PO RE IMMUNIZATION SERVICES WITH ADHS 9.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-041805:9
Organizational Reference No.: E0234809
Issued: 05/01/2015
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Epidemiology and Disease Control Immunization
N 4041 N. Central Avenue, #1400 H Program
I 150 N. 18th Avenue, Suite 120
D Phoenix, AZ 85012 Phoenix, AZ 85007
O P US
R Email: procure@azdhs.gov
T
O
Contract No.: ADHS13-041805 (602) 364-3630
Title: Maricopa County Immunization Services
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I Epidemiology and Disease Control Immunization
Program
L 150 N. 18th Avenue, Suite 120
L Phoenix, AZ 85007
US
T Email: procure@azdhs.gov
O
(602) 364-3630
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.
Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 948-92
Immunization Program CONTRACT# ADHS13-041805 MARICOPA
COUNTY- Contract End Date - 12/31/2017 - PO Period thru
12/31/2015.CFDA# 93.268 PO for the delivery of Immunization services and
activities as follows; * Salary/Fringe - YEARLY $50,000.00 * Immunization
visit for children zero (0) to eighteen (18) years of age - UNIT RATE $50.00
* Immunization Completion for children zero (0) to eighteen (18) years of
age - UNIT RATE $100.00 * Perinatal Hepatitis B Case Management -
1 Prenatal - UNIT RATE $300.00 * Perinatal Hepatitis B Case Management 1.00 TOTAL $ 803,020.00 $ 803,020.00
- Postnatal - UNIT RATE $200.00 * School/Children IDR Management-
Preparation and submittal - UNIT RATE $250.00 * Immunization Visit for
adults nineteen (19) years of age and older - UNIT RATE $50.00 *
Immunization Visit for Flu Vaccine, in children and adults - UNIT RATE
$50.00
LN/FY/Account Code Dollar Amount
1/15/15-99586-54000-6811- ----------- $ 803,020.00

TOTAL: $ 803,020.00
Approved By: Myra Chavez
Phone No.: (602) 364-3649
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 Maricopa County
__________________________________
Date