PO RE CHRONIC DISEASE HEALTH POLICY WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS12-015902:3
Organizational Reference No.: ED176299
Issued: 06/25/2014
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health Bureau of Health Systems Development
4041 N. Central Avenue, #1400 150 North 18th Avenue, Room 300
Phoenix, AZ 85012 Phoenix, AZ 85007
US
Email: procure@azdhs.gov
Contract No.: ADHS12-015902 (602) 542-1219
Title: HSD/ Health Policy/ Maricopa
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Bureau of Health Systems Development
150 North 113th Avenue, Room 300
Phoenix, AZ 85007
US
Email: procure@azdhs.gov
(602) 542-1219
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: 14-99401-75020-6811- Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 948-33
1 1.00 TOTAL $ 91,403.00 $ 91,403.00
Personnel Services / ERE - 86505/75020113 - CFDA: none - PO Effective
Dates: 4/1/14-3/31/15
Class-Item 948-33
2 1.00 TOTAL $ 185,369.00 $ 185,369.00
Professional & Outside Services - 86505/75020/13 Prop 303 Funds
Class-Item 948-33
3 1.00 TOTAL $ 6,000.00 $ 6,000.00
Travel Expenses - 86505/75020-13
Class-Item 948-33
4 1.00 TOTAL $ 2,518.00 $ 2,518.00
Other Operating - 86505/75020/13

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
Class-Item 948-33
5 1.00 TOTAL $ 13,710.00 $ 13,710.00
Indirect - 86505/752020/13
Class-Item 948-33
6 1.00 TOTAL $ 22,809.00 $ 22,809.00
Amendment 2 Addition of Funds: Personnel Services / ERE -
86505175020114 - CF DA: none - PO Effective Dates: 4/1/14-6/30/15
Class-Item 948-33
7 1.00 TOTAL $ 44,760.00 $ 44,760.00
Amendment 2 Addition of Funds: Professional &Outside Services -
86505/75020/14 Proo 303 Funds
Class-Item 948-33
8 1.00 TOTAL $ 1,505.00 $ 1,505.00
Amendment 2 Addition of Funds: Travel Expenses.- 86505/75020-14
Class-Item 948-33
9 1.00 TOTAL $ 2,505,00 $ 2,505.00
Amendment 2 Addition of Funds: Other Operating - 86505/75020/14
Class-Item 948-33
10 1,00 TOTAL $ 3,421.00 $ 3,421.00
Amendment 2 Addition of Funds: Indirect - 86505/752020/14
Class-Item 948-33
11 1.00 TOTAL $ 9,750.00 $ 9,750.00
Professional and Outside Services - Amendment 3 - Index:99401 PCA:
75020 AY: 14 CFDA: 93.994 Title: MCH Block Grant
TOTAL: $ 383,750.00
Approved By: Mcki Strattard
Phone No.: (602) 542-1174

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IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Ma ricopa County
Date