IGA RE TOBACCO EDUCATION AND PREVENTION WITH ADHS.PDF

ARIZONA DEPARTMENT OF
HEALTH SERVICES
INTERGOVERNMENTAL AGREEMENT (IGA) 1740 West Adams, Room 303
Phoenix, Arizona 85007
(602) 542-1040
Contract No. ADHS14-072483 (602) 542-1741 FAX
Project Title: TOBACCO EDUCATION/PREVENTION SERVICES Begin Date: JULY 1, 2014
Geographic Service Area: MARICOPA COUNTY Termination Date: JUNE 30, 2017
Arizona Department of Health Services has authority to contract for services specified herein in accordance with A.R.S. §§ 11-951, 11-952, 36-
104 and 36-132. The Contractor represents that it has authority to contract for the performance of the services provided herein pursuant to:
X Counties: A.R.S. §§ 11-201, 11-951, 11-952 and 36-182.
Indian Tribes: A.R.S. §§ 11-951, 11-952 and the rules and sovereign authority of the contracting Indian Nation.
School Districts: A.R.S. §§ 11-951, 11-952, and 15-342.
City of Phoenix: Chapter II, §§ 1 & 2, Charter, City of Phoenix.
City of Tempe: Chapter 1, Article 1, §§ 1.01 & 1.03, Charter, City of Tempe.
Amendments signed by each of the parties and attached hereto are hereby adopted by reference as a part of this Contract, from the effective
date of the Amendment, as if fully set out herein.
FOR CLARIFICATION, CONTACT:
Arizona Transaction (Sales) Privilege:
Name: Bob England, M.D., Director
Federal Employer Identification No.:
Telephone: (602) 506-6601
Tax License No.:
Fax No:
Contractor Name: Maricopa County Department of Public Health
Address: 4041 North Central
E-mail: bobengland@mail.maricopa.gov
Phoenix, Arizona 85012
CONTRACTOR SIGNATURE: This Contract shall henceforth be referred to as Contract
The Contractor agrees to perform all the services set forth in the No. ADHS14-072483
Agreement and Work Statement.
The Contractor is hereby cautioned not to commence any billable
work or provide any material, service or construction under this
Contract until Contractor receives a fully executed copy of the
Contract.
Signature of Person Authorized to Sign Date State of Arizona
Signed this day of , 2014
Print Name and Title
Procurement Officer
CONTRACTOR ATTORNEY SIGNATURE: RESERVED FOR USE BY THE SECRETARY OF STATE
Pursuant to A.R.S. § 11-952, the undersigned Contractor’s Attorney
has determined that this Intergovernmental Agreement is in proper
form and is within the powers and authority granted under the laws Under House Bill 2011, A.R.S. § 11-952 was
of Arizona.
amended to remove the requirement that
Intergovernmental Agreements be filed
Signature of Person Authorized to Sign Date
with the Secretary of State.
Print Name and Title
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 the proper form and is within the
powers granted under the laws of the State of Arizona to those
parties to the Agreement represented by the Attorney General.
The Attorney General, BY:
Signature Date
Assistant Attorney General:
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1. DEFINITION OF TERMS. As used in this Contract, the terms listed below are defined as follows:
1.1 “Attachment” means any document attached to the Contract and incorporated into the Contract.
1.2 “ADHS” means Arizona Department of Health Services.
1.3 “Budget Term” means the period of time for which the contract budget has been created and during which
funds should be expended.
1.4 “Change Order” means a written order that is signed by a Procurement Officer and that directs the
Contractor to make changes authorized by the Uniform Terms and Conditions of the Contract.
1.5 “Contract” means the combination of the Uniform and Special Terms and Conditions, the Specifications and
Statement or Scope of Work, Attachments, Referenced Documents, any Contract Amendments and any
terms applied by law.
1.6 “Contract Amendment” means a written document signed by the Procurement Officer and the Contractor
that is issued for the purpose of making changes in the Contract.
1.7 “Contractor” means any person who has a Contract with the Arizona Department of Health Services.
1.8 “Cost Reimbursement” means a contract under which a contractor is reimbursed for costs, which are
reasonable, allowable and allocable in accordance with the contract terms and approved by ADHS.
1.9 “Days” means calendar days unless otherwise specified.
1.10 “Fixed Price” establishes a set price per unit of service. The set price shall be based on costs, which are
reasonable, allowable and allocable.
1.11 “Gratuity” means a payment, loan, subscription, advance, deposit of money, services, or anything of more
than nominal value, present or promised, unless consideration of substantially equal or greater value is
received.
1.12 “Materials” unless otherwise stated herein, means all property, including but not limited to equipment’s,
supplies, printing, insurance and leases of property.
1.13 “Procurement Officer” means the person duly authorized by the State to enter into and administer Contracts
and make written determinations with respect to the Contract.
1.14 “Purchase Order” means a written document that is signed by a Procurement Officer, that requests a
vendor to deliver described goods or services at a specific price and that, on delivery and acceptance of the
goods or services by ADHS, becomes an obligation of the State.
1.15 “Services” means the furnishing of labor, time or effort by a Contractor or Subcontractor.
1.16 “Subcontract” means any contract, express or implied, between the Contractor and another party or
between a subcontractor and another party delegating or assigning, in whole or in part, the making or
furnishing of any material or any service required for the performance of this Contract.
1.17 “State” means the State of Arizona and/or the ADHS. For purposes of this Contract, the term “State” shall
not include the Contractor.
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2. CONTRACT TYPE.
This Contract shall be:
X Cost Reimbursement
3. CONTRACT INTERPRETATION.
3.1 Arizona Law. The law of Arizona applies to this Contract including, where applicable, the Uniform
Commercial Code as adopted by the State of Arizona.
3.2 Implied Contract Terms. Each provision of law and any terms required by law to be in this Contract are a
part of this Contract as if fully stated in it.
3.3 Contract Order of Precedence. In the event of a conflict in the provisions of the Contract, as accepted by
the State and as they may be amended, the following shall prevail in the order set forth below:
3.3.1 Terms and Conditions;
3.3.2 Statement or Scope of Work;
3.3.3 Attachments;
3.3.4 Referenced Documents.
3.4 Relationship of Parties. The Contractor under this Contract is an independent Contractor. Neither party to
this Contract shall be deemed to be the employee or agent of the other party to the Contract.
3.5 Severability. The provisions of this Contract are severable. Any term or condition deemed illegal or invalid
shall not affect any other term or condition of the Contract.
3.6 No Parole Evidence. This Contract is intended by the parties as a final and complete expression of their
agreement. No course of prior dealings between the parties and no usage of the trade shall supplement or
explain any terms used in this document.
3.7 No Waiver. Either party’s failure to insist on strict performance of any term or condition of the Contract
shall not be deemed a waiver of that term or condition even if the party accepting or acquiescing in the
nonconforming performance knows of the nature of the performance and fails to object to it.
3.8 Headings. Headings are for organizational purposes only and shall not be interpreted as having legal
significance or meaning.
4. CONTRACT ADMINISTRATION AND OPERATION.
4.1 Term. As indicated on the signature page of the Contract, the Contract shall be effective as of the Begin
Date and shall remain effective until the Termination Date.
4.2 Contract Renewal. This Contract shall not bind, nor purport to bind, the State for any contractual
commitment in excess of the original Contract period. The term of the Contract shall not exceed five years.
However, if the original Contract period is for less than five years, the State shall have the right, at its sole
option, to renew the Contract, so long as the original Contract period together with the renewal periods does
not exceed five years. If the State exercises such rights, all terms, conditions and provisions of the original
Contract shall remain the same and apply during the renewal period with the exception of price and Scope
of Work, which may be renegotiated.
4.3 New Budget Term. If a budget term has been completed in a multi-term Contract, the parties may agree to
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change the amount and type of funding to accommodate new circumstances in the next budget term. Any
increase or decrease in funding at the time of the new budget term shall coincide with a change in the
Scope of Work or change in cost of services as approved by the Arizona Department of Health Services.
4.4 Non-Discrimination. The Contractor shall comply with State Executive Order No. 2009-09 and all other
applicable Federal and State laws, rules and regulations, including the Americans with Disabilities Act.
4.5 Records and Audit. Under A.R.S. § 35-214 and A.R.S. § 35-215, the Contractor shall retain and shall
contractually require each subcontractor to retain all data and other records (“records”) relating to the
acquisition and performance of the Contract for a period of five years after the completion of the Contract.
All records shall be subject to inspection and audit by the State and where applicable the Federal
Government at reasonable times. Upon request, the Contractor shall produce a legible copy of any or all
such records.
4.6 Financial Management. For all contracts, the practices, procedures, and standards specified in and
required by the Accounting and Auditing Procedures Manual for the ADHS funded programs shall be used
by the Contractor in the management of Contract funds and by the State when performing a Contract audit.
Funds collected by the Contractor in the form of fees, donations and/or charges for the delivery of these
Contract services shall be accounted for in a separate fund.
4.6.1 Federal Funding. Contractors receiving federal funds under this Contract shall comply with the
certified finance and compliance audit provision of the Office of Management and Budget (OMB)
Circular A-133, if applicable. The federal financial assistance information shall be stated in a
Change Order or Purchase Order.
4.6.2 State Funding. Contractors receiving state funds under this Contract shall comply with the certified
compliance provisions of A.R.S. § 35-181.03.
4.7 Inspection and Testing. The Contractor agrees to permit access, at reasonable times, to its facilities.
4.8 Notices. Notices to the Contractor required by this Contract shall be made by the State to the person
indicated on the signature page by the Contractor, unless otherwise stated in the Contract. Notices to the
State required by the Contract shall be made by the Contractor to an ADHS Procurement Officer, unless
otherwise stated in the Contract. An authorized ADHS Procurement Officer and an authorized Contractor
representative may change their respective person to whom notice shall be given by written notice, and an
amendment to the Contract shall not be necessary.
4.9 Advertising and Promotion of Contract. The Contractor shall not advertise or publish information for
commercial benefit concerning this Contract without the prior written approval of an ADHS Procurement
Officer.
4.10 Property of the State.
4.10.1 Equipment. Except as provided below or otherwise agreed to by the parties, the title to any and all
equipment acquired through the expenditure of funds received from the State shall remain the
property of the State by and through the ADHS and, as such, shall remain under the sole direction,
management and control of the ADHS. When this Contract is terminated, the disposition of all
such property shall be determined by the ADHS. For Fixed Price contracts, when the Contractor
provides the services/materials required by the Contract, any and all equipment purchased by the
Contractor remains the property of the Contractor. All purchases of equipment need to be reported
to the ADHS Office of Inventory Control.
4.10.2 Title and Rights to Materials. As used in this section, the term “Materials” means all products
created or produced by the Contractor under this Contract, including, but not limited to: written and
electronic information, recordings, reports, research, research findings, conclusions, abstracts,
results, software, data and any other intellectual property or deliverables created, prepared, or
received by the Contractor in performance of this Contract. Contractor acknowledges that all
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Materials are the property of the State by and through the ADHS and, as such, shall remain under
the sole direction, management and control of the ADHS. The Contractor is not entitled to a patent
or copyright on these Materials and may not transfer a patent or copyright on them to any other
person or entity. To the extent any copyright in any Materials may originally vest in the Contractor,
the Contractor hereby irrevocably transfers to the ADHS, for and on behalf of the State, all
copyright ownership. The ADHS shall have full, complete and exclusive rights to reproduce,
duplicate, adapt, distribute, display, disclose, publish, release and otherwise use all Materials. The
Contractor shall not use or release these Materials without the prior written consent of the ADHS.
When this Contract is terminated, the disposition of all such Materials shall be determined by the
ADHS. Further, the Contractor agrees to give recognition to the ADHS for its support of any
program when releasing or publishing program Materials.
4.10.3 Notwithstanding the above, if the Contractor is a State agency, the following shall apply instead: It
is the intention of ADHS and Contractor that all material and intellectual property developed under
this Agreement be used and controlled in ways to produce the greatest benefit to the parties to this
Contract and the citizens of the State of Arizona. As used in this paragraph, “Material” means all
written and electronic information, recordings, reports, findings, research information, abstracts,
results, software, data, discoveries, inventions, procedures and processes of services developed
by the Contractor and any other materials created, prepared or received by the Contractor and
subcontractors in performance of this Agreement. “Material” as used herein shall not include any
pre-existing data, information, materials, discoveries, inventions or any form of intellectual property
invented, created, developed or devised by Contractor (or its employees, subcontractors or agents)
prior to the commencement of the services funded by this Agreement or that may result from
Contractor’s involvement in other service activities that are not funded by the Agreement.
4.10.4 Title and exclusive copyright to all Material shall vest in the State of Arizona, subject to any rights
reserved on behalf of the federal government. As State agencies and instrumentalities, both ADHS
and Contractor shall have full, complete, perpetual, irrevocable and non-transferable rights to
reproduce, duplicate, adapt, make derivative works, distribute, display, disclose, publish and
otherwise use any and all Material. The Contractor’s right to use Material shall include the
following rights: the right to use the Material in connection with its internal, non-profit research and
educational activities, the right to present at academic or professional meetings or symposia and
the right to publish in journals, theses, dissertations or otherwise of Contractor’s own choosing.
Contractor agrees to provide ADHS with a right of review prior to any publication or public
presentation of the Material, and ADHS shall be entitled to request the removal of its confidential
information or any other content the disclosure of which would be contrary to the best interest of
the State of Arizona. Neither party shall release confidential information to the public without the
prior expressly written permission of the other, unless required by the State public records statutes
or other law, including a court order. Each party agrees to give recognition to the other party in all
public presentations or publications of any Material, when releasing or publishing them.
4.10.5 In addition, ADHS and Contractor agree that any and all Material shall be made freely available to
the public to the extent it is in the best interest of the State. However, if either party wants to
license or assign an intellectual property interest in the material to a third-party for monetary
compensation, ADHS and Contractor agree to convene to determine the relevant issues of title,
copyright, patent and distribution of revenue. In the event of a controversy as to whether the
Material is being used for monetary compensation or in a way that interferes with the best interest
of the state or ADHS, then the Arizona Department of Administration shall make the final decision.
Notwithstanding the above, “monetary compensation’ does not include compensation paid to an
individual creator for traditional publications in academia (the copyrights to which are Employee-
Excluded Works under ABOR Intellectual Property Policy Section 6-908C.4.), an honorarium or
other reimbursement of expenses for an academic or professional presentation, or an unprofitable
distribution of Material.
4.11 E-Verify Requirements In accordance with A.R.S. § 41-4401, Contractor warrants compliance with all
Federal immigration laws and regulations relating to employees and warrants its compliance with Section
A.R.S. § 23-214, Subsection A.
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4.12 Federal Immigration and Nationality Act The Contractor shall comply with all federal, state and local
immigration laws and regulations relating to the immigration status of their employees during the term of the
Contract. Further, the Contractor shall flow down this requirement to all subcontractors utilized during the
term of the Contract. The State shall retain the right to perform random audits of Contractor and
subcontractor records or to inspect papers of any employee thereof to ensure compliance. Should the State
determine that the Contractor and/or any subcontractors be found noncompliant, the State may pursue all
remedies allowed by law, including, but not limited to; suspension of work, termination of the Contract for
default and suspension and/or debarment of the Contractor.
5. COSTS AND PAYMENTS.
5.1 Payments. Payments shall comply with the requirements of A.R.S. Titles 35 and 41, net 30 days. Upon
receipt and acceptance of goods or services, the Contractor shall submit a complete and accurate
Contractor’s Expenditure Report for payment from the State within thirty (30) days, as provided in the
Accounting and Auditing Procedures Manual for the ADHS.
5.2 Recoupment of Contract Payments.
5.2.1 Unearned Advanced Funds. Any unearned State funds that have been advanced to the Contractor
and remain in its possession at the end of each budget term, or at the time of termination of the
Contract, shall be refunded to the ADHS within forty-five (45) days of the end of a budget term or of
the time of termination.
5.2.2 Contracted Services. In a fixed price contract, if the number of services provided is less than the
number of services for which the Contractor received compensation, funds to be returned to the
ADHS shall be determined by the Contract price. Where the price is determined by cost per unit of
service or material, the funds to be returned shall be determined by multiplying the unit of service
cost by the number of services the Contractor did not provide during the Contract term. Where the
price for a deliverable is fixed, but the deliverable has not been completed, the Contractor shall be
paid a pro rata portion of the completed deliverable. In a cost reimbursement contract, the ADHS
shall pay for any costs that the Contractor can document as having been paid by the Contractor
and approved by ADHS. In addition, the Contractor will be paid its reasonable actual costs for
work in progress as determined by Generally Accepted Accounting Procedures up to the date of
contract termination.
5.2.3 Refunds. Within forty-five (45) days after the end of each budget term or of the time of termination
of the Contract, the Contractor shall refund the greater of: i) the amount refundable in accordance
with paragraph 4.2.1, Unearned Advanced Funds; or ii) the amount refundable in accordance with
paragraph 5.2.2, Contracted Services.
5.2.4 Unacceptable Expenditures. The Contractor agrees to reimburse the ADHS for all Contract funds
expended, which are determined by the ADHS not to have been disbursed by the Contractor in
accordance with the terms of this Contract. The Contractor shall reimburse ADHS within 45 days
of the determination of unacceptability.
5.3 Unit Costs/Rates or Fees. Unit costs/rates or fees shall be based on costs, which are determined by ADHS
to be reasonable, allowable and allocable as outlined in the Accounting and Auditing Procedures Manual
for the ADHS.
5.4 Applicable Taxes.
5.4.1 State and Local Transaction Privilege Taxes. The State of Arizona is subject to all applicable state
and local transaction privilege taxes. Transaction privilege taxes apply to the sale and are the
responsibility of the seller to remit. Failure to collect taxes from the buyer does not relieve the
seller from its obligation to remit taxes.
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5.4.2 Tax Indemnification. The Contractor and all subcontractors shall pay all federal, state and local
taxes applicable to its operation and any persons employed by the Contractor. Contractor shall
require all subcontractors to hold the State harmless from any responsibility for taxes, damages
and interest, if applicable, contributions required under Federal, and/or state and local laws and
regulations and any other costs, including transaction privilege taxes, unemployment compensation
insurance, Social Security and Worker’s Compensation.
5.4.3 I.R.S. W9 Form. In order to receive payment under any resulting Contract, the Contractor shall
have a current I.R.S. W9 Form on file with the State of Arizona.
5.5 Availability of Funds for the Next Fiscal Year. Funds may not be presently available for performance under
this Contract beyond the first year of the budget term or Contract term. The State may reduce payments or
terminate this Contract without further recourse, obligation or penalty in the event that insufficient funds are
appropriated in the subsequent budget term. The State shall not be liable for any purchases or
Subcontracts entered into by the Contractor in anticipation of such funding. The Procurement Officer shall
have the discretion in determining the availability of funds.
5.6 Availability of Funds for the Current Contract Term. Should the State Legislature enter back into session
and decrease the appropriations through line item or general fund reductions, or for any other reason these
goods or services are not funded as determined by ADHS, the following actions may be taken by ADHS:
5.6.1 Accept a decrease in price offered by the Contractor;
5.6.2 Reduce the number of goods or units of service and reduce the payments accordingly;
5.6.3 Offer reductions in funding as an alternative to Contract termination; or
5.6.4 Cancel the Contract.
6. CONTRACT CHANGES.
6.1 Amendments, Purchase Orders and Change Orders. This Contract is issued under the authority of the
Procurement Officer who signed this Contract. The Contract may be modified only through a Contract
Amendment, Purchase Order and/or Change Order within the scope of the Contract, unless the change is
administrative or otherwise permitted by the Special Terms and Conditions. Changes to the Contract,
including the addition of work or materials, the revision of payment terms, or the substitution of work or
materials, directed by an unauthorized State employee or made unilaterally by the Contractor are violations
of the Contract and of applicable law. Such changes, including unauthorized Contract Amendments,
Purchase Orders and/or Change Orders, shall be void and without effect, and the Contractor shall not be
entitled to any claim under this Contract based on those changes.
6.2 Subcontracts. The Contractor shall not enter into any subcontract under this Contract without the advance
written approval of the Procurement Officer. The subcontract shall incorporate by reference all material
and applicable terms and conditions of this Contract.
6.3 Assignments and Delegation. The Contractor shall not assign any right nor delegate any duty under this
Contract without the prior written approval of the Procurement Officer. The State shall not unreasonably
withhold approval.
7. RISK AND LIABILITY.
7.1 Risk of Loss. The Contractor shall bear all loss of conforming material covered under this Contract until
received and accepted by authorized personnel at the location designated in the Purchase Order, Change
Order or Contract. Mere receipt does not constitute final acceptance. The risk of loss for nonconforming
materials shall remain with the Contractor regardless of receipt.
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7.2 Mutual Indemnification. Each party (as “indemnitor”) agrees to indemnify, defend and hold harmless the
other party (as “indemnitee”) from and against any and all claims, losses, liability, costs or expenses
(including reasonable attorney’s fees) (hereinafter collectively referred to as “claims”) arising out of bodily
injury of any person (including death) or property damage, but only to the extent that such claims, which
result in vicarious/derivative liability to the indemnitee, are caused by the act, omission, negligence,
misconduct, or other fault of the indemnitor, its officers, officials, agents, employees or volunteers.
7.3 Indemnification - Patent and Copyright. To the extent permitted by A.R.S. § 41-621 and A.R.S. § 35-154,
the Contractor shall indemnify and hold harmless the State against any liability, including costs and
expenses, for infringement of any patent, trademark or copyright arising out of performance of the Contract
or use by the State of materials furnished by or work performed under this Contract. The State shall
reasonably notify the Contractor of any claim for which it may be liable under this paragraph.
7.4 Force Majeure.
7.4.1 Liability and Definition. Except for payment of sums due, neither party shall be liable to the other
nor deemed in default under this Contract if and to the extent that such party’s performance of this
Contract is prevented by reason of force majeure. The term “force majeure” means an occurrence
that is beyond the control of the party affected and occurs without its fault or negligence. Without
limiting the foregoing, force majeure includes acts of God; acts of the public enemy; acts of
terrorism; war; riots; strikes; mobilization; labor disputes; civil disorders; fire; flood; lockouts;
injunctions-interventions not caused by or resulting from the act or failure to act of the parties;
failures or refusals to act by government authority not caused by or resulting from the act or failure
to act of the parties; and other similar occurrences beyond the control of the party declaring force
majeure, which such party is unable to prevent by exercising reasonable diligence.
7.4.2 Exclusions. Force Majeure shall not include the following occurrences:
7.4.2.1 Late delivery of Materials caused by congestion at a manufacturer’s plant or elsewhere, or
an oversold condition of the market;
7.4.2.2 Late performance by a subcontractor unless the delay arises out of a force majeure
occurrence in accordance with this force majeure term and condition; or
7.4.2.3 Inability of either the Contractor or any subcontractor to acquire or maintain any required
insurance, bonds, licenses or permits.
7.4.3 Notice. If either party is delayed at any time in the progress of the work by force majeure, the
delayed party shall notify the other party in writing of such delay, as soon as is practicable and no
later than the following working day of the commencement thereof, and shall specify the causes of
such delay in such notice. Such notice shall be delivered or mailed certified-return receipt and
shall make a specific reference to this article, thereby invoking its provisions. The delayed party
shall cause such delay to cease as soon as practicable and shall notify the other party in writing
when it has done so. The time of completion shall be extended by Contract Amendment for a
period of time equal to the time that the results or effects of such delay prevent the delayed party
from performing in accordance with this Contract.
7.4.4 Default. Any delay or failure in performance by either party hereto shall not constitute default
hereunder or give rise to any claim for damages or loss of anticipated profits if, and to the extent
that, such delay or failure is caused by force majeure.
7.5 Third Party Antitrust Violations. The Contractor assigns to the State any claim for overcharges resulting
from antitrust violations to the extent that those violations concern materials or services supplied by third
parties to the Contractor for or toward the fulfillment of this Contract.
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8. DESCRIPTION OF MATERIALS. The following provisions shall apply to Materials only:
8.1 Liens. The Contractor agrees that the Materials supplied under this Contract are free of liens. In the event
the Materials are not free of liens, Contractor shall pay to remove the lien and any associated damages or
replace the Materials with Materials free of liens.
8.2 Quality. Unless otherwise modified elsewhere in these terms and conditions, the Contractor agrees that, for
one year after acceptance by the State of the Materials, they shall be:
8.2.1 Of a quality to pass without objection in the Contract description;
8.2.2 Fit for the intended purposes for which the Materials are used;
8.2.3 Within the variations permitted by the Contract and are of even kind, quantity, and quality within
each unit and among all units;
8.2.4 Adequately contained, packaged and marked as the Contract may require; and
8.2.5 Conform to the written promises or affirmations of fact made by the Contractor.
8.3 Inspection/Testing. Subparagraphs 8.1 through 8.2 of this paragraph are not affected by inspection or
testing of or payment for the Materials by the State.
8.4 Compliance With Applicable Laws. The Materials and services supplied under this Contract shall comply
with all applicable federal, state and local laws, and the Contractor shall maintain all applicable license and
permit requirements.
8.5 Survival of Rights and Obligations After Contract Expiration and Termination.
8.5.1 Contractor’s Representations. All representations and warranties made by the Contractor under
this Contract in paragraphs 7 and 8 shall survive the expiration or termination hereof. In addition,
the parties hereto acknowledge that pursuant to A.R.S. § 12.510, except as provided in A.R.S. §
12-529, the State is not subject to or barred by any limitations of actions prescribed in A.R.S. Title
12, Chapter 5.
8.5.2 Purchase Orders and Change Orders. Unless otherwise directed in writing by the Procurement
Officer, the Contractor shall fully perform and shall be obligated to comply with all Purchase Orders
and Change Orders received by the Contractor prior to the expiration or termination hereof,
including, without limitation, all Purchase Orders and Change Orders received prior to but not fully
performed and satisfied at the expiration or termination of this Contract.
9. STATE’S CONTRACTUAL REMEDIES.
9.1 Right to Assurance. If the State, in good faith, has reason to believe that the Contractor does not intend to,
or is unable to, perform or continue performing under this Contract, the Procurement Officer may demand
in writing that the Contractor give a written assurance of intent to perform. Failure by the Contractor to
provide written assurance within the number of Days specified in the demand may, at the State’s option, be
the basis for terminating the Contract.
9.2 Stop Work Order.
9.2.1 Terms. The State may, at any time, by written order to the Contractor, require the Contractor to
stop all or any part of the work called for by this Contract for a period up to ninety (90) Days after
the order is delivered to the Contractor, and for any further period to which the parties may agree.
The order shall be specifically identified as a stop work order issued under this clause. Upon
receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable
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steps to minimize the incurrence of costs allocable to the work covered by the order during the
period of work stoppage.
9.2.2 Cancellation or Expiration. If a stop work order issued under this clause is canceled or the period
of the order or any extension expires, the Contractor shall resume work. The Procurement Officer
shall make an equitable adjustment in the delivery schedule or Contract price, or both, and the
Contract shall be amended in writing accordingly.
9.3 Non-exclusive Remedies. The rights and remedies of ADHS under this Contract are not exclusive, and
ADHS is entitled to all rights and remedies available to it, including those under the Arizona Uniform
Commercial Code and Arizona common law.
9.4 Right of Offset. The State shall be entitled to offset against any sums due the Contractor in any Contract
with the State or damages assessed by the State because of the Contractor’s non-conforming performance
or failure to perform this Contract. The right to offset may include, but is not limited to, a deduction from an
unpaid balance and a collection against the bid and/or performance bonds. Any offset taken for damages
assessed by the State shall represent a fair and reasonable amount for the actual damages and shall not
be a penalty for non-performance.
10. CONTRACT TERMINATION.
10.1 Cancellation for Conflict of Interest. Pursuant to A.R.S. § 38-511, the State may cancel this Contract within
three (3) years after Contract execution without penalty or further obligation if any person significantly
involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of the State is, or
becomes at any time while the Contract or an extension of the Contract is in effect, an employee of or a
consultant to any other party to this Contract with respect to the subject matter of the Contract. The
cancellation shall be effective when the Contractor receives written notice of the cancellation, unless the
notice specifies a later time. If the Contractor is a political subdivision of the State, it may also cancel this
Contract as provided in A.R.S. § 38-511.
10.2 Gratuities. The State may, by written notice, terminate this Contract, in whole or in part, if the State
determines that employment or a Gratuity was offered or made by the Contractor or a representative of the
Contractor to any officer or employee of the State for the purpose of influencing the outcome of the
procurement, securing the Contract or an Amendment to the Contract, or receiving favorable treatment
concerning the Contract, including the making of any determination or decision about Contract
performance. The State, in addition to any other rights or remedies, shall be entitled to recover exemplary
damages in the amount of three times the value of the Gratuity offered by the Contractor.
10.3 Suspension or Debarment. The State may, by written notice to the Contractor, immediately terminate this
Contract if the State determines that the Contractor or its subcontractor has been debarred, suspended or
otherwise lawfully prohibited from participating in any public procurement activity, including but not limited
to, being disapproved as a subcontractor of any public procurement unit or other governmental body.
10.4 Termination Without Cause.
10.4.1 Both the State and the Contractor may terminate this Contract at any time with thirty (30) days’
notice in writing specifying the termination date. Such notices shall be given by personal delivery
or by certified mail, return receipt requested.
10.4.2 If the Contractor terminates this Contract, any monies prepaid by the State, for which no service
or benefit was received by the State, shall be refunded to the State within 5 days of the
termination notice. In addition, if the Contractor terminates the Contract, the Contractor shall
indemnify the State for any sanctions imposed by the funding source as a result of the
Contractor’s failure to complete the Contract.
10.4.3 If the State terminates this Contact pursuant to this Section, the State shall pay the Contractor the
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 TERMS AND CONDITIONS
Contract price for all Services and Materials completed up to the date of termination. In a fixed
price contract, the State shall pay the amount owed for the Services or Materials by multiplying
the unit of service or item cost by the number of unpaid service units or items. In a cost
reimbursement contract, the ADHS shall pay for any costs that the Contractor can document as
having been paid by the Contractor and approved by ADHS. In addition, the Contractor will be
paid its reasonable actual costs for work in progress as determined by GAAP up to the date of
termination. Upon such termination, the Contractor shall deliver to the ADHS all deliverables
completed. ADHS may require Contractor to negotiate the terms of any remaining deliverables
still due.
10.5 Mutual Termination. This Contract may be terminated by mutual written agreement of the parties
specifying the termination date and the terms for disposition of property and, as necessary, submission of
required deliverables and payment therein.
10.6 Termination for Default. The State reserves the right to terminate the Contract in whole or in part due to
the failure of the Contractor to comply with any material obligation, term or condition of the Contract, to
acquire and maintain all required insurance policies, bonds, licenses and permits, or to make satisfactory
progress in performing the Contract. In the event the ADHS terminates the Contract in whole or in part as
provided in this paragraph, the ADHS may procure, upon such terms and in such manner as deemed
appropriate, Services or Materials, similar to those terminated, and Contractor shall be liable to the ADHS
for any excess costs incurred by the ADHS in obtaining such similar Services or Materials.
10.7 Continuation of Performance Through Termination. Upon receipt of the notice of termination and until the
effective date of the notice of termination, the Contractor shall perform work consistent with the
requirements of the Contract and, if applicable, in accordance with a written transition plan approved by the
ADHS. If the Contract is terminated in part, the Contractor shall continue to perform the Contract to the
extent not terminated. After receiving the notice of termination, the Contractor shall immediately notify all
subcontractors, in writing, to stop work on the effective date of termination, and on the effective date of
termination, the Contractor and subcontractors shall stop all work.
10.8 Disposition of Property. Upon termination of this Contract, all property of the State, as defined herein, shall
be delivered to the ADHS upon demand.
11. ARBITRATION. Pursuant to A.R.S. § 12-1518, disputes under this Contract shall be resolved through the use of
arbitration when the case or lawsuit is subject to mandatory arbitration pursuant to rules adopted under A.R.S. §
12 -133.
12. COMMUNICATION.
12.1 Program Report. When reports are required by the Contract, the Contractor shall provide them in the
format approved by ADHS.
12.2 Information and Coordination. The State will provide information to the Contractor pertaining to activities
that affect the Contractor’s delivery of services, and the Contractor shall be responsible for coordinating
their activities with the State’s in such a manner as not to conflict or unnecessarily duplicate the State’s
activities. As the work of the Contractor progresses, advice and information on matters covered by the
Contract shall be made available by the Contractor to the State throughout the effective period of the
Contract.
13. CLIENT GRIEVANCES. If applicable, the Contractor and its subcontractors shall use a procedure through which
clients may present grievances about the operation of the program that result in the denial, suspension or
reduction of services provided pursuant to this Contract and which is acceptable to and approved by the State.
14. SOVEREIGN IMMUNITY. Pursuant to A.R.S. § 41-621(O), the obtaining of insurance by the State shall not be a
waiver of any sovereign immunity defense in the event of suit.
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 TERMS AND CONDITIONS
15. ADMINISTRATIVE CHANGES. The Procurement Officer, or authorized designee, reserves the right to correct
any obvious clerical, typographical or grammatical errors, as well as errors in party contact information
(collectively, “Administrative Changes”), prior to or after the final execution of a Contract or Contract Amendment.
Administrative Changes subject to permissible corrections include: misspellings, grammar errors, incorrect
addresses, incorrect Contract Amendment numbers, pagination and citation errors, mistakes in the labeling of the
rate as either extended or unit, and calendar date errors that are illogical due to typographical error. The
Procurement Office shall subsequently send to the Contractor notice of corrections to administrative errors in a
written confirmation letter with a copy of the corrected Administrative Change attached.
16. SURVIVAL OF TERMS AFTER TERMINATION OR CANCELLATION OF CONTRACT. All applicable Contract
terms shall survive and apply after Contract termination or cancellation to the extent necessary for Contractor to
complete and for the ADHS to receive and accept any final deliverables that are due after the date of the
termination or cancellation.
17. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA).
17.1 The Contractor warrants that it is familiar with the requirements of HIPAA, as amended by the Health
Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009, and accompanying
regulations and will comply with all applicable HIPAA requirements in the course of this Contract. Contractor
warrants that it will cooperate with the Arizona Department of Health Services (ADHS) in the course of
performance of the Contract so that both ADHS and Contractor will be in compliance with HIPAA, including
cooperation and coordination with the Arizona Strategic Enterprise Technology (ASET) Office, Statewide
Information Security and Privacy Office (SISPO) Chief Privacy Officer and HIPAA Coordinator and other
compliance officials required by HIPAA and its regulations. Contractor will sign any documents that are
reasonably necessary to keep ADHS and Contractor in compliance with HIPAA, including, but not limited to,
business associate agreements.
17.2 If requested by the ADHS Procurement Office, Contractor agrees to sign a “Pledge To Protect Confidential
Information” and to abide by the statements addressing the creation, use and disclosure of confidential
information, including information designated as protected health information and all other confidential or
sensitive information as defined in policy. In addition, if requested, Contractor agrees to attend or participate
in HIPAA training offered by ADHS or to provide written verification that the Contractor has attended or
participated in job related HIPAA training that is: (1) intended to make the Contractor proficient in HIPAA for
purposes of performing the services required and (2) presented by a HIPAA Privacy Officer or other person
or program knowledgeable and experienced in HIPAA and who has been approved by the ASET /SISPO
Chief Privacy Officer and HIPAA Coordinator.
18. COMMENTS WELCOME. The ADHS Procurement Office periodically reviews the Uniform Terms and
Conditions and welcomes any comments you may have. Please submit your comments to: ADHS Procurement
Administrator, Arizona Department of Health Services, 1740 West Adams, Suite 303, Phoenix, Arizona, 85007.
19. AUTHORIZATION FOR PROVISION OF SERVICES:
Authorization for Provision of Services: Authorization for purchase of services under this Contract shall be
made only upon ADHS issuance of a Purchase Order that is signed by an authorized agent. The Purchase Order
will indicate the Contract number and the dollar amount of funds authorized. The Contractor shall only be
authorized to perform services up to the amount on the Purchase Order. ADHS shall not have any legal
obligation to pay for services in excess of the amount indicated on the Purchase Order. No further obligation for
payment shall exist on behalf of ADHS unless a) the Purchase Order is changed or modified with an official ADHS
Procurement Change Order, and/or b) an additional Purchase Order is issued for purchase of services under this
Contract.
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 SCOPE OF SERVICES
1. BACKGROUND:
1.1 Commercial Tobacco use is the leading preventable cause of death and disease in the United States.
Commercial Tobacco use leads to almost 500,000 deaths annually within the United States and almost
7,000 deaths annually in Arizona alone. Tobacco control programs are designed to help reduce
disease, disability and death related to commercial tobacco use.
1.2 In 2010, chronic diseases such as cancer, heart disease, stroke and pulmonary disease, were
responsible for seven (7) of the ten (10) leading underlying causes of death in Arizona. When
combined, these chronic diseases were responsible for more than 29,500 Arizona deaths in 2010.
(Arizona Health Status & Vital Statistics, 2010). These leading causes of mortality and morbidity share
common primary risk factors, including obesity, commercial tobacco use, poor nutrition and physical
inactivity. However, their relationship is not limited to common indicators. Quite often, the populations
most burdened by these conditions overlap; diabetes, for example, is also a significant risk factor for
cardio-vascular disease (CVD).
1.3 The mission of the Arizona Department of Health Services Bureau of Tobacco and Chronic Disease
(ADHS-BTCD) is to work together to build individual, organizational and community capacities to
reduce the impact of commercial tobacco abuse and reduce chronic disease. This is accomplished
through development of quality programs, policies, and services; that include community network
building, youth prevention activities and integrating community efforts that establishes strategic
partnerships and collaborations, in order to eliminate tobacco and chronic disease.
2. PURPOSE:
2.1 The ADHS-BTCD intends to establish Intergovernmental Agreements with counties to provide
Commercial Tobacco education/prevention services and implement chronic disease prevention and
control strategies to address the four (4) leading causes of death (cancer, stroke, heart disease, and
pulmonary disease) specific to Arizona.
3. TASKS:
The Contractor shall:
3.1 Adhere to the guidelines and principles set forth in the ADHS-BTCD Sustaining Arizona’s Tobacco
Program Plan and the 2014-2015 ADHS-BTCD Chronic Disease Prevention and Control Strategies that
pertain to the services and activities identified in the corresponding Action Plans. These documents can
be found on the ADHS Tobacco Free Arizona website (http://tobaccofreearizona.com/reports/pdf/tfa
strategic-plan.pdf) and the ADHS Chronic Disease website (http://www.azdhs.gov/phs/chronicdisease);
3.2 Develop and perform an Action Plan in conjunction with ADHS-BTCD, inclusive of goals, objectives and
timelines to address ADHS-BTCD Sustaining Arizona’s Tobacco Program Plan and the 2014-2015
ADHS-BTCD Chronic Disease Prevention and Control Strategies;
3.3 Implement the Action Plans upon ADHS-BTCD approval;
3.4 Participate in Bi-Monthly calls with BTCD staff to gauge progress and activities in the action plan. This
information will be utilized in the ADHS-BTCD Evaluation Plan for County Contracts. The ADHS-BTCD
Evaluation plan for County Contracts and the Bi-Monthly call sheet will be reviewed and revised each
year to ensure proper assessment of county activities. The template will be issued to the county by
August 1st of each year.
3.5 Cessation Activity:
3.5.1 Contractor shall work with the ASHLine Community Development Team (CDT) to
create/implement ASHLine Outreach/Referral Development Action Plan,
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 SCOPE OF SERVICES
3.5.2 Contractor shall participate in quarterly calls with the ASHLine CDT representative to discuss
status of the ASHLine Outreach/Referral Development Action Plan and to cover any possible
technical assistance need.
3.6 Prevention – Youth Coalition:
3.6.1 Contractor shall work with Pima Prevention Partnership (PPP) to develop and implement a Youth
Coalition Action Plan,
3.6.2 Contractor shall ensure youth coordinators and youth participate in PPP trainings twice a year
and, shall work with PPP on any technical assistance needs and,
3.6.3 Contractor shall provide PPP technical assistance.
3.7 Enforcement:
3.7.1 Attorney General’s Counter Strike Program:
3.7.1.1 Participate in the Arizona Attorney General’s Office (AGO) Counter Strike Program,
3.7.1.2 Promote and recruit youth from the community to participate in the Retailer Compliance
Checks. Youth shall be sixteen (16) or seventeen (17) years of age, possess a valid
Arizona State Identification Card and shall be available on nights and weekends; AGO
compliance checks will be scheduled at a minimum of twice a year,
3.7.1.3 Facilitate and conduct the AGO Merchant Diversion Program with retailers
and clerks that have been cited for selling tobacco to underage youth,
3.7.1.4 Follow up with retailers to provide resources and education,
3.7.1.5 Promote, facilitate, and conduct the AGO Youth Diversion Training,
3.7.1.6 Maintain quarterly communication with the AGO Youth Tobacco Program.
3.7.2 Food & Drug Administration (FDA) – Tobacco Control Act (TCA) Program/SYNAR:
3.7.2.1 Participate in the ADHS-FDA TCA program for youth underage boys throughout each
fiscal year,
3.7.2.2 Promote and recruit youth from the community to participate in the FDA youth underage
boys. Number of inspections will be based on FDA requirements and may vary from
year to year,
3.7.2.3 Have at least two (2) youth available for inspections at all times,
3.7.2.4 Assist SYNAR in ensuring accurate locations of tobacco retailers within each county,
3.7.2.5 Maintain bi-monthly communication with the ADHS-FDA TCA Program Staff.
3.8 Policy:
3.8.1 Identify one (1) policy related to tobacco control (i.e. smoking in multi-unit housing, point of sale
restriction in the retail environment or other policies related to second hand smoke exposure) to
pursue throughout the year. Policy can be multi-year,
3.8.2 Policy implementation plan shall be approved by ADHS-BTCD, and
3.8.3 Participate in policy trainings.
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 SCOPE OF SERVICES
3.9 Chronic Disease:
3.9.1 Adhere to the strategies outlined by the Office of Chronic Disease in conjunction with the ADHS-
BTCD 2013-2017 Chronic Disease Strategic Plan which can be found on Arizona Department of
Health Services/Bureau of Tobacco and Chronic Disease website. The following strategies
include:
3.9.1.1 Provide support and coordinate the delivery of a Chronic Disease Self Manage
Program/Tomando Su Control,
3.9.1.2 Implement the National Million Hearts Campaign/Su Corazon – Su Vida to include
strategies such as ABC’s, Know Your Numbers and My Life Check,
3.9.1.3 Implement the American Heart Association/American Stroke Association Together To
End Stroke Campaign, and
3.9.1.4 School Health Index (SHI)/School Health Advisory Council (SHAC).
(http://www.azdhs.gov/phs/chronicdisease/documents/az-chronic-disease-strategic-
plan-2012-2015.pdf).
3.9.2 Collaborate with County staff that are implementing or participating in other ADHS initiatives (i.e.,
Health in All Policies Initiative, Public Health in Action Grant) to leverage and integrate chronic
disease prevention and control strategies,
3.9.3 Collaborate with community organizations and tribal entities that receive ADHS-BTCD funding to
implement Center for Disease Control and Prevention (CDC) strategies, and
3.9.4 Participate in all chronic disease related conference and technical assistance calls, unless waived
with approval from the ADHS-BTCD. County must inform ADHS-BTCD of non-participation at
least forty-eight (48) hours prior to call.
3.10 Marketing & Media:
3.10.1 Adhere to the Partner Marketing and Media Communication Calendar, which will be issued by
July 1st of each year,
3.10.2 Participate and promote ADHS-BTCD marketing initiatives as requested, and
3.10.3 Local marketing plans utilizing ADHS-BTCD funding shall be submitted to ADHS-BTCD for
approval prior to implementation.
3.11 Meetings, Calls, and Trainings:
Contractor shall attend the following meetings in person, unless waived with approval from ADHS-
BTCD:
3.11.1 County Partner Meetings,
3.11.2 County Partner Specific Meetings (i.e. – ASHLine Summit, Youth Coalition Adult Trainings, Youth
Winter Planning Summit, STAND summer conference, Chronic Disease trainings and
presentations), as deemed necessary by ADHS-BTCD,
3.11.3 Participate in all conference calls and technical assistance calls for ADHS-BTCD, unless waived
with approval from the ADHS-BTCD, Contractor must notify ADHS-BTCD staff of non-
participation at least forty-eight (48) hours prior to call.
3.11.4 Monthly Partner Update Conference Calls, call agenda will be released by ADHS-BTCD no less
than four (4) days prior to the conference call,
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 SCOPE OF SERVICES
3.11.5 ASHLine Community Development Team (CDT) Quarterly Call, to be scheduled by the ASHLine
CDT representative,
3.11.6 Youth Coalition Technical Assistance/Event Calls (as needed for Statewide Tobacco Event
planning and Winter/Summer Conference Planning), and
3.11.7 Participate in Bi-Monthly call with BTCD staff to gauge progress and activities in the action plan.
This information will be utilized in the ADHS-BTCD Evaluation Plan for County Contracts. Calls
will be schedule by BTCD Prevention specialists.
3.12 The ADHS-BTCD Evaluation plan for County Contracts and the Bi-Monthly call sheet will be reviewed
and revised each year to ensure proper assessment of county activities. The template will be issued to
the county by August 1st, of each year.
4. REQUIREMENTS:
The Contractor shall meet all of the following requirements:
4.1 Revisions to the Action Plan strategies, goals, objectives and timelines shall require approval from
ADHS-BTCD staff,
4.2 Staffing changes shall be reported to ADHS-BTCD within five (5) business days,
4.3 Out of state travel under this Agreement shall require prior ADHS-BTCD authorization. Documentation
shall be submitted to ADHS-BTCD for review, including location and reason for travel, how it pertains to
the work covered in this Agreement and costs associated with the travel,
4.4 Equipment purchases shall require prior ADHS-BTCD authorization. Documentation shall be submitted
to ADHS-BTCD for review, including proposed equipment, cost and justification of need. Examples of
equipment include, but are not limited to, computers, computer equipment, software, office furniture,
printers, and phones. Any equipment purchased with ADHS-BTCD funds shall be the property of the
State of Arizona. As such, the property shall be returned to ADHS-BTCD once it is no longer in use or
when the Contract is concluded.
4.5 Property of the State. Any materials, including reports, computer programs and other deliverables,
created under this Contract are the sole property of the State. The Contractor is not entitled to a patent
or copyright on those materials and may not transfer the patent or copyright to anyone else. The
Contractor shall not use or release these materials without the prior written consent of the State.
5. DELIVERABLES AND DELIVERY SCHEDULE:
The Contractor shall:
5.1 Submit a Contractor Expenditure Report (CER), Exhibit 1 an electronic version will be made available
upon request to ADHS-BTCD, due fifteen (15) days after month end,
5.2 Enter at a minimum two (2) submissions for annual awards/recognition program available at
www.tobaccofreearizona.com/resources due by July 31st, of each year, and
5.3 Provide success stories related to specific chronic disease strategies being implemented in their county
on a quarterly basis utilizing the form provided by the ADHS-BTCD staff.
6. NOTICES, CORRESPONDENCE, REPORTS AND INVOICES:
6.1 Notices, Correspondence, Reports and Invoices/CERs from the contractor to ADHS shall be sent to:
Arizona Department of Health Services
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 SCOPE OF SERVICES
Bureau of Tobacco and Chronic Disease
Attn: Courtney Ward, BTCD Office Chief or Stacy Green, Tobacco Program Manager
150 N. 18th Avenue, Suite #310
Phoenix, AZ 85007
Telephone: (602) 542-2075
E-Mail: Courtney.ward@azdhs.gov
6.2 Notices, Correspondence, Reports and Payments from the ADHS to the Contractor shall be sent to:
Maricopa County Department of Public Health
Attn: Bob England, M.D., Director
4041 North Central
Phoenix, Arizona 85012
Telephone: (602) 506-6601
E-mail: bobengland@mail.maricopa.gov
6.3 Payments from ADHS to the Contractor shall be sent to the “Remit To” Address listed on the
Contractor’s ProcureAZ vendor profile.
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 PRICE SHEET
BUDGET
Effective July, 2014
Cost Reimbursement Line Items Budget Amount
1. Personnel Services/ERE $1,297,098
2. Professional & Outside Services $491,225
3. Travel Expenses $15,600
4. Other Operating Expense $212,737
5. Capital Outlay Expense $0
6. Other (Indirect Costs) $194,565
Total Contract Amount (not to exceed) $2,211,225
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 percent (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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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Attachment 1 - Action Plan for FY 2015
County: Maricopa
Time Frame: July 1st – June 30th of every year.
Goal 1: Maricopa County Department of Public Health (MCDPH) efforts in this section are focused primarily on Strategy is integrated with (check all that apply):
advancing policy initiatives through development of the Students Taking A New Direction or STAND youth Tobacco Prevention Policy
coalitions. Chronic Disease Self -Management
Tobacco Cessation Policy
Objective: STAND chapters at three local high schools or community youth organizations (including one that School Health Policy
specifically serves disparate populations) will continue to build and sustain efforts. This will be measured by Other (i.e. increase community collaboration): Youth
adherence to Pima Prevention Partnership Youth Action Plan and youth/adult coordinator attendance at Coalition
events/trainings and monthly reporting.
Agency Lead: Prevention Program Related policy change: Related environmental change:
Supervisor Smoke-free parks Smoke-Free Air
Healthier population
Partners: Pima Prevention Partnership Decreased exposure to
(PPP), Bureau of Tobacco & Chronic secondhand smoke
Disease (BTCD), Trevor G. Browne High
School ., Tanner Community Development
Corporation (TCDC)
What do you plan to do? Who will do the work? What does success look like? What non- Q1 Q2 Q3 Q4
financial Sept Dec. March June
resources are 30th 31st 31st 30th
needed?
Activity 1: MCDPH will establish two new STAND Coordinator 2 newly established STAND Computer X X X X
STAND groups at either a school or groups and 1 continuing STAND
community youth organization and continue Prevention Specialists group Phone
the STAND group at Trevor G. Browne H.S.
3 site coordinators Meeting Space at
school/organization
Activity 2: MCDPH will follow the PPP Youth STAND Coordinator Successfully completed events. Computer X X X X
Action Plan and hold monthly meetings
during school to ensure group is on track Prevention Team Phone
with plan.
Youth and adult leaders.
Activity 3: MCDPH will coordinate and Prevention Team Each STAND group will Computer X X X X
participate in BTCD required tobacco participate in at least 1 statewide
prevention campaigns. (i.e. Great American Marketing Team event Phone
Smoke-Out, Kick Butts Day, and World No
Tobacco Day). ADHS BTCD
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Activity 4: MCDPH Staff and youth will STAND Coordinator Each STAND group will have Computer X X X X
participate in PPP fall and spring regional youth participating in the PPP
trainings, Winter Summit, and STAND PPP trainings Phone
Summer Conference.
ADHS BTCD
Site Coordinators
Activity 5: STAND Coalition members will STAND members Each STAND group will conduct Computer X X X X
conduct at least six peer-to-peer tobacco at least 2 peer-to-peer education
education classes to younger students that STAND Coordinator classes Phone
include recruitment.(two at each STAND
site) STAND Site Coordinator Classroom
Activity 6: MCDPH will pilot the Counter Prevention Team Referrals received by school and X X X X
Strike Youth Tobacco Diversion Training youth participation in program
Program in one school within Maricopa Attorney General’s Office
County.
Schools
Marketing Team
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Goal 1: Maricopa County Department of Public Health (MCDPH) efforts in this section are focused primarily on Strategy is integrated with (check all that apply):
advancing policy initiatives through development of the Students Taking A New Direction or STAND youth Tobacco Prevention Policy
coalitions. Chronic Disease Self -Management
Tobacco Cessation Policy
Objective: The percent of retail tobacco outlets selling tobacco products to minors in Maricopa County will have School Health Policy
decreased from the 2014 rate, as evidenced in the Attorney General’s Office (AGO) and Food & Drug Other (i.e. increase community collaboration):
Administration (FDA) tobacco sales compliance checks report findings.
Agency Lead: Prevention Team Supervisor Related policy change: Related environmental change:
and Community Health Development Enforcement of tobacco Decreased access by minors to
Supervisor retail laws retail tobacco
Partners: Justices of the Peace, Maricopa
County tobacco retailers, Attorney General’s
office (AGO), STAND Coalitions
What non-
What do you plan to do? Who will do the work? What does success look like? financial Q3 Q4
Q1 Q2
resources Sept 30th Dec. 31st March June
are 31st 30th
needed?
Activity 1: MCDPH, in collaboration with the Community Health Program visibility, referrals from Computer X X X X
AGO, will offer Tobacco Retailer Training Development Team justice system and participation by
Program that will be delivered on a quarterly retailers leading to decreased sales Phone
basis or as needed (based on judicial AGO to minors
referrals) to educate clerks and retailers who Meeting
have been cited for failed youth tobacco space
compliance inspections.
Activity 2: MCDPH, in collaboration with the Community Health AGO will provide incremental data Computer X X X X
AGO, will contact retailers and conduct Development Team on retailers who violate the law
preventive training as necessary during Phone
outreach to four cities or communities as a AGO Retailers
participant of a program targeting offending Meeting
retailers within the pilot target area space
Activity 3: MCDPH will recruit 10 youth Prevention team 10 Youth volunteers participate in X X X X
volunteers to participate in the AGO and the the program
FDA compliance checks.
Activity 4: MCDPH will complete compliance Prevention Team 5 Youth volunteers participate two X X X X
checks with the AGO twice a year; and as compliance checks through the
needed with the FDA office. program
Activity 5: MCDPH will complete Synar Prevention Team Completion of canvass X X X X
cluster canvassing in Maricopa County, as
assigned.
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CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Goal: 2 MCDPH efforts in this category focus primarily on increasing Arizona Smokers Help Line (ASHLine) Strategy is integrated with (check all that apply):
referrals through training and outreach to medical, dental and public health practices that see patients on a regular Tobacco Prevention Policy
basis. A specific effort will be made to reach practices that serve disparate populations. Objectives in this section Chronic Disease Self -Management
also include formalizing a referral recruitment and retention plan and piloting a volunteer program to staff health fair Tobacco Cessation Policy
events. School Health Policy
Other (i.e. increase community collaboration):
Objective: Through referral development and organizational policy initiatives, MCDPH will increase the
ASHLine referrals in Maricopa County. This will be measured by the number of referrals reported from
ASHLine in monthly updates and activities tracked in WebQuit.
Agency Lead: Health Initiatives Supervisor Related policy change: Related environmental change:
Clinic policies and protocols Healthier population
Partners: Healthcare providers; dental care Decreased exposure to
providers: Women, Infant and Children (WIC) secondhand smoke
clinics: MCDPH direct service programs;
community partners
What do you plan to do? Who will do the work? What does success look like? What non- Q3 Q4
Q1 Q2
financial Sept 30th Dec. 31st March June
resources 31st 30th
are needed?
Activity 1: MCDPH will conduct 128 Level 2* Health Initiatives Team 32 ASHLine Locations per quarter Computer X X X X
ASHLine Trainings at ASHLine WebQuit receive Level 2 Trainings.
Locations, including at least 3 agencies that Marketing Team Phone
specialize in serving disparate populations.
*Ask, Advise, Refer Training, Use of Meeting
Proactive Fax Referral form space
Transportation
Activity 2: MCDPH will maintain active Health Initiatives Team 160 locations will receive active Computer X X X X
ASHLine outreach (including office visits, ASHLine outreach throughout
emails, and phone calls) with 160 locations Marketing Team FY14 Phone
throughout FY14 as measured by the
ASHLine Summary of Community Meeting
Engagement Staff Activity. space
Activity 3: MCDPH Community Engagement Health Initiatives Team 2,100 ASHLine referrals will be Computer X X X X
Support Staff assigned locations will generate generated by MCDPH ASHLine
2,100 ASHLine referrals, as reported on the Location engagement Phone
Summary of Community Engagement Staff
Activity Report. Vehicle
21

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Activity 4: MCDPH will conduct 12 Level 2* Health Initiatives Team 3 Dental Practices per quarter Computer X X X X
ASHLine Trainings with 64 outreach events receive Level 2 Trainings and 16
to Dental Practices. Marketing Team Dental Practices will receive Phone
*Ask, Advise, Refer Training, Use of outreach
Proactive Referral Fax form Meeting
space
Activity 5: MCDPH will conduct active Health Initiatives Team All Maricopa County WIC Computer X X X X
ASHLine outreach with all Maricopa County Locations will receive ASHLine
14 WIC clinics on a quarterly basis. Marketing Team outreach quarterly (14 total clinics) Phone
Meeting
space
Activity 6:MCDPH will conduct Level 2* Health Initiatives Team 4 MCDPH direct service programs Computer X X X X
ASHLine Trainings with 4 MCDPH direct will receive Level 2 Training.
service programs. Phone
*Ask, Advise, Refer Training, Use of
Proactive Referral Fax form Meeting
space
Activity 7: MCDPH will conduct quarterly calls Health Initiatives Team Formalized Maricopa County Computer X X X X
with ASHLine to discuss the Strategic Plan. Tobacco Cessation Strategic Plan
ASHLine written Phone
Meeting
space
Activity 8: MCDPH will assist at least 80 Health Initiatives Team 80 healthcare providers sign Computer X X X X
healthcare providers to incorporate ASHLine cessation policy
proactive referrals as a written policy in their Phone
patient protocol.
Meeting
space
Activity 9: MCDPH will provide 4 tobacco Health Initiatives Team 4 community partner trainings with Computer X X X X
cessation trainings conducted at the Office of at least 10 attendees at each and
Tobacco and Chronic Disease Programs or Marketing completion certificates issued Phone
OTCDP. A minimum of 10 people will
provided for community partners interested in Meeting
conducting their own on-site cessation space
clasess.
Activity 10: MCDPH will continue to support a Health Initiatives Team Volunteers attend 4 health Computer X X X X
program that utilizes volunteers to increase promotion events throughout the
cessation messaging and ASHLine outreach year Phone
at health fairs and other community events.
Support activites will include 4 training events Meeting
(1 per quarter) and efforts to recruit 5 new space
volunteers per quarter.
Transportation
22

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Activity 11: MCDPH will approach 2 Community Health 2 healthcare systems approached Phone X X X X
healthcare systems regarding better Development Team leading to partnership formed with
integration of AAR trainings, ASHLine 1 system Computer
referrals and chronic disease programs. Health Initiatives Team
Meeting
Space
Transportation
Activity 12: MCDPH will pilot 4 partnerships Community Health Early childhood development staff Phone X X X X
with city or community centers, community Development Team in 4 communities trained in how to
stakeholders and regional partners by educate families about preventing Computer
providing outreach and technical assistance Arizona Smoke Free Living secondhand smoke exposure
that leads to collaboration with early Coalition among children Meeting
childhood agencies to deliver trainings within Space
the pilot target area. First Things First
Transportation
Head Start
Healthy Start
Health Initiatives Team
Activity 13: MCDPH will deliver 3 training Community Health Smoke-Free Home and Car Pledge Phone X X X X
sessions to a minimum of 30 people per Development Team of 120 people throughout the year
quarter; (120 people annually) on preventing (3 training sessions with at least 30 Computer
secondhand smoke exposure among families Arizona Smoke Free Living people per session)
and their children. Coalition Meeting
Space
First Things First
Transportation
Head Start
Healthy Start
Health Initiatives Team
23

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Goal 3: MCDPH efforts in this category fall into three sections: tobacco-free campus policy work with colleges and Strategy is integrated with (check all that apply):
universities through the IGNITE program, advancement of a city-wide smoke-free parks initiative, and continuation Tobacco Prevention Policy
of the smoke-free multi-unit housing efforts in collaboration with the Arizona Smoke Free Living (ASFL) Coalition. Chronic Disease Self -Management
Tobacco Cessation Policy
1. Objective: Advance tobacco-free campus policy adoption and compliance through implementation of the School Health Policy
IGNITE program at a minimum of 10 colleges. Other (i.e. increase community collaboration):
Agency Lead: Prevention Program Related policy change: Related environmental change:
Supervisor Smoke-Free and/or Smoke-Free Air
Tobacco-Free Campuses Healthier population
Partners: Maricopa Community College Decreased exposure to
District (8 colleges), Arizona State University secondhand smoke
campuses, Midwestern University, and Grand
Canyon University.
What do you plan to do? Who will do the work? What does success look like? What non-
Q3
financial Q1 Q2 Q4
resources Sept 30th Dec. 31st March June 30th
31st
are
needed?
Activity 1: MCDPH will train at least 60 Health Initiatives Team Training sign in sheets and post- Computer X X X X
individuals (students, faculty and staff) at tests indicating 60 of individuals
IGNITE schools to increase capacity for self- IGNITE Coordinator trained on how to talk to an Phone
monitoring of tobacco-free policy and individual seen using tobacco on
referring tobacco users to ASHLine. campus, how to do a proactive Meeting
ASHLine referral and, as space
applicable, how to utilize a CO
monitor. ASHLine referrals will also
be tracked
Activity 2: IGNITE campuses will complete at IGNITE Coordinator 60 projects (6 per campus at 10 Computer X X X X
least 60 projects (6per campus at 10 campuses total) completed and
campuses total) designed to increase IGNITE Site Coordinator outcomes reported Phone
awareness of and compliance with tobacco-
free campus policies, promote tobacco Meeting
cessation and increase referrals to ASHLine. space
(ASU and Maricopa Community Colleges)
Activity 3: MCDPH will host a summit for Prevention Education 6 higher education participants Computer X X X X
higher education institutions to promote Supervisor attend summit.
smoke-free campus policies and present the Phone
results of Arizona State University’s tobacco- Southwest Interdisciplinary
free campus policy. Research Center (SIRC) Meeting
space
24

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Activity 4: MCDPH will implement a Smoke- IGNITE Coordinator Implementation Plan Completed Computer X X X X
Free/Tobacco-Free Campus Advocacy Plan Policy Approved
at Midwestern University (MWU). Student leaders and the Cessation support in place Phone
Tobacco Education and Compliance with policy
Cessation Committee Meeting
space
Activity 5: MCDPH will develop and IGNITE Coordinator Implementation plan developed Meeting X X X X
implement a Smoke-Free/Tobacco-Free Policy approved space
Campus Advocacy Plan at Grand Canyon IGNITE Site Coordinator Cessation support in place
University. Compliance with policy
Activity 6: MCDPH, in collaboration with the Prevention Program Evaluation Plan and measurement Computer X X X X
Bureau of Tobacco and Chronic Disease Supervisor tool(s) finalized
(BTCD), will create an evaluation tool for the Phone
IGNITE program.
Meeting
space
Goal 3: MCDPH efforts in this category fall into three sections: tobacco-free campus policy work with colleges and Strategy is integrated with (check all that apply):
universities through the IGNITE program, advancement of a city-wide smoke-free parks initiative, and continuation Tobacco Prevention Policy
of the smoke-free multi-unit housing efforts in collaboration with the Arizona Smoke Free Living (ASFL) Coalition. Chronic Disease Self -Management
Tobacco Cessation Policy
2. Objective: Increase the availability of smoke-free multi-unit housing communities in Maricopa County by 5 School Health Policy
per year. Other (i.e. increase community collaboration):
Agency Lead: Community Health Related policy change: Related environmental change:
Development Supervisor Smoke-free multi-unit Healthier population
housing policies Decreased exposure to
Partners: Arizona Smoke Free Living secondhand smoke
Coalition (ASFL), First Things First (FTF), Smoke-free air
Head Start, Healthy Start
What do you plan to do? Who will do the work? What does success look like? What non-
Q3
financial Q1 Q2 Q4
resources Sept 30th Dec. 31st March June 30th
31st
are
needed?
Activity 1: MCDPH in collaboration with ASFL Community Health Voluntary implementation of Phone X X X X
coalition will provide technical assistance to 5 Development Team smoke-free policies by apartment
multi-unit housing communities to announce, complexes Computer
plan and implement a new Smoke-Free ASFL Coalition
Policy. Meeting
Space
25

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Activity 2: MCDPH in collaboration with ASFL Community Health 10 presentations or workshops Phone X X X X
coalition will provide: Development Team held:
 4 Second-Hand Smoke presentations to  Computer
tenants ASFL Coalition
 4 Second-Hand Smoke/Policy Advocacy Meeting
Presentations to property managers Space
 2 Smoke-Free Workshops for property
managers and owners
Activity 3: Until Sept. 30, 2014, MCDPH will Community Health Tobacco-free initiatives and Phone X X X X
monitor, provide technical assistance and Development Supervisor resources expanded to support
oversight of the contract for the ASFL multi-unit housing properties. Computer
Coalition.
Meeting
Space
Smoke-Free
Materials
Goal 4: MCDPH efforts in this category focus on increasing infrastructure for delivering Chronic Disease Self- Strategy is integrated with (check all that apply):
Management Program (CDSMP) in Maricopa County, promoting the Million Hearts campaign by engaging Tobacco Prevention Policy
communities and cities as a targeted emersion pilot program, and working with School Health Advisory Councils Chronic Disease Self -Management
(SHAC). Tobacco Cessation Policy
School Health Policy
1. Objective: Expand the utilization of Stanford’s CDSMP Initiative in Maricopa County by conducting at Other (i.e. increase community collaboration):
least 1 community or city emersion per quarter.
Agency Lead: Community Health Related policy change: Related environmental change:
Development Supervisor None Healthier Population
Reduced risk of chronic diseases
Partners: Arizona Living Well Institute Better management of chronic
(AzLWI) diseases
What do you plan to do? Who will do the work? What does success look like? What non- Q2 Q3 Q4
Q1
financial Sept 30th Dec. March June
resources 31st 31st 30th
are needed?
Activity 1: MCDPH will maintain current Community Development Support CDSMP workshops Phone X X X X
partnerships by providing technical Specialist
assistance, lay leader training referrals and Computer
workshop facilitation, as needed. Community Health
Development Supervisor Meeting
Space
Transportation
26

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Activity 2: MCDPH will pilot city or community Community Development 4 cities or communities Phone X X X X
emersion programs targeting community Specialist approached leading to assisting 2
centers, city stakeholders and regional CDSMP partners with licensure Computer
partners by providing outreach, and technical Community Health
assistance that leads to a sustainable Development Supervisor Meeting
CDSMP partnerships for agencies within the Space
pilot target area.
Transportation
Participant
application
Activity 3: MCDPH will research payment Community Health Identify payment models and Phone X X X X
models and quality measures with healthcare Development Supervisor quality measures that will benefit
systems to identify intersections with existing physicians and health networks by Computer
chronic disease initiatives to show the Health Initiatives Team working with MCDPH
benefits for future partnerships between Meeting
physicians, health networks and MCDPH. Marketing Team Space
Transportation
Activity 4: MCDPH will assess the need, Health Initiatives Team Meet with 6 unique Phone X X X X
readiness and potential barriers for a locations/stations and interview at
Community Paramedicine Program in Community Health least one individual within each Computer
Maricopa County. Establish communication Development Team location. Provide a
with cities, towns, and emergency medical recommendation based on the Meeting
services to determine who would be the most interviews as to the feasibility of Space
appropriate to pilot with. proceeding with a Community
Paramedicine Program. Transportation
Goal 4: MCDPH efforts in this category focus on increasing infrastructure for delivering CDSMP in Maricopa Strategy is integrated with (check all that apply):
County, promoting the Million Hearts campaign by engaging communities and cities as a targeted emersion pilot Tobacco Prevention Policy
program, and working with School Health Advisory Councils (SHAC). Chronic Disease Self -Management
Tobacco Cessation Policy
2. Objective: Promote the evidenced-based, Million Hearts campaign in Maricopa County cities and School Health Policy
communities by creating partnerships and applicants for the “Team Up. Pressure Down.” Heart360 and Other (i.e. increase community collaboration):
My Life Check.
Agency Lead: Community Health Related policy change: Related environmental change:
Development Supervisor Tobacco Free Worksites Healthier Population
Decreased Exposure to
Partners: American Heart Association secondhand smoke
(AHA), American Stroke Association (ASA), Smoke free air
Million Hearts
27

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
What do you plan to do? Who will do the work? What does success look like? What non- Q1 Q3 Q4
Q2
financial Sept Dec. 31st March June
resources 30th 31st 30th
are needed?
Activity 1: MCDPH will pilot city or community Community Development 4 cities or communities Phone X X X X
emersions targeting community centers, city Specialist approached leading to 2 applicants
stakeholders and regional partners. Provide approved and processed as Computer
outreach, and technical assistance that leads Community Health partners who will implement Team
to a sustainable “Team Up. Pressure Down. Development Supervisor Up. Pressure Down. Meeting
Maricopa Co!” partnerships for 2 agencies Space
within the pilot target area.
Transportation
Participant
application
Activity 2: MCDPH will pilot a city or Community Development 2 applicants approved and Phone X X X X
community emersion program targeting Specialist processed as partners who will
community centers, city stakeholders and implement Heart360. Computer
regional partners by providing outreach, and Community Health
technical assistance that leads to sustainable Development Supervisor Meeting
“Heart360” partnerships. Space
Transportation
Participant
application
Activity 3: MCDPH will pilot a city or Community Development 2 applicants approved and Phone X X X X
community emersion program targeting Specialist processed as partners who will Computer
community centers, city stakeholders and implement My Life Check. Meeting
regional partners by providing outreach, and Community Health Space
technical assistance that leads to sustainable Development Supervisor Transportation
“My Life Check” partnerships.
Participant
application
28

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Goal 4: MCDPH efforts in this category focus on increasing infrastructure for delivering CDSMP in Maricopa Strategy is integrated with (check all that apply):
County, promoting the Million Hearts campaign by engaging communities and cities as a targeted emersion Tobacco Prevention Policy
pilot program, and working with School Health Advisory Councils (SHAC). Chronic Disease Self -Management
Tobacco Cessation Policy
3. Objective: Work with School Health Advisory Councils at a minimum of 130 Maricopa County schools School Health Policy
to complete the School Health Index (SHI) and/or implement school health improvement plans (SHIP). Other (i.e. increase community collaboration):
Agency Lead: Prevention Program Related policy change: Related environmental change:
Supervisor School Wellness Policies Healthier School Environments
Partners: Schools, districts and charters in
Maricopa County, Healthology staff
members
What do you plan to do? Who will do the work? What does success look like? What non-
Q4
financial Q1 Q2 Q3
resources Sept 30th Dec. 31st March 31st June
30th
are
needed?
Activity 1: MCDPH will contract with schools Prevention Team Contracts executed and SHI Phone X X X X
to complete the SHI and develop a SHIP. reports, scorecards and SHIPs
Marketing Team collected from 40 schools. Computer
Meeting
Space
Activity 2: MCDPH will contract with schools Prevention Team Contracts executed and SHIP Phone X X X X
to implement their SHIP. impact reports completed from 80
Marketing Team schools. Computer
Meeting
Space
Activity 3: MCDPH will contract with schools Prevention Team Contracts executed and SHIP X X X X
to implement a third-year SHIP plan. impact reports completed from 10
schools.
29

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 ATTACHMENT 1
Goal 4: MCDPH efforts in this category focus on increasing infrastructure for delivering CDSMP in Maricopa Strategy is integrated with (check all that apply):
County, promoting the Million Hearts campaign by engaging communities and cities as a targeted emersion Tobacco Prevention Policy
pilot program, and working with School Health Advisory Councils (SHAC). Chronic Disease Self -Management
Tobacco Cessation Policy
4. Objective: Increase the capacity of the Healthy Arizona Worksites Program. School Health Policy
Other (i.e. increase community collaboration):
Agency Lead: Community Health Related policy change: Related environmental change:
Development Supervisor None Healthier workforce
Reduced risk of chronic diseases
Partners: Healthy Arizona Worksites Better coordination of worksite
(HAWP); Various health networks within the wellness programs and systems
county level integration
What do you plan to do? Who will do the work? What does success look like? What non- Q4
Q1 Q2 Q3
financial Sept 30th Dec. 31st March 31st June
resources 30th
are needed?
Activity 1: MCDPH will provide worksite Community Development Establish and maintain a Phone X X X X
wellness coordination, support and Specialist database for tracking worksites,
technical assistance for existing HAWP wellness resources and initiatives Computer
worksites including support in completion of Community Health
score card and offering evidence-based Development Supervisor Meeting
programs to address areas needing Space
improvement. Healthy Arizona Worksites
Transportation
30

CONTRACT NUMBER INTERGOVERNMENTAL AGREEMENT
ADHS14-072483 EXHIBIT ONE (1)
Arizona Department of Health Services CONTRACTOR'S EXPENDITURE REPORT 4A. Cost Reimbursement -
Accounting/Contracts 1. Contract Number P.O. # Cumulative Actual Expenditures
1740 W. Adams Street 2. Contractor Name Fixed Price
Phoenix, Arizona 85007
3. Title of Program 4B. Periodic Report
Invoice # 4. Reporting Period Covered: From ________________ To ____________ FINAL REPORT
Contractor's Detailed Statement of Expenditures and Fixed Price
5. COST REIMBURSEMENT Prior Report Period Year to Current Reporting Period Total Year to Date
Approved Budget
(Actual Expenditures) Date Expenditures Expenditures Expenditures
A. Account Classification: ( a ) ( b ) ( c ) ( d )
Personnel Services $ - $ - $ - $ -
ERE $ - $ - $ - $ -
Professional and Outside Services $ - $ - $ - $ -
Travel Expenses $ - $ - $ - $ -
Operating Expense $ - $ - $ - $ -
Capital Outlay Expense $ - $ - $ - $ -
Other $ - $ - $ - $ -
Total $ - $ - $ - $ -
Number of Units Provided Total Funds Earned this Prior Report Period Year to Total Year to Date Funds
6. FIXED PRICE Rate per Unit
this Reporting Period Reporting Period Date Funds Earned Earned
A. Type of Unit: ( 1 ) ( 2 ) ( 3 ) ( 4 ) ( 5 )
TOTAL
ADHS USE ONLY THIS SECTION FOR ADHS ACCOUNTING USE ONLY 7. CONTRACTOR CERTIFICATION
I certify that this report has been examined by me, and to the
Total Expenditures or total Fixed Price best of my knowledge and belief, the reported expenditures
ADHS PROGRAM COORDINATOR CERTIFICATION: Adj (if required): and fixed price information is valid, based upon our official
accounting records (book of account) and consistent with the
Performance satisfactory for payment Less: Year to date payments terms of the contract. It is also understood that the contract
payments are calculated by the Department of Health Services
Performance unsatisfactory, withhold payment Adj (if required): based upon information provided in this report.
No payment due Net payment due:
Index PCA AY Amount
AUTHORIZED CONTRACTOR'S SIGNATURE / TITLE / DATE
PROGRAM COORDINATOR SIGNATURE/DATE
PLEASE PRINT - PREPARED BY / PHONE NUMBER
ADHS/BFS/F-110 (Rev. 1/2008)
31