AMENDMENT 1 RE HYPERTENSION AND DIABETES WITH ADHS.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT
1740 W. Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS14-072293 Amendment No. 1
Manuel Gonzales
Hypertension and Diabetes System of Care
It is mutually agreed that the Intergovernmental Agreement referenced is amended, effective May 1, 2014, as follows:
1. Replace Price Sheet, Page Seventeen (17) with Price Sheet Page Two (2) Amendment One (1).
All other provisions of this agreement remain unchanged.
CONTRACTOR SIGNATURE
Maricopa County through the Department of Public
Health
Contractor Name Contractor Authorized Signature
4041 North Central Avenue
Address Printed Name
Phoenix Arizona 86012
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 date indicated. The Public Agency is hereby cautioned not to commence
has determined that this Intergovernmental Agreement is in proper any billable work or provide any material, service or construction under
form and is within the powers and authority granted under the laws of this IGA until the IGA has been executed by an authorized ADHS
the State of Arizona. signatory.
State of Arizona
Signed this ______ day of _______________________ 2014
Signature Date
Printed Name Procurement Officer
Attorney General Contract No. P0012014000078, which is an
Agreement between public agencies, has been reviewed pursuant to
A.R.S. § 11-952 by the undersigned Assistant Attorney General, who
has determined that it is in proper form and is within the powers and
authority granted under the laws of the State of Arizona.
Signature Date
Assistant Attorney General
Printed Name:
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ARIZONA DEPARTMENT OF
INTERGOVERNMENTAL AGREEMENT (IGA) AMENDMENT HEALTH SERVICES
1740 W. Adams, Room 303
Phoenix, Arizona 85007
PRICE SHEET (602) 542-1040
(602) 542-1741 Fax
Procurement Specialist
Contract No: ADHS14-072293 Amendment No. 1 Manuel Gonzales
Effective May, 2014
Budget Amount May 1, 2014 - Budget Amount January 1, 2015 –
Cost Reimbursement Line Items
December 31, 2014 June 30, 2015
$2,567.94 $3732.58
1. Personnel Services/ERE
$82,182.00 $74,401.00
2. Professional & Outside Services
$0.00 $0.00
3. Travel Expenses
$10,500 $5500.00
4. Other Operating Expense
NOT ALLOWED NOT ALLOWED
5. Capital Outlay Expense
$1,934.06 $1366.42
6. Other (Indirect Costs)
$97,184.00 $85,000
Total Contract Amount (not to exceed)
1. ITEMIZED SERVICE BUDGET (ISB) RESTRICTIONS:
1.1 The Contractor is authorized to transfer up to a maximum of ten percent (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 ten percent (10%) of the Contracted amount, or to a non-funded line
item, shall require a Contract Amendment.
1.2 Indirect Costs shall not exceed fifteen (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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