IGA AMD 2 RE HIV SURV WITH ADHS.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT 1740 West Adams, Room 303
Phoenix, Arizona 85007
(IGA) AMENDMENT (602) 542-1040
(602) 542-1741 FAX
Procurement Officer:
Contract No.: ADHS12-016584 Amendment No.: 2
Jacqueline Ortega-Avila
HIV SURVEILLANCE PROGRAM
Effective January 1, 2015, it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. Pursuant to the Terms and Conditions Provision Six (6), Contract Changes, Item Number 6.1, Amendments,
Purchase Orders and Change Orders, the Price Sheet, page twenty (20) of Amendment One (1) is replaced with
the Revised Price Sheet on page three (3) of this Amendment Two (2).
(CONTINUED ON NEXT PAGE)
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED.
MARICOPA COUNTY DEPARTMENT OF HEALTH
Contractor Name: Authorized Signature
.
4041 N. CENTRAL AVE., SUITE 1500
Address: Print Name
PHOENIX ARIZONA 85012
City State Zip Title
This Intergovernmental Agreement Amendment shall be
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has determined effective the date indicated. The Public Agency is hereby
that this Intergovernmental Agreement is in proper form and is within the powers and cautioned not to commence any billable work or provide any
authority granted under the laws of Arizona material, service or construction under this IGA until the IGA
has been executed by an authorized ADHS signatory.
State of Arizona
Signature Date
Signed this day of 20__.
Print Name Title
Procurement Officer
Attorney General Contract No.: P0012014000078 , which is an Agreement RESERVED FOR USE BY THE SECRETARY OF STATE
between public agencies, has been reviewed pursuant to A.R.S. § 11-952 by the
undersigned Assistant Attorney, who has determined that it is in proper form and is Under House Bill 2011, A.R.S. § 11-952
within the powers and authority granted under the laws of the State of Arizona.
was amended to remove the
requirement that Intergovernmental
Agreements be filed with the
Signature Date
Secretary of State.
Assistant Attorney General
Print Name Title
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT 1740 West Adams, Room 303
Phoenix, Arizona 85007
(IGA) AMENDMENT (602) 542-1040
(602) 542-1741 FAX
Contract No.: ADHS12-016584 Amendment No.: 2 Procurement Officer:
Jacqueline Ortega-Avila
REVISED PRICE SHEET
1.0 Personal Services decreased by $10,812 due to changes in personnel. The total is $67,706.00
2.0 Employee Related Expenses increased by $8,995.00. The total is $30,883.00.
3.0 Professional and Outside Services no changes. The total remains the same at $0.00
4.0 Travel Expenses increased by $1,187.00. The total is $2,114.00.
5.0 Other Operating Expenses decreased by $3,937.00. The total is $0.00
6.0 Capital Outlay Expenses no changes. The total remains the same at $0.00
7.0 Other (Indirect Costs) increased by $4,567.00. The total is $15,105.00
The Price Sheet increased by $0.00 and the Annual Amount of $115,808.00 remains the same.
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT 1740 West Adams, Room 303
Phoenix, Arizona 85007
(IGA) AMENDMENT (602) 542-1040
(602) 542-1741 FAX
Contract No.: ADHS12-016584 Amendment No.: 2 Procurement Officer:
Jacqueline Ortega-Avila
Effective January 1, 2015
ProcureAZ Line Item Cost Reimbursement Line Items Budget Amount
1.0 Personnel Services $67,706.00
2.0 Employee Related Expenses $30,883.00
3.0 Professional and Outside Services $0.00
4.0 Travel Expenses increase $2,114.00
5.0 Other Operating Expenses $0.00
6.0 Capital Outlay Expenses $0.00
7.0 Other (Indirect Costs) $15,105.00
Total Contract Amount (not to exceed) $115,808.00
1. ITEMIZED SERVICE BUDGET (ISB) RESTRICTIONS:
A. The Contractor is authorized to transfer up to a maximum of 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 10% of the contracted amount, or to a non-funded line item, shall
require a contract amendment.
B. Indirect Costs shall not exceed 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. This
manual is incorporated into this contract by reference herein.
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