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Page 1 of 2 ARIZONA STATE CONTRACT CONTRACT RELEASE ProcureAZ Purchase Order No.: AAGO14-071794:1 Organizational Reference No.: P0169909 V Vendor Number: 000033918 Office of the Arizona Attorney General E Maricopa County Human Services S Yvonne Rossmell N 234 N. Central Avenue, Third Floor H 15 South 15th Ave; Basement Phoenix, AZ 85004 I Phoenix, AZ 85007 D US O P Email: Yvonne.Rossmell@azag.gov R T O Contract No.: AAGO14-071794 (602) 542-7703 Title: Disable Veterans Program-Maricopa County MAIL INVOICE IN DUPLICATE TO: B Office of the Arizona Attorney General I Pam Rezek 1275 West Washington Street L Phoenix, AZ 85007 L US Email: Pamela.Rezek@azag.gov T O (602) 542-7976 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: 13- -85886-6299-6299----------- Payment Terms: Net 14 Shipping Terms: As Specified Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0 Item Description Requisition Quantity Unit Unit Price Total Class-Item 952-25 1 3.00 EA $ 3,800.00 $ 11,400.00 Administrative fee for Program 1 as described in the RFP up to $24,999.99 per Unit Year 1 Class-Item 952-25 2 9.00 EA $ 6,500.00 $ 58,500.00 Administrative fee for Program 1 as described in the RFP from $25,000 - $65,000 per unit Year 1 Class-Item 952-25 3 3.00 EA $ 20,000.00 $ 60,000.00 Year 1 Cost per unit up to $25,000 Class-Item 952-25 4 9.00 EA $ 55,000.00 $ 495,000.00 Year 1 Cost per unit between $25,000 and $65,000 TOTAL: $ 624,900.00 Approved By: Georgette Coleman Phone No.: (602) 542-3725