PO RE HIV PREV SVS WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-034910:2
Organizational Reference No.: E0184996
Issued: 08/06/2014
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Bureau of Tobacco and Chronic Disease
N 1001 N CENTRAL AVE H 150 N. 18th Avenue, Suite 310
STE 500 I Phoenix, AZ 85007
D Phoenix, AZ 85004 P US
O Email: procure@azdhs.gov
R
T
O
Contract No.: ADHS13-034910 (602) 364-0824
Title: BTCD Maricopa HIV Prevention (PO 07/01/14 - 06/30/15)
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I Bureau of Tobacco and Chronic Disease
150 N. 18th Avenue, Suite 310
L Phoenix, AZ 85007
L US
Email: procure@azdhs.gov
T
O
(602) 364-0824
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: 14-98437-73020-6811- ----------- 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 952-43
1 1.00 TOTAL $ 147,394.00 $ 147,394.00
HIV Prevention - Partner Services Part A
Class-Item 952-43
2 1.00 TOTAL $ 117,256.00 $ 117,256.00
HIV Prevention - Testing Part A
Class-Item 952-43
3 HIV Prevention - Supplemental Part B 1.00 TOTAL $ 134,500.00 $ 134,500.00
CFDA# 93.940 (100% Federal Funding)
Total Purchase Order - $ 798,299
Purchase Order for the Period 07/01/2014 - 06/30/2015
Items 1-3 represent 50% funding.

TOTAL: $ 399,150.00
Approved By: Byron Homer
Phone No.: (602) 364-1223

C-86-13-050-3-02 ATTACHED TO AND A PART OF
HIV Prevention Services ,
Contract No. ADHS13-034910
Purchase Order ADHS13-034910:2
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