IGA AMD 3 RE TB CONTROL WITH ADHS.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS13-042100 Amendment No. 3 Jacqueline Ortega-Avila/MR
TUBERCULOSIS CONTROL
Effective January 1, 2015, it is mutually agreed that the Intergovernmental Agreement referenced is amended as
follows:
1. Pursuant to Terms and Conditions of the Agreement, Provision Six (6), Contract Changes, Item (6.1), Amendments,
Purchase Orders and Change Orders; the Agreement Price Sheet Effective January 1, 2015 is replaced with the
Revised Price Sheet January 1, 2015 of this Amendment to add additional funding received by the ADHS funding
source for this Program. Pricing will be updated in the ProcureAZ “Items Tab” to reflect the pricing upon execution of
this Amendment.
(CONTINUED ON NEXT PAGE)
ALL OTHER PROVISIONS OF THIS AGREEMENT REMAIN UNCHANGED.
CONTRACTOR SIGNATURE
Maricopa County Department of Public Health
Contractor Name Contractor Authorized Signature
Denny Barney
4041 North Central Avenue, Suite #1400
Address Printed Name
Chairman Board of Supervisors
Phoenix Arizona 85012
City State Zip Title
CONTRACTOR ATTORNEY SIGNATURE This Intergovernmental Agreement Amendment shall be effective the
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has date indicated. The Public Agency is hereby cautioned not to
determined that this Intergovernmental Agreement is in proper form and is commence any billable work or provide any material, service or
within the powers and authority granted under the laws of the State of construction under this IGA until the IGA has been executed by an
Arizona. authorized ADHS signatory.
State of Arizona
Signed this ______ day of _______________________ 2015
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. P0012014000078, which is an RESERVED FOR USE BY THE SECRETARY OF STATE
Agreement between public agencies, has been reviewed pursuant to
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who has Under House Bill 2011, A.R.S. § 11-952
determined that it is in proper form and is 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 Secretary of State.
Signature Date
Assistant Attorney General
Printed Name:
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS13-042100 Amendment No. 3 Procurement Specialist
Jacqueline Ortega-Avila/MR
1.1 Personnel Services and ERE shall decrease by $8,322.00 to reflect the new total amount of $257,647.00.
1.2 Travel Expenses shall decrease by $15,754.00 to reflect the new total amount of $25,117.00.
1.3 Other Operating Expenses shall decrease by $20,608.00 to reflect the new total amount of $5,892.00.
1.4 Other shall decrease by $6,702.00 to reflect the new total amount of $43,299.00.
1.5 The new Agreement total is $331,955.00.
All other funding lines remain the same as Amendment 1.
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ARIZONA DEPARTMENT OF
HEALTH SERVICES
1740 W. Adams, Room 303
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Contract No: ADHS13-042100 Amendment No. 3 Jacqueline Procurement Ortega-Avila/CR Specialist
TUBERCULOSIS CONTROL
REVISED PRICE SHEET
EFFECTIVE JANUARY 1, 2015 THROUGH DECEMBER 31, 2015
ACCOUNT CLASSIFICATION AMOUNT
1. Personnel Services and ERE $257,647.00
2. Professional and Outside Services $0.00
3. Travel Expenses $25,117.00
4. Other Operating Expenses $5,892.00
5. Capital Outlay Expenses $0.00
6. Other $43,299.00
TOTAL $331,955.00
LINE ITEM BUDGET TRANSFERS
With prior approval from the ADHS TB Program Manager, the contractor is authorized to transfer up to a
maximum of thirty-five percent (35%) of the total budget amount between line items. Transfers of funds
are only allowed between funded line items. Transfers exceeding thirty-five percent (35%) or to a non-
funded item shall require an Agreement Amendment.
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