IGA AMD RE REFUGEE MED ASST P WITH ADES.PDF

Intergovernmental Agreement
CONTRACT AMENDMENT
1. CONTRACTOR (Name and address) 2. CONTRACT ID NUMBER
DE101038-001
Maricopa County Department of Public Health
4041 N. Central Ave., Suite 1400 3. AMENDMENT NUMBER
Phoenix, AZ 85012 6
4. THE PARTIES AGREE TO THE FOLLOWING AMENDMENT
Pursuant to Section 3.0, Term of Agreement, Paragraph 3.2, Extension, the above referenced contract is extended
for the period of July 1, 2014 to June 30, 2015. The Health Assessment service rate is not adjusted for the extension
period and shall remain the same as for the previous contract term.
Pursuant to Section 4.0, Amendments or Modifications, the contract reimbursement ceiling for the “Coordination-
Refugee Preventive Health” service for the period of July 1, 2014 through June 30, 2015 is $167,342.
The cumulative reimbursement ceiling is revised to $984,749.
Therefore, the Itemized Service Budget for the period of July 1, 2014 to June 30, 2015 is attached.
5. EXCEPT AS PROVIDED HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT AS HERETOFORE CHANGED AND/OR
AMENDED REMAIN UNCHANGED AND IN FULL FORCE AND EFFECT. THE AMENDMENT SHALL BECOME EFFECTIVE ON THE DATE
OF LAST SIGNATURE UNLESS OTHERWISE SPECIFIED HEREIN. BY SIGNING THIS FORM ON BEHALF OF THE CONTRACTOR, THE
SIGNATORY CERTIFIES HE/SHE HAS THE AUTHORITY TO BIND THE CONTRACTOR TO THIS CONTRACT.
6. 7. NAME OF CONTRACTOR Maricopa County by and through its
ARIZONA DEPARTMENT OF ECONOMIC SECURITY Maricopa County Department of Public Health
SIGNATURE OF AUTHORIZED INDIVIDUAL SIGNATURE OF AUTHORIZED INDIVIDUAL
TYPED NAME TYPED NAME
Denny Barney
TITLE TITLE
Chairman, Maricopa County Board of Supervisors
DATE DATE
IN ACCORDANCE WITH ARS §11-952 THIS CONTRACT AMENDMENT HAS BEEN REVIEWED BY THE UNDERSIGNED WHO HAVE DETERMINED THAT THIS
CONTRACT AMENDMENT IS IN APPROPRIATE FORM AND WITHIN THE POWERS AND AUTHORITY GRANTED TO EACH RESPECTIVE PUBLIC BODY.
ARIZONA ATTORNEY GENERAL’S OFFICE APPROVED AS TO FORM
By: _________________________________________ By: ____________________________________
Assistant Attorney General Public Agency Legal Counsel
Attorney for Maricopa County
Date: _______________________________________ Date: __________________________________
ATTEST: Clerk of the Board Date
_______________________________________