RAY Tech $10,032 5% + 95% = 100% 17,778 17,778
TOTAL: 43,022 43,022
3. PROFESSIONAL AND OUTSIDE SERVICES TOTAL DAAS
ITEM BASIS COST COST
- -
TOTAL: - $0
4.TRAVEL TOTAL DAAS
ITEM BASIS COST COST
Staff Owned Vehicle Mileage Field visits 0 miles @.56per mile 594.00 $594
$0
TOTAL: 594.00 $594
5.SPACE TOTAL DAAS
ITEM BASIS COST COST
$0
TOTAL: - $0
6. EQUIPMENT TOTAL DAAS
ITEM BASIS COST COST
$0
TOTAL: - $0
7. MATERIALS AND SUPPLIES TOTAL DAAS
ITEM BASIS COST COST
$0
TOTAL: - $0
8. OPERATING SERVICES TOTAL DAAS
ITEM BASIS COST COST
$0
$0
8,545 8,545
TOTAL: 8,545 $8,545
9. INDIRECT COSTS TOTAL DAAS
ITEM BASIS COST COST
Allocated Indirect 15.8% 22,833 22,833
TOTAL: 22,833 $22,833
10 SUBTOTAL ADMIN COST 167,342 167,342
11. VOUCHERS
TOTAL DAAS
Medical Screening Vouchers 1,585,262 $1,585,262
TOTAL: 1,585,262 $1,585,262
12. TOTAL SERVICE COST/DAAS TOTAL COST: 1,752,604 1,752,604