IGA AMENDMENT 3 RE IMMUNIZATION SERVICES WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-041805:6
Organizational Reference No.: E0174532
Issued: 06112/2014
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health Epidemiology and Disease Control Immunization
4041 N Central Avenue, Suite 1400 Program
Phoenix, AZ 85012 150 N. 18th Avenue, Suite 120
Phoenix, AZ 85007
US
Email: procure@azdhs.gov
Contract No.: ADH513-041805 (602) 364-3630
Title: Maricopa County Immunization Services
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Epidemiology and Disease Control Immunization
Program
150 N. 18th Avenue, Suite 120
Phoenix, AZ 85007
US
Email: procure@azdhs.gov
(602) 364-3630
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.
Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 948-92
Immunization CONTRACT# ADHS13- 041805- CONTRACT END DATE -
1213112017- PO Period thru 12/31/2014,CFDA# 93.268 PO for the delivery
of Immunizaton services and activities as follows; * Salary/Fringe - YEARLY
$50,000.00 * Immunization visit for children zero (0) to eighteen (18) years
of age - UNIT RATE $50.00 " Immunization Completion for children zero (0)
to eighteen (18) years of age - UNIT RATE $100.00 " Perinatal Hepatitis B
1 Case Management - Prenatal - UNIT RATE $300.00 * Perinatal Hepatitis B 1.00 TOTAL $ 615,454.00 $ 615,454.00
Case Management - Postnatal - UNIT RATE $200.00 * School/Children IDR
Management-Preparation and submittal - UNIT RATE $250.00*
Immunization Visit for adults nineteen (19) years of age and older - UNIT
RATE $50.00 " Immunization Visit for Flu Vaccine, in children and adults -
UNIT RATE $50.00
LN/FY/Account Code Dollar Amount
1/14/14-99486-54000-6811- $ 615,454.00

TOTAL: $ 615,454.00
Approved By: Myra Chavez
Phone No.: (602) 364-3649

C-86-13-074-3-03 Amendment No.3 Immunization
Services
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Maricopa County
Date