PURCHASE ORDER RE MIECHV HM VISITING SVC WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS12-023419:4
Organizational Reference No.: E0197242
Issued: 10/10/2014
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Bureau of Women and Children's Health
N 1001 N CENTRAL AVE H 150 N. 18th Avenue, Suite 320
STE 500 I Phoenix, AZ 85007
D Phoenix, AZ 85004 P US
O Email: procure@azdhs.gov
R
T
O
Contract No.: ADHS12-023419 (602) 364-1400
Title: MIECHV Home Visiting Services
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I Bureau of Women and Children's Health
150 N. 18th Avenue, Suite 320
L Phoenix, AZ 85007
L US
Email: procure@azdhs.gov
T
O
(602) 364-1400
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 Code: 15-92551-43400-6811- ----------- 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 952-81
PO EFFECTIVE 10/1/14 - 9/30/15 *** CONTRACT EFFECTIVE 5/1/12 -
4/30/17 *** CONTRACTOR TO INVOICE ACCORDING TO CONTRACT $ 1,594,246.13
1 PRICE SHEET AS FOLLOWS: PERSONNEL = $640,097.40 ***ERE = 1.00 TOTAL $ 1,594,246.13
$212,322.76 ***PROFESSIONAL & OUTSIDE SERVICES = $492,815.00
*** TRAVEL EXPENSE = $21,900.00 ***OCCUPANCY EXPENSE =
$10,599.58 *** OTHER OPERATING EXPENSE = $60,388.00 *** CAPITAL
OUTLAY EXPENSE = $0.00 *** INDIRECT (IF AUTHORIZED) =
$156,123.39 *** THIS LINE TOTAL = $1,594,246.13 **********************
Nurse Family Partnership for MIECHV
TOTAL: $ 1,594,246.13
Approved By: Dee Vlahos
Phone No.: (602) 364-1425

C-86-12-082-3-05 ATTACHED TO AND A PART OF
Purchase Order No. ADHS12-023419;4
Contract No. ADHS12-023419
MIECHV Home Visiting Services
(Nurse Family Partnership)
IN WITNESS WHEREOF, the parties agree to enter into this Contract and its
Amendments:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date