PO RE EMPOWER PLUS PROGRAM WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.; ADHS14-052676:2
Organizational Reference No,: E0208844
Issued: 12/23/2014
Vendor Number: 000010983 Arizona Department of Health Services
Maricepa County Public Health Bureau of Nutrition and Physical Activity
1001 N CENTRAL AVE 150 N. 18th Avenue, Suite 310
STE 500 Phoenix, AZ 85007
Phoenix, AZ 85004 US
Email: procure@azdhs.gov
Contract Nu.: ADHS14-052676 (800) 252-5942
Title: FY15 Empower Plus Maricopa County MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
ADHS Accounting
1740 W. Adams Street, Suite 302
Phoenix, AZ 85007
US
INVOICES@azdhs.gov
(602) 555-5555
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 Coda: 15-9459244010-6811- Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description 1 Requisition Quantity Unit Unit Price Total
Glass-Item 952-53
1 16.00 EA $ 1,200,00 $ 19,200.00
FY15 - Empower PLUS Learning Session August 1 2014 through
September 30. 2014
Class-Item 952-53
2 54.00 EA $ 200.00 $ 10,800,00
FY15 - Empower PLUS Action Period Technical Assistance/Site
Visits C hort 1
Class-Item 952-53
3 312,00 EA $ 200.00 $ 62,400.00
FY15 EMPOWER PLUS Action Period Technical
Assistance/Site Visits Cohort 2
Class-Item 952-53
4 16.00 EA $ 400.00 $ 6,400.00
FY15 EMPOWER PLUS Trainer Preparation Meeting

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
Class tern 952-53
4.00 EA $ 600.00 $ 2,400.00
FY15 EMPOWER PLUS Reunion Meeting
TOTAL: $ 101,200.00
Approved By: Varsha Shah
Phone No.: (602) 542-2840